Milana Trounce

All Publications

• Teaching Principles of Medical Innovation and Entrepreneurship Through Hackathons: Case Study and Qualitative Analysis. JMIR medical education Preiksaitis, C., Dayton, J. R., Kabeer, R., Bunney, G., Boukhman, M. 2023; 9: e43916

  Abstract

  Innovation and entrepreneurship training are increasingly recognized as being important in medical education. However, the lack of faculty comfort with the instruction of these concepts as well as limited scholarly recognition for this work has limited the implementation of curricula focused on these skills. Furthermore, this lack of familiarity limits the inclusion of practicing physicians in health care innovation, where their experience is valuable. Hackathons are intense innovation competitions that use gamification principles to increase comfort with creative thinking, problem-solving, and interpersonal collaboration, but they require further exploration in medical innovation.To address this, we aimed to design, implement, and evaluate a health care hackathon with 2 main goals: to improve emergency physician familiarity with the principles of health care innovation and entrepreneurship and to develop innovative solutions to 3 discrete problems facing emergency medicine physicians and patients.We used previously described practices for conducting hackathons to develop and implement our hackathon (HackED!). We partnered with the American College of Emergency Physicians, the Stanford School of Biodesign, and the Institute of Design at Stanford (d.school) to lend institutional support and expertise in health care innovation to our event. We determined a location, time frame, and logistics for the competition and settled on 3 use cases for teams to work on. We planned to explore the learning experience of participants within a pragmatic paradigm and complete an abductive thematic analysis using data from a variety of sources.HackED! took place from October 1-3, 2022. In all, 3 teams developed novel solutions to each of the use cases. Our investigation into the educational experience of participants suggested that the event was valuable and uncovered themes suggesting that the learning experience could be understood within a framework from entrepreneurship education not previously described in relation to hackathons.Health care hackathons appear to be a viable method of increasing physician experience with innovation and entrepreneurship principles and addressing complex problems in health care. Hackathons should be considered as part of educational programs that focus on these concepts.

  View details for DOI 10.2196/43916

  View details for PubMedID 36826988

• Drive-through Medicine for COVID-19 and Future Pandemics WESTERN JOURNAL OF EMERGENCY MEDICINE Ngo, J., Ravi, S., Kim, N., Boukhman, M. 2021; 22 (2): 252–56

  View details for DOI 10.5811/westjem.2020.9.48799

  View details for Web of Science ID 000628776700016

• Is EMS Prepared for an epidemic or a pandemic? (expert comment) Trounce, M. B. EMS1.com. 2020 ; EMS1
• COVID-19 and Future Pandemics Trounce, M. B., Shultz, G. P. Hoover Press. 2020 ; Governance in an Emerging New World
• Potential Pandemics Trounce, M. B. Hoover Press. 2019 ; Governance in an Emerging New World
• HITTING A MOVING TARGET: A STRATEGIC TOOL FOR ANALYZING TERRORIST THREATS HEALTH SECURITY Coleman, K., Ishisoko, N., Trounce, M., Bernard, K. 2016; 14 (6): 409–18

  Abstract

  The subject of terrorism risk can be confusing for both the general public and for those responsible for protecting us from attack. Relatively minor terrorist threats are often conflated with much more serious ones, in part because it is hard to quantify either intent or technical ability to carry out an attack. Plotting threats on a "potential mass casualties" versus "ease of obtainment or production" matrix creates some order out of a seemingly endless array of worldwide threats, and it highlights those threats that are in need of more urgent attention. The specific threats on this 2x2 matrix can fall into one or multiple quadrants, which can be qualitatively described as "most dangerous," "dangerous but difficult," "worrisome," and "persistent terror." By placing threats into these quadrants and illustrating movement within and between them, the matrix can help (1) visualize and parse a diverse set of threats, (2) view how threats have changed over time and judge the efficacy of current countermeasures, and (3) evaluate the merit of future actions and investments. Having a dynamic matrix that can visually map the comparative risk of terrorist threat events in toto and that can help us monitor the effectiveness of present and future resource investments can add intellectual rigor to some of the most difficult and daunting decisions pertaining to our nation's safety and security.

