Medicine and Health Sciences Commons^™

Wses Worldwide Emergency General Surgery Formation And Evaluation Project, Federico Coccolini, Yoram Kluger, Luca Ansaloni, Ernest E. Moore, Raul Coimbra, Gustavo P. Fraga, Andrew Kirkpatrick, Andrew Peitzman, Ron Maier, Gianluca Baiocchi, Vanni Agnoletti, Emiliano Gamberini, Ari Leppaniemi, Rao Ivatury, Michael Sugrue, Massimo Sartelli, Salomone Di Saverio, Walt Biffl, Fausto Catena

Surgery Publications

Optimal management of emergency surgical patients represents one of the major health challenges worldwide. Emergency general surgery (EGS) was identified as multidisciplinary surgery performed for traumatic and nontraumatic acute conditions during the same admission in the hospital. EGS represents the easiest viable way to provide affordable and high-quality level of care to emergency surgical and trauma patients. It may result from the association of different physicians with other specialties in a cooperative model. The World Society of Emergency Surgery (WSES) has been working on the EGS organization and implementation since its foundation believing in the need of common benchmarks for …

Low Nt-Probnp Levels In Overweight And Obese Patients Do Not Rule Out A Diagnosis Of Heart Failure With Preserved Ejection Fraction, Leo F. Buckley, Justin M. Canada, Marco G. Del Buono, Salvatore Carbone, Cory R. Trankle, Hayley Billingsley, Dinesh Kadariya, Ross Arena, Benjamin W. Van Tassell, Antonio Abbate

Internal Medicine Publications

Background Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome that presents clinicians with a diagnostic challenge. The use of natriuretic peptides to exclude a diagnosis of HFpEF has been proposed. We sought to compare HFpEF patients with N-terminal pro-brain natriuretic peptide (NT-proBNP) level above and below the proposed cut-off.

Methods Stable patients (n = 30) with left ventricular (LV) ejection fraction ≥ 50% were eligible if they had a diagnosis of HF according to the European Society of Cardiology diagnostic criteria. Characteristics of patients with NT-proBNP below (≤125 pg/mL) and above (>125 pg/mL) the diagnostic …

Intestine‐Specific Expression Of Human Chimeric Intestinal Alkaline Phosphatase Attenuates Western Diet‐Induced Barrier Dysfunction And Glucose Intolerance, Siddhartha S. Ghosh, Hongliang He, Jing Wang, William Korzun, Paul J. Yannie, Shobha Ghosh

Internal Medicine Publications

Intestinal epithelial cell derived alkaline phosphatase (IAP) dephosphorylates/detoxifies bacterial endotoxin lipopolysaccharide (LPS) in the gut lumen. We have earlier demonstrated that consumption of high‐fat high‐cholesterol containing western type‐diet (WD) significantly reduces IAP activity, increases intestinal permeability leading to increased plasma levels of LPS and glucose intolerance. Furthermore, oral supplementation with curcumin that increased IAP activity improved intestinal barrier function as well as glucose tolerance. To directly test the hypothesis that targeted increase in IAP would protect against WD‐induced metabolic consequences, we developed intestine‐specific IAP transgenic mice where expression of human chimeric IAP is under the control of intestine‐specific villin promoter. …

Development Of Esi-Lc-Ms Method For Drug Analysis, Kimberly Yacoub

ETD Archive

Brain cancer, particularly astrocytomas, is one of the ten most common related deaths related to cancer. Temozolomide (TMZ), an oral alkylating chemotherapy drug, is used to treat anaplastic astrocytoma and glioblastoma multiforme. A few advantages of TMZ are its ability to cross the blood-brain barrier, its small size, and it is rapidly absorbed in the small intestine. Since this drug is advantageous to brain cancer patients, it is important to study the extraction of this drug. In addition, it is important to study administering this drug via microdialysis as the efficiency of the drug could increase. In mice brain tumor …

The Impact Of Traumatic Symptomology And Social Support On The Effective Management Of Death Anxiety, Emily Pauline Courtney

ETD Archive

Terror management theory (TMT) posits that people function effectively in the world, in part, by relying on social anxiety-buffer systems to protect against death awareness; however, a new extension called anxiety buffer disruption theory (ABDT), posits that traumatic experiences can overwhelm those buffers, leaving people vulnerable to death anxiety and at increased risk for post-traumatic stress disorder (PTSD) symptoms. To test these hypotheses, participants with low and high posttraumatic stress symptoms were identified and recruited using a general population pre-screen, prompted to engage in a relationship threat priming task (vs. control topic), and then asked to complete a standard measure …

