Medicine and Health Sciences Commons^™

Fluctuating Cohesion: A Grounded Theory Study Of Nursing Students Engaged In A Hybrid Debriefing Format, Carol Lynn Senette

UNLV Theses, Dissertations, Professional Papers, and Capstones

Debriefing is a key component of simulation that promotes development of students’ reflective processes. Instructor-led debriefing (ILD) is considered the gold standard; however, research conducted over the past decade demonstrates the negative effects of anxiety on student reflection during ILD. Nursing students’ experiences with ILDs have been substantially investigated; yet scant research explores students’ perceptions and experiences of more learner-centered debriefing formats that deemphasize the instructor role.

The purpose of this grounded theory study was to explore undergraduate nursing students’ perceptions and experiences of a hybrid debriefing format consisting of peer-led debriefing followed immediately by ILD. Specifically, I aimed to …

Exploring The Lived Experience Of Early-Career Millennial Nursing Faculty: Deriving Meaning From Their Perspective, Adrian Stamps

UNLV Theses, Dissertations, Professional Papers, and Capstones

An innovative way to combat the protracted nursing faculty shortage is to recruit up and coming generations of nurses to academia. The most recent generation to enter the academic ranks are millennials, often categorized in nursing by a birth year between 1981 and 2000. In contrast to preceding generations, millennials are seeking roles in academia earlier in their careers. Research has shown millennials have unique perspectives on the workplace and a tendency to leave positions if they are not satisfied. This pattern could pose a challenge for sustaining the nursing faculty workforce.

How millennials perceive their initial years in the …

An Exploration Of The Numeracy Skills Required For Safe, Quality Nursing Practice, Anna Wendel

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to explore the numeracy skills required for safe, quality nursing practice. Using a descriptive mixed methods design, this study answered two research questions: 1) What numeracy skills do nurses perceive as important for providing safe, quality nursing care in the first three years of practice? 2) How do nurses incorporate numeracy skills into daily patient care during the first three years of practice? Early career nurses from a not-for-profit health care organization in the mid-Atlantic region of the United States (n=109) responded to an online survey tool developed by the student investigator that ranked …

A Step In The Right Direction: Point-Of-Care Ultrasound As An Evaluation Tool Of Achilles Tendon Injuries In The Emergency Department., Chase A Silvers, Robert Lowe, Eric Cortez

Trauma and Acute Care Articles

This report describes the diagnosis of an Achilles tendon tear in a female patient with an inconclusive physical exam, which was limited by the patient's body habitus. Expedient use of point-of-care ultrasound supported the diagnosis of an Achilles tear with findings of a tendinous defect, fibrous stranding, and surrounding anechoic fluid, suggestive of localized hemorrhage. The patient was splinted in plantar flexion and had prompt orthopedic referral with MRI that verified Achilles tear.

Becoming Myself: A Constructivist Grounded Theory Study Of The Gender Transition Experiences Of Practicing Nurses, Rhiannon Dawn Sullivan

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to construct a substantive grounded theory specific to the gender transition experiences of practicing nurses in their personal and professional lives and to explore the barriers and facilitative factors to gender transition for practicing nurses. There has been research regarding transgender individuals’ discrimination experiences in their daily lives related to their gender identity. These negative experiences increase their vulnerability to negative health outcomes, such as anxiety, substance abuse and depression. However, there is very little known about practicing nurses who are transgender. This research is important because the mental and physical health of nurses …

The Moderating Role Of Psychological Inflexibility In The Relationship Between Minority Stress, Substance Misuse, And Suicidality In Lgb+ Adolescents, Sean N. Weeks

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Adolescence is a difficult time, especially for those who do not identify as heterosexual (e.g., gay, lesbian, bisexual, asexual, pansexual; LGB+). Increased rates of substance abuse and suicidality are well documented outcomes that tend to be worse in the LGB+ adolescent community than in mainstream groups. Minority stress, the effect of unique stressors experienced by those in the LGB+ community explained by external and societal influences, has been accepted within the research community as a theory used to explain the health disparities seen in this group. This study proposed a possible further explanation, in addition to minority stress, that helps …

The Role Of The Recently Deorphanized G-Protein Coupled Receptor, Gpr171, In Morphine Tolerance And Withdrawal, Leela Afrose

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Opioid analgesics, such as morphine, represent the gold standard pain killer and the most frequently used drugs for the treatment of moderate to severe pain. Despite being a potent analgesic, morphine has unwanted and dangerous side effects with repeated use, such as tolerance and withdrawal. Tolerance is a state when a person no longer responds to a drug and a higher dose is required to achieve the same initial pain relief. Withdrawal is a set of undesirable psychological and physiological symptoms that occur after someone stops taking a drug or reduces the dose. Morphine tolerance and withdrawal play a vital …

