Louisiana State University Health Sciences Center Research Articles

Abstract A065: The Cancer Research Education Program (CREP): Training the next generation of cancer health disparities researchers through the Southeast Partnership for Improving Research and Training in Cancer Health Disparities (SPIRIT-CHD)

Abstract The Southeast Partnership for Improving Research and Training in Cancer Health Disparities (SPIRIT-CHD) unites Louisiana State University Health Sciences Center (LSUHSC) and Moffitt Cancer Center (MCC) to advance translational research on cancer health disparities and to establish a Cancer Research Education Program (CREP). The CREP addresses a national priority to develop an educational training pipeline for one-on-one mentoring of undergraduates and medical students by a diverse group of LSUHSC and MCC faculty with unique expertise to conduct cancer health disparities research and outreach in underserved communities. The CREP supports 8-week internships providing: (1) hands-on summer research experiences; (2) a curriculum focusing on biobanking, precision medicine, and cancer health disparities; and (3) community outreach experiences in underserved communities. The curriculum includes web-based training modules, immersion experiences (e.g., biobank tour), professional development workshops, and learning activities (e.g., book and journal clubs). Data from the students' pre/post summative (impact/outcome) evaluations determine the acceptability and impact of these research and educational activities, students' knowledge, career aspirations, goal attainment, and their satisfaction based on nationally normed scales. Baseline and post-training data will be analyzed in August, at training completion, to assess program impact. Long-term yearly follow-up data will focus on the impact of CREP on student career trajectories. These data will help modify the CREP for years 2-4 of the SPIRIT-CHD. Seventy-five percent of the student participants in the first cohort were female. Students self-identified as Black/African American non-Hispanic (62.5%), White Hispanic (25%), and Asian non-Hispanic (12.5%). Student projects included genomic, immunologic, and cellular wet-lab research (analyzing proliferation of renal cell carcinoma, RNA sequencing and bioinformatics of Luminal B breast carcinomas, expression differences of polyamine enzymes in prostate cancer) and clinical studies (detection, prevention, and treatment of anal cancer in HIV-positive populations). Dry-lab projects focused on the analysis of Behavioral Risk Factor Surveillance System to assess policy-related trends in colorectal cancer screenings, studying the effectiveness of barbers as lay health educators for skin cancer prevention, and smoking cessation among Hispanics. CREP students also participated in cancer education outreach events to explain their projects to the communities at an elevated risk for certain types of cancer. This program has applicability to undergraduate and medical students nationwide on best practices for efficacious training in cancer health disparities, precision medicine, and biobanking. Ultimately, these efforts will enhance the diversity of the cancer research workforce, while contributing to the reduction of cancer health disparities. Citation Format: Fern Tsien, Paula Gregory, Gwendolyn Quinn, Vani N. Simmons, Z'Kera Sims, Megan E. Sutter, Ayesha Umrigar, Arnold H. Zea, Cathy Meade, Clement K. Gwede. The Cancer Research Education Program (CREP): Training the next generation of cancer health disparities researchers through the Southeast Partnership for Improving Research and Training in Cancer Health Disparities (SPIRIT-CHD) [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A065.

Differential Susceptibility to T Cell-Induced Colitis in Mice: Role of the Intestinal Microbiota.

One of the best characterized mouse models of the inflammatory bowel diseases (IBD; Crohn's disease, ulcerative colitis) is the CD4+CD45RBhigh T cell transfer model of chronic colitis. Following our relocation to Texas Tech University Health Sciences Center (TTUHSC), we observed a dramatic reduction in the incidence of moderate-to-severe colitis from a 16-year historical average of 90% at Louisiana State University Health Sciences Center (LSUHSC) to <30% at TTUHSC. We hypothesized that differences in the commensal microbiota at the 2 institutions may account for the differences in susceptibility to T cell-induced colitis. Using bioinformatic analyses of 16S rRNA amplicon sequence data, we quantified and compared the major microbial populations in feces from healthy and colitic mice housed at the 2 institutions. We found that the bacterial composition differed greatly between mice housed at LSUHSC vs TTUHSC. We identified several genera strongly associated with, and signficantly overrepresented in high responding RAG-/- mice housed at LSUHSC. In addition, we found that colonization of healthy TTUHSC RAG-/- mice with feces obtained from healthy or colitic RAG-/- mice housed at LSUHSC transferred susceptibility to T cell-induced colitis such that the recipients developed chronic colitis with incidence and severity similar to mice generated at LSUHSC. Finally, we found that the treatment of mice with preexisting colitis with antibiotics remarkably attenuated disease. Taken together, our data demonstrate that specific microbial communities determine disease susceptibility and that manipulation of the intestinal microbiota alters the induction and/or perpetuation of chronic colitis.

