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Digest Of The Philadelphia College Of Osteopathic Medicine (Winter 2011), Philadelphia College Of Osteopathic Medicine

Digest

The Winter 2011 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Opening Remarks
• PCOM Updates
• Development News
• Strategic Initiative
• Founders’ Day 2011
• A Cry for Help
• Class Notes
• In Memoriam
• My Turn Essay

Should Benzodiazepines Be Prescribed To Treat Insomnia And Anxiety Related Disorders?, Judith Nicole Margareten

The Science Journal of the Lander College of Arts and Sciences

The following is an excerpt of the introduction of this article: Benzodiazepines are commonly prescribed drugs used to treat insomnia and anxiety. They are often found in forms such as Xanax (alprazolam) and Valium (diazepam). For many, these drugs have proven essential for ensuring a restful night’s sleep, but for others they are the cause of sleepless ones. Negative effects of benzodiazepines such as addiction, dependence, and impaired cognition plague many patients. While doctors are prone to prescribe these medications readily due to their high level of effectiveness, this practice can pose a great risk to certain populations.

A Proposed Mechanism For Drug-Induced Nightmares, Isaac Brezner

The Science Journal of the Lander College of Arts and Sciences

The following is the introduction of this article: The fields of neuropharmacology and psychopharmacology are known to be highly connected, despite our severe lack of knowledge in these fields. One of the many overlaps between the two fields is sleep, which itself entails many mechanisms and events which are, as of yet, unexplainable. From the perspective of either field, one of the most mysterious events occurring during sleep is dreaming. From the cause of dreams to their content, little is known about them or their more sinister subclassification: nightmares. In this field of disturbed dreaming, neuropharmacology makes a large intrusion …

Acceptability Of Behavioral Treatments For Insomnia, Daniel Bluestein, Amanda C. Healey, Carolyn M. Rutledge

Ellmer School of Nursing Faculty Publications

Background: Behavioral treatments for insomnia are safe and efficacious but may not be embraced by patients in primary care. Understanding factors associated with acceptability can enhance successful use of these modalities. The objective of this study was to identify demographic and clinical/psychosocial correlates of behavioral insomnia treatment acceptability.

Methods: This nonexperimental, inventory-based, cross-sectional study enrolled patients from a hospital-sponsored primary care clinic and 2 urban academic family practices. Participants (n = 236) were 18 years of age or older who had clinically significant insomnia (Insomnia Severity Index score >= 8) and were recruited consecutively at these sites. A study coordinator …

A Double-Blind, Randomized, Placebo Controlled Trial Of Ramelteon For The Treatment Of Insomnia And Mood Stability In Patients With Euthymic Bipolar Disorder (Poster), Edward R. Norris Md, Fapa, Fapm, Karen Burke Rn, Julia R. Correll Ba, Ken Zemanek Md, Joel Lerman Md, Michael Kaufmann Md

Department of Psychiatry

No abstract provided.

Evaluation Of Verbal Behavior In Older Adults, Amy Gross

Dissertations

Older adults make up a large and increasing portion of the population (U.S. apply those assessments to the evaluation of verbal behavior in older adults with and without dementia. The research addressed two questions. First, in what way do verbal behavior problems differ between older adults with and without dementia? Second, does language deteriorate in a pattern compatible with Skinner's analysis of functionally independent verbal operants? Thirty-one participants were categorized into Control (n=15) and Dementia (n=16) Groups based on their score on the Dementia Rating Scale-2. Verbal behavior assessments were administered to participants on two occasions, separated by one week. …

Primary Care Practice Addressing Child Overweight And Obesity: A Survey Of Primary Care Physicians At Four Clinics In Southern Appalachia, Nicole Holt, Karen E. Schetzina, William T. Dalton, Fred Tudiver, Hazel Fulton-Robinson, Tiejian Wu

ETSU Faculty Works

Objective: The prevalence of childhood overweight and obesity in southern Appalachia is among the highest in the United States (US). Primary care providers are in a unique position to address the problem; however, little is known about attitudes and practices in these settings.

