ABOUT THE COLLECTION

The Scholarly Project (SP) Course represents a four-year mentored research project for each student. The SP prepares students for lifelong learning and critical thinking. Through the SP, students develop advanced inquiry and problem-solving skills to support clinical practice and future research endeavors throughout their careers. The formal curriculum is embedded in this course, is referred to as the SP Learning Community (SPLC) in which all students participate. The SPLC curriculum is most intense in the first-year during which the students are exposed to issues that relate to information literacy, research methodology, ethical behavior in research, statistics and research proposal and grant writing. In addition, the students receive assistance in how to choose areas they wish to investigate, design a research hypothesis and find a mentor. By the end of the second semester of the first year each student is expected to have his/her project designed and approved and to have selected a mentor who will guide and oversee the progress of the project. Both the SPLC and the independent scholarly activity are monitored by a variety of periodic assessments to assure appropriate guidance and advancement.


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More information is found here: http://medicine.arizona.edu/education/phoenix-track/scholarly-project

Recent Submissions

  • Improving Endoscopic Retrograde Cholangiopancreatography (ERCP) Performance and Complication Rates: A Single Operator Retrospective Review from 2004‐2011

    Choi, Joshua; The University of Arizona College of Medicine - Phoenix; Nadir, Abdul MD (The University of Arizona., 2014-04)
    Endoscopic retrograde cholangiopancreatography (ERCP) is a technically difficult procedure that requires extensive training to achieve competency. The study was undertaken to assess retrospectively whether advanced ERCP training made a difference in the competency of a physician who was performing ERCPs for eleven years before taking an extra year of advanced training in ERCP. The physician did not get any ERCP experience during the two-year formal fellowship between 1995-97, and learned ERCPs from colleagues post formal GIfellowship for four years after which he was given privileges to independently perform ERCPs. Data were collected on 172 and 213 patients who underwent ERCP before and after the training year respectively. Chi-square test was utilized to analyze the data. Baseline characteristics including height, weight, race and indications for ERCP were similar in the two groups. The results of the study showed that rates of biliary cannulation increased from the Pre-ERCP fellowship rate of 83% to 93% (Chi- Square = 9.06, p = 0.0026) and a reduction in postprocedure pancreatitis from 8.1% to 2.7% (Chi- Square = 4.56, p = 0.0327). Data in this study indicate that extra training in ERCP improves outcomes of ERCP in a single operator’s experience.
  • Does more “normal” shoulder motion after arthroplasty improve patient satisfaction?: Correlation of range of motion, patient-reported function,and patient satisfaction following shoulder arthroplasty.

    Winsor, Kimberly; The University of Arizona College of Medicine - Phoenix; Tibor, Lisa MD (The University of Arizona., 2014-04)
    Objective and Hypothesis The goals of this study are to address the following questions regarding shoulder arthroplasty (TSA): (a) Does restoring range of motion (ROM) lead to increased patient satisfaction? (b) How is ability to carry out activities of daily living (ADLs) influenced by ROM? (c) How does ADL performance correlate with patient satisfaction? We hypothesize that more “normal” ROM following TSA leads to increased patient satisfaction and better performance of ADLs. Methods Patients who underwent TSA, reverse TSA, hemiarthroplasty, or humeral head resurfacing were prospectively enrolled in a shoulder arthroplasty registry. 155 patients who had preoperative and 6 month postoperative data for ROM, patient satisfaction, and performance of ADLs were included in the study. Results Of these 155 shoulders, the response rate for patient satisfaction was only 82 (52.9%), with 96.8% reporting they were “satisfied or “very satisfied”. Postoperative ROM was associated with patient satisfaction for forward flexion, adduction, and external rotation. This association demonstrated a “dose;response” relationship, as higher percentage of normal ROM correlated with higher satisfaction. Mean ADL scores were higher for patients who achieved normal ROM in each plane of motion. The greatest improvement in mean ADL score occurred when a patient achieved normal ROM for at least 3 of 5 measurements. There was also a significant association between improved ADL and higher patient satisfaction. Significance Glenohumeral arthrosis causes considerable morbidity, and rates of shoulder arthroplasty are increasing. As the predominant goals of TSA are pain relief and restoration of ROM, it is important to assess postoperative patient satisfaction. While most historic studies have focused on measures of implant performance, interest is increasing in patient-centered outcomes. Both objective and subjective outcomes should be included in future large multicenter registries. Data collected from these registries has the potential to substantially improve success rates and longevity of shoulder arthroplasty.
  • Comparison of recovery time from uncomplicated sports-related mild traumatic brain injury (mTBI) in intercollegiate athletes: A baseline study

