"MUSC Nurses Change Lives"
Currently Funded Research Projects
Nutrition and Food Safety Education Targeting Rural Older Adults: A Volunteer-Based Train-the-Team Approach
This subcontract with Clemson University will examine the feasibility of using a volunteer-based, train-the-team approach to reach rural older adults with information about how to make safe and healthy food choices and to use safe and healthy preparation practices. Two pre-existing volunteer groups will serve as the model for the train-the-team approach - the SC Family and Community Leaders (SCFCL) and the South Carolina chapter of the American Association of Retired Persons (AARP). The study will build on current evidence, capitalize on the potential contribution of pre-existing community-based groups as a source of volunteers to reach older adults with information about food safety and nutrition, and extend the focus to minority populations in an effort to eliminate health disparities. The findings will contribute to the evidence base of effective train-the-team programs and their potential effects over time and might offer a way to shift the current nutrition and food safety education paradigm by offering a way to extend the knowledge base of Clemson Extension, which is usually channeled directly from Extension Agents to the public to a new model, Extension Agents to volunteers to the public.
Advanced Nursing Education Expansion (ANEE)
This award is to support students enrolled in the newly implemented online Doctor of Nursing Practice/ Master of Science in Nursing (DNP/MSN) primary care Nurse Practitioner (NP) program. The objective of this ANEE Project is to maintain the high number of full time nurse practitioner (NP) students who are enrolled in this program by providing additional funding for full time enrollment. The second objective is to offer strong MSN students who apply part-time an opportunity to come into the program in a full time position with financial support.
Nurse Faculty Loan Program
Helene Fuld Health Trust Scholarship Fund for Baccalaureate Nursing Students
The primary mission of the Helene Fuld Health Trust is to support and promote the health, welfare and education of student nurses. The first priority of the Trust is financial aid to nursing students. This grant is made exclusively to fund financial aid for students enrolled in the Baccalaureate degree nursing program here in the College of Nursing.
RWJF New Careers in Nursing: Mentoring Future Nurse Leaders
Advanced Nursing Education Grants: Growing the Next Generation of Nursing Leaders (NGNL)
The goal of this project is to grow the next generation of young nurse leaders from our Medical University of South Carolina (MUSC) online PhD and DNP programs, who will be the vanguards in solving health care disparities among rural and underserved populations in our complex health care environment. Our aim is to produce a nursing leadership workforce that is 1) early career 2) diverse and culturally competent and 3) adept in interprofessional team research skill sets. We will attract early career Post-BSN students to the PhD and DNP Online programs through creative recruitment, innovative marketing and focused mentoring strategies that encourage a younger and diverse applicant pool to study at our programs. Once admitted, we will bolster the skills sets of younger, disadvantaged, and minority online students to navigate doctoral level coursework using the Next Generation of Nursing Leaders Program (NGNL). With the guidance of a nationally recognized consultant on cultural competence, faculty will evaluate and expand the DNP and PhD curricula and clinical experiences to ensure the cultural competencies of our graduates for use with rural and underserved populations. To develop graduates with interprofessional team research skill sets, the faculty will utilize the online environment to construct interdisciplinary group learning experiences that supplement the traditional model of one-on-one research mentorship. Faculty will first map the core concepts of interest among the DNP and PhD students and faculty, and then create what we will call Scholarly Communities of Practice (SCOP). We will use SCOP forums to organize and scaffold research and clinical projects of the DNP and PhD students and faculty, so that the full continuum of knowledge development to knowledge dissemination in a particular topic is readily shared. Each group, led by experienced faculty mentors, will model and practice core teamwork skills in their interaction on projects. Online PhD and DNP students will engage in collaborative efforts of scholarly production with faculty and peers of like interests, learning to work in teams with a common interest but composed of diverse talents and perspectives. Invited interdisciplinary and international guests will be encouraged to collaborate within the SCOP forums.
REACH U.S. Southeastern African American Center of Excellence for Eliminating Disparities (SEA-CEED)
Reach U.S. SEA-CEED CTG (Community Transformation Grant)
The African American communities have effectively responded to the CORE model to provide Community, Outreach, Resource, and Education and it is our hope that we can expand to model hypertension control efforts in the clinical and medical home sites.
