Digital Commons Network^™

The Implications Of “Pay-For-Performance” Reimbursement For Otolaryngology – Head And Neck Surgery, David M. Cognetti, David Reiter

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Objective: To introduce otolaryngologists to outcomes-linked reimbursement ("pay-for-performance"), identify clinical practice implications and recommend changes for successful transition from the traditional "pay-for-effort" reimbursement model. Study design: Policy review Results: Payers are actively linking reimbursement to quality. Since the Institute of Medicine issued its report on medical errors in 1999, there has been much public and private concern over patient safety. In an effort to base health care payment on quality, "pay-for-performance" programs reward or penalize hospitals and physicians for their ability to maintain standards of care established by payers and regulatory groups. More than 100 such programs are operational in …

Methemoglobinemia Induced By Topical Anesthesia During Fiberoptic Endotracheal Intubation, Matthew C. Miller, Michael T. Gaslin, Kathleen Herb, David Rosen

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Poster presentation at 2005 American Academy Of Otolaryngology Head and Neck Surgery Annual Meeting, Los Angeles, CA September 25-28, 2005.

Introduction: Although local anesthetics are usually well tolerated, otolaryngologists need to be aware of the sometimes serious adverse events they can cause. The benzocaine containing sprays Hurricaine and Cetacaine are occasionally associated with the onset of life-threatening methemoglobinemia. The specific treatment for this condition is methylene blue.

Methods and Measures: We describe a case report of a 48 year old female who developed a methemoglobin level of 41% after receiving topical benzocaine to her oropharynx. We discuss the case in …

An Experimental Technique For Measurement Of Heat Generated During Bone Sawing, Hamid Khalili Parsa, Ger Reilly, Brendan Mccormack

Conference Papers

Orthopaedic bone cutting processes such as osteotomy and hip arthroplasty involve the cutting of one with the aid of various manual and powered cutting instruments including manual and powered bone saws. The extent of surgically induced bone necrosis at the point of the cutting tool and the bone is mainly due to the frictional heat generated by bone cutting. Bone necrosis has an impact on bone regeneration, and the rate of healing of the bone post operation. The threshold temperature for impaired regeneration of bone is in the range of 44°C to 47°C. Overheating also affects the sharpness life of …

Detection Of Microcracks During Bone Cutting Using Acoustic Emission Techniques, Ashkan Safari, Ger Reilly, Brendan Mccormack

Conference Papers

Surgeons may use a number of cutting instruments such as osteotomes and chisels to cut bone during operative procedures. The initial loading of cortical bone during the cutting process results in the formation of microcracks in the vicinity of the cutting zone with main crack propagation to failure occurring with continued loading; microcracking acts as a stimulus for main crack formation and has also been shown to occur during the propagation of the main crack. It has also been reported that Acoustic Emission (AE) is generated due to microcrack formation and crack growth, prior to, and during final fracture in …

Medical Education Digest, Vol. 7 No. 5 (September/October 2005), Nova Southeastern University

Medical Education Digest

No abstract provided.

Roles Of Na,K-Atpase In Early Development And Trophectoderm Differentiation., Gerald M Kidder, Andrew J Watson

Obstetrics & Gynaecology Publications

Before implantation into the uterine wall, the mammalian embryo undergoes a period of cell division, cell shape change, and cell differentiation leading to the formation of an outer epithelium, the trophectoderm. The trophectoderm is the part of the embryo that initiates uterine contact and, after transformation to become the trophoblast, uterine invasion. Similar to the kidney nephron, the trophectoderm is a transporting epithelium with distinct apical and basolateral membrane domains; its function is to facilitate transepithelial Na+ and fluid transport for blastocoel formation. That transport is driven by Na,K-adenosine triphosphatase (ATPase) localized in basolateral membranes of the trophectoderm. Preimplantation embryos …

Clinical Kidney Transplantation: A 50th Anniversary Review Of The First Reported Series, Vivian Charles Mcalister

Surgery Publications

BACKGROUND: Histories of kidney transplantation rarely mention a series reported by Gordon Murray of Toronto and published by the American Journal of Surgery 50 years ago.

METHODS: The papers and biographies of Gordon Murray were reviewed in the context of knowledge at that time about renal failure management to determine their contribution to transplantation research and to current practice.

