Medicine and Health Sciences Commons^™

Laser-Assisted Tooth Extraction In Patients With Impaired Hemostasis, Elena Larionova Dr., Ekaterina Diachkova Dr., Elena Morozova Prof., Albert Davtyan Dr., Svetlana Tarasenko Prof.

BioMedicine

Introduction: The provision of efficient dental care to patients with hemostatic disorders is tied to difficulties and problems such as prolonged bleeding after or during surgical manipulation.

Aim: This study aims to increase the efficiency of oral surgery in patients with thrombocytopenia with the use of erbium laser on different stages of tooth extraction.

Methods: Patients (n = 96) were selected for tooth extraction on an outpatient basis: patients with confirmed thrombocytopenia (age 44 ± 15.4, 19–74) were included in the 1st group, and patients without impaired hemostasis (age 47.6 ± 15.3, 19¬81) were included in the …

Developing A Practical Application Of The Isometric Squat And Surface Electromyography, David Phillips, Angelic Rose Del Vecchio, Kevin Carroll, Evan L. Matthews

Department of Exercise Science and Physical Education Scholarship and Creative Works

Electromyography (EMG) is a research tool used in gait analysis, muscle coordination evaluation, clinical evaluation and sports techniques. Electromyography can provide an insight into neural adaptations, cross education effects, bilateral contraction deficiencies, and antagonist activity in exercise-related movements. While there are clear benefits to using EMG in exercise-related professions, accessibility, cost, and difficulty interpreting the data limit its use in strength and clinical settings. We propose a practical EMG assessment using the isometric squat to identify compensatory activation patterns and report early observations. Ten healthy participants were recruited. Participants performed a 2-min isometric handgrip protocol and an isometric squat protocol. …

Weight Reduction Motivation In Osteoarthritis Patients Through Nurse Practitioner Driven Education And Follow-Up: A Pilot Project, Caoilfhionn Mulvey, Martha Fuller Phd

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: The ultimate goal of this short-term pilot project is for

overweight or obese osteoarthritis patients to increase their knowledge on the benefits of

weight loss and physical activity. Research shows that for every kilogram of weight lost,

2.2–4.0 kilograms of weight is taken off of the joint and could reduce joint pain up to

thirty to fifty percent and improve quality of life. Following education from the provider,

patients will understand the correlation of osteoarthritis symptom management with

weight loss.

EBP Model/Frameworks: This project utilizes the Iowa Model of Evidence-Based

Practice to Promote Quality Care. This addresses …

Get America Talking: Implementing Advanced Care Planning In Primary Care, Sasha Recht

Doctor of Nursing Practice Final Manuscripts

Advanced Care Planning (ACP) is an essential part of providing adequate care in the primary care setting. Discussing end of life with patients can be a tedious and uncomfortable conversation for many providers, however, its continued avoidance contributes to the stigma of end of life care and may also result in significant healthcare cost expenditure with the use of unwanted invasive treatments. All providers should engage in consistent advanced care planning in order to improve patient and provider communication, improve patient satisfaction, increase advanced directives on file, reduce the stigma of the topic, and improve quality of life.

Achieving Advance Care Planning In Diverse Populations Via Teleconferencing With Skilled Nursing Facility Residents, Tania Huezo

Doctor of Nursing Practice Final Manuscripts

Background: Advance care planning (ACP) has always been a priority in healthcare, and even more crucial during the COVID-19 pandemic. It has been extremely challenging for ACP to occur in the skilled nursing facility (SNF) population once social distancing restrictions were put in place to protect residents and staff.

Purpose: The purpose of this evidence-based project was to assess the effectiveness of ACP via teleconferencing with skilled nursing facility (SNF) residents in the hope of increasing completion of high-quality Physician’s Orders for Life-Sustaining Treatment (POLST) forms.

Methods: The San Diego Coalition for Compassionate Care developed an ACP community outreach program …

Strategies For The Improvement Of Healthcare Through Simulation, Roger Lankheet

Dissertations

Title:Strategies for the improvement of healthcare through simulation

Background: Medical errors continue to plague the healthcare industry. The annual rates of morbidity are approximately 2.69 million (AHRQ, 2019), while mortality rates exceed 400,000 per annum (Makary & Daniel, 2016). There may be no panacea to combat these egregious rates. However, simulation of patient care events may better prepare healthcare professionals to prevent medical errors as it has been proven to be an effective learning strategy (Kirkham, 2018), enhancing skills while gaining experiential knowledge, without risk to actual patients.

