• Adductor Canal Nerve Block to Improve Total Knee Arthroplasty Recovery

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

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

      Canales, Francisco; The University of Arizona College of Medicine - Phoenix; Carlson, Richard (The University of Arizona., 2018-03-28)
      Alcohol Withdrawal Syndrome (AWS) occurs after an individual significantly reduces or completely stops consuming alcohol after a period of constant consumption. Existing literature plentifully describes social factors that contribute to lower likelihood of development of alcohol dependence among women. Physiological differences make alcohol dependent women more likely to develop alcoholrelated hepatic complications. Animal studies suggest that ovarian hormones are neuroprotective and lead to lower incidence of seizures and allow for quicker recovery from AWS.
    • Analyzing Unspecified Chest Pain Diagnoses and the Impact of Physician Staffing at the PVAHCS ED

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

      Fishel Ben-Kenan, Rotem; The University of Arizona College of Medicine - Phoenix; Polishchuk, Alexei (The University of Arizona., 2018-03-30)
      Purpose and Background: Neuroblastomais the most common pediatric extracranialsolid tumor •50% of patients present with metastatic disease typically involving bone and bone marrow •Despite intensive multimodality therapy, 40% of patients with high-risk neuroblastomawill experience relapse •131I-MIBG is an active salvage agent for relapsed and refractory MIBG-avid disease •It is unknown whether disease progression following 131I-MIBG treatment occurs in previously involved vs. new sites of disease •A better understanding of this pattern may inform the use of consolidative focal therapies following 131I-MIBG administration
    • Assessing the Impact of Cultural Beliefs on the Use of Evidence-Based Treatment for Diarrhea in Developing Countries: A Systematic Review

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

      Morgosh, Kelsey; The University of Arizona College of Medicine - Phoenix; Panchanathan, Sarada; Hartmark-Hill, Jennifer (The University of Arizona., 2018-04-05)
      Medication adherence describes the degree to which patients take medications as prescribed. Adhering to medication is a complex issue that has a significant impact on individual patients as well as on the effectiveness and financial burden of the health care system. Several factors emerge as common barriers to medication adherence in the general population including homelessness and its associated risk factors: low functional health literacy, psychiatric conditions, financial hardship, and transient lifestyle. Little research exists exploring what specific barriers prevent medication adherence in the United States homeless population and how these can be addressed. This descriptive retrospective study seeks to answer which, if any, specific barriers exist as obstacles to medication adherence within the Phoenix area homeless population >=18 years of age. Data was collected via retrospective chart review from the web-based EMR, Practice Fusion, at the interdisciplinary Student Health Outreach for Wellness (SHOW) Clinic which included health literacy and medication adherence surveys administered by staff during patient triage.
    • Beyond Disease-Oriented Care for the Uninsured: Increasing Access to Prevention

      Slaughter, Geoffrey; The University of Arizona College of Medicine - Phoenix; Lee, Maurice (The University of Arizona., 2018-02-28)
      Background/Significance: Cancer is the leading cause of death in Arizona, accounting for nearly 1 in 4 deaths. Disparities in cancer morbidity and mortality are frequently seen in people from certain racial/ethnic populations and people of low socioeconomic groups. Screening guidelines have been established by the United States Preventative Task Force (USPSTF) that allow for cost-effective prevention and early detection of cervical, breast and colorectal cancers. Adherence to these guidelines is an area of major disparity for marginalized healthcare populations in Arizona. The St. Vincent de Paul (SVdP) Medical Clinic provides medical care for uninsured families of the greater Phoenix area. A needs assessment was performed in the summer of 2015 to establish rates of cancer screening for its patients in accordance with USPSTF guidelines. This initial needs assessment demonstrated that the rate of cervical, breast, and colorectal cancer screenings were significantly lower than the national averages for both insured and uninsured patients.
    • Calculating Ventilatory Threshold in Patients After Stroke

      Quezon, Irvin; The University of Arizona College of Medicine - Phoenix; Bosch, Pamela (The University of Arizona., 2018-04-06)
      BACKGROUND: Aerobic training intensity is commonly determined from heart rate reserve (HRR) or a percentage of maximal heart rate measured during a graded exercise stress test. This method has limitations in people after stroke, who may not reach maximal heart rate. Ventilatory Threshold (VT) is an alternate method of establishing aerobic training intensity. VT indicates the exercise intensity above which ventilation increases disproportionately compared to whole-body oxygen uptake, theoretically representing the optimal intensity for sustaining aerobic exercise. CONCLUSION: Ventilatory Threshold in stroke patients undergoing treadmill testing can be effectively calculated from gas exchange data using the Venilation Curve and the V-slope methods. More research is needed to assess other factors that may affect VT measurements, such as medications or diseases impacting respiratory and cardiac function in patients with stroke to determine the most optimal and effective means of establishing training intensity after stroke.
    • Comparative Mid-term Outcomes of Pediatric Hematogenous Methicillin-resistant Staphylococcus aureus and Methicillin-susceptible Staphylococcus aureus osteomyelitis

