• Abnormal Face‐hand Testing is Associated with Anosognosia in Patients with Neuropathologically‐confirmed Alzheimer’s Disease

      Derksen, Brenna; The University of Arizona College of Medicine - Phoenix; Jacobson, Sandra MD (The University of Arizona., 2014-04)
      Objective To investigate whether specific elements of the neurological and neuropsychological evaluation are associated with anosognosia for memory impairment in subjects with neuropathologically-confirmed Alzheimer’s disease. Methods Included were subjects from the Arizona Study of Aging and Neurodegenerative Disease with clinically documented dementia and neuropathological confirmation of AD for whom anosognosia could be confirmed based on antemortem data. Anosognosia was defined by a discrepancy between 1) the patient’s self-report and results of testing, and/or 2) the patient’s self-report and the caregiver’s report regarding memory impairment. The anosognosic and non-anosognosic groups were compared on targeted clinical, cognitive, and neuropathological findings. Results Of 61 subjects included, 34 were diagnosed as anosognosic, and 27 non-anosognosic. The anosognosic group performed worse on two tests of frontal systems function - letter fluency (COWAT) (p=0.010) and a score derived from the Trailmaking test (Trailmaking B time – Trailmaking A time) (p=0.015). In addition, significantly more anosognosic subjects (92%) had abnormal results on face-hand testing (double simultaneous stimulation) compared to non-anosognosic subjects (62% abnormal; p=0.018). Significance In this study of patients with moderate Alzheimer’s disease (mean CDR=2), the anosognosic group showed significantly greater impairment on tests of frontal/executive function. In addition, this group had a significantly higher rate of abnormal face-hand testing, consistent with right parietal pathology. The FHT, which takes about 30 seconds to administer, may prove useful as a marker for anosognosia risk in AD.
    • Acute Exercise Alters Promoter Methylation in Human Skeletal Muscle

      DeMenna, Jacob; The University of Arizona College of Medicine - Phoenix; Coletta, Dawn PhD (The University of Arizona., 2016-04)
      Background And Significance: Insulin resistance is an underlying disease of obesity and type 2 diabetes, which is a metabolic health crisis in the United States. Insulin resistance is caused by a combination of environmental and genetic factors. Understanding the epigenetic factors, specifically DNA methylation and how it influences the expression of genes linked to insulin resistance is of critical importance. Research Question: In this project, we set out to identify patterns of changes in DNA methylation in response to an acute exercise in healthy control subjects. Methods: Five lean (BMI = 23.6 ± 3.3 kg/m2) volunteers underwent a euglycemic hyperinsulinemic clamp with a baseline muscle biopsy and a single bout of aerobic exercise on a stationary bicycle for 48 minutes, rotating between 70 and 90% of VO2max, with a muscle biopsy taken 24 hours after completing the exercise. DNA was isolated from the baseline and 24 hours muscle biopsy, and next‐generation reduced representation bisulfite sequencing (RRBS) was performed, with analysis of the data using methylSig, and KEGG pathway analysis. Results: RRBS analysis captured 676,937 methylation sites, and of these 47,459 were differently methylated following acute exercise (P<0.05) with 4,574 sites occurring in promoter and untranslated (5’ and 3’) regions. The site with the greatest increase in methylation was within the gene NADP(+) ‐dependent malic enzyme cytosolic form (ME1) that demonstrated a significant methylation difference of +63.3%. A site in the gene for adenomatosis polyposis coli down‐regulated 1‐like (APCDD1L) was observed to have the most significant decrease in methylation by ‐65.3%. The gene with the highest incidence of differentially methylated sites was the gene for cardiomyopathy associated 5 (CMYA5) with 11 sites demonstrating a mean increase in methylation of 30.47%. The gene family with sequence similarity 176, member B protein (FAM176B) had the highest frequency of methylated sites (n=7) that were decreased in methylation with a mean decrease of ‐24.28%. KEGG pathway analysis was performed, which revealed significant (P<0.05) increases in methylation in the pathways of Wnt signaling, Heterotrimeric G‐protein signaling ‐Gi alpha and Gs alpha mediated, Cadherin signaling, Melanogenesis, Axon Guidance, and Neuroactive ligand‐receptor interaction. Significantly 4 enriched pathways with decreased methylation post exercise demonstrated one pathway, the Calcium signaling pathway. Conclusion: Our data demonstrates that a single bout of exercise can alter the DNA methylation pattern in skeletal muscle. Changes were observed in genes related to metabolic pathways, supporting previously published findings of changes in mRNA and proteins involved in metabolism following exercise. Future work is warranted with obese and type 2 diabetic participants to explore the differences in response to exercise between these groups.
    • Adductor Canal Nerve Block to Improve Total Knee Arthroplasty Recovery

