Medicine and Health Sciences Commons^™

Improvement In Diabetic Care, Richard Smith

Family Medicine Clerkship Student Projects

Over the years, steps have been taken to 'streamline' the process when it comes to diabetic management in the Village Primary Care (VPC) practice. As more and more outcomes are monitored, it is important to both identify the shortcomings of the practice as far as diabetic management, and attempt to implement processes to ensure better outcomes. VPC is doing well in many areas (LDL/BP/BMI), but is lacking in monitoring and implementing certain areas of diabetic management: Recommending and tracking eye exams, HbA1c, Micro albumin, Foot exams.

Improving Patient Education And Access To Anxiety Treatment, Heather Gardiner

Family Medicine Clerkship Student Projects

According to the World Health Organization, in developed countries, mental health accounts for more disability than any other group of illnesses. About 25% of adults in the United States are reported to have a mental illness. Anxiety disorders are the most prevalent class of mental disorders faced by individuals in the United States. Although anxiety disorders are treatable, only 34% of people diagnosed receive treatment.

School Based Yoga Intervention For Childhood Stress Management, Erica Marden

Family Medicine Clerkship Student Projects

Childhood stress can have immediate and long-term negative impacts on physical health, mental health, school performance, self-esteem, and relationships. For children in rural communities there are fewer resources available as recreational and therapeutic outlets for healthy stress reduction. Extracurricular activity involvement also puts significant financial and time burdens on families. There is a particular need to provide children in rural areas with tools to manage stress that can be incorporated into the school day and require few resources. Yoga is an excellent school-based activity that has proven benefits on physical and emotional health for both students and teachers. It has …

Promoting Public Water Fluoridation In Bennington Vt, Leah Fox

Family Medicine Clerkship Student Projects

The Centers for Disease Control and Prevention has recognized community water fluoridation as one of the ten greatest public health achievements of the 20th century. It reduces tooth decay over a person's lifetime by 25%. Over the past 40 years, there have been 6 failed attempts to fluoridate the drinking water in the town of Bennington. There is an overabundance of tooth decay affecting citizens of Bennington. The need for dental care in Bennington far outweighs the resources available.

Hand-Washing In The Fm Outpatient Setting, Madeline Eells

Family Medicine Clerkship Student Projects

The threat of healthcare-associated infections (HCAIs) is universal, affecting every healthcare facility and system around the world. The diagnosis of HCAI is complex and relies on diverse diagnostic criteria and methods. Although there are many routes of transmission of HCAI, one of the most easily preventable vectors is bacteria carried on healthcare workers hands.

Identifying And Coping With Adolescent Anxiety, Merima Ruhotina

Family Medicine Clerkship Student Projects

Anxiety disorders, which include panic disorder, generalized anxiety disorder, post-traumatic stress disorder, phobias, and separation anxiety disorder, are the most common class of mental disorders present in the general population. These disorders have a negative impact on the quality of life in a number of areas of functioning, including academic performance, social interactions, self confidence, and ability to enjoy daily life experiences and may impact future emotional health. Approximately 20% of youth ages 13 to 18 experience severe mental disorders in a given year. Almost one-half of youth ages 8 to 15 with a mental illness received no mental health …

Low T? Late Onset Hypogonadism, Cheng-Wei Huang

Family Medicine Clerkship Student Projects

Recently, there has been an increase in commercials and ads by pharmaceuticals pushing for testosterone supplementation by capitalizing on the sensitive subject of "low T" or decreased manhood and vague non-specific symptoms of low T. The idea that testosterone is something that occurs within our natural body and that we are only supplementing what’s originally there can be misleading. Many may interpret this as there is no harm but good, but the latest studies have shown otherwise. It is clear that there is a lack of proper understanding regarding testosterone treatment in the public, from when treatment would be suitable …

A Healthy Work Schedule: Improving Dynamics For Nurses’ Health, Amy Schei

Theses and Graduate Projects

Rotating shift work is an unavoidable, integral aspect of nursing at a large hospital in the Midwest; however, the fatigue involved in rotating shift work is avoidable. Research has shown how fatigue related to rotating shifts can impact nurses and ultimately affect patients. Fatigue caused by rotating shift work has been proven to decrease nurses’ levels of alertness and vigilance, which directly correlates to higher incidences of errors with patients. In addition, nurses who work rotating shifts have been proven to have problems with psycho-physical health, biological functions, and social relationships. It is through an understanding of the risks related …

