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Wheelwright J, Halstead ES, Knehans A, Bonavia AS. Ex Vivo Endotoxin Stimulation of Blood for Predicting Survival in Patients With Sepsis: A Systematic Review. CHEST Crit Care 2023; 1:100029. [PMID: 38148988 PMCID: PMC10751038 DOI: 10.1016/j.chstcc.2023.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND Sepsis is a syndrome characterized by host immune dysfunction, with the extent of immunoparalysis differing among patients. Lipopolysaccharide (LPS) is used commonly to assess the immune function of critically ill patients with sepsis. However, the reliability of this ex vivo diagnostic test in predicting clinical outcomes remains uncertain. RESEARCH QUESTION Does LPS-induced tumor necrosis factor (TNF) production from the blood of patients with sepsis predict mortality? Secondary outcomes included ICU and hospital stay durations, nosocomial infection rate, and organ recovery rate. STUDY DESIGN AND METHODS Human sepsis studies from various databases through April 2023 were evaluated. Inclusion criteria encompassed LPS-stimulated blood assays, English language, and reported clinical outcomes. Bias risk was evaluated using the Newcastle-Ottawa scale (NOS). Relationships between TNF production and mortality were analyzed at sepsis onset and during established sepsis, alongside secondary outcomes. RESULTS Of 11,580 studies, 17 studies (14 adult and three pediatric) were selected for analysis. Although 15 studies were evaluated as moderate to high quality using the NOS, it is important to note that some of these studies also had identifiable biases, such as unclear methods of participant recruitment. Nine studies detailed survival outcomes associated with LPS-induced TNF production at sepsis onset, whereas five studies explored TNF production's relationship with mortality during established sepsis. Trends suggested that lower LPS-induced TNF production correlated with higher mortality. However, heterogeneity in methodologies, especially the LPS assay protocol, hindered definitive conclusions. Publication bias was highlighted using funnel plot analysis. Concerning secondary outcomes, diminished TNF production might signify worsening organ dysfunction, although the link between cytokine production and nosocomial infection varied among studies. INTERPRETATION For functional immune profiling in sepsis, streamlined research methodologies are essential. This entails organizing cohorts based on microbial sources of sepsis, establishing standardized definitions of immunoparalysis, using consistent types and dosages of immune stimulants, adhering to uniform blood incubation conditions, and adopting consistent clinical outcomes.
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Affiliation(s)
- Jonathan Wheelwright
- Division of Critical Care Medicine (J. W. and A. S. B.), Department of Anesthesiology and Perioperative Medicine, the Division of Critical Care (E. S. H.), Department of Pediatrics, Penn State Health, and the Penn State College of Medicine (A. K.), Hershey, PA
| | - E Scott Halstead
- Division of Critical Care Medicine (J. W. and A. S. B.), Department of Anesthesiology and Perioperative Medicine, the Division of Critical Care (E. S. H.), Department of Pediatrics, Penn State Health, and the Penn State College of Medicine (A. K.), Hershey, PA
| | - Amy Knehans
- Division of Critical Care Medicine (J. W. and A. S. B.), Department of Anesthesiology and Perioperative Medicine, the Division of Critical Care (E. S. H.), Department of Pediatrics, Penn State Health, and the Penn State College of Medicine (A. K.), Hershey, PA
| | - Anthony S Bonavia
- Division of Critical Care Medicine (J. W. and A. S. B.), Department of Anesthesiology and Perioperative Medicine, the Division of Critical Care (E. S. H.), Department of Pediatrics, Penn State Health, and the Penn State College of Medicine (A. K.), Hershey, PA
