Digital Commons Network^™

Comments Re: Draft Nih Intramural Research Program Policy: Promoting Equity Through Access Planning, Fred Ledley M.D., Edward Zhou Pharmd., Paula Chaves Da Silva Ph.D.

CISI Publication

We commend the NIH initiative to require that licensees of technologies that enable discovery or development of FDA-approved products arising from the NIH intramural program to include an Access Plan to promote “product affordability, availability, acceptability, and sustainability” and recognition that such protections are essential to ensuring a “return on taxpayers' investment in biomedical research.” Recognizing the complexity of anticipating appropriate terms for products that are in pre-clinical or early clinical development at the time of licensing, we also support the proposal that the Access Plan be submitted in late-stage clinical development, though we argue that …

Transformative Learning: Changing Nurses’ Perceptions About People In Poverty, Jacqueline Debrew

Journal of Social, Behavioral, and Health Sciences

Background: Meaningful learning experiences with clients in poverty may help nursing students change their perceptions towards those experiencing poverty and, thus, provide unbiased, nonjudgmental care when they become nurses.

Purpose: The purpose of this research was to understand what learning activities and experiences nursing students found meaningful and led to a change in prior perceptions of people in poverty.

Methods: Guided by Mezirow’s Theory of Transformative Learning, accelerated BSN students enrolled in a mental health nursing course (n = 14) were assigned reflective journals throughout the semester on their assigned clinical experiences, which were analyzed for emergent themes.

Results: …

Using An Evidence-Based Practice Nurse Recognition Practice To Improve Job Satisfaction, Hali Bianchi

Student Scholarly Projects

Practice Problem: The project targeted low job satisfaction and high nurse turnover in a Central Florida bone marrow transplant unit, impacting patient care and costs.

PICOT: (P) For registered nurses (RNs) on the bone marrow transplant unit, (I) does implementing an evidence-based practice employee recognition program (C) compared to no employee recognition program, (O) lead to an increase in job satisfaction (T) over 10 weeks?

Evidence: The evidence supported the effectiveness of meaningful recognition programs, such as personalized verbal acknowledgment from leadership, in boosting job satisfaction among nurses.

Intervention: The intervention involved nurse managers using a weekly employee recognition …

Effect Of Resistance Training On Physical Function During Chemotherapy In Colon Cancer, Justin C. Brown, Shengping Yang, Stephanie L.E. Compton, Kristin L. Campbell, Elizabeth M. Cespedes Feliciano, Sara Quinney, Barbara Sternfeld, Bette J. Caan, Jeffrey A. Meyerhardt, Kathryn H. Schmitz

School of Medicine Faculty Publications

Background: The decline of physical function during chemotherapy predicts poor quality of life and premature death. It is unknown if resistance training prevents physical function decline during chemotherapy in colon cancer survivors. Methods: This multicenter trial randomly assigned 181 colon cancer survivors receiving postoperative chemotherapy to home-based resistance training or usual care control. Physical function outcomes included the short physical performance battery, isometric handgrip strength, and the physical function subscale of the Medical Outcomes Short-Form 36-item questionnaire. Mixed models for repeated measures quantified estimated treatment differences. Results: At baseline, participants had a mean (SD) age of 55.2 (12.8) years; 67 …

A Retrospective Study Of Healthcare Needs Of Unpaid Caregivers In The United States, Ranelle M. Nissen, Jessica Mchugh Conlin, Mackenzie L. Feldhacker, Whitney Lucas Molitor, Allison J. Naber

The Open Journal of Occupational Therapy

Introduction: Demand for caregivers is on the rise. In the US, 53 million individuals provided care in 2020. Older adults constitute nearly half of all care recipients and often receive care from a family member. This study identified the health care needs of caregivers regarding health care use, access to resources, and unmet needs.

Methods: We used a retrospective, cross-sectional design to examine existing data collected between 2013 and 2018 regarding caregiver experiences. Data were analyzed using descriptive statistics and a chi-square test of independence.

