Digital Commons Network^™

Changing Culture One Pdsa At A Time: The Creation Of An Innovation Unit, Jennifer Hoople, Gale Arnold, Jennifer Bletscher, Shawna Bolgen, Andy Branca, Tana Case, Matthew Dietz, Jennifer Ferenczy, Heather Haake, Janine Holbrook, Ingrid Jonely, Liga Mezaraups, Jessica Osantowski, Jessica Sehorn, Linda Severs, Dina Shepelyuk

Books, Presentations, Posters, Etc.

An inpatient unit in an acute care hospital was designated as an Innovation Unit. This unit was challenged with the creation of culture change in regards to process improvement. The team learned to use Improvement Science to facilitate rapid and innovative process improvements. These changes have enhanced the quality of healthcare provided while decreasing cost. The poster highlights some of the Improvement Science processes, forms, and roles of the team as well as some of the projects and successes.

What Health Care Leaders Can Learn From Amazon, Amy Compton-Phillips, Goran Henricks

Books, Presentations, Posters, Etc.

Leading change in the internet economy takes different thinking and skills then those that got us the healthcare miracles we have today. Tech companies learned they needed to perfect the product, get serious about costs, remove friction, control the last mile, and accelerate careers to disrupt their industry. Healthcare leaders, and the systems they run, can use the same concepts to re-think our entrenched care models of today. Design thinking coupled with a scrupulous focus on value can help create the nimble systems we all want to work (and receive care) in. Learn how to go from idea to action …

Service Operations Center Improves Hospital Flow And Reduces Ed Boarding!, Jeanne Rhynsburger, Patty Palmer, Michelle Hansen

Books, Presentations, Posters, Etc.

Swedish Edmonds 3 year journey to optimize hospital flow by opening a Service Operations Center – flow management hub.

Notable improvements included:

1. Patient visit times decreased 27 minutes per patient
2. Emergency department (ED) admit times decreased 68 minutes per patient
3. Boarding hours decreased 20%.

Knowledge Management & Data Literacy, Sony Shah

Books, Presentations, Posters, Etc.

Using Knowledge Management and Data Literacy to enable caregivers to have ready access to Organizations’ documented base of facts, source of information and solutions.

Rrh Library Newsletter, December 2018, Libraries At Rochester Regional Health

Rochester Regional Health authored publications and proceedings

Newsletter sections include: FDA Approval during the Opioid Crisis: Sublingual Sufentanil

Subsidiarity And Federalism: The Relationship Between Law Schools And Their Universities, John Sexton

Fordham Law Review

In his book on the history of Fordham University School of Law, Bob Kaczorowski does not take an explicit position on how decision-making authority on matters ranging from resource utilization to curriculum development should be allocated between a law school and its university. Rather, he offers in detail a story and extensive evidence that tends to reflect and support the view traditionally taken by the American Bar Association (ABA), the vast majority of law faculty, and most law school deans on the subject: listen, you folks over there at the university—we know what we are doing, so just leave us …

The Role Of Direct-Injury Government-Entity Lawsuits In The Opioid Litigation, Edgar Aliferov

Fordham Law Review

The opioid epidemic has ravaged the United States, killing over 100 Americans every day and costing the nation upward of $90 billion a year. All branches and levels of the government have pursued measures to combat the epidemic and reduce its societal costs. Perhaps the most interesting response is the emergence of direct-injury government-entity lawsuits, which seek to recover damages from opioid companies that facilitated prescription pill addictions. Cities, counties, and states across the country are suing opioid manufacturers and distributors in unprecedented numbers. This Note explores the role of direct-injury government-entity claims as compared to other forms of civil …

Reclaiming A Biblical Sexual Ethic: How A Renewed Understanding Of The Doctrine Of The Image Of God Is An Important Response To The Ideas Of The Sexual Revolution And The Self-Esteem Movement, Sarah Stewart

Masters Theses

Sexual ethics have become a large source of debate in modern America and will continue as American sexual mores become more progressive. The church in America also faces the issue of how to respond to issues caused by changes in American sexual ethics. These changes, however, have not been greatly beneficial to society. While debates about sexual ethics are not new, the debate has reemerged in modern society, primarily as the result of two movements, the Sexual Revolution and the Self-esteem Movement. Both of these movements shifted belief in human value away from inherent value, as a result of humans …

Church Conflict In The Atlanta-Rome District: Developing A Systematic Approach To Conflict And Membership Attrition, James C. Clements

Masters Theses

The decline in church membership and attendance of the 22 churches and 18 ministries of the Atlanta-Rome District (ARD) of the Christian Methodist Episcopal (CME) Church has dramatically impacted the ministries and effectiveness of the Atlanta-Rome District churches in conducting what Jesus Christ commanded in the Great Commission. The congregations whose membership once boasted governmental officials and civil rights icons have all but dwindled to a faithful few that continue to support the Spiritual and fiduciary obligations of the local churches. The rise of non-denominational churches with a more contemporary style of worship as well as internal conflicts within the …

