Medicine and Health Sciences Commons^™

Thirty-Three Years Of Dizzy Medical Writing And Editing: A Meta-Analysis And The Hall Of Shame, Herbert L Fred, Mark S Scheid

The Texas Heart Institute Journal

No abstract provided.

Long-Term Follow-Up Study Of Temporary Tricuspid Valve Detachment As Approach To Vsd Repair Without Consequent Tricuspid Dysfunction, Gianluca Lucchese, Lucia Rossetti, Giuseppe Faggian, Giovanni B Luciani

The Texas Heart Institute Journal

Temporary tricuspid valve detachment improves the operative view of certain congenital ventricular septal defects (VSDs), but its long-term effects on tricuspid valve function are still debated.

From 2002 through 2012, we performed a prospective study of 68 children (mean age, 1.28 ± 1.01 yr) who underwent transatrial closure of VSDs following temporary tricuspid valve detachment. Sixty patients had conoventricular and 8 had mid-muscular VSDs. All were in sinus rhythm. Seventeen patients had systemic pulmonary artery pressures. Preoperative echocardiograms showed trivial-to-mild tricuspid regurgitation in 62 patients and tricuspid dysplasia with severe regurgitation in 6 patients. Patients were clinically and echocardiographically monitored …

Quality Improvement And Safety In Healthcare: Reflections On Essential Frameworks To Guide Applied Scholarship That Promotes Transformation And Innovation, Angelo P. Giardino Md, Phd, Mph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The publication of the inaugural issue of the Journal of Nursing and Interprofessional Leadership in Quality and Safety (JONILQS) is a unique milestone that is the culmination of visionary leadership, scholarly effort, and keen attention to the many tasks necessary to launch a journal. The University of Texas Health Science Center at Houston’s School of Nursing launches this journal to address the focus on quality and safety initiatives and research that helps to make the health care we provide safer and better. This journal seeks to highlight practical work from the field that will change things for the better for …

Developing The Improving Post-Event Analysis And Communication Together (Impact) Tool To Involve Patients And Families In Post-Event Analysis, Madelene J. Ottosen Phd, Rn, Emily W. Sedlock Mph, Aitebureme O. Aigbe Drph, Jason M. Etchegaray Phd, Sigall K. Bell Md, Thomas H. Gallagher Md, Eric J. Thomas Md, Mph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The analysis of harmful errors is typically led by a team within the hospital and includes clinicians and staff who were involved at the time of the event. However, the patient and family are often left out of this process and are not asked to participate in the investigation. Because little guidance is available for facilitating patient input, an interprofessional team convened to develop a semi-structured tool to be used in eliciting patient feedback. Some 72 persons who had experienced adverse events were interviewed. Using a thematic analysis approach, the team learned that 51% of the interviewees preferred to participate …

An Assessment Of The Human Papillomavirus Immunization Knowledge, Practices, And Prevention Among A Cohort Of Urban College Students, Nancy H. Busen Phd, Fnp-Bc, Aprn, Robert G. Hanks Phd, Rn, Fnp, Aprn, Eileen R. Giardino Phd, Rn, Aprn, Fnp, Stanley Cron Msph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Human papillomavirus (HPV) is the most common sexually transmitted disease, yet little is known about the college-age knowledge and prevention practices related to HPV. Although sample vaccination rates mirrored national known vaccination rates, a majority of participants did not complete the three dose vaccine schedule. HPV knowledge was similar between males and females while males were more likely to engage in preventative practices. This information can help healthcare providers reinforce vaccination schedule and prevention practices.

From The Editors-In-Chief, Joanne V. Hickey Phd, Rn, Acnp, Faan, Fccm, Eileen R. Giardino Phd, Rn, Aprn, Fnp

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Co-editors in chief welcome The Journal of Nursing & Interprofessional Leadership in Quality and Safety to state what the purpose of the journal is and why it is important for this journal to start.

Implementation Of A Comprehensive Clinical Toolkit For Postpartum Depression Screening: Breaking Barriers In Women's Health Care, Liza C. Rivera Dnp, Msn, Aprn, Whnp-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A quality improvement initiative to increase screening of postpartum women to detect depression and appropriately refer women screening positive for follow-up care was implemented in an obstetrics and gynecology practice. Physicians in the practice (n = 13) completed an educational module on use and benefits of a toolkit and showed a significant post test increase. Review of patient medical charts found a significant increase in screening rate in an 8-week intervention cycle. Through means of establishing a protocol for appropriate referral for follow-up, the goal of referring 50% of women who screened positive was exceeded.

