Medicine and Health Sciences Commons^™

Gastrointestinal Symptoms In Patients With Covid-19, Mohammed Abbas, Rafik Elbeblawy, Islam Gadelmoula, Suvarna Rekha, Bettina Sinanova, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Introduction: Though coronavirus disease 2019 (COVID-19) is predominantly a respiratory illness, a growing number of studies reported gastrointestinal (GI) symptoms among these patients. We examined the incidence of GI symptoms in patients with COVID-19 and GI symptoms as the initial presentation of the disease.

Methods: We examined peer-reviewed studies in English of patients with COVID-19 that reported GI symptoms. We searched PubMed and Google Scholar for articles published up to June 30, 2020, by using the keywords ``COVID-19,'' ``Coronavirus,'' ``severe acute respiratory syndrome coronavirus 2,'', ``SARS-CoV-2,'' ``gastrointestinal tract,'' ``gastrointestinal diseases,'' and ``gastrointestinal symptoms and signs.'' Studies with fewer than 30 …

Gender Identity And Pronoun Usage In Standardized Patient Encounters, Martha M. Popescu, Emily J. Noonan, Laura A. Weingartner

Undergraduate Research Events

The standardized documentation clinicians use to record evaluations of a patient are called Subjective, Objective, Assessment, and Plan (SOAP) notes. Consistent pronoun documentation and usage in these notes is especially important for affirming transgender and gender non-conforming patients as this population experiences significant health disparities linked to medical mistrust. A sample of SOAP notes (n=286) was taken from standardized patient encounters at the University of Louisville School of Medicine in 2017 (n=137) and 2018 (n=149). There were five case iterations of the standardized patient based on gender identity. The notes were coded using the software Dedoose for the following themes: …

Letters That Will Not Be Read, Kaila Pomeranz

Journal of Wellness

No abstract provided.

Wellness In The Helping Professions: Historical Overview, Wellness Models, And Current Trends, Ashley J. Blount, Dalena L. Dillman Taylor, Glenn W. Lambie

Journal of Wellness

Introduction

Wellness and the concept of holism have rich histories throughout the helping professions. However, Westernized medical models often promote the concept of treatment rather than prevention, limiting the helper’s ability to focus on wellness when working with clients/patients. Therefore, in order to support a re-integration to holistic wellness and the prevention of illness, and re-focus on a wellness ideology, we conducted a thorough theoretical overview of wellness in the helping professions to: (a) provide a historical overview of wellness in helping professions, (b) discuss prominent wellness models, (c) review wellness assessments, (d) present wellness supervision models, and (e) offer …

Impact Of Metformin On Feeding, Behavior, And Metabolism In Drosophila Melanogaster., Erica E. Hassoun, Heba Kourhabi, Jason Bui Ho, Dae-Sung Hwangbo

Undergraduate Research Events

Metformin is a first-line drug used in the treatment of type II diabetes mellitus and is the 4th-most prescribed drug in the United States. It functions in lowering blood glucose levels and increasing insulin sensitivity. Despite its wide scale use, the degree to which it affects aspects of behavior and metabolism unrelated to diabetes is not fully understood.

Recent studies have attempted to fill this gap, particularly in the context of metformin’s impact on lifespan. We decided to extend this research by focusing on measurable behaviors as well as traits related to metabolism and physiology. Using the fruit fly Drosophila …

Doc’Apella: A Vocal Performance Group Designed To Reduce Stress And Prevent Burnout Among Medical And Health Sciences Students, Kristy J. Carlson, Laura E. Newton, Paul J. Brosnihan, Steven P. Wengel, Jayme R. Dowdall

Journal of Wellness

Introduction: Burnout is common among health professions trainees characterized by emotional exhaustion induced by repeated stressors. Although traditional stress management activities to promote wellness are effective in reducing stress short-term, alternative approaches are needed with the potential for long-term impact. To address burnout among students at the University of Nebraska Medical Center (UNMC), a vocal group was formed to provide a creative outlet. The purpose of this study was to determine the students’ motivation for joining Doc’Apella and assess the impact on burnout.

Methods: Students enrolled in a health sciences program were invited to participate during the 2018-19 academic year …

Gastrointestinal Sars Cov-2 Infection And The Dynamic Of Its Detection In Stool, Rafik Elbeblawy, Mohammed Abbas, Islam Gadelmoula, Akshitha Kolla, Bettina Sinanova, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Introduction: SARS-CoV-2 has been strongly associated with respiratory illnesses; however the incidence of SARS-CoV-2 infection of the gastrointestinal tract is not fully clear. We examined the frequency of positive stool SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) in COVID-19 patients, duration of stool viral shedding after the viral clearance of respiratory samples, and the association of SARS-CoV-2 infection with gastrointestinal symptoms.

