• Effectiveness of Oral Xa Inhibitors vs. Warfarin in the Prevention of Recurrent Deep Vein Thrombosis, Pulmonary Embolism, and Incidence of Post-Thrombotic Syndrome Following Intervention for First-Time Proximal AcuteIliofemoral, Femoropopliteal, or Popliteal Thrombosis: A Retrospective Chart Review

      Miro, Paulo; The University of Arizona College of Medicine - Phoenix; Thorpe, Patricia (The University of Arizona., 2021)
      BACKGROUND: Anticoagulation is the treatment of deep vein thrombosis (DVT) and prevents thrombus extension and recurrence of DVT. There is limited data on the effectiveness of Oral Xa inhibitors versus Warfarin in the prevention of recurrent DVT, pulmonary embolism (PE), and post-thrombotic syndrome (PTS), specifically in patients who receive intervention for a first-time acute proximal DVT. OBJECTIVES: Add to the literature regarding the effectiveness of Xa inhibitors and Warfarin in the prevention of recurrent DVT, PE, and PTS following a first-time proximal DVT. PATIENTS/METHODS: Retrospective chart review of 35 patients following a first time proximal acute thrombosis and begun on Xa inhibitor or Warfarin as anti-coagulation therapy. Data from 2010 through 2019, with an age range of 18-95, including all genders and ethnicities. Any patients with symptomatic peripheral arterial disease, chronic inflammatory disease, active cancer, history of DVT, inferior vena cava involvement, or with active pregnancy were excluded from the study. A Wilcoxon Rank sum was used to compare continuous variables, and a Chi Squared/Fischer’s Exact method was used to compare categorical variables. RESULTS AND CONCLUSIONS: 18.7% of patients undergoing Warfarin treatment suffered a DVT recurrence by 12 months, while 84.2% of patients undergoing Oral Xa treatment suffered a DVT recurrence by 12 months, a significant difference (p < 0.001). No other outcomes showed a significant difference. This study is limited by a small number of subjects, and lack of standardization across several of the outcome variables. Further research needs to be conducted to clarify the objective of this study.
    • 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 End-to-Side Anastomosis: A Comparative Analysis of Arterial Models in the Rat

      Kaur, Pareena; The University of Arizona College of Medicine - Phoenix; Preul, Mark (The University of Arizona., 2021)
      Background: The end-to-side anastomosis is one of the most common anastomosis configurations used in cerebrovascular surgery. Whereas several living practice models have been proposed for this technique, few involve purely arterial vessels. Objective: The purpose of this study is to compare two arterial models using common carotid (CCA) and common iliac arteries (CIA) in rats. Methods: CIAs and CCAs were exposed in 10 anesthetized rats with their lengths and diameters measured. Also, the mobilization extent of each vessel along its contralateral counterpart was measured after each artery was transected at its proximal exposure point. We also studied the technical advantages and disadvantages of each model for practicing end-to-side anastomosis. Results: The average diameters of the CCA and CIA were 1.1mm and 1.3mm, respectively. The average extents of mobilization along the contralateral vessel were 13.9mm and 10.3mm for CCA and CIA, respectively. The CCA model had the advantages of more arterial redundancy (allowing completing both suture lines extraluminally) and minimal risk of venous injury. The main disadvantage of the CCA model was risk of cerebral ischemia. The CIA model was not limited by ischemia time and provided the technical challenge of microsurgical dissection of the common iliac vein from the CIA, while suffering from limited CIA redundancy. Conclusion: Both CCA and CIA models could be efficiency used for practicing the end-to-side anastomosis technique. Each provides the trainee with a specific set of advantages and disadvantages that could help with optimal selection of the practice model based on trainee’s skill level.
    • Evaluation of New Targeted Therapies in 3D Culture Models for Pancreatic Cancer

