Medicine and Health Sciences Commons^™

Impact Of Peer Review In The Radiation Treatment Planning Process: Experience Of A Tertiary Care University Hospital In Pakistan, Bilal Mazhar Qureshi, Muhammad Atif Mansha, Muneeb Uddin Karim, Asim Hafiz, Nasir Ali, Benazir Mir, Fatima Shaukat, Maria Tariq, Ahmed Nadeem Abbasi

Department of Radiation Oncology

Purpose: To evaluate and report the frequency of changes in radiation therapy treatment plans after peer review in a simulation review meeting once a week.
Materials and Methods: Between July 1 and August 31, 2016, the radiation plans of 116 patients were discussed in departmental simulation review meetings. All plans were finalized by the primary radiation oncologist before presenting them in the meeting. A team of radiation oncologists reviewed each plan, and their suggestions were documented as no change, major change, minor change, or missing contour. Changes were further classified as changes in clinical target volume, treatment field, or dose. …

Reduced Gabaergic Signaling At The Axon Initial Segment Decreases Vigilance State Transitioning, Austin John Boren

UNLV Theses, Dissertations, Professional Papers, and Capstones

Sleep is a highly regulated homeostatic process that is disrupted in an estimated 50-70 million Americans. Regulation of sleep depends upon coordinated signaling of multiple neurotransmitter systems. In particular, inhibitory gamma-aminobutyric acid (GABA) signaling is required to suppress wake-active brain regions in order to initiate and maintain sleep states. GABA type A receptors (GABAARs) are ionotropic receptors with subunit compositions uniquely enriched on subcellular domains of target cells. α2 subunit-containing GABAARs are the primary target of GABA released onto the axon initial segment (AIS), a site critical for phasing the oscillatory activity of cortical cells. α2-containing GABAARs have previously been …

Comparison Of Ondansetron, Dexamethasone, And Its Combination In The Prevention Of Postoperative Nausea And Vomiting, Alina Palanchuk, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Postoperative nausea and vomiting remains a common and unpleasant side effect for patients following surgery. Uncontrolled PONV can result in prolonged hospital stays, unanticipated hospital readmissions, and decreased patient satisfaction. The Apfel score identifies and counts independent risk factors for PONV; females, non-smokers, postoperative opioid use, and history of PONV or motion sickness. Rates of PONV increases as the number of risk factors increase. The primary intervention to decrease PONV is administration of prophylactic antiemetics. Research supports the use of combination antiemetic therapy for patients with a high number of risk factors. The purpose of this evidence based practice …

Ultrasound Simulation For Regional Anesthesia, Kayla Brown, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Regional anesthesia is an essential skill in the practice of Nurse Anesthesia, and future employment demands expertise. Literature supports the addition of simulation training to existing didactic and apprenticeship education to improve clinical expertise. The purpose of this project was to trial simulation training, focused on anatomical visualization with ultrasound for regional anesthesia, as a means to improve student performance and confidence.

Methods • Facility project approval and exemption determination by IRB. • Hands-On Test: Ultrasound to obtain visualization for axillary (cohort 1), interscalene (cohort 2) block on live-model. Expert CRNA observed performance to determine if image was clinically …

Intraoperative Opioid Administration Among Cancer Patients, Amanda Barrett, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Cancer prevalence continues to rise. In vitro and in vivo studies have demonstrated that opioid receptor agonists may be associated with poor outcomes for cancer patients. Laboratory studies have shown that opioids cause immunosuppression; tumor cell progression, recurrence and metastasis. The surgical environment further decreases immune function, causes an inflammatory response and promotes cancer cell mobilization. Anesthesia providers are in a unique position to influence postoperative outcomes. Opioid free anesthetic delivery is a growing trend amongst anesthesia providers and is supported by the literature. The purpose of this project is to compare intraoperative opioid administration rates for patients with …

Effectiveness Of Educational Intervention On Diabetic Knowledge & Hba1c Levels On Kenyan Adults With T2dm, Sabina Jeruto Bett

Doctor of Nursing Practice Projects

Background

Type II diabetes mellitus (T2DM) is a common chronic metabolic disease affecting millions of people globally, which causes many long-term complications such as high blood pressure, chronic kidney disease, improper wound healing and loss of sight. Literature supports that most people, in general and diabetic patients specifically, in Africa, including Kenya are currently not taught about the importance of proper management of their disease. Therefore, many have difficulty following treatment plans, resulting in improper eating, poor glucose control, and diabetic complications. The limited knowledge concerning T2DM contributes to the negative impact this serious disease has on those who live …