Methods: We did a search in PubMed and Google Scholar of studies published in the English language before June 30th, 2020. Search queries included: “COVID-19”, “SARS-CoV-2”, and “stool SARS-CoV-2 RT-PCR”. We excluded studies with less than 8 patients from our …

A Review Of Quarantine Period In Relation To Incubation Period Of Sars-Cov-2, Satya Rashmit Durugu, Hammad Tanzeem, Divya Menghani, Zahid Imran, Priya Krishnan

The University of Louisville Journal of Respiratory Infections

Introduction: The period from exposure to a potential pathogen to the manifestation of symptoms, i.e.  the incubation period, is time the virus spends replicating in the host. An estimation of this period and subsequent quarantine of the host can limit potential spread, particularly in asymptomatic carriers. Effective contact tracing, length of self-quarantine, repeat testing, and understanding of disease transmission are all contingent on a true estimation of this incubation period.

Methods: Articles in English published since December 1st, 2019, on Google scholar, PubMed, and Research Gate, along with bulletins from the World Health Organization and the Centers for Disease Control …

Covid-19 Is Associated With Increased Severity In Pregnant Women, Zahid Imran, Vidyulata Salunkhe, Ahmed A. Eladely, Ahmed Abdelhaleem, Satya Durugu, Daisy Sangroula

The University of Louisville Journal of Respiratory Infections

Introduction: The COVID-19 pandemic originated in China in late 2019; the number of cases is increasing with 2,104,346 cases and 116,140 deaths in the United States as of June 16, 2020. Pregnant women are a vulnerable population in epidemics or pandemics. This review is designed to look in detail at the severity of COVID-19 in pregnant women compared to non-pregnant women of reproductive age.

Methods: Literature searches on PubMed, Google Scholar, the Lancet, and Web of Science were conducted.

Results: We found evidence of increased risk for severe disease and distinctive symptoms among pregnant women diagnosed with COVID-19 compared …

Resilience, Moral Distress, And Workplace Engagement In Emergency Department Nurses, Paul Clark, Timothy Crawford, Brandonn Hulse, Barbara Polivka

Faculty Scholarship

This cross-sectional, correlational study’s purpose was to evaluate the effects of resilience and moral distress on workplace engagement in emergency department nurses providing direct patient care. Data were collected from 175 emergency department nurses using a Web-based survey. The higher the nurses’ resilience and the lower their moral distress, the greater their workplace engagement. Resilience and moral distress were not correlated; furthermore, moral distress did not mediate a relationship between resilience and workplace engagement. Resilience was higher with greater job satisfaction, increased age, and longer tenure as a nurse. Workplace engagement increased with higher job satisfaction and less time seeking …

Promoting Resident Emotional Health Meaningful Connections: An Evaluation Of A Wellness Game, Bruce St. Amour, William B. Dehart

Journal of Wellness

Introduction

Physician wellness is a topic of significant national interest. Physician burnout is at its highest point during residency and is linked to many negative outcomes. The Core Emotional Needs are a useful framework to guide thinking toward wellness in residents: connection and acceptance, healthy autonomy and performance, reasonable limits, and healthy responsibility and standards. We examined the efficacy of a game (“Well, For Me…”) designed to improve social connection and acceptance among residents to reduce social isolation. We hypothesized that this activity would be viewed positively by the residents as an intervention to improve resident wellness.

Methods

Participants …

Eliciting Information During A Standardized Patient History, Sydney E Greene, Laura Weingartner, Emily Noonan

Undergraduate Research Events

ELICITING INFORMATION DURING A STANDARDIZED PATIENT HISTORY

AUTHORS

Sydney Greene, BA Candidate; Emily J Noonan, PhD, MA; Laura A. Weingartner, PhD, MS

BACKGROUND

Learning how to take a detailed patient history is a fundamental skill that is essential for all medical students to master. Understanding the amount of information elicited in various categories of a patient history may reveal areas where many students struggle to engage the patient, gaps in medical education that could be addressed, or possible predictors of patient satisfaction.

