Medical Specialties Commons^™

Using Patient Experience In Optimizing The Total Knee Arthroplasty Patient Journey, Nienke Wolterbeek, Dieuwertje J. Hiemstra, Fiona A. Van Der Hoeven, Kiem G. Auw Yang

Patient Experience Journal

Information was used to improve the patient journey and to achieve patient-centered care. Patients (>18 years, purposive sampling) were interviewed once at one point of their total knee arthrosis journey within the hospital setting. Patients were accompanied and observed during their hospital visit by one of the 19 healthcare professionals which were trained as interviewers. A qualitative research approach with in-depth and semi-structured interviews using a standardized interview guide were used to gather an in-depth understanding of the perceptions of patients. Interviews were written out with the emphasis on positive and negative feedback, quotes and observations that were made. …

Refugees' Perceptions Of Primary Care: What Makes A Good Doctor's Visit?, Anne Mutitu, Bev Zabler, Jeana M. Holt

Patient Experience Journal

Redesigning primary care is a national priority, as the United States (US) struggles with issues of poor access, high cost, and suboptimal quality. Refugees are among the populations who suffer from America’s disjointed health care system, resulting in disproportionate health disparities. Although there are many studies on refugee health, few share refugees' perceptions of primary care. We asked local refugees who were seen for primary care services at a midwestern academic nurse-led clinic, what makes a good doctor's visit?  The clinic served as the hub of a federally funded refugee Community Centered Health Home (CCHH) pilot project. This qualitative study …

Is It Fair To Compare? A Patient And Family Experience Of Two Healthcare Systems And Neurosurgical Teams Within A Two-Week Period, Laura Miller Cpxp

Patient Experience Journal

As the mother of a 28-year-old son with cerebral palsy and hydrocephalus, and as a healthcare consultant focused on patient experience and professional development, I have a unique perspective and skill set. Recently he experienced symptoms that included an excruciating headache, neck pain and lethargy. Fearing his ventriculoperitoneal shunt had malfunctioned, he went to the emergency room and was later admitted on the neuro inpatient floor for a three-day hospitalization. His original shunt had been placed in 1991, and he never had an issue with until August 2018. While in the hospital, he was informed that he was no longer …

Awakening From A Medical Mystery: One Patient’S Experience Of Being Undiagnosed, Dwane Unruh

Patient Experience Journal

This personal narrative pleads for a supportive and comprehensive system or sub-system similar to that which exists for cancer patients, to deal with undiagnosed illnesses. By describing the torment of living with a debilitating illness that medicine could not easily recognize, then by contrasting this experience with my wife’s experience of the cancer care system, and by referring along the way to lessons learned many years ago from reading the works of the inciteful neurologist, Dr. Oliver Sacks, I hope to inspire the medical system to develop a separate, supportive and comprehensive system to deal with the undiagnosed. As it …

Floor Of Mouth Thyroglossal Duct Cyst: A Rare Embryologic Course., John Kerr, Weston L Niermeyer, Peter B Baker, Tendy Chiang

Surgery Articles

A thyroglossal duct cyst (TGDC) is a common pediatric midline neck mass. Most TGDCs occur in the region of the hyoid bone but have been found less commonly in areas from the oral cavity to the sternum. We present the first reported case of a multifocal floor of mouth (FOM)/cervical TGDC representing an atypical embryonic course. We also review atypical presentations of TGDC and provide a summary of cases involving FOM and multifocal cysts.

Induction Techniques That Reduce Redistribution Hypothermia: A Prospective, Randomized, Controlled, Single Blind Effectiveness Study., Jonathan V. Roth, Leonard E. Braitman, Lacy H. Hunt

Student Papers, Posters & Projects

BACKGROUND: While much effort has been devoted to correcting intraoperative hypothermia, less attention has been directed to preventing redistribution hypothermia. In this study, we compared three different anesthetic induction techniques to standard IV propofol inductions (control) in their effect on reducing redistribution hypothermia.

