Medicine and Health Sciences Commons^™

Prescriptions For Bedtime Sedatives After The Introduction Of A General Admission Order Set At An Academic Health Center: The Potential And Pitfalls Of Order Sets, Areeba Kara, Alex N. Isaacs, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective: This study describes the impact of modifications to a general admission order set on physician prescribing of 2 as-needed or pro re nata (PRN) bedtime sedatives.

Methods: The hospitalists at our institution have used a general medical admission order set since 2005. Zolpidem was the only as-needed (PRN) bedtime sedative option on the order set until trazodone was added in December 2008. Trazodone is preferred over zolpidem in the geriatric population. We identified patients admitted by the hospitalists between January 2007 and August 2013 who were prescribed with either zolpidem or trazodone as a PRN sedative. Patient demographics, date …

Prescriptions For Bedtime Sedatives After The Introduction Of A General Admission Order Set At An Academic Health Center: The Potential And Pitfalls Of Order Sets., Areeba Kara, Alex N. Isaacs, Sarah A. Nisly

Scholarship and Professional Work – COPHS

OBJECTIVE:

This study describes the impact of modifications to a general admission order set on physician prescribing of 2 as-needed or pro re nata (PRN) bedtime sedatives.

METHODS:

The hospitalists at our institution have used a general medical admission order set since 2005. Zolpidem was the only as-needed (PRN) bedtime sedative option on the order set until trazodone was added in December 2008. Trazodone is preferred over zolpidem in the geriatric population. We identified patients admitted by the hospitalists between January 2007 and August 2013 who were prescribed with either zolpidem or trazodone as a PRN sedative. Patient demographics, date …

Success With Extended-Infusion Meropenem After Recurrence Of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis In An Adolescent, Kristen R. Nichols, Chad A. Knoderer, Nicholas G. Jackson, John J. Manaloor, John C. Christenson

Scholarship and Professional Work – COPHS

A 13-year-old female experienced a recurrence of baclofen pump-related central nervous system (CNS) infection caused by Achromobacter, despite absence of retained foreign material. Due to the failure of meropenem (120 mg/kg/d in divided doses every 8 hours and infused over 30 minutes) in the initial infection, the dose was infused over 4 hours during the recurrence. Meropenem is an antibiotic for which efficacy is time dependent, and 4-hour versus 30-minute infusions have been shown to prolong the time the concentration of the antibiotic exceeds the minimum inhibitory concentration (MIC) of the organism at the site of infection (T>MIC). …

Late-Occurring Vancomycin-Associated Acute Kidney Injury In Children Receiving Prolonged Therapy, Chad A. Knoderer, Allison L. Gritzman, Kristen R. Nichols, Amy C. Wilson

Scholarship and Professional Work – COPHS

Background: Acute kidney injury (AKI) in patients receiving vancomycin has been associated with trough concentrations ≥15 mg/L and longer therapy duration. The objective of this study was to determine the incidence and factors associated with late AKI in children receiving ≥8 days of vancomycin therapy. Methods: Children aged 30 days to 17 years who were admitted to our institution and received intravenous vancomycin for at least 8 days during January to December of 2007 and 2010 and had a suspected or proven gram-positive infection were included. Late AKI was categorized as AKI occurring after the first 7 days of therapy …

Analysis Of A Standardized Perioperative Pain Management Order Set In Highly Opioid-Tolerant Patients, Alex. N. Isaacs, Kellie L. Knight, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective: The aim was to assess a standardized order set for perioperative pain management in highly opioid-tolerant patients undergoing elective orthopedic surgery.

Methods: This retrospective chart review evaluated a pain order set in highly opioid-tolerant patients undergoing elective total knee or total hip arthroplasty from January 2010 through August 2012. Based on the date of the surgery, patients were allocated into preimplementation or postimplementation order set groups. The primary outcome assessed whether an adjustment in daily opioid dosage was required within the first 48 hours postoperatively. Secondary outcomes included pain scores, length of hospitalization, and safety outcomes.

