Investigative Techniques Commons^™

Recurrent Lateral Patellar Dislocation After Mpfl Repair With Subsequent Tibial Tubercle Anteromedialization And Concomiant Mpfl Reconstruction, Jacob Hardy, Anthony Thomas Drazick, Joshua Pratt, Jeremy M. Burnham

Clinical Practice in Athletic Training

Introduction: Patellar instability is a common knee pathology, particularly among adolescents and young adults, with reported incidence rates ranging from 7 to 77 per 100,000 person-years. Following an initial patellar dislocation, recurrence rates have been reported as high as 86%, particularly in patients with underlying anatomic risk factors. Identification of the multifactorial contributors to patellar instability is critical to guide appropriate management and prevent recurrent episodes. Common pathoanatomic factors associated with recurrent instability include trochlear dysplasia, patella alta, lateralized tibial tubercle, coronal or torsional malalignment, and abnormal patellar shift. This case report describes a patient who presented with a chronic …

Elixhauser Comorbidity Index To Predict Perioperative Bleeding And Adverse Spine Surgery Outcomes, Mitchell K. Ng, Michael A. Mont, Mosadoluwa Afolabi, Prathiksha N V, Amitha Kumar, Stephen S. Johnston

Rothman Institute Papers

Introduction: As spine surgery volume continues to grow, ensuring patient safety and minimizing complications are increasingly critical. Disruptive bleeding—defined as hemorrhagic events requiring clinical intervention—is a significant perioperative challenge. This study aimed to: (1) quantify disruptive bleeding incidence; (2) evaluate associations between patient demographics, Elixhauser Comorbidity Index (ECI), and bleeding risk; and (3) assess the impact of disruptive bleeding on mortality, ventilator use, length of inpatient stay, 90-day readmissions, and inpatient costs. Methods: A nationwide healthcare database was used to identify patients who underwent spine surgery in 2019. Patients were subdivided by the Elixhauser Comorbidity Index (ECI) from 0 to …

Development Of The Self-Administered Health Complexity Screening Instrument, Sheila Specker, Rachel Andrew, Emily Drexler, Emily Koithan, Steven Thurber, Steven Frankel

School of Medicine Faculty Publications

PURPOSE: The purpose of the study was to develop a self-administered screening tool to assist case managers, primary care physicians, and other clinicians in quickly and accurately identifying patients with complex health needs who require a definitive and detailed case management evaluation. In addition to medical and psychiatric items, this tool incorporates multiple social determinants of health (SDOH), known to add to clinical complexity. PRIMARY PRACTICE SETTING: This instrument is most appropriate for identifying patients with high complexity in the primary care sector. Due to the abundance of such patients with high biopsychosocial complexity and costs of treating these patients, …

Ai-Assisted Surface-Enhanced Raman Spectroscopy For Cardiovascular Diagnostics: From Plasmonic Materials To Clinical Translation, Anju Joshi, Gymama Slaughter

Center for Bioelectronics Publications

Raman spectroscopy (SERS) has emerged as a powerful analytical technique, offering molecular fingerprint specificity and ultrasensitive detection of cardiac biomarkers. Recent advances in plasmonic nanostructures, surface functionalization strategies, and flexible sensing platforms have significantly improved the analytical performance of SERS-based biosensors. In parallel, the integration of artificial intelligence (AI) and machine learning has enabled robust interpretation of complex spectral datasets, facilitating automated biomarker classification and improved diagnostic accuracy in heterogeneous biological environments. Despite these advances, the field remains fragmented, with limited integration between nanomaterial design, biomarker selection, and data-driven analysis, and persistent challenges related to reproducibility, standardization, and clinical validation. …

A Painful Diffuse Rash, Bruce M. Lo, Melanie Shoemaker, Kiersten Potter, Katherine Schaffer

Department of Emergency Medicine Faculty Publications

[Patient presentation]

A 41-year-old male with no past medical history presented with 1 week of ulcers to the left side of his face, followed by several days of a painful rash to the trunk and back after a sexual encounter. The patient denies any fever or previous rash and any illicit drug use. Initial vital signs included a temperature of 97 °F, a heart rate of 89 beats per minute, and blood pressure of 135/79 mm Hg. Physical examination revealed a macular papular rash across his trunk and back (Fig 1) and facial ulcerations with eschar (Fig 2) at the …

