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Enteric/Typhoid Fever in a Returning Traveler: an Approach to a Thorough Medical Workup
Get PDFUp to 70% of travelers to low-income regions experience health complications, most of which are self-limiting. However, 8% to 15% require medical evaluation either during travel or upon return, with fever frequently reported as a primary symptom.1 As such, the importance of a thorough medical workup in a returning traveler with fever cannot be overstated, as it may be the first sign of a potentially serious or infectious disease acquired abroad. High risk pathogens to be concerned for include Malaria, Dengue, Chikungunya, Leptospiral, typhoid, and others, and thus it is incredibly important to narrow your differential, which will guide your treatment. This can be done through a comprehensive history, including general medical history as well as specific travelling areas, foods eaten, activities performed and others. Initial laboratory testing should include a complete blood count (CBC), comprehensive metabolic panel (CMP), a peripheral blood smear, and blood cultures. Doing these things offers a systematic approach to narrowing your differential and guides your treatment.https://digitalcommons.unmc.edu/com_msrs/1003/thumbnail.jp
Urology Resident Associate: A Promising Alternative for the Unmatched Urology Applicant
Get PDFBackground. Demand for urology residency spots frequently outstrips supply, with unmatched urology applicants having limited options while waiting for reapplication. We aim to demonstrate our experience with a year-long Urology Resident Associate (URA) position, which merges the role of junior resident and APP with the mission to reduce resident workload and further the training of an unmatched urology applicant.
Methods. A year-long, non-Accreditation Council for Graduate Medical Education (ACGME) accredited URA position was created at our institution in 2023 and filled by an unmatched applicant to our program. The URA was given all the roles and responsibilities of a junior resident, with a primary focus on hospital floor work and consultations. Success of the URA position was gauged through a survey of the urology department, URA involvement in operating room (OR) case load, improvement in the number of residency interviews, and successful urology match.
Results. From July 1, 2023 to June 14, 2024, the URA answered over 2000 pages, reducing resident workload by up to 2 hours per day. The URA covered 275 OR cases, 174 of which were not covered by another resident. A survey of the urology department was overall exemplary, with 77% of respondents rating the URA position as valuable or very valuable. The URA received 67% more interview invites compared to the previous residency application cycle, and successfully matched into urology.
Conclusion. Overall, the URA position provided great value to both our institution and the previously unmatched urology applicant, and would be a good consideration for other institutions looking to assist unmatched applicants and improve resident workflow
Hospital Admissions of Patients Experiencing Housing Instability
Get PDFhttps://digitalcommons.unmc.edu/emet_posters/1048/thumbnail.jp
Enhancing Nurse Confidence in Labor Pain Management and Respectful Maternity Care Through Implementation of the Coping with Labor Algorithm
Get PDFObjective: The objective of this project was to implement the Coping with Labor Algorithm in the labor and delivery setting and study its impact on nurse self-efficacy and on birthing persons’ experiences.
Design: A quasi-experimental pre- and post-design was used for this project.
Setting: The project was conducted in a maternity unit with six labor beds located in the Midwest.
Methods: This project was conducted over twelve weeks. Twenty-five registered nurses were provided in-person education, access to educational materials, and training on how to use the Coping with Labor Algorithm. A pre-test was administered before the unit implementation of the project. Each labor room was supplied with a laminated copy of the algorithm for reference. Upon completion of the twelve-week project, registered nurses were given a post-survey to assess improvement in self-efficacy. Additionally, a unit-collected patient-reported experience measure (PREM) distributed by the Nebraska Perinatal Quality Improvement Collaborative (NPQIC) was utilized to evaluate patient perceptions related to respectful care, communication, decision-making, and overall satisfaction.
Results: There were no statistically significant differences in NSEQ and LSSQ scores based on age, years as a registered nurse, or years working in labor and delivery. While effect sizes suggested moderate to large practical differences, high variability and low small sample sizes likely contributed to the lack of statistical significance. Additionally, an overall increase was observed in patient-reported respect for healthcare choices and respectful treatment during their stay after implementing the Coping with Labor Algorithm.
Conclusion: The implementation of the Coping with Labor Algorithm showed promising improvements in nurse confidence and patient perceptions of respectful maternity care. Although statistical significance was not achieved in self-efficacy and labor support scores across demographic groups, moderate to large effect sizes suggest meaningful, practical differences that merit further exploration. Importantly, the PREM survey revealed an increase in patients feeling their healthcare choices were respected throughout their stay, as well as overall respectful treatment during the study period. These findings highlight the potential clinical impact of structured, person-centered labor support interventions and underscore the importance of continued research in this area.
