Medicine and Health Sciences Commons^™

Symmetrical Drug-Related Intertriginous And Flexural Exanthema Induced By Cellulitis Prophylaxis, Tiffany Truong, Jonathan H. Ryder, Erica Lee, Clayton Mowrer, Ashley Wysong, Jasmine R. Marcelin

Graduate Medical Education Research Journal

Penicillin VK and hydroxyzine are typically well-tolerated antipruritic agents that are indicated in the prophylaxis of cellulitis. We herein report a case of a unique rash occurring during penicillin VK and hydroxyzine treatment in combination with the ingestion of cashews.

A 77-year-old male presented with new onset rash. Eleven days after the administration of penicillin VK and hydroxyzine for cellulitis prophylaxis, he developed a symmetric, erythematous, scaling rash on his buttocks and perineal region with associated pruritus and bleeding without fevers, chills, adenopathy, night sweats, or any other symptoms. He was diagnosed with symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) …

Endotracheal Tube Dislodgment In A High Risk Pulmonary Hypertensive Patient Due To Undiagnosed Tracheomegaly: A Case Report, Andrew Peck, Tammer N. Ghaly, Austin J. Adams, Daniel W. Johnson, Rebecca A. Aron

Graduate Medical Education Research Journal

Introduction

Airway enlargement was first described histologically in 1872, but it was not clinically reported until 1932, when Dr. Mounier-Kuhn published his seminal radiographic studies.¹ Since then, it is estimated that several hundred case reports have been published on congenital Mounier-Kuhn Syndrome (MKS), acquired tracheomegaly, and tracheobronchomegaly (TBM), yet only a few comprehensive literature reviews exist.²

Case

This case report details an elective nasal procedure for a patient with a history of significant pulmonary hypertension ad COPD on 5L home O₂ who had a symptomatic facial trauma. He was considered high risk secondary to his pulmonary disease, …

Paroxysmal Exertion-Induced Dyskinesia Effectively Treated With Methocarbamol, Deepmala Nandanwar, Julia Pavelka, Diego Torres-Russotto

Graduate Medical Education Research Journal

No abstract provided.

Preventing Bleeding Complications Of Paracentesis Using Point-Of-Care Ultrasound: An N-Of-1 Case Study, Adam Karevoll, Willie Talbert, Christopher J. Smith

Graduate Medical Education Research Journal

Abdominal paracentesis is a common bedside procedure, and the advent of point-of-care ultrasound has provided an opportunity to reduce the associated risks. Multiple society guidelines now recommend both site and vascular marking to avoid potential complications. This case illustrates the importance of vascular marking specifically to avoid damage to adjacent blood vessels.

Retropharyngeal Abscess And Pott’S Disease Due To Tuberculosis: A Case Report, Bailey N. Hassman, Steven D. Curry, Jonathan H. Ryder, Angela L. Hewlett, Jayme R. Dowdall

Graduate Medical Education Research Journal

Introduction: Extrapulmonary mycobacterial infection can lead to vertebral spondylitis and osteomyelitis (Pott’s disease). Retropharyngeal abscess with concurrent spinal osteomyelitis is a rare presentation of tuberculosis in the US. Chart review on a patient was completed, and the relevant published literature was reviewed.

Case Presentation: A previously healthy 34-year-old male originally from Sudan presented to an outside hospital with a 2-month history of neck pain, sore throat, odynophagia, fevers, and chills. MRI showed a retropharyngeal abscess and suspected cervical spine osteomyelitis. Acid-fast bacillus (AFB) smear was positive from a neck drain specimen, but sputum was negative. Chest imaging did not show …

Post-Operative Prescription Of Opioid Medications And Patient Education: A Pilot Study, Gavin Stormont, Alexandra Colvin, Shawna Boyle

Graduate Medical Education Research Journal

Abstract

Introduction:

Opioid medications are essential in the management of pain. 80-85% of surgical patients and 51% of inpatients are discharged with opioid prescriptions. With increased prescriptions, an increase in opioid abuse and overdose was identified. In 2018, nearly 47,000 deaths were reported secondary to opioids. Also, in 2015, 504 billion dollars were spent on the opioid crisis.

Our aim was to determine if our division, urology, was prescribing opioids appropriately in the post-operative setting. We sought to identify gaps in patient knowledge of opioid risks, storage, and disposal.

