Medical Specialties Commons^™

Improving Emergency Department Belongings Inventory Electronic Medical Record Documentation, Shanekia Garrett, Stefanie Lai, Jairo Pagan, Wendy Lu, Katie Whitehead

Articles, Abstracts, and Reports

No abstract provided.

How To Talk To Your Kids About Tragic Events, Maggie Mckay, Rachel Lapidus

Parent-ish Podcast

It never gets easier to talk to your kids about tragedies or senseless violence. But, you have the ability to create a safe space for your children to process what has happened.

Click here to stream the podcast episode.

Retrorectal Hernia: A Rare Cause Of Constipation Diagnosed On Magnetic Resonance (Mr) Defecography, Olanrewaju Ogunleye, Abeer H Abdelhafez, Eduardo Matta, Larry Kramer

Faculty, Staff and Student Publications

Retrorectal herniation of the sigmoid colon is a rare condition characterized by the protrusion of a segment of the colon into the pre-sacral space and posterior to the rectum. This herniation occurs through a defect in the peritoneum, which may have developed secondary to congenital mechanisms, surgery, trauma, or inflammatory processes. Here, a case of retrorectal herniation of the sigmoid colon in an elderly female patient presenting with constipation is reported, with a review of the literature.

Independent Study Project: The Impact Of Digitization And Payment On Community Health Promoter (Chp) Motivation And Effectiveness In A Peri-Urban Community In Kisumu, Kenya., Fiona Yohannes

Independent Study Project (ISP) Collection

Community Health Promoters (CHPs) in Kenya are the liaison between the community and higher levels of healthcare. As CHPs’ responsibility in the country has grown, stipends started being distributed, and digitization efforts have begun to support them. This ISP paper aims to investigate how recent digitization and payment of CHPs impact their motivation and effectiveness in a peri-urban community in Kisumu, Kenya. The project includes data analysis on CHP performance data from 2016 to 2021 and analyses of interviews with CHPs and CHAs in April of 2024. It was found that time was positively related to CHP performance. It was …

El Derecho A La Interrupción Voluntaria Del Embarazo A Inicios Del Gobierno De Javier Milei (Argentina, 2024) / The Right To The Voluntary Interruption Of Pregnancy At The Beginning Of The Government Of Javier Milei (Argentina, 2024), Willa Rudel

Independent Study Project (ISP) Collection

El objetivo de esta investigación fue entender las realidades del activismo en relación con el derecho al aborto en Argentina en el período después de la aprobación de la ley 27.610 del derecho a la interrupción voluntaria del embarazo, particularmente en 2020 y durante el gobierno actual de Javier Milei. Para responder la pregunta que articula la presente investigación, realicé seis entrevistas con activistas procedentes de una variedad de formaciones y con distintos tipos de participación en el movimiento. Primero describo la historia del activismo a favor del aborto en Argentina hasta la aprobación de la ley y el estado …

A Physiological Approach To Renal Clearance: From Premature Neonates To Adults, Nick Holford, Conor J. O'Hanlon, Karel Allegaert, Brian Anderson, Amilcar Falcão, Nicolas Simon, Yoke Lin Lo, Alison H. Thomson, Catherine M.T. Sherwin, Evelyne Jacqz-Aigrain, Carolina Llanos-Paez, Stefanie Hennig, Linas Mockus, Carl Kirkpatrick

Pediatrics Faculty Publications

Aims: We propose using glomerular filtration rate (GFR) as the physiological basis for distinguishing components of renal clearance. Methods: Gentamicin, amikacin and vancomycin are thought to be predominantly excreted by the kidneys. A mixed-effects joint model of the pharmacokinetics of these drugs was developed, with a wide dispersion of weight, age and serum creatinine. A dataset created from 18 sources resulted in 27,338 drug concentrations from 9,901 patients. Body size and composition, maturation and renal function were used to describe differences in drug clearance and volume of distribution. Results: This study demonstrates that GFR is a predictor of two distinct …

A Qualitative Study On Mother's Occupational Engagement After A Nicu Experience, Rachel Garcia, Mary Ann Smith, Julie Heftie Ms, Otr/L

