Samples J.R.,Oregon Health And Science University |
Samples J.R.,Rocky Vista University |
Samples J.R.,Western Glaucoma Foundation |
Singh K.,Stanford University |
And 5 more authors.
Ophthalmology | Year: 2011
Objective: To provide an evidence-based summary of the outcomes, repeatability, and safety of laser trabeculoplasty for open-angle glaucoma. Methods: A search of the peer-reviewed literature in the PubMed and the Cochrane Library databases was conducted in June 2008 and was last repeated in March 2010 with no date or language restrictions. The search yielded 637 unique citations, of which 145 were considered to be of possible clinical relevance for further review and were included in the evidence analysis. Results: Level I evidence indicates an acceptable long-term efficacy of initial argon laser trabeculoplasty for open-angle glaucoma compared with initial medical treatment. Among the remaining studies, level II evidence supports the efficacy of selective laser trabeculoplasty for lowering intraocular pressure for patients with open-angle glaucoma. Level III evidence supports the efficacy of repeat use of laser trabeculoplasty. Conclusions: Laser trabeculoplasty is successful in lowering intraocular pressure for patients with open-angle glaucoma. At this time, there is no literature establishing the superiority of any particular form of laser trabeculoplasty. The theories of action of laser trabeculoplasty are not elucidated fully. Further research into the differences among the lasers used in trabeculoplasty, the repeatability of the procedure, and techniques of treatment is necessary. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. © 2011 American Academy of Ophthalmology.
Francis B.A.,Doheny Eye Institute |
Singh K.,Stanford University |
Lin S.C.,University of California at San Francisco |
Hodapp E.,Bascom Palmer Eye Institute |
And 4 more authors.
Ophthalmology | Year: 2011
Objective: To review the published literature and summarize clinically relevant information about novel, or emerging, surgical techniques for the treatment of open-angle glaucoma and to describe the devices and procedures in proper context of the appropriate patient population, theoretic effects, advantages, and disadvantages. Design: Devices and procedures that have US Food and Drug Administration clearance or are currently in phase III clinical trials in the United States are included: the Fugo blade (Medisurg Ltd., Norristown, PA), Ex-PRESS mini glaucoma shunt (Alcon, Inc., Hunenberg, Switzerland), SOLX Gold Shunt (SOLX Ltd., Boston, MA), excimer laser trabeculotomy (AIDA, Glautec AG, Nurnberg, Germany), canaloplasty (iScience Interventional Corp., Menlo Park, CA), trabeculotomy by internal approach (Trabectome, NeoMedix, Inc., Tustin, CA), and trabecular micro-bypass stent (iStent, Glaukos Corporation, Laguna Hills, CA). Methods: Literature searches of the PubMed and the Cochrane Library databases were conducted up to October 2009 with no date or language restrictions. Main Outcome Measures: These searches retrieved 192 citations, of which 23 were deemed topically relevant and rated for quality of evidence by the panel methodologist. All studies but one, which was rated as level II evidence, were rated as level III evidence. Results: All of the devices studied showed a statistically significant reduction in intraocular pressure and, in some cases, glaucoma medication use. The success and failure definitions varied among studies, as did the calculated rates. Various types and rates of complications were reported depending on the surgical technique. On the basis of the review of the literature and mechanism of action, the authors also summarized theoretic advantages and disadvantages of each surgery. Conclusions: The novel glaucoma surgeries studied all show some promise as alternative treatments to lower intraocular pressure in the treatment of open-angle glaucoma. It is not possible to conclude whether these novel procedures are superior, equal to, or inferior to surgery such as trabeculectomy or to one another. The studies provide the basis for future comparative or randomized trials of existing glaucoma surgical techniques and other novel procedures. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. © 2011 American Academy of Ophthalmology.
Jampel H.D.,Wilmer Eye Institute |
Singh K.,Stanford University |
Lin S.C.,University of California at San Francisco |
Chen T.C.,Massachusetts Eye and Ear Infirmary |
And 5 more authors.
