Medicine and Health Sciences Commons^™

The Impact Of Endorsing Spitzer’S Proposed Criteria For Ptsd In The Forthcoming Dsm-V On Male And Female Veterans, Lyndsey N. Miller, Kathleen M. Chard, Jeremiah A. Schumm, Carol O’Brien

United States Public Health Resources

This study explored differences between Spitzer’s proposed model of posttraumatic stress disorder (PTSD) and the current DSM-IV diagnostic classification scheme in 353 Veterans. The majority of Veterans (89%) diagnosed with PTSD as specified in the DSM-IV also met Spitzer’s proposed criteria. Veterans who met both DSM-IV and Spitzer’s proposed criteria had significantly higher Clinician Administered PTSD Scale severity scores than Veterans only meeting DSM-IV criteria. Logistic regression indicated that being African American and having no comorbid diagnosis of major depressive disorder or history of a substance use disorder were found to predict those Veterans who met current, but not proposed …

Two Sessions Of Sleep-Focused Mind–Body Bridging Improve Self-Reported Symptoms Of Sleep And Ptsd In Veterans: A Pilot Randomized Controlled Trial, Yoshio Nakamura, David L. Lipschitz, Richard Landward, Renee Kuhn, Gavin West

United States Public Health Resources

Objective: Sleep disturbance is highly prevalent among veterans. As an alternative to sleep medications with their undesirable side effects, nonpharmacological mind–body interventions may be beneficial for sleep management in primary care. The aim of this pilot study was to investigate whether a novel mind–body intervention, mind–body bridging (MBB), focusing on sleep, could improve self-reported sleep disturbance and comorbid symptoms in veterans.

Methods: This pilot study was a randomized controlled trial at the Veterans Affairs Salt Lake City Health Care System in which 63 veterans with self-reported sleep disturbance received MBB or an active sleep education control. Both interventions …

Cerebrocerebellar Hypometabolism Associated With Repetitive Blast Exposure Mild Traumatic Brain Injury In 12 Iraq War Veterans With Persistent Post-Concussive Symptoms, Elaine R. Peskind, Eric C. Petrie, Donna J. Cross, Kathleen Pagulayan, Kathleen Mccraw, David Hoff, Kim Hart, Chang-En Yu, Murray A. Raskind, David G. Cook, Satoshi Minoshima

United States Public Health Resources

Disagreement exists regarding the extent to which persistent post-concussive symptoms (PCS) reported by Iraq combat Veterans with repeated episodes of mild traumatic brain injury (mTBI) from explosive blasts represent structural or functional brain damage or an epiphenomenon of comorbid depression or posttraumatic stress disorder (PTSD). Objective assessment of brain function in this population may clarify the issue. To this end, twelve Iraq war Veterans (32.0±8.5 [mean±standard deviation (SD)] years of age) reporting one or more blast exposures meeting American Congress of Rehabilitation Medicine criteria for mTBI and persistent PCS and 12 cognitively normal community volunteers (53.0±4.6 years of age) without …

Electroconvulsive Therapy For Major Depression Within The Veterans Health Administration, Paul N. Pfeiffer, Marcia Valenstein, Katherine J. Hoggatt, Dara Ganoczy, Dan Maixner, Erin M. Miller, Kara Zivin

United States Public Health Resources

Objectives: Electroconvulsive therapy (ECT) is the most effective treatment for severe or treatment resistant depression; however, the lack of widely accepted methods for determining when ECT is indicated may contribute to disparities and variation in use. We examined receipt of ECT among depressed patients in the largest coordinated health system in the US, the Veterans Health Administration.

Methods: Using administrative data, we conducted a multivariable logistic regression to identify individual clinical and sociodemographic predictors of receiving ECT, including variables of geographic accessibility to ECT, among patients diagnosed with major depressive disorder between 1999 and 2004.

Results: 307 (0.16%) …

Veterans Affairs General Surgery Service: The Last Bastion Of Integrated Specialty Care, Stephen Poteet, Margaret Tarpley, John L. Tarpley, A. Scott Pearson

United States Public Health Resources

BACKGROUND: In a time of increasing specialization, academic training institutions provide a compartmentalized learning environment that often does not reflect the broad clinical experience of general surgery practice. This study aimed to evaluate the contribution of the Veterans Affairs (VA) general surgery surgical experience to both index Accreditation Council for Graduate Medical Education (ACGME) requirements and as a unique integrated model in which residents provide concurrent care of multiple specialty patients.

