Medicine and Health Sciences Commons^™

Parental Grief: Traumatic Death Of A Child And Length Of Bereavement, Joy Dawn Buscaglia-Dale

Capstone Projects and Master's Theses

There is much empirically based research and case studies in the area of grief itself but few that focus on traumatic grief. For the purpose of this study, we will focus on traumatic grief as it applies to the death of a child. Traumatic grief is defined as a grave form of bereavement that comes about when the death of a loved one is caused by an accident, an impaired driver, SIDS, homicide, suicide, or an act of terrorism. There is no time to say goodbye. The research that has been done indicates that with these types of death, the …

Thrombospondin 1 Deficiency Ameliorates The Development Of Adriamycin-Induced Proteinuric Kidney Disease, Hasiyeti Maimaitiyiming, Qi Zhou, Shuxia Wang

Pharmacology and Nutritional Sciences Faculty Publications

Accumulating evidence suggests that thrombospondin 1 (TSP1) is an important player in diabetic nephropathy. However, the role of TSP1 in podocyte injury and the development of non-diabetic proteinuric kidney disease is largely unknown. In the current study, by using a well-established podocyte injury model (adriamycin-induced nephropathy mouse model), we examined the contribution of TSP1 to the development of proteinuric kidney disease. We found that TSP1 was up-regulated in the glomeruli, notably in podocytes, in adriamycin injected mice before the onset of proteinuria. ADR treatment also stimulated TSP1 expression in cultured human podocytes in vitro. Moreover, increased TSP1 mediated ADR-induced …

Implementing Ways To Reduce Catheter-Associated Urinary Infections (Cautis), Maryam Keyhani

Master's Projects and Capstones

Abstract

Center for Control and Disease Prevention (CDC), estimates that 40% of all Urinary Tract Infections (UTIs) are related to Hospital-acquired Infections (HAIs) (CDC, 2013). The Facility where the project was done consists of oncology, orthopedic, medical-surgical, telemetry, incentive care, and step-down units. This hospital with 242 licensed beds has approximately 51,571 ER visits and a total of 10,606 admissions per year.The prevalence of Cather-associated Urinary Tract Infections (CAUTIs) on the 4th floor, the medical-surgical unit with 42 beds was significantly higher than other units. The hospital goal is to increase patient safety and satisfaction as well as reduce and …

Discharge Improvement Process, Medeina O'Neal

Master's Projects and Capstones

Abstract

The focal point of the project takes account of the CNL educational program component of the Care Environment. The purpose of the CNL role would reflect the Team Managers functionality. “Care Environment identifies clinical and cost outcomes that improve safety, effectiveness, timeliness, efficiency, quality, and the degree to which they are client-centered“ (AACN, 2013). The unit provides care to patients who require constant cardiac monitoring for reasons that may include sepsis, pneumonia, recent surgeries, advanced congestive heart failure, renal failure and COPD. Having a standardized discharge process could hopefully reduce the number of delays, so that the desired goals …

Radiation-Enhanced Therapeutic Targeting Of Galectin-1 Enriched Malignant Stroma In Triple Negative Breast Cancer, Meenakshi Upreti, Amar Jyoti, Sara E. Johnson, Elden P. Swindell, Dana L. Napier, Pallavi Sethi, Ryan Chan, Jonathan M. Feddock, Heidi L. Weiss, Thomas V. O'Halloran, B. Mark Evers

Pharmaceutical Sciences Faculty Publications

Currently there are no FDA approved targeted therapies for Triple Negative Breast Cancer (TNBC). Ongoing clinical trials for TNBC have focused primarily on targeting the epithelial cancer cells. However, targeted delivery of cytotoxic payloads to the non-transformed tumor associated-endothelium can prove to be an alternate approach that is currently unexplored. The present study is supported by recent findings on elevated expression of stromal galectin-1 in clinical samples of TNBC and our ongoing findings on stromal targeting of radiation induced galectin-1 by the anginex-conjugated arsenic-cisplatin loaded liposomes using a novel murine tumor model. We demonstrate inhibition of tumor growth and metastasis …

Evaluating Infection Prevention Strategies In Out-Patient Dialysis Units Using Agent-Based Modeling, Joanna R. Wares, Barry Lawson, Douglas Shemin, Erika M. C. D'Agata

