Now showing items 1-20 of 7868

    • Women's History Month 2019

      University of Maryland, Baltimore (2019-03-13)
    • Longitudinal Assessment of Respiratory Symptoms and Pulmonary Function Among Flavor Manufacturing Workers

      Hines, Stella E.; Rose, Cecile (2009)
      Background: Flavor industry workers exposed to diacetyl in butter flavorings are at risk for bronchiolitis obliterans, manifested mainly by accelerated declines in FEV1 on spirometry associated with worsening respiratory symptoms. We analyzed longitudinal spirometry and symptoms in flavor workers to assess possible work-related fixed airways disease. Methods: 191 workers participated in medical surveillance using serial questionnaires and spirometry. Task-specific diacetyl exposures were measured using NIOSH methods 2557. We used the general linear mixed model to evaluate longitudinal change in FEV1 & respiratory symptoms, then stratified overall changes by smoking status and analyzed by four different exposure variables: job category; reported use of diacetyl,; work with powders, liquids or spray-dried flavors; and cumulative diacetyl exposure. Results: Decline in FEV1 (adjusted for height, race and gender) was not significantly different between production and non-production workers (-40.40 v. -40.67 ml/yr, p=0.95), even when stratified for smoking. In the overall group of flavor workers, we found no significant differences in FEV1 based on reported frequency of diacetyl use, work with different flavor formulations, or cumulative diacetyl exposure. However, never and former smoker production workers in the high cumulative exposure group had greater declines in FEV1 (-41.77 ml/yr and -44.00 ml/yr) compared to current smoker production workers (-29.44 ml/yr, p=0.02 for former v. current smokers). Among participants working in flavor manufacturing for two years or less, workers in the high cumulative diacetyl exposure group did have a greater rate of decline in FEV1 (-65.14 ml/yr) compared to medium ( 42.75 ml/yr, p=0.0166) and low exposure groups (-46.69 ml/yr, p=0.0151). There were few differences in respiratory symptoms or asthma diagnosis among any of the exposure groups. Only for the symptom chest tightness was the yearly prevalence increasing for production workers and workers reporting use of diacetyl, compared to non-production workers (p=0.0069) and those not reporting use of diacetyl (p<0.0001). Conclusions: We found no significant differences in rate of FEV1decline and rate of change in respiratory symptoms over time among flavor workers characterized by four different workplace exposure variables. However, more recently hired flavor workers in the high exposure group did have significantly greater declines in FEV1 compared to the low exposure group, suggesting that regular medical surveillance for work-related lung disease is important, particularly in this subset of flavor workers. We also found that currently smoking flavor workers in high diacetyl exposure categories may have a slower rate of lung function decline compared to non-smokers in the high exposure group, suggesting a “protective” effect from smoking relative to flavor chemical effects.
    • Comparison of a novel, endoscopic chest tube insertion technique versus the standard, open technique performed by novice users in a human cadaver model: A randomized, crossover, assessor-blinded study

      Drumheller, B. (2018-12-27)
      Background: The technique of tube thoracostomy has been standardized for years without significant updates. Alternative procedural methods may be beneficial in certain prehospital and inpatient environments with limited resources. We sought to compare the efficacy of chest tube insertion using a novel, endoscopic device (The Reactor™) to standard, open tube thoracostomy. Methods: Novice users were randomly assigned to pre-specified sequences of six chest tube insertions performed on a human cadaver model in a crossover design, alternating between the Reactor™ and standard technique. All subjects received standardized training in both procedures prior to randomization. Insertion site, which was randomly assigned within each cadaver's hemithorax, was marked by the investigators; study techniques began with skin incision and ended with tube insertion. Adequacy of tube placement (intrapleural, unkinked, not in fissure) and incision length were recorded by investigators blinded to procedural technique. Insertion time and user-rated difficulty were documented in an unblinded fashion. After completing the study, participants rated various aspects of use of the Reactor™ compared to the standard technique in a survey evaluation. Results: Sixteen subjects were enrolled (7 medical students, 9 paramedics) and performed 92 chest tube insertions (n = 46 Reactor™, n = 46 standard). The Reactor™ was associated with less frequent appropriate tube positioning (41.3% vs. 73.9%, P = 0.0029), a faster median insertion time (47.3 s, interquartile range 38-63.1 vs. 76.9 s, interquartile range 55.3-106.9, P < 0.0001) and shorter median incision length (28 mm, interquartile range 23-30 vs. 32 mm, interquartile range 26-40, P = 0.0034) compared to the standard technique. Using a 10-point Likert scale (1-easiest, 10-hardest) participants rated the ease of use of the Reactor™ no different from the standard method (3.8 ± 1.9 vs. 4.7 ± 1.9, P = 0.024). The Reactor™ received generally favorable scores for all parameters on the post-participation survey. Conclusions: In this randomized, assessor-blinded, crossover human cadaver study, chest tube insertion using the Reactor™ device resulted in faster insertion time and shorter incision length, but less frequent appropriate tube placement compared with the standard technique. Additional studies are needed to evaluate the efficacy, safety and potential advantages of this novel device. © 2018 The Author(s).
    • Atrial Fibrillation Risk-Stratification Schemes: Improving Patient-Centeredness and Precision

