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Performance Measures For Small-Bowel Endoscopy: A European Society Of Gastrointestinal Endoscopy (Esge) Quality Improvement Initiative, Cristiano Spada, Deirdre Mcnamara, Edward J Despott, Samuel Adler, Brooks D Cash, Ignacio Fernández-Urién, Hrvoje Ivekovic, Martin Keuchel, Mark Mcalindon, Jean-Christophe Saurin, Simon Panter, Cristina Bellisario, Silvia Minozzi, Carlo Senore, Cathy Bennett, Michael Bretthauer, Mario Dinis-Ribeiro, Dirk Domagk, Cesare Hassan, Michal F Kaminski, Colin J Rees, Roland Valori, Raf Bisschops, Matthew D Rutter

Faculty, Staff and Student Publications

The European Society of Gastrointestinal Endoscopy (ESGE) together with the United European Gastroenterology (UEG) recently developed a short list of performance measures for small-bowel endoscopy (i.e. small-bowel capsule endoscopy and device-assisted enteroscopy) with the final goal of providing endoscopy services across Europe with a tool for quality improvement. Six key performance measures both for small-bowel capsule endoscopy and for device-assisted enteroscopy were selected for inclusion, with the intention being that practice at both a service and endoscopist level should be evaluated against them. Other performance measures were considered to be less relevant, based on an assessment of their overall importance, …

Goosebumps, Efrain Rodriguez

The Texas Heart Institute Journal

No abstract provided.

Endoanchors Minimize Endoleaks In Chimney-Graft Endovascular Repair Of Juxtarenal Abdominal Aortic Aneurysms, Edgar Luis Galiñanes, Eduardo A Hernandez-Vila, Zvonimir Krajcer

The Texas Heart Institute Journal

Juxtarenal abdominal aortic aneurysms (AAAs) are difficult to treat because they often have little or no proximal aortic neck. Patients with this complex anatomy are not usually candidates for an endovascular aneurysm repair (EVAR). Chimney-graft EVAR has been introduced, but type Ia endoleak is a typical risk. We have begun using EndoAnchors to determine whether this risk can be reduced. From July 2013 through July 2014, we used the chimney-graft EVAR technique in 5 patients whose juxtarenal AAAs had a short or no proximal aortic neck. During the procedure, we implanted EndoAnchors as needed. Postprocedurally, at 30 days, and through …

Osborn Waves: Differential Diagnosis, Akriti G Jain, Hammad Zafar, Sanjay Jain, Jason D'Souza

The Texas Heart Institute Journal

No abstract provided.

The Man With 2 Hearts: 25 Years From Heterotopic To Orthotopic Heart Transplantation, Elizabeth L Godfrey, Michael L Kueht, Abbas Rana, O H Frazier

The Texas Heart Institute Journal

Substantial technological advances in mechanical circulatory support have caused a shift in the management of end-stage heart failure. From the 1970s through the 1990s, heterotopic heart transplantation was routinely performed in patients in whom orthotopic transplantation was likely to fail. Heterotopic heart transplantation is now performed less often because modern mechanical circulatory assist devices are routinely used as bridges to orthotopic transplantation; regardless, the operation has helped numerous patients who would not otherwise have received adequate allografts. We describe the case of a man with idiopathic nonischemic cardiomyopathy who, at age 17, was given an ABO- and size-matched heterotopic allograft …

Anomalous Origin Of The Right Coronary Artery From The Pulmonary Artery In A Neonate With Turner Syndrome And Aortic Arch Hypoplasia, Bryan P Stefek, Jason R Imundo, Joseph B Clark

The Texas Heart Institute Journal

Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicuspid aortic valve and aortic coarctation. Individuals with Turner syndrome are also at increased risk for coronary artery anomalies. We present a case of anomalous right coronary artery from the pulmonary artery in a week-old neonate who also had Turner syndrome, patent ductus arteriosus, transverse aortic arch hypoplasia, and impaired ventricular function. Prostaglandin therapy through the ductus increased the patient's myocardial perfusion. …

Percutaneous Coronary Intervention For Interposed Coronary Graft Stenosis After Modified Bentall Procedure In A Teenaged Boy With Takayasu Arteritis, Hiroki Ikenaga, Satoshi Kurisu, Yasuki Kihara

