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  Outcomes after massive honeybee envenomation in patients with comorbid conditions during hospital admission: a retrospective review

  Zelic, Maximilian; The University of Arizona College of Medicine – Phoenix; Ruha, Michelle (The University of Arizona., 2019)

  This study’s aim was to discover the outcomes associated with massive honeybee envenomation. Additionally, we wanted to observe what trends might be seen with regard to outcomes in patients with comorbidities and those without. Honeybees belong to the insect family of Hymenoptera, which includes wasps, yellow jackets and hornets. Hymenoptera are responsible for more deaths than any other venomous insects and pose a risk to the public due to the emergence of well-established populations of Africanized honeybees. These honeybees are prevalent in southwestern states such as Arizona. Africanized bees are more aggressive and take less to provoke stings than non-hybridized bees, and mass envenomations can cause fatal accidents. This study was a retrospective review of patient charts based on ICD-9 and ICD-10 records indicating massive honeybee envenomation and screened to include only patients meeting our inclusion criteria of ≥ 50 stings over a 10 year period at Banner – University Medical Center Phoenix. 25 total patients were included and epidemiological, clinical, and therapeutic data were obtained and compared for noticeable trends in the data with regard to demographics and comorbidities. The 25 patients ranged in age from 16 to 82 years old. Total number of stings varied from an estimated 50 stings, to over 1000. The majority of patients were estimated to have been stung by between 100 to 500 bees representing thirteen patients (52%). Four patients (16%) had a history of CAD, fourteen patients had hypertension (56%), nine patients had diabetes (36%), and one patient had asthma. In terms of outcomes, five patients (20%) required intubation for airway management, two patients were dialyzed (8%), and the average length of stay was 84.2 hours over the course of hospital admission. Our results showed that there was no obvious trend in the outcomes of patients with and without CAD, asthma, hypertension, and diabetes. Significant trends were primarily seen in the total number of stings sustained. In patients with a greater number of stings, the total length of stay increased dramatically. Number of stings also seemed to indicate a greater risk of requiring intubation as well. Finally, creatine kinase levels were also significantly elevated in patients with a higher sting count, supporting prior work done regarding the effect of mass envenomations with resulting rhabdomyolysis. This research supports that fact that ultimately the biggest determinant of a patient’s clinical course is the number of stings that they present with. It seems safe to assume that a mass envenomation on the scale of hundreds to thousands of stings will greatly increase the chance that this particular patient is going to have significant rhabdomyolysis, be at greater risk of requiring advanced airway measures such as intubation, and be admitted to the hospital for a longer period. Future work would be enhanced by implementing a multicenter review to increase the power of the study to allow for statistical comparisons to be made, creating an opportunity to delineate potential differences in outcomes based on comorbid conditions.
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  The Long Term Efficacy of a Behavioral Based Diabetes Prevention Program for High Risk Hispanic Youth

  Wright, Mia; The University of Arizona College of Medicine – Phoenix; Lee, Maurice (The University of Arizona., 2019)

  There is little known about the long term efficacy of diabetes prevention programs in adolescents targeting high risk youth. In this study a chart review was performed to recruit 21 adolescents from the intervention arm and 9 from the control. The HbA1c, BMI% and BP were measured and they all took a health behavior questionnaire. The results varied but the data suggest that there is not an overall decrease in diabetes risk as there was no statistically significant difference in the A1c or BMI.
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  C-Terminally Truncated Apolipoprotein A1 Glutamate Residue 243 Is a Biomarker for Oxidative Stress in Coronary Artery Disease and Chronic Kidney Disease

  Wilson, Zachary; The University of Arizona College of Medicine – Phoenix; Breberda, Christian S. (The University of Arizona., 2019)

