Tulane University School Research Articles

Tulane University School of Medicine

Tulane University School of Medicine

Moving From Robotic to Personalized COVID-19 Care.

HomeCirculation: Heart FailureVol. 13, No. 7Moving From Robotic to Personalized COVID-19 Care Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBMoving From Robotic to Personalized COVID-19 Care Thierry H. Le Jemtel Thierry H. Le JemtelThierry H. Le Jemtel Correspondence to: Thierry H. Le Jemtel, MD, Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, SL-48, New Orleans, LA 70112. Email E-mail Address: [email protected] https://orcid.org/0000-0003-3315-6880 Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA. Search for more papers by this author Originally published25 Jun 2020https://doi.org/10.1161/CIRCHEARTFAILURE.120.007303Circulation: Heart Failure. 2020;13:e007303Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: June 25, 2020: Ahead of Print In retrospect, I may have contracted coronavirus disease 2019 (COVID-19) when directing a diaphoretic patient in respiratory distress toward the emergency room. Without symptoms for a few days, I continued rounding until profuse diarrhea and waves of deep exhaustion made it clear that I was on a downhill course. A few days later, I developed respiratory symptoms and was eventually confirmed as COVID-19 positive. Having heard that COVID-19 providers and patients may not directly communicate but commonly exchange medical information through an interactive personal application device, I recklessly drove North where I hoped a former colleague would communicate effectively with the intensive care unit team on my behalf.Deteriorating rapidly, I learnt that being 77 years old and without relatives and clearly stated advanced directives intubation was ill advised as it would increase the risk of contamination to the Critical Care Team. It did not seem to matter that before getting sick, I exercised 3 to 4 times per week, was free of any cardiac pulmonary or renal disease and working full time as a senior clinician.1With further deterioration and in response to my pleas, I was finally intubated and put in prone position for 5 days. My condition improved, and I was discharged from the hospital 3 weeks ago.The intent of this article is not to start a polemic with physicians who work through algorithms and communicate through their interactive personal application devices. The diagnosis of COVID-19 puts patients in a special hospital track: No visitors and scarce interaction with nurses and rotating attending physicians who monitor the patient through laboratory results. The only physician who sat down and spoke to me was offering enrollment in a randomized therapeutic trial. I fully understand that the lack of personal protective equipment was the major factor behind my limited interaction with nurses and physicians. However, protective equipment was used for instance for the delivery of meals I could not eat and temperature check every 4 hours when all other vital signs and clinical status were stable on telemetry.I am not advocating that critical care physicians risk their life to treat patients with COVID-19. I am pleading that, when time allows, estimated likelihood of success and not age or lack of advanced directives should be the key factor when deciding on mechanical ventilation. A noncritical care physician may help estimate the likelihood of success. When consulted soon after admission, this physician may have the time to collect all pertinent information and contact relatives. Furthermore, this consultant may be the best positioned to supervise continuity of care when patients leave the intensive care unit and to strengthen the physician-patient relationship that is an essential part of therapeutic success.Sources of FundingNone.DisclosuresNone.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to: Thierry H. Le Jemtel, MD, Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, SL-48, New Orleans, LA 70112. Email [email protected]edu

Safety of Mogamulizumab in Mycosis Fungoides and Sézary Syndrome: Final Results from the Phase 3 Mavoric Study

Safety of Mogamulizumab in Mycosis Fungoides and Sézary Syndrome: Final Results from the Phase 3 Mavoric Study

Recognizing and Minimizing Artifacts at CT, MRI, US, and Molecular Imaging.

Understanding the physical principles and technical assumptions that underlie image production can help radiologists eliminate or minimize common imaging artifacts and improve diagnostic accuracy.

Meet the First Authors.

Meet the First Authors.

