Medicine and Health Sciences Commons^™

The Clinical Inquiry Process Diagram Question Development Checklist, Roy E. Brown

VCU Libraries Faculty and Staff Publications

This updated handout, previously published in 2023, serves as a reference for those who are either in an EBP course or are practicing healthcare providers involved in questioning practices to improve patient care. The handout guides the user from identifying and developing a question to determining whether the clinical question, based on evidence, will be an evidence-based practice project/initiative, a performance improvement project, or a research project. It aligns with the fifth version of the Clinical Inquiry Process Diagram and now includes several different formats that can be used when trying to create a focused clinical question.

• Update of The …

Evidence-Based Decision Making At The Bedside Process, Roy E. Brown

VCU Libraries Faculty and Staff Publications

Evidence-based practice (EBP) is crucial in healthcare for improving care and organizational outcomes. However, there is a lack of consensus among various health professions regarding the definition and implementation of evidence-based practice in the clinical environment. This lack of consensus centers on whether EBP is project-based or if it occurs primarily at the bedside. This diagram illustrates how evidence is utilized to inform bedside decision-making. It demonstrates that the process is iterative and the intervention or decision made is contingent upon the evidence, one’s clinical experience, and the patient/situation.

The purpose of the diagram is to help those involved in …

Implementation Of A Cancer Education Program In Rural Counties With The Lowest Hpv Vaccination Rates And Health Rankings, Sarah Arezo, Shillpa Naavaal, Charlotte Garrett, Marcie S. Wright, Vanessa B. Sheppard, Michael A. Preston

Dental Public Health and Policy Publications

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). To address STIs, one rural county public school district developed a series of Family Life Programs to educate pre-teens about pertinent health information. The Schooling Cancer Program (SCP) was developed in partnership with the local Cancer Research and Resource Center to raise awareness about cancer risk factors including HPV-related cancers and HPV prevention methods. Methods: We collected a post-evaluation survey from students who attended a SCP session at one of the targeted middle schools. The SCP educated students about topics focusing on healthy lifestyles. The survey asked students’ …

Alcohol Use And Alcohol Use Disorder Differ In Their Genetic Relationships With Ptsd: A Genomic Structural Equation Modelling Approach, Tulsi Patel

VCU's Medical Journal Club: The Work of Future Health Professionals

Posttraumatic stress disorder (PTSD) is associated with an increased alcohol use and increased risk of developing alcohol use disorder (AUD). Previous literature suggests that the genetic association between PTSD and alcohol use differs from that between PTSD and AUD. Researchers in this study used a genomic Structural Equation Modeling, genomicSEM, to analyze data from a larger genome-wide association studies (GWAS). Participants in the study were of European descent.

Researchers investigated the genetic association between PTSD, alcohol use, and AUD through these large scale statistical analyses. Researchers observed a significant improvement in model fit (p < .001). Genetic correlations (rG) between PTSD and AUD were positive (rG: .36, p < .001), while those between PTSD and alcohol use were negative (rG: -0.17, p < .001). Researchers observed that when specific variables for alcohol use and AUD were isolated, key differences resulted in genetic association with PTSD, which indicated that the genetic makeup of alcohol-related behaviors is different in individuals with PTSD.

Effects Of Dextromethorphan On Mdma-Induced Serotonergic Aberration In The Brains Of Non-Human Primates Using [123i]-Adam/Spect, Sky Evans

VCU's Medical Journal Club: The Work of Future Health Professionals

MDMA, a widely used recreational drug belonging to the entactogen class, acts strongly on serotonin and dopamine receptors, potentially inducing neurotoxicity. In a study on primates, MDMA treatment resulted in reduced serotonin transporter levels, persisting for years. However, co-administration with dextromethorphan (DXM), an antitussive with anti-inflammatory properties, appeared to prevent this decrease, suggesting a protective effect against MDMA-induced serotonergic toxicity. The study employed SPECT scans with [123I]-ADAM radioligand to assess serotonin transporter levels in various brain regions, revealing significant differences between treatment groups.

