Medicine and Health Sciences Commons^™

Ginkgo Biloba Extract Protects Against Methotrexate-Induced Hepatotoxicity: A Computational And Pharmacological Approach, Lina Tariq Al Kury, Fazli Dayyan, Fawad Ali Shah, Zulkifal Malik, Atif Ali Khan Khalil, Abdullah Alattar, Reem Alshaman, Amjad Ali, Zahid Khan

All Works

Ginkgo biloba extract possess several promising biological activities; currently, it is clinically employed in the management of several diseases. This research work aimed to extrapolate the antioxidant and anti-inflammatory effects of Ginkgo biloba (Gb) in methotrexate (MTX)-induced liver toxicity model. These effects were analyzed using different in vivo experimental approaches and by bioinformatics analysis. Male SD rats were grouped as follows: saline; MTX; Gb (pretreated for seven days with 60, 120, and 180 mg/kg daily dose before MTX treatment); silymarin (followed by MTX treatment); Gb 180 mg/kg daily only; and silymarin only. Histopathological results revealed that MTX induced marked hepatic …

Responding To Health Needs Of Women, Children And Adolescents Within Syria During Conflict: Intervention Coverage, Challenges And Adaptations, Chaza Akik, Aline Semaan, Linda Shaker-Berbari, Zeina Jamaluddine, Ghada E. Saad, Katherine Lopes, Joanne Constantin, Abdulkarim Ekzayez, Neha S. Singh, Karl Blanchet, Jocelyn Dejong, Hala Ghattas Ph.D.

Faculty Publications

Background:

Women and children suffer disproportionately in armed-conflicts. Since 2011, the protracted Syrian crisis has fragmented the pre-existing healthcare system. Despite the massive health needs of women and children, the delivery of key reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) interventions, and its underlying factors are not well-understood in Syria. Our objective was to document intervention coverage indicators and their implementation challenges inside Syria during conflict.

Methods:

We conducted 1) a desk review to extract RMNCAH&N intervention coverage indicators inside Syria during the conflict; and 2) qualitative interviews with decision makers and health program implementers to …

Outcomes Of Patients Hospitalized With Community-Acquired Pneumonia With Liver Disease Or Cirrhosis., Bibodh Jung Karki, Sravan K. Ponnekanti, Vidyulata Salunkhe, Nishita Tripathi, Mahder A. Tella, Stephen P. Furmanek, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

Introduction: Liver disease and cirrhosis are common causes of mortality worldwide. Community-acquired pneumonia is recognized as a significant cause of morbidity and mortality in this population of adults. There is a lack of data regarding outcomes or prognosis in patients with liver dysfunction who develop CAP. The objective of this study was to evaluate the clinical characteristics, incidence, and outcomes of hospitalized patients with CAP and liver disease.

Methods: This was a secondary analysis of the University of Louisville Pneumonia Study, which was a prospective population-based cohort study of adults hospitalized with community-acquired pneumonia. All patients were divided into three …

A Mobile Phone–Based Sexual And Reproductive Health Intervention For Female Sex Workers In Kenya: Development And Qualitative Study, Frances H. Ampt, Kelly L'Engle, Megan S. C. Lim, Kate F. Plourde, Emily Mangone, Collins Mudogo Mukanya, Peter Gichangi, Griffins Manguro, Margaret Hellard, Walter Jaoko, Paul A. Agius, Marleen Temmerman, Winnie Wangari, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women's Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya.

Objective: This paper aimed to (1) describe …

‘It’S Been A Huge Stress’: An In-Depth, Exploratory Study Of Vaccine Hesitant Parents In Southern California, Mika Kadono

USF Tampa Graduate Theses and Dissertations

In 2015, the US experienced a widespread measles outbreak that originated at Disneyland, California and spread to six other states, Mexico, and Canada. That year, California passed Senate Bill 277 (SB 277), which eliminated the personal belief exemption for vaccinations required for school entry; California became the third state in the country to eliminate nonmedical exemptions. In 2019, Washington, Maine, and New York followed suit eliminating all nonmedical exemptions amid the largest measles outbreak in the US in 25 years. Many countries, including the US, are experiencing a rise in vaccine preventable diseases due, in part, to increasing vaccine hesitancy, …

Individual And Community Supports That Impact Community Inclusion And Recovery For Individuals With Serious Mental Illnesses, Rachel Elizabeth Terry

