Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes

Doctor of Nursing Practice Scholarly Projects

Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …

Measurement Of Cumulative High-Sensitivity C-Reactive Protein And Monocyte To High-Density Lipoprotein Ratio In The Risk Prediction Of Type 2 Diabetes: A Prospective Cohort Study, Dan Wu, Genyuan Chen, Yulong Lan, Shuohua Chen, Xiong Ding, Chiju Wei, Lois Balmer, Wei Wang, Shouling Wu, Wencan Xu

Research outputs 2022 to 2026

Background: Converging data have suggested that monocytic inflammation and C-reactive protein (CRP) are biologically intertwined processes and are involved in diabetogenesis. This study aimed to investigate the association between systemic inflammation assessed by joint cumulative high-sensitivity C-reactive protein (CumCRP) and monocyte to high-density lipoprotein ratio (CumMHR) and incident type 2 diabetes (T2D) and their predictive value for T2D in a general population. Methods: A total of 40,813 nondiabetic participants from a prospective real-life cohort (Kailuan Study, China) were followed biennially from 2010/2011 until December 31, 2020. Multivariable Cox regression analyses were conducted to evaluate the adjusted hazard ratios (aHRs) of …

Exploring Treatment Burden In People With Type 2 Diabetes Mellitus: A Thematic Analysis In China's Primary Care Settings, Kai Lin, Mi Yao, Lesley Andrew, Rouyan Li, Yilin Chen, Jacques Oosthuizen, Moira Sim, Yongsong Chen

Research outputs 2022 to 2026

Background: Understanding treatment burden is a critical element to the effective management of Type 2 Diabetes Mellitus (T2DM). The current study aims to address the knowledge gap surrounding treatment burden of T2DM from the patient’s perspective in China’s primary care settings. Methods: A narrative review informed the creation of an a priori coding structure to identify aspects of T2DM treatment burden. Focus groups were conducted, employing a maximum variation sampling strategy to select participants from diverse sociodemographic backgrounds across urban, suburban, rural, and remote areas in China. Participants included adults with T2DM care in primary care settings for over a …

Reclaiming Healing Spaces: A Phenomenological Study On The Transformative Power Of Outdoor Therapy From The Lived Experiences Of Black Clinicians Working With Black Clients, Lynn Murphy

Dissertations

This phenomenological study involved assessing the experiences of Black therapists who engaged Black clients in outdoor therapeutic contexts. The study was founded on the existing literature that shows the quality of the therapeutic relationship is pivotal for client retention and the Western standards that have historically favored treatment within indoor environments. To contextualize this research, a comprehensive literature review was commenced, covering topics such as the decolonization of therapy, the historical and present-day relationship between Blacks and the outdoors in the United States, sedentary lifestyles, the psychological benefits of time spent in nature, various types of outdoor therapy, and the …

Performance Analysis Of Hybrid Deep Learning Framework Using A Vision Transformer And Convolutional Neural Network For Handwritten Digit Recognition, Vanita Agrawal, Jayant Jagtap, Shruti Patil, Ketan Kotecha

Journal Articles

Digitization created a demand for highly efficient handwritten document recognition systems. A handwritten document consists of digits, text, symbols, diagrams, etc. Digits are an essential element of handwritten documents. Accurate recognition of handwritten digits is vital for effective communication and data analysis. Various researchers have attempted to address this issue with modern convolutional neural network (CNN) techniques. Even after training, CNN filter weights remain unchanged despite the high identification accuracy. As a result, the process cannot flexibly adapt to input changes. Hence computer vision researchers have recently become interested in Vision Transformers (ViTs) and Multilayer Perceptrons (MLPs). The shortcomings of …

Contemporary Analysis Of Reexcision And Conversion To Mastectomy Rates And Associated Healthcare Costs For Women Undergoing Breast-Conserving Surgery, Youngran Kim, Cecilia Ganduglia-Cazaban, Nina Tamirisa, Anthony Lucci, Trudy Millard Krause

Journal Articles

PURPOSE: This study was designed to provide a comprehensive and up-to-date understanding of population-level reoperation rates and incremental healthcare costs associated with reoperation for patients who underwent breast-conserving surgery (BCS).

