Digital Commons Network^™

Metabolic Requirement For Got2 In Pancreatic Cancer Depends On Environmental Context, Samuel A Kerk, Lin Lin, Amy L Myers, Damien J Sutton, Anthony Andren, Peter Sajjakulnukit, Li Zhang, Yaqing Zhang, Jennifer A Jiménez, Barbara S Nelson, Brandon Chen, Anthony Robinson, Galloway Thurston, Samantha B Kemp, Nina G Steele, Megan T Hoffman, Hui-Ju Wen, Daniel Long, Sarah E Ackenhusen, Johanna Ramos, Xiaohua Gao, Zeribe C Nwosu, Stefanie Galban, Christopher J Halbrook, David B Lombard, David R Piwnica-Worms, Haoqiang Ying, Marina Pasca Di Magliano, Howard C Crawford, Yatrik M Shah, Costas A Lyssiotis

Faculty, Staff and Student Publications

Mitochondrial glutamate-oxaloacetate transaminase 2 (GOT2) is part of the malate-aspartate shuttle, a mechanism by which cells transfer reducing equivalents from the cytosol to the mitochondria. GOT2 is a key component of mutant KRAS (KRAS*)-mediated rewiring of glutamine metabolism in pancreatic ductal adenocarcinoma (PDA). Here, we demonstrate that the loss of GOT2 disturbs redox homeostasis and halts proliferation of PDA cells in vitro. GOT2 knockdown (KD) in PDA cell lines in vitro induced NADH accumulation, decreased Asp and α-ketoglutarate (αKG) production, stalled glycolysis, disrupted the TCA cycle, and impaired proliferation. Oxidizing NADH through chemical or genetic means resolved the redox imbalance …

Evaluating The Effectiveness Of Implementing Depression Screenings With Uninsured African American Adults, Pamela Talley

Dissertations

Problem: Uninsured African Americans are underdiagnosed and often untreated for depression. Individuals usually do not present to their primary care provider with a complaint of depressed mood, however, may report symptoms such as decreased energy, general body aches, digestive concerns, somatic complaints, or older adults' memory or cognitive problems. The purpose of this quality improvement pilot project was to examine the results of the implementation of a depression screening (PHQ-9) in a primary care setting for uninsured adults for detection, diagnosis, and treatment of depression in African American clients.

Results: The PHQ-9 screening questionnaire was given to 100% (N …

Evaluating Mindfulness On Loneliness In An Older Adult Population, Jessica Tieskoetter

Dissertations

Problem: Loneliness is a widespread public health concern and has negatively impacted mortality and health outcomes among older adults. This quality improvement project’s purpose was to evaluate mindfulness on loneliness and quality of life among adults aged 65 years and older, participating in a weekly befriending socialization program.

Methods: A descriptive cohort design was utilized to assess loneliness pre-and post-implementation of a mindfulness telephone line over three months. A convenience sample of 22 older adults enrolled in a befriending socialization program was used. The Iowa Model of Evidence-Based Practice framework was applied to guide the implementation of a practice change …

Implementation Of A Protocol Nurse In The Emergency Department, Marissa Kramer

Dissertations

Abstract

Problem: Increased wait times and extended length of stay (LOS) of patients in the Emergency Department (ED) are contributing to overcrowding, burdening EDs worldwide. A nurse can initiate patient care using protocol order sets while a patient is in the waiting room; however, triage nurses are often too busy to complete these orders. Scheduling a nurse to complete these protocol order sets could reduce ED overcrowding and patient LOS.

Method: A convenience sample was used to retrospectively chart review and collect data utilizing an excel spreadsheet with patients 40 years of age and older with a chief complaint of …

The Mission System: An Electronic Health Record For Medical Treatment In Guatemala, Tawniece M. Curry

Dissertations

Abstract

Problem: The introduction of an electronic health record (EHR) system has become an essential component in monitoring and tracking patient information in most developed countries but are difficult to implement in underdeveloped countries. Guatemala is a country with poor health care and limited resources for patient tracking and monitoring. An organization in Guatemala, Nursing Heart Inc. (NHI), provides care to over 40 underserved rural communities but lacks the ability to monitor and track patient information. In order for NHI to properly monitor and evaluate their programs and track patients’ continuity of care, the introduction of an EHR system is …