Purpose: The purpose of this qualitative study was to gain a …

The Challenges Of Lagging Diversity And Inclusion In Health Care, Ebony Caldwell, Nananamibia Duffy, Deborah Stamps

Advances in Clinical Medical Research and Healthcare Delivery

The healthcare workforce in the United States (US) does not accurately reflect the future growth of diversity, based on projections of a more racially/ethnically diverse patient population in the US over the next decade. Poor health outcomes, particularly in African Americans, continue to occur, and African Americans continue to be underrepresented in medicine. This signals a continuation of health disparities in marginalized communities. Healthcare organizations must address the low number of Black physicians in communities and support education gaps to strengthen pipelines that will ensure a greater diversity in matriculating medical school students.

Trial By Fire: Impact Of Rapid Expansion Of Telemedicine In A Large Community Health System, Scott Stratton-Smith, Cole Nardi, Benjamin Snyder

Advances in Clinical Medical Research and Healthcare Delivery

Background: Our community-based health system transitioned to a largely telehealth-based approach under the pressure of the COVID-19 pandemic. Limited implementation of telehealth had begun in 2018, but provider and patient reluctance and inadequate reimbursement prevented widespread adoption at the time. The pandemic accelerated our system’s telehealth efforts.

Results: In February 2020, video technology was rarely utilized, with the organization averaging fewer than 10 video visits per month. In April 2020, our providers used it for over 30% of all visits in our system, accounting for over 30,000 visits. Before COVID-19, fewer than 20 of our providers had performed a direct-to-patient …

Clinical Presentation Of Covid-19 Disease In Two Rural New York Counties, Richard Terry, Sadaf Mughal, Vidhya Reddy, Tina Burt

Advances in Clinical Medical Research and Healthcare Delivery

Purpose

To analyze the phenotypic expression of Coronavirus infection (COVID-19) among patients residing in the Chemung and Schuyler counties of New York State.

Method

A retrospective review of medical records was performed between March 16, 2020 to April 16, 2020. Sixty- five patients presenting with symptoms of COVID-19 infection were included in this IRB-exempt study. Presence of infection was confirmed using reverse transcriptase polymerase chain reaction (RT- PCR) from nasopharyngeal swab samples, as per Centers for Disease Control and prevention (CDC) guidelines.

Results

Patients varied in age from 13 to 82 years, with nearly equal proportion of females (51%) vs …

Colonic Gallstone Obstruction, Abdoulaziz Toure M.D, Mitchell Witkowski, Vithal Vernenkar D.O, Brian Watkins Md, Ms, Facs, Prasad V. Penmetsa M.D

Advances in Clinical Medical Research and Healthcare Delivery

This report discusses a case of a 79-year-old Caucasian female who presented with large bowel obstruction. A significant CT findings of cholecystocolic fistula and an impacted gallstone at the junction of the descending and sigmoid colon. We present a case of colonic gallstone obstruction that was treated with endoscopic lithotripsy. This interventional approach is effective in stable elderly patients with high surgical risk and in patients with significant comorbidities.

A Rare Case Of Upper Arm Compartment Syndrome In A Patient On Anticoagulant Therapy, Zi Tan, Ammar Ahmed, Amr Khalifa, Roy Trumbo

Advances in Clinical Medical Research and Healthcare Delivery

Background Compartment syndrome is the condition when elevated pressures within an osseofascial compartment cause vascular and neurological compromise, leading to muscle ischemia and possible necrosis if left untreated. It commonly occurs after a traumatic event (e.g., crush injury, fracture, trauma); however, compartment syndrome can still happen spontaneously and in any compartment of the body.

The objective of this case report is to present the signs and symptoms of upper arm compartment syndrome, which is a rare site for compartment syndrome, along with a review of the diagnosis and treatment.

Case Report A 62-year-old man receiving anticoagulant therapy for atrial fibrillation …

Why Are We Doing This?, Richard Alweis, Hemant Kalia

Advances in Clinical Medical Research and Healthcare Delivery

The editors of the journal explain the rationale for founding a new journal and the goals of the journal.

