Medical Specialties Commons^™

Qi Project: Clopidogrel In Nstemi, Amanda Sams, Erin Kaya, Carsten Kirby, Ester Peters, Michael Stewart (Faculty Advisor)

Articles, Abstracts, and Reports

No abstract provided.

Identifying Gaps In Interpretive Services To Improve Patient Care: A Root Cause Analysis, Christiane Phillips, Reed Ritterbusch, Ken Scott, Jenny Wickens

Articles, Abstracts, and Reports

No abstract provided.

Preventable Tacrolimus Toxicity, Brooke Parker, Jessica Sterner, John Mele, Laura Dewald, Cassidy Johnston

Articles, Abstracts, and Reports

No abstract provided.

Improving Caregiver Confidence And Burnout Through Standardizing The Use Of The Agitated Behavior Scale And Behavioral Strategies For Managing Patients With Agitation, John Gilmer, Kate Whiteneck, Alicia Hegie, Mackenzie Waples, Frank Jackson

Articles, Abstracts, and Reports

No abstract provided.

Creation And Implementation Of A Trauma-Informed Care Safety Tool In An Inpatient Mental Health Unit, Katie Rhea, Jeremy Williams, Teresa Rangel

Articles, Abstracts, and Reports

No abstract provided.

Identifying And Improving System Barriers To Promote Successful Breastfeeding In Resident Physicians, Brigette Schuman, Michelle Drobny, Elizabeth Savage, Colleen Zimmermann

Articles, Abstracts, and Reports

No abstract provided.

A Case Report Of Immune Checkpoint Inhibitor-Associated Acute Pancreatitis Presenting As Mixed Dka/Hhs: Histopathological And Radiological Findings, Amanda Sams

Articles, Abstracts, and Reports

No abstract provided.

Supporting Designated Crisis Responders (Dcrs) In Washington State, Shelly Haferkamp, James Miller, John F Wurzel

Articles, Abstracts, and Reports

No abstract provided.

Angiotensinogen In Sex And Hypertension: New Insights From The Multi-Ethnic Study Of Atherosclerosis (Mesa), Alan Daugherty, Hong S. Lu, George L. Bakris

Saha Cardiovascular Research Center Faculty Publications

No abstract provided.

Primary Diffuse Large B-Cell Lymphoma Of The Bone, Binoy Yohannan, Adan Rios

Faculty, Staff and Student Publications

Primary lymphoma of the bone (PLB) is a rare lymphoproliferative neoplasm that can present either as solitary or multiple bone lesions. We report four patients with PLB who were successfully treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by consolidative radiotherapy. All patients achieved a complete remission and had excellent long-term outcomes. PLB has a favorable response to combined modality treatment with chemoimmunotherapy and radiation. Long-term outcomes of PLB tend to be better than those of non-osseous diffuse large B-cell lymphoma.

Impact Of Immunological And Inflammatory Mediators In The Progression Of Type Ii Diabetes: A Pilot Study From A Mexican American Population In The Rio Grande Valley, Peter Elvin, Garrett Edwards, Walid Fakhouri, Craig Hanis, Cláudia Cristina Biguetti

School of Podiatric Medicine Publications

No abstract provided.

El Empoderamiento De Personas Embarazadas Y Posparto En Arica, Chile: Perspectivas Indígenas Y Biomédicas, Abby Perce

Independent Study Project (ISP) Collection

El parto, sin importar las tradiciones o los procedimientos utilizados, es un proceso transformador tanto para quien da a luz como para el bebé. Si bien los procesos de embarazo, parto y posparto son experiencias individualizadas, el apoyo de la comunidad y la atención médica cuidadosa pueden marcar una gran diferencia en los sentimientos de empoderamiento y satisfacción en la vida de los pacientes. Este estudio exploratorio cualitativo tiene como objetivo comprender los contextos culturales que influyen en el apoyo disponible para las personas embarazadas y puérperas en Arica, Chile, así como investigar las formas en que este apoyo conduce …

Vital Signs, Spring 2023, Boonshoft School Of Medicine

Vital Signs

A nine page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, alumni profiles, class notes, and more.