  View details for DOI 10.1089/hs.2016.0062

  View details for Web of Science ID 000391315200005

  View details for PubMedID 27855268

• Educating Health Care Professionals on Human Trafficking PEDIATRIC EMERGENCY CARE Grace, A. M., Lippert, S., Collins, K., Pineda, N., Tolani, A., Walker, R., Jeong, M., Trounce, M. B., Graham-Lamberts, C., Bersamin, M., Martinez, J., Dotzler, J., Vanek, J., Storfer-Isser, A., Chamberlain, L. J., Horwitz, S. M. 2014; 30 (12): 856-861

  Abstract

  The US Department of State estimates that there are between 4 and 27 million individuals worldwide in some form of modern slavery. Recent studies have demonstrated that 28% to 50% of trafficking victims in the United States encountered health care professionals while in captivity, but were not identified and recognized. This study aimed to determine whether an educational presentation increased emergency department (ED) providers' recognition of human trafficking (HT) victims and knowledge of resources to manage cases of HT.The 20 largest San Francisco Bay Area EDs were randomized into intervention (10 EDs) or delayed intervention comparison groups (10 EDs) to receive a standardized educational presentation containing the following: background about HT, relevance of HT to health care, clinical signs in potential victims, and referral options for potential victims. Participants in the delayed intervention group completed a pretest in the period the immediate intervention group received the educational presentation, and all participants were assessed immediately before (pretest) and after (posttest) the intervention. The intervention effect was tested by comparing the pre-post change in the intervention group to the change in 2 pretests in the delayed intervention group adjusted for the effect of clustering within EDs. The 4 primary outcomes were importance of knowledge of HT to the participant's profession (5-point Likert scale), self-rated knowledge of HT (5-point Likert scale), knowledge of who to call for potential HT victims (yes/no), and suspecting that a patient was a victim of HT (yes/no).There were 258 study participants from 14 EDs; 141 from 8 EDs in the intervention group and 117 from 7 EDs in the delayed intervention comparison group, of which 20 served as the delayed intervention comparison group. Participants in the intervention group reported greater increases in their level of knowledge about HT versus those in the delayed intervention comparison group (1.42 vs -0.15; adjusted difference = 1.57 [95% confidence interval, 1.02-2.12]; P < 0.001). Pretest ratings of the importance of knowledge about HT to the participant's profession were high in both groups and there was no intervention effect (0.31 vs 0.55; -0.24 [-0.90-0.42], P = 0.49). Knowing who to call for potential HT victims increased from 7.2% to 59% in the intervention group and was unchanged (15%) in the delayed intervention comparison group (61.4% [28.5%-94.4%]; P < 0.01). The proportion of participants who suspected their patient was a victim of HT increased from 17% to 38% in the intervention group and remained unchanged (10%) in the delayed intervention comparison group (20.9 [8.6%-33.1%]; P < 0.01).A brief educational intervention increased ED provider knowledge and self-reported recognition of HT victims.

  View details for PubMedID 25407038

• How contagious pathogens could lead to nuke-level casualties. http://med.stanford.edu/ism/2014/may/bioterror-0519.html Goldman, B. 2014; May
• FDA Food Safety Modernization Act: Is it Enough? J Bioterr Biodef Coates, A., Boukhman Trounce, M. 2011; 2 (109)
• Humming is as effective as Valsalva's maneuver and Trendelenburg's position for ultrasonographic visualization of the jugular venous system and common femoral veins ANNALS OF EMERGENCY MEDICINE Lewin, M. R., Stein, J., Wang, R., Lee, M. M., Kernberg, M., Boukhman, M., Hahn, I., Lewiss, R. E. 2007; 50 (1): 73-77

