Medicine and Health Sciences Commons^™

Heart Failure Patient Self-Care: An Evidence-Based Outpatient Management Program, Christine Marie Ensign, Shelley Hawkins, Barry Greenberg

Doctor of Nursing Practice Final Manuscripts

Background: According to the American Heart Association, there are over 5 million people in the United States with heart failure (HF) and projections suggest the prevalence of HF will increase by 46% through 2030. HF is the most common cause of hospital admissions in the United States for patients age 65 years or older and despite improvement outcomes, national readmission rates remain high at 23%. Current guidelines recommend health professionals provide comprehensive HF education and counseling that is not only focused on knowledge, but also on skills of management and self-care behaviors. In order to achieve quality patient-centered care, …

Improving Utilization Of 2012 Asccp Guidelines In A Family Practice Setting, Michelle M. Mccormick, Mary Barger

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project is to decrease unnecessary colposcopy referrals using provider education and user friendly tools. This is accomplished by increasing utilization of the 2012 American Society for Colposcopy and Cervical Pathology (ASCCP) Guidelines at a Military Treatment Facility Family Practice Clinic. Despite clear cervical cancer screening guidelines, nationwide, women are continuing to have unnecessary Pap testing regardless of HPV status. Over screening can result in an increase in false positive results, leading to rising healthcare costs, additional office visits, and stress to the patient from procedures that yield little useful information or decrease in morbidity. Although …

Managing End-Of-Life Pain Using A Rectal Medication Administration Device, Yen T. Kim

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project was to improve end-of-life pain management among hospice patients using a rectal medication administration device (RMAD).

Background: Approximately 1.5 to 1.6 million patients received hospice services in 2013 (National Hospice and Palliative Care Organization, 2013), and almost 75% of terminally ill patients experience pain during the dying process (Fink & Gates, 2010). Patients are often unable to tolerate oral pain medications at the end of life. Rectal administration of medication is an appropriate alternative for these patients. The rectal route has several benefits including low cost, consistent and predictable absorption of medications, ease of …

Emergency Protocol Program For High School Athletes, Casandra B. Moyer

Doctor of Nursing Practice Final Manuscripts

This evidence-based project (EBP) involved development and implementation of an emergency protocol (EP) education program for high school athletes and coaches at a southern California high school. A Doctor of Nursing Practice student, collaborating with health care and athletic personnel, conducted an assessment of the high school’s EPs for management of asthma, anaphylaxis, diabetes, and heat illness. Then, an EP and educational program were created; coaches and athletes were educated on the protocol during a coaches’ meeting and practice times, respectively. All participants completed pre- and post-tests, and mean knowledge scores were compared. The overall knowledge score increased by 10% …

Reducing Antipyretic Use For Low-Grade Fevers In Otherwise Healthy Children, Tricia A. Templet

Doctor of Nursing Practice Final Manuscripts

Fever phobia is persistent in the pediatric population, as fever is a common complaint for advice calls, sick visits, and urgent care/emergency department utilization. Fever phobia among parents and healthcare providers is evidenced by the quest to return a child to normothermia. Fevers under 38.5ºC (101.3ºF) are considered benign in healthy children, usually requiring no pharmaceutical intervention. Research consistently demonstrates pediatric nurses inappropriately medicate patients for low-grade fevers. The purpose of this evidence-based practice project was to identify knowledge of the benefits and myths of fever in otherwise healthy children and to decrease the use of antipyretics for low-grade fevers …

Diabetic Prevention The Hard Way: Modified Diet And Increased Exercise, Torrie Reese St.Julien

Doctor of Nursing Practice Final Manuscripts

Background and Purpose: In the United States, 79 million people are pre-diabetic: most have no symptoms. If left untreated, 37% will develop diabetes within 4 years. Fourteen percent of United States health care expenditures are related to diabetic complications. This Evidenced Based Project (EBP) involved a behavioral lifestyle change with the purpose of 7% weight loss and a minimum of 150 minutes of physical activity a week. It was also designed to reduce risk factors and glycated hemoglobin A1c (HgA1c) levels.

