Medicine and Health Sciences Commons^™

Improving Provider Adherence To Guidelines And Screening For Adult Depression In Primary Care, Amber Crenshaw

Doctor of Nursing Practice

The purpose of this QI project was to improve provider adherence to the Institute for Clinical Systems Improvement (ICSI) Guidelines for Adult Depression in Primary Care to enhance the screening, diagnosis, treatment, and management of adult major depressive disorder (MDD). MDD is a widespread, disabling, and treatable psychiatric disorder that is primarily treated and managed by primary care providers (PCPs). Untreated depression is prone to become chronic and can lead to pain, suffering, disability, increased morbidity and mortality, and premature death, with serious repercussions for the individual and society. Universal and routine screening in primary care for depression in adults, …

Evidence-Based Foot Care For Persons With Type 2 Diabetes, Nicole Gutierrez

Doctor of Nursing Practice

Unmanaged Type 2 diabetes leads to macrovascular changes that affect the lower extremities, thereby damaging the sensory nerve fibers and leading to diabetic peripheral neuropathy. These patients may not be able to feel pain, heat, or cold in their lower extremities and often describe feelings of numbness and tingling. This sensory deficit may lead to the development of diabetic foot ulcers which often result in amputation. These preventable foot complications may be identified promptly with adequate diabetic foot exams. Comprehensive diabetic foot examinations reduce the occurrences of foot complications associated with uncontrolled glucose management and improves health outcomes for patients …

A Quality Improvement Initiative To Improve Depression Screening In Prenatal And Postpartum Mothers, Britanni Greene

Doctor of Nursing Practice

Screening for depression during the prenatal and postpartum period is essential. The United States has the highest mortality rate in the developed world, with mental health complications being 1 of the top 5 reasons women expire within the 1st year of childbirth. The purpose of this quality improvement project was to increase depression screening during the gestational and postpartum periods in an obstetric and gynecological clinic. An administration schedule was created to administer the Edinburgh Postnatal Depression Scale (EPDS). The EPDS was administered during the initial prenatal, 32-weeks prenatal, and 6-week postpartum appointments. Women scoring 10 or higher on the …

Quality Improvement Initiative To Increase Comprehensive Eye Exams In Patients With Diabetes, Julia Khoury

Doctor of Nursing Practice

Diabetic retinopathy is the most common microvascular complication associated with poorly controlled diabetes. Yet, only 60% of the diabetic population receives an annual eye examination by an eye specialist. Retinal imaging increases surveillance of retinopathy, however, it does not take the place of a comprehensive eye examination by an ophthalmologist or optometrist. The aim of this quality improvement project was to increase comprehensive eye examinations in patients with diabetes aged 18 to 75 years in a family practice that recently purchased a retinal imager. This quality improvement project occurred over a 10-week period. Project objectives included increasing comprehensive dilated eye …

Implementing A Cognitive Impairment Care Planning Toolkit To Enhance Dementia Care: A Quality Improvement Project, Raquel Garcia-Priestly

Doctor of Nursing Practice

Background: Alzheimer’s is the most expensive disease in the United States with costs reaching $277 billion a year and affecting 5.7 million Americans. By 2050, 14 million Americans will have Alzheimer’s disease and related dementias (ADRD). This burdensome disease not only affects the individual, but also those who are responsible for their care, making it extremely complex to manage. Purpose: To systematically integrate the Alzheimer’s Association’s Cognitive Impairment Care Planning Toolkit in an outpatient mental health clinic to enhance care by effectively addressing the needs of patients with ADRD and of their caregivers. Objectives: Increase the number of patients with …

An Evidence-Based Intervention To Reduce The Use Of Physical Restraints In A Female Adolescent Population At An Inpatient Psychiatric Unit, Mambo Ndingwan

Doctor of Nursing Practice

The use of physical restraints within psychiatric units is problematic since it raises a range of legal, ethical, and clinical questions (American Psychiatric Nurses Association, 2014). The use of physical restraint has become a common practice in many psychiatric units despite the negative effects associated with its use. Selecting strategies such as verbal de-escalation to manage aggressive psychiatric inpatients shows promise with patients when used by providers and staff in mental health facilities. The purpose of this evidence-based project was to introduce and train staff to utilize the Modified Overt Aggression Scale (MOAS) and verbal de-escalation in psychiatric units in …

Managing Childhood Obesity In A Primary Care Clinic, Linda Nnajiofor

Doctor of Nursing Practice

Background: Childhood obesity and overweight have increased health burdens on health care systems, and contribute to chronic diseases such as diabetes, heart disease, asthma, and cancer. Childhood obesity is very complex for healthcare providers to manage in primary care settings.

