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Evaluating And Monitoring Analgesia And Sedation In The Intensive Care Unit, Curtis N. Sessler, Mary Jo Grap, Michael A.E. Ramsey

Internal Medicine Publications

Management of analgesia and sedation in the intensive care unit requires evaluation and monitoring of key parameters in order to detect and quantify pain and agitation, and to quantify sedation. The routine use of subjective scales for pain, agitation, and sedation promotes more effective management, including patient-focused titration of medications to specific end-points. The need for frequent measurement reflects the dynamic nature of pain, agitation, and sedation, which change constantly in critically ill patients. Further, close monitoring promotes repeated evaluation of response to therapy, thus helping to avoid over-sedation and to eliminate pain and agitation. Pain assessment tools include self-report …

Randomized Trial Comparing Daily Interruption Of Sedation And Nursing-Implemented Sedation Algorithm In Medical Intensive Care Unit Patients, Marjolein De Wit, Chris Gennings, Wendy I. Jenvey, Scott K. Epstein

Internal Medicine Publications

Introduction

Daily interruption of sedation (DIS) and sedation algorithms (SAs) have been shown to decrease mechanical ventilation (MV) duration. We conducted a randomized study comparing these strategies.

Methods

Mechanically ventilated adults 18 years old or older in the medical intensive care unit (ICU) were randomly assigned to DIS or SA. Exclusion criteria were severe neurocognitive dysfunction, administration of neuromuscular blockers, and tracheostomy. Study endpoints were total MV duration and 28-day ventilator-free survival.

Results

The study was terminated prematurely after 74 patients were enrolled (DIS 36 and SA 38). The two groups had similar age, gender, racial distribution, Acute Physiology and …

Inflammatory And Coagulation Biomarkers And Mortality In Patients With Hiv Infection, Lewis H. Kuller, Russell Tracy, Waldo Belloso, Stephane De Wit, Fraser Drummond, H. Clifford Lane, Bruno Ledergerber, Jens Lundgren, Jacqueline Neuhaus, Daniel Nixon, Nicholas I. Paton, James D. Neaton

Internal Medicine Publications

Background

In the Strategies for Management of Anti-Retroviral Therapy trial, all-cause mortality was higher for participants randomized to intermittent, CD4-guided antiretroviral treatment (ART) (drug conservation [DC]) than continuous ART (viral suppression [VS]).

We hypothesized that increased HIV-RNA levels following ART interruption induced activation of tissue factor pathways, thrombosis, and fibrinolysis.

Methods and Findings

Stored samples were used to measure six biomarkers: high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), amyloid A, amyloid P, D-dimer, and prothrombin fragment 1+2. Two studies were conducted: (1) a nested case–control study for studying biomarker associations with mortality, and (2) a study to compare DC and …

Metformin For The Treatment Of The Polycystic Ovary Syndrome, John E. Nestler

Internal Medicine Publications

This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author’s clinical recommendations.

A 23-year-old woman with known polycystic ovary syndrome visits her family physician. She has taken oral contraceptive pills in the past but did not tolerate them and is not currently receiving any treatment. She has three or four menstrual …

Treatment Of Patients With The Hypereosinophilic Syndrome With Mepolizumab, Marc E. Rothenberg, Amy D. Klion, Florence E. Roufosse, Jean E. Kahn, Peter F. Weller, Hans-Uwe Simon, Lawrence B. Schwartz, Lanny J. Rosenwasser, Johannes Ring, Elaine F. Griffin, Ann E. Haig, Paul I. H. Frewer, Jacqueline M. Parkin, Gerald J. Gleich

Internal Medicine Publications

BACKGROUND

The hypereosinophilic syndrome is a group of diseases characterized by persistent blood eosinophilia, defined as more than 1500 cells per microliter with end-organ involvement and no recognized secondary cause. Although most patients have a response to corticosteroids, side effects are common and can lead to considerable morbidity.

