Medicine and Health Sciences Commons^™

Identification Of Perioperative Barriers To Enhanced Recovery After Surgery In Colorectal Surgical Populations, Leah Marshall

Master's Projects and Capstones

Enhanced recovery after surgery (ERAS) has evolved over the past 30 years through evidence-based interventions. Enhanced recovery after surgery uses a multidisciplinary and multimodal evidence-based approach to maximize patient recovery. Perianesthesia nurses are critical to its success and have an obligation to understand and participate in the process to optimize patient outcomes. Despite proving to decrease complications and duration of stay in colorectal surgery patients without following colorectal surgery, the implementation of ERAS in colorectal pathways have been met with barriers (Alawadi et al., 2015). Subramaniam & Horgan (2016) describe ERAS pathways as evidence-based interventions that eliminate dated practices based …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Jillian Cule, Maricarmen Reyes

Master's Projects and Capstones

Abstract

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Brittney Pilker, Jillian Cule, Laura Le, Nina Park, Jeffrey Salao, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Dietary Polyunsaturated Fatty Acids Regulate Mammary Tumor Growth And Metastasis By Modulating Tissue Microenvironments, Saraswoti Khadge

Theses & Dissertations

Omega (ω)-6 and ω-3 polyunsaturated fatty acids (PUFAs) are essential fatty acids (FAs) and the precursors of pro- and anti-inflammatory mediators respectively. Epidemiological studies have shown a lower incidence of breast cancer (BC) in the countries where long-chain (LC)-ω-3FAs consumption is higher; however, the role of ω-3FAs in BC growth and metastasis is poorly understood. We used isocaloric, isolipidic ω-6 and ω-3 (contains LC-ω-3FAs) diets and a pair-fed model to evaluate the effects of dietary PUFAs in mammary tumor metastasis. Our studies have resulted in several novel observations including that dietary LC-ω-3FAs modulate mammary gland (MG) microenvironments in non-tumor bearing …

Surveillance, Prevention And Surgical Treatments For Hepatocellular Carcinoma, Kerui Xu

Theses & Dissertations

Liver cancer is the second-leading cause of cancer death, representing roughly 9.1% of all cancer mortality. Of all primary cancers of the liver, hepatocellular carcinoma (HCC) accounts for roughly 85%. HCC has been increasing in the U.S. and other countries. In particular, HCC places a huge burden on the Chinese population, as China alone consists of approximately 50% of the total HCC cases and deaths. In China, chronic hepatitis B virus (HBV) infection is the leading cause for developing HCC. The two challenges in prevention and control of HCC experienced in China are low rates of HCC screening among the …

Development Of Macromolecular Prodrugs For The Treatment Of Chronic Inflammatory Pain, Laura Weber

Theses & Dissertations

Chronic pain afflicts millions of people worldwide. Particularly, the inflammatory conditions in the incurable disease rheumatoid arthritis (RA) generate persistent pain in its sufferers, for which a number of different analgesics have been prescribed, such as glucocorticoids (GCs) and opioids. However, administration of these pain- mitigating pharmaceutics is implicated in the development of adverse systemic effects due to their non-specific tissue distribution and quick excretion, eliciting the need for high dosing frequencies. To address this issue, this thesis is focused on the development of prodrugs based on a macromolecular design approach to instill preferential inflammation-targeting and retentive properties to common …

Towards An In Vitro Model Of Testing Osteoblast Cellular Function In Contact With Various Surfaces, Raheleh Miralami

Theses & Dissertations

Past studies have shown that the success of total joint replacements depends on the biocompatibility of orthopaedic materials, which can be improved by modifying the implant surface. However, the exact roles of these modifications and their effective mechanisms are poorly understood. The objective of this study was to develop and evaluate a model system to investigate the impact of nano-structured surfaces, produced by the ion beam-assisted deposition (IBAD) technique, on biomarkers of osteointegration using an in vitro model. The IBAD technique was employed to deposit zirconium oxide (ZrO₂), Titanium oxide (TiO₂), and Titanium (Ti) nano-films on …

Functional And Mechanical Role Of Splice Variant Of Mucin4 (Muc4/X) And Trefoil Factors In Pancreatic Cancer Pathogenesis, Rahat Jahan

Theses & Dissertations

Pancreatic Cancer (PC) is one of the vicious cancers as it ranks third in the race of leading cause of cancer-related death. Lack of early diagnostic marker, poor understanding of molecular mechanism of the disease and failure to conventional chemotherapy makes this disease dreadful.

