Medicine and Health Sciences Commons^™

Preparing For A National Weightlifting Championships: A Case Series, S. Kyle Travis, Satoshi Mizuguchi, Michael H. Stone, William A. Sands, Caleb D. Bazyler

Caleb D. Bazyler

INTRODUCTION: Monitoring an athlete’s psychological, physiological, and performance level is important when preparing for a major competition. No study to date has tracked a high-level weightlifter peaking for a major competition all the way up to the day of competition. Assessing performance at a competition is vital to ascertain if the athlete has reached a peaked and if peak performance will actually be expressed during the competition. PURPOSE: Therefore, the purpose of this study was to determine when peak jumping performance was achieved and whether psychological or physiological variables explained any jump performance changes in a high-level female weightlifter preparing …

Trends In Patient Selection And Postoperative Outcomes After Pancreatoduodenectomy. A 10-Year Retrospective Acs Nsqip Database Analysis, Jan Grendar, Zelika Jutric, Shu-Ching Chang, L Wang, E Tang, P Newell, C Hammill

Shu-Ching Chang, PhD, MS

Objective: We aimed to assess trends in patient selection and outcomes to evaluate safety in current practice of pancreatoduodenectomy. Methods: NSQIP database from 2005 to 2014 was used to identify patients undergoing a pancreatoduodenectomy. Preoperative optimization measure was created using lack of >10% weight loss, albumin>3 and bilirubin<2. Annual trends in patient characteristics and outcomes were described in univariate and logistic or linear regression analyses for binary and continuous variables, respectively. Results: 23,295 pancreatoduodenectomies were identified. There was no significant trend of age (overall median 65 years, trend p=0.31), severity of systemic disease increased (ASA≥3 in 73% overall, trend OR=1.07, p<0.001), but so did the rate of preoperative optimization (52% overall, trend OR=1.03, p<0.001). Malignant indication percentage was increasing (75% overall, trend OR=1.04, p<0.001) as was rate of associated vascular resection (8% overall, trend OR=1.09, p<0.001), but not multivisceral resections (4% overall, trend p=0.10). The adjusted odds of minor and major complications increased over time (overall 31.2% and 27.7%, trend OR=1.32 and 1.11 respectively, p<0.001 for both). In contrast, unadjusted and adjusted length of stay was shortening (median 9 days, decrease by 1.60% and 1.44% respectively, p<0.001 for both) and mortality continued to decrease (2.5% overall, trend OR=0.95, p=0.002). Conclusion: There has been increasing severity of systemic disease as well as more advanced primary disease in patients undergoing pancreatoduodenectomy. Despite increasing complication rates, preoperative optimization and management of complications were likely improved, as suggested by shortening length of stay and decreasing mortality.

In-House Daily Consensus Conference: An Important Quality Control/Quality Assurance Activity--Experience At A Major Referral Center., Amna Khurshid, Zubair Ahmad, Asim Qureshi

Zubair Ahmad

Background:For every practicing histopathologist, improvement of diagnostic accuracy is an important objective. Personal consults are an important component of quality control (QC)/quality assurance (QA) in our Section of Histopathology. In addition, the College of American Pathologists recommends a daily in-house consensus conference, which is a prospective system by which all difficult and problematic cases are reviewed and discussed and signed out by consensus. Design: In-house consensus conference is held daily using a multi-headed microscope. This collegial session is run by the seniormost consultant in the section and is attended by all histopathology consultants and residents. The consultants and residents …

A Pilot Study Of Deaf Trauma Survivors’ Experiences: Early Traumas Unique To Being Deaf In A Hearing World, Melissa L. Anderson, Kelly S. Wolf Craig, Wyatte C. Hall, Douglas M. Ziedonis

Melissa L. Anderson

Conducting semi-structured American Sign Language interviews with 17 Deaf trauma survivors, this pilot study explored Deaf individuals’ trauma experiences and whether these experiences generally align with trauma in the hearing population. Most commonly reported traumas were physical assault, sudden unexpected deaths, and “other” very stressful events. Although some “other” events overlap with traumas in the general population, many are unique to Deaf people (e.g., corporal punishment at oral/aural school if caught using sign language, utter lack of communication with hearing parents). These findings suggest that Deaf individuals may experience developmental traumas distinct to being raised in a hearing world. Such …

Bilateral Renal Artery Thrombosis Secondary To Blunt Trauma: Case Report And Review Of The Literature., P Frassinelli, Michael D. Pasquale Md, Facs, Fccm, C Reckard, J Goodreau, G Sherwin

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Science And Pre-Health Networking Event: Invited Lecturer, Raymond L. Singer Md

Raymond L Singer MD

No abstract provided.

