• Experiences of mistreatment during medical school: does specialty choice matter?

      Zhang, Jaimei; Kaib, Susan (The University of Arizona., 2020)
      Introduction: Medical student mistreatment remains an issue, with recent data indicating that there has been no change in prevalence of self-reported experiences of mistreatment by medical trainees. Prior studies indicate that mistreatment occurred at higher rates during OB/GYN and surgical clerkships and that individuals in surgical specialties reported lower rates of mistreatment during the surgical clerkship. Methods: Our study surveyed attending and resident physicians on experiences of mistreatment as a medical student. We were interested in determining whether there were differences in severity of mistreatment or type of mistreatment in surgical vs. non-surgical resident and attending physicians. Results: Our results showed no significant difference in number of events reported or severity of mistreatment events. There was a significant difference between number of mistreatment events in the “other” specialty residents compared to both surgical and non-surgical residents. Conclusion: This study did not show significant differences between experiences of mistreatment as medical students in surgical and non-surgical attendings and residents as other studies have indicated.
    • Pityriasis Lichenoides: Evaluating Factors Affecting Outcomes in Pediatric Patients

      Xie, Daniel; O'Haver, Judith (The University of Arizona., 2020)
      BACKGROUND: Pityriasis lichenoides (PL) is a rare cutaneous disorder than occurs in all age groups with a predominance in pediatric patients. OBJECTIVE: To assess clinical features of PL and treatment options affecting disease outcome in pediatric patients at our institution. METHODS: The records of 28 pediatric patients with a confirmed diagnosis of PL were retrospectively reviewed. RESULTS: The median age at presentation of PL was 92 months (range: 12-192 months). Twenty-six patients elected to start antibiotic therapy, with only 23.1% responding well. Thirteen patients in the cohort agreed to methotrexate therapy, which offered a 100% response rate. The median duration of all forms of PL was 36 months (range: 12-144 months). CONCLUSION: PL and its subtypes require additional studies to determine pathogenesis to drive treatment choice. Antibiotics appear to be a safe choice as the first-line therapy. The usage of methotrexate shows excellent results in the treatment of PL.
    • Strong Start for Mothers and Newborns: Impact on OB Triage Visits

      Wolfenden, Emily; Manriquez, Maria (The University of Arizona., 2020)
      Introduction: The Strong Start for Mothers and Newborns Initiative was launched in 2012 as an effort to reduce preterm birth rates, improve birth outcomes, and reduce costs of medical care for those enrolled in Medicaid or the Children’s Health Insurance Program [1]. The Strong Start program modeled a maternity medical home, which includes the services of an additional project manager, registered nurse care coordinator, and two community health workers, with the aim to provide enhanced wrap around prenatal and psychosocial services. Previous studies have shown that implementation of patient-centered medical home models of care among patients with chronic diseases have led to decreases in frequency of ED visits among these patients [2,3]. However, research is lacking regarding the effectiveness of implementation of a maternity medical home model of care on reduction of Obstetric (OB) Triage visits. Methods: This retrospective chart review compared rates of OB Triage visits between two cohorts of women: Strong Start Maternity Medical Home participants and non-Strong Start controls within an urban county hospital network. Results: While the mean number of OB Triage visits among Strong Start participants (0.78; 95% CI 0.70-0.86) was higher than non-Strong Start controls (0.58; 95% CI 0.52-0.64)(P<0.001) the acuity was also greater. Among Strong Start participants, Odds Ratio of >1 OB Triage visits was 2.16 (1.77, 2.62) and Odds Ratio of >2 OB Triage visits was 2.50 (1.94, 3.22) compared to controls (p <0.001). Conclusions: Triage care services increased, among participants of a maternity medical home model of care despite increased access to prenatal education and prenatal service. Further research is necessary to determine trends in OB Triage chief complaints, highlight modifiable factors that may allow a reduction in OB Triage visits, and determine the cost effectiveness of patient enrollment in a maternity medical home model of care.
    • Evaluating Narrative Operative Reports for Endoscopic Sinus Surgery in a Residency Training Program

