Medicine and Health Sciences Commons^™

Improving Nurse-Patient Communication About New Medicines, Srimala Thinsan

Master's Projects and Capstones

Improving Nurse-patient Communication about New Medicines

Abstract

The project aimed at improving nursing communication with patients and families about medication in order to increase patient satisfaction in terms of safety, quality of care, and patient-centeredness in an acute care setting. The selected patient cohort was at a 42-bed medical-surgical unit in a trauma center in Oakland, California. The gap of nurse-patent communication about medicines was identified based on the HCAHPs scores that had been found to be lower than average (44.1% in March 2015; 40.9% in April 2015). The visibility board was provided to show the staff the HCAHPS scores, …

Improving Patient Safety By Calculating The Qt Correction In Critical Care Patients, Diane F. Newcombe

Master's Projects and Capstones

Prolonged QTc is recognized as a precursor to Torsades de Points and other lethal ventricular arrhythmias. 52% or patients in critical care units have prolonged QTc and 69% or critical care patients have risks of developing QTc. Many commonly administered medications in the critical care unit are known to prolong QTc yet a microsystem assessment and a gap analysis revealed only 3% of the patients in the surgical ICU had the QTc calculation performed and assessed by the critical care nurse.

The global aim is to improve patient safety by incorporating calculating of the QT correction (QTc) into the regularly …

Hypertension Management Through Patient Education, Shaleena Kumar

Master's Projects and Capstones

Hypertension serves as a common diagnosis among Americans, and its management to prevent further cardiovascular complications remains as an organizational goal. To prevent complications, the goal of a Primary Care Provider’s patient panel maintaining a blood pressure less than 140/90 has been established on the organization’s national office. In the Primary Care Clinic, an interdisciplinary team consisting of a Registered Nurse, Clinical Psychologist, and Cardiologist implemented a group education class aimed at a Hypertensive Veteran cohort. The purpose of this project is to improve self-management behaviors in the Veteran population, and to help increase the hypertension performance metric by 2% …

Addressing The Problem Of Alarm Fatigue: Enhancing Patient Safety Through Cardiac Alarm Customization, Kimberly A. Kinghorn

Master's Projects and Capstones

The global aim of this project was to improve patient safety on the Surgical Unit at an acute care facility in Southern California through enhanced cardiac alarm customization. Alarms are intended to enhance patient safety. However, unnecessary and non-actionable alarms contribute to alarm desensitization and fatigue, lessening response time to critical alerts. Alarm fatigue has become a growing patient safety concern and is included as one of the Joint Commission’s 2015 National Patient Safety Goals. Assessment data on the Surgical Unit revealed lack of alarm customization and inappropriate default settings. The framework for the project focuses on the CNL curriculum …

Reduction Of Psychiatric Patient Boarding In The Ed, Eriam S. Nnamaliri

Master's Projects and Capstones

REDUCTION OF PSYCHIATRIC PATIENT BOARDING IN THE EMERGENCY ROOM

ABSTRACT

Objective: Psychiatric patient boarding is a public health concern and a threat to patient safety. The prevalence of psychiatric emergencies in the United States continues to increase due to the strain on mental health services. There is a dire need to address psychiatric patient boarding before it gets even worse. The purpose of this project is to identify the causes and identify measures to decrease emergency department length of stay (LOS) for psychiatric patients in the ED. This project is to help facilitate the development of a more precise nursing …

Decreasing Delayed Patient Transfers Prior To Shift Change, Connie M. Vazquez

Master's Projects and Capstones

This project focuses on the CNL competency leadership theme of Clinical Outcomes

Manager. “Clinical Outcomes Manager uses data to change practice and improve outcomes”

(AACN, 2013). With the assistance of my preceptor, lean team members, department managers,

and administration, this project will aim to reduce delayed patient transfers times between the

emergency department and inpatient units by 50%. This project goal will be achieved by writing

and setting in place a new guideline for 45 minute black-out transfer times. The anticipated goal

date for this project is set for mid-August, 2015.

