University of Tennessee Health Science Center
UTHSC Digital Commons (University of Tennessee Health Science Center)Not a member yet
1172 research outputs found
Sort by
Long-Term Functional Effects of Medulloblastoma Treatments
Get PDFAll studies relate directly to components of the evidence-based practice question and were used to understand the possible long-term effects of treatment for clients diagnosed with medulloblastoma cancer. This Critically Appraised Topic (CAT) contains 6 research articles from both national and international journals. Study designs include two cohort studies with a control group, 1 cross sectional study with a control group, 1 retrospective cohort study without a control group, 1 descriptive report on a Randomized Control Trial (RCT), and 1 descriptive study. Through these studies, we found that radiation treatment is associated with impaired IQ and academic achievement and that generalized or separation anxiety is common among medulloblastoma patients after treatment. We also found that better outcomes in functioning were associated with age, dosage, time of diagnosis, and medulloblastoma type. Our recommendations for OT practice include assessing processing speed, working memory, verbal skills, executive function, and attention and monitoring cognitive effects of occupational therapy interventions using a Goal Attainment Scale (GAS)
A Dynamic Ankle Orthosis for Alleviating Mechanical Foot and Ankle Pain, Preserving Joint Motion, and Restoring Patient Function
Get PDFOver two million Americans visit the doctor each year for foot and ankle pain stemming from a degenerative condition or injury. Standard of care ankle-foot orthoses have been shown to effectively manage pain symptoms of the lower limb, but they can also significantly hinder joint motion and limit function. The Dynamic Ankle Orthosis (DAO) was created with the intent to alleviate pain using an offloading mechanism without interfering with natural joint motion. This dissertation presents the development, benchtop validation, functional assessment, and clinical evaluation of this novel treatment option for patients suffering from acute and chronic foot and ankle pain.A benchtop validation study was performed to determine the offloading capacity of the DAO during static double stance and to quantify the brace’s effect on passive ankle motion. Static offloading of the DAO was measured using load cells, and an isokinetic dynamometer measured resistance to passive, non-weight-bearing ankle motion with and without the brace. The DAO offloaded between 11%-30% BW with 77%-95% brace force transference. The DAO permitted a functional range of ankle motion (10° dorsiflexion to 20° plantarflexion) and did not increase resistance to ankle motion.In a gait laboratory setting, a functional assessment was performed with ten healthy subjects to compare ankle joint kinematics and plantar pressures during treadmill walking among the DAO, a standard double upright ankle-foot orthosis (DUAFO), and an unbraced control (CON) condition. Ankle kinematics were assessed using a 3D motion capture system and in-shoe plantar pressures were measured for seven areas of the foot. DAO reduced hallux peak plantar pressures compared to CON and DUAFO. Peak plantar pressures under toes 2-5 were smaller in DAO than DUAFO. Eversion ROM was much smaller in DUAFO compared to CON and DAO. The impact of the DAO on pain and function was evaluated in a clinical setting with twenty-five patients symptomatic with foot and/or ankle pain. Eight functional activities were completed with CON and DAO. Force insoles were used to capture in-shoe vertical forces and a visual analog scale was used to assess pain levels during each activity. A post-test questionnaire was used to measure the self-perceived impact of the DAO on the patient’s symptoms and function. Peak in-shoe forces were reduced during level and stair walking (p\u3c0.05). Average pain was 1.2 to 1.6 points lower with DAO than CON for the active tasks (clinically meaningful). Most participants reported that the DAO either improved (n=19) or did not affect their symptoms (n=5). Function scores were improved on average (+3.7). DAO improved symptoms of osteoarthritis, posterior tibialis tendon dysfunction, postoperative pain, ankle sprains, and nerve disorders. This body of work demonstrates the capacity of the DAO to provide significant offloading during ambulation without greatly affecting kinematic parameters including sagittal and frontal plane ankle motion compared to an unbraced control. Additionally, this work provides novel evidence that the DAO can improve symptoms and the ability of impaired individuals to complete functional activities such as level and stair walking
