University of Nebraska Medical Center
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Using Evidenced-Based Practices to Improve Sonography Scan Lab Instruction: Peyton’s 4-Step Approach
Objective: The purpose of this study was to examine the effects of implementing Peyton’s 4-Step Approach for skills teaching of sonography laboratory instruction in the first semester of a diagnostic medical sonography (DMS) program. Materials & Methods: Participants included DMS students enrolled at UNMC during the fall semester of academic years 2020 and 2021. Data was collected through pre- and post-lab surveys completed by the DMS students. During weekly scan lab sessions, DMS faculty modeled Peyton’s 4-Step Approach to skills training: Step 1: Demonstration, Step 2: Deconstruction, Step 3: Comprehension, and Step 4: Performance. Results: The pre-lab survey found that no DMS students (n=0/26) had prior experience with Peyton’s 4-Step Approach for skills teaching. The post-lab survey found 88% (n=15/17) of DMS students agreed Peyton’s 4-Step Approach to lab instruction aligned with their learning style. For Step 1 (demonstration), 82% (n=14/17) of DMS students routinely watched the pre-lab video prior to lab and 82% (n=14/17) found the videos helpful in learning the scan lab skills. 88% (n=15/17) agreed the live, instructor demonstration with spoken description in Step 2 (deconstruction) was helpful. For Step 3 (comprehension), 88% (n=15/17) agreed the live instructor demonstration guided by student spoken description was helpful. Of the steps used in Peyton\u27s approach, 88% (n=15/17) responded that Step 4 (performance) was most beneficial, while 12% (n=2/17) responded that Step 3 (comprehension) was most beneficial. Conclusion: Implementation of Peyton’s Approach improved sonography lab instruction in the first semester of a DMS program. This technique standardized teaching processes and DMS students found all steps to be helpful in learning lab skills. While performance or “hands on” step was considered the most helpful, students found all steps were beneficial for learning sonography skills
From Survivors to Care Providers: A Multi-Dimensional Study on Physical Activity in Cancer Care
As the population of cancer survivors grows, understanding the dynamics of physical activity (PA) engagement is critical due to its potential benefits in reducing adverse health outcomes and mortality associated with cancer. Despite known benefits, both adherence to and promotion of PA among cancer survivors face significant challenges. This comprehensive study examines PA levels, barriers, facilitators, and perceptions among cancer survivors and oncology care providers over a ten-year period. The objectives are to assess adherence levels to PA among cancer survivors, explore the perceived barriers and facilitators to PA engagement from the survivors\u27 perspectives, and understand the barriers, facilitators, and educational needs of oncology care providers regarding PA prescription. The study employs a mixed-method approach spanning quantitative analysis of nationally representative samples from 2010, 2015, and 2020, as well as qualitative phenomenological studies involving interviews with cancer survivors and oncology care providers in Nebraska, USA. Findings indicate fluctuating PA adherence among cancer survivors, with a peak in 2015 followed by a decline. Major barriers include physical limitations, lack of awareness, and insufficient social support, while facilitators include knowledge of health benefits and support from healthcare providers. Oncology care providers recognize the importance of PA but report significant gaps in guidelines, training, and prioritization of PA counseling within routine cancer care. The study highlights the complex interplay of personal, social, and systemic factors influencing PA engagement among cancer survivors. It underscores the need for targeted educational interventions and systematic changes to enhance PA promotion in oncology settings, aiming to integrate PA as a fundamental component of cancer survivorship care
p85α Degradation Mediated by Ubiquitin E3 Ligase FBXO21 Offers Therapeutic Potential in Leukemia
Acute myeloid leukemia (AML) is a complex and heterogeneous disease characterized by the clonal expansion of myeloid blasts in the bone marrow. Despite significant therapeutic advances over the years, the prognosis for AML patients remains dismal, with high relapse rates and poor overall survival. The ubiquitin-proteasome system (UPS) plays a critical role in maintaining cellular homeostasis by regulating the degradation of proteins involved in essential processes such as cell cycle control, DNA repair, apoptosis, and various signaling pathways. Given this vital function, targeting ubiquitin E3 ligases within the UPS presents a promising strategy for developing more effective and targeted therapies in hematological cancers.
High expression levels of the F-box ubiquitin E3 ligase, FBXO21, correlate with poor patient survival in various hematopoietic malignancies. We identified that silencing FBXO21 in human-derived AML cell lines and primary patient samples induces differentiation, inhibits tumor progression, and sensitizes cells to chemotherapy agents. Moreover, FBXO21 knockdown upregulates cytokine signaling pathways, further implicating its role in AML pathogenesis. Interestingly, our lab has previously shown that Fbxo21 knockout in our novel mouse model has minimal impact on normal hematopoiesis, suggesting that FBXO21’s role in AML is tumor specific.