Results: Sixty patients …

Hypertension Management: Making Sense Of Guidelines And Therapy Options For The Elderly, Miranda Arthur, Lindsay Saum, Jessica E. Wilhoite

Scholarship and Professional Work – COPHS

Goal: The goal of this activity is to increase the awareness of the pharmacist on the complications surrounding hypertension management in the elderly individual, clarify the differences in current guideline recommendations, and aid in making the most appropriate drug therapy decisions regarding the management of hypertension.

Total Nutrient Admixtures (3-In-1): Pros Vs Cons For Adults, Jane Gervasio

Scholarship and Professional Work – COPHS

Total nutrient admixture (TNA) is a complete parenteral nutrition (PN) formulation composed of all macronutrients, including dextrose, amino acids, and intravenous fat emulsions (IVFE), in one bag. The TNA may be safely administered to the patient, with all components aseptically compounded and minimal administration manipulation required, lending itself to decreases in risks of catheter contamination and patient infections. The TNA is compatible and stable at recommended concentrations, and since the IVFE is in the TNA, it is infused at slower rates, allowing for better fat clearance. The TNA offers convenience of administration and a potential cost savings to the healthcare …

Standardized Competencies For Parenteral Nutrition Prescribing: The American Society For Parenteral And Enteral Nutrition Model, Peggi Guenter, Joseph I. Boullata, Phil Ayers, Jane Gervasio, Ainsley Malone, Erica Raymond, Beverly Holcombe, Michael Kraft, Gordon Sacks, David Seres, Parenteral Nutrition Safety Task Force, American Society For Parenteral And Enteral Nutrition (A.S.P.E.N.)

Scholarship and Professional Work – COPHS

Parenteral nutrition (PN) provision is complex, as it is a high-alert medication and prone to a variety of potential errors. With changes in clinical practice models and recent federal rulings, the number of PN prescribers may be increasing. Safe prescribing of this therapy requires that competency for prescribers from all disciplines be demonstrated using a standardized process. A standardized model for PN prescribing competency is proposed based on a competency framework, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)–published interdisciplinary core competencies, safe practice recommendations, and clinical guidelines. This framework will guide institutions and agencies in developing and maintaining …

The Cost Of Treating Cancer Patients With Antineoplastic Medications During Inpatient Hospital Admission, Alexandra Foster, David J. Reeves

Scholarship and Professional Work – COPHS

Abstract from 2015 American College of Clinical Pharmacy Global Conference, San Francisco, CA

Tolerability Of Induction Chemotherapy Dosing Practices In Acute Myeloid Leukemia Patients, Kaylene M. Peric, David J. Reeves

Scholarship and Professional Work – COPHS

For patients with high body surface areas (BSA), differing chemotherapy dosing strategies have been utilized in attempts to reduce toxicity. In a retrospective evaluation, we compared the effects of chemotherapy dosing in acute myeloid leukemia patients with high BSA (>2 m²) who received capped doses (n = 12) to those who received uncapped doses (n = 24), and to patients with BSA ≤ 2 m² (n = 42). There were no statistically significant differences among groups (BSA ≤ 2 m², BSA > 2 m² capped, and BSA > 2 m² uncapped) …

Self-Assembling Modified Β -Cyclodextrin Conjugated Sirna Nanoparticles And Liposomal Sirna Efficiently Knock Down The Mutant Huntingtin Gene In A Modified Pc-12 Cell Line, Rukmini Ladi, Sudip Das, Nandita Das

Scholarship and Professional Work – COPHS

Purpose: To formulate and characterize liposomal siRNA (LP-siRNA) and cationic β-cyclodextrin siRNA (CD-siRNA) nanoparticle complexes and evaluate their efficacy in knockdown of mutant Huntingtin protein (mHtt) in a modified PC-12 cell line.

Curcuminoid In Nanoemulsion Formulations Cause Enhanced Cell Death In The Hela Cancer Cell Culture Model, Nikita Kheradia, Nandita Das, Sudip Das

Scholarship and Professional Work – COPHS

Purpose: To formulate and characterize curcuminoid (insoluble chemoprevention agent) loaded nanoemulsions and evaluate their cytotoxicity in HeLa cells.

