Medicine and Health Sciences Commons^™

Patient-Facing Antihemophilic Factor Clinical Decision Support Tool, Chandni Dargan

Research Days

Background: Hemophilia represents a medical condition suited to individualization. Adherence with prophylactic antihemophilic factor regimens ranges from 6%-167%. Clinical decision support tools (CDS) have been shown to improve guideline compliance and enhance patient adherence.

Objectives/Goal: The objective of this study is to evaluate the usability, usefulness, and satisfaction of a pharmacology-driven, patient-facing antihemophilic factor CDS.

Methods/Design: A patient-facing CDS was created to allow patients and families to explore factor levels at any time during their regimen and with the administration of different dosing regimens. Development followed a user-centered design process to ensure development of a product targeted to the needs …

Association Of Patient Demographics, Code Characteristics, And Survival To Discharge After In-Hospital Cardiac Arrests In The Pediatric Intensive Care Unit, Nathan Lavoy

Research Days

Background: Lower socioeconomic status and minority background have been linked to worse outcomes after out-ofhospital and in-hospital cardiac arrests (IHCA). Despite this, there has not been a focus on IHCA within a pediatric intensive care unit (PICU) evaluating patient demographics and code characteristics.

Objectives/Goal: The primary objective is to describe patient demographics, code characteristics, and survival to discharge of patients that suffer IHCA in a quaternary PICU. The goal of this descriptive, retrospective study is to identify possible differences in outcomes related to patient demographics, laying the foundation for further QI initiatives.

Methods/Design: Participants included patients between 24 hours and …

Neonatal Hypoxia Due To Pulmonary Artery Thrombus, Bianca Cherestal

Research Days

Background: Pulmonary artery thrombus is rare and should be considered in neonates with refractory hypoxia.

Case: Preterm female neonate had persistent hypoxia after birth despite intubation, high-frequency oscillatory ventilation (FiO2 100%), and inhaled nitric oxide. Delivery was via c-section at 33 weeks 4 days for new onset hydrops and poor biophysical profile. Echocardiogram revealed echo brightness in the lumen of the left pulmonary artery (LPA) with no color flow (figure 1a), concerning for occlusive thrombus. Chest CT angiogram confirmed the diagnosis (figure 1b, c). Hematology was consulted and recommended systemic thrombolysis (tissue plasminogen activator, tPA) with concomitant anticoagulation (Bivalirudin). Imaging …

The Effects Of Necrotizing Enterocolitis And Short Chain Fatty Acids On The Developing Brain In Mice, Maribel Martinez, Venkatesh Sampath, Paula Nichols, Wei Yu, Suban Burale, Tianhua Lei

Research Days

Background: Necrotizing enterocolitis (NEC) is a devastating disease in premature infants characterized by acute intestinal inflammation and necrosis with a mortality of 15%-30%. Approximately 50% of infants that survive NEC will develop neurodevelopmental defects[1]. Studies on the effects of NEC on the neonatal brain are limited, however it’s postulated that neurodevelopmental damage is induced via cytokine activation of toll-like-receptor 4 (TLR4) by high mobility group box protein 1 (HMGB1) on the microglia Accumulation of reactive oxygen and demyelination contribute to neuronal damage. Therapies that limit the development of NEC can potentially also limit the neuroinflammatory changes seen in NEC[2]. We …

Repeat Tracheal Aspirates In Pediatric Intensive Care Patients: Understanding Clinical Application, Edward Lyon

Research Days

Background: Tracheal aspirate cultures (TA) are regularly obtained in the pediatric intensive care unit (PICU) when clinical changes in intubated or tracheostomy dependent children occur. Positive TA results are often unable to distinguish infection from colonization. There is no data describing the frequency and impact of repeated TAs on patients in the PICU.

Goal: Our objectives were to describe the frequency of repeated TAs in PICU children and emergence of multidrug resistant organisms (MDRO), identify bacterial profile of TAs, and examine antibiotic prescribing patterns related to these cultures.