  Abstract

  The purpose of this study is to compare ultrasonographic visualization of the jugular and common femoral veins by using a novel technique (humming) and 2 conventional techniques (Valsalva's maneuver and Trendelenburg's position). The Valsalva's maneuver and Trendelenburg's position are common methods for producing venous distention, aiding ultrasonographically guided identification and cannulation of the jugular and common femoral veins. We hypothesize that humming is as effective as either Valsalva's maneuver or Trendelenburg's position for distention and ultrasonographic visualization of these procedurally important blood vessels. Herein, we investigate a new method of venous distension that may aid in the placement of central venous catheters by ultrasonographic guidance.Healthy, normal volunteers aged 28 to 67 years were enrolled. Each subject's internal jugular, external jugular, and common femoral veins were measured in cross-section by ultrasonograph during rest (baseline), humming, Valsalva's maneuver, and Trendelenburg's position. Three measurements were recorded per observation in each position. Subjects were used as their own controls, and measurements were normalized to percentage increase in diameter during each maneuver or position for later comparison.The study population consisted of 7 subjects, with a mean age of 47 years. Cross-sectional area was calculated for each vessel in 3 groups: baseline/control, Valsalva, Trendelenburg, and humming. The mean percentage change (+/-SD) relative to baseline cross-sectional area of the jugular vessels for each subject were external jugular vein: humming 134%+/-25% (95% confidence interval [CI] 124.9% to 146.9%), Valsalva 136%+/-23% (95% CI 121.3% to 147.5%), Trendelenburg 137%+/-32% (95% CI 120.7% to 156.9%); internal jugular vein: humming 137%+/-27% (95% CI 119.4% to 148.2%), Valsalva 139%+/-24% (95% CI 122.4% to 148.7%), Trendelenburg 141%+/-35% (95% CI 116.5% to 156.5%); common femoral vein: humming 131%+/-15% (95% CI 120.4% to 139.1%), Valsalva 139%+/-18% (95% CI 127.9% to 150.4%), Trendelenburg 132%+/-24% (95% CI 113.3% to 142.9%).All 3 maneuvers distended the external jugular, internal jugular, and common femoral veins compared to baseline. There was no important difference in magnitude of cross-sectional area between any of the 3 maneuvers when compared with one another. Humming shares many physiologic similarities to Valsalva's maneuver and may be more familiar and easier to perform during procedures such as ultrasonographically guided central venous catheter placement and insertion of external jugular intravenous catheters.

  View details for DOI 10.1016/j.annemergmed.2007.01.024

  View details for Web of Science ID 000247773500019

  View details for PubMedID 17433497

• Cholera Disaster Medicine. Philadelphia:Elsevier Boukhman MB, Ciottone GR 2005
• Sustainability of Emergency Medicine/ First Responder Training centers in the CIS 3rd Emergency Medicine Mediterranean Congress (poster presentation) Boukhman, M., Kelly S, Freitas R, Ciottone GR, Chen Y, Anderson PD 2005
• Atrial Fibrillation Micromedex Boukhman MP, Wolfe R 2003
• Surgical Management of Insulinomas Atlas of Surgical Oncology Boukhman MP, Perrier NI, Clark OH 2003
• Thresholds in contact sensitization: Immunologic mechanisms and experimental evidence in humans - an overview FOOD AND CHEMICAL TOXICOLOGY Boukhman, M. P., Maibach, H. I. 2001; 39 (12): 1125-1134

  Abstract

  The evidence from practical experience in man, from controlled human testing and from both chemical and biological mechanistic considerations, demonstrates that the thresholds for skin sensitization exist both at the level of induction as well as sensitization. For a given contact allergen, the concentration (expressed in dose per unit area), which is at the threshold, has to be defined in terms of the nature and extent of the skin contact involved, and whether it is the induction of skin sensitization or its elicitation that is involved, since the numerical values will depend heavily on these parameters. The induction and elicitation of contact allergy is influenced by several factors: the total dose of the allergen, its surface concentration, the size of area over which it is applied, antigenic potency of the substance, number of exposures, anatomical site of exposure, effect of draining lymph nodes, matrix (vehicle) of allergen, effect of occlusion, degree of percutaneous penetration, effect of diseased skin/trauma and possibly a host of other, as yet unknown, variables.

