Medicine and Health Sciences Commons^™

Hpv Vaccine Reminders At The Point Of Service: Efficacy And Missed Opportunities. A Claims Based Study Within One Health Plan, B. Dale Magee, Katherine G. Leung, Tiffany A. Moore Simas

B. Dale Magee

Introduction: Our objective is to assess HPV vaccine series completion rates, whether on-screen Point of Service reminders (POS) make a difference, and missed opportunities for reminders to have an effect. Methods: Retrospective, claims-based study of females aged 9-26 receiving an initial dose of HPV vaccine during 2 periods: before (period 1) and after (period 2) implementation of a POS reminder system in 1(“Change Group”) of 2 physician groups using EHRs for both periods. Completion rates, and missed opportunities during eligible periods were calculated for those with continuous enrollment in the health plan investigated. Results: Completion rates within 1 year of …

Predicting Outcomes In Patients With Atrial Fibrillation And Acute Mesenteric Ischemia, Sanjay Bhandari, Geetanjali Dang, Muhammad Shahreyar, Ahmad Hanif, Vijayadershan Muppidi, Atul Bhatia, Jasbir Sra, A. Jamil Tajik, Arshad Jahangir

Atul Bhatia, MD, FACC

Purpose Outcomes in patients with atrial fibrillation who develop acute mesenteric ischemia, and the impact of anticoagulation on complications, are not defined. Methods Patients admitted with acute mesenteric ischemia in the National Inpatient Sample from 2007, with and without atrial fibrillation, were compared for in-hospital outcomes using multivariate regression, and the impact of prior anticoagulation determined. Results Of 48,872 patients with acute mesenteric ischemia, 8,306 had atrial fibrillation, with 680 patients also on anticoagulation. Atrial fibrillation patients were more likely to be older and have hypertension, heart failure, or chronic lung or renal disease. After adjusting for potential confounders, atrial …

Models For Predicting Incident Delirium In Hospitalized Older Adults: A Systematic Review, Sundeep Kalimisetty, Wajih Askar, Brenda Fay, Ariba Khan

Ariba Khan, MD, MPH

Background: Delirium is common in hospitalized older adults, and 40% of cases may be preventable. Hospital Elder Life Program is an evidence-based program to reduce incidence of delirium. It has been successfully implemented in one hospital and will be implemented in four other hospitals. Identification of patients at highest risk of developing delirium using the electronic health record (EHR) may be an effective targeted strategy to reduce the incidence of delirium.

Purpose: To systematically review and summarize the medical literature regarding risk prediction models for delirium in older inpatients.

Methods: A medical librarian customized and conducted the search strategy for …

Predictors Of Mortality In Patients With Transient Severe Left Ventricular Systolic Dysfunction, Kanwar Y. Singh, Firas Zahwe, Bilal Omery, Crystal Platz, Wassim Ballany, Robyn Shearer, Tadele Mengesha, M. Eyman Mortada, Jasbir Sra, Indrajit Choudhuri

Aurora Electrophysiology Fellows

Background: About 20% of patients who develop left ventricular (LV) systolic dysfunction will have improvement in ejection fraction (LVEF) over time. This patient cohort is generally excluded from large sudden death trials and, hence, understudied. Purpose: To evaluate the predictors of mortality in patients with severe LV systolic dysfunction who have improvement in LVEF during follow-up. Methods: Patients who had transient LV systolic dysfunction from 2010 to 2014 within the Aurora Health Care system and who had LVEF improve to ≥ 40%, irrespective of implantable cardioverter-defibrillator (ICD) implant, were studied. Predictors of mortality were identified using Cox proportional hazards model. …

Real-World Relevance Of Manual Electrocardiography Qt Interval Measurement, Satish Velagapudi, Zahra Nur Khaled, Bilal Omery, Firas Zahwe, Michael Anigbogu, Sarah Zukkoor, Indrajit Choudhuri

Aurora Electrophysiology Fellows

Background: Electrocardiography (ECG) QT interval (QTI) prolongation independently predicts sudden death. Hospitalized patients are commonly exposed to multiple QT-prolonging drugs, and manual measurement of ECG QTI based on identifying the intersection of isoelectricity with the tangent to the terminal phase T-wave slope (QTTTT) is advocated due to inaccuracies in automated detection algorithms that may imprecisely identify QT duration.