Efficacy of Medical Students as Stop the Bleed Participants and Instructors

The Stop the Bleed (STB) program trains lay rescuers to identify and control life-threatening bleeding. Recently, medical students were allowed to become coinstructors. The aim of this study was to assess the efficacy of medical student course participation as both learners and instructors. No previous study to date has provided a critical objective assessment of medical student learners and educators of STB courses. Participants anonymously self-reported pre- and postcourse confidence in 6 major skill areas using a 5-point Likert scale. At the end of the course, students' ability to perform STB skills was assessed using an internally validated 15-point objective assessment tool. Two US medical schools (Tulane University School of Medicine and Louisiana State University in New Orleans) which represent private and state institutions, respectively. A total of 423 medical students were enrolled in the course. A pilot group of medical students volunteered to be instructors and their ability to effectively teach the course was objectively assessed. Overall precourse confidence was highest in holding pressure on a wound and lowest in identification of severe active bleeding. Postcourse participant confidence increased significantly in all 6 core areas, including confidence to teach hemorrhage control skills to others. Objective assessment of medical students by STB instructors found 72.4% of medical students achieving perfect scores on their skill proficiency assessments. An assessment of 48 medical student instructors found that all students were able to proficiently serve as instructors. This study demonstrates that medical students can effectively master STB skills and can also serve as competent course instructors. Future program development should focus on continued training of medical students and their involvement as instructors to help increase the availability of STB courses.

Effect of Community and Academic Surgical Rotation Sites on Medical Student Performance Outcomes and Career Choices

We hypothesize that students exposed to both academic and community surgery clerkship sites will have higher National Board of Medical Examiners Subject Exam in Surgery (NBME SES) scores and be more likely to pursue a career in a surgical specialty. The NBME surgery subject exam scores and National Resident Matching Program (NRMP) results were collected for all medical students rotating through the surgery clerkship over 4 years. Permutations of sites were analyzed against exam scores and match rates into surgical and nonsurgical specialties. This study was performed at the Tulane University School of Medicine, in New Orleans, Louisiana, United States of America. Data for a total of 910 students rotating through the surgery clerkship over a period of 4 years was collected and analyzed. There was no statistical difference in NBME subject exam scores (p = 0.44) or match rates into a surgical specialty (p = 0.13) as stratified by site placement. Average NBME surgery subject exam scores were higher for those pursuing a surgical specialty (p < 0.001). The combination of sites experienced during the surgery clerkship did not affect NBME surgery subject exam scores nor lead to a tendency to match into a surgical specialty.

Connections between Soil and Human Health

Connections between Soil and Human Health

Thomas A. LaVeist, PhD, Dean, Tulane University School of Public Health and Tropical Medicine

Thomas A. LaVeist, PhD, is featured on ACHE’s executive leadership podcast, “A Leader Who Cares,” available via iTunes or www.ache.org/journals.

A Surgeon Led Clinically Focused Anatomy Course Increases Student Selection of General Surgery As a Career

This study aims to identify program-specific critical factors in a student's path to general surgery and how different factors contribute to our high rate of matriculation. Semi-structured interviews were conducted focusing on critical factors in student's decision processes to pursue general surgery. Three investigators independently evaluated the transcripts and identified recurring themes based on phenomenological qualitative methods until saturation was achieved. Inter-rater reliability was determined. The study took place at Tulane University School of Medicine, an academic medical center in New Orleans, Louisiana. Current fourth-year students from our medical school, applying into general surgery, were interviewed for the study. Twelve of 21 students were interviewed. The most common factor cited was the positive effect of clinically based anatomy and of having surgeons in anatomy (81%). Other factors mentioned included interest before medical school, clerkship experience, and mentor interactions; Kappa was 0.76 or higher for each theme. A clinically focused anatomy course led by surgeons at our institution has a significant impact on a general surgery career choice. With the constant evolution of the medical field, understanding what guides students toward a career in general surgery will better assist medical education planners in providing resources that will positively impact future classes.

Group A Streptococcus.

