Medical Specialties Commons^™

Role Of Surgery In Spinal Metastases, Altaf Ali Laghari, Humza Faisal Siddiqui, Muhammad Shahzad Shamim

Section of Cardiology

Spinal metastases constitute two-third of all cases of bone metastases. Surgical intervention in these tumours has been recommended in highly selective cases, for confirming diagnosis, stabilizing the spine, and decompressing nerves or spinal cord for alleviation of pain and preservation of function.In this article,the authors have reviewed available evidence on role of surgery in spinal metastases and have presented results of selected papers on this vast topic.

Defining The Hemodynamic Response Of Hypertensive And Normotensive Subjects Through Serial Timed Blood Pressure Readings In The Clinic, Hunaina Shahab, Hamza Sohail Khan, Aysha Almas, Sohail Abrar Khan, Azmina Artani, Aamir Hameed

Section of Cardiology

Background: Every third patient in the clinic is misdiagnosed due to white-coat phenomenon, necessitating needless and costly treatment. We aimed to study the hemodynamic response of the physician's visit on hypertensive and normotensive patients by investigating the trend of blood pressure (BP) before, during and 15 min after the physician-patient encounter.
Methods: A descriptive, cross-sectional study was conducted over a period of 8 months in the cardiology clinics at the Aga Khan University Hospital, Karachi. Both hypertensive and normotensive patients, aged ≥18 years, were recruited. Pregnant females or those with a history of volume loss were excluded. BP readings were …

Rationale And Methods For A Multicenter Clinical Trial Assessing Exercise And Intensive Vascular Risk Reduction In Preventing Dementia (Rrad Study), Amanda N. Szabo-Reed, Eric Vidoni, Ellen F. Binder, Jeffrey Burns, C. Munro Cullum, William P. Gahan, Aditi Gupta, Linda S. Hynan, Diana R. Kerwin, Heidi Rossetti, Ann M. Stowe, Wanpen Vongpatanasin, David C. Zhu, Rong Zhang, Jeffrey N. Keller

Neurology Faculty Publications

Alzheimer's Disease (AD) is an age-related disease with modifiable risk factors such as hypertension, hypercholesterolemia, obesity, and physical inactivity influencing the onset and progression. There is however, no direct evidence that reducing these risk factors prevents or slows AD. The Risk Reduction for Alzheimer's Disease (rrAD) trial is designed to study the independent and combined effects of intensive pharmacological control of blood pressure and cholesterol and exercise training on neurocognitive function. Six hundred and forty cognitively normal older adults age 60 to 85 years with hypertension and increased risk for dementia will be enrolled. Participants are randomized into one of …

Emergency Departments And Care For Marginalized Populations, Irvin B. Harrell

Institute for the Humanities Theses

Healthcare providers in emergency departments (EDs) face a daunting daily task: providing health care in a triage setting to a diverse group of patients many with complex medical issues. Many patients rely on ED services out of financial necessity, when their healthcare issues could be better suited for care from a primary care physician. Many of these already vulnerable patients – minorities, those health illiterate, low-income, uninsured and those with language barriers – must also deal with ED overcrowding and staffing conditions. In some cases, patients leave without being seen while others face bed shortages. This study explores healthcare provider …

The Impact Of Anterior Cruciate Ligament Reconstructive Surgery On Neuromotor Function, Cortney Noel Armitano

Rehabilitation Sciences Theses & Dissertations

The purpose of this dissertation was to examine the systemic neuromechanical implications in individuals who have had an ACL reconstruction (ACLR) compared to healthy controls. The specific aims addressed were to: 1) examine differences in inter-limb coordination during walking at different speeds, 2) examine differences in trunk, neck and head acceleration during gait, and 3) investigate whether the reaction time responses assessed during stepping are negatively affected by ACLR.

