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Article: Picking Apart a Program Evaluation Committee: A Multiple Case Study Characterizing Primary Care Residency Program Evaluation Committee Structure, Program Improvement, and Outcomes.

Lowry, Lacy E / Merkebu, Jerusalem / Schall, Sarah E / Neubauer, Brian E / Battista, Alexis

2024 Volume 16, Issue 4, Page(s) e57439

Abstract: ... December 2022 and April 2023 of four purposively selected primary care residencies (e.g., family medicine ...

Abstract	Background: As of 2014, the Accreditation Council for Graduate Medical Education (ACGME) mandates initiating a Program Evaluation Committee (PEC) to guide ongoing program improvement. However, little guidance nor published reports exist about how individual PECs have undertaken this mandate. Objective: To explore how four primary care residency PECs configure their committees, review program goals and undertake program evaluation and improvement. Methods: We conducted a multiple case study between December 2022 and April 2023 of four purposively selected primary care residencies (e.g., family medicine, pediatrics, internal medicine). Data sources included semi-structured interviews with four PEC members per program and diverse program artifacts. Using a constructivist approach, we utilized qualitative coding to analyze participant interviews and content analysis for program artifacts. We then used coded transcripts and artifacts to construct logic models for each program guided by a systems theory lens. Results: Programs adapt their PEC structure, execution, and outcomes to meet short- and long-term needs based on organizational and program-unique factors such as size and local practices. They relied on multiple data sources and sought diverse stakeholder participation to complete program evaluation and improvement. Identified deficiencies were often categorized as internal versus external to delineate PEC responsibility, boundaries, and feasibility of interventions. Conclusion: The broad guidance provided by the ACGME for PEC configuration allows programs to adapt the committee based on individual needs. However, further instruction on program evaluation and organizational change principles would augment existing PEC efforts.
Language	English
Publishing date	2024-04-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.57439
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Guillain-Barré Syndrome Presenting as an Acute Back Pain.

Hodgeman, Nicholas T / Lowry, Lacy E / Graybill, Sky D

Cureus

2021 Volume 13, Issue 8, Page(s) e17540

Abstract: Acute inflammatory demyelinating polyneuropathy (AIDP), characterized by the autoimmune destruction of Schwann cells with resultant myelin degradation, is the most common subtype of Guillain-Barré Syndrome (GBS). GBS encompasses a myriad of autoimmune ... ...

Abstract	Acute inflammatory demyelinating polyneuropathy (AIDP), characterized by the autoimmune destruction of Schwann cells with resultant myelin degradation, is the most common subtype of Guillain-Barré Syndrome (GBS). GBS encompasses a myriad of autoimmune polyradiculoneuropathies, typically following an antecedent infectious process. Symptom onset is typically 1-3 weeks following an upper respiratory or gastrointestinal illness and consists of rapidly progressive ascending areflexic motor paralysis. Lower cranial nerves are often involved, leading to bulbar weakness and respiratory compromise. Autonomic dysregulation is common and must be managed carefully to avoid potentially fatal autonomic dysregulation. Contrary to the potential severity of the condition, 66% of GBS cases present with the initial complaint of lower back pain. Intravenous Immunoglobulin (IVIg) and/or plasmapheresis coupled with supportive management is the mainstay of GBS treatment. The majority of patients make a full recovery in up to one year. The rapid and serious nature of the disease coupled with the often benign presentation can make the diagnosis a difficult but vital challenge.
Language	English
Publishing date	2021-08-29
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.17540
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Article ; Online: Anchoring Bias on Lyme Disease Leading to Delayed Diagnoses.

Lowry, Lacy / Yabes, Joseph / Pomerantz, Heather / Barsoumian, Alice E

Military medicine

2020 Volume 185, Issue 7-8, Page(s) 406–407

MeSH term(s)	Delayed Diagnosis ; Humans ; Lyme Disease/diagnosis
Language	English
Publishing date	2020-06-05
Publishing country	England
Document type	Letter
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usaa130
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Article ; Online: Not All That Slurs Is Stroke: A Case of Chemotherapy-Induced Leukoencephalopathy.

Lowry, Lacy E / Fenderson, Joshua L / Baur, Russell A

Journal of oncology practice

2019 Volume 15, Issue 1, Page(s) 55–57

MeSH term(s)	Aged ; Fluorouracil/adverse effects ; Humans ; Leukoencephalopathies/chemically induced ; Male ; Speech Disorders/etiology
Chemical Substances	Fluorouracil (U3P01618RT)
Language	English
Publishing date	2019-01-09
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2236338-5
ISSN	1935-469X ; 1554-7477
ISSN (online)	1935-469X
ISSN	1554-7477
DOI	10.1200/JOP.18.00604
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Article: Potentiation of Natural Killer Cells for Cancer Immunotherapy: A Review of Literature.

