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Scholarship & History
The UMB Digital Archive is a service of the Health Sciences and Human Services Library (HS/HSL) that collects, preserves, and distributes the academic works of the University of Maryland, Baltimore. It is a place that digitally captures the historical record of the campus.
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Intubation Timeout Tool Implementation in a Level IV Neonatal Intensive Care UnitProblem & Purpose: Endotracheal intubation is a common lifesaving, but technically challenging procedure performed in the neonatal intensive care unit (NICU). Based on a chart review of intubations performed in a Level IV NICU, use of a timeout protocol was reported 86% of the time, and 48% of intubations were associated with at least one adverse event. In this setting, adverse events occur more often when patients are acutely unstable and when providers demonstrate variable intubation proficiency. The purpose of this quality improvement project was to implement and evaluate an evidence-based pre-procedural intubation-specific timeout tool in a Level IV NICU in order to improve neonatal intubation process consistency and safety, leading to improved patient outcomes. Methods: Project implementation occurred over a ten-week period in a 49-bed Level IV NICU. Implementation included collection of baseline data, identification of champions, staff education, and development of project resources and reminders. The intubation task-specific tool was initiated by the nursing staff for eligible intubation events and involved all intubation providers. A chart audit tool was used to extract demographic and intubation timeout tool data from the electronic health record (EHR). Results: The pre-intubation timeout tool was used for nine intubation events (60%) over the ten-week period. With implementation of the tool, the incidence of intubation-associated adverse events decreased by 8% from baseline chart review. Conclusion: Results suggest that the use of an evidence-based pre-procedural intubation-specific timeout tool improves intubation process, consistency, and safety across multiple intubating neonatal providers. Continuing education tactics are necessary to promote sustainability and accountability leading to improved patient outcomes.
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Mapping local and long-distance resting connectivity markers of TMS-related inhibition reduction in schizophreniaShort interval intracortical inhibition (SICI) is a biomarker for altered motor inhibition in schizophrenia, but the manner in which distant sites influence the inhibitory cortical-effector response remains elusive. Our study investigated local and long-distance resting state functional connectivity (rsFC) markers of SICI in a sample of N = 23 patients with schizophrenia and N = 29 controls. Local functional connectivity was quantified using regional homogeneity (ReHo) analysis and long-range connectivity was estimated using seed-based rsFC analysis. Direct and indirect effects of connectivity measures on SICI were modeled using mediation analysis. Higher SICI ratios (indicating reduced inhibition) in patients were associated with lower ReHo in the right insula. Follow-up rsFC analyses showed that higher SICI scores (indicating reduced inhibition) were associated with reduced connectivity between right insula and hubs of the corticospinal pathway: sensorimotor cortex and basal ganglia. Mediation analysis supported a model in which the direct effect of local insular connectivity strength on SICI is mediated by the interhemispheric connectivity between insula and left sensorimotor cortex. The broader clinical implications of these findings are discussed with emphasis on how these preliminary findings might inform novel interventions designed to restore or improve SICI in schizophrenia and deepen our understanding of motor inhibitory control and impact of abnormal signaling in motor-inhibitory pathways in schizophrenia.
