Digital Commons Network^™

Pebbles In The Shoe: A Multidisciplinary Program To Identify And Resolve Workplace Inefficiencies In A Pediatric Oncology Division, Reeja Raj, Kate Gazouleas, Pavilia Francis, Nancy Gordon, Vidya Gopalakrishnan, Amy Heaton, Ishwaria Subbiah, Priti Tewari, Harjeet Singh, Aaron Walton, Shehla Razvi, Martha Askins, Lisa Triche, Karen Moody

Advances in Cancer Education and Quality Improvement

Introduction: Occupational burnout is a significant concern among pediatric oncology faculty and multidisciplinary staff, characterized by emotional depletion, detachment from work, or a diminished sense of professional achievement. Inefficient work processes can be important contributors to burnout. This report describes the implementation and outcomes of Pebbles in the Shoe (also referred to as Pebbles), a pediatric division–wide initiative designed to address workplace concerns and inefficiencies.

Methods: The Pebbles program was developed and led by our pediatric division's wellness task force. Division members were invited to anonymously submit work-related concerns and irritations through a QR code–accessible electronic form. Five discipline-based work …

Aligning Trainee Leave Policies Across Surgical Fellowships: Development Of A Division-Wide Framework For Leave And Program Completion, Helen M. Johnson, Mara B. Antonoff, Kelly K. Bree, Maxwell G. Lewis, Heather A. Lillemoe, Margaret S. Roubaud

Advances in Cancer Education and Quality Improvement

Background: Surgical fellows and program leaders face difficulties navigating parental, caregiver, medical, and personal leave due to variation in policies. A Division of Surgery (DoS) Trainee Leave and Parental Support Task Force was convened at The University of Texas MD Anderson Cancer Center to review existing requirements and develop a harmonized framework for trainee leave and fellowship program completion.

Methods: The Task Force conducted a comprehensive review of policies relevant to surgical fellow leave and graduation requirements, identified best practices, and drafted a DoS policy. The policy was refined iteratively through engagement with key stakeholders, including program directors, department chairs, …

Creating A Culture Of Well-Being By Removing Barriers To Participation In A Multi-Campus Cancer Center, Adam Siegman, Miranda M. Phillips, Jennifer Bickel

Advances in Cancer Education and Quality Improvement

Background: Healthcare professionals in geographically distributed cancer care settings may face barriers to accessing workforce well-being resources due to geographic distance, staffing constraints, and operational demands. Disconnect & Refresh was developed to improve access to restorative wellness opportunities across community-based cancer care sites.

Methods: Disconnect & Refresh was implemented at The University of Texas MD Anderson Cancer Center across 4 Houston area locations. The initiative included BeWell Paws, virtual reality meditation, chair yoga, and creative wellness activities delivered during the workday. Participation was voluntary and tracked through employee badge scans. Participants were invited to complete an anonymous post-event survey, and …

Faculty Growth Through Academic Career Development Committees, China Crowder, Rebekah Filson, Elizabeth Grubbs, Carin Hagberg, Anne Tsao

Advances in Cancer Education and Quality Improvement

Academic medical centers face ongoing challenges in providing structured, career -stage-–specific faculty development, mentorship, and leadership opportunities that effectively engage faculty throughout their academic careers. The Academic Career Development Committees at The University of Texas MD Anderson Cancer Center represent a structured, faculty-driven model designed to promote professional growth, mentorship, and leadership engagement across all career stages. Grounded in established principles of faculty development and mentorship in academic medicine, the Academic Career Development Committees foster cross-level collaboration, inclusive participation, and intentional skill-building. Outcomes were measured through participant evaluations, attendance and participation trends, mentorship engagement indicators, and qualitative feedback gathered from …

Leadforward: A Department-Based Leadership Development Program To Support Workforce Well-Being, Leisa A. Bryant, Denise Marshall, Loreal Williams, Miranda M. Phillips

Advances in Cancer Education and Quality Improvement

Introduction: Leadership development is increasingly recognized as an important strategy for supporting workforce engagement, professional growth, and succession planning in healthcare settings. To address leadership development needs within Food, Nutrition, and Patient Transportation (FNPT) departments, a structured leadership development program, LeadForward, was developed for emerging and midlevel leaders.

