Medicine and Health Sciences Commons^™

A State-Level Study Of Opioid Use Disorder Treatment Access And Neonatal Abstinence Syndrome, Elizabeth R. Wolf, Sebastian T. Tong, Roy T. Sabo, Steven H. Woolf, Kassie Abbinanti, James Pecsok, Alex H. Krist

Pediatrics Publications

Background Adult opioid use and neonatal abstinence syndrome (NAS) are growing public health problems in the United States (U.S.). Our objective was to determine how opioid use disorder treatment access impacts the relationship between adult opioid use and NAS.

Methods We conducted a cross-sectional state-level ecologic study using 36 states with available Healthcare Cost and Utilization Project State Inpatient Databases in 2014. Opioid use disorder treatment access was determined by the: 1) proportion of people needing but not receiving substance use treatment, 2) density of buprenorphine-waivered physicians, and 3) proportion of individuals in outpatient treatment programs (OTPs). The incidence of …

Providers’ Perception Of Alert Fatigue After Implementation Of User-Filtered Warnings, Hina Afaq, Sahaana Mukundan, Sadaf Zia, Alisa K. Escano Dr., Rebecca Lear Dr., Casey Washington Dr.

Pharmacotherapy and Outcomes Science Publications

Alert fatigue is a complex problem that many health institutions face when using an electronic health record (EHR). The addition of user-filtered warnings (UFW) is a physicians’ proposed intervention at Inova Health System (IHS), a large 5-hospital health system in Northern Virginia, that allows prescribers to filter out specific drug-drug interactions and pregnancy and lactation medication alerts for a 30-day period. This study aims to determine the impact of UFW on physicians’ perception of alert fatigue and to calculate the reduction of medication alerts. It was hypothesized that the reduction in alerts will significantly impact physicians’ perception of alert fatigue …

A Systematic Review Of Cases Of Meningitis In The Absence Of Cerebrospinal Fluid Pleocytosis On Lumbar Puncture, Michelle Troendle, Alexis Pettigrew

Emergency Medicine Publications

Background: Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. However, meningitis may occur in the absence of pleocytosis on CSF.

Areas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. Further, there is little available literature on the subject.

Methods: Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. …

Using Er:Yag Laser To Remove Lithium Disilicate Crowns From Zirconia Implant Abutments: An In Vitro Study, Janina Golob Deeb, Sompop Bencharit, Nishchal Dalal, Aous Abdulmajeed, Kinga Grzech-Leśniak

Periodontics Publications

Background
When implants are restored with cement-retained restorations, prosthetic retrievability can be difficult and often requires sectioning using rotary instruments. Sometimes repeated removals of a cement-retained implant crown are needed such as for treatment of peri-implantitis or immediate implant provisionalization. The purpose of this study was to evaluate the effect of erbium-doped yttrium aluminum garnet (Er:YAG) laser as a non-invasive treatment modality to remove lithium disilicate crowns from zirconia implant abutments following long-term cementation, repetitive debonding and re-cementation, and short-term retrieval.

Material and methods
Twenty identical lithium disilicate crowns were cemented onto zirconia prefabricated abutments using composite resin cement. Ten …

Targeting Intracellular Calcium Stores Alleviates Neurological Morbidities In A Dfp-Based Rat Model Of Gulf War Illness, Laxmikant Deshpande, Edna Santos, Kristin Phillips, Robert Blair

Neurology Publications

Gulf War Illness (GWI) is a chronic multi-symptom disorder afflicting the veterans of the First Gulf War, and includes neurological symptoms characterized by depression and memory deficits. Chronic exposure to organophosphates (OP) is considered a leading cause for GWI, yet its pathobiology is not fully understood. We recently observed chronic elevations in neuronal Ca2+ levels ([Ca2+]i) in an OP- diisopropyl fluorophosphate (DFP) based rat model for GWI. This study was aimed at identifying mechanisms underlying elevated [Ca2+]i in this DFP model and investigating whether their therapeutic targeting could improve GWI-like neurological morbidities. Male Sprague-Dawley rats (9-wks) were exposed to DFP …

A Preliminary Investigation Towards The Risk Stratification Of Allogeneic Stem Cell Recipients With Respect To The Potential For Development Of Gvhd Via Their Pre-Transplant Plasma Lipid And Metabolic Signature, Daniel Contaifer Jr., Catherine H. Roberts, Naren Gajenthra Kumar, Ramesh Natarajan, Bernard J. Fisher, Kevin Leslie, Jason Reed, Amir A. Toor, Dayanjan S. Wijesinghe

