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Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30446

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    Telehealth Visit Satisfaction in Geriatric Patients
    (2021) Rashik, Mohammad
    Background: COVID-19 pandemic has led to a shutdown in access to healthcare and an increase in the use of telehealth. Surprisingly, the literature lacks the effectiveness, acceptability, and satisfaction of telehealth visits for geriatric patients (patients over 65). The purpose of this study was to explore the opinions of geriatric patients about telephone visits. Methods: This study investigates the satisfaction and acceptability of telehealth visits for 58 geriatric patients at UNTHSC geriatrics clinic. Patients were asked about call quality, sharing sensitive information over the phone, whether a telehealth visit was as good as an in person visit and if they would choose telehealth over in person visits. Questions were rated on a Likert-type scale from 0 to 10 with 0 being unlikely, 10 being very likely and 5 being neutral. Results: Participants were 70.7% females, mostly Caucasian. 62% were extremely satisfied with visit quality and extremely comfortable sharing sensitive information. 33.6% agreed telehealth visits were good as in person visits, while 28.1% disagreed. Patient opinions revealed that they did not want to miss out on the immersive experience of physical interactions with physicians. Lastly, 21.4% were very likely to choose telehealth visits in future whereas 12.5% were very unlikely. Conclusions: Most geriatric patients were satisfied with the quality of the telehealth visit and felt comfortable sharing sensitive information. Majority preferred virtual visits over in person visits. Future research needs to include a more diverse geriatric patient population and also incorporate options for virtual (video and audio) telehealth visits.
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    Biomechanic Comparison of Reconstruction Techniques for AC joint Dislocation
    (2021) Tran, Apollo; Bibb, Patrick
    Background: Acromioclavicular (AC) joint disruption comprises 8% of all shoulder injuries. There is still broad debate on when treatment with surgery is indicated and what surgery technique will provide optimal results. Purpose: In this study, we propose a modified technique that we hypothesize will provide the most security to a Rockwood type III AC joint dislocation with the least amount of post-operative complications. Materials and Methods: A rig to mount the cadaver specimens was constructed using a steel rails, screws, and L-brackets and fastened securely to the MTS apparatus. A total of 20 cadaveric shoulders will be gathered and each randomly assigned to one of three groups: 1) reconstruction with graft loop with fibertape augmentation and 2) reconstruction loop using two fibertapes and 3) reconstruction with the Mazzocca technique. The AC and CC ligaments will be released to simulate a Rockwood type III injury and reconstructed using one of the techniques listed above. The reconstructed specimen will then undergo load to failure (120 mm/min) in the superior direction to evaluate maximal loading capacity of the repair construct. Discussion: Difference compared to native for vertical migration of the AC joint, load to failure and mode of failure of the technique will be analyzed for variance if statistical significance is found (P< 0.05) followed by a Bonferroni post hoc analysis. With trials still underway, we anticipate the AC joint repair with augmented graft loop will decrease vertical migration and increase strength compared to previously described techniques.
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    The Impact of Comorbidities on Chronic Low Back Pain
    (2021) Bibb, Patrick; Licciardone, John C.
    Background: With an estimated treatment cost of $635 billion, low back pain is one of the costliest national public health challenges. The NIH Pain Consortium defines chronic low back pain as pain lasting longer than 3 months, with pain symptoms in more than half of the days during the past 6 months. Since 2016, the PRECISION Pain Research Registry has been collecting data from patients with CLBP in Texas. Purpose: This purpose of this study is to determine the impact of multiple comorbidities on psychological and physical components of pain in patients with CLBP. Methods: There were 519 patients in the study, including 264 (50.9%) standard patients with < 2 comorbidities (CLBP-L) and 255 (49.1%) patients with >3 comorbidities (CLBP-H). The psychological characteristics of these two comorbidity groups were compared using the Pain Self-Efficacy Questionnaire (PSEQ) and the Pain Catastrophizing Scale (PCS). The physical characteristics of the groups were compared using a numerical rating scale for pain intensity (NRS) and the Roland-Morris Disability Questionnaire (RMDQ). Results: There was a statistically significant (p< 0.05) negative correlation between comorbidity scores and PSEQ scores, and there were significant positive correlations between comorbidity scores and PCS, NRS, and RMDQ scores. Conclusions: These results provide evidence that patients with CLBP and a greater number of comorbidities may experience more difficulty in psychologically coping with physical pain and disabilities than such patients with fewer comorbidities. These results suggest that psychological interventions, such as cognitive behavioral therapy, may benefit patients with CLBP and numerous comorbidities.
