Medicine and Health Sciences Commons^™

The Correlation Between Traumatic Brain Injury And Incarceration Among Adult Males In The United States, Shadi Shams

Rowan-Virtua Research Day

The United States has one of the largest growing prison populations in the world. A large amount of social and economic resources go towards the cost and maintenance of correctional facilities each year. Additionally, the current correctional programs are insufficient in assisting inmates with getting back to society; especially those with traumatic brain injury (TBI) who often remain undiagnosed and are usually treated unfairly in the prison system instead of receiving the appropriate help. Prior scholarly work has shown that patients in the post-TBI stage are more likely to enter the judicial system. In the recent population-based cohort study, the …

The Effect Of Socioeconomic Status On Primary Care Access And Cancer Screening Rates, Seth Spicer, Liam Courtney, Alyssa Laguerta, Abdul Sanni-Adam, Bharathi Balaji

Rowan-Virtua Research Day

Background: Low cancer screening rates among specific demographics are major health issues that lead to disparities in health outcomes. Early cancer detection is crucial for cure; however, it is not well known how age, race, gender, primary care access, and socio-economic status affect cancer screening rates. This review discusses the importance of cancer screening and the factors that affect screening rates.

Purpose: The purpose of this paper is to investigate how access to primary care affects cancer screening rates, with consideration to age, race, socioeconomic status, and primary care access in order to improve screening rates in underserved populations.

Methods: …

Brief Review: Iv Fluid Choice In The Emergency Department, Kaywan Saed, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Normal saline and balanced crystalloids, such as lactated Ringer's (LR) and Plasma-Lyte A, are commonly used in the emergency setting for fluid resuscitation. However, there has been growing interest in recent years in whether balanced crystalloids may be superior to normal saline, particularly in critically ill patients.

Normal saline has been the traditional fluid of choice for decades due to its widespread availability, low cost, and presumed safety. However, normal saline has a high chloride concentration (154 mmol/L), which can lead to hyperchloremic metabolic acidosis and other adverse effects, such as renal vasoconstriction and reduced renal blood flow.

In contrast, …

Case Report: The Challenge Of Balancing Stewardship And Advocacy, Samuel Thalathoti, Kishan Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 62-year-old female who presented with chief complaint of generalized weakness and was ultimately diagnosed with hypereosinophilia. This chief complaint is challenging for many EM physicians, and the differential diagnosis of generalized weakness is vast. Etiologies of generalized weakness in the adult population ranges from infection, dehydration, cardiovascular disease, to neurologic compromise. It is crucial for the Emergency Physician to put emphasis on proper history collection, detailed physical exam, and appropriate ancillary testing. In this case report we showcase the significance of the optimal evaluation of life-threatening disorders that presents as generalized weakness, as well …

Case Study Of Horner Syndrome Due To Internal Carotid Artery Dissection, Kajel Patel

Rowan-Virtua Research Day

Carotid artery dissection can occur either spontaneously or because of trauma. It is usually the most common cause of stroke in middle-aged patients. The symptoms can be transient or persistent and typically occur a few days after the inciting traumatic event.

A 5-Year Clinical Course Of Phenocopy Syndrome Of Behavioral Variant Frontotemporal Dementia: Case Report And Literature Review, Joseph Melillo, Keyur Patel, Christian White

Rowan-Virtua Research Day

Frontotemporal dementia is a neurocognitive disease which affects language, behavior, or executive functioning. This disease includes a spectrum of presentations which includes multiple variants. The phenocopy syndrome of behavioral variant frontotemporal dementia is one which mimics the behavioral variant of frontotemporal dementia. Patients with this condition show a decline in personality, social conduct and cognitive ability but often display no signs of neurological imaging and exhibit slow progression. This case focuses on a now 70-year-old male who has shown signs of behavioral changes with a slowly progressive clinical course and minimal findings on PET scan, but moderate changes seen on …

A Realistic Path Towards A More Affordable Healthcare System For The United States, James Loome

Honors Theses

This study was performed in order to try to discover ways in which the American healthcare system can improve and become more affordable for its citizens. The main focus was to see how implementing a universal healthcare system could benefit the United States. I analyzed aspects of many different universal healthcare system structures and chose aspects that I think should or should not be included in a revised version of the US healthcare system. There was a strong focus on the aspects of Japan and Costa Rica’s healthcare systems. I also pointed out weaknesses in the US healthcare system that …

05-09-2023 Hsc Committee Agenda, Hsc Committee

HSC Committee (A subcommittee of the UNM Board of Regents)

No abstract provided.

