Medical Specialties Commons^™

The Impact Of An Innovative Simulation On Prelicensure Nursing Student Empathy Levels, Annie Harrison

Articles, Abstracts, and Reports

Empathy is the ability to see oneself in the situation of another and to take actions on behalf of that individual based on that perception. However, empathy has been shown to decrease in nursing education and continues to do so in nursing practice. Importantly, aspects of empathy have been shown to be teachable. This scholarly practice project examined whether an innovative simulation would increase empathy in prelicensure nursing students. This study, guided by self-determination theory (SDT) and designed according to the Plan-Do-Study-Act (PDSA) change model, used a mixed-methods design. The instrument for quantitative data collection was the Toronto Empathy Questionnaire …

Subgroup-Specific Dose Finding For Phase I-Ii Trials Using Bayesian Clustering, Alexandra Curtis, Brian Smith, Andrew G. Chapple

School of Medicine Faculty Publications

In most models and algorithms for dose-finding clinical trials, it is assumed that the trial participants are homogeneous—the optimal dose is the same for all those who qualify for the trial. However, if there are heterogeneous populations who may benefit from the same treatment, it is inefficient to conduct dose-finding separately for each group, and assuming homogeneity across all subpopulations may lead to identification of the incorrect dose for some (or all) subgroups. To accommodate heterogeneity in dose-finding trials when both efficacy and toxicity outcomes must be used to identify the optimal dose (as in immunotherapeutic oncology treatments), we utilize …

A Project Proposal: The Effects Of Standard Protocols During Cpr On Hospital-Acquired Infections Of Post-Open-Heart Surgery Patients In The Cvicu, Jessica Monahan

Symposium of Student Scholars

Abstract

A Project Proposal: The Effects of Standard Protocols during CPR on Hospital-Acquired Infections of Post-Open-Heart Surgery Patients in the CVICU

Background: Hospital-acquired infections (HAIs) are one of the most common complications post-cardiac surgeries and are associated with longer hospitalizations, elevated use of healthcare resources, and increased morbidity and mortality. The effects of HAIs after cardio-pulmonary resuscitation (CPR) in recent post-open-heart surgery patients remains largely unexplored. Therefore, the purpose of this project was to determine, in the CVICU does implementing standard protocols during CPR on recent post-open-heart surgery patients reduce HAIs?

Literature Review: HAIs during CPR can be acquired through …

Decreasing Central Venous Catheter Usage For The Hemodialysis Patient, Antionette Jordan

Dissertations

Abstract

Problem: The central venous catheter (CVC) usage rate in a large urban dialysis clinic was 34.5% and the Centers for Medicaid and Medicare Services (CMS) goal is 10.7%. CVC usage is a quality metric monitored by CMS to assess whether dialysis facilities are providing quality services which can impact reimbursement for the clinic. Failure to meet this metric can result in a penalty of up to 2% in reimbursement. The purpose of this quality improvement project was to determine if an interdisciplinary team (IDT) approach to vascular access planning and care influenced the CVC usage rate by 10% …

New-Onset Acute Ischemic Stroke Following Covid-19: A Case-Control Study, Fariborz Khorvash, Mohammad Amin Najafi, Mohsen Kheradmand, Mohammad Saadatnia, Rojin Chegini, Farideh Najafi

Rothman Institute Papers

Background: Neurological manifestations of coronavirus disease 2019 (COVID-19) have been highlighted. COVID-19 potentially increases the risk of thromboembolism. We aimed to compare patients with COVID-19 with and without new-onset acute ischemic stroke (AIS).

Materials and methods: In this single-center retrospective case-control study, demographics, clinical characteristics, laboratory findings, and clinical outcomes were compared between 51 patients with both COVID-19 and AIS (group A) and 160 patients with COVID-19 and without AIS (group B).

Results: Patients in group A were significantly older, more likely to present with critical COVID-19 (P = 0.004), had higher rates of admission in the intensive care …

Actl6a Coordinates Axonal Caliber Recognition And Myelination In The Peripheral Nerve, Hye-Jin Park, Eric Tsai, Dennis Huang, Michael Weaver, Luciana Frick, Ace Alcantara, John J. Moran, Julia Patzig, Carmen V. Melendez-Vasquez, Gerald R. Crabtree, M.L. Feltri, John Svaren, Patricia Casaccia

