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

  • Marijuana Smoking and the Risk of Developing COPD, Lung Cancer, And/or Chronic Respiratory Symptoms: A Systematic Review

    Byers, Chris; The University of Arizona College of Medicine - Phoenix; Campos‐Outcalt, Doug MD, MPH (The University of Arizona., 2017-06-01)
    The aim of this study is to conduct a systematic review of the existing evidence on marijuana use and its association, or the absence of an association, with an increased risk of developing chronic obstructive pulmonary disease (COPD), lung cancer, and/or chronic respiratory symptoms. We hypothesize that a systematic review will not demonstrate sufficient evidence to determine that marijuana use increases the risk of developing COPD, lung cancer, and/or chronic respiratory symptoms. The term “chronic respiratory symptoms” encompasses the following: cough, sputum production, wheeze, shortness of breath, acute bronchitis, and chest tightness. The following databases were searched for the topics of marijuana smoking, COPD, lung cancer, and chronic respiratory symptoms: MEDLINE (PubMed/OvidSP), the Cochrane Controlled Trials Register, the Cochrane Database of Systematic Reviews, PsycINFO, the Database of Abstracts of Reviews of Effects, and Google Scholar. The search ended September 7th, 2016. Studies were initially limited only by the requirement that they were based upon human research and published in English. Studies were included if they were systematic reviews, randomized controlled trials (RCTs), prospective or retrospective cohort studies, case control studies, or cross‐sectional studies. A total of 739 articles were screened for eligibility, 17 unique studies met the inclusion criteria and underwent qualitative analysis1‐17. The quality of systematic reviews was evaluated using the AMSTAR criteria18; cohort, case‐control, and cross sectional studies were evaluated based upon the Newcastle‐Ottawa Quality Assessment Scale (NOS) 19. No RCTs were identified. The overall quality of the evidence for each outcome was determined by utilizing the GRADE methodology20‐21. Studies were primarily assessed by a single reviewer, with random validation of assessments on a limited number of studies by a second reviewer. Overall, there is very low quality evidence that assesses for an association between marijuana smoking and an increased risk of developing lung cancer, COPD, and/or chronic respiratory symptoms. There was no conclusive finding for lung cancer and COPD. However, seven of eight studies concluded that there was an association between marijuana use and chronic respiratory symptoms. The totality of evidence describing any associations between marijuana smoking and the risk of developing lung cancer, COPD, and/or chronic respiratory symptoms is not strong enough to confidently state that marijuana use is associated with any of these chronic pulmonary conditions. Of all the evidence examined in this systematic review, the most convincing appears to be that relating to a potential positive association between marijuana smoking and the risk of developing chronic respiratory symptoms. Unfortunately, the overall quality of evidence was very low due to significant methodological weaknesses within the studies. Thus, there is insufficient evidence in the current literature to make a definitive statement regarding this possible association.
  • Healthcare Access among Adults with Frequent Mental Distress

    Khan, Khalid Salim; The University of Arizona College of Medicine - Phoenix; Hussaini, Khaleel PhD; Rahman, Shakaib MD; Shennib, Hani MD (The University of Arizona., 2016-05-04)
    Objective: Mental health plays a central role in the well‐being of individuals. Understanding the factors that influence mental wellness is critical in order to develop effective policy that addresses the burden of mental illness in society. The objective of this study is to identify a possible relationship between healthcare access and the presence of mental distress in individuals. Methods: Logistic regression was performed using cross sectional data from a CDC developed nationwide behavioral health surveillance program (BRFSS, 2013‐4). Odds ratios were estimated using frequent mental distress as the outcome of interest while adjusting for confounding variables such as smoking, binge drinking, obesity, etc. Six models were estimated utilizing our hypothesized variables of interest. Results: The calculated adjusted odds ratios (AOR) and confidence intervals (CI) demonstrated a positive correlation between certain variables measuring access to healthcare and the reporting of frequent mental distress, agreeing with the hypothesis. Those variables were financial cost preventing access to medical care (AOR [2], CI [1.9‐2.1]) as well as a span of more than 2 years having elapsed since a routine medical checkup by a healthcare provider (AOR [1.1], CI [1.1‐ 1.2]). The opposite effect was demonstrated in individuals who had no insurance coverage (AOR [.8], CI [.7‐.9]), which was contrary to the hypothesis. Conclusion: After adjusting for confounding variables, a strong relationship exists between individuals who are not able to see a physician due to cost, and the presence of frequent mental distress. Frequent mental distress is also increased in individuals who have not had a routine medical checkup with a physician in the last 2 years.
  • The Use of Clinical Decision Rules to Reduce Unnecessary Head Ct Scans in Pediatric Populations

