Medicine and Health Sciences Commons^™

Comparison Of Multiple Iol Power Calculation Formulas Using Keratometric Data From A Scheimpflug Camera Vs. Swept-Source Oct, Vinicius S. Stefano Et Al.

Graduate Medical Education Research Journal

No abstract provided.

Ergonomics Of Mesh Placement In Robotic Versus Laparoscopic Inguinal Hernia Repair, Kelsey R. Tieken Et Al

Graduate Medical Education Research Journal

No abstract provided.

Utilization Of Telehealth In The Developmental Behavioral Clinics At The University Of Nebraska Medical Center, Beatrice Egboh Et Al

Graduate Medical Education Research Journal

No abstract provided.

Successful Treatment Of Radiation-Induced Colitis And Enteritis With Hyperbaric Oxygen Therapy, Mark D. Ringle, Jeffrey S. Cooper

Graduate Medical Education Research Journal

Introduction

Previously irradiated tissue is characterized by changes including decreased vascularity, impaired cellular proliferation, and local hypoxia consistent with fibroblastic atrophy which can persist long after radiation therapy. Hyperbaric oxygen therapy has been shown to be beneficial in the treatment of complications arising from these late effects of radiation on normal tissue through enhancing fibroblast proliferation, collagen maturation, stem cell recruitment, and angiogenesis.

Methods

We report on three patients with debilitating radiation enterocolitis causing issues including recurrent bowel obstruction, anorexia requiring total parenteral nutrition, pain, diarrhea, fecal incontinence, dehydration, and malnutrition.

Results

In all three cases marked improvement was the …

Hybrid Laparoscopic And Endoscopic Management Of Gastric Band Erosion Resulting In Bowel Obstruction, Katie Marrero Md, Michael Nolte Md, John Kim Do, Facs, Christian Perez Md, Facs, Fasmbs

Graduate Medical Education Research Journal

While laparoscopic gastric banding is not as prevalent, the management of patients with a history of gastric banding remains a concern. Gastric bands have been noted to erode and can migrate through the bowel leading to a variety of issues. We were able to successfully manage this almost completely endoscopically without the need for a bowel enterotomy for retrieval. This allowed for enhanced patient recovery and avoided the morbidity associated with bowel enterotomy which is commonly done in these settings.

Introducer-Free Mis-Assisted Ventriculoperitoneal Shunt Placement: A Technical Document, Eric Chen, Patrick Opperman, Edson Deoliveira, Priscila Rodrigues Armijo, Vishal Kothari, Daniel Surdell

Graduate Medical Education Research Journal

Background

The placement of the distal catheter of a ventriculoperitoneal shunt (VPS) can be challenging in patients with a large body habitus. Given the complications associated with ventriculoperitoneal shunts and known infection risk of obese patients, new techniques for VPS placement that bypass the abdominal fat must be sought. By avoiding the abdominal fat, decreased complications and infection risk may be possible.

Objective

The objective of this technical document is to describe a laparoscopic approach to the abdominal cavity during ventriculoperitoneal shunt surgery that makes use of a direct tunneling technique into the peritoneal space.

Methods

We perform a ventriculoperitoneal …

Hyperbaric Oxygen Therapy For Cerebral Radiation Necrosis Secondary To Stereotactic Radiation: A Case Series, Sruti Prathivadhi-Bhayankaram, Jeffrey S. Cooper

Graduate Medical Education Research Journal

Introduction: Stereotactic radiosurgery (SRS) is an excellent option for the treatment of numerous central nervous system diseases. There exist several forms of SRS, including gamma-knife surgery (GKS) and cyber-knife surgery. The most significant complication of SRS is the delayed effects of therapeutic radiation, also known as radionecrosis. The current treatment options for radionecrosis have a significant side effect profile and posit challenges for medical management. More recently, hyperbaric oxygen therapy (HBO2) has emerged as an option for treatment with minimal side effects.

