Download pdf 2014 abstract book

School of Allied Health Professions
Forum
on
Evidence-Based Medicine
April 30, 2014
2014 Forum on Evidence-Based Medicine
Each spring the School of Allied Health Professions sponsors a forum. This interprofessional event is
intended as an opportunity for students and faculty in all eleven SAHP programs to share scholarly
activity that supports evidence-based clinical practice.
The primary goal of the scholarly activity that is presented in the forum is to promote the understanding of the research process in allied health. The ultimate goal is the continuous updating of
best practices in clinical settings. There are three general categories of scholarly activity that are
presented in this forum: research projects in which data are collected, analyzed, and interpreted;
critical reviews of the literature which address a clinical question based on published, peer-reviewed
research studies; and, educational exhibits which highlight either a specific pathology or new
clinical procedure.
The School of Allied Health Professions would like to thank the faculty and staff who have contributed time and effort to the success of this Forum.
The complete book of abstracts is online at: www.unmc.edu/alliedhealth/forum.htm
Annual School of Allied Health Professions Awards Ceremony
MSC 3001 at 1:05 P.M.
Poster Display and Reception
Truhlsen Campus Events Center from 2:00-3:30PM
Excellence in Research
Ka-Chun “Joseph” Siu, PhD
Excellence in Teaching
Kathleen Volkman, PT, MS, NCS
Outstanding Service
Dennis Strauss, MD
Educational Exhibits
Clinical Laboratory Science
Krystal Davis, Amanda Stastny, Ulrike Otten. An Interprofessional
Guide to Laboratory Testing for Student-Run Free Clinics: A
Reference Guide to Diabetic Diagnostics and Management
1
Computed Tomography
Leicy Franklin. The Correlation between CT Scans and
Childhood Cancer
2
Macey Fuhr. A Look inside Coronary Artery Disease
3
Ariel Heckman. Fibrodysplasia Ossificans Progressiva
4
Rachel Kettelhake. Understanding Esophageal Cancer While
Utilizing Different Imaging Modalities For Diagnosing and
Staging
5
Makenzie Shank. Comparison of Computed Tomography
Perfusion and Magnetic Resonance Imaging Diffusion in
Diagnosing Acute Ischemic Stroke
6
Jared Thompson. Contrast-Induced Nephropathy
7
Corey Andrews, Emily Bluedorn, Courtney Einspahr. Mycotic
Aortic Aneurysm: an Incidental Finding
8
Sarah Liss, Lindsey Nannen, Andrea Sedlacek. Portal Venous
Aneurysm
9
Heather Bell. High Definition Fiber Tractography
10
Hannah Coffman. Imaging Alzheimer's Disease with MRI
11
Tanner Foxhoven. Magnetic Resonance Imaging of the Fetus
12
Meghan McGoldrick. MRI’s Role in the Detection and Diagnosis
of White Matter Disease
13
Karlyn Miller. Epilepsy Evaluation through Functional Magnetic
Resonance Imaging
14
Tannis Reif. Diagnosis of Pulmonary Embolism with CT vs. MRI
15
Chad Schock. Composition of Metals: How Elements from the
Periodic Table Affect MRI
16
Allison Hukill. Radium-223 Dichloride: Advanced Stage Prostate
Cancer Treatment
17
Ahmed Naciri. Lymphoscintigraphy: Lymphoseek Tc-99m
Tilmanocept vs. Tc-99m Sulfur Colloid
18
Lisa Bartenhagen, Tanya Custer. HPV Related Cancers
19
Diagnostic Medical Sonography
Magnetic Resonance Imaging
Nuclear Medicine
Radiation Science Technology
Education
Radiography
Jessica Backhaus. Breast Tomosynthesis: The Digital Future of
Mammography
20
Olga Biletska. Salter-Harris Fractures: Radiologic Factors that
Predict Premature Growth Plate Closure
21
Whitney Brooke. Imaging Modalities Utilized in the Diagnosis of
Inflammatory Breast Cancer
22
Megan Bygland. Out With the Old, Flip the New: Flipped
Classrooms for the Modern Learning Age
23
Conner Coffin. Using Automated Breast Ultrasound Systems to
Image and Detect Masses in Dense Breast Patients
24
Blair Dixon. Müllerian Duct Anomalies: Diagnosing Uterine
Didelphys
25
Molly Gallagher. Working Together for a Common Goal:
Developing Interprofessional Activities among Radiation
Science Professionals and other Healthcare Team Members to
Promote Quality Patient Care
26
Christina Gregg, Tammy Jones. Mapping What Makes Humans
Unique: The Human Connectome Project
27
Blair Hild. Imaging Thoracolumbar Burst Fractures
28
Alicia Hultquist. The Use of YouTube: Enhancing Student
Learning in the Imaging Sciences
29
Brianna Jacobitz. Echocardiography: Congenital Heart Defects in
Children
30
Tammy Jones. Positioning Imaging Science Students for
Effective Learning
31
Katie Kuehn. Multiple Sclerosis in the Medical World
32
Jennifer Laughlin. Volunteerism among Radiation Science
Professionals: A Generational Assessment
33
Sarah Meissner. Computed Tomography: Prognostic or
Pathogenic
34
Brigette Root. Effectiveness of Antibiotic Treatment on Lower
Back Pain: A Case Study
35
Emily Schlautman. There’s an App for ThatTM #Radiology
#Medical Apps
36
Justin Williams. Catheter Ablation as a Means to Treat Atrial
Fibrillation
37
Radiation Therapy
Daniel Gunderson, Kristy Stevens. Advancements in Multiple
Myeloma Treatment
38
Ashley Micek, Erin Rosales. Rapid Arc
39
Blair Thompson, Erinn Moritz. Pediatric Total Body Irradiation
40
Critical Reviews
Physical Therapy
Radiation Science Technology
Education
Celeste Baumert, Morgan Bugosh. Virtual Reality as Intervention
for Patients with Chronic Stroke
41
Kristin Clough, Rashelle Smith. The Effect of Treadmill Training
in Children and Adolescents with Cerebral Palsy
42
Annie Woodruff, Xin Zhang. Effectiveness of Botulinum Toxin A
Injections on Motor Function and Gait Pattern in Children with
Cerebral Palsy
43
Iman Ahmad, James Temme. Nutritional and Life Style
Determinants of Radiation-Induced Oxidative Stress in
Occupationally Exposed Workers
44
Research Projects
Clinical Perfusion
Andrew Beck, David Holt. Dynamic Roller Pump Occlusion Using
Pressure Monitoring
45
Kailin Bellows, David Holt. The Risks of Extracorporeal
Integrated Arterial Filters
46
Dan Gillespie, David Holt. Quantifying Gaseous Microemboli in
Coated Arterial Line Filters versus Non-coated
47
Matthew Hansen, David Holt. Optimizing Platelet Function in
ANH-Collected Blood
48
Kathleen Kubes, David Holt. Assessing the removal of potassium
and plasma free hemoglobin using hemofiltration and
centrifugation cell saver techniques
49
Robert Ledbetter, David Holt. Evaluating the need for a “clear
and colorless” effluent in a cell saver’s wash cycle
50
Trent Little, David Holt. Integrating Apple iOS Technology into a
Graduate Level Perfusion Curriculum
51
Ryan Robertson, David Holt. Removal of Complement C3a and
C5a in Residual Cardiopulmonary Bypass Circuit Blood: A
Comparison between Cell Salvage and Ultrafiltration
52
Kristie Steffens, David Holt. EDAC Evaluation for Strategic
Placement of Arterial Filter Purge
53
Cytotechnology
Medical Nutrition
Physical Therapy
Ria Ward, David Holt. Risk of Vacuum-Induced Air Embolism
With Auto-Venting Arterial Filters
54
Nick Baker, Maheswari Mukherjee, Amber Donnelly. Survey of a
Virtual Microscopy Teaching Module Utilizing Cell Block, Diff
Quick and Pap Stained Slides
55
Vincent DeAgano, Maheswari Mukherjee, Amber Donnelly.
Assessing the Use of Virtual Microscopy in Cytotechnology
Education
56
Sarita Gawandi, Amber Donnelly, Elizabeth R. Lyden, Maheshwari
Mukherjee. Comparative study between fine needle aspiration
cytology glass slides and virtual images
57
Jillian Schneider, Amber Donnelly, Elizabeth R. Lyden, Maheswari
Mukherjee. Digitalizing Cytology Specimens: Reproducibility of
Virtual z-stacked Images by Ventana Scanner
58
Clare Becker. Elderly Adult Malnutrition in the Adult Intensive
Care Unit (AICU)
59
Jessica Hinds. Adequate Protein Intake in the Elderly
60
Jenna Paseka. Prevalence of unintentional weight loss and the
nutritional response upon admission to The Nebraska Medical
Center
61
Heidi Pfeifer. Identification of Enteral Nutrition Target Goal at
The Nebraska Medical Center
62
Nicole Rezac. The Prevalence of Malnutrition in Pediatric
Patients at The Nebraska Medical Center (TNMC)
63
Carly Sorenson. Vitamin D Status Not Associated With
Inflammatory Markers in Bariatric Patients
64
Betsy Becker, Katherine Jones, Patricia Hageman, Ruth
VanGerpen. Integrating Best Evidence into Practice: Outcomes
of a Community-Based 12-week Exercise and Education
Intervention in Women with Cancer
65
Megan Bradberry, Sarah Kennedy. Tai Chi as a Balance
Intervention for Older Adults: Web-based vs. Video-based?
66
Zach Douglas, Zach Long, Katherine Jones, Anne Skinner, Nicole
Vanosdel. Geographic Distribution of Specialized Stroke
Rehabiliation Services in Nebraska
67
Robert Fuchs. Pre and Post-Instruction Changes in Physical
Therapy Student Item Scores for a Standardized Patient
Assessment Tool
68
Troy Goetsch, Travis Jurgens. The Impact of Cognitive Level and
Task Difficulty on Spatiotemporal Gait Measures During Dual
Task Performance in Older Adults
69
Physician Assistant
Radiation Science Technology
Education and Clinical Laboratory
Science
Lukas Hoover-Rathjen, Patricia Hageman, Carol Pullen,
Paul Dizona, Linda Boeckner. Comparison of Participants’
Perspectives about a Web-based Intervention Targeting Guided
Weight loss in Overweight and Obese Rural Women
70
Chun-Kai Huang, Ka-Chun (Joseph) Siu. A Conceptual Model for
Gait Maintenance in Patients with Diabetes
71
Joseph Norman, Bunny Pozehl, Kathleen Duncan, Melody Hertzog,
Steven Krueger. Effects of Exercise Training versus Attention
on Plasma B-type Natriuretic Peptide, 6-Minute Walk Test and
Quality of Life in Individuals with Heart Failure
72
Michaela Schweitzer, Amy Schnoes. The Effectiveness of Massage
Therapy on Weight Gain in Preterm Infants
73
Xin Zhang, Swati Surkar, Regina Harbourne, Sandra Willett,
Max Kurz, Lynne Capoun. Intervention to Advance Postural
Transitions and Problem Solving Ability in Children with
Cerebral Palsy
74
Michael Huckabee, Ryan Wessel. Attitudes and Preferences
of Potential Physician Assistant Program Applicants About
Attending the University of Nebraska-Kearney Campus
75
Tamara Ritsema, Jeffrey Bingenheimer, Patty Scholting, James
Cawley. Differences in the delivery of health education to
patients with chronic disease by provider type, 2005-2009
76
Tamara Ritsema, Lorraine Williams. Doctor Satisfaction with the
Physician Associate Role in Great Britain
77
James Temme, Karen Honeycutt, Stephanie Vas. A Preliminary
Study of Bacterial Cultures Obtained from MR Imaging
Equipment
78
EDUCATIONAL EXHIBITS
ABSTRACT #1
An Interprofessional Guide to Laboratory Testing for StudentRun Free Clinics: A Reference Guide to Diabetic Diagnostics
and Management
Krystal Davis, Amanda Stastny, Ulrike Otten. Clinical
Laboratory Science Education program, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
The University of Nebraska Medical Center’s
student-run free clinics operate within an interprofessional
paradigm. The SHARING, GOODLIFE, and RESPECT clinics
address the specific needs of acute and chronic medical care,
diabetic care, and sexually transmitted infection treatment,
respectively. Diagnostic laboratory testing offered includes
point-of-care, waived testing and send out tests. The presence
of on-site laboratory services at the SHARING, GOODLIFE
and RESPECT clinics has proven to be beneficial both in issues
of quality and convenience. Specimen collection and handling
by clinical laboratory science (CLS) students reduces the
occurrence of pre-analytical error in the testing process.
After collaboration with multiple members of the
SHARING student advisory committee, it was recommended
that reference guides for laboratory testing might be
extremely useful tools. The reference guides could potentially
aid the student healthcare providers in choosing the most
appropriate, informative and cost effective laboratory tests
for their patients. A needs assessment was conducted with a
student provider survey, which confirmed the potential utility
of laboratory guides. A reference guide to diabetic
diagnostics and monitoring was created and is currently
being approved for use at the SHARING Clinics. The intent is
for future CLS students to create additional guides on the
topics of sexually transmitted infections and overall health
and wellness. This poster documents the process used in
determining the student provider expressed need in ordering
diagnostic tests and the endeavor to provide a useful tool to
meet that need at the SHARING clinics
ABSTRACT #2
The Correlation between CT Scans and Childhood Cancer
Leicy Franklin. Computed Tomography Program, Division of
Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
In recent years, Computed Tomography (CT) scans
have become more frequently used in the United States. This
is due to the fact that computed tomography provides
physicians with more information than with plain radiography
and CT can be utilized to view any part of the body in a timely
manner. During CT imaging, an x-ray tube rotates around
the patient, producing multiple images at numerous angles,
thus increasing the dose received by the patient. Although CT
provides physicians with useful information they need to treat
their patients, it also contributes to more exposure to the
patient. It is important for physicians to understand the
increased risk this poses for their patients, especially in the
case of pediatric patients. Pediatric patients are at a greater
risk in regard to radiation exposure due to their decreased
body mass and frame size. Over the years, there has been
stipulation that the doses of radiation children have received
from CT scans has put them at risk for developing cancer.
ABSTRACT #3
A Look inside Coronary Artery Disease
Macey Fuhr. Computed Tomography Program, Division of
Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
The purpose of this research is to explore the
different ways of imaging heart disease, specifically coronary
artery disease (CAD). The benefits of using computed
tomography in the imaging of CAD are evident. The quick
scan times and quality images allow diagnosis to be made
from this noninvasive procedure. Magnetic resonance
imaging of the heart has also been beneficial and is working
towards being combined with positron emission tomography
to allow morphologic information and perfusion abilities of
the heart to be imaged. Echocardiography uses sound waves
to create images and can also be used to see venous or
arterial blood flow as blue or red vessels. The images
obtained through echocardiography are not as detailed as
compared with CT/MRI imaging but the diagnostic quality of
blood flow and muscle contraction is easily verified. Harmonic
power Doppler imaging and mammography are also explored
in short detail. The radiation risks and cost effectiveness of CT
angiography compared to cardiac catheterization is no
question. CT results in a larger radiation dose, while the
cardiac catheterization is a more costly procedure. The future
of cardiac imaging will most likely be seen looking at slices of
a CT scan, because of the cost-effectiveness of the exam.
