Medical Specialties Commons^™

Metastatic Castration-Resistant Prostate Cancer: Critical Review Of Enzalutamide, Joelle El-Amm, Nihar Patel, Ashley Freeman, Jeanny B. Aragon-Ching

Medicine Faculty Publications

Enzalutamide, previously known as MDV300, is an oral, second-generation androgen receptor (AR) signaling inhibitor or antagonist that was approved by the Food and Drug Administration in 2012 for the treatment of metastatic castrate-resistant prostate cancer (mCRPC) postdocetaxel. Preclinical studies have demonstrated impressive affinity to the AR compared to the first-generation AR inhibitors. The landmark Phase III AFFIRM trial demonstrated improved overall survival benefit compared to placebo in addition to improvement in all tested parameters. Enzalutamide is currently being studied in several trials prechemotherapy and in earlier settings of prostate cancer. This review will discuss the mechanism of action of enzalutamide, …

Pediatric Palliative Care For Youth With Hiv/Aids: Systematic Review Of The Literature, Megan L. Wilkins, Ronald H. Dallas, Kathleen E. Fanone, Maureen E. Lyon

Pediatrics Faculty Publications

Improvement in treatment has led to decreased death in youth with human immunodeficiency virus (HIV) in developed countries. Despite this, youth with HIV are still at risk for increased mortality and morbidity compared with their uninfected counterparts. In developing countries, high numbers of youth die from acquired immune deficiency syndrome (AIDS)-related illnesses due to lack of access to consistent antiretroviral treatment. As a result, pediatric palliative care is a relevant topic for those providing care to youth with HIV. A systematic review was conducted to gather information regarding the status of the literature related to pediatric palliative care and medical …

Crystal Structure Of The N-Acetyltransferase Domain Of Human N-Acetyl-L-Glutamate Synthase In Complex With N-Acetyl-L-Glutamate Provides Insights Into Its Catalytic And Regulatory Mechanisms, Gengxiang Zhao, Zhongmin Jin, Norma M. Allewell, Mendel Tuchman, Dashuang Shi

Pediatrics Faculty Publications

N-acetylglutamate synthase (NAGS) catalyzes the conversion of AcCoA and L-glutamate to CoA and N-acetyl-L-glutamate (NAG), an obligate cofactor for carbamyl phosphate synthetase I (CPSI) in the urea cycle. NAGS deficiency results in elevated levels of plasma ammonia which is neurotoxic. We report herein the first crystal structure of human NAGS, that of the catalyticN-acetyltransferase (hNAT) domain with N-acetyl-L-glutamate bound at 2.1 Å resolution. Functional studies indicate that the hNAT domain retains catalytic activity in the absence of the amino acid kinase (AAK) domain. Instead, the major functions of the AAK domain appear to be providing …

Creation And Implementation Of An Emergency Medicine Education And Training Program In Turkey: An Effective Educational Intervention To Address The Practitioner Gap, Jennifer Whitfield Bellows, Katherine A. Douglass, Atilla Ridvan, Jeffrey Smith, G. Bobby Kapur

Emergency Medicine Faculty Publications

Background

The specialty of Emergency Medicine has enjoyed recognition for nearly 20 years in Turkey. However, the majority of underserved and rural Turkish emergency departments are staffed by general practitioners who lack formal training in the specialty and have few opportunities to increase emergency medicine-specific knowledge and skills.

Methods

To address this “practitioner gap,” the authors developed a four-phase comprehensive emergency medicine education and training program for general practitioners practicing in government hospitals in Turkey.

Results

From April 2006 until June 2009, 42 courses were taught by 62 trainers across seven regions in Turkey. A total of 2,262 physicians were …

A Synthetic Model Of Human Beta-Thalassemia Erythropoiesis Using Cd34+ Cells From Healthy Adult Donors, Y. Terry Lee, Ki-Soon Kim, Colleen Byrnes, Jaira F. De Vasconcellos, Seung-Jae Noh, Antoinette Rabel, Emily Riehm Meier, Jeffrey L. Meier

Pediatrics Faculty Publications

Based upon the lack of clinical samples available for research in many laboratories worldwide, a significant gap exists between basic and clinical studies of beta-thalassemia major. To bridge this gap, we developed an artificially engineered model for human beta thalassemia by knocking down beta-globin gene and protein expression in cultured CD34+ cells obtained from healthy adults. Lentiviral-mediated transduction of beta-globin shRNA (beta-KD) caused imbalanced globin chain production. Beta-globin mRNA was reduced by 90% compared to controls, while alpha-globin mRNA levels were maintained. HPLC analyses revealed a 96% reduction in HbA with only a minor increase in HbF. During the terminal …

Racial Disparities In The Use Of Cardiac Revascularization: Does Local Hospital Capacity Matter?, Suhui Li, Arnold Chen, Katherine H. Mead

Health Policy and Management Faculty Publications

Objective: To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.

