• Effect of Carpal Tunnel Syndrome on Trial-to-Trial Adaptation to Object Mass-Sensorimotor Integration for Multi-Digit Grasping

      Sanniec, Kyle; The University of Arizona College of Medicine - Phoenix; Smith, Anthony (The University of Arizona., 2013-01)
      Introduction/Objective: Somatosensory feedback from the fingertips is integrated with voluntary control of hand muscles in order to successfully grip objects. This integration can be disrupted in Carpal Tunnel Syndrome (CTS) and lead to dropping objects. This raises the question of how the central nervous system (CNS) integrates sensory information from CTS-affected and non-affected digits. The primary objective was to use CTS as a model to understand mechanisms underlying sensorimotor integration responsible for whole-hand griping of objects with a changing mass. CTS patients should be able to modulate digit forces to object weight, however, as different grip types involve the exclusive use of CTS-affected digits or a combination of CTS-affected and non-affected digits, we hypothesize sensorimotor deficits to be larger for grips involving the coordination of CTS-affected and non-affected digits. Methods: Sixteen CTS patients (3 males, 13 females) and age- and gender-matched controls participated in the study. Subjects were instructed to use one of four grip types: two digits, three digits, four digits, or all five digits to grasp, lift, hold level and release a grip device for 7 consecutive lifts. Object mass was changed across blocks of trials by inserting either a “light mass” (445g) or a “heavy mass” (745g) underneath the grip device. Force and torque exerted by each digit were measured. Results: CTS patients learned multi-digit force modulation to object weight regardless of grip type. Although controls exerted the same total grip force across all grip types, patients exerted significantly larger grip force than controls but only for manipulations with four and five digits. Importantly, this effect was due to CTS patients’ inability to change the finger force distribution when adding the ring and little fingers. Significance: These findings indicate CTS primarily challenges sensorimotor integration processes underlying the coordination of CTS-affected and non-affected digits.
    • Effectiveness of Pharmacological Treatments in Imploding vs. Exploding Headaches

      Hunt, Megan; The University of Arizona College of Medicine - Phoenix; Files, Julia (The University of Arizona., 2013-03)
      Recent research shows variability in the effectiveness of botulinum toxin A among patients who experience their headaches as imploding compared with those who experience exploding headache sensations. Further research has not yet examined whether such variability exists among other pharmacological treatments. This study examines the effectiveness of acute and preventative medications in imploding vs. exploding headaches. 201 patients were recruited in the Women’s Health Internal Medicine Program at Mayo Clinic. These patients were given surveys to determine their physician identified headache type (imploding, exploding, or ocular), as well as patient-reported information about the effectiveness of prophylactic medications or triptans. This data was analyzed to determine whether a significant difference existed between medications that were effective for imploding, exploding, or ocular headaches. The study found that no such difference existed. The data was also used to analyze the correlation between physician-identified headache type and the patient-identified headache type. There appears to be only a weak correlation between these assignments, suggesting some room for improvement in the way headache directionality is explored by physician and understood by patients. In the future, research will hopefully uncover additional factors which are useful as predictors for migraine pharmacology.
    • Elucidation of the Molecular Actions of 1,25 Dihydroxyvitamin D3 and Docosahexaenoic Acid that may Mediate Cardiovascular Health

