Medicine and Health Sciences Commons^™

Prevalence And Utilization Of Medical Care Services In Persons With Autism Spectrum Disorder Using Medicare Claims, Henry J. Carretta, Phd, Katelyn Graves, Ms, Teal W. Benevides, Phd, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Objective:

To characterize the prevalence of autism spectrum disorder (ASD) among persons in Medicare claims and contrast with prevalence documented during disability determination in Social Security Administration (SSA) Supplemental Security Income (SSI) files.

Poster presented at APHA in Chicago Illinois.

Implications Of Screen Use In Young Children's Occupations, Denise G. Doria, Ots, Michele Mathew, Ots, Mary Muhlenhaupt, Otd, Otr/L, Faota

Department of Occupational Therapy Posters and Presentations

Introduction:

OTs need to address both the duration and quality of screen media children use, to promote their development and participation in healthy occupations.

A Rare Cause Of Obscure Occult Gastrointestinal Bleeding, Haroon Shahid, Md, Jason Korenblit, Md, Mba

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND

• Obscure gastrointestinal (GI) bleeding is defined as persistent or recurrent GI bleeding after negative evaluations with upper endoscopy and colonoscopy.
• Accounts for approximately 5% of GI bleeding.
• Obscure GI bleeding can further be classified as being overt or occult.

-Overt GI bleeding is clinically evident, with either hematemesis, hematochezia, or melena.

-Occult GI bleeding manifests as iron deficiency anemia or a positive fecal occult blood test.

• Our case demonstrates a rare cause of obscure occult GI bleeding.

A Consortium Level Approach To Reducing Ventilator Dependence, Adam P. Johnson, Md, Mph, Vanessa Thompson, Phd, Randi E. Altmark, Rn, Bsn, Scott W. Cowan, Md, Henry A. Pitt, Md, Vanita Ahuja, Md

Department of Surgery Faculty Papers

Significance Statement

We found that all but two institutions in our consortium were poor performing outliers for ventilator dependence, defined as on the ventilator greater than 48 hours. Ventilator dependence is a rare occurrence, so our goal was to identify those patients at highest risk and develop best practices to share for the region.

Endoscopic Management Of Idiopathic Subglottic Stenosis In Twenty-Five Patients, Katherine Mckee-Cole, Md, Ethan C. Bassett, Md, Maurits Boon, Md, Joseph Spiegel, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Introduction

While multiple causes exist for the development of subglottic stenosis, the mechanism responsible for idiopathic subglottic stenosis (ISS) remains unknown. Proposed etiologies include gastro-esophageal reflux (GERD) related exposure, telescoping of the first tracheal ring under the cricoid cartilage, a hormonal cause, and the possibility of an unidentified autoimmune process (1,3,6,8,12,18,19).

As ISS represents a rare disease of yet unknown etiology, the optimal management remains to be defined. The treatment options range from endoscopic management, which is less invasive but tends to show recurrence to open tracheal resection with anastomosis for those patients in whom endoscopic techniques are ineffective or …

Implementation Of Resident-Driven, Quality-Based Improvement Projects At A Single Academic Institution: Resident Value And Institutional Outcomes, Kathleen M. Lamb, Md, Randi E. Altmark, Rn, Bsn, Cnor, Adam P. Johnson, Md, Mph, Richard A. Burkhart, Md, Karen A. Chojnacki, Md, Facs, Scott W. Cowan, Md, Facs

Department of Surgery Faculty Papers

Significance

Finding a viable and sustainable methodology for resident involvement in surgical quality improvement is not only a GME requirement, but also imperative to patient care.

A Five Year Program Review Of Infusing Occupational Therapy Into Over-Night Camping For Children With Disabilities, Audrey Zapletal, Ms, Otr/L, Ashley Kalman-Binkowski, Ms, Otr/L, Lindsey West, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Objectives:

• Describe an OT faculty-student training model in a nontraditional rural setting
• Provide examples of strategies to enhance campers’ participation in a variety of activities
• Discuss the impact of occupational therapy program on satisfaction and participation of campers with disabilities

Evaluating The Use Of Relaxation Interventions To Promote Participation And Quality Of Life In Individuals With Cancer, Abigail Gilmore, Ots, Brianna Schwoyer, Ots, Audrey Zapletal, Ms< Otr/L

Department of Occupational Therapy Posters and Presentations

Background:

