Clinical Practice Guideline For Delirium Screening, Raji George

Walden Dissertations and Doctoral Studies

Summary This doctoral project developed a clinical practice guideline (CPG) to address the critical health issue of early identification of delirium among hospitalized high-risk patients. Hospital delirium is associated with prolonged hospital stay, increased nursing home or rehab use after hospitalization, and higher mortality. Evidence shows that systematic screening improves delirium identification among hospitalized high-risk adults. However, there was no clinical practice guideline for delirium screening at the project facility for high-risk, non-intensive care unit patients. Therefore, the practice-focused question for the project was, “Does the evidence support the development of a CPG for delirium screening in high-risk hospitalized patients …

Distinct Patterns Of Pv And Sst Gabaergic Neuronal Activity In The Basal Forebrain During Olfactory-Guided Behavior In Mice, Elizabeth H Moss, Evelyne K Tantry, Elaine Le, Pey-Shyuan Chin, Priscilla Ambrosi, Katie L Brandel-Ankrapp, Benjamin R Arenkiel

Duncan NRI Faculty and Staff Publications

Sensory perception relies on the flexible detection and interpretation of stimuli across variable contexts, conditions, and behavioral states. The basal forebrain (BF) is a hub for behavioral state regulation, supplying dense cholinergic and GABAergic projections to various brain regions involved in sensory processing. Of GABAergic neurons in the BF, parvalbumin (PV) and somatostatin (SST) subtypes serve opposing roles toward regulating behavioral states. To elucidate the role of BF circuits in sensory-guided behavior, we investigated GABAergic signaling dynamics during odor-guided decision-making in male and female mice. We used fiber photometry to record cell type-specific BF activity during an odor discrimination task …

Tumor Treating Fields Therapy In Platinum-Resistant Ovarian Cancer: Results Of The Engot-Ov50/Gog-3029/Innovate-3 Pivotal Phase 3 Randomized Study, Ignace Vergote, Premal H Thaker, Et Al.

2020-Current year OA Pubs

PURPOSE: Tumor Treating Fields (TTFields) are electric fields that disrupt processes critical for cancer cell viability and tumor progression. The pivotal, phase 3 ENGOT-ov50/GOG-3029/INNOVATE-3 study evaluated efficacy and safety of TTFields therapy with paclitaxel (PTX) vs PTX in patients with platinum-resistant ovarian cancer (PROC).

PATIENTS AND METHODS: Adult patients with PROC with ≤ 5 total prior lines of therapy (LOT), including ≤ 2 prior LOT for platinum-resistant disease, and ECOG PS of 0-1 were randomized 1:1 to receive TTFields (200 kHz; ≥ 18 h/day) + PTX (80 mg/m

RESULTS: Between March 2019 and November 2021, 558 patients (ECOG PS 0, …

Domain Communication In Bifunctional Proline Utilization A From Sinorhizobium Meliloti, Emma Bitterman

Honors Program: Senior Projects (Public)

The reduction potential of flavin bound to Sinorhizobium meliloti proline utilization A (SmPutA) is beneficial in providing vital information on enzyme activity and the active site environment. Flavin is crucial in biological metabolism such as aerobic respiration and other important processes like oxygen activation that are catalyzed by flavin-dependent enzymes. (4). In this study, we seek to determine whether the redox potential of SmPutA-bound flavin can be used to characterize potential long-distance communication and analyze the possibilities of inactivation reversibility. SmPutA is a large bifunctional enzyme that catalyzes the overall oxidation of proline to glutamate via two catalytic domains (1). …

Pmp2+ Schwann Cells Maintain The Survival Of Large-Caliber Motor Axons, Mikolaj M Kozlowski, Amy Strickland, Ana Morales Benitez, Robert E Schmidt, A Joseph Bloom, Jeffrey Milbrandt, Aaron Diantonio

2020-Current year OA Pubs

Neurodegenerative diseases of both the central and peripheral nervous system are characterized by selective neuronal vulnerability, i.e., pathology that affects particular types of neurons. While much of this cell type selectivity may be driven by intrinsic differences among the neuron subpopulations, neuron-extrinsic mechanisms such as the selective malfunction of glial support cells may also play a role. Recently, we identified a population of Schwann cells (SCs) expressing