METHODS

I coded videos of rising third year medical students as they took a patient history and counted …

Prevalence Of Hormone Prescription And Education For Cis And Trans Women By Medical Trainees, Madison T Meister, Laura A. Weingartner, Emily J. Noonan

Undergraduate Research Events

PREVALENCE OF HORMONE PRESCRIPTION AND EDUCATION FOR CIS AND TRANS WOMEN BY MEDICAL TRAINEES

AUTHORS

Madison Meister, BA Candidate; Emily J Noonan, PhD, MA; Laura A. Weingartner, PhD, MS

BACKGROUND

Hormone replacement therapy is a common healthcare practice for contraception, hormone control, and menopause treatment. Transgender patients may also take hormones to affirm their gender identity, such as feminizing hormones (estrogen), for transgender women. Studying how trainees discuss hormone risks for both cis and trans women can demonstrate if disparities exist and how we may address them to overcome healthcare barriers.

METHODS

Fifty videos were analyzed of third-year medical students …

Looking Beyond A Rare Presentation Of Betel Nut Use In A North American Patient- An Opportunity For Lessons And Intervention In Global Health And Gender Equity, Muhammad O. Zaman, Thomas M. Park, Vikas Patel, Riley G. Jones

Journal of Refugee & Global Health

Betel nut is estimated to be the fourth most common psychoactive substance used globally behind caffeine, alcohol, and nicotine with 600 million global users. Betel nut use has a strong association with oral cancer and many other systemic effects including oral submucosal fibrosis. Although North American use is rare, its enduring effects may surface long after use posing a diagnostic challenge to practitioners caring for an increasingly global diaspora. Herein, we present a patient with severe trismus due to advanced oral submucosal fibrosis who was unexpectedly found to be importing and using Betel nut for over thirty years after immigrating. …

Gaining A “Foothold” On The Diagnosis Of Leishmaniasis, Brent M. Troy, Rebecca Hart, Navjyot Vidwan, Bethany Hodge

Journal of Refugee & Global Health

Pediatric refugees and immigrants may present with unusual diagnoses due to their extensive migration and potential harsh conditions in travel. Trauma and family separation add to the difficulty of obtaining a history of exposures. We report a case of one of the more commonly neglected tropical diseases, Leishmaniasis. A 15-year-old male refugee patient presented to the hospital with ulcerative lesions to his legs. His migration history was extensive, starting in Central Africa with travel to South America, followed by migration through Central America to Texas. The patient developed ulcerative lesions on his legs, and he was brought to the children’s …

Factor Structure And Measurement Invariance Of The Maslach Burnout Inventory In Emergency Medicine Residents, Tim P. Moran, Nicole Battaglioli, Simiao Li-Sauerwine

Journal of Wellness

Introduction: Emergency medicine residents suffer from high rates of occupational burnout. Recent research has focused on identifying risk and protective factors for burnout as well as targets for intervention. This research has primarily employed the Maslach Burnout Inventory to evaluate burnout in this population. Factor analytic work has identified three underlying factors measured by the Maslach Burnout Inventory: Emotional Exhaustion, Depersonalization, and Personal Accomplishment. However, this three-factor structure has not been evaluated in emergency medicine residents. Furthermore, its structural equivalence has not been demonstrated across commonly-studied risk factors, such as gender and year of post-graduate training. In the present study, …

The Incidence Of Common Respiratory Viruses During The Covid-19 Pandemic: Results From The Louisville Covid-19 Epidemiology Study, Brian C. Bohn Pharmd, Bcidp, Ashley M. Wilde Pharmd, Bcps-Aq Id, Sarah E. Moore Pharmd, Matthew Song Pharmd, Bcidp, Clayton J. Patross Pharmd, Bcps, Alan D. Junkins Phd, D(Abmm), Paul Schulz Md, Julio A. Ramirez Md Facp

The University of Louisville Journal of Respiratory Infections

Introduction: Social distancing has been utilized during the COVID-19 pandemic to reduce the spread of SARS-CoV-2; it is also expected to reduce the spread of common respiratory viruses.

Methods: This retrospective, descriptive study assessed the rate of positivity of common respiratory viruses from a commercially available respiratory pathogen panel across a five-hospital health system during four-week periods within March to April of 2019 and 2020.

Results: During the four-week period in 2019, the percent positivity of common respiratory viruses from week 1 to week 4 decreased from 6 to 32% among the four included viruses. In the comparator period in …

How Medical Students Screen For Hiv With Standardized Patients Establishing Care., Christopher J. Brown, Emily J. Noonan, Laura A. Weingartner

Undergraduate Research Events

How Medical Students Screen for HIV with Standardized Patients Establishing Care

AUTHORS

Christopher J. Brown, B.S., B.A. Candidate; Emily J Noonan, PhD, MA; Laura A. Weingartner, PhD, MS

BACKGROUND

Approximately 1.1 million people in the U.S. are living with HIV. The US Preventive Services Task Force (USPSTF) recommends HIV testing for everyone 15-65 years old at least once regardless of sexual activity, with more frequent testing for those considered at risk.