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Breaux R, Baweja R, Eadeh HM, Shroff DM, Cash AR, Swanson CS, Knehans A, Waxmonsky JG. Systematic Review and Meta-analysis: Pharmacological and Nonpharmacological Interventions for Persistent Nonepisodic Irritability. J Am Acad Child Adolesc Psychiatry 2023; 62:318-334. [PMID: 35714838 DOI: 10.1016/j.jaac.2022.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 04/11/2022] [Accepted: 06/07/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This meta-analysis examined the efficacy of available pharmacological and nonpharmacological interventions for irritability among youth with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), disruptive behavior disorders (DBD), disruptive mood dysregulation disorder (DMDD), and/or severe mood dysregulation (SMD). METHOD Literature searches were conducted in October 2020, resulting in 564 abstracts being reviewed to identify relevant papers, with 387 articles being reviewed in full. A random effects model was used for the meta-analysis, with subgroup meta-regressions run to assess effects of study design, intervention type, medication class, and clinical population. RESULTS A total of 101 studies were included (80 pharmacological, 13 nonpharmacological, 8 combined). Despite high heterogeneity in effects (I2 = 94.3%), pooled posttreatment effect size for decreasing irritability was large (Hedges' g = 1.62). Large effects were found for pharmacological (g = 1.85) and nonpharmacological (g = 1.11) interventions; moderate effects were found for combined interventions relative to monotherapy interventions (g = 0.69). Antipsychotic medications provided the largest effect for reducing irritability relative to all other medication classes and nonpharmacological interventions. A large effect was found for youth with ASD (g = 1.89), whereas a medium effect was found for youth with ADHD/DMDD/DBD/SMD (g = 0.64). CONCLUSION This meta-analysis provides a comprehensive review of interventions targeting persistent nonepisodic irritability among youth with various psychiatric disorders. Strong evidence was found for medium-to-large effects across study design, intervention type, and clinical populations, with the largest effects for pharmacological interventions, particularly antipsychotic medications and combined pharmacological interventions, and interventions for youth with ASD.
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Affiliation(s)
- Rosanna Breaux
- Virginia Polytechnic Institute and State University, Blacksburg.
| | - Raman Baweja
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Annah R Cash
- Virginia Polytechnic Institute and State University, Blacksburg
| | | | - Amy Knehans
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Vipler B, Knehans A, Rausa D, Haidet P, McCall-Hosenfeld J. Transformative Learning in Graduate Medical Education: A Scoping Review. J Grad Med Educ 2021; 13:801-814. [PMID: 35070093 PMCID: PMC8672835 DOI: 10.4300/jgme-d-21-00065.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 06/29/2021] [Accepted: 08/16/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Transformative learning (TL) is an educational theory focused on deep fundamental shifts in an individual's worldview. Such shifts are well known to occur within graduate medical education (GME). However, TL in GME has yet to be formally explored. OBJECTIVE We performed a scoping review of the literature on TL within GME to identify areas where trainees currently experience or have potential to experience TL, and to explore areas where fostering TL has been used as a pedagogical tool. METHODS In January 2020, we searched 7 databases to identify literature on TL in GME. Additional articles were identified by hand-searching the Journal of Graduate Medical Education. RESULTS A total of 956 articles were identified through database search with 3 unique articles found via hand-searching. Abstracts and manuscripts were screened by 2 authors and disagreements arbitrated by a third, yielding 28 articles for our analysis. The main components of TL (disorienting dilemma, reflection, discourse, action) took various forms. TL was closely linked with professionalism training and professional identity formation. Training programs in primary care fields were most frequently referenced. Often, trainees were experiencing TL without recognition of the theory by their educators. Gaps in the graduate medical education literature exist pertaining to TL in venues such as diversity, equity, and inclusion. CONCLUSIONS Our scoping review uncovered the following themes: TL and professionalism, TL and primary care, and TL by other names. TL is likely occurring but going unrecognized in some settings.
