Medicine and Health Sciences Commons^™

The Effect Of Opioid Overdose Education And Naloxone Distribution Programs On Opioid-Related Mortality, Blake Rogers, Sharon P

Physician Assistant Capstones, 2016 to 2019

Objective: To determine the effectiveness of opioid overdose education and naloxone distribution (OEND) program implementation in reducing opioid-related overdose mortality. Methods: A PubMed search was conducted using the terms “opioid overdose prevention community naloxone,” yielding 80 records, 36 of which were screened. The remaining 44 articles were reviewed for eligibility, resulting in three articles chosen for the study. Results: An interrupted time-series analysis by Walley et al., and two retrospective cohort studies by Albert et al. and Rowe et al. were analyzed. Conclusion: Studies by Walley et al. and Albert et al. demonstrated a positive association between OEND program implementation …

Community-Acquired Pneumonia In Adults: Diagnostic Reliability Of Physical Examination Techniques And Their Teaching In Academia, Amber Tordoff, Lauren A. Williams

Physician Assistant Capstones, 2016 to 2019

Background: Chest physical examination techniques are taught in academia, but their usefulness in the evaluation and diagnosis of patients in the clinical setting is controversial. Objective: To investigate the accuracy of physical examination techniques and their reliability in diagnosing community acquired pneumonia (CAP) and suggest a modified teaching approach to be used in academia. Design: Systematic Literature Review. Methods: Database search of PubMed and Google Scholar using the search terms “prediction of pneumonia in adults” and “prediction rule for pulmonary infiltrates.” Filters were implemented to include articles that only dealt with human subjects and were full text. Articles …

Vitamin C In The Treatment Of Septic Shock, Alyson O. Shaughnessy, Matthew Tieszen

Physician Assistant Capstones, 2016 to 2019

Objective:To assess the efficacy of improving outcomes of septic shock treatment with the addition of Vitamin C to standard treatment compared to standard therapy alone. To assess whether or not Vitamin C has a favorable outcome in the treatment of septic shock in terms of decreasing duration of vasopressor usage, reducing duration of intensive care unit (ICU) stay, and improving mortality.

Design: Systematic literature review.

Methods: Searches were conducted in PubMed and Google Scholar using the terms ascorbic acid, sepsis, septic shock, and vasopressors. In PubMed the following filters were used: humans only, clinical trials, studies within the past …

Root Cause Analysis To Improve Incident Reporting In An Ambulatory Care Setting, Lisa Ann Duncan

Doctor of Nursing Practice (DNP) Projects

Problem: The subject organization (SO) is a Federally Qualified Health Center (FQHC) with an internally developed incident reporting system. The SO wanted to improve patient and employee safety using data from incident reports, but the incident reporting system did not give enough information to recognize patterns and develop countermeasures.

Context: Supervisors welcomed the opportunity to learn more about incident report follow-up and conducting root cause analysis (RCA). Members of the Safety Committee were eager for data to use to develop countermeasures to improve patient and employee safety. Decreases in employee injuries can save the SO from increases in the …

Effectiveness Of High-Fidelity Human Patient Simulation In Learning To Manage Medically-Complex Infants, Erin Clinard

Dissertations, 2014-2019

Survival of preterm and medically-complex infants has dramatically increased over the past thirty years due to significant advances in medical care and technology, however the developmental costs of survival are substantial. Comprehensive care of premature babies is critical and there is a need for more neonatal therapists, including speech-language pathologists (SLPs), with the knowledge and confidence to provide that care.