ABSTRACT #4
Fibrodysplasia Ossificans Progressiva
Ariel Heckman. Computed Tomography Program, Division of
Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
Fibrodysplasia ossificans progressive (FOP) is a rare
genetic mutation disorder that occurs in one out of two
million people around the world. This crippling disease allows
growth of new bone outside of the skeleton, resulting in
patients becoming “frozen” in place. Bone can grow in
muscles, tendons, ligaments, and in the facia of the body. If a
patient has FOP, they can usually be diagnosed at birth by
possessing deformed great toes. An FOP patient will over
time, become wheelchair bound. Life expectancy for the
disease is 40 years of age. The progression of the disease
occurs differently with every FOP patient. The disease can be
triggered by any small amount of trauma to the body,
resulting in an area of inflammation, or a “flare-up”, causing
the ossification process of the soft tissue to begin. This exhibit
will discuss the origin, clinical presentations, treatment and
disease management, and the important role that imaging
professionals play in an FOP’s patient’s life. Without proper
education and awareness about the disease, an uneducated
imaging professional may cause severe harm to an FOP
patient.
modalities including computed tomography, ultrasound,
positron emission tomography, and barium contrast
esophagrams that are effective in diagnosing, staging, and
following this life changing disease. The various imaging
modalities are also helpful for physicians and other
healthcare professionals in formulating an effective treatment
plan specific for each patient. There is a continuing effort by
researchers to find more effective solutions to treat
esophageal cancer each day.
ABSTRACT #6
Comparison of Computed Tomography Perfusion and
Magnetic Resonance Imaging Diffusion in Diagnosing Acute
Ischemic Stroke
Makenzie Shank. Computed Tomography Program, Division
of Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
Stroke is one of the leading causes of death in the
United States. Imaging modalities such as computed
tomography (CT) and magnetic resonance imaging (MRI)
employ certain scanning protocols such as angiography,
perfusion, and diffusion to look for the origin and causes of
specific types of stroke. The purpose of this exhibit is to help
the radiographer compare the advantages and
disadvantages of CT perfusion and MRI diffusion in
diagnosing and treating acute ischemic stroke.
ABSTRACT #5
Understanding Esophageal Cancer While Utilizing Different
Imaging Modalities for Diagnosing and Staging
Rachel Kettelhake. Computed Tomography Program, Division
of Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
Cancer has become more prominent nationwide. The
number of individuals diagnosed with cancer each day is
alarming. Even more concerning is the number of deaths from
cancer every day. In the year 2012, nearly 1,500 people died
of cancer each day. Esophageal cancer is one of many
aggressive cancers impacting Americans. The early symptoms
of esophageal cancer are difficult to distinguish from other
esophageal abnormalities, therefore making it hard to
correctly diagnose esophageal cancer early. Esophageal
cancer, both squamous cell carcinoma and adenocarcinoma
types, is unfortunately frequently diagnosed in an advanced
stage. Healthcare professionals can help people reduce their
possibility of getting esophageal cancer by educating
individuals of the symptoms as well as the risk factors
associated with esophageal cancer, in order to catch the
cancer early. However, there are a number of imaging
1
ABSTRACT #7
Contrast-Induced Nephropathy
Jared Thompson. Computed Tomography Program, Division
of Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
Contrast-induced nephropathy (CIN) is the 3
leading cause of hospital acquired renal failure and affects
150,000 patients annually. CIN is a preventable situation
that accounts for hospital costs of over eight billion dollars
annually. It is caused by a combination of the
vasoconstriction effect of the contrast media and the
cytotoxic effects of the parent benzene ring of iodinated
contrast molecule. Once CIN occurs, there are no proven
treatments and the best thing that can be done is to monitor
the patient. Prevention is the best treatment for CIN.
Prevention can be accomplished by being aware of risk
factors, monitoring renal function, and being educated on
other preventative measures. Other preventative measures
include hydration, being aware of patient medications that
can further reduce renal function, and tracking the amount
rd
and type of contrast media used. Incidence of CIN has
decreased from 15% to 7% which proves that it is a very
preventable condition.
ABSTRACT #8
Mycotic Aortic Aneurysm: an Incidental Finding
Corey Andrews, Emily Bluedorn, Courtney Einspahr.
Diagnostic Medical Sonography program, Division of
Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
The focus of this poster is to share a case study of a
mycotic aortic aneurysm discovered incidentally during a
pelvic ultrasound exam. A mycotic aortic aneurysm is a
bacterial infection of the aorta, which causes the aorta to
balloon outwards. Mycotic aneurysms comprise 2.6% of all
aortic aneurysms. Staphylococcus specis and salmonella are
the primary infectious agents. The majority of patients are
asymptomatic, but clinical manifestations may include fever,
leukocytosis, back pain, GI bleed, neuropathy, and palpable
mass. Sonography and computed tomography are imaging
modalities used to diagnose aortic aneurysms.
ABSTRACT # 9
Portal Venous Aneurysm
Sarah Liss, Lindsey Nannen, Andrea Sedlacek. Diagnostic
Medical Sonography program, Division of Radiation Science
Technology Education, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Portal vein aneurysms are a rare type of aneurysm,
seen either extrahepatically or intrahepatically. Aneurysms
are the result of a weakened vessel wall. The portal vein is
considered aneurysmal when its diameter exceeds 1.5 cm in a
healthy patient, and 1.9 cm in a patient with cirrhosis. Portal
vein aneurysms are typically detected by sonography and
followed up clinically. This poster will highlight a portal
venous aneurysm detected by ultrasound in a young patient
post-liver transplantation.
ABSTRACT # 10
High Definition Fiber Tractography
Heather Bell. Magnetic Resonance Imaging Program, Division
of Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
Injury induced trauma to the brain is one of the
leading causes of permanent disability in the United States.1
1.7 million people sustain a traumatic brain injury each year,
resulting in 30% of death related injuries.1 High definition
fiber tractography (HDFT), a newly developed imaging
technique, accurately displays the brain’s fiber network in
colorful subvoxel resolution images using high-definition
magnetic resonance imaging.3 Brain injuries may often lead
to breaks in fiber tracts that cannot be visualized through
traditional imaging techniques, making it difficult for
clinicians to know exactly what brain functions have been
affected and to predict whether there is long-term damage.
High definition fiber tractography will aid in the diagnosis
and treatment of injury induced brain trauma by allowing
physicians to visualize and locate exact broken, compressed,
or damaged neural connections within the brain’s fiber
network. High definition fiber tractography is still at an early
stage of development and is a continually evolving
technology. HDFT carries the potential to become the future
of diagnoses in patients who have sustained a traumatic
brain injury and other neurological deficits.
ABSTRACT #11
Imaging Alzheimer's Disease with MRI
Hannah Coffman. Magnetic Resonance Imaging Program,
Division of Radiation Science Technology Education, School of
Allied Health Professions, University of Nebraska Medical
Center, Omaha, NE
Alzheimer's disease (AD) represents the most
prevalent form of dementia, accounting for 50-90 percent of
all dementia within the United States. Currently, research is
assessing and determining the optimal approach for
Alzheimer's imaging, particularly through the use of magnetic
resonance imaging (MRI). MRI excels in depicting soft tissue
structures through the use of magnetic resonance and
radiofrequency (RF) pulses which create images of the
anatomy. The magnetic field, combined with the RF pulses,
excite protons from within the subject, mainly hydrogen
nuclei, to produce the images. Different MRI parameter
controls can be manipulated to form images with varied
contrast based on the behavior of fat and water in response
to the magnetic field and applied RF pulses. The purpose of
this exhibit is to discuss the advantages of utilizing MRI for
diagnosis, evaluation and management of AD.
ABSTRACT #12
ABSTRACT #14
Magnetic Resonance Imaging of the Fetus
Tanner Foxhoven. Magnetic Resonance Imaging Program,
Division of Radiation Science Technology Education, School of
Allied Health Professions, University of Nebraska Medical
Center, Omaha, NE
Epilepsy Evaluation through Functional Magnetic Resonance
Imaging
Karlyn Miller. Magnetic Resonance Imaging Program,
Division of Radiation Science Technology Education, School of
Allied Health Professions, University of Nebraska Medical
Center, Omaha, NE
Imaging modalities used in the diagnosis of fetal
abnormalities include ultrasound and magnetic resonance.
These imaging modalities can greatly assist in the diagnosis
of abnormalities that may be present within the developing
fetus. The first fetal MRI dates back to 1983. Although, MRI
has better contrast resolution than alternative imaging
modalities, it is not always the first option. Ultrasound (which
is relatively inexpensive) is more commonly the first imaging
option when it comes to fetal imaging. Physicists and
radiologists have, over time, vastly improved the fetal
imaging protocols. Faster sequences allow technologists to
more efficiently image the fetus. This is a major advantage
because motion in fetal imaging can be very detrimental in
MR imaging. With faster sequences, the fetus has less time
to move around and cause blurred images. In many cases
the mother is kept NPO prior to the exam to help reduce fetal
motion.
With ever growing technology, especially in the
medical field, fetal MRI has a very bright future. No adverse
effects have yet to be noted on follow-ups of children who had
undergone in-utero MRI’s. Fetal MR imaging provides
radiologists with diagnostic images allowing them to make
more informed diagnostic assessments.
ABSTRACT #13
MRI’s Role in the Detection and Diagnosis of White Matter
Disease
Meghan McGoldrick. Magnetic Resonance Imaging Program,
Division of Radiation Science Technology Education, School of
Allied Health Professions, University of Nebraska Medical
Center, Omaha, NE
The majority of the brain is made up of white matter.
This matter is made up of millions of microscopic nerve fibers.
These nerve fibers are responsible for the signals the brain
receives. As one ages, it is normal to lose a certain amount of
white matter. This loss of white matter contributes to
perceived “signs of aging” i.e. forgetfulness, confusion and so
on. MRI is currently equipped with technology that is capable
of tracking these nerve fibers and thus contributing to the
collected data that is needed to understand the true cause
and effect of the aging brain.
Functional magnetic resonance imaging (fMRI) has
been evolving since 1991, when it was first created. Brain
fMRI is only one of the many ultra-fast imaging techniques
that have arisen from conventional magnetic resonance
imaging (MRI). fMRI is capable of capturing images of the
brain during activity and rest. These sets of images can be
manipulated to demonstrate the functional brain activity
associated with particular tasks. If affected by certain
pathologies, such as epilepsy, these images can show its
affect on the motor, visual and language cortexes of the
brain. Treatment planning can be based off of functional
brain imaging to provide better outcomes. Research and
advancements in fMRI are constantly evolving and providing
new pathways for patient care.
ABSTRACT #15
Diagnosis of Pulmonary Embolism with CT vs. MRI
Tannis Reif. Magnetic Resonance Imaging Program, Division
of Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
A medical emergency can be described as a
condition in which ten percent of patient’s not diagnosed
within the first hour, will not survive. One of those conditions
is a Pulmonary Embolism (PE). A pulmonary embolism is a
blood clot that is found in the pulmonary arteries. The
pulmonary arteries supply blood to the lungs. Patients with a
history of deep vein thrombosis are at greater risk for a
pulmonary embolism. This is due to the blood clot traveling
from the extremity, where it originated, and into the lungs,
creating a life threatening event. Due to the seriousness of
this condition, it is important for a quick diagnosis. The most
commonly utilized imaging modality for this condition has
been a contrasted Computed Tomography (CT) scan. MRI
chest scans are also currently being researched as a means
to rule out a pulmonary embolism. As with any advancement,
there are many improvements that need to take place before
this secondary modality will be considered the “gold
standard.” The purpose of this exhibit is to compare CT and
MRI in the diagnosis of a pulmonary.
ABSTRACT #16
Composition of Metals: How Elements from the Periodic Table
Affect MRI
Chad Schock. Magnetic Resonance Imaging Program,
Division of Radiation Science Technology Education, School of
Allied Health Professions, University of Nebraska Medical
Center, Omaha, NE
The periodic table is organized into several groups:
alkali metals, alkaline earth metals, transition metals, posttransition metals, metalloids, lanthanides, actinides,
nonmetals, halogens, and noble gases. Each element group
exhibits specific characteristics that are important to the field
of magnetic resonance imaging (MRI). Each group also has
different susceptibility to magnetic fields and is further
categorized into diamagnetic, paramagnetic and
ferromagnetic materials. The transition metal group contains
ferromagnetic elements that can cause issues while scanning
patients. Iron, cobalt, and nickel are ferromagnetic elements
that are commonly used in metals. If a surgically placed
object is made of materials that are magnetic or composed of
alloys, then artifact or the distortion of an image may occur.
Certain devices such as stents, pacemakers, tattoos, and
aneurysm clips may be harmed during an MRI scan and
could potentially harm the patient. By being aware of the
different elements in the periodic table, the technologist can
reduce the amount of damage done to a patient.
ABSTRACT #17
Radium-223 Dichloride: Advanced Stage Prostate Cancer
Treatment
Allison Hukill. Nuclear Medicine Technology program,
Division of Radiation Science Technology Education, School of
Allied Health Professions, University of Nebraska Medical
Center, Omaha, NE
Radium-223 dichloride (Ra-223) is the first in its
class, alpha emitting radiopharmaceutical that targets areas
of osteoblastic metastasis in advanced stage, castration
resistant prostate cancer (CRPC).
The research presents a review of the published
literature detailing radium-223 dichloride as an advanced
state prostate cancer treatment. The radiopharmacy,
ALSYMPCA clinical trial, and efficacy will be discussed.
Awareness and appreciation of this newly United
States Food and Drug Administration approved
radiopharmaceutical therapy and its efficacy will enable
clinicians to thoroughly asses each advanced stage prostate
cancer patient by planning and implementing the appropriate
intervention. Radium-223 will assist in optimizing the length
and quality of life of patients with advanced stage prostate
cancer.
The results demonstrate that radium-223 dichloride
therapy has significantly delayed the onset of skeletal-related
events (SREs), while improving pain response, as well as
increased the length and quality of life in metastatic
castration resistant prostate cancer (mCRPC) patients.
Currently, when comparing the risks to the benefits
ratio of Ra-223 therapy, it appears to be quite favorable.
Considering the results from the ALSYMPCA trial, efficacy of
Ra-223 therapy is reassuring. Furthermore, this therapy may
improve the quality of life and survival of patients with other
tumor types who suffer from bony metastases as well.
Additional research and clinical trials will be necessary before
Ra-223 therapy of other tumor types can be approved.
ABSTRACT # 18
Lymphoscintigraphy: Lymphoseek Tc-99m Tilmanocept vs. Tc99m Sulfur Colloid
Ahmed Naciri. Nuclear Medicine Technology program,
Division of Radiation Science Technology Education, School
of Allied Health Professions, University of Nebraska Medical
Center, Omaha, NE
Lymphoscintigraphy is used to localize the first
primary lymph node that drains a tumor site. This technique
has been using technetium -99m sulfur colloid for the last
thirty years. In this poster, we will compare Lymphoseek
(technetium-99m tilmanocept), as a newly FDA approved
agent that was specifically made for sentinel lymph node
(SLN) mapping, to sulfur colloid. These agents will be
compared to the characteristics that an ideal agent would
exhibit. These are: standardized size & minimal manipulation,
safe and relatively painless, high injection site clearance and
uptake, good accumulation in SLN, reside in SLN and not
pass to other secondary nodes.
Results of this comparison showed that Lymphoseek
( technetium-99m tilmanocept) has small standardized size,
high uptake in SLN and clears the injection site better than
sulfur colloid, resides and accumulates in the SLN in higher
amounts as compared to sulfur colloid.
