Medicine and Health Sciences Commons^™

Medical Marijuana And Opioids (Memo) Study: Protocol Of A Longitudinal Cohort Study To Examine If Medical Cannabis Reduces Opioid Use Among Adults With Chronic Pain, Chinazo O. Cunningham, Joanna L. Starrels, Chenshu Zhang, Marcus A. Bachhuber, Nancy L. Sohler, Frances R. Levin, Haruka Minami, Deepika E. Slawek, Julia H. Arnsten

School of Medicine Faculty Publications

Introduction In the USA, opioid analgesic use and overdoses have increased dramatically. One rapidly expanding strategy to manage chronic pain in the context of this epidemic is medical cannabis. Cannabis has analgesic effects, but it also has potential adverse effects. Further, its impact on opioid analgesic use is not well studied. Managing pain in people living with HIV is particularly challenging, given the high prevalence of opioid analgesic and cannabis use. This study's overarching goal is to understand how medical cannabis use affects opioid analgesic use, with attention to Δ9-tetrahydrocannabinol and cannabidiol content, HIV outcomes and adverse events. Methods and …

Benchmark Project On Interactive Education Class For Osteoporosis Patients, Adrienne N. Johns

MSN Capstone Projects

Research project focusing on providing patients that have been diagnosed with osteoporosis with an non-traditional interactive educational opportunity to better their health and improve quality of life.

Nocebo-Hypothesis Cognitive Behavioral Therapy (Nh-Cbt) For Persons With Functional Neurological Symptoms (Motor Type): Design And Implementation Of A Randomized Active-Controlled Trial, Matt Richardson, Maria Kleinstäuber, Dana Wong

Psychology Faculty Publications

Introduction: Functional Neurological Symptom Disorders (FNSD) are associated with high levels of disability and immense direct and indirect health costs. An innovative interdisciplinary rehabilitation approach for individuals with functional neurological symptoms of motor type–Nocebo-Hypothesis Cognitive Behavioral Therapy (NH-CBT)—combines CBT and movement retraining with video feedback embedded in a comprehensive explanatory model of the etiology of FNSD. Methods: This protocol describes the development and implementation of a phase II, parallel group, randomized controlled trial with blinded outcome assessors to compare the efficacy of NH-CBT with an active control condition (supportive counseling and movement retraining). Individuals meeting diagnostic criteria of an FNSD …

Cpm Machine Protocol For Knee Replacements, Lacy White

MSN Capstone Projects

A benchmark project was conducted regarding the use of a CPM machine postoperatively to increase standardization of care for total knee replacement patients while also increasing the patient’s range of motion of the knee and decreasing the post-surgical pain. Over a six week period of time, each patient was given a CPM machine no later than 2 hours post op after the total knee replacement surgery and each patient was discharged after a one night stay in the hospital under observation instead of inpatient. When the patient were discharged they would be followed by a home health service who will …

Opioid Education Program, Cynthia De Atley

MSN Capstone Projects

Pain management has become a challenging field both for the patients, their families, and providers. The rise of the opioid crisis has made the availability of opioids limited, even for those patients who truly need the life changing medications. Nurses, physicians, and administrators play a vital role in patient education and the education regarding the importance of using opioids safely. Lack of patient education regarding the use, misuse, and side effects of opioids can lead to potential injuries, overdose, and even death.

Providing patients with an educational program would greatly decrease their risk of misuse and abuse of opioids. During …

Exercise To Improve Cancer-Related Fatigue, Jennifer Watson

MSN Capstone Projects

For the average patient, medical professionals typically recommend exercise to enhance the health of their patients in multiple ways. Oncology patients, however, often have different issues that the treating physicians are more concerned about, so physical activity gets placed on the back burner. The need for exercise in oncology patients is certainly a decision that should be part of an individualized treatment plan, but it is reasonable to believe that most of these patients will benefit from participating in an exercise program. With the high demanding need to decrease chemotherapy side effects and improve lives of those undergoing it, this …

Chronic Pain Treatment Strategies In Parkinson’S Disease, Amber N. Edinoff, Niro Sathivadivel, Timothy Mcbride, Allyson Parker, Chikezie Okeagu, Alan David Kaye, Adam M. Kaye, Jessica S. Kaye, Rachel J. Kaye, Meeta M. Sheth, Omar Viswanath, Ivan Urits

