Medicine and Health Sciences Commons^™

Feasibility And Safety Of Early Post-Covid-19 High-Intensity Gait Training: A Pilot Study, Joakim Halvorsen, Christopher Henderson, Wendy Romney, Magnus Hågå, Tonje Barkenæs Eggen, Jan Egil Nordvik, Ingvild Rosseland, Jennifer Moore

Physical Therapy Faculty Publications

Background: The feasibility and safety of rehabilitation interventions for individuals recovering from COVID-19 after the acute stage is not well understood. This pilot study aims to provide a preliminary investigation of the feasibility and safety of providing high-intensity gait training (HIT) with a targeted cardiovascular intensity of 70–85% of the age-predicted maximum heart rate (HRmax) for individuals undergoing rehabilitation post-COVID-19. Methods: Consecutive patients who were medically cleared for HIT were invited to participate in the study. Participants practiced walking in varied contexts (treadmill, overground, and stairs), aiming to spend as much time as possible within their target cardiovascular intensity zone …

Application Of Teaching Regarding Injury Appearance In Darker Pigmented Skin Patients: A Quality Improvement Project, Tiffany Akiba

DNP Projects

Significance and Background: The skin is the largest organ of our body, and skin injury prevention begins with accurately inspecting skin. Current practices stress on looking for any signs of redness which often signify that the skin is possibly injured or compromised. However, darker skin tones do not appear red when injured. Assessing for redness is a practice that is suited better for lighter skin tones.

Purpose: Provide education to providers on current skin assessment practices of darker skin tones.

Methods: The IHI Model of Improvement was used for this project, and the Plan-Do-Study-Act cycle was used to test for …

Oxygen Therapy Education To Improve Oxygen Safety In The Emergency Department: A Quality Improvement Project, Latania Wolfe

DNP Projects

Background and Significance: Oxygen is often administered in emergency departments (ED) in US without the nurses and other healthcare staff inputting orders for this medication. This gap in placing orders poses a risk to patient safety and poses a regulation issue.

Purpose: The goal of this quality improvement project is to increase the rate of orders placed for patients using oxygen in ED staff by 12% from March 1, 2023 to May 31, 2023.

Methods: The Model for Improvement guided this quality improvement project. Two PDSA cycles were completed.

Results: PDSA #1 Completed SWOT analysis and used information to …

Evaluating The Impact Of A No-Show Policy: A Quality Improvement Project, Adrianne S. Harding

DNP Projects

Significance and Background: No- shows are a global problem that creates a significant challenge for the healthcare system. When a patient misses an appointment, it decreases health care staff productivity, creates a waste of resources and it negatively impacts revenue (Lance et. al, 2021). Current evidence supports interventions that incorporate voluminous data and artificial intelligence with strategies such as overbooking, appointment notification systems and financial incentives to reduce outpatient no-shows (Oikonomidi et al., 2022). This project will evaluate the impact of a no-show policy and provide insights to improve primary care attendance and inform decisions.

Purpose: To evaluate an outpatient …

Decreasing Hospital Readmission Rates Of Heart Failure Patients: An Evidence-Based Quality Improvement Project, Elizabeth Rodriguez

DNP Projects

BACKGROUND: Teach back is an evidence-based health literacy intervention that encourages patient engagement in own treatment, adherence to treatment, medications, and quality of care. Implementation of teach back method could positively impact readmissions to the hospital in patients experiencing heart failure and any other chronic diseases and it could improve patient’s outcomes.

OBJECTIVE: The objective of this project was to implement teach back method in a home care agency in the Hartford area in patients with HF to prevent readmission to the hospital.

METHODS: The IOWA model was used and PSDA as tools to support EBP project.

RESULTS: Pre and …

Preoperative Pain Management Education And Narcotic Use: A Quality Improvement Project, Sarah Scheller

DNP Projects

Introduction: Comprehensive preoperative education is an important aspect of pain management and helps empower patients prior to their surgery. Evidence supports the use of a combination of the teach-back method, videos, and pamphlets to educate patients prior to their surgery. A quality improvement project was initiated for patients having total shoulder arthroplasty surgery with an orthopedic surgeon in Connecticut.

