Carol L Howe

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Journals/Publications

• Bland, V. L., Heatherington-Rauth, M., Howe, C., Going, S. B., & Bea, J. W. (2020). Association of objectively measured physical activity and bone health in children and adolescents: a systematic review and narrative synthesis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA.
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  The influence of day-to-day physical activity on bone in adolescence has not been well characterized. Forty articles were identified that assessed the relationship between accelerometry-derived physical activity and bone outcomes in adolescents. Physical activity was positively associated with bone strength in peri-pubertal males, with less consistent evidence in females. Physical activity (PA) is recommended to optimize bone development in childhood and adolescence; however, the influence of day-to-day PA on bone development is not well defined. The aim of this review was to describe the current evidence for objectively measured PA on bone outcomes in healthy children and adolescents. MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, CINAHL, PsycInfo, and ClinicalTrials.gov were searched for relevant articles up to April 2020. Studies assessing the relationship between accelerometry-derived PA and bone outcomes in adolescents (6-18 years old) were included. Two reviewers independently screened studies for eligibility, extracted data, and rated study quality. Forty articles met inclusion criteria (25 cross-sectional, 15 longitudinal). There was significant heterogeneity in accelerometry methodology and bone outcomes measured. Studies in males indicated a significant, positive relationship between moderate to vigorous PA (MVPA) and bone outcomes at the hip and femur, particularly during the peri-pubertal years. The results for MVPA and bone outcomes in females were mixed. There was a paucity of longitudinal studies using pQCT and a lack of data regarding how light PA and/or impact activity influences bone outcomes. The current evidence suggests that objectively measured MVPA is positively associated with bone outcomes in children and adolescents, especially in males. However, inconsistencies in methodology make it difficult to determine the amount and type of PA that leads to favorable bone outcomes. Given that the majority of research has been conducted in Caucasian adolescents, further research is needed in minority populations.
• Follis, S., Chen, Z., Mishra, S., Howe, C. L., Toosizadeh, N., & Dohm, M. (2020). Comparison of Wearable Sensor to Traditional Methods in Functional Outcome Measures: A Systematic Review. Journal of orthopaedic research : official publication of the Orthopaedic Research Society.
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  Traditional methods of collecting functional outcome measures are widely used for lower extremity arthroplasty outcome assessment. Wearable sensors are emerging as viable tools for functional outcome measures in monitoring of post-arthroplasty recovery. The objective of this review was to compare the efficacy of wearable sensors with traditional methods for monitoring post-arthroplasty functional recovery. Articles were searched for inclusion in this review that used both traditional and wearable sensor functional outcome measures to assess lower-extremity function before and after lower extremity arthroplasty. Two independent screeners reviewed all articles, and resolved differences through consensus and consultation with the senior author. Studies that met inclusion criteria were evaluated for methodologic quality using performed risk of bias assessments. Results from several traditional and wearable sensor functional outcome measures from baseline through follow-up were normalized across studies. Fourteen articles met inclusion criteria. Six studies used statistical methods to directly compare functional outcome measures, and eight studies used qualitative description of comparisons. This review found evidence that wearable sensors detected nuanced functional outcome information on the specific biomechanics and timing of recovery, which were unaccounted for using traditional methods.Wearable sensors have shown promising utility in providing additional recovery information from lower extremity arthroplasty compared with traditional functional outcome measures, but future research is needed to assess the clinical significance of this additional information. Wearable sensor technology is an emerging clinical tool providing advanced and determinative data with the potential for advancing assessment of lower extremity arthroplasty outcomes. This article is protected by copyright. All rights reserved.
• Gordon, P., Aldulaimi, S., & Howe, C. L. (2020). Rebound Bilirubin Levels after Phototherapy in Neonates with Hyperbilirubinemia. American family physician, 102(9), Online.
• Kolman, K. B., Freeman, J., & Howe, C. L. (2020). Hypoglycemia with insulin and sulfonylureas. Canadian family physician Medecin de famille canadien, 66(5), 335.
• Pettit, J., Freeman, J., & Howe, C. (2020). Chlamydia test-of-cure in pregnancy. Canadian family physician Medecin de famille canadien, 66(6), 427-428.
• Rahlin, M., Duncan, B., Howe, C. L., & Pottinger, H. L. (2020). How does the intensity of physical therapy affect the Gross Motor Function Measure (GMFM-66) total score in children with cerebral palsy? A systematic review protocol. BMJ open, 10(7), e036630.
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  Intensive physical therapy (PT) interventions administered to children with cerebral palsy (CP) have received a significant amount of attention in published literature. However, there is considerable variability in therapy intensity among studies and notable lack of information on optimal intervention dosing. This makes it difficult for clinicians to use evidence to inform practice. Many studies use the Gross Motor Function Measure (GMFM-66) to assess functional progress in children with CP. The purpose of this systematic review will be to identify the GMFM-66 change score reported in published studies, with outcomes based on intervention intensity. Whether the type of PT intervention, child's age, and Gross Motor Function Classification System level influence the GMFM-66 scores will be also assessed.