Purpose: To improve childhood overweight and obesity approach and management in a selected primary care practice (Clinic A) in a large east Texas urban community.

Objectives: 1. Increase the percentage of children and adolescents ages 2 to 19 years seen in Clinic A, who received adequate weight management and obesity counseling, to 75%. 2. Increase the number of referrals to …

Improving Residential Asthma Assessment Strategies Within A Low Socioeconomic Community, Monica Ramirez

Doctor of Nursing Practice

Background: Nationally, there are currently 6 million children under the age of 18 with asthma. There are a variety of social determinants and in-home environmental triggers that can contribute to the development of or exacerbation of asthma in children. Therefore, it is important to recognize and improve the needs of children with asthma in older homes and in households with a lower socioeconomic status.

Aim: The aim of this project was to decrease the number of in-home environmental asthma triggers within at-risk homes in San Antonio, Texas.

Purpose: The purpose of this evidence-based practice project was to improve asthma outcomes …

Implementing A Tracking And Referral Follow-Up Process To Increase Screening Colonoscopy Adherence Within A Primary Care Setting, Stephanie Villanueva

Doctor of Nursing Practice

Within the United States, colorectal cancer is the fourth most common cancer diagnosed in both women and men. The American Cancer Society approximated that 97,220 new colon cancer cases and 43,030 rectal cancer cases would occur within 2018. Overall, it was estimated there were approximately 50,630 colorectal cancer deaths in 2018. Despite recommended guidelines, reported screening rates are only 31% to 55%, well below the goal of 75% set by the American Cancer Society. The purpose of this project was to increase preventative colorectal cancer screening referrals and completion of colonoscopies for qualified individuals age 50–75 years within a family …

A Quality Improvement Initiative To Facilitate Provider Adherence To Type Ii Diabetes Mellitus Guidelines, Yazmin Valencia

Doctor of Nursing Practice

Background:A significant number of individuals with type 2 diabetes mellitus do not receive comprehensive diabetes care management to maintain optimal health.

Purpose:This project was designed to facilitate provider adherence to the type 2 diabetes mellitus evidence-based practice standards of care. A primary care practice needs assessment indicated opportunities to improve care management processes which promote adherence to current clinical practice guidelines.

Methods:This 10-week quality improvement project provided the clinical staff and provider with the necessary tools to implement best practices of diabetes care. Objectives assessed throughout project implementation included the design and use of an electronic health …

Winning The Battle And The War Against C. Difficile, Emily Villegas

Articles, Abstracts, and Reports

In 2016 Providence St. Patrick Hospital Serious Infection Rate (SIR) for Hospital Acquired C. difficile Infections (HACDI) was well above the acceptable standard. Several departments were working independently of each other to develop and implement interventions. However, these efforts did not result in sustained improvement and in some cases there where downstream consequences that made the problem worse.

Optimizing Care Teams From The Start, Vanessa Casillas, Ryan Dix

Articles, Abstracts, and Reports

Traditionally, the onboarding plan for a new provider is focused on the new employee. But what happens when the success of your role is largely impacted by the relationships you have with others on the interdisciplinary care team? Interprofessional relationships are a key element of Behavioral Health Consultant (BHC) success in their role and the earlier they can start being developed the better. This presentation will identify strategies to help management teams create effective onboarding plans for the BHC that facilitate smooth adoption of integrated principles and launch successful interdisciplinary collaboration across the care team.