An Examination Of The Relationships Between Attributional Style, Reappraisal, And Depression Risk In Arab Americans, Khadeja Najjar

ETD Archive

While depression is a cross-cultural phenomenon, much of the literature that examines risk factors and mechanisms for its occurrence is examined from a Western perspective. As cultural background and level of acculturation to the host culture is known to shape the expression of depressive disorders, as well as their risk factors, this study examined whether cultural factors influence the relationship between two cognitive emotion regulation processes and depression symptoms. Specifically, this study examined whether the relationship between internal, stable, and global causal attributions for negative events (negative attributional style) and depression is mediated by one’s tendency to reframe the meaning …

Oxidation Of Ferrocene Derivatives With Dibenzoyl Peroxide And Meta-Chloroperoxybenzoic Acid, Jos M. Halstead

ETD Archive

The chemical oxidation of ferrocene and related derivatives (RFc) via organic peroxides solvated in acetonitrile was studied spectrophotometrically by varying concentration and temperature to determine kinetics and activation parameters. The reaction rate of ferrocene with dibenzoyl peroxide depends strongly on whether electron withdrawing or donating substituents are present. Products were analyzed and the effect of different solvents on reactivity were studied. The rate law was first order in both oxidant and reductant, and steric and solvent effects are consistent with outer sphere electron transfer (ET) as the rate-controlling step. B3YLP calculations were conducted to determine reorganization energies using Marcus theory …

Autophagy-Deficient Breast Cancer Shows Early Tumor Recurrence And Escape From Dormancy, Masoud H. Manjili

Massey Comprehensive Cancer Center Publications

Breast cancer patients who initially respond to cancer therapies often succumb to distant recurrence of the disease. It is not clear why people with the same type of breast cancer respond to treatments differently; some escape from dormancy and relapse earlier than others. In addition, some tumor clones respond to immunotherapy while others do not. We investigated how autophagy plays a role in accelerating or delaying recurrence of neu-overexpressing mouse mammary carcinoma (MMC) following adriamycin (ADR) treatment, and in affecting response to immunotherapy. We explored two strategies: 1) transient blockade of autophagy with chloroquine (CQ), which blocks fusion of autophagosomes …

Determining The Quantitative Principles Of T Cell Response To Antigenic Disparity In Stem Cell Transplantation, Ali Salman, Vishal Koparde, Charles E. Hall, Max Jameson-Lee, Catherine Roberts, Myrna Serrano, Badar Abdulrazzaq, Jeremy Meier, Caleb Kennedy, Masoud H. Manjili, Stephen R. Spellman, Dayanjan Wijesinghe, Shahrukh Hashmi, Greg Buck, Rehan Qayyum, Michael Neale, Jason Reed, Amir A. Toor

Massey Comprehensive Cancer Center Publications

Alloreactivity compromising clinical outcomes in stem cell transplantation is observed despite HLA matching of donors and recipients. This has its origin in the variation between the exomes of the two, which provides the basis for minor histocompatibility antigens (mHA). The mHA presented on the HLA class I and II molecules and the ensuing T cell response to these antigens results in graft vs. host disease. In this paper, results of a whole exome sequencing study are presented, with resulting alloreactive polymorphic peptides and their HLA class I and HLA class II (DRB1) binding affinity quantified. Large libraries of potentially alloreactive …

Exploring Resilience Models In A Sample Of Combat-Exposed Military Service Members And Veterans: A Comparison And Commentary, Christina M. Sheerin, Kelcey J. Stratton, Ananda B. Amstadter, The Va Mid-Atlantic Mental Illness Research, Education, Clinical Center (Mirecc) Workgroup, Scott D. Mcdonald

Psychiatry Publications

Background: The term resilience is applied in numerous ways in the mental health field, leading to different perspectives of what constitutes a resilient response and disparate findings regarding its prevalence following trauma.

Objective: illustrate the impact of various definitions on our understanding and prevalence of resilience, we compared various resilience definitions (absence of PTSD, absence of current mental health diagnosis, absence of generalized psychological distress, and an alternative trauma load–resilience discrepancy model of the difference between actual and predicted distress given lifetime trauma exposure) within a combat-exposed military personnel and veteran sample.

