Browsing by Subject "Musculoskeletal Diseases"
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Item A Study to Determine Improved Compliance of Biophosphonate Treatment in Subjects with Osteoporosis(2005-02-01) Enard, April T.; Gwirtz, Patricia A.; Jimenez-Williams, Cynthia; Rubin, BernardEnard, April T. A Study to Determine Improved Compliance of Bisphosphonate Treatment in Subjects with Osteoporosis. Master of Science, February 11, 2005. The ability of patients to adhere to treatment regimens is very poor and continues to impede optimal therapy of osteoporosis. The shortcomings in treating osteoporosis are: a) noncompliance and/or lack of continued persistence of therapy, b) efficacy of therapy on bone turnover marker levels and fracture prevalence, and c) tolerability of therapy to patients. Studies have shown that interventions such as education and awareness of bone mineral density promote patient usage compliance. The slightest improvement in compliance allows further understanding of accurate efficacy of medication therapy to fractures, bone marker levels, and overall improvement of bone mass. Increased compliance/persistence allows accurate comparison of bisphosphonates to one another for effectiveness on osteoporosis patients and allows improvement opportunity in treatment modalities that can positively influence the course of osteoporosis. This phase IV study targets compliancy/persistence in bisphosphonate therapy in treatment of osteoporosis.Item Anisotropy of Myosin and Actin in Contraction of Skeletal Muscle(2004-12-01) Shepard, Athena A.; Borejdo, Julian; Burghardt, Thomas; Harris, BenShepard, Athena A., Anisotropy of Myosin and Actin in Contraction of Skeletal Muscle. Doctor of Philosophy (Molecular Biology and Immunology), December, 2004, 161 pp., 1 table, 42 illustrations, bibliography, 253 titles. Muscle contraction results from the interaction of myosin and actin proteins contained in the muscle sarcomere. During actomyosin interactions, myosin consumes ATP and imparts an impulsive force to actin resulting in sliding of myosin and actin filaments to produce work. These proteins constitute the elementary motor responsible for cellular motility. The overall goal of this research project was to elucidate the mechanism of the actomyosin interaction on a molecular level. Novel time-resolved optical microscopic techniques followed myosin and actin orientation changes during skeletal muscle contraction. Fluorescence anisotropy was used to study the real time orientation changes of myosin, actin, and nucleotide during a single cross bridge cycle beginning in a state of rigor. Rabbit psoas fibers were isolated on a microscopic slide and labeled with fluorescently labeled regulatory light chain to monitor orientation changes of the lever arm of myosin, with fluorescent phalloidin to monitor orientation changes of actin and/or with Alexa ADP to monitor ATP hydrolysis. Caged ATP was perfused into the fiber prior to analysis to allow a small population of cross-bridges to execute a single cross-bridge cycle. Flash photolysis with UV light during analysis converted caged ATP from an inactive from to an active from. Confocal and multi-photon imaging allowed illumination of a small population of fluorescently labeled cross-bridges to measure orientation changes over time. The conclusions of this dissertation are: 1) The regulatory light chain rotates during skeletal muscle contraction and the lever arm model is supported, 2) Release of ADP from S1 corresponds to a single rotation of the lever arm, 3) Actin rotates during skeletal muscle contraction, 4) The rotation of actin is passive, i.e. it rotates as a consequence of dissociation of S1 from actin. The results revealed orientation changes in key contractile proteins during muscle contraction in the non-disease state organism. By understanding the mechanism of muscle contraction in the healthy scenario, hopefully a better understanding of diseased states stemming from mutations in contractile proteins (Usher’s Syndrome, Snell’s Waltzer Disease, and certain familial hypertrophic cardiomyopathies) will be made available, leading to a better preventative measures or treatments to treat such diseases in the future.Item Clinical Diagnosis(W.B. Saunders Company, 1981-01-01) Todd, JamesItem Effects of Osteopathic Manipulative Treatment on Osteoarthritis(2000-08-01) Pham, Chau N.Osteoarthritis (OA) is the most prevalent form of arthritis in the United States. Of those 65 to 74 years old, 18 per 100 women and 8 out of 100 men will experience OA of the knee. (Towheed and Hochberg, 1997) The Center for Disease Control and Prevention (CDC) reported a high prevalence for disability for person [greater than] 65 years. Arthritis or rheumatism accounts for 7.2 million (17.1%) people ranking above back problems and heart disease. (CDC, 1994) The Framingham epidemiologic study of knee osteoarthritis estimated a 27% prevalence for those 44% of those [greater than] 80 years. Nelson, Naimark, Anderson, Kazis, Castell & Meenan, 1987) This study uses the principles of Osteopathy to treat OA for the elderly as osteopathic manipulative treatment (OMT) specifically addresses the symptoms and signs of OA. The typical symptom of OA is pain stiffness “in and around a joint accompanied by limitation of function.” (Klippel, 1997) Pain