As a part of the REACH SEA-CEED communities that focused initially on improving diabetes, the CTL realized that overall healthy lifestyles and control of A1C, blood pressure, and cholesterol were important to the overall health and reduction of illness, disability and deaths in the community. Improvements in health come with community changes at all levels of the socio-ecological model and all levels of prevention. The group started with assessment of needs and assets and has since expanded to SWOT and MAPP. The assessments have led to community actions including: building a health center and "one stop shop" with health care, alcohol and drug, public health, social services/Voc. Rehab, day care, health and fitness center, computer training, community track, and now a swimming pool and Head Start Center are under construction; community library with training for community residents on how to use library; literacy and GED training; community gardens (in 2 communities); food distribution with emphasis on fruits and vegetables (in 1 center); walking trails, medication and housing assistance programs; and selection of the county as an "All American County" because of their significant improvements in community organization and race relations. However, health disparities are still evident and improvements are needed.
Southeastern Virtual Institute for Health Equity and Wellness (SE VIEW) - Project 10
The goal of this cooperative agreement with the United States Department of Defense is to develop educational and outreach programs and conduct community-based research on health disparities and to address the high rates of disease occurrence, disability and mortality in rural, low-income or minority communities.
Preventing Venous Leg Ulcers with Cryotherapy: A Randomized Clinical Trial
The R21 Pilot Project (NINR—1R21NR010604-01) “Cryotherapy for Venous Disorders: A Pilot” demonstrated that cooling inflamed skin affected by venous disorders significantly reduced blood flow after a four-week intense cryotherapy intervention. This new trial will assess the efficacy of this home-based cryotherapy intervention by adding sequenced tapered cooling after a 30-day intense cooling period. The goal is to reduce skin blood flow of chronically inflamed skin, decrease the incidence of venous leg ulcers and pain, and improve quality of life. A myriad of surgical, pharmacologic, and non-pharmacologic therapies such as compression bandages are often tried, many with limited success. More than 70% of patients with venous disorders such as insufficiency develop edema, skin damage, and ulcers. Ulcer prevention is warranted because of the significant socioeconomic implications in terms of lost workdays and wages, decreased productivity and increased health care costs. Clinicians focus on the multiple treatment approaches, often without consideration of how patients can contribute to their own self-care. Our 9-month intervention is based on principles of heat transfer and cryotherapy theories involving microcirculation. With input from a cryotherapy expert and participants who completed the R21 pilot, we propose a sequenced intervention strategy, where cooling will be dosed daily for 30 minutes for the first month, and then decreased to twice weekly dosing in months 2–3, once weekly in months 4–6, then prn in months 7–9. We will measure blood flow, skin temperature, pain, quality of life, and the incidence of leg ulcers after months 1, 3, 6 and 9. Eligible participants will be randomized to treatment (low compression cooling wrap) or usual care (low compression non-cooling “sham” wrap). Participants in both groups will receive all study related materials including standardized instruction, skin thermometer, specially designed low compression wraps, leg elevator pillow, and compression stockings, and during an in-depth orientation session. We hypothesize that cryotherapy will enhance the largely ineffective non-pharmacologic self-care usual care model, that is, telling patients to wear compression stockings, elevate the legs, and get more exercise. These strategies are generally inadequate in achieving sustained change. Among our research methods we include rigorous process, impact and outcome monitoring. In an era of expectation for technological and pharmaceutical “fixes”, this self-care strategy, if efficacious, could be an economical way to decrease morbidity and pain for thousands of patients, frequently viewed as non-responsive to self care. Prevention of ulcers is also a major potential source of saved medical dollars. This trial is significant due to the burden of venous disorders, the complex physical characteristics of the population including excessive obesity and co-morbidity and the need to reach patients with a feasible, motivational, and supportive strategy to promote self-care. The objective is to establish a new practice standard for prevention.
Personalized Bio-behavioral Weight Loss Intervention for African American Women
The Medical University of South Carolina provides a comprehensive training environment that includes senior scientists with expertise in bio-behavioral interventions, genetics, and health disparities research. The candidate has a strong interprofessional and inter-institutional mentoring team with complementary expertise in the development of community based randomized controlled trials (RCT), genetics, obesity prevention and treatment, bio-behavioral interventions, biostatistics and epidemiology.