      Wheeler, Shannon; Lal, Devyani (The University of Arizona., 2020)
      Methods: The quality of NRs for endoscopic sinus surgery (ESS) was evaluated by studying 90 NRs for ESS written between 2014-2017. Thirty-three elements that the attending surgeon regards as “critical” variables, or quality indicators (QIs), that should be documented in the NR, were studied to evaluate quality. “NR efficiency” (average percent of QIs dictated / total word count) was studied. Subgroup analysis by the level of training was additionally performed. Results: Surgical indications, procedural steps and immediate postoperative findings were accurately documented in 71%, 84%, and 82% of patients, respectively. The attending surgeon had the highest quality (proportion of included key elements) of NR (89% +/- 6.2%) followed by junior residents (87% +/- 5.7%) and then senior residents (80% +/- 14%) [p=0.008]. The attending surgeon also demonstrated the highest degree of “NR efficiency”, followed by senior and then junior residents (p<0.0001). Conclusions: The quality of NRs was found to be high overall, but not “perfect” for either the attending or trainee surgeon. NR efficiency amongst residents was expectedly lower than the attending surgeon. We propose that a synoptic reporting system that ensures inclusion of key elements may be helpful in training residents (and attendings) in creating comprehensive and efficient NRs.
    • Current Trends in Creatine Use Rates Among the Adolescent Athletic Population

      Wang, Jeffrey; Kelly, Brian (The University of Arizona., 2020)
      The primary purpose of this study was to obtain the current creatine usage rates among the adolescent athletic population and compare the usage rates between different demographics including sex, age, and sport of participation. We conducted a survey of student athletes in grades 7-12 investigating current trends in creatine use within this population. Of the total participants, 16.3% reported knowing someone who takes creatine; 8.7% have thought about taking creatine themselves; 3.8% admitted to currently using creatine supplements, with the majority of those taking creatine comprising of upper classmen and football athletes. Most students have not researched how creatine or other supplements would affect their health, and 71.2% reported not knowing what creatine was. Only 6.5% believed that creatine use was safe to use as a supplement. The demographics of those using creatine remained consistent since the early 2000s, but the usage rate appears to have dropped. It appears that lack of knowledge on the subject and lack of research could be contributing to the low usage rates seen in this survey. A greater number of students also felt that creatine use was unsafe, and the general consensus seems to be trending away from creatine use in this population.
    • Effects of a workplace sedentary behavior intervention on sleep in office workers with sleep complaints: Results from the Stand and Move at Work Trial

      Schaeffler, Kelby; Buman, Matthew (The University of Arizona., 2020)
      Background: Chronic inadequate sleep is associated with increased risk for cardiovascular disease, hypertension, obesity, immunosuppression and overall mortality. There is an abundance of research on the effects of exercise on sleep, but there is currently no data on the impact of sedentary interventions in the workplace on acute and long-term sleep quality/quantity. Purpose: The purpose of this study is to determine if increased standing and/or light-intensity physical activity (LPA) at work will improve sleep quality and duration in sedentary office-workers with mild to moderate sleep complaints. Methods: For this group randomized trial, 51 participants with mild-to-moderate sleep complaints were selected from the Stand and Move at Work Trial. Participants were randomized into two groups: MOVE+ (a multilevel individual, social, environmental, and organizational intervention targeting increases in LPA in the workplace) and STAND+ (MOVE+ intervention with the addition of the installation of sit-stand workstations). Sedentary behavior/LPA and sleep were measured objectively at baseline, 3 and 12 months with the activPAL3 micro accelerometer (PAL Technologies, Glasgow, United Kingdom) and the GeneActiv (GeneActiv, Activinsight, Wimbolton, UK) wrist-worn actigraphy sensor. Results: The sit-stand workstation intervention was effective, with the STAND+ participants sitting on average 70 minutes/day less than the MOVE+ participants at 12 months (p<0.05). There were no statistically significant differences between intervention groups in objectively or subjectively measured time in bed, total sleep time, sleep onset latency, wake after sleep onset, or sleep efficiency at the 3 or 12-month timepoints. On the individual level, adjusting for group assignment, there was no correlation between change in sedentary behavior and sleep measures, objective or subjective. Conclusion: This study found no correlation between a decrease in sedentary behavior at work and changes in objective or subjective measures of sleep. Limitations of this study include underpowering due to small sample size, potential significance of difference in baseline demographics and sleep/sedentary behavior between in groups, and the nature of the intervention being low-dose.
    • 3D Volumetric Measurement of Normal Pediatric Livers: Creating a Reference Database and Predictive Model

