Medicine and Health Sciences Commons^™

Improve Intra-Operative Nurse-To-Nurse Communication Using A Safety Checklist, Silvinita Tadeo Rowe

Doctoral Projects

Poor and inadequate handoff, or transfer of care of the surgical patient care from the primary to the relief operating room registered nurse circulators, can result in irreversible patient harm, or sentinel events, such as retained foreign items. In this study, Rogers' diffusion of innovation theory was the framework for implementing the handoff safety checklist. Also, Donabedian's structure process and outcome was the model to investigate the feasibility, acceptability, and improvement in the quality of patient handoff communication and improvement of nurse satisfaction over time. Nineteen-statement surveys, conducted at multiple timeframes, were completed by volunteer operating room nurse participants. In …

Identifying Factors In Medication Non-Adherence In Teens Diagnosed With Juvenile Arthritis: A Pilot Study, Susan Viola Senzaki

Doctoral Projects

Purpose: The purpose of this study was to identify factors that correlate with medication non-adherence in teens diagnosed with juvenile arthritis. Background: The impact of medication non-adherence often begins in childhood where children depend and learn from their care-givers how to manage their health. Children with chronic disorders are among those at risk for a higher medication non-adherence. Juvenile arthritis (JA) is a chronic childhood disorder where often medication non-adherence is an issue. Methodology: This was a mixed-method qualitative and quantitative pilot study. Teens between the ages of 11 – 17 years, with juvenile arthritis were asked to volunteer in …

The Effectiveness Of A Standardized Positioning Tools And Bedside Education On The Developmental Positioning Proficiency Of Nicu Nurses, Arlene Spilker

Doctoral Projects

Developmental positioning for preterm infants is an essential skill for neonatal intensive care unit (NICU) nurses. The benefits of developmental positioning are evident in the literature, but less is known about how NICU nurses learn about developmental positioning. This study examined the effect of the Infant Position Assessment Tool (IPAT) and informal education on the developmental positioning skills of NICU nurses. This quasi-experimental study measured IPAT scores before and after an educational intervention, and found a statistically significant increase in the means of the two groups. The use of the IPAT and bedside education is useful for improving the developmental …

Chinese Community Physicians' Perception Toward Collaboration With Advanced Practice Nurses, Ivy Tan

Doctoral Projects

Effective interprofessional collaboration has been shown to be beneficial for both patients and providers. Yet collaboration between physicians and advanced practiced nurses (APNs) has been problematic. Little was known about such collaboration in an ethnic group like the Chinese community. This quantitative descriptive capstone project was to assess the perception among physicians, who are the members of the Chinese Community Healthcare Association in the San Francisco area, toward collaboration with APNs. The study also attempted to gain insight of collaborative attitudes of physicians in the Chinese community in order to fill the gap in the literature in this area. Data …

Attention Deficit Hyperactivity Disorder And Mindfulness Practice In Children And Adolescents: A Comprehensive Review Of Evidence-Based Research, Donna Nikander

Doctoral Projects

Attention Deficit Hyperactivity Disorder (ADHD) is the most common mental illness in the United States among male and female children and adolescents between the ages of 3 and 17. The emerging fields of neurobiology and neuroimaging have proposed a relationship between mindfulness meditation therapies—initially referred to as mindfulness-based stress reduction (MBSR) and now simply known as mindfulness—and improvements in attention and self-regulation, two major problem areas for ADHD sufferers. Furthermore, recent studies suggest that mindfulness therapies may be effective in reducing symptoms of ADHD in children and adolescents. The purpose of this paper is to review, analyze and synthesize the …

Admission Medication Reconciliation Process To Improve Patient Outcomes, Vanessa Ann Irwin

Doctoral Projects

Medication reconciliation is an important process in the acute care setting that has implications for patient safety and outcomes. The medication reconciliation process occurs at transitions in care and involves disciplines including; nurses, pharmacists, and physicians. The role of the nurse in the admission portion of the process includes collecting and entering home medication information into the electronic medical record. It is crucial for the medication information to be entered in an accurate, timely, and complete manner.

The addition of the electronic medical record has not solved documentation challenges related to medication reconciliation but has added more transparency of issues. …

Commercial Sexual Exploitation: The Role Of The Advanced Practice Nurse In Screening Patient At-Risk, Sheri Rickman Patrick

Doctoral Projects

Problem: Human trafficking or commercial sexual exploitation (CSE) is a global problem effecting every country including the United States. The impact of human trafficking while it is devastating to individuals, the impact goes well beyond individual victims and undermines the health, safety and security of all nations (U.S. Department of State Publication, 2007, p. 5).This research is an attempt to assess the knowledge of advance practice nurses or nurse practitioners (NP) in the subject of commercial sexual exploitation and their willingness to screen their patients who may be at-risk.

