Medicine and Health Sciences Commons^™

An Analysis Of The External Environmental And Internal Organizational Factors Associated With Adoption Of The Electronic Health Record, Clemens Kruse

Theses and Dissertations

Despite a Presidential Order in 2004 that launched national incentives for the use of health information technology, specifically the Electronic Health Record (EHR), adoption of the EHR has been slow. This study attempts to quantify factors associated with adoption of the EHR and Computerized Provider Order Entry (CPOE) by combining multiple organizational theories and empirical studies. The study is conducted in two phases. The primary phase of this study identifies and evaluates the effects of external environmental and internal organizational factors on healthcare organizations to adopt the EHR. From secondary data, twelve IVs (df=19) are chosen based on existing models …

The Impact Of Community Use Of Novel Oral Anticoagulants On An Academic Medical Center, Luis Eraso, Md, Taki Galanis, Md, Kristina Kipp, Pharm.D., Walter K. Kraft, Md, Michael Palladino, Pharm.D., Cacp, Alejandro Perez, Md, Kimberle Ferebee-Spruill, Crnp, Geno Merli, Md, Brian G. Swift, Pharm.D., Mba, Lynda Thomson, Brittany Vining

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Warfarin has been a mainstay of therapy for treatment and prevention of venous thromboembolic disease (VTED) and prevention of stroke and systemic embolism for over 50 years. Recent FDA approval of several novel oral anticoagulants has offered more extensive treatment options for management of these disease states.

The availability of the novel anticoagulants offers an attractive alternative to warfarin therapy for patients due to their convenience of use. In comparison to warfarin, dabigatran, rivaroxaban and apixaban offer: - a fixed dosage regimen

- a relatively small potential drug interaction profile

- minimal laboratory monitoring

- little to no dietary restrictions. …

The Effectiveness Of A Parental Education Intervention About A Child-Oriented Approach To Tolieting For Healthy Thai Toddlersthe Effectiveness Of A Parental Education Intervention About A Child-Oriented Approach To Tolieting For Healthy Thai Toddlers, On-Anong Thammajinda

Evidence-Based Practice Project Reports

Toilet training (TT) is a necessary developmental task that all healthy children must ultimately achieve. The Centers for Disease Control and Prevention (CDC, 2001) noticed that E. coli can be spread to playmates by toddlers who are not toilet trained. Studies showed parental participation in the TT process is crucial and parental readiness to pledge to TT is an important step for training. In Thailand, very few studies were conducted about TT a toddler, and all of the studies were descriptive. The purpose of this evidence-based practice project was to determine the effectiveness of a parental education intervention about TT, …

Op-Ed: After Hospital Care, The Test Begins. Even For A Healthcare Professional, A Patient's Care Following Discharge Can Be Overwhelming., Beth Ann Swan

College of Nursing Faculty Papers & Presentations

In 2011, my husband, Eric, a trial attorney, was felled by a brain stem stroke just before he was to board a flight at O'Hare in Chicago. He was just 53 years old with no prior health conditions or problems. From the outset, we knew his recovery and rehabilitation would be long and difficult. We didn't know that his transition to post-hospital medical care would be just as challenging.

I'm the dean and a professor at the Jefferson School of Nursing at Thomas Jefferson University in Philadelphia, and I'm a registered nurse. I thought my training and access to resources …

Cytotoxic Properties Of Novel Platinum Compounds, Bbr3610-Dach And Trans-4-Nbd In Tumor Cells: Cellular Effects Of 1, 2-Dach And Nbd Ligands, Vijay Menon

Theses and Dissertations

Platinum-based chemotherapeutics are used for the treatment of a wide range of cancers and a number of attempts have been made toward developing compounds with better cellular stability and similar or enhanced cytotoxicity as compared to their predecessors. The first part of the work reported here focuses on the cellular effects of the metabolically stable dinuclear platinum compound, BBR3610-DACH. Comet assay showed this compound to form interstrand crosslinks, a highly toxic DNA lesion in HCT116 cells, at equimolar concentrations to its parental compound, BBR3610. Cell cycle studies showed that BBR3610-DACH causes G1/S and G2/M cell cycle arrest with S phase …

Polyethylenimine-Enhanced Alumina Nanoscale Adjuvant For Cancer Vaccine, Naoko Uno, Haiyan Li, Hong-Ming Hu, Jun Jiao