Methods: A 61-item healthcare provider questionnaire assessing current practices, attitudes, perceived barriers, and skill levels in managing childhood overweight and obesity was distributed to physicians in four primary care clinics. Questionnaires were obtained from 36 physicians.

Results: Physicians' practices to address childhood overweight and obesity were limited, despite the fact that most physicians shared the attitude that …

Clinical Use Of Probiotics: A Survey Of Physicians’ Beliefs And Practice Patterns, Anastasia Ensminger

Master's Theses and Doctoral Dissertations

Background: Probiotics have the potential to be used as a preventive agent or adjuvant therapy for various medical conditions, and recent research is beginning to illuminate some of the associated benefits. Some clinicians currently prescribe probiotics in practice. Understanding physicians’ beliefs and practice patterns regarding the use of probiotics will help identify current practices, barriers preventing their acceptance, and the sources of information that impact clinical practice.

Objective: To identify and describe physicians’ beliefs and practice patterns regarding the use of probiotics.

Methods: A cross-sectional online questionnaire was administered to 130 physicians employed by or affiliated with Danville …

Attention-Deficit/Hyperactivity Disorder In Childhood Is Associated With Cognitive Test Profiles In The Geriatric Population But Not With Mild Cognitive Impairment Or Alzheimer's Disease, N. Ivanchak, Erin L. Abner, S. A. Carr, S. J. Freeman, A. Seybert, John Ranseen, Gregory A. Jicha

Sanders-Brown Center on Aging Faculty Publications

The frequency of ADHD in the aging population and its relationship to late-life cognitive decline has not been studied previously. To address this gap in our understanding, the Wender-Utah ADHD Rating scale (WURS) was administered to 310 geriatric subjects with cognitive status ranging from normal cognition to mild cognitive impairment to overt dementia. The frequency of WURS-positive ADHD in this sample was 4.4%. WURS scores were not related to cognitive diagnoses, but did show nonlinear associations with tasks requiring sustained attention. The frequency of ADHD appears stable across generations and does not appear to be associated with MCI or dementia …

The Prevention And Management Of Hiv And Sexual And Gender-Based Violence: Responding To The Needs Of Survivors And Those-At-Risk, Sarah Raifman, Ian Askew, Sajeda Amin, Jill Keesbury, Saiqa Mullick, Judith A. Diers, Meiwita P. Budiharsana, Chi-Chi Undie, Mary Zama, Mantshi Menziwa, Sherry Hutchinson, Naomi Rutenberg

Reproductive Health

The Population Council seeks to understand the social, economic, political, and physical context of risks for sexual and gender-based violence and HIV. Among the top priorities of Council research are supporting and evaluating efforts to prevent violence and HIV, including creating safe spaces for adolescent girls, and working with men and boys to change gender norms within the community; and comprehensively responding to the needs of survivors (including those who are HIV-infected) by strengthening health systems and integrating services. The purpose of this guide is to provide practical guidance on the steps necessary to establish and strengthen sexual violence (SV) …

Preference Assessments For Older Adults With Dementia: Utility Of The Mswo Procedure And Assessment Of The Stability Of Preference, Paige B. Raetz

Dissertations

Individuals with dementia suffer from a variety of cognitive deficits that can lead to a lack of engagement in activities. In recent years, researchers have begun to look at ways to assess preferences in hopes that increased identification of leisure items may lead to increases in engagement. Due to the decline in cognitive status a simple questionnaire may not be sufficient to assess preference for this population. As a result, several recent studies have incorporated the use of systematic preference assessments to assess preference for leisure activities with adults with dementia using a paired stimulus format. The purpose of the …

Impact Of Group Medical Visits For Adult Patients With Type 2 Diabetes Mellitus, Theresa Pye

UNF Graduate Theses and Dissertations

Diabetes is a condition that is primarily self-managed and lifestyle modifications such as diet, exercise, and weight management are necessary to reduce morbidity and mortality. Motivation to implement lifestyle modifications through self management is an integral part of disease management and studies have shown group medical visits are more effective than individual appointments in this patient population. The purpose of this project was to develop, implement and evaluate an evidencebased group medical visit program for up to a maximum of 8 adult patients with type 2 diabetes in a family practice setting for six months. Seven participants with abnormal A1C …

