Medicine and Health Sciences Commons^™

Correlation Of Discharge Diagnostic Codes With Laboratory-Confirmed Methicillin-Resistant Staphylococcus Aureus Bloodstream Infections At A Large Pediatric Hospital, Andrew J. Kreppel

Master of Public Health Program Student Publications

Background: Methicillin-resistant Staphylococcus aureus (MRSA)-specific hospital discharge codes were introduced in October 2008. The purpose of this project is to study the correlation of these codes with laboratory-proven pediatric MRSA bloodstream infections.

Methods: Laboratory and discharge databases were used to identify patientsChildren’s Hospital Medical Center from October 2008 through December 2010 with MRSA bloodstream infections. The laboratory database identified patients with a positive blood culture for MRSA, and the discharge database identified patients with an MRSA bloodstream discharge code (038.12 for MRSA sepsis or 041.12 for MRSA infection with either 790.7 for bacteremia or 771.81 for newborn sepsis or 771.83 …

Single-Port Laparoscopic Surgery In Children: Concept And Controversies Of The New Technique, Felix C. Blanco, Timothy D. Kane

Surgery Faculty Publications

Single-incision laparoscopic surgery (SILS) is emerging as an alternative technique to conventional laparoscopy for the treatment of common surgical diseases. Despite its wide use, the adoption of SILS in children has been slower since the broad application of minimally invasive techniques in children, in general, has historically lagged behind those in adults. This paper reviews the evolution of SILS from its original conception and its application in the field of pediatric surgery.

Care Of The Dying Patient: How Comfortable Are Nursing Students Toward The Care Of Dying Patients At The Completion Of The Associate Nursing Degree Program?, Phyllis Bray

Nursing Theses and Capstone Projects

People are living longer today due to lifestyle changes and treatment of illnesses. End of life nursing care has become a field of nursing practice that requires focus on meeting the needs of the patient and family. Nurses are central figures in advocating for interventions that minimize burden and distress and enhance quality of life for their patients. Given these extremely important responsibilities, new nurses must be adequately prepared to provide sensitive, quality of care for patients at the end of life. This quantitative study aimed to assess how comfortable nursing students feel toward the care of dying patients at …

Role Of Community Health Workers In Improving Diabetes Outcomes, Janet Kegley, Helen Collett, Ralph Fugate

Center of Excellence in Rural Health Presentations

Objective Examine the effectiveness of using community health workers (CHWs) to support nurse-led diabetes self-management education (DSME) with medically underserved clients.

Methods A pretest-posttest group design was used. A sample of 640 was non-randomly drawn from eastern Kentucky Homeplace division clients who reported that they had been told by a health professional they have type-2 diabetes. The sample size for was reduced to 489 because of a decrease in project funding. Inclusion criteria for the study were Kentucky Homeplace clients 18-65+ years of age who reported they had been told by a provider they have diabetes. Clients meeting inclusion criteria …

Chronic Lower Back Pain: A Maladaptive Perceptions Model, Benedict M. Wand

Physiotherapy Conference Papers

High quality evidence suggests that current approaches to the management of CLBP show only limited effectiveness; one explanation of this finding is that current models of management are misdirected or incomplete. This talk proposes a model of CLBP underpinned by data on the psychological contributors to the LBP experience and recent evidence of neuroplastic changes in the brains of people with CLBP (see below). The model suggests that maladaptive cognitive perception about the nature of the back problem and future consequences drive behaviours that might bring about maladaptive neuroplastic changes. These central nervous system changes may enhance sensitivity, influence normal …

Moving In An Environment Of Induced Sensory-Motor Incongruence Does Not Influence Pain Sensitivity In Healthy Volunteers: A Randomised Within-Subject Cross-Over Experiment, Benedict M. Wand, Lareina Szpak, Pamela George, Max Bulsara, Neil E. O'Connell, G Lorimer Moseley

Physiotherapy Conference Papers

A mismatch between the brain's motor control and sensory systems has been suggested as one mechanism whereby maladaptive neuroplastic changes contribute to the experience of chronic pain. Several studies have investigated this hypothesis by artificially inducing a state of sensory-motor incongruence using mirrors. The data to date appear to suggest that creating an environment of sensori-motor incongruence induces various sensory changes and feeling of peculiarity, however the effect on pain is less clear. The aim of this study was to test the hypothesis that healthy participants would demonstrate reduced pain thresholds and report greater intensity of pain in a condition …

Treatment-Based Classification Of Low Back Pain – Who Are The Unclear Classifications?, T R. Stanton, J M. Fritz, A T. Apeldoorn, Benedict M. Wand, M J. Hancock

Physiotherapy Conference Papers

A recent focus in low back pain research has been to identify patient subgroups that respond best to certain treatments. To integrate these subgroup findings into a useable form, a treatment-based classification algorithm for LBP was created.^1,2 To allow the algorithm to be comprehensive – eg, provide a classification for all patients – additional criteria are provided to assist therapists’ decisions for patients who do not clearly meet a treatment subgroup (unclear classifications).