METHODS

We conducted an international, randomized, double-blind, placebo-controlled trial evaluating the safety and efficacy of an anti–interleukin-5 monoclonal antibody, mepolizumab, in patients with the hypereosinophilic syndrome. Patients were negative for the FIP1L1–PDGFRA fusion gene and required prednisone monotherapy, 20 to 60 mg per day, to maintain a stable clinical status and a …

Prolonged Therapy Of Advanced Chronic Hepatitis C With Low-Dose Peginterferon, Adrian M. Di Bisceglie, Mitchell L. Shiffman, Gregory T. Everson, Karen L. Lindsay, James E. Everhart, Elizabeth C. Wright, William M. Lee, Anna S. Lok, Herbert L. Bonkovsky, Timothy R. Morgan, Marc G. Ghany, Chihiro Morishima, Kristin K. Snow, Jules L. Dienstag

VCU Health Publications

Background

In patients with chronic hepatitis C who do not have a response to antiviral treatment, the disease may progress to cirrhosis, liver failure, hepatocellular carcinoma, and death. Whether long-term antiviral therapy can prevent progressive liver disease in such patients remains uncertain.

Methods

We conducted a randomized, controlled trial of peginterferon alfa-2a at a dosage of 90 μg per week for 3.5 years, as compared with no treatment, in 1050 patients with chronic hepatitis C and advanced fibrosis who had not had a response to previous therapy with peginterferon and ribavirin. The patients, who were stratified according to stage of …

Accuracy Of Ct Colonography For Detection Of Large Adenomas And Cancers, Daniel C. Johnson, Mei-Hsiu Chen, Alicia Y. Toledano, Jay P. Heiken, Abraham Dachman, Mark D. Kuo, Christine O. Menias, Betina Siewert, Jugesh I. Cheema, Richard G. Obregon, Jeff L. Fidler, Peter Zimmerman, Karen M. Horton, Kevin Coakley, Revathy B. Iyer, Amy K. Hara, Robert A. Halvorsen Jr, Giovanna Casola, Judy Yee, Benjamin A. Herman, Lawrence J. Burgart, Paul J. Limburg

Radiology Publications

Background

Computed tomographic (CT) colonography is a noninvasive option in screening for colorectal cancer. However, its accuracy as a screening tool in asymptomatic adults has not been well defined.

Methods

We recruited 2600 asymptomatic study participants, 50 years of age or older, at 15 study centers. CT colonographic images were acquired with the use of standard bowel preparation, stool and fluid tagging, mechanical insufflation, and multidetector-row CT scanners (with 16 or more rows). Radiologists trained in CT colonography reported all lesions measuring 5 mm or more in diameter. Optical colonoscopy and histologic review were performed according to established clinical protocols …

Protocol: Streamline Cloning Of Genes Into Binary Vectors In Agrobacterium Via The Gateway® Topo Vector System, Ruqiang Xu, Qingshun Quinn Li

Anatomy and Neurobiology Publications

Background

In plant functional genomic studies, gene cloning into binary vectors for plant transformation is a routine procedure. Traditionally, gene cloning has relied on restriction enzyme digestion and ligation. In recent years, however, Gateway^® cloning technology (Invitrogen Co.) has developed a fast and reliable alternative cloning methodology which uses a phage recombination strategy. While many Gateway- compatible vectors are available, we frequently encounter problems in which antibiotic resistance genes for bacterial selection are the same between recombinant vectors. Under these conditions, it is difficult, if not sometimes impossible, to use antibiotic resistance in selecting the desired transformants. We have, …

It's About The People, Edward F. Ansello

Director's Editorials from Age in Action

The Virginia Center on Aging celebrates 30 years and the people who have made accomplishments possible.

Geriatric Training And Education (Gte) Projects, Edward F. Ansello

Director's Editorials from Age in Action

The Geriatric Training and Education (GTE) initiative is supporting 15 different projects in the current fiscal year that are affecting Virginians in each region, from certified nursing assistants to family caregivers of relatives with dementia to long-term care staff helping elders at the end of life.

Tackling Elder Abuse, Edward F. Ansello

Director's Editorials from Age in Action

The Central Virginia Training Alliance to Stop Elder Abuse, Neglect, and Exploitation was selected to pilot a three-year training initiative for criminal justice professionals on elder abuse, neglect, and exploitation. Our overall intention is to improve the expertise of each component in investigating and prosecuting maltreatment against our elders.

Priorities In A Time Of Crisis, Edward F. Ansello

Director's Editorials from Age in Action

Now, amidst economic stress, is the time to defend certain sections of the budget, including the protection of those among us who are least able.

