Medical Specialties Commons^™

The Protective And Pathological Role Of The Spleen In Malaria, Julie Hwang, Md, Amy Dechet

Books, Presentations, Posters, Etc.

Case Presentation: • Background: There were 241 million cases of malaria globally. Compared to 2,000 cases in the U.S. Splenomegaly has previously been used to determine the severity of malaria. This is a rare case of hyper reactive malarial splenomegaly (HMS) due to chronic plasmodium ovale • 23 year-old female with gradually worsening left upper quadrant abdominal pain of 1 month. Pain sharp and stabbing in quality, no alleviating or aggravating factors. Associated with subjective early satiety and 10 Ibs weight loss, generalized weakness, shortness of breath • PMH: Schistosomiasis 2008,unclear if treated • Soc: Born in Congo and immigrated …

Not Just A Biblical Disease: Hansen’S Disease (Leprosy) Oregon’S Unique Differential, Zach Taylor, Justin Jin, Andrea Roast, Amy Dechet

Books, Presentations, Posters, Etc.

Background: Hansen’s disease (leprosy) is caused by a gram-positive, acid-fast bacilli called Mycobacterium leprae. It is very slow growing and has an indolent disease process. The disease is more prevalent in underdeveloped countries with poor access to care including Brazil, India, sub-Saharan Africa, and the Pacific Islands including Micronesia and the Philippines. However, it is becoming in creasingly common in the United States, specifically in areas with high levels of immigration from Micronesia. Case: Our patient was a 35-year-old Micronesian man who presented with 7 days of non-traumatic right hand pain with progressive swelling. He migrated to US from Micronesia …

Don’T Poke The Bear: Pheochromocytoma Unmasked By Covid-10, Taylor Virtue, Andrea Roast

Books, Presentations, Posters, Etc.

Introduction: Pheochromocytomas are tumors of the adrenal gland which produce excess catecholamines. The classic clinical triad is paroxysmal headache, diaphoresis, and tachycardia. The rare incidence makes this a challenging diagnosis which is even more challenging in the environment of the COVID-19 pandemic. Case Presentation: Setting: Establishing care visit at a primary care office Demographic: 42 year old male Medical history: Previously well-controlled hypertension, prediabetes HPI: • Weeks of profound, persistent fatigue and lightheadedness after the resolution of acute symptoms (fever, chills) from COVID-19 infection. Denies any headaches or palpitations. • Meticulously measuring vital signs at home. He has noticed that …

Tobacco Cessation Email Outreach In A Primary Care Setting, Katie Berry, Md, Meera Jain

Books, Presentations, Posters, Etc.

Background: . • Tobacco use remains the #1 cause of preventable death in the United States • Providence Health and Patient Education Program offers resources for tobacco cessation (eg. Virtual classes), but few patients access these services • Xealth® is a digital healthcare technology company contracted with Providence that aims to provide digital content to improve patient care and resources to analyze data • Study purpose: Assess if digital outreach to patients helps engagement in tobacco cessation services • Our clinic was a pilot clinic to develop the intervention and assess efficacy prior to roll out to all Providence Medical …

Associations Of Social Isolation And Loneliness With Mci Among Older Adults From Underresourced Communities, Fang Fang, Tiffany Hughes, Yueting Wang, Erin Jacobsen

Research and Infrastructure Service Enterprise (RISE) Faculty Publications

Previous studies have shown social isolation and loneliness are associated with poor cognitive outcomes in later life, yet it is unclear if these findings could be confounded by selective attrition. This study examines longitudinal associations of social isolation and loneliness with incident mild cognitive impairment (MCI) accounting for informative drop-out due to death or disease. Data were from a population-based cohort study of older adults in Southwestern Pennsylvania, whose once-vibrant economy heavily relied on the steel industry until it collapsed in the 1970s and has not fully recovered. Participants (N=1,254) were followed for 12 years for the development of MCI. …

Risk An Protective Factors For Increasing Isolation And Loneliness Among Older Adults, Tiffany Hughes, Fang Fang, Yueting Wang, Erin Jacobsen

