COVID-19 Information

Geisel Medical Student Annual Poster Presentation

Monday, February 22, 2021
Starting at 6:00pm EST

Name Summary Poster
Ahmed, Maha Healthcare providers need to be aware of their own biases to reduce discrimination in the healthcare setting. The framework of cultural humility supports the development of a critical consciousness that empowers individuals to analyze their own biases which contribute to structural racism and violence. In this scoping review, we analyzed the strategies in which critical self-reflection is used to teach cultural humility in undergraduate medical education. The most common teaching strategies used to teach cultural humility included both experiential learning and a pedagogy of self-awareness. Narrative medicine, community engagement, and problem based-learning were also employed as tactics to promote reflection among medical students. The interventions were most commonly conducted during the clinical years of a student’s medical education. Teaching Strategies for Cultural Humility in Undergraduate Medical Education: A Scoping Review
Ahn, Boyoung Research shows that implicit biases among physicians contribute to negative health outcomes for patients and perpetuate larger health disparities. It is therefore crucial to train future physicians in clinical decision making and various strategies that can mitigate these biases. This work outlines a clinical decision making elective that can be implemented at Geisel School of Medicine. Geisel Curriculum in the Science of Clinical Decision Making
Ali, Kristina Excessive media use in children is associated with poorer executive function, obesity, poorer sleep quality and quantity, and cognitive, social-emotional and language delays. We explored whether such media use is differentially associated with problematic media use behaviors at a young age. Baseline data was analyzed from parents and children, aged 2-5 years old, enrolled in a prospective cohort study in rural New Hampshire and Vermont. Multivariable linear regression was used to model associations between PMU and child media use, adjusted for covariates. Male sex and more frequent child use of screen media during dinner were associated with higher child PMU (p<.05). Child PMU was also positively and linearly associated with child mobile (Pearson’s r = 0.44, p<.01) and non-mobile (r = 0.40, p<.01) media use, parent media use (r=.30, p<.01), and household chaos (r = 0.53, p<.01). In a linear regression model adjusted for child age and sex, household income, household chaos, and child use of media when eating dinner, each 15-minute increase in daily mobile media use was associated with a 0.10 increase in child PMU (95% CI: 0.02,0.18, p=0.02; R2= 0.53), while non-mobile media use was not associated with child PMU (p=0.24). Results were consistent when further adjusting for parent daily media use. Child PMU score was also strongly and positively associated with average child media nag score (r = 0.62, p=0.001). Greater use of mobile media devices was associated with higher PMU scores while non-mobile media use was not. Effects were small and causality cannot be inferred, yet findings support research to assess if media use relates to PMU differentially by media device type. Future studies are needed to elucidate direction of effect between problematic media use, media characteristics, and child media nag behaviors and how much screen time is associated with clinically relevant manifestations of problematic media use. Mobile media device use and symptoms of problematic media use in a preschool-age sample
Anderson, Blaire We conducted a scoping review to explore how different medical schools in the US and Canada define and implement integration of basic and clinical sciences within preclinical courses in undergraduate medical education (UME), as well as the methods used to evaluate the success of integration. From our literature search, we identified 34 articles and categorized integration efforts into 3 overlapping categories: content integration, structure and format integration, and the use of clinical and diagnostic tools. The most common methods used to evaluate integration techniques included solicitation of student feedback, exam and assessment metrics, as well as direct student observation. From our scoping review, we found that there is no universally accepted framework of effective curricular integration at the course level or standardization in the methods used to evaluate integration efforts. We hope to use these data to design and test new methods to evaluate the extent and quality of curricular integration within UME courses. Integrating Foundational and Applied Science in the Preclinical Curriculum: A Scoping Review
Ansari, Saif This poster is an overview of the development of an Automated Vascular Access Device, its purpose, as well as the results of its development. Development of an Automated Vascular Access Device (AVAD)
Barkatullah, Arhem MRI and magnetic resonance venography findings are important tools in the diagnosis of IIH. Empty sella turcica, optic nerve protrusion, distension of the optic nerve sheath, optic nerve tortuosity, posterior globe flattening, and transverse sinus stenosis have been found to be the most promising diagnostic markers for IIH, although absence of these findings does not rule out the diagnosis. MRI findings as markers of idiopathic intracranial hypertension
