Medical Specialties Commons^™

Interpersonal Psychotherapy Delivered By Nonspecialists For Depression And Posttraumatic Stress Disorder Among Kenyan Hiv–Positive Women Affected By Genderbased Violence: Randomized Controlled Trial, Susan M. Meffert, Thomas C. Neylan, Charles E. Mcculloch, Kelly Blum, Craig R. Cohen, Elizabeth Bukusi, Helen Verdel, John C. Markowitz, James G. Kahn, David Bukusi

Obstetrics and Gynaecology, East Africa

Background: HIV–positive women suffer a high burden of mental disorders due in part to gender-based violence (GBV). Comorbid depression and posttraumatic stress disorder (PTSD) are typical psychiatric consequences of GBV. Despite attention to the HIV-GBV syndemic, few HIV clinics offer formal mental healthcare. This problem is acute in sub-Saharan Africa, where the world’s majority of HIV–positive women live and prevalence of GBV is high.

Methods and findings: We conducted a randomized controlled trial at an HIV clinic in Kisumu, Kenya. GBV-affected HIV–positive women with both major depressive disorder (MDD) and PTSD were randomized to 12 sessions of interpersonal psychotherapy (IPT) …

Learning From Changes Concurrent With Implementing A Complex And Dynamic Intervention To Improve Urban Maternal And Perinatal Health In Dar Es Salaam, Tanzania, 2011-2019, Brenda Sequeira Dmello, Ziada Sellah, Grace Magembe, Natasha Housseine, Nanna Maaløe, Thomas Van Den Akker, Dan W. Meyrowitsch, Timothy Mushi, Mangalu Masweko, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Introduction: Rapid urbanisation in Dar es Salaam, the main commercial hub in Tanzania, has resulted in congested health facilities, poor quality care, and unacceptably high facility-based maternal and perinatal mortality. Using a participatory approach, the Dar es Salaam regional government in partnership with a non-governmental organisation, Comprehensive Community Based Rehabilitation in Tanzania, implemented a complex, dynamic intervention to improve the quality of care and survival during pregnancy and childbirth. The intervention was rolled out in 22 public health facilities, accounting for 60% of the city’s facility births.

Methods: Multiple intervention components addressed gaps across the maternal and perinatal continuum of …

Covid-19 And Teleneurology In Sub-Saharan Africa: Leveraging The Current Exigency, Philip Adebayo, Olusegun John Oluwole, Funmilola Tolulope

Internal Medicine, East Africa

Africa has over 1.3 billion inhabitants, with over 60% of this population residing in rural areas that have poor access to medical experts. Despite having a ridiculously huge, underserved population, very few African countries currently have any form of sustained and organized telemedicine practice, and even fewer have dedicated tele-neurology services. The ongoing COVID-19 pandemic has proved to be one of the most significant disruptors of vital sectors of human endeavor in modern times. In the healthcare sector, there is an increasing advocacy to deliver non-urgent care via telemedicine. This paper examined the current state of tele-neurology practice and infrastructural …

Routine Outpatient Electrocardiogram: What Is The Diagnosis?, Muzamil Khawaja, Vincent R J Siebert, John Allison, Yochai Birnbaum

The Texas Heart Institute Journal

No abstract provided.

Improper Use Of Temporary Epicardial Pacing Wires, Emre Kubat, Isil Tasoz, Kubilay Karabacak, Suat Doganci

The Texas Heart Institute Journal

No abstract provided.

Single-Dose Del Nido Cardioplegia Compared With Standard Cardioplegia During Coronary Artery Bypass Grafting At A Veterans Affairs Hospital, Michael R Reidy, Ernesto Jimenez, Shuab Omer, Lorraine D Cornwell, Sabrina X Runbeck, Ourania Preventza, Gabriel Loor, Todd K Rosengart, Joseph S Coselli

The Texas Heart Institute Journal

Del Nido cardioplegic solution (DNC), used chiefly in pediatric patients, rapidly induces prolonged cardiac arrest during cardiac surgery. To determine whether surgical outcomes after coronary artery bypass grafting in a United States military veteran population differed when DNC was used instead of our standard Plegisol cardioplegia, we retrospectively reviewed 155 consecutive operations performed from July 2016 through June 2017. Del Nido cardioplegia was used to induce cardiac arrest in 70 patients, and Plegisol in 85. Compared with the Plegisol group, the DNC group had a shorter mean cardiopulmonary bypass time (96.8 vs 117 min; P48 hours, atrial fibrillation, tracheostomy, reintubation, …

