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How True Love Feels
Get PDFThe author submitted this entry in the Open Verse Poetry category (Amateur division) for the 2023 On My Own Time (OMOT) Art Show.It is how I felt when I realized my true love
The Influence of Demographic Factors, Resilience, and Other Psychological Factors in Predicting Caregiver Burden in Trauma ICU Populations
Get PDFAlthough only a small number of studies specifically focus on caregivers of ICU patients, findings suggest that these caregivers can experience a substantial burden. Although negative psychological states, including depression and posttraumatic stress disorder (PTSD), are gaining attention in the literature following the injury of a family member, less attention has been paid to the role that potentially protective psychological factors, such as resilience, may have in one's response to injury or critical illness in a family member. The purpose of this study is to examine the role of specific demographics factors and resilience in predicting caregiver burden, depression, and PTSD symptoms in caregivers of trauma patients. Eligible individuals were identified based on their family member's medical diagnosis through the trauma service admission list at Baylor University Medical Center (BUMC), a Level I trauma center and part of the Baylor Scott & White Healthcare system. Participants (aged 18-82, N=91, 73.6% female) completed brief self-report measures assessing depression, PTSD and resilience at baseline, and completed brief self-report measures assessing depression, PTSD, and caregiver burden at three-month follow-up. Regression analyses were used to determine the association between resilience and each outcome (caregiver burden, depression, and PTSD). Results illustrated significant associations between resilience and depression and PTSD separately. Exploratory analyses were conducted to determine the role of demographic factors in predicting caregiver burden, depression, and PTSD over time. A series of linear and logistic regressions were conducted to evaluate the intersectionality of the demographic factors and each outcome. Findings suggest that higher levels of resilience may significantly be associated with lower rates of depression and PTSD. Additionally, the interaction of several demographic factors may significantly be associated with higher rates of depression and PTSD. Current study findings suggest that certain demographic factors are associated with higher levels of depression and PTSD in caregivers. Although further exploration is warranted before drawing firm conclusions, this novel information may be used to direct future research, educate caregivers, clinicians and researchers, and inform the development of interventions specific to this population
InBasket burden: what physicians and health systems can do to address the "elephant in the room"
Get PDFDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern's Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin
Pain
Get PDFThe author submitted this entry in the Open Verse Poetry category (Amateur division) for the 2023 On My Own Time (OMOT) Art Show
Lateral Patient Positioning and Central Lag Screw Placement in Geriatric Cephalomedullary Nailing
Get PDFThe 61st Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 31, 2023, 3-6 p.m., D1.600)Hip fracture is a debilitating condition in the elderly. Cephalomedullary nails are commonly used to achieve internal fixation in these injuries. Proper screw placement within the femoral head (central or inferior in the coronal plane, central in the lateral plane) lowers the risk of the screw cutting out of the femoral head post-operatively. Traditionally, these nails have been implanted with the patient positioned supine, but some surgeons prefer a lateral patient position. This lets adipose tissue fall away from the incision site, potentially improving the surgeon's ability to achieve a desired nail starting point. Lateral nailing also theoretically provides more control over the aiming arm by preventing its rotation due to gravity. Because relatively little research exists comparing these methods, the purpose of this study was to investigate if lateral patient positioning may be associated with higher rates of central lag screw placement than traditional supine nailing. Patients aged 60 or older receiving a cephalomedullary nail for an intertrochanteric femur fracture between June 2009 and April 2022 were identified via a medical records query of three hospitals (n=465). Lateral intra-operative fluoroscope images were for each patient were de-identified and exported to Microsoft PowerPoint, where a custom overlay was applied to divide each femoral head into perfect thirds. The lag screw tip was determined by inspection to reside in the Anterior, Middle, or Posterior third of the head. Cases in which the minor diameter of the screw was touching the line between thirds were considered Junction Anterior-Middle or Junction Posterior-Middle. To prevent bias, the surgical record was accessed last to determine the position of each patient. Compared to supine positioning, lateral positioning was associated with a 0.493 relative risk of placement not fully within the middle region (p=0.004) and a 0.244 relative risk of placement in extreme anterior and posterior regions (p=0.056). Multivariate linear regression analysis revealed that central screw placement was associated with the following: lateral positioning (p=0.030), older patient age (p=0.009), and larger screw diameter (p=0.014). Analysis of only patients receiving 11mm screws (n=346) produced broadly similar results. We conclude that in geriatric intertrochanteric cephalomedullary nailing, lateral positioning of the patient may be associated with higher rates of central screw placement on the lateral fluoroscopy view. Prospective study design is needed to reduce the influence of confounding variables on these results, including varying levels of surgeon experience with this procedure.Southwestern Medical Foundatio
Development and Implementation of a Brief Video-Based Mindful Movement Intervention Prior to Pelvic Exams to Reduce Pain Intensity and State Anxiety
Get PDFMindfulness interventions have demonstrated efficacy for numerous health related outcomes, and been implemented in medical settings to reduce pain and anxiety prior to exams, surgeries, or procedures. This broad investigation begins with a theoretical review exploring a proposed mechanism of mindfulness, improved attention. It presents a theory of mindful movement as a type of mindfulness potentially more efficacious for individuals who struggle with mind-wandering, such as those with depression and anxiety. Mind-wandering and rumination are barriers to mindfulness, and movement has been shown to engage finite executive resources also utilized for mind-wandering. Mindfulness interventions with movement, may promote greater engagement for individuals with attentional challenges, compared to focused attention meditation. Mindful movement may provide a more accessible form of mindfulness for brief interventions, implemented in settings with a wide range of participants.
