Medicine and Health Sciences Commons^™

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 …

Dermatologic Manifestations Of Rheumatic Disease: Malignant Cutaneous Tumors, Divya Shan, Julianna S. Kang, Allison Cinats, Julia R. Nunley, Beth Rubinstein

Open and Affordable Course Content at VCU

Malignant Cutaneous Tumors is a Powerpoint-based learning module that focuses on skin cancers. It begins with the definition of terms and findings, followed by a review of several clinical cases. The goal of the module is to provide the students with the ability to differentiate the most common types of skin cancer and precancerous lesions and gain an awareness of cutaneous lymphomas. This module will include images and clinical findings from diverse skin tones to prepare students to identify cutaneous findings in a heterogeneous patient population. This module is not a comprehensive review of skin cancers but an introduction to …

Dermatoses Of The Breast During Lactation, Divya Shan, Sindhuja Koppu, Valerie Coleman, Gauri Gulati, Kimberly Salkey

Open and Affordable Course Content at VCU

Dermatoses of the Breast during Lactation is a PowerPoint-based learning module that focuses on skin diseases of the breast and nipple that occur during lactation. It covers the diagnosis, workup, and management of a wide range of breast dermatoses with overlapping clinical presentations. Topics covered in this OER include differential diagnoses for breast masses, infections, nipple discharge, and nipple lesions. The goal of the module is to provide students with the ability to differentiate both physiologic and pathologic causes of breast dermatoses and gain awareness of the skin conditions that present in breastfeeding individuals. This module includes images and descriptions …

Enhancing Clinical Judgment In Nursing Students, Mark Tanner

Health Sciences Education Symposium

Background/Objectives: Nurses need to be able to think critically and to use clinical judgment in order to competently do their work required of them in the clinical environment. The National Council of State Boards of Nursing (NCSBN) recognized this and developed the NCSBN Clinical Judgment Measurement Model (CJMM) in order to assess and measure clinical judgment on the NCLEX exams. This model was designed to give guidance to faculty so that they can help students develop the desired skills in critical thinking and clinical judgment. The faculty in a senior-level Adult Medical-Surgical Nursing used the CJMM to redesign the clinical …

Implementation Of A Required Professional Development Course Series In The Doctor Of Pharmacy Program, Nicole E. Omecene

Health Sciences Education Symposium

Purpose/Background: The assessment of professionalism is a challenging and evolving field. The pharmacy education literature describes approaches to assessing professionalism over time; however, an integrated professionalism course series spanning the duration of the program has not been described.1,2 Co-curricular experiences present an opportunity for students to apply content learned in the classroom to real-world experiences where professionalism is expected. These activities include leadership positions, career seminars and health outreach events. Previously described processes for tracking the co-curricular activities differ in the accuracy of data collected and the connection to a professional development course.3,4 The purpose of this educational project is …

An Interprofessional Active-Learning Laboratory On Urinary Incontinence, Krista L. Donohoe

Health Sciences Education Symposium

Background/Objectives:Urinary incontinence (UI) is a common syndrome with peak prevalence in older adulthood. Involuntary loss of urine from the bladder may be due to physical abnormalities, pelvic floor dysfunction, or reversible causes, like medication or infection.1 UI is an underreported and underdiagnosed geriatric syndrome that significantly impacts quality of life, increases risk of institutionalization, and contributes to significant patient- and system-level healthcare expenditures.1 Healthcare practitioners require knowledge and skills necessary to provide quality care to older adults with UI. The National Institute of Diabetes and Digestive and Kidney Diseases, National Institute on Aging, and American Geriatrics Society recommend the healthcare …

Interprofessional Development And Evaluation Of A Virtual Reality Haptic Surgical Training System For Retropubic Midurethral Slings, Lauren Siff

Health Sciences Education Symposium

Purpose and background: Procedures like the midurethral sling, performed without open visual or camera access rely on the surgeon’s spatial orientation of anatomical landmarks and haptic sensation. The “Blind” nature of this technique can results in serious complications^1–4. Surgeons are typically trained via an apprenticeship on live patients, static models, or, cadaver labs. These methods carry higher potential risks for patient safety, significant expense, often require travel, and are limited by distortion of anatomy after multiple uses. Adding haptics and AI to VR simulators has been shown to improve fidelity, realism, and educational value^ 5–10.We formed a transdisciplinary team to …