Mental Health Assessments in ICU and Acute Care
Get PDFThe purpose of our critically appraised topic is to provide a brief summary of assessments that may be relevant to the burn unit or ICU setting, including their validity, reliability, specificity, sensitivity, and limitations. We had a total of eight articles with the following study designs: Systematic Review (2 articles), Longitudinal Study (1 article), Comparative Analysis (1 article), Correlational Analysis (2 articles) and Methodological (2 articles). These articles looked at the reliability, validity, specificity, and sensitivity of the following assessments: Abbreviated Burn Specific Anxiety Scale (A-BSPAS), Beck Depression Inventory-II, Brief Coping Orientation to Problems Experience (B-COPE), Concise Mental Health Checklist (CMHC-9), Confusion Assessment Method for Intensive Care Units (CAM-ICU), Startle, Physiological arousal, Anger, and Numbness (SPAN), Trauma Screening Questionnaire (TSQ), The Confusion Assessment Method (CAM), and Wound-Quality of Life. We found the following assessments applicable for the burn unit or ICU: CAM, B-COPE, CAM-ICU Flowsheet. Our clinical recommendations are for these assessments to be used to perform a screening of the client\u27s mental state, which will help the Occupational therapist develop and plan interventions
Effect of Sound Source Location and Spatial Hearing on the Vestibulo-Ocular Reflex (VOR)
Get PDFAccurate measurement of the vestibulo-ocular reflex (VOR) is imperative in differential diagnosis of vestibular disorders and balance function. However, the assessment protocol faces a number of limitations, including the need to control for extra- vestibular sensory factors such as hearing. Previous research has shown that the use of an auditory stimulus can have a significant effect on functional measures of balance, and many have contributed effects to be the result of spatial hearing. However, no studies have directly assessed the effect of speaker location on the VOR nor investigated correlations of functional spatial hearing with the VOR. Therefore, the aims of this study were to 1) assess the effect of speaker location on the VOR and 2) investigate if spatial hearing abilities are correlated with the strength of the VOR.
A between subjects repeated measures design was utilized with a child group (age 6-9 years) and an adult group (18-40 years). The rationale of the two groups was to compare differences in a group with underdeveloped localization abilities (child) and a group with matured localization abilities (adult). A total of 22 children and 23 adults participated in this study. Localization ability was measured using the root mean square (RMS) error method. VOR gain was measured using the rotational chair test at a rate of .08 Hz in the following auditory conditions: silent (insert earphones turned off), insert earphones turned on, external speaker at 0° azimuth rotating with participant, and external stationary speaker. Order of testing was randomized to control for any order effects. An independent samples t-test confirmed a significant difference in RMS error between groups with the child group performing worse than the adults. Subsequent multivariate analysis of variance indicated a significant effect for speaker location with the external moving speaker having significantly lower gain and the external stationary speaker having significantly increased gain for both child and adult groups. Correlations were run for both groups for both fixed and moving speaker conditions. No correlation was seen in either condition for the child group, however, a positive correlation was seen for both conditions for the adult group, meaning as RMS error increased so did VOR gain.
