Addressing Racial and Socioeconomic Disparities Through Patient Education and Increasing Healthcare Professionals’ Cultural Competency to Reduce Maternal Mortality in the United States
Nicholas Bibiano, Denise Barrientos, Sheeba Cruz, Margie Hernandez, Allison Martin, Christine Mueller, and Julie Tran
Pregnancy-related deaths in the United States continue to increase with a notable disparity for women of color and/or low socioeconomic status. Hundreds of women die each year due to pregnancy or delivery complications as researchers and healthcare providers remain unclear on the solution. The mortality rate is the result of pregnancy complications, the aggravation of preexisting comorbidities, methods of intervention, or events precipitated by the pregnancy.
A Meta-narrative Review: Efficacy of Non-Invasive Prenatal Testing (NIPT) in the Detection of Sex Chromosomal Aneuploidy in Singleton Pregnancy
Tien T. Dao, Arianna Fields, Annie Huynh, Nikkita McGhee, and Christian Pellegrini
Objective: To assess the efficacy of Noninvasive Prenatal Testing (NIPT) as a screening method for Sex Chromosomal Aneuploidy (SCA) and its application in clinical practice.
Methods: Searches on Pubmed and M.D. Anderson Cancer Center Research Medical Library was performed to identify primary research articles published between January 2018 to April 2023.
Results: The average combined SCA's PPV was 46.08%. The average PPV for 45, X, 47, XXX, 47, XXY, and 47, XYY was 26.05%, 44.82%, 50.21%, and 62.99%, respectively. The average PPV for 46, XY was 1.18%; however, there is a lack of statistical data for 46, XY. NIPT is least accurate in detecting 45, X (Turner Syndrome) and most accurate in detecting 47, XYY (Jacobs Syndrome). There is inconsistency in the interpretation of PPV values and, thus use of NIPT for SCA in clinical practice between the selected studies.
Conclusion: Despite its high specificity and sensitivity, NIPT for SCAs have inconsistent but low PPVs. NIPT showed a significantly lower accuracy for predicting monosomy X than sex chromosome trisomies. The studies examined seemed to hold different minimum criteria to designate the effectiveness of NIPT for SCA, and thus their recommendation to whether its use in clinical practice is recommended differed. Although NIPT for SCAs has positive implications in clinical practice, more methodological improvement is needed. Genetic counseling is necessary following a positive NIPT to ensure subsequent confirmatory tests and that prospective parents fully understand the diagnosis and make an informed decision.
A Meta-Narrative Review of RUNX1-RUNX1T1 and its Relativity to CBF Disruption Within the Adult Population
Duong Do, Alma Guerrero, Fatima Osorio Guzman, Robert Hernandez, Aml Ibrahim, and Andrea Nguyen
Acute Myeloid Leukemia (AML) is an aggressive subgroup of leukemias developed from a deviant hematopoietic stem cell, prevented from differentiating into a mature cell. Additionally, core binding factor (CBF) is disrupted by the translocation of chromosomes 8 and 21. This balanced translocation generates the RUNX1-RUNX1T1 fusion gene on the derivative chromosome 8, resulting in t(8;21)(q22;q22.1). These events cause a blockage of hematopoietic stem cell differentiation and ultimately lead to leukemia transformation (Beghini, A. 2019). Using Fluorescence in situ hybridization (FISH) and Karyotyping, molecular translocation can be detected, visualized, and associated with chromosomes 8 and 21 [t(8;21)(q22;q22)]. Furthermore, this study will investigate how gene fusion and translocation disrupt CBF for the purpose of understanding how AML is diagnosed and treatment. To address this, we conducted a meta-narrative review of the number of articles that correspond to each sub-theme of the approach to AML in the context of RUNX1-RUNX1T1 fusion gene, including the utilization of treatments, its detail on correlation to CBF complex, how the research method was depicted, limitations, audience, technology, and treatment. One of the most important aspects of the study was the understanding of genetic abnormalities and the use of genetic analysis in developing future treatment strategies for leukemia. The correlation of RUNX1-RUNX1T1 gene generated on the derivative chromosome 8 will result in t(8;21)(q22;q22.1), a balanced translocation.
