Digital Commons Network^™

Situations Predisposing Primary Care Patients To Use Antibiotics Without A Prescription In The United States, Lindsey A Laytner, Barbara W Trautner, Susan Nash, Fabrizia Faustinella, Roger Zoorob, Kiara Olmeda, Michael K Paasche-Orlow, Larissa Grigoryan

Faculty, Staff and Students Publications

BACKGROUND: Patients' situations can impact their intentions to use antibiotics without medical guidance (non-prescription use) in the future. This survey determines the prevalence of intended (future) use of non-prescription antibiotics for 13 predefined situations and identifies the sociodemographic characteristics associated with intended use for these types of situations.

METHODS: Patient surveys (N = 564) were conducted from January 2020 to June 2021 in the waiting rooms of 6 safety-net primary care clinics and 2 emergency departments in a private healthcare system. We used principal component analysis to identify 3 situational summary factors: barriers to a doctor visit, accessibility of non-prescription …

Twelve Tips For Using The Understanding By Design® Curriculum Planning Framework, Alana D Newell, Cara A Foldes, Alison J Haddock, Nadia Ismail, Nancy P Moreno

Faculty, Staff and Students Publications

BACKGROUND: Health professions faculty engaged in curriculum planning or redesign can struggle with developing courses or programs that align desired learner outcomes, such as competencies to be applied in a clinical setting, with assessment and instruction.

AIMS: Our medical school implemented the Understanding by Design (UbD) framework to achieve alignment of outcomes, assessments and teaching during the renewal of our four-year curriculum. This article shares our strategies and practices for implementing UbD with teams of faculty curriculum developers.

DESCRIPTION: The UbD framework is a 'backward' approach to curriculum development that begins by identifying learner outcomes, followed by the development of …

Integrating Behavioral Health Into Family Medicine: Improving Access To Specialty Care Using A Collaborative Care Model, Christina Stephens

DNP Scholarly Projects

Primary care, an extensive of family medicine remains a key access point for patients entering the healthcare system. Accessing medical care and specialty psychiatric services is limited in rural communities. Patients often find exhaustive wait times, untimely referrals, and reliance on emergency services for crisis management. The primary care provider is able to help their community improve access to behavioral health care by using a collaborative approach. This quality improvement initiative used the framework produced by the AIMS Center at the University of Washington and adopted for use creating an 8-week intensive program in a family medical practice located in …

Empowering Nurse Leaders To Achieve Harmony: Fostering Work-Life Balance, Gilberto Gamba

DNP Scholarly Projects

BACKGROUND: Balancing professional and personal life demands has become a focal point in today’s healthcare organizational culture. Despite the technological advances in providing better and faster healthcare, team members often struggle to achieve work-life harmony while meeting the demands of a growing population of healthcare clients. The evidence highlights nurse leaders as one group for which the identification and implementation of work-life balance interventions is crucial.

METHODS: An original tool based on available evidence was developed and used with a group of nurse leaders participating in an educational activity to engage them in behaviors supporting work-life harmony. A post-educational survey …

The Multidisciplinary Approach To The Development Of Quality Clinical Practice Guidelines: Piloting Management Of The Patient Requiring Inhaled Nitric Oxide For Acute Pulmonary Hypertension In The Neonatal Intensive Care Unit, Amanda Koennecke

DNP Scholarly Projects

BACKGROUND: Clinical practice guidelines communicate recommendations to health care professionals. Poor quality guidelines decrease compliance, foster differences in practice, discordance with resources, and compound inequity in healthcare. The goal of this project was to develop a clinical practice guideline and chronicle the process. The intervention implemented was the creation of a clinical practice guideline with a family integrated and equity endorsing approach.

METHODS: A multidisciplinary team was formed and worked collaboratively to write a clinical practice guideline for inhaled nitric oxide for the management of acute pulmonary hypertension in neonates. The guideline was evaluated using the AGREE II instrument and …

Integrating Behavioral Health Into Family Medicine: Improving Access To Specialty Care For Medically Underserved Community Using A Collaborative Care Model, Christina M. Stephens

DNP Scholarly Projects

Primary care, an extension of family medicine remains a key access point for patients entering the healthcare system. Accessing specialty psychiatric services can be limited in rural communities due to provider shortages and geographical constraints. Primary care providers can facilitate improved access to behavioral health services by introducing a collaborative approach to the traditional medical model. This quality improvement initiative adopted the collaborative care model originally produced by the University of Washington to treat common mental health conditions in the medical setting (2023). A team consisting of a primary care provider, behavioral health case manager and psychiatric consultant served nine …