Benign Metastasizing Leiomyoma In The Heart Of A 45-Year-Old Woman, Mohamad Karnib, Isaac Rhea, Robin Elliott, Saneka Chakravarty, Sadeer G Al-Kindi

The Texas Heart Institute Journal

We report a rare case of benign metastasizing leiomyoma in the heart of a 45-year-old woman 2 years after a uterine leiomyoma had been discovered during hysterectomy. Computed tomograms at presentation showed a large mixed cystic mass in the pelvis and bilateral lung nodules suggestive of metastatic disease. A large cardiac mass, attached to the chordae of the tricuspid valve and later shown to be histopathologically consistent with uterine leiomyoma, was successfully resected through a right atriotomy. This case suggests that benign metastasizing leiomyoma should be considered in the differential diagnosis of right-sided cardiac tumors.

The Primary Care Provider’S Role In Screening And Intervening In The Human Trafficking Of Adolescents: A Systematic Literature Review, Brittany Schmid

All Graduate Theses, Dissertations, and Other Capstone Projects

Human trafficking (HT) is a growing concern within the United States (U.S.) and internationally. With the alarming number of HT victims presenting for medical care, primary care providers (PCPs) are in a unique and privileged position to encounter HT victims within the healthcare system. Adolescents, in particular, are vulnerable to HT because of minimal life experiences, inadequate social support, and limited coping mechanisms (Ertl et al., 2020). Failure to recognize and intervene in cases involving HT victims who are minors is detrimental to the individual’s health, wellbeing, and safety. With the assistance of education and training, community resources, guideline adoption, …

The Impact Of Social Isolation And Cognitive Decline In Older Adults: A Systematic Literature Review, Jody L. Doll-Wilhelm

All Graduate Theses, Dissertations, and Other Capstone Projects

Background: During the COVID-19 pandemic, deaths of Alzheimer’s Disease (AD) and dementia patients surged. Increased social isolation and decreased activity levels in older adults have been suggested as contributing factors to accelerating AD and dementia. However, assessment tools to gauge interventions and outcomes of cognitive decline are variable among the literature.

Objective: Examine the impact of social engagement versus social isolation, like that experienced with the COVID-19 pandemic, on cognitive decline/dementia in older adults (greater than 60 years of age).

Method: A systematic search for studies evaluating the relationship between social isolation and social activity in cognitive …

Effectiveness Of Behavior-Based Counseling For Weight Loss Maintenance: A Systematic Literature Review, Jaime V. Stanczyk

All Graduate Theses, Dissertations, and Other Capstone Projects

Obesity is linked to the development of chronic health conditions such as diabetes, hypertension, and atherosclerotic cardiovascular disease (ASCVD) at an annual expense of $147 billion in related healthcare costs. Effective lifestyle modification treatment for long-term WLM remains elusive. Traditional advice from primary care providers regarding dietary modification and increased physical activity has not led to WLM as a long-term outcome. Newer guidelines for the treatment of obesity now recommend high-intensity behavior-based counseling (BBC) programs that deliver traditional weight loss education in tandem with behavior-change strategies. Methods: A database search was conducted for peer reviewed literature published in 2012-2020 on …

Advance Care Planning And Palliative Care In Heart Failure: A Literature Review, Laura Dack

All Graduate Theses, Dissertations, and Other Capstone Projects

Despite advancing therapies, heart failure remains a progressive disease with high symptom burden. Advance care planning and palliative care assist in maximizing the quality of life for affected individuals. These interventions are supported by current heart failure guidelines yet application into practice is poor. The purpose of this literature review is to investigate the relationship between advance care planning and palliative care interventions on the quality of life of adults with heart failure. A search of the literature was completed between October 20^th, 2020 to November 10^th, 2020. Databases searched include Academic Search Premier, CINAHL Plus, …

Choosing Between Medical Surveillance And Preventive Surgical Interventions Among Asymptomatic Brca Positive Women, Hillary Zupan

All Graduate Theses, Dissertations, and Other Capstone Projects

Women with a known BRCA 1 or BRCA 2 genetic mutation are at an increased risk for the development of cancer, most commonly breast and uterine types. Risk reduction strategies to manage cancer risk include increased medical surveillance and various preventive surgeries. This is a deeply personal decision and one that is influenced by a variety of factors. The aim of this literature review is to identify the key factors impacting the decision-making process of a woman with a BRCA mutation and how a woman ultimately decides between the cancer risk management strategies. Six electronic databases were used to obtain …

Why End-Of-Life Discussion Matters: A Systematic Literature Review, Emily Grandson

