• Rapid Versus Standard Clozapine Titration Orders in a Psychiatric Acute Inpatient Facility

      Kaur, Bhupinder (Rose); The University of Arizona College of Medicine - Phoenix; Sood, Shabnam (The University of Arizona., 2021)
      Objective: The aim of this study is to evaluate if rapid versus standard clozapine titration is associated with reduced length of stay (LOS) for treatment resistant psychiatric inpatients. Methods: This retrospective chart review study collected socio-demographics and clinical outcomes of psychiatric inpatients with clozapine order sets, including primary diagnosis, order initiation date, discharge readiness and post-discharge placement. An electronic health record report of psychiatric inpatients with clozapine orders between September 2016 and April 2018 yielded 93 separate admissions receiving either rapid titration protocol (RTP) or standard titration (STP) based upon the physician preference. Results: Of the 93 patients who were prescribed clozapine, 37 were started on the RTP and 56 were on the STP. The primary diagnosis of patients in both RTP and STP groups was Schizoaffective disorder at 78.38% and 62.5%, respectively. The median discharge ready (DCR) days were in fact lower for RTP than STP inpatients, although this was not statistically significant. Conclusion: Ultimately, it was determined that the median LOS was similar between patients on rapid and standard titrations.
    • Correlation of Admission Troponin Levels with Cardiac Markers in Burn Patients

      Patel, Parth; The University of Arizona College of Medicine - Phoenix; Foster, Kevin (The University of Arizona., 2021)
      Background: Patients who experience severe burn injury undergo systemic changes with specific regards to the cardiovascular system ultimately resulting in systemic hypermetabolism, increased cardiac stress and dysfunction. Troponin I has been used as a biomarker for ischemic disease and cardiac dysfunction for years. The current relationship between TnI levels and clinical cardiac markers such as HR and BP have not been well studied in burn patients. Objective: To assess if admission troponin levels correlate with BP and HR findings in patients with burn injury. Methods: A prospective observational trial of 40 burn patients with burn injury (TBSA 10% or greater) admitted to the burn unit at Valleywise Health Medical Center in Phoenix. Criteria for elevated TnI levels were based upon reference ranges provided by the hospital lab, where TnI levels less than 0.034ng/mL were considered normal, and levels >0.034ng/mL were considered elevated. Initial TnI levels, BP, HR, TBSA were collected alongside demographic information. The groups were analyzed using Wilcoxon Rank Sum for the primary continuous parameters. Result: No significant difference in Age, Gender, Ethnicity, initial SBP, DBP, MAP, HR, and total # deceased between the group of burn patients with significantly elevated TnI versus the group of burn patients with normal TnI. There was a statistically significant difference in the TBSA burned with the significantly elevated TnI having significantly more surface area burned compared to the normal TnI group, where p=0.0264. Conclusion: The level of TnI increase in burn injury does not appear to correlate with clinical markers of cardiac function such as HR and BP. Additionally, TBSA appears to be positively correlated with the level of TnI rise.
    • Idiopathic Thrombocytopenic Purpura Correlates with a Lower Rate of ST-Elevation Myocardial Infarction

      Davis, Mitchell; The University of Arizona College of Medicine - Phoenix; Hashemzadeh, Mehrnoosh (The University of Arizona., 2021)
      Background: Platelets are important parts in the pathogenesis of myocardial infarction (MI). In order to study the role of platelet count in MI, we hypothesize that patients with acquired thrombocytopenia such as idiopathic thrombocytopenic purpura (ITP) may have lower risk of MI. Using a large database, we studied any correlation between the presence of ITP and ST Elevation Myocardial Infarction (STEMI). Method: The Nationwide Inpatient Sample (NIS) was used for this study. Using the available NIS database from the years 2001-2011, we analyzed the correlation between STEMI and ITP utilizing International Classification of Diseases, ninth revision, and Clinical Modification (ICD-9-CM) ICD-9 codes. We used uni- and multivariate analysis adjusting for risk factors. Data was extracted from 106,653 patients with ITP and 79,636,090 patients without ITP. Results: Between the years of 2002 and 2011, we were able to observe significant differences between the patients with ITP and those without. We found that the risk of STEMI is significantly reduced in patients with ITP in uni and multivariate analysis in every year of the 10-year period. For example, we found that in 2002 STEMI occurred in 0.09% of patients with ITP vs. 0.13% without ITP (p<0.007). Then in another example in 2011, the same percentage of ITP patients experienced STEMI with a prevalence of 0.09% vs. 0.15 in patients without ITP (p<0.005). This reduction remains significant after multivariate adjustment Conclusion: Based on our large database, the presence of ITP appears to be associated with a lower risk of STEMI. This finding suggests that platelet counts play important role in the pathogenesis of STEMI and low platelet count may exert protective effect from STEMI.
    • What do individuals experiencing homelessness want for their care?: A needs assessment survey