The findings of study 1 revealed that maximal coordination stability was achieved when walking at the person’s preferred gait speed. However, individuals with a previous ACLR exhibited reduced coordination stability between …

Development And Long-Term Stability Of A Comprehensive Daily Qa Program For A Modern Pencil Beam Scanning (Pbs) Proton Therapy Delivery System, Suresh Rana, Jaafar Bennouna, Alonso Gutierrez

All Publications

No abstract provided.

Maximum Iv Tpa Dose For Obese Patients Is Associated With Greater Likelihood Of Hemorrhagic Conversion And Worse Functional Outcome At Discharge, Amy Starosciak, Felipe De Los Rios La Rosa

All Publications

No abstract provided.

May Measurement Month 2017: An Analysis Of The Blood Pressure Screening Campaign Results In Pakistan-South Asia, Mohammad Ishaq, Feroz Memon, Thomas Beaney, Xin Xia, Elsa Kobeissi, Neil R. Poulter

Section of Cardiology

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. Hypertension is a global health concern for developing countries. In Pakistan, apart from few population-based studies which evaluated the prevalence of hypertension, there is no current nationally representative study (the latest nationwide survey was conducted more than two decades ago). Pakistan Hypertension League, in accordance with the International Society of Hypertension directive under the …

The Use Of Folic Acid In Dengue: Has It Any Value?, Asif Ali Shah, Ahsan Ali Syed, Saad Bin Zafar, Safia Awan

Section of Internal Medicine

Folic acid is used in dengue patients. Our study aims to compare the duration of recovery of thrombocytopenia in patients with dengue infection who received folic acid and those who did not. We retrospectively reviewed the medical records of adult patients admitted over six years with a diagnosis of dengue. Of 2216 patients, 1464 fulfilled the inclusion criteria. Group A were those patients who received folic acid and group B were those who did not. A total of 1322 (90.3%) patients received folic acid. The mean time period required for platelets to double the nadir was 1.7 (±2.2) days in …

The Proliferation Of Porcine Retinal Ganglion Cells Using Pnu 282987, Rebecca Karl, David Linn

Honors Projects

The retinal ganglion cells (RGCs) from porcine eyes were extracted to work towards a potential therapy for glaucoma. There is not a known cause of glaucoma or the apoptosis of RGCs that cause the eventual blindness associated with glaucoma. The goal of this protocol is to protect the RGCs from dying by adding a nicotinic acetylcholine receptor activator to induce neuronal proliferation and protect against glutamate-induced excitotoxicity. PNU 282987 was used as the nicotinic acetylcholine receptor activator due to its neuroprotective properties. We hypothesized that we would observe the proliferation of RGCs (associated with increased cell numbers) with varying levels …

Reconstruction Of Sternoclavicular Defect With Completely Detached Pectoralis Major Flap, Jude Opoku-Agyeman, Sergio Perez, Amir Behnam, David Matera

Plastic Surgery Resident Research

Sternoclavicular joint infection is very rare. Osteomyelitis is a known complication of septic sternoclavicular joint. Once this condition is diagnosed, aggressive management including antibiotic and surgical debridement is warranted. Patients are often left with sizeable sternoclavicular defects that may need surgical reconstruction. In this report, we describe the use of a completely detached pectoralis major flap for the reconstruction of a large sternoclavicular defect after resection for osteomyelitis. Briefly, after the debridement of the infected sternoclavicular joint, the pectoralis major was detached from its sternoclavicular attachments and further detached from the humeral attachments rendering it completely detached on a vascular …

Risk Benefit Analysis Of Treatments For Cystic Acne, Callie Elliott

Undergraduate Honors Theses

Acne is a prevalent skin disorder and is displayed through various different incidences. Cystic acne, a severe form of acne that is difficult to treat, reaches deep into the skin underneath the epidermis layer and produces painful, inflamed cysts that contain sebum, dead skin cells, and Propionobacterium acnes, the acne causing bacteria. Because this is an uncomfortable type of acne and is tough to treat, researchers have developed and tested a number of treatments to determine the best course of treatment for reducing and potentially eradicating cystic acne. These treatments are most commonly in the form of systemic or topical …

