University of Nebraska Medical Center
University of Nebraska Medical Center Research: DigitalCommons@UNMCNot a member yet
10909 research outputs found
Sort by
High-Grade B-Cell Lymphoma, Not Otherwise Specified: CNS Involvement and Outcomes in a Multi-Institutional Series
Get PDFLittle is known about the central nervous system (CNS) risk in high-grade B-cell lymphoma, not otherwise specified (HGBL NOS). Hence, we sought to describe the rates of baseline CNS involvement, risk of CNS recurrence after primary therapy, and management strategies in HGBL NOS. In this multicenter retrospective study, we included 160 adults with newly diagnosed HGBL NOS treated between 2016 and 2021 at 20 US institutions. Eleven patients (7%) had baseline CNS involvement at diagnosis (leptomeningeal = 6, parenchymal = 4, and both = 1). Baseline CNS involvement was significantly associated only with MYC rearrangement (OR = 3.5) and testicular (in men) or female pelvic (in women) involvement (OR = 8.1). There was no significant difference in survival outcomes between patients with HGBL NOS with (median PFS = 4 years) or without (median PFS = 2.4 years) baseline CNS involvement (P = 0.45). The cumulative incidence of CNS recurrence at 3 years was 11%. Patients with baseline CNS involvement were at the highest risk (48.5% vs 8% for those without baseline CNS involvement) and were excluded from the risk factors analysis for CNS recurrence. The risk for CNS recurrence was significantly associated with blood or bone marrow involvement, CD5 expression, non-germinal center B-cell subtype, and dual-expresser lymphoma phenotype, however, high CNS IPI was not. The prognosis of relapsed HGBL NOS was poor, regardless of whether recurrence was systemic or limited to the CNS, and with currently available salvage strategies, including autologous transplantation and chimeric antigen receptor T-cell modalities, almost all patients with CNS recurrence ultimately succumbed to their disease
Effectiveness of Interventions in the Scope of Occupational Therapy for Mental Health in Children and Adolescents: A Systematized Review
Get PDFImportance: 1 in 5 children in the US have a mental health disorder (Larson et al., 2017) which affects health across the lifespan, including engagement in school and play (Rizvi et al., 2024).
Objective: This systemized review explored literature about the effectiveness of mental health interventions for children and adolescents within the occupational therapy (OT) scope of practice.
Data Sources: A medical librarian searched articles from 2019-2024 that were retrieved from PubMed, CINAHL, and PsycINFO.
Study Selection and Data Collection: Studies were included if the outcome measures addressed mental health, interventions were within the scope of OT, participants were children ages birth to 18 years, if the study was conducted in the US, and if the article was published in the last five years. The results from these articles were synthesized and graded using the U.S. Preventive Taskforce (2018) definitions.
Findings: Five RCTs met inclusion criteria. School-based group interventions included mindfulness and relaxation, and motivational interviewing and CBT with one-on-one coaching. Individual interventions in clinical settings included between-session messaging and parent education on adolescence. There is moderate evidence to support these interventions, with mixed results for use of CBT and motivational interviewing with one-on-one coaching. More evidence is needed to make clinical recommendations for treatment dosage.
Conclusion & Relevance: OTPs should consider school-based group intervention such as mindfulness and relaxation, and individual interventions in clinical settings such as parent education on adolescence and technology reminders on a routine basis. School-based group CBT and motivational interviewing practices with one-on-one coaching are recommended on a case-by-case basis when addressing mental health symptoms in children due to mixed results in mental health outcomes.