Methods: A retrospective chart review occurred on 15 patients in the PICU …

Vikela Ekhaya: A Novel, Community-Based, Tuberculosis Contact Management Program In A High Burden Setting, Alexander W Kay, Micaela Sandoval, Godwin Mtetwa, Musa Mkhabela, Banele Ndlovu, Tara Devezin, Welile Sikhondze, Debrah Vambe, Joyce Sibanda, Gloria S Dube, Robert H Stevens, Bhekumusa Lukhele, Anna M Mandalakas

Faculty, Staff and Student Publications

BACKGROUND: The prevention of tuberculosis (TB) in child contacts of TB cases and people living with human immunodeficiency virus (HIV) is a public health priority, but global access to TB preventive therapy (TPT) remains low. In 2019, we implemented Vikela Ekhaya, a novel community-based TB contact management program in Eswatini designed to reduce barriers to accessing TPT.

METHODS: Vikela Ekhaya offered differentiated TB and HIV testing for household contacts of TB cases by using mobile contact management teams to screen contacts, assess their TPT eligibility, and initiate and monitor TPT adherence in participants' homes.

RESULTS: In total, 945 contacts from …

Rates Of Physical Abuse Screening And Detection In Infants With Brief Resolved Unexplained Events (Brues), Angela Doswell

Research Days

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Background: “Apparent Life-Threatening Events” (ALTEs) have been associated with child physical abuse (CPA). In 2016, “Brief Resolved Unexplained Event” (BRUE) and development of its clinical guidelines and risk-stratification replaced ALTE. It is unknown if there is a similar association between BRUEs and CPA.

Objectives: To determine the rate of CPA in infants presenting with a BRUE, examine differences between infants with/without CPA, and examine rates of diagnostic testing used to detect CPA.

Methods/Design: This study was part of the BRUE Research and Quality Improvement Network, composed of 15 academic and community hospitals. Subjects were infants …

Healthcare Utilization Of Victims Of Commercial Sexual Exploitation Compared To Non-Victims, Cree Kachelski

Research Days

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Background: Approximately 17,000 US children are victims of Commercial Sexual Exploitation of Children (CSEC) annually. Nearly 75% of adolescent CSEC victims received medical care within 6 months prior to identification. Screening tools have been developed based on known characteristics of CSEC victims; however, little is known about how CSEC victims compare to non-CSEC adolescents in healthcare utilization. Thus, appropriate medical CSEC screening settings are unknown.

Objectives/Goal: We aimed to identify where and how often adolescents presented to medical care in the 12 months prior to CSEC identification. We hypothesized that compared to controls, CSEC positive …

Cvst As A Rare Complication Of Acute Pediatric Covid-19, Erin Bolen

Research Days

Background: A previously healthy 13-year-old male was admitted to the hospital for a bacterial superinfection in the setting of recent COVID-19, including orbital cellulitis and pansinusitis with subgaleal, epidural, and subdural empyema. Further workup identified an occult, non-occlusive cerebral venous sinus thrombosis (CVST) along the length of the superior sagittal sinus.

Objectives/Goal: To evaluate the reported cases of CVST as a potential complication of COVID-19 in the pediatric population and identify meaningful trends in demographics, presentation, and diagnostic course.

Methods/Design: A literature search was run with various combinations of the following terms, always including “COVID”: “pediatric,” “adolescent,” “CVST,” “cerebral venous …

Evaluation Of A Hirschsprung Disease Systemwide Enterocolitis De-Escalation Strategy, Albert Aickareth

Research Days

Problem Statement/Question: Components of systems that identify, treat and prevent enterocolitis are not well described. In addition, for patients with HSCR both pre and post pull-through, questions regarding a child’s clinical status occur through several different medical access points and may occur outside of colorectal center clinic hours.