Value-Based Medicine: The Financial Impact Of A Pressure Ulcer Prevention Program On A Trauma Population, Jayme D. Lieberman Md, Patrick S. Duffy Md, Kai L. Bortz Rn, Rovinder S. Sandhu Md, Michael D. Pasquale Md, Facs, Fccm, Michael M. Badellino Md

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Sentinel Lymph Node Mapping In Breast Cancer: A Community Hospital Experience, Chand Rohatgi Md, M Chang, M Espinosa

Chand Rohatgi, MD

No abstract provided.

Oncologic Emergencies, David B. Burmeister Do, Facep

David Burmeister

No abstract provided.

Pericardial And Myocardial Disease, David B. Burmeister Do, Facep

David Burmeister

No abstract provided.

Exposure Hypothermia Protocol, David B. Burmeister Do, Facep

David Burmeister

No abstract provided.

Glasgow Coma Scale Instructional Video, David B. Burmeister Do, Facep

David Burmeister, DO, FACEP, CPE

No abstract provided.

Faster Emergency Department Care: A Model Cell Approach, David B. Burmeister Do, Facep

David Burmeister, DO, FACEP, CPE

No abstract provided.

Child Abuse, David B. Burmeister Do, Facep

David Burmeister

No abstract provided.

Blunt Thoracic Trauma, David B. Burmeister Do, Facep

David Burmeister, DO, FACEP, CPE

No abstract provided.

Acute Coronary Syndromes, David B. Burmeister Do, Facep

David Burmeister

No abstract provided.

Airway Adjuncts, David B. Burmeister Do, Facep

David Burmeister

No abstract provided.

Airway Options, David B. Burmeister Do, Facep

David Burmeister

No abstract provided.

Acute Coronary Syndromes, David B. Burmeister Do, Facep

David Burmeister, DO, FACEP, CPE

No abstract provided.

Acute Coronary Syndrome Update, David B. Burmeister Do, Facep

David Burmeister, DO, FACEP, CPE

No abstract provided.

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Lisa Sullivan Vedder, MD

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics.

Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics.

Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Triple Aim For Clinical Teachers (Tact): Faculty Physician Perceptions On Their Ability To Balance Clinical Quality, Trainee Learning, And Teaching Efficiency, Minuja Muralidharan, Anne Getzin, Kjersti E. Knox, Bonnie L. Bobot, Marie M. Forgie, Nicole P. Salvo, Deborah Simpson

Kjersti Knox, MD

Background: A common challenge facing teaching physicians is balancing high-quality student and resident teaching with efficient, high-quality care and patient service. Publicly accessible clinic performance reports increasingly affect where patients seek care and demand that teaching clinics rise to consumer expectations while training future physicians to function in the modern health care workplace. Limited information is available to guide physicians to achieve the triple aim for clinical teachers (TACT): clinical quality/patient experience, trainee learning, and teaching efficiency.

Purpose: To understand clinical teachers’ TACT-related experiences, perceptions and preferences for how to learn TACT-associated skill sets to improve their competence as teachers. …

Relative Cytotoxic Potencies And Cell Death Mechanisms Of Α1-Adrenoceptor Antagonists In Prostate Cancer Cell Lines, Amanda Forbes, Shailendra Anoopkumar-Dukie, Russ Chess-Williams, Catherine M. Mcdermott

Catherine M. McDermott

Background:

Some α1-adrenoceptor antagonists possess anti-cancer actions that are independent of α1-adrenoceptors and the aim of these studies was to assess the relative cytotoxic potencies of α1-adrenoceptor antagonists and the mechanisms involved in these actions.

Methods:

PC-3 and LNCap human prostate cancer cells were exposed to α1-adrenoceptor antagonists (0.01-100μM) and cell survival assessed after 24-72hr. The levels of apoptosis, autophagy and stress related proteins were also determined.