Results: Caregivers were primarily female, White, between the 18 and 64 years …

Educating Nurses On The Components Of A Healthy Work Environment, Kathryn L. Scott

Doctoral Dissertations and Projects

It is essential to look at the entire picture to ensure patient care is offered in the highest quality manner possible. One must look at patient satisfaction, quality outcomes, and job satisfaction experienced by the nursing staff providing care to accomplish this goal. Research has shown that nurse burnout has increased exponentially as of late. Some blame the COVID-19 pandemic; others look at the generation of nurses graduating from nursing school and starting in the field, comparing the baby boomer nurse to the Gen Z nurse. Many factors are involved, and with the recent addition of paying particular attention to …

Framing The Path To Fitness: Age Differences In Response To Framed Exercise Messages, Iliya Sherif, David B. Taullahu, Alyssa R. Minton, Joseph A. Mikels

DePaul Discoveries

Physical activity is one of the most protective health behaviors one can engage in, yet 75% of active adults in the US, meaning those who exercise regularly, fall short of the recommended levels of physical activity, with an even greater percentage of older adults living inactive lives, meaning they exercise minimally and engage in prolonged sedentary behavior (CDC, 2019). The goal of the current study was to explore different types of message framing targeted at encouraging older and younger adults to exercise. We recruited older adults (n = 184; Mage = 69.45 years, age range: 65- 80 years) and younger …

America Is Unprepared To Meet The Needs Of Its Growing Older Adult Population, Sierra Kaplan

Population Health Research Brief Series

In 2030, nearly 73 million Americans will be aged 65 years or older. As Americans continue to have fewer children than in the past, the number of older adults will outnumber children. Thus, fewer young adults will be around to support and care for the older adult population. Coupled with COVID-19 pandemic-driven disruptions to the healthcare industry, America’s health and aging care system is unprepared to support its large and growing older adult population. Over time, we will see increased health care scarcity and inequality in the distribution of elder care services, especially with continued healthcare worker shortages and drastic …

What Constitutes Adequate Control Of High Blood Pressure? Current Considerations, Donald E. Casey, Alexander J. Blood, Stephen D. Persell, Daniel Pohlman, Jeff D. Williamson

College of Population Health Faculty Papers

An estimated 45% of adult Americans currently have high blood pressure (HBP). Effective blood pressure (BP) control is essential for preventing major adverse events from cardiovascular and other vascular-related diseases, such as chronic kidney disease, stroke and dementia. A large and growing number of medical professional societies, health care organizations, and governmental agencies have now endorsed a clinical practice guideline-based target for adequate control of HBP to a systolic BP of less than 130 mm Hg. However, adequate BP control to this goal has been recently estimated to be as low as 30%. The first and most important steps to …

Medicare Drug Price Negotiation Program Draft Guidance, Fred Ledley M.D., Edward Zhou Pharmd, Paula Chaves Da Silva Ph.D.

CISI Publication

This comment focuses on Section 50.1, provisions 1 & 3 of the draft guidance regarding the negotiation of a “maximum fair price” under the Inflation Reduction Act (IRA), research and development (R&D) costs of the primary manufacturer, and prior federal financial support for novel therapeutic discovery and development. Specifically, we argue that a negotiated, “maximum fair price” must consider both public sector (federal) and private sector (manufacturer) investments and provide returns to both commensurate with the scale and risk of their investments. This comment addresses three issues and makes specific recommendations regarding each:

1. In negotiating a “maximum fair price,” both …

Evaluation Of An Educational Training On Telehelath Utilization Rates And Hospital Readmissions In A Home Health Setting., Gabrielle A. Coomer

Doctor of Nursing Practice Papers

Background: Hospital readmissions are on the rise and continue to be a concern within healthcare due to their effects on the quality of care and healthcare costs. Telehealth strategies have been utilized across healthcare settings to improve hospital readmission rates.

Purpose: The purpose of this project was to evaluate the effectiveness of a telehealth training program in increasing telehealth utilization rates and reducing the acute care hospitalization rate within a single home health agency.