Through a mass spectrometry-based proteomic analysis, we identified that FBXO21 ubiquitinates p85α, the regulatory subunit of the phosphoinositide 3-kinase (PI3K) pathway, targeting it for degradation. This degradation leads to decreased PI3K signaling, dimerization of free p85α, and activation of ERK. Further, we found that the YccV domain of FBXO21 is crucial for the interaction with p85α and pinpointed the specific phosphodegron within p85α necessary for its ubiquitination. This knowledge facilitated the creation of a novel compound targeting FBXO21, offering a highly specific approach to modulating PI3K activity in AML. In vivo studies further confirmed FBXO21’s oncogenic role, as Fbxo21 knockdown delayed AML initiation, disease progression, and extended survival in mouse models.
These findings underscore FBXO21 as a critical regulator of AML pathogenesis, with its targeting representing a promising therapeutic strategy that may overcome the limitations of current PI3K inhibitors and provide a more selective approach to treating hematopoietic malignancies
Investigating FIT Kit Completion for CRC Screening in Younger Adults in Rural Areas
Rural regions have higher incidence rates of colorectal cancer (CRC) than urban regions, while screening is lower in rural residents than in urban residents. Rural residents experience barriers to CRC screening due to a lack of access to healthcare, perceived lack of privacy, and other cultural factors. The fecal immunochemical tests (FITs) may provide an inexpensive and convenient alternative for those lacking access to a colonoscopy or sigmoidoscopy. In a clinical trial, we investigated factors that influenced the return of a FIT kit for CRC screening among 1,230 rural residents in a midwestern U.S. state. Participants were selected from two cancer screening databases maintained by the state health department. Participants returning and not returning the FIT kit were compared for differences by age category (45–54, 55–64, 65–74), gender (female vs. male), race (non-white vs. white), and ethnicity (Hispanic vs. not Hispanic) using chi-square tests and logistic regression. Cox proportional hazard models and Kaplan–Meier curves were used to assess differences in FIT kit return time by age and gender. The youngest age group was significantly less likely to return the FIT kit and were slower at returning it when they did. In models adjusted for age category, females were significantly more likely to return the FIT kit than males and returned the FIT kit sooner than males. The results suggest that efforts are needed to reach those 45 to 55, especially males, who are not likely to see the need for CRC screening
Implementing a High-Fidelity Transgender Patient Simulation in Undergraduate Nursing
Purpose: The purpose of this study was to evaluate the knowledge and attitudes of nursing students participating in a high-fidelity transgender patient simulation. The aims were to increase student knowledge and confidence to improve communication and provide more inclusive and equitable care. Healthcare providers are not adequately prepared to manage the unique health needs of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. Nurses are ideally positioned to address gaps in LGBTQ healthcare by providing culturally competent care. Yet, LGBTQ health education is lacking in most undergraduate nursing school curricula. Methods: 62 undergraduate nursing students participated in a post-surgical transgender patient simulation using a high-fidelity mannequin. Students completed pre-clinical course work including a brief video depicting interactions between healthcare providers and gender queer folk and a pre simulation survey. Following the high-fidelity mannequin simulation, students completed a post simulation survey aimed at assessing students’ knowledge, attitude, and beliefs about LGBTQ patients. Pre- and post-survey scores will be compared using a paired t-test. Nursing faculty were also asked to complete a short questionnaire evaluating the perceived effectiveness of the transgender patient simulation. Results: Results of the pre-simulation survey showed 81 % of nursing student harbored favorable attitudes towards transgender individuals. Preliminary post simulation survey results indicate students increased their confidence and capability to care for transgender individuals. Nursing faculty responded positively towards the transgender patient simulation and expressed intent to utilize the simulation in future semesters. Conclusion: Integrating a high-fidelity transgender patient scenario in undergraduate nursing curriculum via stimulation has been shown to increase gender-affirming cultural competency among nursing students. The LGBTQ population needs knowledgeable and competent providers to improve patient outcomes and quality of care. As such, nursing students need further instruction and education about LGBTQ health
Cardiovascular Disease Risk Reduction Program for Hispanics in the US Midwest: A Culturally Adapted Intervention
Cardiovascular disease (CVD) represents the second leading cause of death in Nebraska (NE), accounting for approximately one in every five deaths. In the state, there are marked ethnic and rural-urban disparities in the prevalence of chronic diseases and resultant deaths. For instance, while the rates in NE of coronary heart disease and myocardial infarction between 2001 and 2010 decreased among non-Hispanic Whites, the rates for Hispanics almost tripled. There is little evidence of CVD risk factor reduction strategies being implemented in Midwestern areas and Hispanic populations.