Methods: We present a retrospective case series examining ten patients treated with HBO2 after receiving radiotherapy. Of …

Intimate Partner Violence In Plastic Surgery Practice: Perceptions And Preparedness Amongst Practicing Plastic Surgeons, Sophie L. Cemaj, Collin J. Macdonald, Bria R. Meyer, Erin M. Shriver, Sean Figy

Graduate Medical Education Research Journal

INTRODUCTION

It is estimated that 4 of 10 women in the United States have experienced one or more forms of intimate partner violence (IPV) in their lifetime. The US Preventative Service Task Force recommends that clinicians screen women of reproductive age for IPV and refer women who screen positive to ongoing support services (B recommendation). We aim to identify the perceptions, attitudes, and preparedness of plastic surgeons regarding intimate partner violence

METHODS

An IRB approved survey was sent to members of the American Society of Plastic Surgeons. The survey contained three sections: (1) surgeon and practice demographics, (2) surgeon experience …

Seasonal Variation Of Hip Fractures In Patients With Benign Paroxysmal Positional Vertigo, Steven D. Curry, Pooja M. Varman, Alessandro Carotenuto, Justin C. Siebler, Jonathan L. Hatch

Graduate Medical Education Research Journal

Introduction: Seasonal variation of benign paroxysmal positional vertigo (BPPV) presentation has been reported, with higher rates of presentation in months associated with times of lower serum vitamin D levels. The purpose of this study was to examine the association between the timing of hip fracture in patients with BPPV.

Methods: A retrospective review (2013 to 2019) of adult patients was performed at a tertiary care academic center to identify patients with hip fracture due to ground level fall (ICD-10 code S72) and a previously established diagnosis of vestibular disorder (ICD-10 codes H81-83, A88.1, and R42). Included patients were …

A Glimpse Into Urology Medical School Education: A Multi-Institutional Medical Student Survey, David Fu, Jesus Perez, Jinfeng Jiang, Christopher M. Deibert

Graduate Medical Education Research Journal

Introduction: Urological education and exposure for medical students is imperative as we face a growing geriatric population with increased urological needs. Previous research has examined American Urological Association (AUA) program director opinions of student exposure, but no surveys have been directed at current medical students. The purpose of this study is to quantify student exposure to and opinions of urology to determine precipitating factors that lead students towards or away from urology as a specialty of choice.

Methods: A 14 question (11 multiple choice and 3 fill-in-the blank) Google Survey was developed. Questions ranged from student exposure to urology, consideration …

Scholarly Activity In Residency: A Needs Assessment Of Challenges And Proposed Solutions, Jonathan Hall, Jana L. Wardian Phd, Jasmine R. Marcelin

Graduate Medical Education Research Journal

Introduction

Resident physician participation in scholarly activity is associated with significant benefits ranging from trainees’ personal development to improved quality of patient care. Residency programs have taken varied approaches to improve resident engagement in scholarship, though interventions have demonstrated mixed results regarding objective measures of scholarly productivity. Concerns regarding waining interest in scholarship amongst internal medicine residents prompted a department-wide needs assessment to evaluate opportunities for scholarship and challenges preventing resident participation.

Methods

A web-based survey was developed and distributed to Department of Internal Medicine faculty and residents at the PGY2 level or higher and recent graduates within the last …

Not So Simple, Hanna Deutsch

Graduate Medical Education Research Journal

No abstract provided.

Blues And Yellows, Spriha Pavuluri

Graduate Medical Education Research Journal

No abstract provided.

Evaluation Of Nurse Delirium Screening And Intervention For Hospitalized Older Adult Hip Fracture Patients, Mary Onyarin

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Delirium is associated with longer hospital stays, increased mortality, high medical costs, and poorer functional outcomes (Oh et al., 2014; Robinson & Eiseman, 2008). This project evaluated the use of the Confusion Assessment Method (CAM) tool to screen hospitalized older adult hip fracture patients for delirium. This project also measured the effectiveness of the implementation of the Hospital Elder Life Program (HELP) volunteers as a non-pharmacological intervention to alleviate delirium. This project was implemented on the Orthopedic/Neurological unit of a Midwest tertiary care hospital.