Home Health: The Process Of Assigning An Appropriately Trained Skilled Nurse To Provide Safe Patient Care, Susanne Polos, Msn, Rn, Cnl

Master's Projects and Capstones

The objective of this CNL project was to improve the process of placing an appropriately trained nurse in the client's home to provide safe, quality care. This project is relevant to nursing because of nursing accountability, patient safety, and lack of education of home health nurses. The population included home health patients in the Bay Area of San Francisco of all ages. The project had its base at a home health agency office in Emeryville, California with no actual hands-on patient contact. A CNL was added to the team to ensure appropriate training of the skilled nurse has been completed …

Implementation Of A Debrief “Takeaway” Board, Carly A. Skeath

Master's Projects and Capstones

Abstract

My original focus of my project was to implement Team STEPPS, to help improve the communication and teamwork within our entire perinatal service department. However, as I started I ran into barriers with time and with other projects put out by our management that needed to take president. It is then that I decided to narrow my focus on one aspect of Team STEPPS which we are already implementing, and that is debriefs. As a member of the Perinatal Patient Safety Program (PPSP), I was able to learn about all the takeaway’s we received from debriefs that had occurred, …

Quantify Blood Loss To Prevent Escalation Of Blood Loss, Manprit Virk

Master's Projects and Capstones

Abstract

The CNL project’s aim is to implement quantifying blood loss (QBL) after each delivery to prevent the escalation of postpartum hemorrhage (PPH), and decrease maternal mortality and morbidity related to PPH in Maternal Child Health (MCH). This project is initiated in a Northern California acute-care facility’s MCH department, which consists of: childbearing women pregnant at gestation age of more than thirty-four weeks, and women post delivery. According to CMQCC (2014), 1-3% of pregnancies are affected by postpartum hemorrhage, and the acute-care facility has a current postpartum hemorrhage rate of 2.7%. There is lack of standardized method of measuring blood …

Reducing Wait Time Of Chemotherapy And Biotherapy Administration To Inpatients By Increasing The Numbers Of Chemotherapy Providers, Jessica Y. Liang

Master's Projects and Capstones

The purpose of my CNL project is to decrease the chemotherapy administration wait-time for adult oncology patients by increasing the numbers of certified providers. Unfortunately as an oncology unit, about 44% of the providers are not active chemotherapy providers. As a CNL, we must constantly evaluate our microsystems to improve our clinical practice and standards for the benefits of our patients, organization, and our clinical growth. Four barriers for not taking the online course were identified through surveys (course difficulty, low census of oncology patients, lack of knowledge or uncomfortable giving chemotherapy, and the cost of the course if failed). …

Legal Aid Inequities Predict Health Disparities, James Teufel, Shannon Mace

Hamline Law Review

LEGAL AID INEQUITIES PREDICT HEALTH DISPARITIES

Detangling Graduate Medical Education Financing From Hospital Payment Methodologies, Lawrence Massa, Matthew Anderson

Hamline Law Review

DETANGLING GRADUATE MEDICAL EDUCATION FINANCING FROM HOSPITAL PAYMENT METHODOLOGIES

Closing The Loop: The Effects Of Scheduling Patients' Follow-Up Prior To Emergency Department Discharge, Jens Hansen

Doctor of Nursing Practice (DNP) Program

Background: A large percentage of serious medical errors involve miscommunication during the hand-off of patients between medical providers. In addition, care providers do not effectively or completely communicate important information among themselves, to the patient, or to those taking care of the patient at home in a timely fashion. The communication method whether verbal, recorded, or written has proven to be ineffective. As healthcare disparities increase with healthcare complexity, it is important to extrapolate the best evidence based practice and bring these practices to the front line.