Combined Targeting Of Glioblastoma Stem Cells Of Different Cellular States Disrupts Malignant Progression, Chenfei Lu, Tao Kang, Junxia Zhang, Kailin Yang, Yang Liu, Kefan Song, Qiankun Lin, Deobrat Dixit, Ryan C Gimple, Qian Zhang, Zhumei Shi, Xiao Fan, Qiulian Wu, Daqi Li, Danyang Shan, Jiancheng Gao, Danling Gu, Hao You, Yangqing Li, Junlei Yang, Linjie Zhao, Zhixin Qiu, Hui Yang, Ningwei Zhao, Wei Gao, Weiwei Tao, Yingmei Lu, Yun Chen, Jing Ji, Zhe Zhu, Chunsheng Kang, Jianghong Man, Sameer Agnihotri, Qianghu Wang, Fan Lin, Xu Qian, Stephen C Mack, Zhibin Hu, Chaojun Li, Michael D Taylor, Ning Liu, Nu Zhang, Ming Lu, Yongping You, Jeremy N Rich, Wei Zhang, Xiuxing Wang

Faculty, Staff and Students Publications

Glioblastoma (GBM) is the most lethal primary brain tumor with intra-tumoral hierarchy of glioblastoma stem cells (GSCs). The heterogeneity of GSCs within GBM inevitably leads to treatment resistance and tumor recurrence. Molecular mechanisms of different cellular state GSCs remain unclear. Here, we find that classical (CL) and mesenchymal (MES) GSCs are enriched in reactive immune region and high CL-MES signature informs poor prognosis in GBM. Through integrated analyses of GSCs RNA sequencing and single-cell RNA sequencing datasets, we identify specific GSCs targets, including MEOX2 for the CL GSCs and SRGN for the MES GSCs. MEOX2-NOTCH and SRGN-NFκB axes play important …

Β-Catenin Drives The Foxc2-Mediated Epithelial-Mesenchymal Transition And Acquisition Of Stem Cell Properties, Maria Castaneda, Petra Den Hollander, Steve Werden, Esmeralda Ramirez-Peña, Suhas V Vasaikar, Nick A Kuburich, Claire Gould, Rama Soundararajan, Sendurai A Mani

Faculty, Staff and Student Publications

Background: Aggressive forms of breast cancer, such as triple-negative breast cancer (TNBC), are associated with an increase in cancer cells that exhibit stem cell properties. The activation of the epithelial-mesenchymal transition (EMT) program, mediated by the transcription factor FOXC2, generates these stem-like cells. FOXC2 is linked to poor prognoses across various cancer types and is notably upregulated in TNBC, where it establishes and sustains these stem-like cells within the tumor population.

Methods: Here, we decode the pathways regulating FOXC2 activation using EMT-enriched cell line models. Stemness was assessed using mammosphere assays and mesenchymal markers by western blot. Expression …

Bh3 Mimetics Augment Cytotoxic T Cell Killing Of Acute Myeloid Leukemia Via Mitochondrial Apoptotic Mechanism, Kapil Saxena, Shao-Hsi Hung, Esther Ryu, Shailbala Singh, Qi Zhang Tatarata, Zhihong Zeng, Zhe Wang, Marina Y Konopleva, Cassian Yee

Faculty, Staff and Student Publications

Adoptive cell therapy (ACT) can address an unmet clinical need for patients with relapsed/refractory acute myeloid leukemia (AML), but its effect is often modest in the setting of high tumor burden. In this study, we postulated that strategies to lower the AML apoptotic threshold will augment T cell killing of AML cells. BH3 mimetics, such as venetoclax, are a clinically approved class of compounds that predispose cells to intrinsic apoptosis by inhibiting anti-apoptotic mitochondrial proteins. We explored the anti-leukemic efficacy of BH3 mimetics combined with WT1-specific CD8+ T cells on AML cell lines and primary samples from patients with a …

