• Celiac Disease in the Hispanic Population at Maricopa Integrated Health System

      Massimo, Lauren; The University of Arizona College of Medicine - Phoenix; Chuang, Keng‐Yu (The University of Arizona., 2017-05-23)
      Celiac disease (CD) is an autoimmune gastrointestinal disorder that has been well studied amongst non‐Hispanic white populations. Data specifically describing the disease in the U.S. Hispanic population is limited and available studies that do report prevalence and incidence within this population reveal discrepancies. The aim of this study is to estimate the incidence of CD and to define common presenting symptoms in Hispanics in Phoenix, AZ. Data was collected via a retrospective chart review from Maricopa Integrated Health System (MIHS), an organization caring for a patient population that is >50% Hispanic, between 2004‐2013. The study population is both adult and pediatric patients that had received the ICD‐9 code 579.0. The total number of non‐repeat patients seen at MIHS each year between 2004‐2013 was also determined and broken down by race for incidence calculations. During this 10‐year period, 29 total patients were diagnosed with CD at MIHS. The overall yearly incidence increased from 1 in 44,011 patients in 2004 to 1 in 27,948 in 2013. Of the 29 diagnosed, 52% were Caucasian, 34% Hispanic, 7% Asian and 7% African American. The yearly incidence in Hispanic patients also increased from 0 in 2004 to 1 in 58,302 in 2007 to 1 in 25,826 in 2013. Although diagnosis was greater in females of both races, Hispanic patients were diagnosed at a younger age than Caucasians (22 vs. 31 y/o, respectively). The most common diagnostic approach was serological testing combined with duodenal biopsy. The 3 most common gastrointestinal presenting symptoms in Caucasians were diarrhea, abdominal pain and nausea/vomiting, while those in Hispanics were constipation, bloating/abdominal distention and diarrhea. At the time of diagnosis, at least 1/3rd of both Caucasian and Hispanic patients had presented with another autoimmune disorder. Other associated conditions were neurological symptoms and iron‐deficiency anemia. Data from this study suggests that CD in the Hispanic population may be more common in Phoenix than the overall population in the U.S. as described in the literature. It also suggests that Hispanic patients may have different presenting symptoms than do Caucasians. The reason behind the increase in CD incidence in Hispanics is unclear, although increased physician awareness and diagnosis may play a role. Further research and awareness of CD in the Hispanic population may be necessary to optimize diagnosis & treatment of the condition.
    • Quantitative Factors Correlated with Increased Length of Stay for Adult Patients Presenting to the Emergency Department with Abdominal and Pelvic Pain

      Spiro, Joshua; The University of Arizona College of Medicine - Phoenix; Yarmush, Joel (The University of Arizona., 2017-05-19)
      Abdominal/pelvic pain is one of the most common reasons that patients present to hospital emergency departments (ED). With 129.8 million emergency department visits per year nationally, efficient triage and admission of these patients from the ED is essential. At the New York Methodist Hospital (NYMH) ED, patients presenting with abdominal/pelvic pain are evaluated based on a series of factors such as pain scores, past medical history, physical exam, and laboratory tests. Depending on these factors, clinicians observe, evaluate, and treat their patients requiring varying lengths of stay in the emergency department before either being discharged or admitted to the hospital. Physicians must weigh the benefits and risks of each evaluation they perform knowing that their resources may be needed more urgently by other patients. Determine the quantitative factors correlated with an increased length of stay for adults presenting to the emergency department with abdominal or pelvic pain. Increases in factors such as age, pain, BMI, and vital signs will correlate with an increased length of stay in the emergency department as well as an increased rate of admission to the hospital. Data regarding the above factors were abstracted from a sample of adult patients (n=347) presenting to the New York Methodist hospital emergency department from June 1st, 2013 to May 31st, 2014. The review of patients presenting to the emergency department with abdominal/pelvic pain demonstrated that patients with lengths of stay greater than four hours had a significantly higher value for age, weight, BMI, and blood pressure compared to those with lengths of stay less than four hours. Additionally, patients that were admitted to the hospital had a statistically significantly higher value for age, pain scores, systolic blood pressure, and heart rate. The identification of factors associated with longer lengths of stay provides the first step in identifying how to improve patients’ access to care in a more time efficient manner. Understanding what factors account for delays in care and discharge will allow for more efficient allocation of time and resources to the patients that need it most.
    • Study of an Early Wellness Program in Parkinson ’s Disease: Impact On Quality Of Life And Early Intervention Guidance

