Medical Specialties Commons^™

New Persistent And Chronic Opioid Use In Cancer Survivors After Curative Intent Radiation, Elena V. Fernández

Theses and Dissertations

Background: Emerging evidence suggests that as more patients are surviving cancer, new persistent opioid use (no prior exposure to opioids before cancer therapy but requiring opioid prescriptions after curative intent treatment; NPOU) is of greater concern. In patients receiving curative intent radiation (definitive radiation therapy and as treatment for cure; CIR), the extent to which patients develop NPOU or continue opioid use (COU) following CIR is not known. Neither are factors associated with NPOU or COU, opioid doses, or time to discontinuation (TTD) of opioids in 5CS known. Objectives: Describe longitudinal trends opioid use in cancer survivors who received CIR, …

The Impact Of The Fda Warning On Post-Tonsillectomy Opioid Prescribing In Publicly And Privately Insured Children, Dianna J. Soelberg

Theses and Dissertations

Due to reports of significant adverse events, the U.S. FDA placed a Boxed Warning on the opioid codeine in February 2013 – contraindicating its use in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Studies conducted in privately insured children showed a reduction in codeine prescribing and a slight increase in alterative opioid prescribing following the FDA warning, yet the extent to which the FDA warning impacted prescribing in publicly insured children is unknown. Using a quasi-experimental interrupted time series design, this study evaluated codeine and alternative opioid prescribing before and after the FDA warning in both publicly and privately insured children …

Black Women And Body Image: Implications Of The Racialized Beauty Aesthetic, Rachel L. Boutte

Theses and Dissertations

Black women have the highest prevalence of overweight and obesity relative to any other demographic group in the United States, however current weight management interventions appear least effective for them. Although several hypotheses have been proposed to explain these outcomes, few studies have collected data to evaluate how well they fit the lived experiences of Black women. In particular, the potential roles of body image and body dissatisfaction in the development and maintenance of overweight and obesity in Black women are not well understood. Extant literature largely reports that Black women are inoculated from body dissatisfaction due to cultural factors, …

Investigation Of Molecular Mechanisms Of Liver Preservation Injury: A Complication Preceding Organ Transplantation, Ria C. Fyffe-Freil

Theses and Dissertations

Of the over 108,000 American awaiting a life-saving organ transplant today, over 12,000 (11%) of those need a new liver (OPTN, 2020). Last year, only 35% of patients on the waiting list for an organ were transplanted. Improving the quality of marginal organs by preventing or reversing preservation injury could vastly increase the number of transplants performed. Washout of circulating blood during liver procurement with cold University of Wisconsin solution flushes out any endogenous pro-survival signaling molecules. We investigated lysophospholipid (LPL) surface receptors (G-protein coupled receptors for lysophosphatidic acid (LPA) and sphingosine- 1-phosphate (S1P)) and their role in protecting hepatocytes …

Covid-19 Sampling From The Middle Ear And Mastoid: A Case Report, George B Wanna, Zachary G Schwam, Vivian F Kaul, Maura K Cosetti, Enrique Perez, Peter Filip, Waleed Javaid, Avi Kandel, Alberto Paniz-Mondolfi, Satish Govindaraj, Eric M Genden

Faculty, Staff and Student Publications

No abstract provided.

Microbiotyping The Sinonasal Microbiome, Ahmed Bassiouni, Sathish Paramasivan, Arron Shiffer, Matthew R Dillon, Emily K Cope, Clare Cooksley, Mahnaz Ramezanpour, Sophia Moraitis, Mohammad Javed Ali, Benjamin S Bleier, Claudio Callejas, Marjolein E Cornet, Richard G Douglas, Daniel Dutra, Christos Georgalas, Richard J Harvey, Peter H Hwang, Amber U Luong, Rodney J Schlosser, Pongsakorn Tantilipikorn, Marc A Tewfik, Sarah Vreugde, Peter-John Wormald, J Gregory Caporaso, Alkis J Psaltis

