Purpose: To determine the prevalence of vitamin D deficiency in selected Jordanian full-term newb... more Purpose: To determine the prevalence of vitamin D deficiency in selected Jordanian full-term newborns and risk factors associated with low levels. Methods: Newborn infants were prospectively enrolled during spring and summer months during 2010. Newborns >37 weeks of age and those born within 96 hours at Al Bashir Hospital in Amman, Jordan were included. Demographic information for newborns and their mothers were collected including child’s birth date, child’s birth weight, average daily number of hours mother spends outdoors, mother’s clothing practice, and smoke exposure. Blood samples were obtained from infants by heel stick, placed on filter paper, and then sent to ZRT Laboratory for vitamin D [25(OH)D] measurement. Results: A total of 1,692 (825 males and 867 females) out of 2,009 newborns enrolled met inclusion criteria. The mean gestational age was 39.86 weeks, with a median birth weight of 3.2 kg. The mean age of the mothers was 27.41 years. The majority (87.6%) of mothers...
Small samples with few minority women and/or the absence of comparisons to peers without cancer h... more Small samples with few minority women and/or the absence of comparisons to peers without cancer histories have limited previous research suggesting racial differences in breast cancer survivors' health-related quality of life (HRQoL). This study not only compared HRQoL of African American and white breast cancer survivors, but also compared the HRQoL of these women to that of same-race women with no cancer history. Data from the Women's Health Initiative-Observational Study were used, including 5021 cancer survivors and 88,532 women without a history of cancer. Multivariate regression analyses estimated differences in breast cancer survivors' baseline HRQoL (RAND36), depressive symptoms (CES-D short-form), and sleep quality (WHIIRS). African American breast cancer survivors reported worse physical functioning and general health compared with white survivors. Among African Americans, survivors reported worse role limitations due to physical health, pain, general health, a...
Cerebral vasospasm is a leading cause of death and disability following aneurysmal subarachnoid h... more Cerebral vasospasm is a leading cause of death and disability following aneurysmal subarachnoid hemorrhage (SAH). Nitric oxide (NO) is a potent mediator of vasodilation, and citrulline is a known contributor to NO production. The leukocytosis inflammatory response can increase vasoconstrictive compounds that may also contribute to vasospasm. Dexamethasone is a glucocorticosteroid commonly administered after SAH, which may alter the production of leukocytes and citrulline. The goal of this project was to study the effects of dexamethasone on leukocytosis, citrulline, and angiographic vasospasm. Experimental SAH was induced in 18 New Zealand white rabbits. Intravenous dexamethasone was administered to one group (N.=9) at 2 mg/kg/day. A placebo group (N.=9) was given a saline infusion with otherwise identical procedures. CSF citrulline, leukocytes, protein, and glucose, as well as plasma citrulline were measured at baseline and 3 days post-SAH in a blinded fashion. Basilar artery angio...
This investigation describes the relationship between TBI patient demographics, quality of life o... more This investigation describes the relationship between TBI patient demographics, quality of life outcome, and functional status outcome among clinic attendees and non-attendees. Of adult TBI survivors with intracranial hemorrhage, 63 attended our TBI clinic and 167 did not attend. All were telephone surveyed using the Extended-Glasgow Outcome Scale (GOSE), the Quality of Life after Brain Injury (QOLIBRI) scale, and a post-discharge therapy questionnaire. To determine risk factors for GOSE and QOLIBRI outcomes, we created multivariable regression models employing covariates of age, injury characteristics, clinic attendance, insurance status, post-discharge rehabilitation, and time from injury. Compared to those with severe TBI, higher GOSE scores were identified in individuals with both mild (OR=2.0, 95%CI:1.1-3.6) and moderate (OR=4.7, 95%CI:1.6-14.1) TBIs. In addition, survivors with private insurance had higher GOSE scores as compared to those with public insurance (OR=2.0, 95%CI:1...
