Medicine and Health Sciences Commons^™

Effectiveness Of Using A Simulation Combined With Online Learning Approach To Develop Discharge Teaching Skills, Marianne E. Weiss, Linda B. Piacentine, Lori Candela, Kathleen L. Bobay

College of Nursing Faculty Research and Publications

Background

Despite evidence of the impact of discharge teaching on patient outcomes, nursing students are poorly prepared in the pedagogical skills necessary for their role as patient and family educators in clinical practice. This study evaluated the effectiveness of simulation combined with online learning to improve nursing students’ discharge teaching skills.

Methods

The module included simulations before and after an online module on patient/family teaching for hospital discharge. Evaluation measures were student and independent rater evaluations using the Quality of Discharge Teaching Scale- Evaluation form (QDTS-E).

Results

Students (n=153) improved their performance on both content and delivery subscales of the …

Temporary Abdominal Closure Techniques, Laura R. Brown, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Critically ill patients with underlying intraabdominal hypertension due to sepsis or injury are often managed with a damage control laparotomy (DCL), which involves the minimum intervention necessary to save the patient’s life. In order to save time, the abdomen may be left open to facilitate a second look to confirm the control of bleeding or sepsis before fascial closure. In the interim, some patients will develop bowel and abdominal wall edema with a high-volume resuscitation, especially if the crystalloid fluid is used primarily.

The many causes and management of intraabdominal hypertension as well as the indications for a damage control …

Posterior Urethral Valve, George Bingham, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Posterior urethral valves are one of the most common causes of urinary tract obstruction in the pediatric population. They are obstructing membranous folds in the lumen of the posterior part of the urethra and are exclusive to male patients. Posterior urethral valves were first described by Morgagni in 1717 and then by Langenbeck in 1802, who reported valve-like folds in dissected cadavers. Posterior urethral valves can lead to a spectrum of pathology both inside and outside the urinary system. This includes acute retention, chronic kidney disease, and in severe cases, pulmonary hypoplasia secondary to low amniotic fluid levels.

Posterior urethral …

Simulation Training And Skill Assessment In Obstetrics And Gynecology, Thomas G. Weiss, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Simulation is a valuable teaching tool that increases skill and knowledge acquisition in obstetric and gynecologic clinical scenarios. There are increasing options for simulation from animal and human cadaver, low-fidelity (inanimate simulator), and virtual reality simulation. The role of obstetric and gynecologic simulation also plays a key role in both outcomes-based as well as competency-based medical education.

Simulators were initially created for flight training for pilots in the 1920s, and the ability to reproduce clinical situations has been utilized in obstetric and gynecologic education. Simulations used in medical training were used in the 1960s with standardized patients and mannequins. Simulation …

Melanotic Neuroectodermal Tumor Of Infancy, Mohammad H. Almomani, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Melanotic neuroectodermal tumor of infancy (MNTI) is a rapidly growing benign tumor that arises from the neural crest. It typically occurs in infants in the head and neck region. It was described for the first time in 1918 by Krompecher, and since the origin was unknown, it was described as congenital melanocarcinoma. Until 1966, this tumor was characterized by variable names (e.g., retinal anlage tumor, pigmented congenital epulis, melanotic progonoma, pigmented teratoma, atypical melanoblastoma, etc.). However, Borello and Gorlin found that the tumor produces vanillylmandelic acid (VMA), which is produced by other types of tumors that arise from the neural …

Study Design And Baseline Characteristics Of The Cardinal Trial: A Phase 3 Study Of Bardoxolone Methyl In Patients With Alport Syndrome., Glenn M. Chertow, Gerald B. Appel, Sharon Andreoli, Sripal Bangalore, Geoffrey A. Block, Arlene B. Chapman, Melanie P. Chin, Keisha L. Gibson, Angie Goldsberry, Kazumoto Iijima, Lesley A. Inker, Bertrand Knebelmann, Laura H. Mariani, Colin J. Meyer, Kandai Nozu, Megan O'Grady, Arnold L. Silva, Peter Stenvinkel, Roser Torra, Bradley A. Warady, Pablo E. Pergola

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Alport syndrome is a rare genetic disorder that affects as many as 60,000 persons in the USA and a total of 103,000 persons (10,000) in the European Union [1, 2]. It is the second most common inherited cause of kidney failure and is characterized by progressive loss of kidney function that often leads to end-stage kidney disease. Currently, there are no approved disease-specific agents for therapeutic use. We designed a phase 3 study (CARDINAL; NCT03019185) to evaluate the safety, tolerability, and efficacy of bardoxolone methyl in patients with Alport syndrome.