    Barrett, Jeffrey; The University of Arizona College of Medicine - Phoenix; Panchanathan, Sarada MD, MS (The University of Arizona., 2016-04-20)
    Background: Head computed tomography (CT) imaging is the gold standard study for rapidly identifying emergent traumatic brain injuries (TBIs). Exposure to the ionizing radiation utilized in CT increases lifetime risk for developing neoplasms. Currently there is little consensus on appropriate use of CT imaging for children with mild head injury. Clinical decision rules (CDRs) have been developed to identify children at very low risk of clinically significant brain injury. While these CDRs have been validated, their implementation has not been as well studied. Objective: To evaluate the efficacy of two CDRs in decreasing CT scan rate without missing clinically significant brain injuries. The two CDRs used in this study were the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) and the Pediatric Emergency Care Applied Research Network (PECARN) algorithm. Both variations of the PECARN criteria for age 2 years and older and age <2 years were studied. Design/Methods: The medical records for patients with the diagnosis of head injury evaluated at the Maricopa Medical Center Pediatric Emergency Department for all of 2011 and 2012 were reviewed. A total of 331 charts were identified. The PECARN and CHALICE inclusion criteria and algorithms were applied to these charts to determine if the patients met criteria for CT scan. Patients with suspected non‐accidental injuries were excluded. Results: Of 331 patients, 238 met the inclusion criteria for CHALICE. 96 (40.3%) had CT scans performed. According to the algorithm, only 52 (21.8%) met criteria, which is an absolute rate reduction of 18.5%. One TBI was missed. 129 patients met the inclusion criteria for PECARN age 2 years and older. 73 (56.6%) had CT scans performed. 61 (47.2%) met criteria resulting in an absolute rate reduction of 9.4%. No TBIs were missed. 74 patients met inclusion criteria for PECARN age <2 years. Of these, 25 (33.7%) had CT scans performed and the same number met criteria resulting in no change in number of scans. One TBI was missed. Conclusions: Both the CHALICE and PECARN CDRs have the potential to reduce scan rates in our home institution. The CHALICE CDR would have resulted in a greater reduction in CT scans. PECARN also would have reduced the number of scans in children 2 years and older, but not in children <2 years old. The TBI that did not meet CDR criteria was also missed by clinical suspicion and a CT scan done on a later encounter was suspicious for a non‐accidental injury.
  • Injections of Bone Marrow Aspirate Concentrate as Treatment for Discogenic Pain

    Shillington, Jon Mark; The University of Arizona College of Medicine - Phoenix; Wolff, Michael MD (The University of Arizona., 2016-04-20)
    Low back pain (LBP) is one of the most common musculoskeletal pain complaints, affecting up to 84% of the U.S. adult population. In the United States, the highest rate of incidence is between the ages of 45 and 64 years. The causes for LBP are complex and of multiple origins, but one of the primary causes is mechanical low back pain that is discogenic in etiology. This can be secondary to either internal disc disruption (IDD) and/or degeneration of the intervertebral disc (IVD), also known as degenerative disc disease (DDD) [10,11]. Combined physical and medical therapies are successful in relieving pain in approximately 90% of cases of low back pain. However, the remaining 10% become chronic and generate a serious public health problem, known as chronic low--‐back pain (CLBP). CLBP decreases both the quality of life and the labor capacity of the patient. As specific diagnostic procedures for LBP have improved, discogenic pain has been identified as the primary cause of CLBP amongst adults. Within the classification of discogenic pain, the most common specific cause of pain – up to 42% of LBP complaints – is internal disc disruption (IDD), with other distinguishable causes including disc herniation, degenerative disc disease (DDD), and instability of the lumbar segment [10]. Effective treatment for discogenic LBP – and therefore for CLBP – would provide significant relief for individuals as well as for the overall health care system and the employers affected by the patients’ condition. One promising treatment option involves the use of Mesenchymal Stem Cells (MSC), which may allow for regeneration of the disc itself. Treatment with MSCs via injections derived from autologous concentrated Bone Marrow Aspirate (cBMA) would capitalize on the regenerative potential of MSCs while reducing the risk of infection or rejection, both significant risks of treatment from a heterologous source. This project analyzed data collected from 33 patients with confirmed discogenic LBP, who were treated with intradiscal injections of autologous concentrated Bone Marrow Aspirate. After initial treatment, patients were monitored through follow up visits and questionnaires (VAS, Oswestry, SF--‐36) to determine the efficacy of treatment. The areas of interest for this study were intentionally narrow. This study sought to identify specifically the patients’ self--‐reported pain and functioning levels from 2 weeks post--‐treatment to 12 months post--‐treatment. Those reports were gathered using the aforementioned instruments and synthesized to show overall trends and statistically significant changes in the patients’ self--‐ assessment. The patients were also asked to give an overall impression of whether or not their back pain had improved post treatment. While admittedly limited in authority compared to a double--‐blind, randomized, controlled trial, the information was gathered from the patients with the hopes of augmenting ongoing research related to innovative treatments for discogenic LBP and of identifying new areas for further, future research.
  • The Interaction of β-catenin, Vitamin D, Resveratrol, and Two Common VDR Polymorphic Variants in Colorectal Carcinogenesis