Student Research Symposium

Aluminum oxide nanoparticles (Al2O3 NPs) have been shown to increase the efficiency of cell-mediated immune response. Specifically, CD8 and CD4 immune response is required for T cell activation by dendritic cells. These nanoparticles, when functionalized with peptides and other molecules, can be used as vaccine in cancer treatment. In this study, Al2O3 NPs were attached to E6/E7 proteins. HPV-induced cervical cancer expresses E6/E7 antigens. E6/E7 proteins were attached using surface modification of the Al2O3 NPs; different types of molecules were tested to see which adhered the highest amount of protein and produced the strongest cell response. Protein measurements were done …

The Human Brain Processes Syntax In The Absence Of Conscious Awareness., Laura Batterink, Helen J Neville

Brain and Mind Institute Researchers' Publications

Syntax is the core computational component of language. A longstanding idea about syntactic processing is that it is generally not available to conscious access, operating autonomously and automatically. However, there is little direct neurocognitive evidence on this issue. By measuring event-related potentials while human observers performed a novel cross-modal distraction task, we demonstrated that syntactic violations that were not consciously detected nonetheless produced a characteristic early neural response pattern, and also significantly delayed reaction times to a concurrent task. This early neural response was distinct from later neural activity that was observed only to syntactic violations that were consciously detected. …

Withaferin A Effectively Targets Soluble Vimentin In The Glaucoma Filtration Surgical Model Of Fibrosis, Paola Bargagna-Mohan, Sunil P. Deokule, Kyle G. Thompson, John Wizeman, Cidambi Srinivasan, Sunil Vooturi, Uday B. Kompella, Royce Mohan

Ophthalmology and Visual Science Faculty Publications

Withaferin A (WFA) is a natural product that binds to soluble forms of the type III intermediate filament (IF) vimentin. Currently, it is unknown under what pathophysiological contexts vimentin is druggable, as cytoskeltal vimentin-IFs are abundantly expressed. To investigate druggability of vimentin, we exploited rabbit Tenon's capsule fibroblast (RbTCF) cell cultures and the rabbit glaucoma filtration surgical (GFS) model of fibrosis. WFA potently caused G₀/G₁ cell cycle inhibition (IC₅₀ 25 nM) in RbTCFs, downregulating ubiquitin E3 ligase skp2 and inducing p27(Kip1) expression. Transforming growth factor (TGF)-ß-induced myofibroblast transformation caused development of cell spheroids with numerous elongated invadopodia, which WFA blocked …

Flurbiprofen Benzyl Nitrate (Nbs-242) Inhibits The Growth Of A-431 Human Epidermoid Carcinoma Cells And Targets Β-Catenin, Niharika Nath, Xiaoping Liu, Lloydine Jacobs, Khosrow Kashfi

Publications and Research

Background: The Wnt/β-catenin/T cell factor (TCF) signaling pathway is important in the development of nonmelanoma skin cancers (NMSCs). Nitric-oxide-releasing nonsteroidal anti-inflammatory drugs (NO-NSAIDs) are chemopreventive agents consisting of a traditional NSAID attached to an NO-releasing moiety through a chemical spacer. Previously we showed that an aromatic spacer enhanced the potency of a particular NO-NSAID compared to an aliphatic spacer.

Methods: We synthesized an NO-releasing NSAID with an aromatic spacer (flurbiprofen benzyl nitrate, NBS-242), and using the human skin cancer cell line A-431, we evaluated its effects on cell kinetics, Wnt/β-catenin, cyclin D1, and caspase-3.

Results: NBS-242 inhibited the growth of …

A Beginner’S Guide To The Changing Male Voice, Brianna Connaughton

Honors Theses

No abstract provided.

Members In Mind: Outreach & Education Strategies For Co-Op Insurance Plans. Final Report, Elizabeth Rogers

Muskie School Capstones and Dissertations

As envisioned by the federal policymakers who designed the Patient Protection and Affordable Care Act of 2011 (ACA), and the state-based health leaders who are founding them, Consumer Oriented and Operated Plans (CO-OPs) are intended to be a different kind of insurer: non-profit partners in health and healthcare. While many Americans (including Mainers) should welcome this new model, CO-OPs face challenges in establishing brand recognition and capturing the hearts and minds of consumers. The purpose of this research project was to support CO-OPs, particularly Maine’s CO-OP, Maine Community Health Options (MCHO), in assessing and developing communications strategies that enable individuals …

The Effects Of Intervention Involving A Robot On Compliance Of Four Children With Autism To Requests Produced By Their Mothers, Holly Jeanne Nelson