ABSTRACT # 19
HPV Related Cancers
Lisa Bartenhagen, Tanya Custer. Division of Radiation Science
Technology Education, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Human Papillomavirus (HPV) is associated with more
than 150 viruses. HPV is an infection of the basal epithelium
and transmission can occur either by direct contact or during
childbirth. More than 50% of sexually active people will be
infected with some form of HPV during their lifetime. Two
categories of sexually transmitted HPV include low-risk HPVs,
which are not cancer causing, and high-risk, or oncogenic
HPVs, which can lead to a cancer diagnosis.
Malignancies found to be associated with HPV
infection include cervical, vaginal and vulvar cancers, penile
and anal cancers as well as cancers of the oropharynx.
Treatment of HPV-related cancers often includes surgery,
chemotherapy and radiation therapy. Health education and
prevention is necessary to reduce cancers related to HPV
infections. Education on abstinence and vaccinations are two
methods proven to be effective. The role of the health care
provider is to educate adolescents regarding the risk of
sexually transmitted disease and ways to protect themselves
from HPV-related cancers such as the cases included.
ABSTRACT #20
Breast Tomosynthesis: The Digital Future of Mammography
Jessica Backhaus. Radiography Program, Division of
Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
The use of mammography for early cancer detection
is a widely accepted practice in many countries.
Mammography can drastically reduce the mortality rates of
breast cancer.1 However, standard mammography has
limitations. It is limited by the superimposition of thick breast
tissue. It can mislead the radiologist by making normal tissue
appear abnormal, or it can conceal actual cancers.2 Digital
breast tomosynthesis is a new tool in early detection
methods. The breast anatomy can be complex. Breast
cancer can appear all throughout the breast and in any
breast tissue. Breast tomosynthesis is proving to be more
useful than standard conventional mammography. It can
accurately image through dense breast tissue more efficiently
than conventional mammography. Moreover, research has
shown that combining the use of standard conventional
mammography and breast tomosynthesis has proven to be
more effective than conventional mammography alone.
Breast tomosynthesis can significantly reduce radiologist
recall rates and detect breast cancer quicker and earlier.
However, along with its advantages, breast tomosynthesis
also has disadvantages such as image artifacts. Summing it
all up, breast tomosynthesis is the future of mammography.
It will better improve the rates of discovering abnormal breast
tissue quicker. Adding breast tomosynthesis to routine breast
cancer screening will ultimately improve cancer detection and
should also help lower the radiologist’s recall rate.1 This
exhibit highlights how digital breast tomosynthesis is
improving the future of mammography and detecting
abnormal tissue more accurately.
ABSTRACT #21
Salter-Harris Fractures: Radiologic Factors that Predict
Premature Growth Plate Closure
Olga Biletska. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
This is a retrospective review of the literature
studying Salter-Harris growth plate fractures that can cause
premature epiphyseal closure in pediatric patients. Studies
have attempted to confirm the relationship between the injury
mechanisms, the radiologic pattern, the management, and
the outcome of epiphyseal plates fractures in order to predict
and reduce bone deformity and growth arrest in children.
Based on initial radiographs, fracture displacements between
the epiphysis and metaphysis were measured in millimeters.
The amount of displacement was compared before and after
reduction. Post reduction residual displacement was
recognized as problematic when the physeal gap was >23mm. Depending on Salter-Harris fracture type, amount of
displacement, age, and mechanism of injury, two types of
treatment was performed: closed reduction or open reduction
and internal fixation. If follow-up appointments with
radiographic evaluation revealed the possibility of PPC, a
computed tomography (CT) or magnetic resonance imaging
(MRI) was recommended for accurate physeal gap
measurement and surgical planning.
ABSTRACT #22
Imaging Modalities Utilized in the Diagnosis of Inflammatory
Breast Cancer
Whitney Brooke. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
Breast Cancer is one of the leading causes of death
in the United States. One of the most rare, aggressive forms
of breast cancer is Inflammatory Breast Cancer (IBC). The
importance of imaging modalities is critical in diagnosing IBC
in order to detect this disease at an early stage.
Mammography, ultrasonography, and magnetic resonance
imaging are three of the most common imaging modalities
used to detect IBC. The purpose of this exhibit is to focus on
these three imaging modalities when diagnosing a patient
with IBC.
ABSTRACT #23
ABSTRACT #25
Out With the Old, Flip the New: Flipped Classrooms for the
Modern Learning Age
Megan Bygland. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
Müllerian Duct Anomalies: Diagnosing Uterine Didelphys
Blair Dixon. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
With the medical world evolving with new
information all the time, it is a wonder how students who
pursue education in the medical profession can stay on top of
all the information. It is hard for students to listen to a
professor lecture for an hour and try to comprehend all of the
information. A new concept of learning, called blended
learning, is taking the traditional classroom and flipping it.
Professors now post lectures online and use in-class time for
students to get hands-on education whether it is in a
simulation lab or in groups collaborating together to come up
with a solution to a problem. The effectiveness of a flipped
classroom has a positive effect to students who are exposed
to it.
ABSTRACT #24
Using Automated Breast Ultrasound Systems to Image and
Detect Masses in Dense Breast Patients
Conner Coffin. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
Dense breast tissue makes mammography
interpretation challenging for radiologists because of its
similar appearance to cancer. Because of the overlying
tissue, dense breasts show up coarse and have white spots on
the mammogram, similar to cancerous masses, which appear
granular and white. Sonography has evolved as an adjunct to
mammography in the diagnosis of breast cancer for women
with dense breasts. Automated Breast Ultrasound (ABUS) is
a newly developed technique of sonography used as a
supplementary modality to mammography to allow for a
closer look at breast tissue. This growing imaging system is
cost effective, painless, and gives the radiologist a clearer
look at the breast tissue. ABUS is approximately a fifteen
minute automated scan of the entire breast that creates
three-dimensional images. The machine takes three views
each breast; these views include frontal, medial-frontal, and
lateral-frontal. Currently the market has taken a “wait and
see” approach for ABUS systems, but it is expected for the
ABUS systems to be a part of imaging centers due to it’s low
cost, rapid speed, and non-ionizing radiation.
The female embryo’s reproductive system develops
from the müllerian ducts.1-3 In some instances, the ducts do
not form properly and anomalies of the uterus, cervix, and
vagina occur. There has been a classification system
developed to organize the different types of anomalies that
may occur. One type of müllerian duct anomaly is uterine
didelphys. Uterine didelphys is described as “two uteri and
two cervixes with the duplication of the vagina.”1, 3-6
Diagnosing uterine didelphys may be a difficult task due to
the unique feature of completely separate reproductive
structures, more specifically, the duplication of the vagina.
Ultrasonography and hysterosalpingography (HSG) exams
are the most utilized imaging diagnostic exams to evaluate
reproductive organ anomalies and infertility problems.1,3,5,713 Ultrasonography is usually the first imaging modality
chosen to evaluate these female reproductive complications,
followed by the use of HSG. Magnetic resonance imaging
(MRI) is also an imaging method used to diagnose infertility
and reproductive organ anomalies, although not used as
frequently as ultrasonography and HSG exams.1, 6-15 The
three imaging modalities each have strengths and
weaknesses in accurately diagnosing and differentiating
between the classes of müllerian duct anomalies. Research is
continually underway, to discuss the accuracy of these
imaging modalities in diagnosing and differentiating between
the seven classes of female reproductive anomalies.
ABSTRACT #26
Working Together for a Common Goal:
Developing Interprofessional Activities among Radiation
Science Professionals and other Healthcare Team Members to
Promote Quality Patient Care
Molly Gallagher. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
Interprofessional education is defined as, “an
intervention where the members of more than one health
profession learn interactively together for the explicit purpose
of improving interprofessional collaboration and the
health/welling being of a patient”. With the increasingly high
rate of clinical procedures and advancement of technology in
multiple health professions today, it is essential that
healthcare professionals work together. Interprofessional
education can be integrated at the pre-professional level and
should be carried over to professional practice. The specific
model that is discussed is the Meinersmann-Randall
Transformed Model of Nursing Education or M-RTMNE. The
M-RTMNE model has the components of theory acquisition,
simulation, and a clinical application. Theory acquisition
involves the aspect of integrated coursework at the preprofessional level. The simulation aspect gives preprofessionals a chance to develop important clinical skills.
Once those skills are acquired in a simulation scenario, preprofessionals will move to the next step of clinical application.
These three components are essential in developing an
interprofessionally skilled health care professional.
ABSTRACT #27
Mapping What Makes Humans Unique: The Human
Connectome Project
Christina Gregg, Tammy Jones. Radiography and CVIT
Programs, Division of Radiation Science Technology
Education, School of Allied Health Professions, University of
Nebraska Medical Center, Omaha, NE
The National Institutes of Health’s Human
Connectome Project is an ambitious research effort to
uncover the brain’s neural pathways that underlie human
function. The $40 million in grant funds have been awarded
to a collaborating research consortia consisting of
Washington University, University of Minnesota,
Massachusetts General Hospital /Harvard University and the
University of California Los Angeles. This highly coordinated
research will use state-of-the-art imaging instruments,
analysis tools and informatics technologies with the mission
of freely sharing all resultant data with the research
community at large. Altogether, the Human Connectome
Project will lead to major advances in understanding of what
makes each individual uniquely human and will set the stage
for future studies of abnormal brain circuits in many
neurological and psychiatric disorders.
ABSTRACT #28
Imaging Thoracolumbar Burst Fractures
Blair Hild. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
The thoracolumbar region is the most common site
of injury to the spine, with half of those injuries being better
described as burst fractures. Obtaining adequate images is
vital to treatment planning. This exhibit compares imaging
options for thoracolumbar burst fractures. Radiography,
Computed Tomography (CT), and Magnetic Resonance
Imaging (MRI) are viable imaging options. The various
imaging techniques have advantages and disadvantages.
ABSTRACT #29
The Use of YouTube: Enhancing Student Learning in the
Imaging Sciences
Alicia Hultquist. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
The Internet is continuing to grow and expand
everyday with new websites, new users, and new
technologies. With this growing form of media comes a
change in the way people acquire their knowledge. The
Internet has provided students with a way to gain information
from all over the world without even having to leave their
homes. There are many different varieties of learners in
today’s world. YouTube is a great way for professors to
combine learning styles to help get a message across to their
students. In a pilot study regarding the perception and use of
YouTube among college-level health education faculty, 41.7%
of the respondents reported using YouTube in their courses to
help engage their student’s interest. However, almost all were
willing to take the time to learn about YouTube and ways to
be able to incorporate as a learning resource for their
students.
ABSTRACT #30
Echocardiography: Congenital Heart Defects in Children
Brianna Jacobitz. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
Congenital heart defects (CHD) are the most
common type of birth defects, and are the cause of more
deaths than any other birth defect. In the U.S., roughly 8 out
of 1000 babies, approximately 1%, are born with a CHD.1
The importance of accurate diagnosis cannot be
overemphasized. With advancements in technology, a CHD
can be detected early with the use of an imaging modality
called echocardiography. This exhibit will demonstrate that
echocardiography is the best method in detecting CHD’s in
children.
ABSTRACT #31
Positioning Imaging Science Students for Effective Learning
Tammy Jones. Radiography and CVIT Programs, Division of
Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
Effective student learning is the goal of any
educational curriculum. In order to facilitate effective student
learning, cognitive theories of knowledge acquisition and
pedagogical frameworks and delivery will be examined. A
literature review of relevant scholarly resources was
conducted to provide a foundational knowledge base for the
constructs of cognitive theory and pedagogical frameworks
discussed. The cognitive theories employed include; working
memory, attention, practice, repetition and encoding. The
pedagogical framework and delivery models employed
include; blended learning, teacher and student centered
learning, technology in education, and assessment measures.
From the foundational literature review, a discussion
regarding the traditional and recommended environments for
effective learning will be explored, followed by strategies for
evaluation. The cognitive theories coupled with the
pedagogical framework and delivery models will show that
the recommended environment is most conducive for
fostering effective student learning in a fundamental imaging
science course.
ABSTRACT #32
Multiple Sclerosis in the Medical World
Katie Kuehn. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
Multiple Sclerosis (MS) is one of the most common
debilitating pathologies seen in young adults. Although it
manifests each patient differently, each patient has a
constant struggle. To initially diagnose the disease there are
three diagnostic tests that may be used; spinal tap/lumbar
puncture, visual evoked potentials, and MRI. Of the three,
MRI is considered to be the main diagnostic tool for imaging
patients with MS. MRI scans can visualize MS lesions in the
brain. These lesions are damages in the myelin sheath that
surround the axon, and weaken or diminish nerve
conductivity. Through these lesions you can tell the age of
them, which can be interpreted as how long the MS has been
affecting the patient, and how progressed the disease is. With
this information the treatment plan can be set in place.
Treatment can be conventional with pharmacological
treatment, while the others forms of treatment can be
considered as less conventional such as physical activity to
maintain physical ability and reduce fatigue. Caregivers may
suffer from a different form of fatigue, compassion fatigue.
This fatigue is due to contact with suffering, overexposure,
and increased stress. To cope with this fatigue the caregiver
must acknowledge certain thoughts and feelings that may
come about when helping patients. By coping with
compassion fatigue, there is less tension in the relationships
and a better well-being with both the patient and caregiver.
ABSTRACT #33
Volunteerism among Radiation Science Professionals: A
Generational Assessment
Jennifer Laughlin. Radiography Program, Division of
Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
Maintaining and introducing new volunteers within
an organization is advantageous to success. The American
Society of Radiologic Technologists produced a survey to
explore the generational differences in volunteerism among
radiation science professionals. Their research determined
that while a majority of professionals have at one point or
currently participate in a volunteer activity, they do not
contribute within their profession. The common barrier was
cited as being uninformed as to the options available within
ASRT. The youngest age group surveyed resulted in the lowest
percent of people who have volunteered for the ASRT. Those
currently volunteering represent less than eight percent of
members across all of the generations surveyed. There are
varying motives for volunteering ranging from personal
satisfaction to aiding in career advancement to interest in
learning new skills. While there are ample opportunities to
volunteer in formal or informal settings obstacles continue to
hold individuals back. In order for organizations to continue
operating with costs as low as possible, they should attempt
to boost volunteer numbers.
ABSTRACT #34
Computed Tomography: Prognostic or Pathogenic
Sarah Meissner. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
Since its invention in the 1970s, computed
tomography (CT) has been a topic of interest and study.
Advances in technology have only increased that attention.
Today, CT scans have many capabilities; including 3D
imaging, faster scan times, and the ability to image a larger
area with organs from many systems. Advancements in CT
appeals to both physicians and patients as these
developments lead to an increased confidence in diagnosis
and treatment. Unfortunately, these vast capabilities are
acquired using doses of radiation that are higher than those
of conventional radiography, a fact that is misrepresented
and misunderstood in both interested populations. High
doses of radiation have been linked to carcinogenesis. While
the dose of one CT scan is comparable to the environmental
radiation dose for one year, its levels are still below the
carcinogenic correlation. However, when considering one of
the main uses of computed tomography, screenings, the link
can be considered. If CT scans are used cumulatively, the
dose to the patient increases, potentially reaching that
cancerous dose level. This is of concern when taking into
account the population as a whole. Applying the principle of
as low as reasonably achievable (ALARA) will guarantee that
every scan has a medically indicated need, benefit and
purpose that outweigh the risk, and dose that is the lowest
possible without sacrificing image quality. By promoting and
educating others on this principle, the radiation dose will be
significantly decreased, one scan at a time.