      Avedikian, Saro; The University of Arizona College of Medicine - Phoenix; Han, Haiyong (The University of Arizona., 2021)
      Pancreatic Ductal Adenocarcinoma (PDAC) is a deadly cancer that displays a highly heterogeneous and complex tumor microenvironment. Novel therapeutic agents that target DNA regulatory networks known as super-enhancers (SEs) have recently gained attention in the potential treatment of PDAC. In order to accurately study the effects of super-enhancer inhibitors, cell culture models that accurately mimic the tumor microenvironment are necessary. In this experiment, two PDAC cell lines (B011 and B028) are grown under both 3D and 2D culture conditions and the growth inhibitory effects of three super-enhancer inhibitors (triptolide, THZ1, and THZ2) are determined. The 3D PDAC cell cultures of the B011 cell line demonstrate greater resistance to all three drugs tested from the class of super-enhancer inhibitors. Based on these findings, 3D PDAC culture models may provide more accurate means to study novel chemotherapy agents than traditional 2D culture methods. The implications of this are significant as it may pave the way for quick and affordable precision medicine modalities in the future for the treatment of PDAC.
    • First-year Medical Student Clinical Confidence on Global Health Immersion Trip

      Taylor, Kristin; The University of Arizona College of Medicine - Phoenix; Ross, Robin (The University of Arizona., 2021)
      Introduction There are few reports demonstrating the clinical benefits of global health trips specifically for first-year medical students. The aim of this study was to determine whether first-year medical student confidence in clinical diagnosis improved over their week-long global health immersion trip and to determine what kinds of diagnoses medical students felt confident in making in a global health setting after their first year of medical school education. Methods This study was a survey involving confidence ratings in diagnoses provided by University of Arizona College of Medicine- Phoenix first year medical students who participated in a weeklong medical trip to bateyes (rural communities of sugar cane workers) surrounding Santo Domingo, Dominican Republic in 2019. This study received IRB approval. Confidence in diagnosis was determined by a five-point Likert scale. Diagnoses were separated into categories by body system. Results There were no significant differences in student confidence ratings over time when including all time points. There was a statistically significant increase in confidence from 5/28 and beyond (p=0.001). There were no significant differences in student confidence ratings amongst category of diagnosis. Discussion The results demonstrated that overall, students reported similar confidence throughout the trip. There was a large decrease in confidence level from the first to the second time point and this is likely attributable to being redirected by attending supervision. Confidence then gradually increased throughout the trip. Unfortunately, weaknesses in certain subject areas were not able to be elicited as students reported similar confidence for all categories
    • “Hey Doc, I think I have a Problem.” A Survey Investigating Self-Reported Physician Preparedness and Comfort Levels with Management and Counseling of Patients with a Substance Use Disorder

      Khan, Mohammad; The University of Arizona College of Medicine - Phoenix; Heise, Will (The University of Arizona., 2021)
      Objectives: Given that substance use disorders are an increasing problem in the state of Arizona, physician preparedness to have these difficult conversations regarding substance use disorder disclosure is important. We investigated physician attitudes regarding preparedness to understand how physicians in the Greater Phoenix Area feel regarding this difficult conversation. Methods: We used Qualtrics software to design a survey that was administered to physicians via the local hospital listserve. This survey used a series of questions investigating physician preparedness on a scale of 1-10, with 10 being the most prepared. We also used a paper version of the survey at the 2018 Arizona Association of Family Practitioners winter conference to collect data. Our total response rate 135 surveys, with 112 online and 23 on paper. Of these, 103 were complete and analyzed. Results: Physician preparedness scores from 1-10 were averaged and compared. The overall preparedness score reported by physicians with the standard deviation for alcohol use disorder was 7.21 (1.98), for opioid use disorder was 6.75 (2.13), and for methamphetamine use disorder, the value was 5.47 (2.82). Buprenorphine prescribing privileges were associated with statistically significant increased scores in physician preparedness in all three cases (p-values of 0.01 or less). Physician ability to impact long term outcomes for a patient with drug use disorder was closely associated with how well-equipped the physician’s practice was with a correlation of 0.7 and a p value of <0.0001. Conclusions: Physicians self-reported the most preparedness to address alcohol use disorder, followed by opioid use disorder, and then methamphetamine use disorder. The buprenorphine prescribing privileges are very well associated with increased physician ability to interact with and improve patient outcomes.
    • 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.
    • How does HIV knowledge, attitudes and behaviors of young adults in Arizona compare to those of China and Taiwan?