Students in graduate SLP programs often receive little clinical experience or dedicated coursework in pediatric feeding and swallowing, especially with medically-complex infants. However, hands-on and experiential learning can support the development of the necessary foundational knowledge and confidence of students …

"C.H.A.M.P. Families": Description And Theoretical Foundations Of A Paediatric Overweight And Obesity Intervention Targeting Parents-A Single-Centre Non-Randomised Feasibility Study., Kristen Reilly, Trish Tucker, Jennifer D. Irwin Phd, Andrew Johnson, Erin S Pearson, Dirk E Bock, Shauna M. Burke

Paediatrics Publications

Childhood obesity represents a significant global health challenge, and treatment interventions are needed. The purpose of this paper is to describe the components and theoretical model that was used in the development and implementation of a unique parent-focussed paediatric overweight/obesity intervention. C.H.A.M.P. Families was a single-centre, prospective intervention offered to parents of children aged between 6⁻14 years with a body mass index (BMI) ≥85th percentile for age and sex. The intervention included: (1) eight group-based (parent-only) education sessions over 13-weeks; (2) eight home-based activities; and (3) two group-based (family) follow-up support sessions. The first section of the manuscript contains a …

Probiotics As An Adjunct Treatment To Standard Therapy In Ulcerative Colitis, Melissa Maloof, Grace Berardini

Physician Assistant Capstones, 2016 to 2019

Objective: To determine the effectiveness of probiotics in addition to traditional therapy for patients with ulcerative colitis (UC) using a systematic review. Methods: PubMed and Cochrane Library databases were queried to evaluate patient clinical trials within the past five years using the search terms probiotics and ulcerative colitis. Results: Three trials met inclusion criteria. Two of three studies found no significant improvement in their primary endpoint with probiotics. Yoshimatsu, et al. found that after one year 56.6% of the placebo group remained in remission, whereas 69.5% of the probiotic group remained in remission (p>0.05).⁹ Tursi, et …

Long Term Outcomes Of On-Pump Cabg Versus Off-Pump Cabg, Christopher Fetrow, Jessalyn Dickerson

Physician Assistant Capstones, 2016 to 2019

Objective: Assess the long-term outcomes including mortality, revascularization and myocardial infarction events to determine whether off-pump CABG is more effective for patients compared to on-pump CABG procedures.

Methods: Studies were found using PubMed with the search term, “on and off pump CABG” which yielded 1736 studies. After assessing for records within 5 years the search was narrowed to 370 articles and then down to 353 because some articles were not available in full-text. Our search was then divided into first looking at randomized control trials and meta-analysis availability from the 353 articles meeting our criteria. After narrowing our search for …

Health Care Economics: Policy And Ethics Nur 412, Joanna Burkhardt

Library Impact Statements

No abstract provided.

Implementing Ihi Joy In Work Framework To Decrease Turnover Among Unit Leaders, Allison Reid

Doctor of Nursing Practice (DNP) Projects

Problem: A medical center in an integrated health care system in Northern California has experienced high turnover for unit level leaders employed in an acute care setting. The role of unit level leaders (managers, assistant managers, and supervisors) in this organization is complex, often stressful, and includes 24/7 accountability. These leaders must simultaneously deliver on organizational goals, patient safety, quality, budgets, and staff satisfaction (Loveridge, 2017). Increasing resilience can help these leaders cope with stress and find joy in their work, making them less likely to leave their leadership positions (Hudgins, 2016).

Context: According to Loveridge, the turnover rates of …

Transforming Nursing Preceptors By Developing Emotional Intelligence, Michael Francis

Doctor of Nursing Practice (DNP) Projects

Changing the process of professionally developing nursing preceptors to meet the growing and changing needs of the nursing profession is critical. This evidence-based project leveraged an advanced preceptor education program for inclusion of basic emotional intelligence tenets and transitioning them into preceptor self-awareness, leadership recognition, and return on human capital investment. A large integrated healthcare system in Northern California identified a strategic need for preceptor development and within the system two acute care hospitals and one home health/hospice agency were selected to participate. The intervention included the development of a six-hour curriculum delivered through an interactive and innovative in-person learning …

Frontline Focus: A Nurse Manager's Employee Engagement Toolkit, Christen Straw

Doctor of Nursing Practice (DNP) Projects

Abstract

Average hospital turnover rates in the US reached 18.2% in 2017. Turnover rates for registered nurses (RNs) were also at an all-time high of 16.8%. RN turnover can cost up to $61,100 per nurse resulting in the average hospital loss of $5.7 million per year (NSI, 2018). Employee engagement and job satisfaction levels are predictors of nursing turnover and patient outcomes and should be a top priority for nurse leaders. A disengaged workforce not only affects team morale and organizational spending, but it also impacts the quality of patient care. Multiple studies suggest that employee engagement is the number …