Dissertations and Theses

The current dissertation presents two published manuscripts and discusses a third study that explored the role of social support in promoting community participation for individuals with serious mental illnesses. The first manuscript investigated sense of community as a potential mediating factor between community participation, psychological distress, and mental health functioning utilizing quantitative methods. The results indicated that sense of community acted as a partial mediator between community participation and psychological distress, as well as mental health functioning. The second manuscript is a literature review that explored the influence of social support on community integration for individuals with serious mental illnesses. …

Exploring Effects Of Background Music In A Serious Game On Attention By Means Of Eeg Signals In Children, Fettah Kiran

LSU Master's Theses

Music and Serious Games are separately useful alternative therapy methods for helping people with a cognitive disorder, including Attention Deficit Hyperactivity Disorder (ADHD). The goal of this thesis is to explore the effect of background music on children with and without ADHD. In this study, a simple Tetris game is designed with Beethoven, Mozart music, and no-music. There are different brainwave techniques for recording; among others, the electroencephalography (EEG) allows for the most efficient use of BCI. We recorded the EEG brain signals of the regular and ADHD subjects who played the Tetris we designed according to our protocol that …

Body Temperature And Cardiovascular Control During Exercise In The Heat: Implications For Special Populations And Athletic Performance, Haoyan Wang

LSU Doctoral Dissertations

Exercise in the heat increases the risk of dehydration and hyperthermia, subsequently impaired cardiovascular function and increased thermal stress. The purpose of this dissertation is to determine the fluid balance, cardiovascular function, thermoregulation, and cooling intervention during exercise in the heat. Four novel studies were conducted in this dissertation.

The first and second studies investigated the fluid balance during exercise in the heat across different sports with their special concerns. The first study conducted in female soccer, suggesting most players were in a hypohydration state after practice, and various fluid needs were exhibited by different positions, possibly associated with on-field …

Implementing A Surgical Pre-Operative Checklist: Improving Transparency & Communication, Ritam Ghosh, Md, James Harrop, Md, Jesse Edwards, Md

Health Equity and Quality Improvement (HEQI) Summit

Our goal was to first analyze what the current practice was and if there was a need for improvement. To our knowledge, each surgical service has its own preop protocol and this is not standardized across the hospital. Furthermore, very few services have EPIC based protocols that allow for documentation and information sharing. For example, the neurosurgery service uses paper checklists, a style that is effective yet outdated.

A survey was sent out to multiple departments in order to gauge the current landscape of pre-operative care. Questions were posed to analyze if there was a need for improved documentation by …

Asymptomatic Fluid Collections Following Distal Pancreatectomy – Is Intervention Warranted?, Elwin Tham, Md, Emily Papai, Ms, David Nauheim, Ms, Michael Morano, Ms, Nicole Wagner, Ms, Shawnna Cannaday, Crnp, Theresa P. Yeo, Phd, Geoffrey Krampitz, Md, Phd, Charles J. Yeo, Md, Harish Lavu, Md

Health Equity and Quality Improvement (HEQI) Summit

Objective

To determine the incidence, associated factors, natural history, and interventions for FCs.

Stepwise Implementation Of Vaginal Cleansing And Azithromycin At Cesarean Delivery To Decrease Postoperative Infections; A Quality Improvement Study, Julie Gomez, Ms, Johanna Quist-Nelson, Md, Laura Felder, Md, Daniele Dimascio, Md, Rebecca Eckler, Md, Amanda Paternostro, Md, Michael Posencheg, Md, Jason Baxter, Md, Vincenzo Berghella, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

We aimed to decrease our SSI rate by 30% by sequential implementation of vaginal cleaning1,2 and azithromycin3 for women who underwent a CD after having labored or experienced rupture of membranes.

Post-Operative Atrial Fibrillation And Anticoagulation, J. Vojnika, Md, P. Varano, Md, S. Melnick, Do, Matthew Metzinger, Mba, Cphq, K. Patel, Rn, Msn, Mba, Cphq

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Overall aim: Improve recognition of need for anticoagulation in post-operative atrial fibrillation.

• Increase recognition that thromboembolic risk in post-op atrial fibrillation is similar to that of non-valvular atrial fibrillation
• Increase the rate of appropriate anticoagulation initiation in patients with post-op atrial fibrillation

Identifying Women With Coronary Artery Disease Using Non-Cardiac Ct Imaging, Rachel Redfield, Md, Rani Rajaram, Md, Kathryn Anderson, Ba, Sarah Kamel, Md, Matthew Metzinger, Mba, Lydia Liao, Md, Katherine Sherif, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims

• Identify the percentage of female patients with prior CT scans done for noncardiac reasons who should have the diagnosis of CAD.
• Collaborate with primary care, cardiology and breast imaging to determine how best to integrate this incidental finding into clinical practice.
• Determine current barriers that may prevent providers from taking action on patients with new CAD.