Barth, Brendan William Barb and Brendan, a pediatrician and a medical student, began the summer of 2020 hoping to do a podcast touching on the intersection between the humanities and medicine. Their idea quickly evolved into the formation of The Floor Is Yours, a podcast seeking conversations surrounding the humanities, health, and well being, with the goal of highlighting topics and voices less heard or understood. Through daily conversations over the course of the summer, Barb and Brendan picked up the skills and tools necessary to make a podcast, and began brainstorming topics and reaching out to potential speakers. Episodes of The Floor is Yours touches on the themes of finding joy in turbulent times, developing the humility to embrace your individual messiness, being LGBTQ in today's and yesterday's world, sexual health and the perceptions of sex in our culture, and understanding gender roles as difference. Their efforts led to publishing six episodes over the course of the summer and fall, and they hope to continue seeking conversations around topics and voices less heard or known into the future. They've loved their experience co-leading together, and they've felt fortunate to have had compelling and thoughtful conversations with all of their guests. The Floor is Yours
Bashi, Aya Virtual health care created a platform for sustained access to essential healthcare services during the COVID-19 pandemic. However, in an effort to not further exacerbate existing health inequities, telehealth barriers need to be identified and addressed. To this end, a scoping review was done to identify barriers to accessing and utilizing telehealth services during the COVID-19 pandemic in general and for rural populations in particular. Barriers identified include, but are not limited to, broadband access, digital health literacy, language barriers, accessibility and gender discrimination. Racial minorities, older adults, low-income households, and rural communities were particularly challenged by these barriers. It is essential to establish systematic ways of identifying, measuring, and addressing health inequities in digital health platforms and policies to create more equitable virtual health landscapes. Barriers to Telehealth During COVID-19 and Beyond: A Scoping Review
Bello, Joseph W The blood-brain barrier (BBB) plays a vital role in protecting the brain parenchyma from anything in circulation that has a potential to cause damage. While this is useful for maintaining healthy brain tissue, it can be a formidable obstacle to overcome with regards to brain drug delivery to for treating neurological and neurodegenerative disorders. Nanomedicine is currently one of the leading areas of research to better understand, and hopefully circumvent, the BBB for drug delivery. While the BBB is highly selective, some molecules such as O2, Glucose, Insulin, and some lipids must readily pass into the brain tissue in order for the brain to function properly. Nanoparticles have shown promising outcomes in animal models when used to transport the therapeutic drugs across the BBB by taking advantage of the BBB’s transport mechanisms. In this review, we will discuss the major characteristics and mechanisms behind the BBB, how nanoparticles can be synthesized and modified to bypass the BBB, and how nanoparticles have been used in animal models to circumvent the BBB for drug delivery (specifically in Alzheimer’s disease and Parkinson’s disease models). In addition, we will be discussing the possible future outcomes for the field of nanomedicine with regards to brain drug delivery. Using nanoparticles to facilitate penetration of the blood-brain barrier for drug delivery
Brown, Rachel A Effective clinician-patient communication regarding goals and values is necessary to provide high-quality care and enable patients to make better decisions. Although advanced communication skills are necessary to care for critically ill patients, critical care service physicians often fail to meet patient and family needs. Professional societies have called for improved training of critical care fellows and physicians to address the inadequate serious illness communication within the ICU. The Serious Illness Conversation Guide (SICG) is a best practice tool for discussing goals of care and making value-aligned recommendations, but its impact on fellow clinician communication skills and suitability for the ICU setting has not been established. Longitudinal Competency Improvement in Critical Care: Fellows Trained in Serious Illness Conversations
Cevallos, Priscila The volume of research on racial disparities in breast cancer has increased over past two decades. However, the extent to which the current literature focuses on the inclusion, justification, and discussion of race and ethnicity as a driver of disparities is unknown. In this work, we specifically evaluated the hypothesis that definitions of race are poorly described in study’s methods and that few studies would name racism as a driver of disparities. Our systematic review finds that formal definitions of race are rarely present, categorizations and rationale for including race and/or ethnicity are imprecisely applied, and racism in any form is near absent in discussing drivers of racial disparities in breast cancer care and outcomes. Reporting on Race and Racial Disparities: The Neglect of Racism as a Driver of Inequitable Care