Faculty, Staff and Student Publications

This study offers a novel description of the sinonasal microbiome, through an unsupervised machine learning approach combining dimensionality reduction and clustering. We apply our method to the International Sinonasal Microbiome Study (ISMS) dataset of 410 sinus swab samples. We propose three main sinonasal “microbiotypes” or “states”: the first is Corynebacterium-dominated, the second is Staphylococcus-dominated, and the third dominated by the other core genera of the sinonasal microbiome (Streptococcus, Haemophilus, Moraxella, and Pseudomonas). The prevalence of the three microbiotypes studied did not differ between healthy and diseased sinuses, but differences in their distribution were evident based …

Educational Case: Systemic Mastocytosis With An Associated Hematological Neoplasm, Brenda Mai, Md A Wahed, Lei Chen, Nghia D Nguyen, Xiaohong Iris Wang, Zhihong Hu

Faculty, Staff and Student Publications

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1

Recanalization Of The Chronically Occluded Internal Carotid Artery: Review Of The Literature., Mario Zanaty, Jorge A. Roa, Pascal Jabbour, Edgar A. Samaniego, David M. Hasan

Department of Neurosurgery Faculty Papers

Introduction: We reviewed the literature on interventions for patients with medically refractory chronically occluded internal carotid artery (COICA) to assess the risks and/or benefits after recanalization via an endovascular technique (ET) or hybrid surgery (HS, i.e., ET plus carotid endarterectomy).

Methods: A systematic search of the electronic databases was performed. Patients with COICA were classified into 4 different categories according to Hasan et al classification.

Results: Eighteen studies satisfied the inclusion criteria. Only 6 studies involved an HS procedure. We identified 389 patients with COICA who underwent ET or HS; 91% were males. The overall perioperative complication rate was 10.1% …

Early Surgery For Traumatic Spinal Cord Injury: Where Are We Now?, Jefferson R. Wilson, Christopher D. Witiw, Jetan Badhiwala, Brian K. Kwon, Michael G. Fehlings, James Harrop

Department of Neurosurgery Faculty Papers

Study Design: Narrative review.

Objective: There is a strong biological rationale to perform early decompression after traumatic spinal cord injury (SCI). With an enlarging clinical evidence base, most spine surgeons internationally now favor early decompression for the majority of SCI patients; however, a number of pertinent questions remain surrounding this therapy.

Methods: A narrative review evaluating the status of early surgery for SCI. In particular, we addressed the following questions: (1) Which patients stand to benefit most from early surgery? 2) What is the most appropriate time threshold defining early surgery?

Results: Although heterogeneity exists, the evidence generally seems to …

Minimizing Blood Loss In Spine Surgery., Christopher Mikhail, Zach Pennington, Paul M Arnold, Darrel S Brodke, Jens R Chapman, Norman Chutkan, Michael D Daubs, John G Devine, Michael G Fehlings, Daniel E Gelb, George M Ghobrial, James S Harrop, Christian Hoelscher, Fan Jiang, John J Knightly, Brian K Kwon, Thomas E Mroz, Ahmad Nassr, K Daniel Riew, Lali H Sekhon, Justin S Smith, Vincent C Traynelis, Jeffrey C Wang, Michael H Weber, Jefferson R Wilson, Christopher D Witiw, Daniel M Sciubba, Samuel K Cho

Department of Neurosurgery Faculty Papers

Study Design: Broad narrative review.

Objective: To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery.

Methods: A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery.

Results: There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous …

Implementation Of A Spine-Centered Care Pathway At A Regional Academic Spine Center., George M Ghobrial, Jefferson Wilson, Daniel Franco, Kristen Vogl, Alexander R Vaccaro, James S Harrop

Department of Neurosurgery Faculty Papers

Study Design: Retrospective case series.

Objective: To describe the early implementation of an inpatient spinal surgery unit and measure the impact on cost and length of stay (LOS).