Non-Invasive Detection Of Intracranial Pressure, Andrei V. Nesterenko

Honors Undergraduate Theses

Intracranial pressure is a critical metric used when managing tumors, strokes, TBIs, hydrocephalus, and other operative conditions. Traditional methods for continuous ICP monitoring, intraparenchymal catheters, epidural transducers etc., are invasive and carry a high risk of infection. Previous attempts to create accurate, easy to use, and non-invasive ICP monitoring techniques have been unsuccessful. In this study, we investigated the utility of supraorbital and posterior auricular photoplethysmography to monitor changes in ICP during orthostatic tilt and hyperventilation, which increase and decrease ICP respectively.

Through a continuous 5-minute recording on a tilt-table we characterized SOA and PAA waveforms in 12 participants (ages …

Revisiting Nasal Polyp Scoring In Clinical Trials: Interpretive Variability And The Need For Standardization, Leigh J. Sowerby, Babak Pourmomenarabi, Antonino Maniaci, Olivia Ginty, Joseph Khristian Han

Department of Otolaryngology (ENT) Faculty Publications

[Introduction] Borish et al. provided an excellent review highlighting methodological variability among the six pivotal Phase III trials [1]. One critical yet overlooked issue is the inconsistent application of the endoscopic nasal polyp score (NPS), a primary outcome measure in all trials.

Laboratory Monitoring In Patients With Moderate To Severe Plaque Psoriasis, Jonathan M. Fenkel, John A. Osborne, April W. Armstrong, Bruce Strober, Linda Stein Gold, Michael Cameron, Mark Lebwohl

Department of Medicine Faculty Papers

OBJECTIVES: Plaque psoriasis is a common immune-mediated disease associated with various comorbidities, including cardiovascular disease, diabetes, psoriatic arthritis, liver disease, and mood disorders. Biologic and small-molecule therapies are efficacious and well tolerated in adults with moderate to severe plaque psoriasis. However, dermatologists may be uncertain about appropriate laboratory monitoring in patients treated with these therapies, especially those with comorbidities.

METHODS: This review summarizes prescribing information and provides expert recommendations based on real-world experience in the monitoring of concerning laboratory values in patients with psoriasis.

RESULTS: Individualized monitoring is essential for maximizing the benefits and minimizing the risks associated with biologic …

Validation Of A Prognostic Nomogram For Locally Advanced Oropharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy With/Without Systemic Therapy, P. Bossi, R. Gili, S. Calza, L. Licitra, M. Maddalo, A. Bacigalupo, L. Belgioia, J. Cacicedo, N. Facchinetti, A. Garcia Castano, M. Oliva, P. Bonomo, G. Sanguineti, P. Franco, A. Argiris, A. Psyrri, E. Orlandi

Kimmel Cancer Center Faculty Papers

BACKGROUND: Head and neck squamous-cell carcinoma (HNSCC), particularly oropharyngeal cancer (OPC), exhibits diverse prognostic factors influenced by demographic and lifestyle variables. Prognostic nomograms, such as the one developed by Fakhry et al., incorporate clinical and biological markers to predict overall survival (OS) and progression-free survival (PFS) in OPC patients. However, their applicability to European populations remains unverified. This study aimed to externally validate Fakhry's prognostic nomogram in a large European cohort of locally advanced OPC patients treated with definitive intensity-modulated radiotherapy (IMRT) with or without systemic therapy.

METHODS: This is a retrospective external validation study conducted on 805 OPC patients …

A Comparative Evaluation Of Two Subharmonic-Aided Pressure Estimation (Shape) Analysis Methods, Hailee Mayer, Priscilla Machado, Trang Vu, Annalisa Berzigotti, Jaume Bosch, Elton Dajti, Antonina Antonenko, Kirk Wallace, Flemming Forsberg

