Medicine and Health Sciences Commons^™

Infuse!_Volume 2_Number 1_2018, College Of Nursing

Infuse! College of Nursing Magazine

No abstract provided.

Early Melodic Intonation Therapy For Post-Stroke Aphasia: A Randomized Controlled Trial, Faye Steiner

Yale School of Medicine Physician Associate Program Theses

Stroke patients who lose the ability to produce language (aphasia) often remain able to sing. This observation has stimulated interest in a structured music therapy, Melodic Intonation Therapy, for post-stroke aphasia. While existing studies find positive outcomes with Melodic Intonation Therapy, its efficacy has yet to be substantiated by adequately powered, randomized, controlled trials. Focusing on acute stroke patients, we aim to determine the impact of melodic intonation therapy versus usual care on aphasia recovery. The study will be a single blind, randomized controlled trial with modified melodic intonation therapy and usual care groups. Aphasia severity will be scored at …

Early Hearing Detection Intervention (Ehdi) Program: What Is The Data Telling Us?, Bonny Specker, Lucy Fossen

Ethel Austin Martin Program Publications

Hearing impairments in infants can negatively impact speech and language development, academic achievement, and social and emotional development if left undetected. These negative impacts can be reduced through early intervention. There are three goals of the EHDI Program:

• All newborns will be screened for hearing loss before 1 month of age, preferably before hospital discharge.
• All infants who screen positive will have a diagnostic audiologic evaluation before three months of age.
• All infants diagnosed with a hearing loss will receive appropriate early intervention services before 6 months of age.

The South Dakota Department of Health recently evaluated 2010-2015 EHDI data …

South Dakota Pregnancy Risk Assessment Monitoring System (Prams), Maggie Minett, Tianna Beare, Bonny Specker

Ethel Austin Martin Program Publications

The Pregnancy Risk Assessment Monitoring System (PRAMS) was developed by the Centers for Disease Control and Prevention (CDC) in 1987 and is done in collaboration with various state health departments. PRAMS is a statewide survey that collects valuable information from new mothers on behaviors and attitudes before, during and after pregnancy to find out why some babies are born healthy and others are not. Currently, 47 states, New York City, Puerto Rico, the District of Columbia and the Great Plains Tribal Chairmen’s Health Board (GPTCHB) participate in the PRAMS survey, representing approximately 83% of all U.S. live births. The Ethel …

Comfort With Communication In Palliative And End Of Life Care (C-Cope), Mary J. Isaacson, Mary E. Minton

College of Nursing Faculty Publications

The C-COPE instrument is based on literature review, content from the COMFORT model, and iterative input from four content experts. The COMFORT communication model is grounded in patient-centered care and narrative medicine, where patients, families, and the healthcare team value each other’s story and collaboratively identify wishes and goals of care. COMFORT communication skills include bearing witness, understanding health literacy, actively listening, understanding family communication patterns, talking through the tension, embracing patient and family goals of care, and learning to collaborate with members of the team. The C-COPE operationalizes the key components of the COMFORT model: Communication, Orientation and opportunity, …

Medical School Watercooler Newsletter - July 1, 2018, Lindsey Lyle

Watercooler Newsletter

This is the July 1, 2018 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents Include:

• Pediatrics Hosting Grand Rounds July 20
• Class of 2020 Medical Students Begin Clerkship Rotations

2018 July Parkview Signature Care Thought Leader Forum, Jeanne Wickens, Jason Row Md, Mark Pierce Md

Presentations and Events

No abstract provided.

Opioid Administration And Prescribing In Older Adults In U.S. Emergency Departments (2005-2015)., Erin M Marra, Maryann Mazer-Amirshahi, Peter Mullins, Jesse M Pines

Emergency Medicine Faculty Publications

Introduction: We assess trends in opioid administration and prescribing from 2005-2015 in older adults in United States (U.S.) emergency departments (ED).

Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) survey from 2005 to 2015. ED visits for painful conditions were selected and stratified by age (18-64, 65-74, 75-84, ≥ 85 years). We analyzed trends in opioid administration in the ED and prescribing at discharge to encounters ≥ 65 and assessed predictors of use using survey-weighted chi-square tests and logistic regression. Trends in the use of five commonly prescribed opioids were also explored.

