Atrium Health Foundation

ORAL HYGIENE, PERIODONTAL DISEASE, AND INFECTIVE ENDOCARDITIS

POISON CONTROL STABILIZATION AND ENHANCEMENT PROGRAM

EVALUATION OF A NEW STRATEGY FOR PROTOCOLIZED ANTIBIOTIC CARE FOR SEVERE OPEN FRACTURES...NEW COOPERATIVE AGREEMENT, SIGNED 9/18/2019, EFFECTIVE 9/30/2019, DISTRIBUTED 9/19/2019, FAADC 9/19/2019

PROPHYLACTIC ANTIBIOTIC-COATED NAIL TO PREVENT INFECTION: A CLINICAL TRIAL.

IMPLEMENTING A MULTIMODAL PATH TO RECOVERY (IMPROVE): PRIMARY AND SECONDARY PREVENTION OF OPIOID OVERDOSE IN ACUTE CARE

SICKLE CELL TREATMENT DEMONSTRATION PROGRAM

THE MOBILITY TOOLKIT: ELECTRONICALLY AUGMENTED ASSESSMENT OF FUNCTIONAL RECOVERY FOLLOWING LOWER-EXTREMITY TRAUMA

EXAMINING THE EFFECTS OF HEAD SUPPORTED MASS ON CERVICAL SPINE BIOMECHANICS AND INJURY RISK IN SPECIAL FORCES OPERATORS

NUTRITION EDUCATION FOR CARDIOVASCULAR DISEASE PREVENTION IN INDIVIDUALS WITH SPI

ATRIUM HEALTH, DBA CHARLOTTE MECKLENBURG HOSPITAL AUTHORITY, PROPOSES TO IMPLEMENT THE CITY OF CHARLOTTE AND ATRIUM HEALTH HOSPITAL- BASED VIOLENCE INTERVENTION PROGRAM. UTILIZING A TRAUMA-INFORMED APPROACH, THIS PROGRAM IS DESIGNED TO REDUCE TRAUMA RECIDIVISM AMONG PATIENTS WHO ARE VICTIMS OF COMMUNITY AND INTERPERSONAL VIOLENCE. THE HOSPITAL-BASED VIOLENCE INTERVENTION PROGRAM (HVIP) UTILIZES INNOVATIVE TOOLS TO WORK WITH PATIENTS TO IDENTIFY SOCIAL AND HEALTHCARE NEEDS, SET RESPONSIVE PERSONAL GOALS, AND MAKE CONNECTIONS TO TAILORED SUPPORT FROM CLINICAL AND COMMUNITY-BASED ORGANIZATIONS (CBOS). PROJECT ACTIVITIES INCLUDE CONNECTING PATIENTS WITH INTENSIVE CASE MANAGEMENT TO ADDRESS SOCIAL DETERMINANTS OF HEALTH WITHIN THE HOSPITAL SYSTEM AND OUTSIDE THE HOSPITAL, EQUIPPING HEALTHCARE PROVIDERS WITH THE SKILLS TO ADDRESS VIOLENCE-RELATED INJURIES AND RECIDIVISM, ENHANCING THE HOSPITAL SYSTEM REFERRAL NETWORK, ESTABLISHING PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS, AND CONDUCTING SOCIAL DETERMINANT OF HEALTH INTERVIEWS WITH ALL PROGRAM PARTICIPANTS. EXPECTED OUTCOMES INCLUDE A REDUCTION IN RECIDIVISM, AN INCREASE IN REFERRALS FOR SOCIAL DETERMINANT OF HEALTH NEEDS FOR PROGRAM PARTICIPANTS, TRAINING FOR HEALTHCARE PROVIDERS TO RECOGNIZE THE SIGNS OF RECURRING VIOLENCE, THE DEVELOPMENT OF PROTOCOLS TO ADDRESS THE SPECIFIC NEEDS OF PATIENTS WITH VIOLENT INJURIES, AN INCREASE IN PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS, AND A STREAMLINED REFERRAL PROCESS TO ENSURE SEAMLESS SUPPORT FOR PROGRAM PARTICIPANTS. THE INTENDED BENEFICIARIES OF THE PROJECT ARE PATIENTS WHO ENTER OUR LEVEL 1 TRAUMA CENTER FOR VIOLENT, PENETRATING INJURIES SURROUNDING INTERPERSONAL COMMUNITY VIOLENCE.