Theses and Dissertations

The current study presents the use of a humanoid robot to facilitate compliant behaviors to two types of directives in four children with autism. The children participated in a three-month intervention program that incorporated core components of the SCERTS model in order to facilitate social communication (Prizant, Wetherby, Rubin, & Laurent, 2003). Treatment sessions were comprised of 40 minutes of traditional treatment and 10 minutes of interaction with a humanoid robot. Pre- and post-intervention assessment were conducted, each involving a 5 minute interaction with the child's mother, in which they were presented with directives in the form of physical manipulation …

Defining Late Onset Occult Asymptomatic Cardiotoxicity In Childhood Cancer Survivors Exposed To Anthracycline Therapy: A Cardiac Magnetic Resonance Imaging Study, Olga H. Toro-Salazar, Michael O'Loughlin, Georgine Burke, Eileen Gillan, Bruce T. Liang, Michael Taylor

Presentations - Patient Care

There are over 270,000 childhood cancer survivors in the US. Of these survivors, more than 50% have been treated with anthracyclines and are at risk of developing progressive cardiotoxicity. Novel cardiac magnetic resonance imaging (CMRI) techniques are now able to reliably detect diffuse myocardial fibrosis and changes in regional myocardial function. We hypothesized that these novel CMRI techniques will identify occult asymptomatic cardiotoxicity in a cohort of childhood cancer survivors with normal global systolic function.

In this study we demonstrate that changes in T1 mapping-derived relaxation time and left ventricular myocardial peak circumference strain are present in asymptomatic post-chemotherapy childhood …

Vbp15, A Glucocorticoid Analogue, Is Effective At Reducing Allergic Lung Inflammation In Mice, Jesse M. Damsker, Blythe C. Dillingham, Mary C. Rose, Molly A. Balsley, Christopher R. Heier, Alan M. Watson, Erik J. Stemmy, Rosalyn A. Jurjus, Tony Huynh, Kathleen Tatem, Kitipong Uaesoontrachoon, Dana M. Berry, Angela S. Benton, Robert J. Freishtat, Eric P. Hoffman, John M. Mccall, Heather Gordish-Dressman, Stephanie L. Constant, Erica K.M. Reeves, Kanneboyina Nagaraju

Pharmacology and Physiology Faculty Publications

Asthma is a chronic inflammatory condition of the lower respiratory tract associated with airway hyperreactivity and mucus obstruction in which a majority of cases are due to an allergic response to environmental allergens. Glucocorticoids such as prednisone have been standard treatment for many inflammatory diseases for the past 60 years. However, despite their effectiveness, long-term treatment is often limited by adverse side effects believed to be caused by glucocorticoid receptor-mediated gene transcription. This has led to the pursuit of compounds that retain the anti-inflammatory properties yet lack the adverse side effects associated with traditional glucocorticoids. We have developed a novel …

Do User Fees Increase Tuberculosis Notifications?, Chioma Y. Chukwumah

Economics Honors Projects

Public health sectors around the world strive to provide accessible and affordable care. Tight government budgets and growing populations lead countries to consider adding or raising charges to health care consumers. These user fees may affect the quality, equity and revenue of health care. This paper investigates the impact of user fees on notifications of tuberculosis. In the panel data composed of 176 countries from 1960 to 2012, I find no evidence that suggests user fees increase tuberculosis. In contrast, I find strong and robust evidence suggesting user fees are associated with fewer new cases of tuberculosis.

2013 May 7 - Medical Student Education Committee Minutes, Medical Student Education Committee, East Tennessee State University

Medical Student Education Committee Minutes

No abstract provided.

Interprofessional Roles Shoulder Dystocia: Maximizing Safety In Community Hospitals, Elizabeth Yznaga

Doctor of Nursing Practice (DNP) Projects

Prompted by evidence that clinical simulations improve patient safety, team simulations are emerging in hospital settings. Accrediting organizations such as the U.S. Joint Commission on Accreditation of Healthcare Organizations and the American College of Obstetricians and Gynecologists (Joint Commission, 2004, American College of Obstetricians and Gynecologists, 2002) have recommend simulation of obstetrical emergencies, including shoulder dystocia for hospital teams. National patient safety mandates for simulation training of critical events have not been available to small, rural hospitals because of lack of talent and equipment, creating a gap in resources. Other than demonstrations by manikin companies, this author has currently been …

Evidence-Based Practice For Medical Students In A Family Medicine Clerkship: Collaborative, Active Learning For Clinical Decision Skills, Tagalie Heister, Frank Davis, Rick Brewer, Archana Kudrimoti, Janice Kuperstein, Shari Levy

Library Presentations

Objectives: This active learning experience was designed to enhance the information literacy knowledge and skills of medical students for patient-centered, evidence-based decisions at the point of care. It includes formulating clinical questions using patient/problem, intervention, comparison, outcome (PICO), accessing the highest level of evidence-based medicine (EBM) information available in an effective manner, and evaluating the information in relation to a specific patient in an outpatient setting.

