Medicine and Health Sciences Commons^™

Prescription For Critical Thinking: A Discussion Of Psychotropic Medication And Counseling, Barton W. Biggs

Educational Specialist, 2009-2019

This paper examines questions about the safety and efficacy of psychotropic medication, and looks at how these questions should impact the field of counseling. The paper first looks at increasing rates of use of psychotropic medication, and establishes that nearly every clinical mental health counselor will work with clients who are taking or considering taking such medication. The paper next examines the scientific literature and establishes that there is a legitimate basis for questions to be raised about the safety and efficacy of these medications. The paper goes on to establish that there is a foundation in ethical codes and …

Health Care Service Disparity: Factors Associated With The Distribution Of Primary Care Physicians, Robert L. Morgan

Senior Honors Projects, 2010-2019

Primary care physicians operate on the front lines of health care. Although primary care physicians play a critical role in improving health outcomes, workforce trends in the United States show a growing shortage of primary care physicians as demand for primary care rises. In conveying the importance of primary care physicians, the worsening physician shortage, the inequitable distribution of providers, and the lackluster institutional response thus far, this paper calls into question the effectiveness of current indicators used to identify underserved areas and provide appropriate government assistance. Through the use of data from the 2010 census and American Medical Association …

The Impact Of Interactive Music Therapy On The Pediatric Oncology Population, Kristin Moon Orrigo

Senior Honors Projects, 2010-2019

It is an unfortunate truth that a child with cancer will experience pain or anxiety during their battle with illness. Research shows that Interactive Music Therapy is extremely effective at the bedside of hospitalized pediatric cancer patients in reducing pain (Thrane, 2013; Huang, Good, Zauszniewski, 2010; Potvin, Bradt, Kesslick, 2015; Naylor, Kingsnorth, Lamont, McKenever, 2011; Tanriverdi, Aydemir, 2013) and anxiety (Callaghan, Dun, Baron, Barry, 2012; Thrane, 2013; Potvin et al., 2015; Docherty, Cherven, Stegenga, Ferguson, Roll, Stickler, Haase, 2012; Robb et al.,. 2008; Kemper, Bouhairie, Martin, Woods 2008; Tanriverdi, Aydemir, 2013). In cancer centers, the demand is quickly growing for …

Improving Patient Safety Through Accurate Medication Reconciliation, Dominique Watt

Master's Projects and Capstones

Medication errors due to incorrect medication reconciliation are a very present and serious problem in our microsystem. As an preop/postop outpatient unit, we see an average of 50 patients daily and perform medication reconciliations regularly. The problem is our nurses perform this task inconsistently and often incomplete, leading us to potential medication errors. During my CNL project, I worked with a committee of staff champions and developed a standard work guide for nurses to use in order to effective reconcile patient medications. We used fishbone diagrams, audit tools, surveys and led regular discussions in our huddles in order to develop …

Download Entire Issue- Jefferson Interprofessional Education And Care Newsletter, Fall 2015, Volume 6, Issue 2

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Download entire issue- Jefferson Interprofessional Education and Care Newsletter, Fall 2015, Volume 6, Issue 2

An Online Approach To Interprofessional Education, E. Adel Herge, Otd, Otr/L, Faota, Amber E. King, Pharmd, Bcps

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Despite increasing interest in providing interprofessional education (IPE) opportunities for health profession students, the logistics of scheduling and integrating diverse curriculums remain challenging. Several models to address these potential barriers have been proposed and utilized (Blue et al, 2010). Faculty from three colleges within Thomas Jefferson University developed an asynchronous online interprofessional course as one solution to overcome logistical barriers to IPE.

Interprofessional Grand Rounds is offered to third year pharmacy students and second year occupational therapy (OT) students in the fall semester. The course utilizes a variety of learning activities to evaluate the influence of current public health and …

Examining Health Mentors’ Perceptions Of Student Teamwork, Deirdre Yarosh, Bs, Ma, Pharmd Student, Elena M. Umland, Pharmd

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Statement of Issue:

With the increasing emphasis on interprofessional teamwork in healthcare, the need to train future health care professionals to work together as a functional team to provide patient-centered care is clear. Limited information exists regarding education of health care students and teamwork training.1,2 This research evaluates student team performance.