References: Merikangas, K., He, J.-p., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., . . . Swendsen, J. (2011). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980-989. 10.1016/j.jaac.2010.05.017
Larson, S., Chapman, S., Spetz, J., & Brindis, D. C. (2017). Chronic childhood trauma, mental health, academic achievement, and school-based health center mental health services. Journal of School Health, 87(9), 675-686. https://doi.org/10.1111/josh.12541 U.S. Preventive Services Task Force. (2018). Grade definitions. https:// www.uspreventiveservicestaskforce.org/Page/Name/grade-definitionshttps://digitalcommons.unmc.edu/cahp_ot_sysrev/1018/thumbnail.jp
Characterizing the Francisella tularensis Universal Stress Protein
Get PDFFrancisella tularensis is an extremely virulent pathogen responsible for the zoonotic disease tularemia. F. tularensis employs various defense mechanisms to survive and persist under diverse environmental and host-induced stress conditions. Despite its significance, the full spectrum of stress factors that enable F. tularensis persistence remain inadequately understood. In many bacterial species, universal stress proteins (Usp) play a crucial role in managing adverse conditions. The aim of this study was to elucidate the role of Usp in F. tularensis as a means of clarifying the stress response mechanisms of this pathogen. The F. tularensis Usp is encoded by a single, highly conserved gene among different F. tularensis strains. Transcriptional analysis demonstrated that F. tularensis usp mRNA has a half-life exceeding 30 minutes, with protein and transcript levels remaining consistently high under various stress conditions, including nutrient deprivation, low pH, hydrogen peroxide, and paraquat exposure. Notably, the F. tularensis usp deletionmutant (Δusp) displayed impaired growth and recovery under paraquat-induced oxidative stress compared to the wildtype (WT) strain. Transcriptional studies further revealed that Usp supports the expression of oxyR and katG, key antioxidant defense genes in F. tularensis. A serendipitous discovery was then made when recombinant F. tularensis Usp (rUsp/His6) produced in Escherichia coli exhibited an apparent molecular weight of 33 kDa, surpassing the predicted 30 kDa. While this discrepancy was attributed primarily to a stop codon readthrough event resulting in an additional 20 amino acids at the C-terminus, the additional molecular weight was also attributed to the presence of post-translational modifications (PTM) on multiple rUsp/His6 residues, including lysine acetylation and glutamine polyamination. Together, these findings highlight Usp’s protective role in F. tularensis oxidative stress response, while providing insights into potential regulatory functions of Usp afforded by its observed PTMs
Minimizing Infant Injury Risk by Utilizing Parental Education in a Primary Care Setting
Get PDFIntroduction
Accidental injury and death to infants has been correlated to lack of proper education to parents of infants in the primary pediatric care setting. Sudden infant death syndrome (SIDS) and unintentional injuries were the second and third leading causes of post neonatal death during this period of time (Centers for Disease Control and Prevention [CDC], 2016). Studies have found that motor vehicle accidents are a leading cause of child injury and death for infants under 12 months of age. The CDC found that drowning, suffocation, and poisoning were other leading causes that contributed to child injury and death rates for infants under 12 months of age (Centers for Disease Control and Prevention [CDC], 2022). This project proposal will discuss the impact of proper education to parents and caretakers in the primary pediatric setting related to infant injury incidence. The importance of providing parental education in infancy to parents and caregivers will be examined in the pediatric primary care setting with the goal of decreasing cases of infant injuries in a primary care pediatric clinic.
Methods
The project design is a retrospective chart review that contains a pre and post survey that parents will complete. The survey will ask questions about parental knowledge prior to and after the implementation of a patient education portal and distribution of parent educational materials in clinic. The surveys and educational materials will be given to parents of infants less than 12 months of age. Charts from the previous year of infants under the age of one at the clinic will be checked for Emergency Room (ER) visits and past or recent hospitalizations of the infant. The clinic receives messages if their parents are hospitalized, so the provider is alerted to this. The enrolled infants’ charts will be checked for documentation of education at visits, and if the infant has been to the ER or admitted to the hospital since the last well-child check. This information (data collected) will be documented in an excel spreadsheet. The website will be checked every 1-2 weeks to document the number of parental/guardian views. Once the infants are a year old, they will no longer be a part of the study. Their documentation of education, ER and hospital visits and parent surveys will be looked at collectively. The infant injury rate and mortality of the infants in the study will be compared to those from the previous year.
Results
Our stakeholder’s clinic handed out our 10-question survey along with our QR code that takes the parent/guardian to our education portal, to parents of each baby 12 months and younger for every visit that they checked in for, from 08/23/24 to 09/23/24. Over this month, we received 31 completed surveys. The results showed that majority (80.6%) of parents/guardians who filled out the survey are aware of the patient portal. Only 29% of parents/guardians had accessed their patient portal since their child’s last visit. About 71% of the survey takers had not accessed the portal. Of the 29% who did access the portal, 1 of them accessed for questions or concerns regarding infectious disease or illness, 5 accessed for questions/concerns regarding routing infant care, and 2 accessed for billing related questions or concerns. 100% of the survey takers answered “no”, showing that out of the 31 infants 12 months and under within the past month, none of them had suffered any injuries since they were last seen. 16% of the patients who were surveyed have been to the ER at some point in their lifetime. Of the 5 who had been seen at the ER at some point in their lives, 3 of them were seen for something illness-related, and 2 were seen for “other reasons”, which consisted of “weird breathing” and “sibling shook walker that baby was sitting in”. Results show that majority of those who have accessed the portal for whatever reason, found it to be helpful. 87% of those who answered would find education on safe infant care, infant normal and abnormal and information on infant illness helpful on the portal. 13% of those who completed the survey reported that this information would not be helpful. Question 10 leaves space for any additional feedback from parents and only 2 people responded with additional feedback. This consisted of “there is no information regarding the portal anywhere in clinic or on the website” and “I have found the patient portal to not be very user friendly in the past and have not been able to link multiple children’s accounts”. What we have gathered from this information is that the clinic could advertise the patient portal more, so that all patients/caretakers are aware that there is a patient portal present and available, and that there is room for improvement on the patient portal.
