University of Nebraska Medical Center
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Search Strategies for Efficacy of Surgical Management for Spontaneous Middle Cranial Fossa CSF Leaks: A Systematic Review with Meta-Analyses
Get PDFThe Correlation Between Social Work Encounters and Health Outcomes in Children with Cystic Fibrosis
Get PDFPurpose: The objective of this study is to evaluate the impact social workers have on the health of children with cystic fibrosis and to see if an increased number of social work encounters is an indicator of poor health in these children.
Methods: The electric medical record (EPIC) was used to collect data on 193 patients born between 2000 and 2024 (0 to 23 years). Data from June 1, 2019, to June 1, 2024 (or birth to June 1, 2024) was considered. Physical information, namely age (months and years), mutation (homozygous, heterozygous, or other), BMI (or weight/length) percentile and z-score, %FEV1, modulator (if applicable), visits to CF clinic, outpatient pulmonary exacerbations, and inpatient pulmonary exacerbations was collected. Additionally, social factors: food, housing, or transportation insecurity, education, prior CPS involvement, patient/caregiver mental health (qualitatively and with PHQ-9/GAD-7 (\u3eage 11)), language barriers, and insurance type were taken into account. All values were adjusted for age by months. Statistical analysis by t-test was conducted to check for the significance of the findings.
Results: When considering the entirety of the data set, it can be deduced that the number of social work visits is suggestive of health. Namely, a high number of social work encounters corresponded to lower BMI and FEV1 (-m), and a higher number of exacerbations (+m). Statistically, however, this is not significant, so we accept the null hypothesis that social work encounters have no significant impact on health markers. In patients with the top 10 most social work encounters, exacerbation trends remain consistent, but FEV1 and BMI trends appear in the inverse (+m). Further research is needed to determine why. Our hypothesis is disproven, perhaps due to social workers improving the health of patients by providing support and resources.https://digitalcommons.unmc.edu/surp2024/1002/thumbnail.jp
Diet Quality Differences Between Residents and their Patient Population
Get PDFhttps://digitalcommons.unmc.edu/com_fam_pres/1012/thumbnail.jp
08 - You Are Not Alone: Pregnancy Loss and Grief
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I was a Bereavement RN at a large women’s health clinic for four years and in my work, I met thousands of women experiencing pregnancy losses. Despite how common pregnancy loss is, it can be isolating as many people are not open about the experience. It is heartbreaking that we live in a culture that places the weight and blame of this on women—so much so that the first question they would often ask me is, “What did I do wrong?” I hope that by sharing my experience I can bring awareness to pregnancy loss and create an open dialogue.
About Kirsten
Kirsten Hepburn
PhD graduate student in UNMC College of Nursinghttps://digitalcommons.unmc.edu/livinglibrary2024/1007/thumbnail.jp
Implementation of a Validated Suicide Screening Tool in a University Student Health Center
Get PDFPurpose. Suicide is the second leading cause of death among adults in the United States and Nebraska. Death by suicide impacts millions of adults every year in the United States but warning signs are often missed during visits with primary care providers. The University of Nebraska at Kearney (UNK) Student Health Center (SHC), like many other primary care clinics, did not routinely screen patients for suicide risk. According to the Joint Commission, all patients over 12 years of age should be screened for suicide using a validated screening tool if the visit is for any behavioral health concern. The project’s goals were to implement a validated suicide screening tool, evaluate the use and effectiveness of the suicide screening tool, and evaluate the relationship between the depression screening tool and suicide screening tool. Theoretical Framework. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model was used to guide this project. The ARCC model is a five-step quality improvement plan that includes, assessment of culture and organizational readiness, identification of facilitators and barriers, identification of evidence-based practice (EBP) mentors, implementation of the evidence into practice, and evaluation of the outcomes (University of Maryland School of Nursing, 2020, para. 3). Methods. UNK is a public university in central Nebraska with over 6,000 undergraduate and graduate students. The Columbia Suicide Screening Scale (C-SSRS), a validated six-question yes/no style screening questionnaire, was implemented in UNK\u27s SHC campus clinic for all patients who screened positive for depression on the Patient Health Questionnaire (PHQ-2) or by provider preference. The C-SSRS was administered to the patients by the nurse practitioners to determine the patient\u27s level of suicide risk and appropriate intervention. Interventions included a mental health resource sheet for lowrisk patients, establishing a safety plan with the provider for moderate-risk patients, or referral to an inpatient psychiatric facility for a full psychiatric evaluation for high-risk patients. Results. Over a 14-week period, UNK’s SHC had a total of 773 visits with 729 (94.3%) PHQ-2 screenings completed and 301 (38.9%) C-SSRS screenings completed. Of the 301 C-SSRS screenings completed, 69.8% of patients were at no risk, 17.6% were at low risk, 9.6% were at moderate risk and no patients were at high risk of suicide. Two hundred fifty-eight students completed the PHQ-2 and the C-SSRS screenings. Seven patients (3.7%) were at low risk and three patients (1.6%) were at moderate risk of suicide while scoring two or less on the PHQ-2 screening. Of the patients who scored three or higher on the PHQ-2, six patients (8.6%) declined the C-SSRS screening, 31 patients (44.3%) were at no risk, 19 patients (27.1%) were at low risk, and 14 patients (20%) were at moderate risk for suicide. Eight patients declined the C-SSRS but had an average PHQ-2 score of 4.25. Conclusions. Based on the data, implementation of a validated suicide screening tool is sustainable and beneficial for recognition of suicide risk in the college population. It is vital to screen for suicide risk and connect at-risk college students with appropriate, algorithm-based interventions to work toward decreasing suicide rates across the country. Of note, it may be beneficial to implement the C-SSRS to all students as there were a small number of students (n=10) identified at low or moderate risk without a PHQ-2 score of three or higher. It is also important to ensure the patients who decline the suicide screening still may need to receive intervention as if they are low or moderate risk of suicide based on provider discretion
Search Strategies for “Analgesic Safety and Efficacy of Intrathecal Morphine in Elective Posterior Lumbar Fusion: A Systematic Review with Meta-Analyses”
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Investigating the Association of Total Cholesterol Level and Odds of Angina in Women over 40: a Cohort Study Using Data from the Framingham Heart Study
Get PDFObjective To investigate the association between total cholesterol level and the odds of experiencing angina in women over the age of 40.
