Medicine and Health Sciences Commons^™

The Clinical Inquiry Process Diagram (V. 5), Roy E. Brown

VCU Libraries Faculty and Staff Publications

This updated edition of The Clinical Inquiry Process Diagram improves on the 2023 version. It provides a depiction of the steps involved in the clinical inquiry process, covering research, performance improvement, and evidence-based practice. The revisions in this version emphasize the importance of alerting users to the iterative nature of clinical inquiry and the ongoing need to assess the situation or patient based on evolving evidence. It's crucial to recognize that the clinical inquiry process does not follow a linear, sequential progression. Instead, individuals may find themselves concurrently addressing different aspects of the process or revisiting prior steps as they …

The Clinical Inquiry Process Diagram Question Development Checklist, Roy E. Brown

VCU Libraries Faculty and Staff Publications

This updated handout, previously published in 2023, serves as a reference for those who are either in an EBP course or are practicing healthcare providers involved in questioning practices to improve patient care. The handout guides the user from identifying and developing a question to determining whether the clinical question, based on evidence, will be an evidence-based practice project/initiative, a performance improvement project, or a research project. It aligns with the fifth version of the Clinical Inquiry Process Diagram and now includes several different formats that can be used when trying to create a focused clinical question.

• Update of The …

Evidence-Based Decision Making At The Bedside Process, Roy E. Brown

VCU Libraries Faculty and Staff Publications

Evidence-based practice (EBP) is crucial in healthcare for improving care and organizational outcomes. However, there is a lack of consensus among various health professions regarding the definition and implementation of evidence-based practice in the clinical environment. This lack of consensus centers on whether EBP is project-based or if it occurs primarily at the bedside. This diagram illustrates how evidence is utilized to inform bedside decision-making. It demonstrates that the process is iterative and the intervention or decision made is contingent upon the evidence, one’s clinical experience, and the patient/situation.

The purpose of the diagram is to help those involved in …

Work As A Social Determinant Of Maternal Health: A Qualitative Exploration Of College-Educated Black Women’S Experiences At Work During Pregnancy And Postpartum, Serwaa S Omowale, Laurenia C Mangum, Andrea Joseph-Mccatty, Cherell Cottrell-Daniels, Kaiya A Farris, Rashon King, Brittany C Slatton

Faculty, Staff and Student Publications

BACKGROUND: Black women are disproportionately impacted by higher rates of maternal mortality in the United States (US). Limited research has focused on adverse maternal health outcomes among college-educated Black women, although research has found these outcomes persistent among this population.

OBJECTIVES: This study aimed to fill a critical gap in current research by elucidating the nuanced experiences of college-educated Black women in the workplace during pregnancy and postpartum. By exploring this under-researched area, our study contributes to the academic discourse on Black maternal health disparities within the scope of occupational health. It offers practical insights for enhancing workplace gender equity, …

Perceptions Of Acute Care Telemedicine Among Caregivers For Persons Living With Dementia: A Qualitative Study, Anita Chary, Norvin Hernandez, Ana Paulina Rivera, Vivian Ramont, Tracey Obi, Ilianna Santangelo, Christine Ritchie, Hardeep Singh, Emily Hayden, Aanand D Naik, Shan Liu, Maura Kennedy

Faculty, Staff and Student Publications

Persons living with dementia (PLWD) have high emergency department (ED) utilization. Little is known about using telemedicine with PLWD and caregivers as an alternative to ED visits for minor acute health problems. This qualitative interview-based study elicited caregivers' perspectives about the acceptability of telemedicine for acute complaints. We performed telephone interviews with 28 caregivers of PLWD from two academic EDs, one in the Northeast and another in the South. Using a combined deductive-inductive approach, we coded interview transcripts and elucidated common themes by consensus. All caregivers reported they would need to participate in the telemedicine visit to help overcome communication …

Social Determinants Of Health Predict Readmission Following Covid-19 Hospitalization: A Health Information Exchange-Based Retrospective Cohort Study, Micaela N Sandoval, Jennifer L Mikhail, Melyssa K Fink, Guillermo A Tortolero, Tru Cao, Ryan Ramphul, Junaid Husain, Eric Boerwinkle

Faculty, Staff and Student Publications

INTRODUCTION: Since February 2020, over 104 million people in the United States have been diagnosed with SARS-CoV-2 infection, or COVID-19, with over 8.5 million reported in the state of Texas. This study analyzed social determinants of health as predictors for readmission among COVID-19 patients in Southeast Texas, United States.