      Sandoval, Amber; Bardo, Dianna M. E. (The University of Arizona., 2020)
      Background: Accurate and reproducible measurements of pediatric organs are necessary for defining normal organ volume, size, growth rates, and patterns of development, which aids in determining pathological variants. Currently, no modern reliable database exists for normal liver volume (LV) in children, and although predictive equations have been proposed, many are based on adult data, ethnically homogenous populations, or are derived from smaller samples and have not utilized advanced imaging technology in determining LV in vivo. Objective: To establish normal LV measurements in children, using a three-dimensional (3D) volumetric approach, with additional consideration for height, weight, body surface area (BSA), and body mass index (BMI), and to develop a predictive model using these parameters. Materials and methods: A retrospective review of normal contrast enhanced abdomen and pelvis CT images of 184 patients from 1 month to 18 years, identified within the Phoenix Children’s Hospital picture archive communications system (PACS) was performed. Gender, age, height and weight were recorded for each patient; BSA and BMI were calculated. LV measurements were obtained using segmentation images software (IntelliSpace, Phillips Healthcare, Haifa, Israel). Results: Univariate analysis of LV was most strongly correlated with and predicted by BSA (R2 = 0.90, p < 0.0001), which could be defined by: LV = -115.5 + 941.7*BSA. In multivariate analysis, BSA (p < 0.0001), gender (p = 0.01), and height (p = 0.001) were the covariates that best predicted LV with an adjusted R2 value of 0.90. 3 Stratifying the model by age did not modify the predictive capabilities of the covariates. Further stratifying by gender revealed inconsistent effect modification in some age groups. Conclusion: Univariate analysis of LV was most strongly correlated with and predicted by BSA, which can be defined by: LV = -115.5 + 941.7*BSA.
    • Telephone cardiopulmonary resuscitation after pediatric out-of-hospital cardiac arrest: An analysis of the process measures, outcomes, and barriers to delivery

      Salevitz, Daniel; Bobrow, Bentley (The University of Arizona., 2020)
      Telephone cardiopulmonary resuscitation (T-CPR) has been associated with improved patient outcomes after out-of-hospital cardiac arrest (OHCA) in studies worldwide, however outcomes are similarly poor for adult and pediatric patients. Additionally, relatively little is known about T-CPR process measures and barriers to delivery of T-CPR in the pediatric population when compared with adult patients. We conducted an observational study of suspected and confirmed OHCAs in Arizona between 1/2011 and 12/2014. Telephone CPR process measures and barriers were extracted from suspected OHCA audio recordings from three 9-1-1 centers and linked to EMS confirmed OHCAs and hospital outcomes. Metrics were compared across four groups: Adults (? 18 years old), and pediatrics (0-1 year old, 2-8 years old, and 9-17 years old). In the study period, 4,533 calls were made to dispatch centers, and after exclusion criteria a total of 3,396 calls were included in the outcomes analysis. There was no difference in survival to hospital discharge (p = 0.6395) or functional neurological outcome (p = 0.1189) when comparing the adult and pediatric patients. A total of 2,007 calls were included in the process measures analysis after exclusions. In the pediatric population, there was a higher rate of call-takers starting CPR instructions (p = 0.0009) and bystanders starting chest compressions (p = 0.0011) and rescue breaths (p < 0.0001). Additionally, time to start of CPR instructions (p < 0.0001), first compressions (p = 0.019), and first rescue breaths (p < 0.0001) were significantly shorter for the pediatric population than for adults. Analysis of barriers to delivery of T-CPR revealed that the inability to get a patient to a hard, flat surface was statistically different in frequency between the adult and pediatric calls. Conclusion: Despite better process measures for the pediatric group, survival and functional neurological outcomes are similarly poor for the adult and pediatric populations after OHCA. The inability to get a patient to a hard, flat surface is a significant barrier in adult patients, and further evaluation of barriers to recognition of need for T-CPR in pediatric 9-1-1 calls is needed.
    • Pediatric Primary Headache Sensitivity to Weather Variables

