Medical Specialties Commons^™

Refusal Of Care In The Emergency Department: Self-Reported Reasons For Leaving Without Completing Treatment, Brenden Drerup

Scholarship in Medicine - All Papers

Objective: Emergency department (ED) patients may choose to leave prior to physician evaluation, elope during treatment, or leave against medical advice during treatment. This study was performed to identify the reasons why patients left the ED before completing treatment. Methods: This prospective study was conducted at Miami Valley Hospital, an urban level 1 trauma center. This study identified ED patients who left before completing treatment, including those who left without being seen (LWBS), eloped during treatment, or left against medical advice (AMA), from September to December of 2018. This project included a chart review and a prospective patient telephone survey. …

Commentary On: Cosmeceuticals: The Principles And Practice Of Skin Rejuvenation Of Nonprescription Topical Therapy, Clifford P. Clark, Ashley Goldston

Surgery Faculty Publications

No abstract provided.

Free Abdominal Tissue Transfer And Utilization Of The Umbilical Stalk For “Tubular” Reconstruction In Ear, Nose, And Throat Defects, Jake Laun, Julian Pribaz

Surgery Faculty Publications

Large head and neck burns and cancer-related defects pose many challenges to the reconstructive surgeon with the ultimate goals being aesthetic, as well as functional restoration, or as the renowned Italian plastic surgeon Gaspare Tagliacozzi espoused to “restore, rebuild, and make whole those parts which nature hath given but which fortune has taken away.” The face, in particular, has inherent structures that are vital to interpersonal relationships, as well as everyday function. Large head and neck burns or cancer defects may require a tracheostomy and stoma creation or reconstruction of the external auditory meatus both posing a significant reconstructive challenge. …

A Qualitative Study On Adequate Sleep In Preschool Children – Can We Sleep On It?, Seema Zainulabdin Lasi, Noreen Afzal, Somal Kayani

Human Development Programme

Sleep is a significant marker of physical and psychological health. The present research was undertaken to explore perceptions of parents, teachers and pediatricians about preschool children’s sleep patterns, habits, and problems from urban Karachi, Pakistan. A qualitative research approach was employed; data collection methods were Focus Group Discussion (FGDs) and Key Informant Interviews (KIIs). The themes identified were children’s sleep patterns, sleep environment, sleep rituals, distractions, sleep problems, the impact of inadequate sleep, and recommendations to improve. Emergent themes were inconsistency of rules from parents, lack of opportunities for outdoor physical activity, different kinds of stresses, social and cultural events …

Do Racial Stereotypes Contribute To Medical Misdiagnosis Of Child Abuse? Investigating Tunnel Vision In The Emergency Room, Cynthia J. Najdowski, Kimberly M. Bernstein, Katherine S. Wahrer

Psychology Faculty Scholarship

Despite growing recognition that misdiagnoses of child abuse can lead to wrongful convictions, little empirical work has examined how the medical community may contribute to these errors. Previous research has documented the existence and content of stereotypes that associate race with child abuse. The current study examines whether emergency medical professionals rely on this stereotype to fill in gaps in ambiguous cases involving Black children, thereby increasing the potential for misdiagnoses of child abuse. Specifically, we tested whether the race-abuse stereotype led participants to attend to more abuse-related details than infection-related details when an infant patient was Black versus White. …

Incidence Of Female Breast Cancer In The United States By Race And Region, Tiffany Le

Scholarship in Medicine - All Papers

Objective: Assess the distribution and incidence of female breast cancer in the United States in different races and regions of the United States. Methods: Collect and analyze CDC WONDER data from the Center for Disease and Control to see if there are varying rates of female breast cancer incidence between races and in different regions of the United States. Results: The results are expected to show a significant difference in female breast cancer incidence between races and a non-significant difference in female breast cancer incidence among different regions of the United States.

Long-Term Survival Of Bladder Cancer Metastatic To Femoral Neck Treated With Chemotherapy, Radiation, And Arthroplasty: A Case Report, John Defant, Scott Huff, Joseph D. Henningsen, Anil Krishnamurthy

Scholarship in Medicine - All Papers

Case: A 64-year-old male suffered a pathologic left femoral neck fracture. Biopsy demonstrated metastatic urothelial cancer with a non-muscle invasive bladder cancer primary confirmed by cystoscopy. Patient underwent hemiarthroplasty, chemotherapy, radiation, and eventually, a conversion to total hip arthroplasty. Today, over a decade from initial surgery, the patient remains alive and highly functional. To our knowledge, this is the only report of bone metastatic bladder cancer with over 10-year survival. Conclusion: Bladder cancer metastatic to bone has a 5-year survival rate of 3%. Surgical resection of metastasis with reconstruction may confer a survival benefit in bony oligometastatic bladder cancer.

