Medicine and Health Sciences Commons^™

Tacrolimus As A Liver Flush Solution To Ameliorate The Effects Of Ischemia/Reperfusion Injury Following Liver Transplantation., Shawn D. St Peter, David J. Post, Manuel I. Rodriguez-Davalos, David D. Douglas, Adyr A. Moss, David C. Mulligan

Manuscripts, Articles, Book Chapters and Other Papers

The goal of this report is to evaluate in a prospective randomized fashion the effect of flushing hepatic allografts with tacrolimus before transplantation. A prospective, double-blinded, randomized trial was performed. Twenty patients receiving orthotopic liver transplants from October 2000 to October 2001 were randomized into two groups. Group 1 (active) was administered tacrolimus, 20 ng/mL, plus Plasma-lyte A (Baxter Healthcare Corp, Deerfield, IL) liver flush solution; and group 2 (placebo) was administered only Plasma-lyte A. Ischemia/reperfusion injury was assessed in both groups after transplantation by means of serum laboratory values to assess hepatocellular damage, synthetic function, and ion transport capacity. …

The Treatment Of Hypnotic Dependent Sleep Disorder: A Case Study, Theodore Cooper, K. Lichstein, N. Aguillard

Selected Works Temporary Series

No abstract provided.

The Effectiveness Of Heart Failure Disease Management: Initial Findings From A Comprehensive Program, Janice L. Clarke, David B. Nash

College of Population Health Faculty Papers

A prevalent, chronic condition among members of the mushrooming elderly population in the United States, heart failure (HF) is a logical focus for population-based disease management. Evidence supporting the premise that multidisciplinary interventions can significantly improve clinical outcomes while decreasing the cost of medical care for people with HF is steadily mounting. A growing number of controlled and observational studies focus on the effects of HF disease management on re-admission rates, length of stay, and improvement in appropriate diagnostic testing and prescribing. This paper describes a large-scale, comprehensive HF program and reports on clinical quality, utilization, and financial outcomes observed …

A Preliminary Study On The Reliability Of Physical Performance Measures In Older Day-Care Center Clients With Dementia., Vince Salazar Thomas, Patricia A. Hageman

Journal Articles: Physical Therapy

BACKGROUND: Decline in physical functional ability is an intrinsic component of the dementia syndrome. Reductions in muscle mass and strength represent a major factor in the loss of functional ability Although resistance exercise has been studied as a method for maintaining/recovering function in populations of frail older adults, people with dementia have been systematically excluded because of uncertainty about the reliability of outcome measurements.

OBJECTIVE: The purpose of this study was to determine the test-retest reliability of a battery of established performance-based measures of strength and function among subjects with dementia.

SETTING: A hospital-affiliated adult day-care facility.

SUBJECTS: Twelve of …

Circulating Testosterone And Prostate-Specific Antigen In Nipple Aspirate Fluid And Tissue Are Associated With Breast Cancer., Edward R Sauter, David S Tichansky, Inna Chervoneva, Eleftherios P Diamandis

Department of Surgery Faculty Papers

Preliminary evidence has associated testosterone and prostate-specific antigen (PSA) with breast cancer. Our objective was to determine whether a) testosterone levels in nipple aspirate fluid (NAF), serum, or breast tissue are associated with breast cancer; b) testosterone levels in serum are associated with levels in NAF; c) PSA in NAF, serum, or breast tissue is associated with breast cancer; and d) serum PSA is associated with NAF PSA levels. We obtained 342 NAF specimens from 171 women by means of a modified breast pump. Additionally, we collected 201 blood samples from 99 women and 51 tissue samples from 41 subjects …

Associations Between Water-Treatment Methods And Diarrhoea In Hiv-Positive Individuals, J. N. S. Eisenberg, T. J. Wade, A. Hubbard, D. I. Abrams, R. J. Leiser, S. Charles, M. Vu, S. Saha, C. C. Wright, Deborah A. Levy, P. Jensen, J. M. Colford

