Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

An Objective Structured Clinical Examination (Osce) For Spinal Anesthesia Utilizing Landmarks And Ultrasound Guidance, Ashley Craven, Marli Gray

Doctoral Projects

Spinal anesthesia, a critical regional anesthetic technique, is frequently administered by Certified Registered Nurse Anesthetists (CRNAs) for a variety of surgical procedures, especially those involving areas below the umbilicus. However, CRNAs' experience with spinal blocks may vary when transitioning to new hospital environments, necessitating continued education and skill assessment. This doctoral project aims to address the knowledge gaps through the development of an Objective Structured Clinical Examination (OSCE) specifically designed for CRNAs.

The OSCE incorporates current best practices and research on spinal anesthesia, offering CRNAs an instructional framework for administering spinal blocks using both traditional landmark techniques and ultrasound guidance. …

An Objective Structured Clinical Examination (Osce) For Axillary Nerve Blocks Using Ultrasound-Guidance And Landmark Techniques, Bailee Ladner, Hannah Wallace

Doctoral Projects

The purpose of this doctoral project was to create an informative educational and evaluation tool on axillary brachial plexus nerve blocks using ultrasound-guided and landmark techniques for Certified Registered Nurse Anesthetists (CRNAs). CRNAs can use this in the clinical setting to help improve understanding and performance of axillary brachial plexus blocks. Axillary brachial plexus blocks are beneficial in providing analgesia throughout the perioperative period while minimizing risks associated with general anesthesia. Additionally, axillary blocks have a more desirable safety profile than other peripheral nerve blocks, such as supraclavicular nerve blocks. Local anesthetic systemic toxicity (LAST), due to accidental vascular puncture, …

Point-Of-Care Ultrasound (Pocus): Measuring Inferior Vena Cava (Ivc) Diameter And Collapsibility In The Preoperative Setting, Jordan Parker, Dakota Kilpatrick

Doctoral Projects

Among the many aspects of preparation required for patients undergoing general anesthesia, preoperative optimization is key. One goal of preoperative optimization is the establishment of adequate preoperative intravascular fluid volume. Inadequate fluid volume can increase surgical risks and lead to adverse patient outcomes. Evidence has demonstrated that using point-of-care ultrasound (POCUS) to assess preoperative surgical patients can diminish the consequences associated with altered fluid status and increase the likelihood of hemodynamic stability. One of the varying methods of POCUS is the point-of-care focused cardiac ultrasound (FOCUS). Using FOCUS, the practitioner can measure the IVC diameter and collapsibility index to determine …

Objective Structured Clinical Examination (Osce) For Interscalene Brachial Plexus Block Utilizing Ultrasound Guidance And Landmark Technique, Madison Mize, Mckayla Moore, Peyton Shell

Doctoral Projects

The purpose of this doctoral project was to create learning and evaluation tools for interscalene brachial plexus blocks (ISBPB) to be used by certified registered nurse anesthetists (CRNAs) and students in the Nurse Anesthesia Program (NAP) at The University of Southern Mississippi (USM). ISBPB is a regional anesthesia technique used to provide anesthesia for procedures of the shoulder and upper arm. CRNAs and students can use these tools to refresh their current knowledge and enhance their regional anesthesia skills.

The objective structured clinical examination (OSCE) and cognitive aid for ISBPB utilizing landmark and ultrasound-guided techniques were evaluated by the USM …

Reproductive Autonomy In Immunological Intervention: Ethical Boundaries In Maternal-Fetal Immune Therapy, Marium Z. Rizvi

Journal of Health Ethics

Recent advances in immunology have broken barriers in reproductive medicine through immune-modulating therapies that support fertility and pregnancy. Treatments such as intravenous immunoglobulin (IVIG) and intralipid infusions are increasingly offered to patients with Recurrent Implantation Failure (RIF) or Recurrent Pregnancy Loss (RPL), conditions that result in miscarriages and failed IVF treatments (Pillarysetti et al., 2023). Maternal-fetal immunology reveals a delicate interplay between immune tolerance and defense: the maternal system must accept a genetically foreign fetus while preserving immunological protection. Disruptions in this balance are implicated in implantation disorders and pregnancy failure. As a result, immune-based therapies have emerged as promising …

