Medicine and Health Sciences Commons^™

Partial Least Squares Multimodal Analysis Of Brain Network Correlates Of Language Deficits In Aphasia, Sigfus Kristinsson, Dirk B. Den Ouden, Chris Rorden, Roger Newman-Norlund, Lisa Johnson, Janina Wilmskoetter, Ezequiel Gleichgerrcht, Argye E. Hillis, Gregory Hickok, Julius Fridriksson, Leonardo Bonilha

Communication Sciences and Disorders Faculty Articles and Research

Lesion-symptom mapping techniques are essential to determine brain regions critical for language functions. However, high collinearity in neuroimaging and behavioural data remains a challenge for distinguishing neural substrates supporting multiple language domains (shared variance) and those subserving specific language functions (unique variance). Here, we employed a novel approach to multimodal lesion-symptom mapping using multivariate partial least squares regression to delineate the latent structure of lesion-behavioural mapping in aphasia and decompose the shared and unique neural determinants of language impairments. A total of 86 participants with chronic (>12-month post-stroke) aphasia after left hemisphere strokes were examined. Language impairment was assessed …

Effect Of Perioperative Haemodynamic Management Based On Cerebral Autoregulation Monitored By Cerebral Oximetry Index During Carotid Endarterectomy: Protocol Of A Randomised Trial, Muhan Li, Xueke Yin, Chuanyu Liang, Chenyang Tao, Qixiao Yan, Min Zeng, Shu Li, Daniel I Sessler, Rong Wang, Lei Zhao, Yuming Peng

Faculty, Staff and Student Publications

Introduction: Impaired cerebral autoregulation is associated with postoperative ischaemic brain injury and often occurs in patients with carotid artery stenosis. Adequate cerebral perfusion should therefore be maintained during carotid endarterectomies. Whether guiding intraoperative blood pressure to the Cerebral Oximetry Index (a measure of cerebral perfusion adequacy) reduces postoperative cerebral ischaemia remains unclear.

Methods and analysis: We plan a dual-centre randomised blinded trial. A total of 560 patients having elective carotid endarterectomy will be randomly assigned to guided versus routine haemodynamic management. In patients randomised to guided management, mean arterial pressure will be titrated to maintain a normal cerebral oximetry index. …

Exploring The Association Between Self-Esteem And Blood Pressure: A Cross-Sectional And Longitudinal Investigation, Bijou C. Allard, Julia K. Boehm

Psychology Faculty Articles and Research

High self-esteem is linked to favorable outcomes including better mental health and relationships, however, its impact on cardiovascular health is less understood. This study examined the relationship between self-esteem and blood pressure levels using data from the Midlife in the United States (MIDUS) study (M_age = 54.53; 57% women; 20% non-White). We hypothesized that higher self-esteem would be associated with lower systolic and diastolic blood pressure concurrently and 10 years later. Self-esteem was measured with the Rosenberg Self-Esteem Scale, and blood pressure was clinically assessed. Cross-sectional analyses included 1194 participants; longitudinal analyses included 566 participants. Contrary to expectations, …

Reducing Readmission Rates In A Mental Health Hospital, Zamzam Mohamed

Walden Dissertations and Doctoral Studies

Summary I designed this clinical practice guideline (CPG) doctoral project to address the critical practice problem of high readmission rates in a mental health unit at a large academic medical center. This quality improvement initiative focused on developing and evaluating CPG to improve discharge planning. I aimed to address gaps in continuity of care, inadequate discharge education, and limited post discharge follow-up, which had been identified as contributing factors to early psychiatric readmissions. The practice-focused question guiding this project was: What evidence supports the development of a discharge planning CPG designed to reduce readmission rates in a mental health unit? …

Clinical Practice Guideline For Intentional Rounding, Julia Griggs

Walden Dissertations and Doctoral Studies

This is a quality improvement clinical practice guideline (CPG) to address the inconsistent staff rounding practices, developed following recognition of a fall rate of 3.2 per 1000 patient days and declining patient satisfaction in the project facility. I developed the CPG using current evidence-based practices to establish standardized procedures for purposeful rounding to enhance patient safety, satisfaction, and care quality. Three experts, including an educator, clinician, and administrator, evaluated the CPG using the Appraisal of Guidelines for Research and Evaluation II (AGREE II), a tool consisting of seven domains used for measuring the methodological rigor and transparency in which a …

