Medical Specialties Commons^™

Xylazine Suppresses Fentanyl Consumption During Self-Administration And Induces A Unique Sex-Specific Withdrawal Syndrome That Is Not Altered By Naloxone In Rats, Shailesh N. Khatri, Safiyah M. Sadek, Percell T. Kendrick, Emma O. Bondy, Mei Hong, Sally Pauss, Dan Luo, Thomas E. Prisinzano, Kelly E. Dunn, Julie A. Marusich, Joshua S. Beckmann, Terry D. Hinds Jr., Cassandra D. Gipson

Markey Cancer Center Faculty Publications

Prescription and illicit opioid use are a public health crisis, with the landscape shifting to fentanyl use. Since fentanyl is 100-fold more potent than morphine, its use is associated with a higher risk of fatal overdose that can be remediated through naloxone (Narcan) administration. However, recent reports indicate that xylazine, an anesthetic, is increasingly detected in accidental fentanyl overdose deaths. Anecdotal reports suggest that xylazine may prolong the fentanyl “high,” alter the onset of fentanyl withdrawal, and increase resistance to naloxone-induced reversal of overdose. To date, no preclinical studies have evaluated the impacts of xylazine on fentanyl self-administration (SA; 2.5 …

Interlink Between The Gut Microbiota And Inflammation In The Context Of Oxidative Stress In Alzheimer’S Disease Progression, Tushar K Das, Bhanu P Ganesh

Faculty, Staff and Student Publications

The microbiota-gut-brain axis is an important pathway of communication and may dynamically contribute to Alzheimer's disease (AD) pathogenesis. Pathological commensal gut microbiota alterations, termed as dysbiosis, can influence intestinal permeability and break the blood-brain barrier which may trigger AD pathogenesis via redox signaling, neuronal, immune, and metabolic pathways. Dysbiosis increases the oxidative stress. Oxidants affect the innate immune system through recognizing microbial-derived pathogens by Toll-like receptors and initiating the inflammatory process. Most of the gut microbiome research work highlights the relationship between the gut microbiota and AD, but the contributory connection between precise bacteria and brain dysfunction in AD pathology …

Couvelaire Uterus In A Previable Pregnancy: Complication In Abruptio Placenta, Case Series From Tanzanian Tertiary Hospital, Vicky Kapesi, Brenda Moshi, Willbroad Kyejo, Ahmed Jusabani, Miriam Mgonja, Munawar Kaguta

Imaging & Diagnostic Radiology, East Africa

Introduction and importance: Couvelaire uterus, also previously known as uteroplacental apoplexy. This is a life-threatening condition resulting from bleeding into the myometrium that may extend to the parametrium and peritoneum. Couvelaire uterus is typically associated with abruptio placentae, the premature separation of the placenta. This syndrome can only be diagnosed by direct visualization during caesarean section or biopsy (or both). For this reason, its prevalence is under-reported and underestimated in the literature. Cases findings We present a rare case series of two patients with Couvelaire uterus in previable pregnancy at Aga Khan Hospital, Dar es salaam. This combination is a …

N-Of-1 Trials: The Epitome Of Personalized Medicine?, Joyce P Samuel, Susan H Wootton, Jon E Tyson

Faculty, Staff and Student Publications

Observational studies are notoriously susceptible to bias, and parallel-group randomized trials are important to identify the best overall treatment for eligible patients. Yet, such trials can be expected to be a misleading indicator of the best treatment for some subgroups or individual patients. In selected circumstances, patients can be treated in n-of-1 trials to address the inherent heterogeneity of treatment response in clinical populations. Such trials help to accomplish the ultimate goal of all biomedical research, to optimize the care of individual patients.

Philippines Global Health, Thomas Rieth, Kourtney Bettinger, Ryan Northup

Posters

Provides reflections on resident's experience working with cardiologists and neonatologists in Manila.