Effect Of Psilocybin On Empathy And Moral Decision-Making, Sky Evans

VCU's Medical Journal Club: The Work of Future Health Professionals

Empathy is the ability for human beings, as well as all other mammals, to understand the mental state of another person on an emotional level. It allows us to feel compassion and promote the well-being of those around us. Impaired empathic abilities lead to severe negative social consequences and influence the development and treatment of several psychiatric disorders, specifically in disorders such as antisocial personality disorder. Furthermore, empathy has been shown to play a crucial role in moral and prosocial behavior. In neuroscience and psychiatry research, the serotonin system has been shown to be involved in modulating empathy and moral …

The Clinical Inquiry Process Diagram (V. 5), Roy E. Brown

VCU Libraries Faculty and Staff Publications

This updated edition of The Clinical Inquiry Process Diagram improves on the 2023 version. It provides a depiction of the steps involved in the clinical inquiry process, covering research, performance improvement, and evidence-based practice. The revisions in this version emphasize the importance of alerting users to the iterative nature of clinical inquiry and the ongoing need to assess the situation or patient based on evolving evidence. It's crucial to recognize that the clinical inquiry process does not follow a linear, sequential progression. Instead, individuals may find themselves concurrently addressing different aspects of the process or revisiting prior steps as they …

Overexpression Of Wnt7a Enhances Radiosensitivity Of Non-Small Cell Lung Cancer Via The Wnt/Jnk Pathway, Loan Quynh Tran

VCU's Medical Journal Club: The Work of Future Health Professionals

Wnt7a serves an important role in slowing down the growth of non-small-cell lung cancer (NSCLC). However, little is known about the effect(s) of Wnt7a on the sensitivity of NSCLC to radiation. In the study, NSCLC cell proliferation and apoptosis in response to Wnt7a overexpression and/or radiation as one combination were determined by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyl-tertazolium bromide (MTT) assay and flow cytometry, respectively. The western blot technique was used to further examine the activation of Wnt/cJun N-terminal kinase (JNK) and Wnt/b-catenin signaling pathways in NSCLC cell lines H1650 and A549.

The results indicate that the overexpression of Wnt7a, in combination with radiation inhibits …

Green Tea Mouthwash And The Prevention Of Porphyromonas Gingivalis: Reducing The Risk Of Developing Alzheimer's Disease, Kaeli Luong

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Alzheimer’s disease causes 10% of all deaths in the United States, while severe periodontitis affects 10% of the population worldwide. Although seemingly unrelated, researchers exploring the connection between the two suggest that oral hygiene is necessary to decrease periodontitis that could possibly lead to Alzheimer’s disease. A notable oral pathogen, Porphyromonas gingivalis (P. gingivalis), has been identified in the connection between Alzheimer’s and periodontitis. In this study, green tea mouthwash is being analyzed to find out if the mouthwash can reduce the periodontitis mechanisms of P. gingivalis to reduce the risk of developing Alzheimer’s. Green tea mouthwash contains the catechins, …

Trauma In Weird Literature: Weird Experiences And Neuropsychiatric Conditions, Mijin Cho

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

This study aims to explore the element of trauma or shock in weird fiction using H. P. Lovecraft’s “The Colour out of Space” as the focal text. I am interested in the cognitive estrangement and body disfigurement following encounters with the weird, which in this case would be the meteorite’s Colour, on the characters experiencing it in the story, including the Gardners and Ammi. The goal is to investigate our reactions to being pushed past our thresholds as human beings using analysis of characters, diction, and rhetoric in weird fiction stories and non-fiction patient narratives to better understand how weird …

Proposing An Rna Interference (Rnai)-Based Treatment For Human Immunodeficiency Virus (Hiv) Infection By Analyzing The Post-Transcriptional Gene Targeting Of Sars-Cov-2, Hepatitis C Virus, And A549 Lung Cancer Cells, Arjun Jagdeesh

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Human Immunodeficiency Virus (HIV) is a retrovirus that infects CD4⁺ T cell lymphocytes in humans, leading to the development of Acquired Immunodeficiency Syndrome (AIDS) if left untreated. While current treatment methods, including antiretroviral combination treatments, effectively limit HIV replication, HIV can evade these treatments due to its high mutation rate. Long-term antiretroviral treatment can also be toxic to patients, meaning patients would benefit from a new mechanism of HIV treatment. RNA interference (RNAi) is an antiviral pathway found in mammals, plants, and insects that involves a small-interfering RNA that is incorporated into a protein complex called the RNA-induced Silencing …

Determining Effective Treatment Regimens For Breast Cancer Using Combined Immunotherapy And Chemotherapy In Vivo, Akhila Kunuthuru

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Breast cancer has the highest incidence rate of all cancers globally in women, and those of African descent, especially West African females, face higher rates of triple-negative breast cancer (TNBC), a more aggressive form of breast cancer. Immunotherapy for breast cancer is a relatively new treatment option, and research is ongoing to identify the best combination treatments for increasing survival of those diagnosed with TNBC. Eganelisib (IPI-549: a PI3K-gamma inhibitor that works to shift M2 macrophages to M1 to augment T cell function) with other combinatory treatments has shown promising results in reducing tumor growth and increasing survival in mice. …

