Medicine and Health Sciences Commons^™

Donor Ifnl4 Genotype Is Associated With Early Post-Transplant Fibrosis In Recipients With Hepatitis C, Taylor Aiken, Ari Garber, Dawn Thomas, Nicole Hamon, Rocio Lopez, Rajesh Konjeti, Arthur Mccullough, Nizar Zein, John Fung, Medhat Askar, Binu V. John

Pathology Publications

Background and Aims

Early post-transplant hepatic fibrosis is associated with poor outcomes and may be influenced by donor/recipient genetic factors. The rs368234815 IFNL4 polymorphism is related to the previously described IL28B polymorphism, which predicts etiology-independent hepatic fibrosis. The aim of this study was to identify the impact of donor and/or recipient IFNL4 genotype on early fibrosis among patients transplanted for hepatitis C (HCV).

Methods

Clinical data were collected for 302 consecutive patients transplanted for HCV. 116 patients who had available liver biopsies and donor/recipient DNA were included. 28% of these patients with stage 2 fibrosis or greater were compared to …

Simultaneous Papillary Carcinoma In Thyroglossal Duct Cyst And Thyroid, Gustavo Cancela E Penna, Henrique Gomes Mendes, Adele O. Kraft, Cynthia Koeppel Berenstein, Bernardo Fonseca, Wagner José Martorina, Andreise Laurian N. R. De Souza, Gustavo Meyer De Moraes, Kamilla Maria Araújo Brandão Rajão, Bárbara Érika Caldeira Araújo Sousa

Pathology Publications

Thyroglossal duct cyst (TDC) is a cystic expansion of a remnant of the thyroglossal duct tract. Carcinomas in the TDC are extremely rare and are usually an incidental finding after the Sistrunk procedure. In this report, an unusual case of a 36-year-old woman with concurrent papillary thyroid carcinoma arising in the TDC and on the thyroid gland is presented, followed by a discussion of the controversies surrounding the possible origins of a papillary carcinoma in the TDC, as well as the current management options.

Association Of Intraocular Pressure With Human Immunodeficiency Virus, Matthew T. Young, Rakhi T. Melvani, Faraaz A. Khan, Puneet S. Braich, Surbhi Bansal

Ophthalmology Publications

PURPOSE: Prior studies have shown an association between human immunodeficiency virus (HIV) and reduced intraocular pressures (IOP). The purpose of this study was to determine if patients with HIV on highly active antiretroviral therapy (HAART) had any difference in their IOP compared with patients without HIV or with HIV who are not on HAART.

DESIGN: Retrospective cross-sectional study.

METHODS: We included 400 patients from our academic eye center between 2000 and 2016. Group 1 (G1) consisted of patients with HIV on HAART (n = 176), Group 2 (G2) consisted of patients with HIV who were not on HAART (n = …

Kruppel-Like Factor 2 In Cholangiocarcinoma, Cody J. Wehrkamp, Justin L. Mott

Hepatobiliary Cancers: Pathobiology and Translational Advances

No abstract provided.

A Systematic Review Of Diagnostic Methods To Differentiate Acute Lung Injury/Acute Respiratory Distress Syndrome From Cardiogenic Pulmonary Edema, Kosaku Komiya, Tomohiro Akaba, Yuji Kozaki, Jun-Ichi Kadota, Bruce K. Rubin

Emergency Medicine Publications

Background

Discriminating acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema (CPE) is often challenging. This systematic review examines studies using biomarkers or images to distinguish ALI/ARDS from CPE.

Methods

Three investigators independently identified studies designed to distinguish ALI/ARDS from CPE in adults. Studies were identified from PubMed, and the Cochrane Central Register of Controlled Trials database until July 3, 2017.