No Wrong Door: Virginia’S Key Strategic Initiative For Long-Term Care, Molly Huffstetler

Case Studies from Age in Action

Educational Objectives

1. Describe the rationale, current activities, and vision for No Wrong Door as it pertains to seniors, adults with disabilities, and their caregivers throughout Virginia.

2. Demonstrate the positive potential for collaboration among local long-term care service providers, both public and private.

3. Illustrate the benefits of coordinating long-term care services for an individual through Virginia’s No Wrong Door.

Confident Living Program For Senior Adults Experiencing Combined Vision And Hearing Loss, Paige Berry, Mia Kelley-Bock, Christine Reid

Case Studies from Age in Action

Educational Objectives

1. Identify needs common among older adults who have combined vision and hearing loss.

2. Describe a model program that provides information, resources, and training to older adults experiencing combined vision and hearing loss.

3. Describe how the program benefits not only consumers, but also family, friends, caregivers, students, and service providers.

Making Affordable Assisted Living Work: The Mountainside Senior Living Story, Cheryl Cooper, Gordon Walker

Case Studies from Age in Action

Educational Objectives

1. Describe the challenges of providing affordable assisted living in Virginia.

2. Describe the experience of the Jefferson Area Board for the Aging (JABA), an Area Agency on Aging, in becoming owner and operator of an assisted living facility.

3. Describe the culture change that made Mountainside a unique and award-winning facility.

The Aging Together Partnership: Collaborating To Improve Quality Of Life For Older Adults, April Holmes, Chris Miller

Case Studies from Age in Action

Educational Objectives 1. Demonstrate how the Aging Together experience improves services for older adults. 2. Describe the partnership structure and participation that makes this an effective model for community services amidst demographic changes. 3. Illustrate tangible service improvements resulting from Aging Together collaborations.

Dengue Virus Pathogenesis In Mouse Central Nervous System: Studies On Host Response To Dengue Virus Infection, Juliano Bordignon, Christian Probst, Ana Luiza P. Mosimann, Vanessa Stella, Daniela Pavoni, Gregory A. Buck, Paul Fawcett, Silvio M. Zanata, Lucia Noronha, Marco Krieger, Claudia Nunes Duarte Dos Santos

Microbiology and Immunology Publications

Dengue virus (DENV) causes a self-limiting fever (DF) or severe hemorrhagic fever/shock-syndrome (DHF/DSS). Recently, clinical profile of DENV infection is changing, and neurological manifestations are becoming frequent. We previously demonstrated that mutations on E and NS3 proteins may account for DENV neurovirulence for mice. To validate the involvement of the observed mutations in the appearance of neurovirulent viral phenotypes, we constructed cDNA infectious clones encompassing the observed mutations. Aiming to determine host response to infection with neurovirulent and parental strains of DENV-1, we used a Mus musculus biochip (Virginia Commonwealth University) encompassing whole mouse genome. Newborn Swiss mice were infected …

Impaired Clearance Of Methotrexate In Organic Anion Transporter 3 (Slc22a8) Knockout Mice: A Gender Specific Impact Of Reduced Folates, Adam L. Vanwert, Douglas H. Sweet

Pharmaceutics Publications

Purpose

To elucidate the role of the renal basolateral transporter, Oat3, in the disposition of methotrexate.

Materials and Methods

Chinese hamster ovary cells expressing mouse Oat3 were used to determine kinetics and specificity of inhibition of methotrexate transport. Methotrexate clearance was then examined in vivo in wildtype and Oat3 knockout mice.

Results

NSAIDs, ß-lactams, and uremic toxins inhibited mOat3-mediated methotrexate uptake by 70–100%, while folate, leucovorin, and 5-methyltetrahydrofolate inhibited transport by 25–50%. A Km of 60.6±9.3 μM for methotrexate transport was determined. Oat3 knockout mice exhibited reduced methotrexate-to-inulin clearance ratios versus wildtype. Male wildtype mice, but not knockouts or …

Virginia Commonwealth University Graduate And Professional Programs Bulletin [2008], Virginia Commonwealth University

VCU Bulletins

Graduate and professional programs bulletin for Virginia Commonwealth University for the academic year 2008-2009. It includes information on academic regulations, degree requirements, course offerings, faculty, academic calendar, and tuition and expenses for graduate programs.

