Medicine and Health Sciences Commons^™

In The Surgical Patient Requiring Neuromuscular Blockade, Is There An Increased Incidence Of Postoperative Adverse Respiratory Events With Rocuronium Or Vecuronium?, Martha Claudine Boos

Doctoral Projects

It is estimated that up to 45% of surgical patients will have postoperative residual neuromuscular blockade (NMB) upon arrival to the postanesthesia care unit (PACU), and incomplete recovery can impair upper airway function and contribute to adverse respiratory events (Nagelhout & Plaus, 2014). This retrospective cohort study examined whether there was an increased incidence of postoperative adverse respiratory events with the neuromuscular blocking agents Rocuronium or Vecuronium. Inclusion criteria included any surgical patient ages 18-65 receiving NMB agents Rocuronium or Vecuronium during the procedure. Exclusion criteria included any surgical patient ages 18-65 with ASA classification > 4, any emergent cases, any …

Intentional And Unintentional Poisoning In Pakistan: A Pilot Study Using The Emergency Departments Surveillance Project., Nadeem Ullah Khan, Ricardo Pérez-Núñez, Nudrat Shamim, Uzma Rahim Khan, Naureen Naseer, Asher Feroze, Junaid Abdul Razzak, Adnan A. Hyder

Department of Emergency Medicine

Background: Acute poisoning is one of the most common reasons for emergency department visits around the world. In Pakistan, the epidemiological data on poisoning is limited due to an under developed poison information surveillance system. We aim to describe the characteristics associated with intentional and unintentional poisoning in Pakistan presenting to emergency departments.
Methods: The data was extracted from the Pakistan National Emergency Department Surveillance (Pak-NEDS) which was an active surveillance conducted between November 2010 and March 2011. All patients, regardless of age, who presented with poisoning to any of Pakistan's seven major tertiary care centers' emergency departments, were included. …

The Pakistan National Emergency Department Surveillance Study (Pak-Neds): Introducing A Pilot Surveillance, Mohammed Umer Mir, Abdulgafoor M. Bachani, Haseeb Khawaja, Shiraz Qayoom Afridi, Sabir Ali, Muhammad Mujeeb Khan, Seemin Jamali, Fareed Ahmed Sumalani, Adnan A. Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

Background: Evidence-based decision making is essential for appropriate prioritization and service provision by healthcare systems. Despite higher demands, data needs for this practice are not met in many cases in low- and middle-income countries because of underdeveloped sources, among other reasons. Emergency departments (EDs) provide an important channel for such information because of their strategic position within healthcare systems. This paper describes the design and pilot test of a national ED based surveillance system suitable for the Pakistani context.
Methods: The Pakistan National Emergency Department Surveillance Study (Pak-NEDS) was pilot tested in the emergency departments of seven major tertiary healthcare …

Pattern Of Fall Injuries In Pakistan: The Pakistan National Emergency Department Surveillance (Pak-Neds) Study., Jabeen Fayyaz, Shirin Wadhwaniya, Hira Shahzad, Asher Feroze, Nukhba Zia, Mohammed Umer Mir, Uzma Rahim Khan, Sumera Iram, Sabir Ali, Junaid Abdul Razzak, Adnan A. Hyder

Department of Emergency Medicine

Background: We aimed to analyse the frequency and patterns of fall-related injuries presenting to the emergency departments (EDs) across Pakistan.
Methods: Pakistan National Emergency Departments surveillance system collected data from November 2010 to March 2011 on a 24/7 basis using a standardized tool in seven major EDs (five public and two private hospitals) in six major cities of Pakistan. For all patients presenting with fall-related injuries, we analysed data by intent with focus on unintentional falls. Simple frequencies were run for basic patient demographics, mechanism of falls, outcomes of fall injuries, mode of arrival to ED, investigations, and procedures with …

Characteristics Of Chest Pain And Its Acute Management In A Low-Middle Income Country: Analysis Of Emergency Department Surveillance Data From Pakistan, Nino Paichadze, Badar Afzal Khan, Nukhba Zia, Rakshinda Mujeeb, Muhammad Mujeeb Khan, Junaid Ali Razzak

Department of Emergency Medicine

Background:

Chest pain is one of the most frequent causes of emergency department (ED) visits in high-income countries. Little is known about chest pain patients presenting to EDs of low- and middle-income countries (LMICs). The objective of this study was to describe the characteristics of chest pain patients presenting to emergency departments (EDs) of Pakistan and to determine the utilization of ED resources in the management of chest pain patients and their outcomes.

