Medicine and Health Sciences Commons^™

Shedding Light On Hearing In Coma: Investigating The Applicability Of Functional Near-Infrared Spectroscopy For Assessing Auditory Function And Aiding Prognosis In Patients With Acute Disorders Of Consciousness, Reza Moulavi Ardakani

Electronic Thesis and Dissertation Repository

There is a critical need for a bedside neuroimaging tool to aid in the prediction of functional recovery outcomes for patients with acute disorders of consciousness (DoC) in the early days following severe brain injury. Current neurobehavioral examinations and prognosis tools have limitations in predicting good outcomes, leading to potential mistreatment or premature withdrawal of life support. Functional near-infrared spectroscopy (fNIRS) is a viable candidate for such purposes due to its portability and cost-effectiveness. Auditory processing, viewed as a multi-level and multifaceted brain function, could provide a sensitive and specific marker of residual cognitive function in unresponsive patients. This study …

Depression As A Prognostic Factor For Lumbar Spinal Stenosis Outcomes, Ariel M. Morales

Electronic Thesis and Dissertation Repository

Lumbar spinal stenosis (LSS) is a degenerative disease common in older adults and is associated with significantly reduced health-related quality of life and increased disability. Depression has been found to be associated with poorer health-related outcomes in patients with spinal conditions. A systematic review was conducted to examine the literature regarding the prognostic value of depression for LSS outcomes. Findings suggest small to moderate prognostic value of depressive symptoms for postoperative outcomes in patients with LSS, with strong evidence for disability. Next, a secondary analysis of a cohort study was conducted to investigate two objectives. The first objective was to …

Charting And Navigating The "Scylla And Charybdis" Conundrum Of Our Ageing Hearts - Heart Failure & Atrial Fibrillation, Simon Stewart

Theses

Residing on opposite sides of the Strait of Messina between Sicily and Calabria, Scylla and Charybdis were mythical sea monsters (one a fearsome creature, the other a deadly whirlpool) described by Homer. For anyone seeking to navigate that narrow and treacherous passage, avoid one of these lethal threats and you would be devoured by the other. For many populations around the world, the conundrum of successfully preventing and/or treating heart failure (HF) to increase longevity, only to increase the probability that it will increase the number of people living with and dying from atrial fibrillation (AF), represents a conundrum of …

Quantifying And Predicting Real-World Iatrogenic Severe Hypoglycemia In Adults With Type 1 Or 2 Diabetes Mellitus (The Inphorm Study, United States), Alexandria A. Ratzki-Leewing

Electronic Thesis and Dissertation Repository

Clinical outpatient strategies to accurately predict diabetes-related iatrogenic severe hypoglycemia (SH) are lacking. To redress this gap, we conducted the first-ever prognosis investigation of guideline-defined (Level 3) SH in the United States (US) (iNPHORM).

Chapter 4 details the design and implementation of iNPHORM: a prospective 12-wave panel survey (2020–2021). N=1206 adults with type 1 or insulin- and/or secretagogue-treated type 2 diabetes mellitus (T1DM or T2DM) were recruited from a US-wide, probability-based internet panel. For one-year, we collected monthly data on SH occurrence (frequencies, detection methods, symptoms, causes, and treatments) and related factors (anthropometric, sociodemographic, clinical, environmental/situational, behavioural, and psychosocial).

iNPHORM …

Clinical Impact Of A Highly Sensitive Next-Generation Sequencing Measurable Residual Disease Assay In Patients With Acute Lymphoblastic Leukemia, Nicholas Short

Dissertations & Theses (Open Access)

Measurable residual disease (MRD) is highly prognostic for relapse and overall survival (OS) in acute lymphoblastic leukemia (ALL), although many patients with apparent “MRD negativity” by standard assays still relapse. We evaluated the clinical impact of a highly sensitive next-generation sequencing (NGS) MRD assay in 74 adults with ALL undergoing frontline therapy. Among remission samples that were MRD negative by multiparameter flow cytometry (MFC), 46% were MRD positive by the NGS assay. At the time of complete remission (CR), MRD negativity by MFC at a sensitivity of 1x10^-4 and NGS at a sensitivity of 1x10^-6 was achieved in …