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Affiliation(s)
- Benjamin Vipler
- Benjamin Vipler, MD, MEd, is a Hospitalist, Division of Hospital Medicine, University of Colorado Hospital, and Assistant Professor, University of Colorado School of Medicine
| | - Amy Knehans
- Amy Knehans, MLIS, is Associate Librarian, George T. Harrell Health Sciences Library, Penn State Health Milton S. Hershey Medical Center
| | - Daniel Rausa
- Daniel Rausa, DO, is General Internist, Directorate for Primary Care, Captain James A. Lovell Federal Health Care Center, and Clinical Instructor, Department of Medicine, Rosalind Franklin University of Medicine and Science
| | - Paul Haidet
- Paul Haidet, MD, MPH, is General Internist, Division of General Internal Medicine, Penn State Health Milton S. Hershey Medical Center, and Distinguished Professor of Medicine, Public Health Sciences, and Humanities, Penn State College of Medicine
| | - Jennifer McCall-Hosenfeld
- Jennifer McCall-Hosenfeld, MD, MSc, is General Internist, Division of General Internal Medicine, Penn State Health Milton S. Hershey Medical Center, and Associate Dean for Faculty and Professional Development, Associate Professor of Medicine and Public Health Sciences, Penn State University College of Medicine
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4
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Veldheer S, Scartozzi C, Knehans A, Oser T, Sood N, George DR, Smith A, Cohen A, Winkels RM. A Systematic Scoping Review of How Healthcare Organizations Are Facilitating Access to Fruits and Vegetables in Their Patient Populations. J Nutr 2020; 150:2859-2873. [PMID: 32856074 DOI: 10.1093/jn/nxaa209] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/18/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is compelling evidence on the impact of diet as preventative medicine, and with rising health care costs healthcare organizations are attempting to identify interventions to improve patient health outcomes. OBJECTIVES The purpose of this systematic scoping review was to characterize existing healthcare organization-based interventions to improve access to fruits and vegetables (F&V) for their patient populations. In addition, we aimed to review the impact of identified interventions on dietary intake and health outcomes. METHODS Titles and abstracts were searched in PubMed® (MEDLINE®), Embase®, CINAHL®, and the Cochrane Library® from 1 January 1990 to 31 December 2019. To be selected for inclusion, original studies must have included a healthcare organization and have had a programmatic focus on increasing access to or providing fresh F&V to patients in an outpatient, naturalistic setting. The Effective Public Health Practice Project tool was used to assess study quality in 6 domains (selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts). RESULTS A total of 8876 abstracts were screened, yielding 44 manuscripts or abstracts from 27 programs. Six program models were identified: 1) a cash-back rebate program, 2) F&V voucher programs, 3) garden-based programs, 4) subsidized food box programs, 5) home-delivery meal programs, and 6) collaborative food pantry-clinical programs. Only 6 of 27 studies included a control group. The overall quality of the studies was weak due to participant selection bias and incomplete reporting on data collection tools, confounders, and dropouts. Given the heterogeneity of outcomes measured and weak study quality, conclusions regarding dietary and health-related outcomes were limited. CONCLUSIONS Healthcare-based initiatives to improve patient access to F&V are novel and have promise. However, future studies will need rigorous study designs and validated data collection tools, particularly related to dietary intake, to better determine the effect of these interventions on health-related outcomes.
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Affiliation(s)
- Susan Veldheer
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Christina Scartozzi
- Penn State Health, St. Joseph's Family and Community Medicine Residency Program, Hershey, PA, USA
| | - Amy Knehans
- Penn State College of Medicine, Harrell Library, Hershey, PA, USA
| | - Tamara Oser
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Family Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Natasha Sood
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel R George
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | | | - Alicia Cohen
- Departments of Family Medicine and Health Services, Policy, and Practice, Providence VA Medical Center and Brown University, Providence, RI, USA
| | - Renate M Winkels
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Wageningen University, Division of Human Nutrition and Health, Wageningen, Netherlands
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Veldheer S, Scartozzi C, Knehans A, Oser T, Sood N, Puleo F, Cooper J, George D, Cohen A, Winkels R. How Healthcare Organizations Are Facilitating Access to Fruits and Vegetables in Their Patient Populations: A Systematic Scoping Review. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa059_075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
There is compelling evidence that diet can prevent chronic disease, and with rising health care costs, healthcare organizations are attempting to identify new clinical interventions that can improve the diets of their patients.
The purpose of this systematic scoping review was to understand what clinical strategies healthcare organizations are using to increase access to fruits and vegetables (F&V) for their patient populations. In addition, we aimed to review the impact on health outcomes.