Preventing Falls Using Evidence-Based Interventions In A Long-Term Care Facility, Pibi Bouda

Dissertations

Falls and fall-related injuries are common and significant health issues among older adult patients living in Long-Term Care (LTC) facilities, especially those with memory impairment. The current quality improvement (QI) project aimed to educate staff members and implement a structured 4 Ps hourly rounding (HR) protocol on an LTC facility pilot unit in Missouri. The project was implemented in a memory care unit housing older military veterans patients in a large metropolitan area of Missouri. The project question that guided the intervention was: In older residents living in a memory care unit of an LTC facility, what is the impact …

Comprehensive Pain Assessment For Veterans In Long-Term Care., Christopher Jenkins

Doctor of Nursing Practice Papers

Background Literature supports the need for comprehensive pain assessment (CPA) in long-term care facilities. CPAs provide valuable information for facility providers and health care staff to intervene appropriately regardless of cognitive ability. Without the use of such tools, pain can go undertreated or ignored for this underserved population causing undue suffering and poor quality of life. Chronic pain perpetuates an endless cycle of immobility, falls, injury, functional decline, and eventual death for this population.

Purpose: A CPA was implemented, evaluated, and integrated into the care processes in a long-term care facility for veterans

Method: The IHI improvement model with a …

Education Regarding Advance Directives Improves The End-Of-Life Choices Documentation In Heart Failure Patients, Phebe Hagins Wright

Doctor of Nursing Practice Projects

Background: Heart failure affects the lives of more than 6 million people in the United States and outpatient heart failure clinics offer an opportunity to educate patients while providing evidence-based care. A needs analysis revealed that many heart failure patients do not have an advance directive (AD) on file.

Purpose: The DNP project aims to implement an educational program that provides the tools and knowledge to heart failure patients to assist patients in determining their end-of-life care goals and allow them to document these goals in the Five Wishes document.

Methods: This quality improvement project consisted of a didactic educational …

Implementing A Type 2 Diabetic Comprehensive Educational Website For Health Care Providers In A Rural Health Clinic, Jeanette Caddell

Doctor of Nursing Practice Projects

Background: Type 2 diabetes mellitus (T2DM) can lead to multiple health problems if not treated properly. Research has shown that if T2DM patients have proper education and continued follow-up care from their health care provider, their prognoses are better. The problem is many health care providers (HCP) lack knowledge in educating patients about T2DM.

Purpose: This study aimed to assess HCPs’ knowledge of evidence-based practice measures to educate patients diagnosed with T2DM and provide education via an educational website.

Methods: This quality improvement project consisted of a comprehensive educational website offered to HCPs to increase their knowledge base on educating …

2022-2023 Fall Bulletin, University Of Mississippi Medical Center

Bulletins/Catalogs

2022-2023 Fall Bulletin

Modelo De Predicción De La Demencia En Adultos Mayores De 60 Años [Dementia Prediction Model In Adults Over 60 Years Old], Maria Del Pilar Santacruz-Ortega, Maria Fernanda Cobo-Charry, Bertha Lucia Avendaño-Prieto, Silvia Mejia-Arango

School of Medicine Publications

In order to determine the contribution of the sociodemographic, psychosocial and health variables to a prediction model of dementia in the elderly population, a secondary analysis was carried out with the data from the “Health, Well-being and Aging. Bogotá, 2012”, with 2000 men and women over 60 years of age from urban and rural areas of Bogotá. To select the sample, a probabilistic, multistage, conglomerate and stratified sampling was carried out, based on the 2005 National Census. The SABE questionnaire adapted for Colombia was used. According to the level of measurement of each variable and the distribution of the data, …