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    Surgical Treatment of Acromioclavicular Dislocations: A Scoping Review
    (2021) Tran, Apollo; Beal, Jennifer; Powell, Jake
    Background. While AC joint dislocation accounts for 3.2% of all shoulder injuries, there is still debate on the optimal surgical approach. Over 150 surgical variations have been proposed for AC joint reconstruction. The literature for reconstruction varies widely by technique and focus of analysis, focusing on either clinical or biomechanical studies. Objective. This study aims to clarify research on the most commonly conducted AC joint reconstruction procedures by combining clinical and biomechanical studies into an organized review. In addition, we will identify new procedure designs and evaluate them for possible application in future reconstructive surgeries. Methods.We will complete a literature review to identify biomechanical studies on AC joint fixation using Medline, Scopus, and Excerpta Medica Database (EMBASE) following the 2009 PRISMA statement. Articles will be independently reviewed by at minimum two investigators and any disagreements will be reconciled by consensus in consultation with a third investigator. Results. Analysis of the most commonly performed procedures combines the biomechanical and clinical research associated with each technique. Results are categorized into ligament reconstruction and fixation. Ligament reconstruction pertains to the techniques of Modified Weaver-Dunn, autograft, and allograft. Fixation techniques will include Hook plate, Coracoclavicular Screw Fixation (Bosworth), Cortical Flip Button (endobutton), and K wire fixation. Conclusion. Past reviews focused solely on clinical or biomechanical aspects of AC joint reconstruction, rarely combining the two fields of study. Our review aims to join the different modes of study to provide a clearer picture of technique outcomes.
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    Severe Salt Wasting in a 16-day-old Male
    (2021) Hamilton, Luke; Sun Bae, Mi; Cielonko, Luke A.; Hamby, Tyler; Wilson, Don
    Severe salt-wasting X-linked Adrenal Hypoplasia Congenita (X-AHC) is a rare cause of severe salt-wasting in affected males. We present a 16-day-old non-Hispanic male who experience marked hyponatremia and hyperkalemia, initially thought to have 11-hydroxylase congenital adrenal hyperplasia (CAH). A 16-day-old male was born at term following an uncomplicated pregnancy, labor and delivery. Because of poor feeding, electrolytes were ordered which revealed severe electrolyte imbalance. The child was assumed to have CAH due to elevation of cortisol precursors. He was treated with IV glucocorticoid and remained on IV fluids until his electrolyte balance and acidosis were corrected. These were replaced by oral glucocorticoid and mineralocorticoid, and salt supplementation was given orally. Once able to tolerate oral intake, IV fluids were tapered and discontinued. Based upon the family history, genetic testing was ordered, revealing a mutation in NROB1, consistent with a diagnosis of X-AHC. X-AHC may be misdiagnosed as CAH: a rare disorder caused by a genetic mutation on the NR0B1 gene, is estimated to occur in 1:140,000 to 1:1,200,000 live births. Initial treatment of CAH and X-AHC are similar. Both require mineralocorticoid and glucocorticoid replacement. However, misdiagnosis may lead to life threatening electrolyte abnormalities following withdrawal of mineralocorticoid therapy in infants thought to have 11-OH-lase deficiency. Although much less common than CAH, corrected identification of X-AHC allows proper management, appropriate genetic counseling, and anticipation of concomitant and future co-morbidities associated with X-AHC.
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    Tai Chi and Pulmonary Conditions
    (2021) Logsdon, Liana; Kolenovic, Mersida; Traina, Allison; Liu, Howe; Salem, Yasser
    Introduction: Tai Chi, a low-intensity exercise, has been found to have numerous health benefits throughout all systems of the body. Due to Tai Chi's focus on controlled breath and diaphragmatic breathing, Tai Chi has been shown to improve pulmonary functions in chronic and acute pulmonary disease such as chronic obstructive pulmonary disease (COPD), asthma, lung cancer, and cystic fibrosis. The purpose of this systematic review is to analyze studies related to Tai Chi intervention for subjects with pulmonary disease in order to compare Tai Chi program parameters. Methods: This systematic review examines how a Tai Chi program can improve lung function, forced expiratory volume of 1 second (FEV1), 6 minute walk distance (6MWD) test results, dyspnea scale measures, and overall sense of well-being. This review utilized random control trials from PubMed database within the past 15 years. Key words used were "Tai Chi," "intervention," "cystic fibrosis," "asthma," "COPD," "lung cancer". Results: Individuals with COPD benefitted most from a Tai Chi program with sessions twice per week for 12 weeks. Two studies showed sustained physiological and subject perceived improvements 12 weeks after completion of Tai Chi program for individuals with COPD. Conclusion: Tai Chi is a beneficial intervention for individuals with pulmonary disease in improving lung function, endurance, and overall sense of well-being. This systematic review revealed that further studies are needed to uncover sustained effects of Tai Chi programs and regarding pulmonary conditions such as adult and pediatric asthma, lung cancer, and cystic fibrosis.
