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Effects of Music Therapy for Patients with Dementia
Get PDFObjective: Assessing depression in patients with dementia presents challenges due to the inherent nature of the disease. This review aims to explore the potential effect of music therapy in mitigating agitation and depression symptoms by fostering positive memories and facilitating connections to the patient’s past.
Methods: A comprehensive literature and systematic review was conducted, examining published studies and analyses comparing music therapy’s effects to standard care or alternative care.
Results: Various forms of music intervention have demonstrated a considerable reduction in overall depressive and agitation symptoms, notably for short-term intervention. Music therapy can be applied either independently or in conjunction with pharmacotherapy to effectively alleviate symptoms in dementia patients.
Conclusion: Music therapy has the potential to reduce depression and agitation symptoms in dementia patients. Future research and studies should include more patients, varying environments, and subtype analysis regarding specific types of dementia and their relation to the music processing centers.
Keywords: Music therapy, Dementia, Depression, Agitation, Quality of lif
Is Ubiquitination Responsible for the Internalization of NKCC1 During PKC Activation?
No full textIn the colon, the Cl-driven fluid secretion is dependent on the basolateral Na+ K+ Cl- cotransporter 1 (NKCC1). Activation of protein kinase C (PKC) causes the internalization of NKCC1. However, the PKC-dependent signal causing NKCC1 internalization is not known. We hypothesize that ubiquitin may be the signal responsible. We used Madin-Darby Canine Kidney (MDCK) cells expressing eGFP-tagged NKCC1 to monitor its internalization using fluorescent microscopy. We used phorbol 12-myristate 13-acetate (PMA) which activates PKC and PYR-41 (dissolved in DMSO) to inhibit ubiquitin ligase. Finally, we combined both PYR+PMA to test whether inhibiting ubiquitin ligase will reduce the effect of PKC on NKCC1 internalization. We used FIJI to count the number of internalized NKCC1 vesicles and the number of nuclei. Our results, calculated as vesicles per cell, were as follows: control (3.6±0.6 vesicles/cell, n=18), DMSO (2.4±0.5, n=18), PMA (12.6±3.7 vesicles/cell, n=12), PYR (5.6±0.8 vesicles/cell, n=30), and PYR+PMA (4.5±0.4 vesicles/cell, n=18). A one-way ANOVA found a significant difference between our conditions (p=\u3c0.001). A Tukey’s post-hoc test showed that PMA significantly increased internalization compared to control (p=\u3c0.001), PYR+PMA had significantly less internalization than PMA alone (p=\u3c0.001), and control vs PYR was not significant (p=0.7). Our results suggest that ubiquitin may be the signal responsible for the internalization of NKCC1 during PKC activation
Comparison of Insulin Regimens for Hospitalized Type 2 Diabetics
Get PDFObjective: Sliding-scale insulin (SSI) is commonly used for hospitalized type 2 diabetics despite the American Diabetes Association’s (ADA) recommendations supporting basal-bolus insulin (BBI). This paper aims to distinguish what insulin regimen is beneficial for hospitalized diabetics, critical and non-critical, to improve patient outcomes.
Methods: A qualitative analysis of research conducted by different hospital systems and physicians in the past 5 years including 2 integrative literature reviews, 2 retrospective cohorts, 2 ambi-directional cohorts, and 1 quasi-experiment. After inclusion and exclusion criteria were applied, 7 studies were selected for this review. Outcomes of interest included target glycemic control (110-179mg/dL), decreased hypoglycemic rates, and length of hospital stay from admission.
Results: BBI has been proven to improve in-target ranges of blood glucose levels, decrease hypoglycemia episodes, decrease admission length, and decrease the delay of basal insulin administration. When implemented in hospitals through educational materials and employee training, their results show improved patient outcomes when switched to BBI regimens from standard SSI.
Conclusion: A BBI regimen is the best practice guideline for treating non-critical hospitalized type 2 diabetics.
Keywords: type 2 diabetes, hospitalization, basal-bolus insulin, sliding-scale insulin, glycemic control, length of admission, hypoglycemic episode
Can Safe Injection Sites Decrease the Incidence of Infective Endocarditis?
Get PDFObjective: To discuss how safe injection sites (SIS) help to decrease the incidence of infective bacterial endocarditis in intravenous drug users. Methods: Six studies were chosen from online databases utilizing the search terms infective endocarditis, intravenous drug use, and SIS. They include a case-control study, retrospective cohort study, proposal, semi-structured interviews, narrative review, and cohort study. Results: SIS are imperative in the management and treatment of people who inject drugs (PWID) with infective endocarditis (IE). They help identify associated risk factors and provide a stable and safe environment for PWID as well as provide medical care. Conclusion: Patients who have IV substance use disorders deserve access to feel safe in active addiction. There are effective harm reduction interventions where lives are saved and a connection to treatment is provided including outpatient IE medical care. The United States should follow suit by supporting SIS as they are already showing promise in other countries around the world.
Keywords: Intravenous (IV) drug use, SIS and associated laws, endocarditis, left against medical advice and drug use, infective bacterial endocarditis, and bacterial endocarditis with IV drug use
Using the Watchman Device to Reduce Thrombotic Events
Get PDFObjective: To evaluate the efficacy and safety of the Watchman device in patients with atrial fibrillation, specifically proving the prevention or reduction of major complications when compared to anticoagulant use. Major complications can include thrombotic events which can consist of stroke, clinically relevant bleeding, and device related thrombi.