Methods: The design was web-based with advanced practice nurses who are …

Implementation Of A Patient Satisfaction Survey In A Federally Qualified Health Center, Ricardo Jose Ballin Ii

Doctoral Projects

Safety net FQHCs are typically challenged with initiating and sustaining standardized measurement of patient satisfaction. Baseline survey data establishing how patients rate their satisfaction at San Francisco General Hospital (SFGH) Urgent Care Center (UCC), a public safety net federally qualified health center, located in San Francisco, California is needed. Implementing an existing patient satisfaction survey instrument using a standardized method, with volunteer survey administrators, made this study unique and resulted in a higher rate of survey participation that any other method previously attempted. Survey results determine whether patients' needs and expectations were being met, adding value and allowing for comparison …

Perceived Barriers To Skin To Skin Care From Maternal And Nurse Perspectives, Rachel Alexandra Napoli

Doctoral Projects

The purpose of this doctoral project is to provide foundational data for a skin-to-skin (STS) policy at a community hospital. Two surveys were used to determine the barriers to STS. One survey was given to the nurses electronically in the maternal/child department and the second survey was given to the mothers who delivered at the same hospital during Fall2014. Following data collection, focus groups were formed. The groups consisted of volunteer nurses who reviewed the results of the surveys and developed preliminary data for a STS policy. The three identified barriers to STS by both nurse and maternal surveys were …

Factors Leading To Rapid Response Team Interventions In Adult Medical-Surgical Patients, Christine M. Tarver

Doctoral Projects

Rapid Response Team Intervention (RRTI) is a widely used intervention in acute care hospitals in the United States. Demonstrated effectiveness in preventing transfer to higher level of care or in decreasing in-hospital mortality has not been established. This exploratory study used a retrospective chat1 review to examine differences between medical-surgical acute care inpatients who had an RRTI and a control group. CutTent literature lacks information on proactive detection of patients who may be more likely to deteriorate and therefore require a Rapid Response Team Intervention. Therefore, this study's PICO question was: Are there statistically significant differences between medical-surgical adult inpatients …

Oseltamivir-Warfarin Interaction In Hypoplastic Left Heart Syndrome: Case Report And Review., Jonathan B. Wagner, Susan M. Abdel-Rahman

Manuscripts, Articles, Book Chapters and Other Papers

An 8-year-old boy with hypoplastic left heart syndrome with a previous history of thrombosis within the inferior vena cava receiving stable warfarin dosing for anticoagulation was diagnosed with influenza B. He was subsequently placed on oseltamivir therapy according to the Centers for Disease Control and Prevention clinical practice guidelines. During the hospitalization, his international normalized ratio steadily increased to supratherapeutic levels and returned to baseline after discontinuation of oseltamivir therapy. This case represents a drug-drug interaction that has not been previously reported in children or adolescents. An extensive review of the pharmacokinetic and pharmacodynamic literature did not uncover a definitive …

Himmelfarb Library Liaison Letter - May 2015, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

Teacher Narratives And Student Engagement Testing Narrative Engagement Theory In Drug Prevention Education, Michelle Miller-Day, Michael L. Hecht, Janice L. Krieger, Jonathan Pettigrew, Young Ju Shin, John L. Graham

Communication Faculty Articles and Research

Testing narrative engagement theory, this study examines student engagement and teachers’ spontaneous narratives told in a narrative-based drug prevention curriculum. The study describes the extent to which teachers share their own narratives in a narrative-based curriculum, identifies dominant narrative elements, forms and functions, and assesses the relationships among teacher narratives, overall lesson narrative quality, and student engagement. One-hundred videotaped lessons of the keepin’ it REAL drug prevention curriculum were coded and the results supported the claim that increased narrative quality of a prevention lesson would be associated with increased student engagement. The quality of narrativity, however, varied widely. Implications of …

The Correlation Between Maternal Diabetes And Birth Defects, Erin Stanton

Senior Honors Theses

Diabetes mellitus is one of the most common health problems in the United States, and it is shown to have negative outcomes in infants born to women who are diabetic. Although gestational diabetes mellitus is linked with a few birth defects, research has shown that women with pre-gestational diabetes mellitus have an increased risk of giving birth to infants with birth defects. Among all the defects studied, cardiac and neural tube defects occur most commonly. Appropriate measures should be taken to provide patient teaching, as well as appropriate and effective prenatal care, to women who are at the highest risk …

Vitamin A Is Essential For Proper Embryonic Submandibular Salivary Gland Growth., Deanna Ellene Buenger