Pharmacotherapy and Outcomes Science Publications

The clinical outcome of allogeneic hematopoietic stem cell transplantation (SCT) may be influenced by the metabolic status of the recipient following conditioning, which in turn may enable risk stratification with respect to the development of transplant-associated complications such as graft vs. host disease (GVHD). To better understand the impact of the metabolic profile of transplant recipients on post-transplant alloreactivity, we investigated the metabolic signature of 14 patients undergoing myeloablative conditioning followed by either human leukocyte antigen (HLA)-matched related or unrelated donor SCT, or autologous SCT. Blood samples were taken following conditioning and prior to transplant on day 0 and the …

A Competency-Based Approach To Faculty Development, Betsy Ripley Md, Jean Bailey Phd, Kenneth Warren Edd, Katherine J T Henderson Med

Publications from the Office of the Dean

Background—Faculty development at the Virginia Commonwealth University School of Medicine (VCU SOM) has previously focused on enhancing teaching and learning in the medical and clinical education settings. While this work is important, this narrow focus does not address all facets a faculty member’s role. To broaden their programming, the VCU SOM faculty development team adopted a competency-based approach to the development and planning of faculty development activities.

Summary of work—The Senior Associate Dean for Faculty Affairs completed a research project focused on successful medical faculty who promote through the tenure process and advance in their careers. She identified …

Dental Dam Utilization By Dentists In An Intramural Faculty Practice, Terence A. Imbery, Caroline K. Carrico

General Practice Publications

Objectives: From casual observation of our colleagues, only a few individuals use the dental dam for operative procedures in their faculty practice. The purpose of this study was to obtain faculty perceptions of the dental dam, quantify its utilization in their intramural faculty practice, and determine the factors that influence dental dam usage.


Materials and Methods: A survey containing 11 questions was sent to 19 faculty members who teach full time and maintain an intramural dental practice involving operative dentistry. Thirty electronic dental health records of the 19 providers were reviewed to gather the following information from restorative procedures they …

Medications And Patient Safety In The Trauma Setting: A Systematic Review, Jonathan H. Deantonio, Tammy Nguyen, Gregory Chenault, Michel B. Aboutanos, Rahul J. Anand, Paula Ferrada, Stephanie Goldberg, Stefan W. Leichtle, Levi D. Procter, Edgar B. Rodas, Alan P. Rossi, James F. Whelan, V. Ramana Freeser, Michael J. Vitto, Beth Broering, Sarah Hobgood, Martin Mangino, Dayanjan S. Wijesinghe, Sudha Jayaraman

Surgery Publications

Background: Medication errors account for the most common adverse events and a significant cause of mortality in the USA. The Joint Commission has required medication reconciliation since 2006. We aimed to survey the literature and determine the challenges and effectiveness of medication reconciliation in the trauma patient population.


Materials and methods: We conducted a systematic review of the literature to determine the effectiveness of medication reconciliation in trauma patients. English language articles were retrieved from PubMed/Medline, CINAHL, and Cochrane Review databases with search terms “trauma OR injury, AND medication reconciliation OR med rec OR med rek, AND effectiveness OR …

Use Of Endoloop In Video-Assisted Thoracoscopic Enucleation Of A Very Rare Esophageal Tumor, Yahya Alwatari, Wayne Tse, Kasia Trebska-Mcgowan, Rachit D. Shah

Surgery Publications

A gastrointestinal stromal tumor is an infrequent tumor of the gastrointestinal tract with very rare involvement of the esophagus. We present a case of a patient with dysphagia and a 4 cm submucosal mass. The patient underwent thoracoscopic enucleation with complete resection of the mass. We present case details and operative video highlighting the important surgical steps of exposure and retraction. We believe that the Endoloop is a very useful tool in providing countertraction needed during minimally invasive resection of such lesions.