Advanced Science Research Center

Cells elaborate transcriptional programs in response to external signals. In the peripheral nerves, Schwann cells (SC) sort axons of given caliber and start the process of wrapping their membrane around them. We identify Actin-like protein 6a (ACTL6a), part of SWI/SNF chromatin remodeling complex, as critical for the integration of axonal caliber recognition with the transcriptional program of myelination. Nuclear levels of ACTL6A in SC are increased by contact with large caliber axons or nanofibers, and result in the eviction of repressive histone marks to facilitate myelination. Without Actl6a the SC are unable to coordinate caliber recognition and myelin production. Peripheral …

Optimizing The Performance And Treatment Of The Female Athlete, Sommer Hammoud, Robin V. West

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

A Just-In-Time Video Primer On Pneumothorax Pathophysiology And Early Management, Nicholas Macdonald, Jacob Garcia, Gregory C. Kane, Xiao Chi Zhang, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Audience: Emergency medicine residents (interns, junior residents), medical students, and mid-level providers (physician assistants, nurse practitioners).

Introduction: Pneumothorax refersto the presence of gas within the pleuralspace and is a relatively common clinical entity in the emergency department Traumatic pneumothorax results from blunt or penetrating trauma to the thorax. Iatrogenic pneumothorax is a risk inherent to a number of invasive procedures and represents a significant cause of preventable morbidity. Specifically, central venous catheterization (43.8%), thoracentesis (20.1%), and barotrauma due to mechanical ventilation (9.1%) are the most frequent causes. A feared complication of pneumothorax is the development of tension pneumothorax, which involves …

Time Dependent Analysis Of Rat Microglial Surface Markers In Traumatic Brain Injury Reveals Dynamics Of Distinct Cell Subpopulations, Assaf Gottlieb, Naama Toledano-Furman, Karthik S Prabhakara, Akshita Kumar, Henry W Caplan, Supinder Bedi, Charles S Cox, Scott D Olson

Faculty, Staff and Student Publications

Traumatic brain injury (TBI) results in a cascade of cellular responses, which produce neuroinflammation, partly due to the activation of microglia. Accurate identification of microglial populations is key to understanding therapeutic approaches that modify microglial responses to TBI and improve long-term outcome measures. Notably, previous studies often utilized an outdated convention to describe microglial phenotypes. We conducted a temporal analysis of the response to controlled cortical impact (CCI) in rat microglia between ipsilateral and contralateral hemispheres across seven time points, identified microglia through expression of activation markers including CD45, CD11b/c, and p2y12 receptor and evaluated their activation state using additional …

Decreased Physical Activity Among Youth Resulting From Covid-19 Pandemic-Related School Closures: Natural Experimental Study., Amanda Grimes, Joseph S. Lightner, Katlyn Eighmy, Chelsea Steel, Robin P. Shook, Jordan A. Carlson

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The COVID-19 pandemic has resulted in the closure of schools and may have inadvertently resulted in decreased physical activity for youth. Emerging evidence suggests that school closures due to the COVID-19 pandemic could have hastened the inactivity of youth, possibly due to a lack of structure outside of school and increased access to sedentary activities.

OBJECTIVE: The purpose of this study was to assess changes in physical activity from pre-school closure (before the pandemic) to post-school closure (during the pandemic) among youth in spring 2020.

METHODS: This study used a natural experimental design; youth were enrolled in a physical …

Healthcare Expenditure Associated With Polypharmacy In Older Adults With Cardiovascular Diseases, Min Ji Kwak, Mihyun Chang, Simbo Chiadika, David Aguilar, Elenir Avritscher, Ashish Deshmukh, Parag Goyal, Dae Hyun Kim, Rajender Aparasu, Holly M Holmes

Faculty, Staff and Student Publications

No abstract provided.

Injection Options For Non-Surgical Knee Pain Patients: A Quality Improvement Project, Alicia Emery

Epsilon Sigma at-Large Research Conference

Purpose: In an Orthopedic office in Northeast Tennessee clinical decision making about injection options for non-surgical candidates with knee osteoarthritis is unclear.

Aims: This quality improvement project will develop a clinical guideline so that providers know criteria for choosing optimal knee alternative treatments for non-surgical knee patients.

Outcome measures: An expert panel gave feedback and advice on the information presented for the injection types of Platelet Rich Plasma, Corticosteroids, Amniotic Allograft and Hyaluronic Acid. They edited the guideline then sent the edits back to be complied and edited using the Delphi method.

Process and Methods: The …

The Impact Of Dietary Fiber On Breast Cancer Incidence, Peyton North

Epsilon Sigma at-Large Research Conference

Abstract

Introduction & Background

The role of dietary fiber in breast cancer etiology remains unclear. A negative correlation may be due to fiber’s ability to stave off obesity and aid in the extraction of serum estrogen, two known risk factors for the disease. Effects may differ by source, and type, of fiber. Most of the data available is from research with non-Hispanic white women. However, fiber intake may vary significantly across cultures.

