The Association Of Lower Medication Adherence And Increased Medical Spending, Ryan A. Fuchs

Capstone: Master of Health Administration

Medical prescribing is a common occurrence in daily clinical practice. According to the Centers for Disease Control and Prevention, in 2015-2016 45.8% of the U.S. population used prescription drugs in the past 30 days. (CDC, 2019) Although drug therapy can be effective in treating disease, full benefits are often not realized because many patients do not take their medications as prescribed. There is quite a bit of research out there about non-adherence to medication. Some studies focus on the financial impacts of non-adherence, but most of the studies examine the reasons for medication non-adherence. A gap exists in research about …

The Effect Of Standardized Patient Education On 30-Day Hospital Readmissions For Heart Failure Patients In The Outpatient Setting, Lurie Dimalanta

Master's Projects and Capstones

Problem: Heart failure (HF) is the second leading condition of hospital readmissions. Evidence shows that patient education on self-care and disease management can help reduce and prevent 30-day hospital readmissions. Registered nurse case managers (RN CMs) can help improve patients' ability to self-manage their condition and prevent 30-day hospital readmissions by applying a standard approach to patient education.

Context: The Integrated Care Management (ICM) is an outpatient department that provides post-discharge patient calls. The ICM RN CMs utilized various HF patient education tools for patient teaching. The organization’s HF task force developed health-literate patient resources to be used …

Increasing Colorectal Cancer Screening Rates In The Psychiatric Inpatient Unit, Diane R. Ventura

Master's Projects and Capstones

Increasing Colorectal Cancer Screening Rates in the Psychiatric Inpatient Unit

Abstract

Problem: Colorectal cancer is one of the leading cancer deaths in the United States. The Psychiatric Inpatient Unit has a colorectal cancer screening compliance rate of 40% compared to the statewide average of 80%.

Context: The Psychiatric Inpatient Unit is a 58-bed inpatient intermediate care facility mental health program in Northern California. Upon review of the EMR, most PIU nurses give verbal instructions and patient education on colorectal cancer screenings when due. Still, no printed handout was provided to the patients upon review of the EMR.

Intervention: Review of …

Mentorship In A Nursing School Program, Samantha I. Gavirati Yamamoto

Master's Projects and Capstones

Problem: A Southern Californian community college associate degree nursing program has a peer-to-peer mentorship program that does not get regularly, objectively evaluated.

Context: The community college nursing program has been implementing the peer mentorship program for years, but it does not have an evaluation tool, outside of grades, to evaluate its peer mentors.

Interventions: Implement new educational training tools about mentorship, and its benefits and the many types of roles that a mentor can take on. Also, to develop and implement a pre and post-survey for the mentors to self-evaluate their mentorship skills at the beginning and end of the …

Reproductive Health: A Literature Review On Reducing Maternal Mortality Rates Among Afghan Women Using A Tiered Process Of Interventions, Shirley C. Lam

Master's Projects and Capstones

This literature review examines the risk factors associated with pregnancy that contribute to high maternal mortality rates in Afghanistan and women’s limited access to adequate health services and education. Some of the factors contributing to high maternal mortality rates are political instability/civil conflict, current policies and legislation, workforce shortages in the healthcare field, as well as socioeconomic levels. The underlying theme which influences each of these factors are Afghanistan’s culture and religion. To reduce the rising maternal mortality rates for Afghan women and girls, there must be a shift in mindset from within the culture. A three-layered tiered intervention which …

Delirium And Staff Injury, John Olague Jr

Master's Projects and Capstones

Abstract

Problem: From April 2021 to January 2022 there were 17 cases of reported patient aggression and staff injury due to patients in the hyperactive state of delirium. In a stroke/tele unit, diagnosis of delirium was delayed due to subjective assessment from the confusion assessment method (CAM) tool. This delay allowed patients to reach the hyperactive state of delirium which poses a threat to patient and staff safety. An objective form of assessment for delirium was needed on this stroke/tele unit.

Context: Through a microsystem assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis, stakeholders in this performance improvement plan …

Impact Of Montessori-Based Dementia Programming On Engagement And Affect Of Older Adults With Dementia, Meredith S. Sheppard

Master's Projects and Capstones

The COVID-19 pandemic has profoundly impacted the Adult Day Services program and Adult Day programs across the country. As the Adult Day Services program transitions to an in-person format, goals within the organization include developing appropriate programming, increasing group size, and keeping clients entertained. The framework guiding this quality improvement project is Montessori-Based Dementia Programming ® (MBDP). This project aims to increase client engagement, decrease client anxiety, and decrease staff workload. This will be measured by a self-developed staff workload survey, the Menorah-Park Engagement, and the Affect rating scale. Implementation of MBDP at the Adult Day Center did not meet …