      Kozinn, Rachel; The University of Arizona College of Medicine - Phoenix; Sachdev, Harkanwal; Kozinn, Stuart (The University of Arizona., 2018-02-26)
      Pre-operative peripheral nerve block (PNB) is an adjunct anesthesia technique used in patients undergoing total knee arthroplasty to improve post-operative pain and speed overall recovery. Effective pain management and ability to ambulate post-operatively directly affects the patient’s pace of rehabilitation and recovery. Two types of peripheral nerve blocks, the standard femoral nerve block, and a more specific adductor canal block, have relative advantages and disadvantages. Research on the effectiveness of the adductor canal block for analgesia in patients who have received a total knee arthroplasty is limited. The purpose of this scholarly project is to study the efficacy of the adductor canal block (ACB) as compared with the femoral nerve block (FNB) for post-operative pain management in total knee arthroplasty. We have retrospectively reviewed 40 patients who each received a total knee arthroplasty by a single orthopedic surgeon during the study period from January 2014 to June 2015.
    • After receiving language concordant, individual health education interventions, do Spanish speaking, diabetic inpatients at a safety net hospital demonstrate acquired diabetes self-management competency as measured by pre-training and post training evaluation of key, diabetes self-management knowledge?

      Cagle, Jonathan; The University of Arizona College of Medicine - Phoenix; Abdollahi, Shagyegh (The University of Arizona., 2018-03-28)
      The purpose of this research was to assess the quality of the inpatient, health education diabetes program as it relates to primary Spanish speaking patients. Complications from diabetes account for huge personal and financial costs. There is substantial evidence supporting the use of targeted diabetes education to reduce complications but we need to know if our education interventions are valid. In order to accomplish this by auditing the knowledge of a sample of inpatient diabetics before and after receiving the standard MMC Spanish language diabetes education interventions via Spanish language pre and post surveys (standardized by the previously validated SKILLD survey). Demographic and clinical data were analyzed and all significant data (p value <0.05) were considered for their importance. The data demonstrated that in all 10 items on the survey, overall patients were able to demonstrate significant improvement in survey scores. Additionally, comparisons of demographic data demonstrated that being less than 50 years old was associated with improved survey scores. This indicates overall benefit of the training program as well as possible insight into need for more aggressive training for patients greater than 50 years in age.
    • Alcohol Withdrawal: Does Sex Matter?

      Canales, Francisco; The University of Arizona College of Medicine - Phoenix; Carlson, Richard (The University of Arizona., 2018-03-28)
      Alcohol Withdrawal Syndrome (AWS) occurs after an individual significantly reduces or completely stops consuming alcohol after a period of constant consumption. Existing literature plentifully describes social factors that contribute to lower likelihood of development of alcohol dependence among women. Physiological differences make alcohol dependent women more likely to develop alcoholrelated hepatic complications. Animal studies suggest that ovarian hormones are neuroprotective and lead to lower incidence of seizures and allow for quicker recovery from AWS.
    • Analysis of Field Delivered Therapy for Chlamydia and Gonorrhea in Maricopa County

