Medicine and Health Sciences Commons^™

Systemic Vascular Dysregulation And Retinal Microvascular Alterations In Glaucoma, Amin Ibrahim, Tori Sayers, Alexa Nichols, Igor Zwir, Andrew Tsin, Lorena Flores-Hernandez, Gladys E. Maestre, Jesus D. Melgarejo

Research Colloquium

Background: Glaucoma is a multifactorial, progressive optic neuropathy, for which both mechanical and vascular mechanisms of pathogenesis have been proposed. Optical coherence tomography angiography (OCTA) enables noninvasive visualization of the choroidal and retinal vasculature and may be used to quantify vascular changes associated with glaucoma. Systemic risk factors, including variations in blood pressure (BP), whether low or elevated, have been associated with the vascular pathogenesis of glaucoma. This systematic review aims to synthesize the current evidence on the relationship between systemic vascular dysregulation and OCTA-derived retinal vascular markers in glaucomatous eyes.

Methods: Following PRISMA guidelines, we conducted a systematic search …

Treatment Evolution In Paroxysmal Nocturnal Hemoglobinuria: A Case Series Of Sequential Treatment Versus Early Iptacopan Use, Alyssa L. Sepulveda, Ronald Shaju, Yolanda Gutierrez, Francisco Arias Reyes, Daniela Hernandez

Research Colloquium

Introduction: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired hematopoietic stem cell disorder characterized by complement-mediated intravascular hemolysis, bone marrow failure, and a heightened risk of thrombosis. Prior to targeted therapies, management of PNH was largely supportive, focusing on transfusions, anticoagulation, and bone marrow transplantation. Thromboembolic events were the leading cause of mortality, accounting for approximately 40-67% of deaths prior to the introduction of complement inhibitors such as eculizumab, a monoclonal antibody targeting terminal complement protein C5. In December 2023, iptacopan, an oral factor B inhibitor that targets the alternative complement pathway, was approved for PNH, offering improved patient compliance …

Predictors Of All-Cause In-Hospital Mortality In Patients With Malignant Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors, Elvis Obomanu, Tarfa Verinumbe, Tinsae Anebo, Colton Jones, Claudia Dourado

Einstein Health Papers

BACKGROUND: Factors influencing in-hospital mortality in patients with well-differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs) remain understudied, highlighting gaps in optimizing acute clinical outcomes. This study aimed to identify sociodemographic and clinical predictors of all-cause in-hospital mortality in this population.

METHODS: Using 2016 - 2020 data from the National Inpatient Sample (NIS), patients with malignant well-differentiated GEP-NETs were identified via the International Classification of Diseases, 10th Revision (ICD-10) codes. The primary outcome was in-hospital mortality. Sociodemographic and clinical variables (heart failure (HF), malnutrition, Charlson Comorbidity Index (CCI), and tumor site) were analyzed using multivariable logistic regression.

RESULTS: Among 5,642 patients (mean age …

Impact Of Tricuspid Regurgitation On The Clinical Outcomes Of Patients With Heart Failure, Muhammad U. Almani, Rasha Khan, Noor Fatima, Muhammad Yousuf, Aman Amanullah

Einstein Health Papers

BACKGROUND: Tricuspid regurgitation (TR) is a common occurrence in patients with heart failure (HF), and its role in disease progression has gained attention in recent years. Although TR can worsen clinical outcomes in HF patients, the impact of gender, racial, and socioeconomic factors remains largely unexplored. With growing evidence supporting the role of percutaneous interventions for the treatment of significant TR, understanding these disparities is more crucial than ever.

METHODS: Data were extracted from the National Inpatient and National Readmission 2016-2020 Databases. We used ICD-10 code I50 to identify the patients primarily admitted for HF and subdivided the cohort into …

Bard1: A Friend Or Foe In Pancreatic Ductal Adenocarcinoma?, Lily Zekavat, Aditi Jain

Department of Surgery Faculty Papers

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive solid malignancy with poor overall prognosis and limited response to standard treatments. Growing interest in the modulation of DNA repair mechanisms, including the homologous recombination (HR) repair pathway, has opened new avenues for therapeutic development. BARD1 (BRCA1-Associated RING Domain 1) plays a complex role in tumor biology, functioning either as a tumor suppressor or as an oncogenic driver, depending on isoform expression, cellular context, and regulatory environment. In this review, we examine the dual roles of BARD1, focusing on its regulation and paradoxical activities in PDAC. We summarize evidence that BARD1 and BARD1 …