To Extubate Or Not To Extubate: Risk Factors For Extubation Failure And Deterioration With Further Mechanical Ventilation, Jingui Xie, Guang Cheng, Zhichao Zheng, Haidong Luo, Oon Cheong Ooi

Research Collection Lee Kong Chian School Of Business

Background: Extubation is a critical step in the intensive care unit (ICU). In this study, we aim to investigate the risk factors for both extubation failure and deterioration with further mechanical ventilation (MV). Methods: Data were collected from a cardiothoracic ICU in a tertiary hospital. The risk factors for extubation failure and deterioration with further MV were investigated by multivariate logistic regression. Results: A total of 676 patients were enrolled in the study. Patients with extubation failure had a longer ICU length of stay and a higher mortality rate than patients without extubation failure. An age greater than 65 years, …

Preoccupation With Failure And Adherence To Shared Baselines: Measuring High-Reliability Organizational Culture, Jason M Etchegaray, Eric J Thomas, Jochen Profit

Faculty, Staff and Student Publications

OBJECTIVE: To create, administer, and psychometrically examine a survey to measure two new organizational culture factors - preoccupation with failure and adherence to shared baselines - in healthcare settings.

METHOD: Direct care providers (n = 4484) from a large healthcare system in the Southern United States completed a survey as part of their annual safety culture assessment.

RESULTS: We provide evidence about the internal consistency (Cronbach's alpha ranged from .80 to .89) factor structure, concurrent validity (correlation with overall patient safety grade ranged from .60 to .67, p

CONCLUSIONS: We established evidence for internal consistency and validity of two new …

The Society Of Abdominal Radiology At 10 Years: Reflections, Status Report, And Look To The Future, Manju Ambelil, David M Saulino, Atilla Ertan, Andrew W Dupont, Mamoun Younes

Faculty, Staff and Student Publications

CONTEXT.—: Recent studies examining immunohistochemical staining of colorectal biopsies for cytomegalovirus (CMV) reported that some cases showed only occasional small positive nuclei that were called equivocal for CMV.

OBJECTIVES.—: To determine the extent and clinical significance of equivocal CMV staining in colorectal biopsies.

DESIGN.—: Two-hundred twenty-one consecutive cases of colon and rectal biopsies that were stained for CMV by immunohistochemistry were retrieved from our files and reviewed. Staining results were recorded as negative, unequivocal, or equivocal. Results were correlated with clinicopathologic data, results of polymerase chain reaction studies for CMV, and treatment history.

RESULTS.—: Fifty-two cases (24% of all tested, …

Antimicrobial Sensitivity Pattern, Demographic Findings And Risk Factors Amongst Meningitis And Non-Meningitis Invasive Streptococcus Pneumoniae At Aga Khan University Hospital Clinical Laboratory, Karachi, Pakistan, Seema Irfan, Joveria Farooqi, Afia Zafar, Haresh Kumar

Department of Pathology and Laboratory Medicine

Objective: To determine the resistance rate of penicillin and ceftriaxone amongst invasive meningitis and nonmeningitis isolates of streptococcus pneumoniae. Methods: The prospective cross-sectional study was conducted from January 2011 to March 2014 at the Clinical Microbiology Laboratory of Aga Khan University, Karachi, and comprised all invasive strains of streptococcus pneumoniae. Penicillin and ceftriaxone susceptibilities were performed and interpreted based on minimum inhibitory concentration breakpoints recommended by Clinical and Laboratory Standards Institute guidelines. Data was analysed using Stata 12.
Result: There were 163 strains isolated from sterile body fluids of 109 patients. Of the total, 46(28%) samples were meningitic while 117(72%) …

Spectrum Of Neurological Disorders In Neurology Outpatients Clinics In Urban And Rural Sindh, Pakistan: A Cross Sectional Study, Safia Awan, Alam Ibrahim Siddiqi, Ahmed Asif, Naveeduddin Ahmed, Hazim Brohi, Sajad Jalban, Mohammad Wasay

Section of Neurology

Background: Neurological disorders are the most common cause of morbidity and mortality in developing countries. Available evidence on urban–rural differences on neurological diseases is scare in such countries. Our study objective was to determine the prevalence of neurological diseases in urban and rural tertiary care hospitals of Sindh, Pakistan.