Purpose Statement & Question

The research sought to investigate whether an increased intake of dietary fiber was associated with a corresponding decrease in the incidence of breast cancer. …

Process Improvement To Return Stabilized Behavioral Health Patients To Primary Care, Tessa Woodroof

Epsilon Sigma at-Large Research Conference

Purpose: The purpose of this project is to increase the number of open patient appointments by implementing a validated process in which stabilized behavioral health patients are repatriated to primary care. Currently, there is an increased demand for behavioral health services and decreased supply of behavioral health clinicians at the Nashville Veterans Affairs Medical Center (VAMC).

Aims: This project aims to teach behavioral health providers how to identify appropriate patients and complete successful discharges while helping primary care providers integrate the repatriation process into their workflow. Without the proposed intervention, veterans initiating behavioral health services in the catchment area will …

What Did We Learn About Vads In 2021?, Maya Guglin

The VAD Journal

This is our 8th annual literature review on mechanical circulatory support (MCS) devices.

Our previous reports were well received by the readers. The full text of the reviews for 2014, 2015, 2016, 2017, 2018, 2019, and 2020^1-7 were downloaded 821, 861, 701, 869, 951, 272, and 365 times, respectively.

In this review, we summarized the most interesting and important, from our standpoint, publications from 2021. There may be some slight overlap with the end of 2020 because some papers were published online first, and the year of the publication changed when they became …

Multi-Modality Breast Mri Segmentation Using Nn-Unet For Preoperative Planning Of Robotic Surgery Navigation, Motaz Alqaoud, John Plemmons Md, Eric Feliberti Md, Facs, Krishnanand Kaipa, Siqin Dong, Gabor Fichtinger, Yimming Xiao, Michel Audette

Modeling, Simulation and Visualization Student Capstone Conference

Segmentation of the chest region and breast tissues is essential for surgery planning and navigation. This paper proposes the foundation for preoperative segmentation based on two cascaded architectures of deep neural networks (DNN) based on the state-of-the-art nnU-Net. Additionally, this study introduces a polyvinyl alcohol cryogel (PVA-C) breast phantom based on the segmentation of the DNN automated approach, enabling the experiments of navigation system for robotic breast surgery. Multi-modality breast MRI datasets of T2W and STIR images were acquired from 10 patients. Segmentation evaluation utilized the Dice Similarity Coefficient (DSC), segmentation accuracy, sensitivity, and specificity. First, a single class labeling …

Comparing Orthopedic Randomized Control Trials Published In High-Impact Medical And Orthopedic Journals, Andrew Lachance, Emily Dissler

Costas T. Lambrew Research Retreat 2022

PURPOSE To compare study characteristics, methodologic quality and outcome direction among operative randomized orthopedic trials published in high-impact medical and orthopedic journals and to identify study attributes associated with greater exposure and impact

Physician's Attitudes On Pulmonary Rehabilitation Following Covid-19: A Brief Perspective From A Developing Country, Ivan Cherrez-Ojeda, Emanuel Vanegas, Miguel Felix, María José Farfán Bajaña, Azza Sarfraz, Zouina Sarfraz, Genesis Camacho, Alanna Barrios-Ruiz, Jack Michel

Department of Paediatrics and Child Health

Despite the uncertainty about the follow up of COVID-19 survivors, there is a growing body of evidence supporting specific interventions including pulmonary rehabilitation, which may lead to a reduced hospital stay and improved overall respiratory function. The aim of this short report was to assess the attitudes toward pulmonary rehabilitation following COVID-19 among Ecuadorian physicians. A cross-sectional study was conducted, in which a 5-question survey was used to assess the level of agreement to specific statements with a 5-point Likert scale. Out of the 282 participants, 48.2% (n=136) were male, with a mean of 12.6 (SD=11.3) years of experience. More …

“Cystectomy…What Bugs You?” Creation Of An Institutional Antibiogram, Erin Santos

Costas T. Lambrew Research Retreat 2022

BACKGROUND: Radical cystectomy is associated with high rates of post operative morbidity and mortality to improve readmission rates following radical cystectomy, a post cystectomy discharge pathway was created. We set out to create an institution specific antibiogram to identify and target most common causative organisms to specifically decrease genitourinary infection related complications.