SHORT-TERM CLINICAL DETERIORATION AFTER ACUTE PULMONARY EMBOLISM

RANDOMIZED TRIAL OF NON-SURGICAL THERAPY AND ORAL HYGIENE INSTRUCTION TO REDUCE RISK OF INFECTIVE ENDOCARDITIS - PROJECT SUMMARY INFECTIVE ENDOCARDITIS (IE) HAS HIGH MORBIDITY AND MORTALITY. UPWARDS OF 30% OF CASES OF IE ARE CAUSED BY ORAL BACTERIAL SPECIES THAT ENTER THE BLOODSTREAM AND COLONIZE HEART VALVES. FREQUENT EPISODES OF BACTEREMIA FROM DENTAL BIOFILM (PLAQUE) ARE LIKELY TO BE SIGNIFICANT RISK FACTORS FOR DEVELOPMENT OF IE. OUR PRIOR WORK DEMONSTRATES THAT: 1) THERE ARE ONLY INFORMAL GUIDELINES FOR PREVENTION IN 90% OF PEOPLE AT RISK FOR IE; 2) TOOTH BRUSHING RESULTS IN A HIGH INCIDENCE OF BACTEREMIA OF IE-CAUSING SPECIES; 3) THE RISK OF SUCH BACTEREMIA INCREASES WITH THE LEVEL OF DENTAL PLAQUE AND CALCULUS PRESENT; AND 4) PATIENTS WITH IE HAVE A HIGHER BURDEN OF DENTAL PLAQUE AND CALCULUS THAN MATCHED NON-IE CONTROLS. ALTHOUGH MILLIONS OF PEOPLE IN THE U.S. ARE AT RISK FOR IE BECAUSE OF PRE-EXISTING CARDIAC CONDITIONS, THERE ARE NO PROSPECTIVE STUDIES OR SOLID EVIDENCE TO SHOW THAT IMPROVING ORAL HYGIENE REDUCES BACTEREMIA FROM ROUTINE DAILY ACTIVITIES (E.G., TOOTHBRUSHING). EVIDENCE DOES SHOW, HOWEVER, THAT BACTEREMIA IS A STRONG SURROGATE MARKER FOR RISK OF IE. THE LACK OF SUPPORTING DATA MEANS THAT LONGSTANDING SPECULATION ABOUT THE IMPORTANCE OF ORAL HYGIENE AND GINGIVAL INFLAMMATION AS RISK FACTORS FOR IE HAVE HAD TOO LITTLE IMPACT ON PRACTICE GUIDELINES ON PREVENTION, CLINICAL PRACTICE, OR FUNDING FOR PREVENTIVE CARE. THE NEXT STEP IS TO DETERMINE IF PROFESSIONAL SCALING AND ORAL HYGIENE INSTRUCTION SIGNIFICANTLY REDUCE THE INCIDENCE AND DURATION OF IE-CAUSING BACTEREMIA FROM TOOTHBRUSHING. WE PLAN TO ENROLL 320 PEOPLE AT RISK FOR IE INTO A CLINICAL TRIAL. ENROLLEES WILL BE RANDOMIZED TO PROFESSIONAL SCALING AND ORAL HYGIENE INSTRUCTION VERSUS ROUTINE ORAL CARE. WE WILL TEST THE STEPS IN THE HYPOTHESIZED CAUSAL PATHWAY FROM IMPROVED ORAL HYGIENE TO DECREASED BACTEREMIA FROM IE-CAUSING SPECIES BY: 1) DETERMINING THE IMPACT OF PROFESSIONAL SCALING AND ORAL HYGIENE INSTRUCTION ON THE INCIDENCE AND DURATION OF BACTEREMIA WITH IE-CAUSING SPECIES DURING AND FOLLOWING TOOTHBRUSHING; 2) COMPARING ORAL HYGIENE AND GINGIVAL HEALTH MEASURES BETWEEN RANDOMIZED TREATMENT GROUPS AND TESTING WHETHER IMPROVEMENT IN THESE MEASURES IS ASSOCIATED WITH REDUCED INCIDENCE AND DURATION OF BACTEREMIA FROM TOOTHBRUSHING; AND 3) DETERMINING THE DEGREE TO WHICH REDUCTION IN BACTEREMIA INCIDENCE AND DURATION, AND IMPROVEMENT IN ORAL HYGIENE AND GINGIVAL INFLAMMATION SCORES, ARE MAINTAINED FOLLOWING THE INTERVENTION. THIS STUDY WILL PROVIDE NOVEL, IMPORTANT DATA TO INFORM THE HEALTHCARE COMMUNITY, GUIDELINE COMMITTEES, AND HEALTH FUNDING AGENCIES OF THE IMPORTANCE OF IMPROVING ORAL HYGIENE AND REDUCING GINGIVAL INFLAMMATION AS PRIMARY PREVENTIVE MEASURES FOR ALL PEOPLE AT RISK OF IE.