      Widener, Tim; The University of Arizona College of Medicine - Phoenix; Jurutka, Peter; Haussler, Mark (The University of Arizona., 2013-03)
      Omega 3 polyunsaturated fatty acids (PUFAs), composed of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been demonstrated to be beneficial in primary and secondary cardiovascular disease (CVD) prevention. The mechanism of action of PUFAs is not yet fully understood. Vitamin D, via its active form, 1,25-dihydroxyvitamin D3 (1,25 D3), functions through the vitamin D receptor (VDR), regulating serum calcium and phosphorus, and ultimately bone health. There is now evidence that 1,25 D3 may be cardioprotective as well, but the mechanism is also not fully understood. Evidence supports DHA as a weak VDR agonist, therefore there may be crosstalk between the two ligands and their known and yet to be discovered receptors. In the present research, we probed six genes as potential VDR targets, identified both through literature searches as well as their logical association with proposed 1,25 D3 and DHA cardioprotective mechanisms. Treating human embryonic kidney cells (HEK293) with 1,25 D3 and DHA independently, and in combination, we demonstrate changes of expression of three genes through quantitative real time polymerase chain reaction analysis (qRT-PCR). Nitric oxide synthase (NOS2), involved in the immune system nitric oxide burst, was significantly repressed by 1,25 D3 (fold effect 0.84, p value 0.04), DHA (fold effect 0.85, p value <0.01), with the greatest repression in the 1,25 D3 and DHA combination (fold effect 0.74, p value 0.01). Serpin peptidase inhibitor (SERPINE1), for which expression results in increased thrombus formation through tissue plasminogen activator inhibition, was repressed in the 1,25 D3 treatment group (fold effect 0.78, p value <0.01). Thrombomodulin (THBD), which indirectly activates protein C and increases thrombolysis, was repressed in the DHA (fold effect 0.69, p value <0.01) and combination 1,25 D3 and DHA groups (fold effect 0.75, p value 0.04). SERPINE1 and NOS2 repression is consistent with cardioprotective decreases in thrombus formation and immunomodulation, but THBD repression is not consistent with this hypothesis.
    • Evaluation of CHK1 and WEE1 as Candidate Sensitizers to Cisplatin and Paclitaxel

      Huber, Bryan; The University of Arizona College of Medicine - Phoenix; Cunliffe, Heather; Azorsa, David (The University of Arizona., 2013-03)
      Ovarian cancer is the foremost cause of death from gynecologic malignancies in the developed world. The American Cancer Society estimated 22,280 new cases in 2012 and 15,500 deaths. The majority of patients with advanced ovarian cancer relapse from primary treatment and develop drug-resistant disease. The mechanisms underlying drug-resistance are poorly understood. Inhibition of CHK1, a cell cycle G2/M checkpoint kinase has previously been shown to have a synergistic effect with cisplatin in reducing ovarian cancer cell viability. Additional mediators of the G2/M checkpoint have also been found to potentiate the effect of cisplatin and paclitaxel. We chose to evaluate the role of G2/M checkpoint kinases Chk1 and Wee1 and hypothesized that blockade of these kinases would increase the efficacy of cisplatin and paclitaxel either synergistically or additively in the A2780 ovarian cancer cell line model. We determined whether inhibition of CHK1 or WEE1 resulted in an additive or synergistic cytotoxicity in A2780 cells using siRNA technology and specific inhibition using pharmacologic agents. siRNA silencing of CHK1 or WEE1 resulted in an additive effect with Cisplatin and a synergistic effect with Paclitaxel. The response of A2780 cells to Paclitaxel was potentiated in the presence of Chk1 inhibitor PD407824, but not by Wee1 inhibitor MK1775. Our data demonstrates both CHK1 and WEE1 play a role in mediating resistance of A2780 cells to cisplatin and paclitaxel and suggests inclusion of targeted agents against Chk1 or Wee1 may be effective in the treatment of drug-resistant ovarian cancer.
    • First-Word Characteristics of Individuals with Autism Disorder Based On Onset of Language

      McBride, Andrew; The University of Arizona College of Medicine - Phoenix; Panchanathan, Sarada S. (The University of Arizona., 2013-03)
    • Improving Endoscopic Retrograde Cholangiopancreatography (ERCP) Performance and Complication Rates: A Single Operator Retrospective Review from 2004‐2011