Connecting Disciplines: Dermatologists Discuss Skin Cancer Screening In Physical Therapy, Michael T. Robinson, Lindsay Gietzen

Pacific Journal of Health

Background: This study aims to explore dermatologists’ perspectives on the integration of skin cancer screening within physical therapy practice. The hypothesis is that insights from dermatologists can enhance the efficacy and accuracy of skin cancer screening by physical therapists (PTs), thereby improving early detection rates and patient outcomes. Methods: A total of five dermatologists participated in this study, each with between 5 and 18 years of experience and a diverse range of expert opinions and insights. This qualitative study utilized semi-structured interviews with participating dermatologists. The interview questions focused on their knowledge of skin cancer screening, perceptions of its implementation …

Controlled Substances: A Prescription For Risk Mitigation, Carrie Knaus

Lynchburg Journal of Medical Science

No abstract provided.

Health Literacy: Impact And Interventions, Elizabeth Simpson

Lynchburg Journal of Medical Science

The objectives of this paper are to examine the connection between health literacy level and patient outcome, identify contributing factors of low health literacy, and identify ways in which providers and health literacy programs can promote health literacy on an individual and community level. I conducted a literature search using PubMed and Google Scholar in order to lend evidence to these objectives.

The results demonstrated a clear correlation between low health literacy levels and poor patient outcomes. Low health literacy is also correlated with reduced medication adherence, improper use of medication, more emergency department visits, and unhealthy habits during pregnancy …

Polycystic Ovarian Syndrome: A Clinical Review, Amanda Nettles

Lynchburg Journal of Medical Science

Polycystic ovarian syndrome (PCOS) is a pervasive condition that affects women all over the world. It presents with a wide variety of symptoms like menstrual irregularity, hyperandrogenism, and polycystic ovarian morphology. Although generally considered to be solely a reproductive disorder, PCOS impacts metabolic, psychological, and cardiovascular health, and increases the risk for those diagnosed for other complications. Although PCOS is relatively common, it remains greatly misunderstood, which makes diagnosing the condition even more complex. Risk factors taken into consideration include genetics, environment, and lifestyle. The pathophysiology of PCOS focuses on dysfunction of the hypothalamic-pituitary-ovarian axis, insulin resistance, and inflammation. There …

Evolution Of Btk Inhibitors, Dena Mathew

Lynchburg Journal of Medical Science

The purpose of this clinical review evaluates the evolution of bruton’s tyrosine kinase (BTK) inhibitors in becoming the standard of care in treating chronic lymphocytic leukemia (CLL). The first-generation BTK inhibitor ibrutinib has demonstrated superior efficacy over traditional chemotherapy in several randomized clinical trials in terms of progression free survival (PFS). However, due to cardiovascular toxicities of atrial fibrillation (afib), hypertension (HTN), and bleeding, have led to drug discontinuation. Second-generation BTK inhibitors, acalabrutinib and zanubrutinib have demonstrated reduced rates in cardiovascular toxicities due to improved BTK receptor selectivity, as seen in three head-to-head ibrutinib clinical trials. The emergence of BTK …

Management Of Electrolyte Abnormalities In The Emergency Department, Todd W. Jones

Lynchburg Journal of Medical Science

The objective of this article review is to discuss standard treatment options and review emerging therapies for the more common electrolyte abnormalities. The number of emergency departments (ED) in the United States has declined over the past 15 years, which has created overcrowding. This makes it more difficult to prioritize patients based on severity. The importance of this topic is to assist providers in taking quick action on patients presenting with critical electrolyte levels in busy EDs. A literature search using PubMed from 2019 to 2024 identified numerous articles that supported the purpose. This review will discuss the various electrolyte …

Testosterone: The Forgotten Female Hormone, Katherine A. Horner Pa-C

Lynchburg Journal of Medical Science

ABSTRACT

The purpose of this article is to review the current and past use of testosterone as a replacement hormone for women in peri- and early postmenopause. Healthcare providers are often not educated about testosterone as a sex hormone with profound effects on the female body. Yet, clinicians who treat women in the 4th and 5th decades of life should be familiar with the function of testosterone, clinical symptoms associated with declining levels, women’s perceptions about peri- and postmenopause as well as side effects of testosterone, and the implications of its use as a replacement hormone on other body systems. …