Rethinking Pulmonary Toxicity In Advanced Non-Small Cell Lung Cancer In The Era Of Combining Anti-Pd-1/Pd-L1 Therapy With Thoracic Radiotherapy., Mengqian Li, Lu Gan, Andrew Song, Jianxin Xue, You Lu

Department of Radiation Oncology Faculty Papers

The combination of programmed cell death 1/programmed cell death ligand 1 blockade and thoracic radiotherapy has become the new standard of care in the treatment of locally advanced non-small-cell lung cancer. The information regarding the pulmonary safety of such therapy remains limited to mostly retrospective studies and case reports with a small portion of data from prospective clinical trials. By analyzing the underlying mechanisms of interactions between radiation and immunotherapy from preclinical data and summarizing safety data from relevant clinical studies with pulmonary toxicity, we believe that longer and rigorous follow-up is warranted, to determine if the combination of such …

The Write Stuff - Spring 2019 (Vol.16, No.2), Research Medical Library

Write Stuff 2019

• Setting up a writing critique group
• NIH clarifies terminology regarding rigor of the prior research
• Scientific Publications’ grant proposal editing service
• European Plan S aims to mandate open access by 2020
• NIH tip: Check your funding opportunity announcement 30 days before submitting your grant application
• Unusual terms used in scientific writing and publishing: “Blinded” peer review and clinical trials

Comparison Of The Depth Of Cure Of Flowable Composites Polymerized At Variable Increment Thicknesses And Voltages: An In Vitro Study, Sadia Tabassum, Muhammad Hasan Hameed, Farhan Raza Khan

Section of Dental-Oral Maxillofacial Surgery

Objectives: The aim of this study is to compare the depth of cure of two composite materials (SDR and Filtek bulk-fill) cured at variable increment depths (2, 4, and 6 mm) and voltages (180 and 220 volts).
Materials and Methods: Each sample of the composite material was packed in a mold of 2 mm, 4 mm, and 6 mm and curing light (quartz tungsten halogen) of optimal intensity was exposed for 20 s at 2 different voltages on each specimen. After curing, the specimens were removed and the composite on the nonexposed end was scraped with a plastic instrument. The …

Subsequent Event Risk In Individuals With Established Coronary Heart Disease, Riyaz S. Patel, Vinicius Tragante, Amand F. Schmidt, Raymond O. Mccubrey, Michael V. Holmes, Laurence J. Howe, Kenan Direk, Axel Åkerblom, Karin Leander, Salim S. Virani

Office of the Provost

Background: The Genetics of Subsequent Coronary Heart Disease (GENIUS-CHD) consortium was established to facilitate discovery and validation of genetic variants and biomarkers for risk of subsequent CHD events, in individuals with established CHD.
Methods: The consortium currently includes 57 studies from 18 countries, recruiting 185 614 participants with either acute coronary syndrome, stable CHD, or a mixture of both at baseline. All studies collected biological samples and followed-up study participants prospectively for subsequent events.
Results: Enrollment into the individual studies took place between 1985 to present day with a duration of follow-up ranging from 9 months to 15 years. Within …

Patient Willingness To Undergo Robotic Surgery: Identification And Validation Of A Predictive Model, Emily C. Anania

Doctoral Dissertations and Master's Theses

INTRODUCTION: The purpose of the current dissertation is to better understand the factors which make an individual willing (or unwilling) to undergo robotic surgery. Though surgical feasibility and provider perceptions are often studied, little research has investigated how patients perceive robotic surgical systems.

METHOD: A two-stage approach was taken in order to build and validate a regression equation in order to predict an individual’s willingness to undergo robotic surgery based on several factors. Stage 1 employed a sample size of 1324 participants in order to build the model. Participants responded to a survey indicating their willingness to undergo robotic surgery, …

Improving Communication Of Asthma Related Care Between Pediatric Primary Care Providers And Schools, Jessica N. Heichel

Doctoral Projects

Introduction: Asthma is a life-altering chronic disease that affects many children throughout the state of Michigan. Evidence-based guidelines recommend a written asthma action plan (AAP) be given to all caregivers of children with asthma. This would include schools, but the plans are not making it there. This project focused on collecting school asthma data and designing a process change at a local clinic to send the plans directly to the schools.

