Medical Education Commons^™

A Rare Case Of Upper Arm Compartment Syndrome In A Patient On Anticoagulant Therapy, Zi Tan, Ammar Ahmed, Amr Khalifa, Roy Trumbo

Advances in Clinical Medical Research and Healthcare Delivery

Background Compartment syndrome is the condition when elevated pressures within an osseofascial compartment cause vascular and neurological compromise, leading to muscle ischemia and possible necrosis if left untreated. It commonly occurs after a traumatic event (e.g., crush injury, fracture, trauma); however, compartment syndrome can still happen spontaneously and in any compartment of the body.

The objective of this case report is to present the signs and symptoms of upper arm compartment syndrome, which is a rare site for compartment syndrome, along with a review of the diagnosis and treatment.

Case Report A 62-year-old man receiving anticoagulant therapy for atrial fibrillation …

Why Are We Doing This?, Richard Alweis, Hemant Kalia

Advances in Clinical Medical Research and Healthcare Delivery

The editors of the journal explain the rationale for founding a new journal and the goals of the journal.

Providing High Reliability Care For Picu Patients With Pulmonary Hypertension: A Quality Improvement Project, Anjali Subbaswamy, Nicholas Tan, Iric Guthrie, Kelsey Fath, Cole Linzmeyer, Elizabeth Yakes Jimenez

Quality Improvement/Patient Safety Symposium

Providing High Reliability Care for PICU Patients with Pulmonary Hypertension: A Quality Improvement Project

Anjali Subbaswamy, MD; Nicholas Tan, DO; Iric Guthrie, MD; Kelsey Fath, MD; Cole Linzmeyer, DO; Elizabeth Yakes Jimenez, PhD, RDN, LD

Purpose: Pediatric patients with pulmonary hypertension (PHTN) are a high acuity, low frequency population, and are often admitted to the pediatric intensive care unit (PICU). To mitigate the risk of precipitating a potentially life-threatening pulmonary hypertensive crisis, health care staff need to take specific precautions. This quality improvement (QI) project aims to increase the number of inpatient PHTN patients for whom PHTN precautions are applied …

Pediatric Residency Academic Rotation Improves Self-Rated Proficiency In Quality Improvement Skills, Maria Heubeck, Rebecca Craig, Taylor Ford, Lanier Lopez, Grace Mccauley, Elizabeth Yakes Jimenez

Quality Improvement/Patient Safety Symposium

Category: In-progress research

Title: Pediatric Residency Academic Rotation Improves Self-Rated Proficiency in Quality Improvement Skills

Maria Heubeck, MD; Rebecca Craig, MD; Taylor, Ford, MD; Lanier Lopez, MD; Grace McCauley, MPH; Elizabeth Yakes Jimenez, PhD, RDN, LD

Introduction: As of July 2020, all second-year pediatric residents participate in a one-month academic rotation. The rotation focuses on quality improvement (QI), research, education and leadership skills and experience. This project aims to assess the impact of the rotation on residents’ self-reported QI proficiency, self-rated motivation to pursue scholarly activities, and competency based on ACGME milestones.

Methods: Pediatric residents participating in the academic rotation …

Improving Vaccination Uptake In The Latinx Community Through Standardized Outreach, Vanessa M. Arteaga

Master's Projects and Capstones

Vaccine hesitancy during the COVID-19 pandemic has been an issue in the Latinx and Black community since the initial discussions of the emergency use of the experimental Moderna and Pfizer vaccines. The aim of this project is to standardize the patient outreach process to increase COVID-19 vaccine uptake. Patients at a community clinic in Oakland have expressed hesitance of the COVID-19 vaccine. They also exhibited increased frustration with the staff who are contacting them to schedule vaccine appointments and provide information. This resulted in refusal of the vaccine and less than desirable number of vaccine appointments. The objective of this …

Understanding The Impact Of Racism In Healthcare And How It Is Affecting African American Women (Part 2), Magdalene Boadu

Symposium of Student Scholars

Healthcare is the most sacred part of every person’s life and should be accessible. However, the experience for many is that “you either got it or you don’t”. A way to help “get it”[Healthcare] is through workplace insurance, however, this is not accessible to many. This is especially the case for minority communities who cannot afford insurance plans, if and when offered by their employers, or other alternatives for accessing affordable health care. The terms “affordable and health care” are a paradox, for African American women. This is because of a system that was built to benefit one race but …

Development Of A Multilevel Intervention To Increase Colorectal Cancer Screening In Appalachia, Aaron J Kruse-Diehr, Jill M Oliveri, Robin C Vanderpool, Mira L Katz, Paul L Reiter, Darrell M Gray, Michael L Pennell, Gregory S Young, Bin Huang, Darla Fickle, Mark Cromo, Melinda Rogers, David Gross, Ashley Gibson, Jeanne Jellison, Michael D Sarap, Tonia A Bivens, Tracy D Mcguire, Ann Scheck Mcalearney, Timothy R Huerta, Saurabh Rahurkar, Electra D Paskett, Mark Dignan

Faculty, Staff and Student Publications

BACKGROUND: Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of "Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia," a 5-year, National Cancer Institute Cancer Moonshot

METHODS: Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in …

2021 May 18 - Medical Student Education Committee Minutes, Medical Student Education Committee, East Tennessee State University

Medical Student Education Committee Minutes

No abstract provided.