Methods: A retrospective case review was performed for frequent spine-related diagnosis-related groups (DRGs) cared for by a dedicated multidisciplinary team: combined anterior/posterior (AP) spinal fusion with major complicating or comorbid condition (MCC), combined (AP) spinal fusion with CC, combined (AP) spinal fusion without complicating or comorbid (CC)/MCC, cervical spinal fusion with MCC, cervical spinal fusion with CC, and cervical spinal fusion without CC/MCC. Four time periods were compared: historical control, initial pathway …

Impact Of Learning Support Intervention On Preclinical Students' Conception Of Self-Regulated Learning: A Quasi-Experimental Study Based On The Motivated Strategies For Learning Questionnaire, Kodiappan Radha

Student Works (2020-2029)

Self-regulated learning (SRL), which includes the ability to regulate motivational, cognitive and metacognitive strategies based on the contextual and task demand, is recognized as a critical element for lifelong learning. However, past literature indicate a deficit in undergraduate medical students’ capabilities to self-regulate their learning and shortcoming of implicit methods to develop students’ SRL in medical schools. Thus, the objectives of this research were to analyse (i) the baseline level of the preclinical students’ SRL and (ii) the impact of the learning support intervention on the students’ conception of SRL. These objectives were approached from the perspectives of the students’ …

A Rare Case Of Bleeding Epiphrenic Esophageal Diverticulum From Arteriovenous Malformations., Franklin L. Thelmo, Harvey Guttmann, Waqas Ullah, Ahmad Arslan, Eugen Brailoiu

Abington Jefferson Health Papers

Epiphrenic esophageal diverticula (EED) is a rare condition that usually presents with dysphagia in patients with a known motility disorder. In this article, we present a unique case of EED presenting with hemoptysis with clinical workup negative for any pulmonary pathology. Esophagogastroduodenoscopy revealed arteriovenous malformations within the EED successfully managed with argon plasma coagulation (APC), leading to a resolution of the patient's symptoms.

Proprotein Convertase Subtilisin/Kexin Type-9 (Pcsk-9) Inhibitors Induced Liver Injury - A Retrospective Analysis., Yousuf Zafar, Yasar Sattar, Waqas Ullah, Sohaib Roomi, Mamoon-Ur- Rashid, Muhammad Shayan Khan, Laura Schmidt

Abington Jefferson Health Papers

Background: Proprotein convertase subtilisin/Kexin type 9 (PCSK-9) inhibitors induced liver dysfunction in patients with or without previous liver injury, and this is not well discussed in the previous literature.

Methods: A total sample of 202 patients were retrospectively reviewed at the University of Missouri, Kansas City, from the year 2015 to 2018 based on predefined selection criteria. Inclusion criteria involved patients with dyslipidemia, with or without PCSK-9 inhibitors, liver function tests and lipid profile at baseline and at a mean of 6-month follow-up. The variables, including age, gender, and confounding factors like other medications (statin, oral antidiabetic, and antihypertensive) induced, …

Diabetes Risk Status And Physical Activity In Pregnant Women: U.S. Brfss 2011, 2013, 2015, 2017, Bethany Rand

UNF Graduate Theses and Dissertations

Objective: We sought to examine differences in aerobic activity (AA) and muscle-strengthening activity (MSA) by diabetes risk status (DRS) among pregnant women in the United States.

Background: Pregnant women without complications are advised to engage in physical activity (PA) to mitigate adverse outcomes. Differences may exist among pregnant women of diverging diabetes status in meeting national PA recommendations.

Methods: The sample (n=9,597) included pregnant women ages 18-44, who participated in 2011, 2013, 2015, and 2017 Behavioral Risk Factor Surveillance System. Levels of DRS were: no diabetes (ND), high risk for diabetes (HRD) due to self-reported gestational diabetes or …

Understanding The Context And Social Processes That Shape Person- And Family-Centered Culture In Long-Term Care: The Pivotal Role Of Personal Support Workers, Ellen Helena Melis

Antioch University Dissertations & Theses

This single, exemplar case study explored the context and social processes that shape person-and family-centered culture in a long-term care (LTC) home, using grounded theory and situational analysis for the data collection and analysis. Findings revealed one core dimension: needing to be heard, valued, and understood, and five key roles: personal support workers (PSWs), executive director (ED), senior leadership, nurse managers, and residents and families, which informed five dimensions, each focused on enhancing care for residents: (a) attending to residents’ daily care needs (PSWs), (b) advocating strategically (ED), (c) translating vision into programs and policies (senior leadership), (d) ensuring quality …

Nothing New Under The Sun: How Existing Screening Programs Can Inform The Design Of Social Determinants Of Health Screening In Health Care., Bradley Iott, Denise Anthony, Jessica Pater, Shauna Wagner, Tammy Toscos Phd, Tiffany Veinot

