Digital Commons Network^™

Optical Coherence Tomographic Evaluation Of Hyperacute Bivalirudin-Induced Coronary Stent Thrombosis, Jorge L Peñalver, Wassim Shatila, Emerson Perin

The Texas Heart Institute Journal

Thrombus formation after stent deployment has been linked to the use of heparin and of antithrombotic agents, such as bivalirudin, during percutaneous coronary intervention. Fluoroscopy has been used to identify stent thrombosis, typically after patients become symptomatic. We describe our use of optical coherence tomography to diagnose and evaluate intraprocedural stent thrombosis in a 68-year-old man who was given bivalirudin just before a percutaneous coronary procedure. This imaging method enabled immediate therapeutic intervention.

Echocardiographic Classification And Surgical Approaches To Double-Outlet Right Ventricle For Great Arteries Arising Almost Exclusively From The Right Ventricle, Kun-Jing Pang, Hong Meng, Sheng-Shou Hu, Hao Wang, David Hsi, Zhong-Dong Hua, Xiang-Bin Pan, Shou-Jun Li

The Texas Heart Institute Journal

Selecting an appropriate surgical approach for double-outlet right ventricle (DORV), a complex congenital cardiac malformation with many anatomic variations, is difficult. Therefore, we determined the feasibility of using an echocardiographic classification system, which describes the anatomic variations in more precise terms than the current system does, to determine whether it could help direct surgical plans. Our system includes 8 DORV subtypes, categorized according to 3 factors: the relative positions of the great arteries (normal or abnormal), the relationship between the great arteries and the ventricular septal defect (committed or noncommitted), and the presence or absence of right ventricular outflow tract …

Skin Necrosis Induced By Coumarin Congeners, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Selective Upper-Body Perfusion Technique For Removal Of Renal Cell Carcinoma Extending Into The Inferior Vena Cava And Right Atrium, Selim Aydin, Bora Cengiz, Banu Vural Gokay, Anar Mammadov, Remzi Emiroglu, Saadettin Eskicorapci, Ersin Erek

The Texas Heart Institute Journal

Invasion of a renal cell carcinoma thrombus into the inferior vena cava and right atrium is infrequent. Reaching and completely excising a tumor from the inferior vena cava is particularly challenging because the liver covers the surgical field. We report the case of a 61-year-old man who underwent surgery for a renal cell carcinoma of the right kidney that extended into the inferior vena cava and right atrium. During dissection of the liver to expose the inferior vena cava, transesophageal echocardiograms revealed right atrial mass migration into the tricuspid valve. On emergency sternotomy, the tumor embolized into the main pulmonary …

Bigeminy And A Pacemaker, Luke Cunningham, Yochai Birnbaum

The Texas Heart Institute Journal

No abstract provided.

Eliminating Mental And Physical Health Disparities Through Culturally And Linguistically Centered Integrated Healthcare, Octavio N. Martinez Jr.

Journal of Family Strengths

Since the U.S. Surgeon General’s report on mental health (1999) declared mind and body to be inseparable, integrated healthcare, bringing the body and mind back together, has been gaining significant momentum across the nation as a preferred approach to care for people with co-morbid physical health and mental health conditions. Primary care settings often are the gateway to healthcare for racial and ethnic minority populations and individuals with limited English proficiency (LEP) and, as such, it has become the portal for identifying undiagnosed or untreated behavioral health disorders. An integrated holistic philosophical approach to behavioral healthcare provides an opportunity to …

Optimizing Emergency Department Throughput Using Best Practices To Improve Patient Flow, Puneet Freibott Dnp, Rn, Nea-Bc, Ccrn-K'S

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Emergency Department (ED) crowding and bottle necks are the reality of hospitals across the country. Patients seeking care and needing inpatient beds via the emergency rooms are facing delays with attaining the right level of care. Orchestrating a patient through an ED admission requires a multidisciplinary effort to provide safe, effective and efficient care. This quality improvement project conducted in a tertiary acute care hospital focused on Centers for Medicare and Medicaid metrics to measure Emergency Department (ED) throughput. This multidisciplinary initiative focused on reducing time stamps for patient arrival to the ED through departure to hospital or home. Outcomes …

