Medicine and Health Sciences Commons^™

Centering Health Equity And Structural Racism In Health Sciences Curriculum, Lynn E. Pelco, Kevin A. Harris, Carolyn Watts, Lisa B. Webb

Publications from the Office of the Senior Vice President for Health Sciences

This paper overviews scientific evidence and some of the local Richmond, Virginia history related to structural racism and health disparities. The paper then describe recent demands for racial justice and curriculum transformation that have been made by Virginia Commonwealth University (VCU) health sciences students, faculty and community members as well as the action steps the university has taken to address these demands. The paper concludes by calling on VCU health sciences faculty members to take action in the following three ways: (a) by participating in professional conversations about the intersections of health equity, structural racism, and health sciences education, (b) …

Teledentistry: An Innovative Workforce Model For Dental Hygienists, Kayla T. Khau, Hannah H. Nguyen

Dental Hygiene Student Scholarship

Objective/Aims: This review of literature seeks to explore teledentistry as an alternative dental hygiene workforce model that places a dental hygienist in the role of the mid-level practitioner as part of a digitally-connected oral healthcare team. It will also emphasize the innovative methods of teledentistry giving better health care delivery to diverse populations.

Methods: The review of literature analyzed the conclusions and discussions of primary and secondary scholarly articles from PubMed, Google Scholar, Embase, and CINAHL. Specific key terms included teledentistry, telehealth, teleconsultation, dental hygiene, dentistry, workforce model, health care delivery. Articles included in this review were published within the …

Ectopic Pregnancy In A Woman With T9 Ais A Paraplegia Secondary To High-Grade Spinal Cord Pilocytic Astrocytoma, Elisabeth K. Acker

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Ectopic pregnancy in a woman with T9 AIS A (motor complete, sensory complete) paraplegia secondary to a high-grade spinal cord pilocytic astrocytoma

Background

In the United States, 20,000 women of childbearing age have a spinal cord injury (SCI). While SCI induces transient amenorrhea immediately after injury, women generally have normal reproductive function after SCI, and their fertility is unimpaired. Medications that commonly manage complications of SCI should be avoided or discontinued during pregnancy. Complications inherent to SCI, including urologic issues, are often exacerbated during pregnancy.

Methods

This is a case report on a female Veteran who initially presented to the …

Erector Spinae Plane Block And Improved Perioperative Outcomes In Breast Brachytherapy, Jialiu D. Li, Yvonne Nguyen Md, Michael Buxhoeveden, Sabrina Dhillon

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

Utility Of Non-Invasive Testing For Fibrosis Assessment In Patients With End Stage Renal Disease, Nikita Chadha Do, Taseen Syed Mbbs, Richard K. Sterling Md, Msc

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: Non-alcoholic fatty liver disease (NAFLD) risk factors including metabolic syndrome (MS) and its components obesity (BMI ≥ 30), diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DL), has an increased prevalence in end stage renal disease (ESRD). The goal of study was to assess utility of non-invasive testing (NIT) including transient elastography (TE) for liver stiffness (LS), controlled attenuated parameter (CAP) for steatosis, Fibrosis-4 (FIB-4), AST to platelet ratio (APRI) and NAFLD Fibrosis score (NFS), for assessment of NAFLD in patients with ESRD undergoing renal transplant (RT) evaluation.

Methods: Demographic, clinical and laboratory data were collected within 12 weeks of …

A Closer Look At The Psychiatric Effects Of Deep Brain Stimulation To Further Guide Treatment Of Refractory Epilepsy: A Focused Review, Latangela Smith

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction: Effective treatment of medically-refractory epilepsy remains a formidable challenge in many patients. The SANTE trial (2010) led to the FDA approval of deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) for the treatment of medically-refractory epilepsy. However, ANT DBS also raised significant mental health concerns. This review will take another look at the psychiatric effects of DBS to more definitively outline the mental health risks and identify additional targets to guide future treatment.