The Future Of Healthcare Delivery: Ipe/Ipp Audiology And Nursing Student/Faculty Collaboration To Deliver Hearing Aids To Vulnerable Adults Via Telehealth, Robert E. Novak Ph.D, Asha Fellow, Adelita Gonzales Cantu Phd., Rn, Amanda Zappler Aud, Laura Coco Aud, Craig A. Champlin Phd, Asha Fellow, Julie C. Novak Dnsc, Rn, Faanp, Faan

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A multi-departmental, two-city initiative to provide hearing aid service via a telepractice approach was developed whereby nursing and auditory students with supervisory faculty used AV conferencing for training and interaction with referred patients. Located in two cities, 21 nursing and 15 doctoral level audiology students met virtually, and students received teleaudiology education and practicum with interprofessional education and practice components. Nursing students in one city and a supervising faculty in another city could interact with providers and patients in both cities to provide hearing care. The teleaudiology project delivered hearing health care services, including fitting of digital mini hearing aids, …

Datagauge: A Model-Driven Framework For Systematically Assessing The Quality Of Clinical Data For Secondary Use, Jose Franck Diazvasquez

Dissertations and Theses (Open Access)

There is growing interest in the reuse of clinical data for research and clinical healthcare quality improvement. However, direct analysis of clinical data sets can yield misleading results. Data Cleaning is often employed as a means to detect and fix data issues during analysis but this approach lacks of systematicity. Data Quality (DQ) assessments are a more thorough way of spotting threats to the validity of analytical results stemming from data repurposing. This is because DQ assessments aim to evaluate ‘fitness for purpose’. However, there is currently no systematic method to assess DQ for the secondary analysis of clinical data. …

The Power Of Reasoning: How Student Nurses Develop Confidence In Reasoning, Michael F. Brown

Dissertations and Theses (Open Access)

Background

Clinical Reasoning (CR) is the intellectual capacity to understand the value of patient data related to current knowledge, skills, and experiences within a dynamic domain of patient care with reflective analysis relating the new experience and understanding into new knowledge to be applied in future clinical situations. Poorly developed CR skills inhibit effective problem-solving abilities of nursing students producing levels of unexpected confusion and loss of confidence impeding their adaptability and effectiveness in dynamic healthcare environments. This study explored the effectiveness of human patient simulation (HPS) as an innovative method to facilitate the development of CR in undergraduate nursing …

Repetitive, Pre-Anesthetic Fasting And Malnutrition In A Pediatric Oncology Population Undergoing Radiation Therapy, Laura P. Santibáñez

Dissertations and Theses (Open Access)

Background: Pediatric oncology patients often experience nutritional status changes, particularly malnutrition, which may adversely affect their outcomes. Although the consequences of malnutrition are elucidated, its causes remain unclear. A possible cause of malnutrition in pediatric oncology patients is repetitive, pre-anesthetic fasting prior to non-invasive procedures and treatments, such as anesthesia-assisted radiation therapy (AART). This exploratory study investigated the association between repetitive, pre-anesthetic fasting and non-fasting days and malnutrition in pediatric oncology patients receiving AART.

Procedure: A retrospective cohort of 138 pediatric oncology patients (£ 10 years of age) who received any type of radiation therapy (RT) with or without anesthesia …

Treatment Recidivism In Adolescents With Mental Illness: A Focused Applied Medical Ethnography, Chukwudi C. Ekwemalor

Dissertations and Theses (Open Access)

Background

Treatment recidivism, described as frequent unplanned relapse readmissions, is a national problem predominant in adolescents with mental illness with significant socioeconomic consequences. Adolescents living with mental illness are a sub-culture of adolescence, the critical growth period of developmental and social transition from childhood to adulthood. The main triggers of treatment recidivism in this population are not fully understood from previous studies.

