Digital Commons Network^™

Campus Ornament, Arianne Marcoux

Graduate Medical Education Research Journal

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With Great Power Comes Great Responsibility: Ai And Its Future In Medical Education, Faruq Pradhan, Prasanth Ravipati, Zachary P. Slocum

Graduate Medical Education Research Journal

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Massive Upper Gi Bleeding From Duodenal Invasion Of Hepatocellular Carcinoma Successfully Treated With Embolization And Hemospray®, Patrick Twohig, Erin Walsh, Amy Calderon

Graduate Medical Education Research Journal

Direct invasion of hepatocellular carcinoma (HCC) into the duodenum is a unique and life-threatening complication of HCC that has been rarely reported. A 60-year-old male with known HCC and cirrhosis presented with melena. Computed tomography of the abdomen and pelvis showed a 7cm hepatic mass abutting the duodenum. Esophagogastroduodenoscopy demonstrated a large, actively oozing mass in the duodenum treated with Hemospray® followed by transarterial embolization (TAE). Active upper gastrointestinal bleeding due to duodenal invasion of HCC can be successfully treated with Hemospray® Endoscopic Hemostat and TAE.

Enhancing Dissemination At Medical Conferences: A Cross-Disciplinary Approach For Learners, Raquel Lamarche, Jasmine R. Marcelin

Graduate Medical Education Research Journal

Empowering novice authors, particularly trainees and learners, this perspective piece integrates a cross-disciplinary approach to bolster scholarly dissemination at medical conferences. Through a tripartite methodology — Innovate, Implement, and Influence — the article first delves into innovation, offering four essential heuristics sourced from diverse fields, guiding the germination of ideas. Next, it demystifies the transformation of these ideas into research abstracts through a structured blueprint. The finale encompasses strategies to create compelling presentations that resonate with audiences. Woven throughout is an emphasis on craftsman-like precision in idea execution, fostering relationships, and engaging genuinely with content while maintaining audience-centricity. This blueprint …

Perceptions Of Medical Students By Using Internal Medicine Educational Environment Measure (Imeem) In A Rural Affiliated Teaching Hospital, Sirayut Waramit

Graduate Medical Education Research Journal

Background and Objectives: Students’ perception of the educational setting is an important source for improving and applying changes to the medical educational environment. This study aimed to determine how medical students perceive the important factors of the learning environment in Internal Medicine at a rural affiliated teaching hospital.

Methods: This was a descriptive study carried out in the Department of Medicine, Sakon Nakhon Hospital, Thailand, from May 2021 to April 2023. Sixth-year medical students completed a validated Internal Medicine Education Environment Measure (IMEEM) questionnaire at the end of four weeks of learning the Clerkship Internal Medicine course.

Results: A …

Prostatic Utricle Presenting As A Midline Scrotal Mass, Kaitlyn E. Schultis, Bryant Van Leeuwen, John Makari

Graduate Medical Education Research Journal

The prostatic utricle is a remnant of the Müllerian duct located within the verumontanum. An enlarged, clinically significant prostatic utricle has classically been associated with hypospadias. Prostatic utricles often present with persistent lower urinary tract symptoms, recurrent infections, and urinary incontinence. We present a prostatic utricle that presented as a scrotal mass concerning for rhabdomyosarcoma in a male with normal external genitalia.

Recurrent Polymicrobial Bloodstream Infections As Harbingers Of A Duodenal-Inferior Vena Cava Fistula, Gregory E. Koval, Richard J. Hankins, Jasmine R. Marcelin

Graduate Medical Education Research Journal

This is a case of an 82-year-old patient who presented with recurrent polymicrobial bloodstream infections and no obvious undrained source of infection. She had prior double barrel iliocaval stenting for post thrombotic syndrome. The patient underwent exploratory laparotomy and primary repair of a duodenal-caval fistula with a fascia lata patch and an omental pedicle flap. No further bloodstream infections were documented after the repair. This discussion highlights an uncommon complication of IVC stenting, its presentation as well as the operative approach used to repair the fistula.