Methods: A search of the clinical literature published between January 1, 1990 and December 31, 2019 was completed. The most relevant papers …

Are You In Or Obs? A Qi Project To Improve Resident Accuracy Of Admission Status Of Hospitalized Patients, Brooke Farquhar

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

Efficacy Of Combined Spinal Epidural With Adductor Canal Block For Total Knee Arthroplasty, Simrat Kaur, Nicholas Bastug, Michael Buxhoeveden, Sabrina Dhillon

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction: Combined Spinal Epidural (CSE) is often used as the primary anesthetic for Total Knee Arthroplasties (TKA) (4). Intrathecal morphine (ITM) is associated with pruritus, post-operative nausea and vomiting (PONV), and respiratory depression(3). Our institutional preference for TKA includes an opioid free CSE with Adductor Canal (AC) block. The objective of this study is to ascertain if CSE with AC block is beneficial as compared to CSE with ITM for TKA. We hypothesized improved side-effect profile and non-inferior pain control.

Methods: We reviewed 20 patients that received a CSE and AC block for TKA in 2018 and compared them to …

More Than Meets The Ipex: Finding The Right Source In An Immunosuppressed Patient, Ban Wang, Brant Ward

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Patients with immune dysregulation polyendocrinopathy enteropathy X-linked (IPEX) syndrome usually present with autoimmunity, but are also prone to significant infections. In this case report, we introduce a 21-year-old gentleman with IPEX syndrome who presented to our ED with witnessed episodes of tonic-clonic seizures that likely represented aseptic meningitis secondary to Ehrlichia infection.

We determined that our patient’s clear exposure history to animals likely carrying zoonotic diseases fits the clinical picture of aseptic meningitis that was triggered by systemic tick-borne infection. We were able to make our conclusions based on our patient’s multiple negative viral and bacterial in both blood and …

Erector Spinae Plane (Esp) Blocks In Patients Receiving Subcutaneous Icd Placement: A Noninferiority Trial, Andrew Cutshall, Sabrina Dhillon, Michael Buxhoeveden, Juhee Sharma

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

How To Improve Resident Firearm Safety Education, Hannah Hollon, Elizabeth Wolf, Darina Dinov

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Abstract: How to Improve Resident Firearm Safety Education

Hannah Hollon, MD, Darina Dinov, DO, Elizabeth Wolf, MD, MPH

Background: Gun violence is the second leading cause of death in children, and one third of children in the United States live with a gun in the home.¹ Despite this public health challenge, there is a lack of firearm safety education in residency programs. One study from 1997 surveyed pediatric residencies across the country and found that 34% of programs reported having formal firearm safety education as part of their curricula. The programs cited lack of trained personnel, educational …

The Effect Of Stress Inoculation Training On Endotracheal Intubation, Alexandra P. Lambert

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction

Stressful situations pervade emergency medicine. Many studies demonstrate the deleterious impacts of stress on a physician’s immediate actions and lasting mental health. It is well-documented in the literature that preparedness can help mediate stress. Stress inoculation training (SIT) is utilized to prevent adverse stress response. This training teaches coping skills and defensive thinking to actively mitigate the negative physiological effects that occur during stressful events. SIT theory involves a conceptualization phase, skills training phase and application phase. The goal of this study is to evaluate the effect of SIT on endotracheal intubation performance of novice intubators.

Methods

The study …

Seminal Vesicle Adherent To Rectal Wall Following Neoadjuvant Chemoradiotherapy: A Potential False-Positive Diagnostic Pitfall, Samia Liaquat, Michael O. Idowu, Bryce Hatfield

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

The standard of care for stage T3 and stage T4 rectal adenocarcinomas involves neoadjuvant chemoradiotherapy followed by either low anterior resection or abdominopelvic resection. The presence of residual adenocarcinoma or positive surgical margins provides useful prognostic information and can influence ongoing adjuvant therapy. Although uncommon, mimics of treated adenocarcinoma may be present in the surgical specimen. A high index of suspicion is critical in avoiding potential false-positive pitfall, and the exclusion of mimics of treated adenocarcinoma is paramount to accurate diagnosis and treatment. Seminal vesicle epithelium has long been a challenge in differentiating prostatic adenocarcinoma from benign epithelium. However, the …