Combining Frameworks To Improve Military Health System Quality And Cybersecurity, Dr. Maureen L. Schafer, Dr. Joseph H. Schafer

Military Cyber Affairs

Existing conceptual frameworks and commercially available technology could be considered to rapidly operationalize the use of Quality Measures (QM) within military health systems (Costantino et al. 2020). Purchased healthcare as well as digital healthcare services have paved the way for data collection from multiple information systems thus offering stakeholders actionable intelligence to both guide and measure healthcare outcomes. However, the collection of data secondary to Smart Devices, disparate information systems, cloud services, and the Internet of Medical Things (IOMT) is a complication for security experts that also affect clients, stakeholders, organizations, and businesses delivering patient care. We have combined three …

Medicare Shared Savings Performance: Three-Year Pandemic Analysis, Bryan Adams

Theses & Dissertations

The Centers for Medicare and Medicaid's (CMS) Office of Actuary predicts that U.S. national health expenditures will surpass U.S. gross domestic product per capita by 1.1% annually until 2028, totaling $6.2 trillion in healthcare spending. A significant portion of this spending, 36%, is attributed to Medicare and Medicaid. To address this issue, CMS has implemented the Medicare Shared Savings Program (MSSP) to assist Accountable Care Organizations (ACOs) in reducing healthcare costs and improving the quality of care for beneficiaries. The main objectives of this dissertation are twofold. Firstly, it aims to investigate the relationship between various factors, such as quality …

Lesbian, Gay, Bisexual, Transgender, Queer (Lgbtqia+) Health Disparities In Sexual Health And Sexual Education, Cole T. Mcbride

Curriculum and Instruction Undergraduate Honors Theses

Background: Comprehensive sex education instills knowledge and promotes the health of all youth, however, most sex education remains heteronormative. School-based programs in the United States (US) emphasize monogamous, heterosexual relationships. In 2021, only 7.4% of students received sex education that included positive representations of both LGB and transgender people and nonbinary topics, while 72% of programs across the US omit LGBTQ+ topics. Most new HIV diagnoses occur in gay and bisexual men aged 13-34, but the sex education environment for this group is increasingly hostile as more states prohibit addressing these topics in public schools.

Purpose: The purpose …

Cms Emergency Preparedness Rule: Examining The Relationship Between Nursing Home Facility Characteristics And Regulatory Deficiencies, Tihara Richardson Sommers

School of Public Service Theses & Dissertations

The effects of Hurricane Katrina and other natural disasters have increased the focus on nursing homes, particularly nursing home emergency preparedness. Nursing home administrators and direct care employees have described the challenges faced when responding to an emergency event. Due to numerous emergency preparedness insufficiencies, requirements were implemented to protect the vulnerable population of older adults who reside in nursing homes. In 2016, the Centers for Medicare & Medicaid (CMS) added specific emergency preparedness requirements to the existing fire safety requirements for regulated nursing homes. These deficiency evaluations are the only routinely collected source of information detailing compliance with the …

Medication Errors In Pediatric Care And Preventative Solutions, Tyler Tidwell

Political Science Undergraduate Honors Theses

The research presented extensively examines previous reports covering pediatric medication errors (PMEs). Utilizing specific studies into the frequency and types of medication errors along with public surveys and policy discussion, the data and suggestions here provide commentary on the scope of PMEs, suggested institutional reform, and most importantly, legislative recommended action necessary to stymie the tide of PMEs. A significant portion of the research contained fixates on the literature review to provide ample familiarity with the background and scope of PMEs, but the subsequent sections will discuss their implication. After providing details on the magnitude of the issue, regulatory and …