Recent research found that approximately 34% of patients will receive unclear classifications using the algorithm.³ It has also been shown that the reliability of the …

Functional Changes In The Primary Somatosensory Cortex In Complex Regional Pain Syndrome (Crps): A Systematic Review, Flavia Di Pietro, Tasha R. Stanton, Luke Parkitny, James H. Mccauley, Martin Lotze, Benedict M. Wand, G Lorimer Moseley

Physiotherapy Conference Papers

The brain plays a key role in CRPS. A widely-studied brain region in pain research is the primary somatosensory cortex (S1), a somatotopic map of our body’s surface which functionally reorganises in pain [1]. Changes in the S1 representation of the CRPS-affected body part have contributed to new CRPS treatments, e.g. graded motor imagery. This systematic review and meta-analysis aimed to determine whether CRPS is associated with: a) a change in the size of the S1 representation of the affected body part; b) altered S1 activity, in terms of activation levels and latency of responses.

Discovering Which Experiences Physiotherapy Students Identify As Learning Facilitators In Practical Laboratories: An Action Research Project, J Francis-Coad, A Hill

Physiotherapy Conference Papers

Purpose: Students enrolled in courses that focus on patient contact participate in practical laboratories to learn clinical skills but this can be challenging in a pre-clinical environment. A simulated case based format using role play in small groups is commonly undertaken. Students may find it difficult to actively engage in learning and effective role playing without prior clinical experience. The aim of this study was to discover what type of experiences facilitated student learning in practical laboratory sessions.

Method: Design: Action research study.

Participants: Thirty two undergraduate second year physiotherapy students who were engaging in practical laboratories.

Data …

2012 Cancer Care Annual Report, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center.

Redefining Chronic Toxoplasmosis: A T Cell Exhaustion Perspective, Rajarshi Bhadra, Imtiaz A. Khan

Microbiology, Immunology, and Tropical Medicine Faculty Publications

No abstract provided.

The Adjuvanticity Of An O. Volvulus-Derived Rov-Asp-1 Protein In Mice Using Sequential Vaccinations And In Non-Human Primates, Jing Wang, Nancy Trichoche, Lanying Du, Meredith Hunter, Bin Zhan, Gaddam Goud, Elizabeth S. Didier, Jing Liu, Lu Lu, Preston A. Marx, Shibo Jiang, Sara Lustigman

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Adjuvants potentiate antigen-specific protective immune responses and can be key elements promoting vaccine effectiveness. We previously reported that the Onchocerca volvulusrecombinant protein rOv-ASP-1 can induce activation and maturation of naïve human DCs and therefore could be used as an innate adjuvant to promote balanced Th1 and Th2 responses to bystander vaccine antigens in mice. With a few vaccine antigens, it also promoted a Th1-biased response based on pronounced induction of Th1-associated IgG2a and IgG2b antibody responses and the upregulated production of Th1 cytokines, including IL-2, IFN-γ, TNF-α and IL-6. However, because it is a protein, the r …

Neglected Tropical Diseases As Hidden Causes Of Cardiovascular Disease, Yasmin Moolani, Gene Bukhman, Peter J. Hotez

Microbiology, Immunology, and Tropical Medicine Faculty Publications

No abstract provided.

Cell-Free Circulating Mirna Biomarkers In Cancer., Meng-Hsuan Mo, Liang Chen, Yebo Fu, Wendy Wang, Sidney W. Fu

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Considerable attention and an enormous amount of resources have been dedicated to cancer biomarker discovery and validation. However, there are still a limited number of useful biomarkers available for clinical use. An ideal biomarker should be easily assayed with minimally invasive medical procedures but possess high sensitivity and specificity. Commonly used circulating biomarkers are proteins in serum, most of which require labor-intensive analysis hindered by low sensitivity in early tumor detection. Since the deregulation of microRNA (miRNA) is associated with cancer development and progression, profiling of circulating miRNAs has been used in a number of studies to identify novel minimally …

Application Of Nanomedicine In Emergency Medicine: Point-Of-Care Testing And Drug Delivery In Twenty - First Century, Ali Pourmand, Mohammed Reza Pourmand, Justin Wang, Robert Shesser

Emergency Medicine Faculty Publications

The application of emerging nanotechnology to the practice of medicine represents a frontier of nanomedicine. Nanomedicine has been defined as a science which emphasizes the use of nanoscale tools in conjunction with background knowledge of the human body for medical diagnosis and treatment. Application of nanomedicine in EM may give EM providers the opportunity to diagnose and treat life-threatening diseases in a shorter period of time. These applications include diagnostic utilities, preventive medicine, targeted pharmacotherapy, and tissue regeneration.