The Neural Underpinnings Of Prosody In Autism, Inge-Marie Eigsti, Jillian Schuh, Einar Mencl, Robert T. Schultz, Rhea Paul

Communication Disorders Faculty Publications

This study examines the processing of prosodic cues to linguistic structure and to affect, drawing on fMRI and behavioral data from 16 high-functioning adolescents with autism spectrum disorders (ASD) and 11 typically developing controls. Stimuli were carefully matched on pitch, intensity, and duration, while varying systematically in conditions of affective prosody (angry versus neutral speech) and grammatical prosody (questions versus statement). To avoid conscious attention to prosody, which normalizes responses in young people with ASD, the implicit comprehension task directed attention to semantic aspects of the stimuli. Results showed that when perceiving prosodic cues, both affective and grammatical, activation of …

What Is The Safety And Efficacy Of Tarenflurbil (R-Flurbiprofen) In Mild To Moderate Alzheimer’S Disease?, Lauren Viscount

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine what is the safety and efficacy of Tarenflurbil (R-flubiprofen) in mild to moderate Alzheimer’s Disease.

Does Beta Amyloid Immunization Reduce Amyloid Plaques And Preserve Cognitive Function In Patients With Alzheimer’S Disease?, Andrea Sasin

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this systematic review is to examine the efficacy of beta amyloid immunization in reducing amyloid plaques and preserving cognitive function in patients with Alzheimer’s disease (AD).

Is Extract Err731 From The Rheum Rhaponticum Effective In Relieving Menopausal Symptoms In Women Aged 45 To 55 Years Of Age?, Annette M. Merlino

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: To determine whether ERr 731 extract from the Rheum rhaponticum plant is effective in relieving symptoms of menopausal symptoms in women aged 45 to 55 years of age

Is A Musical Intervention Effective In The Reduction Of Needle Related Procedural Pain In Children?, Heather B. Good

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE:Trypanophobia, or the fear of needles and needle pain is a very common occurrence in children, one that can have significant impacts into adulthood and on an individual’s lifelong healthcare. The objective of this systematic review is to determine whether or not a musical intervention is effective in the reduction of needle-related procedural pain in children. The author searched OVID Medline and Cochrane databases for peer-reviewed articles and systematic reviews addressing the topic, published in English after 1996. Three randomized controlled trials were selected on the basis of their being POEM’s and not included in previous systematic reviews, the results …

Effects Of Two Group Approaches On Life Satisfaction And Mood Of Older Females In Nursing Homes, Bede Redpath Ryan

Wayne State University Dissertations

The purpose of this study was to examine the effects of two group counseling therapy interventions on levels of life satisfaction and mood disturbance of older women, age 65+, living in two Detroit-based skilled nursing home facilities. This quasi-experimental, two-treatment group design examined the pretest-posttest data of two group counseling therapy interventions, Group Art Therapy (GAT) and Group Life Stories Narrative Therapy (GLSNT). Seventeen participants completed the bi-weekly, 90-minute sessions, over a four-week period. A univariate ANCOVA with group membership as fixed independent variable was used to compare life satisfaction post scores with pre scores as covariates. Mean scores were …

Re: Sleep And The Family Doctor: Time To Lead, D. Bluestein, A. C. Healey, C. M. Rutledge

Ellmer School of Nursing Faculty Publications

No abstract provided.