• Vadiei, N., Howe, C. L., Zerr, B., Ladziak, N., Fain, M. J., & Lee, J. K. (2020). Psychotropic medication use patterns in home-based primary care: A scoping review. Mental Health Clinician, 10(5), 282-290.
• Allen, A. M., Weinberger, A. H., Wetherill, R. R., Howe, C. L., & McKee, S. A. (2019). Oral Contraceptives and Cigarette Smoking: A Review of the Literature and Future Directions. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 21(5), 592-601.
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  Evidence continues to mount indicating that endogenous sex hormones (eg, progesterone and estradiol) play a significant role in smoking-related outcomes. Although approximately one out of four premenopausal smokers use oral contraceptives (OCs), which significantly alter progesterone and estradiol levels, relatively little is known about how OCs may influence smoking-related outcomes. Thus, the goal of this review article is to describe the state of the literature and offer recommendations for future directions.
• DeSalvo, J. C., Skiba, M. B., Howe, C. L., Haiber, K. E., & Funk, J. L. (2019). Natural Product Dietary Supplement Use by Individuals With Rheumatoid Arthritis: A Scoping Review. Arthritis care & research, 71(6), 787-797.
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  Natural product dietary supplements (NDS), defined as non-mineral, non-vitamin, ingested, natural product-derived, substances, are the most frequently used complementary and alternative medicine modality in the US, with musculoskeletal disease being the most frequent reason for their use. Because NDS usage is frequently unreported, and patients with RA may be at higher risk for NDS-related side effects due the underlying nature of the disease and frequent use of complex pharmaceutical regimens, a scoping review of the literature was undertaken to examine population-based patterns of NDS use for RA self-management.
• Goel, V., Patwardhan, A. M., Ibrahim, M., Howe, C. L., Schultz, D. M., & Shankar, H. (2019). Complications associated with stellate ganglion nerve block: a systematic review. Regional anesthesia and pain medicine.
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  Stellate ganglion nerve blockade (SGNB) is a vital tool in our armamentarium for the treatment of various chronic pain syndromes. SGNB can be performed using the traditional landmark-based approach, or with image guidance using either fluoroscopy or ultrasound. In this review, we systematically analyzed reported SGNB-related complications between 1990 and 2018. Seven databases were queried for SGNB between January 1, 1990 and November 27, 2018. Search results of the complications associated with SGNB were reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Out of a total of 1909 articles, 67 articles met our inclusion criteria, yielding 260 cases with adverse events. In 134 of the 260 (51.5%) cases, SGNB was performed with image guidance. Sixty-four (24.6%) and 70 (26.9%) of the complication cases reported the use of ultrasound and fluoroscopy guidance, respectively. One hundred and seventy-eight (68.4%) patients had medication-related or systemic side effects, and 82 (31.5%) had procedure-related or local side effects. There was one report of death due to massive hematoma leading to airway obstruction. There was one case report of quadriplegia secondary to pyogenic cervical epidural abscess and discitis following an SGNB. Complications following SGNB have been reported with both landmark-based techniques and with imaging guidance using fluoroscopy or ultrasound. In our systematic review, most adverse events that were reported occurred during or shortly after SGNB. Vigilance, American Society of Anesthesiologists standard monitors for conscious sedation, and accessibility to resuscitation equipment are vital to the safe performance of SGNB.
• Harhash, A. A., Huang, J. J., Howe, C. L., Hsu, C. H., & Kern, K. B. (2019). Coronary Angiography and Percutaneous Coronary Intervention in Cardiac Arrest Survivors with Non-shockable Rhythms and No STEMI: A Systematic Review. Resuscitation.
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  Emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) are thought to improve outcomes in cardiac arrest (CA) survivors with ST segment elevation myocardial infarction (STEMI) and those without STEMI but likely cardiac etiology (shockable rhythms). However, the role of CAG +/- PCI in OHCA survivors with non-shockable rhythms and no STEMI post-resuscitation remains unclear.
• Kato, K., Song, B. H., Howe, C. L., & Chang, E. H. (2019). A Comprehensive Systematic Review of the Association Between Airway Mucins and Chronic Rhinosinusitis. American journal of rhinology & allergy, 1945892419837042.
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  Airway mucins are the major constituents of mucus and one of the first lines of host defense against inhaled pathogens. However, aberrant expression of mucins is associated with mucus hypersecretion resulting in chronic nasal drainage, a common complaint from patients with chronic rhinosinusitis (CRS). Our goal in this systematic review was to determine (1) expression profiles, (2) regulatory mechanisms, and (3) the pathologic roles of mucins associated with CRS.
• Rosputni, C., Short, E., Rahim-Sepulveda, M., Howe, C. L., da Silva, V., Alvarez, K., & Hingle, M. D. (2019). Diabetes Prevention Programs in Rural North America: a Systematic Scoping Review. Current diabetes reports, 19(7), 43.
