Medicine and Health Sciences Commons^™

Improving Unit Dynamics: Incorporating Lead Nurse Program On A Medical-Surgical Unit, Kara Mace

Master's Projects and Capstones

Clinical nursing leadership is now recognized as a key professional competency that will assure quality patient care and efficient work processes. The medical-surgical unit (MSU) at VA Mather has had high turnover rates and low staff satisfaction surveys for the past two years, which has led to a decline in staff morale. Lead nurses are in key positions to develop their unit staff, promote leadership development, and they are encouraged to act as role models in their practice. Change is difficult; therefore, the application of essential leadership skills is a necessary accompaniment to a change strategy in order to produce …

Decreasing Wait Times For New Referrals To An Outpatient Specialty Clinic, Marlene A. Evans

Master's Projects and Capstones

Abstract

New patients to an Outpatient Allergy Clinic are waiting for 60 days or more for an appointment which is of concern because of severe allergic reactions, such as anaphylaxis, from which they could suffer.

The aim of this project was to reduce the wait time by 25 percent or 15 days for all newly referred patients to the Children’s Outpatient Allergy clinic by August 1, 2016. The clinic is affiliated with a Children’s hospital, services adults and children, and sees approximately 750 patients monthly. Many patients have been on service for years.

Implementation

The implementation included a ‘buy in’ …

Issues In Patient Information Transmission: Standardizing Home Health Admission, Philippa Thomas

Master's Projects and Capstones

When 84 patients, current and former, complained about lack of information during the intake process within five months period, a uniform "Patient Screening Tool" (Appendix L) was developed to improve the admissions process to this home health agency. Intake staff is responsible for receiving accurate information from the referral sources, confirming qualifications to receive services, and initiating education about services to the patient. While the population served has a wide range in age, diagnoses, discharge settings and cultures, the majority are over 65, frail, homebound and are returning home after hospital, SNF or rehabilitation settings.

Data were collected through evidence …

Improving Compliance In The Use Of Catheter Kit Supplied Hand Sanitizer Prior To The Insertion Of An Indwelling Urinary Catheter, Antonette B. Prado

Master's Projects and Capstones

Abstract

More than half of the staff nurses (65% through direct observation and 60% through interview) in the operating room (OR) department do not perform hand hygiene prior to insertion of an indwelling urinary catheter. This performance improvement project aims to educate all OR staff nurses on the practice of hand hygiene prior to the insertion of an indwelling urinary catheter by using the hand sanitizer included in the sterile catheter insertion kit. Two forms of interventions were provided in order to promote this process change. The first one being an education session with a power point presentation and the …

Liver Transplant Education And Training For Medical Surgical Icu Nurses, Matthew Redila

Master's Projects and Capstones

This project focuses on the CNL curriculum element of Nursing Leadership and explores the need for appropriate education and training for liver transplant as a new patient population for Medical Surgical ICU nurses. The transplant experience for these nurses currently include critically ill Bone Marrow Transplant, as well as stable heart and lunch transplant. The methods used to implement the project were to develop an education curriculum, a clinical orientation program, and a process to ensure proper communication occurs between all parties prior to clinical orientation. The competency-based orientation document, which is still being drafted, is used to determine clinical …

First-Case Operating Room Delays: Patterns Across Urban Hospitals Of A Single Health Care System, Callie M. Cox Bauer, Danielle M. Greer, Kiley B. Vander Wyst, Scott A. Kamelle

Journal of Patient-Centered Research and Reviews

Purpose

Operating room delays decrease health care system efficiency and increase costs. To improve operating room efficiency in our system, we retrospectively investigated delay frequencies, causes and costs.

Methods

We studied all first-of-the-day nonemergent surgical cases performed at three high-volume urban hospitals of a large health system from July 2012 to November 2013. Times for patient flow from arrival to procedure start and documented reasons for delay were obtained from electronic medical records. Delay was defined as patient placement in the operating room later than scheduled surgery time. Effects of patient characteristics, late patient arrival to the hospital, number of …

Advancing Population Health: New Models And The Role Of Research. An Overview Of The 22nd Annual Health Care Systems Research Network Conference, Robert T. Greenlee, Lois E. Lamerato, Sarah M. Greene

Journal of Patient-Centered Research and Reviews

The Health Care Systems Research Network (HCSRN; formerly HMO Research Network) held its annual conference in Atlanta, Georgia, in April 2016. A consortium of research organizations affiliated with 20 large health care delivery systems, the HCSRN met for the 22^nd consecutive year to report on scientific achievements, develop and share skills and best practices, and promote new research collaborations. The 2016 conference, with a theme of “Advancing Population Health: New Models and the Role of Research,” was co-hosted on behalf of HCSRN by Marshfield Clinic Research Foundation and Henry Ford Health System’s Public Health Sciences Department. The 350 conference …