Cheema, Amal The Infectious Disease Department at DHMC is creating a new care model to provide individualized, multidisciplinary treatment for treating addiction and serious infections secondary to intravenous drug use (IDU) in an outpatient setting. Patients who inject drugs (PWIDs) are often excluded from outpatient IV antibiotic therapy (OPAT) programs due to theoretical concerns of misuse of venous access catheters. To establish a baseline understanding of health outcomes of PWIDs at DHMC, a chart review of twenty-two PWIDs and their illness events from 2018-2020 was performed over Summer 2020. The baseline data gathered and observations on PWIDs’ health outcomes are reported in the poster, and will inform the new care model. Outcomes of Patients Who Inject Drugs Receiving Treatment for Serious Infections: A Chart Review
Dore, Maura Our primary objective of this study was to determine the rate of patient no-shows for telehealth visits at three DHMC General Internal Medicine clinics. We also wanted to identify the demographic variables associated with a higher likelihood of a telehealth of no-show occurrence. These variables can be leveraged to create targeted interventions that reduce patient no-show rates. Rates of Telehealth No-Shows at Dartmouth-Hitchcock General Internal Medicine Clinics
Ghiasuddin, Haider Through the Norris Cotton Cancer Center's Translational Oncology Program I joined the Gaur lab in neuro-oncology as a TOPS scholar. This experience enabled me to research the role of metabolism in the pathogenesis of Glioblastoma (GBM), a disease in great need for novel therapeutics. Once ultimately deciding to focus on the origins of excess glutamate/GABA in GBM, we conducted a preliminary analysis using prior RNA-seq and m-RNA Nanostring data of DHMC and UVM GBM patient samples to examine key genes and enzymes in glutamate and GABA metabolism. This initial analysis showed that inhibition of GAD1 and GABA oxidation together may present an aberrant metabolic pathway specific to GBM patients. Moreover, our results pointed to a need to further study the potential role of GLUD2 in excess glutamate and GBM tumorigenesis. Aberrant Glutamate and GABA Metabolism in Glioblastoma
Gillett, Leah This poster presents a proposed mixed methods quantitative and qualitative study investigating themes in the experiences of nurses using the ESC Care Tool in their care of opiate exposed newborns (OEN). This research could inform ESC Care Tool hospital implementation strategies for hospitals newly exploring use of the ESC Care Tool for their care of OEN. Additionally, this could serve as a pilot study for a nation-wide investigation of the nurse’s experience caring for OEN using the ESC Care Tool. Nurse Experience Caring for Opioid-exposed Newborns using the Eat, Sleep, Console (ESC) Care Tool
Gomez, Robert (Bobby) When unplanned pregnancy and opioid use disorder (OUD) co-occur, consequences to the health of the mother-infant dyad can be dire. This retrospective study explores pregnancy planning among reproductive age females at two rural Maine family medicine practices to understand differences for women with OUD in contrast to those without. A preliminary sample (N=250) suggests a significantly higher proportion of unintended pregnancy among women with OUD, suggesting an unmet need for family planning resources. Family medicine is uniquely positioned to improve the health of this population by addressing the breadth of women’s health care needs, and in turn, promoting infant well-being. Optimizing Care for the Mother-Infant Dyad: Understanding Unplanned Pregnancy Among Women with Opioid Use Disorder in Two Rural Maine Family Medicine Practices
Almada Gossweiler, Romina Review on current state of Medical Spanish curricula across American medical schools Medical Spanish Curricula
Guarino, Isadora (Izzy) Background: Technology can help provide accessible and inexpensive behavioral health care to those in need. The Dartmouth PATH Program is a multimedia-based computerized cognitive behavioral therapy tool designed to address stress, depression, and conflict management. The program maintains anonymity and requires no identifiable information from the user (eg, e-mail address). The stress and depression modules ask users to return to the program for six weekly visits. This program was shaped into an open-access resource and grew in popularity during the COVID-19 pandemic.
Objective: The primary aim was assessing the effectiveness, acceptability, and usability of a validated computer-based health program as a stand-alone therapy tool for depression, stress, and conflict management during the COVID-19 pandemic. A secondary objective was understanding the high dropout rates associated with online behavioral programs by contrasting the use and efficacy of the program for individuals who completed one session with those who returned and completed multiple sessions. The final objective was to determine users’ levels of stress and depression and the nature of problems and triggers they reported during the pandemic.