      Ebbing, Brittany; The University of Arizona College of Medicine - Phoenix; Taylor, Melanie MD, MPH (The University of Arizona, 2017-05-08)
      Chlamydia and gonorrhea are among the most frequently reported infectious diseases in the United States. These two diseases are easily treated with antibiotics; however, challenges exist in providing treatment to cases and their sexual partners. Maricopa County implemented a Field Delivered Therapy (FDT) protocol to treat chlamydia and gonorrhea cases and contacts in 2009. Ultimately, this project sought to inform other public health departments across the United States regarding the benefits of FDT program to treat gonorrhea and chlamydia and provide better insight on how to treat the two most commonly reported infectious diseases. Existing data was analyzed from April 1, 2011 to October 31, 2014 (42 months) for all patients that received FDT in Maricopa County utilizing pharmacy records and electronic health records (PRISM and eClinicalWorks). The following pieces of information were collected from these data sources: gender, age, race/ethnicity, diagnosis, number of partners, and time to treatment. The data were then divided into four FDT groups (FDT, expedited partner therapy via FDT, FDT attempted and FDT planned). There were 172 patients in this analysis; 140 diagnosed or in contact with chlamydia and 16 diagnosed or in contact with gonorrhea. There were 79 patients (45.9%) in the FDT group, 28 (16.3%) in the FDT EPT group, 28 (16.3%) in the FDT attempted and 37 (21.5%) in the FDT planned group. The median age of these patients was 23.8 (range 16.6‐31); 111 (64.5%) were female. The median time to treatment for these patients was 24.6 days (range 0‐64.5 days). Most patients (79.6%) lived outside of central Phoenix. The median number of sexual partners reported by these patients was 6.6 (range 1‐19.7 partners). A majority of the patients were <25 years old, except for in the FDT EPT group where 100% of patients were >25 years old. And the group with the largest <19‐year‐old population (32%) was in the FDT group. All the groups had a female majority, except in the FDT EPT group where 75% of the patients were male. Most patients in the FDT only group received testing at an outside hospital or outpatient clinic, while the FDT attempted and planned were more often tested at the STD clinic. Future Direction/Conclusion Many of the patients that received FDT are young women, some pregnant, that lived outside of Central Phoenix. However, a majority of the overall clients that received expedited partner therapy via FDT were male, a typically hard to reach population for treatment of potentially asymptomatic infections. This study demonstrates an effective method of delivering partner treatment to men. This study can be used to inform other public health departments about this novel practice and to help Maricopa County grow their FDT program to reach even more untreated patients.
    • Analysis of the Proposed Implementation of a Public Health District in Maricopa County

      Hoffman, Laura; The University of Arizona College of Medicine - Phoenix; England, Bob MD, MPH; Barraza, Leila JD, MPH (The University of Arizona., 2016-03-25)
      Background: Since the number and variety of services that a public health department is able to provide is related to its financial resources, it is important that each department have secure funding. The Public Health District model, in which the public health department is mostly funded by a dedicated public tax, rather than as a dependent on the county’s overall budget, has been proposed as an option for the Maricopa County Department of Public Health (MCDPH). This model was implemented in neighboring Pinal County in 2007 and is funded by a 0.1% sales tax. Specific aims: Our study aims are: (1) analyze the current MCDPH funding structure in comparison to other similarly sized county-managed public health departments, as well as review the development and structure of the Pinal County Public Health Services District as a local reference; (2) project the likely financial effects of the implementation of a tax-based Public Health District in Maricopa County; and (3) assess the potential effects on MCDPH management and public health outcomes in Maricopa County. We hypothesize that the implementation of a Public Health District in Maricopa County will secure a source of stable and increased funding and allow for improved public health services. Methods: Specific Aim 1: Budget data for FY 2011-2012 was analyzed for revenue types and percent contribution for each county department in the comparison. Budget data for FY 2003- 2014 for Pinal and Maricopa counties was analyzed in a similar manner. Phone interview with Pinal County Director, Mr. Thomas Schryer, was completed regarding the development of the Public Health District model in Pinal County; Specific Aim 2: Revenue data from the Maricopa County Jail Excise Tax was reviewed and utilized as a proxy to estimate potential income generated by a 0.1% sales tax; Specific Aim 3: The 2012 Maricopa County Community Health Assessment was evaluated to identify areas of need. Results: Specific Aim 1: Funding structures varied greatly between county public health departments, though heavy reliance on government funds was a common theme. Pinal County demonstrated increased funding stability with an increase in overall revenue budget upon implementation of Public Health District model. Specific Aim 2: Estimated revenue from a 0.1% sales tax was calculated to be $70 million in FY 2014-2015, with potential average revenue of $92 million over the next ten years. Specific Aim 3: Top areas for health improvement in Maricopa County include obesity, diabetes, lung cancer, cardiovascular disease and access to care. Conclusion: The current funding structure of the MCDPH follows the trend of other similarly sized county-managed public health departments with a heavy reliance on government funds. The potential revenue generated from a 0.1% sales tax in Maricopa County would be sufficient to significantly decrease the department’s dependence on general county funds and government grants. The result is increased overall funding and financial stability, thus helping the department to better target area needs and improve public health outcomes.
    • Analyzing Unspecified Chest Pain Diagnoses and the Impact of Physician Staffing at the PVAHCS ED

