Medicine and Health Sciences Commons^™

Improving Intravenous Fluid Resuscitation Compliance Of Severe Septic And Septic Shock Adults In A Rural Emergency Room, Alison Douglas

Doctor of Nursing Practice Projects

Background: The Doctor of Nursing Practice (DNP) project focused on the delay in intravenous fluid (IVF) resuscitation of sepsis and septic shock patients in the emergency room (ER) before inpatient admission.

Purpose: The purpose of this project was to improve the time-sensitive administration of IVF resuscitation of adult patients diagnosed with sepsis or septic shock by enhancing ER nurses’ end-user knowledge of and adherence to evidence-based sepsis treatment recommendations over approximately six weeks (42 days).

Methods: Retrospective chart reviews were performed in December 2021 and focused on IVF resuscitation times. Pre-intervention questionnaires were completed, assessing baseline nursing knowledge. Nurse education …

Empowering Emergency Department Nurses To Utilize The Steadi Program For Fall Prevention, Edmond M. Woods

Doctor of Nursing Practice Projects

Background: A fall is defined as an event that results in a person coming to rest inadvertently on the ground, floor, or other lower levels (World Health Organization, 2022). Nationally the incidence of falls among older adults has steadily increased over the last ten years. According to the Centers for Disease Control and Prevention (CDC), "Falls among older adults aged 65 years and older caused over 34,000 deaths in 2019, making it the leading cause of injury contributing to death for that group" (CDC, 2019, para 1). These individuals who fall for the first time often have another fall unless …

Implementing The Use Of The Emergency Severity Index Triage Tool In Urgent Care, Sakeena Spencer

Doctor of Nursing Practice Projects

Background: The urgent care sector has quickly grown in the last decade. Patients who visit healthcare facilities seeking treatment for exacerbations of chronic conditions or episodic illnesses such as asthma without scheduled appointments receive healthcare services from Urgent Care Centers (UCC) or Emergency Departments (E.D.s). Upon visiting the UCC, these patients report life-threatening symptoms; hence require immediate medical attention. UCC healthcare workers should distinguish between non-acute and acute patients to prioritize providing healthcare to patients, ensuring they are not at risk for fatal outcomes. Using the Emergency Severity Index (ESI) triage tool while delivering healthcare services to these patients has …

Association Between Serum Vitamin D And Irritable Bowel Syndrome Symptoms In A Sample Of Adults, Myriam Abboud, Suzan Haidar, Nadine Mahboub, Dimitrios Papandreou, Fatme Al Anouti, Rana Rizk

All Works

Vitamin D may be associated with irritable bowel syndrome (IBS) pathways. This cross-sectional study evaluated the associations between serum Vitamin D and IBS symptoms in a sample of Lebanese adults. Participants (n = 230; mean (SD) age: 43.36 (16.05) years, 62.9% females) were adults, free of diseases affecting Vitamin D metabolism, and recruited from a large university and the surrounding community. Serum Vitamin D (25-hydroxyvitamin D) was assessed using an automated chemiluminescence micro-particle immunoassay kit. The Birmingham IBS Symptom Questionnaire total scale, and pain, constipation, and diarrhea subscales were used to study IBS symptoms. Four linear regression analyses were performed, …

Law Library Blog (October 2022): Legal Beagle's Blog Archive, Roger Williams University School Of Law

Law Library Newsletters/Blog

No abstract provided.

Dentistry And The Law: Dealing With Patients Who Have Been Using Marijuana, Dan Schulte Jd

The Journal of the Michigan Dental Association

When dealing with patients who emit a strong marijuana odor, it's crucial to focus on their capacity to provide informed consent and the ability to deliver treatment up to the standard of care. Judging their level of intoxication solely by appearance and smell can be unreliable, so it's best to avoid making such judgments. Instead, inform patients that you may refuse treatment if their odor or other factors hinder your ability to provide care. To prevent last-minute issues, communicate this policy in advance, particularly to patients with a history of marijuana odor. Dismissing such patients from your practice may also …

Bell’S Palsy: My Journey With A Mysterious Nerve Disorder, Sneha Shah Bds

The Journal of the Michigan Dental Association

This article chronicles the personal journey of a dentist facing Bell's Palsy while pursuing licensure in the United States. Bell's Palsy, an idiopathic unilateral facial paralysis, is explored in detail, including its clinical presentation and differential diagnosis. The author shares their experiences, challenges, and treatments, shedding light on the impact of this mysterious nerve disorder on their daily life, work, and mental well-being. The article highlights the importance of early diagnosis, comprehensive evaluation, and treatment strategies for Bell's Palsy. The author's story serves as a poignant reminder for healthcare professionals to approach patients with empathy and compassion and recognize the …

