Medical Specialties Commons^™

Palliative Performance Scale As A Prognostic Tool For Patients With Dementia In Hospice, Alexandria Nasr

Scholarship in Medicine - All Papers

Objective: Palliative and hospice care have been shown to benefit people with dementia and their families. However, for patients with dementia who are nearing the end of life, hospice referral can be challenging because of the difficulty in predicting prognosis. The objective of this retrospective, exploratory study is two-fold: (1) to describe trajectories by analyzing trends in Palliative Performance Scale (PPS) scores for patients admitted to hospice with a neurocognitive disorder from time of enrollment to time of disenrollment and (2) to determine the relationship between PPS and length of stay (LOS) in hospice care.

Methods: The setting for the …

The Safe Environment For Every Kid Model: Analyzing Demographics Related To Higher Risks Of Child Maltreatment In High-Risk Pediatric Population, Hannah Redding

Scholarship in Medicine - All Papers

Background: The Safe Environment for Every Kid (SEEK) screener was developed by Dr. Howard Dubowitz for primary care clinicians to identify and address risk factors for child maltreatment. The instrument queries parents/guardians regarding their families' needs (e.g. food insecurity) and screens for depressive symptoms in the parent/guardian.

Objective: To examine the frequency of social determinants of health (e.g., food insecurity) and its correlates using the SEEK screener during pediatric visits at a Federally Qualified Health Center in south central Ohio.

Design/Methods: The SEEK screener was distributed to parents/guardians (PG) at Rocking Horse Community Health Center, a Federally Qualified Health Center …

Outcomes And Complications Of Scfe Surgery, Tyler Sanda

Scholarship in Medicine - All Papers

Objective: Slipped capital femoral epiphysis (SCFE) is a common hip disorder affecting children and adolescents. There is much debate concerning best treatment with regards to adverse outcomes, specifically avascular necrosis (AVN). This study analyzed the rates of adverse outcomes after the surgical treatment of SCFEs. It examined risk factors which may lead to the development adverse outcomes. This research will aid clinical decision-making, helping determine optimal surgical treatment of SCFEs and adding to external datasets of SCFE treatment.

Methods: This was a retrospective review of patient health records at a level 2 pediatric trauma hospital. The study included all SCFE …

Determining The Appropriate Technique For Appendix Stump Closure, Cynthia White

Scholarship in Medicine - All Papers

Background In a laparoscopic appendectomy, closure of the appendeceal stump can be done using an endostapler or endoloop. We compared outcome data of the two techniques in patients who underwent laparoscopic appendectomy.

Method We included all patient > 18 years who underwent laparoscopic appendectomy for acute appendicitis at a single institution over a 4-year period. Demographic and outcome data were compared between both groups. Results 501 patients, with no significant differences in age, gender or BMI, were identified for the study. No differences were noted in procedure length, readmission rates, complication rates (including intra-abdominal abscess) or hospital charges. There was a …

Risk Factors Associated With Infection In Open Fractures Of The Upper And Lower Extremities, Paul Tornetta, Gregory J. Della Rocca, Saam Morshed, Clifford Jones, Diane Heels-Ansdell, Sheila Sprague, Brad Petrisor, Kyle J. Jeray, Gina Del Fabbro, Sofia Bzovsky, Mohit Bhandari, Gordon H. Guyatt, Stephen D. Walter, Emil H. Schemitsch, Jeffrey Anglen, Michael Bosse, Susan Liew, Parag Sancheti, Paula Mckay, Kim Madden, Kerry Tai, Lisa Buckingham, Aravin Duraikannan, Stephanie L. Tanner, Rebecca G. Snider, Douglas Altman, Rajiv Gandhi, Markus Bischoff, Bill Ristevski, Krishan Rajaratnam, Dale Williams, Flow Investigators