Spring 2024 Virtual OTD Capstone Symposium

Mothers who are “at-risk” for complications during pregnancy have an increased probability for mental health conditions following delivery, adversely affecting their engagement in motherhood occupations. This qualitative study identifies how best to address the needs of “at-risk” pregnant women. Through the process of conducting semi-structured interviews with women who have experienced NICU with their babies, and interviews with healthcare practitioners working in the NICU, their narrative addresses what approaches would support women while they are going through their “at-risk” pregnancies to assist them with the transition to their occupational roles as mothers and promote bonding with their baby.

An Occupational Therapy Approach To Improving Adl/Iadl Performance In Diabetic Adults With Stroke And Upper Extremity Pathologies, Halle Thomas, Cassandra Nelson

Spring 2024 Virtual OTD Capstone Symposium

This capstone presentation depicts the impact of diabetic management with an occupational therapy approach on upper extremity motor function for the adult stroke population. This program utilizes dietary management, a home exercise program, and task modification strategies to improve ADL and IADL performance.

Speeding Up Time: An Old Back In A Young Athlete, Carey Wagoner, Greg Canty

Posters

Case of a 16 year old female competitive dancer with chronic back pain. Previous diagnosis of mechanical low back pain being treated by PT without improvement. Further workup demonstrated bilateral spinal synovial cysts at L4/L5 facet joints. Patient underwent IR guided aspiration and steroid injection with resolution of her symptoms and ultimately returned to dance.

Incidental Actinomycosis In A 44-Year-Old Female During Total Abdominal Hysterectomy For Abnormal Uterine Bleeding: A Case Report, Willbroad Kyejo, Ally Zain Ismail, Abduel Kitua, Gregory Ntiyakunze, Munawar Kaguta, Ally Mwawnga

Family Medicine, East Africa

Actinomycosis, a rare chronic bacterial infection caused by Actinomyces species, presents diagnostic challenges due to diverse clinical presentations. This report presents a case of peritoneal actinomycosis incidentally discovered during a total abdominal hysterectomy in a 44-year-old female with refractory abnormal uterine bleeding and a history of long-term intrauterine contraceptive device use. The patient presented with persistent abnormal uterine bleeding despite conservative management. Intraoperative findings during total abdominal hysterectomy revealed peritoneal involvement, prompting histopathological evaluation confirming actinomycosis. This case highlights diagnostic complexities associated with actinomycosis, emphasizing the significance of histopathological confirmation. Postoperative management with antibiotics demonstrated favorable outcomes, supporting their efficacy …

Ovarian Torsion, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Time To Full Enteral Feeds In Hospitalised Preterm And Very Low Birth Weight Infants In Nigeria And Kenya, Zainab Imam, Helen Nabwera, Olukemi Tongo, Pauline Andang’O, Isa Abdulkadir, Chinyere Ezeaka, Beatrice Ezenwa, Iretiola Fajolu, Martha Mwangome, Dominic Umoru

Paediatrics and Child Health, East Africa

Background: Preterm (born < 37 weeks’ gestation) and very low birthweight (VLBW; <1.5kg) infants are at the greatest risk of morbidity and mortality within the first 28 days of life. Establishing full enteral feeds is a vital aspect of their clinical care. Evidence predominantly from high income countries shows that early and rapid advancement of feeds is safe and reduces length of hospital stay and adverse health outcomes. However, there are limited data on feeding practices and factors that influence the attainment of full enteral feeds among these vulnera- ble infants in sub-Saharan Africa.

Aim: To identify factors that influence the time to full enteral feeds, defined as tolerance of 120ml/ kg/day, in hospitalised preterm and VLBW infants in neonatal units in two sub-Saharan Afri- can countries.

Methods: Demographic and clinical variables were collected for newborns admitted to 7 neonatal units in Nigeria and Kenya over 6-months. Multiple linear regression analysis was conducted to identify factors independently associated with time to full enteral feeds.