Results: Opioid administration …

Gw Nursing, Summer 2018, George Washington University, School Of Nursing

GW Nursing Magazine

No abstract provided.

Group B Streptococcus In Pregnancy, Lindsay Doyle

Nursing Student Class Projects (Formerly MSN)

Group B Streptococcus (GBS) is the ‘leading infectious cause of neonatal morbidity and mortality in the United States” (Colicchia, Lauderdale, Du, Adams, & Hirsch, 2015, p. 173). GBS is a bacterium present in the vagina and/or anorectal flora of women and is considered to be normal flora which generally does not cause infection, however, if a pregnant woman is GBS positive and left untreated during birth, the newborn passing through the birth canal is at risk for becoming colonized (Bicheno & Geraghty, 2015, p. 224). Infants exposed to GBS may develop sepsis, pneumonia, and meningitis within the first week after …

Pathophysiology Of Sepsis, Billie K. Newland

Nursing Student Class Projects (Formerly MSN)

Sepsis is a life-threatening medical emergency. In the United States, over 1.6 million hospitalizations and 250,000 deaths are attributed to sepsis each year. It is important that healthcare providers are aware of the signs/symptoms of sepsis because effective treatment depends on rapid recognition and treatment. Current quality improvement measures were used to investigate sepsis treatment recommendations. The Centers for Medicare & Medicaid Services (CMS) and Joint Commision (JC) recommend the use of Severe Sepsis/Septic Shock Early Management Bundle (SEP-1). The American College of Emergency Physicians (ACEP) launched the Emergency Quality Network (E-QUAL) Sepsis Initiative as an addition to the SEP1 …

Cystic Fibrosis, Fatime Sylla

Nursing Student Class Projects (Formerly MSN)

The study of the physiological development causing or associating with disease or injury provides an opportunity to find pertinent, personalized medicine for patients. In this perspective, Cystic fibrosis (CF), one of the most common lethal genetic and complex disease was analyzed as a perfect example on how knowing a disease process to the molecular level and understanding how it affects the individuals can lead to successful health results. Recent researches in CF have demonstrated that tailor therapies based on genetic findings have been effective in extending life expectancy of CF fibrosis patients to late 30s or 50s. However, other factors …

Early Intervention, Documentation, And Service Delivery: A Review Of Ifsps And Service Notes, Allison N. Krieger, Megan M. Rodgers, Elaine R. Starkey-Ingalls

Pediatrics

This abstract will be available for download after an embargo period

Adapted Dance Class And Autism Spectrum Disorder, Lindsay Gutting, Carly O'Brien, Kelsey Moggie

Pediatrics

Background: Autism Spectrum Disorder (ASD) is a developmental disability that can cause significant social, communication, and behavioral symptoms. Although a variety of interventions for those with ASD are available, Adapted Dance Class (ADC), also called Dance Movement Therapy (DMT), is a relatively understudied intervention that has the potential support social skill development for this population.

Method: This is a descriptive, exploratory case study in which researchers aimed to discover whether DMT is effective in promoting social and communication skills in adolescents with ASD. We viewed 16 videos of four students who participated in two DMT classes and procedurally documented social …

The Expression Of Mirc1/Mir17-92 Cluster In Sputum Samples Correlates With Pulmonary Exacerbations In Cystic Fibrosis Patients, Kathrin Krause, Benjamin T. Kopp, Mia F. Tazi, Kyle Caution, Kaitlin Hamilton, Asmaa Badr, Chandra Shrestha, Dmitry Tumin, Don Hayes Jr, Frank Robledo-Avila, Luanne Hall-Stoodley, Brett G. Klamer, Xiaoli Zhang, Santiago Partida-Sanchez, Narasimham L. Parinandi, Stephen E. Kirkby, Duaa Dakhlallah, Karen S. Mccoy, Estelle Cormet-Boyaka, Amal O. Amer

