COGS Graduate Academic Conference (GAC): Part 1

Mari and Dimitri interview student researchers at the 16th annual Graduate Academic Conference (GAC), hosted by the Council of Graduate Students (COGS). The first episode of this four-part series features interviews with Sam Norcia and Char Dengler from the College of Nursing, and Bismarck Amaniampong from the Department of Chemistry.

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The Sci-Files is hosted by Mari Dowling and Dimitri Joseph. Together they highlight the importance of science, especially student research at Michigan State University.

Mari Dowling: 00:06

Welcome to the Sci Files, an Impact 89 FM series that explores student research here at Michigan State University. We're your cohosts, Marty Dowling

Dimitri Joseph: 00:15

And Dimitri Joseph.

Mari Dowling: 00:17

Hi. Today, the Sci FiL is at the Graduate Academic Conference. To start up, we have Sam Norsia and Shar Dangler, who are from the College of Nursing, and they're going to tell us a little bit about their research. Hi, guys. Thank you for joining us.

Mari Dowling: 00:28

And could you explain a little bit about what your research is?

Char Dengler: 00:31

Thank you for having us. So our research deals with patient portal adoption and how it affects patient satisfaction. And our quality improvement project occurred at a clinic here on campus, in a nurse practitioner led family practice clinic. And it was done to improve patient satisfaction. We discussed clinic needs or concerns with the community liaison, and it was decided then that they would like to work on patient satisfaction.

Char Dengler: 01:07

That point, my project partner, Sam, and I went ahead and did a literature review, and we're like, what can help with increasing or improving patient satisfaction? And it was discovered that patient pro adoption is a great tool to improve patient satisfaction. How do we get patients to adopt a portal? How do we bump that? Further review of the literature revealed that education is a key tool to having people adopt the portal, and I'll have Sam take over from here.

Sam Norcia: 01:43

Okay. So in the literature review, we found that education for providers and staff proves portal adoption rate. So what we did was we had 2 in services with the staff and provider at the clinic, and we introduced our project. We introduced ourselves. We educated them on the benefits of patient portals, asked for feedback on what they felt about patient portals, how they were already trying to discuss the portal with their patient and their current processes at the clinic.

Sam Norcia: 02:14

And then from there, we met with a graphic artist at MSU and created patient portal brochures, and the brochures included patient education on the benefits of the portal, how to sign up for a portal, proxy access, meaning for older adults that aren't tech savvy, pick someone they trust to access their portal for them, and then also for under the age of 13 for those patients who can see their portal and all those types of things. So the brochures were passed out upon patient check-in when they checked into the front desk. If you weren't signed up for a portal, you would get a brochure. And then, also, we created poster versions of the brochures that were placed on the back of all exam room doors. So patients were exposed to it during the appointment to see the poster and how to sign up for the portal and all that.

Sam Norcia: 03:02

For measuring all of our data over the 3 months time, we receive portal adoption rate percentages throughout the months. Also, patient satisfaction scores that were given to us in percentage form. So prior to our intervention, this was September of 2023, portal adoption rate was below 70%. And then at the end of our intervention, January of 2024, it increased to 76%. So there was a 6% jump in portal adoption rate.

Sam Norcia: 03:30

And then patient satisfaction scores started around 50% in September. And this was well below the national benchmark, which the clinic wanted to reach. And they jumped up to over 80% at the end of our intervention. So we saw that as portal adoption rate went up, patient satisfaction scores went up, They were because they were able to message them. They empowered their health.

Sam Norcia: 03:56

They chose healthier lifestyles. They were more aware of all their lab results and things like that. So although patient portal adoption rate and patient satisfaction scores went up, there's no scientific evidence to say they are correlated because we didn't have the raw data, but it's definitely an area for future

Char Dengler: 04:13

study. There was some burden associated with Portal use and some frustration that they're working through the portal, and there was concern about reimbursement for their time spent working with patients. So during our literature review, we did find evidence for reimbursement. So now insurance companies are recognizing that providers do need to be reimbursed. And so if they are making medical decisions while working with the patient through the portal, they are probably going to be eligible for reimbursement.

Char Dengler: 04:47

So that's very important findings. And then also, our intervention is reproducible and sustainable because our brochures, our educational tools have been adopted by the MSU clinics. So that was pretty exciting. The bottom line, patient satisfaction bumped up 30%.