Implementation Of Violence Risk Assessment Tool On In-Patient Psychiatric Unit, Manuel Alvano

Master's Projects and Capstones

Violence towards healthcare workers in acute care settings, particularly mental health units is increasing nationwide, causing safety and financial concerns for health care organizations. Efforts were made to decrease assaults directed towards healthcare staff on a twenty five bed adult mental health unit in a large academic university hospital. The aim of the project was to decrease assaults by twenty-five percent in six months after implementation of a Violence Risk Assessment (VRA) tool. The ultimate goal was to maintain assault rates below NDNQI. Assaults on the unit for the fourth quarter of 2015 were 2.92, NDNQI 2.05. Assaults with injury …

State Space Analysis Of Dominant Structures In Dynamic Social Systems, Jeremy B. Sato

McKelvey School of Engineering Graduate Student Theses & Dissertations

Many systems involving human relationships are modeled as dynamic systems, as diverse as urban population growth, diffusion of innovations, spread of viruses, and supply chain management. A fundamental assumption is that these systems contain variables which accumulate and deplete over time (people, innovation adoptions, infections, and orders), and whose dynamics are determined by societal rules and human decision making processes. These assumptions allow the system to be formally expressed by ordinary differential equations which are often nonlinear and contain multiple state variables and feedback loops. Analytical methods have been developed to identify the dominant feedback loops which primarily influence the …

Development Of A Breastfeeding Class Specifically For Working Moms, Maryleah S. Needels

Master's Projects and Capstones

Successfully breastfeeding mothers who are planning to return to work and remain exclusively breastfeeding their infants have a knowledge deficit as to the federal law protecting their rights along with the basic skills for pumping, storing, and bottle-feeding of breast milk. There is a significant drop in breastfeeding rates at both the 3 and 6-month marker, which coincides with maternal return to employment. After attending the Working Moms Breastfeeding Class, 100% of mothers reported an increase in knowledge surrounding the law and the CDC’s basic skills for handling pumped breast milk based on a pre/post questionnaire. Bandura’s theory of self-efficacy …

Standardized Blood Transfusion Documentation, Kelly A. Hill

Master's Projects and Capstones

The aim of this project was to improve nurse satisfaction through the use of a standardized blood administration documentation template. The goal was to reduce the time that nurses spend charting by offering a structured documentation template and to ensure that the procedure is correctly recorded in the patient’s electronic record. The leadership theme that supported this project is Information Manager, as the clinical nurse leader (CNL) uses information systems and technology at the point of care to improve health care outcomes. The selected microsystem is a medical/surgical/telemetry unit, which has 38 beds with 38 registered nurses (RNs). When surveyed, …

Reducing The Time It Takes To Execute A Legal Hold On Patients Currently On A Voluntary Status And To Transport Them To A Locked Inpatient Psychiatric Facility, Ariel Cris B. Manipula

Master's Projects and Capstones

The purpose of this presentation is to improve the communication between departments involved in the “step-up” process. An improved level of communication is measured with the amount of time it takes to get patient from outpatient lobby to inpatient unit bed. This process begins when a patient is placed on a legal hold because they are a danger to themselves, danger to others or gravely disabled. The problem is that the current process takes up to an hour and varies heavily on whether or not the unit charge nurse and the admissions and records agent are properly trained and knowledgeable …

Implementing Change To Decrease The Emergency Department Visits For Pediatric Clients Referred To Mental Health Services, Diane Sandoval

Master's Projects and Capstones

The purpose of this clinical nurse leader (CNL) internship project is to implement an improvement intervention to decrease emergency department visits or psychiatric emergency services visit rates for pediatric clients receiving mental health services through the ambulatory clinic. The goal is to increase client safety by preventing harm to themselves or others and improving quality of care provided through timely nursing telephone triage. The project is taking place in a county run pediatric ambulatory clinic. We will participate in a shared leadership team to make recommendations for improvement at the microsystem level. Team members include the charge nurse, clinic manager, …