      Page, Brent Michael; The University of Arizona College of Medicine - Phoenix; Shill, Holly (The University of Arizona., 2017-05-26)
      Previous studies have shown that Parkinson’s disease (PD) patients are at an increased risk for a variety of complications impacting health related quality of life (HRQoL). Additionally, these various complications often lead to increased healthcare utilization. Wellness intervention in PD has shown to be effective in improving HRQoL and objective measures of disease burden such as motor functioning. What has not been demonstrated to date is whether patients who are given the opportunity to participate in regularly administered classes in these modalities will continue to attend and whether benefits will continue to be realized outside the strict confines of a controlled trial. This study examined whether intervening early in PD with a comprehensive Wellness Program is feasible and promotes lasting habits that will continue to provide sustained benefit. It was hypothesized that intervening early in PD with an intensive program involving structured exercise, socialization and PD specific education would serve to maintain or improve subject’s quality of life while decreasing healthcare utilization. Twenty‐one consenting ambulatory adult subjects diagnosed with PD within the last five years completed various screenings at baseline and following a required 6‐month Wellness Program intervention. Subjects were assessed at 12 and 18 months if they continued to participate. Patient demographics, disease specific quality of life, objective mobility, healthcare utilization and falls were assessed. Data were collected at Banner Sun Health Research Institute, located in Sun City, Arizona. All p‐values were 2‐tailed and P<0.05 was considered statistically significant. All data analyses were conducted using STATA‐14. Twenty of twenty‐one subjects completed the required 6‐month intervention. Continued participation was 70% at 12 months and 60% at 18 months. Overall HRQoL was stable at 18 months. Significant improvement was seen in patient reported mobility and emotion sub‐areas at 12 months. Communication specific HRQoL was significantly worsened at 12 months. Subjects demonstrated a stable level of physical activity while fatigue was significantly decreased. All objective measures were significantly improved from baseline. Healthcare utilization was decreased by 18 months. A total of 5 falls were reported by 3 subjects during the 6‐month interventional period. This pilot study demonstrates that comprehensive wellness intervention in early PD is feasible, effective, safe and valuable in establishing long‐term beneficial habits while potentially reducing healthcare utilization. The significant long‐term subject participation observed in this study establishes that wellness intervention may be practical for large scale implementation. The results also highlight the importance of addressing communication specific symptoms early in the course of the disease. Ultimately, this study will aid the design and implementation of future PD wellness interventions.
    • Triage of Trauma Patients Injured By Large Animals: Do Urban Doctors Undertriage?

      Stevenson, Justin; The University of Arizona College of Medicine - Phoenix; Katz, Eric (The University of Arizona., 2017-05-19)
      In the United States the responsibility to develop criteria for trauma patient’s triage status rests upon individual hospitals rather than the American College of Surgeons. Traumatic injuries from large animals represent a potential need for expanded hospital resources. Urban emergency departments are less likely to regularly see patients with large‐animal related injuries and might be expected to underestimate the predicted injuries. There is scarce research on the topic of initial triage designation for large‐animal related injuries. The aim of this study is to investigate the adequacy of the initial triage designation given to patients presenting with injuries from animals larger than themselves at an urban, safety net, academic Emergency Department and Trauma Center (ACS Level 1 Adult, Level 2 Pediatric). A retrospective chart review was performed on patients presenting to the emergency department (ED) from Jan 2006 until September 2015 with injuries resulting from animals larger than the patient. A total of 213 patients met the inclusion criteria. Our study found that trauma patients injured by large animals who are triaged as low priority have dispositions that are not statistically different from those with higher initial prioritization.