Association Of Anti-Mullerian Hormone With C-Reactive Protein In Men, Dinesh Kadariya, Nargiza Kurbanova, Rehan Qayyum

Internal Medicine Publications

While serum anti-mullerian hormone (AMH) levels are inversely associated with all-cause mortality in men, the underlying mechanisms are unclear. Elevated levels of inflammation, also associated with all-cause mortality, and may be the link between AMH and mortality. Hence, we examined the association of AMH with serum c-reactive protein (CRP), a biomarker of inflammation, in men. We included men ≥20 years from the National Health and Nutrition Examination Survey (1999–2004). We used survey weight-adjusted linear regression to examine the association between AMH and CRP without and with adjustment for age, race, body mass index (BMI), smoking, hypertension, diabetes, cholesterol, glomerular filtration …

Unsaturated Fatty Acids To Improve Cardiorespiratory Fitness In Patients With Obesity And Hfpef, Salvatore Carbone, Hayley E. Billingsley, Justin M. Canada, Dinesh Kadariya, Horacio Medina De Chazal, Brando Rotelli, Nicola Potere, Bishal Paudel, Roshi Markley, Dave L. Dixon, Cory R. Trankle, Benjamin W. Van Tassell, Francesco S. Celi, Antonio Abbate

Internal Medicine Publications

No abstract provided.

The Association Between Urinary Genistein Levels And Mortality Among Adults In The United States, Carolyn Marcelo, Melissa Warwick, Catherine Marcelo, Rehan Qayyum

Internal Medicine Publications

Background
Current research on the relationship between phytoestrogens and mortality has been inconclusive. We explored the relationship between genistein, a phytoestrogen, and mortality in a large cohort representative of the United States population.


Methods: Data were analyzed from the National Health and Nutrition Examination Survey (NHANES) from 1999–2010. Normalized urinary genistein (nUG) was analyzed as a log-transformed continuous variable and in quartiles. Mortality data were obtained from the National Death Index and matched to the NHANES participants. Survival analyses were conducted using the Kaplan-Meier analysis. Cox proportional hazard models were constructed for all-cause and cause-specific mortality without and with …

Remote Ischemic Pre-Conditioning Attenuates Adverse Cardiac Remodeling And Mortality Following Doxorubicin Administration In Mice, Zachary M. Gertz, Chad Cain, Donatas Kraskauskas, Teja Devarakonda, Adolfo G. Mauro, Jeremy Thompson, Arun Samidurai, Qun Chen, Sarah W. Gordon, Edward J. Lesnefsky, Anindita Das, Fadi N. Salloum

Internal Medicine Publications

Objectives

Because of its multifaceted cardioprotective effects, remote ischemic pre-conditioning (RIPC) was examined as a strategy to attenuate doxorubicin (DOX) cardiotoxicity.

Background

The use of DOX is limited by dose-dependent cardiotoxicity and heart failure. Oxidative stress, mitochondrial dysfunction, inflammation, and autophagy modulation have been proposed as mediators of DOX cardiotoxicity.

Methods

After baseline echocardiography, adult male CD1 mice were randomized to either sham or RIPC protocol (3 cycles of 5 min femoral artery occlusion followed by 5 min reperfusion) 1 h before receiving DOX (20 mg/kg, intraperitoneal). The mice were observed primarily for survival over 85 days (86 mice). An …

Metabolic Modulation Predicts Heart Failure Tests Performance, Daniel Contaifer Jr., Leo F. Buckley, George Wohlford, Naren G. Kumar, Joshua M. Morriss, Asanga D. Ranasinghe, Salvatore Carbone, Justin M. Canada, Cory Trankle, Antonio Abbate, Benjamin W. Van Tassell, Dayanjan S. Wijesinghe

Pharmacotherapy and Outcomes Science Publications

The metabolic changes that accompany changes in Cardiopulmonary testing (CPET) and heart failure biomarkers (HFbio) are not well known. We undertook metabolomic and lipidomic phenotyping of a cohort of heart failure (HF) patients and utilized Multiple Regression Analysis (MRA) to identify associations to CPET and HFBio test performance (peak oxygen consumption (Peak VO₂), oxygen uptake efficiency slope (OUES), exercise duration, and minute ventilation-carbon dioxide production slope (VE/VCO₂ slope), as well as the established HF biomarkers of inflammation C-reactive protein (CRP), beta-galactoside-binding protein (galectin-3), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP)). A cohort of 49 patients with …

Glycosaminoglycans And Glycosaminoglycan Mimetics In Cancer And Inflammation, Shravan Morla

Medicinal Chemistry Publications

Glycosaminoglycans (GAGs) are a class of biomolecules expressed virtually on all mammalian cells and usually covalently attached to proteins, forming proteoglycans. They are present not only on the cell surface, but also in the intracellular milieu and extracellular matrix. GAGs interact with multiple ligands, both soluble and insoluble, and modulate an important role in various physiological and pathological processes including cancer, bacterial and viral infections, inflammation, Alzheimer’s disease, and many more. Considering their involvement in multiple diseases, their use in the development of drugs has been of significant interest in both academia and industry. Many GAG-based drugs are being developed …