Objectives: The goal of this project was to improve communication between healthcare providers and schools for children with asthma. The objectives were to increase the percentage of children with …

An Integrated Model Of Palliative Care In The Emergency Department To Improve Referrals, Jennifer L. Schlatter

Doctoral Projects

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations.

Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve …

Increasing Screening And Education For Human Trafficking In The Obstetric Department, Chibwe Caroline Powell

Doctoral Projects

Background: Human Trafficking, is a human rights violation with global public health implications. HT is associated with multiple health problems. Healthcare providers working in obstetrics departments are in a unique position to interact with trafficked persons. Lack of specific HT screening tools, training and education have been identified as barriers to recognizing HT victims.

Objectives: The purpose of this quality improvement project was to increase victim identification and referrals by improving screening through implementation of an interdisciplinary screening tool into the EHR workflow and providing HT education.

Methods: This project examined the impact of implementing a HT screening tool and …

An Evidence-Based Toolkit For Early Identification Of Frail Inmates, Morgan A. Kochajda

Doctoral Projects

There are significant numbers of people aging and nearing end of life while being incarcerated (Richter & Hostettler, 2017). Currently the Department of Corrections (DOC) does not have a standardized process for early identification of inmates who may need increased end of life care services. A potential solution to this problem would be the use of a frailty screening tool for early identification of those inmates who may need increased resources. At this time, there is not a formalized relationship between a Midwest hospice and palliative care department and the DOC. There is a desire from leadership of the hospice …

Evidence-Based Toolkit For Reduction Of Overdose Risk In Primary Care Patients On Opioid Therapy, Katelin A. Aris

Doctoral Projects

Introduction: Opioids are powerful pain killing medications that can be highly addictive and can cause risk for overdose and even death (Michigan Prescription Drug and Opioid Task Force, 2015). Many primary care providers treat patients with acute and chronic pain, although it is recognized that many receive inadequate training in pain management and feel unprepared in the complexities of caring for these patients (Becker, Bair, Picchioni, Starrels, and Frank, 2018). To treat these patients safely, provider education and adherence to guidelines put forward by these initiatives is essential.

Methods: An evidence-based prescribing toolkit was devised using guidance from the literature …

Developing An Evidence-Based Supportive Services Program For Cancer Survivors In A Private Oncology Practice, Joseph Ellul

Doctoral Projects

Improvements in cancer treatment have led to a rapidly increasing survivor population. In response, multiple side effects of cancer and cancer treatment as well as the various wellness needs of survivors have been recognized. Survivorship programs have been developed to care for survivors with residual effects of cancer and the side effects of treatment; however, additional support is needed. The purpose of the project was to highlight the need for a comprehensive supportive services program for the cancer survivor population and describe the steps that were required to successfully develop the program. The clinical question addressed by the project was: …

Implementation Of Evidence-Based Chronic Non-Malignant Pain Management Protocol For Primary Care, Jenny E. Kipp

Doctoral Projects

Chronic pain is the most prevalent health condition in the United States and is the most common reason people seek healthcare (Chang, Daubresse, Kruszewski & Alexander, 2014). In 2012, health care providers wrote 259 million prescriptions for opioid pain medications despite little change in self-reported pain prevalence (Centers for Disease Control and Prevention (CDC) 2016; Chang et al., 2014). Initiatives to prevent the under treatment of pain have resulted in overreliance on opioids to treat pain. As a consequence of opioid centric prescribing, an opioid epidemic has evolved with devastating consequences such as dependence, addiction and overdose deaths related to …

Improving Advance Care Planning Documentation In A Home Based Primary Care Program, Emily Radtke

