Medicine and Health Sciences Commons^™

Proficiency-Based Cervical Cancer Brachytherapy Training: An Effort To Combat Recent Trends In Radiation Oncology That Result In Worse Outcomes For An Underserved Population Through Resident Education, Emma Fields

Health Sciences Education Symposium

Radiation therapy is the mainstay of treatment for women with cervical cancer with disease outside of the uterine cervix. To deliver the high doses needed for cure, brachytherapy (BT) is necessary to avoid toxicity to normal tissues (1). Technique is of utmost importance for outcomes of BT, but due to a lack of training during residency, the use of BT is declining nationwide (2, 3). The effectiveness of procedural simulation training, especially proficiency-based training, has been well established in other medical specialties, but there is no simulation training for cervical cancer brachytherapy used anywhere else in the country at this …

Preparing A Better Doctor: The C3 Curriculum And Osce Scores, Kimberly Pedram

Health Sciences Education Symposium

In 2013, a horizontally integrated 18 month curriculum (C3) for undergraduate medical students, which replaced the traditional 24 month basic sciences curriculum, was implemented at the Virginia Commonwealth University School of Medicine. A retrospective, all-inclusive study was conducted comparing the performance of the last group of students completing the 24 month curriculum (the Class of 2016, n=196) and the first group of students completing the 18 month curriculum (the Class of 2017, n=205) on the end-of-course OSCE (Objective Structured Clinical Exam). Students who completed the 18 month curriculum had significantly higher OSCE case scores (7.7 points, p <0.0001) as well as higher OSCE category scores (2.2 points, p = 0.002).

Salivary Biometrics And Assessment Of Autonomous Nervous System Activation During Emergency And Mascal Training, Michael Czekajlo

Health Sciences Education Symposium

A 4.5 day full immersion intensive skills week for emergency medicine and surgical training for finishing second year medical students was performed on a 20 acre movie studio. Utilizing hyper-realistic medical emergency scenarios, we simulated all events beginning at the point of injury, continuing to treatment en route, and ending at transition of care to surgical intervention. The trainees staffed an emergency room (ER) and two operating rooms (OR), triaged multiple victims and performed real surgical procedures on role-playing actors wearing the Human Worn Partial Task Surgical Simulator. Saliva was collected before and after scenarios (i.e., multiple victims from an …

Innovation In Didactic Teaching For Predoctoral Dental Education, Jaisri R. Thoppay

Health Sciences Education Symposium

An innovative model to facilitate predoctoral dental student learning was designed and implemented during the academic year 2016/2017. This model was envisioned as a forum to improve the gaps in the current educational method of the dental education large classroom lecture format. This new method involved multimodal learning tools in accommodating the various learner styles among dental students. The new format consisted of an on-line pre-recorded audiovisual power point presentation, followed by a corresponding graded quiz, culminating a week later into an interactive case discussion in the classroom. This new format, resulted in higher average of the overall grade fro …

Realizing Empathy And Expertise Through Accounts Lived (Reeal)-An Integrated Learning Experience, Mary L. Falk

Health Sciences Education Symposium

Undergraduate nursing students have historically learned to focus on the clinical and technical components of patient care. There is an increasing body of literature about the importance of incorporating empathy into healthcare curricula, and various techniques, such as role modelling, have been utilized. The increasing complexity and demands on nurses, and other healthcare providers, in today's healthcare system have led to a higher incidence of burnout and turnover. It is recognized that patients have felt the effects of this burnout in that they cite feeling a lack of connection and empathy from their clinical providers. We have sought to create …

The Technicom Challenge: Low Fidelity Simulation With High Yield Potential, Susan Haynes

Health Sciences Education Symposium

Participants work in teams of two. One member of the team serves as the “communicator”, the other serves as the “surgeon”. The “communicator” is given a picture of the design and instructs the surgeon how to use the materials inside the box trainer to replicate the design. The “communicator” cannot look inside the box trainer nor share with the “surgeon” the picture of the design.

Several designs may be incorporated into the exercise. Pairs are given a maximum time of five minutes to complete each design. A debriefing is conducted to discuss the challenges in completing the simulation.

Development Of A Calculator For Medical Student Residency Applications, Steven H. Crossman

Health Sciences Education Symposium

This poster describes an attempt to create an evidence-based approach to advising medical students with regard to the number of family medicine residency programs to which they need to apply.