Purpose

The study purpose was to explore treatment recidivism with the following aims:

1. To illuminate treatment recidivism from the perspectives of recidivist adolescents with mental illness.

2. To describe the main factors that contribute to treatment recidivism …

Experiences Of Stress And Coping Over Time By Caregivers Of Stroke Survivors: A Mixed-Methods Approach, Fang Ye

Dissertations and Theses (Open Access)

Background/ Objectives: Caregivers of stroke survivors often experience physical and mental stress, decreased physical and emotional well-being, high burden of care, social isolation, and neglecting self-care. The majority of previous research studies have identified caregiver experiences during the first one-to-two years post stroke. Little is known about caregiver experiences beyond the first two years of the post- stroke recovery trajectory, indicating a need for longitudinal study of their experiences over time. Therefore, the objectives of this study were to 1) investigate caregiver experiences of stress and coping over 5-7 years post stroke using quantitative methods, and 2) explore through …

Role Of Stress And Social Resources On Biomarkers And Fatigue In Staff Nurses: A Biobehavioral Approach, Mona Cockerham

Dissertations and Theses (Open Access)

Purpose

Consecutive 12-hr workdays can contribute to increased stress and fatigue and negative biological responses in nurses, potentially compromising quality of patient care and safety. The primary purpose of this study was to assess changes in stress, fatigue, and biological responses (salivary cortisol and alpha-amylase) over three consecutive 12-hr workdays in acute care nurses and how stress and social resources function in predicting fatigue and biological responses.

Methods

In a prospective study, 81 acute care nurses completed questionnaires and provided saliva samples four times: pre-shifts and post-shifts of day 1 and day 3.

Results

Although stress and biological responses did …

Influences On Self-Care In Women With Heart Failure: A Pilot Study, Joy Corcione

Dissertations and Theses (Open Access)

Background: Heart Failure self-care becomes exceedingly difficult to perform as the disease progresses; therefore social support becomes important in facilitating heart failure self-care. Woman with heart failure represent a significant and growing vulnerable population. Women tend to have lower self-confidence in providing self-care, experience greater negative emotions, decreased social support, experience more adverse psychosocial factors affecting self-care and experience greater psychosocial adversity than do men. Self-care is vital in managing heart failure and social support greatly facilitates self-care behaviors.

Purpose: The purpose of this pilot study was to gain a deeper understanding about the sources of perceived social support and …

Mechanistic And Functional Characterization Of B And T Lymphocyte Attenuator (Btla) In Cd8 Tumor Infiltrating Lymphocytes, Krit Ritthipichai

Dissertations and Theses (Open Access)

This dissertation project focused on understanding the functional role of BTLA on CD8⁺ Tumor Infiltrating Lymphocytes (TIL) from metastatic melanoma patients. Clinical trials of adoptive T-cell therapy (ACT) using autologous ex vivo expanded TIL have demonstrated the great potential of this immunotherapy with an overall clinical response rate 40-50% for stage IV metastatic melanoma patients. We have investigated a number of biomarkers in both the infused TIL and the tumor microenvironment for their association with clinical response. Surprisingly, a subset of CD8⁺ TIL expressing the co-inhibitory molecule BTLA (B-and-T lymphocyte attenuator) was highly associated with clinical response, while …

Identifying Treatment Planning System Errors In Iroc-Houston Head And Neck Phantom Irradiations, James Kerns

Dissertations and Theses (Open Access)

Treatment Planning System (TPS) errors can affect large numbers of cancer patients receiving radiation therapy. Using an independent recalculation system, the Imaging and Radiation Oncology Core-Houston (IROC-H) can identify institutions that have not sufficiently modelled their linear accelerators in their TPS model. Linear accelerator point measurement data from IROC-H’s site visits was aggregated and analyzed from over 30 linear accelerator models. Dosimetrically similar models were combined to create “classes”. The class data was used to construct customized beam models in an independent treatment dose verification system (TVS). Approximately 200 head and neck phantom plans from 2012 to 2015 were recalculated …

Bias And Variability In Image-Based Volumetric Yttrium-90 Dosimetry, Wendy Siman

Dissertations and Theses (Open Access)

90Y-microsphere therapy has been widely accepted as a treatment option for both primary and metastatic liver tumors where the patients are ineligible for surgical resection and external beam radiation therapy. The prognosis of untreated patient having liver cancer is very poor with life expectancy less than a year at advance stage. Hence the ability to predict treatment efficacy right after the treatment from post-therapy imaging will help personalize treatment strategies and achieve better outcome. Such prediction can be modeled from correlation of dose and tumor response metrics.

It has been shown that local dose deposition method can generate dose map …

Circumventing Cisplatin Resistance In Ovarian Cancers Through Reactivation Of P53 By Non-Cross-Resistant Platinum Analogs, Michelle Martinez-Rivera

Dissertations and Theses (Open Access)

Abstract

CIRCUMVENTING CISPLATIN RESISTANCE IN OVARIAN CANCERS THROUGH REACTIVATION OF P53 BY NON-CROSS-RESISTANT PLATINUM ANALOGS

Michelle Martinez-Rivera, B.S.

