Browsing by Author "Cook, Myanna"

Now showing 1 - 9 of 9
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    A case of postpartum hypothermia
    (2023-03-24) Salmon, Chase; Hartman, Jennifer; Cook, Myanna; Venkatesh Shantharam, Rajalakshmi
    A 22 y/o G2P1 at 39+5 presented for a scheduled repeat cesarean section. Pt. had reassuring fetal heart rate tracings and no history of complications during her pregnancy. Her only past medical history included one prior full term cesarean section and morbid obesity. She had no known drug allergies and her only known allergy is to contrast dye. Pt. underwent a repeat low-transverse C-section with a spinal epidural containing Ropivacaine 0.5% 30mL. She had no immediate complications and had an estimated blood loss of 500 ml. Approximately 2 hours postpartum, anesthesia was called to the bedside for a pt. temp of 93.5 ℉, diaphoresis, SBP 140, HR 65, and O2 Sat 95%. Pt. was given 2L O2 via nasal cannula, warm blankets, a bair hugger, and 2mg ativan IV. One hour later, the patient’s temp had improved to 97.1 ℉ and the patient was taken off the bair hugger at 8 hours postpartum. Cesarean sections with spinal anesthesia come with the risk of adverse side effects, such as hypothermic reactions. In this patient, post-op multimodal warming therapies were successful within eight hours of deployment. Core temperature monitoring post-op could serve to catch downward trending body temperatures earlier. Proactive warming measures could be utilized preoperatively and intraoperatively, such as continued forced-air warming and administering warmed IV fluids, to lower the risk of post-cesarean spinal anesthesia-related hypothermia. Hypothermic reactions are a common adverse reaction seen in cesarean sections with spinal anesthesia. Furthermore, this reaction has been associated with additional complications such as wound infection, shock, and maternal mortality. Clinically, this case highlights the efficacy of forced-air and warm blanket warming in treating post-op hypothermia, but it also highlights a potential need for more consistent monitoring of temperature post-op and further research into post-op hypothermia in obese patients, as minimal research on this topic exists.
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    A Case of Uterine Sarcoma: The Impact of Insurance Policy on Timely Access to Hysterectomy
    (2024-03-22) Bell, Kameron; Cook, Myanna; Karki, Sabin; Sakbun, Vannara
    Background: Uterine sarcoma, a uterine cancer subtype, is a rare, aggressive malignancy with non-specific symptoms, complicating early diagnosis and management. Its common symptom, abnormal uterine bleeding, can be mistaken for benign uterine fibroids, leading to treatment delays and poor prognosis. Case: A 41-year-old premenopausal female with a smoking history presented with persistent heavy uterine bleeding for over 6 months. Physical examination and transvaginal ultrasound suggested a 13-week gestational size bulky uterus and a 6.3 x 7.32 cm intrauterine fibroid, respectively. Despite these findings, hysterectomy request was denied by insurance. After a year of continued bleeding, insurance approved the surgery. During the robotic-assisted laparoscopic hysterectomy, anterior and sidewall adhesions raised malignancy suspicion. The surgical team performed a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and right colectomy. Post-operative pathology confirmed uterine sarcoma. Clinical Significance: This case highlights the impact of insurance decisions on patient care, emphasizing timely interventions' necessity and the challenges in distinguishing benign fibroids from uterine malignancy in symptomatic patients. Current literature underscores the diagnostic dilemma surrounding uterine sarcoma, especially differentiating it from benign uterine fibroids. A significant literature gap exists regarding insurance policy impact on accessing timely surgical interventions like hysterectomy, affecting uterine sarcoma prognosis and management. Conclusion: Abnormal uterine bleeding can indicate benign uterine fibroids or uterine sarcoma. In this case, the lack of alternative diagnostics and poor imaging differentiation necessitated a hysterectomy for diagnosis. The delay in insurance approval for surgery underscored the significant impact of insurance decisions on patient care, potentially exacerbating the prognosis and delaying necessary intervention for uterine sarcoma.