Project Description: LeadForward was implemented within the FNPT departments at a comprehensive cancer center. Ten participants completed the inaugural cohort. The curriculum was organized into 6 instructional modules designed to develop leadership competencies among emerging and midlevel leaders. Leadership outcomes were assessed using pre- and postprogram self-assessments across 14 leadership competency …

Standardized Preprocedure Protocolling Of Stereotactic Breast Biopsies Enables Device-Level Supply Chain Forecasting: A Multisite Quality Improvement Analysis, Megan Kalambo, Mike Everding, Maria Montemayor, Falguni Patel, Mohit Nath

Advances in Cancer Education and Quality Improvement

Background: Breast imaging depends on single-use, vendor-proprietary consumables produced by a concentrated set of manufacturers. During supply shortages in 2026, healthcare organizations faced urgent pressure to shift from reactive to proactive inventory management. Stereotactic breast biopsy needle shortages revealed that traditional forecasting based on procedure volume lacks the granularity needed for device-specific demand. We aimed to enable device-level forecasting through standardized preprocedure protocolling.

Methods: In a retrospective analysis of 1,456 stereotactic biopsies across 4 breast imaging sites (June 2025 to June 2026), compliance with a standardized electronic protocolling tool that captured lesion count and needle size (standard vs. petite) was …

Critical Daily Dose Warning Optimization In An Electronic Health Record At A Tertiary Cancer Center, Mckenzie Erwin, Sadika Eslaminejad, David Perez, Jesni Mathew

Advances in Cancer Education and Quality Improvement

Objectives: Clinical decision support is a form of health information technology utilized by electronic health records (EHRs) to reduce prescribing errors. The challenge of incorporating clinical decision support into medication workflows is balancing alert fatigue with clinical appropriateness. At our 777-bed tertiary cancer center, one form of interruptive clinical decision support is critical dose warnings that appear when the ordered dose deviates by a defined threshold from the maximum dose. Our tertiary cancer center relies on a third-party data vendor to provide maximum dose limits that are integrated into the EHR medication ordering process. At the time of project initiation, …

Implementation Of A Low-Cost Tobacco-Free Intervention In A Permanent Supportive Housing Program To Address Cancer Disparities Among People Who Have Experienced Homelessness, Ammar D. Siddiqi, Phoebe Wong, Cathy Crouch, Lorraine R. Reitzel

Advances in Cancer Education and Quality Improvement

Objectives: Permanent supportive housing residents who have experienced homelessness use tobacco products at elevated rates, contributing to higher cancer risk. Agencies that provide wraparound support services to this group are committed to rebuilding their stability by improving their health. Yet, their delivery of tobacco screening and cessation care is limited, as is information about their clients’ tobacco use behaviors. Here, we evaluated a low-cost intervention for an Albert Schweitzer Fellowship project conducted in a permanent supportive housing program with 650 adults who had experienced homelessness in Houston, Texas.

Materials and Methods: Between August 2024 and February 2025, client-facing staff members …

Evaluation Of Shortened Irinotecan Infusion Times And Adverse Effects Incidence For Gastrointestinal Medical Oncology Patients, Rachel N. Ochs, Daniel J. Donovan, Neha A. Betrabet, Wendy M. Covert

Advances in Cancer Education and Quality Improvement

Background: Irinotecan, a topoisomerase I inhibitor, is commonly used to treat gastrointestinal cancers. The infusion time of irinotecan is usually over 90 minutes; however, studies support the safety and feasibility of 30-minute infusions. A shortened infusion duration may improve patient quality of life, optimize infusion chair utilization, and reduce wait times. Faster infusion rates may increase the risk of acute cholinergic side effects, reported in up to 50% of patients (all grades). Current institutional practice in the gastrointestinal medical oncology (GIMO) clinic involves administering irinotecan over 90 minutes and using atropine as needed for reversing cholinergic symptoms. For patients who …

Unlocking Faculty Potential: A Quasi-Experimental Study Of Coaching And Academic Performance In Health Care Settings, Amanda Woods Herron, Katelyn J. Cavanaugh, Michelle Figliuolo Deveau, Courtney L. Holladay

