Medicine and Health Sciences Commons^™

Comparison Of Image Quality In High Pitch Free Breathing Versus Standard Pitch Breath-Holding Computed Tomographic Pulmonary Angiography., Kevin Onyinkwa Ombati

Master of Medicine in Imaging and Diagnostic Radiology

Background: Pulmonary embolism (PE) is the third most common acute cardiovascular disease. Missed diagnosis is responsible for most preventable deaths associated with PE. Artefacts from cardiac and breathing motion are a main pitfall. Advances in Computed Tomographic imaging have enabled rapid imaging in an attempt to overcome these pitfalls. Objective: To compare image quality when using high pitch free breathing versus standard pitch breath holding Computed Tomographic Pulmonary Angiography (CTPA) using a dual source scanner. Methods: This was a randomised control trial whereby patients referred to the radiology department for CTPA examination for suspected pulmonary embolism were randomly selected into …

Medical School Watercooler Newsletter May 28, 2017, Lindsey Lyle

Watercooler Newsletter

This is the May 28, 2017 edition of the Frederick P. Whiddon College of Medicine's Newsletter - Watercooler.

Contents Include:

Dumping Medical School Debt: Tips from a USA College of Medicine Alum

USA Radiology Utilizes Samsung Digital X-Ray Equipment

USA College of Medicine to Host Second Annual Case Report Symposium

Class of 2019 Medical Students to Receive White Coats June 17

A Higher Dietary Inflammatory Index Score Is Associated With A Higher Risk Of Breast Cancer Among Chinese Women: A Case–Control Study, Wu-Qing Huang, Xiong-Fei Mo, Yan-Bing Ye, Nitin Shivappa, Fang-Yu Lin, Jing Huang, James R. Hébert, Bo Yan, Cai-Xia Zhang

Faculty Publications

Previous studies have investigated the association between dietary inflammatory potential and the development of cancer. For breast cancer the results have been equivocal. The present study aimed to investigate whether higher Dietary Inflammatory IndexTM (DII) scores were associated with increased risk of breast cancer among Chinese women. A total of 867 cases and 824 controls were recruited into the present case–control study from September 2011 to February 2016. DII scores were computed based on baseline dietary intake assessed by a validated 81-item FFQ. The OR and 95 % CI were assessed by multivariable logistic regression after adjusting for various potential …

Decreased Foley Insertion: Serial Straight Catheterization Versus Indwelling Catheterization, Joy R. Lopez Bsn, Rn, Stephanie A. Stucka

Patient Care Services / Nursing

No abstract provided.

Effects Of Hypertension Education And Motivation Interviewing By Staff On Patients' Activation, Tammy C. Lu, Kathy S. James, Laura Wolfgang

Doctor of Nursing Practice Final Manuscripts

Objective: This evidence-based practice project piloted a team-based program using Motivational Interviewing (MI) and 5 A’s (Assess, Advise, Ask, Assist, and Arrange) to promote healthy behavior and reduce blood pressure at an on-site corporate primary care clinic.

Methods: Patients were counseled using MI and the 5 A’s techniques. Patients received an educational booklet and monthly telephone follow up. Patients returned to clinic 3 months afterwards. Data collected included Dietary Screener Questionnaire scores, blood pressure, and self-rating of concern and motivation.

Results: A total of 4 people participated with variable follow-up. Readiness for change remained stable and confidence scores remained stable …

Chlamydia Screening In Women At A University Student Health Center, Jaime K. Carroll, Karen Macauley

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidenced-based project was to increase chlamydia pre- screening and screening in women under age 25 presenting with urinary symptoms. Interventions included chlamydia pre-screening alerts embedded into the electronic medical record. Three-month evaluation showed a chlamydia pre-screening rate of 100% and an increase in chlamydia screening by 9%.

