Medicine and Health Sciences Commons^™

An Examination Of Awareness Of Over-The-Counter Nonsteroidal Anti-Inflammatory Drugs And Adverse Events, Michelle Popa

Walden Dissertations and Doctoral Studies

The elderly population is among the fastest growing populations in the United States. Finding and consuming medications safely and effectively are challenging endeavors for this population. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a widely consumed class of medications among the elderly population, with 70% of individuals consuming over-the-counter (OTC) NSAIDs once a week and 34% using them daily. The purpose of this quantitative study was to determine whether (a) patients are aware of the risks associated with the consumption of NSAIDs, and (b) there are differences in awareness based upon specific demographic characteristics and levels of patient-physician communication. The health belief …

Evolution Of Physician-Centric Business Models Under Patient Protection And Affordable Care Act, Tanya Nix

Walden Dissertations and Doctoral Studies

For several decades, the cost of medical care in the United States has increased exponentially. Congress enacted the Patient Protection and Affordable Care Act (PPACA) of 2010 to ensure affordable healthcare to the citizens of the United States. The purpose of this case study was to explore physicians' perspectives regarding physician-centric business models evolving under the requirements of PPACA legislation. Complex adaptive systems formed the conceptual framework for this study. Data were gathered through face-to-face, semistructured interviews and e-mail questionnaires with a purposeful sample of 20 participants across 14 medical specialties within Northeast Texas. Participant perceptions were elicited regarding opinions …

Factors Influencing U.S. Army Personnel Meeting Body Mass Index Standards, Salma Theus

Walden Dissertations and Doctoral Studies

U.S. Army Regulations require soldiers to be fit, as excessive weight negatively impacts their readiness, health, and morale. A quantitative study examined if personal, behavioral, and/or environmental factors predict a soldier's self-efficacy and body mass index. Data were obtained from 117 soldiers on 6 scales: the Armed Services Vocational Aptitude Battery, the Army Physical Fitness Test, the General Self-Efficacy Scale, the Stress Management Questionnaire, the Lifestyle Assessment Inventory, and the Multifactor Leadership Questionnaire. Multiple regression analysis was used to determine if personal (intellectual capabilities and physical fitness), behavioral (lifestyle and stress management), and/or environmental (supervisor leadership) factors predict self-efficacy and …

Academic Predictors Of National Council Licensure Examination For Registered Nurses Pass Rates, Maybeth J. Elliott

Walden Dissertations and Doctoral Studies

The United States continues to be affected by a severe, long-standing nursing shortage that is not projected to resolve within the next 10 or more years. Unsuccessful passage of the National Council Licensure Examination for Registered Nurses (NCLEX-RN) among graduate nurses remains one of several key contributors to the nursing shortage. The goal of this study was to identify if either cumulative fall semester GPA; the overall prenursing science, mathematics, and English GPA; type of high school background; TOEFL score; clinical pass or fail; and on-time program completion best predicted passage of NCLEX-RN. Archived records from the academic years of …

Discrete Trial Instruction: Comparing The Abbreviated Performance Feedback And Lecture Test Models, Tammy J. Dobbs

Walden Dissertations and Doctoral Studies

Growing media attention and a high diagnosis rate of autism places significant demand on the service industry to provide qualified staff to work with individuals who have autism. Discrete trial instruction (DTI) is one of the most sought-after treatment approaches for those individuals. However, there is a gap in research regarding the efficacy of training methods for those who train direct staff to implement DTI. This quantitative study used an applied behavior analysis basis, deriving from foundations of behavior theory, to compare the abbreviated feedback form (AFF) to the lecture test model (LTM) to understand which will improve direct staff's …

Higher Micronutrient Intake Is Associated With Human Papillomavirus-Positive Head And Neck Cancer: A Case-Only Analysis, Anna E. Arthur, Sonia A. Duffy, Gloria I. Sanchez, Stephen B. Gruber, Jeffrey E. Terrell, James R. Hébert, Emily Light, Carol R. Bradford, Nisha J. D'Silva, Thomas E. Carey, Gregory T. Wolf, Karen E. Peterson, Laura S. Rozek

Faculty Publications

No studies have investigated dietary differences between head and neck squamous cell carcinoma (HNSCC) patients with human papillomavirus (HPV)-positive tumors and patients with HPV-negative tumors. This study was designed to investigate the relationship between diet and HPV status in HNSCC patients. Cases of HNSCC were recruited from 2 clinical centers participating in the University of Michigan Head and Neck Specialized Program of Research Excellence (SPORE). HPV tissue genotyping was performed, and epidemiological and dietary data collected. Multivariable logistic regression tested whether pretreatment consumption of 12 selected micronutrients was significantly associated with HPV-positive status in 143 patients newly diagnosed with cancer …