One promising approach for reducing CVD risk involves health education and lifestyle modification programs led by community health workers (CHWs). A notable example is the Community Outreach and Cardiovascular Health (COACH) trial, which applied cognitive behavioral strategies in urban, medically underserved, predominantly African American communities, demonstrating improved clinical outcomes for CVD risks. The intervention included educational and behavioral counseling and follow-up from a primary care provider/community health worker (PCP/CHW) team. Participants in COACH showed significant enhancements in serum lipids, arterial blood pressure, glucose control, and perceptions of chronic care management. However, this intervention has not been culturally adapted or translated to assist Spanish-speaking individuals to be delivered to Hispanic populations.
Prior studies targeting the reduction of CVD risk factors among Hispanic populations in the US have typically embarked on program development. While these studies have demonstrated promising outcomes, the scientific literature highlights essential areas of improvement, particularly in research design and long-term follow-up, which can affect generalizability. In contrast, our study takes a different approach. Rather than starting from ground zero, we aimed to culturally adapt a proven program that has undergone rigorous research methodology and has yielded positive outcomes in other minority populations across the nation. This strategy builds upon existing evidence-based interventions and may enhance the likelihood of effectiveness and sustainability within Hispanic communities. Our long-term goal is to develop health education interventions that facilitate the adoption and maintenance of CVD protective factors, thereby reducing the disproportionate burden of heart diseases among minority populations
An Inquiry into the Relationship between Practice Exam Integration, Study Habits, and Perceived Exam Confidence Among First-Year Medical Students at United States Medical School
This investigation delves into the study behaviors and perceptions of first-year medical students regarding the incorporation of practice exam questions, aiming to elucidate potential correlations with perceived exam confidence. Employing a descriptive survey, the study garnered a 46% response rate (n=61) from a 2023 cohort. Noteworthy is the dedication of 68% of respondents to a minimum of 5 hours daily for academic pursuits during their inaugural year, indicative of a robust commitment to scholarly activities. Findings revealed that 75% of participants consistently integrated practice questions into their study routines, with 69% utilizing them proximate to examinations. Importantly, 50 students (82%) report that they perform better on content that is accompanied by practice questions, with 57.4% (n=35) stating that instructor-developed practice exam questions aid in gauging their knowledge on the information to be tested. Qualitative insights from open-text responses underscored the perceived intrinsic value of practice questions in assessing pre-examination comprehension and facilitating the application of acquired knowledge. These identified trends suggest a widespread assimilation of practice exam resources and a concurrent acknowledgment of their efficacy within the medical student cohort. Continuously evaluating curriculum changes is essential, with a specific emphasis on understanding study habits and customizing students’ education to meet individual needs. Subsequent research endeavors are anticipated to assess the discernible impact of provided practice questions on subsequent exam performance. This inquiry contributes invaluable insights into the integral function of practice exam questions within the realm of medical student study habits and their perceptions of exam confidence. Keywords: curriculum assessment; exam performance; medical education; practice exam questions; student study habit
Disparities in Thyroid Cancer Diagnosis Based on Residence and Distance From Medical Facility
CONTEXT: Rural-urban disparities have been reported in cancer care, but data are sparse on the effect of geography and location of residence on access to care in thyroid cancer.
OBJECTIVE: To identify impact of rural or urban residence and distance from treatment center on thyroid cancer stage at diagnosis.
METHODS: We evaluated 800 adults with differentiated thyroid cancer in the iCaRe2 bioinformatics/biospecimen registry at the Fred and Pamela Buffett Cancer Center. Participants were categorized into early and late stage using AJCC staging, and residence/distance from treating facility was categorized as short (≤ 12.5 miles), intermediate (\u3e 12.5 to \u3c 50 miles) or long (≥ 50 miles). Multivariable logistic regression was used to identify factors associated with late-stage diagnosis.