Doctoral Projects

Advance care planning (ACP) is an importance process of reflection and communication regarding one’s preferences for future health care (Hagen et al., 2015). Findings from research indicate that advance care planning supports patient autonomy, improves quality of end-of-life, and increases patient and provider satisfaction (Bischoff at al., 2013; Brinkman-Stoppelenburg et al., 2014). To promote advance care planning discussion, the Centers for Medicare and Medicare Services (2016) made a decision to compensate health care providers for face-to-face conversations regarding future treatment associated with serious illness, offering two new current procedural terminology billing codes for ACP. The Plan-Do-Study-Act model (AHRQ, 2018) was …

Management Of Distress In Adult Oncology Patients, Lauren Jongsma

Doctoral Projects

Cancer related distress has the potential to negatively impact the health of the patient and their treatment outcome (Grassi, Spiegel, & Riba, 2017). As identification and treatment of distress has a positive impact on patient outcomes; the Commission on Cancer (2016) required distress screening for accreditation. Key stakeholders within a Midwest hospital system expressed a desire for the improvement in the current state of the distress screening. Thus, the scholarly paper describes the key attributes of the organizational assessment, a literature review on evidence-based distress screening tool and a quality improvement project. The Promoting Action on Research Implementation in Health …

Evidence-Based Toolkit To Evaluate Telemedicine Delivery Of Palliative Care, Aubrey E. Dwyer

Doctoral Projects

Advances in healthcare have led to many individuals with cancer to live longer, however the quality of life of these individuals has decreased. Palliative care is a medical sub-specialty that can assist to care for individuals with a life-limiting illness such as cancer. However, the access to palliative care services in rural communities is limited. According to the Institute of Medicine (IOM) report Dying in America, increasing access to palliative care will not only enhance the quality of life for patients with a life-limiting illness, but also contribute to a more sustainable healthcare system. The key stakeholders within a Midwest …

Nurse Care Manager Impact On Type 2 Diabetes Mellitus At A Rural Primary Care Practice, Patrick Joswick

Doctoral Projects

Background: Type 2 Diabetes Mellitus is a common diagnosis managed in the primary care setting. Patients with an uncontrolled state of the condition are most vulnerable to develop complications from the disease. Consequently, type 2 diabetes remains as the leading cause of end stage renal disease and nontraumatic limb amputations.

Objectives: To improve type 2 diabetes quality measures, improve documentation of quality measures, increase the continuity of care, and create a streamlined workflow and communication within an interdisciplinary team.

Methods: Quality improvement project to establish multifaceted management of type 2 diabetes. Data on the management of care was gathered pre-/post-implementation …

Implementation Of An Evidence Based Screening Protocol To Improve The Diagnosis Of Dementia In A Home-Based Primary Care Setting, Lauren Liesbeth Sutton

Doctoral Projects

Dementia is a major public health concern that is both debilitating and deleterious to those afflicted with its various forms. The number of those living with dementia is increasing exponentially as the population continues to rise, with 46.8 million people worldwide currently afflicted with dementia (Chow et al., 2018). Dementia causes cognitive impairment that is severe enough to affect everyday function (Chow et al., 2018). The impairment and disability resulting from dementia indicates a significant health problem in primary care. Findings from research studies indicate that prophylactic and periodic screening for dementia can heighten provider suspicion and translate into earlier …

Preoperative Anemia Management In Adult Outpatient Coronary Artery Bypass Graft Surgical Patients To Improve Treatment Of Preoperative Anemia, Katherine Mills

Doctoral Projects

The transfusion of blood products can lead to life-threatening complications after surgery. In addition, blood products are a scarce and expensive resource. Even though anemia in coronary artery bypass surgery patients is currently undertreated, research has shown that the intravenous infusion of iron products, as well as a single dose of erythropoietin-alpha prior to surgery, decreases the amount of blood products used in the perioperative setting. The goal of this pilot project was to increase the number of patients screened for anemia, and if necessary, treated prior to coronary artery bypass graft surgery.

Methods: This was a practice improvement, pilot …