Data Sources: Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.

Study Design: The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient’s initial admission for AMI. Multi-level hierarchical …

Is Adrenalectomy Necessary During Unilateral Nephrectomy For Wilms Tumor? A Report From The Children's Oncology Group., Kathleen Kieran, James R Anderson, Jeffrey S Dome, Peter F Ehrlich, Michael L Ritchey, Robert C Shamberger, Elizabeth J Perlman, Daniel M Green, Andrew M Davidoff

Pediatrics Faculty Publications

PURPOSE: To determine whether performing adrenalectomy at the time of nephrectomy for unilateral Wilms tumor impacts clinical outcome.

METHODS: We reviewed information on all patients enrolled on National Wilms Tumor Study-4 and -5. Data were abstracted on patient demographics, tumor characteristics, surgical and pathologic status of the adrenal gland, and patient outcomes. The primary endpoints were intraoperative spill and five-year event-free survival (EFS) in patients who did or did not undergo adrenalectomy.

RESULTS: Of 3825 patients with complete evaluable data, the adrenal was left in situ in 2264 (57.9%) patients, and was removed completely in 1367 patients (36.7%) or partially …

Impact Of Vulvovaginal Health On Postmenopausal Women: A Review Of Surveys On Symptoms Of Vulvovaginal Atrophy, Sharon J. Parish, Rossella E. Nappi, Michael L. Krychman, Susan Kellogg-Spadt, James A. Simon, Jeffrey A. Goldstein, Sheryl A. Kingsberg

Obstetrics and Gynecology Faculty Publications

Several recent, large-scale studies have provided valuable insights into patient perspectives on postmenopausal vulvovaginal health. Symptoms of vulvovaginal atrophy, which include dryness, irritation, itching, dysuria, and dyspareunia, can adversely affect interpersonal relationships, quality of life, and sexual function. While approximately half of postmenopausal women report these symptoms, far fewer seek treatment, often because they are uninformed about hypoestrogenic postmenopausal vulvovaginal changes and the availability of safe, effective, and well-tolerated treatments, particularly local vaginal estrogen therapy. Because women hesitate to seek help for symptoms, a proactive approach to conversations about vulvovaginal discomfort would improve diagnosis and treatment.

Smartphone Apps For Disasters: Workshop Lesson Plan, Paul Levett

Himmelfarb Library Faculty Posters and Presentations

This instruction was designed to be delivered to a Disaster Medical Assistance Team (DMAT) or a Community Emergency Response Team (CERT).

Instructional Goal #1: Using a personal smartphone connected to the internet, learners will download medical information apps, before deployment to a disaster environment.

Instructional Goal #2: Recalling real and simulated patient care situations that required additional medical information, learners will identify and search smartphone apps for relevant, current, authoritative, medical information that could be applied to the care of individual patients in disasters.

The Impact Of Interventions To Reduce Length Of Stay In The Emergency Department: A Systematic Review, Jameel Abualenain, Taibah Alabdrabalnabi, Irit R. Rasooly, Paul Levett, Jesse M. Pines

Himmelfarb Library Faculty Posters and Presentations

No abstract provided.

Rhinoscleroma Presenting As A Nasal-Palatal Mass With Airway Obstruction, Mark C. Domanski, Alexander Rivero, David E. Kardon

Surgery Faculty Publications

We report a case of a 45-year-old male with severe rhinoscleroma. The patient presented to the emergency room with dyspnea from a long-standing nasal-palatal mass. A tracheostomy was required for airway control. While dyspnea in the presence of an upper airway mass is typical of malignancy, consideration of non-oncological etiologies is important. We review the epidemiology, pathology, diagnosis, and treatment of rhinoscleroma.

A Risk Score For Identifying Methicillin-Resistant Staphylococcus Aureus In Patients Presenting To The Hospital With Pneumonia., Andrew F. Shorr, Daniela E. Myers, David B. Huang, Brian H. Nathanson, Matthew F. Emons, Marin H. Kollef

Emergency Medicine Faculty Publications

Background

Methicillin-resistant Staphylococcus aureus (MRSA) represents an important pathogen in healthcare-associated pneumonia (HCAP). The concept of HCAP, though, may not perform well as a screening test for MRSA and can lead to overuse of antibiotics. We developed a risk score to identify patients presenting to the hospital with pneumonia unlikely to have MRSA.