METHODS: A retrospective cohort study was conducted investigating demographic and clinical risk factors for 30, 60, and 90-day readmission outcomes among adult patients with a COVID-19-associated inpatient hospitalization encounter within a regional health information exchange between February 1, 2020, to December 1, 2022.

RESULTS AND DISCUSSION: In this cohort of 91,007 …

Circulating Sphingolipids In Relation To Cognitive Decline And Incident Dementia: The Cardiovascular Health Study, Kristine F Moseholm, Héléne T Cronjé, Manja Koch, Annette L Fitzpatrick, Oscar L Lopez, Marcia C De Oliveira Otto, W T Longstreth, Andrew N Hoofnagle, Kenneth J Mukamal, Rozenn N Lemaitre, Majken K Jensen

Faculty, Staff and Student Publications

INTRODUCTION: Whether circulating levels of sphingolipids are prospectively associated with cognitive decline and dementia risk is uncertain.

METHODS: We measured 14 sphingolipid species in plasma samples from 4488 participants (mean age 76.2 years; 40% male; and 25% apolipoprotein E (

RESULTS: Higher plasma levels of sphingomyelin-d18:1/16:0 (SM-16) were associated with a faster cognitive decline measured with 3MSE, in contrast, higher levels of sphingomyelin-d18:1/22:0 (SM-22) were associated with slower decline in cognition measured with DSST. In Cox regression, higher levels of SM-16 (hazard ration [HR] = 1.24 [95% confidence interval [CI]: 1.08-1.44]) and ceramide-d18:1/16:0 (Cer-16) (HR = 1.26 [95% CI: 1.10-1.45]) …

The Relationship Of Neighborhood Disadvantage, Biological Aging, And Psychosocial Risk And Resilience Factors In Heart Failure Incidence Among Black Persons: A Moderated Mediation Analysis, Ganga S Bey, James R Pike, Anthony S Zannas, Qian Xiao, Bing Yu, Amil M Shah, Priya Palta

Faculty, Staff and Student Publications

Objectives: Deprived living environments contribute to greater heart failure (HF) risk among non-Hispanic Black persons, who disproportionately occupy disadvantaged neighborhoods. The mechanisms for these effects are not fully explicated, partially attributable to an insufficient understanding of the individual factors that contribute additional risk or resilience to the impact of neighborhood disadvantage on health. The objective of this study was, therefore, to clarify the complex pathways over which such exposures act to facilitate more targeted, effective interventions. Given the evidence for a mediating role of biological age and a moderating role of individual psychosocial characteristics in the neighborhood disadvantage-HF link, we …

The Perpetual Evidence-Practice Gap: Addressing Ongoing Barriers To Chronic Pain Management In Primary Care In Three Steps, Laura Ellen Ashcraft, Megan E Hamm, Serwaa S Omowale, Valerie Hruschak, Elizabeth Miller, Shaun M Eack, Jessica S Merlin

Faculty, Staff and Student Publications

Background: Most management of chronic pain, a serious illness affecting the physical and psychological wellbeing of millions, occurs in primary care settings. Primary care practitioners (PCPs) attempt to provide evidence-based practices to treat chronic pain. However, there continues to be a gap between the care people receive and the evidence. The objectives for this study were to (1) explore determinants of evidence-based chronic pain management and (2) develop a novel approach to using implementation science to address the evidence-practice gap.