METHODS: The CARDINAL phase 3 study is an international, …

Disease-Modifying Therapy Prescription Patterns In People With Multiple Sclerosis By Age, Yinan Zhang, Amber Salter, Shan Jin, William J Culpepper, Gary R Cutter, Mitchell Wallin, Olaf Stuve

2020-Current year OA Pubs

BACKGROUND: Disease-modifying therapies (DMTs) for multiple sclerosis (MS) are approved for their ability to reduce disease activity, namely clinical relapses and signal changes on magnetic resonance imaging (MRI). Disease activity appears age dependent. Thus, the greatest benefit would be expected in younger people with MS (PwMS) whereas benefits in the elderly are uncertain.

METHODS: Real-world data were obtained from PwMS from the North American Research Committee on Multiple Sclerosis (NARCOMS) registry and the US Department of Veterans Affairs Multiple Sclerosis Surveillance Registry (MSSR).

RESULTS: 6948 PwMS were surveyed from NARCOMS, and the MSSR had 1719 participants. In younger adult PwMS …

Improved Gastrointestinal Profile With Diroximel Fumarate Is Associated With A Positive Impact On Quality Of Life Compared With Dimethyl Fumarate: Results From The Randomized, Double-Blind, Phase Iii Evolve-Ms-2 Study, Annette Wundes, Sibyl Wray, Ralf Gold, Barry A Singer, Elzbieta Jasinska, Tjalf Ziemssen, Jerome De Seze, Pavle Repovic, Hailu Chen, Jerome Hanna, Jordan Messer, Catherine Miller, Robert T Naismith

2020-Current year OA Pubs

BACKGROUND: Diroximel fumarate (DRF) is a novel oral fumarate approved for relapsing forms of multiple sclerosis (MS). DRF demonstrated significantly improved gastrointestinal (GI) tolerability

METHODS: A

RESULTS: In total, 504 patients (DRF,

CONCLUSIONS: The improved GI tolerability with DRF translated into clinically meaningful benefits to QoL, as patients experienced less impact on daily life and work and required less concomitant symptomatic medication use.

TRIAL REGISTRATION: [ClinicalTrials.gov identifier: NCT03093324].

Development Of A Digital Toolkit To Improve Quality Of Life Of Patients With Systemic Lupus Erythematosus, Jerik Leung, Laura Kloos, Alfred H Kim, Elizabeth A Baker

2020-Current year OA Pubs

OBJECTIVE: The purpose of this manuscript is to detail development and initial usability testing of an e-toolkit designed to provide skills and knowledge around self-management behaviors for individuals living with systemic lupus erythematosus.

METHODS: Researchers worked with a steering committee of patients and providers to (1) develop a clickable prototype of an e-toolkit and (2) conduct alpha (individuals not affiliated with an academic clinic as patient or provider) and beta (individual patients with systemic lupus erythematosus as well as members of the clinic healthcare team and individuals who work in patient advocacy organizations) usability testing through semistructured interviews.

RESULTS: During …

Climate Change And Antibiotic Resistance: A Deadly Combination, Jason P Burnham

2020-Current year OA Pubs

Climate change is driven primarily by humanity's use of fossil fuels and the resultant greenhouse gases from their combustion. The effects of climate change on human health are myriad and becomingly increasingly severe as the pace of climate change accelerates. One relatively underreported intersection between health and climate change is that of infections, particularly antibiotic-resistant infections. In this perspective review, the aspects of climate change that have already, will, and could possibly impact the proliferation and dissemination of antibiotic resistance are discussed.