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    Phyllodes Tumor in Adolescent Female
    (2021) Jacob, Sera
    Introduction: Phyllodes tumors are rare occurrences in the general population, accounting for only 0.3-1% of all breast tumors. It is even more uncommon to see it in a pediatric patient. Phyllodes tumors are commonly seen in middle aged women between the ages of 40 to 55. Case Presentation: A 17-year-old Asian American female presented with an incidental finding of a mass on her left breast that she found during a self-breast exam. She has no personal and family history of breast tumors or cancer. She began menarche at the age of 9. An ultrasound was ordered, and the patient was started on antibiotics. Ultrasound findings showed a mass measured to be 4.4 cm x 2.4 cm x 4 cm and a guided core fine needle biopsy was arranged. Biopsy results showed a benign fibroepithelial mass. Patient had the mass excised and the measurements were reported to be 5.2 cm x 4.5 cm x 3 cm. Pathology from the excision showed with that the mass had appearance consistent with benign phyllodes tumor. Patient will follow up every 6 months for the next 3 years to monitor recurrence. Conclusion: This case exhibits a unique presentation of phyllodes tumor in an extremely uncommon age group.
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    Evaluation of effect of below-limit of quantitation (BLQ) data due to nonadherence in population pharmacokinetic (POPPK) modeling
    (2021) Tanaudommongkon, Asama; Chaturvedula, Ayyappa
    Purpose: Data below lower limit of quantitation of analysis method is generally handled using likelihood-based approaches (M3 method) in POPPK. Medication nonadherence can cause BLQ data. Objective of current work is to evaluate the efficiency of M3 method on handling BLQ data generated through non-adherence. Methods: Stochastic simulation and estimation method was used. A two-compartment model with first order absorption was used to simulate a clinical trial with plasma samples collected at steady-state. Non-adherence was simulated with a priori fixed probability in dose omissions resulting in 100%, 70% and 50% of doses taken before plasma sample collection. The simulated dataset was used for estimating parameters with full adherence assumption and M3 method using NONMEM (version 7.4). Process was repeated 200 times for each non-adherence scenario. Parameter bias and precision were calculated for both fixed and random effects parameters using mean estimation error and root mean square error, respectively. Results: The %BLQ data in 100%, 70% and 50% nonadherence scenarios were 10%, 22% and 34%, respectively. The mean estimation error for fixed effect parameters were within the acceptable limits of bias in 100% adherence scenario except Vp showed mild bias (6%). The bias was >5% in fixed effect parameters with 70% and 50% adherence scenarios and increased with level of nonadherence. Between subject variability parameters showed bias >10% in all scenarios. Conclusion: Non-adherence induced BLQ data caused parameter bias although M3 method was used. Further research is warranted to find solutions to this problem.
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    Delayed Recovery of a Prolonged Total IntraVenous Anesthesia Procedure with Risks of Malignant Hyperthermia
    (2021) Aggarwal, Amit; Faisal, Annum; Hussain, Mahammad
    Background: Spinal Cord Ependymoma (SCE) is an intramedullary tumor that requires surgical intervention. Total Intravenous Anesthesia (TIVA) is indicated for such neurosurgery cases. The pharmacodynamics and pharmacokinetics of each drug used must be factored to safely extubate and maintain the airway postoperatively. Case: A 57-year-old male with a history of pulmonary hypertension presented to the hospital with complaints of gait difficulty and sensory deficits secondary to SCE. The patient was scheduled for surgery, and the decision was made to do TIVA due to a family history of Malignant Hyperthermia. Three continuous IV drips were placed: propofol, titrated between 125-300 mcg/kg/min, ketamine at 5 mcg/kg/min, and sufentanil at 0.3 mcg/kg/hr. The patient required a phenylephrine infusion at 35 mcg/min to maintain hemodynamics, which had to be titrated up to 75mcg near the 11-hour point due to severe hypotension. Following extubation, the patient was placed on an oral airway with a simple O2 mask in place. He was noted to have snoring respirations with oxygen desaturating to the low 80's. A jaw thrust was done, and he was placed on a non-rebreather mask. Due to a fixed obtunded state, a hasty decision to re-intubate was made without proper revaluation and communication between providers. The patient was then re-extubated 1.5 hours later with minimal post-op complications. Conclusions: This case illustrates the challenges of prolonged TIVA in the assessment of safely extubating patients while maintaining the airway in the postoperative period.