Methods: Third-year medical students participate in a small-group collaborative, patient-centered learning experience during the family medicine clerkship, coordinated by the clerkship directors with participation by two medical librarians. At orientation, the clerkship directors provide …

Debriefing Simulations: Comparison Of Debriefing With Video And Debriefing Alone, Shelly J. Reed, Claire M. Andrews, Patricia K. Ravert

Faculty Publications

Background: Debriefing as part of the simulation experience is regarded as essential for learning. Evidence concerning best debriefing practices from the standpoint of a student nurse participant is minimal, particularly when comparing debriefing types. This study evaluated the differences in the student experience between two debriefing types: debriefing with video and debriefing without video (debriefing alone). Method: Nursing students participating in an intensive care simulation were randomized into one of the two debriefing types: debriefing with video (n = 32) and debriefing alone (n = 32) following simulation completion. After debriefing was completed, studentswere asked to complete a debriefing experience …

Factors Influencing Medical Adherence Of Clients In Aids Project Worcester, Marianne M. Sarkis, Abby Dnahue, Jacqueline Osei-Owusu, Shan Yi Koay, Maya Baum, Anna Shayo, Amanda Major

Local Knowledge: Worcester Area Community-Based Research

What are the factors and barriers that lead to levels of adherence for those receiving treatment for those in the HIV/AIDS community through AIDS Project Worcester?

Over the last few decades, the HIV/AIDS epidemic has undergone a visible shift. In particular, the demographics of HIV/AIDS infected persons have transitioned from mostly gay affluent, white males to women and men of various minority populations with lower resources and socioeconomic statuses. This trend has also been true for the Worcester community. Based in Worcester, Massachusetts, this research project seeks to identify patterns between the recent change in client demographics and the relation …

A Risk Score For Identifying Methicillin-Resistant Staphylococcus Aureus In Patients Presenting To The Hospital With Pneumonia., Andrew F. Shorr, Daniela E. Myers, David B. Huang, Brian H. Nathanson, Matthew F. Emons, Marin H. Kollef

Emergency Medicine Faculty Publications

Background

Methicillin-resistant Staphylococcus aureus (MRSA) represents an important pathogen in healthcare-associated pneumonia (HCAP). The concept of HCAP, though, may not perform well as a screening test for MRSA and can lead to overuse of antibiotics. We developed a risk score to identify patients presenting to the hospital with pneumonia unlikely to have MRSA.

Methods

We identified patients admitted with pneumonia (Apr 2005 – Mar 2009) at 62 hospitals in the US. We only included patients with lab evidence of bacterial infection (e.g., positive respiratory secretions, blood, or pleural cultures or urinary antigen testing). We determined variables independently associated with the …

Ada News - 05/06/2013, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.

Ability And Willingness To Change Among African Immigrant Patients At Akwaaba, Marianne Sarkis, Temitayo Akinbola, Charise Canales, Hana Chamoun, Jacqueline Leaf, Elisabeth Nebie

Local Knowledge: Worcester Area Community-Based Research

What are the challenges faced in treating Hypertension in the Worcester African Immigrant Community?

This study investigates the relationship between the understanding of high blood pressure, and the ability and willingness to modify behavior among African patients at Akwaaba, a free health clinic in Worcester, Massachusetts. In this research, our team specifically explores how the understanding of lifestyle risk factors of hypertension, such as diet, exercise, and levels of stress, influence the willingness and ability to modify behavior among African born patients at Akwaaba. What become clear was that language barriers, cultural differences, and approach to health care within the …

What's Happening: May 6, 2013, Maine Medical Center

What's Happening

No abstract provided.