Use Of Artificial Intelligence To Identify Predictors Of Functional Outcomes In Patients With Facioscapulohumeral Muscular Dystrophy, Natalie K. Katz

Research Days

Background: Facioscapulohumeral muscular dystrophy (FSHD) is one of the most common forms of muscular dystrophy characterized by slowly progressive muscle weakness. Symptoms initially involve the facial and shoulder girdle muscles, with later involvement of the distal lower extremities, pelvic girdle and proximal lower extremities. FSHD type 1 (FHSD1) is the most common form (~95% of individuals) and is caused by deletion of microsatellite repeats in the D4Z4 region on chromosome 4 (4q35). Normal individuals have >10 repeats whereas individuals with FSHD1 have 1-10 repeats. There is significant variability in regards to disease severity, rates of progression and functional outcomes, but …

Prevalence Of Adolescent Sexual Health Outcomes At Children’S Hospitals During Covid-19, Margarita Abella

Research Days

Background: The Coronavirus Disease 2019 (COVID-19) pandemic mitigation strategies, including social distancing, decreased structured environments, and decreased sexual and reproductive health (SRH) care access, could negatively impact adolescent SRH behaviors and related outcomes. To date, little is known regarding changes in adolescent SRH outcomes during COVID-19.

Objectives/Goal: Our goals were to assess changes in adolescent SRH outcomes, including sexually transmitted infections (STIs), pregnancy, and sexual assault in the hospital (emergency department [ED] and inpatient [IP]) during COVID-19 compared to pre-COVID-19.

Methods/Design: We conducted a retrospective cohort study of adolescent (11-18 years old) IP or ED hospital visits using the Pediatric …

Characterization Of Comorbidities In Patients With A Dual Diagnosis Of Down Syndrome And Autism Spectrum Disorder Using Cerner Health Facts, Michael Slogic

Research Days

Background: Up to 19% of patients with Down syndrome (DS) meet diagnostic criteria for autism spectrum disorder (ASD) (Channell, et al, 2019). While the medical and psychological comorbidities for patients with DS or ASD are well characterized, comorbidities and outcomes for patients with a dual diagnosis (DS-ASD) are poorly understood. A large cohort of patients with DS-ASD, as well as those with ASD and DS alone, are needed to better understand this. Methods for grouping and analyzing complex diagnostic phenotypes are also needed.

Objectives/Goal: Our objective is to utilize Cerner Health Facts, a multi-institutional healthcare database, to identify large populations …

Effectiveness And Safety Of Repeat Dexamethasone For Bronchopulmonary Dysplasia, Christian Oliveros

Research Days

Background: Although a short course of steroids maybe beneficial in infants at high risk for bronchopulmonary dysplasia, response to treatment is variable. In infants with persistent lung disease despite initial treatment, repeat courses of steroids have been described but not well-studied. This 10-year observational study from a single tertiary referral center evaluates the effectiveness and safety of repeat steroid treatment for bronchopulmonary dysplasia.

Objectives/Goal: To describe effectiveness of repeat dexamethasone treatment for bronchopulmonary dysplasia (BPD) and to evaluate potential detrimental effects on growth and neurodevelopment.

Methods/Design: This was a 10-year single-center observational study of infants <30 >weeks’ gestational age at birth …

A Study Examining The Safety And Efficacy Of Ferric Carboxymaltose In A Large Pediatric Cohort, Chandni Dargan Md, David Simon Do

Research Days

Background: Iron deficiency anemia (IDA) is common in the pediatric population with varying high-risk factors. Intravenous (IV) iron supplementation has become more desirable in patients with moderate to severe anemia and in patients who are either unresponsive to or have adverse side-effects secondary to oral iron. Iron sucrose and Iron dextran have been traditionally used in pediatrics while ferric carboxymaltose (FCM) has only been FDA approved in adults. One of the major advantages of FCM is the ease of dosing and efficacy. Though FCM was approved for adults in 2013 and there have been no safety concerns, it is not …

Attitudes Of Pediatric Residents In The Care Of Transgender Youth, Michelle Knoll