    Wong, Andrew; The University of Arizona College of Medicine - Phoenix; Overlin, Amy, MD (The University of Arizona., 2013-03)
    Sports-related mild traumatic brain injuries (mTBIs) have become an increasingly popular topic. Cognitive and physical rest are the mainstays of management, but effective evidence-based therapies do not exist. Very few studies report mean recovery times from mTBI and even less for intercollegiate athletes. The primary aim is to retrospectively compare the recovery time in athletes from a large Division I University that suffered a sports-related mTBI during 2010 - 2012 to published data for quality assessment and improvement. Since the institution's concussion management follows current guidelines, no significant difference was expected. Secondary aims included comparing recovery times between gender, sport, and league. As reported in current literature, no significant gender differences were expected. 53 athletes with sports-related mTBI (27 male and 26 female) showed a mean recovery time of 10.11 days (95 % confidence interval [CI] = 8.58 - 11.65 days), statistically different than the time reported in 1 study of 7 days, but not in another of 7 - 10 days. Mean recovery time in males and females was 9.74 days (95 % CI = 7.38 - 12.1 days) and 10.5 days (95 % CI = 8.4 - 12.6 days), respectively. Mean recovery time in National Collegiate Athletic Association (NCAA) and non-NCAA (club) athletes was 9.91 days (95 % CI = 8.27 - 11.55) and 11.25 days (95 % CI = 5.87 - 16.63), respectively. A nonparametric Wilcoxon rank-sum test showed no significant variation between genders and between NCAA and non-NCAA athletes. Subgroup statistics of 13 sports were inconclusive due to inadequate power. However, the subgroup of male football athletes showed a mean recovery time of 6.5 days (95 % CI = 4.86 - 8.14 days), which was not significantly different than published rates. Multiple confounding variables were not well controlled for including: sport, gender, concussion severity, multiple concussions, etc. However, this study did highlight areas for quality improvement in the institution's concussion management plan. Further investigation with increased power and confounding variable control is indicated for a more definitive mean time to recovery. This study is the first to detail the mean time to recovery from sports-related mTBI in an intercollegiate athletic program. Similar studies should be done at other institutions for quality assessment and improvement of 4 concussion management. Such data will be useful in establishing a baseline for measure of efficacy in future investigations of therapeutic interventions.
  • Elucidation of the Molecular Actions of 1,25 Dihydroxyvitamin D3 and Docosahexaenoic Acid that may Mediate Cardiovascular Health

    Widener, Tim; The University of Arizona College of Medicine - Phoenix; Jurutka, Peter, PhD; Haussler, Mark, PhD (The University of Arizona., 2013-03)
    Omega 3 polyunsaturated fatty acids (PUFAs), composed of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been demonstrated to be beneficial in primary and secondary cardiovascular disease (CVD) prevention. The mechanism of action of PUFAs is not yet fully understood. Vitamin D, via its active form, 1,25-dihydroxyvitamin D3 (1,25 D3), functions through the vitamin D receptor (VDR), regulating serum calcium and phosphorus, and ultimately bone health. There is now evidence that 1,25 D3 may be cardioprotective as well, but the mechanism is also not fully understood. Evidence supports DHA as a weak VDR agonist, therefore there may be crosstalk between the two ligands and their known and yet to be discovered receptors. In the present research, we probed six genes as potential VDR targets, identified both through literature searches as well as their logical association with proposed 1,25 D3 and DHA cardioprotective mechanisms. Treating human embryonic kidney cells (HEK293) with 1,25 D3 and DHA independently, and in combination, we demonstrate changes of expression of three genes through quantitative real time polymerase chain reaction analysis (qRT-PCR). Nitric oxide synthase (NOS2), involved in the immune system nitric oxide burst, was significantly repressed by 1,25 D3 (fold effect 0.84, p value 0.04), DHA (fold effect 0.85, p value <0.01), with the greatest repression in the 1,25 D3 and DHA combination (fold effect 0.74, p value 0.01). Serpin peptidase inhibitor (SERPINE1), for which expression results in increased thrombus formation through tissue plasminogen activator inhibition, was repressed in the 1,25 D3 treatment group (fold effect 0.78, p value <0.01). Thrombomodulin (THBD), which indirectly activates protein C and increases thrombolysis, was repressed in the DHA (fold effect 0.69, p value <0.01) and combination 1,25 D3 and DHA groups (fold effect 0.75, p value 0.04). SERPINE1 and NOS2 repression is consistent with cardioprotective decreases in thrombus formation and immunomodulation, but THBD repression is not consistent with this hypothesis.
  • Monoacylglycerol lipase exerts dual control over endocannabinoid and fatty acid pathways to support prostate cancer

