Medicine and Health Sciences Commons^™

Risk Of Post-Ercp Pancreatitis In Liver Transplant Patients: Single Center Experience, Shailender Singh

Theses & Dissertations

Introduction: Acute pancreatitis remains the most common severe complication of endoscopic retrograde cholangiopancreatography (ERCP). The exact cause of post-ERCP pancreatitis (PEP) is unclear. Regardless of the mechanism that initiates PEP, the pathways of inflammation are similar to other forms of acute pancreatitis and include the activation of various inflammatory cytokines, released from the acinar cells and subsequently from helper T lymphocytes and macrophages. Liver transplants (LTx) patients on immunosuppressive medications have impaired T-cell response and hence decreased ability to generate these cytokines. The aim of this study was to review incidence rates and risk factors of PEP in this …

The Effect Of Mechanical Vibration On Pain And Rate Of Tooth Movement During Initial Orthodontic Alignment, Leslie Ellingson

Theses & Dissertations

Purpose: The purpose of this investigation was to evaluate the effect of mechanical vibration on pain experienced and rate of tooth movement (OTM) during the initial alignment phase of orthodontic treatment.

Materials and Methods: Participants were randomly allocated to control, low frequency or high frequency. An electric toothbrush was modified to provide high frequency vibration. A low frequency vibration device was acquired from a commercial vendor. Experimental groups applied vibration to the dentition for 20 minutes daily. All participants completed questionnaires using visual analog scales at five time points. Pain experience was measured in millimeters (mm) with the scale measuring …

Lost In Translation, Daniel Pena

Master's Projects and Capstones

At the conclusion of a patient’s hospitalization the Registered Nurse (RN) will review all discharge instructions in the patients room in their preferred language. Plan time for the discharge and facilitate a calm quiet environment, such as the patient’s room with the door closed, if possible. Get the discharge instructions printed out in their preferred language and a set for yourself in English would be best so you are able to review the instructions line by line with them. When the patients medical team, such as but not limited to, medical doctors, pharmacists, physical therapists, and social work have completed …

Discharge By 11:00 Am And The Effects On Throughput, Gena Bravo

Master's Projects and Capstones

This Clinical Nurse Leader project aims to improve the discharge process to increase the percentage of patients discharged before 11:00 AM on the Progressive Care Unit (PCU). One evidence-based approach to help alleviate capacity constraints in the hospital is to create an effective and timely discharge process. The goal of this project is to educate the front line staff, care coordinators, and providers to a standardized discharge process. The PCU is a cardiac telemetry unit with 30 private rooms. The patients on the PCU are post-cardiac surgery with some overflow medical patients throughout the unit. Kotter’s theoretical framework was chosen …

Fall Prevention, Linda Fang

Master's Projects and Capstones

Fall Prevention Abstract

Background: According to the CDC, the medical cost for falls was approximately $30 billion in 2012. When a patient falls, and gets serious injury, these costs could sum up to $14,056 per patient. As a result, hospital stays per patient are observed to increase by approximately 6.3 days longer than those patients who haven’t encountered falls.

This study focused on identifying high fall risk patients, and developing a plan of care to reduce the occurrence of falls in a hospital setting. Nurses using safe fall interventions techniques have been proven to inspire fall preventions.

An assessment of …

Interdisciplinary Team Approach In Fall Prevention: Physician Perspective Focus, Anna Gryn

Master's Projects and Capstones

An in-hospital fall is a devastating event for patients and care providers resulting in injuries, physiological and psychological patient declines, and sometimes deaths. Furthermore, fall related costs greatly increase hospitals’ expenses and cause massive distress to caregivers and health providers. Many patient-specific, organizational, and seemingly erratic factors contribute to the occurrence of in-hospital falls. Despite this, hospitals must undertake consistent evidence-based measures to prevent fall occurrences as much as possible.

