Browsing by Author "Perkins, Susan"
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Item Activities of Daily Living Recovery in Home Health Patients with Diabetes(Oxford University Press, 2023-12-21) Webster-Dekker, Katelyn; Lu, Yvonne; Perkins, Susan; Ellis, Jennifer; Otis, Laurie; Winton, Rebecca; Hacker, Eileen; School of NursingOlder adults with diabetes are at high risk for impairments in their ability to perform activities of daily living (ADLs). Home health (HH) services help patients regain their ability to perform ADLs after being hospitalized, but there may be disparities in degree of ADL improvement based on characteristics such as race/ethnicity. We aimed to identify factors associated with improvements in ADLs from the start of HH care to discharge in older adult (age ≥65) patients with diabetes receiving HH. This secondary analysis used Outcome and Assessment Information Set-D data collected between October 1, 2021, and March 31, 2022 in the Southern U.S by a HH agency. We used multiple linear regression to examine factors associated with improvement in ADL performance. The sample (n=1350) was 55% female and 76% White, with a mean age of 76.3 (SD 7.3). Ninety-seven percent of patients improved their ADL score from start of HH care to discharge. Black/African American race (b= -0.33) and having bowel incontinence or an ostomy (b= -0.51) were associated with less ADL improvement. Having a caregiver who needed training/support (b= 0.44) or was unlikely to provide assistance (b= 0.78), the presence of a surgical wound (b= 0.52), pain that interfered with activity (b= 0.46), confusion (b= 0.30), and better scores in prior functioning (b= 0.13) at the start of HH were associated with greater improvement in ADLs upon discharge from HH. These findings require further investigation, but indicate Black patients experienced disparities in ADL improvement which should be addressed.Item Associations between COVID-19 perceptions, anxiety, and depressive symptoms among adults living in the United States(2021-09) Wierenga, Kelly L.; Moore, Scott E.; Pressler, Susan; Hacker, Eileen; Perkins, SusanBackground: Associations among illness perceptions of viruses, anxiety and depression symptoms, and self-management decisions, such as mask-wearing, are critical to informing public health practices to mitigate the short- and long-term consequences of the SARS-CoV-2 viral pandemic. Purpose: Guided by the common-sense model of self-regulation, this observational study examined associations among illness perceptions of COVID-19, anxiety, and depression symptoms among community-dwelling adults. Method: Data were collected from 1380 adults living in the United States early in the pandemic (03-23-2020 to 06-02-2020). Participants completed online surveys. Analyses were conducted using descriptive statistics and correlations. Findings: While increased anxiety symptoms were associated with less perceived personal control, greater concern, and higher emotional responsiveness, increased depression symptoms were related to lower concern as well as greater emotional responsiveness and perceived consequences of the pandemic. Discussion: Associations among illness perceptions, anxiety, and depression symptoms may impact viral spread mitigation behavior adoption.Item Daily Engagement in Meaningful Activity for Home Care Patients with Subjective Cognitive Decline and Caregivers(Oxford University Press, 2023-12-21) Lu, Yvonne; Ellis, Jennifer; Perkins, Susan; Hickman, Susan; Chang, Pei-Shiun; Haase, Joan; Otis, Laurie; Winton, Rebecca; School of NursingPatients with subject cognitive decline (SCD) often lose sense of control, disengage from meaningful activities, and have less confidence in their ability to manage daily challenges. The objectives of pragmatic pilot phase study were to evaluate the feasibility and benefits of a Daily Engagement in Meaningful Activity Professional (DEMA-Pro) for patients with SCD; and explore nurses’ experience of DEMA-Pro implementation. Forty-nine patients at four home healthcare sites received six weekly DEMA-Pro telephone sessions. The Outcome and Assessment Information Set-D were collected at starting date (pre-intervention) and discharge date (post-intervention). Quantitative surveys and qualitative focus group methods were used to explore the DEMA-Pro nurses (n = 3) experiences. The