Implementation And Evaluation Of A Nurse-Driven Protocol For Urinary Catheter Management, Analynn Cisneros

Doctor of Nursing Practice (DNP) Projects

Problem Description: Hospitals compromise quality care and the health of its patients by subjecting the patients to risks that are preventable, such as nosocomial infections (IOM, 1999). The most preventable infection is a catheter-associated urinary tract infection (CAUTI) (Tenke, Meizei, Bode, and Koves, 2016). CAUTIs remain prevalent in the acute care setting (CDC, 2016).

Context: Prior to the implementation of this DNP project, the organization of focus did not have a nurse-driven protocol in place to guide urinary catheter management. Joint Commission mock surveyors recommended a protocol be implemented. A nurse-based protocol would benefit this Magnet hospital. Implementing …

School-Based Suicide Prevention Program Implementation: Improving Awareness Among Parents And Faculty, Nicole Neuman

Doctor of Nursing Practice (DNP) Projects

The health development and critical transition period of preteen to adolescence are subject to adverse experiences and prevalent risk behaviors that may negatively influence mental health. Emerging issues of depression and suicide among school-aged youths present a global epidemic. Well-designed interventions, such as school-based programs, align with national strategies and health initiatives to reduce suicide rates and facilitate treatment of concerning symptoms. Database searches for school-based, suicide, depression, prevention, and screening literature from 2012-2017 identified 12 relevant studies selected for review. Mental wellness and suicide prevention curricula must successfully improve wisdom, enhance coping skills/resilience, and foster relationships which support help-seeking …

Island Of Harm Reduction, Trevor T. Boyer

Capstones

New York City's Rikers Island has a medically assisted treatment (MAT) program for detainees who are addicted to opioids, providing buprenorphine or methadone. For many locked up there, though, Rikers is only a way station before a trip upstate to prison. Even now, over 30 years after its treatment program began, only six other correctional facilities in New York offer pilot opioid treatment programs, which are available only to limited segments of their respective populations.

So for those taking medication in the form or methadone or buprenorphine on Rikers Island pretrial and awaiting sentencing, they're tapered off their doses to …

Art That Heals, Christina Cardona

Capstones

Beryl Brenner was a creative arts therapist for 40 years, and helped veterans heal from war traumas through art all across the city. For the past 11 years, she was at the Brooklyn Campus of the VA NY Harbor Healthcare system in Bay Ridge, where she developed the art therapy program. https://christinacardona1.wordpress.com

Dios, Drogas, Dinero: ¿QuiéN Gana Con El Traslado De Adictos De Puerto Rico A Ee.Uu.?, Claudia E. Irizarry Aponte, Eliana Y. Perez

Capstones

For the last 25 years, evangelical leaders have been shipping off opioid addicts in Puerto Rico to cities in the mainland US, mainly New York City, Chicago and Philadelphia--under the promise they’ll receive state-of-the-art rehabilitation treatment, only to end up in unregulated transitional homes and flophouses where they don’t receive proper medical care or psychotherapy. In turn, many of these unregulated transitional homes, also run by evangelical leaders, may charge Medicaid kickbacks from their “patients.”

While this so-called “air bridge” from Puerto Rico to the U.S. goes back decades, it gained momentum from 2005 to 2014, when evangelical leaders joined …

Climate Grief Hits The Self-Care Generation, Avichai Scher

Capstones

As the effects of climate change intensify, emotional anguish over the future of the planet is emerging. This piece looks at a 10-step program to deal with climate grief "Good Grief."

At Uplift Climate, a conference on climate change for people under 30 held annually, the creators of Good Grief presented their program. The conference focused on climate justice for Native Americans, who have been dealing with climate grief for a long time.