Correlation between motor function recovery and daily living activity outcomes after brachial plexus surgery.

To establish the correlation between clinical evaluation of motor function recovery and daily living activities in 30 patients with upper traumatic brachial plexus injury submitted to surgery. The score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Louisiana State University Health Sciences Center (LSUHSC) scale were determined in 30 patients. Epidemiologic factors were also examined and correlations were determined. There was a significant correlation between the clinical evaluation and the daily living activities after a 12-month period (r = 0.479 and p = 0.007). A direct correlation was observed between the functional recovery of the upper limb and the time between injury and surgery (r = 0.554 and p = 0.001). The LSUHSC scores (p = 0.049) and scores from the DASH questionnaire (p = 0.013) were better among patients who returned to work. Clinical evaluation and daily living activities in adult patients who underwent nerve transfer after brachial plexus injury showed significant and measurable improvements.

Educator Argues for Integrating Infant MH in Child Psychiatry Training

Educator Argues for Integrating Infant MH in Child Psychiatry Training

Head and neck cancer (HN) characteristics and outcomes in a human immunodeficiency virus infected (HIV+) patient cohort: A 12-year experience of the Louisiana State University Health Sciences Center (LSUHSC) and Charity Hospital in New Orleans.

6069 Background: HIV+ patients (pts) are typically excluded from enrollment on randomized clinical trials for head and neck cancer. Data regarding clinical characteristics and outcomes for HIV+ pts...