Pedia: Prioritization Of Exome Data By Image Analysis., Tzung-Chien Hsieh, Martin A Mensah, Jean T Pantel, Dione Aguilar, Omri Bar, Allan Bayat, Luis Becerra-Solano, Heidi B Bentzen, Saskia Biskup, Oleg Borisov, Oivind Braaten, Claudia Ciaccio, Marie Coutelier, Kirsten Cremer, Magdalena Danyel, Svenja Daschkey, Hilda David Eden, Koenraad Devriendt, Sandra Wilson, Sofia Douzgou, Dejan Đukić, Nadja Ehmke, Christine Fauth, Björn Fischer-Zirnsak, Nicole Fleischer, Heinz Gabriel, Luitgard Graul-Neumann, Karen W Gripp, Yaron Gurovich, Asya Gusina, Nechama Haddad, Nurulhuda Hajjir, Yair Hanani, Jakob Hertzberg, Konstanze Hoertnagel, Janelle Howell, Ivan Ivanovski, Angela Kaindl, Tom Kamphans, Susanne Kamphausen, Catherine Karimov, Hadil Kathom, Anna Keryan, Alexej Knaus, Sebastian Köhler, Uwe Kornak, Alexander Lavrov, Maximilian Leitheiser, Gholson J Lyon, Elisabeth Mangold, Purificación Marín Reina, Antonio Martinez Carrascal, Diana Mitter, Laura Morlan Herrador, Guy Nadav, Markus Nöthen, Alfredo Orrico, Claus-Eric Ott, Kristen Park, Borut Peterlin, Laura Pölsler, Annick Raas-Rothschild, Linda Randolph, Nicole Revencu, Christina Ringmann Fagerberg, Peter N Robinson, Stanislav Rosnev, Sabine Rudnik, Gorazd Rudolf, Ulrich Schatz, Anna Schossig, Max Schubach, Or Shanoon, Eamonn Sheridan, Pola Smirin-Yosef, Malte Spielmann, Eun-Kyung Suk, Yves Sznajer, Christian T Thiel, Gundula Thiel, Alain Verloes, Irena Vrecar, Dagmar Wahl, Ingrid Weber, Korina Winter, Marzena Wiśniewska, Bernd Wollnik, Ming W Yeung, Max Zhao, Na Zhu, Johannes Zschocke, Stefan Mundlos, Denise Horn, Peter M Krawitz

Faculty Research 2019

PURPOSE: Phenotype information is crucial for the interpretation of genomic variants. So far it has only been accessible for bioinformatics workflows after encoding into clinical terms by expert dysmorphologists.

METHODS: Here, we introduce an approach driven by artificial intelligence that uses portrait photographs for the interpretation of clinical exome data. We measured the value added by computer-assisted image analysis to the diagnostic yield on a cohort consisting of 679 individuals with 105 different monogenic disorders. For each case in the cohort we compiled frontal photos, clinical features, and the disease-causing variants, and simulated multiple exomes of different ethnic backgrounds.

RESULTS: …

The Alliance Of Genome Resources: Building A Modern Data Ecosystem For Model Organism Databases., Alliance Of Genome Resources Consortium, Carol J Bult, Judith A. Blake, Brian R Calvi, J. Michael Cherry, Valentina Difrancesco, Robert Fullem, Kevin L Howe, Thom Kaufman, Chris Mungall, Norbert Perrimon, Mary Shimoyama, Paul W Sternberg, Paul Thomas, Monte Westerfield

Faculty Research 2019

Model organisms are essential experimental platforms for discovering gene functions, defining protein and genetic networks, uncovering functional consequences of human genome variation, and for modeling human disease. For decades, researchers who use model organisms have relied on Model Organism Databases (MODs) and the Gene Ontology Consortium (GOC) for expertly curated annotations, and for access to integrated genomic and biological information obtained from the scientific literature and public data archives. Through the development and enforcement of data and semantic standards, these genome resources provide rapid access to the collected knowledge of model organisms in human readable and computation-ready formats that would …

Editorial Perspective For Systematic Review On C5 Palsies., Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

Solitary Endobronchial Papilloma: A Rare Entity, Muhammad Soban Arif Maan, Muhammad Waleed, Amir Humza Sohail, Asna Sulaiman, Javaid Ahmed Khan

Section of Pulmonary & Critical Care

No abstract provided.

Cholesterol Efflux Capacity And Its Association With Metabolic Syndrome In A Multi-Ethnic Population (Dallas Heart Study): A Cross-Sectional Study, Oludamilola Akinmolayemi

Dissertations and Theses (Open Access)

Metabolic syndrome (MetS) is a multi-component risk factor for cardiovascular disease (CVD) and type 2 diabetes. MetS has been found to be associated with increased risk of incident CVD, cardiovascular morbidity and mortality, and prevalence atherosclerosis. Cholesterol efflux capacity (CEC) is a measure of the functional property of high-density lipoprotein cholesterol (HDL-C). In addition, it characterizes the ability of HDL-C to accept cholesterol from extra-hepatic cells in the periphery to the liver and has been shown in clinical studies to be inversely associated with atherosclerosis cardiovascular disease (ASCVD) and incident cardiovascular disease (CVD) . Low HDL-C is one of the …

Examining The Relation Between Social Capital And Physical Activity Across Life Stages, Leigh Ann Ganzar