Advances in Cancer Education and Quality Improvement

As faculty in academic medicine face mounting demands to excel in clinical care, research, teaching, and administrative responsibilities, interventions that support professional sustainability are increasingly critical. Coaching has emerged as a promising developmental strategy within health care leadership, yet its impact on research and clinical outcomes in academic medical centers remains underexplored. This quasi-experimental study evaluated the effectiveness of a coaching program using intentional change theory (ICT) as a conceptual framework. ICT emphasizes sustainable personal transformation through alignment between the ideal self and professional goals. We examined a sample of 189 coached clinical faculty and 200 matched peers who had …

Why Should A Data-Driven Cancer Center Prioritize Well-Being?, Peter Pisters

Advances in Cancer Education and Quality Improvement

No abstract provided.

The Future Of Wellness In Health Care, Jennifer Bickel

Advances in Cancer Education and Quality Improvement

No abstract provided.

Complete Atrioventricular Block Revealing Late-Onset Cardiac Fabry Disease: Diagnostic Role Of Native T1 Mapping, Nouhaila Bentama, Lamyae Bakamel, Jalal Tagueniti, Fatiha Ait Yahya, Brahim Meftout

Journal of the Saudi Heart Association

A 63-year-old man presented with symptomatic complete atrioventricular block requiring urgent pacemaker implantation. Evaluation revealed non-obstructive left ventricular hypertrophy with normal coronary arteries. Cardiac magnetic resonance showed diffusely reduced native T1 values and inferolateral late gadolinium enhancement, suggesting Fabry cardiomyopathy; amyloidosis was excluded by bone scintigraphy. Diagnosis was confirmed by markedly reduced alpha-galactosidase A activity, elevated lyso-Gb3, and a pathogenic hemizygous GLA variant (p.Asn215Ser). Enzyme replacement therapy with agalsidase beta was initiated, with early stabilization of myocardial deformation and septal thickness. This case highlights native T1 mapping as a key diagnostic biomarker in unexplained left ventricular hypertrophy.

Murine Typhus In Georgia: Historical Context And A Probable Case Of Resurgence Where Previously-Thought Eradicated, Giovanni Mella-Velazquez, Christopher He, Bolanle Akinsola, Judson Miller

Journal of the Georgia Public Health Association

Background: Murine typhus, caused by Rickettsia typhi, is a flea-borne illness historically endemic to the southeastern United States, with initial cases reported in Atlanta, Georgia in 1913. Following vector control efforts, incidence declined significantly, and the disease was removed from the nationally notifiable disease list in 1987. While recent cases have been reported in select regions, murine typhus has not been documented in Georgia for decades. We present a pediatric case in Atlanta that may represent the first reported instance in nearly 40 years, suggesting possible reemergence in the Southeast.

Methods: We conducted a case report analysis of a pediatric …

Discover To Deliver Pediatric Futures: Viewpoints Of Future Medicine From A Pediatric Health Care System., Vanessa Watkins, Ken Chang, Laura Sarff, Jared Vavroch, Dawn Wolff, Lori A. Erickson

Manuscripts, Articles, Book Chapters and Other Papers

Pediatric health care systems face increasing uncertainty driven by rapid technological change, workforce shifts and shortages, environmental threats, and evolving family and community needs. Pediatrics requires future-focused considerations that go beyond adult systems, including family-centered care, developmental trajectories, and long-term societal impacts on child well-being. While the future cannot be predicted, futures medicine methods offer structured approaches to anticipate change and support proactive, values-driven planning. This Viewpoint describes the application of pediatric futures methods within an academic, independent nonprofit pediatric health system and proposes a practical framework that connects future readiness to strategic decision-making and daily care delivery. Futures medicine …

The Lateral Recovery Position In Medical Vs Dental Emergencies, John Regis, Steven Saxe, Jason Ciccotelli, Saskia Richter, Jessica Immonen

The Journal of Integrative Physiology

The lateral recovery position is widely used in prehospital and clinical settings to help maintain airway patency in unconscious patients who are breathing spontaneously. Tracheal anatomy and asymmetries in respiratory structures, along with gravitational effects on soft tissues, may influence the efficacy and safety of this positioning. Clinical nuances related to the setting and secondary health concerns interestingly create disagreement on preferred side for lateral placement. This article explores the anatomical and physiological considerations that support the lateral recovery position—focusing on tracheal asymmetry and its implications for airway patency—along with emergency medical practices in medical versus dental emergencies. It also …

Comment On “Advancing Lipid Management: Saudi Heart Association Position Statement On Pcsk9-Targeted Therapies In The Primary And Secondary Prevention Of Cardiovascular Disease”, Ali Faris Altebainawi

Journal of the Saudi Heart Association

No abstract provided.