RESULTS: Murray proceeded from a unique leadership position in vascular surgery, anticoagulation therapy, and dialysis to undertake a rational series of animal experiments and human trials of kidney transplantation that led him to the practices of graft irrigation, cold storage, pelvic …

Depression In Primary Care: Difficulties And Paradoxes, Haider Naqvi, Murad Moosa Khan

Department of Psychiatry

The presentation of depression in primary care is in many ways different from that seen in psychiatric settings. The process of detection and treatment is also different. This is particularly so in developing countries like Pakistan, which has high prevalence rates of depression but poorly organized primary health care services and primary care physicians (PCPs) who have little psychiatric training, either at undergraduate or postgraduate levels. There is a need to review difficulties faced by primary care physicians in detection and management of depression. It is hoped this would lead to better and more effective management of depression at primary …

Dealing With A Terrorist Attack: A University Hospital Perspective, Muhammad Shahid, Rifat Rehmani, Muhammad Saleem Khan

Department of Emergency Medicine

No abstract provided.

A Case For Case Reports, Saba Sohail

Department of Radiology

No abstract provided.

Oncolog, Volume 50, Number 09, September 2005, Don Norwood, Razelle Kurzrock Md, Robert S. Benjamin Md

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• A New Source of Stem Cells
• House Call: Complementary and Alternative Medicine: Sorting through the Choices
• DiaLog: Risks and Benefits of Phase I Oncology Trials, by Razelle Kurzrock, MD, Professor, Division of Cancer Medicine Phase I Program, and Robert S. Benjamin, MD, Professor, Department of Sarcoma Medical Oncology

Increased Risk Of Hiv In Women Experiencing Physical Partner Violence In Nairobi, Kenya, Karoline Fonck, Leye Els, Nancy Kidula, Jeconiah Ndinya-Achola, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

As part of a study on etiology of sexually transmitted infections (STI) among 520 women presenting at the STI clinic in Nairobi, data on partner violence and its correlates were analyzed. Prevalence of lifetime physical violence was 26%, mainly by an intimate partner (74%). HIV seropositive women had an almost twofold increase in lifetime partner violence. Women with more risky sexual behavior such as early sexual debut, number of sex partners, history of condom use and of STI, experienced more partner violence. Parity and miscarriage were associated with a history of lifetime violence. We found an inverse association between schooling …

Detection Of Helicobacter Pylori Infection In Patients On Proton Pump Inhibitors, Javed Yakoob, Wasim Jafri, Shahab Abid, Nida Jafri, Muhammad Islam, Z Abbas

Section of Gastroenterology

No abstract provided.

Cerebral Deep Venous Thrombosis: Case Report And Literature Review, Muhammad Zafar Rafique, Vaqar Bari, Kashif Ashraf, Muhammad Nadeem Ahmad

Department of Radiology

The case of a 28 years old woman presenting with headache, drowsiness and vomiting of a short duration, is presented. She was diagnosed as deep cerebral venous thrombosis on the basis of MRI findings. Treatment with heparin gave completed recovery.

The Outcome Of Mta As A Root End Filling Material: A Long Term Evaluation, Christopher M. Sechrist

Loma Linda University Electronic Theses, Dissertations & Projects

Periradicular surgery is a viable option to save natural teeth when non-surgical treatment fails or when endodontic retreatment is not feasible or contraindicated. Laboratory and animal studies have demonstrated that MTA is biocompatible, provides an excellent seal against penetrating bacteria, and promotes hard tissue healing. The purpose of this study was to provide long term (>3 years) clinical evidence for its use as a root-end filling material in endodontics. The clinical records of 294 patients who had MTA used during endodontic treatment from 1996 to 2001 were reviewed. From these, 75 patients whose root end cavities had been filled …

Magnification In Images Produced By Five Popular Digital Lateral Cephalometric Machines, Gretchen Marie Schnepper

Loma Linda University Electronic Theses, Dissertations & Projects

Modern digital lateral cephalometric images are produced by machines that vary in a number of critical features such as: 1) machine geometry, 2) movement (or lack of movement) of the x-ray source, 3) movement (or lack of movement) or x-ray detectors, 4) cephalostat geometry and 5) digital data manipulations by proprietary software. The purpose of this study was to evaluate the magnification characteristics of images produced by five commercial digital lateral cephalometric machines. These digital image magnification characteristics were then compared with images produced by an analog cephalometric machine. The two goals of this study were to: 1) measure the …

Treatment Outcome Of Root Perforations Repaired With Mineral Trioxide Aggregate, Stephen H. Paik

Loma Linda University Electronic Theses, Dissertations & Projects

Root perforations during root canal therapy have a significant negative impact on long-term prognosis of teeth. Proper treatment is critical in managing these accidental procedures. Laboratory and animal studies have demonstrated that Mineral Trioxide Aggregate (MTA) is biocompatible, provides an excellent seal against penetrating bacteria, and promotes hard tissue healing. The purpose of this study was to determine the long term treatment outcome of root perforations repaired with MTA.