Clinical And Radiographic Outcomes For Femoral Neck Fracture Fixation With Femoral Neck System Versus Multiple Cannulated Screws, Samer M. Al-Humadi, D’Arcy Marsh, Michael Doany, David Swanson, David E. Komatsu, Stephen A. Kottmeier, Nicholas Divaris

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: The There are few studies in the orthopaedic surgery literature that examine clinical outcomes for femoral neck system (FNS) fixation of femoral neck fractures. The purpose of this study was to compare primary outcome of non-union for femoral neck fracture fixation using FNS versus multiple cannulated screws (MCS).

Methods: Retrospective electronic medical record search for patients 18 years or older who underwent surgery between March 01, 2018 and September 01, 2021 for femoral neck fracture fixation. Two reviewers examined radiographic and clinical data reaching consensus. Patients were called via telephone to complete Short Form 12-item (SF-12) surveys with consent. …

Alcohol And Opiate Abuse Are Risk Factors For Dislocation After Primary Reverse Shoulder Arthroplasty, Ryan P. Tantone, Kenny Ling, Michael E. Doany, Rosen Jeong, Emma Smolev, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: As indications for reverse total shoulder arthroplasty (RTSA) expand and patients present with increasing comorbidities, complications have become more frequent. Dislocation and instability are devastating complications and have become one of the leading causes of revision surgery. Current literature suggests multifactorial causes for dislocation, but studies are limited to physiologic and mechanical risk factors. The purpose of this study was to investigate social risk factors, including alcohol and drug abuse, and their association with dislocation after RTSA.

Methods: A retrospective cohort of all RTSA performed at a single center by the senior author between January 2012 and March 2021 …

"Keep Your Chin Up, And Keep Eating": Perceptions Of Barriers And Facilitators To Healthful Dietary Behaviors Among Individuals With Gastrointestinal Cancer And Caregivers, Brandy-Joe Milliron, Cynthia Klobodu, Jonathan Deutsch, Karon Martyn, Dan Dychtwald, Emily Riahi, Shawn Carro, Taylor Hisek, Natalie Darcy, Ann C. Klassen

Kimmel Cancer Center Faculty Papers

BACKGROUND: This study explored perceptions of barriers and facilitators to healthful dietary behaviors among patients with gastrointestinal (GI) cancer and their caregivers, including caregiver preparedness, patient and caregiver self-efficacy for symptom management, and other environmental, social, and familial factors that may serve as barriers and facilitators to healthful eating.

METHODS: Using a concurrent mixed methods cross-sectional study design, individuals with GI cancer receiving outpatient chemotherapy and their caregivers completed surveys, dietary assessments, and interviews. Caregiving preparedness, self-efficacy for symptom management, and dietary intake were assessed using validated instruments. Dietary quality was measured using the Healthy Eating Index (HEI)-2020. In-depth interviews …

Early-Phase Drive To The Precursor Pool: Chloroviruses Dive Into The Deep End Of Nucleotide Metabolism, David Dunigan, Irina Agarkova, Ahmed Esmael, Sophie Alvarez, James L. Van Etten

Nebraska Center for Virology: Faculty Publications

Viruses face many challenges on their road to successful replication, and they meet those challenges by reprogramming the intracellular environment. Two major issues challenging Paramecium bursaria chlorella virus 1 (PBCV-1, genus Chlorovirus, family Phycodnaviridae) at the level of DNA replication are (i) the host cell has a DNA G+C content of 66%, while the virus is 40%; and (ii) the initial quantity of DNA in the haploid host cell is approximately 50 fg, yet the virus will make approximately 350 fg of DNA within hours of infection to produce approximately 1000 virions per cell. Thus, the quality and quantity of …

The Persistence And Stabilization Of Auxiliary Genes In The Human Skin Virome, Ema H. Graham, Wesley A. Tom, Alison C. Neujahr, Michael Adamowicz, Jennifer Clarke, Joshua R. Herr, Samodha C. Fernando

Nebraska Center for Virology: Faculty Publications

Background The human skin contains a diverse microbiome that provides protective functions against environmental pathogens. Studies have demonstrated that bacteriophages modulate bacterial community composition and facilitate the transfer of host-specific genes, potentially influencing host cellular functions. However, little is known about the human skin virome and its role in human health. Especially, how viral-host relationships influence skin microbiome structure and function is poorly understood.

