Browsing by Author "Swiezy, Sarah"
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Item Being Born into a Pandemic: COVID-19 and Pregnancy(2021) Swiezy, Sarah; Campbell, Meredith; Eckert, NicoleCase #1: 34yo Asian female G2P1001 presents COVID19+ in 1st trimester. PMH insignificant. Meds: prenatal vitamins. Surg Hx: c/s healthy boy (2017). No h/o GHTN, GDM, or eclampsia. D/t COVID19+ infection, frequent fetal u/s monitoring done at 32w5d, 34w5d, 38w0d. Fetal growth over time: 63.4%, 48.8%, 14.3%. Fluid over time: AFI 8.58cm, MVP 4.52cm; AFI 10.86, MVP 3.52; AFI 2.73, MVP <2. Oligohydramnios diagnosed at 38w0d; emergent repeat c/s performed. Mother and baby healthy s/p delivery, d/c home on PPD#2. Pathology of placental tissue shows increases in villous fibrin accumulation and maternal vascular malperfusion. Case #2: 29yo Caucasian female G1P0 presents to ED at 18w4d with c/o runny nose, cough, and headache; temp. 100.3*F; tests COVID+. PMH insignificant. Meds: prenatal vitamins. No h/o GHTN, GDM, or eclampsia. 21w0d u/s: growth 71.4%, normal anatomy. 30w0d u/s: growth at 82.3%, AFI 15.10cm, MVP 5.38cm. At 39w1d, healthy infant boy (7lb12oz) via VAVD. Mother and baby healthy s/p delivery, d/c home on PPD#2. Placenta not sent for surgical pathology. Conclusion Due to the short time course of the COVID19 pandemic, adequate evidence to link maternal-fetal outcomes to infection during pregnancy is just now becoming available. Other coronaviruses, SARS and MERS, are preferentially fatal in pregnant mothers; and, adverse perinatal outcomes in COVID19+ women are appearing. Case reports have associated COVID19 with preterm birth; one study reported 47% preterm deliveries in COVID19+ mothers. Molecular studies have confirmed ACE2 (receptor allowing viral cellular entry) mRNA overexpression in placentas. Placental histopathology has shown maternal-placental interfacing blood vessel anomalies. Clinical Significance COVID19 represents a monumental threat to public health. Pregnant women and fetuses may be at increased risk for complications compared to the general public. As yet, the relationship between COVID19 and pregnancy remains to be clarified and will require further investigations to understand associations and promote evidence-based treatment practices.Item The Case for the Safe Re-Opening of SRFCs during COVID-19(Journal of Student-Run Free Clinics, 2021) Hopfer, Sarah; Neese, Olivia; Miller, Reese; Swiezy, SarahAt the end of February 2020, the Mollie R. Wheat Memorial Clinic (MWMC), an SRFC in Terre Haute, IN, closed its doors to protect its volunteers and patients from the acute threat of the novel coronavirus. Faced with an uncontrolled contagion and the threat of clinics as a nidus of infection, medical school administrators implemented a short term solution: they shut down all SRFC operations. In October 2020, MWMC, employing student-written infection control protocols, re-opened without students in patient-facing roles as a compromise with medical school administration, who were concerned for the safety of their students, in order to again provide necessary care to its community. This essay, written and submitted during one of the peaks of the pandemic, makes an argument in four parts for opening SRFCs sooner rather than later during a public health crisis, using COVID-19 as its example. The COVID-19 pandemic seems to be waning in America, though the threat of variants loom, and whether or not this is the big pandemic of our lives, over time, there will be other pandemics. The authors hope this essay will provide some future guidance to SRFCs and their medical school administrators for how best to work together to continue serving their communities during a pandemic.Item A Case Series of COVID-19 and Pregnancy Outcomes(2021) Swiezy, Sarah; Eckert, Nicole; Campbell, MeredithIntroduction: COVID-19 has been the largest public health crisis of our lifetime. Much of the morbidity and mortality caused by COVID-19 has been due to lack of adequate research and understanding of the virus. In the absence of data for COVID-19, scientists have used evidence collected during other coronavirus outbreaks, including SARS and MERS, to forecast outcomes in different populations. Both of these coronavirus outbreaks were preferentially fatal in pregnant women, suggesting that COVID-19 may also have grave consequences for gravid women and their fetuses. Given that molecular studies have confirmed