Postoperative hemorrhage after orthotopic liver transplantation (OLT) may require early reoperati... more Postoperative hemorrhage after orthotopic liver transplantation (OLT) may require early reoperative intervention. Previous studies have shown intraoperative transfusion requirement as a main determinant of reoperative intervention after OLT. The goal of this study was to develop an intraoperative hemorrhage model predicting need for reoperation after OLT. A single institution, retrospective review of adult primary OLT patients from January 2002 to 2008 was conducted. Multivariate logistical regression analysis was performed to identify predictors of reoperation due to postoperative hemorrhage. Secondary analysis was conducted on patients in the reoperation group managed with temporary open abdomen techniques. Four hundred and ten primary transplantations were performed with 59 patients (14.4%) requiring reoperation. The adjusted odds of reoperation when intraoperative blood loss (IBL) increases from 1.5 L to 10.0 L is 2.48 [95% confidence interval: (1.18, 5.31)]. IBL of 10.0 L predi...
Background: Individualized Learning Plans (ILPs) are an effective tool for promoting self-directe... more Background: Individualized Learning Plans (ILPs) are an effective tool for promoting self-directed learning among residents. However, no literature details ILP use among medical students. Methods: Fifty fourth-year sub-interns in pediatrics and internal medicine created ILPs, including a self-assessment of strengths and weaknesses based on ACGME core competencies and the setting of learning objectives. During weekly follow-up meetings with faculty mentors and peers, students discussed challenges and revised goals. Upon completion of the rotation, students completed a survey of Likert-scale questions addressing satisfaction with and perceived utility of ILP components. Results: Students most often self-identified strengths in the areas of Professionalism and Interpersonal and Communication Skills and weaknesses in Patient Care and Systems-Based Practice. Eighty-two percent set at least one learning objective in an identified area of weakness. Students expressed high confidence in their abilities to create achievable learning objectives and to generate strategies to meet those objectives. Students agreed that discussions during group meetings were meaningful, and they identified the setting learning objectives and weekly meetings as the most important elements of the exercise. Conclusions: Fourth-year sub-interns reported that ILPs helped them to accomplish rotation goals, with the setting of learning objectives and weekly discussions being the most useful elements.
Many patients, due to a combination of illness and sedatives, spend a considerable amount of time... more Many patients, due to a combination of illness and sedatives, spend a considerable amount of time in a comatose state that can include time in burst suppression. We sought to determine if burst suppression measured by processed electroencephalography during coma in sedative-exposed patients is a predictor of post-coma delirium during critical illness. Observational convenience sample cohort. Medical and surgical ICUs in a tertiary care medical center. Cohort of 124 mechanically ventilated ICU patients. None. Depth of sedation was monitored twice daily using the Richmond Agitation-Sedation Scale and continuously monitored by processed electroencephalography. When noncomatose, patients were assessed for delirium twice daily using Confusion Assessment Method for the ICU. Multiple logistic regression and Cox proportional hazards regression were used to assess associations between time in burst suppression and both prevalence and time to resolution of delirium, respectively, adjusting for time in deep sedation and a principal component score consisting of Acute Physiology and Chronic Health Evaluation II score and cumulative doses of sedatives while comatose. Of the 124 patients enrolled and monitored, 55 patients either never had coma or never emerged from coma, yielding 69 patients for whom we performed these analyses; 42 of these 69 (61%) had post-coma delirium. Most patients had burst suppression during coma, although often short-lived (median [interquartile range] time in burst suppression, 6.4 [1-58] min). After adjusting for covariates, even this short time in burst suppression independently predicted a higher prevalence of post-coma delirium (odds ratio, 4.16; 95% CI, 1.27-13.62; p = 0.02) and a lower likelihood (delayed) resolution of delirium (hazard ratio, 0.78; 95% CI, 0.53-0.98; p = 0.04). Time in burst suppression during coma, as measured by processed electroencephalography, was an independent predictor of prevalence and time to resolution of postcoma/post-deep sedation delirium. These findings of this single-center investigation support lighter sedation strategies.
Objective: Vitamin D deficiency is well recognized in selected Middle Eastern countries, but neon... more Objective: Vitamin D deficiency is well recognized in selected Middle Eastern countries, but neonatal vitamin D status is not well studied in Jordan and other nearby countries. The aim of this study is to determine the prevalence of vitamin D deficiency in Jordanian newborns and risk factors associated with low levels.
