Medicine and Health Sciences Commons^™

Osteoporosis And Its Perspective In Pakistan: A Review Of Evidence And Issues For Addressing Fragility Fractures, Aysha Habib Khan, Lena Jafri, Sibtain Ahmed, Shahryar Noordin

Department of Pathology and Laboratory Medicine

Despite major advances in osteoporosis diagnosis and treatment, low rates of investigating and treating osteoporosis in patients with fragility fracture are reported in Pakistan. Cost of therapies, time and cost of resources for diagnosis, concerns about medications and lack of clarity regarding the onus of responsibility to undertake this care, are some of the barriers to osteoporosis identification and treatment. Data from our part of the world on osteoporosis as well as on fragility fractures is sparse. This review addresses the current screening and diagnostic strategies for osteoporosis and reviews the existing literature to highlight the issues prevalent in our …

Transcriptional Profiling Reveals Extraordinary Diversity Among Skeletal Muscle Tissues, Erin E. Terry, Xiping Zhang, Christy Hoffmann, Laura D. Hughes, Scott A. Lewis, Jiajia Li, Matthew J. Wallace, Lance A. Riley, Collin M. Douglas, Miguel A. Gutierrez-Monreal, Nicholas F. Lahens, Ming C. Gong, Francisco H. Andrade, Karyn A. Esser, Michael E. Hughes

Physiology Faculty Publications

Skeletal muscle comprises a family of diverse tissues with highly specialized functions. Many acquired diseases, including HIV and COPD, affect specific muscles while sparing others. Even monogenic muscular dystrophies selectively affect certain muscle groups. These observations suggest that factors intrinsic to muscle tissues influence their resistance to disease. Nevertheless, most studies have not addressed transcriptional diversity among skeletal muscles. Here we use RNAseq to profile mRNA expression in skeletal, smooth, and cardiac muscle tissues from mice and rats. Our data set, MuscleDB, reveals extensive transcriptional diversity, with greater than 50% of transcripts differentially expressed among skeletal muscle tissues. We detect …

First Results On Survival From A Large Phase 3 Clinical Trial Of An Autologous Dendritic Cell Vaccine In Newly Diagnosed Glioblastoma, Linda M. Liau, Keyoumars Ashkan, David D. Tran, Jian L. Campian, John E. Trusheim, Charles S. Cobbs, Jason A. Heth, Michael Salacz, Sarah Taylor, Stacy D. D'Andre, Fabio M. Iwamoto, Edward J. Dropcho, Yaron A. Moshel, Kevin A. Walter, Clement P. Pillainayagam, Robert Aiken, Rekha Chaudhary, Samuel A. Goldlust, Daniela A Bota, Paul Duic, Jai Grewal, Heinrich Elinzano, Steven A. Toms, Kevin O. Lillehei, Tom Mikkelsen, Tobias Walbert, Steven R. Abram, Andrew J. Brenner, Steven Brem, Matthew G. Ewend, John L. Villano

Internal Medicine Faculty Publications

Background: Standard therapy for glioblastoma includes surgery, radiotherapy, and temozolomide. This Phase 3 trial evaluates the addition of an autologous tumor lysate-pulsed dendritic cell vaccine (DCVax^®-L) to standard therapy for newly diagnosed glioblastoma.

Methods: After surgery and chemoradiotherapy, patients were randomized (2:1) to receive temozolomide plus DCVax-L (n = 232) or temozolomide and placebo (n = 99). Following recurrence, all patients were allowed to receive DCVax-L, without unblinding. The primary endpoint was progression free survival (PFS); the secondary endpoint was overall survival (OS).

Results: For the intent-to-treat (ITT) population (n = 331), median OS (mOS) was 23.1 months …

06-05-2018 Hsc Committee Agenda, Patrice Martin

HSC Committee (A subcommittee of the UNM Board of Regents)

No abstract provided.