      Lodgek, Erika; The University of Arizona College of Medicine - Phoenix; Abbaszadegan, Hamed (The University of Arizona., 2018-04-05)
      Emergency department overcrowding is a reality that exists within the healthcare system. To standardize monitoring performance, the VHA Directive establishes ED performance metric goals (targets) and minimum standards (thresholds) on a fiscal year basis. In line with these pre-determined metrics, the outcomes examined within this study include the number of patients diagnosed with unspecified chest pain and the respective Door to Doc, Admission Decision, Admission Delay, ED LOS, and Inpatient LOS times. The reasoning behind specifically examining patients with unspecified chest pain was because it was one of the top 10 diagnoses made at the PVAHCS ED for the year of 2016 and is an acuity level only assigned to physician providers. The reason for this study is to determine the impact increased physician staffing has on the flow of the Phoenix VA ED with regard to the described outcome measures. Therefore, examining if unspecified chest pain patients solely seen by physicians have improved flow within the ED.
    • Anatomic Patterns of Relapse and Progression Following Treatment with 131I-MIBG in Metastatic Neuroblastoma

      Fishel Ben-Kenan, Rotem; The University of Arizona College of Medicine - Phoenix; Polishchuk, Alexei (The University of Arizona., 2018-03-30)
      Purpose and Background: Neuroblastomais the most common pediatric extracranialsolid tumor •50% of patients present with metastatic disease typically involving bone and bone marrow •Despite intensive multimodality therapy, 40% of patients with high-risk neuroblastomawill experience relapse •131I-MIBG is an active salvage agent for relapsed and refractory MIBG-avid disease •It is unknown whether disease progression following 131I-MIBG treatment occurs in previously involved vs. new sites of disease •A better understanding of this pattern may inform the use of consolidative focal therapies following 131I-MIBG administration
    • Androgen Receptor Expression in Human Coronary Vascular Smooth Muscle During Cytokine, Angiotensin II or Hypoxic Exposure

      Prather, Zachary; The University of Arizona College of Medicine - Phoenix; Gonzales, Rayna, PhD (The University of Arizona., 2012-05-01)
      An increasing body of evidence suggests that androgens may exert beneficial effects against the development and progression of vascular inflammation during pathological conditions. Our previous data have shown that the potent androgen receptor (AR) agonist, dihydrotestosterone (DHT), attenuates inflammation-induced vascular cell adhesion molecule-1 (VCAM-1) and cyclooxygenase-2 (COX-2) in human primary vascular smooth muscle (VSM) cells. Although this response was not blocked by the AR antagonist bicalutamide, it is not known if AR expression is altered during an inflammatory insult in VSM. The goal of this study was to investigate the effects of a variety of inflammatory stimuli: Angiotensin II (more recently recognized as a mediator of inflammation in the blood vessel wall (Ruiz-Ortega, et al. 2000) (Alvarez, et al. 2004)), hypoxia, and interleukin-1 beta (IL-1β; cytokine) on AR expression in human VSM cells. Since DHT’s effect in the presence of an inflammatory stimulus is AR independent, we hypothesized levels of AR are decreased favoring less of an androgenic contribution during pro-inflammatory conditions. We initially confirmed that human VSM expresses AR and levels of the receptor are increased following androgen treatment in the absence of an 5 inflammatory stimulus. We further demonstrated that in addition to the full-length AR 110 kDa band detected via anti-AR-N20, we also detected a band migrating near 45 kDa in human VSM that is not present in rat testis lysate. Recent studies describe a variant form of the AR called AR45 expressed in human heart but not in rat (Ahrens-Fath, et al. 2005) (Weiss, Faus and Haendler 2007). Although we did not determine whether the bands migrating near 45 kDa were AR45 or possibly an endogenous break down product of the full-length AR (110 kDa) we did however observe expression of the lower migrating band during conditions of inflammation that may be cardioprotective. In the presence of an inflammatory stimulus we demonstrated that there was a consistent trend for IL-1β and angiotensin II (ang II) to decrease AR expression in human coronary artery VSM. Using an in vivo global ischemic model of inflammation, AR was robustly decreased following a 20- and 30-minute occlusion and 21 hr reperfusion in rat pial arteries. However, unlike ang II, cytokine, or ischemia, in vitro hypoxic exposure in human VSM cells increased the lower migrating band density (45 kDa) and had no effect on band density at 110 kDa. In summary, our results confirm that levels of the classic AR (and possibly the novel AR45 variant form) are present in human VSM. 6 Additionally levels of AR may be altered under conditions of inflammation in human VSM cells and following ischemia/reperfusion in rodent cerebral arteries. We conclude that the AR independent attenuation of COX-2 and VCAM-1 by DHT following an inflammatory insult may be due in part to a decrease of AR levels in the blood vessel wall.
    • Antipsychotic Rechallenge After Neuroleptic Malignant Syndrome with Catatonic Features