Use of a Self-Guided Computerized Cognitive Behavioral Tool During COVID-19
Haidar, Fatima This retrospective study aims to examine the effects of corticosteroid use on the treatment response and immune-related adverse events (irAEs) observed in patients with late-stage (stage 3 and 4) melanoma who receive Immune Checkpoint Inhibitors (ICIs) as part of their treatment plan. Our preliminary data suggests that corticosteroid use diminishes ICI treatment response in patients who are on higher doses (>20mg prednisone) or longer duration (>21 days) of corticosteroids. Effects of corticosteroid use on the treatment response of melanoma patients receiving ICIs
Haight, Elena To foster active learning in the Phase I Endocrinology course and support the transition to the new preclinical curriculum at Geisel, we drafted formative quizzes for each week of the course that will allow students to assess their areas of strength and weakness, and enable course faculty to identify areas requiring more teaching in advance of benchmark assessments. Development of formative assessment tools for the Geisel School of Medicine Phase I Endocrinology course
Halloran, Sean Following initial evaluation and management youth requiring inpatient mental health treatment are often held in the emergency department or admitted to an inpatient medical unit until inpatient psychiatric placement becomes available. This practice is referred to as boarding. Although the prevalence of boarding is increasing nationally, little research has examined the quality of healthcare delivery during the boarding period. Hospital boarding: A Qualitative Study of Healthcare Quality for Youth Awaiting Psychiatric Placement
Heflin, Katherine J Across the US, rural women are losing their maternity services. Hundreds of labor and delivery (L&D) units have closed over the past two decades, with now over half of all rural counties lacking an L&D unit. With these L&D closures in mind, Katherine "Rin" Heflin, MSPH, has been working with Dr. Timothy Fisher, MD, MS, from Dartmouth Hitchcock and The Dartmouth Institute, as well as with two teammates at the Urban Institute: Sarah Benatar, MA, PhD & Stacey McMorrow, PhD. Rin's sub-project is under the umbrella of a larger project for which the three researchers have been funded by RWJF to investigate the causes and resulting consequences of recent L&D closures in rural New Hampshire. With the guidance of these experts in women's health access, Rin has been exploring the national landscape of rural maternity access after L&D closures. This poster presents the results of the team's literature scan and analysis of the research question: what strategies have been deployed to improve access to necessary maternity services in the rural US in the aftermath of L&D closures, and what can be learned from these approaches? Mitigating Rural Service Gaps Following L&D Unit Closures: An environmental scan of strategies to improve maternity access
Hendrick, Gustaf Point of care ultrasound (POCUS) is used by many departments at Alice Peck Day Memorial Hospital (APDMH). There is currently no standard process for POCUS credentialing, performance, documentation, education, quality assurance, image storage, infection prevention, or billing in place. With this in mind, we lead a multidisciplinary effort to develop APDMH POCUS standards, document our experiences, and share with others through an agnostic POCUS website. To better understand the unique needs of other interested hospital systems, we also surveyed the American College of Emergency Physicians (ACEP) with questions we developed over the course of our project at APDMH. System-Wide Point of Care Ultrasound Initiative at Alice Peck Day Memorial Hospital
Hu, Yiyuan Impact of work status and age when choosing mode of AAA repair
Jensen, Kennedy Much of the evidence exploring burnout derives from urban settings and does not reflect the work and social contexts of physicians in rural areas. We sought to characterize health system factors that influence burnout among physicians practicing in the Canadian Arctic. Using a combination of electronic surveys and qualitative interviews, we conducted a mixed-methods study with non-locum physicians practicing in Nunavut, Northwest Territories, or Yukon in 2019. Factors inversely associated with ‘positive’ burnout profiles included use of electronic medical records (β = -0.7, p < .05), inadequate financial remuneration (β = -1.0, p < .05), and cross-cultural issues (β = -1.1, p < .05). Qualitative analysis revealed burnout was related to physician perceptions of lack of influence over health system policies, systemic failures in cultural safety, discontinuity of care, administrative burden, and physician turnover, among others. This work has important implications for the sustainability of northern health systems and may also shed light on physician well-being and workforce attrition in other resource-constrained or culturally diverse clinical settings. A Mixed Methods Study of Physician Burnout in the Canadian Arctic