Perceived Importance Of Ultrasound Vascular Access Education Among Residents, Raquel Lamarche, Jared Marx, Jihyun Ma, Stephanie Claudy

Graduate Medical Education Research Journal

Background: Peripheral intravenous catheter (PIVC) failure and difficult intravenous access (DIVA) are pervasive issues causing patient suffering and increased costs. Despite their prevalence, there is a gap in internal medicine and pediatric resident training to manage these challenges effectively.

Objective: This study aimed to assess the value of ultrasound-guided-PIVC (USGPIVC) education for internal medicine and pediatric residents and the impact of a 1-hour multidisciplinary workshop on their knowledge and confidence.

Methods: A cross-sectional survey study was conducted at an academic medical center in 2022 to assess residents’ perceptions of USG-PIVC education. This was followed by a USG-PIVC simulation-based workshop with …

How To Write A Manuscript: A Guide For Trainees, Yuqian Tian, Ivy N. Haskins

Graduate Medical Education Research Journal

This is a simple guide for trainees to learn how to write and publish a manuscript. We aim to introduce new trainees to the steps of publishing a manuscript and provide advice to increase their chances of manuscript acceptance.

Impacts Of Perinatal Oxycodone Exposed Offspring In Early Adolescence, Adrian Flores

Theses & Dissertations

The Opioid Epidemic has been a point of public health interest for the last twenty years. In this time, use of prescription opioids has grown exponentially, including use by pregnant women. The initial crisis has been focused on mitigating immediate problems such as lowering the significant loss of life in overdoses and providing support to cessation. Despite these advancements a separate phenomenon is on the rise: The rise in neonatal opioid withdrawal syndrome in neonatal care and associated challenges for these children as they age.

Currently preclinical research and epidemiological data suggests that exposed children are at risk for experiencing …

Feasibility Of A Laboratory Model For Evaluating The Use Of An Alternative Response Option In Mitigating Caregiver Treatment Integrity Errors, Jessie K. Weber

Theses & Dissertations

The current study assessed the feasibility of a laboratory model designed to evaluate options for mitigating common caregiver errors in the implementation of destructive behavior treatment. We developed a computer-based analogue to caregiver implementation of extinction for attention-maintained destructive behavior; the model included contingencies on both caregiver errors of commission and adherence to the treatment protocol. We also conducted a preliminary investigation of the effects of participant access to alternative activities as a potential strategy for mitigating integrity errors. Participants included 14 MTurk workers or staff in a severe behavior clinic, and individual response patterns revealed distinct sensitivities to the …

Improving Intimate Partner Violence Screening In A Women’S Health Practice Through Implementation Of An Evidence-Based Screening Tool, Jasmine Weber

Doctor of Nursing Practice Projects: College of Nursing

The purpose of this quality improvement project was to implement intimate partner violence screening in an outpatient women’s health clinic with no prior screening process in place. Current recommendations are to screen all reproductive age women for intimate partner violence 6 . During a three-month period 170 patients out of 260 eligible patients were screened using the HARK screening tool, 7 of those patients screened positive and were offered referrals to social work. While universal IPV screening was not achieved, a screening rate of 64% is a remarkable improvement from an apparent absence of screening prior to project implementation.

The Impact Of An Educational Cooking Class On Inflammatory Potential Of Diet In Cancer Survivors, Mariah K. Jackson

Theses & Dissertations

Cancer survivors face long-term effects from cancer treatments, with cognitive dysfunction being an important, yet understudied, consequence of cancer treatment. Inflammation is a proposed mechanism for impaired cognition status. As research demonstrates diet is associated with both pro- and anti-inflammatory effects, diet may represent a novel strategy to mitigate cognitive decline in cancer survivors. The purpose of this study was to 1) quantify the impact of an educational cooking class on inflammatory potential of diet (measured by the Dietary Inflammatory Index (DII)) in cancer survivors and 2) determine the relationship between dietary changes and cognitive function in cancer survivors. Dietary …

Examining The Relationship Between Adverse Childhood Experiences And Covid-19 Vaccine Status Using 2022 Brfss Data: A Cross-Sectional Study, Cristhian A. Chau-Valdivia

Capstone Experience

Abstract:

Objective.To determine the association between adverse childhood experiences (ACEs) scores with COVID-19 vaccination outcomes before and after adjusting for demographic variables.