Methods

We identified patients admitted with pneumonia (Apr 2005 – Mar 2009) at 62 hospitals in the US. We only included patients with lab evidence of bacterial infection (e.g., positive respiratory secretions, blood, or pleural cultures or urinary antigen testing). We determined variables independently associated with the …

Rapid 13(C) Urea Breath Test To Identify Helicobacter Pylori Infection In Emergency Department Patients With Upper Abdominal Pain, Andrew C. Meltzer, Rebecca Pierce, Derek A.T. Cummings, Jesse M. Pines, Larissa May, Meaghan A. Smith, Joseph Marcotte, Melissa L. Mccarthy

Emergency Medicine Faculty Publications

Introduction: In emergency department (ED) patients with upper abdominal pain, management includes ruling out serious diseases and providing symptomatic relief. One of the major causes of upper abdominal pain is an ulcer caused by Helicobacter pylori (H. pylori), which can be treated and cured with antibiotics. We sought to estimate the prevalence of H. pylori infection in symptomatic patients using a convenience sample at a single urban academic ED and demonstrate the feasibility of ED-based testing.

Methods: We prospectively enrolled patients with a chief complaint of pain or discomfort in the upper abdomen for 1 year from February …

From Qualitative Work To Intervention Development In Pediatric Oncology Palliative Care Research, Terrah Foster Akard, Mary Jo Gilmer, Debra L. Friedman, Barbara Given, Verna L. Hendricks-Ferguson, Pamela S. Hinds

Pediatrics Faculty Publications

Qualitative methods can be particularly useful approaches to use with individuals who are experiencing a rare disease and thus who comprise a small sample (such as children with cancer) and are at points in care that few experience (such as end of life). This data-based methods article describes how findings from a qualitative study were used to guide and shape a pediatric oncology palliative care intervention. Qualitative data can lay a strong foundation for subsequent pilot intervention work by facilitating the development of an underlying study conceptualization, providing recruitment feasibility estimates, helping establish clinically meaningful inclusion criteria, establishing staff acceptability …

Characteristics Of Children With The Best And Poorest First- And Second-Year Growth During Rhgh Therapy: Data From 25 Years Of The Genentech National Cooperative Growth Study (Ncgs), Paul B. Kaplowitz, Dorothy I. Shulman, James W. Frane, Joan Jacobs, Barbara Lippe

Pediatrics Faculty Publications

Background

Models assessing characteristics contributing to response to recombinant human growth hormone (rhGH) response rarely address growth extremes in both years 1 and 2 or examine how children track from year to year. Using National Cooperative Growth Study (NCGS) data, we determined characteristics contributing to responsiveness to rhGH and the pattern of change from years 1 to 2.

Patients and methods

Height velocity standard deviation score (HV SDS) for 2 years for prepubertal children with idiopathic GH deficiency (IGHD) (n = 1899) and idiopathic short stature (ISS) (n = 1186) treated with similar doses for two years were computed. Group …

Hyper-Arousal Decreases Human Visual Thresholds, Adam J. Woods, John W. Philbeck, Philip Wirtz

Neurological Surgery Faculty Publications

Arousal has long been known to influence behavior and serves as an underlying component of cognition and consciousness. However, the consequences of hyper-arousal for visual perception remain unclear. The present study evaluates the impact of hyper-arousal on two aspects of visual sensitivity: visual stereoacuity and contrast thresholds. Sixty-eight participants participated in two experiments. Thirty-four participants were randomly divided into two groups in each experiment: Arousal Stimulation or Sham Control. The Arousal Stimulation group underwent a 50-second cold pressor stimulation (immersing the foot in 0–2° C water), a technique known to increase arousal. In contrast, the Sham Control group immersed their …

Intensive Goal-Directed Treatments In Enriched Environments Augments Patient Outcomes Post-Stroke, Blake A. Kandah, Michael A. Klonowski, Ryan M. Pelo, Nicole M. Williams, Raquel V. Santiago, Christopher K. Thompson, Kristan A. Leech, Carey L. Holleran, Abigail L. Leddy, T. George Hornby

GW Research Days 2013

Objective: Previous research indicates that patients post-stroke, average 400-800 steps within physical therapy sessions and demonstrate heart rate values of 24-35% of HR Max. This dosage and intensity is inadequate to promote neuroplastic changes and maximize recovery. The goal of this study was to quantify and examine the amount of high-intensity stepping practice that was delivered within an Acute Inpatient Rehabilitation (AIR) setting for individuals with sub-acute stroke.

