Showing papers by "Saint Francis University published in 2009"
TL;DR: Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.
Abstract: The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P = 0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001). Conclusions Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.
4,764 citations
TL;DR: Clinicians and patients should maximize the therapeutic effects of communication by explicitly orienting communication to achieve intermediate outcomes associated with improved health.
1,780 citations
Yale University1, Cedars-Sinai Medical Center2, University of California, Los Angeles3, University of North Carolina at Chapel Hill4, Saint Francis University5, Loma Linda University6, University of California, Irvine7, University of Utah8, University of British Columbia9, Dartmouth College10, Wake Forest University11, Rhode Island Hospital12, Tel Aviv University13, Boston Children's Hospital14, Columbia University15
TL;DR: A high-resolution genetic map of DS phenotypes based on an analysis of 30 subjects carrying rare segmental trisomies of various regions of HSA21 is presented, demonstrating the value of combining advanced genomics with cohorts of rare patients for studying DS, a prototype for the role of copy-number variation in complex disease.
Abstract: Down syndrome (DS), or trisomy 21, is a common disorder associated with several complex clinical phenotypes. Although several hypotheses have been put forward, it is unclear as to whether particular gene loci on chromosome 21 (HSA21) are sufficient to cause DS and its associated features. Here we present a high-resolution genetic map of DS phenotypes based on an analysis of 30 subjects carrying rare segmental trisomies of various regions of HSA21. By using state-of-the-art genomics technologies we mapped segmental trisomies at exon-level resolution and identified discrete regions of 1.8-16.3 Mb likely to be involved in the development of 8 DS phenotypes, 4 of which are congenital malformations, including acute megakaryocytic leukemia, transient myeloproliferative disorder, Hirschsprung disease, duodenal stenosis, imperforate anus, severe mental retardation, DS-Alzheimer Disease, and DS-specific congenital heart disease (DSCHD). Our DS-phenotypic maps located DSCHD to a <2-Mb interval. Furthermore, the map enabled us to present evidence against the necessary involvement of other loci as well as specific hypotheses that have been put forward in relation to the etiology of DS-i.e., the presence of a single DS consensus region and the sufficiency of DSCR1 and DYRK1A, or APP, in causing several severe DS phenotypes. Our study demonstrates the value of combining advanced genomics with cohorts of rare patients for studying DS, a prototype for the role of copy-number variation in complex disease.
356 citations
TL;DR: Patients with moderate to large chondral lesions with failed prior cartilage treatments can expect sustained and clinically meaningful improvement in pain and function after autologous chondrocyte implantation.
Abstract: BackgroundThis is a prospective clinical study to assess the effectiveness of autologous chondrocyte implantation in patients who failed prior treatments for articular cartilage defects of the knee.HypothesisAutologous chondrocyte implantation provides clinical benefit in patients with failed articular cartilage treatments.Study DesignCohort study; Level of evidence, 2.MethodsOne hundred fifty-four patients with failed treatment for articular cartilage defects of the knee received autologous chondrocyte implantation in a multicenter, prospective study. Follow-up was 48 months. Outcomes included change from baseline in knee function, knee pain, quality of life, and overall health. Duration of benefit after autologous chondrocyte implantation was compared with the failed prior non—autologous chondrocyte implantation procedure. Safety information was recorded. Additional analyses were performed on the 2 major cohorts of prior procedures entered into the study, marrow-stimulation technique or debridement alon...
250 citations
TL;DR: Use of endobronchial valves is an effective, nonsurgical, minimally invasive intervention for patients with prolonged pulmonary air leaks.
204 citations
TL;DR: A MDEP designed for those with low literacy significantly increased diabetes knowledge across literacy levels, however, the MDEP did not overcome the learning gap between patients with low and high literacy.
140 citations
TL;DR: Clinical trials are needed to determine the long‐term effectiveness and safety of novel anabolic agents for the management of osteoporosis, and the targeting of an anabolic agent should be specific to bone to preclude non‐skeletal unwanted side effects.