Motor Affordance For Grasping A Safety Handle, Douglas W. Mcdannald, Manhoud Mansour, Garrett Rydalch, David A.E. Bolton

Kinesiology and Health Science Faculty Publications

Mere observation of objects in our surroundings can potentiate movement, a fact reflected by visually-primed activation of motor cortical networks. This mechanism holds potential value for reactive balance control where recovery actions of the arms or legs must be targeted to a new support base to avoid a fall. The present study was conducted to test if viewing a wall-mounted safety handle – the type of handle commonly used to regain balance – results in activation of motor cortical networks. We hypothesized that the hand area of the primary motor cortex would be facilitated shortly after visual access to a …

First Results On Survival From A Large Phase 3 Clinical Trial Of An Autologous Dendritic Cell Vaccine In Newly Diagnosed Glioblastoma., Linda M. Liau, Keyoumars Ashkan, David D. Tran, Jian L. Campian, John E. Trusheim, Charles S. Cobbs, Jason A. Heth, Michael Salacz, Sarah Taylor, Stacy D. D'Andre, Fabio M. Iwamoto, Edward J. Dropcho, Yaron A. Moshel, Kevin A. Walter, Clement P. Pillainayagam, Robert Aiken, Rekha Chaudhary, Samuel A. Goldlust, Daniela A. Bota, Paul Duic, Jai Grewal, Heinrich Elinzano, Steven A. Toms, Kevin O. Lillehei, Tom Mikkelsen, Tobias Walbert, Steven R. Abram, Andrew J. Brenner, Steven Brem, Matthew G. Ewend, Simon Khagi, Jana Portnow, Lyndon J. Kim, William G. Loudon, Reid C. Thompson, David E Avigan, Karen L. Fink, Francois J. Geoffroy, Scott Lindhorst, Jose Lutzky, Andrew E. Sloan, Gabriele Schackert, Dietmar Krex, Hans-Jorg Meisel, Julian Wu, Raphael P Davis, Christopher Duma, Arnold B. Etame, David Mathieu, Santosh Kesari, David Piccioni, Manfred Westphal, David S. Baskin, Pamela Z. New, Michel Lacroix, Sven-Axel May, Timothy J. Pluard, Victor Tse, Richard M. Green, John L. Villano, Michael Pearlman, Kevin Petrecca, Michael Schulder, Lynne P Taylor, Anthony E. Maida, Robert M. Prins, Timothy F. Cloughesy, Paul Mulholland, Marnix L. Bosch

Department of Medical Oncology Faculty Papers

BACKGROUND: Standard therapy for glioblastoma includes surgery, radiotherapy, and temozolomide. This Phase 3 trial evaluates the addition of an autologous tumor lysate-pulsed dendritic cell vaccine (DCVax

METHODS: After surgery and chemoradiotherapy, patients were randomized (2:1) to receive temozolomide plus DCVax-L (n = 232) or temozolomide and placebo (n = 99). Following recurrence, all patients were allowed to receive DCVax-L, without unblinding. The primary endpoint was progression free survival (PFS); the secondary endpoint was overall survival (OS).

RESULTS: For the intent-to-treat (ITT) population (n = 331), median OS (mOS) was 23.1 months from surgery. Because of the cross-over trial design, nearly …

Acclimation And Institutionalization Of The Mouse Microbiota Following Transportation., Dan R Montonye, Aaron C Ericsson, Susheel B Busi, Cathleen Lutz, Keegan Wardwell, Craig L Franklin

Faculty Research 2018

Using animal models, the gut microbiota has been shown to play a critical role in the health and disease of many organ systems. Unfortunately, animal model studies often lack reproducibility when performed at different institutions. Previous studies in our laboratory have shown that the gut microbiota of mice can vary with a number of husbandry factors leading us to speculate that differing environments may alter gut microbiota, which in turn may influence animal model phenotypes. As an extension of these studies, we hypothesized that the shipping of mice from a mouse producer to an institution will result in changes in …

What's Happening: May 28, 2018, Maine Medical Center

What's Happening

No abstract provided.