Recommendation: Future research should incorporate larger and more diverse samples to enhance statistical power and generalizability. Studies should also address unequal variances and thoroughly examine the influence of factors such as race, educational background, and overall nursing experience, including labor and delivery experience, on self-efficacy and labor support. Longitudinal designs are recommended to track changes in NSEQ and LSSQ over time. Additionally, integrating qualitative methods with quantitative data can provide deeper insights. Future studies should explore the relationship between labor and delivery experience and labor support skills and how these factors impact NSEQ and LSSQ within the context of the intervention. Emphasis should also be placed on evaluating the clinical significance of observed changes in these outcomes
Representation and Outcomes of Catheter Ablation for Treatment of Atrial Fibrillation among Patients with Obesity: A Systematic Review of Randomized Control Trials
Get PDFBackground: The prevalence and impact of obesity on outcomes of atrial fibrillation (AF) ablation randomized controlled trials (RCTs) have not been well studied.
Objective: To examine the proportion of participants with obesity enrolled in RCTs of AF ablation and outcomes of ablation when subgroup analysis of participants with obesity were available.
Methods: We systematically searched PubMed and EMBASE for AF ablation RCTs published between January 1, 2015 to May 31, 2022. When body mass index (BMI) data were available, normal distribution was assumed and a z score was used to estimate the proportion of obesity. Results categorized by BMI or body weight status were reviewed. Authors were contacted for additional information.
Results: Of 148 eligible RCTs with 30174 participants, 144 (97.30%) RCTs did not report the proportion of participants with obesity, while published information regarding BMI was available in 63.51%. Three trials excluded patients based on BMI. Using reported BMI, we estimated the proportion of participants with obesity varied greatly across these trials, ranging from 5.82%-71.9% (median 38.02%, interquartile 29.64%, 49.10%). Patients with obesity were represented in a greater proportion among trials conducted in North America (50.23%) and Asia (44.72%), compared to others (32.16%), p \u3c .001. Subgroup analysis or analysis adjusting for BMI was reported in only 13 (8.78%) RCTs; four (30.77%) of these suggested that BMI or body weight might negatively affect primary outcomes.
Conclusion: Obesity is a common comorbidity among AF patients. However, most AF ablation RCTs underreported the proportion of participants with obesity and its impact on the primary outcomes.https://digitalcommons.unmc.edu/emet_posters/1049/thumbnail.jp
Utilizing the Health Belief Model to Design a Community-Based Program to Increase Cervical Cancer Screening Rates Among 21 to 25-Year-Olds in the Omaha Metro Area
Get PDFThe 2021 Douglas County Community Health Needs Assessment found that cervical cancer screening rates have been on a downward trend since 2011. Previous studies on cervical cancer screening interventions have examined refugee populations, and current programs in Douglas County offer assistance to uninsured women, typically aged 40 and older. However, interventions have overlooked young women aged 21 to 25 in the Omaha metro area, who exhibit the lowest cervical cancer screening rates. We will use the PRECEDE-PROCEED Model as a framework to design an educational program for young women aged 21 to 25, guided by the theoretical underpinnings of the Health Belief Model, as well as to develop an implementation and evaluation plan for the program. We aim to create a plan that employs a three-pillar system, including education, patient navigation, and free screening tools. By utilizing data from community health needs assessments and applying findings from Health Belief Model surveys, we can tailor educational materials to fit this age group in Omaha
A Comprehensive Literature Review of Barriers and Facilitators to Alcohol Use Disorder Screening and Treatment
Get PDFBackground: Alcohol Use Disorder (AUD) remains a significant public health issue with extensive personal, societal, and economic impacts. Recent studies indicate that no amount of alcohol consumption is entirely safe, linking it directly to increased chronic disease risks, including cancer. Despite well-documented negative health outcomes, clear guidance on what constitutes AUD through diagnostic criteria provided by the DSM-5, AUD continues to be underdiagnosed and undertreated.
Objectives: This comprehensive literature review explores the key barriers and facilitators influencing AUD screening and treatment engagement.
Methods: A comprehensive literature review was conducted, gathering from various databases including, PubMed, PsycINFO, Scopus, Google Scholar, and relevant governmental resources (Centers for Disease Control and Prevention, SAMHSA, NIA, and WHO). Studies published from 2000 to 2025 were analyzed to identify recurrent themes and synthesize findings.