The Dynamics Of Power And Psychological Safety On Team Cohesion During Interprofessional Simulation-Based Education, Nital Appelbaum

Health Sciences Education Symposium

Healthcare team functioning requires coordination and collaboration between multiple practitioners towards a common goal of delivering safe and quality patient care (Lemieux-Charles & McGuire, 2006). Communication patterns, leadership, mutual support, and situation monitoring are all processes of effective teams (Weaver et al, 2010). However, despite the growing focus on developing interprofessional teams, minimal focus is given to the contextual and cultural forces influencing healthcare team functioning. Negative relationships amongst providers can affect teams in clinical settings, which in turn can undermine patient safety (Carpenter, 1995). Sources of poor team cohesion can be rooted in unequal distributions of power and the …

The First Five Minutes: Enhancing Simulation Education For First-Year Pediatric Residents, Megan E. Coe

Health Sciences Education Symposium

We are looking at the feasibility of redesigning the existing simulation education for first-year residents within the Children’s Hospital of Richmond at VCU’s pediatric residency program to increase learning opportunities and to enhance exposure to pediatric medical emergencies. Novel simulation scenarios were designed to provide an introduction to managing the first five minutes of commonly encountered emergencies on the inpatient wards. These shortened simulations allow for educational objectives to be tailored to the expected knowledge and responsibilities of first-year residents.

Meeting Aging-Related Needs In 2016, Edward F. Ansello

Director's Editorials from Age in Action

Our Virginia Center on Aging has four program focuses. These programs are: dementia, elder abuse and domestic violence in later life, geriatrics education, and lifelong learning. Each achieved substantially in calendar 2016.

Abuse And Neglect Of Animals And People, An Update, Edward F. Ansello

Director's Editorials from Age in Action

Veterinarians have noticed for quite some time that individuals who mistreat their animals may not stop there, carrying over their behavior to spouses, parents and others. Research articles and “overview” publications have increased in number, as have advocacy groups and just the beginnings of connections between domestic violence and animal rights groups.

Oral Health And Aging, Edward F. Ansello

Director's Editorials from Age in Action

The sooner we recognize the importance of oral health to our well-being as older adults, the better we age. We need to consider our dentist as part of our health care team. For those of us in health professions, we should work together more to incorporate oral health into primary care.

Laughter And Well Being As We Age, Edward F. Ansello

Director's Editorials from Age in Action

Laughing at mistakes is demonstrably healthy. As we get older, we have accumulated a lifetime of mistakes. Humor and laughter, laughing at ourselves or our circumstances, can be therapeutic.

Safe Driving For The Mature Adult: Selected Issues, Rebecca Parsio

Case Studies from Age in Action

Educational Objectives

1. Examine issues related to aging and driving assessment.

2. Review Virginia’s Mature Drivers Study.

3. Discuss the levels of care for prevention of driving disability and resources available at each level.

4. Explore the impact of medications and substances (both prescribed and not prescribed) on driving ability.

Utilizing Older Adult Standardized Patients To Enhance The Education Of Health Professional Students, Kimberly Davis

Case Studies from Age in Action

Educational Objectives

1. Identify the uses of standardized patients in geriatrics education.

2. Compare the advantages and limitations of older adult standardized patients.

3. Discuss how competencies can guide simulation development.

4. Describe methods for evaluation of learner performance when using older adult standardized patients.

Integrating Geriatrics In Primary Care: Progress And Prospects, Daniel A. Bluestein, Ryan M. Diduk-Smith

Case Studies from Age in Action

Educational Objectives

1. Demonstrate the need for primary care redesign to better meet the needs of older patients.

2. Identify prospective redesign solutions.

3. Appreciate educational implication that redesign engenders.

Living Well With Chronic Health Conditions: Chronic Disease Self-Management Education In Virginia, April Holmes, Dianne Duke, Joyce Nussbaum

Case Studies from Age in Action

Educational Objectives

1. Review the impact of chronic disease on population health and health care costs.

2. Describe Chronic Disease Self- Management Education (CDSME) programs.

3. Discuss research findings that demonstrate how the Chronic Disease Self-Management Program addresses the triple aims of better care, better health, and lower costs.

4. Explain how CDSME programs are delivered through the Live Well, Virginia! Network.

5. Highlight initiatives to expand CDSME to new target areas and populations.

Proteomic Approach For Extracting Cytoplasmic Proteins From Streptococcus Sanguinis Using Mass Spectrometry, Fadi Elrami, Kristina Nelson, Ping Xu

Philips Institute for Oral Health Research Publications

Streptococcus sanguinis is a commensal and early colonizer of oral cavity as well as an opportunistic pathogen of infectious endocarditis. Extracting the soluble proteome of this bacterium provides deep insights about the physiological dynamic changes under different growth and stress conditions, thus defining “proteomic signatures” as targets for therapeutic intervention. In this protocol, we describe an experimentally verified approach to extract maximal cytoplasmic proteins from Streptococcus sanguinis SK36 strain. A combination of procedures was adopted that broke the thick cell wall barrier and minimized denaturation of the intracellular proteome, using optimized buffers and a sonication step. Extracted proteome was quantitated …