ABSTRACT #35
Effectiveness of Antibiotic Treatment on Lower Back Pain: A
Case Study
Brigette Root. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
Chronic lower back pain is a major disability among
American adults. Different treatments work for particular
cases, but the universal use of intravenous (IV) antibiotics is
being questioned. Antibiotics have been proven as successful
treatment for osteomyelitis, but are now being researched as
a successful remedy for a broader range of chronic lower
back cases, especially herniated discs. A 54-year-old male
with a herniated L5-S1 disc was the focus of the case study.
Infected with streptococcus bacterium, it was treated with
eight weeks intravenous therapy of Vancomycin and other
medications. Studies have validated the effectiveness of
intravenous antibiotic therapy as the first step in healing
discitis and chronic lower back pain in general.
ABSTRACT #36
There’s an App for ThatTM #Radiology #Medical Apps
Emily Schlautman. Radiography Program, Division of
Radiation Science Technology Education, School of Allied
Health Professions, University of Nebraska Medical Center,
Omaha, NE
Mobile medical applications are being created for
radiologists with the goal that they will be able to diagnose
patient images from mobile devices. Mobile devices, such as
the iPad, have proven to show radiologic images successfully
for radiologists to use. The alternative approach with using
mobile devices for viewing and making a diagnosis could
prove to be immensely helpful in emergency conditions when
no workstations are available for the radiologist. There are
apps specifically designed for viewing a patient’s data and
images. Some of these apps include mobile MIM and OsiriX.
They are available on iTunes and can be downloaded onto the
iPhone or iPad. This advancement in radiology could improve
the efficiency in terms of the time it takes the radiologist to
read an image. Faster dictations due to the availability of
seeing the images on a mobile device will result in quicker
reports. The use of mobile devices would not replace the
workstations for radiologists, but rather it would advance
their ability for fast response to patient care.
ABSTRACT #37
Catheter Ablation as a Means to Treat Atrial Fibrillation
Justin Williams. Radiography Program, Division of Radiation
Science Technology Education, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
Nearly 2.5 million Americans have atrial fibrillation
(AF), which is the most common type of arrhythmia. As the
population ages, AF is becoming more common. A heart has
four chambers, the top two being atriums and the bottom two
ventricles. In a heart with normal rhythm the atriums and
ventricles beat separately from one another allowing the
other to expand while it is contracting. During AF an atrium
beats erratically, not giving itself enough time to contract and
expand properly. Typically, patients diagnosed with AF are
given antiarrhythmic medication. However, there are other
remedies besides medications that can be utilized to treat
atrial fibrillation, such as catheter ablation (CA).
The use of fluoroscopy, in the interventional
radiology suite, provides the necessary guidance of a catheter
in a CA procedure which allows patients to receive treatment
that is more effective than antiarrhythmic medications and
less invasive than open heart surgery. The recovery time for
CAs are relatively short compared to the more extensive heart
procedures. However, although CA is effective there are still
risks, complications, and a chance of recurrence associated
with it.
ABSTRACT #38
Advancements in Multiple Myeloma Treatment
Daniel Gunderson, Kristy Stevens. Radiation Therapy
program, Division of Radiation Sciences Technology
Education, School of Allied Health Professions, University of
Nebraska Medical Center, Omaha, NE
Multiple myeloma is a cancer caused when a plasma
cell, which is naturally present in the bone marrow, becomes
malignant. When there is only one plasma cell tumor, it is
known as a solitary plasmacytoma. However, the presence of
numerous plasmacytomas is diagnosed as multiple myeloma.
For years, those suffering from advanced multiple myeloma
have hoped to find a better treatment than the modern day
multi-modality approach that is currently used. Recent
statistics show unfortunate trends in survival from this
standard treatment regimen. Between the years of 2002 and
2008, a five-year survival rate of 43 percent was stated. With
the projected 24,050 new cases in 2014, this is an alarming
value.1Advancements in research have returned new ideas
for treatment, and the success of immunotherapy is being
reviewed.
ABSTRACT #39
Rapid Arc
Ashley Micek, Erin Rosales. Radiation Therapy program,
Division of Radiation Science Technology Education, School of
Allied Health Professions, University of Nebraska Medical
Center, Omaha, NE
Treatment of late-stage nasopharyngeal carcinoma
(NPC) is challenging due to the close proximity of lesions to
nearby organs at risk (OARs). Highly conformal radiation
therapy techniques are extremely important, especially when
these tumors are often extensive and extend into nearby
tissues such as the spinal cord, brain stem, and temporal
lobes.
A study by Queen Elizabeth Hospital in Hong Kong,
China explored the dosimetric differences amongst
TomoTherapy, sliding-window intensity-modulated
radiotherapy or IMRT, and RapidArc. In addition to dosimetric
parameters, monitor units of individual plans and expected
delivery time were recorded as well. The authors hope that
their research may serve as a guideline to aid oncologists in
the selection of patients for the appropriate treatment
technique.
ABSTRACT #40
Pediatric Total Body Irradiation
Blair Thompson, Erinn Moritz. Radiation Therapy program,
Division of Radiation Science Technology Education, School of
Allied Health Professions, University of Nebraska Medical
Center, Omaha, NE
Total Body Irradiation (TBI) is a type of low dose
radiation therapy treatment that delivers a homogenous dose
to the entire body. TBI in conjunction with chemotherapy has
proven useful for eradicating residual malignant or
genetically disordered cells, and for immunosuppression prior
to hematopoietic stem cell transplant. In pediatric total body
irradiation there are several techniques utilized. When
comparing standard and helical TBI treatment studies have
found only slight differences between the two techniques. The
standard technique and a new helical tomotherapy technique
for pediatric total body irradiation will be discussed.
CRITICAL REVIEWS
ABSTRACT #41
Virtual Reality as Intervention for Patients with Chronic Stroke
Celeste Baumert, Morgan Bugosh. Division of Physical
Therapy Education, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
A promising new technique is emerging in stroke
rehabilitation. Virtual reality (VR) is a computer-simulated
environment that allows experience and interaction between
the users and virtual objects. In the physical therapy
rehabilitation, it allows patients learn and exercise in a safe,
three-dimensional environment that a physical therapist can
adjust according to each patient’s needs. In order for
clinicians to perform evidence-based practice, it is necessary
to examine the body of research regarding the effectiveness
of VR as a clinical intervention.
The purpose of this paper was to review studies on
the benefits of VR in combination with traditional physical
therapy compared to traditional physical therapy alone.
Reviewers systematically searched databases (PubMed 20042014, Google Scholar 2000-2014) for studies using VR as an
intervention for people who had suffered from a stroke. This
paper includes studies that only used adults as subjects, had
a control group that received only traditional physical
therapy, and that did not exclusively examine the hand. In
addition, the outcome measures had to be valid and reliable.
Ultimately, three articles were used which met the desired
criteria.
This systematic review summerizes that there is
evidence showing that the use of VR in combination with
traditional physical therapy is significantly more effective for
patients with chronic stroke than traditional physical therapy
alone. In addition, only mild negative side effects like motion
sickness were noted. On average, the vast amount of benefits
outweighed the minimal risks. However, due to the novelty of
VR, standardization of the best types of VR still needs to be
researched. With advancing technology, hopefully one day VR
can become more affordable and thus more accessible to a
wider population of stroke survivors.
ABSTRACT #42
The Effect of Treadmill Training in Children and Adolescents
with Cerebral Palsy
Kristin Clough, Rashelle Smith. Division of Physical Therapy
Education, School of Allied Health Professions, University of
Nebraska Medical Center, Omaha, NE
Cerebral Palsy (CP) is an umbrella term for a group
of non-progressive neuromuscular disorders resulting from
brain lesions acquired before, during, or after birth. The
motor impairments associated with CP can significantly affect
ambulation. Physical therapists have and continue to utilize
treadmill training as a method to improve gait for these
patients. Many studies have been conducted to evaluate the
effectiveness of treadmill training and conventional physical
therapy in children/adolescents. This paper compared four
randomized controlled trials to evaluate the efficacy of
treadmill training (partial body weight support and no body
weight support) and conventional physical therapy. The
research articles were selected based on their inclusion
criteria, reproducibility, and publication date (within the last 5
years).
Treadmill training without body weight support
(TTWBWS) appears to provide more benefit to children with
CP at Gross Motor Function Classification System level I-III as
compared to conventional therapy interventions, but both
training methods improved ambulation overall compared to
baseline. Partial body weight support treadmill training
appears to be no more effective than conventional
interventions. More research is needed for TTWBWS and
exploration of combined treadmill and conventional physical
therapy interventions.
ABSTRACT #43
Effectiveness of Botulinum Toxin A Injections on Motor
Function and Gait Pattern in Children with Cerebral Palsy
Annie Woodruff, Xin Zhang. Division of Physical Therapy
Education, School of Allied Health Professions, University of
Nebraska Medical Center, Omaha NE
Botulinum toxin type A (BTX-A) injections decrease
the spasticity of lower limb muscles, but it is unknown
whether it has benefits on functional outcomes and gait
patterns in children with cerebral palsy (CP). In addition,
limited research has examined the effectiveness of BTX-A
injection by comparing with typical physical therapy (PT) care.
The purpose of this review is to assess treatment
effects of BTX-A on walking of children with spasticity CP
compared with typical PT care.
We systematically searched the databases CINAHL,
Cochrane, PubMed and limited our selected papers to
randomized control trials (RCT) published since the year
2000. Studies were considered eligible for inclusion in the
review if they evaluated the efficacy of BTX-A for the
treatment of leg spasticity in children with CP and compared
the results with typical PT care. Only studies published in
English were included. The methodologies were assessed by
two reviewers. Meta-analysis was not possible because
results were presented in an incompatible form.
Five RCT papers were included. Two studies
demonstrated a significant improvement of gait kinematics
and decrease of spasticity in weeks 6 and 12 for the BTX-A
group, but these significant differences were not maintained
at week 24. The BTX-A group also had better Gross Motor
Function Measure (GMFM) and problem scores at 12 and 24
weeks, with no difference on energy cost. Another study from
El-Etribi and colleagues had similar results. One study showed
BTX-A with comprehensive rehabilitation had no improvement
in lower limb muscle activation patterns during gait but was
effective in improving gait kinematics. The final study showed
that though there were some changes in muscle tone with
BTX-A injections, no group differences were found for gait
analysis, GMFM-66 or the Pediatric Evaluation of Disability
Inventory (PEDI).
Though evidence is controversial in regards to this
topic, the use of BTX-A with typical physical therapy care
seems to improve some functional outcomes and gait
kinematics compared with usual physical therapy care alone.
Due to the limited number of RCT papers, more research
should be done regarding this BTX-A intervention.
ABSTRACT #44
Nutritional and Life Style Determinants of Radiation-Induced
Oxidative Stress in Occupationally Exposed Workers
Iman Ahmad, James Temme. Division of Radiation Science
Technology Education, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha NE
Oxidative stress results when the balance between
the productions of reactive oxygen species (ROS) exceeds the
antioxidant capability of the target cell. It has been shown
that ionizing radiation (IR) produces ROS in living systems
that leads to an oxidative damage to cellular proteins, lipids,
and DNA. Cells have several cellular enzymatic and nonenzymatic antioxidants that detoxify ROS and protect the cell
from oxidative damage. Medical x-ray workers are
occupationally exposed to low level IR, which may lead to
oxidative stress and affect their antioxidant status. In this
exhibit a review of the effect of changing life style, such as
cigarette smoke and dietary manipulations on radiationinduced oxidative stress on x-ray workers have been
discussed. Three research articles were selected for review. A
study by Klucinski et al., 2008 showed that a significant
decrease of antioxidants GPx, SOD and CAT activity in x-ray
groups as compared to controls was observed. A second
study by Kayan, et al., 2009 showed significant increases in
blood LP levels in the smoker and nonsmoker x-ray group
when compared to age-matched controls, emphasizing the
role of oxidative damage in the pathogenesis of ionizing
radiation and smoke in blood. In the third study, Zeraatpishe
et al., 2011 showed that oral administration of lemon balm
infusion in x-ray groups resulted in a significant improvement
in antioxidant enzymes level and marked reduction in LP. The
results of the review in this exhibit can be used to address a
major awareness for improving occupational radiation
protection.
RESEARCH PROJECTS
ABSTRACT #45
Dynamic Roller Pump Occlusion Using Pressure Monitoring
Andrew Beck, David Holt, MA, CCT. Clinical Perfusion
Education program, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Clinical Relevance: Various occlusion techniques are
currently utilized to set occlusion in the DeBakey roller pump
for cardiopulmonary bypass: the traditional static occlusion
method, pressure drop method, and the so-called dynamic
method. The potential for red cell hemolysis, spallation, and
retrograde flow leading to under perfusion illustrates the
importance for proper occlusion. This research investigates
the possibility of establishing a dynamic pump occlusion
technique that more accurately depicts flows seen during
cardiopulmonary bypass by using pressure monitoring.
Methods: This study used three miniature circuits of
different sized polyvinylchloride tubing (1/16” x 3/8”, 3/32” x
3/8”, 3/32” x ½”) at different flows (1l/min, 2l/min, 3l/min,
4l/min) in a double-headed roller pump to test the ability of
setting occlusion to a predetermined pressure point
established by the static occlusion technique. 6 liters of
anticoagulated bovine blood, anticoagulated with acid citrate
dextrose (ACD) and diluted to 32% hematocrit, acted as the
reservoir and circuit solution. An IWX/214 data acquisition
unit and LabScribe 2 software connected to a pressure
transducer on the outlet of the circuit created a pressure
waveform generated by the roller heads. The systolic pressure
on the waveform was monitored to establish a goal pressure
point. With the pump set to an unoccluded setting and off,
the pump was turned up to a predetermined flow as read by
the digital display of the pump head module and occlusion
was adjusted until the desired pressure waveform was
visualized. Each attempt was recorded as successful if
adjusted to within ≤ 3 “clicks” of baseline occlusion.
Results: Out of the 45 occlusion samples that were
tested, 31% were successfully adjusted in ≤ 3 “clicks” (95%
CI: 0.1758, 0.4464) meaning we are 95% confident that the
true proportion of successes ranges from 18% to 45%. A
HemoCue Plasma/Low Hb Photometer was used on blood
samples to reveal plasma free hemoglobin (PFH) levels of
20mg/dl pre data collection and 30mg/dl post data
collection respectively.
Conclusion: The overall success rate of this study
indicates that dynamic pump occlusion with pressure
monitoring at high flows as a consistent means for setting
pump occlusion may be possible but needs further research.
ABSTRACT #46
The Risks of Extracorporeal Integrated Arterial Filters
Kailin Bellows, David Holt. Clinical Perfusion Education
Program, School of Allied Health Professions, University of
Nebraska Medical Center, Omaha, NE
Arterial filters integrated into the oxygenator are
becoming more widely used during extracorporeal circulation
(ECC) because of their benefits. However, minimal research
has been conducted exploring the risks of using this type of
arterial filter. The purpose of this research was to explore
potential risks that may exist with the use of an arterial filter
integrated into the oxygenator during ECC. The potential
risks of focus were related to pressure drop, purge line
shunting, and visibility of emboli. The performance of the
integrated arterial filter throughout these risks was also
compared to the performance of a conventional stand-alone
arterial filter and a circuit with no arterial filter throughout
the same risks. A one-way ANOVA test indicated that the
stand alone filter had a significantly higher pressure drop
(16.8 +/-2.2 mmHg) than the integrated filter and no filter.
