Medical Specialties Commons^™

Is Oral Rivaroxaban Safe And Effective In The Treatment Of Patients With Symptomatic Dvt?, Ami A. Patel

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not oral rivaroxaban is safe and effective in the treatment of patients with symptomatic DVT.

STUDY DESIGN: Review of three English language primary randomized controlled trial studies published from 2007-2011.

DATA SOURCES: Three randomized controlled trials studying the effectiveness and safety of rivaroxaban in the treatment of patients with symptomatic DVT in comparison to enoxaparin and placebo.

OUTCOMES MEASURED: Outcomes measured were episodes of recurrent DVT and bleeding. Patients were monitored for the proposed treatment period and seen at fixed intervals that were matching …

Is Valdecoxib An Effective Treatment Option To Improve Pain In Adults With Diagnosed Osteoarthritis Of The Hip Or Knee?, Karen A. Mcsorley

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Valdecoxib is an effective treatment option to improve pain in adults with osteoarthritis of the hip or knee.

STUDY DESIGN: This review consists of three randomized control trials; two were published in 2002 and the third in 2006.

DATA SOURCES: Sources were studies comparing groups taking Valdecoxib 10mg QD to placebo, which were found via Pubmed, MEDLINE, Ovid, and Cochrane databases.

OUTCOMES MEASURED: The three articles measured various outcomes: pain improvement, stiffness, physical improvement, adverse effects, and onset of analgesia during acute pain …

Does Metformin Use During Pregnancy Effectively Reduce The Rate Of Early Pregnancy Loss In Women With Polycystic Ovary Syndrome?, Inna Prikhodko

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine “Does Metformin use during pregnancy effectively reduce the rate of early pregnancy loss in women with polycystic ovary syndrome?”

STUDY DESIGN: This review is based on two primary double-blind, randomized controlled trials and a prospective controlled trial that was not randomized or blinded to evaluate whether metformin, a medication used to manage PCOS, can also prevent early pregnancy loss in women with PCOS.

DATA SOURCES: All articles used were published in English, in peer-reviewed journals, and located through PubMed, OVID and COCHRANE databases..

OUTCOMES MEASURED: …

Is Electrical Muscle Stimulation Effective In The Progression Of Oral Feeding, For Patients With Dysphagia, Caused By A Stroke?, Kristen Iaconelli

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not electrical muscle stimulation is effective in the progression of oral feeding, for patients with dysphagia, caused by a stroke.

STUDY DESIGN: Review of 3 randomized controlled trials, published between 2008-2009.

DATA SOURCES: All 3 randomized controlled trials were found using the Cochrane database.

OUTCOMES MEASURED: All 3 studies measured subjective swallowing function pre- and post-treatment, however, each trial differed in the way they measured this. Permsirivanich et al used a functional oral intake scale (FOIS), or a 7-point scale reflecting the patient’s report of …

Are Sodium Alginate Solutions Effective In Reducing Postprandial Symptoms In Adults With Gastroesophageal Reflux?, Kristi L. Hackman

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not sodium alginate solutions are effective in reducing postprandial symptoms in adults with gastroesophageal reflux?

STUDY DESIGN: A review of three English language studies published from 2006-2011. Includes two randomized, double-blind, controlled trials and one controlled case series.

DATA SOURCES: Randomized, placebo-controlled studies evaluating the effectiveness and safety of sodium alginate solutions (Gaviscon) for managing gastroesophageal reflux disease (GERD) symptoms in adults were located using the PubMed, CINAHL, and Cochrane Library databases.

OUTCOMES MEASURED: The primary measures of effectiveness used were the Reflux Severity Index Questionnaire …

Does Daily Intake Of Glucosamine Supplements Prevent The Need For Knee Replacements Later In Life For Adult Patients Predisposed To Osteoarthritis?, Nancy Helmy

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not daily intake of glucosamine supplements prevents the need for knee replacements later in life for adults predisposed to osteoarthritis.

STUDY DESIGN: Review of three English language primary randomized controlled trial studies published between 2001 and 2008

DATA SOURCES: Three double blind randomized control trials comparing glucosamine supplements to placebo were found using PubMed.

OUTCOMES MEASURED: Outcomes were measured using radiographic studies of the knees, joint space measurements, and symptoms were evaluated using Lequesne and WOMAC indexes.

