Medicine and Health Sciences Commons^™

Factores De Riesgo Asociados A Recaída De Enfermedad Por Reflujo Gastroesofágico En Pacientes De Primer Nivel De Atención Exitosamente Tratados Con Inhibidor De La Bomba De Protones [Risk Factors Associated With Gastroesophageal Reflux Disease Relapse In Primary Care Patients Successfully Treated With A Proton Pump Inhibitor], Aurelio López-Colombo, M. S. Pacio-Quiterio, L. Y. Jesús-Mejenes, J. E. G. Rodríguez-Aguilar, M. López-Guevara, A. J. Montiel-Jarquín, Juan Carlos Lopez Alvarenga, E. R. Morales-Hernández, V. R. Ortiz-Juárez, L. Ávila-Jiménez

School of Medicine Publications

Resumen

Antecedentes

No existen estudios en primer nivel de atención sobre factores asociados a recaída de enfermedad por reflujo gastroesofágico (ERGE).

Objetivo

Identificar factores de riesgo asociados a recaída de ERGE en pacientes de primer nivel de atención que respondieron adecuadamente a un tratamiento corto con inhibidor de la bomba de protones.

Pacientes y métodos

Estudio de cohorte, se incluyeron casos incidentes de ERGE. Se dio tratamiento con omeprazol durante 4 semanas. Se aplicó ReQuest y un cuestionario de factores de riesgo. Se determinó la tasa de éxito terapéutico y de recaída a las 4 y 12 semanas después de …

Gamma-Delta (Gammadelta) (Γδ) T-Cell Lymphoma - Another Case Unclassifiable By World Health Organization Classification: A Case Report, H Sindhu, R Chen, H Chen, Jonathan Wong, R Chaudhry, Y Xu, Jen Chin Wang

NYMC Faculty Publications

BACKGROUND: We present a case of gamma-delta T-cell lymphoma that does not fit the current World Health Organization classifications. CASE PRESENTATION: A 74-year-old Caribbean-American woman presented with lymphocytosis, pruritus, and non-drenching night sweats. Bone marrow and peripheral blood analyses both confirmed the diagnosis of gamma-delta T-cell lymphoma. An axillary lymph node biopsy was negative for lymphoma. Clinically absent hepatosplenomegaly and skin lesions with biopsy-proven gamma-delta T-cell lymphoma suggest that she is unclassifiable within the current classification system. CONCLUSIONS: We believe this is a case of not otherwise specified gamma-delta T-cell lymphoma. Accumulation of these rare not otherwise specified cases will …

Regional Anesthesia And Breast Cancer Recurrence, Michael Dunnington

Nurse Anesthesia MSNA Student Capstones

Breast cancer is the most common type of cancer in women in the United States, and surgical resection is the definitive treatment. However, cancer recurrence and metastasis remains a concern for the lifetime of the patients affected. Therefore, much interest has been focused on how anesthetic technique may impact the rates of cancer recurrence and metastasis following breast cancer surgery. In this review, the potential for regional analgesia to reduce the recurrence rate of breast cancer post-operatively is discussed. Supporting evidence from multiple studies is presented, along with a discussion of potential areas of future research that is needed. At …

Hypertonic Saline Versus Mannitol To Improve Brain Relaxation In Craniotomy: A Case Study, Morgan Cornell

Nurse Anesthesia MSNA Student Capstones

In neurosurgical procedures, including craniotomy for tumor, neurosurgeons often require a reduction of brain swelling to optimally perform the surgery. The reduction of brain swelling is termed brain relaxation. The anesthesia professional can accomplish brain relaxation using multiple techniques. One such technique is the infusion of certain intravenous fluids to change the osmotic pressure within the cranial vault thereby reducing brain edema (Jaffe, 2014). Highly osmolar fluids such as mannitol and hypertonic saline can be infused to decrease brain edema. Currently, mannitol remains the gold standard for medical treatment of intracranial pressure in neurosurgical procedures (Marko, 2012). This review seeks …

The Impact Of Intraoperative Goal-Directed Fluid Therapy, Marc Yacovone

Nurse Anesthesia MSNA Student Capstones

Anesthetists provide intra-operative fluid therapy by utilizing a variety of different methods. Deciding on the appropriate method is multifaceted, and the choice of method is a determinate of safe and effective outcomes. Camach-Navarro et al. (2015) determined that postoperative complications are linked to either giving too much or too little fluid. Unfortunately, the deleterious effects of improper fluid therapy are often overlooked.