Results

Of 475 titles and abstracts screened, 38 full texts were selected for review, and we finally included 24 studies in this systematic review: 21 prospective observational studies, two retrospective observational studies, and one …

Risk Assessment And Comparative Effectiveness Of Left Ventricular Assist Device And Medical Management In Ambulatory Heart Failure Patients The Roadmap Study 2-Year Results, Randall C. Starling, Jerry D. Estep, Douglas A. Horstmanshof, Carmelo A. Milano, Josef Stehlik, Keyur B. Shah, Brian A. Bruckner, Sangjin Lee, James W. Long, Craig H. Selzman, Vigneshwar Kasirajan, Donald C. Haas, Andrew J. Boyle, Joyce Chuang, David J. Farrar, Joseph G. Rogers

Emergency Medicine Publications

OBJECTIVES The authors sought to provide the pre-specified primary endpoint of the ROADMAP (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients) trial at 2 years.

BACKGROUND The ROADMAP trial was a prospective nonrandomized observational study of 200 patients (97 with a left ventricular assist device [LVAD], 103 on optimal medical management [OMM]) that showed that survival with improved functional status at 1 year was better with LVADs compared with OMM in a patient population of ambulatory New York Heart Association functional class IIIb/IV patients.

METHODS The primary composite endpoint was …

Youtube Atherectomy Videos: What Industry Is Telling Us About This Endovascular Procedure, Dongjin Suh B.S., Michael F. Amendola Md, Associate Professor Of Surgery

VCU Health Publications

BACKGROUND:

Patients are turning to the Internet and YouTube for information about their providers, disease states and potential interventions. Endovascular atherectomy is a common procedure undertaken in the treatment of peripheral vascular disease especially in outpatient treatment centers despite its cost. Little is known how this procedure is portrayed in online video content. We set forth to search YouTube to gain insight to how industry and non-industry portrays this endovascular technology.

METHODS:

YouTube (www.youtube.com) website was accessed in July 2017 with a cleared cached web browser for the key search word “atherectomy”. The top 100 videos with greater than 100 …

Elimination Of Pain Improves Specificity Of Clinical Diagnostic Criteria For Adult Chronic Rhinosinusitis, Scott D. Hirsch, Evan R. Reiter, Laurence J. Dinardo, Wen Wan, Theodore A. Schuman

Otolaryngology Publications

Objective

Determine whether the elimination of pain improves accuracy of clinical diagnostic criteria for adult chronic rhinosinusitis.

Study Design

Retrospective cohort study.

Methods

History, symptoms, nasal endoscopy, and computed tomography (CT) results were analyzed for 1,186 adults referred to an academic otolaryngology clinic with presumptive diagnosis of chronic rhinosinusitis. Clinical diagnosis was rendered using the 1997 Rhinosinusitis Taskforce (RSTF) Guidelines and a modified version eliminating facial pain, ear pain, dental pain, and headache.

Results

Four hundred seventy-nine subjects (40%) met inclusion criteria. Among subjects positive by RSTF guidelines, 45% lacked objective evidence of sinonasal inflammation by CT, 48% by endoscopy, …

Acute Neuroinflammation Induces Ais Structural Plasticity In A Nox2-Dependent Manner, S. D. Benusa, N. M. George, B. A. Sword, G. H. Devries, J. L. Dupree

Anatomy and Neurobiology Publications

Background

Chronic microglia-mediated inflammation and oxidative stress are well-characterized underlying factors in neurodegenerative disease, whereby reactive inflammatory microglia enhance ROS production and impact neuronal integrity. Recently, it has been shown that during chronic inflammation, neuronal integrity is compromised through targeted disruption of the axon initial segment (AIS), the axonal domain critical for action potential initiation. AIS disruption was associated with contact by reactive inflammatory microglia which wrap around the AIS, increasing association with disease progression. While it is clear that chronic microglial inflammation and enhanced ROS production impact neuronal integrity, little is known about how acute microglial inflammation influences AIS …

Family Centered Rounds Simulation And Medical Students' Perceptions, Clifton Lee

Health Sciences Education Symposium

Background: Studies show that family centered rounds (FCR) improve family satisfaction by involving the families in their children’s care. Medical students consistently find FCR beneficial to families but have differing attitudes regarding benefits to the medical team. Some concerns raised by the students include longer rounds, decreased bedside teaching, and lack of opportunities to improve FCR skills. We developed a FCR simulation to aid medical students in FCR presentation.