      Choi, Joshua; The University of Arizona College of Medicine - Phoenix; Nadir, Abdul (The University of Arizona., 2014-04)
      Endoscopic retrograde cholangiopancreatography (ERCP) is a technically difficult procedure that requires extensive training to achieve competency. The study was undertaken to assess retrospectively whether advanced ERCP training made a difference in the competency of a physician who was performing ERCPs for eleven years before taking an extra year of advanced training in ERCP. The physician did not get any ERCP experience during the two-year formal fellowship between 1995-97, and learned ERCPs from colleagues post formal GIfellowship for four years after which he was given privileges to independently perform ERCPs. Data were collected on 172 and 213 patients who underwent ERCP before and after the training year respectively. Chi-square test was utilized to analyze the data. Baseline characteristics including height, weight, race and indications for ERCP were similar in the two groups. The results of the study showed that rates of biliary cannulation increased from the Pre-ERCP fellowship rate of 83% to 93% (Chi- Square = 9.06, p = 0.0026) and a reduction in postprocedure pancreatitis from 8.1% to 2.7% (Chi- Square = 4.56, p = 0.0327). Data in this study indicate that extra training in ERCP improves outcomes of ERCP in a single operator’s experience.
    • Informational Book for Patients Newly Diagnosed With Systemic Lupus Erythematosus

      Tahan, Yarden; The University of Arizona College of Medicine - Phoenix; Finch, William R.; Feuerstein, Burt G. (The University of Arizona., 2013-03)
      Objectives/Hypothesis To provide a useful resource for patients newly diagnosed with SLE (Sys-temic Lupus Erythematosus). Methods Surveys were distributed to patients currently living with SLE via three rheumatology offices. All surveys were completed anonymously. Survey responses were combined with per-sonal patient anecdotes as well as medically focused questions and answers to create a com-plete educational piece under the genre of narrative medicine. Results Patient survey responses provide a variety of information for patients and clinicians. Low response rate encouraged the addition of supplemental sections in the final product in or-der to create a piece with a significant amount of patient-centered information. The format therefore changed with the addition of Doctor in Training sections, highlighting answers to commonly asked patient-centered questions on SLE as well as personal anecdotes building on the narrative medicine format. Significance The combination of patient survey responses, personal anecdotes, and ques-tion/answer sections unite to provide valuable information in a unique format to patients newly diagnosed with SLE. Specifically, the survey responses give future patients a variety of view-points and tips on how to handle living with lupus while the narrative
    • Long-Term Outcome in Occipital Nerve Stimulation Patients

      Brewer, Ann Chang; The University of Arizona College of Medicine - Phoenix; Trentman, Terrence (The University of Arizona., 2013-03)
      Objectives and Hypothesis: Occipital nerve stimulation (ONS) may provide relief for refractory headache disorders. However, scant data exist regarding long-term ONS outcomes. We sought to provide long-term data on ONS efficacy in refractory headache disorder. Methods: The methods used were retrospective review of the medical records of all (non-industry study) patients who were trialed and implanted with occipital nerve stimulator systems at our institution, followed by a phone interview. Up to three attempts were made to contact each patient, and those who were contacted were given the opportunity to participate in a brief phone interview regarding their ONS experience. Data for analysis were gleaned from both the phone interview and the patient’s medical records. Results: Twenty-nine patients underwent a trial of ONS during the 8.5-year study period. Three patients did not go on to permanent implant, 12 could not be contacted, and 14 participated in the phone interview. Based upon the phone interview (if the Patient was contacted) or chart review, ONS was deemed successful in five of the 12 migraine, four of the five cluster headache, and five of the eight miscellaneous headache patients, and therapy was documented as long as 102 months. In one of the 26 patients, success of ONS could not be determined. Among patients deemed to have successful outcomes, headache frequency decreased by 18%, severity by 27%, and migraine disability score by 50%. Fifty-eight percent of patients required at least one lead revision. Significance: These results, although limited by their retrospective nature, suggest that ONS can be effective long term despite technical challenges. The number of patients within each headache subtype was insufficient to draw conclusions regarding the differential effect of ONS. Randomized controlled long-term studies in specific, intractable, primary headache disorders are indicated.
    • Modern Techniques of Adjunctive Pain Control Lower Opioid Use, Pain Scores, and Length-of-Stay in Patients Undergoing Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

