Medicine and Health Sciences Commons^™

Health Profiles Of Newly Arriving Refugees In Kentucky, 2016: Data From The University Of Louisville Global Health Program, Ruth M. Carrico, Timothy L. Wiemken, Rahel Bosson, William A. Mattingly, Rebecca Ford, Sarah Van Heiden, Stanley Kotey, Julio A. Ramirez

Journal of Refugee & Global Health

Objectives: Refugees resettling in the United States bring with them a number of health conditions, the majority chronic. These health conditions may impact their ability to be successful with disease self-management and employment, and acculturate and thrive in their new communities. Knowledge of health conditions present in individual refugee populations can be of benefit to healthcare providers in the community and public health. The objective of this manuscript is to describe the state of health among refugees newly arriving in the US and resettling in Kentucky during 2016.

Methods: Using data from the domestic health screens, immunization clinics, and the …

Refugee-Centered Medical Home:A New Approach To Care At The University Of Louisville Global Health Center, Rahel Bosson, Ruth M. Carrico, Anupama Raghuram, Paula Peyrani, William A. Mattingly, Rebecca Ford, Stephen P. Furmanek, Julio A. Ramirez

Journal of Refugee & Global Health

Refugees arrive to the United States with a full spectrum of health conditions, many of which involve intense case management requiring significant financial investments and use of healthcare resources. Kentucky receives more than 3,000 new refugees each year and ranked 10th in the nation for numbers of new arrivals resettled during 2015. These refugees arrive from diverse countries representing different cultures and speaking different languages. In addition, they arrive with diverse health conditions and medical needs. The aims of this paper are to share experiences from the University of Louisville Global Health Center regarding conceptualization, implementation and evaluation of a …

Use Of Emergency Department For Care Access By Refugees Resettling In Kentucky, 2015: Findings From The University Of Louisville Global Health Center, Ruth M. Carrico, Carmen Mitchell, Dawn Balcom, Linda Goss, Anna Persaud, Karen Mutsch, Timothy L. Wiemken, Rahel Bosson, Julio A. Ramirez

Journal of Refugee & Global Health

Background: Kentucky is one of the largest rural resettlement areas for refugees in the US welcoming more than 3,000 refugees and other entrants during 2015. Refugees arrive with a number of chronic health conditions that require ongoing management in a healthcare system where they lack knowledge and ability to navigate. This may encourage them to seek care that is easy to access but episodic and fragmented. The objective of this study was to determine the frequency and reasons for accessing care via a local emergency department by resettling refugees during their first twelve months of resettlement.

Methods: Using data from …

Subjective Well-Being And Hiv Prevention: A Cross-Country Descriptive Study Using Multiple Indicator Cluster Survey Data, Janine Foggia, Anne Sebert Kuhlmann

Journal of Refugee & Global Health

Subjective well-being (SWB) is positively associated with improved health outcomes and, in particular, preventative behaviors. Yet, the relationship between SWB and HIV prevention is not well understood, especially in the context of developing countries. Furthermore, young females experience a high burden of HIV as well as sociodemographic factors which influence SWB. Therefore, this descriptive study sought to describe the global landscape of three constructs of SWB - happiness, life satisfaction, and life perception - and the following HIV prevention variables: comprehensive HIV knowledge, HIV testing, and condom use among young adult females aged 15-24 years. Descriptive statistics of Multiple Indicator …

Evaluating Mental Health In Cuban Refugees: The Role Of The Refugee Health Screener-15, Rahel Bosson, Victoria A. Schlaudt, Monnica T. Williams, Ruth M. Carrico, Adriana Peña, Julio A. Ramirez, Jonathan Kanter

Journal of Refugee & Global Health

The Refugee Health Screener-15 (RHS-15) is widely used in refugee populations, but the psychometric properties and clinical utility have not been evaluated in Cuban refugees and entrants. The current study explored results from the Spanish version of the RHS-15 in a sample of 53 Cuban entrants and refugees, and of these, 17.6% screened positive for a mental health concern. Analyses suggested that a positive screening was significantly related to symptoms of anxiety, depression, and posttraumatic stress disorder; however, it was not associated with demographic variables such as gender, mode of transport, or the number of countries through which a refugee …

What's Happening: August 21, 2017, Maine Medical Center

What's Happening

No abstract provided.

Ada News - 08/21/2017, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.

Strategies To Improve Interdisciplinary Communication In An Acute Care Inpatient Pediatric Unit, Sarah Thompson, Haley Pelletier, Barbara Bush Children's Hospital-Inpatient, Maine Medical Center, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

MaineHealth Maine Medical Center

Interdisciplinary patient rounding has been shown to improve patient and family satisfaction as well as reduce patient length of stay and readmission rates. In an acute care inpatient pediatric unit, baseline metrics demonstrated that 100% of the time, nursing was not included in these rounds thus resulting in sub optimal communication.