Twitchview(C) Monitor Use For Quantitative Neuromuscular Monitoring: An Objective Structured Clinical Evaluation, Brady Brian, Lovel Bruney

Doctoral Projects

Neuromuscular paralysis is an integral aspect of anesthesia. Muscle relaxation is implemented to provide a suitable surgical environment, aid in intubation, and enhance respiratory compliance (Cook & Simons, 2022). Neuromuscular monitoring is often used for patients undergoing general anesthesia. Proper neuromuscular monitoring is essential when managing a surgical patient undergoing general anesthesia. Anesthesia providers are responsible for knowing the theory behind neuromuscular monitoring and the appropriate execution of placement, monitoring, and interpretation of monitoring devices. Quantitative neuromuscular monitoring is a newer technology that can provide definitive numerical data regarding neuromuscular blockade. Implementing the quantitative neuromuscular monitor can potentially reduce the …

Utilization Of Quantitative Monitoring To Promptly Detect And Reduce The Occurrence Of Residual Paralysis In The Post-Anesthesia Care Unit, Kathryn Elizabeth Nokes, Erin Moran Travis

Doctoral Projects

Objective: To evaluate the effectiveness of an educational workshop using an Objective Structured Clinical Examination (OSCE) on quantitative neuromuscular monitoring. The goal was to improve the knowledge and skills among certified registered nurse anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs) in identifying residual paralysis. The specific aim was to determine the effectiveness of quantitative monitoring in the Post Anesthesia Care Unit (PACU).

Background: Residual paralysis following the administration of neuromuscular blocking drugs (NMBDs) is a significant postoperative complication. Neuromuscular blocking drugs (NMBD) facilitate airway management and manipulation of surgical fields. Quantitative monitoring can be crucial in early detection and …

Early Onset Hypertension Objective Structured Clinical Examinations, Katrina Morace

Doctoral Projects

Hypertension is known as a condition in which raised blood vessel pressure persists. On a normal day, the pressure can rise and fall causing damage to the heart. When the pressure stays at higher readings, damage can be caused to the heart and can also lead to additional health problems. Another word for high blood pressure is hypertension. The blood is carried to all body parts from the heart by the arteries. The harder the heart pumps the higher the blood pressure (Centers for Diseases Control and Prevention [CDC], 2020). When hypertension is not diagnosed and treated at an early …

A Proof Of Concept For Detection Of Palato-Lingual Contact Without Intraoral Electrodes In A Human Participant, Amitava Biswas

Master's Theses

The author of this thesis conceived and investigated an unexpected electrical signal that may not be noticed during regular electroglottography (EGG) when electrodes are conventionally placed on the anterior surface of the throat. It appears that there is a measurable electrical signal from the EGG equipment when electrodes are placed over the frontal cheek (belly of zygomatic muscle), and the tongue is elevated to contact the hard palate, or the tongue is lowered to break the contact. Therefore, this phenomenon is designated as unconventional electroglottography (UEGG, Dr. Steven Cloud, private communication, July 17, 2022).

Two distinctive patterns of waveforms were …

An Objective Structured Clinical Examination (Osce) For Pec-Ii And Intrapec Block For Breast Augmentation Surgery, Kaleb Smith

Doctoral Projects

Ultrasound-guided regional anesthesia techniques are valuable tools for anesthesia providers to learn and implement in their practice. Two specific blocks that student registered nurse anesthetists (SRNAs) need to utilize are PECS-II and the Intrapec block for reconstructive breast augmentation and mastectomies. Teaching these blocks to SRNAs in the clinical setting may be difficult as they will be under higher pressure to perform since they will be practicing on live patients. Understanding this stress led to a review of the current Nurse Anesthesia Program (NAP) curriculum at The University of Southern Mississippi (USM) and found a gap in the education, which …

Objective Structured Clinical Examination For Arterial Line Placement, Delorean Calloway