Department of Math & Statistics Faculty Publications

Patients receiving chronic hemodialysis (CHD) are among the most vulnerable to infections caused by multidrug-resistant organisms (MDRO), which are associated with high rates of morbidity and mortality. Current guidelines to reduce transmission of MDRO in the out-patient dialysis unit are targeted at patients considered to be high-risk for transmitting these organisms: those with infected skin wounds not contained by a dressing, or those with fecal incontinence or uncontrolled diarrhea. Here, we hypothesize that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of MDRO. We also hypothesize that environmental contamination plays a role in the dissemination of …

Hiv-1 Genetic Variation Resulting In The Development Of New Quasispecies Continues To Be Encountered In The Peripheral Blood Of Well-Suppressed Patients., Will Dampier, Michael R Nonnemacher, Joshua Mell, Joshua Earl, Garth D Ehrlich, Vanessa Pirrone, Benjamas Aiamkitsumrit, Wen Zhong, Katherine Kercher, Shendra Passic, Jean W Williams, Jeffrey M Jacobson, Brian Wigdahl

Kimmel Cancer Center Faculty Papers

As a result of antiretroviral therapeutic strategies, human immunodeficiency virus type 1 (HIV-1) infection has become a long-term clinically manageable chronic disease for many infected individuals. However, despite this progress in therapeutic control, including undetectable viral loads and CD4+ T-cell counts in the normal range, viral mutations continue to accumulate in the peripheral blood compartment over time, indicating either low level reactivation and/or replication. Using patients from the Drexel Medicine CNS AIDS Research and Eradication Study (CARES) Cohort, whom have been sampled longitudinally for more than 7 years, genetic change was modeled against to the dominant integrated proviral quasispecies with …

Reducing Iv Infiltrates In The Neonatal Population, Stephanie L. Miller

Master's Projects and Capstones

Abstract

The objective of the CNL project is to improve the quality of care provided to our patients. The project focuses efforts to reduce IV infiltrates by auditing all running IV lines, IV management monitoring and auditing infiltrate grading and documentation to find commonalities that could be causing infiltrates.

The project is focusing on the neonatal population at a children’s hospital in the Neonatal Intensive Care Unit (NICU). This NICU is an 80 bed unit that houses both critical care patients and intermediate care neonates.

Auditing was a major component to the project and helped with identifying common causes so …

The Development Of Standardized Patient Controlled Analgesia Documentation To Improve Patient Care, Collyn West

Master's Projects and Capstones

On a 28 bed post-surgical unit, reviewing patient records revealed only 26% had thorough patient controlled analgesia (PCA) documentation. A pre-quiz no staff knew all of the required components for documentation or which policies to reference and, on average, the staff were only able to correctly answer 30% of the questions. Therefore, a project utilizing the clinical nurse leader improvement theme of clinical outcomes management was initiated to standardize the documentation of PCA medication administration to improve post-operative pain management, improve patient satisfaction, and improve patient safety.

The current process was determined using a fishbone diagram, a SWOT analysis was …

Obstetric Triage Improvement, Whitney Depaoli

Master's Projects and Capstones

The objective of the obstetric triage improvement project is to decrease the average length of stay for perinatal patients presenting to the obstetric triage. The setting is a university hospital in a large urban city. The population includes pregnant patients with obstetric complaints presenting to triage for further evaluation. Methods used include a root cause analysis, process mapping, lean transformation methodology, and standardization of workflow. The results of the project include reducing the average length of stay in obstetric triage from a baseline of 152 minutes to 120.58 minutes, which represents a 21% decrease. The creation of standard workflows, the …

An Interdisciplinary Approach To Reducing Falls: Utilizing Team Huddles And Visual Aids To Increase Nursing Staff And Patient Knowledge On T.E.A.M. Fall Risk Interventions, Jennifer A. Viernes

Master's Projects and Capstones

One of the most important aspects of patient safety is the prevention of patient falls (PFs). PFs are a never event and are preventable. The project addresses the ongoing increase in PFs on a medical-surgical oncology unit in an inpatient hospital setting. The increase in PFs created urgency to provide solutions to these preventable circumstances. This Clinical Nurse Leader (CNL) led the project and conducted a comprehensive microsystem assessment of the potential causes of PFs calling for further investigation of the unit’s current fall policy. After conducting two surveys of both the nursing staff (NS) and patients’ knowledge of fall …

