Medical Specialties Commons^™

Early Screening Of Colorectal Cancer Using Feature Engineering With Artificial Intelligence-Enhanced Analysis Of Nanoscale Chromatin Modifications, Andrew Chang, Sravya Prabhala, Ali Daneshkhah, Jianan Lin, Hariharan Subramanian, Hemant Kumar Roy, Vadim Backman

Faculty, Staff and Students Publications

Colonoscopy is accurate but inefficient for colorectal cancer (CRC) prevention due to the low (~ 7 to 8%) prevalence of target lesions, advanced adenomas. We leveraged rectal mucosa to identify patients who harbor CRC field carcinogenesis by evaluating chromatin 3D architecture. Supranucleosomal disordered chromatin chains (~ 5 to 20 nm, ~1 kbp) fold into chromatin packing domains (~ 100 to 200 nm, ~ 100 to 1000 kbp). In turn, the fractal-like conformation of DNA within chromatin domains and the folding of the genome into packing domains has been shown to influence multiple facets of gene transcription, including the transcriptional plasticity …

Genetic Ancestry And Radical Prostatectomy Findings In Hispanic/Latino Patients, Natalia L. Acosta-Vega, Rodolfo Varela, Jorge Andrés Mesa, Jone Garai, Alberto Gómez-Gutiérrez, Silvia J. Serrano-Gómez, Jovanny Zabaleta, María Carolina Sanabria-Salas, Alba L. Combita

School of Medicine Faculty Publications

Background: African ancestry is a known factor associated with the presentation and aggressiveness of prostate cancer (PC). Hispanic/Latino populations exhibit varying degrees of genetic admixture across Latin American countries, leading to diverse levels of African ancestry. However, it remains unclear whether genetic ancestry plays a role in the aggressiveness of PC in Hispanic/Latino patients. We explored the associations between genetic ancestry and the clinicopathological data in Hispanic/Latino PC patients from Colombia. Patients and methods: We estimated the European, Indigenous and African genetic ancestry, of 230 Colombian patients with localized/regionally advanced PC through a validated panel for genotypification of 106 Ancestry …

Antibiotic Treatment For Well-Appearing Infants Born At ≥35 Weeks’ Gestation To Mothers With Chorioamnionitis Before And After Implementation Of Neonatal Early-Onset Sepsis Calculator, Surichhya Bajracharya, Preetha Prazad, Catherine Bennett, Nahren Asado

Journal of Patient-Centered Research and Reviews

Purpose

Our quality improvement study aimed to determine whether application of a neonatal early-onset sepsis calculator (NSC) among well-appearing infants born at ≥ 35 weeks’ gestation to mothers with chorioamnionitis decreases the number of lab evaluations (LEs) and antibiotic treatments (Abxs) without missing early-onset sepsis.

Methods

We compared 2 years (January 1, 2019–January 3, 2021) of data from a historical-control group before implementation of the NSC to 1 year (January 4, 2021–December 31, 2021) of data from a calculator group after implementation of the NSC to evaluate whether LE and Abx decreased following implementation of the NSC on January 4, …

A Systematic Review: Mirror Neurons & Schizophrenia, Yashesvi Sharma, Surajit Dey

Annual Research Symposium

This research project establishes a link between Mirror Neuron System (MNS) activity and this information's implications in treating and understanding schizophrenia, specifically, schizophrenic patients with negative symptoms.

Fire Safety In The Or, Raghda Abo Al Haija, Leah Cullop, Keeli Mckeel

Scholars Week

Fire safety in the operating room (OR) is crucial, and so it is important for the OR team to be aware of practices that help prevent and manage operating room fires. This presentation compiles evidence-based research on practices and interventions that promote OR fire safety.

Local Anesthetic Systemic Toxicity (Last): Provider Education, Alexis Johnson

Scholars Week

Abstract

Background: Local Anesthetic Systemic Toxicity (LAST) is a rare but serious complication due to accumulation of local anesthetics. If not treated quickly, LAST can cause detrimental complications such as seizures and cardiac arrest. Therefore, it is important that anesthesia providers are well versed in preventing, recognizing, and treating this adverse event.

Methods: A LAST flowchart written by The American Society of Regional Anesthesia and Pain Medicine (ASRA) was printed and placed in each operating room in a small suburban hospital. Anesthesia staff were also educated on recognizing signs and symptoms, onset time, high risk patients, and prevention.