Intervention: A 30-minute PowerPoint presentation on the definition of telehealth, goals, and benefits of telehealth, patient eligibility, special considerations for clinicians, billing and coding guidelines, …

Lgbt Cultural Competence Education For Nurse Leaders In A Large Metropolitan Healthcare System: Quality Improvement, Trevor Mcguffin, Andrew Mitchell

Doctor of Nursing Practice Papers

Background: In the United States, seven percent of adults identify as LGBT. The LGBT population is disproportionately affected by health disparities and barriers to care when compared to the cis-heterosexual population. Due to healthcare providers’ limited LGBT health education and experience, inconsistencies in LGBT culturally competent care perpetuate health disparities and barriers to care for the LGBT population.

Purpose: The purpose of this quality improvement project was to educate nurse leaders on LGBT cultural competency and facilitate nurse leaders’ behavior change.

Methods: This quality improvement project consisted of three LGBT cultural competence modules and two guided behavior change pathways. Outcomes …

Improving Transitions In Care Through Early Discharge Planning: A Quality Improvement Initiative., Sarah Markgraf

Doctor of Nursing Practice Papers

Background: A substantial body of evidence has shown transitions in care are one of the weakest links in healthcare networks, especially for older adults with complex comorbidities. Residents receiving short-term rehabilitation (i.e., rehab) transitioning to home from a skilled nursing facility (SNF) are the most vulnerable in the first 30 days post-discharge for adverse resident events, including avoidable rehospitalization. Avoidable rehospitalizations cost Medicare billions of dollars annually and lead to poor resident outcomes. Early discharge planning in SNFs for short-term stay rehabilitation has decreased rates of avoidable rehospitalizations, improved quality of life in geriatric residents, and improved care partners' perceived …

Intergenerational Programming: An Initiation For Implementation For Individuals With Dementia, Joshua Dano

Occupational Therapy Student Capstones

No abstract provided.

Exploring Maternal Perspectives On Human Milk Banks In Pakistan And Identifying Barriers And Enablers For Establishment, Hina Baba Jan, Naghma Rizvi, Kiran Mubeen, Marina Baig

Journal of Asian Midwives (JAM)

Background: Low-and middle-income countries including Pakistan still have low breastfeeding rates and infant feeding remains a concern. Human milk banks (HMBs) play a crucial role in neonatal and infant health by providing safe, pasteurized donor human milk to infants who do not have access to their mother's own milk, particularly preterm and low-birth-weight infants. The perception regarding the concept and use of HMBs has yet to be explored in several contexts, especially in the low-and middle-income countries including Pakistan.
Aim: To explore the perceptions of mothers regarding human milk banks in Pakistan, focusing on the barriers and enablers to …

Un-Barre-D: Decreasing Barriers To Participation For Individuals With Parkinson’S Using Ballet, Lauren Jew

Occupational Therapy Student Capstones

No abstract provided.

Assessing Readiness To Quit As An Intervention For Tobacco Cessation In Oncology Patients, Victoria Gabriela Maddox

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Smoking and tobacco use is the leading cause of preventable death in the United States. Twenty percent of all cancer diagnoses are directly linked to smoking, and tobacco-related diseases and cancers contribute to one in every five deaths annually in the United States. Less than one in ten smokers are successful at quitting. Smokers attempting to quit are more successful in cessation programs after evaluation of self-efficacy, such as the readiness to quit.

Purpose: This evidence-based practice project aimed to evaluate the impact of motivational interviewing with the 5A’s model on smoking cessation efforts in patients at an …

Appropriate Policies For Patients Utilizing Insulin Pumps With Continuous Glucose Monitoring During Hospital Admission, Mary Elizabeth Holiday

Doctor of Nursing Practice Scholarly Projects

Problem Statement: A growing number of patients with diabetes are using advanced diabetes management technology with an integrated insulin pump and continuous glucose monitor (CGM); however, multiple concerns surround their use during hospitalization, ranging from patient safety risks to nursing comfort in overseeing these devices.