Method: In this combat-trauma exposed …

Supporting Play Exploration And Early Developmental Intervention Versus Usual Care To Enhance Development Outcomes During The Transition From The Neonatal Intensive Care Unit To Home: A Pilot Randomized Controlled Trial, Stacey C. Dusing, Tanya Tripathi, Emily C. Marcinowski, Leroy R. Thacke, Lisa F. Brown, Karen D. Hendricks-Muñoz

Physical Therapy Publications

Background

While therapy services may start in the Neonatal Intensive Care Unit (NICU) there is often a gap in therapy after discharge. Supporting Play Exploration and Early Development Intervention (SPEEDI) supports parents, helping them build capacity to provide developmentally supportive opportunities starting in the NICU and continuing at home. The purpose of this single blinded randomized pilot clinical trial was to evaluate the initial efficacy of SPEEDI to improve early reaching and exploratory problem solving behaviors.

Methods

Fourteen infants born very preterm or with neonatal brain injury were randomly assigned to SPEEDI or Usual Care. The SPEEDI group participated in …

Is Counseling Integral To Buprenorphine-Assisted Opioid Addiction Treatment? Examining Counseling Participation And Treatment Retention At A Richmond, Virginia Clinic, John R. Gyourko, Hilary Colin King

Social Work Student Works

Treatment providers in Virginia are required by law to offer counseling or referrals to all clients receiving medication-assisted opioid use disorder (OUD) treatment (American Society of Addiction Medicine, 2016; Medical Society of Virginia, 2018). Prescribing physicians widely regard counseling as a critical component of medication-assisted OUD treatment (Lin, Lofwall, Walsh, & Knudsen, 2019), and clients perceive counseling to be among the most important factors promoting recovery from opioid dependence (Hay, Huhn, Tompkins, & Dunn, 2019). Research investigating the efficacy of counseling as an OUD treatment component, however, has been equivocal to date (Brown, 2018; Dugosh et al., 2016). The current …

Toward Competitive Employment For Persons With Intellectual And Developmental Disabilities: What Progress Have We Made And Where Do We Need To Go, Paul Wehman, Joshua Taylor, Valerie Brooke, Lauren Avellone, Holly N. Whittenburg, Whitney Ham, Alissa Molinelli Brooke, Staci Carr

Physical Medicine and Rehabilitation Publications

Progress toward competitive integrated employment (CIE) for people with intellectual and developmental disabilities (IDD) over the last 40 years has been mixed. Despite evidence showing that supported employment interventions can enable adults with IDD to effectively get and keep jobs, national rates of integrated employment remain below a third of the working-age population. Progress is being made to improve these outcomes. Pathways have been identified that lead to CIE through supported employment, customized employment, internship experiences, and postsecondary education. The recent passage of the Workforce Innovation and Opportunity Act (WIOA) has created fresh momentum and increased the onus on interagency …

Pharmacy Staff Perspectives On Alcohol And Medication Interaction Prevention Among Older Rural Adults, Faika Zanjani, Hannah Allen, Rachel Vickers Smith, Demetra Antimisiaris, Nancy Schoenberg, Catherine Martin, Richard Clayton

Gerontology Publications

Older adults are at high risk for alcohol and medication interactions (AMI). Pharmacies have the potential to act as ideal locations for AMI education, as pharmacy staff play an important role in the community. This study examined the perspectives of pharmacy staff on AMI prevention programming messaging, potential barriers to and facilitators of older adult participation in such programming, and dissemination methods for AMI prevention information. Flyers, telephone calls, and site visits were used to recruit 31 pharmacy staff members who participated in semistructured interviews. A content analysis of interview transcriptions was conducted to identify major themes, categories, and subcategories. …

Improving Resident Understanding Of Healthcare Business And Policy Through The Development Of A High-Yield And Dynamic Educational Series, John Legge

Health Sciences Education Symposium

Objective: Residents have a strong desire to be engaged in and learn about the financial and societal impact of health care delivery and reform initiatives1,2. In order to address this need, a Business and Health Policy Educational Series was developed, with positive feedback from participating residents. Background: During the Program Evaluation Committee (PEC) meeting, as part of the annual review of the ACGME education curriculum for the Virginia Commonwealth University Neurology Residency Program, a deficiency was identified with regard to resident self-perception of understanding of the business and policy of healthcare and reform initiatives. This deficiency is one shared at …

Improving The Clinical Learning Environment: A Collaborative Workshop For Students, Residents, And Faculty, Deborah Diazgranados