The traditional nursing approach to falls prevention is not sufficient to control fall rates because the issue is too complex and must be approached from multiple perspectives rather than just …

Lessons Learned From Cuba: Using Healthcare Systems And Stillbirth Rate Example, Ravi Patel

Master's Projects and Capstones

Cuba and the U.S. have different health care systems but similar health outcomes. In 2015 U.S. and Cuba had the same stillbirth rate. Cuba is a prevention-based system that is free for all, while the U.S. is a treatment-based system that uses a fee for service system. Cuba has ratified international laws that hold it accountable for improving health outcomes especially for women and children. The U.S. can learn from Cuba when it comes to improving health outcomes. The U.S. can improve their health outcomes by including more preventative based interventions and ratifying international law that will hold the U.S. …

Health Starts In The Home: An Assessment Of Efforts To Improve Occupant Health Through Healthy Building Materials In San Francisco’S Affordable Housing, Staci Hoell

Master's Projects and Capstones

Americans spend 90% of their lives indoors, and much of this time is spent at home, surrounded by building materials that typically have added chemicals like flame retardants, highly fluorinated compounds, and antimicrobials. Recent research has linked these chemicals to adverse health outcomes such as asthma, endocrine disruption, cancer, neurodevelopmental issues, and reproductive problems (Bayer et al., n.d.; Green Science Policy Institute). Furthermore, these chronic health conditions disproportionately affect low-income populations. Fortunately, substantial efforts in research, practice, and policy are working to reduce the use of these potentially harmful chemicals in building materials, particularly in San Francisco’s affordable housing sector. …

Improving Early Sepsis Identification On Inpatient Units, Courtney Sumanqui

Master's Projects and Capstones

Sepsis is a medical emergency that if left untreated can rapidly cause death for many patients due to effects that this systemic infection has on the human body. Millions of Americans nationwide are affected by sepsis on an annual basis. To reduce the number of patients who decline to sepsis in the hospital, efficient sepsis protocols must be effectively implemented throughout the hospital. Healthcare organizations must dedicate themselves to providing high quality patient care from the time of admission to discharge. This quality improvement project focused on improving early sepsis identification on inpatient units.

Nurse practices, knowledge, understanding related to …

Improving Early Sepsis Identification On Inpatient Units, Leslie Virtudazo

Master's Projects and Capstones

Sepsis is a life-threatening condition that arises from a complication of severe infection characterized by a systemic inflammatory response (SIRS). As a time critical illness requiring early identification and treatment, delayed recognition of sepsis can lead to organ failure and death. Effective sepsis protocols need to be established and implemented to reduce the number of patients declining to sepsis in the hospital setting. For this project, nursing practice and knowledge of SIRS and sepsis protocol were assessed to obtain a baseline measure of the nurses’ knowledge.

A root cause analysis was used to identify existing barriers to performing timely sepsis …

Cpap-Mad Combination Therapy For Cpap Intolerant Patients With Moderate To Severe Osa, Jacob Stadiem

Theses & Dissertations

The treatment of obstructive sleep apnea (OSA) allows for a multidisciplinary approach between dentistry and medicine. Continuous positive airway pressure (CPAP) is the gold standard for OSA treatment, but the non-adherence rates are high. The mandibular advancement device (MAD) has a higher acceptance rate than the CPAP, however the efficacy is much lower in cases of moderate to severe OSA. This thesis attempted to evaluate if there was a change in compliance when a MAD was added as a combination therapy to moderate to severe OSA subjects that were currently non-compliant with their CPAP. In addition, the change in air …

Gerontological Community-Academic Partnership For An Msn Internship, Francine Serafin-Dickson

Doctor of Nursing Practice (DNP) Projects

The growing population of older adults beckons nursing education to evolve and prepare the future nursing workforce with skills and knowledge to coordinate care for the community-dwelling older adult (gerontological) population. The purpose of this project is to develop, implement, and evaluate academic partnerships with agencies serving community-dwelling older adults for the Master of Science in Nursing (MSN) Clinical Nurse Leader (CNL) students. The formation of Community-Academic Partnerships (CAP) offers the opportunity for an experiential learning internship in combination with a gerontological curriculum. The curriculum is integrated into the CNL role courses and internship, focusing on person-centered interactions with older …

Improving Early Sepsis Identification On Inpatient Units, Corrina Lau

Master's Projects and Capstones

Background: On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. Now that care for sepsis patients is a core measure, it is important that all healthcare providers are knowledgeable in how to treat and identify sepsis.