      Nabar, Sean J.; The University of Arizona College of Medicine - Phoenix; Shrader, M. Wade (The University of Arizona., 2013-04-17)
      Study Design. Retrospective analysis. Objective. To determine if the use of adjunctive pain medications (subcutaneous bupivacaine, dexmedetomidine infusion, and intravenous ketorolac) will reduce the need for opioids, reduce postoperative pain, and shorten length of hospital stay in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. Methods. Retrospective review of children 10 to 18 years with adolescent idiopathic scoliosis receiving posterior spinal fusion surgery over the past 10 years at Phoenix Children’s Hospital. Physicians managed the patients’ pain postoperatively with adjunctive medications in addition to intravenous and oral opioids. Variables of interest were local anesthetic bupivacaine delivered subcutaneously via elastomeric pain pump, sedative/analgesic dexmedetomidine infused for up to 24 hours postoperatively, and the NSAID ketorolac delivered intravenously. These three medications were used either alone or in some combination determined by the physician’s clinical judgment. Primary outcomes analyzed were normalized opioid requirement after surgery, VAS pain scores, and length of stay in the hospital. Results. One hundred and ninety-six children were analyzed with no significant differences in demographics. Univariate analysis showed that all three adjunct medications improved outcomes. A multivariate regression model of the outcomes with respect to the three medication variables of interest was developed to analyze the effects of the three medications simultaneously. The regression analysis showed that subcutaneous bupivacaine significantly reduced normalized opioid requirement by 0.98 mg/kg (P = 0.001) and reduced VAS pain scores by 0.67 points (P = 0.004). Dexmedetomidine significantly reduced the average VAS pain scores in the first 24 hours by 0.62 points (P = 0.005). Ketorolac had no effect in the multiple regression analysis. Conclusion. The use of subcutaneous bupivacaine provides good analgesia with low pain scores. A reduction in opioid requirement is beneficial and may be directly related to presence of the bupivacaine pump, although this may be limited by potential treatment bias. The three adjunct medications improve our outcomes favorably and should be studied prospectively.
    • Monoacylglycerol lipase exerts dual control over endocannabinoid and fatty acid pathways to support prostate cancer

      Ward, Anna; The University of Arizona College of Medicine - Phoenix; Nomura, Daniel (The University of Arizona., 2013-03)
      Cancer cells couple heightened lipogenesis with lipolysis to produce fatty acid networks that support malignancy. Monoacylglycerol lipase (MAGL) plays a principal role in this process by converting monoglycerides, including the endocannabinoid 2-arachidonoylglycerol (2-AG), to free fatty acids. Here, we show that MAGL is elevated in androgen-independent versus androgen-dependent human prostate cancer cell lines, and that pharmacological or RNA-interference disruption of this enzyme impairs prostate cancer aggressiveness. These effects were partially reversed by treatment with fatty acids or a cannabinoid receptor-1 (CB1) antagonist, and fully reversed by co-treatment with both agents. We further show that MAGL is part of a gene signature correlated with epithelial-to-mesenchymal transition and the stem-like properties of cancer cells, supporting a role for this enzyme in pro-tumorigenic metabolism that, for prostate cancer, involves the dual control of endocannabinoid and fatty acid pathways.
    • Myocardial Protection Strategy Utilizing Retrograde Cardioplegia

