Medicine and Health Sciences Commons^™

The Differences In Code Status Conversation Approaches Reported By Emergency Medicine And Palliative Care Clinicians: A Mixed-Method Study, Kei Ouchi, Thidathit Prachanukool, Emily L Aaronson, Joshua R Lakin, Masaya Higuchi, Shan W Liu, Maura Kennedy, Anna C Revette, Anita N Chary, Jenson Kaithamattam, Brandon Lee, Thanh H Neville, Mohammad A Hasdianda, Rebecca Sudore, Mara A Schonberg, James A Tulsky, Susan D Block

Faculty, Staff and Students Publications

BACKGROUND: During acute health deterioration, emergency medicine and palliative care clinicians routinely discuss code status (e.g., shared decision making about mechanical ventilation) with seriously ill patients. Little is known about their approaches. We sought to elucidate how code status conversations are conducted by emergency medicine and palliative care clinicians and why their approaches are different.

METHODS: We conducted a sequential-explanatory, mixed-method study in three large academic medical centers in the Northeastern United States. Attending physicians and advanced practice providers working in emergency medicine and palliative care were eligible. Among the survey respondents, we purposefully sampled the participants for follow-up interviews. …

Harnessing Physical Activity Monitoring And Digital Biomarkers Of Frailty From Pendant Based Wearables To Predict Chemotherapy Resilience In Veterans With Cancer, Gozde Cay, Yvonne H Sada, Mohammad Dehghan Rouzi, Md Moin Uddin Atique, Naima Rodriguez, Mehrnaz Azarian, M G Finco, Sarvari Yellapragada, Bijan Najafi

Center on Aging Staff Publications

This study evaluated the use of pendant-based wearables for monitoring digital biomarkers of frailty in predicting chemotherapy resilience among 27 veteran cancer patients (average age: 64.6 ± 13.4 years), undergoing bi-weekly chemotherapy. Immediately following their first day of chemotherapy cycle, participants wore a water-resistant pendant sensor for 14 days. This device tracked frailty markers like cadence (slowness), daily steps (inactivity), postural transitions (weakness), and metrics such as longest walk duration and energy expenditure (exhaustion). Participants were divided into resilient and non-resilient groups based on adverse events within 6 months post-chemotherapy, including dose reduction, treatment discontinuation, unplanned hospitalization, or death. A …

Surgical Outcome Of Postinfarction Left Ventricular Free Wall Rupture, Chan-Young Na

The Texas Heart Institute Journal

BACKGROUND: Left ventricular free wall rupture (LVFWR) is a rare and fatal complication after acute myocardial infarction. Early recognition and aggressive treatment are recommended.

METHODS: Between August 1999 and February 2023, 11 patients aged between 64 and 79 years developed LVFWR after acute myocardial infarction (mean interval, 3.5 days). Three patients had active bleeding (blowout-type LVFWR), and the other 8 patients experienced the oozing or sealed state. Eight patients were treated using a sutureless technique with Teflon felt and glue, 2 patients were treated using the primary suture closure technique, and 1 was treated using both the primary suture and …

Ogilvie's Syndrome: Acute Colonic Pseudoobstruction. A Review For Residents., Tyler Bayliss, Caleb Clark, Errington C. Thompson

Marshall Journal of Medicine

Ogilvie's syndrome (acute colonic pseudoobstruction) was first described in 1948. Acute colonic pseudoobstruction can occur in a variety of clinical settings, including postsurgical, obstetrics, pelvic surgery, critical care and sepsis. Clinicians need to recognize the syndrome early. Colonic distention without evidence of obstruction can be seen on plain films of the abdomen or CT scan. Successful therapies, including bowel rest, neostigmine and colonoscopic decompression, have been used. Avoiding respiratory compromise from abdominal distention and colonic perforation of the primary goals of treatment. Surgical intervention should be reserved for patients who are refractory to medical treatment or develops signs and symptoms …

Overcoming Communication Challenges: Training Family Medicine Interns Amidst Covid-19, Ny'nika T. Mcfadden, Connie C. Leeper, Catanya G. Stager, Amanda H. Wilkerson

Marshall Journal of Medicine

Introduction

Assessing and addressing possible deficiencies in medical school training is important for residency programs. Due to virtual rotations and low patient volumes, the COVID-19 pandemic disrupted medical students’ opportunities to practice patient communication. Communication skills are essential for medical students and residents. Continuous participation in communication training can increase the self-efficacy of healthcare professionals. Due to the likely impact of COVID-19, we designed and implemented a tailored workshop that focused on increasing 16 incoming family medicine interns’ level of comfort communicating with patients and their families.