The Texas Heart Institute Journal

Anastomotic occlusion of an interposed coronary artery graft after a Bentall procedure is rare and catastrophic. It can lead to myocardial infarction or sudden cardiac death. We found several reports of occlusion and stenosis of a coronary-graft anastomosis, but few describe occlusion of the interposed coronary graft itself, as evaluated with use of intracoronary ultrasonography and computed tomography. We report the case of a 17-year-old boy with Takayasu arteritis who had a myocardial infarction caused by severe ostial stenosis in an interposed left coronary graft. The graft occlusion was confirmed by results of electrocardiography, aortography, and intracoronary ultrasonography. The patient …

Incidence And Predictors Of Obstructive Coronary Artery Disease And The Role Of Cardiac Troponin Assays In Patients With Unstable Angina, Sushan Yang, Nirmanmoh Bhatia, Meng Xu, John A Mcpherson

The Texas Heart Institute Journal

In a time when cardiac troponin assays are widely used to detect myocardial injury, data remain scarce concerning the incidence and predictors of substantial obstructive coronary artery disease that causes unstable angina. This retrospective single-center study included consecutive patients hospitalized for unstable angina from January 2015 through January 2016. Patients with troponin I levels above the upper reference limit and those who did not undergo angiography were excluded. Multivariate logistic regression analysis was used to identify predictors of obstructive coronary artery disease that warranted revascularization and of major adverse cardiac events up to 6 months after discharge from the hospital. …

Adam Christian Thebesius' Channels Into The Human Heart: The Thebesian Veins And The Thebesian Valve, Magdalena Mazurak, Jacek Kusa

The Texas Heart Institute Journal

In 1708, Adam Christian Thebesius, a 22-year-old student at Leiden University, presented his graduate thesis, Disputatio medica inauguralis de circulo sanguinis in corde. More than a doctoral dissertation, this groundbreaking work opened new channels into the study of the human coronary venous system. Thebesius' theory about the vascular communication between the coronary arteries and the chambers of the heart helped to advance understanding of hemodynamic principles and to clarify the physiologic pathways of the coronary circulation. The following article—the third in a trilogy about Lower Silesian scientists—provides an overview of the life story and achievements of this Silesian physician …

Surgical Thrombectomy For Pulmonary Embolism: Updated Performance Rates And Outcomes, Fahad Alqahtani, Muhammad Bilal Munir, Sami Aljohani, Abdul Tarabishy, Ahmad Almustafa, Mohamad Alkhouli

The Texas Heart Institute Journal

Treatments for pulmonary embolism are numerous and often complex. Current data on surgical thrombectomy are important but are not readily available. We studied the National Inpatient Sample to evaluate trends in the performance rates and outcomes of surgical thrombectomy in the United States from 2003 through 2014. We think that our findings have meaningful application to the triage and risk stratification of patients who have hemodynamically significant pulmonary embolism.

Use Of Best Practice Alerts To Improve Adherence To Evidence-Based Screening In Pediatric Diabetes Care, Daniel Desalvo, Sara K. Bartz, Blair Mockler, Rona Y. Sonabend

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: Youth with type 1 diabetes (T1D) are at increased risk for comorbid autoimmune conditions and long-term complications. To help with early identification of these complications, the American Diabetes Association (ADA) has published evidence-based screening guidelines. The aim of our quality improvement intervention was to improve and sustain adherence to the ADA recommended screening guidelines to >90% for youth with T1D in the Texas Children’s Hospital (TCH) Diabetes Center by utilizing best practice alerts (BPA) within the electronic medical record (EMR).

Methods: In accordance with the ADA Standards of Care screening guidelines for youth with T1D, we analyzed the database …

Implementation Of A Critical Incident Stress Management Program For Nurse Anesthetists., Peter C. Slivinski, Joanne V. Hickey

Journal of Nursing & Interprofessional Leadership in Quality & Safety

BACKGROUND: Healthcare is a stressful profession where in addition to routine stressors, there are critical incident (CI) events which are occurrences capable of overwhelming an individual’s normal coping mechanisms. The purpose of this quality improvement project was to improve the process by which certified registered nurse anesthetists (CRNAs) exposed to critical incident events are provided post-critical incident support thus mitigating the potential for CI stress

METHODS: We created a CI stress management pilot program for nurse anesthetists employed by an academic hospital located in the Southeastern United States. The program was based upon concepts introduced by Medically Induced Trauma Support …