Ultraviolet Light Exposure Decreases Thyroid Cancer Risk: A National Perspective, Tessa R. Lavorgna, Mohammad Hussein, Peter P. Issa, Eman Toraih, Emad Kandil

School of Medicine Faculty Publications

Ultraviolet (UV) light has been reported to have both pro-oncogenic and anti-oncogenic effects. Since patient pigmentation can influence the role of UV light exposure, we thought to investigate the recent trends in thyroid cancer incidence and survival with an emphasis on patient race and UV exposure. Patients diagnosed with thyroid cancer from the Surveillance, Epidemiology, and End Results (SEER) database were identified. A total of 284,178 patients were enrolled. Data were stratified according to population sex, race, and state. UV exposure data in Watt-Hours Per Square Meter for the state were obtained from the National Cancer Institute Cancer Atlas. Thyroid …

Six-Year Results From Relevance: Lenalidomide Plus Rituximab (R2) Versus Rituximab-Chemotherapy Followed By Rituximab Maintenance In Untreated Advanced Follicular Lymphoma, Franck Morschhauser, Nancy L Bartlett, Et Al.

2020-Current year OA Pubs

No abstract provided.

Acute Glycogen Synthase Kinase-3 Inhibition Modulates Human Cardiac Conduction, Gang Li, Brittany D Brumback, Lei Huang, David M Zhang, Tiankai Yin, Catherine E Lipovsky, Stephanie C Hicks, Jesus Jimenez, Patrick M Boyle, Stacey L Rentschler

2020-Current year OA Pubs

Glycogen synthase kinase 3 (GSK-3) inhibition has emerged as a potential therapeutic target for several diseases, including cancer. However, the role for GSK-3 regulation of human cardiac electrophysiology remains ill-defined. We demonstrate that SB216763, a GSK-3 inhibitor, can acutely reduce conduction velocity in human cardiac slices. Combined computational modeling and experimental approaches provided mechanistic insight into GSK-3 inhibition-mediated changes, revealing that decreased sodium-channel conductance and tissue conductivity may underlie the observed phenotypes. Our study demonstrates that GSK-3 inhibition in human myocardium alters electrophysiology and may predispose to an arrhythmogenic substrate; therefore, monitoring for adverse arrhythmogenic events could be considered.

Tnfr1 Contributes To Activation-Induced Cell Death Of Pathological Cd4+ T Lymphocytes During Ischemic Heart Failure, Vinay Kumar, Rachel Rosenzweig, Suman Asalla, Sarita Nehra, Sumanth D Prabhu, Shyam S Bansal

2020-Current year OA Pubs

CD4

Lung Allograft Standardized Histological Analysis (Lasha) Template: A Research Consensus Proposal, Fiorella Calabrese, Chieh-Yu Lin, Et Al.

2020-Current year OA Pubs

BACKGROUND: Routine monitoring of lung-transplanted patients is crucial for the identification of immunological and non-immunological complications. Determining the etiology of acute allograft dysfunction, particularly in alloimmune-mediated disorders, relies heavily on the lung biopsy with histopathologic analysis. Standardization of the pathologic diagnosis of rejection (e.g., cellular and antibody-mediated) is based on consensus statements and guidelines, indicating the importance of a multidisciplinary approach to achieve a definitive etiological diagnosis. In addition to these statements and guidelines, refinements and standardizations are feasible through systematic analysis morphological, immunophenotypic and molecular alterations observed in transbronchial biopsies. This study is to identify key morphologic features to …

Peristaltic Pumps Adapted For Laminar Flow Experiments Enhance In Vitro Modeling Of Vascular Cell Behavior, Javier Abello, Shreya Raghavan, Yvette Y. Yien, Amber N. Stratman

2020-Current year OA Pubs

Endothelial cells (ECs) are the primary cellular constituent of blood vessels that are in direct contact with hemodynamic forces over their lifetime. Throughout the body, vessels experience different blood flow patterns and rates that alter vascular architecture and cellular behavior. Because of the complexities of studying blood flow in an intact organism, particularly during development, the field has increasingly relied on in vitro modeling of blood flow as a powerful technique for studying hemodynamic-dependent signaling mechanisms in ECs. While commercial flow systems that recirculate fluids exist, many commercially available pumps are peristaltic and best model pulsatile flow conditions. However, there …

Gynecologic Oncology Patient Perspectives And Knowledge On Advance Care Planning: A Quality Improvement Intervention, Sarah P. Huepenbecker, Sophia Lewis, Mark C. Valentine, Marguerite L. Palisoul, Premal H. Thaker, Andrea R. Hagemann, Carolyn K. Mccourt, Katherine C. Fuh, Matthew A. Powell, David G. Mutch, Lindsay M. Kuroki

2020-Current year OA Pubs

OBJECTIVES: Assess and improve advance care planning (ACP) awareness and uptake among gynecologic oncology patients.

