Medicine and Health Sciences Commons^™

Understanding The Context Of Balanced Scorecard Implementation: A Hospital-Based Case Study In Pakistan., F Rabbani, Sabrina Nh Lalji, Farhat Abbas, Sm Wasim Jafri, Junaid A. Razzak, Naheed Nabi, Firdous Jahan, Agha Ajmal, Max Petzold, Mats Brommels, Goran Tomson

Section of Urology

Background: As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Methods: Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs …

Oncolog, Volume 56, Number 03, March 2011, Bryan Tutt, Joe Munch

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Glioblastoma Cure Remains Elusive Despite Treatment Advances: Aggressive surgery followed by radiation therapy and chemo-therapy offers hope of long-term survival for some patients with glioblastoma, but for most glioblastoma patients, the prognosis is poor
• Assessing and Addressing the Biological Effects of Stress in Cancer Patients: Stress has long been linked to cancer progression. But the precise mechanisms by which stress exacts its pro-tumor effects are not fully understood
• MD Anderson One of Four Centers to Test Cancer Cell Detection Chip: A new test that could monitor the effectiveness of cancer treatment
• HOUSE CALL: Yoga and Tai Chi: Two distinct disciplines …

Research To Practice: The Influential Role Of The Job Developer: Increasing Self-Determination And Family Involvement During The Job Search, Jaimie Ciulla Timmons, Ashley Wolfe

Research to Practice Series, Institute for Community Inclusion

Job developers can influence decision-making during the job search and placement process. For a study exploring the employment decisions of people with intellectual and/or developmental disabilities (IDD), researchers interviewed 16 individuals with IDD, their family members, and professionals involved in their job search. Participants were asked what factors, circumstances, or people affected their decisions about work. The job developer was consistently named the most influential person in the job-search process.

Report On The Chelsea School Nursing Program, Edward J. Collins, Jr. Center For Public Management, University Of Massachusetts Boston

Edward J. Collins Center for Public Management Publications

At the request of the Chelsea Public Schools, the Collins Center conducted an analysis of the school health services delivery system. The research included: (1) Review of City and School documents, (2) Interviews and on‐site visits, (3) Review of related research, and (4) Conversations with other experts. Like most urban school systems, Chelsea is facing the challenges of increased educational, social, and health care needs of its students and dwindling financial resources. Despite this, it was clear that the nurses and staff care deeply about their work and the children they serve. An innovative and cooperative network within each school …

Gastric Malt Lymphoma: A Rarity, Shahid Pervez, Naureen Ali, Hina Aaqil, Khalid Mumtaz, Syed Siddiq Ullah, Nake Akhtar

Department of Pathology and Laboratory Medicine

Association of Helicobacter pylori (H. Pylori) infection with gastric 'Mucosa Associated Lymphoid Tissue' (MALT) lymphomas (MALTomas) is well established. In this study the frequency and characteristics of gastric MALToma over a period of 18 years was evaluated. During this period 24 patients with gastric MALToma were diagnosed; out of them, 13 (54.2%) had active H. Pylori infection. The mean and median age was 49.7 and 53.5 years. The male: female ratio was 17:7. The common presenting complaints were epigastric pain (n=10) and dyspepsia (n=9). Endoscopic findings revealed mild gastric hyperemia (n=16), superficial erosions (n=4) and superficial ulcers (n=4). It was …

Activation Of The Basolateral Membrane Cl- Conductance Essential For Electrogenic K+ Secretion Suppresses Electrogenic Cl- Secretion, Quanhua He, Susan T. Halm, Jin Zhang, Dan R. Halm

Neuroscience, Cell Biology & Physiology Faculty Publications

Adrenaline activates transient Cl^--secretion and sustained K⁺-secretion across isolated distal colonic mucosa of guinea pig. The Ca⁺⁺-activated Cl^- channel inhibitor CaCCinh-A01 [30μM] significantly reduced electrogenic K⁺-secretion, detected as short-circuit current (I_sc). This inhibition supported the cell model for K⁺-secretion in which basolateral membrane Cl^- channels provide an exit pathway for Cl^- entering the cell via Na⁺/K⁺/2Cl^--cotransporters. CaCCinh-A01 inhibited both I_sc and transepithelial conductance in a concentration dependent manner, IC₅₀ = 6.3 μM. GlyH-101, another Cl^- channel …