METHODS

Rising third-year medical students were recorded taking health histories from standardized patients. These recordings were coded for HIV screening, including: risk factors such as unprotected sex, intravenous drug …

Wellness Review 2020, Part 1, Jacob Shreffler, Brian A. Ferguson, Martin Huecker

Journal of Wellness

Introduction: Welcome to Part 1 of the bi-annual Journal of Wellness review of 2020 wellness literature (January – June). In this review, JWellness editors continue the goal of bringing a cohesive awareness of recent publications within the wellness domain, encompassing wellness leaders from all disciplines in healthcare. We provide insight into unique perspectives and new science published outside of JWellness, dealing with burnout prevention and wellness initiative implementation.

Methods: PubMed was searched for empirical research studies, review articles, and editorials using keywords such as “wellness,” “well-being,” “burnout” and “healthcare professionals.” We have included 26 articles in this review.

Literature in …

Evaluating Family Satisfaction On An Advanced Certification Palliative Care Unit., Ruby Aebersold

Doctor of Nursing Practice Papers

Inpatient palliative care programs with The Joint Commission (TJC) Advanced Certification for Palliative Care are accountable for evaluating multiple health outcomes, including family satisfaction. A midwestern urban hospital’s palliative care unit received certification in January 2019. To comply with TJC standards, a clear data management and evaluation plan for family satisfaction data was needed. Investigation of the previous family satisfaction measure processes revealed areas in need of improvement in the satisfaction survey distribution, data collection, and evaluation processes. Satisfaction surveys were often unable to be distributed to families of deceased patients because the documented mailing address was a nursing facility. …

Nursing And Caregiver Satisfaction And The Implementation Of A Discharge Education Roadmap For Newly Diagnosed Pediatric Oncology Patients., Sable Iglesias

Doctor of Nursing Practice Papers

The initial diagnosis of a pediatric cancer is a stressful and overwhelming experience. During this time, distressed caregivers are expected to learn about the diagnosis, treatment plan, and how to care for their child at home. Simultaneously, parental reactions to a new cancer diagnosis often make learning a difficult process. The discharge education process is often a responsibility of the nursing staff. However, there are currently no evidence-based, systematic guidelines to direct the discharge education process of newly diagnosed pediatric oncology patients. Consequently, there is a lack of standardization across institutions, resulting in considerable variability in content provided in teaching …

Implementing A Standardized Pediatric Bone Marrow Transplant Orientation., Erika L. Shell

Doctor of Nursing Practice Papers

Nurse orientation programs focus on establishing a nurse’s ability to perform skills necessary in the organization’s setting. The purpose of this project was to develop a unit-specific orientation program for the experienced registered nurse transitioning into providing care for pediatric bone marrow transplant (BMT) patients at a local children’s hospital to enhance nurse knowledge and satisfaction. Melnyk and Fineout-Overholt’s rating system for the hierarchy of evidence was used in the selection of articles with high levels of evidence for the critical appraisal of the supporting literature for the program development. The best practices for orientation content provide constructive effects on …

Alcohol Misuse And Abuse Among College Students: An Implementation Of A Screening Program., Tiffany Slaughter Newcomb

Doctor of Nursing Practice Papers

Excessive alcohol use in the United States creates serious economic, health, and mortality problems (CountyHealthRankings, 2018). College students experience high rates of use, binge drinking, and 20% of college students meet the criteria for alcohol use disorder [AUD] (NIH, 2014). Screening by healthcare providers (HCPs) in the student health setting is critical and a recommended strategy for reducing negative consequences of alcohol use experienced by college students (US Preventive Services Task Force, 2018).

Aims: The objective of this project was to implement an alcohol screening program among college-age undergraduate students in a university student health center.

Methods: HCPs …

Soluble Epoxide Hydrolase Inhibition: A Novel Therapeutic Strategy In Alcoholic Liver Disease., Jeffrey Barr Warner

Electronic Theses and Dissertations

Emerging evidence suggests that soluble epoxide hydrolase (sEH) inhibition is a valuable therapeutic strategy for the treatment of numerous diseases. sEH rapidly degrades cytochrome P450-produced epoxygenated lipids (epoxy-fatty acids, epFAs), which generally exert beneficial effects on several cellular processes. sEH hydrolysis of epoxy-fatty acids produces dihydroxy-fatty acids which are typically less biologically active than their parent epoxide. sEH inhibition has shown efficacy in treating numerous pathologies associated with non-alcoholic liver disease, yet no efforts to date have tested the efficacy of sEH inhibition in alcoholic liver disease (ALD). Herein, we measured the levels of sEH expression and epFAs in human …

