College of Health and Pharmacy

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A SURVEY STUDY EXPLORING THRUST JOINT MANIPULATION CURRICULUMS WITHIN ENTRY-LEVEL DOCTOR OF PHYSICAL THERAPY PROGRAMS
(2024-04-18) Howland, Chad
Background and Purpose: The Commission of Accreditation in Physical Therapy Education (CAPTE) requires entry-level Doctor of Physical Therapy (DPT) programs to produce students competent in delivering physical therapy interventions, which include thrust joint manipulation (TJM). However, no mandate exists concerning TJM curricular design or what constitutes entry-level competency. This study sought to explore the current state of TJM education and provide an update on curriculum characteristics and standards. Methods and Results: An online-based survey was distributed to accredited entry-level DPT programs between September 2022 to August 2023. Eligible respondents were physical therapist educators serving as the primary instructor in musculoskeletal coursework for the spine or pelvis. The survey collected data on program demographics, instructor demographics, TJM curriculum design, and perceived competency of students specific to TJM of the spine or pelvis. Survey respondents’ data was analyzed using descriptive statistics (n = 78). Survey results showed the highest percentage (78.%) of respondents were board-certified orthopedic specialists (OCS), with less than one-half reporting advanced certifications in spinal manipulative therapy (47.4%). Nearly all respondents (94.8%) viewed TJM as an entry-level skill and considered their students satisfactory or above satisfactory by graduation. Most respondents view TJM of the upper cervical spine as a post entry-level skill (Figure). A disparity between spinal regions taught in TJM curricula was observed, with lumbar TJM representing the highest percentage of responses (98.7%). Conclusion: Compared to a decade ago, a higher percentage of physical therapist educators teaching TJM reported advanced certifications in orthopedics or manual therapy. However, both program and TJM curriculum characteristics appear comparable to previous reports. The results from this study may not be generalizable to all entry-level DPT programs given the low response rate.
BLOOD FLOW RESTRICTION TRAINING FOR PERSISTENT KNEE EXTENSOR WEAKNESS
(2023-04-20) Scott, Wayne; Michaud-Gardner, Alyssa; Sylvia, Jack; Topiwala, Dave
This case study presents the effects of 8 weeks of blood flow restriction training (BFRT) for persistent knee extensor weakness following a long standing repaired ACL injury. A 20 year old female with no history of knee injury prior to the initial ACL tear in 2020 received a patellar bone graft 6 months later. The patient received traditional physical therapy for 6 weeks, which was inconsistent due to COVID-19 interruptions. The participant presented with an antalgic gait and difficulty performing stairs as a result of persistent knee extensor muscle weakness. The participant's knee extensor strength was tested using a Biodex force dynamometer. Initial testing demonstrated that the involved side knee extensors could only produce 68.7% of the muscle torque of the uninvolved side knee extensors. The participant underwent BFRT at a frequency of 2 sessions per week for a total of 8 weeks. The participant performed unilateral knee extensions, step ups, and leg presses for sets of 30, 15, 15 and 15 reps. Blood flow was restricted with a tourniquet inflated to 80% of the pressure which caused full arterial blood flow occlusion for the duration of each exercise with 2 minutes of cuff deflation between exercises. Following 8 weeks of training, the participant’s knee extensors on the involved side were able to produce 82.9% of the muscle torque of the uninvolved side knee extensors. In this case, BFRT demonstrated the ability to improve persistent knee extensor weakness following ACL repair. This improvement in strength was maintained at 3 and 6 month follow up testing. Significantly, the patient’s antalgic gait and difficulty performing stairs resolved during the 8 weeks of training.
CAN BLOOD FLOW RESTRICTION TRAINING REVERSE LONG-STANDING QUADRICEPS WEAKNESS?
