Surgical Procedures, Operative Commons^™

Location Of All-Cause 30-Day Readmission Following Total Joint Replacement: Surgical Hospital Versus Outside Hospital, Leslie R. Harrold, David C. Ayers, Philip Noble, Regis O'Keefe, Tom Bowen, Matthew Sloan, Patricia D. Franklin

Patricia D. Franklin

Background: Evaluating posthospital complications and hospital readmissions in the United States is limited under the current system. This is due to an inability to quantify posthospital care delivered to patients at locations other than the surgical hospital. In order to circumvent this issue, information can be sought directly from patients about posthospital health care utilization. This approach provides a more complete record in comparison with methods that evaluate complications treated only at the surgical hospital. Methods: Participants undergoing total joint replacement (TJR) between 5/10/11 and 5/17/11 were identified from the Function and Outcomes Research in Comparative ...

Advanced Problem Solving In The Biotherapeutics Industry: Parameters Influencing The Delivery Of A Novel Cell Therapy Product And Exploration Of A New Method For Determining Activity Of Clostridium Histolyticum Collagenase, A Wound Debridement Enzyme, Melanie A. Harris B.S.

Theses and Dissertations

Biotechnology is a multi-faceted industry with many unique challenges that require knowledge in a broad range of topics. When working in the wound care field it is necessary to not only create a product in the laboratory, but also effectively bring it to the patient. This task requires many skilled people who can test it for efficacy, design and conduct clinical trials, confirm quality and consistency, design packaging, consider transportation issues and so on. The following investigation focuses on the testing of a cellular product and its accompanying device under various conditions as well as the exploration of a new ...

Dynamic Simulation And Neuromuscular Control Of Movement: Applications For Predictive Simulations Of Balance Recovery, Misagh Mansouri Boroujeni

Doctoral Dissertations

Balance is among the most challenging tasks for patients with movement disorders. Study and treatment of these disorders could greatly benefit from combined software tools that offer better insights into neuromuscular biomechanics, and predictive capabilities for optimal surgical and rehabilitation treatment planning. A platform was created to combine musculoskeletal modeling, closed-loop forward dynamic simulation, optimization techniques, and neuromuscular control system design. Spinal (stretch-reflex) and supraspinal (operational space task-based) controllers were developed to test simulation-based hypotheses related to balance recovery and movement control. A corrective procedure (rectus femoris transfer surgery) was targeted for children experiencing stiff-knee gait and how this procedure ...

Location Of All-Cause 30-Day Readmission Following Total Joint Replacement: Surgical Hospital Versus Outside Hospital, Leslie R. Harrold, David C. Ayers, Philip Noble, Regis O'Keefe, Tom Bowen, Matthew Sloan, Patricia D. Franklin

Senior Scholars Program

Background: Evaluating posthospital complications and hospital readmissions in the United States is limited under the current system. This is due to an inability to quantify posthospital care delivered to patients at locations other than the surgical hospital. In order to circumvent this issue, information can be sought directly from patients about posthospital health care utilization. This approach provides a more complete record in comparison with methods that evaluate complications treated only at the surgical hospital.

Methods: Participants undergoing total joint replacement (TJR) between 5/10/11 and 5/17/11 were identified from the Function and Outcomes Research in Comparative ...

Hydatid Cyst Of Thoracic Spine: A Rare Cause Of Paraplegia, Rahul Soangra, Mool Chand Soangra

Physical Therapy Faculty Articles and Research

Primary spinal hydatid cysts are uncommon and extradural involvement is rare. We report an unusual case of Paraplegia due to hydatid disease of primary site of infection extra spinal muscles in thoracic region from T5 to T8 level extending into a daughter cyst at T9 level, is main cause of acute Paraplegia. Magnetic resonance imaging (MRI) showed an extradural round cystic lesion in the spinal canal filling the posterior and left postero-lateral expect at T9 level, markedly compressing the cord. The cyst was removed after laminectomy and opening of the dural sac, with excision of extraspinal mass in left paravertebral ...