Research Brief: "Suicides In The Military: The Post-Modern Combat Veteran And The Hemingway Effect", Institute For Veterans And Military Families At Syracuse University

Institute for Veterans and Military Families

This brief is about current suicide prevention interventions within the military. In policy and practice, practitioners should monitor the wellness of aging veterans and ensure that a support system exists for their veteran patients, while veterans should participate in social events with other veterans; the VA and DoD should implement programs to ensure that veterans have feelings of belongingness and the VA should monitor veterans' well-being for 2-3 years after service during transitions. Suggestions for future research include examining the communities and veteran service organizations that produce the most useful support for veterans with mental health problems.

Assessment Of Pediatric Primary Care Providers Behaviors And Procedures Regarding Pediatric Overweight And Obesity, Jessie N. Meiser

DNP Projects

CAPSTONE INTRODUCTION

Childhood overweight/obesity is a critical public health problem with devastating consequences. Many factors have combined to create the epidemic, and primary care providers can play an important role in addressing the problem by identifying overweight/obese children and encouraging them to engage in healthy behaviors. However, providers face a number of competing priorities making it difficult for them to provide these services effectively without outside support.

Obesity has reached an epidemic proportion in the nation’s youth. The Data Resource Center for Child and Adolescent Health (2011) found that 35.7% of children age 10 – 17 in Kentucky are overweight …

Community Based Interventions For The Prevention And Control Of Tuberculosis, Ahmed Arshad, Rehana A. Salam, Zohra S. Lassi, Jai K. Das, Imama Naqvi, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

In 2012, an estimated 8.6 million people developed tuberculosis (TB) and 1.3 million died from the disease. With its recent resurgence with the human immunodeficiency virus (HIV); TB prevention and management has become further challenging. We systematically evaluated the effectiveness of community based interventions (CBI) for the prevention and treatment of TB and a total of 41 studies were identified for inclusion. Findings suggest that CBI for TB prevention and case detection showed significant increase in TB detection rates (RR: 3.1, 95% CI: 2.92, 3.28) with non-significant impact on TB incidence. CBI for treating patients with active TB showed an …

Community-Based Interventions For The Prevention And Control Of Helmintic Neglected Tropical Diseases, Rehana A. Salam, Hasina Maredia, Jai K. Das, Zohra S. Lassi, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

In this paper, we aim to systematically analyze the effectiveness of community-based interventions (CBIs) for the prevention and control of helminthiasis including soil-transmitted helminthiasis (STH) (ascariasis, hookworms, and trichuriasis), lymphatic filariasis, onchocerciasis, dracunculiasis, and schistosomiasis. We systematically reviewed literature published before May 2013 and included 32 studies in this review. Findings from the meta-analysis suggest that CBIs are effective in reducing the prevalence of STH (RR: 0.45, 95% CI: 0.38, 0.54), schistosomiasis (RR: 0.40, 95% CI: 0.33, 0.50), and STH intensity (SMD: -3.16, 95 CI: -4.28, -2.04). They are also effective in improving mean hemoglobin (SMD: 0.34, 95% CI: 0.20, …

Ajulemic Acid Induces Cell Death In Retinoblastoma Cells, Emily A. Evans

Honors Theses

Retinoblastoma is a cancer of the retina affecting one in every 15,000-20,000 births. It is normally diagnosed in infancy or early childhood and although it is treatable, enucleation is commonly required. Other treatments include radiation, photocoagulation, or cryotherapy and are often followed by chemotherapy. In an attempt to find an alternate method of treatment that lowers the frequency of enucleation and the serious side-effects resulting from current treatments, ajulemic acid (AJA), a synthetic derivative of Cannabis, has been used to treat retinoblastoma cells. Thus far, significant cell death has occurred among retinoblastoma cells that have been treated with AJA concentrations …

Clinical And Biochemical Characteristics Of Children With Juvenile Idiopathic Arthritis, Shakeel Ahmed, Syed Rehan Ali, Sidra Ishaque, Nabil Sami

Department of Paediatrics and Child Health

Objective: To determine the clinical and biochemical characteristics of children with Juvenile Idiopathic Arthritis (JIA) at a tertiary care centre in Karachi, Pakistan.

Study Design: A descriptive study.

Place and Duration of Study: Paediatric Rheumatology Clinic of The Aga Khan University Hospital (AKUH), Karachi, from January 2008 to December 2011.

