Medicine and Health Sciences Commons^™

Quality And Access To Care For Cardiovascular Disease Prevalence In Women Veterans: Population Estimate Using Electronic Health Records, Meena Marie Kim-Dopp, Vanessa Gow-Lee, Linda Ferry, Sharon Jamie, Ralph Clark, Suma Singh

Loma Linda University Student Journal

Electronic Health Records are used to measure quality indicators for cardiovascular disease (CVD), but have not been tested for sensitivity and specificity. Computerized Patient Record System (CPRS) used by the Veterans Health Affairs (VHA), has active CVD clinical reminders from Healthcare Effectiveness Data & Information Set (HEDIS) that are compared nationally. San Bernardino County, CA has a 7.8% prevalence of self-reported CVD in both genders. For HEDIS measures, there is only a 4 point CVD composite score gender difference for VHA nationally, but at the Loma Linda VHA there is an 18 point gender difference (2016). Women Veterans (WV) are …

Is Engagement Alone Sufficient To Ensure “Active Learning”?, Reed Krause, Amy C. Hayton Md, Jeff Wonoprabowo, Lawrence Loo

Loma Linda University Student Journal

“Active Learning” is commonly defined as any instructional method that engages students in the learning process. However, active learning encompasses a broad range of educational methods and its impact on learning outcomes has been variable. In 2015, our IM clerkship redesigned its half-day learning sessions from a largely passive didactic style of lecturing to more active learning approaches. We further revised the curriculum in 2016 to further convert the sessions to primarily case based learning led by a faculty or resident. The goal of our intervention was to increase the Self-Reported Engagement Measure (STOBE) of each didactic session and improve …

Does Ecg And Arrhythmia Simulation Training In Adjunct To Didactics Improve Medical Students’ Clinical Skills Compared To Didactics Alone?, Reed Krause, Amy C. Hayton Md

Loma Linda University Student Journal

Medical Schools continue to face the challenge of bridging the gap between classroom education and its application in the clinical environment. Several studies have shown utility of incorporating simulation training into a variety of healthcare related topics. We hypothesize that incorporating ECG and arrhythmia simulation training in adjunction to ECG and arrhythmia didactics; it would improve Year-3 medical students’ preparedness for managing arrhythmias in the clinical setting.

Percutaneous Externally Assembled Laparoscopic (Peal) Donor Nephrectomy: A Cohort Pain Comparison, Tyler Miskin, Isaac Kelly, Matthew Pierce, Samuel Abourbih, Duane D. Baldwin

Loma Linda University Student Journal

Donor nephrectomies can be technically demanding. Donors also may not be fully psychologically prepared for their post-operative pain or cosmetic outcome. A novel Percutaneous Externally Assembled Laparoscopic (PEAL) paradigm was developed to decrease incisional pain and laparoscopic scars. The aim of this study is to compare the post-operative outcomes between donor nephrectomies performed with and without the PEAL instruments.

Glycemic Control In Insulin And Non-Insulin Dependent Diabetic Patients With St Elevation Predicts Time To Presentation, Jonathan Evans, David Hamilton, Tigran Khachatryan, Daniel K. Amponsah, Andrew Stewart, Islam Abudayyeh, Kenneth Jutzy, Eric Suh, Anthony Hilliard

Loma Linda University Student Journal

Worldwide, the annual number of people diagnosed with diabetes continues to increase. Classically, Diabetes Mellitus (DM) has been associated with silent or atypical initial symptoms and increased time to presentation in patients presenting with ST elevation myocardial infarction (STEMI) compared to non-DM patients. It is less clear whether the type of treatment or the adequacy of glycemic control impacts the time to presentation and type of symptoms. Therefore, we sought to evaluate the impact of poor glycemic control on these outcomes as measured by hemoglobin A1c.

Magnetically Focused Proton Irradiation Of Small Volume Radiosurgery Targets Using A Triplet Of Quadrupole Magnets, Patrick Mcgee, Grant Mcauley, Andrew Wroe, James M. Slater, Jerry D. Slater

Loma Linda University Student Journal

Proton therapy is an advantageous choice for the irradiation of tumors in proximity of critical structures due to rapid dose fall off and high dose deposition at target compared to dose at the surface of the patient (ie, peak-to-entrance dose ratio (P/E)). However, with target fields below 1.0 cm, as often encountered in proton radiosurgery, multiple Coulomb scattering (MCS) broadens proton beams leading to diminished P/E advantages and reduced dose delivery efficiency (DDE). Magnetic focusing tends to counteract MCS and is a promising method to reduce these undesirable effects. The purpose of this research is to investigate the advantages of …

Diffusion Tensor Imaging Findings In Pediatric Patients With Mild Traumatic Brain Injury, Tshea Dowers, B L. Bartnik, Barbara Holshouser, Stephen Ashwal, Samuel Barnes

Loma Linda University Student Journal

Approximately 14% of school age children with sports-related concussions (SRC) remain symptomatic 3 months after injury. Previous studies have used diffusion tensor imaging (DTI) to detect white matter tract changes in regions of interest in symptomatic patients; however data in the pediatric population remains limited. This study was undertaken to determine whether DTI metrics can provide valuable information in pediatric mTBI patients with persistent symptoms.

