Medicine and Health Sciences Commons^™

Measure Dx: Implementing Pathways To Discover And Learn From Diagnostic Errors, Andrea Bradford, Marjorie Shofer, Hardeep Singh

Faculty, Staff and Students Publications

Despite the high frequency of diagnostic errors, multiple barriers, including measurement, make it difficult learn from these events. This article discusses Measure Dx, a new resource from the Agency for Healthcare Research and Quality that translates knowledge from diagnostic safety measurement research into actionable recommendations. Measure Dx guides healthcare organizations to detect, analyze, and learn from diagnostic safety events as part of a continuous learning and feedback cycle. Wider adoption of Measure Dx, along with the implementation of solutions that result, can advance new frontiers in reducing preventable diagnostic harm to patients.

Iranian Health Transformation Plan In Physiotherapy Services: Comparison Of Household Based Financial Outcomes, Seyedeh Mitra Hosseini Malekroudi, Zahra Mohtasham-Amiri, Enayatollah Homaie Rad

Journal of Health Research

Background: Physiotherapy services are important because they help disabled patients to return to work and other social activities. High out-of-pocket payments of physiotherapy services are one of the major barriers to the utilization of these services. In 2014 a reform was implemented in Iran named as Health Transformation Plan aimed to improve Universal Health Coverage of Iranians. We tried to find the effects of HTP on the financial outcomes of physiotherapy services.

Method: Data of Iranian Household Income and Expenditures Survey (IHIES) before and after HTP was used in this study. Out of Pocket payments and utilization of physiotherapy services …

A Case Report And Literature Review On Argatroban Refractory Heparin-Induced Thrombocytopenia, Imad Ud Deen, Swati Ajay Jha, Sadaf Mustafa

Journal of Community Hospital Internal Medicine Perspectives

Heparin-induced thrombocytopenia (HIT) is characterized by low platelets and thrombosis after exposure to Heparin products. It is classically characterized by a rapid and significant drop in platelets and life-threatening thrombosis. Thrombosis can occur up to 50% of the cases if left untreated. It requires immediate discontinuation of all heparin products and switching to a non-heparin anticoagulant to prevent further thrombosis. Here we present a case of a 56-year-old male who presented to the Emergency Department with sudden onset of severe left leg pain. Duplex study showed arterial thrombosis in the common iliac and distal iliac arteries. He received TPA at …

Level Of Trust In Health Care Systems During Covid-19 Pandemic Among Health Care Workers Of Pakistan, Asmara Ahmed Malik, Sobia Awan, Ali Tahir Rana, Jahanzeb Malik, Uzma Ishaq, Mamoona Zahoor, Syed Muhammad Jawad Zaidi

Journal of Community Hospital Internal Medicine Perspectives

This survey aimed to evaluate the levels of trust and satisfaction among healthcare workers towards the national healthcare delivery system and whether it has been affected by the global disruption created by COVID-19. This was an analytical cross-sectional study that took place from January to October 2021 at a tertiary level health care facility in Rawalpindi, Pakistan, using an online data collection tool. Our sample included 10, 133 healthcare workers of all cadres. Our study found a significant level of distrust of healthcare workers towards multiple aspects of the healthcare delivery system, particularly towards government agencies and other members of …

A Rare Case Of Pembrolizumab Associated Encephalopathy, Sijan Basnet, Rajanbir Singh, Biswaraj Tharu, Tushar Pawar, Garima Basnet

Journal of Community Hospital Internal Medicine Perspectives

We present a unique case of a 55-year-old man with confusion thought to be due to pembrolizumab which he was receiving for renal cell carcinoma. His workup for other possible etiologies for encephalopathy was negative. He was treated with high dose intravenous methylprednisolone followed by prednisone taper and intravenous immunoglobulin with gradual improvement in his mentation.

