Medicine and Health Sciences Commons^™

Models For Predicting Incident Delirium In Hospitalized Older Adults: A Systematic Review, Sundeep Kalimisetty, Wajih Askar, Brenda Fay, Ariba Khan

Journal of Patient-Centered Research and Reviews

Background: Delirium is common in hospitalized older adults, and 40% of cases may be preventable. Hospital Elder Life Program is an evidence-based program to reduce incidence of delirium. It has been successfully implemented in one hospital and will be implemented in four other hospitals. Identification of patients at highest risk of developing delirium using the electronic health record (EHR) may be an effective targeted strategy to reduce the incidence of delirium.

Purpose: To systematically review and summarize the medical literature regarding risk prediction models for delirium in older inpatients.

Methods: A medical librarian customized and conducted the search strategy for …

An Interdisciplinary Process Change: Conversion Of Picc Line Capping Solution From Heparin To Normal Saline, Angela Colella, Brandon Bodager, Frank Spexarth, Natalie Mcdonough, Deb Kastenholz, Paul Grebe

Journal of Patient-Centered Research and Reviews

Background: Heparin-induced thrombocytopenia (HIT) and HIT with thrombosis syndrome (HITTS) are serious conditions. Patients are at increased risk for developing HIT/HITTS with any exposure to heparin, even intravenous line flushes. Patients may be exposed to heparin multiple times each day when they have a peripherally inserted central catheter (PICC) that is flushed and capped with heparin. At Aurora Health Care, heparin is the standard capping solution for PICCs, but with a recent switch to positive pressurized caps, normal saline may be a capping option that reduces patient exposure to heparin.

Purpose: To reduce heparin exposure at a single hospital by …

Evaluation Of Patient Opinions And Experiences With Electronic Cigarettes At A Family Medicine Residency Clinic, Ima D. Tanner, Breana C. Cummens, Jessica J.F. Kram, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Background: Since 2003, electronic cigarettes (e-cigs) have grown in popularity. E-cigs are often marketed as a safer, healthier alternative to smoking traditional cigarettes or as an aid for smoking cessation. However, the risks and benefits of e-cig use, as well as the beliefs that influence use or avoidance, are poorly understood.

Purpose: To assess our patient population’s perception or beliefs as they relate to e-cig use.

Methods: A 13-question survey regarding nicotine and e-cig use was distributed to English-speaking adult patients at Aurora St. Luke’s Family Practice Clinic from August 2015 to January 2016. Questions assessed patient demographics and smoking …

Determining The Incidence And Factors Of Cardiotoxicity In Breast Cancer Patients Treated With Anthracycline And/Or Trastuzumab-Containing Regimen At Aurora Health Care, Stephanie Ghojallu, Matthew Rappelt, Han-Yang Chen, Ruth Perez, Lydia Garlie, Geoffrey Riddell, Yingying Gu, Jun Zhang, Rubina Qamar, Bijoy K. Khandheria, Arshad Jahangir, Yang Shi

Journal of Patient-Centered Research and Reviews

Background: Anthracycline and trastuzumab are common breast cancer treatments. While improving survival, they elevate risk of congestive heart failure. The incidence of cardiotoxicity (CTx) with these therapies varies in the literature from 10% to 59%, higher than those reported in clinical trials (4%–10%) that excluded patients with preexisting cardiovascular comorbidities. Studies have failed to establish consensus on the risk factors for CTx associated with these therapies.

Purpose: We aim to determine the incidence and risk factors of CTx in breast cancer patients treated with anthracycline and/or trastuzumab at Aurora Health Care.

Methods: A retrospective review of patients with breast cancer …

Are There Advantages To Hiring In-House Training Program Graduates?, Jessica J.F. Kram, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Background: Several studies have compared international graduates on measures of performance, quality and satisfaction. No studies have compared internally versus externally hired graduates in relation to these measures.

Purpose: To identify if there is a difference in hiring patterns and care management (CM)/patient satisfaction (PS) scores between internal and external graduate hires.

