Faculty Research
Permanent URI for this collection
Browse
Recent Submissions
Item A Rare Presentation of Drug-induced Liver Injury with Fluticasone and Vilanterol Inhaler Use(2019) Rishi, Mohit; Wagner, Amanda; Ulanja, Mark B.; Beutler, Bryce D.; Singh, KarmjitDrug-induced liver injury (DILI) is a rare and potentially lethal condition associated with the use of many commonly-used medications, including inhaled fluticasone-vilanterol. Therefore, a careful review of medications should always be obtained in the setting of acute onset hepatic dysfunction. We present the first reported case of idiosyncratic drug-induced liver injury associated with the use of this medication.Item Assessing Asthma Symptoms in Adolescents and Adults: Qualitative Research Supporting Development of the Asthma Daily Symptom Diary(Value in Health, 2016) Gater, Adam; Nelsen, Linda; Fleming, Sarah; Lundy, J. Jason; Bonner, Nicola; Hall, Rebecca; Marshall, Christopher J.; Staunton, Hannah; Krishnan, Jerry A.; Stoloff, Stuart; Schatz, Michael; Haughney, JohnDespite the widespread availability of patient-reported asthma questionnaires, instruments developed in accordance with present regulatory expectations are lacking. To address this gap, the Patient-Reported Outcome (PRO) Consortium's Asthma Working Group has developed a patient-reported asthma daily symptom diary (ADSD) for use in clinical research to assess outcomes and support medical product labeling claims in adults and adolescents with asthma. Objectives: To summarize the qualitative research conducted to inform the initial development of the ADSD and to provide evidence for content validity of the instrument in accordance with the Food and Drug Administration's PRO Guidance. Methods: Research informing the initial development and confirming the content validity of the ADSD is summarized. This comprised a review of published qualitative research, semi-structured concept elicitation interviews (n = 55), and cognitive interviews (n = 65) with a diverse and representative sample of adults and adolescents with a clinician-confirmed diagnosis of asthma in the United States to understand the asthma symptom experience and to assess the relevance and understanding of the newly developed ADSD. Results: From the qualitative literature review and concept elicitation interviews, eight core asthma symptoms emerged. These were broadly categorized as breathing symptoms (difficulty breathing, shortness of breath, and wheezing), chest symptoms (chest tightness, chest pain, and pressure/weight on chest), and cough symptoms (cough and the presence of mucus/ phlegm). Conceptual saturation was achieved and differences in the experience of participants according to socio-demographic or clinical characteristics were not observed. Subsequent testing of the ADSD confirmed participant relevance and understanding. Conclusions: The ADSD is a new patient-reported asthma symptom diary developed in accordance with the Food and Drug Administration's PRO Guidance. Evidence to date supports the content validity of the instrument. Item performance, reliability, and construct validity will be assessed in future quantitative research.Item Developing Clinical Faculty Understanding of Interprofessional Education: An Inter-institutional, Interprofessional Approach(2017) Bierwas, Debra A.; Rogers, Oaklee; Taubman, Brenda; Kroneberger, Lorie; Carroll, Holly; Enking, PatrickThe call for increasing interprofessional education requires institutional support for educators in the clinical environment. Innovative ideas, such as partnering with multiple universities and programs to facilitate an interprofessional workshop, have the opportunity to reach a broader group of clinical educators. The purpose of this study was to examine the attitude of healthcare professionals towards interprofessional learning, familiarity with concepts of interprofessional teaching, and interprofessional practice, and to examine the influence of an interprofessional faculty development workshop on participant familiarity with concepts of interprofessional teaching and learning. Methods: The occupational therapy, physical therapy, and physician assistant programs from two universities collaborated to implement an all-day inter-institutional, interprofessional clinical faculty development workshop. Community clinical educators who participated in the event were surveyed pre-and postworkshop to examine their attitude, readiness, and knowledge of interprofessional learning and teaching. Using the revised version of the Readiness of Interprofessional Learning Scale, the following subscales were measured and analyzed: 1) Teamwork and Collaboration, 2) Negative Professional Identity, 3) Positive Professional Identity, and 4) Roles and Responsibilities. Results: Forty-three participants representing six different healthcare professions completed