Lowry, Lacy E / Zehring, William A

Frontiers in immunology

2017 Volume 8, Page(s) 1061

Abstract: It is widely acknowledged that the human immune system plays a crucial role in preventing the formation and progression of innumerable types of cancer (1). The mechanisms by which this occurs are numerous, including contributions from both the innate and ...

Abstract	It is widely acknowledged that the human immune system plays a crucial role in preventing the formation and progression of innumerable types of cancer (1). The mechanisms by which this occurs are numerous, including contributions from both the innate and adaptive immune systems. As such, immunotherapy has long been believed to be an auspicious solution in the treatment of malignancy (2). Recent research has highlighted the promise of natural killer (NK) cells as a more directed immunotherapy approach. This paper will focus on the methods of potentiation of NK cells for their use in cancer therapy.
Language	English
Publishing date	2017
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2606827-8
ISSN	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2017.01061
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Article ; Online: Spontaneous splenic rupture associated with apixaban: a case report.

Lowry, Lacy E / Goldner, Jonathan A

Journal of medical case reports

2016 Volume 10, Issue 1, Page(s) 217

Abstract: Background: Spontaneous splenic rupture associated with anticoagulant use is a rare but potentially lethal disorder. Lack of prompt recognition can be associated with poor patient outcomes. The use of novel oral anticoagulants is becoming more common ... ...

Abstract	Background: Spontaneous splenic rupture associated with anticoagulant use is a rare but potentially lethal disorder. Lack of prompt recognition can be associated with poor patient outcomes. The use of novel oral anticoagulants is becoming more common and thus consideration of this disorder while evaluating a patient who presents with abdominal pain while using these agents is extremely important. This is the first reported case of spontaneous splenic rupture associated with apixaban. Case presentation: We describe the clinical case of an 83-year-old white man who complained of sudden severe abdominal pain 5 days into a hospital stay for acute-on-chronic congestive heart failure and exacerbation of chronic obstructive pulmonary disease. Neither he nor his wife reported any significant trauma for the past 6 months prior to his admission. His medical history included chronic atrial fibrillation treated with medications including apixaban 2.5 mg twice daily. An urgent abdominal computed tomography scan demonstrated a large splenic hematoma and evidence of intraperitoneal bleeding from which he rapidly declined, developing hypovolemic shock. An emergency splenic arteriogram displayed a patent splenic artery and an embolization was successful in stabilizing him. Due to evidence of recurrent bleeding, an exploratory laparotomy and splenectomy was subsequently performed the following day. Conclusions: The diagnosis of spontaneous splenic rupture is important to consider in a patient using apixaban who presents with abdominal pain and associated signs of hypotension and anemia. For hemodynamically unstable patients, prompt treatment to stop significant bleeding through splenic artery embolization or splenectomy is warranted and may be lifesaving.
MeSH term(s)	Aged, 80 and over ; Anticoagulants/adverse effects ; Factor Xa Inhibitors/adverse effects ; Humans ; Male ; Pyrazoles/adverse effects ; Pyridones/adverse effects ; Rupture, Spontaneous/diagnostic imaging ; Splenectomy ; Splenic Rupture/chemically induced ; Splenic Rupture/diagnostic imaging ; Splenic Rupture/surgery ; Tomography, X-Ray Computed
Chemical Substances	Anticoagulants ; Factor Xa Inhibitors ; Pyrazoles ; Pyridones ; apixaban (3Z9Y7UWC1J)
Language	English
Publishing date	2016-08-09
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2269805-X
ISSN	1752-1947 ; 1752-1947
ISSN (online)	1752-1947
ISSN	1752-1947
DOI	10.1186/s13256-016-1012-6
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Neglected No More: Emerging Cellular Therapies in Traumatic Injury.

Lowry, Lacy E / Herzig, Maryanne C / Christy, Barbara A / Schäfer, Richard / Pati, Shibani / Cap, Andrew P / Bynum, James A

Stem cell reviews and reports

2021 Volume 17, Issue 4, Page(s) 1194–1214

Abstract: Traumatic injuries are a leading cause of death and disability in both military and civilian populations. Given the complexity and diversity of traumatic injuries, novel and individualized treatment strategies are required to optimize outcomes. Cellular ... ...