Evidence-Based Role Of Aspirin In Giant Cell Arteritis: A Literature Review, Anum Qureshi, Fatima Halilu, Sam W. Serafi, Howard Hauptman, Tristan Flack

Journal of Community Hospital Internal Medicine Perspectives

Giant cell arteritis (GCA), or temporal arteritis, is a medium to large vessel vasculitis seen in the elderly. Its presentation varies from fever of unknown origin to cranial ischemic complications including complete vision loss. The early initiation of steroids is key to preventing complications of GCA. Here we discuss the role of aspirin in the treatment of GCA, both as an antithrombotic agent and its increasingly utilized antiinflammatory properties. The aim of this review article is to examine the evidence behind the rationale of aspirin use as an adjunct to steroids for the prevention of cranial ischemic complications.

2022-09-09_Michiganoverview_Covidbedppe, Michigan Department Of Health & Human Services

Michigan COVID-19 Hospital Data

Contains the tables Statewide Hospital Capacity Report for COVID-19, COVID-19 Metrics, Statewide Hospital Available PPE Tracking for COVID-19, as well as the tables PPE Days On Hand and Patient Census.

Covid-19 Newsletter (Vol. 135), Center For Disaster Medicine, New York Medical College

COVID-19 Newsletter

No abstract provided.

Designing Optimal Convolutional Neural Network Architecture Using Differential Evolution Algorithm, Arjun Ghosh, Nanda Dulal Jana, Saurav Mallik, Zhongming Zhao

Faculty, Staff and Student Publications

Convolutional neural networks (CNNs) are deep learning models used widely for solving various tasks like computer vision and speech recognition. CNNs are developed manually based on problem-specific domain knowledge and tricky settings, which are laborious, time consuming, and challenging. To solve these, our study develops an improved differential evolution of convolutional neural network (IDECNN) algorithm to design CNN layer architectures for image classification. Variable-length encoding is utilized to represent the flexible layer architecture of a CNN model in IDECNN. An efficient heuristic mechanism is proposed in IDECNN to evolve CNN architecture through mutation and crossover to prevent premature convergence during …

Mutations In Bcor, A Co-Repressor Of Crx/Otx2, Are Associated With Early-Onset Retinal Degeneration, Maéva Langouët, Christine Jolicoeur, Awais Javed, Pierre Mattar, Micah D Gearhart, Stephen P Daiger, Mette Bertelsen, Lisbeth Tranebjærg, Nanna D Rendtorff, Karen Grønskov, Catherine Jespersgaard, Rui Chen, Zixi Sun, Hui Li, Najmeh Alirezaie, Jacek Majewski, Vivian J Bardwell, Ruifang Sui, Robert K Koenekoop, Michel Cayouette

Faculty, Staff and Student Publications

Many transcription factors regulating the production, survival, and function of photoreceptor cells have been identified, but little is known about transcriptional co-regulators in retinal health and disease. Here, we show that BCL6 co-repressor (BCOR), a Polycomb repressive complex 1 factor mutated in various cancers, is involved in photoreceptor degenerative diseases. Using proteomics and transcription assays, we report that BCOR interacts with the transcription factors CRX and OTX2 and reduces their ability to activate the promoters of photoreceptor-specific genes. CUT&RUN sequencing further shows that BCOR shares genome-wide binding profiles with CRX/OTX2, consistent with a general co-repression activity. We also identify missense …

Body Size At Different Ages And Risk Of 6 Cancers: A Mendelian Randomization And Prospective Cohort Study, Daniela Mariosa, Karl Smith-Byrne, Tom G Richardson, Pietro Ferrari, Marc J Gunter, Nikos Papadimitriou, Neil Murphy, Sofia Christakoudi, Konstantinos K Tsilidis, Elio Riboli, David Muller, Mark P Purdue, Stephen J Chanock, Rayjean J Hung, Christopher I Amos, Tracy A O'Mara, Pilar Amiano, Fabrizio Pasanisi, Miguel Rodriguez-Barranco, Vittorio Krogh, Anne Tjønneland, Jytte Halkjær, Aurora Perez-Cornago, María-Dolores Chirlaque, Guri Skeie, Charlotta Rylander, Kristin Benjaminsen Borch, Dagfinn Aune, Alicia K Heath, Heather A Ward, Matthias Schulze, Catalina Bonet, Elisabete Weiderpass, George Davey Smith, Paul Brennan, Mattias Johansson

