Medical Specialties Commons^™

Multi-Dose Enteral L-Citrulline Administration In Premature Infants At Risk Of Developing Pulmonary Hypertension Associated With Bronchopulmonary Dysplasia, Candice D. Fike, Judy L. Aschner, Charul Avachat, Angela K. Birnbaum, Catherine M.T. Sherwin

Pediatrics Faculty Publications

Objective: Information is needed to guide the design of randomized controlled trials (RCTs) evaluating L-citrulline therapy for premature infants with pulmonary hypertension associated with bronchopulmonary dysplasia (BPD-PH). Based on our single-dose pharmacokinetic study, we evaluated the ability of a multi-dose enteral L-citrulline strategy to achieve a target trough steady-state L-citrulline plasma concentration and its tolerability in premature infants. Study design: Plasma L-citrulline concentrations were measured in six premature infants receiving 60 mg/kg L-citrulline every 6 h for 72 h before the first and last L-citrulline doses. L-citrulline concentrations were compared to concentration-time profiles from our previous study. Results: Target trough …

Association Between Gallstone Disease And Kidney Stone Disease: A Systematic Review And Meta-Analysis, Faramarz Beigi, Alizamen Salehifard Jouneghani, Sae Heari-Soureshjani, Catherine M.T. Sherwin, Ghorbanali Rahimian

Pediatrics Faculty Publications

Background and aims: Gallstone disease (GSD) and kidney stone disease (KSD) have increased due to lifestyle in recent decades. This systematic review and meta-analysis aimed to investigate the association between these two diseases. Methods: A comprehensive electronic database search was conducted before August 25, 2024. This systematic review and meta-analysis included observational studies. The meta-analysis employed a random-effects model to compute the overall summary estimates of the association between GSD and KSD using risk ratios with 95% confidence intervals (CIs) as the primary measure of the effect size. Heterogeneity was evaluated using chi-square tests, the I² statistic, and forest plots. …

Issue 6: Pulmonary & Critical Care Insider, Bharat Bajantri Md, Sarah Ellsworth-Hoffman Mls

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 6

Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.

The goal of this newsletter is to give a brief summary of the most pertinent articles to everyday practice and an attempt to keep up with literature as best as possible. Newsletters go out every 1-2 months.

Summaries/Topics in this issue:

Wasted Blood in Hospital Setting

Blood Transfusions

MINT Trial

Epinephrine related death

Non-invasive Airway Management of Comatose Poisoned Emergency Patients

Angiotensin II (AT2) and Vasopressors

Angiotensin II for the Treatment …

Veterans Direct Admission Reassessment Tool Validation For The Reduction Of Rapid Response Code Blue, And Code Stroke Team Activations In Newly Arrived Direct Admission Veterans, Joshua Monroe Wells

DNP Projects

Abstract

Purpose: Rapid clinical assessment of newly arriving direct admission veteran patients to the Department of Veterans Affairs Health Care System (VAHCS) Lexington is of the utmost importance to determine current patient condition, alteration from previously known condition at time of provider acceptance or time of report, and appropriate level of care for these veterans. The facility has seen an increase in the number of unexpected patient declines by direct admission patients presenting to medical surgical units at the VA Health Care System Lexington KY. This recurrent decline resulted in the facility performing a Root Cause Analysis (RCA), which identified …

When Divergent Worlds Collide: Dr. Santiago Ramón Y Cajal’S Influence On The Surrealism Movement, William J. Hardman Iii, Md

MA Theses

Dr. Santiago Ramón y Cajal’s drawings were created for the sole purpose of illustrating his newly discovered and earth-shattering revelations in the field of neuroscience culminating with his magnum opus: the “Neuron theory” and the “Theory of Dynamic Polarization.” For these discoveries and many others, he shared the 1906 Nobel Prize in medicine and physiology with his rival Dr. Camilo Golgi, an Italian pathologist. At no time did he envision that his drawings would capture the interest of artists as it did with members of the Surrealism Movement. This thesis will explore and present for the first time supporting evidence …

Empathy Development Among Undergraduate Health Professions’ Students Serving As Caregivers To Hospice Patients, Kelly Melekis, Carol S. Weisse, Emma Phillips, Claire Slattery