The research plan, which builds on the training objectives, is directly responsive to the National Institute of Nursing Research's (NINR) mission of integrating the biological and behavioral sciences, employing new technologies to research questions, improving research methods, and developing the scientists of the future. The broad goal of this research is to identify key components for development of efficacious socio-culturally tailored behavioral interventions for long-term weight loss in low socioeconomic status (SES) obese AA women. The socio-cultural preferences will be incorporated into behavioral change strategies, the communication of genetic information, and the adaptation of the format and delivery of the evidence-based Diabetes Prevention Program materials and approaches to promote weight loss. To meet this goal, the candidate will conduct an exploratory study using genetic database secondary data analyses. Secondly, an intervention development phase, with 80 obese AA women living in public housing neighborhoods in the Charleston, SC region, to integrate new knowledge and skills from genetics while advancing skills in bio-behavioral research intervention development and methodology. The results of the proposed preliminary studies will inform a larger, adequately powered and resourced community based RCT for obese AA women, that incorporates the use of genetic information and socio-cultural preferences to prescribe tailored weight loss strategies and promote long-term weight loss outcomes.
This proposed research addresses the use of health information technology (HIT) to improve health care decision-making by evaluating how quality of care is improved while using EMRs, and how to increase the adoption of new roles in practice settings to improve communication between patients and practices about health care. The specific aims of this two year project are to: 1) Complete a mixed methods secondary analysis to synthesize findings related to improving quality using HIT in primary care across seven nationally funded PPRNet initiatives. 2) Examine current perspectives of PPRNet-TRIP study practice participants related to: developing and sustaining QI efforts; and team development for an increasingly more active health care delivery role through robust EMR implementation. 3) Integrate findings from PPRNet’s previous studies with the current perspectives of practice representatives to refine the overarching theory-based “PPRNet-TRIP QI Model”. The aims and products of the proposed R03 will further the goals of supporting safe, efficient and effective health care for all Americans through use of HIT to improve performance in real world of primary care practices.
A Peer Navigator Intervention for Individuals with Spinal Cord Injury
Communication Intervention for Adolescent Immunizations: Cluster Randomized Trial
Though recommendations for adolescent immunizations have increased, adolescent immunization rates fall well below childhood rates. Missed opportunities for immunization are documented, though the conversations that contribute to vaccine hesitancy and refusal are less documented. The process of health communication between health providers, adolescents, and parents that characterizes information transfer in preventive health visits remains a critical but under-explored site for intervention. Most communication studies between adolescents and health providers use surveys, post-hoc interviews, or code health topics.
This study will record 120 spoken interactions pre- and 120 post-intervention between providers and diverse adolescents and parents in South Carolina and Oklahoma discussing recommendations for tetanus/diphtheria toxoid/acellular pertussis (Tdap), meningococcal conjugate vaccine (MCV 4), and human papillomavirus vaccine (HPV) at preventive health visits. Using methods from discourse analysis, patterns of communication and decision making will be compared to parental willingness to accept vaccines to determine best practices. Applying an integrated health behavior model, findings will be used to develop, test, and implement a provider-patient/parent communication intervention in two pediatric practice-based research networks representing multicultural populations to monitor variations for cultural tailoring.
Focus groups of adolescents, parents, and providers in online and face-to-face environments will refine the intervention and preferences for intervention delivery. Using simulation methods for provider prompting and patient priming, the intervention will be randomly allocated to 6 clinical practices in a cluster randomized trial. Guidance from the USPSTF Counseling and Behavioral Interventions Work Group will be used to evaluate the intervention. Subsequent follow-up will rate visits using the Structured Communication Adolescent Guide (SCAG) recording and repeating discourse analysis to determine changes in communication practices and immunization rates at the practice level.
Ethno-Cultural Barriers to Health Literacy/Disease Management in AAs
More research is needed in this area, as health literacy not only measures a person’s ability to read and comprehend, but also the ability to act on medical instructions and information. This is particularly true for the African American (AA) community which suffers disparate impact from chronic illness. The substantive aim of this descriptive, mixed method study is to explore the effects of beliefs and culture on health literacy and ultimately the management of diabetes in AAs from four regions in South Carolina. Our methodological aim is to develop a reliable, valid and generalizable survey tool with items that represents cultural beliefs, values, experiences and preferences for health information. This study is innovative in that it acknowledges the heterogeneity of the AA community and will apply theoretically grounded models to guide the substantive and methodologic aims. We will use focus groups and cognitive interviews in year one and instrument pre-testing and population survey implementation in years two and three. Findings from this study will guide the selection of messages and strategies that will be subsequently tested within targeted populations to improve health outcomes. This study can advance the science as it relates to promoting health literacy and disease management among vulnerable populations.
