Demographic changes are putting the healthcare sector globally under pressure. Aging populations and a rise in chronic diseases have seen a need for more hospital care, which could not be met in nursing capacity. The resulting higher demands to the existing workforce have resulted in a rise of burnout and a low retention rate in the industry. Meanwhile, advancements in robotics have allowed for collaborative robots to work closely with humans, automating repetitive tasks in many industries. However, the healthcare sector is still reluctant to change and is not yet seeing larger-scale implementations of automated processes. This project investigated the problems with the design of medical collaborative robots today, while identifying repetitive and tedious tasks with potential for automation by applying user-centered research methods, and proposes actionable design principles for a successful implementation of robotics in hospitals. The result is a logistical system consisting of a fully autonomous, integrated mobile unit and distributed access points. The latter allows for an asynchronous interaction between the mobile unit and nurses, ensuring independence in completion of each stakeholder’s respective tasks. The system is designed to retain and empower nurses’ contact with their patients, by taking time-intensive tasks in medical logistics out of their hand. This saved time, in turn, can be translated to more time spent on care-related activities, improving patient’s outcome and overall quality of care.

COVID-19 has led to a surge in the adoption of digital transformation in almost every sector. Digital health and well-being are no exception. For instance, now people get checkupsvia apps or websites instead of visiting a physician. The pandemic has pushed the health-care sector worldwide to advance the adoption of artificial intelligence (AI) capabilities.Considering the demand for AI in supporting the well-being of an individual, we presentthe real-life diagnosis as a digital twin(DT) diagnosis using machine learning. The MachineLearning (ML) technology enables DT to offer a prediction. Although several attemptsexist for predicting disease using ML and a few attempts through ML of DT frameworks,those do not deal with disease risk prediction. In addition, most of them deal with singledisease prediction after the occurrence and rely only on clinical test data like- ECG report,MRI scan, etc.To predict multiple disease/disease risks, we propose a dynamic machine learning algo-rithm (MLA) selection framework and a dynamic testing method. The proposed frameworkaccepts heterogeneous electronic health records (EHRs) or digital health status as datasetsand selects suitable MLA upon the highest similarity. Then it trains specific classifiers forpredicting a specific disease/disease risk. The dynamic testing method for prediction isused for predicting several diseases.We described three use cases: non-communicable disease(NCD) risk prediction, mentalwell-being prediction, and COVID-19 prediction. We selected diabetes, risk of diabetes,liver disease, thyroid, risk of stroke as NCDs, mental stress as a mental health issue, andCOVID-19. We employed seven datasets, including public and private datasets, with adiverse range of attributes, sizes, types, and formats to evaluate whether the proposedframework is suitable to data heterogeneity. Our experiment found that the proposed methods of dynamic MLA selection could select MLA for each dataset at cosine similarityscores ranging between 0.82-0.89. In addition, we predicted target disease/disease risks atan accuracy ranging from 94.5% to 98%.To verify the performance of the framework-selected predictor, we compared the accuracy measures individually for each of the three cases. We compared them with traditionalML disease prediction work in the literature. We found that the framework-selected algorithms performed with good accuracy compared to existing literature.

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Transgender individuals are defined as those whose gender does not match the sex they were assigned at birth. Healthcare providers receive inadequate training in transgender medicine, which could lead to provider stigma and lower health outcomes and higher health disparities. The purpose of our study was to assess the effect of an educational intervention on first and second year ETSU medical students’ knowledge and attitudes regarding transgender healthcare. A transgender healthcare-centered Integrated Grand Rounds (IGR) was used as a setting to conduct a 9-item survey regarding definitions, medical management, and attitudes/comfort levels with transgender care. First and second year medical students (n=140) who participated in the intervention had the option to complete pre and post surveys on paper before and after IGR. Of the 140 participants, 138 (98.6%) completed the pretest and posttest measures. The participants’ attitudes about transgender patients and their comfort in treating transgender patients significantly improved between pre and posttest surveys (p