Implementation Of Advanced Airway Management Course: A Pilot Quality Improvement Project For Improved Emergency Outcomes For Operating Room And Pacu Nurses, Elizabeth Patry

DNP Scholarly Projects

Background: Airway management has always been central to critical care; it is a complex skill to learn and necessary for patient survival. To properly care for a patient’s airway, the provider must fully understand airway anatomy including upper and lower anatomy and how they work together to allow for oxygen transportation (Day, 2022). Unfortunately, many nursing school curriculums and department orientations are not able to provide the level of education and training necessary. Due to an extreme nursing shortage, many hospitals are not able to provide in depth orientations upon hire and annual review, this lack of professional support affects …

Reducing Wait Times In The Medical Clinic Of The Homeless Intake Center: A Quality Improvement Project, Otuodichinma Christy Nwankpa, Otuodichinma Christy Nwankpa

DNP Scholarly Projects

Background: Homelessness in the U.S. is a critical issue, with New York City experiencing significant challenges due to an increasing number of families requiring shelter. The Department of Homeless Services (DHS-NYC) faces operational inefficiencies, particularly in the medical clinic at the intake center, leading to prolonged wait times.

Local Problem: Families with children experience long wait times in the DHS-NYC medical clinic, which impacts their overall health and well-being. Reducing these wait times is essential for improving service delivery and families satisfaction.

Purpose:

This quality improvement project aims to reduce wait times for families with children at the medical clinic …

Reducing Burnout And Enhancing Resilience Of Psychiatric Nurses Through Self-Care Practices., Bosede Akilo

DNP Scholarly Projects

ABSTRACT

Background: Burnout is a pervasive issue among healthcare workers, particularly mental health nurses (MHNs), leading to emotional exhaustion, depersonalization, and decreased job satisfaction. Burnout is responsible for a high turnover in MHNs, low motivation, and medical errors which is the third leading cause of death, due to the stressors within the work environment. Mental health settings are marked with huge emotional challenges that lead to the characteristic burnout presentations exhibited by the staff. The local problem being addressed is that MHNs face significant stressors, including high workloads, aggressive patient interactions, and lack of support, which contribute to burnout. The …

The Impact Of Multidisciplinary Just-In-Time Training On Confidence In The Delivery Of Care In The Humanitarian And Disaster Response Environment, Jennifer Verstreken

DNP Scholarly Projects

Background: Team Rubicon International deploys emergency medical teams with little targeted training on the health and illness patterns common to the geographic region and the type of disasters to which they respond, such as cholera, malaria, and malnutrition. These high-risk, low-incidence illnesses are infrequently seen in Western medical practices. Medical, nursing, and paramedical training programs address these illness patterns in the curriculum. Still, a lack of consistent exposure to the care and treatment of patients with these illnesses can lead to a lack of knowledge and confidence in delivering appropriate care.

Purpose: This quality improvement project aimed to determine if …

Assessing Barriers And Facilitators To School Nurse Recommendations Of Human Papillomavirus Vaccination, Amy E. Dark

DNP Scholarly Projects

Background Vaccine hesitancy among students and caregivers is a pervasive challenge for educational leadership and school health staff, leaving the school community at risk for vaccine preventable disease. The human papillomavirus (HPV) vaccine is an underutilized primary prevention strategy against six HPV related cancers.

Purpose The purpose of this quality improvement (QI) project was to measure the effect of an evidence-based educational intervention and facilitated role play on the knowledge and confidence of school nurses (SNs) when discussing HPV vaccination.

Methods This QI project was performed using a brief educational presentation with facilitated role play and a pre/post survey design. …

Enhanced Neuroprotection And Neuropromotion In Extremely Premature Infants Through Mindful Hands-On Care And Increased Family Involvement, Kristen Sergott

DNP Scholarly Projects

Background: Medical breakthroughs including antenatal corticosteroids and exogenous surfactants have improved survival in extremely premature and extremely low birth weight (EP-ELBW) infants. Currently, babies as young as 22 weeks’ gestation are being actively resuscitated and provided with intensive care in neonatal intensive care units (NICUs) around the world. As a consequence of premature delivery, fragile and immature newborns are at risk for significant morbidities affecting their multiple organ systems. Additionally, such infants encounter neurodevelopmental trauma induced by recurrent stressful experiences ubiquitous to the NICU. Postnatal stress contributes to alterations in the hypothalamic-pituitary-adrenal (HPA) axis and is associated with alterations in …

Β2-Glycoprotein I Promotes The Clearance Of Circulating Mitochondria, Swapan Kumar Dasgupta, Jahnavi Gollamudi, Stefanie Rivera, Ross A Poche, Rolando E Rumbaut, Perumal Thiagarajan