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  The aims of this systematic scoping review were to characterize the extent to which diabetes prevention programs have focused on rural populations in North America and where possible, identify efficacious program components.
• LaGrandeur, W., Armin, J., Howe, C. L., & Ali-Akbarian, L. (2018). Survivorship care plan outcomes for primary care physicians, cancer survivors, and systems: a scoping review. Journal of cancer survivorship : research and practice.
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  With the focus on survivorship care-coordination between oncology and primary care providers (PCPs), there is a need to assess the research regarding the use of survivorship care plans (SCPs) and determine emerging research areas. We sought to find out how primary care physicians have been involved in the use of SCPs and determine SCP's effectiveness in improving care for cancer survivors. In this scoping review, we aimed to identify gaps in the current research and reveal opportunities for further research.
• Lazkani, M., Singh, N., Howe, C., Patel, N., Colón, M. J., Tasset, M., Amabile, O., Morris, M., Fang, H. K., & Pershad, A. (2018). An updated meta-analysis of TAVR in patients at intermediate risk for SAVR. Cardiovascular revascularization medicine : including molecular interventions.
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  Transcatheter aortic valve replacement (TAVR) has been approved for use in patients with severe aortic stenosis at intermediate, high and extreme surgical risk. This meta-analysis was performed to assess the safety and efficacy of TAVR compared to surgical aortic valve replacement (SAVR) in intermediate risk patients.
• Lee, J. Z., Low, S. W., Pasha, A. K., Howe, C. L., Lee, K. S., & Suryanarayana, P. G. (2018). Comparison of tricuspid annular plane systolic excursion with fractional area change for the evaluation of right ventricular systolic function: a meta-analysis. Open heart, 5(1), e000667.
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  Accurate determination of right ventricular ejection fraction (RVEF) is challenging because of the unique geometry of the right ventricle. Tricuspidannular plane systolic excursion (TAPSE) and fractional area change (FAC) are commonly used echocardiographic quantitative estimates of RV function. Cardiac MRI (CMRI) has emerged as the gold standard for assessment of RVEF. We sought to summarise the available data on correlation of TAPSE and FAC with CMRI-derived RVEF and to compare their accuracy.
• Lee, J. Z., Singh, N., Nyotowidjojo, I., Howe, C., Low, S. W., Nguyen, T., Pinto, D., Kumar, G., & Lee, K. S. (2018). Comparison of regadenoson and nitroprusside to adenosine for measurement of fractional flow reserve: A systematic review and meta-analysis. Cardiovascular revascularization medicine : including molecular interventions, 19(2), 168-174.
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  FFR is useful in defining the physiological significance of intermediate coronary stenosis and requires induction of maximal hyperemia and measurement of pressure proximal and distal to the stenosis. Hyperemia normally is induced by either IV or IC adenosine, a medication associated with short-term side effects. IV regadenoson and IC nitroprusside have been suggested as viable alternatives. This meta-analysis aims to identify all studies comparing use of intravenous (IV) regadenoson or intracoronary (IC) nitroprusside with IV adenosine to determine differences related to the agent utilized for assessment of fractional flow reserve (FFR).
• Schmitz, H., Howe, C. L., Armstrong, D. G., & Subbian, V. (2018). Leveraging mobile health applications for biomedical research and citizen science: a scoping review. Journal of the American Medical Informatics Association : JAMIA.
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  This systematic review aims to analyze current capabilities, challenges, and impact of self-directed mobile health (mHealth) research applications such as those based on the ResearchKit platform.
• Siyahian, A., Malik, S. U., Mushtaq, A., Howe, C. L., Majeed, A., Zangeneh, T., Iftikhar, S., Habib, S., Zahid, U., Riaz, I. B., Warraich, Z., Faridi, W., & Anwer, F. (2018). Title: Prophylaxis for Hepatitis B Virus Reactivation after Allogeneic Stem Cell Transplantation in the Era of Drug Resistance and Newer Antivirals: a Systematic Review and Meta-Analysis. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.
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  Patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) are at a very high risk of hepatitis B virus reactivation (HBVr). Lamivudine is commonly used as prophylaxis against HBVr in high risk patients undergoing allo-HSCT. Unfortunately, its efficacy is diminishing due to the development of HBV mutant drug resistant strains. With the availability of newer antiviral agents like Entecavir, Telbivudine, Adefovir and Tenofovir, it is important to assess their role in HBVr prophylaxis. A comprehensive search of seven databases was performed to evaluate efficacy of antiviral prophylaxis against HBVr in allo-HSCT patients (PubMed/Medline, Embase, Scopus, Cochrane Library, Web of Science, CINAHL, and ClinicalTrials.gov - June 21, 2017). We identified 10 studies with 2067 patients undergoing allo-HSCT; these primarily evaluated the use of Lamivudine and Entecavir as prophylaxis against HBVr in patients undergoing allo-HSCT because there was little or no data about Adefovir, Telbivudine, or Tenofovir as prophylaxis in this specific patient population. Thus, included studies were categorized into two main prophylaxis groups: Lamivudine and Entecavir. Results of our meta-analysis suggests that Entecavir is very effective against HBVr, although further clinical trials are required to test efficacy of new antivirals and explore the emerging threat of drug resistance.