Quantitative Analysis Of High-Resolution, Contrast-Enhanced, Cone-Beam Ct For The Detection Of Intracranial In-Stent Hyperplasia, Thomas F. Flood, Imramsjah M. J. Van Der Bom, Lara Strittmatter, Ajit S. Puri, Gregory M. Hendricks, Ajay K. Wakhloo, Matthew J. Gounis

Radiology Publications and Presentations

BACKGROUND: Intracranial in-stent hyperplasia is a stroke-associated complication that requires routine surveillance. OBJECTIVE: To compare the results of in vivo experiments to determine the accuracy and precision of in-stent hyperplasia measurements obtained with modified C-arm contrast-enhanced, cone-beam CT (CE-CBCT) imaging with those obtained by 'gold standard' histomorphometry. Additionally, to carry out clinical analyses comparing this CE-CBCT protocol with digital subtraction angiography (DSA). METHODS: A non-binned CE-CBCT protocol (VasoCT) was used that acquires x-ray images with a small field-of-view and applies a full-scale reconstruction algorithm providing high-resolution three-dimensional (3D) imaging with 100 microm isotropic voxels. In an vivo porcine model, VasoCT ...

Aav Gene Therapy Strategies For Lysosomal Storage Disorders With Central Nervous System Involvement, Diane Golebiowski, Allison Bradbury, Churl-Su Kwon, Imramsjah Van Der Bom, Lorelei Stoica, Aime Johnson, Diane Wilson, Heather Gray-Edwards, Judith Hudson, Jacob Johnson, Ashley Randle, Brian Whitlock, James Sartin, Anna Kuhn, Matthew Gounis, Wael Asaad, Doug Martin, Miguel Sena-Esteves

Brian K Whitlock, PhD, DVM, DACT

Gene therapy is one of the most promising approaches for the treatment of lysosomal storage disorders (LSDs). This is especially true for the 75 % of LSDs that have central nervous system (CNS) involvement, where enzyme replacement therapy (ERT), the standard of care for LSDs, is ineffective in treating the neurological features of these diseases. Recombinant adeno-associated virus (AAV) vectors have emerged as the most efficient and promising gene transfer vehicles for the CNS and in particular for LSDs. Direct infusion of AAV vectors into interconnected structures in the brain has achieved widespread distribution of vector and therapeutic levels of lysosomal ...

Can The Nintendo Wii Be Used As A More Effective Method Of Rehabilitation Than Traditional Physiotherapy Exercises For Patients With Knee Reconstruction Surgery?, Samantha Snyder

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not the Nintendo Wii can be used as a more effective method of rehabilitation than traditional physiotherapy exercises for patients with knee reconstruction surgery?

STUDY DESIGN: Review of three English language primary studies, published after 1999.

DATA SOURCES: Two randomized controlled trials (RCTs) and one case study with no comparison group were found using PubMed. These studies analyzed Nintendo Wii intervention in patients that underwent knee reconstructive surgery in need of rehabilitation.

OUTCOME MEASURED: The outcome measured was improvement in balance through use of the Activity-Specific Balance ...

Does Neuromuscular Electrical Stimulation As An Adjunct To Traditional Physical Therapy Improve Post-Operative Mobility After Total Knee Arthroplasty In Comparison To Traditional Pt Alone In Patients 50-85 Years Old?, Kelsey L. Welsh

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective Evidence Based Medicine (EBM) review is to determine whether or not neuromuscular electrical stimulation (NMES) as an adjunct to traditional physical therapy (PT) improves post-operative mobility including walking and stairclimbing ability following total knee arthroplasty (TKA) in comparison to traditional PT alone in patients 50-85 years old.

STUDY DESIGN: Review of three English language primary studies published after 1999.

DATA SOURCES: Three randomized controlled trials comparing traditional PT with PT and adjuvant NMES following TKA in patients 50-85 years old found using PubMed and EBSCOhost Web.

OUTCOMES MEASURED: Clinical outcome was measured in each ...