Minor surgical procedures which result in little to no blood loss, often lead to positive outcomes using the fixed volume calculation approach to fluid therapy. However, when major surgical procedures are performed on sick patients a fluid management …

The Role Of Platelet Rich Plasma In Pain Management And Decrease In Opioid Use, Sara Cunha

Nurse Anesthesia MSNA Student Capstones

Platelet-rich plasma, also known as PRP, has become increasingly popular for the treatment of orthopedic injuries and symptomatic pain that results from such injuries. By promoting a localized inflammatory response, PRP injections increase blood flow to the injured area and expedite the healing process, thereby leading to pain relief. PRP has the potential to be a key player in the future of pain management. However, current evidence of the impact of PRP on pain relief is controversial. This paper aims to review the most current randomized controlled trials evaluating the efficacy of PRP in pain relief in a variety of …

Dexmedetomidine In The Prevention Of Emergence Delirium In Children, Lauren Anderson

Nurse Anesthesia MSNA Student Capstones

This review examines the use of intravenous dexmedetomidine in the role of decreasing or preventing emergence delirium in pediatric patients undergoing ambulatory surgery. The included randomized controlled trials evaluated the administration of dexmedetomidine, whether as a bolus, infusion, or in combination, and its effectiveness in preventing or reducing emergence delirium. The analysis scales for emergence delirium varied between studies, and it was noted that multiple scale components overlapped with pain scale components used in the trials. It has also been noted that differentiating between pain and emergence delirium can be challenging for clinicians (Somaini, Engelhardt, Fumagalli & Ingelmo, 2016). To …

Neurotoxic Effects Of Anesthesia On The Developing Brain, Nicole Hachey

Nurse Anesthesia MSNA Student Capstones

Each year, thousands of neonates receive anesthesia and/or sedation for various surgical procedures. With advancements in neonatal care and surgical techniques, the number of infants receiving anesthesia globally will continue to increase. A relatively large and growing body of literature suggests that exposure to general anesthetics can be detrimental to the developing brain. Based upon various animal studies, it is thought that exposure of the immature brain to anesthetic agents may result in apoptosis, neurodegeneration and ultimately long-term cognitive deficiencies (Walters & Paule, 2016). This information presents a dilemma for practitioners when caring for a neonate requiring a surgical procedure, …

Thoracic Epidural Versus Continuous Intercostal Catheter For Patients Undergoing Video Assisted Thoracoscopic Surgery (Vats), Brittany Guilmet

Nurse Anesthesia MSNA Student Capstones

Advances in technology have pushed many practitioners towards the implementation of minimally invasive surgery. Many different specialties have rapidly adopted this new approach and patient outcomes have improved as a result of this transition. One specialty, thoracic surgery, has evolved with this change through the development of video assisted thoracoscopic surgery (VATS). Despite improved patient outcomes, thoracic surgery remains one of the most painful procedures that a patient can endure. Although there are many different analgesic modalities available, the gold standard for post-operative analgesia in this patient population remains unknown. The aim of this literature review is to compare the …

Use Of Brca Mutation Test In The Us, 2004-2014, Fangjian Guo, Jacqueline M. Hirth, Yu-Li Lin, Gwyn Richardson, Lyuba Levine, Abbey B. Berenson, Yong-Fang Kuo

School of Medicine Publications

Introduction

BRCA mutation testing has been used for screening women at high risk of breast and ovarian cancer and for selecting the best treatment for those with breast cancer. To optimize the infrastructure and medical resources allocation for genetic testing, it is important to understand the use of BRCA mutation testing in the U.S. health system.