Literature Search: A comprehensive literature search using the Cumulative Index to Nursing and …

Medical School Watercooler Newsletter - August 16, 2015, Lindsey Lyle

Watercooler Newsletter

This is the August 16, 2015 edition of the Frederick P. Whiddon College of Medicine's Newsletter - Watercooler.

Contents Include:

Construction Update: USA Physicians Group Professional Office Building

USA Welcomes Dr. Ron Brooks

Med School Café - Expert Advice for the Community

USA College of Medicine CME Achieves Accreditation with Commendation

Chronic Ldh Elevation After Left Ventricular Assist Device Implantation, Hesham R. Omar, Navin Rajagopalan, Maya Guglin

The VAD Journal

A 61-year-old woman who underwent HeartMate II left ventricular assist device placement for non-ischemic cardiomyopathy developed elevated lactate dehydrogenase within two weeks after implantation. After eight months of observation and several hospital admissions during which there was no evidence of pump thrombosis, she presented with clinically manifest hemolysis. During pump exchange there was notable pannus formation on the inflow cannula of the left ventricular assist device. The pannus around the inflow likely existed for several months, limiting the flow and creating a low-grade hemolysis and this low flow state stimulated thrombus formation triggering gross hemolysis. Thoratec analysis of the pump …

Simulated Diabetic Ketoacidosis Therapy In Vitro Elicits Brain Cell Swelling Via Sodium-Hydrogen Exchange And Anion Transport., Keeley L Rose, Andrew J Watson, Thomas A Drysdale, Gediminas Cepinskas, Melissa Chan, C Anthony Rupar, Douglas D Fraser

Obstetrics & Gynaecology Publications

A common complication of type 1 diabetes mellitus is diabetic ketoacidosis (DKA), a state of severe insulin deficiency. A potentially harmful consequence of DKA therapy in children is cerebral edema (DKA-CE); however, the mechanisms of therapy-induced DKA-CE are unknown. Our aims were to identify the DKA treatment factors and membrane mechanisms that might contribute specifically to brain cell swelling. To this end, DKA was induced in juvenile mice with the administration of the pancreatic toxins streptozocin and alloxan. Brain slices were prepared and exposed to DKA-like conditions in vitro. Cell volume changes were imaged in response to simulated DKA therapy. …

Chronic Hemodialysis In A Patient With Left Ventricular Assist Device., Amr Idris, Georges Lolay, Ana L. Castellanos, Navin Rajagopalan, Maya Guglin

The VAD Journal

Renal dysfunction in the setting of heart failure is a common medical problem. This dysfunction can range from reversible ischemic changes to renal failure requiring renal replacement therapy. Patients who are candidates for mechanical circulatory support with left ventricular assistant device (LVAD) pose unique challenge with respect to receiving dialysis. We present a 47 year old patient who required renal replacement therapy peri-implantation of LVAD for management of acute on chronic kidney disease, and was discharged for chronic hemodialysis in an outpatient setting. In this report we highlight the challenges of managing volume overload in patients with impaired renal function …

Phases Of Su(3) Gauge Theories With Fundamental Quarks Via Dirac Spectral Density, Andrei Alexandru, Ivan Horváth

Anesthesiology Faculty Publications

We propose that, in SU(3) gauge theories with fundamental quarks, confinement can be inferred from spectral density of the Dirac operator. This stems from the proposition that its possible behaviors are exhausted by three distinct types (Fig. 1). The monotonic cases are standard and entail confinement with valence chiral symmetry breaking (A) or the lack of both (C,C’). The bimodal (anomalous) option (B) was frequently regarded as an artifact (lattice or other) in previous studies, but we show for the first time that it persists in the continuum limit, and conclude that it informs of a nonconfining …

Reinforcing The Global Fight Against Huntington’S Disease: A Visit To Brazil And A Reminder Of Our Common Struggles, Kenneth P. Serbin

At Risk for Huntington's Disease

No abstract provided.