    Van Pelt, Chad; The University of Arizona College of Medicine - Phoenix; Jurutka, Peter PhD (The University of Arizona., 2016-04-20)
    Vitamin D and resveratrol have been widely researched in recent years, especially their apparent abilities to impact a host of physiological processes. Resveratrol, a phytoalexin found in various berries, peanuts, and other vegetables, is purported to possess anti-aging, anti-inflammatory, antioxidant, anticancer, neuroprotective, and antiarthritic properties, while the classical endocrine functions of vitamin D are the control of calcium and phosphate homeostasis. The biologically active metabolite of vitamin D, 1,25-dihydroxyvitamin D (1,25D), is typically synthesized in the kidney, bound to vitamin D binding protein, and shuttled to cellular target sites. Mounting data on the effect of locally synthesized 1,25D in immune, epithelial, neural, and other tissues have led to an increased awareness of the myriad functions of vitamin D, including detoxification, cellular aging and its modulation, immune regulation, neurotransmitter activity, and metabolic control. Both endocrine and intracrine actions of vitamin D are mediated by the vitamin D receptor (VDR), a nuclear receptor that controls vitamin D-directed transcription of target genes. Importantly, the VDR has numerous polymorphisms, one of which results in two phenotypically distinct isoforms, designated M1 and M4. VDR M4 is postulated to be more active than M1 in vitamin D-dependent transactivation. Variable binding affinities between the two isoforms and VDR interacting proteins such as TFIIB and RXR have also been observed. Another protein known to interact with VDR is β-catenin, the mediator of the Wnt/β-catenin signaling pathway that can drive colorectal carcinogenesis. The goal of this study was to investigate the ability of vitamin D and resveratrol to regulate the Wnt/β-catenin system via stimulation of β-catenin-VDR (both M1 and M4) interaction and subsequent inhibition of β-catenin-mediated transcription. The current data reported herein support and extend previous work by demonstrating that VDR binds directly to β-catenin and that both vitamin D and resveratrol appear to enhance this interaction. We also present data that 1,25D-stimulated VDR is capable of inhibiting β-catenin transcriptional activity. Significantly, we have shown that the two common VDR polymorphisms M1 and M4, are functionally variable, both in their induction of vitamin D-dependent genes and in their inhibition of β-catenin-mediated transcription. VDR M4 exhibits both elevated transactivation and amplified capacity for β-catenin suppression compared to M1, and studies employing site-directed mutagenesis of VDR implicate the glutamic acid at position 2 as being responsible for the reduced activity of the M1 variant. Both polymorphic VDR variants display 1,25D-mediated enhancement of -catenin association, with the M1 SNP possessing a lower basal (-1,25D) binding to this protein partner but a higher fold stimulation in -catenin interaction in the presence of 1,25D. Taken together, these data support the notions that VDR influences pathways important for colorectal carcinoma (CRC) development, and that supplementation with vitamin D and resveratrol may reduce colon cancer risk in the general population, especially in individuals with the less active M1 VDR polymorphism. A comprehensive understanding of 1,25D and resveratrol action in VDR signaling may allow for a more personalized approach toward treating vitamin D–related disorders and evaluating risk for carcinogenesis.
  • Safety and Visual Outcomes of Novel Abexterno Akreos® Single Pass Method of Transscleral Sutured Posterior Chamber IOL Implantation for Scleral Fixation of IOL

    Wallman, Andrew; The University of Arizona College of Medicine - Phoenix; Monson, Bryan MD (The University of Arizona., 2016-04-20)
    We present the safety and efficacy of a novel transscleral sutured posterior chamber intraocular lens (TSSPCIOL) implantation approach utilizing 25 gauge vitrectomy and a foldable posterior chamber intraocular lens implant (AKREOS AO60, Bausch & Lomb). 80 consecutive eyes that underwent single surgeon TSSPCIOL implantation between October 2008 and July 2012 at a referral‐based retina institution were analyzed for best spectacle‐corrected visual acuity (BCVA) and safety indicators. Postoperative complications included retinal detachment in 2 eyes (2.5%), Irvine‐Gass cystoid macular edema in 3 eyes (3.75%), with 2 of those cases occurring late, persistent postoperative corneal edema in 1 eye (1.25%), hyphema in 2 eyes (2.5%) and 1 case of postoperative vitreous hemorrhage with spontaneous clearing. The modified external approach with AKREOS® TSSPCIOL placement with 25 gauge vitrectomy has relatively few complications, improves visual acuity in patients requiring TSSPCIOL, and offers several advantages over traditional anterior chamber or conventional scleral sutured techniques.
  • The Proportion of Adolescents Complaining of Anterior Knee Pain with Osteochondritis Dissecans and the Utility of Screening Radiographs in its Diagnosis.

    MacKenzie, James; The University of Arizona College of Medicine - Phoenix; Vaughn, Jeffrey M DO; Shrader, M Wade MD (The University of Arizona., 2016-04-01)
    Osteochondritis dissecans is a rare condition which can cause disabling knee pain in adolescents. Treatment and prognosis hinges upon the stage of the lesion and early detection is paramount 1‐3. Until recently, epidemiologic information regarding OCD in adolescents was unavailable. However in 2013 Kessler et al. demonstrated an incidence of 9.5/100,000 in the general adolescent population 4. Chief complains from patients with OCD usually localize pain to the knee joint line, but less commonly, patients may complain of anterior knee pain. This retrospective chart review looked at the amount of OCD diagnoses in adolescents specifically complaining of anterior knee pain without causative trauma in the years 2009 and 2010 at a major children’s hospital. It was noted that 7.5% of children with this presentation had a diagnosis of OCD. This number was over three orders of magnitude higher than the incidence seen in the general adolescent population as established by Kessler and may support the use of screening radiographs in this subset of patients to detect OCD in its early stages.
  • Inferior Vena Cava Filter Fracture and Migration to the Heart: A Review of the Literature and Case Report