Methods:

This study used pilot active surveillance data from seven major EDs in Pakistan. Data were collected on all patients presenting to the EDs of the participating …

How Vital Are The Vital Signs? A Multi-Center Observational Study From Emergency Departments Of Pakistan, Amber Mehmood, Siran He, Waleed Zafar, Mirza Noor Ali Baig, Fareed Ahmed Sumalani, Junaid Razzak

Department of Emergency Medicine

Background: Vital signs play a critical role in prioritizing patients in emergency departments (EDs), and are the foundation of most triage methods and disposition decisions. This study was conducted to determine the frequency of vital signs documentation anytime during emergency department treatment and to explore if abnormal vital signs were associated with the likelihood of admission for a set of common presenting complaints.
Methods: Data were collected over a four-month period from the EDs of seven urban tertiary care hospitals in Pakistan. The variables included age, sex, hospital type (government run vs. private), presenting complaint, ED vital signs, and final …

The Pediatric Disease Spectrum In Emergency Departments Across Pakistan: Data From A Pilot Surveillance System, Huba Atiq, Emaduddin Siddiqui, Surraya Bano, Asher Feroze, Sayyeda Ghazala Kazi, Jabeen Fayyaz, Shivam Gupta, Junaid A. Razzak, Adnan A Hyder, Asad Mian

Department of Emergency Medicine

Background: There is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system.
Methods: Through the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of …

Uncovering The Burden Of Intentional Injuries Among Children And Adolescents In The Emergency Department, Uzma R. Khan, Butool Hisam, Nukhba Zia, Mohammed Umer Mir, Olakunle Alonge, Seemin Jamali, Adnan Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

Introduction: In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan.
Methods: The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional …

Dead On Arrival In A Low-Income Country: Results From A Multicenter Study In Pakistan, Munawar Khursheed, Junaid Ahmad Bhatti, Fatima Parukh, Asher Feroze, Syed Saad Naeem, Haseeb Khawaja, Junaid Razzak

Department of Emergency Medicine

BACKGROUND:

This study assessed the characteristics of dead on arrival (DOA) patients in Pakistan.

METHODS:

Data about the DOA patients were extracted from Pakistan National Emergency Department Surveillance study (Pak-NEDS). This study recruited all ED patients presenting to seven tertiary care hospitals during a four-month period between November 2010 and March 2011. This study included patients who were declared dead-on-arrival by the ED physician.

RESULTS:

A total of 1,557 DOA patients (7 per 1,000 visits) were included in the Pak-NEDS. Men accounted for two-thirds (64%) of DOA patients. Those aged 20-49 years accounted for about 46% of DOA patients. Nine …

Emergency Care Of Traumatic Brain Injuries In Pakistan: A Multicenter Study, Junaid Ahmad Bhatti, Kent Stevens, Muhammad Umer Mir, Adnan Ali Hyder, Junaid Razzak

Department of Emergency Medicine

Background:

This study assessed factors associated with emergency care outcomes and out-of-pocket treatment costs in traumatic brain injury (TBI) patients in Pakistan.

Methods:

Data on TBI patients were extracted from a four-month surveillance study conducted in the emergency departments (ED) of seven large teaching hospitals. Emergency care access to physicians and imaging facilities were compared with respect to ED outcomes (discharged, admitted or dead). Out-of-pocket treatment costs (in United States dollars [USD]) were compared among different patient strata.