Health Services and Informatics Research

Research Objective Up to 80% of the factors contributing to an individual’s health status are social determinants of health (SDOH). As healthcare systems transition to value-based payment models which compensate providers for patient health outcomes, many have called for healthcare organizations to screen patients for SDOH-related social needs and for providers to consider them when providing medical care. Screening for social needs is expected to involve collecting information that may make patients feel vulnerable, creating a need to develop screening methods that emphasize patient comfort. Similarly, social needs screening may place burdens on providers that have limited training and time …

Exercise And Nutrition Induced Weight Loss For Prostate Cancer Patients, Rebekah Louise Wilson

Theses: Doctorates and Masters

This thesis encompasses six main chapters - two reviews and four experimental chapters, in addition to a general introduction and discussion.

Review 1 (Chapter 2) is a discussion of the negative impact of obesity on prostate cancer prognosis and common prostate cancer treatments.

Review 2 (Chapter 3) is an evaluation of the current literature examining prostate cancer patients receiving androgen deprivation therapy (ADT) and how exercise and nutrition interventions can be used to induce fat loss, while preserving or improving lean mass.

Study 1 (Chapter 4) is an examination of the efficacy of a weight loss program in altering body …

Potential Roles Of Extracellular Vesicles In The Pathophysiology, Diagnosis, And Treatment Of Autoimmune Diseases., Jing Tian, Giacomo Casella, Yuan Zhang, Abdolmohamad Rostami, Xing Li

Department of Neurology Faculty Papers

Since extracellular vesicles (EVs) were discovered in 1983 in sheep reticulocytes samples, they have gradually attracted scientific attention and become a topic of great interest in the life sciences field. EVs are small membrane particles, released by virtually every cell that carries a variety of functional molecules. Their main function is to deliver messages to the surrounding area in both physiological and pathological conditions. Initially, they were thought to be either cell debris, signs of cell death, or unspecific structures. However, accumulating evidence support a theory that EVs are a universal mechanism of communication. Thanks to their biological characteristics and …

Emerging Regenerative Medicine And Tissue Engineering Strategies For Parkinson's Disease., James P Harris, Justin C Burrell, Laura A Struzyna, H Isaac Chen, Mijail D Serruya, John A Wolf, John E Duda, D Kacy Cullen

Department of Neurology Faculty Papers

Parkinson's disease (PD) is the second most common progressive neurodegenerative disease, affecting 1-2% of people over 65. The classic motor symptoms of PD result from selective degeneration of dopaminergic neurons in the substantia nigra pars compacta (SNpc), resulting in a loss of their long axonal projections to the striatum. Current treatment strategies such as dopamine replacement and deep brain stimulation (DBS) can only minimize the symptoms of nigrostriatal degeneration, not directly replace the lost pathway. Regenerative medicine-based solutions are being aggressively pursued with the goal of restoring dopamine levels in the striatum, with several emerging techniques attempting to reconstruct the …

Conditions For Combining Gene Therapy With Bone Marrow Transplantation In Murine Krabbe Disease., Mohammad Rafi, Paola Luzi, David A Wenger

Department of Neurology Faculty Papers

No abstract provided.

High Lymph Node Positive To Sampled Ratio As A Potential Indication For Postoperative Radiation Therapy In Patients With Pn2 Non-Small-Cell Lung Cancer, Nikhil P Mankuzhy, Muayad F Almahariq, Craig W Stevens, Thomas J Quinn

Articles

Background: The role for postoperative radiation therapy (PORT) for patients with non–small-cell lung cancer (NSCLC) with mediastinal lymph node (LN) involvement (pN2 disease) is controversial. We performed a SEER analysis comparing surgery alone with PORT among patients with pN2 NSCLC. As we await the final results of the LUNG ART trial, a subset of patients with a high LN positive to sampled (LPR) ratio may benefit from PORT. Patients/methods: Patients with pN2 NSCLC, ranging from 1989-2016, were assessed from the Surveillance, Epidemiology and End Results (SEER) database. A propensity score (PS)-matched, inverse probability of treatment weighting (IPTW) analysis was conducted …