Church Life Cycle, Benjamin Boatman

Masters Theses

With thousands of American churches permanently closing their doors each year, it is important to take a closer look at the churches that are in desperate need for renewal. The Body of Christ is eternal, but each church will individually display the life cycle that is observed in the human body. With so many churches in desperate need, all attempts must be made to provide suggestions that may result in their ability to continue on with the mission of Christ. The purpose of this research study is to examine the body of Christ as to its scriptural background, compare the …

Emt- And Stroma-Related Gene Expression And Resistance To Pd-1 Blockade In Urothelial Cancer., Li Wang, Abdel Saci, Peter M. Szabo, Scott D. Chasalow, Mireia Castillo-Martin, Josep Domingo-Domenech, Arlene Siefker-Radtke, Padmanee Sharma, John P. Sfakianos, Yixuan Gong, Ana Dominguez-Andres, William K. Oh, David Mulholland, Alex Azrilevich, Liangyuan Hu, Carlos Cordon-Cardo, Hélène Salmon, Nina Bhardwaj, Jun Zhu, Matthew D. Galsky

Department of Cancer Biology Faculty Papers

Cancers infiltrated with T-cells are associated with a higher likelihood of response to PD-1/PD-L1 blockade. Counterintuitively, a correlation between epithelial-mesenchymal transition (EMT)-related gene expression and T-cell infiltration has been observed across tumor types. Here we demonstrate, using The Cancer Genome Atlas (TCGA) urothelial cancer dataset, that although a gene expression-based measure of infiltrating T-cell abundance and EMT-related gene expression are positively correlated, these signatures convey disparate prognostic information. We further demonstrate that non-hematopoietic stromal cells are a major source of EMT-related gene expression in bulk urothelial cancer transcriptomes. Finally, using a cohort of patients with metastatic urothelial cancer treated with …

Parp-1 Regulates Dna Repair Factor Availability., M J Schiewer, Amy C. Mandigo, Nicolas Gordon, Fangjin Huang, Sanchaika Gaur, Renée De Leeuw, Shuang G Zhao, Joseph Evans, Sumin Han, Theodore Parsons, Ruth Birbe, Peter Mccue, Christopher Mcnair, Saswati N. Chand, Ylenia Cendon-Florez, Peter Gallagher, Jennifer J Mccann, Neermala Poudel Neupane, Ayesha A Shafi, Emanuela Dylgjeri, Lucas J Brand, Tapio Visakorpi, Ganesh V Raj, Costas D. Lallas, Edouard J Trabulsi, Leonard G Gomella, Adam Dicker Md, Phd, William Kevin Kelly, Benjamin E Leiby, Beatrice Knudsen, Felix Y Feng, Karen E Knudsen

Department of Cancer Biology Faculty Papers

PARP-1 holds major functions on chromatin, DNA damage repair and transcriptional regulation, both of which are relevant in the context of cancer. Here, unbiased transcriptional profiling revealed the downstream transcriptional profile of PARP-1 enzymatic activity. Further investigation of the PARP-1-regulated transcriptome and secondary strategies for assessing PARP-1 activity in patient tissues revealed that PARP-1 activity was unexpectedly enriched as a function of disease progression and was associated with poor outcome independent of DNA double-strand breaks, suggesting that enhanced PARP-1 activity may promote aggressive phenotypes. Mechanistic investigation revealed that active PARP-1 served to enhance E2F1 transcription factor activity, and specifically promoted …

Improving Postpartum Depression Screening And Treatment Referral Rates In An Ob-Gyn Clinic, Ciddet Abrahams

Doctor of Nursing Practice

Abstract

Background: Up to 25 % of adult women are diagnosed with postpartum depression. This diagnosis may also lead to poor health outcomes for the mother and the infant. Four out of five women with a positive screening for postpartum depression do not receive care from a mental health provider.

Purpose: The purpose of the project was to improve postpartum depression screening and follow-up care to mental health services in a clinic providing obstetrical and gynecological care in the central Texas area.