What You Need To Know About Bar-Code Medication Administration, Marie E. Mcbee Dnp, Msn, Martha Kuhlmann Dnp, Msn, Rn, Fnp, Pmhcns-Bc, Aprn, Pam Patterson Dnp, Msn, Ne-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Medication errors are the most common type of preventable error. Bar-code medication administration (BCMA) technology was designed to reduce medication administration errors. Poor system design, implementation and workarounds remain a cause of errors. This paper reviews the literature on BCMA, identifies a gap in the findings and identifies three evidence based practices that could be used to improve system implementation and reduce error. The literature review identified that Bar-code medication administration and system workarounds are well documented and affect patient safety. Based on the critical analysis of 10 studies, we identified gaps in the standardization of BCMA planning, implementation, and …

Trajectories Of Self-Reported Sleep Disturbance Across Inpatient Psychiatric Treatment Predict Clinical Outcome In Comorbid Major Depressive Disorder And Generalized Anxiety Disorder, Elizabeth M Hartwig, Katrina A Rufino, Cara A Palmer, Christopher Shepard, Candice A Alfano, Bella Schanzer, Sanjay J Mathew, Michelle A Patriquin

Staff and Researcher Publications

Background: As there has been a demonstrated link between sleep disturbance and suicide, the present study investigated the relationship between self-reported sleep disturbance during inpatient psychiatric treatment and clinical outcomes at discharge and six months post-discharge.

Methods: Participants were 2,970 adults receiving care in a long-term inpatient psychiatric hospital. Greater than 90% of inpatients reported at least mild sleep disturbance throughout treatment. Group-based trajectory modeling was used to determine patterns of sleep disturbance changes over time.

Results: Participants fit into distinct categories based on their trajectories of sleep problems across treatment: No Sleep Problems (10.3% of participants, no sleep problems …

Peripheral Intravenous Infiltrates: Engaging Staff To Increase Reporting, Emily Weber, Kimberly Castrillon, Joyce Ramsey-Coleman

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A large free standing children’s academic hospital aimed to improve patient safety and outcomes by decreasing the overall severity of peripheral intravenous infiltration and extravasations (PIVIEs). A care bundle was developed by creating a PIVIE measurement tool within the electronic medical record (EMR) and integrating the tool into standardized daily practice for nurses. The care bundle included creating a team of clinical leaders consisting of empowered bedside nurses acting as mobilized resources embedded into each unit. The initiative resulted in a large scale increase in reported PIVIEs system-wide within 1 month of education dissemination to bedside RN staff. The QI …

Improving Nurse Anesthetist Intraoperative Handoff Process By Developing And Implementing An Evidence-Based, Facility-Specific Cognitive Aid, Jason Silva, Myron Arnaud

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Miscommunication or non-transfer of pertinent patient information during intraoperative handoffs between anesthesia providers creates patient safety risks. An evidence-based facility-specific cognitive aid was developed and introduced to nurse anesthetists in an anesthesiology department of a large academic hospital with the aim of improving the intraoperative patient handoff process. The program used a handoff cognitive aid that addressed five pertinent patient information points. A secondary measure was evaluation of provider satisfaction. Twenty-four nurse anesthetists utilized the handoff cognitive aid during handoffs in the course of a 4-week pilot program. Eighty-eight nurse anesthetist handoffs were observed (23 with and 65 without the …

The Effect Of Meditation On Stroke-Survivor Resilience: Secondary Analysis Of Existing Data, Mary Love

Dissertations and Theses (Open Access)

Purpose: To test the effect of meditation on resilience of community-dwelling stroke survivors, and to identify resilience predictor variables in these survivors.

Methods: Sub-study with secondary analysis of existing data from the parent study, MEditatioN for post stroke Depression (MEND). Paired samples t-test was used to evaluate the effect of meditation on resilience of stroke-survivors (n=20) in the intervention group. Bivariate analysis and general linear modeling (GLM) were used to identify demographic, clinical, and psychological predictor variables of baseline resilience for all stroke survivors (n=34).