consent rate was 67.1%, the completed intervention rate 36.7%, and the partial completed intervention rate 25.5%. For 36 subjects with discharge data available, both IADLs and self-care scores improved (d = 3.11 and d = 2.66, respectively). Specifically, those that completed all DEMA-Pro sessions (n=14), partial completers (n=12), and non-completers (n=10), had improved scores on IADLs (d = 4.0, 4.2, and 2.5, respectively) and Self-Care (d = 3.7, 3.1 and 2.0, respectively). Completers had greater improvement than non-Completers for both outcomes and greater improvement on IADLs than partial completers (all p-values < 0.03). Nurses reported high satisfaction with their training, and high confidence that the implementation of the intervention met patient and caregiver needs. The DEMA-Pro has shown benefits and feasibility that will need further testing in a large pragmatic trial in homecare settings.Item Dependence receptor UNC5A restricts luminal to basal breast cancer plasticity and metastasis(BMC, 2018-05-02) Padua, Maria B.; Bhat-Nakshatri, Poornima; Anjanappa, Manjushree; Prasad, Mayuri S.; Hao, Yangyang; Rao, Xi; Liu, Sheng; Wan, Jun; Liu, Yunlong; McElyea, Kyle; Jacobsen, Max; Sandusky, George; Althouse, Sandra; Perkins, Susan; Nakshatri, Harikrishna; Surgery, School of MedicineBACKGROUND: The majority of estrogen receptor-positive (ERα+) breast cancers respond to endocrine therapies. However, resistance to endocrine therapies is common in 30% of cases, which may be due to altered ERα signaling and/or enhanced plasticity of cancer cells leading to breast cancer subtype conversion. The mechanisms leading to enhanced plasticity of ERα-positive cancer cells are unknown. METHODS: We used short hairpin (sh)RNA and/or the CRISPR/Cas9 system to knockdown the expression of the dependence receptor UNC5A in ERα+ MCF7 and T-47D cell lines. RNA-seq, quantitative reverse transcription polymerase chain reaction, chromatin immunoprecipitation, and Western blotting were used to measure the effect of UNC5A knockdown on basal and estradiol (E2)-regulated gene expression. Mammosphere assay, flow cytometry, and immunofluorescence were used to determine the role of UNC5A in restricting plasticity. Xenograft models were used to measure the effect of UNC5A knockdown on tumor growth and metastasis. Tissue microarray and immunohistochemistry were utilized to determine the prognostic value of UNC5A in breast cancer. Log-rank test, one-way, and two-way analysis of variance (ANOVA) were used for statistical analyses. RESULTS: Knockdown of the E2-inducible UNC5A resulted in altered basal gene expression affecting plasma membrane integrity and ERα signaling, as evident from ligand-independent activity of ERα, altered turnover of phosphorylated ERα, unique E2-dependent expression of genes effecting histone demethylase activity, enhanced upregulation of E2-inducible genes such as BCL2, and E2-independent tumorigenesis accompanied by multiorgan metastases. UNC5A depletion led to the appearance of a luminal/basal hybrid phenotype supported by elevated expression of basal/stem cell-enriched ∆Np63, CD44, CD49f, epidermal growth factor receptor (EGFR), and the lymphatic vessel permeability factor NTN4, but lower expression of luminal/alveolar differentiation-associated ELF5 while maintaining functional ERα. In addition, UNC5A-depleted cells acquired bipotent luminal progenitor characteristics based on KRT14+/KRT19+ and CD49f+/EpCAM+ phenotype. Consistent with in vitro results, UNC5A expression negatively correlated with EGFR expression in breast tumors, and lower expression of UNC5A, particularly in ERα+/PR+/HER2- tumors, was associated with poor outcome. CONCLUSION: These studies reveal an unexpected role of the axon guidance receptor UNC5A in fine-tuning ERα and EGFR signaling and the luminal progenitor status of hormone-sensitive breast cancers. Furthermore, UNC5A knockdown cells provide an ideal model system to investigate metastasis of ERα+ breast cancers.Item Epilepsy care delivery during COVID-19 in resource limited countries: A survey in collaboration with International Epilepsy Equity Group(Elsevier, 2023-01) von Gaudecker, Jane; Clarke, Dave; Perkins, Susan; Ali, Amza; Sanjuan, Daniel; Vidaurre, JorgeBackground: The impact of the pandemic has had worse effects in countries with already stretched healthcare resources. The study