Results: Ten …

The Impact Of Neurological Diseases In Kisumu, Kenya: Case Studies At Jootrh And Kcrh, Jack F. Dunham

Independent Study Project (ISP) Collection

Introduction: The burden that neurological diseases put on health systems is high, and growing across the globe, especially in Low- and Middle-Income Countries (LMICs) like Kenya. For this reason, our study sought out to study the burden and impact of neurological diseases at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) and Kisumu County Referral Hospital (KCRH), which are in Western Kenya.

Methods: Utilizing data from handwritten patient records spanning 23 months, our study collected said data and analyzed the prevalence, incidence, distribution, and outcomes of different neurological diseases as they impact the Kisumu community.

Results/Discussion: Comparing …

Managing Picky Eating In Your Child And Signs It May Be Something More, Maggie Mckay, Sara R. Gould

Parent-ish Podcast

No parent loves to hear "I don't like that!" at meal times. Dr. Sara Gould discusses how you can manage picky eating with your child, and when to look for signs that this could be something more serious.

Click here to stream the podcast episode.

Pods: A Team-Based Approached To Reduce The Left Without Being Seen Rate In An Urban, High-Volume Emergency Department, Charis Keane Md, Daryn Brauner Msn, Amy Bobbit Rn, Nikki Campbell Bsn, April Alfano Ms

Posters

The purpose of this QI project is to evaluate the impact of the Patient-Oriented Discharge System (PODS) model, a registered nurse-provider team-based approach, on reducing the rate of LWBS in a high-volume, urban ED

Improving Pain Air Cycles With Implementation Of Evidence-Based Reassessment Strategies, Carissa Corraro Dnp (C), Bsn, Rn.

Posters

The purpose of this quality improvement project was to implement evidence-based strategies (i.e., compliance audits, educational in-services, badge reels, and Posters with QR codes) to increase compliance of oncology nurses’ documentation of pain assessments and reassessments.

Transcatheter Aortic Valve Implantation Vs Surgical Aortic Valve Replacement In Solid Organ Transplant Recipients: Readmission Rates And Health-Care Burden, Manoj Kumar, Shafaqat Ali, Sanchit Duhan, Faryal Farooq, Bijeta Keisham, Yahya Khlidj, Malalai Manan, Yasar Sattar, Mahin R. Khan, Rohan Gajjar, Priya Hotwani Md, Sanjay Kumar, Hameem U. Changezi, Ahmad Munir, Kalgi A. Modi, Tarek Helmy

Internal Medicine Residency

Background Transcatheter Aortic Valve Implantation (TAVI) outnumbers Surgical Aortic Valve Replacement (SAVR) for Aortic Stenosis in the US. Readmission rates and the healthcare burden of these procedures in Solid Organ Transplant (SOT) recipients are poorly studied.

Methods National Readmission Database (2016-2020) was used to identify SOT recipients (Renal, Heart, Kidney, Lung & Pancreas) undergoing TAVI or SAVR. Propensity score matching (PSM) was used to remove confounding factors from outcomes. Descriptive and regression based analysis was performed.

Results Among 3,394 hospitalizations for Aortic Valve Replacement, 2,181 underwent TAVI & 1,213 underwent SAVR. SAVR was associated with higher median LOS (10 vs …

Storytelling Heals The Wounded Mind, Liliana Whitaker

Classical Conversations

Humans are storytelling creatures. We use stories to communicate ideas in a memorable and engaging way, inspire people to believe in the best version of themselves, find truth in our legal system, empathize with experiences different than our own, and entertain ourselves for hours on end. Recent neuroscience proposes that the human mind thinks through stories. Narrative is the technical and broad term for story, defined as a series of actions and events that unfold over time according to proper cause and effect. Narrative practice is an emerging field comprising of storytelling treatments in therapy and medicine, usually focusing on …

Objective Assessment Of Rupture Parameters In Intact And Acute Post-Cystorrhaphy Cadaveric Bladders, Geoffrey D. Towers, Dani G. Zoorob, Rose A. Maxwell, Ashley N. Reid, Jerome L. Yaklic, Jason C. Massengill