Research and Infrastructure Service Enterprise (RISE) Faculty Publications

Social isolation and loneliness are associated with poor health and quality of life as well as decreased longevity. This study examines patterns of change in self-reported isolation and loneliness, and factors associated with these patterns, using data from 1,474 cognitively normal participants followed annually for up to 12 years in a population-based cohort study of older adults. Composite measures of isolation and loneliness were created, and trajectory analyses were conducted to detect patterns of change in these composites over time. Multinomial logistic regression tested associations of baseline demographic, health, and lifestyle factors with patterns of change in isolation and loneliness. …

Evaluating Outcomes Post-Adoption Of Reck Solution For Total Shoulder Arthroplasties: A Retrospective Quality Analysis, Benjamin Levi Tillis

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Evaluating Outcomes Post-adoption of RECK Solution for Total Shoulder Arthroplasties: A Retrospective Quality Analysis

Benjamin Tillis

Introduction: Local infiltration analgesia (LIA) has become an integral part of postoperative pain relief for West Virginia University (WVU) Medicine’s total joint arthroplasty procedures. However, not all LIAs are the same. Liposomal bupivacaine has a unique mechanism of delivery which could potentially lead to longer lasting effects. Ropivacaine, epinephrine, clonidine, and ketorolac (RECK) solution offers a multimodal approach to enhancing the duration of effect for the LIA. In 2022, WVU Medicine switched from liposomal bupivacaine to the RECK solution for total joint …

Impact Of Tiered Implementation Of Clinical Decision Support System For Acute Kidney Injury And Nephrotoxin Exposure In Cardiac Surgery Patients, Christopher M. Justice Ii

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Nephrotoxin exposure may worsen kidney injury and impair kidney recovery if continued in patients with acute kidney injury (AKI).

Objective: To determine if tiered implementation of a clinical decision support system (CDSS) would reduce nephrotoxin use in cardiac surgery patients with AKI.

Methods: We assessed patients admitted to the cardiac surgery intensive care unit at a tertiary care center from January 2020 to December 2021, and August 2022 to September 2023. A passive electronic AKI alert was activated in Jul 2020, followed by an electronic nephrotoxin alert in March 2023. In this alert, active nephrotoxic medication orders resulted in …

The Effect Of Calcium Channel Blockers On Digital Ulcers In Systemic Sclerosis: Data From A Prospective Cohort Study, Laura Ross, Dylan Hansen, Nancy Maltez, Kathleen Morrisroe, Kimti Kumar, Jennifer Walker, Wendy Stevens, Joanne Sahhar, Gene-Siew Ngian, Lauren Host, Mandana Nikpour, Susanna Proudman

Faculty, Staff and Student Publications

Digital ulcers (DU) are a common, severe vascular manifestation of systemic sclerosis (SSc) with few effective treatment options. Using data from the Australian Scleroderma Cohort Study (ASCS), we sought to evaluate the effect of calcium channel blockers (CCB) on the treatment and prevention of DU.Using data from 1953 participants, with a median of 4.34 years of follow-up, we used generalised estimating equations to evaluate the clinical characteristics associated with CCB use and ascertain the risk factors for the presence of DU at subsequent study visits. A time-dependent Cox-proportional hazard model was applied to evaluate the risk of future occurrence of …

Unraveling The Prognostic Significance Of Frgs Gene Family In Gastric Cancer And The Potential Implication Of Rgs4 In Regulating Tumor-Infiltrating Fibroblast, Yalan Yang, Siyuan Xing, Xi Luo, Lulu Guan, Yao Lu, Yiting Wang, Feng Wang

Faculty, Staff and Student Publications

Regulator of G-protein signaling (RGS) proteins are regulators of signal transduction mediated by G protein-coupled receptors (GPCRs). Current studies have shown that some molecules in the RGS gene family are related to the occurrence, development and poor prognosis of malignant tumors. However, the RGS gene family has been rarely studied in gastric cancer. In this study, we explored the mutation and expression profile of RGS gene family in gastric cancer, and evaluated the prognostic value of RGS expression. Then we established a prognostic model based on RGS gene family and performed functional analysis. Further studies showed that RGS4, as an …