      Blank, Tiana; The University of Arizona College of Medicine - Phoenix; Belthur, Mohan (The University of Arizona., 2018-03-28)
      The bacteria staphylococcus aureus is the most common etiology of acute hematogenous osteomyelitis (AHO) in healthy pediatric patients, accounting for 70-90% of cases. • AHO occurs at a rate of 1/10,000 pediatric patients/year. • Increasing prevalence of community-acquired methicillin resistant staph aureus (MRSA) is leading to a concurrent rise of such invasive pediatric infections in the US. • MRSA AHO on average have longer hospital stays, more febrile days, longer antibiotic therapy, and increase in overall complications vs. methicillin sensitive staph aureus (MSSA). • There is a lack of data on the functional outcome of these patients beyond 2 years post index infection. • Goal of study: compare treatment and midterm (2 years post index infection) functional outcomes between patients with MRSA vs. MSSA infections, and localized vs. disseminated infections. • Hypothesis: treatment and outcomes between MRSA and MSSA, and localized and disseminated, will be different, specifically that MRSA and disseminated will have worse midterm functional outcomes
    • Comparing FAST Proficiency of Self vs Non-Self Models of Training

      Johnson, Keith; The University of Arizona College of Medicine - Phoenix; Grimsman, Jason (The University of Arizona., 2018-03-30)
      The increase in available ultrasound technology has allowed healthcare professionals to begin learning the skills to use it starting early in their training and careers. The best methods of training to increase proficiency in its use have not been investigated, however. This study compares two different training methods of the Focused Assessment with Sonography in Trauma (FAST). First year medical students were randomized into two groups; one who trained using a conventional live human model and the other who trained using themselves as the model. Both groups were then assessed on a non-self live human model and scored based on time to completion of the FAST and the ability to identify pertinent anatomic landmarks. There was no significant difference in mean scores between both groups. The non-self training group was significantly faster than the self training group. This suggests that the conventional training model remains the best method for increasing proficiency in the FAST exam, although there are significant limitations and further investigations are needed.
    • Comparing Optical Coherence Tomography Radial and Cube Scan Patterns for Measuring Bruch’s Membrane Opening Minimum Rim Width (BMO-MRW) in Glaucoma and Healthy Eyes: Cross-sectional and Longitudinal Analysis

      Kabbara, Sami; The University of Arizona College of Medicine - Phoenix; Belghith, Akram (The University of Arizona., 2018-04-03)
      Background and Significance: Spectral Domain-Optical Coherence Tomography (OCT) is one of the most widely used imaging modality in Ophthalmology. It utilizes light waves to visualize the various layers of the retina. The OCT machines offer two different scan patterns, the circular and the cube scan patters. It is important to compare these scan pattern to see if any discrepancy exist in quantifying retinal indices. One of the newer indices is the Bruch’s membrane opening minimum rim width (BMO-MRW), which is the minimum distance between from the BMO to the inner limiting membrane (ILM). The BMO-MRW is being used in the diagnosis of glaucoma. Hypothesis: To compare the cube and radial scan patterns of the SD-OCT for quantifying the BMO-MRW. We hypothesis that there might be some differences between the two scan patterns.
    • Comparing Quality of Life in Global Vitiligo Populations

      Welbourn, Brandon; The University of Arizona College of Medicine - Phoenix; Beyda, David (The University of Arizona., 2018-02-28)
      This comprehensive review will provide an overview of the current literature regarding vitiligo and its skin manifestations, as well as the stigma surrounding skin depigmentation diseases. We will also discuss measurement of quality of life. This comprehensive review will provide the background information necessary to understand the psychological impact of the disease vitiligo on global populations.
    • A Comparison of How Adolescent Patients and Their Parents Rate Communication by Pediatric Resident Physicians.

      Ohmart, Connor; The University of Arizona College of Medicine - Phoenix; Bhavaraju, Vasudha (The University of Arizona., 2018-04-05)
      There are unique challenges in caring for the adolescent population, including communication in a way that is effective for both the adolescents and their parents or caregivers. While we assume that both are seeking similar qualities in their resident doctor, we sought to determine if a difference exists between adolescents and their parents in the judgment of adequate physician communication. This may offer insight into what each population values most in the skill set of their provider and may guide future pediatric resident education.
    • Contributing Factors to Late Second Trimester Ultrasounds

      Mistry, Porus; The University of Arizona College of Medicine - Phoenix; Connell, Mary (The University of Arizona., 2018-02-27)
      Background: The level II ultrasonography (US) is designed to detect fetal anatomy and the presence of any fetal anomalies. Previous studies have revealed that a relatively low percentage of women received appropriate prenatal care in Maricopa County. However, the specific barriers and limitations to receiving prenatal care have not been adequately studied. Thus, we constructed a survey to gain insight on the barriers that limit adequate access to level II US. Research Question: What are the significant factors that contribute to late Prenatal Care Level II Ultrasonography at Maricopa Integrated Health System?
    • Correction, Depression, Cardiac Compression and Haller Indices Fail to Correlate with Cardiopulmonary Impairment in Pectus Excavatum