Obstetrics and Gynecology Faculty Publications

Background: Certain procedures, particularly those used to treat symptoms of bladder pain syndrome/interstitial cystitis (BPS/IC), involve filling the bladder to or over its capacity for visualization and/or relief of symptoms. Rarely, if excessive pressure or volume is used, bladders may rupture causing significant harm to the patient. The purpose of this study was to identify baseline data for pressure and volume when hydrodistention is attempted in explanted cadaveric bladders, as well as determine bladder rupture pressure changes in the acute post-cystorrhaphy state. Methods: Eight explanted cadaveric bladders were filled using a systematic digital pump system. Intravesical pressure and volume were …

Comparing Universal Versus Targeted School Screenings For Depression Among Teens, Reach Dissemination Committee, Maine, Usa

REACH: Research Evidence-to-Action for Community Health

The US Preventive Services Task Force endorses universal adolescent major depressive disorder (MDD) screening in primary care; however, most adolescents lack preventive health care, resulting in worsening disparities in MDD screening and treatment.

Wcn24-931 Aki Phenotypes In Ugandan Children Hospitalized With Hypoxemia And Malaria, Andrea Conroy, Anthony Batte, Rodney Ogwang, Sophie Namasopo, Robert Opoka, Michael Hawkes

Paediatrics and Child Health, East Africa

Introduction: Acute kidney injury (AKI) is a frequent life-threatening complication in hospitalized children. Emerging data suggest AKI is a heterogeneous condition that varies based on the underlying cause and is composed of distinct phenotypes. The objective of this study was to define AKI phenotypes using proposed classification systems in Ugandan children hospitalized with hypoxemia and to evaluate differences in phenotypes by malaria infection.

Methods: Between 2019 and 2021, 2402 Ugandan children <5 years of age hospitalized with hypoxemia were enrolled in a cluster randomized trial of solar powered oxygen delivery across 20 districts in Uganda. At enrollment, urine NGAL was measured using a point-of-care lateral flow test with a positive test defined as a level ≥150ng/mL. Malaria was assessed using a threeband rapid diagnostic test. In an extended sub-study, 491 children had creatinine measured to define AKI. AKI was defined using a single creatinine measure at enrolment and phenotypically characterized using two acute dialysis quality initiative (ADQI) proposed AKI phenotypes. The AKI biomarker definition incorporated urine NGAL into the KDIGO definition[group 1, no AKI; group 2, subclinical AKI (biomarker positive); group 3, AKI; group 4, biomarker positive AKI]. The ADQI sepsis AKI phenotype groups stage 1 AKI as sepsis phenotype (SP)-1 irrespective of biomarker status and differentiates severe AKI (stage 2/3) based on biomarker positivity where severe AKI that is biomarker negative is (SP2) and severe biomarker positive AKI is SP3.

Results: Overall, 491 children were included in the extended study with AKI defined and uNGAL measured. The median age was 1.3 years (interquartile range, 0.7 to 2.3) and 53.8% …

Neurocognitive Impairment In Ugandan Children With Sickle Cell Anaemia Compared To Sibling Controls: A Cross-Sectional Study, Paul Bangirana, Amelia Boehme, Annet Birabwa, Robert Opoka, Deogratias Munube, Ezekiel Mupere, Phillip Kasirye, Grace Muwanguzi, Maxencia Musiimenta, George Ru

Paediatrics and Child Health, East Africa

Introduction: The neurocognitive functions in Ugandan children aged 1–12 years with sickle cell anemia (SCA) were compared to their non-SCA siblings to identify risk factors for disease-associated impairment.

Methods: This cross-sectional study of the neurocognitive functions in children with SCA (N = 242) and non-SCA siblings (N = 127) used age- and linguistically appropriate standardized tests of cognition, executive function, and attention for children ages 1–4 and 5–12. Test scores were converted to locally derived age-normalized z-scores. The SCA group underwent a standardized stroke examination for prior stroke and transcranial Doppler ultrasound to determine stroke risk by arterial …

Decoding Implant-Related Sickness: Unraveling The Complexities Of Breast Implant Illness, Madison M. Stewart

Senior Theses

This thesis investigates the phenomenon of breast implant illness (BII), examining its potential correlation with individual factors such as obesity and poor lifestyle habits. BII, characterized by nonspecific symptoms, is often self-diagnosed by patients influenced by social media and internet sources, leading to requests for implant removal. Conducting a comprehensive meta-analysis, the study scrutinizes existing literature to evaluate the association between BII, obesity, and lifestyle choices. Employing inclusion criteria, peer-reviewed publications are analyzed through systematic review methodology to offer insights into the interplay between BII and adiposity, exploring inflammatory mechanisms and patient behaviors like exercise and smoking. The research aims …