    Ward, Anna; The University of Arizona College of Medicine - Phoenix; Nomura, Daniel, PhD (The University of Arizona., 2013-03)
    Cancer cells couple heightened lipogenesis with lipolysis to produce fatty acid networks that support malignancy. Monoacylglycerol lipase (MAGL) plays a principal role in this process by converting monoglycerides, including the endocannabinoid 2-arachidonoylglycerol (2-AG), to free fatty acids. Here, we show that MAGL is elevated in androgen-independent versus androgen-dependent human prostate cancer cell lines, and that pharmacological or RNA-interference disruption of this enzyme impairs prostate cancer aggressiveness. These effects were partially reversed by treatment with fatty acids or a cannabinoid receptor-1 (CB1) antagonist, and fully reversed by co-treatment with both agents. We further show that MAGL is part of a gene signature correlated with epithelial-to-mesenchymal transition and the stem-like properties of cancer cells, supporting a role for this enzyme in pro-tumorigenic metabolism that, for prostate cancer, involves the dual control of endocannabinoid and fatty acid pathways.
  • Cognitive Effects of Music: Working Memory Is Enhanced in Healthy Older Adults After Listening to Music

    Wang, Alan; The University of Arizona College of Medicine - Phoenix; Denburg, Natalie PhD (The University of Arizona., 2013-03)
    Music is ubiquitous in all media, and, in the last decade, has become a potential tool for enhancing cognition. This study aimed to investigate the facilitating effect of music on working memory performance in a healthy older adult cohort. Sixty-three healthy, community-dwelling older adults who had previously undergone comprehensive neuropsychological testing were enrolled in the study. Participants were randomized into one of two groups, and were presented with a series of positive and negative musical clips. Following listening, working memory performance was tested using Wechsler Digit Span and a computerized Spatial Span task. For each task, a total score consisting of number of correct forward and backward sequences was calculated. A significant improvement in Digit Span scores was found after listening to music as compared to Digit Span scores collected ~5 years ago. Contrary to our hypothesis, this facilitative effect of music on working memory held for both positive and negative musical stimuli. It has been shown that negative music can illicit the same pleasurable feelings as positive music, and, given West’s frontal lobe hypothesis, can therefore produce the same effects on working memory as positive music.
  • Informational Book for Patients Newly Diagnosed With Systemic Lupus Erythematosus

    Tahan, Yarden; The University of Arizona College of Medicine - Phoenix; Finch, William R, MD; Feuerstein, Burt G., MD, PhD (The University of Arizona., 2013-03)
    Objectives/Hypothesis To provide a useful resource for patients newly diagnosed with SLE (Sys-temic Lupus Erythematosus). Methods Surveys were distributed to patients currently living with SLE via three rheumatology offices. All surveys were completed anonymously. Survey responses were combined with per-sonal patient anecdotes as well as medically focused questions and answers to create a com-plete educational piece under the genre of narrative medicine. Results Patient survey responses provide a variety of information for patients and clinicians. Low response rate encouraged the addition of supplemental sections in the final product in or-der to create a piece with a significant amount of patient-centered information. The format therefore changed with the addition of Doctor in Training sections, highlighting answers to commonly asked patient-centered questions on SLE as well as personal anecdotes building on the narrative medicine format. Significance The combination of patient survey responses, personal anecdotes, and ques-tion/answer sections unite to provide valuable information in a unique format to patients newly diagnosed with SLE. Specifically, the survey responses give future patients a variety of view-points and tips on how to handle living with lupus while the narrative
  • Naloxone Utilization in a Tertiary Care Medical Center