      Cox, Analissa; The University of Arizona College of Medicine - Phoenix; Cevallos, Manuel (The University of Arizona., 2021)
      INTRODUCTION: The Centers for Disease Control (CDC) 2018 HIV Surveillance Report indicates that 13.6 per 100,000 people were diagnosed with HIV in the United States2. In Arizona specifically, this value was 12.7 per 100,000 in 20182. According to the Arizona Department of Health, groups most susceptible to contracting HIV in Arizona are African Americans, men, men having sex with men (MSM), and those ages 20-293. These data can be compared to countries, like China and Taiwan, that studied their college students using the International AIDS Questionnaire – English (IAQ-E). METHODS: The IAQ-E is a knowledge, attitudes, and behaviors (KAB) assessment that tells us the respondents’ level of understanding given different facts, myths, risks, and attitudes. We sought to assess the KAB of young Arizonans by presenting them with the IAQ-E and assessing respondents’ level of agreement using a Likert scale (strongly disagree =1 to strongly agree = 5). HYPOTHESIS: Based on Arizona’s sexual education curriculum and overall cultural stigma, we hypothesized that the results would show relatively moderate knowledge and negative attitudes and understanding of behaviors related to HIV/AIDS. RESULTS: The IAQ-E and demographic survey was distributed to college students in Arizona using Qualtrics, totaling 591 participants. The average age range was between 21-22, 77.2% biologically female, 19.9% biologically male and almost 3% non-binary/other or transgender, 2.2 % African American, and 22.84% identified with the LGBTQ community. Overall, students in Arizona have higher knowledge of HIV/AIDS compared to both China and Taiwan, and their attitudes were more positive than China, yet more negative than Taiwan. The behaviors showed positive understanding in all three groups, despite culture differences. Arizona participants exhibited increasing levels of understanding with increasing age (p <0.0001), increasing GPA (p <0.0001), and being married (p 0.002). CONCLUSION: The purpose of this project was to better understand the general knowledge, attitudes and behaviors regarding HIV/AIDS in young Arizonans and compare that to other countries. Understanding these differences can help design targeted public health interventions to decrease future transmission within the state and beyond.
    • 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.
    • The impact of medical student research as a discussion topic during the residency interview process

      Daus, Kelly; The University of Arizona College of Medicine - Phoenix; McEchron, Matthew (The University of Arizona., 2021)
      Background: Students with a greater number of research experiences are more successful in the National Residency Match Program (NRMP.) As a result, approximately two-thirds of allopathic medical schools have implemented a scholarly research project (SP) as a part of their curriculum. While inclusion of a SP in the medical school curriculum increases research productivity, literature to date has not investigated its ability to provide students with a means to communicate their scholarly strengths to residency programs during interview discussions. Methods: 123 students from the graduating class of 2019 and 2020 at the University of Arizona College of Medicine Phoenix (UACOMP) completed a 17-question survey examining the student’s SP and whether they completed additional research. Survey participants were asked to quantify how many residency interviewers asked about their SP or additional research during the interview process. Results: 27% of interviewers (SD 27.0) asked students about their SP and 41% of interviewers (SD 32.0) asked students about additional non-SP research. 40% of interviewers asked about research overall to include SP and/or non-SP research. A greater percentage of interviewers (50%, SD 26.2) asked students about their SP if they had undertaken additional research compared to interviewers of students who did not undertake additional research (29%, SD 28.4, p = 0.0237). A greater percentage of interviewers at academic institutions (31%, SD 27.9) asked students about their SP, compared with a smaller percentage of interviewers at predominantly non-academic programs (22%, SD 25.5, p = 0.0054). There were no significant differences in the proportion of interviewers asking about the SP based on the type of specialty, competitiveness of specialty, topic relatedness of project, and publication/presentation status of project. Conclusion: Student research experiences may serve as a meaningful discussion topic during the residency interview. Approximately one-third of interviewers ask about the SP regardless of specialty, research topic, and publication/presentation status of the project. Students with additional research experiences beyond their SP may experience a higher percentage of interviewers asking about their SP. Also, students applying to predominantly academic programs may experience a higher proportion of interview questions about research compared to peers interviewing at non-academic programs.
    • Impact of Prenatal Visit Utilization on Pregnancy Outcomes within Differing Risk Populations