"Fueling For A Healthy Life:" A Cooking Class For Adolescent And Young Adult Childhood Cancer Survivors, Hope Dominique

Senior Theses

Following cancer treatment, childhood cancer survivors (CCS) are at an increased risk of developing chronic diseases and face an increased risk of health-related death during adulthood. Recent literature demonstrates that modifying lifestyle factors such as nutrition can reduce the risk of late mortality in survivors, suggesting that interventions promoting a healthy lifestyle may improve quality and quantity of life for CCS. However, many adolescent and young adult (AYA) CCS do not adhere to national dietary guidelines and face both real and perceived barriers to adopting healthier eating habits while in a critical period for establishing behaviors that contribute to lifelong …

Gibbon Surgical Review, Volume 7, Issue 1, 2024

Gibbon Surgical Review

Table of Contents

6 - Socially Responsible Surgery: Better Practices for Better Outcomes

8 - Interview with Dr. Talar Tatarian - Assistant Professor

10 - Global Surgery : Current State and Involvement as a Trainee

12 - Interview with Dr. Ibnouf Sulieman - Transplant Surgery Fellow

14 - Resident Spotlight - Dr. Sam Nasser - PGY3

16 - A Review of the FIRST and SECOND Trials

18 - Residency Signaling in General Surgery

20 - Navigating Competency: Entrustable Professional Activities (EPAs)

22 - The Effect of Language Barriers on Surgical Outcomes

24 - Research Spotlight: The First Complete Human Eye …

Behavioral Health Integration And Outcomes That Matter To Patients: A Longitudinal Mixed-Methods Observational Study, Reach Dissemination Committee, Maine, Usa

REACH: Research Evidence-to-Action for Community Health

The study team hypothesized that patients would have a better experience over time in clinics that had greater degrees of behavioral health integration.

Telehealth Implementation Of A Young Adult Ibd Clinic: Uptake, Benefits To Patient Care, And Challenges, Angela Combs Ma, Alaina Linafelter, Jordan Sevart, Michele H. Maddux

Posters

Introduction: Since the COVID-19 pandemic, pediatric psychologists have been at the forefront of telemedicine expansion to ensure access for patients and families to needed mental health services. This has required adaptations across the care continuum – from scheduling to service delivery to documentation. This poster aims to summarize the telehealth (TH) application of a Young Adult IBD Clinic (YAC-IBD) that provides transition preparation to youth with Inflammatory Bowel Disease (IBD). Methods: In April 2020, the YAC-IBD was converted from in-person visits to a virtual visit format. Since then, 119 youth ages 17-21 (inclusive) have been seen in this clinic. This …

Increasing Palliative Care Team Involvement In Pediatric Hematopoietic Stem Cell Transplant Patients, Meagan Vacek, Lisa Tarbell, Melissa List, Erin Hall, Jennifer Linebarger, Kelstan Ellis, Gina Jones, Joel Thompson

Posters

Background: Palliative care facilitates communication, helps with physical and psychological symptom management, and assists in goals of care and advance care planning discussions.1 Multiple organizations, including the American Academy of Pediatrics and American Society of Clinical Oncology encourage palliative care engagement and their involvement with hematopoietic stem cell transplant (HSCT) patients has been shown to be beneficial as HSCT is associated with a high degree of morbidity and possible mortality.2-3 Objective: To increase the number of PaCT consults for patients receiving HSCT for our targeted diagnoses from 48% to 75% by December 2023. Methods: Chart review was conducted for patients …

Primary Hypertrophic Osteoarthropathy: A Case Series, Varuni Pragya, Mahabaleshwar Mamadapur Dr, Rahul Bisaralli Dr, Deepak Benny Dr, Purna Bansal

Digital Journal of Clinical Medicine

Skeletal dysplasia encompasses a spectrum of over 400 rare inheritable skeletal abnormalities typically manifested early in childhood. Hypertrophic Osteoarthropathy is a clinical syndrome marked by abnormal skin and osseous tissue proliferation at the distal extremities. It is characterized by unique clinical features such as digital clubbing, periostosis of tubular bones, and synovial effusions.

