Campaigning Beyond: Sepsis Awareness Among Non-Clinical Staff, Cynthia Wong

Master's Projects and Capstones

Problem: Sepsis stands as the foremost cause of illness and death among hospitalized patients globally, yet a considerable number remain oblivious to this critical condition. Based on the pre-implementation survey among non-clinical staff members of an urban hospital, awareness of sepsis must be heightened to ensure swift recognition and response.

Context: The project conducted takes place in five distinct non-clinical departments at a large hospital organization in Northern California. Each department plays an essential role in the holistic and efficient functioning of the organization to provide quality patient care.

Interventions: A sepsis awareness campaign was implemented throughout the month of …

Dodge The Fall: A Newborn Fall Prevention Initiative, Lenora Thompson

Master's Projects and Capstones

Problem: This newborn fall prevention initiative was developed in response to an increase in the number of newborn falls at a Bay Area hospital on the postpartum unit. This hospital had gone six years without a newborn fall but by September of 2023 had three falls on the postpartum unit.

Context: The setting for this newborn fall prevention initiative is an urban, NICU level III Bay Area hospital that provides high-risk obstetric care. This Bay Area hospital has 247 licensed patient beds; 10 beds make up the postpartum unit and 11 beds make up the antepartum unit which serve as …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Emily Beck

Master's Projects and Capstones

Problem: With a recent influx of sepsis cases, hospital stakeholders identified gaps between sepsis protocol and practice. This quality improvement project aimed to increase sepsis bundle compliance and utilization among registered nursing staff in the emergency department to improve sepsis management and patient outcomes ultimately.

Context: The microsystem assessed is a 44-bed emergency department at Hospital A, a level II adult trauma center within the greater San Francisco Bay Area. The current registered nurse roster within this department, excluding four on leave, is 115 individuals and represents the target population for this change project.

Interventions: Interventions were not implemented due …

Lovenox Prophylaxis: Improving Lovenox Nurse Education In A Postpartum Unit, Amy T. Nguyen

Master's Projects and Capstones

Problem: This quality improvement project aimed to increase nurse education about Lovenox

prophylaxis within the postpartum unit to reduce risks of pulmonary embolism among high-risk postpartum women in the postpartum unit. Context: A microsystem assessment was completed by Clinical Nurse Leader (CNL) students in the postpartum unit at Hospital X located in the southern Bay Area. This unit accommodates 25 beds and provides care for postpartum mothers after both cesarean section and vaginal births. Intervention: An anonymous pre-intervention survey was distributed to the registered nurses on the unit. Educational handouts were created and distributed to the nurses on the unit. …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Andrea Garcia

Master's Projects and Capstones

Problem: Compliance and timeliness with the sepsis bundle protocol are continuously increasing, resulting in poor patient outcomes. This quality improvement project aims to increase sepsis bundle compliance and earlier sepsis management in the Emergency Department (ED) to reduce sepsis mortality rates and length of hospital stay.

Context: Hospital A’s emergency department is a level II adult trauma center located in the Greater Bay Area that treats a range of patients presenting with life-threatening diagnoses such as sepsis, traumatic injuries, and electrolyte imbalances.

Interventions: The sepsis committee team was provided recommendations to implement post-data analysis. Interventions recommended included standardizing and increasing …

Improving Preeclampsia Education And Assessment Frequency Among Nurses In The Postpartum Unit, Jazmin Garduno

Master's Projects and Capstones

Problem: This study aims to improve maternal-child health education and assessment among the multidisciplinary staff in a postpartum unit. Pre-assessment questionnaires and data will be collected over one month, and will guide the changes that need to be implemented.

Context: Clinical Nurse Leader students conducted a microsystem assessment in the Postpartum Unit of a hospital in the Bay Area, conducive to improving preeclampsia education and the frequency of assessment for patients with preeclampsia without severe features.

Intervention: We implemented supplemental Preeclampsia education for the nurses on the Maternal-Child Postpartum Unit. In addition to the education, we used pre- and post- …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Monica P. Rabago Moreno

Master's Projects and Capstones

Problem: This quality improvement project aims to enhance early sepsis management and sepsis bundle compliance among Emergency Department nurses to reduce the risk of sepsis-related deaths as well as hospital length of stays.

Context: A microsystem assessment, in the emergency department (ED) unit, was performed in Hospital A located in the Greater San Francisco Bay area by Clinical Nurse Leader (CNL) students. This ED unit cares for a variety of critical care patients ranging from urgent to life-threatening conditions.