Abstract	Traumatic injuries are a leading cause of death and disability in both military and civilian populations. Given the complexity and diversity of traumatic injuries, novel and individualized treatment strategies are required to optimize outcomes. Cellular therapies have potential benefit for the treatment of acute or chronic injuries, and various cell-based pharmaceuticals are currently being tested in preclinical studies or in clinical trials. Cellular therapeutics may have the ability to complement existing therapies, especially in restoring organ function lost due to tissue disruption, prolonged hypoxia or inflammatory damage. In this article we highlight the current status and discuss future directions of cellular therapies for the treatment of traumatic injury. Both published research and ongoing clinical trials are discussed here.
MeSH term(s)	Cell- and Tissue-Based Therapy ; Humans ; Wounds and Injuries/therapy
Language	English
Publishing date	2021-01-08
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
ZDB-ID	2495577-2
ISSN	2629-3277 ; 1558-6804 ; 1550-8943
ISSN (online)	2629-3277 ; 1558-6804
ISSN	1550-8943
DOI	10.1007/s12015-020-10086-7
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Article: Reducing the Inappropriate Use of Proton Pump Inhibitors in an Internal Medicine Residency Clinic.

Boster, Joshua / Lowry, Lacy E / Bezzant, Matthew L / Kuiper, Brandon / Surry, Luke

Cureus

2020 Volume 12, Issue 1, Page(s) e6609

Abstract: Introduction Proton pump inhibitors (PPI) are commonly prescribed in the primary care setting. While generally considered to be safe, there is growing evidence suggesting that PPI misuse is associated with a variety of significant adverse outcomes and ... ...

Abstract	Introduction Proton pump inhibitors (PPI) are commonly prescribed in the primary care setting. While generally considered to be safe, there is growing evidence suggesting that PPI misuse is associated with a variety of significant adverse outcomes and unnecessary cost. The goal of this quality improvement project was to identify patients with non-guideline recommended PPI prescriptions in our internal medicine residency clinics and implement a process to de-prescribe or reduce the dose of PPIs across this patient population. Methods PPI prescription rates, dosage, and indication were extracted from the medical records of all 854 patients empaneled to the internal medicine residency clinics at a multicenter closed referral military hospital system. Appropriate PPI indication was consensus based upon published guidelines, and patients without an appropriate indication were targeted for intervention. These patients were directly contacted by their primary care physicians, via phone or during a clinic visit, to discuss the risks and benefits of ongoing PPI use as well as alternative therapies or tapering regimens at the physician's discretion. For moderate to high dose PPI, the dose was decreased by 50% every week until the lowest tolerated dose was achieved or until discontinuation. For low dose PPI, discontinuation was recommended as the initial intervention. Six months following the intervention, the empanelment was reevaluated for ongoing PPI usage, tapered dosage, or discontinuation. Results Of a total of 854 patient records reviewed at the initiation of the project, 322 patients were noted to be prescribed PPIs. Of this subset, 66% (217/322) did not meet a guideline recommended indication for their use. At the completion of the six-month intervention period, 44% (96/217) of patients were successfully weaned to a reduced dose or were no longer using a PPI. Conclusions PPIs are widely used and generally considered to be a well-tolerated therapy for acid-secretion disorders. PPI overprescription and the associated adverse effects and economic burden are increasingly recognized. We show that a simple, focused, resident-driven quality improvement intervention can be effective in de-prescribing efforts to reduce inappropriate PPI use in the outpatient primary care setting.
Language	English
Publishing date	2020-01-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.6609
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Exome Sequencing-Based Screening for BRCA1/2 Expected Pathogenic Variants Among Adult Biobank Participants.

Manickam, Kandamurugu / Buchanan, Adam H / Schwartz, Marci L B / Hallquist, Miranda L G / Williams, Janet L / Rahm, Alanna Kulchak / Rocha, Heather / Savatt, Juliann M / Evans, Alyson E / Butry, Loren M / Lazzeri, Amanda L / Lindbuchler, D'Andra M / Flansburg, Carroll N / Leeming, Rosemary / Vogel, Victor G / Lebo, Matthew S / Mason-Suares, Heather M / Hoskinson, Derick C / Abul-Husn, Noura S /