Methodology: Clinical and laboratory profile and outcome of children less than 15 years of age attending the Paediatric Rheumatology Clinic of the Aga Khan University, Karachi with the diagnosis of Juvenile Idiopathic Arthritis according to International League against Rheumatism were studied. These children were classified into different types of JIA; …

Acute Cerebellitis With Hydrocephalus, Nida Amjad, Anwarul Haque, Khalid Ahmed

Department of Paediatrics and Child Health

We report a case of an 8 years old child who presented with sudden onset of headache and vomiting. He had broad-based gait and intention tremors on admission. MRI brain revealed isointense signals on T1-weighted imaging and hyperintense signals on T2-weighted imaging. Cerebellar swelling was also identified with significant mass effect obliterating the fourth ventricle. CT head showed prominent third and lateral ventricles. He was treated with high dose corticosteroids and required an external ventricular drain (EVD) insertion. He made an uneventful recovery and suffered no neurologic deficit. The clinical and radiologic findings in this boy were consistent with cerebellitis …

Effect Of L-Type Calcium Channel Blocker (Amlodipine) On Myocardial Iron Deposition In Patients With Thalassaemia With Moderate-To-Severe Myocardial Iron Deposition: Protocol For A Randomised, Controlled Trial, Amarah Shakoor, Maaman Zahoor, Alina Sadaf, Najveen Alvi, Zehra Fadoo, Arjumand Rizvi, Farheen Quadri, Fateh Ali Tipoo, Mohammad Khurshid, Zaffar Sajjad, Steven Colan, Babar S Hasan

Department of Paediatrics and Child Health

Introduction: Sideroblastic cardiomyopathy secondary to repeated blood transfusions is a feared complication in thalassaemia. Control of myocardial iron is thus becoming the cornerstone of thalassaemia management. Recent evidence suggests a role for L-type Ca²⁺ channels in mediating iron uptake by the heart. Blocking the cellular iron uptake through these channels may add to the benefit of therapy to standard chelation in reducing myocardial iron. We aim to determine the efficacy of amlodipine (a calcium channel blocker) as an adjunct to standard aggressive chelation in retarding myocardial iron deposition in thalassaemics with or without cardiomyopathy.
Outcomes: The primary outcome …

21st-Century U.S. Safety Professional Educational Standards: Establishing Minimum Baccalaureate Graduate Learning Outcomes For Emerging Occupational Health And Safety Professionals, Wayne Edward Hartz

Antioch University Full-Text Dissertations & Theses

How can the public be assured of competency in those professing to protect its occupational health and safety (OSH)? Currently, in the U.S. there are 193 higher education OSH programs, 186 with baccalaureate degrees with over 55 different degree titles. This research seeks to define minimum OSH baccalaureate graduate core competencies across all programs by asking: What would employers look for in a portfolio to demonstrate competence in a new OSH graduate? Professional members of the American Society of Safety Engineers (ASSE) participated as subject matter experts in an anonymous online survey to provide framing data. The ASSE Educational Standards …

Effect Of An Herbal/Botanical Supplement On Recovery From Delayed Onset Muscle Soreness: A Randomized Placebo Controlled Trial, Corey A. Rynders, Judy Y. Weltman, Sara D. Rynders, James Patrie, John Mcknight, Frank I. Katch, Jay Hertel, Arthur Weltman

Human Movement Sciences & Special Education Faculty Publications

Background: We examined the effects of a proprietary herbal/botanical supplement (StemSport, Stemtech, San Clemente, CA.) suggested to increase circulating stem cells, decrease inflammation, and attenuate exercise induced muscle damage on recovery from delayed onset muscle soreness (DOMS).

