• A Comprehensive Institutional Overview of Intrathecal Nusinersen Injections for Spinal Muscular Atrophy

      Mousa, Mohammad; The University of Arizona College of Medicine - Phoenix; Towbin, Richard (The University of Arizona., 2021)
      Background: Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder resulting in progressive muscle weakness. In December 2016, the U.S. Food and Drug Administration approved the first ever treatment for SMA, a drug named nusinersen (Spinraza) which is administered intrathecally. However, many SMA patients have neuromuscular scoliosis and/or spinal instrumentation resulting in challenging intrathecal access. Therefore alternative routes must be considered in these complex patients. Methods: This study was reviewed and approved by our institution’s institutional review board. From March to December 2017, institutional SMA patients were referred for intrathecal nusinersen injections. In select patients with spinal hardware, spinal imaging was requested to facilitate pre-procedure planning. Standard equipment for intrathecal injections was utilized. All patients were followed-up by their referring neurologist. Results: A total of 104 intrathecal nusinersen injections were performed in 26 patients with 100% technical success. 60 procedures were performed without pre-procedural imaging and via standard interspinous technique. The remaining 44 procedures were performed in 11 complex (i.e. neuromuscular scoliosis and/or spinal instrumentation) patients requiring pre-procedural imaging for planning purposes. 19 of 44 complex procedures were performed via standard interspinous technique from L2 to S1. 22 of 44 complex procedures were performed using a neural-foraminal approach from L3 - L5. 3 of 44 complex procedures were performed via cervical puncture technique. There were no immediate or long-term complications but 1 short term complication of meningismus and back pain at the injection site. Conclusion: Although we achieved 100% technical success in intrathecal nusinersen administration, our practice habits evolved during the course of this study. Our early experience has led to the development of an algorithm to assist in promoting safe and effective nusinersen administration in children with Spinal Muscular Atrophy regardless of SMA type, abnormal spinal anatomies and complex spinal instrumentation.
    • 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.
    • CT Texture Analysis (CTTA): Developing a Diagnostic Imaging Biomarker for KRAS Mutation in Metastatic Colon Cancer

      Khurana, Sukhdeep; The University of Arizona College of Medicine - Phoenix; Silva, Alvin (The University of Arizona., 2021)
      PURPOSE To evaluate multi-parametric modeling on imaging textures from contrast-enhanced, multiphasic computed tomography (CT) for identification of Kirsten rat sarcoma (KRAS) gene mutations in metastatic colon cancer to the liver. METHOD AND MATERIALS This retrospective study included 99 patients diagnosed histologically with colon cancer: 51 KRAS wild-type and 48 KRAS gene mutation. Matched-size regions of interest (ROIs) were drawn over viable tumor and unaffected background liver on multiphase CT. Paired ROIs were spatially rescaled, intensity-normalized, and then analyzed using 3 Texture Algorithms: GLCM, LBP, and Gabor. Feature selection method was based on KNN classifier and DEFS (Differential Evolution-based Feature Selection). For each of the 30 independent experiments, patients were randomly allocated into training (n = 79) and testing (n = 20) datasets to develop predictive models for KRAS gene mutation. Classification models were generated based on: 1) All features; and 2) Selected features as per DEFS. RESULTS Predictive models utilizing all 56 features (13 GLCM, 26 LBP, and 14 Gabor) resulted in an average accuracy/sensitivity/specificity of 61/54/62%; ranging from a single best model (80/80/90%) to a single worst model (35/20/20%). Predictive models utilizing a DEFS optimized 3-feature subset resulted in average accuracy/sensitivity/specificity of 89/80/84%; ranging from a single best model (95/92/96%) to a single worst model (80/68/68%). Among the three texture algorithms, LBP provided better discriminatory power compared to GLCM and Gabor. CONCLUSION Utilizing advanced analytics with machine learning techniques (CTTA and DEFS selection analysis), multi-textural data obtained from conventional, multiphase CT images has the capability to detect a therapeutically relevant genetic aberration (KRAS mutation) in metastatic colon cancer with high accuracy, sensitivity and specificity.
    • Current Trends of Clostridioides difficile infections (CDI) in the United States: Results from the National Inpatient Sample Database