Faculty, Staff and Students Publications

β2-glycoprotein I (β2-Gp1) is a cardiolipin-binding plasma glycoprotein. It is evolutionarily conserved from invertebrates, and cardiolipin-bound β2-Gp1 is a major target of antiphospholipid antibodies seen in autoimmune disorders. Cardiolipin is almost exclusively present in mitochondria, and mitochondria are present in circulating blood. We show that β2-Gp1 binds to cell-free mitochondria (CFM) in the circulation and promotes its phagocytosis by macrophages at physiological plasma concentrations. Exogenous CFM had a short circulation time of less than 10 minutes in mice. Following infusion of CFM, β2-Gp1-deficient mice had significantly higher levels of transfused mitochondria at 5 minutes (9.9 ± 6.4 pg/ml versus 4.0 …

Toward A Sustainable Attitude: Aeathetics, The Arts, And The Environment, Roberta Dreon, Diego Mantoan

Contemporary Aesthetics (Journal Archive)

Preface to the Special Issue 2024 of Contemporary Aesthetics.

An Interactive, Case-Based Workshop On The Patient Experience For Internal Medicine Residents, Julian Swanson, Doris Lin, Kristen A Staggers, Priti Dangayach

Faculty, Staff and Students Publications

INTRODUCTION: The technological revolution has narrowed the information gap between physician and patient. This has led to an evolution in medicine from paternalistic to patient-centric, with health care systems now prioritizing patient experience to achieve higher satisfaction scores. Therefore, it is imperative to start early in educating trainees on how to best address the holistic needs of the patient while also delivering high-quality care.

METHODS: We implemented a 1-hour workshop that was repeated weekly over 8 weeks to capture all internal medicine residents in our program. During the workshop, we reviewed the historical evolution of patient care from paternalistic to …

Shared Decision-Making During Virtual Care Regarding Rheumatologic And Chronic Conditions: Qualitative Study Of Benefits, Pitfalls, And Optimization, Lisa Zickuhr, Catherine Mccarthy, Emma Nolan-Thomas, Tiffany Westrich-Robertson, Elizabeth A Baker, Janice L Hanson

2020-Current year OA Pubs

OBJECTIVE: Virtual care (VC) is an accepted modality of care delivery, and shared decision-making (SDM) benefits patients with rheumatologic and chronic conditions (RCCs). Unfortunately, research suggests reduced quality of SDM during VC. This study explores the benefits and shortcomings of SDM regarding RCCs during VC with suggestions for optimally using VC during SDM.

METHODS: Following Stiggelbout's framework for SDM, we conducted focus groups of patients with RCCs and providers to understand their experiences with SDM during VC, probing for facilitating and challenging factors. We conducted content analysis of the transcripts, defining themes, and inductively reasoned to identify relationships among themes. …

Cardiac Tamponade Secondary To Esophagopericardial Fistula, Caitlin T Perez-Stable, Lauren T Callaghan, Christopher K Wong, Jorge M Escobar, Mahboob Alam

Faculty, Staff and Students Publications

Esophagopericardial fistulas are an extremely rare structural defect that may arise from malignant or iatrogenic etiologies. This article reports the case of a patient with cardiac tamponade secondary to hydropneumopericardium from esophagopericardial fistula. Given the high morbidity and mortality of this condition, this article describes challenges in diagnosis and clinical decision-making to improve early identification and interdisciplinary management.

Perspectives From Public Health Practitioners And Advocates On Community Development For Active Living: What Are The Lasting Impacts?, Natalicio Serrano, Laurel Schmidt, Amy A Eyler, Ross C Brownson

2020-Current year OA Pubs

PURPOSE: Evidence suggests differential impacts of community development, including gentrification and displacement. Public health practitioners and advocates are key stakeholders involved in the community development process related to active living, yet little is known about their perceptions of its impacts. We explored the perspectives of relevant leaders of public health departments and key community and advocacy organizations on community development, gentrification, and displacement.

APPROACH: Purposive key informant interviews.

SETTING: CDC State Physical Activity and Nutrition (SPAN) funding recipients.

PARTICIPANTS: CDC SPAN recipient leadership (n = 10 of 16) and advocacy organizations they partnered with (n = 7 of 16).

METHOD: …

A Prdm16-Driven Signal Regulates Body Composition In Testosterone-Treated Hypogonadal Men, Siresha Bathina, Georgia Colleluori, Dennis T Villareal, Lina Aguirre, Rui Chen, Reina Armamento-Villareal

Faculty, Staff and Students Publications

BACKGROUND: Testosterone (T) therapy increases lean mass and reduces total body and truncal fat mass in hypogonadal men. However, the underlying molecular mechanisms for the reciprocal changes in fat and lean mass in humans are not entirely clear.