• High levels of anxiety and distress are associated with the diagnosis, treatment, and remission stages of cancer.
• Psychological symptoms have the potential to negatively influence functional performance, quality of life, overall health, and recovery of individuals with cancer.
• Improvements in occupational performance and quality of life, as well as reductions in anxiety and pain have been demonstrated in a variety of health conditions with the use of therapeutic relaxation techniques, such as:
  • Yoga/Tai Chi
  • Mindfulness based stress reduction (MBSR)
  • Relaxation Training
  • Massage
• Research continues to emerge investigating trends in use, patient experiences, and efficacy of therapeutic relaxation techniques with …

Genetic And Pharmacological Modulation Of Trigeminal Pain Molecules In A Model Of Traumatic Brain Injury, Brittany V. Daiutolo, Ashley L. Tyburski, Shannon W. Clark, Md, Melanie B. Elliott, Phd

Department of Neurosurgery Faculty Papers

Introduction

Headache following traumatic brain injury (TBI) is highly prevalent, and it is also the most common and persistent symptom of post-concussion syndrome [1,2]. It could arise de novo or as a pre-existing headache disorder, in which migraine was the most frequent headache phenotype in both civilian and military patients with mild TBI [1,2]. Most post-traumatic headaches will resolve within a couple of weeks following injury; however, headache in a substantial subset of patients may last more than three months and contribute to a prolonged recovery from injury, disability, and a poor quality of living [2]. Headaches can persist well …

Low Level Lead Exposure Impairs Attentional Set Shifting Task Performance Depending Upon Sex And Developmental Periods Of Exposure, L.S. Neuwirth, D.W. Anderson, J. S. Schneider

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Introduction

Exposure to low levels of lead (Pb) impairs a variety of cognitive processes. Although children exposed to Pb developmentally present with a variety of cognitive impairments that include deficits in learning, memory, language, and executive functioning, experimental work on Pb toxicity in rats has focused mostly on learning and memory deficits and less on executive functions. However, detrimental effects on executive functioning could lead to or even underlie a variety of other cognitive problems attributed to Pb exposure. In this study, we examined the ability of Long Evans rats (control and Pb-exposed: 150ppm Pb-acetate in food given perinatally (gestation …

Do I Buy It? How Aidettm Training Changes Residents’ Values About Communication Skills In Doctor-Patient Interactions, Andrea Braverman, Phd, Austin Katona, B.Sc., Elisabeth Kunkel, Md, Leo Katz, Md, Matthew Keller, Md, Constantine Daskalakis, Sc.D, Jennifer Jasmine Arfaa, Phd, Mhsa

Department of Obstetrics and Gynecology Presentations and Grand Rounds

OBJECTIVES

Acquiring communication and interpersonal skills is an important part of providing patient-centered care and improving patient satisfaction. This study explores whether residents’ own values about patient communication change over time.

Implications Of The New Icsd-3 Diagnostic Criteria For Narcolepsy In Patients Diagnosed By Icsd-2, John Konikkara, Md, Robert Tavella, Mph, Rpsgt, William Breuninger, Rpsgt, Karl Doghramji, Md

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND

The ICSD-2 diagnostic criteria for narcolepsy mandated 2 sleep-onset REM periods (SOREMPs) on multiple sleep latency testing (MSLT). Subsequent data suggested that a SOREMP within 15 minutes of nocturnal sleep onset, in the absence of another sleep disorder, is a highly specific finding for narcolepsy, but with low sensitivity. Therefore, the diagnostic criteria for the ICSD-3 allow for a minimum of one SOREMP during the MSLT, provided that the preceding overnight polysomnogram (PSG) also exhibits 1 SOREMP. We sought to re-evaluate the effects of this revision on diagnostic sensitivity by retrospectively applying ICSD-3 diagnostic criteria to patients who had …

Can Doctors Change? Attempts To Improve Adherence To The 2013 Statin Guidelines For Diabetic Patients At An Urban Academic Family Medicine Clinic, Marshall Miller, Md, Victoria Rose, Md, Jill Kropa, Md, Rina Edi, Md, Margaret Crenshaw, Md, Emily Levy, Md, Christopher Hwang, Md, Elizabeth Collins, Md, Danielle Dang, Md, Lori Atkinson, Md