Purpose: This project aimed to determine if an accurate, reformed inpatient policy supporting specific automated insulin pump use during admission maintained patient glucose control, improved patient satisfaction, and increased nursing comfort levels.

Methods: Pre- and post-policy nursing knowledge surveys, retrospective admission glucose metrics, and patient experience narratives were evaluated.

Inclusion Criteria: Patients and nurses were …

Tech Note 2024-1 A Novel Framework To Estimate Social And Private Value Created Through Commercialization Of A Pharmaceutical Product, Paula Chaves De Silva, Fred D. Ledley

CISI Publication

This framework posits that the value created by a new medicine is embodied in the total health value (health benefit) provided to those using the products. This value is then distributed between social value and private value by the price paid for the product and how these revenues are expensed for different purposes. In this framework, the social value created includes the residual health value (net price paid) along with the scientific value, jobs creation, and social payments to public sector organizations. The private value created includes shareholder value (change in market capitalization plus cash distributions to shareholders) as well …

The Implementation Of Comfort Medication Kits In Hospice Patients’ Homes To Reduce Hospice Revocations, Brandi J. Parker

Doctor of Nursing Practice Projects

Background: When hospice patients experience a symptomatic crisis at the end of life, unmanaged symptoms can lead to unwanted hospitalizations and the revocation of their hospice benefits. Strategies to reduce the incidents of hospice revocation are needed to improve patient care and quality of life.

Purpose: The quality improvement project aimed to reduce hospice revocation rates by implementing comfort medication kits in eligible hospice patients’ homes.

Methods: The project’s intervention included identifying patients at high risk for revocation, patients with a cancer diagnosis, and patients with a prognosis of two weeks or less. Comfort medication kits were placed in the …

Implementing Delirium Prevention Strategies To Reduce The Need For 1:1 Observation In A Palliative Care Unit, Natalyn Finley

Doctor of Nursing Practice Projects

Background: Delirium is a common complication within the palliative care community that is preventable. Delirium is a condition characterized by confusion and disturbed thought processes. One to one observation was the facility’s intervention used to prevent delirium. The best intervention is non-pharmacological interventions.

Purpose: This quality improvement (QI) project aimed to reduce 1:1 observation hours without increasing patient safety issues.

Methods: The Doctor of Nursing Practice (DNP) student educated nursing staff about the American Nurses Association’s (ANA) evidence-based interventions to help decrease delirium. The staff received the ANA interventions form and the Confusion Assessment Method (CAM) tool. The DNP student …

Reducing The Incidence Of In-Hospital Cardiac Arrests (Ihca) By Utilizing Infographics, Alexis Morgan Pope

Doctor of Nursing Practice Projects

Background: In-hospital cardiac arrests (IHCA) have negative outcomes on patients and can prolong hospitalization or lead to death. The rate of IHCA has been increasing over the past few years in the United States. A medical intensive-care stepdown unit in a level three trauma center has an incidence of IHCA above the national average and a survival-to-discharge rate less than the national average.

Purpose: The project aimed to improve patient outcomes and reduce the rate of IHCA by placing infographics containing evidence-based practice in the unit with the highest incidence.

Methods: A pre-post implementation quality improvement design was used to …

Nutric: Enhancing Surgical Intensive Care Unit Patient Nutrition Consultations, Misty Armstrong

Doctor of Nursing Practice Projects

Background: Daily nutritional screenings in the critical care population can identify patients in need of nutritional modifications during hospital admission. Inadequate nutritional assessments of critically ill patients lead to poor outcomes. Daily nutritional assessments result in the early identification of patients at risk for nutritional compromise compared to weekly assessments.

Purpose: The purpose of this project was to incorporate a daily nutritional assessment using the Nutrition Risk in the Critically Ill (NUTRIC) scores for patients in a surgical intensive care unit to identify patients in need of a referral to a registered dietician.

