Digital Commons Network^™

Genetic Editing: Technology Ahead Of Its Time, Natalie Champagne

Academic Festival

For my capstone topic I will be writing a bioethics paper discussing the potential uses and social implications of genetic editing. Editing the human genome is a controversial topic spanning across many different circles from the science community to health professionals to the public and religious groups up to international legislation. I will begin by providing background on the process of CRISPER/cas9 which is the technology that makes genetic editing possible. Next it is important to discuss the current uses and potential uses of the technology as well as the legislative response. Currently the laws in place focus primarily on …

Implementing Auc Monitoring In A Pharmacist-Managed Vancomycin Dosing Protocol: A Retrospective Cohort Study, Brandon L S Robinson, Blake Bennie, Mahmoud Nasiri, Kieu Nguyen, Reba Forbess, Mallory Gessner-Wharton, Cassie Robertson

HCA Healthcare Journal of Medicine

Background

Consensus guidelines on the therapeutic drug monitoring of vancomycin published in 2020 recognize that using the calculated area-under-the-curve (AUC) to guide dosing maximizes clinical efficacy and minimizes risk when compared to traditional trough-based dosing. The purpose of this study was to determine whether AUC monitoring results in reduced acute kidney injury (AKI) rates in adult patients receiving vancomycin for all indications.

Methods

In this study, patients 18 years or older who received pharmacist-managed vancomycin therapy were selected using pharmacy surveillance software from 2 timeframes. Patients were excluded if they received less than 48 hours of therapy or had unstable …

Clinical Impact Of Oral Step-Down Therapy For Gram-Negative Bacteremia: A Retrospective Study, Nhi Nguyen, Ashitha Jayachandran, Minhhang Mui, Kelsey Olson

HCA Healthcare Journal of Medicine

Background

In recent years, there has been a growing body of evidence that supports oral step-down therapy for the treatment of gram-negative bacteremia. The purpose of this study was to compare outcomes for hospitalized patients who received intravenous-only (IV-only) therapy versus oral step-down therapy with low, moderate, and highly bioavailable antimicrobials for the treatment of gram-negative bacteremia.

Methods

In this retrospective, single-center, observational study, we examined data from adult patients hospitalized with gram-negative bacteremia in a 1-year period. Data analysis was performed using information collected from electronic medical records and a clinical surveillance system.

Results

A total of 199 patients …

Implementation Of Clinical Pharmacy Surveillance Technology And A Pharmacy Practice Model Re-Design Across A Multi-State Health System, Elizabeth H. Wiggins, Joan Kramer, L. Hayley Burgess, Carley Warren

HCA Healthcare Journal of Medicine

Background

Outcomes-directed pharmacy models are necessary to further comprehensive, patient-centric clinical care. This report describes the implementation of clinical surveillance technology and the development of clinical pharmacy metrics to measure outcomes that support return on investment. The overall goal of clinical surveillance technology implementation in this quality improvement project was to extend the pharmacists’ reach and to improve patient safety and clinical outcomes with greater operational efficiencies.

Methods

In 2013, a clinical pharmacy surveillance tool was piloted and expanded over the next 2 years to 154 hospitals across the health system. Over the next 6 years, the number of hospitals …

Best Practice Proposal To Enhance Application Of The Standardized Antimicrobial Administration Ratio (Saar), Jill Butterfield-Cowper

HCA Healthcare Journal of Medicine

A core element of hospital antibiotic stewardship programs is the tracking of outcomes. It is recommended that hospitals do this by reporting to the National Healthcare Safety Network (NHSN) Antimicrobial Use (AU) Option. With this, hospitals can access the Standardized Antimicrobial Administration Ratio (SAAR) for various antibiotic groupings and locations. While there are benefits to the SAAR, several limitations reduce the interpretation and utility of SAAR values. In particular, the SAAR cannot inform users of antimicrobial appropriateness. This article describes an antimicrobial days of therapy (DOT) report that was developed by a tele-stewardship infectious diseases pharmacist. This article proposes that …

Diversity, Equity, And Inclusion In The Profession Of Pharmacy: The Perspective Of Three Pharmacy Leaders, Aigner George, Keith Teelucksingh, Kara Fortune

HCA Healthcare Journal of Medicine

Diversity, equity, and inclusion (DEI) is a growing force within all industries, with healthcare being no exception. The 2020 sociopolitical landscape made DEI a priority for the majority of organizations. The structural element of DEI education in pharmacy is comprised of academia, professional organizations, and healthcare systems and companies. To address inequities that stand before students, professional pharmacy organizations must have a voice that sets an inclusive tone. This article provides background into DEI in the pharmacy profession and provides the unique perspectives of 3 pharmacy leaders.