  High density lipoprotein (HDL) oxidation is a potential biomarker for coronary artery disease (CAD) severity. Methionine sulfoxidation, tyrosine chlorination and C-terminal truncation are Apo A- I modifications that inactivate HDL and lead to pro-oxidant action. We hypothesize that C-terminal truncation of apolipoprotein A1 glutamate residue 243 (Apo A-I Des-Q243) is a byproduct of a protease, such as a matrix metalloprotease (MMP), and it is associated with the presence and severity of coronary artery disease and chronic kidney disease (CKD). We enrolled 103 patients presenting for evaluation of chest pain in this cross-sectional study at Maricopa Medical Center. Plasma and serum samples were collected, processed, and transferred to Arizona State University (ASU) Biodesign Institute for high pressure liquid chromatography-mass spectrometry (HPLC-MS). A statistical analysis was conducted with a spearman’s coefficient, two-tailed linear regression and multivariate analysis of the relative fractional abundance (RFA) of Apo A-I Des-Q243 and clinical variables. Multivariate analysis revealed significantly reduced levels of Apo A-I Des-Q243 in the presence of male gender (-1.5%, P=0.035), atrial fibrillation (-2.8%, P=0.04), and ACEi/ARB use (-2.4%, P=0.001). Additionally, a diagnosis of CKD (2.3%, P=0.037) and the presence of four (9.6%, P=0.005) or five (4.7%, P=0.045) coronary stents, regardless of vessel location, were associated with significantly increased levels of Apo A-I Des-Q243. American Indian/Alaskan race as compared to Caucasian race (Plasma -5.8%, 95% CI -9.9- -1.8%, P=0.005; Serum -4.6%, 95% CI -8.5- -0.8%, P=0.02), and the eGFR (Plasma ρ=-0.024, P=0.014, Serum ρ=-0.291, P=0.003) only reached significance in the linear regression and spearman’s correlation analysis respectively. Apo A-I Des-Q243 is elevated in patients with multiple coronary stents, and thus may be contributing to vascular inflammation and plaque formation. Furthermore, Apo A-I Des-Q243 is elevated in CKD and is directly correlated with its severity as determined by eGFR. These findings highlight the renin-aldosterone system’s (RAS) role in HDL oxidation and the anti-oxidant action of ACEi/ARBs. Apo A-I Des-Q243 appears to be an important link between CAD and CKD and is a promising biomarker that warrants further study.
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  An Analysis of Mortality, Morbidity, and Primary Care Providers in Arizona's 126 Primary Care Areas

  Wassermann, Michael; The University of Arizona College of Medicine – Phoenix; Cartsonis, Jonathan (The University of Arizona., 2019)

  The United States is currently facing a primary care provider shortage. Medical schools nationwide have increased enrollment in order offset the effects of the shortage. In order to justify the effects of increasing total quantity of future physicians, there should be a demonstrated relationship between total quantity of providers and a reduction in morbidity / mortality at a population health level. This study investigates if there is any association between the total number of primary care providers and mortality per 100,000 persons (all deaths, heart disease, all cancer, chronic lower respiratory disease, and all accidents), or morbidity per 100,000 persons (chronic diseases, congestive heart failure, hypertension, uncontrolled diabetes, and stroke)? Is there any difference in total number of primary care providers, mortality per 100,000 persons, or morbidity per 100,000 persons in rural vs urban primary care areas? Data was gathered from the Arizona Department of Health Services community profiles dashboard. 2013 morbidity / mortality data for all 126 of Arizona’s Primary Care Areas was analyzed utilizing linear regression and Wilcoxon rank sum. Linear regression demonstrated a statistically significant reduction in a number of mortality / morbidity categories as total number of primary care providers increased. Correlation data demonstrated a statistically significant relationship between number of primary care providers and increase in chronic lower respiratory diseases (p value = 0.027). Additionally, rural primary care areas showed higher incidence of congestive heart failure (p < 0.001) and chronic diseases (p = 0.02) and lower total numbers of primary care providers (p < 0.001) compared with urban primary care areas. Our findings demonstrate distinct differences between urban and rural primary care areas. There may be some association between total number of primary care providers and their potential effect on mortality/morbidity incidence. Further research needs to be completed in order to elucidate a greater understanding of these potential relationships.
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  Determination of the Correlation Between Types of Strabismus and Certain Medical Conditions

  Warrington, Nicole; The University of Arizona College of Medicine – Phoenix; Salevitz, Mark (The University of Arizona., 2019)