Uterine Necrosis After Uterine Artery Embolization For Symptomatic Fibroids, Steve Mutiso, Felix Oindi, Nigel Hacking, Timona Obura

Obstetrics and Gynaecology, East Africa

Introduction: Uterine artery embolization (UAE) is a minimally invasive intervention that is used in the treatment of fibroids. UAE can lead to complications including postembolization syndrome, postprocedure pain, infection, endometrial atrophy leading to secondary amenorrhea, and uterine necrosis. Uterine necrosis afer UAE is very rare and hence poses a clinical dilemma for any clinician in its identifcation and management. We document a case of uterine necrosis afer UAE and conduct a literature review on its causation, clinical features, and management principles.

Case: A patient presented one month afer UAE with abdominal pain and abdominal vaginal discharge. Her work-up revealed features …

Medical School Watercooler Newsletter - May 27, 2018, Lindsey Lyle

Watercooler Newsletter

This is the May 27, 2018 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents Include:

• Class of 2020 Medical Students to Receive White Coats June 16
• USA COM Scientists Awarded Notable $9.9 Million NIH Grant
• USA COM Welcomes Coordinator of Clinical Education for Student Affairs
• June Med School Café – ‘Stop the Bleed’

Daily Associations Between Objective Sleep And Consumption Of Highly Palatable Food In Free-Living Conditions, W. S. Chan

Dartmouth Scholarship

Objectives:

Prior studies have shown that individuals with shorter sleep duration and later sleep timing consume more highly palatable food (HPF). It is unclear if this relationship exists at the within‐individual level, e.g. if sleeping less or later on one night is associated with greater HPF consumption in the following day in naturalistic environments. This study examined the daily associations between naturalistic sleep and HPF consumption.

Methods:

Data were obtained from 78 healthy young adults (age = 20.38 [SD = 2.40] years). Participants carried a wrist actigraph and completed daily diaries tracking food consumption and covariates for seven consecutive days. …

Gaze-Driven Video Games As Vision Training: A Case Study In Cerebral Palsy, Mckenna Wade

Undergraduate Honors Theses

Cerebral Palsy is a disorder that primarily affects motor control, but frequently impacts gaze behavior as well. Due to the primary therapeutic emphasis on motor symptoms, there is a dearth of therapies available for gaze behavior in Cerebral Palsy. Based on research suggesting that video games and Augmented Reality have been useful for improvement of gaze behavior and rehabilitation for other impaired individuals, this case study applies a set of therapeutic gaze-dependent Augmented Reality video games to an adolescent male with Spastic Diplegic Cerebral Palsy. The video games were determined to be a good fit for the participant by the …

The Weight Of A Healthy Home: Early Screening For Childhood Obesity Risk, Sara Herbenick, Kathy James, Dnsc, Aprn, Faan, Jill Milton, Msn, Fnp

Doctor of Nursing Practice Final Manuscripts

Purpose

Despite the Healthy People 2020 target of 14.5%, the California obesity prevalence among low-income children ages 2 to 19 was 21% in 2010. An obesogenic home environment is a major contributor to overeating and sedentariness during this phase of development as children have less autonomy and are influenced by family environmental cues. The purpose of this evidence-based project was to implement a screening tool at a low socioeconomic elementary school clinic to identify children at risk of developing obesity and provide standardization for practitioners on educating parents regarding child obesity risk factors. The Family Nutrition and Physical Activity (FNPA) …

A Common Goal: Primary Care And Psychiatry Improve Depression Detection And Outcomes, Katherine Kilkenny

Doctor of Nursing Practice Final Manuscripts

Background: Major Depressive Disorder (MDD) affects over 15 million (6.7%) adult Americans. While one in four primary care patients suffer from depressive symptoms, MDD is accurately diagnosed as little as 25% of the time.

Purpose: Implementation of an evidence-based protocol outlining the process for screening, behavioral health referral, and the role of a collaborative care team would improve detection and treatment of adult MDD patients in the ambulatory setting.