Evaluation Of A Vancomycin Dosing Protocol And Pharmacokinetic Parameters In Burn Patients, T. A. Walroth, K. A. Lavery, S. Erdman, N. R. Buening, D. R. Foster, Kendra M. Damer, R. Sood

Scholarship and Professional Work – COPHS

Published abstract from the 47th American Burn Association Annual Meeting. Chicago, IL April 2015.

Upper Limb Ambidexterity In The Wrestling Snap Down Technique, Nicholas A. Decastro

Undergraduate Review

The sport of wrestling dates back as far as recorded history. Folk style is a subdivision of that ancient sport, considered the most popular form of wrestling in U.S high schools and universities. An important skill used by Folk style wrestlers is the snap down technique. However, there is a lack of scientific literature that examines the kinematic motions of the snap down technique bilaterally. Understanding athletic ambidexterity is an important factor in athletic performance and injury prevention, particularly in wrestling. Therefore, the purpose of the research study was to bilaterally examine the kinematic motions of the upper extremity in …

In A Right State Of Mind: An Analysis Of Cognitive And Linguistic Function Following A Rare Case Of Atypical Language Dominance In Aphasia, Emily Manton

Undergraduate Review

As the foundation for effective communication, the power of the human brain to create and execute language derives from the ability of its structural components to remain intact. Extensive research has found that in 97% of people worldwide, language is typically carried out by the left hemisphere of the brain. Research for lesions in this area therefore, have been well documented. For the 3% of individuals who fall in the category of "atypical cerebral dominance" however, there is little in the available literature. Therefore, this empirical prospective case study sought to document the cognitive and linguistic functions of a 59 …

A Cross-Cultural Qualitative Study: The Differences In Attitudes And Opinions On Advance Care Planning Among African, Caucasian, And Latino Americans, Jennifer Sims

International ResearchScape Journal

The purpose of this study is to identify African American and Latino Americans’ beliefs and attitudes about advance care planning (ACP) and compare these with beliefs held by Caucasian Americans. The objectives are to identify if there are differences in opinions between racial groups and to provide relevant information for health and social service providers. African American and Latino American participants in this study indicated many factors that affect their hesitation to utilize ACP services: spiritual and religious beliefs; family caregiving; and lack of knowledge about ACP services. Implications for practice include providing easy-to-understand information about ACP to clients of …

A Dietary Intervention For Chronic Diabetic Neuropathy Pain: A Randomized Controlled Pilot Study, A. E. Bunner, C. L. Wells, J. Gonzales, U. Agarwal, Elham Bayat, Neal D. Barnard

Neurology Faculty Publications

Background:

Diabetic neuropathy is a common and often debilitating condition for which available treatments are limited. Because a low-fat plant-based diet has been shown to improve glycemic control in individuals with type 2 diabetes, we hypothesized that such a diet would reduce painful symptoms of diabetic neuropathy.

Methods:

In this 20-week pilot study, individuals with type 2 diabetes and painful diabetic neuropathy were randomly assigned to two groups. The intervention group was asked to follow a low-fat, plant-based diet, with weekly classes for support in following the prescribed diet, and to take a vitamin B12 supplement. The control group was …

High Fidelity Simulation And Aviation Training To Improve Problem Solving Skills And Coordination, Evan M. Lester, Paul A. Craig

International Symposium on Aviation Psychology - 2015

The Flight Operations Center – Unified Simulation (FOCUS) lab was created in 2010 to break down the “barrier” between aerospace concentrations at Middle Tennessee State University (MTSU) and address several aspects of teamwork in aviation. While participating in the FOCUS lab’s high-fidelity simulations, teams of senior undergraduate aerospace students work together to solve complex and real-world scenarios, which helps improve each student’s coordination, teamwork, problem-solving, and communication skills. Each team’s performance in the FOCUS lab’s simulations is evaluated by the FOCUS lab research team and discussed at the team’s After Action Review (AAR) to determine how the team can improve …