Results: Of the 2280 newborn infants admitted, 484 were preterm and VLBW. Overall, 222/484 (45.8%) infants died with over half of the deaths (136/222; 61.7%) occurring before …

Kawasaki Disease In Kenya And Review Of The African Literature, Angela Migowa, Catherine Njeri, Edwin Were, Thomas Ngwiri, L Colmegna

Paediatrics and Child Health, East Africa

Background: Kawasaki disease has been described across the globe, although publications from Africa are limited. To our knowledge, there are no publications on Kawasaki disease from Kenya, which triggered this report.

Methods: A retrospective cross-sectional study was undertaken to identify in-patients with a discharge diagnosis of Kawasaki disease, over 2 different 5-year periods, at two pediatric hospitals in Nairobi, Kenya. We reviewed the medical records of all patients and report their clinical findings, diagnostic workup and treatment. In addition, we undertook a detailed review of the literature.

Results: Twenty-three patients with Kawasaki disease were identified, of those 12 (52.2%) had …

Do You Want To Be A Urologist? Gender Differences For Medical Student Perception Of Urology, David Chung, Suvig Dua, Michael Morra, Karim Sidhom, Kunal Jain, Gregory Hosier

Faculty, Staff and Student Publications

INTRODUCTION: Gender inequality has been prevalent in the history of medicine, specifically within surgical specialties. Though there have been advances, urology has remained overwhelmingly male-dominant, with slow growth in female recruitment. This survey study evaluated whether gender-related differences in the perception of urology are present among future applicants that could account for gender disparity seen in recruitment.

METHODS: An anonymized, online survey was distributed to medical students enrolled at the Max Rady College of Medicine during the 2022-2023 semester. Attracting and deterring survey statements were created using current literature to guide topics of interest. Participants rated each statement using a …

Clinical Care For Life's Essential 8 By Medical Specialty In The United States, An Observational Cohort Study., Michael E Johansen, Madeline R Sterling, Jeremy B Sussman

Heart and Vascular Articles

No abstract provided.

The Time Is Now For Vascular Medicine, Heather L Gornik, Raghu Kolluri, Herbert Aronow, Bruce Gray, Geno Merli, Ido Weinberg, Joshua A Beckman

Heart and Vascular Articles

No abstract provided.

Simplifying Transcatheter Tricuspid Valve Replacement With 3-Dimensional Intracardiac Echocardiography., Carlos E Sanchez, Steven J Yakubov

Heart and Vascular Articles

Transcatheter tricuspid valve replacement (TTVR) offers the potential for improved outcomes for the significant number of patients with severe tricuspid valve regurgitation relative to current treatment options. Imaging is a critical component of the success of this procedure. Here we describe strategies and techniques for the use of 3-dimensional intracardiac echocardiography as an adjunct to standard transesophageal echocardiography during TTVR procedure.

Successful Extravascular Implantable Cardioverter-Defibrillator Implantation In A Patient With Recurrent Transvenous Implantable Cardioverter-Defibrillator Erosion., Andrea Robinson, Sreedhar Billakanty, Eugene Fu, Anish Amin

Heart and Vascular Articles

No abstract provided.

Continuous Renal Replacement Therapy For Lithium Toxicity: A Worthy Treatment To Avoid Intradialytic Hypotension And Vasopressors., Pooya Zardoost, Zachary Buckman, Joseph Weaver, Sidney Elston, Alex Prouty, Ryan Stuart, Henry L Wehrum

Ambulatory and Primary Care Articles

While intermittent hemodialysis (HD) is the most efficient method of removing lithium in patients with lithium toxicity, continuous renal replacement therapy is an acceptable alternative in the setting of intradialytic hypotension. This form of dialysis can reduce the need for vasopressors during HD, which increases mortality.

Parosteal Lipoma Of The Left Femur: A Case Report., James P Waters, Sydney Horenstein, Austin Egger, Parker Johnsen, Tae Won Kim

Orthopedic Surgery Resident Research

Multidisciplinary team collaboration in the diagnosis of rare tumors such as parosteal lipoma is highly important, especially when suspicious of malignancy. The use of radiological and physical examinations is imperative to monitor recurrence and quality of life.

