Medicine and Health Sciences Commons^™

Hyperdynamic Left Ventricular Ejection Fraction Is Associated With Higher Mortality In Covid-19 Patients, Annas Rahman, Max Ruge, Md, Alex Hlepas, Batha Nair, Joanne Gomez, Jeanne Du Fey De Lavallaz, Setri Fugar, Nusrat Jahan, Annabelle Santos Volgman, Kim A. Williams, Anupama Rao, Karolina Marinescu, Tisha Suboc

Division of Internal Medicine Faculty Papers & Presentations

Study objective: To compare the characteristics and outcomes of COVID-19 patients with a hyperdynamic LVEF (HDLVEF) to those with a normal or reduced LVEF.

Design: Retrospective study.

Setting: Rush University Medical Center.

Participants: Of the 1682 adult patients hospitalized with COVID-19, 419 had a transthoracic echocardiogram (TTE) during admission and met study inclusion criteria. Interventions: Participants were divided into reduced (LVEF < 50%), normal (≥50% and <70%), and hyper- dynamic (≥70%) LVEF groups.

Main outcome measures: LVEF was assessed as a predictor of 60-day mortality. Logistic regression was used to adjust for age and BMI.

Results: There was no difference in 60-day mortality between patients in the reduced LVEF and normal LVEF …

Physical Therapy Differential Diagnosis For A Patient With Viral Central Nervous System Infection In Acute Care: A Case Study, Michael S. Castillo

Philippine Journal of Physical Therapy

Introduction: This case report presents a patient with respiratory distress who went into coma and was admitted in the intensive care unit (ICU). The paper will discuss the initial impressions in the ICU and the differential diagnosis considered to arrive at an accurate diagnosis. It will demonstrate how information from physical therapy contributed to discern the proper diagnosis, and the evolving treatment plan and interventions as the patient progressed and discharged out of the ICU into the hospital floors.

Methods: This is a case of a 32-year-old male who self-admitted to the emergency department (ED) of his local hospital …

Framework For The Priority Actions Of Filipino Physical Therapists In Disaster Risk Reduction And Management, Francis Clarence C. Chua, Cheryll Didi Nellie N. Obra

Philippine Journal of Physical Therapy

Introduction: The study was conducted to develop a framework where physical therapists could be integrated into the disaster risk reduction and management (DRRM) initiatives of a province in the northern Philippines.

Methods: This was a mixed-methods study that utilized a research and development design. A validated questionnaire on the experience and perceptions of DRRM was administered to 20 selected physical therapists. A validated interview guide was administered to 10 local disaster control office head and members. Descriptive statistics were used to analyze the quantitative data. Thematic analysis was used to synthesize and examine the qualitative data.

Results: …

Benchmark Project Cryotherapy To Prevent Chemo Induced Peripheral Neuropathy, Stephanie Davis

MSN Capstone Projects

As a nurse working in chemotherapy infusion, I have a direct role in symptom management. For patients receiving Taxanes, the most common adverse effect reported by patients is peripheral neuropathy. According to one meta-analysis, Taxane-induced peripheral neuropathy (TIPN) has very high incidence ranging from 11 to 87% and severely impairs patients’ quality of life (Jia et al., 2021). Patients may experience pain, weakness, loss of sensation, decrease in ability to perform ADLs, increased falls among many other impairments as a result. We understand the importance of performance status in oncology patients. This can lead to dose reductions or held treatments …

Ocular Adnexal Lymphoma: A Single-Institution Retrospective Study, César A. Fernández, Roger K. Henry, Carol L. Shields, Jurij R. Bilyk, Sara E. Lally, Ralph C. Eagle, Tatyana Milman