Intervention: An intervention was not implemented in the ED unit due to time constraints and limitations; however, CNL students provided recommendations …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Camila Sanchez

Master's Projects and Capstones

Problem: The purpose of this quality improvement (QI) project revolves around increasing overall staff nurse compliance, enhancing their sepsis education resources, and usage of their provided education and bundle. This goal was created to produce more positive patient outcomes at Hospital X, along with its improved management of sepsis. Hospital X is an acute care facility located in the San Francisco Bay Area.

Context: The unit that was studied during this QI project was the emergency department of Hospital X. This unit provides level I trauma services in addition to other types of emergency care and contains 44 beds. Not …

Improving Triage Accuracy In The Emergency Department, Catriona E. Clohessy

Master's Projects and Capstones

Problem: Hospital Z’s emergency department was experiencing a triage inaccuracy rate that exceeded the accepted national benchmark of 10%. This quality improvement project aimed to reduce triage inaccuracy to less than 10% in the emergency department at Hospital Z, through improved education and availability of supplemental reference materials.

Context: This quality improvement project was conducted in a 40 bed emergency department at Hospital Z. This microsystem serves a diverse patient population from the surrounding community that experience a variety of conditions requiring emergency medical intervention.

Interventions: Clinical Nurse Leader nursing students partnered with unit leadership to create a new ESI …

Improving Triage Accuracy In The Emergency Department, Joselyn Silverman

Master's Projects and Capstones

Problem: High rates of patients being mis-triaged was occurring at Hospital X leading to poor patient outcomes and incorrect staffing levels.

Context: This quality improvement project took place at Hospital X’s emergency department. A stakeholder analysis and a microsystem assessment along with a staff survey was created in order to determine areas of improvement and staff responsiveness.

Interventions: Eight educational seminars were conducted along with Hospital X leadership and students created supplemental materials for the staff to use on a daily basis.

Measures: Two data pulls were conducted over the course of the quality improvement project; one prior to the …

Improving Triage Accuracy In The Emergency Department, Maia E. Baglin

Master's Projects and Capstones

A Northern California emergency department (ED) faced increased triage inaccuracy. An analysis of 400 random ED visits from January to April 2023 discovered a 23% mistriage rate, with under- and over-triage rates at 16.25% and 6.75%, respectively. Mistriage creates an imbalance in unit acuity, leading to inappropriate staffing levels. Potential breaks in the triage process, include inaccurate triaging by the screener or triage nurses, as well as delays in the providers inputting initial orders, leaving patients waiting without appropriate care orders. An educational training focusing on the updated Emergency Nurses Association Emergency Severity Index (ESI) algorithm version 5 was mandated. …

Improving Triage Accuracy In The Emergency Department, Vince Harrington

Master's Projects and Capstones

Problem: Mistriage was occurring at higher than acceptable rates. In turn, this caused poor staffing levels and patient outcomes. This project seeks to improve triage accuracy according to the Emergency Nurses Association’s (ENA) Emergency Severity Index (ESI) algorithm.

Context: The Emergency Department in a prominent bay area hospital that was experiencing high rates of mistriage.

Interventions: The staff nurses were required to attend a retraining on the Emergency Nurses Association (ENA) Emergency Severity Index (ESI) algorithm. Following the retraining, a follow up online exam with sample patients must be passed at 100%. Furthermore, badge buddies containing the ESI algorithm will …

Improving Early Sepsis Recognition: Resocializing Intensive Care Unit Nurses In A Large Hospital On The Inpatient Sepsis Bundle Checklist, Elizabeth Rose Maykel

Master's Projects and Capstones

Problem: In order to lower sepsis morbidity and mortality rates through early recognition and treatment, this quality improvement project sought to raise sepsis awareness and bundle compliance within the Intensive Care Unit.

Context: Clinical Nurse Leader (CNL) students completed a microsystem assessment of the Intensive Care Unit at Hospital X in Northern California. This unit cares for patients with sepsis, organ failure, respiratory failure, different types of shock, acute kidney injury, and traumatic brain injury.