  There are numerous subtypes of strabismus: esotropia where one eye deviates inward compared to the other, exotropia where one eye deviates outward compared to the other, hypertropia where one eyes is higher than the other, concomitant strabismus where the degree of deviation is the same in each gaze, incomitant strabismus where the degree of deviation varies in different gazes. Adult strabismus can be caused by various conditions including vasculopathic diseases (diabetes, hypertension, and stroke), compressive CNS lesions, myasthenia gravis, sensory strabismus, thyroid ophthalmopathy, multiple sclerosis, trauma, post-surgical strabismus, recurrent childhood strabismus, longstanding adult strabismus without proven cause, syndrome related strabismus, restrictive orbital masses, and congenital fibrosis of the extraocular muscles. It is currently unknown whether any of these underlying conditions correlate with a specific type of strabismus. The purpose of this study is to determine if underlying conditions correlate with a certain misalignment (i.e. esotropia, exotropia, hypertropia, concomitant, or incomitant). If there is a statistically significant correlation between a certain misalignment and systemic disease, this could add to the algorithm that physicians use to diagnose these systemic conditions. This was a retrospective review of 692 patients >=21 years of age who presented to a pediatric ophthalmologist with adult strabismus from September 2008 to September 2015. The inclusion criteria were: (1) an age of 21 years or older, (2) a confirmed diagnosis of new-onset or recurrent childhood strabismus, (3) any severity and type of deviation, and (4) documentation of diplopia in any field of gaze. The variables that were extracted from the files were: the type of misalignment (esotropia, exotropia, hypertropia, concomitant, incomitant) and the underlying disorder (vasculopathic diseases (diabetes, hypertension, and stroke), compressive central nervous system (CNS) lesions, myasthenia gravis, sensory strabismus, thyroid ophthalmopathy, multiple sclerosis, trauma, post-surgical strabismus, recurrent childhood strabismus, longstanding adult strabismus without proven cause, syndrome related strabismus, restrictive orbital mass caused strabismus, and congenital fibrosis). Interpretation of the data consisted of determining if a correlation between type of misalignment and underlying condition exists. The average age of the population is 60.5 years with a standard deviation of 16.9, of which 49.6% were male. Results of this study indicate that multiple conditions that cause strabismus have a proclivity to negatively or positively predict a certain type of strabismus. Specifically, post-surgical patients are more likely to have hypertropia than esotropia or exotropia, sensory strabismus patients are more likely to have exotropia. Adult patients with recurrent childhood strabismus are more likely to have exotropia and concomitancy. Compressive CNS lesions, thyroid ophthalmopathy, and traumatic causes of strabismus are more likely to cause incomitant strabismus. Vasculopathic causes of strabismus do not have a tendency to cause any certain type of strabismus. These findings will assist ophthalmologists in delineating a cause of their patient’s strabismus based on which types of strabismus correlate with certain conditions.
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  Systematic Review of Quality of Life for Family Members of Children with Autism Spectrum Disorder in Asia and Mindfulness Based Interventions for Children with Autism Spectrum Disorder and Their Parents: Mechanism, Evidence, and Feasibility

  Vincent, Kathleen; The University of Arizona College of Medicine – Phoenix; Melmed, Raun (The University of Arizona., 2019)

  Autism Spectrum Disorder (ASD) is a lifetime neurodevelopmental disorder with presence of symptoms early in development. About 1 in 68 children have been identified with ASD globally. Parents of children with ASD face diverse hurdles that can have a significant impact on their quality of life (QOL), and interventions may be able to improve these outcomes. A systematic review was conducted to assess the QOL for family members of children with ASD in Asia and to elucidate interventions that can impact QOL outcome measures. This study sought to synthesize QOL outcomes for parents of children with ASD across Asia by drawing from currently available primary research. It also sought to examine interventions that have been used in this population to investigate their impact on QOL outcomes in order to unveil the most efficacious interventions for impacting a given outcome. A total of 34 studies were included for review; 17 were used for quantitative analysis and 17 used for qualitative review. Parents of children with ASD in Asia were found to have lower QOL in the areas of general health, role physical, social, vitality, mental health, stress, and overall well-being than parents of typically developing (TD) children. High sense of coherence was shown to be associated with higher parental QOL and lower parental stress. Certain factors were found to be associated with higher sense of coherence including: male gender, parent age greater than 45, and child age greater than seven. Mothers were broadly found to have lower QOL than fathers. Mothers had a lower sense of coherence, lower health-related QOL, poorer overall well-being, and higher stress levels. Coping strategies that parents of children with ASD were found to use most often were religion and a focus on positive growth to create meaning. Not all interventions resulted in positive outcomes. A Mindfulness Based Intervention in Jordan positively impacted QOL outcomes. A Multidisciplinary Parent Education program in China had a significant positive impact on family functioning, while a Cognitive Behavioral Therapy (CBT) intervention for children with ASD decreased parental stress. Additionally, parents having and maintaining contact with parents in a similar situation helped improve well-being, parental stress and family functioning, following an intervention. This preliminary work investigating QOL for family members of children with ASD emphasizes the importance of discovering QOL outcome targets and pairing these with efficacious interventions that are specific to the needs of the population.
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  Retrospective Study Comparing the Efficacy of Epidural Analgesia to Perineural Nerve Catheter Analgesia for Postoperative Pain Management in Pediatric Patients Following a Unilateral Lower Limb Surgery