Methods: We conducted a quality improvement study on graduates hired by Aurora Health Care from Jan. 1, 2006, to Dec. 14, 2015. CM scores were determined based on hire date. PS scores were calculated based on the calendar year, regardless of exact hire date. PS scales for scoring …

Does Travel Time To A Radiation Facility Impact Patient Decision-Making Regarding Treatment For Prostrate Cancer? A Study Of The New Hampshire State Cancer Registry, Fady Ghali, Maria Celaya, Michael Laviolette, Johann Ingimarsson, Heather Carlos, Judy R. Rees, Elias Hyams

Dartmouth Scholarship

Purpose: We sought to determine whether further distance from a radiation center is associated with lower utilization of external beam radiation therapy (XRT). Methods: We retrospectively identified patients with a new diagnosis of localized prostate cancer (CaP) within the New Hampshire State Cancer Registry from 2004 to 2011. Patients were categorized by age, D’Amico risk category, year of treatment, marital status, season of diagnosis, urban/rural residence, and driving time to the nearest radiation facility. Treatment decisions were stratified into those requiring multiple trips (XRT) or a single trip (surgery or brachytherapy). Multivariable regression analysis was performed. Results: A total of …

The Crux Of The Heart –– The Closest Approach Of The Right Atrium To The Left Ventricle, Lynn Erickson, David Krum, Hannah Samuel, Anwer Dhala, Jasbir Sra

Journal of Patient-Centered Research and Reviews

Background: Accessory pathways, the source of atrioventricular reentry tachycardia, occasionally connect the left ventricle to the right atrium. This is possible because, in some patients, a portion of the right atrium abuts the left ventricle on the posterior wall of the heart, near the mid-coronary sinus. This anatomic region is known as the “crux” of the heart. These accessory pathways can be difficult to ablate because of the unusual and unexpected substrate. While the presence of these accessory pathways is described in the literature, the prevalence of the underlying anatomic substrate is not currently known.

Purpose: To measure the closest …

The Perception For Good Death Of Community Dwelling Japanese And Thailand Respondents, Michiyo Ando, Supawadee Somchit, Mitsunori Miyashita, Laiad Jamjan

Asian/Pacific Island Nursing Journal

Having a “good death” is a very important goal of palliative care, and it is useful for nurses to understand cultural differences in the perception of a good death to propose nursing care. The purpose of this study was to compare the perception of a “good death” among community-dwelling Japanese and Thai people. Three hundred sixty-nine respondents completed the Good Death Questionnaire. The research design was a cross-sectional study. The scores of the Japanese respondents on “good relationships with medical staff,” “being respected as an individual,” and “fighting against cancer” were higher among Thai respondents. On the other hand, “environmental …

Continuing Development Of An All Payer Health Care System In Maryland, David P. Paul Iii, Taeko Matsumoto, Alberto Coustasse, Lama Mohammed Bakhamis, Mary Lynn Harshbarger

Management Faculty Research

The state of Maryland, in collaboration with the Centers for Medicare and Medicaid, developed the first all-payer system model in the U.S. in 1971, and some 35 years later in response to financial pressures, modernized this program. The focus of the modernized program was to improve overall per capita expenditure, quality of care, and the outcome of Marylanders’ health.

This study showed positive change in moving its healthcare delivery model from volume-driven care to value-driven coordinated care. Maryland hospitals have changed their mindsets to achieve the Triple Aim of cost reduction, health improvement, and quality of care improvement for the …

The Development And Psychometric Testing Of The Health Literacy Knowledge, Application, And Confidence Scale (Hlkacs), Marguerite Catherine Debello

Master's Theses and Doctoral Dissertations

Health literacy continues to be a pervasive issue faced by adults today within the healthcare environment. One in four adults cannot make informed decisions regarding their own care and do not understand basic healthcare information. Nursing provides the majority of healthcare teaching, yet little is known about the current knowledge level of such providers about health literacy knowledge and strategies. The purpose of this study was to determine the reliability and validity of the Health Literacy Knowledge, Application, and Confidence scale (HLKACS) with nursing students enrolled in baccalaureate and associate degree nursing programs in the state of Michigan. The study …

Health And Health Care In Kentucky: Variations By Region And Metro/Micro/Rural Status, Tyrone F. Borders, Keith Branham

Institute for Rural Health Policy Reports

Health policy makers and health system managers frequently make decisions to allocate and organize resources according to differences in unmet needs across geographic areas. This report describes, compares, and contrasts key health, health behavior, and health care access indicators by region and metropolitan status in Kentucky.

Sex Ed To Go- An Analysis Of Comprehensive Sexual Education Mobile Phone Applications, Kerstin M. Kalke

Communication ETDs

The United States has one of the highest teen pregnancy rates among developed countries and the numbers of STIs have increased during the last few years. Mobile phone applications constitute a promising platform to disseminate sexual health information and to reduce adverse health outcomes, particularly among teens. In order to be effective, apps have to follow a comprehensive approach to sexuality education, include concepts of behavior change theories, and adhere to health literacy principles.