Takotsubo Cardiomyopathy, Aimee Baker

Nursing Student Class Projects (Formerly MSN)

This poster evaluates the current understanding of Takotsubo Cardiomyopathy (TTC) and describes current treatment recommendations, long-term prognosis, and advanced practice nursing implications. TTC is a relatively rare disease and is present in about 2% of suspected ST-segment myocardial infarctions in women. (Sattar et al., 2017) TTC is not well understood and has several current hypotheses regarding cellular pathology. This poster explores the current understanding of pathophysiologicderangements from an organ system and two pathologic hypotheses at the cellular level. Current treatment recommendations include subclasses of treatments stratified by types of complications. Also, this poster introduces a new subclass of heart failure …

Assessment Of The Clinical Validity Of Ctdna Analysis For Melanoma Management, Anda-Gabriela Marsavela

Theses: Doctorates and Masters

Metastatic melanoma is responsible for almost 80% of all skin cancer-related deaths and the incidence of people affected continues to rise worldwide. The emergence of targeted therapy and immune-checkpoint inhibitors has improved the clinical management of melanoma, but durable survival benefit is only seen in a minority of patients. The use of these very expensive systemic therapies on all appropriate patients also poses a high economic burden on health systems across numerous countries. Currently, surveillance for treatment failure is not optimal. Thus, reliable and accurate biomarkers of patient disease status are urgently required.

Circulating tumour DNA (ctDNA) analysis has emerged …

Urinary Bile Acid Indices As Diagnostic And Prognosic Biomarkers For Liver Diseases, Jawaher Alamoudi

Theses & Dissertations

Hepatobiliary diseases result in the accumulation of toxic bile acids (BA) in the liver, blood, and other tissues which may contribute to an unfavorable prognosis. We compared the urinary BA profile between 300 patients with hepatobiliary diseases vs. 103 healthy controls. Also, we investigated the use of the urinary BA profile to develop survival models to predict the prognosis of hepatobiliary diseases. The urinary BA profile, a set of non-BA parameters, and the adverse events of liver transplant and/or death were monitored in patients with cholestatic liver diseases for up to 7 years. The BA profile was characterized by calculating …

The Symbiome Project: An Exploratory Investigation Of The Biological, Psychological, And Social Mechanisms That Contribute To The Transition From Acute To Chronic Musculoskeletal Pain, Joshua Y. Lee

Electronic Thesis and Dissertation Repository

This dissertation presents the initial findings of the SYMBIOME project; which attempts to combine the objective and subjective aspects of musculoskeletal pain to develop a prognostic clinical phenotype. Chapter 2 presents a moderator analysis of functional outcomes (pain interference and pain severity). Psychosocial moderators can affect the relationship between biomarkers and pain. For pain severity, TNF-α, TGF-β1, and CRP were moderated by employment status, pre-existing psychopathology, and sex. For pain interference, IL-1β, cortisol, TGF-β1, CRP, and IL-6 were moderated by pre-existing pain, peri-traumatic fear, region of injury, and peri-traumatic stress. Chapter 3 presents a latent growth curve analysis in determining …

Patient Versus Physician Perceptions Of Prognosis And End-Of-Life Outcomes In Acute Leukemia, Sophia Elana Shimer

Yale Medicine Thesis Digital Library

PATIENT VERSUS PHYSICIAN PERCEPTIONS OF PROGNOSIS AND END-OF-LIFE OUTCOMES IN ACUTE LEUKEMIA.

Sophia Shimer and Kerin Adelson. Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.

