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Interactive Module\u27s Effectiveness on Empathy and Attitudes of Healthcare Students
Get PDFCONTEXT: As the prevalence of social determinants of health (SDH) continues to have an impact on the management of chronic conditions, it is imperative to expose health professional students to these encounters.
OBJECTIVES: This study investigates the role that virtual interactive modules play on osteopathic medical students and physician assistant (PA) students\u27 empathy and attitudes toward individuals with diabetes mellitus who are also affected by an array of SDHs.
METHODS: Students from both health professional programs were asked to complete a pre-survey and post-survey that encompassed the Diabetes Attitude Scale, the Jefferson Empathy Scale, and the Assessing Student Competence and Knowledge of Social Determinants of Health (ASCK-SDH) Instrument. Students engaged with virtual interactive modules to follow the life of a patient, Lula Mae, who lives in the Appalachian area with Type 2 diabetes.
RESULTS: Results from 151 osteopathic medical students concluded significant findings for the Diabetes Attitudes Scale (p\u3c 0.001), Jefferson Empathy Scale (p\u3c 0.02), and ASCK-SDH (p=0.02). While the matched data pairs for the PA students were too small in number to be significant, the data showed a positive trend pre-module to post-module.
CONCLUSIONS: This interactive module improved health professionals\u27 awareness, empathy, and attitudes toward SDH affecting those with chronic conditions. This implementation can be a valuable and insightful medical educational tool that can be adapted for other scenarios like various clinical rotations and sensitive healthcare topics to enhance the development of health professional students\u27 cultural competency and health equity awareness by exposure to various cultural, socioeconomic, and social identities in their future medical decision-making
Evaluating Current Practices in Operative Nontechnical Skills Training and Feedback in General Surgery Residency: A Mixed Methods Approach
No full textBackground: Non-technical skills (NTS) are the interpersonal and cognitive abilities that are critical to accomplishing high-risk tasks. Deficiencies in NTS, including communication, teamwork, leadership, and decision-making, are linked to errors in the operating room. Structured training and feedback in NTS remain inconsistent and have not been integrated into daily training. This dissertation addresses this gap by evaluating current NTS training and feedback practices and developing a rubric to enhance the effectiveness of NTS feedback.
Methods: We conducted five complementary studies to assess current NTS training and feedback. The first was a systematic review aimed at identifying intraoperative NTS training interventions for general surgery residents in the United States. Second, a mixed-method survey to compare residents\u27 and faculty\u27s perceptions of formative feedback on technical skills (TS) versus NTS feedback. Third, we created and validated a rubric for assessing both TS and NTS feedback using literature review, stakeholder perspectives, and a modified Delphi panel. Fourth, we conducted a retrospective analysis of narrative feedback from the University of Nebraska Medical Center (UNMC) general surgery program’s work placement assessment tool (SIMPL) to examine resident, attending, and case factors associated with providing or receiving narrative feedback. Lastly, we applied the rubric to evaluate the frequency and effectiveness of NTS narrative feedback.
Results: The systematic review revealed that most NTS training took place in simulation environments and was rarely integrated into routine clinical practice. Survey findings (n = 79) revealed that while both faculty and residents agreed on what makes NTS feedback effective, they perceived it as occurring less frequently and being more difficult to deliver than TS feedback. The rubric demonstrated high interrater reliability (ICC \u3e 0.84 across domains). In the SIMPL dataset, only 24% of evaluations included NTS feedback; of those, 20% met criteria for effective feedback.
Conclusions: Despite the importance of NTS development in general surgery residents, NTS feedback remains infrequent and often lacks the qualities that promote learner growth. The validated rubric offers a feasible and reliable approach for assessing and enhancing feedback effectiveness. It can be incorporated into faculty development initiatives to promote more meaningful engagement with NTS in surgical training
Model Informed Approach to Support the Repurposing of Brompheniramine for Tumor Associated Neuroinflammation: Mechanistic Dose Prediction and Brain Exposure Assessment
No full textNeuroinflammation is a hallmark of primary and metastatic brain tumors, contributing significantly to disease progression through proinflammatory cytokine regulation, blood brain barrier (BBB) disruption, and immune cell infiltration. The Histamine H1 Receptor (H1R) is expressed on glial, endothelial and tumor cells, and mediates proinflammatory signaling within the tumor microenvironment (TME). Inhibiting H1R may reduce neuroinflammation within the TME and promote anti-tumor environment, thereby limiting tumor progression. Brompheniramine, a first generation H1R antagonist, with proven BBB permeability is a promising repurposing candidate for targeting tumor associated neuroinflammation. However, the brain concentrations of brompheniramine and the duration of its exposure have not been reported, suggesting the need for additional evaluation to better understand its therapeutic potential.