Association Of Rare Apoe Missense Variants V236e And R251g With Risk Of Alzheimer Disease, Yann Le Guen, Michael E Belloy, Benjamin Grenier-Boley, Itziar De Rojas, Atahualpa Castillo-Morales, Iris Jansen, Aude Nicolas, Céline Bellenguez, Carolina Dalmasso, Fahri Küçükali, Sarah J Eger, Katrine Laura Rasmussen, Jesper Qvist Thomassen, Jean-François Deleuze, Zihuai He, Valerio Napolioni, Philippe Amouyel, Frank Jessen, Patrick G Kehoe, Cornelia Van Duijn, Magda Tsolaki, Pascual Sánchez-Juan, Kristel Sleegers, Martin Ingelsson, Giacomina Rossi, Mikko Hiltunen, Rebecca Sims, Wiesje M Van Der Flier, Alfredo Ramirez, Ole A Andreassen, Ruth Frikke-Schmidt, Julie Williams, Agustín Ruiz, Jean-Charles Lambert, Michael D Greicius, Members Of The Eadb, Gr@Ace, Degesco, Demgene, Gerad, And Eadi Groups, Beatrice Arosio, Luisa Benussi, Anne Boland, Barbara Borroni, Paolo Caffarra, Delphine Daian, Antonio Daniele, Stéphanie Debette, Carole Dufouil, Emrah Düzel, Daniela Galimberti, Vilmantas Giedraitis, Timo Grimmer, Caroline Graff, Edna Grünblatt, Olivier Hanon, Lucrezia Hausner, Stefanie Heilmann-Heimbach, Henne Holstege, Jakub Hort, Deckert Jürgen, Teemu Kuulasmaa, Aad Van Der Lugt, Carlo Masullo, Patrizia Mecocci, Shima Mehrabian, Alexandre De Mendonça, Susanne Moebus, Benedetta Nacmias, Gael Nicolas, Robert Olaso, Goran Papenberg, Lucilla Parnetti, Florence Pasquier, Oliver Peters, Yolande A L Pijnenburg, Julius Popp, Innocenzo Rainero, Inez Ramakers, Steffi Riedel-Heller, Nikolaos Scarmeas, Philip Scheltens, Norbert Scherbaum, Anja Schneider, Davide Seripa, Hilkka Soininen, Vincenzo Solfrizzi, Gianfranco Spalletta, Alessio Squassina, John Van Swieten, Thomas J Tegos, Lucio Tremolizzo, Frans Verhey, Martin Vyhnalek, Jens Wiltfang, Mercè Boada, Pablo García-González, Raquel Puerta, Luis M Real, Victoria Álvarez, María J Bullido, Jordi Clarimon, José María García-Alberca, Pablo Mir, Fermin Moreno, Pau Pastor, Gerard Piñol-Ripoll, Laura Molina-Porcel, Jordi Pérez-Tur, Eloy Rodríguez-Rodríguez, Jose Luís Royo, Raquel Sánchez-Valle, Martin Dichgans, Dan Rujescu

Faculty, Staff and Students Publications

IMPORTANCE: The APOE ε2 and APOE ε4 alleles are the strongest protective and risk-increasing, respectively, genetic variants for late-onset Alzheimer disease (AD). However, the mechanisms linking APOE to AD-particularly the apoE protein's role in AD pathogenesis and how this is affected by APOE variants-remain poorly understood. Identifying missense variants in addition to APOE ε2 and APOE ε4 could provide critical new insights, but given the low frequency of additional missense variants, AD genetic cohorts have previously been too small to interrogate this question robustly.

OBJECTIVE: To determine whether rare missense variants on APOE are associated with AD risk.

DESIGN, SETTING, …

Location-Specific Cutaneous Electrical Stimulation Of The Footsole Modulates Corticospinal Excitability To The Plantarflexors And Dorsiflexors During Standing, Gagan Gill, Davis A. Forman, Joanna E. Reeves, Janet L. Taylor, Leah R. Bent

Research outputs 2022 to 2026

Non-noxious electrical stimulation to distinct locations of the foot sole evokes location-specific cutaneous reflex responses in lower limb muscles. These reflexes occur at latencies that may enable them to be mediated via a transcortical pathway. Corticospinal excitability to the plantarflexors and dorsiflexors was measured in 16 participants using motor evoked potentials (MEPs). Spinal excitability was measured in eight of the original participants using cervicomedullary motor evoked potentials (CMEPs). Measurements were collected with and without preceding cutaneous stimulus to either the heel (HEEL) or metatarsal (MET) locations of the foot sole, and evoked potentials were elicited to coincide with the arrival …

Evaluating The Extent Of Fall Prevention Knowledge Of Direct Care Clinicians In A Post-Acute Hospital Setting: A Quality Improvement Initiative, Joseph Henry Mitchell Jr

Doctor of Nursing Practice Projects

Background: Events, such as falls, continue to maintain permanence in countless public health settings and organizations, attributing to unnecessary resource utilization. Proven methods for mitigating fall occurrences transpire through reliable fall education and by creating programs that directly impact these incidents. These agendas are essential and can lessen undue stress, obligations, and associated fiscal liability.