The statistical test also indicated that the integrated filter had
a significantly higher volume (182.4 +/-8.5 mL) shunted via
the purge line than the stand alone filter and no filter. Lastly,
Fisher’s Exact test determined that there was a significant
difference in terms of visibility between the integrated filter
(38.5%) and the stand alone filter (100%) and the integrated
and no filter (100%). These results suggest more risk exists
with the use of an arterial filter integrated into the oxygenator
during ECC related to increased shunting and decreased
visibility but less risk exists with the use of an arterial filter
integrated into the oxygenator during ECC related to pressure
drop.
ABSTRACT #47
Quantifying Gaseous Microemboli in Coated Arterial Line
Filters versus Non-coated Arterial Line Filter
Dan Gillespie, David Holt. Clinical Perfusion Science
Education program, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Arterial line filters incorporated into an
extracorporeal circuit provide a last resort for defense against
passage of emboli before entering the patient. Gaseous
emboli provide a drastic hurdle for cardiopulmonary bypass
during cardiac procedures for perfusionists. Cerebral
microemboli are the main cause of cognitive dysfunction after
coronary bypass grafting (Borger, 2001). Many of the
gaseous microemboli are introduced during perfusion
interventions such as when air is injected into the venous side
of the extracorporeal circuit. The arterial line filter is placed
on the arterial side of the oxygenator in the circuit and serves
as the last line of defense for removing particulate and
emboli. Many new advances in arterial line filters have
provided substantial protection for patients. Coating the filter
with heparin or endothelium-like coatings is one such
technique that has become widely popular. The main goal of
these coatings is to provide a replicative endothelium surface
for blood interaction to avoid complement activation. This
research investigates gaseous emboli with regards to the
counts and volume of emboli when comparing coated versus
non-coated filters.
This study utilized a miniaturized extracorporeal
circuit with a Terumo Capiox SX 25RX oxygenator, ½” venous
tubing, 3/8” arterial tubing, and various arterial line filters. A
double-headed Debakey roller pump was utilized with a flow
of 3 liters/min for each trial. The Terumo emboli detection
and classification quantifier (EDAC) was utilized to count the
emboli. Bovine blood was the fluid of choice for the circuit. It
was diluted to 25% HCT, anticoagulated with acid citrate
dextrose, and heated to 37 degrees Celsius. A postoxygenator EDAC transducer, pre-filter transducer, and postfilter transducer was used on each trial. 15 mL of air was
introduced pre-filter for each trial. Three trials were done for
each filter. Five filters were used for a total of 15 trials. Three
coated filters were used. Two non-coated filters were used.
The data was collected and exported to an EXCEL document
for statistical analysis. Data were evaluated with a repeated
measures ANOVA model to account for the correlated nature
of the paired data produced from the before and after
measurements.
It has been show in this research that a significant
difference in coating does not exist for the Before load
measurements (p=.32) whereas, there is a significant
difference for the comparison of coating for the after load
measurement (p=.007) when compared to the non-coated
filters. A significant difference in coating does not exist for the
before measurements (p=.35) whereas, there is a significant
difference for the comparison of coating for the after
measurement counts (p=.004) when compared to the noncoated counts.
ABSTRACT #48
Optimizing Platelet Function in ANH-Collected Blood
Matthew Hansen, David Holt. Clinical Perfusion Education
program, School of Allied Health Professions, University of
Nebraska Medical Center, Omaha, NE
Introduction: Acute normovolemic hemodilution, or
ANH, is a technique employed preoperatively that reduces
the patient’s RBC mass by removing whole blood, and
replacing the volume removed with a colloid/crystalloid just
prior to surgery. The intention is to reduce the amount of
RBC loss during the intraoperative, and immediate
postoperative period by preserving a portion of RBC mass in
the ANH container. This blood is then returned at the end of
the case, or when the patient meets the criteria for
transfusion. While this technique yields many benefits, a
reduction in postoperative bleeding, and possible elimination
of the patient’s need for allogeneic blood products, has not
been reported consistently in current literature. This study
aimed to determine a treatment for this blood that may
better preserve platelet function in order to reduce bleeding,
and the subsequent need for allogeneic transfusions.
Methods: Fresh human blood samples were obtained from
18 subjects. One was used as a baseline, while the other four
were utilized as a control and three experimental groups.
After three hours of exposure to a combination of rocked vs.
unrocked, and room temperature vs. physiological
temperature, the samples were compared to baseline. All
samples were run on a Sonoclot Analyzer for determination of
ACT, clot rate, and platelet function.
Results: The results from this study show that of the four
treatment groups, only samples stored that were rocked, and
at room temperature, significantly preserved platelet
function. For both ACT and clot rate, only the control
treatment (unrocked, room temp) sample was found to not
statistically differ from the baseline values.
Conclusions: In conclusion, this investigation has shown that
the current protocol, or lack thereof, dictated by the AABB for
ANH-collected blood, does not best preserve platelet function
during the operative time period until reinfusion. This
research has shown that simple rocking of the blood may, in
fact, aid in platelet preservation, and reduce postoperative
bleeding. This reduction in bleeding also may reduce the
number of required allogeneic transfusions seen in cardiac
surgery.
ABSTRACT #49
ABSTRACT #50
Assessing the removal of potassium and plasma free
hemoglobin using hemofiltration and centrifugation cell saver
techniques
Kathleen Kubes, David Holt. Clinical Perfusion Education
program, School of Allied Health Professions, University of
Nebraska Medical Center, Omaha, NE
Evaluating the need for a “clear and colorless” effluent in a cell
saver’s wash cycle
Robert Ledbetter, David Holt. Clinical Perfusion Education
program, School of Allied Health Professions, University of
Nebraska Medical Center, Omaha, NE
Objective: The use of autologous blood continues to
be a primary treatment option for patients with the most
commonly used techniques including cell salvage with
centrifugation and hemofiltration. Both techniques have
advantages and disadvantages with hemofiltration being
ideal as it conserves the platelets, albumin, and coagulation
factors while removing excess fluid. However it has been
unsuccessful in removing plasma free hemoglobin and
potassium to levels lower than what is found in cell salvage
processing. This study aimed to explore a new technique of
hemofiltration using a wash medium to aid in the removal of
excess potassium and removal of plasma free hemoglobin
than cell salvage with centrifugation.
Methods: Bovine blood was placed in a 7-gallon
bucket with anticoagulant. The blood was diluted using
sodium chloride to simulate the hemodilution of blood
commonly seen in surgical patients. The potassium levels
were increased to approximately 10 mEq/L. Two groups were
used to process the blood, Group A using hemofiltration with
0.9% NaCl wash medium and Group B using cell salvage with
centrifugation. The hematocrit, potassium levels, and
plasma free hemoglobin levels were analyzed pre and postprocessing.
Results: In all five trials, the remaining potassium
and plasma free hemoglobin was higher in the hemofiltration
group versus the cell saver with centrifugation group. The
amount of remaining potassium and plasma free hemoglobin
in the hemofiltration blood was significantly higher than in
the cell salvage with centrifugation blood when analyzed with
a t-test (p = 0.001 for both tests).
Conclusions: When comparing the plasma free
hemoglobin levels and potassium levels in post-processed
hemofiltrated blood and cell salvage with centrifugation
blood, cell saver with centrifugation continues to be the
superior method in eliminating both potassium and plasma
free hemoglobin.
Background: The use of cell salvage provides benefits
such as removal of plasma free hemoglobin, leukocytes,
potassium, as well as hemoglobin concentration. To ensure
that a quality wash of the salvaged blood has occurred, a
“clear and colorless” effluent was established as the gold
standard. In effort to determine if the effluent’s color
necessitates an efficient wash, this study examines the
characteristics and effectiveness of two cell savers, one that
observes the standard and one that does not.
Methods: Bovine blood was placed in a 5-gallon
bucket with anticoagulant. The blood was exposed to
atmospheric air via a roller pump. This was done to simulate
the blood to air interface that occurs with suction tubing. In
effort to replicate bypass, the blood was continuously
pumped through a heat exchanger via a roller head pump.
Four protocols were established, three with the CS5 and one
with the Autolog. Twelve trials were performed for each
protocol; platelet count, hemoglobin/hematocrit, white cell
count, potassium level, and plasma free hemoglobin were
measured both prior to cell salvage and post cell salvage.
Results: For the primary outcome of percent PFH
removal, there was no significant difference between the
mean differences of the control and experimental protocols
For Potassium removal, there was not a significant difference
between Protocol B, but there is a difference between the
control and Protocols C and D. For the endpoint of leukocyte
removal there is not a difference between the control and
mean difference for Protocol D, but there is a difference
between the control and Protocols B and C. In regards to
platelet removal there is not a difference between the control
and the mean difference for Protocols B, C, and D. For the
outcome of hemoglobin concentration there is a difference
between the control and the mean difference for Protocol B,
but there is not a difference between the control and the
mean difference of Protocols C and Protocol D.
Conclusion: For the primary marker of plasma free
hemoglobin removal, the presence of a “clear and colorless”
effluent line does not necessitate a higher quality of product
when compared to an effluent line that has particulate
remaining in it.
ABSTRACT #51
Integrating Apple iOS Technology into a Graduate Level
Perfusion Curriculum
Trent Little, David Holt. Clinical Perfusion Education program,
School of Allied Health Professions, University of Nebraska
Medical Center, Omaha, NE
Technology is everywhere; it is an evolving and
striking entity born from the industrial revolution that creates
jobs and fosters change. Thus, some of the fastest areas of
expected growth are centered on technological advancement.
As such, both up and coming professionals and those well
versed in their field are learning to utilize its capabilities. One
may be tempted to inquire however, “is technology being fully
utilized in the educational arena and can it be soundly
integrated into a curriculum?” Currently, those that believe
that a sophisticated mobile technology can benefit a student
of higher learning are addressing this concept. Though as of
now, it is scarce to find a study that gains insight into how
tablet administration affects study behavior when the
curricula, teaching practices and tablet content are tailored
to that individual program.
Methods: Nine clinical perfusion students served as
the control group and utilized a “bring your own form of
technology” design, while the remaining 8 clinical perfusion
students utilized a university funded Apple iPad to use
concurrently in their educational pathway. Data was
gathered from feedback responses related to progressive
semester attitudes and perceptions, the iPad’s functionality
as a testing platform, and the overall view on the
implementation.
Conclusions: A controlled study was conducted to
collect quantitative and qualitative data of the impact of the
tablet administration. Overall, we found that the students
with provided iPads’ from the university found their
application to be mild to moderate, at best. Additionally, the
students’ attitude and perception of the tool decreased over
the period of the semester yet, some benefits of the
implementation shined through. For example, providing true
portability of school material, reducing printing within the
program and reducing computer lab usage were noted by
direct student feedback.
ABSTRACT #52
Removal of Complement C3a and C5a in Residual
Cardiopulmonary Bypass Circuit Blood: A Comparison
between Cell Salvage and Ultrafiltration
Ryan Robertson, David Holt. Clinical Perfusion Education
program, School of Allied Health Professions, University of
Nebraska Medical Center, Omaha, NE
Reperfusion injury is a deleterious physiological
phenomenon that occurs is post-ischemic myocardial and
pulmonary tissue after cross clamp removal during cardiac
surgery. Inflammation, edema, and cellular damage via
oxygen free radicals are all characteristic of reperfusion
injury. A potent mediator of inflammation, complement, is
activated via foreign surface contact via the cardiopulmonary
bypass circuit. The aim of this study is to reduce reperfusion
injury by determining which blood processing method will
reduce activated complement components C3a and C5a is
residual cardiopulmonary bypass circuit blood.
For this study, a microcircuit of non-bio coated
tubing was used in conjunction with a hemoconcentrator and
a cell saver. Bovine blood was used to simulate residual pump
blood. This blood was circulated for 60 minutes to ensure
alternative complement pathway activation. After activation,
blood was shunted to the cell saver to undergo cell salvage.
Following cell salvage, the remaining circuit blood was
circulated through the hemoconcentrator. Blood samples
were collected at baseline, after activation, and after both cell
saver and hemoconcentrator treatments. Samples were
centrifuged and supernatant plasma was collected and
frozen. Plasma samples underwent sandwich ELISA for
complement components C3a and C5a.
Regression analysis and students t-test determined
significance with a confidence interval of 95%. There were no
significant reductions in complement C3a or C5a from the
activated control group to either of the experimental groups.
Additionally, there was no significant difference between
experimental groups. Surprisingly, there was a significant
reduction in complement from baseline to activation and a
significant increase in complement C3a from activation to cell
salvage. The results of this study indicate that neither cell
salvage nor ultrafiltration significantly reduces activated
complement C3a and C5a. Methods of reducing complement
and other pro-inflammatory mediators are still debated as
results are often confounding and conflicting between
studies. Further research into the reduction of proinflammatory mediators is warranted to ameliorate post-cross
clamp reperfusion injury.
ABSTRACT #53
ABSTRACT #54
EDAC Evaluation for Strategic Placement of Arterial Filter
Purge
Kristie Steffens, David Holt. Clinical Perfusion Education
program, School of Allied Health Professions, University of
Nebraska Medical Center, Omaha, NE
Risk of Vacuum-Induced Air Embolism with Auto-Venting
Arterial Filters
Ria Ward, David Holt. Clinical Perfusion Education program,
School of Allied Health Professions, University of Nebraska
Medical Center, Omaha, NE
Objective: To determine if the location of the arterial
filter purge line influences the size and count of gaseous
microemboli (GME) post arterial line filter.
Clinical Relevance: Cardiopulmonary bypass circuit
management is essential to help eliminate emboli, especially
GME, post arterial line filter. GME removal is especially
concerning to perfusionists, as consequences for patients on
bypass include a decrease in functional endothelial cells,
hypoxia downstream from the blockage, blood brain barrier
disruption and compliment activation, among others. The
arterial filter purge line diverts a portion of GME away from
the patient and back into the reservoir, and can be managed
in a way that can reduce emboli. It was hypothesized that a
purge line location that would filter the redirected blood
would reduce both the size and count of GME post arterial
filter.
Methods: Three different purge line locations were
tested: one that was directed through the cardiotomy filter,
one directly on the venous line, and one directly on the
venous reservoir through no filters. The Emboli Detection and
Classification (EDAC) system was placed post filter to
measure the count and load of GME for each test trial. A mini
bypass circuit was assembled with the use of bovine blood
and siphon drainage, and Bard Prime-Vu filters to test the
hypothesis. 15ml of air was introduced pre-arterial filter for
each run so visible air was seen in the circuit. 3 trials were
done for each purge line location for a total of sample size of
12. EDAC data on GME size and count was exported in an
Excel document for analysis.
Results: Using One Way ANOVA, the F-test p-value
was 0.62 and 0.33 for GME count and GME load between all
three locations respectively.
Conclusions: With p-values greater than an alpha
value of 0.05, there is no significant difference between
gaseous microemboli count and volume if the arterial filter
purge line is placed on the cardiotomy filter, venous line or
venous reservoir of the bypass circuit.