Health Professions Education

Although empathy is considered a core competency for healthcare providers and has been shown to play an important role in improving patient outcomes, empathy development while working with dying patients is not well understood and may present challenges during clinical training. This qualitative study explored empathy development among 24 undergraduate health professions students participating in an experiential training program where they served as caregivers providing bedside care to hospice patients. An exploratory case study design was used to assess empathy development as expressed via responses to a series of questions and vignettes prior to and upon completion of the training …

Improving Preventive Care Tasks In Adults Aged 50 And Older With Pre- Visit Planning In Primary Care: Review Of Literature, Destinee Rice

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Introduction: Primary care providers are seeing an increased number of elderly patients with several chronic health issues. The time required to address multiple chronic health issues during an appointment impedes timely completion of preventive care tasks. Previsit planning can aid in closing this gap in preventative care by having all necessary information prepared before a patient’s visit.
Evidence Summary: A literature search was conducted in Cumulative Index to Nursing and Allied Health Literature and PubMed using subject headings and MeSH terms. The search was refined to include articles within the last 10 years. Articles were further narrowed down by their …

Implementing The Teach-Back Method On Pessary Utilization In A Urogynecology Clinic, Marissa Eich

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: The effectiveness of pessary patient education using the teach-back method and improving nurse confidence and conviction related to pessary use are essential in improving patient outcomes.
/="/">Local Problem: The current limitations in pessary education stem from constraints in nurse availability and workload distribution.
/="/">Methods: The quality improvement initiative involved conducting surveys to evaluate nurse confidence using surveys adapted from the Agency for Healthcare Research and Quality toolkit before the nurse education session, 1 month into the intervention, and at 3 months, when the implementation period ended. These surveys assessed the effectiveness of the teach-back method.
/="/">Intervention: …

Reducing Emergency Department Decision To Admit To Disposition Time Using The Sydney Triage To Admission Risk Tool, Jolyn Sackmann

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Long emergency department (ED) length of stay (LOS) is associated with increased mortality, delay in care, longer inpatient (IP) stays, readmission risk, poor patient satisfaction, and opportunity for error. Within the ED LOS is a quality indicator measuring the time a provider determines a patient will be admitted to the time the patient leaves the ED for an IP unit, called ED-2. Prolonged ED-2 indicates impaired ED output.
/="/">Local Problem: Despite previous interventions, the ED-2 at a rural Midwest hospital was about 63.5 minutes; the goal set forth by the Centers for Medicare and Medicaid is 35 minutes …

Impact Of Chronic Kidney Disease On The Outcomes Of Patients Undergoing Left Atrial Appendage Occlusion: Insights From A Large National Database, Frederick Berro Rivera, Sung Whoy Cha, Akanimo Antia, Polyn Luz S. Pine, Gabriel A. Tangco, Princess C. Lapid, Sathika Jariyatamkitti, Nathan Ross B. Bantayan, Wailea Faye C. Salva, Anne Mira Nicca Idian, Grace Nooriza Opay Lumbang, Charcel Lex Layese, Edgar V. Lerma, Fareed Moses S. Collado, Annabelle Santos Volgman, Amir Kazory

Ateneo School of Medicine and Public Health Publications

Introduction

Studies exploring the effectiveness and safety of left atrial appendage occlusion (LAAO) in patients with chronic kidney disease (CKD) are limited.

Methods

We utilized the National Inpatient Sample (NIS) to identify hospitalizations for LAAO from 2016 to 2020 and further identified cases with concomitant CKD. The primary outcome was mortality, and secondary outcomes were cerebrovascular accidents, major bleeding, vasopressor requirements, percutaneous coronary intervention, cardiac arrest, acute respiratory failure, transfusion, length of stay (LOS), and total hospital charges. Multivariable logistic regression was performed to further adjust for covariates.

Results

A total of 89,309 LAAO procedures from 2016 to 2020 were …

Association Between Encephalopathy And Clinical Outcomes Of Covid-19: Findings From The Philippine Corona Study, V. M.M. Anlacan, F. G.C. Gabriel, R. D.G. Jamora, E. Q. Villanueva, M. C.C. Sy, M. H.L. Lee Yu, A. I. Espiritu

Ateneo School of Medicine and Public Health Publications

Introduction

This study aimed to determine whether encephalopathy is associated with such COVID-19 outcomes as disease severity, mortality, respiratory failure, intensive care unit (ICU) admission, duration of ventilator dependence, and length of ICU and hospital stay.