Ubr3, A Novel Modulator Of Hh Signaling Affects The Degradation Of Costal-2 And Kif7 Through Poly-Ubiquitination, Tongchao Li, Junkai Fan, Bernardo Blanco-Sánchez, Nikolaos Giagtzoglou, Guang Lin, Shinya Yamamoto, Manish Jaiswal, Kuchuan Chen, Jie Zhang, Wei Wei, Michael T. Lewis, Andrew K. Groves, Monte Westerfield, Jianhang Jia, Hugo J. Bellen

Markey Cancer Center Faculty Publications

Hedgehog (Hh) signaling regulates multiple aspects of metazoan development and tissue homeostasis, and is constitutively active in numerous cancers. We identified Ubr3, an E3 ubiquitin ligase, as a novel, positive regulator of Hh signaling in Drosophila and vertebrates. Hh signaling regulates the Ubr3-mediated poly-ubiquitination and degradation of Cos2, a central component of Hh signaling. In developing Drosophila eye discs, loss of ubr3 leads to a delayed differentiation of photoreceptors and a reduction in Hh signaling. In zebrafish, loss of Ubr3 causes a decrease in Shh signaling in the developing eyes, somites, and sensory neurons. However, not all tissues that require …

Louisiana State University Health Sciences Center - 2016 - 142nd Commencement, Office Of The Registrar, Lsu Health Sciences Center-No

Graduation & Commencement Programs

The program for the 142nd Commencement of LSU Health Sciences Center - New Orleans held May 19, 2016.

Preventing And Reducing Clabsi With Daily 2% Chg Wipes, Karen Ha

Master's Projects and Capstones

This project aims to decrease central line associated bloodstream infections in pediatric patients my microsystem hospital. The process begins re-enforcing daily CHG (2% Chlorhexidine Gluconate) wipes to 100% compliance rates on our patients with central lines tailored to their age and body weights. The process ends with reducing the CLABSI rates of our unit and the entire hospital to 0. By working on the process we expect personal and organizational commitment to transform the culture of safety through integration of standardized communication, issue escalation, non punitive response to errors, rounding by all leaders, and culture of continuous improvement. It is …

Reduce The Rooming Time, Gagandeep Singh

Master's Projects and Capstones

The aim of the project Reducing the Rooming Time by the Medical Assistant is to reduce the rooming time from thirteen minutes to ten minutes. In the Department of Adult and Family Medicine, there are about eighty physicians who are supported by eighty medical assistants. The appointment length is twenty minutes. The rooming procedures take about thirteen minutes to complete which leaves only seven minutes for physicians to see their patients. This has led to patients, physicians, and staff unsatisfied.

A team was created which include physicians, medical assistants, and receptionists. Data was obtained by the system’s analyst that looked …

Helping Diabetic Patients Reduce Their Hba1c By Follow-Up Phone Calls, Every Two Weeks, Stacie Webster

Master's Projects and Capstones

Abstract

This project focused on the Clinical Nurse Leader (CNL) essential of Quality Improvement and Safety. I used the CNL competency of using performance measures to assess and improve the delivery of evidence-based practices for this project. The primary care practice in which I work received data that revealed almost 44% of the diabetic patients have a Hemoglobin A1c (HbA1c) >8%. I aim to assist these patients to reduce their HbA1c to

Reference

American Diabetes Association. (2016, January). Glycemic Targets: Assessment of Glycemic Control. Diabetes Care, 39, 33-40. Retrieved from http://care.diabetesjournals.org/site/misc/2016-Standards-of-Care.pdf

The Use Of Personalized Whiteboards In The Inpatient Acute Care Setting And Their Effect On Patient And Nurses Perception Of Communication, Cheryl Karn

Master's Projects and Capstones

A microsystem assessment of two inpatient medical-surgical wards in a medical facility determined a majority of nurses reported dissatisfaction with the amount and type of communication with the interdisciplinary team. This, along with a review of Press-Ganey scores from the inpatient wards, revealed patients reported decreased satisfaction when asked if “nurses kept me informed”, compared to previous quarterly reports as well as other VA facilities. Multiple studies have shown the benefit of personalized whiteboards (PWs) at the patient bedside in improving not only communication but also safety and patient outcomes. A PW was developed by the Clinical Nurse Leader …

Promoting Patient Safety By Implementing Bedside Shift Report, Maroof A. Olanigan

Master's Projects and Capstones

ABSTRACT

Patient safety is a very broad and general term used to ensure that all aspects of patient care, from medical and nursing services to social and spiritual, are provided with the best interest of the patient. The aim statement for the project is improving patient safety by ensuring the implementation of bedside shift report by 80% of nurses by August 2016. Kurt Lewin’s change theory is going to be used to effect the change.