Burden Of Type 2 Diabetes And Associated Cardiometabolic Traits And Their Heritability Estimates In Endogamous Ethnic Groups Of India: Findings From The Indigenius Consortium, Vettriselvi Venkatesan, Rector Arya, Juan Carlos Lopez Alvarenga, Krishna K. Sharma, Roy G. Resendez, Juliet A. Ezeilo, Marcio Almeida, Srinivas Mummidi, John Blangero, Ravindranath Duggirala

School of Medicine Publications

To assess the burden of type 2 diabetes (T2D) and its genetic profile in endogamous populations of India given the paucity of data, we aimed to determine the prevalence of T2D and estimate its heritability using family-based cohorts from three distinct Endogamous Ethnic Groups (EEGs) representing Northern (Rajasthan [Agarwals: AG]) and Southern (Tamil Nadu [Chettiars: CH] and Andhra Pradesh [Reddys: RE]) states of India. For comparison, family-based data collected previously from another North Indian Punjabi Sikh (SI) EEG was used. In addition, we examined various T2D-related cardiometabolic traits and determined their heritabilities. These studies were conducted as part of the …

Exploring A Role For Occupational Therapists In Adult Eating Disorder Treatment, Felicia Titus, Karen Park

Spring 2022 Virtual OTD Capstone Symposium

Background: Occupational therapists working in eating disorder (ED) treatment in the United States is an emerging practice area. The main objective of this study was to seek an understanding of the perceived gaps in current adult ED treatment in the United States, from both the perspectives of ED treatment providers and individuals with an ED to discover if there is a role for occupational therapists.

Methods: The design of this study was a convergent mixed methods in which the data was collected through online surveys and recorded semi-structured interviews of ED treatment providers (N = 15) and individuals diagnosed …

Advocating For Occupational Therapy In The Pediatric Primary Care Setting, Margaret Bauer

Spring 2022 Virtual OTD Capstone Symposium

This project explored the experiences of caregivers interacting within the pediatric primary care setting in order to determine a need for occupational therapy to help support acquisition of child developmental milestones, screening for developmental delays, and implementation of health behaviors into family routines. An IRB research study was conducted to survey primary caregivers of children across the country to ascertain their experiences and knowledge of OT, ease of health behavior implementation, and comfortably discussing child development with their pediatrician's. A needs assessment survey was distributed at a San Diego pediatric primary care clinic, and a program was developed to support …

Mucormycosis: Covid-19 And Corticosteroids, Mittal Savaliya, Nivedita Jha, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Intake Patterns Of Specific Alcoholic Beverages By Prostate Cancer Status, Hui Yi Lin, Tung-Sung Tseng, Xinnan Wang, Zhide Fang, Arnold H. Zea, Liang Wang, Julio Pow-Sang, Catherine M. Tangen, Phyllis J. Goodman, Alicja Wolk, Niclas Håkansson, Manolis Kogevinas, Javier Llorca, Hermann Brenner, Ben Schöttker, Jose Esteban Castelao, Manuela Gago-Dominguez, Marija Gamulin, Davor Lessel, Frank Claessens, Steven Joniau, Jong Y. Park

School of Public Health Faculty Publications

Background: Previous studies have shown that different alcoholic beverage types impact prostate cancer (PCa) clinical outcomes differently. However, intake patterns of specific alcoholic beverages for PCa status are understudied. The study’s objective is to evaluate intake patterns of total alcohol and the three types of beverage (beer, wine, and spirits) by the PCa risk and aggressiveness status. Method: This is a cross-sectional study using 10,029 men (4676 non-PCa men and 5353 PCa patients) with European ancestry from the PCa consortium. Associations between PCa status and alcohol intake patterns (infrequent, light/moderate, and heavy) were tested using multinomial logistic regressions. Results: Intake …

Convection Enhanced Delivery Of The Oncolytic Adenovirus Delta24-Rgd In Patients With Recurrent Gbm: A Phase I Clinical Trial Including Correlative Studies, Erik H P Van Putten, Anne Kleijn, Victor W Van Beusechem, David Noske, Cor H J Lamers, Anna L De Goede, Sander Idema, Daphna Hoefnagel, Jenneke J Kloezeman, Juan Fueyo, Frederick F Lang, Charlotte E Teunissen, René M Vernhout, Cathy Bakker, Winald Gerritsen, David T Curiel, Arnold Vulto, Martine L M Lamfers, Clemens M F Dirven

Faculty, Staff and Student Publications

Purpose: Testing safety of Delta24-RGD (DNX-2401), an oncolytic adenovirus, locally delivered by convection enhanced delivery (CED) in tumor and surrounding brain of patients with recurrent glioblastoma.

