Medicine and Health Sciences Commons^™

Sensitivity Of Single Organ Versus Multiorgan Point-Of-Care Ultrasound Compared To Computed Tomography Pulmonary Angiography In Detecting Pulmonary Embolism In Adult Patients, Jessica Stangenes

Theses and Graduate Projects

Background: Pulmonary embolism (PE) is a serious and potentially life-threatening complication of venous thromboembolism and its diagnosis remains a challenge. The current gold standard to confirm diagnosis of PE is multi-row computed tomography pulmonary angiography (CTPA) but has limitations and alternative imaging modalities are being investigated. Point-of-care ultrasound (POCUS) has been applied in the diagnostic process in PE but whether it can safely replace the gold standard is of question.

Methods: A literature review was conducted to evaluate the sensitivity of single versus multiorgan point-of-care ultrasound (POCUS) compared to CTPA in detecting PE in adult patients.

Discussion: Several prospective observational …

Antibiotic Resistance Of Streptococcus Pneumoniae In The United States And Latin American Countries: Contributing Factors And Potential Solutions, Brian Sherman

Theses and Graduate Projects

Antibiotics have been heralded as one of the greatest contributions to modern medicine.

While antibiotics have been documented throughout many parts of the world, it was the discovery of penicillin in 1928 that marked the modern era of medicine.1 An antibiotic is a natural, semi-synthetic, or synthetic compound that interferes with the growth of, or results in the death of a microorganism, specifically bacteria.2 These medications are used to treat or prevent infection of humans or animals. With the advent of antibiotics, many infections that would cause significant morbidity and mortality were greatly reduced. The 1930s-1960s is regarded as the …

Opioid Agonist Therapy And Detoxification: Improving Outcomes For Fetuses Born To Addicted Mothers, Kao Lee

Theses and Graduate Projects

The use of opioids has increased significantly in the last decade. Concern for the undertreatment of pain emerged in the mid-1990s, prompting providers to treat pain as a fifth vital sign. The pharmaceutical industry marketed their products as having significantly less abuse potential than reality. Prescriptions for pain medications soared with prescription opioids leading the way. Prescription opioids became ubiquitous in medicine cabinets and reports of abuse rose. Casually administered, illicit sale, theft, and doctor shopping became more common as reports of overdose also rose. By 2010, the United States government was issuing strategies to combat the opioid crisis.

People …

An Evaluation Of Home-Based Primary Care (Hbpc): Impact On Cost And Outcomes And Patient Satisfaction In The United States And Abroad, Isaac Pierre

Theses and Graduate Projects

Over the past century, the role of medical home visits in patient care has undergone significant changes. Historically, physicians routinely delivered medical care to sick patients in their own homes. In 1930, for example, such calls represented 40% of physician-patient encounters. As healthcare providers developed an increasing reliance on technology and as payment models began to prioritize volumes and efficiency, the provision of health care shifted to hospitals and office-based settings. An analysis of house calls in 1972 found that the number of in-home visits amounted to a mere 5% of physician-patient encounters and these rates continued to decrease to …

Do Cognitive Stimulating Activities Help Prevent The Development Of Dementia In Seniors Living In Latin America?, Sarah Kane

Theses and Graduate Projects

Dementia is a term used to describe a group of symptoms that alter a person’s intellectual functioning.1 It is caused by a variety of illnesses and can lead to memory impairment, decreased problem solving and decision making capacity, and diminished ability to perform everyday activites. It is estimated that approximately 50 million people worldwide currently have dementia and that number is expected to increase to 152 million by 2050. A majority of that increase can be attributed to the rise in those living with dementia in low- and middle-income countries. Latin America has the highest rates of dementia with a …

The Right Vasopressor At The Right Time Does Early Use Of Vasopressors Decrease Morbidity And Mortality In Septic Shock, Michael Kittok

Theses and Graduate Projects

Sepsis and septic shock is a disease process that carries a high mortality rate and is responsible for a large portion of healthcare expenditures in the United States. The Surviving Sepsis Campaign has been working to decrease the mortality of sepsis since 2001. Their mission is two-fold; providing evidence based guidelines to help direct treatment, and raising awareness to healthcare providers and patients about sepsis. A main goal in treating sepsis is to reverse the hypoperfused state by giving crystalloid fluids and administering vasopressors, specifically norepinephrine, after patients have received adequate fluids. Would modifying this treatment by giving a combination …

An Evaluation Of The Refugee Experience Of Liminality And The Impact Of Best Practice Models Of Care, Hanna Erickson

Theses and Graduate Projects

Globalization presents massive challenges for healthcare providers and the blend of language, expectation and cost creates increased risk for all patients. Refugees are among the most vulnerable of populations when overall health outcomes are measured and access to healthcare is analyzed.1 This is due to rapid modernization of health care systems and the fact that refugees are typically leaving a volatile place of origin and migrating to a wealthier, more stable country where different modalities are used to access care. Women of childbearing age comprise a huge portion of refugees and will be the population of focus examined here.