Doctoral Projects

The University of Southern Mississippi (USM) is lacking a uniform guideline for arterial line placement. This DNP project promotes the addition of an objective clinical structured examination into the nurse anesthesia curriculum for future student registered nurse anesthetists (SRNAs) to gain comprehension and clinical experience in a simulation lab prior to practicing on real patients. Peer-reviewed literature and evidence-based practices have been researched and organized into a learning tool and checklist to be used as a step-by-step guideline. Having a guideline such as an OSCE in place can increase student competency and foster a culture of safety leading to better …

Barriers To Preoperative Warming: Best Practice Guideline, Tyler Comans, Zachary Hays, Caleb Leach

Doctoral Projects

The lack of preoperative warming has a direct relationship to perioperative hypothermia complications which include, but are not limited to: increased infection rate, coagulopathies, and increased myocardial oxygen consumption; all contributing to poor patient and facility outcomes. Implementation of an evidence-based educational module with visual aid can potentially increase the utilization of active warming techniques in the preoperative setting by perioperative staff. The DNP Project investigated barriers to preoperative warming by perioperative staff at a large teaching hospital in the southeastern United States. Barriers were assessed by a voluntary survey sent to 87 perioperative staff members. Twenty-two surveys were completed …

Ultra-Conformal Skin Electrodes With Synergistically Enhanced Conductivity For Long-Time And Low-Motion Artifact Epidermal Electrophysiology, Yan Zhao, Song Zhang, Tianhao Yu, Yan Zhang, Guo Ye, Han Cui, Chengzhi He, Wenchao Jiang, Yu Zhai, Chunming Lu, Xiaodan Gu, Nan Liu

Faculty Publications

Accurate and imperceptible monitoring of electrophysiological signals is of primary importance for wearable healthcare. Stiff and bulky pregelled electrodes are now commonly used in clinical diagnosis, causing severe discomfort to users for long-time using as well as artifact signals in motion. Here, we report a ~100 nm ultra-thin dry epidermal electrode that is able to conformably adhere to skin and accurately measure electrophysiological signals. It showed low sheet resistance (~24 Ω/sq, 4142 S/cm), high transparency, and mechano-electrical stability. The enhanced optoelectronic performance was due to the synergistic effect between graphene and poly (3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS), which induced a high …

A Novel Method For Ecg Signal Classification Via One-Dimensional Convolutional Neural Network, Xuan Hua, Jungang Han, Chen Zhao, Haipeng Tang, Zhuo He, Qinghui Chen, Shaojie Tang, Jinshan Tang, Weihua Zhou

Faculty Publications

This paper develops an end-to-end ECG signal classification algorithm based on a novel segmentation strategy and 1D Convolutional Neural Networks (CNN) to aid the classification of ECG signals and alleviate the workload of physicians. The ECG segmentation strategy named R-R-R strategy (i.e., retaining ECG data between the R peaks just before and after the current R peak) is used for segmenting the original ECG data into segments to train and test the 1D CNN models. The novel strategy mimics physicians in scanning ECG to a greater extent, and maximizes the inherent information of ECG segments for diagnosis. The performance of …

3d Fusion Between Fluoroscopy Angiograms And Spect Myocardial Perfusion Images To Guide Percutaneous Coronary Intervention, Haipeng Tang, Robert R. Bober, Chen Zhao, Chaoyang Zhang, Huiqing Zhu, Zhuo He, Zhihui Xu, Weihua Zhou

Faculty Publications

Background

Percutaneous coronary intervention (PCI) in stable coronary artery disease (CAD) is commonly triggered by abnormal myocardial perfusion imaging (MPI). However, due to the possibilities of multivessel disease, serial stenoses and variability of coronary artery perfusion distribution, an opportunity exists to better align anatomic stenosis with perfusion abnormalities to improve revascularization decisions. This study aims to develop a multi-modality fusion approach to assist decision-making for PCI.