Slowly Cycling Rho Kinase-Dependent Actomyosin Cross-Bridge "Slippage" Explains Intrinsic High Compliance Of Detrusor Smooth Muscle, Christopher J. Neal, Jia B. Lin, Tanner Hurley, Amy S. Miner, John E. Speich, Adam P. Klausner, Paul H. Ratz

Biochemistry and Molecular Biology Publications

Biological soft tissues are viscoelastic because they display timeindependent pseudoelasticity and time-dependent viscosity. However, there is evidence that the bladder may also display plasticity, defined as an increase in strain that is unrecoverable unless work is done by the muscle. In the present study, an electronic lever was used to induce controlled changes in stress and strain to determine whether rabbit detrusor smooth muscle (rDSM) is best described as viscoelastic or viscoelastic plastic. Using sequential ramp loading and unloading cycles, stress-strain and stiffness-stress analyses revealed that rDSM displayed reversible viscoelasticity, and that the viscous component was responsible for establishing a …

Epigenetic Silencing Of Socs3 Expression Contributes To Fibrosis In Crohn’S Disease, Emily T. Marshall, Chao Li, John K. Kuemmerle

MD Student Summer Research Fellowship Program Posters

Identified risk polymorphisms affecting the Jak-STAT3 pathway in patients with Crohn’s disease could affect TGF-β1 and collagen I expression and in the pathway’s negative regulator, SOCS3. Genetic factors, however, account for only ~25% of disease. Epigenetic events also shape gene expression. Recent experiments showed that autocrine IL-6 production in mesenchymal cells, subepithelial myofibroblasts (SEMF) and muscle cells, of patients with fibrostenotic Crohn’s disease causes sustained Jak-STAT3 activity, excess TGF-β1 and Collagen I production and fibrosis. SOCS3 paradoxically decreased in these cells. We now identify epigenetic mechanisms that silence SOCS3 expression in SEMF of patients with fibrostenotic Crohn’s disease. In a …

Rare Mutations And Potentially Damaging Missense Variants In Genes Encoding Fibrillar Collagens And Proteins Involved In Their Production Are Candidates For Risk For Preterm Premature Rupture Of Membranes, Bhavi P. Modi, Maria E. Teves, Laurel N. Pearson, Hardik I. Parikh, Piya Chaemsaithong, Nihar U. Sheth, Timothy P. York, Roberto Romero, Jerome F. Strauss

Human and Molecular Genetics Publications

Preterm premature rupture of membranes (PPROM) is the leading identifiable cause of preterm birth with ~ 40% of preterm births being associated with PPROM and occurs in 1% - 2% of all pregnancies. We hypothesized that multiple rare variants in fetal genes involved in extracellular matrix synthesis would associate with PPROM, based on the assumption that impaired elaboration of matrix proteins would reduce fetal membrane tensile strength, predisposing to unscheduled rupture. We performed whole exome sequencing (WES) on neonatal DNA derived from pregnancies complicated by PPROM (49 cases) and healthy term deliveries (20 controls) to identify candidate mutations/variants. Genotyping for …

Breastfeeding After Gestational Diabetes: Does Perceived Benefits Mediate The Relationship?, Jordyn T. Wallenborn, Robert A. Perera, Saba W. Masho

Family Medicine and Population Health Publications

Introduction. Breastfeeding is recognized as one of the best ways to decrease infant mortality and morbidity. However, women with gestational diabetes mellitus (GDM) may have breastfeeding barriers due to the increased risk of neonatal and pregnancy complications. While the prevalence of GDM is increasing worldwide, it is important to understand the full implications of GDM on breastfeeding outcomes.The current study aims to investigate the (1) direct effect of GDM on breastfeeding duration and (2) indirect effect of GDM on breastfeeding duration through perceived benefits of breastfeeding. Methods. Prospective cohort data from the Infant Feeding and Practices Study II was analyzed …

Do Successive Preterm Births Increase The Risk Of Postpartum Depressive Symptoms?, Timothy O. Ihongbe, Saba W. Masho

Family Medicine and Population Health Publications

Background. Postpartum depression and preterm birth (PTB) are major problems affecting women’s health. PTB has been associated with increased risk of postpartum depressive symptoms (PDS). However, it is unclear if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. This study aims to determine if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. Methods. Data come from the 2009–2011 national Pregnancy Risk Assessment Monitoring System. Study sample included 55,681 multiparous women with singleton live births in the index delivery. Multiple logistic regression was …

Leveraging Social Media To Promote Evidencebased Continuing Medical Education, Simone Flynn, Paul Hebert, Deborah Korenstein, Mark Ryan, William B. Jordan, Salomeh Keyhan

Family Medicine and Population Health Publications

Importance

New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME).