Detection Of Coronary Artery Disease On Ct Chest Imaging, K. Mirzozoda, Md, Mba, J. Vojnika, Md, R. Mohammed, Md, H. Landon, Md, C. Murphy, Y. Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Overall aim: Improve diagnosis and management of CAD based on CT chest imaging.

• Improve diagnosis of silent CAD based on CT chest imaging: more patients who have findings of CAC on CT chest imaging will be diagnosed with CAD.
• Increase the number of appropriate statin prescriptions based on CAD findings on CT chest imaging.

Use Of Visual Aids In Improving Immunization Rates, Kuljit Kaur, Do, Jennifer Brennan, Do, Manuela Modelowski, Do, Olubunmi Olarewaju, Do, Anthony Abbruzzi, Do

Health Equity and Quality Improvement (HEQI) Summit

We assessed the use of visual aids in vaccine administration in the outpatient setting. Specifically, our objective was to determine if placing visual aids outlining vaccine guidelines in the adult outpatient primary care office would increase the compliance rate of immunizations; and if so, to what degree.

Obstacles To Nurse-Performed Ultrasound Guided Peripheral Iv Placement, Ali Elsaied, Do, Farhan Khan, Do, Rishi Kalwani, Md, Cara Kanter, Md, Kenn Ghafferian, Do

Health Equity and Quality Improvement (HEQI) Summit

With an aging population, the rate of obesity, the regional prevalence of dialysis patients and the increase in IV drug abuse, obtaining routine vascular access in the emergency department (ED) has become more challenging. Ultrasound (US) guided IV placement has been pivotal in identifying deeper veins to access. This is traditionally performed by ED physicians, however given the time constraints, lower acuity patients who require US IV access can experience significant delays to care. We attempted to train ED nurses to perform this skill, however many trained nurses are still not attempting US IVs regularly. This study aimed to identify …

Process Design For Optimizing Text-Based Communication Between Physicians And Nurses, R. Benson Jones, Md, Jane Khalife, Md, Brittany Heckel, Md, Michelle Hannon, Md, Guy Katz, Md, Sonia Bharel, Md, Richard Schmidt, Md, Riti Kanesa-Thasan, Md, Kevin Hines, Md, Timothy Kuchera, Md, Joshua Levin, Md, Christian Fernandez, Md, Emma Lundsmith, Md, Rebecca Jaffe, Md

Health Equity and Quality Improvement (HEQI) Summit

Background and Aim

• Communication between physicians and nurses is a cornerstone of high-quality inpatient care.
• HIPAA-compliant text-based methods offer an alternative to the pager for communication between nurses and physicians.
• While messaging is popular in the personal setting, text-based professional communication in hospitals may increase the number of messages without improving coordination between care providers. (1)
• In addition, urgent messages that are more appropriately calls could be missed by the physician, leading to a delay in action. Other institutions use triage systems to communicate a question or clinical change by the urgency of expected physician response, which have attempted to …

Standardizing Postoperative Handoffs Using The Evidence-Based Ipass Framework Improves Handoff Communication For Postoperative Neurosurgical Patients In The Neuro-Intensive Care Unit, Richard F. Schmidt, Md, Matthew D. Vibbert, Md, Coleen A. Vernick, Do, Andrew M. Mendelson, Do, Caitlin Harley, Msn, Giuliana Labella, Msn, Jessica Houser, Bsn, Patrick Becher, Bsn, Erin Simko, Bsn, Pascal M. Jabbour, Md, Stavropoula I. Tjoumakaris, Md, M. Reid Gooch, Md, Ashwini D. Sharan, Md, Christopher J. Farrell, Md, James S. Harrop, Md, Robert H. Rosenwasswer, Md, Rebecca C. Jaffe, Md, Jack Jallo, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Within one year of initiation of the process improvement plan, we wanted to improve:

• Direct communication of airway and hemodynamic concerns
• Direct communication of operative events, complications, and perioperative management goals.
• Attendance at postoperative handoffs
• Confirmation of information by receiving teams
• Staff perceptions of handoff efficacy and teamwork.