Phlebotomy-Free Days In Common Conditions Among Hospitalized Children And The Association With Clinical Outcomes, Megan Collins, M Hall, Ss Shah, Mj Molloy, Pl Aronson, Jm Cotter, Mj Steiner, Mj Tchou, Jr Stephens, Jessica L. Markham

Posters

Background: Phlebotomy is an invasive procedure associated with pain and iatrogenic anemia. Minimizing phlebotomy for hospitalized children could improve their experience and avoid unnecessary tests. Objective: To describe: 1) the prevalence of phlebotomy-free days among children hospitalized with common conditions and 2) the association of phlebotomy-free days with clinical outcomes. Design/Methods: We performed a multicenter, cross-sectional study of children hospitalized 1/1/2018 to 12/31/2019 with an All Patient Refined Diagnosis Related Group (APR-DRG) for common infections across 38 hospitals in the Pediatric Health Information System (PHIS) database. We excluded patients with length of stay (LOS) < 2 days, medical complexity, interhospital transfers, and those receiving intensive care. We defined phlebotomy-free days (PFDs) as hospital days with no laboratory blood testing and measured the proportion of PFDs per hospital day (PFD ratio) for each condition and hospital. Hospitals were grouped into low, moderate and high average PFD ratios. Adjusted outcomes were compared across groups and included LOS, costs, and all-cause 14- and 30-day readmission rates. Results: We identified 126,135 patient encounters (Table 1). Bronchiolitis (N=31,302), non-bacterial gastroenteritis (N=20,430), and pneumonia (N=16,031) accounted for the greatest number of hospital days. Bronchiolitis (0.78) and pneumonia (0.54) had the highest overall PFD ratios, while bone and joint infections (0.28) and non-bacterial gastroenteritis (0.30) had the lowest overall PFD ratios. There was wide variation across hospitals and conditions in PFD ratios (Figure 1). We identified 8 hospitals with low, 21 with moderate, and 9 with high PFD ratios (Figure 1 and Table 1). There were statistically significant but small differences in the distributions of age, payer, and H-RISK among patients in the low, moderate, and high PFD hospital groups (Table 1). There were no differences in adjusted outcomes across low, moderate, and high PFD hospital groups (Table 2). Conclusion(s): Among children hospitalized with common infectious conditions, there was variation across conditions and hospitals in the proportion of PFDs per hospital day. Hospitals with low, moderate and high ratios of PFDs had no differences in outcomes. Our data suggest at least some laboratory overuse and opportunities to improve the experience and care of children hospitalized with infections.

Sepsis-Induced Acute Lung Injury And The Development Of Bronchopulmonary Dysplasia In Premature Infants, Jacob S. Ward, Hung-Wen Yeh, Megan Tucker, Venkatesh Sampath

Posters

Background: Bronchopulmonary dysplasia (BPD) is a significant cause of morbidity and mortality in premature infants with several known risk factors. Recent literature described the harmful effect of inflammation on the developing lung. Recently, we showed that late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) causes acute lung injury (ALI) in preterm infants as measured by increases in pulmonary severity scores (PSS). The aim of this study was to investigate the association between LOS-induced ALI and BPD outcomes. We hypothesized that LOS would increase the likelihood of developing BPD, and the associated LOS-induced ALI will add to the ability to predict development …

Sharprazor: Automatic Removal Of Hair And Ruler Marks From Dermoscopy Images, Reda Kasmi, Jason Hagerty, Reagan Harris Young, Norsang Lama, Januka Nepal, Jessica Miinch, William V. Stoecker, R. Joe Stanley

Mechanical and Aerospace Engineering Faculty Research & Creative Works

Background: The removal of hair and ruler marks is critical in handcrafted image analysis of dermoscopic skin lesions. No other dermoscopic artifacts cause more problems in segmentation and structure detection. Purpose: The aim of the work is to detect both white and black hair, artifacts and finally inpaint correctly the image. Method: We introduce a new algorithm: SharpRazor, to detect hair and ruler marks and remove them from the image. Our multiple-filter approach detects hairs of varying widths within varying backgrounds, while avoiding detection of vessels and bubbles. The proposed algorithm utilizes grayscale plane modification, hair enhancement, segmentation using tri-directional …

Implementing Team Birth To Improve Patient Satisfaction On An Ldrp (Team Birthsingleroom ) Unit, Deanna Higgins, Alyson Willard, Teresa Rangel

Articles, Abstracts, and Reports

No abstract provided.