School of Pharmacy Faculty Articles

Neurological disorders, including Parkinson’s disease (PD), have increased in prevalence and are expected to further increase in the coming decades. In this regard, PD affects around 3% of the population by age 65 and up to 5% of people over the age of 85. PD is a widely described, physically and mentally disabling neurodegenerative disorder. One symptom often poorly recognized and under-treated by health care providers despite being reported as the most common non-motor symptom is the finding of chronic pain. Compared to the general population of similar age, PD patients suffer from a significantly higher level and prevalence of …

Restoring Functional Mobility For A Patient Following A Comminuted Patella Fracture Status Post Open Reduction Internal Fixation: A Case Report, Elaina Cosentino

Case Report Papers

Background and Purpose: The patella serves an important role in the protection and biomechanics of the knee joint. A fracture of the patella typically requires surgery and immobilization, which can have detrimental impacts on functional mobility. The purpose of this case study was to document a rehabilitation program following a comminuted patella fracture status post open reduction internal fixation (ORIF).
Case Description: The patient was a 62-year-old female who sustained a comminuted patella fracture following a traumatic fall down the stairs, and underwent ORIF to her right patella. She was prescribed a straight knee immobilizer for eight weeks leaving her …

Longitudinally Extensive Transverse Myelitis: A Sub-Saharan Conundrum, Antonina Obayo, Sylvia Mbugua, Sayed Karar

Internal Medicine, East Africa

Spinal cord schistosomiasis is a rare, underdiagnosed manifestation of schistosomiasis. We present the case of a 36-year-old male who presented to our institution with a one-week history of low back pain with rapidly progressive lower limb weakness, loss of sensation, and flaccid paraparesis. An MRI of the spine showed a longitudinally extensive transverse myelitis from T6 to L1, with enhancement at the cauda equina region. Further review of the images and serological tests eventually led to diagnosis of spinal schistosomiasis. He was treated with praziquantel and high-dose steroids, with minimal improvement in his symptoms.

Applications Of Non-Invasive Neuromodulation For The Management Of Disorders Related To Covid-19, Abrahão Fontes Baptista, Adriana Baltar, Alexandre Hideki Okano, Alexandre Moreira, Ana Carolina Pinheiro Campos, Ana Mércia Fernandes, André Russowsky Brunoni, Bashar W. Badran, Clarice Tanaka, Daniel Ciampi De Andrade, Daniel Gomes Da Silva Machado, Edgard Morya, Eduardo Trujillo, Jaiti K. Swami, Joan A. Camprodon, Katia Monte-Silva, Katia Nunes Sá, Isadora Nunes, Juliana Barbosa Goulardins, Marom Bikson, Pedro Sudbrack-Oliveira, Priscila De Carvalho, Rafael Jardim Duarte-Moreira, Rosana Lima Pagano, Samuel Katsuyuki Shinjo, Yossi Zana

Publications and Research

Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19.

Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders.

Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders.

Results: …

Effects Of Visual Referencing On Backward And Forward Treadmill Walking In Vr Environments, Rahul Soangra, Sivakumar Rajagopal

Physical Therapy Faculty Articles and Research

Backward walking is used increasingly as a rehabilitation exercise for stroke and diabetic peripheral neuropathy patients to improve strength and balance. However, it is unclear how visual referencing affects backward and forward walking. In this study, we evaluated spatiotemporal gait characteristics changes due to visual referencing while backward/forward walking. Sixteen healthy young participants were recruited in this study. All participants walked for 2 min with and without visual referencing in the virtual reality environment. While walking backward participants faced the virtual reality screen similar to forward walking, but their treadmill belt direction of movement was reversed. All participants walked at …

Chest Physiotherapy Via The Progressa Bed, Courtney Hatton Bsn, Rn, Emily Graveno Bsn, Rn, Cianael M. Paasewe Bsn, Rn, Gabrielle Schoolcraft Bsn, Rn, Caleb Shenkman Adn, Rn

Patient Care Services / Nursing

No abstract provided.

Development, Reliability And Validity Of The Safe Use Of Mobility Aids Checklist (Sumac) For 4-Wheeled Walker Use In People Living With Dementia., Susan W. Hunter, Alison Divine, Humberto Omana, Ed Madou, Jeffrey Holmes

Physical Therapy Publications

BACKGROUND: Balance and gait problems are common and progressive in dementia. Use of a mobility aid provides physical support and confidence. Yet, mobility aid use in people with dementia increases falls three-fold. An assessment tool of mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safe use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change.