Results Population dynamics and genetic diversity of bacteriophage communities in viral metagenomic data collected from three anatomical skin locations from 60 subjects at five different time points revealed that cutaneous bacteriophage populations are mainly composed of …

Direct Selective Laser Trabeculoplasty In Open Angle Glaucoma Study Design: A Multicentre, Randomised, Controlled, Investigator-Masked Trial (Glaurious), Nathan Congdon, Augusto Azuara-Blanco, Yoram Solberg, Carlo E Traverso, Michele Iester, Carlo Alberto Cutolo, Alessandro Bagnis, Tin Aung, Scott J Fudemberg, Richard Lindstrom, Thomas Samuelson, Kuldev Singh, Eytan Z Blumenthal, Gus Gazzard, Glaurious Study Group

Wills Eye Hospital Papers

Introduction: Laser trabeculoplasty is an effective and widely used treatment for glaucoma. A new laser technology, the Eagle direct selective laser trabeculoplasty (DSLT) device, may provide automated, fast, simple, safe and effective laser treatment for glaucoma in a broader range of clinical settings. This trial aims to test the hypothesis that translimbal DSLT is effective and not inferior to selective laser trabeculoplasty (SLT) in reducing intraocular pressure (IOP) in open angle glaucoma (OAG).

Methods and analysis: This is a multicentre, randomised, controlled, investigator-masked study. The primary efficacy outcome is intergroup difference in mean change from baseline IOP measured at 6 …

Erratum

Saudi Medical Journal

No abstract provided.

A Nursing Staff Education Module On Survivorship Care Plans In Primary Care, Janette Francis

Walden Dissertations and Doctoral Studies

Survivorship care plans (SCPs) bridge the gap in the transition of care from oncology to primary care providers (PCPs) for breast cancer survivors. Despite strong recommendations for SCPs, their use remains limited. Guided by Knowles’ adult learning theory, the project focused on, first, determining whether a predeveloped staff education activity was valid using the Lynn model criteria for validation. Second, if in a rural clinic where SCP were not consistently used providers, nurses, and staff knowledge regarding the importance of SCP would increase following an educational program. An expert panel of 5 educational experts validated the educational module for appropriateness …

Factors Impacting College Students’ Receipt Of Human Papillomavirus Vaccination, Joy Yvette Payne

Walden Dissertations and Doctoral Studies

Less than half of U. S. students entering college have had a human papillomavirus (HPV) vaccination, placing them at risk for HPV-related cancers. This study’s purpose was to identify predictors of HPV vaccination initiation in college students. Andersen’s behavioral model of health services use was used to examine the differences in predisposing, enabling, and need factors in U.S. college students ages 18–26 years who received an initial HPV vaccination in college compared to those who never received an HPV vaccination. The study was a quantitative, cross-sectional survey design using multivariable logistic regression for data analyses. Data were collected through an …

Oncology Nurses, Compassion Fatigue And General Health: A Mixed-Methods Study, Michelle Rampersad

Walden Dissertations and Doctoral Studies

Current literature on compassion fatigue is expansive, but there is a lack on the relationship between compassion fatigue and general health complaints in oncology nurses; how they perceive compassion fatigue and its relation to their general health. Using Pender’s health promotion model, this mixed methods study addressed how oncology nurses perceive compassion fatigue and whether a correlation exists between compassion fatigue and general health complaints. Data were collected from a sample of 55 oncology nurses through two separate Survey Monkey links. All 55 participants completed quantitative data points including a demographic questionnaire, the Professional Quality of Life 5 tool, and …

Diagnostic Dilemma: Schwannoma Or Ganglion Cyst, Karthik Ks, Prakash M, Gurumurthy B, Sujanatheja Js, Pramod Bm, Punith N

Digital Journal of Clinical Medicine

Schwannomas are rare, slow growing benign tumors of peripheral nerve sheath originating from Schwann cells surrounding the nerve associated with delayed presentation of pain and paresthesia. Their incidence being 5% of all upper extremity tumors. They may be a part of neurofibromatosis called schwannomatosis with multiple peripheral schwannomas. We present a case of solitary schwannomas from the peripheral nerves probably superficial branch of median nerve mistaken initially for ganglion cyst.