MH Care Benefits From Oil Spill Settlement

Back to table of contents Previous article Next article Community NewsFull AccessMH Care Benefits From Oil Spill SettlementAaron LevinAaron LevinSearch for more papers by this authorPublished Online:3 Aug 2012https://doi.org/10.1176/pn.47.15.psychnews_47_15_1-bAbstractUniversities in four states will expand mental health work-force capacity and provide services to people affected by the 2010 BP oil spill in the Gulf of Mexico, sharing a $36 million chunk of the $7.8 billion overall spill settlement.People directly affected by the aftermath of the 2010 BP oil spill in the Gulf of Mexico have higher rates of mental health symptoms than unexposed populations. A special fund created as part of the $7.8 billion legal settlement will go to provide therapeutic and supportive mental health services in the region.AP Photo/Michael SpooneybargerThe funds will go to the Mental and Behavioral Health Capacity Project, created by the settlement decree to provide therapeutic and supportive services in federally qualified health centers, other primary care clinics, and school-based programs in affected coastal communities.Under a formula based on needs and disparities, the Louisiana State University Health Sciences Center (LSUHSC) will get $14.4 million. Another $8.2 million each will go to the University of Southern Mississippi and the University of South Alabama. The University of West Florida will manage $5.8 million of the funds.The amounts will be distributed over five years and must be formally certified in a final court decree in November, Howard Osofsky, M.D., Ph.D., a professor and chair of psychiatry at LSUHSC, told Psychiatric News.LSUHSC researchers have conducted school-based surveys in the region since the aftermath of Hurricane Katrina in 2005 and community mental health needs assessments since the Gulf Oil Spill in 2010.“Both in 2010 and 2011, we found significant elevations in mental health symptoms in people directly affected by the spill, compared with those in the same areas not exposed,” said Osofsky.Local resources have been strained since many mental health professionals left the Gulf Coast area after Hurricane Katrina and did not return.At the University of Southern Mississippi (USM), the five-year grant will support 125 M.S.W. students and psychology trainees working in primary care settings and human service agencies.“The money will be used to increase access for community residents by adding training for people working in existing mental health programs and by training new ones,” said Timothy Rehner, Ph.D., a professor of social work in the USM School of Social Work in Hattiesburg and director of its Caribbean Studies Program.“We’ll start this summer by hiring a director for the program, then a trauma-focused faculty instructor, and then begin recruiting students,” said Rehner in an interview. “We can have the first group of 20 students by spring.”The University of West Florida (UWF) in Pensacola will train primary care clinicians, helping them make the doctor’s office a place to encourage discussion of mental health issues and set up follow-up appointments, said Glenn E. Rohrer, Ph.D., L.C.S.W., a professor at UWF and director of its School of Justice Studies and Social Work.“We want to get psychiatrists, psychologists, and social workers in as part of the training process and get the next generation thinking about integrated care,” said Rohrer.The project will move carefully to determine how communities can best benefit from the funds, said Osofsky. Initial efforts will be directed at discussions with local clinic personnel, schools, community providers, and others.The project team will spend time learning what people in coastal communities believe they need or don’t need, said Osofsky.“How can we cooperate with them and with professionals from other mental health disciplines?” he said. “We’re not there to tell them what to do.”Depending on those local needs, psychiatrists or advanced residents and other mental health professionals could make clinic visits to provide direct services, serve as consultants to primary care clinicians, offer telepsychiatry services, or provide training for schools and communities.“We plan to have direct 24-hour availability for primary care physicians to speak to a psychiatrist,” said Osofsky.In the long run, the project also hopes to increase the capacity of mental health care and primary care in the region and demonstrate how states, communities, and university-based clinicians can work collaboratively to improve mental health outcomes, he said.“However, the process has to be sustainable,” said Rohrer. “What can we do to prepare for the next disaster? And that is a matter of when, not if.” The settlement document covering the Mental and Behavioral Health Capacity Project of the Gulf Region Health Out-reach Program is posted at www.deepwaterhorizonsettlements.com/Documents/Medical%20SA/Ex14_Grant_Proposal_Mental_and_Behavioral_Health_Capacity_Project.pdf. ISSUES NewArchived

NICU Care in the Aftermath of Hurricane Katrina: 5 Years of Changes

Geographic circumstances: I was on duty in the NICU of a flooded downtown New Orleans hospital during Hurricane Katrina and returned to the NICU when it reopened. About the author: I am a professor of pediatrics and the division head of neonatology at Louisiana State University Health Sciences Center in New Orleans. With 7 dedicated and resilient colleagues, I practice neonatology at 4 area hospitals and am active in medical education. I spent 4 days in a flooded downtown New Orleans hospital immediately after Hurricane Katrina and have been involved in the evolution of hospital, local, and statewide hurricane-preparedness efforts as they relate to NICU patients. When I entered University Hospital on August 28, 2005, I did not realize how much the events of the next few days would change my life both personally and professionally. As division head of our 12-person Louisiana State University Health Sciences Center (LSUHSC) neonatology group, I was assigned to be the in-house attending at University Hospital; several of my colleagues were similarly moving into 1 of the other 8 local hospitals in which we provided neonatology care. University Hospital was the site for maternal-child services of the modern-day Charity Hospital, a series of hospitals that had survived various floods and fires over the years to provide indigent care in New Orleans dating back to 1736. The following morning, August 29, 2005, Hurricane Katrina would arrive and bring a massive storm surge that would breach an inferior levee system. More than 80% of New Orleans was covered by floodwater, including the area surrounding University Hospital. Katrina's wrath resulted in more than 1800 deaths and more than $80 billion in damage, and the greater New Orleans area was the site for most of these losses, including more than 700 deaths. The experiences and losses of thousands … Address correspondence to Brian M. Barkemeyer, MD, Division of Neonatology, Department of Pediatrics, LSU Health Sciences Center, 200 Henry Clay Ave, New Orleans, LA 70118. E-mail: bbarke{at}lsuhsc.edu

