Medical Specialties Commons^™

Quality Improvement: Implementing A Foot Exam To Improve Care For Patients With Diabetes Mellitus, Emily Paprocki, Ryan Mcdonough, Tiffany Musick, Joseph Cernich

Posters

The American Diabetes Association guidelines recommend an annual foot exam in patients with type 1 and 2 diabetes who are ten years old or older and who have been diagnosed with diabetes at least five years. Quality improvement tools were used to improve the care provided to our patients by implementing an annual food exam.

Outcomes Following Dynamic Compression Bracing For Pectus Carinatum, Charlene Dekonenko, Robert M. Dorman, Amy L. Pierce, Beth A. Orrick, David Juang, Pablo Aguayo, Jason D. Fraser, Tolulope A. Oyetunji, Charles L. Snyder, Shawn D. St Peter, G W. Holcomb Iii

Posters

We describe our experience with dynamic compression bracing for pectus carinatum patients and their satisfaction with bracing.

Old Dog With New Tricks: 99mtc-Sestamibi Spect-Ct For Renal Mass Differentiation, Zachary Beswick, Ishani Dalal

MERF 2019 - Teaching and Education

Small renal masses have historically presented a diagnostic challenge for radiologists and urologists. MRI and CT have a limited capability to differentiate benign and malignant small solid renal masses. The relatively poor negative predictive value of renal biopsy limits the ability to avoid surgical resection in small renal masses with negative biopsy. 99mTc-sestamibi SPECT-CT can be an important tool in directing the management of patients with renal masses.We present the analysis of 99mTc-sestamibi uptake patterns in patients with small renal masses who underwent further characterization of these masses with 99mTc-sestamibi SPECT-CT. Pertinent interpretation points in differentiating renal cell carcinoma from …

Exploring The Potential Yield Of Prenatal Testing By Evaluating A Postnatal Population With Structural Abnormalities, Peyton Busby

Dissertations and Theses (Open Access)

After identification of one or more structural abnormalities in a fetus, pregnant women are offered a host of different testing options to identify a possible genetic cause for the structural abnormality(ies). When considering what type of test to undertake, there is limited information on the diagnostic yield of the varying testing options. Some women may miss an opportunity to gain the information they are seeking or make a less informed decision when they choose a testing option after identification of a structural abnormality due to this lack of information. This study aimed to identify the potential diagnostic yield of all …

Trust And Glycemic Control In Black Patients With Diabetic Retinopathy: A Pilot Study, Barry W. Rovner, Robin J. Casten

Department of Psychiatry and Human Behavior Faculty Papers

Diabetic retinopathy (DR) is more prevalent in blacks than whites because, compared to whites, blacks on average have worse glycemic control. Both of these racial disparities reflect differences in sociocultural determinants of health, including physician mistrust. This randomized, controlled 6-month pilot trial compared the efficacy of a culturally tailored behavioral health/ophthalmologic intervention called Collaborative Care for Depression and Diabetic Retinopathy (CC-DDR) to enhanced usual care (EUC) for improving glycemic control in black patients with DR (n = 33). The mean age of participants was 68 years (SD 6.1 years), 76% were women, and the mean A1C was 8.7% (SD 1.5%). …

Inadvertent Radial Head Inversion During Closed Reduction Of A Pediatric Radial Neck Fracture, Zachary J. Sirois, Sarah Kreul, Craig F. Shank

Orthopaedic Surgery Faculty Publications

Management of displaced pediatric radial neck fractures can be fraught with challenges. This unique case presents an 11-year-old female with a Salter-Harris type II radial neck fracture and how her radial head overturned 180° with the articular surface facing the radial shaft rather than the capitellum during closed manipulation under anesthesia. The malreduction subsequently required open reduction and highlights the importance of a careful stepwise approach to managing markedly displaced radial neck fractures. After closed reduction, meticulous assessment of intraoperative imaging when determining proper alignment is of the utmost importance as a result of the transverse nature of Salter-Harris type …

Comparison Of Best Versus Worst Clinical Outcomes For Adult Cervical Deformity Surgery., Justin S Smith, Christopher I Shaffrey, Han Jo Kim, Peter Passias, Themistocles Protopsaltis, Renaud Lafage, Gregory M Mundis, Eric Klineberg, Virginie Lafage, Frank J Schwab, Justin K Scheer, Michael Kelly, D Kojo Hamilton, Munish Gupta, Vedat Deviren, Richard Hostin, Todd Albert, K Daniel Riew, Robert A Hart, Doug Burton, Shay Bess, Christopher P Ames

Articles, Abstracts, and Reports

Study Design: Retrospective cohort study.