• Bea, J. W., Blew, R. M., Howe, C., Hetherington-Rauth, M., & Going, S. B. (2017). Resistance Training Effects on Metabolic Function Among Youth: A Systematic Review. Pediatric exercise science, 29(3), 297-315.
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  This systematic review evaluates the relationship between resistance training and metabolic function in youth.
• Cioltan, H., Alshehri, S., Howe, C., Lee, J., Fain, M., Eng, H., Schachter, K., & Mohler, J. (2017). Variation in use of antipsychotic medications in nursing homes in the United States: A systematic review. BMC geriatrics, 17(1), 32.
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  The use of antipsychotic medications (APMs) in nursing home residents in the U.S. is an increasingly prominent issue and has been associated with increased risk of hospitalization, cardiovascular events, hip fractures, and mortality, among other adverse health events. The Food and Drug Administration has placed a black box warning on these drugs, specifying that they are not meant for residents with dementia, and has asked providers to review their treatment plans. The purpose of this systematic PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)-based review was to summarize original research studies on facility level characteristics contributing to the use of antipsychotics in nursing homes across the United States, in order to investigate the variation of use.
• Gordon, J. S., Armin, J., Hingle, M. D., Giacobbi Jr., P., Cunningham, J. K., Johnson, T., Abbate, K., Howe, C. L., & Roe, D. J. (2017). Development and evaluation of the See Me Smoke-Free multi-behavioral mHealth app for women smokers. TRANSLATIONAL BEHAVIORAL MEDICINE, 7(2).
• Kopp, L. M., Gastelum, Z., Guerrero, C. H., Howe, C. L., Hingorani, P., & Hingle, M. (2017). Lifestyle behavior interventions delivered using technology in childhood, adolescent, and young adult cancer survivors: A systematic review. PEDIATRIC BLOOD & CANCER, 64(1), 13-17.
• Francis, R. H., Mudery, J. A., Tran, P., Howe, C., & Jacob, A. (2016). The case for Using evidence-Based Guidelines in setting Hospital and Public Health Policy. Frontiers in surgery, 3.
• Yen, T. C., Toosizadeh, N., Howe, C., Dohm, M., Mohler, J., & Najafi, B. (2016). Postural Balance Parameters as Objective Surgical Assessments in Low Back Disorders: A Systematic Review. Journal of applied biomechanics, 32(3), 316-323. doi:10.1123/jab.2015-0246
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  Balance assessments could render useful objective performance measures to evaluate the efficacy of low back surgeries, yet these assessments have not been collectively examined to determine longitudinal sensitivity across surgical interventions. The purpose of the review was to determine sensitivity of balance measurements for disparate spinal disorders after surgical intervention. We searched PubMed, Embase, Scopus, the Cochrane Library, Web of Science, and CINAHL. Articles were selected based on: 1) sample consisted of low back disorder individuals; and 2) balance measurements were obtained both pre- and post-surgery. Most of the articles addressed two specific low back disorders: 1) adolescent idiopathic scoliosis/spinal fusion; and 2) disc herniation/decompression surgery. For scoliosis patients, body sway increased (14-97%) immediately following surgery but gradually reduced (1-33%) approaching the one year post-spinal fusion assessment. For patients with disc herniation, sway range, sway velocity, sway area, and sway variability all decreased (19-42%) immediately post-surgery. Balance assessments for adolescents with idiopathic scoliosis who underwent surgical intervention should be performed with visual occlusion, focus on time domain parameters, and evaluated with longer follow-up times. Patients with disc herniation who underwent decompression surgery should have balance assessments with visual deprivation, test conditions specifically addressing hip strategy, and correlation with pain.
• Miller, G., Miller, C., Marrone, N., Howe, C., Fain, M., & Jacob, A. (2015). The impact of cochlear implantation on cognition in older adults: a systematic review of clinical evidence. BMC geriatrics, 15, 16.
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  Hearing loss is the third most prevalent chronic condition faced by older adults and has been linked to difficulties in speech perception, activities of daily living, and social interaction. Recent studies have suggested a correlation between severity of hearing loss and an individual's cognitive function; however, a causative link has yet to be established. One intervention option for management of the most severe to profound hearing loss in older adults is cochlear implantation. We performed a review to determine the status of the literature on the potential influence of cochlear implantation on cognition in the older adult population.
• Oulton, J., Rhodes, S. M., Howe, C., Fain, M. J., & Mohler, M. J. (2015). Advance directives for older adults in the emergency department: a systematic review. Journal of palliative medicine, 18(6), 500-5.
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  It has been more than two decades since the passage of the Patient Self-Determination Act (PSDA) of 1991, an act that requires many medical points of care, including emergency departments (EDs), to provide information to patients about advance directives (ADs).