Insula And Amygdala Resting-State Functional Connectivity Differentiate Bipolar From Unipolar Depression, E Ambrosi, D B Arciniegas, A Madan, K N Curtis, M A Patriquin, R E Jorge, G Spalletta, J C Fowler, B C Frueh, R Salas

Staff and Researcher Publications

Objective: Distinguishing depressive episodes due to bipolar disorder (BD) or major depressive disorder (MDD) solely on clinical grounds is challenging. We aimed at comparing resting-state functional connectivity (rsFC) of regions subserving emotional regulation in similarly depressed BD and MDD.

Method: We enrolled 76 in-patients (BD, n = 36; MDD, n = 40) and 40 healthy controls (HC). A seed-based approach was used to identify regions showing different rsFC with the insula and the amygdala. Insular and amygdalar parcellations were then performed along with diagnostic accuracy of the main findings.

Results: Lower rsFC between the left insula and the left mid-dorsolateral …

Parent-Reported Problematic Sleep Behaviors In Children With Comorbid Autism Spectrum Disorder And Attention-Deficit/Hyperactivity Disorder, Katharine C Reynolds, Michelle Patriquin, Candice A Alfano, Katherine A Loveland, Deborah A Pearson

Staff and Researcher Publications

Background: Sleep problems are frequent and well documented in children with Autism Spectrum Disorders (ASD), children with Attention Deficit/Hyperactivity Disorder (ADHD) and children with internalizing problems, however limited work has examined sleep problems in children presenting with comorbid ASD/ADHD. In healthy children, sleep problems negatively impact social, emotional, and academic functioning. The current study sought to examine diagnostic severity as predictors of sleep problems in children with comorbid ASD/ADHD. Additionally, the association between sleep and "real-life" functional domains (i.e., intellectual functioning, academic achievement, and executive functioning) were assessed.

Method: Sleep, internalizing difficulties, intellectual functioning, academic achievement and executive functioning were …

Reducing Antibiotic Use In Pediatric Upper Respiratory Infection: A Multifaceted Parent-Clinician Approach, Sydnee H. Lucas Dnp, Aprn, Sydney Thompson Dnp, Arnp, Fnp-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The goal of this QI initiative was to decrease inappropriate antibiotic for the treatment of pediatric upper respiratory infection (URI) in the retail clinic setting. The approach included the use of a protocol to treat viral upper respiratory illness, a visual aid decision-making tool for guideline adherence, prescription pad for nonprescription remedies, and shared decision-making techniques for providers to involve patients and parents in management plans regarding nonprescription remedies, supportive treatment, and signs and symptoms that would warrant a return visit. An improvement trend during the first 3 months of the initiative showed a shift in antibiotic avoidance from a …

Reducing Medication Errors Through Workflow Redesign, Rosslyn W. Blake Dnp, Aprn, Gnp

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Lack of medication reconciliation at the point of transitions between skilled nursing facilities/nursing homes (SNF/NHs) and acute care hospitals (ACHs) is a common point of origin for medical errors that cause harm to patients. The goal of this quality improvement initiative was to improve medication reconciliation at the point of transition from the SNF/NH to the ACH which in turn would reduce medication errors, adverse drug events, and medication-induced injury to the vulnerable elderly population. We implemented a workflow redesign process to reconcile the accuracy of residents’ medications at the time of transfer from the SNF/NH to the ACH. After …

Using Business Modeling To Streamline Cost Of Anesthesia In A Cardiopulmonary Laboratory, Johnny Dang Dnp, Crna, Kristen Starnes-Ott Phd, Crna