Behavioral and Recreational Risk Factors for Free‐Living Amebic Infections

Free‐living amebae of the genera Acanthamoeba , Balamuthia , Naegleria , and Sappinia are rare causes of infectious diseases in humans with the exception of Acanthamoeba keratitis (AK), which is reported in over 10,000 soft contact lens wearers annually worldwide. Unlike several Acanthamoeba species, which can cause both AK and granulomatous amebic encephalitis (GAE), only one species of Naegleria , Naegleria fowleri , is known to infect humans by causing an acute, fulminant, usually lethal, central nervous system (CNS) infection, known as primary amebic meningoencephalitis (PAM). 1–6 Both Acanthamoeba species and N fowleri are distributed worldwide; found commonly in freshwater; and have even been isolated from tap water, air conditioning systems, and improperly maintained swimming pools. 1–5 Balamuthia mandrillaris , formerly known as leptomyxid ameba, is another opportunistic, free‐living ameba. Like Acanthamoeba spp, B mandrillaris is capable of causing skin lesions and GAE in individuals with compromised or competent immune systems, who inhale infective spores or develop indolent, granulomatous skin lesions in soil‐contaminated wounds. Lastly, Sappinia pedata , a recently identified free‐living ameba that lives in soil and domestic animal feces, has caused a single case of non‐GAE in an immunocompetent Texas farmer. CNS infections caused by these ubiquitous organisms remain rare despite expanding world populations; but are, nevertheless, increasing today due to a combination of factors including increased freshwater recreational activities during heat waves for PAM, more immunocompromised individuals susceptible to GAE, and more soft contact lens wearers at risk of AK. 6,7 The purpose of this review will be to describe the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of free‐living amebic infections. In addition, United States Centers for Disease Control and Prevention (CDC) laboratory‐confirmed cases of PAM, B mandrillaris GAE, and AK will be analyzed statistically to determine significant risk factors for exposure and infection; and to … Corresponding Author: James H. Diaz, MD, MPH&TM, Dr PH, School of Public Health, Louisiana State University Health Sciences Center (LSUHSC) in New Orleans, 1615 Poydras Street, Suite 1400, New Orleans, LA 70112, USA. E‐mail: jdiaz{at}lsuhsc.edu

Nurses' experiences of responding to a health care disaster or adventitious crisis: a systematic review of qualitative evidence.

Review Question/Objectives The purpose of this systematic review is to systematically review and synthesise research literature reporting nurses’ experiences of responding to a health care disaster or adventitious crisis. This review aims to answer the following specific question: What are nurses’ experiences of responding to a health care disaster or adventitious crisis? Inclusion criteria Types of participants The review will consider publications that include registered nurses who have worked in a disaster, healthcare disaster, or adventitious crisis (e.g. flood, hurricane, earthquake, tsunami, volcanic eruption, terrorist attack) in the years 1945 through 2011. 5 Nurses that will be included in this study are licensed practical nurses, professional registered nurses, and advanced practice registered nurses. Phenomena of interest This review will examine the experiences of nurses in responding to a disaster, health care disaster, or adventitious crisis. Consideration will be given to, but not be limited to, the following challenges: • reporting to work • personal and family safety • dwelling in uncertainty • providing front line clinical care • changing standards of care in health care disasters or adventitious crisis • functioning with severely limited resources, communication • triaging and providing care in a range of settings • maintaining infection control • crisis debriefing • mental health sequelae Context Context will include a consideration of the cultural factors, including, but not limited to, geographic location, specific racial or ethnic considerations, gender based interests, detail about the setting (for example, acute care, primary health care, or the community) as they relate to the experiences reported in the studies.

Restoration of medical oncology services at Charity Hospital in New Orleans after Hurricane Katrina: A 2-year experience of the Louisiana State University Health Sciences Center (LSUHSC).