Methods: Sixteen subjects (male = 7, female = 9; age 23.8 ± 10 years; height 171.9 ± 10 cm, mass 72.2 ± 15 kg) were randomized in a crossover, double-blind, placebo controlled trial to receive a placebo or StemSport supplement (6150 mg/day) for 14 days. DOMS was induced on day 7 for both placebo and active conditions in the non-dominant elbow flexor group …

Peroneal Reaction Time After Ankle Sprain: A Systematic Review And Meta-Analysis, Matthew C. Hoch, Patrick O. Mckeon

Human Movement Sciences & Special Education Faculty Publications

Background: Many studies have examined the temporal response of the peroneal muscles to sudden inversion perturbation in patients with a previous ankle sprain. The purpose of this systematic review with meta-analysis was to synthesize the evidence and determine whether peroneal reaction time (PRT) impairments are present after ankle sprain. Methods: An electronic search was conducted using PubMed Central and EBSCOhost (1965-January 2013). Articles were included if they 1) examined the PRT to sudden inversion perturbation in patients with a history of ankle sprain using a mechanical tilt platform, 2) made comparisons with a control group or contralateral limb with no …

Effectiveness Of Diathermy In Comparison With Ultrasound Or Corticosteroids In Patients With Tendinopathy: A Critically Appraised Topic, Philip A. Szlosek, John Taggart, Julie M. Cavallario, Johanna M. Hoch

Human Movement Sciences & Special Education Faculty Publications

Clinical Scenario: Many therapeutic modalities have been used to treat the pain and inflammation commonly associated with tendinopathies. One modality that has been used to treat patients with tendinopathies is diathermy. Focused Clinical Question: Is there evidence to suggest that diathermy is more or equally as effective at reducing pain in patients with tendinopathy when compared with ultrasound or corticosteroid treatments? Summary of Search, "Best Evidence" Appraised, and Key Findings: The literature was searched for randomized control trials (RCTs) that investigated the effects of diathermy treatments in comparison with ultrasound or corticosteroid treatments on pain in patients with tendinopathy. Three …

High-Intensity Tasks With External Load In Military Applications: A Review, Eric K. O'Neal, Jared H. Hornsby, Kyle J. Kelleran

Human Movement Sciences & Special Education Faculty Publications

This article provides a synopsis of the limited investigations examining the impact of external load (EL) on performance of high-intensity tasks under load (HITL), EL training intervention effects on HITL performance, and injuries from EL training. Repetitive lifting tasks and initiation of locomotion, such as rapidly moving from a prone position to sprinting appear to be more hindered by EL than maximal sprinting velocity and may explain why training with EL does not improve obstacle course or prolonged (200-300 yard shuttle) drills. EL training appears to offer very little if any benefit for HITL in lesser trained populations. This contrast …

Appalachian And Pacific Crest Trail Hikers: A Comparison Of Benefits And Motivations, Eddie Hill, Edwin Gómez, Marni Goldenberg, Barbara Freidt, Stephanie Fellows, Laura Hill

Human Movement Sciences & Special Education Faculty Publications

The Appalachian Trail (AT) and Pacific Crest Trail (PCT) are two scenic trails named in the National Trails System Act of 1968. Recently, trails and footpaths have been used to promote such benefits as healthy lifestyles, sense of community, and an increased quality of life. The purpose of this study was to compare the motivations and benefits from hikers of the AT and the PCT. Grounded in Driver’s benefits model and means-end theory, and using an Internet questionnaire, 766 usable questionnaires were collected. Significant differences were found between AT and PCT users who: hike to prevent a worse health condition; …

Measuring The Effectiveness Of The Leave No Trace Peak Program, Jennifer Miller, Eddie Hill, Amy Shellman, Ron Ramsing, Ben Lawhon

Human Movement Sciences & Special Education Faculty Publications

The Leave No Trace Center for Outdoor Ethics developed the Promoting Environmental Awareness in Kids (PEAK) program to teach children the seven Leave No Trace principles. The purpose of this study was to assess the effectiveness of the PEAK program. A significant increase was found between the pre-test (M = 3.41, SD = .34) and the post-test (M = 3.61, SD = .36) with the post-test scores being significantly higher, F(1, 140) = 11.15, p<.01. No significant difference was found between the pre-test (M = 3.48, SD = .35), post-test (M = 3.63, SD = .35), and 8-month post-test (M = 3.38, SD = .41). The 8-month post-test indicated a drop in scores, though not statistically significant, below the pre-test. Results supported the PEAK program’s effectiveness, in the short-term, in teaching children the Leave No Trace principles. However, longer-term retention was not supported.