This study used a mixed-methods approach consisting of a quantitative content analysis and qualitative thematic analysis to assess the quality of sexual education apps available to …

Download Entire Bodine Journal Volume 1, Issue 1, 2008

Bodine Journal

No abstract provided.

Factors Associated With Severe Late Toxicity After Concurrent Chemoradiation For Locally Advanced Head And Neck Cancer: An Rtog Analysis, Mitchell Machtay, Md, Jennifer Moughan, Ms, Andrew Trotti, Md, Adam S. Garden, Md, Randal S. Weber, Md, Jay S. Cooper, Md, Arlene Forastiere, Md, K. Kian Ang, Md

Bodine Journal

Purpose

Concurrent chemoradiotherapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases both local tumor control and toxicity. This study evaluates clinical factors that are associated with and might predict severe late toxicity after CCRT.

Methods

Patients were analyzed from a subset of three previously reported RTOG trials of concurrent chemoradiotherapy for locally advanced SCCHN (RTOG 91-11; 97-03; and 99-14). Severe late toxicity was defined in this secondary analysis as chronic Grade 3-4 pharyngeal/laryngeal toxicity (RTOG/EORTC late toxicity scoring system) and/or requirement for a feeding tube ≥2 years after registration and/or potential treatment-related death (e.g. pneumonia) within …

Increasing Tumor Volume Is Predictive Of Poor Overall And Progression-Free Survival: Secondary Analysis Of The Radiation Therapy Oncology Group 93-11 Phase I-Ii Radiation Dose-Escalation Study In Patients With Inoperable Non-Small-Cell Lung Cancer, Maria Werner-Wasik, R. Suzanne Swann, Phd, Jeffrey Bradley, Md, Mary Graham, Md, Bahman Emani, Md, James Purdy, Phd, William Sause, Md

Bodine Journal

Purpose

Patients with non–small-cell lung cancer (NSCLC) in the Radiation Therapy Oncology Group (RTOG) 93-11 trial received radiation doses of 70.9, 77.4, 83.8, or 90.3 Gy. The locoregional control and survival rates were similar among the various dose levels.We investigated the effect of the gross tumor volume (GTV) on the outcome.

Methods and Materials

The GTV was defined as the sum of the volumes of the primary tumor and involved lymph nodes. The tumor response, median survival time (MST), and progression-free survival (PFS) were analyzed separately for smaller (≤45 cm3) vs. larger (>45 cm3) tumors.

Results

The distribution of …

Inhibition Of P73 Function By Pifithrin-Α As Revealed By Studies In Zebrafish Embryos, William R Davidson, Qing Ren, Gabor Kari, Ori Kashi, Adam Dicker Md, Phd, Ulrich Rodeck

Bodine Journal

The p53 family of proteins contains two members that have been implicated in sensitization of cells and organisms to genotoxic stress, i.e., p53 itself and p73. In vitro, lack of either p53 or p73 can protect certain cell types in the adult organism against death upon exposure to DNA damaging agents. The present study was designed to assess the relative contribution of p53 to radiation resistance of an emerging vertebrate model organism, i.e., zebrafish embryos. Consistent with previous reports, suppressing p53 protein expression using antisense morpholino oligonucleotides (MOs) increased survival and reduced gross morphological alterations in zebrafish embryos exposed to …

Vegf Trap In Combination With Radiotherapy Improves Tumor Control In U87 Glioblastoma, Phyllis Wachsberger, Phd, Randy Burd, Phd, Chris Cardi, Ms, Mathew L. Thakur, Constantine Daskalakis, Jocelyn Holash, Phd, George D. Yancopoulos, Phd, Adam Dicker Md, Phd

Bodine Journal

Purpose

To determine the effect of vascular endothelial growth factor VEGF Trap (Regeneron Pharmaceuticals, Tarrytown, NY), a humanized soluble vascular endothelial growth factor (VEGF) receptor protein, and radiation (RT) on tumor growth in U87 glioblastoma xenografts in nude mice.

Methods and Materials

U87 cell suspensions were implanted subcutaneously into hind limbs of nude mice. VEGF Trap (2.5–25 mg/kg) was administered every 3 days for 3 weeks alone or in combination with a single dose of 10 Gy or fractionated RT (3 x 5 Gy). In addition, three scheduling protocols for VEGF Trap plus fractionated RT were examined.