An Evidence-Based Toolkit For Human Papillomavirus Vaccine Education Of Female Adolescents In The School Setting, Nancy R. Kloha

DNP Projects

A new vaccine to prevent human papillomavirus infection was approved in 2006 in the United States (U.S.). Uptake of the vaccine has been less than optimal (CDC, 2010c). New venues for promoting vaccine acceptance are needed (Middleman & Tung, 2010). The goal of this capstone clinical project is to create an evidence based toolkit for use by school nurses in educating female adolescents, parents, communities and other healthcare providers about the HPV vaccine.

Schools nurses have daily access to young people in the target group for HPV immunization. A vital component of vaccine acceptance is education of those who are …

A Systematic Approach To Manage Clinical Deterioration On Inpatient Units In The Health Care System, Colleen H. Swartz

DNP Projects

The transformation of health care delivery in the United States is accelerating at unbelievable speed. The acceleration is a result of many variables including health care reform as well as the covariation occurring with adjustments in regulations related to resident work hours. The evolving care delivery model has exposed a vulnerability of the health system, specifically in academic medical centers of the United States. Academic medical centers have established a care delivery model grounded and predicated in resident presence and performance. With changes in resident work expectations and reduced time spent in hospitals, an urgent need exists to evaluate and …

Usefulness Of The Echocardiographic Multi-Parameter Score (Emps) In Evaluating Left Ventricular Global Heart Function, Bingyuan Zhou, Junhua Yang, Xiangjun Yang, Yongming He, Caiming Zhao, Sudan Xu, Huifeng Wang

The Texas Heart Institute Journal

In this study, we established a new index by combining several echocardiographic parameters to quantify heart failure. We selected 233 consecutive patients who underwent both echocardiographic and plasma B-type natriuretic peptide (BNP) tests within 24 hours after referral for suspected heart failure. The echocardiographic parameters included systolic function, diastolic function, left ventricular chamber remodeling, valvular lesions, systolic pulmonary arterial pressure, and regional wall-motion abnormality. Each factor was scored from 1 to 3 points according to its severity. The total point from these 6 factors is the echocardiographic multi-parameter score (EMPS).

The EMPS for 37, 51, 77, and 38 patients from …

Left Atrial Ablation For Atrial Fibrillation: Creating The “Box Lesion” With A Bipolar Radiofrequency Device, Leonid Sternik, Hartzel V Schaff, David Luria, Michael Glikson, Alexander Kogan, Ateret Malachy, Maya First, Ehud Raanani

The Texas Heart Institute Journal

The maze procedure is the gold standard for the ablation of atrial fibrillation, and the “box lesion” around the pulmonary veins is the most important part of this procedure. We have created this lesion with a bipolar radiofrequency ablator, abandoning the usual use of this device (to achieve bilateral epicardial isolation of the pulmonary veins).

From March 2004 through the end of May 2010, we performed surgical ablation of atrial fibrillation in 240 patients. Of this number, 205 underwent operation by a hybrid maze technique and the remaining 35 (our study cohort) underwent the creation of a box lesion around …

The Evaluation And Management Of Electrical Storm, Michael Eifling, Mehdi Razavi, Ali Massumi

The Texas Heart Institute Journal

Electrical storm is an increasingly common and life-threatening syndrome that is defined by 3 or more sustained episodes of ventricular tachycardia, ventricular fibrillation, or appropriate shocks from an implantable cardioverter-defibrillator within 24 hours. The clinical presentation can be dramatic. Electrical storm can manifest itself during acute myocardial infarction and in patients who have structural heart disease, an implantable cardioverter-defibrillator, or an inherited arrhythmic syndrome. The presence or absence of structural heart disease and the electrocardiographic morphology of the presenting arrhythmia can provide important diagnostic clues into the mechanism of electrical storm. Electrical storm typically has a poor outcome.

The effective …

Onco-Cardiology: The Time Has Come, Edward T H Yeh

The Texas Heart Institute Journal

No abstract provided.

Internal Medicine Problems As They Present To The Cardiologist, Ira Martin Grais

The Texas Heart Institute Journal

No abstract provided.