Health Sciences Education Symposium

The AAMC Graduation Questionnaire (AAMC GQ) surveys the students at the completion of their training. Results from this survey show that students report mistreatment and unprofessional behavior during their training. The results of this survey, both locally and nationally, motivated faculty in the school of medicine to develop a workshop that would introduce the learning climate to students, and allow the students to interact with faculty to understand mistreatment and professionalism in the learning environment. In this presentation, we will highlight the need for educating students about the learning climate, professionalism and mistreatment; provide attendees with the definition of mistreatment; …

Central Venous Catheter Confirmation By Ultrasonography: A Novel Instructional Protocol, Jordan Tozer

Health Sciences Education Symposium

Central Venous Catheter Confirmation by Ultrasonography: A Novel Instructional Protocol

Implementation Of A Multi-Pronged Approach To Improve Education In Quality Improvement (Qi) And To Increase Resident Involvement In Qi Work, Ashlie Tseng

Health Sciences Education Symposium

Objective: To evaluate a multi-tiered approach to incorporating QI and PS training and participation in a pediatrics residency program. Methods: We developed a multi-tiered approach to QI/PS training during the 2013-14 year, and expanded upon it during subsequent years. We tracked resident participation in Departmental QI Grand Rounds and ACGME and Department survey results. The initial intervention involved didactic and small group sessions/to facilitate project development. We also instituted Departmental QI Grand Rounds. In the following year (2014-15), we increased the number of didactics and started a practice improvement project within the resident group practice where residents were provided individualized …

Teaching Cross-Sectional Anatomy In Parallel With Gross Anatomy Through A Curriculum Incorporating Ct Scanning Of Cadavers, Peter Haar

Health Sciences Education Symposium

Navigating and interpreting cross-sectional medical image sets are important skills used by most physicians to apply anatomical knowledge to patient care. However, few medical schools provide formal instruction in understanding cross-sectional anatomy. For these reasons, a curriculum was developed in which the medical school gross anatomy cadavers were CT scanned prior to dissection, and CT images of specific cadavers were correlated both to labelled atlas images and to direct structural observations of those same cadavers during dissection. The students were taught to navigate CT data sets in axial, coronal, and sagittal planes, to mentally synthesize three-dimensional understandings of individual cadaveric …

Implementation Of A School-Wide, Epa-Based Acting Internship Curriculum, Adam Garber

Health Sciences Education Symposium

Objectives. The core entrustable professional activities for entering residency (Core EPAs) were established by the AAMC as a framework to assess competency. The Acting Internship (AI) rotation is an excellent space to assess core EPAs, however many institutions have no structured AI curriculum. Our goal is to develop a standardized, school-wide AI curriculum that includes evaluation and assessment of designated core EPAs. Method. At our institution, two non-departmental AI directors were directed to oversee all AI rotations across the school and implement goals, objectives, and curriculum focused around specific core EPAs. A clinical skills-focused curriculum combining a mix of didactic …

Medical Rhetoric-Making The Case For Oral Presentations, Patrick Fadden

Health Sciences Education Symposium

The oral case presentation is a vital skill in clinical medicine. It not only serves the purpose of delivering clinical information but it also provides the platform in which providers explain diagnostic reasoning. Although it plays a central role in clinical care, the development and refinement of these communicative skills are often “trial and error” in medical training. This may lead to delayed acquisition in skill development which can impact the efficiency and effectiveness of patient care. The intent and purpose of the oral case presentation also has been shown to be incongruent among medical students and attendings, further dampening …

Why Residents’ Perceptions Of The Clinical Learning Environment Matter: Correlations Between The Acgme Resident Survey, Perceived Organizational Support, And Psychological Safety, Nital Appelbaum

Health Sciences Education Symposium

Purpose. To utilize two validated instruments to assess the cultural facets of the clinical learning environment in medical education and correlate findings with external program evaluation data. Identification of measurement tools could allow early intervention in graduate medical education to better facilitate work and learning processes. Method. During FY17, our institution surveyed residents across nineteen training programs on perceived organizational support and psychological safety to assess the clinical learning environment. These data were aggregated to the departmental level and correlated with nineteen residency program results on the FY17 ACGME Resident Survey. Results. Perceived organizational support correlated positively with domains of …