      Donato, Britton; The University of Arizona College of Medicine - Phoenix; Notrica, David (The University of Arizona., 2018-03-29)
      Background: Pectus excavatum (PE), the most common congenital chest wall deformity in children, is the posterior intrusion of the anterior chest wall. The standard for determining disease severity is the Haller Index (HI), which has been shown to poorly correlate with physiologic impairment. Recently, more novel indices have been introduced in an effort to more accurately reflect burden of disease but limited evidence demonstrates a correlation between the indices and physiologic impairment. Data confirming such a correlation would provide a means to measure both the severity of deformity and changes in functional disability in patients with PE. Methods: This is a retrospective study of 71 children who underwent evaluation for corrective surgery for pectus excavatum with preoperative cardiopulmonary exercise testing and endexpiratory chest computed tomography or magnetic resonance imaging at a regional children’s hospital. Regression models were performed to predict VO2 max or O2 pulse predicted. Results: The regression models were not significant at predicting VO2 max or O2 pulse predicted. Additionally, when evaluating the either VO2 max or O2 pulse predicted along with the indexes independently in the linear regression model, there was no statistically significant relationship identified. Conclusions: We found that when assessing for a correlation between the HI, correction index, depression index, or cardiac compression index at end-expiration together and independently with cardiopulmonary impairment, both the linear and multiple regression models failed to identify a statistically significant relationship. While it would be highly advantageous for a PE severity index to correlate with objective physiologic impairment, our data suggest that the currently defined indices calculated at end-expiration fail to do so.
    • Determinants of LARC Usage in Women in Latin America and the Caribbean

      Jones, Ashley; The University of Arizona College of Medicine - Phoenix; Manriquez, Maria (The University of Arizona., 2018-03-30)
      Research question: What is the difference in prevalence of LARCs between women living in urban and rural areas of Latin America and the Caribbean (LAC)? Background, significance, and rationale: While LARCs have been shown to be effective, approved for long duration of use, and cost-effective there is an unmet need for this type contraception in rural areas. The LAC region has a need for improved family planning services, evidenced by the high percentage of maternal deaths due to unsafe abortions. Methods: Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2010 and 2015 in LAC countries were reviewed and analyzed to determine difference in prevalence of LARC use between women living in urban versus rural areas. Additionally, a systematic literature review was performed resulting in selection of 11 primary research articles evaluated for LARC prevalence and sociodemographic factors associated with LARC use.
    • Development of a non-invasive biomarker of eosinophilic esophagitis

      Galvin, Katie; The University of Arizona College of Medicine - Phoenix; Wright, Benjamin (The University of Arizona., 2018-03-30)
      Background: Eosinophilic esophagitis (EoE) is a non-IgE mediated, antigen-driven disease characterized by eosinophilic inflammation with resultant tissue remodeling, fibrosis, and esophageal dysfunction. The current standard of care requires multiple esophageal biopsies. Eosinophil peroxidase (EPX) is an eosinophil-specific granule protein that serves as a surrogate for eosinophil activity. We aim to develop a rapid, minimally invasive clinical screening test for EoE. We hypothesize EPX from buccal swabs will be elevated in samples from EoE patients versus non-EoE controls.
    • Discussing the Challenges in Creating an Online Library of 3D Printable Assistive Living Devices

      Kantzos, Andrew; The University of Arizona College of Medicine - Phoenix; Lifshitz, Jonathan (The University of Arizona., 2018-02-26)
      Our goal is to identify the barriers and process of creating a digital library of medical assistive devices that can be personalized and 3D printed for people living with disabilities. In the past, and true today, traditional manufacturing methods make it cost prohibitive to create personalized devices to assist individual patients with their activities of daily living (ADL). Now and in the immediate future, availability and affordability of 3D printing makes it feasible to produce low volumes of devices, on demand, using a distributed manufacturing model. This document discusses three main challenges to originating and creating this library: (1) the validity of using 3D printing for assistive device technology, (2) organizational approaches to optimize the library accessibility, and (3) creating an intuitive search method to navigate the library.
    • The effect of high-intensity interval exercise on doxorubicin-induced TLR4 inflammatory signaling in rat myocardium

      DiLizia, Matthew; The University of Arizona College of Medicine - Phoenix; Angadi, Siddhartha; Dickinson, Jared (The University of Arizona., 2018-02-26)
      Background:Doxorubicin(Dox) is a common anti-cancer agent that causes collateral damage to the heart. Pre-conditioning (exercise prior to Doxtherapy) may attenuateDox-induced cardiomyopathy by modulating inflammatory pathways.The effect of pre-conditioning on TLR4 signaling in Dox-induced cardiomyopathy is uncertain. Conclusion: The impact of TLR4 on Doxinduced cardiac inflammation may not be significantly modulated by pre-conditioning HIIT. However, HIIT pre-conditioning may impact downstream mediators NFkB, pNFkB and pIkB in models of Dox-induced cardiac inflammation.