• Parvaneh, S., Howe, C. L., Toosizadeh, N., Honarvar, B., Slepian, M. J., Fain, M., Mohler, J., & Najafi, B. (2015). Regulation of Cardiac Autonomic Nervous System Control across Frailty Statuses: A Systematic Review. Gerontology, 62(1), 3-15.
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  Frailty is a geriatric syndrome that leads to impairment in interrelated physiological systems and progressive homeostatic dysregulation in physiological systems.
• Ramaswamy, R., Leipzig, R. M., Howe, C. L., Sauvigne, K., Usiak, C., & Soriano, R. P. (2015). The portal of geriatrics online education: a 21st-century resource for teaching geriatrics. Journal of the American Geriatrics Society, 63(2), 335-40.
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  The way students are taught and evaluated is changing, with greater emphasis on flexible, individualized, learner-centered education, including the use of technology. The goal of assessment is also shifting from what students know to how they perform in practice settings. Developing educational materials for teaching in these ways is time-consuming and can be expensive. The Portal of Geriatrics Online Education (POGOe) was developed to aid educators in meeting these needs and become quicker, better-prepared teachers of geriatrics. POGOe contains more than 950 geriatrics educational materials that faculty at 45% of allopathic and 7% of osteopathic U.S. medical schools and the Centers for Geriatric Nursing Excellence have created. These materials include various instructional and assessment methodologies, including virtual and standardized patients, games, tutorials, case-based teaching, self-directed learning, and traditional lectures. Materials with common goals and resource types are available as selected educational series. Learner assessments comprise approximately 10% of the educational materials. POGOe also includes libraries of videos, images, and questions extracted from its educational materials to encourage educators to repurpose content components to create new resources and to align their teaching better with their learners' needs. Web-Geriatric Education Modules, a peer-reviewed online modular curriculum for medical students, is a prime example of this repurposing. The existence of a robust compendium of instructional and assessment materials allows educators to concentrate more on improving learner performance in practice and not simply on knowledge acquisition. It also makes it easier for nongeriatricians to teach the care of older adults in their respective disciplines.
• Stolz, L. A., Stolz, U., Howe, C., Farrell, I. J., & Adhikari, S. (2015). Ultrasound-guided peripheral venous access: a meta-analysis and systematic review. The journal of vascular access, 16(4), 321-6.
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  The objective of this study was to determine through a systematic review of the literature and meta-analysis whether success rates, time to cannulation, and number of punctures required for peripheral venous access are improved with ultrasound guidance compared with traditional techniques in patients with difficult peripheral venous access.
• Toosizadeh, N., Yen, T. C., Howe, C., Dohm, M., Mohler, J., & Najafi, B. (2015). Gait behaviors as an objective surgical outcome in low back disorders: A systematic review. Clinical biomechanics (Bristol, Avon), 30(6), 528-36.
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  Objective motor performance measures, especially gait assessment, could improve evaluation of low back disorder surgeries. However, no study has compared the relative effectiveness of gait parameters for assessing motor performance in low back disorders after surgery. The purpose of the current review was to determine the sensitive gait parameters that address physical improvements in each specific spinal disorder after surgical intervention.
• Schwenk, M., Howe, C., Saleh, A., Mohler, J., Grewal, G., Armstrong, D., & Najafi, B. (2014). Frailty and technology: a systematic review of gait analysis in those with frailty. Gerontology, 60(1), 79-89.
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  New technologies for gait assessment are emerging and have provided new avenues for accurately measuring gait characteristics in home and clinic. However, potential meaningful clinical gait parameters beyond speed have received little attention in frailty research.
• Singh, N., Lee, J. Z., Huang, J. J., Low, S. W., Howe, C., Pandit, A., Suryanarayana, P., & Lee, K. S. (2014). Benefit of statin pretreatment in prevention of contrast-induced nephropathy in different adult patient population: systematic review and meta-analysis. Open heart, 1(1), e000127.
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  Previous studies have suggested that statin pretreatment prevents contrast-induced nephropathy (CIN). However, single randomised trials are limited in their number of patients. This meta-analysis aims to assess the role of statin use in CIN prevention, as well as to determine patient subgroups that will benefit from statin pre-treatment.
• Skiba, M. B., McElfresh, J. J., Howe, C. L., Crane, T. E., Kopp, L. M., Jacobs, E. T., & Thomson, C. A. (2020). Dietary Interventions for Adult Survivors of Adolescent and Young Adult Cancers: A Systematic Review and Narrative Synthesis. Journal of adolescent and young adult oncology.