Purpose: We evaluated the performance of QTTTT compared to a standard automated (12SL, GE Healthcare) method (QT-12SL).

Methods: Consecutively obtained ECGs of 250 hospitalized patients were reviewed. The QTI in leads II, aVR, V5 and V6 determined by QT-12SL and QTTTT were …

An Interdisciplinary Process Change: Conversion Of Picc Line Capping Solution From Heparin To Normal Saline, Angela Colella, Brandon Bodager, Frank Spexarth, Natalie Mcdonough, Deb Kastenholz, Paul Grebe

Angela Colella, PharmD, BCPS

Background: Heparin-induced thrombocytopenia (HIT) and HIT with thrombosis syndrome (HITTS) are serious conditions. Patients are at increased risk for developing HIT/HITTS with any exposure to heparin, even intravenous line flushes. Patients may be exposed to heparin multiple times each day when they have a peripherally inserted central catheter (PICC) that is flushed and capped with heparin. At Aurora Health Care, heparin is the standard capping solution for PICCs, but with a recent switch to positive pressurized caps, normal saline may be a capping option that reduces patient exposure to heparin. Purpose: To reduce heparin exposure at a single hospital by …

Quality Improvement Of Procedural Services In Family Medicine Residency Clinics, Keisha Rogers, Nora Guschwan, Lisa Sullivan Vedder

Aurora Family Medicine Residents

Background: Performing common procedures in our family medicine residency clinics is often a difficult and inefficient process. A 2008 Society of Teachers of Family Medicine consensus statement on procedural training found higher job satisfaction and better financial compensation for family practitioners who performed procedures. Patient satisfaction is likely increased when minor procedures are able to be performed by their primary clinician. This would suggest a disconnect between the known benefits of providing procedural services and the ability of our residency clinics to provide those services in an efficient manner. Purpose: To assess clinician and staff comfort with performance of common …

Identifying Disparities In Colorectal Cancer Screening Rates In Milwaukee-Based Academic And Nonacademic Clinics, Jasmine Wiley, Jonathan J. Blaza, Will Lehmann, Deborah Simpson, Jeffrey A. Stearns, Shelby L. Pischke, Tracy L. Greiten

Aurora Family Medicine Residents

Background: The Institute for Healthcare Improvement’s Triple Aim focuses on improving the patient’s experience of care, improving population health and reducing the per capita cost of health care. Health care systems and providers continuously seek to improve quality of care through understanding what percentage of their patients are achieving quality-of-care standards for various indicators, including immunizations, tobacco cessation, asthma and cancer screening. As health care moves toward reimbursing for value-based care, deepening our understanding of patient population characteristics within each of these conditions is vital to continuous quality improvement.

Purpose: To determine if there are race/ethnicity/age/preferred language (REAL) disparities in …

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

Aurora Family Medicine Residents

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 …

Impact Of A Family Medicine Resident Wellness Curriculum: A Feasibility Study, Christine Runyan, Judith A. Savageau, Stacy E. Potts, Linda F. Weinreb

Judith A. Savageau

BACKGROUND: Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited.

OBJECTIVES: The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion.

METHODS: The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and …

Decade-Long Trends In The Timeliness Of Receipt Of A Primary Percutaneous Coronary Intervention, Han-Yang Chen, Joel M. Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Catarina I. Kiefe, Robert J. Goldberg

Catarina I. Kiefe

OBJECTIVES: The purpose of this study was to examine decade-long trends (2001-2011) in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI) who received a primary percutaneous coronary intervention (PCI).