Mucin 4 (MUC4), a high molecular weight glycoprotein is one of the top differentially expressed molecules in PC while not expressed in normal pancreas. Accumulating evidence from our lab suggested its tumorigenic role in PC by increasing cell proliferation, invasion, chemotherapy resistance, tumor growth, and metastasis. Previously, our lab and other has identified 24 different splice …

Post-Traumatic Stress Disorder Screening Project For Adult Males From The Middle East And Afghanistan, Ricky Norwood

Master's Projects and Capstones

Current research indicates a significant rise in PTSD signs and symptoms of adult males arriving from the Middle East and Afghanistan. In an effort to increase the awareness of Post-Traumatic Stress Disorder (PTSD) in clinical personnel and adult males from the Middle East and Afghanistan, the Sacramento Refugee Health Clinic implemented a PTSD Screening Project. This project was designed to ensure the maximum number of the adult males from the Middle East and Afghanistan would be appropriately screened for PTSD and provided additional opportunities to meet the mental and acute primary care needs of these patients in an adequate and …

Finding The Narrative In Incident Reports, La'eeqa Aslam

Master's Projects and Capstones

The Progress Foundation, as licensed by the state of California and the Community Care Licensing, is required to use incident reports for internal audits and remain in compliance as a health facility. Incident reports are used to record events or accidents that have occurred within an organization. Often times, reports are made, handed off, and given from the residence home to the Community Care Licensing with little to no information of how an incident was managed. The Progress Foundation is working towards tracking information from the incident reports to improve internal management and understand the trends in the reports.

In …

Improving Knowledge And Attitude Of Primary Healthcare Givers Towards Vulnerable Populations: A Quality Improvement Project, Kimberly Shankel

Master's Projects and Capstones

Improving Knowledge and Attitude of Primary Healthcare

Givers Towards Vulnerable Populations

Kimberly Shankel

University of San Francisco

Abstract

Problem

This project aims to improve patient satisfaction for vulnerable population patients while in hospital, namely transgender and gender non-conforming people. A major roadblock for this population in seeking medical care is their fear of discrimination when accessing healthcare, resulting in a delay, or avoidance of medical care. Multiple studies agree there is a need for nursing education on cultural competence to improve care and satisfaction for vulnerable populations.

Context

The site for this quality improvement project is a small suburban hospital …

Combining Patient-Centered-Care And Technology To Reduce Falls In A Medical/Telemetry Unit, Megan Mira

Master's Projects and Capstones

Abstract

PROBLEM: From October 2017 through June 2018 there were 25 patient falls recorded on the 5^th floor medical surgical telemetry unit. Top factors contributing to this high fall rate include: poor patient-centered-care planning, and inadequate set-up for use of technology.

CONTEXT: According to the Joint Commission, 2015, each fall with injury costs $14,000. This estimate doesn’t include the potential indirect costs that account for the long-term effects of injuries such as disability, dependence on others, lost time from work, household duties, and reduced quality of life.

INTERVENTIONS: Staff education was introduced and focused on using a new mindfulness …

Catheter-Associated Urinary Tract Infection Reduction: A Quality Improvement Project, Wallace Kramm

Master's Projects and Capstones

Abstract

Problem: Hospital-acquired infections are preventable harm that occurs to patients while in the hospital. Catheter-associated urinary tract infection (CAUTI) is a preventable hospital-acquired infection that continues to plague hospitals nationwide. The Centers for Disease Control and Prevention estimates that there are more than 13,000 CAUTI related deaths in the United States annually (Scanlon, 2017). In addition to the harm caused to patients by CAUTIs, the estimated $500 million yearly cost for CAUTI treatment has created a fiscal burden on healthcare systems (Scanlon, 2017). Decreasing the rate of CAUTI by decreasing overall number of catheters is the goal of this …

Mdr Matters! Improving Primary Nurse Participation In Multidisciplinary Rounds, Alma Alcantara

Master's Projects and Capstones

Abstract

Problem: The current model of multidisciplinary rounds (MDR) in a 40-bed medical-surgical unit within a Northern California community hospital has demonstrated low participation rates from primary nursing. The primary nurse attendance in MDRs is consistently at 50% participation, below the target goal of 80%. This lack of engagement leads to ineffective communication and fragmented care coordination resulting in suboptimal quality care and cost outcomes.