      Sabb, Dylan; Hickman, Carolyn (The University of Arizona., 2020)
      Objective: To determine the relationship between weather patterns and pediatric Emergency Department visits for primary headache. Methods: A retrospective descriptive correlational design was used. Chart reviews were done on 351 medical records of children less than 18 years of age. Study setting was visits to an Emergency Department at an academic pediatric hospital in the Southwest region of the United States. One calendar year of assessments of weather variables to include temperature, relative humidity, precipitation, and barometric pressure were obtained at multiple time points prior to presentation to identify weather-sensitive subsets. In addition, assessments of demographic (date of birth, sex, race, zip code) and clinical variables (chief complaint, diagnoses codes, imaging, medication, and disposition) were collected. Results: Findings indicate that there is a correlation between weather variables and Emergency Department visits in pediatric patients, especially in forecasts of two to five days. Conclusion: A subset of pediatric patients with primary headaches are sensitive to temperature changes within the 5 days preceding the presentation of the headache.
    • Provider variability in intensity modulated radiation therapy utilization among Medicare beneficiaries in the United States

      Rosen, David; Walker, Gary V. (The University of Arizona., 2020)
      Intensity modulated radiation therapy (IMRT) is a radiation therapy (RT) modality that improves dose conformality compared with conventional external beam RT and is now used in the treatment of approximately 40% of patients. 1 Although there is a well-documented improved side effect profile in using IMRT to treat both prostate and head and neck cancers,2,3 the benefits of routine IMRT in other disease sites are less established. Moreover, there are some disadvantages to ubiquitous IMRT utilization, including a relatively high price,4 the potential for near misses, and a large volume of low-dose normal tissue exposure with emerging implications such of beam path toxicity and second malignancies.5,6 The Medicare Physician and Other Supplier Public Use File (POSPUF) was first created in 2014 by the Centers for Medicare and Medicaid Services (CMS) and contains data on services rendered by physicians to Medicare beneficiaries in the United States. In this study, we used the POSPUF to analyze the variability in IMRT use among radiation oncology providers.
    • Lesion Size as a Predictor of Non-Operative Therapy Failure in Juvenile Osteochondritis Dissecans of the Knee

      Roehr, Mark; Kelly, Brian (The University of Arizona., 2020)
      Background: The primary challenge in juvenile osteochondritis dissecans of the knee management lies in the lack of definitive non-operative treatment criteria. The purpose of this study was to evaluate the predictive nature of the lesion size and to determine a lesion size cutoff point beyond which a patient’s likelihood of successful 3 month non-operative therapy significantly declines. Methods: 36 knees were retrospectively identified that met the inclusion criteria of stable JOCD lesions that received a 3 month non-operative therapy treatment consisting of either unloader bracing and/or activity restriction. The primary outcome of interest was improved clinical status at three months with accompanying MRI evidence of reossification. Continuous and categorical variables including lesion size were analyzed using logistic regression to ascertain the likelihood of a surgical intervention following a non-operative treatment regimen. Results: Following three months of non-operative treatment, 23 of the 36 knees (64%) had progression toward healing. The mean starting age of the patients with lesions that progressed toward healing was 10.4 years +/- 2.10 years and the mean age that required surgical referral was 12.4 years +/- 1.18 years (p = 0.002). The mean surface area of the lesions that demonstrated progression toward healing was 185.0mm2 +/- 103.7mm2, and the mean surface area of the lesions that did not progress toward healing and were referred for surgical management was 266.6mm2 +/- 95.5mm2 (p = 0.01). The mean lesion surface area cut point >250mm2 contained 13 knees. Of these 13 knees, 4 progressed toward healing (17.4% of the healing group), while 9 required surgical referral (69.2% of the surgery group) (OR = 6.84, 95% CI [1.17,39.8], p = 0.032). Conclusion: Increased lesion size and increased age were the strongest predictors of JOCD non-operative therapy failure. Stable lesions with a mean surface area that is > 250mm2 are at an increased risk for non-opperative failure and should be considered for direct surgical referral on a case by case basis.
    • Ethical Guidelines for Human Subjects Research in Least Developed Countries: How do they compare to the Council for International Organizations of Medical Sciences International Ethical Guidelines?