RESULTS: Overall, 71% lived in an urban area and 29% lived in a rural area. Distance from home to the treating facility was short for 224 (28%), intermediate for 231 (28.8%), and long for 345 (43.1%). All 224 (100%) short, 226 (97.8%) intermediate, and 120 (34.7%) long distances were for urban patients; in contrast, among rural patients, 5 (2.16%) lived intermediate and 225 (65.2%) lived long distances from treatment (
CONCLUSION: Older age at diagnosis, living in rural areas, and residing farther from the treatment center are all independently associated with late stage at diagnosis of thyroid cancer
Learner Influence on Pediatric Patient Experience: Exploring Family Members’ Perspectives
Background: The patient experience in pediatric settings is influenced by complex interactions between the patient, parent/guardian, learners, and providers. This study aimed to understand the influence of healthcare learners on care satisfaction in pediatric settings using patient experience feedback from family members. Methods: NRC Health “Feedback Management” data from a regional Children’s hospital was collected from August 1st, 2020 to August 31st, 2023 using key identifiers related to learners (e.g. “Student,” “Resident,” “Trainee,” “Learner,” “Fellow”). Each viable survey underwent reflexive thematic analysis by two independent reviewers. Additionally, two investigators independently assigned values to each comment regarding both the learner and overall interactions using a three-point scale (3=positive, 2=neutral, 1=negative). Inter-rater reliability was 0.983 for learner-specific comments and 0.970 for overall experience comments. Strongly positive and strongly negative remarks of the learner interaction were isolated and evaluated. Results: The dataset consisted of 302 eligible narrative comments from patients/parents that included one or more keywords. The average rating was 2.273/3 for learner interactions and 2.199/3 for overall interactions. The reflexive thematic analysis generated 24 primary themes and 21 subthemes that were grouped under five overarching categories of learner-specific patient care experience: Communication, Learner Effects, Rapport, Care Delivery, and Competency. Feedback involving positive interactions focused on recognition of the learner, positive rapport building, and effective information explanation. Feedback involving negative learner interactions emphasized task repetition, lack of communication, poor bedside manner, and increased visit time. Conclusions: Learners fill an important role on the pediatric medical team through experiential learning. This study shows that the presence and involvement of learners can influence pediatric care satisfaction, both positively and negatively. The resulting themes from family member narratives emphasize relevant clinical learning environmental factors that impact perceptions of the pediatric care experience
Homeobox A10: Regulator of Pancreatic Cancer Progression and Survival
Pancreatic ductal adenocarcinoma (PDAC) has one of the lowest incidence rates among all major cancers, yet it is disproportionally responsible for 8% of all cancer deaths. This high death rate is primarily attributed to the immunosuppressive tumor microenvironment and a lack of clinically relevant molecular targets. However, the underlying biology responsible for these poor outcomes remains obscure. To facilitate improved management of PDAC, an in-depth understanding of the molecular player(s) involved in PDAC aggressiveness is needed. Therefore, we analyzed the transcriptomic profiles of PDAC patients with long- and short-term survival and performed gene set enrichment analysis (GSEA), identifying a novel short-surviving prognostic subtype driven by master regulator HOXA10. Pathway analyses highlighted the involvement of the HOXA10 signature in immune suppression, cell cycle regulation, and enhanced tumorigenesis. CIBERSORT immune profiling of the HOXA10-associated prognostic genes further demonstrated a significant correlation with immunosuppressive T cells and macrophages, suggesting that they may play a role in the telltale picture of immunosuppression in the PDAC microenvironment. Notably, differential expression of HOXA10 and its associated signature was observed in clinical tissues of long- and short-surviving PDAC patients. We have also demonstrated a positive relationship between HOXA10 expression and disease progression, with a trend of enhanced expression in high-grade compared to low-grade PanIN lesions, and in 20- and 25-week LSL-KrasG12D/+;LSL-Trp53R172H/+;Pdx-1-Cre (KPC) tumors compared to 5 weeks. Further, live-cell analysis of Hoxa10 knockdown cells suggested a decrease in their proliferation with concurrent enhancement of apoptosis as compared to the control. Interestingly, our bioluminescence measurements using IVIS imaging demonstrated a substantial delay in orthotopic tumor growth in doxycycline-treated Hoxa10 knockdown tumor-bearing mice compared to the control group. A considerable reduction in the tumor weight was also observed. Additionally, mice harboring Hoxa10 knockdown tumors survived longer. They demonstrated decreased levels of immunosuppressive cell types compared to mice bearing the control tumors, corroborating our findings and indicating an association between the HOXA10 signature and poor patient survival. These findings altogether point towards a potential role of HOXA10 in PDAC tumorigenesis and lethality. Specifically, HOXA10 may contribute to tumor burden through the enrichment of immunosuppressive phenotypes, resulting in the poor survival of PDAC patients