Frequency-Dependent Cerebellar Circuits Independently Gate Social Vocalizations And Movement, Cheryl Brandenburg, Snigdha Srivastava, Alejandro G Rey Hipolito, Tao Lin, Benjamin R Arenkiel, Roy V Sillitoe

Faculty, Staff and Students Publications

Communication depends on precise coordination between motor execution and cognition. Here we reveal that the cerebellum exerts real-time control over social vocalizations in adult mice. Optogenetic activation of excitatory cerebellar output in the superior cerebellar peduncle suppressed ultrasonic vocalizations with frequency-dependent potency while inducing distinct motor phenotypes. Systematic functional mapping across cerebellar regions and cell types revealed that vocal suppression can occur in the absence of overt motor impairment, suggesting selective control of vocal output beyond gross movement disruption. We identified the periaqueductal gray (PAG), a conserved midbrain vocal control center, as a key downstream mediator of this effect. Deep …

Ribosomal Biogenesis In Acute Myeloid Leukemia: A Less-Attended Process With Profound Implications For Oncogenesis And Therapeutic Vulnerability, Muhammad-Redha Abdullah-Zawawi, Nadiah Abu, Nurul Syakima Ab Mutalib, Farah Azima Abdul Muttlib, Hafiza Alauddin

Saudi Medical Journal

No abstract provided.

Drooling In Children With Cerebral Palsy: A Retrospective Observational Study Of Clinical Characteristics, Severity, And Treatment, Kamel Awadh Alenazi, Lama Dakhakhni, Nancy Hassan, Wejdan Almuhraj

Saudi Medical Journal

Objectives: To report the characteristics, severity, and treatment of drooling in cerebral palsy (CP) children.
Methods: This retrospective observational study included CP children with active complaints of drooling from the Drooling Clinic, Sultan Bin Abdulaziz Humanitarian City (Riyadh, Saudi Arabia). Drooling severity was assessed via the Modified Drooling Questionnaire (MDQ). The functional motor and manual ability levels were classified via the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS).
Results: In total, 122 patients were identified. Mean age was 6.28 ± 2.71 years, and 67/122 (54.9%) were boys. Gastroesophageal reflux disease was noted in 23/122 (18.9%). …

Sinonasal Inverted Papilloma: Demographics, Recurrence Predictors, And Surgical Outcomes — A 10-Year Retrospective Review At A Tertiary Center In Saudi Arabia, Ali J. Asiry, Majed A. Alali, Nasir A. Magboul, Salem A. Alrasheed, Ibraheem M. Alkanhal, Mohammed A. Alabduljabbar, Raid H. Almadi, Abdullah S. Aldughaither, Faisal S. Alfawaz, Ali Majrashi, Saud Alromaih, Ghassan Alokby, Tamadar Al Doheyan

Saudi Medical Journal

Objectives: To characterize the demographic, clinical, and radiological profile of patients with sinonasal inverted papilloma (IP) managed at a tertiary center in Saudi Arabia, to determine recurrence rates in primary versus revision cases, and to identify factors associated with recurrence.
Methods: This retrospective observational study included 59 adult patients with histopathologically confirmed sinonasal inverted papilloma (IP). Demographic, clinical, radiological, and surgical data were extracted from medical records. Tumors were staged using the Krouse system. Patients were stratified into primary or revision cases, and associations with recurrence were evaluated.
Results: Most patients were men (72.9%) and older than 45 (79.7%) years …

Incidence Rate And Factors Predicting The Recurrent Cerebral Ischemic Events After The First-Ever Ischemic Stroke: A Single-Center Exploratory Study From The Eastern Region Of Saudi Arabia, Azra Zafar, Mustafa Al-Qarni