  Trif, Daniel; The University of Arizona College of Medicine – Phoenix; Belthur, Mohan (The University of Arizona., 2019)

  The primary aim of this study was to determine if peripheral nerve catheterization offers a better analgesic alternative than an epidural catheter in pediatric patients who undergo a unilateral lower limb surgery. Postoperative pain management is not only important in promoting comfort to patients in pain but can also promote rehabilitation and optimal healing. Multimodal analgesia is the use of multiple modalities to treat patients’ pain; two of these methods include epidural and peripheral catheters. Epidural catheter infusions offer global analgesia from the waist to both of the lower extremities. Epidurals do pose side effect risks that include infection, urinary retention, hypotension, pruritus, nausea/vomiting, headaches, backaches, and respiratory depression. Peripheral nerve infusions can act more locally at a targeted area and deliver carefully dosed anesthetics to nerve fibers that can hinder the sensory function of nerves while preserving the motor function, allowing for earlier rehabilitation. The use of multimodal analgesia as a postoperative pain management plan can still vary greatly from clinician to clinician, so it would be of benefit to determine which subset of patients may benefit from having a catheter infusion as part of their treatment regimen and whether a peripheral infusion is superior to an epidural infusion. This was a retrospective study that looked at 65 pediatric patients, ages 5-15, that received either an epidural infusion (n = 53) or a peripheral nerve block infusion (n = 12) for a unilateral lower limb operation. Their charts were analyzed to determine pain scores, PCA usage, PRN morphine equivalents, total morphine equivalents, adverse events, length of catheter use, and length of hospital stay, amongst other things. The epidural group was used as the control for the study and the data analysis revealed that the patients that received a peripheral infusion had 43% higher (p = 0.35) pain scores, received 98% less (p = 0.001) continuous morphine equivalents in their infusions, required 31% less (p = 0.34) PRN morphine equivalents, had 68% less (p = 0.049) PCA usage rates, received 32% less (p = 0.39) total morphine equivalents, had 30% less (p = 0.45) adverse effects, and left the hospital 0.54 days earlier (p = 0.13) on average when compared to patients that received continuous epidural infusions. The data indicates that although the pains scores were higher for the peripheral infusion patients, these patients required less opioid exposure, which indicates relatively acceptable pain management for the patient and healthcare team while also allowing for the opportunity to engage in rehabilitation and avoid the global effects of epidural infusions and the associated increased profile risk. The conclusion of this study suggests that continuous peripheral infusions are a valid alternative to epidural infusions for pediatric patients that undergo a unilateral lower limb surgery and that a randomized control trial would be warranted to offer more definitive insight.
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  Does Obesity Exist in Developing Countries? Evaluation of a Rural Clinic Population in the Dominican Republic

  Tay, Kimberly; The University of Arizona College of Medicine – Phoenix; Barcellona, Dawn (The University of Arizona., 2019)

  There is a growing obesity prevalence in developed and developing countries. According to the WHO, in 2014, more than 1.9 billion adults were overweight and 600 million of them were obese while 41 million children under the age of 5 were overweight or obese. Therefore, we are also seeing an increased prevalence of obesity related comorbidities like diabetes and hypertension. This study aims to determine the obesity rate in the bateys in the Dominican Republic (DR), compare it to the US obesity rates US, and determine necessary interventions to prevent further complications from the growing obesity epidemic. Patients were evaluated in mobile clinics in the bateys in the DR during medical service trips in 2016 by UACOMP Global Health teams. A retrospective chart review was performed to collect patients’ age, sex, height, and weight. The BMI was calculated for each patient. Pediatric (<18 y) patients’ BMI was recorded as a percentile based on age. Compared to the US pediatric population, there was a difference of 3.6% in overweight children and 4.4% in obese children among the clinic patients in the bateyes. Approximately 55% of the bateyes’ adult population was overweight (BMI>25-30) versus 31% in the US. About 23%of the bateyes’ adult patients was obese (BMI≥30) compared to 36% in the US. These results indicate a growing obesity epidemic in the rural farming villages in the DR that is like the trend in the US. We hope to implement public health interventions by educating this population about the dangers of obesity and its associated comorbidities, including coronary artery disease and diabetes.
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  Associations of Chest Compression Release Velocity and Age, Weight, and Gender during Cardiac Resuscitation