      Karbasi, Michael; The University of Arizona College of Medicine - Phoenix; Willis, Brigham (The University of Arizona., 2013-03)
      Introduction: Myocardial protection strategies are a central component of neonatal arterial switch operations. Traditionally antegrade cardioplegia through the aortic root has been the method of delivery, but use of retrograde cardioplegia via the coronary sinus has become the standard of practice by many in the field. Methods: After obtaining IRB approval and informed consent, a retrospective chart review was done to assess outcomes between 48 patients receiving antegrade (n= 5) and retrograde (n= 43) cardioplegia during neonatal switch operations. Preoperative demographics and postoperative outcomes were compared between the two groups. Results: Patients from the retrograde cardioplegia group demonstrated a trend towards shorter postoperative ventilation days (6.67 +/- 8.57 vs. 10.2 +/- 10.1) and hospital length of stay (18.3 +/- 15.3 vs. 24.8 +/- 11.8) which were not statistically significant. Patients receiving retrograde cardioplegia demonstrated a trend towards an increased incidence of postoperative arrhythmias which was not statistically significant. The retrograde group also demonstrated an increased cardiopulmonary bypass (CPB) time (95.6 +/- 36.59 vs. 146.74 +/- 44.26) and a trend towards an increased aortic cross clamp (ACC) time (74.4 +/- 24.42 vs. 101.30 +/- 29.56) which was not statistically significant. All patients survived to discharge in both groups. With results trending towards shorter hospital length of stays, postoperative ventilation days and zero mortality in patients receiving retrograde cardioplegia, it can be utilized as a safe and efficacious strategy for myocardial protection during neonatal switch operations.
    • Naloxone Utilization in a Tertiary Care Medical Center

      Shah, Ruby; The University of Arizona College of Medicine - Phoenix; Rosenfeld, David (The University of Arizona., 2013-03)
      The purpose of this research project was to review the use of naloxone for oversedation events from 2008-2011 at the Mayo Clinic Hospital in Phoenix, Arizona. Opiates are generally an accepted form of acute and chronic pain management. Opiate analgesic use has increased in past decades due to several factors including cultural and healthcare ideas on the importance of pain management, as well as the availability, cost, and marketing of the drugs. Concomitant with the increased use of opiates has been a rise in addiction, diversion, and abuse. In addition, opiate overdose is a potentially lethal consequence. Balancing the use of opiates for effective pain control and the possible risks of opiates is a constant effort for healthcare professionals. Monitoring the use of naloxone has arisen as an effective metric to examine the safety and outcomes of opiate utilization in a hospital setting. Reviewing every dose of naloxone delivered over the years 2008-2011 has allowed us to recognize trends that have led to improvements in patient safety. 154 cases of naloxone use for sedation events were reviewed in a retrospective case controlled unmatched chart review. We were able to determine that patient risk for oversedation is greatest within our surgical practices, especially general and orthopedic, and that the overall risk is greatest within the first 24 hours in all surgical patients. In addition, we were able to determine statistically significant increase in risk with elevated creatinine level, American Society of Anesthesiology (ASA) Class, and patient controlled analgesia (PCA) use compared to our unmatched control group. The significance of these findings is that it identifies certain risk groups and factors that carry increased risk for sedation events, and therefore can lead to improvements in quality and education across the institution.
    • Neurodevelopmental effects of synthetic glucocorticoid at different time point on stress and metabolism gene expression in the developing hypothalamus

      Chong, David; The University of Arizona College of Medicine - Phoenix; Handa, Robert (The University of Arizona., 2013-03)
      The clinical use of synthetic glucocorticoids (sGC) to improve acute respiratory status in newborns with bronchopulmonary dysplasia, have been shown to have the undesired effects of increasing the risk of developing metabolic and neuropsychiatric disease in adulthood. Current data indicate that critical periods of sensitivity exist in fetal development during which exposures, such as sGC use, are more likely to result in long-term disease. In this study, we hypothesize that exposure to the sGC dexamethasone (DEX) at different time points during early development will result in unique expression profiles of hypothalamic genes in the adult rats. Sprague Dawley rat pups were treated with 0.2 mg/kg DEX beginning on postnatal day (PND) 4-6. Brain tissue from offspring was harvested at PND 7, 21, 90 and quantitative real-time PCR (RT-qPCR) was performed to measure the mRNA level of hypothalamic genes involved in metabolic and behavioral regulation. Results were also compared to a previous study in which pregnant Sprague Dawley dams were treated prenatally with DEX (gestational day 18-21). Of the genes we measured, thyrotropin releasing hormone (Trh) expression was decreased in the adult animals when DEX was administered either prenatally or postnatally. Subsequent examination of brain sections by immunohistochemistry (IHC) showed decreases in fiber and neuron counts that were only seen in the offspring treated with DEX prenatally. Further evidence suggesting a critical window of exposure include observations that mRNA coding for somatostatin and oxytocin, and plasma levels of the protein IGF-1 decreased only in the animals treated with DEX postnatally. Collectively, these data demonstrate that permanent effects of sGCs on hypothalamic gene expression are dependent upon the timing of the exposure
    • Organization and role of international collaboration in research production