Staff and Researcher Publications

It is unclear if body weight in early life affects cancer risk independently of adult body weight. To investigate this question for 6 obesity-related cancers, we performed univariable and multivariable analyses using 1) Mendelian randomization (MR) analysis and 2) longitudinal analyses in prospective cohorts. Both the MR and longitudinal analyses indicated that larger early life body size was associated with higher risk of endometrial (odds ratioMR = 1.61, 95% confidence interval = 1.23 to 2.11) and kidney (odds ratioMR = 1.40, 95% confidence interval = 1.09 to 1.80) cancer. These associations were attenuated after accounting for adult body size in …

Health Workers’ Documentation Process As A Prerequisite To The Integration Of Patient Care At A Regional Referral Hospital In Uganda, Grace Nakate, Mary Moleki, Ahmed Sarki, Valerie Fleming

School of Nursing & Midwifery, East Africa

Background: Integrated patient care is necessary for better care outcomes. Documentation enhances the integration of care; however, in the Ugandan setting, documentation of care is poor (e.g., omissions and incomplete records) and integration of patient care is not visible. This study presents a review of patient health records that was undertaken to understand documentation of care at a regional referral hospital in Eastern Uganda. This information will help in developing a documentation model to facilitate the integration of patient care in Uganda.

Methodology: This retrospective review involved 513 patient health records from the medical-surgical, pediatric, and obstetric/gynecological departments of Jinja …

Imm-Bcp-01, A Patient-Derived Anti-Sars-Cov-2 Antibody Cocktail, Is Active Across Variants Of Concern Including Omicron Ba.1 And Ba.2, Pavel A Nikitin, Suzanne M Scheaffer, Michael S Diamond, Et Al

2020-Current year OA Pubs

Monoclonal antibodies are an efficacious therapy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, rapid viral mutagenesis led to escape from most of these therapies, outlining the need for an antibody cocktail with a broad neutralizing potency. Using an unbiased interrogation of the memory B cell repertoire of patients with convalescent COVID-19, we identified human antibodies with broad antiviral activity in vitro and efficacy in vivo against all tested SARS-CoV-2 variants of concern, including Delta and Omicron BA.1 and BA.2. Here, we describe an antibody cocktail, IMM-BCP-01, that consists of three patient-derived broadly neutralizing antibodies directed at nonoverlapping surfaces …

Adapting The Fast-M Maternal Sepsis Intervention For Implementation In Pakistan: A Qualitative Exploratory Study, Sheikh Irfan Ahmed, Bakhtawar M H. Khowaja, Rubina Barolia, Raheel Sikandar, Ghulam Kubra Rind, Sehrish Rani, Raheela Rani, James Cheshire, Catherine Louise Dunlop, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Objective: A maternal sepsis management bundle for resource-limited settings was developed through a synthesis of evidence and international consensus. This bundle, called 'FAST-M' consists of: Fluids, Antibiotics, Source control, assessment of the need to Transport/Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). The study aimed to adapt the FAST-M intervention including the bundle care tools for early identification and management of maternal sepsis in a low-resource setting of Pakistan and identify potential facilitators and barriers to its implementation.
Setting: The study was conducted at the Liaquat University of Medical and Health Sciences, which …

Associations Of 24-Hour Movement Behaviors, Parental Academic Support, And Academic Achievement In Alaskan Adolescents, You Fu, Ryan D. Burns, Nora Constantino, Xavier Lopez, Samantha Dyer

International Journal of Physical Activity and Health

The purpose of this study was to examine the associations between meeting recommendations for 24-hour movement behaviors, parental academic support, and student academic achievement in a sample of Alaskan adolescents. Data were obtained from the 2019 Alaska Youth Risk Behavior Survey (YRBS; N = 1,897; mean age = 15.8 ± 1.3 years old). The associations between meeting recommendations for the 24-hour movement behaviors of physical activity, screen use, and sleep with high academic achievement (mostly A’s and B’s) were examined using weighted multivariable logistic regressions. Subpopulation analyses determined if associations differed by levels of parental academic support. Approximately 18.8% of …

Sleep, Sirtuin 1 And Alzheimer’S Disease: A Review, Mehrane Mehramiz, Tenielle Porter, Simon Laws, Stephanie R. Rainey-Smith