A Meta-narrative Review of Textured Implants and Associated Lymphoma Risks
Steven Mendoza, Savannah R. Camacho, Chau Pham, and Chau Pham
In 2011, the Food and Drug Administration (FDA) identified that breast implants are associated with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Until 2022, a total of 1130 cases were globally recorded (Health, 2021). Even though researchers are attempting to determine the risks, the accurate etiology has not been determined yet. Comparisons of previous published works are widespread in different potential causes. Hence, we aim to focus on defining how different implants link to BIA-ALCL, especially smooth and textured implants. The review follows the meta-narrative approach with the Pubmed database (2018- now) to collect, combine, and contrast data. All the articles focus on the correlation between the texture of breast implants and BIA-ALCL. The 5 selected studies highlighted similarities and differences to find gaps, limitations among articles and investigate answers for new findings. Classification systems for implant surfaces are divided into groups based on texturing, the parameters of surface area, and bacteria growth. There have been no confirmed cases of BIA-ALCL in patients who have received only smooth breast implants while evidence has reflected textured surface links to the risk of this cancer. Intermediate and high textured surfaces are 10 times higher that links to ALCL than low-surface-area texture (Siltex). Silimed polyurethane, measured as surface grade 4, carries the highest surface area and surface roughness and has been demonstrated to have significantly higher rates of bacterial growth. Without a uniform definition, using the same terms (eg, microtexture and macrotexture) in multiple contexts causes difficulties to compare risks for BIA-ALCL
A Meta-Narrative Review on the Use of R.O.S.E in Telecytology for the Patient, Pathologist, and Cytologist
Brittany M. McDermott, Torye Smith, Daniel Onwunumagha, and Jennifer L. Willis
Advancements in technology have given rise to a path of convenience, ease, and flexibility for workers to work remotely. A new tool in laboratory diagnostics is Telecytology for Rapid On-Site Evaluation. A cytologist processes a specimen on site and captures an image or video of the findings. The media is sent directly to a pathologist for further evaluation, and then a diagnosis is given to the patient. With this being a relatively new practice, we need to ask what the advantages and disadvantages are for everyone involved: the patient, the cytologist, and the pathologist. We found articles that were less than five years old and reviewed the methodologies in the articles. We found that there were many advantages including decreased diagnosis time, availability to patients in rural areas, and fewer repeated procedures. We also found disadvantages such as extensive training requirements and the possibility of incorrect diagnoses. Our findings indicate there is success in using Telecytology for R.O.S.E., but that faults are present to some degree. As technology continues to advance, we expect more studies to be conducted that highlight the success of Teleyctology with Rapid On-Site Evaluation.
A Meta-narrative Review to Investigate Psychological Distress and Coping Mechanisms Among Healthcare Workers, Related to the COVID-19 Pandemic
Daphnie Austria, Zane Best, Nohely Delgado, Giovanna De Vita, Alexis German, Katherine Le, Kimberly Krumwiede Hoggatt, Mary Coolbaugh-Murphy, and Denise Juroske Short
Objective: Determining the factors that influence psychological distress of healthcare workers during the COVID-19 pandemic.
Background: Due to the sudden occurrence and high transmission rate of the virus that causes COVID-19, many hospitals became overwhelmed and had to respond quickly to the high patient demand. This caused increased burnout among healthcare workers, which we explored on this project.
Methodology: PubMed search of peer reviewed articles under topics of burnout, distress, and mental health of healthcare workers during the COVID-19 pandemic yielded 11 articles that we focused on for this meta-narrative review.
Discussion: Articles analyzed had a higher response from nurses and women. Burnout was evaluated by using modified versions of the Maslach Burnout Inventory-General Survey which measured emotional exhaustion, depersonalization, and personal accomplishment. Depression, anxiety, and insomnia were prevalent features discussed in the sources. Most of the articles highlighted that increasing psychological stress can lead to PTSD. Psychological distress was greatly influenced by job stress and high job demand. Coping mechanisms such as maintaining regular working hours, adequate supplies and protocols for safety, support, and encouraging resilience were seen to manage the increased psychological distress.
Conclusion: We observed that during the COVID-19 pandemic healthcare workers experienced significant psychological distress. We were able to identify coping mechanisms that could aid with stress management. We urge medical institutions to incorporate these measures to prevent a negative impact on the quality of patient care, and arm healthcare workers with tools to manage distress in times of drastic increases in patient caseload.
Meta-Narrative Review of PD-L1 by immunotherapy on Triple-Negative Breast Cancer
Hannah Lazo, Tyler Harris, Hao Truong, and Alina Masroor
Triple-negative breast cancer (TNBC) is an aggressive form of subtype breast cancer and there are currently new treatments being discovered such as the combination of immunotherapy and chemotherapy. In immunotherapy against triple-negative breast cancer, checkpoint inhibitors like PD-1/PD-L1 treat TNBC by blocking the “off” signal that prevents T-cells from killing cancer cells. As a group, we conducted a meta-narrative review collecting results from primary sources such as clinical trials and human experimental studies to support our research question on how PD-L1 inhibitor treatments compare to other treatments in patients with TNBC. The review included articles searched from Embase, Pubmed, EMBASE, and Cochrane Library for randomized controlled trials, clinical trials, and case studies published within 5 years. The articles relate to PD-1/PD-L1 inhibitors combined with chemotherapy or PD-L1 immunotherapy for triple-negative breast cancer. The results found that PD-L1 immunotherapy treatment in combination with other forms of traditional cancer therapy, such as radiation and chemotherapy, had a slightly significant positive response. However, the treatment was overwhelmingly successful in patients who exhibited PD-L1 positive TNBC compared to patients who were PD-L1 negative. Secondly, and a major concern for immunotherapy treatment is the adverse events, potentially developing autoimmune diseases. From the articles pulled, there seemed to be no new adverse events that developed for patients outside the standard toxic effects found from radiation and chemotherapy treatment.