Virtual, Non-Clinical “Bootcamp” To Prepare For The Nbme Subject Matter (Shelf) Exam During The Pediatric Clerkship, Clifton Lee

Health Sciences Education Symposium

Background: Medical education changed due to the COVID-19 pandemic. Educational sessions were offered virtually. There are published education innovations for pre-clinical curricula (1). However, providing virtual education during the clinical clerkship was a daunting challenge. In addition to the delay in patient care exposure, students’ performance in the NBME Subject Matter (Shelf) Exam scores have declined during the pandemic (2). VCU School of Medicine also needed to provide continued instructions to students whose clinical clerkships were delayed.

Description of the Innovation: Due to the COVID-19 pandemic, the clinical start for the class of 2022 was delayed by 3 months. During …

The Value Of Positive Feedback: An Underutilized Tool In Ophthalmology Resident Education, Meagan Shinbashi

Health Sciences Education Symposium

Purpose/Background/Objectives: Little research has been performed on the use of positive feedback as a teaching tool in ophthalmology postgraduate medical education settings. Additionally, there is a paucity of research assessing the effectiveness of feedback from trainees’ perspectives. To address these gaps, we explored the effects of positive feedback on resident professional identity formation, performance, and wellness through a pilot program within the ophthalmology residency program’s wellness curriculum at Virginia Commonwealth University.

Methods: This study employed quantitative data collection through surveys before and after a positive feedback exercise activity of ophthalmology residents at the Virginia Commonwealth University Health System. Participants were …

Research4life (R4l) Scholar Program: New Initiative To Promote Diversity, Equity, And Inclusion In Medicine Through A Bottom-Up Approach, Somaya Albhaisi

Health Sciences Education Symposium

Purpose and background: According to the Pew Research Center, Hispanics are 17% of the workforce but only represent 8% of people in a science, technology, engineering and math (STEM) position. African Americans are 11% of the workforce but hold 9% of STEM jobs. The Research4Life (R4L) program is designed to increase the number of minority students who pursue medical education and careers in Medicine and research. A formalized mentorship and clinical research program is one pipeline to increase representation of underrepresented groups in medicine and academic medical careers.(1)

Description of Innovative Practice: The R4L scholar program is a structured summer …

The Neoresident Curriculum: A Combined Learning Experience For Pediatric Residents, Kelly Stanley

Health Sciences Education Symposium

Purpose and background, including relevant citations: All pediatric residents are required to rotate through the neonatal intensive care unit (NICU). The NICU is a unique unit that provides care for premature and ill neonates. At Children’s Hospital of Richmond at VCU (CHOR VCU), pediatric residents complete 12 weeks in the NICU, 4 weeks each year. As a part of this rotation, these residents are responsible for attending high risk deliveries. At birth about 10% of neonates will require resuscitation (1). Before starting residency, each resident is required to complete the neonatal resuscitation program (NRP). This certification requires renewal every two …

Pilot Test Of A Large-Scale, First-Hand Research Opportunity For Medical Students, Brian Cassel

Health Sciences Education Symposium

Purpose and background: While VCU is an R1 university, many students graduate without first-hand research experience. We sought to create a new learning opportunity for second year medical students (M2s) through access to real-world clinical data from a federated research network of healthcare organizations, TriNetX. TriNetX gives users access to millions of de-identified patient records for a wide variety of purposes: cohort discovery; determining possible enrollment rates for clinical trials; evaluating outcomes; and evaluating disparities. Several VCU researchers have published studies using TriNetX data [i]. Prior to our project, TriNetX access and instruction had not been pushed out to medical …

Standardized Patient Simulations: A Pilot Program In The Ophthalmology Residency Curriculum, Yusrah Hasan

Health Sciences Education Symposium

Background: Patient simulations are being used to provide a safe environment for learners to practice giving bad news to patients.

Methods: This series of simulations was implemented at Virginia Commonwealth University Ophthalmology Residency program among three cohorts of residents in 2019, 2020 and 2021. Each simulation involves a case scenario in which the learner must synthesize clinical information to recognize a patient’s diagnoses and deliver bad news to the patient in a tactful manner.