Examining Effects Of Perceived Discrimination And Loneliness On Overall Health Outcomes In Black Americans, Apoorva Saravanan

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

On average, Black Americans suffer more from a wide range of diseases when compared to White Americans. The national mortality rate for Black Americans is also 24% higher than their White counterparts. Although there are multiple factors contributing to such disparities, one line of research provides strong evidence that negative health outcomes are more likely to occur in Black Americans who experience racial discrimination than those who experience no discrimination. A separate line of research also provides evidence that loneliness is a major health risk factor. In fact, prior research indicates that the experience of discrimination and loneliness are both …

Solutions To Period Poverty In The United States, Sanya Surya

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Many women around the world lack access to menstrual hygiene products and hygienic, private sanitation facilities: an issue commonly known as “period poverty”. Women who experience this phenomenon often resort to unhealthy alternatives, putting them at higher risk for infections. Period poverty also causes many women to miss significant amounts of school and/or work, resulting in school drop-outs and adverse career outcomes. Menstrual inequities have recently come under greater study in low- to middle-income countries, but evidence suggests that women in the United States are adversely affected by period poverty as well. With this in mind, I set out to …

Six-Month Pain And Function Outcome Expectations Were Established For Total Knee Arthroplasty Using The Smallest Worthwhile Effect, Daniel L. Riddle, Nancy Henderson

Physical Therapy Publications

Introduction: Interpretations of patient-reported outcome measures following knee arthroplasty lack context and typically do not account for costs, risks and benefits compared to an alternative treatment. The primary purpose of our paper is to estimate expectations patients have for pain and function destination outcome, six-months following surgery relative to the outcome expected if knee arthroplasty was not done. Secondary purposes were to determine if statistically significant changes in the smallest worthwhile six-month outcome occurred following an interactive discussion and to assess the construct validity of the expected six-month outcome obtained at baseline.

Methods: This was a secondary analysis …

Socioeconomic Status And Health Disparities Drive Differences In Accelerometer-Derived Physical Activity In Fatty Liver Disease And Significant Fibrosis, Lucia Tabacu, Sajag Swami, Mark Ledbetter, Mohamad S. Siddiqui, Ekaterina Smirnova

Internal Medicine Publications

Background and aims: The cornerstone of clinical management of patients with nonalcoholic fatty liver disease (NAFLD) are lifestyle changes such as increasing physical activity (PA) aimed at improving cardiometabolic risk. To inform NAFLD prevention and treatment guidelines we aimed to: (i) quantify the role of PA on lowering the risk for NAFLD and fibrosis; (ii) characterize NAFLD and fibrosis association with PA in the context of socioeconomic environment.

Methods: A sample of 2648 participants from the NHANES 2003–2006 was selected to develop survey weighted multivariable logistic regression models for predicting NAFLD and significant fibrosis, diagnosed non-invasively via fatty …

Improving Medication-Enhanced Psychotherapy Options For Ptsd: The Potential Of Oxytocin As A Treatment For Hypervigilance In Women With A History Of Childhood Sexual Abuse And Related Ptsd, Elianna Bavuso

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Childhood sexual abuse (CSA) is a notable public health concern, affecting a significant proportion of girls in high-income countries. A considerable number of CSA survivors develop Post-Traumatic Stress Disorder (PTSD) by adolescence, which is often considered to be a lifelong disorder with severe emotional and social consequences. Women with CSA-related PTSD display hypervigilance, which is characterized by significantly increased fear network activity and poor top-down control over the amygdala. This meta-analysis examines the potential of intranasal oxytocin (OT) as a treatment for hypervigilance symptoms in women with CSA-related PTSD. The evidence reviewed suggests that intranasal oxytocin can help normalize the …

A Three-Dimensional In Vitro Model Of Disease That Improves Preclinical Research By Incorporating Genetic Diversity And Increasing Physiological Accuracy, Akash Jagdeesh

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Biomedical research is essential for the discovery of new medications and treatments, and is built upon the cooperation of preclinical (in vitro/vivo) research and clinical trials. However, 85% of treatments successful in vitro/vivo fail in clinical trials, suggesting that in vitro models are poor indicators of clinical success. The issue lies in conventional “two-dimensional” in vitro models containing genetically identical cells grown on a flat plate, which lack the variety of cell types and cooperation/structure found in real tissue. Moreover, 2D in vitro models do not simulate humans’ genotypic variability, which affects both pathophysiology and treatment effectiveness. In contrast, 3D …