The setting highlighted the class divide of who is affected by climate change. The effects of climate change are now so strong, that climate grief is hitting …

Nursing Partnership With Patients, Parents And Families For Safety Through Simulation, Courtnay Caufield

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The importance of communication between nurses, patients, and their family members with respect to treating each other as partners in safety cannot be overstated. It is imperative that families and patients feel empowered to speak up and report clinical errors at any time and be able to communicate effectively to prevent harm and encourage communication.

Context: This is especially important in the acute care setting, where patients may be in contact with multiple people and processes daily. Attention to this safety partnership can be established through improvements in patient satisfaction scores, which are usually collected from patients and …

Caritas Intervention To Reduce Stress And Increase Resilience Among Caregivers, Randy L. Williams Ii

Doctor of Nursing Practice (DNP) Projects

Problem

Workplace stress and burnout consistently rank among the highest concerns in surveys of caregivers. A gap analysis was conducted among a group of patient care coordinators and medical social workers. The gap analysis identified a need for tools to address stress, feelings of being overworked, and irritability.

Context

The setting is an acute care trauma facility providing care to general medical–surgical adult patients, cardiac care, pediatrics, and maternal child care. This facility exists within a larger integrated health care system, consisting of more than 20 acute care facilities in Northern California. The participants were patient care coordinators and medical …

Implementing A Surgical Infection Prevention Practice In An Integrated Healthcare System, Tammy Peacock

Doctor of Nursing Practice (DNP) Projects

Problem: One of the most preventable health care associated infections (HAI) is surgical site infection (SSI). Approximately sixty percent of SSI’s could be prevented. The devastation of an SSI to the patient can be catastrophic. The cost to the health care system for treating SSI’s can be substantial (Ban et al., 2017).

Context: The rate of surgical site infections has been on the increase over the past three years. The concern for the amount of harm affecting our patients was worrisome. The cost of reputation and the bottom line to the organization was recognized by senior leadership. The support from …

Teamstepps: A Foundation For Shared Governance In A High-Risk Obstetrical/Neonatal Service Line, Genevieve Wright

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Declining registered nurse (RN) engagement in the maternal child health (MCH) department, despite improvements in RN staffing, some reductions in nurse-patient ratios, the addition of support staff resources, and a focus on quality and safety.

Context: The project setting is an MCH department of a 184-bed community hospital, part of a large national organization, serving a diverse population in Northern California. The initial stakeholders included RNs, managers, and assistant managers; the team was later expanded as the project developed (see Appendix A).

Intervention: The original aim of this project was to improve nurse engagement among frontline nurses through …

Improving Management Of Obstetrical Emergencies: Using Simulation-Based Training, Amira Amatullah

Doctor of Nursing Practice (DNP) Projects

The aim of this Executive Leadership Doctorate in Nursing Practice project was to assess the effectiveness of simulation-based training as a strategy to ensure patient safety and quality care by improving the knowledge and confidence of obstetric nursing staff. Collateral goals included the development of a simulation-based interactive training program to improve staff response to obstetric emergencies and the establishment of an Interprofessional Simulation Training Center.

The use of simulation-based training is widely accepted ans used in healthcare education. Several benefits of simulation-based training include a learner-centered approach, safe acquisition of technical skills training and development of effective communication skills. …

Student Perspectives On Working In Interdisciplinary Teams To Implement Mhealth, Elina Chun

Undergraduate Honors Theses

Interprofessional education of students in healthcare professions can lead to positive outcomes for students that are unique in a university setting. The purpose of this thesis is to describe benefits and challenges students encounter when working with students of other majors. This study used a convenience sample of students working on a university project to implement mHealth. Participants responded to two surveys with quantitative and qualitative questions. Students reported greater appreciation for diversity, the necessity of communication skills, and self-awareness of their own responsibilities in a team.

Early Career Physical Therapy Faculty Networking And Scholarly Productivity: A Mixed-Methods Study, Betsy J. Becker

Theses & Dissertations

While it is well-known that physical therapist (PT) faculty must retain a scholarly agenda, few report being activity engaged and many programs have low scholarly dissemination. There is evidence that knowledge of the make-up of a faculty network leads to improved performance and innovation. The purpose of this explanatory sequential mixed methods study was to explore agency (behaviors and perspectives about career advancement) and the professional network structure and composition of early career PT faculty as they relate to scholarly activity. This dissertation research study included 50 early career faculty who worked in accredited entry-level physical therapy programs.