Levothyroxine Requirement In A Patient With Lrba Deficiency And Gvhd Induced Cholestasis, Yusriya Al Rawahi, Hussain Alsaffar, Amr Abdalla, Azza Nasser Al Shidhani

Sultan Qaboos University Medical Journal

Levothyroxine is a lipophilic hormone that is absorbed in the small intestine, mainly in the jejunum and ileum. The absorption of levothyroxine after oral administration averages 60–80%. We report a 7-year-old male patient who presented to a tertiary care hospital in Muscat, Oman, in 2020 at the age of three years with an early diagnosis of lipopolysaccharide beige-like anchor protein (LRBA) deficiency. LRBA deficiency is characterised by recurrent infections, autoimmune thyroid disease and autoimmune cytopenia. The patient was prescribed levothyroxine treatment (112.5 mcg daily) and underwent haematopoietic stem cell transplantation (HSCT) in March 2023; four months post-HSCT, he developed appendicitis …

Blood-Based Proteomic Profiling Identifies Osmr As A Novel Biomarker Of Aml Outcomes, Patrick K Reville, Bofei Wang, Jennifer Marvin-Peek, Bin Yuan, Yu-An Kuo, Araceli Garza, Jessica Root, Wei Qiao, Andrea Arruda, Ivo Veletic, Yiwei Liu, Nicholas J Short, Courtney D Dinardo, Tapan M Kadia, Naval G Daver, Philip L Lorenzi, Koji Sasaki, Steven Kornblau, Mark D Minden, Farhad Ravandi, Hagop M Kantarjian, Hussein A Abbas

Faculty, Staff and Student Publications

Inflammation is increasingly recognized as a critical factor in acute myeloid leukemia (AML) pathogenesis. We performed blood-based proteomic profiling of 251 inflammatory proteins in 543 patients with newly diagnosed AML. Using a machine learning model, we derived an 8-protein prognostic score termed the leukemia inflammatory risk score (LIRS). Individual proteins were evaluated in multivariable Cox models, and model performance was assessed by cumulative concordance index. Findings were validated in internal and external cohorts across 2 institutions. Blood-based LIRS significantly outperformed the European LeukemiaNet 2022 risk model and was independently prognostic of overall survival after accounting for known clinical and molecular …

Educating Staff On Using Medication-Assisted Treatment (Mat) In Opioid Use Disorder (Oud), Demie Alaekwe

Walden Dissertations and Doctoral Studies

Medication-assisted treatment (MAT) programs, especially those led by providers, can expand access to care for persons with opioid use disorder (OUD). The gap in practice at the site was the insufficient knowledge among nurses on how to effectively use MAT in treating OUD. The purpose of this staff educational project was to design and implement a training module to educate mental health providers on the principles and interventions of MAT. The practice-focused question was: Does educating nurses on MAT principles while incorporating evidence from the literature improve their knowledge as measured by pre- and post-test? The ADDIE pedagogy model was …

Implementation And Effectiveness Of A Nurse-Enabled, Shared-Care Follow-Up Model For Early Breast Cancer Survivors (The Ibis-Survivorship Study): Protocol For A Stepped-Wedge Cluster Randomised Trial, Raymond J. Chan, Fiona Crawford-Williams, Bogda Koczwara, G. Bruce Mann, Elizabeth Eakin, Jane Turner, Meinir Krishnasamy, Louisa G. Collins, Helen Skerman, Karla Hemming, Nicolas H. Hart, Jon Emery, Bethany Crowe, Kerry Patford, Jane Mahony, Caroline Kristunas, Gillian Blanchard, Laura Healey, Jasotha Sanmugarajah, Rhea Liang, Paul Craft, Amy Shorthouse, Ruth Mccaffery, Mary Azer, Patsy Yates