Method: A convenience sample of twenty-one Pennsylvania PCPs participated in one-time semi-structured telephone interviews. Interviews were transcribed verbatim and both …

Self-Perception Of Mental Health, Covid-19 And Associated Sociodemographic-Contextual Factors In Latin America, Pablo Roa, Guillermo Rosas, Gloria Isabel Niño-Cruz, Sergio Mauricio Moreno-López, Juliana Mejía-Grueso, Haney Aguirre-Loaiza, Javiera Alarcón-Aguilar, Rodrigo Reis, Adriano Akira Ferreira Hino, Fernando López, Deborah Salvo, Andrea Ramírez-Varela

Faculty, Staff and Student Publications

This study aimed to estimate the prevalence of alterations in self-perceived mental health during the COVID-19 pandemic and their associated factors in four Latin American countries. This is a cross-sectional study based on data collected from adults in 2021 through the Collaborative Response COVID-19 Survey by the MacDonnell Academy at Washington University in St. Louis (United States). The sample was composed of 8,125 individuals from Brazil, Colombia, Mexico, and Chile. A generalized linear model for a binary outcome variable with a logistic link and fixed country effects was used. There were 2,336 (28.75%) individuals who considered having suffered alterations in …

Colonial Drivers And Cultural Protectors Of Brain Health Among Indigenous Peoples Internationally, Rita Henderson, Joyla A Furlano, Shayla Scott Claringbold, Ashley Cornect-Benoit, Anh Ly, Jennifer Walker, Lisa Zaretsky, Pamela Roach

Faculty, Staff and Student Publications

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This …

The Investigation Of The Effects Of Adolescent Substance Use On Socioeconomic Outcomes During Adulthood, Bedis Elkamel

Honors Undergraduate Theses

Background: Adolescence is a crucial point in life where choices, behaviors, and environmental influences can significantly shape future outcomes. This research investigates the increasing concerns surrounding adolescent substance use and examines its long-term effects on socioeconomic status (SES) in adulthood. Substance use during adolescence has been shown to have significant long-term physiological impacts, as the brain is still developing at this age. Additionally, many short- and long-term effects are associated with substance use, such as impacts on academics, physical and emotional well-being, and social life. Several studies have been conducted to explore the relationship between substance use and SES, however, …

Sociodemographic Correlates Of Low Health Literacy Skills Among Cancer Survivors: National Findings From Brfss 2016 And Implications For Precision Survivorship Care, Qi Chen, John Moore, Lailea Noel, Kirk Von Sternberg, Barbara Jones

Publications and Research

Purpose: This study aimed to explore associations of sociodemographic factors with difficulties in three health literacy (HL) skills and the severity of low HL skills.

Design: Cross-sectional secondary data analysis. Subjects: Data came from 17,834 adults who responded to the HL module with a response rate of 47% in the 2016 Behavioral Risk Factor Surveillance System.

Measures: Independent variables included sex, age, race/ethnicity, education, employment and income. Dependent variables are three HL skills: obtaining, understanding oral, and understanding written health information.

Analysis: We conducted weighted Chi-square tests and multinominal logistic regressions.

Results: Cancer survivors younger than 65 (aged 18-39: AOR=4.46, …

Gender Equality– A Sustainable Development Goal In Progress At A Medical College And Hospital In South India, Mr. Manoj S M, Kusuma Kasapura Shivashankar, Suma M. Natraj, Praveen Kulkarni

Digital Journal of Clinical Medicine

Background: Gender Equality is one of the most important SDG and attaining it will ensure a peaceful, prosperous and a balanced world with equal opportunities for both women and men. The Indian scenario in the field of women education has changed with mindset of most parents undergoing a paradigm shift and many girls are encouraged to attend schools, colleges and women are allowed to work. Considering the above shift, our study intended to find out if the same was true and SDG-5, Gender Equality was attained or in progress at our medical college and hospital and hence the study.