Orthopaedic Surgery Faculty Publications

Introduction: Open fractures are associated with a high risk of infection. The prevention of infection is the single most important goal, influencing perioperative care of patients with open fractures. Using data from 2,500 participants with open fracture wounds enrolled in the Fluid Lavage of Open Wounds trial, we conducted a multivariable analysis to determine the factors that are associated with infections 12 months postfracture. Methods: Eighteen predictor variables were identified for infection a priori from baseline data, fracture characteristics, and surgical data from the Fluid Lavage of Open Wounds trial. Twelve predictor variables were identified for deep infection, which included …

Outcomes And Management Approaches Of Resuscitative Endovascular Balloon Occlusion Of The Aorta Based On The Income Of Countries, Ramiro Manzano-Nunez, David Mcgreevy, Claudia P. Orlas, Alberto F. Garciá, Tal M. Hörer, Joseph Dubose, Carlos A. Ordoñez, Aast-Aorta Investigators And The Abotrauma Registry Group

Department of Surgery Faculty Publications

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries' income based on the World Bank Country and Lending Groups. Methods: We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and …

Accidental Silver Clay Tattoo: Mystery Finding In A Jewelry Smith, Tom Selby, Christina E. Borchers, Jeffery B. Travers, Samia Borchers

Dermatology Faculty Publications

Permanent tattoos result from the introduction of insoluble pigmentsinto the dermis. The mechanism can be intentional for cosmetic ormedical purposes, as with professional tattooing; or accidental asseen with carbon-related traumatic tattooing. Pigments are generallycomposed of various inorganic salts or metals. Pathology in non-inflamed tattoos will show dermal pigment granules of different sizesand shapes.1 Local inflammatory reactions can occur.Unintentional tattooing related to trauma involving asphalt, carbon,graphite, and gun powder are well known. Other cases involvingjewelry and fireworks have been reported in the literature.2,3 Similarissues arise with accidental placement of amalgam in the oralmucosa during dental procedures.4 We present an interesting caseof …

Atypical Mycobacterium Marinum: A Case Of Fish Tank Granuloma, Emily Wooton, Christina E. Borchers, Samia Borchers, Nicholas Shamma, Bernard Rose, Max Rubin

Dermatology Faculty Publications

Our case involves a 76-year-old female who presented to her family physician with a presumed infection on her right dorsal hand and wrist, which she believed to be secondary to a possible stick pin or spider bite at a department store while rummaging through jeans.

Human Botfly Infestation: Furuncular Myiasis, Rachel Rhee, Christina E. Borchers, Samia Borchers, Gregory Maupin, Jeffery Weinstein

Dermatology Faculty Publications

Dermatobia hominis is one of many species of botflies whose larvae is parasitic to humans and is uniquely indigenous to Central and South America. The larvae of the human botfly gain nutrients to survive by feeding underneath mammal skin. As a consequence, within 24 hours, small 2- 3mm painful, erythematous, draining, and purulent papules with a classical air-pore develop as the initial cutaneous sign. At first, the lesions resemble that of an insect bite, but over time they enlarge to 10-35mm in diameter with a surrounding area of induration. The most common areas where the larvae are cutaneously deposited include …

Cutaneous Invasive Ductal Carcinoma Masquerading As Pseudoxanthoma Elasticum, Christina E. Borchers, Hershel Dobkin, Zachary Ingersoll, Marc Handler

Dermatology Faculty Publications

In the United States, 214,880 women are diagnosed with breast carcinomaeach year, with an overall 5-year survival of 90%. When cutaneousmetastases are present, the 5-year survival is 24%. Invasive ductalcarcinoma (IDC) comprises 80% of all breast cancers, with 30% of womenhaving metastatic disease upon initial diagnosis. Cutaneous metastases ofbreast carcinoma occurs at a rate of 24% per primary breast malignancywith 70% of breast carcinoma cutaneous metastases being IDC subtype.Our patient presented as clinically exhibiting features of pseudoxanthomaelasticum (PXE), a genetic disease affecting connective tissue inintertriginous areas, but upon pathologic examination revealed metastaticIDC. Review of the literature has not elicited other …