  Sutter, John; The University of Arizona College of Medicine – Phoenix; Bobrow, Bentley J. (The University of Arizona., 2019)

  Higher chest compression release velocity (CCRV) has been associated with better outcomes after out-of-hospital cardiac arrest (OHCA), and patient factors have been associated with variations in chest wall compliance and compressibility. We evaluated whether patient sex, age, weight, and time in resuscitation were associated with CCRV during pre-hospital resuscitation from OHCA. This observational study of prospectively collected OHCA quality improvement data in two suburban EMS agencies in Arizona between 10/1/2008 and 12/31/2016. Subject-level mean CCRV during the first 10 minutes of compressions was correlated with categorical variables by the Wilcoxon rank-sum test and with continuous variables by the Spearman’s rank correlation coefficient. Generalized estimating equation and linear mixed-effect models were used to study the trend of CCRV over time. During the study period, 2,535 adult OHCA cases were treated. After exclusion criteria, 1,140 cases remained for analysis. Median duration of recorded compressions was 8.70 minutes during the first 10 minutes of CPR. An overall decline in CCRV was observed even after adjusting for compression depth. The subject-level mean CCRV was higher for minutes 0-5 than for minutes 5-10 (mean 347.9 mm/s vs. 339.0 mm/s, 95% CI of the difference -12.4 ~ -5.4, p < 0.0001). Males exhibited a greater mean CCRV compared to females [344.4 mm/s (IQR 307.3-384.6) vs. 331.5 mm/s (IQR 285.3-385.5), p=0.013]. Mean CCRV was negatively correlated with age and positively correlated with patient weight. CCRV declines significantly over the course of resuscitation. Patient characteristics including male sex, younger age, and increased weight were associated with a higher CCRV.
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  A Randomized Control Trial of Benefits of Intrahopsital Exercise on Post-Transplantation Deconditioning in the Pediatric Hematopoietic Stem Cell Transplant Population

  Smith, Charles; The University of Arizona College of Medicine – Phoenix; Ngwube, Alexander (The University of Arizona., 2019)

  Deconditioning is a common adverse effect of short and long-term immobilization. For months pediatric hematopoietic stem cell transplant patients can be quarantined while hospitalized, much of which time is spent immobilized putting these patients at a higher risk for loss of muscle strength, functionality, endurance, and quality of life. Studies have shown that exercise as an effective countermeasure to deconditioning in stem cell transplant patients. However, research is lacking in pediatric HSCT due to the complications associated with treatment. This study was conducted to determine if there is a correlation between intrahopsital exercise and improved functionality, endurance, strength, and quality of life. In addition, this randomized control study looked at the merit and feasibility of adding an exercise routine into treatment plans. We have currently recruited 23 of our target 40 patients, 12 in the control arm and 11 in the intervention arm, ages 8-17 at Phoenix Children’s Hospital. Each participant received baseline measured by an OT or a PT for functionality using (WeeFIM), muscle strength using manual muscle testing (MMT), endurance using the 6-minute walk test, and quality of life using the NIH PROMIS measures. Measurements were taken again at discharge and 6-weeks post-discharge. During hospital admittance the intervention group performed exercise routines 3-times weekly while the control group were encouraged to spend time out of bed. Patients recruited were receiving their first HSCT and did not have any post-HSCT complications such as severe infection or GVHD. Data and results are limited due to the timepoint of the study and the limited number of recruited patients affecting the power of the study. No statistically significant difference is noted between the two arms in functional status, muscle strength, or endurance. There appears to be an increase in quality of life patients in the interventional arm compared to the control arm. Simple analysis has shown that compliance with time out of bed decreases across both groups the further away from transplant. Currently the study is midway, and data is limited to make any conclusions but shows promise.
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  Pre-Hospital Factors that Lead to Increased Mortality and Morbidity in Trauma Patients in Developing Countries: A Systematic Review

  Smith, Gabriella; The University of Arizona College of Medicine – Phoenix; Beyda, David (The University of Arizona., 2019)