Methods: …

Frozen By Worry And Fatigue? A Mixed Methods Approach To Understanding The Lived Experiences Of Freezing Of Gait, Sarah M. Ghose

Theses and Dissertations

This study utilized a mixed methods emergent, phenomenological approach to (1) understanding the lived experience of freezing of gait for individuals diagnosed with Parkinson’s Disease and (2) determining the role of anxiety and sleep in freezing of gait outcomes. Participants included 13 adults diagnosed with Parkinson’s Disease (N=14 for qualitative data, N=13 for quantitative data; 23.1% female-identifying, 76.9% male-identifying) who were predominantly white (92.3%) with an average age of 69 years (SD = 6.73 years). Data collection consisted of semi-structured interviews, self-report measures, actigraphic sleep data, and salivary alpha amylase biomarker collection. Results are organized into …

The Influence Of Flavor On The Abuse Liability Of A Heated Tobacco Product And Its Feasibility As A Menthol Cigarette Substitute, Augustus White

Theses and Dissertations

Heated Tobacco Products (HTPs) purport to expose people that use cigarettes to fewer of the harmful or potentially harmful constituents of tobacco while still delivering reinforcing amounts of nicotine (Auer, Concha-Lozano et al., 2017). An exemplar of the HTP class, IQOS, and its three varieties of “HeatSticks” have been authorized by the Food and Drug Administration (FDA) as “Modified Risk Tobacco Products” (MRTP). However, as the FDA is planning to ban menthol as a characterizing flavor in cigarettes, questions remain regarding whether characterizing flavors should be permitted in HTPs (FDA, 2022e). New evidence regarding HTP abuse liability (i.e., the likelihood …

Investigating Black Emerging Adult Health And Model Of Care Choices, Alexandra Wynn

Theses and Dissertations

This mixed methods study aimed to analyze the health profiles of Black emerging adults (who do not seek medical care for chronic condition management) college students to identify factors influencing their use of preventive services and their choices in healthcare plans. The study revealed distinct profiles of Black emerging adults based on patterns of factors related to their engagement with healthcare, such as barriers to care, insurance access, usual source of care, self-rated health, intention to seek care, discrimination, trust in physician, medical mistrust, and sex-assigned at birth. Interviews were conducted to investigate the similarities and differences among all participants …

Associations Between Childhood Trauma And Tobacco Dependence Among Latine Adults: Testing The Protective Effects Of Compassion For Self And Others, Camila Tirado

Theses and Dissertations

Tobacco dependence has posed a significant public health challenge in the United States and disproportionately affects Latine adults' risk of developing a variety of adverse health conditions. Childhood trauma is a recognized risk factor for dependence, overall health, and mental health concerns. Still, the influence of compassion for self or compassion for others in this context remains unclear. This cross-sectional study investigated the moderating effects of self-compassion and compassion for others on the relationship between childhood trauma and cigarette dependence among Latine adults. Data was collected through questionnaires assessing childhood trauma, self-compassion, cultural values and factors, compassion for others, and …

Acute Effects Of An Oral Nicotine Pouch In People Who Use Smokeless Tobacco, Alisha Eversole

Theses and Dissertations

People who use smokeless tobacco (SLT) are exposed to a variety of carcinogenic toxicants, yet, despite health risks, nearly 6 million people in the US use SLT. SLT contains and delivers nicotine, a psychostimulant that causes dependence and hinders cessation efforts. An orally-administered nicotine pouch marketed as “tobacco-free” recently has become available for purchase in the US. However, there are very few non-industry-sponsored studies regarding the effects of these oral nicotine pouches.