Objective: Factors that predict outcomes for adult cervical spine deformity (ACSD) have not been well defined. To compare ACSD patients with best versus worst outcomes.

Methods: This study was based on a prospective, multicenter observational ACSD cohort. Best versus worst outcomes were compared based on Neck Disability Index (NDI), Neck Pain Numeric Rating Scale (NP-NRS), and modified Japanese Orthopaedic Association (mJOA) scores.

Results: Of 111 patients, 80 (72%) had minimum 1-year follow-up. For NDI, compared with best outcome patients (n = 28), worst outcome patients (n = 32) were more likely to have had a …

Decreased Odds For Vasospasm Treatment In Patients With Aneurysmal Subarachnoid Hemorrhage After Transitioning From Neurosurgery Led Care To A Neurology Led Multidisciplinary Approach., Russell Bartt, Stephanie Jarvis, Lauren Cittadino, Benjamin Atchie, Kathryn Mccarthy, Rebecca Van Vliet, Alicia Bennett, Jeffrey Wagner, Alessandro Orlando, David Bar-Or

Articles, Abstracts, and Reports

Introduction: The limited research on the management of aneurysmal subarachnoid hemorrhages (aSAHs) has not assessed the efficacy of neurology-led care. Our objective was to describe aSAH patients' outcomes after transitioning from a neurosurgery-led intensive care unit (ICU) to a neurology-led multidisciplinary care neurocritical care unit (NCCU). The study hypothesis was that the neurology-led multidisciplinary care would improve patient outcomes.

Methods: This was a retrospective cohort study. We included patients (≥ 18) with aSAHs from 1/16 to 8/16 (pregroup) and from 3/17 to 11/17 (postgroup). The pregroup care was led by a neurosurgeon. The postgroup care included a neurologist, a pulmonary …

Left Atrial Model, Borna Sobati, Sarah Porello, Tess Pate

Biomedical Engineering

The objective is to produce an electrophysiological model of an adult human left atrium. This model will be used to test mapping probe catheters used for locating cardiac arrhythmias against current technology used in practice. Dr. Chris Porterfield requested this model and other physicians or probe catheter manufacturers may also use this product in the future. Dr. Porterfield also discussed the possibility of future senior project groups using the model as a bench test for designing new catheter tips. The model will precisely simulate electrical behaviors of the heart in normal as well as arrhythmic conditions. Ideally, the model will …

Dementia In Pakistan; An Unprecedented Challenge And Local Cultural Beliefs, Problems And Actions Required., Qamar Zaman, Maimoona Siddiqui, Zaha Iqbal Malik

Pakistan Journal of Neurological Sciences (PJNS)

Changing cultural and social dynamics has brought a major shift in lifestyles and associated risk factors for various disorders that were previously uncommon in Pakistan. Dementia is among the one of these emerging problems that is going to affect the elderly population worldwide but more so in the developing world. To adequately deal with the problems faced by patients with dementia and their caregivers, several important measures are needed that can help to reduce the morbidity and burden on the families and overall society. Increasing the awareness regarding the risk factors may help to reduce the dementia burden similarly knowledge …

Use Of Novel Oral Anticoagulants For Treatment Of Cerebral Venous Sinus Thrombosis: A Case Series And Follow Up, Rizwana Shahid, Noman Ishaque, Aishah Albakr, Nourah Abdulaziz Alkhaldi, Feras Abdulsalam, Abdullah Alsulaiman

Pakistan Journal of Neurological Sciences (PJNS)

Thrombosis of cerebral venous sinuses and/or cortical veins (CVST) is an infrequent type of stroke for which anticoagulation is considered standard of treatment. However, 40% of CVST patients have evidence of parenchymal changes like edema or haemorrhage on neuroimaging which complicates use of anticoagulation in such cases. Therefore, Novel Oral Anticoagulants (NOACs) are recently being used for treatment of CVST as they are associated with half the risk of intracerebral haemorrhage as caused by vitamin K antagonist. Case reports and case series have reported use of NOACs in CVST with good outcomes both clinically and radiologically. We report use of …

Performance Of The Promis After Operative Interventions For Shoulder Instability, Christina J. Hajewski, Natalie A. Glass, Robert W. Westermann, Matthew Bollier, Brian R. Wolf, Carolyn Hettrich

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to capture patient-reported outcomes (PROs) in an efficient manner. Few studies have assessed this instrument postoperatively.