pre-and postcourse surveys. Forty-four percent reported participating in interprofessional education. Overall, the attendees reported the value of the workshop as a 4.6 on a 5.0 point Likert scale, with 5.0 being the highest rating. Self-reported familiarity of the fundamental concepts of interprofessional teaching, interprofessional practice, and interprofessional education improved up to 32% following participation in the workshop. The highest increase in familiarity was in the area of knowledge of interprofessional practice and education. Participants reported high levels of agreement about the value of teamwork, collaboration, and positive professional identity. Conclusion: Integrating the Core Competencies for Interprofessional Collaborative Practice into educational programs and clinical practice can facilitate improved understanding of professional roles and improved collaborative practice.Item What a medical school chair wants from the dean(2018) Hromas, Robert; Leverence, Robert; Mramba, Lazarus K.; Jameson, J. Larry; Lerman, Caryn; Schwenk, Thomas L.; Zimmermann, Ellen M.; Good, Michael L.Economic pressure has led the evolution of the role of the medical school dean from a clinician educator to a health care system executive. In addition, other dynamic requirements also have likely led to changes in their leadership characteristics. The most important relationship a dean has is with the chairs, yet in the context of the dean's changing role, little attention has been paid to this relationship. To frame this discussion, we asked medical school chairs what characteristics of a dean's leadership were most beneficial. We distributed a 26-question survey to 885 clinical and basic science chairs at 41 medical schools. These chairs were confidentially surveyed on their views of six leadership areas: evaluation, barriers to productivity, communication, accountability, crisis management, and organizational values. Of the 491 chairs who responded (response rate = 55%), 88% thought that their dean was effective at leading the organization, and 89% enjoyed working with their dean. Chairs indicated that the most important area of expertise of a dean is to define a strategic vision, and the most important value for a dean is integrity between words and deeds. Explaining the reasons behind decisions, providing good feedback, admitting errors, open discussion of complex or awkward topics, and skill in improving relations with the teaching hospital were judged as desirable attributes of a dean. Interestingly, only 23% of chairs want to be a dean in the future. Financial acumen was the least important skill a chair thought a dean should hold, which is in contrast to the skill set for which many deans are hired and evaluated. After reviewing the literature and analyzing these responses, we assert that medical school chairs want their dean to maintain more traditional leadership than that needed by a health care system executive, such as articulating a vision for the future and keeping their promises. Thus, there appears to be a mismatch between what medical school chairs perceive they need from their dean and how the success of a dean is evaluated.Item Association between physical health and cardiovascular diseases: Effect modification by chronic conditions(2018) Saquib, Nazmus; Brunner, Robert; Desai, Manisha; Allison, Matthew; Garcia, Lorena; Stefanick, Marcia L.This study assessed whether the physical component summary score of the RAND-36 health-related quality-of-life survey was associated with incidence of coronary heart disease, stroke, congestive heart failure, angina, or peripheral arterial disease, and whether baseline chronic conditions modified these associations. Methods: Analysis was limited to 69,155 postmenopausal women (50-79years) in the Women's Health Initiative Study who had complete data on the RAND-36, the outcomes, and covariates. Chronic conditions were defined as blood pressure 140/90mm or self-reported heart disease, diabetes, hypertension, arthritis, asthma, emphysema, cancer, and/or cholesterol-reducing medication use. Outcomes data were ascertained during follow-up (1993-2005) with medical records. Results: There were 2451 coronary heart disease, 1896 stroke, 1533 congestive heart failure, 1957 angina, and 502 peripheral arterial disease events during follow-up (median 8.2years). Participants in the lowest physical component summary quintile, compared to the highest, had a significantly higher risk of developing coronary heart disease (hazard ratio (95% confidence interval) 2.0 (1.7, 2.3)), stroke (1.8 (1.5, 2.2)), angina (2.4(2.0, 2.9)), and peripheral arterial disease (3.0 (2.0, 4.4)), irrespective of chronic conditions. Interactions between physical component summary and existing chronic conditions were not significant for any outcome except congestive heart failure (p=0.005)