Wright State University Boonshoft School Research Articles

Lichen Planus

HomeRadioGraphicsVol. 43, No. 4 PreviousNext Cases from the Cooky JarFree AccessLichen PlanusEdward McDermott , Nadia Solomon, Annelise M. Silva, Parisa KhoshpouriEdward McDermott , Nadia Solomon, Annelise M. Silva, Parisa KhoshpouriAuthor AffiliationsFrom the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin D07 R2WY, Ireland (E.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (N.S.); Department of Education, Wright State University Boonshoft School of Medicine, Dayton, Ohio (A.M.S.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Md (P.K.).Address correspondence to E.M. (email: [email protected], @edwardmcd).Edward McDermott Nadia SolomonAnnelise M. SilvaParisa KhoshpouriPublished Online:Mar 16 2023https://doi.org/10.1148/rg.220200MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Lichen planus is a chronic condition that predominantly affects middle-aged and older women and represents an autoimmune T-cell–mediated inflammatory disorder (Fig 1) that affects the skin, oral and genital mucosa, esophagus, hair, and nails (1). Cutaneous involvement manifests with flat violaceous papules, and mucosal manifestations typically manifest with white lacelike lesions, papules, erythematous lesions, and erosions (Fig 2) (2). Esophageal lichen planus has been reported in more than 50% of patients with mucocutaneous lichen planus and is underrecognized and underreported (2).Figure 1. Esophageal lichen planus. There are limited studies of the pathogenesis of esophageal lichen planus, but it appears to be mediated by cytotoxic CD8-positive T cells. Biopsy of affected esophageal tissue shows keratinization with inflammatory cell infiltration of the epithelium with activated T lymphocytes (6).Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. Mucosal manifestations of lichen planus in a 73-year-old woman who presented with solid food dysphagia. (A) Photograph shows white plaquelike lesions on the tongue. (B) Endoscopic image demonstrates erythema and white papules (arrows).Figure 2.Download as PowerPointOpen in Image Viewer Barium esophagography is the most relevant imaging study to evaluate esophageal lichen planus. Imaging features include a smooth small-caliber esophagus with cervical esophageal webs, strictures, and pseudodiverticula (Fig 3) (3,4). Strictures most commonly occur in the proximal esophagus, and their presence correlates with a longer duration of disease (5). Squamous cell carcinoma of the esophagus has been rarely reported in patients with esophageal lichen planus; for this reason, early diagnosis is key.Figure 3. Esophageal lichen planus in a 73-year-old woman (same patient as in Fig 2). Barium esophograms show smooth long stricturing of the entire course of the esophagus with tapered margins (white arrow in A) and esophageal webs (black arrows in A). There are focal weblike strictures in an overall small-caliber lumen of the cervical esophagus (black arrow in B). Overall thin smooth luminal narrowing of the entire course of the esophagus is seen in C.Figure 3.Download as PowerPointOpen in Image Viewer Patients with esophageal lichen planus often present with dysphagia related to the strictures, with reflux-type symptoms, and weight loss. Strictures can be treated with balloon dilation, although this often requires regular repeat treatments (5). Endoscopic findings include superficial white papules, pseudomembranes, webs, and strictures.Disclosures of conflicts of interest.—All authors have disclosed no relevant relationships.AcknowledgmentWe thank Ciléin Kearns, MD, MBChB, for feedback and advice on the medical illustration in Figure 1.All authors have disclosed no relevant relationships.

Oral Anticoagulants for Atrial Fibrillation: Benefits Outweigh Risks for Older Adults

Oral Anticoagulants for Atrial Fibrillation: Benefits Outweigh Risks for Older Adults

Prescribing and Deprescribing for Heart Failure

Prescribing and Deprescribing for Heart Failure

Wright State University Boonshoft School of Medicine.

Wright State University Boonshoft School of Medicine.

Unilateral Anhidrosis With Ipsilateral Basal Cell Carcinomas

Wright State University Boonshoft School of Medicine, Dayton, Ohio Dayton Skincare Specialists, Kettering, Ohio Dayton Skin Care Specialists, Kettering, Ohio The authors have indicated no significant interest with commercial supporters.