Methods: An educational video and handout were created, and preoperative education sessions using the teach-back methods were performed. Postoperative phone calls were placed at 24 and 72 hours to assess the patient’s use of narcotic pain medication, alternative pain management medication …

Implementation Of The Stop-Bang Screening Tool In The Primary Care Setting: A Quality Improvement Project, Thriciana Powell

DNP Projects

Significance and Background. There are approximately 25 million adults in the United States with obstructive sleep apnea (OSA). OSA is a sleeping disorder that is caused by periodic airflow blockage during sleep. It has been linked to numerous health problems and within the primary care setting OSA is not routinely screened for at visits. This leads to delayed diagnosis of a serious health issue and the potential for poor health outcomes. The STOP-BANG questionnaire (SBQ) is a simple eight-question tool that is used to screen patients for OSA. The STOP section focuses on snoring, tiredness, observed apnea, and high blood …

Sunscreen Is Not Just For White People: Church-Based Sunscreen Education For Black Women, Lauren Mitchell

DNP Projects

Significance and Background: African American women are an undeserved population in healthcare, particularly regarding skin cancer prevention. The lack of education and misinformation surrounding skin cancer has resulted in general mistrust of the healthcare system amongst African Americans. Proper education on sunscreen use and skin cancer screening is essential to prevent late diagnosis of skin cancer and to promote prevention efforts.

Purpose: This quality improvement project utilized evidence-based practice to provide education on the proper use of sunscreen and skin cancer screening to African American women in a faith-based setting in Southern Connecticut.

Methods: A pre-survey was conducted to assess …

Implementation Of An Activity Protocol In The Acute Care Setting: A Quality Improvement Project, Crystal M. Ryan

DNP Projects

Background: Physical activity following cardiothoracic surgery can help decrease post-operative complications, expedite functional recovery, improve overall well-being, shorten hospital length of stay (LOS), and reduce morbidity and mortality (Miwa et al., 2017). Of these patients, 58% developed complications after cardiac surgery; of these complications, 31% were pulmonary, 16% were of cardiac in nature, and 14% were neurological (Yayla, 2018).

Purpose: This quality improvement project aims to implement an evidence-based protocol for evaluating the correlation between physical activity in uncomplicated post-operative coronary artery bypass and length of stay.

Methods: The Plan-Do-Study-Act (PDSA) tool from the Institute for Healthcare Improvement (IHI) guided …

Medical Device-Related Pressure Injury (Mdrpi) Prevention In The Intensive Care Unit (Icu): An Evidence Based Practice Quality Improvement Project, Sana Shah

DNP Projects

Introduction: All intensive care unit (ICU) patients utilize various medical devices for care and treatment, placing them at high-risk for medical device-related pressure injuries (MDRPIs), which can lead to life-threatening infections, wounds/scars, and consumption of additional time and products to rectify these issues. Lack of appropriate decompression measures and improper bedside handoff report was recognized in the ICU at a hospital in Connecticut (CT).

Method: A literature search using CINAHL, MEDLINE, and the Cochrane Database of Systematic Reviews was conducted, restricting the search to the period between 2018-2022. The keywords searched were: “pressure injuries,” “adult patients,” “intensive care …

Does Physical Activity Moderate The Association Between Shorter Leukocyte Telomere Length And Incident Coronary Heart Disease? Data From 54,180 Uk Biobank Participants, Meiruo Xiang, Luke C. Pilling, David Melzer, Ben Kirk, Gustavo Duque, Rui Liu, George A. Kuchel, Andrew R. Wood, Brad Metcalf, Breno S. Diniz, Melvyn Hillsdon, Chia-Ling Kuo

Health Science Faculty Publications

Telomere shortening is a biological aging hallmark. The effect of short telomere length may be targeted by increased physical activity to reduce the risk of multiple aging-related diseases, including coronary heart disease (CHD). The objective was to assess the moderation effect of accelerometer-based physical activity (aPA) on the association between shorter leukocyte telomere length (LTL) relatively in the population sample and incident CHD. Data were from the UK Biobank participants with well-calibrated accelerometer data for at least 6.5 days (n = 54,180). Relative mean LTL at baseline (5–6 years prior to aPA assessment) was measured in T/S ratio, using a …

Implementation Of A Functional Pain Scale In An Adult Cancer Center, Kristine Pantchenko

DNP Projects

Background: Best practices include assessing functional status in addition to pain intensity in patients with cancer experiencing pain. The Defense and Veterans Pain Rating Scale (DVPRS) is an effective tool for assessing pain intensity and functional status in patients with cancer.

Objective: To improve pain assessment among outpatient oncology patients in an adult cancer center by implementing the DVPRS and evaluating patient and nurse satisfaction with this tool.