Methods: Research was conducted in reviewing studies consisting of two meta-analyses, one systematic review, and two randomized controlled trials. These studies needed to include the use of the Watchman device being compared to different types of anticoagulants in patients with atrial fibrillation. In total, twenty research studies were reviewed and five were chosen. Research studies needed to be after 2018 and peer-reviewed to be considered. Primary endpoints included risk of stroke, all cause mortality, and cardiovascular mortality. Secondary endpoints included clinically relevant bleeding and device related thrombi.
Results: The use of the Watchman provided promising results in being safe, effective, and viable option for patients with atrial fibrillation who are not able to tolerate anticoagulant therapy. The risk of thrombotic events in the Watchman device is comparable to anticoagulant therapy and in some cases a better long term option.
Conclusion: The Watchman device is a promising alternative compared to the mainstay treatment of anticoagulant therapy in patients with atrial fibrillation. Since this device is not a first line treatment, more research should be done to build up a solid foundation on the long term safety and efficacy of the device.
Keywords: watchman procedure, atrial fibrillation, anticoagulant therapy, left atrial appendage, thrombotic event
A Review of Breast-Conservation Therapy vs Mastectomy in Early-Stage Breast Cancer
Get PDFObjective: When it comes to early-stage breast cancer, many individuals choose to undergo a mastectomy out of fear of the worst, believing there are no other effective, long-lasting treatments available. The objective of this paper is to determine the effectiveness of breast-conservation therapy (BCT) compared to a mastectomy alone (MA) at improving the overall survival and quality of life in patients diagnosed with early-stage breast cancer.
Methods: An electronic literature review was conducted using Google scholar, Science direct, BMC cancer, PubMed, and Valparaiso University Christopher center to evaluate the prognosis and quality of life of early-stage breast cancer patients who underwent BCT versus MA.
Results: It was found that among early-stage breast cancer patients who underwent BCT versus MA, overall survival, psychosocial well-being, and sexual well-being were superior in BCT versus MA. Those with the breast cancer (BrCA) gene mutation had higher locoregional recurrence rates and equivocal overall survival with BCT versus MA. Physical well-being was found to be superior in MA versus BCT, but research was limited in this finding.
Conclusion: At this time, there is sufficient evidence to conclude that BCT is a viable alternative to a MA in improving prognosis and quality of life in those diagnosed with early-stage breast cancer.
Keywords: early-stage breast cancer, breast conservation therapy, mastectomy, overall survival, quality of life, BREAST-Q, EQ-5D-3
Reducing Cardiovascular Mortality in Treating Acute STEMI
Get PDFObjective: When cardiologists and cardiac surgeons are evaluating patients who are experiencing a myocardial infarction, both coronary artery bypass grafting, and percutaneous coronary intervention are amongst the most widely used management options. Although there are pros and cons to each option, this poses a difficult decision amongst providers to choose the best management for patients with an acute myocardial infarction. The overarching goal of this paper is to investigate each treatment option and its effect on cardiovascular mortality. Methods: A literature search has been performed using Google Scholar, PubMed, and Summon from 2018 to current accounting for 17,900 sources. Out of these sources, 6 studies were selected using inclusion and exclusion criteria. One of the studies is retrospective leaving the other five to be meta-analysis studies of randomized controlled trials. These studies must have included patients ages fifty or greater undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) with measurements of cardiovascular mortality. Outcomes of interest include cardiovascular mortality, overall mortality, and major adverse cardiac-cerebral outcomes (MACCE). Results: In this study, patients who underwent CABG had lower rates of cardiovascular mortality whereas patients with PCI had higher rates of cardiovascular mortality. Conclusion: CABG is the preferred method of treatment for patients with myocardial infarction regarding reducing cardiovascular mortality; however, it is still unclear if these results vary from patient to patient in regard to their personal past medical history, length of follow up, and if they are undergoing these procedures after an acute myocardial infarction or with acute on chronic coronary artery disease.
Keywords: STEMI, CABG, PCI, acute, cardiovascular mortality, revascularization, recurrent myocardial infarction, stroke, MACC
Skilled Smiths and Princes of Elves: The Wayland-legend and the First Age of Middle-earth
Get PDFThis article examines the influence of the legend of Wayland the Smith, a literary figure common to medieval Germanic literature, upon the fantasy writings of J.R.R. Tolkien. Although Tolkien did not publish on Wayland specifically, his scholarly interests included the figure, who frequently appeared in the Old English and Old Norse texts Tolkien studied and taught. Despite clear evidence of Tolkien’s interest in Wayland, and the frequency with which scholarly and creative discourse discussed Wayland in Tolkien’s lifetime, few scholars have engaged the connection between Tolkien’s writings and the medieval figure. This article attempts to address this lacuna in the scholarship. It does so by engaging the Wayland-legend in Tolkien’s work, examining it both in terms of his scholarly endeavors, by looking at his coursework and published literary criticism, and his creative writing, by examining parallels to the Wayland-legend in two characters of Tolkien’s legendarium, the Elven smiths Fëanor and Eöl. This article ultimately concludes that Wayland, especially via Vǫlundarkviða, profoundly influenced Tolkien’s development of Fëanor and Eöl, both of whom absorb Wayland’s possessive, vengeful nature. These Waylandish character traits – Fëanor’s over-attachment to his creations and Eöl’s dominating treatment of others – have vast thematic ramifications for the text: each character embodies one of the two chief evils of Tolkien’s sub-created world