Meta-Narrative Review of Possible Impacts of Genetic Screening on Treatment of Breast Cancer
Toqa Al Alawi, Sheza Khan, Ivey Knebel, Steven Luong, Vilma Sanchez, and Kamilah Walker-Charles
Objective: To examine the impacts of genetic screening on the treatment of breast cancer, in relation to differences, outcomes and decisions in treatment plans or surgery in patients that performed genetic screening versus those that did not.
Background: Genetic screening technology has become commercially available, yet standard preventative care for breast cancer has no genetic screening involved. Genetic screening in breast cancer treatment is performed, but its usage is not standardized.
Methods: Findings were synthesized using the meta-narrative review style to examine articles retrieved from searches of digital databases PubMed and the M.D. Anderson Scholarly Library.
Discussion: Articles were selected using a series of limiting criteria, with 12 final articles examined for the synthesized findings. Data regarding the usage of genetic screening in breast cancer treatment specifically, comparisons between genetically screened patients and non-screened patients, effects of genetic screening on patients, and any accessibility barriers to genetic screening were gathered.
Conclusion: A gap in the literature was found due to only 1 article containing comparative data between patients that performed genetic screening and those that did not. However, several barriers to genetic screening have been identified: limiting stages built into the treatment pathway, physician bias in genetic counseling recommendation, and socioeconomic barriers to genetic screening. Future research can be directed towards generating comparative data and reducing barriers to genetic screening.
Predictive Markers of Coagulopathy in COVID-19 Infection: A Meta Narrative Review
Arili A. Bedoy, Adriana L. Chapa, Jose Enriquez, Christy C. Saquin, Uyen N. Tran, and Ashley N. Trevizo
In late 2019, COVID was initially discovered in Wuhan, China, and the COVID-19 pandemic primarily began in early 2020. Along with respiratory distress, COVID-19 patients had an increased risk of forming abnormal clotting. In ICU COVID-19 patients, abnormal clotting increases the risk of mortality by approximately 74% (Montiel et al., 2022). The aim for this meta-narrative review was to identify what hemostatic parameters are predictive of coagulopathy in COVID-19 patients. Determining predictive markers of coagulopathy in COVID-19 infection may allow for early identification of severe cases before bleeding and thrombotic manifestations occur. The review included articles primarily from PubMed and were published between 2020 and 2022. After screening for eligibility, seven articles were deemed fit to be included. Our findings indicate that elevated D-dimer levels were the most common predictive hemostatic parameter utilized, along with elevated Von Willebrand Factor, elevated Factor VIII, and decreased fibrinogen levels. COVID-19 patients that presented with these parameters upon admission were highly likely to experience clotting events such as deep vein thrombosis and pulmonary embolism. Although many of the articles in this review focused on elevated D-dimer as an early marker of coagulopathy, one study found that elevated soluble thrombomodulin was the best predictor of coagulopathy in COVID patients. Future research will be needed to confirm soluble thrombomodulin’s ability as a predictive parameter and compare its suggestive power to D-dimer levels. Clinical trials will also be needed to assess how these predictive markers can be used to inform prophylactic treatment in COVID-19 patients.
Understanding the Efficacy and Safety of Stem Cell Therapy and CAR T-cell Therapy in Leukemia Patients
Amita Panda, Wendy Perla, Betelhem Negash, Johnny Duong, and Cong Nguyen
CAR T-cell therapy and Stem cell therapy are effective treatments with varying benefits, efficacy, and safety for patients with recurrent leukemia. CAR T-cell therapy and Stem cell therapy are both effective immunotherapies that use engineered cells to combat cancers. The implications of this study allow patients to understand the benefits and disadvantages of both therapies and paves the way for future advancement within immunotherapy. This review selected studies from reputable medical journals, clinical trials and peer-reviewed research published within the last five years obtained from multiple databases including PubMed, Wiley Online Library, and Google Scholar. We compared the efficacy and safety of CAR T-Cell therapy to Stem cell therapy in patients with leukemia using meta narrative principles to synthesize relevant information. Here we show that CAR T-cell therapy is a safer treatment option since its side effects such as cytokine release syndrome (CRS), neurotoxicity, and infections can be managed with secondary treatment. These treatment approaches include corticosteroids and supportive care aid in patient recovery within two weeks to a month. Compared to CAR T-cell therapy, Stem cell therapy has a higher risk of graft vs. host disease, suggesting that it is less effective for patients with recurrent leukemia. Furthermore, our results indicate that CAR T-cell therapy is a safer and more effective treatment for patients with relapsing leukemia. However, the combination of CAR T-cell therapy with Stem Cell therapy has shown to be the most effective method of treatment for patients with refractory leukemia.
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