Methods
Titles and abstracts were searched in PubMed® (MEDLINE®), Embase®, CINAHL®, and the Cochrane Library® from January 1, 1990 to December 31, 2019. Original studies must have included a healthcare organization and had a programmatic focus on increasing access to or providing fresh F&V to patients in an outpatient, naturalistic setting. The Effective Public Health Project tool was used to assess study quality in 6 domains (selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts). Two reviewers independently verified included studies, study quality, and data extraction.
Results
A total of 8877 abstracts were screened which yielded 46 manuscripts from 30 studies. There were 6 program models identified including: 1) cash-back rebate programs, 2) prescription voucher programs, 3) garden-based programs, 4) subsidized food boxes/community supported agriculture (CSA) programs, 5) home-delivery meal programs, and 6) collaborative food pantry-clinical programs. Only 6/30 studies included a control group. The overall quality of the studies was weak due to study participant selection bias, and incomplete reporting on tools used for data collection, confounders, and dropouts. Generally, studies that measured dietary intake found some improvements after these interventions. Other objective health markers such as blood pressure and body mass index had mixed results.
Conclusions
Healthcare-based models currently being tested that provide patients with access to F&V are novel and appear to have promise. However, future studies will need to use rigorous study designs, validated data collection tools and more sophisticated data analysis methodologies to better determine the effect of these interventions on health outcomes.
Funding Sources
This study was funded with internal fund to RW and SV.
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Affiliation(s)
| | - Christina Scartozzi
- Penn State Health, St. Joseph's Family and Community Medicine Residency Program
| | | | - Tamara Oser
- University of Colorado School of Medicine Aschutz Medical Campus Department of Family Medicine
| | | | | | | | | | - Alicia Cohen
- Providence VA Medical Center and Brown University, Departments of Family Medicine and Health Services, Policy, and Practice
| | - Renate Winkels
- Wageningen University, Division of Human Nutrition and Health, Wageningen, the Netherlands
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Toth S, Flohr TR, Schubart J, Knehans A, Castello MC, Aziz F. A meta-analysis and systematic review of venous thromboembolism prophylaxis in patients undergoing vascular surgery procedures. J Vasc Surg Venous Lymphat Disord 2020; 8:869-881.e2. [PMID: 32330639 DOI: 10.1016/j.jvsv.2020.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/06/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Perioperative venous thromboembolism (VTE) is generally considered preventable. Whereas the non-vascular surgery literature is rich in providing data about the impact of VTE prophylaxis on VTE outcomes, vascular surgery data are relatively sparse on this topic. This study sought to evaluate the evidence for VTE prophylaxis specifically for the population of vascular surgery patients. METHODS A systematic search was conducted in MEDLINE, Cochrane, and Embase databases in December 2018. Included were studies reporting primary and secondary outcomes for common vascular surgery procedures (open aortic operation, endovascular aneurysm repair [EVAR], peripheral artery bypass, amputation, venous reflux operation). A meta-analysis was performed comparing the patients who did not receive VTE prophylaxis and had VTE complications with patients who developed VTE despite receiving prophylaxis. RESULTS From 3757 uniquely identified articles, 42 publications met the criteria for inclusion in this review (1 for the category of all vascular operations, 5 for open aortic reconstructions, 2 for EVAR, 1 for open aortic surgery or EVAR, 3 for abdominal or bypass surgery, 2 for peripheral bypass surgery, 2 for amputations, 1 for vascular trauma, and 25 for surgical treatment of superficial venous disease). Five studies met the criteria for inclusion in the meta-analysis. The results demonstrated slightly lower relative risk for development of VTE among patients receiving VTE prophylaxis (relative risk, 0.70; 95% confidence interval, 0.26-1.87). After open aortic reconstruction, the risk of VTE is 13% to 18% and is not reduced by VTE prophylaxis. For EVAR patients, the risk of VTE without prophylaxis is 6%. For patients undergoing peripheral bypass surgery and not receiving therapeutic or prophylactic anticoagulation, the risk of VTE is <2%. For patients undergoing amputations, VTE prophylaxis reduces the risk of VTE. For patients undergoing surgical treatment of superficial venous disease, there is an abundance of literature exploring the utility of VTE prophylaxis, but the evidence is conflicting; some studies demonstrated a benefit, whereas others showed no reduction of VTE with prophylaxis. CONCLUSIONS Overall, there is a paucity of literature that addresses the effectiveness of VTE prophylaxis specifically in the population of vascular surgery patients. Our meta-analysis of the literature does not demonstrate a statistically significant benefit of VTE prophylaxis among the vascular surgery patients evaluated; however, it does suggest a low incidence of VTE among patients who receive VTE prophylaxis. Clinicians should identify the patients at high risk for development of postoperative VTE as the risk-benefit ratio may favor VTE prophylaxis in a selected group of patients. Clinicians should use their judgment and established VTE risk prediction models to assess VTE risk for patients. Vascular surgeons should consider reporting VTE incidence as a secondary outcome in publications.