Department of Family & Community Medicine Presentations and Grand Rounds

In November 2013 new statin guidelines were released. Generally, physicians are slow to adopt new guidelines and adherence to new guidelines often remains low even years after they have been issued. In this study, multiple interventions, including patient handouts, email reminders, and education sessions were implemented to increase adherence with new statin prescribing guidelines in a large urban practice. The numbers of prescriptions were analyzed for 6 weeks prior to and 6 weeks after the interventions. Statin prescribing in diabetic patients not already on a statin pre-intervention was 11.7% and post-intervention was 13.0% (p-value 0.5936). There was a small increase …

Multiparametric Mr Enterography Without The Use Of Antiperistaltic Agents: Performance And Interpretation, Amelia M. Wnorowski, Md, Flavius Guglielmo, Md, Robert Ford, Md, Donald G. Mitchell, Md

Department of Radiology Faculty Papers

Purpose

To describe how to perform and interpret MR enterography (MRE) without using antiperistaltic agents.

Genetic Polymorphisms And Antidepressant Adverse Effects, Rajnish Mago, S. Gupta, Kelly Huhn, R. Shah

Department of Psychiatry and Human Behavior Faculty Papers

Abstract

Background

Aim: to assess whether pharmacogenetic polymorphisms are associated with increased adverse effects or non-response with certain antidepressants whose metabolism is highly dependent on specific CYP450 isoenzymes. This is interim analysis of an ongoing study

Methods

We used a Case Control design comparing patients with major depressive disorder or generalized anxiety disorder who had had increased adverse effects from specified antidepressants (Cases) to patients who were poor responders to an antidepressant but without significant adverse effects (Controls) Genecept Assay™ (battery of pharmacogenetic tests relevant to psychiatry) was obtained using saliva or cheek swab

Results

Importantly, 57.1% of Cases were …

Accuracy Of Melena Identification On Physical Exam In Post Graduate Training – Implications Of Level Of Training, Medical Specialty, Rectal Exam Concordance And Appropriateness Of Therapy, Richard M. Wu, Md, Mph, Eugene Han, Md, Andrew Dargan, Md, Cecilia Kelly, Md, Mitchell Conn, Md, Mba

Division of Gastroenterology and Hepatology Faculty Papers

Introduction

Melena is commonly misidentified by young resident physicians.

The magnitude of this inaccurate physical exam has not been quantified.

Precise identification of melena may have important diagnostic and therapeutic implications.

Treatment Plan Adherence To Guidelines In Senior Adult Oncology Patients, Amy R. Mackenzie, Md, Andrea M. Barsevick, Phd, Ronald Myers, Phd, Ludmila De Oliveira Koch, Md, Scott W. Keith, Phd, Thomas Wolf, Ma, James Cocroft, Ma, Joshua Schoppe, Mph, Ulysses Williams Iii, Andrew Chapman, Do

Department of Medical Oncology Faculty Papers

Materials & Methods:

• Review of 287 records
• Patients ≥ 65 years old with new diagnosis of cancer
• Seen by 6, dual-boarded hematologists/ oncologists practicing in an urban academic cancer center
• Treatment plans compared to national guidelines to determine plan adherence status
• Patients were recommended:

Adherent plan (AP) or Non-adherent plan (N-AP)

Declaring A Patient Brain Dead On Extracorporeal Membrane Oxygenation (Ecmo): Are There Guidelines Or Misconceptions, Kristin J. Kreitler, Nicholas C. Cavarocchi, Hitoshi Hirose, Sharon West, Richard Hasz, Michelle Ghobrial, Rodney D. Bell

Department of Surgery Faculty Papers

Objectives:

• To review the clinical practice variations and trends with declaring patients brain dead on ECMO
• To highlight the need for the development of consensus guidelines to assist clinicians in the accurate diagnosis of brain death in this specific patient population

Granular Cell Tumor Of The Common Hepatic Duct As An Unusual Cause Of Jaundice In A Hepatitis C Patient: Looking Beyond The Tip Of The Iceberg!, Tripti R. Chopade, Mbbs, Colin L. Smith, Md, Warren R. Maley, Md, Ali A. Siddiqui, Md, David A. Sass, Md

Division of Gastroenterology and Hepatology Faculty Papers

Introduction

Granular cell tumors (GCTs) are rare, benign mesenchymal tumors of Schwann cell origin. Since they were originally described by Abrikossoff in 1926,most GCTs have been described in the dermis, oral area, or subcutaneous tissue of the chest and arms. Only 5%-9% of reported cases have involved the gastrointestinal tract and fewer than 1% of cases have occurred in the biliary tract.Tumors involving the bile duct are difficult to distinguish radiographically from more common etiologies of biliary stricturing, and a tissue diagnosis is difficult to obtain endoscopically. Diagnosis and treatment is most often made via surgical resection.