Objective

To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME.

Design

We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different “hooks” (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and …

Harnessing Information Technology To Inform Patients Facing Routine Decisions: Cancer Screening As A Test Case, Alex Krist, Steven H. Woolf, Camille Hochheimer, Roy T. Sabo, Paulette Kashiri, Resa M. Jones, Jennifer Elston Lafata, Rebecca S. Etz, Shin-Ping Tu

Family Medicine and Population Health Publications

PURPOSE Technology could transform routine decision making by anticipating patients’ information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases.

METHODS Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men …

Coexisting Sickle Cell Anemia And Sarcoidosis: A Management Conundrum!, Fnu Nutan, Nagesh S. Gollahalli

Family Medicine and Population Health Publications

Sickle cell disease and Sarcoidosis are conditions that are more common in the African American population. In this report we share an unfortunate patient who had hepatic sarcoidosis but could not receive steroids since that precipitated acute liver failure. We have discussed potential therapy options but we need more options that improve mortality.

Interleukin-18 Mediates Cardiac Dysfunction Induced By Western Diet Independent Of Obesity And Hyperglycemia In The Mouse, S Carbone, P J H Lee, A G Mauro, E Mezzaroma, R Buzzetti, B Van Tassell, A Abbate, S Toldo

Family Medicine and Population Health Publications

Obesity and diabetes are independent risk factors for heart failure and are associated with the consumption of diet rich in saturated fat and sugar, Western diet (WD), known to induce cardiac dysfunction in the mouse through incompletely characterized inflammatory mechanisms. We hypothesized that the detrimental cardiac effects of WD are mediated by interleukin-18 (IL-18), proinflammatory cytokine linked to cardiac dysfunction. C57BL/6J wild-type male mice and IL-18 knockout male mice were fed highsaturated fat and high-sugar diet for 8 weeks. We measured food intake, body weight and fasting glycemia. We assessed left ventricular (LV) systolic and diastolic function by Doppler echocardiography …

Combined Cognitive And Vocational Interventions After Mild To Moderate Traumatic Brain Injury: Study Protocol For A Randomized Controlled Trial, Emilie I. Howe, Knut-Petter S. Langlo, Hans Christoffer Aargaard Terjesen, Cecilie Røe, Anne-Kristine Schanke, Helene L. Søberg, Unni Sveen, Eline Aas, Heidi Enehaug, Daniele E. Alves, Pål Klethagen, Kjersti Sagstad, Christine M. Moen, Karin Torsteinsbrend, Anne-Margrethe Linnestad, Tonje Haug Nordenmark, Birte Sand Rismyhr, Grete Wangen, Juan Lu, Jennie Ponsford, Elizabeth W. Twamley, Helene Ugelstad, Øystein Spjelkavik, Marianne Løvstad, Nada Andelic

Family Medicine and Population Health Publications

Background

A considerable proportion of patients with mild to moderate traumatic brain injury (TBI) experience long-lasting somatic, cognitive, and emotional symptoms that may hamper their capacity to return to work (RTW). Although several studies have described medical, psychological, and work-related factors that predict RTW after TBI, well-controlled intervention studies regarding RTW are scarce. Furthermore, there has traditionally been weak collaboration among health-related rehabilitation services, the labor and welfare sector, and workplaces.

Methods/design

This study protocol describes an innovative randomized controlled trial in which we will explore the effect of combining manualized cognitive rehabilitation (Compensatory Cognitive Training [CCT]) and supported employment …

The Dynamics Of Power And Psychological Safety On Team Cohesion During Interprofessional Simulation-Based Education, Tanya Huff

2017 Emswiller Interprofessional Symposium

No abstract provided.

Structural Modeling And Functional Analysis Of The Essential Ribosomal Processing Protease Prp From Staphylococcus Aureus, Erin A. Wall, Adam L. Johnson, Darrell L. Peterson, Gail E. Christie

Microbiology and Immunology Publications

In Firmicutes and related bacteria, ribosomal large subunit protein L27 is encoded with a conserved N-terminal extension that is removed to expose residues critical for ribosome function. Bacteria encoding L27 with this N-terminal extension also encode a sequence-specific cysteine protease, Prp, which carries out this cleavage. In this work, we demonstrate that L27 variants with an un-cleavable N-terminal extension, or lacking the extension (pre-cleaved), are unable to complement an L27 deletion in Staphylococcus aureus. This indicates that N-terminal processing of L27 is not only essential but possibly has a regulatory role. Prp represents a new clade of previously uncharacterized cysteine …