that COVID-19 enters cells through the ACE-2 receptor, which is also present on human placental cells, there is potential for COVID-19-induced abnormalities in the interface between mom and baby, leading to maternal-fetal morbidity or mortality. To date, several case series have demonstrated adverse perinatal outcomes in COVID-19-positive pregnant women, including placental abnormalities and pre-term birth; however, these studies have been limited in scale and scope. More data is needed to fully understand the implications of COVID-19 infection in pregnancy so that evidence- based treatment recommendations can be made to OB/GYNs caring for COVID+ patients. Methods: We reviewed the charts of all of the pregnant women presenting for routine obstetric care to the UAP OB/GYN offices in Terre Haute, IN between Nov 2020 and Feb 2021. We identified 33 women who were pregnant at the time of COVID-19 infection. Data were input into a Qualtrics survey for ease of viewing the results. Results/Conclusions: We are currently waiting for 6 (18%) of the patients in our sample to deliver in the next 4-6 weeks To date we have a sample of mostly Caucasian women infected in their 2nd and 3rd trimester. Here we evaluate their pre-, peri-, and immediate post-partum maternal and infant outcomes.Item Case-Based Options Counseling Panel to Supplement an Indiana Medical School’s Pre-Clinical Family Planning and Abortion Education Curriculum(2022-04-16) McKinzie, Alexandra; Brown, Lucy; Swiezy, Sarah; Komanapalli, Sarah; Bernard, CaitlinBackground: While 25% of US women will seek an abortion before age 45, targeted laws have led to a decline in abortion clinics, subsequently leaving 96% of Indiana counties and the 70% Hoosier women residing in these counties without access to services they desperately need.1,2 Despite the need for a physician workforce that is educated and able to provide full-spectrum reproductive health care, few medical institutions have a standardized family planning and abortion pre-clinical curriculum. Methods: A Qualtrics survey was disseminated to students from Indiana University School of Medicine (IUSM) to evaluate (1) student interest in curriculum reform, (2) self-assessed preparedness to counsel on contraceptive and pregnancy options, and (3) preferred modality of instruction for family planning and abortion topics. Based on the pre-panel survey feedback, a case-based pregnancy options counseling panel will be implemented in the students’ pre-clinical, didactic course Endocrine, Reproductive, Musculoskeletal, Dermatologic Systems (ERMD) in February 2022. A Qualtrics post-panel survey will be disseminated to evaluate students’ perceived efficacy and quality of the panel, as well as their self-assessed preparedness to counsel on pregnancy options. Results: Participants in the pre-panel survey (n=303) were primarily female (61.72%) and White (74.43%). Across all class levels, many (60.80%) students expected to learn about family planning and abortion in their pre-clinical education. While most (84-88%) participants felt prepared to counsel about common, non-controversial pharmacotherapies (e.g. beta-blockers and diuretics), only 20% of students felt prepared to counsel on abortion options. Overall, 85.67% of students believed that IUSM should enhance its reproductive health coverage in pre-clinical, didactic courses. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. Expected Results: The authors predict that following the panel, students will indicate improved confidence in providing pregnancy options counseling. Additionally, students will provide constructive feedback on the structure and content of the panel for incorporation into future years’ curriculum. Conclusions: IUSM students overwhelmingly expressed interest in expanding their pre-clinical curriculum’s coverage of family planning and abortion topics. To specifically improve students’ self-assessed preparedness to provide pregnancy options counseling and address students’ self-cited learning gaps, a case-based provider panel session will be implemented in response to students’ preferred modality feedback.Item Curriculum Integration of Pregnancy Termination and Family Planning in Didactic Medical Education(2021-04) Brown, Lucy; Swiezy, Sarah; Komanapalli, Sarah; McKinzie, Alexandra; Bernard, CaitlinBackground: Given that one in four women will seek an abortion before age 45, there is an urgent need to demystify abortion-related