Arterial filters have become a standard of care at
most facilities. An auto-venting arterial filter is a filter that
must be placed below the reservoir, but will vent any
accumulated or trapped air to the atmosphere. It avoids
dependency on a vent line and removes the need for recirculating blood through that line. Since there is a port open
to air on an auto-venting filter, it is hypothesized that
applying excessive vacuum for venous return will have the
potential to pull air in across the venting membrane and
introduce air into the arterial line.
To test the hypothesis, two identical circuits were
assembled; one using gravity siphon and one using vacuum
assist drainage. The Emboli Detection and Classification
(EDAC) system was used to count and quantify the bubbles in
the circuit pre and post the auto-venting arterial filter. Bovine
blood was used as a substrate to mimic human blood. A
pressure drop was induced by ceasing flow for three seconds
then ramping back up to full flow. Three different flows were
tested with both gravity siphon drainage and vacuum
assisted drainage to see what if any effects the starting flow
had on pressure drop and bubble formation in the arterial
line. There were a total of 9 trials run at flow rates of 1 L/min,
3 L/min, and 5 L/min for both gravity siphon drainage and
vacuum assisted drainage, totaling 18 trials.
Results showed that there was a large variance
between trials. A normal distribution model was used and
ANCOVA was used to determine significance of covariance.
There were no significant differences observed in the type of
drainage, gravity siphon or vacuum assisted, or the main
effects of flow and sensors reading bubbles counts.
At this time, it can be concluded that gravity siphon
and vacuum assisted drainage are both equally safe if the
auto-venting arterial filter is placed as directed, below the
reservoir. Future experiments may want to test the circuit
using excessive vacuum, over -40 mmHg, and the height of
placement of the auto-venting arterial filter.
ABSTRACT #55
Survey of a Virtual Microscopy Teaching Module Utilizing Cell
Block, Diff Quick and Pap Stained Slides
Nick Baker, Maheswari Mukherjee, Amber Donnelly.
Cytotechnology Education Program, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
Cytotechnology education programs and residency
programs in the U.S. have traditionally used glass slides and
light microscopy for teaching cellular morphology. It can be
difficult to compare different stains/prep types to each other
using light microscopy because you cannot view more than
one glass slide at a time. Additionally, cytotechnology
students are more comfortable interpreting Pap stained slides
than DQ and cell block prepared specimens due to the fact
that they have more experience interpreting cases using the
Pap stain. The objective of this research was to survey
cytotechnology students as well as pathology residents
regarding a virtual microscopy (VM) teaching module utilizing
cell block (CB), diff quik (DQ), and Pap stained slides from
body cavity fluids. Six cases were selected for this project
using the laboratory computer system, CoPath. All slides were
scanned to create virtual images using the BioImagene Coreo
Au scanner. All images were annotated and comparison
annotations were created for each case to compare Pap, DQ,
and CB to one another. The participants completed surveys
before and after viewing the VM module. The pre-survey
results showed that 90% of participants felt that the VM
module would increase their confidence in interpreting the
various stains/prep types. The post survey results showed
that over 80% of the participants felt that the VM module
increased their understanding and confidence amongst DQ,
and CB slide interpretation.
ABSTRACT #56
Assessing the Use of Virtual Microscopy in Cytotechnology
Education
Vincent DeAgano, Maheswari Mukherjee, Amber Donnelly.
Cytotechnology Education Program, School of Allied Health
Professions, University of Nebraska Medical Center, Omaha,
NE
Virtual microscopy (VM) has become a common
method of teaching in histology programs across the country.
The purpose of this study was to determine the extensive use
and efficacy of VM in Cytotechnology (CT) education
programs across the United States. To obtain data for this
study, a survey was conducted in which 10 questions related
to VM were formulated and sent to all CT programs in the
United States. The questions included the following topics:
general use of VM within the program; scanner and software
brands; focal plane levels; amount of time VM has been used
in program; number of slides scanned with VM; utilization of
VM; opinion of VM’s effectiveness; and reasons for not using
VM in CT programs.
Of all the CT programs (29), 24 responded to the
survey. Only 3 of the 24 respondents utilize VM in their CT
programs. 2 of the 3 programs use a single focal plane level
for scanning while the other uses a multifocal plane level. 1
of the 3 programs has scanned 500 – 1000 slides with VM
and only 1 program has utilized VM for 2 – 4 years. 3 of the
respondents use VM solely for teaching and 1 respondent
uses unannotated images for daily slide screening. A popular
opinion of VM’s effectiveness is that it helped to preserve
slides by digitizing them as all respondents “strongly agreed”
with this assertion. However, another firm opinion was that
teaching with glass slides is important, an assertion that 7 of
8 respondents “strongly agreed” with and the other
respondent “agreed” with. For the programs that do not use
VM, 68.43% of the respondents suggest the idea is too
expensive and 50% also indicate the development of the
teaching module as time consuming. Aperio was the most
common instrument used for scanning and digitizing images.
Based on the results from this survey, VM is not a common
method of teaching in CT programs across the United States
but may have greater implications in future education.
ABSTRACT #57
Comparative study between fine needle aspiration cytology
glass slides and virtual images
Sarita Gawandi, Amber Donnelly, Elizabeth R. Lyden,
Maheshwari Mukherjee. Cytotechnology Education Program,
School of Allied Health Professions, University of Nebraska
Medical Center, Omaha, NE
Virtual microscopy (VM), where glass slides are
scanned into digital images, has been widely used in
educational, training, and research purposes in pathology.
Although the diagnostic sensitivity of VM has been tested
several times in histopathology, there are not many studies
comparing whole slide scanned images (WSI) with glass
slides in non-gynecological cytology. Gerhard et al (2013),
studied thyroid cases and noted a moderate agreement rate
for virtual images and conventional glass slides between two
observers. The purpose of this study was to compare the
diagnostic agreement between VM and LM among three
cytologists for specimens obtained from fine needle
aspirations of different body sites
Twelve cases including breast, lymph node, liver,
pancreas, and thyroid each with Pap and Diff-Quik stained
slides were scanned. Three experienced reviewers were asked
to interpret the WSI images followed by conventional glass
slides with a gap of a few days in between. For both glass
slides and virtual images the reviewers were given a list of
diagnoses to select from. There was a concordance of 88.9%
among all three participants when they all agreed on correct
diagnosis of positive and negative for a particular case using
both VM and light microscopy (LM). The concordance
between original diagnosis and VM diagnosis was 91.7%,
which was the same as concordance between original
diagnosis and LM diagnosis (91.7%). The overall
intraobserver diagnostic agreement in all three participants
between VM and LM was 94%. The interobserver reliability
among all three participants using VM was 72% indicating
substantial agreement, and by using LM was 75%, also
indicating substantial agreement.
The results suggest that there was a comparable
diagnostic performance between VM and LM assessment.
Thus VM is a good option to LM in assessment of breast,
pancreas, liver, lymph node, and thyroid FNA; however, more
such studies comprising larger numbers of cases are needed
to confirm the results considering the advantages of VM over
LM.
ABSTRACT #58
Digitalizing Cytology Specimens: Reproducibility of Virtual zstacked Images by Ventana Scanner
Jillian Schneider, Amber Donnelly, Elizabeth R. Lyden,
Maheswari Mukherjee. Cytotechnology Education program,
School of Allied Health Professions, University of Nebraska
Medical Center, Omaha, NE
Whole slide imaging (WSI) in cytopathology is an
emerging practice that is useful in education, archiving
patient records and proficiency examinations; however, the
thickness and 3-D nature of cytology slides require scanning
multiple z-stacked focal planes at high magnification. The
large digital files and increased virtual screening time spent
focusing over the z-axis have inhibited WSI from becoming a
feasible option during the diagnosis process. To ensure
correct diagnoses in practical applications, the scanner
should consistently produce the same focused image when
given set parameters. To investigate the precision of The
Nebraska Medical Center’s (TNMC) scanner, Ventana iScan
Coreo Au, five pre-diagnosed glass slides containing five
annotated cell groups were selected from TNMC’s Cytology
Laboratory archives. Each slide was scanned three times at
three focal plane levels using 1-micron (µ) intervals on 40x
magnification producing a total of 225 annotated cell groups.
One pathologist and three cytotechnologists reviewed the
digital images and determined if the same cells within an
annotated group were similarly in focus on each of the three
scans. Out of the 75 comparisons of the three focal plane
levels, 7 comparisons (9.3%) contained three cell groups that
were considered to be similarly in focus, or “the same;” 46
(61.3%) revealed that all three cell groups were not similarly
in focus, or “different;” and 22 (29.3%) showed at least one
group was considered to be dissimilar, or “mixed.” There was
no association between focal plane level and comparison
outcome (p=0.75). During the panel, each cell group was also
recorded as in focus or out of focus (OOF) regardless of
similarity to the other comparable groups. 56 of the 225
groups (24.9%) were determined to be OOF. Of the 56 OOF
groups, 4 groups (7%), 13 groups (23%), and 39 groups
(70%) occurred on the -1 µ level, 0 µ level (optimal focal plane
level calculated by the scanner), and 1 µ level, respectively. A
Chi-Squared test showed a significant difference (p< 0.0001)
in overall distribution of OOF groups between the three focal
plane levels. The results indicate TNMC’s scanner does not
repeatedly produce the same digitalized image of a glass
slide when given the same scanning parameters and the 1 µ
level appears to have produced a disproportionately high
number of OOF groups.
ABSTRACT #59
Elderly Adult Malnutrition in the Adult Intensive Care Unit
(AICU)
Clare Becker, Dietetic Intern. Medical Nutrition Therapy
Education program, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Objective: Determine the prevalence of malnutrition
among elderly adults upon admission to the AICU, and, in
those patients who were malnourished, to determine whether
or not parenteral nutrition (PN) was initiated appropriately.
Clinical Relevance: In the critical care setting,
malnutrition is estimated to be around 50%. The acute-phase
inflammatory response alters energy and protein
requirements by elevating energy expenditure and nitrogen
excretion, respectively. In the elderly, catabolism of lean body
mass (LBM) is most detrimental to their recovery. Therefore, it
is vital to assess the prevalence of malnutrition, and
determine if patients who are malnourished are receiving
appropriate nutrition support.
Methods: A medical record review was conducted on
10 patients for exploratory analysis. The criteria for
malnutrition used in this study were: energy intake,
unintentional weight loss upon admission, physical exam
(body fat, muscle mass/wasting, edema), and overall
clinical/disease status. The guidelines for initiation of PN were
directly from the A.S.P.E.N. guidelines for subjects determined
to be malnourished.
Results: All 10 of the patients were included in the
results of the study. Of the 10 subjects, 70% (7/10) were
determined to be malnourished upon admission to the AICU.
Of the seven subjects who were malnourished, appropriate
PN was initiated for 71% (5/7). Edema, overall
clinical/disease status, and energy intake were the most
common criteria met by the subjects.
Conclusions: A standardized assessment may be
beneficial in the AICU to help clinicians screen for
malnutrition in order to avoid LBM catabolism and initiate
appropriate nutrition support therapy. Additional research is
needed to determine the most applicable criteria to use when
diagnosing malnutrition in the AICU setting.
ABSTRACT #60
Adequate Protein Intake in the Elderly
Jessica Hinds, Dietetic Internship. Medical Nutrition Therapy
Education program, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Objective: To compare the protein intake of men and
women > 65 to their ideal protein intake.
Clinical Relevance: Research has shown that
inadequate protein intake results in further loss of muscle
mass that delays recovery in the elderly. Depleted muscle
mass reduces the function capacity of older adults. Evidence
suggests that making sure that adequate protein is consumed
will promote a healthier nutritional status in hospitalized
elderly patients.
Methods: A medical record review was conducted on
31 subjects who had a documented calorie count.
Results: A total of 16 males and 15 females were
included in the results of the study. Of these 31 subjects, a
nutrition score of 2 (probably inadequate) was reported. The
average prealbumin and albumin were 13.4 and 2.8
respectively. The mean caloric intake was 1040 as well as
45g of protein. Twenty-three of the thirty-one patients were
provided with a scheduled supplement. A t-test was
conducted comparing the mean of protein intake between the
group that received a protein supplement and those who did
not. No significant difference was found between the two
groups (p =0.06). Overall, the patients met 61% of their
protein needs.
Conclusion: Additional research is needed to
determine the best ways for elderly to achieve their ideal
protein intake while hospitalized. It is in the best interest of
the patient to find ways for all of them to meet their minimum
protein needs.
ABSTRACT #61
Prevalence of unintentional weight loss and the nutritional
response upon admission to The Nebraska Medical Center
Jenna Paseka, Dietetic Intern. Medical Nutrition Therapy
Education program, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Objective: The purposes were to identify the
prevalence of unintentional weight loss upon admission to
The Nebraska Medical Center in adults and identify the
nutritional response.
Clinical Relevance: Unintentional weight loss is
associated with an increased mortality risk of 9-38%. In-
hospital complications, decline in activities of daily living,
delayed wound healing, and increased morbidity are all
linked to unintentional weight loss. The goal is to have
nutrition consults for those admitted with unintentional
weight loss to determine nutritional interventions.
Methods: In a retrospective cross-sectional study of
100 electronic medical records of patients aged 19 or older
at The Nebraska Medical Center, unintentional weight loss
was identified upon admission using a screening tool
administered by nurses. If the subject reported unintentional
weight loss, data was collected from the medical record to
assess if a nutrition consult was ordered within 24 hours and
whether a nutritional intervention was implemented.
Results: The prevalence of unintentional weight loss
was 12% among the reviewed subjects. Of those 12 subjects,
42% had a nutrition consult for a dietitian ordered within 24
hours of admission with 80% of the consults leading to a
nutritional intervention.
Conclusions: Unintentional weight loss upon
admission is present in patients admitted to The Nebraska
Medical Center. Less than half of the subjects had nutrition
consults ordered within 24 hours; however, when consults
were ordered, early interventions were implemented. There is
a need for further evaluation of the nutritional screening
process upon admission in order to improve outcomes
through nutritional interventions.
ABSTRACT #62
Identification of Enteral Nutrition Target Goal at The Nebraska
Medical Center
Heidi Pfeifer, Dietetic Intern. Medical Nutrition Therapy
Education program, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Objective: To identify if the target goal of enteral
nutrition (EN) was determined and clearly identified at the
time of initiation of the nutrition support therapy in the
Intensive Care Unit (ICU) at the Nebraska Medical Center
(TNMC).
Clinical Relevance: The ASPEN Guidelines for the
Provision and Assessment of Nutrition Support Therapy in the
Adult Critically Ill Patient states that the goal rate should be
clearly stated and identified at initiation of EN. Nutrition is an
important factor for the recovery of patients, especially those
in the ICU. Early initiation of EN, within the first 24-48 hours,
is associated with better outcomes in the ICU including
decreased length of ventilation, lower infection rates, and
decreased length of stay (3,4). Likewise, overfeeding patients
is associated with other risks including glucose overload, fatty
liver, higher rates of infectious complications and increased
mortality.
Methods: Information was gathered through a
retrospective cross-sectional chart review of subjects admitted
to the adult ICU at TNMC who received EN from September
2013-December 10, 2013.
Results: The average number of times the goal rate
of EN was stated before the initiation of the nutrition therapy
was 95.6% (65 out of 68).
Conclusions: The results of this study show that a
majority of the time at TNMC the goal rate of EN is stated at
the time of initiation of the therapy. There is, however, still
room to improve.