Journal Articles: Epidemiology

This manuscript extends our previously published work (based on data from one clinic) on the association between three drinking water-treatment modalities (boiling, filtering, and bottling) and diarrhoeal disease in HIV-positive persons by incorporating data from two additional clinics collected in the following year. We conducted a cross-sectional survey of drinking water patterns, medication usage, and episodes of diarrhoea among HIV-positive persons attending clinics associated with the San Francisco Community Consortium. We present combined results from our previously published work in one clinic (n = 226) with data from these two additional clinics (n = 458). In this combined analysis we …

Participant Blinding And Gastrointestinal Illness In A Randomized, Controlled Trial Of An In-Home Drinking Water Intervention, John M. Colford, Judy R. Rees, Timothy J. Wade, Asheena Khalakdina, Joan F. Hilton, Isaac J. Ergas, Susan Burns, Anne Benker, Catherine Ma, Cliff Bowen, Daniel C. Mills, Duc J. Vugia, Dennis D. Juranek, Deborah A. Levy

Journal Articles: Epidemiology

We conducted a randomized, triple-blinded home drinking water intervention trial to determine if a large study could be undertaken while successfully blinding participants. Households were randomized 50:50 to use externally identical active or sham treatment devices. We measured the effectiveness of blinding of participants by using a published blinding index in which values >0.5 indicate successful blinding. The principal health outcome measured was "highly credible gastrointestinal illness" (HCGI). Participants (n=236) from 77 households were successfully blinded to their treatment assignment. At the end of the study, the blinding index was 0.64 (95% confidence interval 0.51-0.78). There were 103 episodes of …

Nipple Aspirate Cytology And Pathologic Parameters Predict Residual Cancer And Nodal Involvement After Excisional Breast Biopsy., E R Sauter, H Ehya, A Mammen, G Klein

Department of Surgery Faculty Papers

We previously demonstrated that abnormal nipple aspirate fluid (NAF) cytology predicted residual breast cancer (RC) and tumour size after excisional biopsy (EB), although normal NAF cytology did not exclude RC. Tumour size correlates with the risk of lymph node (LN) metastases. LN metastases provide prognostic information allowing medical and radiation oncologists to determine the need for adjuvant therapy. We hypothesized that pathologic factors known after EB, combined with NAF cytology, would predict with a high degree of accuracy the presence of RC and LN spread. NAF cytology and pathologic parameters: tumour distance from biopsy margins, multifocal and multicentric disease, sub-type …

The Effects Of Line Dancing On Balance And Coordination In The Elderly, Sara Welder

Physical Therapy Scholarly Projects

The purpose of this study was to determine if a six-week line dancing program has a significant effect on balance and coordination in a geriatric population. If proven effective, line dancing can be added to the options available to physical therapists for balance and coordination training.

A total of 12 volunteer subjects participated in this study. They were separated into two groups, a control group (n = 6, 4 females and 2 males), and a dance group (n = 6, all female) according to participant's preference. Subjects were in good health, were high functioning , and were found to be …

The Effects Of Line Dancing On Balance And Coordination In The Elderly, Christa M. Stelmachuk

Physical Therapy Scholarly Projects

The purpose of this study was to determine if a six-week line dancing program has a significant effect on balance and coordination in a geriatric population. A total of 12 volunteer subjects participated in this study. They were separated into two groups, a control group (n = 6, 4 females and 2 males) and a dance group (n = 6, all female) according to participants' preference. Subjects were in good health, were high functioning, and were found to be at low risk for falls. Age of subjects ranged from 72 to 94 years, with a mean age of 85.67.

The …

Accessory Cell Defect In Unresponsiveness Of Neonates And Aged To Polysaccharide Vaccines., Subbarao Bondada, H Wu, D A Robertson, R L Chelvarajan

Microbiology, Immunology, and Molecular Genetics Faculty Publications

T independent antigens elicit antibody responses in the absence of carrier specific T helper cells but require signals from accessory cells (macrophages and dendritic cells) or specific cytokines. They are further subdivided into TI-1 and TI-2 categories based on the ability of TI-1 but not TI-2 antigens to elicit immune responses from neonates. Most bacterial polysaccharides including the pneumococcal polysaccharide vaccines belong to the TI-2 class. It is hypothesized that defects in accessory cell function play a critical role in the failure of neonates to respond to such TI-2 antigens. Immune responses to these TI-2 stimuli are also reduced in …

Associations Among Hospital Capacity, Utilization, And Mortality Of Us Medicare Beneficiaries, Controlling For Sociodemographic Factors., E. S. Fisher, J. E. Wennberg, T. A. Stukel, J. S. Skinner, S. M. Sharp

Dartmouth Scholarship

To explore whether geographic variations in Medicare hospital utilization rates are due to differences in local hospital capacity, after controlling for socioeconomic status and disease burden, and to determine whether greater hospital capacity is associated with lower Medicare mortality rates.