Rosuvastatin Therapy Does Not Affect Serum Mmp-13 Or Timp-1 Levels In Hypercholesterolemic Patients, Cihan Cevik, Kenneth Nugent, Gary Meyerrose, Mohammad Otahbachi, Cemil Izgi, Mark Lyte, R David Fish

The Texas Heart Institute Journal

Matrix metalloproteinases degrade the collagen content of atherosclerotic plaque and reduce plaque stability. In tissue sections of atherosclerotic plaque, the expression of matrix metalloproteinases is increased. 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) decrease the tissue expression of matrix metalloproteinases-1, -2, -3, and -9 in atheromatous plaque by attenuating the inflammatory process that leads to increased expression. However, it is not known whether statins decrease levels of matrix metalloproteinase-13—an enzyme crucial to the initiation of collagen degradation—as part of their plaque-stabilizing effect.

We prospectively examined the effect of statin therapy on serum levels of matrix metalloproteinase-13, tissue inhibitor of metalloproteinase-1, and …

Cd34-Positive Stem Cells In The Treatment Of Heart And Vascular Disease In Human Beings, Alexander R Mackie, Douglas W Losordo

The Texas Heart Institute Journal

Bone marrow-derived CD34(+) cells are a well-characterized population of stem cells that have traditionally been used clinically to reconstitute the hematopoietic system after radiation or chemotherapy. More recently, CD34(+) cells have also been shown to induce therapeutic angiogenesis in animal models of myocardial, peripheral, and cerebral ischemia. The mechanism by which CD34(+) cells promote therapeutic angiogenesis is not completely understood, although evidence supports both direct incorporation of the cells into the expanding vasculature and paracrine secretion of angiogenic growth factors that support the developing microvasculature. Phase I and phase II clinical trials have explored the usefulness of CD34(+) cells in …

Prehypertension: A Meta-Analysis Of The Epidemiology, Risk Factors, And Predictors Of Progression, Xiaofan Guo, Liling Zou, Xingang Zhang, Jue Li, Liqiang Zheng, Zhaoqing Sun, Jian Hu, Nathan D Wong, Yingxian Sun

The Texas Heart Institute Journal

We investigated the prevalence and risk factors of prehypertension, as well as the predictors of progression from prehypertension to hypertension. To do this, we performed a systematic review and meta-analysis of cross-sectional and longitudinal studies, after unrestricted searches of PubMed and The Cochrane Library through September 2010. In addition, we reviewed references, major textbooks, and review articles. Pooled prevalence, standardized mean differences, and odds ratios were estimated by using a random-effects model.

Twenty-six articles met our inclusion criteria; these included 20 cross-sectional and 6 longitudinal studies, with a total sample of 250,741 individuals. The overall pooled prevalence of prehypertension was …

Reflections On A Heart Surgery Career With Insights For Western-Trained Medical Specialists In Developing Countries, Sami S Kabbani

The Texas Heart Institute Journal

Herein, I describe my experience (spanning 40 years) in helping to develop the specialty of cardiovascular surgery in Syria. Especially in the early years, the challenges were daunting. We initially performed thoracic, vascular, and closed-heart operations while dealing with inadequate facilities, bureaucratic delays, and poorly qualified personnel. After our independent surgical center was established in early 1976, we performed 1 open-heart and 1 closed-heart procedure per day. Open-heart procedures evolved from the few and simple to the multiple and complex, and we solved difficulties as they arose. Today, our cardiac surgical center occupies an entire 6-floor building. We have 12 …

Medical Professionalism Meets Generation X: A Perfect Storm?, Charles S Bryan

The Texas Heart Institute Journal

No abstract provided.

Interposition Grafting Of Large Extracranial Carotid Aneurysm, Marlous Huyzer, Michel M P J Reijnen, Johannes E M Sybrandy, Jacob Buth, Clark J Zeebregts

The Texas Heart Institute Journal

Extracranial carotid aneurysms are a rare entity and carry an inherent risk of thromboembolic complications. Treatment options consist of endovascular and conventional surgical techniques. We describe the cases of 3 patients who were treated with an interposition graft for a large extracranial carotid aneurysm.