Anthelmintic Resistance And The Use Of Diatomaceous Earth As An Alternative Anthelmintic In E. Caballus, Brandy Spoor

Honors Theses

No abstract provided.

A Rare Case Of Rapidly Progressive Cll/Sll Presenting As Bilateral Tonsillar Enlargement And Upper Airway Obstruction, William Mangin, Kashif Aslam

North Texas GME Research Forum 2023

Although chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) differ in clinical presentation, they are both arise from the same pathologic process, namely the clonal expansion of mature B-cells. This malignancy is usually quite indolent and carries a favorable prognosis. Thanks to a number of highly-effective oral targeted therapies, such as the Bruton tyrosine kinase (BTK) inhibitor, Ibrutinib, patient outcomes have improved significantly. Unfortunately, these therapies are not always well tolerated and many patients are forced to discontinue the medication due to side effects. Many patients experience a disease flair and some even transformation to a high-grade malignancy after …

Case Of Shiga-Toxin Producing E. Coli Dysentery In Adult Patient In The Absence Of Diarrhea, Diana Roy

North Texas GME Research Forum 2023

This is a unique case of a 38 year old Caucasian female with no significant medical history who presented to the hospital with complaint of 3 days of abdominal pain, nausea/vomiting, dark red formed stool, and fever (TMax 102F), as well as dizziness, body aches and throat pain. She reported eating meatloaf with her daughter two days before symptom onset, and daughter was reported to be ill as well. Upon initial exam, patient was found to have temp 100F, was hypotensive and tachycardic with lactate of 4.2. FOBT was positive. Significant lab values include creatinine 3.39 (baseline normal), hemoglobin of …

Independent Freestanding Emergency Centers: The Face Of An Alternative Model To Healthcare In Rural America, Alisha Patel

Belmont Health Law Journal

This Note will attempt to provide a background of rural healthcare disparities and the issues facing these regions. This Note will also explore the history of IFECs in the United States to better understand the context of the issues and reasons as to why emergency regulations such as EMTALA do not already extend to IFECs. Part 1 of this Note will examine the origin of IFECs and their role in the healthcare landscape today. Part II will discuss EMTALA and the challenges associated with IFECs during a public health emergency. Lastly, Part III of this Note will highlight the advantages …

A Case Of Erythema Nodosum, Mahmood Ahmad, Sunitha Valayil

North Texas GME Research Forum 2023

Background: Erythema nodosum (EN) is characterized as a delayed hypersensitivity reaction to subcutaneous adipose tissue. This panniculitis process presents as erythematous, tender nodules and plaques most commonly located on the pretibial areas. EN may be idiopathic or may be caused by a number of factors such as infection, chronic systemic inflammatory processes, drugs or malignancy.

Case presentation: A 29-year-old male with no significant past medical history presented with a 2-week history of worsening bilateral lower extremity erythema, nodules and pain. This patient was initially seen in the emergency department after a 4-day history of his symptoms. At this time, he …

Extraintestinal Salmonellosis Unmasked In A Parotid Mass, Kahmalia-Kalee Sada

North Texas GME Research Forum 2023

Salmonella infection can cause a wide range of presentations, predominantly gastrointestinal but occasionally with cardiovascular or other extraintestinal manifestations. The diagnosis of extraintestinal salmonellosis requires a high degree of clinical suspicion and should be considered in patients with deep-seated abscesses. [1]. Typically, these types of infections, are extremely rare, and when revealed are typically seen in the immunocompromised patient with chronic illness, HIV, or Hepatitis. While the incidence of nontyphoid salmonellosis is estimated at over 2 million cases annually, extraintestinal manifestations account for less than 1% of cases. Studies have revealed that individuals with diabetes have risk for salmonellosis due …

Ramsay Hunt Syndrome With Oral Findings: A Rare Case, İlknur Eninanç, Büşra Şahin

Journal of Dentistry Indonesia

Ramsay Hunt syndrome (RHS) is a disease that is caused by the varicella-zoster virus and is characterized by severe ear pain, auricular vesicular eruptions, and peripheral facial paralysis.