A …

Cervical Cancer Screening And Prevention In Central America, Madeline Jensen

Theses and Graduate Projects

Cervical cancer is the fourth most frequent cancer in women around the world. In the Central American region, it is a leading cause of mortality for young women due to inadequate preventive and screening measures. The disease is slow-growing and caused by the human papillomavirus, which is transmitted via sexual contact. The HPV vaccination was created in order to prevent the disease, and there are a variety of quality screening methods to quickly identify progression. The most common screening methods include the Papanicolaou (Pap) test and visualization by acetic acid (VIA). While frequent screening is common in developed countries, rates …

Geographic Variances Of Osteoporosis: What Interventions Can Be Implemented To Raise Awareness And Reduce The Risk Of Fractures In Latin America?, Kayla Mork

Theses and Graduate Projects

Osteoporosis is a major public health problem worldwide. Its complications are those related to fragility fractures, which cause considerable morbidity, mortality, and resource utilization. The socioeconomic burden is relatively well understood in the United States, but less studied in developing regions of the world. This paper will compare the epidemiology and socioeconomic burden of osteoporosis between the United States and Latin America. It will also review the current prevention, screening, diagnosis, and treatment methods, with an emphasis on raising awareness, improving management, and prioritizing osteoporosis as a public health problem. Information was gathered through a PubMed literature review and an …

Reproductive Health Needs In Individuals With Intellectual And Developmental Disabilities, Emily Bo Lafountaine

Theses and Graduate Projects

Currently, 11.8 million individuals live with a cognitive impairment or are diagnosed with an intellectual or developmental disability (IDD) in the United States with approximately 820,000 women with IDD of reproductive age. Before the 1970s, this population had been largely institutionalized, facing stigmatization and unethical contraceptive methods including poor sexual and reproductive education, barriers to healthcare, and involuntary sterilization. Living in state-funded institutions, private institutions, or with relatives or caregivers, this population is continuing to be integrated into communities with increasing societal recognition regarding their human rights, including sexual and reproductive health4. With their integration into communities and education systems, …

Barriers That Prevent Initial Prescription Of Hydroxyurea In Sickle Cell Disease, Harini Halaharvi

Theses and Graduate Projects

Sickle cell disease (SCD) is one of the most common inherited red blood cell disorders, affecting millions of people worldwide. According to CDC, SCD affects approximately 100,000 Americans and is most prominent in people with ancestry from sub-Saharan Africa, Spanish- speaking regions in the Western Hemisphere (South America, the Caribbean, and Central America), Saudi Arabia, India, and Mediterranean countries such as Turkey, Greece, and Italy. 1 out of every 365 black or African-American and 1 out of every 16,300 Hispanic-American children are born with SCD.1 Approximately 6,000 Latin Americans are born with SCD annually in both US and Latin American …

Diagnostic Techniques In Resource-Limited Countries Compared With Developed Countries, Rachel Schiltz

Theses and Graduate Projects

The diagnostic techniques between resource-limited countries and developed countries like the United States vary greatly. The lack of technology and availability of resources such as imaging studies in developing countries and the possible overreliance on those imaging studies when easily accessible is one reason. This paper will address the challenge clinicians face when evaluating patients for possible acute appendicitis. It will compare differences in diagnostic approaches used in the United States versus resource-limited nations that do not have readily available imaging studies to confirm suggestive appendicitis based on history, exam, and lab findings. It will compare outcomes of techniques used …

Using Music Therapy As An Adjunct To Pharmacologic Therapies For Chronic Pain, Andrea L. Rosenberg

Theses and Graduate Projects

Chronic pain affects more than 1 in 4 individuals in the United States. Many patients are being prescribed opioids to manage this pain, leading to an immense problem involving addiction, overdoses, and preventable deaths. Music therapy has been shown to provide “music analgesia,” improving anxiety, depression, and mobility problems associated with chronic pain conditions. The most benefit was seen when the music was known to the patient, the patient had a role in choosing the music, and when the music had a beat of less than 120 beats per minute. These promising results include a wide variety of chronic pain …