Purpose: To compare the PROMIS Physical Function computer adaptive test (PROMIS PF CAT) and Upper Extremity (PROMIS UE) item bank to other previously validated PRO instruments and to evaluate ceiling and floor effects and construct validity responsiveness in patients who underwent operative interventions for shoulder instability.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: A total of 72 patients who underwent operative interventions for shoulder instability completed the American Shoulder and Elbow …

Evaluation Of The Project P.A.T.H.S. In Mainland China: Findings Based On Student Diaries, Daniel T. L. Shek, Xiaoqin Zhu, Janet T. Y. Leung, Tak Yan Lee, Florence K. Y. Wu

Pediatrics Faculty Publications

Objectives: Based on 859 student diaries, the present study evaluated a positive youth development program entitled “Tin Ka Ping (TKP) Positive Adolescent Training through Holistic Social programs (P.A.T.H.S.) ” project implemented in mainland China during the 2015–2016 academic year. Method: To understand the perceived effectiveness of the students, the study analyzed quantitative as well as qualitative data derived from the student diaries. Results: The students held very positive views toward the program and the implementers. The narratives of the students also showed that they perceived improvement in the intrapersonal, interpersonal, familial, and societal domains after joining the program. Conclusion: In …

Commentary: Ganglion Cell Complex Of Retinal Layer Thickness By Optical Coherence Tomography In Cases Of Multiple Sclerosis Without Optic Neuritis Compared To Healthy Eyes, Padmaja Sudhakar

Neurology Faculty Publications

No abstract provided.

Novel Mechanisms And Biomarkers In Alcohol-Induced Organ Injury., Christine E. Dolin

Electronic Theses and Dissertations

Background. Ethanol (EtOH) consumption is known to affect multiple organs; this is unsurprising, as the concentration of EtOH in the blood at relevant doses reaches the millimolar range. The overarching goal of this dissertation was to elucidate mechanisms of alcohol-induced organ injury, specifically the effects of alcohol on the hepatic extracellular matrix (ECM) proteome, the alcoholic hepatitis (AH) plasma peptidome, and the effects of alcohol on the renal cortex proteome and transcriptome. Methods. Mice were pair-fed ethanol-containing liquid diet chronically, and then some mice were administered lipopolysaccharide (LPS). Liver sections from these mice were processed in a series of increasingly …

An Evaluation Of The Supply And Demand Of Radiation Oncology Medical Physicists In The United States., Christine Marie Swanson

Electronic Theses and Dissertations

Background: This dissertation is a mixed methods evaluation of the radiation oncology medical physics workforce in the United States. Radiation oncology medical physicists serve a vital role in the safe treatment of patients with radiation therapy. While cancer incidence continues to rise, the pathways to board certification in radiation oncology medical physics continue to narrow causing a potential shortage of radiation oncology physicists in the United States. While there is no lack of data about the medical physics community it has scarcely been used to evaluate the current state of the workforce. In order to ensure patient safety, appropriate physics …

A Case Of An Anomalous Right Coronary Artery Arising From The Left Coronary Cusp, Muhammad Shabbir Rawala, Ahmer A. Longi, Arfeen A. Khan, Syed Inam Rizvi, Syed B. Rizvi

Section of Internal Medicine

An anomalous origin of the right coronary artery is usually asymptomatic. It is mostly found incidentally on an invasive diagnostic angiogram. It does lead to an increased risk of sudden cardiac death, especially in younger patients. We present a case of a 41-year-old who had presented to the hospital with complaints of chest pain. The patient was evaluated by cardiology who performed an angiography that identified an anomalous origin of the right coronary artery arising from the left coronary cusp but no evidence of coronary artery disease. Once identified, these anomalous vessels should be corrected surgically, as these conditions increase …

Quantifying Expression Of Interneuron Subtype Markers For Dlx-2 Transfected Ng2 Cells, Timothy Nolan

Honors Scholar Theses

Neurons are a post-mitotic cell population, and therefore, they are not able to regenerate in vivo after a traumatic injury. Because inhibitory GABAergic interneurons and oligodendrocyte precursor cells (OPCs) are derived from the same precursor, recent studies have focused on transforming these OPCs into GABAergic neurons. However, there are different types of GABAergic interneurons that have different electrophysiological responses, which can lead to functional differences. The Nishiyama laboratory had already used a key gene in GABAergic interneuron and OPC differentiation, Distal-less homeobox 2 (Dlx-2), to transfect OPCs; early electrophysiology tests showed most of these transfected cells behaved like immature neurons, …

Discontinuation Of Proton Pump Inhibitor Use Reduces The Number Of Endoscopic Procedures Required For Resolution Of Walled-Off Pancreatic Necrosis., Patrick C. Powers, Ali Siddiqui, Reem Z. Sharaiha, Grace Yang, Enad Dawod, Aleksey A. Novikov, Amy Javia, Cynthia Edirisuriya, Arish Noor, Tayebah Mumtaz, Usama Iqbal, David .E Loren, Thomas E. Kowalski, Natalie Cosgrove, Yordano Alicea, Amy Tyberg, Iman Andalib, Michel Kahaleh, Douglas G. Adler