      Bond, Alicia Giuffrida; The University of Arizona College of Medicine - Phoenix; Cornelius, Christian, MD (2011-03)
      Neuroleptic malignant syndrome (NMS) is a life-threatening condition that can occur in patients who require long-term antipsychotic therapy, and who therefore must be rechallenged with antipsychotics after their NMS episode. Current guidelines are based on limited data and recommend that rechallenge be undertaken by titrating from low doses of low-potency antipsychotics, after a period of two weeks following resolution of symptoms. We present the case of a patient with an NMS course complicated by residual catatonia course and a literature review with analysis to determine whether time to rechallenge, potency of rechallenge drug, and dose of rechallenge drug are independent predictors of NMS recurrence in patients. One hundred thirteen instances of neuroleptic rechallenge in non-catatonic NMS cases and 29 cases of rechallenge in NMS with catatonic features were identified through broad Medline and PsycInfo database searches and were analyzed by a single reviewer for rechallenge data. Fifty-five cases involved female patients, and 87 male patients; patients ranged in age from 12 to 86, with a mean of 37. There was no statistically significant relationship found between rate of NMS recurrence and time elapsed before rechallenge, either for all cases or by subgroup. Although the recurrence rate for patients rechallenged with highest-potency antipsychotics was found to be higher than those rechallenged with lowest-potency drugs,the relationship was not significant. The maximum antipsychotic dose reached during rechallenge was significantly lower among patients with recurrence of NMS than those who did not recur, likely due to recurrences early in dose titration. There was no statistically significant relationship between starting dose and recurrence. Based on our analysis, time between resolution of symptoms and rechallenge may have no bearing on risk of recurrence, in contrast to current recommendations. Dose of rechallenge drug is also unlikely to be an independent predictor of recurrence. Several studies, including ours, have shown a statistically insignificant but consistent positive relationship between potency of rechallenge drug and risk of recurrence.
    • Arizona Alzheimer’s Registry: Strategy and Outcomes

      Saunders, Kelley; The University of Arizona College of Medicine - Phoenix; Tariot, Pierre MD (The University of Arizona., 2014-04)
      Background: The Arizona Alzheimer’s Consortium (AAC) is a statewide Alzheimer’s disease (AD) research consortium. In 2006 the AAC created the Arizona Alzheimer’s Registry (Registry), a screening and referral process for people interested in participating in AD-related research. The Registry goals were to increase awareness of AD research and accelerate enrollment into AAC studies. Registrants were matched to AAC studies according to interest, location, and eligibility. Methods: Anyone age 18 and older was eligible. Registrants were recruited by community outreach, mass mailings, earned and paid media, and the Internet. Those interested received a welcome packet, consent, and questionnaire, which were reviewed by staff via telephone prior to brief cognitive screening. Evaluation of medical history, cognitive status, and interests resulted in a referral to existing AAC studies or being held for future referral. Results: 2263 people contacted the Registry. 1257 consented and 1182 underwent an initial cognitive screening. Earned media was the most effective recruitment strategy. Registrants had a mean age of 68.1 (SD 10.6), 97% were Caucasian, had 15.2 (SD 2.7) mean years of education, and 60% were female. 30% reported a family history of dementia, 20% reported a diagnosis of cognitive impairment or dementia, and 70% subjectively reported normal cognition. Initial telephone assessments revealed 681 with no impairment, 269 with possible cognitive impairment, and 234 with possible dementia. 301 were referred to AAC sites for potential enrollment into a study. Conclusion: The Registry created an infrastructure and process to screen and refer a high volume of eager Registrants. These methods were found to be effective at prescreening individuals for studies, which facilitated AAC research recruitment. The established infrastructure and experiences gained from the Registry have served as the prototype for the web-based Alzheimer’s Prevention Registry, a national registry focusing on AD prevention research.
    • Assessing Chlamydia Rates and Screening in a Community Health Care Setting