The current study used clinical laboratory methods to determine the acute effects of an oral nicotine pouch in people who use SLT. Participants completed four sessions (within subjects, …

Mild Traumatic Brain Injury In Yucatan Minipigs: Assessing Changes In Approachability And Mechanical Nociception Following Diffuse Central Fluid Percussion Injury, Mark D. Pavlichenko

Theses and Dissertations

Traumatic brain injury (TBI) is a major healthcare concern affecting millions. Symptoms of TBI include sensory sensitivity and social changes that may persist long-term. Due to similarities in cytoarchitecture, metabolism, and inflammation, higher order minipig models are advantageous for translational TBI research, however, there remains a shortage of information regarding their behavioral and sensory sequelae following injury. Therefore, in this study, we assessed changes in sociability and somatosensation in adult male and female Yucatan minipigs for up to one-week following a sham or central fluid percussion injury (cFPI). Specifically, the voluntary human approach task (VHAT) and the forced human approach …

Cellular Metabolism Is A Viable Therapeutic Target For Radiation-Induced Pulmonary Fibrosis, Josly Pierre-Louis Odoom

Theses and Dissertations

Herein, we provide evidence for cellular metabolic reprogramming as a driver of radiation-induced pulmonary fibrosis (RIPF). We are the first to identify a distinct metabolic signature for RIPF in a cohort of patients with radiographic sequela. We also used a RIPF mouse model to detect the metabolic pathways that enrich during pathogenesis. Our previous work highlighted the importance of lactate, a derivative of the glycolysis end-product pyruvate. Consequently, we took a special interest in the effects of radiation on the glycolysis pathway. We learned that radiation accelerates and reprograms glycolysis to an anabolic state in a pyruvate kinase M2 (PKM2)-dependent …

Life After Discharge: Predicting Longitudinal Trajectories Of Community Integration And Global Functioning In Black Individual With Traumatic Brain Injury, Chimdindu Ohayagha

Theses and Dissertations

The onset of traumatic brain injury (TBI) begins a chronic health pathway that contributes to various impairments and comorbidities across the lifespan. Common consequences of TBI include mental health issues, cognitive impairments, and reduced functional independence, all of which impact how an individual integrates into their community. Community integration is a primary goal for rehabilitation after TBI. Studies show that racially/ethnically minoritized individuals have a higher incidence of TBI, higher rates of mortality, and report poorer functional and community integration outcomes. Limited studies have explored longitudinal outcomes of community integration in a Black-only sample of individuals with TBI. Additionally, no …

The Patient Experience Of Language Discordance And Interpreter Services In The Emergency Department, Keri L. Baker

Theses and Dissertations

Background: Clear communication is critical to the interaction of a patient and medical provider. For non-English speaking patients, language discordance, described as the lack of proficiency in a shared language, with the medical team results in a poor patient experience and poor patient outcomes. The predominant solution to language discordance is the use of interpreter services, however these services are underused in the emergency department (ED). Studies examining underuse of interpreter services have primarily focused on the clinician and little is known about the patient’s influence on the use of interpreter services.

Methods: Semi-structured interviews were conducted with 12 Spanish-speaking …

Aadej Comm 10 4 2024

AADEJ - The Communicator

The Communicator is the official journal of the American Association of Dental Editors and Journalists (AADEJ). It is published quarterly, distributed digitally via email to members, and posted on the Association's website, AADEJ.org. Each issue includes regular updates from the editorial team and AADEJ board, as well as feature articles on current issues in the field.

Associations Between Positive Affect And Physical Activity From Young Adulthood To Midlife: A 25-Year Prospective Study, Farah Qureshi, Laura D. Kubzansky, Ying Chen, Jackie Soo, Eric S. Kim, Donald Lloyd-Jones, Julia K. Boehm

Psychology Faculty Articles and Research

Objective: Positive affect may influence health by promoting physical activity, but evidence evaluating this association is mostly cross-sectional and cannot discern directionality. This study used a counterfactual-based framework to estimate the causal effect of positive affect on physical activity patterns over 25 years, accounting for potential reverse associations. Method: Data were from 3,352 participants in the Coronary Artery Risk Development in Young Adults study. Repeated assessments of positive affect and physical activity were collected from 1990 to 2016. Longitudinal associations were evaluated in two ways: (a) using baseline positive affect in traditional linear mixed models that accounted for reverse causal …