1. Monika L. Dietrich, MD* 2. Russell W. Steele, MD†,‡ 1. *Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 2. †Department of Pediatrics, Ochsner Health Center for Children, New Orleans, LA 3. ‡University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA * Abbreviations: ANF: : acute necrotizing fasciitis ARF: : acute rheumatic fever GAS: : group A Streptococcus IVIG: : intravenous immunoglobulin MRSA: : methicillin-resistant Staphylococcus aureus MSSA: : methicillin-susceptible S aureus PANDAS: : pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections PSGN: : poststreptococcal glomerulonephritis STSS: : streptococcal toxic shock syndrome 1. Clinical prediction rules for group A Streptococcus pharyngitis are unreliable in children, and unless viral etiology is strongly suspected, throat swab with a rapid antigen detection test should be performed. 2. Avoid “proof of cure” cultures when treating pharyngitis. 3. Clindamycin is important in invasive group A Streptococcus infection for toxin mediation but should not be used alone secondary to possible resistance. After completing this article, readers should be able to: 1. Understand the epidemiology, transmission, and major virulence factors of group A Streptococcus (GAS) infections. 2. Plan the appropriate diagnostic evaluation of suspected GAS infection. 3. Recognize the clinical features of, and major complications associated with, invasive and noninvasive GAS infections. 4. Plan appropriate management for a patient with a GAS infection. In 1933, Rebecca Lancefield changed our understanding of β-hemolytic streptococci by developing a system of serologic classification based on the carbohydrate composition of cell wall antigens. Of these organisms, the most significant in human pathogenicity is group A Streptococcus (GAS), otherwise known as Streptococcus pyogenes . (1) GAS is responsible for an impressively wide variety of clinical manifestations, from noninvasive infections, such as pharyngitis, scarlet fever, erysipelas, and cellulitis, to invasive disease, including sepsis, streptococcal toxic shock syndrome (STSS), and necrotizing fasciitis (Table 1). It has also been linked to multiple nonsuppurative complications including acute rheumatic fever (ARF), poststreptococcal glomerulonephritis (PSGN), and the controversial pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Globally, an estimated 18 million people are suffering from a serious GAS-related illness, with about 1.78 million new cases annually. Hundreds of millions of people develop less serious GAS infection every year, placing a massive burden on healthcare systems. The …

Evaluation of Training Program for the Maternal and Child Health Workforce at Tulane University.

ObjectivesDespite significant investments in Maternal and Child Health (MCH), the United States still lags behind other countries in key MCH indicators. A well-trained workforce is needed to improve MCH. The Division of MCH Workforce Development of HRSA's Maternal and Child Health Bureau provides funding to schools of Public Health to support Centers of Excellence in MCH, which is focused on preparing the next generation of MCH leaders through specialized training and mentorship. One such center, the Tulane Center of Excellence in MCH (CEMCH), is housed at the Tulane University School of Public Health and Tropical Medicine. This study evaluated the perceived effectiveness and acceptability of the CEMCH leadership training program. MethodsA mixed-methods approach was used, consisting of semi-structured interviews and quantitative surveys which were analyzed through inductive methods based in grounded theory and non-parametric methods respectively. Results Results indicated an overall high level of program satisfaction by all stakeholders. Mentorship and personal attention emerged as an important benefit for both former and current Scholars. The opportunity to gain real-world understanding of MCH work through program activities was an added benefit, although these activities also presented the most challenges. Community stakeholders generally did not view the program as providing immediate organizational benefit, but recognized the distal benefit of contributing to a well-trained MCH workforce. Conclusions for PracticeThese results will be used to inform other MCH training programs and strengthen Tulane's CEMCH. A well-trained MCH workforce is essential to improving MCH, and high-quality training its foundation.

Conducting Team‐based Learning Simultaneously Across Multiple Venues: Challenges and Impact on Student Satisfaction

ObjectiveEarly studies have demonstrated that conducting Team‐based Learning (TBL) modules in a technology‐enhanced environment can be conducive to active learning. Precise details regarding the advantages of these spaces are limited. We hypothesized that students would value the environment of Tulane University's Center for Active Learning due to the technological advantages, increased level of access to subject matter experts, and ease of group interaction.MethodsThe Gross Anatomy course at Tulane University School of Medicine is a regions‐based course encompassing lecture, cadaveric dissection, and TBL sessions across 11 weeks at the beginning of the first year of Medical School. In the 2017–2018 academic year, six TBL modules were implemented to teach radiological anatomy. Four of the TBLs took place in cadaver labs (CL) each accommodating 26–32 students, and two of the TBLS took place in the Center for Active Learning (CAL), which can accommodate the entire cohort of 175 first‐year medical students. All students participated in the TBLs in groups of 6. In the DL, 14 teaching assistants facilitated the TBL modules. In the CAL, the course director facilitated the TBLs and a radiologist provided any instruction needed to complete the exercises. All TBL modules were conducted following the core principles of the TBL pedagogy described by Michaelson and Sweet which include pre‐work and individual and group readiness testing. Group‐ and facilitator‐led discussions followed the quizzes to identify gaps in preparation. Team application exercises to reinforce the learned material followed. In the DL, the students used individual laptop computers to access the group quizzes and application exercises. In the CAL, these were deployed on multiple wall‐mounted 65” flat‐screen monitors, easily viewable to all in the room. Four times during the course students were queried regarding their perceptions of the TBLs using a 5‐point Likert scale and standardized open‐ended questions. Answers to the questions underwent qualitative analysis and were coded based on common themes.ResultsTotal number of subjects was 175. The data collected from the Likert responses revealed that 77.1% believed the TBL sessions were effective in helping them learn and understand the radiographic material regardless of the location. Key themes that emerged from the open‐ended questions included: difficulty with accessing the documents on personal laptops within the DL; preferences for either the teaching assistants or the course director and radiologist for facilitation of the learning process, and preferences for a collaborative learning space.ConclusionConducting the TBL modules within the CAL increased student's ease of access to the quiz contents and the application exercises. Students prefer the CAL over the labs to increase student participation and discussionby the course director. More studies are needed to further explore the preferences to optimize learning through the TBL modules.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Effect of Anatomical Radiology Team‐based Learning on Student Ability to Recognize Imaging Findings Critical to Medical Practice