    Shah, Ruby; The University of Arizona College of Medicine - Phoenix; Rosenfeld, David, MD (The University of Arizona., 2013-03)
    The purpose of this research project was to review the use of naloxone for oversedation events from 2008-2011 at the Mayo Clinic Hospital in Phoenix, Arizona. Opiates are generally an accepted form of acute and chronic pain management. Opiate analgesic use has increased in past decades due to several factors including cultural and healthcare ideas on the importance of pain management, as well as the availability, cost, and marketing of the drugs. Concomitant with the increased use of opiates has been a rise in addiction, diversion, and abuse. In addition, opiate overdose is a potentially lethal consequence. Balancing the use of opiates for effective pain control and the possible risks of opiates is a constant effort for healthcare professionals. Monitoring the use of naloxone has arisen as an effective metric to examine the safety and outcomes of opiate utilization in a hospital setting. Reviewing every dose of naloxone delivered over the years 2008-2011 has allowed us to recognize trends that have led to improvements in patient safety. 154 cases of naloxone use for sedation events were reviewed in a retrospective case controlled unmatched chart review. We were able to determine that patient risk for oversedation is greatest within our surgical practices, especially general and orthopedic, and that the overall risk is greatest within the first 24 hours in all surgical patients. In addition, we were able to determine statistically significant increase in risk with elevated creatinine level, American Society of Anesthesiology (ASA) Class, and patient controlled analgesia (PCA) use compared to our unmatched control group. The significance of these findings is that it identifies certain risk groups and factors that carry increased risk for sedation events, and therefore can lead to improvements in quality and education across the institution.
  • Effect of Carpal Tunnel Syndrome on Trial-to-Trial Adaptation to Object Mass-Sensorimotor Integration for Multi-Digit Grasping

    Sanniec, Kyle; The University of Arizona College of Medicine - Phoenix; Smith, Anthony, MD (The University of Arizona., 2013-01)
    Introduction/Objective: Somatosensory feedback from the fingertips is integrated with voluntary control of hand muscles in order to successfully grip objects. This integration can be disrupted in Carpal Tunnel Syndrome (CTS) and lead to dropping objects. This raises the question of how the central nervous system (CNS) integrates sensory information from CTS-affected and non-affected digits. The primary objective was to use CTS as a model to understand mechanisms underlying sensorimotor integration responsible for whole-hand griping of objects with a changing mass. CTS patients should be able to modulate digit forces to object weight, however, as different grip types involve the exclusive use of CTS-affected digits or a combination of CTS-affected and non-affected digits, we hypothesize sensorimotor deficits to be larger for grips involving the coordination of CTS-affected and non-affected digits. Methods: Sixteen CTS patients (3 males, 13 females) and age- and gender-matched controls participated in the study. Subjects were instructed to use one of four grip types: two digits, three digits, four digits, or all five digits to grasp, lift, hold level and release a grip device for 7 consecutive lifts. Object mass was changed across blocks of trials by inserting either a “light mass” (445g) or a “heavy mass” (745g) underneath the grip device. Force and torque exerted by each digit were measured. Results: CTS patients learned multi-digit force modulation to object weight regardless of grip type. Although controls exerted the same total grip force across all grip types, patients exerted significantly larger grip force than controls but only for manipulations with four and five digits. Importantly, this effect was due to CTS patients’ inability to change the finger force distribution when adding the ring and little fingers. Significance: These findings indicate CTS primarily challenges sensorimotor integration processes underlying the coordination of CTS-affected and non-affected digits.
  • Determining variable contagiousness of MRSA by setting