Methods

We performed a subgroup analysis comparing outcomes in patients with and without encephalopathy, based on data from a nationwide retrospective cohort study among adult patients hospitalized with COVID-19 at 37 hospital sites in the Philippines. The patient outcomes included for analysis were disease severity, mortality, respiratory failure, ICU admission, duration of ventilator dependence, and length of ICU and hospital stay.

Results

Of a …

End-Of-Life Care For Patients With End-Stage Heart Failure, Comparisons Of International Guidelines, Frederick Berro Rivera, Sarang Choi, Genquen Philip Carado, Arcel V. Adizas, Nathan Ross B. Bantayan, Gerard Jude P. Loyola, Sung Whoy Cha, John Paul Aparece, Anlene Jane B. Rocha, Siena Placino, Marie Francesca M. Ansay, Gerard Francis E. Mangubat, Mer Lorraine P. Mahilum, Abdullah Al-Abcha, Natasha Suleman, Nishant Shah, Tisha Marie B. Suboc, Annabelle Santos Volgman

Ateneo School of Medicine and Public Health Publications

Heart failure (HF) is a chronic, debilitating condition associated with significant morbidity, mortality, and socioeconomic burden. Patients with end-stage HF (ESHF) who are not a candidate for advanced therapies will continue to progress despite standard medical therapy. Thus, the focus of care shifts from prolonging life to controlling symptoms and improving quality of life through palliative care (PC). Because the condition and prognosis of HF patients evolve and can rapidly deteriorate, it is imperative to begin the discussion on end-of-life (EOL) issues early during HF management. These include the completion of an advance directive, do-not-resuscitate orders, and policies on device …

Action Apac: Understanding Perceptions, Attitudes And Behaviours In Obesity And Its Management Across South And Southeast Asia, Kwang Wei Tham, Asma Ahmed, Apussanee Boonyavarakul, Mariana Mercado Garcia, Miroslava Guajardo, Zubaidah Nor Hanipah, Tran Quang Nam, Nemencio A. Nicodemus, Faruque Pathan, Jack Garcia Uranga Romano, Sidartawan Soegonda, Edgardo L. Tolentino, Ambika Gopalakrishnan (A G) Unnikrishnan, Brian J. Oldfield

Ateneo School of Medicine and Public Health Publications

To identify perceptions and attitudes among people with obesity (PwO) and healthcare professionals (HCPs) toward obesity and its management in nine Asia-Pacific (APAC) countries, a cross-sectional online survey was conducted among adult PwO with self-reported body mass index of ≥25 kg/m2 (≥27 kg/m2, Singapore), and HCPs involved in direct patient care. In total, 10 429 PwO and 1901 HCPs completed the survey. Most PwO (68%) and HCPs (84%) agreed that obesity is a disease; however, a significant proportion of PwO (63%) and HCPs (41%) believed weight loss was the complete responsibility of PwO and only 43% of PwO discussed weight …

Diagnostic Accuracy Of Bowel Ultrasonography In Patients With Inflammatory Bowel Disease: A Systematic Review And Meta-Analysis, Sheza Malik, Sruthi Venugopalan, Bettina Gabrielle Tenorio, Shahab R. Khan, Priyadarshini Loganathan, Udayakumar Navaneethan, Babu P. Mohan

Ateneo School of Medicine and Public Health Publications

Background

Bowel ultrasonography (BUS) is emerging as a promising noninvasive tool for assessing disease activity in inflammatory bowel disease (IBD) patients. We evaluated the diagnostic accuracy of BUS in IBD patients against the gold standard diagnostic method, standard colonoscopy.