Sociodemographic Regulation of CV Function and Structure
The fundamental objective of this proposal is to identify whether exposure to chronic stress is associated with development of early risk markers of Cardiovascular disease (CVD) and type 2 diabetes (T2D) and whether this differs between African Americans (AAs) and European Americans (EAs). Collecting data on 2 additional occasions in the Georgia CV Twin study (523 pairs, 302 EA and 221 AA) who will be 19.5±3.5 yrs. old will yield 5 evaluations over a crucial time span capturing the transition from childhood into adulthood. Particularly informative will be addition of new indices of sympathetic nervous system and hypothalamic-pituitary-adrenal axis activation (i.e., blood pressure, high density lipoprotein, triglycerides, waist circumference, fasting glucose and insulin), environmental stress (e.g., childhood trauma, job strain, perceived discrimination and unfairness, community social status) and a measure of vascular function (i.e., arterial stiffness).
Smartphone Medication Adherence to Stop Hypertension (SMASH)
The MedMinder contains 28 compartments (4 potential dosages per day across seven days) and is programmed to remind patients when to take their medications. Initially, one receives a blinking light from the particular compartment for 30 minutes. If not opened during that time, a loud chime is activated for 30 minutes. After that, an automated personalized call goes out to the patient (and a significant other if desired) to remind the patient to take their missed dose. Patients were also told how the devices are programmed to relay information (e.g., BP, when meds are taken, tray refilled, etc.) to a teleprocessing center where personalized summary reports could be sent back to the patient and/or their doctors at the FQHC. All 21 patients were receptive to using such a system for management of medication usage and monitoring of BP, if it was provided to them. All liked the idea of staying connected to their doctor via such a system. Based upon their comments and suggestions for delivery of reminder, motivational, and reinforcement messages, we have developed SMASH, a prototype model for a mobile health medication and BP monitoring system with interconnected linkages between the patient and healthcare provider.
Importantly, the prototype system will be further refined prior to and following the initial proof of concept clinical trial via input from the patients and providers. Their input will help ensure refinements are made if needed in the mobile health adherence enhancement model to make it fully acceptable and feasible for a larger scale pilot feasibility clinical trial which will follow.
Technology Applications Center for Healthful Lifestyles (TACHL)
One of the biggest challenges public health researchers face is the development of efficacious, cost-effective lifestyle intervention and healthcare management programs which can be personalized to meet the specific needs and characteristics of individuals. TACHL provides a unique opportunity to address this challenge. The Center provides an outstanding environment to engage in multi-disciplinary based research with scientists from diverse disciplines at MUSC, University of South Carolina (USC) and Clemson University. Through multi-institutional collaborations it develops, evaluates and commercializes technology for individuals, worksites, community groups and health care provider networks to foster efficacious health promotion, disease prevention and health care management and work force capacity-building. Products include software and information systems for mobile smart phones, personal digital assistants, iPad®/tablet technologies, web based computer assisted programs, interactive call centers and others which will implement and monitor various programs including physical activity, diet, stress reduction, smoking prevention/cessation, biomarker monitoring and medication adherence. Product development is guided by the preferences of various users. For example, youth may prefer interactive game based computer technology applications for health behavior change, young adults may prefer smart phone delivered interventions and self-monitoring/adherence programs while seniors and others may prefer direct contact with healthcare call centers via phone and/or video conferencing via computer interface.
TACHL fosters more efficacious health promotion, disease prevention, and healthcare delivery/ adherence related programs applicable to all South Carolinians. These advances will help meet the long term vision of the Center which is to improve the health and well-being of all South Carolinians, provide indirect economic benefits to the state via improved work productivity, decreased absenteeism and decreased health care costs. The Technology Center will also foster economic growth to the state via the commercialization of new technology products, development and recruitment of companies involved in various aspects of software and systems technology development and program delivery. A diversity of new jobs will result including software and hardware developers, technology based educational training, clinical intervention, publishing and advertising positions among other high-tech business related occupations. The 10-year goal is to become a multi institution based national center of excellence. Most importantly, the activities of TACHL will help contribute to a reduction in the chronic disease health disparities ravaging the state and result in improved health and well-being of all South Carolinians.