METHODS: Institutional review board approval was obtained for retrospective analysis of electronic medical records involving all surgical cases performed by the general surgery service from 2005 to …

Substance Use Disorders In Iraq And Afghanistan Veterans In Va Healthcare, 2001–2010: Implications For Screening, Diagnosis And Treatment, Karen H. Seal, Greg Cohen, Angela Waldrop, Beth E. Cohen, Shira Maguen, Li Ren

United States Public Health Resources

Background: The prevalence and correlates of alcohol use disorder (AUD) and drug use disorder (DUD) diagnoses in Iraq and Afghanistan veterans who are new users of Department of Veterans Affairs (VA) healthcare nationwide has not been evaluated.

Methods: VA administrative data were used in retrospective cross-sectional descriptive and multivariable analyses to determine the prevalence and independent correlates of AUD and DUD in 456,502 Iraq and Afghanistan veterans who were first-time users of VA healthcare between October 15, 2001 and September 30, 2009 and followed through January 1, 2010.

Results: Over 11% received substance use disorder diagnoses: AUD, …

Motivational Interview Improves Treatment Entry In Homeless Veterans, R. Morgan Wain, Paula L. Wilbourne, Keith W. Harris, Heather Pierson, Jasmine Teleki, Thomas A. Burling, Steven Lovett

United States Public Health Resources

Motivational Interviewing (MI) has successfully been used to facilitate entry and compliance in drug and alcohol treatment programs. Some questions have been raised as to the effectiveness of MI in severely distressed populations. This study aims to assess the effectiveness of MI in a population of homeless, unemployed, and substance dependent veterans who are being wait-listed for entry into a residential treatment program. Seventy-five veterans placed on a wait-list were randomized to receive a single MI or standard (Std) intake interview. Outcomes assessed were entry, and length of stay (LOS). Secondary outcomes assessed included program completion and rates of graduation. …

Insomnia Characteristics And Clinical Correlates In Operation Enduring Freedom/Operation Iraqi Freedom Veterans With Post-Traumatic Stress Disorder And Mild Traumatic Brain Injury: An Exploratory Study, D. M. Wallace, S. Shafazand, A.R. Ramos, D.Z. Carvalho, H. Gardener, D. Lorenzo, W.K. Wohlgemuth

United States Public Health Resources

Background: There is limited data on chronic insomnia in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, in whom post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) often co-exist. Our aim was to compare sleep characteristics of three groups of OEF/OIF veterans: (1) healthy sleepers (HS), (2) those with insomnia associated with PTSD and mTBI (PTSD–mTBI), and (3) those with insomnia associated with PTSD alone.

Methods: Consecutive veterans with insomnia complaints (>6 months) were recruited over 6 months from the Miami VA Post Deployment clinic. Participants completed a sleep disorders clinical interview, medical history, and questionnaires …

Factors Influencing Receipt Of Outpatient Rehabilitation Services Among Veterans Following Lower Extremity Amputation, Jianxun Zhou, Barbara E. Bates, Jibby E. Kurichi, Pui L. Kwong, Dawei Xie, Margaret G. Stineman

United States Public Health Resources

Objective: To determine patient-, treatment-, and facilitylevel characteristics associated with receiving outpatient rehabilitation services after lower extremity amputation within the Veterans Affairs (VA) system.

Design: Observational study.

Setting: All Veterans Affairs Medical Centers (VAMCs).

Participants: Veterans (N=4165) with lower extremity amputation discharged from VAMCs between October 1, 2002, and September 20, 2004. Interventions: Not applicable.

Main Outcome Measures: Receipt of outpatient rehabilitation services up to 1 year postdischarge. A Cox proportional hazards model was used to determine the adjusted hazard ratio and 95% confidence interval of veterans to receive outpatient services.

