Browsing by Subject "Surgery"
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Item A Comparison of Medicare Prospective Payment Systems on P.T.C.A. and Stent Outcomes in an Urban Hospital(2001-05-01) Compton, Ben H.; Doug A. Mains; P. E. HilsenrathCompton, Ben H., A Comparison of Medicare Prospective Systems on P.T.C.A. and STENT Outcomes in an Urban Hospital. Master of Public Health (Health Services Administration), May 2001, 57 pp., 10 tables, 1 graph, bibliography, 51 titles. To determine if differences in outcomes exist between Medicare prospective payment systems when doing percutaneous transluminal coronary angioplasty (PTCA) or STENT surgeries. From January 1999 and December 2000, 146 Medicare patients were identified with 35 being outpatient and 111 inpatient. A separate group of 1-day inpatients was used as a comparison for the outpatient group. Results from the comparison reveal that in the three groups, the majority of patients were white, non-Hispanic males who were about 70 years of age. The 1-day inpatient group had the highest profit of all three with about $3,000 while the inpatient group broke even. The outpatient group had no in-hospital deaths or complications while all three had equal amounts of comorbidities. The conclusion is that losses will probably occur if PTCA and STENTs are done outpatient. Possible solutions are moving to an inpatient setting or determining which costs can be reduced in the outpatient setting.Item Adult Women and Coronary Heart Disease: Studies on Surgical Procedures and Perception(2010-12-01) Schlorke, Patricia; Bae, Sejong; Biswas, Swati; Chen, OliveSchlorke, Patricia J., Adult Women and Coronary Heart Disease: Studies on Surgical Procedures and Perception. Doctor of Public Health (Biostatistics), December 2010, 124 pp., 12 tables, 3 figures, bibliography, 95 titles. Coronary heart disease (CHD) was the number one cause of death in the United States. The main CHD symptom was a heart attack. The most common form of a heart attack was chest pain and shortness of breath, which occurred in men. However, women did not usually have chest pain, but other symptoms such as abdominal pain or indigestion. This could lead women to perceive or believe that they would not have heart disease or heart attacks. This thought could lead women to not obtaining health care, such as surgical procedures, for CHD. Health professionals knew the signs and symptoms of CHD in men, but they may be uncertain in their diagnosis in women. This could lead to women not asking their health care professional about heart attacks or other symptoms. The purpose of this dissertation analyzed CHD in two areas in all women 18 years and older. These two areas were: (a) comparing hospital length of stay between men and women who had either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA); and (b) women’s perceptions about CHD. Data for the surgical procedures study came from the 2006 National Hospital Discharge Survey (NHDS) and for the perception study came from the 2007 Behavioral Risk Factor Surveillance System (BRFSS). The results showed for the surgical procedures men and women had increased hospital days of care (DOC) for all surgical procedures. The results for the perception study showed women varied by age, race-ethnicity, education, income, and other factors in heart attack symptom knowledge. These two studies had the following conclusions. The results for increased hospital DOC had implications, such as increased health utilization, for present and future hospitalizations. The results for heart attack symptom knowledge showed a need for more awareness and communication of heart attack symptoms among all women across the United States.Item An American Text-Book of Gynecology, Medical and Surgical for Practitioners and Students(W.B. Saunders, 1899-01-01) Baldy, J.M.; Cragin, Edwin M.D.; Etheridge, J.H. M.D.; Goodell, William M.D.; Kelly, Howard M.D.; Krug, Florian M.D.; Montgomery, E.E. M.D.; Pryor, William M.D.; Tuttle, George M.D.; Byford, Henry M.D.2nd Edition. 1899Item Analysis of the Clinical Research Methodologies Employed During a Phrase Three Efficacy Study for Ultracet as a Post-Herniorrhaphy Analgesic(2001-08-01) Aguilar-Zanatta, Jorge; Rustin Reeves; Don Peska; Della WeisThe history of pain management stems back many thousands of years. However, not until recent times have significant advancements in biochemistry and pharmacology allowed analgesics to be incorporated in clinical interventions and everyday life. Due to these advancement, attempts to refine pharmacological action on receptors in terms of specificity would render medications with fewer side effects. The technology is present, but the application and development of modern analgesics in post-surgical settings is substandard. According to C.L. Ireson and R.W. Schwartz, (2001), the outcomes of ailment interventions in the United States are “…no better and in numerous situations worse that those achieved in other countries,” even though the United States has the most expensive healthcare in the