Methods: The interventional approach was modeled after the Diabetes Prevention Program (DPP) and Group Lifestyle Balance Program. Participants were …

Promoting Completion Of Advance Directives In A Hispanic Religious Congregation: An Evidence-Based Practice Project, Luis Daniel San Miguel, Mary Jo Clark

Doctor of Nursing Practice Final Manuscripts

Background: Hispanics utilize more aggressive medical treatment at the end of life and are less likely to receive end-of-life care consistent with their wishes than nonHispanic Whites. Hispanics are less likely than nonHispanic Whites to have an advance directive (AD). Increasing AD completion among Hispanics can promote end-of-life care consistent with their wishes, diminish healthcare disparities, and eliminate unnecessary healthcare spending. Objectives: To promote completion of advance directives by increasing knowledge, positive attitudes, and comfort with advance care planning (ACP) among Hispanics through culturally sensitive interventions. Intervention: The project was conducted in Spanish and implemented among a …

Improving Hpv Vaccinations In Military Women, Sarah Beth Wedel

Doctor of Nursing Practice Final Manuscripts

Project Purpose: The purpose of the project was to implement Human Papillomavirus (HPV) patient education during every well woman exam (WWE) to improve patient knowledge and HPV vaccination rates in military women aged 18-26 years.

Background: The Human Papillomavirus (HPV) has been identified as the biggest risk factor for cervical cancer and, despite the availability of a vaccine; HPV continues to be the most common STI in the U. S. (American Cancer Society, 2013). Approximately 79 million Americans are currently infected with HPV, and 14 million individuals will become infected annually, leading to more than 10,000 cases of cervical cancer …

Supporting Self-Management In Veterans With Chronic Pain: A Policy Perspective, Erin W. Lind

Doctor of Nursing Practice Final Manuscripts

The purpose of the project was to do an evidence-based review of the effectiveness of promoting self-care on pain levels and quality of life among veterans with chronic pain at a national level. A review of current chronic pain management policies for veterans in southern California was also conducted. Active self-management initiatives permit more diverse, patient-centered treatment, promote self-management, and are relatively safe and cost-effective. Our results have confirmed that chronic pain is on the forefront of priorities for the Veterans Health Administration (VHA) due to an increasing rate of both chronic pain and opioid overdoses.

Transition Program For Adolescents With Congenital Heart Disease Focusing On Self-Management Knowledge, Elizabeth A. Hartman Valles, Kathleen Sweeney Cpnp, Jeffrey Frazer M.D.

Doctor of Nursing Practice Final Manuscripts

Introduction: The primary goal of this project was to implement a pilot transition education program to prepare adolescents with congenital heart defects (CHD) by increasing knowledge about self-management of their health condition.

Method: An educational program was developed and included use of an interactive binder. A total of 20 adolescents with CHD between the ages of 16 – 18 years participated in transition education during a single outpatient cardiology visit with pre and post education knowledge assessment performed using the Leuven Knowledge Questionnaire for Congenital Heart Disease (LKQCHD).

Results: Following participation in the transition education, the overall mean knowledge scores …

Fatalism, Diabetes Management Outcomes, And The Role Of Religiosity, Vincent Berardi, John Bellettiere, Orit Nativ, Slezak Ladislav, Melbourne Hovell, Orna Baron-Epel

Psychology Faculty Articles and Research

This study aimed to determine whether fatalistic beliefs were associated with elevated levels of glycated hemoglobin (HbA1c) and to establish the role of religiosity in this relationship. A cross-sectional survey was conducted on a sample of 183 Jewish adults with diabetes visiting a large medical center in northern Israel. Self-administered questionnaires assessed level of religiosity, fatalistic beliefs, diabetes management behaviors, and demographic/personal characteristics; laboratory tests were used to measure HbA1c. Multivariate regression indicated that fatalism was significantly associated with HbA1c (β = 0.51, p = 0.01). The association was no longer statistically significant after including self-reported religiosity in the …

Telephone Calls To Reduce 30-Day Readmissions For Older Adults With Heart Failure, Juanette G. Clark

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this evidenced based practice project was to evaluate the effectiveness of discharge follow-up calls for heart failure (HF) patients recently discharged from a private hospital.

