Health Sciences

Making Learning Visible in the Clinical Team-based Simulations

In the medical field, the concept of “breaking bad news” is incredibly important for future doctors and social workers to practice and receive meaningful feedback on. The moment a medical professional tells a family member bad news, that instance stays with the patient’s family for the rest of their life. Our team transcribed, analyzed, and interpreted over 150 medical simulation videos to analyze body language, tone of voice, and responses to see how they reacted to feedback from debriefers. Our goal is to optimize the feedback given in order to fully prepare future medical professionals for this critical task. This study was conducted on a sample of over 150 fifteen-minute long videos of medical and social work students debriefing with supervisors about their breaking bad news standardized patient simulation.

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Neutrophil depletion’s effect on lung cancer

jmanassa

Lung cancer remains the leading cause of cancer-related deaths worldwide, with non-small cell lung cancer (NSCLC) making up 85% of lung cancers. NSCLC is comprised of adenocarcinomas and lung squamous cell carcinoma and develops primarily in individuals over the age of 55 who regularly smoke. Current research on the tumor microenvironment revealed that neutrophils, a type of white blood cell responsible for fighting infections, actually aids tumor progression by allowing the creation of chemotaxis that promote tumor metastasis. Additionally, current immunotherapies are only 30% effective. This study looks specifically at how neutrophils affect the tumor microenvironment (TME). We hypothesized that if neutrophils depleted in mice with adenocarcinoma they would decrease in tumor burden, as the chemotaxis transport mechanism for cancer cells would be gone. We have established a murine model of lung cancer, wherein expression of oncogenic Kras and p53 can be controlled genetically, allowing activation of oncogenic Kras to initiate tumor growth, tumor eradication upon Kras depletion and re-activation as a means to model relapse, and p53 speeds up tumor progression. Control mice were used alongside our cancer inducible mice, to test the effects of neutrophil depletion. Half of the mice were given the antibody IgG that has no effect on neutrophil depletion while GR-1, a neutrophil depleted antibody was given to the other half. After 4-week treatment, we took lung tissue; paraffin embedded it and stained it with HE. Tumors were counted and the subsequent analysis revealed 1) Mice with both Kras and p53 on have more tumors than those with just Kras on 2) Neutrophil depletion resulted in lower tumor counts for mice. In summary, neutrophils play likely a tumor-promoting role in lung cancer. Depletion of neutrophils by antibodies resulted in a decrease in tumor burden suggesting new treatment option for lung cancer patients by modulating TME.

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Quantifying Gene Regulation in HNSCC

anishaag

My project focuses on developing precision medicine for head and neck squamous cell carcinoma (HNSCC). Many HNSCC tumors are caused by human papilloma virus (HPV) infection. E7, an HPV protein, has proven to occasionally change the expression of certain genes in HPV positive tumors. My project aims to analyze RNA expression patterns to determine what triggers HPV-mediated gene regulation. We collect RNA from patient-derived cell lines and generate a complimentary DNA (cDNA) sample. We then use the process of qPCR to replicate the cDNA and measure the CT value. This value quantifies RNA expression where a low CT value implies higher amounts of RNA in the original sample meaning increased transcription of our gene of interest. Finally, we will use a script written in R Code to create a summary table of qPCR data along with a graph of CT values. We have already generated, and verified using qPCR, cell lines that express HPV genes. We expect that the expression of the HPV E7 gene will decrease the expression of the HLAA, HLAB, and HLAC genes, all of which are needed for an antiviral and anti-tumor immune response. By measuring the effect HPV genes have on the transcription of immune response genes, we will be able to understand the mechanism by which HPV evades the immune system. As of now, treatments for HNSCC are similar to those for the majority of cancer types. This research will help develop treatment tailored to HNSCC which can hopefully improve recovery for afflicted patients.

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A National Study of Expedited Partner Therapy in Academic Emergency Departments

Rafael Cortes

Background: Rates of sexually transmitted infections (STIs) in the United States are rising dramatically. EDs serve as the primary source of care for many patients diagnosed with STIs. Expedited Partner Therapy (EPT), an evidence-based practice for treating partners of patients with STIs without an exam, can decrease rates of STI reinfection and increase the number of partners treated. Despite the potential benefits of EPT, its use in EDs is poorly understood. Objective: This study characterizes the knowledge, beliefs, interest, and practice of EPT among academic ED medical directors through a cross-sectional survey. We also explore barriers and facilitators to EPT implementation through semi-structured interviews of medical directors and key informants conducted using an interview guide informed by the Consolidated Framework for Implementation Science. Interviews were recorded, transcribed, and iteratively coded, and qualitative thematic analysis was used to identify themes and subthemes by consensus. Results: A total of 48 out of 70 medical directors responded. There was a high awareness of EPT (73%), but only 38% knew how to prescribe EPT, and even fewer (19%) had actually implemented it. Most respondents supported EPT (79%), and were more likely to support EPT if they were already aware of it (89% vs 54%). 41% of those who had not implemented EPT thought that it would be feasible, and 56% thought that departmental support would be likely. Many participants cited medicolegal barriers and lack of clarity regarding the ED’s role in STI care as obstacles to EPT adoption. Other participants cited a perceived benefit of EPT use was the prevention of untreated STIs, particularly among a vulnerable population. Conclusion: Our findings show relatively low use but high interest in EPT in academic EDs, and show the need for increased awareness to implement this public health intervention in the ED setting.