Methods: The study had a retrospective, descriptive design. The investigators evaluated the use of the …

Compassion Fatigue In Nebraska Medicine Icu Nurses, Jena M. Mcfadden, Jessica M. Harms

Doctor of Nursing Practice Projects: College of Nursing

Abstract

Objective: As caregivers in high-pressure and demanding environments, critical care/intensive care unit (ICU) nurses are at risk for compassion fatigue. The purpose of this study is to explore compassion fatigue and compassion satisfaction levels within ICU specialty nursing at Nebraska Medicine during COVID.

Aims: Four aims were considered throughout the course of the study: 1. How do overall compassion fatigue (CF) and satisfaction (CS) at Nebraska Medicine’s ICU’s compare with national norms? 2. How do (CF) and (CS) levels (mild, moderate, severe) differ between the Intensive Care Units?3. Do years of experience correlate with compassion fatigue levels (mild, moderate, …

Individualized Pain Plans For Pediatric Sickle Cell Patients, Teresa Zingale, Morgan O'Malley, Michael Marx

Doctor of Nursing Practice Projects: College of Nursing

Background: Vaso-occlusive (VOC) pain crisis in sickle cell pediatric patients is a hallmark symptom, and both unpredictable and crippling. There is a lack of evidence as to what is best practice to avoid a VOC pain crisis in pediatric sickle cell patients. Individualized Pain Plans were created and trialed based off the format asthma action plans with goals to improve overall pain management and to prevent or decrease emergency department visits and hospitalizations.

Aims: This is a cross-sectional and quality improvement study designed to evaluate the effectiveness of previously implemented Individualized Sickle Cell Pain Plans in a midwestern children’s hospital. …

Identifying Moral Distress In Emergency Nurses, Sarah Taylor

Doctor of Nursing Practice Projects: College of Nursing

Abstract Moral Distress (MD) is an ongoing reality for emergency department (ED) nurses and often emerges when caring for patients at the end of life. Repeated exposure to MD can result in resignation from the nursing profession. This study measured moral distress using the Measure of Moral Distress for Healthcare Professionals (MMD-HP) survey tool. The goal was to identify stressors known to cause moral distress, measure the frequency of their occurrence during the COVID-19 pandemic, and analyze the correlation to influence ED nurses to leave the position. The MMD-HP ranks the frequency of occurrence of stressful situations leading to moral …

The Development Of Polymeric Dexamethasone Prodrug Nanomedicines For The Treatment Of Lupus Nephritis, Zhifeng Zhao

Theses & Dissertations

Lupus nephritis (LN) is a significant cause of morbidity and mortality among lupus patients. Glucocorticoids (GCs) are uniformly used in clinical LN management. Their notorious toxicities, however, have hampered the long-term clinical application. To circumvent GCs’ adverse effects while maintaining their potent therapeutic efficacy, we have developed a micelle-forming polyethylene glycol (PEG)-conjugated dexamethasone prodrug (ZSJ-0228), which could passively target the inflamed kidney in NZB/W F1 lupus-prone mice. It was found that monthly ZSJ-0228 treatment for five months significantly reduced the incidence of nephritis in NZB/W F1 mice with an improved survival rate. Unlike the dose equivalent daily dexamethasone treatment, long-term …

Feasibility And Efficacy Of Bisphosphonate Use For The Prevention Of Bone And Muscle Loss, Laura E. Flores

Theses & Dissertations

Loss of bone and muscle mass often occurs in tandem, increasing the risk of fragility fractures. Whereas many drugs are approved for the treatment of bone loss, there are few treatments available for the concomitant loss of bone and muscle. Identification of a treatment to mitigate pathologic bone and muscle atrophy has the potential to impact countless populations and influence approaches for healthy aging. Bisphosphonates have emerged as a potential treatment for both bone and muscle loss in cellular, murine, and observational human studies. Our findings of modest weight maintenance in postmenopausal women treated with 12-months of risedronate, relative to …

Biologically-Inspired Nanoparticles For Oncology Applications, Aishwarya Bapat

Theses & Dissertations

Cancer is the leading cause of death in the United States and its high mortality rate can be attributed towards poor diagnosis methods and less effective therapeutic treatments. Many nanotechnology-based diagnostics and therapeutics are being developed to improve cancer patient outcomes. In this work, we have studied nanoparticles for diagnostic and therapeutic applications in cancer treatment.