Abstract: Bone formation is determined by the number and function of osteoblasts. Cell number is governed by factors that regulate the replication and differentiation of pre-osteoblasts and factors that regulate osteoblastic cell death. Cell function is controlled by signals acting on the mature osteoblast. Platelet-derived and fibroblast growth factors are bone cell mitogens. Bone morphogenetic proteins (BMPs) and Wnt induce the differentiation of mesenchymal cells toward osteoblasts, and insulin-like growth factor (IGF)-I stimulates the function of mature osteoblasts and prevents their death. The activity of BMP, Wnt, and IGF-I is modulated by extracellular antagonists or binding proteins. Changes in growth factor synthesis and activity may play a role in the pathogenesis of selected forms of osteoporosis, and alterations in the expression or binding of the extracellular antagonists can be associated with changes in bone mass. Current approaches to bone anabolic therapies for osteoporosis include the administration of a growth factor, such as IGF-I, or the neutralization of an antagonist. Ideally, the targeting of an anabolic agent should be specific to bone to preclude non-skeletal unwanted side effects. Clinical trials are needed to determine the long-term effectiveness and safety of novel anabolic agents for the management of osteoporosis.
109 citations
TL;DR: It is concluded that serum IGF‐1 not only regulates bone size, shape, and composition during ontogeny, but it plays a more fundamental role—that of regulating an individual's ability to adapt its bone structure to mechanical loads during growth and development.
Abstract: Strong correlations between serum IGF-1 levels and fracture risk indicate that IGF-1 plays a critical role in regulating bone strength. However, the mechanism by which serum IGF-1 regulates bone structure and fracture resistance remains obscure and cannot be determined using conventional approaches. Previous analysis of adult liver-specific IGF-1–deficient (LID) mice, which exhibit 75% reductions in serum IGF-1 levels, showed reductions in periosteal circumference, femoral cross-sectional area, cortical thickness, and total volumetric BMD. Understanding the developmental sequences and the resultant anatomical changes that led to this adult phenotype is the key for understanding the complex relationship between serum IGF-1 levels and fracture risk. Here, we identified a unique developmental pattern of morphological and compositional traits that contribute to bone strength. We show that reduced bone strength associated with low levels of IGF-1 in serum (LID mice) result in impaired subperiosteal expansion combined with impaired endosteal apposition and lack of compensatory changes in mineralization throughout growth and aging. We show that serum IGF-1 affects cellular activity differently depending on the cortical surface. Last, we show that chronic reductions in serum IGF-1 indirectly affect bone strength through its effect on the marrow myeloid progenitor cell population. We conclude that serum IGF-1 not only regulates bone size, shape, and composition during ontogeny, but it plays a more fundamental role—that of regulating an individual's ability to adapt its bone structure to mechanical loads during growth and development.
107 citations
TL;DR: It is demonstrated that it is possible and instructive to define professionalism in terms of tangible behaviors, and focusing on behaviors rather than attributes may facilitate discussion, assessment, and modeling of professionalism in both medical education and clinical care.
Abstract: PurposeAlthough professionalism has always been a core value in medicine, it has received increasingly explicit attention over the past several years Unfortunately, the terms used to explain this competency have been rather abstract This study was designed to identify and prioritize behavi
67 citations
TL;DR: Oturator nerve block using USG to achieve interfascial injection without nerve stimulation had success similar to that reported in studies using nerve stimulation.
64 citations
TL;DR: Focus groups of African American seniors conducted to identify current perceptions about influenza and influenza vaccination found some participants had confidence in the vaccine, some questioned its preventive ability or believed that the vaccine caused influenza, and others noted expected side effects.
Abstract: African American seniors (65 and older) are less likely to be vaccinated against influenza than are non-Hispanic White seniors. There is a clear need for targeted messages and interventions to address this disparity. As a first step, 6 focus groups of African American seniors (N = 48) were conducted to identify current perceptions about influenza and influenza vaccination. Emergent thematic categories were organized using the 4 main constructs of the extended parallel process model. Susceptibility varied based on perceptions of individual health status, background knowledge, and age-related risk. Some participants saw influenza as a minor nuisance; others viewed it as threatening and potentially deadly. Participants discussed issues related or antecedent to self-efficacy, including vaccine accessibility and affordability. Regarding response efficacy, some participants had confidence in the vaccine, some questioned its preventive ability or believed that the vaccine caused influenza, and others noted exp...
TL;DR: The results demonstrate that the use of the eLearning format provides both a satisfactory and effective alternative learning medium for nurses in the healthcare setting.
Abstract: Despite the education challenges faced by healthcare institutions, the use of online technology (eLearning) to demonstrate competency for practicing nurses in the acute care environment has only recently been explored. The authors discuss the implementation of an online-based nursing education competency. The results demonstrate that the use of the eLearning format provides both a satisfactory and effective alternative learning medium. The study provides support for the use of online learning in the healthcare setting.