world. Furthermore, a study performed by Carr et al. (1998), has identified the United States as demonstrating consistent inadequacies in postoperative pain management. Several factors have been identified as being contributors of poor post-surgical pain control in America. Lack of awareness of the available strategies in acute pain control and its implementation in post surgical care are labeled as being problematic observations (Puid et al., 2001). In response to these conditions as well as the managed health care time and cost limitations, new and efficacious pharmaceuticals must be made available to a broad spectrum of socio-economic strata. Currently, there is a great debate over the use of laparoscopic herniorrhaphy versus open tension free approaches. In terms of cost, the laparoscopic herniorrhaphy versus open tension free approaches. In terms of cost, the laparoscopic herniorrhaphy versus open tension free approaches. In terms of cost, the laparoscopic procedure is more expensive and yields less postoperative pain, however the open tension free approaches are less expensive and yield more postoperative pain (Sarli et al., 2001, Medical Research Council Laparoscopic Groin Hernia Trial Group, 2001, Parviz et al., 1995). There are advantages and disadvantages to both procedures. Assuming that efficacious postoperative analgesics were available, the open tension free repair would be more feasible in terms of cost and hernia recurrence rates (Sarli et al., 2001). In terms of pharmaceutical development, the laws and guidelines by the regulatory agencies such as the Food and Drug Administration, institutional review boards, and pharmaceutical sponsor protocols must be followed. Along with good clinical practice standards, interdisciplinary collaboration in pain studies produce results that are statistically and clinically salient. The patient’s well-being and comfort is the ultimate goal in clinical pain studies and in medicine in general, therefore postoperative pain should be aggressively managed.Item Bariatric Surgery And The Lap Band: An Analysis of Efficacy(2003-12-01) Crane, Dave; Doug A. Mains; Claudia Coggin; Karan SinghCrane, B.A., M.A., Dave, Master of Public Health (Health Management and Policy), December 2003, Bariatric Surgery and the Lap Band: An Analysis of Efficacy, 40 pages, 15 tables, references, 45 titles. Obesity has quickly become both a national and global health issue. The evidence is increasingly consistent that obesity has a causal relationship with serious medical complications. The Lap Band, a surgical procedure for weight control, was approved by the Food and Drug Administration in June, 2001. The purpose of this study was to assess the efficacy of this procedure by reviewing existing literature and studying a patient population that had received Lap Band surgery. The retrospective review included information on 93 patients in the bariatric program at the University of North Texas Health Science Center at Fort Worth. The preliminary data in this study agrees with other studies , which shows that the Lap Band is an effective intervention for morbidly obese patients.Item Buchanan, Sam, D.O.(1992-10-21) Buchanan, Sam; Stokes, C. RayDr. Buchanan, a member of TCOM's 2nd graduating class, served as Chairman of the Surgery Department. He shares highlights from his school days and his hopes for the surgery department. Interviewed by C. Ray Stokes, October 21, 1992Item Clinical Internship in the Surgery Department at the University of North Texas Health Science Center: Assessment of Human Antibody Response to Urokinase Part A: Specimin Acquisition Trial for the Assessment of Human Antibody Response to Urokinase in Subjects Treated for Acute Lower-Extremity Ischemia(2003-12-01) Hughes, Telicia A.; Rustin E. ReevesSignificance and Specific Aim of the Study. Significance. FDA has informed Abbott Laboratories of additional concerns related to manufacturing deficiencies for urokinase (Abbokinase). Until these problems are corrected, further distribution of Abbokinase would violate federal laws designed to assure the safety of drugs for patient use. FDA’s concerns about the product relate to serious deficiencies in the manufacturing processes, the testing of the product, and the screening and testing of the donors of the kidney cells used to make Abbokinase. Abbokinase is derived from cultures of human kidney cells from newborns who have died of natural causes, and is approved in the United States to dissolve blood clots in the lungs and heart arteries. It is also approved to help clear intravenous catheters. During inspections of Abbott Laboratories and of BioWittaker, Inc. Abbott’s supplier of human kidney cells, FDA identified numerous significant deviations from current good manufacturing practice (CGMP) regulations designed to assure product safety. Compliance with CGMP is important because products manufactured from human sources have the potential to transmit infectious agents. CGMP for products such as Abbokinase requires important, overlapping safeguards in the