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Time Driven Activity Based Costing (TDABC) measurement system, a model used in the business arena, can capture clinical processes and costs that other costing models often overlook. Use of this system permitted tying costs to time and resources and identified areas of inefficiency such as depleted supplies and health care and emergency supplies placed inconveniently. A multidisciplinary team developed an anesthesia checklist for use in a remote cardiopulmonary laboratory. The compliance rate for checklist completion was approximately 85%. Checklist implementation translated to a decrease in case delays and time expenditure in patient care by 58% with a cost savings …

Education Program Using Non-Pharmacologic Support During Benzodiazepine Reduction In Patients With Anxiety Disorders, Kelly D. Kearney Dnp, Rn, Pmhnp-Bc, Diane Wardell Phd, Whnp-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A private mental health clinic developed an initiative to aid patients with anxiety disorders to taper their use of benzodiazepines. Based on best practices, a treatment protocol was developed in which patients attended 4 sessions (1 per month) in which they combined instruction in non-pharmaceutical anti-anxiety techniques (guided imagery, mindfulness meditation, deep breathing, progressive muscle relaxation, exercise, emotional freedom) with cognitive behavioral therapy and use of selective serotonin re uptake inhibitors. Participants experienced a reduction in benzodiazepine use. This small scale initiative showed that the holistic approach to anxiety management was an effective plan to decrease the use of benzodiazepines …

Clara's Final Christmas Gift, Gus W Krucke

Faculty, Staff and Student Publications

No abstract provided.

Transcatheter Tricuspid Valve-In-Valve Replacement With An Edwards Sapien 3 Valve, Pranav Loyalka, Angelo Nascimbene, Benjamin Metz, Igor D Gregoric, Ajay Sundara Raman, Biswajit Kar

The Texas Heart Institute Journal

A few case reports and case series have documented the outcomes in patients with tricuspid bioprosthetic valvular degeneration who underwent transcatheter implantation of the Medtronic Melody and the Edwards Sapien XT and Sapien 3 valves. In this report, we describe the case of a 49-year-old woman with severe bioprosthetic tricuspid valvular stenosis and multiple comorbidities who underwent transcatheter tricuspid valve replacement with a Sapien 3 valve.

Incremental Validity Of The Pid-5 In Relation To The Five Factor Model And Traditional Polythetic Personality Criteria Of The Dsm-5, J Christopher Fowler, Michelle A Patriquin, Alok Madan, Jon G Allen, B Christopher Frueh, John M Oldham

Staff and Researcher Publications

Background: This study assessed the incremental validity of the Personality Inventory for DSM-5 (PID-5) beyond the impact of demographic, burden of illness, five-factor model of personality, and DSM-5 personality disorder criteria with respect to associations with admission psychiatric symptoms and functional disability.

Methods: Psychiatric inpatients (N = 927) were administered the Big Five Inventory, PID-5, and personality disorder criteria counts. Prior treatment utilization, as well as baseline depression, anxiety, emotion regulation, and functional disability were administered within two days of the personality measures. Hierarchical regression models were used to explore the association of personality functioning with symptom functioning, emotion regulation …

Evaluation Of Chest Pain After Implantable Cardioverter-Defibrillator Placement, Amir Gahremanpour, Mohammad Saeed, Yochai Birnbaum

The Texas Heart Institute Journal

No abstract provided.

The Two Anomalies Of Wilhelm Ebstein, Magdalena Mazurak, Jacek Kusa

The Texas Heart Institute Journal

The year 2016 was the 180th anniversary of Wilhelm Ebstein's birth and the 150th anniversary of his description of the congenital tricuspid valve malformation that came to be known as Ebstein anomaly. We present a brief history of the life and work of Dr. Wilhelm Ebstein. Despite his distinguished career, he is seemingly forgotten in his own birthplace. We include a review of the relevant historical medical literature.