Results: The increase in stroke-survivor resilience scores from baseline (mean 3.46, SD=.81) to intervention completion …

Assessing Hospitalizations Due To Assaults At Dell Seton Medical Center (2015-2018), Stephani L. Curry

Dissertations and Theses (Open Access)

Physical assaults are a major public health concern in the United States, with rates being on the rise during the last couple of years (WISQARS Nonfatal Injury Reports, n.d.). In Austin at the Dell Seton Medical Center [DSMC], physical assaults are a main reason for hospitalization, making up nearly 10% of their hospitalizations, with around 250 patients per year. No subgroup of the population is risk free from physical assaults; however, national data suggest some sociodemographic groups are at higher risk than others (“Injury and Violence Prevention”, n.d.). Given the diversity of Austin, TX, it was unclear whether local sociodemographic …

Epidemiology Of Tuberculosis In Internationally Displaced Children Resettling In Harris County, Gabriella S. Lamb

Dissertations and Theses (Open Access)

Background More than 300,000 refugees arrived in the United States (U.S.) from 2010-2015, and Texas accepts the 2nd highest number of refugees. Texas also accepts large numbers of asylees, parolees, and special immigrant visa holders. Additionally, a large proportion of trafficked persons in the U.S. live in or pass through Texas. Foreign-born children are disproportionately affected by tuberculosis (TB) and account for two-thirds of U.S. childhood TB cases. Children are at greater risk for progression from TB infection to disease and experience greater morbidity and mortality from TB disease. This makes screening for and treatment of TB infection in children …

The Association Of Cell Phones With Adolescents' Academic Performance, Sleep, Time Spent With Friends, And Cyberbullying Exposure, Johanna E. Peyton

Dissertations and Theses (Open Access)

This study examined the association between owning or having access to a cell phone with/without internet access and adolescent academic performance, whether they met the guidelines for recommended nightly sleep, the amount of time spent with friends outside of school and the presence and frequency of cyberbullying experienced by 8th and 11th grade participants in the 2015-2016 SPAN study in Texas. This study also examined the association between gender of the adolescent and the above-mentioned outcomes.

The study group consisted of 5,421 adolescents from 8th grade and 3,635 from 11th grade. The 8th grade sample contained 51.48% males(48.6% females) and …

Exploring Prenatal Risk Factors Among Hispanic Children With Autism Spectrum Disorders. – A Pilot Study In The Rio Grande Valley, Lauren Tien

Dissertations and Theses (Open Access)

Background: Peer-reviewed studies suggest that a hostile gestational environment is associated with delayed neurological development in infants. Autism spectrum disorder (ASD) is estimated to affect 1 in 59 children in the United States; however, few studies have specifically investigated risk factors for autism in Hispanic children. Purpose: The University of Texas RGV Hispanic Autism Research Center (HARC) studied Hispanic children with ASD and their biological mothers to identify potential environmental exposures and prenatal risk factors that could impact the risk for ASD through preliminary research in the Rio Grande Valley. Methods: This pilot study recruited 25 Hispanic mothers and their …

Trends In Advanced Hiv Disease And Long-Term Outcomes Of Hivinfected Children Treated With Antiretroviral Therapy In Eastern And Southern Africa: 2003-2017, Peter James Elyanu

Dissertations and Theses (Open Access)

Despite the over 10-years’ experience providing pediatric antiretroviral therapy(ART) and implementing different WHO guidelines, data on updated trends (after 2010) in advanced disease at ART start, and on long-term survival of children receiving ART are scarce. Without these data, the impact of recent WHO guidelines on early treatment initiation and long-term survival remains unclear. First, we examined trends in advanced disease at ART start, then described 10-year survival and investigated risk factors of early mortality in children treated with ART and lastly examined the association between rapid ART initiation and outcomes (mortality and loss to follow-up) of HIV infected. We …

Cost-Effectiveness Of Collegiate Recovery Programs, Sierra Castedo De Martell

Dissertations and Theses (Open Access)

The prevalence of substance use disorders (SUDs) is greater among full-time college students and young adults regardless of enrollment status than it is among any other age group (1,2). These disorders represent substantial costs to both society and to institutions of higher education, both in terms of life years lost and in lost tuition revenue. The recent proliferation of collegiate recovery programs (CRPs) – supportive communities and resource centers for students seeking to maintain SUD recovery while pursuing a higher education – have the potential to help ameliorate some of these costs. While these CRPs are typically low-cost compared to …

Diagnostic Coding Of Physical Abuse Among Patients Evaluated By A Multidisciplinary Child Protection Team In A Pediatric Level I Trauma Center, Holly Hughes Garza

Dissertations and Theses (Open Access)

Child abuse is a substantial public health problem. Numerous studies have used hospital discharge data coded using the International Classification of Diseases, 9th and 10th Editions, Clinical Modification (ICD-9 and ICD-10) to identify cases of physical abuse seen in hospitals. Published studies on the sensitivity and specificity of ICD coding for physical child abuse are limited using ICD-9, and non-existent with ICD-10. This study examined the accuracy of ICD coding for physical child abuse, among patients less than 18 years of age, who were evaluated due to concern for physical abuse by a Multidisciplinary Child Protection Team (MCPT) during 2012-2013 …