METHODS: Using a quality improvement Plan-Do-Check-Act framework, we completed a single institution needs assessment and intervention. The needs assessment was a 26-question survey assessing baseline ACP knowledge and preferences of gynecologic oncology patients. We used this survey to implement an outpatient intervention in which patients were offered ACP resources (pamphlet, discussion with their gynecologic oncologist, and/or social work referral). We conducted a post-intervention survey among patients who had and had not received ACP resource(s) to assess whether our intervention increased ACP knowledge, discussions, or uptake. …

Neuroinflammation And Covid-19, Abigail Vanderheiden, Robyn S. Klein

2020-Current year OA Pubs

Coronavirus disease 2019 (COVID-19) has caused a historic pandemic of respiratory disease. COVID-19 also causes acute and post-acute neurological symptoms, which range from mild, such as headaches, to severe, including hemorrhages. Current evidence suggests that there is no widespread infection of the central nervous system (CNS) by SARS-CoV-2, thus what is causing COVID-19 neurological disease? Here, we review potential immunological mechanisms driving neurological disease in COVID-19 patients. We begin by discussing the implications of imbalanced peripheral immunity on CNS function. Next, we examine the evidence for dysregulation of the blood-brain barrier during SARS-CoV-2 infection. Last, we discuss the role myeloid …

Multi-Modulated Frequency Domain High Density Diffuse Optical Tomography, Guy A. Perkins, Adam T. Eggebrecht, Hamid Dehghani

2020-Current year OA Pubs

No abstract provided.

Health Literacy And Its Association With Human Papilloma Virus Vaccination Among Adults: Findings From The Behavioral Risk Factor Surveillance System, Vinodh Bhoopathi, Bhagavatula Pradeep, Maharaj Singh

College of Nursing Faculty Research and Publications

Health literacy is associated with the utilization of preventive health services. We examined the association between health literacy (HL) levels and receipt of at least one dose of the human papilloma virus (HPV) vaccination. We analyzed the data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) among adults aged 18 to 32. The primary outcome variable was the ‘yes/no’ response to the question that assessed whether the participant received at least the first dose of HPV vaccination. The primary independent variable was a summative HL score (range 3 through 12) we created for each respondent by adding the scores …

The Association Of Preoperative Frailty And Neighborhood-Level Disadvantage With Outcome In Patients With Newly Diagnosed High Grade Glioma, Pranav Mirpuri, Maharaj Singh, Richard Rovin

College of Nursing Faculty Research and Publications

Objective

Individual patient and socioeconomic factors are underexplored prognostic factors for glioblastoma (GBM). Frailty, a measure of physiological vulnerability, and area deprivation, a measure of socioeconomic status, are easily obtained during the preoperative evaluation. These metrics are predictors of outcome and access to treatments for other cancers. Therefore, we sought to determine the association of frailty and neighborhood disadvantage with outcomes of patients with newly diagnosed GBM.

Methods

This was a retrospective review of newly diagnosed patients with GBM undergoing surgery from 2015 through 2020. The 5-factor modified frailty index and national area deprivation index were determined for each patient. …

Defining Foundational Competence For Prelicensure And Graduate Nursing Students: A Concept Analysis And Conceptual Model, Katie L. Mcdermott, Kristina Dreifuerst

College of Nursing Faculty Research and Publications

Aim

To define the concept of foundational competence as it pertains to prelicensure and graduate nursing students during their educational program, thereby informing pedagogical and assessment practices.

Background

Competence has many definitions and uses, however a lack of consensus of a clear and useful definition in nursing persists. Without shared language, competence remains open for interpretation across and among groups and impedes the ability to teach and assess it in a competency-based education framework.

Method

Using the Walker & Avant method of concept analysis, literature was reviewed and synthesized to define and explain the concept of foundational competence in nursing …

Semiautomated Analysis Of An Optical Atp Indicator In Neurons, Taher Dehkharghanian, Arsalan Hashemiaghdam, Ghazaleh Ashrafi

2020-Current year OA Pubs

No abstract provided.