      Zeien, Justin; The University of Arizona College of Medicine - Phoenix; Hartmark-Hill, Jennifer (The University of Arizona., 2021)
      The homeless population is growing across the United States, particularly in urban areas. Homelessness has a detrimental impact on health and quality of life, especially among the unsheltered homeless population. Oftentimes, there is a disconnect between existing community services and actual needs of individuals experiencing homelessness. The purpose of this study was to identify prioritized needs in an urban unsheltered homeless population and measure associations with self-reported health. We conducted a needs assessment from April-June 2018 of 144 unsheltered homeless individuals in metro Phoenix, Arizona. The 16-question survey investigated perceptions of priority needs, sources of medical care, health literacy, and health status. Survey results were analyzed using Wilcoxon Rank Sum Test, Chi-squared analysis, and multivariable logistic regression. Most respondents (91.6%) identified food as a top need. The majority (64.1%) utilized emergency departments (EDs) as their primary source of care, and 40.1% reported suboptimal health. Suboptimal health was more likely to be reported in those who expressed transportation (OR 3.03, 95% CI: 1.30-7.07) or medical care (OR 2.47, 95% CI: 0.99-6.14) as a top priority need. Health illiteracy (OR 3.68, 95% CI: 0.76-17.9) was associated with suboptimal health, as was obtaining care at an ED (OR 2.05, 95% CI: 0.81-5.25). The data demonstrate that food security was the top priority need of this urban unsheltered population. Interventions improving accessibility to transportation, high-quality medical care, and health education should be implemented to improve the health of this population. Such interventions may also decrease care sought in ED settings. These conclusions are likely generalizable to other unsheltered homeless populations in large urban cities; however, regional and cultural differences exist. Our needs assessment may serve as a template for future needs assessments of other urban unsheltered homeless populations.
    • A Comparative Performance of Medical Students at University of Arizona College of Medicine – Phoenix in Rural and Urban Clinical Rotation Sites

      Nguyen, Julia; The University of Arizona College of Medicine - Phoenix; Cartsonis, Jonathan (The University of Arizona., 2021)
      BACKGROUND: Despite many recent developments of rural programs in medical education, there are still very few published data comparing the academic performances of medical students who are learning in rural settings with their traditional urban counterparts. PURPOSE: To determine whether the academic performance of medical students at the University of Arizona, College of Medicine – Phoenix partaking in clinical learning experiences at rural rotation sites differ from their corresponding colleagues rotating in the traditional urban clinical settings. METHODS: Comparison of performances, assessed based on clerkship evaluations and shelf scores, between medical students with rural clinical rotation sites (n=64) and those with urban clinical rotation sites (n=177) for the 2017 (n=81), 2018 (n=80), 2019 (n=80) graduating classes. RESULTS: Medical students with rural clinical rotations performed at least as well as their urban counterparts across all shelf examinations as well as clerkship evaluations. Notably, students with rural Internal Medicine clinical rotations obtained higher clerkship evaluation scores (p=0.012) compared to their urban peers. CONCLUSION: This study provides evidence that students with rurally-trained clerkships at the University of Arizona, College of Medicine – Phoenix performed at least as well as their traditional urban peers on shelf examinations and clerkship evaluations. The broader implications of this study lie in the high-quality training in rural communities, evidenced specifically by clerkship performance in Internal Medicine.
    • Efficacy of a Free Clinic Utilized as a Transitional Clinic for the Uninsured: Outcomes on Chronic Disease Management and ED/Hospital Rates

