475. The Utility of Community-Academic Partnerships in Promoting the Equitable Delivery of COVID-19 Vaccines in Black Communities

Background In the U.S., non-Hispanic Black individuals are disproportionately represented amongst COVID-19 mortalities. The COVID-19 vaccines are poised to change this outcome; however, inequitable access and decades of medical mistreatment have resulted in healthcare mistrust and an associated low uptake within this group. Loma Linda University (LLU) houses the largest mass vaccination site in San Bernardino County (SBC) California; nevertheless, there has been a perpetual low representation of Black vaccinees. To increase the number of Black persons vaccinated, a selected team at LLU leveraged a community-academic partnership model to address vaccine hesitancy and increase access to the COVID-19 vaccines. The objective of this study was to evaluate the number of Black persons vaccinated in community settings compared to the mass clinic. Methods LLU developed a tiered approach to increase COVID-19 vaccinations within Black SBC communities. The first tier engaged faith leaders with the academic community in disseminating COVID-19 health information, the second included culturally representative LLU healthcare professionals in the delivery of COVID-19 educational webinars, and the third was to conduct low barrier, remote-site vaccination clinics, within targeted Black communities. Following these efforts, we compared the number of Black individuals vaccinated in the LLU mass clinic to those vaccinated in the community remote-site clinics. Results The remote-site COVID-19 vaccination clinics commenced in February 2021. From February 1 until April 30, 2021, 24,808 individuals were vaccinated in the LLU mass clinic with a first dose (Pfizer or Moderna) or single dose (Janssen) of a COVID-19 vaccine, however, only 908 (3.7%) were Black vaccinees. Contrastingly, the LLU remote site clinics vaccinated 1,542 individuals with a first or single dose of a COVID-19 vaccine. Of those vaccinees, 675 (44%) were Black. Conclusion The multi-tiered community approach (remote-site vaccination clinics) resulted in a necessary overrepresentation of Black vaccinees, previously underrepresented in the LLU traditional mass vaccination clinic effort (44% vs. 3.7%, respectively). Further research is warranted to examine the key elements to increase vaccinations amongst minoritized groups. COVID-19 Vaccination Comparisons Between Models This table includes data from the Loma Linda University Mass Vaccination Clinic and the Remote-Site Vaccination Efforts compared to the San Bernardino County Demographics Disclosures All Authors: No reported disclosures

RESEARCH INVOLVING HUMAN SUBJECTS IN UKRAINE: HOW TO LEVERAGE ARISING OPPORTUNITIES?

The review of the applications for grants of the National Research Foundation of Ukraine revealed evidence that many applicants-clinicians are not aware of the principles of Good Clinical Practice (GCP) that are implemented in different forms in the vast majority of research involving human subjects across the globe. In the essay, based on the experience of researching at Danylo Halytsky Lviv National Medical University (Ukraine), Loma Linda University (USA), Friedrich Schiller University Jena (Germany), as well as industry (Sanofi-Aventis-Deutschland GmbH., Frankfurt am Main, Germany), the author shares his thoughts about the gaps in education, training, regulations and administrative flaws that prevent more rapid progress in clinical research in Ukraine. Despite the complexity of the problem, implementation of relatively simple steps at institutional and/or national levels, as suggested, can boost the efficiency of research, increase the quality of applications and move clinical research in Ukraine to a qualitatively different level

Effects of universal critical CHD screening of neonates at a mid-sized California congenital cardiac surgery centre

Introduction: CHD affects over 1 million children in the United States. Studies show decreased mortality from CHD with newborn cardiac screening. California began a screening programme on 1 July, 2013. We evaluated the effect of mandatory screening on surgical outcomes at Loma Linda University Children’s Hospital since 1 July, 2013. Methods: We evaluated all infants having congenital heart surgery at Loma Linda University Children’s Hospital between 1 July, 2013 and 31 December, 2018. Primary target diagnoses include hypoplastic left heart syndrome, pulmonary atresia with intact ventricular septum, tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia, and truncus arteriosus. Secondary target diagnoses include aortic coarctation, double outlet right ventricle, Ebstein anomaly, interrupted aortic arch, and single ventricle. Patients were stratified by timing of diagnosis (pre-screen, screen positive, and screen negative). Primary end points were post-operative length of stay, operative mortality, absolute mortality, and actuarial survival. Results: The cohort included 274 infants. Of these, 79% were diagnosed prior to screening (46% prenatally). Only 38% of those screened were positive, with 13% of the cohort having a “missed diagnosis.” Conclusions: Primary targets were more likely to be diagnosed by screening (53%), while secondary targets were unlikely to be diagnosed by screening (10%) (p = 0.004). Outcomes such as length of stay, operative mortality, and actuarial survival were not different based on timing of diagnosis (p > 0.05). Despite late diagnosis, those not diagnosed until after screening did not have adverse outcomes.

