Medical Specialties Commons^™

Prosthetic Valve Endocarditis With Cardiobacterium Hominis: A Case Report, Kaci Griffin, Timothy Jang, Rees Adomako, Jasmine R. Marcelin, Jonathan H. Ryder

Graduate Medical Education Research Journal

Background: Cardiobacterium hominis (C. hominis) is an uncommon cause of infective endocarditis and often presents sub-acutely with fevers, cardiac murmurs, or embolic phenomena. We present a rare case of C. hominis infective prosthetic valve endocarditis that presented with new-onset atrial flutter and systemic emboli.

Case: A 38-year-old male presented to the emergency department with palpitations, shortness of breath, and chest tightness and was found to be in atrial flutter. He underwent a transesophageal echocardiogram-guided cardioversion and was incidentally found to have a one-centimeter echodensity on the ventricular side of his prosthetic aortic valve. (Figure 1.) He …

Occupational Therapy Using Cbt To Improve Work Productivity In Schizophrenia: A Case Study, Artha Nisa Thohiroh Triyantari, Reza Nur Arsyi, Muhammad Luthfi, Ayleen Alicia K, Hermito Gideon, Zulfa Khoirunisah, Putri Dirgantara, Purnama Betty R. Sitorus

Jurnal Fisioterapi Terapan Indonesia

Schizophrenia is a chronic mental disorder that often impairs an individual's social and occupational functioning, including productivity-related activities. Patients with schizophrenia frequently face challenges in maintaining employment or running an independent business due to cognitive and emotional disturbances affecting their adaptive skills. This single-case study integrates Cognitive Behavioral Therapy (CBT) into occupational therapy to enhance productivity in a schizophrenia patient through an entrepreneurial activity—independently opening a coffee shop. The study subject is a 50-year-old male diagnosed with schizophrenia undergoing psychosocial rehabilitation at RSJ Dr. Soeharto Heerdjan. The CBT-based intervention was designed to develop adaptive thinking patterns and occupational skills through …

Enhancement Of Functional Ability In Supraspinatus Tendinitis Using Ultrasound And Isotonic Exercise: Case Study, Tu Lidya Ike Putri, Christabelle Aurelia

Jurnal Fisioterapi Terapan Indonesia

Supraspinatus tendinitis is an inflammation of the supraspinatus tendon caused by the supraspinatus muscle tendon overlapping with the caput longus bicep tendon so that friction and repetitive pressure occur over a long period of time and result in damage to the supraspinatus muscle tendon and supraspinatus tendinitis occurs. Characterized by complaints of pain around the shoulder followed by limitation of motion in the shoulder joint. The clinical question arises "can the application of ultrasound and isotonic exercise reduce pain and functional ability improvement?". To be able to answer this question, an evidence search was conducted on 3 data bases, namely …

Perbandingan Konservatif Fisioterapi Dengan Core Stability Exercise Pada Kasus Nyeri Punggung Bawah, Angria Pradita, Nurul Halimah

Jurnal Fisioterapi Terapan Indonesia

ABSTRACT: Low back pain is a major complaint caused by multifactorial conditions. The most common factors of low back pain complaints are due to age, occupation and gender. This study aims to compare the differences in therapeutic effects of conservative physiotherapy with the provision of electrotherapy, namely; microwave diathermy combined with transcutaneous electrical nerve stimulation (TENS), core stability exercise techniques and a combination of electrotherapy with core stability exercise (CSE). This type of research is quasi experimental with a pre-post test design in a population of 90 low back pain patients who seek treatment at the Physiotherapy clinic. By using …

Treating Type Ii Medial Tibial Stress Syndrome With Primal Reflex Release Technique: A Novel Approach, Shelli Green, Jenna Morogiello, Kurrel Fabian, James May, Alan Nasypany

Clinical Practice in Athletic Training

Five NCAA Division I cheerleaders (age 20 ± 1.4; 3 males, 2 females) presented with Medial Tibial Stress Syndrome (MTSS). Following an evaluation, all patients diagnosed with MTSS were treated using Primal Reflex Release Technique (PRRT). Immediate improvements in reported pain were demonstrated after one treatment. Improvements in perceived dysfunction were demonstrated after 4.2 (± 0.84) treatments over 15.4 (± 5.86) days with no time lost. All improvements were maintained at two-week follow-up. Type II MTSS patients treated with PRRT may experience an immediate, lasting reduction in pain, improvement in function, and shorter time to overall resolution.