      Keller, Rachel; The University of Arizona College of Medicine - Phoenix; Brite, Kathleen, MD (The University of Arizona., 2013-03)
      Introduction: Chlamydia trachomatis is the most prevalent treatable sexually transmitted disease, with peak prevalence in young women, resulting in a CDC recommendation for annual screening. A community health center in Phoenix Arizona implemented this recommendation in 2010. Objective: Determine the prevalence of Chlamydia and assess changes in screening based on a protocol for screening at a community health center. Hypothesis: The prevalence of Chlamydia in the center’s population is greater than the national average of 6.8%, and the rate of screening will have increased with a protocol in place. Methods: Data from 2011 were collected by review of 1,074 charts, noting type of visit, if symptomatic for Chlamydia, if Chlamydia screening performed and results. Data from 2008, prior to screening protocol, were obtained via review of 313 charts, recording if the women were screened and result obtained. Results: The 2011 review revealed a Chlamydia rate in the women who were screened of 8.7%: when broken down by age the prevalence ranged up to 12.5% in 16 year olds. The study also demonstrated that in 2011, after the institution of the protocol for screening, 66% of the women in the designated age group were screened for Chlamydia at the visit or in the prior year, an increase of 39 percentage points when compared with 2008. The 2008 screening rate was 27%, with 3.5% of the women having a positive result using point-of-care testing. Discussion: Transition from point-of-care testing to send out NAAT testing may have impacted the detection rate of Chlamydia in the women screened. The 2011 data demonstrate a Chlamydia prevalence of 8.7% (6.7-11.1), which based on the 95% CI is not significantly above the national average of 6.8%. The screening rate in 2011 showed a statistically and clinically significant improvement of 39 percentage points for women utilizing the clinic.

      Dahl, Aaron; The University of Arizona College of Medicine - Phoenix; Sinha, Madhumita MD (The University of Arizona., 2015-04-10)
      Objective: Effective physician‐patient communication is critical to the clinical decision making process. The informed consent process for any intervention can be one of the most important moments for effective physician‐patient communication in regards to outcome and liability. We studied parental recall of information provided during an informed consent discussion process prior to performance of emergency medical procedures in a pediatric emergency department of an inner city hospital with a large bi‐lingual population. Methods: Parent/child dyads undergoing emergency medical procedures were surveyed prospectively in English/Spanish, post‐procedure for recall of informed consent information. Logistic regression analysis was used; outcome variables were the ability to name a risk, a benefit, and an alternative to the procedure and predictors were language, education, and acculturation. Results: Fifty‐five parent/child dyads completed the survey. Logistic regression analysis showed that respondents with less than high school education were approximately 80% less likely to be able to name a risk or a benefit, while respondents with a high school education were approximately 24 times more likely to be able to name an alternative procedure. Conclusion: A gap in communication exists between physicians and patients during the consent taking; it is significantly impacted by socio‐demographic factors like education level, language and acculturation.
    • Assessing the Impact of Cultural Beliefs on the Use of Evidence-Based Treatment for Diarrhea in Developing Countries: A Systematic Review

      Joshi, Rhucha; The University of Arizona College of Medicine - Phoenix; Connell, Patrick (The University of Arizona., 2018-03-30)
      Diarrhea is the fourth leading cause of children under five worldwide. Recommendations for diarrhea treatment include oral rehydration therapy, continued feeding, zinc supplementation, and antibiotic use if indicated. The use of these therapies is lower than expected in developing countries. This study aims to determine how cultural beliefs impact the use of evidence-based approaches for diarrhea treatment, specifically in developing countries. A systematic review of primary research articles was done to assess knowledge of and attitudes towards evidence-based treatments, analyze care-seeking behaviors, and identify beliefs attached to treatment practices. Most cultural beliefs fall into the following themes: misconceptions about evidence-based treatments; feeding practices; home remedies and herbal medicines; inappropriate use of medications; and traditional healers and spiritual beliefs. The results show the possibility for working with traditional healers and the local population to gather more data about beliefs and practices. This information can be used to develop culturally sensitive treatment programs that can operate within the framework of local beliefs and practices.