ABSTRACT #63
The Prevalence of Malnutrition in Pediatric Patients at The
Nebraska Medical Center (TNMC)
Nicole Rezac, Dietetic Intern. Medical Nutrition Therapy
Education program, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Objective: To identify the prevalence of malnutrition
in pediatric patients between the ages of 3 and 18 on
admission at TNMC.
Clinical Relevance: Malnutrition in pediatric
hospitalized patients has been associated with negative
hospital outcomes. While ASPEN has published diagnostic
criteria for malnutrition in adults, there have been no criteria
established for the diagnosis of malnutrition in pediatric
patients. Due to the lack of standardized diagnostic criteria,
malnutrition in pediatric patients may be largely
unrecognized.
Methods: The prevalence of malnutrition on
admission was determined using a cross sectional
retrospective chart review of inpatients between the ages of 3
and 18 at TNMC. The subjects had been admitted to TNMC
between August 2013 and October 2013. All subjects that
were reviewed were included. The subjects that were
classified as malnourished exhibited two of the following
seven diagnosis criteria. 1) < 5th percentile in CDC growth
charts; 2) shift downward on CDC growth chart for weight of
2 or more percentiles; 3) < 75% of estimated energy needs
consumed in first three days after admission; 4) disease or
condition present for increased risk; 5) indicators of
inflammation present; 6) physical findings including: loss of
subcutaneous fat, muscle loss, localized/generalized fluid
accumulation; 7) developmental/functional decline. Findings
were compared with the professional opinion of the clinician
conducting the retrospective chart review.
Results: Of the 10 subjects reviewed, 60% (6/10)
were determined to be malnourished upon admission. The
clinician identified 30% of the subjects (3/10) as
malnourished. The agreement of the diagnosis of malnutrition
using the diagnostic criteria compared with the professional
opinion of the clinician was measured using Cohan’s Kappa
Coefficient (K= .62963).
Conclusions: Malnutrition of pediatric patients on
admission to TNMC is a prevalent problem. Future research
should be done to standardize diagnostic criteria to improve
the identification and treatment of this condition.
ABSTRACT #64
Vitamin D Status Not Associated With Inflammatory Markers
in Bariatric Patients.
Carly Sorenson, Dietetic Intern. Medical Nutrition Therapy
Education progam, School of Allied Health Professionals,
University of Nebraska Medical Center, Omaha, NE
Objective: The aim of this study was to investigate
the association between vitamin D status and markers of
inflammation commonly available in patients undergoing
medically supervised weight loss prior to bariatric surgery at
The Nebraska Medical Center.
Clinical Relevance: Research has shown that lowgrade inflammation characterizes obesity and may contribute
to many metabolic complications. Vitamin D deficiency has
also been associated with obesity. This is significant because
vitamin D has been reported to play a role in mediating
inflammatory pathways. Because both inflammation and
poor vitamin D status are associated with obesity,
investigating the relationship between serum 25(OH)D levels
and inflammation in obesity may be beneficial.
Methods: A retrospective medical record review of
eligible adults participating in supervised weight loss at The
Nebraska Medical Center (n = 11) between April and
December 2013 was conducted. Serum 25(OH)D, albumin,
transferrin, and white blood cell count were recorded. Vitamin
D deficiency was set at serum 25(OH)D <30 ng/mL.
Results: Seven of 11 patients (64%) were found to
have vitamin D deficiency (mean = 18 ng/mL). Correlative
data analysis revealed no significant association between
serum 25(OH)D and WBC, albumin, or transferrin. No
significant difference was found between the mean
inflammatory biomarker levels in the vitamin D deficient and
sufficient groups.
Conclusions: The relationship between the triad of
obesity, vitamin D status and inflammation is complex. As the
prevalence of obesity continues to grow, it is of critical
importance to investigate ways to decrease the risks of
comorbid conditions associated with obesity. Although
previous studies have shown an inverse correlation between
vitamin D status and inflammatory markers, the current study
does not suggest an association between vitamin D status
and the indicators of inflammation studied.
ABSTRACT #65
ABSTRACT #66
Integrating Best Evidence into Practice: Outcomes of a
Community-Based 12-week Exercise and Education
Intervention in Women with Cancer
Betsy Becker , Katherine Jones , Patricia Hageman , Ruth
VanGerpen . Division of Physical Therapy Education , School
of Allied Health Professions, University of Nebraska Medical
Center, Omaha, NE, Bryan Medical Center , Lincoln Nebraska
Tai Chi as a Balance Intervention for Older Adults: Web-based
vs. Video-based?
Megan Bradberry, Sarah Kennedy. Division of Physical
Therapy Education, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha NE
1
1
1
2
1
2
Objective: The objective of this project was to
evaluate the effectiveness of a 12-week evidence-based
cancer exercise and education intervention on outcomes of
fatigue, pain, depression, sleep disturbance and quality of life
for women with cancer.
Methods: The intervention was delivered by an
interprofessional team, led by a physical therapist, in a
medically-based wellness center. Women with any type of
cancer were eligible to enroll regardless of whether or not
they were on active cancer treatment but excluded if they had
any contraindication to exercise. Small groups completed
hour-long supervised group exercise sessions twice weekly.
These sessions included resistance training, aerobic, flexibility,
balance, aquatic or yoga. Weekly education sessions
included topics such as nutrition, sleep disturbance,
depression, coping, lymphedema, exercise habits, healing
arts, women’s health, spirituality, and stress management.
Participants reported their pre- and post-intervention
perceptions of fatigue, pain, depression, sleep disturbance
and quality of life on a 0 -10 point Likert scale (0 = none, 10 =
worst). We used the related-sample Wilcoxon Signed Rank
test to compare pre- and post- intervention scores and sample
Mann-Whitney U test to compare change scores between
those on and off treatment.
Results: Approximately 80% (n=139) of the women
having a mean age of 53.6 years (SD=11.8; range 23-87)
completed the intervention. We found significant decreases in
the perceptions of self-reported fatigue (-5.5, p<.001), pain (0.5, p=.017), depression (-1.0, p<.001), sleep disturbance (0.5, p<.001), and quality of life (-1.4, p<.001); however, a
subgroup analysis revealed that the impact of the
intervention varied according to treatment status. Specifically,
perceptions of fatigue decreased significantly for the 49
women who were on treatment (-1.4 vs. -0.03 p=.007) as
compared to the 90 women who had completed treatment.
Women on active treatment reported significantly higher
levels of fatigue at the start of the intervention than did the
women who had completed treatment (6.4 vs. 5.0, p<.0001).
Conclusions: Our findings indicate that
implementation of an evidence-based exercise and education
intervention is effective in improving self-reported outcomes
for women with cancer. The most significant impact of the
intervention appeared to be in decreasing fatigue for women
on active cancer treatment.
Objectives of the research: (1) To assess the
feasibility of implementing a web-based Tai Chi program. (2)
To compare the effectiveness of a web-based Tai Chi exercise
program with a DVD-based Tai Chi exercise program on
improving balance among older adults.
Clinical Relevance: A Tai Chi exercise program has
been shown to improve balance in older adults. Previous
studies have focused on instructor-led Tai Chi classes. Little
attention has been paid to a program that could be done in
the home, eliminating barriers to access of an instructor-led
class.
Methods: Eleven adults (10 females, 1 male),
average age 67 ± 11.5 years, were recruited from various
senior centers and companies in the local community.
Subjects were randomly divided into two groups (Web and
DVD) and asked to practice the Tai Chi program at home
using their assigned delivery method twice a week for 12
weeks. Functional Balance measures (Berg Balance Test,
Dynamic Gait Index, and Timed Up and Go Test) and
questionnaires (Centers for Epidemiologic Studies Depression
Screening, Health Survey Questionnaire, Tinetti Falls Efficacy
Scale, and Norbeck Social Support Questionnaire) were
administered to all participants at baseline and following
completion of the program.
Results and Discussion: Both groups showed
improvements in outcome measures between baseline and
post-test. Compliance was an issue with this study. The
dropout rate for the study was 83%. All participants who
dropped out were in the web-based group. This lack of
compliance within the web-based group suggests the specific
website used in this study was not feasible for older adults.
Conclusions: The results of this pilot study suggest
that a home-based Tai Chi program may be beneficial for
older adults, but the specific website used is not feasible for
this population at this time.
ABSTRACT #67
Geographic Distribution of Specialized Stroke Rehabilitation
Services in Nebraska
Zach Douglas, Zach Long, Katherine Jones, Anne Skinner,
Nicole Vanosdel. Division of Physical Therapy Education,
School of Allied Health Professions; College of Public Health,
University of Nebraska Medical Center, Omaha, NE
The World Health Organization’s International
Classification of Functioning, Disability, and Health model
describes environmental factors as one of the three
determinants that affect impairments, activity limitations, and
participation restrictions. Access to specialized stroke
rehabilitation services is an important environmental factor
that helps increase quality of life for stroke survivors after
inpatient rehabilitation. These services are rarely, if ever,
found within a single facility, and a 2010 assessment
indicated uncertainty in terms of where these services were
located. This study’s purpose was to determine the
geographic distribution – including the location and contact
information – of 12 specialized stroke rehabilitation services
in Nebraska, and to examine disparity of access to services
based on that distribution. We used internet search engines
and email surveys to create a database of locations and
contact information for these services across Nebraska. We
then used Community Analyst to geocode and generate maps
for each service. Community Analyst is a web-based
geographic information system that integrates population
data and generates drive-time buffers around geographic
coordinates. The results show that approximately 90 percent
or more of adult Nebraskans 18 years of age or older have
access to eight specialized stroke rehabilitation services when
used infrequently. Results also indicate approximately 70
percent or more of adult Nebraskans 18 years of age or older
have access to four specialized stroke rehabilitation services
when used frequently. These results show that the primary
barrier to accessing specialized stroke rehabilitation services
in Nebraska may be a lack of information regarding their
existence and location rather than the absence of services
available.
and which items were most likely to exhibit scoring
differences.
Clinical Relevance: Instructions for scoring items
may appear to be ambiguous or require the clinical judgment
of an experienced rater. For this reason, item scoring can
have inter- and intra-rater reliability problems, especially
among novice raters.
Methods: All subjects were physical therapy students
in the summer session of the first year of the three-year
Doctor of Physical Therapy curriculum at the University of
Nebraska Medical Center over two years. All subjects were
shown a video of a physical therapist simulating an individual
with Parkinson’s Disease performing all 14 items on the Berg
Balance Scale. Each student was assigned a uniquely
numbered audience response unit. Items were shown in class
and the students entered the score choice for each. At the
next class session, a lecture/discussion was presented as an
introduction to the use of standardized assessment tools and
students asked questions regarding the interpretation of item
instructions and descriptions of rating choices without
divulging individual scores. The subjects again scored the
items on the same video they saw previously. Results: Pre- and
post-discussion percent agreements were calculated for each
item. Of the 8 items ranked lowest, there were 5 items in
common between the two classes of students for which data
were collected (range 36.2 to 70.0% for Class 1 and 40.8 to
67.3% for Class 2). An examination of the item instructions
and scoring descriptors of the lowest ranked items reveals
that a common thread was language that appears to require
clinical judgment.
Conclusions: For novice raters of performance on an
assessment tool like the Berg Balance Scale, an instructional
session incorporating information about the purpose and
design characteristics of standardized patient assessment
tools, along with discussion to help raters better understand
assistance terminology and safety, may contribute to changes
in rating results, illustrated by lower rates of agreement preand post-instruction, especially for test items requiring clinical
judgment.
ABSTRACT #69
ABSTRACT #68
Pre and Post-Instruction Changes in Physical Therapy Student
Item Scores for a Standardized Patient Assessment Tool
Robert Fuchs. Division of Physical Therapy Education, School
of Allied Health Professions, University of Nebraska Medical
Center, Omaha NE
Objective: The objective was to find out if an
instructional session would alter the way standardized
assessment items were scored by physical therapy students
The Impact of Cognitive Level and Task Difficulty on
Spatiotemporal Gait Measures during Dual Task Performance
in Older Adults
Troy Goetsch, Travis Jurgens. Division of Physical Therapy
Education, School of Allied Health Professions, University of
Nebraska Medical Center, Omaha NE
Objective: The purpose of this study was to
determine how cognition and task difficulty impact dual-task
cost (DTC).
Clinical Relevance: This information is necessary to
better design dual-task training programs for older adults of
varying cognition.
Methods: Twenty-three subjects (12 women, average
age 80.7) were divided into two groups based on Montreal
Cognitive Assessment (MoCA) scores (≥ 26 or not). Subjects
completed a single task (ST): normal walking, and three
randomized dual tasks (DT): 1) walking + counting forward by
1’s (FWD1), an easy task, 2) walking + counting backward by
3’s (BWD3), a difficult task, and 3) walking + forward digit
span (FDS), a task with intermediate difficulty. Gait velocity,
step length, coefficient of variability in step time, percentage
of gait cycle in double-support, and center of pressure path
efficiency were calculated from data collected using the Zeno
Walkway (Protokinetics, Havertown, PA). DTC was calculated
for each variable using [(Difference between DT and ST
performance) / ST performance] x 100. Two-way ANOVA was
performed to assess the effects of group and task (α≤ 0.05).
Results: MoCA scores ranged from 18-28 (average
24.3). There was a significant task effect for each gait
variable; BWD3 had greater DTC than both FWD1 and FDS.
FWD1 and FDS did not differ. There was no group effect for
any variable except double-support percentage; the low
cognition group had greater DTC than the high cognition
group. For step length, there was a difference among tasks
within the low cognition group, but not within the high
cognition group, leading to a significant interaction for this
variable. No interactions were found for other variables.
Conclusions: Task difficulty influenced DTC; BWD3
proved more costly for each variable than either FWD1 or
FDS. The lack of difference between FWD1 and FDS was
unexpected because the difficulty of FDS was individualized to
each subject, while FWD1 seems automatic in nature. Due to
few group differences, these gait measures may be
appropriate to assess DTC for older adults of varying
cognitive abilities. However, because the range of MOCA
scores for this study was on the higher end, further research
may assess the effects of cognition and task on individuals
with even lower cognition.
ABSTRACT #70
Comparison of Participants’ Perspectives about a Web-based
Intervention Targeting Guided Weight loss in Overweight and
Obese Rural Women
Lukas Hoover-Rathjen, Patricia Hageman, Carol Pullen, Paul
Dizona, Linda Boeckner . Division of Physical Therapy
Education, School of Allied Health Professions, and College of
Nursing, University of Nebraska Medical Center; Nutrition
and Health Sciences, University of Nebraska-Lincoln
1
2
1
2
3
1
2
3
Background: Obesity is a growing health concern in
the United States, particularly among rural midlife and older
women. Little is known about the use of and perceptions
about web-based guided weight loss in a population of rural,
vulnerable, overweight and obese women.
Purpose: The purpose of this study is to compare the
perspectives of overweight and obese rural women, after six
months of participation, who reported and did not report
weight loss.
Methods: 301 rural women, ages 40-69, enrolled in
the Women Weigh-in for Wellness community-based
randomized control trial [ClinicalTrials.gov, NCT01307644].
The web-based intervention delivered weekly messaging with
a focus on perceived benefits and barriers to action, selfefficacy, interpersonal influences, and goal setting. Women
were provided with a pedometer to record the number of
steps taken daily and were able to record their weight loss,
steps, calorie counting, and goals on the website. Of 301
enrolled, 266 remained in the study at the 6-month
evaluation period, and these 266 women were asked to
complete a survey about their attitudes and perspectives
about the intervention.