Purpose: To determine the prevalence of vitamin D deficiency in selected Jordanian full-term newb... more Purpose: To determine the prevalence of vitamin D deficiency in selected Jordanian full-term newborns and risk factors associated with low levels. Methods: Newborn infants were prospectively enrolled during spring and summer months during 2010. Newborns >37 weeks of age and those born within 96 hours at Al Bashir Hospital in Amman, Jordan were included. Demographic information for newborns and their mothers were collected including child’s birth date, child’s birth weight, average daily number of hours mother spends outdoors, mother’s clothing practice, and smoke exposure. Blood samples were obtained from infants by heel stick, placed on filter paper, and then sent to ZRT Laboratory for vitamin D [25(OH)D] measurement. Results: A total of 1,692 (825 males and 867 females) out of 2,009 newborns enrolled met inclusion criteria. The mean gestational age was 39.86 weeks, with a median birth weight of 3.2 kg. The mean age of the mothers was 27.41 years. The majority (87.6%) of mothers...
Small samples with few minority women and/or the absence of comparisons to peers without cancer h... more Small samples with few minority women and/or the absence of comparisons to peers without cancer histories have limited previous research suggesting racial differences in breast cancer survivors' health-related quality of life (HRQoL). This study not only compared HRQoL of African American and white breast cancer survivors, but also compared the HRQoL of these women to that of same-race women with no cancer history. Data from the Women's Health Initiative-Observational Study were used, including 5021 cancer survivors and 88,532 women without a history of cancer. Multivariate regression analyses estimated differences in breast cancer survivors' baseline HRQoL (RAND36), depressive symptoms (CES-D short-form), and sleep quality (WHIIRS). African American breast cancer survivors reported worse physical functioning and general health compared with white survivors. Among African Americans, survivors reported worse role limitations due to physical health, pain, general health, a...
Cerebral vasospasm is a leading cause of death and disability following aneurysmal subarachnoid h... more Cerebral vasospasm is a leading cause of death and disability following aneurysmal subarachnoid hemorrhage (SAH). Nitric oxide (NO) is a potent mediator of vasodilation, and citrulline is a known contributor to NO production. The leukocytosis inflammatory response can increase vasoconstrictive compounds that may also contribute to vasospasm. Dexamethasone is a glucocorticosteroid commonly administered after SAH, which may alter the production of leukocytes and citrulline. The goal of this project was to study the effects of dexamethasone on leukocytosis, citrulline, and angiographic vasospasm. Experimental SAH was induced in 18 New Zealand white rabbits. Intravenous dexamethasone was administered to one group (N.=9) at 2 mg/kg/day. A placebo group (N.=9) was given a saline infusion with otherwise identical procedures. CSF citrulline, leukocytes, protein, and glucose, as well as plasma citrulline were measured at baseline and 3 days post-SAH in a blinded fashion. Basilar artery angio...
This investigation describes the relationship between TBI patient demographics, quality of life o... more This investigation describes the relationship between TBI patient demographics, quality of life outcome, and functional status outcome among clinic attendees and non-attendees. Of adult TBI survivors with intracranial hemorrhage, 63 attended our TBI clinic and 167 did not attend. All were telephone surveyed using the Extended-Glasgow Outcome Scale (GOSE), the Quality of Life after Brain Injury (QOLIBRI) scale, and a post-discharge therapy questionnaire. To determine risk factors for GOSE and QOLIBRI outcomes, we created multivariable regression models employing covariates of age, injury characteristics, clinic attendance, insurance status, post-discharge rehabilitation, and time from injury. Compared to those with severe TBI, higher GOSE scores were identified in individuals with both mild (OR=2.0, 95%CI:1.1-3.6) and moderate (OR=4.7, 95%CI:1.6-14.1) TBIs. In addition, survivors with private insurance had higher GOSE scores as compared to those with public insurance (OR=2.0, 95%CI:1...
