Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Light Image Therapy In The Health Care Environment., Anna Rae Dutro

Electronic Theses and Dissertations

Use of positive distraction in the built healthcare environment to assist in alleviating stress in a patient was investigated. A backlit light image was mounted in the ceiling of an examination room to create a positive distraction for patients in the ETSU Pediatric Clinic in Johnson City, TN. Survey instruments were used to collect sample data from patients and physicians in a randomized, balanced controlled study designed to determine if patients experienced less stress in the room with the backlit image as compared to other rooms (treatments). Although a statistical difference was not determined between the room with the backlit …

Theoretical And Experimental Evaluation Of Spatial Resolution In A Variable Resolution X-Ray Computed Tomography Scanner, Roman Melnyk

Theses and Dissertations (ETD)

A variable resolution x-ray (VRX) computed tomography (CT) scanner can image objects of various sizes with greatly improved spatial resolution. The scanner employs an angulated discrete detector and achieves the resolution boost by matching the detector angulation to the scanner field of view (FOV) determined by the size of an object being imaged. A comprehensive evaluation of spatial resolution in an experimental version of the VRX CT scanner is presented in this dissertation. Two components of this resolution were evaluated – the pre-reconstruction spatial resolution, described by the detector presampling modulation transfer function (MTF), and the post-reconstruction spatial resolution, given …

Laryngeal Mask Airway Insertion Anaesthesia And Insertion Techniques, Abdul Monem, Fauzia A. Khan

Department of Anaesthesia

Laryngeal Mask Airway has gained wide acceptance for routine airway management, difficult airway and in emergency situations. The classical method of insertion was recommended by Dr Brain. Over the years various induction and insertion techniques have been described with variable results. Combination of induction agents with narcotics, with or without small dose muscle relaxants has been found to be very effective. There is less also lesser incidence of mucosal trauma with partially inflated cuff. Insertion with cuff facing laterally or backwards and rotating it forwards into position has also been described. A review of various options and their advantages and …

Is Electrical Stimulation A Predictive Tool For Autonomic Dysfunction In Males With Diabetes?, Susan Dorothy Rand

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to examine whether electrical stimulation can be used as a predictive tool to assess autonomic dysfunction in males with diabetes. The study was designed to better understand the extent of autonomic nervous system (ANS) dysfunction in the diabetic population.

Controls and patients with diabetes were recruited from the community at large and the Loma Linda University Diabetes Treatment Center and were managed by a physician. Twelve (12) people with diabetes and thirteen (13) control subjects participated. Mean age (years) for people with diabetes was 52.4 +/- 6.1 and 47.2 +/-11.1 for controls (p =0.05). …

Elimination/Challenge Diet

Marcus Institute of Integrative Health of Integrative Medicine Protocols

There are several approaches to identifying food intolerance, and food influences on chronic symptoms and chronic disease. The following instructions describe the approach that we have found to be most helpful for improving patient symptoms and identifying the specific food or foods that may be problematic.

Epidural Anaesthesia During Labour For A Patient With Congenital Complete Heart Block: A Case Report, Abdul Monem, Ursula Chohan, Mohammed Ali

Department of Anaesthesia

We report labour pain management in a full-term pregnant patient with Congenital Complete Heart Block. She delivered uneventfully under routine monitoring with facilities for pacing at hand. She previously had an uneventful normal delivery and a D&E, both outside our hospital. Only findings were a low heart rate of 45-50 beats per minute. She never had syncopal attacks. She had a good effort tolerance on ETT. Her ejection fraction was 60% on Echocardiogram. She was given a single shot low dose spinal with fentanyl followed by epidural insertion. She successfully delivered through mid-cavity forceps in about 2.5 hours. The only …

Audit Of An Acute Pain Service In A Tertiary Care Hospital In A Developing Country, Muhammad Qamarul Hoda, Mohammad Hamid, Fauzia Anis Khan