Methods: On the first day of the clerkship, medical students presented a patient admission to two evaluators playing a parent and an attending physician. The patient admission note was emailed to …

Teddy Bear Triage And Treatment: Novel Technique Of Mass Casualty Incident Education, Jeffrey D. Ferguson

Health Sciences Education Symposium

Providing education on medical care and triage during mass casualty incidents (MCI) can be challenging. Table top exercises lack the impact of a hands-on experience necessary to emphasize the scale of a real event, while full scale events are often time and resource intensive. We present a novel method using low-cost stuffed bears to expose learners to MCI triage methodology and medical care.

A Prospective Trial: Traditional Versus Video-Based Teaching For Gynecologic Surgery, Mireille Truong

Health Sciences Education Symposium

This prospective study compared the effect of traditional versus video-based education in gynecologic surgery on cognitive and surgical skills performance among millennial medical trainees and evaluated the impact of individual learning preference on performance. Residents and medical students in their OBGYN rotation at an urban university-hospital were recruited and assigned to either traditional training (TT) or video-based training (VBT) for teaching of skills needed for total laparoscopic hysterectomy. Pre- and post-intervention knowledge and skills assessments were performed. Subjects’ learning preference was evaluated with the validated VARK© questionnaire. VBT and TT change in knowledge and skills assessment scores was compared, and …

Insights From A Dual Admission Family Medicine Scholars' Track, Carolyn Peel

Health Sciences Education Symposium

There is a shortage of primary care physicians both nationally and in Virginia. This problem is multi-factorial and in large part beyond the control of our department. However, in order to address some of the local cultural issues that contribute to this, we developed the fmSTAT program. At VCU SOM and most other academic medical centers, family medicine interested students receive little support and sometimes direct challenge regarding career choice. fmSTAT is VCU's initiative to promote a supportive culture to attract and produce family physician graduates.

Improving The Physical Exam With Technology - Point Of Care Ultrasound, Sammy Pedram

Health Sciences Education Symposium

Point of Care Ultrasound is rapidly becoming standard of care for utilization in real time medical diagnostics and decision making. As such we sought to introduce ultrasound to medical students beginning in their first year and specifically incorporating it to mirror their physical exam teaching in the Practice of Clinical Medicine (PCM) course to help strengthen both their learning of the physical exam while also better understanding the utility of ultrasound use at the bedside. We sought to see if this strategy would result in improved examination scores via testing during their required objective structured clinical examination (OSCE) in the …

Innovative Use Of The Wordpress/Rampages Platform To Improve Implementation Of Active Learning Strategies In The Vcu Child And Adolescent Psychiatry Fellowship Didactic Curriculum, Ravinderpal Singh

Health Sciences Education Symposium

Many factors have led to changes in the approach to graduate medical education, including ongoing development of new technology, the dynamics of information transfer, and generational preferences for active learning and novel teaching strategies. In response, the VCU Child and Adolescent Psychiatry Fellowship program decided to pursue curriculum reform, using active learning strategies and employing technology to achieve improvements in the learning and retention of material for learners to be successful in treating patients and families now and in the future. A fundamental aspect of these changes included a partnership with VCU SOM instructional technologist to create an online platform …

Surgical Ethics Online Needs Assessment And Pilot Curriculum, Michael Amendola

Health Sciences Education Symposium

National undergraduate medical student curriculums dedicated to the ethical practice of surgery are lacking. To that end, we propose a Surgical Ethics Online (SEO) course. SEO will be undertaken during third year medical school surgical clerkships at Virginia Commonwealth University School of Medicine (VCU-SOM). SEO is an online collaborative educational program centered around clearly defined objectives that focus on the principles of clinical ethics. Learners will be evaluated with a pre- and post-program assessment as well as with online discussion forum evaluation. The program will be formally distributed to VCU-SOM in the fall of 2018. An abridged pilot and needs …