Objectives: The primary objective of the project was to increase postpartum depression screening rates. The second objective was …

Depression Screening At A Mental Health Outpatient Clinic: A Quality Improvement Project, Renee Licorish

Doctor of Nursing Practice

Project Background: Depression is one of the most common mental health problems in the United States. Many individuals may seek treatment but go undiagnosed due to the lack of recognition by clinicians. Clinical guidelines recommend the use of a standardized depression screening tool within a clinician’s evaluation process. The Patient Health Questionnaire 9 (PHQ-9) is such a tool and recommended for use in the outpatient care setting. Aims of the Project: To increase depression screening of clients at a hospital-based outpatient behavioral health clinic. Purpose and Objectives: Implementation of the PHQ-9 into the clinic’s mental health assessment process to increase …

Building Shared Values In The Community: Culture Of Health, Donnelle D. Storrs

Doctor of Nursing Practice

The zip codes where patients live are stronger determinants of health outcomes than the frequency of visits with a primary care provider. Providers have a unique opportunity to extend health care beyond the clinic walls and engage in efforts to improve the communities where their patients grow, live, work, and age. In order to impact the health of patients, a culture of health needs to be developed. The Robert Wood Johnson Foundation culture of health action framework directed the build of a foundation of health as a shared value in a neighborhood with high morbidity and mortality rates in southwest …

Quality Improvement On Depression Protocols In The Military Training Environment, Priscilla R. Colunga

Doctor of Nursing Practice

Background: Active Duty military members are highly susceptible to depression and suicide due to separation from family during training and deployments, exposure to traumatic experiences in combat, and loss of friends during combat.

Purpose and Objectives: Depression and suicide remain a high priority among military personnel. This process improvement project aimed to improve the rate of depression screening and improve the assessment, treatment, and management of soldiers with depression in a primary care setting to prevent disease progression while waiting to be seen by a behavior health specialist.

Interventions: During the 6-week time frame, all active duty military and reservists …

Recognizing Delirium At End Of Life In The Hospice Setting: A Process Improvement Project, Latonya Roberts

Doctor of Nursing Practice

Despite advancements in health care, hospice registered nurses and medical professionals caring for patients at end of life lack the required knowledge effectively to care for this patient population. Educational gaps contribute to deficiencies. This process improvement project aimed to increase nurses’ and medical staff’s knowledge and recognition of delirium at end of life through the use of a delirium assessment tool and evidenced-based treatment guideline when managing symptoms. Project implementation occurred at a small hospice company with a patient census of 180, utilizing 2 teams of registered nurses, medical doctors, and a nurse practitioner. A 2-hour educational session had …

Assessing The Effectiveness Of A Quality Improvement Intervention To Decrease Missed Opportunities For Human Papillomavirus Vaccination At A Nurse Managed Health Center, Maria Medina-Calvo

Doctor of Nursing Practice

Purpose: To decrease the number of missed opportunities for human papillomavirus vaccine eligible patients seeking healthcare in a Nurse Managed Health Center. Background & Significance: Human papillomavirus genital infection has inflicted nearly 79 million Americans. Annually, about 14 million newly infected individuals are identified, with noted predominance in teens and young adults, and of this number approximately 19,200 females and 11,600 males receive a cancer diagnosis as a result of the human papillomavirus infection. The incidence of infections can be reduced with a human papillomavirus vaccine, but only about 63% of females and even fewer males initiate the human papillomavirus …

Implementation Of The Human Papillomavirus Vaccine Among Health Professions Students, Emeka C. Nnabuife

Doctor of Nursing Practice

The human papillomavirus (HPV) is the most widespread sexually transmitted infection in America. College-aged students are a high-risk group for HPV transmission, but their HPV vaccination rates are low. The purpose of this evidence-based project was to implement an HPV vaccination program at a health science center university student health clinic to increase vaccination rates to meet the guidelines of the American College Health Association (ACHA) and the Centers for Disease Control and Prevention (CDC). The objectives of this project were as follows: 1) to educate providers and staff on the importance of the HPV vaccine; 2) to increase HPV …

The Implementation Of Obesity Guidelines In A Rural Clinic, Teresa M. Beard

Doctor of Nursing Practice

Background Over 36% of Americans are obese. It is estimated that, by year 2030, 51% of the population will be obese. With the increased prevalence of co-morbidities associated with obesity, it is important to gain control of this disease. Method The aim of this project is to implement the 2013 American College of Cardiology, American Heart Association Task Force on Practice Guidelines, and The Obesity Society Guidelines for the Management of Overweight and Obesity in Adults in order to identify those patients who require treatment for obesity and provide them with appropriate resources. The primary interventions are to provide color-coded …

Diabetes Education And Management, Dina Balzano

Doctor of Nursing Practice

Purpose: Implementation of a diabetic self-management and education program based on the 2017 national standards of care.

Background: Empowering patients with the knowledge to manage their diabetes in conjunction with health care provider’s recommendations is essential. The American Association of Diabetes (2012) and American Association of Diabetic Educators (2017) have deemed the use of diabetic self-management education and support as the highest level of evidence based practice to prevent and effectively manage the long-term complications of diabetes (Burke, Sherr & Lipman, 2014).