Research outputs 2022 to 2026

Introduction Breast cancer is the most commonly diagnosed cancer among women worldwide. Survivors often experience physical and psychological effects arising from breast cancer and its treatment, which can last months and years, adversely impacting quality of life. As the number of early breast cancer survivors increases, models of specialist-led follow-up care in hospital settings are not sustainable and evidence suggests that they may not meet survivors’ needs. Nurse-enabled, shared-care, follow-up models between cancer specialist and primary care teams have potential to address this need. Methods and analysis The proposed research is a multicentre, prospective, pragmatic, stepped-wedge cluster-randomised trial designed to …

Small Gifts, Big Questions: The Ethical Dilemma In Accepting Gifts In Medicine, Meiqi Luo, Md

The Medicine Forum

I remember discussing the topic of gift-giving by patients in a small group session in medical school. When asked whether it’s ethical for medical professionals to accept gifts from patients, I responded, “It depends on the value of the gifts.” If the gifts were of appropriate value and given purely out of appreciation, they serve to strengthen the physician-patient relationship. However, what I failed to realize was the difficulty in determining the value and intention of a gift. My personal experience of receiving gifts from a patient made me aware of such ethical ambiguities.

At the community clinic where I …

Navigating Care And Loss Through Aging, Disease, And Decision-Making In The Covid Era, Michael Predi, Do

The Medicine Forum

There is only one of the loved one you know.
Often it can be hard to let go.
Five years old the world became cold.
Lost my mother to breast cancer.
A cold wound that can’t be answered
Father raised you in a foreign land.
Drove you to school, combed your hair, gave you a life you could have never planned.
Taught me that I would catch a cold from the wind.
No arguing about modern medicine, my dad was thick skinned,
Here comes college, first generation, what an exciting time.
Get to medical school so exciting; here comes the …

Existential Pain, Kian Waddell

The Medicine Forum

A new type of pain
Never covered in a lecture
Not neuropathic, visceral, post-procedural, cancer, phantom pains,
But existential.

She didn’t want pain meds
And she had her reasons -
We didn’t push.

What she wanted was to talk
To be heard
For us to be silent and stop
Asking her every second
If she’d moved bowels, vomited, slept…

What she wanted was to talk.
What other medication is there for pain of the soul?

Eternal Light, Anurag Modak, Md

The Medicine Forum

The microscope is held aloft in a sea of darkness,
Illuminating the gyri and sulci of the exposed brain below.
Its harsh, sterile light creates a veritable barrier
So hot, so intense, it threatens to explode forth at any moment.

The screens scattered across the room provide companionship to this lonely machine
And I, residing amidst the sea of shadows,
Bear witness to its solitude
To the silence of the light.

I have seen vessels tied and aneurysms clipped,
And an eon has gone by…
There’s an air of anticipation,
An expectation of something more.

But, solace and quietude prevail …

Unmasking The Dvt Mimic: A Rare Case Of Diabetic Myonecrosis In A Young Patient, Avish Patel, Md, Paul Endres, Md, Alexander Marchese, Md, Dianna Cheney-Peters, Md

The Medicine Forum

Diabetic myonecrosis is an uncommon complication of diabetes mellitus, often falsely believed to be a deep vein thrombosis (DVT). Patients present with similar presentations of edema and focal tenderness that are most often unilateral in a proximal lower extremity.¹ When venous ultrasound is negative, magnetic resonance imaging (MRI) is the preferred diagnostic modality over muscle biopsy, given the potential complications.^2,3 Treatment includes rest, analgesia, and improved glycemic control.⁴ Given the rise of metabolic disorders and insulin resistance, it is important to be aware of this diagnosis to prevent overutilization of healthcare resources.⁵

Recurrent Post-Viral Rhabdomyolysis In A 36-Year-Old Male: A Case Report, Warda Naqvi, Md, David Walz, Md, Lucy Checchio, Md

The Medicine Forum

Rhabdomyolysis is a syndrome of skeletal muscle breakdown, releasing intracellular contents such as creatine kinase (CK) and myoglobin into the bloodstream, which can precipitate acute kidney injury (AKI).¹ While trauma, extreme exertion, and toxins are frequent culprits, infections, particularly viral illnesses, represent a less common but significant trigger.² Influenza and other respiratory viruses have been implicated in sporadic cases of rhabdomyolysis, often presenting with acute myalgias and elevated CK levels following a viral prodrome.³ In contrast, recurrent rhabdomyolysis is typically associated with inherited metabolic myopathies (e.g., McArdle disease) or autoimmune myositis, conditions often marked by distinct genetic …