The Impact Of Bisphenol A And Triclosan On Immune Parameters In The U.S. Population, Nhanes 2003–2006, Erin M. Rees Clayton, Megan Todd, Jennifer B. Dowd, Allison E. Aiello

Publications and Research

Background: Exposure to environmental toxicants is associated with numerous disease outcomes, many of which involve underlying immune and inflammatory dysfunction.

Objectives: To address the gap between environmental exposures and immune dysfunction, we investigated the association of two endocrine-disrupting compounds (EDCs) with markers of immune function.

Methods: Using data from the 2003–2006 National Health and Nutrition Examination Survey, we compared urinary bisphenol A (BPA) and triclosan levels with serum cytomegalovirus (CMV) antibody levels and diagnosis of allergies or hay fever in U.S. adults and children ≥ 6 years of age. We used multivariate ordinary least squares linear regression models to examine …

Triggers Of Blood Transfusion In Percutaneous Nephrolithotomy, Ali Akbar Zehri, Syed Raziuddin Biyabani, Khurram Muthair Siddiqui, Amanullah Memon

Section of Urology

Objective: To determine the triggers of blood transfusion in patients undergoing percutaneous nephrolithotomy (PCNL).
Study Design: Observational study.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 1988 to 2007.
Methodology: The percutaneous surgery database was retrospectively reviewed to identify patients with postoperative haemorrhage and need for blood transfusion. Blood loss was estimated by the postoperative drop in haemoglobin factored by the quantity of any blood transfusion. Various patients and procedure-related factors were assessed for association with total blood loss or blood transfusion requirement using stepwise univariate, forward multivariate regression analysis.
Results: A total of 326 procedures …

Maternal Health Behaviours During Pregnancy In An Irish Obstetric Population And Their Assocations With Socio-Demographic And Infant Characteristics, Roslyn Tarrant, Katherine Younger, Margaret Sheridan-Pereira, John Kearney

Articles

Objectives: To examine the prevalence and combined occurrence of peri-conceptional folic acid (FA) supplement use, smoking and alcohol consumption during pregnancy in a sample of women in Dublin, and determine the factors associated with these health behaviours.

Subjects/Methods: A prospective observational study (2004-2006) involving the recruitment of 491 pregnant women from antenatal clinics in a Dublin maternity hospital, with postpartum follow-up of 450 eligible mothers. Data on FA use, maternal smoking and alcohol consumption patterns during pregnancy were collected from the antenatal patient-administered questionnaire, which was completed by participants, and returned to the investigator on the day of recruitment. …

Implementing Integrated Primary And Behavioral Healthcare Within A Housing First Program, Lara C. Weinstein, Md, Benjamin Henwood, Lcsw

Department of Family & Community Medicine Presentations and Grand Rounds

At Pathways to Housing-Philadelphia, mental health services to support consumers' independent living are delivered through Assertive Community Treatment (ACT) teams. ACT is an evidence-based mental health intervention known to reduce psychiatric hospitalization and increase housing stability. ACT team members include social workers, substance abuse, counselors, nurses, and psychiatrists, with ideal staff to client ratios of 1 to 10. Through a novel collaboration between the program and the Deparment of Family and Community Medicine at Thomas Jefferson University, a primary-care physician was embedded into the ACT services to form an integrated health-care team.