Electronic Theses and Dissertations

Submandibular salivary glands (SMG) are important for the production of saliva. Salivary glands may be damaged by autoimmune disease, surgery, or radiation therapy. Retinoic acid (RA) is a signaling metabolite derived from Vitamin A that is essential for proper embryonic growth and development; specifically for cardiovascular, limb and craniofacial development. The goal of this study was to determine if there is a reproducible defect in the growth of SMGs in RA deficient mouse embryos compared to wild type. This study aims to characterize SMG growth in RA deficient embryos and determine if the growth could be stimulated by RA in …

Adolescent And Adult African Americans Have Similar Metabolic Dyslipidemia., Samuel S. Gidding, Scott W. Keith, Bonita Falkner

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: African Americans (AAs) have lower triglyceride (TG) and higher high-density lipoprotein cholesterol (HDL-C) than other ethnic groups; yet, they also have higher risk for developing diabetes mellitus despite the strong relationship of dyslipidemia with insulin resistance. No studies directly compare adolescents and adults with regard to relationships among dyslipidemia, high-sensitivity C-reactive protein (hs-CRP), and insulin resistance. Here, we compare AA adolescents to adults with regard to the relationships of adiposity-related lipid risk markers (TG-to-HDL ratio and non-HDL-C) with body mass index (BMI), waist circumference (WC), homeostasis model of insulin resistance (HOMA), and hs-CRP.

METHODS: Two cohorts of healthy AA …

Policy Considerations For Community Health Workers In An Era Of Health Reform, Sara Kahn-Troster

Muskie School Capstones and Dissertations

In order to better understand how CHWs are being integrated in state health reform initiatives, including facilitating care coordination, enhancing access to community-based services, and addressing social determinants of health, the author, working in collaboration with the National Academy for State Health Policy (NASHP), developed a nation-wide scan of CHW policy activity, published online as State Community Health Worker Models in February, 2015. The CHW chart gives a comprehensive look at how states are utilizing CHWs as part of quality improvement, health care reform, and expanded models of public health.

Evaluation Of Patient To Provider Oriented Telemedicine In Hospitals And Physician Practices, Macklin G. Gaynor

Muskie School Capstones and Dissertations

This project explores barriers to telemedicine adoption and meaningful integration with contemporary healthcare delivery systems.

Conception To Implementation: Quality Improvement In Behavioral Health Home Organizations, Elizabeth A. Miller

Muskie School Capstones and Dissertations

This capstone project developed quality improvement tools to be used by community mental health agencies participating in the Maine Behavioral Health Homes Initiative. Providing technical assistance, analysis of feedback, and developing recommendations were the foundation of this project with a central tenet to enhance the existing Quality Improvement Project Template created by MaineCare, Maine’s Medicaid Office. These recommendations suggest the Quality Improvement Project Template may be improved by providing an additional fillable quality improvement process outline, providing a list of example projects and focus areas for quality improvement projects, and providing tools to assist in implementation of quality improvement projects. …

A Comparison And Analysis Of Community Midwifery Education Programs In Afghanistan With Other Countries, Nematullah Niazi

Muskie School Capstones and Dissertations

The purpose of this paper is to analyze and compare the Afghan Community Midwifery Education program with similar programs in other countries, to identify problems in CME implementation, and to develop recommendations to resolve gaps for a more effective and successful CME approach. To this end, the Afghan CME program is compared with midwifery programs in Pakistan, Kenya, and with Afghanistan’s Institute of Health Science midwife program.

An Inventory Of Community Wellness Programs In Biddeford, Maine, A Silver

Muskie School Capstones and Dissertations

This report highlights wellness initiatives from the perspective of two population segments: those with chronic condition, or those who may be at risk for chronic conditions, and high-risk populations, which this project defines as those living below the federal poverty level who engage in behaviors that potentially lead to avoidable health problems. The rationale was that these groups require extensive resources and that it would be easier to identify gaps in community wellness support for these populations.

Telephone Usage At Mercy Hospital's Primary Care Practices, Julia C. Nason

Muskie School Capstones and Dissertations

This capstone focuses on Mercy’s primary care practices, reviews how their phone process currently works, reasons for patients calling, and then researching best practices for the telephones.

Issues Of Sovereignty In Wabanaki Communities And Impacts On Health Outcomes, Ralph E. Cammack

Muskie School Capstones and Dissertations

The purpose of this capstone is to explore how Wabanaki communities of Maine experience sovereignty as it relates to the dominant culture of Maine and how this interaction has led to current health outcomes and disparities. I do this by examining how the communities view sovereignty and understanding how internalized anger impacts these communities.

Evidence Informed Checklist Increase Patient Experience Of Quietness During A Hospital Stay, Monica Alborg

Muskie School Capstones and Dissertations

This checklist is made to be used by staff at hospitals, especially nurse managers and quality improvement specialists. A staff member can pick and choose what items on the checklist are feasible to implement within their organization. Ongoing quality improvement strategies are suggested in the checklist to remain abreast of ways to mitigate noise in hospitals.