Deprescribing Proton Pump Inhibitors In A Rural Health Clinic, Jason Thomas Barney

Doctoral Dissertations & Projects

Background: Proton pump inhibitors (PPIs) have been extensively prescribed for gastrointestinal pathologies, contributing to $14 billion in annual expenditure in the United States alone. Inappropriate PPI prescriptions, affecting 48% of adults, raise concerns about prolonged usage and associated health risks. Addressing these issues is vital, considering the significant impact of PPIs on patient health and healthcare costs.

Local Problem: A Midwestern clinic grapples with inappropriate and unnecessary PPI use among patients. In response, a comprehensive deprescribing intervention combining a provider algorithm with patient education was implemented to reduce PPI usage that was medically unnecessary.

Methods: A literature …

Robust Capital Cost Optimization Of Generation And Multitimescale Storage Requirements For A 100% Renewable Australian Electricity Grid, Raheel A Shaikh, David J Vowles, Alex Dinovitser, Andrew Allison, Derek Abbott

Faculty, Staff and Student Publications

Transitioning from a fossil-fuel-dependent economy to one based on renewable energy requires significant investment and technological advancement. While wind and solar technologies provide lower cost electricity, enhanced energy storage and transmission infrastructure come at a cost for managing renewable intermittency. Energy storage systems vary in characteristics and costs, and future grids will incorporate multiple technologies, yet the optimal combination of storage technologies and the role of interconnectors in alleviating storage needs are not widely explored. This study focuses on optimal generation-storage capacity requirements to elucidate associated investments. We propose a multitimescale storage solution consisting of three storage categories and an …

Peripheral Artery Disease Causes Consistent Gait Irregularities Regardless Of The Location Of Leg Claudication Pain, Hafizur Rahman, Todd Leutzinger, Mahdi Hassan, Molly Schieber, Panagiotis Koutakis, Matthew A. Fuglestad, Holly Despiegelaere, G. Matthew Longo, Philippe Malcolm, Jason M. Johanning

School of Podiatric Medicine Publications

Highlights

• Peripheral artery disease (PAD) is a multi-level disease.

• PAD diffusely impairs the performance of leg muscles.

• PAD causes similar irregularities in gait biomechanics regardless of where claudication pain is located in the leg.

Abstract

Background

The most common symptom of peripheral artery disease (PAD) is intermittent claudication that involves the calf, thigh, and/or buttock muscles. How the specific location of this leg pain is related to altered gait, however, is unknown.

Objectives

We hypothesized that because the location of claudication symptoms uniquely affects different leg muscle groups in people with PAD, this would produce distinctive walking patterns.

Methods

A …

A Rare Case Of Biliary Atresia With Biliary Ascites On A (Hepatobiliary Iminodiacetic Acid) Hida Scan, Poonamjeet Loyal, Khalid Makhdomi, Samuel Gitau

Imaging & Diagnostic Radiology, East Africa

Biliary atresia is one of the most challenging conditions in pediatric surgery even when it is the only finding. Here we present a rare case of biliary atresia complicated with biliary ascites due to ductal perforation identified on a hepatobiliary iminodiacetic acid (HIDA) scan.

Wcn24-2067 Regional Differences In Acute Kidney Injury In Ugandan Children Hospitalized For Hypoxemia, Anthony Batte, Rodney Ogwang, Robert Opoka, Sophie Namasopo, Michael Hawkes, Andrea Conroy

Paediatrics and Child Health, East Africa

Introduction: Acute kidney injury (AKI) is associated with increased mortality in hospitalized patients and incidence is highest in resource limited settings. The objective of this study was to assess sub-National regional differences in the incidence of AKI in children <5 years of age hospitalized with an acute febrile illness and hypoxemia.