Healthcare and ancillary workers in hospital settings are at an increased risk of Tuberculosis (TB) due to the nature of their job and exposure to persons with TB. Knowledge of healthcare workers (HCWs), (physicians, residents, nurses, midlevels etc.) who provide direct care and ancillary staff (technicians, aides, administrators, etc.) who provide indirect care in medical institutions play an important role in the diagnosis, treatment, control, and prevention of TB. Research has shown a variation in knowledge based on TB prevalence, facility type, available resources, provider training and clinical experience, education level of staff, etc. The purpose of this study is to assess the knowledge of TB among HCWs and ancillary staff in an underserved medical institution who provide care to low-income populations in the United States. This is a cross sectional observational study. A validated questionnaire that assesses TB knowledge will be used. Participants from a historically black college in Tennessee will be recruited in the study. Participants will include HCWs such as attending physicians and residents from all residency programs as well as nurses, midlevels, etc. within the institution. We will also recruit ancillary staff in the same departments. The survey will be distributed between Jan. 2018-Feb. 2018, and will contain 10 questions. Information on demographics, work history (age, sex, education, job category, duration of employment, training level) and TB knowledge (general information on TB) will be captured. The survey will be distributed via email through RedCap, a secure web application for creating and managing online surveys. Emails of participants will be obtained through the institution’s employee and student directory. A minimum of 200 participants will be surveyed, to obtain a power of 80% and CI of 95%. Survey will be entered into the REDCap electronic research database and entered data from participants will be checked for completeness and accuracy. Knowledge will be assessed as: poor (75%-85% correct); and outstanding (>85% correct). We will compare differences in TB knowledge of HCWs and ancillary staff and between practicing physicians and physicians in training. Data analysis will be performed using R software. The expected results are that healthcare workers have higher knowledge level than ancillary workers and that practicing physicians have higher knowledge level than physicians in training due to years of clinical experience and education. As TB continues to be one of the leading causes of death worldwide, it is important that HCWs exhibit a good level of knowledge. The findings from this study will generate data to guide TB education efforts for providers and healthcare facility ancillary staff. Results will help to clarify misconceptions about TB transmission and enhance the quality of care for patients with TB and reduce the risk of nosocomial transmission of TB.

Type 2 Diabetes affects approximately 30 million people across the Unites States. This chronic disease has significant effects on quality of life, and financial burden for patients and the healthcare system. Pharmacist intervention in addition to standard care for patients with Type 2 Diabetes has shown improved outcomes for patients; an essential aspect of these interventions is the completion of comprehensive care. Our objective is to identify the common missing components of comprehensive care to allow for development of targeted interventions and resources at the Rural Health Services Consortium. These findings may be implemented to improve the care of patients with diabetes in this clinic and others in similar clinics across the Appalachian region. Patients with Type 2 Diabetes who received their diabetes care at the Rural Health Consortium clinic in Rogersville, Tennessee were retrospectively evaluated for missing evidence-based interventions that could improve their health and quality of life, such as dental care, vaccinations, yearly diabetic foot exams, and eye exams. Completion of comprehensive care was calculated for patients enrolled in the site’s Diabetes Care Program for the year prior to their enrollment via retrospective chart review. A total of 28 patients were evaluated in this study from the Diabetes Care Program, a pharmacist-led diabetes care initiative designed to augment standard care, with the eventual goal of comparing this data to the year of enrollment in the program. IRB approval has been granted for this study. Preliminary results indicate consistent completion of evidence-based laboratory measurements, including lipid panels and hemoglobin A1C, and the initiation of appropriate medication therapy, such as ACE/ARBs, statins, Aspirin, and diabetic medications. However, age-appropriate and disease-specific vaccinations were less likely to be completed, and there was a lack of documentation for other critical health services, most notably dental care. This data will be implemented in future quality improvement measures for diabetic patients at the Rural Health Consortium and may serve as a model for other rural healthcare providers who serve diabetic patients.