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A physician assistant entry-level doctoral degree: more harm than good?Background: As most health professions in the United States have adopted clinical or practice doctorates, there has been an ongoing debate on whether physician assistants (PAs) should transition from a master's to a doctorate as the terminal degree. The authors examined perceived risks, benefits and impact of transitioning to an entry-level PA doctoral degree. Methods: A multi-prong, mixed-methods approach was used that included a literature review and collecting quantitative and qualitative data using a survey and interviews. Bivariate analysis and binomial logistic regression were performed to evaluate relationships between perceptions/perspectives on an entry-level PA doctoral degree and the anticipated impact of it causing more harm than good to the PA profession. Deductive content analysis was used to analyze the qualitative data. Results: Of 636 PA clinicians and students (46% response rate), 457 (72%) disagreed that an entry-level PA doctoral degree should be required. More than half of the respondents (54%) agreed that it should be offered but not required and 380 respondents (60%) agreed that an entry-level doctoral degree would cause more harm than good. Race, educational attainment, occupation, and length of practice as a PA were significantly associated with having a perception of causing more harm. There was strong positive association between the perception of a doctoral degree causing more harm with expectations of having a negative impact on the availability of clinical training sites (OR = 4.39, p < .05). The most commonly cited benefits were parity with other professions and competitive advantage, whereas the perceived risks were increased cost for education, decreased diversity in the profession, and negative impact on the PA/physician relationship. Conclusions: The major takeaway of our study was that perceived benefits and risks are strongly influenced by the lens of the stakeholder. While the majority of PAs and students appear to be not in favor mainly due to the potential harm, the proportion of those in favor is not insignificant and their views should not be ignored. Addressing concerns with key stakeholders could help the PA profession to transition to a doctoral degree with minimal adverse impact.
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A Novel Marker Detection System for People with Visual Impairment Using the Improved Tiny-YOLOv3 ModelBackground and objective: Daily activities such as shopping and navigating indoors are challenging problems for people with visual impairment. Researchers tried to find different solutions to help people with visual impairment navigate indoors and outdoors. Methods: We applied deep learning to help visually impaired people navigate indoors using markers. We propose a system to help them detect markers and navigate indoors using an improved Tiny-YOLOv3 model. A dataset was created by collecting marker images from recorded videos and augmenting them using image processing techniques such as rotation transformation, brightness, and blur processing. After training and validating this model, the performance was tested on a testing dataset and on real videos. Results: The contributions of this paper are: (1) We developed a navigation system to help people with visual impairment navigate indoors using markers; (2) We implemented and tested a deep learning model to detect Aruco markers in different challenging situations using Tiny-YOLOv3; (3) We implemented and compared several modified versions of the original model to improve detection accuracy. The modified Tiny-YOLOv3 model achieved an accuracy of 99.31% in challenging conditions and the original model achieved an accuracy of 96.11 %. Conclusion: The training and testing results show that the improved Tiny-YOLOv3 models are superior to the original model.
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Use of the Renal Artery Doppler to Identify Small for Gestational Age Fetuses at Risk for Adverse Neonatal Outcomes.Objective: To measure the sensitivity and positive predictive value (PPV) for an adverse neonatal outcome among growth-restricted fetuses (FGR) comparing the cerebral–placental ratio (CPR) with the cerebral–renal ratio (CRR). Methods: Retrospective analysis of 92 women who underwent prenatal ultrasound at the University of Maryland and the University of Padua. Renal, middle cerebral and umbilical artery Doppler waveforms were recorded for all scans during the third trimester. The last scan prior to delivery was included for analysis. We calculated the test characteristics of the pulsatility indices (PI) of the umbilical and renal arteries in addition to the derived CPR and CRR to detect a composite adverse neonatal outcome. Results: The test characteristics of the four Doppler ratios to detect increased risk for the composite neonatal outcome demonstrated that the umbilical artery pulsatility index had the best test performance (sensitivity 64% (95% CI: 47–82%), PPV 24% (95% CI: 21–27), and positive likelihood ratio 2.7 (95% CI: 1.4–5.2)). There was no benefit to using the CRR compared with the CPR. The agreement between tests was moderate to poor (Kappa value CPR compared with CRR: 0.5 (95%CI 0.4–0.70), renal artery PI:−0.1 (95% CI −0.2–0.0), umbilical artery PI: 0.5 (95% CI 0.4–0.7)). Only the umbilical artery had an area under the receiver operating curve that was significantly better compared with the CPR as a reference (p-value < 0.01). Conclusions: The data that we present do not support the use of renal artery Doppler as a useful clinical test to identify a fetus at risk for an adverse neonatal outcome. Within the various indices applied to this population, umbilical artery Doppler performed the best in identifying the fetuses at risk for an adverse perinatal outcome.