Methods: This was a secondary analysis of a stepped wedge cluster randomized controlled trial, which enrolled children <5 years of age hospitalized with hypoxemia between 2019 and 2021. At least one measure of kidney function was available in 1452 children. A single creatinine was measured at enrolment in a sub-set of 495 children with serum stored and AKI defined using KDIGO criteria where baseline creatinine was estimated using the age-based Pottel equation assuming a normal glomerular filtration rate of 120mL/min per 1.73m2. Markers were divided into structural (uNGAL positive, proteinuria, hematuria) or functional (AKI, saliva urea nitrogen (SUN)) measures of kidney injury.

Results: 1452 children were included in this AKI sub-study (Figure 1). The mean age of participants was 1.49 years (standard deviation (SD), 1.21) and 55.7% were male (809/1452). Overall 2.6% of children died (38/1452). The majority of participants enrolled were from the West (31.3%) …

Something's Gnawing At Me, Catharine Kral, Brian Harvey

Posters

17-year-old female presented to Sports Medicine clinic with a chief complaint of bilateral hip pain and difficulty walking who was found to have bilateral ovarian teratoma.

Novel Insights Into The Autoimmune Mechanisms In Coxsackievirus B Infections And Their Prevention By Vaccination, Mahima Theresa Rasquinha

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Coxsackievirus Bs (CVBs) are RNA viruses of the genus Enterovirus belonging to the Picornaviridae family. CVBs commonly infect humans, and multiple CVB types can induce similar diseases such as myocarditis, pancreatitis, and type 1 diabetes (T1D). Although CVB infections can lead to the generation of autoantibodies, their role in disease is poorly defined, and vaccines are not available to prevent or minimize these infections. To fill these gaps, we first analyzed the autoantibody repertoire in mice infected with CVB3 by Phage ImmunoPrecipitation Sequencing (PhIP-Seq) and identified autoantibodies for several novel antigens not previously reported. The data were validated using enzyme-linked …

Detection And Management Of Post Intensive Care Syndrome, Ann Tomy

Nursing | Student Research Posters

Post Intensive Care Syndrome (PICS) is a collection of symptoms that more than half of patients who survive a critical illness experience after discharge.Those symptoms include weakness, fatigue, sleep disturbances, cognitive dysfunction, post-traumatic stress disorder, mental health conditions, and a lack of effective coping strategies. PICS can significantly impact an individual's quality of life, complicating the recovery process and posing challenges for reintegration into daily activities and societal roles. The etiology of PICS is multifactorial, with the severity and duration of the illness, the nature of medical interventions in the ICU, and the pre-existing health condition of the patient all …

The Impact Of Silver-Impregnated External Ventricular Catheter On The Rate Of Catheter-Related Infection At The Aga Khan University Hospital, Nairobi, Monica Adongo Nyikal

Master of Medicine in General Surgery

Background: 

External Ventricular Drain insertion has been practised at the Aga Khan University Hospital for more than 15 years, with the initial use of plain catheters. Subsequently between 2016 and 2017 the use of Silver-impregnated external ventricular catheters was adopted in the hospital with the aim of reducing external ventricular catheter-related infections. There is a need to assess the effect of the Silver-impregnated external ventricular drain (EVD).

Objectives: 

The primary objective of the study was to determine the difference in the incidence of EVD related infections between the plain EVD and Silver-impregnated EVD at AKUHN in the duration between the …

Uncemented Total Knee Arthroplasty Is On The Rise. A Retrospective Review From The Michigan Arthroplasty Registry Collaborative Quality Initiative (Marcqi), Michael E. Sacchetti, Sarah Fried, Madeleine Declercq, Jacob H. Keeley, Robert Runner

Conference Presentation Abstracts

OBJECTIVE: Cemented total knee arthroplasty (TKA) is the gold standard treatment for osteoarthritis, but uncemented TKA offers benefits like improved osseointegration and reduced complications from cement debris. This study aimed to investigate (1) if there has been a rise in uncemented TKA and (2) if there are differences in early complications between cemented and uncemented TKA. METHODS: We retrospectively reviewed data from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database of primary TKA patients from 2017 to 2021 at a single health system (six hospitals). Uncemented TKA (uncemented fixation for femur and tibia) patients were analyzed for demographics and …