FABP4 RELEASED FROM STEATOTIC HEPATOCYTES IN ALCOHOLIC LIVER DISEASE ENHANCES HEPATIC TUMOR PROGRESSION - SUMMARY ALCOHOL USE DISORDERS (AUDS) ARE SIGNIFICANT CLINICAL AND FINANCIAL HEALTHCARE BURDENS IN THE UNITED STATES AND GLOBALLY. WITHIN THE SPECTRUM OF PATHOLOGIES AFFECTED BY AUDS, THE CENTRAL ROLE OF THE LIVER IN ALCOHOL METABOLISM MAKES IT PARTICULARLY SUSCEPTIBLE TO DAMAGE. ALCOHOLIC LIVER DISEASE (ALD) ARISES FROM SUSTAINED, HEAVY ALCOHOL INGESTION AND IS CHARACTERIZED BY A SERIES OF WORSENING LIVER PATHOLOGIES (FAT ACCUMULATION (HEPATOSTEATOSIS), ALCOHOLIC HEPATITIS, FIBROSIS-CIRRHOSIS). IN ALD, HEPATIC CYTOCHROME P450 2E1 IS INDUCED TO METABOLIZE ETHANOL LEADING TO ELEVATED INTRAHEPATIC ACETALDEHYDE AND OXIDATIVE STRESS, FACTORS THAT INCREASE THE RISK OF GENETIC DAMAGE AND DEVELOPMENT OF HEPATOCELLULAR CARCINOMA (HCC). INTRACELLULAR LIPID MOVEMENT AND STORAGE ARE CLOSELY REGULATED PROCESSES REQUIRED TO MAINTAIN LIVER AND SYSTEMIC HOMEOSTASIS. IN HEALTHY INDIVIDUALS FATTY ACID BINDING PROTEINS (FABPS) ARE EXPRESSED IN A TISSUE- SPECIFIC MANNER AND FUNCTION AS CRITICAL CHAPERONES DURING LIPID SEQUESTRATION AND MOVEMENT. IN THE HEALTHY LIVER, FABP1 IS THE PREDOMINANT FABP EXPRESSED IN HEPATOCYTES. RECENT STUDIES REPORT FABP4 (AN ISOFORM USUALLY EXPRESSED IN ADIPOCYTES AND MACROPHAGES) IS SYNTHESIZED AND RELEASED BY ADIPOCYTES TO ACT AS A PARACRINE- ENDOCRINE SIGNALING MOLECULE IN SPECIFIC DISEASE STATES, INCLUDING CANCERS ARISING IN CLOSE PROXIMITY TO ADIPOSE TISSUE. STUDIES BY OUR GROUP REPORT FABP4 MRNA AND PROTEIN EXPRESSION IS DRAMATICALLY UPREGULATED IN HEPATOCYTES ISOLATED FROM ALCOHOL-FED RODENTS, AND FOLLOWING ALCOHOL METABOLISM BY CYP2E1-EXPRESSING HCC CELLS. THESE FINDINGS OF INCREASED FABP4 EXPRESSION IN ALD MODEL SYSTEMS ARE ALSO EVIDENCED IN TISSUE AND SERUM FROM ALD/ALD-HCC PATIENTS. FUNCTIONALLY, WE REPORT EXOGENOUS RHFABP4 STIMULATES ERK-MAPK AND JNK SIGNALING LEADING TO HCC PROLIFERATION AND MIGRATION IN VITRO. COLLECTIVELY, THESE DATA HAVE LED US TO HYPOTHESIZE THAT “ALCOHOL METABOLISM IN ALD-INDUCED STEATOTIC HEPATOCYTES LEADS TO THE INDUCTION OF FABP4 SYNTHESIS AND RELEASE WHICH IN TURN STIMULATES HCC CELL GROWTH AND MIGRATION”. TWO SPECIFIC AIMS ARE PROPOSED; AIM 1 WILL DETERMINE THE MECHANISM[S] BY WHICH HEPATIC ALCOHOL METABOLISM INDUCES FABP4 EXPRESSION, AND DEFINE THE SIGNALING MECHANISM[S] BY WHICH FABP4 REGULATES HEPATOMA CELLFUNCTION. TO ACHIEVE THIS, WE WILL COMBINE KNOWLEDGE DERIVED FROM OUR PRELIMINARY DATA USING ESTABLISHED IN VITRO MODELS WITH INNOVATIVE PROTEOMIC APPROACHES (CELL SIGNALING PHOSPHO-ANTIBODY ARRAY) TO ACCURATELY DETERMINE THE SIGNALING NETWORKS REGULATED BY FABP4. AIM 2 WILL DEMONSTRATE THE SIGNIFICANCE OF FABP4 SIGNALING IN ALCOHOL-DEPENDENT HCC EXPANSION AND PROGRESSION IN VIVO. THESE STUDIES WILL UTILIZE A NOVEL HEPATOCYTE-SPECIFIC FABP4-/- MOUSE (HS-FABP4-/-) AND AN ORTHOTOPIC MODEL OF TUMOR PROGRESSION. IN PARALLEL, WE WILL EXPAND OUR ONGOING ANALYSES OF TISSUE AND SERUM FROM ALD AND ALD-HCC PATIENTS FOR FABP4 EXPRESSION TO DETERMINE THE CLINICAL RELEVANCE OF ALTERED FABP4 EXPRESSION DURING ALD AND HCC PROGRESSION.