Improving Self-Care Management In Heart Failure Patients, Sible Rebello

Doctor of Nursing Practice Final Manuscripts

This evidence-based project aimed to improve self-care and decrease the 30-day readmission rates in cardiology clinic heart failure (HF) patients. Thirty-day HF readmission rates, pose a financial burden to hospitals and consistent patient engagement and education in self-care among HF patients can decrease health care utilization, reduce mortality and improve quality of life. Patients received HF education during the first post-discharge clinic visit followed by weekly telephone calls. The Self-Care of Heart Failure Index (SCHFI) was administered to assess baseline knowledge of the self-care and reevaluated at the end of 30 and 90 days. None of the participants were readmitted …

Physician Orders For Life-Sustaining Treatment (Polst) Utilization In A Skilled Nursing Facility: An Educational Quality Initiative, Ryan Hazley Bsn, Rn, Dnp Student, Karl Steinberg Md, Cmd, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

According to expert reports and recent research, frequent clinician-patient conversations about individual end-of-life preferences are necessary to avoid unwanted treatment and to ensure that desired treatments are received. The ongoing diffusion of Physician Orders for Life-Sustaining Treatment (POLST) educational initiatives in skilled nursing facilities (SNFs) are vital to success of California’s POLST program, which is now recognized as only 1 of 3 mature POLST programs in the country. The purpose of this evidence-based practice project was to answer the question: Among staff in a skilled nursing facility, does implementing a formal POLST education program compared to current practice improve staff …

Supporting Self-Care In Veterans With Chronic Pain: Nurse Practitioner-Led Telephone Follow-Up, Marissa A. Munsayac Bsn, Rn, Dnp(S)

Doctor of Nursing Practice Final Manuscripts

Background
Veterans are disproportionately affected by chronic pain. Conventional pain management lacks emphasis on self-care and relies heavily on prescription opioids. Primary care providers (PCP) are able to educate veterans on self-care management; however, frequent follow-up is needed to improve overall pain and quality of life.

Objective
To implement a Nurse Practitioner (NP) telephone follow-up guided by the 5A’s framework among veterans with chronic pain in a primary care setting. This pilot evidence-based project (EBP) aimed to improve follow-up of self-care management in order to decrease pain, increase quality of life, and decrease pain medication use.

Materials & Methods
The …

Implementing An Emr Change For The Diabetic Foot Assessment, Nicole O'Neil, Karen Sue Hoyt

Doctor of Nursing Practice Final Manuscripts

The purpose of this project was to implement the American Diabetes Association (ADA) foot assessment guidelines utilizing an electronic medical record (EMR) template. Aims of this evidence based practice (EBP) project were to improve documentation of the comprehensive diabetic foot exam, increase identification of loss of protective sensation (LOPS), and increase podiatry and vascular surgery referrals. Diabetes Mellitus (DM) causes many health complications. The lifetime risk of foot ulceration in diabetic patients is 25%. The goal of Healthy People 2020 is to increase this number by 10% to a total of 21,617,200 individuals. The ADA recommends annual comprehensive foot exam …

Enhancing Depression Care Outcomes In Primary Care Patients Through Secure E-Mail Structured Follow-Up Monitoring By Mental Health Nurse Practitioner, Sophia Lawrence Aprn, Kathy James Dns, Henry S. Kane Md

Doctor of Nursing Practice Final Manuscripts

Improving Antidepressant Medication Follow-Up Management

Sophia Lawrence, MSN, RN, PMHNP-BC

Doctor of Nursing Practice Student

Faculty Chair: Kathy James, DNSc, APRN, FAAN

Clinical Mentor: Henry Kane, MD, Psychiatrist

Purpose: The purpose of this evidence-based practice project is to integrate a structured follow-up management protocol for patients prescribed antidepressant in primary care and improve HEDIS antidepressant medication management scores.

Background: Depression is a highly prevalent condition affecting 14 million adults in the United States annually. Antidepressant is an effective treatment. However adherence to antidepressant medication remains a significant problem and treatments have failed to improve in primary care.

Methods …

Evaluation Of Hypertensive Clinical Significance In A Primary Care Setting With Veterans With Diabetes, Claire S. Moga Msn, Rn

Doctor of Nursing Practice Final Manuscripts

Analyses of hypertensive confounding factors were identified by looking retrospectively at patient demographics, medications, recent blood pressure and the medical history of hypertensive patients with diabetes. The data trends found in this database highlighted potential areas for improvement with regards to the care of patients with this co-morbidity in the outpatient setting. All prescription anti-hypertensives prescribed for the 102 patients followed the National Joint Committee (JNC-8) Hypertension Guideline Algorithm. Of 102 adult males (over the age of 18), 22 patients had a blood pressure that is out of control (over 140/90). Within this group of patients, 33.3% of the patients …