6025 Background: Oncology services at Charity Hospital were discontinued following Hurricane Katrina in August 2005. Displaced, uninsured and underinsured patients received cancer care throughout the United States in an ad hoc manner following the storm. Medical oncology and chemotherapy services resumed September 1, 2007; on-site radiation oncology remains unavailable. Demographic, clinical and displacement data of the re-established patient cohort were reviewed. Methods: We identified patients evaluated in the LSUHSC Oncology Clinics from September 1, 2007 to August 31, 2009. Data collected included: time from diagnosis of malignancy to initial oncology evaluation, insurance status, percentage displaced for 6 months or more due to Hurricane Katrina, ethnicity, referrals for radiation oncology and number outpatient clinical encounters (OCE) pre- and post-Hurricane Katrina. Results: 464 patients were evaluated in the study time period. 65% of patients had new cancer diagnoses and 35% re-established cancer care in the charity system. Mean time from new diagnosis to initial oncology evaluation was 59 days. 44% were insured by Medicaid, 13% by Medicare, 43% had no medical insurance. 34% were confirmed to be displaced for greater than six months. 62% were African- American and 25% Caucasian. 30% were referred to outside facilities for radiation oncology reimbursed by Medicaid or Charity Hospital. For fiscal years 2004 and 2005, there were 4468 OCE and 3348 OCE, respectively. There were 2439 OCE from 2007 to 2009, representing a 70% decline in patient volume following Hurricane Katrina. Conclusions: Oncology services for a minority-based, underinsured patient population were severely impacted by Hurricane Katrina. Following the storm, persistent system-wide resource limitations led to suboptimal timeliness of medical oncology evaluations. Health care systems serving underinsured patients require a disaster plan to minimize interruption of oncology care. Our experience illustrates the need for resources to ensure rapid re-establishment of care for economically disadvantaged patients following natural disasters. No significant financial relationships to disclose.

Mite‐Transmitted Dermatoses and Infectious Diseases in Returning Travelers

Mites are among the smallest arthropods with most barely visible without magnification. 1 Mites are closely related to ticks, but they are tissue‐juice feeders, not blood‐feeders, and do not transmit as broad a variety of infectious microbial diseases. 1 In fact, the only infectious diseases transmitted by mites are rickettsialpox and scrub typhus. 1 The most common ectoparasitic dermatoses caused by mites are chiggers and scabies. 1 Travelers are uniquely predisposed to contracting several mite‐transmitted dermatoses and infectious diseases including: (1) scabies mites from close personal contacts; (2) zoonotic scabies from domestic or wild animals and pets; (3) rickettsialpox from sleeping in or visiting mice‐infested dwellings; and (4) chiggers and scrub typhus after stumbling onto trombiculid larvae‐infested “mite islands” in endemic regions worldwide. This review will describe the epidemiology, clinical manifestations, and management of the most common mite‐transmitted dermatoses and infectious diseases in returning travelers. A MEDLINE search, 1966 to 2008, of the world's scientific literature of case reports, case series, original articles, reviews, and observational and longitudinal studies was conducted to determine the epidemiology, outcomes, clinical manifestations, preferred diagnostic interventions, and management for mite‐transmitted dermatoses and infectious diseases in returning travelers. In addition, a clinical classification of mite‐transmitted infestations and infections was developed to assist clinicians in assessing potential mite‐transmitted skin and systemic infectious diseases in travelers. ### Classification of Mites and Disease Ecology of Mite‐Transmitted Dermatoses and Infectious Diseases Mite infestations and infections were classified into the following distinct clinical and etiological categories: (1) the mite‐transmitted dermatoses caused by human mites: scabies and follicle mite infestations (also known as demodecidosis or demodicosis); (2) the mite‐transmitted dermatoses caused by non‐human mites: chiggers, zoonotic scabies, animal and plant and plant insect mite infestations, and dust mite allergies; and (3) the mite‐transmitted systemic infectious diseases: scrub typhus and rickettsialpox (Table 1). Only two non‐human, animal mites may transmit infectious diseases: (1) chiggers or trombiculid … Corresponding Author: James H. Diaz, MD, MPH&TM, Dr PH, Schools of Medicine and Public Health, Louisiana State University Health Sciences Center (LSUHSC), 1615 Poydras Street, Suite 1400, New Orleans, LA 70112, USA.E‐mail: jdiaz{at}lsuhsc.edu