ROLE OF EXOSOMAL MICRORNAS IN ALCOHOL-INDUCED LIVER INJURY

CLASSIFYING SEPSIS SURVIVORS INTO ACTIONABLE PHENOTYPES

PRECLINIC DOSE AND DELIVERY REGIME OPTIMIZATION AND LONG-TERM EFFICACY EVALUATION OF RIBITOL TREATMENT FOR FKRP RELATED DYSTROGLYCANOPATHY

PERSONALIZED CLINICAL DECISION SUPPORT TO IMPROVE PARTICIPATION IN HOSPITAL AT HOME - PROJECT SUMMARY INPATIENT HOSPITALIZATION IS COSTLY – ACCOUNTING FOR $1.1 TRILLION IN HEALTH CARE SPENDING ANNUALLY IN THE UNITED STATES – AND IS ASSOCIATED WITH HIGH MORBIDITY AND MORTALITY RISKS. HOSPITAL AT HOME (HAH) IS AN ALTERNATIVE CARE MODEL WHERE CARE TEAMS PROVIDE ACUTE HOSPITAL-LEVEL CARE IN A PATIENT’S HOME. DESPITE DECADES OF DATA THAT SUPPORT HAH EFFICACY RELEVANT TO KEY PATIENT-CENTERED OUTCOMES, BARRIERS TO HAH PARTICIPATION LIMIT ITS WIDESPREAD ADOPTION AND POPULATION HEALTH IMPACT. OUR CENTRAL HYPOTHESIS IS THAT PROVIDERS AND PATIENTS REQUIRE CLINICAL DECISION SUPPORT (CDS) INTEGRATING DATA FROM DISPARATE SOURCES AND A SHARED DECISION MAKING (SDM) FRAMEWORK TO HELP INFORM POINT-OF-CARE DECISIONS REGARDING HAH AND SURMOUNT LOW PARTICIPATION RATES. THE OVERARCHING GOAL OF OUR WORK IS TO IMPROVE VALUE-DRIVEN CARE BY HELPING PATIENTS ENGAGE IN THE DECISION OF WHICH ACUTE-LEVEL CARE OPTION BEST MEETS THEIR NEEDS. THE OBJECTIVE OF THIS STUDY IS TO EVALUATE WHETHER A HEALTH INFORMATION TECHNOLOGY (IT)-ENABLED SDM SOLUTION INCORPORATING EXPECTED PATIENT OUTCOMES AND PREFERENCES AND DEPLOYED AT THE POINT-OF-CARE IMPROVES PATIENT AND PROVIDER PARTICIPATION IN HAH AS A CARE MODEL. TO ACHIEVE THIS OBJECTIVE, WE WILL: 1) CHARACTERIZE PATIENT, CAREGIVER, AND PROVIDER PERCEPTIONS OF THE RISK TRADEOFFS, NEEDS, AND CARE PREFERENCES FOR HAH; 2) PARTNER WITH PATIENTS, CAREGIVERS, AND PROVIDERS TO