Medicine and Health Sciences Commons^™

Renal Replacement Therapy In Patients With Left Ventricular Assist Device: What Do The Cardiologists Need To Know?, Hesham R. Omar

The VAD Journal

Renal failure after left ventricular assist device (LVAD) implantation occurs either due to worsening chronic kidney disease which is common in end-stage heart failure, or due to acute kidney injury in the peri-implantation period, and is associated with high morbidity and short-term mortality. The increased utilization of LVAD in refractory heart failure either as a bridge to transplantation or destination therapy will eventually create a population of patients with LVADs who are dialysis-dependent. There are multiple challenges encountered during dialysis of patients with LVADs including the unfamiliarity of nephrologists with the LVAD technology, difficulty in hemodynamic monitoring with continuous flow …

Accounting For Indirect Costs In Public Health Cost Analyses, Melanie D. Whittington, Adam Atherly, Lisa Vanraemdonck

Frontiers in Public Health Services and Systems Research

Background. There is a gap in research regarding the resources needed to deliver public health activities, which inhibits informed decision making around investments in public health and the allocation of funds among activities. When conducting cost analyses in public health, it is important to include costs from all cost components, including personnel, non-personnel, and indirect costs. However, defining, identifying, and measuring indirect costs is challenging and can impede studies of this type. Purpose. The purpose of this pilot study is to create a catalog of the methodologies public health researchers have used to account for indirect costs. Methods. We surveyed …

Assessment Of Quality Improvement In Ontario Public Health Units, Madelyn P. Law, J. Ross Graham, Erica Bridge

Frontiers in Public Health Services and Systems Research

Background: Quality Improvement (QI) approaches are used extensively in healthcare settings and increasingly in public health. However, the proliferation of QI in Canadian public health settings is unknown.

Purpose: The purpose of this study was to (a) assess the QI maturity in Ontario local public health units in Canada, and (b) to determine the relevance of the QI Maturity Tool in a Canadian setting

Methods: The QI Maturity Tool (Version 5) was used to conduct a cross-sectional assessment of the QI maturity of 36 local public health units in Ontario, Canada. After tool items were reviewed for relevance, individuals most …

Cross-Sector Partnerships And Public Health: Challenges And Opportunities With The Private Sector, Lee Johnston, Diane Finegood

Frontiers in Public Health Services and Systems Research

Over the past few decades, cross-sector partnerships that include the private sector have become an increasingly accepted practice in public health, particularly in efforts to address infectious disease in low and middle income countries. Now they are becoming a popular tool in efforts to reduce and prevent obesity and the epidemic of non-communicable disease. Partnering with business presents a means of acquiring resources, as well as opportunities to influence the private sector toward more healthful practices. Collaboration is a core principle of public health practice; however public-private or non-profit-private partnerships present risks and challenges that warrant specific consideration. In this …

Speaking The Language Of The Decision-Makers, Angela Carman Drph

Frontiers in Public Health Services and Systems Research

In a system experiencing dwindling resources, public health practitioners must be able to explain their goals, services, and impact via terms and concepts understood by policymakers, governmental representatives, and community members. The use of concepts such as private sector partnership development, quality improvement, expense management, and cost analysis can provide public health practitioners means for growth and improvement, as well as the ability to communicate value to decision makers.

Low-Dose Vitamin K Can Improve Warfarin Control In Patients On Lvad Support, Daizo Tanaka, Venessa L. Kotch, Cheryl Abbas, Gordon Reeves, John Wc Entwistle Iii

The VAD Journal

Background

Anticoagulation with oral vitamin K antagonists (VKA) is very important in patients supported on a left ventricular assist device (LVAD) to prevent thromboembolic complications. Some patients tolerate VKAs poorly and have an unstable INR as a result. It is reported that low-dose vitamin K can improve INR control in patients with an unstable INR in other clinical settings. We evaluated its safety and effectiveness in patients on LVAD support.

