Interdisciplinary – Page 8 – UROP Spring Symposium 2021

Interdisciplinary

Arch Replacement During Type A Aortic Dissection Repair

Prior to and following aortic surgery, surgeons periodically track the diameter of the aorta to follow growth and determine whether surgical re-intervention is required. By the use of imaging studies such as CT and TEE/TTE, we can examine the data from preoperative and postoperative imaging. This can be used to follow growth, which is a risk factor for reoperation. The different management techniques of managing the aortic arch during acute type A aortic dissection (ATAAD) treatment involves different extents of replacement of the arch. For this project, aortic dissection patients surgically treated at Michigan Medicine in the past year will be added to an online database. Information pertaining to the aortic dissection repair including preoperative, intraoperative, and postoperative variables such as age, pre-existing comorbidities, and postoperative stroke will be collected in the database. Through a retrospective chart review and analysis of this REDcap aortic dissection database, aortic dissection patients will be separated into four groups of varying extent of aortic arch replacement during ATAAD repair: (1) the hemiarch (proximal repair beyond the innominate artery without any arch vessels involved) (2) zone 1 (innominate and left common carotid artery) (3) zone 2 (right common carotid and subclavian arteries) and (4) zone 3 (also known as total arch, includes the region distal to the subclavian artery). A statistical analysis comparing baseline characteristics (gender, median age, hypertension, coronary artery disease, and diabetes) using chi-square and fisher tests will be performed to determine whether these are significantly different between groups.

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Hospital Compliance with Online Dissemination of Standard Charges for Health Care Services

In the United States, prices for healthcare services have remained largely concealed from patients. Although patients pay high prices for care that they receive retrospectively, these prices are largely unknown when seeking care initially. For the first time ever, federal Policy CMS-1694-F now requires hospitals to post a list of standardized charges for all health care services online. Although hospital compliance with this policy is essential to achieve its intended purpose, there has not been a comprehensive evaluation into hospital compliance to our knowledge. In this study, we use a cross-sectional survey of a stratified random sample of 500 US hospitals drawn from the pool of 3,451 US general medical and surgical hospitals in the 2018 American Hospital Association Annual Survey. The data collection took place between July 10, 2020 – January 03, 2021. We searched for a list of standard charges posted on hospital websites. If the list was present, we determined if the data was provided in a machine readable format and included the CMS specified shoppable services (evaluation & management services, laboratory & Pathology Services, Radiology Services, and Medicine and Surgery Services). We then looked to see if the list included Diagnosis Related Groups, listings of professional fees and if services were abbreviated. After removing 9 hospitals from our sample that closed or did no longer exist, we determined that 93% of the 491 hospitals in the sample had posted their standard charges. In this sample, however, only 35% of the lists were machine-readable, and 91% of hospitals used abbreviations for their services. The vast majority of hospitals included CMS-defined shoppable services (between 87%-99% for each type of service). In multivariable models, we found that hospitals that were a part of a health system were more likely to provide their standard charges online (odds ratio 3.1, 95% confidence interval 1.5-6.5, P=.003). As CMS considers new federal policies to further improve price transparency for healthcare services, this research allows us to have a much stronger understanding of hospitals’ compliance with price transparency initiatives. Additionally, we can better understand their effectiveness in order to communicate information to policy makers.

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State Trends in Medically Unnecessary Surgical Births

The United States currently faces the issue of high rates of Cesarean-sections performed in hospitals across the nation. Among all developed countries, the U.S. maintains one of the highest C-section rates at 31% of births completed by Cesarean. These C-sections have been linked to increased marital and neonatal complications, including increased morbidity, and they are also very costly toward patients. Studies suggest that many of these C-sections are classified under the category Nulliparous Term Singleton Vertex (NTSV), which are done on low-risk women and hence are likely avoidable procedures. This study aims to understand differences between NTSV C-section rates across the United States. The type of data reviewed includes each state’s C-section rate, NTSV C-section rate, number of deliveries/year, and whether the state has C-section reduction programs. It has been found that California, Michigan, New Jersey, and Florida, despite all being states with C-section reduction programs, are still experiencing high rates of NTSV C-sections. It has also been determined that the accessibility of information regarding C-sections varies greatly among different states. We plan to move forward in this study to find other nonclinical factors that may be confounding C-section rates in each state, in hopes of revealing improvements that could be made toward reducing the regularity of NTSV C-section rates in the United States.

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Cesarean Deliveries in Mississippi: A Case Study on Reproductive Health Care

In the Zochowski lab, we are currently studying trends in medically unnecessary surgical (NTSV) births on a state by state basis (NTSV meaning nulliparous (first birth), term (head down), singleton (only one infant), vertex). By looking at a variety of non-clinical factors like hospital location, staffing, presence of doulas/midwives, patient race, ethnicity, insurance status, etc. we hope to be able to better understand how NTSV C-section rates are influenced across institutions. Through data collection, organization, and interpretation, I am helping to build a database of state level information in an attempt to answer why are more and more hospitals pushing for C-section deliveries? My role in this project is to complete a checklist of tasks in order to retrieve data needed for each of the states I have been assigned. This presentation is a further analysis of the data collected in the state of Mississippi.