The quantitative …

Health-Related Perception And Responsibility Behavior Among Individuals With And Without Chronic Illness, Danielle Dohrmann

Theses & Dissertations

Few studies have examined perceptions of responsibility attribution and well-being, and health responsibility behaviors in individuals with none, one, and multiple chronic illnesses. Adults (N = 421) in medical clinics completed questionnaires for this cross-sectional descriptive study. The Revised Causal Dimensional Scale measured responsibility attribution whereas sub-sections of the Chronic Disease Self-Management Program evaluation measured well-being perception and the health responsibility behavior of communication associated with a clinic visit. Chi-square, Wilcoxon-Mann-Whitney U, and Kruskal-Wallace tests were used to examine demographic characteristics and group differences. Individuals with multiple morbidities and of advanced age perceived their illnesses as more stable and rated …

Delivery Of Microrna With Cxcr4-Targeted Nanoparticles In Metastatic Cancer Treatment, Ying Xie

Theses & Dissertations

Metastasis is the main contributor to cancer-associated deaths. Inhibition of CXCR4 emerged as one promising approach in metastatic cancer therapy. MiRNAs represent a new class of therapeutics for cancer treatment through RNA interference-mediated gene silencing. Polymeric CXCR4 antagonist (PCX) is a dual-functional polycation to inhibit CXCR4 and deliver nucleic acids. This dissertation hypothesized that blockade of CXCR4 by PCX combined with delivery of miRNA cooperatively enhances metastatic cancer therapy.

In chapter 1, an overview of CXCR4 inhibition, miRNA delivery and CXCR4 targeted nanomedicine in cancer therapy is given.

Chapter 2 reports that PCX can effectively deliver miR-200c mimic and that …

Increasing Physical Activity To Improve Health Through Primary Care Clinics In Rural Nebraska, Jill Reed

Theses & Dissertations

Addressing the lack of physical activity (PA) in rural adults is vital because of the role it plays in the risk for many chronic diseases. The purpose of the study was to explore the feasibility of conducting a 12-week intervention to increase PA behavior in inactive rural adults recruited from a primary care clinic. Subjects were randomized to the intervention (n=30) or control (n=29) group and wore a Fitbit to track PA. The intervention group completed action plans and received weekly motivational text messages to improve PA behaviors. Semi-structured interviews were conducted with study participants (n=10) and a focus group …

Development Of Glucocorticoid Prodrug For The Treatment Of Lupus Nephritis, Xiaobei Wang

Theses & Dissertations

Nephritis is one of the major complications of systemic lupus erythematosus (SLE). While glucocorticoids (GC) are frequently used as the first line treatment for lupus nephritis, long-term GC usage is often complicated by severe adverse effects. To address this challenge, we have developed a polyethylene glycol (PEG)-based macromolecular prodrug (ZSJ-0228) of dexamethasone, which self-assembles into micelles in aqueous media. When compared to the dose equivalent daily dexamethasone 21-phosphate disodium (Dex) treatment, monthly intravenous administration of ZSJ-0228 for two months significantly improved the survival of lupus-prone NZB/W F1 mice and was much more effective in normalizing proteinuria, with clear histological evidence …

Development Of Macromolecular Prodrugs For The Treatment Of Chronic Inflammatory Pain, Laura Weber

Theses & Dissertations

Chronic pain afflicts millions of people worldwide. Particularly, the inflammatory conditions in the incurable disease rheumatoid arthritis (RA) generate persistent pain in its sufferers, for which a number of different analgesics have been prescribed, such as glucocorticoids (GCs) and opioids. However, administration of these pain- mitigating pharmaceutics is implicated in the development of adverse systemic effects due to their non-specific tissue distribution and quick excretion, eliciting the need for high dosing frequencies. To address this issue, this thesis is focused on the development of prodrugs based on a macromolecular design approach to instill preferential inflammation-targeting and retentive properties to common …