Saudi Medical Journal

Objective: First-ever ischemic stroke (FIS) patients carry a higher risk of recurrent ischemic strokes (RIS). This study reports the incidence rate and describes the factors predicting recurrences in FIS patients.
Methods: This retrospective study, enrolling patients with FIS, was carried out at the King Fahd Hospital. Association between different variables and RIS was determined by estimating the 95% confidence intervals (95% CI) and odds ratio (OR).
Results: The majority of patients were Saudi (74.1%) and male (72.9%). Over a 5-year follow-up study, the incidence rate was 26.1% (95% confidence interval [CI] = 22.2-30.1) for all recurrences and 22.7% (95% CI …

Beyond Chronological Age: Performance Status And Clinical Frailty Predict Survival In Saudi Geriatric Lymphoma Patients: A Competing Risk Analysis, Musa Fares Alzahrani, Ghazi S. Alotaibi, Sarah S. Sewaralthahab, Fatima A. Alshalati, Ibrahim N. Alrumaih, Badraa A. Muharib, Kazi Nur Asfina, Saleh Ahmed Alkholaif, Shaden A. Albassam, Saleh Abdullah Aljanah, Shahad A. Al Hemidin, Ahmed Y. Jamal, Fadi S. Alakeel, Walid A. Alkeridy, Farjah H. Algahtani, Aamer Aleem

Saudi Medical Journal

Objective: To evaluate the prognostic impact of performance status, frailty, and treatment intensity on survival outcomes in a geriatric lymphoma cohort using a competing risk framework. In Saudi Arabia, despite a growing aging population, there is a lack of literature detailing frailty or survival dynamics for geriatric lymphoma patients.
Methods: We conducted retrospective cohort study in Tertiary center in Riyadh, Saudi Arabia. Geriatric patients (≥ 60 years) diagnosed with lymphoma during 2011–2024 were analyzed. Baseline demographics, laboratory parameters, pathology, and frailty status were extracted. Survival dynamics were modeled using cumulative incidence functions to isolate lymphoma-related mortality (LRM) from age-related competing …

Growth, Methodological Evolution, And Clinical Maturity Of Artificial Intelligence Research In Major Medical Journals, 2018–2025: A Longitudinal Bibliometric Study, Abdulraoof Alsaeedi, Norah Alqarni, Ibrahim Rozi, Mohamed Ibrahim

Saudi Medical Journal

Objectives: To quantify changes in the volume, methods, and clinical maturity of artificial intelligence (AI) and machine learning (ML) research in major medical journals from 2018 through 2025.
Methods: We conducted a longitudinal bibliometric study of PubMed-indexed records from 99 leading clinical and general medical journals. The search was conducted on July 2026. Records were deduplicated and classified as empirical AI/ML research, evidence synthesis, AI discourse, or unclassified. Empirical studies were categorized by model family and clinical maturity. Journal-year Poisson generalized estimating equations used total substantive publications as an offset and clustered observations by journal.
Results: Among 6,891 unique publications, …

Barriers To And Needs For The Implementation Of Artificial Intelligence In Radiation Therapy Planning In Saudi Arabia. A Cross-Sectional Survey, Abdulaziz Alshaikh, Ghadah Alqarni, Abdulaziz Alghamdi, Khalid Alrabiah, Nasser Al-Rajhi, Mohammed Aldehaim

Saudi Medical Journal

Objectives: To assess radiation oncology physicians' perceptions of artificial intelligence (AI) in radiation therapy planning in Saudi Arabia and identify barriers to and support needs for its implementation.
Methods: A cross-sectional online survey was distributed through the Saudi Association of Radiation Oncology email list to 142 physicians from April to May 2026. We analyzed responses using descriptive statistics and exploratory 2-sided Fisher exact tests comparing residents with nonresidents.
Results: Forty-three complete responses were analyzed (response rate: 30.3%). A total of 33 (76.7%) respondents agreed or strongly agreed that AI would improve planning accuracy and efficiency. Nineteen (44.2%) reported no workplace …

Artificial Intelligence Readiness Among Paramedics At The Saudi Red Crescent Authority: A Cross-Sectional Study, Mohammed Jamaan Alsahli

