Medicine and Health Sciences Commons^™

Biodegradable Hybrid Nanogels For Combination Chemotherapy, Swapnil Desale

Theses & Dissertations

Combination chemotherapy is commonly used to treat cancer, because such a therapy regimens usually involve sequential administration of multiple drugs and allow targeting different cell signaling pathway. The co-delivery of drug combination at a controlled ratio via the same vehicle is offering the advantages such as spatial-temporal synchronization of drug exposure, synergistic therapeutic effects and suppression of drug resistance. Undoubtedly, there are several molecular and pharmacological factors that determine the effectiveness of drug combinations. A rationally designed drug combination is required since certain drug ratios and the definitive exposure to the targets of interest can only be synergistic while others …

Evaluation Of Upper Airway Changes Following Surgical Removal Of The Adenoids Using 3-D Cone Beam Ct, Christopher C. Schultz

Theses & Dissertations

Purpose: The purpose of this study was to evaluate the changes in volume, cross-sectional area and depth of the upper airway following the surgical removal of the adenoids.

Materials and Methods: 16 patients were diagnosed with hypertrophic adenoids and referred for surgical removal. Pre-surgical and post-surgical CBCT scans were taken on each patient. Volume measurements of the total airway, oropharynx and nasopharynx were recorded. In addition, cross-sectional areas and airway depths at the posterior nasal spine (PNS) and cervical vertebrae 2 were recorded. 15 patients diagnosed with no or mild adenoid hypertrophy were treated as the control group. The controls …

The Feedforward And Feedback Controls On Gait In Adults With Diabetes, Chun-Kai Huang

Theses & Dissertations

There are nearly 26 million people with diabetes mellitus (DM) in the US, and half of chronic DMs develop somatosensory deficits due to diabetic polyneuropathy or diabetic peripheral neuropathy (DPN). The absence or impaired somatosensory feedback (e.g. touch sensation or joint proprioception) resulted from the damage of large nerve fiber, and motor deficits such as attenuated muscle strength and abnormal plantar pressure of lower extremity have been identified in DPN, and these sensorimotor impairments lead to an increased number of falls. To reduce the risk of falling, a well-coordinated and adapted limb movement driven by the feedforward (anticipatory) and feedback …

Preventing 30-Day Readmissions Of Clostridium Difficile Patients Utilizing Targeted Discharge Instructions, Keith A. Howard

Doctor of Nursing Practice (DNP) Projects

The Patient Protection and Affordable Care Act of 2010 ushered in a new era of fiscal accountability for healthcare organizations. Healthcare organizations and providers are now jointly held responsible for the improved quality of patient care and sustained reductions in patient care events termed healthcare-acquired conditions. To ensure compliance with this newly enacted legislation, the Centers for Medicare and Medicaid Services (CMS) began penalizing hospitals for targeted conditions leading to 30-day readmissions beginning in October 2012. Annually, CMS has focused attention on conditions that endanger patient health and welfare while secondarily attempting to reduce the excessive financial expenditures in …

Alarm Management: Electrocardiographic Lead Management, Dale Elaine Dominguez Ms.

Master's Projects and Capstones

Abstract

Alarm Management: Electrocardiographic Lead Management

Quality improvement and safety that incorporates the Clinical Nurse Leader (CNL) competency of putting in place quality improvements plans that are bases on evidence, analysis, and risk anticipation is the thesis for this project. The associated problem is the myriads of electrocardiographic (ECG) alarms that alert staff to patient issues each day. Of those alerts, 88% to 90% are false or do not require immediate attention (Sendelbach & Jepsen, 2013). The high numbers of false alerts cause staff to become desensitized to the sound. This desensitization may cause staff not to respond to a …

Staff Education: Nutrition Education In The Intellectually /Developmentally Disabled Community, Claire C. Bradley-Davalos Msn Rn

Master's Projects and Capstones

The objective of my project is to develop staff education regarding a nutrition initiative developed to address the 44% obesity rate among clients in our care. My target population is direct care staff working in the Intellectually/Developmentally Disabled (IDD) community, and high functioning clients who live independently in the community. The staff knowledge was tested pre- and post-education to demonstrate knowledge retained. Staff are required to get a score of 80 or better to pass. Test results are interpreted to see which content areas need further teaching or clarification. Initial results indicate that four areas of education need to be …