METHODS: This is a retrospective cohort study using Merative™ MarketScan

RESULTS: The commercial cohort included 17,129 women with a median age of 55 (interquartile range [IQR] 49-59) years, and the Medicare cohort included 6977 women with a median age of 73 (IQR 69-78) years. Overall reoperation rates were 21.1% (95% confidence interval [CI] 20.5-21.8%) for the commercial cohort and 14.9% (95% CI 14.1-15.7%) for the Medicare cohort. In both cohorts, …

Blunt Cerebrovascular Injury (Bcvi): Universal Cta Neck Screening At Level 2 Trauma Center, Tamine Gogel

Doctor of Nursing Practice Projects

Blunt Cerebrovascular Injury (BCVI) refers to injuries to the vessels supplying blood to the brain, primarily carotid and vertebral arteries, and can result from trauma, resulting in stroke by vessel dissection, thrombus formation, embolization, and hemorrhage. Timely identification is crucial for effective intervention and improved outcomes. This doctoral project proposes the implementation of universal screening using Computed Tomography Angiography (CTA) of the neck during initial workup for blunt force trauma at a Level II ACS-verified trauma center. The primary objective is to mitigate potential delays in diagnosing and treating BCVI, thereby reducing the likelihood of complications. Patients ≥ 15 years …

Honoring Veterans’ Wishes: Efficacy Of An Evidence-Based Shared Decision-Making Tool In Va Icu Goals-Of-Care Discussions, Stephanie Alexander, Anna Astashchanka Md, Venktesh Ramnath Md

Doctor of Nursing Practice Final Manuscripts

Abstract

Introduction: This Doctor of Nursing Practice project aimed to enhance the knowledge and confidence of the San Diego Veterans Health Administration’s (VASD) Intensive Care Unit (ICU) medical providers in goals-of-care discussions (GOCD). Additionally, this project aimed to improve the documentation of these discussions.

Background: Delays in GOCD can lead to futile medical and surgical interventions, inappropriate antibiotic use, and higher rates of mental health conditions in patients and their loved ones. Earlier GOCD are associated with lower ventilation and resuscitation rates, earlier hospice enrollment, reduced ICU admissions, lower financial costs, and better patient and caregiver quality of life. However, …

Care Of The Critically Ill Nontrauma Patient: Improving Emergency Department Readiness And Patient Care Through The Implementation Of A Dedicated Resuscitation Bay, Martha H. Buck Rn, Bsn, Tcrn

Doctor of Nursing Practice Final Manuscripts

Current best practice among emergency departments worldwide includes the maintenance of a dedicated resuscitation space. This practice allows for team members and equipment to be ready at a moment’s notice to provide care to a patient in need of lifesaving interventions. This evidence-based performance improvement project seeks to implement this standard of care in a busy, urban emergency department in Southern California.

Prior to this study, patients at this facility were placed in the next available care space, without the maintenance of a dedicated resuscitation area for critically ill patients. Survey data evaluating staff levels of perceived readiness to care …

Early Cholestasis And Vitamin K Deficiency Secondary To Biliary Atresia Presenting As Coagulopathy And Thymic Hemorrhage, Abbey Elsbernd, Lauren Amos Md

Research Days

Background

Bleeding and progressive coagulopathy are established symptoms of early cholestasis, including extrahepatic biliary atresia. We present a patient with bleeding secondary to vitamin K deficiency and cholestasis-induced fat malabsorption with unusual presentation of mediastinal mass.

Objective

Describe a case of late-onset vitamin K deficiency and cholestasis presenting as jaundice and coagulopathy with associated bleeding into thymic structures Design/Method

Case report

Results

A 4-week-old term male infant was brought to the ED with fussiness and bruising. Prior to presentation, he was afebrile and followed regularly with his primary care provider for jaundice below phototherapy thresholds. Infant received vitamin K at …

Pain Outcomes In Adolescents With Surgically Confirmed Endometriosis: A Single Site Retrospective Cohort Analysis, Madeline Ross, Samantha Janssen, Priya Suvarna, Adam Booser, Ashli Lawson

Research Days

Background: In adolescents with significant dysmenorrhea, empiric therapy via analgesics and hormonal medications is considered gold standard. However, those with refractory pain may have endometriosis. Thus, it is recommended to engage in shared medical decision making with these patients regarding diagnostic laparoscopy. If endometriosis is detected intraoperatively, these lesions are often fulgurated or excised. There currently is a paucity of data regarding the benefits of diagnostic laparoscopy and destruction of lesions in the adolescent population.

Objectives/Goal: To evaluate long-term pain management outcomes and care patterns in adolescent patients undergoing surgical evaluation for endometriosis.

Methods/Design: This was a single-site, retrospective cohort …

Association Of Respiratory Viral Testing And Antibiotic Use For Pediatric Patients Admitted For Acute Respiratory Illness Between 2017-2021 At Children’S Mercy-Kansas City, Edward Lyon, Brian Lee, Rangaraj Selvarangan, Jennifer Schuster

Research Days

Retrospective comparison of hospitalized pediatric patients who did or did not have clinical viral respiratory testing performed to understand if antibiotics were used differently between these groups.