Background/Project Intent (Aim Statement): Hirschsprung associated enterocolitis (HAEC) is a severe and potentially life-threatening complication of Hirschsprung Disease (HSCR) that can present with a variety of symptoms from mild abdominal pain to fulminant colitis. We evaluated our system-wide enterocolitis de-escalation strategy for both hospital staff and patient caregivers. Our primary analysis was …

Impact Of A Mental Health Screening Process In A Pediatric Ed, Bryan Stocker Do, Shobhit Jain Md, Kathryn Worland Msw, Celeste Tarantino Md, Lina Patel Md, Shayla Sullivant Md

Research Days

Background: Up to 20% of children in the United States experience a mental health disorder and suicide is the second leading cause of death among adolescents. Children presenting with mental health concerns to the Emergency Department (ED) can be challenging due to lack of access to trained professionals and long lengths of stay. Specialized teams have shown to be beneficial, but little is known about their impact in the ED.

Objectives/Goal: This study explored the impact of specialized social workers partnering with emergency medicine providers to provide care during an acute mental health crisis.

Methods/Design: We performed this work at …

X-Linked Nephrogenic Syndrome Of Inappropriate Antidiuresis Secondary To Vasopressin Receptor 2 Mutation, Erica Zarse

Research Days

Background: X-linked nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is a rare cause of hyponatremia with a similar biochemical evaluation to the syndrome of inappropriate antidiuretic hormone secretion but with suppressed vasopressin (AVP) levels.

Objectives: We present a case of hyponatremia due to NSIAD.

Results: A 25-month-old male with developmental delay became unresponsive 30 minutes after falling off a couch onto a hardwood floor. He presented with tonic-clonic movements and eye deviation requiring antiepileptics. Serum laboratories noted hyponatremia (123 mmol/L), hypoosmolality (262 mOsm/kg) and hypochloremia (90 mmol/L) prompting endocrine consult. Head imaging normal. Urine dilute with specific gravity 1.004, osmolality 160 …

Covid-19: Perspectives From Youth In Detention, April Mcneill-Johnson

Research Days

Background: The COVID-19 pandemic amplified health disparities among youth in detention. Understanding perspectives of these youth on the pandemic and COVID-19 vaccination may identify strategies to mitigate pandemic-related health disparities in this group.

Objectives/Goal: To explore perspectives on the COVID-19 pandemic, effect on detention experience and the COVID vaccine among youth in detention.

Methods/Design: This is a secondary analysis of a study examining healthcare needs and experiences of youth in detention. We recruited a convenience sample of youth (14-17 years) detained in urban midwestern juvenile detention centers from January-November 2021. We conducted semistructured individual interviews & used a thematic analysis …

Gastrointestinal Fibromatosis: A Case Of Successful Oral Tyrosine Kinase Inhibitor Delivery To An Infant With Proximal Duodenal Obstruction, Darius Blanding

Research Days

Background: Infantile myofibromatosis (IM) is a rare disorder characterized by the fibrous proliferation of the skin, bone, muscle, and viscera that usually presents at birth, or soon after. Although IM is a benign condition, significantly higher morbidity and mortality have been reported when the viscera is involved. This case report is of a 6-week-old female who presented with poor feeding along with subcutaneous nodules that were diagnosed as IM. Upper and lower endoscopy were performed for worsening feeding intolerance showing marked nodularity throughout the gastrointestinal (GI) tract, including partial obstruction of the proximal duodenum by biopsy-proven myofibromas, confirming visceral IM …

Subclinical Status Epilepticus In The Setting Of An Acute Covid-19 Infection, Thomas Rieth

Research Days

Background: While COVID-19 commonly presents as an upper respiratory infection, acute COVID infections has the potential to have multisystem involvement. Neurological symptoms, which have mainly been reported in adults, are rare in children and are not well recognized. Better understanding of the neurological manifestations of COVID-19 in children can lead to earlier detection of COVID-19 and help with medical decision making and treatment.

Objectives/Goal: To describe an unusual presentation of COVID-19 in a previously healthy female and explore the neurological presentations of COVID-19.