Department of Anaesthesia

The first anaesthesia based acute pain service (APS) was introduced in Pakistan at the Aga Khan University Hospital in July 2001, with the aim of patient safety and satisfaction. The American Society of Anesthesiologist task force guidelines were used for the introduction of APS. APS has managed 6810 patients during four and half years period. Common analgesic techniques used, were intravenous infusion (50%), patient controlled intravenous analgesia (18%) and epidural infusions (30%). Common reported side effects were nausea and vomiting with intravenous infusion (10%) and PCIA (10%) while motor block was noticed with epidural infusion (29%). This article aims to …

Comparison Of Two Sedation Techniques In Patients Undergoing Surgical Procedures Under Regional Anaesthesia, Aliya Ahmed, Fauzia Anis Khan, Aziza Hussain

Department of Anaesthesia

Objective: Intraoperative comfort and patient satisfaction during surgical procedures under regional anaesthesia can be improved with the use of supplemental intravenous sedation. The authors conducted a study to compare two sedation techniques for surgical procedures performed under regional anaesthesia, i.e., midazolam and pethidine combination compared with midazolam and tramadol combination.Methods: Forty adult American Society of Anaesthesiologists (ASA) grade 1-111 patients, aged between 40-65 years undergoing surgery under regional anaesthesia (sub-arachnoid block) were included. The patients were randomly divided into two groups. All patients received standardized premedication, intraoperative monitoring and oxygen therapy. Group A patients received midazolam 0.03 mg/kg followed by …

Diagnostic Classifications And Resource Utilization Of Decedents Served By The Department Of Veterans Affairs, Sonia A. Duffy, Laurel Copeland, Faith Hopp, Robert J. Zalenski

Social Work Faculty Publications

Background: Given the volume and cost of inpatient care during the last year of life, there is a critical need to identify patterns of dying as a means of planning end-of-life care services, especially for the growing number of older persons who receive services from the Veterans Health Administration (VHA).

Methods: A retrospective computerized record review was conducted of 20,933 VHA patients who died as inpatients between October 1, 2001 and September 30, 2002. Diagnoses were aggregated into one of five classification patterns of death and analyzed in terms of health care resource utilization (mean number of inpatient days and …

Cec: Clinical Exchange Corner, Mary Lloyd Moore, Laura Reynolds

CEC Publications

No abstract provided.

Smallpox, Richard N. Bradley

Richard N Bradley

Description Viral infection of the human respiratory tract. Causes Infection by variola virus. Risk Factors Exposure to a biological warfare or bioterror attack or contact with an infected person. Symptoms

Fever, cough and body aches, followed by a spotted, bumpy rash.

Diagnosis

Confirmed by testing blood or the fluid from the blisters.

Treatments

None currently approved but experts are testing some medications.

Pathogenesis

The virus enters and multiplies in the respiratory passages.

Prevention

Avoid those with the disease. During an outbreak a vaccine is available that will prevent the disease or lessen its severity.

Epidemiology

Completely eradicated from nature, but …

Role Of Stellate Ganglion Block In Post Cabg Sympathetically Mediated Chest Pain, Mueen Ullah Khan, Imtiaz Ahmed

Department of Anaesthesia

Acute chest pain is a common presentation in emergency. After clinical assessment undiagnosed chest pain can become a difficult problem. Sympathetically mediated chest pain is a rare presentation, as it is similar to that of secondary hyperalgesia in the intact skin surrounding an injury site. We are reporting a case of a 62 years old man who presented with atypical chest pain four months after coronary artery bypass grafting (CABG). On investigation no new change was noticed than previous evaluation. On chronic pain assessment he was having hyperalgesia to light touch in addition to the spontaneous chest pain. He was …

Severe Anaphylactic Reaction At Induction Of Anaesthesia, Aliya Ahmed, Anand Kumar

Department of Anaesthesia

Anaphylaxis is an IgE mediated severe allergic reaction causing release of vasoactive substances from mast cells and basophils after re-exposure to an antigen. Signs and symptoms include flushing, urticaria, hypotension, tachycardia, bronchospasm, cardio-respiratory arrest etc. It can occur at induction of anaesthesia when multiple drugs are being administered, but prompt diagnosis with correct management is the key to a successful outcome. This case report describes a patient who developed severe bronchospasm with difficulty in inflating the lungs and dropping oxygen saturations, alongwith hypotension, tachycardia and widespread flushing, at induction of anaesthesia for elective breast surgery. She was promptly managed and …