Results

Improved tumor …

A Cone Beam Ct-Based Study For Clinical Target Definition Using Pelvic Anatomy During Post-Prostatectomy Radiotherapy, Timothy Showalter Md, A. Omer Nawaz, Ma, Ying Xiao, James Galvin Phd, Richard K. Valicenti, Md

Bodine Journal

Introduction:

Radiation therapy (RT) is delivered after radical prostatectomy (RP) either as salvage treatment for an elevated prostate-specific antigen (PSA) level1-6 or as adjuvant therapy for patients with highrisk pathologic features7-8. Recent prospective data demonstrated a disease-free survival benefit of adjuvant RT for pathologic T3N0 prostate cancer9-10. Despite literature supporting the delivery of post-RP RT to the prostatic fossa (PF), no clear target definition guidelines exist for intensity modulated radiation therapy (IMRT) or image-guided RT (IGRT)11.

Visualization of the PF is limited on standard CT images, with significant interobserver variability and uncertainty in CTV definition12. Efforts to incorporate complementary imaging …

Toxicity Of Radiotherapy In Patients With Collagen Vascular Disease, Alexander Lin, Md, Eyad Abu-Isa, Md, Kent A. Griffith, Mph, Ms, Edgar Ben-Josef, Md

Bodine Journal

Background

A diagnosis of collagen vascular disease (CVD) may predispose to radiotherapy (RT) toxicity. The objective of the current study was to identify factors that influence RT toxicity in the setting of CVD.

Methods

A total of 86 RT courses for 73 patients with CVD were delivered between 1985 and 2005. CVD subtypes include rheumatoid arthritis (RA; 33 patients), systemic lupus erythematosus (SLE; 13 patients), scleroderma (9 patients), dermatomyositis/polymyositis (5 patients), ankylosing spondylitis (4 patients), polymyalgia rheumatica/temporal arteritis (4 patients), Wegener granulomatosis (3 patients), and mixed connective tissue disorders (MCTD)/other (2 patients). Each patient with CVD was matched to 1 …

Table Of Contents: Bodine Journal Volume 1, Issue 1, Fall 2008

Bodine Journal

No abstract provided.

Download Entire Bodine Journal Volume 2, Issue 1, 2009

Bodine Journal

No abstract provided.

Flexible Needle-Tissue Interaction Modeling With Depth-Varying Mean Parameter: Preliminary Study, Kai Guo Yan, Tarun Podder, Yan Yu, Tien-I Liu, Christopher W.S. Cheng, Wan Sing Ng

Bodine Journal

Flexible needle steering has aroused a lot of research interest in recent years. It has the potential to correct targeting errors, which may be caused by needle bending, tissue deformation, or error in insertion angle. In addition, control and planning based on a steering model can guide the needle to some areas that are currently not amenable to needles because of obstacles, such as bone or sensitive tissues. Thus, there is a clear motivation for needle steering. In this paper, a spring–beam– damper model is proposed to describe the dynamics during the needle–tissue contact procedure. Considering tissue inhomogeneity, depth-varying mean …

Does Intraoperative Radiation Therapy Improve Local Tumor Control In Patients Undergoing Pancreaticoduodenectomy For Pancreatic Adenocarcinoma? A Propensity Score Analysis, Timothy Showalter Md, Atul Rao, Rani Anne Md, Francis E. Rosato, Ernest L Rosato, Jocelyn Andrel, Terry Hyslop, Xia Xu, Adam C. Berger

Bodine Journal

Background:

Locoregional recurrence (LRR) is an important factor after pancreaticoduodenectomy (PD) for pancreatic cancer. IORT administered to the resection bed may improve local tumor control.

Methods:

We performed a retrospective analysis of patients who underwent PD at Thomas Jefferson University Hospital (TJUH) between 1995 and 2005 to identify patients who underwent resection with and without intraoperative radiation therapy (IORT). Data collected included age, gender, complications, margin status, stage, survival, and recurrence. Unadjusted analyses of the IORT and non-IORT groups were performed using Fisher’s chi-square method for discrete variables and Wilcoxon Rank Sum test for continuous variables. To account for biases …

Combination Of Vandetanib, Radiotherapy, And Irinotecan In The Lovo Human Colorectal Cancer Xenograft Model, Phyllis Wachsberger, Phd, Randy Burd, Phd, Anderson Ryan, Phd, Constantine Daskalakis, Phd, Adam Dicker Md, Phd

Bodine Journal

Purpose:

The tumor growth kinetics of the human LoVo colorectal xenograft model was assessed in response to vandetanib, an orally available receptor tyrosine kinase inhibitor, radiotherapy (RT), or irinotecan (CPT-11), as single therapies and in combination.