The goal of this performance improvement project was to attain increased nursing participation. Data collection demonstrated several reasons for lack of participation and corrective actions were instituted. After undertaking this KPI goal and utilizing operational excellence, 95% of the time, nurses were called to morning rounds with the medical …

Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic

MaineHealth Maine Medical Center

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less.

A root cause analysis identified several deficiencies to includelack of essential equipment, variations in

staff education and the absence of daily reminders.

Post KPI implementations, an overall decrease in the percentage of patients with poorly …

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit, P6 Inpatient Geri-Med Psychiatry, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

MaineHealth Maine Medical Center

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted.

The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better …

Week Of August 21, 2017, New York Medical College

InTouch

• Eduardo Lopez, M.D., is the Inaugural the Catherine and Ladislav P. Hinterbuchner Endowed Chair in Rehabilitation Medicine
• Sixth Annual STAR Student Research Forum Showcases Impressive Summer Investigative Works
• SHSP Students Join LEND at WIHD
• SHSP Hosts Special Public Health Practice Council Meeting

Hops (Humulus Lupulus L.) Bitter Acids: Modulation Of Rumen Fermentation And Potential As An Alternative Growth Promoter, Michael D. Flythe, Isabelle A. Kagan, Yuxi Wang, Nelmy Narvaez

Animal and Food Sciences Faculty Publications

Antibiotics can improve ruminant growth and efficiency by altering rumen fermentation via selective inhibition of microorganisms. However, antibiotic use is increasingly restricted due to concerns about the spread of antibiotic-resistance. Plant-based antimicrobials are alternatives to antibiotics in animal production. The hops plant (Humulus lupulus L.) produces a range of bioactive secondary metabolites, including antimicrobial prenylated phloroglucinols, which are commonly called alpha- and beta-acids. These latter compounds can be considered phyto-ionophores, phytochemicals with a similar antimicrobial mechanism of action to ionophore antibiotics (e.g., monensin, lasalocid). Like ionophores, the hop beta-acids inhibit rumen bacteria possessing a classical Gram-positive cell envelope. This …

Improving Type And Screen Specimen Collection Prior To Elective Surgery, Nordx Blood Bank Staff, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

MaineHealth Maine Medical Center

To avoid delays in the availability of compatible blood for elective surgery patients requiring transfusion, a type and screen specimen should be completed at least 24 hours prior to surgery. Baseline metrics in an acute care inpatient blood bank demonstrated a significant number of cases with no type or screen completed.

The objective of this KPI was to prevent any delays in providing compatible blood products to scheduled surgical patients. Several internal and external system issues were identified as a result of a root cause analysis and a number of actions were initiated.

Outcomes have been positive. Data collection post …

Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

MaineHealth Maine Medical Center

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge.

In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant …

Improving Cardiology Patient Flow In Nuclear Medicine, Kelly Haar, Hannah Sullivan, Kathryn Laverdiere, Nuclear Medicine Department, Haley Pelletier, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

MaineHealth Maine Medical Center

At baseline, a nuclear medicine department found it difficult to complete cardiac stress tests within scheduled times. Using the performance improvement process, a nuclear medicine department looked to improve patient experience related to wait times for this test.

Two goals were identified and a root cause analysis was initiated. After identifying some process issues, two KPIs were developed to address them.

A root cause analysis identified some processing issues and two KPIs were instituted to address them.

As a result, one outcome was to hire an additional physician assistant to address the barrier of inadequate cardiology coverage. Next steps include …

Interdepartmental Rounding, Peggy Anderson, Carrie Strick, R3 Med-Surg Unit, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Maine Medical Center Operational Excellence

MaineHealth Maine Medical Center

STRATEGIES FOR IMPROVING COMMUNICATION BETWEEN DOCTORS AND NURSES IN AN ACUTE CARE HOSPITAL

Effective interdisciplinary communication is imperative for safe patient care in an acute care hospital environment.

A surgical unit used their HCAHPs scores to assess how often patients perceived there was good communication between different doctors and nurses during their hospital stays. The data demonstrated that this occurred 22% less often than the national average.

As a result of a root cause analysis, a number of countermeasures were initiated with the goal of achieving scores greater than the national average. Post KPI inception in the second quarter of …

Communication Of Medication Side Effects In An Acute Care Hospital, Deb Bachand, Rachel Caiola, R6 Neurology Med-Surg Unit, Haley Pelletier, Brendan Lilley, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

MaineHealth Maine Medical Center

COMMUNICATION OF MEDICATION SIDE EFFECTS IN AN ACUTE CARE HOSPITAL

Effective patient education of prescribed medication side effects improves patient safety and reduces overall risk. On an acute care hospital unit, nursing staff felt previous attempts at this education had been ineffective as demonstrated by their HCAHPs scores for communication about medications.