Competition For Antigen Selects T Cell Responses That Undergo Memory Inflation And Maintains Clonal Dominance During Mcmv Infection, Holly Turula, Lila A. Farrington, Corinne Smith, Ann B. Hill, Christopher M Snyder

Department of Microbiology and Immunology Faculty Papers

Cytomegalovirus (CMV) establishes a life-long, persistent/latent infection. Continuous immune surveillance by CMV-specific CD8+ T cells results in their accumulation over time, a process called “memory inflation”. These “inflationary” T cells migrate systemically and comprise the largest T cell populations in humans, making CMV-based vaccines attractive. Why T cells specific for only some CMV-derived epitopes undergo inflation is unclear. We found previously that recombinant murine (M)CMV expressing the SIINFEKL peptide only induced inflation of SIINFEKL-specific T cells, in contrast to wild-type MCMV infection. We show here that:

• Co-infecting mice with viruses expressing and lacking SIINFEKL enabled T cells with multiple specificities …

Evaluation Of An Innovative Program To Improve Outcomes Among Military Beneficiaries With Diabetes, Carol A.B. Andrews

Nursing Theses and Dissertations

Patient Centered Medical Home (PCMH) is a health care model implemented in all United States Air Force (USAF) medical facilities which uses a team-based approach to promote accessibility, quality care, and appropriate service utilization, while decreasing costs. To measure the effectiveness of this model, the National Committee for Quality Assurance (NCQA) has developed a tool to document and recognize facilities that incorporate all model elements. However, the effects of the full model implementation on patient outcomes in military settings have not been studied. This research fills an important gap in the literature because it studies the effect of PCMH implementation …

Challenges Of Smoking Cessation Research In Mongolia, Carol M. Rowley

Nursing Theses and Dissertations

The deleterious impact of tobacco use on health has been well-known for years. Nevertheless, cigarette smoking is a behavior which generally is not easily abandoned due to its addictive propensities. Thus, it is important for nurses to be competent in the delivery of evidence-based smoking cessation interventions which can help their clients achieve tobacco-free status. This need is particularly urgent in nations with high smoking prevalence rates, including many developing nations. The purpose of this study was two-fold. First, an investigation was undertaken to determine the smoking habits and influences among Eastern European nations, the former Soviet Union, and Mongolia. …

Fit To Care: An Action Research Study Exploring The Use Of Communication Theory To Strengthen Caring Relationships Between Teachers And Students, Pamela K. Lake

Nursing Theses and Dissertations

Watson's Theory of Human Caring lends theoretical structure to nursing curricula grounded in Caring Science. A key principle within the theory is the caring trusting teacher-student relationship. This relationship can be threatened by the need to relay instructional feedback to students when performance has fallen below standards. The tension resulting from this exchange is uncomfortable to all concerned and can damage the relationship and lead to even worse student performance. Nursing literature has not reported studies addressing this problem. Communication studies have extensive reports of such research. Feedback Intervention Theory (FIT) is based on skilled facework to improve student outcomes …

Oral Transmission Of Listeria Monocytogenes In Mice Via Ingestion Of Contaminated Food, Elsa N. Bou Ghanem, Tanya Myers-Morales, Grant S. Jones, Sarah E. F. D'Orazio

Microbiology, Immunology, and Molecular Genetics Faculty Publications

L. monocytogenes are facultative intracellular bacterial pathogens that cause food borne infections in humans. Very little is known about the gastrointestinal phase of listeriosis due to the lack of a small animal model that closely mimics human disease. This paper describes a novel mouse model for oral transmission of L. monocytogenes. Using this model, mice fed L. monocytogenes-contaminated bread have a discrete phase of gastrointestinal infection, followed by varying degrees of systemic spread in susceptible (BALB/c/By/J) or resistant (C57BL/6) mouse strains. During the later stages of the infection, dissemination to the gall bladder and brain is observed. The …

Breastfeeding Influencing Factors In Thai Adolescent Mothers, Supannee Kanhadilok

Theses and Dissertations

Background: Breastfeeding is well established as the optimal method for ensuring healthy infant nutrition. However, many adolescents remain unaware of the role of breastfeeding. Adolescent mothers continue to have the lowest rate of breastfeeding in many countries including Thailand, with only 17% of Thai adolescent mothers continuing to breastfed at 6 months postpartum. Objective: Examine factors influencing breastfeeding behaviors in adolescent mothers, particularly those in Thailand. Methods: This dissertation project involved two research studies focusing on breastfeeding influencing factors in adolescent mothers. The first study was an integrative review of 22 articles published in 2000-2012. The findings revealed that personal …