Approximation Of Anterolateral Curvature Of Lumbar Vertebra, Ben A. Friesem

Biomedical Engineering

The study of lateral interbody lumbar spinal surgery and designing an optimal intervetebral device is a complex endeavor. Interbody spinal fusion is performed for a variety of clinical situations, including back pain, vertebral fractures, and tumor conditions that require stabilization of the vertebral segments. The fundamental goal of spinal fusion is to attain a solid fixation at the implant-vertebral interface.
            Replacement of a degenerated vertebral disc with an artificial intervertebral disc (AID) is currently possible, but poses problems mainly in the force distribution through the vertebral column. Data on the intervertebral disc space geometry will provide a better fit of …

Relationship Between Self-Stigma And Personal Empowerment Among People Who Have Severe Mental Illness, Diane Fischer Hickman Phd

Dissertations

The purpose of this study was to examine the relationship between self-stigma of mental illness and personal empowerment among people who have a severe mental illness. It had been hypothesized that self-stigma of mental illness and personal empowerment are at opposite end of a continuum. As such, individuals who perceive themselves in a stigmatized manner tend to reciprocally perceive themselves as being relatively powerless, rather than having a strong sense of personal empowerment. Likewise, individuals who perceive themselves as having a relatively strong sense of personal empowerment tend to experience a low degree of self-stigma. To test this hypothesis, a …

The Pulmonologist's Role In Caring For Pregnant Women With Regard To The Reproductive Risks Of Diagnostic Radiological Studies Or Radiation Therapy., Robert Brent

Department of Pediatrics Faculty Papers

Radiography of the chest, head, neck, teeth, or extremity exposes the embryo or ovary to insignificant exposures of radiation except when radionuclides are utilized. In some instances, there is no exposure at all. Pulmonologists are fortunate with regard to the specific studies they request to provide clinical care because most of the diagnostic tests do not directly expose the uterus (embryo) or ovary. This article discusses radiation risks and their evaluation and pregnancy-related issues in diagnostic radiological studies.

Mental Health Problems Of New Thai Army Recruits In Phra Mongkutklao Hospital, P Khantong, C. Nimnuan

Chulalongkorn Medical Journal

Problem/Background : Mental illness in Thai army privates has increased during last year. This problem costs the military a lot of health care budget. The researcher was therefore, interested to study mental health problems of the new Thai army recruits so that the obtained data can be used in promoting and preventing their mental health problems. Objective : To study mental health problems and related factors of the new Thai army recruits at Phra Mongkutklao Hospital in 2009. Research Design : Cross-sectional descriptive study. Setting : Phra Mongkutklao Hospital. Materials and Methods : The participants were 220 new Thai army …

Urological Involvement In Renal Transplantation., Daniel D Sackett, Pooja Singh, Costas D Lallas

Department of Urology Faculty Papers

Historically, urologists were the primary surgeons in renal transplantation. Specialization and increased complexity of the field of transplantation, coupled with a de-emphasis of vascular surgical training in urology, has created a situation where many renal transplants are carried out by surgeons with a general surgery background. Because of its genitourinary nature, however, urological input in renal transplantation is still vital. For living donors, a urologist should be involved to help evaluate and prepare certain patients for eventual donation. This could involve both medical and surgical intervention. Additionally, urologists who carry out living donor nephrectomy maintain a sense of ownership in …

Epidermal Growth Factor Receptor Overexpression In Resected Pancreatic Cancer, Amit Mahipal, Mary J. Mcdonald, Agnieszka Witkiewicz, Brian I. Carr

Department of Medical Oncology Faculty Papers

Conclusions:

Membrane EGFR overexpression is associated with poorer clinical outcomes in patients with pancreatic cancer receiving adjuvant therapy post resection.

Cytoplasmic EGFR overexpression is not associated with clinical outcomes.

Year In Review, Scott A. Waldman, Andre Terzic

Department of Pharmacology and Experimental Therapeutics Faculty Papers

If examination of journal performance is a surrogate for the vitality of a discipline, the continued ascension of Clinical Pharmacology and Therapeutics (CPT) bodes well for the evolution and practice of human therapeutics in this decade. CPT has excelled as the authoritative, cross-disciplinary journal in experimental and clinical medicine devoted to publishing advances in the nature, action, efficacy and evaluation of therapeutics in humans. Building on a foundation that established the core tenets, and a framework providing the structural integrity for the field, CPT was conceived by visionary precedent editors and editorial teams who were themselves leaders of …