Naloxone Education To Improve Distribution In Primary Care: A Quality Improvement Project, Joanna Boback

DNP Projects

Significance and Background: Opioid overdose is a major public health problem in the United States. The Centers for Disease Control and Prevention (CDC) developed guidelines for prescribing opioids which have not been widely integrated into practice. These guidelines specify co-prescribing naloxone with opioids as a form of harm reduction. A policy to reflect these recommendations was needed to guide prescribing at a Federally Qualified Health Center (FQHC) in Connecticut to increase low naloxone prescribing rates. Evidence supported the use of provider education to increase prescribing rates.

Purpose: Deliver education to providers across the health system on best practices related to …

Implementation Of The Stop-Bang Screening Tool In The Primary Care Setting: A Quality Improvement Project, Thriciana Powell

DNP Projects

Significance and Background. There are approximately 25 million adults in the United States with obstructive sleep apnea (OSA). OSA is a sleeping disorder that is caused by periodic airflow blockage during sleep. It has been linked to numerous health problems and within the primary care setting OSA is not routinely screened for at visits. This leads to delayed diagnosis of a serious health issue and the potential for poor health outcomes. The STOP-BANG questionnaire (SBQ) is a simple eight-question tool that is used to screen patients for OSA. The STOP section focuses on snoring, tiredness, observed apnea, and high blood …

Reducing Urinary Catheter Usage In The Intensive Care Unit Setting And Education Related To Preventing Cautis: A Qi Project, Kristina Diurno

DNP Projects

Significance and Background: Catheter-associated urinary tract infections (CAUTIs) are common but preventable hospital-associated infections. The inappropriate and prolonged use of indwelling urinary catheters can pose a significant risk for patients and healthcare organizations. The Centers for Disease Control and Prevention identified that the most important factor related to an increased risk of CAUTI is the length of time an indwelling catheter remains in place. This DNP (Doctor of Nursing Practice) project assessed the barriers to removing indwelling catheters in the intensive care unit (ICU) while providing encouragement of prompt removal.

Purpose: Three aims were developed for this quality improvement project: …

Use Of An Alarm Bundle To Reduce Alarm Fatigue In The Icu: A Quality Improvement Project, Blerina Petitti

DNP Projects

Significance and Background: In the critical care setting, frequent false alarms can lead to sensory overload and delayed reactions to alarms (aka, alarm fatigue). Patients are at risk because overtime staff may ignore or become desensitized to all alarm sounds, even true ones.

Purpose: The purpose of this QI project is to establish alarm management protocol in a 14-bed ICU. The goals were to reduce alarm fatigue and create a safe environment for patients and clinical staff.

Methods: The Model of Improvement (IHI, 2023) with cycles of the Plan-Do-Study-Act (PDSA) was used to implement an alarm bundle checklist that …

Evaluating The Impact Of A No-Show Policy: A Quality Improvement Project, Adrianne S. Harding

DNP Projects

Significance and Background: No- shows are a global problem that creates a significant challenge for the healthcare system. When a patient misses an appointment, it decreases health care staff productivity, creates a waste of resources and it negatively impacts revenue (Lance et. al, 2021). Current evidence supports interventions that incorporate voluminous data and artificial intelligence with strategies such as overbooking, appointment notification systems and financial incentives to reduce outpatient no-shows (Oikonomidi et al., 2022). This project will evaluate the impact of a no-show policy and provide insights to improve primary care attendance and inform decisions.