Process: A systematic Patient Health Questionnaire (PHQ-9) based screening protocol was implemented. Every new and existing patient completed the PHQ-9 during scheduled primary care appointments. If a patient scored 15 or …

Stop, Meditate, And Listen: A Treatment Modality For Iraqi Refugees With Depression, Katherine Goehring

Doctor of Nursing Practice Final Manuscripts

Purposes: To implement a mindfulness meditation program with Arabic speaking clients as an adjunctive treatment of depression

Background: Depression rates among Iraqi refugees are between 28.3 and 75% compared to 8.6% in the general population (Slewa-Younan, Guajardo, Heriseanu, & Hasan, 2015). Treatment options are limited at Neighborhood Healthcare in El Cajon due to budget limitations, cultural beliefs and language barriers, among other reasons. Individual therapy is intended to be a brief intervention due to limited staffing. Many middle eastern refugees decline group therapy due to stigma surrounding mental health treatment and concerns about privacy. Even though traditional treatment …

Optimizing Chronic Pain Management: Self-Care Utilization Among Veterans With Post-Traumatic Stress Disorder, Paul Krug, Anamarie J. Lazo, Joseph Burkard, David Bittleman

Doctor of Nursing Practice Final Manuscripts

Purpose: To implement a chronic pain management regimen that utilizes a self-care approach, integrating all dimensions of the biopsychosocial model to optimally treat the complex needs of younger Veterans with comorbid PTSD and chronic pain. The project aims to provide more insight and knowledge on safer chronic pain management among Veterans, reflected by improvement in patient’s pain level, quality of life, and depression scale.

Design: The project was implemented at the ASPIRE Center, a domiciliary residential rehabilitation treatment program for Veterans who suffer from PTSD and traumatic brain injury. The 5A’s behavior change model was utilized during clinic …

Focus On Fitness: Incorporating Exercise Into The Treatment Of Children And Adolescents With Attention-Deficit Hyperactivity Disorder, Kristin Lulich

Doctor of Nursing Practice Final Manuscripts

Background: Psychotropic medications, particularly stimulants are frequently used as the first-line treatment for Attention Deficit Hyperactivity Disorder (ADHD). Many patients and their caregivers have concerns about psychotropic options for treatment. Review of current literature demonstrates the efficacy of physical activity in reducing symptoms of ADHD. Purpose: This evidence based practice (EBP) project introduced regular, scheduled aerobic activity into the treatment plan of children and adolescents with ADHD. The aim of this EBP was to reduce symptoms of ADHD measured by caregivers using the Vanderbilt Ratings Scale. The Johns Hopkins Nursing Evidence Based Practice Model was used to implement this project. …

Power To The Patients: A Heart Failure Transitions Of Care Program In A Heart Resource Center, Katherine Nicole Oxina Padiernos Bsn, Rn, Dnp Student, Scot Nolan Dnp, Rn, Cns, Ccrn, Teri Armour -Burton Phd, Cnml, Ne-Bc, Colleen Austel Nadeau Bsn, Rn, Chfn

Doctor of Nursing Practice Final Manuscripts

Background: In the United States an estimated 5.7 million adults have heart failure (HF), costing $30.7 billion annually. National HF readmission rates have remained high at 21.3%. After an extensive literature review, the purpose of this project was to incorporate teach back methods, self care education, resource accessibility, and increased post-discharge contact through an outpatient heart failure transitions of care program.

Methods and Results: Prior to discharge, HF patients were recruited and given a pre-test Self Care of Heart Failure Index (SCHFI). A DNP student and progressive care unit registered nurses provided discharge education utilizing a Healthy Heart Tracker booklet …

Improving Quality Of Life In Veterans With Chronic Pain Through Patient Engagement, Linda Nyagaya

Doctor of Nursing Practice Final Manuscripts

Background: Various psychosocial factors affect follow up care among veterans with chronic pain. Engaging veterans by giving them the choice to decide contact modality for after clinic visit increases likelihood of successfully reaching patient and adherence to recommended pain management.

Purpose: To engage veterans through self-determined effective communication method: telephone, email or Myhealthevet for follow up care. The intervention aims to improve chronic pain self-care by assessing number of medications used for pain, numeric pain rating and quality of life score.