All Graduate Theses, Dissertations, and Other Capstone Projects

End-of-life (EOL) discussions are a challenging yet vital topic of conversation in intensive care units (ICU) between healthcare providers, patients, and their families. There is great disparity in where, when, and how EOL discussions take place, but the consequences of neglecting their importance can be devastating physically, psychologically, and financially for all parties involved. Multiple inadequacies in the EOL discussion process have not only contributed to a personal and societal financial burden but an unacceptable quality of death for many ICU patients. A literature review was performed to determine what practice and policy changes could be made to improve EOL …

Perceived Barriers And Facilitators To Cervical Cancer Screening In Asian American Women, Bouathong Thepsombath

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this systematic review is to explore barriers and facilitators of cervical cancer screening in Asian-American women. Articles selected for review were found using a database search method using select predetermined key terms. The clinical question this review sought to answer is: In Asian-American women (21-65 years of age), how does perception of cervical cancer screening impact screening compliance? Nine articles addressing the topic of interest were included in the review. Emerging themes related to answering the question under study included the health literacy of Asian-American women, modesty, acculturation, income comfortability, and self-efficacy. This review found information that …

Reducing Polypharmacy In Older Adults At End Of Life: The Outcome On Quality Of Life, Melissa Jenson

All Graduate Theses, Dissertations, and Other Capstone Projects

Background: Older adults at the end of life are commonly prescribed multiple medications which can lead to polypharmacy. Research has shown that optimizing medications through targeted deprescribing reduces inappropriate medications, reduces adverse effects and improves select outcomes. However, the impact of deprescribing remains uncertain--specifically whether this intervention improves quality of life (QOL). Objective: Explore polypharmacy in older adults at the end of life examining outcomes of deprescribing on the QOL. Methods: A systematic literature search using Academic Search Premier, CINAHL, Medline, JSTOR and Nursing and Allied Health Database was conducted between October 2020 to November 2020. Select articles …

Cannabis Treatment Of Autism In Children: A Literature Review, Mai Xiong

All Graduate Theses, Dissertations, and Other Capstone Projects

Objectives: This literature review aims to summarize the effects of medical cannabis use in children on Autism Spectrum Disorder (ASD) symptoms, side effects and provide recommendations for practice, education, and research. Background: ASD is characterized by core behaviors of significant impairment in social communication and interaction and restricted and repetitive patterns of behavior, interests, or activities (APA, 2013). In addition to these core behaviors, individuals with ASD often have noncore behavioral disorders and several medical comorbidities. Treatment for ASD symptoms includes Cognitive Behavioral Therapy (CBT), aripiprazole (Abilify) and/or risperidone (Risperdal). As of this review, 14 states have added ASD …

Determining Risk Factors That Affect Progression In Patients With Nonproliferative Diabetic Retinopathy, Dalbert J Chen, Jacky C Kuo, Alex J Wright, Alice Z Chuang, Wenyaw Chan, Robert M Feldman, Eric L Crowell

Faculty, Staff and Student Publications

PURPOSE: to determine risk factors that affect nonproliferative diabetic retinopathy (NPDR) progression and establish a predictive model to estimate the probability of and time to progression in NPDR.

RESULTS: Two hundred thirty patients were included. Initially, 65 eyes (28.3%) had no retinopathy; 73 (31.7%) mild NPDR; 60 (26.1%) moderate NPDR; and 32 (13.9%) severe NPDR. Patients were followed for a mean of 5.8 years (±2.0 years; range 2.1-9.4 years). 164 (71.3%) eyes progressed during the follow-up. Time-independent risk factors affecting progression rate were age (hazard ratio (HR) = 0.99,

CONCLUSION: HbA1c level is a significant modifiable risk factor in controlling …

A Multivariable Model Of Parent Satisfaction, Pain, And Opioid Administration In A Pediatric Emergency Department, Candice D. Donaldson, Thomas W. Heyming, Louis Ehwerhemuepha, Brooke N. Jenkins, Michelle A. Fortier, William Feaster, Zeev N. Kain

Psychology Faculty Articles and Research

Introduction: Children and adolescents are not impervious to the unprecedented epidemic of opioid misuse in the United States. In 2016 more than 88,000 adolescents between the ages of 12–17 reported misusing opioid medication, and evidence suggests that there has been a rise in opioid-related mortality for pediatric patients. A major source of prescribed opioids for the treatment of pain is the emergency department (ED). The current study sought to assess the complex relationship between opioid administration, pain severity, and parent satisfaction with children’s care in a pediatric ED.