The Prevalence Of Practicing Safety Professionals’ Knowledge, Involvement, And Competency Associated With Workplace Wellness Programs: Gauging The Safety Profession’S Engagement With The Total Worker Health Initiative, Jennifer C. Laine

Dissertations and Theses (Open Access)

The morbidity and mortality burden of occupational injuries and illnesses in the United States became such a public health concern that in 1970 the Occupational Safety and Health Act was signed into law. This law requires employers to provide workplaces “free from recognized hazards” and spurred the development of specific regulations along with the creation of academic and professional training programs to educate individuals about the safety sciences and careers in safety fields. Today there are an estimated 26,000 professionally trained and board certified safety professionals supporting workplace programs across the country, alongside numerous non-certified, but degreed, practicing safety professionals. …

Predictors Of On-Treatment Mortality Of Patients Undergoing Palliative Radiation Therapy: Improving The Quality Of End-Oflife Cancer Care, Matthew Stephen Ning

Dissertations and Theses (Open Access)

PURPOSE: Excessive medical treatment at end-of-life is an indicator of poor quality care. While radiation therapy (RT) is effective for palliation, some patients die shortly after or even during treatment. Any treatment that requires terminal patients to spend significant time in the hospital setting contradicts palliative goals. This study investigates patterns of end-of-life RT to inform quality improvement initiatives.

METHODS: All patients who died within 6 months of starting RT at a single large academic cancer center between 2015 through 2018 were identified through our institutional databases on an Institutional Review Board-approved protocol. Clinical factors including age, treatment service, number …

Measuring Goal Attainment In Chronic Disease Self-Management Within Clinical And Research Contexts: Development And Initial Testing Of The Goal Attainment Outcome Measure For Stroke (Gam-S), Barbara Kimmel

Dissertations and Theses (Open Access)

Background and Aims: Self-management (SM) skills help stroke survivors achieve behavior risk factors control. Goal setting and attainment are fundamental for SM. The most salient elements of SM effectiveness and measurements are just beginning to be understood. Investigation of measurement of goal attainment of SM risk factors has been the major aim of the study. My dissertation explores research questions concerning the goal attainment measure using data collected at the Veterans hospital.

Methods and Results: Introductory Chapters 1 and 2, include the background on stroke prevention through self-management interventions and a preliminary literature review of goal attainment in the context …

Social Capital And Health Services Utilization In Msm, Edward Tsai

Dissertations and Theses (Open Access)

While incidence of HIV has decreased overall and in most population subgroups, men who have sex with men (MSM) continue to remain at disproportional risk for new infection. In particular, MSM of color experience HIV incidence rates that continue to rise and represent the overwhelming majority of new cases each year. Evidence suggests greater risk among MSM may not be attributable primarily to individual behavioral level factors, but instead to structural and social environmental level factors such as access to health services. Access to health services represents a critical link in HIV and STI prevention, as health services provide serological …

Turf For Teams: Considering Both The Team And I In The Work-Centered Design Of Systems, Vickie Nguyen

Dissertations and Theses (Open Access)

Teams are an inherent part of many work domains, especially in the healthcare environment. Yet, most systems are often built with only the individual user in mind. How can we better incorporate the team, as a user, into the design of a system? By better understanding the team, through their user, task, representational, and functional needs, we can create more useful and helpful systems that match their work domain. For this research project, we utilize the TURF framework and expanded it further by also considering teams as a user, thus, creating the TURF for Teams framework. In addition, we chose …

Human Papillomavirus Vaccination Status And Endorsement Among Undergraduate Nursing Students: A Secondary Data Analysis, Ashley Hollins

Dissertations and Theses (Open Access)

Background: Human papillomavirus (HPV) vaccination has immense potential to prevent HPV-related infections but vaccination rates remain suboptimal. Nurses could potentially increase vaccination rates by providing recommendations and addressing vaccine concerns. As student nurses’ transition into practice, it is important to identify factors that could influence their attitudes and uptake of the HPV vaccine; however, these factors remain unknown.

Purpose: We proposed to: (1) identify factors associated with HPV vaccination status and (2) to identify student nurses’ perception of parental vaccine hesitancy, preferred counseling strategies, and factors associated with intention to counsel parents on HPV.

Methods: The current study was a …