The patients had presented with an extracranial carotid aneurysm with a diameter of 30 to 43 mm. In all cases, the aneurysm was excluded by means of an interposition graft, without major perioperative complications. There was 1 case of temporary paresis of the facial nerve and another of temporary paresis of the vocal cord. After a …

Adjusting Wheal Size Measures To Correct Atopy Misclassification, Hongmei Zhang, Wilfried J. Karmaus, Jianjun Gan, Weichao Bao, Yan D. Zhao, Dewi Rahardja, John W. Holloway, Martha Scott, Syed Hasan Arshad

Faculty Publications

Purpose: Skin prick testing (SPT) is fundamental to the practice of clinical allergy identifying relevant allergens and predicting the clinical expression of disease. Wheal sizes on SPT are used to identify atopic cases, and the cut-off value for a positive test is commonly set at 3 mm. However, the measured wheal sizes do not solely reflect the magnitude of skin reaction to allergens, but also skin reactivity (reflected in the size of histamine reaction) and other random or non-random factors. We sought to estimate wheal sizes exclusively due to skin response to allergens and propose gender-specific cutoff points of atopy. …

Fitness And Adiposity As Predictors Of Functional Limitation In Adults, Andréa L. Maslow, Anna E. Price, Xuemei Sui, Duck-Chul Lee, Ilkka Vuori, Steven N. Blair

Faculty Publications

Background: This study examined the associations of body mass index (BMI), waist circumference (WC), and cardiorespiratory fitness (CRF) with incident functional limitation (IFL) in adults.

Methods: Patients (n = 2400), 30+ years [mean age, 45.2 (SD, 8.3); 12% women], completed a baseline health examination during 1979 to 1995. CRF was quantified by age- and sex-specific thirds for maximal treadmill exercise test duration. Adiposity was assessed by BMI and WC (grouped for analysis according to clinical guidelines). Incident IFL was identified from mail-back surveys during 1995, 1999, and 2004.

Results: After adjusting for potential confounders and either BMI or WC, CRF …

Prostate Cancer Incidence Rates In Africa, Lisa W. Chu, Jamie Ritchey, Susan S. Devesa, Sabah M. Quraishi, Hongmei Zhang, Ann W. Hsing

Faculty Publications

African American men have among the highest prostate cancer incidence rates in the world yet rates among their African counterparts are unclear. In this paper, we compare reported rates among black men of Sub-Saharan African descent using data from the International Agency for Research on Cancer (IARC) and the National Cancer Institute Surveillance, Epidemiology, and End Results Program from 1973-2007. Although population-based data in Africa are quite limited, the available data from IARC showed that rates among blacks were highest in the East (10.7-38.1 per 100,000 man-years, age-adjusted world standard) and lowest in the West (4.7-19.8). These rates were considerably …

Groundwater Uranium And Cancer Incidence In South Carolina, Sara E. Wagner, James B. Burch, Matteo Bottai, Robin C. Puett, Dwayne E. Porter, Susan Bolick-Aldrich, Tom Temples, Rebecca C. Wilkerson, John E. Vena, James R. Hébert

Faculty Publications

Objective

This ecologic study tested the hypothesis that census tracts with elevated groundwater uranium and more frequent groundwater use have increased cancer incidence.

Methods

Data sources included: incident total, leukemia, prostate, breast, colorectal, lung, kidney, and bladder cancers (1996–2005, SC Central Cancer Registry); demographic and groundwater use (1990 US Census); and groundwater uranium concentrations (n = 4,600, from existing federal and state databases). Kriging was used to predict average uranium concentrations within tracts. The relationship between uranium and standardized cancer incidence ratios was modeled among tracts with substantial groundwater use via linear or semiparametric regression, with and without stratification …

Alcohol Consumption And Risk Of All-Cause And Cardiovascular Disease Mortality In Men, Erin K. Howie, Xuemei Sui, Duck-Chul Lee, Steven P. Hooker, James R. Hébert, Steven N. Blair

Faculty Publications

This study examined the association between consumption of alcoholic beverages and all-cause and cardiovascular disease (CVD) mortality in a cohort of men (n = 31,367). In the Cox proportional hazards model adjusted for age, year of examination, body mass index (BMI), smoking, family history of CVD, and aerobic fitness, there were no significant differences in risk of all-cause mortality across alcohol intake groups. Risk of CVD mortality was reduced 29% in quartile 1 (HR = 0.71, 95% confidence interval (CI): 0.53, 0.95) and 25% in quartile 2 (HR = 0.75, 95% CI: 0.58, 0.98). The amount of alcohol consumed …

Association Between Depression And C-Reactive Protein, Yunsheng Ma, David E. Chiriboga, Sherry L. Pagoto, Milagros C. Rosal, Wenjun Li, Philip A. Merriam, James R. Hébert, Matthew C. Whited, Ira S. Ockene