  Trauma is a growing global concern and the WHO estimates that injuries account for one-sixth of the global adult disease burden. Furthermore, there is a disproportionate number of trauma related deaths that occur lower middle-income countries compared to higher income countries. Studies show that deficiencies in care in preventable related deaths include pre-hospital delays, delays in treatment and inadequate resuscitation. Additionally, most trauma related deaths occur in the prehospital setting and it is in the lower to middle income countries where structured emergency medical services are lacking. This review seeks to identify and categorize the contributing prehospital factors that lead to increased mortality and morbidity in trauma patients in developing countries. A systematic review was performed using primary journal articles (written in English) that report pre-hospital interventions and morbidity and mortality outcomes in trauma patients in developing countries. PubMed/MEDLINE and other literature databases were used to locate these primary journal articles by utilizing combinations of search terms “developing countries (MeSH),” “Emergency Medical Services (MeSH),” “pre-hospital emergency response,” and “third world countries.” Our analysis found that patients who experienced a prehospital delay had an 86% increase in mortality. Regarding prehospital care, which was not a well-defined factor across all three papers, one papers found that patients who did not experience adequate prehospital care had a 226% increase in mortality while the other papers only included frequency rates of interventions and corresponding data on mortality. Regarding intubation, one study showed that prehospital intubation was associated with increased mortality compared to emergency department intubation. This study adds to the scarce literature how a lack of prehospital infrastructure is associated with an increased likelihood of mortality. It also highlights the importance and necessity of an increase in quality primary research conducted in developing countries. Only prehospital delay had enough papers with data and thus was the only factor we were able to perform a meta-analysis. Our analysis found that patients who experienced a prehospital delay had an 86% increase in mortality.
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  Pediatric RSV Patients: Radiographic Findings on Admission and Clinical Outcomes

  Shoshan, Dor; The University of Arizona College of Medicine – Phoenix; Connell, Mary (The University of Arizona., 2019)

  Respiratory Syncytial Virus (RSV) is a common cause of respiratory tract infection in children. This retrospective review attempts to evaluate the association of admission chest radiographs with severity of clinical outcome. Radiographic findings were correlated with ‘severe’ and ’non-severe’ clinical outcomes, whereby a severe outcome was defined as hospitalization > 2 days, PICU admission, or mechanical ventilation during hospitalization. A non-severe outcome was defined as absence of the previous criteria. The most common abnormal chest radiograph findings were: interstitial prominence (n=182 [61.5%]), airspace opacity (n=106 [35.8%]), and hyperinflation (n=78 [26.3%]). The radiographic findings found to be associated with a severe clinical outcome were hyperinflation (p=0.033) and airspace opacity (p<0.001). Clinicians should consider more aggressive treatment and closer monitoring when these findings are present on admission chest radiography.
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  Comparing the Effects of Narrative Nonfiction and Literary Fiction on Empathy Retention in Medical Students

  Shi, Aishan; The University of Arizona College of Medicine – Phoenix; Hartmark-Hill, Jennifer (The University of Arizona., 2019)

  Integration of medical humanities into medical student curricula has been shown to improve medical student empathy and resilience. The purpose of this study is to determine if narrative nonfiction pieces help students retain equal or more empathy skills compared to reading literary fiction. Previous studies show that interventions that utilize medical humanities can vary in medium and genre, and face the challenge of small sample size and confirmation bias due to a lack of randomized trials. In contrast, this study compares the reading of Narrative Nonfiction and Literary Fiction in building empathy in second year medical students randomized to each genre. Participants were asked to read selections from their assigned genre during the intervention period. Baseline, pre-intervention, and post-intervention assessments were measured by the Reading the Mind in the Eyes –Revised. Results demonstrated a statistically significant decrease in empathy across the overall study period, and there was no empathy retention difference between genres. Additionally, female gender identity and increased engagement in the arts and humanities prior to medical school were correlated with higher empathy scores across time. These findings indicate the need for longitudinal and personalised learning in medical humanities for more thorough studies and maximised benefits on empathy retention.
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  Examining the Safety and Cost of Risk-Reducing Salpingectomies as Prophylactic Treatment for Women Seeking Sterilization Who Are at Low to Moderate Risk for Ovarian Cancer

  Samareh-Jahani, Farmin; The University of Arizona College of Medicine – Phoenix; Kaufmann, Bruce (The University of Arizona., 2019)