METHODS: Elective, afebrile patients, age 18 to 55 years, were randomly assigned to one of four groups (n = 50 each). Group "INH/100" was induced with 8% sevoflurane in 100% oxygen, Group "INH/50" with 8% sevoflurane in 50% oxygen and 50% nitrous oxide, Group "PROP" with 2.2 mg/kg propofol, and Group "Phnl/PROP" with 2.2 mg/kg propofol immediately …

Pain, Functional Disability, And Their Association In Juvenile Fibromyalgia Compared To Other Pediatric Rheumatic Diseases., Mark Connelly, Jennifer E Weiss, Carra Registry Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Severe pain and impairments in functioning are commonly reported for youth with juvenile fibromyalgia. The prevalence and impact of pain in other diseases commonly managed in pediatric rheumatology comparatively have been rarely systematically studied. The objective of the current study was to determine the extent to which high levels of pain and functional limitations, and the strength of their association, are unique to youth with juvenile primary fibromyalgia syndrome/JPFS) relative to other pediatric rheumatic diseases.

METHODS: Using data from 7753 patients enrolled in the multinational Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry, we compared the levels and …

Multimodal Treatment And Neoadjuvant Chemotherapy Trends, Utilization And Survival Effects In Intrahepatic Cholangiocarcinoma – A Propensity Score Analysis, Ovie Utuama

USF Tampa Graduate Theses and Dissertations

Intrahepatic Cholangiocarcinomas (ICC) are fatal malignancies common among the elderly. Patients are diagnosed late and often relapse, even after curative-intent surgery (CIS). In this context, additional systemic chemotherapy (multimodal treatment) is recommended for most patients but reported survival benefits are minimal and are limited to small single institutional studies. For this reason, using a national cancer registry, we sought to characterize multimodal treatment trends and utilization in general and neoadjuvant chemotherapy, specifically, as well as evaluate their survival effects among the larger population. We hypothesized that, 1). Elderly ICC patients would have survival benefits equivalent to younger patients, 2). Neoadjuvant …

Increasing Rates Of Larc Uptake And Continuation Through Contraceptive Counseling: An Effective Approach For Women With Underutilization, Malia Johnson

DNP Qualifying Manuscripts

Unintended pregnancies in women with a substance use disorder are estimated to be nearly double that of the general population, of which negative health consequences are increased for both mother and neonate. Unintended pregnancies are preventable through the use of highly effective contraception that is less susceptible to the effects of typical versus perfect use. Long-acting reversible contraception (LARC) is ideal for this patient population. Therefore, a thorough literature review was performed to evaluate the role of contraceptive counseling on LARC uptake and continuation among women. The results indicated that contraceptive counseling does influence LARC uptake and continuation and it …

Failure To Rescue As An Outcome Metric For Pediatric And Congenital Cardiac Catheterization Laboratory Programs: Analysis Of Data From The Impact Registry., Michael L. O'Byrne, Kevin F. Kennedy, Natalie Jayaram, Lisa J. Bergersen, Matthew J. Gillespie, Yoav Dori, Jeffrey H. Silber, Steven M. Kawut, Jonathan J. Rome, Andrew C. Glatz

Manuscripts, Articles, Book Chapters and Other Papers

Background Risk-adjusted adverse event (AE) rates have been used to measure the quality of pediatric and congenital cardiac catheterization laboratories. In other settings, failure to rescue (FTR) has demonstrated utility as a quality metric. Methods and Results A multicenter retrospective cohort study was performed using data from the IMPACT (Improving Adult and Congenital Treatment) Registry between January 2010 and December 2016. A modified FTR metric was developed for pediatric and congenital cardiac catheterization laboratories and then compared with pooled AEs. The associations between patient- and hospital-level factors and outcomes were evaluated using hierarchical logistic regression models. Hospital risk standardized ratios …

Hx Of, Bonni Boles

Akesis

My purpose in creating this comic strip was to tell a story that depicts some of the struggles I have had with the health care system and how a patient's history can go overlooked. I suffered from chronic insomnia for over 10 years before a licensed professional counselor, someone tasked with actually listening to me, helped me to get on medication to help with sleep. My mental health, and general health, problems became much less severe and more manageable after finally sleeping regularly.

Sleep hygiene has been found to not have much success with chronic insomnia. I didn't need someone …

Skull And Cervical Spine Study, Paul J. Mangiafico

Akesis

Anatomical drawings are a really fun way to understand and appreciate the structure and the complexity of the human body. The material used to create this drawing was a #2 mechanical pencil.

Twin, Amy L. Courtney

Akesis

Reflective essay about being an identical twin who no longer looks identical.