Purpose: This DNP project aimed to ascertain and expand unit nurses' fall prevention strategy knowledge in a long-term acute care hospital, bringing awareness of evidence-based practices through a learning addendum.

Methods: This program, based on a descriptive, quasi-experimental, pre-, and post-analysis, strategically …

Improving Workflow Efficiency In A Medical Clinic Utilizing A Competency Evaluation Tool With Skills Checklist, Jillian England Johnson

Doctor of Nursing Practice Projects

Background: Checklists are commonly used in many healthcare settings to validate one’s competency in a skill or task. Competency is essential to help reduce human errors and prevent patient harm, improving patient outcomes while carrying out evidence-based care.

Purpose: The purpose of this DNP project was to improve patient care, patient care outcomes, and workflow efficiency in a charitable clinic by identifying strengths and opportunities for growth among the staff and volunteers through a competency evaluation tool utilizing a skills checklist.

Methods: This quality improvement project included implementing a competency evaluation tool with a skills checklist for staff and volunteers …

Training Sexual Assault Nurse Examiners (Sane) And Patient Advocates To Improve Utilization Of The Alabama Crime Victims Compensation Commission (Acvcc) Program For Sexual Assault Victims, Erica Starling

Doctor of Nursing Practice Projects

Background: Sexual assault is a nationwide problem that often goes unreported. According to the Rape, Abuse and Incest National Network (RAINN), every 68 seconds an American is sexually assaulted. One out of every six women has been a victim of sexual assault in their lifetime. Sexual violence has long-term effects on victims including post-traumatic stress disorder, suicidal ideations and/or attempted suicide, substance use disorder, work and/or family life struggles, unplanned pregnancy, and/or sexually transmitted infections (STI).

Purpose: The purpose of this project is to improve the utilization of the Alabama Crime Victims Compensation Commission Program (ACVCC) for victims …

A Clinical And Community Linkage Benefitting Patients With Chronic Conditions, David B. Clapp

Doctor of Nursing Practice Projects

Background: Connecting healthcare clinics and community resources can improve the health of patients. It is shown that this type of linkage is an effective approach to addressing health concerns and to potentially prevent long-term health issues.

Purpose: The purpose of the DNP project is to promote and provide a clinical-community linkage at a local specialty clinic to determine if the providers find that offering community resources to patients increases their perception of quality of care provided.

Methods: Utilizing a guideline set forth by the CDC, providers within a specialty clinic were provided with a pre-test to determine if their current …

Implementing A Pressure Injury Prevention Bundle To Decrease Hospital-Acquired Pressure Injuries In An Adult Medical-Surgical Unit, Laura Brock

Doctor of Nursing Practice Projects

Background: Pressure injuries affect approximately 2.5 million people in the United States and cost the American healthcare system more than $11.6 billion annually. Healthcare organizations have sanctions placed on them by government agencies to minimize the occurrence of pressure injuries to reduce financial burdens and poor patient outcomes.

Purpose: The project aimed to evaluate the effectiveness of reducing the incidence of hospital-acquired pressure injuries after implementing a pressure injury prevention bundle over eight weeks in a medical-surgical unit in a rural hospital in Alabama.

Methods: This quality improvement project consisted of three key components: educating nurses to …

Addressing Polypharmacy: Implementing The Medication Appropriateness Index Clinical Tool To Increase Deprescribing By Healthcare Providers, Lori Floyd

Doctor of Nursing Practice Projects

Background: Polypharmacy is a national and local issue of concern within healthcare. Deprescribing medications has been identified as a plausible solution for patients experiencing polypharmacy. However, many healthcare providers are unaware of the practice of deprescribing and, if aware, may not be implementing clinical tools for deprescribing effectively. The family medicine clinical site supplies an opportunity for healthcare providers to utilize an evidence-based clinical tool to review medications, identify if inappropriate, and deprescribe if indicated.