Early Childhood Behavioral Health: Can the Medical Neighborhood Move Us Forward?

The importance of early childhood experiences in setting the foundation for long-term health and behavioral outcomes has been well established. It has been maintained that the science of child development and the core capabilities of adults highlight several principles that can be used to improve outcomes for children and families. To assure optimal outcomes, we must support responsive relationships for children and adults, strengthen core life skills, and reduce sources of stress in the lives of children and families.1 In this issue of Pediatrics , Brown et al2 report their findings in “Preventive Behavioral Health Programs in Primary Care: A Systematic Review.” They focus on studies of preventive behavioral health for children 0 to 5 years old. The authors use the guidelines from the Society for Prevention Research3 to examine the efficacy, effectiveness, and readiness for scale-up of preventive interventions considered applicable … Address correspondence to John C. Duby, MD, CPE, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children’s Hospital, 1 Children’s Plaza, Dayton, OH 45404. E-mail: john.duby{at}wright.edu

Help Wanted: Psychiatrist/Psychotherapist

Help Wanted: Psychiatrist/Psychotherapist

Free Online Training Modules Hoped to Attract More Students to Psychiatry

Free Online Training Modules Hoped to Attract More Students to Psychiatry

ADMSEP Leaders Adapt Milestones to Medical Student Education

ADMSEP Leaders Adapt Milestones to Medical Student Education

Warfarin-Induced Tissue Necrosis (WITN): Case Report and Literature Review A Proposed Name Change

Volume 1 | Issue 1 Warfarin-Induced Tissue Necrosis (WITN): Case Report and Literature Review, A Proposed Name Change Simman R*1, Gould N2 and Jackson SE3 1Plastic and Reconstructive Surgery, Pharmacology and Toxicology, Wright State University Boonshoft School of Medicine, Dayton Ohio 2Family Medicine Program, Grand View Hospital, Kettering Health Network. Dayton, Ohio 3Clinical Assistant Professor of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio *Corresponding author: Simman R, Department of Surgery, Wright State University Boonshoft School of Medicine, E-mail: plasticsimman@yahoo.com Case Report Open Access Volume 1 | Issue 1 Journal of Surgery and Operative Care

Domain of Competence: Practice-Based Learning and Improvement

From the Wright State University Boonshoft School of Medicine, Dayton, Ohio (Dr Burke); Department of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minn (Dr Benson); Association of American Medical Colleges, Washington, DC (Dr Englander); Competency-Based Assessment, The American Board of Pediatrics, Chapel Hill, NC (Dr Carraccio); and Department of Pediatrics, Childrens Hospital of Philadelphia, Philadelphia, Pa (Dr Hicks) The views expressed in this report are those of the authors and do not necessarily represent those of the Accreditation Council for Graduate Medical Education, the American Board of Pediatrics, the Association of Pediatric Program Directors, or the Academic Pediatric Association. The authors declare that they have no conflict of interest. Publication of this article was supported by the American Board of Pediatrics Foundation and the Association of Pediatric Program Directors. Address correspondence to Ann E. Burke, MD, Wright State University Boonshoft School of Medicine, One Children’s Plaza, Dayton Children’s Hospital, Department of Pediatrics, Dayton, OH 45404 (e-mail: ann.burke@wright.edu).