      Oehrlein, Elisabeth Maria; Perfetto, Eleanor M. (2018)
      Background: Despite treatment-guideline recommendations and availability medications to reduce stroke risk, widespread underutilization of oral anticoagulants (OACs) has been previously documented among individuals with atrial fibrillation (AF). Younger age and female gender are important in light of evidence that these groups, in particular, may not receive optimal AF care. The objective of this dissertation was to identify: 1) What are the barriers to patients initiating OACs? 2) Are providers aware of and using the RSSs and do disparities exist by age and gender? 3) Are RSSs predictive of stroke and OAC initiation among subpopulations (women and <65 years of age)? Methods: In Aim 1, we invited patients and health care providers (HCPs) to participate in in-depth interviews. In aims 2 and 3, we conducted retrospective cohort studies using Optum’s Clinformatic Data Mart (2008-2016). We used logistic regression to calculate odds ratios and 95% confidence intervals to identify whether RSSs were associated with OAC initiation and whether disparities exist by age or gender in aim 2. For Aim 3, we used a discrete time approach to estimate the risk of ischemic stroke associated with RSSs. Separately, we tested whether incorporating risk factors identified in the literature as predictive of ischemic stroke improved prediction among women and patients ≤65 years. Results: Themes from qualitative interviews include: specialists heightened perception of stroke risk compared to generalists and comorbidities/characteristics absent from RSSs also factor into risk consideration. The proportion of patients initiating OACs was only approximately 30%. CHADS2, but not CHA2DS2-VASc, scores corresponded with higher odds of OAC initiation. We found no statistically significant differences between odds of initiating OACs among OAC-recommended males/females or age categories. Among women and those ≤65 years, all CHA2DS2-VASc scores >1 and CHADS2 scores >0 were significant predictors of stroke. Prognostic models developed within subpopulations were no better at predicting stroke than existing RSSs. Conclusions: RSSs are associated with ischemic stroke among newly diagnosed females and <65 years of age patients. Initiation of OAC treatment was consistently low. More research is needed to more clearly understand why RSSs might not be followed and why OACs are not initiated.
    • Innovation of Vancomycin Treatment in Neonates Via A Bayesian Dose Optimization Toolkit For Adaptive Individualized Therapeutic Management

      Pastoor, Devin DeForest; Gobburu, Jogarao (2018)
      Personalized medicine continues to gain momentum as a topic for discussion, yet directly linking patient-level decision support to more advanced analytical techniques, such as nonlinear mixed effects modeling, is not being practiced in most hospitals. Current practice for Vancomycin therapy uses dosing nomograms to determine the dosing regimen for patients. For simplicity, these nomograms stratify patients into bins based on some combination of weight, serum creatinine, and/or age to adjust starting regimens. Yet, studies across the US and Europe have shown as few as 37% of neonates achieve recommended target concentrations using such nomograms. The purpose of this research was to develop a bayesian decision support toolkit to provide adaptive, individualized dose recommendations for neonates. First, a bayesian nonlinear mixed effect model was developed and qualified for predictive forecasting in individual patients. Second, this model was used to develop a novel algorithm for dose individualization. Finally, a web application was developed to allow clinicians to provide decision support for clinicians involved in vancomycin dosing decisions. The proposed strategy can decrease the number of patients improperly dosed up to 90%, drastically reducing the chance for treatment failure, toxicity-related adverse events, and resistance development.
    • Stigma as a barrier to the use of Employee Assistance Programs

      Milot, Marc (Workreach Solutions, APAS Laboratory Inc., 2019-02)
      An Employee Assistance Program (EAP) can be an impactful workplace benefit, but not all employees will access one in a time of need. One potential but rarely studied barrier to the use of EAPs is perceived stigma. This study by Workreach Solutions investigated the association between worker perceptions of stigma and the likelihood of accessing an EAP for distressing personal problems in a representative sample of employed Canadians (N=1001). A number of insights emerged from the study, one being that an important proportion of workers reported perceptions of stigma in relation to receiving help from EAP counselling services (EAP treatment stigma). Further, workers with greater perceptions of mental health stigma reported greater EAP treatment stigma, and perceptions of stigma in relation to EAPs reduced the self-reported likelihood of their use. The study concluded that worker perceptions of stigma can be considered a barrier to the use of EAPs, a phenomenon similar to that observed with other psychological or mental health services. Some workers who could benefit from an EAP might choose not to use one due to perceived stigma in relation to receiving help. The findings also suggested that stigma may help explain gender-based patterns of EAP utilization, generally involving lower use by men workers. Workplace interventions aimed at reducing employee perceptions of stigma could increase use of EAPs and by proxy help to improve organizational health.
    • University of Maryland School of Nursing MS Clinical Nurse Leader Program Information

      University of Maryland, Baltimore. School of Nursing (2018)
    • University of Maryland School of Nursing Policy on Course Evaluation Review

      University of Maryland, Baltimore. School of Nursing (2017)
    • Memorandum of Understanding between University of Maryland School of Nursing and Laurel College Center 2019

      University of Maryland, Baltimore. School of Nursing; Howard Community College; Prince George's Community College; Laurel College Center (2019)
    • Agreement for Dual Admission between University of Maryland School of Nursing and Wor-Wic Community College Department of Nursing

      Wor-Wic Community College Department of Nursing; University of Maryland, Baltimore. School of Nursing (2018)
    • Agreement for Dual Admission between University of Maryland School of Nursing and Community College of Baltimore County

      Community College of Baltimore County; University of Maryland, Baltimore. School of Nursing (2018)
    • EAPs in the Health 2.0 World

      Burke, John J., M.A.; Taylor, Chuck (2016-03-10)
    • University of Maryland School of Pharmacy. Annual Report 2015-2016

      Unknown author (University of Maryland, Baltimore. School of Pharmacy, 2016)
    • Data Snapshot 2018

      Unknown author (University of Maryland, Baltimore. School of Pharmacy. Maryland Poison Center, 2018)