Prenatal Programming Of Human Neurological Function, Curt A. Sandman, Elyssia Poggi Davis, Claudia Buss, Laura M. Glynn

Psychology Faculty Articles and Research

The human placenta expresses the genes for proopiomelanocortin and the major stress hormone, corticotropin-releasing hormone (CRH), profoundly altering the "fight or flight" stress system in mother and fetus. As pregnancy progresses, the levels of these stress hormones, including maternal cortisol, increase dramatically. These endocrine changes are important for fetal maturation, but if the levels are altered (e.g., in response to stress), they influence (program) the fetal nervous system with long-term consequences. The evidence indicates that fetal exposure to elevated levels of stress hormones (i) delays fetal nervous system maturation, (ii) restricts the neuromuscular development and alters the stress response of …

Reduction Of Mammoplasty Using Inferior Pedicle In Heavy Breasts (Macromastia)., Stanley Ominde Khainga, Ronald Wasike, P. K. Biribwa

General Surgery, East Africa

Symptoms associated with heavy breasts are pain in the upper part of the body; back pains, poor body posture and headache. These patients also have difficulties in finding suitable clothes and experience poor self-image and problems such as establishing sexual relationships. Reduction mammoplasty procedure provides weight and volume reduction of the breast as well as enhancement of the aesthetic appearance of the breasts. In this study, the inferior pedicle technique was used in reduction of thirty five patients over the last four years with macromastia. In all the patients except three, good results were achieved. One patient suffered nipple necrosis …

Prenatal Maternal Stress Programs Infant Stress Regulation, Elyssia Poggi Davis, Laura M. Glynn, Feizal Waffarn, Curt A. Sandman

Psychology Faculty Articles and Research

Objective: Prenatal exposure to inappropriate levels of glucocorticoids (GCs) and maternal stress are putative mechanisms for the fetal programming of later health outcomes. The current investigation examined the influence of prenatal maternal cortisol and maternal psychosocial stress on infant physiological and behavioral responses to stress.

Methods: The study sample comprised 116 women and their full term infants. Maternal plasma cortisol and report of stress, anxiety and depression were assessed at 15, 19, 25, 31 and 36 + weeks' gestational age. Infant cortisol and behavioral responses to the painful stress of a heel-stick blood draw were evaluated at 24 hours after …

Development Of Fetal Movement Between 26 And 36 Weeks’ Gestation In Response To Vibroacoustic Stimulation, Marybeth Grant-Beuttler, Laura M. Glynn, Amy L. Salisbury, Elyssia Poggi Davis, Carol Holliday, Curt A. Sandman

Psychology Faculty Articles and Research

BACKGROUND: Ultrasound observation of fetal movement has documented general trends in motor development and fetal age when motor response to stimulation is observed. Evaluation of fetal movement quality, in addition to specific motor activity, may improve documentation of motor development and highlight specific motor responses to stimulation.

AIM: The aim of this investigation was to assess fetal movement at 26 and 36-weeks gestation during three conditions (baseline, immediate response to vibro-acoustic stimulation (VAS), and post-response).

DESIGN: A prospective, longitudinal design was utilized.

SUBJECTS: Twelve normally developing fetuses, eight females and four males, were examined with continuous ultrasound imaging.

OUTCOME MEASURES: …

A Concept Mapping Needs Assessment Of Young Families With Parental Cancer, Richard P. Durant

Antioch University Dissertations & Theses

The purpose of this research is to investigate the support needs of young families living with and beyond a parental diagnosis of cancer. The sample includes 56 participants comprised of 31 professional stakeholders and 25 patient stakeholders affiliated with the Charles R. Wood Cancer Center. It was hypothesized there would be differences in how the groups of stakeholders rated needs in terms of importance, satisfaction, and utilization. Differences in ratings are thought to be barriers to effective program development. While not a formal research hypothesis, it was anticipated other program development barriers germane to naturalistic clinical settings would emerge from …

Refractory Pain, Existential Suffering, And Palliative Care: Releasing An Unbearable Lightness Of Being, George P. Smith Ii

Scholarly Articles

Since the beginning of the hospice movement in 1967, “total pain management” has been the declared goal of hospice care. Palliating the whole person’s physical, psycho-social, and spiritual states or conditions is central to managing the pain which induces suffering. At the end-stage of life, an inextricable component of the ethics of adjusted care requires recognition of a fundamental right to avoid cruel and unusual suffering from terminal illness. This Article urges wider consideration and use of terminal sedation, or sedation until death, as an efficacious palliative treatment and as a reasonable medical procedure in order to safeguard the “right” …