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    Role of Screening Questionnaires in Reducing the Risk of Opioid Abuse
    (2021) Jacob, Sera; Hill, David; Gibson, John; Hadley, Lesca
    Purpose An epidemic that is a growing concern, especially to health care providers, is the opioid epidemic in America. Opioid abuse is an issue that is affecting medical care all over the country, in urban and rural areas. It has been starting right in family medicine clinics, where it is daily goes by uncaught. Will the increased use of screening questionnaires reduce the risk of opioid misuse in adults ages 18 and older? Methods Patients were asked to anonymously complete an Opioid Assessment for Patients with Pain-Revised (SOAPP-R) worksheet. Patients were first asked permission and then they were free to complete the worksheet anonymously. A data table was kept updated with the amount of responses received. Results The results showed that after four weeks of data collection, 11 patients were screened out of 40 patients who were seen for opioid medication refills. Enhancement results were calculated to be 27.5% people screened for opioid abuse compared to prior to enhancement results which was 0% of people screened. Out of the 11 screening questionnaires, 2 people showed an increased risk of opioid misuse. Conclusions This project showed how many patients could be adequately screened for opioid misuse in a family medicine clinic in a rural town. I learned the benefits of how to conduct a quality improvement project. Next steps for the project would be that the clinic would conduct screenings periodically for patients to minizine opioid risk.
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    Effects of Urinary Tract Infection on Hip and Knee Arthroplasty Outcomes
    (2021) Garcia, Laura; Barnes, Kalan; Dalton, Stewart; Teigen, Kari; Wagner, Russell
    Introduction: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures performed in the United States. However, the effects of periprosthetic joint infections (PJI) can be devastating leading to invasive interventions and potentially impaired functionality, decreased patient satisfaction, and increased mortality. Risk factors for the development of PJIs have been well-documented, however, the association between urinary tract infections (UTIs) and PJIs remains controversial. Our aim was to establish the risk of developing a PJI in patients with an identified UTI in the preoperative, perioperative, and postoperative periods. Methods: Through retrospective chart review, data was abstracted from electronic medical records from JPS Health Network of all patients with a scheduled THA and TKA since 2014. We identified patients with UTIs 15 days prior to surgery and followed up with 12 months post-surgery for subsequent development of PJI. Results: A total of 2,220 surgeries were scheduled, and 1,697 surgeries were completed. Forty-six patients with a UTI completed surgery within 15 days of the UTI diagnosis, and 2 patients developed a PJI (4.3%, 95% Confidence limits: 0.5%, 14.8%) within 12 months post-surgery. Out of 1,274 patients with a surgery without UTI, 47 (3.7%, 95% confidence limit: 2.7%, 4.9%) developed a PJI. Conclusions: Our data does not suggest UTI in the preoperative period increases the risk of PJIs after THA and TKA. However, the study needs more power to establish significant results. Future analysis will look at the association between UTIs in the postoperative setting and PJI development.
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    Extensor Tendon Repair Outcomes Based on Timing of Repair
    (2021) Garcia, Laura; Yousuf, Hayyan; Pientka II, William; Dalton, Stewart
    Purpose:Extensor tendons lie superficially on the dorsum of the hand, and are covered by relatively thin soft tissue. As such, they are prone to injury and are associated with morbidity. Mechanism of injury can vary from simple lacerations to more complex injuries with severe tissue damage. Appropriate acute management of flexor tendon injuries has been shown to be associated with more favorable outcomes; however, the extensor tendon has only recently begun to receive the same attention. There is a known correlation between surgical outcomes of flexor tendon lacerations and time from injury to repair, but the same data does not exist for extensor tendon injuries. In the present study, we aim to determine if a correlation exists between the time from injury to tendon repair, and post-surgical joint stiffness as a predictor of surgical outcomes. Methods: We have conducted a retrospective chart review of patients who have undergone extensor tendon repair surgery at JPS Health Network since 2012. Results: Our preliminary data analysis reveals that among patients that experienced surgical stiffness, there was a statistically significant relationship between increased time to surgery and increased occurence of post surgical stiffness. Conclusion: Our preliminary data indicates that early repair of extensor tendon repair should be considered in order to avoid post operative joint stiffness.