(2024-04-18) Gregoire, Jacob; Hammill, Elizabeth; Lemay, Amber; Olsen, Madison; Sargent, Hannah; Scott, Wayne
Background: Blood Flow Restriction Training (BFRT) involves the application of a tourniquet device during resistance exercises, offering a method for muscle strengthening with low-load training, which reduces stress on joints and tissues. BFRT is commonly employed in rehabilitating injuries of the knee including ligament injuries and damage to the menisci. Previous studies suggest that BFRT induces hypertrophy through a combined response to metabolic stress and mechanical tension. Purpose: This study investigated if BFRT could address long-standing quadriceps weakness following ACL, medial meniscus and MCL injury, commonly referred to as the "unhappy triad." Study Design: A case study was conducted on a 24-year-old female soccer player, five years postoperative ACL and meniscus repair, who reported knee pain, weakness, and instability during functional activities and sports. Methods: The participant underwent BFRT sessions twice a week for eight weeks. Exercises were performed with 80% blood flow restriction on the affected limb, interrupting arterial blood flow during 3 exercises with a 2-minute rest break in between exercises during which the cuff was deflated. Exercises included unilateral knee extensions, step-ups, and leg presses, comprising four sets of each exercise with repetitions of 30, 15, 15, and 15, with 30 seconds of rest in between each set. Results: Our study revealed improvements in maximal volitional isometric contraction (MVIC) torque, burst torque, self-reported confidence, and thigh symmetry. MVIC torque of the affected limb increased by 8.5% and burst torque increased by 23% indicating enhanced strength. Conclusion: The case study highlights promising outcomes of BFRT in improving strength in the knee extensor muscles of persons with chronic weakness. Future research should explore qualitative assessments and BMI, skinfold measurements, and functional evaluations to provide a comprehensive understanding of BFRT's efficacy.
CAN WALKING THE PLANK IMPROVE GAIT?
(2024-04-18) Andrews, Evan; Driscoll, Alyssa; Matte, Kayla; Newcomb, Ryley; Payeur, Mikaylah; Scott, Danielle; Wheelock, Ryan; Sidaway, Ben
Purpose: This study examined the effect of balance practice on narrow planks on the fall risk, balance confidence and gait characteristics of older adults. Participants and methods: The Dynamic Gait Index (DGI), the Activities-specific Balance Confidence (ABC) scale and fear of falling were recorded in 10 older adults (73-91 years). The participants then walked over a 6 m long computerized gait mat at normal and quick walking speeds enabling various gait parameters to be recorded. Following these pretests participants practiced walking along planks that decreased in width with practice. Participants practiced for 30 minutes twice a week for 4 weeks. A post-test was conducted at the end of practice and a retention test was administered a week following practice. Data were analyzed using t-tests and analyses of variance (ANOVA). Results: Practice walking on planks significantly improved DGI and ABC scores. The DGI mean improved from “fall risk” to “no risk” and from “moderate physical functioning” to “high physical functioning.” Analysis of gait parameters revealed significant increases in gait velocity at both speeds along with an increase in stride length. The increase in stride length was accompanied by a significant decrease in stride length variability and stance percentage. Conclusion: Quantitative gait markers of fall risk in older adults showed significant improvement following the plank training. The balance training improved dynamic postural control enabling participants to reduce stance time and thus take longer strides consequently increasing gait speed. The improvement in DGI and ABC scores demonstrate clinically meaningful impacts in both gait performance and self-reported balance confidence.
CHARACTERIZATION AND ANALYSIS OF BIOACTIVES IN BLUEBERRY-DERIVED EXOSOMES: NEW INSIGHTS INTO A POTENTIAL ANTIOXIDATION NANOMEDICINE
(2023-04-20) Dunham, Kaitlyn; Canham, Spencer; Palmer, Emilie; Bai, Shuhua; Yang, Tianzhi
Blueberries provide evident benefits of reducing oxidative stress and inflammation, improving cognitive function, and protecting against neurodegenerative diseases as a “super” fruit. However, high levels of bioactive molecules in blueberries, such as anthocyanin, have poor stability and absorption, leading to low bioavailability in the brain. Exosomes attract strong interest as an important vehicle of intercellular communication and as a delivery carrier of bioactive molecules. Herein, the study focuses on characterizing blueberry-derived exosomal nano-vesicles that contain bioactive molecules, and determining if they have better stability and are more readily taken up by cells. Blueberry juice was directly extracted with an electric blender and passed through filter papers. The collected juice was sequentially centrifuged at 1,000 × g for 10 min, 3,000 × g for 20 min, and 10,000 × g for 40 min at 4 °C to remove large particles and debris. The final supernatant was centrifuged at 100,000 × g for 30 min to obtain exosomes. The exosome morphology was observed with scanning electron microscopy (SEM) and the particle size was determined with a Nano Sizing Analyzer. The exosomes had a size of 82.7±6.4 nm and appeared as individually sphere-shaped morphology as shown in SEM images. Exosomes were analyzed and quantified for total proteins and RNAs. Well-known exosome-unique markers, including Cis-Golgi matrix protein GM130, adaptor protein and sort cargo ALIX, tumor susceptibility gene TSG10, intercellular adhesion molecule 1 (ICAM-1), apoptosis ANXA5, integral membrane protein FLOT, epithelial cell adhesion molecule (EpCam), and transmembrane tetraspanin family CD63 and CD81, were detected by an Exo-Check array. MicroRNA sequencing analysis revealed that the intersection between differentially expressed genes and miRNAs contained in exosomes could unveil a set of candidate target genes. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) study demonstrated that the exosomes showed cytotoxicity in neural cancerous cells. The characterized exosomes with biomolecules may deliver therapeutic molecules in the brain and target neural cells, leading to improved efficacy in the treatment of neurodegenerative diseases.