Efficacy Of A Single Dose Hpv Vaccine And Its Potential Outcomes In Low-Income Countries, Brooke Schramm

Theses and Graduate Projects

Cervical cancer is a leading worldwide cause of cancer mortality in women and disproportionately burdens low-income countries. Human papillomavirus (HPV) has been proven as the primary cause of genital warts, some oropharyngeal cancers, and anogenital cancers such as cervical, vulvar, anal, and penile malignancies. HPV vaccination coupled with regular HPV screenings are major strategies for preventing HPV infections, but with high costs and infrastructure complexities associated with current vaccination and screening programs, many world regions are unable to provide protection against HPV infection and its sequalae. If unabated, cervical cancer incidence is expected to increase worldwide over the coming decades …

Barriers To Sexual And Reproductive Health Care Access In Central America With A Focus On Modern Contraception, Maria Mccoshen

Theses and Graduate Projects

Reproductive health is an important indicator of overall population health and is a priority of international organizations such as the United Nations (UN) and the World Health Organization (WHO). The UN includes the right to sexual and reproductive health (SRH) in their international covenant on rights stating, “...a woman’s reproductive option is considered a basic human right”. This paper will evaluate whether SRH, specifically modern contraceptive access, is met throughout areas of Central America, with a focus on the country of Costa Rica.

Physical Activity Guidelines In Patients With Hemophilia: Benefits, Barriers, And Recommendations, Chelsea Johnson

Theses and Graduate Projects

Hemophilia describes a group of genetic disorders that lead to the dysfunction of proteins involved in the clotting cascade.1 These proteins, also known as coagulation factors, are required to form clots and ultimately cessate bleeding. Although there are three distinct forms of congenital hemophilia (hemophilia A, hemophilia B, and hemophilia C), the affected proteins (factor VIII, factor IX, and factor XI, respectively), are within the same pathway leading to the formation of a clot. In condensed terms, each of these factors play a role in the ultimate activation of thrombin, which activates fibrinogen to form a fibrin clot and solidify …

Maternal Health Interventions In Rural, Resource-Limited Countries, Katherine Tilton

Theses and Graduate Projects

Pregnant women are continuing to die at unacceptable rates around the globe. According to the World Health Organization, complications during pregnancy and childbirth are the leading cause of death and disability among reproductive age women in developing countries. Maternal mortality is often a reflection of a combination of causes: medical conditions while giving birth (ie. hemorrhage, eclampsia, and sepsis); other pre-existing medical conditions (ie. malaria, diabetes, HIV/AIDS); and socio-economic factors (ie. access to contraception, religious beliefs, and political agendas) that when combined, largely compromise health care, most often in the poor, rural and marginalized communities. Nearly all maternal deaths (99%) …

Preventing Road Traffic Incidents In Low- And Middle-Income Countries, Kayla Fuechtmann

Theses and Graduate Projects

Globally, approximately 1.35 million people die each year due to road traffic injuries (RTIs), with millions more suffering from serious injuries and living with long-term adverse health consequences. RTIs are the leading cause of preventable death, yet they continue to be the number one cause of death among those aged between 5 and 29 years of age. Even more, motor vehicles crashes are the number one killer of healthy United States citizens in foreign countries.

Interventions In Reducing Weight Bias In Healthcare Providers And Preservice Students, Nora Powers

Theses and Graduate Projects

Weight bias is harmful to patients and pervasive in healthcare providers and healthcare students. Effective interventions to reduce weight bias in healthcare providers and students are urgently needed and would improve patient care and patient outcomes. A literature review of current research on interventions to reduce weight bias in healthcare professionals and students was conducted to evaluate strategies for efficacy. Twenty articles investigating weight bias reducing interventions in healthcare providers and students were analyzed. Five primary strategies are currently used: self- reflection and awareness of one’s own bias; empathy building experiences; the influence and experiences of others; narratives of and …

Climate Change And Dengue Fever: Are They Connected?, Chelsey Rilatos

Theses and Graduate Projects

Dengue virus is the most common mosquito born disease worldwide and is an endemic infection in many tropical and subtropical habitats, especially areas where poor public health infrastructure makes it difficult to control. According to the Centers for Disease Control and Prevention (CDC), the dengue virus is a leading cause of febrile illness among travelers returning from Latin America. The dengue virus is a member of the family Flaviviridae and is transmitted to humans by the vector Aedes mosquitos, most frequently the Aedes aegypti mosquito, and secondarily by Aedes albopictus. Dengue infection results in a spectrum of clinical disease, ranging …