      Young, Rebecca; The University of Arizona College of Medicine - Phoenix; Erickson, Laurie (The University of Arizona., 2021)
      Objectives: To investigate the association between number and timing of prenatal visits (PNV) and pregnancy outcomes within differing maternal risk populations [non-high-risk (“non-HR”) and high-risk (“HR”)]. Methods: Retrospective study of mothers who delivered at Banner University Medical Center Phoenix during the 2017 calendar year. Inclusion criteria included maternal documentation at time of delivery of either: complete absence of PNV or complete PNV records. Maternal groups were either classified as “non-HR” or “HR” if received any of the following diagnoses: advanced maternal age (AMA), obesity, diabetic (DM) disorders, hypertensive (HTN) disorders, or asthma. Data collection included total PNV quantity per pregnancy and trimester. Pregnancy outcomes included labor interventions, labor complications, delivery complications, and adverse neonatal outcomes. Result: Of 503 mothers in the cohort, 324 met inclusion criteria and were evenly split between non-HR (159, 49.07%) and HR mothers (165, 50.93%). Pregnancy outcomes were then compared within same risk group depending on total pregnancy PNV utilization category [low (≤8 PNV), mid (9-11 PNV), and (≥12 PNV] and frequency of PNV per trimester (“T1,” “T2,” or “T3”). Non-HR mothers with a higher total PNV category were more likely to have labor interventions (odds ratio [OR] 4.02; 95% confidence interval [CI] 1.26-12.9, p = 0.019). Non-HR mothers with higher quantities of PNV in T3 were less likely to have labor interventions (OR 0.69; 95% CI 0.48-0.98, p = 0.039). HR mothers with higher PNV quantities in T1 and T2 were less likely to have labor interventions (T1: OR 0.34; 95% CI 0.13-0.91, p = 0.032) (T2: OR 0.42; 95% CI 0.21- 0.84, p = 0.015). HR mothers with higher quantities of PNV in T2 were less likely to have labor complications (OR 0.70; 95% CI 0.51-0.98, p = 0.043). Conclusions for Practice: Labor interventions were less likely found by non-HR mothers with higher quantities of PNV in T3 and by HR mothers with higher quantities of PNV in T1 and T2. Labor interventions were more likely found by non-HR mothers with a higher total PNV category. Labor complications were less likely found by HR mothers with higher quantities of PNV in T2. Limitations include small sample size and study would therefore benefit from further investigation. Anticipated clinical benefits could include contributing to the development of tailored PNV recommendations dependent on maternal health history ultimately resulting in increased cost savings, decreased unnecessary interventions, and decreased poor outcomes.
    • 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.
    • Increased Risk of Depression in Patients with Crohn’s Disease