METHODS: Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629). Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department (ED) …

Decade-Long Trends In The Timeliness Of Receipt Of A Primary Percutaneous Coronary Intervention, Han-Yang Chen, Joel M. Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Catarina I. Kiefe, Robert J. Goldberg

Jorge L. Yarzebski

OBJECTIVES: The purpose of this study was to examine decade-long trends (2001-2011) in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI) who received a primary percutaneous coronary intervention (PCI). METHODS: Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629). Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department (ED) …

A Delphi Process To Address Medication Appropriateness For Older Persons With Multiple Chronic Conditions, Terri R. Fried, Kristina Niehoff, Jennifer Tjia, Nancy Redeker, Mary K. Goldstein

Jennifer Tjia

BACKGROUND: Frameworks exist to evaluate the appropriateness of medication regimens for older patients with multiple medical conditions (MCCs). Less is known about how to translate the concepts of the frameworks into specific strategies to identify and remediate inappropriate regimens.

METHODS: Modified Delphi method involving iterative rounds of input from panel members. Panelists (n = 9) represented the disciplines of nursing, medicine and pharmacy. Included among the physicians were two geriatricians, one general internist, one family practitioner, one cardiologist and two nephrologists. They participated in 3 rounds of web-based anonymous surveys.

RESULTS: The panel reached consensus on a set of markers …

The Dna Default And Its Discontents: Establishing Modern Parenthood, Katharine K. Baker

Katharine K. Baker

Models For Predicting Incident Delirium In Hospitalized Older Adults: A Systematic Review, Sundeep Kalimisetty, Wajih Askar, Brenda Fay, Ariba Khan

Brenda Fay

Background: Delirium is common in hospitalized older adults, and 40% of cases may be preventable. Hospital Elder Life Program is an evidence-based program to reduce incidence of delirium. It has been successfully implemented in one hospital and will be implemented in four other hospitals. Identification of patients at highest risk of developing delirium using the electronic health record (EHR) may be an effective targeted strategy to reduce the incidence of delirium.

Purpose: To systematically review and summarize the medical literature regarding risk prediction models for delirium in older inpatients.

Methods: A medical librarian customized and conducted the search strategy for …

Injuries Associated With Sport Participation Amongst Australian Army Personnel, Ben Schram, Rodney Pope, Rob Orr

Rob Marc Orr

Abstract published in the Journal of Military and Veteran’s Health, 24(4), p. 29.

Injuries Associated With Sport Participation Amongst Australian Army Personnel, Ben Schram, Rodney Pope, Rob Orr

Rodney P Pope

Abstract published in the Journal of Military and Veteran’s Health, 24(4), p. 29.

Incidence, Etiology And Classification Of Neurologic Injury Associated With Surgical Intervention For Acute Type A Aortic Dissection, Alexander Puddifant

Alexander Puddifant

Self-Complementary Adeno-Associated Virus Vectors Improve Transduction Efficiency Of Corneal Endothelial Cells, Anja K. Gruenert, Marta Czugala, Christian Mueller, Marco Schmeer, Martin Schleef, Friedrich E. Kruse, Thomas A. Fuchsluger

Christian Mueller

Transplantation of a donor cornea to restore vision is the most frequently performed transplantation in the world. Corneal endothelial cells (CEC) are crucial for the outcome of a graft as they maintain corneal transparency and avoid graft failure due to corneal opaqueness. Given the characteristic of being a monolayer and in direct contact with culture medium during cultivation in eye banks, CEC are specifically suitable for gene therapeutic approaches prior to transplantation. Recombinant adeno-associated virus 2 (rAAV2) vectors represent a promising tool for gene therapy of CEC. However, high vector titers are needed to achieve sufficient gene expression. One of …

Assessment Of Work-Integrated Learning: Comparison Of The Usage Of A Grading Rubric By Supervising Radiographers And Teachers, Andrew Kilgour, Peter W. Kilgour, Tania Gerzina, Beverly J. Christian

Peter Kilgour

Introduction

Professional work-integrated learning (WIL) that integrates the academic experience with off-campus professional experience placements is an integral part of many tertiary courses. Issues with the reliability and validity of assessment grades in these placements suggest that there is a need to strengthen the level of academic rigour of placements in these programmes. This study aims to compare the attitudes to the usage of assessment rubrics of radiographers supervising medical imaging students and teachers supervising pre-service teachers.