Artificial Intelligence In Head And Neck Cancer: Towards Precision Medicine., Jacob Hagen, Logan Hornung, William Barham, Supratik Mukhopadhyay, Ada Bess, Kevin Contrera, Kevin Contrera, Devraj Basu, Vlad Sandulache, Guillaume Spielmann, Sagar Kansara

School of Medicine Faculty Publications

Simple Summary: This review was conducted to highlight current and potential applications of artificial intelligence (AI) in the care of patients with head and neck cancer, the barriers to its clinical implementation, and the relative scarcity of research in this field. While AI has demonstrated success in other areas of oncology, its role in head and neck cancer remains limited, with progress slowed by technical, ethical, and logistical challenges. Nevertheless, integrating AI with multiomics approaches presents a promising opportunity to advance precision medicine in this patient population. The findings presented in this manuscript may encourage further multi-institutional studies aimed at …

Interplay Between Admission And Early Postpartum Blood Pressure And Risk Of Postpartum Readmission For Hypertension, Juan C. Naranjo, J. Hunter Collins, Elizabeth F. Sutton

School of Medicine Faculty Publications

No abstract provided.

A Single Center Study Of The Symbol Digit Modalities Test As A Screening Tool For Cognitive Impairment In Parkinson’S Disease, Daniyell Thomason, Morganne Manuel, Shannin Moody, Jesus Lovera, Brain Copeland, Deidre Devier

School of Medicine Faculty Publications

Background: Parkinson’s Disease (PD) can include physical signs and possibly cognitive impairment, resulting from the convergence of pathologicalprocesses involving dopaminergic dysfunction, accumulation ofalpha-synuclein, cholinergic deficits, and disruption of otherneurotransmitter systems. We used screening tests to evaluate thecharacteristics of cognitive performance in patients with PD and to assess their validity compared tothe Montreal Cognitive Assessment (MoCA). Methods: This is a natural history study of participants with PD and controls screened for possible cognitive impairment using the MoCA, Symbol Digit Modalities Test (SDMT), and King-Devick (KD). The groups were compared on performance and then factors associated with cognitive performance (age, diagnosis, and …

Barriers To And Strategies For Improved Treatment Adherence In Vitiligo: A Systematic Review, Lauren Gawey, Aditya Joshi, Muhammad Rahman, Tyler Hernandez, Krishna Babaria, Roshni Sabhaya, Debbie Wang, Raveena Ghanshani, Jennifer L. Hsiao, Vivian Y. Shi

School of Medicine Faculty Publications

No abstract provided.

Artificial Intelligence In Head And Neck Cancer: Towards Precision Medicine, Jacob Hagen, Logan Hornung, William Barham, Supratik Mukhopadhyay, Adam Bess, Kevin Contrera, Devraj Basu, Vlad Sandulache, Guillaume Spielmann, Sagar Kansara

School of Medicine Faculty Publications

Over the past 20 years, the capabilities of artificial intelligence (AI) have gained significant interest. While AI has been implemented to various degrees in several disciplines, its unique applications in head and neck cancer (HNC) remain underdeveloped. This narrative review examines the existing body of literature regarding the use of AI in HNC. Studies to date have demonstrated AI’s utility across multiple phases of the HNC treatment continuum. Despite its promise, integrating AI into clinical practice faces several challenges, including concerns about system integrity, generalizability, privacy, and bias. In this review, we address these challenges and offer insights into future …

Early Definitive Fusion Versus Magnetic Growing Rods In "Tweeners": What Do Parents Prefer?, Sylvia Culpepper, Ravi Rajendra, Brett Lullo, Anthony A. Catanzano, Tyler C. Mcdonald, R Carter Clement

School of Medicine Faculty Publications

INTRODUCTION: In treating early-onset scoliosis (EOS), pediatric orthopaedic surgeons and families must often choose between growth-friendly interventions such as magnetically controlled growing rods (MCGR) and early definitive posterior spinal fusion (PSF). While each strategy has associated pros and cons, little is understood about the specific preferences of patients' families. Addressing potential nuances in these preferences is crucial for meaningful shared decision-making (SDM). To better understand the factors influencing family decisions, we conducted a choice-based conjoint (CBC) analysis to explore parents' preferences for PSF and MCGR as treatment options. METHODS: A survey was developed using Sawtooth Software (Lighthouse Studio version 9.2.0) …