Procedure Used For Establishing Screening Test Cut-Points Based On Aviation Occupational Task Performance, Nelda Milburn, Thomas Chidester, Kevin Gildea, Linda Peterson, Carrie Roberts, Deborah Perry

International Symposium on Aviation Psychology - 2015

Previous research has shown that some individuals with color vision deficiencies (CVD) are capable of performing some aviation occupational tasks as well as those with normal color vision (NCV); implying that passing a screening test with a diagnosis of NCV may not be necessary for all aviation occupations. Our goal was to find outcome consistency between performance on occupational tasks and several screening tests; further, to compare those pass/fail outcomes to the Colour Assessment and Diagnosis (CAD) test for aviation certification. The strategy involved establishing a pass/fail cut-point separately for four occupational tasks at the 5th percentile of the NCV …

A Coalition Study Of Warfighter Acceptance Of Wearable Physiological Sensors, Lauren E. Menke, Christopher Best, Gregory J. Funke, Adam J. Strang

International Symposium on Aviation Psychology - 2015

Combat operations are often high tempo, resulting in undesirable levels of operator workload and stress. Adaptive automation has been suggested as a solution to these issues. However, this augmentation approach is predicated on operator consent to monitoring. Acceptance of such systems may be influenced by concerns regarding the use of monitor data and mistrust of automation technology. The purpose of the current investigation was to examine operator acceptance of physiological monitoring and future augmentation strategies after limited exposure to one device. During a simulated exercise, eleven command and control operators were equipped with a physiological monitor prior to each mission. …

Toward An Integrated Ecological Plan View Display For Air Traffic Controllers, Brem Beernink, Clark Borst, Joost Ellerbroek, Rene Van Paassen, Max Mulder

International Symposium on Aviation Psychology - 2015

To cope with increasing demand on the air traffic management system, this paper proposes a novel user interface which supports air traffic controllers in conflict detection and resolution. The concept is based on previous work on 3D solution space displays for air traffic control, but then aimed at improving the interaction by better integrating speed, heading, and altitude constraints on the Plan View Display. A preliminary, subjective human-in-the-loop evaluation study was performed using five participants with various experience levels in real-life air traffic control. Results from the evaluation indicate that both successful use of the interface as well as the …

The Effects Of Workload And Stress On Teamwork In A High Fidelity Simulation, Andrea M. Georgiou

International Symposium on Aviation Psychology - 2015

With a unique high fidelity simulation lab, participants completed 3 hour work shifts to a run a simulated regional airline. The experimental design consisted of three teams randomly assigned to either a minimal, moderate, or maximum level of difficulty. Increases in workload and stress were implemented with various triggers and the participants had to quickly develop solutions to mitigate the problems. After the simulation, the participants completed the CATME (Comprehensive Assessment of Team Member Effectiveness) online survey for evaluations of their performance for five variables. (Ohland et al., 2012). Based on one-way analysis of variance (ANOVA), the results suggest only …

Church Pew Exercise Integrated With Conventional Physical Therapy Following Total Knee Arthroplasty (Tka): Case Report, Randell Gonzales, Jerome V. Danoff

Exercise and Nutrition Sciences Faculty Publications

Background and Purpose: Physical therapy treatment following Total knee Arthroplasty (TKA) consists of a combination of strengthening and range of motion exercises. The exercise technique, church pew exercise (CPE), has been proposed to enhance quadriceps facilitation and improve function. This is a technique that has the patient standing and rocking forward/back. The backward motion is arrested by engagement of the upper calf against a solid object, creating a sudden flexion torque at the knee and a sudden extension torque at the hip. The combination of CPE with standard physical therapy is claimed to provide better quadriceps control and faster walking …

Impact Of Health Insurance Expansions On Nonelderly Adults With Hypertension., Suhui Li, Brian K. Bruen, Paula M. Lantz, David Mendez

Health Policy and Management Faculty Publications

Introduction

Hypertension is a risk factor for cardiovascular disease (CVD), the leading cause of death in the United States. The treatment and control of hypertension is inadequate, especially among patients without health insurance coverage. The Affordable Care Act offered an opportunity to improve hypertension management by increasing the number of people covered by insurance. This study predicts the long-term effects of improved hypertension treatment rates due to insurance expansions on the prevalence and mortality rates of CVD of nonelderly Americans with hypertension.