Methods

Sixteen incoming family medicine interns participated in the workshop during orientation in …

A Case Of Occlusive Myocardial Infarction Caused By Nephrotic Syndrome In A 26-Year-Old Type 1 Diabetic, Kyle Admire, Charlotta Jornlid, Chelsea Ryan, Rebecca Pauly

Marshall Journal of Medicine

Nephrotic syndrome is a rare condition distinguished by proteinuria exceeding 3g per day. Other associated characteristics include hematuria, hypoalbuminemia, edema, and hyperlipidemia. There is an array of complications of this syndrome, which are primarily due to the profound losses of protein in the urine. One such complication is thromboembolism, with most documented cases in the form of venous thromboembolism of the extremities which is in part due to urinary loss of antithrombin III and increased synthesis of prothrombotic factors. There are limited available data regarding arterial thrombi and especially few reports about coronary thromboses, which can be life-threatening. In this …

Management Of Cryptogenic Stroke Secondary To Large Asd With Percutaneous Occluder Device And Antiplatelet Drugs, Riya Gupta, Naveed Iqbal

Marshall Journal of Medicine

Atrial septal defects (ASD) represent the most common congenital heart disease diagnosed in adult population and can present with variable clinical findings. Recent literature emphasizes the importance of management of ASD especially if it is associated with structural right heart changes such as RV dysfunction, right ventricular enlargement, arrythmias or paradoxical embolism.

The decision between medical therapy versus surgical closure of ASD is a common clinical conundrum especially in the setting of cryptogenic stroke.

More Physicians Alone Won’T Solve Rural America’S Health Care Problems, Atul Grover

Marshall Journal of Medicine

Policymakers have voiced their hope that locating family doctors and other primary care physicians within rural communities would, by itself, improve the health status of rural residents. However, access does not necessarily translate to better health. Rural populations face disproportionately worse health outcomes and inequities compared to urban populations. To improve the health care of rural America, it is critical to define—and periodically reassess—the problem and identify varying targeted policies.

Ultrasound – An Underutilized Diagnostic Tool For Ventricular Assist Device Driveline Infections, Kristina Krzelj, Tomislav Tokic, Tomislav Kopjar, Maja Cikes, Davor Milicic, Hrvoje Gasparovic

The VAD Journal

Patients with ventricular assist device (VAD) driveline infections (DLI) have reduced quality of life and increased risk of severe complications, such as sepsis, hemorrhagic or ischemic stroke, and wound infections. The management of VAD patients imposes a significant financial burden due to prolonged in-hospital stays, frequent re-admissions, expensive diagnostics, and the need for antibiotic therapy and/or surgical intervention. There is considerable room for improvement in DLI management, particularly in the early detection and treatment stages. Ultrasound, an easily applicable device available in almost every hospital, offers an unrecognized potential for the early detection of DLI. By increasing awareness about the …

La Incidencia Y El Tratamiento De Las Hernias En Ecuador En Comparación Con Los Estados Unidos Y Otros Países Del Mundo, Caleb Smith

NEXUS: The Liberty Journal of Interdisciplinary Studies

No abstract provided.

Bioethics Of Human Cloning: Are We Playing God?, Caleb Smith, Mary Katherine Flage

NEXUS: The Liberty Journal of Interdisciplinary Studies

No abstract provided.

Women’S Comfort With Mobile Applications For Menstrual Cycle Self-Monitoring Following The Overturning Of Roe V. Wade, Gabrielle M. Salvatore, Iris Bercovitz, Danielle Arigo

College of Science & Mathematics Departmental Research

Background: The overturning of Roe v. Wade in June 2022 has many implications for American women of reproductive age, as well as for researchers focused on women’s health in the United States (U.S.). Personal reproductive health data, such as information collected by menstrual cycle (MC) tracking applications (apps), can now be bought, sold, or accessed by law enforcement to enforce limits on abortion. American women have grown concerned about data privacy and have even deleted MC tracking apps following the overturning of Roe v. Wade. This concern is problematic as these apps may advance our understanding of women’s MC experiences …

An Investigation Of The Relationship Between Adverse Childhood Experiences And Women’S Mental Health, Dr. Mercedes Zubieta Richmond

Walden Dissertations and Doctoral Studies

No abstract provided.