Opportunistic Diagnosis Of Stis In High-Risk Populations, Kathleen W. Fitzgerald

Doctor of Nursing Practice Final Manuscripts

Introduction

Chlamydia and gonorrhea continue to be a detriment to public health, particularly those under the age of 25. These sexually transmitted infections can cause long-term health problems and should not be viewed lightly. Specifically, untreated or recurrent Chlamydia is the number one cause of ectopic pregnancy, tubal infertility, and pelvic inflammatory disease. Urinary tract complaints are a prime opportunity for concurrent testing since many patients with dysuria may actually have a sexually transmitted infection causing urethritis. Traditional testing can be difficult and invasive because it requires either a pelvic exam or a repeat dirty urine sample spaced at least …

Improving Advance Directive Completion Rates Through Advance Care Planning, Erica Shadae Koeppen, Joseph Burkard, Ellen Ward

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice (EBP) project is to assess the effectiveness of a multimodal intervention to increase advance care planning discussions (ACP) and advance directive (AD) completion rates.

Background: Advance care planning (ACP) and advance directives (AD) is the ongoing discussion and recording of patient preferences and goals of care in the event they lose the capacity to speak for themselves. The Center of Disease Control and Prevention (CDC) estimates that 70% of Americans are without ADs. Centers for Medicare and Medicaid Services (CMS) reimburses for advance care planning consultations. ACP has improved multiple outcomes including higher …

Creating A Palliative Care Referral To Improve Quality Of Life In Heart Failure Patients, Johnny Garcia

Doctor of Nursing Practice Final Manuscripts

Background: A transitional care program was developed at a southern San Diego hospital to guide patients dealing with heart failure from an inpatient to an outpatient setting to decrease hospital readmissions. Although, very successful with a quarterly readmission average of 9%, patients that are considered end-stage heart failure categorized by ejection fraction less than 30% and have greater than one visit in a thirty day period do not qualify for transitional care. These patients’ readmission rates average 50%. The literature shows that patients who will not significantly improve within six months would benefit from palliative and hospice care, thus a …

Guidleine Implementation For Dermal Filler Administration Via Blunt-Tip Cannula To Decrease Post-Procedure Hematoma Formation, Tony Rosales, Karen Sue Hoyt, John W. Love

Doctor of Nursing Practice Final Manuscripts

Dermal filler injections are the second most common in-office cosmetic procedure and are typically administered using pre-packaged 27-gauge needles. In addition to pain and bruising, needle administration has been associated with an increased risk of serious complications due to possible embolization of facial arteries. An alternative technique to needle administration, blunt-tipped cannula administration has emerged as a possibly safer and less painful alternative. Because the tip of the cannula is blunted, blunt-tipped cannulas are believed to decrease the risk of vascular embolization, while also decreasing pain and bruising. Based on current research, an evidence-based project converting from needle to blunt-tipped …

A Right To Choose: A Multi-Modal Approach To Improve Advance Directive Completion Rates, Ashzra D. Jones, Lucia K. Gonzales

Doctor of Nursing Practice Final Manuscripts

ABSTRACT

Purpose: Advance Directives (AD) ensure that patients receive care consistent with their individual values, while also minimizing the decisional burden often placed on families when a patient’s wishes are not documented at the end of their life. This quality improvement (QI) project was intended to improve patients’ overall understanding of Advance directives (AD) and improve completion rates in a primary care setting for patients eighty years and above using a multimodal system.

Methods: This QI project occurred in a primary care setting from March 2016 through March 2017. The multi-modal approach used included contacting patients by telephone, …

Who's Hungry In San Diego, Alison M. Schurman, Kathy S. James

Doctor of Nursing Practice Final Manuscripts

Objective: Food insecurity (FI) is a lack of access to nutritious food. FI has been linked to multiple preventable diseases from behavioral disorders to asthma to obesity and its sequelae. In San Diego County, 14 percent of families are food insecure. The AAP recommends screening for FI at all well appointments using the two-question FI screening tool. The aim of this project was to implement this tool at a multi-clinic, low income population community health center where ninety-five percent of patients meet qualification for SNAP benefits.