    Routh, Joshua; The University of Arizona College of Medicine - Phoenix; Panchanathan, Sarada, MD, MS (The University of Arizona., 2013-03)
    Objective and Hypothesis Methicillin resistant Staphylococcus aureus (MRSA) is currently a major cause of skin and soft tissue infections (SSTI) in the United States. In order to characterize the spread of MRSA in the pediatric population we built a probabilistic, discrete-event, individual-based simulation. Specifically, our model looked at the spread of MRSA in households and at schools to determine if there was a difference in communicability between the two settings. Methods We developed a probabilistic, discrete-event, individual-based model. This model was validated using insurance billing data for skin and soft tissue infections. The first validation trained the model for two years of data, and validated it with the next two years of data. The second method trained the model in one region and validated it in another. Following the validation, the Poisson-bootstrap resampling method was used to find specific values for a contagiousness factor(CF) in households and schools. Results Both methods of validation supported the model with no statistically significant difference. The bootstrap resulted in a CFhousehold of 30.69 (95% CI [29.09, 32.29]) and a CFschool of 0.55 (95% CI [0.46 to 0.64]). Effective reproduction number for the school setting was found to be 0.0015 and 0.06 to 3.04 for households of different size. Conclusion In this study we characterize a marked difference in communicability in the household and at school, which has not previously been shown. The identification of colonization clusters in households can be used to design strategies reduce the disease burden. The model can be used to simulate and predict responses to different interventions.
  • Prevalence of Imploding, Exploding and Ocular Headache Types in a Women’s Health Outpatient Practice

    Patel, Salma; The University of Arizona College of Medicine - Phoenix; Files, Julia, MD (The University of Arizona., 2013-03)
    Objectives: (i) Determine the prevalence of imploding, exploding and/or ocular headaches in women with migraine in a primary care practice of women (ii) Investigate the concordance of physician diagnosis with patient self-diagnosis of pain directionality (iii) Assess correlation between the type of headache and severity of migraines, reproductive stage, and response to acute and prophylactic treatments Background: botulinum toxin A is a drug made from the toxin produced by Clostridium botulinum that works by weakening or paralyzing certain muscles or by blocking certain nerves.17 Recent migraine trials evaluating the efficacy of botulinum toxin A therapy noted differences in the efficacy of botulinum toxin A therapy based on directionality of pain ((imploding exploding and ocular). 5,6,7 However, the prevalence of these migraine types and their responses to conventional migraine prevention therapies has not yet been assessed. Methods: 201 patients participated in structured clinician-administered interviews and completed written questionnaires. Directionality of migraines were determined by both patients and physicians. Descriptive statistics, kappa coefficients and Kruskal-Wallis tests were used to assess migraine prevalence, physician-patient diagnosis concordance and association of migraine to severity, treatment and reproductive stage respectively. Results: 201 patients were enrolled with average age of 46. All patients reported directionality of their migraine and prevalence varied depending upon the method used to assign directionality and were: 33%-42% imploding headaches with or without ocular pain, 18%-44% exploding headaches with or without ocular pain, 7%-39% had ocular pain only, and 8%-13% had imploding and exploding headaches with or without ocular pain. The concordance between physician diagnosis of headache directionality with patient written response, between physician diagnosis and patient diagnosis via selection of representative picture, and between patient diagnosis via written question and via selection of representative pictures were week to moderate using Kappa coefficient. No correlation between the type of headache and severity of migraines, reproductive stage, and response to acute and prophylactic treatments was found (p>0.05). Conclusion: Improved methods of determining pain directionality and target therapy are needed.
  • Death Certification of ‘‘Suicide by Cop’’

    Neitzel, Amber Rae; The University of Arizona College of Medicine - Phoenix; Gill, James R., M.D. (The University of Arizona., 2013-03)
    Death certification of ‘‘suicide by cop’’ is controversial among some medical examiners and coroners. We present five such deaths that were certified as suicides and discuss the medico-legal issues involved with these certifications. To certify such a death as a suicide, certain criteria should be met. Suicide by cop is a circumstance that involves competing intentional acts that may result in dichotomous determinations of the manner of death. Despite the absence of direct self-infliction, there is overwhelming evidence that these five individuals intended to end their own lives. Their use of an unusual method to accomplish this goal may inappropriately result in a reflexive certification of homicide. All of the decedents possessed weapons or a facsimile of a weapon. We present five instances of suicide by cop and contend that these types of deaths are best certified as suicides. KEYWORDS: forensic science, forensic pathology, suicide, police, gunshot wounds, manner of death
  • Modern Techniques of Adjunctive Pain Control Lower Opioid Use, Pain Scores, and Length-of-Stay in Patients Undergoing Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