A root cause analysis demonstrated some flaws and several countermeasures were instituted. The goal of this KPI project was to attain a higher than national average for the specific HCAHPs score.

Post KPI inception, the unit’s HCAHPs data showed steady improvement. Within one month, the goal of an …

Aligning Opioid Prescribing Pathways, Andrea Lai, Outpatient Pharmacy, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

MaineHealth Maine Medical Center

There is a drug epidemic sweeping the State of Maine and it continues to worsen each passing year. In 2017, the Maine legislature passed Public Law Chapter 488 to strengthen the controlled substance prescription monitoring program. An outpatient pharmacy, located in a large acute care hospital, created a performance improvement project to clarify opioid prescription and resolve any non-compliance with Chapter 488.

After a root cause analysis, several KPIs were established to include tracking the number of phone calls made by pharmacists to non-compliant providers to clarify scripts, provide one on one education and ultimately resolve non-compliance. Repeat offenders were …

Patient Fall Prevention, R9 West Cardiovascular, Cathy Palleschi, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

MaineHealth Maine Medical Center

PATIENT FALL PREVENTION STRATEGIES IN AN ACUTE HOSPITAL

Every year in the United States, hundreds of thousands of patients fall resulting in injury. Injured patients often require prolonged hospital stays and a resultant increase in medical costs.

The purpose of this study was to identify the current state of fall prevention strategies on a hospital inpatient acute care cardiac unit. Through a root cause analysis, some deficiencies were identified and a process improvement plan was implemented.

Several positive outcomes were attained as a result of the countermeasures initiated. Patient falls per month and total waste in dollars saw a decline …

Medical School Watercooler Newsletter - August 20, 2017, Lindsey Lyle

Watercooler Newsletter

This is the August 20, 2017 edition of the Frederick P. Whiddon College of Medicine's Newsletter - Watercooler.

Contents Include:

Ashton Hennig Appointed Manager of Outreach, Special Projects

Students Participate in DREAM Program to Prepare for Medical School

USA Welcomes Dr. J. Ivan Lopez

USA Gastroenterology Recognized for Excellent Customer Service

Department of Radiology Donates School Supplies

Efficacy Of A Weight Loss Intervention For African American Breast Cancer Survivors, Patricia M. Sheean, Melinda Stolley, Ben Garber, Claudia Arroyo, Linda Schiffer, Anjishnu Banerjee, Alexis Visotcky, Giamila Fantuzzi, Desmona Strahan, Lauren Matthews, Roxanne Dakers, Cynthia Carridine-Andrews, Katya Seligman, Sparkle Springfield, Angela Odoms-Young, Susan Hong, Kent Hoskins, Virginia Kaklamani, Lisa Sharp

Nursing: School of Nursing Faculty Publications and Other Works

African American women with breast cancer have higher cancer-specific and overall mortality rates. Obesity is common among African American women and contributes to breast cancer progression and numerous chronic conditions. Weight loss interventions among breast cancer survivors positively affect weight, behavior, biomarkers, and psychosocial outcomes, yet few target African Americans. This article examines the effects of Moving Forward, a weight loss intervention for African American breast cancer survivors (AABCS) on weight, body composition, and behavior.

A Standardized Electronic Handover Report For Anesthesia Providers, Amber Kristine Lindsay, Elisa Rue

College of Science and Health Theses and Dissertations

Background: Despite numerous studies and agencies recommending the standardization of handovers to improve the quality and safety of patient care, intraoperative anesthesia handovers have remained unstandardized at many institutions.

Objectives: The purposes of this study were to 1) develop the preliminary Anesthesia Handover Report (AHR) and evaluate its accessibility, layout, and content using feedback from an Expert Sampling Group; 2) create the finalized AHR and evaluate the impact it had on the perceived quality of handover among anesthesia providers; and 3) to assess the uptake of the finalized AHR.

Methods: This study was implemented at NorthShore University Health System (NSUHS), …

Intra-Operative Awareness With Recall Under General Anesthesia, Kelly Lannert, Dulcie J. Schippa

College of Science and Health Theses and Dissertations

Background: Anesthesia practitioners are familiar with awareness with recall (AWR) as a phenomenon, however, research has shown it is inadequately assessed, evaluated, and treated in patients receiving general anesthesia leading to significant undesired sequela.

Objectives: The purpose of this quality improvement project (QIP) was to attempt to improve the perceived knowledge and comfort of anesthesia practitioners relative to the assessment, evaluation, and treatment of patients with AWR, thus, closing the gap between knowledge and practice.