Remedy, Michael Cyr

Akesis

In keeping with this issues’ theme this piece is meant to highlight the subtle places terminal illness hides biologically, socially and spiritually and how and where it is expressed, sometimes despite the best efforts of the patient or caregivers. This piece also makes effort to convey the importance of humanity in medicine and highlight loving connection as an important part of the arsenal we use against sickness.

Hexis Habitus, Jessica Rehrig

Akesis

This photograph is one that was taken years ago after gymnastics practice. It was mindlessly taken: poor quality, out of frame, buried amongst memories saved in a rarely viewed album. At the time, it captured nothing more than a habitus, a commonplace that seemed unnecessary to freeze in time.

Years have passed since training, and our hands no longer serve as an outward reflection of diligence and dedication. Today those calluses exist in the internal habitus of our character, and in one mindlessly taken, poor quality, out of frame photograph.

Clay And Stone, Jess W. Rempel

Akesis

Clay handprints on a canyon wall in southern Utah, found after the people who made them had gone. The Navajo sandstone of the canyon wall dates to the Jurassic period, with a record of eons revealed by the water that carved the canyon away. People love to leave their mark on places that make marks on them: some of the earliest recorded graffiti in Pompeii simply read "Gaius was here." I enjoyed stumbling upon the hand prints which allowed me into the hikers' experience, and their joy could add to the lasting impression that place made upon me. Our experiences …

Corporeal Quintessence, Jordan Lamb, Michael Cyr

Akesis

In keeping with the theme of “Historia Habitus” this collection is meant to illustrate how the physical form is a living history, with every movement written into the striations of the human musculature. The old adage “you are what you eat” is easily extended to “you are what you do”. Contemplate the hours and repetitions that have gone into sculpting the highlighted regions of our model/athletes. We hope this collection stimulates reflection on what the body can tell you about your past and what your, or perhaps your patient’s, lifestyle can predict about the future.

The Journey Of Life, Rolene Yousefyan

Akesis

The materials used to create this piece were oil pastels. The inspiration behind this piece was the importance of mental health awareness along with our ability to grow and become who we are today based on our past experiences and history.

Our Histories, Our Horizons: A Letter To Our Readers

Akesis

Volume 5, Issue 1 marks a new chapter in the history of our narrative medicine journal as we realize an important goal of Akesis—establishing a foothold on the Portland campus of UNE. Our hope is that Akesis becomes a familiar name among students, faculty, and staff, and that our call for submissions and issue publications are events everyone anticipates and enjoys. This issue also welcomes six new editors to Akesis, students representing a diverse sampling of UNE’s graduate and professional programs from both campuses. The success of this issue’s call for submissions is due to the efforts of …

Validation Of A 5-Item Tool To Measure Patient Assessment Of Clinician Compassion In The Emergency Department., Praveen Sabapathi, Michael B. Roberts, Brian M Fuller, Michael A Puskarich, Christopher W Jones, J Hope Kilgannon, Valerie Braz, Christina Creel-Bulos, Nathaniel Scott, Kristina L Tester, Anthony Mazzarelli, Stephen Trzeciak, Brian W Roberts

PCOM Scholarly Works

BACKGROUND: To test if the 5-item compassion measure (a tool previously validated in the outpatient setting to measure patient assessment of clinician compassion) is a valid and reliable tool to quantify a distinct construct (i.e. clinical compassion) among patients evaluated in the emergency department (ED).

METHODS: Cross-sectional study conducted in three academic emergency departments in the U.S. between November 2018 and April 2019. We enrolled adult patients who were evaluated in the EDs of the participating institutions and administered the 5-item compassion measure after completion of care in the ED. Validity testing was performed using confirmatory factor analysis. Cronbach's alpha …

Progression-Free But No Overall Survival Benefit For Adult Patients With Bevacizumab Therapy For The Treatment Of Newly Diagnosed Glioblastoma: A Systematic Review And Meta-Analysis., Nagham Kaka, Karim Hafazalla, Haider Samawi, Andrew Simpkin, James Perry, Arjun Sahgal, Sunit Das