Identifying Attrition Phases In Survey Data: Applicability And Assessment Study, Camille J. Hochheimer, Roy T. Sabo, Robert A. Perera, Nitai Mukhopadhyay, Alex H. Krist

Biostatistics Publications

Background: Although Web-based questionnaires are an efficient, increasingly popular mode of data collection, their utility is often challenged by high participant dropout. Researchers can gain insight into potential causes of high participant dropout by analyzing the dropout patterns.

Objective: This study proposed the application of and assessed the use of user-specified and existing hypothesis testing methods in a novel setting—survey dropout data—to identify phases of higher or lower survey dropout.

Methods: First, we proposed the application of user-specified thresholds to identify abrupt differences in the dropout rate. Second, we proposed the application of 2 existing hypothesis testing methods to detect …

Promoting Cultural Humility: Lgbtqia+ Education For Healthcare Providers, Lexi Robertson, Lauren Connelly

VCU Health Nursing

Abstract:

Purpose:

LGBTQIA+ patients experience devastating mental health and substance abuse disparities. While our organization has a broad non-discrimination statement that includes gender identity and sexual orientation, there is no guidance for how to best serve these patients. Evidence suggests training sessions are a successful means of increasing LGBTQIA+ cultural competency, with “Safe Zone” identified as being especially successful on college campuses. The Healthcare Equality Index also calls for education to demonstrate healthcare organizations’ commitment to LGBTQIA+ patients.

Intervention:

We developed an educational workshop - Safe Zone – with university psychologists. This workshop included interactive exercises that focused on increasing …

Own Your Outcomes: Driving Down Hapis In The Cardiac Surgery Intensive Care Unit, Linda Currie

VCU Health Nursing

Abstract:

Purpose (What): To achieve sustainable reduction of pressure injury (PI) rates through systematic culture change, in a quaternary, level 1, urban academic medical center cardiac surgery intensive care unit (CSICU).

Relevance/Significance (Why): The CSICU is a high-risk patient population, hosting multiple potential barriers to pressure injury prevention. Prior to 2012, the CSICU pressure injury rate was 17% higher than the National Database of Nursing Quality Indicators benchmark, negatively impacting patient outcomes and organizational goals. Leveraging Magnet principles of Evidence-Based Practice, CSICU advanced practice nurse leaders empowered and motivated bedside nurses to lead and sustain unit culture change.

Strategy and …

Creating A Clinical Ladder Education Program For Perioperative Surgical Services (Clepps), Velma Davis, Natalie Sorensen

VCU Health Nursing

Problem Statement:

Low participation in challenging the Clinical Ladder within the Perioperative Surgical Services was observed. The period 2016-2017, only five nurses from the department challenged and were successful on the ladder. As a process improvement initiative, the department implemented CLEPPS, using the organization’s clinical ladder program as a tool.

Background:

It is documented in the literature that a robust Clinical Ladder Program increases staff satisfaction, enhances professional development, and improve patient outcomes.

The Perioperative Surgical Services has a total of 102 Clinical Nurse II within the department who were eligible for advancement on the clinical ladder. An internal survey, …

Multimodal Needs Assessments For Curricular Refinement – Learner, Expert, Emr, Catherine Grossman

Health Sciences Education Symposium

OBJECTIVES •Explore the educational formats and resource preferences of house staff •Identify ICU topics thought to be important by experts in the field •Identify clinically relevant ICU topics •Build an interactive, standardized cognitive aid that serves both as an instructional resource for house staff and a prompt for those teaching

A Guide To Prescribing Sufficient Post Surgical Quantities Of Opiate Pain Medications, Adam Pflugrath

Health Sciences Education Symposium

Purpose: To examine opiate pain medication prescription and consumption after surgical procedures at VCU Medical Center.