The current study tests the efficacy of a 5-minute mindful movement video prior to pelvic examination in a sample of 99 women at an outpatient gynecology clinic, with the aim of reducing anxiety and pain. Participants were randomized into Treatment (5-minute mindful movement video; n=49) and Control (educative materials about mindfulness benefits; n=50). Upon arrival, women completed a PHQ-9, and baseline measurements of anxiety and pain using a visual analogue scale. They then completed the group specific activity and rated anxiety prior to examination. After examination participants rated exam pain, post-exam anxiety, and completed questionnaires assessing exam satisfaction and intervention acceptability. Physicians (n=2) rated ease of performing pelvic examination and ability to obtain clinical information.
Results demonstrated clinically anxious individuals who completed the intervention reported significantly lower anxiety before pelvic examination (p=.000, partial η2=.262) and after (p= .010, partial η2=.126) compared to control group. No significant differences in pain, patient exam satisfaction, or physician perception of the exam were noted between groups. Acceptability and interest in the intervention was also high. This study demonstrates the ability to implement a brief mindful movement video into the flow of a medical clinic and reduce pelvic exam anxiety.
In general, this broad investigation supports ongoing research exploring mindful movement from a mechanistic perspective, and the implementation of brief mindful movement interventions in medical settings
Disability in older adults
Get PDFDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern's Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin
Voice Silenced
No full textThe author submitted this entry in the 10-Word Story category (Amateur division) for the 2023 On My Own Time (OMOT) Art Show.This work received a Third Place Award in the "10-Word Story" category from all literary works submitted in the 2023 On My Own Time show.In the face of societal expectations to stay silent due to my youth, I defied the limitations placed upon me and found the courage to express myself. Through resilience and unwavering belief, I broke free from age-defined boundaries, proving that our voices hold power regardless of our age. This personal journey stands as a testament to the importance of challenging societal norms and making a meaningful impact
Should all patients with chronic kidney disease be treated with a sodium-glucose transporter-2 inhibitor?
Get PDFDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern's Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin
Aspirin Use Is Associated with Improved Outcomes in Inflammatory Breast Cancer Patients
Get PDFPURPOSE: Inflammatory breast cancer (IBC) is the most aggressive form of breast cancer and has a high propensity for distant metastases. Our previous data suggested that aspirin (ASA) use may be associated with reduced risk of distant metastases in aggressive BC; however, there are no reported studies on the potential benefit of ASA use in patients with IBC.
METHODS: Data from patients with non-metastatic IBC treated between 2000-2017 at two institutions, were reviewed. Overall survival (OS), disease-free survival (DFS), and distant metastasis-free survival (DMFS) were performed using Kaplan-Meier analysis. Univariate and multivariable logistic regression models were used to identify significant associated factors.
RESULTS: Of 59 patients meeting the criteria for analysis and available for review, 14 ASA users were identified. ASA users demonstrated increased OS (p=.03) and DMFS (p=.02), with 5-year OS and DMFS of 92% (p=.01) and 85% (p=.01) compared to 51% and 43%, respectively, for non-aspirin users. In univariate analysis, pT stage, pN stage, and aspirin use were significantly correlated (p < .05) with OS and DFS. On multivariable analysis, ASA use (HR=.11, CI 0.01- 0.8) and lymph node stage (HR=5.9, CI 1.4-25.9) remained significant for OS and DFS (aspirin use (HR =0.13, CI 0.03-0.56) and lymph node stage (HR=5.6, CI 1.9-16.4).
CONCLUSION: ASA use during remission was associated with significantly improved OS and DMFS in patients with IBC. These results suggest that ASA may provide survival benefits to patients with IBC. Prospective clinical trials of ASA use in patients with high-risk IBC in remission should be considered