Results:

The relative cytotoxic potency order was prazosin=doxazosin>terazosin=silodosin=alfuzosin>tamsulosin on both cell types, but LNCaP cells were significantly more sensitive to these effects than PC-3 cells. Prazosin and doxazosin increased levels of …

Practice Management Guidelines For The Appropriate Triage Of The Victim Of Trauma, Robert Barraco, William Chiu

Robert D Barraco MD, MPH

No abstract provided.

Geriatric Psychology, Robert D. Barraco Md

Robert D Barraco MD, MPH

No abstract provided.

Geriatric Medication Therapy: Weighing The Evidence Versus Best Practice, Lindsay Saum, Cathy Ramey

Lindsay Saum

Goals: The goal of this article is to provide a review of available evidence for safe prescribing in older adults and recommend medication therapies based on anticipated pharmacokinetic/physiologic changes in this population.

Does The Expression Of Ki-67, P16 And Cox-2 At Initial Diagnosis Of Breast Atypia Or Usual Ductal Hyperplasia Predict A Second Clinically Significant Event?, Judy Tjoe, Philippe Gascard, Jianxin Zhao, Gary Neitzel, Maharaj Singh, Brittany Last, James Marx, Thea Tlsty, Sanjay Kansra

Judy Tjoe, MD

Background: Women diagnosed with atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH) have a fivefold increased risk of developing breast cancer. Because ADH/ALH can be precursors or predictive markers of a subsequent clinically significant event (SCSE), i.e. atypia, in situ or invasive carcinoma, the clinical outcome for these patients ranges anywhere from remission to invasive malignancy. Currently we cannot predict which atypical breast lesion is likely to be associated with future cancer, resulting in aggressive management and, possibly, overtreatment. Kerlikowske et al. reported that a combination of three biomarkers (cell cycle regulator p16INK4a, proliferation antigen Ki-67 and stress response …

Development And Validation Of A Preprocedural Risk Score To Predict Access Site Complications After Peripheral Vascular Interventions Based On The Vascular Quality Initiative Database, Daniel Ortiz, Maharaj Singh, Arshad Jahangir, Suhail Allaqaband, Anjan Gupta, Tanvir Bajwa, Mark W. Mewissen

Arshad Jahangir, MD

Purpose

Access site complications following peripheral vascular intervention (PVI) are associated with prolonged hospitalization and increased mortality. Prediction of access site complication risk may optimize PVI care; however, there is no tool designed for this. We aimed to create a clinical scoring tool to stratify patients according to their risk of developing access site complications after PVI.

Methods

The Society for Vascular Surgery’s Vascular Quality Initiative database yielded 27,997 patients who had undergone PVI at 131 North American centers. Clinically and statistically significant preprocedural risk factors associated with in-hospital, post-PVI access site complications were included in a multivariate logistic regression …

Essentials Of Herb-Drug Interactions In The Elderly With Cardiovascular Disease, Sulaiman Sultan, Maria Viqar, Rabaiya Ali, A. Jamil Tajik, Arshad Jahangir

Arshad Jahangir, MD

As the number of individuals, particularly the elderly, using herbal products with prescription drugs continues to grow, the risk for adverse interactions increases but remains poorly recognized. The true incidence and nature of adverse herb reactions or herb-drug interactions remains unknown since no postmarketing surveillance mechanism exists. Adverse events are greatly underreported, and information regarding safety mainly comes from case reports and suboptimally conducted studies in a limited number of healthy young volunteers or patients with limited comorbidities. Therefore, convincing evidence for the safety of herbal products in the elderly is lacking, and the true magnitude of problems that herb-drug …

A Meta-Analysis Of Incidence And Risk Factors Of Trastuzumab-Induced Cardiotoxicity In Breast Cancer, Zeeshan Ali Jawa, Ruth Perez, Lydia Garlie, Maharaj Singh, Rubina Qamar, Bijoy Khandheria, Arshad Jahangir, Yang Shi

Arshad Jahangir, MD

Background: A monoclonal antibody, trastuzumab targets the human epidermal growth factor receptor 2 (HER2) oncogene that is overexpressed in 25–30% of breast cancers. In combination with first-line therapy, trastuzumab resulted in significant improvement in survival outcomes for those with HER2-positive metastatic breast cancer. Due to its improvement in outcome and prolonged survival, trastuzumab has been established as standard of care in both adjuvant and metastatic settings. However, along with common adverse events, trastuzumab has been found to be associated with cardiotoxicity. An estimated 1–4% of patients treated with trastuzumab will develop heart failure and ~10% of patients will experience a …