Multimodality Minimally Invasive Treatment Of Large Joint Osteoarthritis: A Pilot Trial Of Stromal Vascular Fraction From Autologous Fat Combined With Platelet-Rich Plasma, Phil Giddings, Insiyah Campwala, Subhas Gupta

Loma Linda University Student Journal

Osteoarthritis (OA) is a degenerative joint disease that can cause severe pain in those affected. Currently, there are no therapeutic drugs available to treat osteoarthritis. While total joint arthroplasties (TJA) allow for improved function, there are no less invasive, yet effective procedures that can be done for patients unwilling or unable to undergo major surgery.

Platelet-rich plasma (PRP) has been shown to reduce the symptoms of OA when injected into the affected joint. Patients treated by this method alone have improved self-reported pain (at least a 50% reduction from original value) as well as lower extremity function. While the effects …

Identification Of Unreported Sources Of Objects Containing High Release Nickel, David J. Eng, Mary A. Rasmussen, Chandler Rundle, James K. Parker, Daniel Bergman, Sharon E. Jacob

Loma Linda University Student Journal

Globally, nickel is the leading cause of allergic contact dermatitis (ACD). Nickel is ubiquitous, and published literature continues to index items most frequently associated with Ni-ACD. Unregulated nickel exposure in North America is evident by the unprecedented rates of sensitization seen in patch-tested cohorts, 18.5% in children (ages 0-18 years) and 28.1% in adults.¹ Conservative estimates of ACD within the pediatric population suggest at least one million cases in the US yearly with roughly one-quarter of those cases due to nickel.^2-3 The United States could potentially save $5.7 billion annually in health care costs, extrapolating current cost-saving data …

The Feasibility Of Percutaneous Externally Assembled Laparoscopic Nephrectomy: A New Surgical System, Benjamin West, Jerry Thomas, Mohamed Keheila, Nazih Khater, Samuel Abourbih, Salim Cheriyan, Matthew Pierce, Duane D. Baldwin, Jim Shen

Loma Linda University Student Journal

Laparoendoscopic single-site (LESS) nephrectomy provides excellent cosmetic outcomes, but is technically challenging due to loss of triangulation and increased instrument collision. A novel Percutaneous Externally Assembled Laparoscopic (PEAL) surgical system was developed to simplify minimally invasive surgery while providing a nearly scarless outcome. In this study, the feasibility of the PEAL system for nephrectomy was determined.

Comparing The Vaginal Wall Sling With Autologous Rectus Fascia And Polypropylene Sling On Outcome And Patient Satisfaction, Mohamed Keheila, Salim Cheriyan, Jim Shen, Catalino J. Bautista, Josianne Bailey, Kevin Kim, Marina Germanos, Isaac Kelly, Matthew Pierce, Andrea Staack

Loma Linda University Student Journal

Since 2011 FDA safety update on transvaginal synthetic mesh for treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP), providers are encouraged to counsel patients on risks related to synthetic mesh slings, such as dyspareunia, erosion, and extrusion. As an alternative to synthetic slings patients often choose autologous slings. We aim to compare outcome and patient satisfaction in patients, who received an autologous vaginal wall sling (VWS), rectus fascia sling (RFS), or synthetic suburethral sling (SSS) for treatment of SUI.

Assessing Dietary Advancement For Dysphagia Patients At Risk For Aspiration, Cedric Thiel, Thomas Murry, Brianna Crawley, Priya Krishna

Loma Linda University Student Journal

Fiberoptic endoscopic evaluation of swallowing (FEES) evaluates oral intake safety by allowing direct observation of laryngeal function before and after swallowing. The purpose of this study was to delineate the impact of abnormal vocal fold mobility and altered laryngeal sensation on dietary management in hospitalized patients previously diagnosed with aspiration.

Impact Of Macra Legislation And Mips Scores On Cost Effective Analysis For Negative Pressure Wound Therapy Devices, Jeremy W. Kubiak, Subhas Gupta

Loma Linda University Student Journal

The Medicare Access and CHIP Reauthorization Act (MACRA) changes reimbursement from a fee-for-service payment system to fee-for-value. Physicians will be scored according to the quality of their care in the MIPS program and will receive a positive or negative modifier to their Medicare reimbursement based on that score.

Ischemic Time And Risk Factors Associated With The Incidence Of Cardiogenic Shock In Patients Presenting With St Elevation Myocardial Infarction, Daniel K. Amponsah, Jonathan Evans, David Hamilton, Tigran Khachatryan, Andrew Stewart, Islam Abudayyeh, Kenneth Jutzy, Anthony Hilliard

Loma Linda University Student Journal

Cardiogenic shock (CS) is the number one predictor of mortality in patients with ST-elevation myocardial infarction (STEMI). Emergent evaluation and treatment including revascularization when indicated is recommended upon arrival to hospital. There is variation in time to presentation and total ischemic time in this patient population. We sought to evaluate the impact of ischemic time on incidence of CS and variables which may influence its presentation.