Perceptions Of Acute Care Telemedicine Among Caregivers For Persons Living With Dementia: A Qualitative Study, Anita Chary, Norvin Hernandez, Ana Paulina Rivera, Vivian Ramont, Tracey Obi, Ilianna Santangelo, Christine Ritchie, Hardeep Singh, Emily Hayden, Aanand D Naik, Shan Liu, Maura Kennedy

Faculty, Staff and Student Publications

Persons living with dementia (PLWD) have high emergency department (ED) utilization. Little is known about using telemedicine with PLWD and caregivers as an alternative to ED visits for minor acute health problems. This qualitative interview-based study elicited caregivers' perspectives about the acceptability of telemedicine for acute complaints. We performed telephone interviews with 28 caregivers of PLWD from two academic EDs, one in the Northeast and another in the South. Using a combined deductive-inductive approach, we coded interview transcripts and elucidated common themes by consensus. All caregivers reported they would need to participate in the telemedicine visit to help overcome communication …

Streptococcus Pneumoniae Serotype 19a In Hospitalized Children With Invasive Pneumococcal Disease After The Introduction Of Conjugated Vaccines In Lima, Peru, Theresa J Ochoa, Olguita Del Águila, Isabel Reyes, Eduardo Chaparro, María E Castillo, Francisco Campos, Andrés Saenz, Roger Hernandez, Alessandra Luna-Muschi, Franco Castillo-Tokumori, Andrea E Montero, Brayan E Gonzales, Erik H Mercado

Faculty, Staff and Student Publications

BACKGROUND: The Pneumococcal conjugate vaccine (PCV) has decreased cases of invasive pneumococcal disease (IPD) worldwide. However, the impact of PCVs introduction may be affected by the serotype distribution in a specific context.

METHODS: Cross-sectional multicenter passive surveillance study of IPD cases in pediatric patients hospitalized in Lima, Peru between 2016 and 2019 (after PCV13 introduction) to determine the serotype distribution and antimicrobial resistance of Streptococcus pneumoniae. Serotyping was performed by a sequential multiplex PCR and confirmed by whole genome sequencing.

RESULTS: Eighty-five S. pneumoniae isolates were recovered (4.07/100,000 among childrenage). Serotype 19A was the most common (49.4%). Children infected with …

Understanding Primary Care Physician Perspectives On The Diagnosis And Management Of Non-Alcoholic Fatty Liver Disease: A Qualitative Study, Natalia I Heredia, Jemima C John, Sonia Singh, Jessica P Hwang, Larkin L Strong, Maya Balakrishnan, Lorna H Mcneill

Faculty, Staff and Student Publications

Primary care physicians (PCPs) are well suited to manage patients with non-alcoholic fatty liver disease (NAFLD), but the limited, existing research suggests inadequate knowledge about the natural history, diagnostic methods, and management of NAFLD. The purpose of this qualitative study is to further understand the knowledge and practices for the diagnosis and management of NAFLD among PCPs. We conducted in-depth interviews with PCPs in the Greater Houston area, addressing current clinical practices used for diagnosing and managing NAFLD, as well as the perceptions of the PCPs regarding the burden of NAFLD on patients. We recorded interviews, transcribed them, coded transcripts, …

Laminar Multi-Contrast Fmri At 7t Allows Differentiation Of Neuronal Excitation And Inhibition Underlying Positive And Negative Bold Responses, Xingfeng Shao, Fanhua Guo, Junghwan Kim, David Ress, Chenyang Zhao, Qinyang Shou, Kay Jann, Danny Jj Wang

Faculty, Staff and Students Publications

A major challenge for human neuroimaging using functional MRI is the differentiation of neuronal excitation and inhibition which may induce positive and negative BOLD responses. Here, we present an innovative multi-contrast laminar functional MRI technique that offers comprehensive and quantitative imaging of neurovascular (CBF, CBV, BOLD) and metabolic (CMRO2) responses across cortical layers at 7T. This technique was first validated through a finger-tapping experiment, revealing ‘double-peak’ laminar activation patterns within the primary motor cortex. By employing a ring-shaped visual stimulus that elicited positive and negative BOLD responses, we further observed distinct neurovascular and metabolic responses across cortical layers and eccentricities …