Methods

Major databases were searched from inception to May 2023 for studies on BUS diagnostic accuracy in IBD. Outcomes of interest were pooled sensitivity, specificity, positive (PPV), and negative (NPV) predictive values. Endoscopic confirmation served as ground truth. Standard meta-analysis methods with a random-effects model and I2 statistics were applied. Risk of bias was assessed using the Quality Assessment of Diagnostic …

Financial Sequelae Of Cancer For Patients' Family Members And Caregivers: A Focus On The Philippines, Rod Carlo Columbres, Erin Jay G. Feliciano, Lance Isidore Catedral, Jose Ma H. Zaldarriaga, Michelle Ann B. Eala, Jerickson Abbie Flores, Enrico D. Tangco, Narjust Florez, Frederic Ivan L. Ting, Edward Christopher Dee

Ateneo School of Medicine and Public Health Publications

No abstract provided.

Non-Coding Rnas Involved In The Molecular Pathology Of Alzheimer’S Disease: A Systematic Review, Reynand Jay Canoy, Jenica Clarisse Sy, Christian Deo Deguit, Caitlin Bridgette Castro, Lyoneil James Dimaapi, Beatrice Gabrielle Panlaqui, Wenzel Perian, Justine Yu, John Mark Velasco, Jesus Emmanuel Sevilleja, Anna Gibson

Ateneo School of Medicine and Public Health Publications

Alzheimer’s disease (AD) is the leading cause of dementia globally, having a pathophysiology that is complex and multifactorial. Recent findings highlight the significant role of non-coding RNAs (ncRNAs), specifically microRNAs (miRNAs), long non-coding RNAs (lncRNAs), circular RNAs (circRNAs), and piwi-interacting RNAs (piRNAs) in the molecular mechanisms underlying AD. These ncRNAs are involved in critical biological processes such as cell proliferation, apoptosis, oxidative stress, amyloid-beta aggregation, tau phosphorylation, neuroinflammation, and autophagy, which are pivotal in AD development and progression. This systematic review aims to consolidate current scientific knowledge on the role of ncRNAs in AD, making it the first to encompass …

Developmental Profile Of Filipino Children Born During The Sars-Cov-2 Pandemic: Pilot Study, Angel Belle Dy, Michelle Alexandra Edillon, Mikhaela Francesca Marietta A. Malonzo, Glenda Darlene Garcia, Alane Blythe C. Dy, Clarisse Joyce S. Espiritu, Ma Bianca Carmela Aquino, Shannen Louise T. So, Nina Linly D. Capulong, Rizza Victoria C. Dagal, Lourdes Bernadette Tanchanco

Ateneo School of Medicine and Public Health Publications

Objective

The Philippines experienced one of the longest restriction periods during the COVID-19 pandemic. This study aimed to provide a developmental profile of 18-25 month-old children and identify factors associated with their development during their early years being born and raised during the pandemic.

Methods

The study population was recruited through convenience sampling among families living in proximity to the daycare centers in Cainta, Rizal, Philippines. 116 children qualified to participate and underwent developmental screening using the Early Childhood Care and Development (ECCD) Checklist and their parents were interviewed related to demographic and social factors.

Results

The mean score of …

Projecting Temperature-Related Dengue Burden In The Philippines Under Various Socioeconomic Pathway Scenarios, Xerxes Seposo, Sary Valenzuela, Geminn Louis C. Apostol, Keith Alexius Wangkay, Percival Ethan Lao, Anna Beatrice Enriquez

Ateneo School of Medicine and Public Health Publications

Introduction

As climate change advances, the looming threat of dengue fever, intricately tied to rising temperatures, intensifies, posing a substantial and enduring public health challenge in the Philippines. This study aims to investigate the historical and projected excess dengue disease burden attributable to temperature to help inform climate change policies, and guide resource allocation for strategic climate change and dengue disease interventions.

Methods

The study utilized established temperature-dengue risk functions to estimate the historical dengue burden attributable to increased temperatures. Future projections were derived using Coupled Model Intercomparison Project Phase 6 (CMIP6) Shared Socioeconomic Pathway (SSP) scenarios to estimate the …

The Anthropometric Determinants Of Peak Expiratory Flow Rate Among Children In Dar Es Salaam, Tanzania, Willbroad Kyejo, Nancy Matillya, Neelam Ismail, Gloria Gachocha, Hajaj Salum, Rosebella Iseme, Mariam Noorani

Family Medicine, East Africa

Background: Peak expiratory flow rate (PEFR) is an important tool for assessing lung function, which can be affected by environmental and physical factors such as altitude, nutrition, genetics, age, height, and weight. Conducting a study to assess the correlation between peak expiratory flow rate and anthropometric measurements in Tanzanian schoolchildren is crucial to derive a population-specific prediction formula and further simplify respiratory health assessment.