Methods: Stakeholders chose one week to screen all patients presenting to clinic for FI …

Implementing Awhonn’S Evidence Based Guidelines For Managing The Second Stage Of Labor, George S. Knapp

Doctor of Nursing Practice Final Manuscripts

Objective: To improve cesarean rates without worsening perineal tissue integrity or neonatal 5 minute Apgar score. Design: Quality improvement project evaluated with descriptive statistics. Setting: A 24-bed perinatal floor at a general acute care hospital in San Diego County California. Patients: Nulliparous term mothers with a vertex singleton pregnancy (NTSV) with or without epidural anesthesia (EA). Intervention/Measurements: To implement the Association of Women’s Health, Obstetrical, and Neonatal Nurses’ (AWHONN) evidence based clinical practice guidelines, Nursing Care and Management of the Second Stage of Labor and Nursing Care of the Woman Receiving Regional Analgesia/Anesthesia in Labor and measure the outcomes of …

Implementation Of Screening Guidelines To Improve Quality Of Care In A Small, Ethnically Diverse Pediatric Primary Care Practice…Then What?, Brooke Basford

Doctor of Nursing Practice Final Manuscripts

Although best practice guidelines have been shown to be effective, the process of translation into everyday practice can be challenging. The purpose of this evidence-based project (EBP) was the implementation of standardized screening tools into annual well-child visits in a small, ethnically diverse pediatric primary care practice in southern California. Standardized screening is recognized as an important process in identifying conditions early to facilitate early intervention. The practice site identified obesity has a priority and consequently the Department of Health Care Services: Child Health and Disability Prevention (CHDP) Program Guidelines for Diet and Nutrition Screening for Children assessment form was …

A Web-Based Stress Reduction Program For Occupational Health, Michelle N. Kabakibi, Karen Macauley

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidenced-based practice project is to implement a sustainable 6-week mindfulness web-based program to reduce stress of call center employees in a corporate setting.

Background/significance: Stress is a major public health issue, calling for a need of better stress management programs to prevent and manage chronic stress. Stress is caused when an individual perceives environmental demands as beyond his/her adaptive capacity. In the workplace, stress leads to emotional exhaustion, job dissatisfaction, lower productivity, and impaired performance (Allexandre et al., 2016). According to The National Institute for Occupational Safety and Health report, 40% of workers reported …

Prevalence Of Binge Eating Disorder In An Insurance-Based Weight Management Center, Kimberly M. Kittleson Dnp, Fnp, Karen Macauley Phd, Dnp, Fnp-Bc, Gnp-Bc

Doctor of Nursing Practice Final Manuscripts

Purpose: This project was anticipated to demonstrate an increase in the number of those diagnosed with BED according to Diagnostic and Statistical Manual (DSM) 5 criteria, diagnosed with ICD-10 code F50.8 or R63.2 and treated according to best practice guidelines.

Background: Binge eating disorder (BED) is the most common eating disorder in the United States, more than both anorexia and bulimia combined. It affects 3.5 percent of women, 2 percent of men and 30 percent of those seeking weight management.

Design: This evidenced-based project consisted of a retrospective analysis of 150 patients seen in a weight management …

Improving Syphilis Follow-Up Rates: A Quality Improvement Project, Erin Edwards, Mary Barger, Winston Tilghman

Doctor of Nursing Practice Final Manuscripts

San Diego County has seen a rise in the number of syphilis cases over the past decade. Syphilis is relatively simple to treat, but requires close serological monitoring to ensure the patient received adequate treatment. Repeat serological testing should be completed at 3 months for patients diagnosed with primary and secondary syphilis. The patient population at a public health clinic in San Diego County has a poor rate of compliance with follow-up appointments (7%). Patient reminders are known to improve patient adherence with follow-up visits. The goal of this project was to incorporate patient reminder cards and patient education to …

Evaluating An Employee Health Tobacco Cessation Program For Enhanced Success, Leah Griffiths, Kathy S. James

Doctor of Nursing Practice Final Manuscripts

Tobacco smoking is the number one cause of preventable death in the US. It increases risk for cardiovascular and respiratory disease, diabetes, and many types of cancer. When contrasted with nonsmoking employees, smokers have a greater amount of lost productivity, as well as cost of health and life insurance claims due to illness. The purpose of this evidence-based project was to identify current smokers and monitor the consistency of their progression through the 5 A’s framework within an employee health clinic. Data was collected over two years and 600 charts were reviewed. After the data was analyzed, it was estimated …

Implementation Of A Metabolic Management Practice Change In A Community Behavioral Health Clinic: An Evidence Based Practice Project, Brenda J. Boyle

Doctor of Nursing Practice Final Manuscripts

Purpose: To increase psychiatric providers’ adherence to the recommendations set forth in the American Psychiatric Association Consensus Guideline for metabolic management of patients prescribed second generation antipsychotic medications (SGAs).

