Louis Stokes Medical Center

Cleveland, OH, United States

Louis Stokes Medical Center

Cleveland, OH, United States
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Ko J.S.,Case Western Reserve University | Zwiebel S.,Case Western Reserve University | Wilson B.,Geriatric Research | Becker D.B.,Louis Stokes Medical Center
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2017

Purpose: Carpal tunnel syndrome (CTS) has a high incidence in diabetic patients, with a reported incidence up to 21%. In severe cases of CTS, patients may undergo carpal tunnel release (CTR) surgery, which involves the risk of infection and other complications. To decrease the risk of infection, some physicians provide prophylactic antibiotics. Our study examines the effects of prophylactic antibiotic use, especially in a high-risk, diabetic population. Methods: A total of 469 CTR surgeries performed by plastic surgery specialists were reviewed for diabetic status at the time of surgery and perioperative antibiotic use. Postoperative infections occurring at the surgical site were recorded. Associations between perioperative antibiotic use and infection in diabetics and nondiabetics were then analyzed. Results: No significant decrease in infection rate was seen in those who were given perioperative antibiotic use. This relationship held true for diabetics as well. Conclusions: No benefit of antibiotic use during CTR surgery was seen. There was, however, a trend toward a protective effect in patients with uncontrolled diabetes mellitus, suggesting that such patients may benefit from perioperative antibiotic use. Level of Evidence: III (Retrospective cohort study), Therapeutic. © 2017.

Foldes E.L.,Case Western Reserve University | Ackermann D.M.,MetroHealth Medical Center | Bhadra N.,Case Western Reserve University | Kilgore K.L.,Case Western Reserve University | And 4 more authors.
Journal of Neuroscience Methods | Year: 2011

Nerve cuff electrodes are a principle tool of basic and applied electro-neurophysiology studies and are championed for their ability to achieve good nerve recruitment with low thresholds. We describe the design and method of fabrication for a novel circumpolar peripheral nerve electrode for acute experimental use. This cylindrical cuff-style electrode provides approximately 270° of radial electrode contact with a nerve for each of an arbitrary number of contacts, has a profile that allows for simple placement and removal in an acute nerve preparation, and is designed for adjustment of the cylindrical diameter to ensure a close fit on the nerve. For each electrode, the electrical contacts were cut from 25 μm platinum foil as an array so as to maintain their positions relative to each other within the cuff. Lead wires were welded to each intended contact. The structure was then molded in silicone elastomer, after which the individual contacts were electrically isolated. The final electrode was curved into a cylindrical shape with an inner diameter corresponding to that of the intended target nerve. The positions of these contacts were well maintained during the molding and shaping process and failure rates during fabrication due to contact displacements were very low. Established electrochemical measurements were made on one electrode to confirm expected behavior for a platinum electrode and to measure the electrode impedance to applied voltages at different frequencies. These electrodes have been successfully used for nerve stimulation, recording, and conduction block in a number of different acute animal experiments by several investigators. © 2010 Elsevier B.V.

Heaton W.A.,Feinstein Institute for Medical Research | Good C.E.,Case Western Reserve University | Good C.E.,University Hospitals Case Medical Center | Galloway-Haskins R.,Feinstein Institute for Medical Research | And 4 more authors.
Transfusion | Year: 2014

Background Despite existing strategies, bacterial contamination of platelets (PLTs) remains a problem, and reliable testing near the time of use is needed. We evaluated the BacTx assay (Immunetics, Inc.), a rapid colorimetric assay for detection of bacterial peptidoglycan, for this purpose. Study Design and Methods Apheresis- and whole blood-derived PLT units, the latter tested in 6-unit pools, inoculated with 10 representative bacterial species (eight aerobic, two anaerobic), were tested with the BacTx assay at two sites to determine analytic sensitivity and time to detection. Specificity on sterile PLTs and reproducibility across different PLT units and assay kit lots was also determined. Results Analytical sensitivity for the 10 bacterial species ranged from 6.3×102 to 7.6×104 colony-forming units (CFUs)/mL. In time-to-detection studies after inoculation of PLTs with 0.7 to 5.3 CFUs/mL, 10 replicates of all eight aerobic species were positive when bacterial titers were above the analytic sensitivity detection limit, which occurred at 48 hours for 60 PLT units and at 72 hours for the remaining 4 units, as well as at 7 days for all units. Specificity was 99.8% and reproducibility was 100%. Conclusions The BacTx assay had an analytical sensitivity below the 105 CFUs/mL threshold of clinical significance, detected all eight aerobic bacterial species 48 to 72 hours after inoculation as well as at 7 days, and had high specificity and reproducibility. These findings suggest that the BacTx assay will be a valuable test for detection of clinically relevant levels of bacterial contaminants in PLT units and pools near time of use. © 2014 AABB.