Topics in Geriatric Medicine

OPEN ACCESSOctober 10, 2013Topics in Geriatric Medicine Michael Markus, MD, Catherine Sheffield Michael Markus, MD Wright State University Boonshoft School of Medicine Google Scholar More articles by this author , Catherine Sheffield Wright State University Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9580 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractThis team-based learning (TBL) module was created to reinforce lessons learned in the basic science years and introduce third-year medical students beginning their clinical rotations to the common and interrelated geriatric syndromes of polypharmacy, delirium, and falls. Despite increasing educational efforts, these three areas are recognized as major causes of hospitalization, morbidity, and mortality among the elderly. It is intended to introduce basic diagnostic tools and sharpen the learner's awareness of commonly ignored risks in the healthcare setting through the use of the TBL format (e.g., advanced preparation reading, individual readiness test, group readiness test, group application exercise). After experiencing this module, learners will understand and apply salient features of the epidemiology, and mechanisms of, as well as interventions for, polypharmacy, delirium, and falls in people aged 65 and older.This module has been used six times in the last 2 years for third-year medical students before entering their clerkships. An assessment for retention of information both 1 and 2 years postexperience is in the planning stages. Student feedback has been positive. Educational Objectives By the end of this session, learners will be able to: Predict the adverse effects of polypharmacy based on the number and physiologic effects of the drugs individually and interactively.Recognize potential adverse effects of the most common drugs contributing to the cumulative anticholinergic load.Adjust medications by identifying duplicates.Identify medications prescribed for the side effects of another drug.Adjust medications by applying specific guidelines, (i.e., the “Beers Criteria”).Establish a diagnosis of delirium versus dementia on the basis of symptom onset, duration, physical findings, as well as exposure to sedatives, opiates, and anticholinergic drugs.Use the confusion assessment method in a clinical setting.Apply pharmacologic and non-pharmacologic interventions to decrease the risk of developing delirium and mitigate its consequences.Describe the epidemiologic impact of falls on the patient, hospital, extended care facility, and community.Assess barriers to safe ambulation based on history, neuromuscular, and cardiovascular examination.Utilize the “get up and go” test.Identify and intervene to minimize risk factors for future falls with emphasis on pharmacologic and environmental factors. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Topics in Geriatric Medicine Group Application Exercise.pptx Topics in Geriatric Medicine IRAT GRAT.pptx Topics in Geriatric Medicine.docx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationMarkus M, Sheffield C. Topics in Geriatric Medicine. MedEdPORTAL. 2013;9:9580. https://doi.org/10.15766/mep_2374-8265.9580 Copyright & Permissions© 2013 Markus and Sheffield. This is an open-access article distributed under the terms of the Creative Commons Attribution license.KeywordsTeam-Based LearningFallsTBLAccidental FallsPolypharmacyDelirium Disclosures None to report. Funding/Support None to report. Loading ...

Palliative and end-of-life care training during the surgical clerkship

BackgroundIn 2000, the Liaison Committee on Medical Education required that all medical schools provide experiential training in end-of-life care. To adhere to this mandate and advance the professional development of medical students, experiential training in communication skills at the end-of-life was introduced into the third-year surgical clerkship curriculum at Wright State University Boonshoft School of Medicine. Materials and methodsIn the 2007–08 academic year, 97 third-year medical students completed six standardized end-of-life care patient scenarios commonly encountered during the third-year surgical clerkship. Goals and objectives were outlined for each scenario, and attending surgeons graded student performances and provided formative feedback. ResultsAll 97 students, 57.7% female and average age 25.6 ± 2.04 y, had passing scores on the scenarios: (1) Adult Hospice, (2) Pediatric Hospice, (3) Do Not Resuscitate, (4) Dyspnea Management/Informed Consent, (5) Treatment Goals and Prognosis, and (6) Family Conference. Scenario scores did not differ by gender or age, but students completing the clerkship in the first half of the year scored higher on total score for the six scenarios (92.8% ± 4.8% versus 90.5% ± 5.0%, P = 0.024). ConclusionsEarly training in end-of-life communication is feasible during the surgical clerkship in the third-year of medical school. Of all the scenarios, “Conducting a Family Conference” proved to be the most challenging.