BackgroundPast studies have shown incorporating radiology into gross anatomy courses improves student understanding of spatial relationships and confidence in radiological interpretations. As a method of teaching, the use of Team‐based Learning (TBL) has become popular to improve team interactions, retention of material and application of challenging concepts. However, incorporating clinically oriented radiology into TBL sessions during the first‐year medical gross and developmental anatomy course has not been studied. We hypothesize implementation of clinically oriented radiology TBL modules in the first‐year medical school anatomy course will be an effective method of teaching the higher order thought processes needed to identify critical imaging findings and will be well received by the learner.MethodsRadiology content experts were queried regarding critical findings commonly encountered in various medical specialties. A total of five TBLs were developed incorporating these critical findings. All medical students participated in the TBLs, in groups of 6. Groups were proctored by teaching assistants who were trained by radiologists and surgeons. Four block tests were given over the course. The tests were composed of structure identification practical examinations and radiographic findings where the student used the findings to develop a diagnosis. The practical examination results were evaluated for correct answers for the test as a whole and on the radiologic answer subset. Whole test and radiologic subset results were compared using chi‐squared test with p&lt;0.05 considered significant. At the conclusion of each block students were queried regarding their perceptions of the TBLs using a 6‐point Likert scale and standardized open‐ended questions. Answers to the questions underwent qualitative analysis and were coded based on common themes.ResultsTotal number of subjects was 206. Comparison of group mean for the structural identification and the radiographic findings for each block test showed no difference. (Table 1). The data collected from the Likert responses identified 77.1% believed the TBL sessions were effective in helping learn and understand the radiographic material. Key themes that emerged from the open‐ended questions included: Value of peer‐to‐peer teaching, increased confidence in the ability to recognize imaging findings, and improved critical thinking competencies.ConclusionTeaching clinically‐oriented radiologic anatomy through TBL modules is an effective method of developing the thought processes needed to solve problems given to learners in the form of examination questions requiring the development of a diagnosis. Additionally, the TBL format increased student confidence in approaching radiological imaging, promoted peer to peer teaching, and increased student self‐reported critical thinking abilities.Support or Funding InformationThe study was in part funded by a mini grant received by MLK from the Office of Medical Education at Tulane University School of Medicine.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Impact of Redesigned Anatomy Problem-Based Learning Curriculum on Student Satisfaction

Problem-based learning (PBL) was developed by McMaster University (MMU) in response to students’ concerns about conventional lecture-based pedagogy. Tulane University School of Medicine (TU) supplemented its traditional lecture and dissection-based curriculum for Gross and Developmental Anatomy with the addition of PBL in 2007. In 2016, TU restructured the PBL modules to resemble the structure of MMU’s PBL. TU eliminated the lecture portion of the old PBLs to enhance interactive self-directed learning, and divided the class into smaller groups to facilitate more student interaction. It was hypothesized that this would increase students’ confidence in their problem-solving skills and enhance overall satisfaction with the PBL portion of the curriculum despite an increase in pre-class workload. Two-hundred first-year medical students were given anonymous surveys after each of the three PBL sessions to assess the students’ overall satisfaction with the PBL. A traditional Likert scale was used and written comments were collected. The TU students valued the revised PBL as a learning tool; specifically, the benefit of pre-class research, small group discussion, close faculty interactions, and clinical application of lecture material. Data collected demonstrated that 89% of students were satisfied with this part of their curricula for each respective PBL, despite the shift of initiative onto the students for self-directed learning in the new PBLs. The education of medical students supplemented by PBLs continues to be a useful tool and can be considered as a positive addition to a Gross and Developmental Anatomy course.