Intranasal Naloxone Adminstration Education, Natalie O. Levchenko

Master's Projects and Capstones

The Clinical Nurse Leader project focused on the provision of education on intranasal naloxone administration to healthcare providers in Lake County in order to educate patients, their families, peers, and members of their social network. Fatal opioid overdose rates from prescribed or illicit opioids are four times greater in Lake County than California. The setting is Lake County, California, with a population of 65, 000, a radius of 1,300 square miles, and an annual per capita income of $21,000, with 24.3 % living in poverty. The CNL project focused on the Clinical Nurse Leader elements: Systems Analyst/Risk Anticipator, Outcomes Manager, …

Strategies To Prevent Hospital Transfers In The Snf Environment, Vinai P. Decena

Master's Projects and Capstones

This project focuses on the CNL curriculum element of Care Environment Management. The purpose of this project is to reduce hospital readmissions in geriatric patients who are currently having any changes of medical condition within the SNF microsystem. In this project, the CNL functions as the team manager and care coordinator. The CNL facilitated, and utilized patients’ outcome data to make changes in care processes to reduce acute hospital transfers in the skilled nursing facility. The CNL lead the interdisciplinary team and was resource or point of contact for this project. The CNL educated nurses to utilize (Interventions to Reduce …

Planetary Health: Report On The 7th Annual Global Health Conference, Lucille B. Pilling Edd,Mph,Rn

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Triple Aim Forces Drive Academic Health Systems Growth, Richard G. Stefanacci Do,Mgh,Mba,Agsf,Cmd, Terri Schieder Rn, Mba

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Telehealth At Jefferson: The Future Of Medicine, Danica Stone

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Mater: Innovative Programs For Maternal Addiction Education Treatment And Research, Meghan Gannon Phd Msph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Specialized Medical Home For Patients With Spinal Cord Injury, Mendel Kupfer Md, Marci Ruediger Pt, Ms, Norah V. Dixon Ma

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Medical School Watercooler Newsletter - August 14, 2016, Lindsey Lyle

Watercooler Newsletter

This is the August 14, 2016 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents Include:

• 50 Years Later: Roy Lewis Returns to Mast in Building To Oversee Addition
• USA Lions Club Hosts Kickoff Run for Sight
• USA Welcomes Dr. Christopher Jones
• USA Department of Surgery to Host Grand Rounds

Stigmatization Fo Hiv/Aids: A Cross-Cultural Analysis, Jamie Doctrow

Mahurin Honors College Capstone Experience/Thesis Projects

The Human Immunodeficiency Virus (HIV) is the cause of a public health epidemic that has impacted millions of individuals worldwide. Though medical advances have decreased the number of AIDS related deaths by 42% since the peak year of 2004 (UNAIDS, 2015), many individuals with HIV/AIDS are unaware of their status and are not currently receiving antiretroviral treatment. Many experts have suggested that a significant barrier to HIV/AIDS prevention and treatment is the social stigma that has become attached to the disease. No single cause of this stigmatization has been identified, but a variety of influences may play a role. To …

Non-Suicidal Self-Injury, Suicidal Behaviors, And Body Investment In Heterosexual And Sexual Minority Young Adults, Emily Cox

Mahurin Honors College Capstone Experience/Thesis Projects

College-aged individuals who identify with a sexual minority orientation are at high risk for non-suicidal self-injury (NSSI) and suicidal behaviors. Research is lacking on identification of factors contributing to increased risk for this population. This study examined two facets of body investment, body protection and body feelings, as they relate to NSSI, individual and total suicidal behaviors, and sexual orientation. It was hypothesized that NSSI and individual suicidal behaviors would be more frequent in the sexual minority sample compared to the heterosexual sample, body protection and body feelings would be poorer in sexual minorities compared to the heterosexual sample, and …

Learning To Relate: A Heuristic Inquiry Exploring The Development Of Therapeutic Relationships, Megan King

Creative Arts Therapies Theses

This heuristic inquiry explored the creation of therapeutic relationships. The intention of this research was to learn how to build therapeutic relationships with clients that I felt uncomfortable around, with whom I did not have much experience and whom I did not want to relate to due my personal prejudices around severe illnesses and extreme developmental and cognitive delays. This study was important not only to expand my knowledge and experiences working with these populations but to also inform my future clinical experiences with new clients as I embark on my professional career. I collected data through reflective journaling and …

Cultural Diversity And The Impact Of Acculturation And Personal Experience On Perceptions Of Suicide, Susan Breidenich

Mahurin Honors College Capstone Experience/Thesis Projects

Many factors influence cross-cultural differences in suicide rates and behaviors. One potential explanation is that attitudes and values influence the way individuals perceive suicide. In addition, previous literature indicates that attitudes can change in response to individual experiences. Further research on cultural attitudes toward suicide and individual experiences that influence them could inform prevention and treatment efforts targeted toward multicultural populations. The aim of this study is to examine the impact of culture, acculturation, and personal experience (i.e., exposure to suicidal behavior through close relationship) on suicide attitudes. The hypotheses were (1) that significant differences in attitudes towards suicide will …

