UT Southwestern Medical School
Permanent URI for this collectionhttps://hdl.handle.net/2152.5/6690
Welcome to the UT Southwestern Medical School’s electronic theses and dissertations (ETD) collection.
Most UT Southwestern ETDs are subject to a default embargo period of two (2) years from the date of degree conferral. These embargoed ETDs are unavailable until the embargo expires.
It might be possible to contact the author for more information before the end of the embargo. For assistance or more information, please contact the UT Southwestern Medical School Dean’s Office by email.
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Print theses and dissertations from 1943 to 2004 are located in the Library's Special Collections and Archives (Room E3.314) and are available by appointment. (Note: Former students may request a digitized copy of their work by email, but other users may submit an Interlibrary Loan request.) For more information, contact archives@utsouthwestern.edu.
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Browsing UT Southwestern Medical School by Author "Ambardekar, Aditee"
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Item Assessing the Need for and Developing a Standardized Patient Handover Curriculum for Undergraduate Medical Education(2017-04-03) Gajera, Prakash; Reed, W. Gary; Greilich, Philip; Ambardekar, AditeeBACKGROUND: Improving patient handoff communication is a national patient safety goal; however, few medical schools have standardized handoff training curricula for their medical students. Studies show that a large number of medical students perform handoffs and observe handoff errors during their clerkships [1,2]. This lack of formalized training has a negative impact on medical student perceptions of handoffs [3]. This project assessed the need for handoff education at our institution and developed a curriculum aimed at medical students. IMPLEMENTATION: Clerkship directors were interviewed & preclinical medical students were surveyed for a stakeholder analysis. Prior to starting core clerkships, 200 total students participated in four 1-hour workshops consisting of a 20-minute lecture and three 10-minute handoff scenarios. Trained residents performed the scenarios and led group discussions. Pre- and post-course engagement surveys were used to evaluate the workshop. EVALUATION & OUTCOMES: Clerkship directors desired handoff training before clerkships; however, there was concern that the curriculum would be too advanced. Survey of pre-clinical students showed 71% had heard of standardized patient handoffs, but 94% had no training. 75% believed training should be done prior to core clerkships, and 64% believed handoff simulations were the best method for learning. Students scored 10.7% higher on the post-engagement quiz and 98% of students believed they better understood the elements of a good handoff after the workshop. IMPACT & LESSONS LEARNED: Standardized patient handoff curriculum designed for preclinical medical students improved confidence and knowledge about the handoff process. Concerns about creating handoff curriculum for medical students were addressed by focusing on general concepts rather than specific handoff tools and by creating simple handoff evaluation scenarios. Further work will focus on evaluating the impact of this workshop on the handoff experience during clerkships.Item Development of a Vascular Surgery Simulation Curriculum: From Design and Implementation to Studying the Impact of Peer-Assisted Learning on Skills Acquisition(2019-04-01) Patel, Rutvi; Farr, Deborah; Sendelbach, Dorothy; Ambardekar, Aditee; Ramanan, BalaBACKGROUND: In the last few decades, increasing emphasis has been placed on moving residents' early learning curves out of the operating room into a simulated environment. In response, ample research focusing on development/validation of instructional modules, simulators and assessment methodologies has been conducted. However, evaluation of the best methods of implementing these curriculums is lagging behind, and there is currently no standardized method of disseminating surgical simulation curriculums. OBJECTIVE: The goal of this project was two-fold: to create a standardized vascular surgery simulation curriculum for junior surgical residents, and to conduct a study evaluating the effects of Peer-Assisted Learning (PAL) on surgical skills acquisition and learner confidence. METHODS: Instructional materials (video + written instructions, task trainers) for a simulated end-to-side vascular anastomosis procedure were created in collaboration with vascular surgery faculty. Using the end-to-side anastomosis as the procedure being taught, 45 PGY 1-3 general surgery residents were randomized to Solo or PAL practice. Learners in the Solo arm practiced independently, whereas learners