    Nabar, Sean J.; The University of Arizona College of Medicine - Phoenix; Shrader, M. Wade, MD (The University of Arizona., 2013-04-17)
    Study Design. Retrospective analysis. Objective. To determine if the use of adjunctive pain medications (subcutaneous bupivacaine, dexmedetomidine infusion, and intravenous ketorolac) will reduce the need for opioids, reduce postoperative pain, and shorten length of hospital stay in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. Methods. Retrospective review of children 10 to 18 years with adolescent idiopathic scoliosis receiving posterior spinal fusion surgery over the past 10 years at Phoenix Children’s Hospital. Physicians managed the patients’ pain postoperatively with adjunctive medications in addition to intravenous and oral opioids. Variables of interest were local anesthetic bupivacaine delivered subcutaneously via elastomeric pain pump, sedative/analgesic dexmedetomidine infused for up to 24 hours postoperatively, and the NSAID ketorolac delivered intravenously. These three medications were used either alone or in some combination determined by the physician’s clinical judgment. Primary outcomes analyzed were normalized opioid requirement after surgery, VAS pain scores, and length of stay in the hospital. Results. One hundred and ninety-six children were analyzed with no significant differences in demographics. Univariate analysis showed that all three adjunct medications improved outcomes. A multivariate regression model of the outcomes with respect to the three medication variables of interest was developed to analyze the effects of the three medications simultaneously. The regression analysis showed that subcutaneous bupivacaine significantly reduced normalized opioid requirement by 0.98 mg/kg (P = 0.001) and reduced VAS pain scores by 0.67 points (P = 0.004). Dexmedetomidine significantly reduced the average VAS pain scores in the first 24 hours by 0.62 points (P = 0.005). Ketorolac had no effect in the multiple regression analysis. Conclusion. The use of subcutaneous bupivacaine provides good analgesia with low pain scores. A reduction in opioid requirement is beneficial and may be directly related to presence of the bupivacaine pump, although this may be limited by potential treatment bias. The three adjunct medications improve our outcomes favorably and should be studied prospectively.
  • Safety and efficacy of lung recruitment maneuvers in post-­‐operative pediatric cardiac surgical patients

    Morandi, Tiffany; The University of Arizona College of Medicine - Phoenix; Willis, Brigham C., MD (The University of Arizona., 2013-03)
    OBJECTIVE: To demonstrate the safety of lung recruitment maneuvers in post-operative pediatric cardiac surgical patients. To assess the ability of lung recruitment maneuvers to improve lung function. HYPOTHESIS: We hypothesize that ventilator recruitment strategies be well-­tolerated in cardiac patients, and that they may benefit such patients by improving physiologic variables such as lung function and oxygenation. METHODS: Sixty‐two pediatric post-operative cardiac surgical patients were randomly selected to include in this retrospective chart review. Study subjects were selected from all patients who met inclusion criteria in the year immediately following implementation of a lung recruitment protocol in a local free‐standing pediatric hospital. Physiologic variables before, during, and after lung recruitment were recorded as well as patient demographics, diagnoses, morbidities and mortality. RESULTS: A statistically significant increase in dynamic compliance of the lungs and renal non-invasive regional oximetry was noted immediately after each recruitment maneuver. There was no statistically significant change in blood pressure, heart rate or oxygen saturation during the maneuvers. There was a transient increase in central venous pressure during the maneuvers (average increase < 1 mmHg). Of the 62 patients, there were 7 cases of pneumonia and 5 cases of small pneumothorax, often resolving without intervention. Significance: Demonstrating recruitment maneuvers are safe in pediatric patients with cardiac disease will allow practitioners to confidently utilize them when caring for ventilated patients. Such patients may benefit from potential improvements in lung function and decreased ventilator-associated morbidities.
  • First-Word Characteristics of Individuals with Autism Disorder Based On Onset of Language

    McBride, Andrew; The University of Arizona College of Medicine - Phoenix; Panchanathan, Sarada S., MD, MS (The University of Arizona., 2013-03)
  • Assessing the University of Arizona Medical School Admission Committee Members’ Knowledge of Predictors of Rural Practice for Medical School Applicants