Common Misconceptions In Hormone Therapy (Ht) Treatment In Menopause, Miranda Zuhlke

Lynchburg Journal of Medical Science

ABSTRACT
The purpose of this review is to address the misconceptions surrounding Hormone Therapy (HT) in menopause largely surrounding the findings from Women’s Health Initiative (WHI). The review explores the history of HT, the risks and benefits, along with current guidelines for HT and non-hormonal options. A comprehensive search was conducted using electronic databases focusing on the effect of HT on breast cancer, cardiovascular health, bone health, and quality of life. Studies that analyzed the implications from the WHI were included as well as the North American Menopause Society (NAMS) current recommendations and guidelines for treatment options in menopause. Findings …

Stop The Bleed! Acute Epistaxis Management, Christopher R. Cannell

Lynchburg Journal of Medical Science

Epistaxis, the most common Otolaryngology-related emergency, is responsible for one in 200 emergency department (ED) visits in the United States (US) and one-third of otolaryngology visits.^1,11 Up to 60% of the population will experience epistaxis during their lifetime, and 6% -10 % will require medical intervention.^2,3 Epistaxis occurs in children and adults and has a seasonal variation. Although 85% of nosebleeds are idiopathic, they are more frequent in those on supplemental oxygen, anticoagulation, antiplatelet therapy, and in those with other conditions that may predispose them to bleeding. Most clinicians will encounter patients with acute epistaxis; therefore, it is …

Screening For Prodromal Symptoms Of Schizophrenia In Primary Care Settings, Thomas S. Christy

Lynchburg Journal of Medical Science

Schizophrenia is a debilitating mental health disorder with severe and wide-ranging consequences. Early detection of prodromal symptoms (subtle warning signs preceding full-blown psychosis) can significantly improve patient outcomes. Primary care settings, where early intervention is typically most feasible, lack standardized tools to screen for prodromal symptoms of schizophrenia, however. This review examines existing psychosis screening questionnaires to determine their suitability for primary care use. In addition to highlighting the significant role of primary care providers in managing mental health conditions, this review outlines the challenges associated with recognizing early signs of schizophrenia, particularly in resource-limited settings, and therefore why utilizing …

Does Combining Methadone With Psychotropics Further Increase The Risk Of Qtc Prolongation? Considerations For Ekg Monitoring., Christine A. Rowland

Lynchburg Journal of Medical Science

Co-occurring mental health and substance use disorders affect millions of American adults, with opioid use disorder (OUD) being a significant concern. Methadone Maintenance Treatment (MMT) is widely used for OUD, but both methadone and several psychotropic medications increase the risk of QTc prolongation, a precursor to life-threatening arrhythmias such as Torsades de pointes (TdP). Despite the potential risks, there are no definitive guidelines for EKG monitoring in individuals prescribed both methadone and psychotropics, leaving clinicians with an ethical dilemma regarding treatment decisions. This article reviews recent literature on the risk factors for QTc prolongation, focusing on the combined impact of …

A Clinical Overview Of Endometriosis, Adriane Strawn

Lynchburg Journal of Medical Science

Endometriosis, the finding of endometrial tissue in areas of the body other than the interior of the uterus, affects about 10% of menstruating women worldwide and is a common reason for dysmenorrhea and infertility. The underlying pathophysiology is not fully known but thought to be mostly due to retrograde menstruation through the oviducts into the abdominopelvic cavity. Other major pathogenic theories include vascular and lymphatic spread and coelomic metaplasia. Patient symptoms may include dysmenorrhea, dyschezia, dyspareunia, pelvic pain, infertility, and fatigue, but patients can also be asymptomatic. Endometriosis is difficult to diagnose, and although it is possible to visualize certain …