Barshes N.R.,Baylor College of Medicine | Sigireddi M.,Texas Tech University Health Sciences Center | Wrobel J.S.,University of Michigan | Mahankali A.,Michael bakey Veterans Affairs Medical Center | And 3 more authors.
Diabetic Foot and Ankle | Year: 2013

Most cases of lower extremity limb loss in the United States occur among people with diabetes who have a diabetic foot ulcer (DFU). These DFUs and the associated limb loss that may occur lead to excess healthcare costs and have a large negative impact on mobility, psychosocial well-being, and quality of life. The strategies for DFU prevention and management are evolving, but the implementation of these prevention and management strategies remains challenging. Barriers to implementation include poor access to primary medical care; patient beliefs and lack of adherence to medical advice; delays in DFU recognition; limited healthcare resources and practice heterogeneity of specialists. Herein, we review the contemporary outcomes of DFU prevention and management to provide a framework for prioritizing quality improvement efforts within a resource-limited healthcare environment. © 2013 Neal R. Barshes et al.

Cascio M.A.,Case Western Reserve University | Yomtovian R.,Louis Stokes Medical Center
Transfusion Medicine Reviews | Year: 2013

Food and Drug Administration guidelines prohibit men who have sex with men (MSM) from donating blood to prevent the spread of the human immunodeficiency virus (HIV/AIDS). Although the deferral criteria leave "sex" undefined, donor educational materials distributed before the health questionnaire often offer a definition. This study analyzes educational materials for their contribution to the donation process and construction of HIV/AIDS. It applies a discourse analysis approach to a sample (n = 52) of such materials obtained in summer 2009 from blood collection organizations listed in the AABB (now referred to as "Advancing Transfusion and Cellular Therapies Worldwide") Directory of Community Blood Centers and Hospital Blood Banks [AABB. Directory of Community Blood Centers and Hospital Blood Banks. Bethesda, MD: AABB; 2009]. It finds that when materials define sex, the definition is "vaginal, oral, or anal sex whether or not a condom or other protection was used," and when materials define HIV/AIDS risk behaviors, the definition is, with few exceptions, "sexual contact with an infected person or by sharing needles or syringes used for injecting drugs." Widespread use of these definitions demonstrates the influence of "Making Your Blood Donation Safe." Through analysis of this document and variations upon it, this research finds that the category MSM therefore provides one component of the construction of HIV/AIDS as the providence of MSM, together with heterosexual Africans and other risk populations, conflating group membership with individual risk. Deferring MSM therefore fails as a behavior-based deferral because it collapses multiple sexual behaviors with varying risks into a single risk category. It constructs all MSM as HIV positive and implicitly constructs non-MSM as risk-free. © 2013 Elsevier Inc.

Burant C.J.,Case Western Reserve University | Burant C.J.,Louis Stokes Medical Center
International Journal of Aging and Human Development | Year: 2016

The latent growth curve model (LGCM) is a useful tool in analyzing longitudinal data. It is particularly suitable for gerontological research because the LGCM can track the trajectories and changes of phenomena (e.g., physical health and psychological wellbeing) over time. Specifically, the LGCM compares lines of change across a set of individuals and determines the overall model's line of change. LGCMs can be used to track either linear or curvilinear trajectories. Since the technique uses structural equation modeling, models are also adjusted for measurement error. This article will present a step-by-step approach to setting up, analyzing, and interpreting an LGCM using post-hospitalization recovery in depressive symptomatology as an example. This article will demonstrate how to test linear, quadratic, and freely estimated lines of change using LGCMs with the purpose of finding the line of trajectory for depressive symptoms that best fits the data. © The Author(s) 2016.

Jacono F.J.,Case Western Reserve University | Jacono F.J.,Louis Stokes Medical Center
Respiratory Physiology and Neurobiology | Year: 2013

Breathing occurs in single breaths and in patterns which are altered by the onset, progression and resolution of respiratory diseases. Through modulations of rate, depth, and patterning of breathing, the ventilatory control system maintains numerous critical variables within their homeostatic ranges. A dynamic respiratory control system is critical to successful adaptation in the face of progressive pulmonary pathology. The objective of this review, is to illustrate functional changes and compensatory mechanisms which occur with the onset and progression of acute and chronic lung disease. Chronic obstructive pulmonary disease (COPD) will be considered as a model of a slowly progressive pulmonary process, where destruction of lung parenchyma and airway obstruction leads to hypoxemia and hypercapnia. Over time, adaptations of the respiratory control system to this disease include changes in the intrinsic properties of respiratory muscles, chemoreceptor signaling, and central respiratory drive which increase motor output to the respiratory muscles. In contrast, acute respiratory distress syndrome (ARDS) is an exemplar of an acute pulmonary process. The result of severe lung injury, ARDS is characterized by lung infiltrates, rapidly progressive hypoxemic respiratory failure, and possible progression to pulmonary fibrosis. Changes in breathing patterns result from these functional changes, as well as altered processing of afferent feedback by the central controller, possibly influenced by brainstem inflammation. Taken together, these disease models highlight the plasticity of the respiratory control system in response to the development and progression of lung disease. © 2013.