ITERATIVELY DESIGN HOSPITAL-LEVEL OUTPATIENT MANAGEMENT EVALUATION AND DECISION SUPPORT (HOME-DS), A HEALTH IT- ENABLED SDM SOLUTION THAT INCORPORATES RISK-MODEL PROBABILITIES AND PATIENT AND CAREGIVER PREFERENCES; AND 3) EVALUATE THE FEASIBILITY OF IMPLEMENTING HOME-DS IN ACUTE CARE AND ESTABLISH THE ACCEPTANCE RATE OF HAH. WE WILL FOCUS HOME-DS ON ADULTS AGED 18 AND OLDER HOSPITALIZED WITH SUSPECTED PNEUMONIA, A PREVELANT CONDITION THAT HAS BEEN COMMONLY INCLUDED IN HAH MODELS. WE WILL APPLY THE PREVIOUSLY VALIDATED AND BROADLY ACCEPTED PNEUMONIA SEVERITY INDEX (PSI) AS THE QUANTITATIVE RISK SCORE INPUT FOR HOME-DS. USER PERSONAS AND NEEDS FOR THE INITIAL HOME-DS PROTOTYPE WILL BE DEFINED THROUGH KEY INFORMANT INTERVIEWS WITH PATIENTS HOSPITALIZED WITH PNEUMONIA, THEIR CAREGIVERS, AND PROVIDERS (AIM1); USER-CENTRIC DESIGN PRINCIPLES WILL FURTHER GUIDE ITERATIVE DEVELOPMENT OF THE HOME-DS PROTOTYPE (AIM 2); AND WE WILL TEST THE FEASIBILITY OF IMPLEMENTING HOME-DS IN ACUTE CARE TO GUIDE PATIENT AND CAREGIVER DECISION MAKING IN SELECTING HOSPITAL LEVEL CARE IN THE HOME OR TRADITIONAL HOSPITAL (AIM 3). WE HYPOTHESIZE HOME-DS IS FEASIBLE TO IMPLEMENT WITHIN THE PROVIDER WORKFLOW FOR HOSPITAL ADMISSION AND CAN YIELD PARTICIPATION RATES IN HAH OF 50%. THE PROPOSED PROJECT WILL ENGAGE A HETEROGENEOUS POPULATION WITH PNEUMONIA, AS THIS IS A POPULATION WITH SUBSTANTIAL ACUTE CARE UTILIZATION COSTS AND A LARGE GAP IN UNDERSTANDING IMPLEMENTATION CHALLENGES TO EXPLAIN WHY ALTERNATIVES TO TRADITIONAL HOSPITALIZATION ARE NOT USED MORE WIDELY. RESULTS WILL DEMONSTRATE THE VALUE OF HEALTH IT THAT INTEGRATES CLINICAL DATA WITH PATIENT PREFERENCES TO PROMOTE EFFECTIVE SDM ENHANCING PATIENT-CENTERED ACUTE CARE OPTIONS.

CARES FUNDING FOR POISON CENTERS