Conclusion
Overall, our interpretation of the survey results is that most people were aware that the clinic had a patient portal and for the most part, found it useful for what they needed to access the portal for. Majority of the responders would find educational material helpful if it was available and present on the patient portal and think there could be tweaks or improvements made to the portal to make it more user friendl
Cybersecurity Vulnerabilities and Considerations in U.S. Healthcare Facilities: A Scoping Review
Get PDFRobust cybersecurity measures are essential for business continuity of U.S. healthcare institutions which is to maintain care standards for all patients. Hackers seek to disrupt healthcare delivery for financial and political means, to disrupt services in retaliation, or simply for malicious intent (Wasserman & Wasserman, 2022). The COVID-19 pandemic further accelerated innovation and digitization in healthcare, including wearable and implanted medical devices, telehealth care delivery options, artificial intelligence, and cloud-based data management (Kioskli, Fotis, & Mouratidis, 2021). This progress in innovation continues today but also brings new vulnerabilities and challenges to stay ahead of cybersecurity threats.
Given that cyberattacks have tripled in the last few years, understanding the risks, current gaps, and methods to reduce exposure to these targets will equip healthcare institutions with strategies to reduce impacts of cyberthreats (Alder, 2024). There are many organizational and technical considerations for healthcare organizational cybersecurity efforts, include building strong detection programs with trained information technology (IT) personnel and providing education and training to all healthcare staff thereby allowing the system to maintain essential services for patients and the community at large. This scoping review seeks to outline cyberattack mechanisms and targets, describe the current state of U.S. healthcare cybersecurity programs, and provide considerations for emergency response planning and cyberattack prevention for the future
A Cohort Study Examining the Risk of Smoking on the Likelihood of Developing Angina Among Women Under Age 65
Get PDFObjective:
To determine if current smoking status is a risk factor for angina among women under the age of 65.
Methods:
A subset of participants from the Framingham Heart Studywere used to complete a cohort study. The analyses evaluated population means and characteristics, followed by bivariate and multivariable logistic regression, to determine the association of smoking and other key factors with angina.
Results:
Smoking status had a significant association to angina(OR 0.67, 95% CI: 0.52, 0.86, p-value= 0.0015). Age as a categorical variable had a significant relationship with angina (OR 0.97, 95% CI: 0.617, 1.520, p-value=
Conclusions:
Smoking had a significant association with occurrences of angina, but the association became nonsignificant after additional control variables were added into the model
The Use of Abdominal Fascial Plane Blocks for Post-Operative Analgesia in Intestinal Rehabilitation Patients – A Retrospective Comparative Study
No full textBackground: Short gut syndrome affects both pediatric and adult patients often requiring multiple surgical procedures to improve intestinal function. Identifying methods to improve pain control and reduce opioid consumption is an important consideration for this patient population.
Methods: A retrospective chart review of 115 patients less than 12 years of age undergoing abdominal procedures between August 1, 2012, and December 31, 2019, was performed. From this group, 64 patients had a perioperative abdominal wall fascial plane block performed and were compared to 51 patients who did not have a block performed.
Results: Mean opioid use defined as morphine equivalent daily dose per kilogram was not different between the two groups at 24 hours. However, the median inter-quartile range showed a statistical difference at 24 hours. No adverse events were noted in patients who received abdominal wall fascial plane blocks.
Conclusion: The addition of abdominal wall fascial plane blocks is a safe option to improve post-operative pain control in pediatric intestinal rehabilitation patients. Further research into the abdominal fascial plane block can better define the optimal timing of the block and help in the selection of which procedure to reduce opioid consumption post-operatively
The Hunger Vital Sign Alone Misses Patients Who Are Not Food Secure
Get PDFhttps://digitalcommons.unmc.edu/com_fam_pres/1020/thumbnail.jp