Thus, to predict brompheniramine’s brain concentrations and support dose selection for the treatment of neuroinflammation, we developed a physiologically based pharmacokinetic (PBPK) model using Simcyp®. Model input parameters were derived from a literature reported pharmacokinetic (PK) data. A surrogate pharmacodynamic (PD) EC50 of 90.42 ng/ml for anti-inflammatory efficacy was estimated using skin PD endpoints.
Simulation trials were conducted for single and multiple dosing regimens, including the FDA approved adult dose of 24mg once daily (QD). Following a 2-week dosing regimen of 24mg QD, brain concentrations remained above the EC50for over 94% of the dosing interval. After reaching steady state at approximately 166.5h, concentrations remained above 2*EC50 for 78.5% of the interval, indicating sustained therapeutic exposure in brain tissue. The model indicated a good performance, with the predicted pharmacokinetics parameters falling within 0.5-2.0-fold range of observed clinical data.
Overall, this study provides a mechanistic and quantitative framework for evaluating brompheniramine’s pharmacokinetics and provides guidance for dosing regimens in patients with glioblastoma or brain metastases. These findings highlight brompheniramine’s therapeutic potential to repurpose for tumor associated neuroinflammation
Temporal Patterns of Ectopic Pregnancy: Using the Electronic Health Record to Illuminate a Dark Corner in Women\u27s Health
No full textEctopic pregnancy remains a significant contributor to pregnancy-related morbidity and mortality, yet little is known about whether its occurrence follows discernible temporal patters that could inform prediction and prevention efforts. This dissertation aimed to explore the temporal characteristics of ectopic pregnancy through three interrelated projects: development of a new theoretical framework, a scoping review of the literature on ectopic pregnancy temporal patterns, and an empirical study using electronic health records data from a ten-year period at a single academic medical center. The Nursing Genomic and epigenomic, Environment, and Microbiome (N-GEM) situation-specific theoretical framework was introduced as a novel nursing theory that positions ectopic pregnancy within dynamic, interacting systems shaped by time-sensitive biological and environmental factors. Building on this theoretical foundation, a scoping review revealed that the existing research on ectopic pregnancy seasonality is highly heterogeneous, methodologically inconsistent, and often limited by exclusionary data sources. This study leveraged electronic health record data to create a comprehensive pregnancy dataset that included non-live birth outcomes, enabling a more inclusive and temporally accurate analysis of ectopic pregnancy incidence. Although no statistically significant monthly trends in ectopic pregnancy were identified, the findings suggest that calendar month-based models may be insufficient for capturing the complexity of ectopic pregnancy risk. This work advances nursing science by integrating theory development, evidence synthesis, and informatics-based methods to better understand the temporal dimensions of reproductive health and paves the way for future interdisciplinary research into ectopic pregnancy etiology, prediction, and prevention
A Case of Large Gastric Varices Requiring an Unusual Dual-Access Approach to Transvenous Obliteration
Get PDFBackground:
Balloon-occluded retrograde transvenous obliteration (BRTO) is an image-guided procedure used to treat high-risk gastric varices by occluding portosystemic shunts and injecting sclerosant to induce thrombosis. Gastric varices occur in approximately 20% of patients with portal hypertension, with bleeding carrying mortality rates up to 45%. In most cases, retrograde venous access through the renal vein and shunt is sufficient for variceal obliteration. However, unusual venous anatomy or flow dynamics can complicate this process, requiring advanced techniques.
Case:
A 55-year-old male with cirrhosis was found to have a massive gastric varix with a large gastrorenal shunt. Standard retrograde access was achieved entering from the right femoral vein into the left renal vein. A dense coil pack was placed at the shunt opening toward the renal vein, but contrast injection failed to demonstrate adequate stasis within the varix. Due to persistent flow, an anterograde transhepatic portal venous approach was added to access the variceal complex directly. Once adequately visualized, a vascular plug was placed from the portal side into the shunt to prevent flow. Only after plug deployment did contrast stasis occur within the varix, confirming successful flow isolation. Sclerosant was then injected to complete the procedure. Adequate thrombosis was confirmed by demonstrating absence of contrast flow from the renal side as well. The patient tolerated the procedure well, with no immediate complications, and follow-up imaging confirmed variceal thrombosis.