    Bowles, Brad; The University of Arizona College of Medicine - Phoenix; Shennib, Hani MD (The University of Arizona., 2016-04-01)
    Background and Significance: The utilization of IVC filters for pulmonary embolism prevention has increased significantly over the past decade as the indications continue to expand. Although the risks associated with IVC filters are small, a well‐known complication is filter fracture and subsequent embolization of the fragment. Case reports have been published on the devastating effects of fragment migration to the heart, causing intense chest pain, pericardial effusion, cardiac tamponade and death. Research Question: There is a paucity of experience and guidelines for treating patients with a metallic foreign object lodged within the heart. Is there a consensus on the proper management of these cases? How do these patients present and what are the outcomes of treatment? Some clinicians have chosen to observe and monitor, while others have gone to the operating room for open‐heart surgery and retrieval of the fragment. Methods: In an attempt to answer these questions, a systematic review of the published literature was conducted between 1985 and 2015. Only articles related to IVC filter fracture and subsequent fragment migration to the heart were included. The clinical presentation, workup, management, treatment and outcomes were collected as available. Results: A total of 23 articles were published consisting of a prospective study, retrospective series and case reports. There were 37 migrated fragment to the heart reported in 29 patients. The most common clinical presentations were chest pain (69.0%) and no symptoms (27.6%). Regarding treatment, ten patients underwent observation, three had successful endovascular retrieval, 12 went to the operating room for open‐heart surgery and four cases were unreported. Of the 12 patients with reported pericardial effusion, 11 (91.7%) underwent open surgical repair. Of the eight asymptomatic patients, seven (87.5%) were ultimately in observation and the management of the other was unreported. Conclusions: There appears to be a consensus in the literature that observation and close follow up are appropriate options for asymptomatic patients. Symptomatic patients with pericardial effusion may benefit from open‐heart surgery. Cardiovascular compromise such as cardiac tamponade should be managed with open surgery. Based upon these findings and other details in the cases, we have proposed a management algorithm.
  • Label‐free Microscopic Assessment of Glioblastoma Biopsy Specimens Prior to Biobanking

    Zehri, Aqib; The University of Arizona College of Medicine - Phoenix; Preul, Mark MD (The University of Arizona., 2016-04)
    Introduction: Glioblastoma is the most common primary brain tumor with a median 12‐ to 15‐ month patient survival. Improving patient survival involves better understanding the biological mechanisms of glioblastoma tumorigenesis and seeking targeted molecular therapies. Central to furthering these advances is the collection and storage of surgical biopsies (biobanking) for research. We addressed an imaging modality, confocal reflectance microscopy (CRM), for safely screening glioblastoma biopsy samples prior to biobanking to increase the quality of tissue provided for research and clinical trials. We hypothesize that CRM is a safe and effective method for screening specimens prior to biobanking. Methods: Intracranial implantation of human glioma cells was performed to create glioblastoma xenografts. Rodents xenografts were anesthetized to collect whole brain specimens, which were sectioned into tumor containing slices. One set of slices were incubated with DAPI and imaged. A coefficient of determination analysis was then used to compare cells identified with CRM to cells labeled with DAPI. The other set of slices were imaged using CRM at various time points and subsequently frozen for later analysis of DNA, RNA, and protein integrity. We subsequently imaged human glioma biopsies with CRM to determine cellularity and necrosis. Results: CRM provides definitive contrast between cell nuclei, cytoplasm, and extracellular tissue to help identify tumor regions, margins, and acellular regions of animal glioblastoma specimens without altering DNA, RNA, or protein expression of imaged tissue. When imaging fresh human biopsy samples, CRM can differentiate a cellular glioblastoma biopsy from a necrotic biopsy. Conclusion: These data illustrate CRM’s potential for rapidly and safely screening clinical biopsy samples prior to biobanking, which demonstrates its potential as an effective screening technique that can improve the quality of tissue biobanked for patients with glioblastoma.
  • Coccidioidomycosis as a Cause of Sarcoid in Arizona