Annual Higher Ground Women's Leadership Conference 2008, The Grace E. Harris Leadership Institute At Virginia Commonwealth University

The Grace E. Harris Leadership Institute Publications

No abstract provided.

Virginia Commonwealth University Undergraduate Bulletin Courses [2008], Virginia Commonwealth University

VCU Bulletins

Listing of undergraduate courses for 2008-2009.

Genome-Wide Association Identifies A Common Variant In The Reelin Gene That Increases The Risk Of Schizophrenia Only In Women, Sagiv Shifman, Martina Johannesson, Michal Bronstein, Sam X. Chen, David A. Collier, Nicholas J. Craddock, Kenneth S. Kendler, Tao Li, Michael C. O'Donovan, F. Anthony O'Neill, Michael J. Owen, Dermot Walsh, Daniel R. Weinberger, Cuie Sun, Jonathan Flint, Ariel Darvasi

Psychiatry Publications

Sex differences in schizophrenia are well known, but their genetic basis has not been identified. We performed a genome-wide association scan for schizophrenia in an Ashkenazi Jewish population using DNA pooling. We found a female-specific association with rs7341475, a SNP in the fourth intron of the reelin (RELN) gene (p = 2.9 × 10−5 in women), with a significant gene-sex effect (p = 1.8 × 10−4). We studied rs7341475 in four additional populations, totaling 2,274 cases and 4,401 controls. A significant effect was observed only in women, replicating the initial result (p = 2.1 × 10−3 in …

Virginia Commonwealth University Undergraduate Bulletin [2008], Virginia Commonwealth University

VCU Bulletins

Undergraduate bulletin for Virginia Commonwealth University for the academic year 2008-2009. It includes information on academic regulations, degree requirements, course offerings, faculty, academic calendar, and tuition and expenses for undergraduate programs.

Sequence And Structural Evolution Of The Ksga/Dim1 Methyltransferase Family, Heather Colleen O'Farrell, Zhili Xu, Gloria M. Culver, Jason P. Rife

Medicinal Chemistry Publications

Background One of the 60 or so genes conserved in all domains of life is the ksgA/dim1 orthologous group. Enzymes from this family perform the same post-transcriptional nucleotide modification in ribosome biogenesis, irrespective of organism. Despite this common function, divergence has enabled some family members to adopt new and sometimes radically different functions. For example, in S. cerevisiae Dim1 performs two distinct functions in ribosome biogenesis, while human mtTFB is not only an rRNA methyltransferase in the mitochondria but also a mitochondrial transcription factor. Thus, these proteins offer an unprecedented opportunity to study evolutionary aspects of structure/function relationships, especially with …

The X-Ray (2008)

The X-Ray (MCV, 1913-2010)

The yearbook of the Medical College of Virginia.

Virginia Dental Journal (Vol. 85, No. 4, 2008)

Virginia Dental Journal

No abstract provided.

Virginia Dental Journal (Vol. 85, No. 1, 2008)

Virginia Dental Journal

No abstract provided.

Virginia Commonwealth University Commencement Program [2008], Virginia Commonwealth University

VCU Commencement Programs

No abstract provided.

Virginia Commonwealth University Fall Commencement Program [Corrected Copy] [2008], Virginia Commonwealth University

VCU Commencement Programs

No abstract provided.

Bridging The Gaps: Building A University Link Tank, Grace E. Harris Leadership Institute, Virginia Commonwealth University, Christian Barrett, James Frazier, Dale Jones, Kelly Lockeman, Brigitte Sicat, Donna Steigleder, Linda Zyzniewski

L. Douglas Wilder School of Government and Public Affairs Publications

This project proposed a University Link Tank as a mechanism by which to build bridges between employees via a network of small groups. Participation in the Link Tank would be voluntary and open to all VCU and Health System employees. The program would be modeled similarly to the Faculty Learning Community (FLC) program, which is administered by the Center for Teaching Excellence, but it would concentrate on issues that are not specifically related to teaching. Topics will be proposed annually. The program would also concentrate on effectively utilizing existing VCU resources to resolve issues.