topics and expand providers’ foundational knowledge about pregnancy termination and family planning. An effective way of addressing gaps in women’s reproductive healthcare is integration of the public health importance, legal factors, and counseling surrounding family planning and pregnancy termination into medical school curricula in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Objective: Determine whether Indiana University School of Medicine’s (IUSM’s) current pregnancy termination and family planning curricula follow proposed APGO educational guidelines. Evaluate medical student preparedness and interest surrounding family planning and pregnancy termination. Methods: To assess the alignment between IUSM and APGO educational guidelines, session learning objectives (SLOs) from the didactic course Endocrine, Reproductive, Musculoskeletal, Dermatologic Systems (ERMD) syllabus were compared to the relevant APGO objectives. Data was collected through a survey via Qualtrics disseminated to all IUSM students which was intended to assess students’ feelings of preparedness providing accurate medical information regarding reproductive health topics, including contraception, abortion, ethical and legal implications of pregnancy termination, personal values clarification, and others, as well as interest in integrating those topics into IUSM curriculum. Results: Participants (n=303) were primarily female (61.72%) and White (74.43%) and included students who had completed the Reproductive Block of the Endocrine, Reproductive, Musculoskeletal, and Dermatologic Systems (ERMD) Course and the OB/GYN Clerkship (35.64%), only the ERMD Course (25.08%), or neither (39.27%). Across all levels of undergraduate medical education, the majority (60.80%) of students expected to learn about family planning and contraception in preclinical or clinical years of medical school. Overall, 85.67% of students believed that IUSM should enhance its reproductive and sexual health coverage in the current curriculum, including expanding family planning and contraception didactic training.Item Development and Implementation of Pregnancy Options Counseling Curriculum in Preclinical Medical Education(2022-04-28) Komanapalli, Sarah; Brown, Lucy; Swiezy, Sarah; McKinzie, Alexandra; Stout, JulianneINTRODUCTION: Pre-clinical education during medical school is an opportunity to lay a strong foundation for clinical skill development. Options counseling for pregnancy is one such topic that is essential for students to learn early in their education. The most recent estimates from the CDC report that 102.1 per 1,000 women aged 15–44 will be pregnant. Teaching medical students the skills for pregnancy options counseling centers patient goals and prevents significant adverse outcomes, particularly those that come from being denied appropriate abortion counseling. In a previous assessment of student preparedness and interest, we found that Indiana University School of Medicine (IUSM) adequately covers family planning topics, but has gaps in abortion counseling during preclinical education. Our survey definitively showed that IUSM medical students are interested in learning about options counseling and feel unprepared to counsel about abortion; additionally, abortion counseling preparedness did not improve in our sample even after completing the OBGYN clerkship. Based on these findings, we sought to implement curriculum change in the form of a panel-based discussion that would improve student education and comfort with this crucial healthcare topic. STUDY OBJECTIVE: 1) Introduce options counseling education into IUSM preclinical reproductive education and 2) evaluate changes in student preparedness and 3) satisfaction with the panel discussion METHODS: We used data from prior surveys that demonstrated high student interest and poor preparedness regarding complete options counseling to approach faculty regarding adding options counseling to preclinical curriculum. We subsequently collaborated with pre clinical education course faculty to design and implement a panel discussion about options counseling for the preclinical reproductive coure. We then developed a survey in Qualtrics to distribute to students following the panel. The survey has 17 questions including 3 free response prompts. The survey evaluates whether students feel prepared to provide options counseling after the panel, how well topics were covered, and satisfaction