Tuberculous Pericardial Abscess With Impending Pericardial Effusion And Cardiac Tamponade, Saulat H. Fatimi, Faheem-Ul-Haq, Fatima Jalil, Marium Muzaffar, Hashim Muhammad Hanif

Section of Cardiothoracic Surgery

The case of a 59 year male with acute tuberculous pericardial abscess who presented with cough, dyspnoea, haemoptysis, signs of Tamponade and a large Pleural Effusion is reported. Performing Pericardiocentesis did not improve his symptoms hence he was subjected to surgery. Acute tuberculous pericardial abscess was the diagnosis made after histopathology which was successfully managed with sternotomy along with drainage of pus.

Igf2 Promotes Activation Of Estrogen Receptors In Basal-Like Breast Cancer Cells, Angelique Richardson

Loma Linda University Electronic Theses, Dissertations & Projects

The autocrine-paracrine effects of IGF2 are important in the growth and differentiation of normal breast. In breast cancer (BC), IGF2 is initially stimulated by estrogen, progesterone and prolactin to regulate proliferation and cancer progression. These actions are mediated by the IGF-1R and insulin receptor A (IR-A) both members of the tyrosine- kinase receptors family. The activation of Estrogen Receptor (ER) is also very important in BC growth and progression. As BC progresses to estrogen-independent growth, the IGF-1R and the estrogen receptor (ER) interact in crosstalk mechanisms that are synergistic and results in enhanced activation of both receptors signaling cascades. This …

The Effects Of Consumption Of California Dried Mission Figs On Serum Lipid Concentrations In Hyperlipidemic Adults, Joycelyn M. Peterson

Loma Linda University Electronic Theses, Dissertations & Projects

Background: The National Cholesterol Education Program and American Heart Association have recommended the use of functional or cholesterol-reducing foods, some categories of which include viscous or soluble fibers, soy protein, plant sterols, and nuts, as aids to reduce serum cholesterol concentrations. Figs are a rich source of viscous fiber and antioxidants. Fig consumption has not been studied in regard to effects in reducing serum lipid concentrations. In previous pilot data, increasing fig consumption for six weeks among volunteers was found to be feasible.

Objective: To evaluate the effect of the consumption of California dried mission figs on serum lipid …

The Traumatic Stress Response In Child Maltreatment And Resultant Neuropsychological Effects, Kathryn R. Wilson, David J. Hansen, Ming Li

Department of Psychology: Faculty Publications

Child maltreatment is a pervasive problem in our society that has long-term detrimental consequences to the development of the affected child such as future brain growth and functioning. In this paper, we surveyed empirical evidence on the neuropsychological effects of child maltreatment, with a special emphasis on emotional, behavioral, and cognitive process–response difficulties experienced by maltreated children. The alteration of the biochemical stress response system in the brain that changes an individual’s ability to respond efficiently and efficaciously to future stressors is conceptualized as the traumatic stress response. Vulnerable brain regions include the hypothalamic–pituitary–adrenal axis, the amygdala, the hippocampus, and …

Organs Watch: Possibilities And Perils For Public Anthropology, Roberto Abadie

Department of Sociology: Faculty Publications

Recent technological advances in biomedicine have introduced new therapeutic possibilities but have also contributed to the emergence of a global market for human bodies and body parts. For example, artificial modes of human reproduction created a market for eggs, semen, and surrogate wombs. In addition, organ transfer generated a demand for kidneys and half livers. The whole body has become a valuable commodity as professional research subjects venture into the economy of Phase I Clinical Trials, testing drug safety for pharmaceutical companies. In the process, the trade has become a deeply unequal one in which poor, vulnerable, and easily exploited …

Factors Affecting Depression In Workplace: Marital Status, Bmi, Stress Level, Work Duration, Job Pattern, And Daytime Sleepiness, K. Kongsomboon