These results indicate the possible need to control for environmental auditory stimulus location when undergoing vestibular assessment. However, further studies need to be performed to corroborate the evidence presented
Genomic Instability and the Oncohistone H3K27M Drive Gliomagenesis in a Murine Model
Get PDFMaintaining genome stability is crucial for human health and it is of particular importance in neural cells during early brain development. Genome maintenance occurs at two broad stages; surveillance during DNA replication and DNA damage repair in differentiating and mature cells. Neural cells are particularly sensitive to DNA strand breaks and defective DNA damage responses can result in detrimental effects on the nervous system, including cancer. Multiple DNA repair pathways play critical roles in preventing DNA damage accumulation in stem and neural progenitor cells. The mechanisms that protect progenitor genomes also suppress DNA mutations that can result in cancer. A primary objective of this dissertation is to understand the relative contributions of key DNA repair factors that prevent tumorigenesis during cortical development. We have compared the differential effects of inhibition of homologous recombination (HR), via BRCA2-inactivation and non-homologous end-joining (NHEJ), via LIG4-inactivation towards tumorigenesis by directing their deletion specifically to early cortical progenitors using an Emx1-cre recombinase driver. We find that coincident loss of either of these repair pathways with p53 inhibition result in distinct high-grade glioma (HGG) formation resulting from elevated genome instability by DNA damage accumulation during embryogenesis. Furthermore, the presence of the oncohistone H3K27M mutation, commonly found in pediatric HGGs, enhances genome instability and accelerates cortical gliomagenesis with p53 inactivation and defective HR or NHEJ. Additionally, the H3K27M resultant gliomas showed distinctive differences in increased brain tumor penetrance and diffusion. Through RNA-sequencing and whole exome sequencing we identify upregulation of genes normally controlled by bivalent gene promoter post-translational modifications, which result in transcriptional alterations in genes important for both neural development and tumorigenesis. Mechanistically, this is done by targeting specific populations of cortical cells that are more susceptible to DNA damage and transformations that may cause additional critical mutations during a limited timeframe of early cortical development which eventually result in HGGs. We provide evidence supporting that BRCA2 functions to provide DSBR and genome stability to the early-born proliferating cortical progenitor cell population, while LIG4 provides the same function but to a lesser extent to progenitor cells and more so to post-mitotic neurons. Since, epigenetic regulation is tightly connected with neural development and differentiation, we propose the specific genes that H3K27M effects may differ depending on the time period and particular cell state from which the HGG initiates. We believe this contributes to reduced heterogeneity in glioma expression signatures with H3K27M in addition to either HR- or NHEJ-deficiency. Ultimately this work highlights the power of inducible genetically engineered mouse models as an approach to better understand the complexities of providing a connection between genome instability and gliomagenesis
VERU-111 as an Oral Tubulin Inhibitor Suppressing Triple-Negative Breast Cancer and Evaluation of Novel Tubulin Inhibitors for Cancer Therapy
Get PDFTriple negative breast cancer (TNBC) has aggressive clinical features strongly associated with poorer overall prognosis and higher mortality rates relative to other molecular subtypes. FDA-approved drugs, such as paclitaxel, are effective in treating TNBC. Yet, treatment failure is commonly observed due to the development of acquired chemoresistance, which remains a clinical challenge for TNBC therapy
Leveraging Health Informatics and Parental Empowerment: Perspectives from Parents and Caregivers of Medically Complex Children
Get PDFThis research paper focuses on the barriers that parents and caregivers of special-needs children patients face with leveraging technology and informatics as they attempt to communicate with their child’s healthcare specialists regarding specialized and critical oversight and management of complex medical conditions and the need for empowerment for this population of parents and caregivers. The literature suggests that the age and socioeconomic status of the individual has a big impact on the use of electronic applications. A review of the literature showed that the special needs population has not been represented. This study surveys a range of parents and caregivers to include a various age ranges, genders, education and socioeconomic statuses to identify the barriers this unique population has encountered
Mean Arterial Pressure in Acute Ischemic Stroke Study