Methods: This cross-sectional study was conducted in a single center private primary and secondary school in Dar es Salaam, Tanzania using data from an asthma screening camp. Variables of interest were height, weight, Body Mass Index …

Associated Factors And Outcomes Of Acute Kidney Injury In Covid-19 Patients In Kenya., Susan Cheruiyot, Jacob Shabani, Jasmit Shah, Catherine Gathu, Ahmed Sokwala

Family Medicine, East Africa

Background; Corona Virus Disease 2019 (COVID-19), an infection caused by the SARS-CoV-2 virus, has been the largest global pandemic since the turn of the 21st century. With emerging research on this novel virus, studies from the African continent have been few. Corona Virus Disease 2019 has been shown to affect various organs including the lungs, gut, nervous system, and the kidneys. Acute kidney injury (AKI) is an independent risk factor for mortality and increases the health care burden for patients with persistent kidney dysfunction and maintenance dialysis. Sub-Saharan Africa has a high number of poorly controlled chronic illnesses, economic inequalities, …

Higher Procedural Volumes Are Associated With Faster Treatment Times, Better Functional Outcomes, And Lower Mortality In Patients Undergoing Endovascular Treatment For Acute Ischemic Stroke, Raul G. Nogueira, Diogo C. Haussen, Eric E. Smith, Jie-Lena Sun, Ying Xian, Brooke Alhanti, Rosalia Blanco, Brian Mac Grory, Mohamed F. Doheim, Ameer E. Hassan

School of Medicine Publications

Objective We aimed to characterize the association of hospital procedural volumes with outcomes among acute ischemic stroke (AIS) patients undergoing endovascular therapy (EVT).

Methods This was a retrospective, observational cohort study using data prospectively collected from January 1, 2016, to December 31, 2019, in the Get With The Guidelines-Stroke registry. Participants were derived from a cohort of 60,727 AIS patients treated with EVT within 24 hours at 626 hospitals. The primary cohort excluded patients with pretreatment NIHSS6 hours, and inter-hospital transfers. There were two secondary cohorts: (1) EVT metrics cohort: excluded patients with missing data on time from door-to-arterial-puncture; (2) …

Kvx-053, A Protein Tyrosine Phosphatase 4a3 Inhibitor, Ameliorates Sars-Cov-2 Spike Protein Subunit 1 - Induced Acute Lung Injury In Mice, Pavel A. Solopov, Ruben Manuel Luciano Colunga Biancatelli, Tierney Day, Betsy Gregory, Elizabeth R. Sharlow, John S. Lazo, John D. Catravas

Bioelectrics Publications

The Acute Respiratory Distress Syndrome (ARDS), often preceded by acute lung injury (ALI), is characterized by the accumulation of inflammatory fluid in the lung alveoli, leaky alveolar epithelium and endothelium, and overexpression of pro-inflammatory cytokines. This progression from ALI to ARDS is a major contributor to the high mortality observed in COVID-19 patients. The Spike protein of SARS-CoV-2 binds to lung ACE2 and, in addition to facilitating viral cell entry, it plays an important role in the development of ALI and ARDS, especially in the later phases of COVID-19 as well as long COVID. Protein tyrosine phosphatase (PTP) 4A3 is …

Spinal Fusion Enhanced Recovery After Surgery, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Impacts Of Climate Change On Vector-Borne Disease Burden In The United States: Exploring The Epidemiological Evidence, Leah V. Loetman

Honors Theses

Climate change models predict shifts in vector-borne diseases (VBDs) around the world, including in the United States. However, to my knowledge there has yet to be a comprehensive descriptive epidemiological study examining prevalence, geographic distribution, and trends for all tick- and mosquito-borne diseases in the United States. I compiled data from the U.S. Centers for Disease Control (CDC), which publishes yearly case numbers for 17 vector-borne diseases. However, these publications depend on a scattered framework of state regulations regarding disease reporting. I compiled data from the CDC to determine the current geographic distribution, prevalence, and trends of tick- and mosquito-borne …