Interventions: The implemented intervention included a refresher huddle on sepsis bundle awareness. Though the intervention was ineffective, the students did offer recommendations …

Resocialization Of An Inpatient Handoff Sepsis Bundle Checklist On A Medical-Surgical Unit, Sophia Kawada

Master's Projects and Capstones

Problem: In September 2023, it was found that only 25% of nurses were familiar with an inpatient handoff sepsis bundle checklist (IHSBC) on a Medical-Surgical Unit in Hospital A. This evidence-based project aimed to improve resocialization of the IHSBC such that compliance to the bundle continues to be maintained well above the benchmark of 75%. Context: Clinical Nurse Leader (CNL) students at the University of San Francisco conducted a microsystem assessment of the Medical-Surgical Unit at Hospital A. This hospital aimed to maintain high rates of compliance with the IHSBC. Interventions: Resocialization of the IHSBC was completed in October, and …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Efrain Perez Trujillo

Master's Projects and Capstones

Problem: This quality improvement (QI) project aims to optimize early sepsis management and sepsis bundle compliance among Emergency Department (ED) registered nurses in order to reduce the risk of sepsis-related deaths and associated hospital length of stay.

Context: Clinical Nurse Leader (CNL) students conducted a microsystem assessment on the ED at Hospital A, located within the greater San Francisco Bay Area. This microsystem, equipped with 115 nurses and 44 rooms, consists of an acuity of care for urgent to life-threatening medical conditions, including sepsis.

Intervention: Following time constraints, and limitations, implementation of an intervention was not feasible; however, CNL students …

Best Practices To Manage Nitrate Contamination Of Groundwater In Agricultural Zones: A Comparative Analysis Of Farming Impacts On Areas Of Central Valley And High Plains Aquifers, Rekha Duthulur

Master's Projects and Capstones

Nitrate is one of the most common contaminants in groundwater and causes multiple health impacts when consumed. Contamination is most significant in agricultural areas and has increased steadily since the 1950s with the introduction of nitrogen fertilizers. The depth of an aquifer, sediment type, hydrogeology, redox conditions, microbe activity, fertilizer application, natural nitrogen deposits, and well construction influence the degree of nitrate contamination of an aquifer. The sources of nitrate pollution are fertilizer, manure, concentrated feeding lots, natural nitrogen deposits, atmospheric deposition, septic systems, wastewater treatment plants, and industrial activities. Nitrogen compounds applied on the surface are stored in the …

Assessing Wastewater Treatment In Yopal Colombia Using Gis, Leydi P. Puerto Bohorquez

Master's Projects and Capstones

The amount of wastewater has surged alongside population growth, urbanization, and economic development, which can influence the wastewater treatment process, especially in the treatment capacity, particularly in developing countries. In Colombia, the low coverage of Wastewater Treatment Plants (WWTP) leads to a complex environmental issue. This has threatened water quality and aquatic ecosystems of waterbodies that receive this type of water by increasing disease prevalence and creating hypoxic conditions. To determine how a WWTP could impact water quality, it was necessary to understand the treatment process and the physicochemical parameters being monitored. The focus is to answer the central research …

Addressing Linguistic Isolation Through Community Based Esl And Emergency Preparedness, Lisa Guay

Master's Projects and Capstones

Linguistic isolation acts as a barrier to the well-being and social integration of Limited English Proficient (LEP) adults. Community-based English as a Second Language (ESL) classes, designed with learner-centric curricula, may help LEPs gain access to social and navigational capital in the form of English proficiency, confidence and social integration. Community-based ESL programs provide adult English Language Learners (ELLs) with a path to English proficiency and social integration, but curricula should be geared toward ELLs’ needs. There is a need for ESL curricula focused on emergency and disaster preparedness, curricula which may contribute positively to adult ELLs’ speaking skills and …

Cultivating Well-Being In English As A Second Language: Teaching Stress Reduction Techniques In The Adult Esl Classroom, Sara C. Coronado

Master's Projects and Capstones

Adult immigrant and refugee speakers of English as a Second Language (ESL) including California community college students may suffer trauma and stressors that can lead to negative mental health outcomes during the stages of migration, yet underutilize mental health services owing to cultural stigma, structural barriers, and a lack of English language proficiency. In addition, ESL speakers may also suffer from language anxiety evoked by speaking the less-developed language in the classroom as well as outside of the classroom during interactions with the majority language community. Both forms of anxiety share symptoms including tense muscles, rapid breathing, shortness of breath, …

Self-Calibrated Subspace Reconstruction For Multidimensional Mr Fingerprinting For Simultaneous Relaxation And Diffusion Quantification, Jessie E.P. Sun, Ken Sakaie, Mark A. Griswold