Wills Eye Hospital Papers

PURPOSE: To characterize demographic, clinical, and histopathologic features of ocular adnexal lymphoma (OAL) at a single institution. METHODS: Retrospective review of all patients with pathologic diagnosis of OAL between 2015 and 2020. RESULTS: There were 133 patients with OAL, with a median age of 65 years (range 23-97) and a slight female predominance (male: female = 1:1.46), (n = 79, 59%). The majority of tumors were non-Hodgkin B-cell lymphomas (n = 131, 99%), most frequently Extranodal Marginal Zone B-Cell Lymphoma (EMZL, n = 93, 70%), followed by follicular lymphoma (n = 21, 16%), chronic lymphocytic leukemia/small lymphocytic lymphoma (n = …

Ocular Adnexal Metastases From Renal Cell Carcinoma: An Update And Comprehensive Literature Review, Tejal Magan, Tejus Pradeep, Madalina Tuluc, Jurij R. Bilyk, Tatyana Milman

Wills Eye Hospital Papers

PURPOSE: The purpose of this study was to review the clinical presentation, systemic work-up, and outcomes of all previously reported ocular adnexal (OA) metastases from renal cell carcinoma (RCC). METHODS: This was a literature review. PubMed and Google Scholar databases were searched for all well-documented cases of OA metastases from RCC. RESULTS: Final analysis identified 44 patients with either biopsy-confirmed (41/44, 93%) or treatment response-documented (3/44, 6%) OA metastases from RCC. Thirty-four (77%) patients were male. The median age was 60 years (mean: 60, range: 22-87 years). The most common presenting signs were proptosis (19/44, 43%) and OA mass (14/44, …

Stroke Network Of Wisconsin (Snow) Scale Predicts Large Vessel Occlusion Stroke In The Prehospital Setting, Kessarin Panichpisal, Sarah Erpenbeck, Paul Vilar, Reji P. Babygirija, Maharaj Singh, M. Riccardo Colella, Richard A. Rovin

Journal of Patient-Centered Research and Reviews

Purpose: In previous trials, the Stroke Network of Wisconsin (SNOW) scale accurately predicted large vessel occlusion (LVO) stroke in the hospital setting. This study evaluated SNOW scale performance in the prehospital setting and its ability to predict LVO or distal medium vessel occlusion (DMVO) in patients suspected of having acute ischemic stroke (AIS), a scenario in which transport time to an endovascular treatment-capable facility (ECSC) is critical.

Methods: All potential AIS patients with last-known-well time of ≤ 24 hours were assessed by Milwaukee County Emergency Medical Services for LVO using SNOW. Patients with a positive SNOW score were transferred to …

Responding To Sexual Abuse In Health Care: Development Of A Guide For Patients, Tristan Mcintosh, Heidi Walsh, Meredith Parsons, Erin D. Solomon, Jessica Mozersky, James M. Dubois

Journal of Patient-Centered Research and Reviews

This report details the development of a stakeholder- and evidence-informed online resource guide for patients that provides information to raise awareness about sexual abuse in health care, the value of chaperones, and options for responding to sexual abuse. The guide was developed to reflect lessons learned from 10 years of researching physician wrongdoing (ie, sexual violations, improper prescribing, and unnecessary invasive procedures), a 5-year National Institutes of Health-funded mixed-methods study of 280 cases of egregious wrongdoing in medicine, and an expert working group. Focus groups were conducted with 22 patients from diverse backgrounds to obtain feedback on the acceptability of …

Association Of Natural Waterways And Legionella Pneumophila Infection In Eastern Wisconsin: A Case-Control Study, Hannah M. William, Kayla Heslin, Jessica J. F. Kram, Caroline P. Toberna, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Preliminary research has suggested possible associations between natural waterways and Legionella infection, and we previously explored these associations in eastern Wisconsin using positive L. pneumophila serogroup 1 urine antigen tests (LUAT) as diagnostic. This case-control study was a secondary analysis of home address data from patients who underwent LUAT at a single eastern Wisconsin health system from 2013 to 2017. Only zip codes within the health system’s catchment area that registered ≥ 3 positive cases and ≥ 50 completed tests, as well as geographically adjacent zip codes with ≥ 2 positive cases and ≥ 50 tests, were included. A 1:3 …