aim was to explore changes in epilepsy care delivery in resource-limited countries during and since the acute phase of the COVID-19 pandemic. Method: A cross-sectional survey was conducted in 22 countries among health care providers (HCPs) caring for persons with epilepsy (PWE), in collaboration with newly formed global collaborators, the International Epilepsy Equity Group. Findings were compared based on World Bank Ranking (WBR) and HCPs’ practice type. Data were analyzed using Chi-square tests (α= 0.05) and pairwise multiple comparisons with α= 0.017 (Bonferroni adjustment). Open-ended responses were analyzed using thematic analysis. Findings: A total of 241 HCPs participated in the study. Of these, 8.30%, 65.98%, and 21.99% were from high-income (HIC), upper-middle-income (UMIC), and lower-middle-income countries (LMICs), respectively. Among HCPs, 31.12% were adult specialists, and 43.98% were pediatric specialists. During the acute phase of the pandemic, HCPs reported that the major barrier for PWE was difficulty reaching physicians/healthcare providers. Except for difficulty reaching physicians/healthcare providers (WBR P=0.01 HICItem Indiana Center for Breast Cancer Research(Office of the Vice Chancellor for Research, 2014-04-11) Nakshatri, Harikrishna; Gilley, David P.; Wells, Clark D.; Nephew, Kenneth; Radovich, Milan; Guise, Theresa; Bales, Casey; Perkins, Susan; Badve, Sunil; Vladislav, Ioan Tudor; Miller, KathyThe mission of IUPUI breast cancer signature center is to address prevention, early detection, and treatment of breast cancer through translational projects, supportive cores, and synergistic programs. This poster details our efforts improve resources for breast cancer research and efforts to develop multi-PI investigator proposals. The Signature Center has developed two web resources: the Breast Cancer Prognostics Database (PROGgene) to study prognostic implications of genes of interest in publically available breast cancer databases and PROGmiR, a microRNA database. The PROGgene can be used to study overall, recurrence free and metastasis free survival in large patient series. PROGmiR allows investigators to study the prognostic importance of microRNAs. Both PROGgene and PROGmiR have recently been published and accessed by investigators from >10 countries. The signature center has also devoted considerable efforts in developing tumor tissue resource. Tissue Bank includes a total sample of N = 600 cases with 30% non-Caucasian cases. Currently 460 cases have been assembled into a Tissue Microarray with clinical and follow up data. Expression pattern of AP2γ, a potential marker of breast cancer progression, has been analyzed in a TMA with ~170 cases. The breast cancer signature center has funded four pilot projects and projects for the fourth round of funding are currently under review. Drs. Clark Wells received funding for the project “Histologic Analysis of the Protein Levels of Amot130, AmotL1 and YAP in Normal, Hyperplastic and Invasive Breast Cancer Tissues”, which resulted in a publication in PNAS. Dr. David Gilley and his group received funding for the project: “Luminal mammary progenitors are a unique site of telomere dysfunction”, which was published in Stem Cell Reports. In the third project, Dr. Theresa Guise is investigating the mechanisms of cancer-associated muscular dysfunction with a future plan for a clinical trial. Drs. Ken Nephew and Milan Radovich received funding to obtain preliminary results for a multi-PI R01 or P01, which will explore genomics and epigenomics of breast cancer using clinical trial materials. Progress made by the signature center was integral in our request to Vera Bradley Foundation for Breast Cancer. This foundation has recently committed $15 million for the breast cancer program, which will be used to develop three themes of research with a focus on personalized therapies to improve outcome in breast cancer patients.Item Interventions to Promote Colorectal Cancer Screening in Primary Care: Results of a Randomized Trial(Office of the Vice Chancellor for Research, 2013-04-05) Rawl, Susan M.; Christy, Shannon M.; Perkins, Susan; Tong, Yan; Krier, Connie; Wang, Hsiao-Lan; Champion, Victoria L.; Myers, Laura Jones; Imperiale, Thomas; Willis, Deanna; Rhyant, Broderick; Springston, Jeffrey; Skinner, Celette SuggAims: The purpose of this randomized trial