Research Days

Background: Transgender individuals have health disparities compared to the general population and face several barriers to medical care. Prior studies indicate physician knowledge on transgender topics is poor and that transphobia is associated with poor knowledge even after educational interventions. Objectives/Goal: We sought to examine pediatric residents’ attitudes about transgender individuals and assess concerns related to the treatment of transgender youth. Methods: A survey was sent to 89 US Pediatric and combined (e.g. Med-Peds) residency programs and advertised on social media. Approximately 32 programs forwarded the survey to an estimated 1325 residents; 138 residents completed it. The survey consisted of …

Portable Low Field Strength Mri: Preliminary Experience In Neonates And Children, Johnston Fite

Research Days

Background: High field strength MRI (HF-MRI) is a pediatric imaging staple. However, HF-MRI access is limited by strong (1.5 – 3.0 T) magnetic fields with associated safety concerns, space requirements, and cost. To address these limitations, Hyperfine (Guilford, CT) developed a low magnetic field (0.064 T) portable MRI device, named Swoop. Preliminary data in adults shows benefits despite decreased image quality. In this study, initial evaluation of Swoop’s image quality in pediatric patients was assessed.

Objectives/Goal: The objective in this study was the initial evaluation of Swoop’s image quality in pediatric patients to serve as a baseline.

Methods/Design: The study …

Variability In Blood Gas Levels During Non-Invasive Ventilatory Support Following Planned Extubation And Association To 36-Week Bronchopulmonary Dysplasia In Preterm Neonates, Michelle Klueppelberg

Research Days

Background: Despite shifts to non-invasive support, as of 2012, 87% of preterm infants admitted to the neonatal intensive care unit (NICU) continued to receive some form of invasive mechanical ventilation1 . As a result, research around how prolonged respiratory support may impact the development of chronic lung disease, specifically bronchopulmonary dysplasia (BPD) has flourished. To date, literature has established associations between the time on invasive mechanical ventilation and incidence BPD2,3. Resulting in the development of standardized extubation strategies and bringing with them objective measures of extubation readiness4,5. Yet, due to their volatile conditions, some neonates will inevitably need to be …

Biomedical Ethics In The Medical School Curriculum: Lessons Learned From The Holocaust, Emma Flanagan

College Honors Program

The Holocaust, the murder of 6 million Jews, is the only medically-santioned genocide. This thesis explores the roles of Nazi doctors in the planning, organizing, and implementation of the organized mass murder of European Jewry. Given the German medical community’s complicity, it is imperative that physicians today are well informed about their profession’s history of involvement in the Holocaust. In addition, and by way of contrast, a study of the moral challenges faced by doctors imprisoned in concentration camps or in the ghettos of Nazi-occupied Europe might serve to better prepare physicians for future ethical dilemmas. In a survey of …

A New Paradigm: Ecmo Therapy In Pediatric Hematology/Oncology Patients, Igor Areinamo

Research Days

Background: The use of extracorporeal membrane oxygenation (ECMO) for support of pediatric patients has significantly increased in the past years. Patients with known oncologic diseases, immunodeficiencies, or bone marrow transplants (BMT) have traditionally not been considered candidates for Extracorporeal membrane oxygenation (ECMO) due to perceived high risk for mortality. Ongoing advances have continued to push the boundaries of ECMO use and we report our recent experience with this patient population

Objectives/Goal: To evaluate survival to discharge of pediatric patients who require ECMO support and who also have an underlying hematologic or oncologic disease process. To determine specific patient characteristics that …

Low Dose Doxorubicin Inhibits Immune Checkpoint Upregulation In Acute Leukemias, Bradley C. Stockard

Research Days

Background: Evasion of drug and immune response in therapy-resistant leukemic stem cells (LSCs) is a major cause of relapse. A previous study has identified an alternative mechanism of action for low-dose doxorubicin (DXR) that inhibits upregulation of immune checkpoints (IC) in LSCs.

Objectives/Goal: The objective of this study is to establish the DXR dose range that will achieve the inhibition of immune checkpoint expression in leukemic cell lines.

Methods/Design: Cells were analyzed for expression of CTLA-4, LAG-3, PD-1, TIGIT, and TIM-3 via flow cytometry. Analysis was performed on days 3, 5, and 8 of treatment at concentrations identified as low, …

Posterior Reversible Encephalopathy Syndrome After Dinutuximab, Kayeleigh Higgerson Do, Chandni Dargan Md

Research Days

Background: Posterior reversible encephalopathy syndrome (PRES) is a reversible disorder associated with edema of subcortical white matter and cortical gray matter that usually involves the occipital and parietal lobes. Endothelial injury secondary to abrupt blood pressure changes breaks down the blood brain barrier leading to brain edema. Per the ANBL0032 Fall 2015 Study Progress Report, Dinutuximab was the probable cause of PRES in two patients. There have been published reports of PRES with other anti-GD2 antibody therapies but very few reports of Dinutuximab as the causative agent.

Objectives/Goal: To report a case of PRES after Dinutuximab

Methods/Design: Case Report

Results: …