COMPENSATION FOR BOARD OF PHARMACY MEMBERS IN THE UNITED STATES
(2023-04-20) Pham, Hannah; Ifeji, Chidubem; White, Cassandra
Background: No published data exists regarding compensation and demographic differences between the memberships of the 50 United States (U.S.) Boards of Pharmacy. Objectives: The purpose of this study was to quantify and compare the per diem pay rate for U.S. Board of Pharmacy members. Board member demographics and compensation for mileage and meals were also evaluated. Methods: In June 2022, each state Board of Pharmacy was contacted to gather data including per diem pay, mileage and meal compensation, number of meetings per year, number and gender of Board members, length of appointment, and regulatory statutes. Results: The average per diem pay for Board members was $75.86 (median = $50.00, range = $0.00 to $250.00, n = 48 states). Most states report paying Board members for mileage (95.1%, n = 39 out of 41) and meals (80.0%, n = 28 out of 35). On average, Boards are composed of 8.3 members (median = 7.5, range = 5-17, n = 50), meet 8.3 times annually (median = 8, range 3-16, n = 47), and have a 4.5 year length of appointment (median = 4, range = 3-6, n = 47). Males represented 61.2% of occupied Board positions and pharmacists accounted for 74.1% of all positions. The average year for pharmacy statute update was 2002. Conclusion: Compensation for U.S. Board of Pharmacy members varies greatly, from unpaid (n = 8 states) to a high of $250.00 per diem. Only 38.8% of occupied Board positions are held by women and pharmacy technicians represent just 3.6% of all positions. Fair compensation, increased female and pharmacy technician representation, and more timely pharmacy statute updates are necessary in order to achieve inclusion, diversity, and equity between state Boards of Pharmacy.
CURRENT PRACTICE OF SCREENING FOR DEPRESSION IN INDIVIDUALS WITH POST-STROKE APHASIA
(2024-04-18) Bucklin, Calista; LeBoeuf, Clarence; Drakopoulos, Anthony; Davis, Kimberly
This study aims to identify current practices regarding mental health assessment protocols and tools utilized among practicing occupational therapists (OT) and occupational therapist assistants (OTA) currently working with clients who have experienced post-stroke aphasia. This was done by creating a survey that gathered information surrounding participants' current knowledge of depression among aphasic patients, what the current practice is at their place of work around screening for depression in patients with Aphasia, and whether or not they think a protocol would be beneficial for this population. The Husson IRB approved this study as a qualitative study with a descriptive design and non-probability sampling. An invitation to participate was sent through two American Occupational Therapy Association (AOTA) CommunOT listservs. In addition, the invitation was sent to all members of the Maine and New Hampshire Occupational Therapy Associations. Data was collected anonymously using Google Forms. The survey was open and available between March 12 and April 5, 2024. Preliminary data identifies the majority of practitioners working with clients with post-stroke aphasia are occupational therapists with between 2 and 24 years of experience and a median of 10 years. Approximately 18% of respondents are not aware of the prevalence of individuals who experience post-stroke aphasia and nearly 46% state that they are not aware that these individuals are seven times more likely to have symptoms of depression. While all respondents indicated that screening for depression would be beneficial, only nine percent reported that they did assess and none used a standardized method. Based on this data, there appears to be a knowledge gap in care and treatment for clients who experience post-stroke aphasia and symptoms of depression. Standardized assessment tools and protocol development, in addition to specific training, are needed to help ensure quality holistic care of people who have post-stroke aphasia.