Clinical and Translational Science Institute

Introduction—Cystic fibrosis (CF) is a multi-organ disorder characterized by chronic sinopulmonary infections and inflammation. Many patients with CF suffer from repeated pulmonary exacerbations that are predictors of worsened long-term morbidity and mortality. There are no reliable markers that associate with the onset or progression of an exacerbation or pulmonary deterioration. Previously, we found that the Mirc1/Mir17–92a cluster which is comprised of 6 microRNAs (Mirs) is highly expressed in CF mice and negatively regulates autophagy which in turn improves CF transmembrane conductance regulator (CFTR) function. Therefore, here we sought to examine the expression of individual Mirs within the Mirc1/Mir17–92 cluster in …

Stigma At Every Turn: Health Services Experiences Among People Who Inject Drugs, Catherine E. Paquette, Jennifer L. Syvertsen, Robin A. Pollini

Clinical and Translational Science Institute

Background—People who inject drugs (PWID) encounter varying forms of stigma in health services contexts, which can contribute to adverse outcomes. We explored the lived experience of stigma among PWID to elucidate pathways by which stigma influences health care access and utilization. Methods—We conducted 46 qualitative interviews with PWID in California’s Central Valley between March and December 2015, as part of a multi-phase, multi-method study examining implementation of a new pharmacy syringe access law. A “risk environment” framework guided our data collection and we used a deductive/inductive approach to analyze the qualitative data. Results—Participants repeatedly cited the impact of stigma on …

Injection Drug Use, Hiv/Hcv, And Related Services In Nonurban Areas Of The United States: A Systematic Review, Catherine E. Paquette, Robin A. Pollini

Clinical and Translational Science Institute

Background—Injection drug use (IDU) in nonurban areas of the United States is a growing public health concern, but there has been no comprehensive assessment of existing research on injection-related HIV and hepatitis C (HCV) in nonurban communities. We conducted a systematic review to assess the current literature and identify knowledge gaps. Methods—We systematically searched six databases for relevant articles published between January 1990 and June 2016 and screened, extracted, and analyzed the resulting data. Studies were included if they reported original findings from the nonurban U.S. related to 1) IDU and its role in HIV/HCV transmission, and/or 2) HIV/HCV services …

Web-Based Training Methods For Behavioral Health Providers: A Systematic Review, Carrie B. Jackson, Lauren B. Quetsch, Laurel A. Brabson, Amy D. Herschell

Clinical and Translational Science Institute

There has been an increase in the use of web-based training methods to train behavioral health providers in evidence-based practices. This systematic review focuses solely on the efficacy of web-based training methods for training behavioral health providers. A literature search yielded 45 articles meeting inclusion criteria. Results indicated that the serial instruction training method was the most commonly studied web-based training method. While the current review has several notable limitations, findings indicate that participating in a web-based training may result in greater post-training knowledge and skill, in comparison to baseline scores. Implications and recommendations for future research on web-based training …

Appropriate Use Of Venous Imaging And Analysis Of The D- Dimer/Clinical Probability Testing Paradigm In The Diagnosis And Location Of Deep Venous Thrombosis, Albeir Y. Mousa, Mike Broce, David De Wit, Mina Baskharoun, Shadi Abu-Halimah, Michael Yacoub, Mark C. Bates

Clinical and Translational Science Institute

Background—The D-dimer (DD) level combined with the pretest Wells criteria probability (WCP) score can safely exclude deep venous thrombosis (DVT). The objective of this study was to examine the correlation between DD results alongside WCP score with findings on venous duplex ultrasound (VDU). The hypothesis is that VDU remains overutilized in low-risk patients with negative DD and that higher DD levels may correlate with thrombus burden and location. Methods—Patients who presented to a high-volume tertiary care center with lower limb swelling with or without associated pain were retrospectively examined through June and July for 4 consecutive years (2012 to 2015). …

Predictors Of Binge Eating Among Bariatric Surgery Candidates: Disinhibition As A Mediator Of The Relationship Between Depressive Symptoms And Binge Eating, Stephanie Cox, Cassie Brode