Treatment Of Post-Operative Pain In Children With Severe Neurological Impairment, Jordan Keys

Presentations

Background: The assessment of pain in children with severe neurologic impairment (SNI) can be more challenging than in neurotypical children.

Objective: To describe the type, number of classes, and duration of post-operative pain medications for procedures common among children with SNI. Secondarily, to describe the variability in pain management strategies across children’s hospitals, specifically for opioid administration.

Design/Methods: This retrospective cohort study of the Pediatric Health Information System included children hospitalized with SNI aged 0-21 years old who underwent common procedures during 2019. We defined SNI using previously described high-intensity neurologic impairment (HINI) diagnosis codes and identified six common ( …

Pediatric Malaria With Respiratory Distress: Prognostic Significance Of Point-Of-Care Lactate, Catherine Mitran, Robert Opoka, Andrea Conroy, Sophie Namasopo, Kevin Kain, Michael Hawkes

Paediatrics and Child Health, East Africa

Respiratory distress (RD) in pediatric malaria portends a grave prognosis. Lactic acidosis is a biomarker of severe disease. We investigated whether lactate, measured at admission using a handheld device among children hospitalized with malaria and RD, was predictive of subsequent mortality. We performed a pooled analysis of Ugandan children under five years of age hospitalized with malaria and RD from three past studies. In total, 1324 children with malaria and RD (median age 1.4 years, 46% female) from 21 health facilities were included. Median lactate level at admission was 4.6 mmol/L (IQR 2.6–8.5) and 586 patients (44%) had hyperlactatemia (lactate …

Examining The Feasibility Of Telehealth Trauma-Focused Cognitive Behavioural Therapy (Tf-Cbt) With Young People In Foster Care, Jill Mcleigh, Adrianna Martin, Laura Lamminen

Behavioral Health/Developmental Delay

Despite the high rate of trauma exposure among young people with child welfare involvement, various systematic and patient barriers exist that inhibit utilization of evidence-based trauma treatments. One strategy for alleviating barriers to such treatments is using telehealth. A few studies have found that the clinical outcomes of telehealth TF-CBT are comparable to those found from clinic-based, in-person treatment administration. Studies have yet to examine the feasibility of telehealth TF-CBT with young people in care. The current study sought to address this gap by examining outcomes for patients who received telehealth TF-CBT, along with factors that may have impacted successful …

Utilizing The System Engineering Trade Study Analysis Method To Analyze Patient Aeromedical Evacuation, Sara Shaghaghi, Jeremy M. Slagley, Michael E. Miller, Gaiven Varshney

Faculty Publications

The US Air Force has gone through many aeromedical patient isolation transport system designs. The first designs were developed in response to the Ebola outbreak in 2014 and, more recently, the COVID-19 pandemic. The trade study analysis part of the system engineering design method was used to analyze the historic and current aeromedical patient contamination control transport systems. A trade study is a process that evaluates alternatives based upon various “-ilities”, such as reconfigurability, flexibility, durability, cost, and more, and performs a systematic analysis to aid designers in producing a ‘good’ design alternative given the large set of possible solutions. …

Recognizing Ethyl Chloride Neurotoxicity: Inhalant Abuse Hidden In Plain Sight., Robert Young, Cody Carter, Serge Cardinali, Zeryab Khan, Katelyn Bennett, Amy Jarosz, Jeffery Sobecki, Rupali Sharma, Ryan Martin

Ambulatory and Primary Care Articles

Ethyl chloride is a common topical anesthetic. However, when abused as an inhalant, effects can range from headaches and dizziness to debilitating neurotoxicity requiring intubation. While previous case reports describe the short-term reversible neurotoxicity of ethyl chloride, ours show chronic morbidity and mortality outcome. During the initial evaluation, it is essential to consider the rising trend of commercially available inhalants being used as recreational drugs. We present a case of a middle-aged man presenting with subacute neurotoxicity due to repeated abuse of ethyl chloride.