Methods

We developed a state-transition model to simulate the lifetime health events of the population aged 25 to …

Effect Of Cold Plasma On Glial Cell Morphology Studied By Atomic Force Microscopy., Nina Recek, Xiaoqian Cheng, Michael Keidar, Uros Cvelbar, Alenka Vesel, Miran Mozetic, Jonathan Sherman

Neurological Surgery Faculty Publications

The atomic force microscope (AFM) is broadly used to study the morphology of cells. The morphological characteristics and differences of the cell membrane between normal human astrocytes and glial tumor cells are not well explored. Following treatment with cold atmospheric plasma, evaluation of the selective effect of plasma on cell viability of tumor cells is poorly understood and requires further evaluation. Using AFM we imaged morphology of glial cells before and after cold atmospheric plasma treatment. To look more closely at the effect of plasma on cell membrane, high resolution imaging was used. We report the differences between normal human …

Educational Neuroscience, Constructivism, And The Mediation Of Learning And Creativity In The 21st Century., M. Layne Kalbfleisch

Pediatrics Faculty Publications

No abstract provided.

Absolute Reticulocyte Count Acts As A Surrogate For Fetal Hemoglobin In Infants And Children With Sickle Cell Anemia., Emily Riehm Meier, Colleen Byrnes, Maxine Weissman, Y Terry Lee, Jeffery L Miller

Pediatrics Faculty Publications

Hemoglobin switching is largely complete in humans by six months of age. Among infants with sickle cell anemia (HbSS, SCA), reticulocytosis begins early in life as fetal hemoglobin (HbF) is replaced by sickle hemoglobin (HbS). The objective of this study was to determine if absolute reticulocyte count (ARC) is related to HbF levels in a cohort of pediatric SCA patients. A convenience sample of 106 children with SCA between the ages of 1 month and 20 years who were not receiving hydroxyurea or monthly blood transfusions were enrolled in this observational study. Hematologic data, including ARC and HbF levels, were …

Characterizing The Propagation Of Uterine Electrophysiological Signals Recorded With A Multi-Sensor Abdominal Array In Term Pregnancies., Diana Escalona-Vargas, Rathinaswamy B. Govindan, Adrian Furdea, Pam Murphy, Curtis L Lowery, Hari Eswaran

Pediatrics Faculty Publications

The objective of this study was to quantify the number of segments that have contractile activity and determine the propagation speed from uterine electrophysiological signals recorded over the abdomen. The uterine magnetomyographic (MMG) signals were recorded with a 151 channel SARA (SQUID Array for Reproductive Assessment) system from 36 pregnant women between 37 and 40 weeks of gestational age. The MMG signals were scored and segments were classified based on presence of uterine contractile burst activity. The sensor space was then split into four quadrants and in each quadrant signal strength at each sample was calculated using center-of-gravity (COG). To …

Making The Leap From Research Laboratory To Clinic: Challenges And Opportunities For Next-Generation Sequencing In Infectious Disease Diagnostics., Brittany Goldberg, Heike Sichtig, Chelsie Geyer, Nathan Ledeboer, George M Weinstock

Pediatrics Faculty Publications

Next-generation DNA sequencing (NGS) has progressed enormously over the past decade, transforming genomic analysis and opening up many new opportunities for applications in clinical microbiology laboratories. The impact of NGS on microbiology has been revolutionary, with new microbial genomic sequences being generated daily, leading to the development of large databases of genomes and gene sequences. The ability to analyze microbial communities without culturing organisms has created the ever-growing field of metagenomics and microbiome analysis and has generated significant new insights into the relation between host and microbe. The medical literature contains many examples of how this new technology can be …

Lower Limb Coordination During A Land-Cut Task Following Anterior Cruciate Ligament Reconstruction And Rehabilitation, Sarah B. Clarke, Ian Kenny, Andrew Harrison

Conference Presentations

No abstract provided.