Methods: The Model for Healthcare Improvement was followed for the planning, implementation, and evaluation of this project. Nurses completed an online education module and self-assessment quiz before an in-person simulation checkoff demonstrated …

Tetrahydrocurcumin Improves Lipopolysaccharide-Induced Myocardial Dysfunction By Inhibiting Oxidative Stress And Inflammation Via Jnk/Erk Signaling Pathway Regulation, Hanzhao Zhu, Liyun Zhang, Hao Jia, Lu Xu, Yu Cao, Mengen Zhai, Kaifeng Li, Lin Xia, Liqing Jiang, Xiang Li, Yenong Zhou, Jincheng Liu, Shiqiang Yu, Weixun Duan

Chemistry Undergraduate Publications

Background

Acute myocardial dysfunction in patients with sepsis is attributed to oxidative stress, inflammation, and cardiomyocyte loss; however, specific drugs for its prevention are still lacking. Tetrahydrocurcumin (THC) has been proven to contribute to the prevention of various cardiovascular diseases by decreasing oxidative stress and inflammation. This study was performed to investigate the functions and mechanism of action of THC in septic cardiomyopathy.

Methods

After the oral administration of THC (120 mg/kg) for 5 consecutive days, a mouse model of sepsis was established via intraperitoneal lipopolysaccharide (LPS, 10 mg/kg) injection. Following this, cardiac function was assessed, pathological section staining was …

Establishing The Content Validity Of A Student Pharmacist Patient Counseling Competency Assessment In Oncology, Matthew Newman, Emily Pherson, Bradley Burton, Eric C. Nemec

Physician Assistant Studies Faculty Publications

Objective. The main goal of this project was to establish content validity and describe internal consistency of a patient counseling competency assessment instrument used to evaluate student pharmacists practicing in an oncology setting. Methods A modified e-Delphi panel of oncology clinical pharmacy specialists, clinical pharmacy generalists, and oncology pharmacy residents was employed. Iterative rounds of the e-Delphi process were conducted until consensus was reached on a majority of the instrument items. Consensus was defined as agreement by at least 75% of participants that an item was, or was not important. Internal consistency of defined sections of the instrument was determined …

Increasing Opioid Abuse Screening In Primary Care Clinic: An Evidence-Based Quality Improvement Project, Carlos Milla

DNP Projects

Introduction

To address substance abuse multiple organizations recommend increase drug abuse screening as part of routine health care. CAGE AID is five-question tool used to screen for drug and alcohol use, answering yes to two or more questions indicates further assessment is advised. Unfortunately, most primary care centers do not use screen for substance abuse using validated instrument tools such as the CAGE-AID tool.

Purpose

The purpose of this evidence-based practice (EBP) project is to implement the CAGE-AID Substance abuse screening tool by nurse practitioners students in a family clinic located in Bridgeport in order to increase to number of …

Implementing A Patient Reported Outcome Measure For Patient With Anemia Of Chronic Kidney Disease (Ckd) In The Outpatient Setting, Marissa Finger

DNP Projects

Introduction: Chronic kidney disease (CKD) is a growing public health concern in the United States. People with CKD suffer from many symptoms that cause distress and low quality of life (QoL). Research has found an association between symptom burden in patients with CKD and the disease's worsening progression. There is little data on ways to monitor and address CKD symptoms routinely.

Purpose: The purpose of this project was to identify symptoms related to advancing kidney disease using patient-reported outcome measures (PROMs) through IPOS-Renal survey and implement a nurse-driven protocol to manage patient reported symptoms.

Interventions/Setting: Over a three-month period at …

Improving Specialist Referrals In Outpatient Primary Care: An Evidence-Based Practice Quality Improvement Project, Kimberly Gaznabie

DNP Projects

Background: In the United States, more than a third of patients receive specialty referrals per year, constituting more than half of outpatient visits. Patients require efficient, immediate referrals for specialty-based treatment plans and the prevention of worsening conditions.

Purpose: This evidence-based practice improvement project aimed to improve the specialty-provider referral system for a community-based outpatient primary care clinic.