Inter- And Intra-Physician Variation In Quantifying Actinic Keratosis Skin Photodamage, Benjamin Schmeusser, Christina E. Borchers, Jeffrey B. Travers, Samia Borchers, Justin Trevino, Max Rubin, Heidi Donnelly, Karl Kellawan, Lydia Carpenter, Shalini Bahl, Craig A. Rohan, Elizabeth Muennich, Scott Guenthner, Holly Hahn, Ali Rkein, Marc Darst, Nico Mousdicas, Elizabeth E. Cates, Ulas Sunar, Trevor J. Bihl

Dermatology Faculty Publications

We investigated the variations in physician evaluation of skin photodamage based on a published photodamage scale. Of interest is the utility of a 10-level scale ranging from none and mild photodamage to actinic keratosis (AK). The dorsal forearms of 55 adult subjects with various amounts of photodamage were considered. Each forearm was independently evaluated by 15 board-certified dermatologists according to the Global Assessment Severity Scale ranging from 0 (less severe) to 9 (the most progressed stage of skin damage). Dermatologists rated the levels of photodamage based upon the photographs in blinded fashion. Results show substantial disagreement amongst the dermatologists on …

Spotlight Commentary: Why We Need To Pay Attention To Toxicity Associated With Herbal Medicines, Elena Y. Enioutina, Kathleen M. Job, Catherine M.T. Sherwin

Pediatrics Faculty Publications

No abstract provided.

Renal Survival In Children With Glomerulonephritis With Crescents: A Pediatric Nephrology Research Consortium Cohort Study, Joseph G. Maliakkal, M. John Hicks, Mini Michael, David T. Selewski, Katherine Twombley, Michelle N. Rheault, Meredith Seamon, Jason M. Misurac, Cheryl L. Tran, Loretta Reyes, Joseph T. Flynn, Ali M. Onder, Alexandru R. Constantinescu, Vaishali Singh, Cynthia Pan, Abiodun Aderogba Omoloja, Qiang Wu, William E. Smoyer, Guillermo Hidalgo, Scott E. Wenderfer

Pediatrics Faculty Publications

There is no evidence-based definition for diagnosing crescentic glomerulonephritis. The prognostic implications of crescentic lesions on kidney biopsy have not been quantified. Our objective was to determine risk factors for end-stage kidney disease (ESKD) in patients with glomerulonephritis and crescents on kidney biopsy. A query of the Pediatric Nephrology Research Consortium’s Pediatric Glomerulonephritis with Crescents registry identified 305 patients from 15 centers. A retrospective cohort study was performed with ESKD as the primary outcome. Median age at biopsy was 11 years (range 1–21). The percentage of crescents was 3–100% (median 20%). Etiologies included IgA nephropathy (23%), lupus (21%), IgA vasculitis …

Gynecologic Surgrete, New Horizons Guyana 2019: An Experience Of A Lifetime For Global Health Engagement And Medical Readiness, Bethany L. Charron, Katherine L. Dengler, Bao Tram Nguyen, Ashley Coggins, Jason C. Massengill, Trisha J. Tomkins

Obstetrics and Gynecology Faculty Publications

New Horizons is an annual training exercise designated for military medical professionals and civil engineers to assist partner nations of Southern Command (SOUTHCOM), as well as provide exceptional training to U.S. military members.1 In Spring of 2019, a gynecologic surgery readiness training exercise (SURGRETE) team composed of 16 joint-service military healthcare professionals, specifically including a fellowship-trained female pelvic medicine and reconstructive surgery (FPMRS) surgeon, an FPMRS fellow, an obstetrics and gynecology (OB/GYN) specialist, three OB/GYN residents, and additional anesthesia, nursing, and surgical technician support, traveled to Guyana to participate in the New Horizons global health exercise. The mission of the …

Trends In Cancer Prevalence In Punjab, Pakistan: A Systematic Study From 2010 To 2016, Sana Hafeez, Asmat Mahmood, Rizwan Ullah Khan, Naila Malkani