Standardizing Handoff Report In A Medsurg Telemetry Floor, Brandon Tyler Thompson

Master's Projects and Capstones

Problem: Hospital A’s 9^th floor telemetry units lacked a standardized method of handoff and required investigation. Current practices were evaluated, and an intervention was designed based on weak communication areas. Context: Using a 5 P’s assessment the key stakeholders included unit nurses, the nursing director, nurse educators, and unit nurse managers, and the patients were medsurg telemetry patients. The process included handoff in care and the pattern evaluated was methods of reporting with the purpose of providing high quality evidence-based patient centered care. A SWOT analysis revealed strong teamwork, interdisciplinary collaboration, and proficiency in health record technologies as strengths …

Reducing Hospital-Acquired Pneumonia By Educating Patient Care Technicians On Route Bundle Care Measures, Munroop K. Thiara

Master's Projects and Capstones

Hospital-acquired pneumonia (HAP) is an infection of the lungs that can lead to severe and sometimes fatal outcomes. HAP can be prevented by oral care interventions, but without proper patient care, treatment can be very expensive. Evidence-proven HAP preventative measures such as the ROUTE bundle and increased patient mobility can significantly lower the risk of pneumonia as well as prevent additional hospital costs. Hospital X is a private nonprofit health care organization in the urban suburbs of a large Northern California city with a current HAP rate of 2.3 and with targeted goals of 2.0. By creating a project that …

Reducing The Risk Of Central Line Associated Blood Stream Infection With Chlorhexidine Gluconate Education, Scarlett Ocon

Master's Projects and Capstones

Problem: A nosocomial central line-associated bloodstream infection is a preventable infection that is costly and potentially fatal. In order to combat bloodstream infections chlorhexidine gluconate wipes have been used as antiseptic. Medical surgical units do not have accessible CHG for bathing purposes. In addition, the staff lacks knowledge of how to use CHG wipes. The current standard bathing practice on this unit consists of using soap and water or disposable washcloths spontaneously without a predetermined time. The aim of this quality improvement project is to educate the registered nurses (RNs) and certified nurse assistants (CNAs) on the benefits of daily …

Analyzing The Effects Of Climate Impacts In El Salvador And How They Influence Pollution, Ecosystems And Communities, Veronica Norio-Tomasino

Master's Projects and Capstones

Due to projections of rising temperatures and increased frequency and severity of extreme weather events, the rate at which climate change is impacting nations is devastating. However, developing countries and vulnerable communities are not the primary contributors to climate change, but they are at a greater risk for climate impacts by industrialized nations. As a result of increased human activity, developing nations such as El Salvador are particularly susceptible to climate-related events. Deforestation, water pollution, and human health risks are some activities that have contributed to El Salvador's vulnerability to climate change, drastically affecting rural communities suffering from multidimensional poverty. …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

Implementation Of Staff Education To Standardize Use Of Positions During The First Stage Of Labor, Kelsey Jo Koch

Master's Projects and Capstones

The aim of this project was to assess whether supplemental education on labor positioning for Labor and Delivery nurses would increase the nurses’ confidence in utilizing patient positioning to promote fetal descent and progress labor. Previous research suggests that upright, mobile positions during the first stage of labor have various benefits, including reduced cesarean rates, shorter lengths of labor, and less epidural usage. However, a major barrier to maximizing these benefits is a gap in knowledge among Labor and Delivery nurses, resulting in inconsistent use of various positions. This improvement project addresses this problem at a large community hospital in …

Implementation Of Staff Education To Standardize The Use Of Positions During The First Stage Of Labor, Minh Chau T. Phan

Master's Projects and Capstones

This project aims to educate labor and delivery (L&D) nurses on effective laboring positions that can aid fetal descent during the first stage of labor. In an L&D unit of a south Bay Area County hospital, there is a lack of standardization of knowledge and practices on laboring positions among the nursing staff. Evidence shows that upright positions and frequent mobility are effective in shortening the duration of labor and minimizing unnecessary cesarean deliveries. Based on the evidence, a project was implemented using verbal education of evidence-based laboring positions. An educational handout was also provided along with a recorded video …

Improving Early Sepsis Management Compliance In The Emergency Care Setting, Mckayla Howie

Master's Projects and Capstones

This quality improvement project implements educational materials informed by organization-dependent nursing informatics and SEP-1 campaign metrics to improve early sepsis management compliance in the emergency department setting. The microsystem scored below a 90% compliance target in first vital to lactic acid result within one hour, lactic acid result to antibiotic administration within one hour, and antibiotic order to administration within thirty-five minutes before implementation. Factors identified as contributing to low compliance include rates of timely and accurate sepsis screening, use of a standardized sepsis order set, and intervention documentation. An educational inservice covering correct sepsis workflow in the electronic health …