Methods and Materials:

LoVo cells were injected subcutaneously into the right hind limb (5x106 cells in 100μL phosphate-buffered saline) of athymic NCR NUM mice and tumors were grown to a volume of 200–300mm3 before treatment. Vandetanib was administered at 50 mg/kg daily orally for 14 days starting on Day 1. RT was given as three fractions (3x3 Gy) on Days 1, 2, and 3. …

Nuclear Factor Κb Inhibitors Alleviate And The Proteasome Inhibitor Ps-341 Exacerbates Radiation Toxicity In Zebrafish Embryos, Borbala Daroczi, Gabor Kari, Qing Ren, Adam Dicker Md, Phd, Ulrich Rodeck

Bodine Journal

Inflammatory changes are a major component of the normal tissue response to ionizing radiation, and increased nuclear factor κB (NF-κB) activity is an important mediator of inflammatory responses. Here, we used zebrafish embryos to assess the capacity of two different classes of pharmacologic agents known to target NF-κB to modify radiation toxicity in the vertebrate organism. These were proteasome inhibitors, including lactacystin, MG132, and PS-341 (Bortezomib/VELCADE), and direct inhibitors of NF-κB activity, including ethyl pyruvate (EP) and the synthetic triterpenoid CDDO-TFEA (RTA401), among others. The proteasome inhibitors either did not significantly affect radiation sensitivity of zebrafish embryos (MG132, lactacystin) or …

Bodine Journal, Table Of Contents, Volume 2, Issue 1, Fall 2009

Bodine Journal

No abstract provided.

A Qualitative Study Of Rural Nurse Practitioners' In Medically Underserved Clinics, Jama J. Bogart

Doctor of Nursing Practice Scholarly Project

Retention of nurse practitioners is a serious problem in rural medically underserved areas. This study focused on the underserved areas in southeast Kansas, southwest Missouri, and northern Oklahoma. Approximately, three million persons reside in rural medically-underserved areas of the study area. Seventy-three percent of these adults have at least two or more complex chronic medical conditions and there are only 526 nurse practitioners to care for them. Rural providers face many challenges in caring for these individuals and experience anxiety and stress while caring for them. The purpose of this research study was to explore, analyze, and describe the phenomena …

Mesenteric Vascular Dysregulation And Intestinal Inflammation Accompanies Experimental Spinal Cord Injury, Emily Swartz Besecker, Gina M. Deiter, Nicole Pironi, Timothy K. Cooper, Gregory Michael Holmes

Health Sciences Faculty Publications

Cervical and high thoracic spinal cord injury (SCI) drastically impairs autonomic nervous system function. Individuals with SCI at thoracic spinal-level 5 (T5) or higher often present cardiovascular disorders that include resting systemic arterial hypotension. Gastrointestinal (GI) tissues are critically dependent upon adequate blood flow and even brief periods of visceral hypoxia triggers GI dysmotility. The aim of this study was to test the hypothesis that T3-SCI induces visceral hypoperfusion, diminished postprandial vascular reflexes and concomitant visceral inflammation. We measured in vivo systemic arterial blood pressure and superior mesenteric artery (SMA) and duodenal blood flow in anesthetized T3-SCI rats at 3 …

‘Crying A Few Million Tears’ For The Fallen Victims Of Huntington's Disease, Kenneth P. Serbin

At Risk for Huntington's Disease

No abstract provided.

Reproducibility And Reliability Of Chromatin Immunoprecipitation In Clinical Research, Kelli Mcdonough

Master's Theses and Doctoral Dissertations

Association between histones and DNA is crucial for many cellular functions such as gene transcription and epigenetic silencing. Changes to chromatin structure influence gene expression via histone modifications. Chromatin immunoprecipitation (ChIP) is an experimental technique used to investigate the interactions between histones and DNA. ChIP determines the specific location in the genome that histone modifications are associated with, indicating the target of the histone modifiers. Despite the appeal of ChIP as an in vitro technique, there are limitations to its use. There is variability from one preparation to the next, given the many steps and reagents used throughout the technique. …