RESULTS: The Reginster (2001) and Pavelka (2002) studies demonstrated no …

Is The Use Of Honey An Effective Dressing Option For The Treatment Of Diabetic Foot Ulcers?, Michelle A. Wimmer

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine whether or not honey could be used as an effective topical treatment for diabetic foot ulcers in diabetic patients.

STUDY DESIGN: Review of three primary journal articles published in English between the years of 2008 and 2010.

DATA SOURCES: Two Randomized Controlled Trials comparing honey as a treatment for diabetic foot ulcers to either previous failed treatments or Povidone Iodine Solution, and a pilot prospective study, exploring the effectiveness of PEDYPHAR a royal jelly ointment. All articles were found using Pubmed, OVID and Cochrane Database.

OUTCOMES MEASURED …

Is Local Infiltration Analgesia (Lia) A Safe And Effective Method For Post-Operative Pain Management After A Unilateral Total Knee Arthroplasty (Tka)?, Brooke A. Bonnette

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine whether or not local infiltration analgesia (LIA) is a safe and effective method for post-operative pain management after a unilateral total knee arthroplasty (TKA).
STUDY DESIGN: Review of three English language primary studies published in 2010 and 2011.

DATA SOURCES: Three randomized controlled trials comparing local infiltration analgesia to three separate controls: epidural analgesia, placebo infiltration and femoral nerve block found using PubMed.

OUTCOMES MEASURED: Clinical outcome was measured by total morphine use postoperatively and average knee pain intensity at rest and upon movement postoperatively. Total morphine use …

What Is The Effectiveness Of Onabotulinumtoxina (Botox®) In Reducing The Number Of Chronic Migraines (Cm) In Patients 18-65 Years Old?, Kristin A. Beddingfield

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not onabotulinumtoxinA (Botox®) is effective in reducing the number of chronic migraines (CM) in patients 18-65 years old? Study Design: Review of three published, double blind randomized controlled trials were used for this review, which were found on PubMed; were selected based on their relevance to the clinical question and if they included patient oriented outcomes.

OUTCOMES MEASURED: The outcomes measured were headache/migraine free days measured by >50% responder rate analysis, the Treatment Responder Rate based on Physician Global Assessment, and total adverse events reported by …

Is Phlogenzym Effective In Reducing Moderate To Severe Osteoarthritis Pain In Adults?, Vanessa K. Wood

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Phlogenzym (or ERC) effective in reducing moderate to severe osteoarthritis pain in adults.

STUDY DESIGN: Review of three randomized controlled trials in the English language from 2001 to 2006.

DATA SOURCES: Two double blind RCTs and one open RCT was found using Cochrane Library EBM Online Database, Ovid Medline, and PubMed Online.

OUTCOMES MEASURED: Each of the three studies measured for pain at rest, pain with motion, and restricted function at baseline assessing efficacy using the Lequesne’s Algofunctional Index, visual analog scales, and …

Is High Dose Radioactive Iodine-131 More Effective Than Low Dose Iodine-131 In The Therapy Of Patients With Hyperthyroidism?, Tyler L. Warnecke

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not high dose radioactive iodine-131 is more effective than low dose iodine-131 in the therapy of patients with hyperthyroidism.

STUDY DESIGN: The review included three primary English language studies that were peer reviewed articles published in 2003, 2010 and 2011.

DATA SOURCES: This paper evaluates three randomized control trials (one prospective randomized and two comparative randomized) looking at the effectiveness of high dose and low dose radioactive iodine-131 for the treatment of hyperthyroidism.

OUTCOMES MEASURED: Each study examined patients being treated with high …

Is Transdermal Glyceryl Trinitrate A Safe And Effective Treatment For Primary Dysmenorrhea?, Sarah E. Visich

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective evidence based medicine review is to determine whether or not transdermal glyceryl trinitrate is a safe and effective treatment for primary dysmenorrhea.

STUDY DESIGN: Review of two English language randomized control trials (RCTs) published in 1996 and 1999 and one English language pilot study in 1997.

DATA SOURCES: Two double-blind, randomized, placebo-controlled cross-over studies and one pilot study comparing transdermal glyceryl trinitrate to placebo were found using PubMed, Medline and OVID.

OUTCOME MEASURED: Outcomes measured were based on pain intensity scores (PID) assessed on a visual analog scale and the …

Does Etravirine Decrease Central Nervous System (Cns)/Neuropsychiatric (Nps) Adverse Events Compared To Efavirenz, In Hiv Positive Patients?, Angelo D. T. Smith

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Etravirine (ETR) decreases adverse reactions on the central nervous system (CNS) compared to Efavirenz (EFV) in Human Immunodeficiency Virus (HIV) positive patients.