Methods. Data were from 2022 Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding 13 categories of ACEs, COVID-19 vaccination, and demographic variables. Data was weight adjusted for survey respondent data. This complex design combined the core and optional modules. Participants who received at least one dose of the COVID-19 vaccine were categorized as vaccinated. The sample size is 12,514.

Results. Participants who were female (OR=1.35, 95% CI: [1.19,1.52]), greater than or equal to 65 years old (OR=4.76, 95% …

Mental Health Perceptions Among Us Veterans And Non-Veterans: 2022 Behavioral Risk Factor Surveillance System, Nicole Frederickson

Capstone Experience

Objective. To determine the association between veteran status and perceived mental health in US adults.

Methods. 2022 Behavioral Risk Factor Surveillance System cross-sectional telephone survey data were used. Analyses were adjusted for confounding sociodemographic and health-related characteristics. Weighted multinomial logistic regression was used to determine the association between veteran status and reporting 0, 1-13, or 14+ poor mental health days.

Results. A total of 430,653 individuals were included in this analysis. Veteran status was associated with decreased odds of reporting 1-13 poor mental health days than nonveterans (OR=0.81; 95% CI 0.77, 0.86) but greater odds of reporting 14+ poor mental …

Association Between Frequent Mental Distress And Insurance Status Using The 2022 Brfss, Christina Clayson

Capstone Experience

Objectives

Determine if there is a direct relationship between frequent mental distress and health insurance coverage.

Methods

Data from the 2022 BRFSS was used to calculate adjusted percentages. Crude odds ratios for both mental distress and insurance coverage. Multivariate analysis calculated crude and adjusted odds ratios for frequent mental distress by insurance coverage with income as a covariate.

Results

Individuals reporting frequent mental distress had lower income, less education, and were younger. Individuals without health insurance were more likely to be younger, Hispanic, and not have graduated high school. There was no significant association between frequent mental distress and not …

Substance Use Patterns Among High School Students - A Replication Study Of The 2020 Youth Risk Behavior Survey, Haley Irons

Capstone Experience

The study selected for replication is “Prescription Opioid Misuse and Use of Alcohol and Other Substances Among High School Students” by Christopher Jones and colleagues published in the Morbidity and Mortality Weekly Report Supplement in August 2020. The original report used data from the Centers for Disease Control’s 2009-2019 Youth Risk Behavior Survey (YRBS), which is a cross-sectional survey administered every two years to a sample of public- and private-school students in 9th–12th grade in the United States. Researchers from the original report aimed to use the 2009-2019 YRBS data to examine substance use among high school students, characterize the …

A Cross-Sectional Analysis Of Adverse Childhood Experience Exposure On Cancer Diagnosis Utilizing The 2022 Behavioral Risk Factor Surveillance Survey Data, Emma Zipperer

Capstone Experience

Objective: To determine the association between Adverse Childhood Experiences (ACEs) and cancer diagnosis based on ACE exposure levels.

Methods: We utilized data collected in the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey. The study population (n=54,148) was restricted to states that reported on the optional model of experiencing ACEs and those who responded about cancer diagnosis. A univariate analysis, bivariate analysis and a multivariate logistic regression were performed. Odds of cancer diagnosis among those with differing ACE exposure levels were calculated.