Dissertations and Theses (Open Access)

Physical inactivity in adults increases the risk for adverse health outcomes, including non-communicable diseases and premature death. Children who are not sufficiently physically active face increased risk for non-communicable disease risk factors, mental health issues, and poor academic performance. Despite these risks, the majority of people do not achieve sufficient physical activity levels. Social capital is an aspect of the social environment that can shape physical activity behavior throughout different life stages. The three studies of this dissertation sought to assess the association between social capital, from both the cohesion and network perspectives, and physical activity behavior in different life …

Insuring The Integrity Of Global Registries, Aardhra Meenakshi Venkatachalam

Dissertations and Theses (Open Access)

Data quality is a priority in public health because it is used for public health program planning and implementation, research, as well as policy. The information gleaned from the data allows us to assess health status, and improve health needs. This paper evaluated methods for cleaning, managing and addressing missing data in the Lagos State Ambulance Service registry. The techniques included screening, data organization, diagnostic phase, treatment phase and a missing data phase to holistically handle the data. The percentage of systemic errors was reduced through the use of the 5-step method. Missing data was informative for state of origin, …

Nonlinear Functional Models On Causal Inference, Rong Jiao

Dissertations and Theses (Open Access)

Statistical analysis has experienced significant progress on association study, but it remains elusive to understand the etiology and mechanism of complex phenotypes. As a major analytical platform, association analysis may hamper the theoretic development of biomedical science and its application. Thus, many researchers suggest making the transition from association to causation. The mainstream of research in genetics and epigenetics data analysis focuses on statistical association or exploring statistical dependence between variables. Despite significant progress in dissecting the genetic architecture of complex diseases by genome-wide association studies (GWAS), the signals identified by association analysis can only explain a small proportion of …

Additional Graduate Degrees Associated With Promotion Among Primary Care Clinical Faculty, Michael A. Hansen

Dissertations and Theses (Open Access)

Introduction: Many young and ambitious physicians purposefully seek out meaningful careers in academic medicine, yet there are no evidence-based findings to assist these individuals in how to succeed in advancing their careers in this unique work environment. For early and mid-career faculty, a growing number of trainings and opportunities are available but with little insight as to which choices may have the biggest impact. One common perception is the need for additional advanced training, such as a Master of Public Health. Aims and Method: This study sought to provide evidence-based information about additional training by quantifying the benefit of added …

The Importance Of Being A Consequential Public Health Journal, Alfredo Morabia

Publications and Research

No abstract provided.

Factors Associated With C5 Palsy Following Cervical Spine Surgery: A Systematic Review., Andrew Jack, Wyatt L Ramey, Joseph R Dettori, Zane Tymchak, Rod J Oskouian, Robert A Hart, Jens R Chapman, Dan Riew

Articles, Abstracts, and Reports

Study Design: Systematic review.

Objectives: C5 palsy (C5P) is a not uncommon and disabling postoperative complication with a reported incidence varying between 0% and 30%. Among others, one explanation for its occurrence includes foraminal nerve root tethering. Although different risk factors have been reported, controversy about its causation and prevention persists. Inconsistent study findings contribute to the persistent ambiguity leading to an assumption of a multifactorial nature of the underlying C5P pathophysiology. Here, we report the results of a systematic review on C5P with narrow inclusion criteria in the hope of elucidating risk factors for C5P due to a common …

A Pilot Genome-Wide Analysis Study Identifies Loci Associated With Response To Obeticholic Acid In Patients With Nash., Samer Gawrieh, Xiuqing Guo, Jingyi Tan, Marie Lauzon, Kent D Taylor, Rohit Loomba, Oscar W Cummings, Sreekumar Pillai, Pallav Bhatnagar, Kris V Kowdley, Katherine Yates, Laura A Wilson, Yii-Der Ida Chen, Jerome I Rotter, Naga Chalasani

Articles, Abstracts, and Reports

A significantly higher proportion of patients with nonalcoholic steatohepatitis (NASH) who received obeticholic acid (OCA) had histological improvement relative to placebo in the FLINT (farnesoid X nuclear receptor ligand obeticholic acid for noncirrhotic, NASH treatment) trial. However, genetic predictors of response to OCA are unknown. We conducted a genome-wide association study (GWAS) in FLINT participants to identify variants associated with NASH resolution and fibrosis improvement. Genotyping was performed using the Omni2.5 content GWAS chip. To avoid false positives introduced by population stratification, we focused our GWAS on white participants. Six regions on chromosomes 1, 4, 6, 7, 15, and 17 …