Purpose: The purposes of the Doctor of Nursing Practice (DNP) project were to increase deprescribing activity among prescribing healthcare providers and to increase prescribing healthcare …

Implementation And Evaluation Of A Syphilis Screening Tool To Increase Patient Testing For Syphilis Among Adults 18 Years And Older In A Rural Primary Care Clinic, Valeria S. Wiggins

Doctor of Nursing Practice Projects

Background: Sexually transmitted infections (STIs) are an increasing epidemic in the United States (U.S.) that need immediate interventions to reverse the effects of syphilis on the sexual health of adults in rural populations. Many are unaware of the growing rate of syphilis and the overall impact it causes nationally. When syphilis is detected early, it can be easily treated and cured. Rural primary care providers are ideal candidates for implementing education, screening, testing, and treatment.

Purpose: The Doctor of Nursing Practice (DNP) project aims to increase the frequency of screening patients in rural primary care clinics for high-risk sexual behaviors. …

Implementing A Troponin Trending Toolkit In A Rural Emergency Department To Increase Provider Adherence To Troponin Trending Guidelines, Ace Beam

Doctor of Nursing Practice Projects

Background: Cardiac biomarkers are used for the diagnosis and risk stratification of patients with chest pain and suspected acute coronary syndrome (ACS) (Kamal, 2021). Cardiac troponin is the only biomarker recommended to be used for the diagnosis of acute myocardial infarction (AMI) at this time due to its superior sensitivity and accuracy (Kamal, 2021). Emergency departments routinely provide care for patients presenting with chest pain symptoms and should be prepared to utilize evidence-based guidelines for troponin trending to effectively evaluate these patients.

Purpose: The purpose of the DNP project was to improve emergency department healthcare provider compliance to evidence-based high-sensitivity …

Implementing The 4ds (Diet, Drinks, Drugs, And Dialysis) To Lower Hyperphosphatemia Among Outpatient Hemodialysis Patients, Morgan Atchison

Doctor of Nursing Practice Projects

Background: Hyperphosphatemia, also known as excess phosphate in the blood, is a problem that continually causes health issues for the outpatient hemodialysis population. Hyperphosphatemia yields multiple health comorbidities and can increase mortality (Rastogi et al., 2021).

Purpose: Hyperphosphatemia is directly correlated with end-stage renal disease (ESRD) (Goyal & Jialal, 2020). This project aimed to decrease the incidence of hyperphosphatemia in the chronic outpatient hemodialysis setting. The primary objective of this project was to increase adherence levels to diet, drinks, drugs, and dialysis (4Ds) in those receiving chronic outpatient hemodialysis in the pursuance of achieving and maintaining blood serum phosphorus levels …

Providing Education To Staff Members On Implementing Follow-Up Education At Discharge To Patients With Low Heart Scores, Daniel Burton

Doctor of Nursing Practice Projects

Background: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) provides accreditation to hospitals, including “heart certification.” The facility was successful at meeting the four measures previously assigned to them. As a result, they were given four new measures. One of these standards is providing discharge education based on “heart scores.”. Only 35% of patients are receiving discharge/follow-up education at discharge from the emergency department (ED).

Purpose: The purpose of this study is to increase the number of patients receiving chest pain education and follow-up instructions in the ED as evidenced by the improvement in documentation of the interventions.

Methods: …

Clabsi’S: Reducing The Rates In An Urban Intensive Care Unit By Consistent Use Of The Central Line Maintenance Evaluation Tool (Clmet), Bridget Smith

Doctor of Nursing Practice Projects

Background: Quality improvement efforts from an urban facility have observed a need for staff education on the central line maintenance bundle and consistent surveillance with the Central Line Maintenance Evaluation Tool (CLMET).

Purpose: To address the practice gap of central line maintenance bundle usage at the bedside by utilizing the CLMET consistently.

Methods: A voluntary didactic program offered to staff and encouraging daily utilization of the CLMET that included real-time feedback by the supervisors.

Results: Pretest grade for the unit (n=13, 82.06) and the post-test grade (n=13, 86.33), which is + 4.27 points after education. Pre-implementation, January 1st through 31st, …

Project Ankle-Brachial Index: Implementation Of An Evidence-Based Peripheral Artery Disease Protocol, Melaney Banks

Doctor of Nursing Practice Projects

Background: Peripheral artery disease (PAD) is a narrowing or blocking of the arteries due to plaque buildup, which prevents oxygen, blood, and other nutrients from getting to the legs. When this buildup reaches a certain point, it becomes atherosclerosis, which is more prevalent in a smoker. Smoking intensifies the problem of plaque buildup if an individual already suffers from PAD. When an individual smokes, the nicotine causes the arteries to constrict and narrow, reducing blood flow further. The ankle-brachial index (ABI) is a simple, cost-effective diagnostic test to identify the presence of PAD which will improve patient outcomes.