Mcconnell’S Sign In The Absence Of Pulmonary Embolism, Alicia Bao, Md, Tendai Marume, Md

The Medicine Forum

McConnell’s sign is an echocardiographic finding characterized by hyperdynamic motion of the right ventricular (RV) apex with akinesis of the RV free wall. It is widely known as an indicator of RV strain in acute pulmonary embolism (PE) but has been described in other conditions such as sepsis-induced RV dysfunction, acute cor pulmonale, and right-sided heart failure. In critically ill patients, RV dysfunction is a major contributor to hemodynamic instability, respiratory failure, and poor outcomes. Given the overlapping signs of various underlying conditions, McConnell’s sign serves as a useful marker for assessing RV involvement but can be challenging to interpret …

A Case Of Streptococcus Pneumoniae Necrotizing Pneumonia With Pneumothorax And Abscess Formation, Susanna Betti, Md

The Medicine Forum

A 63-year-old female with a past medical history of left breast ductal carcinoma in situ, now post-left-sided lumpectomy and radiation in 2005, presented to an outside hospital with chest pain and a cough productive of green sputum. Computed tomography (CT) chest demonstrated patchy ground-glass opacities and dense consolidations in the right middle and lower lobe. Blood cultures and bronchoalveolar lavage culture were positive for Streptococcus pneumoniae, and she was started on antibiotics for community-acquired pneumonia. Her respiratory status rapidly worsened and she required intubation. She developed a large right-sided pneumothorax and had a chest tube placed for a …

A Complex Case Of Multifactorial Hypoxemia From Metastatic Testicular Cancer, Susanna Betti, Md

The Medicine Forum

A 27-year-old male with no known past medical history presented for evaluation of a 14.1 cm testicular mass (Figure A). He was found to have severe anemia (Hgb 2.8 g/dL), and biopsy demonstrated a non-seminomatous mixed germ cell tumor of testicular origin with imaging demonstrating widespread metastases to the brain, lungs, and liver. The patient received multiple blood transfusions and one dose of bleomycin, etoposide, and cisplatin followed by the development of acute respiratory failure. Computed tomography angiography (CTA) chest was negative for pulmonary thromboembolism but demonstrated diffuse ground-glass opacities (Figure B, arrows) and metastatic pulmonary masses containing dilated vessels …

Heart Core: A Framework For Leading With Empathy In Medical Education, Akash Patel, Do, Mark Liotta, Md

The Medicine Forum

In medical training, much of what defines leadership happens outside of clinical decision-making. It happens at 2 a.m. when a resident breaks down from burnout. It happens when a team is navigating interpersonal conflict or when a trainee is overwhelmed by grief, imposter syndrome, or failure. While these moments are deeply impactful, many of us are never taught how to lead through them.

This gap inspired us to create HEART CORE, a framework designed to help residents, faculty, and administrators approach complex, emotional, or high-stakes situations with clarity and compassion. Although it was originally built for chief residents handling difficult …

The Factor Viii Debate: An Auto-Cancelled Lab Near Miss, Avish Patel, Md, Daniel Elchediak, Md, Zachary Pang, Md, Charlotte Shields, Md, Bethanne Venkatesan, Md, Ananya Venkatesh, Md, Michael Alessandro, Bsn, Jeffrey Riggio, Md, Ms, Alexis Wickersham, Md

The Medicine Forum

Near misses, medical errors with no appreciable resultant harm, often go undetected and underreported despite great emphasis on patient safety event reporting over the past two decades.¹ Additionally, near misses are often not triggers for proactive institutional corrective action due to the widespread retroactive safety culture following more harmful or catastrophic safety events.² At Thomas Jefferson University Hospital, all internal medicine first-year residents (PGY1s) participate in an immersive safety event review curriculum of near miss or low-harm safety events, previously described in the literature.³ The following details the event review findings and implemented health-system level changes following …

Enhancing Community Health Center Safety Through Participatory Co-Design, Arman Afifi, Bs, Kelsey Smith, Bs, Megan Reed, Phd, Mph, Lara Weinstein, Md