Relationship Between Single Motherhood Status And Stunting Among Children Under 5 In Kgatleng, Botswana, Mulume Sf Mwamba, Shirley Gerrior, Reginald Taylor

Journal of Social, Behavioral, and Health Sciences

Undernutrition affects sub-Saharan African countries with increased stunting among children under 5 years old. The short- and long-term effects of this stunting include the potential for slow growth in early life, impaired health, and educational and economic disadvantages in adolescent and adult years. In this quantitative cross-sectional study, we analyzed the relationship between single-mother families and the occurrence of stunting among children under 5 years old in the Kgatleng District of Botswana. We collected primary data from 196 mothers and their children who visited selected clinics in Kgatleng. The results of the binary logistic regression analysis were significant: χ2 (1, …

Associations Between Residential Greenspace, Socioeconomic Status, And Stroke: A Matched Case-Control Study, Heloise Cheruvalath, Jennifer Homa, Maharaj Singh, Paul Vilar, Amin Kassam, Richard A. Rovin

Journal of Patient-Centered Research and Reviews

Purpose: Studies have shown increased residential greenspace is associated with improved outcome following stroke. This study sought to determine if residential greenspace is an independent stroke risk factor.

Methods: A retrospective 1:4 matched case-control study involving 1174 stroke and 4696 control patients over a 3-year period from Milwaukee County, Wisconsin, was conducted. Greenspace was determined using normalized difference vegetation index (NDVI) for a 250-meter radius surrounding a subject’s residence. The area deprivation index (ADI) for the census block tract of a subject’s residence was obtained from the Neighborhood Atlas® (University of Wisconsin School of Medicine and Public Health). …

Electrocardiogram-Based Machine Learning Emulator Model For Predicting Novel Echocardiography-Derived Phenogroups For Cardiac Risk-Stratification: A Prospective Multicenter Cohort Study, Heenaben B. Patel, Naveena Yanamala, Brijesh Patel, Sameer Raina, Peter D. Farjo, Srinidhi Sunkara, Márton Tokodi, Nobuyuki Kagiyama, Grace Casaclang-Verzosa, Partho P. Sengupta

Journal of Patient-Centered Research and Reviews

Purpose: Electrocardiography (ECG)-derived machine learning models can predict echocardiography (echo)-derived indices of systolic or diastolic function. However, systolic and diastolic dysfunction frequently coexists, which necessitates an integrated assessment for optimal risk-stratification. We explored an ECG-derived model that emulates an echo-derived model that combines multiple parameters for identifying patient phenogroups at risk for major adverse cardiac events (MACE).

Methods: In this substudy of a prospective, multicenter study, patients from 3 institutions (n = 727) formed an internal cohort, and the fourth institution was reserved as an external test set (n = 518). A previously validated patient similarity analysis model was used …

Vitamin D Level Testing In An Urban Midwest Clinic: To Test Or Not To Test?, Daniel Mundt, Marianne Klumph, Kayla Heslin, Wajih Askar

Journal of Patient-Centered Research and Reviews

Vitamin D deficiency (VDD) is significantly higher among urban populations in the U.S. Midwest, with African Americans being disproportionately affected. There is ongoing debate surrounding who and how often individuals should be screened for VDD. This study aimed to understand the prevalence of VDD, associated risk factors, and discrepancies in testing at an urban-based internal medicine residency clinic. Data were retrospectively collected on all adult patients seen by the clinic during 2018 and descriptive statistical analysis performed. Among 3976 total patients (mean age: 53 years), 18% (n = 698) had vitamin D levels analyzed, with deficiency found in 71% of …