Faculty Scholarship

Purpose: To propose a new reconstruction method for multidimensional MR fingerprinting (mdMRF) to address shading artifacts caused by physiological motion-induced measurement errors without navigating or gating. Methods: The proposed method comprises two procedures: self-calibration and subspace reconstruction. The first procedure (self-calibration) applies temporally local matrix completion to reconstruct low-resolution images from a subset of under-sampled data extracted from the k-space center. The second procedure (subspace reconstruction) utilizes temporally global subspace reconstruction with pre-estimated temporal subspace from low-resolution images to reconstruct aliasing-free, high-resolution, and time-resolved images. After reconstruction, a customized outlier detection algorithm was employed to automatically detect and remove images …

Association Of Covid-19 Coinfection With Increased Mortality Among Patients With Pseudomonas Aeruginosa Bloodstream Infection In The Veterans Health Administration System, Leila S. Hojat, Brigid M. Wilson, Federico Perez, Maria F. Mojica, Mendel E. Singer, Robert A. Bonomo

Faculty Scholarship

Objective: Pseudomonas aeruginosa bloodstream infection (PA-BSI) and COVID-19 are independently associated with high mortality. We sought to demonstrate the impact of COVID-19 coinfection on patients with PA-BSI. Design: Retrospective cohort study. Setting: Veterans Health Administration. Patients: Hospitalized patients with PA-BSI in pre-COVID-19 (January 2009 to December 2019) and COVID-19 (January 2020 to June 2022) periods. Patients in the COVID-19 period were further stratified by the presence or absence of concomitant COVID-19 infection. Methods: We characterized trends in resistance, treatment, and mortality over the study period. Multivariable logistic regression and modified Poisson analyses were used to determine the association between COVID-19 …

Reducing Hospital-Acquired Pressure Injury In An Inpatient Medical-Surgical Telemetry Adult Unit By Educating And Encouraging Basic Wound Care Prior To Wound Care Consult, See Wai (Amy) Kong

Master's Projects and Capstones

Problem: A medical center in the Diablo Service Area had one of the highest rates in hospital-acquired pressure injury (HAPI), benchmarking with other facilities, with the project unit one of the top offenders. The patients and the medical center both suffered from the harm. Barriers to HAPI prevention included lack of patient turnings, skin assessment, and early standard wound care treatment.

Context: This project focused on the primary care team standardizing early wound care treatment to avoid wound progression.

Interventions: Interventions included re-educating the primary care team on early basic wound care using a standard wound care guideline created by …

Mentoring Nurses After Specialty Training Or Orientation In Labor And Delivery, Benjamin Jlopleh Worji

Master's Projects and Capstones

Mentoring Nurses After Specialty Training or Orientation in Labor and Delivery

Abstract

Background: The setting for this project was a northern California hospital-based healthcare system referred to as “Hospital KV.” Hospital KV is a non-profit, integrated hospital that operates to improve the community’s health. Hospital KV’s maternal child health (MCH) department comprises a labor and delivery(L&D) unit, a mother and baby unit (MBU), also referred to as a postpartum unit, and an intermediate nursery (IMN).

Problem: The hospital KV MCH department faced the challenge of a nursing shortage. The nursing shortage was associated with substantial challenges to Hospital KV, its …

Enhancing Diabetic Patient Continuous Glucose Monitoring Access, Colleen Ildefonso

Master's Projects and Capstones

Problem: Diabetic patients utilize treatments that require frequent monitoring and medication changes based on their blood sugar results. Continuous Glucose Monitoring (CGM) is more commonly used for diabetes management as time in range is becoming more prevalent to measure diabetes outcomes. Many diabetic patients find CGM use more accessible than finger sticks and glucometers. In contrast, others utilize the technology to closely monitor their blood sugars for interventions throughout the day. However, older adults have difficulty facilitating new CGM technology and may require further reinforcement using additional education methods such as teach-back.

Context: The endocrinology clinic serves a patient population, …

Reducing Care Companion Utilization In Medical-Surgical And Telemetry Units, Mary Jane B. Sagabaen

Master's Projects and Capstones

Abstract

Problem: The facility highly utilized sitters or care companions, negatively impacting the staffing plan, budget, and productivity. An average of 56 hours of care companions were used daily. This greatly exceeded the budget of 33 hours a day. Reassigning Patient Care Technicians (PCT) as care companions resulted in inadequate nurse support for patient care and increased cost for additional staffing needs. Despite this, the fall rate remained higher than the target.