Purpose: To evaluate an outpatient …

A Comparative Analysis Of Human Insulin Versus Analog Insulin: Glycemic Control, Adherence, Utilization, And Cost-Effectiveness, Sohul Ahmed Shuvo

Theses and Dissertations (ETD)

Background: Despite being a lifesaving medicine for many patients with diabetes, insulin cost is growing out of reach for many. Of the two broad classes of insulin available in the US, analog insulin is newer, costlier, and more widely used than human insulin. The new mode of delivery with pen devices has shown promise in improving adherence and achieving glycemic control and gaining popularity. But comparing adherence to different insulins is challenging due to the lack of a validated insulin adherence method. Very little is known about the comparative benefits of different insulin types and different modes of delivery in …

Diversity, Equity, And Inclusion Efforts Among Healthcare Providers And Systems In The United States, Peyton Jobe

Health, Human Performance and Recreation Undergraduate Honors Theses

The purpose of this study was to compare patient experiences measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to healthcare provider’s diversity, equity, and inclusion efforts. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a patient survey given upon patient discharge. The results cumulate to score hospitals on patient experiences. In the sample, there were 392 hospital websites that were evaluated for the existence of policies, procedures, or statements related to diversity, equity, and inclusion efforts or stances. Of those, 121 of the hospitals received the lowest possible rating for patient experience …

Decreasing Hospital Readmission Rates Of Heart Failure Patients: An Evidence-Based Quality Improvement Project, Elizabeth Rodriguez

DNP Projects

BACKGROUND: Teach back is an evidence-based health literacy intervention that encourages patient engagement in own treatment, adherence to treatment, medications, and quality of care. Implementation of teach back method could positively impact readmissions to the hospital in patients experiencing heart failure and any other chronic diseases and it could improve patient’s outcomes.

OBJECTIVE: The objective of this project was to implement teach back method in a home care agency in the Hartford area in patients with HF to prevent readmission to the hospital.

METHODS: The IOWA model was used and PSDA as tools to support EBP project.

RESULTS: Pre and …

Abc's Of Geriatric Trauma, Teresita Hogan

Journal of Geriatric Emergency Medicine

The ABC's approach to geriatric trauma alerts clinicians to specific important factors in emergency evaluation of an injured older adult.

Lymphatic Dysfunction And Associated Systemic Inflammation In Lymphedema, Assessed By Nirf-Li Imaging And Plasma Cytokine/Chemokine Analysis, Anna Vang

Dissertations and Theses (Open Access)

Breast cancer-related lymphedema (BCRL) manifests as swelling of the upper extremities and trunk as a result of lymphatic fluid buildup due to radiation therapy (RT), surgical lymph node removal, or chemotherapy. As there is currently no cure, BCRL treatment aims to improve quality of life (QOL). First-line treatment involves specialized massage therapy and the use of compression garments. Second-line treatments include reparative lymphatic microsurgeries such as lymphovenous bypass (LVB) and/or vascularized lymph node transplant (VLNT). There is a need for better understanding of the etiology of BCRL and lymphatic microsurgery outcomes. Blood specimens and near-infrared fluorescent lymphatic imaging (NIRF- LI)data …

Assessment Of Saudi Arabians' Awareness Of Oral Health And Oral Hygiene In A Group Of 200 Dental Clinic Participants, Mahmoud Al Ankily, Mohamed Shamel, Sara Abdel Wahed, Mohamed Mansy

Dentistry

Oral mucosa lesions cause oral sores, discoloration, and anomalies. Oral mucosa genetic and developmental disorders may affect anybody. Oral cavity carcinoma causes 4% of all malignancies worldwide. Early detection of oral cancer improves survival rates. Oral precancerous diseases include color, abnormalities, surface texture, and location that predict malignancy. The goal of this study was to examine the Saudi Arabians' awareness of oral health and oral hygiene. An observational, cross-sectional approach was adopted for the study. Individuals with a probable malignant oral disease who visited an OPD at a dental hospital and had relevant behaviors were recruited in the study. In …

Telecontraception: An Evaluative Research Study On Birth Control Accessibility Via Smart Phone Applications, Salma Yazmin Atiya

Open Access Theses & Dissertations

Birth control accessibility in the United States continues to be a growing issue. Studies have shown that barriers such as transportation to clinics, ability to obtain an appointment at a clinic, having time off work or school, cost, lack of insurance, and residing in contraceptive deserts prevents women from obtaining birth control. However, with telemedicine on the rise, new technologies are becoming available, such as telecontraceptionâ??a recent innovation, where people can obtain birth control through a website or an app on smart phone devices. Telecontraception could potentially serve as a tool to narrow the birth control accessibility gap for uninsured …