Saudi Medical Journal

Objective: To evaluate AI readiness among paramedics working within the Saudi Red Crescent Authority (SRCA) and examine demographic and professional characteristics related to their readiness.
Methods: This cross-sectional study was conducted among SRCA paramedics. Data were collected through a structured online questionnaire covering demographic and professional features and the validated Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS), which assesses four dimensions: Cognition, Ability, Vision, and Ethics. Comparisons between groups were performed with the Mann-Whitney U and Kruskal-Wallis tests, while correlations were assessed using Spearman's rank correlation, and a multiple linear regression model examined factors independently related to AI …

Artificial Intelligence In Gastrointestinal Precision Medicine: A Critical Appraisal Through The Lens Of Inflammatory Bowel Disease, Abdulrahman G. Alharbi, Abdulrahman A. Aljabri

Saudi Medical Journal

Artificial intelligence (AI) now supports many facets of gastrointestinal and hepatic care, from lesion recognition during endoscopy to the interpretation of large molecular datasets. This review first outlines AI's broader role across gastroenterology and hepatology, and then uses inflammatory bowel disease (IBD) as a case study for AI-assisted multiomics integration. The review applies a consistent evidentiary framework that distinguishes exploratory, retrospective, and prospective study designs. Retrospective genomic and image-based studies report promising discriminative performance for risk classification and lesion detection, but this evidence remains largely exploratory or retrospective, whereas prospective randomized evidence is currently strongest for AI-assisted endoscopic polyp detection. …

Efficacy And Safety Of Botulinum Toxin For The Treatment Of Psoriasis: A Systematic Review And Meta-Analysis, Rahaf A. Alothman, Hussein M. Alshamrani, Mishari T. Alrubaiaan, Ruba M. Alghanmi, Reshale A. Johar, Lina K. Almutairi, Mohammed H. Abduljabbar, Ahmed M. Baabdullah, Sultan S. Alfaer

Saudi Medical Journal

Objective: To evaluate the current literature on Botulinum toxin (BoNT) use in psoriasis treatment, focusing on efficacy and safety. Botulinum toxin, known for its neuroprotective effects, is a promising therapeutic agent for inflammatory skin diseases.
Methods: We searched electronic databases, including MEDLINE, Web of Science, and Google Scholar, from inception until March 2025 to identify randomized controlled trials and cohort studies in English that enrolled patients with psoriasis treated with BoNT injections over their lesions, reported outcomes related to the clinical question, and included raw numbers of outcomes.
Results: Of the 342 retrieved articles, 166 duplicates were removed. Screening of …

Association Of Kirsten Rat Sarcoma Viral Oncogene Homolog Mutation With The Prognosis Of Colorectal Cancer In Arab Countries And Saudi Arabia: A Systematic Review And Meta-Analysis, Mohammed Ageeli Hakami, Hassan Abdullah Albargy

Saudi Medical Journal

Objectives: To quantify the potential impact of Kirsten rat sarcoma (KRAS) mutation on survival outcomes in colorectal cancer (CRC) patients from Arab countries, particularly in Saudi Arabia. As a chief cause of cancer-associated mortality worldwide, CRC shows a rising incidence across Arab countries. Among molecular drivers, KRAS mutation plays a pivotal role in tumor initiation, resistance to therapies, and disease progression. Nonetheless, the prognostic influence of KRAS mutation in Arab populations remains inconclusive.
Methods: Key databases were searched to find appropriate publications. Eligible studies evaluated KRAS mutation’s association with overall survival (OS) in CRC patients from Arab nations. Hazard ratios …

Evaluating The Diagnostic Performance And Clinical Interpretability Of Explainable Ai (Xai) In Digital Histopathology: A Meta-Analysis Of Diagnostic Performance, Bandar S. Alshreef, Yousif A. Kariri

Saudi Medical Journal

Objective: To explore peer-reviewed research on the application of Explainable Artificial Intelligence (XAI) techniques for histopathology-driven cancer risk evaluation, and to address the limitations delaying its transition into routine clinical pathology practice (such as model reliability, clinical interpretability, and governance oversight).
Methods: We conducted a systematic review with quantitative meta-analysis of studies evaluating explainable artificial intelligence (XAI) in histopathology. Searches were performed in Web of Science, Scopus, PubMed, and Google Scholar through November 2025. Eligible studies were assessed for diagnostic performance, explainability approaches, and methodological quality. Of the 47 included studies, 9 provided sufficient quantitative data for meta-analysis. Post-hoc visual …