      Hartnett, Erin; The University of Arizona College of Medicine - Phoenix; Lee, Maurice (The University of Arizona., 2021)
      Objectives. To analyze the effectiveness of a novel system of transitional care to a medical home for uninsured populations living with chronic, uncontrolled diabetes. To quantify the impact of A1C management and healthcare maintenance on rates of hospitalization and/or emergency department visits due to disease complications. Methods. A retrospective chart review was performed, and patients were surveyed in Summer 2018 to determine current medical home status and what their last A1C was measured at after transitioning from the free clinic. The patient population selected included 38 patients who entered the transition process with a mean age 52 (±6.9 years). This group was made up of 14 men and 24 women. 16 total participants were fully transitioned to an FQHC (8 men and 8 women). Results. 50% successfully established care in a medical home. Established patients had an average initial A1C of 10.2%, time of transition A1C of 6.4% and post-transition A1C of 7.4%. Hospitalizations were reduced by 91% for all patients and Emergency Department visits was reduced by up to 79%. Conclusions. Transitioning to a medical home after achieving A1C control in a transitional clinic increased the likelihood of continued disease management and decreased the likelihood that they would require a higher level of care related to disease complications. Policy Implications: Medical homes may improve chronic disease outcomes for patients and healthcare systems.
    • The importance of interprofessional communication as perceived by first-year medical students and the influence of early clinical exposure upon these perceptions

      Leslie, Alicia; The University of Arizona College of Medicine - Phoenix; Denny, Lee Anne (The University of Arizona., 2021)
      The importance of interprofessional communication in the clinical realm and the beneficial nature of early clinical exposure for medical students have been well documented in the literature. This study evaluates how the opinions of first-year medical students at the University of Arizona College of Medicine-Phoenix change over the course of the first year in regard to the importance of interprofessional communication. It also aims to discover whether or not students find the two early clinical exposure courses at the College of Medicine to be useful in developing these opinions. This qualitative research study utilizes a survey composed of two free response questions sent out at the beginning and end of the 2018-2019 school year to the Class of 2022. Using thematic analysis, the authors found that many of the themes in responses stayed the same throughout the year. Students appear to particularly appreciate interprofessional communication for its influence in team-based dynamics and high-quality patient care. This study also found that students frequently described one early clinical exposure course, Community Clinical Experience, as influential in developing perceptions about interprofessional communication.
    • Incidence of Complications Associated with Long Term Use of Peripherally Inserted Central Catheters in Pediatric Cardiac Patients

      Malla, Akshara; The University of Arizona College of Medicine - Phoenix; Vellore, Shilpa; Anton-Martin, Pilar (The University of Arizona., 2021)
      Peripherally inserted central catheter (PICC) lines are increasingly used in neonatal and pediatric cardiac patients for long term, stable central line access and treatments. Although previous studies describe complications in the general pediatric population, this study’s objective is to determine the incidence of PICC line-related complications amongst pediatric cardiac patients.
    • Music-listening and Stress: The Effects of Music-Listening on Autonomic Nervous System Activation Prior To and During a Stress-inducing Task

      Chou, Cecilia; The University of Arizona College of Medicine - Phoenix; Standley, Cynthia (The University of Arizona., 2021)
      Music and the arts have played a fundamental role in human culture throughout history. In the field of rehabilitative therapy and integrative medicine, music-listening has been explored as an accessible, low-cost intervention regarding stress management and stress-related health issues. The proposed study seeks to add to our understanding of music, stress, and their physiological effects, using wearable BioHarness data logger devices in the medical student population. Eighteen medical students were randomized into two groups that studied with selfselected music or no music immediately prior to a stressful school exam. Participants recorded subjective measurements of stress and anxiety prior to the study period and after the exam. The BioHarness devices recorded objective data including respiratory rate and heart rate variability, which were further analyzed with OmniSense Analysis software to approximate parasympathetic and sympathetic nervous system activation in each participant. We found that music-listening was associated with a lower maximum heartrate during the exam, compared to the no-music group. These promising findings, while taken from a small sample size, point to a potential benefit of music-listening on alleviating stress activation among medical students.
    • How Are Pancreas Cancer Surgery Outcomes Affected by Tumor Board Decisions?

      Bisht, Roy; The University of Arizona College of Medicine - Phoenix; Kumar, Rachit (The University of Arizona., 2021)
      Tumor board review of complex patients is an important factor for quality and safety. In this study, we compare the surgical outcomes of patients presented at two gastrointestinal cancerspecific tumor boards within a large healthcare system. Site A represents an academic-type tumor board with a focus on neoadjuvant therapy, whereas Site B represents a community-type tumor board with a primary surgical approach.