Femtosecond Laser Beam Propagation Through Corneal Tissue: Evaluation Of Therapeutic Laser-Stimulated Second And Third-Harmonic Generation, William R. Calhoun Iii

Theses and Dissertations

One of the most recent advancements in laser technology is the development of ultrashort pulsed femtosecond lasers (FSLs). FSLs are improving many fields due to their unique extreme precision, low energy and ablation characteristics. In the area of laser medicine, ophthalmic surgeries have seen very promising developments. Some of the most commonly performed surgical operations in the world, including laser-assisted in-situ keratomileusis (LASIK), lens replacement (cataract surgery), and keratoplasty (cornea transplant), now employ FSLs for their unique abilities that lead to improved clinical outcome and patient satisfaction.

The application of FSLs in medical therapeutics is a recent development, and although ...

Physiological And Psychological Changes Following Liposuction Of Large Volumes Of Fat In Overweight And Obese Women, Allan Geliebter, Emily Krawitz, Tatiana Ungredda, Ella Peresechenski, Sharon Y. Giese

Lander College of Arts and Sciences Publications and Research

Background: Liposuction can remove a substantial amount of body fat. We investigated the effects of liposuction of large volumes of fat on anthropometrics, body composition (BIA), metabolic hormones, and psychological measures in overweight/obese women. To our knowledge, this is the first study to examine both physiological and psychological changes following liposuction of large volumes of fat in humans.

Method: Nine premenopausal healthy overweight/obese women (age = 35.9 ± 7.1 SD, weight = 84.4 kg ± 13.6, BMI = 29.9 kg/m2 ± 2.9) underwent liposuction, removing 3.92 kg ± 1.04 SD of fat. Following an overnight fast ...

Use Of Swine Small Intestine Submucosa As A Dermal Suture, Paige E. Black

PCOM Biomedical Studies Student Scholarship

The purpose of this preliminary study is to determine if swine small intestine submucosa (SIS) can be used to create a suture that will perform comparably to commercially available chromic gut sutures when placed into a wound in rat dermis. This study is part of an ongoing collaboration that has explored SIS as a biologic scaffold in various tissues and surgical procedures. In this study, eight Sprague-dawley rats were divided into two groups, each receiving a full thickness skin wound between the scapula, made by a 5mm biopsy punch. The wound was then closed with commercially available chromic gut suture ...

Quantitative Spatial Frequency Fluorescence Imaging In The Sub-Diffusive Domain For Image-Guided Glioma Resection, Mira Sibai, Israel Veilleux, Jonathan T. Elliott, Frederic Leblond, Brian Wilson

Open Dartmouth: Faculty Open Access Articles

Intraoperative 5- aminolevulinic acid induced-Protoporphyrin IX (PpIX) fluorescence guidance enables maximum safe resection of glioblastomas by providing surgeons with real-time tumor optical contrast. However, visual assessment of PpIX fluorescence is subjective and limited by the distorting effects of light attenuation and tissue autofluorescence. We have previously shown that non-invasive point measurements of absolute PpIX concentration identifies residual tumor that is otherwise non-detectable. Here, we extend this approach to wide-field quantitative fluorescence imaging by implementing spatial frequency domain imaging to recover tissue optical properties across the field-of-view in phantoms and ex vivo tissue.

Accurate Modelling And Positioning Of A Magnetically-Controlled Catheter Tip, Vi T. H. Le

Theses: Doctorates and Masters

This thesis represents the initial phase of a proposed operator and patient friendly method designed to semi-automate the positioning and directing of an intravascular catheter in the human heart using a variable electromagnetically induced field to control a catheter tip equipped with three tiny fixed magnets oriented in XYZ planes. Here we demonstrate a comprehensive mathematical model which accurately calculates the magnetic field generated by the electromagnet system, and the magnetic torques and forces exerted on a three-magnet tip catheter. From this we have developed an iterative predictive computer algorithm to show the displacement and deflection of the catheter tip ...

Absence Of Jc Viremia In A Case With Jc Virus Nephropathy: A Case Report And Literature Review, Samer Bani-Hani Md, Facp, Uma Gunasek Md

Tennessee Medicine E-Journal

BK virus associated nephropathy (BKVAN) is an important cause of graft dysfunction with a high rate of graft loss. Current literature describes the pathophysiology of Polyoma Virus Associated Nephropathy (PVAN) induced by BKV but it lacks detailed definition of allograft nephropathy induced by JC virus (JCV). BKVAN is typically associated with BK Viremia, and the latter is the most commonly used screening measure for BKVAN in most transplant centers [1]. We are reporting a case of JCV associated nephropathy in renal allograft recipient who did not have JC viremia during the entire course of his disease and did not respond ...