Clinical and Translational Science Institute

Background—Current and lifetime psychopathology is common in adult patients seeking bariatric surgery, with major depressive disorder and binge eating disorder affecting a higher proportion of this group than the general population. While depressive symptoms have been previously associated with eating pathology, potential mediators of this relationship are not well understood. Methods—This study used a naturalistic, retrospective design to investigate cognitive and behavioral aspects of eating behavior (cognitive restraint, disinhibition, and hunger) as potential mediators of the relationship between depressive symptoms and binge eating within a sample of 119 adult patients (82.4% female; 96.6% white; mean age = 47 years) seeking …

Lowering Minimum Eye Height To Increase Peak Knee And Hip Flexion During Landing, Boyi Dai, Taylour J. Hinshaw, Tyler A. Trumble, Chaoyi Wang, Xiaopeng Ning, Qin Zhu

Clinical and Translational Science Institute

The purpose was to determine the effect of lowering minimum eye height through an externally focused object on knee and hip flexion and impact forces during jump-landing. Kinematics and ground reaction forces were collected when 20 male and 19 female participants performed jump-landing trials with their natural minimum eye height, and trials focusing on lowering their minimum eye height to an external object, which was set at 5% or 10% of standing height lower. Participants demonstrated decreased minimum eye height and increased peak knee and hip flexion during early-landing and stance phase when focusing on lowering eye height to the …

Glioblastoma Survival Outcomes At A Tertiary Hospital In Appalachia: Factors Impacting The Survival Of Patients Following Implementation Of The Stupp Protocol, Ogaga Urhie, Ryan Turner, Brandon Lucke-Wold, Walid Radwan, Janice Ahn, Kymberly Gyure, Sanjay Bhatia

Clinical and Translational Science Institute

Glioblastoma is a fatal brain cancer with low median and yearly survival rates. The standard of care for treating glioblastoma is gross total resection (GTR) coupled with the Stupp protocol, but various factors influence the interventions undertaken and survival achieved. As health disparities exist in rural areas, survival in these areas need to be assessed in order to understand which factors detract from the successes of these standard medical interventions. We retrospectively determined the impact of age of diagnosis, number of lesions, the molecular marker O6-methylguanine methyltransferase (MGMT), extent of surgery, and completion of the Stupp protocol on survival among …

Sphingosine-1-Phosphate Modulates The Effect Of Estrogen In Human Osteoblasts, Duangrat Tantikanlayaporn, Irina L. Tourkova, Quitterie Larrouture, Jianhua Luo, Pawinee Piyachaturawat, Michelle R. Witt, Harry C. Blair, Lisa J. Robinson

Clinical and Translational Science Institute

Production of sphingosine‐1‐phosphate (S1P) is linked to 17β‐estradiol (E2) activity in many estrogen‐responsive cells; in bone development, the role of S1P is unclear. We studied effects of S1P on proliferation and differentiation of human osteoblasts (hOB). Ten nM E2, 1 μM S1P, or 1 μM of the S1P receptor 1 (S1PR1) agonist SEW2871 increased hOB proliferation at 24 hours. S1PR 1, 2, and 3 mRNAs are expressed by hOB but not S1PR4 or S1PR5. Expression of S1PR2 was increased at 7 and 14 days of differentiation, in correspondence with osteoblast‐related mRNAs. Expression of S1PR1 was increased by E2 or S1P …

Effects Of Cytochrome P450 Single Nucleotide Polymorphisms On Methadone Metabolism And Pharmacodynamics, Taha Ahmad, Monica A. Valentovic, Gary O. Rankin

Clinical and Translational Science Institute

Methadone is a synthetic, long-acting opioid with a single chiral center forming two enantiomers, (R)-methadone and (S)-methadone, each having specific pharmacological actions. Concentrations of (R)- and (S)-methadone above therapeutic levels have the ability to cause serious, life-threatening, and fatal side effects. This toxicity can be due in part to the pharmacogenetics of an individual, which influences the pharmacokinetic and pharmacodynamic properties of the drug. Methadone is primarily metabolized in the liver by cytochrome P450 (CYP) enzymes, predominately by CYP2B6, followed by CYP3A4, 2C19, 2D6, and to a lesser extent, CYP2C18, 3A7, 2C8, 2C9, 3A5, and 1A2. Single nucleotide polymorphisms (SNPs) …