A Comparison Study Of Depression In The Elderly: Traveling South Versus Staying In The Midwest For The Winter, Sandra M. Zieffler

Physical Therapy Scholarly Projects

Depression is the primary mental health disorder in the elderly (people 65 years old and older). As the elderly are the fastest growing segment of the population in the United States, an increasing number of elders will be affected by this illness. The purpose of this study was to compare depression in the elderly between those who stay in the Midwest (Minnesota or North Dakota) year-round and those who travel south for all or part of the winter. A four-page self-administered questionnaire was distributed to 227 people thought to be at least 65 years old. The questionnaire consisted of background …

The Effect Of TʻAi Chi Chih On Balance In The Elderly, Justin Berry

Physical Therapy Scholarly Projects

Loss of balance and falls among the elderly is a large health care problem, annually causing thousands of injuries and millions of dollars in health care costs. This study investigates whether T'ai Chi Chih can influence balance in the elderly. T' ai Chi Chih is a gentle form of exercise that originated as a martial art.

Fifteen subjects (T'ai Chi Chih, n = 9; control, n = 6) initially underwent two standard functional balance measures (Berg and Tinetti measures), were tested for eyes open single leg stance, and had their blood pressure taken. Subjects were randomly assigned to either a …

Small Bowel Strangulation As Yet Another Complication Of The Rectus Abdominis Donor Site., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

Radiculopathy And Myelopathy At Segments Adjacent To The Site Of A Previous Anterior Cervical Arthrodesis., Alan S. Hilibrand, Gregory D. Carlson, M A Palumbo, P K Jones, H H Bohlman

Rothman Institute Papers

BACKGROUND: We studied the incidence, prevalence, and radiographic progression of symptomatic adjacent-segment disease, which we defined as the development of new radiculopathy or myelopathy referable to a motion segment adjacent to the site of a previous anterior arthrodesis of the cervical spine.

METHODS: A consecutive series of 374 patients who had a total of 409 anterior cervical arthrodeses for the treatment of cervical spondylosis with radiculopathy or myelopathy, or both, were followed for a maximum of twenty-one years after the operation. The annual incidence of symptomatic adjacent-segment disease was defined as the percentage of patients who had been disease-free at …

How Occupational Therapists Teach Older Patients To Use Bathing And Dressing Devices In Rehabilitation., Ruth Levine Schemm, Laura N. Gitlin

Department of Occupational Therapy Faculty Papers

OBJECTIVE: This article describes the methods occupational therapists use to teach bathing and dressing device use to older patients in rehabilitation programs. The relationship of three patient characteristics to five aspects of assistive device instruction was examined.

METHOD: The study sample included 86 patients and 19 occupational therapists who provided the assistive device training. Patients were 55 years of age or older and in rehabilitation for an orthopedic deficit, cerebrovascular accident, or lower limb amputation. Therapists recorded information on teaching methods, perceptions of patient knowledge, and expectations for future device use after each treatment session.

RESULTS: Patients received an average …

A Longitudinal Study Of Hospitalization Rates For Patients With Chronic Disease: Results From The Medical Outcomes Study., Eugene C. Nelson, Colleen A. Mchorney, Willard G. Manning, W H. Rogers

Dartmouth Scholarship

To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease. Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles.A four-year prospective study of resource utilization among 1,681 patients under treatment for hypertension, diabetes, myocardial infarction, or congestive heart failure in the practices of 367 clinicians.

The Effects Of Exercise On The Elderly Population: A Literature Review, Angela M. Thoreson

Physical Therapy Scholarly Projects

The population of those 65 years old or older has increased dramatically over the past several decades and will continue to grow well into the 21 st Century. This change in U.S. demography has also led to an increased interest in geriatric medicine and the implications physical activity has on the social, medical, and economical aspects of treating this patient population.