Harnessing The Power Of Psychological Hardiness Among Adolescents: A Concept Paper, Preejana Sharma Ms, Linu Sara George Dr, Shweta Rai Dr, Tessy Treesa Jose Dr

Manipal Journal of Nursing and Health Sciences

During adolescence, developing psychological hardiness is crucial because it influences individuals’ response to pressure and helps them become more adaptable and resilient in dealing with challenging and uncertain situations. It is essential for adolescents to learn how to regulate their emotions, particularly intense emotions such as stress, anger, and anxiety, as it significantly impacts their overall well-being. In this paper, we delve into the multifaceted nature of psychological hardiness and explore its implications for personal growth and well-being. Psychological hardiness is an indispensable part of adolescent life because it helps regulate emotions and general health, enabling adolescents to cope with …

Prognostic Properties Of Kras Gene Mutation Subtypes In Resected Pancreatic Cancer, Faria Nusrat, Eliyahu Gorgov, Md, Wilbur Bowne, Md, Obehioye Isesele, Akshay Khanna, Harish Lavu, Md, Aditi Jain, Phd, Charles J. Yeo, Md, Avinoam Nevler, Md

Alpha Omega Alpha Research Symposium Posters

Introduction

• Pancreatic ductal adenocarcinoma (PDAC) is an aggressive and therapy-resistant cancer with an overall 5-year survival rate of almost 12%, making it among the most lethal of all major cancers.¹
• PDAC has a distinct genomic profile, with somatic KRAS protooncogene mutations in ~90% of cases.^2,3
• Current literature has not reached a consensus on disease prognosis based on KRAS mutation subtype.^2-5

The Influence Of The Green Hospital Implementation Policy On The Energy Saving Behavior Of Xyz Hospital Employees Using The Theory Of Planned Behavior Approach, Dika Asmawati, Wiku Bakti Bawono Adisasmito, Masyitoh Basabih

Journal of Indonesian Health Policy and Administration

This research uses the Theory of Planned Behavior as the theoretical framework to analyze the relationship between the implementation of green hospital policy and energy-saving behaviors of employees in the hospital environment. The study's sample consists of 150 permanent employees, and the statistical data are analyzed using the Structural Equation ModelingPartial Least Square (SEM-PLS) technique. The analysis results indicate that implementing the green hospital policy influences the supportive factors of behavior: attitudes, subjective norms, and perceived behavioral control. However, the tests also reveal that subjective norms do not positively correlate with the energy-saving behaviors of employees at the hospital. The …

Device-Assisted Enteroscopy In The Surveillance Of Intestinal Hamartomas In Peutz-Jeghers Syndrome, Omar Wahid Mohamed Elfeky, Suraj Panjwani, David Cave, Daniel Wild, Daniel Raines

School of Medicine Faculty Publications

Background: PJS is an autosomal dominant, genetic disorder characterized by the formation of hamartomatous polyps in the gastrointestinal tract. These polyps result in significant morbidity due to adverse events including intestinal obstruction, bleeding, and malignancy. The aim of this study was to describe the role of DAE in monitoring and prophylactic polypectomy within the small bowel. Methods: Electronic medical records were surveyed to identify all DAE procedures performed in patients with PJS within three U.S. referral centers between Jan 1st 2007 and January 1st 2020. Individual charts were reviewed to collect and analyze specific data points. Primary end points included …

Cardiometabolic Health: Actionable Prevention Strategies And New Care Models, Omar Leonards, David Aguilar

School of Medicine Faculty Publications

No abstract provided.

Clinical Practice Guideline-Inconsistent Management Of Fever And Neutropenia In Pediatric Oncology: A Children's Oncology Group Study, L. Lee Dupuis, Brian T. Fisher, A. J. Sugalski, Allison Caren Grimes, Michelle Nuño, S. Ramakrishnan, M. P. Beauchemin, Paula D. Robinson, Nancy Santesso, Alexandra Walsh, A. R. Wrightson, Lolie Yu, Susan K. Parsons, Lillian Sung

School of Medicine Faculty Publications

Background: The primary objective was to measure the proportion of episodes where care delivery was inconsistent with selected recommendations of a clinical practice guideline (CPG) on fever and neutropenia (FN) management. The influence of site size on CPG-inconsistent care delivery, and association between patient outcomes and CPG-inconsistent care were described. Methods: This retrospective, multicenter study included patients less than 21 years old with cancer who were at high risk of poor FN outcomes and were previously enrolled to a Children's Oncology Group (COG) study at participating National Cancer Institute Community Oncology Research Program (NCORP) institutions from January 2014 through December …

"Unveiling Predatory Publication: Safeguarding The Integrity Of Nurse Researchers", Remya U R, Mamatha Shivananda Pai, Baby S Nayak

Manipal Journal of Nursing and Health Sciences

No abstract provided.