Clinical And Neurophysiological Effects Of Dry Needling On Individuals With Chronic Ankle Instability, Jennifer Mullins

Theses and Dissertations--Rehabilitation Sciences

Ankle sprains are generally considered innocuous injuries; however, as many as 74% of patients will develop chronic symptoms. 1-3 Chronic ankle instability (CAI) is defined by a history of ankle sprain accompanied by ongoing bouts of giving way, residual ankle sprain symptoms, and a decrease in patient-perceived function. As understanding of sensorimotor deficits in individuals with CAI have advanced, treatment strategies have evolved to include a robust focus on balance training to mitigate dynamic and static postural control impairments exhibited in individuals with CAI. A problem arises as these improvements have not been conclusively linked to a decrease in CAI. …

Biopsychological Predictors Of Pain And Function In Patients With Rotator Cuff Conditions, Nicole Cascia

Theses and Dissertations--Rehabilitation Sciences

Predicting worse patient-reported outcomes in those with Rotator Cuff (RC) conditions is dependent on examining both biological and psychological impairments. In order to help determine which biopsychological factors are associated with pain and function in patients with RC related conditions and to determine who may be at an increased risk for worse outcomes after Reverse Shoulder Arthroplasty (RSA), biopsychological associations between patient demographics, scapular motion, humeral motion, RC tear size, pain associated psychological distress, and function were clinically evaluated to investigate prediction models for pain and function. The central hypothesis is that in a group of patients with symptomatic Cuff …

Anterior Cruciate Ligament Injury-Induced Alterations In Inflammation And Muscle Physiology, Emily R. Hunt

Theses and Dissertations--Rehabilitation Sciences

Long term weakness and atrophy of the quadriceps muscle are a direct result of anterior cruciate ligament (ACL) injuries and persist for up to 10 years post injury. Muscle atrophy ensues regardless of ligamentous reconstruction surgery, indicating that muscle atrophy following injury is a function of the ligament rupture and not reconstruction surgery. Elucidating the mechanisms underlying quadriceps atrophy following ACL rupture is crucial for developing interventions to restore proper quadriceps size and mitigate weakness thereby allowing for improved patient function. In addition to understanding the specific mechanisms that contribute to quadriceps atrophy following ACL rupture, the timing of atrophic …

Assessing Accuracy Of Attending Provider On The Pennsylvania Birth Certificate, Emily C. Mcgahey

Doctor of Midwifery Advances in Midwifery Projects

Introduction: Birth certificate data is a cornerstone of public health reporting, yet numerous studies document that much of the data collected is unreliable. Limited evidence suggests that the attendant at birth item may not be accurately captured on the current birth certificate, therefore not representative of the care provided by midwives in the United States. The primary purpose of this study was to determine whether midwives are accurately represented as attendant at birth on the Pennsylvania birth certificate. A secondary purpose was to assess midwives’ motivation to improve data collections if significant discrepancies were found.

Methods: A cross-sectional survey was …

1. President's Office Records, 1941-1998, The University Of Texas Md Anderson Cancer Center

Director's Office Records: Ernst Bertner and R. Lee Clark Archives

The President's Office Records include materials generated and received by the President of the institution, and his staff, during his time in office. The early records also include the materials generated and received by the Director of the institution, and his staff, prior to the time the position of President existed. Additionally, there are records from the President Emeritus office included in the record group.

Burnout Among Medical Residents; Their Impressions Of Its Impact On Patient Care And Coping Mechanisms, Elizabeth Ochola

Master of Medicine in Obstetrics and Gynecology

Introduction: Burnout is a syndrome that occurs as a result of chronic workplace stress that has not been successfully managed. This global definition is given by the International Classification of Diseases; 11th edition. The ICD-11 further characterizes burnout using three dimensions: Emotional exhaustion described as feelings of energy depletion or exhaustion; depersonalization described as; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and low personal accomplishments seen as reduced professional efficacy. Burnout refers specifically to phenomena in the occupational context and is not applied to describe experiences in other areas of life. …

Rural Disparities In Lung Cancer Mortality: An Ecologic Study In Florida, Batel Amouyal