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Affiliation(s)
- Sandra Toth
- Division of Vascular Surgery, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Tanya R Flohr
- Division of Vascular Surgery, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Jane Schubart
- Division of Outcomes Research and Quality, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Amy Knehans
- Harrell Health Sciences Library Research and Learning Commons, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Maria C Castello
- Division of Vascular Surgery, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Faisal Aziz
- Division of Vascular Surgery, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pa.
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Roche M, Parisi L, Li L, Knehans A, Phaeton R, Kesterson JP. The role of pemetrexed in recurrent epithelial ovarian cancer: A scoping review. Oncol Rev 2018; 12:346. [PMID: 29983902 PMCID: PMC6007165 DOI: 10.4081/oncol.2018.346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 02/14/2018] [Indexed: 12/12/2022] Open
Abstract
Ovarian cancer is the leading cause of mortality among gynecologic malignancies, with most cases diagnosed at an advanced stage. Despite an initial response, most develop a recurrence and subsequent resistance to standard therapies. Pemetrexed (AlimtaTM) is a new generation multi-targeted antifolate initially approved for the treatment of malignant pleural mesothelioma. In recent years, it has shown promise in the treatment of recurrent epithelial ovarian cancer. In this review, we outline the current literature and discuss the future of pemetrexed in the setting of recurrent epithelial ovarian cancer.
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Affiliation(s)
- Michael Roche
- Department of Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Laura Parisi
- Department of Obstetrics and Gynecology, The University of Kansas Medical Center, Kansas City, Kansas
| | - Linda Li
- Department of Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Amy Knehans
- Harrell Health Sciences Library, Penn State College of Medicine, Hershey, Pennsylvania
| | - Rebecca Phaeton
- Division of Gynecologic Oncology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Joshua P. Kesterson
- Division of Gynecologic Oncology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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Kolanowski A, Boltz M, Galik E, Gitlin LN, Kales HC, Resnick B, Van Haitsma KS, Knehans A, Sutterlin JE, Sefcik JS, Liu W, Petrovsky DV, Massimo L, Gilmore-Bykovskyi A, MacAndrew M, Brewster G, Nalls V, Jao YL, Duffort N, Scerpella D. Determinants of behavioral and psychological symptoms of dementia: A scoping review of the evidence. Nurs Outlook 2017; 65:515-529. [PMID: 28826872 DOI: 10.1016/j.outlook.2017.06.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/20/2017] [Accepted: 06/06/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are prevalent in people with neurodegenerative diseases. PURPOSE In this scoping review the Kales, Gitlin and Lykestos framework is used to answer the question: What high quality evidence exists for the patient, caregiver and environmental determinants of five specific BPSD: aggression, agitation, apathy, depression and psychosis? METHOD An a priori review protocol was developed; 692 of 6013 articles retrieved in the search were deemed eligible for review. Gough's Weight of Evidence Framework and the Cochrane Collaboration's tool for assessing risk of bias were used. The findings from 56 high quality/low bias articles are summarized. DISCUSSION Each symptom had its own set of determinants, but many were common across several symptoms: neurodegeneration, type of dementia, severity of cognitive impairments, and declining functional abilities, and to a lesser extent, caregiver burden and communication. CONCLUSION Research and policy implications are relevant to the National Plan to Address Alzheimer's Disease.