We report three cases of HPOA for further understanding and insight into this infrequent cause of clubbing. Case 1 involved a 25-year-old male presenting with joint pain, primarily in wrists and knees, accompanied by progressive swelling in both lower limbs for the past 3 years. Case 2 …

Implementing In-Room Recycling On A Family Medical Center, Ariann Schultz, Sarah Johnson

Articles, Abstracts, and Reports

No abstract provided.

Perceived Moral Distress Among Patient-Facing Healthcare Professionals During The Covid-19 Pandemic, Sarah Sumner, Karen Colorafi, Teresa Rangel

Articles, Abstracts, and Reports

No abstract provided.

Preventing And Responding To Workplace Violence In The Emergency Department, Janina La Porte, Stefanie Lai, Alicia Rodriguez

Articles, Abstracts, and Reports

No abstract provided.

Changing The Way Providers Order Blood Return To Intensive Care Patients, Chloe Morris

Spring Showcase for Research and Creative Inquiry

Patients with anemia and other conditions resulting in loss of blood often come with orders to return wasted blood to them. While using typical blood draw practices, patients are placed at an increased risk of infection when their blood is exposed to the outside world. My question is, will using a closed system decrease the instances of infection in patients who receive their waste blood after draws? By utilizing a waste syringe attached to the IV line, nurses can avoid detaching and reattaching syringes to collect and give back the patient's blood. Patients who are already at an increased risk …

Platelet-Derived Thrombospondin 1 Promotes Immune Cell Liver Infiltration And Exacerbates Diet-Induced Steatohepatitis, Taesik Gwag, Sangderk Lee, Zhenyu Li, Alana Newcomb, Josephine Otuagomah, Steven A. Weinman, Ying Liang, Changcheng Zhou, Shuxia Wang

UK CARES Faculty Publications

Background & Aims: Recent studies have implicated platelets, particularly a-granules, in the development of non-alcoholic steatohepatitis (NASH). However, the specific mechanisms involved have yet to be determined. Notably, thrombospondin 1 (TSP1) is a major component of the platelet a-granules released during platelet activation. Hence, we aimed to determine the role of platelet-derived TSP1 in NASH.

Methods: Platelet-specific Tsp1 knockout mice (TSP1Dpf4 ) and their wild-type littermates (TSP1 F/F) were used. NASH was induced by feeding the mice with a diet enriched in fat, sucrose, fructose, and cholesterol (AMLN diet). A human liver NASH organoid model was also employed.

Results: Although …

Primary Care Organizational Readiness And Implementation Climate For Task Sharing Of Tele-Mental Health Interventions, Frances Chu, Brenna Renn, Erin Abu-Rish Blakeney, Sean Munson, Oleg Zaslavsky

Articles, Abstracts, and Reports

Primary Care Organizational Readiness and Implementation Climate for Task Sharing of Tele-Mental Health Interventions

Chu, F.; Renn, B.; Blakeney, E.; Munson, S.; Zaskavsky, O. Providence Swedish/University of Washington, Seattle, WA

Purpose: To examine perceptions of organizational readiness and implementation climate for task sharing of telemental health (TMH) interventions from primary care healthcare professionals by levels of behavioral health integration (BHI) and roles. Background/Significance: BHI clinics have positive impact on patient outcomes. Task sharing, a strategy used to address shortages of behavioral/mental health (BMH) specialists, with TMH interventions adds complexity. Method: The mixed methods study surveyed 151 healthcare professionals with Organizational …

Testing For Bleeding Disorders In Child Abuse: Adherence To Aap Recommendations And Results Of Testing, Lyndsey Hultman, Angela Doswell, Henry T. Puls, Shannon L. Carpenter, Angela Bachim, Kristine Campbell, Daniel Lindberg, Joanne Wood, James Anderst

Presentations

Background: The American Academy of Pediatrics (AAP) recommends evaluations for bleeding disorders in children who have bruising and/or intracranial hemorrhage (ICH) concerning for abuse. Adherence to these recommendations is not known nor are the frequencies of identification of bleeding disorders or laboratory findings suggestive of a bleeding disorder. Objective: Using a multicenter research network (CAPNET), the objectives of this study were to characterize (1) the adherence to AAP recommendations for bleeding disorder testing in total and across CAPNET sites and (2) the frequency of identification of specific bleeding disorders and laboratory values concerning for bleeding disorders. Methods: We performed a …