Context: An intervention strategy to standardize the MDR model was implemented over three months. A literature review revealed that effective and consistent MDR practices can directly influence primary nurse participation. This change management project focus …

Raising Oas Cahps Scores: Using Patient Education, Katrina Pangilinan

Master's Projects and Capstones

At the Golden Gate Endoscopy Center (GGEC), the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery (OAS CAHPS) survey results on patient satisfaction have been below the 50th percentile for the last three quarters of 2018. Patient satisfaction scores are a quality measure for the patient care experience and important for the success of the organization and its providers. Based on patient comments from previous surveys, patients feel that the center does not explain the possible side effects of the anesthesia in a way they can understand. Other patient comments and concerns included confusion regarding dietary restrictions …

Reducing Inpatient Readmissions Through Early Follow-Up Appointment Planning: A Quality Improvement Project, Isabella Cuenco

Master's Projects and Capstones

Problem: Inpatient readmissions have a highly negative impact on healthcare systems. Not only do these hospitalizations have a detrimental effect on patient outcomes they also are accompanied by a prohibitive financial burden to the hospitals.

Context: Follow-up appointment with a primary care provider after discharge has been demonstrated as a viable strategy to reduce the risk of readmissions.

Interventions: Create a volunteer program to schedule patient appointments with a primary care provider within seven days of discharge.

Measures and Results: Compare the number of patients that were discharged with a follow-up appointment after the intervention to before the intervention, and …

"Improving Nursing Communication Outcomes Through The Tell-Us Card", Jillian Cule, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Staff Retention Through Standardized Training Materials In Adult Primary Care Clinic, David Smith

Master's Projects and Capstones

As non-profits, community health clinics face a unique set of challenges. Primary amongst these is a shortage of financial resources. Staff turnover, including Registered Nurses (RNs) and Medical Assistants (MAs), can result in avoidable increased wage costs related to training of newly-hired RNs/MAs (clinical staff). Retention of experienced RNs/MAs can be directly correlated with job satisfaction, the obverse of which is job frustration. The intent of this RN/MA training and orientation project is to ameliorate frustration related to a lack of informational resources and clear competency expectations. Upon completion and implementation, project efficacy will be assessed via four longitudinal measures: …

Virtual Reality Simulation Of Glenoid Reaming Procedure, Mohammadreza Faieghi

Electronic Thesis and Dissertation Repository

Glenoid reaming is a bone machining operation in Total Shoulder Arthroplasty (TSA) in which the glenoid bone is resurfaced to make intimate contact with implant undersurface. While this step is crucial for the longevity of TSA, many surgeons find it technically challenging. With the recent advances in Virtual Reality (VR) simulations, it has become possible to realistically replicate complicated operations without any need for patients or cadavers, and at the same time, provide quantitative feedback to improve surgeons' psycho-motor skills. In light of these advantages, the current thesis intends to develop tools and methods required for construction of a VR …

Differences In Quadriceps Muscle Layer Thickness (Qmlt) And Contributing Risk Factors To Muscle Mass In Community-Dwelling And Institutionalized Older Adults, Nesrine Cheikh

Electronic Thesis and Dissertation Repository

Sarcopenia, a major concern in the older adult population, is defined as age-related loss of muscle mass and strength. Quadriceps muscle layer thickness (QMLT) measured using ultrasonography (US) is a newly-validated tool to measure muscle mass, which can be used to identify sarcopenic individuals. Our objective was to determine the association of factors such as handgrip strength (HGS), protein intake, nutritional status (via Subjective Global Assessment-SGA) and fat mass (FM) percentage with QMLT size (measured by US) in community-dwelling and institutionalized older adults. Additionally, we aimed to understand how perceived food intake of protein-rich foods could have an impact actual …

An Exploration Of The Nursing Leaders’ Experiences Addressing Indigenous Health In University Undergraduate Nursing Programs In Ontario, Danae Coggins

Electronic Thesis and Dissertation Repository

Introduction. Although there are serious health inequities experienced by Indigenous people compared to non-Indigenous people in Canada and racism and discrimination continues to be rife in health care environments, there remains a general lack of attention to Indigenous health (IH) in health professional education programs. In response, the Truth and Reconciliation Commission (TRC) has recommended this be addressed within health profession education, including nursing (Truth and Reconciliation Canada, 2015). However, there is a paucity of evidence describing the challenges and facilitators to incorporating IH into nursing education.

Methodology and Methods. This qualitative study employs interpretive description approaches informed by …

Internet Based Interventions For Improving Mental Health On College Campuses: A Scoping Review Of Ibis, Caceti Dobrowolski

Honors Theses

BACKGROUND Over the past decade, Internet Based Interventions (IBI) have emerged as a possible mental health approach, reported to reduce cost and provide access to needed services. There is a dearth of literature that clearly defines the scope and components of IBIs and its efficacy. Moreover, little is known about the efficacy of IBI for college students, a population that reportedly underutilizes mental health services.