Research has shown that people who participate regularly in aerobic activity have lower mortality and morbidity rates, even if an exercise program is started later in life. Moderate exercise has been proven to be an important part of treatment …

Stent Placement Compared With Balloon Angioplasty For Obstructed Coronary Bypass Grafts. Saphenous Vein De Novo Trial Investigators., M P Savage, J S Douglas, D L Fischman, C J Pepine, S B King, J A Werner, S R Bailey, P A Overlie, S H Fenton, J A Brinker, M B Leon, S Goldberg

Department of Medicine Faculty Papers

BACKGROUND: Treatment of stenosis in saphenous-vein grafts after coronary-artery bypass surgery is a difficult challenge. The purpose of this study was to compare the effects of stent placement with those of balloon angioplasty on clinical and angiographic outcomes in patients with obstructive disease of saphenous-vein grafts.

METHODS: A total of 220 patients with new lesions in aortocoronary-venous bypass grafts were randomly assigned to placement of Palmaz-Schatz stents or standard balloon angioplasty. Coronary angiography was performed during the index procedure and six months later.

RESULTS: As compared with the patients assigned to angioplasty, those assigned to stenting had a higher rate …

Mirizzi Syndrome Type Ii: Is Laparoscopic Cholecystectomy Justified?, D C Desai, R D Smink

Department of Surgery Faculty Papers

Mirizzi syndrome type II is an uncommon cause of obstructive jaundice caused by an inflammatory response to an impacted gallstone in Hartmann's pouch or the cystic duct with a resultant cholecystocholedochal fistula. Two cases of Mirizzi syndrome type II are presented. Clinically only one patient had jaundice and endoscopic retrograde cholangiopancreatogram (ERCP) established a preoperative diagnosis of Mirizzi syndrome. The other patient's diagnosis of Mirizzi syndrome was made intraoperatively. It is important to properly identify the anatomy at the time of surgery to avoid compromising the common bile duct. Operative treatment of Mirizzi syndrome type II includes laparoscopic or open …

Where Do Elderly Veterans Obtain Care For Acute Myocardial Infarction: Department Of Veterans Affairs Or Medicare?, S M. Wright, J Daley, E S. Fisher, G E. Thibault

Dartmouth Scholarship

To examine Department of Veterans Affairs (VA) and Medicare hospitalizations for elderly veterans with acute myocardial infarction (AMI), their use of cardiac procedures in both systems, and patient mortality. DATA SOURCES: Merging of inpatient discharge abstracts obtained from VA Patient Treatment Files (PTF) and Medicare MedPAR Part A files. A retrospective cohort study of male veterans 65 years or older who were prior users of the VA medical system (veteran-users) and who were initially admitted to a VA or Medicare hospital with a primary diagnosis of AMI at some time from January 1, 1988 through December 31, 1990 (N = …

Environmental Illumination In Relation To Balance Performance In Healthy Community-Dwelling Elders, Laura Habermann

Physical Therapy Scholarly Projects

The purpose of this study was to determine the effects low levels of lighting have on balance in healthy, community dwelling elders. The balance of 14 volunteer subjects (13 females and 1 male) who are older than 65, who live in · the community and who are generally healthy was tested. Each subject's balance was tested in both optimal and poor lighting conditions using the functional reach balance assessment tool. Subjects were given two practice trials and were then instructed to reach three times in each condition while the researcher measured the amount of light in the room and the …

Lower Extremity Strength Training To Decrease Falls In The Elderly, Kelly L. Spadolini

Physical Therapy Scholarly Projects

p>As the elderly population grows, the health care needs of people over the age of sixty-five will dominate the medical profession. Methods of prevention of health problems are key to providing the optimal medical care. Falling has been reported as the most prevalent means of injury in older people. One third of all seniors living in the community and one half of those residing in nursing homes fall each year. Research indicates that elderly people who fall have weaker lower extremity strength than elderly people who do not fall. As a result, some clinicians have incorporated strengthening regiments into …

Computed Tomography In Staging Of Patients With Melanoma Metastatic To The Regional Nodes., T M Johnson, D J Fader, A E Chang, Alan M. Yahanda Md, Facs, J W Smith, K R Hamlet, V K Sondak

PCI Publications and Projects

BACKGROUND: This study addresses the yield and clinical impact of computed tomography (CT) imaging in otherwise asymptomatic patients with stage III melanoma metastatic to the regional nodes.