Mutuality In Movement: A Relational Approach To Dance/Movement Therapy With Domestic Violence Survivors, Heather L. Maclaren

Creative Arts Therapies Theses

This qualitative case study explored the integration of relational-cultural therapy and dance/movement therapy (DMT), or relational-DMT, with survivors of domestic violence. The study examined how participants experience relational-DMT and the therapeutic relationship we established together. Three culturally diverse participants receiving individual short-term counseling services at a domestic violence service agency were included in the study. Three forms of data were collected over six to eight therapy sessions. Following each session, the participants completed the Helpful Aspects of Therapy questionnaire, while the researcher completed embodied case documentation (Fogel, 2007). After the final therapy session, a semi-structured interview was conducted with each …

Interleukin-6 Increases Matrix Metalloproteinase-14 (Mmp-14) Levels Via Down-Regulation Of P53 To Drive Cancer Progression, Jillian Cathcart, Anna Banach, Alice Liu, Jun Chen, Michael S. Goligorsky, Jian Cao

NYMC Faculty Publications

Matrix metalloproteinases (MMPs) play critical roles in cancer invasion and metastasis by digesting basement membrane and extracellular matrix (ECM). Much attention has focused on the enzymatic activities of MMPs; however, the regulatory mechanism of MMP expression remains elusive. By employing bioinformatics analysis, we identified a potential p53 response element within the MMP-14 promoter. Experimentally, we found that p53 can repress MMP-14 promoter activity, whereas deletion of this p53 response element abrogated this effect. Furthermore, we found that p53 expression decreases MMP-14 mRNA and protein levels and attenuates MMP-14-mediated cellular functions. Additional promoter analysis and chromatin immunoprecipitation studies identified a mechanism …

Isolated Prehospital Hypotension Correlates With Injury Severity And Outcomes In Patients With Trauma, Clayton D. Damme, Jiangtao Luo, Keely L. Buesing

Journal Articles: Anesthesiology

Objective Patients normotensive in the trauma bay despite documented prehospital hypotension may not be recognized as significantly injured. The purpose of this study was to determine whether isolated prehospital hypotension portends poor outcomes and correlates with injury severity.

Methods Prospective cohort study conducted at a level 1 university trauma center. The lowest recorded prehospital systolic blood pressure (SBP) and the first recorded SBP on hospital arrival were used to divide patients into either the normotensive (NP) or hypotensive (HP) group. Patients who failed to achieve normotension on hospital arrival were excluded. Hypotension was defined as SBP≤110 mmHg.

Results Compared to …

Pleural Effusion As A Manifestation Of Multiple Myeloma, Nousheen Iqbal, Muhammad Usman Tariq, Mohammad Usman Shaikh, Hashir Majid

Section of Pulmonary & Critical Care

Multiple myeloma is a clonal B-cell malignancy, characterised by proliferation of plasma cells and secretion of paraproteins. These plasma cells accumulate predominantly in the bone marrow; rarely, they invade other areas, especially the thorax. Myeloma presenting with a pleural effusion is rare and reported in only 6% of patients with myeloma. Such patients generally present late and have a poor prognosis. Here, we describe a patient presenting with a lung mass, renal failure and a massive unilateral pleural effusion due to multiple myeloma who was treated successfully.

Novel Ph-Sensitive Cyclic Peptides, Dhammika Weerakkody, Anna Moshnikova, Naglaa Salem El-Sayed, Ramona-Cosima Adochite, Gregory Slaybaugh, Jovana Golijanin, Rakesh Tiwari, Oleg A. Andreev, Keykavous Parang, Yana K. Reshetnyak

Pharmacy Faculty Articles and Research

A series of cyclic peptides containing a number of tryptophan (W) and glutamic acid (E) residues were synthesized and evaluated as pH-sensitive agents for targeting of acidic tissue and pH-dependent cytoplasmic delivery of molecules. Biophysical studies revealed the molecular mechanism of peptides action and localization within the lipid bilayer of the membrane at high and low pHs. The symmetric, c[(WE)4WC], and asymmetric, c[E4W5C], cyclic peptides translocated amanitin, a polar cargo molecule of similar size, across the lipid bilayer and induced cell death in a pH- and concentration-dependent manner. Fluorescently-labelled peptides were evaluated for targeting of acidic 4T1 mammary tumors in …