METHODS: Healthcare professionals (HCP) experienced in rehabilitation of …

Proposing A New Algorithm For Premanipulative Testing In Physical Therapy Practice, Brent Harper, Daniel Miner, Harrison Vaughan

Physical Therapy Faculty Articles and Research

In the field of physical therapy, there is debate as to the clinical utility of premanipulative vascular assessments. Cervical artery dysfunction (CAD) risk assessment involves a multi-system approach to differentiate between spontaneous versus mechanical events. The purposes of this inductive analysis of the literature are to discuss the link between cervical spine manipulation (CSM) and CAD, to examine the literature on premanipulative vascular tests, and to suggest an optimal sequence of premanipulative testing based on the differentiation of a spontaneous versus mechanical vascular event. Knowing what premanipulative vascular tests assess and the associated clinical application facilitates an evidence-informed decision for …

An International Study Exploring The Experience Of Survivors Of Critical Illness As Volunteers Within Icu Recovery Services, Carly Robinson, Elizabeth Hibbert, Anthony J. Bastin, Joel Meyer, Ashley A. Montgomery-Yates, Tara Quasim, Andrew Slack, Mark E. Mikkelsen, Theodore J. Iwashyna, Kimberly J. Haines, Carla M. Sevin, Joanne Mcpeake, Leanne M. Boehm

Internal Medicine Faculty Publications

Objectives:
Many clinicians have implemented follow-up and aftercare to support patients following ICU. Some of this care is supported and facilitated by peer volunteers. There is limited contemporary work that has explicitly explored volunteer roles within ICU recovery services or the experience of volunteers undertaking these roles. We sought to explore the experience of survivors of critical illness, as volunteers, involved in ICU recovery services and understand their motivation for undertaking these roles.

Design:
Qualitative exploration using in-depth semistructured interviews. The study design used an inductive content analysis process. We also documented the roles that were adopted by volunteers in …

A One Health Framework To Estimate The Cost Of Antimicrobial Resistance, Chantal Morel, Richard Alm, Christine Årdal, Alessandra Bandera, Giacomo Bruno, Elena Carrara, Giorgio Colombo, Marlieke De Kraker, Sabiha Essack, Isabel Frost, Bruno Gonzalez-Zorn, Herman Goossens, Luca Guardabassi, Stephan Harbarth, Peter Jørgensen, Souha Kanj, Tomislav Kostyanev, Ramanan Laxminarayan, Finola Leonard, Gabriel Levy Hara, Marc Mendelson, Malgorzata Mikulska, Nico Mutters, Kevin Outterson, Jesus Rodriguez Baňo, Evelina Tacconelli, Luigia Scudeller

Faculty Scholarship

Objectives/purpose

The costs attributable to antimicrobial resistance (AMR) remain theoretical and largely unspecified. Current figures fail to capture the full health and economic burden caused by AMR across human, animal, and environmental health; historically many studies have considered only direct costs associated with human infection from a hospital perspective, primarily from high-income countries. The Global Antimicrobial Resistance Platform for ONE-Burden Estimates (GAP-ON€) network has developed a framework to help guide AMR costing exercises in any part of the world as a first step towards more comprehensive analyses for comparing AMR interventions at the local level as well as more harmonized …

Evaluation Of Semi-Quantitative Compared To Quantitative Cultures Of Tracheal Aspirates For The Yield Of Culturable Respiratory Pathogens - A Cross-Sectional Study, Salima Rattani, Joveria Farooqi, Ghazala Jabeen, Saeeda Chandio, Qaiser Kash, Aijaz Khan, Kauser Jabeen

Department of Pathology and Laboratory Medicine

Background: Diagnosis of lower respiratory tract infections (LRTI) depends on the presence of clinical, radiological and microbiological findings. Endotracheal suction aspirate (ETSA) is the commonest respiratory sample sent for culture from intubated patients. Very few studies have compared quantitative and semi-quantitative processing of ETSA cultures for LRTI diagnosis. We determined the diagnostic accuracy of quantitative and semi-quantitative ETSA culture for LRTI diagnosis, agreement between the quantitative and semi quantitative culture techniques and the yield of respiratory pathogens with both methods.
Methods: This was a cross-sectional study conducted at the Aga Khan University clinical laboratory, Karachi, Pakistan. One hundred and seventy-eight …

A Protocol For A Randomized Controlled Trial Investigating The Safety And Cost-Effectiveness Of Outpatient Total Hip Arthroplasty, Bryn O. Zomar, Jacquelyn D. Marsh, Brent A. Lanting, Dianne M. Bryant