Results:

ED outcomes were available for 1,787 TBI patients. Of them, most were males (79%), aged <25 years (46%) and arrived by ambulances (32%). Nurses or paramedical staff saw almost all patients (95%). Physicians with practice privileges (medical officers, residents or consultants) saw about half (55%) of them. Computerized tomography (CT) scans were performed in two of five patients (40%). Of all, 26% (n = 460) were admitted and 3% died (n = 52). Emergency care factors significantly associated with being admitted or died were arriving by ambulance (adjusted odds ratio [aOR] = 2.37, 95% confidence interval (CI) [95%CI] = 1.78-3.16); seen by medical officer/residents (aOR = 2.11; 95%CI = 1.49-2.99); and had CT scan (aOR = 2.93; 95%CI = 2.25-3.83). Out-of-pocket treatment costs at the ED were reported in 803 patients. Average costs were USD 8, (standard deviation [SD] = 23). Costs were twice as high in those arriving in ambulances (USD 20, SD = 49) or who underwent CT scans (USD 16, SD = 37).

Conclusion:

TBI patients' access to ambulance …

Ambulance Use In Pakistan: An Analysis Of Surveillance Data From Emergency Departments In Pakistan., Nukhba Zia, Hira Shahzad, Syed Muhammad Baqir, Shahab Shaukat, Haris Ahmad, Courtland Robinson, Adnan Ali Hyder, Junaid Razzak

Department of Emergency Medicine

Background:

The utilization of ambulances in low- and middle-income countries is limited. The aim of this study was to ascertain frequency of ambulance use and characteristics of patients brought into emergency departments (EDs) through ambulance and non-ambulance modes of transportation.

Methods:

The Pakistan National Emergency Departments Surveillance (Pak-NEDS) was a pilot active surveillance conducted in seven major tertiary-care EDs in six main cities of Pakistan between November 2010 and March 2011. Univariate and multivariate logistic regression was performed to investigate the factors associated with ambulance use.

Results:

Out of 274,436 patients enrolled in Pak-NEDS, the mode of arrival to the …

Pattern Of Presenting Complaints Recorded As Near-Drowning Events In Emergency Departments: A National Surveillance Study From Pakistan., Siran He, Jeffrey C. Lunnen, Nukhba Zia, Uzma Rahim Khan, Khusro Shamim, Adnan Ali Hyder

Department of Emergency Medicine

Background:

Drowning is a heavy burden on the health systems of many countries, including Pakistan. To date, no effective large-scale surveillance has been in place to estimate rates of drowning and near-drowning in Pakistan. The Pakistan National Emergency Department Surveillance (Pak-NEDS) study aimed to fill this gap.

Method:

Patients who presented with a complaint of “near-drowning” were analyzed to explore patterns of true near-drowning (unintentional) and intentional injuries that led to the “near-drowning” complaint. Bivariate analysis was done to establish patterns among patients treated in emergency departments, including socio-demographic information, injury-related information, accompanying injuries, and emergency department resource utilization.

Result: …

Comparison Of Outcomes In Heart Bypass Patients Undergoing Insertion Of An Internal Jugular Vein Central Line By Ultrasound Compared To Traditional Landmark Technique, Sayha Ol Ma

Doctoral Projects

Patients that undergo heart bypass surgery require central line placement from a healthcare provider. To place this device one must use either ultrasound guided or landmark technique. Using ultrasound guided compared to landmark technique may reduce complications. The goal of this project was to determine if ultrasound use of central line placement is a safer practice compared to using the traditional technique.