The End Of An Era: The Cancer Stem Cell Hypothesis And Its Therapeutic Implications, Emily Paton

Independent Study Project (ISP) Collection

Cancer, a leading cause of death in many developed countries, has become a global health burden. Much of the drain on healthcare systems has resulted from the high cost and ineffectiveness of conventional cancer treatments, which often lead to cancer relapse or metastasis. The failures of chemotherapy, radiation, and surgery have been elucidated by the cancer stem cell (CSC) hypothesis, which postulates that a small percentage of tumor cells drive tumorigenesis. These cells can sustain cancer through their capacity to self-renew and differentiate into specialized tumor cell types, similar to how healthy stem cells maintain healthy tissues. Conventional cancer treatments ...

A Prospective Randomized Comparison Of Patient Specific Instruments With Standard Tka Instrumentation, Christina Kane, Anthony Porter, Patricia D. Franklin, David C. Ayers

Patricia D. Franklin

Introduction: Patient specific instruments (PSI), an alternative to standard total knee arthroplasty (TKA) technology, have shown mixed results regarding effectiveness in previous studies. This study evaluated the accuracy of the predicted PSI plan, compared incremental cost savings with PSI, and compared outcomes of PSI and standard TKA patients.

Patients and Methods: This randomized, prospective feasibility study included 19 primary TKA patients receiving a cruciate-retaining cemented prosthesis from a single surgeon (DCA). 9 patients randomized to PSI received a pre-operative knee MRI for PSI fabrication using proprietary software.10 standard TKAs were completed. Operative data collected included operating times, implant details ...

Development Of A Fatal Noncompressible Truncal Hemorrhage Model With Combined Hepatic And Portal Venous Injury In Normothermic Normovolemic Swine, Ujwal R. Yanala, Jason M. Johanning, Iraklis I. Pipinos, Gustavo F. Larsen, William H. Velander, Mark A. Carlson

William H. Velander Publications

Noncompressible truncal hemorrhage and brain injury currently account for most early mortality of warfighters on the battlefield. There is no effective treatment for noncompressible truncal hemorrhage, other than rapid evacuation to a surgical facility. The availability of an effective field treatment for noncompressible truncal hemorrhage could increase the number of warfighters salvaged from this frequently-lethal scenario. Our intent was to develop a porcine model of noncompressible truncal hemorrhage with a ,50% one-hour mortality so that we could develop new treatments for this difficult problem. Normovolemic normothermic domestic swine (barrows, 3 months old, 34–36 kg) underwent one of three injury ...

Psychometric Evaluation Of Joint-Specific Patient-Reported Outcome Measures Before And After Total Knee Replacement: A Dissertation, Barbara L. Gandek

GSBS Dissertations and Theses

Background: Patient reports of pain and function are used to inform the need for and timing of total knee replacement (TKR) and evaluate TKR outcomes. This dissertation compared measurement properties of commonly-used patient surveys in TKR and explored ways to develop more efficient knee-specific function measures.

Methods: 1,179 FORCE-TJR patients (mean age=66.1, 61% female) completed questionnaires before and 6 months after TKR. Patient surveys included the knee-specific Knee injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and generic SF-36 Health Survey. Tests of KOOS and WOMAC measurement properties included evaluations ...

Surgical Approach In Total Hip Arthroplasty: Patient Outcomes And Impact On Costs, Stephen M. Petis

Electronic Thesis and Dissertation Repository

Total hip arthroplasty is often renowned as one of the most important surgical advances of the past century. Orthopaedic surgeons must choose a surgical approach to gain access to the hip joint in order to perform the reconstruction. There is debate in the literature as to which surgical approach optimizes patient outcomes, minimizes complications, and reduces costs to hospitals as a high volume procedure.

In the current studies, patient reported outcomes were compared at short-term follow-up using a prospective study design across the anterior, posterior, and lateral approach. A micro-costing method was used to acquire costs related to each procedure ...