Chulalongkorn Medical Journal

Background : It has been reported that Thai people have high prevalence of depression in workplace. Its impact is highest on individual-level effect of work performance. Employers who identify the risk factors and promote effective treatment may improve both the clinical and corporate outcomes. Objective : To determine risk factors of personnel's depression of the Faculty of Medicine of Srinakharinwirot University, consisted of career group, gender, age group, marital status, underlying disease, BMI, work time, work duration, sleep duration, excessive daytime sleepiness, job pattern, and stress level. Design : Cross-sectional study Material and Method : Staff and officers of the …

Effects Of Meloxicam And Etoricoxib On Blood Pressure And Vascular Reactivity In Rats, P Trongtorsak, S Sukpat, D Buapool, K. Thornola

Chulalongkorn Medical Journal

Background : Treatment with selective cyclooxygenase-2 (COX-2) inhibitor is associated with increased risk of cardiovascular events. Inhibition of COX-2 reduces vascular prostacyclin synthesis without disrupting COX-1-derived thromboxane synthesis, which may alter vascular tone and responsiveness. Objective : To examine the effects of two COX-2 inhibitors, meloxicam and etoricoxib, on blood pressure and vascular reactivity in rats. Methods : Unconscious blood pressure was obtained from Sprague Dawley rats by a tail-cuff method, and then the rats were divided into 3 groups (n = 9 in all groups): 1) non - treated control, 2) meloxicam 1 mg/kg/d, 3) etoricoxib 3 mg/kg/d. Drugs …

Anti-R-Huepo Associated Pure Red Cell Aplasia: Information Update, K. Praditpornsilpa

Chulalongkorn Medical Journal

Recombinant Epo (r-HuEpo) ถูกสังเคราะห์เป็นยาที่ใช้รักษาภาวะซีดในผู้ป่วยไตวายเรื้อรังโดยกระบวนการ biotechnology การค้นพบยานี้ช่วยทำให้ผู้ป่วยไตวายเรื้อรังมีคุณภาพชีวิตที่ดี และมีอัตราการเกิด cardiovascular morbidity ลดลง ผู้ป่วยบางรายที่ได้รับยาอาจเกิดภาวะ pure red cellaplasia (PRCA) ซึ่งเกิดจาก anti-r-HuEpo antibody ทำให้เกิดภาวะซีดรุนแรงจนอาจทำให้เกิดภาวะแทรกซ้อนทางหัวใจและหลอดเลือดจนอาจทำให้ผู้ป่วยเสียชีวิต เกณฑ์ในการวินิจฉัยที่สำคัญที่สุดในการระบุภาวะ anti-r-HuEpo associated PRCA ได้แก่ การตรวจ anti-r-HuEpo และพิสูจน์พบว่าanti-r-HuEpo มี neutralization effect ด้วย neutralization assay ยังไม่ทราบสาเหตุของ anti-r-HuEpoassociated PRCA ที่แน่ชัด อย่างไรก็ตามมีสมมุติฐานที่น่าสนใจหลายสาเหตุ ได้แก่ สมมุติฐานleacheat therapy, บทบาทของ cold chain, และบทบาทของปัจจัยทางพันธุกรรม ปัจจุบันยังไม่มีการศึกษาในลักษณะ clinical trial ถึงแนวทางการรักษาผู้ป่วยภาวะ anti-r-HuEpo associated PRCAมีข้อแนะนำให้ผู้ป่วยทุกรายหยุดยา r-HuEpo โดยไม่ควรเปลี่ยนยี่ห้อผลิตภัณฑ์ และควรพิจารณาปลูกถ่ายไตแก่ผู้ป่วยในผู้ป่วยที่ไม่มีข้อห้าม ในผู้ป่วยที่ไม่สามารถปลูกถ่ายไตควรได้รับยากดภูมิคุ้มกันข้อมูลที่มีอยู่แสดงให้เห็นว่ายากดภูมิคุ้มกันอาจมีประสิทธิภาพในการรักษา ทั้งนี้ขึ้นกับ regimenในการใช้ยา.