Methods

This retrospective cohort study included 53,254 adult women with insurance claims for BRCA mutation testing between 2004 and 2014 from ClinformaticsTM Data Mart Database. Data analysis was performed in 2016. This study assessed trends in the use of BRCA mutation testing in women …

19th Annual Pacific Research Day Abstracts, University Of The Pacific

Excellence Day

No abstract provided.

Community Living Integration Club For Women In Recovery From Sex Trafficking, Toni Thompson

Occupational Therapy Program Student Theses, Dissertations and Capstones

Sex trafficking is one form of human trafficking, a heinous human rights violation that transcends international borders. People who have been trafficked often present with complex neurobehavioral, psychological, emotional, physiological, sensory, and developmental difficulties. The United Nations developed the international 3 p protocol to guide governmental agencies, non-governmental groups, and individuals in developing programs and legal actions of trafficking prevention, protection, and prosecution. Protection encompasses the recovery of trafficking survivors and community integration has been identified as an essential foundation for successful recovery. Measurable components of community integration include safe housing, stable employment, and vocation-focused education. This Capstone describes the …

Should We Set A Formalized Discharge Instruction Education Standard?, Jinyu Zhang, Md, Maria Vershvovsky, Md, Noha Ghusson, Md, Jeffrey Riggio, Md, Lily Ackermann, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Smart AIM:

With a more formalized discharge instruction evaluation process for PGY-1s, discharge instructions for specific diagnoses will have less error in a year’s time.

Vaginal Preparation With Povidone Iodine Prior To Cesarean Delivery, Laura Felder, Md, Amanda Paternostro, Md, Johanna Quist-Nelson, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives: To reduce the rate of postoperative endometritis in patients undergoing cesarean delivery by implementing a new departmental guideline for vaginal preparation prior to cesarean sections, after labor or rupture of membranes

Utilization Of A Multimodal Preoperative Pain Regimen Prior To Gynecologic Oncology Exploratory Laparotomies, Lauren C. Hand, Md, Alison Vogell, Md, Talia Maas, Md, Kristina Masi, Md, Rebecca J. Mercier Md Mph, Norman G. Rosenblum, Md, Phd, Christine H. Kim, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objective:

The aim of this study was to evaluate the use of a combination of non-opioid preoperative pain medications including Tylenol, Lyrica, and Celecoxib (TLC) in patients undergoing gynecologic oncologic exploratory laparotomies. We evaluated postoperative narcotic use in morphine equvalents (ME) as well as pain scores, anti-emetic use, and length of stay.

Quiet In The Operating Room! Team Stepps And Or Distractions, Zabecca S. Brinson, Md, Adam P. Johnson, Md, Mph, Rose Farmer, Rn, Tesa Leonard, Crna, Susan Cacciatore, Rn, Maritza Sanchez, Rn, Lorie Weikel, Rn, Paul Sammut, Rn, Francesco Palazzo, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background and Objective:

From the moment that a patient enters the operating room to the time that they are brought to the post anesthesia care unit, a distraction has the potential to lead to an adverse outcome for the patient. During the critical portions of the surgery, it is even more important for all members of the operating staff to be focused and engaging in safe practices. Distractions in the operating room can hinder safe communication and potentially endanger patient safety. Team training has been shown to both improve team communication and reduce distractions.

The objective of this project was …

Transrectal Ultrasound Guided Prostate Biopsy Antibiotic Prophylaxis: Standard Vs. Augmented Antibiotic Regimens, And The Role For Pre-Biopsy Rectal Swab Cultures, Thomas Hardacker, Md, Mba, Danielle Squadrito, Rn, Christopher Caputo, Md, Mark Mann, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives:

To evaluate peri-procedural antibiotic prophylaxis regimens based on pre-procedural rectal swab cultures.

To evaluate infection rates between transrectalbiopsy patients receiving FQs alone and those receiving ceftriaxone or gentamicin in addition to FQs.