Patients and methods: Dose-escalation phase I study with 3+3 cohorts, dosing 107 to 1 × 1011 viral particles (vp) in 20 patients. Besides clinical parameters, adverse events, and radiologic findings, blood, cerebrospinal fluid (CSF), brain interstitial fluid, and excreta were sampled over time and analyzed for presence of immune response, viral replication, distribution, and shedding.

Results: Of 20 enrolled patients, 19 received the oncolytic adenovirus Delta24-RGD, which was found to be safe and feasible. …

Cytospin-A Regulates Colorectal Cancer Cell Division And Migration By Modulating Stability Of Microtubules And Actin Filaments, Fan Fan, Jason Roszik, Ling Xia, Susmita Ghosh, Rui Wang, Xiangcang Ye, David Hawke, Lee M Ellis, Rajat Bhattacharya

Faculty, Staff and Student Publications

Simple Summary

In this study, we report the effects of depleting cytospin-A (CYTSA), also known as the sperm antigen with calponin homology and coiled-coil domain (SPECC1L) protein, on the proliferation and migration of colorectal cancer (CRC) cells. Mutations in this protein have been previously linked to different developmental disorders. In our studies, depletion of CYTSA in various CRC cells led to significant decreases in proliferation, increases in cell death, and increased formation of multinucleated cells. Knocking down CYTSA also led to severe inhibition of CRC cell migration and invasion. These effects could be related to a significant decrease in the …

Surgery In Advanced Ovary Cancer: Primary Versus Interval Cytoreduction, Mackenzie Cummings, Olivia Nicolais, Mark S. Shahin

Department of Obstetrics and Gynecology Faculty Papers

Primary debulking surgery (PDS) has remained the only treatment of ovarian cancer with survival advantage since its development in the 1970s. However, survival advantage is only observed in patients who are optimally resected. Neoadjuvant chemotherapy (NACT) has emerged as an alternative for patients in whom optimal resection is unlikely and/or patients with comorbidities at high risk for perioperative complications. The purpose of this review is to summarize the evidence to date for PDS and NACT in the treatment of stage III/IV ovarian carcinoma. We systematically searched the PubMed database for relevant articles. Prior to 2010, NACT was reserved for non-surgical …

A Photography-Based, Social Media Walking Intervention Targeting Autonomous Motivations For Physical Activity: Semistructured Interviews With Older Women, Michael C Robertson, Maria Chang Swartz, Ursela Christopherson, Jason R Bentley, Karen M Basen-Engquist, Debbe Thompson, Elena Volpi, Elizabeth J Lyons

Faculty, Staff and Students Publications

BACKGROUND: Older adult women are at risk for negative health outcomes that engaging in sustained physical activity can help prevent. However, promoting long-term maintenance of physical activity in this population has proven to be a challenge. Increasing autonomous motivations (ie, intrinsic, integrated, and identified regulations) for physical activity may facilitate enduring behavior change. Digitally delivered games for health that take a celebratory technology approach, that is, using technology to create new ways to experience valued behaviors and express valued beliefs, may be a useful way to target autonomous motivations for physical activity. Formative research with the target population is needed …

Analysis Of Quality Of Life In Parkinson's Disease Caregivers: A Quantitative Research Study, Peyton Dooley, Claribell Bayona, Krisitin Domville

Spring 2022 Virtual OTD Capstone Symposium

Parkinson’s disease is a commonly known movement and neurodegenerative disorder affecting a large portion of the male population. This disease is gruesome and progressive; it often interferes with a person’s daily routines and activities due to deficits in postural stability, tremors, slowed movement, and rigidity (Tysnes et al., 2017). Most persons with Parkinson’s have informal caregivers, often female spouses, or significant others of the individual. Caregivers of Parkinson’s disease prioritize their loved ones needs over their own, neglecting their own daily activities and routines including self-care, social participation, leisure, and physical activity. Occupational therapists and other health care professionals often …

Improving Postpartum Hypertension Discharge Education: A Pilot Project, Kathryn Barth

Dissertations

Problem: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity, mortality, and postpartum readmission. Several evidence-based algorithms and protocols have been implemented in the inpatient setting to treat severe blood pressure and prevent complications. However, there remains an opportunity to improve the postpartum care transition and discharge education for patients with these conditions in an attempt to decrease 30-day postpartum hypertension readmissions.

Methods: This pilot project utilized a descriptive design and took place on a postpartum unit at a Midwest metropolitan high-risk obstetrical teaching hospital. Interventions included patient-specific discharge education, distribution of a home blood pressure …