Update To Gabapentinoid Use In The United States, 2002-2021., Michael E Johansen, Donovan T Maust

Ambulatory and Primary Care Articles

Gabapentinoids are commonly used medications for numerous off-label conditions. The 2002-2021 Medical Expenditure Panel Survey (MEPS) was used to investigate the proportion of the adult population who were gabapentinoid users, the ages of these users, medications and diagnoses associated with users, and the likelihood of starting, stopping, or continuing gabapentinoids. Gabapentinoid users continued to increase since our last publication from 4.0% in 2015 to 4.7% in 2021. Gabapentinoid use was much more likely among individuals who used other medications used in chronic pain. Between 2017-2021, numerous chronic pain conditions were associated with gabapentinoid use. New gabapentinoid users clearly outnumbered gabapentinoid …

Exploring Artificial Intelligence And The Future Of Primary Care., Meghan Gilfoyle, K Taylor Bosworth, T M Ayodele Adesanya, Ashley Chisholm, Minika Ohioma, Bryce Ringwald, Chloe L Warpinski, Jacqueline K Kueper, Winston Liaw

Ambulatory and Primary Care Articles

No abstract provided.

Review Of Current Dual-Antiplatelet And Triple Therapy Prescribing Practices At Providence Medical Group, Gina Kim, Christine Doran, Lauren Powell

Books, Presentations, Posters, Etc.

Abstract: Approximately 10% of patients with recent percutaneous intervention (PCI) have concomitant atrial fibrillation (AF) and others may have concomitant venous thromboembolism (VTE). This makes choosing the optimal antithrombotic regimen challenging. The ACC published a 2020 decision pathway to guide safe and evidence-based use of antiplatelet and anticoagulant combinations for certain patients. These situations include patients with prior AF on anticoagulation and the need for PCI, patients with new-onset AF requiring anticoagulation in a patient already on antiplatelet therapy for coronary artery disease (CAD), patients with prior VTE on anticoagulation and the need for PCI, and patients with new or …

Ofatumumab Associated Legionella Pneumonia In A Young Multiple Sclerosis Patient, Jobe Ashby, Md, Omar Pandhair

Articles, Abstracts, and Reports

2024-2025 PGY2

Assessment Of Appropriate Anticoagulation And Rates Of Bte In Ambulatory Oncology Patients Using A Validated Risk Assessment Model (Khorana Scote), David Page, Alan Su, Nikki Moxon, Staci Mellinger, Tracy L. Kelly, Katherine Lyon, Pharmd, Ian Ingram, Stephanie Matta, Pharmd, Bcop

Books, Presentations, Posters, Etc.

Abstract: Cancer associated venous thromboembolisms (VTE) are associated with higher health care resource utilization (number of hospitalizations, hospital length of stay, inpatient/outpatient medical services) and can complicate treatment of cancer. The Khorana Predictive Model for Chemotherapy-Associated VTE is a validated risk assessment model that determines a patient’s risk of developing VTEs and provides recommendations for starting prophylactic anticoagulation in ambulatory oncology patients. The Khorana Score is composed of various patient characteristics including site of primary cancer, prechemotherapy platelet count, hemoglobin level, prechemotherapy leukocyte count, and BMI. National Comprehensive Cancer Network (NCCN) supportive care guidelines recommend prophylactically starting an anticoagulant if …

Titratable, Weight-Based Cisatracurium Infusions For Ventilation Synchrony In Ards, Nanako Miimi, Pharmd, Celine Munoz

Books, Presentations, Posters, Etc.

Abstract: Cisatracurium is a non-depolarizing neuromuscular blocking agent used for paralysis in paitents with acute respiratory distress syndrome on mechanical ventilation. Paralysis prevents ventilator dyssynchrony and reduces patient’s work of breathing, which decreases the risk of pneumothorax. On November 1, 2023, PSVMC critical care units transitioned from fixed dosing of cisatracurium for ARDS to a weight-based, titratable dosing protocol. A single-center retrospective cohort study demonstrated cisatracurium titrated using train-of-four was associated with similar ventilatory and clinical outcomes with three folds reduction in cisatracrurium dose in comparison to fixed dose strategy. The purpose of this project is to evaluate the drug …