Background:

Thomas Jefferson University (TJU) offers a unique, two-year program emphasizing delivery of patient-centered care and providing valuable skill development by pairing interprofessional student teams with a Health Mentor (HM). The HM is an adult community volunteer with one or more chronic health condition(s). Student teams include representatives from …

In Addition To Checking Out A Book, You Can Check Out Your Health Too: A New Partnership Between Jefferson College Of Nursing And The Philadelphia Free Public Library, Kathryn Shaffer, Edd, Rn, Msn, Cne

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

At Jefferson Health is all we do, but at Jefferson College of Nursing (JCN), Health is H.E.R.E (humanistic, evidenced-based, reflective, excellence in clinical leaders). With a redesign of the undergraduate nursing curriculum, Jefferson College of Nursing (JCN) has transformed the way nurses of the 22nd century will practice, with a focus on caring for patients in all areas of the care continuum. The newly designed curriculum centers around four themes that are threaded throughout, Innovation, Practice Excellence, Interprofessional Collaboration, and Population Health. JCN believes that patients are partners in their health and that care is a collaborative effort.

To model …

From The Editors, Elizabeth Speakman, Edd, Rn, Anef, Fnap, Christine Arenson, Md, Lauren Collins, Md, Shoshana Sicks, Edm

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

This fall has seen a flurry of activity at the Jefferson Center for InterProfessional Education (JCIPE). In September, Lauren Collins, MD, Associate Director of JCIPE, was selected as one of five recipients of the prestigious Macy Faculty Scholars (MFS) program, a two-year career development award supported by the Josiah Macy Jr. Foundation. She now joins a national network of other MFS recipients in helping to re-envision training of health professions students and delivery of collaborative care. Elizabeth Speakman, EdD, RN, ANEF, FNAP, JCIPE Co-Director, completed her three-year Robert Wood Johnson Executive Nurse Fellowship and was recently selected to attend the …

How The Manipulation Of The Ras Homolog Enriched In Striatum Alters The Behavioral And Molecular Progression Of Huntington’S Disease, Franklin A. Lee

University of New Orleans Theses and Dissertations

Huntington’s disease is an incurable, progressive neurological disorder characterized by loss of motor control, psychiatric dysfunction, and eventual dystonia leading to death. Despite the fact that this disorder is caused by a mutation in one single gene, there is no cure. The mutant Huntingtin (mHtt) protein is expressed ubiquitously throughout the brain but frank cell death is limited to the striatum. Recent work has suggested that Rhes, Ras homolog enriched in striatum, which is selectively expressed in the striatum, may play a role in Huntington’s disease neuropathology. In vitro studies have shown Rhes to be an E3 ligase for the …

Family Studies Graduates With National Honors, College Of Education And Human Development

Family and Consumer Sciences News

Jerry Phelps, a family studies student who graduated in fall 2015, is one of 29 students from across the country graduating with National Council on Family Relations (NCFR) honors.

The Happy Older Latinos Are Active (Hola) Health Promotion And Prevention Study: Study Protocol For A Pilot Randomized Controlled Trial, Daniel E. Jimenez, Charles F. Reynolds, Margarita Alegría, Philip Harvey, Stephen Bartels

Dartmouth Scholarship

Results of previous studies attest to the greater illness burden of common mental disorders (anxiety and depression) in older Latinos and the need for developing preventive interventions that are effective, acceptable, and scalable. Happy Older Latinos are Active (HOLA) is a newly developed intervention that uses a community health worker (CHW) to lead a health promotion program in order to prevent common mental disorders among at-risk older Latinos. This pilot study tests the feasibility and acceptability of delivering HOLA to older, at-risk Latinos.