Department of Radiology Faculty Papers

Pressure measurement in clinical practice is a valuable tool for diagnostic evaluation, especially in diseases such as portal hypertension. Currently, portal pressures are measured by invasive hepatic vein catheterization, posing risks to patients, and limiting how often measurements can be obtained. Subharmonic-aided pressure estimation (SHAPE) is an ultrasound-based technique that leverages ultrasound contrast agents (UCAs) to estimate changes in hydrostatic pressure. UCAs act as nonlinear oscillators when exposed to high enough acoustic pressures (typically > 200 kPa) and produce significant energy components ranging from subharmonics to higher harmonics. Tissues do not generate significant subharmonic components, thus making it the optimal component …

Impact Of A Focused Best Practice Workshop On Athletic Trainer Confidence, Jaclyn B. Arduini, Jennifer L. Volberding, Zachary A. Murray

Clinical Practice in Athletic Training

Athletic trainers are required to be proficient in emergency management skills, without review these skills may decay creating a potentially dangerous knowledge gap. Confidence measures of emergency management skills were taken before and after a workshop to determine if they changed due to the review of material. All 11 confidence measures increased post workshop, seven significantly, including rectal temperature, hemostatic agents, external hemostatic modalities, in-line stabilization, measurement and application of a cervical collar, football and other equipment removal. ATs should aim to incorporate emergency management review into continuing education choices.

Incorporating Balance Training Into Ankle Sprain Injury Prevention Programs: An Evidence-To-Practice Review, David Tomchuk, Jacob Meyer, Kyle Schneider, Ben Fox

Clinical Practice in Athletic Training

Ankle sprains are among the most common injuries in sports and non-sporting activities. For patients, ankle sprains can result in multiple short and long-term hardships, such as financial burdens of evaluation and treatment, absenteeism from sport and physical activity, and diminished ankle and lower extremity function. However, athletic trainers and other stakeholders are also impacted by administrative and time burdens in caring for ankle sprains and how ankle sprains affect team dynamics and performance. The 2022 guiding systematic review evaluated the effectiveness of incorporating preventive balance training exercises on the incidence of ankle sprains in soccer athletes. The search performed …

Examining Burnout Among Athletic Trainers Employed In The College And Secondary School Settings, Stephanie M. Singe, Dayna Liu, Alexandrya Cairns

Clinical Practice in Athletic Training

Burnout continues to be an important concern for athletic trainers working traditional employment settings. The purpose of this study was to compare the secondary school and collegiate settings in relation to burnout. Both secondary school and collegiate athletic trainers participated in a self-reported, online cross-sectional design (Qualtrics) to collect data on their experiences with burnout. Data collection occurred during the second week of October 2023 and ceased during the early weeks of November. Collegiate athletic trainers reported moderate burnout overall (54.56 ±15.89) on the CBI whereas secondary school athletic trainers reported low burnout overall (46.67 ±16.57). On the personal-related burnout …

Use Of An Electronic Dynamometer Following Pitching To Identify Fatigue In Softball Pitchers, Bethany L. Hansberger, Peter Lisman

Clinical Practice in Athletic Training

This study used a case-series design to collect in-game fatigue measures for collegiate softball pitchers immediately after pitching during the competitive season. Five softball pitchers (age = 19.8 ± 1.5 years; height = 169.9±6.1 cm; body mass = 79.1±22.6 kg) from one Division I program were recruited. Isometric internal and external rotation, scaption, and grip strength measures were collected using an electronic dynamometer at the beginning and conclusion of the fall non-traditional season, and at the beginning of preseason in January. Strength measures were also obtained during the competitive season at the conclusion of pitching in a game and compared …

Concurrent Acl And Medial/Lateral Meniscal Repair In A Collegiate Soccer Player: Disablement Model Case Study, Rebecca L. Perry, Angelica Alicea, Jeanette Welch, Carl White, Emily E. Hildebrand, Peter Lisman

Clinical Practice in Athletic Training

This case examines a 19-year-old female Division I collegiate soccer player who underwent anterior cruciate ligament (ACL) reconstruction with medial and lateral meniscal repairs. Though meniscal tears often occur in conjunction with ACL injury, incidence of concurrent medial and lateral tears with presence of a displaced bucket-handle lesion is rare. This patient attempted to tackle an oncoming opponent in which contact caused forceful trunk rotation away from her planted right foot. Sideline evaluation revealed medial and posterior knee pain with active knee range of motion deficits. Further evaluation revealed apprehension and muscle guarding during Lachman’s, anterior drawer, and valgus stress …