Methods: This was a cross sectional study conducted in selected urban and rural region of tertiary care hospitals of Sindh, Pakistan. The outpatients medical records of adults (18 years and above) was obtained from January 1st, 2014 to December 31st, 2014.

Results: A total of 10,786 outpatients visit were recorded in …

Patient-Centered Design Grounded In User And Clinical Realities Towards Valid Digital Health, Victor P. Cornet, Carly Daley, Davide Bolchini, Tammy Toscos Phd, Michael Mirro Md, Richard J. Holden

Health Services and Informatics Research

Valid design of patient-centered digital health or health information technology (IT) systems is based on a thorough and accurate understanding of both “user reality” and “clinical reality.” Type 1 Design Error (User-Reality Error) occurs when designers do not accommodate user characteristics, tasks, context of use, needs, or preferences. Type 2 Design Error (Clinical-Reality Error) occurs when designers do not accommodate the clinical reality, including biomedical knowledge, clinical workflows, and organizational requirements. Both types of errors can invalidate the design, leading to products being rejected by patient end-users or their healthcare delivery systems, product non-use or inappropriate use, and risk of …

Visualization Of Cardiac Implantable Electronic Device Data For Older Adults Using Participatory Design., Ryan Ahmed, Tammy Toscos Phd, Romisa Rohani Ghahari, Richard J Holden, Elizabeth Martin, Shauna Wagner, Carly Daley, Amanda Coupe, Michael Mirro Md

Health Services and Informatics Research

Patients with heart failure (HF) are commonly implanted with cardiac resynchronization therapy (CRT) devices as part of their treatment. Presently, they cannot directly access the remote monitoring (RM) data generated from these devices, representing a missed opportunity for increased knowledge and engagement in care. However, electronic health data sharing can create information overload issues for both clinicians and patients, and some older patients may not be comfortable using the technology (i.e., computers and smartphones) necessary to access this data. To mitigate these problems, patients can be directly involved in the creation of data visualization tailored to their preferences and needs, …

Selection Biases In Technology-Based Intervention Research: Patients' Technology Use Relates To Both Demographic And Health-Related Inequities., Tammy Toscos Phd, Michelle Drouin, Jessica Pater, Mindy Flanagan, Rachel Pfafman, Michael Mirro Md, Facc, Fhrs, Faha

Health Services and Informatics Research

OBJECTIVE: Researchers conduct studies with selection biases, which may limit generalizability and outcomes of intervention research. In this methodological reflection, we examined demographic and health characteristics of implantable cardioverter defibrillator patients who were excluded from an informatics intervention due to lack of access to a computer and/or the internet.

MATERIALS AND METHODS: Using information gathered from surveys and electronic health records, we compared the intervention group to excluded patients on demographic factors, computer skills, patient activation, and medical history.

RESULTS: Excluded patients were older, less educated, less engaged and activated in their health, and had worse health (ie, more medical …

Health Coaching To Encourage Obese Adults To Enroll In Commercially-Available Weight Management Programs: The Path To Health Study, Natalia I Heredia, Minjae Lee, Kevin O Hwang, Belinda M Reininger, Maria E Fernandez, Lorna H Mcneill

Faculty, Staff and Student Publications

Physicians are recommended to screen and refer obese patients to weight management programs (WMPs). There are often limited referral options for physicians, though commercially-available WMPs could be a potential solution. The purpose of this study (Path to Health) was to evaluate the efficacy of health coaching to promote enrollment in commercially-available WMPs through a two-arm, RCT with obese patients (n = 168) randomly assigned to intervention (n = 84) or control groups (n = 84). Intervention participants received phone health coaching to help them select and enroll in WMPs. We collected data on program enrollment, weight, self-reported physical activity (PA), …

Knowledge Of Women Of Childbearing Age Regarding Preconception Counseling, Allison Britt, Shelby Jackson, Jessica Mcgee, Jenna Pugh

MSN Research Projects

The purpose of the current research study was to assess the knowledge of women of childbearing age regarding key components of preconception counseling and look at relationships between demographics and knowledge of preconception health care.