Editorial introductions

Editorial introductions

In This World but Not of It: Conflicting Vietnam War Perspectives Within the Mormon Hierarchy

Research Article| January 01 2017 In This World but Not of It: Conflicting Vietnam War Perspectives Within the Mormon Hierarchy Luke Miller Luke Miller LUKE MILLER graduated from Brigham Young University in 2015 with a bachelor of arts in history where he focused on military, Mormon, and intellectual history. He currently lives in New Orleans with his lovely wife where he is studying to be a doctor of medicine at Tulane University School of Medicine. Search for other works by this author on: This Site Google Journal of Mormon History (2017) 43 (1): 152–177. https://doi.org/10.5406/jmormhist.43.1.0152 Cite Icon Cite Share Icon Share Facebook Twitter LinkedIn MailTo Permissions Search Site Citation Luke Miller; In This World but Not of It: Conflicting Vietnam War Perspectives Within the Mormon Hierarchy. Journal of Mormon History 1 January 2017; 43 (1): 152–177. doi: https://doi.org/10.5406/jmormhist.43.1.0152 Download citation file: Zotero Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All Scholarly Publishing CollectiveUniversity of Illinois PressJournal of Mormon History Search Advanced Search The text of this article is only available as a PDF. Copyright 2017 by the Board of Trustees of the University of Illinois2017 Article PDF first page preview Close Modal You do not currently have access to this content.

Health provider experiences with galactagogues to support breastfeeding: a cross-sectional survey.

BackgroundExclusive breastfeeding for infants up to 6 months is widely recommended, yet breastfeeding rates are relatively low in the US. The most common reason women stop breastfeeding early is a perceived insufficiency of milk. Galactagogues are herbal and pharmaceutical products that can help increase milk supply; however, data on their efficacy and safety is limited. Lactation consultants, obstetricians, and other health providers are an important point of contact for breastfeeding women experiencing challenges with lactation. This study explored providers’ perceptions, experiences, and practices in relation to galactagogue recommendation.MethodA cross-sectional survey was conducted among a convenience sample of English-speaking health providers in the US who counsel breastfeeding women and their infants.ResultsMore than 70% of respondents reported to recommend galactagogues. The most frequently recommended galactagogue was fenugreek with respondents indicating that they recommend it either ‘always’ (8.5%) or ‘most of the time’ (14.9%) and ‘sometimes’ (46.8%). More than 80% of the respondents indicated that galactagogues were useful for their clients and only one-third reported side effects. Reasons for refraining from recommending galactagogues were insufficient evidence of its efficacy and safety. Respondents reported a wide variety of sources of information used for their own education about galactagogues.DiscussionDespite little evidence regarding safety and efficacy, some galactagogues are widely recommended and often perceived to be useful. However, concerns about their efficacy and safety remain. In order to assure both providers and users about safety and efficacy, more robust studies as well as better pharmacovigilance systems are needed.

Factors associated with vitamin D status of low-income, hospitalized psychiatric patients: results of a retrospective study.

BackgroundRecent evidence has indicated a potential role of vitamin D3 in a range of neuropsychiatric outcomes, as well as on cognitive function, but conflicting data have left that role uncertain. Understanding potential associations of vitamin D status with psychiatric illness will allow clinicians to better assess therapeutic options. Few studies have examined vitamin D status among a racially diverse group of psychiatric patients who have been hospitalized, and none has done so in the southern US where socioeconomic inequality is high.MethodsIn this retrospective study, medical records from 113 patients hospitalized for psychiatric illness were retrieved and analyzed. Vitamin D status in this population was estimated, along with any patterns of association between deficiency and risk factors.ResultsThe vast majority of patients hospitalized for psychiatric illness in this biracial, low-income sample had either insufficient or deficient vitamin D levels. African-American patients had lower levels of vitamin D than Caucasian patients.DiscussionOur findings demonstrate that hospitalized psychiatric patients are at increased risk for vitamin D deficiency and in particular low-income, African-American populations. These results suggest that vitamin D should be assessed and therapy considered at the initiation of psychiatric hospitalizations.

Educator Argues for Integrating Infant MH in Child Psychiatry Training

Educator Argues for Integrating Infant MH in Child Psychiatry Training