Suturing Education For Athletic Trainers: An Evidence-To-Practice Review, Morgan K. Webb, Brett T. Heim, Allyson E. Ritchey, Kenya Moore, Zachary K. Winkelmann

Clinical Practice in Athletic Training

Teaching suturing skills to medical students is a critical component of their education. Implementing suturing into a comprehensive framework is developed from how professors teach the skill. Suturing is a required skill by the General Medical Council that all medical students must have, and how it is being introduced to new students is changing. This review aimed to summarize different educational interventions and determine the most efficient and cost-effective way to teach future suturing skills. The original systematic review included 25 articles in the final data synthesis. Fourteen studies were randomized control trials, six were quasi-experimental, and five were observational. …

Conservative Management Of Athletic Pubalgia In A Collegiate Beach Volleyball Athlete: A Case Study, Sydney F. Hendrick, Amy L. Fraley, Madison V. Kefferstan, Zachary K. Winkelmann

Clinical Practice in Athletic Training

A 24-year-old female collegiate beach volleyball athlete experienced sharp pain in the pubis symphysis region after turning and running to reach a ball hit over her right shoulder. The patient was unable to move her lower extremities without extreme pain and required help off the court. She was referred to the student health center, where no initial imaging was performed. Differential diagnoses included osteitis pubis, abdominal strain, and athletic pubalgia. Magnetic resonance imaging (MRI) showed a small partial sports hernia with the shearing of the aponeurotic plate. The team physician recommended conservative management. The patient requested a consultation with a …

Introducing Patient-Centered Outcomes To Preceptors In Caate-Approved Athletic Training Programs, K. Judge

Clinical Practice in Athletic Training

The 2020 standards set by the Commission on Accreditation of Athletic Training Education (CAATE) now require the incorporation of the International Classification of Function and Patient-Centered Outcomes into professional practice. These standards can be introduced initially through simulation, but to develop a competent and culturally aware professional, outcome measures should be completed during clinical experiences under the guidance of approved preceptors. As this is a relatively new standard, many preceptors did not receive this as part of their education and may be uncomfortable integrating outcomes into their practice. This lack of integration can negatively affect the learning opportunities of athletic …

Psychological And Psychosocial Effects Of Contemplative Practices In The Athletic Population: A Systematic Review, Victoria Baker, Emily Duckett, Alison Gardiner-Shires, Lindsey Keenan

Clinical Practice in Athletic Training

Mental health concerns in athletes are becoming a primary focus for institutions, companies, coaches, and more. An athlete carries an abundant load of stressors due to their lifestyle. The stressors can negatively impact an athlete by producing anxiety, depression, insomnia, and other mental health concerns. Previous studies have found a connection between the use of contemplative practices on psychological and psychosocial effects in athletes, creating an opportunity to evaluate the research of contemplative practices in the athletic population. 5, 7, 8, 13-16 A systematic review was conducted using nine electronic databases. Seven studies were included in this review, each assessing …

Neuromuscular Deficits Following An Isolated Pcl Tear In A Collegiate Lacrosse Player: A Case Study, Mckenna G. Witlin, Erin R. Mcmullan, Courtney M. Meyer, Amy L. Fraley

Clinical Practice in Athletic Training

This disablement model case study outlines a 21-year-old female collegiate lacrosse player attending a United States service academy who presented with a unique neuromuscular deficit following a conservative grade II PCL tear rehabilitation. Nearing the end of her rehabilitation protocol, she noticed difficulty with toe-off while running; however, she did not report to the athletic trainer due to the institution’s holiday break proximity. An unexpected transfer of care occurred when the patient returned after the holidays, and she was cleared for full participation upon return. Several days after the patient was cleared, she reported her ankle feeling “stuck.” Upon evaluation, …

Improving The Discussion Of Suicide Prevention: A Quality Improvement Project, Chelsea Reynolds, Alyssa Zeitouni, Kathryn Stephenson