METHODS: The database from the University of Michigan Mutlidisciplinary Melanoma Clinic was reviewed and identified 127 asymptomatic patients with stage III melanoma (regional nodal disease) who received CT scans of the head, chest, abdomen, and/or pelvis. Scans were confirmed as true positive, false positive, and normal.

RESULTS: Four hundred twenty-six head and body CT scans were performed at the time of presentation of stage III disease. Twenty patients had a true-positive CT scan …

Physical Therapy Interventions For Falls In The Elderly, Melanie Benson

Physical Therapy Scholarly Projects

The elderly in America represent a population that is continually growing. As part of the aging process, various changes occur that contribute to falls. Therefore, as the number of elderly people in America increases, the possibility of falls in the elderly also increases.

The consequences of falls in the elderly are significant. Some of the more serious consequences include functional decline, increased medical cost, and death. Therefore, the scope of the problem is clear; strategies to prevent falls and treat those who have fallen are indicated.

The purpose of this independent study is to review the literature pertaining to falls …

Balance Exercise For Fall Prevention In The Elderly, Lorrina Mcclellan

Physical Therapy Scholarly Projects

Falls are a very common and serious problem in the elderly population. Individuals who fall may suffer from physical trauma, psychological problems, and possible death. In the past, falls were thought to be an unavoidable occurrence that accompanied aging. Research has .recently identified risk factors that may predict those who are at risk for falling. By recognizing and then modifying these risk factors, potential falls may be prevented. Examples of risk factors that occur with aging include visual impairments, vestibular decline, deterioration of muscle strength, decrease in joint flexibility, and the loss of sensation. Natural biological declines may have profound …

Polypharmacy And Physical Therapy In The Geriatric Population, Cathy A. Reuer

Physical Therapy Scholarly Projects

Physical therapists are seeing more and more elderly individuals with acute, chronic, or multiple disease conditions. Many of these conditions are treated with medications. It is common for the geriatric patient to be taking multiple medications. Polypharmacy is a relevant concern for physical therapists as adverse effects are often revealed in the musculoskeletal and central nervous systems. These manifestations can cause adverse effects in evaluation, treatment, and outcomes.

The purpose of this study is to discuss the common non-prescription and prescription medications consumed by the elderly, describe the biologic and physiologic changes that occur with age and how these changes …

Guidelines And Benefits For Exercising The Elderly, Nita Farbo

Physical Therapy Scholarly Projects

The population of elderly individuals is continually growing due to advancements in medicine and technology. Several physiological and psychological changes occur throughout the aging process. Regular physical activity is an effective therapy for slowing the aging process and preventing many of the conditions that occur with aging, such as hypertension, coronary artery disease, obesity, diabetes, depression, and anxiety. In addition, the active individual is more independent and functional in his or her activities of daily living compared to the person who remains sedentary. Older individuals who maintain functional levels of flexibility, strength, and cardiovascular endurance are rarely candidates for nursing …

Elevated Expression Of Type Vii Collagen In The Skin Of Patients With Systemic Sclerosis. Regulation By Transforming Growth Factor-Beta., Lidia Rudnicka, John Varga, Angela M. Christiano, Renato V. Iozzo, Sergio A. Jimenez, Jouni Uitto

Department of Dermatology and Cutaneous Biology Faculty Papers

A hallmark of systemic sclerosis (SSc) is the development of tissue fibrosis. Excessive production of several connective tissue components normally present in the dermis, including type I, III, V, and VI collagens as well as fibronectin and proteoglycans, is a consistent finding in the skin of SSc patients. Type VII collagen is a major constituent of anchoring fibrils, present in the skin at the dermal-epidermal basement membrane zone. TGF-beta has been shown to upregulate the expression of the type VII collagen gene. In this study, we assessed the expression of type VII collagen and TGF-beta in the skin of patients …