      Reed, Melissa; Beyda, David (The University of Arizona., 2020)
      Background: The most vulnerable populations for human subjects research are those living in the most resource poor settings. As technology has progressed to support convenient long-distance travel, international communication, and data sharing via the internet, international research has become a more manageable task. While some dismiss the ethical guidelines for human subjects research as necessary only for the most barbaric researchers, history demonstrates the need for ethical guidelines as well as oversight of adherence to such guidelines. Methods: Forty-eight countries designated as least developed countries (LDCs) were identified and selected for analysis. An internet search was utilized to identify research guidelines for LDCs available online or primary research studies conducted in such countries to determine to what extent authors noted ethical considerations. Council for the International Organizations of Medical Sciences (CIOMS) guidelines were distilled into keywords by the authors and compared to guidelines for LDCs. Frequencies and percentages of comparison to CIOMS guidelines were tabulated across the 48 LDCs. Findings: Of the 48 LDCs identified, 22 did not have published research guidelines or mention of a Research Ethics Committee (REC). An additional 10 countries had documentation of some sort of REC, 3 countries had at least one ethical guideline in addition to a REC, and 13 countries had no mention of a REC but did have established ethical guidelines available online. Overall, the average number of guidelines per country was 5 with a SD of 4.11. Conclusion: Over half of countries had online documentation of limited ethics oversight for research, indicating a clear lack of thoroughness in the available guidelines as compared to the international gold standard guidelines from CIOMS. The majority of primary research articles reviewed showed no mention of ethical considerations despite some of the articles using chart review or engaging in patient care interventions. Based on the findings of this study, authors recommend the adoption of existing ethical guidelines by countries still lacking individualized guidelines, as well as a movement toward journals requiring documentation of ethical approval or ethical considerations as a requirement prior to approving articles for publication.
    • Forensic Nursing Examination to Screen for Traumatic Brain Injury Following Intimate Partner Violence and Strangulation

      Ralston, Bridget; Lifshitz, Jonathan (The University of Arizona., 2020)
      Intimate partner violence (IPV) causes harm to an estimated 42 million victims each year. Routine forensic examination excludes specific evaluation of traumatic brain injury (TBI), thereby missing an opportunity to diagnose and offer treatment. This quality assurance/quality improvement project was designed to determine whether TBI signs and symptoms are detected in IPV patients using existing forensic nurse examination protocols. TBI signs and symptoms were cataloged from medical records to infer the incidence of TBI and inform an expansion of the nursing exam. Retrospective review of 19 cases collected over 31 days in June and July 2017 identified a predominance of young (average age 32.3), female (89.5%) patients with obstetric history (76.5% with 1 or more pregnancy), presenting with symptoms including lightheadedness / dizziness (84.2%), headache (78.9%), difficulty breathing (78.9%), and throat pain (68.4%). Subjective mechanism of injury included strangulation (100%), blow to the head with the perpetrator’s hand (52.6%), and fall to the ground (36.8%). TBI was not diagnosed during the exam, but recorded signs and symptoms indicated patterns consistent with brain injury. As a result of these findings, our team proposes expansion of the exam to include near point of convergence, balance, and hand-eye coordination testing to ensure detection of TBI signs in IPV victims. By detecting TBI signs early, community efforts can guide patients towards recovery, appropriate treatment options and successful return to society.
    • Optimization of a Novel Hepatobiliary Scintigraphy Protocol

      Peterson, Juliana; Singer Pressman, Melissa (The University of Arizona., 2020)
      Strategic use of medical imaging can improve healthcare quality and reinforce the practice of precision medicine by providing specific, individualized diagnostic information. Unfortunately, excessive radiologic scan duration times limit imaging center efficiency, leading to decreased patient satisfaction and heightened facility costs. A novel hepatobiliary scintigraphy protocol outlined by Verma et al. can be utilized with equivalent diagnostic ability to maximize scanner operation. The current study demonstrated multiple ways in which the new scintigraphy protocol can be optimized to increase imaging facility productivity. The models presented allow for customization based on facility preference and capability in order to decrease costs and generate revenue, while improving patient satisfaction.
    • Does exposure to chronic stress in rodents alter the level of SIRT1 in the nucleus accumbens?