Framework/EBP Model: The Iowa Model and 5A’s will guide implementation and assessment of this project. Patients will self-determine the …

Diabetes Self Management Education In An Underserved Primary Care Setting, Jessica Salas

Doctor of Nursing Practice Final Manuscripts

Objective: A key component to the management of type 2 diabetes is appropriate self management of the disease by the patient. The purpose of this project was to provide culturally appropriate Diabetes Self Management Education in an underserved primary care setting to improve glycemic control among Spanish speaking patients who have uncontrolled diabetes.

Research Design and Methods: The evidence based practice project took place at a primary care practice in an underserved area. Fifteen Spanish speaking patients with uncontrolled type 2 diabetes with a hemoglobin A1c greater than 7% were included in the intervention. The intervention included implementation of Diabetes …

In Honor Of Self: A Weight Loss Project For A Military Population With Mental Disorders, Tanya Denise Stevenson-Gaines

Doctor of Nursing Practice Final Manuscripts

Background: Obesity in people diagnosed with mental disorders is at an epidemic level. Individuals with a mental illness who are prescribed medication for stability are at risk for obesity and metabolic syndrome. People with mental disorders have a 10 to 30-year decrease in life expectancy associated with chronic illnesses. Military personnel are separated from service when they are measured outside of body composition assessment standards.

Aims: To address the problem of obesity in military members by providing a weight loss program with structured and collaborative weight management education and telephonic coaching.

Methods: Stakeholders were informed about the purpose and goals …

Screening For Binge Eating Disorder In Patients Undergoing A Weight Loss Program, Doris Cheruiyot

Doctor of Nursing Practice Final Manuscripts

Background: Binge eating disorder (BED) is the most common eating disorder in the United States, it is more prevalent than Anorexia Nervosa and Bulimia combined. BED is characterized by recurrent episodes of binge eating accompanied by feeling a lack of control and marked distress over one’s eating behaviors. BED is a serious condition that impairs health-related quality of life (HRQL) and increases health care costs.

Purpose: The purpose of this project was to identify patients at risk for binge eating disorder at an outpatient weight loss clinic using the validated BEDS-7 screening tool.

Evidence-based Intervention: The 7-item Binge-Eating Disorder Screener …

Reducing Pediatric Asthma Visits In The Emergency Department, Kathleen Grimley Ahn

Doctor of Nursing Practice Final Manuscripts

Purpose/Aims: The purpose of this project was to reduce the number of unnecessary pediatric asthma management visits to an urban emergency department (ED) by performing a brief action plan for improved National Heart, Lung, and Blood Institute (NHLBI) guideline adherence. This plan was shared with parents during an NP-initiated follow-up phone call.

Rationale/Background: Inadequate outpatient management of pediatric asthma can result in avoidable visits to the ED. Acute exacerbations comprise a large portion of pediatric asthma patients seeking care in the ED. Reasons for persistent under-utilization of outpatient care for asthma management in primary care settings are multifactorial. Daily symptom …

Family Nurse Practitioner Student Competencies In Integrated Psychiatric Healthcare, Mark Manning

Doctor of Nursing Practice Final Manuscripts

Title: Practicum to Practice: Family Nurse Practitioner Student Competencies in Integrated Psychiatric Mental Healthcare.

Background: Major Depressive Disorder (MDD) is a widespread and costly diagnosis that affects nearly 16 million people annually and costs the United States nearly $83 Billion. Primary care providers such as Family Nurse Practitioners (FNP) play a crucial role in screening for health problems, preventing, and managing illness. Opportunities exist to integrate psychiatric mental healthcare into FNP curriculum and clinical practicums to better prepare providers to identify and screen for depression.

Purpose: The purpose of this evidenced-based practice project is to evaluate FNP student competencies …

Identification Of Nurse-Controlled Predictors Of Pain In Patients Undergoing A Total Hip Or Total Knee Arthroplasty, Melodie Ruth Daniels

Dissertations

Objectives: The purpose of this study was to examine relationships among nursing interventions and pain status during hospitalization in orthopedic surgical patients receiving total hip or knee arthroplasty in one of four community hospitals in San Diego, California.

Background: The epidemic of opioid-related adverse events creates a need for opioid sparing approaches to pain management. Pain management practices have been studied in relation to medicine; however, the relationship between pain and opioid sparing, nurse-specific interventions is not clear.