The Happy Older Latinos Are Active (Hola) Health Promotion And Prevention Study: Study Protocol For A Pilot Randomized Controlled Trial, Daniel E. Jimenez, Charles F. Reynolds, Margarita Alegría, Philip Harvey, Stephen Bartels

Dartmouth Scholarship

Results of previous studies attest to the greater illness burden of common mental disorders (anxiety and depression) in older Latinos and the need for developing preventive interventions that are effective, acceptable, and scalable. Happy Older Latinos are Active (HOLA) is a newly developed intervention that uses a community health worker (CHW) to lead a health promotion program in order to prevent common mental disorders among at-risk older Latinos. This pilot study tests the feasibility and acceptability of delivering HOLA to older, at-risk Latinos.

Methods/Design: HOLA is a multi-component, health promotion intervention funded by the National Institute of Mental Health (NIMH). …

Developing Inter-Professional Oral Health Education: An Evaluation Of Educational Resources, Jordan A. Jew

Master's Projects and Capstones

As healthcare continues to evolve, providers will need to uphold the quality of patient care provided to patients. Traditional healthcare holds many gaps that do not recognize the unmet needs that exist within today’s society. To maximize the abilities of healthcare services, inter-professional education introduces a collaborative approach that develops a network of shared knowledge and clinical skills beyond the primary scope of practice.

In this project, oral health learning modules developed for family practice residents were introduced to first-year dental students at the Dugoni School of Dentistry to improve their knowledge and confidence to both educate and practice with …

Global Health Security Agenda Legal Landscape Assessment, Natasha M. Nussbaum

Master's Projects and Capstones

The Global Health Security Agenda (GHSA) was created on February 13, 2014, to improve country's ability to detect, prevent and respond to emerging health threats. Eleven action packages were created. The detection action package included antimicrobial resistance, zoonotic diseases, national biosafety/biosecurity and immunization. The prevention action package included establishing a national laboratory system, strengthening real-time biosurveillance, advancing timely and accurate disease reporting and establishing a trained global health security workforce.The response action package focused on establishing emergency operation centers, linking public health and law enforcement and enhancing medical countermeasures/personnel deployment.

The following paper summarizes the components performed for the GHSA …

N653 Fall Prevention Final Project, Sam Clark

Master's Projects and Capstones

N653 Fall Prevention Final Project

by Samuel K. Clark, RN

This project was done with patient safety in mind through the use of the most current EBP available.

Correction Of Verication Bias Using Log-Linear Models For A Single Binaryscale Diagnostic Tests, Haresh Rochani, Hani M. Samawi, Robert L. Vogel, Jingjing Yin

Biostatistics: Faculty Publications

In diagnostic medicine, the test that determines the true disease status without an error is referred to as the gold standard. Even when a gold standard exists, it is extremely difficult to verify each patient due to the issues of costeffectiveness and invasive nature of the procedures. In practice some of the patients with test results are not selected for verification of the disease status which results in verification bias for diagnostic tests. The ability of the diagnostic test to correctly identify the patients with and without the disease can be evaluated by measures such as sensitivity, specificity and predictive …

Preoperative Education: A Patient-Centered Care Approach, Gia L. Wendt

Master's Projects and Capstones

Abstract

This project addresses the need for delivering high quality preoperative education to the Arabic speaking patient population served by Sharp Healthcare’s orthopedic service line. A goal set during the institution’s 2015 The Joint Commission Disease-Specific Care survey is to discharge major joint patients to home in two days or less. Data abstracted from Sharp Healthcare’s orthopedic registry revealed that only 30% of Arabic speaking patients are meeting this goal. The current process for educating Arabic speaking patients preoperatively during a one to one educational session with a third party interpreter takes three hours, costs $402.00 per patient, and education …