Objective: The aim of this case report is to provide information about the clinical findings and treatment process of RHS, which is a rare case and may have oral findings and stress the importance of early diagnosis.

Case Report: A 60-year-old male patient had previously consulted an otolaryngologist and a family physician with complaints of vesicular eruptions in the right ear auricle and on the mandible. The patient in whom a diagnosis …

Determination Of Individuals’ Attitudes Toward Covid-19 Vaccines And Health Fatalism: A Cross-Sectional Study From Turkey, Emre Erkal, Bedriye Cansu Demirkiran, Şerife Köleoğlu, Sevgi Demir Çam

Makara Journal of Health Research

Background: Vaccines have positive effects on the course of epidemics. This study was conducted to determine individuals’ attitudes toward coronavirus disease-2019 (COVID-19) vaccines, their health fatalism, and factors affecting these.

Methods: This cross-sectional study included 944 participants living in Turkey, who were included in the study by snowball sampling, one of the nonprobability random sampling methods. Participant information form, attitudes toward the COVID-19 vaccine scale, and religious health fatalism scale were used to collect the study data. Independent sample t-test, one-way analysis of variance and Pearson correlation analysis were used in the data analysis.

Results: Participants had …

2023 North Texas Division Research Forum Program, Hca Healthcare

North Texas GME Research Forum 2023

No abstract provided.

Early Diagnosis Of Purulent Pericarditis Secondary To Methicillin-Sensitive Staphylococcus Aureus In An End-Stage Renal Disease Patient, Stephen Shey, Alejandro Espinosa-Tello, Amnah Andrabi

North Texas GME Research Forum 2023

Introduction Purulent pericarditis is a rare illness in the modern age of medicine due to the increased usage of antibiotics. Unfortunately, diagnosis of this disease is often delayed due to its nonspecific symptoms. Without treatment, the mortality is nearly one hundred percent due to major complications such as cardiac tamponade and constrictive pericarditis. As a result, most cases of purulent pericarditis are discovered post-mortem. This case report details an early diagnosis of purulent pericarditis secondary to methicillin-sensitive Staphylococcus aureus (MSSA) in an end-stage renal disease (ESRD) patient. Case Presentation A 66-year-old female with past medical history of ESRD initially presented …

Improving Utilization Of Clinical Pharmacy Services In A Health Professional Shortage Area, Samantha E. Tallman

Masters Projects

Background: Integration of clinical pharmacy specialists (CPS) into primary care has increased over the last decade. CPS are highly educated advanced practice providers and specialize in chronic disease and medication management, and offer additional support to both patients and PCPs. Despite their extensive training and expertise, the role of CPS is often unknown or misunderstood amongst PCPs and results in the underutilization of CPS services. As a result, referrals to their service remain low. The purpose of this quality improvement project is to increase referrals to embedded CPS and identify encounter types by associated diagnoses.

Objectives: Develop and implement a …

Metagenomic Analysis Of Dna Viruses With Targeted Sequence Capture Of Canine Lobular Orbital Adenomas And Normal Conjunctiva, Elizabeth A F Schaefer, Shirley Chu, Kristine M Wylie, Todd N Wylie, Obi L Griffith, Jacqueline W Pearce, Gayle C Johnson, Jeffrey N Bryan, Brian K Flesner

2020-Current year OA Pubs

Our study aims are: (1) to evaluate phenotypically normal canine conjunctival and orbital tissue and tissue from canine lobular orbital adenomas (CLOAs) for the presence of viral genomic material and (2) phylogenetically classify detected DNA viruses to determine if a DNA virus is associated with CLOAs. A total of 31 formalin fixed paraffin embedded CLOA tissue samples, 4 papillomas or sarcoid, and 10 fresh clinically normal conjunctival tissues were included in this study. Genomic DNA was isolated from all samples and sequencing libraries were prepared. The libraries were molecularly indexed and pooled and viral DNA was enriched via targeted sequence …

Interbacterial Competition Amongst Lactobacilli Isolated From Human Urinary Tract, Kaylie Rose Jean Hintze

Honors Capstone Projects and Theses

No abstract provided.