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State trends in medically unnecessary surgical births

Recent studies in the United States have shown that over one third of birthing women have primary cesarean (C-section) sections to deliver their children. C-section surgeries pose risks to the mother and her child, carrying a longer, more involved recovery than a traditional, noninvasive vaginal delivery. In many cases, a birth is considered ?NTSV (?Nulliparous, Term, Singleton, Vertex?), or low-risk, and a c-section is given despite a lack of medical indication. The United States has one of the highest incidences of NTSV c-sections in the western hemisphere. We are interested in examining the non-clinical and social factors that may influence c-section rates and interventions among women with low-risk pregnancies that end in cesarean section, NTSV c-sections. To do this, we collected data from all fifty states’ previous studies and statistics on births, c-sections, health collaboratives, and demographics, and compiled it into a database to find statistical significance with each factor. When comparing the states, we found that the access to information differed greatly depending on the state being studied. With these findings, we hope to then go further to identify specific nonclinical factors, socioeconomic status, race, insurance, and other demographics that may influence c-section rates within each state. These conclusions will inform improvements to the healthcare system that can aid the reduction of NTSV c-sections in the United States.

State trends in medically unnecessary surgical births Read More »

State trends in medically unnecessary surgical births

Recent studies in the United States have shown that over one third of birthing women have primary Cesarean sections to deliver their children. C-section poses risk to the mother and her child, and carries a much longer recovery time than a vaginal delivery. In many cases, a birth is considered NTSV (Nulliparous, Term, Singleton, Vertex), or low-risk, and a c-section is given despite a lack of medical indication. The United States has one of the highest incidences of NTSV c-sections in the western hemisphere. In this study, we are interested in examining the non-clinical and social factors that may influence c-section rates and interventions among the NTSV or low-risk population. To do this, we collected data from all fifty states on births, c-sections, health collaboratives, and demographics, and compiled it into a database to make statistical analysis on each factor. When comparing the states, we found that the access to information differed greatly depending on the state being studied. With these findings, we hope to then go further to identify specific nonclinical factors that influence c-section rates within each state. These conclusions will then inform improvements in obstetric healthcare practices that can aid the reduction of NTSV c-sections in the United States.

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Analyzing CRISPR-Cas9 Genomic Engineering through Targeted Deletions

Background: Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) is a technology used to edit genomes at very high precision. It enables precise editing of genomic loci with a RNA-guided CRISPR associated protein 9 (Cas9) nuclease that can cleave the targeted DNA complementary to a guide RNA (gRNA). Precise gene editing via CRISPR-Cas9 has great potential in treating inherited diseases (e.g., cystic fibrosis) or correcting genetic defects.

Objective: To test the specificity and function of the CRISPR-Cas9 in a proof-of-principle experiment, we used two human Emx1 (hEmx1) gene-specific gRNA sequences (3.1+4.1) to guide the Cas9 enzyme for the deletion of the targeted region in human 293AD cells.

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Analyzing CRISPR-Cas9 through Genomic Deletions

Background: Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) is a technology used to edit genomes at very high precision. It enables precise editing of genomic loci with a RNA-guided CRISPR associated protein 9 (Cas9) nuclease that can cleave the targeted DNA complementary to a guide RNA (gRNA). Precise gene editing via CRISPR-Cas9 has great potential in treating inherited diseases (e.g., cystic fibrosis) or correcting genetic defects.

Objective: To test the specificity and function of the CRISPR-Cas9 in a proof-of-principle experiment, we used two human Emx1 (hEmx1) gene-specific gRNA sequences (3.1+4.1) to guide the Cas9 enzyme for the deletion of the targeted region in human 293AD cells.

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Relationship Between Depression and Subjective Executive Functioning in Parkinson’s Patients

In addition to physical symptoms, Parkinson’s patients are often diagnosed with mental complications including depression and cognitive dysfunction. However, little is known about the correlation between Parkinson’s patients’ depression and subjective cognitive skills, including executive functioning. This is important because executive dysfunction can cause difficulty in Parkinson’s patients’ ability to complete daily tasks. The main goal of this research is to examine how mental factors such as depression impact a Parkinson’s patient’s subjective executive functioning. In order to compare these two variables, archival clinical data was analyzed in a sample of 175 patients with Parkinson’s disease (PD; N(men) = 120, M(age) = 64.41, SD = 8.58). The Geriatric Depression Scale – Short Form (GDS-SF) was used to measure depression, the Frontal Systems Behavior Scale (FrSBe) was used to measure subjective executive functioning, and the Unified Parkinson Disease Rating Scale (UPDRS) Part III was used to measure PD severity. Pearson’s correlation revealed a significant relationship between the GDS and FrSBe scores, such that higher depression scores correlated with higher self-reported executive dysfunction, R = .42, p < .001. The partial correlation revealed that this relationship remained significant while controlling for UPDRS Part III, R = .45, p < .001. Findings were consistent with this study's hypothesis, such that Parkinson's patients with greater depression were more likely to self-report executive functioning problems. A possible explanation for this is that depressed Parkinson's patients are more likely to have negative self-perceptions, which may cause them to rate their executive functioning skills more poorly.

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Examining how COVID has affected African American women with Hypertension

Forty seven percent of African American women are living with hypertension, which increases their risk of contracting COVID-19. We asked 100 African American women living with hypertension (ages 21 to 64) to complete a questionnaire using qualtrics. Using a cross sectional descriptive survey, participants were asked to self-report their blood pressure during COVID. A portion of the survey was used to raise the questions of how paticipants have been maintaining their health through eating and exercise patterns as a result of the virus. Sixty one percent of participants reported that they have not had to change the way that they manage their blood pressure since COVID-19. Participants that reported that they did have to change the way that they managed their blood pressure, ensured that they have had to exercise more, practice healthier eating habits, and that they haven’t seen their physician since COVID-19. In addition, the majority of participants did not lose their job or income due to the “Stay at Home” mandate, nor are they concerned about their ability to get their medications and supplements used to control their blood pressure. Our findings raise the question regarding if participants are considering all factors that have been impacted in their lives by COVID and how participants have been managing their hypertension in the first place.

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