Jimenez, Tomas The volume of research on racial disparities in breast cancer has increased over past two decades. However, the extent to which the current literature focuses on the inclusion, justification, and discussion of race and ethnicity as a driver of disparities is unknown. In this work, we specifically evaluated the hypothesis that definitions of race are poorly described in study’s methods and that few studies would name racism as a driver of disparities. Our systematic review finds that formal definitions of race are rarely present, categorizations and rationale for including race and/or ethnicity are imprecisely applied, and racism in any form is near absent in discussing drivers of racial disparities in breast cancer care and outcomes. Reporting on Race and Racial Disparities: The Neglect of Racism as a Driver of Inequitable Care
Kang, Kevin Adipose Tissue Preservation: Comparison of four reagents with storage at low temperature
Kim, Kyung Sik (Kenny) Patients presenting to the ED with mild-to-moderate alcohol withdrawal are currently treated on a case-by-case basis, with providers using clinical judgement to guide treatment in the absence of a standard protocol. We conducted a literature review of current guidelines on best-practice recommendations for the treatment of mild-to-moderate withdrawal in outpatient and ED settings, and administered a survey to DHMC ED providers to gauge how they currently manage their patients with mild-to-moderate alcohol withdrawal. We found that a standardized protocol for care of these patients would be appropriate, and have taken steps to work with the ED and Addiction Treatment Center at DHMC to come up with protocols and discharge plans for these patients. Developing a standardized protocol for treatment of mild to moderate alcohol withdrawal in the DHMC ED
Kinnear, Kathryn (Katie) An ongoing project developing and evaluating a virtual CenteringPregnancy program to provide pregnant people group prenatal education and support during the COVID-19 pandemic. Pregnant in a Pandemic: Virtual CenteringPregnancy Program Development and Pilot
Lites, Christopher (Chris) COVID-19 has increased isolation and decreased access to gyms and recreational centers that facilitate structured individual and group exercise (weight training, indoor cardio, boxing, etc). It remains unclear how medical students have adapted to this novel environment. Our goal in this survey study is to elicit physical activity perspectives and assess the change in exercise habits of medical students. We found that medical student activity has decreased significantly since the pandemic, and the majority of medical students are dissatisfied with their current levels of physical activity. School-from-home coupled with the closings of exercise facilities may encourage more sedentary lifestyles, and it remains unclear if this will result in a permanent change in behavior. Since physical activity has shown to improve wellbeing and decrease burnout of medical students, it is important to encourage and/or provide suggestions for COVID-safe modes of exercise (virtual classes, community challenges, socially-distanced/outdoor equipment). Medical Student Physical Activity Before & Throughout COVID-19
Liu, Sean Is there variability between patients when it comes to goal quality? There is a gap in the orthopaedics literature surrounding the effect of patient goal quality on outcomes. We propose the setting of high-quality goals as a means of increasing patient satisfaction and improving patient reported outcome measures after an orthopaedic procedure. This study explores preoperative patient goal quality (evaluated against SMART criteria) and investigates the relation between goal quality and patient activation, as well as patient reported outcome measures. Our findings show that few patients produce relevant or time-bound goals and even fewer produce goals that meet all of the SMART criteria; however, patient goal quality is not associated with patient activation and is inconsistently associated with patient reported outcome measures. Examining Patient Goal Quality, Patient Activation, and Patient Reported Outcome Measures in an Orthopaedic Surgical Population
May, Emily Our projects describes the development of formative pathophysiology assessments in the Phase 1, Year 1 Cardiovascular Medicine course. Integration of Formative Pathophysiology Assessment into the Phase 1
Morris, Linda The poster gives an outline of a clinical trial design and the rationale behind it. Pre-clinical and clinical data suggest that hydroxychloroquine (HCQ) has efficacy in prostate cancer treatment by modulating autophagy. This clinical study is designed to examine this effect closer by comparing tissue and serum markers of autophagy before and after HCQ treatment in patients undergoing radical prostatectomy for prostate cancer. A Placebo Controlled Proof of Principle Study of Hydroxychloroquine (HCQ) in Resectable Prostate Cancer in Patients Undergoing Radical Prostatectomy