DISCIPLINARY OUTCOMES FOR MAINE BOARD OF PHARMACY COMPLAINTS IN 2022
(2024-04-18) White, Cassandra; Dumont, Erica; Mroz, Katherine
The purpose of the licensing system regulated by the Maine Board of Pharmacy (MeBOP) is to protect the public against 1. dishonest or unethical licensees, and 2. licensees who have fallen below minimum standards of competence in the practice of pharmacy. Violators are subject to disciplinary action that can range from a formal warning to license revocation, with or without civil penalties. The purpose of this study was to quantify and compare complaints submitted to the MeBOP for the 2022 calendar year. The majority of complaints in 2022 were against pharmacists (57.9%, n = 66 of 114 complaints), consistent with disciplinary records for all United States (U.S) Boards of Pharmacy (BOP)1. 78.8% were licensed as a pharmacist-in-charge (PIC). The MeBOP had far less complaints against pharmacy technicians (1.8%, n = 2 of 114) compared to U.S. BOPs (25.2%, n = 1,309 of 5,196)1. There was a high number of dismissed complaints (53.5%), while 14% resulted in a letter of guidance and 32.5% were offered consent agreements. 21.9% of complaints were against licensees with prior discipline. The average civil penalty (n = 34 of 114) was $12,000 (median = $1,625, range = $250 - $175,000). Investigation into complaint data for U.S. BOPs is necessary in order to establish best practices for the management of complaints, complaint outcomes, and the impact of complaints on licensees. The MeBOP and other U.S. BOPs can collect and use complaint data to contemplate ways to promote a more just culture. Future studies are needed to evaluate the number of complaints each U.S. BOP receives, PIC designation and license status, types of violations (e.g. prescription misfill, drug diversion), ways to promote the reduction of recidivism, as well as the civil penalties and how these compare across states. 1. NABP Clearinghouse Update - 2022. Innovations. March 2023;52(3):7.
Domestic Violence and Children’s Mental Health
(2023-05) Thompson, Zainab
Exposure to domestic violence is a significant predictor of children’s mental health problems. Children exposed to domestic violence will likely develop internalizing and externalizing disorders, substance abuse disorders, poor school outcomes, and a lack of prosocial behaviors (Colizzi et al., 2020). Exposure to family violence contributes to adverse childhood experiences (ACEs), which are linked to causing trauma and long-term psychological distress (Lloyd, 2018). Most mental health problems begin during the teenage years when children encounter ACEs and continue to adversely affect them in adulthood (Colizzi et al.). Children's mental health problems become a burden to the guardians, community, and society and are associated with increased healthcare costs (Orr et al., 2020). Therefore, preventing mental disorders development and reinforcing resilience in violence-exposed children is thus relevant to evade these negative consequences. The project aimed to identify the effects of family or domestic violence exposure on children, the protective and risk factors that influence the effects of violence exposure, and the intervention applicable to prevent violence-exposure effects for children aged below thirteen years. The project’s recommended intervention is a public health preventive approach at the primary, secondary, and tertiary levels to prevent violence-exposed children from developing mental health problems and disorders. Specifically, the intervention will include mindfulness training, cognitive behavior therapy, psychosocial fulfillment, and learning to regulate social and emotional responses to challenges faced, which will help prevent the development of mental health problems in children and teenagers. The reviewed literature suggests that the intervention should be evidence-based, and population-based, incorporate risk assessments and promotion of protective factors, integrate multisector and multilevel collaboration, and be operationalized within a socio-ecological framework (Carlson et al., 2019; Colizzi et al. ; Eriksson et al., 2022; Fong et al., 2019). Eventually, the intervention will reinforce resilience and positively 3 influence the mental health of at-risk and violence-exposed children to offer a better quality of life. Catering for children facing developmental adversity is essential to prevent negative consequences later in life. Future research should focus on how to best implement this intervention that specifically targets violence-exposed children and their mental health.
EFFECTS OF BISPHOSPHONATE TREATMENT OF POST-MENOPAUSAL WOMEN ON BONE QUALITY PARAMETERS OF NEWLY FORMED BONE DETERMINED BY RAMAN SPECTROSCOPY. A COMPARISON VS HEALTHY PREMENOPAUSAL WOMEN
(2023-04-20) Phipps, Roger J.; Gamsjaeger, Sonja; Shane, Elizabeth; Cohen, Adi; Dempster, David W.; Eriksen, Erik F.; Paschalis, Eleftherios P.
In the treatment of postmenopausal osteoporosis (PMO), the potent bisphosphonates (BPs) alendronate (ALN; Fosamax), risedronate (RIS; Actonel) and zoledronate (ZOL; Reclast) are first line therapy. They produce similar decreases in fracture risk despite different levels of suppression of bone resorption and bone turnover (ALN>ZOL>RIS). To determine if differences in effects on bone quality may play a role in this apparent discrepancy, this study assessed the effects of these BPs on bone quality indices of newly formed trabecular bone. Methods: Iliac crest bone biopsies from PMO patients treated with ALN (for 3 years and ≥ 5 years), RIS (for 3 years and ≥ 5 years), and ZOL (for 6 months, 2 years, ZOL2 and 3 years, ZOL3) were analyzed by Raman microspectroscopy. Bone quality indices mineral to matrix ratio (MM), mineral crystallite maturity/crystallinity (MMC), and glycosaminoglycan (GAG), and pyridinoline (Pyd) content were determined. Biopsies from placebo treated PMO women (PMO-PLC) were also analyzed. Data were compared with those in healthy adult premenopausal women (HC) by ANCOVA followed by post-hoc testing (significance p<0.05). Results: Both RIS groups had MM, MMC and Pyd values similar to HC. ZOL3 had MM and Pyd similar to HC and ZOL2 had MMC similar to HC. Both ALN groups had only MM similar to HC. None of the BP-treated groups had similar GAG to HC. The PLC group had MM similar to HC but was significantly different for MMC, GAG and Pyd. Conclusion: in this analysis PMO patients treated with RIS (Actonel) formed bone with quality closest to that in HC. Those treated with ALN (Fosamax) formed bone with quality least similar to HC. These differences in effects on bone quality may in part explain how these BPs achieve similar antifracture efficacy in treatment of PMO despite differences in bone turnover suppression.