The Implementation Of A No-Show And Cancellation Policy In The Primary Care Setting: Quality Improvement Project, Dwayne Hall

DNP Projects

The purpose of this quality improvement project is to evaluate the implementation of a no-show and cancellation policy in an urban out-patient primary care setting. The high occurrence of patient no-shows and cancellations in primary care settings is a persistent problem affecting how efficiently healthcare is delivered. No-shows occur when a patient makes an appointment and does not attend the appointment. It diminishes the practice opportunity to schedule other patients in the missed appointment time slot, thus leading to a loss of revenue. It tends to affect practice resource allocation, thereby worsening the quality of healthcare services. The current problem …

Decreasing Time To Antibiotic Administration In Febrile Neutropenic Adult Oncology Patients In The Emergency Department: An Evidence-Based Quality Improvement Project, Kristin Murray

DNP Projects

Introduction—Significance and Background: Febrile Neutropenia (FN) is the most common and serious complication of hematopoietic cancers and in patients receiving chemotherapy. Patients in this immunocompromised state have weakened immunity to fight off infection and a mortality rate of almost 10%. Thus, Infectious Diseases Society of America has identified the single most important determining factor of outcomes is the timing of antibiotic (TTA) administration and has identified the gold standard to be 60 minutes. Current practice does not follow guidelines and the current policy does not address the urgency of antibiotic administration.

Purpose: The purpose of this project is to improve …

Increasing Patient Satisfaction Of Post-Cesarean Mothers: An Evidence-Based Practice Quality Improvement Project, Amanda Jones

DNP Projects

Introduction: The first hour after delivery, referred to as the “Golden Hour” or “Sacred Hour,” is when the mom, baby, and the support person get 1-hour of uninterrupted bonding time together. This time is critical because it promotes neonatal thermoregulation, decreases newborn stress levels, improves mother–newborn attachment, and encourages breastfeeding. Unfortunately, most cesarean births do not receive the Golden Hour and instead experience delayed bonding time.

Purpose: The purpose of this Evidence-Based Practice (EBP) project was to incorporate the Golden Hour for post-cesarean section mothers in a mid-sized community-based hospital in XXX, CT in order to increase patient satisfaction post-c-section; …

The Use Of Telemedicine In Primary Care To Improve Medication Adherence: Quality Improvement Project, Chadae S. Haffenden-Morrison

DNP Projects

Introduction: Lack of medication adherence, a major issue in healthcare, can be costly to the healthcare system and result in poor patient outcomes. Wong et al. (2020) noted that enhanced involvement with health care professionals using the Telemedicine platform can improve a patient’s medication adherence as well as decrease the use of emergency services and hospitalizations. Telemedicine allows the healthcare provider, to contact the patient through a mobile phone or computer to provide education and reinforcement regarding medication adherence.

Purpose: The purpose of this project was to improve medication adherence and health outcomes, by piloting a quality improvement project using …

Enhancing Depression Screening For The Adolescent Population In The Pediatric Emergency Department By Utilizing The Patient Health Questionnaire: A Quality Improvement Project, Chelsea Alvarez

DNP Projects

Background:

Mental health disparities make up 16% of the global burden of disease and injury in people ages 10-19. Many cases of mental health are unidentified and left untreated. Failure to address mental health disorders in children can lead to poor outcomes of health and well-being. Evidence-based practice supports the utilization of screening tools such as the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adolescents ages 12-18 years.

Objectives:

By implementing the PHQ-9 in the pediatric emergency department, the goals for this quality improvement project were to increase staff knowledge on the PHQ-9, improve staff screening compliance, and to …

Implementation Of A Nurse Driven Palliative Care Consult: A Quality Improvement Project, Socnite Sebourne-Francis

DNP Projects

Background: Palliative care consult (PCC) is an approach that can improve the quality of life and symptom management of patients facing life-threatening illnesses. At a 20-bed medical oncology unit in Connecticut, patients with poor prognosis and worsening symptoms have high re-admission rates within 30 days of post-hospital discharge; yet healthcare providers fail to initiate PCC.

Purpose: This project hypothesizes how implementing a nurse-driven PCC on admission or hospital stays compared to the timing of a physician to a physician PCC improves a plan of care for oncology patients? Will it result in a decrease in 30-day re-admission rates? The …

Improving The Quality Of Burn Care Through Implementation Of The American Burn Association Competencies, Laura Ritter

DNP Projects

Background and Significance: Specialty certification is an important method to demonstrate that nurses possess training, expert knowledge, and skill in a specialty field. The American Burn Association (ABA) and the Burn Nurse Competency Initiative (BNCI) developed 11 competencies that specify the training, expert knowledge, and skills that nurses require for all aspects of burn nursing practice. The ABA and Board of Certification of Emergency Nurses are in the process of developing a burn certification for nurses. They suggest that all burn units begin to adopt these competencies to ensure consistent and competent care.