Purpose: The Purpose is to be a “values-driven integrated healthcare delivery system in collaboration with those who share our values.” Patients observed were ages 18-years-old and older from five inpatient units. The professionals in this hospital consisted of a multidisciplinary approach that included, but not limited to, a team …

A Multi-Prong Fall Awareness Program To Reduce The Occurrence Of Falls In A Skilled Nursing Unit, Cheri Labrador

Master's Projects and Capstones

Abstract

A multi-prong falls awareness program to reduce the occurrence of falls in a skilled nursing unit

Keywords: Fall awareness program, skilled nursing unit, fall rate

The project goal was to reduce the patient fall rate by 20% by implementing a fall awareness program for clinical staff. The program had two prongs and began with a pre-survey to determine current fall prevention knowledge. The staff was encouraged to participate in the training by providing risk factors that contribute to falls and simple strategies to prevent falls based on their knowledge of the patients (Boushon et al, 2012). A post-survey was …

Response: Commentary: Skilled Bimanual Training Drives Motor Cortex Plasticity In Children With Unilateral Cerebral Palsy, Ya-Ching Hung, Kathleen M. Friel, Andrew M. Gordon

Publications and Research

No abstract provided.

Next Generation Sequencing Technologies For Real-Time Genotyping And Targeted Sequencing For Precision Medicine, Priyanka Rawat

Biomedical Engineering ETDs

Astounding success of Human genome project and accelerating success of sequencing technologies have enabled $ 1000 genome goals possible. But, this is still far-fetched from the reach of many resource refrained populations with high genetic variations causing lethal genetic diseases. Based on present technology principles, I have developed prototypes for affordable, scalable and customizable point-of-care genotyping and targeted sequencing. Ion-sensitive field effect transistors with novel read-out and signal amplification techniques are used for laying foundation of possible ISFET based allele-arrays. Sequencing-by-synthesis based full-fledge sequencer is made with novel immobilization, flow-cell and data acquisition methods for massive sequenciing.

Serum Amyloid A3 Is A High Density Lipoprotein-Associated Acute-Phase Protein, Lisa R. Tannock, Maria C. De Beer, Ailing Ji, Preetha Shridas, Victoria P. Noffsinger, Laura Den Hartigh, Alan Chait, Frederick C. De Beer, Nancy R. Webb

Internal Medicine Faculty Publications

Serum amyloid A (SAA) is a family of acute-phase reactants. Plasma levels of human SAA1/SAA2 (mouse SAA1.1/2.1) can increase ≥ 1,000-fold during an acute-phase response. Mice, but not humans, express a third relatively understudied SAA isoform, SAA3. We investigated whether mouse SAA3 is an HDL-associated acute-phase SAA. Quantitative RT-PCR with isoform-specific primers indicated that SAA3 and SAA1.1/2.1 are induced similarly in livers (∼2,500-fold vs. ∼6,000-fold, respectively) and fat (∼400-fold vs. ∼100-fold, respectively) of lipopolysaccharide (LPS)-injected mice. In situ hybridization demonstrated that all three SAAs are produced by hepatocytes. All three SAA isoforms were detected in plasma of LPS-injected mice, although …

Assessment Of Falls Protocol Use On Medical-Telemetry Units, Fanny Ku

Master's Projects and Capstones

Purpose: The purpose of this quality improvement project is to identify a root cause analysis for an increase in falls at a large, metropolitan hospital and implement interventions designed to reduce the incidence of falls on the medical-telemetry unit.