Methods: 14 patients with a diagnosis of sub-acute stroke were admitted to AIR. Standardized outcomes included the 6-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), the Berg Balance Scale (BBS) and the …

A Comparative Study Of The Standard Prenatal Care In Nicaragua To Standard United States Prenatal Care, Lynsa Minh Nguyen

GW Research Days 2013

OBJECTIVE: To determine the efficacy and cost effectiveness of the standard prenatal care offered in Nicaragua and the United States.

METHODS: In a comparative study of standard prenatal care in Nicaragua with the prenatal care in the U.S., the number of appointments, the types of tests/screenings, the frequency of tests/screenings, and the maternal and neonatal mortality rates were compared. Data concerning prenatal care was collected from a U.S. obstetric gynecologist and a Nicaraguan government nurse and doctor in the respective countries. The mortality rates used were provided by The World Bank.

RESULTS TO DATE: Standard prenatal care in Nicaragua recommended …

Patient-Driven Resource Planning Of A Health Care Facility Evacuation, Bruno P. Petinaux, Kabir Yadav

Emergency Medicine Faculty Publications

Introduction: The evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old.

Methods: Utilizing a cross-sectional survey of charge nurses of the clinical units in an urban, academic, adult trauma health care facility (HCF), the evacuation needs of hospitalized patients were assessed periodically over a two-year period.

Results: Survey data were collected on 2,050 patients. Units with patients …

Neurosurgery Concepts: Key Perspectives On Regulatory Proteins, Management Of Ossification Of The Posterior Longitudinal Ligament, And Radiosurgery For Intracranial Lesions, Jonathan H. Sherman, Zachary A. Smith, Jin Mo Cho, Michael Lim, Chaim B. Colen, Chae-Yong Kim, Vincent Yat Wang, Gabriel Zada, Gordon Li, Isaac Yang

Neurological Surgery Faculty Publications

No abstract provided.

Pathogen-Specific Risk Of Chronic Gastrointestinal Disorders Following Bacterial Causes Of Foodborne Illness, Chad K. Porter, Daniel Choi, Brooks Cash, Mark Pimentel, Joseph Murray, Larissa May, Mark S. Riddle

Emergency Medicine Faculty Publications

Background

The US CDC estimates over 2 million foodborne illnesses are annually caused by 4 major enteropathogens: non-typhoid Salmonella spp., Campylobacter spp., Shigella spp. and Yersinia enterocoltica. While data suggest a number of costly and morbid chronic sequelae associated with these infections, pathogen-specific risk estimates are lacking. We utilized a US Department of Defense medical encounter database to evaluate the risk of several gastrointestinal disorders following select foodborne infections.

Methods

We identified subjects with acute gastroenteritis between 1998 to 2009 attributed to Salmonella(nontyphoidal) spp., Shigella spp., Campylobacter spp. or Yersinia enterocolitica and matched each with up to 4 …

Broadening Access To Medical Care During A Severe Influenza Pandemic: The Cdc Nurse Triage Line Project., Lisa M. Koonin, Dan Hanfling

Emergency Medicine Faculty Publications

The impact of a severe influenza pandemic could be overwhelming to hospital emergency departments, clinics, and medical offices if large numbers of ill people were to simultaneously seek care. While current planning guidance to reduce surge on hospitals and other medical facilities during a pandemic largely focuses on improving the “supply” of medical care services, attention on reducing “demand” for such services is needed by better matching patient needs with alternative types and sites of care. Based on lessons learned during the 2009 H1N1 pandemic, the Centers for Disease Control and Prevention and its partners are currently exploring the acceptability …

Asynchronous Web-Based Learning, A Practical Method To Enhance Teaching In Emergency Medicine, Ali Pourmand, Raymond Lucas, Mehdi Nouraie

Emergency Medicine Faculty Publications

Objective: To compare medical knowledge acquisition among emergency medicine (EM) residents who attend weekly core content lectures with those absent but asynchronously viewing the same lectures in a Web-based electronic platform.

Subjects and Methods: During the study period all EM residents attending or absent from weekly educational conferences were given a quiz on the covered material. During Phase 1, absentees were not given supplemental educational content for missed lectures. During Phase 2, absentees were sent a link to an online multimedia module containing an audiovisual recording of the actual missed lecture with presentation slides. Scores between attendees and absentees during …

Bedside Teaching On Time To Disposition Improves Length Of Stay For Critically-Ill Emergency Departments Patients, Ali Pourmand, Raymond Lucas, Jesse M. Pines, Hamid Shokoohi, Kabir Yadav

Emergency Medicine Faculty Publications

Introduction: We tested the effect of a brief disposition process intervention on residents’ time to disposition and emergency department (ED) length of stay (LOS) in high acuity ED patients.