Office Based Coding 101: It's a No Brainer

OPEN ACCESSJuly 19, 2011Office Based Coding 101: It's a No Brainer Deborah Miller, Katherine Clark, DO, Philip Whitecar, MD, Jennifer Hawkins, MD Deborah Miller Wright State University Boonshoft School of Medicine Google Scholar More articles by this author , Katherine Clark, DO Wright State University Boonshoft School of Medicine Google Scholar More articles by this author , Philip Whitecar, MD Wright State University Boonshoft School of Medicine Google Scholar More articles by this author , Jennifer Hawkins, MD Wright State University Boonshoft School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.8438 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractThis comprehensive training program is designed to introduce and enhance the evaluation and management of current procedural terminology coding skills for the office setting. The use of color, imagery, and small group learning aid retention of the information presented. The program stresses level of service code selection based on medical decision making. A unique color-coded audit form is used to maximize the visual learning experience. A PowerPoint presentation and 12 weekly maintenance-of-skills scenarios are additional teaching methods. The workshop is designed to be completed in 90 minutes. On the day of the workshop they complete a preintervention evaluation and a 10 item pretest. They are then divided into groups of five and given several copies of the color coded audit sheet to be used during the presentation and discussion. The PowerPoint slides aid in describing of the necessity to code properly and the elements that comprise the 99212–99215 and 99202–99205 levels of service. Interspersed are pretest questions. Groups are asked to discuss the level of service designation and reach consensus for each case scenario as they appear in the presentation. At the conclusion of the module, a 10 item posttest is administered and participants are asked to complete a program evaluation. Following the workshop learners receive a weekly maintenance of skills scenario by email. Evaluation is based on posttest performance. This coding workshop was developed as part of a Master's in Academic Medicine degree requirement at Wright State University Boonshoft School of Medicine. The workshop was presented to a group of Family Medicine residents. Pre- and posttest assessments were made around the workshop and at the end of 12 weeks. No significant improvement in ability to choose correct level of service was detected for the group, but participation was low despite incentives. Those individuals that participated in the maintenance of skills segment regularly showed statistical improvement in post-posttest scores. The color coded audit sheet is the product of over 10 years of modifications by all the authors. Educational Objectives By the end of this module, the learner will be able to: Understand the process of current procedural terminology (CPT) coding in the office.Apply CPT office-based coding principles using example cases.Explain CPT level of service selected for case scenarios. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide coding101.doc OFFICE CHART AUDIT FORM.doc Coding exercises answers.doc Coding Tests.doc Curriculum for coding intervention.doc Evaluations - survey.xls Office Based Coding.ppt To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2011 Miller et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsEvaluation and ManagementChartsCodingCPTCurrent Procedural Terminology Disclosures None to report. Funding/Support None to report. Prior Presentations Miller, DE. An innovative CPT coding intervention to promote learning and retention of skills. Presented at: Innovations in Medical Education, University of Southern California, Keck School of Medicine; March 2009; Pasadena, California. Loading ...

Developing a Research-Focused Learning Community at One Medical School

This report describes the development of a research-focused learning community at Wright State University Boonshoft School of Medicine in Dayton, Ohio (USA). At its outset, the collaboration among students, faculty, and administrators was not perceived to be a learning community. It formed around the goal of helping students to find faculty research mentors for student-initiated elective courses and extracurricular projects. It brought together peer-based academic support efforts and student services provided by the medical school administration. Over time it developed into a series of meetings, lectures, workshops, and symposia where students and faculty could discuss research and career issues in professional settings. In the past year, the collaboration was named the Research Learning Community (RLC) as the organizing principle for two new student research elective courses. With its emphasis on research experiences for students, the RLC represents a new application of a learning community model at a medical school, and it suggests promising directions for educational research about student and faculty engagement in the learning environments.

Menorrhagia Presentation Profile in Adolescents With Documented Platelet Function Disorders

Lawrence Amesse MD, Ph.D., MMM, Teresa Pfaff-Amesse MD, William T. Gunning Ph.D., Nancy Duffy RN, James French MD 1 From the Section of Pediatric & Adolescent Gynecology, Division of REI, Department of OB/GYN 2 Division of Pediatric Hematology and Oncology, Department of Pediatrics, Wright State University Boonshoft School of Medicine 3 Department of Pathology, University of Toledo College of Medicine