Coping Strategies During The Covid-19 Pandemic Among The Undergraduate Nursing Students Attending Virtual Classes In Selected Nursing Institutions Of Udupi Taluk, Karnataka., Rohan Shettigar Mr, Karthik Gavalkar Mr, Jeeshpa Karkera Ms, Pooja P Ms, Swathi Shenoy Ms, Pratibha Kamath, Radhika R. R Pai Dr

Manipal Journal of Nursing and Health Sciences

Introduction

Psychological and sociocognitive behavior changes will occur during the Covid-19 pandemic, especially concerning students’ academic activities, which might impact one's health and well-being. As a result of this, it could result in dysfunctional behaviors and unhealthy lifestyles, which may indicate a shift in well-being that calls for quick attention and intervention.

Methods

A descriptive survey design was adopted for the present study to identify the coping strategies adopted by nursing students during COVID-19. The study was conducted among 60 fourth-year B.Sc. Nursing students using the purposive sampling technique. The data was collected using structured questionnaires on coping strategies adopted …

A Study To Assess The Effect Of Back Massage On Amount Of Breast Milk Among Mothers Of Neonates Admitted In Nicu At A Selected Hospital, Calicut., Aswathi A, Soya K

Manipal Journal of Nursing and Health Sciences

Abstract

Breastfeeding is one of the most natural act and intimate human interaction. Separation of mother and baby after birth creates an interruption in maintaining lactation. The main objective of this study was to identify the effect of back massage on amount of breast milk among mothers of neonates admitted in NICU. An experimental pretest-posttest control group design was adopted. The tools used were baseline proforma, calibrated breastmilk measuring cup and breast milk volume diary. Subjects were selected using consecutive sampling and allocated as 30 in each group. As first step baseline data were collected. Then the amount of expressed …

Modified Himawari Technique For Comminuted Patella Fractures: A Case Report - An Economically Yet Rigidly Efficient Option, Leong Li Theng Dr, Eyrique Goh Boay Heong Dr

Manipal Journal of Nursing and Health Sciences

Comminuted patella fracture is a tricky and complicated case to manage and yet a common fracture. It’s often complicated with post operative pseudoarthrosis, malunion, poor rehabilitation and reduced knee range of motion. Tension band wiring, Cerclarge wiring and screw fixation are the common surgical modalities however it’s unable to hold peripherally scattered fragments in place rigidly. It is often associated with failure osteosynthesis, fracture displacement, resulting in post op osteoarthritis. Here we demonstrate a case of a modification of the original Himawari Technique as a much cost-effective method compared to the original, while being a superior treatment option with good …

Impaired Neutrophil Extracellular Trap-Forming Capacity Contributes To Susceptibility To Chronic Vaginitis In A Mouse Model Of Vulvovaginal Candidiasis, Junko Yano, Paul L. Fidel

School of Dentistry Faculty Publications

Vulvovaginal candidiasis (VVC), caused by is characterized by aberrant inflammation by polymorphonuclear neutrophils (PMNs) in the vaginal lumen. Data from the established murine model shows that despite potent antifungal properties, PMNs fail to clear due to local heparan sulfate that inhibits the interaction between PMNs and , resulting in chronic vaginal immunopathology. To understand the role of neutrophil extracellular traps (NETs) in defense against at the vaginal mucosa, we investigated the NET-forming capacity of PMNs in chronic VVC-susceptible (CVVC-S/C3H) and -resistant (CVVC-R/CD-1) mouse strains. Immunofluorescence revealed the formation of NETs (release of DNA with PMN-derived antimicrobial proteins) in PMN cocultures …

Selective Neural Inhibition Via Photobiomodulation Alleviates Behavioral Hypersensitivity Associated With Small Sensory Fiber Activation, Andrew Buzza, Kalista Tapas, Junqi Zhuo, Stephen J. Lewis, Michael W. Jenkins, Michael Moffitt

Faculty Scholarship

Objective: Photobiomodulation at higher irradiances has great potential as a pain-alleviating method that selectively inhibits small diameter nerve fibers and corresponding sensory experiences, such as nociception and heat sensation. The longevity and magnitude of these effects as a function of laser irradiation parameters at the nerve was explored. Methods: In a rodent chronic pain model (spared nerve injury—SNI), light was applied directly at the sural nerve with four delivery schemes: two irradiance levels (7.64 and 2.55 W/cm2) for two durations each, corresponding to either 4.8 or 14.4 J total energy, and the effect on sensory hypersensitivities was evaluated. Results: At …