Get PDFBackground. There is little, if any, evidence available on the validation of blood pressure (BP) measurements obtained in the acute care setting. Despite this, acute stroke practitioners trust and rely on non-invasive blood pressure (NIBP) devices to guide acute ischemic stroke (AIS) patients’ treatment. Although systolic blood pressure (SBP) has been found to be the most unreliable measurement displayed on NIBP devices, treatment decisions for AIS are based on them. Today, 25 years after the FDA’s approval of alteplase, practitioners continue to use BP parameters of 185/110 and 180/105 to guide the initiation of alteplase bolus and infusion, although the shift to the use of NIBP devices challenges the validity of these dated parameters. Theoretically, by inserting the inclusion and exclusion systolic and diastolic blood pressure thresholds into the mean arterial pressure (MAP) equation, one could deduce the exclusion threshold for MAP to be \u3e 130. Furthermore, if a MAP of 130 mmHg were to be adopted as the threshold for treatment, many patients who would otherwise be excluded, would receive alteplase treatment. A clear understanding of MAP in relation to SBP and diastolic blood pressure (DBP) in patients with AIS, which is now exclusively measured with NIBP devices, is critical for safe and effective alteplase management. Study Aims. To understand agreement between SBP, DBP, and MAP measured by NIBP and measured manually in alteplase-treated AIS patients. An additional secondary study aim was to investigate the relationship between MAP and outcomes in alteplase-treated AIS patients. Methods. Two trained examiners from three comprehensive stroke centers and four primary stroke centers measured five sets of manual-derived BP and NIBP-derived SBP, DBP, and MAP in 95 acute ischemic stroke patients treated with alteplase for a total of 475 paired sets of measures. The two examiners used a dual-auditory stethoscope to ensure accuracy of the manual measures. To avoid interruption of acute stroke care, all measurements occurred during the 24 hours following the alteplase infusion. The data was analyzed using Bland-Altman analysis for measures of agreement. Results. Our study found no agreement in SBP, DBP, and MAP for 475 paired manual and NIBP measurements, with SBP and MAP manual and NIBP measures showing the least agreement between methods. Although DBP-paired measures did not agree, they were in closer agreement than SBP and MAP measures on Bland-Altman (BA) analysis for measures of agreement, and 44% of DBP measures fell within 5 mmHg of each other. NIBP measures were consistently higher than manual measurements and differed from manual measurements as much as 50 mmHg for SBP, 40 mmHg for DBP, and 44 mmHg for MAP. We found that the higher the systolic blood pressure, the greater the disagreement. Additionally, we analyzed the percentage of measurements that fell within a difference of 5, 10, 15, and 20 mmHg for SBP, DBP, and MAP separately. For SBP, 39% of the 475 sets of measures fell within 5 mmHg and 62% fell within 10 mmHg. For DBP, 44% fell within 5mmHg and 72% fell within 10 mmHg. For MAP, 34% fell within 5 mmHg and 62% fell within 10 mmHg. Conclusion. Despite the widespread use of NIBP devices, few clinicians are familiar with their fundamental operating principles and the potential for inaccuracies and disagreement between manual and NIBP measurements. Clinically acceptable limits of agreement for SBP, DBP, and MAP in AIS patients should be defined a priori based on clinical necessity, biological considerations, and treatment goals. Additionally, our study takes an important first step in reframing AIS treatment context toward consideration of MAP as a key measure to guide the initiation of alteplase treatment and ongoing patient management. It is likely that stroke guidelines are silent regarding MAP because the information to understand safe MAP levels in AIS patients during and after alteplase administration is lacking. The safe MAP for AIS patients receiving alteplase treatment is not yet known, but work must continue in this area
Renal and Cardiovascular Outcomes Associated with Cannabis Use in Veterans with Advanced Chronic Kidney Disease Transitioning to Dialysis
Get PDFBackground: Legalization of cannabis and its constituents may lead to increased exposure of a higher number of consumers to cannabis use, including those with chronic kidney disease (CKD). We expect increase in cannabis use, especially, in patients with compromised kidney function. However, there is sparse literature on the effects of cannabis use on cardiorenal and mortality outcomes among patients with advanced CKD. Objectives: The main goal of the current study was to examine the effect of cannabis use on renal and cerebrovascular outcomes as well as mortality in patients with advanced CKD. Using a nationwide cohort of US veterans with advanced CKD transitioning to dialysis, we were guided by the following aims: Aim 1) Evaluate the effect of cannabis exposure on kidney function by 1a) examining the association of cannabis exposure with progression of CKD, and 1b) investigating the association of cannabis exposure with the incidence of acute