Results: Post-simulation surveys were completed by the 2020 and 2021 cohort of residents. All learners felt that the experience improved their communication skills with patients. 44% …

Strength In Caring: An Interprofessional Innovation To Cultivate Organizational Wellness, Kelly Lockeman

Health Sciences Education Symposium

Background. The impact of COVID-19 on the physical and mental health of individual providers and entire health care systems has had a devastating blow to already fragile networks.[1] It is imperative to identify strategies that heal, repair, and build capacity in health care providers and fix the system in which they practice. Building resilience through self-care is only a part of the solution.[2,3] Health care organizations are striving for solutions that target issues such as psychological safety, interprofessional teamwork, and wellness-centered leadership, which are more likely to reduce burnout than individualized self-care programs.[4,5] The purpose of the Strength in Caring …

Chesterfield Fire And Ems Mobile Integrated Healthcare: Background And A Case Study, David Bigelow

Case Studies from Age in Action

Learning Objectives

• Explain the history of Mobile Integrated Healthcare.
• Understand the importance of reducing hospital readmissions.
• Learn how MIH partners with Adult Protective Services and others for the benefit of their patients.

The Effect Of Periodic Ketogenic Diet On Newly Diagnosed Overweight And Obese Patients With Type 2 Diabetes, Tryphena Pilli

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

Ketogenic diet can help lower blood glucose levels in newly diagnosed overweight and obese patients with T2DM.

Cd4+ T Helper 2 Cells Suppress Breast Cancer By Inducing Terminal Differentiation, Arjun Jagdeesh

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

In this 2022 publication, Boieri et al. investigated how thymic stromal lymphopoietin (TSLP) can activate CD4+ and CD8+ T cell helper 2 (Th2) for breast cancer suppression. T cell helper 1 (Th1) cells are involved in the targeted immune response by attracting cytotoxic T lymphocytes and natural killer cells. However, Th2 cells are known to inhibit the T cell helper 1 immune response by causing allergic inflammation. Th2 activation in patients with allergic diseases conferred decreased risk of breast cancer. PyMt-tg mice were retroorbitally injected with TSLP and tumor growth and survival rate were compared between wild type mice and …

Inhibition Of Type 1 Immunity With Tofacitinib Is Associated With Marked Improvement In Longstanding Sarcoidosis, Devam Purohit

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

This presentation focused on the inhibition of type 1 immunity with tofacitinib and its effect on patients with sarcoidosis. The drug tofacitinib is mainly a rheumatoid arthritis drug, and the main objective of the study was to see if the drug could be used for sarcoidosis. After the completion of the experiment, it was found that the drug dramatically reduced the CSAMI activity score (a score used to indicate the activity of sarcoidosis) by 82.7% on average after six months of use.

School Division Policies Related To Suicide Prevention And Response, David Naff, Fatemah A. Khawaji, Morgan Meadowes, Jill Flynn, Meg Sheriff, Lauren Powell, Lisa Gwyn, Tameka Burroughs, Jean Samuel

MERC Publications

Suicide is one of the leading causes of death among youth age 10-19, and is an increasing concern in the wake of COVID-19. K-12 schools are crucial spaces for offering mental health support to students, and can implement policies to help prevent suicidal thoughts and behaviors. This MERC research and policy brief focuses on education policy related to suicide prevention and response. It is structured to answer five questions: 1) What are recent trends in youth suicide? 2) What does research show about school division policies that are effective in suicide prevention and response? 3) What policies in Virginia and …

Adult Day Services: A Model That Works, Heather Turbyne-Pollard

Case Studies from Age in Action

Learning Objectives

1. Demonstrate the need for adult day services.

2. Illustrate the benefits beyond those to the older adults served.

3. Demystify common misconceptions about adult day services.

Care At The Intersections: A Case Study, Alyssa Camp

Case Studies from Age in Action

Learning Objectives

1. Increase understanding of trans elder care.

2. Recognize the ethical considerations of caring for a trans elder with dementia.

3. Understand the value of LGBTQ+ training and programing in assisted living.