Reducing Clostridium Difficile, Norabel V. Zafra

Master's Projects and Capstones

This CNL project aims to reduce the number of laboratory identified Clostridium Difficile Infections (CDI) events by 20% by December 2015. This CNL projects focuses on reducing CDI in an 8 unit bed specifically designated for medically ill geriatric patients above 70 years old residing in the West Texas region. A majority of the geriatric patients living with multiple co-morbidities require maximum assistance with activities of daily living and medication management. The geriatric patients will be discharge to a skilled nurse facility, long-term acute care, rehabilitation, independent living, or home with home health. A variety of methods such as reinforcing …

Implementation Of A Warming Protocol To Prevent Inadvertent Perioperative Hypothermia In The Ambulatory Surgical Setting, Joan Abigail Slagle

Master's Projects and Capstones

The implementation of a standardized warming protocol aims to improve patient outcomes by preventing inadvertent perioperative hypothermia (IPH) and its complications in the ambulatory surgical setting. All patients, regardless of age or gender, are at risk for experiencing a 1-2° C drop in body core temperature within thirty minutes of anesthesia induction. The global aim of this project is to prevent IPH and its complications in the ambulatory surgical setting by implementing a warming protocol at a freestanding ambulatory surgery center. While an audit of the microsystem revealed a normothermia rate of 28%, a standardized warming protocol is expected to …

Decreasing Risk Of Delirium With Early Progressive Mobility, Donna J. Larson Mrs.

Master's Projects and Capstones

Abstract

The goal to consistently mobilize the mechanically ventilated patient to decrease the risk or progression of delirium is the primary focus of my project. This project took place in two, 12-bed critical care units. One is a cardiovascular, medical, surgical intensive care unit and the other is a neurotrauma critical care unit. The methods for implementation included writing the management of pain, agitation, and delirium policy based upon the recommended bundle from the Society of Critical Care Medicine referred to as the ABCDE bundle. As part of this bundle, the progressive mobility policy was revised so that a physician …

Barriers Encountered By Nurses And Nursing Assistants That Prevent Purposeful Rounding, Mar Joseph B. Odias

Master's Projects and Capstones

Purpose: The aim of the study was to identify barriers encountered by registered nurses (RNs) and nursing assistants (NAs) that prevent purposeful (hourly) rounding.

Background: The literature has shown that purposeful rounding improves patient outcomes and safety. However, few studies show the barriers encountered by nursing staff that hinder the purposeful rounding process.

Methods: A pre-post test design was implemented on a 25-bed oncology, urology medical surgical unit with a staff of 38 RNs, 9 NAs, and 4 Unit Secretaries (US). A pre-implementation needs assessment survey was completed by 55% (21/38) of RNs, 33% (3/9) of NAs, and 100% (4/4) …

How The Manipulation Of The Ras Homolog Enriched In Striatum Alters The Behavioral And Molecular Progression Of Huntington’S Disease, Franklin A. Lee

LSU New Orleans Theses and Dissertations

Huntington’s disease is an incurable, progressive neurological disorder characterized by loss of motor control, psychiatric dysfunction, and eventual dystonia leading to death. Despite the fact that this disorder is caused by a mutation in one single gene, there is no cure. The mutant Huntingtin (mHtt) protein is expressed ubiquitously throughout the brain but frank cell death is limited to the striatum. Recent work has suggested that Rhes, Ras homolog enriched in striatum, which is selectively expressed in the striatum, may play a role in Huntington’s disease neuropathology. In vitro studies have shown Rhes to be an E3 ligase for the …

Decrease Arrival To Ct Time To Improve Stroke Outcomes, Curt Peterson

Master's Projects and Capstones

Abstract Final

The specific goal of the project is to decrease the arrival to t-PA treatment times to <45 minutes in > 50% of the cases. The decreased treatment time will prove to shorten the average length of stay on average by two days (Audebert & Sobesky, 2014). The goal will be accomplished by decreasing the arrival to computerized tomography (CT) scan completion time by at least 20%. The specific population of patients will be all stroke alert arrivals to the process’s microsystem via EMS, an Advanced Primary Stroke Center in Sacramento California. Root Cause Analysis, Strength, Weakness, Opportunity, Threat (SWOT), and Plan, Do, …