Clinical Characteristics, Risk Factors, And Outcomes Among A Large Midwestern U.S. Cohort Of Patients Hospitalized With Covid-19 Prior To Vaccine Availability, Viviana Zlochiver, Ana Cristina Perez Moreno, Michael Peterson, Khalil Odeh, Ashley Mainville, Katherine Busniewski, Jon Wrobel, Mohamed Hommeida, Blair Tilkens, Payal Sharma, Hlu Vang, Sara Walczak, Fekadesilassie Moges, Kritika Garg, A. Jamil Tajik, Suhail Q. Allaqaband, Tanvir Bajwa, M. Fuad Jan

Journal of Patient-Centered Research and Reviews

Purpose: The COVID-19 pandemic posed unprecedented demands on health care. This study aimed to characterize COVID-19 inpatients and examine trends and risk factors associated with hospitalization duration, intensive care unit (ICU) admission, and in-hospital mortality.

Methods: This retrospective study analyzed patients with SARS-CoV-2 infection hospitalized at an integrated health system between February 2, 2020, and December 12, 2020. Patient characteristics and clinical outcomes were obtained from medical records. Backward stepwise logistic regression analyses were used to identify independent risk factors of ICU admission and in-hospital mortality. Cox proportional hazards models were used to evaluate relationships between ICU admission and in-hospital …

Sitting, John Brill

Journal of Patient-Centered Research and Reviews

A family physician volunteers for a hospital shift as a patient sitter and reflects on the experience in this creative writing article. Freed from clinical responsibilities in a hospital setting, sitting and observing the patient’s interactions with health care professionals and staff reinforced the importance of human connection to recovery.

The Use Of Active Coping Compared To Self-Distraction To Reduce Perceived Stress In Upper Division Nursing Students, Grace Elizabeth Kimbro

Honors Capstone Projects and Theses

No abstract provided.

Gm1 Ganglioside Modifies Microglial And Neuroinflammatory Responses To Α-Synuclein In The Rat Aav-A53t Α-Synuclein Model Of Parkinson's Disease, Jay S Schneider, Garima Singh, Courtney K. Williams, Vikrant Singh

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Among the pathological events associated with the dopaminergic neurodegeneration characteristic of Parkinson's disease (PD) are the accumulation of toxic forms of α-synuclein and microglial activation associated with neuroinflammation. Although numerous other processes may participate in the pathogenesis of PD, the two factors mentioned above may play critical roles in the initiation and progression of dopamine neuron degeneration in PD. In this study, we employed a slowly progressing model of PD using adeno-associated virus-mediated expression of human A53T α-synuclein into the substantia nigra on one side of the brain and examined the microglial response in the striatum on the injected side …

Oleyl Conjugated Histidine-Arginine Cell-Penetrating Peptides As Promising Agents For Sirna Delivery, Muhammad Imran Sajid, Dindyal Mandal, Naglaa Salem El-Sayed, Sandeep Lohan, Jonathan Moreno, Rakesh Kumar Tiwari

Pharmacy Faculty Articles and Research

Recent approvals of siRNA-based products motivated the scientific community to explore siRNA as a treatment option for several intractable ailments, especially cancer. The success of approved siRNA therapy requires a suitable and safer drug delivery agent. Herein, we report a series of oleyl conjugated histidine–arginine peptides as a promising nonviral siRNA delivery tool. The conjugated peptides were found to bind with the siRNA at N/P ratio ≥ 2 and demonstrated complete protection for the siRNA from early enzymatic degradation at N/P ratio ≥ 20. Oleyl-conjugated peptide -siRNA complexes were found to be noncytotoxic in breast cancer cells (MCF-7 and MDA-MB-231) …