White Blood Cell Subtypes Are Associated With A Greater Long-Term Risk Of Death After Acute Myocardial Infarction, Arthur Shiyovich, Harel Gilutz, Ygal Plakht

The Texas Heart Institute Journal

We evaluated the association between white blood cell counts and long-term mortality rates in 2,129 patients (mean age, 65.3 ± 13.5 yr; 69% men) who had survived acute myocardial infarction. We obtained white blood cell counts and differential counts of white blood cell subtypes within the first 72 hours of hospital admission. The primary outcome was all-cause death at 1, 5, and 10 years after acute myocardial infarction.

In regard to death in the long term, we found significant negative linear associations (lymphocytes), positive linear associations (neutrophils and the neutrophil-to-lymphocyte ratio), and nonlinear U-shaped associations (basophils, eosinophils, monocytes, and total …

Unproven Stem Cell-Based Interventions: Advancing Policy Through Stakeholder Collaboration, Kirstin R W Matthews, Ana S Iltis

The Texas Heart Institute Journal

No abstract provided.

Taking What We Have And Making What We Need: Utilizing Natural Helping Support Networks To Decrease Self Directed Violence Among Adolescents Of Color., Ladrea Ingram, Vanessa Drew-Branch

Journal of Family Strengths

Previous research has linked family and community connectedness with decreased risk of self-directed violence among adolescents. Despite the strong correlation between social connectedness and lowered risk of self-directed violence, very few interventions use social connections as mediators. This article identifies the risk and protective factors associated with self-directed violence among adolescents of color. In alignment with Healthy People 2020, this paper highlights the social determinants of self-directed violence including factors associated with individual’s social and physical environments. The authors provide an interdisciplinary review of current trends and historical data on self-directed violence in adolescents of color. The researchers suggest, the …

Predictors Of Obesity In African American College Students, Christiana Chinenye Osuagwu

Journal of Family Strengths

Abstract

Introduction: Obesity is the second highest cause of death in the United States due to its numerous co-morbidities, and data reveal that African Americans are at greatest risk for this disease. The study explored the multiple factors that predict obesity in the African American college students.

Method: Using a hybrid of the PRECEDE-PROCEED and the vital renewal models, a mixed methods study design that included 142 male and female African American college students was conducted. A Likert-scaled survey for the quantitative phase and a focus group interview for the qualitative arm were utilized. Constructs of attitude, culture, environment, …

Injustice And Inequality In Healthcare: Trends And Progress, Angelo Giardino, Robert Sanborn

Journal of Family Strengths

Angelo P. Giardino and Robert Sanborn discuss the latest issue of the Journal of Family Strengths.

Addressing Nutritional Literacy In Preschool Learning Environments, Cynthia Warren

Journal of Family Strengths

INTRODUCTION: Obesity among preschool children is more common among lower-income families. Prevalence of type 2 diabetes in U.S. Mexican and African American populations has steadily increased and is associated with modifiable risk factors, such as poor dietary habits.

AIM: The purpose of this study was to conduct an assessment of the preschool Bienestar/NEEMA Health Program, focusing on: students’ knowledge increase, teacher input on the classroom materials used, parental feedback on take-home activities, and input on the program's food service training by the school district's nutrition coordinator.

SAMPLE: Curriculum was implemented and assessed in one Head Start school over …

Use Of Short Assessment Of Health Literacy For Spanish Adults (Sahlsa-50) To Determine The Health Literacy Rate Of The Spanish-Speaking Population In An Urban Emergency Department, Dick Kuo M.D., Sheetal Thaker, Martin Duncan, Michael Puente, Sonia Parra, Ashley Rider, Kelsey Horter, Malford T. Pillow

Journal of Family Strengths

Background: The Hispanic population presents a great opportunity in terms of potential improvements in clinical outcomes and cost reduction for interventions through assessing and improving health literacy. While there are various tools to assess health literacy, many do not assess comprehensive Spanish health literacy.

Objectives: We sought to determine the health literacy rate of our Spanish-speaking population in the ED using the SAHLSA-50 tool.