    Yourison, Isaac; The University of Arizona College of Medicine - Phoenix; Kuberski, Tim MD (The University of Arizona., 2016-03-25)
    BACKGROUND AND SIGNIFICANCE: Sarcoidosis is a granulomatous disease of unknown etiology. Coccidioidomycosis is a granulomatous fungal infection due to Coccidioides immitis and Coccidioides Posadasii endemic to the Southwestern United States and the majority of the cases are reported from Arizona. The cause of sarcoidosis has been studied for over a hundred years without establishing an etiology. Establishing the cause of sarcoid would be a significant contribution to the understanding of an important multisystem disease. RESEARCH QUESTIONS: Based on clinical observations a group of patients with two granulomatous diseases – sarcoidosis and coccidioidomycosis led to the hypothesis for this Scholarly Project – can sarcoidosis be caused by the fungus Coccidioides? METHODS: A literature review was performed which resulted in 5 patient case reports, a medical record review was conducted of patients with sarcoidosis between 2004‐2014 at Maricopa Medical Center with a case‐control comparison to 68 matched patients, and PCR analysis of 34 sarcoid biopsy specimens from the 68 sarcoid patients identified from the medical record. Also, two main patients with sarcoidosis were studied, one prospectively and the other retrospectively, both patients had their diagnosis of sarcoidosis made in Arizona and both develop sarcoidosis. There was no evidence of an etiology for their sarcoidosis at the time of diagnosis, specifically no evidence of coccidioidomycosis. The prospective patient was followed for eight years before he developed coccidioidomycosis. Predicting correctly that a patient diagnosed with sarcoid in Arizona would eventually develop coccidioidomycosis provides strong evidence for an etiologic relationship between Coccidioides and sarcoidosis. INCOMPLETE STUDIES: There is one major study for this Project that has not been completed: 1. Genetic studies on patients with both sarcoidosis and coccidioidomycosis to determine if there is a genetic predisposition to disseminated coccidioidomycosis
  • A Survey to Assess Parent Perspective of the Impact of a Gluten‐Free, Casein‐Free Diet on Their Child’s Symptoms of Autism Spectrum Disorder

    Wendt, Rebecca; The University of Arizona College of Medicine - Phoenix; Melmed, Raun MD; Savi, Christine PhD (The University of Arizona., 2016-03-25)
    With the prevalence of Autism Spectrum Disorder (ASD) rising (approximately 1 in 45)1 treatment for the disorder becomes even more important. Families turn to both traditional and alternative medicinal sources for help. The Gluten‐Free, Casein‐Free (GFCF) diet is an example of an alternative therapeutic approach. Study Aims: Our aims were to design and begin initial validation of a survey to evaluate the use and efficacy of the GFCF diet in children with ASD with concurrent gastrointestinal (GI) symptomatology. We also aimed to assess feasibility of the survey in the target population through piloting the survey. This is the first step in determining association of the GFCF diet in children with ASD. Methods: A survey was developed with expert review, meant for completion by parents and primary caregivers of children with ASD. The survey content included demographics, treatments used, GI symptoms (as measured by a modified Rome III parent report form), food allergies and intolerances, and frequency of aberrant behaviors (as measured by the Aberrant Behavior Checklist). Questions regarding diet use (specifically gluten‐free diet, casein‐free diet, or GFCF) were included in the treatment modalities and as well as questions regarding compliance and length of time used. The survey was advertised to our target population and 38 completed responses were obtained for a pilot study. Results: The pilot study revealed questions which were not clear to the target population and required modifications. Data from the responses revealed 14/38 participants who attempted the GFCF diet or its variants with their child, 11 for 3 months or greater. Number of food intolerances was heightened among those who used the diet or its variants. Heightened ABC irritability subscores were noted among those with GI symptoms. Conclusions: The pilot survey developed for this project suggests that the use of the GFCF diet in children with ASD is not only common but also might be a useful therapeutic agent. The need for further validation of the tool is paramount.
  • Effectiveness and Student Perception of Simulated Case Based Learning in a Pre Clinical Medical Education

    Weed, Michael; The University of Arizona College of Medicine - Phoenix; Savi, Christine PhD (The University of Arizona., 2016-03-25)
    Over the past decade, patient simulation has become an important teaching tool in allopathic medical education. Initially, medical simulation was used exclusively in the clinical years of medical training, but implementation into pre‐clinical curriculum is becoming increasingly common. Because simulated teaching experiences are a relatively new practice in pre‐clinical medical education, little is known about their value in this setting. We hypothesize that high‐fidelity patient simulation is an effective method of teaching basic medical sciences during the pre‐clinical years and that it will be viewed favorably by students when compared to other established teaching modalities. The purpose of our study is to: (1) test for an effect of teaching method on test score performance by comparing the results of relevant test items given to two student groups: a simulation group and a traditional case‐based instruction group; (2) determine student perception of simulation as a learning method for basic medical sciences. Methods: A one tier, mixed methods design was used to sequence this study. Test item scores were obtained from the classes of 2015 and 2016 at the University of Arizona College of Medicine ‐ Phoenix and results were analyzed using descriptive statistics to compare means and item difficulty. A Fisher’s exact test was conducted to compare test item performance between students who did and did not use simulation in their case‐based instruction group. Presimulation and post‐simulation surveys were also administered and thematic extraction used to triangulate results to quantitative findings. Results: There was no significant difference between performance of the simulation (n=48) and non‐simulation (n=79) group on the three test items. Survey results from this particular study indicate that students do enjoy learning in the simulated case‐based environment and that they find it to be intellectually stimulating. They also believe simulation will be useful in their careers. They do not, however, believe that it is as effective at teaching basic medical sciences when compared to the traditional lecture hall setting. Students also find simulation learning to be more stressful than small group learning. Conclusion: Our findings suggest that students who learn material through simulated case instruction perform as well as their counterparts who learn the material in traditional small group non‐simulated settings. However, our survey data suggests that while student perception of simulation is positive overall, there are instances in which simulation is viewed less favorably than both small group and traditional lecture environments. When analyzed together, the test item performance and survey findings show that while simulation can be an effective teaching tool in pre‐clinical medical education, there was not a significant difference when compared to lecture hall and non‐ simulated small group learning settings.
  • Expedited Partner Therapy, Addressing Increased STD Infection Rates in Arizona