in the PAL arm practiced with a same-level peer while employing PAL techniques such as roleplaying and providing peer feedback. Pre-test and post-test videotaped performances were recorded, and assessed by 2 experts who were blinded to group, test and learner. Survey questionnaires were used to gauge participant confidence. RESULTS: Learners showed significant improvement in their post-test checklist scores, global rating scores and self-reported confidence in comparison to their pre-test scores (all p <0.05). There were no significant differences in pre-test outcome measures (checklist, global ratings, time taken, self-reported confidence) between Solo and PAL groups. Comparing post-test outcomes between groups, PAL learners had significantly higher global ratings (p = 0.02) and significantly lower time to anastomosis completion (p = 0.01); there were no significant differences in self-reported confidence (p = 0.25). CONCLUSION: This project resulted in the development and implementation of a standardized simulated vascular surgery curriculum for junior surgical residents at UT Southwestern Medical Center. Our study shows that learners who practiced with a peer showed better skill acquisition. With no current standardization in dissemination of simulation curriculums, it is important to study methods that enhance skill acquisition, and subsequently incorporate these techniques into future simulation curriculums through curricular reform.Item Isoflurane Preserves Viability of Highly Metabolic Renal Epithelial Cells Exposed to Anoxia(2016-04-01) Mantravadi, Vasudha; Kojima, Koji; Ambardekar, Aditee; Lin, Xihui; Gingrich, KevinBACKGROUND: Cells subjected to ischemia, whether in the context of hypoxia, hypovolemia, or circulatory collapse, undergo damage and death as a result of oxygen deprivation. Previous studies have shown that general anesthetics can protect cells from ischemic injury by lowering their aerobic metabolism and decreasing production of toxic metabolites, among other mechanisms (1, 2, 3). This very preliminary study investigated the potential protective effect of isoflurane on the survival of cells that have a fairly high baseline metabolic rate, human renal proximal tubular epithelial cells (HK-2) and human microvascular endothelial cells (HMEC), in an anoxic environment. METHODS: Cultured HK-2 and HMEC cells were incubated in a Forma Scientific Anaerobic System at 37C either in the absence (control) or presence (experimental) of 5% isoflurane for 0, 24, 48, 72, and 96 hours. Cell viability and metabolic activity were then assessed using live/dead fluorescence imaging and an MTT cell metabolism assay, respectively. RESULTS: In vitro exposure of cells to anoxia without isoflurane over a period of 96 hours, resulted in a reduction of viability of HK-2 cells from a baseline of 98%, to approximately 8-9%. Over the same period of time, viability of cells exposed to isoflurane and anoxia decreased to 35%. This represented a fourfold increase in survival of HK-2 cells exposed to isoflurane at 96 hours. At earlier time points, both cell death in anoxia, and the protective effect of isoflurane were less dramatic. HMECs did not undergo significant cell death upon exposure to either anoxia or anoxia with isoflurane, with 98% of the cells surviving the exposure to anoxia in both cases. The net metabolic activity, as assessed by absorbance using the MTT assay, decreased in HK-2 cells over increasing periods of anoxia, a trend that did not change with the addition of isoflurane. Metabolic activity of HMECs remained intact and relatively stable throughout the course of anoxic exposure. CONCLUSION: In this preliminary study, continuous exposure of HK-2 cells to 5% isoflurane during anoxic incubation had a protective effect on cell viability over a period of 96 hours. Whether this effect was also present in the less metabolically active HMECs, was not determined, as anoxia over the time period of the study had little effect on cell viability in either the experimental group or in the control group. The protective effect observed for HK-2 cells will likely vary with differences in metabolic requirements of different cell types, types and concentrations of anesthetic agents, and duration of anesthetic exposure. Anesthetic treatment may need to be tailored specifically to a cell type to confer the protective effects desired.Item The State of Anesthesia Practice in Sub-Saharan Africa: Statistics, Case Studies, and Ways Forward(2020-03-12) Choo, Vincent; Mihalic, Angela; Ambardekar, Aditee; Tao, WeikeBACKGROUND: There is substantial need for additional anesthesia resources in Sub-Saharan Africa. In this region of the world, maternal and surgical mortality are high. Non-coincidentally, the number of anesthesiologists and anesthesia providers is low and provision of