Restoring Faculty Vitality In Academic Medicine When Burnout Threatens, Darshana T. Shah, Valerie N. Williams, Luanne E. Thorndyke, E. Eugene Marsh, Roberta E. Sonnino, Steven M. Block, Thomas R. Viggiano

Clinical and Translational Science Institute

Increasing rates of burnout—with accompanying stress and lack of engagement—among faculty, residents, students, and practicing physicians have caused alarm in academic medicine. Central to the debate among academic medicine’s stakeholders are oft-competing issues of social accountability; cost containment; effectiveness of academic medicine’s institutions; faculty recruitment, retention, and satisfaction; increasing expectations for faculty; and mission-based productivity. The authors propose that understanding and fostering what contributes to faculty and institutional vitality is central to preventing burnout during times of change. They first look at faculty vitality and how it is threatened by burnout, to provide a framework for a greater understanding of …

Synergistic Effect Of Black Tea Polyphenol, Theaflavin-3,3'-Digallate With Cisplatin Against Cisplatin Resistant Human Ovarian Cancer Cells, Haibo Pan, Jin Li, Gary O. Rankin, Yon Rojanasakul, Youying Tu, Yi Charlie Chen

Clinical and Translational Science Institute

Theaflavin-3, 3’-digallate (TF3) is a phenolic compound extracted from black tea. We previously demonstrated that TF3 selectively inhibited ovarian cancer cells. Ovarian cancer has high death rate because of acquired cisplatin resistance. We aimed to investigate the synergistic effect of TF3 and cisplatin (CDDP) against cisplatin resistant ovarian cancer cells. In the present study, combination treatment with TF3 and CDDP showed a synergistic cytotoxic effect in A2780/CP70 and OVCAR3 cells. Combination treatment showed a synergistic pro-apoptotic effect and synergistically induced G1/S phase cell cycle arrest. Synergistic apoptosis was accompanied by regulating protein expression of cleaved caspase 3/7, cytochrome c, Bax …

The Association Of Perceived Memory Loss With Osteoarthritis And Related Joint Pain In A Large Appalachian Population, Kim E. Innes, Usha Sambamoorthi

Clinical and Translational Science Institute

Objective. Previous studies have documented memory impairment in several chronic pain syndromes. However, the potential link between memory loss and osteoarthritis (OA), the second most common cause of chronic pain, remains little explored. In this cross-sectional study, we examine the association of perceived memory loss to OA and assess the potential mediating influence of sleep and mood disturbance in a large Appalachian population. Design. Cross-sectional. Setting. US Ohio Valley. Subjects. A total of 21,982 Appalachian adults age 40 years or older drawn from the C8 Health Project (N 5 19,004 adults without and 2,478 adults with OA). All participants completed …

Preeclampsia And The 20th Century: "Le Siècle Des Lumières", Pierre-Yves Robillard, Gustaaf Dekker, Gérard Chaouat, Philippe Le Bouteiller, Marco Scioscia, Thomas C. Hulsey

Clinical and Translational Science Institute

The authors delineate seven quantum leap forward and, or revolutions having occurred during the 20th century in the understanding of the physiopathology of preeclampsia. First the discovery of the inflatable arm band permitting to measure blood pressure in 1896. Second, the discovery that eclamptic (convulsions), and later “pre”eclamptic (proteinuria) women presented hypertension in 1897 and confirmed in 1903, discovery of the hypertensive disorders of pregnancy. Third, the eight major textbooks published all along the 20th century by delineating risk factors of preeclampsia with the concept of “preeclampsia, disease of primigravidae”. Fourth, the discovery in the 1970’s that human trophoblast implantation …

Multimorbidity Trends In United States Adults, 1988-2014, Dana E. King, Jun Xiang, Courtney S. Pilkerton

Clinical and Translational Science Institute

No abstract provided.

Challenges Associated With The Use Of Policy To Identify And Manage Risk For Suicide And Interpersonal Violence Among Veterans And Other Americans, Robert M. Bossarte

Clinical and Translational Science Institute

No abstract provided.