Ninety-nine records from the Graduate Endodontic Clinic at Loma Linda University School of Dentistry from 1996 to 2001 were reviewed. Clinical and radiographic evaluations were completed. Three independent examiners evaluated digitized …

Lymphoepithelioma-Like Carcinoma Of Urinary Bladder: (Lelca), Nausheen Yaqoob, Naila Kayani, Jaipal Piryani, Mohammad Nasir Sulaiman, Sheema H. Hasan

Department of Pathology and Laboratory Medicine

Lymphoepithelioma-like carcinoma of the bladder (LELCA) is an uncommon neoplasm of the urinary bladder and up till now only 49 cases have been reported in the English literature. It is imperative to distinguish between lymphoepithelioma-like carcinoma and malignant lymphoma as primary bladder lymphoma is extremely rare. We report a case of a 55 year old lady who presented with the complaint of burning micturition and gross hematuria for the past 5 months. There were no other known comorbids. Pelvic ultrasound was normal. Cystoscopy showed a 4x4 cm sessile mass in the bladder. Histopathological examination was consistent with the diagnosis of …

Review Of "Multiple Pregnancy: Epidemiology, Gestation & Perinatal Outcome. Second Edition", Edward J. Hayes

Department of Obstetrics and Gynecology Faculty Papers

Book Review

Brain Neprilysin Activity And Susceptibility To Transgene-Induced Alzheimer Amyloids, Troy L. Carter, Steve Pedrini, Jorge Ghiso, Michelle E. Ehrlich, Sam Gandy

Department of Neurology Faculty Papers

Neprilysin (NEP) is a zinc metalloproteinase that degrades enkephalins, endothelins, and the Alzheimer’s disease amyloid ß (Aß) peptides. NEP-deficient mice possess increased levels of brain Aß^1-40 and Aß^1-42. The objective of this study was to determine whether tissue NEP specific activity differs according to age and/or across mouse strains, especially those strains predisposed toward formation of Aß-amyloid plaques following overexpression of the human Alzheimer amyloid precursor protein (APP). The C57Bl/6J mouse strain appears to be relatively susceptible to cerebral amyloidosis, whereas the Swiss Webster (SW) strain appears more resistant. We investigated whether NEP specific activity in brain …

P38 Mitogen-Activated Protein Kinase (Mapk) First Regulates Filamentous Actin At The 8-16-Cell Stage During Preimplantation Development., Andrew J M Paliga, David R Natale, Andrew J Watson

Obstetrics & Gynaecology Publications

BACKGROUND INFORMATION: The MAPK (mitogen-activated protein kinase) superfamily of proteins consists of four separate signalling cascades: the c-Jun N-terminal kinase or stress-activated protein kinases (JNK/SAPK); the ERKs (extracellular-signal-regulated kinases); the ERK5 or big MAPK1; and the p38 MAPK group of protein kinases, all of which are highly conserved. To date, our studies have focused on defining the role of the p38 MAPK pathway during preimplantation development. p38 MAPK regulates actin filament formation through the downstream kinases MAPKAPK2/3 (MAPK-activated protein kinase 2/3) or MAPKAPK5 [PRAK (p38 regulated/activated kinase)] and subsequently through HSP25/27 (heat-shock protein 25/27). We recently reported that 2-cell-stage murine …

The Effects Of An Analgesic (Biofreeze®) On The Motoneuron Pool Excitability Of The Soleus Muscle, Desiree R. Barth

All-Inclusive List of Electronic Theses and Dissertations

Objective: The purpose of this study was to determine the effects on the Hoffman reflex and motor response with an analgesic (Biofreeze®). Design: The study was a 2X6 design. The independent variables in this study were treatment and time. The dependent variables were the H-reflex (volts) and the M response (volts). Treatment was randomly assigned to control for the effects of order. Setting: This study took place in the Exercise Physiology Laboratory located in the Health and Human Performance Building at Indiana State University. Subjects: 14 volunteers who were physically active and had no known neurological problems. Measurements: Skin and …

The Relationship Of Attitude, Self-Efficacy, Physician, And Significant Other Influence To Type 2 Diabetes Outcomes, Heidi A. Larson

All-Inclusive List of Electronic Theses and Dissertations

The purpose of this study was to investigate the Theory of Planned Behavior (TPB) and its' relationship to Type 2 diabetes outcomes. One hundred and sixty-two adults ages 45 to 75 with Type 2 diabetes were recruited from two physicians' offices in the Midwest. Participants completed instruments that assessed (a) diabetes-specific attitude, (b) diabetes-specific self-efficacy, ( c) physician influence, ( d) significant other influence, and ( e) diabetes-specific quality of life. A measurement of metabolic control was also obtained. Multiple regressions were performed using (a) quality of life and (b) metabolic control as criterion variables. Attitude, self-efficacy, and physician influence …

Vital Signs, Fall 2005, Boonshoft School Of Medicine

Vital Signs

A twenty-eight page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, faculty profiles, class notes, and more.