Methods

The records of all patients supported on an implantable LVAD between January, 2013 and March, 2014 were reviewed retrospectively to identify those who had received low-dose vitamin K while …

Damaging Cardiac And Cancer Genetic Variants In The Lvad Population, Brian D. Lowes Md, Phd, Eric T. Rome, Kajari Dhar, Jeff Kittrell, James D. Eudy, John Y. Um, Alexandra Moulton, J. Zao, Ronald Redder, Michael J. Moulton, Daniel R. Anderson, Eugenia Raichlin

The VAD Journal

Background: Next generation sequencing technology, coupled with population genetic databases, have made broad genetic evaluation relatively inexpensive and widely available. Our objective was to assess the prevalence of potentially damaging cancer and cardiac gene variants in advanced non-ischemic cardiomyopathy patients.

Methods: Explanted human heart tissue procured at LVAD placement was obtained from the University of Nebraska Medical Center Heart Tissue Bank. Genomic DNA was isolated from tissues and amplified by PCR using targeted ampliseq primer pools from an inherited disease panel. Individual libraries were amplified by emulsion PCR on Ion Sphere particles and sequencing was performed on a …

Early Manifestations Of Atrial Tamponade In A Patient Implanted With Syncardia Total Artificial Heart., Manoj Thangam, Bindu Akkanti, Sriram Nathan, Daniel Ocazionez-Trujillo, Indranee Rajapreyar, Manish K. Patel, Jayesh Patel, Pranav Loyolka, Biswajit Kar, Igor Gregoric

The VAD Journal

Implantation rates of the SynCardia Total Artificial Heart (TAH) system is growing owing to the increasing incidence of biventricular heart failure and the limited number of transplantable hearts. Among the complications associated with the device, atrial tamponade is an emergent condition that requires immediate attention. Atrial tamponade occurs when increasing pericardial hemorrhage leads to atrial compression that produces tamponade physiology and compromises cardiac output. Unfortunately to our knowledge, information concerning the early manifestations of tamponade in TAH patients is extremely scarce. Previous reports have focused on decreased cardiac output as an indicator of tamponade. However, other presentations including pulmonary decompensation …

Massive Pulmonary Embolism With Hemodynamic Compromise Successfully Treated With Veno-Arterial Extracorporeal Membrane Oxygenation, B. Akkanti, S. Nathan, E. N. Centeno, K. Akasapu, P. Doshi, R. Hussain, F. Raissi, A. Nascimbene, R. Srinivasan, I. Rajapreyar, M. Patel, J. Patel, M. Akay, P. Loyalka, B. Kar, I. Gregoric

The VAD Journal

Introduction: Cardiogenic shock that results from pulmonary embolus has a high mortality rate. Systemic thrombolysis is frequently used in submassive and massive pulmonary embolus and has been shown to restore circulation. However, in the event of impending or ongoing cardiac arrest, systemic thrombolysis or anticoagulation alone has not been always shown to be effective. Case reports have previously established that extracorporeal membrane oxygenation can effectively be used as an effective rescue strategy in cases of cardiac arrest as a result from massive pulmonary embolus. We report six cases of massive pulmonary embolism (PE), in which veno-arterial extracorporeal membrane oxygenation (VA …

Misdiagnosis: Dysfunction Between Western Health Organizations And Developing Nations, Dannette Smith Cook

Ex-Patt Magazine

Improving the global public health system is no simple task. Find out how Indonesia can help explain a culture of distrust between developing nations and international health organizations.

Prevailing Against Polio: India's Holistic Development Strategy, Anonymous Submission

Ex-Patt Magazine

No abstract provided.

Promoting Children's Adherence To Asthma Self-Management, Demetrius Abshire

Kaleidoscope

Asthma is the most common chronic childhood condition, affecting about nine million children in the United States. Despite effective treatments available to children and their families, adherence to asthma self-management is low. This paper identifies barriers to asthma-self-management and discusses effective education and behavioral strategies to promote self-management in children with asthma. Implications specific to the profession of nursing are incorporated throughout the discussion. In addition to practical nursing interventions in clinic and hospital settings, areas of future nursing research are addressed.