Wright State University Boonshoft School of Medicine

Wright State University Boonshoft School of Medicine

Spironolactone Suppresses the Frequency of Ventricular Arrhythmias among Patients With Left Ventricular Systolic Dysfunction and Implantable Cardioverter-Defibrillators

Spironolactone Suppresses the Frequency of Ventricular Arrhythmias among Patients With Left Ventricular Systolic Dysfunction and Implantable Cardioverter-Defibrillators Abdul Wase, Zulfiqar Mirza, Aparna Innaparthy, Anwarul Kabir, Muhammed B. Quraishi, Ronald Markert; Internal Medicine/Cardiology, Heart and Vascular Institute, Good Samaritan Hospital, Dayton, OH; Internal Medicine, WrigWright State University Boonshoft School of Medicine, Dayton, OH; Educational Research, Wright State University Boonshoft School of Medicine, Dayton, OH

Abdominal pain in a female adolescent: question

A 16-year-old white female presented to the emergency department (ED) with complaints of multiple episodes of vomiting, colicky left flank, and lower quadrant abdominal pain for 2 days. She denied fevers, dysuria and, gross hematuria but complained of urinary frequency. A review of systems was unremarkable. Past medical history was significant for poorly controlled insulindependent diabetes mellitus and autosomal dominant polycystic kidney disease. Her last menstrual period was 2 weeks prior, and her other gynecological history was unremarkable. Vital signs, including blood pressure (BP) were normal. Physical examination was remarkable for non-specific mild left lower quadrant tenderness, and there was no costovertebral angle, rebound tenderness, or masses on palpation. Results of laboratory data are shown in Table 1. A 1-L bolus of normal saline was administered intravenously, followed by morphine and acetaminophen/ oxycodone. Within a few hours she was completely pain free and discharged home with instructions to follow up with her nephrologist within 1 week. She returned to the ED 2 days later due to worsening of colicky abdominal pain, vomiting, and tactile fever. On physical examination she was alert but ill appearing, mildly dehydrated, and afebrile, and she had a BP of 133/88 mmHg. The abdomen was distended but soft, with left flank pain and left costovertebral angle tenderness, no masses were palpable, and rebound tenderness was absent. Repeat laboratory data results are shown in Table 1. Urine culture obtained at initial presentation was positive for >100,000 colony forming units of Escherichia coli that was sensitive to a host of antimicrobial agents. A pregnancy test was negative. An assessment of pyelonephritis was made, but due to the persistence of colicky abdominal pain, a non-contrast computerized tomography scan was performed (Fig. 1). The answer to this question can be found at http://dx.doi.org/10.1007/ s00467-010-1561-7. A. Omoloja : L. Canessa Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, OH, USA

Assuring the Research Competence of Orthopedic Graduates

To assure that orthopaedic residents have the knowledge needed to critically appraise the medical/surgical literature and the skills needed to design and conduct musculoskeletal and orthopaedic research. Residency program of the Department of Orthopaedic Surgery, Sports Medicine and Rehabilitation at Wright State University Boonshoft School of Medicine, Dayton, Ohio. Established in 2005, members of the residency program's Research Team (RT) include orthopaedic faculty and residents, university faculty and graduate students, community scientists, and department staff. The membership and responsibilities of the Research Team are described. The goals of the three-month research rotation during the second year of residency and the activities of the assigned resident are reported. The work of the two research residents during the second year of their six-year program is explained. Helpful educational resources are noted, the role of the faculty research mentor defined, funding sources listed, and the financial support for RT members and research staff presented. The scholarly activity of orthopaedic surgery residents increased substantially from the five-year period before the implementation of the Research Team (September 2000 through August 2005) to the four-year period after initiation of the RT (September 2005 through November 2009). For peer-reviewed scholarship activity, publications on which residents were authors increased from 1 to 10 per year, national presentations at professional meetings increased from 6 to 11 per year, and local and regional presentations increased from 2 to 4 per year. The Research Team is an effective strategy for assuring that orthopaedic residents have the knowledge and skills to evaluate clinical care evidence and to conduct musculoskeletal and orthopaedic research.