Research outputs 2022 to 2026

Sleep plays a major role in brain health, and cognition. Disrupted sleep is a well-described symptom of Alzheimer’s disease (AD). However, accumulating evidence suggests suboptimal sleep also increases AD risk. The deacetylase Sirtuin 1 (Sirt 1), encoded by the SIRT1 gene, impacts sleep via its relationship to wake-sleep neurotransmitters and somnogens. Evidence from animal and human studies supports a significant and complex relationship between sleep, Sirt 1/ SIRT1 and AD. Numerous hypotheses attempt to explain the critical impact of Sirt 1/ SIRT1 on wake- and sleep- promoting neurons, their related mechanisms and neurotransmitters. However, there is a paucity of studies …

Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infection (Pandas): A Qualitative Study Of Parental Perceptions Of Factors In Remission, Janice Diane Weddle

Doctoral Dissertations and Projects

Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) starts as the child’s body has an inappropriate reaction to the immune response for streptococcal infection. PANDAS is characterized by the sudden onset of neuropsychiatric disorders, including obsessive-compulsive disorder (OCD), anxiety, chorea movements, and tics. Previous research has drawn conflicting conclusions on PANDAS treatment efficacy and long-term treatment outcomes leaving remission rates unclear. The purpose of this qualitative phenomenological case study was to explore parents’ perceptions of factors related to PANDAS remission. Parents of children diagnosed with PANDAS were recruited through Facebook PANDAS support groups and the National Institute of Mental …

Coexistence Of Cutaneous Squamous Cell Carcinoma And Basal Cell Carcinoma In A Renal Transplant Recipient: A Case Report., Diana Voloshyna, Tanveer Ahamad Shaik, Sunita Shrestha, Ajmat Ansari, Faraz Saleem, Muhammad Abu Zar Ghaffari

Faculty and Staff Scholarship

In solid organ transplant patients, non-melanoma skin cancer remains a leading cause of mortality. The most common skin malignancies in solid organ transplant patients are squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). In organ transplant patients, SCC is 100 times more prevalent, and BCC is 10 times more prevalent than in the general population. Many risk factors for developing such malignancies are equivalent to those in the general population. However, in the transplant population, such cancers occur at an earlier age, act more aggressively, and often appear at multiple locations. Thus, assiduousness on the patient's part and healthcare …

Air Quality And Cancer Prevalence Trends Across The Sub-Saharan African Regions During 2005–2020, Omolola Okunromade, Jingjing Yin, Clara Ray, Atin Adhikari

Health Policy & Community Health: Faculty Publications

Poor air quality and environmental pollution remain some of the main etiological factors leading to cancers and cancer-related deaths worldwide. As a result of human activities, deleterious airborne chemicals can be dispersed not only in the environment but also released in occupational environments and industrial areas. Air pollutants and cancer links are now established through various oxidative stress-related mechanisms and related DNA damages. Generally, ambient and indoor air pollutants have been understudied in sub-Saharan Africa (SSA) compared to other regions in the world. Our study not only highlights the deleterious effects of air pollutants in these developing countries, but it …

Interplay: The Essential Role Between Insm1 And N-Myc In Aggressive Neuroblastoma, Chiachen Chen, Michael S. Lan

School of Medicine Faculty Publications

An aggressive form of neuroblastoma (NB), a malignant childhood cancer derived from granule neuron precursors and sympathoadrenal lineage, frequently comprises MYCN amplification/elevated N-Myc expression, which contributes to the development of neural crest-derived embryonal malignancy. N-Myc is an oncogenic driver in NB. Persistent N-Myc expression during the maturation of SA precursor cells can cause blockage of the apoptosis and induce abnormal proliferation, resulting in NB development. An insulinoma-associated-1 (INSM1) zinc-finger transcription factor has emerged as an NB biomarker that plays a critical role in facilitating tumor cell growth and transformation. INSM1 plays an essential role in sympathoadrenal cell differentiation. N-Myc activates …

Active And Passive Immunization With An Anti-Methamphetamine Vaccine Attenuates The Behavioral And Cardiovascular Effects Of Methamphetamine, Colin N. Haile, Kurt J. Varner, Xia Huijing, Reetakshi Arora, Frank M. Orson, Thomas R. Kosten, Therese A. Kosten