A retrospective chart review was performed to compare internal jugular central line placement by ultrasound with the traditional landmark placement to evaluate results related to patient outcomes. Data from fifty health records were analyzed using chi-square. The complications …

The Regional Study Of Sleep-Related Behaviors Of Nurse Anesthetists: Personal And Professional Implications: A Replication Study, Jarrod Fontenelle

Doctoral Projects

Universally, anesthesia providers are expected to be knowledgeable, astutely responding to clinical challenges while maintaining a prolonged vigilance for administration of safe anesthesia and critical care. A fatigued anesthetist is the consequence of cumulative acuity manifesting as decreased motor and cognitive powers. This results in patient harm, impaired judgement, late and inadequate responses to clinical changes, poor communications, and medical errors. With increased expectations and medical-legal claims, anesthesiologists work to provide efficient and timely services, but are rendered sleep deprived themselves. It is the right time to address the issue of the health of anesthesia providers and the profession. The …

Does The Use Of A Regional Nerve Block Decrease The Incidence Of Post Operative Nausea And Vomiting, Decrease Pain Scores, Or Decrease Discharge Time Compared To General Anesthesia Alone?, Donald Lane Whitney

Doctoral Projects

Problem Statement: The use of regional anesthesia in orthopedic surgeries has been shown to decrease the rate of postoperative nausea and vomiting (PONV), postoperative pain, and decrease postoperative discharge time. However, some healthcare facilities continue to provide anesthesia for these procedures without the use of regional anesthesia techniques.

Purpose: The purpose of this capstone project was to determine if the addition of a regional anesthetic technique would be beneficial to the patient and cost efficient to the healthcare facility.

Methods: A retrospective chart review was conducted and data collected on the population of interest. Inclusion criteria were patients undergoing orthopedic …

Evaluation Of Vaccination Policies Among Outpatient Oncology Clinics In Utah: A Pilot Study, Karlen Beth Luthy, Sarah L. Stocksdale, Janelle L B Macintosh, Lacey M. Eden, Renea L. Beckstrand, Katherine Edmonds

Faculty Publications

Background: In Utah, all major hospital facilities have employee vaccination policies. However, the presence of health care worker vaccination policies in the Utah outpatient oncology setting was unknown.

Objectives: The objectives were to identify Utah oncology outpatient employee vaccination policies and to identify what consequences, if any, were present for unvaccinated employees.

Methods: This was a cross-sectional, descriptive study design in which clinic managers from outpatient oncology clinics in Utah were asked, via questionnaire, to describe the clinic’s employee vaccination policy and the consequences for refusing the policy.

Findings: Most vaccination policies applied to employees primarily assigned to work in …

Preventing Surgical Site Infections By Utilizing Chg Wipes For Preoperative Skin Preparation, Jini K. Paek

Master's Projects and Capstones

Abstract

The Clinical Nurse Leader project took place at a 106-bed community hospital in Washington. The microsystem has five operating rooms where they provide outpatient, and inpatient surgical procedures. The goal of this project is to reduce and sustain a near zero number of surgical site infections by implementing the use of a no rinse 2% CHG cloth in the surgical patient. The specific aim of the project is to reduce the rate of SSIs by 80% by December 31^st, 2015. Due to a lack of a standardized care, specifically designed for the prevention of SSIs, the microsystem …

A Pilot Study Of Propofol As An Anti-Emetic In Laparoscopic, Gynecologic Surgery Patients, Flem-Flam Aaron Flemister

Doctoral Projects

The goal of this project was to use sub-hypnotic doses of propofol to decrease post operative nausea and vomiting (PONV) rates in the immediate post-operative period in females, ages 18-65, undergoing laparoscopic gynecologic surgery.

PONV is one of the largest complications of anesthesia affecting 20-30% of all surgical patients. Risk factors associated with PONV are female gender, laparoscopy, general anesthesia, opioids, volatile agents, and post-operative pain; all of which are frequently encountered. The incidence of PONV can prolong recovery time, delay discharge, increase patient cost, decrease patient satisfaction, and can cause significant medical complications. Propofol has previously demonstrated anti-emetic properties; …

The Effectiveness Of A Preoperative Multimodal Antiemetic Regimen On Reducing Early Postoperative Nausea And Vomiting In Total Joint Arthroplasty Patients, Jerry Mosley