Plasma Growth Hormone As A Prognostic Biomarker To Durvalumab And Tremelimumab In Patients With Advanced Hepatocellular Carcinoma, Shadi Chamseddine, Michael Lapelusa, Lianchun Xiao, Yehia I Mohamed, Sunyoung S Lee, Zishuo Ian Hu, Rikita I Hatia, Manal Hassan, James C Yao, Dan G Duda, Saumil Datar, Hesham M Amin, Ahmed O Kaseb

Faculty, Staff and Student Publications

INTRODUCTION: In this study, we explored the potential of plasma growth hormone (GH) as a prognostic biomarker in patients with advanced HCC treated with durvalumab plus tremelimumab (D+T).

METHODS: In this study, we included 16 patients with advanced HCC who received D+T at MD Anderson Cancer Center between 2022 and 2023 and had plasma GH measurements recorded before treatment. Plasma GH levels were measured from prospectively collected blood samples and were correlated with progression-free survival (PFS) and overall survival (OS). The cutoff for normal GH levels in women and men was defined as ≤3.7 μg/L and ≤0.9 μg/L, respectively. The …

Image-Guided Deployment And Monitoring Of A Novel Tungsten Nanoparticle-Infused Radiopaque Absorbable Inferior Vena Cava Filter In A Swine Model, Erin Marie San Valentin, Jossana A Damasco, Marvin Bernardino, Karem A Court, Biana Godin, Gino Martin Canlas, Adam Melancon, Gouthami Chintalapani, Megan C Jacobsen, William Norton, Rick R Layman, Natalie Fowlkes, Stephen R Chen, Steven Y Huang, Marites P Melancon

Faculty, Staff and Student Publications

PURPOSE: To improve radiopacity of radiolucent absorbable poly-p-dioxanone (PPDO) inferior vena cava filters (IVCFs) and demostrate their effectiveness in clot-trapping ability.

MATERIALS AND METHODS: Tungsten nanoparticles (WNPs) were incorporated along with polyhydroxybutyrate (PHB), polycaprolactone (PCL), and polyvinylpyrrolidone (PVP) polymers to increase the surface adsorption of WNPs. The physicochemical and in vitro and in vivo imaging properties of PPDO IVCFs with WNPs with single-polymer PHB (W-P) were compared with those of WNPs with polymer blends consisting of PHB, PCL, and PVP (W-PB).

RESULTS: In vitro analyses using PPDO sutures showed enhanced radiopacity with either W-P or W-PB coating, without compromising the …

Dimensionality Reduction And Nearest Neighbors For Improving Out-Of-Distribution Detection In Medical Image Segmentation, Mckell Woodland, Nihil Patel, Austin Castelo, Mais Al Taie, Mohamed Eltaher, Joshua P Yung, Tucker J Netherton, Tiffany L Calderone, Jessica I Sanchez, Darrel W Cleere, Ahmed Elsaiey, Nakul Gupta, David Victor, Laura Beretta, Ankit B Patel, Kristy K Brock

Faculty, Staff and Students Publications

Clinically deployed deep learning-based segmentation models are known to fail on data outside of their training distributions. While clinicians review the segmentations, these models tend to perform well in most instances, which could exacerbate automation bias. Therefore, detecting out-of-distribution images at inference is critical to warn the clinicians that the model likely failed. This work applied the Mahalanobis distance (MD) post hoc to the bottleneck features of four Swin UNETR and nnU-net models that segmented the liver on T1-weighted magnetic resonance imaging and computed tomography. By reducing the dimensions of the bottleneck features with either principal component analysis or uniform …