METHODS: Secondary analysis of specimens obtained from a single-arm, open-label clinical trial on pharmacogenetics of response to T therapy in men with late-onset hypogonadism, conducted between 2011 and 2016 involving 105 men (40-74 years old), who were given intramuscular T cypionate 200 mg every 2 weeks for 18 months. Subcutaneous fat (SCF), peripheral blood mononuclear cells (PBMC) and serum were obtained from …

Steroid Receptor Coactivators In Treg And Th17 Cell Biology And Function, Yosi Gilad, Ortal Shimon, Sang Jun Han, David M Lonard, Bert W O'Malley

Faculty, Staff and Students Publications

Steroid receptor coactivators (SRCs) are master regulators of transcription that play key roles in human physiology and pathology. SRCs are particularly important for the regulation of the immune system with major roles in lymphocyte fate determination and function, macrophage activity, regulation of nuclear factor κB (NF-κB) transcriptional activity and other immune system biology. The three members of the p160 SRC family comprise a network of immune-regulatory proteins that can function independently or act in synergy with each other, and compensate for - or moderate - the activity of other SRCs. Recent evidence indicates that the SRCs are key participants in …

Development, Implementation, And Evaluation Of Three Outreach Events To Improve Covid-19 Vaccine Uptake Among Racial And Ethnic Minority Communities In Houston, Texas, 2022, Carmin Munoz-Lavanderos, Abiodun Oluyomi, Omar Rosales, Norvin Hernandez, Nana Mensah-Bonsu, Hoda Badr

Faculty, Staff and Students Publications

OBJECTIVES: Lack of access to timely, accurate, and linguistically appropriate COVID-19 information has complicated the dissemination of evidence-based information and contributed to vaccine hesitancy among racial and ethnic minority groups in the United States. We developed community events that provided outreach, education, and access to COVID-19 vaccination to overcome vaccine hesitancy in these communities.

METHODS: Using spatial analysis techniques, we identified 3 communities with low vaccine uptake in Houston, Texas, in fall 2021; engaged 20 stakeholders from these communities via 4 focus groups to understand barriers to vaccination; and developed and implemented 3 COVID-19 vaccine education and outreach events tailored …

The Next-Generation Dna Vaccine Platforms And Delivery Systems: Advances, Challenges And Prospects, Bowen Lu, Jing Ming Lim, Boyue Yu, Siyuan Song, Praveen Neeli, Navid Sobhani, Pavithra K, Srinivasa Reddy Bonam, Rajendra Kurapati, Junnian Zheng, Dafei Chai

Faculty, Staff and Students Publications

Vaccines have proven effective in the treatment and prevention of numerous diseases. However, traditional attenuated and inactivated vaccines suffer from certain drawbacks such as complex preparation, limited efficacy, potential risks and others. These limitations restrict their widespread use, especially in the face of an increasingly diverse range of diseases. With the ongoing advancements in genetic engineering vaccines, DNA vaccines have emerged as a highly promising approach in the treatment of both genetic diseases and acquired diseases. While several DNA vaccines have demonstrated substantial success in animal models of diseases, certain challenges need to be addressed before application in human subjects. …

Proton Pump Inhibitors: Rational Use And Use-Reduction - The Windsor Workshop, Peter Kahrilas, Foteini Anastasiou, Albert J Bredenoord, Hashem B El Serag, Joachim Labenz, Juan Mendive, Edoardo V Savarino, Daniel Sifrim, Mihaela Udrescu, Rena Yadlapati, A Pali Hungin

Faculty, Staff and Students Publications

BACKGROUND: Despite deprescribing initiatives to curb overutilization of proton pump inhibitors (PPIs), achieving meaningful reductions in PPI use is proving a challenge.

SUMMARY: An international group of primary care doctors and gastroenterologists examined the literature surrounding PPI use and use-reduction to clarify: (i) what constitutes rational PPI prescribing; (ii) when and in whom PPI use-reduction should be attempted; and (iii) what strategies to use when attempting PPI use-reduction.