Background: Acute leukemia poses unique challenges for prognostication. In many cases, cure is possible but unlikely and treatment is risky. Little is known about how patients perceive their prognosis. The purpose of this study was to assess prognostic understanding and end-of-life outcomes in patients with acute leukemia.

Methods: In this observational study, we surveyed patients admitted with acute leukemia and their treating hematologists. We elicited patient preferences for …

Associations Between Low-Carbohydrate Diet Score And Prognostic Factors Among Adults With Diabetes Mellitus: An Analysis Of The Nhanes 2005-2016, Elta N. Charles

Honors Undergraduate Theses

Background: Type 2 diabetes mellitus is one of the leading chronic diseases affecting Americans. There is a lack of literature discussing the link between diet and prognosis of those already diagnosed with DM. Objective: To provide insight into which diet is better for the outlook of diabetes mellitus by examining the associations between the low-carbohydrate diet (LCD) score and three diabetes-related health indicators: blood hemoglobin (HbA1c), triglycerides, and retinopathy. Methods: A total of 3,313 U.S. adults with DM were selected from the National Health and Nutrition Examination Survey 2005-2016. Presence of retinopathy was ascertained through self-reporting. Dietary intake was measured …

Systemic Therapy Versus Catheter Directed Techniques For The Treatment Of Acute Massive Pulmonary Embolism, Lawrence Duane Lee

Physician Assistant Scholarly Project Papers

Acute massive pulmonary embolism is characterized by obstruction of the pulmonary arterial tree that exceeds 50% of the cross-sectional area causing acute and severe cardiopulmonary failure from right ventricular overload. Systemic thrombolytic therapy is recommended as standard, first-line treatment in patients with massive pulmonary embolism unless contraindicated and catheter directed therapies, including low dose thrombolytic administration directly into thrombus and mechanical thrombectomy can be adjunctive or used as an alternative to systemic treatments. This literature review researched articles looking both systemic thrombolysis and endovascular techniques for the treatment of acute massive pulmonary embolism with an emphasis on long term clinical …

Functional Magnetic Resonance Imaging As An Assessment Tool In Critically Ill Patients, Loretta Norton

Electronic Thesis and Dissertation Repository

Little is known about whether residual cognitive function occurs in the earliest stages of brain injury. The overarching goal of the work presented in this dissertation was to elucidate the role of functional neuroimaging in assessing brain activity in critically ill patients. The overall objective was addressed in the following four empirical chapters: In Chapter 2, three versions of a hierarchically-designed auditory task were developed and their ability to detect various levels of auditory language processing was assessed in individual healthy participants. The same procedure was then applied in two acutely comatose patients. In Chapter 3, a hierarchical auditory task …

Development Of Clinical Prediction Models For Surgery And Complications In Crohn’S Disease, Leonard M. Guizzetti

Electronic Thesis and Dissertation Repository

Background and Objective: Crohn’s disease (CD)-related complications account for a substantial proportion of IBD-related healthcare expenditure. Identifying patients at risk for complications may allow for targeted use of early therapeutic interventions to alter this natural course. The objective of this project was to develop risk prediction models of CD-related surgery and complications.

Methods: Using data from the REACT cluster-randomized clinical trial (N=1898 from 41 community practices), prediction models were developed and internally validated for CD-related surgery and CD-related complications, defined as the first CD-related surgery, hospitalization or complication within 24 months. Performance of each model was assessed in terms of …

Pediatric Oncology Nurses' Experiences With Prognosis-Related Communication, Amy Rose Newman

Dissertations (1934 -)

Health care providers (HCPs) in pediatric oncology are faced with the challenge of communicating the devastating news of a cancer diagnosis and prognosis. This type of communication can be referred to as prognosis-related communication (PRC). While the initial conversation with the patient and family regarding prognosis is generally considered the responsibility of the physician, patients and family members will subsequently turn to nurses for clarification of the information presented. If nurses are excluded from initial conversations, they may feel as though they are “working in the dark,” trying to answer questions while not contradicting what the physician said. This strained …