In the first work, novel fluorescent NPs loaded with indocyanine green (ICG) were developed for bioimaging applications of pancreatic cancer. Targeted fluorescent nanoparticles (NPs) are being developed to image a range of cancer types with the goal to improve patient outcomes by utilizing in …

Building An Artificial Intelligence Framework For Hypertension Diagnosis: A Use Case Of The Problem List Curation, Ketemwabi Yves Shamavu

Theses & Dissertations

Hypertension is the world's leading factor in cardiovascular disease. Forty-seven percent or close to one in two Americans aged 18 and older are affected. It predicts approximately a thousand deaths per day. Based on recent statistics from the Centers for Disease Control and Prevention, one in three patients with hypertension does not know they are hypertensive. Seventy-five percent of hypertensive patients have uncontrolled hypertension - meaning that they are not treated to target. While there is extensive literature on hypertension diagnosis and management, there is an apparent gap in understanding and acknowledging that a person is hypertensive. Moreover, blood pressure …

The Development Of Thermoresponsive Hydrogel-Based Drug Delivery Systems For The Treatment Of Musculoskeletal Diseases, Ningrong Chen

Theses & Dissertations

Water-soluble polymers are one of the most commonly used drug delivery vehicles for musculoskeletal diseases. During the past few decades, various biocompatible polymers have been employed in the development of thermoresponsive hydrogels as drug delivery systems for the treatment of local musculoskeletal pathologies. As part of our laboratory’s contribution to this field of study, I have successfully developed three thermoresponsive hydrogel-based formulations for the treatment of three different pathologies associated with the musculoskeletal system.

As my initial effort, I have developed a bone-targeting injectable hydrogel drug delivery system based on Pluronic 127 (Poloxamer 407), which is a Generally Recognized As …

Linking Spinal Cord Circuits With Upper Limb Sensorimotor Control In Adults With Cerebral Palsy, Saihari Dukkipati

Theses & Dissertations

Cerebral palsy (CP) is the most common neurological disorder originating in childhood, but most of the people living with CP are currently adults. While people with CP continue to get older, the amount of research focused on adults has been rather limited. The early childhood insults leading to CP are thought to originate in the brain, but the effects on the entire neuromuscular system across the lifespan have only recently started to be explored. Of note, recent neuroimaging evidence suggests that the cervical spinal cord structure is atypical in adults with CP. However, it is largely unclear how the neurophysiological …

Design, Synthesis, And Biological Investigation Of Pyridine Sulfones As Anti-Chlamydia Trachomatis Agents, Mohamed A. Seleem

Theses & Dissertations

Chlamydia trachomatis is the most prominent cause of sexually transmitted bacterial infections worldwide, with around 128 million reported cases annually. This pathogen can cause severe urogenital and ocular consequences, resulting in infertility and trachoma. In its unique developmental cycle, Chlamydia fluctuates between two distinct forms, elementary bodies (EBs) and reticulate bodies (RBs). We hypothesized that caseinolytic protease P (ClpP), a conserved protease among bacterial species, drives the Chlamydia developmental cycle. Earlier work by the Ouellette group demonstrated that Chlamydia relies on its ClpP2 paralogue (ctClpP2) to differentiate between its developmental forms. Dysregulation of ctClpP2 had a significant …

Tourniquet-Induced Ischemia-Reperfusion Injury, Junliang Qian

Theses & Dissertations

Ischemia-reperfusion (IR) is a pathological condition characterized by an initial restriction of blood supply to an organ followed by subsequent restoration of reperfusion associated with exacerbation of tissue damage. For pre-hospital emergency situations and surgical procedures, tourniquet or femoral artery ligation are widely used to stop extremity hemorrhage or create a bloodless operating field. To fully evaluate the underlying mechanisms in IR pathophysiology and potential therapeutic options, we compared tourniquet- and femoral artery ligation-induced IR injuries in the hindlimb of mice. We found that tourniquet/IR-induced acute hindlimb injuries are more severe than those induced by femoral artery ligation/IR, including alteration …