Severity Of Methamphetamine Relapses Of Individuals Receiving Substance-Dependency Treatment At Thanyarak Institute, W Jitpong, V Verachai, R. Kalayasiri

Chulalongkorn Medical Journal

Objective : To study the severity relapse of methamphetamine or ya-ba use and its related factors. Methods : Data from 250 methamphetamine users who reported sustained cessation for at least one month but got relapse and receiving inpatient treatment at Thanyarak Institute was collected retrospectively by using three questionnaires, namely; 1) General Background Questionnaire; 2) Severity of Dependence Scale (SDS) Thai version; and 3) Mini International Neuropsychiatric Interview - lifetime (MINI-lifetime) Thai version. Demographics, family/social variables, diagnosis, and treatments were analyzed for association with methamphetamine relapse severity by using Chi-Squares test, Fisher’s Exact Test and logistic regression analysis. Results : …

Diagnosis Of Coronary Stenosis With Ct Angiography Comparison Of Automated Computer Diagnosis With Expert Readings., Ethan J Halpern, David J Halpern

Department of Radiology Faculty Papers

RATIONALE AND OBJECTIVES: To compare computer-generated interpretation of coronary computed tomography angiography (cCTA) by commercially available COR Analyzer software with expert human interpretation.

MATERIALS AND METHODS: This retrospective Health Insurance Portability and Accountability Act‑compliant study was approved by the institutional review board. Among 225 consecutive cCTA examinations, 207 were of adequate quality for automated evaluation. COR Analyzer interpretation was compared to human expert interpretation for detection of stenosis defined as ≥50% vessel diameter reduction in the left main, left anterior descending (LAD), circumflex (LCX), right coronary artery (RCA), or a branch vessel (diagonal, ramus, obtuse marginal, or posterior descending artery). …

Ercc1 And Rrm1 As Predictors Of Survival And Response In Pancreatic Ductal Adenocarcinoma Treated With Gemcitabine-Based Chemotherapy, Thomas Holdbrook, Kathleen D. Danenberg, Suneeta Satti, Jessica Kline, Charles J. Yeo, Jonathan R. Brody, Peter Mccue, Agnieszka K. Witkiewicz

Department of Surgery Faculty Papers

Conclusion:

In this study, we used RT-PCR and IHC to analyze RRM1 and ERCC1 mRNA and protein expression in PDA specimens. PDA patients with low expression of RRM1 by IHC derived benefit from gemcitabine-based chemotherapy. Assessment of RRM1 mRNA expression was limited by the small sample size. Low ERCC1 expression by RT-PCR was associated with a 2.5 times higher risk of mortality than high expression (p=0.031). There was no association between ERCC1 expression by IHC and survival; however, agreement between mRNA and protein expression was poor for ERCC1. This study demonstrates the ERCC1 and RRM1 expression have an impact on …

Menstrual Bleeding Patterns In Adolescents Using Etonogestrel (Eng) Implant, Amit M. Deokar, Wendy Jackson, Hatim A. Omar

Pediatrics Faculty Publications

Background: Etonogestrel (ENG) implant is an effective method of contraception. The implant is designed to provide contraceptive efficacy for 3 years with a relatively quick return of fertility upon its removal. Menstrual irregularities are not uncommon on long-acting progestins and can often be the factor for discontinuation or removal. A retrospective chart analysis was done on 58 patients who chose to be on the ENG implant. Age ranged from 12 to 24 years. The cycle ranged from 1 to 17 months. The mean length of use of the implant was 10.9 months. Over the 20-month period, 13 ENG implants were …

Policy And Practice: An Analysis Of The Implementation Of Supported Employment In Nebraska, Heng-Hsian N. Liu

Department of Psychology: Dissertations, Theses, and Student Research

Supported employment (SE) is an evidence-based practice (EBP) for persons with severe mental illness (SMI) aimed at competitive employment.  SE has a large evidence base, demonstrating outcomes across settings and populations. SE has been promoted by the Centers for Medicare and Medicaid Services (in the U.S. Department of Health and Human Services) and widely disseminated through the internet via a “community tool-kit” sponsored by the Substance Abuse and Mental Health Services Administration.

The SE literature expresses the opinion that state governments can successfully implement SE.  Researchers have developed implementation guidelines and identified stages of statewide implementation; however, most SE implementation …