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Affiliation(s)
| | - Marie Boltz
- College of Nursing, Penn State, University Park, PA
| | | | - Laura N Gitlin
- Department of Community-Public Health, Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD; Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Helen C Kales
- The Program for Positive Aging, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | | | - Kimberly S Van Haitsma
- Program for Person Centered Living Systems of Care, College of Nursing, The Pennsylvania State University, University Park, PA; Polisher Research Institute, Madlyn & Leonard Abramson Center for Jewish Life, North Wales, PA
| | - Amy Knehans
- Penn State College of Medicine, Harrell Health Sciences Library, Research & Learning Commons, Hershey, PA
| | | | | | - Wen Liu
- College of Nursing, The University of Iowa, Iowa City, IA
| | | | | | | | - Margaret MacAndrew
- Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Glenna Brewster
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Danny Scerpella
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD
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Abstract
The George T. Harrell Health Sciences Library at Penn State College of Medicine began a fee-based systematic review service, a model for cost recovery, in October 2013. This article describes the library's experience in establishing, introducing, and promoting the new service, which follows the Institute of Medicine's recommended standards for performing systematic reviews. The goal is to share this information with librarians who are contemplating starting such a service.
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Affiliation(s)
- Amy Knehans
- a George T. Harrell Health Sciences Library, Penn State Hershey , Hershey , Pennsylvania , USA
| | - Esther Dell
- a George T. Harrell Health Sciences Library, Penn State Hershey , Hershey , Pennsylvania , USA
| | - Cynthia Robinson
- a George T. Harrell Health Sciences Library, Penn State Hershey , Hershey , Pennsylvania , USA
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Münte T, Knehans A. EEG-Befunde bei rezidivierender Salizylat-Intoxikation. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
This article reviews current concepts regarding the prevention of cardiovascular disease for women, with particular attention to modifiable risk factors. The background describes the magnitude of the problem, assesses the quality of the data with respect to risk factor reduction, and emphasizes several important concepts. Changes at menopause, states of endocrine aberration, and benefits and risks of hormone substitution need to be understood in conjunction with all other potentially modifiable and nonmodifiable cardiovascular risk factors. Primary care physicians have a window of opportunity to prevent this number one women's health problem. Integrating behavior modification is the key to prevention as part of the regular gynecologic visit.
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Affiliation(s)
- R A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center
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Abstract
OBJECTIVE We present current concepts and assess the quality of information available for the prevention of cardiovascular disease in women. METHODS This article reviews research bearing on the prevention of cardiovascular disease in women, with particular attention to modifiable risk factors. We describe the magnitude of the problem and assess the quality of the data with respect to the classic risk factors. The concept is emphasized that changes at menopause, states of endocrine aberration, and benefits and risks of hormone substitution and oral contraception must be understood in conjunction with all other potentially modifiable and nonmodifiable risk factors. CONCLUSIONS Primary care physicians, especially obstetrician/gynecologists, have a pivotal role to play in the reduction of this disease. Behavior modification is the key to integrating prevention into the regular annual visit.
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Affiliation(s)
- R A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Abstract
Family patterns of cardiovascular risk behavior are well documented. Significant correlation exists between spouse-spouse, parent-child, and sibling-sibling for cholesterol, high- and low-density lipoprotein, diet, physical activity, and smoking. Family/environmental influences are important in how/if risk and/or preventive behavior is learned. The family matriarch commonly functions as gatekeeper, controlling eating behavior, access to health care, and other patterns. She often acts as menu planner, shopper, and preparer of meals for all family members. She provides information and verbal reinforcement about food and is a powerful model concerning dietary practices. In fact, the mother, as head of household in most single-parent families, may be the only adult model for many children. Because relevance and credibility are the most important characteristics of a behavioral model, parents (especially mothers) are strong models for observational learning by children. Risk factor information and risk reduction activities adopted by the matriarch can be generalized to the entire family if she learns the skills to act as a change agent. Initiation of this process of education and training the matriarch lies with primary care providers for women (Ob-Gyns see most women). By teaching risk reduction to the matriarch as a component of primary care, physician interaction can have a rippling effect.