Teaching Tools to Teach Geriatric Medicine to Family Medicine Residents

Objective: To determine if pocket-sized, reference guides are helpful tools for teaching geriatric medicine to family medicine residents. Setting: Loma Linda University Healthcare Education Consortium, a family medicine residency in San Bernardino County, California. Participants: Family medicine residents that successfully completed the required geriatrics rotation between July 2019 and June 2020. Results: From the twelve family medicine residents, 100% believed their geriatric medicine rotation helped them to be successful in residency. The preferred study tool was the pocket guides, mainly the “Geriatric Medicine Pocket Guide” and “2019 AGS Beers Criteria”. For a more comprehensive reading, the study tool most used was search engines such as Up-to-date and Dynamed. Geriatrics at Your Fingertips (Reuben et al., 2016) and the “Guiding Principles for the Care of Older Adults with Multimorbidity Pocket Card” were not as helpful due to the perceived increased efforts to rapidly find clinically relevant information. Conclusion: Pocket guides, especially “Geriatric Medicine Pocket Guide” and “2019 AGS Beers Criteria”, are helpful teaching tools that can be used to augment geriatric medicine education in a family medicine residency.

Discrepancies in periodontitis classification among dental practitioners with different educational backgrounds

Background The 2018 classification of periodontal disease characterizes the disease with a multidimensional staging and grading system. The purpose of this multicenter study was to examine variations in periodontitis classification among dental practitioners with different postgraduate educational backgrounds at the University of Maryland School of Dentistry and the Loma Linda University School of Dentistry using the 2018 classification. Methods This cross-sectional observational study included two cohorts: dental practitioners with periodontal backgrounds (n1 = 31) and those with other educational backgrounds (n2 = 33). The survey instrument contained three periodontitis cases presented with the guideline of the 2018 classification and a questionnaire including closed and open-ended questions. The participants were asked to review each case and to fill out the questionnaire independently. Fisher’s exact test was conducted to examine the differences in responses between the two cohorts. Polychoric correlations were calculated to examine the relation between the level of familiarity with the 2018 classification and the accuracy of the classification. Results The distribution of item responses was significantly different between the two cohorts regarding only one item, grading for Case 1 (p = 0.01). No significant differences in accuracy between the two cohorts were observed except for two items, grading in Case 1 (p = 0.03) and staging in Case 3 (p = 0.04). There were no significant differences in risk factor identification for each case among the two cohorts (p = 1.00, Case 1; p = 0.22, Case 2). Staging in Case 3 ($$\widehat{\rho }$$ ρ ^ = 0.52) and risk factor identification in Case 2 ($$\widehat{\rho }$$ ρ ^ = 0.32) were significantly correlated with familiarity with the 2018 classification. Conclusion A fair level of agreement in periodontitis classification was observed among dental practitioners with different educational backgrounds when the 2018 classification was used. The periodontal cohort showed better agreement levels and partially better accuracy. Risk factor identification for periodontal disease was difficult regardless of the educational background.

Effect of Dietary Nitrate and Anthocyanins on Anaerobic Exercise in Untrained Individuals

Objectives The purpose of this study was to examine the effects of dietary nitrate and anthocyanins on exercise performance in healthy untrained individuals. Methods In a randomized double-blind crossover study, six men (mean age 24.3 y) and 23 women (mean age 24.1 y) were randomly assigned to Treatment A (5.05 g beetroot powder + placebo/d) or Treatment B (5.05 g beetroot powder + 480 mg tart cherry/d) for seven days. Each treatment was followed by a seven-day washout after which subjects switched treatments. At the end of each treatment period, subjects performed a modified Wingate Anaerobic Test on a Monark 928E bike. Data on speed (RPM), power (watts), and heart rate were collected and analyzed using linear mixed models adjusted for baseline subject characteristics, treatment sequence (A-B, B-A), energy (kcal), and sleep (hours). Results Average heart rate during the first five seconds of the cycling sprint was significantly lower after treatment A than after treatment B (−1.6 to 2.7 BPM, P < 0.05). Participants pedaled five meters further after treatment B compared to treatment A (P = 0.25). No significant differences were observed between treatments on RPM and blood pressure. Conclusions Supplementation with beetroot and tart cherry powder for seven days may improve anaerobic exercise performance by maximizing potential heart rate and energy output in untrained individuals. Funding Sources The study was sponsored by the School of Allied Health Professions, Loma Linda University.

Losing Access to Care: Your Pharmacy is Closing

Many folks who have a minor ailment, a question about medicines, or a health concern in general often stop by their local pharmacy to ask the pharmacist for advice. I grew up in a rural area of Southern Illinois that did not have a fulltime physician. The health department clinic was only open on select mornings each week to administer vaccines. The pharmacist was the only healthcare professional that my family could easily see within 30 miles. Regardless of where we live, we've likely taken for granted that there is a pharmacy nearby. Today those pharmacies are often owned by CVS or Walgreens or are situated in a grocery store or big box retailer like Wal-Mart, Costco or Target. Health systems like Loma Linda University Health also own community pharmacies. There are still nearly 22,000 privately owned pharmacies in the U.S.

Creating a Lifestyle Medicine Specialist Fellowship: A Replicable and Sustainable Model

As new specialties emerge in medicine, certification pathways must be defined and formalized. The Lifestyle Medicine Physician certification, including both experiential and educational pathways, have been in place for several years. Although raising competence across all specialties through the Lifestyle Medicine Physician Diplomates to a foundational level is essential, additional expertise must be attained to be a true Lifestyle Medicine Specialist as outlined by the American Board of Lifestyle Medicine. This column will describe how Loma Linda University Health (LLUH) created a Lifestyle Medicine Specialist Fellowship that meets the educational pathway requirements for the Lifestyle Medicine Specialist certification and how it can be replicated and sustained at other training sites across the nation.