production process, including adequate –screening of donors and testing of cells, -controls for proper harvesting, storage, and handling of materials used in all stages of manufacturing, and –processes to remove or inactivate infectious agents from the product. Over the past several months, the firm has reported to FDA that a number of in-process lots of Abbokinase was contained with microorganisms. Six such lots were found to contain various strains of reovirus, a virus that usually results in no symptoms or causes minor respiratory or gastrointestinal symptoms. Association of reovirus infection with other human diseases have been reported, although a causal link has not been established. Another in-process lot was contaminated with mycoplasma, a microorganism that can cause respiratory infections, and, on rare occasions, other infections that may be serious. Abbott has assured FDA that none of these in-process lots were manufactured into final product or distributed. These recent findings of contamination and Abbott’s inability to locate the source of the problem have raised further concerns at FDA about Abbott’s entire manufacturing process for Abbokinase. Abbot’s deviations from CGMP could significantly impact the safety of the product. One FDA concern is that deficiencies in manufacturing practices could also lead to the product being contaminated with microorganisms that have not yet been detected. FDA also obtained additional information regarding the inadequacy of the screening and testing of the mothers and donors of the human kidney cells used to produce Abbokinase. Information was also obtained regarding the seven instances of in-process lots of product being contaminated with reovirus and mycoplasma. In the letter to Abbott, the agency has detailed the steps Abbott needs to take to correct the serious and significant manufacturing deviations. These include: -completing a thorough and adequate investigation of the reovirus and mycoplasma contamination, including the source of the contamination, -manufacturing Abbokinase using human kidney cells that have been obtained, processed, and tested through adequate methods, and –assuring that fully validated methods are used in the manufacturing process to test for infectious agents and remove them. Abbott submitted a supplemental new drug application providing for changes in procurement and processing of neonatal kidney cells, improvements in the manufacture and testing of the drug substance and drug product, revised release specifications for the drug substance and drug product, revised release specifications for the drug substance and drug product, a revised CBER lot release protocol, withdrawal of the “Open-Cath” dosage strengths, and revised labeling. Labeling revisions include updated information regarding product source and adverse reactions, as well as withdrawal of the coronary artery thrombosis and catheter clearance indication. The Department of Health and Human Services completed the review of that supplemental application, as amended, and it was approved based on Abbott’s written commitments, one of which is –To conduct a study to assess the immunogenicity of Urokinase after primary dosing. Urokinase is indicated in adults for the lysis of acute massive pulmonary emboli, defined as obstruction of blood flow to a lobe or multiple segments for the lysis of pulmonary emboli accompanied by unstable hemodynamics, i.e., failure to maintain blood pressure without supportive measures. Therefore, it is important to complete this study, to meet federal requirements, so that Urokinase could be fully marketed and help to improve the quality of life. Specific Aim. 1. To access the human antibody response to Urokinase, a thrombolytic agent in subjects treated for lower extremity ischemia. A.) Technique: All subjects will receive an intra-arterial infusion of a minimum of 240,000 IU of Urokinase (UK). In part A of this study we will obtain serum specimens from subjects receiving UK. These blood specimens will be used in part B of this study for the qualitative/quantitative assessment of antibody response to Urokinase, specifically IgM, IgE, IgG. Antibody directed against the UK drug substance, API, and the inactive peptides/protein in the formulation.Item Comparative study of the physical symptoms following bilateral mastectomy with immediate breast reconstruction and delayed breast reconstruction(2015-05-01) Bhat, Ritika U.; Dory, Ladislav; Basu, AlakanandaBreast reconstruction following a mastectomy can be done either immediately, at the time of the mastectomy, or following a recovery from the original surgery. This study compares the post-operative symptom experiences of these two groups of patients through secondary data analysis, using an existing survey, “How Women Decide” conducted at Texas Health Harris Methodist Hospital, Fort Worth (THFW). Statistical analysis was performed using SPSS 20. Tiredness/fatigue is the only symptoms which approached significance between the two groups; patients in the immediate breast reconstruction group