Background: HF is the number one discharge diagnosis among patients 65 years and older. It affects 5.8 million people in the United States. HF admissions total (1) million annually, however, 24% of these patients are readmitted within 30 days of discharge. Re-hospitalizations are associated with high mortality rates and expenditures approximated at $13,000 per patient contributing to the overall annual expenditure of $33.7 billion. In 2012, the Centers for Medicare …

Transition After Breast Cancer Treatment: Implementing Survivorship Care Plans, Susan Hope Klein

Doctor of Nursing Practice Final Manuscripts

The success of cancer treatments have resulted in a rapid growth of survivors, providing the impetus for the oncology community to examine models of care supporting smooth transition from active treatment to survivorship care. While initially a recommendation of the Institute of Medicine, treatment summaries and survivorship care plans are now an accreditation requirement for many organizations. This article describes the implementation of an evidence based practice project designed to meet these standards while improving the knowledge and satisfaction of a population of breast cancer patients at a community-based oncology practice.

Instituting Patient-Self Test Meters In Adults On Warfarin In A Cardiology Practice, Melvyn Grace Manzano Rabanal

Doctor of Nursing Practice Final Manuscripts

Background: Warfarin is the oral anticoagulant that is most commonly used to control and prevent thromboembolic disorders. It requires meticulous testing and dosing adjustments to attain therapeutic international normalized ratio (INR) levels. Patient self-testing (PST) is associated with a reduced risk of all-cause mortality and lower rates of thromboembolism and bleeding. PST meters offers convenience and promotes self-initiative of care.

Purpose: The purpose of the project is to evaluate the effectiveness of INR PST in adult patients diagnosed with atrial fibrillation, deep vein thrombosis, and mechanical heart valve on warfarin therapy in a Cardiology practice compared to traditional …

Improving Asthma Symptoms Using Asthma Action Plans, Ryan Daniel Thebo, Michael Terry

Doctor of Nursing Practice Final Manuscripts

Asthma is a chronic disorder characterized by airflow obstruction, causing chest tightness, wheezing, coughing, and shortness of breath. In California, 7.9% of patients have an asthma diagnosis. The 2007 NHLBI Expert Panel Report 3 recommended using asthma action plans in asthma management (NHLBI, 2007). Patients with asthma were taught to use an AAP to improve asthma control. Overall, 80% of patients improved by at least one EPR3 asthma control category.

Antigen Discovery For The Identification Of Vaccine Candidates And Biomarkers Using A T Cell Driven Approach In Combination With Positional Scanning Peptide Libraries, Valeria A. Judkowski, Radleigh Santos, Gonzalo R. Acevedo, Marc Giulianotti, Jon R. Appel, Silvia A. Longhi, Karina A. Gomez, Clemencia Pinilla

Mathematics Faculty Articles

The prevention and treatment of infectious diseases is highly dependent on the availability of reliable diagnostic tests and protective or therapeutic vaccines. There also exists an urgent need to develop reliable biomarkers to monitor treatment success and to predict disease progression from asymptomatic to symptomatic disease in several disease scenarios. The elucidation of the disease-relevant antigens that elicit the protective immune responses is critical and required for the development of biomarkers, diagnostics, and vaccines. However; one of the main obstacles to the study of antigen specificity in human T cells is their low frequency in PBMC samples. To overcome this …

Implementation Of An Evidence-Based Educational Workshop And Toolkit: Menopausal Women's Healthcare Needs For The Primary Care Provider, Pamela Doerr-Kashani Dnp, Rn

Doctor of Nursing Practice (DNP) Projects

This evidence-based change of practice project involved the development of an educational workshop for primary care providers (PCPs). The intent of the project was to improve PCP’s knowledge of menopausal health, and to create their comfort level when discussing menopausal healthcare with clients. The workshop Menopausal Women’s Healthcare Needs for the Primary Care Provider (Doerr-Kashani, 2014) was created in response to an identified gap in knowledge among PCPs nationally on menopause-related health issues. The workshop was designed as a resource to support PCPs to competently address women’s menopause-related health issues, and enable them to provide comprehensive, evidence-based care within the …