Early Preclinical Experience Of A Mixed Reality Ultrasound System With Active Guidance For Needle-Based Interventions: The Guide Study, David Bloom, Jamie N Colombo, Nathan Miller, Michael K Southworth, Christopher Andrews, Alexander Henry, William B Orr, Jonathan R Silva, Jennifer N Avari Silva

2020-Current year OA Pubs

BACKGROUND: Use of ultrasound (US) to facilitate vascular access has increased compared to landmark-based procedures despite ergonomic challenges and need for extrapolation of 2-dimensional images to understand needle position. The MantUS™ system (Sentiar, Inc.,) uses a mixed reality (MxR) interface to display US images and integrate real-time needle tracking.

OBJECTIVE: The purpose of this prospective preclinical study was to evaluate the feasibility and usability of MantUS in a simulated environment.

METHODS: Participants were recruited from pediatric cardiology and critical care. Access was obtained in 2 vascular access training models: a femoral access model and a head and neck model for …

High Polygenic Risk Scores Are Associated With Early Age Of Onset Of Alcohol Use Disorder In Adolescents And Young Adults At Risk, John I Nurnberger Jr, Kathleen Bucholz, Laura Bierut, Vivia Mccutcheon, Andrey P Anokhin, Et Al.

2020-Current year OA Pubs

BACKGROUND: Genome-wide association studies have been conducted in alcohol use disorder (AUD), and they permit the use of polygenic risk scores (PRSs), in combination with clinical variables, to predict the onset of AUD in vulnerable populations.

METHODS: A total of 2794 adolescent/young adult subjects from the Collaborative Study on the Genetics of Alcoholism were followed, with clinical assessments every 2 years. Subjects were genotyped using a genome-wide chip. Separate PRS analyses were performed for subjects of European ancestry and African ancestry. Age of onset of DSM-5 AUD was evaluated using the Cox proportional hazard model. Predictive power was assessed using …

Variability In Energy Expenditure Is Much Greater In Males Than Females, Lewis G Halsey, Susan B Racette, Et Al.

2020-Current year OA Pubs

In mammals, trait variation is often reported to be greater among males than females. However, to date, mainly only morphological traits have been studied. Energy expenditure represents the metabolic costs of multiple physical, physiological, and behavioral traits. Energy expenditure could exhibit particularly high greater male variation through a cumulative effect if those traits mostly exhibit greater male variation, or a lack of greater male variation if many of them do not. Sex differences in energy expenditure variation have been little explored. We analyzed a large database on energy expenditure in adult humans (1494 males and 3108 females) to investigate whether …

Newborn Mid-Upper Arm Circumference Identifies Low-Birth Weight And Vulnerable Infants: A Secondary Analysis, D Taylor Hendrixson, Patrick N Lasowski, Aminata Shamit Koroma, Mark J Manary

2020-Current year OA Pubs

BACKGROUND: Low birth weight (LBW) infants are at increased risk of morbidity and mortality. Identification of LBW may not occur in settings where access to reliable scales is limited. Mid-upper arm circumference (MUAC) may be an accessible, low-cost measure to identify LBW and vulnerable infants.

OBJECTIVES: We explored the validity of newborn MUAC in identifying LBW and vulnerable newborns in rural Sierra Leone.

METHODS: This study was a secondary analysis of infant data from a randomized controlled clinical trial of supplementary food and anti-infective therapies compared with standard care for undernourished pregnant women. Data for singleton liveborn infants with birth …

Antimicrobial Stewardship For Sepsis In The Intensive Care Unit: Survey Of Critical Care And Infectious Diseases Physicians, M Cristina Vazquez Guillamet, Jason P Burnham, Maria Pérez, Marin H Kollef, Constantine A Manthous, Donna B Jeffe

2020-Current year OA Pubs

OBJECTIVE: To evaluate the attitudes of infectious diseases (ID) and critical care physicians toward antimicrobial stewardship in the intensive care unit (ICU).

DESIGN: Anonymous, cross-sectional, web-based surveys.

SETTING: Surveys were completed in March-November 2017, and data were analyzed from December 2017 to December 2019.

PARTICIPANTS: ID and critical care fellows and attending physicians.

METHODS: We included 10 demographic and 17 newly developed, 5-point, Likert-scaled items measuring attitudes toward ICU antimicrobial stewardship and transdisciplinary collaboration. Exploratory principal components analysis (PCA) was used for data reduction. Multivariable linear regression models explored demographic and attitudinal variables.

RESULTS: Of 372 respondents, 315 physicians had …

Phase Ib Study Of Eprenetapopt (Apr-246) In Combination With Pembrolizumab In Patients With Advanced Or Metastatic Solid Tumors, H Park, Et Al.