MANAGEMENT OF ONE HUNDRED SEVENTY-ONE OPERATIVE AND NONOPERATIVE OBSTETRICAL BIRTH PALSIES AT THE LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER

The management of obstetrical brachial plexus injury, often called birth palsy, remains one of the most controversial topics in pediatric neurosurgery. Most birth palsies have acceptable spontaneous recoveries, whereas only a minority require surgical intervention. A selective approach for surgery was used in this Louisiana State University Health Sciences Center (LSUHSC) series, for which the operative rate was 9%. At LSUHSC, the patient with obstetrical brachial plexus injury is followed for 6 to 9 months before surgery, which is performed if there is no satisfactory biceps and/or shoulder function. This is a retrospective analysis of 169 patients with 171 palsies referred to LSUHSC for possible surgery. There were 76 patients with 77 birth palsies managed operatively and nonoperatively at LSUHSC between 1975 and 1991. An additional 93 patients with 94 palsies who were managed between 1992 and 2003 were included in this analysis. The results of initial and follow-up examinations using Eng's criteria for impairment ratings (IRs) were available for 151 of 171 (88%) nonoperative and operative obstetrical brachial plexus injuries managed between 1975 and 2001. Fifty-two percent of the nonoperative patients evaluated at an initial visit had an IR of 4 or 5, which represents very poor function by comparison to IR of 1 in the Eng scale, which represents almost no abnormality. The percentage of patients in this category (4-5) improved to 30% after follow-up visits. For the 16 operative cases, the initial and follow-up percentages of patients with IRs of 4 or 5 were 67% and 22%, respectively. Ultimately, 47% of the nonoperative patients achieved a grade 2 IR after follow-up compared with 17% of the operative patients. Using this selective approach at LSUHSC, in which the operative rate was 9%, acceptable outcomes were obtained both in patients not having surgery and also in those having surgical intervention.

NERVE TRANSFER SURGERY FOR ADULT BRACHIAL PLEXUS INJURY

To review the clinical outcomes in our patients who have undergone nerve transfer operations for brachial plexus reconstruction at the Louisiana State University (LSU) over a 10-year period. A secondary objective is to compare clinical outcomes in patients who had only nerve transfer operations as compared with patients whose nerve transfers were supplemented with direct repair of brachial plexus elements. Retrospective review of the medical records, imaging, and electrodiagnostic studies (electromyographic and nerve conduction studies) of patients with brachial plexus injuries who underwent nerve transfer operations at LSU over a period of 10 years. A total of 81 patients were treated between 1995 to 2005 at the LSU Health Sciences Center; 7 of these patients were lost to follow-up, leaving 74 patients, with an average follow-up of 3.5 years, for review. We evaluated recovery of elbow flexion and shoulder abduction. Ninety percent of patients with medial pectoral to musculocutaneous nerve transfers recovered to LSU grade 2 (Medical Research Council grade 3), and 60% of those patients with intercostal to musculocutaneous nerve transfer regained similar strength in elbow flexion. Shoulder abduction recovery to LSU grade 2 (Medical Research Council grade 3) after spinal accessory to suprascapular and/or thoracodorsal to axillary nerve transfer, was 95% and 36%, respectively. There was a tendency for better motor recovery when nerve transfer operations were combined with direct repair of plexus elements. Nerve transfers for repair of brachial plexus injuries result in excellent recovery of elbow and shoulder functions. Patients who had direct repair of brachial plexus elements in addition to nerve transfers tended to do better than those who had only nerve transfer operations.