experienced more tiredness/fatigue. No other aspects covered in the survey differed between the two groups. The study also found that hot flashes and tiredness/fatigue are the most common symptoms affecting the patients following bilateral mastectomy with breast reconstruction surgery. A larger sample size may have uncovered additional significant differences.Item DISCOVERY AND DEVELOPMENT OF A BIO-INSPIRED SURGICAL ADHESIVE(2014-03) Hoffman, Jason T.; Carter, Brian; Kosmopoulos, Victor; Schetz, John A.Our main focus is to develop a bio-inspired adhesive to be used within a surgical environment to facilitate accelerated healing. This would be beneficial for securing bone fragments, in conjunction with a plate or screw, or anchoring other tissues. Purpose (a): Our goal is to develop an adhesive for securing bone to bone, metal to bone, and tissue to bone. As the aging population increases, the number of fractures due to falls and loss of bone density will increase. The incidence of bone fractures in elderly women, ages 50-79, exceeds the combined incidents for all types of cardiovascular disease and breast cancer. Although there are bone “fillers” (e.g., putties, cements and fillers), there are currently no true adhesives for bone. Drawbacks of current filler-type products complicating their use include the need to completely dry bone prior to application and high curing temperatures which can damage surrounding tissue. Methods (b): In light of naturally-occurring glues from aquatic mussels being able to harden underwater, we adapted the same type of chemistries for our approach. Specifically, we utilized catechol-like chemistries to strengthen protein-based adhesives. A bone surrogate model consisting of hydroxyapatite was employed to measure the tensile strength. Results (c): In previous proof of concept stages, we were able to secure bone to bone but were able to achieve only a small fraction of our target adhesive strength. Using new protein-based approaches we have improved our technology to obtain thousand-fold higher tensile strengths. Conclusions (d): We envision future applications of this adhesive medical device technology to include bone reconstruction, securing screws and metal plates to bone, and cartilage or ligaments to bone. Having a bone adhesive with sufficient strength to serve as a stabilizing force for immediate weight bearing would promote bone regrowth and accelerated healing.Item Ergonomic Efficiency Field Evaluation of the C-03-35 Intraocular Lens Delivery System(2004-05-01) Kajtoch, Michael; Gwirtz, Patricia A.; Bens, Annita V.; Hileman, KendraObjective: The purpose of this post-market clinical investigation is to validate the ergonomic efficiency of the C-03-35 Intraocular Delivery System following cataract removal by phacoemulsification. The C-O-35 Delivery System is a newly approved device developed by Alcon Laboratories, Inc, which allows the delivery of the ACRYSOF Model SA60AS soft acrylic intraocular lens in a sterile, single-use and disposable unit that combines the hand piece plus the ACRYSOF intraocular lens-contained cartridge in an integrated system. This system is somewhat different from the predecessor MONARCH II Delivery System, which requires the surgeon to correctly insert the ACRYSOF intraocular lens into a cartridge and then assemble the cartridge into a reusable hand piece. The C-03-35 Delivery System eliminates these steps; therefore, it should decrease the risk of damage that may occur to the optic or the haptic as well as reducing surgery time. Materials and Methods: This study is an open label ergonomic assessment of the C-03-35 Delivery System that will be completed after the operative visit (performed on one eye only) of 120 patients by up to twelve investigators. The investigators will enroll patients requiring cataract extraction with intraocular lens implantation into the study that meet predetermined inclusion/exclusion criteria. Data Collection and Analysis: Upon concluding the surgical procedure, the investigator will complete a series of Case Report Forms consisting of questions assessing the ergonomic efficiency of the C-03-35 Delivery System. The Case Report Forms will comprise of questions regarding the optic and haptic placement, ease of use, as well as any adverse events that might have occurred. In addition, the investigator will complete an Exit Case Report Form once the patient concludes the study, is discontinued from the study, or if the patient fails to attend the follow-up visits. The required C-03-35 Case Report Form examination schedule is included in Appendix C. The information obtained from the Case Report Forms will then be entered into a clinical database. The safety information will be analyzed by the Biostatics Department by comparing the safety data obtained from the field evaluation to the Federal Food and Drug Administration’s standards called the FDA Grid of Historical Controls. The FDA Historical Grid provides pharmaceutical companies with performance guidelines by which the investigational test article is