Empowering Patients With Central Venous Catheters: Utilizing Evidence-Based Video-Assisted Education To Reduce Central Line-Associated Bloodstream Infections, Pritam C. Steiner

Master's Projects and Capstones

An evidence-based Central Venous Catheter (CVC) dressing change video was created to enhance patient independence, and to increase resource efficiency among nursing staff in an inpatient pediatric setting in which Central Line-Associated Bloodstream Infection (CLABSI) rates were rising. Pediatric oncology patients confer the highest risk of developing CLABSIs due to long-term CVC access, neutropenic effects of treatment regimens, and constant fluctuations between inpatient, outpatient clinic, and homecare settings. Use of video-assisted education is anticipated to standardize and improve patient care, decrease healthcare costs, and increase nurse productivity, and is widely supported by research. Qualitative data collection was conducted by surveying …

Reduced A1c Levels Through Diabetes Self-Management Strategies In The Teen Population: A Systematic Review, Nicole O'Neil

Master's Projects and Capstones

This project utilized current evidence-based practices to improve the diabetes education in the endocrine clinic for the adolescent population ages 15-18. Based on a clinic audit, an average hA1C level of 8.1% was revealed. The goal was to decrease these levels from 8.1% to 7.9% within 90 days through the implementation of the revised diabetes brochure. Evidence suggests the following: DSME improves clinical outcomes and quality of life; an A1C level >7% is associated with increased risks of complications ; teaching aimed at lowering glycemic levels have decreased numerous complications; there is a need to ensure age appropriate, family-centered care, …

Improving Inpatient Influenza Compliance Rates With A Standing Orders Program, Marlee E. Gruber

Master's Projects and Capstones

Influenza vaccinations are recommended yearly as part of a primary care performance measure to prevent and control seasonal influenza. Rates of influenza are steadily increasing and can lead to severe negative impacts and even fatalities with patients. According to the Center for Disease Control (CDC)’s Morbidity and Mortality Weekly Report (MMWR), less than 40 percent of the U.S. population receives the flu vaccine yearly. It is suggested by the CDC that Annual vaccination is the most effective method for preventing influenza virus infection and its complications. The Department of Health and Human Services’ Healthy People 2020 includes a goal of …

Reducing Clabsi In The Nicu With Iv Tubing Competency, Tessa A. Toscano Ms

Master's Projects and Capstones

Central line-associated bloodstream infection (CLABSI) is a significant problem in a Level IV neonatal intensive care unit (NICU) on the West Coast of California. A clinical nurse leader (CNL) student joined a team consisting of the unit’s nursing manager, nursing educator, clinical nurse specialist (CNS), and CNS student. Literature review highlighted the association between the development of CLABSI and the practice of changing central line intravenous (IV) tubing. Five interviews of nurses and 15 observations of nurses performing IV tubing change revealed practice variations within six major steps of the procedure. The team revised the IV tubing change policy to …

Increasing Self Care Compliance With Follow-Up Appointments, Elsa T. Owens

Master's Projects and Capstones

The congestive heart failure patient faces many challenges after discharge from the hospital. Learning how to manage diet, medications, and other lifestyle changes needed for symptom management can lead to multiple readmissions and rapid progression of condition. Many patients feel overwhelmed at time of discharge from the hospital, and many miss key components in discharge instructions and education. The main objective of the organizations Heart Failure program is to educate patients who have been admitted into the hospital with systolic or diastolic heart failure. Within our team we set out to educate our patients and their families on reducing incidents …

Reinforcing Teach-Back Method Regarding Pain Management For Non-Verbal Patients And Their Families, Renee Krystle Doll Lazaro

Master's Projects and Capstones

Pain has been known to have physiologic, psychologic and emotional consequences. Education in pain management has been part for standard care for nurses. The purpose of this study was to reinforce teach-back techniques with nurses when delivering pain management education with non-verbal patients in order to improve patient outcomes in the adult ICU. By using the teach-back method, the nurse will be able to hone a more collaborative approach in dealing with pain, encourage autonomy and include the patient/family in making informed decisions regarding treatment for pain. Reinforcement regarding teach-back was focused on teaching points, and rewording teach-back cues to …