School of Medicine Faculty Publications

Background: Methamphetamine use disorder (MUD) is a growing health concern with no FDA-approved treatment. The present series of studies build upon our previous work developing an anti-methamphetamine (MA) vaccine for MUD. We determined the effects of a formulation that included tetanus-toxoid (TT) conjugated to succinyl-methamphetamine (TT-SMA) adsorbed onto aluminum hydroxide (alum) in combination with the novel Toll-Like Receptor-5 agonist, entolimod. Methods: Mice were vaccinated (0, 3, 6 weeks) with TT-SMA+alum and various doses of entolimod to determine an optimal dose for enhancing immunogenicity against MA. Functional effects were then assessed using MA-induced locomotor activation in mice. Experiments using passive immunization …

Covid-19 And Children, Carl A Pierce, Kevan C Herold, Betsy C Herold, Janet Chou, Adrienne Randolph, Binita Kane, Sammie Mcfarland, Deepti Gurdasani, Christina Pagel, Peter Hotez, Sarah Cobey, Scott E Hensley

Center for Medical Ethics and Health Policy Staff Publications

There has been substantial research on adult COVID-19 and how to treat it. But how do severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections afflict children? The COVID-19 pandemic has yielded many surprises, not least that children generally develop less severe disease than older adults, which is unusual for a respiratory disease. However, some children can develop serious complications from COVID-19, such as multisystem inflammatory syndrome in children (MIS-C) and Long Covid, even after mild or asymptomatic COVID-19. Why this occurs in some and not others is an important question. Moreover, when children do contract COVID-19, understanding their role in …

A Case Of Malpositioned Endotracheal Tube With Resultant Left Lung Collapse., Anushri Naga, Anushri Naga

Digital Journal of Clinical Medicine

BACKGROUND

ENDOTRACHEAL INTUBATION IS USUALLY DONE AS A PART OF EMERGENCY MANAGEMENT OF PATIENTS WITH A THREATENED AIRWAY AND GENERAL ANAESTHSIA, IN ORDER TO ENSURE PATENCY OF THE AIRWAY AS WELL AS PROPER VENTILATION. POSITIONING AN ET TUBE CORRECTLY IS OF PARAMOUNT IMPORTANCE IN ORDER TO PREVENT HYPOVENTILATION, INAPPROPRIATE VENTILATION AND ALSO COLLAPSE OF LUNG DUE TO MALPOSITIONING OF ET TUBE.

ETT POSITION IS USUALLY ASSESSED USING FRONTAL CHEST RADIOGRAPH. THE POSITION OF THE ETT IS DEPENDENT ON THE POSITION OF THE HEAD & NECK. THE MANDIBLE CAN BE USED FOR ASSESSMENT OF WHETHER THE NECK IS IN A NEUTRAL …

Post Covid-19 Cognitive Impairment In A Patient With Bipolar Disorder, Nilanjana Dutta, Raghav Gupta, Dr. M Kishor Mbbs, Md

Digital Journal of Clinical Medicine

COVID-19 has caused widespread health conditions, psychological and social distress among people and there is evidence that shows profound neuropsychiatric complications during acute and post-recovery phases of the infection. Cognitive impairment occurring after COVID-19 infection can be explained by various mechanisms, including persistent systemic inflammation, direct viral invasion, alteration in the blood-brain barrier, and cerebrovascular endothelial injury.There are few studies that have explored the impact of COVID-19 on pre-existing psychiatric conditions. This case report highlights the temporal association of cognitive impairment with COVID-19 and the need for cognitive assessment and management in post-COVID-19 patients with pre-existing psychiatric conditions.

Obsessive Compulsive Disorder With Porn Addiction During The Covid-19 Pandemic, Varuni Pragya, M Kishor Dr.