UPPER-EXTREMITY PERIPHERAL NERVE INJURIES

Data from three Louisiana State University Health Sciences Center (LSUHSC) publications were summarized for median, radial, and ulnar nerve injuries. Lesion types, repair techniques, and outcomes were compared for 1837 upper-extremity nerve lesions. Sharp laceration injury repair outcomes at various levels for median and radial nerves were equally good (91% each) and better than those for the ulnar nerve (73%). Secondary suture and graft repair outcomes were better for the median nerve (78% and 68%, respectively) than for the radial nerve (69% and 67%, respectively) and ulnar nerve (69% and 56%, respectively). In-continuity lesions with positive nerve action potentials during intraoperative testing underwent neurolysis with good results for the median (97%), radial (98%), and ulnar nerves (94%). For radial, median, and ulnar nerve in-continuity lesions with negative intraoperative nerve action potentials, good results occurred after suture repair in 88%, 86%, and 75% and after graft repair in 86%, 75% and 56%, respectively. Good outcomes after median and radial nerve repairs are attributable to the following factors: the median nerve's innervation of proximal, large finger, and thumb flexors; and the radial nerve's similar innervation of proximal muscles that do not perform delicate movements. This is contrary to the ulnar nerve's major nerve supply to the distal fine intrinsic hand muscles, which require more extensive innervation. The radial nerve also has a motor fiber predominance, reducing cross-motor/sensory reinnervation, and radial nerve-innervated muscles perform similar functions, decreasing the chance of innervation of muscles with opposite functions.

LOWER-EXTREMITY PERIPHERAL NERVE INJURIES

With the use of data from 3 Louisiana State University Health Sciences Center (LSUHSC) publications, various parameters for buttock/thigh-level sciatic nerve and tibial and common peroneal divisions/nerve injuries were summarized, and outcomes were compared. Data from 806 buttock/thigh-level sciatic nerve and tibial and common peroneal division/nerve injury repairs were summarized. Lesion types, repair techniques, and outcomes were compared. Acute lacerations undergoing suture repair were best for the thigh-then-buttock-level tibial (93%/73%) and then same-level common peroneal divisions (69%/30%); at the knee level, tibial outcomes (100%) were better than those for the common peroneal nerve (CPN) (84%). Secondary graft repairs for lacerations had good outcomes for the thigh-then-buttock-level tibial (80%/62%), followed by common peroneal divisions at the same levels (45%/24%). The knee/leg-level tibial nerve (94%) did better than the CPN (40%) here. In-continuity lesions with positive intraoperative nerve action potentials underwent neurolysis with better results for the thigh-then-buttock-level tibial division (95%/86%) than for same-level CPN (78%/69%). The knee/leg-level tibial nerve did better than the CPN (95%/93%). Better recovery of buttock- and thigh-level tibial division/nerve occurs because: 1) the CPN is lateral and thus vulnerable to a more severe injury; 2) the tibial nerve is more elastic at impact owing to its singular-fixation site (the CPN has a dual fixation); 3) the tibial nerve has a better blood supply and regeneration; 4) the tibial nerve has a higher force-absorbing fascicle/connective tissue count than the CPN; and 5) the tibial nerve-innervated gastrocnemius soleus requires less reinnervation for functional contraction than deep peroneal branches, which innervate long, thin extensor muscles at multiple sites and require coordinated nerve input for effective contraction.

Should Distance Technology Be Used to Educate NP Students?

Roxanna Smith Thomas, BSN, CCRN, FNP-S, is a nurse practitioner who completed her MSN as a family health nurse practitioner from Louisiana State University Health Sciences Center (LSUHSC) in New Orleans. She is a graduate from the BSN program at Northwestern State University in Shreveport, Louisiana. She has had a wide variety of professional experience in the medical intensive care unit at the LSUHSC in Shreveport since 2001. She also is a member of AACN, AANP, and LANP and an active participant in various professional organizations.

Changes in Undergraduate Medical Education, Admissions, and Student Outcomes at LSU School of Medicine: Three Years After Katrina

Much has been written about the effects of Hurricane Katrina on the Louisiana State University Health Sciences Center (LSUHSC) School of Medicine in New Orleans1–4 and the importance of disaster planning for all medical schools. As we approach Katrina’s third anniversary, it is useful to reflect on the storm’s longer term effects on the school. This brief report summarizes the current status of our admissions process and undergraduate medical education curriculum. Pre-Katrina (July 2005) and immediate post-Katrina (July 2006) measures are used as benchmarks for comparison.