The Medicine Forum

Health and social service programs are often designed from the top down, with people in power making decisions that affect others. Integrating all staff and clients in the co-design process ensures that interventions are culturally competent and tailored to the unique challenges faced by the community. Participants bring firsthand knowledge, allowing for a more accurate assessment of needs and preferences. Additionally, involving marginalized individuals helps build trust between service providers and the community, creating a foundation for sustained collaboration and positive outcomes. Overall, participant inclusion is not only a practical necessity but an ethical imperative in delivering effective and equitable …

From Er To Mortality In 48 Hours: A Fatal Case Of Overwhelming Post-Splenectomy Infection, Miriam Stern, Ba, Blaise O’Malley, Bs, Amry Majeed, Md, Michael Grodsky, Md

The Medicine Forum

Overwhelming post-splenectomy infection (OPSI) is a known complication of asplenia.^1,2 While the precise rates of morbidity and mortality are unknown, estimates range from 38% to as high as 70%.² Because the spleen plays an important role in protecting against infections with encapsulated microorganisms, OPSI is most commonly caused by infection with encapsulated bacteria, specifically Streptococcus pneumoniae.^1–3 While pneumococcal vaccines have been shown to improve immunogenicity in asplenic people, OPSI remains a danger to both vaccinated and unvaccinated patients.^4,5 Additional measures to protect asplenic patients from overwhelming infection have been proposed, but the evidence remains mixed. …

String Theory - A Case Of Hypermucoviscous Klebsiella Pneumoniae Causing Distant Necrotizing Infections, Natasa Kostic, Md, Marina Gonzalez, Md

The Medicine Forum

Klebsiella pneumoniae is a Gram-negative, encapsulated bacterium belonging to the Enterobacteriaceae family. It is more frequently associated with nosocomial infections and is one of several bacteria developing high rates of antibiotic resistance.¹ Since the mid-1980s, there have been reported cases of Klebsiella pneumoniae causing life-threatening, invasive infections acquired in the community by otherwise healthy individuals. The propensity to form metastatic foci of infection in immunocompetent hosts is unusual for an enteric, Gram-negative pathogen.² This hypervirulent variant of K. pneumoniae was originally noted only in Asian-Pacific countries but is now being identified globally.³ The variant has unique mucoid …

Negative Urine Nucleic Acid Amplification Testing In A Case Of Disseminated Gonococcal Infection Presenting As Migratory Arthritis, Benjamin Richter, Md

The Medicine Forum

Disseminated gonococcal infection (DGI) is a well-documented complication of Neisseria gonorrhoeae infection, most characteristically presenting as migratory arthritis, tenosynovitis, and dermatitis. Although modern nucleic acid amplification tests (NAATs) and cultures from mucosal sites have significantly improved diagnostic capabilities, discrepancies between clinical manifestations and laboratory findings still occur.¹ One such challenge arises when the urine gonorrhea test returns negative despite strong clinical evidence pointing toward gonococcal involvement.

Migratory arthritis—a transient, shifting pattern of joint inflammation—has long been recognized as a hallmark of DGI.² Typically, the pathogen is detected in blood, synovial fluid, or from mucosal specimens; however, negative urine …

From Cure To Crisis: A Case Of Severe Hypoxic Respiratory Failure Due To Daptomycin-Associated Eosinophilic Pneumonitis, Muneeba Ali, Md, Enad Haddad, Md, Warda Naqvi, Md, Conrad Reed, Md

The Medicine Forum

Daptomycin is a cyclic lipopeptide antibiotic that commonly treats Gram-positive infections. Most frequently prescribed for osteoarticular infections.¹ Daptomycin is associated with numerous side effects, including myopathy, rhabdomyolysis, eosinophilic pneumonia, and anaphylactic hypersensitivity reactions.1 Daptomycin-induced eosinophilic pneumonitis (DIEP) is a rare but potentially life-threatening adverse effect associated with prolonged use.² There are several established criteria for diagnosing this medical condition. However, the variation in its clinical presentation, coupled with the favorable outcomes of early diagnosis and the severe consequences of delayed diagnosis, emphasizes the need for further discussions. This case highlights the importance of monitoring patients on prolonged daptomycin …