    Wade, Laura; The University of Arizona College of Medicine - Phoenix; Manriquez, Maria MD (The University of Arizona., 2016-03-25)
    Introduction: Chlamydia and gonorrhea are the two most reported sexually transmitted diseases (STDs) in Maricopa County.1 Effective treatment of the sex partner(s) of patients diagnosed with these STDs is an important step in preventing repeated infections. Expedited partner therapy (EPT) is the practice of prescribing antibiotics to the sex partner(s) of a patient diagnosed with a STD. EPT is recommended by the CDC in cases of uncomplicated chlamydia or gonorrhea infection.2 On September 26, 2008, Arizona statue was revised to allow for the use of EPT.3 Our study seeks to determine whether the use of EPT results in fewer repeat infections of chlamydia or gonorrhea within six months of initial diagnosis. Methods: We performed a retrospective chart review of 200 female patients diagnosed with chlamydia or gonorrhea between 2010 and 2013. We recorded how partner treatment was addressed, whether or not the patient had a repeat infection within six months, provider specialty and additional demographic information. Data was analyzed using One‐Way ANOVA or Wilcoxon Rank‐Sum for continuous variables and Chi‐Squared or Fisher’s Exact was used for categorical variables. Results: Overall documented percent repeat infection of 14.7% (n=20) out of 136 patients with follow up testing within 6 months. Loss to follow up of 32% (n=64). Percent repeat infection in EPT 0.0% (n=0), partner referral 16.1% (n=9), partner notification 20.9% (n=9) and not documented 16.7% (n=2). When comparing percent repeat infection in EPT (0.0%) to all other treatments combined (14.7%) the difference is statistically significant with p=0.025. Conclusions: The use of EPT results in fewer repeat infections in patients diagnosed with chlamydia. Limitations include loss to follow up and incomplete documentation in the electronic health record. Further investigation into the barriers to EPT is warranted to increase utilization of this strategy for partner treatment.
  • Chronic Pain in Noonan Syndrome: A Previously Unreported but Common Symptom

    Vegunta, Sravanthi; The University of Arizona College of Medicine - Phoenix; Grebe, Theresa A. MD (The University of Arizona., 2016-03-25)
    Background and Significance: Noonan syndrome (NS) is a multiple malformation syndrome characterized by pulmonic stenosis, cardiomyopathy, short stature, lymphatic dysplasia, craniofacial anomalies, cryptorchidism, clotting disorders, and learning disabilities. Eight genes in the RAS/MAPK signaling pathway are implicated in NS. Chronic pain is an uncommon feature. Research question and Methods: To investigate the prevalence of pain in NS, we distributed a two‐part questionnaire about pain among NS individuals at the Third International Meeting on Genetic Syndromes of the Ras/MAPK Pathway. The first part of the questionnaire queried demographic information among all NS participants. The second part was completed by individuals with chronic pain. Questions included musculoskeletal problems and clinical features of pain. Results: Forty‐five questionnaires were analyzed; 53% of subjects were female. Mean age was 17 (2–48) years; 47% had a PTPN11 mutation. Sixty‐two percent (28/45) of individuals with NS experienced chronic pain. There was a significant relationship between prevalence of pain and residing in a cold climate (P = 0.004). Pain occurred commonly in extremities/joints and head/trunk, but more commonly in extremities/joints (P = 0.066). Subjects with hypermobile joints were more likely to have pain (P = 0.052). Human growth hormone treatment was not statistically significant among subjects without chronic pain (P = 0.607). We conclude that pain is a frequent and under‐recognized clinical feature of NS. Conclusion: Chronic pain may be associated with joint hypermobility and aggravated by colder climate. Our study is a preliminary investigation that should raise awareness about pain as a common symptom in children and adults with NS.
  • “It’s About Heart”: A Qualitative Study of Rural Family Physician Training Needs.

    Varner, Samantha; The University of Arizona College of Medicine - Phoenix; Brown, Steven MD (The University of Arizona., 2016-04)
    Efforts to reduce a chronic physician shortage and meet the needs of rural communities face long standing challenges such as physician recruitment and retention. While these topics have been researched at length, issues surrounding the contribution of training specifically geared toward the needs of the Southwest’s rural communities are not well understood. The goal of this investigation is to discuss with rural family physicians the realities of rural practice and to determine what, if any, skills and competencies are specific to rural family practice and that, if addressed in training, would increase the number of students and residents pursuing rural family medicine and increase the number of physicians in rural areas. Methods: Physicians throughout rural areas in the Southwest meeting the role of thought leader were interviewed. Chain sampling was used to generate diversity of ideas. Interviews were conducted in person or by phone using a semi‐structured format and a topic guide. Participants were asked to discuss what skills they feel are important to a successful practice in a rural community, the degree to which the competencies were covered in their residency training, and how having or not having these skills might affect job satisfaction and retention. Interviews were recorded and transcribed. Transcripts were analyzed by a two person committee for repeating themes. Results: Seven major repeating themes were evident in the data. Of these residency training type, individual resilience, comfort with lack of resources, community were some of the most common and important to participants. Conclusion: This study has shown that the challenges to recruitment and retention of family physicians in rural areas are many and complex. These results combined with the extensive literature studying successful recruitment and retention programs demonstrates the enormous potential that exists in a multifactorial approach to rural recruitment and retention to meet the tremendous need for more family physicians in rural areas.
  • Building a Medical App: Approach, Infrastructure, and Challenges of Developing a Congenital Heart Defects App for Educational Purposes