      Bala, Shruti; The University of Arizona College of Medicine - Phoenix; Coonrod, Dean MD, MPH (The University of Arizona., 2015-04)
    • Assessing the University of Arizona Medical School Admission Committee Members’ Knowledge of Predictors of Rural Practice for Medical School Applicants

      LeSueur, Philip; The University of Arizona College of Medicine - Phoenix; Galper, Carol, PhD (The University of Arizona., 2013-03)
      Objective: There is a disparity in physician to population ratios between rural and urban Arizona. The University of Arizona Medical School has a unique opportunity to increase the supply of physicians serving in rural Arizona through its admissions process. This study is a quality improvement project which examined whether or not the admission committee members at both the Tucson and Phoenix campuses are considering probability of future rural practice when making admission decisions and if they know the evidence based predictors for rural practice. Methods: The admission committee members from the University of Arizona Medical School were asked to fill out a questionnaire regarding their preferences for future rural practitioners and if they knew the two most accurate predictors for rural practice. Results: There were 22 respondents to the survey- 12 out of 13 from Phoenix and 10 out of 14 from Tucson. Fifty-nine percent (n=13) of the total respondents listed likelihood to practice in a rural community as positively affecting their admission decision, 27 percent (n=6) said it does not affect their decision at all, and 13 percent (n=3) said it affects their decision very positively. All 22 respondents correctly identified rural background as one of the two strongest predictors of rural practice while 11 correctly identified stated interest in family practice as the other. Conclusion: The University of Arizona Medical School admissions committees are well positioned to increase the supply of rural physicians in Arizona. Even still, some of the members of the committee could benefit from education regarding accurate predictors of rural practice.
    • Assessment of Scholarly Project Requirements at U.S. Allopathic Medical Schools

      Wypiszynski, Sarah; The University of Arizona College of Medicine - Phoenix; McEchron, Matthew PhD (The University of Arizona., 2017-05-25)
      Over 100 years after the Flexner Report first revolutionized medical education, medical schools across the United States are rethinking the role of scholarly research in their curricula. Scholarly research helps fulfill a number of essential elements of the medical school curriculum. The Scholarly Project (SP) engenders self‐directed independent learning, critical thinking skills, writing skills, life‐long learning, and many other objectives. The SP also allows students to assess evidence and the credibility of sources. According to a 2010 study, the Association of American Medical Colleges (AAMC) Curriculum Directory listed 84 medical schools with required research and 9 schools with a required thesis. This research requirement can take on many forms, some of which have been outlined for specific medical schools. Since then, more schools have embraced SP’s in their curricula, and the SP requirements and objectives have evolved dramatically at many U.S. medical schools. This project aims to (1) identify which U.S. allopathic medical schools have required and elective SP’s, (2) determine the components of these SP’s with respect to the duration and placement within the four‐year curriculum, the types of projects that qualify as SPs, the capstone requirement for the finished SP product, the curricular elements, and the objectives of the SP, and (3) determine how many schools have a required, four‐year longitudinal, hypothesis‐driven SP that culminate in a manuscript or thesis. The 136 allopathic medical schools on the AAMC Application Service website as of September 4, 2014 were included in this research. The individual website of each school was queried to attempt to determine the presence and characteristics of a formal SP within the curriculum. Each school was then contacted with the information that was found from the initial query in order to verify and/or elaborate on the preliminary results. Each SP was analyzed to determine (1) whether it was required or optional, (2) its duration and placement within the 4‐year curriculum, (3) the capstone requirement, (4) whether the research was required to be hypothesis‐driven, (5) the topic areas available for students, (6) whether there was formal curriculum in scholarly pursuit within the general medical curriculum, and (7) what the program objectives were. A total of 136 medical schools were surveyed in this study. Our analysis revealed that 78 of these schools include some structured SP in their curricula. Of these, 48 SPs are required, and 30 are optional. The majority of these SPs (36) require less than 1 year for completion. A total of 48 of the 78 medical schools had a manuscript or thesis requirement for the final capstone. Of the 48 schools with a required SP, 25 required the research to be hypothesis driven. A total of 43 of the 78 schools included required scholarship/research curricula as part of the overall medical education curriculum. The objectives of the programs are described in detail in this study. This study identified four medical schools with a required, 4‐year longitudinal, hypothesis‐driven SP that culminates with production of a manuscript or thesis. The four allopathic medical schools with a required, 4‐year longitudinal, hypothesisdriven SP that culminates in a manuscript/thesis are as follows: the Albert Einstein College of Medicine of Yeshiva University, the University of Arizona College of Medicine‐ Phoenix, the Virginia Tech Carilion School of Medicine and Research Institute, and Yale University. The details of each program are explored in the text.
    • Assessment of the Analgesic Efficacy of Intravenous Ibuprofen in Biliary Colic