Results: …

Angiogenic Biomarkers For Risk Stratification In Women With Suspected Preeclampsia, Andreea Balan, Heather Young, Linda Ojo, Jennifer Keller, Sharon Maynard

Epidemiology Faculty Posters and Presentations

This poster presents the results of a single-center prospective cohort study of 315 pregnant women who presented to George Washington University Hospital Labor and Delivery service with a clinical suspicion of preeclampsia between February 2007 and November 2011. Informed consent was obtained. Baseline demographic information and medical history was collected on each patient including maternal age, ethnicity, body mass index, tobacco and other substance use, gestational age, medical problems and obstetric history. Serum samples were obtained from each enrolled subject within 24 hours of admission, and sFlt1, PlGF and sEng ELISA assays were performed in duplicate by a blinded laboratory …

Nursing Vigilance - Blocking The Road To Delirium Through A Culture Of Care, Mary Ann Kinney

Theses and Graduate Projects

Vigilance at the bedside: The most viable tool we as nurses have is vigilance in our patient care. Vigilance is a gift and a tool that must be nurtured through academia and practice. The application and results of this tool lead to identifying and circumventing hospital and surgical post-operative delirium in orthopedic patients resulting in reduction of length of hospital stay, cost and eliminating the precursor delirium leading to dementia.

Case Study Scenario And Simulation: Supplementing A Student Nurse's Missed Foundational Clinical Nursing Experience, Lori Versaguis

Theses and Graduate Projects

Optimizing clinical education for student nurses in a local associate degree nursing (ADN) program is essential to prepare them to become competent professional nurses. The focus of this project is to develop a case study scenario and related simulation for associate degree nursing students who are absent from clinical experiences in a foundational nursing class. An innovative approach to replace a missed clinical experience is an educational module utilizing a patient care scenario followed by realistic nursing evaluation and interuentions in a simulation lab. Margaret Newman's theory of health as expanding consciousness supports this case scenario and simulation project. Bloom's …

Transcultural Nursing In Community: A Doctor Of Nursing Practice Project To Advance Nursing Education In Partnership With An Indigenous Community, Deb Shuhmacher

Theses and Graduate Projects

Through a culturally responsive partnership process, a doctoral project to advance nursing education on the Pine Ridge Indian Reservation in Pine Ridge, South Dakota is presented. The collaborative partnership is explored across a dominant Western culture and an Indigenous tribal community. A lens of awareness for White dominant culture is explained in relation to building a partnership with a Lakota tribal community. Traditional Indigenous values of mutuality, reciprocity, honor, and respect are discussed as significant in building a partnership. The process of engaging Indigenous wisdom and respecting Indigenous self-determination is foundational for the partnership process. Dr Leininger's culture care theory …

Transcultural Nursing In Guatemala: A Different Yield, Katherine A. Baumgartner

Theses and Graduate Projects

Daily life in Guatemala for most indigenous Mayan persons involves struggle, risk, and hardship. This country holds sharp contrasts: amazing beauty with volcanoes and jungles, and thousands of years of the advanced Mayan civilization along side the history of Spanish colonization, oppression, the daily face of poverty. Following a thirty-six year civil war, which ended in 1996, thousands of Guatemalan refugees returned from Mexico to re-create their lives in their homeland.

It is within this context, that a health initiative was begun as an international collaboration. The purpose of this initiative was to establish a program to educate and support …

The Caring Connection: Using Leadership Metis To Facilitate Community Outreach For Hospital-Based Nurses, Susan Rein Loushin

Theses and Graduate Projects

This presentation and poster describes advanced practice as a leadership process that links nurses working in a hospital setting with people in the neighborhood who are homeless. It gives voice to the experiences of nurses volunteering within the homeless community. There is documented evidence supporting the virtues of volunteerism and the effect on the target population. However, there appears to be a gap in the literature regarding the effect outreach projects have on the personal and professional lives of nurses volunteering their time in the community.

This DNP project .created opportunities and leadership for nurses to work as citizen professionals …

Somali Cares: Listening To The Voices Of The Other, Joyce P. Miller

Theses and Graduate Projects

Care during pregnancy is an important preventative health intervention for women and their unborn baby in all cultures. Healthcare inequities exist among some ethnic minority groups and contribute to racial disparities in birth outcomes. Pregnant Somali women, newly immigrated to the United States, ffie forced to seek prenatal care within a cultural context that can be very different from their own experiences and expectations. This refugee population is expected to fit into a medical system that is not only unfamiliar to them, but at times unable to meet their needs during pregnancy. As Somali women seek access to western healthcare …

Ways Of Knowing Transcultural Herbal Healing, Kristin M. Mchale

Theses and Graduate Projects

This project was born from 5 years of deeply moving transcultural learning experiences. As I walked with cultural guides from the Pine Ridge Reservation in South Dakota, energy workers of the Celtic tradition in England, traditional folk healers in Mexico, healers of the US southwest, Alaska natives, and Italian mountain people, stories unfolded which showed a universal commonality; a connection to the land and the use of herbs for health and healing. Across the globe, herbal remedies are used by people of all cultures for health and healing throughout the lifespan. Within many cultures, knowledge of herbs is a source …