Honors Undergraduate Theses

Lung cancer is the leading cause of cancer death in the United States and worldwide. The higher mortality among patients with lung cancer is related to cases being diagnosed in late stage where treatment is limited. Urban and rural health outcomes are potentially influenced by differences in accessibility to health care services. We are unaware of existing research examining geographic differences in or factors related to lung cancer mortality in Florida. Therefore, this study aims to examine lung cancer mortality differences between urban and rural counties in Florida. We examined all 67 counties in Florida to investigate if a rural …

The Effect Of Interventions On Radiotherapy-Induced Skin Toxicity: A Systematic Review, Claudia R. Figueroa

Honors Undergraduate Theses

Various studies show a variety of interventions for radiotherapy-induced skin toxicity. Radiotherapy-induced skin toxicity is the most common side effect for women with breast cancer who undergo radiotherapy sessions. Intervention agents include topical creams, barrier films, oral agents, as well as laser therapy. However, despite the variety of intervention agents available, there is still a lack of accepted guidelines to manage radiotherapy-induced skin toxicity. This thesis aims to conduct a systematic review and meta-analysis of published randomized controlled trials with the primary purpose of exploring the available intervention methods to prevent radiotherapy-induced skin toxicity and evaluate the effects of different …

A Policy Analysis Of The 2017 Fasting Guidelines Among Gi Surgical Patients, Toney Banks

Doctor of Nursing Practice Projects

The objective of the fasting guidelines is to improve the quality and efficacy of anesthesia care. It is based on two main researched principles: The ingested material must be clear without particulates, and it must not be within two hours of the procedure. The purpose of this project is to equip the medical community with the latest guidelines on NPO (fasting), ensuring that patients are seen on time without delays or cancellations of surgery and with improved patient comfort. A retrospective chart review of 500 randomly chosen charts from patients seen at an Endoscopy Center. Pearson’s Chi-square value and the …

Evaluating An Incentive Program To Improve Teamwork And Productivity In The Operating Room, Christopher Bejil

Walden Dissertations and Doctoral Studies

The operating room (OR) is a complex system that must run efficiently to remain profitable and of value to its multiple stakeholders who include the patient, surgeon, OR staff member, and hospital administration. The OR at the practice site struggled with teamwork and efficiency in the areas of first-case on-time starts, turnover time, and last-case out times, resulting in a less than favorable impact on the organizational bottom line. The practice-focused question asked if a performance-based incentive bonus program can improve OR efficiency in the department’s three major problem areas. Using Gittell’s relational coordination theory as a framework, the practice …

Leading Well: Anesthesiology Program Directors As Servant Leaders And Their Development Of Resident Wellness Programs, Amy Noel Dilorenzo

Theses and Dissertations--Education Sciences

Anesthesiology residents are at significant risk of developing serious issues during training including burnout, depression, and substance abuse. Recent accreditation requirements mandate that these well-being issues be addressed by residency training programs. Program directors, as the leaders of residency programs, are charged with protecting the wellness of residents and leading wellness initiatives. The program director role can be well-described in a servant leadership construct because they are charged with caring for the individual needs of their residents.

This dissertation is a report of a mixed-methods study that explores anesthesiology program directors’ self-perceptions as servant leaders and their efforts to lead …

Elucidating The Complex Signaling Events Driving Intestinal Stem Cell Plasticity Following Injury, Evan Lynch

Theses and Dissertations--Microbiology, Immunology, and Molecular Genetics

Signaling events governing intestinal stem cell (ISC) homeostasis maintain the delicate balance of active self-renewal and passive differentiation to replenish intestinal epithelial cells (IEC) every 3-5 days. However, under certain contexts, ISC function is irreversibly compromised—requiring committed IEC lineages to dedifferentiate and regain “stemness”. In the current studies, we examine the signaling events driving epithelial cell responses to injury to expose pathologic failures in the healing response. Our specific goal is to tease out the cellular contexts that promote dedifferentiation to design effective therapeutics for disease conditions compromising ISC function.