      Zurcher, Kenneth; The University of Arizona College of Medicine - Phoenix; Quan, Dan DO (The University of Arizona., 2017-05-22)
      It is estimated over 20 million people aged 20‐74 have gallbladder disease, with biliary colic being a common and painful symptom in these patients. Likely due to the relatively recent approval of intravenous ibuprofen use for fever and pain in adults, no assessment of its analgesic efficacy for biliary colic currently exists in the literature. In this double‐blind, randomized, controlled trial we aim to assess the analgesic efficacy of intravenous (IV) ibuprofen given in the emergency department (ED) for the treatment of biliary colic. Analgesic efficacy was evaluated using a visual analog scale (VAS) to assess for a decrease in pain scores. A VAS score decrease of 33% in relation to the VAS taken at the time of therapy drug administration was considered a minimum clinically important difference (MCID) in patient‐perceived pain. A VAS was administered in triage upon enrollment, at the time of therapy administration, at 15‐minute intervals during the first hour post‐administration, and 30‐minute intervals in the second hour. As the standard of care for suspected biliary colic at the study institution is administration of a one‐time dose of IV morphine, patients were not denied initial morphine analgesia and were permitted to receive “rescue” morphine analgesia at any point during their ED course. A total of 22 patients completed the study. 9 were randomized to the IV ibuprofen arm, 9 to placebo, and 4 were excluded for a diagnosis other than biliary colic. Mean VAS values at time 0 to time 120 decreased from 5.78 to 2.31 in the ibuprofen group, and from 5.89 to 2.67 in the control group. There was no statistically significant difference in treatment status of ibuprofen vs. placebo (p‐value (p.) 0.93), though there was a significant decrease in the measured VAS scores over time (0 minutes to 120 minutes, p.0.031) in both ibuprofen and placebo groups. A statistically significant and clinically important decrease in average VAS scores were seen in both placebo and ibuprofen groups (55% and 60%, respectively). There was no difference in time needed to achieve a clinically significant reduction in pain between groups. The sample size of this study may be inadequate to fully assess the analgesic efficacy of IV ibuprofen for biliary colic. In the analysis group (n=18) no significant difference in treatment status of ibuprofen vs. placebo was seen, however there was a statistically and clinically significant decrease in pain in both groups. Two potential confounding factors may have affected the trial’s results: administration of standard‐of‐care IV morphine following initial triage assessment, and the inherent episodic and self‐limited nature of biliary colic.
    • Assessment of the baseline thoroughness of cleaning at one hospital dialysis suite

      Molyneux, Melissa; The University of Arizona College of Medicine - Phoenix; Po, John MD, PhD (The University of Arizona., 2014-04)
      One fifth to one third of hemodialysis patients develop infections from bacterial and viral pathogens over the total course of their treatment, many of which are healthcare acquired, leading to significant morbidity and mortality. Over recent years, significant strides have been made to decrease the rate of healthcare-acquired infections (HAIs) by reducing the risk of transmission of pathogens, including increased compliance to hand-washing of healthcare workers (HCW) and improved quality of environmental cleaning. The goal of the project was to improve the thoroughness of cleaning of a hemodyalysis (HD) suite using objective monitoring and a program of education and feedback. To achieve this goal, the project was broken down into three aims: 1. Determine the baseline thoroughness of cleaning using a novel marker system; 2. Educate and provide feedback to hospital administration and environmental services staff involved in overseeing and in cleaning the HD suite, and; 3. Determine if the program improves the thoroughness of cleaning when compared to baseline. Due to institutional constraints, the third aim of the project was not performed. This investigation demonstrated a baseline thoroughness of cleaning for all high-touch surfaces to be 42% of surfaces cleaned, indicating there are opportunities for improvement in the sanitation practices of the hospital hemodialysis suite. Most individual surface types fell below the internal goal of 90% cleaned. Through presenting the baseline data to hospital administration and environmental services staff, areas of potential improvement in hemodialysis suite sanitation practices were identified, which included the assignment of the cleaning of individual surfaces to specific hospital departments. Though the follow-up testing could not be performed, it is likely that the identification of these areas for process improvement resulted in increased cleaning of overlooked surfaces.