Clinical Practice in Athletic Training

Suicide is currently the second leading cause of death among adolescents in the United States and the third leading cause of death in this age group worldwide.1,2 Suicide prevention is understandably a growing focus in pediatrics. Currently, at the Children’s Hospital Outpatient Clinic, that is staffed by pediatric resident physicians, suicidal ideation is screened for using a PHQ-9 screen. However, at the time this study was initiated and completed, the TEEN screen was utilized. After the screening is performed, regardless of type, it is up to the provider to address these findings in a safe and effective manner. The goal …

Non-Invasive Detection Of Choroidal Melanoma Via Tear-Derived Protein Corona On Gold Nanoparticles: A Machine Learning Approach, Hakimeh Rakhshandeh, Ahmad Nasiraei, Hamid Riazi-Esfahani, Babak Masoomian, Fariba Ghassemi, Mojtaba Arjmand, Saeed Heidari Keshel, Fatemeh Atyabi, Rassoul Dinarvand

Wills Eye Hospital Papers

This study investigates the feasibility of using tear sample analysis, based on protein corona formation on gold nanoparticles combined with electrospray ionization mass spectrometry (ESI-MS) and machine learning techniques, as a non-invasive approach for the detection of choroidal melanoma. The aim is to assess whether protein-nanoparticle interactions can support early and reliable identification of this ocular condition. Tear samples were collected using Schirmer strips from six healthy individuals and six patients diagnosed with choroidal melanoma, with subsequent augmentation to 18 samples per group. Gold nanoparticles (AuNPs, ~ 20 nm) were synthesized via citrate reduction and incubated with tear samples to …

Corticobasal Syndrome With Mixed Pathology In The Absence Of Grn Mutation: A Clinico-Pathological Case Of Ftld-Tdp With Coexisting Alzheimer’S And Lewy Body Pathology, Hugo Zamarron, David Irwin, Jeffery Phillips, Edward Lee, Matthew Tisdall, Corey Mcmillan

Research Colloquium

Background: Corticobasal syndrome (CBS) is a neurodegenerative disorder characterized by often asymmetric fronto-pariteal and extra-pyramidal features that is traditionally associated with tauopathy, but pathological findings are heterogenous, including other forms of frontotemporal lobar degeneration (FTLD) and mixed pathologies of aging. We present clinical, radiographic, and histopathologic features of asymmetry in a unique patient with CBS and underlying FTLD with TDP-43 pathology (FTLD-TDP), co-occurring with other age-related pathologies.

Case Presentation: A 76-year-old man presented with progressive cognitive and motor dysfunction including asymmetric parkinsonism, left-sided dystonia and rigidity, apraxia, visuospatial impairment, and a subtle social disorder including apathy and social withdrawal. The …

Reliability And Spatial Consistency Of Mr Diffusion Tensor Imaging Measures Along The Cerebral Perivascular Space, Enchao Qiu, Joga Chaganti, Phillip Phan, M. Alizadeh, Devon Middleton, Kiran Talekar, Prabath Mondel, Scott H. Faro, Feroze Mohamed, Hsiangkuo Yuan

Department of Radiology Faculty Papers

BACKGROUND AND PURPOSE: Diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) has emerged as a promising noninvasive method for evaluating water motion that may reflect glymphatic system function. However, the reliability of DTI-ALPS measurements across different region-of-interest (ROI) selection methods remains underinvestigated. This study aimed to assess the interrater reliability among three neuroradiologists in native space and compare DTI-ALPS indices derived from ROIs placed in subjects' native space versus standardized Montreal Neurological Institute (MNI) space.

METHODS: DTI-ALPS indices from 16 healthy subjects were calculated from both left and right hemispheres using two ROI placement approaches: (1) native space ROIs …

Enhancing Cataract Surgery Outcomes: Optimal Use Of Pre- And Post-Operative Eye Drops, Keith Skolnick M.D., Anu Valiaveedu

Mako: NSU Undergraduate Student Journal

Many preoperative and postoperative cataract patients struggle with comprehending the use of prescription medication as directed. Language barriers and low health literacy levels are major factors contributing to improper use of prescriptions. To increase patients comprehension, the Fort Lauderdale Eye Institute employed an educational intervention consisting of a live presentation and an instructional video. Results found that 44% of patients were hesitant to ask questions to clinical staff, 32% felt overwhelmed, and nearly 70% lacked confidence in using their prescribed eye drops. Following the intervention, 91% of patients reported increased confidence in their medications, and most indicated that the video …