The Predilection Of Specific Diseases To Affect Different Sections Of The Esophagus, Monjur Ahmed

Division of Gastroenterology and Hepatology Faculty Papers

Certain esophageal diseases have a predilection for affecting different parts of the esophagus. This predilection is noted in our clinical practice as we investigate various esophageal diseases using multiple imaging and motility studies, as well as endoscopic procedures with biopsies. Clinical presentations vary with the stage and location of the disease. Clinicians can suspect certain diseases when a particular part of the esophagus is involved and then can perform appropriate investigations. Esophageal diseases with section involvement, with their symptomatology, diagnostic tests, and management, have been discussed in this narrative review. This review aims to revisit those diseases with a current …

Reaching International Consensus On The Definition Of Refractory Migraine Using The Delphi Method, Jennifer Robblee, Fawad A. Khan, Michael J. Marmura, Hope L. O'Brien, Lawrence D. Robbins, Marielle K. Samaha, Morris Levin, Simona Sacco, Raffaele Ornello, Stephanie J. Nahas, Heike Hesse, Annika Ehrlich, Adam S. Sprouse-Blum, Christina Sun-Edelstein, Bronwyn Jenkins, Elizabeth K, Seng, Shivang Joshi, Meredith J. Barad, Mi Ji Lee, Sheena K. Aurora, Mario Fernando Prieto Peres

Department of Neurology Faculty Papers

Aim: Despite its frequency in tertiary headache centers, the International Classification of Headache Disorders, 3rd edition (ICHD-3) does not include refractory migraine. Multiple definitions have been proposed with a recent 2020 proposal for both refractory migraine and resistant migraine by the European Headache Federation (EHF). The aim is to reach an international consensus on the definition of refractory migraine.

Methods: This study is a Delphi consensus carried out by a group of international experts in headache medicine. Following a focus group, a panel of 20 experts and one facilitator reviewed the EHF proposed criteria to build upon their definitions. The …

Redefining The Albumin-Bilirubin Score: Predictive Modeling And Multidimensional Integration In Liver And Systemic Disease, Berkay Demirors, Ramin Shekouhi, Paola Berrios Jimenez, Anjali Yadav, Guido Chiriboga, Vishal A. Mahesh, Harsheen K. Manaise, Jade Bowers, Angel Aguayo Merly, Emmanuel Gabriel

School of Medicine Faculty Publications

This editorial comment is on the article by Xu et al. It offers an in-depth analysis of liver function assessment tools and their prognostic roles in non-malignant liver diseases, with a focus on the albumin-bilirubin (ALBI) score. ALBI’s components, grading system, and clinical relevance across various liver conditions are reviewed and compared with traditional models such as the Child-Pugh and model for end-stage liver disease scores. We included recent studies evaluating ALBI’s role in estimating liver function, suggesting it may help differentiate patients who appear similar under other staging systems, and assist in guiding clinical decisions. Although ALBI is primarily …

Isolated Transaminitis As A Sentinel Sign Of Duchenne Muscular Dystrophy In An Infant: A Case Report, Ayesha Khalid, Tuba Chaudhry, Ayesha Liaqat, Lauren Tufts

School of Medicine Faculty Publications

Duchenne muscular dystrophy (DMD) is an X-linked recessive muscular dystrophy (MD) that typically presents after ambulation due to progressive proximal muscle weakness. The average age of diagnosis is 4.83 years. However, there are some subtle signs that can help in early diagnosis and delay the progression of the disease. We present a non-classical DMD case in a six-month-old infant with failure to thrive, persistent emesis, transaminitis, and truncal weakness, leading to an early diagnosis of DMD. Initial workup for failure to thrive was unremarkable, other than persistently elevated liver enzymes aspartate aminotransferase (AST) and alanine transaminase (ALT) with normal alkaline …

Study Of Clinical And Bacteriological Profile Of Culture-Positive Neonatal Sepsis At A Tertiary Care Hospital, Qudsiya Ansari, Vaibhav Pawar, Kailas Randad, Poonam Wade