Arterial To End-Tidal Carbon Dioxide Difference In Neurosurgical Patients Undergoing Craniotomy: A Review Of Practice, Fauzia Anis Khan, Mueenullah Khan, Shemila Abbasi

Department of Anaesthesia

Objective: To see if PETCO2 reflects PaCO2 with acceptable accuracy.Methods: In this audit the.anaesthetic chart of fifty consecutive patients, age 12 years and above undergoing craniotomy for intracranial pathology, were reviewed.Results: The difference between end tidal carbon dioxide (ETCO2) value corresponding to the time of taking the arterial sample and the PaCO2 was calculated. The mean end tidal CO2 was 29.3 +/- 2.8 and the mean PaCO2 was 32.63 +/- 4.5. The mean difference between the two values was calculated as 4.09 +/- 3.0. The regression coefficient was 0.496, which showed a moderate association. A wide variability was observed in …

The Development Of The Self-Injury Self-Report Measure., Sonia Lorraine Coney

Electronic Theses and Dissertations

Despite the amount of research that has been conducted on self-injury there is a lack of empirically validated instruments with which to measure self-injurious behavior. The present study developed a measure to examine self-injury and the associated features. Undergraduate students (n = 184) were administered a set of surveys to assess demographics, self-injurious behavior, suicidal ideation, Axis I and Axis II disorders, and impulsivity. Results indicated that a reliable measure, able to assess the extent of self-injury as well as associated features, was developed. Such a measure will enable clinicians to better assess self-injury and enable researchers to more fully …

Left Ventricular Noncompaction Mimicking Peripartum Cardiomyopathy., Chetan Patel, Girish S. Shirali, Naveen Pereira

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Detection Of Simulated Apical Root Resorption Using Three Cone Beam Ct Machines, Marcus Paulson

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to determine orthodontists' ability to discriminate small differences of simulated apical root resorption (SARR) on extracted teeth, using the output from three cone beam computed tomography (CBCT) machines. Twenty-four unrestored maxillary anterior teeth exhibiting normal morphology, were collected. The teeth were scanned by three CBCT machines: 1) the NewTom 3G (AFP imaging, USA), 2) the iCAT (Imaging Sciences, USA) 3) and the MicroCAT II (Siemens Medical, USA). Using a sandblaster the apical portion of each tooth was reduced in 0.5 mm increments up to a total reduction of 1.5 mm. Each root modification was …

Survival After Bidirectional Cavopulmonary Anastomosis: Analysis Of Preoperative Risk Factors., Mark A. Scheurer, Elizabeth G Hill, Nagavardhan Vasuki, Scott Maurer, Eric M. Graham, Varsha Bandisode, Girish S. Shirali, Andrew M. Atz, Scott M. Bradley

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Prognostic factors for survival after bidirectional cavopulmonary anastomosis for functionally single ventricle are not well defined. We analyzed preoperative hemodynamic and echocardiographic data to determine risk factors for death or transplantation at least 1 year after bidirectional cavopulmonary anastomosis.

METHODS: Data for all patients who underwent bidirectional cavopulmonary anastomosis before 5 years of age at our institution from September 1995 through June 2005 were analyzed. Available preoperative echocardiograms and catheterizations were reviewed. Survivors were compared with those who died or underwent transplantation. Bivariable associations between demographic and clinical risk factors and survival status (alive without transplantation vs dead or …

The Physiological Consequences Of Bed Rest, Kristin J. Stuempfle, Daniel G. Drury

Health Sciences Faculty Publications

Bed rest often is used to treat a wide variety of medical conditions. However, bed rest results in profound deconditioning of the body. Bed rest reduces the hydrostatic pressure gradient within the cardiovascular system, reduces muscle force production, virtually eliminates compression on the bones, and lowers total energy expenditure. This review focuses on the deconditioning that occurs in the cardiovascular, muscular, and skeletal systems following bed rest. Reduction in plasma volume reduces cardiac preload, stroke volume, cardiac output, and ultimately, maximal oxygen consumption. Skeletal muscle volume, muscle cross sectional area, and fiber cross sectional area decrease, which results in diminished …