The Tb27 Transcriptomic Model For Predicting Mycobacterium Tuberculosis Culture Conversion, Maja Reimann, Korkut Avsar, Andrew R Dinardo, Torsten Goldmann, Gunar Günther, Michael Hoelscher, Elmira Ibraim, Barbara Kalsdorf, Stefan H E Kaufmann, Niklas Köhler, Anna M Mandalakas, Florian P Maurer, Marius Müller, Dörte Nitschkowski, Ioana D Olaru, Cristina Popa, Andrea Rachow, Thierry Rolling, Helmut J F Salzer, Patricia Sanchez-Carballo, Maren Schuhmann, Dagmar Schaub, Victor Spinu, Elena Terhalle, Markus Unnewehr, Nika J Zielinski, Jan Heyckendorf, Christoph Lange

Faculty, Staff and Students Publications

RATIONALE: Treatment monitoring of tuberculosis patients is complicated by a slow growth rate of Mycobacterium tuberculosis. Recently, host RNA signatures have been used to monitor the response to tuberculosis treatment.

OBJECTIVE: Identifying and validating a whole blood-based RNA signature model to predict microbiological treatment responses in patients on tuberculosis therapy.

METHODS: Using a multi-step machine learning algorithm to identify an RNA-based algorithm to predict the remaining time to culture conversion at flexible time points during anti-tuberculosis therapy.

RESULTS: The identification cohort included 149 patients split into a training and a test cohort, to develop a multistep algorithm consisting of …

Circulating Sphingolipids In Relation To Cognitive Decline And Incident Dementia: The Cardiovascular Health Study, Kristine F Moseholm, Héléne T Cronjé, Manja Koch, Annette L Fitzpatrick, Oscar L Lopez, Marcia C De Oliveira Otto, W T Longstreth, Andrew N Hoofnagle, Kenneth J Mukamal, Rozenn N Lemaitre, Majken K Jensen

Faculty, Staff and Student Publications

INTRODUCTION: Whether circulating levels of sphingolipids are prospectively associated with cognitive decline and dementia risk is uncertain.

METHODS: We measured 14 sphingolipid species in plasma samples from 4488 participants (mean age 76.2 years; 40% male; and 25% apolipoprotein E (

RESULTS: Higher plasma levels of sphingomyelin-d18:1/16:0 (SM-16) were associated with a faster cognitive decline measured with 3MSE, in contrast, higher levels of sphingomyelin-d18:1/22:0 (SM-22) were associated with slower decline in cognition measured with DSST. In Cox regression, higher levels of SM-16 (hazard ration [HR] = 1.24 [95% confidence interval [CI]: 1.08-1.44]) and ceramide-d18:1/16:0 (Cer-16) (HR = 1.26 [95% CI: 1.10-1.45]) …

A Comprehensive Program To Improve Treatment Of Precancerous Cervical Lesions In The Rio Grande Valley Of Texas, Melissa Varon, Mila Pontremoli Salcedo, Bryan Fellman, Catherine Troisi, Rose Gowen, Maria Daheri, Ana M Rodriguez, Paul Toscano, Laura Guerra, Monica Gasca, Blanca Cavazos, Elena Marin, Susan Fisher-Hoch, Maria E Fernandez, Belinda Reininger, Li Ruosha, Ellen Baker, Kathleen Schmeler

Faculty, Staff and Student Publications

OBJECTIVE: To assess the impact of a multicomponent intervention in women with cervical dysplasia who were treated with loop electrosurgical excision procedure (LEEP), as well as the time between colposcopy and treatment.

DESIGN: Retrospective cohort study.

INTERVENTION: Clinic participation in a multicomponent cervical cancer prevention program that included community outreach, patient in-reach, and navigation, as well as provider capacity building with in-person training and ongoing telementoring through Project ECHO.