The Impact Of Physical Activity Education During Pregnancy, Lizeth Banuchi

DNP Research Projects

Abstract

Background: Physical Activity (PA) during pregnancy is important to maintain optimal maternal and neonatal health. Gestational Diabetes Mellitus (GDM) requires close monitoring during pregnancy due to the health risk it can cause to mother and fetus. It is evident that PA can help improve maternal health outcomes to positively offer overall wellness throughout the pregnancy.

Objective: The purpose of this Quality Improvement Project (QIP) is to evaluate the impact of PA education on PA implementation during pregnancy and improve clinical practice for healthcare providers to introduce PA education during prenatal care per ACOG and CESP guidelines.

Method: This quality …

A Lifestyle Management Coaching Intervention For Fear Of Cancer Recurrence In Young Breast Cancer Survivors, Lisa R. Murphy

DNP Research Projects

Abstract

Objective: A significant challenge facing young breast cancer (BC) survivors is learning how to manage fear of cancer recurrence (FCR) during survivorship. Limited tailored FCR interventions and age-appropriate support exist. This Doctor of Nursing (DNP) project, based upon best practice guidelines, aimed to evaluate how a Lifestyle Management Coaching Intervention (LMCI) could help young female BC survivors learn how to decrease and manage their FCR more effectively and experience improved health outcomes.

Method: Eligible participants were female BC survivors aged 18-59 with Stage I-III BC demonstrating elevated baseline FCR screening scores during the extended survival period recruited from the …

Effects Of A Residential Lifestyle Intervention Program On Selected Lipid Measures And Nutritional Choices, Delores M. Rugless

DNP Research Projects

Abstract

Objective: Cardiovascular disease has been the leading cause of death since the early 1920s. As with other chronic diseases, cardiovascular disease is primarily influenced by behaviors and the environment, with poor nutrition being a major contributing factor. Despite knowing the importance of lifestyle modification to manage cardiovascular disease effectively, many individuals have difficulty adhering to lifestyle modification principles. Residential lifestyle modification centers provide the education and support necessary to assist individuals with implementing behavioral changes. This DNP project aimed to demonstrate the value of diet modification implemented at a residential lifestyle center to decrease specific cardiovascular risk factors. Method: …

A Dnp Quality Improvement Project To Assess The Traumatic Brain Injury Survivor And Their Family Caregivers' Coping And Resiliency, Marcelle Angall-Leonce

DNP Research Projects

Abstract

Background: Traumatic brain injury (TBI) support groups are vital to TBI survivors in the community and provide resources to family caregivers (FCs) to mitigate caregiver burden. Resiliency is a necessary characteristic to cope with chronic diseases and the demands of caregiving. However, a gap exists in how TBI support groups mitigate family stress and empower coping and resiliency for the TBI survivor and FCs. Method: The quality improvement project assessed TBI survivors' and FCs' coping and resiliency before and after an educational module on coping, resiliency, and self-care strategies. Intervention: A quality improvement project in a support group of …

Pectus Excavatum With Bar Placement Eras, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Disrupting And Expanding The Discourse: Palliative Care Clinicians' Experiences With Patients' Non-Physical Suffering, Maxxine Rattner

Theses and Dissertations (Comprehensive)

While one of the primary aims of palliative care is to prevent and relieve suffering, both physical and non-physical, research to date has been very limited re: clinicians’ experiences with patients’ non-physical suffering (e.g., suffering that may be psychological, emotional, social, spiritual and/or existential in nature); both how clinicians work with/respond to this kind of suffering in their day-to-day work, and the effect of this aspect of their work on clinicians themselves. No research to date has considered the impact of palliative care’s dominant non-physical suffering discourse — which presents the relief of non-physical suffering as falling along a binary …

Gastric Sleeve Enhanced Recovery After Surgery, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Genital Ulcers (Painful, Aphthous) In Females, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

How Do Glp-Ira Medications Affect Gut And Brain Hunger Signaling To Allow For Reduction In Weight And Better Glycemic Control In Adults With Obesity And Type 2 Diabetes?, David White

Graduate Research Projects

No abstract provided.