Counseling Training For Audiology Students: Using Standardized Patients, Catherine Schroy

Arts & Sciences Graduate Student Theses and Dissertations

The implementation of Universal Newborn Hearing Screening (UNHS) has resulted in earlier diagnosis of hearing loss in children. Research shows that early diagnosis of hearing loss results in better outcomes in speech and language, socio-emotional, and cognitive development. Early diagnosis, however, often comes as a surprise to parents of newborns. When parents are told their child has a hearing loss, it is often before they have been able to observe behaviors that would lead to the suspicion of hearing loss. Parents are usually told about the hearing loss diagnosis by an audiologist and are often dissatisfied with how the news …

Expression Of Emotional Arousal In Two Different Piglet Call Types, Linhart Pavel, Victoria F. Ratcliffe, David Reby, Marek Špinka

Bioacoustics Collection

Humans as well as many animal species reveal their emotional state in their voice. Vocal features show strikingly similar correlation patterns with emotional states across mammalian species, suggesting that the vocal expression of emotion follows highly conserved signalling rules. To fully understand the principles of emotional signalling in mammals it is, however, necessary to also account for any inconsistencies in the way that they are acoustically encoded. Here we investigate whether the expression of emotions differs between call types produced by the same species. We compare the acoustic structure of two common piglet calls—the scream (a distress call) and the …

10 New Jmc Yearbooks Added To The Jdc, Kelsey Duinkerken, Msi

Jefferson Digital Commons News

Jefferson Medical College yearbooks (published under various titles) are a rich source of Jefferson history. Scott Memorial Library and University Archives and Special Collections have been preserving the yearbooks by digitizing and uploading them to the Jefferson Digital Commons. Yearbooks from 1899 to 1960 were digitized previously and ten more years have been completed and added to the JDC in the latest phase of the project.

Individual Attitudes Toward Innovation, Occupational Stress And Social Support For Work Among Hiv Health Care Providers In Southwest China, Shan Qiao Ph.D., Xiaoming Li Ph.D., Bonita Stanton, Yuejiao Zhou, Zhiyong Shen, Zhenzhu Tang

Faculty Publications

No abstract provided.

Effect Of Chemical Pocket Disinfection As An Adjunct To Non-Surgical Maintenance Therapy Of Inflamed Periodontal Pockets, Chad Riggs

Theses & Dissertations

Purpose: Scaling and root planing with adjunctive chemical pocket disinfection (SRP+C) utilizing sodium hypochlorite solution has been used to treat inflamed pockets of periodontal maintenance patients for many years, without evidence of its benefits. The primary objective was to determine if SRP+C is more effective than scaling and root planing alone (SRP) in improving clinical outcomes. The secondary objective was to compare the effect of SRP+C and SRP on pro-inflammatory IL-1β, anti-inflammatory IL-1ra, and anti-inflammatory index (IL-1ra/IL-1β ratio) found in gingival crevicular fluid (GCF).

Materials and Methods: Pockets (≥ 5 mm and BOP) of 31 maintenance patients were included. Test …

Use Of Smartphones To Capture Measures Of Functional Status In Frail And Non-Frail Community Dwelling Older Adults, Cassia R. Hanton

Theses & Dissertations

Numerous important health outcomes directly relate to one's ability to maintain normal gait speed. The purpose of this study is to employ ubiquitous smartphone technology, using algorithms developed and validated by our lab in a controlled setting, to continuously and noninvasively measure aspects of subject health status, including step counts, gait speed, and activity level, in a naturalistic community setting. A total of 33 ambulatory, independently dwelling older adults were recruited from Nebraska Medicine, including 22 healthy control and 11 frail individuals. Clinical performance measurements of frailty (4MW, TUG, F8W) and validated survey responses (LLFDI, SAFFE, PROMIS) were compared to …

Development Of Hypoxia Trapping Enhanced Bb2r-Targeted Radiopharmaceutics For Prostate Cancer, Zhengyuan Zhou