Anakinra Treatment Efficacy In Reduction Of Inflammatory Biomarkers In Covid-19 Patients: A Meta-Analysis, Zunaira Naveed, Musharraf Sarwar, Zahid Ali, Danish Saeed, Khadija Choudhry, Azza Sarfraz, Zouina Sarfraz, Miguel Felix, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Introduction: Anakinra is being empirically considered for the treatment of COVID-19 patients. The aim is to assess the efficacy of anakinra treatment on inflammatory marker reduction, including c-reactive protein (CRP) concentrations, serum ferritin, and serum d-dimer levels.
Methods: Adhering to PRISMA 2020 statement guidelines, a systematic search was conducted across the following databases from December 2019 until January 10, 2022: PubMed/MEDLINE, Cochrane Central, Web of Science, Scopus, and EMBASE. The following keywords were employed: Anakinra, COVID*, SARS-CoV-2, inflammatory, CRP, D-dimer, Ferritin, hematological, laboratory, clinical, trials. The findings were collated and presented in a tabulated manner, and statistically analyzed using Review …

Emergency Department Antimicrobial Use In A Low-Resource Setting: Results From A Retrospective Observational Study At A Referral Hospital In Liberia, Sojung Yi, Anu Ramachandran, Lane Epps, Alex Mayah, Taylor W Burkholder, Michael Senyu Jaung, Ahson Haider, Paul Whesseh, John Shakpeh, Kayla Enriquez, Corey Bills

Faculty, Staff and Students Publications

OBJECTIVE: Data on antimicrobial use in low-income and middle-income countries (LMICs) remain limited. In Liberia, the absence of local data impedes surveillance and may lead to suboptimal treatment, injudicious use and resistance against antimicrobials. This study aims to examine antimicrobial prescribing patterns for patients in the emergency department (ED) of a large Liberian public hospital. Secondarily, this prescribing was compared with WHO prescribing indicators.

DESIGN: Retrospective observational study.

SETTING: An adult ED of a large public hospital in Monrovia, Liberia.

PARTICIPANTS: A total of 1082 adult patients (>18 years of age) were recorded in the ED, from 1 January …

Let Food Be Thy Medicine: The Role Of Whole Food Consumption And Mental Wellness In Children, Bianca A. Allen

MOT Student Capstones

Mental Health is one of the most neglected areas of health in the U.S healthcare system, yet there continues to be an alarming rate of individuals diagnosed with mental health disorders. This group of affected individuals includes the presence of children with 3 out of 4 children predicted to experience behavior problems and mood fluctuations before the age of 17. To 3 combat mental illness, psychotropic medications are prescribed at a startling rate with children as young as 2 being placed on mental health prescriptions. Although psychotropic medications have positive outcomes on mental illness, long terms use of this class …

Safe Patient Handling And Mobility Olympics, Johnny R. Cortez

MSN Capstone Projects

The focus of this study is the implementation of a Safe Patient Handling and Mobility (SPHM) program titled SPHM Olympics. The study reviews the necessary components and background necessary to implement the project as well as evaluation tools to monitor the impact of the program on the safety of culture at Houston Methodist West (HMW). The program originated from the SPHM committee’s need to improve the utilization of SPHM equipment and techniques by clinical staff throughout the hospital as evidenced by the substantial number of clinical staff suffering from musculoskeletal disorders and HMW clinical staff’s current views that SPHM techniques …

Appointment Reminder System Benchmark Study, Anthony Rawlinson

MSN Capstone Projects

The average appointment “no-show” rate is 23% across 105 studies (Dantas et al., 2018). These “no-shows” cost an estimated 150 billion dollars a year to the American healthcare industry (Ruiz-Hernandez et al., 2020). Previous estimates place the cost of one no-show event at a primary office in the range of $125 to $274 (Aysola et al., 2020). These missed appointments not only cause a loss in office revenue, but also harm the patients missing the appointment (Marbouh et al., 2020). Some of the repercussions patients suffer from are longer wait times for appointments, higher Emergency Room (ER) admission rates, and …

Health Literacy In Acute Care Benchmark Study, Micah Duke

MSN Capstone Projects

Poor health literacy levels directly correlate to poor patient discharge adherence and to an increase in repeat emergency department visits and healthcare costs. In addition, poor health literacy levels are directly correlated to a decrease in patient health outcomes. Studies clearly demonstrate that determining patient health literacy levels can be used to develop appropriate discharge instructions and education that will improve patient adherence and health outcomes, thus reducing emergency department readmissions and healthcare costs.