Leadership Skills Development For Pediatric Residents, Hadi Anwar

Health Sciences Education Symposium

Physicians are expected to be leaders. Pediatrics residents have identified a lack of leadership development in their training. Some residency programs have developed skills-based leadership curriculums that are perceived positively by participants. A leadership curriculum is being developed for VCU pediatrics residents in a fellowship track. A needs assessment was done to identify high-priority leadership skills. The curriculum aims to improve communication, conflict resolution, decision-making, and time management skills using role-play, reflection, and feedback from direct observation. Expected challenges are developing appropriate instructors and time constraints. Curriculum creators will collect evaluations from participants and qualitative feedback to continually improve the …

Quick Qi: A Two-Week Self-Directed Quality Improvement Project, Charles Leiner

Health Sciences Education Symposium

The Accreditation Council for Graduate Medical Education endorses a formal longitudinal quality improvement (QI) curriculum. Our internal medicine program’s tandem-block schedule, in which residents rotate through two-week blocks, creates a unique challenge in teaching QI to internal medicine residents. To overcome the educational barriers of a two-week rotation, we created a short, self-directed QI curriculum to introduce basic QI theory and methods. Through this curriculum, we aim to expose residents to existing QI activities, showcase institutional QI endeavors, foster resident-driven QI projects, and develop teaching experience in the realm of QI and patient safety. The curriculum involves residents in institutional …

Converting Serious Safety Events Into Educational Opportunities, Michael Joseph Vitto

Health Sciences Education Symposium

Over the past year, the Associate Director of the Simulation Center worked with the EM Quality and Safety Director to identify serious safety events (SSE) and critical incidents. As part of the case review, an informal root cause analysis (RCA) was conducted and root causes related to safety risks or breakdowns were identified. These system vulnerabilities were woven into simulation cases for hospital code team training. The cases focused on skills and attitudes that would help prevent, capture, or mitigate similar vulnerabilities while providing clinical care. The objective of this educational innovation was to intentionally translate lessons learned from SSE …

Teaching Quality Improvement In A Pediatric Residency Program, Tamar Springel

Health Sciences Education Symposium

The Accreditation Council for Graduate Medical Education (ACGME) requires residents to demonstrate competence in practice-based learning and improvement (PBLI) and systems-based practice (SBP), two competencies dependent on the principles and practice of quality improvement (QI). In addition, pediatric residents at VCUHS are required to complete a QI project during their residency. We judged the pediatric residents to be sub-par in achieving these competencies as demonstrated by the quality of projects submitted during the last academic year, and set out to improve the QI education they receive by designing a longitudinal curriculum integrating both didactic (using lectures and on-line modules provided …

Emergency Medicine Elective Impact On Third-Year Medical Student Specialty Choice, Nathan Lewis

Health Sciences Education Symposium

Emergency Medicine (EM) is a competitive, sought-after specialty among medical students (1). National standardized curricula have been developed for both third-year (M3) and fourth-year (M4) rotations (2-3), however, there is variability in course implementation (4). Additionally, it is unclear to what extent earlier rotations help students choose a specialty. We developed a two-week elective course to allow M3 students exposure to EM earlier than previously allowed at our medical school. Students were asked to complete an entry survey describing their specialty interests and sources of influence. During the course, students were encouraged to observe the environment and speak to providers, …

The Use Of Interactive Holographic Technology To Teach Surgical Anatomy And Improve Self-Perceived Preparedness For Surgery In Urogynecology, Lauren Siff

Health Sciences Education Symposium

Abstract Purpose: One of the biggest challenges teaching urogynecologic surgery is developing a spatial understanding of the 3-Dimensional relationships of musculature, ligamentous supports and neurovasculature of the pelvic floor. Therefore, we created an innovative curriculum to improve trainee-preparedness for complex vaginal surgery. The aim of the study is to determine if an interactive holographic curriculum will improve self-perceived preparedness, surgical knowledge and learner-satisfaction compared to usual self-study. Methods: This is a prospective study of 18 OB/GYN residents. Participants prepared like they were “scrubbing into a case of uterosacral ligament suspension (USLS) and sacrospinous ligament fixation (SSLF).” They then completed a …

Fighting Frailty With The Mediterranean Diet, Edward F. Ansello

Director's Editorials from Age in Action

It’s appropriate for each of us to examine our eating habits, not just our nutrition intake. The various aspects of the Mediterranean Diet hold potential benefits beyond the important feature of helping to reduce frailty.

Lewy Body Dementia, Edward F. Ansello

Director's Editorials from Age in Action

While Alzheimer’s disease is the most common and widely known cause of dementia, it is not the only cause. Dementia with Lewy Bodies (DLB), in fact, may be the second most common cause of progressive dementia but it is certainly less well known.