Methods: We surveyed a convenience sample of 300 patients from October to November 2012 that presented to our busy, high volume, urban ED. All subjects completed the SAHLSA-50 tool and demographic form with Spanish-speaking research assistants. …

A Novel Bioinformatic Approach To Understanding Addiction, Latifa F. Jackson

Journal of Family Strengths

Finding the genetic markers that influence complex, multigenic substance addiction phenotypes has been an area of significant medical study. Understanding complex disease traits like addiction has been hampered by the lack of functional insights into novel variants to the human genome. We hypothesized that gene location plays a role in functional genomic neighborhoods.

To test whether there is a relationship between opiate, dopamine, and GABA disease and population allele frequencies, we used genes obtained from addiction literature curated by the National Center for Biotechnology Information (NCBI). These addiction and metabolism focused search terms generated opiate, dopamine, and GABA addiction results …

Illness Severity Among Non-English, Non-Spanish Speaking Patients In A Public Emergency Department, Malford T. Pillow M.D., M.Ed., Thomas Ence M.D., Tyler Dirvonas M.D., William F. Peacock M.D., Dick Kuo M.D.

Journal of Family Strengths

Background: Patients with limited English proficiency (LEP) have poor health outcomes compared to English proficient patients. Most studies on language proficiency and health disparities focus on Spanish.

Objective: This study examines whether non-Spanish speaking LEP patients experience greater disparities than Spanish speaking LEP patients by comparing disease acuity and language proficiency in an emergency department.

Design: This is a retrospective case-control study from November 2010 to February 2012 comparing differences between non-English non-Spanish (NENS) speaking patients to English speaking patients with differences between Spanish speaking and English speaking patients.

Main outcomes: Primary endpoints include the emergency severity index …

Geospatial Distribution And Population Substructure Of Subgroups Of Us Ethnic Minorities: Implications For Perpetuation Of Health Disparities And Paucity Of Precision Medicine, Hasan Jackson, Fatimah L.C. Jackson

Journal of Family Strengths

Substructure due to familial-associated divisions exists in all large populations. Geographical heterogeneity in US ethnic minorities is a function of historical, social, political, and economic factors overlaying regional geographical biodiversity. Using geospatial, historical, demographic, genetic, and epidemiological databases, we identify 40 US microethnic isolates across the US, the “minorities within ethnic minorities” and locate their geospatial distributions within the US. Key components of the environment relevant to health disparities are identified and elaborated in terms of their impact on genomics. US ethnic minority microethnic isolates often have distinct genetic and social histories from the US ethnic majority that put these …

Stigma And The Reluctance To Address Mental Health Issues In Minority Communities, Gary L. Kreps

Journal of Family Strengths

Health disparities are a serious problem for members of minority communities in the United States. Disparities do not only lead to negative influences and inequities in the outcomes from serious physical health problems (such as cancer, heart disease, HIV/AIDS, and diabetes) for members of minority communities, but also lead to significant problems with outcomes from serious mental health conditions (including stress-related, manic-depressive, and psychotic disorders, as well as suicidal tendencies) for ethnic and racial minority group members in the US. While current epidemiological evidence suggests that the actual rates of incidence of mental health problems is not significantly different across …

Factors Influencing Attendance, Postpartum Follow-Up, And Contraceptive Usage Among Teenage Centeringpregnancy® Participants, Latia Hickerson

Dissertations and Theses (Open Access)

Background: Teenage mothers are less likely to obtain postpartum examinations and contraception, increasing risks for negative social and health outcomes. The CenteringPregnancy® prenatal care model has been found to improve outcomes. However, little is known about factors influencing CenteringPregnancy® attendance or how this attendance impacts future pregnancy rates among teenagers.

Aim: The purpose of this study was to explore the association between CenteringPregnancy® attendance, postpartum return, contraception initiation and method selection. Additionally, the Group Care and Perinatal Behaviors Framework was used to assess the association between food insecurity, housing insecurity, intimate partner violence relationship status, partner group attendance and total …