Methods: The retrospective descriptive study examined Electronic Health Record (EHR) data of patients (N = 1657) discharged after a total hip …

Priapism Among Male Adolescents With Sickle Cell Disease, Prince Ocansey

Dissertations

The purpose of this qualitative phenomenological study was to describe the lived experience of priapism among male adolescents with sickle cell disease (SCD). A painful genetic disorder with no cure, SCD severely impacts the lives of patients, as well as their families and friends. Priapism is one of the complications of SCD and involves persistent and painful penile erections. The review of literature established a gap in researchers’ understanding of the lived experience of priapism among male adolescents with SCD. This study aimed to bridge that gap.

Using a convenience sampling method, 7 adolescent males between the ages of 16 …

What’S Keeping America’S Heroes Awake? Screening For Obstructive Sleep Apnea In Male Veterans With Hypertension And Diabetes, Aaron James Stirling

Doctor of Nursing Practice Final Manuscripts

Purpose: To reduce cardiovascular risk through optimal obstructive sleep apnea (OSA) management with proactive screening utilizing the Epworth Sleepiness Scale (ESS) in male Veterans with hypertension (HTN) and diabetes mellitus (DM).

Background: OSA is a common finding in primary care, with 1 in 5 adults feeling its effects: excessive sleepiness, impaired cognition, reduced quality of life and increased mortality. Unmanaged OSA has been highly correlated with increased cardiac risk in populations with chronic diseases such as HTN and DM. Fortunately, identification and treatment of OSA has been shown to improve cardiovascular outcomes and reduce mortality. Evidence supports outpatient screening to …

Management Of Chronic Low Back Pain With A Nonpharmacological Pain Management Kit Among Military Personnel, Heidi M. Sterling Bsn, Rn, Dnp Student, Karen A. Macauley Phd, Dnp, Fnp-Bc, Gnp-Bc, Robert Topp Phd, Rn

Doctor of Nursing Practice Final Manuscripts

Background & Purpose:Low back pain is the second leading cause of disability in the United States, affecting 17% of Americans. Chronic low back pain (CLBP) is particularly debilitating among professions such as active duty military personnel (ADMP) who are required to maintain military readiness without the assistance of opioids. This scenario can result in individuals enduring untreated pain or resigning from participation in their unit. The purpose of this project is to determine the effect of providing a nonpharmacological pain management kit (NPMK) on pain and functional ability among ADMP who report CLBP.

Study Design:ADMP who suffer from CLBP were …

Prevention Of Functional Decline In Hospitalized Geriatric Patients: An Evidence-Based Mobility Pilot Project On An Acute Care Elderly (Ace) Unit, Hannah Grushkowsky

Doctor of Nursing Practice Final Manuscripts

Problem: Functional decline is the leading complication of hospitalization in the elderly. Loss of functional independence during hospitalization results from the inability to maintain function during hospitalization compounded by acute illness. Potential negative outcomes from decreased function include increased length of stay (LOS), morbidity, and added discharges to a skilled nursing facilities (SNF).

Introduction: A mobility-based protocol created by an interdisciplinary team was implemented for three months on an 8 to 12-bed specialized Acute Care Elderly (ACE) medical-surgical floor. The purpose of the project was to evaluate if an evidence-based practice (EBP) mobility protocol can decrease discharges to SNFs, falls, …

The Effect Of Mantram Repetition On Qol In Low-Income, Urban Dwelling Older Adults, Marissa Katerina Mackiewicz

Dissertations

Background: Quality of life is an important concept of increasing significance for the healthcare in the United States, especially when taken in perspective of the aging population. Low-income, urban dwelling older adults are challenged in a number of ways that may negatively impact their QOL. This unique group is prone to report lower QOL, therefore, interventions targeted to improve QOL are timely. The purpose of this study was to describe the effect of mantram repetition (MR) on QOL in a sample of low-income, urban dwelling older adults.

Methods: A quasi-experimental pre-posttest study was conducted using a sample population of low-income …