TL;DR: Multimedia tools developed with community input that are designed to present important health messages using graphics and audio can reach Hispanic/Latino adults across literacy levels and ethnic backgrounds.
TL;DR: The study finds that, in contrast with the well-established patterns in Western communities, the young and educated exhibit a higher level of fear of crime in urban China than their counterparts and consistent with Western literature, females are fearful and that personal victimization experience increases thelevel of fear.
Abstract: Previous research in the West has established major socio-demographic correlates of fear of crime. The interpretation of these correlates is typically based on the concept of physical or social vulnerability of individuals. These correlates are implicitly regarded as invariant to social or community contexts, reflecting universal human behavioral patterns. The present study argues that social change may alter patterns of perceptions associated with fear among socio-demographic groups, thus affecting socio-demographic correlates of fear of crime. We explore how social changes in China have created a generational gap that influences the effects of age and education on fear of crime. The study finds that, in contrast with the well-established patterns in Western communities, the young and educated exhibit a higher level of fear of crime in urban China than their counterparts. The study also finds that consistent with Western literature, females are fearful and that personal victimization experience increases the level of fear. We discuss the social and community processes that produce these interesting patterns.
TL;DR: The presence of certified medical directors is an independent predictor of quality in US nursing homes and is responsible for up to 15% improvement in quality.
TL;DR: Chemical prophylaxis for VTE with some type of heparin is the standard of care for patients undergoing bariatric surgery, and research is necessary to establish the role of inferior vena cava filters, discharging patients with chemoprophylaxis and to determine the adequate dosage and duration.
TL;DR: Insulin glargine use during pregnancy is not associated with increased maternal or neonatal morbidity compared with NPH insulin, and among pregestational diabetics, insulin gl argine use was associated with lower rates of macrosomia, neonatal hypoglycemia and neonatal hyperbilirubinemia.
Abstract: Objective. To compare maternal and neonatal outcomes of pregestational and gestational diabetics treated with insulin glargine versus Neutral Protamine Hagedorn (NPH) insulin.Methods. A retrospective cohort study examining outcomes from pregestational and gestational diabetics treated with either insulin regimen. Comparisons were made using the t-test for continuous data and the Chi-square or Fisher's exact test for categorical data.Results. Fifty-two pregnant women treated with insulin glargine were compared with 60 pregnant women treated with NPH. No significant differences in rates of maternal complications were noted. No significant differences in neonatal outcomes for gestational diabetics were noted. Among pregestational diabetics treated with insulin glargine, significantly fewer macrosomic infants (relative risk [RR], 0.38; 95% confidence intervals (CI), 0.17–0.87; p = 0.04) and lower rates of neonatal hyperbilirubinemia (RR, 0.27; 95% CI, 0.07–0.98; p = 0.05) were noted when compared with those t...
TL;DR: Overall, rAAV-mediated OPG gene transfer effectively reversed Ti-particle-induced bone resorption in this experimental model, and may be due to the blockage of local osteoclastogenesis and possibly the down-regulation of RANKL expression.
TL;DR: C/EBP beta plays a role in mesenchymal cell differentiation and its misexpression in vivo causes osteopenia, and the phenotype of the Cebpb inactivation may be secondary to systemic indirect effects, and to direct effects of C/E BP beta in osteoblasts.
Abstract: CCAAT/Enhancer Binding Proteins (C/EBPs) are expressed by osteoblasts and adipocytes during differentiation. C/EBPβ is critical for adipogenesis; however its role in osteoblastogenesis is unclear, and its function in the postnatal skeleton is not known. To study C/EBPβ in osteoblasts in vivo, we created transgenic mice expressing full length C/EBPβ under the control of a 3.8 kilobase fragment of the human osteocalcin promoter. Two transgenic lines were established in an FVB genetic background, and compared to wild type littermate controls. Both C/EBPβ transgenic lines exhibited osteopenia, with a 30% decrease in bone volume, due to a decrease in trabecular number. The number of osteoblasts and osteoclasts per bone perimeter was not changed. Bone marrow stromal cells from C/EBPβ transgenics showed reduced mineralization, and reduced alkaline phosphatase mRNA levels. Calvarial osteoblasts from C/EBPβ transgenics displayed reduced alkaline phosphatase activity. To determine the consequences of the Cebpb deletion in vivo, the phenotype of Cebpb null mice was compared to that of wild type controls of identical genetic composition. Cebpb null mice exhibited reduced weight, body fat, and bone mineral density, and decreased bone volume, due to a decrease in trabecular number. The number of osteoblasts and osteoclasts per bone perimeter was not changed. C/EBPβ down regulation by RNA interference in calvarial osteoblasts had no effect on osteoblast differentiation/function. The phenotype of the Cebpb inactivation may be secondary to systemic indirect effects, and to direct effects of C/EBPβ in osteoblasts. In conclusion, C/EBPβ plays a role in mesenchymal cell differentiation and its misexpression in vivo causes osteopenia.