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  Adolescent and young adult (AYA) cancer survivors, here defined as individuals diagnosed with cancer between 15 and 39 years of age, are at high risk for adverse late-term metabolic effects of treatment through adulthood. Diet is a modifiable lifestyle behavior that may improve metabolic health outcomes in AYA cancer survivors. However, the details of dietary interventions for this unique population remain largely undescribed. In this systematic review, we aim to synthesize the results of dietary interventions for adult AYA cancer survivors. Seven databases and clinical trial registries were searched in March 2019 for interventions targeting dietary behaviors in AYA cancer survivors (PROPSERO systematic review number: CRD42019126376). Descriptive statistics and a narrative synthesis were completed to detail intervention participants and components. After full text review of 233 studies, four studies met all inclusion criteria. All studies were heterogeneous for participant age, cancer type, and duration, and were designed for feasibility and preliminary efficacy. Included studies followed different dietary guidance; however, each resulted in a significant change on a primary outcome of either dietary quality or body composition. Three of the four studies included a theoretical framework, where self-efficacy was a central construct. Counseling, in person, telephone, or electronic, provided behavioral support. Results of this systematic review suggest high potential to change dietary behaviors in AYA, but interventions remain limited. AYA cancer survivors demonstrate unique physiological and psychosocial needs, and future interventions designed to address this care gap should be targeted for this population with consideration of social support, delivery mode, and individual tailoring.
• Toosizadeh, N., Bunting, M., Howe, C., Mohler, J., Sprinkle, J., & Najafi, B. (2014). Motorized mobility scooters: the use of training/intervention and technology for improving driving skills in aging adults - a mini-review. Gerontology, 60(4), 357-65.
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  Motorized mobility scooters (MMS) have become the most acceptable powered assistive device for those with impaired mobility, who have sufficient upper body strength and dexterity, and postural stability. Although several benefits have been attributed to MMS usage, there are likewise risks of use, including injuries and even deaths.
• Howe, C. L. (2013). Internet resources on geriatrics and gerontology. MLA News, 53(2), 21.
• Chi, A., Liao, Z., Nguyen, N. P., Xu, J., Welsh, J. S., Jang, S. Y., Howe, C., & Komaki, R. (2012). Dosimetric selection for helical tomotherapy based stereotactic ablative radiotherapy for early-stage non-small cell lung cancer or lung metastases. PloS one, 7(4), e35809.
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  No selection criteria for helical tomotherapy (HT) based stereotactic ablative radiotherapy (SABR) to treat early stage non-small cell lung cancer (NSCLC) or solitary lung metastases has been established. In this study, we investigate the dosimetric selection criteria for HT based SABR delivering 70 Gy in 10 fractions to avoid severe toxicity in the treatment of centrally located lesions when adequate target dose coverage is desired.
• Howe, C. L. (2012). Internet resources on hospice and palliative care. Arizona Geriatrics Society Journal, 17(1), 22.
• Howe, C. L., Mohler, M. J., D’Huyvetter, K., Lisa, O. O., Vivyenee, R., Craig, R., Amit, S., & Mindy, F. (2012). Making geriatric education relevant to all medical students: The geriatrics for specialists conference.. Arizona Geriatrics Society Journal, 17(1), 19-21.
• Weiss, B. D., Berman, E. A., Howe, C. L., & Fleming, R. B. (2012). Medical decision-making for older adults without family. Journal of the American Geriatrics Society, 60(11), 2144-50.
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  Each year in the United States, individuals who lack decision-making capacity because of acute or chronic cognitive impairment are in situations in which important medical decisions must be made for them, but tens of thousands of these individuals have no known family members or designated surrogates available to help with those decisions. Such individuals constitute 16% of patients in intensive care units, 3% of nursing home residents, and a large but unspecified number of individuals in a variety of settings who are facing end-of-life decisions. Several approaches are currently used to aid in medical decision-making for people without families or designated surrogates, including hospital ethics committees, court-appointed surrogate agents, reliance on advance directives if they are available, and even the use of computer-based decision systems. These approaches all have limitations and often result in individuals receiving care that would not have been their preference. Additionally, because clinical care teams must wrestle with uncertainty about best approaches to care, lengths of hospital stay for individuals without family are longer, resulting in higher healthcare costs and potentially more-aggressive interventions than individuals with family experience. This article reviews medical decision-making for older adults without families or designated surrogates and proposes a solution: "health fiduciaries"--a new type of professional trained and certified to act as a surrogate decision-maker for individuals who are unable to make decisions for themselves.
• Chi, A., Liao, Z., Nguyen, N. P., Howe, C., Gomez, D., Jang, S. Y., & Komaki, R. (2011). Intensity-modulated radiotherapy after extrapleural pneumonectomy in the combined-modality treatment of malignant pleural mesothelioma. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 6(6), 1132-41.
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  Local therapy is becoming increasingly important as a part of the definitive treatment for malignant pleural mesothelioma after extrapleural pneumonectomy (EPP) because of the emergence of trimodality therapy consisted of chemotherapy, EPP, and adjuvant radiotherapy. Herein, we explore the current evidence and indications for adjuvant intensity-modulated radiotherapy (IMRT), as well as how to further improve this technique and adapt new technology in the delivering adjuvant radiotherapy in the setting of trimodality therapy.
• Howe, C. L. (2011). Do geriatricians get burned out?. Arizona Geriatrics Society Journal, 16(1), 17-21.
• Howe, C. L., Auflick, P. A., & Freiburger, G. (2011). Upward evaluation at the Arizona Health Sciences Library. Journal of the Medical Library Association : JMLA, 99(1), 91-4.