Methods/Design: HOLA is a multi-component, health promotion intervention funded by the National Institute of Mental Health (NIMH). …

Regulatory Roles Of Mical-L1 And Ehd1 In Cell Signaling And Mitosis, James B. Reinecke

Theses & Dissertations

Membrane trafficking is a basic cell biological process that controls the distribution of proteins and lipids. Our lab is particularly interested in delineating the cellular functions as well as the molecular mechanisms that regulate the C-terminal Eps15 Homology Domain (EHD) protein family of adenosine-5’-triphosphatases in mammalian cells. EHD1-4 are ubiquitously expressed in mammalian tissues and serve partially overlapping but also distinct functions in regulating membrane shaping and fission along the endocytic pathway. Specifically, EHD1 is recruited to tubular recycling endosomes (TREs) by Molecule Interacting with CasL Like-1 (MICAL-L1) and facilitates TRE fission and release of cargo from the perinuclear endocytic …

Postural Responses To Perturbations Of The Vestibular System During Walking In Healthy Young And Older Adults, Jung Hung Chien

Theses & Dissertations

It has been shown that approximate one-third of US adults aged 40 years and older (69 million US citizens) have some type of vestibular problems. These declining abilities of the vestibular system affect quality of life. Difficulties in performing daily activities (dressing, bathing, getting in and out of the bed and etc.) have been highly correlated to loss of balance due to vestibular disorders. The exact number of people affected by vestibular disorders is still difficult to quantify. This might be because symptoms are difficult to describe and differences exist in the qualifying criteria within and across studies. Thus, it …

Epacs: Epigenetic Regulators That Affect Cell Survival In Cancer., Catherine Murari

Theses & Dissertations

Cyclic adenosine monophosphate (cAMP) is a second messenger responsive to many external stimuli, playing an important role in cellular gene expression, metabolism, migration, differentiation, hypertrophy, apoptosis and secretion. All of these cellular functions are important in many diseases including cancer. Most of its effects were initially attributed to the classical protein kinase A (PKA) protein, but cellular functions such as proliferation and migration were found to be PKA independent and dependent on the newly discovered exchange proteins directly activated by cAMP (EPACs). EPACs are single polypeptides that primarily function as guanine exchange factors (GEFs) for Rap proteins that allow the …

Designing A Care Delivery System Through Interprofessional Coordinated Care In A Medical Neighborhood Setting, Diane P. Kelly

Doctor of Nursing Practice (DNP) Projects

Abstract

The Patient Protection and Affordable Care Act (2010) has two significant aims: to improve the quality of healthcare and in doing so, to lower the cost of healthcare. The Centers for Disease Control and Prevention (CDC) reports that chronic health conditions, such as diabetes, hypertension, cardiovascular disease, and mental health, which in 2005 affected nearly one of every two Americans, continues to increase (CDC, 2010). Chronic health conditions and lack of access to care are both national and local concerns. These challenges will require the exploration of new models for the delivery of care, as needs shift over time …

Using A Strategic Model For Professional Development: The Importance Of Evidence-Based Competencies As A Foundation For Professional Practice., Peggi B. Winter

Doctor of Nursing Practice (DNP) Projects

Abstract

A nursing professional practice model (PPM) is designed to provide a framework for how nursing practices, communicates, leads, collaborates, and provides the highest quality of care as we navigate the complex healthcare system. An infrastructure for learning, competency, and performance needs to be integrated into this model as a foundation for accelerating business and clinical initiatives, promoting standardization, and sharing successful practices. It is now, more than ever, a necessity to have a well-trained, highly competent nursing workforce. Simply having the knowledge and the skill to do a job is insufficient; rather, it is implied that a competency has …

A Population Health Approach For Community Health Improvement, Sandra Gregg

Doctor of Nursing Practice (DNP) Projects

Providence Health & Services (Providence), a not-for-profit Catholic health care system serving five western states, established an organizational vision of Creating healthier communities, together (Providence Health & Services, 2014). This vision served as the catalyst for the alignment of divisional initiatives to positively impact community health status. To effectively achieve its vision, the organization committed to the incorporation of population health principles in the development of an infrastructure to expand the reach and impact of community investments, along with the establishment of effective processes for inter-divisional collaboration and compliance with community benefit mandates. Thus, in 2015, Providence established a community …

Impetus To Transform: Essential Nursing Leadership Development Through Simulation, Mary J. Mette

Doctor of Nursing Practice (DNP) Projects

Abstract

A nurse manager’s ability to effect positive change and inspire others to higher levels of achievement is related to his or her leadership style in the practice setting, as well as the culture present in the organization as a whole. The aim of this Doctor of Nursing evidence-based change in practice project was to create an educational modality that supported training nurse leaders through innovation and creative problem solving in today’s acute healthcare setting.