Dnp Final Report: Translation Of Evidence-Based Practice: Developing Nurses' Ability To Recognize And Respond To Clinical Deterioration, Bryan Stephen Jordan

DNP Final Reports

Clinical deterioration is a serious physiologic disturbance or a sudden worsening patient condition increasing the risk of morbidity and mortality (Jones et al., 2013). Clinical deterioration compromises hemodynamic stability and produces marked physiological decompensation (Padilla & Mayo, 2017). Patients often exhibit physiological signs several hours or more before decompensation is readily apparent (Andersen et al., 2016; Khanna et al., 2019). The need for early recognition of clinical deterioration has been well-identified and documented (Ashbeck et al., 2021). Increasing time duration from the onset of clinical deterioration to intervention is associated with increased resuscitation and critical care requirements, the presence of …

The Comorbidity Of Depression And Neurocognitive Disorder In Persons With Hiv Infection: Call For Investigation And Treatment, Karl Goodkin, Teresa H. Evering, Albert M. Anderson, Ann Ragin, Cynthia L. Monaco, Christina Gavegnano, Ryan J. Avery, Sean B. Rourke, Lucette A. Cysique, Bruce J. Brew

School of Medicine Publications

Depression and neurocognitive disorder continue to be the major neuropsychiatric disorders affecting persons with HIV (PWH). The prevalence of major depressive disorder is two to fourfold higher among PWH than the general population (∼6.7%). Prevalence estimates of neurocognitive disorder among PWH range from 25 to over 47% – depending upon the definition used (which is currently evolving), the size of the test battery employed, and the demographic and HIV disease characteristics of the participants included, such as age range and sex distribution. Both major depressive disorder and neurocognitive disorder also result in substantial morbidity and premature mortality. However, though anticipated …

Vaccine Coverage And Factors Associated With Vaccine Adherence In Persons With Hiv At An Urban Infectious Disease Clinic, Navina K. Birk, Lea Monday, Tarandeep Singh, Medha R. Cherabuddi, Marwa Hojeij, Brandon Ho, Anne Chen, Indira Brar, George Alangaden

Infectious Diseases Articles

Information on vaccination rates and factors associated with adherence in persons with HIV (PWH) is limited. We report vaccine adherence in 653 adult PWH attending an urban Infectious Disease Clinic from January 2015 to December 2021. Vaccines evaluated included influenza, pneumococcal, tetanus, hepatitis A virus (HAV) and hepatitis B virus (HBV), human papillomavirus (HPV), and zoster vaccines. Vaccine reminders were triggered at every visit, and all vaccines were accessible in the clinic. The mean age was 50 y (±SD 13), male gender was 78.6%, and black race was 74.3%. The overall adherence to all recommended vaccines was 63.6%. Vaccine adherence …

Factors Associated With Handwashing Behaviors During The Covid-19 Pandemic: An Analysis Of The Community Health Survey In Korea, Soojung Jo, Soo-Yeon Han, Nancy Howe

School of Nursing Faculty Publications

Introduction: Handwashing is the most effective preventive behavior for coronavirus disease-19 (COVID-19) infection. However, research has shown the lower handwashing behaviors among Korean adults. Objectives: This study aims to analyze factors associated with handwashing as a preventive behavior for COVID-19 infection based on the health belief model (HBM) and the theory of planned behavior (TPB) behavioral theories. Methods: This secondary data analysis utilized the Community Health Survey developed by Disease Control and Prevention Agency conducted in 2020. Sampling method was stratified and targeted 900 people living in the territory of each community public health center. In total, 228,344 cases were …

Analysis Of Wild Rodent Gut Microbiota As A Function Of Exposure To Ticks And Tick-Borne Pathogens, Joshua Pandian