Advances In Upper Gastrointestinal Surgery: Management And Diagnostic Techniques, Gregory L. Falk

Theses

Upper gastrointestinal surgery has progressively moved from the surgically open abdomen to minimally invasive surgery, largely due to technological improvements in instrumentation. A direct result of this Gestalt has been improved patient comfort, rapid recovery and significantly less length of stay in the hospital and therefore significant cost-savings. This was the key impetus to my development of many of the skills in minimally invasive surgery and the subsequent dissemination to other surgeons in an organized and well-recognized teaching system. Many of the novel techniques of this type of surgery led to several publications both in the English and French oncological …

The Impact Of A Blood Pressure Reduction Program In Optimizing Control Of Hypertension Amongst Adult Females In An Outpatient Ambulatory Clinic, Brooke Englert

DNP Projects

Background: Hypertension (HTN) is a public health problem that, when well-controlled, can significantly reduce the risk of stroke, coronary heart disease, heart failure and death. Effective patient-provider communication strongly incentivizes an improvement in medical outcomes. Communication with patients can often be effectively delegated to other clinical staff, such as registered nurses (RNs) or clinical service technicians (CSTs) (Tavakoly Sany, Behzhad, Ferns & Peyman, 2020).

Purpose: Given the increased risk of all-cause and cardiovascular disease mortality of uncontrolled HTN, the purpose of this study was to implement and evaluate a standardized, evidence-based practice intervention via communication between APRN providers and patients …

Assessing Palliative Care Knowledge Among Medicine/Pulmonary Intensive Care Unit Staff To Identify Barriers And Increase Palliative Care Referrals, Ryan Mckendrick

DNP Projects

Background: To conduct a needs assessment to identify areas of opportunity for increased awareness of the interdisciplinary medicine/pulmonary intensive care unit (MICU) staffs’ knowledge of palliative care and identify potential barriers to initiating referrals for palliative care consultations. Then provide an educational intervention and assess effectiveness with a post interventions assessment of referrals. The goal of this project is to increase referrals for palliative care consults.

Methods: A pre-/post-survey design will be utilized to assess palliative care knowledge to identify barriers to palliative care consultation referrals. An educational intervention that addresses palliative care knowledge deficits and addresses barriers will be …

Evaluating Kentucky Advanced Practice Registered Nurses’ Confidence, Comfort, And Knowledge Levels Regarding Dermatology Care After A Web-Based Video Training, Victoria Hayden

DNP Projects

Background: It can take an average of 38.9 days to see dermatology from referral to initial appointment. As a result, delays in diagnosis and treatment of life-threatening conditions such as malignant melanoma could occur. Primary care providers frequently refer patients for benign conditions that can be appropriately managed in the primary care setting; often due to lack of knowledge or confidence in their clinical management skills. Educational resources equip providers with the knowledge and tools to feel confident in their management of various skin conditions in a primary care setting. Purpose: The purpose of this project was to …

Depression Management Among Primary Care Providers: Evaluation Of An Educational Intervention, Whitney Hunt

DNP Projects

Background: Nearly one-third of patients diagnosed with depression and prescribed an antidepressant medication will stop taking their medication within the first month. Timely follow-up care can improve medication adherence and symptoms for depressed patients on antidepressants however, most patients do not receive timely follow-up. Common system and provider-based barriers to timely follow-up include limited provider time, lack of training, and mental health stigma.

Objective: The purpose of this project was to assess provider attitudes, knowledge level, perceived barriers, and current depression management strategies in a primary care setting.

Methods: In this quasi-experimental one group pre/post-test study a survey was used …