A Descriptive Examination Of Perceived Stress And Coping Among Athletic Trainers Employed In The National Collegiate Athletic Association, Stephanie M. Singe, Elisabeth M. Mckenna, Alexandrya Cairns, Christianne Eason

Clinical Practice in Athletic Training

Time and work demands are high for the collegiatea athletic trainer, which can increase work stress and burnout may result. High perceived levels of stress and burnout can impact an athletic trainer’s mental health and wellness. Data were collected via an online descriptive, cross-sectional survey (Qualtrics) examining the perceived stress and coping strategies used among athletic trainers employed in the collegiate setting. Respondents completed the pereceived stress scale (ɑ=.90), and a series of close-ended questions related to their self-reported strategy of coping. Data was collected during September of 2022. We had 987 (men 371, women 607, did not disclose 9) …

Driving After A Concussion In Adolescents And Young Adults, What Is The Current Research And Consensus?, Melanie Kwok, Tamara Valovich Mccleod

Clinical Practice in Athletic Training

N/a

Comparison Of Patellar Taping And Strapping For Treating Patellofemoral Pain, Kaison Ames, Eric G. Post

Clinical Practice in Athletic Training

Among collegiate athletes, patellofemoral pain (PFP) represents nearly one-third of all sport-related injuries. There have been multiple studies using a patellar tendon strap as an intervention to treat PFP that showed an improvement in knee pain, as well as studies showing improvement in knee pain when using patellar taping for PFP. However, there is very limited research written that compares the effectiveness of a patellar tendon strap versus a patellar tendon taping technique for patients with PFP. Therefore, the purpose of this study was to compare the effectiveness of patellar taping versus patellar strapping to reduce PFP in collegiate athletes. …

Thoracic Mobility And The Effects It Has On The Human Body: An Evidence To Practice Review, Megan Kurzec, Barton E. Anderson

Clinical Practice in Athletic Training

Decreased thoracic mobility, stability, and strength are prevalent issues in athletes, contributing to various musculoskeletal problems. This Evidence to Practice Review synthesizes findings from a guiding systematic review that identified exercises targeting the thoracic spine in athletes. The review included a comprehensive search across six databases, five journals, and five social media platforms, yielding 38 exercises designed to improve thoracic mobility, motor control, work capacity, and strength. Despite the low level of evidence (Level D), these exercises are widely used in clinical practice. This review provides a framework for exercise prescription, offering athletic trainers a range of exercise options to …

Partnerships To Improve Access To Healthcare For Refugees And Immigrants In Philadelphia, Jessica Deffler, Chelsea Salas-Tam, Jenna Gosnay, Marc Altshuler

Department of Family & Community Medicine Faculty Papers

The United States has welcomed refugees since World War II. Currently, the world is experiencing an unparalleled refugee crisis that calls for action by nations across the globe. There are over 82 million people who are forcibly displaced from their homes today (UNHCR Global Trends, Forced displacement in 2020. [cited 2021 Sep 28]. Available from: https://www.unhcr.org/flagship-reports/globaltrends/). Over the last decade, Philadelphia has become home to hundreds of refugees from countries in Southeast and Central Asia, Africa, the Middle East, as well as many others. For newly arrived refugees, finding stable housing, medical care, and employment is difficult due to cultural, …

Automated Segmentation Of The Ulnar Nerve In Mri Using Deep Learning Techniques, Akhil Nagulapalli

Theses

Cubital Tunnel Syndrome (CuTS), a condition caused by compression of the ulnar nerve, results in numbness, tingling, pain, and even muscle atrophy, affecting fine motor skills and diminishing patient quality of life. Accurate diagnosis of CuTS is challenging, as current diagnostic methods—including clinical exams, nerve conduction studies, and unaided MRI—often lack the precision to reliably identify the nerve and detect compression in its early stages. Deep learning-based segmentation offers a promising solution, enabling precise and automated identification of nerve structures in MRI images, which could significantly improve diagnostic accuracy and support timely intervention.

A novel deep learning model for segmenting …

Approved Car-T Therapies Have Reproducible Efficacy And Safety In Clinical Practice, Daniel Goyco Vera, Hiral Waghela, Mohamed Nuh, Jonathan Pan, Premal Lulla

Faculty, Staff and Students Publications

CAR-T cell therapy has established itself as a highly effective treatment for hematological malignancies. There are currently six commercial CAR-T products that have been FDA approved for diseases such as B-ALL, LBCL, MCL, FL, MM, and CLL/SLL. "Real-world" studies allow us to evaluate outcomes from the general population to determine their efficacy and safety compared to those who were included in the original trials. Based on several well conducted "Real-world" studies that represent diverse populations, we report that outcomes from the original trials that led to the approval of these therapies are comparable to those in practice.