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Affiliation(s)
- R A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City
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Affiliation(s)
- G Stoppe
- Psychiatrische Universitätsklinik Göttingen
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Reichel H, Grüssinger A, Knehans A, Kühn K, Schmidt-Gayk H, Ritz E. Long-term therapy with cyclosporin A does not influence serum concentrations of vitamin D metabolites in patients with multiple sclerosis. Clin Investig 1992; 70:595-9. [PMID: 1392429 DOI: 10.1007/bf00184801] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Animal studies have shown that cyclosporin A (CyA) stimulates renal 25-hydroxyvitamin D3 [25(OH)D3]-1 alpha-hydroxylase activity; in contrast, studies in renal transplant recipients indirectly suggest that CyA reduces 1 alpha,25-dihydroxyvitamin D3 [1,25(OH)2D3] production. To clarify the effect of CyA on vitamin D metabolite concentrations, we measured parameters of calcium metabolism in 37 CyA-treated patients (median trough whole blood levels 171-222 ng/ml) with multiple sclerosis and initially normal kidney function. The patients participated in a randomized double-blind study to assess the efficacy of CyA in multiple sclerosis. An age- and sex-matched control group (n = 39) received azathioprine (Aza). Measurements were made at the end of a 2-year treatment period. The 1,25(OH)2D3 serum concentrations were not significantly different between the two groups, although they were numerically lower in CyA-treated patients [median (range), 28.4 pg/ml (7.8-85.9) vs 41.0 pg/ml (9.2-105.1) in Aza-treated patients]. The 25(OH)D3 levels were comparable in both groups. There was no correlation between the 25(OH)D3 and 1,25(OH)2D3 concentrations. The renal function in both groups was stable in the last 6 months of the study. At the end of the study period, the endogenous creatinine clearance was significantly lower in the CyA-treated group (85 +/- 17 ml/min versus 99 +/- 22 in the Aza-treated group, P less than 0.05). The carboxyterminal parathyroid hormone (C-PTH) was within the normal range in both groups, although CyA-treated patients had significantly higher concentrations (P less than 0.01). The urinary excretion of mineral ions, cations and protein was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Reichel
- Medizinische Klinik, Universität Heidelberg
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16
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Devenport L, Knehans A, Thomas T, Sundstrom A. Macronutrient intake and utilization by rats: interactions with type I adrenocorticoid receptor stimulation. Am J Physiol 1991; 260:R73-81. [PMID: 1847024 DOI: 10.1152/ajpregu.1991.260.1.r73] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Corticosterone-free (adrenalectomized, ADX) and intact rats were offered experimentally compounded diets in which 65% of available calories were supplied by a single macronutrient (single-diet study). ADX impaired the intake, weight gain (especially as body fat), and efficient utilization of high-protein and high-fat diets. In contrast, no behavioral, metabolic, or compositional changes could be found among ADX rats maintained on a diet high in carbohydrates. When ADX rats were given separate sources of macronutrients (self-selection study) they did not self-select a high-carbohydrate diet. Instead, they displayed a strong fat avoidance and a relative increase in protein intake, the macronutrient they utilize least efficiently. Separate groups of ADX animals were continuously infused with 25 or 125 micrograms.kg-1.day-1 aldosterone, a specific type I adrenocorticoid receptor agonist. Type I receptor stimulation eliminated all ADX-related deficiencies found in the single-diet and self-selection studies: caloric intake, feeding efficiency, carcass composition, and macronutrient preferences were restored to or beyond the corresponding values of adrenal-intact rats. The normal rat's ability to ingest and utilize macronutrients optimally is dependent on corticosterone's stimulation of type I receptors.