Results: High ACE exposure had 20% higher odds of cancer diagnosis when compared to low ACE exposure. White, …

Exploring The Mental Health Experience Of Perinatal Military Spouses Based In Sigonella, Italy, Lyndsey Dannenberg

Capstone Experience

The perinatal period can have a profound impact on the mental health of women, their infants, and their families, especially when it comes to depression and anxiety disorders. This study aims to delve into the experiences of perinatal mental health among military spouses stationed overseas, on Naval Air Station Sigonella, Italy, and contribute to the limited research on active-duty military spouses and their perinatal mental health while stationed overseas. The research uses a qualitative phenomenological approach, seeking to provide valuable insights into the lived experiences of military spouses and their perinatal mental health. Risk factors associated with perinatal mental illness …

Associations Between Self-Reported Cognitive Decline And Chronic Diseases: A Cross-Sectional Analysis Of Behavioral Risk Factor Surveillance System (Brfss) 2022, Hailey Child

Capstone Experience

Objective: This study seeks to capture how self-reports measure cognitive decline. The association between chronic conditions and cognition with age consideration in individuals aged 45 and older is investigated.

Methods: Univariate analysis generates frequencies and weighted percentages of 2022 BRFSS data. Chi-square tests and polytomous regressions generate odds ratios for bivariate analyses. A weighted multiple logistic regression model stratified by age group analyzes self-reported cognitive decline.

Results: Respondents ages 45 to 54 with three or more chronic diseases have the highest odds (OR = 6.81; 95% CI = 4.42, 10.48) of cognitive decline. Respondents 75 and older …

Ordinal Logistic Regression Analysis Of The Frequency Of Marijuana Use Among Adult Informal Caregivers In 20 U.S. States, Behavioral Risk Factor Surveillance System (Brfss) 2021, Athena Plichta

Capstone Experience

Objectives. To examine the association between frequency of marijuana use among informal caregivers of persons with dementia (PWD) and other health conditions compared to non-caregivers in 20 U.S. states.

Methods. We used complex survey data from the optional modules Caregiver and Marijuana Use of the 2021 BRFSS survey. Univariate and bivariate analyses were performed to determine the frequency and distribution of sample population characteristics and calculate crude relationships. Ordinal logistic regression modelled the relationship between the three-level outcome and covariates.

Results. Frequency of marijuana use and caregiver status were not associated. There was no difference in increased use among individuals …

Strategies To Encourage Recall And Prevent Relapse After Full Mouth Rehabilitation Under General Anesthesia In Children, Claire Koukol

Capstone Experience

Background: Dental caries are preventable. Dentists utilize many prevention strategies in the office and provide at-home education to families. However, once a child develops Early Childhood Caries (ECC), especially in more severe cases, they may need general anesthesia (GA) to complete treatment. While this is an effective way to achieve full mouth dental rehabilitation (FMDR), this burdens the healthcare systems and families and does not come without risk to the patient. Patients with high caries experience remain at high risk of caries relapse after FMDR under GA, sometimes necessitating additional FMDR under GA. While there has been a significant amount …

Nurse Initiated Standing Orders: A Process Improvement At An Emergency Department In Interior Alaska, Justin D. Melberg

Capstone Experience

Emergency Departments (EDs) are a valuable and limited public health resource. In addition to treating acute medical emergencies, EDs bridge the gaps in urgent care and primary care accessibility, operating twenty-four hours a day, seven days a week, providing care regardless of an individual’s ability to pay. EDs across the country operate at or above capacity regularly, and overcrowding is projected to increase due to decreased facilities and available inpatient beds. Innovative measures are necessary to increase patient throughput and decrease length of stay while maintaining quality care. Nurse initiated standing orders, also known as nurse driven protocols, standing orders, …

Environmental Exposure Effects To Humans And Trends Of Harmful Algal Blooms In Nebraska, Ericka Sanders

Capstone Experience

Harmful algae blooms (HAB) are becoming more of a human health concern. Humans are exposed to harmful algae blooms from freshwater bodies used for recreational activities. The presence of harmful algae blooms has been increasing across the United States. Aerosol, dermal, and ingestion routes of exposure are ways humans can develop an illness when around a HAB. Environmental exposure to humans above 8 ppb per liter of surface water can cause mild to severe symptoms and, in rare cases, may be fatal. Exposure can be acute or chronic. The Nebraska Department of Environment and Energy (NDEE) has implemented a monitoring …

Examining The Impact Of Adverse Childhood Experiences (Aces) On Breast And Colorectal Cancer Screening Behaviors In Adulthood, Meagan A. Kraft

Capstone Experience

Objective: To investigate the relationship between adverse childhood experiences (ACEs) and screening for breast and colorectal cancer in adulthood.