measured. In the case of intraocular lenses, the FDA Historical Grid provides standards for overall visual acuity (%20/40), best-case visual acuity (%20/40), and adverse events. Only adverse events will be compared to the FDA Historical Grid and analyzed for this field evaluation. The visual acuity parameters of the intraocular lens will not be analyzed in this study, since the C-03-35 Delivery System uses a FDA approved ACRYSOF Model SA60AS lens with established performance. In addition, the ergonomic efficiency questions such as ease of use will be summarized into a table. Although not currently on the protocol of the study, this information may also be further compared against the MONARCH II Delivery System analysis results, since safety as well as ergonomic efficiency data were also collected during that study. The FDA Grid of Historical Controls is included in Appendix D.Item Jenkins, William, D.O. and Jenkins, Constance, D.O.(1993-10-15) Jenkins, William; Jenkins, Constance; Stokes, C. RayDr. William Jenkins along with his wife Dr. Constance Jenkins where involved with TCOM since the beginning. Dr. William Jenkins was Chairman for the Surgery Department and Dr. Constance Jenkins was Director of TCOM's Central Clinic. Both were awarded the Founder's Medal. Interviewed by C. Ray Stokes, October 15, 1993Item Molecular Regulation of Cardiac Stem Cell Growth and Differentiation by Extrinsic Factors and Novel Intracellular Signaling Pathways(2008-05-01) Bartosh, T.J.; Rouel S. Roque; Harold Sheedlo; Robert WordingerT. J. Bartosh, Molecular regulation of cardiac stem cell growth and differentiation by extrinsic factors and novel intracellular signaling pathways. Doctors of Philosophy (Biomedical Sciences), May 2008, 293 pp., 4 tables, 59 illustrations, bibliography, 353 titles. Insufficient myocardial regeneration following ischemic injury provokes cardiac dysfunction, adverse tissue remodeling, and ultimately heart failure. Stem cell replacement therapy appears to be a promising strategy for improving cardiac function, however, challenges involving inadequate stem cell differentiation, engraftment, and survival following transplantation currently impede the efficacy of regeneration protocols. These limitations emphasize the significance of identifying extrinsic factors and corresponding molecular mechanisms regulating cardiac cell differentiation. Recent reports recognizing a stem cell component in the adult heart (i.e. cardiac stem cells, CSC) have provided additional targets and/or tools for myocardial repair. This investigation verified the presence of CSC in the adult dog heart, described methods to generate three dimensional (3D) cardiac microtissues (‘cardiospheres’) from CSC, and revealed features of cardiospheres potentially useful for identifying extrinsic procardiogenic factors, evaluating myocardial response to stress, and delivering functional CSC into the damaged heart. Specifically, cardiosphere formation was facilitated by culturing CSC in growth medium on a poly-L-ornithine substratum. Cardiospheres are comprised of interior cells that exhibited characteristics of CSC; differentiating cardiomyocytes at the periphery with organized contractile machinery; and/or vascular cells capable of forming vessel-like networks. Upon co-culture with neonatal cardiomycocytes, spheres developed foci of contracting regions. Furthermore, cardiospheres exhibited increased resistance to oxidative stress and survived subcutaneous injections without undergoing neoplastic transformation further supporting their ability to effectively promote myocardial regeneration. Retionic acid (RA), the active form of vitamin A, augmented expression of myocyte-specific proteins in cardiospheres, thus, RA may improve the success of cardiac regenerative therapies and provide an appropriate stimulus to model underlying mechanisms fundamental for CSC differentiation. The tendency for cultured stem cells to undergo various levels of multi-lineage commitment is, however, cumbersome for deciphering precise cues that direct cell fate decisions. In this study, the molecular pathways important for RA-induced cardiac differentiation were examined using h9c2 cardioblasts as a stable cell model. In h9c2 cells, RA treatment promoted transcriptional enhancement of the muscle-enriched gene regulatory protein MEF2C, morphological alterations indicative of differentiation, and a robust increase in expression of myocyte differentiation genes including cardiac myosin heavy chain (cMHC) and ventricular myosin light chain-2 (vMLC2). These changes were preceded by rapid events involving elevation of intracellular Ca^2+ and phosphorylation of p38 MAPK. The effects of RA were attenuated using CA^2+ buffering agents or chemical inhibitors of L-type Ca^2+ channels (LTCC) and the phosphatase calcinuerin, but not by RA receptor antagonists. Furthermore, overexpression of dominant negative (dn) MEF2C, dnp38 MAPK, or CAIN, a physiological calcineruin inhibitor, abrogated MEF2 activity and RA-induced differentiation. These results imply that