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Affiliation(s)
- L Devenport
- Department of Psychology, University of Oklahoma, Norman
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17
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Ratliff R, Knehans A, McCarthy M. 283 EFFECTS OF FREQUENCY OF EXERCISE TRAINING ON PLASMA LIPIDS AND LIPOPROTEINS. Med Sci Sports Exerc 1990. [DOI: 10.1249/00005768-199004000-00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Abstract
Corticosterone possesses two distinctly opposite metabolic actions. The actions are strictly dose-dependent and are linked to type I and type II corticosteroid receptor binding. These conclusions are drawn from continuous infusion studies where corticosterone yields a bitonic dose-response curve for body weight gain and feeding efficiency. Anabolic at low serum levels, corticosterone concentrations above 2 micrograms/dl bring about an opponent catabolic process that intensifies and eventually masks the anabolic action. Relatively pure type I (aldosterone) and type II (RU28362 and dexamethasone) corticosterone receptor agonists produce opposite monotonic functions that respectively mimic the ascending and descending arms of the corticosterone dose-response curve. Stimulation of either receptor increases the proportion of carcass fat to lean body mass by either increasing carcass lipids (type I) or by reducing protein (type II).
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Affiliation(s)
- L Devenport
- Department of Psychology, University of Oklahoma, Norman 73019
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19
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Stark E, Walter GF, Wurster U, Knehans A, Patzold U. [Diagnosis and therapy of primary intracranial germ cell tumors]. Nervenarzt 1988; 59:164-7. [PMID: 3374717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- E Stark
- Neurologische Klinik mit klinischer Neurophysiologie, Medizinische Hochschule Hannover
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20
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Abstract
Aldosterone diminishes the ability to endure starvation. Its exogenous administration to adrenalectomized rats advances the onset of hypothermia and death. The impairment seems to lie in an inability to mobilize energy stores fully: animals given the steroid are unable to lose weight at a normal rate. The findings help to establish the significance of mineralocorticoids in the regulation of energy exchange and solve some theoretical questions as to their general mode of action.
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Stark E, Knehans A, Wurster U, Patzold U. Primary germinoma of the brain. Immunocytochemical demonstration of tumour cells in the cerebrospinal fluid. Clin Neurol Neurosurg 1986; 88:263-5. [PMID: 2433090 DOI: 10.1016/s0303-8467(86)80043-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A patient is presented, who developed a suprasellar tumour. Stereotactical biopsy of the tumour revealed the diagnosis of a dysgerminoma. Immunocytochemical examination of the CSF showed neoplastic cells staining for human chorionic gonadotropin and for alpha-fetoprotein. The authors stress the possibility to diagnose primary intracranial germ cell tumours without operation.
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Koh ET, Mueller J, Osilesi O, Knehans A, Reiser S. Effects of fructose feeding on lipid parameters in obese and lean, diabetic and nondiabetic Zucker rats. J Nutr 1985; 115:1274-84. [PMID: 3900313 DOI: 10.1093/jn/115.10.1274] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Effects of fructose feeding in moderate amounts on lipid metabolism of obese versus lean, and diabetic versus nondiabetic Zucker rats, were studied. Forty pairs of male lean and obese animals were assigned to two dietary groups, fructose and glucose. For each diet, one-half of lean and obese animals were injected with streptozotocin intraperitoneally (i.p.) to induce diabetes, and the other half were injected with buffer i.p. as a nondiabetic control group. After 9 wk of feeding, animals were fasted overnight, decapitated and exsanguinated. Organs were removed and weighed. Blood glucose, insulin, lactic acid, triglycerides, cholesterol, total liver lipids and urinary glucose were determined. Hyperphagia was observed in obese, non-diabetic and lean-diabetic animals. Streptozotocin injection drastically reduced insulin levels, and produced an impairment of growth, hyperglycemia, glucosuria, polydipsia and polyuria. Fructose feeding increased organ weights in kidney, liver and retroperitoneal adipose tissue, regardless of diabetic state. However, lactic acid levels were lower in fructose-fed groups than glucose-fed groups. In obese rats serum triglyceride levels were also lower in fructose-fed groups than in glucose-fed groups. Serum cholesterol was not affected by fructose feeding. The results indicated that fructose feeding did not produce hyperlipemia and lactic acidosis in the blood circulation in Zucker rats. However, fructose feeding did not improve glucose intolerance in diabetic animals, rather fructose feeding produced hyperinsulinemia in nondiabetic, obese animals.
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