Intensive Care In Oncology: Admission And Outcomes In Adult Patients With Cancer, Surya John

Honors Undergraduate Theses

Background: Historically, patients with cancer have been perceived as poor candidates for ICU admission. General ICU admission criteria lists cancer patients as low priority in ICU admission depriving them of the care they rightfully deserve. The purpose of this literary synthesis was to examine ICU admission criteria, risk factors, and outcomes of ICU admission in relation to hematological and solid tumor cancers and discuss ways that practitioners and nurses can educate patients with cancer and their families on appropriateness of ICU care.

Methods: A total of 768 articles were found in a literature search including all literature from 2005 to …

Comparison Of Treatment Planning Decisions When Combining Cbct And Digital Radiography Verses Digital Radiography Alone, Mckay Barlow Packer

Theses and Dissertations

Cone beam computed tomography (CBCT) is the recommended imaging modality of choice for evaluating previous endodontic treatment (1). The aim of this study was to compare treatment planning decisions made when evaluating previous endodontic treatment to determine if treatment planned and projected prognosis differs when digital radiography is used alone or in combination with CBCT. A retrospective chart review was conducted. Patients for whom a CBCT was taken were included in the study. Twenty-eight patients qualified. Patient’s periapical digital radiographs (Dexis©) were evaluated by 2 calibrated endodontists, a treatment plan was identified and a prognosis was projected. Later the same …

Predicting Protracted Recovery From Sports-Related Concussion Using Computerized Neurocognitive Test Scores And Symptom Cluster Scores, Amanda Sepulveda

Open Access Theses & Dissertations

Background: A previous study showed that symptom evaluation, in conjunction with computerized neurocognitive testing, improved predictions of protracted recovery in a group of male high school football players. The determination of prognosis following sports-related concussion can be used to facilitate return-to-play and academic decision making in concussion management.

Purpose: The purpose of this study was to replicate and extend previous research in determining the accuracy, sensitivity, specificity, and predictive value of computerized neurocognitive test scores and symptom cluster scores in predicting protracted recovery following sports-related concussion.

Study Design: Systematic replication, Cohort study (prognosis)

Methods: 30 concussed collegiate athletes were followed …

A Study To Investigate The Significance Of Knowing One's Prognosis In People Diagnosed With Life-Limiting Illnesses, Erika Currier

Graduate College Dissertations and Theses

ABSTRACT

Background: For patients with life-limiting illnesses, having adequate knowledge of prognosis can strongly impact the choice between curative and supportive treatment.

Objectives: The purpose of this research study is to explore patient understanding of prognosis and to illuminate the experience of having or not having prognostic information in people diagnosed with life-limiting illnesses. This study aims to investigate the patient's understanding of the term "prognosis", the significance of the term "prognosis" to the patient, and how prognosis may or may not affect future treatment choices. In addition, this study aims to further understand the experience of prognostic communication between …

Cortisol And Testosterone In Hair As Biological Markers Of Systolic Heart Failure, Justin Chan

Electronic Thesis and Dissertation Repository

Congestive heart failure (CHF) is associated with increased stress and alterations in metabolism, favoring catabolism over anabolism. Hormonal profiles of patients with heart failure have been assessed using serum and saliva as matrices, which are only point measurements and do not provide long-term information. Scalp hair is a novel matrix that allows for measurement of hormones over a period of several months. We aimed to evaluate whether levels of cortisol and testosterone and their ratio (C/T) in hair correlate with severity of heart failure. We conducted a prospective study in ambulatory male patients with a left ventricular ejection fraction (LVEF) …

Prognosis And Movement Patterns In Patients After Rotator Cuff Repair, Jayaprakash Raman