STUDY DESIGN: Review of three, English language, primary randomized controlled trial studies published in 2011.

DATA SOURCES: Three randomized controlled trials studying the possible decrease of ADR’s in HIV positive patients who are taking Efavirenz compared to study medication Etravirine.

OUTCOME(S) MEASURED: Outcomes measured were by surveys from patients that assess the development or cessation of CNS ADR’s. The self …

In Adults With Acute Diarrhea, Which Treatment Is More Effective Between Loperamide And Racecadotril?, Lorena A. Castillo

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine which treatment is more effective between loperamide and racecadotril to treat acute diarrhea in adults.

STUDY DESIGN: Review of three English language primary randomized controlled studies published from 1999-2005.

DATA SOURCES: First study was a RCT that was double blinded, double placebo, parallel study group and second and third study was RCT single blinded, comparative parallel group that all compared efficacy of loperamide and racecadotril. These were all found by using PubMed, COCHRANE and NCBI.

OUTCOMES MEASURED: Each of the studies measured the efficacy of each …

Mitochondrial Cardiomyopathy: Pathophysiology, Diagnosis, And Management, Deborah E Meyers, Haseeb Ilias Basha, Mary Kay Koenig

The Texas Heart Institute Journal

Mitochondrial disease is a heterogeneous group of multisystemic diseases that develop consequent to mutations in nuclear or mitochondrial DNA. The prevalence of inherited mitochondrial disease has been estimated to be greater than 1 in 5,000 births; however, the diagnosis and treatment of this disease are not taught in most adult-cardiology curricula. Because mitochondrial diseases often occur as a syndrome with resultant multiorgan dysfunction, they might not immediately appear to be specific to the cardiovascular system. Mitochondrial cardiomyopathy can be described as a myocardial condition characterized by abnormal heart-muscle structure, function, or both, secondary to genetic defects involving the mitochondrial respiratory …

Coronary Artery Diameter Related To Calcium Scores And Coronary Risk Factors As Measured With Multidetector Computed Tomography: A Substudy Of The Accuracy Trial, Yasmin S Hamirani, Khurram Nasir, Emil Avanes, Jigar Kadakia, Matthew J Budoff

The Texas Heart Institute Journal

Arterial remodeling, an early change of atherosclerosis, can cause dilated arterial diameter. We measured coronary artery diameter with use of noncontrast 64-slice multidetector computed tomography (MDCT), and studied its association with coronary artery calcium levels and traditional coronary risk factors.

We included 140 patients from the ACCURACY trial whose noncontrast MDCT images showed measurable coronary arteries. Using 3 measurements of left main coronary artery (LMCA) and right coronary artery (RCA) diameters within 3 mm of the ostium, we associated the results with traditional coronary risk factors and calcium scores.

The prevalence of LMCA and RCA calcium was 22% and 51%, …

Emerging Modifiable Risk Factors For Cardiovascular Disease In Women: Obesity, Physical Activity, And Sedentary Behavior, Ann Smith Barnes

The Texas Heart Institute Journal

No abstract provided.

Can The Bicuspid Aortic Valve Be Spared? The Con Position, With Caveats And Nuances, Joseph E Bavaria, Caroline M Komlo, Tyler Rhode, Prashanth Vallabhajosyula

The Texas Heart Institute Journal

No abstract provided.

Perventricular Device Closure Of Residual Muscular Ventricular Septal Defects After Repair Of Complex Congenital Heart Defects In Pediatric Patients, Da Zhu, Kaiyu Tao, Qi An, Shuhua Luo, Changping Gan, Ke Lin

The Texas Heart Institute Journal

Residual muscular ventricular septal defects are surgical challenges, especially after the repair of complex congenital heart defects. We investigated perventricular device closure as a salvage technique in pediatric patients who had postoperative residual muscular ventricular septal defects.