University of Pittsburgh1, University of Tulsa2, University of Wisconsin–Milwaukee3, Mayo Clinic4, Boston University5, Boston Medical Center6, Yale University7, Johns Hopkins University8, Northwestern University9, Saint Francis University10, Medical University of South Carolina11, United States Department of Veterans Affairs12, University of Maryland, College Park13, Toronto Rehabilitation Institute14
TL;DR: This work finds Campbell-Taylor's interpretation of the literature to be incomplete and one-sided, leading to misleading and pessimistic conclusions on dysphagia assessment and management practices performed by speech-language pathologists in Long-Term Care settings.
TL;DR: Med patients are at-risk for poor treatment compliance following laparoscopic Roux-en-Y gastric bypass; however, they achieve similar weight losses 6 months postoperatively.
Abstract: Background
We examined whether patients with a history of mood and eating disorders (MED) had less weight loss and poorer treatment compliance after laparoscopic Roux-en-Y gastric bypass (LRYGBP) than patients with a history of either mood (MD) or eating disorders (ED), or no history of mood or eating disorders (ND).
TL;DR: Four distinct conceptions of health emerged from responses to the “how do you know” question: physical, psychosocial, capacity, and control, which varied with survey year as well as respondent age and education.
Abstract: Our objective was to determine how large, random samples of Americans define health. Two questions were used to ascertain concepts of health: Are you healthy? and How do you know? (What does health mean to you?) These questions were added to omnibus telephone surveys conducted with two random samples of adults from the 48 contiguous United States: one in 1995 (N = 1,000); the other in 2002 (N = 1,011). The surveys also collected demographic data. This study focuses on cases with complete data (N = 950 in 1995, N = 967 in 2002). In both survey samples, more than 92% of respondents reported that they were healthy. Four distinct conceptions of health emerged from responses to the "how do you know" question: physical, psychosocial, capacity, and control. While prevalence varied with survey year as well as respondent age and education, these four concepts were evident in both 1995 and 2002. There are four robust concepts of health in America. Ongoing attention to these concepts may enhance efforts to communicate about and improve health.
TL;DR: The results suggest that this compound alleviates infantile anxiety-like behavior with great specificity in rats bred for high anxiety/depressive phenotypes by selectively targeting 5-HT1A receptors, possibly by both pre- and post-synaptic mechanisms.
Abstract: To address the development of early anxiety disorders across the lifespan, the High USV line of rats was bred based on rates of infant ultrasonic vocalization in the 40–50 kHz range of predominant frequencies (USV) to maternal separation at postnatal day (P) 10. In this study, rates of USV in High line infants (pups: Postnatal Day 11 ± 1) were compared to those of randomly-bred controls in response to EPIX compound PRX-00023, a unique serotonin (5-HT) agonist, acting exclusively at the 5-HT1A receptor, or buspirone, a nonspecific 5HT1A agonist. After testing, pups were examined for sedation and other drug-related effects. The results indicated that all doses of buspirone reduced USV rates in isolation, consistent with other reports. PRX-00023 significantly reduced USV rates at the lowest doses (0.01–0.05 mg/kg). None of the PRX-00023 doses produced sedation, whereas all but the lowest dose of buspirone (0.1 mg/kg) produced sedation effects. The results suggest that this compound alleviates infantile anxiety-like behavior with great specificity in rats bred for high anxiety/depressive phenotypes by selectively targeting 5-HT1A receptors, possibly by both pre- and post-synaptic mechanisms.
TL;DR: A case of severe aplastic anemia (AA) that was probably induced by lenalidomide is described, where a 64‐year‐old male patient developed progressive pancytopenia three weeks into therapy with lenalidomside for his relapsed MM.