RA promotes cardiomyocyte differentiation, independent of RA response element activation, via induction of CA^2+ -regulated signaling pathways by activating the LTCC-calcineurin/38MAPK-MEF2 axis. Taken together, these findings enhance our understanding of extrinsic factors and molecular mechanisms indispensable for myocyte differentiation and subsequently provide novel therapeutic targets and cellular tools for regeneration and repair of damaged myocardium.Item MUSSEL ADHESIVE PROTEIN-INSPIRED BONE GLUE FOR INTEROSSEOUS ADHESION AND HEALING(2013-04-12) Hoffman, JasonPurpose: According to the National Ambulatory Medical Care Survey & American Academy of Orthopaedic Surgeons approximately 1 in 40 people in the USA fracture a bone each year. A rapid return to ambulation is not only desirable from a patient and caregiver perspective, but also immediate weight bearing following bone fracture is believed to promote faster healing and it shortens hospital stays. A variety of bone fillers and cements currently exist, but none of them are capable of gluing broken bones back together. Our goal is to create a technology that is not a filler but rather a biocompatible glue with adhesive properties found in nature. This technology will allow us to glue bones together or bones and surgical implants such as metal plates. Unlike current bone cements, we seek to develop a technology that does not require a high curing temperature or drying of surfaces prior to its application. Inspired by the underwater adhesive properties demonstrated by the glue proteins of aquatic mussels (mollusk bivalves), we are developing an adhesive substance with biomimetic properties capable of accelerated interosseous healing in an aqueous environment similar to that encountered during orthopedic surgical intervention. This would be achieved while still providing the strength and structure of current more invasive techniques. Methods: Similar to mussel glue proteins, we exploited catechol-like chemistries to achieve adhesion to wetted bone. To demonstrate proof-of-concept, a variety of free-flowing liquid prototype adhesives were applied to the ends of moist transversely sectioned long bones from chickens and sheep. These were then allowed to cure at room temperature with the application of minimal compression. Results: We are currently engaged in molecular tailoring of adhesive functionalities to optimize the molecular properties of our glues. Important parameters include adhesive strength and elastic modulus similar to bone. Conclusions: Through the application of our bioinspired bone adhesive, the healing process following various orthopedic injuries can be accelerated by significantly decreasing the time required before weight bearing and ambulation. This coat and stick technology can be delivered via a syringe or other minimally invasive device and thus has the potential to decrease post-surgical infection rates along with other common complications associated with open reduction with internal fixation procedures.Item Osteopathic Manipulative Treatment for Postoperative Nausea and Vomiting(2008-05-01) Schrick-Senasac, Simon L.; Hollis King; Kimberly Fulda; Monte TroutmanSchrick-Senasac, Simon L., Osteopathic Manipulative Treatment for Postoperative Nausea and Vomiting. Masters of Science (Clinical Research and Education, Osteopathic Manipulative Medicine), May, 2008, 95 pp., 9 tables, 7 illustrations, bibliography, 68 titles. Purpose: Despite advances, no therapy has been able to prevent postoperative nausea and vomiting (PONV). This pilot study sought to evaluate the effect of osteopathic manipulation on PONV and to assess the feasibility for reproduction. Methods: Individuals undergoing anesthesia were recruited as subjects. Seventeen subjects completed the study – eight receiving treatment, nine as controls. Nausea and pain visual analog scale (VAS) scores as well as vital signs were collected periodically throughout the study. A post-discharge survey was completed 1 day following treatment. Results: There was no overall reduction of PONV; early emesis was reduced as were 30-minute and peak nausea VAS scores. Additional analysis found pain VAS scores less elevated in treated subjects than controls. This was accompanied by reduced utilization of analgesics following surgery. Conclusions: Incidence of PONV was universally low, likely due to widespread phrophylaxis. Reduction of pain corresponds with research linking manipulation to modulation of neuroendocrine systems. This study demonstrated potential and feasibility for larger reproduction.Item Review of Blunt Pancreatic Trauma and Its Outcome(2007-12-01) Sanghvi, ChiragSanghvi, Chirag. Review of Blunt Pancreatic Trauma and Its Outcome. Master of Public Health (Biostatistics), December 2007, 37 pp., 4 tables, bibliography, 42 titles. Blunt pancreatic trauma (BPT) is an uncommon injury involving 1%-2% of blunt abdominal traumas but it can be associated with a high complication rate. Various studies have shown complication rate to range from 30%-64% following blunt