Journal of Bioresource Management

Cancer is the second leading cause of death globally. However, in Pakistan, in the absence of a national cancer registry, it is difficult to predict the current status of cancer incidence. Therefore, a need was felt to design a study that can give a depiction of the prevalence of common cancer types and their relevance to the local population in the absence of a proper cancer registry system. In view of this, data was collected from 2010 to 2016 for breast, prostate, head and neck, cervical and colorectal cancer from the cancer hospitals and centres located all over Punjab, Pakistan. …

The Perils Of Recreational Marijuana Use: Relationships With Mental Health Among Emergency Department Patients, Catherine A. Marco, John Paul Detherage Iii, Ashley Lafountain, Megan Hanna, Justin Anderson, Rachel Rhee, Jacqueline Ziegman, Dennis Mann

Emergency Medicine Faculty Publications

Abstract Introduction Marijuana is a commonly used drug in the United States. Many states have legalized the recreational use of marijuana. The effects of marijuana on mental health are unknown. Methods In this prospective survey study, eligible participants included ED patients age 18 and older, who had ever used recreational marijuana. A survey instrument was developed, piloted, and revised. Data collected included reasons for marijuana use, marijuana's perceived effectiveness, and history of mental health conditions, including depression, anxiety, and suicidal thoughts. Results Among 303 participants (86% response rate), the median age of first marijuana use was 16 ([IQR 14, 19], …

Predictors Of New-Onset Atrial Fibrillation In Geriatric Trauma Patients, Catherine A. Marco, Jennifer Lynde, Blake Nelson, Joshua Madden, Adam Schaefer, Claire Hardman, Mary Mccarthy

Emergency Medicine Faculty Publications

Geriatric patients (age >65) comprise a growing segment of the trauma population. New-onset atrial fibrillation may occur after injury, complicating clinical management and resulting in significant morbidity and mortality. This study was undertaken to identify clinical and demographic factors associated with new-onset atrial fibrillation among geriatric trauma patients . Methods: In this case control study, eligible participants included admitted trauma patients age 65 and older who developed new-onset atrial fibrillation during the hospitalization. Controls were admitted trauma patients who were matched for age and injury severity score, who did not develop atrial fibrillation. We evaluated the associations between new-onset atrial …

Vital Signs, Spring 2020, Boonshoft School Of Medicine

Vital Signs

A thirty-one page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, alumni profiles, class notes, and more.

Investigation Into The Reproducibility Of The Association Of Cord Blood Magnesium Concentration And Cerebral Palsy Or Death In Children, Christopher Luke Dixon, Xiaoxi Liu, Alfred Balch, Maged Costantine, Catherine M. Sherwin

Pediatrics Faculty Publications

Objective: To evaluate the association of cord blood magnesium concentrations at the time of birth with cerebral palsy (CP) and neonatal death. Study Design: A secondary analysis of a randomized controlled trial that randomized women at imminent risk of delivery between 24 and 31 weeks of gestation to receive magnesium sulfate or placebo. This ‘study’s primary outcome was a composite of either moderate to severe CP or death. Secondary outcomes included CP, moderate to severe CP, neonatal death, and neonatal head ultrasound findings. We used a logistic regression model to evaluate the relationship between the concentration of magnesium in cord …

The Reliability Of Histamine Pharmacodynamic Response Phenotype Classification In Children With Allergic Disease., Kumar Ss, Liu X, Sherwin Cm, Jones Bl

Pediatrics Faculty Publications

We have identified distinct histamine pharmacodynamic response phenotypes in children with allergic disease utilizing histamine iontophoresis with laser Doppler (HILD). These response phenotypes may be relevant in guiding therapeutic decision making for agents targeting the allergic response pathways. However, the reliability of these response phenotypes has not been assessed. Therefore, we performed HILD in children with allergic rhinitis and/or asthma on two to three separate occasions. HILD response-time data were analyzed in NONMEM using a linked effect PKPD model. Examination of observed vs. classified response phenotypes predicted response plots and the sum of residuals. The intraclass correlation coefficient (ICC) was …