Inflammatory Myopathies: Update On Diagnosis, Pathogenesis And Therapies, And Covid-19-Related Implications., Marinos C. Dalakas

Department of Neurology Faculty Papers

The inflammatory myopathies constitute a heterogeneous group of acquired myopathies that have in common the presence of endomysial inflammation. Based on steadily evolved clinical, histological and immunopathological features and some autoantibody associations, these disorders can now be classified in five characteristic subsets: Dermatomyositis (DM) Polymyositis (PM), Necrotizing Autoimmune Myositis (NAM), Anti-synthetase syndrome-overlap myositis (Anti-SS-OM), and Inclusion-Body-Myositis (IBM). Each inflammatory myopathy subset has distinct immunopathogenesis, prognosis and response to immunotherapies, necessitating the need to correctly identify each subtype from the outset to avoid disease mimics and proceed to early therapy initiation. The review presents the main clinicopathologic characteristics of each subset …

Acute Right Ventricular Dysfunction In A Critically Ill Patient With Covid-19, Chakradhar Venkata, Senthil Aruchamy, Jan Kasal

2020-Current year OA Pubs

• Right ventricular dysfunction is common in critically ill patients with COVID-19. • Echocardiography is crucial for diagnosing hemodynamic complications of COVID-19. • Pulmonary embolism and acute cor pulmonale can complicate SARS-CoV-2 infection.

A Randomized, Placebo-Controlled Trial Evaluating Effects Of Lebrikizumab On Airway Eosinophilic Inflammation And Remodelling In Uncontrolled Asthma (Clavier), Cary D Austin, Kaharu Sumino, Et Al.

2020-Current year OA Pubs

BACKGROUND: The anti-interleukin 13 (IL-13) monoclonal antibody lebrikizumab improves lung function in patients with moderate-to-severe uncontrolled asthma, but its effects on airway inflammation and remodelling are unknown. CLAVIER was designed to assess lebrikizumab's effect on eosinophilic inflammation and remodelling.

OBJECTIVE: To report safety and efficacy results from enrolled participants with available data from CLAVIER.

METHODS: We performed bronchoscopy on patients with uncontrolled asthma before and after 12 weeks of randomized double-blinded treatment with lebrikizumab (n = 31) or placebo (n = 33). The pre-specified primary end-point was relative change in airway subepithelial eosinophils per mm

RESULTS: There was a baseline …

Clinical Presentation Of Coronavirus Disease 2019 (Covid-19) In Pregnant And Recently Pregnant People., Yalda Afshar, Stephanie L Gaw, Valerie J Flaherman, Brittany D Chambers, Deborah Krakow, Vincenzo Berghella, Alireza A Shamshirsaz, Adeline A Boatin, Grace Aldrovandi, Andrea Greiner, Laura Riley, W John Boscardin, Denise J Jamieson, Vanessa L Jacoby

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To describe the clinical presentation, symptomology, and disease course of coronavirus disease 2019 (COVID-19) in pregnancy.

METHODS: The PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) study is an ongoing nationwide prospective cohort study of people in the United States who are pregnant or up to 6 weeks postpregnancy with known or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed the clinical presentation and disease course of COVID-19 in participants who tested positive for SARS-CoV-2 infection and reported symptoms at the time of testing.

RESULTS: Of 991 participants enrolled from March 22, 2020, until July 10, 2020, 736 had …

Consensus Parameter: Research Methodologies To Evaluate Neurodevelopmental Effects Of Pubertal Suppression In Transgender Youth., Diane Chen, John F Strang, Victoria D Kolbuck, Stephen M Rosenthal, Kim Wallen, Deborah P Waber, Laurence Steinberg, Cheryl L Sisk, Judith Ross, Tomas Paus, Sven C Mueller, Margaret M Mccarthy, Paul E Micevych, Carol L Martin, Baudewijntje P C Kreukels, Lauren Kenworthy, Megan M Herting, Agneta Herlitz, Ira R J Hebold Haraldsen, Ronald Dahl, Eveline A Crone, Gordon J Chelune, Sarah M Burke, Sheri A Berenbaum, Adriene M Beltz, Julie Bakker, Lise Eliot, Eric Vilain, Gregory L Wallace, Eric E Nelson, Robert Garofalo

Department of Pediatrics Faculty Papers

Purpose: Pubertal suppression is standard of care for early pubertal transgender youth to prevent the development of undesired and distressing secondary sex characteristics incongruent with gender identity. Preliminary evidence suggests pubertal suppression improves mental health functioning. Given the widespread changes in brain and cognition that occur during puberty, a critical question is whether this treatment impacts neurodevelopment.