Methods This retrospective cohort study was conducted using a subset of the cohort from the Framingham Heart Study to create a multivariable logistic regression model for analysis. Out of the 4,434 participants in the Framingham cohort, 2,148 participants were women over the age of 40 and included in this study.
Results Of the participants who experienced angina (n=308) in this study, 62% had high cholesterol at the baseline. After controlling for age, women with high cholesterol had 2.03 (95% CI: 1.03-2.39, p=0.0002) higher odds of experiencing angina compared to participants with normal levels of cholesterol.
Conclusions This study found that in women over the age of 40, the total cholesterol level is significantly associated with increased odds of experiencing angina. This study can be a steppingstone to further investigate the association in women through stratifying angina by type and cholesterol level by densit
PDAC-cells Differentially Modulate Expression of Neutrophil Serine Proteases and Their Inhibitors
Get PDFPro-inflammatory tumors are a defining feature of pancreatic cancer. Infiltrating leukocytes modulate inflammation and aid in PDAC disease progression; this leads them to be therapeutic targets for researchers. Neutrophils, which are pro-tumorigenic, are the most abundant leukocyte in circulation; although past research has indicated that neutrophils aid in tumor progression, the mechanisms behind tumor-associated neutrophils are relatively unknown. One focus of my laboratory is neutrophil serine proteases (NSP), enzymes produced by neutrophils capable of inducing apoptosis. The inhibitors of these NSPs are serine protease inhibitors (serpins), and past research has shown that deficiencies in them have led to high cell mortality, indicating that these serpins and NSPs may modulate apoptosis levels (4). My lab has also shown that neutrophil survival increases with the treatment of PDAC-conditioned media. The specific objective of my project is to understand how PDAC cells modulate the expression of neutrophil serine proteases and their inhibitors. We used cDNA from a mouse promyelocyte neutrophil cell line (MPRO) that was treated with different PDAC-conditioned media. Expression levels of NSP genes (Cathepsin G (CatG), Neutrophil Elastase (NE), and Proteinase 3 (PR3)) and their inhibitors (Serpin b1a, Serpin b6a, and Serpin a1a) were observed using qRT-PCR (1). We observed that for NSPs, the trend indicated greater expression in the gemcitabine-resistant treated cell lines (CD18/HPAF GemR and T3M4 GemR), compared to the parental treated cell lines (CD18/HPAF and T3M4). Additionally, for L3.3 (low metastatic) and L3.6 (high metastatic) treated neutrophils, we see upregulation expression of serine proteases in L3.6 treated cells compared to L3.3 treated cells. In contrast, for NSP inhibitors, the trend indicates greater expression in the parental cell lines than in gemcitabine-resistant cell lines. There is upregulation in both L3.3 and L3.6 cell expression as well. Together, our data suggests that PDAC cells differentially modulate the expression of NSPs and their inhibitors.https://digitalcommons.unmc.edu/surp2024/1007/thumbnail.jp
Functional Analyses of Response Chains
Get PDFAlthough functional analyses (FAs) have been used to determine the cause of problem behavior and to develop effective treatment (Iwata et al., 1982/1994; Hanley et al., 2003), they may pose an increased risk of injury to the participant and others when the target response is a severe behavior (Smith & Churchill, 2002). Several studies have explored the efficacy of using response class hierarchies (precursors) in an FA, but fewer studies have explored early sub-responses in a behavior chain. Therefore, the purpose of this study was to 1) identify a systematic process for defining response chains of severe behavior and verify the early sub-response as a precursor; 2) evaluate the validity and relative safety of an FA of early sub-responses in a response chain of severe behavior; and 3) conduct a post-hoc analysis to identify variables associated with the safety of a response chain FA