Increasing Accurate And Timely Completion Of Medication Reconciliation In Pediatrics, George Thieroff, Megan Coe, Maria Belen Pappa, Imen Becetti, Kemper Wesley Steffe, Kelley Byrum, Kristi Higgins, Ashlie Tseng

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

Quiet Please: The Effects Of Sleep Quality And Quantity As A Result Of A Qi Project To Minimize Nighttime Sleep Interruptions, Chari Stump, Ashlie Tseng, Jennifer Brigle, Clifton Lee

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Quiet Please! The effects on sleep quality and quantity as a result of QI project to minimize nighttime interruptions

INTRODUCTION: Sleep is a significant component of health that is often overlooked in hospitalized patients. We introduced a QI project in 2016 to minimize nighttime interruptions in clinically stable patients by performing “passive vitals” which eliminated temperature and blood pressure readings at 4am and allowed patients to sleep longer overnight. Despite this intervention, the effects on sleep quality and quantity are unknown.

OBJECTIVE: The objective was to compare total sleep time, sleep interruptions, and sleep quality between patients eligible for passive …

The Influence Of Health Disparities On Risk Factors In Patients With Colorectal Cancer, Neha Hippalgaonkar Md, Khalid Matin Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

"I Play One On Television." A Case For Palliative Telemedicine, Sarah E. West, Danielle Noreika, Egidio Delfabbro

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

Comparison Of The Performance Of Two Different Alk Antibody Clones (D5f3 And Alk1) In Anaplastic Large Cell Lymphoma (Alcl), Dana Martin, Steven Smith, Alden Chesney, Terra Lewis, Raghavendra Pillappa

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background:Anaplastic large cell lymphoma (ALCL) is a T-cell lymphoma characterized by CD30 expression and subdivided into anaplastic lymphoma kinase (ALK) positive and negative subtypes that show clinically significant differences in outcomes. The current standard for evaluating ALK status is immunohistochemistry using the mouse monoclonal anti-human CD246 (ALK1) or fluorescence in situ hybridization. The novel rabbit monoclonal anti-human CD246 (D5F3) is proposed as an alternative to ALK1 and FDA approved for diagnosis of ALK-rearranged lung adenocarcinoma. However, its performance has not been systematically tested and compared to ALK1 in ALCL.

Design: Twenty-seven cases of ALCL were identified from institutional database searches …

What’S That Beeping Sound? Case Report, Ellie Balakhanlou Md, Olivier Rolin Md, Eugenio Monasterio

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Abstract Title: What’s that Beeping Sound? A Case Report

Ellie Balakhanlou, Medical Doctor - Medical Resident, Virginia Commonwealth University School of Medicine (Role: Presenting Author)

Olivier Rolin, Medical Doctor – Assistant Professor, Virginia Commonwealth University School of Medicine (Role: Corresponding Author)

Eugenio Monasterio, Medical Doctor – Assistant Professor, Virginia Commonwealth University School of Medicine (Role: Corresponding Author)

Disclosure: None. Setting: Outpatient pediatric clinic Patient: A 21 year old female with spastic quadriplegic cerebral palsy (CP) with an intrathecal baclofen (ITB) pump

Case Description:

The patient presented with concerns of intermittent beeping sounds from her pump. She does not endorse any …

Polysomnographic Features Of Sleep Paralysis (Sp) Captured In A Patient With Narcolepsy, Alex Dworetz Do, Ee-Rah Sung Do, Maha Alattar Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction:

SP is a transient episode of muscle atonia that occurs during the transition between sleep and wakefulness, manifesting as immobility despite preserved consciousness. Isolated SP may occur in healthy individuals, however recurrent SP is a well-documented feature of narcolepsy. There is limited literature describing the polysomnographic features of SP, partly owning to its rarity and unlikelihood of being captured during a single study. We aim to illustrate the key neurophysiological features in a patient experiencing SP.