Educational Curriculum For Peripheral Nerve Stimulation Developed By The North American Neuromodulation Society., Hemant Kalia, Alaa Abd-Elsayed, Mark Malinowski, Adam Burkey, Rany T Abdallah, Eellan Sivanesan, Tariq Malik, Reda Tolba, Yashar Eshraghi, Kris Ferguson, Maricela Schnur, Ahmed Raslan, Maged Guirguis, Marc Russo, Konstantin V Slavin

Neuroscience Articles

BACKGROUND: Peripheral nerve stimulation (PNS) is an effective neuromodulation therapy for chronic neuropathic and nociceptive pain. Although the total number of PNS implantations has increased over the last decade, no curriculum exists to guide training and learning of this therapy. The goal of the North American Neuromodulation Society (NANS) education committee is to develop a series of competency-based curriculums for neuromodulation therapies. The PNS curriculum is the latest part of such series, following the curriculums for spinal cord stimulation and intrathecal drug delivery system.

MATERIALS AND METHODS: A multidisciplinary task force (anesthesiology, physical medicine and rehabilitation, neurosurgery, preventive medicine and …

Comparison Of Sports Medicine Questions On The Orthopaedic In-Training Examination Between 2009 And 2012 And 2017 And 2020 Reveals An Increasing Number Of References, Brandon Klein, Mark Lagreca, Peter B. White, Robert Trasolini, Randy M. Cohn

Orthopedic Surgery Resident Research

Purpose

To provide an updated analysis of the sports medicine section of the Orthopedic In-Training Examination (OITE).

Methods

A cross-sectional review of OITE sports medicine questions from 2009 to 2012 and 2017-2020 was performed. Subtopics, taxonomy, references, and use of imaging modalities were recorded and changes between the time periods were analyzed.

Results

The most tested sports medicine subtopics included ACL (12.6%), rotator cuff (10.5%), and throwing injuries to the shoulder (7.4%) in the early subset, while ACL (10%), rotator cuff (6.25%), shoulder instability (6.25%), and throwing injuries to the elbow (6.25%) were the most common in the later subset. …

Effect Of Drain Duration And Output On Perioperative Outcomes And Readmissions After Lumbar Spine Surgery, Brian A. Karamian, Parth Kothari, Gregory R. Toci, Mark J. Lambrechts, Jose A. Canseco, Jennifer Mao, Raj Narayan, Sammy Alfonsi, Francis Sirch, Nadim Kheir, Nicholas Semenza, Barrett I. Woods, Jeffrey A. Rihn, Mark Kurd, Kris Radcliff, I David Kaye, Alan S. Hilibrand, Christopher K. Kepler, Alex R. Vaccaro, Gregory D. Schroeder

Rothman Institute Papers

Study design: Single-center retrospective cohort.

Purpose: To compare surgical outcomes of patients based on lumbar drain variables relating to output and duration.

Overview of literature: The use of drains following lumbar spine surgery, specifically with respect to hospital readmission, postoperative hematoma, postoperative anemia, and surgical site infections, has been controversial.

Methods: Patients aged ≥18 years who underwent lumbar fusion with a postoperative drain between 2017 and 2020 were included and grouped based on hospital readmission status, last 8-hour drain output (<40 mL cutoff), or drain duration (2 days cutoff). Total output of all drains, total output of the primary drain, drain duration in days, drain output per day, last 8-hour output, penultimate 8-hour output, and last 8-hour delta (last 8-hour output subtracted by penultimate 8-hour output) were collected. Continuous and categorical data were compared between groups. Multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis were performed to determine whether drain variables can predict hospital readmission, postoperative blood transfusions, and postoperative anemia. Alpha was 0.05.

Results: Our cohort consisted of 1,166 patients with 111 (9.5%) hospital readmissions. Results of regression analysis did not identify …

Validation Of A Brief Measure For Complicated Grief Specific To Reproductive Loss, Cara Buskmiller, Kathryn R Grauerholz, Jennifer Bute, Maria Brann, Michaelene Fredenburg, Jerrie S Refuerzo

Faculty, Staff and Student Publications

Objective

Complicated grief reactions follow some pregnancy outcomes, like miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. Stigma can delay treatment and worsen outcomes. Screening tools such as the Edinburgh Postnatal Depression Scale detect complicated grief poorly, and specific tools for prolonged or complicated grief after a reproductive loss are cumbersome. In this study, a five-item questionnaire to detect complicated grief after reproductive loss of any type was designed and preliminary validated.