      Hsieh, David; The University of Arizona College of Medicine - Phoenix; Whitfield, G. Kerr (The University of Arizona., 2013-03)
      The prevalence of multi-national and cross-disciplinary collaborative in the production of knowledge defines modern science as a social enterprise that extends beyond political, social, and geographic boundaries. The purpose of this study was to assess global trends in the composition and impact of multinational research teams. By examining the bibliometric data of 3.7 million primary research articles published from 1975 to 2005, it was ascertained that the frequency and scale of international collaborations has increased globally. Of note, the publications of many countries associated with lower research output were more often consistently affiliated with other nations across the time frame studied. By analyzing the number of times a publication is cited, it was discovered that multinational research studies have a greater research impact than research without an international presence, although the number of affiliated nations does not strictly correlate with citations. Taken together, this study provides insight into the dynamics of research teams which may better inform us how scientific partnerships between countries may be fostered and which collaborations may be advantageous.
    • Pain Scales in the ED: Can They Predict Admission for Abdominal Pain?

      Johnson, Annelyssa; The University of Arizona College of Medicine - Phoenix; Sarko, John; Smith, Ed (The University of Arizona., 2013-03)
      OBJECTIVES and HYPOTHESIS: The purpose of this project was to assess whether pain scales have an association with the disposition of adult emergency department patients with abdominal pain. It is hypothesized that higher pain scores are associated with a greater likelihood of admission. METHODS: One hundred forty-nine patients (63 admitted and 86 discharged) 18 years and older who were evaluated for abdominal pain in the emergency department (ED) at Maricopa Medical Center were identified retrospectively through a case-control chart review. Demographic variables were compared to assess pain in different groups. Receiver operating characteristics curves (ROC) were created for initial, final, and change in pain scores. Logistic regression was performed to assess the interaction of the prespecified variables initial pain, presence of comorbidities, duration of pain, patient temperature, white blood cell count, and age. RESULTS: In an unadjusted analysis, patients with a higher initial pain score were admitted more often. There was no difference in final or change in pain score and disposition. Men had higher initial pain scores but women were more often admitted. No difference was found between races in pain scores. Patients with surgical diagnoses were admitted more often, and those with nonspecific or OB/GYN-related diagnoses were more often discharged. Patients were less likely to be admitted if imaging was not done. In an adjusted analysis, age was the only variable associated with an increased chance of admission, with an odds ratio of 1.048 (95% confidence interval 1.016-1.082) for each one-year increase. The initial pain score was not associated with admission in the adjusted analysis (odds ratio 1.095 (95% confidence interval 0.943-1.272)).
    • Patient Attitudes Regarding Medical Student Involvement in a Primary Care Setting