Mistreatment Of Providers By Patients In Emergency Medicine, Cyrus Massouleh

Health Sciences Education Symposium

Background: •Mistreatment and disrespect of healthcare providers including verbal harassment, sexual harassment, and physical harassment is relatively commonplace in the clinical setting. •Per Bureau of Labor Statistics, healthcare professionals are at a 16x greater risk of violence than professionals in other service fields1. •Much of this mistreatment is from colleagues and superiors2, but a significant portion is from patients and their families with prior studies showing anywhere from 6-67% percent of the mistreatment done by patients or their families2,4,5,6. •Providers may feel that being mistreated is an expected part of the job7,8. •Many resources have been dedicated to understanding and …

Using A Mixed Methods Approach To Explore Perceptions Of Early Learners In Classroom-Based Interprofessional Education Experiences, Abigale Matulewicz

Health Sciences Education Symposium

Background:

- Interprofessional education (IPE) is a global imperative

- Health profession education programs, motivated by accreditation requirements, have added IPE activities into their required curricula.

- Curriculum development varies considerably across institutions and debate exists regarding appropriate timing for introducing learners to IPE in order to optimally improve health outcomes.

- Some evidence shows benefit of early learner IPE in professional identity development, interprofessional socialization and positive attitude development toward interprofessional practice.

- At Virginia Commonwealth University (VCU), IPE is integrated longitudinally through the curriculum for several of the health professions programs via IPEC courses.

Stress And Wellness Levels In Emergency Medicine Residents And Attendings Compared To Residents And Attendings From Other Specialty Training Programs, Grace Hickam

Health Sciences Education Symposium

Introduction:

Physicians are at high risk for burnout when compared to the general population. Burnout is a constellation of symptoms characterized by emotional exhaustion, depersonalization and decreased/low sense of personal accomplishment¹. Burnout affects health, relationships, motivation, and patient outcomes. Elements of emergency medicine (EM) may make EM residents/attendings more vulnerable to stress. Examining physician resilience and finding ways to implement change is essential to improving the culture of residency training. The objective of this study was to compare well-being and stress between EM residents and other residents and to compare EM residents and attendings.

Follow Up: Medical Rhetoric – Making The Case For Oral Presentations, Rabia Qaiser

Health Sciences Education Symposium

Goal: •Oral case presentation skill is fundamental in clinical communication •This skill is first developed in medical school pre-clinical training •Continued development is often by “Trial and Error” – often without a formal curriculum Purpose: Development of a new curriculum designed to acknowledge the importance of this skill development and create a method in building this skill mindfully

Medical Education Board Game: Interactive Learning, Ulysses Davila

Health Sciences Education Symposium

Background:

Researchers have been interested in promoting improved retention of medical knowledge through custom designed board games for a number of years (Bochennek, et al 2007, Karbownik et al, 2016, and Shaw et al 2013). Studies demonstrate at least a subjective medical student desire to continue to develop study methods like board games for routine use in medical education.

Use Of 360-Degree Assessment During Interprofessional Simulation To Enhance Formative Feedback, Kelly Lockeman

Health Sciences Education Symposium

Background: •Effective interprofessional teamwork is essential for quality patient care [1], and within-team feedback improves team performance [2]. •Learners trained to assess peers are more confident and skilled at evaluating others and better prepared to provide meaningful feedback to their colleagues when they enter the workforce [3,4]. •This is particularly important in interprofessional teams where tensions between professional groups can create unique challenges [5].

Implementation Of A Workplace-Based Assessment To Measure Performance Of The Core Entrustable Professional Activities In The Pediatric Clerkship, Clifton Lee

Health Sciences Education Symposium

Background: In 2013, the AAMC convened a panel of medical education experts to delineate the 13 Core Entrustable Professional Activities (Core EPAs) medical school graduates should be able to perform without direct supervision by day one of their residency. 1 Assessment of these EPAs requires direct observation to render entrustment decisions. 2 As part of our engagement in the AAMC Core EPA pilot,3 we created a workplace-based assessment (WBA) system to assist in measurement of student performance for the Core EPAs at the Virginia Commonwealth University School of Medicine.

For the Pediatrics clerkship, we identified 6 Core EPAs to assess …

Prioritizing Urinary Incontinence For Current And Future Healthcare Professionals, Leighton N. Thumm

Health Sciences Education Symposium

Introduction: •Urinary incontinence (UI) is a common syndrome that often goes unreported and undiagnosed •As calls to action from the National Institute on Aging and American Geriatrics Society suggest, the healthcare workforce must work interprofessionally to meet the needs of people with UI •Understanding the challenges of and opportunities for improving continence care in Virginia is a first step •The primary goal of this study was to assess changes in awareness of and confidence in providing interprofessional UI care after participating in an interactive workshop