    LeSueur, Philip; The University of Arizona College of Medicine - Phoenix; Galper, Carol, PhD (The University of Arizona., 2013-03)
    Objective: There is a disparity in physician to population ratios between rural and urban Arizona. The University of Arizona Medical School has a unique opportunity to increase the supply of physicians serving in rural Arizona through its admissions process. This study is a quality improvement project which examined whether or not the admission committee members at both the Tucson and Phoenix campuses are considering probability of future rural practice when making admission decisions and if they know the evidence based predictors for rural practice. Methods: The admission committee members from the University of Arizona Medical School were asked to fill out a questionnaire regarding their preferences for future rural practitioners and if they knew the two most accurate predictors for rural practice. Results: There were 22 respondents to the survey- 12 out of 13 from Phoenix and 10 out of 14 from Tucson. Fifty-nine percent (n=13) of the total respondents listed likelihood to practice in a rural community as positively affecting their admission decision, 27 percent (n=6) said it does not affect their decision at all, and 13 percent (n=3) said it affects their decision very positively. All 22 respondents correctly identified rural background as one of the two strongest predictors of rural practice while 11 correctly identified stated interest in family practice as the other. Conclusion: The University of Arizona Medical School admissions committees are well positioned to increase the supply of rural physicians in Arizona. Even still, some of the members of the committee could benefit from education regarding accurate predictors of rural practice.
  • Success Rates for Reduction of Pediatric Distal Radius and Ulna Fractures by ED Physicians

    Kaye, Bryan; The University of Arizona College of Medicine - Phoenix; Bulloch, Blake, MD (The University of Arizona., 2013-03)
    Objective: To determine the success rates for reduction of pediatric distal radius and/or ulna fractures by emergency department (ED) physicians. Methods: We conducted a retrospective study of children <18 years of age who presented to a large, urban free standing children’s hospital between January 1, 2009 and December 31, 2010 with a fracture of the radius and/or ulna. Patients were excluded if they had an open fracture, were taken directly to the operating room without attempted ED manipulation, or had additional fractures besides isolated radius/ulna fractures. The primary endpoint was the proportion of successful reductions of closed forearm fractures in the ED, as defined by first orthopedic follow up visit. Results: All reductions were performed by Board certified/eligible Pediatric Emergency Medicine (PEM) physician or PEM fellow. There were a total of 15 different PEM faculty and 10 PEM fellows that were involved in the fracture reductions during the study period. There were 295 forearm fractures reduced in the ED during the study period. The mean age was 8.27 years (median 8 years; range 1 to 16) and males comprised 69.2% (n=204) of the study group. A total of 225 (76.3%) fractures were of the distal forearm and 70 involved the midshaft (23.7%). All but 67 (22.7%) patients returned for their orthopedic follow up exam. A total of 33 (14.5%) of all patients required re-manipulation at follow up; 24 in the distal forearm fracture group (22 were closed reductions and 2 open reduction with internal fixation [ORIF]), versus 9 in the midshaft group (7 closed reductions and 2 ORIF). Conclusion: The literature reveals that between 7% and 39% of children who have fracture reductions in the ED by orthopedics will require re-manipulation. Our rate of 14.5% is consistent within that range. With training, pediatric ED physicians have similar success rates as orthopedists in the reduction of forearm fractures.
  • Assessing Chlamydia Rates and Screening in a Community Health Care Setting

    Keller, Rachel; The University of Arizona College of Medicine - Phoenix; Brite, Kathleen, MD (The University of Arizona., 2013-03)
    Introduction: Chlamydia trachomatis is the most prevalent treatable sexually transmitted disease, with peak prevalence in young women, resulting in a CDC recommendation for annual screening. A community health center in Phoenix Arizona implemented this recommendation in 2010. Objective: Determine the prevalence of Chlamydia and assess changes in screening based on a protocol for screening at a community health center. Hypothesis: The prevalence of Chlamydia in the center’s population is greater than the national average of 6.8%, and the rate of screening will have increased with a protocol in place. Methods: Data from 2011 were collected by review of 1,074 charts, noting type of visit, if symptomatic for Chlamydia, if Chlamydia screening performed and results. Data from 2008, prior to screening protocol, were obtained via review of 313 charts, recording if the women were screened and result obtained. Results: The 2011 review revealed a Chlamydia rate in the women who were screened of 8.7%: when broken down by age the prevalence ranged up to 12.5% in 16 year olds. The study also demonstrated that in 2011, after the institution of the protocol for screening, 66% of the women in the designated age group were screened for Chlamydia at the visit or in the prior year, an increase of 39 percentage points when compared with 2008. The 2008 screening rate was 27%, with 3.5% of the women having a positive result using point-of-care testing. Discussion: Transition from point-of-care testing to send out NAAT testing may have impacted the detection rate of Chlamydia in the women screened. The 2011 data demonstrate a Chlamydia prevalence of 8.7% (6.7-11.1), which based on the 95% CI is not significantly above the national average of 6.8%. The screening rate in 2011 showed a statistically and clinically significant improvement of 39 percentage points for women utilizing the clinic.
  • Patient Attitudes Regarding Medical Student Involvement in a Primary Care Setting