Methods

A questionnaire patterned after the extensively validated Brief Grief Questionnaire (BGQ) was created by a group of physicians and lay advocates to employ …

Peripartum Cardiomyopathy, Victoria L Morris, Carolina Mendoza, Gowri S Stevens, Jessica L Wilson, Adeola A Kosoko

Faculty, Staff and Student Publications

AUDIENCE: This simulation is appropriate for emergency medicine (EM) residents of all levels.

INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare, idiopathic condition that occurs in the mother around the time of childbirth. Heart failure with reduced ejection fraction and/or reduced systolic function diagnosed in patients during the last month of pregnancy or up to five months following delivery defines PCCM.1 Another broader definition from the European Society of Cardiology defines PPCM as heart failure that occurs "towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found."2 Though PPCM occurs worldwide, …

Concurrent Intrathecal And Intravenous Nivolumab In Leptomeningeal Disease: Phase 1 Trial Interim Results, Isabella C Glitza Oliva, Sherise D Ferguson, Roland Bassett, Alexandra P Foster, Ida John, Tarin D Hennegan, Michelle Rohlfs, Jessie Richard, Masood Iqbal, Tina Dett, Carol Lacey, Natalie Jackson, Theresa Rodgers, Suzanne Phillips, Sheila Duncan, Lauren Haydu, Ruitao Lin, Rodabe N Amaria, Michael K Wong, Adi Diab, Cassian Yee, Sapna P Patel, Jennifer L Mcquade, Grant M Fischer, Ian E Mccutcheon, Barbara J O'Brien, Sudhakar Tummala, Matthew Debnam, Nandita Guha-Thakurta, Jennifer A Wargo, Fernando C L Carapeto, Courtney W Hudgens, Jason T Huse, Michael T Tetzlaff, Elizabeth M Burton, Hussein A Tawbi, Michael A Davies

Faculty, Staff and Student Publications

There is a critical need for effective treatments for leptomeningeal disease (LMD). Here, we report the interim analysis results of an ongoing single-arm, first-in-human phase 1/1b study of concurrent intrathecal (IT) and intravenous (IV) nivolumab in patients with melanoma and LMD. The primary endpoints are determination of safety and the recommended IT nivolumab dose. The secondary endpoint is overall survival (OS). Patients are treated with IT nivolumab alone in cycle 1 and IV nivolumab is included in subsequent cycles. We treated 25 patients with metastatic melanoma using 5, 10, 20 and 50 mg of IT nivolumab. There were no dose-limiting …

Implementation Of An Activity Protocol In The Acute Care Setting: A Quality Improvement Project, Crystal M. Ryan

DNP Projects

Background: Physical activity following cardiothoracic surgery can help decrease post-operative complications, expedite functional recovery, improve overall well-being, shorten hospital length of stay (LOS), and reduce morbidity and mortality (Miwa et al., 2017). Of these patients, 58% developed complications after cardiac surgery; of these complications, 31% were pulmonary, 16% were of cardiac in nature, and 14% were neurological (Yayla, 2018).

Purpose: This quality improvement project aims to implement an evidence-based protocol for evaluating the correlation between physical activity in uncomplicated post-operative coronary artery bypass and length of stay.

Methods: The Plan-Do-Study-Act (PDSA) tool from the Institute for Healthcare Improvement (IHI) guided …

Sunscreen Is Not Just For White People: Church-Based Sunscreen Education For Black Women, Lauren Mitchell

DNP Projects

Significance and Background: African American women are an undeserved population in healthcare, particularly regarding skin cancer prevention. The lack of education and misinformation surrounding skin cancer has resulted in general mistrust of the healthcare system amongst African Americans. Proper education on sunscreen use and skin cancer screening is essential to prevent late diagnosis of skin cancer and to promote prevention efforts.

Purpose: This quality improvement project utilized evidence-based practice to provide education on the proper use of sunscreen and skin cancer screening to African American women in a faith-based setting in Southern Connecticut.

Methods: A pre-survey was conducted to assess …