• Howe, C. L. (2010). Howe CL. Staffing ratios in nursing homes. Arizona Geriatrics Society Journal. 2010;15(2):23-6.. Arizona Geriatrics Society Journal, 15(2), 23-6.
• Howe, C. L. (2010). Prescribing statins for older adults. Arizona Geriatrics Society Journal, 15(1), 24-9.
• Howe, C. L. (2010). Review: health care decision-making WebCT module for medical students. Journal of the American Geriatrics Society, 58(9), 1788-90.
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  The Health Care Decision-Making Module was initially created as an interactive WebCT program and was subsequently converted to a pdf format for posting on the Portal of Geriatric Online Education in early 2006 and updated on October 29, 2009. WebCT was the first of what are now many comprehensive software programs used by universities for conducting online courses. The current Health Care Decision-Making module is a straightforward pdf with embedded hyperlinks and exercises, allowing for easy downloading, sharing, and adapting by other institutions.
• Howe, C. L., & Weiss, B. D. (2010). Hyperlipidemia in older adults: To treat or not to treat?. Arizona Geriatrics Society Journal, 15(1), 11-12.
• Howe, C. L. (2009). Cancer pain in the elderly: Patient experience and provider treatment. Arizona Geriatrics Society Journal, 14(1), 28-9.
• Howe, C. L. (2009). Topical negative pressure for the treatment of decubitus ulcers in frail elder. Arizona Geriatrics Society Journal, 14(2), 28-9.
• Howe, C. L. (2010). Using technology: Some internet resources on aging. Arizona Geriatrics Society Journal, 14(1), 26-7.
• Howe, C. L. (2008). Pneumoperitoneum: What does free air under the diaphragm really mean in the older adult?. Arizona Geriatrics Society Journal, 13(1), 23-4.
• Howe, C. L. (2008). Pneumoperitoneum: What does free air under the diaphragm really mean in the older adult?. Arizona Geriatrics Society Journal, 13(2), 18-19.
• Howe, C. L. (2007). Discussing advance directives in American Indian communities.. Arizona Geriatrics Society Journal, 12(1), 18-19.
• Howe, C. L. (2007). Will my elderly patient be able to tolerate chemotherapy?. Arizona Geriatrics Society Journal, 12(2), 19-20.

Presentations

• Pickering, A., Dunleavy, J., Dreifuss, H., Howe, C. L., & Dreifuss, B. (2018, November 7-9th). Building It So They Will Come: Factors Contributing to Delays in Seeking Available Emergency Medical Care in Rural Uganda - A systematic Review. 2018 African Conference on Emergency Medicine: Breaking Barriers in Emergency Medicine Education. Kigali, Rwanda: African Federation of Emergency Medicine.
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  Objectives:Karoli Lwanga Hospital and Global Emergency Care (501c3 NGO) operate an Emergency Department (ED) in Uganda’s Rukungiri District. Despite available Emergency Care (EC), preventable death and disability persist due to delayed patient presentations. Implementation of effective EC requires assessment of socioeconomic, cultural, and structural factors leading to treatment delay. We undertook a systematic literature review to assess current knowledge and research regarding access to EC. Methods: A systematic literature review was performed using controlled vocabulary terms and key words to search the following databases for studies on factors impacting access to EC facilities in rural Uganda or the immediately adjacent countries: Ovid/MEDLINE, Elsevier/Embase, Elsevier/Scopus, Wiley/Cochrane Library, Thomson-Reuters/Web of Science, EBSCO/CINAHL, and K4Health/Popline. Results:4091 articles were initially identified; 4004 were excluded due to irrelevance to the topic. Strict inclusion/exclusion criteria were applied to the full text of 87 articles and 27 met criteria and quality assessment comprising the basis of this review.Knowledge of barriers to utilization of available EC is limited, with most literature specific to rural Uganda and adjacent countries focusing on obstetric and paediatric emergencies, which makes generalizations imperfect. However, this review suggests that cost and transportation are not the sole determinants of EC access and utilization. Challenges may be more complex, relating to identification of emergency conditions, healthcare decision-making, perceptions of healthcare quality and traditional culture and beliefs. Conclusion:Currently, the research needed for optimal implementation of EC in rural locations in Uganda and adjacent countries remains limited. A better understanding of community members’ challenges in accessing and utilizing EC is necessary for EC system development, as low utilization and/or delayed presentation limits the impact of EC in reducing preventable morbidity and mortality. Qualitative research in the ED and community-based settings may better elucidate factors affecting EC seeking behaviours and access to these vital services.

Poster Presentations

• Lectura, M., Armin, J., & Howe, C. L. (2019, December). Increasing Resident Comfort in Assessing Fall Risk: An EMR-based Intervention. Society of Teachers of Family Medicine (STFM): Conference of Practice & Quality Improvement,. Sheraton Grand Phoenix Hotel Phoenix, Arizona.: Society of Teachers of Family Medicine (STFM).