From February 2009 through June 2011, 14 pediatric patients at our hospital had residual muscular ventricular septal defects after undergoing surgical repair of complex congenital heart defects. Ten patients met our criteria for perventricular device closure of the residual defects: significant left-to-right shunting (Qp/Qs >1.5) or substantial hemodynamic instability (a defect ≥2 mm in size). The patients' mean age was 20.4 ± 13.5 …

Two Cases Of Bezold-Jarisch Reflex Induced By Intra-Arterial Nitroglycerin In Critical Left Main Coronary Artery Stenosis, Sachin P Shah, Sergio Waxman

The Texas Heart Institute Journal

The Bezold-Jarisch reflex, a well-described phenomenon, occurs upon the stimulation of intracardiac mechanoreceptors and is mediated by vagal afferent nerve fibers. Several factors can sensitize the cardiovascular system to develop this reflex, including acute myocardial ischemia, natriuretic peptides, and, rarely, nitroglycerin administration in the setting of acute myocardial infarction. The development of the Bezold-Jarisch reflex in the presence of severe coronary artery stenosis, specifically left main coronary artery stenosis, has not been described. We report 2 cases of patients who underwent elective coronary angiography and were given intra-arterial nitroglycerin during radial sheath insertion to reduce radial artery spasm. In both …

Feasibility Of Temporary Biventricular Pacing After Off-Pump Coronary Artery Bypass Grafting In Patients With Reduced Left Ventricular Function, Daniel Y Wang, Lauren A Kelly, Marc E Richmond, T Alexander Quinn, Bin Cheng, Michelle D Spotnitz, Santos E Cabreriza, Yoshifumi Naka, Allan S Stewart, Craig R Smith, Henry M Spotnitz

The Texas Heart Institute Journal

In selected patients undergoing cardiac surgery, our research group previously showed that optimized temporary biventricular pacing can increase cardiac output one hour after weaning from cardiopulmonary bypass. Whether pacing is effective after beating-heart surgery is unknown. Accordingly, in this study we examined the feasibility of temporary biventricular pacing after off-pump coronary artery bypass grafting.

The effects of optimized pacing on cardiac output were measured with an electromagnetic aortic flow probe at the conclusion of surgery in 5 patients with a preoperative mean left ventricular ejection fraction of 0.26 (range, 0.15–0.35). Atrioventricular (7) and interventricular (9) delay settings were optimized in …

Preoperative Statin Therapy In Cardiac Surgery Is More Effective In Patients Who Display Preoperative Activation Of The Inflammatory System, José Martínez-Comendador, José Rubio Alvarez, Juan Sierra, Elvis Teijeira, Belén Adrio

The Texas Heart Institute Journal

We sought to determine whether preoperative statin treatment is more effective in reducing, after cardiac surgery with cardiopulmonary bypass, systemic inflammatory response and myocardial damage markers in patients who have elevated preoperative interleukin-6 levels than in patients who have normal preoperative interleukin-6 levels.

The study involved a prospective cohort of 164 patients who underwent coronary and valvular surgery with cardiopulmonary bypass. There were 2 study groups: group A (n = 60), patients with elevated preoperative interleukin-6 levels; and group B (n = 104), patients with normal preoperative interleukin-6 levels. Each group was subdivided according to whether patients were (group 1) …

Components Of The Complete Blood Count As Risk Predictors For Coronary Heart Disease: In-Depth Review And Update, Mohammad Madjid, Omid Fatemi

The Texas Heart Institute Journal

Atherosclerosis is an inflammatory disease, and several inflammatory biomarkers, such as C-reactive protein, have been used to predict the risk of coronary heart disease. High white blood cell count is a strong and independent predictor of coronary risk in patients of both sexes, with and without coronary heart disease. A high number of white blood cells and their subtypes (for example, neutrophils, monocytes, lymphocytes, and eosinophils) are associated with the presence of coronary heart disease, peripheral arterial disease, and stroke. The coronary heart disease risk ratios associated with a high white blood cell count are comparable to those of other …

Surgical Pulmonary Embolectomy: The Resurrection Of An Almost Discarded Operation, Samuel Z Goldhaber

The Texas Heart Institute Journal

No abstract provided.

Inverted Takotsubo Cardiomyopathy And The Fundamental Diagnostic Role Of Echocardiography, Arantza Manzanal, Lara Ruiz, Jose Madrazo, Majesh Makan, Julio Perez

The Texas Heart Institute Journal

Takotsubo cardiomyopathy is characterized by the development of transient focal wall-motion abnormalities that involve the apical and midventricular segments, in the absence of obstructive coronary artery disease. A variant, inverted takotsubo cardiomyopathy, was described in 2010. We report 3 cases in which each patient's transthoracic echocardiogram revealed the characteristic basal and midventricular segmental akinesis of this variant. This pattern is not associated with coronary artery distribution, and it therefore can be differentiated from coronary artery disease with the use of echocardiography, by evaluating the distribution and temporal changes of akinetic areas.

