• “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.
    • 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.
    • REVAMP: A prospective study on the impact of virtual medicine on CPAP compliance and satisfaction of care

      Lee, David; The University of Arizona College of Medicine - Phoenix; Pineda, Lilibeth (The University of Arizona., 2021)
      Although continuous positive airway pressure (CPAP) is the gold standard treatment for the chronic sleep disorder, obstructive sleep apnea (OSA), compliance with the CPAP machine among patients continues to be a challenge. REVAMP (Remote Veterans Apnea Management Platform) is a personalized, interactive web platform and mobile app that enables veterans to be evaluated for their OSA and better optimize their management of OSA. REVAMP aims to improve transparency and access to healthcare, reduce patient burdens of traveling and wait times, and establishes better communication with patients and their healthcare team. The purpose of this project was to assess whether the utilization of REVAMP improves the compliance of CPAP for rural Arizona veterans diagnosed with OSA compared to veterans who do not use any additional aide or intervention for their CPAP machine. From 2016 to 2020 for patients from the Phoenix VA Health Care System, 50 patients were randomly selected for a control population and 51 patients were randomly selected from the population enrolled in REVAMP with CPAP compliance as the primary outcome measured. CPAP compliance is defined as 30 nights of CPAP usage for >=4 hours per night at least 70% of nights used. CPAP compliance data came from each patient’s CPAP machine that has its data collected via a wireless modem and stored onto the REVAMP or Resmed Airview platforms that are accessed by a secure VA account. The REVAMP population presented an overall 60.8% compliance rate compared to the 24.0% overall CPAP compliance rate for the control population. The REVAMP mean CPAP usage (%) was found to be 75.2 +/- 33.0 compared to the control population with mean CPAP usage (%) 45.1 +/- 40.4 (p < 0.0001) and a mean CPAP usage >=4 hours per night (%) as 62.5 +/- 37.1 compared to the control population of mean CPAP usage >=4 hours per night (%) as 32.6 +/- 37.4 (p < 0.0001). Based on these findings, there is strong evidence to suggest that interventions like REVAMP that increase education, transparency, and communication with a patient’s healthcare team increase compliance rates for treatments like CPAP. It is also possible that patients who enroll in REVAMP are a self-selecting population who are more motivated to seek out interventions to improve their condition, and further studies should investigate such manners.
    • Biological evaluation of potential retinoid X receptor-selective agonists: the search for a more effective treatment for Alzheimer’s disease

      Khan, Zainab; The University of Arizona College of Medicine - Phoenix; Jurutka, Peter (The University of Arizona., 2021)
      Alzheimer’s disease (AD) is the most common form of dementia affecting millions of people; however, treatment options are currently limited. Previous studies have shown potential to slow the progression of AD by 4-[1-(5,6,7,8-Tetrahydro-3,5,5,8,8-pentamethyl-2-naphthalenyl)- ethenyl]benzoic acid (bexarotene), an antineoplastic agent modeled after a vitamin A derivative, in animal models. Bexarotene binds to the retinoid X receptors (RXRs) and stimulates RXR homodimerization and activation of RXR target genes. It also impacts RXR heterodimerization with other nuclear receptors, including the liver-X-receptor (LXR) and retinoic acid receptor (RAR). Bexarotene’s reversal of beta amyloid (Aβ) plaques in mouse models likely occurs via RXR-LXR activation and induction of apolipoprotein E (ApoE) expression. However, bexarotene has many adverse effects, including hyperlipidemia, skin toxicity, hypothyroidism, etc. The current study developed and tested novel bexarotene analogues for their ability to upregulate ApoE expression, crucial in AD neuroprotection, without producing the significant adverse effects of hyperlipidemia and skin toxicity through upregulation of sterol regulatory element-binding protein (SREBP) and activation of RAR, respectively. In order to test bexarotene analogues, luciferase assays were performed in both human colon cancer and human embryonic kidney cell lines. Two screening assays were completed to assess their ability (1) to induce RXR homodimerization through mammalian two-hybrid assays (M2H) and (2) to induce RXR responsive element DNA sequence (RXRE) based transcription. We then assessed the ability of the analogues (1) to induce ApoE expression through LXRE-based luciferase assays, while evaluating their potential for adverse effects through (2) SREBP- and (3) RARE-based reporter systems. Results from the M2H and RXRE assays revealed that our novel analogues produce a wide range of transcriptional activity. LXRE, SREBP, and RARE assays revealed similar results. Specifically, analogue A44 had significantly higher activity with LXRE (p < 0.05) and significantly lower activation via SREBP (p < 0.05) and RARE (p < 0.05) as compared to bexarotene. These assays revealed that our novel bexarotene analogues can potentially be more effective and potent RXR ligands than bexarotene with the capability to circumvent RAR cross-over and elevated SREBP expression, and thus the adverse effects of bexarotene. These analogues may have the potential to slow the progression of AD through increased ApoE expression without the current limitations associated with bexarotene use.
    • 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.
    • Anaplastic Thyroid Cancer: The Trajectory of Prolonged Diagnosis and Short Survival

