Browsing by Author "Taft, Carter"
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Item It’s not a GIST: A Histopathological Investigation of a Rare Gastric Schwannoma(2023) Thai, Stephen; Phan, Jenny; Taft, Carter; Roth, Hannah; Tovar-Vidales, Tara; Crowe, NicoleBackground: Gastric schwannomas are rare gastrointestinal mesenchymal tumors, accounting for <0.2% of all gastric neoplasms. Gastric schwannomas are benign, arise from the gastrointestinal nerve plexus, and are often misdiagnosed as gastrointestinal stromal tumors (GISTs). Gastric schwannomas are typically incidental findings on conventional imaging studies, surgery, or autopsy. Reported patients are usually asymptomatic. Gastric schwannomas can be differentiated from GIST and other mesenchymal gastrointestinal tumors through the use of immuno-histochemical markers such as S100, Vimentin, and glial fibrillary acidic protein (GFAP). Case Information: During routine dissection of a 78-year-old female, a 1.5 x 1.2 x 1.0 cm tan, firm nodule protruding from the anterior stomach wall was identified. The nodule was located 11 cm from the gastroesophageal junction, 7 cm from the incisura angularis, and 6 cm from the pyloric sphincter. Sectioning revealed white, whorled, and rubbery cut surfaces. No hemorrhage, necrosis, or cystic spaces were grossly appreciated. Subsequently, the tissue underwent routine fixation, processing, paraffin embedding, sectioning, and hematoxylin and eosin (H&E) staining. Using light microscopy, histopathologic findings included a well-circumscribed area containing mostly eosinophilic spindle cells with nuclear palisading, foci of lymphoid infiltration,and a micro-trabecular pattern noted centrally. Additionally, a peripheral lymphoid cuff was present. No mitotic figures were identified. Based on our histopathology findings, we hypothesized the presented nodule to be a gastric schwannoma. This diagnosis was corroborated by immunohistochemistry to demonstrate positive S100b protein expression. Common differential diagnoses include gastrointestinal stromal tumors (GISTs), leiomyomas, and solitary fibrous tumors, all of which lack S100 protein reactivity. Conclusion: This case aims to contribute an additional report about gastric schwannomas to better enhance our collective understanding of this rare lesion.Item Shaping Tomorrow’s Surgeons: Insights into PGY-1 Orthopaedic Training Across the United States(2024-03-21) Taft, Carter; Wong, Zachary; Rosenthal, Reece; Eaddy, SamuelPurpose Orthopaedic surgery residency offers valuable opportunities for first-year residents to diversify their medical training beyond their specific field. The American Board of Orthopaedic Surgery (ABOS) mandates a five-year residency program for board certification, wherein the initial year, termed postgraduate year one (PGY-1), the curriculum is variable. ABOS permits up to six months in orthopaedic surgery rotations, with the remaining six months offering various educational experiences. Among the non-orthopaedic surgery months, at least three must be dedicated to either general surgery, trauma surgery, plastic/burn surgery, surgical or medical intensive care, or vascular surgery. The additional three months can encompass a range of hospital services. This study examined the rotations included in residency programs across the nation to analyze trends in PGY-1 orthopaedic resident experiences. Methods This study gathered data from the Electronic Residency Application Service (ERAS) list of participating orthopaedic programs across the United States for the 2023 application cycle. Program-specific information regarding PGY-1 rotations, both in orthopaedic and non-orthopaedic fields, as well as matriculated residents was gathered by utilizing each program’s publicly available internet resources. Programs with inadequate information regarding these variables were excluded from the study. Individual rotations were primarily divided into “month” intervals, which were defined on a program-to-program basis. Results A total of 174 orthopaedic residency programs out of 201 participating programs with sufficient public data regarding PGY-1 curriculum were included in this study (86.6%). On average, these programs took 4.63 residents per application cycle.In assessing the ABOS requirement of 3 months of non-orthopaedic surgical rotations, the utilization rates among orthopaedic programs were as follows: intensive care (72.1%), plastics/burn care (67.4%), trauma (61%), general surgery (52.3%) and vascular (47.7%). The threshold of six months of orthopaedic surgery rotations was met by 90.11% of programs, with general orthopaedics, trauma, spine, and joints being the mostcommon subspecialties with an average of 4.1, 2.4, 1.2, and 1.6 months spent in these areas, respectively. Conclusions Among nationally accredited orthopaedic programs, notable differences exist in PGY-1 rotations. Our data revealed that within non-orthopaedic rotations, intensive care, plastics/burn care, and trauma were the most common, whereas general orthopaedics, trauma, and spine predominated within orthopaedic rotations. Understanding these curriculum differences in the first year of orthopaedic residency iscrucialto applicants as they navigate the intricacies of this highly technical field, marked by significant variability in training. Moreover, this information is valuable to current orthopaedic residents and program directors as they shape their program’s educational direction, ensuring that rotations are comprehensive and aligned with national trends. Future directions for our study include surveying program directors regarding the philosophy of their PGY-1 curriculum, aiming to better categorize the factors influencing educational design.Item Use of an Integrated Collaborative Care Model for Pediatric Mental Health Care(2024-03-21) Taft, Carter; Bui, PriyaPurpose This study evaluates the effectiveness of collaborative care models in pediatric psychiatry aimed at addressing the mental health (MH) needs of children and adolescents within the primary care setting. The model integrates primary care clinicians and mental health professionals to provide comprehensive, patient-centered MH care. In addition to reviewing existing literature on collaborative care models, this study aims to describe the unique collaborative care model implemented at the University of North Texas Health Science Center (UNTHSC) Department of Pediatrics and Women’s Health. Methods The collaborative care model at UNTHSC involves a team structure comprising Pediatricians, Behavioral Health Care Managers, and Child and Adolescent Psychiatric consultants. Patients eligible for the model receive initial assessments, treatment plans, and routine interventions tailored to their MH needs. The treatment process involves regular case reviews, interventions, and relapse planning, with specific adaptations to align with the needs and resources available within the UNTHSC pediatric department. Results Previous studies on integrated care models, including the TEAM UP and Behavioral Health Integration Program, have demonstrated improved treatment effectiveness and patient outcomes. In these models, warm handoffs, increased visits, and enhanced competence in managing MH conditions were observed. Collaborative care has been shown to significantly reduce depression scores, with 55% achieving remission in one study. The findings from the UNTHSC collaborative care model are anticipated to complement existing literature, offering insights into the specific strategies and outcomes achievable within a pediatric primary care setting. Conclusions The findings demonstrate the effectiveness of the collaborative care model in treating pediatric MH conditions within primary care settings. Patients enrolled in this model are expected to experience improved treatment outcomes, while healthcare professionals benefit from enhanced satisfaction and coordination of care. This study aims to provide detailed insights into the logistics, fiscal considerations, patient population, and staff involved, including the unique collaborative care model implemented at UNTHSC Department of Pediatrics, enabling the replication of similar collaborative care approaches in pediatric primary care settings to address MH needs comprehensively.