Results: Of 266 women who received the survey, 184
(69%) responded with 146 (79.3%) participants reported
losing weight and 38 (20.7%) participants reported losing no
weight. Chi squared analysis showed that posting weekly
results was associated with self-reported weight loss. ANOVA
analyses showed that women who reported losing weight had
higher ratings of perceived helpfulness for website messaging
influencing lifestyle change and website tracking.
Conclusion: Online weight loss interventions are
feasible for overweight and obese rural women. Self-reported
weight loss among overweight and obese rural women, ages
40-69, were associated with posting weekly results, higher
mean ratings of perceived helpfulness in website tracking,
and a higher influence of online messages on lifestyle
changes. Physical therapists may be able to use similar
methods to promote weight loss in their patients.
ABSTRACT #71
A Conceptual Model for Gait Maintenance in Patients with
Diabetes
Chun-Kai Huang, Ka-Chun (Joseph) Siu. Division of Physical
Therapy Education, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Sensory systems including visual perception,
somatosensory and vestibular sensation are well integrated
in healthy people during walking; however, people who suffer
from diabetic peripheral neuropathy (DPN) have the
abnormal or loss of sensation on their feet, which increases
instability and the incidence of fall injuries.
Objective: We proposed a conceptual model that
depicts how DPN patients would utilize their sensory systems
to maintain a stable gait. This model included: 1) Patients
with DPN would adjust their foot placement by the central
nervous system where the sensory feedback is mainly
received from visual and vestibular perception; 2) Patients
with DPN would primarily rely on the visual system to
maintain their balance during walking. Therefore, a
preliminary study was conducted to demonstrate how the
visual perception impacts on gait maintenance among
healthy adults, patients with diabetes mellitus (DM) and with
DPN.
Clinical Relevance: The preliminary data show the
supportive evidence to establish our conceptual model, which
suggests patients with diabetes could rely on perceived visual
information to maintain their gait. The manipulation of visual
information plays a crucial role in foot adjustment in the foreaft direction (e.g. stride length is important for adjusting gait
speed). Physical Therapists can acquire the information from
our conceptual model that visual information can be utilized
as a manipulated factor to develop a balance training
program for patients with diabetes, especially those with DPN
and intact vision.
Methods: Two healthy adults, three patients with
DM, and one patient with DPN were recruited. All
participants were instructed to walk on a treadmill with a
moving virtual corridor presented ahead. The spatiotemporal
gait characteristics and the measurement of gait variability
[e.g. coefficient of variation (CV) that can reveal the average
value of deviation from the mean] were analyzed and
compared between the conditions with or without the virtual
environment.
Conclusions: The perceived visual information (the
presence of a moving virtual corridor) significantly impacted
gait by increasing the CV of stride length (p= 0.02) in DM
patients, and this phenomenon was also shown substantially
in the DPN patient. More participants with DM and DPN
were warranted to confirm the results and to distinguish the
group differences.
ABSTRACT #72
Effects of Exercise Training versus Attention on Plasma B-type
Natriuretic Peptide, 6-Minute Walk Test and Quality of Life in
Individuals with Heart Failure
Joseph Norman , Bunny Pozehl , Kathleen Duncan , Melody
Hertzog , and Steven Krueger . Division of Physical Therapy
Education , School of Allied Health Professions, University of
Nebraska Medical Center, Omaha, NE, College of Nursing ,
University of Nebraska Medical Center, Lincoln, NE, BryanLGH Heart Institute , Lincoln, NE.
1
2
2
2
3
1
2
3
Introduction: Comparisons of Exercise Groups (EX) to
Attention Control Groups (AT-C) have been conducted in
various patient populations but to our knowledge have not
been reported in individuals with heart failure (HF).
Purpose: The purpose of this study was to compare
EX with AT-C to more specifically assess the impact of
exercise training on individuals with HF.
Design: An experimental design was utilized for
comparisons.
Methods: Forty-two individuals with HF were
randomized to AT-C or EX that met with the same frequency
and format of investigator interaction. Baseline, 12 and 24week measurements of B-type naturetic peptide (BNP), 6minute walk test (6-MWT), and the Kansas City
Cardiomyopathy Questionnaire (KCCQ) were obtained.
Comparisons of group baseline measures were performed by
chi-square and t-test analyses. Change over time was
assessed by repeated-measures ANOVA.
Results: Forty subjects completed the 24 weeks of
the study and were used in the analyses. Two subjects were
lost to follow up. BNP tended to increase in the AT-C while
remaining stable in the EX over time. A clinically significant
increase in 6-MWT was demonstrated by the EX (55 m) but
not the AT-C (32 m). The EX achieved a clinically significant
change on the KCCQ at 12 weeks (+8), with further
improvement by 24 weeks (+11), compared to baseline, while
the AT-C demonstrated a clinically significant change only at
24 weeks (+5).
Conclusions: Attention alone was inadequate to
positively impact BNP levels or 6-MWT distances, but did
have a positive impact on quality of life after 24 weeks.
Although exercise offers enhanced benefits, individuals with
HF unable to participate in an exercise program may still gain
quality of life benefits from participation in a peer-support
group that discusses topics pertinent to HF.
ABSTRACT #73
The Effectiveness of Massage Therapy on Weight Gain in
Preterm Infants
Michaela Schweitzer, Amy Schnoes. Division of Physical
Therapy Education, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Low birth weight in preterm infants increases the risk
for developmental delays as their life progresses. In order to
decrease this risk, massage therapy (MT) is used with preterm
infants in the NICU; however, it is unknown how effective the
MT is at improving weight gain. It is also unknown how
effective the combination of tactile and kinesthetic
stimulation with MT impacts weight gain and what other
factors are improved with MT. Therefore, this paper examines
the effectiveness of MT on weight gain and the protocol that
is most consistent with increased weight gain. Four research
articles were reviewed from the most current available
studies. These studies were critiqued based on applicability to
the research question, adequate sample size, and journal
impact factors. Three studies showed that MT with tactile and
kinesthetic components is effective at producing significant
weight gain in medically stable preterm infants without other
major medical complications. The fourth study did not include
a kinesthetic component to the MT and found no significant
difference between MT and the control group for weight gain.
Standardized MT protocol with tactile and kinesthetic
components should be developed and used in all MT
treatments as it may help prevent developmental delays, has
minimal cost and low risk for the infants. Although the fourth
study showed no significant results, it showed higher
cognitive scores in infants, 12 months after receiving MT. This
study also included more medically complex infants.
Therefore, more developmental long term outcome measures
of MT should be investigated further to see if MT is effective
at inducing weight gain for preterm infants with congenital
disorders and other major medical conditions.
ABSTRACT #74
Intervention to Advance Postural Transitions and Problem
Solving Ability in Children with Cerebral Palsy*
Xin Zhang, Swati Surkar, Regina Harbourne, Sandra Willett,
Max Kurz, Lynne Capoun. Division of Physical Therapy
Education, School of Allied Health Professions; the MunroeMeyer Institute, University of Nebraska Medical Center,
Omaha NE
The relationship of postural control and early selfmobility to cognitive development, although implied in many
descriptions of the developmental process, is not well
understood. The ability to learn about objects partly relies on
motor abilities, and should be reflected in problem solving
ability. The purpose of this pilot study was to investigate and
compare the effects of a perceptual motor approach (PMA)
and a body weight support (BWS) intervention in advancing
postural transitions and problem solving skills in children with
CP.
Twelve infants with mild to moderate CP between
the ages of nine months and three years were randomized
into two intervention groups, the BWS intervention and the
PMA. Infants in both groups received 60 minutes of physical
therapy intervention twice weekly for 12 weeks. Gross motor
function was measured using the Gross Motor Function
Measure-88 (GMFM). Play and problem solving skills were
measured with the Early Problem Solving Indicator (EPSI). The
GMFM and the EPSI were measured pre and post
intervention.
The GMFM score in all dimensions significantly
increased overall between pre and post intervention (Look:
P=0.006, Explore: P=0.008, Function: P=0.004, and Solution:
P=0.031). BWS intervention may be more helpful in
advancing dynamic motor abilities, such as crawling and
walking by showing larger mean change of GMFM scores. In
contrast, the perceptual motor approach may be more
beneficial in improving static posture control, such as sitting
and standing. The scores of EPSI Explore and Function
decreased in BWS group while they were increased
(3.00±10.56 and 7.17±11.44 respectively) in PMA group. This
finding suggests that problem solving skills can be addressed
and improved with specific types of motor intervention.
*This research was funded by a grant from the Section on
Pediatrics, American Physical Therapy Association, to R.
Harbourne.
ABSTRACT #75
Attitudes and Preferences of Potential Physician Assistant
Program Applicants about Attending the University of
Nebraska-Kearney Campus
Michael Huckabee, Ryan Wessel. Division of Physician
Assistant Education, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Objective: The purpose of this study was to
determine attitudes and preferences of potential applicants
to the UNMC PA Program to be established at the University
of Nebraska-Kearney (UNK). Identifying demographic
characteristics, attitudes, and preferences of those likely
interested in attending the satellite campus would contribute
to an informed plan for developing the instructional
strategies in UNK, as well as give direction to promoting the
opportunity to the correct target audience.
Methods: A web-based quantitative survey of
attitudes and preferences about the UNMC PA Program at
UNK was administered to applicants who accepted an
invitation for an admissions interview for the 2013 and 2014
years. The survey was administered after the application
process was concluded for that respective year. Responses
from interviewed candidates were separated into three
groups: those who were accepted into the PA Program in
Omaha, those who were put on the alternate list, and those
who were not accepted. Measures of central tendency were
analyzed including means, standard deviations, and data
ranges.
Results: Survey response rate was 40% (94/233)
with representation across various population sizes, primarily
from the Midwest region of the country. Of those responding,
28% reported prior experience with instructional television
learning. When asked about choice of locations, 45%
preferred the Omaha campus but would attend Kearney as a
second choice, 5% preferred the Kearney campus. Of
perceived concerns rated by respondents, 27% were
concerned about sufficient access to faculty in the basic
sciences, with others marking concerns of a new campus
(20%), ITV courses (19%) and access to the medical library
(18%).
Conclusions: Of applicants to the UNMC campus in
Omaha in 2013 and 2014, half would attend the program at
Kearney. Only 28% of applicants have had experience with
ITV learning. Perceived concerns about student access to
faculty, technology, and library access deserve to be clearly
addressed.
ABSTRACT #76
Differences in the delivery of health education to patients with
chronic disease by provider type, 2005-2009
Tamara Ritsema, Jeffrey Bingenheimer, Patty Scholting,
James Cawley. Division of Physician Assistant Education,
School of Allied Health Professions, University of Nebraska
Medical Center, Omaha, NE
Introduction: Health education provided to patients
can reduce mortality and morbidity of chronic disease.
Although some studies describe the provision of health
education by physicians, few studies have examined how
physicians, physician assistants, and nurse practitioners differ
in the provision of health education. The objective of our
study was to evaluate the rate of health education provision
by physicians, physician assistants, and nurse
practitioners/certified midwives.
Methods: We analyzed 5 years of data (2005-2009)
from the outpatient department subset of the National
Hospital Ambulatory Medical Care Survey. We abstracted
data on 136,432 adult patient visits for the following chronic
conditions: asthma, chronic obstructive pulmonary disease
(COPD), depression, diabetes, hyperlipidemia, hypertension,
ischemic heart disease, and obesity.
Results: Health education was not routinely provided
to patients who had a chronic condition. The percentage of
patients who received education on their chronic condition
ranged from 13.0% (patients with COPD or asthma who were
provided education on smoking cessation by nurse
practitioners) to 42.2% (patients with diabetes or obesity who
were provided education on exercise by physician assistants).
For all conditions assessed, rates of health education were
higher among physician assistants and nurse practitioners
than among physicians.
Conclusion: Physician assistants and nurse
practitioners provided health education to patients with
chronic illness more regularly than did physicians, although
none of the 3 types of clinicians routinely provided health
education. Possible explanations include training differences,
differing roles within a clinic by provider type, or increased
clinical demands on physicians. More research is needed to
understand the causes of these differences and potential
opportunities to increase the delivery of condition-specific
education to patients.
ABSTRACT #77
Doctor Satisfaction with the Physician Associate Role in Great
Britain
Tamara Ritsema, Lorraine Williams. Division of Physician
Assistant Education, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Introduction: Physician Associates (PAs) are a new
profession to the United Kingdom. There has been no prior
national assessment of the perspective of doctors who work
with PAs with regard to their role.
Methods: Doctors in all specialties who supervise
PAs were surveyed in late 2012.
Results: Doctors were found to be generally satisfied
with the role of PAs and believed that the addition of PAs to
the team benefited doctors and patients. Doctors reported
that they have received positive feedback from patients about
the role of PAs as well. Respondents believe that the current
unregulated status of the profession impairs their ability to
use their PA staff to their fullest potential.
Conclusion: Doctors who work with PAs are satisfied
with their role on the team and in the National Health Service
(NHS). They believe PAs are well accepted by patients, but are
eager for the legal status of PAs to be resolved and support
statutory regulation for the PA profession.
ABSTRACT #78
A Preliminary Study of Bacterial Cultures Obtained from MR
Imaging Equipment
James Temme, Karen Honeycutt, Stephanie Vas.
Radiation Science Technology Education and Clinical
Laboratory Science, School of Allied Health Professions,
University of Nebraska Medical Center, Omaha, NE
Purpose: All health care team members are
responsible for delivering quality patient care and decreasing
incidence of health care-associated infections (HAIs). The
potential of magnetic resonance (MR) imaging equipment to
harbor microorganisms is not documented in the literature.
This study sought to determine whether MR imaging
equipment harbored pathogens that could lead to HAIs.
Methods: Surface surveillance bacterial cultures
were obtained from 8 MR units in Nebraska hospitals.
Cultures were collected after completion of patient care each
day from the unit bore, coil, table surface, and control panel;
collection and plating were completed using a commercial
system. Cultures incubated at body temperature were
evaluated for bacterial growth after 24 and 48 hours. Room
temperature sheep blood agar plates were evaluated for
fungal growth at 2 and 7 days.
Results: None of the MR cultures recovered clinically
significant isolates that are established pathogens leading to
HAIs. All culture sites grew the environmental contaminant
Bacillus species and Staphylococcus coagulase negative, a
common and normal skin flora, as well as Micrococcus
species, a normal skin flora and environmental contaminant.
The table and control panel cultures grew the widest variety
of isolates, including 2 environmental molds. Most sites had
light culture growth quantity, but 1 MR imaging table grew
>100 colonies of a mixture of 3 gram-negative rods and 1 MR
imaging table grew > 100 colonies of a single isolate,
Pseudomonas stutzeri, an environmental contaminant that
can cause disease in a compromised host.
Conclusion: This preliminary study indicates that
cultured MR units did not harbor microorganisms reported to
be etiologic agents of HAIs. Most sites reported light culture
growth of normal skin flora or environmental contaminants
that patients encounter routinely. Standard disinfection
protocols preliminarily appear to inhibit the colonization of
microorganisms that lead to HAIs.
.
School of Allied Health Professions
984000 Nebraska Medical Center
Omaha, NE 68198-4000
(402) 559-6673
www.unmc.edu/alliedhealth