    Stoker, Alexander; The University of Arizona College of Medicine - Phoenix; Richardson, Randy MD (The University of Arizona., 2016-03-25)
    Mobile software application (apps) have exploded in popularity since 2008, when Apple’s App Store opened and have become increasingly present in medical education and medical practice. As evidence of educators realizing the potential apps have for educating students, the University of Arizona has created a department called the Office of Instruction and Assessment (OIA), which has a programming team that is committed to assisting faculty in the design, development and implementation of apps for University of Arizona Students. Congenital heart defects are the most common type of birth defect in the United States, affecting nearly 1% of, or about 40,000, births per year. There are complex three‐dimensional relationships involved in many of the congenital heart defects that may be difficult for students to fully understand through the traditional method of reading and looking at two‐dimensional diagrams. The principle goal of this project was to participate in the design and development of an educational mobile app that allows the user to interactively rotate digital 3D models of hearts with congenital heart defects. Multiple approaches to developing an educational medical app were explored including utilizing basic app‐building programs that do not require computer coding or programming, paying a for‐profit company to develop an app, and collaborating with a larger educational institution that has the resources available for developing an app and has a potential use for the app. This thesis aims to describe the resources available to develop an educational app, the major factors that determine the best approach for app development and the challenges associated with each approach. Through the case example of developing “Heart Defects” with the Office of Instruction and Assessment at the University of Arizona and publishing the app on the Apple App Store it was determined that the major factors guiding the approach to app development are complexity of the app, computer programming experience of the individual planning to develop an app, and having access to a larger institution with the ability to develop apps and the institution having a perceived benefit from developing the app.
  • The Utility of Hemoglobin A1c in Detecting Prediabetes in Obese Youth

    Srivastava, Sarika; The University of Arizona College of Medicine - Phoenix; McClellan, Donald MD (The University of Arizona., 2016-03-25)
    Introduction. The incidence and prevalence of Type 2 diabetes mellitus has been steadily increasing over the past ten years, and is currently approximately 4.1 per 1000 12‐19 year olds in the US2. This increase has been linked to obesity and a sedentary lifestyle. Prediabetes, in the pediatric population is defined as having a fasting plasma glucose concentration ≥ 100 to 125 mg/dL or 2‐hour glucose concentration during an oral glucose tolerance test ≥ 140 mg/dL but <200 mg/dL. Aims. The goal of this study is to describe the sensitivity and specificity of hemoglobin A1c at various thresholds to identify prediabetes, as defined by impaired fasting glucose and/or impaired glucose tolerance; the population included in this study consist of obese youth referred to the Division of Endocrinology and Diabetes at Phoenix Children’s Hospital for weight‐related issues. We anticipate describing various levels of sensitivity and specificity of hemoglobin A1c in comparison with gold standard tests, such that it can be used to propel further studies to ultimately reduce the immense patient burden of fasting in the pediatric population. Methods. We conducted a retrospective cross‐sectional chart review and employed receiver operating characteristic (ROC) curve analysis of data including but not limited to hemoglobin A1c, fasting plasma glucose, and 2‐hr post‐prandial plasma glucose. The benefits of this study include the potential of reducing the patient burden of fasting prior to examination. This review will determine, if any, the potential value in being able to use hemoglobin A1c clinically to detect prediabetes in pediatric patients; determining this may provide critical information to improve the monitoring and screening of prediabetes. Conclusions. Compared to the gold standards of fasting plasma glucose and oral glucose tolerance tests, we found that hemoglobin A1c had a low sensitivity and specificity for identifying prediabetes.
  • Comparison of 64‐Slice EKG‐Gated Computed Tomographic Angiography, Transthoracic Echocardiography, and Transesophageal Echocardiography for Detection and Complete Characterization of Anomalous Coronary Arteries in Infants with Comorbid Congenital Cardiac Malformations