First, we generated a novel transgenic animal using the epithelial-specific …

Residential Radon Exposure, Its Contribution To Lung Cancer, And Social Determinants Of Radon Testing, Stacy Stanifer

Theses and Dissertations--Nursing

Lung cancer is a highly preventable form of cancer. Cigarette smoking is the leading cause of lung cancer followed by radon gas exposure and exposure to secondhand smoke. Kentucky leads the nation in both incidence and mortality from lung cancer. Tobacco use in Kentucky continues to be a major public health concern as nearly one-quarter of adults report current tobacco use and just over one-third of Kentucky homes with children lack rules which prohibit smoking in the home. Radon, a colorless, odorless radioactive gas, occurs naturally from the decay of uranium found in rocks and soil and is harmful when …

Antiresorptive Bone Therapy Use In Advanced Lung Cancer And Associated Outcomes, Noor Naffakh

Theses and Dissertations--Pharmacy

Background/Rationale: Studies have shown antiresorptive agents decrease skeletal related events in metastatic non-small cell lung cancer. However, two prevalence studies have found low utilization rates of antiresorptive therapy in advanced lung cancer. The first study reported a rate of 14.8% during the 1995-2009 time period, while the second study reported a 33% usage rate during the time frame of 2002-2011. We believe these low utilization rates are associated with the poor prognosis of these patients. The prognosis of advanced lung cancer has improved significantly since these trials were conducted, and the utilization of denosumab has not been evaluated. We hypothesize …

Extensively Drug-Resistant Pseudomonas Aeruginosa In Vitro Susceptibility And Mechanisms Of Resistance, Chanah Gallagher

Theses and Dissertations--Pharmacy

Pseudomonas aeruginosa causes severe healthcare-associated infections. Forty-eight extensively drug-resistant (XDR)-P. aeruginosa isolates were selected from 287 isolates collected for evaluation based on clinical susceptibility data. In vitro activity of commonly utilized antimicrobials (i.e. antipseudomonal beta-lactams, aminoglycosides, fluoroquinolones, and polymyxins) plus ceftolozane-tazobactam, ceftazidime-avibactam, and aztreonam-avibactam against XDR-P. aeruginosa were determined. The mechanism of resistance profile was determined through phenotypic expression analysis. Overall, polymyxin B and colistin were 100% susceptible. Apart from the polymyxins, ceftolozane-tazobactam had the highest susceptibility (94%) followed by ceftazidime-avibactam (90%) and amikacin (83%). Ceftolozane-tazobactam activity was not significantly different from ceftazidime-avibactam (p=0.6831). Only 40% of isolates …

Breast Implant-Associated Anaplastic Large Cell Lymphoma: Molecular Features, Epidemiological Risk Factors, And Evidence-Based Clinical Recommendations, Ryan Decoster

Theses and Dissertations--Clinical and Translational Science

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging cancer of the immune system that can form around textured-surface breast implants. In this dissertation, the cellular and molecular mechanisms of BIA-ALCL are reviewed with a focus on the role of oncogenic JAK-STAT3 signaling in BIA-ALCL tumorigenesis and progression. Herein, the epidemiology of BIA-ALCL is systematically studied to better define the risk of BIA-ALCL and to determine the oncologic safety of smooth surface devices relative to BIA-ALCL formation. Next, a systematic review is conducted which critically appraises current clinical guidelines in order to establish an evidence base to better inform …

The Effect Of Haptoglobin Phenotypes On Markers Of Neuroinflammation In Patients With Aneurysmal Subarachnoid Hemorrhage, Kevin Hatton

Theses and Dissertations--Clinical and Translational Science

Aneurysmal subarachnoid hemorrhage (aSAH) is a severe form of hemorrhagic stroke resulting from the spontaneous rupture of an intracranial aneurysm and release of oxygenated blood into the subarachnoid space. In the United States alone, aSAH occurs in approximately 30,000 patients each year and occurs, primarily, in otherwise healthy adults, frequently without warning. Sadly, approximately 40% of patients with aSAH will die in the first 30 days. Of those who survive, only about 75% will be able to live semi-independently again and only about 60% will be able to return to work.

Delayed brain injuries (DBI), which may affect up to …

Impact Of Nicu Design On Feeding-Related Outcomes In Preterm Infants, Emma Kate Calvert

Theses and Dissertations--Communication Sciences and Disorders

Many NICUs around the country are moving away from traditional open-bay designs in favor of single-family rooms (SFRs) as more is understood about the impact of the sensory environment on neurodevelopment in preterm infants. SFRs house one infant and their family for the length of the infant’s stay and are associated with improvements in numerous outcomes, including increased milk intake and weight gain and earlier transition to enteral feeding. Oral feeding remains a critical requirement for NICU discharge; however, the impact of NICU design on feeding outcomes remains unknown.