Enhancing Kidney Donation Through Live Organ Video Educated Donors (LOVED)
Chronic Kidney Disease is diagnosed in four times as many African Americans (AAs) as Whites and nearly twice as many AAs perish from the condition. Kidney transplantation offers the best outcomes for patients with End Stage Renal Disease (ESRD) but rates of procurement far outnumber cadaver organ availability, especially among AAs. A superior option is living donor kidney transplantation (LDKT). Since AAs comprise only 18.5% of LDKT recipients, innovative and culturally preferred strategies are needed to increase LDKT within the AA community. We hypothesize that a patient-centered, two tiered culturally sensitive education/motivation intervention targeting AA ESRD patients and potential donors (PDs) using mobile health (mHealth) technology will result in: 1) increased ESRD patients’ willingness to ask for donation; 2) increased number of PDs who complete medical evaluation; and, 3) increased number of LDKTs. We will leverage mHealth technology as the delivery mechanism to maximize large scale dissemination potential. Guided by behavioral change and technology acceptability theories, the Live Organ Video Educated Donor [LOVED] program will be developed to address two domains. LOVED I will be tailored for AA ESRD patients and navigated by an AA LDKT recipient. LOVED II will be tailored for potential LDKT donors and navigated by an AA LDKT donor. iPad program delivery will include testimonial audio/video clips, home-work assignments, videoconferencing, chat room sessions, and text/emails. The proposed mixed methods research utilizes qualitative and quantitative studies in a 3 phase process of development that will involve:
Smartphone Management of Hypertension and Diabetes (SMOHAD)
S.C. has high rates of uncontrolled essential hypertension (EH) & type two diabetes (T2D), leading risk factors for stroke, renal failure & mortality. Highest rates occur among ethnic minorities living in poor, under served, often rural areas. Leading causes of ineffective disease control are med non-adherence & lack of timely changes in regimens by providers (therapeutic inertia). Our mobile health (mHealth) program, Smartphone Management of Hypertension & Diabetes (SMOHAD) will facilitate med adherence & sustained control of EH & T2D among poor, rurally located Hispanics and African Americans. SMOHAD utilizes an electronic medication tray & a combo blood pressure/glucometer Bluetoothed to a smart phone. Patients receive a series of signals from the tray at predesignated times to take meds (blinking light, chime, automated call). They use the BP/glucometer to self monitor their biofunction. Signals from the tray & device are relayed via the phone to our server & processed. Based upon med adherence levels & related biofunction levels, they receive personalized motivational/reinforcement messages. Patients will be recruited by their local federally qualified health center, consented & randomized to either SMOHAD or standard of care (SOC) control. SMOHAD patients will be shown & then demonstrate how to use the devices. Desired results will be medically established levels of control: BP<140/90 mmHg & hemoglobin A1c <7%. Patients will be tested prior to & after the 3 months trial and 3 months later. Results will be measured comparing SOC control vs. SMOHAD groups in % reaching medical standards of control for BP & HA1c, as well as changes in levels of these biofunction indices. The SMOHAD program aligns with Verizon's strategy of capitalizing upon the ubiquity of mobile phone usage across ethnic groups & socioeconomic status to help enhance delivery of cost effective & sustainable healthcare programs, especially for the under served.For more information contact Dr. Treiber at firstname.lastname@example.org
(top of page)
A Community Partnership Approach For Advancing Burden Measurement in Rare Genetic Conditions
This pilot study proposes beginning a long-range process of burden measurement development with goals for developing domains generalizable for measurement across a multitude of rare diseases. The strategy for this pilot is to begin a measurement tool's conceptualization, field-testing, and validation in a narrow population for future dissemination to other populations with rare disease. The population living with alpha-1 antitrypsin deficiency (AATD, Alpha-1) was selected as the starting Ònarrow populationÓ because despite its narrowly defined genetic etiology, the sociocultural and psychosocial experiences of its population are diverse due to its variable age of onset, genotype and penetrance so that this single rare disease population collectively shares with many other populations similar burdens independent of symptoms. Another justification for starting with the Alpha-1 community came from a preliminary assessment of the Alpha-1 patient stakeholder community's collective identity, virtual infrastructure resources and grassroots involvement that reflect that this population has strong indicators of potential for community based participatory research (CBPR) partnership's sustainability.