Methods: The method for this project used …

Implementing A Comprehensive Tobacco-Cessation Program For Patients With Tobacco Use Disorder, Jalen Eaton

Doctor of Nursing Practice Projects

Background: Individuals who use tobacco are at an increased risk for the development of heart disease, congestive heart failure, and chronic obstructive pulmonary disease. Tobacco use is one of the most preventable causes of death in the world.

Purpose: The focus of the quality improvement project was to improve access to tobacco cessation resources in patients with tobacco use disorder at a primary care clinic.

Methods: Weekly stakeholder meetings were held to ensure the validity of the project. The plan, do, study, act (PDSA) model of continuous quality improvement guided the project. A comprehensive tobacco-cessation program including informational materials and …

Reducing No-Show Rates In An Outpatient Gi Endoscopy Lab, Mwaba Chisela

Doctor of Nursing Practice Projects

Background: Patients who do not attend their scheduled appointments cost the healthcare industry approximately $150 billion annually. They are at higher risk of missed diagnoses, delay in care, and increased morbidity and mortality.

Purpose: This quality improvement project aimed to determine the effectiveness of serial reminders using phone calls and electronic messaging to reduce no-shows for patients scheduled for gastrointestinal (GI) endoscopy.

Methods: No-show data was retroactively analyzed from June 2023 to December 2023 and compared to post-implementation data from February 2024 to March 2024. For eight weeks, a trained staff team called patients scheduled for endoscopic procedures seven days …

Accessible Travel Facilitating Access Capstone, Wynter Hale

Occupational Therapy Student Capstones

No abstract provided.

Healthy Living For Older Adult And Aapi Populations With Chronic Conditions, Cierilyn Legaspi

Occupational Therapy Student Capstones

No abstract provided.

The Validation Of Remote-Synchronous And Remote-Asynchronous Physical Performance-Based Outcome Measurements, Kieran James Mullen

Master's Theses (2009 -)

Performance-based outcome measures are used by clinical and research communities to identify health risks, assess change in physical function over time, and assess the success of treatment. With the onset of COVID-19, remote assessments were sought as alternatives to in-person testing, however there is inadequate literature on the validity of remote performance-based outcome measurement to assess physical function. Current literature is limited to small cohort studies, and none take advantage of novel comparison of agreement methodology. This study assessed the level of agreement between three methods of performance-based outcome data collection: in-person data collection, remote synchronous data collection, and remote …

Mitochondrial Health, Physical Functioning, And Daily Affect: Bioenergetic Mechanisms Of Dementia Caregiver Well-Being, E Lydia Wu-Chung, Luis D Medina, Jensine Paoletti-Hatcher, Vincent Lai, Jennifer M Stinson, Itee Mahant, Paul E Schulz, Cobi J Heijnen, Christopher P Fagundes

Faculty, Staff and Student Publications

Objective: Chronic stress adversely affects mental and physical well-being. However, health outcomes vary among people experiencing the same stressor. Individual differences in physical and emotional well-being may depend on mitochondrial biology, as energy production is crucial for stress regulation. This study investigated whether mitochondrial respiratory capacity corresponds to individual differences in dementia spousal caregivers' mental and physical health.

Methods: Spousal caregivers of individuals with Alzheimer's disease and related dementias ( N = 102, mean age = 71, 78% female, 83% White) provided peripheral blood samples and completed self-report questionnaires on quality of life, caregiver burden, and a 7-day affect scale. …

Evidence-Based Strategies For Fall Prevention, Angelia Palmer

All Doctor of Nursing Practice (DNP) Scholarly Projects

Patient falls represent the largest category of preventable adverse events in hospitals, with 700,000 to 1,000,000 falls occurring annually in U.S. hospitals and 30-35% resulting in injuries. The cost of fall-related injuries exceeds $50 billion globally, with an average of $14,056 per fall.

The aim of this project was to introduce a standardized fall prevention approach to improve performance and reduce falls in the medical-surgical department.

A comprehensive literature review indicates multifactorial bundled approaches, clinical pathways, purposeful rounding, and patient and family engagement as effective fall prevention strategies.

This quality improvement (QI) project design was based on the Plan, Do, …