Testosterone Replacement Therapy In The Middle-Aged Male, Gina N. Demilt

Lynchburg Journal of Medical Science

The purpose of this review was to investigate the use of testosterone supplementation in the middle-aged male with a focus on the pathophysiology of testosterone throughout the lifespan, current supplementation options and their adverse effects, and the overall benefit of supplementing to enhance quality of life. A comprehensive search of electronic databases was conducted identifying studies that assessed clinical outcomes, pathophysiology, supplementation options, adverse effects and benefits of treatments. The findings suggested that testosterone levels naturally decline with age with most men developing symptoms of hypogonadism around age 60. Testosterone supplementation outside of current guidelines is not recommended, however men …

Effective Interventions For Preventing Burnout In Health Education Students, Heidi Vonderheide

Lynchburg Journal of Medical Science

This article aims to investigate effective interventions to reduce burnout in health education students. A comprehensive electronic literature search of PubMed and Google Scholar identified articles discussing the prevalence and effects of burnout in health care providers and students, as well as interventions to reduce burnout and improve the quality of life of health education students. The findings suggest pass-fail grading, physical exercise, mindfulness training, and mental health programming significantly reduce burnout among health education students. Significant variability in both intervention design and outcome measurement highlights the limitations of the findings and underscores the need for future research. Effective burnout …

Optimizing Interventions For Major Depressive Disorder And Provider Burnout: Self-Speak Exercise Dosing (Sed), Laureen Maloney-Gepfert

Lynchburg Journal of Medical Science

ABSTRACT

Major Depressive Disorder (MDD) is ranked highest among mental illnesses in the United States (US) and significantly contributes to the mental health care crisis. Patients experience resistance to pharmacologic interventions, side effects, co-morbidities, and mental health provider shortages. Subsequently, 33 % of Serious Mental Illnesses (SMIs) are being redirected to Primary Care Providers (PCPs). Concurrently, prescriber mental health is in crisis. Growing workloads for physicians and Advanced Practice Providers (APPs) have increased provider burnout syndrome (BOS). Major Depressive Disorder and BOS are positively affected by exercise, Cognitive Restructuring (CR), and Behavioral Activation (BA). Sports medicine and psychology research shows …

Roadmap To Better Mental Health Care, James R. Kilgore, James C. Somers, Jenna Rolfs, Everett Allen, Tom Colletti, Blake Rogers, Maggie Banger, Nikoleta Delis, Debra S. Munsell Dhsc, Pa-C

Lynchburg Journal of Medical Science

This article will describe the current providers involved in delivering mental health services, the projected needs for mental health providers in the next decade, and interventional strategies that may enhance their delivery of care. By adopting comprehensive, patient-centered interdisciplinary strategies, and utilizing new and innovative tools and pharmaceutical agents healthcare providers can mitigate the adverse effects of lack of access and the delivery of mental health care.

Spirituality And Ptsd Outcomes Among Service Members And Military Veterans, Jennifer Urbina Dmsc, Pa-C

Lynchburg Journal of Medical Science

Post-traumatic stress disorder (PTSD) is a prevalent and debilitating condition among military service members and veterans, often co-occurring with moral injury (MI) and spiritual distress (SD). While conventional PTSD treatments include cognitive behavioral therapy (CBT), exposure-based therapies, and pharmacological interventions, growing evidence suggests that spirituality may play a vital role in improving PTSD outcomes. This paper explores the integration of spirituality in PTSD treatment, examining its potential to mitigate symptoms, enhance resilience, and facilitate post-traumatic growth. Military chaplaincy, spiritually integrated therapies, and Department of Defense (DoD) holistic health models provide frameworks for addressing the spiritual dimensions of PTSD. Studies indicate …

Image Quality Analysis Of Head Cts Obtained On A New Portable Scanner Compared To Stationary Ct, Mara M. Kunst, Juan E. Small, Sebastian E. Flacke, Joseph D. Burns, Maximilian Smith, Christoph D. Wald

The Lahey Journal

Background/Purpose: The use of mobile head CT scanning in the ICU setting has both clinical and economic advantages, particularly if able to provide image quality close or equal to fixed CT scanners.