Addressing Unprofessional Behaviors In The Clinical Learning Environment: Lessons From A Multi-Year Virtual, Intergenerational, Interdisciplinary Workshop, Stacey Rose, Anita Kusnoor, Phuong Huynh, Jocelyn Greely, Yesenia Rojas-Khalil, Doris Kung, Anne Gill, Nadia Ismail, Nital Appelbaum

Faculty, Staff and Students Publications

INTRODUCTION: Optimizing the clinical learning environment (CLE) is a medical education priority nationwide.

MATERIALS AND METHODS: We developed a virtual, one-hour workshop engaging students, housestaff and faculty in small-group discussions of five case scenarios adapted from reported unprofessional behaviors in the CLE, plus didactics regarding mistreatment, microaggressions and bystander interventions.

RESULTS: Over two sessions (2021-2022), we engaged 340 students and 73 faculty/housestaff facilitators. Post-session surveys showed significant improvement in participants' ability to recognize and respond to challenges in the CLE.

DISCUSSION: Our innovative workshop, including scenarios derived from institutional reports of unprofessional behaviors, advanced participants' knowledge and commitment to improve …

Psychological Effects Of Number Of Knee Surgeries In Female Collegiate Soccer Athletes, Jun Yamada, Eric G. Post

Clinical Practice in Athletic Training

Psychological readiness is an important factor for returning to sport successfully following anterior cruciate ligament (ACL) reconstruction. To date, no studies have determined the effect of the number of knee surgery to psychological readiness. The primary purpose of this investigation was to determine whether the number of knee surgeries impacts psychological readiness. The secondary purpose was to examine the relationship between the number of surgeries and knee function. Data was collected from participants on the women’s soccer teams at a local division Ⅰ, Ⅲ, and NAIA college. Inclusion criteria were 1) currently fully participating in activities without any limitations, and …

Treating Chronic Low Back Pain And Plantar Fasciitis With Myokinesthetic System: A Case Study, Sadie Buboltz-Dubs, Russell Baker

Clinical Practice in Athletic Training

The purpose of this case study was to report the effects of the MyoKinesthetic (MYK) System on the pain and function of a collegiate softball player previously diagnosed with chronic non-specific low back pain and foot pain. The patient had been experiencing bilateral foot pain since childhood and conservative treatment options had failed to resolve her pain long term. Additionally, the patient had been experiencing persistent back tightness and soreness. Upon arrival at the university, the patient was evaluated using the MYK postural analysis to identify if a primary nerve root dysfunction could be the cause of her pain. The …

Neurofilament Light Chain In Serum Of Cancer Patients With Acute Neurological Complications, Amulya Gottiparthy, Keng Lam, Suprateek Kundu, Zixi Yang, Ivo Tremont-Lukats, Sudhakar Tummala

Faculty, Staff and Student Publications

Aim: Neurofilament light chain (NfL) is a nonspecific sensitive biomarker of axonal damage.

Methods: This case series identified cancer patients with neurological complications who had serum NfL measurements and paired these results to outcomes.

Results: NfL serum levels were available in 15 patients with hematological malignancies or solid tumors. The neurological complications studied were immune effector cell-associated neurotoxicity syndrome, immune checkpoint inhibitor-related encephalopathy, anoxic brain injury, Guillain-Barre syndrome, hemophagocytic lymphohistiocytosis, transverse myelitis, paraneoplastic syndrome, central nervous system demyelinating disorder and chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. All patients but one with serum NfL >900 pg/ml died …

Supporting Mental Wellness In Transgender Athletes, Abaigeal C. Fields, Zachary K. Winkelmann

Clinical Practice in Athletic Training

N/a

A Review Of Automated External Defibrillator Considerations In Athletic Training, Bryana M. Mammana, Susan W. Yeargin, Zachary K. Winkelmann

Clinical Practice in Athletic Training

N/a

Correlation Between Pre-Season Single-Leg Hop Testing Data And Lower Extremity Injuries In Collegiate Soccer Players, Ashley Kuchenbuch, Justin M. Stanek

Clinical Practice in Athletic Training

Lower extremity injuries are very common in collegiate soccer athletes and often lead to long-term rehabilitation programs and a decline in the athlete’s overall quality of life. Using single leg hop tests to identify “at-risk” athletes before the competitive season begins could allow medical staff to implement injury prevention programs that could help reduce the incidence of lower extremity injuries throughout the season. The purpose of this study was to determine if data taken from single leg hop (SLH) testing could help predict lower extremity injuries in female collegiate soccer players. A convenience sample of twenty-one participants were chosen to …