Community Health Workers: Bearers Of The Light In Health, Healing, And Care, Jean M. Gunderson

Theses and Graduate Projects

Since the 1940's with the development of the community oriented Primary care model of sydney and Emily Kark that originated in Africa and was transposed to the United States, Community Health Workers (CHWs) have been integrated in community health activities. As individuals from the community intimately connected to its people and its cultural life-ways and meaning, they provide primary services and care as advocates, liaisons, educators, cultural brokers, and navigators; bridging multifaceted hanscultural constructs within systems. Thi increasing diversity of communities, the health inequities, and the call for culturally responsive care, reinforce the significance of understanding the practice of community …

Comparison Of Registered Nurse Job Satisfaction To Patient Satisfaction And The Link To The Role Of The Nurse Manager, Deborah M. Spotts

Theses and Graduate Projects

This is an in depth qualitative research study using a compelling literature review and an in depth case study of one hospital comparing registered nurse job satisfaction scores with patient satisfaction scores. The literature review indicates that research positively correlates nurse job satisfaction to patient care satisfaction. This research study focuses on understanding the possible relationship between registered nurse job satisfaction and patient satisfaction with nursing care. The role of the nurse manager is explored in order to understand possible the impact of that role on the satisfaction scores of both groups.

Osteochondral Grafting Of Knee Joint Using Mosaicplasty, Muhammad Abdul Wajid, Muhammad Idrees Shah, Mohsin E. Azam, Tashfeen Ahmad

Section of Orthopaedic Surgery

Focal cartilage defects of articular surface-traumatic and degenerative are difficult to treat, thus a variety of surgical techniques have been developed and reported for treatment of such defects. Procedures such as Priddies perforations, microfracture, abrasion chondroplasty have shown long-term results which are often less than adequate. One of the reasons is that all these techniques lead to the formation of fibrocartilage which has inferior mechanical properties as compared to the native hyaline cartilage. Mosaicplasty is a procedure which aims at replacing the lost articular cartilage with hyaline cartilage including underlying bone support, thus providing adequate stability to the cartilage and …

Arthroscopic Repair Of Meniscal Tears With Inside-Out Technique, Hasnain Raza, Kashif Abbas, Masood Umer

Section of Orthopaedic Surgery

Objective: To review the clinical results of arthroscopic meniscal repair and to identify factors that may affect the outcome.
Methods: A total of 15 arthroscopic meniscal repairs with inside-out in 14 patients over a 7-year period were evaluated retrospectively. The mean age was 41.2 +/- 11.5 years with a range of 26-64 years. Eleven patients underwent repair for medial meniscal tear, two patients for lateral meniscus and one patient for both in the same knee. All patients were functionally evaluated by Lysholm functional knee scores over an average follow-up of 1 year and 5 months (range: 0.5-7 years).
Results: The …

Thoracolumbar Tuberculosis: Implications For Appropriate Management Based On Disease Location And Proposal Of A Novel Scoring System, Shahryar Noordin, Salim Allana, Tashfeen Ahmad, Zafar Sajjad, Khabir Ahmad, Ather Enam, Riaz Hussain Lakdawala

Section of Orthopaedic Surgery

Objective: To identify factors indicating disease severity in patients with thoracolumbar tuberculosis requiring surgical intervention.
Design: Medical charts of patients who underwent surgery for thoracic and lumbar spinal tuberculosis from 1990-2005 were reviewed. Patients with different levels of disease were compared in terms of neurological deficits, duration of symptoms, previous antituberculous therapy, nutritional status and associated co-morbids.
Results: Ninety-three patients aged 7-77 years (mean age 40 years) were included. Thoracic spine was involved in 80% of operated patients, and lumbar spine in 20%. Severe neurological impairment (Frankel A to C) was present in 68% of patients with thoracic disease, as …

Abdominal Angina: A Rare Cause Of Chronic Abdominal Pain, Ziaur Rehman, Abdul Rehman Alvi, Ziad Sophie

Section of General Surgery

We report here a case of chronic postprandial abdominal pain and weight loss of more than one year duration. He was diagnosed to have abdominal angina (chronic mesenteric ischemia) on CT angiography. Open surgical revascularization procedure-right common iliac mesenteric polytetrafluoroethylene (PTFE) bypass graft achieved positive short and longterm outcome with follow-up of twenty two months.