Decreasing Hospital Acquired Pneumonia In Adult Patients, Samantha M. Flaherty

Master's Projects and Capstones

This Northern California Hospital holds to high-performance standards. It exists to provide high-quality care, aspiring to improve its members' health and lives while continually advancing its practice—pioneering preventive medicine, conducting comprehensive research, and driving innovative care (“Northern California Hospital,” 2022). By gathering and measuring data and analyzing adverse and advantageous patient outcomes, this Northern California Hospital's Quality Outcomes Department is able to identify gaps between the present and the intended goals. The quality department implements changes by working with care teams and providers to minimize the void between goals, making future patient care optimal.

The indicted Northern California Hospital focuses …

Nurse-Led Education On Oral Chemotherapy Medications, Carmen Lucia Glick Alonso

Master's Projects and Capstones

Problem: Breast cancer is one of the leading causes of cancer death among women in the United States. Annually, around 264,000 breast cancer cases are diagnosed in women and 2,400 in men (Centers for Disease Control and Prevention, 2022). According to the American Cancer Society, the risk of a woman in the United States being diagnosed with breast cancer in their life is around 13% (2022).

Context: Along with a cancer diagnosis comes the need to introduce patient education about new oral chemotherapy treatments. As a treatment team member, the oncology nurse plays a vital role in this …

United States Pharmacopeia General Chapter <800>: Improving Safe Handling And Administration Of Hazardous Drugs, Courtney Clark

Master's Projects and Capstones

Problem: This quality improvement project is dedicated to increasing the safe handling and administration of United States Pharmacopeia (USP) General Chapter Hazardous Drugs (HDs) within the Medical/Surgical unit to minimize the risk of exposure to patients, healthcare personnel, and the environment.

Context: The quality improvement project was implemented in two Medical/Surgical units in Hospital A in the San Francisco Bay Area. The patient population of these units has the highest receipt of HDs outside of a traditional Hematology/Oncology unit.

Intervention: The proposed intervention is the use of active and passive observation to assess compliance with USP protocols within the two …

Improving Safe Handling And Administration Of Usp<800> Hazardous Drugs Within The Medical-Surgical Unit, Pavlo Karaputa

Master's Projects and Capstones

Nurses comprise the largest proportion of healthcare providers who make contact with Hazardous Drugs (HDs) during multiple types of clinical activities and have a risk of exposure. Hazardous drugs (HDs) are a class of pharmaceuticals that pose serious health risks to individuals who handle them, including organ toxicity, reproductive and developmental defects, infertility, miscarriage, genetic toxicity, cancer, and even death. This project was implemented in a hospital system within Northern California, on two units that serve medical-surgical, oncology, geriatric, and transplant patients. The Medical Surgical microsystem at this hospital comprises a small group of professionals such as registered nurses (RNs), …

Reduction Of Embodied Carbon In Buildings Through Use Of Low Carbon Strategies And Standardization And Enforcement Of Life Cycle Assessment, Bhargavi Sai Sudhakar

Master's Projects and Capstones

The building and construction industry is energy intensive and as of 2021, this industry is responsible for 37% of the total global greenhouse gas emissions. In previous studies of conventional buildings, the operational energy of a building contributed to 80% and the embodied energy contributed to 20% of the total life cycle energy. With increase in policies and standards that focus on reducing the operational energy, low energy and certified green buildings have emerged where the operational energy has considerably reduced. The relative and absolute share of embodied energy in these energy efficient buildings have increased due to excessive use …

Evaluating Equity In Transportation Greenhouse Gas Emission Reduction Strategies In Local Climate Action Planning In Oakland, California, Eliza J. Kane

Master's Projects and Capstones

Emissions from California’s transportation sector contribute to global climate change and impact local air quality and public health. Forty-one percent of California’s greenhouse gas emissions in 2019 were from transportation. Transportation emissions are also a source of many health-harming air pollutants such as carbon monoxide, volatile organic compounds, and particulate matter. Disadvantaged communities in California experience disproportionate impacts from transportation emissions and suffer worse health effects, including higher incidences of asthma, cardiovascular disease, and premature death. Cities have led the way in policymaking to mitigate and adapt to climate change, including creating Climate Action Plans (CAPs) to propose strategies to …