An Endemic Issue: Malawi's Struggle To Prevent Childhood Malaria, Hailey A. Smalley

Graduate Student Theses, Dissertations, & Professional Papers

Malaria is one of the most prolific diseases in the world, generating hundreds of millions of cases and hundreds of thousands of deaths a year. In 2021, the World Health Organization initiated preliminary trials for the first malaria vaccine in three countries, including Malawi. This project explores the impact of the malaria vaccine on community perspectives and health outcomes related to malaria , describes ongoing challenges that health workers face when disseminating the vaccine, and explains how Malawi’s experience implementing the malaria vaccine reflects larger trends in international aid.

The Role Of Age As A Risk Factor For Pickleball-Related Injuries, Ches Jones, Bart Hammig

Health, Human Performance and Recreation Faculty Publications and Presentations

Pickleball is a popular sport that includes players from many different demographics. The popularity has resulted in not only increases in participation but also in activity related injuries. The purpose of this study was to identify risk factors along with potential mechanisms for injuries related to pickleball and identify effective countermeasures. Methods included the identification of pickleball related injuries from a US National Emergency Room database (NEISS). A narrative section of the database was used to identify and categorize potential mechanisms of injury. Results indicated that the types and mechanisms of injury relate to three specific age groups: younger, middle …

Spatial Analysis Of Socioeconomic Factors At Found Locations Of Orphaned Mammals In Champaign County, Illinois, Usa, Colleen Elzinga, Stephanie Heniff, William Sander, William Marshall Brown, Csaba Varga, Samantha Sander

Human–Wildlife Interactions

Young mammals make up a significant portion of animals brought into wildlife rehabilitation centers. Unfortunately, some of these presumed orphaned individuals are inappropriately removed from their native habitat. As such, there is a need for educational community outreach centered on the proper identification of orphaned wildlife that benefit from human intervention, while maximizing limited resources of rehabilitation facilities. This study evaluated found locations of common mammalian orphans presenting from Champaign County to the University of Illinois Wildlife Medical Clinic, Illinois, USA, between 2015 and 2020. The found locations of the orphans (99 Virginia opossums [Didelphis virginiana], 80 common …

“Putting On Our People Lens”: Lived Experience As Pedagogy, Tessa Zoe Milman, Sarah Bream, Celso Delgado, Erin Mcintyre, Tristan Scremin, Leslie Moreno, Maggie Yeo, Deborah Pitts

Journal of Occupational Therapy Education

In the professional education of mental health practitioners, including occupational therapists, there has been a lack of meaningful inclusion of people labeled with mental illness into curricula, beyond guest speaker panels and presentations. This study explored the experiences of students, faculty, and ‘Experts by Experience’ within a mental health occupational therapy course that incorporated Experts with lived experience as co-facilitators of weekly fieldwork debriefs. The study utilized focus groups and interviews to understand the experiences of students, mental health faculty, and ‘Experts by Experience’. Key themes that emerged from the qualitative data analysis were organized under three broad categories: 1) …

Occupational Therapy Students’ Service Learning: Rehabilitation Archeology With Military Veterans, Lola Halperin, Jaimee Mb Hegge, Sharon Mccloskey, Stephen Humphreys

Journal of Occupational Therapy Education

Existing research evidence pertaining to the occupational therapy (OT) role with adventure-based outdoor activities for military veterans and the authors’ positive experience serving members of a non-profit veteran-run organization that promotes rehabilitation archeology suggest that outdoor rehabilitation for this client population is a promising avenue for the profession. Moreover, students’ exposure to outdoor experiences designed for military veterans as well as other populations presenting with physical and mental health conditions has the potential to significantly augment OT curriculum by impacting both the learning trajectory and personal transformation of the students. This paper describes a unique service-learning experience involving graduate OT …