Therapeutic Potential Of Citrulline As An Arginine Supplement: A Clinical Pharmacology Review, Jahidur Rashid, Shaun S. Kumar, Kathleen M. Job, Xiaoxi Liu, Candice D. Fike, Catherine M. T. Sherwin

Pediatrics Faculty Publications

Supplemental arginine has shown promise as a safe therapeutic option to improve endogenous nitric oxide (NO) regulation in cardiovascular diseases associated with endothelial dysfunction. L-arginine, an endogenous amino acid, was reported in clinical studies in adults to improve cardiovascular function in hypertension, pulmonary hypertension, pre-eclampsia, angina, and mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome. L-citrulline, a natural precursor of L-arginine, is more bioavailable than L-arginine because of hepatic first-pass metabolism avoidance and longer circulation time. Although not yet well studied, arginine/citrulline has immense therapeutic potential in some life-threatening diseases of children. However, optimal clinical development of arginine or …

Mandatory And Permissive Reporting Laws: Obligations, Challenges, Moral Dilemmas, And Opportunities, Joel M. Geiderman, Catherine A. Marco

Emergency Medicine Faculty Publications

The duty to report certain conditions to public health or law enforcement authorities is one that falls on all physicians and other health care workers as part of their duty to protect the public from harm. In an open society, others, such as teachers, clergy, police officers, or simply neighbors, share the responsibility of protecting individuals at risk, often by reporting them to authorities. The emergency physician and others in the emergency department are uniquely positioned to identify people at risk or who pose a risk, and to report them as required or allowed under the law. In some circumstances, …

A Comparison Between The Teg 6s And Teg 5000 Analyzers To Assess Coagulation In Trauma Patients, Matthew D. Neal, Ernest E. Moore, Mark Walsh, Scott Thomas, Rachael A. Callcut, Lucy Z. Kornbilth, Martin Schreiber, Akpofure Peter Ekeh, Adam J. Singer, Lawrence Lottenberg, Michael Foreman, Susan Evans, Robert D. Winfield, Michael D. Goodman, Carl Freeman, David Milia, Noelle Saillant, Jan Hartmann, Hardean E. Achneck

Department of Surgery Faculty Publications

BACKGROUND

Trauma-induced coagulopathy is a major driver of mortality following severe injury. Viscoelastic goal-directed resuscitation can reduce mortality after injury. The TEG 5000 system is widely used for viscoelastic testing. However, the TEG 6s system incorporates newer technology, with encouraging results in cardiovascular interventions. The purpose of this study was to validate the TEG 6s system for use in trauma patients.

METHODS

Multicenter noninvasive observational study for method comparison conducted at 12 US Levels I and II trauma centers. Agreement between the TEG 6s and TEG 5000 systems was examined using citrated kaolin reaction time (CK.R), citrated functional fibrinogen maximum …

Mucin-Rich Vs. Mucin-Poor Endocrine Mucin-Producing Sweat Gland Carcinoma: A Comparison Of Two Cases, Christina E. Borchers, Michael Heaphy, Ronald E. Warwar, Nicholas Shamma

Dermatology Faculty Publications

No abstract provided.

Impact Of The Affordable Care Act On Referral To Care For People Living With Hiv In Appalachia, Cameron A. Wade, Timothy N. Crawford, Nicole Leedy, Alice C. Thornton

Family Medicine Faculty Publications

Introduction: The Affordable Care Act (ACA) enacted on March 23, 2010 significantly impacted access to healthcare for people living with HIV (PLWH). Expansion of care was accomplished in three areas: eliminating exclusions for pre-existing conditions, elimination of lifetime caps on healthcare expenditures, and expansion of Medicaid eligibility.

Purpose: This study evaluated the impact of state implementation of the ACA Medicaid expansion on referral to HIV care at a Ryan White federally funded clinic in Kentucky (University of Kentucky Bluegrass Care Clinic [UK BCC]).