Bone and Joint Institute

© 2020 The Author(s). Background: A significant proportion of the overall cost of total hip arthroplasty (THA) results from the inpatient hospital stay following the procedure. Considering the substantial and increasing number of these procedures performed annually, shifting to an outpatient model of care where the patient is discharged home the same day as their surgery represents a potential for significant cost savings. The potential significant impact of an outpatient care model on constrained healthcare budgets and lack of high-quality evidence regarding its effectiveness warrants a rigorous comparative trial. The purpose of this prospective, randomized controlled trial is to evaluate …

The Short-Term Effects Of Thoracic Transverse Mobilization In Patients With Subacromial Shoulder Pain, Hannah Descoteaux Spt, Kyle Morris Spt, Sarah Taketa Spt, Robert Boyles Pt, Dsc, Ocs, Faaompt

Physical Therapy Research Symposium

Background: There is evidence that thoracic manipulation is effective for treating subacromial shoulder pain (SSP). However, evidence is limited for thoracic mobilization. Manipulation is not safe for all patients; therefore, effects of thoracic mobilization on SSP needs to be researched further.

Purpose: To measure the effects of thoracic spine transverse mobilization (TSTM) and a home exercise in patients with SSP immediately after treatment, and 48 hours later. Shoulder range of motion (ROM), shoulder pain, and patient perception of treatment effects were assessed.

Methods: This is a single treatment pretest/posttest design consisting of eight patients (five females, three males; mean age …

A Consensus Guide To Using Functional Near-Infrared Spectroscopy In Posture And Gait Research, Jasmine C. Menant, Inbal Maidan, Lisa Alcock, Emad Al-Yahya, Antonio Cerasa, David J. Clark, Eling D. De Bruin, Sarah Fraser, Vera Gramigna, Dennis Hamacher, Fabian Herold, Roee Holtzer, Meltem Izzetoglu, Shannon Lim, Annette Pantall, Paulo Pelicioni, Sue Peters, Andrea L. Rosso, Rebecca St George, Samuel Stuart, Roberta Vasta, Rodrigo Vitorio, Anat Mirelman

Physical Therapy Publications

Background: Functional near-infrared spectroscopy (fNIRS) is increasingly used in the field of posture and gait to investigate patterns of cortical brain activation while people move freely. fNIRS methods, analysis and reporting of data vary greatly across studies which in turn can limit the replication of research, interpretation of findings and comparison across works.

Research question and methods: Considering these issues, we propose a set of practical recommendations for the conduct and reporting of fNIRS studies in posture and gait, acknowledging specific challenges related to clinical groups with posture and gait disorders.

Results: Our paper is organized around three main sections: …

Appraisal Of Clinical Practice Guideline: Shoulder Pain And Mobility Deficits: Adhesive Capsulitis, Sanaa A. Alsubheen, Joy C. Macdermid

Bone and Joint Institute

No abstract provided.

Correspondence: Reply To Hadidi Et Al, Vanitha Arumugam, Joy C. Macdermid

Bone and Joint Institute

No abstract provided.

Regulation, Quality Reporting And Third-Party Certification Of Healthcare Providers, Amir Jahan Khan, Muhammad Ashar Malik

Community Health Sciences

The newly established provincial healthcare commissions in Pakistan have started certification of healthcare providers. The policy-makers perceive that without third-party certification or licencing the healthcare quality will be suboptimal in the country. This paper reviews the current literature on third-party certification and studies objectives and progress of the largest healthcare commission in Pakistan. It analyses the certification role of the Punjab Healthcare Commission and draw lessons for future regulation and strengthening of the quality reporting process. It also documents the short-term and long-term trade-off resulting from the enforcement of quality certification in the absence of appropriate alternative investment in medical …

Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes., Eric O Klineberg, Peter G Passias, Gregory W Poorman, Cyrus M Jalai, Abiola Atanda, Nancy Worley, Samantha Horn, Daniel M Sciubba, D Kojo Hamilton, Douglas C Burton, Munish Chandra Gupta, Justin S Smith, Alexandra Soroceanu, Robert A Hart, Brian Neuman, Christopher P Ames, Frank J Schwab, Virginie Lafage

Articles, Abstracts, and Reports

STUDY DESIGN: Retrospective review of prospective database.

OBJECTIVE: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes.

