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Browsing by Author "Friel, Rylee"
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Item Confounding Histoplasmosis in Hodgkin’s Lymphoma(2022-03-24) Zhou, Shannon; Friel, Rylee; Holohan, Maggie; Geers, Erica; Alali, Muayad; Belsky, JenniferCase Description: A 17-year-old, black female was diagnosed with Hodgkin’s Lymphoma (HL), confirmed with lymph node biopsy. Initial infectious workup was negative for Histoplasmosis capsulatum (H. capsulatum), and she was started on routine chemotherapy. After 2 cycles of chemotherapy, routine 18FDG/PET scan demonstrated reduction in previous mediastinal adenopathy, but new areas of adenopathy. Due to concern of disease progression in conjunction with new fevers and dyspnea, she had a biopsy which histologically confirmed H. capsulatum with positive IgG and IgM. She was started on antifungal therapy with dose reduction of chemotherapy. FDG/PET scan 5 weeks into antifungal therapy demonstrated continued FDG uptake in previous H. caspulatum concerning areas, and she was continued on both chemotherapy and antifungal therapy. Radiation to her mediastinal mass and persistent areas of FDG uptake is under discussion. Conclusion: Hodgkin lymphoma (HL) is the most common form of lymphoma and classically presents in late adolescent females as lymphadenopathy. 18FDG/PET scans are used to visualize malignant tissue and aid in staging and end of treatment assessment. We present a case of HL whose case was complicated by concurrent H. capsulatum infection, creating a clinical conundrum regarding treatment. Clinical Significance: Acute H. capsulatum infection can appear as a pulmonary consolidation and/or lymphadenopathy with FDG avidity, making it difficult to discern infection from malignancy. This often results in biopsy, chemotherapy reduction, and ambiguity regarding future radiation therapy. Future research should focus on more FDG sensitive tracers to differentiate malignant tissue from infectious or inflammatory tissue. In addition, immunosuppression in the setting of chemotherapy puts patients at risk for opportunistic infections such as H. capsulatum. Screening for opportunistic disease in endemic areas before initiating chemotherapy should be considered.Item Emergent Intervention of a Non-Communicating Rudimentary Uterine Horn Pregnancy(2023-03-24) Friel, Rylee; Evelyn, Crowley; Ali, Yasmin; Bell, Libby; Tian, Wendy; Scott, NicoleBackground: Non-communicating rudimentary uterine horns (NRCH) arise from Mullerian duct malformations during embryonic development. Pregnancies of the rudimentary horn account for 0.0013% to 0.00067% of all pregnancies. Such pregnancies are non-viable and pose major risks to the mother. Without early detection and management, maternal mortality rates can be as high as 88% due to rupture. Case Description: A 22-year-old G1P0 female at 7 weeks gestation presented to the emergency department with abdominal pain for 3 weeks. A transvaginal ultrasound (TVUS) was performed and a fetal pole with cardiac activity was seen in the right adnexa, suspicious for ectopic pregnancy. She had an unremarkable TVUS 1 year ago. A diagnostic laparoscopy was performed for presumed treatment of ectopic pregnancy. During the procedure, patient was found to have a right non-communicating rudimentary uterine horn with pregnancy noted inside. The left horn was connected to the cervix and otherwise normal. Intraoperatively, the right ureter was not identified. Due to high risk of rupture, the rudimentary right horn with pregnancy and the right fallopian tube were resected. A postoperative CT urogram revealed a solitary renal kidney and single left ureter. Clinical Significance: The high mortality rate of ruptured NCRH pregnancies highlights the importance of early detection and proper management of such pregnancies. Mullerian duct anomalies are usually detected with ultrasound or magnetic resonance imaging prior to conception. In this case, the NRCH was formerly unknown and treated as an ectopic pregnancy with fetal cardiac activity. The complete resection of the rudimentary horn with pregnancy and fallopian tube proved to be an appropriate management for this emergent situation. Conclusion: In emergent situations of an undetected NRCH until pregnancy, resection of rudimentary horn with ipsilateral fallopian tube is not only therapeutic, but also preventative for potential future ectopic pregnancies.Item Evaluating the Effectiveness and Perceived Benefit of a Breast Imaging Website as an Educational Tool for Radiology Residents(2023-04-28) Friel, Rylee; Miller, Elise; Niemeyer, KathrynBACKGROUND: The use of social media by medical professionals has grown exponentially over the last decade. Residents are using social media and educational content more frequently as they provide information easily accessible on their personal devices. Reading articles has been shown to help improve residents scores on post-test evaluations. However, how does a resident know which articles are reliable and are appropriate for their level of training? Guided educational materials provided during residency rotations can help lead trainees to the most accurate sources and steer them toward what they need to know. PURPOSE: To evaluate the effectiveness and perceived benefit of an educational website as an adjunctive teaching tool for radiology residents during their breast imaging rotations. METHODS AND MATERIALS: An educational website was created on Wix.com with teaching content organized by appropriateness for level of training. Educational tools included PowerPoint presentations designed for different training levels as well as links to important journal articles and other online resources Links to the department’s YouTube channel, Instagram account, and Twitter account were provided on the website as well. Residents were provided the link to the website at the beginning of their breast imaging rotations. They were given a 20-question multiple self-assessment at the end of their rotation and given an anonymous survey determining level of training and their use of the website over the rotation. Two years later, after the website had been utilized for several years, residents were later sent a survey of 9 questions related to their perceived benefit of the website. RESULTS: There were 21 eligible residents who completed the breast imaging rotation over the 7-months the self-assessment was administered. Of these, 16 residents completed the post-breast imaging rotation quiz for a total participation rate of 76%. 