Egfr Is A Master Switch Between Immunosuppressive And Immunoactive Tumor Microenvironment In Inflammatory Breast Cancer, Xiaoping Wang, Takashi Semba, Ganiraju C Manyam, Jing Wang, Shan Shao, Francois Bertucci, Pascal Finetti, Savitri Krishnamurthy, Lan Thi Hanh Phi, Troy Pearson, Steven J Van Laere, Jared K Burks, Evan N Cohen, James M Reuben, Fei Yang, Hu Min, Nicholas Navin, Van Ngu Trinh, Toshiaki Iwase, Harsh Batra, Yichao Shen, Xiang Zhang, Debu Tripathy, Naoto T Ueno

Faculty, Staff and Student Publications

Inflammatory breast cancer (IBC), the most aggressive breast cancer subtype, is driven by an immunosuppressive tumor microenvironment (TME). Current treatments for IBC have limited efficacy. In a clinical trial (NCT01036087), an anti-EGFR antibody combined with neoadjuvant chemotherapy produced the highest pathological complete response rate ever reported in patients with IBC having triple-negative receptor status. We determined the molecular and immunological mechanisms behind this superior clinical outcome. Using novel humanized IBC mouse models, we discovered that EGFR-targeted therapy remodels the IBC TME by increasing cytotoxic T cells and reducing immunosuppressive regulatory T cells and M2 macrophages. These changes were due to …

Mitochondrial Autophagy In Ischemic Aged Livers, Jae-Sung Kim, William C Chapman, Yiing Lin

2020-Current year OA Pubs

Mitochondrial autophagy (mitophagy) is a central catabolic event for mitochondrial quality control. Defective or insufficient mitophagy, thus, can result in mitochondrial dysfunction, and ultimately cell death. There is a strong causal relationship between ischemia/reperfusion (I/R) injury and mitochondrial dysfunction following liver resection and transplantation. Compared to young patients, elderly patients poorly tolerate I/R injury. Accumulation of abnormal mitochondria after I/R is more prominent in aged livers than in young counterparts. This review highlights how altered autophagy is mechanistically involved in age-dependent hypersensitivity to reperfusion injury.

An Fmri Protocol For Administering Liquid Incentives To Human Participants, Debbie M Yee, Jennifer L Crawford, Todd S Braver

2020-Current year OA Pubs

This protocol describes the materials and approaches for administering liquid incentives to human participants during fMRI scanning. We first describe preparation of the liquid solutions (e.g., neutral solution and saltwater) and liquid delivery setups. We then detail steps to connect the setups to the computer-controlled syringe pump in the MRI control room, followed by procedures for testing the syringe pump dispensing a liquid bolus during the task. Description of custom software and required adapters for implementing the liquid setup are included. For complete details on the use and execution of this protocol, please refer to Yee et al. (2021).

Evaluation Of Mtorc1 Signaling In Mouse Atherosclerotic Macrophages By Flow Cytometry And Immunofluorescence, Xiangyu Zhang, Jeremiah Stitham, Astrid Rodriguez-Velez, Se-Jin Jeong, Arick Park, Yu-Sheng Yeh, Divya Kapoor, Bettina Mittendorfer, Babak Razani

2020-Current year OA Pubs

Previous studies have demonstrated that a high-protein diet leads to increased atherosclerosis in mice, and that this adverse effect is caused by activation of macrophage mTORC1 signaling. Here, we provide a detailed protocol for the evaluation of diet-induced mTORC1 signaling in plaque macrophages in atherosclerosis-prone apolipoprotein E (ApoE) knockout (KO) mice. This protocol includes flow cytometry and immunofluorescence analysis of atherosclerotic macrophages that can be used to study the atherogenic potential of a variety of mTORC1 modulators. For complete details on the use and execution of this protocol, please refer to Zhang et al. (2020).

A Systematic Approach To Provide Feedback To Presenters At Virtual And Face-To-Face Professional Meetings, S Beth Bierer, Anna Cianciolo, Heeyoung Han, Janice Hanson

2020-Current year OA Pubs

INTRODUCTION: To promote their personal and professional growth, medical educators need practical, actionable feedback on their scholarship, as well as guidance for documenting their scholarship in educator portfolios. We offer a framework and resources to provide formative and summative feedback to faculty, administrators, and/or learners delivering an oral presentation at a face-to-face or virtual health professions education meeting.

METHODS: In 2014, the leadership of the Central Group on Educational Affairs (CGEA) meeting planning committee developed and piloted a process to provide individuals with formative and summative feedback on their oral CGEA research presentations at face-to-face meetings and create a transparent …

Sovereign Lands, Brent D. Chicken, Amanda J. Dick

Oil and Gas, Natural Resources, and Energy Journal

No abstract provided.

Oklahoma, Matt Schlensker, Sandra Fraley

Oil and Gas, Natural Resources, and Energy Journal

No abstract provided.

New Mexico, Blake C. Jones

Oil and Gas, Natural Resources, and Energy Journal

No abstract provided.