Effects of Distraction Techniques During Immunizations
(2023-05) Walker, April M.
Routine vaccine injections are some of the most common painful procedures during childhood especially when they are administered without adopting any pain management practice. According to the Center for Disease Control and Prevention (2022), an experience of pain is a biological component that makes some people react very strongly to the idea of procedures involving a needle. Pain from a needle is usually not severe but the brain still focuses on it. Therefore, managing the pain can reduce fear and avoidance of medical care during childhood related experiences of painful procedures such as immunizations. The purpose of this project is to determine if the use of distraction techniques vs. no distraction techniques during immunizations decrease pain levels. An Evidence Based Practice (EBP) conceptual framework will be used to provide evidence that distraction techniques during childhood immunizations decrease pain levels. The expected outcome of this project is to increase awareness of the use of distraction techniques vs. no distraction techniques while administering immunizations to children. The hope is that this study will prove effective for implementing distraction techniques for children receiving immunizations and provide education for healthcare facilities, healthcare providers, and parents to implement appropriate pain and distress management strategies during future vaccinations (Ouach et al., 2019).
ERROR ESTIMATION AND KNOWLEDGE OF RESULTS IN LEARNING A NOVEL MOTOR TASK
(2023-04-20) Duffy, Hannah; Lees, Jennifer; Shamaly, Shannon; Sidaway, Ben
When learning a new motor skill, feedback on the errors in performance, or knowledge of results, is important in order to make adjustments to the future response attempts. However, previous studies have shown that when high frequencies of feedback are provided to a learner such feedback can suppress intrinsic error detection and corrections processes resulting in poorer performance when that feedback is no longer available. Other studies have shown that requiring error estimation during practice prior to feedback being provided enhances learning of the skill. Such research though has not investigated the role of different frequencies of error estimation on learning nor has the combined effect of requiring error estimation while providing different frequencies of knowledge of results been investigated. It remains unknown whether there is an optimal frequency of error estimation for motor learning or whether error estimation may interact with the frequency of feedback. The present study included 6 randomly assigned intervention groups of young adults (18-35 years) that were differentiated on the basis of knowledge results (0%, 33%, or 100%) and error estimation (0%, 33%, or 100%) frequency. Each group was taught a shuffle-board like skill aiming at a target that was hidden from view. Each group performed a series of ten blocks of 12 practice trials followed by three retention tests (5 min, 1 day, 1 week), and a transfer test. Response error (absolute, constant, and variable) was calculated for each phase of the experiment along with the accuracy of error estimation. Preliminary results show that requiring overt error estimation of learners ameliorates the negative impact of high frequencies of knowledge of results feedback on skill learning. Discussion focuses on the potential interaction of error estimation and feedback for motor learning in clinical practice.
EXAMINATION OF THE POTENTIAL ROLE OF UDP IN INTERLEUKIN-8 EXPRESSION BY FIBROBLASTS DURING CELL INJURY
(2023-04-20) Kennard, Emma; Lindblad, William J.