2020-Current year OA Pubs

BACKGROUND: We conducted a phase I, multicenter, open-label, dose-finding, and expansion study to determine the safety and preliminary efficacy of eprenetapopt (APR-246) combined with pembrolizumab in patients with advanced/metastatic solid tumors (ClinicalTrials.gov NCT04383938).

PATIENTS AND METHODS: For dose-finding, requirements were non-central nervous system primary solid tumor, intolerant to/progressed after ≥1 line of treatment, and eligible for pembrolizumab; for expansion: (i) gastric/gastroesophageal junction tumor, intolerant to/progressed after first-line treatment, and no prior anti-programmed cell death receptor-1 (PD-1)/programmed death-ligand 1 (PD-L1) therapy; (ii) bladder/urothelial tumor, intolerant to/progressed after first-line cisplatin-based chemotherapy, and no prior anti-PD-1/PD-L1 therapy; (iii) non-small-cell lung cancer (NSCLC) with …

Congenital Aneurysm Of The Muscular Interventricular Septum Associated With Bifascicular Block, Hoang H. Nguyen, Patrick Y. Jay

2020-Current year OA Pubs

Isolated congenital aneurysm of the muscular interventricular septum is rare. We present a patient with congenital aneurysm of the basal muscular ventricular septum, who also develops conduction abnormalities with first-degree heart block, right bundle branch block, and left posterior fascicular block. The case details the natural history of the aneurysm over a 10-year period follow-up during which the patient remained asymptomatic with evidence of regression of the aneurysm. Given the aneurysm's location close to the proximal right bundle and left posterior fascicle, we believe that the cause for the aneurysm also injured both fascicles resulting in bifascicular block. The diagnosis …

Quantitative Single-Cell Analysis Of Leishmania Major Amastigote Differentiation Demonstrates Variably Extended Expression Of The Lipophosphoglycan (Lpg) Virulence Factor In Different Host Cell Types, Michael A. Mandell, Wandy L. Beatty, Stephen M. Beverley

2020-Current year OA Pubs

Immediately following their deposition into the mammalian host by an infected sand fly vector, Leishmania parasites encounter and are engulfed by a variety of cell types. From there, parasites may transit to other cell types, primarily macrophages or dendritic cells, where they replicate and induce pathology. During this time, Leishmania cells undergo a dramatic transformation from the motile non-replicating metacyclic stage to the non-motile replicative amastigote stage, a differentiative process that can be termed amastigogenesis. To follow this at the single cell level, we identified a suite of experimental 'landmarks' delineating different stages of amastigogenesis qualitatively or quantitatively, including new …

The Inner Nuclear Membrane Protein Nemp1 Supports Nuclear Envelope Openings And Enucleation Of Erythroblasts, Didier Hodzic, Jun Wu, Karen Krchma, Andrea Jurisicova, Yonit Tsatskis, Yijie Liu, Peng Ji, Kyunghee Choi, Helen Mcneill

2020-Current year OA Pubs

Nuclear envelope membrane proteins (NEMPs) are a conserved family of nuclear envelope (NE) proteins that reside within the inner nuclear membrane (INM). Even though Nemp1 knockout (KO) mice are overtly normal, they display a pronounced splenomegaly. This phenotype and recent reports describing a requirement for NE openings during erythroblasts terminal maturation led us to examine a potential role for Nemp1 in erythropoiesis. Here, we report that Nemp1 KO mice show peripheral blood defects, anemia in neonates, ineffective erythropoiesis, splenomegaly, and stress erythropoiesis. The erythroid lineage of Nemp1 KO mice is overrepresented until the pronounced apoptosis of polychromatophilic erythroblasts. We show …

Impact Of Updated Clinical Practice Guidelines On Outpatient Treatment For Clostridioides Difficile Infection And Associated Clinical Outcomes, Erik R Dubberke, Justin T Puckett, Engels N Obi, Sachin Kamal-Bahl, Kaushal Desai, Bruce Stuart, Jalpa A Doshi

2020-Current year OA Pubs

BACKGROUND: The 2017 Infectious Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA)

METHODS: A pre-post study design was employed using Medicare data. CDI treatment utilization and clinical outcomes (4- and 8-week sustained response, CDI recurrence) were compared between patients indexed from April-September 2017 (preguideline period) and those indexed from April-September 2018 (postguideline period). Clinical outcomes associated with fidaxomicin versus vancomycin were compared using propensity score-matched analyses.

RESULTS: From the pre- to postguideline period, metronidazole use decreased (initial CDI: 81.2% to 53.5%; recurrent CDI: 49.7% to 27.6%) while vancomycin (initial CDI: 17.9% to 44.9%; recurrent CDI: 48.1% to 66.4%) …