An Evidence-Based Approach To Designing Virtual Patients, Benjamin Collins

Health Sciences Education Symposium

Virtual patients (VPs) are used for developing clinical reasoning which is an area of deficit in medical trainees. There are a number of studies showing that virtual patients have a positive effect on clinical reasoning skills but it remains uncertain how to best design or utilize VPs. Reasons for this include broad definitions of VPs, prior studies with poor descriptions of their design, and few studies looking at which design features are most efficacious. In this study on effective VP design, I outline the direct evidence from prior studies on VPs and indirect evidence from studies of other e-learning methods …

Digital Histology 2.0: An Open Educational Resource, John W. Bigbee

Health Sciences Education Symposium

The teaching of histology is increasingly relying on digital resources in lieu of traditional microscope laboratories. For nearly 20 years, health science education at VCU has depended on a Digital Histology curricular resource on CD-ROM, previously licensed by Wiley Publishing. Now facing issues related to accessibility and technological constraints, this resource is being re-designed as a web-based, mobile-friendly, interactive, open educational resource for VCU health science students and all learners across the world.

For the past two decades, there has been a steady decline in the use of microscopes in histology instruction (1,2). As a replacement, a number of digital …

Sharon Kaufer Flores, Ms, Assistant Professor, School Of Medicine, Department Of Family Medicine And Population Health, Sharon Kaufer Flores

Health Sciences Education Symposium

Beginning in the summer of 2016, the Department of Family Medicine and Population Health (DFMPH) developed a system to increase participation of third and fourth year medical students in global health service by creating elective offerings building on pre-existing brigade opportunities. A standardized M3/M4 elective application, enrollment and evaluation mechanism was developed to facilitate student participation in multiple international environments. In this academic year, 14 students have successfully completed these new electives.

Diabetes Immersion In A Pre-Clinical Endocrine Course, Diane M. Biskobing

Health Sciences Education Symposium

We describe a 2-day experience in the pre-clinical Endocrine course during which the students experience the complexities of living with diabetes mellitus. During this time they are asked to follow a carbohydrate controlled diet, monitor blood glucose and injection insulin (saline). They then wrote a reflection about the experience.

Interprofessional Education At Vcu: Training Healthcare Students To Be Collaborative Practitioners, Kelly Lockeman

Health Sciences Education Symposium

Over the past five years, VCU has developed a comprehensive interprofessional education (IPE) curriculum with almost 2000 students from both the medical campus and the Monroe Park campus engaged in IPE activities annually. 90 faculty members are facilitating these learners in classrooms, clinical settings, and community practice sites. This presentation will describe the conceptual framework for VCU’s IPE curriculum, give an overview of the courses and activities, discuss evaluation methods and selected results, and present the challenges and opportunities for the future of IPE at VCU.

Medical Toxicology For The Emergency Medicine Clerkship, Michelle Troendle

Health Sciences Education Symposium

Medical toxicology is frequently a weak subject area for medical students. This may be due to few fellowship-trained medical toxicologists at academic institutions, overshadowing of medical toxicology by “bread and butter” emergency medicine lectures, and material not being presented in an engaging manner. Power points are often used for lectures to deliver a large amount of content in a short time frame. However, students may become disengaged and experience a “death by power point” feeling.

Just-In-Time Teaching (Jitt) Applied To Pathology Residency Training, Adele Kraft

Health Sciences Education Symposium

JiTT is an active teaching and learning strategy that combines web-based assignments with classroom learning. JiTT sessions can be limited to one-hour; each learning activity is an event by itself and it can be used in small groups composed of learners with heterogeneous backgrounds previously exposed to the material. The main strengths of JiTT are the ability to make student thinking visible, help develop expert-like thinking processes, improve transfer of knowledge and promote reflective learning. We demonstrate our experience in applying this learning strategy to Pathology resident teaching.