Childhood Immunization Coverage And Challenges: United States Vs. Latin America, James Cedric Holden

Theses and Graduate Projects

All countries are classified, for analytical purposes, into three broad classifications, based off a country’s economic condition. The World Economic Situation and Prospects (WESP) is responsible for these classifications. The gross national income per capita (GNI) is the measurement used to classify a county’s economy: as developed, in transition or developing. The United States is an example of a country that is considered developed, while the countries of Central America are all considered developing. This classification system is useful; however, it may not provide great insight into the health of a nation’s population. Good health of a country’s population directly …

Addressing Cost And Time Barriers In Chronic Disease Management Through Telemedicine: An Exploratory Research In Select Low-And Middle-Income Countries, Saleem Sayani, Momina Muzammil, Karima Saleh, Abdul Muqeet, Fabiha Zaidi, Tehniat Shaikh

Office of the Provost

Despite evidence supporting telehealth provision in developed countries, there is limited evidence regarding its economic benefits for patients living in areas where access and cost present major barriers to health care, particularly in low- and middle-income countries (LMICs). This study explores the economic benefits of telemedicine for patients, in terms of cost and times savings, and its potential role in improving chronic disease outcomes. This retrospective cross-sectional study compared telemedicine services with hypothetical in-person consultations, with a focus on patient travel time and travel cost savings. A database containing teleconsultation visits (N = 25,182) conducted at health facilities in remote …

Use Of Intraarticular Injections Of Platelet-Rich Plasma In The Treatment Of Knee Osteoarthritis: A Review Article, Naveed Baloch, Obada Hasan, Zain Baig, Umme-E-Hani Abdullah, Mohammad Atif, Hiroshi Ohuchi

Section of Orthopaedic Surgery

Osteoarthritis is one of the most common degenerative conditions affecting knee joint. As our understanding in the disease pathogenesis is evolving, so do the treatment modalities. One of the postulated mechanisms suggests the production of inflammatory cytokines secondary to repeated micro trauma than in turn lead to cartilage damage overtime. Cartilage being avascular structure has limited potential for repair. Based on this, recent studies have been focusing on stimulating cartilage-healing process by growth factors. This is where platelet-rich plasma comes in to light. Literature is showing promising results of platelet-rich plasma in treating knee osteoarthritis. In this review we have …

Does Surgical Approach Affect Outcome After Fixation Of Intra-Articular Fractures Of Distal Humerus?: Retrospective Cohort Study From A Level-1 Trauma Centre In A Metropolitan City, Muhammad Atif, Obada Hasan, Yasir Mohib, Rizwan Haroon Rashid, Pervaiz Hashmi

Section of Orthopaedic Surgery

Introduction: Fractures around the distal humerus fractures make up to 2% of all fractures. Complex intra-articular distal humerus fractures present as challenge to restore of painless, stable and mobile elbow joint. Surgical exposure to all critical structures is of paramount importance to achieve anatomic reduction. Conflict still persists regarding the choice of ideal approach. In this study we compare the effect of surgical approach triceps lifting vs olecranon osteotomy on the functional outcome after fixation of distal humerus fractures.
Methods: Non-funded, non-commercial, retrospective cohort study was conducted on patients with closed distal humerus intra-articular fractures between 2010 and 2015 at …

Arthroscopic Removal Of Loose Bodies In Synovial Chondromatosis Of Shoulder Joint, Unusual Location Of Rare Disease: A Case Report And Literature Review, Hussain Wahab, Obada Hasan, Ahmed Habib, Naveed Baloch

Section of Orthopaedic Surgery

Introduction: Synovial chondromatosis is a benign mono-articular arthropathy affecting synovial joints. It mostly affects knee joint, followed by hip, elbow and wrist and is rarely reported for shoulder joint. The exact pathogenesis is not known. Usual symptoms are pain, difficulty in movement due to mechanical obstruction. The classic treatment is arthrotomy, removal of chondromatoid loose bodies and synovectomy. With recent advances arthroscopic removal of the chondromatoid loose bodies is a good option with relatively better post op rehabilitation and faster recovery.
Case presentation: 20 years old gentleman presented to clinic with history of pain in right shoulder for 2 years …

Follow-Up Bibliometric Analysis Of Neurosurgical Publications From Pakistan And Institutional Comparison With Other Countries Using H-Index And I-10 Index, Muhammad Waqas Saeed Baqai, Usman Tariq Siddique, Muhammad Shahzad Shamim