      Zamarripa, Alec; The University of Arizona College of Medicine - Phoenix; Kannadath, Bijun (The University of Arizona., 2021)
      Background Clostridioides difficile infection (CDI) is a cause of significant hospital morbidity and mortality in the United States. Objective Our aim was to analyze the current trends of CDI burden using the National Inpatient Sample (NIS) database, which tracks all hospital discharges in the United States. Methods Using the NIS, all adult discharges (age ≥ 18 years) between 2012 and 2017 were evaluated. Discharges with CDI were identified based on the appropriate ICD9 (00845) and ICD10 (A047, A0471, A0472) codes. All data was analyzed after applying recommended weights using Stata Statistical Software: Release 16. (College Station, TX) and pandas statistical package in Python. Main Measures The overall CDI trends, including incidence, mortality, age, and length of stay were analyzed. The incidence and mortality rates were also analyzed with respect to race, sex, comorbidity (diabetes, hypertension, hyperlipidemia), and hospital location, size, and ownership. Key Results Records representing 181,132,460 adult discharges in the United States over 6 years (2012 – 2017) were included in the analysis; of these, 2,088,825 (1.15%) discharges had CDI. Overall incidence increased until peaking in 2015 at 1.21%, before declining to 1.06% in 2017. Despite the fluctuation in incidence rate, the mortality rate exhibited a steady decrease from 7.32% in 2012 to 6.25% in 2017. Also, the average length of stay decreased from 10.6 days to 9.9 days, along with average age of CDI patients dropping from 67.9 years to 66.2 years. Incidence and mortality rates were consistently higher in males compared to females. Incidence was typically higher in White Americans; however, Asians/Pacific Islanders regularly demonstrated the highest mortality rates during the study period. Finally, incidence and mortality rates were highest in large-bedded, urban teaching hospitals. Conclusion Improvement in overall mortality rate (Δ -1.07%) outpaced improvement in the incidence rate (Δ -0.09%), which may be indicative of improved diagnosis and management of CDI. Specifically, the adoption of oral vancomycin and fidaxomicin as standard treatments may be a key reason for our findings. However, primary prevention efforts are still struggling to effectively control the spread of CDI, especially in large-bedded, urban teaching hospitals – this may be due in part to a higher acuity patient population. Despite limitations, these findings suggest a lessening of overall burden of CDI in the United States.
    • Did the Millennium Development Goal Target 7c (to halve between 1990 and 2015 the proportion of the global population without sustainable access to safe drinking water) Reduce the Prevalence of Diarrheal Illness in the Dominican Republic

      Frazier, Weston; The University of Arizona College of Medicine - Phoenix; Beyda, David (The University of Arizona., 2021)
      Background: Waterborne diseases are caused by a variety of microorganisms, biotoxins, and toxic contaminants, which lead to devastating illnesses. According to the World Health Organization, diarrheal illnesses are the ninth leading cause of death worldwide. Developing countries are at especially high risk due to the lack of quality infrastructure and the Dominican Republic is no exception. Access to a quality public water supply has been shown to significantly reduce the incidence of diarrheal illnesses worldwide and in 2012, the Dominican government celebrated as achieved the completion of the Millennium Development Goal Target 7c (to halve between 1990 and 2015 the proportion of the global population without sustainable access to safe drinking water). Our aim was to determine whether the initiative was successful at reducing the prevalence of diarrheal illnesses across the country. Methods: This is a cross-sectional study that obtained data using the Demographic and Health Surveys Database. Census data from the Dominican Republic was obtained from 2002, 2007 and 2013 Since the Millennium Development Goal Target 7c was celebrated as complete in 2012, data from 2002 and 2007 censuses were used to compare the change in prevalence of diarrheal illness in the 2013 census data. Odds ratio values and 95% confidence intervals were then calculated to evaluate various demographics and outcomes. Findings: Census data from the Dominican Republic including the years 2002, 2007, and 2013 actually revealed a steadily increasing prevalence when participants were asked if they had, “Diarrhea within the last 2 weeks (2002: 15.6%, 2007: 16.5%, and 2013: 17.7%; p=0.03).” This increase was observed throughout the course of the Millennium Development Goal Target 7c, which began in 1990 and was celebrated as accomplished in 2012. Before 2012, a total of 16.1% of participants reported that they had, “Diarrhea within the last 2 weeks”, while after 2012, 17.7% of participants reported that they had (p=<0.0001). This resulted in an odds ratio of 1.23 (p=<0.0001) with the current water supply. Other data that supports the poor state of the current water supply is the increased odds of having diarrhea when water is piped into the dwelling or brought in by a tanker, with odds ratios of 1.24 (p=<0.0001) and 1.11 (p= 0.043) when compared to a bottled water source respectively. Higher education decreased the odds of contracting diarrheal illness with an odds ratio of 0.77 (p=0.003). Secondary and higher education also decreased the risk of blood in the stool with odds ratios of 0.44 (p=0.01) and 0.45 (p=0.03) respectively. Interpretation: It appears the Millennium Development Goal Target 7c (to halve between 1990 and 2015 the proportion of the global population without sustainable access to safe drinking water), was ineffective at reducing the prevalence of diarrhea in the Dominican Republic. In fact, the prevalence has increased throughout the course of the initiative. The increase was especially notable in populations that used water piped into dwellings and tanker truck water sources. This is precisely the water supply that the initiative set out to improve. Using diarrhea as a single factor to determine the water quality in the Dominican Republic, it appears that the state of the country’s water is significantly worse than before.
    • 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.