Distributed Task Related Bold Signal During Auditory Sub-Second Timing, Yuriy Bronshteyn

Kaleidoscope

The brain's input/output functions depend heavily on temporal processing. We sought to identify regions of the brain active in task performance during temporal discrimination of a sub-second auditory interval. We presented ten subjects with 40 paired tones and asked them to judge whether these comparison intervals were longer or shorter than a 100 ms standard. We then localized correlations between the Blood Oxygenation Level Dependent signal and task performance across subjects using event-related functional magnetic resonance imaging. We saw no task-related frontal cortex activation and significant activation of traditional auditory areas. Auditory regions included the bilateral superior and middle temporal …

Utilizing Performance Management To Harness The Power Of Quality Improvement In Public Health, Leslie M. Beitsch, Valerie A. Yeager, John W. Moran

Frontiers in Public Health Services and Systems Research

Widespread adoption of quality improvement activities in public health trails other U.S. sectors. Launching the national public health accreditation program of the Public Health Accreditation Board (PHAB) has propelled health department momentum around quality improvement uptake. Domain 9 of the PHAB standards focuses on evaluation and improvement of performance, and is acting as a strong driver for quality improvement and performance management implementation within health departments. Several performance management models have received broad acceptance, including among government and nonprofits, and have direct public health application. Turning Point is a model designed specifically for public health users. All models in current …

Public Health Surveillance Using Electronic Health Records: Rising Potential To Advance Public Health, Guthrie S. Birkhead, Michael Klompas, Md Mph, Nirav R. Shah

Frontiers in Public Health Services and Systems Research

Background: Public health surveillance has traditionally relied on manual processes including paper-based reporting by clinicians. The introduction of electronic laboratory reporting increased the efficiency and completeness of infectious disease surveillance but clinical and risk factor data are often still collected manually. The use of electronic health records (EHR) has significant promise to enrich surveillance by collecting these data automatically and by expanding surveillance to chronic diseases (e.g., diabetes, hypertension, obesity). However, the extent of the use of EHRs for public surveillance is not well studied.

Evidence Acquisition: The peer-reviewed medical literature was searched for descriptions of the use of EHRs …

Measuring Population Care Performance: Development Of The Population-Patient Satisfaction Survey For Use With Community Groups, Michele Issel, Christine Lurie, Betty Bekemeier

Frontiers in Public Health Services and Systems Research

Background: Assessing the satisfaction of the “population-patient” requires conceptualizing the dimensions of satisfaction differently from that of individual patients.

Purpose: The focus of this study was to develop and pilot test a short questionnaire that can reliably assess satisfaction with the care provided by public health nurses (PHNs) carrying out population-level activities in their communities.

Methods: An instrument-development approach was used. With input from five experts, items were developed to assess seven dimensions of population-patient satisfaction, and then refined before use in the community with a convenience sample of community participants recruited by PHNs in six counties across two states. …

Local Health Departments’ Costs Of Providing Environmental Health Services, Simone Singh, Nancy L. Winterbauer, Ashley Tucker, Lisa Macon Harrison

Frontiers in Public Health Services and Systems Research

Background: A detailed understanding of the costs that local health departments (LHDs) incur in the provision of public health services plays an important role in their efforts to provide services in an effective and efficient manner. However, surprisingly little evidence exists about the key cost components that LHDs incur in the provision of services.

Purpose: The purpose of this report was to provide empirical estimates of LHDs’ cost structure.

Methods: Using cost information for 2012 from 15 LHDs in North Carolina for two public health services—food and lodging and onsite water—this report first presents estimates of the total costs per …

Use Of Facebook By Local Health Departments: Usage, Public Health Themes, And Maintenance, Rakhi Trivedi, Gulzar H. Shah, Ankit Bangar

Frontiers in Public Health Services and Systems Research

Background: Recent research shows that social media offer unprecedented opportunities for communications with stakeholders in public health and other industries.

Purpose: This study examines the manner in which U.S. local health departments (LHDs) use Facebook. Public health program themes discussed on Facebook profiles of LHDs were analyzed and ranked by the frequency of mentions on Facebook.