The purpose of the study is to evaluate the image quality of a new portable CT scanner, compared to a fixed CT platform.

Materials/Methods: Inpatients (n=11), age> 60 requiring head CT evaluation were enrolled and consented to obtain an additional head CT on the portable CT, following their fixed exam.

Nine patients were able to complete the study; seven patients received duplicate exams with matched imaging technique, and …

Comparing Testosterone Suppression In Intramuscular And Subcutaneous Leuprolide Acetate Formulations, Annalise Mcdonald, Kali Sullivan, Cara Cloghessy, Benjamin Sweigart, Brendan J. Connell

The Lahey Journal

Introduction

Androgen deprivation therapy (ADT) is commonly used to treat prostate cancer. Leuprolide acetate (LA) is a common ADT, manufactured as an intramuscular injection, Lupron® (LA-IM), and a subcutaneous injection, Eligard® (LA-SC) with the goal of testosterone < 50 ng/dL. We investigated for differences in testosterone suppression between the two formulations in patients with prostate cancer.

Methods

Clinical data was abstracted from our medical records system for patients with prostate cancer who started leuprolide acetate between January 2016 through March 2022 with a subsequent testosterone value checked. Primary endpoint was the proportion of subjects with testosterone levels < 50mg/dL, with secondary endpoints including the proportion of subject achieving testosterone levels < 20ng/dL and median testosterone levels.

Results

525 subjects were included. The LA-IM and LA-SC groups were balanced for age and race but the doses of leuprolide differed …

Assessing The Impact Of Covid-19 Pandemic On Surgical Trends Of Ophthalmology Residents Graduating After 2020, Max Liu, Meghana Kalavar, Vamsee Vemulapalli, Mustapha Tahiru, Thuy Le, Andrew J. Hendershot

Journal of Academic Ophthalmology

Purpose: To examine the effects of the COVID-19 pandemic on surgical volumes of ophthalmology residents who completed training after 2020. Methods: Aggregated average case logs of primary surgeon and surgeon + assist (S+A) procedures for graduating ophthalmology residents in the U.S. between 2012 and 2023 were gathered from the Accreditation Council for Graduate Medical Education (ACGME). Trends for primary surgeon and S+A procedures were assessed. The annual percent change in primary surgeon and S+A procedures was determined using linear regression to compare changes over three time periods: 2012-2019, 2019- 2020, and 2020-2023. Results: Total cases as a primary surgeon and …

Cross-Sectional Analysis Of International Rotations Among Ophthalmology Residency Programs, Malcolm M Kates, Riley Ct Duke, Krupa H. Patel, Russell W Read

Journal of Academic Ophthalmology

Background: Applicants to ophthalmology residency programs have increasingly expressed interest in international surgical rotations. As such, ophthalmology residency program directors (PDs) have expanded international offerings to meet this desire but the true number of residency programs with international offerings is unknown. Methods: In February 2023, the official residency websites of all 125 accredited US-based ophthalmology residency programs were analyzed for any mention of international rotations. Websites were identified using a Google™ search by entering the program name and “ophthalmology residency.” All websites were surveyed for information regarding international rotations including the presence/absence of an international rotation and any additional information …

The Relationship Between Open Access Article Publishing And Short-Term Citations In Ophthalmology, Hassaam S Choudhry, Carter Burton, Luis Cupertino, Matthew Montani, Riya Patel, Sri Guttikonda, Albert S Khouri

Journal of Academic Ophthalmology

Purpose: In recent years academic journals have increasingly transitioned to a paid open access (OA) model. The present study aims to identify whether OA or subscription access (SA) influences short-term citations of articles in ophthalmology. Methods: The Dimensions database was queried in October 2022 for articles published in 2019 in the following journals with both open and subscription access options: Ophthalmology, American Journal of Ophthalmology, JAMA Ophthalmology, Graefe's Archive for Clinical and Experimental Ophthalmology, and British Journal of Ophthalmology. Article access, citations, country, article type (review, letter/viewpoint/comment, original investigation), study type (basic science/animal model, case report/series, clinical trial, NA, observational) …