Conclusion:
This case demonstrates a rare hybrid BRTO technique requiring both retrograde and anterograde access, reported in fewer than 5% of cases. Portal plug placement was essential to achieve flow disruption and sclerosant retention. While BRTO is typically performed through a single venous access, anatomical variations or inadequate contrast stasis may necessitate more complex hybrid approaches. This case underscores the importance of procedural adaptability and precise intraoperative imaging in interventional radiology.https://digitalcommons.unmc.edu/com_msrs/1002/thumbnail.jp
Targeting Cancer-Associated Fibroblast-Driven LIF/LIFR Axis Improves the Therapeutic Efficacy of Gemcitabine and Nab-Paclitaxel in Pancreatic Cancer
Get PDFPancreatic ductal adenocarcinoma (PDAC) is inherently therapy resistant due to cancer cell-stroma crosstalk across several signaling pathways. Among these, the LIF/LIFR axis has been implicated in cancer cell and cancer-associated fibroblast (CAF) crosstalk. We evaluated the efficacy of EC359, a competitive inhibitor of LIFR, in combination with gemcitabine. EC359 reduced tumor burden by 90% compared to controls and by 55% compared to gemcitabine alone in cancer cell and CAFs co-implannation model. The RNA-seq analysis revealed a significant alteration in extracellular matrix components, stemness, microtubule assembly, and immune response, suggesting simultaneous targeting of cancer cell-intrinsic and stroma-mediated mechanisms by EC359. In autochthonous murine model of PDAC, EC359 enhanced the therapeutic efficacy of gemcitabine and nab-paclitaxel, accompanied by an increase in dendritic cells but a reduction in T-regulatory cells. Thus, EC359 reduces PDAC cell stemness, stabilizes microtubule assembly, and reduces the immunosuppressive microenvironment to improve the efficacy of standard-of-care in PDAC
Bad News
Get PDFThis is a representation of a patient sitting on the edge of his hospital bed. It is based on a memory I have from a clinical rotation, in which someone was diagnosed with cancer with a very poor prognosis. The dark green coating the room and his body represents the overwhelming fear he possibly feels. The blue represents sadness, while the red represents anger.https://digitalcommons.unmc.edu/emet_posters/1052/thumbnail.jp
Role of Stabilin-1 Expressing Macrophages in Colorectal Liver Metastasis
No full textColorectal cancer (CRC) is the 2nd most common cause of cancer-related mortality, primarily due to its spread to distant organs. Colorectal liver metastasis (CRLM) is the foremost form of CRC spread due to the anatomical link between the liver and intestine. Despite advancements in diagnostic tools and adjuvant therapies, the survival rate of CRLM remains low, indicating the significant need to identify targetable mechanisms. Stabilin-1 (STAB1), a scavenger receptor expressed on tumor-associated macrophages, has been linked to tumorigenesis and poor outcomes in various cancers. However, the role of STAB1 in CRLM is not known. Here, we investigated the role of STAB1 expression in a preclinical model of CRLM. Wild-type (WT) and Stab1 knockout (KO) mice were intrasplenically injected with saline (vehicle control) or MC38 CRC cells, followed by assessment of tumor burden, liver injury, immune profiles, and macrophage phenotypic markers. As expected, CRLM burden and metastasis-promoting cytokines and macrophages were significantly enhanced in WT mice injected with MC38 cells compared to vehicle controls. In contrast, Stab1 KO mice showed a blunted expression of prometastatic factors, indicating potential protection from CRLM. However, the tumor burden was not consistently reduced in Stab1 KO mice, with differences between the sexes observed. Notably,male Stab1 KO mice displayed reduced CRLM while female Stab1 KO mice exhibited increased CRLM with an accompanying 2-fold accumulation of tumor-promoting M2-type macrophages at the liver-tumor interface. These findings suggest a sex-dependent role of STAB1 in CRLM development and highlight its potential as a therapeutic target
Feasibility Study of Service Expansion to Non-American Indians at the Santee Health & Wellness Center
Get PDFChallenges with obtaining access to healthcare in rural communities continue to be a clear issue. There are both structural and economic issues that limit patient access to care. With geographic issues also affecting access, many patients in Nebraska must travel further and wait longer throughout most rural communities to receive needed care. Care services seem to be retracting vs expanding, and patients continue to seek options that are closer to home and more comprehensive in scope. It is vital for communities and health services organizations to assess all care options and services they can expand or currently have to attract more rural patients. This study provides a comprehensive evaluation of the community care needs along with a feasibility analysis to determine the actions needed to expand access to care at the Santee Health and Wellness Center (Health Center) in Niobrara, Nebraska. The Santee Health and Wellness Center is a tribally managed, outpatient, ambulatory health center in Northeast Nebraska on the Santee Sioux Reservation. This study examines the potential impacts to the Health Center if non-American Indian clientele were allowed to utilize Health Center services. A market analysis, and a review of the potential structural and policy steps needed for expanding services to non- Indian populations is provided in addition to a final recommendation report