Health Insurance Education And Advocacy, Jacob Robante

Capstone Projects and Master's Theses

This capstone aims to highlight the benefits of health insurance for individuals and communities. Currently, at my internship at Salinas Valley Health Orthopedics, we face a large number of uninsured patients. As a result, these patients are left with extensive medical bills that may be difficult to pay since they do not have adequate health insurance to assist with some of the costs. The project's purpose is to educate the community about the importance of health insurance coverage, provide information on available options and resources, and increase enrollment in healthcare plans. The project was implemented through an outreach and educational …

A Systematic Literature Review Of Ransomware Attacks In Healthcare, Jasler Klien Adlaon

Electronic Theses, Projects, and Dissertations

This culminating experience project conducted a Systematic Literature Review of ransomware in the healthcare industry. Due to COVID-19, there has been an increase in ransomware attacks that took healthcare by surprise. Although ransomware is a common attack, the current healthcare infrastructure and security mechanisms could not suppress these attacks. This project identifies peer-viewed literature to answer these research questions: “What current ransomware attacks are used in healthcare systems? “What ransomware attacks are likely to appear in the future?” and “What solutions or methods have been used to prepare, prevent, and recover from these attacks?” The purpose of this research is …

Development Of A Computable Phenotype Using Electronic Health Records For Venous Thromboembolism In Medical Inpatients: The Medical Inpatient Thrombosis And Hemostasis Study, Ryan M Thomas, Katherine Wilkinson, Insu Koh, Ang Li, Janine S A Warren, Nicholas S Roetker, Nicholas L Smith, Chris E Holmes, Timothy B Plante, Allen B Repp, Mary Cushman, Neil A Zakai

Faculty, Staff and Students Publications

BACKGROUND: Accurate and efficient methods to identify venous thromboembolism (VTE) events in hospitalized people are needed to support large-scale studies. Validated computable phenotypes using a specific combination of discrete, searchable elements in electronic health records to identify VTE and distinguish between hospital-acquired (HA)-VTE and present-on-admission (POA)-VTE would greatly facilitate the study of VTE, obviating the need for chart review.

OBJECTIVES: To develop and validate computable phenotypes for POA- and HA-VTE in adults hospitalized for medical reasons.

METHODS: The population included admissions to medical services from 2010 to 2019 at an academic medical center. POA-VTE was defined as VTE diagnosed within …

The Impact Of Kentucky’S Medicaid Expansion On Adult Coverage And Diagnosis Of Type 2 Diabetes Mellitus And Diabetic Peripheral Neuropathy, The Use Of Antihyperglycemics And The Role Of Social Determinants Of Health 2011-2018., Brian Mcroberts

Electronic Theses and Dissertations

Objectives: This study analyzed the impact of Medicaid expansion in Kentucky on coverage of adults aged 19-64 and the diagnosis of type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN) and the use of antidiabetic medications or insulin (antihyperglycemics) for T2DM, controlling for Social Determinants of Health (SDOH). Method: This study assembled ICD-based claims and prescription drug NDC claims from all adult residents of Kentucky enrolled in Medicaid from 2011 to 2018. Three-digit zip code (Zip-3) data was appended to each case from the American Community Survey to provide SDOH variables. Tests performed included ANOVA, decision trees, varimax rotated …

An Analysis Of The Effects Of Certified Electronic Health Records On Organizations And Patients., Picandra Elzie

Electronic Theses and Dissertations

The growing technological advancement of electronic health records can become an issue with quality and electronic patient information exchange if hospitals do not adhere to federal guidelines. It is recommended that hospitals utilize certified electronic health records (EHRs) to receive financial incentives. This certification is supposedly also associated with the quality of the EHR itself. The certification process is criticized for allowing EHR vendors to meet a set of limited functions known in advance. EHRs can affect healthcare quality and electronic health information exchange. This dissertation explored what is known about the effects of certified EHRs on length of stay …