Results: The final review included 81 articles. This review identified significant barriers at the health care delivery systemic, provider, and individual levels, including 1) fragmented screening efforts in primary care, 2) stigma surrounding AUD, 3) racial and gender disparities in treatment access, 4) financial constraints, and 5) lack of perceived need for treatment among individuals with AUD. In contrast, facilitators, such as 1) integrated screening in primary care, 2) mental health comorbidity-driven engagement, 3) peer and family support, 4) harm reduction approaches, and 5) policy interventions, have been found to enhance treatment accessibility and retention.
Conclusion/Implications: Addressing AUD effectively requires systemic reforms, including normalizing AUD screening, integrated treatment approaches, and targeted stigma-reduction strategies. Recommendations include 1) enhancing routine AUD screening in primary care settings utilizing validated tools like AUDIT and SBIRT. 2) Increase provider training and competency on addiction management and stigma reduction. 3) Expand treatment approaches to incorporate multidisciplinary models including psychotherapy, pharmacology, harm reduction, and peer support. 4) Address disparities through culturally tailored interventions, target outreach for marginalized communities, and policy initiatives to reduce financial barriers to AUD treatment. The recommendations from this study inform public health policies, clinical best practices, and future research efforts, ultimately reducing the burden of AUD and improving health outcomes for affected populations
Contract to Kill: GNAS Mutation
Get PDFThe mutation in Gsα-coding GNAS exons, popular as gsp oncogene, is the most frequent mutation across all heterotrimeric G proteins involved in oncogenesis. GNAS R201, the most frequently mutated, followed by Q227, are found predominantly across various neoplasms and cancers such as IPMN, pituitary, thyroid, appendiceal, colorectal, etc. This review emphasizes the pivotal significance of the gsp oncogene and its ramifications underpinning the sustained addiction to GNAS mutation. Recent studies delineating the mechanistic intricacies that provide solid evidence of the profound impact of oncogenic GNAS on tumor formation, progression, and maintenance are highlighted. We have leveraged the discoveries of Gsα as an ideal neoantigen candidate for vaccine therapy, allele-specific inhibitors, and cyclic peptide-based small molecular inhibitors for G proteins and explored the therapeutic potential to target oncogenic GNAS directly. Alternative therapeutic modalities and patient-centric studies to mitigate the impact of GNAS mutations are also discussed. The exposition of novel studies and strategies designed to address the potential challenges inherent in these approaches of targeting the activating mutations of GNAS, along with probable avenues for further investigation, are highlighted. This review aims to reverberate the current understanding of the oncogenic potential of GNAS, the genomic and biological landscape of GNAS-driven neoplasms and cancers, and potential therapeutic strategies against them
Proteomics Profiling of Research Models for Studying Pancreatic Ductal Adenocarcinoma
Get PDFPancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with a five-year survival rate of 10-15% due to late-stage diagnosis and limited efficacy of existing treatments. This study utilized proteomics-based systems modelling to generate multimodal datasets from various research models, including PDAC cells, spheroids, organoids, and tissues derived from murine and human samples. Identical mass spectrometry-based proteomics was applied across the different models. The preparation and validation of the research models and the proteomics were described in detail. The assembly datasets we present here contribute to the data collection on PDAC, which will be useful for systems modelling, data mining, knowledge discovery in databases, and bioinformatics of individual models. Further data analysis may lead to the generation of research hypotheses, predictions of targets for diagnosis and treatment, and relationships between data variables
State Case Count as an Indicator of Successful Multistate Outbreak Investigation
No full textBackground/Objectives: Shiga-Toxin producing Escherichia coli (STEC) is a contaminant found in multiple food types and causes multistate outbreaks due to the industrialization of food production. In this report I examine the differences in outbreaks categorized by the regulating agency responsible in outbreak prevention and compare outbreak case counts when organized by positive outbreak investigation and response outcomes.
Methods: STEC Multistate outbreak data was obtained from the Center for Disease Control’s National Outbreak Reporting System (NORS) for outbreaks occurring from 2006-2023. Outbreaks were organized into those regulated by either the US Food and Drug Administration (FDA) or the US Department of Agricultures’ Food Safety and Inspection Service (USDA-FSIS) according to the contaminated food. Description of outbreaks organized by regulating agency was performed for the number of outbreaks, STEC serotype, recall, outbreak cases, hospitalizations, HUS cases, and deaths. Comparison was also performed for total cases, outbreak duration, distribution, and public health response time. Total cases and highest state case counts were also compared between outbreaks organized into binary outbreak investigation variables.
Results: Outbreak duration was significantly shorter in the FDA regulated foods. Medians of total cases and highest state case count were also higher in positive outbreak investigation variables