from OA may originate from “periostitis at sites of bony remodeling; subchondral microfractures; irritation of sensory nerve endings in the synovium from osteophytes; periarticular muscle spasm; bony angina due to decreased blood flow and/or elevated intraosseous pressure; and synovial inflammation accompanied by release of prostaglandins, leukotrienes, and other cytokine.” (Klippel, 1997) Other symptoms include morning stiffness, gel phenomenon, buckling/instability. The signs of OA are bony enlargements, limitation of range of motion, crepitus, tenderness on pressure, pain, join effusion, malalignment and/or joint deformity. (Hazzard, 1999) Most often, pain and limitation of movement from OA cause signficiant changes in lifestyle for the older adult; functional independence is adversely affected. Decreased functional independence that affects the quality of life makes this the most debilitating illness in the 65 and older population. Studies have shown that patients with osteoarthritis of the hip and knee have comparable number of days with restricted activity as patients rheumatoid arthritis. (Towheed, 1997; Holman & Lorig, 1997). Treatment goals for managing osteoarthritic patients is to control pain subsequently minimizing functional limitation and disability. (Hazzard, 1999) To treat the above dysfunction, current treatments for OA include pharmacologic agents such as NSAIDs, analgesics, intra-articular steroid injections, topical analgesics; glucosamine sulfate and hyaluronic acid; nonpharmacologic measures include weight reduction, therapeutic ultrasound, acupuncture, transcutaneous electrical nerve simulation (TENS), physical therapy, pulsed electrical stimulation, orthotics, hydrotherapy, self management courses, and support groups. (Womheim, 1996; Zizic, 1995; Creamer, 1997; & McNoll, 199*) The primary objective of pharmacologic treatments is to decrease pain resulting in an increased functional capacity and improved quality of life. There are side effects and limitations to pharmacologic regimens. For example, the usage of NSAIDs in the treatment of the elderly can result in gastrointestinal bleeding. (McNoll, 1998) Non-pharmacologic treatments are viable alternatives in treating osteoarthritis; osteopathic manipulative treatment is such an alternative. A primary osteopathic principle dictates that structure and function are reciprocally inter-related. Any change from the “normal” is called somatic dysfunction. Specifically, somatic dysfunction is the altered or impaired function of related components of the somatic (body framework) system-skeletal, arthrodial, and myofascial structures and related vascular, lymphatic, and neural elements. (Greenman, 1989) OMT is used to return the body to its normal state by increasing symmetry and motion thereby improving body balance and reducing inflammation and pain by increasing fluid flow. When considering the physiological causes for OA of the knee coupled with the side effects from pharmacological treatment, health care providers must consider alternative treatments. The principles of osteopathy provide a logical spring board to meet that challenge. This present study provides a preliminary understanding of the efficacy of OMT for OA of the knee.Item Effects of Osteopathic Manipulative Treatment on Symptom Severity and Functional Status in Carpal Tunnel Syndrome(2005-05-01) Meyer, Patricia M.Meyer, Patricia M, Effects of Osteopathic Manipulative Treatment on Symptom Severity and Functional Status in Carpal Tunnel Syndrome. Master of Science (Clinical Research and Education), May, 2005, 55pp., 7 tables, 54 figures, bibliography 44. Carpal tunnel syndrome (CTS) is symptoms like paresthesias and weakness caused by compression of the median nerve. It affects up to 10% of the adult population in the U.S. with medical costs exceeding $2 billion annually. The goal of this study is to evaluate the benefits of Osteopathic Manipulative Treatment (OMT) on the symptom severity and daily functioning of subjects with CTS. The OMT group was compared to a ultrasound placebo group. Outcome measures include symptom severity, functional status scores, and strength measures. Subjects receive six treatments with measures taken at three points in the study. Thirty-two subjects were used in the study analysis. The OMT group had significantly improved symptom severity and functional status scores over time. These scores were not significantly different from the changes in the ultrasound group. While outcome measures show trends toward improvement with OMT, they are not significantly different from placebo.Item Impact of Shared Decision Making Practices on Healthcare Utilization, Healthcare Expenditures, and Satisfaction with Care among Patients with Angina, Cancer, and Osteoarthritis/Joint Pain, Medical Expenditure Panel Survey 2007-2010(2014-05-01) Brown-Philpot, Lindsey; Nuha Lackan; Jose Pagán; Kristine A. LykensShared decision-making (SDM) within the healthcare environment is grounded in open communication between patients and their care providers. In SDM, clinical and comparative effectiveness information are synthesized with patient values and treatment goals in order to arrive at treatment plans. Researchers and policymakers hope that SDM will facilitate enhanced treatment compliance and quality of care delivery, while