OBJECTIVE The purpose of this scoping review was to assess the efficacy of IBI as a mental health intervention for college students.

METHODS Three databases were used to initially identify 400 studies and through the …

Implementation Of A Delirium Protocol In A Community Living Center: A Short And Long-Term Care Facility, Marguerite C. Burch

Graduate Theses, Dissertations, and Capstones

Delirium is the most frequent complication associated with hospitalizations of older adults and is responsible for 17.5 million hospital days at a cost of more than $6 billion each year. It is estimated delirium occurs in approximately 14 – 56% of all hospitalized elderly patients. Outcomes associated with delirium in the adult population are prolonged hospital lengths of stay, increased mortality, and post-hospitalization cognitive impairment. Hospitalized patients diagnosed with delirium may be discharged to rehabilitation centers or nursing homes for recuperation, and/or for permanent residence.

Delirium is often misdiagnosed because the presentation of signs and symptoms mimic other medical conditions …

Pharmacologic Treatment Of Agitation In Traumatic Brain Injuries, Brianna L. Pankratz

Nursing Capstones

No abstract provided.

The Role Of Cognitive Behavioral Therapy In Treating Substance Use Disorders, Jessica M. Johnson

Nursing Capstones

No abstract provided.

Implementation Of A Pediatric Post-Operative Hand-Off Tool: A Patient Safety Project, Kaye Remo

Master's Projects and Capstones

Abstract

Problem: The clinical nurse leader (CNL) performed a microsystem assessment using the Dartmouth assessment tool to evaluate the microsystem’s readiness to provide safe care for pediatric post-operative cardiovascular patients. The microsystem is a 12-bed unit caring for critically ill pediatric patients requiring intensive monitoring and therapy. The microsystem’s interdisciplinary team is comprised of medical doctors, nurses, respiratory therapists, social workers, nutritionists, child life specialists, and pharmacists. During assessment and gap analysis, the CNL identified gaps in nursing knowledge and skills to deliver safe care for this patient population during the immediate post-operative phase of recovery. There is a …

Evaluation Of Perioperative Peripheral Nerve Injury In Cardiac Surgery Using A Novel Automated Ssep Monitoring Device, Satoru Fujii

Electronic Thesis and Dissertation Repository

INTRODUCTION: The high incidence of peripheral nerve injury (PNI) in conventional cardiac surgery (CCS) is believed to result from mechanical injury during sternotomy and/or retraction of the sternum. Minimally invasive cardiac surgery (MICS) is a newly developed type of cardiac surgery which does not require sternotomy or retraction of the sternum. Since surgery related PNI can lead to serious problems for both the patients and care providers, the incidence and details of PNI in cardiac surgery needs to be investigated. OBJECTIVE: To compare the degree of nerve injury in MICS and CCS using somatosensory evoked potential (SSEP) signals. …

Resident And Facility Factors Associated With Rehospitalization From Skilled Nursing Facilities, Angelina M. Flores-Montoya, Mark B. Parshall, Marie L. Lobo, Stephen H.A. Hernandez, Christine A. Mueller

Nursing ETDs

ABSTRACT

Older adults often require short-term nursing home care after an acute hospital stay to receive skilled nursing or rehabilitation services. Rehospitalization after a skilled nursing facility (SNF) admission is a potential indicator of poor nursing home quality that is associated with substantial risks of complications and increased costs of care. This study examined resident and facility factors associated with 30-day rehospitalizations during a one-year study period from SNFs in New Mexico. The Minimum Data Set 3.0 was used to explore resident factors and Nursing Home Compare data was used for facility factors. Among residents admitted to the SNF from …

The Influence Of Depression On Pain In The Postoperative Setting: A Systematic Review, Lewis Lateef Olaoluwa

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Over 5% of Americans over the age of 12 reported depression between 2005–2006, and it remains the second leading cause of death in the adolescent and the early adulthood population. The estimated worldwide impact of depression affects approximately 300 million people (World Health Organization [WHO], 2017). Few research studies analyzed the correlation of depression and postoperative pain. The impact of depression on physiological wellbeing, and evidence from various studies suggest a correlation between psychological illnesses such as depression and the physiological manifestations of pain. This systematic review will consider Randomized Controlled Trials (RCT’s), however in the absence of RCT’s, a …

A Review Of Metformin To Reduce Weight In Patients Using Olanzapine, Monida Luu

Nursing Capstones

No abstract provided.