Communication In Interventional Radiology: Addressing The Challenges Of Complexity And The Impact Of Secure Text-Message Communications, Aakriti Mishra, Daniel Harwood, William Schaeffer, Anna Fabre, Emily Ochmanek, Paul Vantine, Sean Biggs, Ryan Lebaron

Quality Improvement/Patient Safety Symposium

Background: The utilization of smartphone-based technology to improve multidisciplinary communication and patient care provides an exciting opportunity for quality improvement research. In our institution, consult requests have traditionally been responded to verbally, in person or over the phone. Unfortunately, this is prone to communication errors and duplication of work. Approximately three years ago, our division developed a uniform consultation note that could easily be placed in the patient record. Additionally, we analyze the impact of a HIPAA compliant messaging system (“Tiger Connect™”) on communication inside and outside the interventional radiology (IR) department.

Methods and materials: The electronic health record (EHR) …

Technology-Based Advance Care Planning Education For Primary Care Patients, Taryn Achong

Doctor of Nursing Practice (DNP) Projects

Background: Advance Care Planning (ACP) encompasses a multidisciplinary, collaborative process that allows patients to understand their health and make informed decisions in their treatment plans. Considering the COVID-19 pandemic and recent research, ACP is considered imperative for all patients. Evidence-based approaches include supplemental group sessions, case manager interventions, and provision of at-home resources. Within the pandemic, there has also been a rapid shift to telemedicine, restricting most ACP efforts. Therefore, the utilization of technology-based ACP resources and telemedicine is highly supported.

Purpose: This DNP project serves to assist an internal medicine practice located in Hawaii’s metropolitan area. Although the …

Present Anesthesiology Practices In The Context Of Patent Foramen Ovale: Pfo Anesthesiology Survey, Hank M. Spellman Ms, Huynh (Wendy) Nguyen Md, Ricardo Falcon Md, Tim Petersen Phd, Codruta Soneru Md

Quality Improvement/Patient Safety Symposium

Institutions around the US often have no defined standard of care (SOC) measures concerning perioperative management of posterior spinal fusion (PSF) surgery patients with a patent foramen ovale (PFO). There is a tacit risk for paradoxical air embolism (PAI) for patients who undergo PSF (1,2,3). The sequelae of PAI include stroke, myocardial infarction, splanchnic infarction, cardiovascular collapse, and death. Upon IRB approval of our survey, data was gathered from 350 pediatric anesthesiologists. There were 49 responses; 46 of whom completed the survey. 81% of respondents practice in surgical settings and 92% provide anesthesia for PSF. 63% had 10-years or more …

Utilizing Tracer Methodology To Evaluate The Effectiveness Of A Hospital Antimicrobial Stewardship Program, Christine Smyth

Doctor of Nursing Practice (DNP) Projects

Antimicrobial resistant organisms are a growing threat in the United States and globally. It has become the expectation that healthcare institutions, including hospitals, contribute resources to create and maintain antimicrobial stewardship programs to decrease antimicrobial resistance, improve patient outcomes, and decrease the spread of multi-drug resistant organisms. The methods utilized to evaluate antimicrobial stewardship at hospitals often only evaluate outcome measures and fail to capture knowledge of the hospital antimicrobial stewardship program among prescribers, clinical pharmacists, and nurses, as well potential barriers to antimicrobial stewardship among healthcare providers. The purpose of this Doctor of Nursing project is to implement and …

Understanding Older Adults Living In Medically Underserved Areas Perspectives Regarding Type 2 Diabetes Care Received, Christopher Rogers

Seton Hall University Dissertations and Theses (ETDs)

Older adults with type 2 diabetes living in medically underserved areas (MUAs) have unique health and social needs that must be taken into consideration when supporting their type 2 diabetes treatment and management care. Effective treatment and management of type 2 diabetes for older adults living in MUAs requires incorporating the preferences, desires, needs, values, and goals of the person at the center of the care into his/her care plan. Shifting care to be conducive to the treatment and management goals and plans co-created with older adults living in MUAs based on their individual physical, psychological, social, and spiritual preferences, …

The Probability Of Success-Through Fault Tree Analytical Binomial Result, Tyleka Riddle

Night Flight: Online Literary Journal

Prestigious Appeal Rule of Thumb (Ear Drum Plugs)