Embedding Mindfulness Practice In Entry-Level Occupational Therapy Education Program: Experiences And Outcomes, Mary Muhlenhaupt, Otd, Otr/L, Faota, Shelly Wallock, Dr.P.H., Otr/L

Department of Occupational Therapy Posters and Presentations

Objective:

To embed mindfulness practice into an entry-level occupational therapy curriculum and assess outcomes to reduce student stress and promote well-being.

Cross-Cultural And Inter-Professional Knowledge Translation Of Developmentally Supportive Care In An Indian Nicu, Amy Carroll, Otd, Otr/L, Susan Toth-Cohen, Phd, Otr/L

Department of Occupational Therapy Posters and Presentations

Synopsis:

A cross-cultural, and inter-professional NICU Team, including an American OT, used knowledge translation (KT) frameworks to apply current global evidence in developmentally supportive care in ways that were useful, cost effective, and meaningful to the families and staff in their tertiary care NICU setting in Gurgaon, India. The team used Pre & Post videotaping of routine care and procedures to measure the change in practice.

Objectives

1. Increase NICU nurses’ use of DSC during routine care and procedures

2. Decrease the use of non-supportive behaviors

An Assessment Of The Reliability Of Platelet-Associated Flags Generated By The Sysmex Xe-5000 Automated Hematology Analyzer In Detecting Platelet Clumps, Jennifer M. Hawkins, Do, Gene Gulati, Ph.D, Guldeep Uppal, Md, Jerald Z. Gong, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

XE-5000 is an automated hematology analyzer utilized by clinical laboratories worldwide to perform CBC and differential leukocyte counts on EDTA-anticoagulated blood specimens. The overall reliability of the results generated by this analyzer has been assessed and found acceptable for clinical use. The CBC results generated on some of the blood specimens are, however, flagged by the analyzer for verification of the result of the flagged parameter by other means. One such parameter of clinical significance is the automated platelet count, which is often unreliable if the blood specimen contains platelet clumps.

Experiential Global Health Education For The Health Professions: Lessons Learned From Experience-Based Learning For Students And Healthcare And Population Health Professionals, Rob Simmons, Drph, Mph, Mches, Cph, James Plumb, Md, Mph, Lucille Pilling, Edd, Mph, Rn, Ellen Plumb, Md

College of Population Health Lectures, Presentations, Workshops

Purpose:

• Describe key components of developing and sustaining a global health experiential learning experience

• Global Health Education for the Health Professions
• An area for multi-disciplinary study, research, and practice that places priority on achieving equity in health for all people worldwide
• Emphasizes transnational health issues, determinants, and solutions that promote interdisciplinary collaboration providing a synthesis of population based prevention, often including individual-level education and healthcare

Loss Of Expression Of Swi/Snf Chromatin Remodeling Complex Components And Setd2 Are Heterogeneous, Widespread, And Co-Occur In Clear Cell Renal Cell Carcinoma, Wei Jiang, Md, Phd, Essel Dulaimi, Theodore Parsons, Qiong Wang, Karthik Devarajan, Raymond O'Neill, Charalambos C. Solomides, Md, Stephen C Peiper, Phd, Jospeh R. Testa, Robert Uzzo, Haifeng Yang

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

The subunits of the SWI/SNF chromatin remodeling complex have one of the highest mutation rate in human cancers (see Figure 1). Polybromo-1 (PBRM1), a subunit of the SWI/SNF complex, is the second most mutated gene (40%) in clear cell Renal Cell Carcinoma (ccRCC). ARID1A, another subunit that competes with PBRM1 for binding to the complex, was infrequently mutated. The protein expressions of BRG1 and BRM (two catalytic subunits of the complex), and SETD2, a histone modifier (10-15% mutation rate), are not known in ccRCC. In this study we examined their protein expressions by immunohistochemistry (IHC) in tissue microarrays (TMAs), …