Methods: A Delphi consensus procedure engaged 24 international experts in neurodevelopment, gender development, puberty/adolescence, neuroendocrinology, and statistics/psychometrics to identify priority research methodologies to address the empirical question: is pubertal suppression treatment associated with real-world neurocognitive sequelae? Recommended study approaches reaching 80% consensus were …

New Faculty Perspectives In A Jesuit Institution Amidst Unprecedented Challenges, Cassandra Stroup, T.J. Sayre, Allyson L. Spence

Jesuit Higher Education: A Journal

The struggles and stressors that new faculty members face has been well documented, but during our first year at a Jesuit institution, we encountered unexpected, unprecedented challenges. Fortunately, we developed a unique sense of community as new faculty stemming from Regis University’s Manresa Experience. The Manresa Experience exposed us to Jesuit Values, provided networking opportunities with colleagues, and introduced a togetherness that would help unite us against two unforgiving viruses. The first virus plagued Regis University in Fall 2019, when a cyberattack crippled our entire network security. As new faculty members, we were unable to utilize valuable resources that would …

Editorial, H. Luis Vargas

Counseling and Family Therapy Scholarship Review

Editor-in-Chief H. Luis Vargas' editorial for the latest issue of Counseling and Family Therapy Scholarship Review.

Stem Education In College: An Analysis Of Stakeholders’ Recent Challenges And Potential Solutions, Santanu De, Georgina Arguello

FDLA Journal

A vast majority of academic disciplines and curricula in the college center around Science, Technology, Engineering, and Mathematics (STEM), which are critical to developing the skills necessary for a global workforce. Rapid changes in pedagogical setups, educational modes, and advances in instructional technology entail diverse challenges for key stakeholders (i.e. students, faculty, and the organizations). This paper highlights the most relevant challenges and potential solutions in STEM higher education at the college level, reported in the last decade. The holistic analysis combining the three stakeholders’ perspectives would help elucidate significant contemporary aspects impacting the fields. The goal is to further …

Evaluation Of Outpatient Anticoagulation Bridging After Left Ventricular Assist Device Implantation, Rebecca A. Rainess, Lauren Alderman, Teresa Cicci, Monty Yoder, Barbara Pisani, Thomas O’Neill, Diego Malaver

The VAD Journal

Objective: The aim of this study is to evaluate the safety of outpatient anticoagulation bridging following left ventricular assist device (LVAD) implantation.

Methods: This study is a retrospective, single-center cohort of adult patients who underwent LVAD implantation (HeartMate II™ or HeartMate 3™) and received warfarin and at least one dose of therapeutic enoxaparin or fondaparinux for outpatient anticoagulation bridging. The primary endpoint was the incidence of bleeding complications within one week of completing the bridging episode. Secondary endpoints included the incidence of new hemolysis or thrombosis within 30 days, INR at the time of bridge initiation, duration of anticoagulation bridge, …

Cutaneous Manifestations Of Covid-19: Case Report And Discussion, Abigail Russell, Gary Gross, Vashist Nobbee

HCA Healthcare Journal of Medicine

Introduction: Various cutaneous manifestations of COVID-19 have been described and awareness of these findings is beneficial for clinicians for an accurate diagnosis.

Clinical Findings: We present a case of skin findings consistent with acral microthrombi induced changes in an elderly gentleman who was positive for COVID-19.

Outcomes: The patient had a mild course of COVID-19. Cutaneous findings resolved after one week from presentation with supportive care.

Conclusions: This case highlights the importance of awareness of manifestations of COVID-19, which may assist in timely diagnosis and prevention of transmission.