Purpose: To adopt the ABA …

Pain Assessment Policy Update And Nursing Education On Best Practices For Pain Assessment: A Quality Improvement Project, Jennifer Zhang

DNP Projects

Significance and Background: Chronic pain assessment should focus on patients' functional status, quality of life (QOL), and pain control. A tool to assess pain intensity and biopsychosocial impacts of pain for patients with chronic pain was needed in a Federally Qualified Health Center (FQHC). The Defense and Veterans Pain Rating Scale (DVPRS) incorporates a numeric rating scale with four functional questions on pain interference on ADLs. DVPRS design stimulates communication between patients and providers about their pain, its impact on function, and state of mind. Treatments are focused on making the pain tolerable and optimizing patient function while avoiding unwanted …

Standardizing Naturalistic Teaching Opportunities For Problem-Based Learning In Diabetes Education: A Quality Improvement Project, Austin Mccaslin

DNP Projects

Significance and Background:

Poor diabetes management is linked to serious long and short-term health complications. Despite this, medication adherence is a significant problem in adolescents with type 1 diabetes. Management is further complicated by low socioeconomic status, even when mitigated by free healthcare, highlighting health literacy as a culprit of disparities. Evidence shows that a common barrier for adolescents is proficiency in dose determination. Carbohydrate counting is an integral skill, necessary for attaining glycemic control. At a homecare agency serving adolescents with poorly controlled diabetes by providing oversight of medication administration and education, it was noted that patients continued to …

Improving Heart Failure Patient Referrals To The Center For Advanced Heart Failure & Pulmonary Vascular Disease At Hartford Hospital: A Quality Improvement Project, Dawn M. Surprenant

DNP Projects

Significance and Background: According to the Health Resources & Services Administration (2021), health literacy is the degree to which individuals have the capacity to process and understand basic health information to make appropriate health decisions. Low health literacy is prevalent in populations such as older adults, minorities, and in individuals with lower socioeconomic status and living in medical underserved areas. Recommendations are to access health literacy in cardiac patients, especially in the acute care setting to improve health outcomes upon discharge.

Purpose: To determine whether a health literacy assessment in hospitalized congested heart failure patients, before discharge, will affect referral …

Non-Opioid Pharmacologic Agents In The Treatment Of Non-Cancer Chronic Pain In The Outpatient Setting, Diane Eannotti

DNP Projects

Opioid prescription related overdose deaths have increased substantially with evidence demonstrating only modest short-term benefits in chronic pain and thus represents the need to identify alternative treatments to opioids. A needs assessment performed for a federally qualified community health center revealed patients presently taking non-opioid pharmacologic agents in the treatment of chronic non-cancer pain (CNCP) needed additional education in managing multiple non-opioid medications. A targeted approach at improving patient experience and population health supporting the quadruple aim was undertaken with this project.

Purpose: The purpose of this quality improvement project consisted of performing medication management visits for 28 referred patients …

Implementing A Telephone Follow-Up Process For Patients With Poorly Controlled Type 2 Diabetes: A Nurse-Led Quality Improvement Project, Amber Gomes

DNP Projects

Background: Diabetes is the seventh leading cause of death in America with approximately 1.5 million people diagnosed yearly (ADA, 2020). The current problem in the practice setting is the lack of follow-up of patients with hemoglobin A1c’s (HbA1c’s) 9% or greater. The current workflow utilizes care coordinators to perform patient outreach to patients with diabetes and a HbA1c of 9% or greater. This workflow is not structured and consists of randomly selecting a patient with a HbA1c 9% or greater and placing one phone call to them to provide education.

Purpose: The purpose of the project was to develop and …

Transformed Waldenström Macroglobulinemia Responsive To Tafasitamab Plus Lenalidomide: A Case Report, Syed Alishan Nasir, Deep Pandya, Steven Wojkiewicz, Bhavna Khandpur, Elizabeth Downes, Pradip Pathare, Richard Frank

Physician Assistant Studies Faculty Publications

The histologic transformation (HT) of Waldenström macroglobulinemia (WM) into diffuse large-cell lymphoma is an uncommon but poor-prognostic event for which there is no standard therapy. Knowledge of this entity is mainly derived from largely retrospective studies, which report abysmal average survival rates even with the utilization of first-line chemoimmunotherapy and especially in patients who meet the high-risk criteria based on prognostic indices used for WM. We present the case of a 75-year-old man with high-risk, transformed WM who was ineligible for standard chemoimmunotherapy (due to pancytopenia and multiple comorbidities) and was consequently treated with tafasitabmab, an anti-CD19 monoclonal antibody plus …