Methods

WIL placement assessment practices in two programmes, pre-service teacher training (Avondale College of Higher Education, NSW) and medical diagnostic radiography (Faculty of …

National Rugby League Athletes And Tendon Tap Reflex Assessment: A Matched Cohort Clinical Study., James Maurini, Paul Ohmsen, Greg Condon, Rodney Pope, Wayne Hing

Wayne Hing

BACKGROUND: Limited research suggests elite athletes may differ from non-athletes in clinical tendon tap reflex responses. METHODS: n this matched cohort study, 25 elite rugby league athletes were compared with 29 non-athletes to examine differences in tendon reflex responses. Relationships between reflex responses and lengths of players' careers were also examined. Biceps, triceps, patellar and Achilles tendon reflexes were clinically assessed. RESULTS: Right and left reflexes were well correlated for each tendon (rS = 0.7-0.9). The elite rugby league athletes exhibited significantly weaker reflex responses than non-athletes in all four tendons (p < 0.005). Biceps reflexes demonstrated the largest difference and …

Targeted Gene Delivery To The Enteric Nervous System Using Aav: A Comparison Across Serotypes And Capsid Mutants, Matthew J. Benskey, Nathan C. Kuhn, James J. Galligan, Joanna Garcia, Shannon E. Boye, William W. Hauswirth, Christian Mueller, Sanford L. Boye, Fredric P. Manfredsson

Christian Mueller

Recombinant adeno-associated virus (AAV) vectors are one of the most widely used gene transfer systems in research and clinical trials. AAV can transduce a wide range of biological tissues, however to date, there has been no investigation on targeted AAV transduction of the enteric nervous system (ENS). Here, we examined the efficiency, tropism, spread, and immunogenicity of AAV transduction in the ENS. Rats received direct injections of various AAV serotypes expressing green fluorescent protein (GFP) into the descending colon. AAV serotypes tested included; AAV 1, 2, 5, 6, 8, or 9 and the AAV2 and AAV8 capsid mutants, AAV2-Y444F, AAV2-tripleY-F, …

Pnaktide Inhibits Na/K-Atpase Reactive Oxygen Species Amplification And Attenuates Adipogenesis, Komal Sodhi, Kyle Maxwell, Yanling Yan, Jiang Liu, Muhammad Chaudhry, Morgan Getty, Zijian Xie, Nader G. Abraham, Joseph I. Shapiro Md

Yanling Yan

Obesity has become a worldwide epidemic and is a major risk factor for metabolic syndrome. Oxidative stress is known to play a role in the generation and maintenance of an obesity phenotype in both isolated adipocytes and intact animals. Because we had identified that the Na/K-ATPase can amplify oxidant signaling, we speculated that a peptide designed to inhibit this pathway, pNaKtide, might ameliorate an obesity phenotype. To test this hypothesis, we first performed studies in isolated murine preadipocytes (3T3L1 cells) and found that pNaKtide attenuated oxidant stress and lipid accumulation in a dose-dependent manner. Complementary experiments in C57Bl6 mice fed …

Modern Evaluation Of Abdominal Trauma, Errington C. Thompson, Md, Chadwick J. Knight, Md

Errington Thompson

Abdominal trauma can be mysterious to some physicians. If patients are evaluated for being stable or unstable, then abdominal trauma can be easily managed. Using a combination of physical examination, ultrasound and CT scans, patients can be quickly and efficiently evaluated.