Covid-19 With Congruent Affect, Mitchell Thomas

HCA Healthcare Journal of Medicine

Music is a vehicle of capturing an individual’s experiences: a new beginning, a broken heart, complete joy, and even catharsis. Before deciding to embark on my path in medicine, music was my interest. Creating music is my therapeutic method of relieving stress, providing a productive outlet when coping with my stressors, and allowing me to focus on becoming a better student doctor. It has carried me through tough times and continues to do so. This instrumental song I wrote represents how I felt as a second-year medical student going through the COVID-19 pandemic; from being isolated in a state away …

Starting Residency With Covid-19, Seena Khosravi, Ashish Sinha

HCA Healthcare Journal of Medicine

Introduction

By Dr. Ashish Sinha, MD, PhD, DABA, MBA, FASA

As a Program Director of a just established anesthesia program, one faces enough challenges. A curve ball that I was not expecting was one of my residents to inform me on July 3rd that he was feeling feverish with chills, had myalgia and a headache. First response in my mind, that I didn’t verbalize was, ”Anosmia too?” I arranged COVID testing ASAP in a drive-by setting, which we could avail immediately. My resident had driven from New Orleans, LA to Riverside, CA, making a few stops along the way, (food, …

Covid Intensive Care Unit Through The Eyes Of Ophthalmologists, Laura Drayer Turner, Dharshana Ramanathan, Sneha Melmane, Geeta Menon

HCA Healthcare Journal of Medicine

The disproportionate impact of COVID on the mortality and morbidity of people of black, Asian and minority ethnic (BAME) backgrounds has been recognised and is under investigation. Here we present a different impact: that on the psyche. As three doctors of BAME heritage, we shared an experience of being redeployed from ophthalmology to the COVID Intensive Care Unit. We share our reflections on the experience and lessons learned.

Informing Strategy To Ensure Detection: Perceptions Of Coronavirus Testing In A Southeastern U.S. Urban Homeless Population, Colleen Bell, Theodore Bosi, Barbara L. Gracious

HCA Healthcare Journal of Medicine

Introduction: Attitudes of those in the homeless population toward testing, particularly during a pandemic, are critical to understand, so that they and their communities may be safely triaged and protected. Homeless persons are more likely to be exposed during viral epidemics, and have greater vulnerability for more severe viral illness, due to greater medical comorbidities. The literature reflects a dearth of published papers describing the perceptions, interest, and motivations of homeless people to seek or receive viral testing, despite their status as a high-risk population.

Methods: A quality improvement project consisting of a cross-sectional survey took place at 8 SARS-CoV-2 …

The Impact Of Covid-19 On Admission Rates For Individuals With Substance Use Disorders, Devin J. Mcdonald, Linda Zhang, William Brady Dehart

HCA Healthcare Journal of Medicine

Background: Limited data exist regarding the prevalence of substance use disorders or utilization of mental health care during the COVID-19 pandemic. Our study aims to specifically identify trends in the utilization of behavioral health units (BHU) in those with substance use disorders (SUD).

Methods: Patient electronic health records (EHR) were analyzed from fourteen hospitals principally located in the US mid-Atlantic region. To compare SUD admissions before and after COVID-19 quarantine time periods, patient data from BHUs were collected from two time-periods: February 1st, 2019 to May 31st, 2019, and February 1st, 2020 to May 31st, 2020.

Results: The number of …

The Effect Of Hydroxychloroquine On In-Hospital Mortality In Covid-19, Samar Aboulenain, Nakeya Dewaswala, Fergie Ramos, Pedro Torres, Ahmed Abdallah, Mohamed Abdul Qader, Baher Al-Abbasi, Charles R. Bornmann, Karolina N. Dziadkowiec, Kai Chen, Jesus E. Pino, Robert Chait, Kleper De Almeida

HCA Healthcare Journal of Medicine

Background: Hydroxychloroquine (HCQ) is an antimalarial medication that has been tested against various viral illnesses. The available evidence regarding the role of HCQ in the coronavirus disease 2019 (COVID-19) remains controversial.

Methods: This is a comparative retrospective cohort study that aims to evaluate the efficacy and safety of HCQ in hospitalized patients with COVID-19. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included ICU admission rate, mechanical ventilation, prolonged length of stay (LOS), QTc prolongation and cardiac arrest.

Results: A cohort of 175 hospitalized patients with COVID-19 were included with a median (interquartile range [IQR]) age of 66 [48–79] …

Innovative Conservation Of Inhaled Medication Devices During The Covid-19 Pandemic Through A Canister Reassignment Process, Mandelin K. Cooper, L. Hayley Burgess, Karla Miller, Theresa Baltz, Julia Moody, Elizabeth Wiggins, Jeffrey Guy

HCA Healthcare Journal of Medicine

Background: The ideal practice for patients requiring metered-dose inhalers (MDI) with coronavirus disease 2019 (COVID-19) is to use patient specific MDIs. However, this practice may not be possible during a time of increased usage throughout the country and limited availability of the medication. Nebulized medications are a concern due to the potential for aerosolized virus and increased exposure for health care workers. An alternative program of canister reassignment is proposed to address concerns for infection prevention, cross-contamination of MDI canisters and the shortage of MDI’s due to the COVID-19 pandemic.