Methods: LHDs included in the study were those indicating use of Facebook in the 2010 National Profile of Local Health Departments. Using the list from the profile study, the primary data from LHDs’ public Facebook profiles were collected over a period of 4 months. …

The Dietary Habits And Nutrition Education Levels Of Parents Of Pre-School Children At A Community Head Start Program, Lisa Renee Keys

Kaleidoscope

The health of America’s youth is jeopardized as obesity, often beginning in childhood, becomes a major epidemic. Parents have exceptional influence on their children, especially nutritionally, which impacts how their children grow and develop. Parents with minimal nutrition education and who do not practice healthy eating habits may unintentionally influence their children in practices that could lead to nutrition-related disease and/or obesity. This research evaluated the dietary habits and nutrition knowledge of parents of preschoolers at a community Head Start program in Lexington, KY, which served a high percentage of Hispanic children. The parents were given a survey evaluating their …

Peak Flow Versus Symptom Monitoring To Manage Childhood Asthma, Ashleigh Ohlmann

Kaleidoscope

Asthma is the most prevalent chronic respiratory disease in children. If asthma is not well managed, it can result in significant morbidity and mortality. The purpose of this paper is to assess the effects of peak flow versus symptom monitoring on asthma health outcomes in children. A literature review was conducted for research articles related to peak flow and symptom monitoring as they relate to asthma outcomes in children. The MEDLINE, PubMed, and CINAHL databases were accessed. The search was narrowed to include articles from the years 2000-2006 using the search terms child, asthma, peak flow meter, and symptom monitoring. …

Domestic Violence In The Workplace, Amanda Fallin

Kaleidoscope

Intimate partner violence (IPV) is a pervasive problem that follows victims from the home into the workplace. Many women who experience violence in their homes are also harassed at work and are abused in the workplace. For the current study, thirty women who reported a history of workplace violence were recruited from a homeless women’s shelter. Of the participants, thirteen experienced domestic violence in the workplace, and this paper focuses on the results obtained from those thirteen respondents. This paper also discusses the link between poverty and homelessness, intimate partner violence, and workplace violence.

Behavioral And Morphological Parameters Of Neurons Predict The Inhibitory Potential Of Cspg Motifs: A Novel Technique, Edward Matin Kobraei

Kaleidoscope

Our lab aims to systematically identify the structural elements of chondroitin sulfate proteoglycans (CSPGs) that inhibit regeneration following spinal cord injury (SCI). CSPGs are extracellular matrix molecules produced by astrocytes of glial scar tissue following SCI. Central to this project is the use of CSPGs referred to as “Designer PGs,” which contain engineered modifications in the GAG chains and/ or the protein core of the neural CSPG aggrecan. Using established bioassays in vitro, we qualitatively and quantitatively measure growth cone behaviors and morphology as they interact with Designer PG molecules. These measurements are then translated into a composite inhibitory quotient …

Social Disruption And Physical Limitation Related To Quality Of Life Of Adolescents With Asthma, Jennifer L. Baumgardner

Kaleidoscope

During adolescence, teenagers experience many physical, emotional, and social changes. Teenagers with chronic conditions, however, may face challenges in normal adolescent development because their illness can impact body image, independence, and peer socialization. Little is known about the effect of asthma on adolescent quality of life (QOL). In this paper, I review the existing literature on social disruption and physical limitations related to asthma and the subsequent impact on adolescent asthma QOL. In addition, adolescent issues leading to poor control of asthma symptoms and interventions to improve asthma QOL for adolescents are addressed.

Role Of Cytoskeletal Dynamics In Platelet Arf6 Activation, Brett Taylor Begley

Kaleidoscope

Platelets undergo morphological changes upon activation, such as shape change and aggregation. These changes are known to be the result of actin remodeling, whereas the role of microtubule remodeling has been controversial. The objective of this study was to re-examine the role of actin and microtubule dynamics in platelet function. We used aggregometry to measure the effect of cytoskeletal inhibitors on platelet shape change, aggregation, and dense core release. Microtubule assembly was found to have no role in platelet function, because treatment with vinblastine or nocodazole had no effect on shape change, aggregation, or secretion. Microtubule disassembly was necessary for …