Digital Journal of Clinical Medicine

Background: Neonatal sepsis is a significant global health challenge, leading to substantial morbidity and mortality among neonates. Its clinical manifestations and causative agents show regional and temporal variations, necessitating localized studies to guide effective management. This study aimed to assess the clinical features, bacteriological profile, and antimicrobial resistance patterns in culture-positive neonatal sepsis at a tertiary NICU. Methods: This retrospective observational study analyzed records of 131 inborn neonates with culture-proven sepsis admitted between April 2019 and March 2020. Data on demographic characteristics, clinical presentations, causative organisms, and treatment outcomes were examined. Antibiotic susceptibility patterns were also evaluated. Results: Of the …

Practice Patterns In The Management Of Pemphigus – An International Survey Study, Idy Tam, Gabriela Cobos, Zachary M. Schwager, Erin X. Wei

The Lahey Journal

Introduction: Anti-CD20 therapy (rituximab) has emerged as an effective and disease modifying treatment for pemphigus, especially in early disease. However, significant variability exists around the clinical application of this therapy.

Methods: In this survey-based study among bullous disease experts, we investigated practice patterns surrounding the use of rituximab in the management of pemphigus. Anonymized surveys were sent to physician members of the internation Pemphigus and Pemphigoid Foundation. Topics of inquiry included the use of rituximab first line in newly diagnosed pemphigus, rituximab dosing regimen, use of concomitant steroid sparing agents, criteria for retreatment, and the use of antimicrobial prophylaxis.

Results: …

Opposing Synovial Cannabinoid Receptor Type 2 And Transient Receptor Potential Vanilloid 1 Expression In Painful Osteoarthritis, Collin A. Toups, Lauren G. Guillot, Kaitlyn Redondo, Sydney Jensen, Jennifer Klein, Luis Marrero

School of Medicine Faculty Publications

Knee osteoarthritis (kOA) poses a major health challenge worldwide, but current non-surgical treatments have limited long-term success and do not address the underlying disease process. This study explores the complex relationship between the endocannabinoid system (ECS) and the endovanilloid system (EVS) in the synovial membrane of patients with kOA undergoing total knee replacement, focusing on how these systems relate to patient-reported pain and histological synovitis. Synovial tissues and fluid from patients grouped into high and low pain categories based on the Knee Injury and Osteoarthritis Outcome Score (KOOS) were examined for cannabinoid receptor type 2 (CB2R), transient receptor potential vanilloid …

Targeting Kinin B1r Attenuates Hypertension Through At1r-Dependent Mechanisms, Drew Theobald, Riley N. Bessetti, Yumei Feng Earley, Eric Lazartigues, Karen Litwa, Srinivas Sriramula

School of Medicine Faculty Publications

BACKGROUND: Neurogenic hypertension is chronically high blood pressure that is initiated and maintained through excessive sympathetic nervous system activity and has been associated with increased B1R (kinin B1 receptor) activation. We previously reported a central role for B1R in mediating inflammatory pathways in the development of deoxycorticosterone acetate salt hypertension. Additionally, we identified a causal relationship between B1R expression after Ang II (angiotensin II) stimulation, and that B1R can mediate the bidirectional interaction between neuroinflammation and oxidative stress. However, whether there are any interactions between AT1R (Ang II-type I receptor) and B1R, and if B1R can mediate the effects of …

Nevus Sebaceous Of Jadassohn With Secondary Cystic Papillary Hidradenoma, Jordan A. Book, Rosemary Prejean, Jonathan M. Joseph, Nicholas Culotta, Christopher Haas

School of Medicine Faculty Publications

Nevus sebaceous of Jadassohn (NS) is a congenital cutaneous hamartoma that typically presents at birth as a plaque on the face, scalp, or neck. While NS is associated with a risk of neoplastic transformation, the majority of secondary tumors are benign, with the most common being trichoblastomas and syringocystadenomas. In this report, we present a rare case of a 63-year-old male with a right parietal scalp NS with a secondary cystic papillary hidradenoma (HP), which is a benign tumor that almost exclusively occurs in the perineal region. Histopathologic examination was consistent with NS, revealing hyperkeratosis, parakeratosis, increased sebaceous glands, ectopic …