Context: The patient population is mainly 65 years old and above, sometimes with confusion, dementia, delirium, and at high risk for falls and elopement. The culture included promptly …

Utility Of T-Cell Immunosequencing In Distinguishing Mycosis Fungoides Progression From Treatment Related Cutaneous Adverse Events, Safiyyah Bhatti, Daniel Joffe, Lauren Banner, Sahithi Talasila, Jenna Mandel, Jason Lee, Pierluigi Porcu, Neda Nikbakht

Department of Dermatology and Cutaneous Biology Faculty Papers

Cutaneous adverse events of both topical and systemic drugs in patients with mycosis fungoides (MF) present a diagnostic challenge as it is often difficult to distinguish drug associated rash from disease progression in the skin. Mogamulizumab and mechlorethamine gel are approved treatments for MF, both of which can cause treatment related cutaneous adverse events. It can often be challenging to distinguish mogamulizumab associated rash (MAR) and mechlorethamine gel associated hypersensitivity dermatitis from MF progression both clinically and histologically. High-throughput sequencing (HTS) of the T-cell receptor (TCR), also known as immunosequencing, can be used to assess T-cell clonality to support a …

Top Tips For Effective Use Of Periodontal Instruments In Primary Care, Morag Powell, Ruth Potterton, Ewen Mccoll

Peninsula Dental School

Stabilisation of primary disease is a key pillar of successful treatment and in addition to managing caries, managing periodontal disease is a crucial component of a successful treatment plan. The recent European Federation of Periodontology (EFP) S3 level clinical practice guidelines (CPG)1 are evidence‐based clinical guidelines providing recommendations to treat periodontitis. Crucial to successful implementation of these recommendations is delivering behavioural change and non-surgical instrumentation. Often this is given passing attention with insufficient time allocated to behaviour change in treatment planning. Similarly, poorly maintained periodontal instruments and equipment not used to their full utility or design can lead to poorer …

Synthetic Produced Water Treatment By Directional Solvent Extraction In A Semi-Continuous System, Pablo Vicaria

Masters Theses (Archived)

Directional Solvent Extraction (DSE) is a system used to remove salts from brine water, utilizing organic solvents such as Diisopropylamine (DIPA); it is a well-studied system where the results obtained are promising because the removal of salts can be greater than 94%. The high demand of pure water for the oil and gas industry increases each year as access to fresh water is becoming complex and expensive. It is necessary to develop new technologies with higher recovery rates and environmentally friendly waste disposal. With a proposed semi-continuous system, divided into four stages, an analysis on retention times (RT), and a …

Engaging With ‘Less Affluent’ Communities For Food System Transformation: A Community Food Researcher Model (Foodsequal Project), C. Pettinger, L. Hunt, H. Gardiner, P. Garg, L. Howard, C. Wagstaff

School of Health Professions

The UK food system is distorted by inequalities in access, failing the people most in need, yet it should provide access to safe, nutritious affordable food for all citizens. Dietary patterns are associated with sociodemographic characteristics, with high levels of diet-related disease mortality attributed to poor dietary habits. Disadvantaged UK communities face urgent public health challenges, yet area often treated as powerless recipients of dietary and health initiatives. The need for food system transformation has been illustrated within recent UK government policy drivers and research funding. The Food Systems Equality project1 is a research consortium that aims to ‘co-produce healthy …

Lilrb3 Modulates Acute Myeloid Leukemia Progression And Acts As An Effective Target For Car T-Cell Therapy, Sunny Mai, Alan Hodges, Hui-Ming Chen, Jilu Zhang, Yi-Ling Wang, Yongbin Liu, Fumiko Nakatsu, Xiaoxuan Wang, Jing Fang, Yitian Xu, Vitaliy Davidov, Kyeongah Kang, Sai Ravi Pingali, Siddhartha Ganguly, Masataka Suzuki, Marina Konopleva, Brooke Prinzing, Youli Zu, Stephen Gottschalk, Yong Lu, Shu-Hsia Chen, Ping-Ying Pan

Faculty, Staff and Students Publications

Identifying novel cell surface receptors that regulate leukemia cell differentiation and can be targeted to inhibit cellular proliferation is crucial to improve current treatment modalities in acute myeloid leukemia (AML), especially for relapsed or chemotherapy-refractory leukemia. Leukocyte immunoglobulin-like receptor type B (LILRB) is an immunomodulatory receptor originally found to be expressed in myeloid cells. In this study, we found that LILRB receptors can be induced under inflammatory stimuli and chemotherapy treatment conditions. Blockade of LILRB3 inhibited leukemia cell proliferation and leukemia progression. Additionally, treatment with LILRB3 blocking antibodies upregulated myeloid lineage differentiation transcription factors, including PU.1, C/EBP family, and IRF, …