College Student-Athlete Perceptions Of Characterizations And Interpersonal Trust In Their Athletic Trainer: A Point-Of-Care Research Study, Ryan N. Moran, Deidre Leaver-Dunn, Jeff Allen, Jessica Wallace

Clinical Practice in Athletic Training

Patient-centered care is essential in athletic training with limited research examining the relationship between patient and clinician. Previous theory has identified constructs of quality athletic trainers (ATs); however, it remains unknown how current athletes perceive these theorized constructs in the ATs providing them medical care. The purpose of this study was to determine the perceptions of characterizations of a quality athletic trainer and interpersonal trust between the student-athlete and AT in the collegiate setting and establish reliability of these surveys. A second aim was to explore differences between sex, previous exposure to an AT, and having had access to an …

The Impact Of Video-Assisted Education On Knowledge And Retention Compared To Paper Education Material, Keiona M. Nance, Matthew J. Drescher, Lindsey E. Eberman, Matthew J. Rivera

Clinical Practice in Athletic Training

When educating patients, clinicians must be effective to assure patients understand their treatment plan and abide by such to achieve optimal outcomes. Teaching methods that stimulate numerous senses more positively impact learning outcomes. The purpose of this study is to compare paper and video-assisted education at the point-of-care with the aim of changing patient education and local practice in a system for individuals undergoing total hip arthroplasties (THAs). We used a randomized cohort design to explore patient knowledge and retention and educational method at the point-of-care. We compared the current education method (paper) to video-assisted materials using pre and post-education …

Exploratory Clinical Assessment And Treatment Of Autonomic Nervous System Dysregulation Post Concussion: A Case Study, Megan Coker, James May

Clinical Practice in Athletic Training

The physiological alterations in autonomic nervous system (ANS) function due to concussion are suggested to play a role in persistent post-concussion symptoms (PPCS). Currently, there are few objective and clinically feasible measurements to assess ANS vitality in patients experiencing PPCS. The following case study details an assessment and treatment protocol targeted towards regulating the ANS in an adolescent female suffering from PPCS one month after injury. Pre-intervention, patient-reported outcome measures (PROMs) used to assess perceived pain, anxiety, stress, and breathing function were administered as well as a physical assessment performed for breath function and vagus nerve integrity. The patient was …

Comparing Mental Health Between Ncaa Division Iii Student-Athletes Competing In Team- And Individual-Sports, Autumn Presley, Tiffany Franklin, Jeffrey Williams

Clinical Practice in Athletic Training

Mental health is a topic that has gained attention in recent years, but few studies have examined NCAA Division III student-athletes. Division III student-athletes are known to experience high levels of distress, and previous literature indicates there may be a significant psychological difference between student-athletes who compete in individual-sports compared to those who participate in team-sports. The purpose of this study was to explore mental health challenges (levels of depression, stress, and anxiety symptoms) among Division III student-athletes, particularly between those participating in team- and individual-sports. A cross-sectional survey design was used. The independent variable was group (team-sport athletes and …

Medical Disqualification As A Barrier To Healthcare In Military Service Members, Kaitlyn A. Jones, Joshua R. Jaime, Zachary K. Winkelmann

Clinical Practice in Athletic Training

N/a

Transcriptomic Profile Analysis Of Brain Tissue In The Absence Of Functional Trpm8 Calcium Channel, Erick B Saldes, Alexandra Erdmier, Jai Velpula, Timothy E Koeltzow, Michael X Zhu, Swapna Asuthkar

Faculty, Staff and Student Publications

Background/Objectives: Transient Receptor Potential Melastatin 8 (TRPM8) is a non-selective, Ca2+-permeable cation channel involved in thermoregulation and other physiological processes, such as basal tear secretion, cell differentiation, and insulin homeostasis. The activation and deactivation of TRPM8 occur through genetic modifications, channel interactions, and signaling cascades. Recent evidence suggests a significant role of TRPM8 in the hypothalamus and amygdala related to pain sensation and sexual behavior. Notably, TRPM8 has been implicated in neuropathic pain, migraines, and neurodegenerative diseases such as Parkinson's disease. Our laboratory has identified testosterone as a high-affinity ligand of TRPM8. TRPM8 deficiency appears to influence behavioral traits in …

Implications Of Myocardial Strain In Primary Mitral Regurgitation-A Cardiovascular Magnetic Resonance Study, Simone Romano, Danai Kitkungvan, Duc T Nguyen, Carlos El-Tallawi, Edward A Graviss, Afshin Farzaneh-Far, Dipan J Shah

Faculty, Staff and Student Publications

Aims: Chronic primary mitral regurgitation (MR) results in progressive left ventricular (LV) remodelling. Abnormal myocardial deformation (strain) can be present despite preserved ejection fraction (EF). Cardiovascular magnetic resonance (CMR) feature-tracking techniques allow assessment of global longitudinal strain (GLS) from routine cine images. The aim of this study is to evaluate the prognostic value of CMR feature tracking-derived GLS in patients with primary MR.