Intraoperative Analgesia For Day-Care Surgery: Practice Trends, Aliya Ahmed, Shemila Abbasi, Chandar Prakash, Subhash Chandar

Department of Anaesthesia

Our objective was to determine the trends of providing intraoperative analgesia for day-care surgery among the various anaesthesiologists at our university hospital. All patients having surgical procedures under general anaesthesia in the Surgical Day Care Unit (SDC) of the Hospital were included. The study was done over two months and 142 patients were enrolled during the study period. Of these 45% received pethidine for intraoperative analgesia, 24% pethidine and ketorolac, 6% pethidine and paracetamol suppositories, 18% received fentanyl, 2% tramadol and 5% received other analgesic combinations. Of the 22% patients who received pethidine intraoperatively needed rescue analgesia in recovery room, …

Comparison Of Laser And Phosphoric Acid Etching On Sealant Shear Bond Strength, Seth David Latimer

Loma Linda University Electronic Theses, Dissertations & Projects

PURPOSE: To compare the effect of traditional phosphoric acid etching with Er,Cr:YSGG laser enamel etching on the shear bond strength of sealant material.

METHODS: Extracted healthy third molars were mounted in acrylic exposing the flattest surface available. Three groups of twenty teeth were used to evaluate traditional acid etching with 37% phosphoric acid as a control group as well as two different laser settings. The sealant material was attached using specialized jigs and then subjected to shear bond strength testing utilizing the ultradent method (MTS machine). Statistical methods employed were the Kruskal-Wallis rank test and the Mann-Whitney U test.

RESULTS: …

Customer Focused Incident Monitoring In Anaesthesia, F A. Khan, S Khimani

Department of Anaesthesia

The database of incident forms relating to anaesthesia services in an institutional risk management programme were reviewed for 2003-2005, the aim being to identify any recurring patterns. Incidents were prospectively categorised as relating to attitude/behaviour, communication breakdown, delay in service, or were related to care, cost, environment, equipment, security, administrative process, quality of service or miscellaneous. The total number of anaesthesia-related incidents reported during the period was 287, which related to 0.44% of the total number of anaesthetics administered during the time period. In all, 170 incidents were reported by the department, 96 by internal customers and 21 by external …

Depth And Size Limits For The Visibility Of Veins Using The Veinviewer Imaging System, Soujanya Ganesh

Theses and Dissertations (ETD)

Administration of fluids or medication and blood draw procedures require the nurse or the phlebotomist to access the veins in patients at hospitals or phlebotomy centers. It is important to minimize the discomfort associated with sticking needles in the patient more than once and most often, necessary to find an appropriate vein within few minutes. However, problems involved in accessing veins in pediatric and obese patients make it very difficult to perform a successful stick in a short time. The VeinViewer Imaging System is an infrared imaging device that provides the nurses and phlebotomists a means for locating veins in …

A System For Interactive Assessment And Management In Palliative Care, Chi-Hung Chang, Alexander A. Boni-Saenz, Ramon A. Durazo-Arvizu, Susan Desharnais

All Faculty Scholarship

The availability of psychometrically sound and clinically relevant screening, diagnosis, and outcome evaluation tools is essential to high-quality palliative care assessment and management. Such data will enable us to improve patient evaluations, prognoses, and treatment selections, and to increase patient satisfaction and quality of life. To accomplish these goals, medical care needs more precise, efficient, and comprehensive tools for data acquisition, analysis, interpretation, and management. We describe a system for interactive assessment and management in palliative care (SIAM-PC), which is patient centered, model driven, database derived, evidence based, and technology assisted. The SIAM-PC is designed to reliably measure the multiple …

Biochemical Characteristics Of Inconsistent Free T₄ Assays, Kristofer S. Fritz

Loma Linda University Electronic Theses, Dissertations & Projects

Serum levels of free thyroxine (T₄) are helpful in the clinical evaluation of patients who are suspected of having thyroid disease, since free T₄ (unbound) is known to closely relate to hyper, eu and hypothyroidism. There are documented inconsistencies among commercially available direct free thyroxine immunoassays. The biochemical basis for these inconsistencies is not understood and has not been characterized. Direct free T₄ measurements have been linked to both T₄-binding serum protein concentrations and protein-bound T₄ concentrations. A free T₄ reference method using direct equilibrium dialysis radioimmunoassay has been well characterized. New …