      Smith, Savion; The University of Arizona College of Medicine - Phoenix; Alishahi, Yasmin (The University of Arizona., 2021)
      Introduction Individuals with IBD have been shown to be at an increased risk of developing depression and anxiety. Previous work has demonstrated patients with UC were more likely to report depressive symptoms preceding their diagnosis of IBD than the general population. Young patients with CD also have a greater risk for developing anxiety disorders. One study demonstrated mental conditions are often diagnosed within one year prior to UC diagnosis. This signifies that psychiatric disorders may either be a consequence of early symptoms of the undiagnosed gastrointestinal condition or may increase an individual’s susceptibility to develop IBD. Psychological disease may amplify symptom severity, particularly abdominal pain perception in adults with IBD. Previous work has demonstrated that psychological state may influence perception of abdominal pain and patients with depression were more likely to take IBD-related disability. Methods This was a retrospective chart review. We used a subset of Veterans charts from the national VA database. Patient charts were divided into two groups: CD with depression and CD without depression (control). From the CD with depression group, all patients with a diagnosis of Crohn’s disease with depression were used, however, patients with a diagnosis of CD who did not receive treatment at the VA were excluded. Patients were considered in remission if their most recent colonoscopy showed no active disease. Patients were considered to have active disease if their most recent colonoscopy demonstrated signs of inflammation. When reported, depression severity was recorded in charts as mild, moderate or severe. From this we created a depression severity score by converting them to numerical values (mild=1, moderate=2, severe=3). Severity score is recorded as an average of these values. Results A total of 159 patient charts were included in this study, 122 from the Depression group and 37 from the no depression group. The odds of active Crohn’s Disease increased with depression (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.21-6.81; p>0.016). The odds of depression also increased with substance abuse (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.28-11.7; p>0.016) and PTSD (odds ratio [OR], 6.39; 95% confidence interval [CI], 1.85-22.0; p>0.003). Mean depression severity score of remission patients was 2.00 and mean depression severity score for active Crohn’s patients was 2.06. Notably, patients the odds of having more severe depression were higher for tobacco users (users: odds ratio [OR], 2.14; mean [SD], 2.14 [0.38]; 95% confidence interval [CI], 0.35-6.14; p>0.59; non-users: mean [SD], 1.96 [0.77]) and patients with substance abuse (users: odds ratio [OR], 2.37; 95% confidence interval [CI], 0.69-8.20; mean [SD], 2.21 [0.58]; p>0.17; non-users: mean [SD], 1.88 [0.77]) . Discussion These findings provide additional evidence that depression is associated with increased Crohn’s disease activity in the Veteran population. Based on this data, one may consider that treating an individual’s depression may reduce the frequency and severity of Crohn’s disease activity. There may be benefits to holistically treating a patient’s IBD through also evaluating and monitoring his or her psychological health. Other studies have demonstrated the likelihood that psychiatric disorders often co-exist with inflammation, infections, and autoimmune diseases. Furthermore, our data demonstrated strong associations found between substance abuse and the likelihood of depression. Interestingly, our results indicated no association for the measured CRP and calprotectin between the Crohn’s Disease with depression and the Crohn’s disease without depression groups.
    • Interprofessional Escape Room: Evaluating Teamwork among Healthcare Profession Students

      Hearn, Jaimie; The University of Arizona College of Medicine - Phoenix; Denny, Lee Anne (The University of Arizona., 2021)
      Purpose: The aim of this study is to evaluate interprofessional teamwork amongst health professions students in an escape room and compare the evaluation of teamwork to the time it takes to “escape the room.” Methods: 42 interprofessional student teams of MD, PA, PT, and OT students participated in an escape room and 40 teams were included in the final data analysis. Each team was evaluated using a modified version of the Jefferson Teamwork Observation Guide (JTOG). Primary outcomes: total JTOG score, overall impression of teamwork score, and escape room time. Secondary outcomes: IPEC theme scores (themes represented in the JTOG) of leadership, communication, roles and responsibilities, and values and ethics. Results: Total JTOG scores had little correlation to escape room time (correlation coefficient = 0.084). Teams with higher overall impression scores tended to escape faster; for every 1-point increase in score, escape room time decreased by 4.78 minutes (95% CI - 7.01, -2.55; p<0.001). For every 1-point increase in the leadership theme, teams took 1.07 minutes longer to escape (95% CI 0.11, 2.04; p=0.031). For every 1-point increase in the teamwork theme, teams took 15.2 minutes longer to escape (95% CI 6.61, 23.7; p=0.001). For every 1-point increase in the communication theme, teams escaped 2.55 minutes faster (95% CI -5.33, 0.23; p=0.07). Conclusion: Teams that escaped the room the fastest had higher overall impression scores of teamwork and higher communication theme scores. Overall, greater team functioning and communication clinically translates to teams being faster and more efficient at problem-solving and moving through tasks.
    • 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.
    • Primary Care Attitudes & Culture at the University of Arizona College of Medicine-Phoenix