Compliance Of Primary Care Providers With Knee Osteoarthritis Guidelines, Komalben Desai, Catherine Elridge, Ashley Barber, Melissa Floyd

MSN Research Projects

The purpose of this study was to determine the compliance of primary care providers with AAOS guidelines of knee osteoarthritis (OA) and identify the most commonly used management options chosen by primary care providers for knee osteoarthritis.

Abnormal Involuntary Movement Scale In Tardive Dyskinesia: Minimal Clinically Important Difference, Martha Sajatovic

Faculty Scholarship

Background: A minimal clinically important difference has not been established for the Abnormal Involuntary Movement Scale in patients with tardive dyskinesia. Valbenazine is a vesicular monoamine transporter 2 inhibitor approved for the treatment of tardive dyskinesia in adults. Efficacy in randomized, double-blind, placebo-controlled trials was defined as the change from baseline in Abnormal Involuntary Movement Scale total score (sum of items 1-7). Objectives: To estimate an minimal clinically important difference for the Abnormal Involuntary Movement Scale using valbenazine trial data and an anchor-based method. Methods: Data were pooled from three 6-week double-blind, placebo-controlled trials: KINECT (NCT01688037), KINECT 2 (NCT01733121), and …

Generalized Anxiety Disorder: Management Practices Among Primary Care Providers In Northern Mississippi, Jennifer Bolen, Grace Henson, Sabrina Mcclain, Al Rayburn, Benjamin Spencer

MSN Research Projects

The purpose of this research was twofold. First, the research revealed the practices among primary care providers in northern Mississippi for treating GAD whether psychotherapy, pharmacological, or a combination. The specific modalities of psychotherapy and pharmacotherapy were listed. Second, the research revealed that these management practices are consistent with contemporary evidence-based research.

Are Health Care Providers Educating 1 Heir Patients On Proper Storage And Disposal Of Electronic Nicotine Devices?, Larisa Bell, Shada Breeze Chunn, Kaitlyn Smith, Tammy Steele

MSN Research Projects

The purpose of our research is to determine if healthcare providers are educating patients on the proper storage and disposal of electronic nicotine devices and the associated liquids.

Recombinant Zoster Vaccine (Shingrix) Knowledge And Practices Of Primary Care Providers In Mississippi, Leigh Gault, Casie Brown, Mackinzie Lee, Kimberly Word

MSN Research Projects

The purpose of this study was to determine Mississippi primary care providers' (PCP) knowledge and practices of the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) recommendations for administering the Shingrix vaccine to immunocompetent adults aged 50 years and older.

Comprehensive Staff Education And Implementation Of A Checklist Tool To Increase Staff Adherence To Pitocin Titration Protocols, Tara N. Cassell

Electronic Theses and Dissertations

This quality improvement project was designed to increase staff adherence to an existing Pitocin titration protocol used in a labor and delivery unit at a community hospital. In the current U.S. health care climate, safe patient care is paramount and the Institute for Safe Medication Practices identified Pitocin as a high-alert medication. Evidence-based practice recommends the use of a titration protocol to guide proper use of Pitocin. Prior research has shown improvements in patient outcomes when facilities implement Pitocin titration protocols, with staff adherence key to the successful implementation of evidence-based titration protocols, which may be improved with the use …

A Phenomenological Investigation Of Women’S Infertility And Miscarriage Grief Experiences, Tristan Mcbain

Dissertations

Infertility and miscarriage are reproductive losses that often produce grief reactions in affected women. This phenomenological study investigated the grief experiences of infertility and miscarriage through the ambiguous loss and disenfranchised grief frameworks in order to better understand both the obscurity of reproductive loss and how the resulting grief may be invalidated.

Sixteen women volunteered to participate in this study and each fell into one of the following three categories: women affected by infertility without miscarriage (4); women affected by miscarriage without infertility (4); and women affected by infertility and miscarriage (8). A phenomenological hermeneutic approach was utilized to uncover …

Tattoo Narratives And Counseling, Danny Lane Mccarty

Graduate Theses and Dissertations

Much research has been done on tattoos and on those who acquire them, but most of the research has focused on negative correlations that might exist with people who have tattoos. This current research, however, showed that people’s tattoo narratives can relate to how they view self, others, and the world, and to how they approach life. A narrative approach to qualitative research was used, and ten people participated in the study. Participants’ views of self, others, and the world were discussed as these views emerged from the narratives. Their possible approaches to life were also addressed. Themes that emerged …