Postoperative hemorrhage after orthotopic liver transplantation (OLT) may require early reoperati... more Postoperative hemorrhage after orthotopic liver transplantation (OLT) may require early reoperative intervention. Previous studies have shown intraoperative transfusion requirement as a main determinant of reoperative intervention after OLT. The goal of this study was to develop an intraoperative hemorrhage model predicting need for reoperation after OLT. A single institution, retrospective review of adult primary OLT patients from January 2002 to 2008 was conducted. Multivariate logistical regression analysis was performed to identify predictors of reoperation due to postoperative hemorrhage. Secondary analysis was conducted on patients in the reoperation group managed with temporary open abdomen techniques. Four hundred and ten primary transplantations were performed with 59 patients (14.4%) requiring reoperation. The adjusted odds of reoperation when intraoperative blood loss (IBL) increases from 1.5 L to 10.0 L is 2.48 [95% confidence interval: (1.18, 5.31)]. IBL of 10.0 L predi...
Background: Individualized Learning Plans (ILPs) are an effective tool for promoting self-directe... more Background: Individualized Learning Plans (ILPs) are an effective tool for promoting self-directed learning among residents. However, no literature details ILP use among medical students. Methods: Fifty fourth-year sub-interns in pediatrics and internal medicine created ILPs, including a self-assessment of strengths and weaknesses based on ACGME core competencies and the setting of learning objectives. During weekly follow-up meetings with faculty mentors and peers, students discussed challenges and revised goals. Upon completion of the rotation, students completed a survey of Likert-scale questions addressing satisfaction with and perceived utility of ILP components. Results: Students most often self-identified strengths in the areas of Professionalism and Interpersonal and Communication Skills and weaknesses in Patient Care and Systems-Based Practice. Eighty-two percent set at least one learning objective in an identified area of weakness. Students expressed high confidence in their abilities to create achievable learning objectives and to generate strategies to meet those objectives. Students agreed that discussions during group meetings were meaningful, and they identified the setting learning objectives and weekly meetings as the most important elements of the exercise. Conclusions: Fourth-year sub-interns reported that ILPs helped them to accomplish rotation goals, with the setting of learning objectives and weekly discussions being the most useful elements.
Many patients, due to a combination of illness and sedatives, spend a considerable amount of time... more Many patients, due to a combination of illness and sedatives, spend a considerable amount of time in a comatose state that can include time in burst suppression. We sought to determine if burst suppression measured by processed electroencephalography during coma in sedative-exposed patients is a predictor of post-coma delirium during critical illness. Observational convenience sample cohort. Medical and surgical ICUs in a tertiary care medical center. Cohort of 124 mechanically ventilated ICU patients. None. Depth of sedation was monitored twice daily using the Richmond Agitation-Sedation Scale and continuously monitored by processed electroencephalography. When noncomatose, patients were assessed for delirium twice daily using Confusion Assessment Method for the ICU. Multiple logistic regression and Cox proportional hazards regression were used to assess associations between time in burst suppression and both prevalence and time to resolution of delirium, respectively, adjusting for time in deep sedation and a principal component score consisting of Acute Physiology and Chronic Health Evaluation II score and cumulative doses of sedatives while comatose. Of the 124 patients enrolled and monitored, 55 patients either never had coma or never emerged from coma, yielding 69 patients for whom we performed these analyses; 42 of these 69 (61%) had post-coma delirium. Most patients had burst suppression during coma, although often short-lived (median [interquartile range] time in burst suppression, 6.4 [1-58] min). After adjusting for covariates, even this short time in burst suppression independently predicted a higher prevalence of post-coma delirium (odds ratio, 4.16; 95% CI, 1.27-13.62; p = 0.02) and a lower likelihood (delayed) resolution of delirium (hazard ratio, 0.78; 95% CI, 0.53-0.98; p = 0.04). Time in burst suppression during coma, as measured by processed electroencephalography, was an independent predictor of prevalence and time to resolution of postcoma/post-deep sedation delirium. These findings of this single-center investigation support lighter sedation strategies.
Objective: Vitamin D deficiency is well recognized in selected Middle Eastern countries, but neon... more Objective: Vitamin D deficiency is well recognized in selected Middle Eastern countries, but neonatal vitamin D status is not well studied in Jordan and other nearby countries. The aim of this study is to determine the prevalence of vitamin D deficiency in Jordanian newborns and risk factors associated with low levels.
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