Methods and Results

Coronary arteries from fluoroscopic angiography (FA) were reconstructed into 3D artery anatomy. Left ventricular (LV) epicardial surface was extracted from SPECT. The artery anatomy and epicardial surface were non-rigidly fused. The …

Using Collaborative Objective Simulation Clinical Evaluation With Undergraduate Nursing Students And Nurse Anesthesia Students Labor Epidural Placement In An Active Labor Patient, Chaka K. Jackson, Aisha Pierre

Doctoral Projects

Developing interdisciplinary teamwork and patient communication skills are essential for the student registered nurse anesthetist (SRNA) to provide quality patient care when administering epidural anesthesia. The synthesis of the evidence revealed limited available information on simulation use for SRNA epidural administration and collaboration. This doctoral project examined the effectiveness of learning through traditional simulation to enhance communication and collaboration between the Bachelor of Science in Nursing (BSN) and the Nurse Anesthesia Program (NAP) students. The BSN and NAP students were provided with a simulation environment to care for a laboring patient while improving patient safety and quality outcomes. The project …

Evaluation Of An Intervention To Maintain Therapeutic Pressure Of The Endotracheal Tube Cuff During Intraoperative Surgery, Jamare Reed

Doctoral Projects

The current practice of intraoperatively assessing the cuff pressure of the endotracheal tube (ETT) is arbitrary and potentially leads to negative impacts on patients. This best practice project aimed to review and synthesize the existing evidence-based literature on measuring ETT cuff pressure and to establish a policy guideline for anesthesia providers to measure ETT cuff pressure in the intraoperative environment. Based on the star model of the knowledge transformation framework model provided by the Academic Center for Evidence-Based Practice (ACE), the creation of evidence-based policy on ETT cuff measurement is expected to potentially prevent poor patient outcomes, patient expenses, and …

Machine Learning For The Preliminary Diagnosis Of Dementia, Fubao Zhu, Xiaonan Li, Haipeng Tang, Zhuo He, Chaoyang Zhang, Guang-Uei Hung, Pai-Yi Chiu, Weihua Zhou

Faculty Publications

Objective: The reliable diagnosis remains a challenging issue in the early stages of dementia. We aimed to develop and validate a new method based on machine learning to help the preliminary diagnosis of normal, mild cognitive impairment (MCI), very mild dementia (VMD), and dementia using an informant-based questionnaire.

Methods: We enrolled 5,272 individuals who filled out a 37-item questionnaire. In order to select the most important features, three different techniques of feature selection were tested. Then, the top features combined with six classification algorithms were used to develop the diagnostic models.

Results: Information Gain was the most …

Fully Automated Bone Age Assessment On Large-Scale Hand X-Ray Dataset, Xiaoyang Pan, Yizhe Zhao, Hao Chen, De Wei, Chen Zhao, Zhi Wei

Faculty Publications

Bone age assessment (BAA) is an essential topic in the clinical practice of evaluating the biological maturity of children. Because the manual method is time-consuming and prone to observer variability, it is attractive to develop computer-aided and automated methods for BAA. In this paper, we present a fully automatic BAA method. To eliminate noise in a raw X-ray image, we start with using U-Net to precisely segment hand mask image from a raw X-ray image. Even though U-Net can perform the segmentation with high precision, it needs a bigger annotated dataset. To alleviate the annotation burden, we propose to use …

Deep Learning-Based Structure-Activity Relationship Modeling For Multi-Category Toxicity Classification: A Case Study Of 10k Tox21 Chemicals With High-Throughput Cell-Based Androgen Receptor Bioassay Data, Gabriel Idakwo, Sundar Thangapandian, Joseph Luttrell Iv, Zhaoxian Zhou, Chaoyang Zhang, Ping Gong

Faculty Publications

Deep learning (DL) has attracted the attention of computational toxicologists as it offers a potentially greater power for in silico predictive toxicology than existing shallow learning algorithms. However, contradicting reports have been documented. To further explore the advantages of DL over shallow learning, we conducted this case study using two cell-based androgen receptor (AR) activity datasets with 10K chemicals generated from the Tox21 program. A nested double-loop cross-validation approach was adopted along with a stratified sampling strategy for partitioning chemicals of multiple AR activity classes (i.e., agonist, antagonist, inactive, and inconclusive) at the same distribution rates amongst the training, validation …