Advisory Professor: Zahid H. Siddik, Ph.D.

Cisplatin (cis-Pt), an anticancer platinum (Pt) drug, is used widely in the treatment of several malignancies, such as ovarian cancer. This Pt compound induces DNA damage, which results in p53 activation through post-translational modifications, mainly phosphorylation, culminating in execution of programmed cell-death. However, despite initial therapeutic response to cis-Pt, clinical resistance to this drug emerges leading to disease progression. Pt-resistance phenotypes have been associated with dysfunction in the p53 signaling pathway. Therefore, an effort to understand …

Determining Mechanisms Of Response To Polo-Like Kinase 1 Inhibition In Non-Small Cell Lung Cancer, Ruchitha Goonatilake

Dissertations and Theses (Open Access)

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death worldwide. The discovery of genetic alterations in some patients (~15%) has made it possible to use targeted therapies without the use of chemotherapy. To identify potential therapeutic targets in NSCLC, we systematically evaluated two cancer cell line databases with sensitivity data for a broad range of drugs. We identified polo-like kinase 1 (Plk1) as the most promising target for further investigation based on a subset of sensitive cell lines and inhibitors that were in advanced clinical development. To identify potential biomarkers of response and mechanisms of Plk1 inhibitor-induced …

Regulation Of Breast Cancer Initiation And Progression By 14-3-3zeta, Chia-Chi Chang

Dissertations and Theses (Open Access)

14-3-3ζ is a ubiquitously expressed family member of proteins that have been implicated to have oncogenic potential through its interactions and involvement in cancer initiation and progression. 14-3-3ζ belongs to the highly conserved 14-3-3ζ protein family and modulates numerous pathways in cancer. Overexpression of 14-3-3ζ is an early event, occurs in more than 40% of human breast cancer cases, and is associated with disease recurrence and poor prognosis. Metabolic reprogramming is a hallmark of cancer. Cancer cells elevate aerobic glycolysis to produce metabolic intermediates and reducing equivalents, thereby facilitating cellular adaptation to the adverse environment and sustaining fast proliferation. Interestingly, …

Underuse Of Oral Anticoagulants For Nonvalvular Atrial Fibrillation: Past, Present, And Future, Ramsey M Wehbe, Ajay Yadlapati

The Texas Heart Institute Journal

No abstract provided.

Periodontitis In Chronic Heart Failure, Hanna Fröhlich, Kristina Herrmann, Jennifer Franke, Alamara Karimi, Tobias Täger, Rita Cebola, Hugo A Katus, Christian Zugck, Lutz Frankenstein

The Texas Heart Institute Journal

Periodontal disease has been associated with an increased risk of cardiovascular events. The purpose of our study was to investigate whether a correlation between periodontitis and chronic heart failure exists, as well as the nature of the underlying cause.

We enrolled 71 patients (mean age, 54 ± 13 yr; 56 men) who had stable chronic heart failure; all underwent complete cardiologic and dental evaluations. The periodontal screening index was used to quantify the degree of periodontal disease. We compared the findings to those in the general population with use of data from the 4th German Dental Health Survey.

Gingivitis, moderate …

Association Between High Endocardial Unipolar Voltage And Improved Left Ventricular Function In Patients With Ischemic Cardiomyopathy, Ki Park, Dejian Lai, Eileen M Handberg, Lem Moyé, Emerson C Perin, Carl J Pepine, R David Anderson

The Texas Heart Institute Journal

We know that endocardial mapping reports left ventricular electrical activity (voltage) and that these data can predict outcomes in patients undergoing traditional revascularization. Because the mapping data from experimental models have also been linked with myocardial viability, we hypothesized an association between increased unipolar voltage in patients undergoing intramyocardial injections and their subsequent improvement in left ventricular performance.