pancreatic injury. With Institutional Review Board (IRB) approval a retrospective chart review study was performed for last 12 years. Chart review failed to support the hospital assigned diagnosis of BPT in 3 patients, leaving 37 cases for analysis. BPT had an overall mortality rate of 22%. In the patients surviving the injury, early surgical intervention (≤12 hours) had a complication rate of 31% versus 57% for delayed surgical intervention ([greater than] 12 hours). BPT has a high mortality rate but is usually secondary to other organs involved in the injury. Delayed surgical intervention has a higher complication rate compared to early intervention.Item Review of the Current Treatment Options for a Prostate Cancer, Evolution of Radiosurgery, and Initiation of a Cyberknife Prostate Cancer Trial(2007-03-01) Camarena, Julieanna Angel; Oglesby, Michael; Gwirtz, Patricia A.; Aschenbrenner, JohnCamarena, Julieanna, Angel. Review of the Current Treatment Options for Prostate Cancer, Evolution of Radiosurgery, and Initiation of Cyberknife Prostate Cancer Trial. Master of Science (Clinical Research Management), May 2008, 141 pp., 3 tables, 4 illustrations, bibliography, 73 titles. Prostate cancer is the uncontrolled growth of the prostate gland cells. It is the most common cancer found in American men other than non-melanoma skin cancer. This disease will affect 1 in 6 men during their lifetime. With early diagnosis and treatment, prostate cancer has a cure rate of 90%. Currently there are several treatment options available for prostate cancer. The most common forms of treatment for early and intermediate state prostate cancers are surgery, radiation therapy, hormone deprivation therapy, and active surveillance. New treatment modalities including CyberKnife radiosurgery are currently being tested to gather data on safety and efficacy. Although the CyberKnife system gained clearance from the Food and Drug Administration in 2001 to treat tumors anywhere in the body where radiation treatment is indicated, long term data has not accrued on this device to assess its safety and efficacy. Investigational new treatments such as the CyberKnife must undergo clinical trials even after it is approved to determine long term effects of the procedure. As an intern with a CyberKnife, prostate cancer clinical trial, the author assisted in initiating the clinical trial at a major institution and observed the many aspects of clinical research with a focus on the role of a clinical research coordinator. Through this experience, the author researched the key components in a protocol and the background information necessary to compose a clinical trial protocol in the area of prostate cancer.Item Review of the History of Coronary Stenting, Role and Evolution of Adjunctive Pharmacotherapy and Experience with an Ongoing Drug-Eluting Stent Trial(2005-12-01) Kang, Mi Jung; Bens, Annita V.; Ratka, Anna; Oglesby, MichaelKang, Mi Jung. Review of the History of Coronary Stenting, Role and Evolution of Adjunctive Pharmacotherapy and Experience with an Ongoing Drug-Eluting Stent Trial. Master of Science (Clinical Research Management), December 2005, 116 pp., 6 tables, 12 figures, bibliography, 61 titles. The history of stent development with regard to the use of coating materials and eluting drugs, with special emphasis on mechanism of release and duration of action of drugs used in drug-eluting stents, was summarized. The general safety profile of currently used adjunctive pharmacotherapy to coronary stenting, with special emphasis on the clinical trials providing the scientific assessments of the effectiveness and safety of the regimens was reviewed. The enrollment process and the critical role of the Clinical Research Coordinator (CDC) in the process of the implementation of a clinical study with a new drug-eluting stent were described.Item Structure and Function of an Interdisciplinary Research Committee at a Hospital-Based Non-Academic Institution(2011-05-01) Fisch, Nathan J.; Patricia GwirtzPurpose: Define the structure, function and activities of a trauma research committee and establish a Standard Operating Policy for a new committee. Hypothesis: By surveying existing trauma research committees, a recommended organizational strategy and membership framework can be developed for the new trauma research committee. Design: Level 1 Trauma Centers across the United States were asked how their trauma research committees are organized. The data was presented to the new committee and a model for committee operation was suggested. Results: Using the model along with input from the trauma research committee’s leadership, a Standard Operating Policy was developed. Members were asked to review the policy and agree to follow its policies and participate in trauma research.Item Surgery from an Osteopathic Standpoint(Volk, Jones & McMein Co., 1904-01-01) Young, Frank M.D., D.O.Collaborated by Charles E. Still. 438 p. : ill. ; 25 cm.Item Surgical and Applied Anatomy(Lea & Febiger, 1917-01-01) Keith, Arthur; Mackenzie, W.; Treves, Frederick