Ophthalmology | Year: 2011
Objective: To review the published literature to summarize and evaluate the effectiveness of visual function tests in diagnosing glaucoma and in monitoring progression. Methods: Literature searches of the PubMed and Cochrane Library databases were conducted last on May 7, 2010, and were restricted to citations published on or after January 1, 1994. The search yielded 1063 unique citations. The first author reviewed the titles and abstracts of these articles and selected 185 of possible clinical relevance for further review. The panel members reviewed the full text of these articles and determined that 85 met inclusion criteria. They conducted data abstraction of the 85 studies, and the panel methodologist assigned a level of evidence to each of the selected articles. One study was rated as level I evidence. The remaining articles were classified broadly as providing level II evidence. Studies deemed to provide level III evidence were not included in the assessment. Results: Standard white-on-white automated perimetry remains the most commonly performed test for assessing the visual field, with the Swedish interactive threshold algorithm (SITA) largely replacing full-threshold testing strategies. Frequency-doubling technology and its refinement into Matrix perimetry, as well as short-wavelength automated perimetry, now available with SITA, have been evaluated extensively. Machine learning classifiers seem to be ready for incorporation into software to help distinguish glaucomatous from nonglaucomatous fields. Other technologies, such as multifocal visual-evoked potential and electroretinography, which were designed as objective measures of visual function, provide testing free of patient input, but issues prevent their adoption for glaucoma management. Conclusions: Advances in technology and analytic tools over the past decade have provided us with more rapid and varied ways of assessing visual function in glaucoma, but they have yet to produce definitive guidance on the diagnosis of glaucoma or its progression over time. Further research on an objective measure of visual function is needed. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. © 2011 American Academy of Ophthalmology.
Caputo L.M.,Swedish Medical Center |
Salottolo K.M.,Swedish Medical Center |
Slone D.S.,Swedish Medical Center |
Mains C.W.,St Anthony Hospital |
And 3 more authors.
Injury | Year: 2014
Objective To synthesise published and unpublished findings examining the relationship between institutional trauma centre volume or trauma patient volume per surgeon and mortality. Background Evidence on the relationship between patient volume and survival in trauma patients is inconclusive in the literature and remains controversial. Methods A literature search was performed to identify studies published between 1976 and 2013 via MEDLINE (Pubmed) and the Cumulative Index to Nursing and Allied Health Literature (EbscoHost) as well as footnote chasing. Abstracts from appropriate conferences and ProQuest Dissertations and Theses were also searched. Inclusion criteria required studies to be original research published in English that examined the relationship between mortality and either institutional or per surgeon volume in American trauma centres. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement checklist and flowchart. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was employed to rate the quality of the evidence. Results Of 1392 studies reviewed, 19 studies met defined inclusion criteria; all studies were retrospective. The definition of volume was heterogeneous across the studies. Patient population and analysis methods also varied across the studies. Sixteen studies (84%) examined the relationship between institutional trauma centre volume and mortality. Of the 16 studies, 12 examined the volume of severely injured patients and eight examined overall trauma patient volume. High institutional volume was associated with at least somewhat improved mortality in ten of 16 studies (63%); however, nearly half of these studies found only some subpopulations experienced benefits. In the remaining six studies, volume was not associated with any benefits. Four studies (25%) analysed the impact of surgeon volume on mortality. High volume per surgeon was associated with improved mortality in only one of four studies (25%). Conclusions The studies were extremely heterogeneous, thus definitive conclusions cannot be drawn regarding optimal volume before a clear advantage in survival is observed. A prospective study defining volume as a continuous variable is warranted to support current admission criteria for American trauma patients. © 2013 Elsevier Ltd © 2013 Published by Elsevier Ltd. All rights reserved.