Section of Neurosurgery

Aim: The aim of the study was to analyze the neurosurgical research output of Pakistan and compare it with that of developed countries.
Methodology: We conducted a bibliometric analysis of publically available databases for all neurosurgical publications from Pakistan. All indexed peer-reviewed publications from January 2009 to December 2014 where at least one author was affiliated with any neurosurgical departments in Pakistan and research was conducted in Pakistan were selected. Manual and electronic search was done using MeSH terms to search for articles from Pakistan. Articles were then categorized according to design, subspecialty, region, and year.
Results: Our search identified …

Predicting Adherence To Therapy In Rheumatoid Arthritis, Psoriatic Arthritis Or Ankylosing Spondylitis: A Large Cross-Sectional Study., Josef S Smolen, Dafna Gladman, H Patrick Mcneil, Philip J Mease, Joachim Sieper, Maja Hojnik, Pascal Nurwakagari, John Weinman

Articles, Abstracts, and Reports

Objective: This analysis explored the association of treatment adherence with beliefs about medication, patient demographic and disease characteristics and medication types in rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) to develop adherence prediction models.

Methods: The population was a subset from ALIGN, a multicountry, cross-sectional, self-administered survey study in adult patients (n=7328) with six immune-mediated inflammatory diseases who were routinely receiving systemic therapy. Instruments included Beliefs about Medicines Questionnaire (BMQ) and 4-item Morisky Medication Adherence Scale (MMAS-4

Results: A total of 3390 rheumatological patients were analysed (RA, n=1943; PsA, n=635; AS, n=812). Based on the strongest significant …

Erratum: Author Correction: Surgical Standards For Management Of The Axilla In Breast Cancer Clinical Trials With Pathological Complete Response Endpoint., Judy C Boughey, Michael D Alvarado, Rachael B Lancaster, W Fraser Symmans, Rita Mukhtar, Jasmine M Wong, Cheryl A Ewing, David A Potter, Todd M Tuttle, Tina J Hieken, Jodi M Carter, James W Jakub, Henry G Kaplan, Claire L Buchanan, Nora T Jaskowiak, Husain A Sattar, Jeffrey Mueller, Rita Nanda, Claudine J Isaacs, Paula R Pohlmann, Filipa Lynce, Eleni A Tousimis, Jay C Zeck, M Catherine Lee, Julie E Lang, Paulette Mhawech-Fauceglia, Roshni Rao, Bret Taback, Constantine Goodellas, Margaret Chen, Kevin M Kalinsky, Hanina Hibshoosh, Brigid Killelea, Tara Sanft, Gillian L Hirst, Smita Asare, Jeffrey B Matthews, Jane Perlmutter, Laura J Esserman

Articles, Abstracts, and Reports

[This corrects the article DOI: 10.1038/s41523-018-0074-6.].

High-Dose Ipilimumab And High-Dose Interleukin-2 For Patients With Advanced Melanoma., Ann W Silk, Howard L Kaufman, Brendan Curti, Janice M Mehnert, Kim Margolin, David Mcdermott, Joseph Clark, Jenna Newman, Praveen K Bommareddy, Lisa Denzin, Saltanat Najmi, Azra Haider, Weichung Shih, Michael P Kane, Andrew Zloza

Articles, Abstracts, and Reports

High-dose ipilimumab (IPI) and high-dose interleukin-2 (IL-2) are approved agents for metastatic melanoma, but the efficacy and safety of the combination are unknown. The objective of this study was to evaluate the feasibility, safety, and efficacy of combination high-dose IPI and high-dose IL-2 in patients with histologically confirmed advanced unresectable stage III and IV melanoma. This Phase II, multicenter, open-label, single-arm trial was conducted in nine patients enrolled between 12/2014 and 12/2015. Subjects were treated with high-dose IPI 10 mg/kg intravenous (IV) every 3 weeks for four doses starting at week 1 and high-dose IL-2 (600,000 IU/kg IV bolus every …

Ethical Patient Care Overview For Doctoral Nursing Students, Courtney Reinisch

School of Nursing Faculty Scholarship and Creative Works

Clinical care is guided by knowledge, competency, and the maintenance of ethical standards. Maintenance of ethical standards is necessary by all care providers across disciplines. Attention should be paid to the following ethical tenets: autonomy, beneficence, non-malfeasance, justice, veracity, and confidentiality. Avoiding paternalism is a goal for providers to optimize outcomes for individuals and families. Providers who demonstrate a thorough understanding of ethical principles best serve individuals, communities, and populations by strengthening trust with adherence to ethical standards.