A survey was administered to 48 frontline managers in a Northern California healthcare system to access the gaps and voids in their ability to integrate …

The Role Of A Psychiatric Mental Health Nurse Practitioner As Part Of A Mobile Health Unit For The Homeless Population, Joan Alviar Fraino

Doctor of Nursing Practice (DNP) Projects

An estimated 2.3 to 3.5 million people are homeless in the U.S., often living with chronic medical and mental illnesses. The underserved population, such as the homeless, continues to experience gaps in services, resulting in poor healthcare outcomes and readmission to the hospital setting. They often present in crisis through the emergency room, contributing to an already overburdened healthcare system. Increased spending and overutilization of healthcare services continues to rise in the United States (U.S.). Due in part to advancements in technology and expanded health insurance coverage, American healthcare continues be one of the most expensive commodities in the U.S. …

Development And Implementation Of A Violence Risk Assessment Tool, Mira Aidasani-Diwata

Doctor of Nursing Practice (DNP) Projects

The purpose of this quality improvement project was to provide a means to effectively assess patients as they are admitted to the hospitals and to effectively communicate a patient’s violent tendencies within the healthcare setting. Workplace violence is a serious problem that affects all healthcare professionals. Although serious assaults and homicides attract more media attention, the majority of workplace violence consists of non-fatal assaults. Nurses, aides, and patient care technicians suffer the most non-fatal assaults resulting in injury. Due to the growing incidence of assault and injury among healthcare workers, some states are calling for additional study on workplace violence. …

The Creation And Implementation Of Guidelines For The Appropriate Termination Of Patient-Provider Relationships, Rowena D. Nolasco

Doctor of Nursing Practice (DNP) Projects

Primary care providers have terminated patient-provider relationships when they deem them no longer therapeutic. Healthcare providers are increasingly considering this an acceptable practice. However, the criteria for this decision remain unclear. As providers discharge challenging or difficult patients from their practices, questions to support this decision arise. Discharged patients face displacement and healthcare is disrupted. This project will (a) describe problematic patient-provider relationships and its effects, (b) identify possible alternatives to the firing of patients, (c) list appropriate reasons for termination, and (d) present recommended procedures to avoid allegations of medical abandonment. The project's product is an Appropriate Discharge or …

Caution: Line-Of-Sight In Icu Designs, Diane C. Bartos

Doctor of Nursing Practice (DNP) Projects

It has been estimated that by the end of 2015, the U.S. will spend approximately $200 billion in new healthcare facilities construction. Infection prevention, patient and family satisfaction, and technologies influence contemporary designs of critical care units. All of these impacts have created larger patient care units, with a majority of single patient rooms. These larger spaces have created challenges for the clinicians to maintain the line-of-sight. The line-of-sight is one tool clinicians often use to maintain patient safety.

Since the seminal publication by the Institute of Medicine in 1999, patient safety concerns have escalated after revealing numerous deaths in …

Fnp Led Mobile Health Services For The Homeless Population, Tenzin D. Lama

Doctor of Nursing Practice (DNP) Projects

A small percentage of the U.S. population uses the greatest portion of the healthcare services. Homeless people are often such a group of “super-utilizers” of the healthcare system. Due to multiple medical and psychosocial conditions, people experiencing homelessness face numerous barriers to accessing healthcare, thus leading increased utilization of hospitals and emergency departments (EDs) services. Many of these events are preventable through improved primary care interventions. The literature on Respite/Recuperative Care, Transitional Care, and Mobile Health interventions have shown effectiveness in providing safe and quality care to homeless individuals during the critical transitional period post hospital discharge while also reducing …

Patient-Reported Outcomes Screening For Improved Patient Wellness: A Cancer Center Initiative, Alison Morris