Implementing Emergency Bedside Backpacks In The Nicu To Improve Patient Outcomes, Melissa M. Garcia

Master's Projects and Capstones

Abstract

Planning for a disaster, by implementing a unit specific disaster plan, has become an essential recommendation for Neonatal Intensive Care Units. Emergent situations have resulted from past natural disasters proving the need for additional planning when it comes to units with fragile populations. Research has shown instituting a specialized disaster plan, increases patient safety resulting in improved patient outcomes. This prospectus aims to implement emergency bedside backpacks as the first step in the development of a NICU specific disaster plan. These backpacks are meant to be an addition to the current hospital emergency plan, with the goal being to …

Improving Patient Medication Reconciliation Participation And Compliance Through Education, Maria Elena Herrera

Master's Projects and Capstones

Abstract

The healthcare world is complex. At the center of this world are patients and their safety. Medication knowledge and medication reconciliation compliance are factors that influence patient’s safety and their overall health outcomes. This project explores the theme of patient safety by examining the relationship between patient education and health outcomes. The microsystem, located in the heart of San Francisco, is an outpatient clinic specializing in patients with renal impairment that each diverse and unique. A pre-implementation survey found that only 38% of patients were bringing their medications to appointments. A goal of improving compliance to 50% by December …

Improving Patient Satisfaction, Wait Times, And Access To Care In A College Health Setting; Expanding The Rn Role As Prescribing Agent With Standardized Procedures, Kimberly D. Perris

Master's Projects and Capstones

The CNL theme for this project is Nursing Leadership, Advocate for the Profession and is inspired by the Institute of Medicine’s call for all nurses to work to the maximum scope of their practice. The specific aim was to demonstrate RN confidence working independently, and proficiency using one RN protocol to provide hormonal contraception with an overall aim of improving patient satisfaction and access to care. This project took place in a rural university student health center where family planning and contraception services are the number one service provided.

The RN visit project has been multidisciplinary and collaborative in creating …

Enhancing Education Of Medication Side Effects To Improve Patient Outcomes, Kyle R. Woolley

Master's Projects and Capstones

Patient satisfaction scores regarding how effectively staff educates patients about possible side effects of new medications are not consistently above the national average at a large metropolitan hospital in California (MHC). The results of these patient satisfaction scores shed light on the need for evidence-based strategies to improve a patient’s perception of the medication education provided to them. The basis of the incentive to improve care is ultimately increased safety and better patient outcomes. From the Root Cause Analysis, it became apparent that a few common barriers need to be addressed, but the one most frequently reported by everyone that …

Interaction Between Angiotensin Ii And Bdnf In Modulating Sympathetic Nerve Activity, Bryan K. Becker

Theses & Dissertations

Over activation of the sympathetic nervous system is prevalent in many forms of cardiovascular disease such as chronic heart failure (CHF) and hypertension. Although increased neuronal renin-angiotensin system activity in presympathetic neurons has been well implicated in mediating this sympatho-excitation, many of the neuronal effects of angiotensin II (Ang II) signaling remain poorly understood. One particular mechanism of Ang II-mediated increases in presympathetic neuronal activity is through reductions in voltage-gated K⁺ currents. Another pathway that has profound effects on neuronal K⁺ currents and that has been previously implicated in Ang II-signaling is brain-derived neurotrophic factor (BDNF) activity through …

The Role Of Genetic Alterations In Tumor Initiation, Progression And Transformation, Weiwei Zhang

Theses & Dissertations

Follicular lymphoma (FL) is the second most common lymphoma in the United States. Although it is generally an indolent lymphoma, FL is not curable, and, in about 30% of patients, the FL undergoes transformation into an aggressive lymphoma (tFL) with marked worsening of prognosis. To identify mutations preferentially present in tFL, we performed whole exome sequencing (WES) on paired FL and tFL arising in the same patients and developed a mutational analysis pipeline. After we identified potentially important genes that have been found to be mutated in our paired FL and tFL study, we constructed a custom capture platform including …