Ives S.J.,Geriatric Research | Harris R.A.,Skidmore College | Harris R.A.,Georgia Regents University | Witman M.A.H.,Geriatric Research | And 10 more authors.
Hypertension | Year: 2014

Chronic obstructive pulmonary disease (COPD) is characterized by low pulmonary function, inflammation, free radical production, vascular dysfunction, and subsequently a greater incidence of cardiovascular disease. By administering an acute oral antioxidant cocktail to patients with COPD (n=30) and controls (n=30), we sought to determine the role of redox balance in the vascular dysfunction of these patients. Using a double-blind, randomized, placebo-controlled, crossover design, patients with COPD and controls were ingested placebo or the antioxidant cocktail (vitamin C, vitamin E, α-lipoic acid) after which brachial artery flow-mediated dilation and carotid-radial pulse wave velocity were assessed using ultrasound Doppler. The patients exhibited lower baseline antioxidant levels (vitamin C and superoxide dismutase activity) and higher levels of oxidative stress (thiobarbituic acid reactive species) in comparison with controls. The patients also displayed lower basal flow-mediated dilation (P<0.05), which was significantly improved with antioxidant cocktail (3.1±0.5 versus 4.7±0.6%; P<0.05; placebo versus antioxidant cocktail), but not controls (6.7±0.6 versus 6.9±0.7%; P>0.05; placebo versus antioxidant cocktail). The antioxidant cocktail also improved pulse wave velocity in patients with COPD (14±1 versus 11±1 m·s; P<0.05; placebo versus antioxidant cocktail) while not affecting controls (11±2 versus 10±1 m·s; P>0.05; placebo versus antioxidant). Patients with COPD exhibit vascular dysfunction, likely mediated by an altered redox balance, which can be acutely mitigated by an oral antioxidant. Therefore, free radically mediated vascular dysfunction may be an important mechanism contributing to this population's greater risk and incidence of cardiovascular disease. © 2013 American Heart Association, Inc.

Kim J.,University of Pennsylvania | Shaklee J.F.,University of Pennsylvania | Smathers S.,University of Pennsylvania | Prasad P.,University of Pennsylvania | And 8 more authors.
Pediatric Infectious Disease Journal | Year: 2012

Background: The incidence and severity of Clostridium difficile infection (CDI) is increasing among adults; however, little is known about the epidemiology of CDI among children. Methods: We conducted a nested case-control study to identify the risk factors for and a prospective cohort study to determine the outcomes associated with severe CDI at 2 children's hospitals. Severe CDI was defined as CDI and at least 1 complication or ≲γτ∀2 laboratory or clinical indicators consistent with severe disease. Studied outcomes included relapse, treatment failure, and CDI-related complications. Isolates were tested to determine North American pulsed-field gel electrophoresis type 1 lineage. Results: We analyzed 82 patients with CDI, of whom 48 had severe disease. Median age in years was 5.93 (1.78 -12.16) and 1.83 (0.67- 8.1) in subjects with severe and nonsevere CDI, respectively (P = 0.012). All patients with malignancy and CDI had severe disease. Nine subjects (11%) had North American pulsed-field gel electrophoresis type 1 isolates. Risk factors for severe disease included age (adjusted odds ratio [95% confidence interval]: 1.12 [1.02, 1.24]) and receipt of 3 antibiotic classes in the 30 days before infection (3.95 [1.19, 13.11]). If infants less than 1 year of age were excluded, only receipt of 3 antibiotic classes remained significantly associated with severe disease. Neither the rate of relapse nor treatment failure differed significantly between patients with severe and nonsevere CDI. There was 1 death. Conclusions: Increasing age and exposure to multiple antibiotic classes were risk factors for severe CDI. Although most patients studied had severe disease, complications were infrequent. Relapse rates were similar to those reported in adults. Copyright © 2012 by Lippincott Williams & Wilkins.

Bates M.D.,Louis Stokes Medical Center
Journal of National Black Nurses' Association : JNBNA | Year: 2011

This descriptive pilot study explored the knowledge and attitudes of African-American males toward genetic testing and their willingness to participate in genetic testing. A convenience sample of 104 African-American males, from 19 to 79 years of age, was recruited from a national fraternity meeting. Data were collected using four surveys: Demographic and Background Data, Perceived Knowledge of Genetic Testing, Attitudes Toward Genetic Testing, and Willingness to Participate in Genetic Testing. Perceived genetic knowledge was low with a mean score of 5.6; however, participants had a favorable attitude toward genetic testing. Findings from this study suggested that participants were willing to participate in genetic testing with a total score of 46.8. Significant correlations existed between perceived genetic knowledge and willingness to participate in genetic testing. Interventions to increase perceived genetic knowledge and educate the participant on who is conducting the test and how the test will be performed may be beneficial to increase participation in genetic testing.

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