In truant fashion, with proven accidental probabilistic perception for proposed cued facial expression recognition and voice commands without filtering. The estimated cost analysis for design and development generated from the enhanced project in the word "no”: Additionally, an audio noise effect size (ES) for desired level of comprehensive sensory receptors in sound reference to noisy party syndrome. Sytoss, (2019) "Resulting in a cocktail party theory for chalkboard distinction and conversation with applied facial recognition. As well as, the enhanced project management tool, EPMT, to provide output and input determination for higher-level acoustic …

Effects Of Social Determinants Of Health In Progression To Type 2 Diabetes, Folabi I. Ariganjoye

Applied Research Projects

The prevalence of prediabetes and diabetes in the United States and around the world has increased faster than expected in the last 30 years. The economic burden this costs a nation can be astronomic both in terms of expense and loss in productivity. One-third of U.S. adults, 86 million people, have prediabetes. Effective management is needed that can reach these 86 million, and others at high risk, to reduce their progression to diagnosed Type 2 diabetes. After the literature review, there was not enough literature to support how these led to the progression to diabetes. The abundant literature is centered …

Technology Management Maturity Assessment Model In Healthcare, Amir Shaygan

Dissertations and Theses

Significant gaps in the practical transformation of clinical knowledge into practices, increasing healthcare costs, costly medical errors, healthcare institutions' obligations towards improving safety, clinical outcomes, and efficacy of care from one side; and the rise of disruptive innovations, the adoption of electronic health records and novel diagnostic tools, and the plethora of data from the other side has made the need for a new approach in managing the U.S healthcare systems an imperative. Continuous learning has been utilized to mitigate some of these issues have been in healthcare organizations. Continuous learning is especially important in the research centers that act …

Local Implementation And Standardization Of The Pediatric Severe Traumatic Brain Injury Guidelines, Michelle Brown

Research Days

Problem Statement/Question: Severe pediatric Traumatic Brain Injury (TBI) remains a significant cause of morbidity and mortality. Evidence-based guidelines leave gaps in how to best implement and deliver standardized care on the local hospital level.

Background/Project Intent (Aim Statement): We aim to improve clinical outcomes for severe TBI patients (Glasgow Coma Scale ≤8) with standardization of care according to updated evidence-based guidelines. We will target early guideline adherence (initial 72 hours of PICU admission) with a focus on 1) targeted temperature management (TTM40mmHg).

Methods (include PDSA cycles): The Children’s Mercy Hospital Pediatric ICU Severe TBI Guidelines were updated after the 3rd …

Improving The Rate Of Ppsv-23 Vaccination In Children With Type I Diabetes, Henry S. Jeng Dr

Research Days

Background/Project Intent (Aim Statement): The routine use of PCV-13 has resulted in a dramatic reduction in the incidence of pneumococcal infections among young children. However, serious pneumococcal infections caused by additional vaccine serotypes continue to occur in older children with high-risk conditions.1 As per the CDC, children with Diabetes should receive the PPSV-23 vaccine beginning at 2 years of age and at least 8 weeks after their last indicated dose of PCV-13.2 A review of division data from March 2016 to November 2018 revealed that only 2.6% of the eligible patient population with Diabetes have received the PPSV-23 vaccine. More …

Reach, Effectiveness, Adoption, And Maintenance Of Mobile Electronic Clinical Decision Support Tools Deployed As Part Of National Quality Improvement Projects, Ellen K. Kerns

Theses & Dissertations

Electronic clinical decision support (ECDS) tools are often developed within quality improvement (QI) projects to increase adherence with the latest clinical practice guidelines. However, the potential reach and maintenance of ECDS use beyond the time and location of their associated project are very limited. Deploying ECDS using a mobile app (mECDS) has shown the potential to be a viable method of overcoming these limitations. However, it is unclear what pattern the reach and adoption of such a tool might follow and what effect this use has on clinical practice. Our team developed an app which contained two different mECDS tools …

Empathy Training To Combat Provider Burnout In Geriatric Healthcare, Heather N. Block

Honors Thesis

The correlation between provider empathy and the quality of patient care is strong (Hojat, 2016). Provider bias, whether conscious or unconscious, can be detrimental for patients, particularly for vulnerable geriatric populations. This population is especially vulnerable due to the ailments that often accompany age such as diabetic neuropathy, glaucoma, hearing loss, tinnitus, cataracts, retinitis pigmentosa, and illnesses that affect mobility. The Aging Awareness Activity was created to help future healthcare providers understand the difficulties facing the geriatric population. Using hands-on tools to simulate hearing, visual, dexterity, and movement impairments allows for participants to practice activities of daily living with impairment …