Methods: We examined data from a tertiary pediatric care facility. A health …

Women’S Perception Of Preeclampsia And Antenatal Care Attendance In Northwestern Nigeria, Aisha Nana Adamu

Walden Dissertations and Doctoral Studies

Researchers have demonstrated a significant relationship between antenatal care (ANC) attendance and pregnant women’s sociodemographic characteristics. What has not been clearly studied is the relationship between ANC attendance and pregnant women’s perceptions about conditions such as preeclampsia (PE) that could affect their pregnancies. ANC could facilitate the timely management of these conditions, ultimately improving the outcomes for PE affected women. In this study the relationship between pregnant women’s perceptions about PE and their ANC attendance was examined. Guided by the health belief model (HBM), the research questions were used to explore the associations between four HBM constructs (perceived susceptibility, severity, …

Prevention And Self-Care Education For Osteoporosis In A Rural Orthopedic Clinic, Jean Sanford

Walden Dissertations and Doctoral Studies

Abstract Osteoporosis affects 25 million people in the United States causing over 1.5 million fractures every year. The gap in practice at a rural southeast orthopedic clinic was a lack of patient education on prevention and self-care management of osteoporosis and osteopenia. The purpose of the project was to develop a program to educate clinic providers on prevention and self-care management for osteoporosis and osteopenia. The Knowles theory of adult learning framed the project components. A 10-question pretest/posttest assessing knowledge was administered to 10 registered nurse participants. For the presurvey, five participants demonstrated a lack of knowledge of medication administration …

Chronic Pain, Malingering, And The Word Memory Test, Dawn Marie Emmett Bishop

Walden Dissertations and Doctoral Studies

AbstractThe importance of using scientifically grounded strategies to detect malingering has been established in the literature and past research. Many reliable tools have been established for the detection of malingered neurocognition; however, research on how pain may affect these tools is sparse. The purpose of this study was to investigate the effect of pain on cognitive symptom validity testing and to establish the validity of the Word Memory Test (WMT), a cognitive symptom validity test with good sensitivity and specificity, when the test taker is feigning pain (simulating) or remembering pain. The biopsychosocial model and the gate theory of pain …

Impact Of 17-Beta Estradiol And Moderate-Intensity Exercise On Mesenteric Arterial Function Of Uc Davis Type-2 Diabetes Mellitus Rats, Md Rahatullah Razan

University of the Pacific Theses and Dissertations

The studies in this dissertation were designed to investigate the impacts of estrogen (17-β estradiol/E2) and moderate-intensity exercise (MIE) on the mesenteric arterial (MA) function of the University of California Davis type-2 diabetes mellitus (UCD-T2DM) Rat model. Our recent report suggests that diabetes impairs MA vasorelaxation in both sexes of the UCD-T2DM model. Particularly, we reported that MA from prediabetic male rats showed a greater impairment compared to that in prediabetic females. However, when females become diabetic, they exhibit a greater vascular dysfunction than males. Therefore, the aim of the first study was to investigate whether female sex hormone, specifically …

Athletics As A Life Curriculum: Lessons Learned Through Different Aspects Of Athletics, Thomas J. Davis

College of Graduate Studies: Theses & Dissertations

For my dissertation, I decided to write a memoir to have the opportunity to go through the self-reflection process and learn more about my inner self. I wanted to learn how the life experiences I write about have affected me as a student-athlete, coach, teacher, parent, and how they have shaped me into who I am today. I took instances from my life in athletics that I believe are significant in the development of my overall being. Educational scholars such as William Pinar (1995, 2004), John Dewey (1916/2019, 1933), Frederic Gros (2011), Immanuel Kant (1908/2015), Nel Noddings (2005), and Paulo …

Performance In Mortality Prediction Of Saps 3 And Mpm-Iii Scores Among Adult Patients Admitted To The Icu Of A Private Tertiary Referral Hospital In Tanzania: A Retrospective Cohort Study, Nadeem Kassam, Eric Aghan, Samina Somji, Omar Aziz, James Orwa, Salim Surani

Internal Medicine, East Africa

Background: Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the Intensive Care Unit (ICU). They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management of patients while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified Acute Physiology Score (SAPS 3) and Mortality Probability Models (MPM0-III) and compared their performance in predicting outcome as well as identifying disease pattern and factors associated with increased mortality.

Methods: This was a retrospective cohort study of adult patients admitted to the ICU of …

F-Wave Parameters And Body Mass Index In Carpal Tunnel Syndrome, Philip Adebayo, Rose E. Mwakabatika

Internal Medicine, East Africa

Background: Severe carpal tunnel syndrome (CTS) readily lends itself to both clinical and electrophysiological recognition. The uncertainty sometimes is in identifying and quantifying motor involvement in mild and, perhaps, in moderate CTS. Our study aimed to evaluate F responses in mild and moderate CTS and determine the contribution of BMI to the F-wave parameters.