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    A Glimpse into Menstrual Health Literacy in Appalachian Ohio
    (American Medical Women's Association (AMWA) 108th Annual Meeting, 2023-03-24) Cook, Myanna; Yeend, Brianna; Karki, Sabin; Stephanian, Brooke; Richcreek, Stephanie
    Evidence supports that health literacy is intricately linked to education level. Appalachian Ohio reports the second lowest percentage of postsecondary education in Appalachian states, which falls 10% below the national average. Coshocton, Ohio is located in North Central Appalachia and is classified as a high poverty rural area. Prior research has established that youth across the United States often lack adequate menstrual health education, which could lead to delayed recognition of serious health issues. Currently, the Ohio Department of Education does not require menstrual education as part of broader sexual health education in schools. Given the low rates of higher education, and thus health literacy, along with lack of state required menstrual education, low levels of menstrual health literacy might disproportionately affect this area. Within the same month at an outpatient clinic in Coshocton, Ohio, two adolescent females and their mothers, who also grew up in Appalachian Ohio, presented with menstrual concerns. Both parties expressed concerns about early menarche, cycle length, menstrual flow, and clots. In both cases, the patients were experiencing clinically normal menstruation. The patients and their mothers were counseled on normal range menses. Research surrounding menstrual health literacy in rural areas is lacking. The presented cases may point to a pattern of inadequate menstrual education in Coshocton, Ohio, as the patients and parents were unaware of normal menstrual patterns. In order to progress patient care, further research should aim to discern whether this area and greater Appalachia demonstrate lower levels of menstrual health literacy. Patients in Appalachia demonstrate lower education levels, which is correlated to lower health literacy. These cases highlight potentially inadequate menstrual education in Coshocton, Ohio. Further research and improved menstrual education should be pursued in the area.
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    Indiana Pregnancy Options Resources
    (2024-03-01) Cook, Myanna
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    Integration of ultrasound simulation to improve medical student knowledge and satisfaction on the obstetrics and gynecology clerkship
    (Elsevier, 2023-06-12) Shanks, Anthony L.; Darwish, Adrianna; Cook, Myanna; Asencio, Ivana; Rouse, Carrie; Obstetrics and Gynecology, School of Medicine
    Background: There has been increased use of ultrasound in contemporary medical education. Students tend to report a higher sense of satisfaction when ultrasound is incorporated into medical education, but little is known about whether its use leads to an improvement in medical knowledge acquisition independent of the ultrasound skill. In addition, there is no consensus among obstetrics and gynecology clerkships on the most effective way to incorporate ultrasound into the clerkship curriculum. Objective: This project described a method to integrate ultrasound simulation into an obstetrics and gynecology clerkship curriculum. Our hypothesis was that the incorporation of ultrasound simulation in the obstetrics and gynecology clerkship curriculum will lead to an increase in standardized assessments of obstetrics and gynecology knowledge. Study design: A prepost study at a single institution with multiple methods design was employed. Of note, 10 high-yield pathology topics commonly tested on the Association of Professors of Gynecology and Obstetrics quizzes and National Board of Medical Examiners examinations were summarized into study sheets and associated with a representative ultrasound simulation module. All students were provided access to the summary sheets. Students with instruction in ultrasound simulation consisted of the postintervention group and were compared with students that did not have ultrasound simulation (preintervention group). Quiz and examination scores were compared between the groups. In addition, students who accessed the ultrasound simulator were given a survey at the end of their rotation to obtain qualitative information regarding satisfaction and the incorporation of ultrasound into the clerkship curriculum. Results: There was no significant difference in quiz or examination scores between students who had access to the ultrasound simulation and those who did not. Most students found the integration of ultrasound simulation into the obstetrics and gynecology clerkship to be beneficial, to enhance their learning, to boost their confidence in ultrasound skills, and to be a potential substitute for clinical ultrasounds during the rotation. Conclusion: Integration of ultrasound simulation into obstetrics and gynecology clerkships and medical school education is understudied but can be a valuable educational tool. The incorporation of ultrasound into the medical education system is a topic of current studies. This study found that integration was viewed favorably by students, although integration was not associated with an improvement in medical knowledge measured via quiz and examination performance. Our research provided students with a standardized ultrasound education experience, which improved student satisfaction with the obstetrics and gynecology clerkship but did not correlate to increased demonstrated medical knowledge and understanding of examinations. Moving forward, student participants provided various suggestions on how we can continue to enrich medical students' education with the implementation of ultrasound.