Osteosarcoma Tumor Thrombus: A Case Report With A Review Of The Literature, Pournima Navalkele, Sarah M Jones, Jason K Jones, Jorge D Salazar, Patrick C Toy, Rathi V Iyer, Betty Herrington

The Texas Heart Institute Journal

Tumor thrombus arising from osteosarcoma is rare. We report the case of a 20-year-old man with proximal humerus osteosarcoma, accompanied by an extensive intravascular tumor thrombus extending into the heart. Our review of the literature found 14 previous reports on osteosarcoma with tumor thrombus. The combination of positron emission tomography and computed tomography is very useful in differentiating tumor thrombus from vascular thrombus, thereby avoiding unnecessary anticoagulation therapy. This same imaging combination can also be used to evaluate the response to treatment. Surgical resection of the tumor thrombus is highly recommended. The effect of tumor thrombus on survival is still …

Predicting Early Death After Cardiovascular Surgery By Using The Texas Heart Institute Risk Scoring Technique (Thirst), Saurabh Sanon, Vei-Vei Lee, Macarthur A Elayda, Sreedevi Gondi, James J Livesay, George J Reul, James M Wilson

The Texas Heart Institute Journal

Preoperative risk-prediction models are an important tool in contemporary surgical practice. We developed a risk-scoring technique for predicting in-hospital death for cardiovascular surgery patients. From our institutional database, we obtained data on 21,120 patients admitted from 1995 through 2007. The outcome of interest was early death (in-hospital or within 30 days of surgery). To identify mortality predictors, multivariate logistic regression was performed on data from 14,030 patients from 1995 through 2002 and risk scores were computed to stratify patients (low-, medium-, and high-risk). A recalibrated model was then created from the original risk scores and validated on data from 7,090 …

Endovascular Treatment Of Acute Type B Dissection Complicating Aortic Coarctation, Seyed Ebrahim Kassaian, Kyomars Abbasi, Mehdi Mousavi, Mohammad Sahebjam

The Texas Heart Institute Journal

Surgical treatment poses a high risk to patients with concomitant aortic coarctation and dissection, and an interventional approach could be an alternative. We describe the case of a 52-year-old man with a long history of untreated hypertension and aortic coarctation who emergently presented at our institution with an acute Stanford type B dissection. The patient's elevated serum creatinine level, perfusion deficit in the right lower limb, and hypertension did not respond to medical therapy, and he did not consent to surgery. By endovascular means, we used a self-expandable stent-graft to cover the entry point of the dissection; then, we deployed …

Preventing Sudden Cardiac Death In Athletes: In Search Of Evidence-Based, Cost-Effective Screening, Paolo Angelini, Mladen I Vidovich, Christine E Lawless, Macarthur A Elayda, J Alberto Lopez, Dwayne Wolf, James T Willerson

The Texas Heart Institute Journal

Sudden cardiac death in athletes is a recurrent phenomenon at sporting events and during training. Recent studies have associated sudden cardiac death with such cardiovascular conditions as coronary artery anomalies, cardiomyopathies, and electrocardiographic abnormalities, most of which are screenable with modern imaging techniques. We recently inaugurated the Center for Coronary Artery Anomalies at the Texas Heart Institute, which is dedicated to preventing sudden cardiac death in the young and investigating coronary artery anomalies. There, we are conducting 2 cross-sectional studies intended to firmly establish and quantify, in a large group of individuals from a general population, risk factors for sudden …

Preventing Deep Wound Infection After Coronary Artery Bypass Grafting: A Review, Charles S Bryan, William M Yarbrough

The Texas Heart Institute Journal

The consequences of deep wound infections before, during, and after coronary artery bypass grafting have prompted research to clarify risk factors and explore preventive measures to keep infection rates at an irreducible minimum. An analysis of 42 studies in which investigators used multivariate logistic regression analysis revealed that diabetes mellitus and obesity are by far the chief preoperative risk factors. A 4-point preoperative scoring system based on a patient's body mass index and the presence or absence of diabetes is one practical way to determine the risk of mediastinitis, and other risk-estimate methods are being refined. Intraoperative risk factors include …