Inappropriate Electrolyte Repletion For Patients Undergoing Endoscopic Procedures, Daniel Altman, Md, Solomon R. Dawson, Md, Kevin Kwak, Md, Drew Johnson, Md, Harshal Mehdi, Md, Christie Mulholland, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

At Thomas Jefferson University Hospital (TJUH), there has been a perceived necessity among housestaff and fellows to routinely check and replete serum potassium and magnesium for inpatients prior to endoscopic procedures In addition, there was an unwritten policy that these electrolytes needed to be aggressively repleted, with a goal potassium above 4.0 and magnesium above 2.0 Contributing factors include absence of clear policy, fear of adverse outcomes during procedures, and fear of delay of procedures leading to increased hospital stay This practice has led to unwarranted lab draws, costs of lab tests and electrolyte riders, and possible delayed procedures

Goals …

Standardization Of Monofilament Use In A Resident-Run Clinic, Odunayo Banjoko, Md, Doron Schneider, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Study Aim:

The aim of this study was to improve incidence of regular foot exams among clinic diabetic patients.

Preventing Isolated Perioperative Reintubation: Who Is At Highest Risk?, Tyler M. Bauer, Md, Adam P. Johnson, Md, Chris Wirtalla, Md, Jordan E. Goldhammer, Md, Rachel R. Kelz, Md, Scott W. Cowan, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives:

1. We aim to characterize IPR nationally through a retrospective review of the National Surgical Quality Improvement Program participant user file (NSQIP PUF).

2.Identify risk factors for IPR including analysis of procedure type and preoperative characteristics.

Knowledge, Perception, And Use Of Medications During Pregnancy In Hispanic Women In Utah County, Ut, Jessica Martinez, Gene Cole

Journal of Undergraduate Research

The purpose of this study was to research, primarily, how Hispanic view and respond to prescription drugs during pregnancy. The study’s population was Hispanic women in Utah County who are/were pregnant and their adherence to prescription drugs versus home remedies. We conducted our research at the Mountainlands Community Health Center in Provo, Utah. We sought to understand the opinions and perceptions Hispanic women have towards use of prescription and alternative medicine during pregnancy.

Prenatal Care Enhanced With Digital Health Tools Can Reduce Visit Frequency While Improving Patient Satisfaction, Kathryn I. Marko, Nihar Ganju, Anish Sebastian, Joshua Benham

Medicine Faculty Posters and Presentations

100 low-risk obstetric patients were enrolled to evaluate the use of digital health technology in prenatal care. 50 patients were placed on an alternate prenatal care schedule (8 visits), supplemented with an integrated technology platform of a mobile application and connected devices including a wireless weight scale and blood pressure cuff. The remaining 50 control patients received routine care, without the technology platform. Patients were evaluated for satisfaction and engagement throughout pregnancy.

Psychometric Properties Of The Ndetei–Othieno–Kathuku (Nok) Scale: A Mental Health Assessment Tool For An African Setting, Christy A. Denckla, David M. Ndetei, Victoria N. Mutiso, Christine W. Musyimi, Abednego M. Musau, Eric S. Nandoya, Kelly K. Anderson, Snezana Milanovic, David Henderson, Kwame Mckenzie

Paediatrics Publications

Background: Research suggests that psychiatric conditions in children and adolescents are highly debilitating, with sparse resources for assessment and treatment in low- and middle-income countries (LMICs). Objectives: The primary aim of this study was to evaluate the reliability, validity, and latent factor structure of an ethnographically-grounded assessment instrument for detecting common mental health complaints among rural Kenyan children and adolescents. Methods: The Ndetei–Othieno–Kathuku Scale (NOK) was delivered to 2 282 children aged 10 to 18 years old. Exploratory factor analysis identified four latent factors. This structure was confirmed in subsequent confirmatory factor analyses. External validity was explored by investigating associations …

Echocardiography Role In Syncope Patients, Ali Raza Ghani, Md, Irfan Ahsan, Md, Wajahat Humayun, Md, Usman Sarwar, Md, Margot I. Boigon, Md, Mary Maglak, Phd

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Methods: We did a retrospective chart review of 138 patients admitted to observation floor with diagnosis of syncope.