Abstract: Lenalidomide is an important contemporary treatment option for patients with multiple myeloma (MM) Rare instances of autoimmune conditions have been observed in association with its use Although moderate myelosuppression is not uncommonly seen in patients treated with lenalidomide, aplastic anemia has not previously been reported to be associated with this agent We describe a case of severe aplastic anemia (AA) that was probably induced by lenalidomide A 64-year-old male patient developed progressive pancytopenia three weeks into therapy with lenalidomide for his relapsed MM A bone marrow aspirate and biopsy confirmed the diagnosis of AA and suggested the existence of an immunological reaction at the level of marrow A gradual spontaneous recovery of normal hematopoiesis followed after the lenalidomide discontinuation
TL;DR: It is intriguing that a Jamaican female patient with prekallikrein deficiency, associated with a severe bleeding diathesis, presented with a moderate nasal bleeding tendency in her youth, followed by severe recurrent mucosal bleeding later in life.
TL;DR: The 5-item COPD-AQ proved a practical tool for assessing COPD status and was sufficiently simple for routine clinical use, however, overall validation was limited by small numbers of patients in the validation sample.
TL;DR: Preliminary data are provided to suggest that requiring additional presurgical weight loss attempts may not be warranted for the vast majority of extremely obese bariatric candidates.
Abstract: Background
Extremely obese bariatric surgery candidates report numerous episodes of both successful and unsuccessful dieting attempts, but little is known about the clinical significance of frequent dieting attempts in this patient group.
TL;DR: It was concluded that WHOQOL-BREF Chinese version was successfully used in the evaluation of QOL of HIV/AIDS individuals in Chinese population and proved to be a reliable and useful tool.
Abstract: This study is aimed to evaluate the quality of life (QOL) for individuals living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Hubei province-central China by using WHOQOL-BREF instrument (Chinese version). One hundred and thirty six respondents (HIV/AIDS individuals) attending out-patient department of Chinese Center for Disease Control and Prevention (Chinese CDC) were administered a structured questionnaire developed by investigators. QOL was evaluated by using WHOQOL-BREF instrument (Chinese version). The results showed that the mean score of overall QOL on a scale of 0-100 was 25.8. The mean scores in 4 domains of QOL on a scale of 0-100 were 82.9 (social domain), 27.5 (psychological domain), 17.7 (physical domain) and 11.65 (environmental domain). The significant difference of QOL was noted in the score of physical domain between asymptomatic (14.6) and early symptomatic individuals (12) (P=0.014), and between patients with early symptoms (12) and those with AIDS (10.43) (P<0.001). QOL in psychological domain was significantly lower in early symptomatic (12.1) (P<0.05) and AIDS patients (12.4) (P<0.006) than in asymptomatic individuals (14.2). The difference in QOL scores in the psychological domain was significant with respect to the income of patients (P<0.048) and educational status (P<0.037). Significantly better QOL scores in the physical domain (P<0.040) and environmental domain (P<0.017) were noted with respect to the occupation of the patients. Patients with family support had better QOL scores in environmental domain. In our research, QOL for HIV/AIDS individuals was associated with education, occupation, income, family support and clinical categories of the patients. It was concluded that WHOQOL-BREF Chinese version was successfully used in the evaluation of QOL of HIV/AIDS individuals in Chinese population and proved to be a reliable and useful tool.
TL;DR: The results question the 50,000/μl threshold and demonstrate the need for hematology analyser specific thresholds.
Abstract: Objective. A lamellar body count (LBC) ≥50,000/μl is suggested to document fetal lung maturity (FLM). We sought to determine the LBC threshold for FLM with the Cell-dyn 4000 hematology analyser.Methods. We queried our database for patients who underwent LBC testing from 2001 to 2007. Included were deliveries between 35 and 38 weeks gestation with testing ≤7 days from delivery. We excluded twins, anomalies and cases of ruptured membranes. Data were analysed for sensitivity and specificity of predicting respiratory distress syndrome (RDS) and plotted on a receiver operating characteristic curve.Results. There were 209 patients meeting study criteria. Of these, 120 had diabetes. Five neonates experienced RDS, all born to non-diabetic mothers with LBC values ≤72,000/μl. At this value the sensitivity is 100%, false positive rate 18% and the p value is 0.0146.Conclusion. Our results question the 50,000/μl threshold and demonstrate the need for hematology analyser specific thresholds.