Seven Pillars Of Small War Power, Randy Borum

Mental Health Law & Policy Faculty Publications

No abstract provided.

Effects Of Fatty Acids And Bexarotene On Breast Cancer Cell Progression, Jessica Trappmann

Undergraduate Honors Theses

Breast cancer cell growth can be inhibited in vivo by retinoid X receptor (RXR) specific retinoids. In both animal and cell culture studies, omega-3 fatty acids share growth regulatory effects similar to those ofRXR specific retinoids (rexinoids). One synthetic rexinoid, bexarotene (LCD 1069, Targretin), is used clinically to treat cancer patients. Of concern is that some patients are unable to tolerate high doses of such treatment drugs. We hypothesized that n-3 fatty acids and bexarotene may work synergistically to slow breast cancer cell growth. To test our hypothesis, we used an in vitro cell culture model, MCF-7, a human breast …

The Experiences Of Legally Married Same-Sex Couples In California, Erin Christine Falvey

CGU Theses & Dissertations

With the aim of increasing practitioner competence, this dissertation provides marriage and family therapists and mental health service providers with insight into the experiences of legally married same-sex couples. Specifically, the inquiry's objective was to elicit narratives of strength and agency from these couples who navigated the oppressive circumstances of an anti-gay amendment campaign situated within the debate over the extension of marriage rights to same-sex couples. Fourteen couples were interviewed in order to respond to the dissertation's overriding question: How do the lesbian and gay couples and families who are among those who were legally married in California before …

Biopharmaceutic And Pharmacokinetic Evaluation Of Hesperidin And Hesperetin For Ocular Delivery, Ramesh Srirangam

Electronic Theses and Dissertations

The bioflavonoid hesperidin and its aglycone hesperetin are promising candidates for the treatment of diabetic retinopathy and diabetic macular edema because of their pharmacological properties. The objective of this project was to characterize the biopharmaceutic and pharmacokinetic characteristics of hesperidin and hesperetin for ocular delivery, especially with respect to the distribution of these compounds to the posterior segment of the eye. Hesperidin and hesperetin were found to be water insoluble compounds. Although they demonstrated good permeability across the ocular tissues, hesperetin's permeability was found to be higher than that of hesperidin. Hesperidin demonstrated symmetrical transcorneal and transretinal permeation whereas hesperetin …

Exploring The Association Between Pain Intensity And Facial Display In Term Newborns, Martin Schiavenato, Meggan Butler-O'Hara, Paul Scovanner

Nursing Faculty Scholarship

BACKGROUND
Facial expression is widely used to judge pain in neonates. However, little is known about the relationship between intensity of the painful stimulus and the nature of the expression in term neonates.

OBJECTIVES
To describe differences in the movement of key facial areas between two groups of term neonates experiencing painful stimuli of different intensities.

METHODS
Video recordings from two previous studies were used to select study subjects. Four term neonates undergoing circumcision without analge-sia were compared with four similar male term neonates undergoing a routine heel stick. Facial movements were measured with a computer using a previ-ously developed …

Tegument Protein Subcellular Localization Of Human Cytomegalovirus, John Paul Tomtishen Iii

Honors Theses

To determine the subcellular localization of the tegument proteins pp65, pp71, pp150, and pp28 as fusions to one of several fluorescent proteins. Since these tegument proteins play pivotal roles in several stages of the viral life cycle, knowledge of where and the mechanism of how these proteins localize upon release could result in a better understanding of their function during a lytic infection as well as assist in the development of an effective, novel antiviral treatment.

Situation Assessment Of The Hiv Response Among Young People In Zambia, Sam Kalibala, Drosin Mulenga

HIV and AIDS

The main objective of this situational assessment is to compile and synthesize existing recent information on HIV and young people together with the current AIDS response for young people in Zambia—including programs, policies, and key partners—and to document gaps and challenges in the response. The assessment aims to further strengthen this response by all stakeholders including the Government of the Republic of Zambia, the UN, faith-based organizations, civil society organizations, donors, young people, and youth-led organizations. Recommendations include: amending and strengthening laws related to HIV programming for young people and involving them in design and implementation; offering health services, life …