Inpatient hypoglycemic events less than 50 mg/dL are prevalent among hospitalized patients and can lead to poor health outcomes, including increased mortality. Some studies indicate that among hospitalized patients, older individuals, patients with co-morbidities, and those who are admitted to intensive care units are the most common inpatient populations to suffer from hypoglycemic events. Studies also suggest that inpatient hypoglycemic events are more often medication attributable in contrast to physiologic causes. The aims of this quantitative study are to: 1) determine the root causes that lead to hypoglycemic events in the hospital setting, 2) describe patterns in chart documentation related to hypoglycemic events, and 3) identify measures to attain effective prevention of hypoglycemia. Specifically, this study examines the time range between the hypoglycemic event measurement and the blood glucose measurement prior to the event to determine if tighter glycemic control results in improved patient outcomes, the use and documentation of rescue medications after a hypoglycemic event, and the presence of dietary intake charting in the medical record prior to the hypoglycemic event. We collaborated with the glycemic team at a local medical center to collect data drawn from patient medical records. Patient medical records were selected if they had experienced a hypoglycemic event less than 50 mg/dL between March 2017 and June 2017. Analysis used descriptive measures to identify patterns and inconsistencies in the data derived from the medical charts related to potential root causes of hypoglycemia. Using a systematic approach to identify the root cause of inpatient hypoglycemia informs future development of tools and policies to reduce the incidence of inpatient hypoglycemia in the future and improve patient outcomes. The expected results of this study attributes the hypoglyemic events to infrequent and inaccurate diet intake documentation, and longer time intervals between blood glucose monitoring. 

The research question for our study is, “Is a component of a multilevel intervention effective in promoting awareness of cardiovascular health and decreasing weight?” Within King County, an almost 10-year-difference in life expectancy exists between low- and high-income areas. While many factors may contribute to this disparity, cancer and cardiovascular disease (CVD) are the leading causes of mortality. Obesity and metabolic syndrome are major risk factors for both cancer and CVD, and disproportionally affects lower income populations. The Women Take Heart (WTH) study is part of a multilevel intervention that spans school, family, and individual levels, aimed at promoting awareness of positive health behaviors. The WTH intervention focuses on teaching women in the Renton community physical and nutritional health information. We hypothesize that targeted, weekly teachings by experts on complex health behaviors will increase health knowledge and decrease participant weight. We will assess the efficacy of WTH through quantitative methods. These include examining pre- and post-intervention values of physical and metabolic measurements, as well as pre- and post-questionnaire responses. We anticipate the results of our study will show increased health empowerment, increased knowledge of positive health behaviors, and decreased biologic markers of metabolic syndrome. If this intervention is effective, it could be implemented to address the high rates of obesity in low-income communities, which in turn could lower rates of cancer and CVD.

Osteoarthritis and disturbed sleep negatively impact the daily life of many older adults (65+) in the United States. While previous research shows that physical activation can improve osteoarthritis and sleep disturbances, it is often a challenge to motivate older adults to engage in daily physical activity. Walking is the most common and affordable form of physical activity and therefore provides a practical target for health behavioral interventions. The objective of this study is to examine if, in older adults with osteoarthritis and sleep problems, a wearable wrist-worn device (Fitbit) combined with infrequent motivational text messages and phone calls targeting physical activity improve participants step count and sleep. To examine this question, we recruited 20 older adults over the age of 65 who have clinically diagnosed osteoarthritis, have a sleep deficiency (defined by a score greater than or equal to 12 on the Insomnia Severity Index) and were judged to be underactive (doing physical activity less than 30 minutes a day). This data is then analyzed to see if there is a change in participants step count and the effect of this change on their sleep symptoms. Preliminary results show that step count improved over time such that there was almost a 400 step increase per day between baseline and week 14. Ultimately, this work will increase our understanding of mobile interventions and their potential effectiveness in helping patients to engage in more physical activity as a cost-effective way of improving sleep.

Traumatic brain injury (TBI) afflicts people of all ages, with older adults having the highest rates of TBI-related hospitalizations and deaths among all age groups. Many of the issues and complications that TBI patients face are mediated by the immune response. Aging is a complex process which results in a decline of the immune system due to the altering of cellular production, proliferation and function resulting in an overall decline of immunocompetence. Injury sets off a chain reaction of immune cellular responses, the cell of interest in this project is TH2 cells, which have been shown to play a role in chronic inflammation. The purpose of this study was to explore if the age of an individual influences the TH2 cellular response in relation to traumatic brain injury. The TH2 cells used in the study were collected from younger (aged 21-64) and older (aged 65+) adult participants at < 24hours following mild/moderate TBI and at 3 months post injury. TH2 cells were stimulated with phytohaemagglutinin (PHA) and anti-CD3 and then incubated overnight. They were then analyzed for IL-5 production using the ELISpot assay. The number of cells producing IL-5 were counted, in triplicate, and the mean was taken to determine cellular response when stressed. The results were compared to determine if there is a difference between cytokine release amongst younger and older adults who experience TBI. By having a better understanding of how TH2 cell function is affected by age, we are exploring if overall outcomes following traumatic brain injuries are related to differential immune responses. This knowledge can potentially assist in identifying strategies to improve clinical outcomes.

Managing chronic pain is difficult, as pain mechanisms and relief strategies are poorly understood. Chronic pain afflicts many adults nationwide, diminishing functional activity, and quality of life. Recently, opioid therapy has become a treatment option for chronic pain, increasing prescription opioid use and related public health issues. Additionally, pain education among providers, prescribers, and clinicians is generally insufficient. Providers require education in alternate pharmacological strategies, and effective non-pharmacological strategies. Telehealth technologies developed recently can span geographic distance to improve quality of pain care for patients by improving provider knowledge of pain-management. The question remains: is telehealth-based pain education effective in improving provider’s knowledge and management of pain? We hypothesized that clinicians who attend weekly Telepain sessions will demonstrate improvement on their quarterly evaluation of pain-medicine knowledge and confidence, and the KnowPain-12 questionnaire. Providers (N=128) participated in or observed a weekly video-conference, orchestrated by pain specialists representing internal medicine, rehabilitation medicine, addiction medicine, psychiatry, social work, nursing, and anesthesiology. Telepain sessions are divided into two segments: a didactic lecture on a pertinent, evidence-based topic related to pain, and case presentations and discussion by clinicians. Participating providers completed a quarterly questionnaire critiquing the conference, as well as self-report questionnaires related to pain management knowledge (KnowPain-12; mean score of 1-5) and perceived competence (mean score of 1-7). To determine if Telepain attendance led to improvements in pain knowledge and perceived competence, a generalized linear model (GLM) was fit, where KnowPain-12 mean total scores were the outcome variable and Telepain attendance time was the predictor variable. A generalized estimating equation was used. Results of the GLM indicated improved pain knowledge with increased Telepain participation time (coefficient = 0.002, 95% confidence interval = -0.0002, 0.0044, p = 0.08), suggesting that telehealth interventions such as Telepain may be an effective option for delivering advanced provider pain education remotely.