Preliminary Outcomes, Acceptability, And Feasibility Of A Brief Crisis Response Planning Intervention For Reducing Suicide Risk In Primary Care Behavioral Health Patients, Aubrey R. Dueweke

Graduate Theses and Dissertations

Primary care is an important setting for improving identification and treatment of people at risk for suicide. However, there are few developed protocols for management of suicide risk in this setting. This study aimed to evaluate the preliminary outcomes, acceptability, and feasibility of a brief crisis response planning intervention for patients at a moderate risk for suicide in a primary care behavioral health (PCBH) setting. The outcomes examined included change in suicidal cognitions, suicidal intent, hope, and coping efficacy. Twenty-two adult primary care patients at moderate risk for suicide participated in this study, which involved filling out self-report measures before …

How Does Alcohol Intoxication Impair Risk Detection Of Sexual Assault? Testing An Integration Of Alcohol Myopia And Social Information Processing Theories, Alexander James Melkonian

Graduate Theses and Dissertations

Sexual assault among young adults is a highly prevalent public health concern. Alcohol is often implicated as a risk factor for sexual assault through its impairing effects on an individual’s ability to process and respond to social cues in the environment. The effect of alcohol myopia can result in greater focus of attention on salient environmental cues. The relationship between alcohol intoxication and resulting behavior may depend on what type of information is most salient. The current study examined the effects of alcohol on social information processing as it relates to sexual assault risk detection. Method: Participants were 48 young …

Prediction And Evaluation Of Breast Myopathy, Barbara De Almeida Mallmann

Graduate Theses and Dissertations

Broiler breast myopathies, including woody breast, white striping, and spaghetti breast, negatively impact the industry. Therefore, evaluation, prediction, and frequency of these muscle abnormalities on modern birds are important for decision making. Modern broilers are not highly active and often sit with the breast of the bird resting on the floor. Therefore, the first experiment was to promote bird movement and explore the impact on the breast myopathies. The movement was stimulated by human interaction (walking through pen) and higher light intensity so that birds walked around the pen more often throughout the day. The control group had normal low …

Dynamics Of Momentary Perceived Self-Regulation Abilities As Novel Predictors Of Overeating In Daily Life, Kayla Dawn Skinner

Graduate Theses and Dissertations

Despite an increase of research in the realm of overeating - a well-known contributor to obesity - the psychological mechanisms that maintain overeating behaviors across time and context are still poorly understood. It may be that people’s perceptions of their self-regulation abilities fluctuate over time, and overeating results from momentary increases in negative mood eliciting negative perceptions of their self-efficacy and current willpower, stronger beliefs that cravings can be controlled and a greater ability to tolerate distress. The current study examined the dynamics of and momentary predictors of overeating using a 7-day EMA protocol to study unsuccessful restrained eaters (n …

Implicit Bias And The Boundaries Of Belief: A Single-Representational Dual-Attitude Account Of Implicit Attitudes, Austin Dakota Synoground

Graduate Theses and Dissertations

Since their inception, implicit attitudes have been defined as associative mental states, separate from beliefs, which are considered to be propositional in nature. Recently, several philosophers have challenged this distinction, arguing that implicit attitudes are actually unconscious beliefs. In turn, I argue that the attitudes detected by current experimental paradigms are blind to distinctions between implicit attitudes, which I define as the products of an associative learning mechanism, and unconscious beliefs, which are the products of a propositional learning mechanism. Specifically, I argue for a single-representational dual-attitude account of implicit bias.

Influence Of Heating And Biological Sex On Vascular Dysfunction Associated With Long-Duration Sitting And Standing, Aaron Richard Caldwell

Graduate Theses and Dissertations

Purpose: The purpose of these studies was to determine if arterial angulations (through sitting or standing), shear stress (through local heating), or a combination of these factors affected vascular function. Moreover, this studied estimated the magnitude of the effect that biological sex has on these vascular responses. Methods: Twenty-six healthy, young (18-40 years old) males (n=13) and females (n=13) completed two experimental trials (2-h sitting and 2-h standing). In a randomized fashion, one leg was passively heated in order to increase shear rate. Following a 48-h washout, participants returned to the laboratory to complete the other trial. Flow-mediated dilation (FMD) …