Human Dna Exonuclease Trex1 Is Also An Exoribonuclease That Acts On Single-Stranded Rna, Fenghua Yuan, Tanmay Dutta, Ling Wang, Lei Song, Liya Gu, Liangyue Qian, Anaid Benitez, Shunbin Ning, Arun Malhotra, Murray P. Deutscher, Yanbin Zhang

Toxicology and Cancer Biology Faculty Publications

3' repair exonuclease 1 (TREX1) is a known DNA exonuclease involved in autoimmune disorders and the antiviral response. In this work, we show that TREX1 is also a RNA exonuclease. Purified TREX1 displays robust exoribonuclease activity that degrades single-stranded, but not double-stranded, RNA. TREX1-D200N, an Aicardi-Goutieres syndrome disease-causing mutant, is defective in degrading RNA. TREX1 activity is strongly inhibited by a stretch of pyrimidine residues as is a bacterial homolog, RNase T. Kinetic measurements indicate that the apparent K_m of TREX1 for RNA is higher than that for DNA. Like RNase T, human TREX1 is active in degrading native …

Implementing A Rib Fracture Management Pathway And Pic Scoring Tool To Reduce Icu Readmissions, Susan Mastroianni

Master's Projects and Capstones

The purpose of the project was to improve the management of patients with rib and or sternal fractures in a 413 bed Level I Trauma Center. The pathway included best practice guidelines paired with clinical expertise to reduce Intensive Care Unit (ICU) readmissions, costs, complications and length of stay (LOS). Analysis of the data revealed 55% of ICU readmissions were due to respiratory causes. The timeline guided the creation, deployment, and evaluation of the project over a two phase, one and one half year period. Methods included analysis of the data, meetings with lead team members to define the scope …

Human Dna Exonuclease Trex1 Is Also An Exoribonuclease That Acts On Single-Stranded Rna, Fenghua Yuan, Tanmay Dutta, Ling Wang, Lei Song, Liya Gu, Liangyue Qian, Anaid Benitez, Shunbin Ning, Arun Malhotra, Murray P. Deutcher, Yanbin Zhang

ETSU Faculty Works

3′ repair exonuclease 1 (TREX1) is a known DNA exonuclease involved in autoimmune disorders and the antiviral response. In this work, we show that TREX1 is also a RNA exonuclease. Purified TREX1 displays robust exoribonuclease activity that degrades single-stranded, but not double-stranded, RNA. TREX1-D200N, an Aicardi-Goutieres syndrome disease-causing mutant, is defective in degrading RNA. TREX1 activity is strongly inhibited by a stretch of pyrimidine residues as is a bacterial homolog, RNase T. Kinetic measurements indicate that the apparent Km of TREX1 for RNA is higher than that for DNA. Like RNase T, human TREX1 is active in degrading native tRNA …

Re-Examination Of 30-Day Survival And Relapse Rates In Patients With Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome, Cassiana E. Bittencourt, Jennifer P. Ha, Robert W. Maitta

Faculty Scholarship

Background and Objectives: Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are characterized by microangiopathic hemolytic anemia and thrombocytopenia. Interestingly, markedly different survival rates have been reported despite increases in survivability. We studied TTP-HUS 30-day mortality and relapse rates of patients who received TPE at our institution and compared them to published data. Patients and Methods: Retrospective study analyzed 30-day mortality and relapse rates attributed to TTP-HUS from 01/01/2008 to 12/31/2012 and compared them to comparable literature reporting mortality and survival. Studies describing other etiologies for TPE and different mortality time interval were excluded. Results: Fifty-nine patients were analyzed …

Value-Based Medicine: The Financial Impact Of A Pressure Ulcer Prevention Program On A Trauma Population, Jayme D. Lieberman Md, Patrick S. Duffy Md, Kai L. Bortz Rn, Rovinder S. Sandhu Md, Michael D. Pasquale Md, Facs, Fccm, Michael M. Badellino Md

Department of Surgery

No abstract provided.