Results: A 10 year old previously healthy female presented with a 1 day history of altered mental …

A Case Of Fibrous Hamartoma In Term Neonate, Elizabeth Perry

Research Days

Case report abstract: Fibrous hamartoma of infancy (FHI) is a rare, benign lesion characterized as a tumor of myofibroblastic origin that has characteristic features of triphasic histology. FHI was first described in 1956 by Reye and formally named by Enzinger in 1965 (1, 2). The lesion is defined as a hamartoma due to the histologic presentation of disorganized mesenchymal, fibrous, and adipose tissue with absence of mitotic figures; this combination of derived tissue without evidence of anaplasia is diagnostic for FHI. These lesions typically arise as a single, solitary mass, are most commonly located on the extremities, trunk, sacrum, or …

Early Onset Obesity In A 4-Year-Old Female Found To Have Variants In Both The Single-Minded Homolog 1 And Sh2b Adaptor Protein 1 Genes, Erica Zarse

Research Days

No abstract provided.

Cases From A Community Hospital… Jchimp Series #1: 55-Year-Old Male With Acute Pe Who Developed Persistent Epistaxis., Jerrica N. Mueller, Bobby Mathew, Douglas D. Reh, Joseph Fuscaldo

Journal of Community Hospital Internal Medicine Perspectives

This is the first in a new series of case reports that will present real scenarios from our community hospital. The cases are chosen to highlight clinical dilemmas and offer review and perspective on what is currently known about the topic. We present the case of a 55-year-old Caucasian male who presented to the emergency department of our community hospital for worsening dyspnea. Evaluation in the Emergency department revealed a diagnosis of extensive pulmonary emboli in the pulmonary vasculature. The patient was admitted to the ICU. A clinical decision was made to initiate treatment with low-dose tissue plasminogen activator (tpa) …

Development Of A Community Hospital Medicine Affiliated Inpatient Rotation For Family Medicine Residents - A Collaborative Success, David M. Gallagher, Anthony J. Viera, William E. Bynum, Poonam Sharma, John W. Ragsdale, Jeffrey Eschbach, Lalit Verma

Journal of Community Hospital Internal Medicine Perspectives

Background: Hospitalists perform key roles as inpatient educators for family medicine residents. For the past decade, Duke University Family Medicine Residency Program had its inpatient family medicine resident rotation at non-Duke facilities.

Objective: The authors describe the steps taken in 2020 to develop an inpatient Duke family medicine rotation at a North Carolina community hospital, Duke Regional Hospital, and provide outcomes data.

Methods: Duke Family Medicine Residency and Duke Regional Hospital Medicine collaborated in addressing key issues to develop an inpatient rotation for family medicine residents. Performance metrics of patients cared for by both the family medicine inpatient resident team …

Duchenne’S Muscular Dystrophy & Occupational Therapy, Vanessa Sagredo, Meagan C. Romero

Client Educational Handouts

No abstract provided.

Social Media Use By Residents And Faculty In Otolaryngology Training Programs., Vrinda Gupta, Stephanie J Braverman, Johnny P Mai, Michael Noller, Macario Camacho, Anthony M Tolisano, Philip E. Zapanta

Health Sciences Education Research

OBJECTIVES: Despite the growth of social media in healthcare, the appropriateness of online friendships between otolaryngological residents and attendings is poorly defined in the current literature. This issue is of growing importance, particularly as residency programs increasingly utilize social media as a means of connecting with and evaluating applicants due to limited in-person experiences during the COVID-19 pandemic. Our objective was to better understand the prevalence of and concerns surrounding social media use between residents and faculty.

METHODS: This study sent out 2 surveys in 2017 to all United States Otolaryngology residency program directors to disperse to their residents and …

Comparison Of Collaborative Goal Setting With Enhanced Education For Managing Diabetes-Associated Distress And Hemoglobin A1c Levels: A Randomized Clinical Trial, Lechauncy Woodard, Amber B Amspoker, Natalie E Hundt, Howard S Gordon, Brian Hertz, Edward Odom, Anne Utech, Javad Razjouyan, Suja S Rajan, Nipa Kamdar, Jasmin Lindo, Lea Kiefer, Praveen Mehta, Aanand D Naik

Faculty, Staff and Student Publications

IMPORTANCE: Type 2 diabetes is a prevalent and morbid condition. Poor engagement with self-management can contribute to diabetes-associated distress and hinder diabetes control.