• Vadiei, N., Howe, C., Fain, M., Zerr, B., Ladziak, N., & Lee, J. (2019, MAR). Psychotropic medication use patterns in home-based primary care: a systematic review. American Journal of Geriatric Psychiatry. Atlanta, Georgia: American Association for Geriatric Psychiatry.
• Allen, A. M., Weinberger, A. H., Wetherill, R. R., Howe, C. L., & McKee, S. A. (2018, Spring). Oral Contraceptive Use and Cigarette Smoking: A Review of the Literature. Society for Research on Nicotine and Tobacco Annual Meeting. Baltimore, MD: Society for Research on Nicotine and Tobacco.
• Babiker, H., Zahid, U., Howe, C. L., Scott, A., Riaz, I. B., Elliott, C. M., Saboda, K., Acharya, U. H., Elquza, E., Recio Boiles, A., Elquza, E., & Mahadevan, D. (2018, January/ Spring). Analyzing the efficacy and safety of immunotherapy in pancreatic ductal adenocarcinoma (PDA): A systematic review and meta-analysis. GI ASCO. San Francisco, CA: ASCO.
• Siyahian, A., Malik, S. U., Mushtag, A., Howe, C. L., Majeed, A., Zangeneh, T., Iftikhar, S., Zahid, U., Bin, R. I., Warraich, Z., Faridi, W., & Anwer, F. (2018, MAR). How to Prevent Hepatitis B Reactivation after Allogeneic Stem Cell Transplantation in the Era of Novel Antiviral Drugs: A Systematic Review and Meta-Analysis. BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION.
• Shah, A., Callahan, K., Usiak, C., Sauvigne, K., Leipzig, R. M., Marshall, N., & Howe, C. L. (2017, July). Creation and use of a national competency based geriatrics education curriculum: WebGems. 21st International Association of Gerontology and Geriatrics (IAGG) Annual Conference. San Francisco: International Association of Gerontology and Geriatrics.
• Yousman, W., Lee, J. Z., Wong, W. X., Sargeant, J., Howe, C. L., Nyotowidjojo, I., Pasha, A., Fortuin, D., & Lee, K. S. (2017, March). Comparison of two-year outcomes in drug-eluting stents versus coronary artery bypass grafting for treatment of unprotected left main coronary artery disease in elderly patients: A meta-analysis.. American College of Cardiology 66th Annual Scientific Session. Washington, DC: American College of Cardiology.
• Anand, S., Lee, J., Reddy, S., Suryanarayana, P., Howe, C. L., Doraiswamy, V., & Lee, K. S. (2016, May). Comparison of baseline characteristics, treatment, and outcomes of Hispanic and non-Hispanic white patients in acute coronary syndromes: a meta-analysis of registries from the United States from 1982 to 2007. American College of Cardiology 65th Annual Scientific Session. Chicago, IL: American College of Cardiology.
• Lee, J. L., Singh, N., Huang, J. J., Howe, C. L., Ortega, G., Simin, G., Low, S. w., Lee, K., & Pandit, A. (2015, March). Colchicine for Prevention of Post-procedural Atrial Fibrillation: A Meta-analysis.. American College of Cardiology 64th Annual Scientific Session. San Diego, CA: American College of Cardiology.
• Stocker, H., Alsheri, S., Howe, C., Lee, J., Fain, M., Eng, H., Schachter, K., & Mohler, M. (2015, October). Variation in Use of Antipsychotics in Nursing Homes in the United States: A Systematic Review.. Arizona Geriatrics Society 27th Annual Fall Symposium. Phoenix, AZ: Arizona Geriatrics Society.
• Stocker, H., Alsheri, S., Howe, C., Lee, J., Fain, M., Eng, H., Schachter, K., & Mohler, M. (2016, May). Variation in Use of Antipsychotics in Nursing Homes in the United States: A Systematic Review.. 2016 Annual Meeting of The American Geriatrics Society. Long Beach, CA: American Geriatrics Society.
• Cherian, P., Rhodes, M., Mohler, M. J., Howe, C., Sanders, A., & Fain, M. (2013, May). Systematic Review of Evidence for Implementation of Geriatric-ED Model.. 2013 Annual Meeting of The American Geriatrics Society. Grapevine, TX: American Geriatrics Society.
• Mohler, M. J., Morrison, A., D'Huyvetter, K., O'Neill, L., Lee, J., Kennedy, T., Keller, C., Weiss, B., Howe, C., & Fain, M. (2013, June). How the Arizona Geriatric Education Center Went Interprofessional: The Framework, Strategies and Challenges.. 2013 Collaborating Across Borders (CAB) IV Conference. Vancouver, BC, Canada: Collaborating Across Borders.
• Schwenk, M., Mohler, M. J., Howe, C., Saleh, A., Grewal, G., & Najafi, B. (2013, May). Quantitative Gait Analysis in those with Frailty: A Systematic Review. 2013 Annual Meeting of The American Geriatrics Society. Grapevine, TX: American Geriatrics Society.