Unintended pregnancy rates remain a world wide public health concern. Healthy People 2030 has designated unintended pregnancies a key initiative, stating that increasing the use of contraception and decreasing unintended pregnancy is an important public health goal. According to the American Academy of Family Physicians, approximately one-half of the 6.6 million pregnancies each year in the United States are unintended. Family medicine physicians have an ideal position to provide contraception counseling in our communities. Unfortunately when surveyed, although 95% of medicine faculty and residents responded that contraceptive counseling is important, only one-quarter of providers reported providing contraceptive counseling “routinely” (defined as ≥ 80% of the time) to reproductive aged women during prevention-focused visits. Several studies have attempted to understand why primary care physicians are not routinely providing preconception and contraception counseling with multiple factors identified including inadequate knowledge of contraception methods (especially in regards to long-acting reversible contraceptives or LARCs), lack of time, lack of routine sexually history taking, and provider misconception regarding contraception. This study was completed as a quality improvement project among ETSU Health Family Medicine Kingsport residents. The aim of the quality improvement project was to determine if increasing awareness of gaps in contraception counseling and providing contraception counseling education would increase the rates of contraception counseling during yearly visits (well child checks, annual physicals, and annual wellness visits) for women of reproductive age (defined as ages 14-45). Clinic charts were reviewed in a 3 month time period pre and post an educational intervention. The educational intervention included a 1 hour lecture on current contraception methods and recommendations. A survey was also collected pre and post educational intervention to identify self-reported rates of contraception counseling and other perceived barriers to contraception counseling in our clinic. The rates of contraception were determined by either the presence or absence of the billing ICD-10 code Z30.09 (Encounter for contraceptive management). Pre-intervention chart review revealed a documented contraceptive counseling rate of 13% at annual preventative visits. Despite these low rates, 71% of residents surveyed pre-intervention strongly agreed that contraceptive counseling was important at annual exams for women of reproductive age. Post-intervention chart review revealed a contraceptive counseling rate of 31% at annual preventative visits, an 18% increase in contraceptive counseling. The results showed that while residents did not self-identify inadequate knowledge of contraceptive methods as a barrier to providing counseling, raising awareness of the importance of contraception counseling and providing an educational intervention did increase rates of contraception counseling. The major barrier identified by providers was a perceived lack of time. One limitation of this study was measuring contraceptive counseling rates by the use of the billing ICD-10 code of Z30.09. By only using this ICD code, visits that documented sexually activity, current contraceptive use, and/or history of prior hysterectomy but did not properly bill for Z30.09 were not included.

Delta-8-tetrahydrocannabinol (THC), although less potent than THC, can still reduce memory cognition and anxiety. However, Delta-8 can have adverse effects at high doses, like inducing anxiety, confusion, and hallucinations. The brain of Danio rerio (zebrafish) resembles human neuroanatomical and neurochemical pathways and demonstrates robust behavioral phenotypes, making zebrafish an excellent model organism for memory and anxiety. Subjects will be fed 5mg of Delta 8-THC before entering the experimental apparatus. Fish for both memory and anxiety tests will be observed and recorded through Noldus Ethovision Software. For testing memory, five female and five male zebrafish will be individually placed in a three-compartment memory tank. One side of the memory tank will have a star shape, while the other side will have a circle shape. About .83mg of commercial fish flakes will be administered to the fish on the circle side in the first trial, then on the star side in the second trial, and will continue on either side for 20 trials. Correct responses will be scored when the fish are present on the side of the tank used to present the fish flakes. We hypothesize that there will be fewer correct responses for fish fed with Delta-8-THC than the control. For testing anxiety, ten male and female zebrafish will be fed 5mg of Delta 8-THC before entering the diving tank. Typically, zebrafish experiencing anxiety will stay at the bottom of the diving tank, but if they are relaxed, they will be at the top. We hypothesize that fish fed with Delta-8-THC will spend more time at the top of the diving tank than the control.

Family physicians are often tasked with ensuring patients have the durable medical equipment (DME) they need for a given ailment. This includes nebulizers, rolling walkers, crutches, wheelchairs, and hospital beds. Family physicians are expected to be familiar with the DME indications and ordering procedures in order to obtain these items for their patients. For many of our family medicine residents, this is a vast and overwhelming facet of primary care that is often dreaded due to lack of knowledge concerning medical indications and processes of ordering DME. Therefore, our project at ETSU Family Medicine Residency of Bristol aimed to improve our residents comfort with and understanding of the clinic’s protocol surrounding the ordering of DME. We started with an evaluation of our residents’ knowledge and comfort with the indications, ordering protocol, and documentation requirements of durable medical equipment. We then conducted an educational didactic on the information needed to be able to document and order DME in our clinic. Additionally, we provided our physicians with “dot phrase macros” for proper documentation required when ordering DME through insurance. After the presentation, we re-assessed the resident’s knowledge and comfort with understanding and ordering DME in our clinic. We found that overall there was an improvement in the residents’ comfort and understanding of the DME ordering processes as well as an improvement in their knowledge of DME ordering requirements. As a result of these findings, we plan to continue DME education for all future residents at ETSU Family Medicine Residency of Bristol.