Digital Journal of Clinical Medicine

BACKGROUND:

COVID-19 Pandemic is an unprecedented humanitarian crisis that has affected the mental health of individuals immensely. OCD was among the mental health conditions that emerged with the new norm that is associated with repeated hand wash, social distancing and testing to confirm COVID-19. Nissen et al. (2020) found that there was a significant positive correlation between total OCD severity scores and the occurrence of OCD aggressive and sexual symptoms. [6] The COVID-19 lockdown translated into physical isolation, driving individuals to waste time online with no definite purpose, spending longer, abnormal durations of time online when bored, leading to increased …

Methodological Characteristics, Physiological And Physical Effects, And Future Directions For Velocity-Based Training In Soccer: A Systematic Review, Jorge Ribeiro, José Afonso, Miguel Camões, Hugo Sarmento, Mário Sá, Ricardo Lima, Filipe Manuel Clemente

Baltic Journal of Health and Physical Activity

Introduction. This systematic review was conducted to (1) characterize the main elements of studies of velocity-based training (VBT) (e.g., training protocols) conducted in soccer, (2) summarize the main physiological and physical effects of VBT on soccer players, and (3) provide future directions for research. Methods: A systematic review of Cochrane Library, EBSCO, PubMed, Scielo, Scopus, SPORTDiscus, and Web of Science databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The database search initially identified 127 titles. Of those, five articles were deemed eligible for the systematic review, two studies used a traditional …

Persistent Left Superior Vena Cava, Connected To The Left Atrium Via The Left Superior Pulmonary Vein. An Unusual Cause Of Air Lock, Abdelkader Boukhmis, Mohamed El Amin Nouar

Journal of the Saudi Heart Association

The intraoperative diagnosis of a persistent left superior vena cava (LSVC) that drains into the left atrium (LA) via the left superior pulmonary vein may be difficult because of its extrapericardial pathway. We report here the case of a 48-year-old man, operated for a mitro-aortic endocarditis complicating a Laubry-Pezzi syndrome. The opening of the LA was followed immediately by a sudden air lock. It was only after opening of the left pleura that we were able to find and then ligate the LSVC. The patient underwent mitral valve repair, closure of the infundibular septal defect and aortic valve replacement.

Using Clear Aligners For Asymmetric Dental Decompensation In Skeletal Class Iii Facial Asymmetry Before Orthognathic Surgery, Yu-Ming Liang, Szu-Ching Lee, Fong Jenny, Tzu-Ying Wu

Taiwanese Journal of Orthodontics

In this case report of orthodontic combined with orthognathic surgery, we demonstrate the effectiveness of an aligner system in the treatment of asymmetric arch form. Without the help of temporary anchorage device and inter-arch elastic, unilateral arch expansion and opposite side arch constriction were achieved successfully. Cone-beam computed tomography was used to assess to evaluate the outcome and key to success was discussed.

Substitution Of A Dilacerated Impacted Maxillary Central Incisor With A Deep Horizontal Impacted Canine, Wei-Lun Chang, Szu-Ching Lee, Hsuan-Hung Chen, Man-Tin Lui, Tzu-Ying Wu

Taiwanese Journal of Orthodontics

The treatment of multiple impacted anterior teeth is challenging. Proper treatment plan, meticulous biomechanics design and close collaboration with interdisciplinary team work are key factors to achieve better esthetic and periodontal outcomes. For impacted tooth cases, CBCT images can provide more detailed information about the location of the impacted tooth and its surrounding periodontal conditions during treatment. This case report described the treatment of a mild skeletal Class III, facial asymmetry teenager with dilacerated impacted maxillary left central incisor. Because of the unpredictable prognosis of dilacerated impacted central incisor, our treatment goal was to forced erupt the deeply horizontal impacted …

Correction Of Extruded Upper First Molars And Bimaxillary Protrusion By Temporary Anchorage Device, Ignatia Wulandari, Retno Widayati

Taiwanese Journal of Orthodontics

Early loss of the lower first molar may cause extrusion of the upper first molar and mesial tipping of the lower second molar. It could be locked by the mesial contour of the upper second molar, causing the door-wedge effect which impedes the intrusion of the upper first molar. Skeletal Class II malocclusion, canting, and the need for anterior retraction on the upper arch was adding space requirement and anchorage problem to the case. Treatment by using absolute anchorage would be the most efficient way to treat this case. This case report aims to show how to manage molar extrusion, …