Methods and results: Consecutive patients undergoing CMR for chronic MR from January 2012 to June 2018 were enrolled. Patients with LVEF < 50% were excluded. The composite primary outcome aiming to detect decompensation related to MR comprised (i) referral for mitral surgery owing to symptoms or LV systolic dysfunction or (ii) cardiovascular death. The secondary outcome was all-cause death. A total of 422 patients were followed for a median of 2.7 years, and the primary endpoint was met in 93 patients (34 patients reported symptoms at baseline). At multivariable analysis, GLS≥ -16.6% was associated with primary outcome [hazard ratio (HR) 1.90, P = 0.01]. In moderate MR cohort, patients with GLS≥ -16.6% had worse event-free survival, whereas there was no significant difference in mild or severe MR groups. GLS≥ -16.0% remained associated with all-cause death after adjusting for other covariates including the MR severity (HR 2.24, P = 0.02).

Conclusion: In patients with primary MR with preserved systolic function, GLS was associated with our composite …

Disruption Of Distal Appendage Protein Cep164 Causes Skeletal Malformation In Mice, Hiroyuki Yamaguchi, Megumi Kitami, Margaret Li, Sowmya Swaminathan, Radbod Darabi, Ken-Ichi Takemaru, Yoshihiro Komatsu

Faculty, Staff and Student Publications

The primary cilium is a cellular antenna to orchestrate cell growth and differentiation. Deficient or dysfunctional cilia are frequently linked to skeletal abnormalities. Previous research demonstrated that ciliary proteins regulating axoneme elongation are essential for skeletogenesis. However, the role of the ciliary proteins responsible for initiating cilium assembly in skeletal development remains unknown. Here, we investigate the function of centrosomal protein of 164 kDa (CEP164), a key ciliogenesis regulator that localizes at the distal appendages of the mother centriole, during skeletal development in mice. Interestingly, the mesodermal cell-specific Cep164 deletion resulted in severe bone defects and osteoblast-specific deletion of Cep164 …

Predicting Kidney Graft Function And Failure Among Kidney Transplant Recipients, Yi Yao, Brad C Astor, Wei Yang, Tom Greene, Liang Li

Faculty, Staff and Student Publications

Background: Graft loss is a major health concern for kidney transplant (KTx) recipients. It is of clinical interest to develop a prognostic model for both graft function, quantified by estimated glomerular filtration rate (eGFR), and the risk of graft failure. Additionally, the model should be dynamic in the sense that it adapts to accumulating longitudinal information, including time-varying at-risk population, predictor-outcome association, and clinical history. Finally, the model should also properly account for the competing risk by death with a functioning graft. A model with the features above is not yet available in the literature and is the focus of …

A Bayesian Pharmacokinetics Integrated Phase I-Ii Design To Optimize Dose-Schedule Regimes, Mengyi Lu, Ying Yuan, Suyu Liu

Faculty, Staff and Student Publications

The schedule of administering a drug has profound impact on the toxicity and efficacy profiles of the drug through changing its pharmacokinetics (PK). PK is an innate and indispensable component of the dose-schedule optimization. Motivated by this, we propose a Bayesian PK integrated dose-schedule finding (PKIDS) design to identify the optimal dose-schedule regime by integrating PK, toxicity, and efficacy data. Based on the causal pathway that dose and schedule affect PK, which in turn affects efficacy and toxicity, we jointly model the three endpoints by first specifying a Bayesian hierarchical model for the marginal distribution of the longitudinal dose-concentration process. …

Iatrogenic Ventricular Septal Defect After Transcatheter Aortic Valve Implantation: A Rare Complication, Muhammad Sabri, Hussam Al Hennawi, Shayan Qadir, Lucy Checchio, Chaitra Janga, Hamza Muhammadzai, Donald C. Haas

Abington Jefferson Health Papers

Iatrogenic ventricular septal defect (VSD) is a rare complication following transcatheter aortic valve implantation (TAVI). An 83-year-old male underwent TAVI for severe aortic stenosis (AS) and was diagnosed with a peri-membranous VSD on echocardiography, which was not evident on pre-procedural imaging. This case highlights the risk factors, symptoms, diagnosis, and management of iatrogenic VSD following TAVI.