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Browsing Virginia Tech Carilion School of Medicine (VTCSOM) by Subject "3 Good Health and Well Being"
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- A Case Series of E-cigarette or Vaping-Associated Lung Injury With a Review of Pathological and Radiological FindingsPourshahid, Seyedmohammad; Khademolhosseini, Sara; Hussain, Shahzad; Ie, Susanti R.; Cirino-Marcano, Maria Del Mar; Aziz, Sameh; Biscardi, Frank; Foroozesh, Mahtab (Cureus, 2022-05-08)There has been a recent outbreak of e-cigarette or vaping-associated lung injury (EVALI) but the exact pathophysiology remains unknown. Tetrahydrocannabinol (THC) and vitamin E derivates are the major components in vaping-generated aerosols that are associated with EVALI. So far, there is no standard treatment for EVALI. Most cases are treated with antibiotics and steroids. Counseling for smoking cessation is an integral part of care for EVALI patients. Referral to addiction medicine may be beneficial. Considering the nonspecific presenting symptoms and the growing popularity of vaping devices, providers need to consider EVALI in the differential diagnosis of bilateral patchy ground-glass opacities with respiratory, constitutional, or gastrointestinal symptoms in patients using e-cigarettes. Here, we present four EVALI cases and review the pertinent imaging and pathological findings.
- Evolving roles and needs of psychiatry chief residents during the COVID-19 pandemic and beyondRatnakaran, Badr; Hanafi, Sarah; Wobbe, Heather; Howland, Molly (Dove Medical Press, 2023-06)Psychiatry chief residents have diverse leadership roles within psychiatry residency programs. Chief residents have historically been viewed as “middle managers”, and other leadership roles include administrative work, teaching, and advocacy for residents. Chief residents also help in managing the logistics of complex healthcare systems and mediating between many groups with conflicting needs and perspectives. The COVID-19 pandemic has changed the functioning of psychiatry residency programs, and this has also led to the evolution of the roles of the chief residents in psychiatry. During the COVID-19 pandemic, the chief residents had to help with adapting to the changes in teaching and clinical work with residents and faculty. They had to liaison with various healthcare providers in making decisions related to COVID-19 in residency programs. Along with these changes, chief residents also had to advocate for the wellbeing and needs of their fellow residents. This perspective article is written by authors who have served during or after the transition to the COVID-19 pandemic. We discuss our experiences as chief residents as well as evolving roles and wellness needs of chief residents in psychiatry. Based on the administrative, advocacy, academic and middle management roles of chief residents in psychiatry and their wellbeing, we also make recommendations for support and interventions needed for chief residents in the context of the COVID-19 pandemic and beyond.
- Integrating Oral Health into Health Professions School CurriculaGill, Stephanie A.; Quinonez, Rocio B.; Deutchman, Mark; Conklin, Charles E.; Rizzolo, Denise; Rabago, David; Haidet, Paul; Silk, Hugh (Taylor & Francis, 2022-07)Oral health is essential to human health. Conditions associated with poor oral health involve all organ systems and many major disease categories including infectious disease, cardiovascular disease, chronic pain, cancer, and mental health. Outcomes are also associated with health equity. Medical education organizations including the Association of American Medical Colleges and National Academy of Medicine recommend that oral health be part of medical education. However, oral health is not traditionally included in many medical school, physician assistant, or nurse practitioner curricula. Several challenges explain this exclusion including lack of time, expertise, and prioritization; we therefore provide suggestions for integrating oral health education into the health professions school curriculum. These recommendations offer guidance for enhancing the oral health curriculum across institutions. We include key organizational and foundational steps, strategies to link oral health with existing content, and approaches to achieve curricular sustainability.
- Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumoniaMeduri, G. Umberto; Shih, Mei-Chiung; Bridges, Lisa; Martin, Thomas J.; El-Solh, Ali; Seam, Nitin; Davis-Karim, Anne; Umberger, Reba; Anzueto, Antonio; Sriram, Peruvemba; Lan, Charlie; Restrepo, Marcos I.; Guardiola, Juan J.; Buck, Teresa; Johnson, David P.; Suffredini, Anthony; Bell, W. Andrew; Lin, Julia; Zhao, Lan; Uyeda, Lauren; Nielsen, Lori; Huang, Grant D. (Springer, 2022-08-01)Purpose: Severe community-acquired pneumonia (CAP) requiring intensive care unit admission is associated with significant acute and long-term morbidity and mortality. We hypothesized that downregulation of systemic and pulmonary inflammation with prolonged low-dose methylprednisolone treatment would accelerate pneumonia resolution and improve clinical outcomes. Methods: This double-blind, randomized, placebo-controlled clinical trial recruited adult patients within 72–96 h of hospital presentation. Patients were randomized in 1:1 ratio; an intravenous 40 mg loading bolus was followed by 40 mg/day through day 7 and progressive tapering during the 20-day treatment course. Randomization was stratified by site and need for mechanical ventilation (MV) at the time of randomization. Outcomes included a primary endpoint of 60-day all-cause mortality and secondary endpoints of morbidity and mortality up to 1 year of follow-up. Results: Between January 2012 and April 2016, 586 patients from 42 Veterans Affairs Medical Centers were randomized, short of the 1420 target sample size because of low recruitment. 584 patients were included in the analysis. There was no significant difference in 60-day mortality between the methylprednisolone and placebo arms (16% vs. 18%; adjusted odds ratio 0.90, 95% CI 0.57–1.40). There were no significant differences in secondary outcomes or complications. Conclusions: In patients with severe CAP, prolonged low-dose methylprednisolone treatment did not significantly reduce 60-day mortality. Treatment was not associated with increased complications.
- Mapping the cell-membrane proteome of the SKBR3/HER2+ cell line to the cancer hallmarksLazar, Iulia M.; Karcini, Arba; Haueis, Joshua R. S. (PLOS, 2022-08-01)The hallmarks of biological processes that underlie the development of cancer have been long recognized, yet, existing therapeutic treatments cannot prevent cancer from continuing to be one of the leading causes of death worldwide. This work was aimed at exploring the extent to which the cell-membrane proteins are implicated in triggering cancer hallmark processes, and assessing the ability to pinpoint tumor-specific therapeutic targets through a combined membrane proteome/cancer hallmark perspective. By using GO annotations, a database of human proteins associated broadly with ten cancer hallmarks was created. Cell-membrane cellular subfractions of SKBR3/HER2+ breast cancer cells, used as a model system, were analyzed by high resolution mass spectrometry, and high-quality proteins (FDR<3%) identified by at least two unique peptides were mapped to the cancer hallmark database. Over 1,400 experimentally detected cell-membrane or cell-membrane associated proteins, representing ~18% of the human cell-membrane proteome, could be matched to the hallmark database. Representative membrane constituents such as receptors, CDs, adhesion and transport proteins were distributed over the entire genome and present in every hallmark category. Sustained proliferative signaling/cell cycle, adhesion/tissue invasion, and evasion of immune destruction emerged as prevalent hallmarks represented by the membrane proteins. Construction of protein-protein interaction networks uncovered a high level of connectivity between the hallmark members, with some receptor (EGFR, ERBB2, FGFR, MTOR, CSF1R), antigen (CD44), and adhesion (MUC1) proteins being implicated in most hallmark categories. An illustrative subset of 138 hallmark proteins that included 42 oncogenes, 24 tumor suppressors, 9 oncogene/tumor suppressor, and 45 approved drug targets was subjected to a more in-depth analysis. The existing drug targets were implicated mainly in signaling processes. Network centrality analysis revealed that nodes with high degree, rather than betweenness, represent a good resource for informing the selection of putative novel drug targets. Through heavy involvement in supporting cancer hallmark processes, we show that the functionally diverse and networked landscape of cancer cell-membrane proteins fosters unique opportunities for guiding the development of novel therapeutic interventions, including multi-agent, immuno-oncology and precision medicine applications.
- Mental health bias in physical care: An integrative review of the literatureHallyburton, Ann; Allison-Jones, Lisa (Wiley, 2023-08-01)What is known on the subject?: Individuals experiencing mental illness make up a significant portion of the world's population. Individuals with mental illness experience higher rates of morbidity and die on average at least a decade earlier than individuals without mental health disorders. What this paper adds to existing knowledge?: Issues of stigma, diagnostic overshadowing, premature closure, inadequate workup, fear and lack of training negatively impact the care of individuals with mental illness. Issues impacting the care of individuals experiencing mental illness cross geographic and care setting boundaries. What are the implications for practice?: Partnerships between physical and mental health practitioners are needed to thoroughly assess and accurately diagnose symptoms experienced by individuals with mental illness. Educational interventions can help prepare practitioners to care for individuals with mental illness. Nurses can better advocate for effective patient care by learning about the phenomenon of diagnostic overshadowing and calling attention to its occurrence. Abstract: Introduction Individuals with mental illness experience significantly higher overall rates of morbidity and mortality than counterparts without mental illness. Misdiagnosis of symptoms emanating from physical illnesses as psychiatric in nature presents one important cause. Aim This integrative review explores research on healthcare professionals' misattribution of physical health symptoms to patients' comorbid psychiatric issues and seeks to identify unifying themes, shared causes, and possible strategies for addressing the issue. Method This review uses Whittemore and Knafl's 2005 integrative review methodology coupled with vetted quality appraisal tools. Results Following a systematic search of allied health, medical, psychological, sociological and general literature, 24 publications employing qualitative, quantitative, mixed and synthesis research methodologies were selected. Each study was appraised according to design, and relevant data were extracted. Discussion Themes of stigmatization, diagnostic overshadowing, incomplete medical examination, insufficient training, and fears experienced by providers and patients emerged. Implications for Practice Increased partnering between physical and mental health practitioners, continuing education, and improving patient–provider communication are key to providing equitable care. Nurses play primary roles in empathizing with patients, advocating for appropriate care and educating others on the dangers of misattributing physical symptoms to psychiatric cause.