Macromolecular Fluorescent Conjugates For Bioimaging Applications, Paul Lovell

Theses & Dissertations

Bioimaging tools enable the visualization of small anatomical features as well as structures that may be obscured by other tissue. One such group of tools are fluorescent probes, molecules that emit detectable signals when stimulated by an excitation source. Incorporating fluorescent conjugates for clinical purposes would enable direct usage for the diagnosis, detection, or treatment of diseases. The development of specific targeting agents is feasible due to the number of nanomaterials and biological products that contain fluorophores. Specific targeting agents can target a particular region of interest, such as a cancerous tumor for removal or vital nerve structure for avoidance …

Polymeric Nanocarriers For Delivery Of Small Molecules Inhibiting Tubulin Polymerization For The Treatment Of Pancreatic Cancer And Lung Metastatic Melanoma, Rajan Sharma Bhattarai

Theses & Dissertations

The aim of this thesis is to develop delivery systems for the novel small molecules which inhibit tubulin polymerization. One of the small molecules was modified to lipid conjugate to increase the lipophilicity of the molecules which in turn drastically improved the drug loading in amphiphilic polymeric system. The second molecule was conjugated to the amphiphilic polymeric backbone with pH sensitive Schiff’s linker for the tumor site specific delivery in lung metastatic melanoma model.

Chapter 1 discusses the tumor microenvironment for the solid tumor especially focusing on Pancreatic Ductal Adenocarcinoma (PDAC). Further the drug delivery system currently researched for addressing …

The Role Of Calprotectin In T-Lymphocyte Driven Inflammation In A Mouse Model Of Psychological Trauma, Cassandra Moshfegh

Theses & Dissertations

Post-traumatic stress disorder (PTSD) is a debilitating psychological disorder that affects nearly 45 million Americans. This mental disorder is characterized by behavioral symptoms such as learned helplessness, hyperarousal, withdrawal, and flashbacks. The deleterious effects of PTSD are far-reaching and go beyond behavioral dysfunction, as these individuals are at a three-fold higher risk of comorbid inflammatory diseases. Autonomic, metabolic, and cardiovascular diseases plague these individuals later in their lifetime, however, the mechanistic link connecting psychological trauma to this systemic peripheral immunological dysfunction remains elusive. T-lymphocyte-induced inflammation plays a significant role in all these disease pathologies. Previous work from our laboratory demonstrated …

Regulation Of Pancreatic Cancer Progression By Micronutrients, Chunbo He

Theses & Dissertations

Cancer cells rely on altered metabolism to support their uncontrolled proliferation under harsh conditions. Understanding the mechanisms of how metabolic alterations support tumor growth may provide a way to enhance current therapies. Vitamins are micronutrients that our body needs in small quantities but are essential for health maintenance. A number of metabolic processes relevant to cancer initiation and progression are also regulated by vitamins. Here, our studies showed that pancreatic ductal adenocarcinoma (PDAC) cells display an aberrant metabolism of vitamin B6 (VB6) to support their fast proliferation. VB6 was highly demanded and rapidly metabolized by PDAC cells. Depletion of VB6 …

Gut Commensals Modulate Siv/Shiv Pathogenesis And Therapeutics, Samuel Johnson

Theses & Dissertations

Despite significant advancements in combination antiretroviral therapy (cART), ongoing inflammation in the brain and gut remain two of the most significant hurdles in the health of people living with human immunodeficiency virus (HIV). Additionally, a viral reservoir in each compartment inhibits cure efforts by allowing rapid viral rebound following cART interruption. Emerging understanding of the gut-brain axis (GBA) implicates each compartment in the modulation of the other in a complex bi-directional interaction mediated by vagus innervation, circulating lymphocytes, and microbiome composition and biproducts. Using multiple models of the simian (and simian-human) immunodeficiency virus (SIV/SHIV) and therapeutic intervention, I present how …