Prior studies from our lab show scraping a monolayer of fibroblasts, an in vitro wound model, results in cell migration and enhanced expression of inflammatory mediators including interleukin-8 (IL-8) by residual cells. This effect is more pronounced in fibroblasts from the skin of diabetic people than non-affected people. This expression is seen in the cells adjacent to the scraped area but also in cells 2 and 3 cells removed from the scraped edge. Studies in epithelial cells suggest that nucleotides, specifically uridine 5’-diphosphate (UDP) released from cells upon wounding in the same model bind to P2Y6 receptors on cells inducing cell migration. We hypothesized that UDP may serve as a wound mediator for fibroblasts and that it may induce the expression of IL-8. Human dermal fibroblasts (GM 1872 cells, Coriell Institute) were cultured in 100 mm dishes and grown to confluence in DMEM high glucose media containing 10% fetal calf serum and penicillin-streptomycin. Cell monolayers were scraped in a grid pattern and cultured for 24 hrs. with/out additives. UDP at 100 and 10 µM was added to non-scraped and scraped cultures of fibroblasts to determine the potential involvement of UDP that we have seen in IL-8 expression. Following 24 hr. incubation, total RNA was extracted and quantitation of IL-8 mRNA content was assessed by qPCR. Modified culture media used for the 24 hr. culturing was analyzed for UDP content by ion-pairing HPLC. UDP, immediately released from scraped cell monolayers, was determined by HPLC following a 10X concentration of PBS used to maintain cell viability during scraping. Despite a lower limit of detection of 20 ng, no UDP could be detected and further studies with LC/MS are continuing to ascertain if any quantifiable UDP is released from the scraped cells. Cell levels of mRNA for IL-8 normalized to GAPDH are being analyzed to determine if exogenous UDP enhances the expression of this cytokine. These studies will increase our understanding of what factors during fibroblast injury promote migration and the expression of pro-inflammatory mediators.
HOMELESS AND HUNGRY IN BANGOR: RX 504 SERVICE LEARNING CAPSTONE PROJECT
(2023-04-20) Johnson, Jessica; Doctor of Pharmacy Candidates, Class of 2024
Husson University School of Pharmacy Class of 2024 enrolled in RX 504 - Clinical Pharmacy Capstone, a required service-learning course that allows students to apply knowledge developed over the course of their studies to a real-world problem in their local community. Doctor of Pharmacy candidates established a goal of assessing the needs of individuals experiencing homelessness in Penobscot County. First, students held a discussion surrounding the documentary “Hungry Now,” which explored the current homelessness crisis in the state of Maine. Second, students read published scientific literature evaluating the barriers to healthcare and medication adherence unique to persons experiencing homelessness. Students proposed possible solutions and explored how their various ideas might help individuals to overcome barriers to accessing needed medical care. Third, we visited the Bangor Area Homeless Shelter on two separate occasions with the goal of sharing a nutritious meal and speaking with residents to explore their needs and concerns regarding their medication regimens. Additionally, students advocated for expanded access to vaccinations in Maine by writing and delivering verbal testimonies at the Maine State House and provided community education at the Maine Science Festival. Through this community-engaged service-learning experience, Pharmacy students explored themes of access, wellness, identity, responsibility, and sustainability; developed a better understanding of the daily struggles faced by unhoused individuals in their local community; and were empowered to take evidence-based action in response to identified health disparity.
IMPACT OF PHARMACISTS EMBEDDED IN A GERIATRIC MEDICINE FELLOWSHIP
(2024-04-18) White, Cassandra; Hartsig, Angela
Maine Dartmouth Geriatric Medicine (MDGM) provides primary and specialty consultative care to adults age 65 and older using an interprofessional team approach consisting of geriatricians, social workers, nurses, and medical assistants as well as student learners including medical fellows, residents, and students. The practice site also houses the Maine-Dartmouth Geriatric Medicine Fellowship. In July 2020, the first Husson University School of Pharmacy (HUSOP) pharmacy practice faculty member was embedded into MDGM, followed by a second faculty member joining the practice site in July 2021. Both faculty worked to establish an interprofessional pharmacist-led medication review service with each offering a 6-week Ambulatory Care Advanced Pharmacy Practice Experience (APPE) for final-year Doctor of Pharmacy students throughout the academic year. For each patient visit, the pharmacy team provides a comprehensive medication review with the patient and then offers recommendations to providers regarding medication management such as addressing falls and mobility issues, polypharmacy and adverse drug events, affordability, and other common geriatric syndromes. This is an ongoing retrospective study in which the historical “Patient Experience Survey” data from MDGM patient visits that occurred in July 2019-July 2020 (before pharmacists started at MDGM), July 2020-July 2021 (first pharmacist started at MDGM), and July 2021-2022 (second pharmacist started at MDGM) is currently being collected. The “Patient Experience Survey” contains two medication-related questions including: “Did someone in this provider’s office review your medications with you?” and “Did someone in this provider’s office talk about the cost of your prescription medicine?” For each of these two questions, the percentage of patients who answered “Yes, definitely” or “Yes, mostly” and will be reviewed to observe if there was an improvement in response rate with the embedding of the pharmacist(s) at MDGM.