Methods:

We report a 24-year-old female who presented to our sleep clinic for excessive daytime somnolence and recurrent SP episodes upon …

Depression Is Associated With Weight Gain In Patients Transplanted For Nash Cirrhosis But Not Other Etiologies Of Cirrhosis, Jose Hernandez-Roman, Steven Shen, Samarth Patel, Mohammad Bilal Siddiqui, Anchalia Chandrakumaran, Masoud Faridnia, Emily Zhang, Emily Lee, Mohammad Shadab Siddiqui

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

The present study was to bridge this gap in knowledge by evaluating the relationship between depression, liver disease and weight change after LT. Weight gain after liver transplantation (LT) is common, particularly in patients transplanted for NASH cirrhosis, and is associated with reduced survival. In non-LT patients, presence and sub-optimal management of depression is closely associated with weight gain and obesity. The impact of depression as predictor of post-LT weight gain is currently not known. Method:All adult patients receiving LT between 7/2007 to 7/2017 were included in the analysis. Patients with graft failure or death within 6 months after …

Chronic Post-Surgical Abdominal Pain Treated With Percutaneous Peripheral Nerve Stimulation Of Iliohypogastric And Ilioinguinal Nerves, Harnek Bajaj, Denise Lester

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Chronic pelvic and lower abdominal pain can be a severely debilitating condition that affects between 7% to 24% of the general population (4). The anterior rami of L1 and T12 give contributions to the ilioinguinal and iliohypogastric nerves which provide sensory innervation to the lower abdomen and pubic regions (3). Entrapment or damage of these nerves can occur due to a variety of mechanisms, and common treatment options have included medications (2), nerve blocks (1), and in rare cases, surgical resection of the involved nerve. In this case, a 47 year old morbidly obese female with history of chronic left …

Improving Early Antibiotic Administration For Treatment Of Sepsis At Children’S Hospital Of Richmond At Vcu: 2012-2019, Hannah Miller Md, Ashlie Tseng Md, Perry Taylor Pharmd, Matthew Schefft Do Msha, Sheila Pedigo Pharmd Bcpps, Tracy Lowerre Bsn Ms, Jose Munoz Md, Mark Astoria Md, Jonathan Silverman Md Mph

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: The Surviving Sepsis Campaign recommends initiating IV antibiotic administration within one hour of recognition of severe sepsis. Several studies have shown that prompt blood culture collection, administration of broad-spectrum antibiotics, and fluid resuscitation following recognition improves child survival.

Objective: Our goal was to evaluate effectiveness of sepsis initiatives and institutional changes in the timing of early antibiotic administration at Children’s Hospital of Richmond at VCU.

Methods: We formed a Pediatric Sepsis Committee with representatives from each unit in 2013. In 2016, the committee began tracking time from the order of a first stat dose IV antibiotic to administration as …

Prevalence Of The Hypervirulent Nap1/Bi/027 Strain Of C. Difficile In Southwestern Virginia And Risk Factors Associated With Infection, Andrew O. Hanna, Anthony Baffoe-Bonnie, Shikha Vasudeva

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

C. difficile infection (CDI) incidence has increased over the last several decades. The BI/NAP1/027 ribotype was discovered in 2005 and has since been responsible for multiple outbreaks in the US and Canada. This subtype of C. Difficile is known to be more virulent in vivo and produce more severe disease. Limited regional data of the prevalence of this ribotype is available, which could help guide treatment. Using infection control data from a large regional hospital and a VA medical center, this study documented the prevalence of the 027 ribotype in Southwest Virginia. Patients were included if they were tested at …

Getting On The Same Page: A Quality Improvement Project To Reduce Overnight Nursing-To-Resident Physician Pages In An Inpatient Rehabilitation Unit, Renae Fisher Md, Rajbir Chaggar Md, Anthony Zenger Md, Susan Hamilton Rn, Bsn, William Carter Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction
Many Physical Medicine and Rehabilitation (PM&R) residency programs utilize “home call” systems for nighttime coverage of inpatient services. In this system, trainees are expected to work at full capacity the following day after taking nocturnal call. While “on call,” trainees receive both urgent and non-urgent pages throughout the night, which disrupt sleep. To mitigate fatigue, improve hand-offs and improve timing of patient care, this study targeted reducing non-urgent overnight pages from nurses to home call PM&R residents between 11pm to 6am.