A Survey Of Poison Control Centers Worldwide, Ali Pourmand, Justin Wang, Maryann Mazer

Emergency Medicine Faculty Publications

To stem the rising incidence of toxic exposure as well as the associated morbidity and mortality, the past century has seen the establishment and evolution of poison control centers (PCCs) worldwide. Depending on the location, PCCs vary in terms of staffing model, services offered, and funding sources. In this article, we discuss a survey of poison control centers worldwide.

Electronic Health Records Critical In The Aftermath Of Disasters, Mahshid Abir, Farzad Mostashari, Parmeeth Atwal, Nicole Lurie

Emergency Medicine Faculty Publications

No abstract provided.

Impact Of Antiviral Treatment And Hospital Admission Delay On Risk Of Death Associated With 2009 A/H1n1 Pandemic Influenza In Mexico, Gerardo Chowell, Cecile Viboud, Lone Simonsen, Mark A. Miller, Santiago Echevarría-Zuno, Margotx González-León, Víctor H. Borja Aburto

Global Health Faculty Publications

Background

Increasing our understanding of the factors affecting the severity of the 2009 A/H1N1 influenza pandemic in different regions of the world could lead to improved clinical practice and mitigation strategies for future influenza pandemics. Even though a number of studies have shed light into the risk factors associated with severe outcomes of 2009 A/H1N1 influenza infections in different populations (e.g., [1-5]), analyses of the determinants of mortality risk spanning multiple pandemic waves and geographic regions are scarce. Between-country differences in the mortality burden of the 2009 pandemic could be linked to differences in influenza case management, underlying population health, …

Fusion, 2012, George Washington University, William H. Beaumont Medical Research Honor Society

Fusion

No abstract provided.

A Pruritic, Psoriasiform Rash In An 82 Year Old Patient: Clues To Diagnosing Atypical Celiac Disease, J. Yang, Mikhail Kogan

Medicine Faculty Posters and Presentations

No abstract provided.

Basic Concepts In Understanding Recovery Of Function In Vestibular Reflex Networks During Vestibular Compensation, Kenna D. Peusner, Mei Shao, Rebecca Reddaway, June C. Hirsch

Anatomy and Regenerative Biology Faculty Publications

Unilateral peripheral vestibular lesions produce a syndrome of oculomotor and postural deficits with the symptoms at rest, the static symptoms, partially or completely normalizing shortly after the lesion due to a process known as vestibular compensation. The symptoms are thought to result from changes in the activity of vestibular sensorimotor reflexes. Since the vestibular nuclei must be intact for recovery to occur, many investigations have focused on studying these neurons after lesions. At present, the neuronal plasticity underlying early recovery from the static symptoms is not fully understood. Here we propose that knowledge of the reflex identity and input–output connections …

Targeting The Cancer Cell Cycle By Cold Atmospheric Plasma, Olga Volotskova, Teresa S. Hawley, Mary Ann Stepp, Michael Keidar

Anatomy and Regenerative Biology Faculty Publications

Cold atmospheric plasma (CAP), a technology based on quasi-neutral ionized gas at low temperatures, is currently being evaluated as a new highly selective alternative addition to existing cancer therapies. Here, we present a first attempt to identify the mechanism of CAP action. CAP induced a robust ~2-fold G2/M increase in two different types of cancer cells with different degrees of tumorigenicity. We hypothesize that the increased sensitivity of cancer cells to CAP treatment is caused by differences in the distribution of cancer cells and normal cells within the cell cycle. The expression of γH2A.X (pSer139), an oxidative stress reporter indicating …

Cuentos - 2012, George Washington University, Medical Faculty Associates

Cuentos

Cuentos is the humanities magazine of the George Washington University Medical Faculty Associates Department of Internal Medicine.

Reintegration Of Child Soldiers In Burundi: A Tracer Study, Mark J.D. Jordans, Ivan H. Komproe, Wietse A. Tol, Aline Ndayisaba, Theodora Nisabwe, Brandon A. Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

No abstract provided.