IMPROVING QUALITY OF LIFE FOR CANCER SURVIVORS THROUGH THE IMPLEMENTATION OF A WELLNESS WORKSHOP
(2024-04-18) Cummings, Ashley; Gott, Mallory; Hanning, Amelia; Rowe, Madison; Wasson, Courtney; Slike, Michelle
Research suggests that cancer survivors living in rural communities struggle with adequate resources related to survivorship. Proper education and intervention has been shown to improve life post-diagnosis. The purpose of this project was to design and implement an evidence-based, educational workshop to improve the quality of life for cancer survivors in rural areas of Maine. Following a needs assessment completed through a rural health facility and the YMCA, focus was placed on the following educational topics: physical and mental well-being, fatigue, lymphedema management, and chemo-induced peripheral neuropathy. Two workshops, one in-person and one virtual, were completed in an effort to reach residents in rural areas of Maine. Both workshops were two hours long and were designed and taught by entry-level doctor of physical therapy (DPT) students. Content was delivered using a PowerPoint presentation and active learning strategies. A total of 12 participants completed the workshop, 9 in-person and 3 virtual. Assessment of teaching effectiveness was completed utilizing pre- and post-test assessments, satisfaction surveys, and follow-up phone call interviews 6 months following the competition of the workshop. Strengths identified by the participants during the assessment included organization, informative content, and detailed resources that could be used following the workshops. Weaknesses identified included PowerPoint presentation style and the preference of in-person versus virtual learning. Notably, education on oncology rehabilitation, lymphedema, fatigue management, and chemo-induced peripheral neuropathy led to awareness of resources and enhanced self-care abilities. Wellness resources are lacking for cancer survivors in rural locations throughout the United States. This demand can be met through educational workshops similar to this project. Providing cancer survivors with educational information can improve their quality of life, reduce the risk of recurrence of cancer, and improve the effect of chronic conditions often experienced by cancer survivors.
Improving Recognition of Postpartum Depression Using A Standardized PHQ-9 Score
(2023-05) Morrill, Rebecca
Current screenings for postpartum depression (PPD) lack evidence-based standardized guidelines regarding tools, frequency, and timing. A lack of consensus on critical PPD screening scores exists causing gaps in care regarding when to refer women for further mental health services. Providers indicate their schedule is too busy to conduct meaningful interviews with patients thus leading to lack of assessments all together. Gaps exist with implementation protocols as well as training for staff. The purpose of this study is to determine if identification of a patient with a Patient Health Questionnaire-9 (PHQ-9), set as the standard screening tool, of a score of ten or higher should receive a referral for mental health treatment. Furthermore, to disseminate a synthesis of evidence regarding screening for PPD to include suggested intervals of screening, and identification of at-risk patients who score high on the PHQ-9. The effects of PPD can extend long after the neonatal period, threatening the life of the mother-infant dyad if missed. Research indicates only twenty percent of women who screen high for PPD will actually obtain mental health services, even though by the year 2030 PPD is predicted to be the second largest health problem. Literature and evidence indicate that screenings completed within two days of birth are able to identify how likely a patient is to develop anxiety or depression up to a two to eight-week period postpartum. A comprehensive literature review was conducted and yields high level evidence recommending the use of the PHQ-9 as a widely validated tool for screening for depression in the perinatal setting. Compared to existing tools such as PHQ-2, WHO-5, and EPDS, evidence determined PHQ-9 to have the highest validity and reliability for screening against minor depressive symptoms. Strong evidence suggests a cutoff score of 10 and above for identification of depression. When applied to the perinatal population, a cutoff score of 10 is useful for clinicians to initiate referral. Implementing the PHQ-9 tool at standard intervals, 3 applying a standard cutoff score for referral and recognizing at-risk mothers for PPD will further decrease associated mortality with untreated PPD and improve the mother-infant bond.
INVESTIGATING BLUEBERRY-DERIVED EXOSOMES AS A NOVEL APPROACH IN NEURODEGENERATIVE DISEASE THERAPY
(2024-04-18) Warner, April; Canham, Spencer; Yang, Tianzhi; Bai, Shuhua
Blueberries are renowned for their neuroprotective properties, including their ability to mitigate oxidative stress and enhance cognitive function, making them promising candidates for combating neurodegenerative diseases. This study investigates the potential of blueberry-derived exosomes (BBDExo) as a novel nanosized antioxidant system for neurodegenerative disease therapy. BBDExo were isolated from blueberries through sequential centrifugation and analyzed for protein and polyphenol content. Their stability under gastrointestinal conditions and their uptake by brain endothelial bEND.3 cells were assessed, along with their effects on neuronal SH-SY5Y cells, to ascertain their therapeutic potential. The results showed that BBDExo displayed a nanosized, oval-shaped morphology, averaging 82.7±6.4 nm in size. They demonstrated stability in simulated gastrointestinal environments, maintaining their polyphenol content for up to 4 hours. The uptake of BBDExo by bEND.3 cells was dose-dependent, indicating potential for blood-brain barrier transport. Furthermore, BBDExo significantly enhanced the proliferation of SH-SY5Y cells, with a peak increase of 158.8±1.8% at a concentration of 25 µg/mL. Additionally, BBDExo notably reduced the release of the pro-inflammatory cytokine interleukin-8 in stressed SH-SY5Y cells. These findings suggest that BBDExo offer improved stability and enhanced cellular uptake of bioactive compounds, potentially increasing their effectiveness in neurological applications. The ability of BBDExo to interact with targeted brain inflammatory cells and regulate anti-inflammatory responses demonstrates their promise as an innovative nanomedicine for neurodegenerative diseases, potentially leading to improved therapeutic efficacy and disease management.