Machine Learning For Prediction Of Sudden Cardiac Death In Heart Failure Patients With Low Left Ventricular Ejection Fraction: Study Protocol For A Retrospective Multicentre Registry In China, Fanqi Meng, Zhihua Zhang, Xiaofeng Hou, Zhiyong Qian, Yao Wang, Yanhong Chen, Yilian Wang, Ye Zhou, Zhen Chen, Xiwen Zhang, Jing Yang, Jinlong Zhang, Jianghong Guo, Kebei Li, Lu Chen, Ruijuan Zhuang, Hai Jiang, Weihua Zhou, Shaowen Tang, Yongyue Wei, Jiangang Zou

Faculty Publications

Introduction: Left ventricular ejection fraction (LVEF) ≤35%, as current significant implantable cardioverter-defibrillator (ICD) indication for primary prevention of sudden cardiac death (SCD) in heart failure (HF) patients, has been widely recognised to be inefficient. Improvement of patient selection for low LVEF (≤35%) is needed to optimise deployment of ICD. Most of the existing prediction models are not appropriate to identify ICD candidates at high risk of SCD in HF patients with low LVEF. Compared with traditional statistical analysis, machine learning (ML) can employ computer algorithms to identify patterns in large datasets, analyse rules automatically and build both linear and …

Does The Use Of An On-Q Pump Improve Postsurgical Outcomes In Patients With Secondary Chronic Shoulder Pain?: A Retrospective Study, Deborah Thompson-Spencer

Doctoral Projects

Orthopedic shoulder surgery is a common therapy for many medical conditions, but the healing process for orthopedic shoulder surgery can be adversely impacted by chronic shoulder pain. Frequently, chronic pain is not adequately controlled by opioid analgesics provided to patients during the surgical healing process, resulting in greater pain and diminished postsurgical mobility. The focus of this Doctor of Nursing Practice project was to examine the question of whether, among male and female adult patients (40-64 years of age) with a history of secondary chronic shoulder pain lasting three or more months who have undergone orthopedic shoulder surgery, the use …

Nmd-12: A New Machine-Learning Derived Screening Instrument To Detect Mild Cognitive Impairment And Dementia, Pai-Yi Chiu, Haipeng Tang, Cheng-Yu Wei, Chaoyang Zhang, Guang-Uei Hung, Weihua Zhou

Faculty Publications

Introduction

Using machine learning techniques, we developed a brief questionnaire to aid neurologists and neuropsychologists in the screening of mild cognitive impairment (MCI) and dementia.

Methods

With the reduction of the survey size as a goal of this research, feature selection based on information gain was performed to rank the contribution of the 45 items corresponding to patient responses to the specified questions. The most important items were used to build the optimal screening model based on the accuracy, practicality, and interpretability. The diagnostic accuracy for discriminating normal cognition (NC), MCI, very mild dementia (VMD) and dementia was validated in …

Deep Learning Based Analysis Of Histopathological Images Of Breast Cancer, Juanying Xie, Ran Liu, Joseph Luttrell Iv, Chaoyang Zhang

Faculty Publications

Breast cancer is associated with the highest morbidity rates for cancer diagnoses in the world and has become a major public health issue. Early diagnosis can increase the chance of successful treatment and survival. However, it is a very challenging and time-consuming task that relies on the experience of pathologists. The automatic diagnosis of breast cancer by analyzing histopathological images plays a significant role for patients and their prognosis. However, traditional feature extraction methods can only extract some low-level features of images, and prior knowledge is necessary to select useful features, which can be greatly affected by humans. Deep learning …

A Learning-Based Automatic Segmentation And Quantification Method On Left Ventricle In Gated Myocardial Perfusion Spect Imaging: A Feasibility Study, Tonghe Wang, Yang Lei, Haipeng Tang, Zhou He, Richard Castillo, Cheng Wang, Dianfu Li, Kristin Higgins, Tian Liu, Walter J. Curran, Walter J. Curran, Weihua Zhou, Xiaofeng Yang

Faculty Publications

Background: The performance of left ventricular (LV) functional assessment using gated myocardial perfusion SPECT (MPS) relies on the accuracy of segmentation. Current methods require manual adjustments that are tedious and subjective. We propose a novel machine-learning-based method to automatically segment LV myocardium and measure its volume in gated MPS imaging without human intervention.