News Article | February 23, 2017
PROVIDENCE, R.I. [Brown University] -- More than 100 years ago, the influential "Flexner Report" on medical education decried the then-prevalent model of for-profit medical education, leading to its complete disappearance from the United States for decades. But just recently, for-profit medical education has returned, note three Brown University scholars in a new JAMA article that considers what the revival might mean. "It's not so much that we're in favor of it," said Dr. Phil Gruppuso, professor of pediatrics in the Warren Alpert Medical School and former associate dean for medical education. "We are merely documenting that it's happening. We hope that it can make a positive contribution since it's going to happen." The turning point came in 1996 when antitrust litigation against the American Bar Association forced it to accredit for-profit law schools, wrote co-authors Gruppuso, Dr. Eli Adashi, professor of obstetrics and gynecology and former dean of medicine and biological sciences, and current Brown medical student Gopika Krishna. Legal advisors for the Liaison Committee on Medical Education, which accredits allopathic (M.D.-granting) medical schools, took notice. By 2013, LCME had abandoned its prohibition on accrediting for-profit schools. At one time, the country had only one for-profit medical school: the Rocky Vista University College of Osteopathic (D.O.-granting) Medicine in Colorado, which opened in 2007. But the first allopathic for-profit school emerged in 2014 when Ponce Health Sciences University School of Medicine in Puerto Rico was acquired by the for-profit public benefit corporation Arist Medical Sciences University. Since then, two more schools have attained accreditation. There are now nearly 500 students in the for-profit medical class of 2020. Modern accreditation standards mean that many of the Flexner-era ills of for-profit education -- little or no requirements for admission or graduation and lax attention to instructional quality or attendance -- are long bygone, the authors wrote. But acceptance of for-profit medical education is still far from universal, the article states. In fact, Adashi and Gruppuso said that many fellow medical educators still haven't realized that for-profit instruction has returned. "It's a fait accompli, although most people don't know that," Adashi said. "They are very surprised to hear it." Instead, the widespread presumption of the field is that medical education is exclusively not for-profit oriented. "Additional reputational challenges faced by the new for-profit medical schools stem from the view that medical education is an inviolable public good that is ethically incompatible with the for-profit motive," Adashi, Krishna and Gruppuso wrote. The schools, for example, will have to do much better than some for-profit colleges outside of medicine that have recently become entangled in commercial failures and scandals, they said. Because for-profit medical schools are not tied to research universities, they may be more hard pressed to offer students exposure to making scientific and medical advances, Adashi said. But he acknowledged that research pursuits, while important, may at times lead to distractions from teaching. Limited to just the classroom, for-profit instructors might be in a position to accomplish the mission of graduating competent licensable physicians who can assist in closing the nation's physician shortage, Adashi said. The absence of research might pose another narrow advantage for for-profit schools, Adashi and Gruppuso said: a lower cost structure. Were schools, despite their profit motive, to use these lower costs to charge lower tuitions, they could address the serious problem of medical student debt. But so far data suggests that for-profit schools are not charging lower tuitions or offering more generous scholarships, they said. "Finally, new for-profit medical schools could distinguish themselves by committing to innovation in undergraduate medical education in the best tradition of the private sector and in the spirit of a market economy," the authors wrote. But to do any good, given that they are for-profit schools, they'll have to show they can operate in the black, Gruppuso said. He has doubts. "The tuition-based business model, if that is what it is, remains puzzling," Gruppuso said. "It's not nearly clear that a medical school, properly structured and meeting all the accreditation requirements, can actually make money."
Crisler J.D.,Wichita State University |
Newville T.M.,Wichita State University |
Newville T.M.,Rocky Vista University |
Chen F.,Jet Propulsion Laboratory |
And 2 more authors.
Astrobiology | Year: 2012
The martian surface environment exhibits extremes of salinity, temperature, desiccation, and radiation that would make it difficult for terrestrial microbes to survive. Recent evidence suggests that martian soils contain high concentrations of MgSO 4 minerals. Through warming of the soils, meltwater derived from subterranean ice-rich regolith may exist for an extended period of time and thus allow the propagation of terrestrial microbes and create significant bioburden at the near surface of Mars. The current report demonstrates that halotolerant bacteria from the Great Salt Plains (GSP) of Oklahoma are capable of growing at high concentrations of MgSO 4 in the form of 2 M solutions of epsomite. The epsotolerance of isolates in the GSP bacterial collection was determined, with 35% growing at 2 M MgSO 4. There was a complex physiological response to mixtures of MgSO 4 and NaCl coupled with other environmental stressors. Growth also was measured at 1 M concentrations of other magnesium and sulfate salts. The complex responses may be partially explained by the pattern of chaotropicity observed for high-salt solutions as measured by agar gelation temperature. Select isolates could grow at the high salt concentrations and low temperatures found on Mars. Survival during repetitive freeze-thaw or drying-rewetting cycles was used as other measures of potential success on the martian surface. Our results indicate that terrestrial microbes might survive under the high-salt, low-temperature, anaerobic conditions on Mars and present significant potential for forward contamination. Stringent planetary protection requirements are needed for future life-detection missions to Mars. © 2012, Mary Ann Liebert, Inc.