There were in-services given to nurses on the floor and the project was also discussed in staff meetings. Flyers were posted around the units to …

Breast Cancer Specimen Collection, Handling & Adherence To Asco/Cap Guidelines, Vicki F. Rocconi

Master's Projects and Capstones

Breast Cancer Specimen Collection, Handling & Adherence to ASCO/CAP Guidelines

Background

Specimens removed from their blood supply begin to degrade immediately. Specimens are placed in formalin to halt the process of degradation. Under or over-exposure of specimens to formalin can result in false positive or false negative test results for estrogen receptors, progesterone receptors & Her-2/neu receptors.

Goals & Objectives

Improve the process of breast cancer specimen collection & handling and insure that the process is consistent with ASCO/CAP Guidelines (College of American Pathologists, 2013). The objectives included: Documentation of the time the specimen was removed from the blood supply. …

Managing Postoperative Pain For Timely Discharge Of Total Hip Replacement Patients, Elmer De Leon

Master's Projects and Capstones

This project requires three competency area of Clinical Nurse Leader: 1) Essential 2:Organizational and Systems Leadership, good fiscal stewardship is a condition of quality care, 2) Essential 3: Quality Improvement and Safety, practice guidelines are based on evidence, and 3) Essential 4: Translating and Integrating Scholarship into practice, client-centered practice is intra- and interdisciplinary. The purpose of this study is to develop a nursing intervention that would result in enhanced comfort for total hip replacement patients so timely hospital discharge (i.e., within 2 days) can be achieved. The preceptor site for this project is a hospital located in northern California. …

Chronic Pain Management In The Inpatient Care Setting, Addie J. Mcclendon

Master's Projects and Capstones

The objective of this quality control initiative was to improve the comfort level of nurses caring for patient with chronic pain, as well as patient satisfaction with nursing pain interventions on an inpatient medical surgical unit with a high population of patients with chronic pain (as much as 30%). Nurses and patients were surveyed using a brief survey to determine the baseline comfort levels of comfort with chronic pain management. The results of the initial survey and current evidence for chronic pain management techniques were used to construct an inforgraphic for nurse education. The nurses were educated on evidence based …

Reducing The Incidence Of Hospital-Acquired Pressure Ulcers By Enhancing The Role Of Unit-Based Skin Champions, Anne V. Loewenthal

Master's Projects and Capstones

Reducing the Incidence of Hospital-Acquired Pressure Ulcers by Enhancing the Role of Unit-Based Skin Champions

Abstract

Hospital Acquired Pressure Ulcer continues to be an alarming issue in today’s healthcare systems. Often preventable, it is a significant nursing role and a frequently used benchmark for quality care. Studies have shown that hospital-acquired pressure ulcer (HAPU) complications have been associated with “up to 60,000 deaths each year in the United States” (AHRQ, 2014). A major health problem, it presents grave consequences on the patient’s well-being, significant treatment and recovery delays, increase length of inpatient stays, and have become a “never” event from …

Improving Patients' Pain Management Through Proper Documentation, Virzen Merina

Master's Projects and Capstones

The aim of this project was to improve pain documentation on the Surgical Unit as a means to enhance caregiver communication on finding the best methods to manage patients’ pain. Effectively managing patients’ pain leads to better patient outcomes, increased patient and nurse satisfaction, and decreased length of hospitalization. The setting is a not-for-profit hospital in Southern California. The microsystem selected is the 32-bed capacity Surgical Unit that mainly admits pre- and post-surgical patients, but also accommodates non-surgical, telemetry, and trauma cases.