was to compare rates of self-reported colorectal cancer (CRC) screening and forward movement in stage of adoption at 6 months post-intervention. African American primary care patients (n=595) who were eligible for CRC screening were randomly assigned to receive a computer-delivered tailored CRC screening intervention (n=286) or a non-tailored screening brochure (n=309) prior to their scheduled visit with their primary care provider. Hypotheses were that differences between groups would be observed in proportions of patients who: 1) completed fecal occult blood tests (FOBT) or colonoscopy; and 2) had moved forward in stages of adoption for these tests. Methods: Participants completed baseline and 6-month telephone interviews; interventions were delivered prior to primary care provider visits. Differences between groups were examined using chi-square tests, predictors of screening were determined using logistic regression models. Results: In the computer-tailored group, the FOBT completion rate was 12.6% compared to 7.8% in the brochure group (p=0.05). The colonoscopy completion rate was 17.5% in the computer group vs. 15.2% in the brochure group (p=0.45). Forward stage movement for FOBT was observed in 28.4% of the computer groups vs. 20.8% in the brochure group (p=0.03). Forward stage movement for colonoscopy was 38.5% in the computer group and 36.8% (p=0.68) in each group, respectively. Conclusions: The computer-tailored intervention was more effective than the brochure at increasing FOBT completion and movement toward action. More research is needed to explain why the tailored intervention was not more effective at increasing colonoscopy completion and to identify moderators of intervention efficacy.Item Primary Care Patients Who Complete Colonoscopy after Referral and Those Who Do Not: Are they Different?(Office of the Vice Chancellor for Research, 2014-04-11) Olofinkua, Oluwakemi Blessing; Rawl, Susan M.; Habermann, Barbara; Christy, Shannon M.; Perkins, Susan; Tong, Yan; Gebregziabher, Netsanet; Mabis, Michelle; Krier, Connie; Mirchandani, Amit; Fatima, HalaUp to 50% of people in one safety net hospital in the Midwest who received a recommendation for colonoscopy from their healthcare provider failed to complete the test. Research is needed to understand the complex interplay between individual, social, and health care systems and their influence on colonoscopy completion. The purpose of this study was to compare people who completed colonoscopy after receiving a referral with those who did not on demographic and clinical characteristics, CRC knowledge, and health beliefs (perceived risk, perceived benefits, perceived barriers). Quantitative data were collected via telephone interviews from 90 patients; 46 who completed colonoscopy and 44 non-completers. In-depth interviews were conducted with 42 participants to examine perceptions of barriers and facilitators to test completion. Data were analyzed using two-sample t-tests, chi-square tests, Fisher’s exact tests and content analysis. People who completed colonoscopy had a higher mean CRC knowledge score (p=.0008), and a smaller proportion had hypertension (p=.03). No group differences in perceived risk (p=0.81), perceived benefits (p=0.66), and perceived barriers scores (p=0.24) were observed. Non-completers frequently reported that life events interfered with their ability to keep their appointments. While receipt of a provider recommendation is the most important predictor of CRC screening, results showed that receipt of a recommendation with immediate referral to an endoscopist and automatic colonoscopy appointment-making were not sufficient to insure test completion. Education and tailored counseling about the need for and benefits of colonoscopy, along with reminders and tangible assistance to complete the test in the context of competing demands, may be required to increase completion rates.Item Randomized double-masked controlled trial of cognitive training in breast cancer survivors: a preliminary study(Springer, 2022) Von Ah, Diane; McDonald, Brenna C.; Crouch, Adele D.; Ofner, Susan; Perkins, Susan; Storey, Susan; Considine, Robert; Unverzagt, Fred; Radiology and Imaging Sciences, School of MedicinePurpose: To evaluate the acceptability, satisfaction, and preliminary efficacy of cognitive training for improving cognitive function and health