Division of Gastroenterology and Hepatology Faculty Papers

Background and Objectives: Endoscopic drainage/debridement of symptomatic walled off necrosis (WON) using lumen-apposing metal stents (LAMS) is both safe and effective. While endoscopic management of WON is the standard approach to treatment, the ideal concomitant medical therapy remains unclear. The purpose of this study was to further elucidate the effect of proton pump inhibitor (PPIs) therapy on the technical and clinical success of endoscopic treatment of WON.

Methods: Two hundred and seventy-two patients in 8 centers with WON managed by endoscopic drainage using LAMS were evaluated. Patients were followed for at least 6 months following treatment. The patients were divided …

Downregulation Of Thromboxane A2 And Angiotensin Ii Type 1 Receptors Associated With Aging-Related Decrease In Internal Anal Sphincter Tone., Ipsita Mohanty, Jagmohan Singh, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

Aging-associated decrease in internal anal sphincter (IAS) tone (AADI) is a major contributor in the rectoanal incontinence (RI). To determine the pathogenesis of AADI, we investigated the effect of aging on GPCR activation and related downstream signaling. We particularly investigated two GPCRs that characterize IAS smooth muscle cells (SMCs): thromboxane A ₂ and angiotensin II type 1. Two groups of Fischer 344 rats (6-month-old [young group] and 26-month-old [old group]) were employed to determine the GPCR function by isometric contraction, the expressions of GPCRs, and their downstream regulatory signaling proteins (regulator of G-protein signaling 2, RGS2; GPCR Kinase 5, GRK5; …

Assessment Of Magnetic Resonance Imaging Safety: Allied Health Professional Clinical Competence, Tiffany Houser

Electronic Theses and Dissertations

Magnetic resonance imaging is a major advancement in the diagnostic imaging field. Most patients can tolerate an MRI however, there are some who are unable to complete a lengthy scan while lying completely still without sedatives or anesthesia. Non-MRI healthcare providers are trained to use equipment that is “unsafe” in the MRI suite due to the strong magnetic field. Staff who are not fully knowledgeable and trained in MRI safety measures can endanger staff and patients.

The purpose of this study was to determine the knowledge level of non-MRI healthcare providers regarding safety risks associated with MRI and to determine …

A Sensory-Based Program To Enhance Occupational Performance For Dementia, Ivy Annahi Torres-Flores, Jacob Gantan, Heather Anne August, Naomi Grace Wong

Occupational Therapy | MSOT Capstone Projects

Dementia is a neurological disease, causing behavioral and cognitive symptoms, that progressively impairs an individual’s ability to engage in meaningful activities. Progressive deterioration associated with dementia impacts occupational performance and independence and quality of life. Sensory based interventions, such as drumming groups, have been hypothesized to be a non-pharmacological intervention for individuals with dementia. The purpose of this study was to analyze the effects of a sensory based intervention program, in this case participation in a drumming group, on functional engagement during self-feeding for individuals with dementia. Researchers gathered data over the course of two days using the Functional Behavior …

Tisagenlecleucel Model-Based Cellular Kinetic Analysis Of Chimeric Antigen Receptor-T Cells., Andrew M. Stein, Stephan A. Grupp, John E. Levine, Theodore W. Laetsch, Michael A. Pulsipher, Michael W. Boyer, Keith August, Bruce L. Levine, Lori Tomassian, Sweta Shah, Mimi Leung, Pai-Hsi Huang, Rakesh Awasthi, Karen Thudium Mueller, Patricia A. Wood, Carl H. June

Manuscripts, Articles, Book Chapters and Other Papers

Tisagenlecleucel is a chimeric antigen receptor-T cell therapy that facilitates the killing of CD19+ B cells. A model was developed for the kinetics of tisagenlecleucel and the impact of therapies for treating cytokine release syndrome (tocilizumab and corticosteroids) on expansion. Data from two phase II studies in pediatric and young adult relapsed/refractory B cell acute lymphoblastic leukemia were pooled to evaluate this model and evaluate extrinsic and intrinsic factors that may impact the extent of tisagenlecleucel expansion. The doubling time, initial decline half-life, and terminal half-life for tisagenlecleucel were 0.78, 4.3, and 220 days, respectively. No impact of tocilizumab or …

Xanthogranulomatous Pyelonephritis: Synchronous Upper And Lower Gastrointestinal Bleed, Muhammad Usman Mirza, John Van Taunay, Muhammad Waleed, Shiva Shankar Vangimalla, Sharana Hegde, Muhamad Alhaj Moustafa

Medical College Documents

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic granulomatous destructive process of the renal parenchyma. It is caused by a chronic inflammatory process due to recurrent urinary tract infections and/or obstructing renal calculi. Rarely, it presents with advanced complications including abscesses and fistula formations. In this article, we report a unique presentation of XGP with simultaneous upper and lower gastrointestinal bleeding in the setting of XGP with reno-gastric and reno-colic fistulas.