MAIN OUTCOME MEASURES: Medical records were reviewed to evaluate women with cervical dysplasia undergoing treatment with LEEP within 90 days of colposcopy, as well as time between colposcopy and treatment. Baseline …

Variant Of The Lactase Lct Gene Explains Association Between Milk Intake And Incident Type 2 Diabetes, Kai Luo, Guo-Chong Chen, Yanbo Zhang, Jee-Young Moon, Jiaqian Xing, Brandilyn A Peters, Mykhaylo Usyk, Zheng Wang, Gang Hu, Jun Li, Elizabeth Selvin, Casey M Rebholz, Tao Wang, Carmen R Isasi, Bing Yu, Rob Knight, Eric Boerwinkle, Robert D Burk, Robert C Kaplan, Qibin Qi

Faculty, Staff and Student Publications

Cow's milk is frequently included in the human diet, but the relationship between milk intake and type 2 diabetes (T2D) remains controversial. Here, using data from the Hispanic Community Health Study/Study of Latinos, we show that in both sexes, higher milk intake is associated with lower risk of T2D in lactase non-persistent (LNP) individuals (determined by a variant of the lactase LCT gene, single nucleotide polymorphism rs4988235 ) but not in lactase persistent individuals. We validate this finding in the UK Biobank. Further analyses reveal that among LNP individuals, higher milk intake is associated with alterations in gut microbiota (for …

The Impact Of Body Mass Index And Physical Disability On Home-Based Anal Self-Sampling, Jenna Nitkowski, Maria E Fernandez, Tim Ridolfi, Elizabeth Chiao, Anna R Giuliano, Vanessa Schick, Michael D Swartz, Jennifer S Smith, Alan G Nyitray

Faculty, Staff and Student Publications

PURPOSE: Self-sampling is increasingly being used in screening programs, yet no studies to date have examined the impact of bodily characteristics on self-sampling experiences. Our objective was to assess whether body mass index (BMI) and physical disability were associated with anal self-sampling difficulty.

METHODS: We recruited sexual minority men (SMM) and trans persons in Milwaukee, Wisconsin to participate in an anal cancer screening study. Between January 2020 and August 2022, 240 participants were randomized to a home (n = 120) or clinic (n = 120) screening arm. Home participants received a mailed at-home anal self-sampling kit and were asked to …

The Perpetual Evidence-Practice Gap: Addressing Ongoing Barriers To Chronic Pain Management In Primary Care In Three Steps, Laura Ellen Ashcraft, Megan E Hamm, Serwaa S Omowale, Valerie Hruschak, Elizabeth Miller, Shaun M Eack, Jessica S Merlin

Faculty, Staff and Student Publications

Background: Most management of chronic pain, a serious illness affecting the physical and psychological wellbeing of millions, occurs in primary care settings. Primary care practitioners (PCPs) attempt to provide evidence-based practices to treat chronic pain. However, there continues to be a gap between the care people receive and the evidence. The objectives for this study were to (1) explore determinants of evidence-based chronic pain management and (2) develop a novel approach to using implementation science to address the evidence-practice gap.

Method: A convenience sample of twenty-one Pennsylvania PCPs participated in one-time semi-structured telephone interviews. Interviews were transcribed verbatim and both …

Colonial Drivers And Cultural Protectors Of Brain Health Among Indigenous Peoples Internationally, Rita Henderson, Joyla A Furlano, Shayla Scott Claringbold, Ashley Cornect-Benoit, Anh Ly, Jennifer Walker, Lisa Zaretsky, Pamela Roach

Faculty, Staff and Student Publications

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This …

Higher Baseline Serum Bilirubin Levels Are Associated With Increased Risk Of Early Neurological Deterioration In Women With Acute Ischemic Stroke, Meng Sun, Yingfeng Weng, Jiwei Cheng, Guoyi Li, Qian Xiao

Faculty, Staff and Student Publications

BACKGROUND AND OBJECTIVES: Early neurological deterioration (END) occurs in up to one-third of patients with acute ischemic stroke (AIS) and associated with poor outcome. The role of serum bilirubin in END remains controversial. This study aims to investigate the association of total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) with END.