Methods: A comprehensive MDI canister reassignment process was developed for …

Sars-Cov-2 Antibody Positivity And Prevalence In An Outpatient Medical Setting In Las Vegas, Nv, Sassan Kaveh, Kimball Kaufman, Tina Danai, Hossein Akhondi

HCA Healthcare Journal of Medicine

Background: SARS-CoV-2 antibody testing shows the prevalence of COVID-19 disease in different communities and has epidemiological significance.

Methods: SARS-CoV-2 IgM and IgG were tested in 319 patients, staff and visitors of a primary care clinic in Las Vegas, NV on a continuous as-requested basis.

Results: Prevalence of SARS-CoV-2 antibodies was 3.76% in a primary care office in Las Vegas, NV. Positivity of IgM was 0.31% and IgG 3.44%. The most common symptoms reported amongst those who tested positive were cough, shortness of breath and loss of smell and taste. The most common comorbidities included hypertension, chronic lung disease, seasonal allergies, …

Universal Testing Of Covid-19 Infection On A New Orleans, La Labor And Delivery Unit, Vidda Moussavi, Tiffany C. Chang, Alison M. Key, Minmin Luo, Alice S. Tong, Chi Dola

HCA Healthcare Journal of Medicine

Background: The greater New Orleans area emerged as an early epicenter of the COVID-19 pandemic, with one of the highest infection and death rates per capita in the United States. The first case of COVID-19 in an obstetric patient at Tulane Lakeside Hospital occurred on March 22, 2020. Given increasing concern for asymptomatic carriers, the labor and delivery unit implemented universal testing of all patients and their support partners starting on April 1, 2020.

Methods: A retrospective chart review of all obstetric encounters was performed to determine the incidence of COVID-19, characterize the natural history of COVID-19 and evaluate obstetric …

Covid-19 Needs Assessment And Support For Primary Care Practices In Western North Carolina, Sheri Denslow, Jill Fromewick, Kacey Scott, Jesse Bossingham, Brian Cass, Bryan Hodge, Erica L. Richman, Tammy Garrity, Kathleen Mottus, Jacqueline R. Halladay

HCA Healthcare Journal of Medicine

Background: It is critical to ensure that Primary Care Providers (PCPs) have adequate personal protective equipment (PPE), supplies, training, staffing, and contingency planning during pandemics, particularly in rural areas. In March 2020, during the onset of the COVID-19 pandemic, the Mountain Area Health Education Center (MAHEC), in collaboration with the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill, rapidly created and conducted a needs assessment of PCPs in western North Carolina (WNC).

Methods: A group of twenty volunteers conducted a telephone survey of PCPs in a 16 county region of WNC. Practices were asked about their …

Remdesivir-Warfarin Interaction: A Case Report, Kayihura Manigaba, Josh Hawks, Marie Kima

HCA Healthcare Journal of Medicine

A greater than 65-year-old Caucasian woman receiving long-term anticoagulation with warfarin for atrial fibrillation experienced a sudden rise in an international normalized ratio (INR) after she was started on remdesivir for management of 2019 Novel Coronavirus (COVID-19). Patient INR was maintained within the target therapeutic range of 2–3 with a warfarin dose of 11 mg/week before starting remdesivir. After 2 days of remdesivir therapy, the patient’s INR increased significantly and remained elevated during the 5 day course of remdesivir therapy. Patient required an interruption of her warfarin therapy for 7 days, and her INR did not return to the targeted …

Acute Ischemic Stroke As The Presenting Feature Of Covid-19 In The Young And Pregnant, Nermila A. Ballmick, Jiri F. Kubac, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left …

Neuropsychiatric Presentation Of Covid-19: A Case Report Of Disinhibition In An Acute Sars-Cov-2 Infection, I. Jack Abramson, Kristy A. Fisher, Clara V. Alvarez, Jacqueline Horan Fisher

HCA Healthcare Journal of Medicine

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) viral infection is notable for a high degree of symptom diversity. Emerging evidence suggests viral invasion of the central nervous system; therefore, serious neurological and psychiatric manifestations are anticipated. We present the case of a 67-year-old male physician with a history of stable Bipolar Disorder for decades, hospitalized for persistent COVID-19 symptoms with documented positive serology, who presented with new and acute onset neuropsychiatric symptoms of disinhibition proximate the viral infection. We postulate neuroinvasion as the putative origin of the patient’s psychiatric instability. Further investigation is needed to expand upon our understanding of the …