    Kaser, Scott; The University of Arizona College of Medicine - Phoenix; Carroll, Andrew MD (The University of Arizona., 2013-03)
    Previous studies on patient comfort with medical student involvement have consistently reported positive or neutral results within multiple specialties. The objective of this study was to examine patient attitudes toward medical students in a private family practice setting. This study also looked to examine whether recent medical student interaction alters patient attitude and if patient attitude can be improved with the prospect of providing feedback. It was hypothesized that there would be a positive pre-to-post test change in patient attitudes and that patients would respond positively to the prospect of providing feedback. Ninety-nine consecutive consenting adult patients completed a self-administered questionnaire before and after their office visit, which included a medical student interaction. Patient demographics (age, gender, race, prior student exposure, # years with doctor) as well as their attitudes toward the involvement of medical students were recorded. Data were collected for 10 months at Renaissance Medical Group, a private family practice with one physician provider. Data were compiled in Excel and analyzed with STATA12. Paired two-tailed T-tests and ANOVA were used to determine statistical significance. The results demonstrated that, prior to medical student interaction on 8 of 9 measures, patients have positive attitudes toward medical students. After medical student interaction, on 7 of 9 measures, respondents changed their response to a more positive position (P<=0.05). In addition, patients demonstrated a willingness to provide feedback to the medical student, but providing this feedback would not significantly alter their patient care experience. There were also statistically significant demographic differences on specific measures. This study provides evidence that patients respond positively to medical student interaction in the private Family Medicine setting. This study also demonstrates areas in which the patient care experience can be improved and provides the basis for further study on the patient - medical student interaction.
  • Myocardial Protection Strategy Utilizing Retrograde Cardioplegia

    Karbasi, Michael; The University of Arizona College of Medicine - Phoenix; Willis, Brigham, MD (The University of Arizona., 2013-03)
    Introduction: Myocardial protection strategies are a central component of neonatal arterial switch operations. Traditionally antegrade cardioplegia through the aortic root has been the method of delivery, but use of retrograde cardioplegia via the coronary sinus has become the standard of practice by many in the field. Methods: After obtaining IRB approval and informed consent, a retrospective chart review was done to assess outcomes between 48 patients receiving antegrade (n= 5) and retrograde (n= 43) cardioplegia during neonatal switch operations. Preoperative demographics and postoperative outcomes were compared between the two groups. Results: Patients from the retrograde cardioplegia group demonstrated a trend towards shorter postoperative ventilation days (6.67 +/- 8.57 vs. 10.2 +/- 10.1) and hospital length of stay (18.3 +/- 15.3 vs. 24.8 +/- 11.8) which were not statistically significant. Patients receiving retrograde cardioplegia demonstrated a trend towards an increased incidence of postoperative arrhythmias which was not statistically significant. The retrograde group also demonstrated an increased cardiopulmonary bypass (CPB) time (95.6 +/- 36.59 vs. 146.74 +/- 44.26) and a trend towards an increased aortic cross clamp (ACC) time (74.4 +/- 24.42 vs. 101.30 +/- 29.56) which was not statistically significant. All patients survived to discharge in both groups. With results trending towards shorter hospital length of stays, postoperative ventilation days and zero mortality in patients receiving retrograde cardioplegia, it can be utilized as a safe and efficacious strategy for myocardial protection during neonatal switch operations.

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