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Increasing access to STD treatment in the Emergency Department through EPT

ejwchang

Background: Rates of sexually transmitted infections (STIs) in the United States are rising dramatically. EDs serve as the primary source of care for many patients diagnosed with STIs. Expedited Partner Therapy (EPT), an evidence-based practice for treating partners of patients with STIs without an exam, can decrease rates of STI reinfection and increase the number of partners treated. Despite the potential benefits of EPT, its use in EDs is poorly understood. Objective: This study characterizes the knowledge, beliefs, interest, and practice of EPT among academic ED medical directors through a cross-sectional survey. We also explore barriers and facilitators to EPT implementation through semi-structured interviews of medical directors and key informants conducted using an interview guide informed by the Consolidated Framework for Implementation Science. Interviews were recorded, transcribed, and iteratively coded, and qualitative thematic analysis was used to identify themes and subthemes by consensus. Results: A total of 48 out of 70 medical directors responded. There was a high awareness of EPT (73%), but only 38% knew how to prescribe EPT, and even fewer (19%) had actually implemented it. Most respondents supported EPT (79%) and were more likely to support EPT if they were already aware of it (89% vs 54%). 41% of those who had not implemented EPT thought that it would be feasible, and 56% thought that departmental support would be likely. Many participants cited medicolegal barriers and lack of clarity regarding the ED’s role in STI care as obstacles to EPT adoption. Other participants cited a perceived benefit of EPT use was the prevention of untreated STIs, particularly among a vulnerable population. Conclusion: Our findings show relatively low use but high interest in EPT in academic EDs, and show the need for increased awareness to implement this public health intervention in the ED setting.

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Multimodal Retinal Imaging of Usher Syndrome Animal Model of Photoreceptor Degeneration

ecgilly

Emilie Gilligan Pronouns: she/her Research Mentor(s): Yannis Paulus, Assistant Professor, Tenure Track Research Mentor School/College/Department: Ophthalmology and Visual Sciences, Michigan Medicine Presentation Date: Thursday, April 22, 2021 Session: Session 5 (3pm-3:50pm) Breakout Room: Room 12 Presenter: 5 Event Link Abstract For privacy concerns this abstract cannot be published at this time. Authors: Emilie Gilligan, Ashley

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THE ASSOCIATION OF VISION, DISABILITY, AND WELLBEING TRAJECTORIES IN OLDER US ADULTS

rohankai

The National Health and Aging Trends Study (NHATS) is an ongoing national study of the elderly population in the U.S. and is focused on vision impairment (VI) and blindness disability and allows researchers to study the variety of the key disadvantageous consequences linked with VI in older adults. This assessment of VI through NHATS to done through a series of survey questions that require binary responses and past studies to construct a binary indicator of VI an approach that may restrict the precision of the data measurements. To address this, a 6-level measurement of VI was created to validate each of the vision-related questions in the survey. It is expected that there will be a more rapid deterioration experience in the vision of older adults leading to a decline in function and wellbeing when contrasted to those with healthier vision. This study examines the association of vision with changes in injury and wellbeing directions in the elderly. The hypothesis is that a higher level of VI will be strongly connected with declining disability and wellbeing trajectories. Further, we anticipate that the impact of VI on disability and wellbeing will be greater among minority groups such as Black and Hispanic subjects compared to White participants. The results of this study will inform future targeted interventional research to optimize health, wellbeing, and independence for the growing number of older adults with VI.

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Stakeholder perspectives on using patient-reported outcomes: a qualitative study

adamchal

Stakeholder perspectives on using patient-reported outcomes: a qualitative study Authors: Adam Chalak, Yomei Shaw, Faith Reger, Neda Kortam, Yujia Li, Dinesh Khanna Background/objectives: Patient-reported outcome measures (PROs) are questionnaires that provide patients coping with disease a medium that essentially places them at the forefront of the decision-making and treatment process. The questions aim to measure patient perceptions of symptoms and health status. Quite recently, we have seen a surge in literature based on this healthcare tool in rheumatology. Although reviewing PRO results helps patients and health care providers communicate about impacts of disease on wellbeing, we see a significant lack of clinical implementation in rheumatology. This qualitative study serves as the pilot study for an upcoming clinical trial of strategies to promote PRO use in rheumatology. We conducted interviews with stakeholders to assess the acceptability of study procedures and materials to rheumatology health care providers and patients. Methods: Semistructured interviews were conducted with healthcare providers and patients in rheumatology over video or phone call. Interview transcripts were transcribed and were subsequently analyzed by qualitative coding through NVIVO software. Results: Eight health care providers, two patients, and three research team members participated in the interviews. Based on comments extracted from the interviews, we see that many HCPs and patients find great significance and relevance in the utilization of PRO data in treatment and patient-self management. However, many clinicians note various logistics issues (such as time management, patient motivation, data interpretation, question difficulty) that hinder implementation. Conclusion: This study provides insight on how PRO measures can be integrated more effectively in the clinical setting while also revealing misconceptions on the tool by HCPs.

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Integrating patient-reported outcomes into rheumatology practice

freger

Background: Many patients with rheumatic diseases have symptoms like pain and fatigue in spite of their treatment [1,2]. Patients also often disagree with their health care providers (HCPs) in their perceptions about their disease [3]. One method that helps facilitate better patient-provider communication about symptoms is the use of patient reported outcomes (PROs). PROs are a patient’s self report of their health status or symptoms. Many HCPs in the Division of Rheumatology do not use PROs in their clinical practice. Objectives: The aim of this study is to assess the impacts, barriers, and facilitators of incorporating PROMIS measures for pain, physical function, and sleep disturbance into clinical rheumatology practice.

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