Ndukwe, Marilyn The emergence and subsequent pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus had led to a surge in antimicrobial therapy. Patients presenting with COVID-19 have a clinical phenotype similar to bacterial respiratory infections, which can result in the use of broad-spectrum antibiotics that do not improve recovery from the viral illness and may result in unintended harm to the patient from antibiotic side effects and selection of resistant bacteria. According to the July 2020 International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) report, 72% of COVID-19 patients received antimicrobial therapy that tended to be mostly Ceftriaxone and Azithromycin, the empiric therapy for community acquired pneumonia. This is despite multiple papers suggesting that bacterial co-infection is rare with COVID-19. Evaluation of Antibiotic Selection in Patients Hospitalized with COVID-19 at DHMC
Obat, Dennis 27 weeks of intensive PLEX with 5% Albutein was perfomed on 15 ALS patients and their functional decline measured by serial ALSFRS-R scores and FVC measured over a 12-month period and compared to a control group of patients. The study found that the PLEX did not significantly slow the decline over the whole study period. There was, however, a statistically significant difference in the rate of decline during the intensive PLEX period as measured by ALSFRS-R. Rate of decline in FVC was not statistically different over the study period or the treatment period. Evaluating the Efficacy of Plasma Exchange for treatment of ALS
O'Connor, Michaela J Fanconi Anemia (FA) is an autosomal recessive disease that predisposes patients to bone marrow failure and cancers such as head and neck squamous cell carcinoma as children. FA results from mutations in FA/BRCA pathway proteins that are important in homologous recombination of DNA double-stranded breaks. IFN-γ is an inflammatory cytokine expressed at higher levels in the bone marrow of these patients and is thought to increase expression of PD-L1, leading to cancer cell protection from cytotoxicity. At the same time, elevated PD-L1 expression on cancer cells in these patients could be a bio marker of response to PD-1 checkpoint inhibitor immunotherapy to treat the cancer. This study explores the expression of PD-L1 in the presence and absence of IFN-γ in FA-mutated head and neck squamous cell carcinoma cell lines compared to non-FA mutated lines. PD-L1 expression is modulated by Interferon-gamma and Fanconi Anemia mutations in a Head and Neck Squamous Cell Carcinoma Cell Line
Okorie, Chiamaka (Amaka) Healthcare providers are often targeted as research participants, especially for implementation science studies evaluating provider- or system-level issues. Frequently, provider eligibility is based on both provider and patient factors. Manual chart review and self-report are common recruitment strategies, but demand substantial time, effort, and resources. Existing electronic health record (EHR) data may streamline provider identification for implementation science research. As an example, we describe recruitment methods for a Department of Veterans Affairs (VA)-funded study focused on implementing risk-aligned surveillance for bladder cancer patients. Using Electronic Health Records to Streamline Provider Recruitment For Implementation Science Studies
Palladino, Thomas Suspension laryngoscopy is commonly performed, but little is known about forces generated these procedures. The goal of this study was to identify correlates between patient factors and forces applied to soft tissues of the upper aerodigestive tract during suspension laryngoscopy, as well as effects these forces have on hemodynamic responses and anesthetic requirements. Forces During Suspension Laryngoscopy: Relationships with Hemodynamics, Anesthetic Requirements, and Patient Factors
Panton, Jasmin Suspension laryngoscopy is commonly performed, but little is known about forces generated these procedures. The goal of this study was to identify correlates between patient factors and forces applied to soft tissues of the upper aerodigestive tract during suspension laryngoscopy, as well as effects these forces have on hemodynamic responses and anesthetic requirements. Using Design-Thinking to Inform Preoperative Informed Consent: Balancing Surgeon and Patient Preferences
Panton, Zachary (Zach) A multicenter, retrospective analysis to determine ideal timing for ORIF and fasciotomy in patients suffering from traumatic tibial plateau fracture with concomitant ipsilateral compartment syndrome. Tibial Plateau Fractures and Compartment Syndrome: A Multicenter Retrospective Analysis
Pineda, Andrew Current guidelines recommend that the decision to pursue colonoscopy in older adults with polyps should be individualized. Because of this, written recommendations by endoscopists after colonoscopy play an important role in management. The purpose of this study was to understand primary care provider perspectives regarding written recommendations from colonoscopy reports among their patients, especially older adults with a history of polyps. Using semi structured interviews of 10 PCP’s in the NH/VT states, we obtained feedback on the content, inclusion of rationale, clarity and language of reports. We then identified key themes related to format of recommendations, key information in reports, amount of information, and areas for improvement. Written Communication after Colonoscopy: A Primary Care Perspective