The Impact Of Hospice And Dementia Special Care Units On End-Of-Life Care For Individuals With Dementia, Catherine Elizabeth Mccarty

USF Tampa Graduate Theses and Dissertations

ABSTRACT

Hospice and Dementia Special Care Units (DSCUs) have been shown to be gold standards of care for individuals who are dying and for those with dementia in nursing homes. Using a retrospective administrator and family survey, this study investigated whether the processes of care used in hospice and DSCUs are associated with increased quality of end of life (EOL) care for individuals with dementia. A convenience sample of 17 facilities in four states (FL, PA, MD and MA) was included in the study. Nursing home administrators were surveyed between September 2008 and October 2009. The administrators identified 116 family …

Work Interrupted: A Questionnaire Assessing The Relationship Between Work-Related Distress And Psychological Adjustment To Cancer, Betsy A. Bates Freed

Antioch University Dissertations & Theses

Cancer is an increasingly survivable disease that significantly impacts the ability of individuals to negotiate successfully the developmental task most distinctly affiliated with middle adulthood: creating meaning through achievement, creativity, and service. For many adults, these goals are accomplished through employment. When cancer intrudes, patients may be deprived of the ability to participate fully in the “generativity” that developmental psychologist Erik Erikson deemed essential to a healthy adulthood. In qualitative studies, patients’ narratives speak of many work-related losses — of routine, normality, economic stability, social connection, purpose, and identity. While psychosocial issues and quality of life are viewed with increasing …

Dementia Caregiving Outcomes: The Impact Of Caregiving Onset, Role Occupancy, And Care-Recipient Decline, Katherina Nikzad-Terhune

University of Kentucky Doctoral Dissertations

Dementia is characterized as a progressive loss of brain function that results in the deterioration of many cognitive and physical abilities. Alzheimer’s disease (AD) is the most common form of dementia, causing steady declines in memory, functional abilities, and mental functioning. With a projected increase of degenerative illnesses, such as AD, family caregiving for individuals with the disease is also steadily increasing. Caring for an individual with AD has been characterized as a “career,” and within this career are a number of key transitions, including the onset of caregiving. Preexisting caregiving research reveals a number of negative consequences for AD …

Association Of Retinoic Acid Receptor Genes With Meningomyelocele, Phong X Tran, Kit Sing Au, Alanna C Morrison, Jack M Fletcher, Kathryn K Ostermaier, Gayle H Tyerman, Hope Northrup

Faculty, Staff and Student Publications

BACKGROUND: Neural tube defects (NTDs) occur in as many as 0.5-2 per 1000 live births in the United States. One of the most common and severe neural tube defects is meningomyelocele (MM) resulting from failed closure of the caudal end of the neural tube. MM has been induced by retinoic acid teratogenicity in rodent models. We hypothesized that genetic variants influencing retinoic acid (RA) induction via retinoic acid receptors (RARs) may be associated with risk for MM.

METHODS: We analyzed 47 single nucleotide polymorphisms (SNPs) that span across the three retinoic acid receptor genes using the SNPlex genotyping platform. Our …

Case Of “Slow” Stroke From Carotid Artery Occlusion Treated By Delayed But Cautious Endovascular Intervention, Kachi Illoh, Emilio Supsupin, Hashem M Shaltoni, Edwin D Cacayorin

Faculty, Staff and Student Publications

In a challenging case of carotid occlusion with slowly evolving stroke, we used brain imaging to facilitate endovascular revascularization resulting in the relief of the patient's symptoms. Patients with carotid occlusion and continued neurological worsening or fluctuations present enormous treatment challenges. These patients may present "slow" strokes with subacute infarcts that present significant challenges and risks during attempts at revascularization of the occluded artery. We present such a case in which we used multimodal imaging techniques, including MR-perfusion, to facilitate endovascular revascularization. Our approach of delayed but cautious intra-arterial thrombolytic therapy, guided by brain imaging, and followed by stent placement …