KEY MESSAGES: Before starting a PPI for reflux-like symptoms, patients should be educated on potential causes and alternative approaches including dietary and lifestyle modification, weight loss, and relaxation strategies. When commencing a …

Gsk-3Β As A Potential Coordinator Of Anabolic And Catabolic Pathways In Hepatitis C Virus Insulin Resistance, Gokul C Das, F Blaine Hollinger

Faculty, Staff and Students Publications

INTRODUCTION: Chronic hepatitis C infection can result in insulin resistance (IR). We have previously shown that it occurs through the interaction of pathways for glucose homeostasis, insulin signaling, and autophagy. But it is not known how soon the pathways are activated and how IR is related to the signals generated by catabolic and anabolic conditions occurring in infected cells. We have extended our studies to a cell culture system mimicking acute infection and to downstream pathways involving energy-sensor AMPK and nutrient-sensor mTOR that are active in catabolic and anabolic processes within the infected cells.

METHODS: Huh7 liver cells in culture …

Review Of The Myth Of Middle East Exceptionalism: Unfinished Social Movements Movements, Shahrzad Khosrowpour

Library Articles and Research

A review of The Myth of Middle East exceptionalism: Unfinished Social Movements by Mojtaba Mahdavi.

Natural Laboratories Of The Deep Sea: Linking Community Composition And Environmental Variables On Low-Temperature Venting Outcrops Of Ridge Flank Hydrothermal Systems To Explore Potential Impacts Of Climate Change, Inform Habitat Suitability Models, And To Understand The Impacts Of High Bathymetric Resolution On Seafloor Characterization, Anne Marie Hartwell

Doctoral Dissertations

The deep sea covers over two-thirds of the globe and represents 95% of the ocean. Most life on Earth is suspected to live on or near the seabed. Yet, these ecosystems are the least known on Earth and are important to explore as they are home to a diverse array of species that are currently under threat because of multiple anthropogenic pressures, including warming oceans. Exploration of these systems is critical to further the understanding of species interactions, biodiversity and their overall relationship to environmental and terrain variables. Many of these variables are used in species distribution models and technological …

Multi-Jurisdictional Hazard Mitigation Plan For Landslides For The Big Sandy Area Development District, Kentucky, Matt M. Crawford, Hudson J. Koch, Jason M. Dortch

Contract Reports--KGS

Landslides are a complex geologic hazard that occurs worldwide, impacting lives, infrastructure, and property. The Big Sandy Area Development District, Kentucky incurs high landslide activity impacting several municipalities. This hazard mitigation planning project includes landslide susceptibility and risk assessments for the Big Sandy Area Development District. We based the landslide susceptibility model on statistics of hillslope morphological features such as slope, curvature, roughness, aspect, and elevation. Using a dual machine learning approach, we modeled the probability of landslide occurrence, defined as an area that is occupied, or might be occupied in the future, by a landslide. We also developed the …

Racial And Ethnic Disparities In Hospital Practices That Support Breastfeeding In The United States, Jane Lazar Tucker

Open Access Dissertations

Breastfeeding is the optimal form of infant nutrition and has many health benefits for mothers as well as infants (CDC, 2022a; Victora et al., 2016). Though rates of breastfeeding have improved in recent years, disparities in breastfeeding persist among Black and Hispanic women compared to White women (Beauregard et al., 2019; Chiang et al., 2021), despite similar intentions to breastfeed across all racial/ethnic groups (Hamner et al., 2021). Hospital practices that support breastfeeding, such as the baby being placed skin-to-skin immediately after delivery or staying in the room with the mother throughout the hospital stay, are known to predict breastfeeding …

The Impact Of Multi-Tier Supply Chain Complexity And Network Centrality On Buying Firms’ Performance, Li Liu

Open Access Dissertations

Firms establish business relationships and exchange products and services in multi-tier supply chains. Lower-tier suppliers provide parts, components, and services to buying firms through tier-1 suppliers in the multi-tier supply network. The complexity and network characteristics of those lower-tier suppliers could impact buying firm’ performance. These firms are more likely to be driven by the supply-side economics to pursue innovativeness and support in the information and communication technology (ICT) industry, due to the shift from physical processes to information and resource-based integration across the entire supply chains. Despite the potential, it is challenging for buying firms to identify and manage …

Translanguaging Through Experiencing: The Lived Experiences Of Multilingual Learners Studying Chinese, Jiangping Cai

Open Access Dissertations

Although the United States has a population with diverse linguistic and cultural backgrounds, multilingual education has been greatly influenced by monolingual and raciolinguistic ideologies (Flores & Rosa, 2019; García, 2014; Ruiz, 1984). With world language enrollment continuing to decline (Lusin et al., 2023), investigation of the lived experiences of diverse groups of multilingual learners (MLLs) would help to understand language learning from a sociocultural perspective, and better support multilingual education and planning. The purpose of this qualitative study was to explore the Chinese learning experiences of native English multilingual students studying Chinese at a U.S. public university language program. The …