Trends In Hospital-Based Management Of Acute Asthma From A Teaching Hospital In South Asia., S F. Hussain, M D. Omar, H. Ari, S .R. Sameeruddin, Ali Bin Sarwar Zubairi, Javaid Khan

Department of Medicine

The aim of this study is to evaluate the hospital-based management of acute asthma in south Asia and to compare practices over a 10-year period. Adult patients (n = 102) admitted at a teaching hospital with acute asthma were studied. Documentation of precipitating factors, family history and physical signs were inadequate in more than half of patients. Pulse oximetry was documented in 95 (93%) patients, but peak flow monitoring was performed only in 50 (49%) patients. Ten-year trend showed deterioration in history and physical examination skills, under use of peak flow readings, and poor pre-discharge instructions. Some aspects of improved …

The Experience Of American And Canadian Cancer Patients In Deciding To Seek Alternative Care In Mexican Cancer Clinics, Alicia Bright

Dissertations, Masters Theses, Capstones, and Culminating Projects

Background. Each year, despite warnings from the American Cancer Association, many US and Canadian citizens travel to Tijuana, Mexico, for cancer care. The main criticism of these clinics is that they provide treatments that are unproven, potentially unsafe, and expensive. Despite this, about 35 clinics exist in Tijuana that provide alternative care to patients who pay cash for these services.

Objectives. To understand the lived experience of people who have made the choice to receive cancer treatment at alternative cancer clinics in Tijuana, and gain insight into the process by which that decision occurs.

Population. 5 participants were interviewed. Three …

Renal Involvement In Systemic Lupus Erythematosus In Pakistan, Malik Anas Rabbani, Muhammad Hammad Tahir, Bilal Karim Siddiqui, Bushra Ahmad, A Shamim, Syed Mansoor Shah, Aasim Ahmad

Section of Nephrology

Objective: To find the prevalence of lupus nephritis, delineate its clinical, immunological and therapeutic characteristics and compare them with the data worldwide.PATIENTS AND Methods: Between 1985 and 2001, 198 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association (ARA) admitted to the hospital were studied by means of a retrospective review of their records.Results: Renal involvement was found in 89 (45%) patients. Biopsy showed lupus nephritis in 42 patients; there were 9 male and 33 females. Mean age at initial presentation was 27 years and mean duration of follow-up was 2 .3 years. The histological …

Experimental Ocular Toxoplasmosis In Genetically Susceptible And Resistant Mice, Fangli Lu, Shiguang Huang, Mark S. Hu, Lloyd H. Kasper

Dartmouth Scholarship

Genetic factors determining the pathogenesis and course of ocular toxoplasmosis are poorly understood. In this study, we explored the development of experimental ocular pathogenesis in genetically dissimilar mice infected with either the RH strain, the PLK strain, or the immunodominant surface antigen 1 (SAG1 [P30])-deficient mutant of the RH strain of Toxoplasma gondii. At 11 days postinfection, ocular infection of C57BL/6 mice with all of the strains of parasites resulted in severe inflammatory lesions and high numbers of parasites in eye tissue; less severe ocular lesions at earlier histopathology and prolonged survival were observed in this mouse strain infected …

Digest Of The Philadelphia College Of Osteopathic Medicine (Fall 2005), Philadelphia College Of Osteopathic Medicine

Digest

The Fall 2005 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Opening Remarks
• PCOM Updates and Kudos
• Uncommon Callings
• Take a Deep Breath
• Remembering Dr. Meals
• Class Notes
• In Memoriam
• My Turn
• Andrew Taylor Still Legacy Society
• PCOM Events

Tcpf Is A Soluble Colonization Factor And Protective Antigen Secreted By El Tor And Classical O1 And O139 Vibrio Cholerae Serogroups, Thomas J. Kirn, Ronald K. Taylor

Dartmouth Scholarship

Vibrio cholerae causes diarrhea by colonizing the human small bowel and intoxicating epithelial cells. Colonization is a required step in pathogenesis, and strains defective for colonization are significantly attenuated. The best-characterized V. cholerae colonization factor is the toxin-coregulated pilus (TCP). It has been demonstrated that TCP is required for V. cholerae colonization in both humans and mice. TCP enhances bacterial interactions that allow microcolony formation and thereby promotes survival in the intestine. We have recently discovered that the TCP biogenesis apparatus also serves as a secretion system, mediating the terminal step in the extracellular secretion pathway of TcpF. TcpF was …