Methods: Retrospective chart review of all newly enrolled patients at the UK BCC between March 2010 and …

Marijuana Use And Mental Health Among Emergency Department Patients, Megan Hanna

Scholarship in Medicine - All Papers

Background: According to the Centers for Disease Control and Prevention (CDC), marijuana is the most commonly used illicit drug in the U.S. with an increasing number of users in recent years.

Objective: This study was undertaken to identify common reasons for marijuana use and any relationship between its use and mental health among Emergency Department (ED) patients. Methods: A total of 303 ED patients participated from the Miami Valley Hospital Emergency Department. Eligible participants included those with any marijuana use. Subjects were administered a survey which identified age of first use, reasons for use, and presence of anxiety and depression …

The Verbal Numeric Pain Scale: Ed Patient Understanding And Perspectives, Bracey Bayonnet

Scholarship in Medicine - All Papers

Objective: The objective of this study is to identify patient self-reported pain scores and understanding and perspectives of the Verbal Numeric Pain Scale. Methods: In this prospective survey study, eligible participants were interviewed by research assistants. Data collected included ED patients self-reported pain scores, previous painful experiences, and their understanding of the Verbal Numeric Pain Scale,

Results: Among 164 participants (92% response rate), the mean triage pain score was 6.4 (95% CI 6.0-6.9). Many participants had experienced significant painful experiences in the past, including major surgery (N = 113), broken bone (N = 102), childbirth (N = 89) and kidney …

Defining Current Gaps In Quality Measures For Cancer Immunotherapy: Consensus Report From The Society For Immunotherapy Of Cancer (Sitc) 2019 Quality Summit, Sara Pai, David Blaisdell, Rachel Brodie, Robert G. Carlson, Heidi Finnes, Michele Galioto, Roxanne E. Jensen, Tom Valuck, Antonia R. Sepulveda, Howard L. Kaufman

Population and Public Health Sciences Faculty Publications

Background Quality measures are important because they can help improve and standardize the delivery of cancer care among healthcare providers and across tumor types. In an environment characterized by a rapidly shifting immunotherapeutic landscape and lack of associated long-term outcome data, defining quality measures for cancer immunotherapy is a high priority yet fraught with many challenges. Methods Thus, the Society for Immunotherapy of Cancer convened a multistakeholder expert panel to, first, identify the current gaps in measures of quality cancer care delivery as it relates to immunotherapy and to, second, advance priority concepts surrounding quality measures that could be developed …

The Va Mission Act Of 2018: A Potential Game Changer For Rural Gme Expansion And Veteran Health Care, Anne Victoria Neale, Phil Lupo, Marjorie A. Bowman, Dean A. Seehusen

Population and Public Health Sciences Faculty Publications

The Veterans Healthcare Administration (VHA) is the largest health care delivery system in the United States. It includes 172 medical centers (VAMCs), with over 1,100 Community Based Outpatient Centers (CBOCs) and various other sites of care. In addition to training physicians to care for veterans and active duty service members, the VHA is also directed to assist in supplying health care personnel to the nation.Through its Office of Academic Affiliations (OAA), VHA develops partnerships with Accreditation Council for Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) accredited residency program sponsoring institutions. These collaborations include 144 out of 152 allopathic medical schools …

Effect Of Hiv Prevalence And Gender On Cardiovascular Disease Deaths, Tanjeev Ahmad

Scholarship in Medicine - All Papers

Cardiovascular disease is a widely diagnosed condition that can have many etiologies and factors that changes its prognosis. This project was aimed at investigating two potential factors that changes its prognosis: HIV status and gender. Data on HIV status was collected from NCHHSTP AtlasPlus for all US states and territories and data on cardiovascular disease deaths and corresponding gender was collected from Interactive Atlas of Heart Disease and Stroke for all US states and territories. Using a linear regression test, a correlation was tested for between HIV status and cardiovascular disease deaths for every US state/territory followed by a test …