Faculty Publications

Objective. Depression has been associated with increased cardiovascular disease risk, and a depression-related elevation of high sensitivity C-reactive protein (hs-CRP) has been proposed as a possible mechanism. The objective of this paper is to examine association between depression and high sensitivity C-reactive protein (hs-CRP). Methods. Subjects consisted of 508 healthy adults (mean age 48.5 years; 49% women, 88% white) residing in central Massachusetts. Data were collected at baseline and at quarterly intervals over a one-year period per individual. Multivariable linear mixed models were used to assess the association for the entire sample and by gender. Results. The …

Self-Rated Health Status And Cardiorespiratory Fitness As Predictors Of Mortality In Men, Jennifer Gander, Duck-Chul Lee, Xuemei Sui, James R. Hébert, Steven P. Hooker, Steven N. Blair

Faculty Publications

Self-rated health (SRH) and cardiorespiratory fitness (fitness) are independent risk factors for all-cause mortality. The purpose of this report is to examine the single and joint effects of these exposures on mortality risk. The study included 18 488 men who completed a health survey, clinical examination and a maximal exercise treadmill test during 1987–2003. Cox regression analysis was used to quantify the associations of SRH and fitness with all-cause mortality. There were 262 deaths during 17 years of follow-up. There was a significant inverse trend (p_trend <0.05) for mortality across SRH categories after adjustment for age, examination year, body mass index, physical activity, smoking, alcohol consumption, abnormal ECG, hypertension, hypercholesterolaemia, cardiovascular disease, diabetes and cancer. Adjustment for fitness attenuated the association (p value =0.09). The authors also observed an inverse association between fitness and mortality after controlling for the same covariates and SRH (p_trend = 0.006). The combined analysis of SRH and fitness showed that fit …

The Sun Safety Attitudes Of Parents And The Effects On Their Children, Matthew Welch

Theses : Honours

Parents are seen as the most important role models in the development of health practice behaviours, including sun safety for their children. The aim of the current study is to explore the experiences and sun protection knowledge, attitudes and behaviours of a parent of a child who has seen a UV photograph of both themselves and their child. By utilising UV flash photography, parents were able to see the damage done to their face and their child’s face caused by overexposure to the sun. The study was conducted through a qualitative, phenomenological approach, with the data analysed through the process …

Outdoor Recreation Participation Of Pennsylvanians With Disabilities, Elizabeth H. Weybright, Alan R. Graefe, Andrew J. Mowen, Nate E. Trauntvein

Kinesiology and Health Science Faculty Publications

Approximately 16% of United States residents report having some sort of physical disability that limits their recreation participation. Many of these individuals may have an abundance of free time due to unemployment, part-time work status, or retirement, and therefore recreation and leisure have the potential to provide great meaning in their lives. Qualitative and quantitative data from a State Comprehensive Outdoor Recreation Plan was used to better understand the outdoor recreation habits and perceptions of Pennsylvania residents with disabilities. Using descriptive, chi square, and ANOVA statistics, results indicate that these individuals perceive fewer benefits from outdoor activities, experience different types …

Minimal Vs Extensive Esophageal Mobilization During Laparoscopic Fundoplication: A Prospective Randomized Trial., Shawn D. St Peter, Douglas C. Barnhart, Daniel J. Ostlie, Kuojen Tsao, Charles M. Leys, Susan W. Sharp, Donna Bartle, Tracey Morgan, Carroll M. Harmon, Keith E. Georgeson, G W. Holcomb Iii

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: Laparoscopic Nissen fundoplication has been traditionally performed with extensive esophageal dissection to create 2 to 3 cm of intraabdominal esophagus. Retrospective data have suggested that minimal esophageal mobilization may reduce the risk of postoperative herniation of the wrap into the lower mediastinum. To compare complete esophageal dissection to leaving the phrenoesophageal attachment intact, we conducted a 2-center, prospective, randomized trial.

METHODS: After obtaining permission/assent, patients were randomized to circumferential division of the phrenoesophageal attachments (MAX) or minimal mobilization with no violation of the phrenoesophageal membrane (MIN). A contrast study was performed at 1 year. The primary outcome variable was …

Beliefs, Concerns, And Methods Of Parents Raising Children Bilingually: A Study Of Hispanic Iowa Mothers Attempting To Maintain Heritage Language In Their Children, Briana Vera

Honors Program Theses

The purpose of my thesis was to discover more about parents who are raising their children to be English-Spanish bilingual, particularly their beliefs, concerns, and methods regarding this issue. I focused specifically on mothers in Iowa whose native language was Spanish and who had at least one child in the household between the ages of four and sixteen. A point of interest I focused on were the beliefs, concerns, and methods these mothers have and use to maintain their children‟s heritage language (Spanish) as the community language (English) becomes more prominent in their children‟s lives. This information is important for …