simultaneously controlling unnecessary healthcare utilization and costs. The specific aims of this study sought to determine whether six individual SDM practices had an impact on healthcare utilization, healthcare expenditures, and patient reported satisfaction with care among patients with three preference-sensitive health conditions: angina, cancer, and osteoarthritis/joint pain. Data from the Medical Expenditure Panel Survey were used to determine if six individual SDM practices were significant predictors of healthcare utilization, healthcare expenditures, and patient satisfaction with care. Results indicate that patients reporting that providers explained information in a manner that was easy to understand and showed respect for what patients had to say experienced lower incidence rate ratios of outpatient care utilization (IRR=0.9270, 95% CI 0.8616-0.9975; IRR=0.8900, 95% CI 0.8295-0.9549). Those reporting their providers showed respect for what they had to say also experienced lower outpatient care expenditures on average than those whose providers did not show respect for what they had to say ($2,964.69 vs. $2,619.27, difference=-$345.42, p=0.0400). Patients who reported that providers explained all treatment options experienced $87.97 per year more in emergency department expenditures and $1,198.07 per year more in inpatient hospital expenditures than those who reported their providers did not explain all of the treatment options when a medical decision was to be made (p=0.0252; p=0.0036). All six SDM practices were significant predictors of patient satisfaction with care. Provider communication practices have a significant impact on aspects of care utilization and expenditures among patients with angina, cancer, and osteoarthritis/joint pain. Patient-perceived experiences of SDM practices are significant predictors of patient satisfaction with care among patients with these conditions. Effective communication is imperative during medical decisions in order to help ensure the value and quality of healthcare delivery to patients with angina, cancer, and osteoarthritis/joint pain.Item Line-of-Duty Injury or Illness Incidence in an Air National Guard Unit(2001-05-01) Lorich, Michael F.; Marshall, Muriel; Clark, Sharon; Rene, AntonioLorich, Michael F., Line-of-Duty Injury or Illness Incidence in an Air National Guard Unit. Master of Public Health, DO/MPH track, May 2001, 31 p.p., 3 tables, 4 illustrations, reference list, addendum. Line-of-duty injuries or illnesses (LODs) suffered by members of Air National Guard units may demonstrate the status of unit safety, unit readiness and deployability, a potentially significant area of unit expenditures, and areas of needed health promotion. This descriptive pilot study was conducted at the unit commander’s request to determine an apparent doubling of the prevailing incidence of LODs over a recent quarterly period. Tracking of injuries and injured individuals was problematic. The vast majority of LODs were musculoskeletal in nature. Decreased fitness level (Identified as elevated body mass index (BMI)) among males and increased age were related to increased LODs. Recommendations were given to improve tracking, identify individuals at increased risk, provide pre-training assessment, and institute health promotion focused on musculoskeletal injuries.Item Risk Factors Associated with Low Bone Mineral Density and Hip Fracture Among United States 20-90 Years of Age (NHANES III Study)(1999-06-01) Nandi, Shubhra; Rene, Antonio; Licciardone, John C.; Fong, Nelson C.Nandi, Shubhra. Risk Factors Associated with Low Bone Mineral Diversity and Hip Fracture Among United States Females 20-29 Years of Age. (NHANES III Study). Master of Public Health, June 1999, 45p.p. Osteoporosis has become a great public health problem because of the growing segment of the elderly population. The manifestation of osteoporosis results in morbidity with disability and a diminished quality of life due to hip fracture and spine fracture. This is also the major cause of hospital expenditure. Thus, understanding the development of low bone mineral density at various skeletal sites and the prevention of the causes related to the diminished bone mineral density is of great importance. This is a descriptive study of risk factors associated with low bone mineral density and hip fracture among United States females 20-90 years of age. Data was collected by the National Center for Health Statistics from 1988-1994 in two phases. Several risk factors have been associated with low bone mineral density. They are age, race, body mass index, fat-free mass, smoking, alcohol intake, caffeine intake, calcium supplement intake, dairy intake, and the level of physical activity. The primary objective of this study was to elucidate the relationship of low bone mineral density in a specific race-ethnic population with the perceived risk factors. This cross-sectional study provides information to confirm that Non-Hispanic Whites have low bone mineral density at the end of their decade of life compared to Non-Hispanic Blacks and Hispanic Americans. A significant association between low bone mineral density and age, race ethnicity, body mass index, and milk intake was detected (P [less than] 0.05). Other factors did not display any statistically significant correlation.