Methods:

Our institution initiated an after-visit summary (AVS) detailing opioid abuse, …

Assessing The Educational Quality Of Training Videos For Collection Of A Nasopharyngeal Swab, Evan M. Ryan, Matthew T. Solverson, Dallin N. Christensen, Kristy J. Carlson, Kaeli K. Samson, Samuel K. Pate, Jayme R. Dowdall, Christie A. Barnes

Graduate Medical Education Research Journal

Introduction: The SARS-CoV-2 pandemic has forced healthcare systems to disseminate their training materials quickly and broadly, including instruction on identifying cases of infection through correct nasopharyngeal swabbing. Incorrect nasopharyngeal swabbing technique leads to substandard sampling, patient discomfort, and increased risk of complications. We set out to evaluate the quality of educational videos on the nasopharyngeal swab procedure.

Methods: Using video search engines, videos on nasopharyngeal swabbing were identified and distributed to two reviewers. The quality of videos was assessed using a scoring system that examined indications, contraindications, personal protective equipment use, swab depth, swab angle, and audiovisual quality. Descriptive statistics …

A Content Analysis Of The Scholarly Activity Requirements In Acgme-Accredited Residency And Fellowship Programs, Kari Nelson, Jacob Pfeifer, Emily Zurbuchen, Chandrakanth Are

Graduate Medical Education Research Journal

Background: The Accreditation Council for Graduate Medical Education (ACGME) common and specialty program requirements stipulate that residents/fellows participate in scholarly activities. The ACGME provides a reporting template tool for scholarly activity to be utilized by all specialties for evaluation annually. In this study, we aimed to: 1) Conduct a content analysis of the specialty scholarly activity requirements for all ACGME-accredited training programs to identify commonalities and variations, and 2) Assess alignment between the specialty scholarly activity requirements and the reporting template tool provided by the ACGME.

Methods: The scholarly activity requirements for all ACGME-accredited residency and fellowship specialties …

Point Of Care Spirometry Assessment For Pediatric Asthma Prevalence In A Family Homeless Shelter In Omaha, Nebraska, Nathaniel Mattison, Dale Agner, Breanne Parets, Haley Mathews, Emily Saliga, Maria Vacha, Jamicah Harris, Ryan Saliga

Graduate Medical Education Research Journal

Abstract:

Introduction: The few studies on pediatric asthma in US homeless shelters describe a 27.9 – 39.8% prevalence, and historically Omaha has had a high incidence of fatal pediatric asthma. Thereby, Clarkson Family Medicine (CFM) residency began a pediatric asthma outreach to a local family-homeless shelter to assess the prevalence of pediatric asthma and follow-up appointment attendance.

Methods: We obtained a voluntary parent-child assessment of the child’s respiratory history and an Asthma Control Test (ACT) between ages 4-18 for children residing at the family-homeless shelter. We obtained a pre-albuterol and post-albuterol mobile spirometer assessment using the Global Initiative for …

From The Levee, Jimmy Mccluskey

Graduate Medical Education Research Journal

No abstract provided.

Evaluating The Impact Of Nursing Assistant Employment On New Graduate Nurse Practice In The Acute Care Setting, Amy Bliemeister

Doctor of Nursing Practice Projects: College of Nursing

Background: New graduate nurses (NGNs) are expected to enter the acute care setting ready to provide safe and quality care in a fast-paced environment filled with high acuity patients, shortened lengths of stay, and difficult nurse to patient ratios (Clark & Springer, 2012). Employers, nursing students, and consumers are setting high expectations all nursing graduates will possess specific skills, knowledge, and competencies upon entry into practice (American Association of Colleges of Nursing, 2020).

Purpose: The purpose of this project was to determine the impact of NA program completion and employment on the NGN during the first year of nursing practice. …

Barriers To Discharge: A Retrospective Medical Record Review Examining Potential Barriers To Patient Discharge At The End-Of-Life, Pauline Felker, Kelly Purdy

Doctor of Nursing Practice Projects: College of Nursing

It is estimated that 70% of Americans would prefer to die at home, but less than one-quarter do so. Patients near the end of life often face several barriers that prevent them from successfully transitioning from an acute care setting to their preferred place of death. These barriers include but are not limited to a lack of trust between facilities and community care providers, ineffective communication, delayed discharge planning, difficulty accessing medications and supplies, lack of control, feelings of uncertainty, and feelings of burden. This study utilized a survey of 102 medical records of patients who died in the hospital …