kidney injury (AKI); Aim 2) Investigate the association of cannabis exposure with the incidence of stroke; and Aim 3) Examine the association of cannabis exposure with mortality (mortality due to any reason and cardiovascular mortality). Methods: We used a retrospective cohort study design in a nationally representative cohort of US veterans with incident End-Stage Renal Disease (ESRD) who transitioned to renal replacement therapy from October 1, 2007 through March 31, 2015. The Transition of Care in Chronic Kidney Disease (TC-CKD) cohort consisted of 102,477 US veterans with incident ESRD identified from the US Renal Data System (USRDS). Urine toxicology tests (UTOX) determined the use of cannabis, opioids, other drugs, and combinations of the same in the patients who had undergone a UTOX test within the year prior to dialysis initiation. After applying inclusion and exclusion criteria, 7,146 patients comprised our study population. Chapter 2 discusses our examination of the association between UTOX groups and renal outcomes, including both long-term changes in estimated glomerular filtration rate (eGFR) and the incidence of AKI. We used mixed-effects models with random intercepts and slopes and logistic regression to examine the association between UTOX groups and the risk of change in eGFR and AKI, respectively. Chapter 3 describes our investigation of the association between UTOX groups and cerebrovascular accident (CVA) events using Cox proportional hazard models. Finally, Chapter 4 presents our research on the association between UTOX groups and mortality using Cox proportional hazard models (mortality due to any reason) and Fine and Grey’s competing risk regression (cardiovascular mortality). Results: Cannabis users were more likely to be younger (57 years cannabis users vs. 60 years no drug use), less likely to be white (45% cannabis users vs. 55% no drug use), and more likely to be smokers (69% cannabis users vs. 38% no drug use). We observed that cannabis use alone or combined with opioids or other drugs (vs. no drug use) was not significantly associated with steeper eGFR slopes or risk of AKI (P-value 0.4-1.0). We also found that the use of cannabis alone, opioids, other drugs alone, or a combination of these (vs. no drug use) was not significantly associated with the risk of CVA events (P-value 0.4-1.0). Finally, cannabis use alone or combined use of cannabis with opioids or with other drugs (vs. no drug use) was not significantly associated with mortality due to any reason or CV mortality (P-value 0.4-1.0). Conclusion: This study is the first, to our knowledge, to ascertain use of cannabis, opioids, or other drugs via UTOX tests to examine the association between various combinations of exposures and renal/cardiovascular/mortality outcomes in patients with advanced CKD transitioning to dialysis. The study findings suggest the absence of a harmful association between exposure to cannabis and renal/cerebrovascular/mortality outcomes. Future clinical trials and further epidemiological studies are needed to confirm these findings and further expand our understanding of the health effects of cannabis use in the general population as well as in patients with compromised kidney function
Librarians Helping to Combat Organizational Health Literacy Through an Updated Health Literacy Assessment Tool
Get PDFObjective: Health literacy continues to be a challenge libraries and organizations face. To help address organizational health literacy, the University of Tennessee Medical Center (UTMC) created a Task Force and utilized the Health Literacy Environment of Hospitals and Health Centers (HLEHHC) tool to assess UTMC’s health literacy attributes. When using this tool, it was discovered that some of the questions needed to be updated. This will discuss the process in which the UTMC Task Force and original author Rima Rudd revised and updated the HLEHHC to create the Health Literacy Environment, version 2 (HLE2).
Methods: This update was a two year collaborative process. An extensive literature review on health literacy was performed. Each section of the HLEHHC was reviewed, as well as each question, leading to question updates and removals. Changes were made to the rating scale to better reflect the questions. The new tool undertook a peer review process, followed by more updates. After those changes were made, the tool was pilot tested. Additional updates were then made based on pilot testing.
Results: The HLE2 is composed of five new sections: Organizational Policies, Institutional Practices, Navigation, Culture and Language, and Communication. The rating scale is yes/no as well as a frequency Likert scale. Directions are located at the beginning of each section along with how to score.
Conclusion: Through this collaborative process, Rima Rudd and the UTMC Task Force updated the HLEHHC to include timely questions and specific directions for use. Librarians are at the forefront helping to address the challenge of organizational health literacy. The HLE2 is available for use to analyze literacy-related barriers for organizations