outcomes in breast cancer survivors (BCS). Patients and methods: BCS enrolled in this 2-group randomized, double-masked controlled trial of cognitive training. Primary outcomes included the acceptability and satisfaction of the interventions. Secondary outcomes included examining the effect size and reliable improvement of perceived cognitive function and health outcomes, including work ability, health perception (status and change), and quality of life. Exploratory outcomes were performance on neuropsychological tests and plasma levels of brain-derived neurotropic factor (BDNF). Data were collected at baseline and immediately post-intervention. Using ANCOVA models, the intervention was compared to attention control while adjusting for covariates and baseline values. The effect sizes for differences in means and the reliable improvement percentage were reported. Results: Thirty-six BCS completed the study and were on average 57.6 (SD = 8.0) years old, 59.4% Caucasian, and had some college education (74.5%). Both programs were reported to be satisfactory and acceptable. Non-significant small effect sizes were noted for the intervention on cognitive abilities (d = 0.26) and cognitive concerns (d = - 0.32), with reliable improvement noted in 32% and 28% of BCS, respectively. Small to medium effect sizes were noted in improvement in work ability (d = 0.37) and health perception status (d = 0.30) and change (d = 0.60, p < 0.05). Conclusions: Cognitive training was acceptable to BCS and resulted in improvement in perceived cognitive function and perceptions of "real-world" health benefits. A larger randomized controlled trial is warranted to determine its effectiveness for objective cognitive performance.Item Risk of Lower Extremity Amputation Revision in Patients with Peripheral Vascular Disease Adjusting for a Competing Risk of Death(2019-08) Severance, Sarah Elizabeth; Bakoyannis, Giorgos; Yiannoutsos, Constantin; Perkins, Susan; Katz, BarryObjectives: The aims of this study are to estimate the cumulative incidence of lower extremity amputation (LEA) revision and reamputation adjusting for a competing risk of death, estimate the one-year event-free mortality rates for patients with peripheral vascular disease undergoing LEA, and develop predictive models for LEA revision and reamputation adjusting for a competing risk of death. Methods: This was a retrospective review of the prospectively collected Vascular Quality Initiative (VQI) registry between 2013 and 2018. Adults undergoing unilateral LEA were included. Demographics, comorbidities, medications, smoking status, history of vascular procedures and revascularization attempts, and procedure urgency were considered. Models to predict LEA revision and reamputation were developed using multivariable regression on the interval-censored competing risks data using semiparametric regression on the cumulative incidence function. Results: The cumulative incidences of LEA revision and revision-free mortality within one year of index amputation are 14.9% and 15.5% respectively. Patient BMI, smoking status, aspirin use, history of revascularization, and level of planned LEA are significantly associated with the odds of LEA revision. Age, amputation urgency, dialysis, and level of planned LEA are associated with the one-year odds of revision-free mortality. A patient receiving an index above knee amputation (AKA) has 61% lower odds of LEA revision (p < 0.0001) but 51% higher odds of revision-free mortality following LEA (p < 0.0001). Previous revascularization procedures increase the odds of revision by 23% (p < 0.0001). The cumulative incidences of reamputation and one-year reamputation-free mortality following LEA are 11.5% and 16.9% respectively. Urgency of the procedure, history of revascularization procedures, and level of planned LEA are statistically associated with the odds of reamputation when adjusting for the competing risk of death. Patients receiving index AKA have 62% lower odds of reamputation (p < 0.0001) compared to BKA. Dialysis is the strongest predictor of one-year mortality (OR 2.576, p < 0.0001). Conclusions: Patients with appropriately managed PVD, which still progresses to amputation have higher odds of LEA revision and reamputation. Revision risk can be predicted and compared on the basis of patient factors and the planned index amputation.