Optimization Of Spinal Cord Perfusion Pressure For Improvement Of Neurological Outcome In Traumatic Spinal Cord Injury: A Systematic Review And Meta-Analysis, Gabrielle E. Hovis, Brandon Sherrod, Nitin Agarwal, Berje H. Shammassian, Anthony M. Digiorgio, Ramesh Grandhi, Bryce Picton

School of Medicine Faculty Publications

The optimal hemodynamic management of traumatic spinal cord injury (tSCI) is not well established. We performed a systematic review and meta-analysis of patients with acute tSCI to assess the role of lumbar cerebrospinal fluid drainage (CSFD) and to identify factors predictive of neurological improvement. Three studies involving 46 patients with acute tSCI, lumbar drain placement with CSFD, and available pre- and post-intervention American Spinal Injury Association (ASIA) Impairment Scale or International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor scores were identified. One study was analyzed separately (Cohort A) using ASIA grade because post-intervention ISNCSCI motor scores were …

A Novel Sialylation Pathway Mediated By Extracellular Vesicles In Aggressive Prostate Cancer, Camila A. Bach, Md Niamat Hossain, Ishan J. Chaudhari, Cecilia E. Verrillo, Nicole M. Naranjo, Isabella Amoroso, Anna Testa, Samuel Sey, W. Kevin Kelly, Susan L. Bellis, Aurelio Lorico, Ada G. Blidner, Gabriel A. Rabinovich, Lucia R. Languino

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

Altered cell surface glycosylation is a hallmark of cancer; among aberrant glycan structures, hypersialylated proteins contribute to disease progression. The enzyme ST6 β-galactoside α2,6-sialyltransferase 1 (ST6GAL1) mediates α2,6-linked sialylation of N-glycosylated proteins and is upregulated in many cancers, including prostate cancer (PrCa). We propose that ST6GAL1 may be released by cancer cells in small extracellular vesicles (sEVs) in the PrCa tumor microenvironment to potentially modulate cell surface sialylation in recipient cells. We isolated sEVs from PrCa cells by density gradient separation and characterized them by nanoparticle tracking analysis using ZetaView and immunoblotting analysis. We identified ST6GAL1 in both its membrane-bound …

Spatial-Temporal Variation Of Diarrhea Among Children Under 5 Years Old Between 2010-2020 In Rwanda, Amans Ntakarutimana Dr., Patrick A. Tschida Dr., Elias Nyandwi Dr.

Journal of Social, Behavioral, and Health Sciences

We used secondary data from the Rwanda Demographic and Health Surveys of 2010, 2015, and 2020 to assess the spatial-temporal variation of diarrhea among children under 5 years old between the years 2010 and 2020 in Rwanda. Stratified descriptive statistics, pairwise comparisons, and logistic regression designs were used for data analysis in SPSS. A statistically significant variation of diarrhea among children under 5 years old was observed across districts, regions, and urban–rural areas but not at the national level between 2010–2020. Some districts of the Western region, including Nyabihu (OR = 2.5), Ngororero (OR = 2.3), and Karongi …

Modeling Musculoskeletal Combat Casualty Care: Nato Trauma System Performance In Large Scale Combat Operations, Mark P. Cote, Kaitlyn E. Holly, Roman J. Schoenfeld, Matthew R. Bryan, Malina O. Hatton, Mitchel B. Harris, Tracey P. Koehlmoos, Andrew J. Schoenfeld

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: It is unclear whether the current North Atlantic Treaty Organization (NATO) trauma system will be effective in the setting of Large-Scale Combat Operations (LSCO). We sought to model the efficacy of the NATO trauma system in the setting of LSCO. We also intended to model novel scenarios that could better adapt the current system to LSCO.

METHODS: We developed a discrete-event simulation model for patients with combat musculoskeletal injuries treated within the standard NATO system. The primary outcome of the model was survival. The model's health states were characterized as stable, hypovolemia, sepsis, shock, or death. The model simulated …

Debunking Myths: Sickle Cell Trait, Crises & Sudden Death, Michael R. Debaun, Corey J. Hebert, Yvette Marie Miller

School of Medicine Faculty Publications

No abstract provided.