Evaluation Of A Hybrid Antimicrobial Restriction Process At A Large Academic Medical Center, Jesse D Smith, Linh H Nguyen, Tamara Krekel, Jerrica Waggoner, David J Ritchie, Michael J Durkin, Kevin Hsueh, Elizabeth A Neuner

2020-Current year OA Pubs

We conducted a retrospective review of a hybrid antimicrobial restriction process demonstrating adherence to appropriate use criteria in 72% of provisional-only orders, in 100% of provisional orders followed by ID orders, and in 97% of ID-initiated orders. Therapy interruptions occurred in 24% of provisional orders followed by ID orders.

Transmission Dynamics: Data Sharing In The Covid-19 Era, Randi E Foraker, Albert M Lai, Thomas G Kannampallil, Keith F Woeltje, Anne M Trolard, Philip R O Payne

2020-Current year OA Pubs

Problem: The current coronavirus disease 2019 (COVID-19) pandemic underscores the need for building and sustaining public health data infrastructure to support a rapid local, regional, national, and international response. Despite a historical context of public health crises, data sharing agreements and transactional standards do not uniformly exist between institutions which hamper a foundational infrastructure to meet data sharing and integration needs for the advancement of public health.

Approach: There is a growing need to apply population health knowledge with technological solutions to data transfer, integration, and reasoning, to improve health in a broader learning health system ecosystem. To achieve this, …

Rethinking Immune Checkpoint Blockade: Beyond The T Cell, Xiuting Liu, Graham D Hogg, David G Denardo

2020-Current year OA Pubs

The clinical success of immune checkpoint inhibitors has highlighted the central role of the immune system in cancer control. Immune checkpoint inhibitors can reinvigorate anti-cancer immunity and are now the standard of care in a number of malignancies. However, research on immune checkpoint blockade has largely been framed with the central dogma that checkpoint therapies intrinsically target the T cell, triggering the tumoricidal potential of the adaptive immune system. Although T cells undoubtedly remain a critical piece of the story, mounting evidence, reviewed herein, indicates that much of the efficacy of checkpoint therapies may be attributable to the innate immune …

Human Cortical Serotonin 2a Receptor Occupancy By Psilocybin Measured Using [11c]Mdl 100,907 Dynamic Pet And A Resting-State Fmri-Based Brain Parcellation, Frederick S Barrett, Yun Zhou, Theresa M Carbonaro, Joshua M Roberts, Gwenn S Smith, Roland R Griffiths, Dean F Wong

2020-Current year OA Pubs

Psilocybin (a serotonin 2A, or 5-HT

Intensive Care Unit Nurse: Could We Call A Palliative Care Consult? Intensive Care Unit Provider: It's Too Early. Palliative Care Integration In The Intensive Care Unit: The Struggle To Translate Evidence Into Practice, Natalie S. Mcandrew, Jill L. Guttormson, Sean Marks, Mary Rhodes, Jayshil Patel, Colleen Mccracken

College of Nursing Faculty Research and Publications

Despite evidence regarding the value of palliative care, there remains a translation-to-practice gap in the intensive care setting. The purpose of this article is to describe challenges and propose solutions to palliative care integration through the presentation and discussion of a critical care patient scenario. We also present recommendations for a collaborative palliative care practice framework that holds the potential to improve quality of life for patients and families. Collaborative palliative care is characterized by close working relationships with families, interprofessional intensive care unit healthcare teams, and palliative care specialists. The shortage of palliative care specialists has become a pressing …

Inhibition Of Candida Albicans And Mixed Salivary Bacterial Biofilms On Antimicrobial Loaded Phosphated Poly(Methyl Methacrylate), Andrew R. Dentino, Dong Hwa Lee, Kelley Dentino, Arndt Guentsch, Mohammadreza Tahriri

School of Dentistry Faculty Research and Publications

Biofilms play a crucial role in the development of Candida-associated denture stomatitis. Inhibition of microbial adhesion to poly(methyl methacrylate) (PMMA) and phosphate containing PMMA has been examined in this work. C. albicans and mixed salivary microbial biofilms were compared on naked and salivary pre-conditioned PMMA surfaces in the presence or absence of antimicrobials (Cetylpyridinium chloride [CPC], KSL-W, Histatin 5 [His 5]). Polymers with varying amounts of phosphate (0–25%) were tested using four C. albicans oral isolates as well as mixed salivary bacteria and 24 h biofilms were assessed for metabolic activity and confirmed using Live/Dead staining and confocal microscopy. …