Background: Falls, regardless of severity, may inflict irreparable consequences on patients, families, and hospitals. Approximately 20-30% of falls result in physical or emotional harm, including minor bruises, emotional trauma, and fractures (“Falls,” 2004). When falls occur, hospitals are generally responsible for all costs incurred from the sentinel event, and do not receive re-imbursement from insurances for services provided. In the large, …

Development Of A Formalized Mentorship Program For Newly Licensed Registered Nurses At A Large Community Medical Center, Quynh-Hoa Nguyen

Master's Projects and Capstones

Retention, competency, job satisfaction, and lateral violence are issues facing the nursing workforce, especially newly licensed registered nurses (NLRNs). The United States is facing a nursing shortage; therefore it is important to develop strategies to retain qualified registered nurses (RNs). The Master of Science in Nursing/Clinical Nurse Leader (MSN/CNL) student team conducted a literature review on how to address these issues. A mentorship program is the proposed intervention to assist novice nurses during their transition into the nursing role. The student team performed a needs assessment through surveys and interviews to gain valuable data on the medical center. The assessment …

Development Of A Formalized Mentorship Program For Newly Licensed Registered Nurses At A Large Community Medical Center, Javier Moreno

Master's Projects and Capstones

With mentorship being a key to addressing several issues at a large community medical center, the leadership of the institution engaged with students of a Clinical Nurse Leader (CNL) Program to conduct a thorough assessment. This paper addresses the charge for a standardized and formalized evidence-based approach to a nurse mentorship program to address key areas that enhance not only the work environment but also the quality of care. These key areas include the 1) promotion of professional development and engagement via 2) acquisition of skills necessary to achieve nursing competence, 3) address lateral violence, 4) increase in staff retention …

Homecare Portacath Protocol In Ivig Administration, Cindy Watson

Master's Projects and Capstones

Homecare Portacath Protocol in IVIg Administration

The objective for this CNL internship project was to close a practice gap that was discovered while evaluating my microsystem for system improvements. My microsystem is a medium sized Home Health Agency with a specialty of in home infusion therapy. While evaluating protocols for immunoglobulin (Ig) infusion I found that there was no protocol for the administration of Ig by portacath. After consulting with the Director of Nursing (DON) and my colleagues on the Infusion Team, it was agreed that a current evidence based protocol was needed to close the practice gap. The methods …

Implementation Of A Fruit And Vegetable Voucher Program In San Francisco, Alexandra Kambur

Master's Projects and Capstones

Chronic disease has emerged as the predominant public health challenge of the 21st century. Chronic diseases like cardiovascular disease, cancer, type 2 diabetes and obesity have maintained their top positions as the leading causes of poor health, disability, death, and high health-care expenditures for over a decade. Health and hunger go hand-in-hand. Today over 15 million households in the United States struggle with food insecurity, meaning they do not have sufficient access to food that meets their dietary needs for an active and healthy life. The issue of food insecurity in cities like San Francisco, California is exacerbated by the …

Oh Baby! Evaluating The Impact Of Blossom's Natural Childbirth Prep Course On Women's Childbirth Experience, Florence Oxenham

Master's Projects and Capstones

The United States has some of the highest rates of maternal morbidity and mortality among developed countries. Comprehensive childbirth education is an important component of improving maternal health outcomes. This project was a pilot evaluation of a childbirth education course offered by Blossom Birth Services, a community-based non-profit organization providing resources for new and expectant families in the San Francisco Bay Area. A 41-item survey questionnaire was developed and administered to explore the impact of Blossom’s Natural Childbirth Prep course on women’s knowledge, feelings, and sense of self-efficacy regarding childbirth. Likert scales were used and thematic analysis of qualitative data …

To Asq Or Not To Asq: A Suicide Risk Screening Improvement Project, Gina Mumper

Master's Projects and Capstones

Abstract

Suicide is the second leading cause of death in children between the ages of 10-19 years. Most people who die by suicide have visited a healthcare provider within the prior year. Inpatient healthcare providers, particularly clinical nurse leaders (CNLs), are in a strategic position to assess adolescents for suicide risk regardless of their admitting diagnosis. “To ASQ or Not to ASQ” is an evidence-based project aimed at improving compliance with the Ask Suicide Screening Questions (ASQ) in an eight-bed medical-surgical adult and pediatric overflow intensive care unit (MSICU) in a large tertiary 629-bed academic medical center. Methods included convenience …