A Patient With Recently Diagnosed Hiv Found To Have Cryptococcus Meningitis With Course Complicated By Pneumocystis Jirovecii Pneumonia, Cmv Colitis, And Kaposi Sarcoma, Benjamin Richter, Md

The Medicine Forum

Opportunistic infections (OIs) remain a major cause of morbidity and mortality in individuals with advanced human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), particularly in those with severe immunosuppression. Among the most life-threatening OIs are cryptococcal meningitis, Pneumocystis jirovecii pneumonia (PJP), cytomegalovirus (CMV) colitis, and Kaposi sarcoma (KS), each of which poses significant diagnostic and therapeutic challenges.

Here is a case of a man with recently diagnosed HIV who was admitted to the hospital with a chief complaint of headache and was found to have cryptococcal meningitis with a hospital course complicated by Pneumocystis jirovecii pneumonia (PJP), CMV colitis, and Kaposi sarcoma. …

A Case Of Varicella Zoster Virus Meningitis Presenting As Idiopathic Vocal Fold Paralysis, Dustin Sneed, Md, M. D. Kilpatrick, Md, Alicia Bao, Md

The Medicine Forum

The typical presentation of a patient with herpes zoster, the reactivation of varicella zoster virus (VZV), involves a painful dermatomal vesicular rash known as shingles. However, as the following case demonstrates, VZV reactivation can present with atypical symptoms, sometimes without the characteristic rash. This presentation is known as zoster sine herpete. This case focuses on a patient presenting with dysphagia and dysphonia, who was diagnosed with VZV meningitis with suspected laryngeal involvement. We discuss workup and treatment for this disease, and the importance of a wide differential and multidisciplinary consultation to improve patient outcomes.

When The Cure Complicates: Ifosfamide, Methylene Blue, And A Life-Threatening Dilemma, Michael Predi, Do, Sarah Sulkowski, Md, Anika Patel, Ba, Evan Nardone, Md

The Medicine Forum

Ifosfamide, an alkylating agent and a cyclophosphamide analog, can be used alone or in combination with other agents as salvage therapy for metastatic soft tissue sarcoma. Neurotoxicity, often presenting as encephalopathy, is a common side effect of ifosfamide therapy, affecting up to 60% of patients.¹ Symptoms can range in severity from mild cognitive disturbances to severe, potentially fatal neurological impairments, such as hallucinations, confusion, drowsiness, and coma, which may develop within 2 to 96 hours of drug administration.²

Treatment of neurotoxicity includes cessation of ifosfamide and initiation of methylene blue (MB), which is used as both a therapeutic …

An Unusual Complication Of Metastatic Colorectal Cancer: Port-Site Hematoma As The First Sign Of Bone Marrow Involvement And Disseminated Intravascular Coagulation, Michael Predi, Do, Julia Palecki, Md, Jordan M. Isaacs, Ba, Ruben Rhoades, Md

The Medicine Forum

Disseminated intravascular coagulation (DIC) is a life-threatening condition marked by a spectrum of thrombosis due to activation of procoagulant factors and bleeding due to eventual consumption of these factors. DIC invariably occurs secondary to an underlying condition, including infection, inflammatory conditions, trauma, and malignancies. Treatment of DIC primarily involves treatment of the underlying cause.¹

Bone marrow invasion occurs when tumor cells infiltrate the hematopoietic marrow space, displacing progenitor cells and causing cytopenias. This process is distinct from bone metastases, where malignant cells spread to the cortical or trabecular bone, typically causing bone pain, pathologic fractures, or hypercalcemia. Disseminated carcinomatosis …

Immune Thrombocytopenic Purpura In The Setting Of Newly Diagnosed Colorectal Cancer: A Case Report, Beatriz Torre, Md, Karlie Brasch, Md, Christopher Henry, Md

The Medicine Forum

Immune thrombocytopenic purpura (ITP) is an acquired thrombocytopenia caused by autoantibodies against platelet antigens. ITP is most often associated with infection or autoimmune disease, but it has also been linked to malignancy.¹ In this case, we discuss the relationship between ITP and colon cancer.