For this exploratory analysis, we evaluated 86 patients with left ventricular dysfunction, heart-failure symptoms, possible angina, and no revascularization options, who were undergoing endocardial mapping. Fifty-seven patients received bone marrow mononuclear cell (BMC) injections and 29 patients received cell-free injections of a …

A Phase I Dose-Escalation Study Of The Braf Inhibitor Vemurafenib In Combination With The Mtor Inhibitor Everolimus In Subjects With Advanced Cancer, Javier Munoz

Dissertations and Theses (Open Access)

Vemurafenib has been approved in the United States for the treatment of relapsed or refractory BRAF mutation positive malignant melanoma and is being investigated in various other malignancies. The RAS/RAF/MEK/ERK (MAPK) pathway is critical to cell proliferation in many human cancers. The mTOR inhibitors are well known to exert profound anticancer effects across malignancies through inhibition of the PTEN/PI3K/AKT/mTOR (mTOR) pathway. We hypothesize that the toxicity profile of the combination of vemurafenib and everolimus will be well tolerated. The primary objective is to find the maximum tolerated dose (MTD) and the toxicity of the combination of vemurafenib and everolimus following …

The Impact Of Cortical State On Neural Coding And Behavior, Charles Beaman

Dissertations and Theses (Open Access)

The brain is never truly silent – up to 80% of its energy budget is expended during ongoing activity in the absence of sensory input. Previous research has shown that sensory neurons are not exclusively influenced by external stimuli but rather reflect interactions between sensory inputs and the ongoing activity of the brain. Yet, whether fluctuations in the state of cortical networks influence sensory coding in neural circuits and the behavior of the animal are unknown. To shed light on this issue, we conducted multi-unit electrophysiology experiments in visual areas V1 and V4 of behaving monkeys. First, we studied the …

Development Of An In Silico Kir Genotyping Algorithm And Its Application To Population And Cancer Immunogenetic Analyses, Howard Rosoff

Dissertations and Theses (Open Access)

Gene content determination and variant calling in the complex KIR genomic region are useful for immune system function analysis, pathogenesis and disease risk factor elucidation, immunotherapy development, evolutionary investigations, and human migration modeling. Sequence-specific oligonucleotide and sequence-specific primer PCR methods are the de facto standards for KIR presence/absence identification, but the current platforms are unsuitable for SNP calling, impractical for KIR typing large cohorts of DNA samples, and inapplicable for typing repositories in which sequence data, but not cells or cell analytes, are available. Alternative typing methods, such as in silico sequence-based typing, can address the problems associated with amplicon-based …

Investigating The Roles Of Δnp63 As A Suppressor Of Migration, Invasion, And Metastasis, Ramon E. Flores Gonzalez

Dissertations and Theses (Open Access)

Cancer is one of the leading causes of death and disease in the world. Considerable resources are spent to study and understand cancer, with the hope of developing new treatments and eventually cures that will help millions of people. Efforts to understand cancer are hindered by its inherent complexity and instability. Nonetheless, understanding the basics of tumor development and progression are the key to focused on studying the role of ΔNp63 in cancer, a p53 family member known to be involved in epithelial development, microRNA biogenesis, and stem cell maintenance. Using the strength of in vivo mouse models, we found …

Clinical Significance Of Homologous Recombination Deficiency Score Testing In Endometrial Cancer, Jean M. Hansen

Dissertations and Theses (Open Access)

Objectives: Homologous recombination deficiency (HRD) score is related to chemotherapy response in breast and ovarian cancers. The role of HRD is unknown in endometrial cancer. We examined the relationship between HRD score and survival in a cohort of endometrial cancer patients and with tumor growth using murine orthotopic models.

Methods: TCGA was queried to determine frequency and clinical significance of alterations in the HR pathway in endometrial cancer. 137 formalin-fixed paraffin-embedded endometrioid adenocarcinoma patient samples were tested for HRD score, microsatellite instability (MSI) and high mutation load (HML) using a next generation sequencing assay targeting the coding regions of 43 …

Development Of Rational Combination Therapy With Parp Inhibitors And Kinase Inhibitors In Tnbc, Wen-Hsuan Yu

Dissertations and Theses (Open Access)

Poly (ADP-ribose) polymerase inhibitors (PARPi) emerge as potential targeting drugs for BRCA-deficient cancers including triple negative breast cancer (TNBC). However, it has been reported that a subgroup of patients even with BRCA mutation fails to respond to PARPi in multiple clinical trials. In this study, we identified c-Met, a tyrosine kinase, phosphorylates PARP1 at Y907 and that the phosphorylation increases PARP1 activity, thereby rendering cancer cells resistant to PARPi. The combination of c-Met inhibitors (METi) and PARPi has a synergistic effect for c-Met overexpressed TNBC in vitro and in vivo. In addition to c-Met, through functional analysis, we found …