OBJECTIVE: To evaluate the implementation and effectiveness of Empowering Patients in Chronic Care (EPICC), an evidence-based intervention to improve diabetes-associated distress and hemoglobin A1c (HbA1c) levels after the intervention and after 6-month maintenance.

DESIGN, SETTING, AND PARTICIPANTS: This hybrid (implementation-effectiveness) randomized clinical trial was performed in Veterans Affairs clinics across Illinois, Indiana, and Texas from July 1, 2015, to June 30, 2017. Participants included adults with uncontrolled type 2 diabetes (HbA1c level >8.0%) who received primary care …

Fixed-Dose Prothrombin Complex Concentrate Versus Weight-Based Dose For Reversal Of Factor Xa Inhibitors, Kevin Chau, Bryce Winn, Peter Martsin

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2022

No abstract provided.

Evaluation Of Pharmacist-Led Transitions Of Care (Toc) Discharge Pilot Program For Reducing 30-Day Readmission Rates In Patients With Chronic Obstructive Pulmonary Disease (Copd, Ann Tong, Hyesoo Chae, Addison Pang, Tony Lucchi

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2022

No abstract provided.

Leveraging A Digital Platform To Address Health Literacy And Equity Needs Of A Vulnerable Population: The Justice-Involved, Gail M. Kouame

University Faculty and Staff Publications

This is a presentation given by Gail Kouame addressing the health disparities of incarcerated populations at the Wisconsin Health Literacy Summit in Madison Wisconsin.

The Difference In Quality Of Care With Patients Who Face Language Barriers In The Hospital, Camille Serrano

Nursing | Senior Theses

Background

This thesis aims to explore the difference in quality of care between those who are admitted into the hospital with a language barrier and those who are admitted with none. Communication was identified to be the most essential aspect of stable, effective, and successful nursing. One of the primary and most crucial roles as a nurse is to advocate for their patient, however due to this immutable health disparity the quality of care is spread so thin that those with diverse linguistic backgrounds are not receiving equal levels of care. When the efficacy of communication is lost, a nurse’s …

Antimicrobial Stewardship On Hospital Discharge: Pharmacist Intervention On Antibiotic Prescribing Practices, Jenny Zhu, Chinh Nguyen, Brent Footer

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2022

No abstract provided.

New Dentist News (May 2022), Ada Committee On The New Dentist

New Dentist News

New Dentist News offers timely information on scientific, social, educational, political and economic developments affecting new dentists. This collection is historical and items may not reflect current standards. For up-to-date information contact the ADA. The New Dentist News was alternately titled ADA Lifeline, 1997-June 2001.

A Survey To Highlight Areas Of Focus For Patient Care In Settings Utilizing Medical Interpretation, Azayzel Deregis

Undergraduate Honors Theses

This thesis recounts my personal experience working as a volunteer medical interpreter for the Language and Culture Resource Center at East Tennessee State University. The result of my time spent volunteering as a medical interpreter, shadowing professional medical interpreters, and witnessing patient-provider interactions during interpreted sessions was an inspiration to study medical interpretation further and delve into the challenges faced by patients who require medical interpreters. During my time researching this topic, I found that the United States is severely lacking in Spanish medical interpreters—with some healthcare facilities employing no medical interpreters—even though the size of the Hispanic population is …

Implementing Uniform Curriculum To Increase Efficiency And Access To Simulation, Christine Mallar, Bethany Rocheleau, Shelly Chipman, Mike Shepherd, Erin Siebers

Costas T. Lambrew Research Retreat 2022

• Using Standardized Patients (SPs) is effective in improving communication skills.

• Conducting SP training can be cost prohibitive in terms of time and labor.

• Demands of current curriculum created a need for an innovative and more efficient approach to meet new CLER requirement.