Changes In Pt And Ot Students’ Self-Efficacy Using An Interprofessional Case Based Experience, Dixie H. Bowman

Health Sciences Education Symposium

This poster describes an interprofessional simulation activity for physical therapy and occupational therapy students and a research study exploring the impact of the learning experience.

Learning About End-Of-Life Care In Nursing: A Global Classroom Educational Innovation, Shelly Orr

Health Sciences Education Symposium

This presentation aims to examine how a ‘global classroom’ was developed using online technology, to enhance the learning of nursing students in end-of-life care. It presents an account of how this initiative was managed to demonstrate its potential for implementation more widely.

Navigating Unchartered Waters With Ussonar To Build An Integrative Mskus Curriculum For Mcv Rheumatology Fellowship Program, Faizah Siddique

Health Sciences Education Symposium

Musculoskeletal ultrasound (MSKUS) is an increasingly popular tool for the rheumatologist and less than 50% of rheumatology fellowship programs in the United States have a defined formal curriculum. The objectives here are to develop a formal and novel MSKUS curriculum for MCV Rheumatology program using an evidence-based 8-step model for our curriculum development. Results of Stage 1, situational analysis, showed unanimous need for dedicated need for MSKUS curriculum. While still early in this project, we hope to complete the remainder of the Stages by the end of 2017.

Medical Gross Anatomy For Large Classes In A 'Flipped' Classroom, M. Alex Meredith

Health Sciences Education Symposium

Medical gross anatomy is under pressures from curriculum change, advances in technology and class size. Our innovations involve a fundamental change in student involvement. Students are now engaged with self-instruction of introductory material via custom-made videos; active group dissections with integrated clinical correlations; functional/clinical didactic material and self-assessment quizzes. Also, a longitudinal, self-directed group exercise (called “Cadaver Rounds”) utilizes their cadaver as their “first patient” involves dissection, CT scans, Path samples and physical exams to present a final report of a plausible clinical condition their cadaver experienced. Ultimately, these changes “flipped” the classroom for Medical gross anatomy.

Patient Safety Initiative : Web Based Education On The Vcuhs Code Carts, Cheryl Bodamer

Health Sciences Education Symposium

We developed standardized web based learning modules on the VCUHS adult and pediatric code carts that enables health care providers in an organization to receive standardized training that is readily accessible to improve retention of the items and their location in the code carts.

Preparing M1/M2 Students For The Surgical Wards – An On Call Shadowing Program, Adrian Diaz

Health Sciences Education Symposium

Traditionally, medical students gain initial exposure to surgical fields during their third year of Medical School. Many pre-clinical medical students have little exposure to surgeons, and therefore may enter the third year clerkship with pre-conceived notions of surgeons, or surgery in general. By this time many students have already established preset attitudes and pre-conceived notions about surgeons and surgery. Our goal is to construct a program through which interest in surgery can be positively influenced in the pre-clinical years, and possibly attract talented students to the field. This program would also help better prepare students for a third year surgery …

Nurturing The Student, Sustaining The Mission: International/Inner City/Rural Preceptorship (I2crp) Program, Yeri Park

Health Sciences Education Symposium

Several medical education tracks focused on preparing students to work in medically underserved communities are available in U.S. medical schools to increase awareness of primary care and to enable students to practice in medically underserved areas. The Virginia Commonwealth University School of Medicine’s International/Inner city/Rural Preceptorship Program (originally known as ICRP then changed to I2CRP with introduction of international component in 2012) began in 1998 with the mission of increasing the number of students going into primary care to practice in medically underserved settings in rural, urban and/or international communities. The program requires students to participate in didactics, journal cub …