  Ovarian cancer ranks fifth among the most common cause of cancer deaths in women. There is evidence that the site of origin for the majority of the most serious form of ovarian cancers is the fallopian tube. There is growing consensus for risk-reducing salpingectomies (RRS) to be performed for women who are at moderate risk for developing ovarian cancer especially at a time of patient desired sterilization. A retrospective chart review to determine the safety and cost of risk-reducing salpingectomies in comparison to tubal ligations was performed using the Healthcare Cost and Utilization Project inpatient database from 2008-2012. Results showed no significant difference between each procedure for length of stay in days (95%CI -0.19, 0.79 p: 0.24) or intraoperative complications (OR 4.84 (95%CI 0.38, 60.9 p: 0.22)). There was a significant difference between the total charges associated with each procedure with tubal ligation having a mean cost of $2,227.21 (95%CI $403.2, $4051.10) and the bilateral salpingectomy procedure having a mean cost of $11,189.80 (95%CI $6,582.70, $15,796.80 p<0.001). The cost difference between the two procedures should shift the conversation towards the question of whether hospital billing and insurance coverage for bilateral salpingectomy without oophorectomy should be examined more closely in order to provide RRS as a prophylactic treatment for women at moderate risk for developing ovarian cancer seeking sterilization.
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  Physical, Emotional/Psychological and Sexual Abuse Analysis based on Victim Characteristics

  Salefsky, Sherilyn; The University of Arizona College of Medicine – Phoenix; Hussaini, Khaleel (The University of Arizona., 2019)

  It is estimated that 25-35% of women and men in Western countries have experienced Intimate Partner Violence (IPV). Research has been performed indicating that there are long term effects of physical and emotional problems including associations with higher rates of mental illness and substance abuse. However, most research has been geared towards females as the victims of abuse. Research looking at the risk factors and long-term outcomes of male abuse victims has been limited. For this reason, this study was designed to determine the associated diagnoses and demographic factors which are associated in victims of physical, emotional/psychological and sexual abuse in both males and females presenting to Emergency Departments in Arizona.
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  Increasing Rates of Screening for Food Insecurity in a General Pediatrics Teaching Practice

  Romo, Ryan; The University of Arizona College of Medicine – Phoenix; Samaddar, Kristen (The University of Arizona., 2019)

  Food insecurity is a widespread and complex problem that affects approximately 21% of the nation’s children. Demographic and socioeconomic data alone are not indicative of all families that are unable to access enough food to fully meet basic nutritional needs because of insufficient means. Screening for food insecurity is essential to identify these families so that they can be set up with resources to increase their access to resources. This study assesses if the implementation of a two-question food insecurity screen at well child checks improves screening rates through prospectively looking at patients in PCH’s General Pediatric Clinic. The validated screen includes the questions, “In the past 12 months, did you ever worry whether the food for you and your family would run out before you had enough money to buy more?” and “In the past 12 months were there times when the food for you and your family just did not last and there was no money to get more?” (Hagar et al. 2010). A family who answered positively to either of these questions was identified as food insecure and set up with resources. Three stages of data were analyzed for identification of food insecurity. These included: 1) previous practices, 2) following provider education, and 3) following integration of the validated screening tool in the EMR. 60 well child visits, 20 from each age group (<1yr, 1-4yr, and 5-11yr), were randomly selected and reviewed for each stage. The integration of the screening tool into the EMR showed statistically significant improvement of screening rates and consequently more families were able to be identified as food insecure. This increase in identification improved overall quality of care by allowing providers to then share resources with families to gain access to food. The screen also has the potential to lower the cost of care through prevention of poor/fair health, hospitalizations, and developmental risks that are associated with FI in children. The next steps include identifying more resources to provide the families, improve follow up to see if the resources are actually being accessed, and encourage the use of the screen in other clinical settings seeing how not everyone presents for primary care.
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  Healthcare Charges Incurred from Scorpion Envenomation Treated with Centruroides F(ab’)2 Antivenom

  Roberts, Alexa; The University of Arizona College of Medicine – Phoenix; O'Connor, Ayrn (The University of Arizona., 2019)