Moyamoya Disease In Pregnancy: Management After Intracranial Bypass Grafting, Alexis C. Gimovsky, Charles Macri, Susanne L. Bathgate, D. E. Ross

Obstetrics and Gynecology Faculty Publications

Moyamoya disease (MD) is a chronic, progressive cerebrovascular disease distinguished by bilateral stenosis or occlusion of the arteries around the circle of Willis with resulting prominent arterial collateral circulation. We describe a pregnant woman in whom this diagnosis was confirmed by cerebral angiogram and treated with bilateral superficial temporal artery-middle cerebral artery (STA-MCA) bypass grafting prior to conception. The patient was managed with strict blood pressure monitoring and low-dose aspirin antepartum, intrapartum, and postpartum. The patient presented in spontaneous labor at term and underwent a spontaneous vaginal delivery without complications.

Physiologically Based Pharmacokinetic Modeling In Pediatric Drug Development: A Clinician's Request For A More Integrated Approach., Karel M. Allegaert, Anne Smits, John N. Van Den Anker

Pediatrics Faculty Publications

No abstract provided.

Hypertension-Related Gene Polymorphisms Of G-Protein-Coupled Receptor Kinase 4 Are Associated With Nt-Probnp Concentration In Normotensive Healthy Adults, Junichi Yatabe, Midori S. Yatabe, Minoru Yoneda, Robin A. Felder, Pedro A. Jose, Hironobu Sanada

Pediatrics Faculty Publications

G protein-coupled receptor kinase 4 (GRK4) with activating polymorphisms desensitize the natriuric renal tubular D1 dopamine receptor, and these GRK4 polymorphisms are strongly associated with salt sensitivity and hypertension. Meanwhile, N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be useful in detecting slight volume expansion. However, relations between hypertension-related gene polymorphisms including GRK4 and cardiovascular indices such as NT-proBNP are not clear, especially in healthy subjects. Therefore, various hypertension-related polymorphisms and cardiovascular indices were analyzed in 97 normotensive, healthy Japanese adults. NT-proBNP levels were significantly higher in subjects with two or more GRK4 polymorphic alleles. Other hypertension-related gene polymorphisms, such as those …

Hiv-1 Resistant Cdk2-Knockdown Macrophage-Like Cells Generated From 293t Cell-Derived Human Induced Pluripotent Stem Cells, Marina Jerebtsova, Namita Kumari, Min Xu, Gustavo Brito Alvim De Melo, Xiaomei Niu, Kuan-Teh Jeang, Sergei Nekhai

Pediatrics Faculty Publications

A major challenge in studies of human diseases involving macrophages is low yield and heterogeneity of the primary cells and limited ability of these cells for transfections and genetic manipulations. To address this issue, we developed a simple and efficient three steps method for somatic 293T cells reprogramming into monocytes and macrophage-like cells. First, 293T cells were reprogrammed into induced pluripotent stem cells (iPSCs) through a transfection-mediated expression of two factors, Oct-4 and Sox2, resulting in a high yield of iPSC. Second, the obtained iPSC were differentiated into monocytes using IL-3 and M-CSF treatment. And third, monocytes were differentiated into …

Evaluation Of Sedimentation Rate Methodology Reveals An Unusual Pediatric Subpopulation With Lupus Or Lupus-Like Syndrome And Hemolytic Anemia, Edward C. Wong, Deborah Yuan, Claas Hinze, Lawrence Jung

Pediatrics Faculty Publications

Purpose

Sedimentaion rate is often used to manage pediatric patients with rheumatologic disease. Most management decisions are dependent on studies which have used Wintrobe or Westergren sedimentation rate methodologies. However, these methods suffer from the need for relatively large amounts of blood and long turn-around times. Determination of sedimentation rate using laser kinetic rate determination has allowed calibration to Westergren methods, low volume of blood needed for testing and very rapid results. We sought to compare the Wintrobe method to the ESR Stat method (kinetic method; HemaTechnologies, Lebanon NJ) to determine suitability of the ESR Stat method for patient testing. …

The Test Characteristics Of Head Circumference Measurements For Pathology Associated With Head Enlargement: A Retrospective Cohort Study, Carrie Daymont, Moira Zabel, Chris Feudtner, David M. Rubin

Pediatrics Faculty Publications

Background

The test characteristics of head circumference (HC) measurement percentile criteria for the identification of previously undetected pathology associated with head enlargement in primary care are unknown.

Methods

Electronic patient records were reviewed to identify children age 3 days to 3 years with new diagnoses of intracranial expansive conditions (IEC) and metabolic and genetic conditions associated with macrocephaly (MGCM). We tested the following HC percentile threshold criteria: ever above the 95th, 97th, or 99.6thpercentile and ever crossing 2, 4, or 6 increasing major percentile lines. The Centers for Disease Control and World Health Organization growth curves were used, as well …