Catecholamine Signaling In Ca1 Correlates With Novelty, Movement, And Sleep State, Meenakshi Kakani

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Norepinephrine (NE) and dopamine (DA) signaling in the hippocampus are important for normal learning and memory. Genetically-encoded fluorescent indicators of catecholamine binding allow for imaging real-time neurotransmitter dynamics. Previous microdialysis studies have found an increase in hippocampal catecholamines in response to novel environmental exposure or exercise. Since animals move in response to contextual novelty, it is unknown whether the changes in transmitter release are due to novelty or other changes in behavior or arousal. Outside of the hippocampus, arousal, novelty detection, reward, and sleep state are all related to catecholamine signaling. In this study, we use the fluorescent indicators GRAB-DA …

The “Desegregation“ Of Mcv Hospitals, 1968 To 1971, Robert E. Petres

Publications from the Office of the Senior Vice President for Health Sciences

The “desegregation“ of MCV Hospitals, 1968 to 1971 Robert E. Petres

Retired OB/GYN physician recounts his experiences as resident at the Medical College of Virginia (MCV)’s St. Philip Hospital in Richmond, Va. in the late 1960s and early 1970s.

MCV declared the desegregation of its hospitals in 1965, but when Petres arrived in 1968, he observed something different. The obstetrical hospitals may have been racially integrated as a matter of policy, but in practice they were segregated. “Private Service" patients – most white women in Richmond – delivered their babies in the obstetrics unit of West Hospital, where there were …

A Multifaceted Approach Using Implementation Science Methods To Increase Chg Bathing Compliance And Reduce Central Line Associated Blood Stream Infections On A Non-Icu Unit, Emily E. Warwick

VCU Health Nursing

BACKGROUND or RATIONALE:

The Acute Care Surgery unit (ACS) is a General and Progressive level of care post-operative unit at VCU Health system. Between quarter four 2021 and quarter one of 2023, five Central line associated blood stream infections (CLABSIs) occurred. NDNQI data revealed ACS had a higher CLABSI rate per 1,000 patient days than the national average of other similar type units in other magnet hospitals.

STATEMENT OF THE PROBLEM:

A GAP analysis revealed ACS did not achieve the 80% CHG compliance goal set by VCU Health’s Infection Prevention Department in all six quarters that these five CLABSIs occurred. …

Ur-Ine Good Hands In The Neuroscience Intensive Care Unit, Molly Lehatto, Courtney Hastings, Monika Mehlbrech, Christina Szabo

VCU Health Nursing

Purpose:

The purpose of this performance improvement project was to decrease the harm to patients related to catheter associated urinary tract infections (CAUTIs) in the Neuroscience Intensive Care Unit (NSICU). Historically, the NSICU had the highest CAUTI rates in our organization with as many as 6 CAUTIs per calendar year quarter. A core group of nurses partnered with providers, hospital infection preventionists and nursing leaders to improve practices for placing, removing, and managing urinary catheters and to implement guidelines for urine testing stewardship.

Description:

Significance: In 2020, the NSICU had 12 CAUTIs, the highest number of CAUTIs in the entire …

Infiltrating Cd8+ T Cells Exacerbate Alzheimer’S Disease Pathology In A 3d Human Neuroimmune Axis Model, Jefin Jose, Devam Purohit

VCU's Medical Journal Club: The Work of Future Health Professionals

In this study, Jorfi et al. employed a neuroimmune axis model containing neurons, astrocytes, and microglia to examine the role of immune cells in Alzheimer's disease. Jorfi et al. found that T cells selectively infiltrated the BRAIN compartment of the neuroimmune axis model as compared to B cells and monocytes. Jorfi et al. further found that CD8+ T cells demonstrated heightened cytotoxicity in the Alzheimer's disease brain, illuminating the role of immune cells in neurodegeneration. Upon further examination, the CXCR3-CXCL10 signaling pathway was found to have an important role in inflammation.

A Genome-Wide In Vivo Crispr Screen Identifies Essential Regulators Of T Cell Migration To The Cns In A Multiple Sclerosis Model, Jefin Jose

VCU's Medical Journal Club: The Work of Future Health Professionals

Kendirli et al. (2023) used a CRISPR screen to determine the proteins involved in T cell migration into the CNS in multiple sclerosis. Overall, eighteen facilitators and five brakes to T cell infiltration into the CNS were identified. Kendirli et al. specifically identified ITGA4, FERMT3, and HSP90B1 to make up the adhesion module, CXCR3, GNAI2, and TBX21 to make up the chemotaxis module, and GRK2 and S1PR2 to make up the egress module. This study demonstrated the ability of a CRISPR screen to identify elements in a disease process and thus identify targets for future multiple sclerosis therapies.