A Novel Model Of “Remedy And Elimination Of Tuberculosis”, Akanksha Mishra

Master's Theses

Tuberculosis (TB), is one of the top ten causes of death worldwide. TB is commonly linked to poverty and creates poverty as it is the single largest cause of death in the 15-49-year-old age group in South-East Asia (WHO, 2017). It is also linked to the HIV population, and its leading cause of death. TB is effected by socio-economic factors, cultural factors, and health policy. My goal of this dissertation is to identify systematic approaches that shall support the mission set by World Health Organization (WHO): to eliminate TB globally by the year 2050. Measures might include addressing social barriers …

Two-Component Hydrogel As Biomimetic Vitreous Substitutes, Sruthi Santhanam

McKelvey School of Engineering Graduate Student Theses & Dissertations

The vitreous humor of the eye is a biological hydrogel principally composed of fibrillary collagen interspersed with semi-flexible polyelectrolyte, hyaluronic acid (HA). Certain pathological conditions necessitate its removal and replacement. Current vitreous substitutes, such as silicone oils and perfluorocarbons, are hydrophobic, do not resemble the properties of the vitreous, and have known complications. An ideal vitreous substitute should have properties of the natural vitreous, perform its functions, and be biocompatible in the eye. Inspired by the structure and composition of the natural vitreous, we used bio-mimicry to develop an injectable two-component hydrogel. The hydrogel is composed of a fibrillary gellan, …

"All Set Togo Home":Improving Discharge Planning For Patient's Safe And Timely Discharge, Jasmin Milana

Master's Projects and Capstones

Abstract

The project focuses on the improvement of the discharge planning for patient’s safe and timely discharge in the medical oncology and telemetry unit at the county hospital. The facility has 54-bed capacity with an average daily census of 35 to 40 specializing in cancer, end-stage diseases, cardiac issues, HIV/AIDS, sepsis, palliative and comfort care, diabetes, respiratory diseases, psychiatric and placement patients. The unit has no discharge coordinator. Nurses are responsible for the quality and safe discharge of patients. These nurses experience frustrations due to fragmented system of the discharge process, nurses’ heavy workload, and prioritizing patients with higher acuity. …

Improving Early Sepsis Identification, Stephanie Senda

Master's Projects and Capstones

Sepsis is a serious complication which is initiated by the body’s extreme response to an infection. If sepsis is not identified and treated promptly, it can rapidly lead to tissue damage, organ failure and death. Accounting for high morbidity and mortality rates in the United States, sepsis has become an area of focus within the healthcare spectrum as it is frequently unrecognized and undertreated. The focus of this project is for the Clinical Nurse Leader (CNL) students to evaluate the policies and processes in place within a large metropolitan hospital as well as the hospitals ability to recognize and treat …

Sexual Health Education In New Mexico Public Secondary Schools, Elizabeth Dickson

Nursing ETDs

Previous research has shown that comprehensive sexual health education (SHE) can significantly reduce risky sexual behavior and can increase protective behavior in adolescents. While an important component for all adolescents, this is particularly important for adolescents at high risk for adverse health outcomes, such as unplanned adolescent pregnancy and sexually transmitted infections. The aims of this descriptive study were to explore the content and delivery of SHE in New Mexico and to describe influences on decisions pertaining to implementation of state SHE policy. The social ecological model (SEM) was used as a theoretical framework to better understand levels of influence …

Coping With Labor Education For Nurses, Donna Vo

Master's Projects and Capstones

The “Coping With Labor Education for Nurses” education plan is substantiated by data from the California Maternal Quality Care Collaborative (CMQCC) vaginal birth initiative toolkit and other research. Evidence-based data from multiple sources indicates that improving how labor support is offered at the bedside for the laboring patient can potentially decrease cesarean rates, reduce expenses, and increase savings. The objectives of this plan are to improve patient advocacy and the level of labor support interventions labor and delivery nurses will provide for patients to improve patient satisfaction score above 80%, decrease or maintain cesarean rates below 24.9%, and improve patient …