Prospectus Summary Brief: Nicu Communication Improvement, Joy E. Lawley

Master's Projects and Capstones

Joy Lawley RNC, NICU Communication Improvement: A prospectus summary brief. Effective communication in the neonatal intensive care unit (NICU) not only reduces errors and adverse patient outcomes but also create an environment that promotes staff satisfaction. The purpose of this prospectus is that of improving the process of communication between the perinatal departments. The specific aim was to improve communication to the NICU through standardize communication tools (SBAR) from patient delivery to discharge starting April 1, 2015. With 100% participation of all staff members within a three month period and a 95% staff satisfaction related to improved communication from staff …

Genetic Heterogeneity Of Pseudoxanthoma Elasticum: The Chinese Signature Profile Of Abcc6 And Enpp1 Mutations., Liang Jin, Qiujie Jiang, Zhengsheng Wu, Changxia Shao, Yong Zhou, Luting Yang, Jouni Uitto, Gang Wang

Department of Dermatology and Cutaneous Biology Faculty Papers

Pseudoxanthoma elasticum (PXE), an autosomal recessive disorder characterized by ectopic mineralization, is caused by mutations in the ABCC6 gene. We examined clinically 29 Chinese PXE patients from unrelated families, so far the largest cohort of Asian PXE patients. In a subset of 22 patients, we sequenced ABCC6 and another candidate gene, ENPP1, and conducted pathogenicity analyses for each variant. We identified a total of 17 distinct mutations in ABCC6, 15 of them being, to our knowledge, previously unreported, including 5 frameshift and 10 missense variants. In addition, a missense mutation in combination with a recurrent nonsense mutation in ENPP1 was …

Acute Care Surgical Service Experience With Ruptured Visceral Artery Aneurysms, Jayme D. Lieberman Md, Meghan L. Good Md, Rovinder S. Sandhu Md, Michael M. Badellino Md

Department of Surgery

No abstract provided.

Indications For Warfarin In Trauma Patients, Victor V. Ha Md, Rovinder S. Sandhu Md

Department of Surgery

No abstract provided.

Robotic Sublobar Resection For The Surgical Management Of Isolated Pulmonary Nodules, Victor S. Reis Md, Kyle M. Langston Pa-C, Alec Talsania, Alexander Werner, Michael F. Szwerc Md, Timothy S. Misselbeck, Mark E. Perry Md

Department of Surgery

No abstract provided.

Comparison Of Wound Complications In Open Vs Closed Lateral Internal Sphincterotomy For Anal Fissure (Presentation), Gregg M. Baranski Md, Arthur Yushuva Md, John S. Park Md

Department of Surgery

No abstract provided.

Delirium Education For Nurses On A Medical-Surgical Unit, Carole Santos

Master's Projects and Capstones

Failure to recognize delirium compromises patient safety and may lead to harmful outcomes. By June 2015, nurses on medical-surgical units will screen 100-percent of patients for delirium according to an established protocol. The project mesosystem is a 411-bed, level I trauma center and teaching hospital; the microsystem is a 28-bed medical-surgical telemetry unit.

An audit of microsystem data collected over four months in 2014 revealed that delirium was consistently underidentified (10% in September, 26% in October, 34% in November, and 22% in December), suggesting that medical-surgical nurses were not equipped to effectively perform delirium screening.

Nursing education consisting of bedside …

Patient Engagement In Transitional Care, Sheeree Dela Pena

Master's Projects and Capstones

The Clinical Nurse Leader Master’s project was conducted about a public health program called the Transitional Care Program that was working in partnership with a county hospital system, Santa Clara Valley Medical Center. The specific aim was to reduce hospital re-admissions of high-risk patients by supporting patient motivation and engagement in the Transitional Care Program by May 2015. Over a four-month period, data was collected through ten client visits, interviews with two public health nurses, information available about the program, and current research conducted on transitional care, hospital discharges, and patient engagement. Various aspects of the program were assessed, such …