- New-Onset Psychotic Symptoms Following Abrupt Buprenorphine/Naloxone Discontinuation in a Female Patient with Bipolar Disorder: A Case ReportLin, Yezhe; Zhang, Alexander D.; Sun, Ching-Fang; White, Justin B.; Qi, Ansi; Farrell, Jessica A.; Trestman, Robert L.; Martin, Rachel K.; Kablinger, Anita S. (2022)Buprenorphine and naloxone (Suboxone) is a combination medication-assisted treatment (MAT) for opioid use disorder. MAT withdrawal-induced psychosis is a rare clinical presentation. To our best knowledge, only three reports have summarized the characteristic manifestations of buprenorphine withdrawal psychosis, yet all of them were male. In this case report, we present a 41-year-old female patient with bipolar disorder and comorbid substance use disorder who developed new-onset psychosis and relapse of manic symptoms following abrupt discontinuation of Suboxone. Manic and psychotic symptoms remitted after a short-term hospitalization with the treatment of an antipsychotic and a mood stabilizer. In addition to discussing this case presentation and treatment approach, we review existing literature and discuss possible underlying mechanisms to enhance understanding of this clinical phenomenon. Psychopharmacology Bulletin.
- Reallocating Cervical Cancer Preventive Service Spending from Low- to High-Value Clinical ScenariosRockwell, Michelle S.; Armbruster, Shannon D.; Capucao, Jillian C.; Russell, Kyle B.; Rockwell, John A.; Perkins, Karen E.; Huffstetler, Alison N.; Mafi, John N.; Fendrick, A. Mark (American Association for Cancer Research, 2023-07-05)Timely follow-up care after an abnormal cervical cancer screening test result is critical to the prevention and early diagnosis of cervical cancer. The current inadequate and inequitable delivery of these potentially life-saving services is attributed to several factors, including patient out-of-pocket costs. Waiving of consumer cost-sharing for follow-up testing (e.g., colposcopy and related cervical services) is likely to improve access and uptake, especially among underserved populations. One approach to defray the incremental costs of providing more generous coverage for follow-up testing is reducing expenditures on "low-value" cervical cancer screening services. To explore the potential fiscal implications of a policy that redirects cervical cancer screening resources from potentially low- to high-value clinical scenarios, we analyzed 2019 claims from the Virginia All-Payer Claims Database to quantify (i) total spending on low-value cervical cancer screening and (ii) out-of-pocket costs associated with colposcopy and related cervical services among commercially insured Virginians. In a cohort of 1,806,921 female patients (ages 48.1 ± 24.8 years), 295,193 claims for cervical cancer screening were reported, 100,567 (34.0%) of which were determined to be low-value ($4,394,361 total; $4,172,777 for payers and $221,584 out-of-pocket [$2/patient]). Claims for 52,369 colposcopy and related cervical services were reported ($40,994,016 total; $33,457,518 for payers and $7,536,498 out-of-pocket [$144/patient]). These findings suggest that reallocating savings incurred from unnecessary spending to fund more generous coverage of necessary follow-up care is a feasible approach to enhancing cervical cancer prevention equity and outcomes. PREVENTION RELEVANCE: Out-of-pocket fees are a barrier to follow-up care after an abnormal cervical cancer screening test. Among commercially insured Virginians, out-of-pocket costs for follow-up services averaged $144/patient; 34% of cervical cancer screenings were classified as low value. Reallocating low-value cervical cancer screening expenditures to enhance coverage for follow-up care can improve screening outcomes. See related Spotlight, p. 363.