Background: Research suggests that SGAs increase the indicators of metabolic syndrome and a need exists in collecting patients’ biometrics that influences metabolic management.

Methods: Guided by the Iowa Model of Research in Practice, baseline data was collected on blood pressure and body mass index documentation. Metabolic management education was provided to providers in a community behavioral health clinic and four weeks of post data was collected.

Results: A 70% …

Timing Is Everything: Discharge Teaching To Parents In Pediatric Outpatient Surgery, Kate Boulder Dnp Candidate, Ccrn, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

Background: Over 50 years of literature support the nursing “golden rule” that discharge teaching begins upon admission. Parents’ poor understanding of pediatric post-operative instructions following outpatient day surgery can put their child at risk for some preventable complications after arriving home.

Purpose: To improve parents’ understanding of discharge education using earlier initiation of post-operative teaching to best meet the needs of adult learners caring for a child under age 18 after surgery.

Process Used: Parents were educated using four cardinal strategies: early initiation of instructions, reinforcement of key points throughout the length of stay, optimal timing in a distraction-free environment, …

Activity Trackers: Are They The Answer, Connor Ogden, Neil Peterson

Journal of Undergraduate Research

Physical inactivity in young adults leads to a 40% greater chance of cancer mortality, 50% greater risk of dementia, 60% greater risk of stroke, type 2 diabetes, obesity, and a number of other health related issues1. In our country in which sedentary jobs have increased by 83% since 1950, and 69%2 of all adults are obese or overweight, these health related factors due to inactivity become a real concern. Many companies have created these activity trackers as a solution to solving physical inactivity. The purpose of this project was to evaluate what aspects of the Microsoft Band that young adults …

The Effects Of Resistance-Based Warm-Ups On Linear Speed And Power Output, Brock Baumgarn, Jackson Canfield, Chris Carroll

Applied Health Sciences Student Works

PURPOSE: The aim of this study was to examine the speed (yard/sec) and power (Inertial Power Units) of an athlete via the modalities of a 20-yard dash (yards/sec), a broad jump (m), and a portable conical pulley (CP) (VersaPulley, Santa Ana, CA; Inertia 0.27 kg· m2) device. Subjects were tested after completing resistance versus non- resistance based warm-ups. Research of overall effectiveness of warm-ups in direct correlation to athletic performance has been field-tested in a variety of different forms. This study was designed to create a baseline for each athlete and then take the same warm -up and by applying …

Patient Attitudes Toward A Physician Led Radiology Review: Improved Understanding Of Medical Conditions And A Potential New Quality Metric, Jessica A. Latona, Md, Sami S. Tannouri, Md, Theresa P. Yeo, Phd, Shawnna Cannaday, Crnp, Harish Lavu, Md, Jordan M. Winter, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives:

We were interested in understanding patient perspectives regarding the importance of reviewing their imaging studies with a surgeon.

Specific Aims:

1. What value do patients place on viewing their imaging?

2. Do patients have a better understanding of their disease and planned operation after a surgeon led review of imaging studies?

3. Do patients find viewing images an accessible educational tool?

Hypothesis Of K+-Recycling Defect Is Not A Primary Deafness Mechanism For Cx26 (Gjb2) Deficiency, Hong-Bo Zhao

Otolaryngology--Head & Neck Surgery Faculty Publications

K⁺-recycling defect is a long-standing hypothesis for deafness mechanism of Connexin26 (Cx26, GJB2) mutations, which cause the most common hereditary deafness and are responsible for >50% of nonsyndromic hearing loss. The hypothesis states that Cx26 deficiency may disrupt inner ear gap junctions and compromise sinking and recycling of expelled K⁺ ions after hair cell excitation, causing accumulation of K⁺-ions in the extracellular space around hair cells producing K⁺-toxicity, which eventually induces hair cell degeneration and hearing loss. However, this hypothesis has never been directly evidenced, even though it has been widely referred …