Methods: This was a quasi-experimental study design in a single teaching hospital where ED residents are responsible for administrative bed requests for patients. Enrollment was performed for intervention and control groups on an even-odd day schedule. Inclusion criteria were ED patients triaged as Emergency Severity Index (ESI) 1 and 2. In the intervention group, the attending physician prompted the resident to make the disposition immediately after the evaluation of resuscitation patients. …

Reducing Ambulance Diversion At Hospital And Regional Levels: Systematic Review Of Insights From Simulation Models, M. Kit Delgado, Lesley J. Meng, Mary P. Mercer, Jesse M. Pines, Douglas K. Owens, Gregory S. Zaric

Emergency Medicine Faculty Publications

Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion.

Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent …

Age-Related Accumulation Of T Cells With Markers Of Relatively Stronger Autoreactivity Leads To Functional Erosion Of T Cells., Zohreh Tatari-Calderone, Milica Stojakovic, Ramita Dewan, Gama L. Bouder, Dragana Jankovic, Stanislav Vukmanovic

Pediatrics Faculty Publications

Background

Thymic involution is a prominent characteristic of an aging immune system. When thymic function is reduced/absent, the peripheral T cell pool is subject to the laws of peripheral T cell homeostasis that favor survival/expansion of T cell receptors with relatively higher functional avidity for self-peptide/MHC complexes. Due to difficulties in assessing the TCR avidity in polyclonal population of T cells, it is currently not known whether high avidity T cells preferentially survive in aging individuals, and what impact this might have on the function of the immune system and development of autoimmune diseases.

Results

The phenotype of T cells …

The Treatment Of Cutaneous Abscesses: Comparison Of Emergency Medicine Providers' Practice Patterns, Gillian Schmitz, Tress Goodwin, Adam Singer, Chad S. Kessler, David Bruner, Hollyn Larabee, Larissa S. May, Samuel D. Luber, Justin Williams, Rahul Bhat

Emergency Medicine Faculty Publications

INTRODUCTION:

Cutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (I&D) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. Although guidelines exist to support clinician management of abscesses, they do not clearly specify these additional interventions. This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage that could be managed in an ED or outpatient setting.

METHODS:

Four hundred and seventy-four …

Perceptions Of Emergency Department Crowding In The Commonwealth Of Pennsylvania, Jesse M. Pines, Joshua A. Isserman, John J. Kelly

Emergency Medicine Faculty Publications

Introduction: The state of emergency department (ED) crowding in Pennsylvania has not previously been reported.

Methods: We assessed perceptions of ED crowding by surveying medical directors/chairs from Pennsylvania EDs in the spring of 2008.

Results: A total of 106 completed the questionnaire (68% response rate). A total of 83% (86/104) agreed that ED crowding was a problem; 26% (27/105) reported that at least half of admitted patients boarded for more than 4 hours. Ninety-eight percent (102/104) agreed that patient satisfaction suffers during crowding and 79% (84/106) stated that quality suffers. Sixty-five percent (68/105) reported that crowding had worsened during the …

Prenatal Diagnosis Of Long Qt Syndrome: Implications For Delivery Room And Neonatal Management, E. Anne Greene, Charles I. Berul, Mary T. Donofrio

Pediatrics Faculty Publications

This case describes the prenatal diagnosis and integrated peripartum management of a foetus with 2:1 atrioventricular block and torsade de pointes due to congenital long QT syndrome. The unique issues related to the detection of intrauterine conduction abnormalities and ventricular arrhythmias, along with the immediate postnatal care, have been described as an interesting teaching case with successful outcome.

Role Of Deregulated Micrornas In Breast Cancer Progression Using Ffpe Tissue, Liang Chen, Youhuai Li, Yebo Fu, Jin Peng, Meng-Hsuan Mo, Michael Stamatakos, Christine B. Teal, Rachel F. Brem, Alexander Stojadinovic, Michael Grinkemeyer, Timothy A. Mccaffrey, Yan-Gao Man, Sidney W. Fu

Pathology Faculty Publications

MicroRNAs (miRNAs) contribute to cancer initiation and progression by silencing the expression of their target genes, causing either mRNA molecule degradation or translational inhibition. Intraductal epithelial proliferations of the breast are histologically and clinically classified into normal, atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC). To better understand the progression of ductal breast cancer development, we attempt to identify deregulated miRNAs in this process using Formalin-Fixed, Paraffin-Embedded (FFPE) tissues from breast cancer patients. Following tissue microdissection, we obtained 8 normal, 4 ADH, 6 DCIS and 7 IDC samples, which were subject to RNA isolation …