Doctoral Projects

Postoperative nausea and vomiting (PONV) occurs frequently in all types of surgeries including after total joint orthopedic procedures. The resulting PONV can lead to many unwanted occurrences including immobilization, distress, and many serious adverse health complications. These unwanted occurrences may then lead to increased cost to the patient and healthcare facility. Administration of a preoperative multimodal regimen known to reduce PONV has the potential to reduce such unwanted anesthetic side effects influencing a reduction in overall healthcare cost. The purpose of this study is to determine the effectiveness of the preoperative kit which includes the administration of metoclopramide, famotidine, ondansetron, …

The Effects Of Consistent Exercise On Work Productivity Among Anesthesia Providers, Samuel K. Self

Doctoral Projects

Studies have been done that link various measurements of workplace productivity with varying levels of individual health. A thorough literature review examined the research to find any significant relation between regular exercise (as defined by the American Heart Association) and an improvement in workplace productivity among anesthesia providers. A Qualtrics survey was used to measure specific results regarding exercise activity and work productivity from anesthesia providers. This group included 53 certified registered nurse anesthetists and anesthesiologists. Descriptive analysis, Chi-square test of Independence, Fisher’s Exact test, and Cramer’s V test were all used to analyze the data. One significant correlation was …

Family Centered Care In Icu Settings, Victoria Kingsinger

Honors Theses

More than 5 million patients are admitted each year to Intensive Care Units (ICUs) in the US, and approximately 55,000 critically ill patients are cared for each day. ICU patients are a diverse population that has a need for an increased level of care. These patients often require ventilatory or cardiovascular support, invasive monitoring, and intense nursing and physician observation (Society of Critical Care Medicine, 2015). There are five primary admitting diagnoses for adults, which include respiratory failure, postoperative management, ischemic heart disorders, and sepsis. The mean age of patients is rising, particularly due to the baby boom generation, and …

Recommendations For The Development Of New Hospital Guidelines Due To The Effects Of Antibiotics On Clostridium Difficile Colitis, Megan Kohsel

Honors Theses

Clostridium difficile colitis is an infection that causes inflammation of the colon and diarrhea. This can even lead to death in some cases. The incidence of this infection and its overall effects have been on the rise throughout the last twenty years as antibiotics have been prescribed more frequently. Therefore, it is necessary that the rate of C. difficile infection is lowered by improved guidelines for hospitals, so that fewer people are infected and also that fewer antibiotics are prescribed to avoid the infection with C. difficle.

Burn Injury Characteristics: Findings From Pakistan National Emergency Department Surveillance Study, Emaduddin Siddiqui, Nukhba Zia, Asher Feroze, Safia Awan, Arifa Liaquat Ali, Junaid Razzak, Adnan Hyder, Asad Latif

Department of Emergency Medicine

Background: Burn injury is an important yet under-researched area in Pakistan. The objective of this study was to determine the characteristics and associated outcomes of burn injury patients presenting to major emergency departments in Pakistan.
Methods: Pakistan National Emergency Department Surveillance (Pak-NEDS) was a pilot active surveillance conducted between November 2010 and March 2011. Information related to patient demographics, mode of arrival, cause of burn injury, and outcomes was analyzed for this paper. Data were entered using Epi Info and analyzed using SPSS v.20. Ethical approval was obtained from all participating sites.
Results: There were 403 burn injury patients in …

Effectiveness Of Food-Demos To Increase Nutrition Knowledge, Megan Hemmelgarn

Honors Projects

This research investigated the effectiveness of a one-time food-demo at increasing the knowledge and improving the behavior of vegetable and diary consumption in the diets of college-aged females. Participation included a convenience sample of 26 college-aged females living in residence halls at a Bowling Green State University in Northwest Ohio. Testing was delivered before intervention as a baseline of knowledge and diet behavior. Post-testing was delivered immediately after intervention and evaluated any gain in knowledge from the baseline. One-month after intervention, post 2-testing was distributed evaluating retention of knowledge and behavioral change. Overall, participants experienced knowledge gain immediately after intervention …

Autism Spectrum Disorder: A Case Study Of Mikey, Gabrielle Lober

Honors Theses

This paper describes Autism Spectrum Disorder (ASD) including diagnostic criteria, suspected causes, prevalence, comorbidities, and influences on client factors. A hypothetical case study is presented to give readers an illustration of what someone with ASD might look like. Possible treatment based on evidence and selected frame of references will be given for the hypothetical client. This paper is not all inclusive of the role of occupational therapy in the treatment of Autism Spectrum Disorder, but gives an illustrative example.