4 of these residents were first years, 7 were second years, and 5 were third years. The average first year score was 52%, average second year score was 64%, and average third year score was 65%. Only 2 residents indicated that they did not use the website. Overall, residents who used the website scored higher on the exam than those who did not (63% vs 52%). On follow-up survey three years later, 19 residents completed the survey. 78.95% stated use of website once per week and 21.05% stated use multiple times per week. Regarding website use outside of breast imaging rotations, 36.84% of residents reported use for board examination and related conferences, while 63.16% reported no use outside of studying for breast imaging rotations. When asked on a scale from 1-10 how useful the curriculum website was, the average was 7.11 with 73.7% recording a 7 or an 8. Overall, 89.47% expressed interest in having similar websites for other rotations. CONCLUSIONS: Online curriculum tools can be used as successful adjunctive teaching tools for radiology residents on their breast imaging rotations. Residents who utilize this tool perform both better on the post-procedure self-assessment had seen a perceived benefit in this educational tool.Item Inspired to Learn: Integrating Pre-Clinical Respiratory Educational Principles into Clinical Clerkship Practice(2023-04-28) Sharpe, Shannen; Friel, Rylee; Barron, Emily; Shockley, Emily; Thamba, Aish; Bontrager, Erin; Ganapaneni, Sruthri; Stoll, Kennedy; Vellutini, Natalie; Roy, Lynn; Cooper, Shannon; Kochhar, Komal; Carlos, GrahamIntroduction: IUSM students have reported on the Graduation Questionnaire (GQ) that there is a lack of pre-clinical content incorporated into clinical rotations. Student performance on respiratory/pulmonology questions on the USMLE Step 1 and 2 exams is similar to other medical disciplines at IUSM, despite feedback from students that the Pulmonary Grand Rounds (PGR) teaching method is very effective. Rather than presenting content via recorded didactic lectures, the PGR team, composed of a multidisciplinary physician panel, presents clinical vignettes in an interactive setting. Furthermore, according to student feedback, the current model lacks a sufficient content review of relevant Phase I material. Students have requested additional support with pre-clerkship study/review materials content. Through this study, we aim to empirically evaluate the impact of designing interactive pre-clerkship modules reviewing relevant Phase 1 PGR material on the medical knowledge and clinical competencies of Phase II students. Background: The American Medical Women’s Association organization called for scholarship pertaining to educational innovation. The PGR curriculum provides us with a unique opportunity to evaluate the impact of undergraduate medical education on student knowledge retention and engagement from a metacognition perspective. A diverse group of students and faculty was pulled together with the IUSM Research in Medical Education unit to creatively address the ability to quantify engagement and knowledge retention above in a scholarly project. PGR is a unique multi-modal teaching design built at a large medical school with nine campuses to increase student engagement via zoom, Top Hat, and a case-based teaching approach with a multidisciplinary panel. Study objective: Evaluate student engagement and knowledge retention through clerkship standardized examination performance, Step 2 performance, and GQ with the implementation of a spaced repetition learning model comprised of interactive pre-clerkship modules which reinforce session objectives introduced in pre-clinical education. Methods: In Phase I, PGR includes over 200 board-style questions throughout nine sessions. Students engage with the medical content by answering these questions on TopHat and discussing the reasoning for correct vs. Incorrect answers with the expert panel. Students are again tested over similar content during their local and NBME exams. We proposed the creation of an optional module for each clerkship for students to use prior to Phase II. The modules would include a question bank supplemented with videos to foster preparation and enhance performance on clinical clerkships and Step 2. This question bank would utilize the same questions students had originally seen in PGR months earlier to improve concept retention and memory. The instructional videos would connect physiology to the clinical scenarios the students expect to encounter during their clerkship. We would anonymously track student engagement through a pilot-tested survey and performance on the modules along with clerkship National Board of Medical Examiners exams, Step 2, and the GQ. Finally, we plan to assess knowledge gaps to supplement future grand rounds curriculum while providing clinically relevant information to improve patient care.