The purpose of this benchmark project is to implement procedures for consistently obtaining patient health literacy levels, along with language preferences, using the HLS-SF12 and to …

Supporting Nurse Residency Programs By Determining Nurse Residency Value, Byron Carlisle

MSN Capstone Projects

There is a strong influence on retention of the new graduate nurse during the first year of a nurse residency program. A positive correlation between nurse residency programs and return on investment were found. The retention of the new graduate nurse is influenced on precepting and mentoring of the new graduate nurse. Standardizing the reporting of interventions should be the focus on future studies as there are many interventions in regards to precepting and mentoring that influence retention.

Resuscitation Of Hypovolemic Trauma Patients: Controlled /Hypotensive Resuscitation Vs. Conventional Resuscitation, Pamala D. Mcgowan

MSN Capstone Projects

The manner in which clinicians have used to resuscitate hemorrhagic trauma patients has been a continuous repetitive cycle over time. The cycle has gone from “run the fluids wide open in the patient” to “less is more in the patient”. As more evidence-based practice (EBP) emerges, reasons for ‘less is more’ become acutely evident. Large fluid volume resuscitation is highly suspicious for the exacerbation of the lethal triad of trauma: hypothermia, acidosis, and coagulopathy, thereby increasing bleeding and mortality (Cotton et al., 2006). The increased risk of bleeding also worsens the complications associated with trauma resuscitation. This all creates a …

Central Line Maintenance Team, Lauren Spears

MSN Capstone Projects

Background: CLASBI infections increase morbidity and mortality rates in intensive care units. Studies have shown that line teams can reduce CLASBI rates by 65% (Cuccaro et al., 2020).

Objective: This narrative review aims to determine if initiation of central line maintenance teams will help reduce CLASBI rates in the ICU.

Summary Databases including CINAHL, PubMed, and Cochrane were searched for randomized control trials (RCT), systemic, qualitative and case control studies to find research study evidence to determine if a dedicated central line maintenance team, specifically for insertion and dressing changes, will help reduce CLASBI rates in the ICU setting. The …

Using Simulation To Develop Clinical Judgment In New-To-Practice Emergency Department Nurses: An Evidence-Based Benchmark Project, Moreno Divine Comiskey

MSN Capstone Projects

In the past 6 months, the Emergency Department at the George Washington University Hospital has onboarded over twice as many new-to-practice nurses as experienced emergency nurses. Studies suggest that these new-to-practice nurses often are deficient in clinical judgment, and our observations at our hospital support these findings. Researchers have found that onboarding programs that include simulation have success in improving clinical judgment, and advocate for its use. Simulation gives another angle to the onboarding program in addition to preceptorship and classroom learning, and allows participants to bridge the gap between theory and practice safely and without fear of harming a …

The Use Of Standardized Patients To Improve Communication Skills: A Benchmark Study, Baylee A. Azbell

MSN Capstone Projects

Effective communication is an important skill set for all nurses to withhold. In the medical field, poor communication skills have been associated with negative patient outcomes, increase in patient dissatisfaction and complaints, faulty treatment adherence, inadequate patient education, malpractice claims and poor patient and healthcare team relationships (Lin et al., 2013). Communication is a learned skill and needs to be taught from the very beginning of nursing school. Nursing schools need to be proactive and prepare their nursing students in promoting clear communication skills to ensure patient safety and satisfaction in care. This issue led to the benchmark project that …

Change Of Policy Regarding Evidence Based Practice Interventions In Postpartum Hemorrhages And Promotion Of Standardization Of Care, Danielle Fulton

MSN Capstone Projects

Postpartum Hemorrhages are occurring at a devastating rate and require intervention, as postpartum women can die from hemorrhages. This project aims to establish interventions that should be a set policy, to help decrease the rate in which postpartum hemorrhages occur and the morbidity rate.