Effectiveness Of Iterative Interventions To Increase Research Productivity In One Residency Program., Richard Alweis, Suzanne Wenderoth, Anthony A. Donato

Reading Hospital Internal Medicine Residency

BACKGROUND: The Accreditation Council for Graduate Medical Education requires residency programs to expose residents to research opportunities.

OBJECTIVE: The purpose of this study was to assess the impact of a series of iterative interventions to increase scholarly activity in one internal medicine residency.

METHODS: Retrospective analysis of the effectiveness of a series of interventions to increase resident and faculty scholarly productivity over a 14-year period was performed using quality improvement methodology. Outcomes measured were accepted regional and national abstracts and PubMed indexed manuscripts of residents and faculty.

RESULTS: Initially, regional meeting abstracts increased and then were supplanted by national meeting …

Role Of Maternal Dietary Peanut Exposure In Development Of Food Allergy And Oral Tolerance, Magdia De Jesus

Biomedical Sciences Faculty Scholarship

Background The impact of maternal ingestion of peanut during pregnancy and lactation on an offspring’s risk for peanut allergy is under debate. Objective To investigate the influence of maternal dietary peanut exposure and breast milk on an offspring’s allergy risk. Methods Preconceptionally peanut-exposed C3H/HeJ females were either fed or not fed peanut during pregnancy and lactation. The offsprings’ responses to peanut sensitization or oral tolerance induction by feeding antigen prior to immunization were assessed. We also assessed the impact of immune murine milk on tolerance induction pre- or post-weaning. For antigen uptake studies, mice were gavaged with fluorescent peanut in …

The Effects Of Neuromobilization Combined With Posture Training In The Management Of A Patient With Cervical Radiculopathy: A Case Report, Courtney Naimi

Case Report Papers

Background and Purpose: Management of cervical radiculopathy can include cervical traction, neural mobilization, manual therapy, and therapeutic exercise, whereas management of lateral epicondylitis can include eccentric tendinopathy management, manual therapy, and therapeutic exercise. Some evidence exists discussing neuromobilization for the management of axial diagnoses. However, there is sparse literature describing neuromobilization for management of both the presence of right C7, C8 radiculopathy and contralateral lateral epicondylitis. Therefore, the purpose of this case report is to discuss the outcomes of neuromobilization techniques for a patient presenting with right C7, C8 cervical radiculopathy with contralateral lateral epicondylitis. Case Description: A 64-year-old male …

A Body-Based Program Development Project To Prevent Burnout Among Mental Healthcare Professionals, Amanda J. Abeling

Creative Arts Therapies Theses

Using the Delphi Method as a guide, a self-care program for staff members was developed out of one dance/movement therapy intern’s experiences at a suburban mental healthcare facility. Designed to increase one’s connection to self, personal observations were gathered, professionals in the field were consulted and the program was created and implemented. Themes of stress, fatigue, and burnout among the mental health care profession are discussed. Previous research on body awareness, dance/movement therapy theories, and self-care are also discussed in order to provide a framework with which to understand the development of the program. 72 pages.

Dance/Movement Therapy In-Service Model: A Collaborative Creation, Erin Arline Howe

Creative Arts Therapies Theses

The purpose of this thesis was to create a dance/movement therapy (DMT) in-service model for dance/movement therapists to effectively communicate and increase knowledge about DMT to colleagues on an interdisciplinary team. The Delphi Method was used to organize a panel of professional dance/movement therapists to collaborate and produce a cohesive in-service for other professional dance/movement therapists. Panel members offered their perspectives on the following research questions: What are effective ways to communicate the work of a dance/movement therapist to an interdisciplinary team? Which ways are ineffective in communicating the work of a dance/movement therapist to an interdisciplinary team? How do …