      Peoples, Sandy; Ferguson, Deveroux (The University of Arizona., 2020)
      In this study we show that chronic social defeat stress, an ethologically validated model of depression in mice, stably induces SIRT1 levels in the nucleus accumbens, an area of the brain that is associated with motivation and reward. We exposed rodents to chronic social defeat stress for a period of ten days and then assessed the rodents on a social interaction test to determine stress response. Rodents were then classified as susceptible or resilient to chronic stress. SIRT1 mRNA and protein levels were then measured in the nucleus accumbens. Results showed that SIRT1 mRNA and protein levels were increased in susceptible rodents but not control or resilient rodents. This supports our hypothesis that SIRT1 levels are associated with depression and anxiety-like behaviors induced by chronic stress and may identify a novel signaling pathway for the treatment of major depressive disorders.
    • Methylene Blue Use in Pediatric Patients in the Cardiovascular Intensive Care Unit

      Patel, Sarah; Willis, Brigham C. (The University of Arizona., 2020)
      Objective: 1) Compare trends in mean arterial blood pressures and vasoactive-inotropic scores of pediatric patients after treatment of hypotension with methylene blue compared to controls; 2) Describe the dose administered and the pathologies of hypotension cited for methylene blue use; 3) Compare the morbidity and mortality of pediatric patients treated with methylene blue versus controls. Design: A retrospective chart review. Setting: Cardiac ICU in a quaternary care free-standing children’s hospital. Patients: Thirty-two patients with congenital heart disease who received methylene blue as treatment for hypotension, fifty patients with congenital heart disease identified as controls. Interventions: None. Measurements and Main Results: Demographic and vital sign data was collected for all pediatric patients treated with methylene blue during a three year period. Linear regression models examined trends in mean arterial blood pressures twelve hours post methylene blue treatment and vasoactive-inotropic scores for twenty-four hours post treatment. Methylene blue treatment correlated with an increase in mean arterial blood pressure of 10.8mm Hg over a twelve hour period (p< 0.001). Mean arterial blood pressure trends of patients older than one year did not differ significantly from controls (p=0.79), but patients less than or equal to one year of age had increasing mean arterial blood pressures that trended toward significance compared to controls (p=0.07). Similarly, a statistically significant decrease in vasoactive-inotropic scores was observed over a twenty-four hour period (?= -0.62, p< 0.001, ECMO ?= -6.07, p= 0.029). This difference remained significant compared to controls (p=0.001). Survival estimates did not detect survival differences between the groups (p=0.5). Conclusion: Methylene blue may be associated with a decreased need for vasoactive-inotropic support and may correlate with an increase in mean arterial blood pressure in patients who are less than or equal to one year of age.
    • Prevalence of Sexually Transmitted Infections (STI’s) among Incoming Refugees in Maricopa County, Arizona

      Osman, Fawsia; Khurana, Renuka (The University of Arizona., 2020)
      Objective: The aim for this study was to determine the prevalence rate of Sexually Transmitted Infections (STI’S) among incoming refugees in Maricopa County in the state of Arizona. Design: A retrospective study Setting: Maricopa County Public Health Department Participants: 1,471 refugees from the Maricopa County Main outcome measures: Prevalence of Chlamydia, Gonorrhea, HIV and syphilis among incoming refugees compared to the Maricopa County prevalence. Results: The overall prevalence rates among those tested were 1.12% (90 of 8,055) for Chlamydia, 0.19% (15 of 8,055) for Gonorrhea, 0.73% (80 of 11,018) for HIV, and 55.5% (71of 138) for Syphilis (+TPPA+RPR). The prevalence rates of Chlamydia(p<0.001), HIV (p<0.001) and Syphilis (p<0.001) were statistically significant when compared to the Maricopa County rates while the rate of Gonorrhea (p<0.84) did not show statistical difference. There was no statistically significant difference noted in the all the STI’s tested among males and females. Between the various age groups, Chlamydia was statistically higher among the age group of 15- 25 p<0.04 while HIV was statistically significant among the age group of 36-45 p<0.04. Among the different regions, syphilis, the seroprevalence rate was highest among those from the Caribbean (73.7%) p<0.02 than among persons from the other three region (South/southeast Asia, Sub-Saharan Africa, Middle East and North Africa). Chlamydia had the highest prevalence among those from the Middle East/ North Africa (2.0%) p<0.04. There was no statistically significant among the prevalence of Chlamydia, Gonorrhea, HIV and Syphilis and HIV over the years from 2013-2017. Conclusion: Overall, the higher prevalence rates of Chlamydia, HIV and Syphilis when compared to the population they immigrate into indicate the importance of routine screening of incoming refuges and utility of CDC refugee post-arrival screening and evaluation recommendations.
    • Endoscopically Assisted Targeted Keyhole Retrosigmoid Approaches for Microvascular Decompression: Quantitative Anatomic Study