INVOLVEMENT OF DIVALENT METAL TRANSPORTER HOMOLOGS IN THE TOXICITY OF LANTHANIDE SERIES ELEMENTS IN Caenorhabditis elegans
(2023-04-20) Ireland, Nicholas; Miller, Lydia; Caito, Samuel
Lanthanide series elements are transition metals that are used in a variety of electronics, including superconductors, electronic polishers, hybrid car components, and rechargeable batteries, as well as in fertilizers, antimicrobials, contrast agents for medical imaging and diesel fuel additives. Lanthanides are also present in electronic waste and are released during electronic cigarette smoking. Levels of lanthanides have risen significantly in both industrial areas and environmentally. While we are starting to recognize health effects of lanthanide exposure, it is currently unknown how lanthanide metals enter cells. If we are to understand their toxicokinetics in the human body, it is imperative to determine mechanisms by which lanthanides are distributed. We hypothesized that endogenous divalent metal transporters (DMTs) are responsible for lanthanide entry into cells, and that genetic ablation of DMT transporters in Caenorhabditis elegans would protect the worms from lanthanide-induced toxicity. In this study, we performed a competitive inhibition survival assay by pretreating wildtype worms with nonlethal doses of metals that enter cells through a variety of mechanisms, then treating the worms with increasing concentrations of lanthanum (La). Lethality was assessed 48 hours post exposure. Worms treated with either manganese or iron, metals that enter cells via DMTs, shifted the La dose-response survival curve to the right, suggesting La was competing for the same transporter as iron or manganese. However worms pretreated with zinc, magnesium, or chromium could not block lanthanum-mediated lethality. These data suggest that DMTs are responsible for lanthanides to enter cells. We then treated transgenic worms that lacked DMT homologs smf-1, smf-2, or smf-3, with increasing concentrations of La or ytterbium (Yb). Knock out of either of the smf genes shifted the dose-response curve for La or Yb to the right, showing protection. These results suggest that DMTs are important mediators for lanthanide series elements to enter eukaryotic cells.
IS DUAL TASK ABILITY FULLY RECOVERED IN ATHLETES WHO HAVE COMPLETED THE CONCUSSION RETURN-TO-PLAY PROTOCOL?
(2023-04-20) Hartman, Zachary; Marquis, Gabrielle; Siegel, Sondra
Purpose: This study investigated deficits in dual task ability in collegiate athletes with acute concussions who have completed the return-to-play protocol. While previous research has demonstrated the persistence of deficits using standard cognitive tests, this study specifically addressed performance in a contextually relevant, sports-related challenge. Methods: Concussed and non-concussed college athletes completed a demographics and history questionnaire, and were assessed for balance using the Balance Error Scoring System test. For the novel test, gait parameters were measured under three conditions using an instrumented gait mat. Conditions included: walking at a comfortable pace, walking while watching a sport-related video and performing a cognitive task, and walking while watching the video and performing the cognitive and a secondary physical task. The cognitive task was also performed by the participant in a standing position. Response accuracy on the cognitive task was recorded for all conditions. Outcome Measures: Measures included gait speed, cadence, stance percentage, step variability, and response accuracy for the cognitive task. Results: The control group demonstrated better performance than the experimental group with comfortable gait and with gait plus the cognitive task, with significant differences in stride width percentage, percentage of stance time, and cadence. There were no apparent differences between the two groups for the condition of gait combined with cognitive and physical tasks. There were no significant differences in response accuracy between the groups; participants demonstrated near 100% accuracy under all conditions. Conclusions: Greater impairments in gait were seen in all participants as the cognitive and physical task became more challenging, but accuracy in the cognitive task was not sacrificed in either group. Gait parameters measured during a sport-related cognitive task may be sufficient to discern a difference in performance between concussed and non-concussed athletes and may be more relevant to a return-to-play decision than standard cognitive tests.

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