Zirconia Restorations: An American Dental Association Clinical Evaluators Panel Survey, Nathaniel C. Lawson, Kevin Frazier, Ana K. Bedran-Russo, Sharukh Khajotia, Jacob Park, Olivia Urquhart

School of Dentistry Faculty Research and Publications

Background

Zirconia is a relatively new dental material used for indirect dental restorations. Little is known about how dental practitioners are using this material in their practice.

Methods

A survey on zirconia restorations was developed and administered electronically through e-mail communications to the American Dental Association Clinical Evaluators (ACE) Panel on August 31, 2020. Reminders were sent to nonrespondents, and the survey closed 2 weeks after the launch date.

Results

When using zirconia for a restoration, respondents choose it to restore natural teeth (99%) more often than implants (76%). Almost all respondents (98%) use it for posterior crowns, whereas approximately …

The Use Of Mineral Trioxide Aggregate In The Treatment Of Horizontal Root Fractures: A Case Presentation And Literature Update, Elif Ballikaya, H. Cem Güngör

School of Dentistry Faculty Research and Publications

Root fracture is a rarely seen traumatic injury in permanent dentition. It has a prevalence of 0.5-7 %. Tooth survival is significantly affected by the type of healing and the location of the root fracture. Additionally, the patient’s age, stage of root development, mobility and dislocation of the coronal fragment, and diastasis between fragments following this kind of injury are among the important factors. In this case presentation, the management with MTA plug and 6-year follow-up of a horizontal root fracture was reported. A literature update regarding the use of MTA in the management of horizontal root fractures was also …

Spect/Ct Correlation In The Diagnosis Of Unilateral Condilar Hyperplasia, Diego Fernando López, Valentina Borrás Ríos Borrás, Juan Manuel Muñoz, Rodrigo Cardenas-Perilla, Luis Eduardo Almeida

School of Dentistry Faculty Research and Publications

Objective:

To evaluate the correlation between metabolic bone activity measured by single photon emission computed tomography (SPECT) and the anatomic condylar characteristics acquired by computed tomography (CT), in patients with unilateral condylar hyperplasia (UCH).

Method and Materials/Patients:

Observational, descriptive study in a group of 71 patients with clinical diagnosis of UCH and indication of SPECT/CT. Bone SPECT images obtained in a gamma-camera GE Infina and processed in a station Xeleris 3 with the program Volumetrix MI Evolution for bone. CT images acquired in a PET/CT Biograph mcT20 equipment (Siemens) processed in a station Osirix V 7.5.1 (Pixmeo, Bomex, Switzerland).

Results: …

Systematic Review Of Family Engagement Interventions In Neonatal, Paediatric, And Adult Icus, Natalie S. Mcandrew, Teresa Jerofke-Owen, Christine A. Fortney, Breanna Hetland, Deena K. Costa, Jill L. Guttormson, Eric Harding

College of Nursing Faculty Research and Publications

Aims and objectives

The purpose of this systematic review was to evaluate interventions that have been used to engage families in direct care activities (active family engagement) in adult, paediatric, and neonatal intensive care unit (ICU) settings.

Background

Family engagement is universally advocated across ICU populations and practice settings; however, appraisal of the active family engagement intervention literature remains limited.

Search strategy

Ovid Medline, PsycArticles & PsycInfo, Scopus, and CINAHL were searched for family interventions that involved direct care of the patient to enhance the psychological, physical, or emotional well‐being of the patient or family in neonatal, paediatric, or adult …

If Not Otitis Externa...Then What?, Elizabeth A. Flasch, Sadia Ansari, Timothy Martin

College of Nursing Faculty Research and Publications

Ear pain is one of the most common presentations in urgent care, especially among pediatric patients. Further, acute otitis media (AOM) is the most common condition for which antibacterial agents are prescribed for children in the United States. Clinician visits make up 634 per 100 children during 2005-2006. It is imperative that clinicians differentiate AOM from new onset of otorrhea not due to acute otitis externa (AOE), the most common diagnoses made by clinicians with regional variations based on age and geography.1

