Medical Education Commons^™

Evaluating Medical Student Confidence And Competency Related To Dermatologic Morphology And The Effect Of An Educational Module And Summary Document, Grant Starkey

MD Honors Theses

Abstract

Background: Non-dermatologist physicians perform ~60% of visits related to the primary diagnosis of a dermatological condition, yet dermatology education and training are extremely limited within medical school making up 0.23-0.3% of the curricula. This data points to the possible need for further educational resources for medical students regarding dermatology. In 2007, the American Academy of Dermatology (AAD) created a curriculum for medical students to use while on a dermatology clerkship to supplement their medical school curriculum. The goal of this study is to evaluate current University of Nebraska Medical Center (UNMC) medical student’s confidence and ability in describing skin …

Variation In Thiopurine Metabolism In Hispanic Children, Kayeleigh Higgerson Do

Research Days

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Overall survival rate is > 90% in the United States. However, ethnic and racial disparities remain. Hispanic patients have an inferior overall survival compared to non-Hispanics. The reasons for these differences remain unclear. Mercaptopurine (6MP) is a crucial drug in ALL treatment. Variations in the TMPT and NUDT15 genes lead to altered 6MP metabolism and accumulation of toxic metabolites (6TGN or 6MMPN). Each metabolite is associated with specific dose-limiting toxicities. The accumulation of 6TGN causes myelosuppression, and increased 6MMPN causes GI toxicity. While variants in these genes have been identified …

Potassium Status In Pediatric Chronic Kidney Disease, Katherine L. Kurzinski

Research Days

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Background: Potassium trends are well described in adult chronic kidney disease (CKD) and hyperkalemia is known to be associated with increased disease progression, morbidity, and mortality. Large scale studies assessing potassium trends and the prevalence of hyperkalemia in pediatric CKD have not been performed.

Objectives/Goal: We aimed to characterize median serum potassium levels and the prevalence of hyperkalemia for each CKD stage using the CKiD cohort. The relationship of serum potassium and hyperkalemia with patient demographics, CKD etiology (glomerular or non-glomerular), presence of acidosis, and degree of proteinuria was also evaluated.

Methods/Design: Median serum potassium …

Association Of Rare Variants In Kidney Developmental Genes With Hypertension And Ckd: A Uk Biobank Study, Benjamin L. Spector

Research Days

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Background: Prior studies show chronic kidney disease (CKD) is heritable but only a few common variants have been associated with CKD and kidney dysfunction. Much of CKD heritability remains unknown and limited studies have explored the role of rare genetic variants in this missing heritability.

Objectives/Goal: Identify rare genetic variants in renal developmental genes associated with hypertension and CKD.

Methods/Design: We examined the association between rare variants in 58 candidate genes from five renal developmental compartments and presence of CKD and elevated blood pressure (BP) in 49,989 individuals using whole exome sequencing and phenotypic data …

Treatment Of Recurrent Wilms Tumor With Irinotecan/Temozolomide, Meagan Vacek

Research Days

Background: Despite improvement in relapse free survival (RFS) in recurrent Wilms tumor, the 4- year RFS rate for patients treated with vincristine/dactinomycin/doxorubicin is approximately 40%. Ifosfamide, carboplatin and etoposide are commonly used in relapsed solid tumors but have significant toxicities and require hospital admission for administration. Our patient focused on quality of life, and this led to exploration of other treatment options.

Objectives/Goal: Describe a case of multiply relapsed Wilms tumor with management on oral chemotherapy for improved quality of life and remission for almost 1 year.

Methods/Design: Case Report

Results: The patient is an 11-year-old female diagnosed with Wilms …

Wilms Tumor Presenting With Spontaneous Necrosis And Clostridium Perfringens Co-Infection, Ronald Palmen, Abbey Elsbernd, Kristin Palmen

Research Days

Background: Wilm’s Tumor (WT) is the most common renal malignancy of childhood. The initial presentation of WT may mimic infection or other malignancies with nonspecific symptoms including fever, abdominal/flank pain, or hematuria. This poses a diagnostic challenge for providers, particularly when both infection and malignancy are observed. We describe a case of WT with spontaneous necrosis initially obscured by overlying Clostridium perfringens infection, making diagnosis of the cancer difficult.

Case Description: A previously healthy 5-year-old girl presented to the emergency department with a two-day history of left flank pain and fevers. In the emergency department, she was tachycardic (130 bpm), …

Acute Complications In Pediatric Patients With Diabetes Admitted With Isolated Diabetic Ketoacidosis, Isolated Hyperglycemic Hyperosmolar State, And Mixed Hyperosmolar Diabetic Ketoacidosis, Erica Zarse

Research Days

Background: Diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), and mixed DKA and HHS (hyperosmolar DKA) are hyperglycemic emergencies for which children with diabetes mellitus (DM) are admitted to the hospital. To date, there is little evidence to guide the management of pediatric diabetic patients with hyperosmolarity.