Pomponio, Maria Spinal epidural abscess (SEA) is an uncommon infection associated with significant mortality. Discharges who live in rural regions of the US encounter unique barriers to healthcare delivery. Whether this impacts outcomes for rural discharges with SEA is unknown. To analyze the incidence, presentation, and outcomes of SEA in rural and urban hospitals in order to gain insight on the challenges of rural based healthcare in treating SEA. Understanding the association between rurality and outcomes of spinal epidural abscess
Quarles Stephens, Katherine (Katie) Sexual and Gender minority curriculum at Geisel, a review of areas of improvement and suggested changes. Sexual and Gender Minority Curriculum Improvement
Ramirez, Paolo Current guidelines recommend that the decision to pursue colonoscopy in older adults with polyps should be individualized. Because of this, written recommendations by endoscopists after colonoscopy play an important role in management. The purpose of this study was to understand primary care provider perspectives regarding written recommendations from colonoscopy reports among their patients, especially older adults with a history of polyps. Using semi structured interviews of 10 PCP’s in the NH/VT states, we obtained feedback on the content, inclusion of rationale, clarity and language of reports. We then identified key themes related to format of recommendations, key information in reports, amount of information, and areas for improvement. Written Communication after Colonoscopy: A Primary Care Perspective
Ratnapala, Nicole (Nikki) During the COVID-19 pandemic, gynecologic diagnosis for patients seen via telehealth predicts utilization of telehealth alone versus need for an office or procedure visit. Utilization of Health Services after a Gynecology Telehealth Visit during the COVID-19 Pandemic
Roldan, Christopher Vestibular Migraines (VM) are a collection of vestibulopathies (dizziness, vertigo, motion sensitivity) with or without migraines. VM accounts for up to 1% of illness in the American population, and specifically in migraines/headache clinics account for 9-11% of presenting patients. Current literature has failed to investigate data from CDP studies which we argue may be a way to make existing workup protocols more diagnostically useful. The data for this project includes 100 out of 3,500 patients whose CDP results were collected for the last 10 years. We compared the SOT results for VM and vestibular schwannoma (VS). Our results showed that unlike VS patients with an isolated peripheral pathology, vestibular migraine patients are not “vision dependent balancers” and maintain a consistent level of balance until there is a significant change in somatosensory cues. They can be termed “somatosensory sensitive.” The data presented shows only a small glimpse into the complexity of the entire data set. Future work will rely on artificial learning programs to find patterns in the data set that we can’t find using traditional methods. CDP as a Diagnostic Tool for the Evaluation of Vestibular Migraines
Ronner, Evette Improving Education for Medical Students About Caring for Patients with Disabilities
Ryan, Chenin Down Syndrome (DS) is the most common chromosomal disorder with an extensive range of dermatologic manifestations. While DS is a highly researched congenital condition, literature surrounding common dermatoses among the DS population is limited. This literature review aims to synthesize studies published on these cutaneous manifestations and compare the prevalence of these conditions between the DS and non-DS populations. Dermatologic Conditions in Patients with Down Syndrome
Shentu, Yujia (Yoga) Glioma accounts for a third of all primary brain tumor. Neutrophil-to-lymphocyte ratio (NLR) is computed as a systemic inflammation marker. Elevated NLR predicts worse outcome in tumor grading and survival. Change in Neutrophil-to-Lymphocyte Ratio Following Glioma Resection
Sorensen, Tanya Pre-Admission Testing Cognitive Screening Project: Improving patient care by creating a robust cognitive screening process that identifies at-risk patients with the purpose of decreasing adverse perioperative outcomes. Pre-Admission Testing Cognitive Screening Project