Pmh Connect, English (Greyscale For Printing), Sara W. Moyer, Patricia Kinser

School of Nursing Publications

Mental health related symptoms and associated experiences in the perinatal period present challenges, particularly regarding identification and appropriate management. Perinatal Mental Health (PMH) screening occurs in clinical settings on a more regular basis than ever before thanks to validated screening measures used at perinatal visits; however, pregnant and parenting individuals report several concerns when completing these screeners and providers report barriers in addressing resultant findings. To address barriers and enhance the PMH screening experience, this team of clinicians and researchers propose a tool – the PMH Connect: a Perinatal Mental Health Screening Connection, Education, and Decision Aid – to be …

Pmh Connect, EspañOl_Full Color, Sara W. Moyer, Patricia Kinser

School of Nursing Publications

Mental health related symptoms and associated experiences in the perinatal period present challenges, particularly regarding identification and appropriate management. Perinatal Mental Health (PMH) screening occurs in clinical settings on a more regular basis than ever before thanks to validated screening measures used at perinatal visits; however, pregnant and parenting individuals report several concerns when completing these screeners and providers report barriers in addressing resultant findings. To address barriers and enhance the PMH screening experience, this team of clinicians and researchers propose a tool – the PMH Connect: a Perinatal Mental Health Screening Connection, Education, and Decision Aid – to be …

Pmh Connect, EspañOl_Greyscale For Printing, Sara W. Moyer, Patricia Kinser

School of Nursing Publications

Mental health related symptoms and associated experiences in the perinatal period present challenges, particularly regarding identification and appropriate management. Perinatal Mental Health (PMH) screening occurs in clinical settings on a more regular basis than ever before thanks to validated screening measures used at perinatal visits; however, pregnant and parenting individuals report several concerns when completing these screeners and providers report barriers in addressing resultant findings. To address barriers and enhance the PMH screening experience, this team of clinicians and researchers propose a tool – the PMH Connect: a Perinatal Mental Health Screening Connection, Education, and Decision Aid – to be …

Pmh Connect, English, Full Color, Sara W. Moyer, Patricia Kinser

School of Nursing Publications

Mental health related symptoms and associated experiences in the perinatal period present challenges, particularly regarding identification and appropriate management. Perinatal Mental Health (PMH) screening occurs in clinical settings on a more regular basis than ever before thanks to validated screening measures used at perinatal visits; however, pregnant and parenting individuals report several concerns when completing these screeners and providers report barriers in addressing resultant findings. To address barriers and enhance the PMH screening experience, this team of clinicians and researchers propose a tool – the PMH Connect: a Perinatal Mental Health Screening Connection, Education, and Decision Aid – to be …

Rapid Onset Hydralazine-Induced Antineutrophil Cytoplasmic Antibody (Anca) Associated Vasculitis Presenting With Hemoptysis And Kidney Failure: Case Report, Rachel E. Easter, Andinet Gizaw, Natalie Klein

Internal Medicine Publications

Hydralazine-induced vasculitis can be challenging to recognize and diagnose as presenting symptoms vary and can mimic other conditions or diseases, however, swift intervention and treatment is key in halting progression of the disease and providing patients with the best possible outcomes. A 71-year-old African American female presented to the emergency department with weakness, fatigue, anemia, blood-streaked sputum, fever, chills, and severe myalgias. Hydralazine was prescribed to treat resistant hypertension eight months prior to presentation. Hydralazine was discontinued on hospital day (HD) 4. Pertinent laboratory values showed elevated inflammatory markers, positive antinuclear antibody (ANA), negative rheumatoid factor (RF), normal complement levels, …

Dermatologic Manifestations Of Rheumatic Disease: Cutaneous Manifestations Of Vasculitides, Julianna S. Kang, Julia Nunley, Tiffany Ho, Mavra Masood, Fnu Nutan, Beth Rubinstein

Open and Affordable Course Content at VCU

Cutaneous Manifestations of Vasculitides is a Powerpoint based learning module that begins with the definition of terms and findings often found in vasculitis, followed by a review of several systemic vasculitides, highlighting how characteristic cutaneous lesions may be predictive of the vessel of involvement as well as the associated histologic changes. Moreover, significant clinical and laboratory findings utilized to make the correct diagnosis will be emphasized. This module is not meant to be an exhaustive review of vasculitis, but to serve as an introduction to understanding disease processes and how systemic vasculitis and skin findings interrelate.

It is part of …