Methods: This cross-sectional study utilized nationwide survey data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). Data regarding ACEs and compliance with breast and colorectal cancer screening guidelines were analyzed from 12 states. Weighted logistic regression models were used to assess the relationship between ACEs and breast cancer screening compliance in a population of 18,369 women, and colorectal cancer screening compliance in a population of 30,884 men and women. Screening compliance among those with a high ACE score was compared …

Assessing How Children Modify The Impact Of Having Health Insurance On Smoking Status Using The 2021 Behavioral Risk Factor Surveillance System Survey, Zak Lippert

Capstone Experience

Objective: To understand if children living in the home modify the relationship between health insurance and smoking.

Methods: This analysis used the 2021 Behavioral Risk Factor Surveillance System Survey. The outcome was being a current smoker with health insurance as the exposure. The analysis was stratified by children to determine if children changed how having health insurance impacted smoking. The odds ratios for each stratum were compared to determine if children was a modifying factor.

Results: Children had a modifying effect on health insurance. For someone with children, if they had insurance, their odds of smoking were 0.91 (95% CI: …

Relationship Of Adverse Childhood Experiences And Depression Using The 2022 Behavioral Risk Factor Surveillance System Data In 12 States, Ivy Sovine

Capstone Experience

Objective: To determine if reporting adverse childhood experiences (ACE) is linked to depression in adults, taking into consideration the influence of sociodemographic factors.

Methods: A secondary analysis was performed using the cross-sectional 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey data. Twelve states included the optional ACE module, respondents who did not answer the questions about depression, education, or at least one ACE question were excluded from the analysis. The study population included 59,860 respondents. We examined the relationship between depression and ACE by using weighted univariate analysis, bivariate models, and logistic regressions.

Results: Among the respondents, 21% (12,112) reported …

Body Mass Index And Acute And Chronic Work-Related Injuries; A Random Sample Analysis Of Occupational Health Clinic Records, Nicole M. Lundy

Capstone Experience

Workplace injuries are detrimental because they impact the productivity and wellbeing of workers. The ultimate goal is to minimize job-related injuries due to workplace exposure. This study examines the relationship between body mass index (BMI), age, gender, and injury patterns. Data was collected through a chart review of patients from an occupational medicine health clinic in Grand Rapids, Michigan from January 2022 through December 2022.

This was an exploratory study with no population sample control group. Variables investigated were body mass index, gender, age, and type of injury sustained. The injuries were classified by body part into head, back, lower …

The Power Of An Effective Safety Culture, Justin B. Negley

Capstone Experience

Workplace injuries and illnesses have continued to decrease significantly through increased regulations, awareness, and technological advances. These enhancements are not enough to continue to drive these rates lower. A robust safety culture within an organization is required to truly affect change that will continue to diminish the occurrence of injuries and illnesses within the workplace. This project seeks to define the key aspects and elements that are fundamental to a culture of safety as a top priority amongst competing demands. The foundations of a robust safety culture were identified through a systematic literature review, a site comparison example of safety …

Certified Midwives: An Exploration Of Their Impact On Maternal Health Outcomes – A Comprehensive Literature Review, Heather Hollister

Capstone Experience

Maternal health outcomes in the United States have been consistently worse than other high-income countries, with a disproportionate impact on women of color. Midwives have long played an important role in maternal health worldwide. The literature review examines the evidence for midwives as key contributors to improving maternal health outcomes. The paper reviews the existing literature on midwifery, including the impact on maternal health, labor and delivery outcomes, and patient satisfaction. Electronic searches were conducted through Cochrane Library, CINAHL, Medline and Embase. Articles were screened according to inclusion and exclusion criteria including that they must be a randomized study; participants …