Suresh, Arvind We conducted a scoping review to explore how different medical schools in the US and Canada define and implement integration of basic and clinical sciences within preclinical courses in undergraduate medical education (UME), as well as the methods used to evaluate the success of integration. From our literature search, we identified 34 articles and categorized integration efforts into 3 overlapping categories: content integration, structure and format integration, and the use of clinical and diagnostic tools. The most common methods used to evaluate integration techniques included solicitation of student feedback, exam and assessment metrics, as well as direct student observation. From our scoping review, we found that there is no universally accepted framework of effective curricular integration at the course level or standardization in the methods used to evaluate integration efforts. We hope to use these data to design and test new methods to evaluate the extent and quality of curricular integration within UME courses. Integrating Foundational and Applied Science in the Preclinical Curriculum: A Scoping Review
Synan, Liam We found that hospital ratings on crowd-sourced websites are correlated with HCAHPS recommended hospital ratings but not surgical safety, and that ratings on different platforms were significantly different. The importance of these findings is that they demonstrate that crowd-sourced websites patients use to investigate hospitals may assess domains similar to those assessed by more validated measures. Crowd-Sourced Hospital Ratings are Correlated with Patient Satisfaction but not Surgical Safety
Tawde, Prianca While current literature sees clear correlations between opiate use in conscious patients and a variety of complications, little is known about long-term effects of opiates given to unconscious patients in surgery. Through literature and the perioperative data available through the multicenter perioperative outcomes group (MPOG), we inspected how varying amounts of intraoperative oral morphine equivalents correlated to different perioperative outcomes and ICD-10 diagnoses. Within this dataset, we saw that there were no significant differences demonstrated in the selected outcomes as they relate to the amount of intra-operative opioid used. We also outlined the limitations to the MPOG data as a tool for retrospective research. A view of Perioperative effects of Intra-operative Opioid use in Anesthesia
Telma, Katherine The SARS-CoV2 pandemic has disrupted health care around the world. The CovidSurg Collaborative is an international collaboration of hospitals providing real-time data to evaluate changes in practice and outcomes during the pandemic. I will be presenting a CovidSurg Collaborative paper on elective colorectal cancer surgery during the early pandemic. CovidSurg – Cancer: An International Cohort Study Assessing Cancer Surgery Safety During the SARS-CoV2 Pandemic - Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
Thamer, Semran Keratoconus is a progressive degenerative corneal disorder that often warrants the need for corneal transplantation. Photochemical corneal collagen cross-linking is the gold standard for addressing the underlying pathophysiology of keratoconus but does little to improve functional vision. Our study evaluates the safety and efficacy of combining refractive surgery with corneal collagen cross-linking to treat keratoconus. Photochemical Corneal Collagen Cross-Linking Combined with Refractive Surgery to Treat Keratoconus
Tocci, Noah A gap in the literature exists on the accuracy of the newest generation PET/ CT scanners in detecting cervical nodal metastasis, a tool that is essential for cancer staging. Through a retrospective chart review we sought to identify the overall sensitivity, specificity and accuracy for the newest generation PET/CT scanners and determine if the increased spatial resolution overcalls positive nodes during staging in head and neck cancer patients. Performance of Latest Generation PET/CT Scanner for detection of Metastatic Lymph Nodes in Head and Neck Cancer
Vargas, Irene Our primary objective of this study was to determine the rate of patient no-shows for telehealth visits at three DHMC General Internal Medicine clinics. We also wanted to identify the demographic variables associated with a higher likelihood of a telehealth of no-show occurrence. These variables can be leveraged to create targeted interventions that reduce patient no-show rates. Rates of Telehealth No-Shows at Dartmouth-Hitchcock General Internal Medicine Clinics
Wighton, Nakia An ongoing project developing and evaluating a virtual CenteringPregnancy program to provide pregnant people group prenatal education and support during the COVID-19 pandemic. Pregnant in a Pandemic: Virtual CenteringPregnancy Program Development and Pilot
Wray, Jennifer Point of care ultrasound is increasingly utilized in out of hospital settings. Because of Its portability and durability, its use is expanding to wilderness settings. This project investigates and distills the uses, considerations and limitations of handheld ultrasound in wilderness settings into an accessible, introductory chapter in the Advanced Wilderness Life Support text, a course designed for medical personnel interested in wilderness medical management. Handheld Ultrasound in Wilderness Settings: An Update to the Advanced Wilderness Life Support (AWLS) Text