Phylogenetic Tree Construction And “Truncal Loss” Analysis Reveal Hidden Associations Between Loss Of Protein Expression In Swi/Snf Complex Components And Tumor Stage And Survival In Clear Cell Renal Cell Carcinoma (Ccrcc), Wei Jiang, Md, Phd, Essel Dulaimi, Karthik Devarajan, Qiong Wang, Raymond O'Neill, Charalambos C. Solomides, Md, Stephen C Peiper, Phd, Robert Uzzo, Joseph R. Testa, Haifeng Yang, Phd

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

Polybromo-1 (PBRM1), a targeting subunit of the SWI/SNF chromatin remodeling complex, is mutated at a rate of ~40% in clear cell Renal Cell Carcinoma (ccRCC), second only to VHL. Whether its mutation is correlated with tumor stage is controversial. As other components of the SWI/SNF complex were also reported to be mutated in ccRCC, we aim to examine the protein expression patterns of PBRM1, ARID1A, BRG1, and BRM in ccRCC, and to investigate possible association between their loss of expression and tumor stage, as well as survival. We also included a histone modifier, SETD2, which is recently discovered to …

Assessment For Risk Factors Associated With Local Recurrence In Chordoma, John A. Abraham, Md, Wei Jiang, Md, Phd

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

Chordoma is a rare but locally aggressive malignant neoplasm showing notochordal differentiation. The clinical differential diagnoses can be extensive, and definitive diagnosis often relies on histopathologic evaluation. Histologically, chordoma shows dual epithelial and mesenchymal differentiation, with various morphologies. Despite surgical resection and use of adjuvant radiation therapy, the local recurrence rate of chordoma remains high. We aim to establish factors associated with the increased risk of recurrence and help guide treatment decisions.

Age-Related Ebv-Associated Lymphoproliferative Disorder With Widespread Gastrointestinal Involvement And Subsequent Development Of T-Cell Lymphoma, Guldeep Uppal, Md, Alaina Chodoff, Msii, Zi-Xuan Wang, Phd, Jeffrey P. Baliff Md, Jerald Z. Gong, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

Age-related EBV-associated lymphoproliferative disorder (AR-EBVLPD) has emerged as a new subset of B-cell lymphoproliferative disorders. We report a unique case of AR-EBVLPD with a widespread gastrointestinal presentation and subsequent transformation to EBV-associated T-cell lymphoma. To our knowledge, this is the first report of a generalized polymorphic extranodal AR-EBVLPD with subsequent transformation to EBV-induced T-cell lymphoma.

Pathology Encountered During Cadaver Dissection Provides An Opportunity For Integrated Learning And Critical Thinking, Guiyan Zhang, Bruce Fenderson

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Abstract

Cadaver dissection engages medical students in active learning, critical thinking, and problem solving. During dissection, students at SKMC are encouraged to document pathologic findings in their cadavers and discuss the findings with their peers. Here, we describe two cases that provided opportunities for integrating anatomy with pathology and clinical medicine. The first case was a benign ovarian neoplasm. This large pelvic mass displaced the urinary bladder and uterus, and compressed the ureters and rectum. Students discussed clinical complications of this pelvic mass and reviewed pathologic findings that differentiate benign from malignant neoplasms. The second case was breast cancer with …

The Ot's Role In An Interprofessional Research Team, Sara Benham, Otd, Otr/L, Atp, Susan Toth-Cohen, Phd, Otr/L

Department of Occupational Therapy Posters and Presentations

Why Interprofessional Research?

The research field receives contributions from multiple disciplines and is inclusive by nature. •Feels natural in our day to day work practices to collaborate with other professions. •A plan to build research capacity includes establishing a research culture, environment, and infrastructure as well as partnership with other disciplines (Frontera et al., 2006).

Routine Surveillance Of Patients With Hypertensive Disorders In Pregnancy, Johanna Quist-Nelson, Md, Lauren Cooper, Md, Abigail Wolf, Md

Department of Obstetrics and Gynecology Presentations and Grand Rounds

BACKGROUND

• Hypertensive disorders in pregnancy carry morbidity and mortality for mothers and infants
• Hypertensive disorders include a full spectrum from gestational hypertension and preeclampsia to eclampsia.
• In 2013 the American College of Obstetricians and Gynecologists released an executive summary with new task force recommendations for closer monitoring of patients with hypertensive disorders including:

Twice weekly blood pressure monitoring

Weekly office visits

Ultrasound surveillance of fetal growth

Weekly laboratory surveillance

Delivery at 37 weeks for patients with gestational hypertension and preeclampsia without severe features