Transition Skills Lab: A Telehealth Intervention For Improving Healthcare Transition In Youth With Special Health Care Needs, Angela Combs, Alaina Linafelter, Jordan Sevart, Michele H. Maddux

Research Days

The goal of this abstract is to evaluate youth skill-building and confidence across health care tasks through the virtual Transition Skills Lab.

Exploring The Role Of Pain On Physical Activity Among Youth With Acute Lymphoblastic Leukemia Using The Biopsychosocial Model, Anna E. Van Asselt, Renee Gilbert, Meghan Tokala, Jacee Weber, Meredith L. Dreyer Gillette, Robert C. Gibler, Carolyn R. Bates, Keith August

Research Days

The Role of Pain on Physical Activity in Pediatric ALL

Keywords: Biopsychosocial model, pediatric Acute Lymphoblastic Leukemia, pain, physical activity

Introduction: Engaging in physical activity (PA) during cancer treatment benefits a child’s physical and mental well-being (McLaughlin et al., 2021). However, engaging in PA may be challenging due to treatment and disease-related pain (Uhl et al., 2020). Pediatric cancer research has primarily focused on management of procedural and chronic pain, with fewer studies examining how pain may interfere with PA during treatment (Clews et al., 2022). The current study qualitatively investigated the impact of pain on PA using a …

Long-Term Physical And Emotional Functioning In Children Following Intensive Interdisciplinary Pain Treatment For Amplified Pain Syndrome, Sabrina Ung, Jacqueline Pabis Phd, Jenny Scheurich Phd, Dustin Wallace Phd

Research Days

The current study aimed to examine the efficacy of pediatric interdisciplinary pain treatment (IIPT) several years after treatment completion by exploring mean-level changes of physical and mental health functioning pre-intervention, post-intervention, and at follow-up 2 to 6 years after IIPT completion.

Delirium On Admission To The Cicu, Spencer Wittmeyer, Jaime Silva-Gburek, Kelly S. Tieves

Research Days

Background: Delirium is increasingly recognized in the pediatric cardiac intensive care unit (CICU) with an incidence up to 67% and is associated with worse outcomes including increased mortality, prolonged hospitalization, and increased rates of intubation and mechanical circulatory support. The Cornell Assessment for Pediatric Delirium (CAPD) is the only validated tool for the diagnosis of delirium in the pediatric population. The CAPD may be limited in children with developmental disabilities as it does not account for baseline ability in scoring. Prior work has identified low specificity for the CAPD in children with developmental disabilities and those requiring mechanical ventilation. This …

Reducing Sharps Disposal In The Operating Room, Kasey Brooks, Brandon Layton

Research Days

Used an education program to reduce the amount of sharps waste in the operating room within the anesthesia department.

Double Aortic Arch With Atresia Of The Left Aortic Arch Proximal To The Left Common Carotid Artery In A Patient With Phace Syndrome – A Management Conundrum, Mohamed Aashiq Abdul Ghayum, Anmol Goyal, Aliessa P. Barnes, Sanket Shah

Research Days

Background Cardiac anomalies in PHACE syndrome (P: posterior fossa anomalies, H: hemangiomas, A: arterial lesions, C: cardiac abnormalities, E: abnormalities of the eye) often consists of complex aortic arch anomalies with double aortic arch (DAA) being an uncommon association. Atresia of the proximal segment of the left arch in DAA is extremely rare and can pose a diagnostic and management conundrum due to formation of a loose vascular ring and asymptomatic nature as seen in our case.

Case Description A 5-year-old male, diagnosed with PHACE syndrome, at a different center was noted to have an incidental finding on head imaging …

Rare Complications Associated With Use Of Bovine Pericardium, Mohamed Aashiq Abdul Ghayum, Nitin Madan, William J. Gibson, Sanket Shah

Research Days

Background

Bovine Pericardium (BP), with numerous and improving preparation techniques, has been used extensively for over 50 years in repair of simple and complex congenital heart defects. It has several advantages over other surgical materials. However, there is a paucity of data in the pediatric population regarding complications associated with BP. Herein, we report two rare complications noted with BP use.

Case Description

Case 1. A 14-month-old male, with trisomy 21 and complete Atrioventricular canal defect, repaired using BP. A routine surveillance echocardiogram showed a mass attached to the atrial septum and atrial aspect of the left atrioventricular valve (Figure …