Evaluation And Characterization Of The Biomechanical Properties Of Tissue Engineered Vascular Grafts Implanted In The Arterial Circulation, Brooks Van Udelsman

Yale Medicine Thesis Digital Library

We used a murine model to assess the in vivo evolving biomechanical properties of tissue engineered vascular grafts (TEVGs) implanted in the arterial circulation. The initial polymeric tubular scaffold was fabricated from (poly)lactic acid (PLA) and coated with a 50:50 copolymer of (poly)caprolactone and (poly)lactic acid (P[PC/LA]). Following seeding with syngeneic bone marrow derived mononuclear cells, the TEVGs (n=50) were implanted as aortic interposition grafts in wild-type mice and monitored serially using ultrasound. A custom biaxial mechanical testing device was used to quantify in vitro the circumferential and axial mechanical properties of grafts explanted at 3 or 7 months. At …

Primary Stroke In A Woman With Sickle Cell Anemia Responsive To Hydroxyurea Therapy., Samir K. Ballas, Ubaldo E. Martinez-Outshoorn, Michael P. Savage

Cardeza Foundation for Hematologic Research

The most common cause of stroke in children with sickle cell anemia is infarction due to ischemia. In adults, however, stroke is most commonly hemorrhagic in nature. Other causes of stroke in patients with sickle cell disease are very rare. In this short communication, we describe a woman with sickle cell anemia responsive to hydroxyurea (HU) therapy who had primary stroke due to paradoxical embolization caused by a large atrial septal defect. Successful management of the stroke included surgical closure of the defect with trans-esophageal echocardiographic guidance. To the best of our knowledge, this is the first patient with sickle …

Introduction To Special Topic Section: Toward A Transpersonal Medicine, Randy Fauver

International Journal of Transpersonal Studies

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Transpersonal Healing: Assessing The Evidence From Laboratory And Clinical Trials, Marilyn Schlitz

International Journal of Transpersonal Studies

Transpersonal or distant healing intention (DHI) is one of the most commonly used forms of complementary and alternative healing. While it is popular, its efficacy is uncertain and the mechanism of action unclear. This article provides an overview of both the laboratory research and clinical trials of DHI, summarizing the state of the field. There appears to be support, based on controlled laboratory studies, for a transpersonal dimension to DHI. Results of randomized, controlled clinical trials are more equivocal. While results do not offer clear evidence to support DHI as an evidence-based modality, this provocative field reveals important epistemological and …

A Possible Mechanism Of Action For The Placebo Response: Human Biofield Activation Via Therapeutic Ritual, Marie G. Brook, Randy Fauver

International Journal of Transpersonal Studies

The lack of an identified mechanism of action for the placebo response contributes to its perception as clinically unimportant in Western medicine and minimizes its value as a contributing factor to the effectiveness of both conventional and alternative medical treatments. The therapeutic ritual is one of the principle contributors to the placebo response. Two key elements predicting salutogenic outcomes in both the placebo response and therapeutic ritual are patient meaning making and the patient/healer relationship. A detailed examination of human biofield dynamics shows its role in storing, communicating, and regulating the flow of information associated with healing in Western and …

Ayurvedic Psychology: Ancient Wisdom Meets Modern Science, Daniel Rhoda

International Journal of Transpersonal Studies

Ayurveda is a holistic medical system based on ancient Indian texts that utilizes natural treatments, botanical medicines, and lifestyle and dietary practices to promote healing of the body, mind, senses, and spirit. Interest in Ayurveda has grown in the United States over the last two decades, as consumers, therapists, scientists, and health regulators have recognized its holistic and preventative benefits. According to Ayurveda, every human being is composed of a unique proportion of these elemental energies, a foundational theory in Ayurveda known as tridosha. The three doshas (vata, pitta, kapha) represent three psychobiological constitutional types that govern …

Receptor Of Advanced Glycation Endproducts (Rage) Is Positively Correlated With Tumor Necrosis Factor-Α In Adolescents With Obesity, Tasnim Rahman, Daniel H. Conrad, Anshu Gupta

Undergraduate Research Posters

Introduction: Obesity in childhood is associated with an increased prevalence of diabetes and other traditional cardiometabolic risk factors, suggesting an epidemic of premature cardiovascular disease among today’s youth. Glycotoxins, known as advanced glycationend products (AGE’s), activating via the membrane-bound receptors (mRAGE), have been implicated in the pathophysiology of inflammation, (increased tumor necrosis factor-α [TNF-α ]), insulin resistance and vascular dysfunction in adults, but the role of RAGE in the early stages of metabolic disorders is unknown. In this study, we assessed relationship of cardiometabolicrisk factors, mRNA expression of TNF-α and RAGE in peripheral monocytes in adolescents with obesity.

Methods: Thirty …