Reproducibility Of Two Non-Consecutive Scans Using A Newtom 3g; In Vitro Model, Hyoung Jin Park

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The aim of this study was to evaluate the reproducibility of mineral density measurement expressed in Hounsfield Units (HU) using a phantom device with known mineral densities and the NewTom 3G Cone Beam Computerized Tomography (CBCT).

Materials and Methods: A phantom device made of 21 HA cylindrical disks with known densities was fabricated. The phantom was scanned in 6, 9, and 12 inch fields of view using a NewTom 3G CBCT. The scans were repeated at non-consecutive sessions. Volumetric data in each of the scans were formatted to DICOM images. HU values of the regions of interest were retrieved …

Direct Comparison Of Feature Tracking And Autocorrelation For Velocity Estimation, Gregory R. Bashford, Derek J. Robinson

Biomedical Imaging and Biosignal Analysis Laboratory

Feature tracking is an algorithm for estimating tissue motion and blood flow using pulse-echo ultrasound. It was proposed as a computationally simpler alternative to other techniques such as autocorrelation and time-domain cross correlation. The advantage of feature tracking is that it selectively extracts easily identifiable parts of the speckle signal (e.g., the local maxima), reducing the amount of information being processed. Studies on feature tracking to date have used stationary, specklegenerating targets to simulate blood flow. Also, feature tracking has not been compared with accepted commercial methods. This study directly compares feature tracking performance with the complex autocorrelation method, which …

The Effectiveness Of Shoulder Injury Assessment Techniques: Analyzing The Occurrences Of False Positives, Alec Cianfichi

Undergraduate Theses and Capstone Projects

Shoulder injuries are very common in sports such as baseball, football, and tennis due to high impact and stress placed on the shoulder joint. Due to the greater chance of shoulder injuries in these types of sports, it is imperative for shoulder injury assessments to be accurate in order to ensure that the athlete does not participate with an injured shoulder or lose participation time due to an incorrect assessment. In order to assess the validity of the Apprehension, Relocation, and Surprise test for shoulder instability, student athletes with no known shoulder injuries were evaluated. Tests were conducted under the …

Impact Of Suture Choice On Stricture Formation Following Repair Of Esophageal Atresia, Shawn D. St Peter, Patricia A. Valusek, Charles L. Snyder, G W. Holcomb Iii, Daniel J. Ostlie

Manuscripts, Articles, Book Chapters and Other Papers

Background/ Purpose: The most common complication following repair of esophageal atresia is anastomotic stricture. Despite strong opinions of pediatric surgeons regarding the type of suture used for the anastomosis, these opinions remain unsubstantiated by any data present in the literature. Therefore, we investigated the rate and severity of stricture formation relative to the suture size and material.
Materials & Methods: A retrospective analysis of our most recent 20-year experience with repair of esophageal atresia and tracheoesophageal fistula (EA/TEF) was performed. Stricture was defined as the need for dilation. Outcomes were analyzed based on absorbability, texture, and type of …

Smoking During Pregnancy Affects Speech-Processing Ability In Newborn Infants, Alexandra P.F. Key, Melissa Ferguson, Dennis L. Molfese, Kelley Peach, Victoria J. Molfese

Center for Brain, Biology, and Behavior: Faculty and Staff Publications

BACKGROUND: Tobacco smoking during pregnancy is known to adversely affect development of the central nervous system in babies of smoking mothers by restricting utero–placental blood flow and the amount of oxygen available to the fetus. Behavioral data associate maternal smoking with lower verbal scores and poorer performance on specific language/auditory tests.

OBJECTIVES: In the current study we examined the effects of maternal smoking during pregnancy on newborns’ speech processing ability as measured by event-related potentials (ERPs).

METHOD: High-density ERPs were recorded within 48 hr of birth in healthy newborn infants of smoking (n = 8) and nonsmoking …