Improving Resulted Hemoglobin A1c Rates: A Feasibility Study For Point-Of-Care Hemoglobin A1c Testing At An Urban Family Medicine Office, Phoebe Askie, Md, Mph, Daniel Chung, Md, Laura Parente, Md, Yury Parra, Md, Grace Amadi, Md, Mariana R. Kuperman, Md, Mph, Bruce Reaves, Md, Miranda Aragon, Md, Kyle Bardet, Md, Sunny Lai, Md, Anna Woods, Md, Marc Altshuler, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Study Aims:

• Our practice’s goal is to increase the number of up to date hemoglobin A1c for diabetic patients seen at JFMA in order to help improve glycemic control
• The aim of this study is to see if point of care (POC) hemoglobin A1C is a feasible way to increase the number of up to date hemoglobin A1C. We looked at various factors including timing, training, and flow.

The First Histological Analysis Of The Tissues Lining The Fossa Navicularis: Insights To Its Etiology., Sarvenaz Sheikh, Joe Iwanaga, Steven Rostad, Tarush Rustagi, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The fossa navicularis (FN) is an anatomical variant on the ventral surface of the basilar part of the occipital bone that, to date, has only been investigated in bone specimens. We aim to clarify the structure of the fossa navicularis by gross anatomical, radiological, and histological methods. The FN was found in the occipital bone of the Caucasian male cadaver. There was no bony or histological continuity between the FN and posterior cranial fossa. The histological analysis found that the overlying tissue was composed of loose connective tissue with a mixture of collagen and elastic fibers and a vascular matrix …

Rebon Shrimp Powder Addition Influence To Nutritional Values, Organoleptic Properties And Acceptance Of Supplementary Food By Children Aged 4-5 Years Old, Priyo Sulistiyono, Dewi Marhaeni Diah Herawati, Insi Farisa Desy Arya

Kesmas

Prevalensi gizi kurang dan stunting pada anak bawah lima tahun (balita) di Kota Cirebon masih cukup tinggi yaitu mencapai 13,9% dan 15,7%. Udang rebon (Acetes erythraeus) memiliki kandungan protein dan kalsium yang tinggi. Pengaruh penambahan udang rebon dalam makanan tambahan (bubur lemu dan bolu kukus) terhadap kualitas gizi diteliti. Penelitian ini bertujuan untuk mengetahui pengaruh bubuk udang rebon terhadap nilai gizi, sifat organoleptik dan daya terima. Uji laboratorium dan perangkat lunak Nutriservey digunakan untuk analisis nilai gizi bubuk udang rebon dan gizi makanan tambahan. Uji organoleptik menggunakan rancangan acak lengkap dengan empat perlakuan (bubuk udang rebon 0%, 5%, 10%, 15%) …

"The Weekend Effect": Weekday Versus Weekend Comparison Of Patients Admitted With Nstemi In Terms Of Length Of Hospital Stay, Door To Balloon Time And Left Ventricular Function, Wajahat Humayun, Md, Ali Raza Ghani, Md, Asoka Balaratna, Md, Mary Naglak, Phd

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

The primary objective of our study was to determine the difference in the outcome, if any, between patients presenting with NSTEMI on weekends versus weekdays. We also looked for the difference in clinical outcomes between these two groups of patients.

Poster presented at annual House Staff Quality Improvement and Patient Safety Posters.

The Case Of The 10 Pound Giant: A Near Miss Root Cause Analysis, Debbie Chen, Md, Megan Margiotta, Md, Grant Turner, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives:

Through an Interprofessional Root Cause Analysis of this Near Miss event, we aimed to: 1.Identify issues contributing to the incorrect dosing of acyclovir 2.Understand relevant institutional policies and compare this to usual practice 3.Propose possible solutions

Got Sugar? Pharmacist Intervention To Improve A1c, Rino Sato, Md, Matthew Murphy, Md, Margaret Ivanov, Md, Alan Gandler, Md, Roshni S. Patel, Pharmd, Bcps, John Caruso, Md, Loren Chen, Md, Albert Lee, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

AIM:

Within 6 months, we aim to decrease by 10% the number of our diabetic patients with an A1c >8 through Clinical Pharmacist referrals.