The majority of AOE-related visits occur during the summer months (June through August); visits occur most commonly in …

Clinicopathologic Implications Of Complement Genetic Variants In Kidney Transplantation, Zhen Ren, Stephen J Perkins, Latisha Love-Gregory, John P Atkinson, Anuja Java

2020-Current year OA Pubs

Genetic testing has uncovered rare variants in complement proteins associated with thrombotic microangiopathy (TMA) and C3 glomerulopathy (C3G). Approximately 50% are classified as variants of uncertain significance (VUS). Clinical risk assessment of patients carrying a VUS remains challenging primarily due to a lack of functional information, especially in the context of multiple confounding factors in the setting of kidney transplantation. Our objective was to evaluate the clinicopathologic significance of genetic variants in TMA and C3G in a kidney transplant cohort. We used whole exome next-generation sequencing to analyze complement genes in 76 patients, comprising 60 patients with a TMA and …

Just Culture For Medical Students: Understanding Response To Providers In Adverse Events, Brijen J Shah, Bonnie Portnoy, Dennis Chang, Marc Napp

2020-Current year OA Pubs

INTRODUCTION: Individual and organizational response to an adverse event is a key part of the life cycle of a patient safety event. Just culture is a safety concept that emphasizes system drivers of human behavior. We developed a learning activity for medical students to teach and discuss just culture as part of a patient safety curriculum.

METHODS: This small-group, discussion-based learning activity was aimed at third-year medical students. Over 5 years, 628 students participated in it. The session had three components: a presession case-based survey, a didactic lecture, and a facilitated small-group discussion. Participants evaluated the session using our institution's …

Unfriendly Fire: How The Tobacco Industry Is Destroying The Future Of Our Children, Andrew Bush, Thomas Ferkol, Et Al.

2020-Current year OA Pubs

Tobacco has long been known to be one of the greatest causes of morbidity and mortality in the adults, but the effects on the foetus and young children, which are lifelong, have been less well appreciated. Developing from this are electronic nicotine delivery systems or vapes, promulgated as being less harmful than tobacco. Nicotine itself is toxic to the foetus, with permanent effects on lung structure and function. Most vapes contain nicotine, but they also contain many other compounds which are inhaled and for which there are no toxicity studies. They also contain known toxic substances, whose use is banned …

Microbiopsy Sampling For Examining Age-Related Differences In Skeletal Muscle Fiber Morphology And Composition, Garrett Hester, Trisha Vandusseldorp, Phuong L. Ha, Kaveh Kiani, Alex A. Olmos, Melody Jabbari, Shania Kalladanthyil, Soobin An, Alyssa R. Bailly, Benjamin E. Dalton, Anton Bryantsev

Faculty Articles

The increasingly popular microbiopsy is an appealing alternative to the more invasive Bergström biopsy given the challenges associated with harvesting skeletal muscle in older populations. Parameters of muscle fiber morphology and composition derived from the microbiopsy have not been compared between young and older adults. The purpose of this study was to examine muscle fiber morphology and composition in young (YM) and older (OM) males using the microbiopsy sampling technique. A secondary aim was to determine if specific strength is associated with serum levels of C-terminal agrin fragment [CAF; an indicator of neuromuscular junction (NMJ) degradation]. Thirty healthy, YM ( …

The Free And Cued Selective Reminding Test Predicts Braak Stage, Ellen Grober, Qi Qi, Lynn Kuo, Jason Hassenstab, Richard J Perrin, Richard B Lipton

2020-Current year OA Pubs

BACKGROUND: The ultimate validation of a clinical marker for Alzheimer's disease (AD) is its association with AD neuropathology.

OBJECTIVE: To identify clinical measures that predict pathology, we evaluated the relationships of the picture version of the Free and Cued Selective Reminding Test (pFCSRT + IR), the Mini-Mental State Exam (MMSE), and the Clinical Dementia Rating scale Sum of Boxes (CDR-SB) to Braak stage.