METHODS: This study was a cross-sectional retrospective study with 344 AIS patients enrolled. We retrospectively reviewed consecutive AIS patients with END through a medical record retrieval system and enrolled patients as control randomly from the AIS patients without END at the same period. The bilirubin levels were …

Patterns Of Failure For Recurrent Head And Neck Squamous Cell Carcinoma Treated With Salvage Surgery And Postoperative Imrt Reirradiation, Abdallah S R Mohamed, Geoffrey V Martin, Sweet Ping Ng, Vinita Takiar, Beth M Beadle, Mark Zafereo, Adam S Garden, Steven J Frank, C David Fuller, G Brandon Gunn, William H Morrison, David I Rosenthal, Jay Reddy, Amy Moreno, Anna Lee, Jack Phan

Faculty, Staff and Student Publications

PURPOSE/OBJECTIVES: The purpose of this study was to evaluate patterns of locoregional recurrence (LRR) after surgical salvage and adjuvant reirradiation with IMRT for recurrent head and neck squamous cell cancer (HNSCC).

MATERIALS/METHODS: Patterns of LRR for 61 patients treated consecutively between 2003 and 2014 who received post-operative IMRT reirradiation to ≥ 60 Gy for recurrent HNSCC were determined by 2 methods: 1) physician classification via visual comparison of post-radiotherapy imaging to reirradiation plans; and 2) using deformable image registration (DIR). Those without evaluable CT planning image data were excluded. All recurrences were verified by biopsy or radiological progression. Failures were …

Autonomic Modulation Of Cardiac Function In Hypertrophic Cardiomyopathy, Jenna Rose Disser

Dissertations, Master's Theses and Master's Reports

Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disorder. HCM is characterized by cardiac hypertrophy, fibrosis, and an increased risk of fatal arrhythmias and sudden cardiac death. Previous studies in humans with HCM have demonstrated increased cardiac norepinephrine spillover and reduced beta-1 receptor (β1R) expression in the left ventricle (LV). We have previously demonstrated that cardiac sympathetic tone is elevated in an alpha-tropomyosin mutant mouse model of HCM. We hypothesized that HCM mice would demonstrate reduced β1R expression in the LV and attenuated heart rate (HR) and dP/dt max responses to ramped infusion of the β1R agonist, dobutamine. …

Evaluation Of A Novel 3d-Printed Task Trainer For The Simulation Of Gynecological Procedures At A Medical Academic Center, Jami Monico, Karen S. Carlson

Manuscripts: Obstetrics & Gynecology

Introduction

Learning and mastering the performance of gynecological procedures in a secure and supervised simulation setting is important for learners, especially in the early phases of medical education. This project aims to assess the efficacy of an innovative gynecological task trainer for diverse simulation sessions. Following engagement with the task trainer, learners evaluated their experiences with a comprehensive questionnaire. The results of the survey were scientifically analyzed and interpreted.

Methods

The innovative gynecological task trainer was created with 3D-printed plastic, silicone, and a tabletop base. Learners engaged in simulations in which they performed gynecologic procedures using the task trainer. Subsequently, …

A Structured Diabetes Continuous Glucose Monitor Education Program To Improve Patient Knowledge And Self-Efficacy, Krystal Abucevicz-Swick

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction/background: Continuous glucose monitor (CGM) is a recommended method of glucose monitoring for patients living with diabetes who are on insulin or experience documented hypoglycemia. CGM is a tool that can improve patient management of diabetes but works best when paired with education to achieve the maximum therapeutic benefits.

Purpose: The purpose of this project was (1) to develop an evidence-based structured CGM education program toolkit for people with diabetes who are ordered CGM, (2) to implement the CGM education toolkit into the Diabetes Self-Management and Education Services (DSMES) program at the project site, (3) to improve patient knowledge about …

Implementing A Nurse-Driven Clostridium Difficile Screening Protocol, Sandrela Magnuson

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Background: Clostridium difficile infection (CDI) is a prevalent infection often contracted in hospitals. CDI is also increasingly originating from community settings. In addition to the health risks associated with CDI, diagnosis of a hospital-acquired CDI can have a significant financial impact on hospital systems. When hospital acquired, hospital systems are no longer reimbursed by payers. Secondary to the increasing prevalence of community-acquired CDI, mechanisms for early detection and isolation are warranted.

Local Problem: J.W. Ruby Memorial Hospital has an integrated Clostridium difficile (C. difficile) electronic health record (EHR) screening questionnaire that requires updating to align with current guidelines.

Purpose: …