    Sridhar, Shravan; The University of Arizona College of Medicine - Phoenix; Richardson, Randy R. MD (The University of Arizona., 2016-03-25)
    Background and Objective: Computed tomographic angiography (CTA) offers several benefits over echocardiography in the detection of CAAs (coronary artery anomalies). These include higher spatial resolution, operator independency, non‐invasiveness, and the availability of reconstructive techniques to track the entire arterial course.1,4,9 Accordingly, standard clinical practice (per ACC/AHA guidelines for adults with CAAs) for adults with suspected CAAs includes use of CTA as a first‐line imaging modality.6 Currently, there is no evidence favoring either CTA, transthoracic echocardiography (TTE), or transesophageal echocardiography (TEE) for initial imaging of infants with suspected CAAs. Therefore, the aims of this retrospective study include investigating the efficacy of CTA, TTE, and TEE in the detection and complete characterization of CAAs. Methods: Imaging and surgical data for 27 patients who presented for evaluation of congenital heart disease between 2006 and 2011 were evaluated. Patients had a mean age of 2.2 ± 0.7 months at initial evaluation and had undergone EKG‐gated 64‐slice cardiac CTA with 3D reconstruction in addition to multiple TTE and TEE studies. Performance metrics (including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of each modality in CAA detection were computed. Concordance between each modality and surgical/conventional angiographic diagnosis in the characterization of anatomy along the origin, course, and termination of anomalous coronary arteries was evaluated. The rate of limitations of each modality in the imaging and interpretation of coronary anatomy was also reported. Results: Using surgical/angiographic diagnosis as the gold standard, CTA produced a sensitivity, specificity, and accuracy of 80%, 50%, and 74%, respectively. TTE produced a sensitivity, specificity, and accuracy of 20%, 50%, and 26%, respectively. TEE produced a sensitivity, specificity, and accuracy of 27%, 100%, and 42%, respectively. CTA outperformed TTE and TEE at characterizing anatomy at the origin and course of an anomalous coronary artery. At characterizing anatomy at the termination of an anomalous coronary artery, CTA outperformed TEE but did not significantly outperform TTE. CTA had a higher rate of documented limitations to imaging/interpretation compared to TTE and TEE but a lower rate when compared to conventional angiography. Conclusion and Impact: CTA is a rapid, non‐invasive, operator‐independent imaging modality that offers high resolution, 3‐dimensional imaging of CAAs in infants. The results of this study indicate that CTA is the most sensitive and accurate modality for detection of CAAs in infants and is optimal for characterizing anatomy along the entire length of an anomalous coronary artery. As such, CTA may be the optimal modality for first‐line coronary artery imaging in infants with suspected anomalous coronary artery anatomy who have a high pretest probability for having a CAA.
  • Improving Colorectal Cancer Screening Rates in an Urban Community Health Center

    Seelbaugh, Joseph; The University of Arizona College of Medicine - Phoenix; Brite, Kathleen MD (The University of Arizona., 2016-03-25)
    Colorectal cancer (CRC) is a leading cause of cancer‐related deaths. Although screening has been shown to significantly reduce mortality associated with the disease, CRC screening rates remain low, especially among many minority groups. The purpose of this study was to determine whether an organized screening regimen improves screening in a community clinic serving patients with low baseline CRC screening rates. The study was conducted at the Wesley Health Center, a Federally Qualified Health Clinic (FQHC) that serves a predominantly uninsured patient population. Participants were patients aged 50 – 75 years who visited the clinic for routine primary care. A team of clinicians and support staff at the Wesley Health Center developed a systematic CRC screening protocol with interventions tailored for the clinic. Following the implementation of the screening regimen, screening rates among the targeted population were examined over a one‐year period and compared to a recent one‐year period previous to protocol implementation. The primary outcome was the change in CRC screening rates in the intervention group compared to screening rates prior to implementation of the protocol. Results of the study showed CRC screening rates of 45.6% over the trial period, as compared to 13.7% prior to screening interventions, a statistically significant difference (p < 0.001). The investigation provides valuable information regarding the use of practical strategies to increase CRC screening in community health care settings.
  • The Effects of Stigma Toward Mental Illness on Family Physicians

    Sipe, Michelle; The University of Arizona College of Medicine - Phoenix; Goto, Kristine PhD (The University of Arizona., 2016-03-25)
    Many individuals utilize primary care as their main source of mental health care, as in many areas of the US access to specialized psychiatric care does not meet the demand. Prior research has showed that many healthcare practitioners, including those working in generalist fields, carry stigmatized views about individuals with mental illness. Such stigmatized views can result in misattribution of symptoms to mental illness and a decline in proper diagnosis and treatment. Our study aims to examine if stigmatized views about mental illness relate to family medicine physicians’ comfort levels with treating mental illness, patterns of referral to psychiatrists, or amount of continuing medical education on psychiatric issues. Our hypothesis is that family medicine physicians who carry less stigmatized views will be more comfortable and up to date with psychiatric care practices and less likely to refer mental health issues to specialized mental health services. Methods: We administered an email survey to family medicine physicians via the Arizona Academy of Family Physicians monthly electronic newsletter. The survey contained demographic questions, a short (5‐question) validated stigma questionnaire (Attitudes to Mental Illness Questionnaire or AMIQ), and questions regarding self‐stated comfort level with mental illness, amount of recent mental‐health CME, and likelihood of referral for various mental illnesses. Results: AMIQ stigma ratings and referral rates for anxiety were significantly related (p=.012), as were AMIQ stigma ratings and amount of mental health CME (p=.001). Other trends were discovered, but were not significant. Impact: These results further demonstrate the need for increased emphasis on psychosocial and psychiatric issues, particularly stigma reduction, in family medicine residency training and CME. If family medicine physicians with high levels of stigma are less likely to treat mentally ill patients or seek further education regarding psychiatric issues, it could disrupt their patients’ quality, cost, and continuity of care.

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