Methods: We used an end-to-end fully convolutional neural network to segment LV myocardium by delineating its endocardial and epicardial surface. A novel compound loss function, which encourages similarity and penalizes discrepancy between prediction and training dataset, is utilized in training stage to achieve excellent performance. …

Ethical Implications Of Treatment For Gender Dysphoria In Youth, Kelsey Hayes

Journal of Health Ethics

This manuscript explores ethical implications on treatment for youth with diagnosed gender dysphoria. The ethical considerations outlined and analyzed in this essay involve illuminating an understanding of whether the administration of pubertal suppression with GnRH agonists, and cross-sex hormones to children with gender dysphoria is morally justified as treatment to manage their psychological distress, or if safer more understood alternatives exist. This essay emphasizes that as health care professionals we must ensure youth with gender dysphoria receive adequate medical treatment and care however, this essay concludes through extensive literature review, that the use of inconclusive and under researched methods to …

Continuous Epidural Analgesia For Postoperative Pain Management: A Policy Analysis, Madison Nowell

Doctoral Projects

Postoperative pain management is a necessary component of the care of every surgical patient. Epidural analgesia is a widely used method to provide excellent postoperative pain relief and enhance postoperative recovery (Sawhney, 2012). Epidural analgesia is associated with fewer side effects than alternative pain management techniques; however, when epidural catheters are managed improperly, or pain is inadequately assessed, epidural analgesia fails to provide adequate pain relief (Deni et al., 2016). More than 80% of surgical patients experience moderate to severe postoperative pain, and 28 to 50% of these patients have a pain score greater than 6 out of 10 at …

Cause And Consequence Of Aβ: Lipid Interactions In Alzheimer Disease Pathogenesis, Vijay Rangachari, Dexter N. Dean, Pratip Rana, Ashwin Vaidya, Preetam Ghosh

Faculty Publications

Self-templating propagation of protein aggregate conformations is increasingly becoming a significant factor in many neurological diseases. In Alzheimer disease (AD), intrinsically disordered amyloid-β (Aβ) peptides undergo aggregation that is sensitive to environmental conditions. High-molecular weight aggregates of Aβ that form insoluble fibrils are deposited as senile plaques in AD brains. However, low-molecular weight aggregates called soluble oligomers are known to be the primary toxic agents responsible for neuronal dysfunction. The aggregation process is highly stochastic involving both homotypic (Aβ-Aβ) and heterotypic (Aβ with interacting partners) interactions. Two of the important members of interacting partners are membrane lipids and surfactants, to …

Myocardial Stunning-Induced Left Ventricular Dyssynchrony On Gated Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging, Zhixin Jiang, Haipeng Tang, Jianzhou Shi, Yanli Zhou, Cheng Wang, Dianfu Li, Qijun Shan, Weihua Zhou

Faculty Publications

Objectives Myocardial stunning provides additional nonperfusion markers of coronary artery disease (CAD), especially for severe multivessel CAD. The purpose of this study is to assess the influence of myocardial stunning to the changes of left ventricular mechanical dyssynchrony (LVMD) parameters between stress and rest gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).

Patients and methods A total of 113 consecutive patients (88 males and 25 females) who had undergone both stress and rest ^99mTc-sestamibi gated SPECT MPI were retrospectively enrolled. Suspected or known patients with CAD were included if they had exercise stress MPI and moderate to …

Assessing Speech-Language Pathologists’ Knowledge And Use Of Language Acquisition Through Motor Planning, Mary Catherine Cazalas

Honors Theses

Many individuals who are nonverbal require augmentative and alternative communication devices to communicate. The purpose of this research was to assess speech-language pathologists’ knowledge of a particular method of implementing augmentative and alternative communication devices known as language acquisition through motor planning (LAMP). Further, this research was designed to determine the percentage of speech pathologists who have used LAMP during their careers as well as the perceived level of success speech pathologists have found with LAMP. Mississippi speech-language pathologists were used as the sample for this study. A survey was created electronically via the online survey development software, “Survey Monkey,” …