      Kaser, Scott; The University of Arizona College of Medicine - Phoenix; Carroll, Andrew (The University of Arizona., 2013-03)
      Previous studies on patient comfort with medical student involvement have consistently reported positive or neutral results within multiple specialties. The objective of this study was to examine patient attitudes toward medical students in a private family practice setting. This study also looked to examine whether recent medical student interaction alters patient attitude and if patient attitude can be improved with the prospect of providing feedback. It was hypothesized that there would be a positive pre-to-post test change in patient attitudes and that patients would respond positively to the prospect of providing feedback. Ninety-nine consecutive consenting adult patients completed a self-administered questionnaire before and after their office visit, which included a medical student interaction. Patient demographics (age, gender, race, prior student exposure, # years with doctor) as well as their attitudes toward the involvement of medical students were recorded. Data were collected for 10 months at Renaissance Medical Group, a private family practice with one physician provider. Data were compiled in Excel and analyzed with STATA12. Paired two-tailed T-tests and ANOVA were used to determine statistical significance. The results demonstrated that, prior to medical student interaction on 8 of 9 measures, patients have positive attitudes toward medical students. After medical student interaction, on 7 of 9 measures, respondents changed their response to a more positive position (P<=0.05). In addition, patients demonstrated a willingness to provide feedback to the medical student, but providing this feedback would not significantly alter their patient care experience. There were also statistically significant demographic differences on specific measures. This study provides evidence that patients respond positively to medical student interaction in the private Family Medicine setting. This study also demonstrates areas in which the patient care experience can be improved and provides the basis for further study on the patient - medical student interaction.
    • Postpartum Depression Tool in Burmese Women

      Belmonte, Chari; The University of Arizona College of Medicine - Phoenix; Veres, Sharry (The University of Arizona., 2013-04-12)
      Background: In the United States, the prevalence of postpartum depression is 10-15%. There is limited study on the appropriate postpartum screening tool for Burmese refugees in the United States. Hypothesis: The Burmese and Karenni versions of Edinburgh Postnatal Depression Scale (EPDS) are appropriate to use as a tool for screening postpartum depression in Burmese refugees. Aims: This study examines the views of Burmese refugees on the questions of Edinburgh Postnatal Depression Scale as a routine screening for postnatal depression and their opinion and experiences on postpartum depression. Methods: A qualitative approach was chosen to complete this study. A medical student and a Burmese interpreter participated in a one-on-one interview with 30 Burmese women sharing their views and opinions on translated EPDS and postpartum depression. Results: Thirty Burmese women were interviewed in the Phoenix area. The qualitative analysis indicate that the EPDS screening turned out to be a useful and culturally appropriate tool for the Burmese refugees to screen postpartum depression in this specific population. Conclusions: Without consistent and culturally appropriate screening for Burmese women, it would be hard to treat Burmese women for postpartum depression. Our study shows that acceptability for routine screening with a translated EPDS amongst health visitors is possible to achieve. Using the Edinburgh Postnatal Depression Scale in Burmese and Karenni language should be considered when seeing Burmese refugees in the clinic.
    • Prevalence of Imploding, Exploding and Ocular Headache Types in a Women’s Health Outpatient Practice

      Patel, Salma; The University of Arizona College of Medicine - Phoenix; Files, Julia (The University of Arizona., 2013-03)
      Objectives: (i) Determine the prevalence of imploding, exploding and/or ocular headaches in women with migraine in a primary care practice of women (ii) Investigate the concordance of physician diagnosis with patient self-diagnosis of pain directionality (iii) Assess correlation between the type of headache and severity of migraines, reproductive stage, and response to acute and prophylactic treatments Background: botulinum toxin A is a drug made from the toxin produced by Clostridium botulinum that works by weakening or paralyzing certain muscles or by blocking certain nerves.17 Recent migraine trials evaluating the efficacy of botulinum toxin A therapy noted differences in the efficacy of botulinum toxin A therapy based on directionality of pain ((imploding exploding and ocular). 5,6,7 However, the prevalence of these migraine types and their responses to conventional migraine prevention therapies has not yet been assessed. Methods: 201 patients participated in structured clinician-administered interviews and completed written questionnaires. Directionality of migraines were determined by both patients and physicians. Descriptive statistics, kappa coefficients and Kruskal-Wallis tests were used to assess migraine prevalence, physician-patient diagnosis concordance and association of migraine to severity, treatment and reproductive stage respectively. Results: 201 patients were enrolled with average age of 46. All patients reported directionality of their migraine and prevalence varied depending upon the method used to assign directionality and were: 33%-42% imploding headaches with or without ocular pain, 18%-44% exploding headaches with or without ocular pain, 7%-39% had ocular pain only, and 8%-13% had imploding and exploding headaches with or without ocular pain. The concordance between physician diagnosis of headache directionality with patient written response, between physician diagnosis and patient diagnosis via selection of representative picture, and between patient diagnosis via written question and via selection of representative pictures were week to moderate using Kappa coefficient. No correlation between the type of headache and severity of migraines, reproductive stage, and response to acute and prophylactic treatments was found (p>0.05). Conclusion: Improved methods of determining pain directionality and target therapy are needed.
    • Randomized comparison of the portable laparoscopic trainer to a standardized trainer

