For most Union College PA students, their capstone project—similar to a master’s thesis—ends with a presentation to the PA faculty, staff, and their fellow students. But for Tamara Dietze and Ashley Waldrep, their capstone projects lived on when they were recently published in scholarly peer-reviewed journals.
Waldrep relied upon her experience in clinical research with cancer patients to study the evaluation techniques that doctors use today with women who have breast cancer and are receiving neoadjuvant chemotherapy, as well as how accurately they can predict tumor responses. Her paper was published in the International Journal of Cancer Research and Treatment.
Her story began when she first came to Lincoln after graduating from York College in 2007. In 2008, she started work in the field of clinical research at a hematology/oncology practice in Lincoln, where she coordinated clinical trials for cancer patients.
“Over the next six years I came to realize that what I enjoyed most about my work was the daily interaction with our study patients, and being able to help them in any way possible,” said Waldrep. “I realized that I wanted to have a more direct role in patient care, so I decided to become a physician assistant.”
She found the Union College PA program to be a good fit for many reasons, in particular because it had a smaller-school atmosphere, where instructors knew students by name and held them personally accountable for their performance. “I also appreciated the Christ-centered atmosphere for learning. I knew from my husband Barrett’s experience (a 2014 Union College PA graduate) that I would have the opportunity to earn a quality education and become a competent PA.”
Because of her previous experience in medical research, Waldrep wanted to do an original study for her capstone project. “I maintained a good relationship with my prior employer, Nebraska Hematology-Oncology P.C.,” she said, “and one of the physicians there had sparked my interest in studying neoadjuvant chemotherapy—which is a type of chemotherapy administered before surgery for the treatment of breast cancer. Through close consultation with our capstone instructor, collaboration with the physicians at NHO, and the reviewing of the project by the Union College’s institutional review board, we were able to make it happen.”
The project itself is a retrospective analysis of the outcomes of patients who have early stages of breast cancer, and have received neoadjuvant chemotherapy. Completing the analysis took nearly the entire summer between her first and second year in the PA program. “The capstone paper that I presented to the PA program was a synopsis of relevant findings from the patient dataset,” she explained. “The paper that was published is actually an analysis of only a small portion of the capstone research, and analyzes the accuracy of clinical response evaluation when compared to true pathologic response. ”
In other words, she sought to determine how accurate physical examinations and imaging techniques are in predicting the response of a tumor to neoadjuvant chemotherapy. “More specifically, how does an individual’s specific subtype of breast cancer influence this accuracy?” Waldrep and her fellow researchers hope these hypothesis-generating findings will inspire more prospective research in the future, and hopefully confirm which methods of clinical evaluation are the most accurate for breast cancer patients receiving neoadjuvant chemotherapy.
“It’s rewarding to know that we could use already existing records of real-world patient experiences to come to a few conclusions that could assist the direction of future prospective research on the topic,” concluded Waldrep. “Our findings aren’t practice-changing since they’re from a small cohort of patients who were analyzed after their treatments were completed. But they are hypothesis-generating. They could lead to the provision of better quality and better value in care. It is nice to know that the experience of these patients, studied right here in Lincoln, Neb., will potentially contribute to the world-wide knowledge on this subject.”
Waldrep’s article, “Breast Cancer Subtype Influences the Accuracy of Predicting Pathologic Response by Imaging and Clinical Breast Exam After Neoadjuvant Chemotherapy,” can be found online at http://ar.iiarjournals.org/content/36/10/5389.full.pdf+html
Unlike Waldrep, Tamara Dietze’s clinical experience focused on infants and prenatal complications. Before enrolling in Union’s PA program, Dietze worked in clinical research at University of Nebraska Medical Center (UNMC). “I had worked with a Ph.D. there, Tiffany Moore, on a project that looked at the levels of physiologic stress in preterm infants who were born less than 32 weeks gestational age. We studied how stress related to whether or not they had developed feeding difficulties or necrotizing enterocolitis, a terrible complication in which bacteria invades the wall of an infant’s intestine and causes local infection and inflammation, which can ultimately destroy the the tissue of the intestine.”
In their studies they found that yes, there was an association, but unfortunately it raised even more questions. “It led us to question whether or not a mother’s physiologic stress levels during pregnancy have more to do with the infants having complications than anything that happened after birth.” Though they would have liked to go back and get data on those moms to compare, they lacked both time and resources.
So, when it came time for her capstone project for the PA program, Dietze already knew she wanted to do original research.
“I had spent several years working in clinical research and knew how much I enjoyed the process and science of it. Also, I had the unique opportunity of having connections to people doing research at UNMC.” Dietze contacted Dr. Moore and together, they decided it would be a great opportunity to go back and finally collect that data from the moms to compare it to their preterm infants, and see if there was any connection between the mother’s’ stress while pregnant and the baby’s stress after they were born, and whether they had developed some of the most common complications of birth.
“It took several weeks to get the appropriate clearances, gather the data, and write the manuscript,” Dietze recalled. “Dr. Moore and my advisor from the PA program, Dr. Frankie Rose, both encouraged me to publish it after it was written.” As she had already done most of the work, they believed it wouldn’t take much more to ready it for publishing.
Tamara Dietze’s finished product, “Maternal Variables Associated with Physiologic Stress and Prenatal Complications in Preterm Infants,” appeared in the Journal of Neonatal-Perinatal Medicine 9 (2016) 271-277.
“I had never published a paper before, so the entire process of publishing a manuscript in a peer-reviewed journal was a learning experience for me,” said Dietze. She acknowledged that accepting criticism after your hard work can be difficult, but welcoming input during the review process makes the paper better and makes the science better.
“Because in the end, it’s not about getting your name on an article,” Dietze reflected. “It’s about contributing to science and the medical field and using evidence to improve the care we provide our patients.”