Editorial., Jeffrey C Wang, Jens R Chapman, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Phase Iib, Randomized, Double-Blind Trial Of Gc4419 Versus Placebo To Reduce Severe Oral Mucositis Due To Concurrent Radiotherapy And Cisplatin For Head And Neck Cancer., Carryn M Anderson, Christopher M Lee, Deborah P Saunders, Amarinthia Curtis, Neal Dunlap, Chaitali Nangia, Arielle S Lee, Sharon M Gordon, Philip Kovoor, Roberto Arevalo-Araujo, Voichita Bar-Ad, Abhinand Peddada, Kyle Colvett, Douglas Miller, Anshu K Jain, James Wheeler, Dukagjin Blakaj, Marcelo Bonomi, Sanjiv S Agarwala, Madhur Garg, Francis Worden, Jon Holmlund, Jeffrey M Brill, Matt Downs, Stephen T Sonis, Sanford Katz, John M Buatti

Articles, Abstracts, and Reports

PURPOSE: Oral mucositis (OM) remains a common, debilitating toxicity of radiation therapy (RT) for head and neck cancer. The goal of this phase IIb, multi-institutional, randomized, double-blind trial was to compare the efficacy and safety of GC4419, a superoxide dismutase mimetic, with placebo to reduce the duration, incidence, and severity of severe OM (SOM).

PATIENTS AND METHODS: A total of 223 patients (from 44 institutions) with locally advanced oral cavity or oropharynx cancer planned to be treated with definitive or postoperative intensity-modulated RT (IMRT; 60 to 72 Gy [≥ 50 Gy to two or more oral sites]) plus cisplatin (weekly …

Large Scale Improvement Model In Primary Care, Lisa Scardina, Evan Krause

Articles, Abstracts, and Reports

It can be surprisingly hard for organizations to prioritize, structure, and pace initiatives in a way that creates focus and alignment. Often leaders are unaware of all the initiatives under way and their impact on the organization. Overload can result in costly productivity and quality problems and caregiver burnout. With record low unemployment, companies that do not adjust the workload are also at risk of losing valuable talent.

Antithrombin Population Pharmacokinetics In Pediatric Ventricular Assist Device Patients, Brady S Moffett, Marc Anders, Timothy Humlicek, Marianne Galati, Jun Teruya, Iki Adachi, Sebastian Tume

Library Staff Publications

OBJECTIVES: Describe the pharmacokinetics of antithrombin in pediatric patients undergoing ventricular assist device therapy and provide dosing recommendations for antithrombin in this population.

DESIGN: A retrospective population pharmacokinetic study was designed.

SETTING: Large tertiary care children's hospital Subject inclusion criteria consisted of less than 19 years old.

PATIENTS: Subjects less than 19 years old undergoing therapy with a HeartWare ventricular assist device (HeartWare, Framingham, MA) or Berlin EXCOR ventricular assist device (Berlin GmbH, Berlin, Germany), who received a dose of antithrombin with a postdose antithrombin activity level from January 1, 2011, to June 30, 2017.

INTERVENTIONS: Population pharmacokinetic analysis and …

Influences Of Reasoning And Achievement Motivation On Complex Problem Solving In A New Microworld Operationalization, Stephan Bartholdy, Ulrike Kipman

Journal of Global Education and Research

Complex Problem Solving (CPS) can be defined as those psychological processes that enable a person to achieve goals under complex conditions, which are characterized by their complexity, connectivity, dynamics, lack of transparency, and polytely. Although many hypothesized influences have previously been tested concerning their relevance for the process of solving complex problems (e.g., general intelligence), results were often found to be rather heterogeneous. As this was found to be partially caused by fundamental differences between measurements of CPS, a new operationalization was used in the present study: Following the Microworld approach, CPS was assessed in the simulation game Cities: Skylines …

Hypertension Self-Management Intervention: Text Messages To Improve Blood Pressure And Medication Adherence Among African American Older Adults, Elesha R. Roberts

Nursing Dissertations - Archive

The most widely used form of mobile health technology has been text messaging. Because of the wide use, acceptability, and cost effectiveness of text messaging it may be a useful tool to develop hypertension self-management interventions for African American older adults with hypertension. Despite the wide use of text messaging interventions, no studies were found that include a large sample of African American older adults, with hypertension and the use of text messaging to improve blood pressure control and medication adherence. Therefore, the purpose of this pilot feasibility study was to determine if a text message intervention has an effect …