6-Year Experience Of Outpatient Total And Completion Thyroidectomy, Ethan Frank, Joshua Park Md, Alfred Simental, Christopher Vuong Md, Steve Lee Md, Phd, Pedro Andrade Filho Md, Daniel Kwon Md, Yuan Liu Md

Loma Linda University Student Journal

Outpatient thyroidectomy has become slowly accepted with various published reports predominantly examining partial or subtotal thyroidectomy. Concerns regarding the safety of outpatient total and completion thyroidectomy remain, especially in regards to vocal fold paralysis, hypocalcemia, and catastrophic hematoma. We aimed to evaluate the safety of outpatient thyroid surgery in a large cohort. We conducted a retrospective review comparing outcomes in those who underwent outpatient (n=251) versus inpatient (n= 291) completion or total thyroidectomy between February 2009 and February 2015. Outpatient completion and total thyroidectomy had lower rates of temporary hypocalcemia (6% vs. 24.4%; p< 0.001) and no significant difference in rates of return to emergency department (1.2% vs. 1.4%), hematoma formation (0.8% vs. 0.7%), temporary (2% vs. 4.1%) or permanent (0.4% vs. 0.7%) vocal fold paralysis, or permanent hypocalcemia (0.4% vs. 0%) compared to the inpatient group. Outpatients requiring calcium replacement had shorter duration of postoperative calcium supplementation (44.4±59.3 days vs. 63.3 ±94.4 days; p < 0.001). Our data demonstrates similar safety in outpatient and inpatient total and completion thyroidectomy.

Perioperative Medicine And The Future Of Anesthesia, Alvin Kennedy

Loma Linda University Student Journal

No abstract provided.

Diagnosis And Treatment Of Certain Reversible Diseases Of The Kidney, Walter E. Macpherson

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

No abstract provided.

Cavernous Hemangioma (Cavernoma) Of Ileum, J. Mark Cox

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

Hemangioma of the small intestine is rare. A case of cavernoma of the ileum was discovered at the Riverside Sanitarium and Hospital at Nashville, Tennessee. This tumor was found during a laparotomy on a female patient who had complained of increasing severity of abdominal pain over a period of two years.

The symptom complex of griping lower abdominal pain in the midline and back, nausea, occasional blood in the stools, and midline abdominal tenderness should bring to mind the possibility of intestinal hemangioma.

Intravenous Procaine During Thoracic Surgery, Forrest E. Leffingwell

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

Surgery on the heart and paracardial structures or traction on the hilus of the lung may initiate serious arrhythmias which can result in death if not promptly controlled. Procedures involving the pericardium are particularly apt to be followed by severe derangements of rhythm. Thus anesthesiology is faced with another challenge.

It is now evident that the intravenous administration of procaine has become a valuable addition to the armamentarium of the anesthesiologist in his endeavor to preserve the integrity of the thread of life while the surgeon carries out his heroic assignment without restrictions.

The Central Action Of Procaine, Clarence W. Olsen

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

Procaine was introduced as a local anesthetic with advantage over cocaine, especially as regards relative freedom from dangerous central effects. It [now] appears that when procaine hydrochloride is injected intravenously, the indications of a central effect are more emphatic when the solution is given rather rapidly.

Probably some of the central effects of procaine can be obtained with local infiltration. This is, of course, generally admitted when untoward results occur, but it should also be considered in connection with the favorable effects. Macpherson recently expressed the idea that in some cases we are getting the beneficial effects of procaine injection …

Quantitative Sugar Estimations In Pleural Fluid - An Aid To Diagnosis, John E. Peterson

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

In a study of 33 cases of serous effusion it would appear that determination of the sugar content of the pleural fluid may provide an early clue to the etiologic diagnosis.

The Neuropsychiatric Factor In Allergic Disease, Norman Shure, M Coleman Harris

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

A concept of the causation of allergic disease herewith is presented in which, in addition to the allergic factors, emotional states and psychic stimuli are introduced as integral parts of every case. The adoption of the terms "intrinsic" for the neuropsychiatric factors and "extrinsic" for the organic factors in the production of allergic disease is suggested.

A Resume Of Intravenous Procaine Therapy, Fred B. Moor

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

Summary:

1. The intravenous injection of procaine hydrochloride for a variety of clinical conditions constitutes a surprising new chapter in therapeutics.

2. With adequate precautions as to dosage and rate of administration, procaine can be safely given by the intravenous route in concentrations of 0.1 to 1 per cent.

It has been used successfully for serum sickness, the pruritis of jaundice, trauma of soft tissues, bones and joints, in the prevention and treatment of cardiac arrhythmias during intrathoracic surgery, for the relief of pain in osteoarthritis, for the control of pain during the dressing of burns, for postoperative pain, and …

Fractures Of The Nasal And Maxillary Bones, Milo C. Schroeder

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

No abstract provided.

Irradiation Of The Nasopharynx, Charles E. Futch, John D. Abbey

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

No abstract provided.

The Otolaryngologic Patient And Nutrition, Lloyd K. Rosenvold

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

No abstract provided.

Plastic Surgery Of The Nose And Face, Edward King

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

No abstract provided.

Intracranial Surgery, William T. Grant

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

No abstract provided.