Department of Neurosurgery Faculty Papers

Glioblastoma (GBM) is the most common high-grade primary brain tumor in adults. Standard multi-modality treatment of glioblastoma with surgery, temozolomide chemotherapy, and radiation results in transient tumor control but inevitably gives way to disease progression. The need for additional therapeutic avenues for patients with GBM led to interest in anti-angiogenic therapies, and in particular, bevacizumab. We sought to determine the efficacy of bevacizumab as a treatment for newly diagnosed GBM. We conducted a literature search using the PubMed database and Google Scholar to identify randomized controlled trials (RCTs) since 2014 investigating the safety and efficacy of bevacizumab in the treatment …

Frequency Of Early Morbidities In Low Birth Weight Neonates At The Aga Khan University Hospital, Karachi, Saroop Chand, Fayaz Ahmed Memon, Muhammad Hussain Shah, Abdul Lateef Leghari, Parveen Uzma, Rohan Advani, Muhammad Sohail Salat, Shabina Ariff

Department of Paediatrics and Child Health

Background:
Globally, approximately 14.6% children are born with low birth weight (LBW) annually. In Pakistan, this figure however reaches approximately 16%. Low birth weight infants are vulnerable to develop early morbidities like hypothermia, hypoglycemia, respiratory distress syndrome and hypocalcemia. There is a scarcity of statistics which creates a gap in development of strategies for improving quality of care in developing countries. The aim of our study was to determine the frequency of early morbidities such as respiratory distress syndrome (RDS), hypoglycemia, hypothermia and hypocalcemia in low birth weight neonates.
Methodology:
prospective descriptive study was conducted via non-probability sampling technique from …

A “Sweet” Look Into A Rare Disease: Presentation And Management Of Acute Febrile Neutrophilic Dermatosis, Christian L. Menezes Do, Joseph Moran Do, Kaitlyn Musco Md, Andres Zirlinger Md

Department of Medicine

No abstract provided.

Scleroderma Renal Crisis: Identifying Risk Factors And Preventing Adverse Outcomes, Yesha K. Shah Do, Joseph V. Moran Do, Timothy B. Coyle Md

Department of Medicine

No abstract provided.

High Dose Biotin And Its Effects On Thyroid Function Testing, Emily C. Skutnik Do, Rebecca A. Lopes A, Sandhya Venkataraman Do, Angela Magdaleno Do, Leslie A. Colip Md

Department of Medicine

No abstract provided.

Pediatric Moyamoya Presenting As A Subarachnoid Hemorrhage From A Ruptured Anterior Cerebral Artery Aneurysm., Mohammad Hassan A. Noureldine, Ibrahim Saikali, Anis Nassif, Rita Chahinian, Ahmad Sweid, Raghid Kikano, Michel Mawad

Department of Neurosurgery Faculty Papers

BACKGROUND: The incidence of Moyamoya disease (MMD)-associated intracranial aneurysms ranges from 3% to 14% in adult patients, whereas this complication has rarely been reported in children.

CASE DESCRIPTION: We herein report the first case, to our knowledge, of an extremely rare subarachnoid hemorrhage presentation of a child with a ruptured anterior cerebral artery dissecting aneurysm secondary to a newly discovered, unilateral Moyamoya-like pathology.

CONCLUSIONS: MMD-associated aneurysms are extremely rare in children, and hemorrhage may be the initial presentation of the disease. Prompt intervention is essential to exclude the ruptured aneurysm that is at risk of rebleeding because of persistent hemodynamic …

Secretion Of A Heparin-Like Anticoagulant (Hlac) In Plasma Cell Neoplasia, Kevin J. Hess Do, Joseph Moran Do, Rachel Kinney Do

Department of Medicine

No abstract provided.

Dry Eyes, Dry Mouth, And Amyloidosis – A Case Report, Andrea M. Soliman Do, Grace Guerrier Md, Carolyn Casey Do, Shereen M F Gheith Md, Phd

Department of Medicine

No abstract provided.

Stress Can Make Patients Crabby, Reema M. Vaze Md, Gregory R. Varghese Do, Mohammad Saqib Md

Department of Medicine

No abstract provided.

Bullous Rash Leading To A Diagnosis Of Iga Vasculitis With Renal Involvement Responsive To Therapy, Kaitlyn L. Buzard Do, Attiya Harit Ms, Adam Turner Bs, Thomas W. Doherty Md

Department of Medicine

No abstract provided.