Dewey, Frederick E / Overton, John D / Reid, Jeffrey G / Baras, Aris / Willard, Huntington F / McCormick, Cara Z / Krishnamurthy, Sarath B / Hartzel, Dustin N / Kost, Korey A / Lavage, Daniel R / Sturm, Amy C / Frisbie, Lauren R / Person, T Nate / Metpally, Raghu P / Giovanni, Monica A / Lowry, Lacy E / Leader, Joseph B / Ritchie, Marylyn D / Carey, David J / Justice, Anne E / Kirchner, H Lester / Faucett, W Andrew / Williams, Marc S / Ledbetter, David H / Murray, Michael F

JAMA network open

2018 Volume 1, Issue 5, Page(s) e182140

Abstract: Importance: Detection of disease-associated variants in the BRCA1 and BRCA2 (BRCA1/2) genes allows for cancer prevention and early diagnosis in high-risk individuals.: Objectives: To identify pathogenic and likely pathogenic (P/LP) BRCA1/2 variants ... ...

Abstract	Importance: Detection of disease-associated variants in the BRCA1 and BRCA2 (BRCA1/2) genes allows for cancer prevention and early diagnosis in high-risk individuals. Objectives: To identify pathogenic and likely pathogenic (P/LP) BRCA1/2 variants in an unselected research cohort, and to characterize the features associated with P/LP variants. Design, setting, and participants: This is a cross-sectional study of adult volunteers (n = 50 726) who underwent exome sequencing at a single health care system (Geisinger Health System, Danville, Pennsylvania) from January 1, 2014, to March 1, 2016. Participants are part of the DiscovEHR cohort and were identified through the Geisinger MyCode Community Health Initiative. They consented to a research protocol that included sequencing and return of actionable test results. Clinical data from electronic health records and clinical visits were correlated with variants. Comparisons were made between those with (cases) and those without (controls) P/LP variants in BRCA1/2. Main outcomes: Prevalence of P/LP BRCA1/2 variants in cohort, proportion of variant carriers not previously ascertained through clinical testing, and personal and family history of relevant cancers among BRCA1/2 variant carriers and noncarriers. Results: Of the 50 726 health system patients who underwent exome sequencing, 50 459 (99.5%) had no expected pathogenic BRCA1/2 variants and 267 (0.5%) were BRCA1/2 carriers. Of the 267 cases (148 [55.4%] were women and 119 [44.6%] were men with a mean [range] age of 58.9 [23-90] years), 183 (68.5%) received clinically confirmed results in their electronic health record. Among the 267 participants with P/LP BRCA1/2 variants, 219 (82.0%) had no prior clinical testing, 95 (35.6%) had BRCA1 variants, and 172 (64.4%) had BRCA2 variants. Syndromic cancer diagnoses were present in 11 (47.8%) of the 23 deceased BRCA1/2 carriers and in 56 (20.9%) of all 267 BRCA1/2 carriers. Among women, 31 (20.9%) of 148 variant carriers had a personal history of breast cancer, compared with 1554 (5.2%) of 29 880 noncarriers (odds ratio [OR], 5.95; 95% CI, 3.88-9.13; P < .001). Ovarian cancer history was present in 15 (10.1%) of 148 variant carriers and in 195 (0.6%) of 29 880 variant noncarriers (OR, 18.30; 95% CI, 10.48-31.4; P < .001). Among 89 BRCA1/2 carriers without prior testing but with comprehensive personal and family history data, 44 (49.4%) did not meet published guidelines for clinical testing. Conclusions and relevance: This study found that compared with previous clinical care, exome sequencing-based screening identified 5 times as many individuals with P/LP BRCA1/2 variants. These findings suggest that genomic screening may identify BRCA1/2-associated cancer risk that might otherwise remain undetected within health care systems and may provide opportunities to reduce morbidity and mortality in patients.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; BRCA1 Protein/analysis ; BRCA1 Protein/genetics ; BRCA2 Protein/analysis ; BRCA2 Protein/genetics ; Biological Specimen Banks/statistics & numerical data ; Biomarkers, Tumor/analysis ; Biomarkers, Tumor/blood ; Cross-Sectional Studies ; Early Detection of Cancer/methods ; Exome/genetics ; Female ; Humans ; Male ; Middle Aged ; Pennsylvania ; Virulence/genetics ; Whole Exome Sequencing/methods ; Whole Exome Sequencing/statistics & numerical data
Chemical Substances	BRCA1 Protein ; BRCA1 protein, human ; BRCA2 Protein ; BRCA2 protein, human ; Biomarkers, Tumor
Language	English
Publishing date	2018-09-07
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2018.2140
Database	MEDical Literature Analysis and Retrieval System OnLINE

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