The purpose of this study was to compare feeding outcomes between …

Donor Age Effects On The Proliferative And Chondrogenic/Osteogenic Differentiation Performance Of Equine Bone Marrow- And Adipose Tissue Derived Mesenchymal Stem Cells In Culture, Jasmin Bagge

Theses and Dissertations--Veterinary Science

Orthopedic injuries are a major cause of lameness and morbidity in horses. Bone marrow (BM)- and adipose tissue (AT) derived mesenchymal stem cells (MSCs) have shown potential to facilitate the repair of orthopedic injuries and are being used increasingly in veterinary clinics. Presently, the use of MSCs as a therapy for equine patients is most commonly applied as autologous transplants, using BM- and AT-MSCs harvested from the patient shortly after the time of injury. Cell-based therapies are therefore delayed to enable primary cell numbers to be expanded in culture. Of concern, however, are human and rodent studies that have shown …

Comparative Chondrogenesis Of Interzone And Anlagen Cells In Equine Skeletal Development, Chanhee Mok

Theses and Dissertations--Veterinary Science

At the presumptive sites of future synovial joints during mammalian skeletogenesis, articular cartilage develops from interzone located between the cartilaginous anlagen of bones. Thus, two types of cartilaginous tissues differentiate in close proximity. While anlagen cartilage is transient, progressing through endochondral ossification to form bones, articular cartilage is stable and functions throughout life to facilitate both low friction movement and load distribution. Despite important life-long functional properties, articular cartilage has a very limited intrinsic ability to repair structural defects. On the other hand, structural lesions in bones generally heal well by forming a cartilaginous callus and recapitulating endochondral ossification to …

Case Report: Concomitant Diagnosis Of Plasma Cell Leukemia In Patient With Jak2 Positive Myeloproliferative Neoplasm., Christine J Kurian, Colin Thomas, Sarah Houtmann, Thomas Klumpp, Adam Finn Binder

Division of Internal Medicine Faculty Papers & Presentations

Plasma cell dyscrasias and myeloproliferative neoplasms (MPN) are hematologic malignancies arising from two distinct hematopoietic cell lineages. They rarely occur concomitantly. Here, we report a case of a patient with a recent diagnosis of a JAK2 V617F positive MPN who presented with a new diagnosis of plasma cell leukemia. The patient had presented to the hospital with a leukocytosis predominantly comprised of plasma cells, followed by work-up involving peripheral blood flow cytometry, FISH analysis, and bone-marrow biopsy. FISH analysis was suggestive of a common progenitor cell for these distinct hematologic malignancies. To our knowledge, this case represents the second reported …

Safety, Feasibility, And Efficacy Of Early Rehabilitation In Patients Requiring Continuous Renal Replacement: A Quality Improvement Study, Kirby P. Mayer, Amanda R. Hornsby, Victor Ortiz Soriano, Timothy C. Lin, Jennifer T. Cunningham, Hanwen Yuan, Caroline E. Hauschild, Peter E. Morris, Javier A. Neyra

Physical Therapy Faculty Publications

Introduction: Early rehabilitation in critically ill patients is associated with improved outcomes. Recent research demonstrates that patients requiring continuous renal replacement therapy (CRRT) can safely engage in mobility. The purpose of this study was to assess safety and feasibility of early rehabilitation with focus on mobility in patients requiring CRRT.

Methods: Study design was a mixed methods analysis of a quality improvement protocol. The setting was an intensive care unit (ICU) at a tertiary medical center. Safety was prospectively recorded by incidence of major adverse events including dislodgement of CRRT catheter, accidental extubation, bleeding, and hemodynamic emergency; and minor adverse …

Challenges Of Diagnosis And Management Of Postpartum Choriocarcinoma In Resource Limited Settings: A Case Report From A Tertiary Hospital Of Western Kenya, Amubuomombe Philippe, Benjamin Elly, Andrew Cheruiyot, Sahara Shurie, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Choriocarcinoma is a rare occurrence in pregnancy. It is a highly curable malignant tumour that arises from trophoblastic cells within the uterus. However, the timely diagnosis of choriocarcinoma following birth is challenging, especially in low resource settings because most clinicians are not aware about the existence of the disease following uneventful pregnancy and birth. This report discusses the case of a 28 years old patient, para 2, diagnosed with choriocarcinoma two months after uneventful vaginal delivery at term. She underwent a total abdominal hysterectomy, followed by chemotherapy treatment; and succumbed to her disease. It highlights difficulties encountered on diagnosis and …