The Role Of Primary Care Physicians In Post-Partum Depression (Ppd), Elizabeth Bowman

Rowan-Virtua Research Day

Background

• Symptoms of depression lasting longer than 2 weeks following birth
• 10-15% of new mothers affected yet 50% of cases go undiagnosed
• Long-lasting consequences for the mother, baby, and father
• Multi-factorial condition

Conclusion

• Primary care providers are the first-line defense against PPD
• Many providers are resistant to PPD screenings
• Interventions from primary care providers are effective

Mental Health Outcomes At A Student-Run Free Clinic, Jessica-Sophie Horoschak, Riya Tandra, Sahil Parikh, Shayna Peterzell, Roma Padalkar, Tara Pellegrino

Rowan-Virtua Research Day

In this project we aim to:

1. Assess the outcomes of screening, management, and diagnosis for patients at the Rowan Community Health Center (RCHC).

2. Compare the outcomes of screening, management, and diagnosis between different groups (gender, race, income, insurance status) using validated surveys.

3. There is a need for accessible and affordable primary care in the South Jersey area, which the RCHC is hoping to meet.

Hypothesis:

The quality of mental health care available to patients at the RCHC is comparable to that at other insured practices.

The Application Of Point-Of-Care Ultrasound In Ed Intubations And Airway Access: A Systematic Review, Frank Wheeler, James Espinosa, Alan Lucerna, Jeffrey Gardecki

Rowan-Virtua Research Day

Intubation is an essential procedure performed on a routine basis in the emergency room. Unsuccessful intubations are associated with deleterious outcomes. A systematic review was performed to investigate the accuracy of point of care ultrasound (POCUS) in successful Endotracheal Tube (ET) tube confirmation, utilizing ultrasonography, identification of the cricothyroid membrane utilizing ultrasound, and dynamically during use of ultrasonography in the process of intubation. This review demonstrated high sensitivity and specificity for ultrasound confirmation of ET tube placement, high success rate in ultrasound-guided intubation, and lower than expected accuracy in identifying the cricothyroid membrane. Ultrasonography should be considered for ET tube …

Case Report: The Value Of Vigilance And Iterative Evaluations With An Uncooperative Patient In The Emergency Department, Duwayne Campbell

Rowan-Virtua Research Day

Discussion

A Flexible and Vigilant Approach: The initial presenting information from EMS could have led to anchoring bias. A flexible approach led to new information, which led to interative testing.

Iterative physical examination. There are cases, as seen in this case report, where the physical examination was unreliable or even impossible. Iterative evaluations ultimately led to appropriate imaging and accurate diagnosis.

Iterative testing: In the case presented, the radiologist reported a finding as being present on a prior CXR; however, given the patient’s clinical presentation, further imaging studies were necessary.

Covid-19 Resources For Speakers Of Other Languages (Covid Resol), Ali Harb, Irvin Santiago-Bautista, Sulleymarie Sanchez

Rowan-Virtua Research Day

Objectives

• identify barriers to COVID 19 testing and vaccination in NJ Hispanics with limited English proficiency (LEP)
• develop resources targeted towards vaccination for Hispanic NJ residents and communities in Atlantic, Camden, and Cumberland counties
• share evidence based information regarding the COVID 19 pandemic and disease spread prevention

Conclusions

• Barriers to equitable COVID 19 care for NJ Hispanics with LEP may include but is not limited to resource availability in Spanish, misinformation about COVID 19, a lack of understanding about where and how to get tested and/or vaccinated, and transportation accessibility
• Increased efforts for providing equitable access to vaccination and testing …

Assigning Level Of Care In Blunt Chest Trauma Patients: Applying Objective Scoring Systems, Alyssa Imperatore, Kaitlyn Oldewurtel, James Eakins

Rowan-Virtua Research Day

25% of all traumatic deaths are related to blunt chest trauma and another 50% have in-hospital morbidity and mortality. Recognizing patients with high risk of mortality is just as important as recognizing the immediate severely injured patients. Atlanticare Regional Trauma Center developed a scoring system in an attempt to properly assign these patients to an appropriate level of care. The system was developed based on a literature review but has not yet been studied to review its effectiveness in improving outcomes in chest trauma patients. Therefore, the scoring system is used as a guideline and not an official document in …