Methods: A retrospective review of the clinical and electrophysiological data of patients with CTS seen at the clinical neurophysiology laboratory of Aga Khan Hospital, Dar es Salaam, between 1 August 2017 and 31 July 2019 was retrieved. Carpal tunnel syndrome was graded according to the …

Screening For Malnutrition In Oral Cavity Cancer Patients Prior To Treatment: A Cross-Sectional Study, Haissan Iftikhar, Anwar Suhail, Amna Urooba, Karim Rizwan Nathani, Zeeshan Shaikh, Muhammad Wasif

Section of Otolaryngology, Head & Neck Surgery

This study was conducted to assess the frequency of pre-operative malnourishment in patients being treated for oral cavity squamous cell carcinoma. A retrospective chart review was carried out at the Aga Khan University Hospital, Karachi, on 62 patients. Patients were screened pre-operatively through a standard nutritional assessment tool at the time of admission to assess for malnutrition. Mean age of presentation was 48.34±13.11 years, mean height was 165 ± 8.62cm, weight 66.09±14.98 kg and BMI of 24.09±4.84. Males were 82.3% and 17.7% were females. At the time of admission, a significant number or patients, 12 (19.4%) were prone to malnourishment, …

Training In Temporal Bone Surgery: A Review Of Current Practices, Muhammad Wasif, Abdul Basit Shah Vardag, Ainulakbar Mughal, Syed Akbar Abbas, Shayan Khalid, Hamdan Ahmed Pasha

Section of Otolaryngology, Head & Neck Surgery

The temporal bone consists of complex anatomy, and the presence of various vital structures in close proximity makes the surgery of temporal bone highly challenging. Such a surgery requires years of training under the direct observation of trainers. Over the course of history, different training models have been adopted by experts to help train the young surgeons in this complex procedure. Cadaveric dissections of the temporal bone remains the gold standard in training of residents as the cadavers present the actual anatomical details which the surgeons encounter while operating on patients. However, due to scarcity of available cadavers, their one-time-only …

Use Of Endoscope In Teaching Of Otolaryngology Residents About Site And Size Of Tympanic Membrane Perforation And Its Impact On Degree Of Hearing Loss In Adult Patients: A Cross Sectional Study, Muntazir Hussain, Muhammad Wasif, Mohammad Sohail Awan, Shayan Khalid, Zeeshan Sheikh, Haissan Iftikhar

Section of Otolaryngology, Head & Neck Surgery

Objective: To determine the association between site and size of perforation of the tympanic membrane and the level of conductive hearing.
Methods: The cross-sectional study was conducted from November 2015 to October 2016 at Aga Khan University Hospital Karachi and comprised patients with tympanic membrane perforation without any other middle-ear disease. Karl-Storz Rigid Endoscope attached to a camera was used to take pictures of the tympanic membrane. Site of the perforation was determined using a vertical line to divide the membrane into two anterior and posterior halves. Size of the perforation was calculated as a percentage of the total membrane …

Use Of Polarized Light In The Diagnosis Of "Fuzz" Granuloma In The Conjunctiva Of A Child., Andrew R. Dorion, Gordon Crabtree, R. Patrick Dorion

Student Papers, Posters & Projects

Synthetic fiber granulomas, also known as "Teddy Bear" granulomas or "Fuzz Ball granulomas," are usually seen in childhood. We present a case of a 5-year-old child with a "Fuzz Ball" granuloma of the conjunctiva. The resected specimen was processed routinely. The use of polarized light during microscopic examination of the resected tissue made the diagnosis evident due to the prominent birefringence of the synthetic foreign material fibers.

Updates On The Diagnosis And Management Of Hepatocellular Carcinoma, Aimun Raees, Muhammad Kamran, Hasan Özkan, Wasim Jafri

Section of Gastroenterology

Introduction: Globally, the incidence, as well as mortality, related to hepatocellular carcinoma (HCC) is on the rise, owing to relatively few curative options. Underlying cirrhosis is the most common etiology leading to HCC, but risk factors of cirrhosis show great regional variability. Over the years, there has been a steady development in the diagnostic and therapeutic modalities of HCC, including the availability of a wide range of systemic chemotherapeutic agents. We aim to review the recent advancements in the diagnostic and therapeutic strategies for HCC.
Methodology: The literature search was done using databases PubMed, Cochrane, and Science Direct, and the …