Electronic Thesis and Dissertation Repository

Rotator cuff repairs are done in patients who failed to achieve functional improvement with conservative management for rotator cuff tears. This thesis focuses on prognostic factors that predict outcomes after rotator cuff repair (RCR) and change in functional range of motion (ROM) and muscle endurance before and after RCR. A meta-analysis was performed to statistically analyze all available evidence in the literature concerning prognostic factors that determine outcome after RCR. Based on this study, several factors were identified that had significant and moderate effects on outcomes after RCR. Two prospective studies were conducted to analyze change in functional ROM and …

Short Term Treatment Effectiveness And Long Term Prognosis In Patients With Lateral Epicondylosis/Tennis Elbow, Pritika Gogia

Electronic Thesis and Dissertation Repository

This thesis investigated the short term and long term outcomes of patients who underwent treatment for lateral epicondylosis (LE). The first manuscript compared the immediate effects of counterforce brace versus kinesiotaping on pain free grip during a repetitive upper extremity reaching task in thirty patients (n=30) with LE. The study found kinesiotape to be superior over bracing as it not only improved immediate pain free grip strength by 17.5% but also maintained this during activity as compared to brace which had a smaller improvement of 9.3%. The second manuscript determined the extent of work disability/limitations experienced by patients (n=32) following …

Communication Metaphor Of Patient Prognosis In The Spirit Of Hope, Dory Hanks

Theses and Graduate Projects

Prognosis for terminally ill patients is intended to serve the purpose of educating patients on the expected clinical outcome of their illness. This information is generally communicated to a patient by their primary physician when options for fufiher treattnent or "cure" are limited. Learning a prognosis may be helpful to some patients, while burdensome to others. A review of the literature reveals many barriers to effective communication of prognosis. The purpose of this project is to develop a metaphor for enhanced communication of prognosis to be used by hospice nurses that incorporates a caring perspective on living with hope during …

Clinical Consequences Of Micrornas In Colorectal Cancer, Liselle C. Bovell

All ETDs from UAB

Colorectal cancer (CRC) is a heterogeneous disease, and factors such as tumor location, the environment, genetics, and ethnic differences, can influence its development and progression. Over the last few decades, overall CRC mortality rates have declined; however, racial disparities in mortality rates have increased. The discovery of biomarkers that focus on identifying individual differences based on confounders such as tumor stage and patient race/ethnicity is needed, for such biomarkers can lead to development of personalized therapeutic approaches to target these molecules. MicroRNAs (miRNAs) are a class of small molecules that regulate genes at the post-transcriptional level. Altered miRNA expression levels …

Identification Of Neuroblastoma And Its Prognostic Markers Using Raman Spectroscopy, Rachel Kast

Wayne State University Dissertations

Introduction: Neuroblastoma is the most common cancer of infancy. It is one of several peripheral nervous system tumors, including ganglioneuroma, peripheral nerve sheath tumor, and pheochromocytoma. It is commonly situated on the adrenal gland. It displays similar histology to other small round blue cell tumors, including non-Hodgkin lymphoma, rhabdomyosarcoma, and Ewing sarcoma. One method of judging neuroblastoma aggressiveness uses tumor histology factors, including mitosis-karyorrhexis index, Schwannian stromal development, degree of differentiation, and patient age. Tumor aggressiveness can also be judged based on the amplification of certain genes, including MYCN. Raman spectroscopy is a physics-based method which identifies the biochemical …

Health Prognisis Of Electronics Via Power Profiling, Jonathan Amilcar Cervantes

Open Access Theses & Dissertations

The objective of this research is to investigate a new approach for the early detection of latent defects in electronic devices in the field. Reliability is assessed through the non-traditional approach of recording and evaluating the power profile of electronic devices within a deterministic state of operation. Traditionally, measuring the quiescent current (Iddq) of a device has been employed in manufacturing tests to detect defective parts prior to deployment to the field. However, the monitoring of the deterministic power signature (i.e. boot up or during a self-test routine) has never been exploited to monitor the health of a device in …