Raab S.S.,University of Colorado at Denver |
Grzybicki D.M.,Rocky Vista University
Cancer Cytopathology | Year: 2011
The process of cytologic-histologic correlation is highly valuable to the fields of both cytopathology and surgical pathology, because correlation provides a wealth of data that may be used to improve diagnostic testing and screening processes. In this study, overall improvement appeared to be driven largely by improvement in preanalytic Papanicolaou (Pap) test sampling, because longer institutional participation also was associated with improved sampling sensitivity. The authors hypothesized that Pap test sampling may have improved secondary to the introduction of liquid-based technology, which was implemented in many laboratories during the study time frame. Through the performance of continuous data tracking and retrospective root cause analysis to identify factors that may have influenced any observed changes in performance indicators, institutions may learn which initiatives are successful or unsuccessful. The future of correlation lies in the standardization of methods, the development of more formal and rigorous root cause analysis processes to determine system components underlying correlation discrepancies, and the active use of correlation data to redesign testing and screening processes for quality and patient safety improvement. © 2011 American Cancer Society.
Michels A.,University of Colorado at Denver |
Michels N.,Rocky Vista University
American Family Physician | Year: 2014
Primary adrenal insufficiency, or Addison disease, has many causes, the most common of which is autoimmune adrenalitis. Autoimmune adrenalitis results from destruction of the adrenal cortex, which leads to deficiencies in glucocorticoids, mineralocorticoids, and adrenal androgens. In the United States and Western Europe, the estimated prevalence of Addison disease is one in 20,000 persons; therefore, a high clinical suspicion is needed to avoid misdiagnosing a life-threatening adrenal crisis (i.e., shock, hypotension, and volume depletion). The clinical manifestations before an adrenal crisis are subtle and can include hyperpigmentation, fatigue, anorexia, orthostasis, nausea, muscle and joint pain, and salt craving. Cortisol levels decrease and adrenocorticotropic hormone levels increase. When clinically suspected, patients should undergo a cosyntropin stimulation test to confirm the diagnosis. Treatment of primary adrenal insufficiency requires replacement of mineralocorticoids and glucocorticoids. During times of stress (e.g., illness, invasive surgical procedures), stress-dose glucocorticoids are required because destruction of the adrenal glands prevents an adequate physiologic response. Management of primary adrenal insufficiency or autoimmune adrenalitis requires vigilance for concomitant autoimmune diseases; up to 50% of patients develop another autoimmune disorder during their lifetime. © 2014 American Academy of Family Physicians.
Glaser K.,Rocky Vista University
Maryland medicine : MM : a publication of MEDCHI, the Maryland State Medical Society | Year: 2012
The benefits of global health experiences on our students are vast and can be enhanced by our development of structured curricula and feedback systems that will maximize the benefits to students and to the populations they treat now and in the future.
Herman-Montemayor J.R.,Rocky Vista University |
Hikida R.S.,Ohio University |
Staron R.S.,Ohio University
Journal of Strength and Conditioning Research | Year: 2015
The purpose of this investigation was to identify adaptations in satellite cell (SC) content and myonuclear domain (MND) after 6-week slow-speed vs. "normal-speed" resistance training programs. Thirty-four untrained females were divided into slow speed (SS), traditional strength (TS), traditional muscular endurance (TE), and nontraining control (C) groups. Three sets each of leg press, squat, and knee extension were performed 2 days per week for the first week and 3 days per week for the following 5 weeks. The SS group performed 6-10 repetition maximum (6-10RM) for each set with 10-second concentric (con) and 4-second eccentric (ecc) contractions for each repetition. Traditional strength and TE performed 6-10RM and 20-30RM, respectively, at "normal" speed (1-2 seconds per con and ecc contractions). Traditional muscular endurance and SS trained at the same intensity (40-60% 1RM), whereas TS trained at 80-85% 1RM. Pretraining and posttraining muscle biopsies were analyzed for fiber cross-sectional area, fiber type, SC content, myonuclear number, and MND. Satellite cell content of type I, IIA, IIAX, and IIX fibers significantly increased in TS. However, SC content of only type IIAX and IIX fibers increased in SS, and there was no change in TE or C. Myonuclear number did not change in any group. Myonuclear domain of type I, IIA, IIAX, and IIX fibers increased in TS, whereas MND of only type IIA fibers increased in SS, and there was no change in TE or C. In conclusion, slow-speed resistance training increased SC content and MND more than training with a similar resistance at normal speed. However, high-intensity normal-speed training produced the greatest degree of fiber adaptation for each variable. © 2015 National Strength and Conditioning Association.