Purpose: This …

Implementing Hand Hygiene Protocol For Direct Care Staff In An Inpatient Psychiatric Facility To Improve Hand Hygiene Compliance, Juliet Mkpuechina

Doctor of Nursing Practice Projects

Background: Handwashing with soap and running water is one of the most effective ways to prevent diseases and infections spread through touch. Hand hygiene refers to handwashing with soap, water, and other disinfecting agents to prevent infection. According to Chassin et al. (2017), hand hygiene compliance reduces healthcare-associated infections (HAI). Studies show that an increase in handwashing compliance can be correlated to a decrease in healthcare-associated infections. Studies have proven that though it is challenging to link hand hygiene to a reduction in healthcare-associated infections directly to improved hand hygiene compliance, many hospitals have seen a decline in HAIs as …

Utilization Of Remap Conversation Tool To Improve Advance Care Completion In The Home-Based Palliative Care Community Setting, Gwendolyn Starkey

Doctor of Nursing Practice Projects

Background: The World Health Organization and the American Society of Clinical Oncology guidelines endorses mandatory communication skills training in care goals for seriously ill patients (Back et al., 2019). In one survey of primary care providers (PCP), 68% reported no formal training to discuss advance care planning (Comer et al., 2020). Advance care planning is essential to manage chronic conditions in our growing aging population to provide the best patient care. This manuscript aimed to discuss best practices and techniques in advance care planning and optimize skills to provide patient-centered care conversations that honor patient wishes, reduce unwanted hospitalizations, and …

Implementing Antimicrobial Stewardship For Healthcare Providers In An Urgent Care Setting To Reduce Antibiotic Misuse For Respiratory Infections, Ashley Pauldin

Doctor of Nursing Practice Projects

Background: Antimicrobial resistance has been identified as a major threat by the World Health Organization (WHO), and antimicrobial stewardship is a key strategy to overcome resistance. A major contributing factor to this crisis is the inappropriate use of antibiotic prescriptions in outpatient settings. Although evidence-based guidelines on appropriate treatment for acute upper respiratory infections (URIs) have been developed, the need for improving provider and patient awareness and knowledge in the urgent care setting is critical.

Purpose: The purpose of the DNP project was to implement antimicrobial stewardship guidelines in the urgent care facility to decrease the misuse of antibiotic prescribing …

Utilizing Multimodal Communication Strategies To Improve Average Risk Women Veteran Patient Participation In Returning Colorectal Fecal Immunochemical Test Kits, Shuntae Hooten

Doctor of Nursing Practice Projects

Background: Cancer is one of the most dreadful diseases present in today’s world. It is responsible for millions of deaths worldwide. The disease is debilitating to one’s physical and emotional well-being. Cancer impacts not only the affected individual but also those close to them. When colorectal cancer is identified early via preventive screenings, it has a greater chance of responding to treatment, therefore, increasing the chances of survival. The fecal immunochemical test (FIT) kit plays a pivotal role in the early detection of colon cancer. Schreuders et al. (2016) revealed that FIT kits have better adherence, usability, and accuracy, citing …

Evaluation Of The Implementation Of The Munro Pressure Ulcer Risk Assessment Scale To Mitigate Pressure Ulcers In The Perioperative Setting, Sherry Lynn Grandison

Doctor of Nursing Practice Projects

Background: The process of implementing appropriate skin assessment and documentation throughout the patient’s operative experience assists in the early detection of pressure ulcers.

Purpose: This Doctor of Nursing Practice (DNP) project had two goals. The first was to determine a practical tool that would ensure that surgical nurses demonstrate competence and comply with the process of identifying compromised skin integrity, and the second goal was to effectively communicate the findings with other clinical team members.

Methods: The DNP project focused on the use of the Munro Pressure Ulcer Risk Scale Assessment Tool to identify pressure ulcers and to promote collaboration …