Honors Theses

Due to advances in high-throughput parallel sequencing, researchers have conducted novel studies exploring relationships between microbiome compositions and different aspects of organism health. Some of these studies have shown that the gut microbiome of rodent models has effects on organism health and behavior and that infection with pathogens and the composition of the skin microbiome are linked to changes in gut microbiome composition. While previous studies have shown how vector microbiota impact vector behavior and pathogen transmission, the effect vectors have on reservoir species microbiomes has been a less prominent focus. We were interested in the relationships between tick parasitism, …

The Current State Of Prenatal Detection Of Genetic Conditions In Congenital Heart Defects, Areebah S Ahmad, Kathleen M Mulligan, David X Zheng, Katie A O'Connell, Benjamin Gallo Marin, Misha V Koshelev

Faculty, Staff and Student Publications

Interest in subspecialty training remains high for dermatology residency graduates. Fellowship program directors (FPDs) are largely responsible for fellowship organization and development. Here, we study the dermatology fellowship leadership landscape and identify notable differences in the characteristics of current dermatopathology, paediatric dermatology, and Mohs micrographic surgery and dermatologic oncology FPDs.

Editor's Note, Anucha Apisarnthanarak

Asian Medical Journal and Alternative Medicine

No abstract provided.

Molnupiravir Metabolite--N4 -Hydroxycytidine Causes Cytotoxicity And Dna Damage In Mammalian Cells In Vitro, Pholasit Chamod, Sutheera Sangsiri, Krittin Tangjittham, Pattranit Liu, Pakapon Mongkhonsakunrit, Jessada Pakotiprapha, Tanaboon Rimdusit, Onmanee Prajuabjinda, Saovapak Poomirat

Asian Medical Journal and Alternative Medicine

N⁴-hydroxycytidine (NHC) is the active metabolite of molnupiravir—a new drug for COVID-19 treatment. NHC exerts antiviral activity by incorporating into SAR-CoV-2 RNA leading to false base-paring and lethal mutations to the virus. However, the risk of non-specific mutagenesis to host cells has been a concerned. The goal of this study is to detect cytotoxic activity and DNA damage induced by NHC in rapid-growing cells including human keratinocyte (HaCaT), and human adenocarcinomic alveolar basal epithelial (A549) cells in vitro by using sulforhodamine B (SRB) colorimetric and comet assays. NHC induced cytotoxicity in a concentration-dependent manner (0.1-30µM) in HaCaT and …

Oral Care, Juliette Canzona

Academic Festival

Oral care is a fundamental intervention led by nurses which provides patient comfort and prevents adverse outcomes in critically ill patient’s. Evidence shows that the neglect of oral care places a patient at a higher risk for HAI’s, mortality, longer hospital stays, increased duration of mechanical ventilation and increased cost in their care (Lombardo, 2022). Many barriers to implementing frequently performed oral care have been established through research and studies. These barriers include time restraints due to understaffing and high workloads, competing clinical priorities, lack of knowledge, unaware of guidelines/protocol, and nurse’s own biases/ perception of oral care. The goal …

Effects Of Oral Care, Juliette Canzona

Academic Festival

Oral care is a fundamental intervention led by nurses which provides patient comfort and prevents adverse outcomes in critically ill patient’s. Evidence shows that the neglect of oral care places a patient at a higher risk for HAI’s, mortality, longer hospital stays, increased duration of mechanical ventilation and increased cost in their care (Lombardo, 2022). Many barriers to implementing frequently performed oral care have been established through research and studies. These barriers include time restraints due to understaffing and high workloads, competing clinical priorities, lack of knowledge, unaware of guidelines/protocol, and nurse’s own biases/ perception of oral care. The goal …

Epidemiology Through The Lens Of Differential Equations, Cameron Connelly

Academic Festival

The spread of a disease can be modelled through systems of differential equations, specifically, epidemiological models. Given the properties of differential equations, we are able to find the equilibria of these systems and perform an analysis using Jacobian matrices to determine how disease transmission will behave. In this paper, we will examine a few epidemiological models. They vary because of inherent differences in how certain pathogens affect the human body.