      Xiong, Maggie; The University of Arizona College of Medicine - Phoenix; Milas, Mira (The University of Arizona., 2021)
      Purpose: Anaplastic thyroid cancer (ATC) is almost uniformly lethal in its progression, but due to its rarity and complexity, its presentation is difficult to recognize and manage by physicians and patients alike. Delayed diagnosis is common and makes ATC virtually untreatable. We aim to examine the number of appointments with healthcare providers, imaging studies performed, and admission days as metrics of delayed diagnosis in order to identify opportunities to expedite care of ATC patients in the future. Methods: A retrospective electronic medical record review was conducted to include 8 patients from January 2016 to December 2018. Both pre- and post-diagnosis variables were examined and include: number of unique encounters, type/number of imaging studies, demographics (sex, ethnicity, residence, employment, religion, language, marital status), days admitted inpatient, time to diagnosis, and specific medical specialties utilized. Pre- and post-diagnosis imaging studies included computer tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), radiographs (X-ray), and positron emission tomography (PET). IRB approval was obtained through the UA BEACON© registry. Results: We analyzed 4 women and 4 men with ATC whose mean time to diagnosis (TTD) from initial chief complaint was 53 days. In that time, 12 clinicians per patient (median) provided care. Men had a far longer mean TTD compared to women (75 vs 31 days), as well as longer mean inpatient admission for evaluation (19 vs 11 days). After ATC diagnosis, the median number of encounters per patient rose to 24.5, reflecting multispecialty care required for treatment. Here also, men had more median post-diagnosis specialist encounters than women (41.5 vs 11). Female patients had a median number of 4 imaging studies pre-diagnosis and 2 imaging studies post-diagnosis while male patients had a median number of 6 imaging studies pre-diagnosis and 12.5 imaging studies post-diagnosis. Discussion: This study suggests that male patients with ATC have a more difficult trajectory both pre- and post-diagnosis compared to female patients. They require longer time and more imaging studies before physicians arrive at the ATC diagnosis. Subsequently, men stay longer in the hospital, still with significantly higher numbers of studies and physician encounters. The root causes of this gender discrepancy are unclear and likely multifactorial, but could represent greater ATC disease severity and gender-specific barriers to care. This study highlights the need to recognize early signs of ATC and consider this diagnosis sooner.
    • 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.
    • Chief Complaints: Can They Predict COVID-19 Positive Patients?

      White, Krichelle; The University of Arizona College of Medicine - Phoenix; Heise, William (The University of Arizona., 2021)
      Background: The COVID-19 pandemic has overwhelmed emergent and nonemergent medical facilities with patients often presenting with a vast array of clinical symptoms. We aim to evaluate the chief complaints of patients presenting to Urgent Care and Emergency facilities to better understand which chief complaints are more likely to be associated with these patients being confirmed COVID-19 positive. It is hypothesized that patients who have more commonly associated COVID-19 presenting symptoms will have a greater likelihood of positive test results. Methods: The study was a retrospective computational analysis that investigated the chief complaints of all confirmed and suspected COVID-19 cases presenting to Banner Health facilities within the state of Arizona from March through October 2020. The chief complaint and demographic data were extracted from Cerner’s underlying database. For each of these visits, the full list of chief complaints and patient demographics were extracted from the electronic health record. To more meaningfully characterize the chief complaint list, semantically and clinically similar chief complaints were aggregated. An example of aggregated complaints includes “SOB” and “Dyspnea”. Results: During the study period there were 70,884 unique encounters of COVID-19 suspected patients with 59,225 unique patients identified and 17,408 (29%) being confirmed COVID-19 positive. The twenty unique chief complaints were then correlated by patient encounter. Among the entire study population, “fever” was the most common chief complaint followed by “cough”. “Cough” (48%) and “fever” (41%) were the most common chief complaint for COVID-19 positive patients. Patients who presented with “loss of taste” or “loss of smell” were most likely to test positive with an OR of 5.53, 95% CI 5.12-5.97 and 7.64, 95% CI 6.96-8.39 respectively. Conclusion: Our research highlights an important aspect of the initial evaluation of COVID-19 patients within the clinical setting. Our study identified chief complaints that commonly are associated with the diagnosis of COVID-19 along with those that are less likely to be associated. This effort provides healthcare providers with data to that can better predict and identify patients that have an increased likelihood of being infected with COVID-19 based on their initial chief complaint.
    • 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.
    • 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.