Objectives: The objective of this study is to compare the in-hospital complications at our institution in patients who have isolated DKA to those with a component of hyperosmolarity.

Methods: We reviewed medical records of patients from 01/2019 through 12/2020 admitted with DKA (serum bicarbonate ≤16 mEq/L) and/or HHS (blood glucose ≥600 mg/dL and osmolality …

Memory T Cell Populations In Human Leukemia, Sara Mcelroy

Research Days

Background: Incorporating the immune system into cancer management is an area of robust research. Treatment modalities aimed at activating cytotoxic T cells against malignancies include immune checkpoint inhibitors, bispecific T-cell engagers, and chimeric antigen receptor (CAR) tumor-specific T cells. Most anti-cancer T cell research is narrowly focused, but knowledge about the nature of diverse sub-populations of T cells in cancer, particularly memory T cells, is vital prior to potential incorporation into therapies. T memory stem cells (Tscm) are of interest due to their longevity and powerful abilities of self-renewal and creating the full spectrum of memory CD8+ T cells, including …

Quality Improvement Project To Improve Provider-To-Nursing Communication During Daily Rounds, Kayeleigh Higgerson Do, Sara Mcelroy Md

Research Days

Problem Statement/Question: We aim that by June 2021, our Heme/Onc resident service daily table rounds will include 80% of bedside nurses to improve communication between the provider team and bedside nurse.

Background/Project Intent (Aim Statement): Daily rounds on our Heme/Onc resident service include table rounds (discussion of overnight events and daily plan) and bedside rounds (team goes to see patients and relay daily plan). These rounds infrequently include the bedside nurse caring for the patient, leading to poor communication of the plan from the provider team. This is a problem, because it has the potential to lead to medical errors …

Acute Kidney Injury In Youth With Diabetes Admitted With Isolated Diabetic Ketoacidosis, Isolated Hyperglycemic Hyperosmolar State, And Hyperosmolar Diabetic Ketoacidosis: A Single Center Experience, Erica Zarse

Research Days

Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are hyperglycemic emergencies for which children are admitted to the hospital.

Objectives/Goal: Our objective was to compare acute kidney injury (AKI) between youth with isolated DKA to those with hyperosmolarity and explore associations to risk of AKI.

Methods/Design: Charts were reviewed from 01/2019 through 12/2020 for youth admitted with DKA (serum bicarbonate ≤16 mEq/L) and/or HHS (blood glucose ≥600 mg/dL and osmolality ≥320 mOsm/kg). Isolated HHS youth were combined with hyperosmolar DKA for analysis. AKI was defined as elevated creatinine level for age. The total amount of isotonic fluids administered was …

Increasing Obesity Education In An Underserved Latino Population, Morgan Lippert, Kelsey Beard

Doctor of Nursing Practice Projects

Obesity is a rapidly growing health problem in the United States. Certain populations are at high risk for developing obesity including the Latino population and underserved communities. This Quality Improvement project aimed to develop a more patient centered approach for primary care providers use to deliver obesity education to an at-risk Latino population. The project was completed at a clinic in southern Illinois where the majority of the population is underserved and Spanish speaking. Obesity education tools in both Spanish and English were given to the patients in order to decrease the language barrier and improve patient education and understanding …

Evaluation Of The University Of Nebraska Medical Center’S 4ms Geriatric Training Program At Nebraska Medicine Midtown, Holly M. Sesker

Capstone: Master of Health Administration

In 2015, the Health Resources and Services Administration (HRSA) created the Geriatrics Workforce Enhancement Program (GWEP) to address geriatric workforce challenges and improve the health outcomes of older adults. The GWEP redefines care delivery through a movement for age-friendly healthcare guided by evidence-based practices that align with the 4Ms: What Matters, Medication, Mentation, and Mobility. The 4Ms identify the key issues that should drive the decision-making and care for every older adult. 4Ms training sessions were conducted at the Nebraska Medicine Midtown Clinic and evaluated through a cross-sectional survey administered to both residents (trainees) and attendings (trainers). Data was collected …

The Racial And Ethnic Makeup Of The Asthma Clinical Trials Informing The 2020 Nhlbi Asthma Guidelines Update, Esosa Adah

Research Days

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Rationale: Black/African American and Hispanic people in the United States are disproportionately impacted by asthma with increased prevalence, morbidity, and mortality. However, these groups are often under-represented in asthma clinical and translational research studies which is a barrier to achieving health equity. We describe the racial/ethnic makeup of participants included in clinical trials which informed the recent 2020 National Heart, Lung, and Blood Institute(NHLBI) asthma management guidelines focused update.

Methods: We identified clinical trials included within the 2020 NHLBI asthma management guidelines focused update. We determined the frequency (%) of studies reporting study participant racial/ethnic …

Financial Outcomes By Severity Across Children's Hospitals, Jonathan Hartley

Research Days

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Background: Hospitalizations represent a significant driver of healthcare costs for children. Little is known about how payor type and the severity of children cared for on the pediatric medical inpatient floor impact a hospital’s financial outcomes.