Dimitri Joseph: 05:06

Did you provide any updates to the portal or was the portals already established and the main focus was to to increase the usage of patient portals?

Sam Norcia: 05:15

The patient portal was already established. So our goal was to just increase awareness of what it does, what it provides, and to improve the amount of people sign up for the portal.

Dimitri Joseph: 05:27

And just to give our listeners a foundational understanding, what is a patient portal?

Char Dengler: 05:32

Patient portal is a platform where patients can access this platform via computer, via tablet, via smartphone, and it's website connected to the electronic health record that's linked to the clinic where they obtain their care. In most patient portals, you can communicate with your provider, you can make appointments or request appointments, you can ask for refills, you can pay your bills. There's a variety of options based on what clinic asks for for options for their portal.

Dimitri Joseph: 06:05

From what I'm hearing, it's a way to communicate to the medical team. It makes sense that making someone aware that they have this tool will increase their satisfaction. So I'm glad that you you 2 have done this research and highlighted that.

Mari Dowling: 06:20

I can imagine that it alleviates also the frustration of having to call an office and wait for the callback and wait to get your lab results and things like that.

Char Dengler: 06:29

To be completely transparent, there are some limitations or issues relating to patient portal use. Of course, it can be frightening if you find something in your portal for results that you're not understanding or that needs to be further discussed with your provider before the provider can review it and get back to you. So there are some disclosures or warnings that some of the things that you may read might be upsetting to you. Please contact the office if you have any questions or concerns, and it just freely allows the patient to have that insight. But on the other sides of things, some patients look at it and think that the provider already knows what the results are.

Char Dengler: 07:08

Like, say they get the results at 9 AM. The results are in the computer at 3 PM. They're like, why hasn't the doctor called me? You know? So we try to talk with patients too about realistic expectations, about hearing back, and also what is appropriate to communicate through the portal.

Char Dengler: 07:24

So, say, if a patient is having chest pain, they wouldn't, hey, doctor. I'm having or provider, I'm having chest pain. No. No. You would go to the emergency room.

Char Dengler: 07:33

And, also, we did share in our brochure, our educational tool, that the response typically take 3 to 5 days. The bigger picture for our portal adoption not only does it affect patient satisfaction, but it also has the possibility to affect decreasing emergency room visits, decreasing hospital admissions, and actually increasing overall health care dollar cents. So it's a pretty big deal. Yeah. Very

Mari Dowling: 08:01

cool and very important reasons that you guys are undertaking. So thank you so much for sharing this with us, and we hope to hear more in the future.

Dimitri Joseph: 08:07

Yes. Thank you

Char Dengler: 08:08

so much.

Bismarck Amaniampong: 08:09

Thank you.

Mari Dowling: 08:11

Next, we have Bismarck Amanyankong with us to discuss his research. Hi, Bismarck. Could you tell us a little bit about what your research entails?

Bismarck Amaniampong: 08:17

So my lab is a molecular biology lab. We also do a bit of organic chemistry and synthetic biology. And so what we basically do is that we identify microorganisms. We engineer or evolve those organisms to consume a particular carbon source, and then that organism produces whatever compound wants to produce. And so for instance, you want the organism to produce lactic acid, which is a monomer for making biodegradable materials, then we can engineer microbes to produce that.

Dimitri Joseph: 08:48

I love this topic. So I can see why you love your science so much.

Bismarck Amaniampong: 08:51

It's it's interesting. I mean, think about how you can manipulate an organism to achieve, like, a benefit.

Dimitri Joseph: 08:57

You are encompassing synthetic biology to its core, where you're manipulating an organism to do something productive to what you see fit. So that that brings to the question, what are the major compounds or molecules that you're most interested in producing?

Bismarck Amaniampong: 09:14

For my research, I'm looking at producing lactic acid, which is, as I said, used to making biodegradable, materials and shikimate acid. And so this is the precursor that is used in making Tylenolu. Tylenolu. What is Tylenolu? Tylenolu is it's used in treating flu.

Bismarck Amaniampong: 09:33

Right? In,

Dimitri Joseph: 09:34

the true inflammation.

Bismarck Amaniampong: 09:35

Inflammatory. Exactly. And so back in the days, the way that this process was made was to harvest it from the plants. And so you take a plant, extract some ethanol or I don't know what, abstract that compound from the plant. But that will mean that we have to cut down all those plants, right, in order to get them.