Quantifying "Medical Renal Disease": A Pediatric Pilot Study Using Ultrasound Radiomics For Differentiating Acute Kidney Injury And Chronic Kidney Disease, Laura De Leon-Benedetti, Laith Sultan, Hansel Otero, Tatiana Morales-Tisnés, Joya Sims, Kate Fitzpatrick, Julie Fitzgerald, Susan Furth, Benjamin Laskin, Bernarda Viteri

SKMC Student Presentations and Publications

Background: Differentiating acute kidney injury (AKI) from chronic kidney disease (CKD) in children remains a critical unmet need due to the limitations of current clinical and biochemical markers. Conventional ultrasound lacks the sensitivity to discern subtle parenchymal alterations. This study explores the application of ultrasound radiomics—a novel, non-invasive, and quantitative image analysis method—for distinguishing AKI from CKD in pediatric patients. Methods: In this retrospective cross-sectional pilot study, kidney ultrasound images were obtained from 31 pediatric subjects: 8 with oliguric AKI, 14 with CKD, and 9 healthy controls. Renal parenchyma was manually segmented, and 124 advanced texture features were extracted using …

Cryptococcoid Sweet Syndrome Or Halogenoderma? Highlighting The Crucial Need For Serum Iodine Testing, Jacob R. Kilgore, Jonathan M. Joseph, Addie Walker, William Snider, Nicholas Culotta, Carson Bogatto, Aaron Coulon

School of Medicine Faculty Publications

No abstract provided.

Implementation Of A Triage System For The Residents At A Residential Facility To Improve Triage Assessment Skills Of The Staff As Well As Improve The Level And Timeliness Of Care, Andrew J. Choi Rn, Neha Gopal Rn, Andres N. Padilla Rn, Dana Son

Master's Projects and Capstones

Triage is an integral part of the clinical process which involves assessing patients and determining their level of care in order to get them appropriate, timely treatment. Several countries utilize a standardized triage system with established criteria to aid staff in their decision-making during assessments (Peta et al., 2023). The Nursing and Residential Triage (NaRT) tool, from the Manchester Triage System (MTS), was shown to enhance staff clinical assessment skills and help avoid inappropriate ED transfers during a study among older adults in a residential facility (Markey et al., 2024). For this project, the main issue identified at the residential …

Evaluation Of The User Experience For A Point Of Care Molecular Test For Causes Of Vaginitis, Barbara Van Der Pol, Rebecca Lillis, Irving Nachamkin, Stephen Young, La Shonda Crane, Jacqueline Brown, R. Lamar Parker, Alice Weissfeld, Xiaohong Liu, Christina Huang, Aarthi Raman

School of Medicine Faculty Publications

Background: Vaginitis is a major cause of healthcare visits in the US, costing over $1.2 billion annually. Point-of-care (POC) nucleic acid amplification tests (NAATs) could improve accuracy of diagnosis and treatment during initial visit for vaginitis compared to send-out NAATs. Methods: A secondary analysis of data was collected from test operators at POC testing sites where the Xpert Xpress Multiplex Vaginal Panel test (“MVP test”) was performed. Users completed a survey assessing their experience with the instrument system and the PCR-based MVP test. Results: The MVP test demonstrated consistent performance, measured by positive and negative percent agreement, across all user …

Incidence, Risk Factors And Clinical Outcomes Of Pericardial Effusion In Left Ventricular Assist Device Patients, Muhammad Zubair Khan, Yevgeniy Brailovsky, Mohammad Alfrad Nobel Bhuiyan, Gregary D. Marhefka, Abu S. M. Faisal, Adrija Sircar, Parker O'Neill, J. Eduardo Rame, Sona Franklin, Muhammad Waqas, Hadia Shah, Indranee Rajapreyar, René J. Alvarez

Division of Cardiology Faculty Papers

BACKGROUND: Development of pericardial effusion in patients with left ventricular assist devices (LVADs) can be detrimental to health outcomes. This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.

AIM: To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion. The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.

METHODS: Data were obtained from the National Inpatient Sample database between 2016 and 2018. Statistical …