      Fox, Joe; The University of Arizona College of Medicine - Phoenix; Castle, Erik (The University of Arizona., 2013-04-12)
      PURPOSE: To evaluate the effectiveness of the portable laparoscopic trainer in improving skills in novice subjects. MATERIALS AND METHODS: Twenty-nine medical students with no prior surgical experience were recruited and given a pretest of three tasks on a standardized laparoscopic trainer. Subjects were evaluated objectively and subjectively. Fifteen subjects were randomized to receive a portable laparoscopic trainer and 14 subjects were assigned to the standardized laparoscopic trainers at our facility. The portable trainer group was advised but not required to complete at least 3 hours of training. The group at the facility had a proctored 1-hour session each week for 3 weeks. Each subject was then retested and evaluated with the same pretest tasks. Objective and subjective improvements between the groups were compared. HYPOTHESIS: Both the portable and standardized trainer groups were expected to improve comparably based on objective and subjective measures. The portable group had a theoretical objective advantage due to unlimited practice time and the standardized group had the advantage of proctored training sessions, thought to increase subjective performance. RESULTS: Baseline demographics and pretest scores were similar between both groups. All students in the facility group completed the three 1-hour proctored sessions. The portable trainer group reported an average 204 minutes of practice. Objectively, the facility group did better on the post-test in overall time, and in two exercises. Subjectively, the facility group had a significant improvement compared with the portable trainer group (4.6 versus 2.4 point average increase, P=0.03). CONCLUSIONS: Both groups showed objective and subjective improvement after a 3-week period of training. The portable trainer group did report longer average practice time, but this made no significant difference in subjective or objective improvement. The portable laparoscopic trainer is an effective method for improvement of basic inferior compared to proctored sessions on a standard trainer.
    • Safety and efficacy of lung recruitment maneuvers in post-­‐operative pediatric cardiac surgical patients

      Morandi, Tiffany; The University of Arizona College of Medicine - Phoenix; Willis, Brigham C. (The University of Arizona., 2013-03)
      OBJECTIVE: To demonstrate the safety of lung recruitment maneuvers in post-operative pediatric cardiac surgical patients. To assess the ability of lung recruitment maneuvers to improve lung function. HYPOTHESIS: We hypothesize that ventilator recruitment strategies be well-­tolerated in cardiac patients, and that they may benefit such patients by improving physiologic variables such as lung function and oxygenation. METHODS: Sixty‐two pediatric post-operative cardiac surgical patients were randomly selected to include in this retrospective chart review. Study subjects were selected from all patients who met inclusion criteria in the year immediately following implementation of a lung recruitment protocol in a local free‐standing pediatric hospital. Physiologic variables before, during, and after lung recruitment were recorded as well as patient demographics, diagnoses, morbidities and mortality. RESULTS: A statistically significant increase in dynamic compliance of the lungs and renal non-invasive regional oximetry was noted immediately after each recruitment maneuver. There was no statistically significant change in blood pressure, heart rate or oxygen saturation during the maneuvers. There was a transient increase in central venous pressure during the maneuvers (average increase < 1 mmHg). Of the 62 patients, there were 7 cases of pneumonia and 5 cases of small pneumothorax, often resolving without intervention. Significance: Demonstrating recruitment maneuvers are safe in pediatric patients with cardiac disease will allow practitioners to confidently utilize them when caring for ventilated patients. Such patients may benefit from potential improvements in lung function and decreased ventilator-associated morbidities.