The Role Of G Protein-Coupled Estrogen Receptor In Vascular Function And Hypertension, Natalie Catherine Fredette

Biomedical Sciences ETDs

Regulation of arterial tone relies heavily on molecular crosstalk between endothelial and smooth muscle cells. Although it has been demonstrated that estrogen (E2) exerts protective effects against cardiovascular disease (CVD), the exact mechanisms and balance of E2 signaling in endothelial and smooth muscle cells remain unresolved. Here we characterize the G protein-coupled estrogen receptor (GPER) in the vasculature by elucidating its pathway in endothelial nitric oxide (NO) production and vascular smooth muscle maintenance of reactive oxygen species (ROS) by NADPH oxidases (NOX). NO is thought of as a vasoprotective entity, while the overproduction of ROS by NOX can lead to …

In Vivo Characterization Of G Protein-Coupled Estrogen Receptor In Mammary Tumorigenesis, Nicole Andrea Marjon

Biomedical Sciences ETDs

The steroid hormone, estrogen (17β-estradiol or E2), is involved in numerous and varied physiological processes. Until recently, all E2-dependent effects were thought to be propagated exclusively through the classical estrogen receptors (ERs), ERα and ERβ. However, in double ERα/β knockout mice, select E2-dependent effects remain, suggesting the existence of additional E2 receptors, such as the G protein-coupled estrogen receptor (GPER) 1. E2 plays a central role in the progression of breast cancer, and inhibiting E2 signaling in women with breast cancer increases long-term survival. The role of GPER in breast cancer is largely unknown. E2 stimulation of GPER activates the …

The Role Of Ofd1 In The Pathogenesis Of Polycystic Kidney Disease, Stephanie Justine Jerman

Biomedical Sciences ETDs

Oral-facial-digital syndrome type1 (OFD1) is an inherited disorder caused by expression of mutant OFD1 protein and results in abnormalities in facial and limb development and polycystic kidney disease that resembles Autosomal Dominant Polycystic Kidney Disease (ADPKD). The similarities in renal disease pathogenesis in patients with OFD1 and ADPKD suggest that the proteins implicated in these diseases, OFD1 and the polycystins, respectively, function on a common pathway in the affected cell types. This calls for an investigation to uncover the mechanism by which OFD1 contributes to polycystic kidney disease pathogenesis, which remains unknown. This thesis details for the first time the …

Tumor Promoting Properties Of Field Cancerized Fibroblasts In Cell Culture, Randi L. Smith

Biomedical Sciences ETDs

Our recent studies have shown that Tumor Adjacent Histologically Normal (TAHN) breast tissue demonstrates many of the characteristics of breast tumors. For example, through immunohistochemical staining with markers such as alpha smooth muscle actin and TGF-β, we have shown the accumulation of myofibroblasts in TAHN tissues 1 cm from the tumor margin (TAHN-1). Additionally, TAHN-1 epithelia stain positive for epithelial to mesenchymal transition (EMT) associated proteins, such as transforming growth factor beta and alpha smooth muscle actin. The purpose of this study was to determine if TAHN-1 fibroblasts retained myofibroblast characteristics and if they could induce EMT in primary culture. …

Multilevel Deregulation Of Survival Mechanisms In Npm-Alk+ T-Cell Lymphoma, Deeksha Vishwamitra

Dissertations and Theses (Open Access)

The anaplastic lymphoma kinase (ALK) is a single chain transmembrane receptor tyrosine kinase that belongs to the insulin receptor superfamily. Other members of this superfamily include the insulin receptor (IR), type I insulin-like growth factor receptor (IGF-IR), and the leukocyte tyrosine kinase. The common structural finding among these tyrosine kinases is the YXXXYY motif present within their respective tyrosine kinase domains. Binding of its ligands causes ALK receptor homodimerization and protein kinase activation. ALK has been previously shown to play a significant role during early developmental stages. In human embryos, the expression of ALK is mainly seen in …

Serum Omentin As A Potential Biomarker For Complex Atypical Hyperplasia And Endometrioid Endometrial Adenocarcinoma, Laura L. Holman Md

Dissertations and Theses (Open Access)

Obesity is a significant risk factor for endometrial cancer, the most common gynecologic malignancy in the United States, but much remains unclear about the relationship between obesity-related factors and the development of endometrial cancer. Omentin, a recently discovered adipokine, has been shown to be present in lower levels in patients who are obese and/or insulin resistant. A case-control study was conducted using the serum of 140 women with endometrial cancer and 75 women with endometrial hyperplasia who were matched 1:1 based on body mass index (BMI) and menopausal status to women with no history of endometrial cancer (controls). The concentration …