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    MSK PoCUS Training for Rural Clinics
    (2024-04-26) Smeltzer, Kathryn; Tollar, Roarke; Cook, Myanna; Wilcox, James; Ireland, Ellen
    INTRODUCTION: Point of care ultrasound (PoCUS) is a portable diagnostic technology with broad applicability, no radiation, and is less expensive than alternative imaging methods. PoCUS is emerging as high utility technology to expand bedside physical exams for primary care practitioners. Access to medical care in rural areas is an ongoing issue, especially for specialty care. By using PoCUS, rural providers may be able to more completely screen for conditions and determine if patients will need to seek specialty care, such as orthopedic intervention, which is often more time consuming for rural patients. OBJECTIVES: This study is to identify barriers to learning and using point of care ultrasound technology for rural primary care practitioners for expanded examination, including for orthopedic applications. The secondary objective of this pilot study is to evaluate the best practices of expanding rural PoCUS training. METHODS: The team identified six rural primary care practitioners at outpatient clinics around Indiana. Grant funding was used to equip these clinics with portable ultrasound probes with PoCUS-software-equipped iPads. Training consisted of approximately one hour of independent didactic material and two hours of in-person hands-on training with our investigators and students. Initial surveys were collected before and after the in-person training session. After a few months of individual practice, teleguidence training sessions were offered to the participants. Post-training surveys will be collected approximately six months after the initial training session. At this time, the first and second surveys for the six physicians have been analyzed and provide preliminary results. RESULTS: The pre-training survey from the six physicians before the in-person training session found that previous PoCUS experience of these physicians varies greatly, and nearly all of these practitioners have not used ultrasound in their clinic within the last year. This survey also showed unanimously that these physicians make orthopedic diagnoses in their practice but do not feel comfortable using ultrasound in supporting these diagnoses, showing the potential for PoCUS in their clinical practice. The second survey results have shown that even after just two hours of training, the physicians are comfortable with using ultrasound to support their orthopedic diagnoses, to the point that the majority are also somewhat comfortable teaching this material to others. All of the physicians agreed that the independent didactic material supplemented the in-person training, which supports both the quality and platforms provided for this material. The enthusiasm and improved confidence after the training sessions also support the quality of our investigators’ in-person training sessions. Though it was not difficult to recruit physician participants, one of the biggest obstacles this study faced was scheduling the in-person training session. CONCLUSION: Implementation of PoCUS in rural clinics for the evaluation of orthopedic diagnosis was met with enthusiasm and has shown potential for streamlining evaluation at specialty clinics. Major barriers to adopting this technology include finding adequate time for medical practitioners to learn and practice using the equipment and scheduling live, on-going training.
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    Resolution 23-008: Mestrual Health and Hygiene Education
    (2023-10-01) Cook, Myanna; Cornwell, Ailish; Orozco, Ana; Hatfield, Angela
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    The Effects of Maternal Stress on TLR Expression in Neonatal Mus musculus Alveolar Epithelial Cells
    (2018-10-18) Cook, Myanna; Smith, Arianna
    Prior research has confirmed an association between maternal stress and offspring asthma. Recent studies suggest a role for epithelial expressed toll-like receptors (TLRs) in allergic asthma development. In this study, we were interested in isolating alveolar epithelial cells (AECs) from neonatal mice and analyzing how maternal stress potentially changes the expression of TLRs in the AECs. C57bl/6J strain mice were mated and pregnant dams started treatment at midgestation (E12.5) with free access to Vehicle or CORT-treated drinking water until the litter was born. The litter was sacrificed on postnatal day 7 (7 PND). The lungs were harvested and both AECs (EpCAM+) and immune cells (CD45+) were isolated based on staining with epithelial cell adhesion molecule (EpCAM) , CD45, and CD31 fluorescent antibodies. Here we present our optimized protocol for isolating EpCAM+ and CD45+ cells in 7 PND neonates through fluorescence activated cell sorting (FACS). Further experiments to investigate TLR expression in 7 PND AECs will be conducted. Also, we plan to further explore alveolar immune cell populations in the neonates.