      Puracan, Jasper; The University of Arizona College of Medicine - Phoenix; Briney, Stephanie (The University of Arizona., 2021)
      Introduction. There has been prior research that indicate perceptions held by medical students regarding the field of primary care in medicine can change over time, whether through direct intervention or naturally as a consequence of a medical school’s curriculum. However, the currently held beliefs of medical students and faculty at the University of Arizona College of Medicine – Phoenix (UACOM-P) is unknown. Methods. A cross-sectional study was performed to assess attitudes and beliefs held by members of the UACOM-P community regarding the field of primary care. A Qualtrics survey instrument was developed and distributed to medical students and faculty at UACOM-P in the summer of 2019, with responses from 75 medical students and 33 faculty members. Results. Analysis indicate that there is a generally positive view held by the study population towards primary care, though the strength of endorsement of certain aspects differed between medical students and faculty. There also appeared to be differences between subgroups under both populations, such as Certificate of Distinction versus dual degree students and physician versus non-physician faculty. Discussion. The UACOM-P community has an overall positive attitude toward the field of primary care, with notable differences in some cases. Follow-up studies that may come after this investigation must capture more of the target population and consider impacts of global events such as the COVID-19 pandemic in order to negate potential confounding factors and biases. Future, well designed longitudinal research that assesses how these beliefs change overtime can shed more light on the primary care culture at UACOM-P and can inform campus leadership on future directions to take to support the mission of the program.
    • A race against time: Does Epinephrine compliance by emergency physicians increase ROSC in cardiac arrest patients

      Pho, Karen; The University of Arizona College of Medicine - Phoenix; Stites, Daniel (The University of Arizona., 2021)
      One of the most crucial medicinal intervention during a cardiac arrest is epinephrine. Advanced cardiac life support (ACLS) guidelines lays out the recommendation of delivering epinephrine every 3 – 5 minutes. The purpose of this study is to evaluate if physicians are compliant with delivering epinephrine as recommended, and how does compliance vs. non-compliance affect patient outcomes as measured by attaining return of spontaneous circulation (ROSC). The design of this study is a retrospective chart review with analysis, using Wilcox-Rank sum and Chi-Square fisher exact test to evaluate for statistical significance, which was defined with a P value < 0.05. There were 111 patient charts included in the study, and the results were charted into 3 categories: demographics by non-compliance, any non-compliance and mean non-compliance, and demographics by sinus rhythm. None of the results showed any statistical significance except for the mean number of doses a patient receives to achieve sinus rhythm, which was a mean of 10.3 vs 3.95. Although this study did not achieve statistical significance overall, it highlighted some clinical significance that may be of importance moving forward for all physicians. One clinical aspect that this study highlights further is the health disparity that people of color encounter. Patients who are people of color experienced higher mean number of noncompliance and percentage of any non-compliance. The overall conclusion that this study emphasized is that more studies into the overall quantity of epinephrine given during resuscitation may be worthwhile. Additionally, further emphasis on the importance of physician awareness of health disparity among people of color is needed.
    • 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.
    • Referral Patterns to Pediatric Pulmonology for Asthma-like Symptoms

      Prynn, Tory; The University of Arizona College of Medicine - Phoenix; Drewek, Rupali (The University of Arizona., 2021)
      Objective: This study aimed to characterize referrals for asthma-like symptoms to a pediatric pulmonology clinic, evaluate consult interventions, and identify opportunities for improving access. Methods: A retrospective chart review examined patients ages 5-18 years, referred to the pulmonology clinic at Phoenix Children’s Hospital between July 2016 and July 2019. Descriptive statistics summarized demographics, prior asthma diagnosis, ICS use and compliance, reason for referral and intervention during consult. An appropriate referral was defined as prior asthma and ICS Step 3. Results: The total 171 study subjects had mean (standard deviation) age of 9.4 (3.8) years, with 100 (58%) males, and prior asthma diagnosis in 105 (61%). The most common reason for pulmonology referral was asthma in 90 (53%) patients, of which 70 (78% of 90) had prior asthma. Among 105 patients with asthma, 79 (76%) had a history of ICS, with 33 (42% of 79) patients reporting spacer compliance issues. The rate of appropriate referrals was 0.11 (95% confidence interval: 0.06-0.16). During the pulmonology consult, nearly half 10 (53%) of 19 patients appropriately referred received an ICS step up. Among 151 inappropriate referrals, ICS was initiated for 91 (60%) and increased for 45 (30%). Education was provided to all patients during pulmonology consult. Conclusions: Mild-to-moderate asthma can be effectively treated by primary care providers (PCPs) with implementation of ICS, thus prioritizing healthcare resource utilization by enabling the pulmonologist to see higher acuity patients sooner. Further study is warranted to identify strategies and tools for PCPs to optimize asthma management.