Methods: The project was implemented at a family practice clinic in south San Antonio. A diabetic self-management and …

Screening, Brief Intervention, And Referral To Treatment For Alcohol Misuse In Primary Care, Sai-Han Ackerman Yu

Doctor of Nursing Practice

An annual average of 88,000 deaths in the United States from 2006 to 2010 has been attributed to alcohol misuse, defined as risky or heavy alcohol consumption. Heavy or risky alcohol use for all adults aged 65 and older and for women aged 18 and older is defined as consuming more than 7 drinks per week and/or 3 drinks per day. For men aged 18 to 65 years of age, heavy or risky alcohol use is defined as consuming more than 14 drinks a week and/or 4 drinks a day. Chronic alcohol misuse increases the incidence of heart problems, cognitive …

Implementing Pneumococcal Vaccination Recommendations For Adults Age 19 And Over In A Family Care Clinic, Truc Le

Doctor of Nursing Practice

Pneumococcal vaccines are essential to children and adults. Having pneumococcal vaccines not only prevents pneumococcal infections but can also potentially lessen the severity of the disease. There are many scholarly articles attesting the herd effect in adults who received pneumococcal vaccines. Therefore, the purpose of this quality improvement project was to raise awareness of the pneumococcal vaccine and increase the vaccination rate in a primary care clinic in Texas. The Centers for Disease Control and Prevention’s pneumococcal vaccination schedule was utilized as guide for vaccine administration. The staff and provider were educated on screening, documenting, and administering the pneumococcal vaccine …

Anemia Management For Patients Receiving Peritoneal Dialysis, Kenisha Marajah

Doctor of Nursing Practice

The purpose of this quality improvement project was to develop an anemia management evidence-based intervention for patients receiving peritoneal dialysis (PD) and to educate staff on implementation of the anemia management protocol in a PD clinic in a southwestern county in Texas. Anemia is a common complication of chronic kidney disease (CKD) resulting from the inability of the kidneys to produce erythropoietin needed for red blood cell production. Erythropoiesis-stimulating agents such as Aranesp or Epogen may be administered to dialysis patients to stimulate erythropoiesis in the presence of kidney disease. Iron storage and iron availability remains imperative in effectively stimulating …

Forage News [2018-12], Department Of Plant And Soil Sciences, University Of Kentucky

Forage News

• Feeding Your 2018 Hay
• Kentucky Alfalfa and Stored Forages Conference Program Set
• Jan. 28 Equine Pasture Program
• Silage/Forage Sample Collection Method
• Heart of America Grazing Conference, Jan 22-23

Saving The Smokies: Land Rights In The Middle And Mountain South, Robin J. Happel

Student Theses 2015-Present

From the Trail of Tears to the forced evictions that turned Cades Cove into a ghost town, Appalachia’s residents have long been betrayed by their governments. Currently, mountaintop removal – the destruction of hundreds of mountain peaks for coal – mirrors past abuses, and has sparked a new cycle of catastrophic health effects and land loss. This legacy of human rights abuses is far from Appalachia’s only option, however. In examining both the past and current socioeconomic structures that enable environmentally destructive practices like mountaintop removal, it is possible to chart a path forward. And, by adopting a system similar …

Populist Placemaking: Grounds For Open Government-Citizen Spatial Regulating Discourse, Michael N. Widener

West Virginia Law Review

No abstract provided.

Formation And Speciation Of Disinfection By-Products In Treated Wastewater Effluent During Chlorination, Numan Habip

All Theses

The main goal of this work is to investigate the formation and speciation of disinfection by-products (DBPs) in treated wastewater samples following chlorine oxidation. Disinfection is an essential process in water and wastewater treatment to remove pathogens. However, it was discovered that the use of chlorine for disinfection also results in some toxic chemicals known as disinfection by-products. Since the 1970s, more than 600 DBPs have been discovered, and the control of DBPs has become one of the main issues for drinking water regulations, treatment operations and researchers. Almost two billion people living in different regions or countries are going …

Role Of Stereotactic Radiosurgery In The Treatment Of Acromegaly, Komal Naeem, Aneela Darbar, Muhammad Shahzad Shamim

Section of Neurosurgery

Acromegaly is a rare, indolent disease due to overproduction of growth hormone. Surgery is identified as primary treatment, but has its limitation, thus frequently requiring alternate treatment options as adjunct to surgery. Stereotactic radiosurgery (SRS) has been used as adjuvant and alternate therapy in patients with inoperable or residual disease; or those not fit for surgery. It has shown reasonable results for treating macroadenoma and tumours invading cavernous sinuses with significant reduction in tumour size and durable endocrinological remission. Factors favouring better outcomes include time from last resection to SRS, older age, peri-procedural withdrawal of medication, higher margin and maximum …

Routine Episiotomies Without Consent, Komal Abdul Rahim, Nasreen Rafiq

School of Nursing & Midwifery

No abstract provided.