Doctor of Nursing Practice (DNP) Projects

Background: People experiencing serious illness have significant unmet physical, emotional, social and spiritual needs. The Quality Oncology Practice Initiative (QOPI) requires patients to be screened for emotional wellbeing and pain by their second oncology visit. This project details one cancer center’s quality improvement initiative to (a) implement electronic screening of every cancer patient by their second oncology visit, (b) design processes for ongoing assessment and intervention of need(s), and (c) develop measurable and sustainable evaluation metrics to ensure that palliative care needs are met. Methods: In June 2015, we launched electronic collection of patient-reported outcomes (PROs) using the Patient Reported …

Depression Screening And Early Intervention On The Post-Stroke Patient, Marco Oliver Dugan Lopez

Doctor of Nursing Practice (DNP) Projects

Statistics in the United States (US) have shown an increase in the prevalence of Cardiovascular Disease (CVD) or risk for developing CVD. Approximately 78 million American adults, 20 years and older, have hypertension, 31.9 million have elevated serum cholesterol levels, and 68.2 million use tobacco products. Within California, San Francisco (SF) was ranked 8th among counties with adult residents that have CVD. It is estimated that approximately 1.02% of these individuals will have a stroke each year and 16.25% will die from stroke. Of those that survive, it is estimated that at least half will develop neurologic deficits, and at …

Improving The Patient Experience By Implementing Patient-Centered Care In A Community Hospital, Richard A. Billingsley Dnp, Mha, Rn

Doctor of Nursing Practice (DNP) Projects

Health care is a complex business currently undergoing extensive reform. These changes require new methods of care deliver and ways in which health care organizations are operating. At the forefront of this change effort is the 2010 Patient Protection and Affordable Care Act, which is transforming health care from a volume-based, fee-for-service process to the delivery of services that have value, improve quality outcomes, increase satisfaction, elicit greater efficiency, demonstrate improved safety outcomes, show cost-effectiveness, promote better access to services, and result in high reliability between providers and organizations. The goal of providing a more positive health care experience is …

Phase Ii Clinical Trial Of Concurrent Neoadjuvant Chemotherapy With Radiotherapy In Locally Advanced Breast Cancer, Muriel Brackstone

Electronic Thesis and Dissertation Repository

Locally advanced breast cancer (LABC) represents 15% of all non-metastatic breast cancers, with an overall poor prognosis, despite current guidelines that recommend neoadjuvant chemotherapy followed by surgery and adjuvant radiation. Therefore, a novel treatment paradigm using concurrent neoadjuvant chemoradiotherapy was proposed. A clinical trial was designed, where 32 LABC patients were treated with q3 weekly 5-fluorouracil, epirubicin and cyclophosphamide for three cycles, followed by weekly docetaxel for 9 weeks with concurrent regional radiation (45+5.4Gy) for the first 6 weeks. Patients subsequently underwent modified radical mastectomies. Pathological complete responses (pCR) and 3 year overall survival rates were compared to a matched …

Improving Patient Medication Reconciliation Participation And Compliance Through Education, Maria Elena Herrera

Master's Projects and Capstones

Abstract

The healthcare world is complex. At the center of this world are patients and their safety. Medication knowledge and medication reconciliation compliance are factors that influence patient’s safety and their overall health outcomes. This project explores the theme of patient safety by examining the relationship between patient education and health outcomes. The microsystem, located in the heart of San Francisco, is an outpatient clinic specializing in patients with renal impairment that each diverse and unique. A pre-implementation survey found that only 38% of patients were bringing their medications to appointments. A goal of improving compliance to 50% by December …

Enhancing Education Of Medication Side Effects To Improve Patient Outcomes, Kyle R. Woolley

Master's Projects and Capstones

Patient satisfaction scores regarding how effectively staff educates patients about possible side effects of new medications are not consistently above the national average at a large metropolitan hospital in California (MHC). The results of these patient satisfaction scores shed light on the need for evidence-based strategies to improve a patient’s perception of the medication education provided to them. The basis of the incentive to improve care is ultimately increased safety and better patient outcomes. From the Root Cause Analysis, it became apparent that a few common barriers need to be addressed, but the one most frequently reported by everyone that …