      Onaka, Naomi; Preul, Mark C. (The University of Arizona., 2020)
      OBJECTIVE: We describe and quantitatively assess minimally invasive keyhole retrosigmoid approaches targeted to the upper, middle, and lower cranial nerve (CN) complexes of the cerebellopontine angle (CPA). METHODS: Anatomic dissections were performed on 10 sides of 5 fixed, silicone-injected cadaver heads. Surgical views through various trajectories were assessed in endoscopic videos and 3-dimensional (3D) interactive virtual reality microscope views. Surgical freedom and angles of attack to the proximal and distal areas of CN complexes of the CPA were compared among upper and lower keyholes and conventional retrosigmoid craniotomy using neuronavigation. RESULTS: Compared with keyholes, the conventional approach had superior surgical freedom to most areas except for the distal CN V, the root of CN VII, and the root of CN IX, where differences were not significant. The conventional retrosigmoid approach provided a larger horizontal angle of attack than either the upper or lower keyholes for all selected areas; however, the vertical angles of attack were not different. Splitting the petrosal fissure resulted in a significant increase in the vertical angle of attack to the root zones of CNs V and VII but not to the distal areas of these nerves or CN IX. Illustrative cases of endoscope-assisted keyhole retrosigmoid approaches for the treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia are presented. - CONCLUSIONS: Targeted keyhole retrosigmoid approaches require detailed understanding of the 3D anatomy of the CPA to create appropriate locations of corridors, including skin incisions and keyholes. Endoscope assistance complements the standard microsurgical technique by maximizing the visualization and identification of the delicate neurovascular structures.
    • Mental Health in the Arizona Asian Pacific Islander Community

      Nguyen, George; Briney, Stephanie (The University of Arizona., 2020)
      There is a disparity within the Asian community with regards to overcoming the mental health stigma. To understand how we can overcome this health obstacle within the Phoenix Asian American community the question lies: does an educational intervention increase mental health literacy in the Asian American community in Arizona? A cross-sectional study of Asian Americans in the city of Phoenix, AZ was done using subject from the Greater Phoenix Chinese Christian Church and Vietnamese Chinese Association of Arizona between September 14th, 2019 and Dec 21st, 2019. From the study, mental health literacy had significant improvement post intervention using an educational model in the form of understand depression treatments, seeking help, and being more open to mental health discussion with family members.
    • The Need for Standardized Medical Mission Evaluation Criteria: A Systematic Review and Look at Past Missions

      Nelson, Madalyn; Dolan, William (The University of Arizona., 2020)
      Background: Many civilian and military global health missions occur every year. There is not only a scarcity of documentation of medical missions, but there is also a lack of standardized evaluation criteria for these missions. In order to create standardized evaluation criteria, it is first necessary to compile currently used criteria. Objective: The objective of this article is to determine what criteria are currently being used to evaluate global health medical missions. This will provide a starting point from which standardized evaluation criteria can be created. Methods: This article is a systematic review of the literature. Articles were compiled through literature searches completed in 2016, sources were chosen based on inclusion and exclusion criteria, and were evaluated based on their medical mission evaluation criteria. Findings: 24 articles fit within the inclusion and exclusion criteria. Among these 24 articles, there were 17 different evaluation criteria identified. The 2 most commonly used criteria were official mission reports (including the location, size, duration and number of patients treated on the mission) and patient data (including patient risk factors, patient labs, procedures and outcomes). Conclusion: This review demonstrates that there is a need for better documentation and a need for consensus about the most important medical mission evaluation criteria, which in turn can be used to create standardized medical mission evaluation criteria. Based on the criteria compiled in this review, we present the M.D. NELSON standardized medical mission evaluation criteria, which include general medical mission concepts as well as specific evaluation criteria.