Return To Sport And Performance Outcomes After Hand Fractures In Professional Baseball Players, Ryan W. Paul, Sean M. Wilson, Gaston Davis, Amit Syal, Steven B. Cohen

Rothman Institute Papers

BACKGROUND: About 7% of injuries in the Major League Baseball (MLB) involve the hand. Fractures of the hand are not uncommon in professional baseball players while fielding or from being hit by a pitch while batting; however, the outcomes of professional baseball players treated both operatively and nonoperatively are unclear.

PURPOSE/HYPOTHESIS: The purpose of this study was to report the return-to-sport (RTS) rate, RTS time, and performance outcomes in professional baseball position players who sustained a hand fracture. The secondary purpose was to compare outcomes between positions and between operatively versus nonoperatively treated players. It was hypothesized that there would …

Standardizing Assessment Of Open Vascular Skills: National Roll-Out And Early Impact Of The Fundamentals Of Vascular Surgery Curriculum, Yana Etkin, Kristyn Mannoia, Pail Dimusto, Libby Weaver, Khalil Qato, Gabriela Velazquez, Malachi Sheahan

School of Medicine Faculty Publications

Background: Exposure to open vascular case is declining in surgical training, creating a need for standardized, objective assessment of fundamental open skills. The Association of Program Directors in Vascular Surgery developed the Fundamentals of Vascular Surgery (FVS) curriculum to teach and assess three core skills—end-to-side anastomosis, patch angioplasty, and clockface precision suturing. This study describes FVS development and validation, nationwide rollout, and early implementation experience across U.S. training programs. Methods: A multiphase project was conducted: (1) validation (2012–2019) of the 3 FVS tasks with 313 trainees scored by trained raters using OSATS checklists and global rating scales; reliability and construct …

High Energy Consumption Characterizes Abnormal Brain State Transitions In Temporal Lobe Epilepsy, Sam S. Javidi, Qirui Zhang, Ankeeta Ankeeta, Michael R. Sperling, Joseph I. Tracy

Farber Institute for Neuroscience Faculty Papers

Temporal lobe epilepsy (TLE) patients experience shifts between non-seizing and seizing brain states, but the structural networks underlying these transitions remain undefined and poorly characterized. We detected dynamic brain states in resting-state fMRI and constructed linked structural networks utilizing multi-shell diffusion-weighted MR data. Leveraging network control theory, we interrogated the structural data for all possible brain state transitions, identifying those requiring abnormal levels of transition energy (low or high) in TLE compared to matched healthy participants (n's = 25). Results revealed three transitions requiring significantly higher energy in TLE; no abnormally low-energy transitions were observed. In HPs, transitions relied on …

Increased Risk Of Postoperative Complications In Patients With Hypertension Undergoing Mohs Micrographic Surgery, Alexandra Elder, Henry Yang, Megan O'Donnell-Capelli, Jenna Mandel, Molly Wallace, Lauren Banner, Ramsay Hafer, Thomas Rohan, Neda Nikbakht

Department of Dermatology and Cutaneous Biology Faculty Papers

Hypertension has been previously associated with higher intraoperative bleeding risk in patients undergoing Mohs micrographic surgery. However, the risks of common postoperative Mohs micrographic surgery complications have not been substantiated by large studies. Our study aimed to assess the risks of common Mohs micrographic surgery complications for patients with hypertension utilizing the TriNetX database, a global health records database encompassing over 105 million patients' data, from January 2009 to January 2024. After 1:1 propensity score matching for age, sex, race, diabetes, nicotine dependence, obesity, and anticoagulant use, the final analysis included 80,739 patients in each cohort of patients with hypertension …

Evidence-Based Best Practices For Diabetes Education And Self-Care In Appalachia: A Literature Review, Angela J. Occidental, Inga M. Zadvinskis, Jacqueline Hoying

Journal of Appalachian Health

Introduction: The Appalachian Region has a higher prevalence of type 2 diabetes mellitus (T2DM) and associated adverse health outcomes. Although numerous papers report best practices for diabetes care and education, a clinician-friendly, synthesized summary of best practices tailored to Appalachian cultural preferences is lacking.

Purpose: This paper uses the Melnyk & Fineout-Overholt evidence-based framework to identify the best practices for T2DM care and education for Appalachian residents.

Methods: A comprehensive literature search using the databases CINAHL, Academic Search Complete, and PubMed was guided by a PICOT question. Quality appraisals were completed for fifty-two articles; thirty papers were selected to synthesize …