Methods

We implemented a prospective quality improvement study with interventions including holding “Getting on the Same Page” meetings …

Hypoxic Ischemic Encephalopathy Severity, Seizure Medication Strategies And Early Neurodevelopmental Outcome, Desiree Garcia-Alvarez

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

Selecting The Optimal Unrelated Hematopoietic Stem Cell Transplant Donor For Relapse Prevention In Acute Myeloid Leukemia, Elizabeth Krieger, Rehan Qayyum, Amir Toor

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction/Background

Hematopoietic cell transplantation (HCT) provides

a cure for patients with acute myeloid leukemia.

Natural killer cells (NK) play an important role

in graft versus leukemia (GVL) effect after HCT,

through killer immunoglobulin-like receptor (KIR)

interaction with HLA ligands. This study is

undertaken to validate our previously published

mathematical model accounting for the KIR-KIRL

interactions in a post HCT setting.

Methods

Retrospective data were obtained from the Center

for International Blood and Marrow Transplant

Registry for 2317 donor recipient pairs (DRP) who

underwent 7/8 or 8/8 HLA allelic matched

unrelated donor (URD) HCT for AML. KIR-HLA

interaction scores were calculated …

Quiet A Puzzle: A Case Report Of 15 Year Old Female With Severe Anemia Due To Scurvy, Shaikha Alqahtani, Wang Zhihong

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Scurvy is historically thought of a disease affecting sailors in the seventeenth century. Vitamin C deficiency is rare in the developed world. It is mainly found in patients with poor nutrition and specifically those with developmental delay. The spectrum of scurvy is varied and includes dermatological, dental, bone and systemic manifestations. We present to you a case of a 15 year old female with a history of trisomy 21 presenting with severe anemia as a direct cause of vitamin C deficiency.

She presented with a one month history of progressive bilateral lower extremity bruising and inability to walk. Physical exam …

A “Behind-The-Scenes” Look At Interprofessional Care Coordination: How Person-Centered Care In Safety-Net Health System Complex Care Clinics Produce Better Outcomes, E. Marshall Brooks, Jodi M. Winship, Anton J. Kuzel

Family Medicine and Population Health Publications

Introduction: While the effectiveness of team-based care and wrap-around services for high utilizers is clear, how complex care clinics deliver effective, person-centered care to these vulnerable populations is not well understood. This paper describes how interactions among interprofessional team members enabled individualized, rapid responses to the complex needs of vulnerable patients at the Virginia Commonwealth University Health System’s Complex Care Clinic.

Methods: Researchers attended twenty weekly care coordination meetings, audio-recorded the proceedings, and wrote brief observational field notes. Researchers also qualitatively interviewed ten clinic team members. Emergent coding based on grounded theory and a consensus process were used to identify …

Characterization Of Respiration-Induced Motion In Prone Versus Supine Patient Positioning For Thoracic Radiation Therapy, Christopher L. Guy, Elisabeth Weiss, Mihaela Rosu-Bubulac

Radiation Oncology Publications

Purpose

Variations in the breathing characteristics, both on short term (intrafraction) and long term (interfraction) time scales, may adversely affect the radiation therapy process at all stages when treating lung tumors. Prone position has been shown to improve consistency (ie, reduced intrafraction variability) and reproducibility (ie, reduced interfraction variability) of the respiratory pattern with respect to breathing amplitude and period as a result of natural abdominal compression, with no active involvement required from the patient. The next natural step in investigating breathing-induced changes is to evaluate motion amplitude changes between prone and supine targets or organs at risk, which is …