Systemic Candidiasis And Cytomegalovirus Infection In The Setting Of Artificial Cardiac Device Deployment., Manoj Thangam, Bindu Akkanti, Maan Malahafio, Sriram Nathan, Indranee Rajapreyar, Pranav Loyalka, Biswajit Kar, Igor Gregoric

The VAD Journal

Heart failure is a serious cause of morbidity and mortality worldwide. The advent of implantable cardiac assist devices has generated a new arsenal for treating severe heart failure. However, the potential ramifications of ventricular assist device (VAD) usage are not fully understood. Immune modulation resulting from VAD implantation is an area of growing research. Although we do not fully understand the mechanisms contributing to host immune alteration, changes in cytokine concentrations, deceased lymphocyte activity, and the local effects of device materials have been shown to down regulate immune function. ^7,8 Infection is a serious complication that affects prognosis in this …

Commentary On "Systemic Candidiasis And Cytomegalovirus Infection In The Setting Of Artificial Cardiac Device Deployment", Moises A. Huaman

The VAD Journal

No abstract provided.

Use Of Social Media As A Virtual Community And Support Group By Left Ventricular Assist Device (Lvad) Patients, Bryan Boling, Amanda Hart, Chizimuzo T.C. Okoli, Tamra Halcomb, Peggy El-Mallakh

The VAD Journal

Abstract

Background

Left ventricular assist device (LVAD) patients may benefit from participating in a social support group; however, several factors may limit the availability of these communities. Alternatively, online social support communities may be more accessible for LVAD patients. No studies have examined patterns and reasons for health-related social media use among people with LVADs

Methods

An online survey of patients actively participating in LVAD social media groups was conducted using both multiple choice and open-ended questions.

Results

Thirty-nine participants (65% male) completed the survey. Participants’ reasons for weekly engagement in online communities were to seek (69.2%) and offer (66.7%) …

Insights Into Alzheimer’S Disease: The Levels Of Signaling Proteins In Brain Of Control Subjects Versus Brain From Subjects With Mild Cognitive Impairment, Georgianne F. Tiu

Kaleidoscope

The purpose of this study was to measure the expression levels of key signaling proteins in brain tissue from subjects with mild cognitive impairment (MCI) compared to control subjects. MCI is considered to be the beginning phase of Alzheimer’s disease (AD). Tumor necrosis factor alpha (TNF-α), nuclear factor kappa beta (NF-κβ), phospho Bad (pBad), and ubiquitin C-terminal hydrolase-L1 (UCH-L1) are four of the proteins that were investigated. Trends of either decreases or increases in protein expression levels in MCI vs. control brain were investigated. Western blot analysis was used in order to identify these trends. These signaling protein levels are …

Childhood Obesity: What Role Does Public Policy Play?, Shannon Turbeville

Kaleidoscope

The purpose of this review is to explore public policies that impact the health of American children and adolescents. The National School Lunch Program (NSLP) has a significant impact on school-age children’s nutritional intake. Foods provided by the NSLP have been analyzed for their nutritional content. Although these foods did not exceed the recommended total caloric intake, they were below other nutritional standards, and these shortcomings are primarily attributable to cultural preferences. Other important contributors to childhood obesity are unregulated school food items sold in vending machines. These items are becoming increasingly more prevalent in schools. Public policy is an …

Chronic Ldh Elevation After Left Ventricular Assist Device Implantation, Hesham R. Omar, Navin Rajagopalan, Maya Guglin

The VAD Journal

A 61-year-old woman who underwent HeartMate II left ventricular assist device placement for non-ischemic cardiomyopathy developed elevated lactate dehydrogenase within two weeks after implantation. After eight months of observation and several hospital admissions during which there was no evidence of pump thrombosis, she presented with clinically manifest hemolysis. During pump exchange there was notable pannus formation on the inflow cannula of the left ventricular assist device. The pannus around the inflow likely existed for several months, limiting the flow and creating a low-grade hemolysis and this low flow state stimulated thrombus formation triggering gross hemolysis. Thoratec analysis of the pump …