Moral Distress And Moral Residue Among Nurses Working In The Surgical Intensive Care Unit: A Descriptive Qualitative Approach., Adam Tyler Booth

Electronic Theses and Dissertations

Introduction: Approximately one in five Americans will die in the intensive care unit (ICU). Nurses spend more time with chronically ill and end-of-life patients than any other healthcare professional, and may perceive some actions in the ICU as immoral. Moral distress is defined as knowing the right course of action to take but being hindered by institutional constraints. Development of the Moral Distress Scale-Revised revealed that 31% of ICU nurses left a prior position or considered leaving their current nursing job because of moral distress. The purpose of this descriptive qualitative study is to explore surgical ICU (SICU) nurses’ perceptions …

Identification And Structural Characterization Functional Motifs In The Porphyromonas Gingivalis Mfa1 Short Fimbria., Mohammad K. Roky

Electronic Theses and Dissertations

Porphyromonas gingivalis is a causative agent of periodontal disease, initially colonizes the oral cavity by adhering to commensal streptococci. Adherence requires the interaction of the minor fimbrial protein (Mfa1) of P. gingivalis with streptococcal antigen I/II (Ag I/II). A peptide derived from Ag I/II peptide has been well characterized and shown to significantly reduce P. gingivalis colonization and bone loss in vivo, suggesting that this interaction represents a potential target for therapeutic intervention. However, the functional motifs of Mfa1 involved in the interaction with Ag I/II remain uncharacterized. A series of N- and C-terminal peptide fragments of Mfa1 were …

Epithelial Responses To Porphyromonas Gingivalis In The Community Context., Zackary Ray Fitzsimonds

Electronic Theses and Dissertations

Porphyromonas gingivalis, a keystone pathogen for periodontal disease, initiates a complex molecular dialogue with gingival epithelial cells, leading ultimately to disruption of host signaling pathways. Dysbiotic host responses are also thought to contribute to the initiation and progression of oral squamous cell carcinomas. Recently, the homeostatic commensal Streptococcus gordonii has been shown to antagonize P. gingivalis-induced epithelial cell signaling events in host cells, such as proliferation and migration. The aim of this study was to characterize pathways that P. gingivalis targets to disturb host signaling, with a specific focus on pathways that S. gordonii can restore to homeostatic …

Modulation Of Inflammatory Pathway By Inflammatory Inhibitor Jsh-23 Mitigates Diabetic Retinopathy., Rubens Petit Homme

Electronic Theses and Dissertations

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM). Its pathology is consisted of the breakdown of the blood-retinal barrier (BRB), particularly the inner blood-retinal barrier (iBRB). The exact mechanism that leads to the iBRB impairment and the development of DR has not been elucidated yet. However, chronic inflammation that is hallmark of the type I DM has recently become a key focus in DR study. Hyperglycemia causes dysregulation of nuclear factor-kappa B (NF-kB); and its constant activation increases the expression of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and intercellular adhesion molecule-1 (ICAM-1) in the …

Trust In Primary Care Providers: Perspectives From Deaf People., Greir Ander Huck Flynn

Electronic Theses and Dissertations

Trust is an integral part of the patient-provider relationship, responsible for influencing several key aspects of healthcare behaviors and patient perceptions of health outcomes. Though the topic has previously been discussed by scholars, little evidence exists to support the application of our understanding of trust in culturally Deaf populations. As such, this dissertation seeks to lay the necessary groundwork for further investigations on the topic by first understanding the nature of trust in patient-provider relationships from the perspectives of culturally Deaf people. The dissertation is comprised of five chapters. The first chapter provides an introduction to salient terms and concepts …

Tumor-Derived Exosomes Drive Immunosuppressive Macrophages In A Pre-Metastatic Niche Through Nf-Kβ Dependent Glycolytic Metabolic Reprogramming., Samantha M. Morrissey

Electronic Theses and Dissertations

The formation of a pre-metastatic niche is a fundamental requirement for primary tumor metastasis. One of the defining characteristics of a pre-metastatic niche is infiltration of immunosuppressive macrophages. However, how these macrophages acquire their immunosuppressive phenotype remains largely unexplored. Here, we demonstrate that tumor-derived exosomes (TDE) polarize macrophages towards an immunosuppressive phenotype characterized by increased PD-L1 expression through NF-kB-dependent metabolic reprogramming in mice and humans. While NF-κB has previously been shown to act as a direct transcription factor for PD-L1, we report a novel mechanism where TDE-induced NF-κB activation drives PD-L1 expression by augmenting the glycolytic capacity of macrophages through …