Influencing A Culture Of Quality And Safety Through Huddling, Tysa Ferguson, Natalia Mccain

Doctor of Nursing Practice Projects: College of Nursing

Not available

The Role Of Micrornas In The Pathophysiology Of Neonatal Hypoxic-Ischemic Brain Injury, Eric S. Peeples

Theses & Dissertations

Neonatal hypoxic-ischemic brain injury (HIBI) is a devastating injury resulting from impaired blood flow and oxygen delivery to the brain at or around the time of birth. The subsequent metabolic failure and cellular injury in the brain can be partially attenuated by rapid initiation of therapeutic hypothermia, but even with prompt induction of hypothermia, more than one in four survivors suffer from major developmental disabilities – an indication of the critical need for more effective therapies. MicroRNAs (miRNA) may be able to act as therapeutic targets in neonatal HIBI; however, very little is known about the endogenous expression of miRNAs …

Intention To Breastfeed: Breastfeeding Attitudes, Norms, Self-Efficacy, Social Support Network And Community Resources Of African American, Low-Income, Emerging Adult Women, Pregnant For The First Time, Sara E. Brown

Theses & Dissertations

African American (AA) women continue to have the lowest rates of breastfeeding. This continues to create a health disparity even though breastfeeding is extensively recognized in the scientific and health care communities as the optimal feeding choice for infants. This study examined the relationship between the external variables (social support network and community resources) and the explanatory variables (attitudes, norms, and perceived self-efficacy) and intention to breastfeed, for the AA, first time, low-income, emerging adult pregnant woman. The Integrated Behavior Model (IBM) was used as the theoretical framework to guide this study in better understanding the variables influencing breastfeeding intention. …

Giving Birth At A Critical Time: Assessing Perinatal Depression Among Syrian Refugees In Low Resource Settings, Nada Alnaji

Theses & Dissertations

Refugee mothers are at an increased risk of suffering from stress and mental health conditions during the first year after giving birth to a child. The objective of this study is to enhance the early identification of treatable mental health conditions among perinatal women living within humanitarian settings. The central hypothesis is that a culturally specific approach can be helpful for the long-term success of mental health efforts. In this study, we use qualitative interview methods to understand the cultural paradigms and predisposing factors for perinatal depression related to being a Syrian refugee in Lebanon during the COVID-19 pandemic. In …

The Effect Of Orthodontic Treatment With Extraction On The Upper Airway Dimensions And Three-Dimensional Morphology: A Retrospective Study Using Cone-Beam Computed Tomography Technique, Ehsan Mostaghni

Theses & Dissertations

The purpose of this study was to evaluate the effect of orthodontic treatment with and without extractions of teeth on the upper airway dimension and morphology. Records of 40 consecutively treated patients who received orthodontic treatment with or without dental extractions were evaluated. Pre-and post-treatment volumes, minimum cross-sectional areas, and linear dimensions of oropharyngeal airways were quantified using InVivo Dental 6.0 (Anatomage, San Jose, CA). Additionally, pre and post CBCT images of the upper airways were superimposed on each other using voxel-based registration and fixed coordinate system using 3D Slicer 4.1.1 (www.Slicer.org) and ITK-SNAP (http://www.itksnap.org). While the …

Design And Synthesis Of Small Molecular Probes For Cns And Kidney Disorders, Swagat H. Sharma

Theses & Dissertations

The G protein regulated inwardly rectifying potassium channels (GIRK) are a family of inwardly rectifying potassium channels and are key effectors in signaling pathways. GIRK 1/2 channel subunit, predominantly found in the brain, is involved pathophysiology of various neurological disorders including, but not limited to, epilepsy, anxiety, Parkinson's, pain, reward, and addiction. Previously, our laboratory had identified a series of urea containing molecules as GIRK1/2 preferring activators. Unfortunately, the urea series suffers from significant PK liabilities (solubility, brain penetration and high clearance). The chapter 1 of the dissertation describes our efforts in developing three new series of activators with improved …

Characterization Of Aerosols Produced By Common Orthodontic Procedures, Anna R. Schoettger