METHODS: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 >weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], …

Risk Of Knee Osteoarthritis Associated With High Heel Use, Emily Carlson

WWU Honors College Senior Projects

The objective of this study is to summarize literature regarding the relationship between high heel use and development of knee osteoarthritis. Knee osteoarthritis is a progressively degenerative disease commonly observed in women with well documented biological and environmental risk factors. Deviations in walking mechanics caused by walking in high heels result in compressive forces on the medial aspect of the knee joint consistent with degenerative changes in the cartilage indicative of knee osteoarthritis. Frequent high heel wearing may also degrade the knee joint capsule, resulting in pain. Due to genetic predisposition, women are already at high risk for knee osteoarthritis …

A Pilot Evaluation Of Simulation-Based Interprofessional Education For Occupational Therapy, Speech Pathology And Dietetic Students: Improvements In Attitudes And Confidence, Brennen Mills, Sara Hansen, Charn Nang, Helen Mcdonald, Philippa Lyons-Wall, Jacqui Hunt, Therese O’Sullivan

Research outputs 2014 to 2021

Many higher education institutions struggle to provide interprofessional practice opportunities for their pre-licensure students due to demanding workloads, difficulties with timetabling, and problems with sourcing suitable placements that provide appropriate practice opportunities. A series of complex unfolding video-based simulation scenarios involving a patient who had experienced a stroke was utilized as a case study for a three-hour interprofessional practice workshop. 69 occupational therapy (OT), speech pathology (SP) and dietetics (DT) students participated in a mixed-methods study comparing interprofessional attitudes before and after the workshop. Attitudes toward interprofessional practice improved pre- vs. post-workshop and overall. Students were highly satisfied with the …

Defining Pain And Interference Recovery Trajectories After Acute Non-Catastrophic Musculoskeletal Trauma Through Growth Mixture Modeling, Joshua Y. Lee, David M. Walton, Paul Tremblay, Curtis May, Wanda Millard, James M. Elliott, Joy C. Macdermid

Bone and Joint Institute

© 2020 The Author(s). Background: Recovery trajectories support early identification of delayed recovery and can inform personalized management or phenotyping of risk profiles in patients. The objective of this study was to investigate the trajectories in pain severity and functional interference following non-catastrophic musculoskeletal (MSK) trauma in an international, mixed injury sample. Methods: A prospective longitudinal cohort (n = 241) was formed from patients identified within four weeks of trauma, from attendance at emergency or urgent care centres located in London, ON, Canada, or Chicago, IL, USA. Pain interference was measured via the Brief Pain Inventory (London cohort) or the …

The Story Behind The Ontario Health Insurance Plan And Its Impact On The Public Sector, Marvin L. Simner

History Publications

The Ontario Health Insurance Plan is a provincially supported health care program that required fifteen years to develop and emerged though seven distinct and frequently controversial stages. It was said at the time to have generated more heated debate in the House than any other legislation that previously had been approved by the provincial government. The purpose of this report is to provide a comprehensive review of these seven stages, the arguments that accompanied each stage, and the impact of the stages on the local community. In the final section we discuss how certain elements in these stages, if known …

Impact And Mortality Of Covid-19 On People Living With Dementia: Cross-Country Report, Aida Suárez-González, Gill Livingston, Lee Fay Low, Suzanne Cahill, Niamh Hennelly, Walter D. Dawson, Wendy Weidner, Martina Bocchetta, Cleusa P. Ferri, Jordi A. Matias-Guiu, Multiple Additional Authors

Institute on Aging Publications

This report brings together international evidence on the impact of the COVID-19 pandemic on people living with dementia and an overview of international policy and practice measures to mitigate the impact of COVID-19 among people living with dementia.

Key Findings

• We have collected data on impact and mortality of COVID-19 in people living with dementia in 9 countries: The United Kingdom (UK), Spain, Ireland, Italy, Australia, the United States (US), India, Kenya and Brazil.
• The share of people whose deaths were linked to COVID-19 in care homes who had dementia ranges from 29% to 75% across those countries. Within countries, …

Pediatric Sjs-Ten: Where Are We Now?, Michele Ramien, Jennifer Goldman

Manuscripts, Articles, Book Chapters and Other Papers

Stevens-Johnson syndrome and toxic epidermal necrolysis are rare severe blistering skin reactions triggered by medications or infections. Over the last 5 to 10 years, a number of important publications have advanced understanding of these diseases and their response to treatment. Importantly, a subset of patients with disease triggered by infection has been identified as having Mycoplasma pneumoniae-induced rash and mucositis, suggesting a reconsideration of the diagnostic paradigm. We present an update on pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis in the broader context of cutaneous adverse drug reactions and focus on challenges and recent advances in diagnosis, management, and prevention.