Method: The sample consisted of 150 anesthesia practitioners from the Northshore University HealthSystem. Pre-and post-test Likert-type surveys were used and uploaded into Qualtrics to maintain …

A Needs Assessment For Development Of An Interpreter Services Educational Tool For Crnas, Rachel Ferral, Angela Meyer

College of Science and Health Theses and Dissertations

Background: Despite evidence of provider misuse of interpreter services and the resultant adverse outcomes that can and have occurred, few studies have assessed or addressed the gaps in knowledge and attitudes of certified registered nurse anesthetists (CRNAs) towards interpreter service usage when providing care for and consenting limited English proficient (LEP) patients. Objectives: The purpose of this descriptive survey study was to identify CRNA knowledge and attitudes toward interpreter service usage for LEP patients to guide the development of a competency educational tool for CRNAs. Methods: A descriptive, online survey research design was used. The Qualtrics online survey platform was …

Pharmacological And Non-Pharmacological Management Of Depression In Patients With Alzheimer’S Disease, Alicia Cebulak

Nursing Capstones

No abstract provided.

Task-Management Training For Recognition, Prioritization And Decision-Making For The Srna, Laura Majewski, Pauline Kenneth Borja Tselonis

College of Science and Health Theses and Dissertations

Background: Non-technical skill deficiency can increase the chance of error, which can result in adverse events. While the traditional anesthesia teaching plays a significant role on knowledge acquisition and development of technical skills, non-technical skills have been identified to be the key determinant of successful anesthesia particularly during crisis management (Yee et al., 2005). Task-related non-technical skills, such as recognition, prioritization, and decision-making are essential for safe administration of anesthesia (Wunder, 2016). Purpose: The purpose of this study is to improve three non-technical skills (recognition, prioritization, and decision-making) in SRNAs new to the clinical setting with the use of an …

Implementing The Weefim System In Outpatient Pediatric Rehabilitation, Chelsea Ratilainen

Master's Projects and Capstones

Abstract

This project was designed to achieve an unmet criteria in the accreditation process for the outpatient pediatric rehabilitation program at a local, community hospital in the greater Bay Area. The clients range from 6 months old to 20 years old with functional disabilities. The Commission of Accreditation of Rehabilitation Facilities (CARF) requires that applicants demonstrate outcome measure data over a 6 month time period. During the self-evaluation process this was noted to be a deficiency in the department’s efforts. The WeeFIM system was chosen as the first tool to implement in the department. This is a functional improvement measurement …

Video Simulation As An Educational Strategy To Increase Knowledge And Perceived Knowledge In Novice Nurse Anesthesia Trainees, Rachel A. Kozlowski, Jennifer A. Kurdika

College of Science and Health Theses and Dissertations

Background: Video simulation is gaining popularity as an alternative method of teaching and can play an important role in nurse anesthesia education.

Objectives: The purpose of this study is to analyze the effects of an educational video simulation on acquisition of knowledge and perceived knowledge of anesthesia induction in novice nurse anesthesia trainees (NATs).

Method: A single group pre-test post-test design was used to compare knowledge and perceived knowledge on standard and rapid sequencing induction of anesthesia. Pre test scores on knowledge and perceived knowledge were obtained and followed by a viewing of pre-recorded video simulation on standard and rapid …

Crna’S Knowledge And Attitudes Regarding Acupressure As An Adjunct To Postoperative Nausea And Vomiting Prevention, Kimberly A. Homa, Jacqueline Kuhn

College of Science and Health Theses and Dissertations

Background: Postoperative nausea and vomiting (PONV) continues to be a problem for patients despite multimodal pharmacologic treatments available. Although acupressure has demonstrated clinical usefulness, it is still not widely used in mainstream anesthesia practice. Objectives: The purpose of this descriptive survey design was to assess current knowledge and attitudes among CRNAs and SRNAs regarding acupressure for PONV treatment. A secondary objective was to develop an educational handout designed to increase the use of acupressure as an adjunct to postoperative nausea and vomiting prevention using the findings from this current study. Methods: A descriptive, cross sectional survey design was utilized to …

Evaluation Of A Video-Based Left Ventricular Assist Device Education Program For Certified Registered Nurse Anesthetists And Student Registered Nurse Anesthetists, Andrew Gause, Zain Rehman

College of Science and Health Theses and Dissertations

Background: Video-based educational programs have been proven as a more effective means of instruction than traditional lecture and paper-based formats. Therefore, a video-based left ventricular assist device (LVAD) program was developed to address an identified knowledge gap for the NorthShore University HealthSystem (NSUHS) Certified Registered Nurse Anesthetists (CRNA) and Student Registered Nurse Anesthetists (SRNA). Objectives: The purpose of this quality improvement project (QIP) was to pilot a newly developed educational video intervention and evaluate the CRNAs’ and SRNAs’ pre- and postintervention knowledge difference of the LVAD and the LVAD patient population. Methods: The sample consisted of CRNAs and SRNAs from …