Theses & Dissertations

Introduction: Aerosols can harbor active viruses, including SARS-CoV-2, making it vital that clinical protocols implemented in the orthodontic office be based on which procedures produce aerosols. Research shows that various procedures in the field of orthodontics generate aerosols, however, there is a lack of consensus as to which procedures should be deemed aerosol-generating procedures (AGPs). The current study aimed to better understand aerosol production of various orthodontic procedures. Methods: Orthodontic procedures were performed in a closed-room dental operatory on acrylic teeth mounted onto a dental manikin. Procedures performed included: debonding, bonding, and repositioning of one bracket. Variations introduced included: high-speed …

Alignment Of Cervical Vertebrae And Reliability Of Cephalometric Measurements, Ece Agirgol

Theses & Dissertations

Cervical vertebrae are in close relationship with dentofacial structures due to their anatomical position. In previous studies, the inclination of cervical vertebrae was measured by mostly Nasion-Sella line as the reference plane to evaluate the relationship with dentofacial structures.

The aim of this study is to observe the correlation between cervical vertebrae inclination and lateral cephalometric measurements. 124 lateral cephalograms taken in Natural Head Position of subjects over 18 years of age were traced with Dolphin Imaging Software 11.95 Premium. Cervical vertebrae inclination was measured by using the lines passing from landmarks on second, third and forth cervical vertebrae. Correlation …

Evaluation Of Stratified Antibiograms For Use In Laboratory And Antimicrobial Stewardship, Linsey Donner

Theses & Dissertations

Antibiograms are critical for choosing empiric antimicrobial therapy. Cumulative antibiograms, which aggregate susceptibility data, can mask differences within specific patient subsets or clinical syndromes. This dissertation was done to determine if antibiotic susceptibilities showed substantial differences when comparing stratified antibiograms to cumulative antibiograms.

Antibiotic susceptibility data was retrospectively obtained from Nebraska Medicine January 1, 2017 – December 31, 2019 for Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, and Enterococcus faecalis. The University of Nebraska Medical Center’s web antibiogram clinical decision support tool was used to export the data. Bacteria-antibiotic susceptibility rates of stratified antibiograms …

Post-Transplant Hepatic Graft Fibrosis In Pediatric Liver-Inclusive Transplant Recipients, Hanh D. Vo

Theses & Dissertations

Hepatic graft fibrosis is a common histologic finding following pediatric liver transplant (LT) that may affect the long-term graft outcome. Hence, it is essential to identify hepatic graft fibrosis at a stage where fibrosis is not yet clinically apparent but has the potential for progression to initiate appropriate intervention and prevent its progression. Liver biopsy is the gold standard for fibrosis staging, but it is invasive, requires general anesthesia in children, and has potential complications. Our long-term goal is to implement non-invasive tests to assess and monitor the progression of hepatic graft fibrosis in liver-inclusive transplant children. The work presented …

Delivery Of Sirna With Drugs Targeting Polyamine Metabolism As Combinational Cancer Treatment, Ao Yu

Theses & Dissertations

Cancer has been a major public health issue worldwide for years and is the second leading cause of death in the United States. Important barrier must be broken to extend the life expectancy in every country. The standard care for cancer causes severe side effects which affects patients’ physical health and quality of life. Polyamines are highly related with the cell proliferation and apoptosis. Dysregulated polyamine metabolism in cancer leads to increased polyamine concentration in neoplastic cells. Thus, polyamine metabolism for cancer therapy can be an intriguing target. However, the heterogeneity affecting key cancer pathways poses significant challenges for effective …

Glad To Be Out. I Was Running Out Of Womb: A Study Of Omega-6 And Omega-3 Fatty Acid Metabolites At Delivery And Their Relationship To Infant Growth, Prematurity, And Admission To The Neonatal Intensive Care Unit, Maranda Thompson

Theses & Dissertations

Normal pregnancy relies on inflammation for implantation, placentation, and parturition, but uncontrolled it can lead to poor infant outcomes. Maternal diet is one modifiable factor that can impact inflammation. Omega-3 and omega-6 fatty acids have been shown to be metabolized into bioactive metabolites that effect inflammation. The presence and importance of these metabolites at the time of delivery are not well understood. Therefore, the purpose of this dissertation was to first quantify omega-3 and omega-6 metabolites in maternal plasma, cord plasma, and placental tissue. Then the relationships between metabolites and infant outcomes, including birth weight percentile, length percentile, head circumferences …

Implementation Of Maternal Fetal Triage Index To Improve Nurse Knowledge And Timeliness In Obstetric Triage: A Pilot Project, Emilie Long

Doctor of Nursing Practice Projects: College of Nursing

Objective: The objective of this project was to implement an obstetric triage acuity scale in a labor and delivery setting and study the effect on nurse knowledge and timeliness of care.