Objectives/Goal: The primary objective of this study is to compare financial outcomes of pediatric hospitalizations to the medical inpatient floor across patient severity quartiles. Secondary objectives included financial outcomes stratified by payor type across severity quartiles.

Methods/Design: Retrospective cohort study included children aged 0-18 years discharged during calendar year 2019 from hospitals that reported clinical information to the Pediatric …

Everyday Ethics And Equity At The Bedside, Shika Kalevor, Angie Knackstedt

Research Days

Background: Traditional bioethics training, although important, may not be completely suited to the nursing role. In contrast to traditional clinical ethics, which focuses on healthcare dilemmas, everyday ethics focuses on routine clinical encounters between clinicians, patients, and families and may be better suited to help nurses address issues such as bias and racism at the bedside.

Objectives/Goal: This study aims to provide a data-backed approach to ethics education for nurses as it pertains to improvements in the understanding of Diversity, Equity, & Inclusion (DEI) efforts in healthcare. This study also provides an opportunity for the field of bioethics to provide …

Likelihood Ratios For Reactions To Egg Based On Specific Ige And Oral Challenges, Melissa Anderson

Research Days

Background: Specific IgE (sIgE) to foods has been used to predict the risk of a systemic reaction (SR) when the food is ingested. An arbitrary cutoff of 0.35 is often used to separate a positive likelihood ratio (LR+) from a negative one (LR-), yet there is little evidence supporting the use of this value.

Objectives/Goal: The objective of this project was to establish a more accurate method for estimating the probability of food allergy to egg.

Methods/Design: Egg-sIgEs were measured and open oral egg challenges were performed on 155 children with a clinical history of egg allergy. Logistic regression (LR) …

Improving Advanced Therapeutic Endoscopy Performance At An Academic Children's Hospital, Julia Snodgrass, Thomas M. Attard, Donna Ditsch, John Colgan, Amanda Weston, Jessica Koch, Nadia Ibrahimi, Pang Krasaelap, Voytek Slowick, Laura Shroyer

Research Days

Problem Statement/Question: Advanced therapeutic endoscopy is infrequently needed but critical in the management of children with complex gastroenterology disorders. Hands-on experience in specific advanced techniques, set up of endoscopy equipment and familiarity with new ancillary equipment for use during endoscopy have been intra-departmentally identified as potential areas for improvement.

Background/Project Intent: Our aim is to improve provider scoring on an endoscopy practice test based on technical aspects of therapeutic techniques, indications and set up of standard and new endoscopic equipment by 20% over pre-practice session testing.

Methods: The Model for Improvement framework was utilized. A multidisciplinary team was created including …

Who Is My Child’S Main Doctor? Assessing Caregiver Perceptions Of Teaching Teams At A Pediatric Tertiary Care Center., Jonathan Ermer

Research Days

Background: The size and structure of large academic teaching teams can create a barrier to communication and relationship-building with caregivers. Studies have shown that from a patient perspective, being able to name their doctor and identify their role is important. Benefits include increased patient satisfaction, improved relationships in line with the family-centered care movement, and improved patient safety. Although important, studies in both adults and pediatrics have shown that patients and caregivers do not know who their doctors are. Acknowledging the hierarchy present on family-centered rounds is not only burdensome and confusing to patients and caregivers, but it can also …

A Case Of An Elevated Tryptase, Sonya Parashar

Research Days

Introduction: Hereditary Alpha Tryptasemia (HαT) is an autosomal dominant disorder characterized by an elevated baseline tryptase that occurs up to 3% of the population and clinically resembles mast cell activation syndrome.

Case description: A full-term, 13-month-old female patient presented to Allergy and Immunology clinic for persistently elevated tryptase. Her initial symptom was non-bloody loose stools, but she later developed recurrent flushing, joint pain, constipation, and frequent nighttime awakenings. Her past medical history included gastroesophageal reflux disease. Family history was significant for an older sibling with history of flushing. At all visits, physical examination was normal. Tryptase ranged between 11.7 - …

Evaluating Caretaker Satisfaction With Same-Day Discharge After Gastrostomy Tube Placement, James A. Fraser Md, Shai Stewart Md, Kayla B. Briggs Md, Shawn D. St. Peter Md, Tolulope A. Oyetunji Md Mph

Research Days

Background: Same-day discharge (SDD) after outpatient laparoscopic gastrostomy tube (G-tube) placement has been our standard institutional practice since 2017, following written and video-based preoperative education regarding G-tube use, maintenance, and exchange at the time of consultation.

Objectives/Goal: We aim to evaluate caretaker satisfaction with our same day discharge protocol following laparoscopic gastrostomy tube placement.

Methods/Design: Following IRB approval, all patients planned for SDD after G-tube placement from FebruarySeptember 2021 at a tertiary care academic center were identified. Retrospective chart review was performed to identify demographic information, successful same-day discharge or reason for postoperative admission, time to first postoperative feed, length …