Autophagy And Cell Wall Integrity Pathways Coordinately Regulate The Development And Pathogenicity Through Moatg4 Phosphorylation In Magnaporthe Oryzae, Pusheng Guo, Yurong Wang, Jiayun Xu, Zhixiang Yang, Ziqi Zhang, Jinyi Qian, Jiexiong Hu, Ziyi Yin, Leiyun Yang, Muxing Liu, Xinyu Liu, Gang Li, Haifeng Zhang, Ryan Rumsey, Ping Wang, Zhengguang Zhang

School of Medicine Faculty Publications

Autophagy and Cell wall integrity (CWI) signaling are critical stress-responsive processes during fungal infection of host plants. In the rice blast fungus Magnaporthe oryzae, autophagy-related (ATG) proteins phosphorylate CWI kinases to regulate virulence; however, how autophagy interplays with CWI signaling to coordinate such regulation remains unknown. Here, we have identified the phosphorylation of ATG protein MoAtg4 as an important process in the coordination between autophagy and CWI in M. oryzae. The ATG kinase MoAtg1 phosphorylates MoAtg4 to inhibit the deconjugation and recycling of the key ATG protein MoAtg8. At the same time, MoMkk1, a core kinase of CWI, also phosphorylates …

Development Of A Culinary Medicine Toolkit To Improve Implementation Of Virtual Cooking Classes For Low-Income Adults With Type 2 Diabetes, David Ai, Natalia I Heredia, Vanessa Cruz, Diana C Guevara, Shreela V Sharma, Dolores Woods, Melisa Danho, John Wesley Mcwhorter

Faculty, Staff and Student Publications

Culinary medicine (CM) addresses diseases through nutrition and culinary education. To promote access to educational material for people with diabetes and engagement in virtual classes, we created a virtual culinary medicine toolkit (VCMT) sensitive to literacy levels and language preferences. The VCMT was developed to accompany existing virtual CM programs and help improve participant interaction and retention, offering educational materials for providers and participants. The provider VCMT offers level-setting education to reduce mixed nutrition messaging, including educational resources discussing inclusive nutrition and mindful eating topics. Each handout has a QR code and link to engaging, animated videos that provide further …

Association Between Regulatory T Cells And Ischemic Heart Disease: A Mendelian Randomization Study, Yucheng Hou, Ke Si, Jingyue Yang, Tan Liu, Basel Abdelazeem, Nonthikorn Theerasuwipakorn, Jingwei Zhao, Zhenya Shen

Faculty, Staff and Student Publications

BACKGROUND: An imbalance of innate and acquired immune responses is significantly involved in the pathophysiology of coronary atherosclerosis and the occurrence of ischemic heart disease (IHD). Regulatory T cells (Tregs) play an essential regulatory role in atherosclerotic plaque formation and maintenance; therefore, dysfunction of Tregs triggers the formation of atherosclerotic plaques and accelerates their progression. However, due to the inherent limitations of observational research, clinical evidence is limited concerning the relationship between the variation in peripheral Tregs and the risk of IHD, and the cause-and-effect relationship between these factors is unclear. Mendelian randomization (MR) uses genetic variation as a proxy …

A Study To Assess The Effectiveness Of Nurse-Led Rehabilitation Package On Knowledge And Skill Regarding Homecare Management Among Caregivers Of Neurosurgical Patients At Selected Hospital, Chennai., Arulmozhi Manavazhagan, Deepa M

Manipal Journal of Nursing and Health Sciences

Background: The neurosurgical patients require special care not only during the hospital stay but also in the home after discharge. Long-term care at home is provided by the caregivers of the patients at their home. Caregivers are referred to as “secondary patients,” who face lot of difficulties while they care for the neurosurgical patients at home.. Aim: The present study aims to assess the effectiveness of nurse-led rehabilitation package on knowledge and skill regarding homecare management among caregivers of neurosurgical patients at selected hospital, Chennai. Method: The research approach was quantitative in nature and Pre-experimental one group pre and post-test …

Awareness And Attitude Regarding Menstrual Cup Usage Among Nursing Students In Selected Areas Of Udupi District., Royden Gomes, Monica Dsouza, Neena Quadras, Wendy H. Sellate, Maria Pais, Ranjani P

Manipal Journal of Nursing and Health Sciences

Introduction

Menstruation is a complex, coordinated biological process that signals the start of a woman's reproductive life. Women and adolescent girls all across the world require menstrual hygiene management solutions that are safe, effective, and affordable. The market has a wide variety of alternatives, including sanitary napkins, tampons, menstrual cups, and more. Menstrual cups are one of the world's safest, most comfortable, environmentally friendly, and sustainable menstrual hygiene management options.

Methods

The current study used a descriptive survey methodology with a purposive sample to determine the awareness and attitude toward menstrual cup use among 60 nursing students. Structured questionnaires were …