Bismarck Amaniampong: 09:54

And so, back in the days, my PI developed a way to feed e coli, which is a microbe in our guts. Engineer that e coli, feed it with glucose, and then that engineered microbe will produce shikimate acid, which can then be converted into the active ingredients in terms of Cool. Very cool.

Dimitri Joseph: 10:14

Yeah. In in order to do the science that you practice, you have to understand a lot of different fields. For instance, the microbes and the ability to manipulate the systems or engineer the DNA and the RNA and the the molecules that are producing your goal of interest. Could you give us some insight about some of the biology that you're changing?

Bismarck Amaniampong: 10:39

Yeah. Yeah. Definitely. I mean, if I go from where I begin. Right?

Bismarck Amaniampong: 10:43

The reason why my project is at least more interesting to me is that we are not looking at starting with glucose. Now, currently, most chemicals are made from, you know, petroleum sources or, some kind of corn, stevia using, like, fermentation processes. If you look at the petroleum route, it requires less amount of energy, methane intensive, it's expensive, and all that. Now these process also produce carbon dioxide and methane pollution. Right?

Bismarck Amaniampong: 11:11

These guys are accumulating increased global warming, changes the pattern of, climate. And so our research focus on capturing this c o two and the thing, converting those into bacterial food, and then feeding that to the engineered microbe. And so I guess the main challenge of that was how do I make or how do I force the microorganism to consume the unknown food? Right? And you kind of go with this way.

Bismarck Amaniampong: 11:37

It's like, you have someone who is a meat lover, and then you're like, okay. No more meat for you. Let's just give you some veggies. Right? And so if there's no food to eat, the organism will starve sometime, couple of hours, I don't know, maybe a day or 2, but it wouldn't die or consume those days.

Bismarck Amaniampong: 11:55

And so what happened was that when I get the c o two on methane derived material food or chemical, we call that ABCA. The microbes first, we're not consuming it. And so how to expose these microbes over and over again for a period of 8 days until they start consuming it as they were consuming our favorite food, of course. And so that alone causes the bacteria to engineer themselves. We call that air condition.

Bismarck Amaniampong: 12:20

Cool.

Mari Dowling: 12:21

Yeah. Interesting. So it almost seems like you're engineering them at 2 different levels, 2 different ends where it's like the intake and the outtake.

Bismarck Amaniampong: 12:29

Exactly. Yep.

Mari Dowling: 12:30

That's really interesting. Yeah. How did you guys come up with that as being the the mechanism that you wanted to go after?

Bismarck Amaniampong: 12:36

Right. And so once we we had a starting point, like a feedstock, mostly, we people use glucose. Right? And there's been research to use other compounds too, like lignin from other parts of plants. But, like, those comes with their own challenges.

Bismarck Amaniampong: 12:51

So first, we identify the main problem, c02 and methane. We want to be able to improve or if it's not just at all, like, make sure that these microorganisms can consume this type of material. And so that that was the main challenge. So that was just a test and error to see if they'll consume it. Yeah.

Bismarck Amaniampong: 13:10

If they didn't consume it, they become find a different route around that. And there's one lot that we found around that was to convert the c o two and thing to the bacteria food I call it. We call that acivilant dicarboxylic acid, ADCA. It's a 4 carbon. The 2 s are carboxylate groups, and then in the middle, the 2 carbons are gonna have, triple bonds.

Bismarck Amaniampong: 13:32

And so that resembles a compound that we find in e coli. And so we thought that, okay, if this compound resembles something that's already in their system, then most likely, they should be able to consume it. So that is how we ended up converting t02 methane to ADCA and then filling that ADCA to the microorganism. Now when it comes to the endoplasm, that was more about showing what we can do. And so we chose the 2 compounds, lactic acid, 3 carbons, simple, has a kerosene.

Bismarck Amaniampong: 14:01

Then we chose shikimate acid, which is pharmaceutical. And so we are showing that we can make a commodity chemical, making polymers, and pharmaceutical is more like an expensive money for it.

Dimitri Joseph: 14:13

Yeah. Very cool. Thank you, Bismarck, for giving us that very complete explanation of the from the beginning, the middle, and the end about how you're using this micro and feeding it something that it typically doesn't prefer. But through the chemical, structure information, you you had a hypothesis that believed that this was a appropriate chemical that can be used downstream production. Thank you.

Dimitri Joseph: 14:39

Thank you for you doing the beautiful science that you do.