An Atypical Cause Of Atypical Hemolytic Uremic Syndrome, Abhinav Sharma, Carolina De Elia, Eric Arguelles, Christine L. Gilkerson

Christine Gilkerson, MD

Atypical hemolytic syndrome is an extremely rare, life threatening, progressive disease. Approximately one to two cases per million are seen annually in the US (3,4). It is known to be associated with variety of conditions including infections, drugs, autoimmune conditions, vaccination, malignancy, organ transplantation, pregnancy, and metabolic conditions (11,13).We hereby describe a case of atypical hemolytic uremic syndrome associated with CABG surgery. A 58 year old female presented to the emergency department (ED) with three days of worsening shortness of breath and cold like symptoms including nausea, vomiting and rhinorrhea. Twenty six days prior to presentation she had undergone Coronary …

Left Ventricular Noncompaction Syndrome: A Rare Congenital Cardiomyopathy, Ashwini V. Mallad, Mbbs, Waseem Ahmed, Md, Madhulika Urella, Md, Dr. Mehiar El-Hamdani, Md, Facc, Fscai

Mehiar El Hamdani, MD

Isolated left ventricular noncompaction cardiomyopathy (LVNC) is a rare congenital condition occurring due to arrest of myocardial compaction in the first trimester, resulting in a thin layer of compacted epicardium and thick hypertrabeculated myocardium containing deep recesses. This article presents a 44-year-old female with progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and pleuritic chest pain. Examination revealed elevated jugular venous distention, lower extremity edema, and bibasilar crackles on lung auscultation, while the electrocardiogram (EKG) exhibited left bundle branch block. Two-dimensional echocardiography (2D-Echo) showed a dilated left ventricle (LV) with ejection fraction (EF) of 25% and severe diffuse hypokinesia. Cardiac magnetic resonance …

Left Ventricular Noncompaction Syndrome: A Rare Congenital Cardiomyopathy, Ashwini V. Mallad, Waseem Ahmed, Madhulika Urella, Dr. Mehiar El-Hamdani Md, Facc, Fscai

Mehiar El Hamdani, MD

Cardiac MRI showing thick myocardium of left ventricle.

Retrograde Pedal Access For Revascularization Of Infrapopliteal Arterial Occlusive Disease In Critical Limb Ischemia (Cli) Patients As A Primary Approach., Ahmed Amro, Alaa Gabi, Shahed Elhamdani, Haytham Aljoudi, Mehiar El-Hamdani

Mehiar El Hamdani, MD

Introduction: We are presenting three cases (out of similar several cases) where tibio-pedal approach was performed as an initial primary approach for limb salvage in patients with CLI secondary to Infra-popliteal (IP) disease. We consider this approach to be a necessary evolution in endovascular intervention. Discussion: Retrograde pedal access is safe, feasible with high technical success rate and a relatively low procedural complication rate, with low 30 days mortality and low rate of major adverse cardiac events. Freedom from major adverse limb events and limb salvage are both high at 1 year follow up. It allows quick therapy and short …

Endovascular Therapy Of Tasc-D Lesion In Critical Limb Ischemia, Ahmed Amro, Md, Alaa Gabi, Md, Dr. Mehiar El-Hamdani, Md, Facc, Fscai

Mehiar El Hamdani, MD

CLI (Rutherford class IV-VI) is a terminal stage of peripheral artery disease (PAD); it is defined by the presence of resting pain and/or tissue loss for at least two weeks that may require urgent revascularization to promote healing and prevent limb loss.For patients with infrarenal aortoiliac occlusive disease, the revascularization options are surgery like aortofemoral bypass and axillofemoral bypass or percutaneous intervention. Aortoiliac and aortofemoral bypass procedures are associated with 74% to 95% 5-year patency rates, respectively, which are comparable but not superior to percutaneous therapies.These operations may imply a significant morbidity and mortality on CLI patients who usually have …

Splenic Infarction: An Uncommon Presentation Of Acute Infectious Mononucleosis, Madhulika Urella, Roma Srivastava, Waseem Ahmed, Yehuda Lebowicz

Yehuda Z. Lebowicz, MD

Contrast enhanced CT showing multiple splenic infarcts