To improve pain assessment documentation, collaboration was sought with the multidisciplinary team (IT department, clinical nurse specialists, and …

Transitioning Care From Hospital To Home, Increasing Awareness Of Take-Home Pressure Injury Prevention Kits, Erika A. Yazdanbakhsh Mrs

Master's Projects and Capstones

With proper implementation of evidence-based interventions, most pressure injuries (PI) can be prevented. While prevention is considered standard of care while inpatient, there is a need to transition this care from hospital to home. This CNL project aimed to increased awareness of take home PI prevention kits made available to staff nurses at on medical surgical hospital unit with 15 staff nurses. An author-blinded, internal chart review and a comprehensive review of evidence-based literature were studied to provide background data and support for implementation using the staff huddle. Direct observation and staff interaction was incorporated with Lewin’s change theory to …

Transforming A Primary Care Practice Into A Patient Centered Medical Home, Heloise Lim

Doctor of Nursing Practice (DNP) Projects

Patient-Centered Medical Home (PCMH) recognition is a process and a road map to improving quality of and access to care. Extant studies have shown that adoption of the PCMH model of care has lowered healthcare expenditure by 15-20% (Nielsen, Langner, Zema, Hacker, & Grundy, 2012). In an effort to reduce healthcare cost in the United States, private and public sectors have embraced the philosophy of PCMH by developing national programs and initiatives for primary care practices to obtain PCMH recognition. A number of payers and health plans have used PCMH recognition as a means to validate high-performing practices and reward …

An Exploration Of Existential Group Art Therapy For Substance Abuse Clients With A History Of Trauma, Sung Liskin

LMU Theses and Dissertations

The purpose of this study was to explore existential group art therapy (EGAT) as an alternate or integrated method in treating clients with substance abuse and a history of trauma. Subjects for this study were male and/or female adults, ages 18 and older, volunteer participants who were in treatment for substance addiction at Tarzana Treatment Centers. A group of seven participants who met the criteria for both substance abuse and history of trauma received Existential Group Art Therapy (EGAT) treatment for eight consecutive weeks. Participants were asked to fill out the Scale for Existential Thinking (SET) at the start of …

Exploring Sexuality Through Art Making, Martha C. Cowley, Jane Gallop, Amanda Hale Feinberg

LMU Theses and Dissertations

This research examined the usefulness of art making in exploring sexuality. Specifically, women participating in partners of sex addicts groups and the LGBTQ online community were invited to take an online survey, exploring both visually and verbally discuss how they view their sexuality and how they think others view their sexuality. The data was then analyzed within and between categories to produce three overarching themes: (1) Expressing sexuality: the tension between the self and others (2) The usefulness of art making to explore sexuality, and (3) Limitations and challenges of the study. Through the discussion of the themes, researchers found …

An Exploration Of Creative Arts Therapies In Pediatric Hospitals, Jacqueline Marie Carlson, Hilda Mercedes Galan

LMU Theses and Dissertations

This research paper explores the use of creative arts therapies with children and families in a pediatric hospital setting as experienced by the therapists who provide these services. The research investigates art therapy, music therapy and dance/movement therapy at Children’s Hospital Los Angeles (CHLA), with an in depth consideration of the role of art therapy services in this setting. The researchers reviewed general literature regarding hospitalization, specifically its effects on children and families, availability and role of psychosocial services and the intensive care units (ICU). Literature discussing creative arts therapies (art therapy, music therapy and dance/movement therapy) was also reviewed, …

The Role Of The Art Therapist: A Multi-Faceted Approach, Lauren E. Peña

LMU Theses and Dissertations

This research explores the role of the art therapist in a nonclinical setting. The research dissects the experiences of nine art therapists who participated in an artist residency that was informed by art therapy but was not clinically based. The spectrum of literature reviewed focused on the professional identity of art therapists and therapists as well as social action art therapy and working with Native American cultures. A qualitative approach was utilized through the conduction of a focus group along with four individual interviews, which were both enhanced by a parallel art making process. Analysis of the data resulted in …

Exploration Of The Process Of An Altered Book Project With Women Cancer Survivors, Jillian E. Luz

LMU Theses and Dissertations

This research examines the experience of a long-term creative arts project within a women’s cancer support group. Specifically, the research explores the effects of a creative arts project on quality of life. Literature describing cancer support groups has been reviewed, as well as literature published which specifically studied the effects of art therapy with those living with from medical illnesses including, but not limited to, cancer. Qualitative data was gathered through surveys, interviews, and by analysis of the creative art projects. Group participants were offered the directive to create an altered book in which to express their cancer journey. The …