METHODS: 315 cases from the clinicopathologic series at the Knight Alzheimer's Disease Research Center were classified according to Braak stage. Boxplots of each predictor were compared to identify the earliest stage at which decline was observed and …

Stages Of Objective Memory Impairment Predict Alzheimer's Disease Neuropathology: Comparison With The Clinical Dementia Rating Scale-Sum Of Boxes, Ellen Grober, Qi Qi, Lynn Kuo, Jason Hassenstab, Richard J Perrin, Richard B Lipton

2020-Current year OA Pubs

BACKGROUND: The ultimate validation of a clinical marker for Alzheimer's disease (AD) is its association with AD neuropathology.

OBJECTIVE: To examine how well the Stages of Objective Memory Impairment (SOMI) system predicts intermediate/high AD neuropathologic change and extent of neurofibrillary tangle (NFT) pathology defined by Braak stage, in comparison to the Clinical Dementia Rating (CDR) Scale sum of boxes (CDR-SB).

METHODS: 251 well-characterized participants from the Knight ADRC clinicopathologic series were classified into SOMI stage at their last assessment prior to death using the free recall and total recall scores from the picture version of the Free and Cued Selective …

Exploring Intentional Medication Non-Adherence In Patients With Systemic Lupus Erythematosus: The Role Of Physician-Patient Interactions, Jerik Leung, Elizabeth A Baker, Alfred H J Kim

2020-Current year OA Pubs

OBJECTIVE: Medication non-adherence contributes to worse health outcomes among SLE patients. The underlying mechanisms that drive medication non-adherence are poorly understood. The purpose of this study was to explore possible mechanisms of medication non-adherence by eliciting patient experiences.

METHODS: Consented adult patients with ACR- or SLICC-classified SLE were recruited. Ten semi-structured interviews were conducted across six participants. Interviews were audio recorded, transcribed, and analysed using an iterative process. The findings were presented to an interactive public forum with SLE patients, family members and friends of patients, and health-care professionals to assess validity and for elaboration of the concepts developed.

RESULTS: …

A Phase Ii Study Of Laser Interstitial Thermal Therapy Combined With Doxorubicin In Patients With Recurrent Glioblastoma, Omar H Butt, Alice Y Zhou, Jiayi Huang, William A Leidig, Alice E Silberstein, Milan G Chheda, Tanner M Johanns, George Ansstas, Jingxia Liu, Grayson Talcott, Ruth Nakiwala, Joshua S Shimony, Albert H Kim, Eric C Leuthardt, Jian L Campian, Et Al.

2020-Current year OA Pubs

BACKGROUND: The blood-brain barrier (BBB) is a major limiting factor for drug delivery in brain tumors. Laser interstitial thermal therapy (LITT) disrupts the peritumoral BBB. In this study, we examine survival in patients with recurrent glioblastoma (GBM) treated with LITT followed by low-dose doxorubicin, a potent anti-neoplastic drug with poor BBB permeability.

METHODS: Forty-one patients with recurrent GBM were enrolled; thirty patients were evaluable. Participants underwent LITT followed by 6 weekly doxorubicin treatments starting within one week (Early Arm) or at 6-8 weeks (Late Arm) after LITT. The overall survival (OS), local progression-free survival (PFS), and any PFS were compared …

Does Circulating Progesterone Mediate The Associations Of Single Nucleotide Polymorphisms In Progesterone Receptor (Pgr)-Related Genes With Mammographic Breast Density In Premenopausal Women?, Favour A Akinjiyan, Yunan Han, Jingqin Luo, Adetunji T Toriola

2020-Current year OA Pubs

UNLABELLED: Progesterone is a proliferative hormone in the breast but the associations of genetic variations in progesterone-regulated pathways with mammographic breast density (MD) in premenopausal women and whether these associations are mediated through circulating progesterone are not clearly defined. We, therefore, investigated these associations in 364 premenopausal women with a median age of 44 years. We sequenced 179 progesterone receptor (PGR)-related single nucleotide polymorphisms (SNPs). We measured volumetric percent density (VPD) and non-dense volume (NDV) using Volpara. Linear regression models were fit on circulating progesterone or VPD/NDV separately. We performed mediation analysis to evaluate whether the effect of a SNP …