The Long Road Home: Rebuilding Public Inpatient Psychiatric Services in Post-Katrina New Orleans

In August 2006, a year after Hurricane Katrina, the first acute inpatient public psychiatric unit for adults was opened in New Orleans to serve patients referred from local emergency departments. This article describes the clinical and administrative experiences of providing inpatient care in post-Katrina New Orleans, including the increased demand for programs to treat patients with co-occurring disorders, the expanded scope of practice for psychiatrists to include primary care, and ongoing staff shortages in a traumatized and displaced workforce. Lessons learned in regard to disaster planning and recovery are also discussed.

Little Rebuilding Evident in New Orleans MH System

Little Rebuilding Evident in New Orleans MH System

Post Katrina: the story of the LSUHSC School of Nursing.

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER (LSUHSC) SCHOOL OF NURSING HAS A REMARKABLE STORY TO TELL. Hurricane Katrina blew through New Orleans in August zoo j, followed by a breach in the levees that effectively destroyed 80 percent of our beloved, cany city. As the world watched in horror, people abandoned their homes, their work, and all that constituted normal life. * Post Katrina, it has taken extraordinary effort by many people to regain some elements of normalcy for a city that is by no means repaired and restored. This article tells how, in those early days after the hurricane, nursing education kept on course within the LSUHSC system and how, surprisingly, the catastrophe provided a unique opportunity to plan a refashioned school of nursing. Making Do in Baton Rouge Although all LSUHSC buildings in New Orleans were forced to close for repairs, the six schools of the health sciences centers reopened on September 26, 2005, at our Baton Rouge flagship campus. Ninety-six percent of our students showed up. In efforts to educate our students in Baton Rouge and on other campuses across the state, logistics were daunting. LSU set up a telephone call-in service and established a website that had 2.5 millions hits within days. The Pete Maravich basketball stadium on the Baton Rouge campus was converted into a MASH unit. Staffed almost entirely by volunteers, it briefly became the largest acute care hospital in the country, processing 6,000 patients and triaging 15,000 others with special needs. Faculty slowly trickled into Baton Rouge, and it became possible to begin the process of organizing temporary structures for classrooms and housing. Housing was the most critical issue. Funds from FEMA allowed LSUHSC to hire a recently refurbished Finnish ferry, that normally crossed the Baltic Sea, as home for faculty, staff, and students. Buses were arranged to take students to class, and two meals each day, dinner and breakfast, were provided from the moored, stationary ship, where one could watch the Mississippi River roll inexorably downstream. Finding classroom space and clinical sites presented a major challenge. For an entire academic year, undergraduates had all their lectures before 11 am in a movie theatre where the aroma of popcorn was pervasive, the air was stuffy and stale, and the LCD player perched precariously on a seat in the back row. It was an odd experience to teach in a movie theater. We felt dwarfed by our PowerPoints, which loomed overhead on a huge screen, while with no place to put material we did an odd sort of juggling dance to follow our own notes, manage the PowerPoint, and ensure that our students remained engaged. Fortunately, Southeastern Louisiana University (SLU) lent us space for monthly Friday evening and Saturday classes for our graduate students. SLU also provided lab space, allowed us to place a librarian in their library, and made space available for a few faculty meetings. We were made to feel welcome, but it wasn't our home. Clinical sites were a different story. With scrambling, and the willingness to drive considerable distances and use both evening and night shifts, we were able to patch together sufficient sites. Nurse practitioners in various agencies helped us out, offering to become temporary part-time faculty for clinical supervision. The senior administration determined that all our health disciplines would continue to provide education to our student body. We had been undergoing undergraduate curriculum revision for some time and had just initiated a second-degree, accelerated baccalaureate program. Plus, we had begun development of a doctor of nursing practice program. The disruption provided the impetus to look at things in new ways. We had to be creative and willing to do things differently. We brought all changes to the Louisiana State Board of Nursing. The board, which also had to relocate to Baton Rouge and understood our difficulties and our needs, was willing to work with us, provided we kept them informed. …