A CBPR partnership in alpha-1 antitrypsin deficiency (AATD, Alpha-1) is proposed as a novel approach to implementing the measure development process with a rare disease population. Unlike traditional local CBPR partnerships, this rare disease community partnership has a geographically dispersed roster and is linked to its constituency by online media including chat rooms, Facebook, webinars, website and virtual communities. The partnership represents the interests of Alpha-1 research stakeholders across the US and will be supported by the community communication network of its support organizational infrastructure. This CBPR MUSC/Alpha-1 partnership is comprised of diverse stakeholders in the alpha-1 antitrypsin research environment: academic scientists, clinicians, non-profit organizational support leaders, and individual patients living with Alpha-1, listed in the roster of the proposal.
The partnership will apply instrument development methodology to produce a measurement tool that defines the domains of burden independent of underlying rare disease symptoms by engaging local and geographically distributed adults living with Alpha-1 across the United States; with long range goals that it will contribute to measurement of burden across a multitude of rare genetic conditions.
Measuring and Comparing Social Impact of AATD
Abrazos is a bilingual early childhood development program designated for 3-year old Spanish-speaking children in order to promote school readiness as well as improve their mother's English and literacy skills. Childcare is also provided for siblings under 3 years old.
This project will provide coordinated leadership for the development and implementation of this program in the Charleston, Berkeley and Dorchester counties. Like most mothers, immigrant Latina mothers share the desire to have healthy families. However, in their new communities here in SC, they oftentimes lack the information and power to make an informed decisions for themselves and their families. PASOs provides a bridge between the Latino community and the health care system in order to maximize the health of Latino women and children, and provide them with access to needed resources.
Teen Health Advocate Leadership Program Planning Plan
Entering its fourth year, the Teen Health Leadership Program (THLP) demonstrates an effective partnership between an academic medical center and local public high school to address community concerns related to adolescent health and development. Johns Island, the site of the THLP, is a rural community plagued by poverty and isolation. Partnerships with community organizations and larger institutions are critical to bring necessary resources to the island. In collaboration with the school district and multiple community organizations, THLP seeks to empower high school students to assist and serve their community. Through innovative computer technologies and the internet, the THLP provides health literacy training, enabling the students to design and implement outreach projects to improve the awareness and use of quality health information in their community. The THLP has produced relevant results related to sustainable partnerships, health literacy and community engagement. First, participatory development of the program among partners and integration of the program into existing structures has produced a sustainable mechanism to support the program for years to come. Second, the internet and use of creative technologies are critical components to achieve health literacy when working with adolescents. Finally, with adequate support, adolescents can serve as messengers of positive health promotion to address the health concerns of their community.
Education, Outreach and Advocacy to Reduce Health Disparities
Charleston PASOs - Improving Access to Health Services in the Tricounty Hispanic Community
Barriers such as misinformation about where, how, and when to access services; low literacy; poverty; lack of health insurance; language; cultural differences; and discrimination act to limit access to care and resources.
These barriers lead to healthcare disparities in identifying and utilizing medical homes and resources, and create unnecessary costs related to late-stage diagnosis of medical conditions, medical errors, and duplication of services. If this population is ignored, access to care and resources will be reduced even more.
In order to improve access, and prevent unnecessary costs, Tricounty Hispanics need a trusted, reputable source of health information and navigation services. PASOs respects Hispanic cultural values and provides information in a way that can be understood, supported, and adopted by the Hispanic community. The PASOs program also partners with businesses, nonprofits, grass-roots, faith-based, state, county health, and social service agencies to ensure Hispanic residents' needs are being met. As a result, the Hispanic community contacts PASOs when in need because it views PASOs as a trusted source for information on health, referrals to health resources, and for assistance with applying for benefits. PASOs can ensure individuals are referred into medical homes and eligible children are enrolled in Medicaid. Evidence shows that the PASOs model helps to promote healthy behaviors within the Hispanic community which can ultimately reduce preventable health conditions.