Theses & Dissertations

The Gastrin-Releasing Peptide Receptor (BB2r) has been investigated as a diagnostic and therapeutic target for prostate and other cancers due to the high expression level on neoplastic relative to normal tissues. A variety of BB2r-targeted agents have been developed utilizing the bombesin(BBN) peptide, which has shown nanomolar binding affinity to human BB2r. However, as with most of the low-molecular weight, receptor-targeted drugs, a major challenge to clinical translation of BB2r-targeted agents is the low retention at the tumor site due to intrinsically high diffusion and efflux rates. Our laboratory seeks to address this deficiency by developing synthetic approaches to selectively …

Targeted Magnetite Tissue Delivery For Antiretroviral Pharmacokinetics, Tianyuzi Li

Theses & Dissertations

Pharmacokinetics and pharmacodynamics studies are required for bench to bedside translation of any new drug, formulation or device. Multifunctional magnetite nanocarriers enable magnetic resonance imaging tracking of nanomaterial encased antiretroviral drugs serving to improve the effectiveness of formulation developments. Targeting ligands used to deliver nanoparticles to HIV harboring cells can be tested using multifunctional magnetite nanocarriers. To this end, two types of magnetite nanocarriers were developed. These included small magnetite antiretroviral therapy particles. The second were ALN-PEG coated magnetite particles for testing macrophages targeting ligands. Overall, these works should serve to speed the development of long acting nanoformulated ART to …

Improving Antibiotic Resistant Infection Transmission Situational Awareness In Enclosed Facilities With A Novel Graphical User Interface For Tactical Biosurveillance, Valeriya V. Kettelhut

Theses & Dissertations

Serious challenges associated with antibiotic resistant infections (ABRIs) force healthcare practitioners (HCP) to seek innovative approaches that will slow the emergence of new ABRIs and prevent their spread. It was realized that traditional approaches to infection prevention based on education, retrospective reports, and biosurveillance often fail to ensure reliable compliance with infection prevention guidelines and real-time problem solving. The objective of this original research was to develop and test the conceptual design of a situational awareness (SA)-oriented information system for coping with healthcare-associated infection transmission.

Constantly changing patterns in spatial distribution of patients, prevalence of infectious cases, clustering of contacts, …

The Role Of Glutaminase 1 In Hiv-1 Associated Neurocognitive Disorders And In Brain Development, Yi Wang

Theses & Dissertations

Glutaminase is the enzyme that converts glutamine into glutamate, which serves as a key excitatory neurotransmitter and one of the energy providers for cellular metabolism. Glutamate is essential for proper brain functioning but at excess levels, it is neurotoxic and has a key role in the pathogenesis of various neurodegenerative diseases, including HIV-1 associated neurocognitive disorders (HAND). However, the detailed mechanism of glutamate-mediated neurotoxicity remains unclear. In part I, we identified the regulation of glutaminase 1 (GLS1) in the central nervous system (CNS) of HAND animal models including HIV-Tat transgenic (Tg) mouse and HIVE-SCID mouse, since GLS1 is the dominant …

Polymeric Nanocarriers For Treatment Of Melanoma And Genetically Modified Mesenchymal Stem Cells To Improve Outcome Of Islet Transplantation, Vaibhav Mundra

Theses & Dissertations

Melanoma is a lethal malignancy with limited treatment options for advanced metastatic stages. New targeted therapeutic options with discovery of BRAF and MEK inhibitors have shown significant survival benefit. Despite the recent progress, inefficient tumor accumulation and dose limiting systemic toxicity remains pressing challenges for treating metastatic melanoma and there is a need for drug delivery approach to improve therapeutic index of chemotherapeutics. Nanoparticle based drug delivery represents promising approach to enhance efficacy and reduce the dose limiting systemic toxicity. Nanoparticles can be formulated either by physical encapsulation of drugs or by covalent conjugation of drugs to the polymeric backbone. …