medications and other basic supplies is lacking. This thesis aims to describe anesthesia practice in Sub-Saharan Africa using statistics and case studies, present current initiatives already in place to improve access to care, and suggest other strategies that may improve anesthesia capacity in the future. OBJECTIVE: Non-adherence to minimum guidelines from the World Federation of Societies of Anaesthesiologists (WFSA) for anesthesia practice in the areas of staffing and physical resources is associated with poor anesthesia and surgical outcomes, which could be improved by improving training programs and increasing available physical resources. METHODS: A Pubmed literature search was performed using key words. Relevant articles from these searches were retrieved and references from these articles were also examined. Websites for organizations mentioned in the articles were queried. Websites containing factual information about individual Sub-Saharan African countries were consulted. The information found was grouped by themes and presented. RESULTS: The numbers of anesthesiology providers in Sub-Saharan Africa are insufficient to provide safe anesthesia care. A lack of medications and supplies and inadequate technology, including monitoring equipment, contribute to the problem. The situation in Ghana, Mozambique, Liberia, and Rwanda helps to illustrate this problem. Initiatives such as the founding of the World Federation of Societies of Anaesthesiologists and Lifebox, as well as formalizing task-sharing, have attempted to improve the situation. Continuing to ensure that equipment adapted to the reality of the practice environment in the region and careful planning and coordinating of future humanitarian projects can help improve anesthesia care provided in the region. CONCLUSION: The current state of anesthesia in Sub-Saharan Africa is insufficient to meet population needs. The causes are multi-factorial and include issues providing adequate human and material resources. Establishing strong, coordinated humanitarian efforts on the ground is critical to addressing the problem. Reorganizing manpower to best utilize precious human resources is another way forward. Providing appropriate resources in the form of equipment and medications, as well as encouraging local research, can help provide innovative solutions for the region.Item Uses of Hypnosis in Pediatric Anesthesia and Pediatric Headaches: A Literature Review(2017-12-29) Zimmern, Vincent; Mihalic, Angela; Ambardekar, Aditee; Remster, EricBACKGROUND: Managing pain and anxiety is a significant challenge for pediatricians. Infants, children, and teenagers - especially those with severe needle phobia -- can experience significant degrees of stress and anxiety prior to and after surgery, and during vaccinations or venipunctures. Headaches and migraines - another significant source of pain and anxiety for children and adolescents - can be difficult to treat with conventional pharmaceutical approaches. Hypnotherapy, or the use of hypnosis to achieve a therapeutic outcome, has a long history of providing some degree of somatic analgesia and anxiolysis. OBJECTIVE: The objective of this study is to critically review the literature dealing with hypnosis as a therapeutic tool in pediatric anesthesia and pediatric headaches. METHODS: A large database of medical and psychological publications (PubMed) was searched for studies in which hypnosis was used either for pediatric anesthesia/analgesia or for pediatric headaches. Those studies were then manually curated for their pertinence to hypnosis and pediatrics. They were subsequently classified according to the level of evidence that they provide in favor of hypnosis as a treatment modality. RESULTS: At this time, there is a relatively strong literature arguing in favor of hypnosis for peri-procedural pain relief and anxiolysis. There is limited evidence, however, to suggest that hypnosis can or should be used in scenarios that normally require general anesthesia. While there is increasing evidence to suggest a role for hypnosis in the management of recurrent headaches in children, there is as yet little substantial evidence to suggest a role in migraine headaches, despite one promising study. CONCLUSION: Given the increased popularity of complementary and alternative medicine (CAM), hypnotherapy is likely to be increasingly incorporated into the repertoire of tools for managing pain, anxiety, and headaches, perhaps in combination with relaxation, mindfulness, and biofeedback approaches. Additional studies of hypnosis, in specific clinical settings such as immobilization for radiotherapy, ophthalmologic procedures, and migraine headaches are needed. A more standardized approach to hypnotic induction by the hypnosis community would allow for more rigorous studies and trials.