overall. RESULTS: The panel will take place on February 7, 2022 and the survey will be open for weeks after the panel, at which point we will analyze student responses. We expect that our post-panel survey will demonstrate increased preparedness to counsel patients about options during pregnancy. CONCLUSIONS/IMPLICATIONS: Future panels and additional course development will fill gaps in preclinical education regarding options counseling, while expanding the skills of medical students. In addition, being prepared to offer patient centered care could better prepare students for clerkships and clinical experiences. This is a promising start to enhance preclinical education regarding women’s health.Item Evaluation of family planning and abortion education in preclinical curriculum at a large midwestern medical school(Elsevier, 2022) Brown, Lucy; Swiezy, Sarah; McKinzie, Alexandra; Komanapalli, Sarah; Bernard, CaitlinOBJECTIVE: Evaluate a Midwestern medical school's current pregnancy termination and family planning undergraduate medical curriculum (UMC) in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Assess 1) student interest 2) preparedness to counsel patients, and 3) preferred modality of instruction. STUDY DESIGN: A survey assessed students about UMC. Course syllabus learning objectives and APGO educational guidelines were compared. RESULTS: There were 309 responses total; six did not complete all survey questions and were excluded. Participants (n = 303) were primarily female (62%) and White (74%). Across all class levels, many (61%) students expected to learn about family planning and contraception in UMC. While most (84-88%) participants who completed the preclinical course with or without the clerkship felt prepared to counsel about common, non-controversial pharmacotherapies, only 20% of students felt prepared to counsel on abortion options, and 75% of students who had completed both the preclinical and OBGYN clerkship felt unprepared for abortion counseling Overall, 86% of all students surveyed believed that the medical school should enhance its reproductive health coverage in UMC. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. CONCLUSION: We identified potential gaps in UMC where students expressed high level of interest with low level of preparedness regarding abortion options counseling, even among senior students. Considering the high percentage of students expecting to learn about pregnancy termination and family planning in their UMC, this expectation is not being met. Students were open to a variety of modalities of instruction, indicating that several possible options exist for curricular integration. IMPLICATIONS: Despite evidence of need for training in family planning and abortion, few medical institutions have a standardized curriculum. Little available literature exists on curricula covering pregnancy options and contraception counseling, signifying a gap of knowledge and an opportunity to study how to integrate these important topics into UMC.Item Student-Perceived Preparedness in Contraceptive and Abortion Counseling(2021-03) Swiezy, Sarah; Brown, Lucy; Komanapalli, Sarah; McKinzie, Alexandra; Bernard, CaitlinProject Background: Upwards of 25% of women will seek an abortion by age 45; however, 17% of accredited American medical schools lack any formal abortion-related curriculum, and only 50% offer a clinical elective exposing students to abortion counseling and procedures. The gap between the large number of women seeking this care and the small amount of curriculum designed to prepare students to effectively counsel and provide this care is stark, and it represents an urgent area of study and curriculum re-design. Methods: We performed a cross-sectional survey of students at all levels of medical training to assess student-perceived level of preparedness to provide non-directive counseling on reproductive health topics, such as contraception and abortion. Preparedness was measured on a 6-point preparedness scale (1=very unprepared and 6=very prepared). Mean scores were analyzed as a whole and stratified by training level. We also performed a comparative analysis of the Association of Professors of Gynecology and Obstetrics (APGO) abortion-related learning objectives (LOs) and the corresponding LOs in our didactic reproductive health course curriculum at our institution. Results: Our preliminary survey population (n=57) included majority female (66.7%) and underclassmen (MS1 = 42.1%, MS2 = 31.6%), and varied in intended specialty. Mean preparedness to provide contraception and abortion counseling score was 2.26±0.55. When stratified to include only students in their clinical years (MS3/4, dual degree), mean preparedness score only slightly increased to 2.97±0.75. Our curriculum analysis revealed that LOs from our didactic reproductive health course covered all 5 APGO LOs on Family Planning, but did not cover 2 of the 4 APGO LOs on Pregnancy Termination. Conclusions: We identified gaps in our institution’s Pregnancy Termination curriculum, as defined by the nationally recognized APGO LOs. We also identified that current didactic and clinical training at our institution inadequately prepares medical students to provide comprehensive reproductive health counseling to women, based on mean self-reported preparedness scores. The next step is to disseminate a more in-depth survey from Feb-Mar 2021 to the same student population to further evaluate student perceptions about preparedness for reproductive health counseling compared to preparedness to counsel about hypertension management to determine whether student preparedness in family planning significantly lags preparedness in other areas of medicine. Our ultimate goal is to positively influence curriculum enhancement in comprehensive reproductive health care at our institution.Item TONSL is an immortalizing oncogene and a therapeutic target in breast cancer(American Association for Cancer Research, 2023) Khatpe, Aditi S.; Dirks, Rebecca; Bhat-Nakshatri, Poornima; Mang, Henry; Batic, Katie; Swiezy, Sarah; Olson, Jacob; Rao, Xi; Wang, Yue; Tanaka, Hiromi; Liu, Sheng; Wan, Jun; Chen, Duojiao; Liu, Yunlong; Fang, Fang; Althouse, Sandra; Hulsey, Emily; Granatir, Maggie M.; Addison, Rebekah; Temm, Constance J.; Sandusky, George; Lee-Gosselin, Audrey; Nephew, Kenneth; Miller, Kathy D.; Nakshatri, Harikrishna; Surgery, School of MedicineStudy of genomic aberrations leading to immortalization of epithelial cells has been technically challenging due to the lack of isogenic models. To address this, we utilized healthy primary breast luminal epithelial cells of different genetic ancestry and their hTERT-immortalized counterparts to identify transcriptomic changes associated with immortalization. Elevated expression of TONSL (Tonsoku Like, DNA Repair Protein) was identified as one of the earliest events during immortalization. TONSL, which is located on chromosome 8q24.3, was found to be amplified in ~20% of breast cancers. TONSL alone immortalized primary breast epithelial cells and increased telomerase activity, but overexpression was insufficient for neoplastic transformation. However, TONSL-immortalized primary cells overexpressing defined oncogenes generated estrogen receptor-positive adenocarcinomas in mice. Analysis of a breast tumor microarray with ~600 tumors revealed poor overall and progression free survival of patients with TONSL overexpressing tumors. TONSL increased chromatin accessibility to pro-oncogenic transcription factors including NF-κB and limited access to the tumor suppressor p53. TONSL overexpression resulted in significant changes in the expression of genes associated with DNA repair hubs, including upregulation of several genes in the homologous recombination (HR) and Fanconi Anemia pathways. Consistent with these results, TONSL overexpressing primary cells exhibited upregulated DNA repair via HR. Moreover, TONSL was essential for growth of TONSL-amplified breast cancer cell lines in vivo, and these cells were sensitive to TONSL-FACT complex inhibitor CBL0137. Together, these findings identify TONSL as a regulator of epithelial cell immortalization to facilitate cancer initiation and as a target for breast cancer therapy.Item Truth and Transparency in Crisis Pregnancy Centers(Women's Health Reports, 2020-07-27) Polcyn, Carly; Swiezy, Sarah; Genn, Leah; Wickramage, Pavithra; Siddiqui, Neha; Johnson, Candice; Nair, Pooja; Bernard, Caitlin; Miller, VelvetThe prevalence of crisis pregnancy centers (CPCs), their false claims, and the real harm they cause necessitate public education about their unethical practices. Also called ‘‘pregnancy resource centers’’ and ‘‘pregnancy sup- port centers,’’ CPCs are nonmedical institutions designed to deceive women seeking comprehensive pregnancy care, as their volunteers are instructed to pedal misinformation about reproductive health care.