Design: A quasi-experimental pre and post-test design was used for this pilot project.

Setting: This project was conducted in an obstetric triage unit located within a fourteen-bed labor and delivery unit in the Midwest.

Methods: This pilot project was conducted over a two-month time period. Fifteen registered nurses qualified to care for obstetric triage patients were given education on the chosen triage acuity scale. A pre-test was administered before …

Engineering Advanced Micro And Nanofiber Materials For Biomedical Applications, Alec D. Mccarthy

Theses & Dissertations

At the functional crossroads of engineering and biomedical sciences lies the interdisciplinary field of biomedical engineering. Principles of biomedical engineering are vast, and the rigorous application of engineering towards clinically-relevant medicine has the ability to take novel concepts from bench to bedside. Arguably one of the most promising and productive sub-fields within the biomedical engineering discipline is biomaterial engineering. Here, novel biomaterials, synthesized from natural, synthetic, or hybrid materials, can be used in tissue repair and regeneration, hemostasis, as anatomical support and drug delivery vessels, or as diagnostic devices.

Of particular interest are applications of nanofiber and microfiber objects, which …

The Ecology Of Mental Health And The Impact Of Barriers On Mental Health Service Utilization, Alisha Aggarwal

Theses & Dissertations

Mental health has emerged as a major public health concern in recent times with several disparities and barriers related to adequate health service utilization. Different age groups experience diverse symptoms and face distinct barriers in accessing and utilizing healthcare. Policies like Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act were launched to improve insurance coverage and delivery of mental health services. However, a large gap of unmet needs exists for adequate mental health service utilization in the country. This dissertation aims to describe the financial and non-financial barriers to mental health service utilization …

Development Of A Muc16-Targeted Near-Infrared Antibody Probe For Fluorescence-Guided Surgery Of Pancreatic Cancer, Madeline T. Olson

Theses & Dissertations

Pancreatic cancer (PDAC) is an extremely lethal disease with an overall survival rate of 10%. Surgery remains the only potentially curative treatment option, but resections are complicated by infiltrative disease, proximity of critical vasculature, peritumoral inflammation, and dense stroma. Surgeons are limited to tactile and visual cues to differentiate cancerous tissue from normal tissue. Furthermore, translating preoperative images to the intraoperative setting poses additional challenges for tumor detection, and can result in undetected and unresected lesions. Thus, PDAC has high rates of incomplete resections, and subsequently, disease recurrence. Fluorescence-guided surgery (FGS) has emerged as a method to improve intraoperative detection …

The Rotator Cuff Tendon-To-Bone Interface: Maturation, Aging, And 3d Bioprinting For Regeneration, Xiping Jiang

Theses & Dissertations

Rotator cuff tendon injuries often occur at the tendon-to-bone interface (i.e., enthesis) area with a high prevalence for the elderly population. In addition, regeneration of the gradient structure of the enthesis is still a significant clinical challenge. Our studies aim to identify the histological, molecular, and biomechanical alterations of the rotator cuff enthesis with maturation and aging, and develop a novel therapeutic method using three-dimensional (3D) bioprinting technique to regenerate a functional enthesis. Striking variations of the entheses were observed both histologically and biomechanically during the maturation process. The histological features did not show many differences at the insertion site …

Humanized Mice For Brain Infection Of Emerging Viruses, Edward Makarov

Theses & Dissertations

Studies on the pathogenesis of emerging viruses that present a global threat are critical for pathogen classification and therapeutic development. Humanized mice enable investigation of viral pathogens, including Human immunodeficiency virus (HIV-1), Zika virus (ZIKV), Coronavirus 2 (SARS-CoV-2), and Dengue virus (DENV), offering an advanced understanding into the mechanisms of viral perseverance in its natural human host cells and for therapeutic discovery. Realizing the diverse dynamics of various viral infections with the capacity to establish an innovative acuity for therapeutics and mechanics when utilizing humanized mice contributes a formerly inaccessible insight into human-specific viral pathogenesis and treatment. We recently developed …