An Integrative Review: Maternal Engagement In The Neonatal Intensive Care Unit And Health Outcomes For U.S.-Born Preterm Infants And Their Parents, Susanne Klawetter, Jennifer C. Greenfield, Stephanie Rachel Speer, Kyria Brown, Sunah S. Hwang

School of Social Work Faculty Publications and Presentations

Hospitals and perinatal organizations recognize the importance of family engagement in the neonatal intensive care unit (NICU). The Agency for Healthcare Research and Quality (AHRQ) defines family engagement as “A set of behaviors by patients, family members, and health professionals and a set of organizational policies and procedures that foster both the inclusion of patients and family members as active members of the health care team and collaborative partnerships with providers and provider organizations.” In-unit barriers and facilitators to enhance family engagement are well studied; however, less is known specifically about maternal engagement’s influence in the NICU on the health …

Decreasing Unplanned Extubations By Taping Technique & Creating A Culture Of Safety, Karishma Rao, Beckie Palmer, Christopher R. Nitkin, Christian Anthony Schneider, Brandy Huitt, Molly Terhune, Ashley Orwick, Dianne Wilderson, Sarah Carboneau, Jenny Mckee, Kerrie A. Meinert, Eugenia K. Pallotto

Presentations

Describes strategies used to decrease the unplanned extubation rate in the Level IV neonatal intensive care unit to less than 1.0 event per 100 ventilator days by December 2018.

Molecular Mechanisms Of Metabolic Reprogramming In Pancreatic Cancer, Sonam Kumari

Theses and Dissertations (ETD)

Pancreatic cancer ranks as third deadliest cancer worldwide in both men and women. The lack of diagnostic methods, chemo-resistance and invasiveness of the disease diminishes the overall survival rate in patients. Dysregulated glucose metabolism and several molecular determinants including oncogenic signaling pathways play pivotal roles in the development, progression and metastasis of pancreatic cancer. The aberrant glucose metabolism is the most prevalent key factor that influences pancreatic tumorigenesis. The cancer cells of pancreas utilize oxygen for the breakdown of glucose to lactate, which is known as Warburg effect. This phenotype of pancreatic cancer encourages proliferation, growth, migration and invasive phenotypes …

Study Of Natural Killer Cells And Their Therapeutic Role In Pediatric Cancer, Hong Ha Rosa Nguyen

Theses and Dissertations (ETD)

NK cells are known to play an important role in the natural defense against viral infections and tumor immune surveillance. Through complex interactions between NK cell receptors and target cell ligands, transformed or unhealthy cells are identified and rapidly eliminated. NK cells have been used for therapeutic purposes in pediatric oncology, for example by harnessing the mechanisms of NK cell surveillance in acute myeloid leukemia (AML) or intervention-augmented antibody-dependent cell-mediated cytotoxicity (ADCC) in neuroblastoma. However, the underlying cellular mechanisms in these processes are not fully understood. In my thesis research, I sought to gain a deeper understanding of the molecular …

Neuroblastoma In Adolescents And Children Older Than 10 Years: Unusual Clinicopathologic And Biologic Features, Laura Mccarthy, Katherine Chastain, Terrie Flatt, Eugenio Taboada, Robert E. Garola, John Herriges, Linda D. Cooley, Atif Ahmed

Posters

This poster describes four cases of neuroblastoma diagnosed since 2008 in children greater than 10 years and presents their clinical, histologic and biologic features, emphasizing unusual clinicopathologic characteristics and the role of DNA microarray analysis and Next Generation Sequencing in their management.

Predictive Performance Of Existing Population Pharmacokinetic Models Of Tacrolimus In Pediatric Kidney Transplant Recipients, Alenka Chapron, Susan M. Abdel-Rahman

Posters

With the goal of developing a clinician-driven tacrolimus (TAC) pharmacokinetic dosing tool, our initial objectives were 1) to examine whether published TAC population pharmacokinetic (popPK) models could serve as a foundation for the dosing tool, and 2) evaluate their performance predicting TAC concentrations in an independent cohort of Children's Mercy patients.