• Underreporting of Fatigue in Gynecologic Oncology Patients

      Chavez, Marin; The University of Arizona College of Medicine - Phoenix; Chase, Dana (The University of Arizona., 2017-04-27)
      Cancer‐related fatigue (CRF) is a well‐documented symptom among gynecologic oncology patients. However, there is little known about the etiology, and treatment options are currently suboptimal. While the lack of knowledge surrounding the intricacies of CRF impedes effective care, there is arguably a more serious barrier to delivering adequate treatment. Fatigue symptoms are highly underreported to physicians making it impossible to offer treatment to a large subsection of patients. This study will focus specifically on gynecologic oncology patients, a population with a staggering prevalence of CRF. The purpose of this study is to identify clinical, psychosocial, and lifestyle characteristics that may be associated with the underreporting of fatigue specifically in gynecologic oncology patients. The design of this study is a cross‐sectional survey. 89 subjects were recruited from three outpatient sites. Inclusion criteria included: (a) women age ≥18 years old with a known ovarian, uterine, cervical, vaginal, vulvar, or primary peritoneal cancer; (b) Currently attending physician’s office hours and/or undergoing chemotherapy at one of the above listed centers. This study will focus specifically on the reporting of CRF in gynecologic oncology patients. Results showed that barriers to reporting fatigue were significantly correlated with the chemotherapy cycle a patient was undergoing. Additionally, the date of last treatment, a patient’s weight, and the cancer stage was associated with higher levels of underreporting in this population. The prevalence of cancer related fatigue is staggering; however, there is limited research as to why patients are underreporting such a significant symptom to their health care team. With the knowledge from this study, screening for fatigue can become more efficient by targeting women in specific chemotherapy cycles. Practitioners can also use this data to identify patients with high‐risk characteristics that might contribute to their unwillingness to discuss fatigue symptoms.
    • Understanding Severe Acute Malnutrition in Children Globally: A Systematic Review

      Kellerhals, Sarah; The University of Arizona College of Medicine - Phoenix; Caputo, Grace (The University of Arizona., 2017-06-19)
      Severe acute malnutrition (SAM) affects 13 million children under the age of 5 worldwide, and contributes to 1‐2 million preventable deaths each year. Malnutrition is a significant factor in approximately one third of the nearly 8 million deaths in children who are under 5 years of age worldwide. There have been many revolutions in treatment of SAM over time; however, the exact etiology of this preventable condition is not well understood. This review serves to identify the most common risk factors for the development of SAM in children and to identify the most effective treatment for the disease. There are many factors that contribute to developing and surviving SAM as a child, and this systematic review serves to highlight the most common variables that lead to this cause of mortality. An exhaustive review of PubMed was conducted to complete this review. The literature review demonstrates that the most common risk factor for the development of SAM is low maternal literacy.
    • Understanding the Effect of Morphine on the Accuracy of Nuclear Hepatobiliary Imaging Through a Case Study

      Dhadvai, Sandeep; The University of Arizona College of Medicine - Phoenix; Verma, Nishant (The University of Arizona, 2017-05-08)
      Many patients present with upper abdominal pain and receive some type of pain relieving therapy prior to gallbladder imaging. The physiologic effect of morphine and other analgesics on gallbladder function has been well‐studied. What hasn’t been studied as much are the implications on clinical practice and the decision about whether morphine is the best option to use in suspected chronic gallbladder disease. This case study serves to illustrate the influence of morphine in a patient who underwent both inpatient and outpatient hepatobiliary scintigraphy with dramatically different results. This case study perfectly shows the considerations that must be taken when using morphine because it eliminates many confounding variables; the only difference in the patient at the time of initial and subsequent presentation was the presence of morphine.
    • The Use of Pulmonary Dead Space Fraction to Identify Risk of Prolonged Mechanical Ventilation in Children after Cardiac Surgery

      Siddiqui, Muniza; The University of Arizona College of Medicine - Phoenix; Willis, Brigham (The University of Arizona., 2017-05-18)
      Children with prolonged mechanical ventilation after cardiac surgery have a higher risk for poor outcome due to a variety of ventilator‐associated morbidities. It therefore becomes essential to identify these children at higher risk of prolonged mechanical ventilation as well as find methods to identify children ready to be extubated as early as possible to avoid these complications. One physiological variable, the pulmonary dead space fraction (VD/VT), has been suggested as a possible indicator of prolonged mechanical ventilation. VD/VT essentially measures the amount of ventilated air that is unable to participate in gas exchange. Can VD/VT be used successfully in children undergoing cardiac surgery to identify those at risk for prolonged mechanical ventilation and identify those ready for extubation? Retrospective chart review of 461 patients at Phoenix Children’s Hospital in the Pediatric Cardiac Intensive Care Unit since the initiation of standard application of the Philips NM3 monitors in October 2013 through December 2014. From the 461 patients screened, only 99 patients met all the inclusion criteria. These 99 patients consisted of 29 patients with balanced single ventricle physiology and 61 patients with two ventricle physiology. Initial postoperative and pre‐extubation VD/VT values correlated with length of mechanical ventilation for patients with two ventricle physiology but not for patients with single ventricle physiology. Additionally, pre‐extubation VD/VT values of greater than 0.5 indicated higher rates of extubation failure in two ventricle patients. Conclusion: For children with two ventricle physiology undergoing cardiac surgery, VD/VT should be used clinically to estimate the length of mechanical ventilation for these children. VD/VT should also be checked in these patients before attempting to extubate. If VD/VT is found to be higher than 0.5, extubation should not be attempted since the patient is at a much higher risk for extubation failure.
    • The Vaginal and Gastrointestinal Microbiomes in Gynecologic Cancers: A Review of Applications in Etiology, Symptoms and Treatment

      Goulder, Alison; The University of Arizona College of Medicine - Phoenix; Chase, Dana (The University of Arizona., 2017-05-26)
      The human microbiome is the collection of microorganisms in the body that exist in a mutualistic relationship with the host. Recent studies indicate that perturbations in the microbiome may be implicated in a number of diseases, including cancer. More specifically, changes in the gut and vaginal microbiomes may be associated with a variety of gynecologic cancers, including cervical cancer, uterine cancer, and ovarian cancer. Current research and gaps in knowledge regarding the association between the gut and vaginal microbiomes and the development, progression, and treatment of gynecologic cancers are reviewed here. In addition, the potential use of probiotics to manage symptoms of these gynecologic cancers is discussed. A better understanding of how the microbiome composition is altered at these sites and its interaction with the host may aid in prevention, optimization of current therapies, development of new therapeutic agents and/or dosing regimens, and possibly limit the side effects associated with cancer treatment.