  Centruroides F(ab’)2 antivenom (AV) is a safe and effective treatment for bark scorpion envenomation; however, concern exists regarding the substantial charges associated with this therapy and resulting unexpected costs of treatment. This retrospective review seeks to quantitate patient charges associated with antivenom use to better understand its impact on patient and healthcare economics. This is a retrospective review of 527 patients presenting to a hospital system with severe scorpion envenomation between April 2013 and May 2015. Included patients had Centruroides scorpion envenomation and received AV. They were excluded if they were not a grade III or IV envenomation, did not receive antivenom or their clinical records were not available. Patient charges and hospital costs were acquired from institutional financial records and were included if total costs were accurate as defined by costs > $2500. Clinical manifestations, length of stay (LOS), method and amount of AV administration were abstracted. Continuous data were reported as medians with interquartile range and linear regression was utilized to determine predictors of outcomes. All patients had a grade 3 or 4 envenomation and received AV. The total number of vials received were 1 (18.2%) to a maximum of 7 (0.4%) with most patients receiving three vials (46.7%). Most patients received three vials of antivenom initially (52.6%) as compared to one vial (43.6%) and only few receiving two vials (3.8%). Median total charges were $28,060 ($18,805 - $33,742). Linear regression showed that total charges were predicted by total number of vials administered and LOS (adjusted R2 of 0.75). Charges of care were found to increase by $7901.59 per vial of AV and by $415.48 for each hour of LOS. The only predictors of total charges were age, number of vials and total length of stay. Correlation between total charges and costs was poor. Despite established safety and efficacy, anticipated patient charges appear to influence the manner in which bark scorpion antivenom is administered by healthcare providers.
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  Surgery Night Float Team: Should Medical Students Have a Spot on the Roster?

  Richter, Madeline; The University of Arizona College of Medicine – Phoenix; Keric, Natasha (The University of Arizona., 2019)

  Following the trend of residency programs, more medical schools are offering night float (NF) schedules for clerkships and sub-internship rotations. The efficacy of this structure to educate students and prepare them for residency was evaluated. This study investigates the question: Is a night float surgical rotation an effective educational experience for 4th year medical students to prepare for internship in that it matches or exceeds day-shift rotations in operative and procedural opportunities, autonomy, and instructive interactions with attending physicians and residents? Twenty individuals were surveyed after a month-long 4th year NF rotation in Trauma and Emergency Surgery. Thirteen participants responded (65%), reporting more bedside procedures (84.7%) and one-on-one teaching with residents (84.7%), when compared to daytime shifts. All participants (100%) reported: increased autonomy; that this elective better prepared them for their surgical residencies; and that they would recommend this type of program to other students considering a career in surgery. Overall the NF surgical sub-internship effective and well-received, with increased autonomy, more frequent procedures, and added resident-led education, when compared to a traditional daytime surgical clerkship/sub-internship. A NF schedule can be a valuable learning experience that prepares medical students for surgical residency.
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  Salvage Hyperthermic Gemcitabine and Docetaxel Combination Chemotherapy After BCG Failure in Non-Muscle Invasive Bladder Cancer Patients

  Rao, Mounica; The University of Arizona College of Medicine – Phoenix; Lamm, Donald L. (The University of Arizona., 2019)

  In patients with non-muscle invasive bladder cancer (NMIBC), intravesical BCG has been shown to reduce the rate of disease recurrence and disease progression, as well as improve disease-specific survival. While Bacillus Calmette-Guerin (BCG) has become the gold-standard therapy for NMIBC, there are still patients who fail this therapy or are not good candidates for it. Although a radical cystectomy is recommended when BCG is failed, some patients either desire bladder preservation or are not surgical candidates. Thus, further exploration into salvage chemo therapy treatments should be done to provide these patients with an alternative treatment option. The purpose of this study is to analyze if combination Gemcitabine and Docetaxel chemotherapy (GEM/DOCE) is a successful salvage option in adults who have failed or cannot tolerate BCG therapy for NMIBC, and are poor surgical candidates for a radical cystectomy (RC) or desire bladder preservation. In this retrospective study, 60 patients were included. Overall treatment success was 83% (50/60) at first surveillance, 69% at 1-year, and 55% at 2-years after induction of GEM/DOCE in the entire cohort, and 90%(53/51) at first surveillance, 74% at 1-year, and 56% at 2-years in the BCG-failure patients. These success rates are quite favorable and warrant further investigation in a prospective manner to further optimize this salvage protocol for patients who remain a challenge to treat.
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  What are the physical characteristics of the distal tibiofibular syndesmotic joint in uninjured patients?

  Rahman, Qasim; The University of Arizona College of Medicine – Phoenix; Gridley, Daniel G. (The University of Arizona., 2019)

  The syndesmosis is a crucial component for the ankle joint as any injury to it can immobilize a person. The ultimate goal of treatment is to restore the syndesmosis and ankle joint to their respective pre-injury, anatomic alignments. Few studies have attempted to characterize normal syndesmotic joints. Many of these studies have had certain limitations: small population size, minimal diversity in subject demographics, and very few raters taking part in data collection. The purpose of this study is to review a normal distal tibiofibular syndesmosis and characterize the parameters of an uninjured joint using both computed tomography (CT) and magnetic resonance imaging (MRI).

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