  View details for Web of Science ID 000172349200001

  View details for PubMedID 11696387

• Contact Urticaria Syndrome: Occupational Hazards. Clinics in Occupational and Environmental Medicine. Boukhman MP, Maibach HI 2001; 1(1) (1): 13-34
• Localization of insulinomas 70th Annual Session of the Pacific-Coast-Surgical-Association Boukhman, M. P., Karam, J. M., Shaver, J., Siperstein, A. E., DeLorimier, A. A., Clark, O. H. AMER MEDICAL ASSOC. 1999: 818–22

  Abstract

  Intraoperative ultrasonography is more sensitive than preoperative and other intraoperative techniques for localizing insulinoma.Retrospective review.A tertiary referral center.All patients with a biochemical diagnosis of organic hyperinsulinism who were referred to University of California, San Francisco, from 1975 to 1998.Sensitivities of the localization techniques for insulinoma were evaluated.The sensitivities of tumor localization with arteriography, computed tomography, preoperative ultrasonography, magnetic resonance imaging, magnetic resonance imaging with gadolinium, transhepatic venous sampling, palpation, and intraoperative ultrasonography were 47%, 24%, 50%, 30%, 40%, 55%, 76%, and 91%, respectively. Nine of the 11 nonpalpable and nonvisible tumors at operation were localized by intraoperative ultrasonography.The currently available preoperative localization tests are not reliable enough to be recommended when intraoperative ultrasonography is available.

  View details for Web of Science ID 000081876300004

  View details for PubMedID 10443803

• Allergic contact dermatitis from tropicamide ophthalmic solution CONTACT DERMATITIS Boukhman, M. P., MAIBACH, H. I. 1999; 41 (1): 47-48

  View details for Web of Science ID 000081212100014

  View details for PubMedID 10416714

• Hyperinsulinemic Hypoglycemia in Children (poster presentation) Pacific Coast Surgical Association. 70th Annual Meeting. Boukhman, M., Clark, OH 1999
• Localization of Insulinomas (abstract) JAMA Boukhman MP, Siperstein AI, Clark OH 1999; 282 (17): 1608
• Insulinoma - Experience from 1950 to 1995 WESTERN JOURNAL OF MEDICINE Boukhman, M. P., Karam, J. H., Shaver, J., Siperstein, A. E., Duh, Q. Y., Clark, O. H. 1998; 169 (2): 98-104

  Abstract

  Insulinomas are rare tumors that originate from the islet cells of the pancreas. The purpose of this study was to analyze our experience in patients with insulinoma and present our approach to these patients. Medical records of 67 patients treated at the University of California, San Francisco (UCSF) Medical Center, 56 surgically and 11 medically, from 1954 to 1995 were retrospectively reviewed. Presenting symptoms, physical findings, laboratory data, pre and intraoperative localization studies, operative management, operative success, and post-operative complications were analyzed. Among the entire cohort, there were 11 patients with Multiple Endocrine Neoplasia type I (MEN 1) and 7 patients with multiple tumors. 46 out of 48 patients (96%) having first operations for benign tumors and 5 out of 8 patients (63%) having reoperations for benign tumors were successful, as were 6 out of 12 patients (50%) having operations for islet cell carcinoma. Overall, preoperative localization studies were positive in only 46% of patients and therefore failed to improve our surgical outcome. Careful palpation with intraoperative ultrasonography gave the best localization results. Enucleation of solitary tumors is curative in sporadic cases and gives the lowest complication rate. In patients with MEN 1, subtotal pancreatectomy with enucleation of tumours from the pancreatic head and uncinate process is recommended over simple enucleation because of frequent multiple tumors.

  View details for Web of Science ID 000075386300004

  View details for PubMedID 9735690

  View details for PubMedCentralID PMC1305178