Preventing Prostate Biopsy Complications: To Augment Or To Swab?, L. Glick, S. Vincent, T. M. Han, C. Caputo, D. Squadrito, J. Y. Leong, C. Fonshell, K. Syed, J. F. Danella, S. Ginzburg, T. J. Guzzo, M. Hagg, J. D. Raman, M. Smaldone, R. G. Uzzo, J. J. Tomaszewski, A. C. Reese, E. J. Trabulsi, L. G. Gomella, M. J. Mann

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• The aim of this study was to determine the antibiotic prophylaxis associated with the fewest infectious complications following prostate biopsy
• Determining the safest method allows the Jefferson Department of Urology to modify its biopsy protocol and improve the rate of post-biopsy complications

Hepatitis A Vaccination Program In Jefferson Emergency Departments, Katelyn Levy, Md, Belinda Lao, Md, Mitchell Berman, Md, Joseph Jean, Md, Sejal Patel, Pharmd, Benjamin Slovis, Md, Scott Sutherland, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Increase the rate of hepatitis A vaccination in high-risk patients (homeless and drug users) who present to Thomas Jefferson University Hospital and Jefferson Methodist emergency departments over a 5 month period starting on 9/4/2019.

Improving Outpatient Pneumococcal Vaccination Rates In Patients Age <65, Evan Nardone, Md, Mark Mallozzi, Md, Alvin George, Md, Christine Kurian, Md, Omar Safdar, Md, Timothy Kuchera, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• To increase pneumococcal vaccination rates for patients 19-64 at JHAP to reach 70% over 3 months.
• To increase resident knowledge of indications for pneumococcal vaccination in patients 19-64 by 25% over 3 months

Improving Osteoporosis Screening Rates In A Primary Care Practice Using An Emr-Based Intervention, Conor Murphy, Ashley Barnes, Rukaiya Bashir, Peter Block

Health Equity and Quality Improvement (HEQI) Summit

Objective

• Osteoporosis is defined as a T-score ≤ -2.5 on DEXA or history of fragility fracture
• Affects a significant proportion of our population over 65 with an estimated annual cost burden of $22 billion
• Only 46% of females over 65 years of age had been screened for osteoporosis at JHAP
• Our study aims to increase that percentage between July 2019 and July 2020 from 46% to 60%

Quick Response (Qr) Code Based Just-In-Time Training Platform For Seldom Used Anesthesia Equipment, Daniel Katz, Do, Sean Washek, Do, David Barnabei, Do, Andrea Creamer, Md, David Nelson, Md, Mba

Health Equity and Quality Improvement (HEQI) Summit

Aim for Improvement

This quality improvement initiative aims to introduce, improve, and maintain proficiency with seldom used critical pieces of anesthesia equipment prior to use in emergent clinical situations through the following

• Provide just-in-time usage instructions through smartphone technology
• Remove barriers that lead to unfamiliarity with rarely used equipment, we hope to reduce patient safety incidents due to improper usage

The aim was to improve the department’s familiarity and self-reported competence with seldom used equipment by at least 50%

General Surgery Mobile Procedure Cart: Providing Safe And Efficient Procedure Based Care To The Bedside, Ryan Lamm, Ellen Caparosa, James Fraser, Lindsay Lynch, Uzma Rahman, Lindsay Weil, Harish Lavu

Health Equity and Quality Improvement (HEQI) Summit

Objective

To create a mobile supply cart with all necessary supplies needed for the most common general surgery bedside procedures in order to decrease the amount of times residents need to “shop” for supplies from other locations and prevent delays in procedures to get supplies that are not available. In turn, this will increase patient safety and quality of procedure-based care delivered.

Reading Room Assistance Pilot: Improving Radiologist Workflow, Michael Hoy, Md, Christopher G. Roth, Md, Ms-Hqs, Rashmi Balasubramanya, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Our aim for improvement was to find ways to decrease distractions and phone calls in the body radiology reading room and to convert unpredictable and “immediate-response distractions” to “managed distractions” that can be addressed without aborting patient care/case interpretation immediately and unnecessarily. The goal was to decrease interruptions which would allow more time to be spent on reading cases, learning, and teaching. One metric that we identified was the number of phone calls to the reading room, which we intend to decrease by 50% within the first quarter. Another metric was the radiology attending and resident attitudes …

Improving Patient Safety Through A Postoperative Debriefing Initiative, Ellina Hattar, Md, Monica Young, Dnp, Mba, Rn, Cnor, Erin Leonetti, Rn, Omaditya Khanna, Md, Anthony Stefanelli, Md, James Harrop, Md, Ashwini Sharan Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Effective and clear communication in the operating room is a necessary aspect of any surgery. Every member of the operative team is integral in fostering an environment focused on patient safety. As such, the institution of a postoperative debrief session may allow for feedback from every member of the team that will ultimately aid in improving a patient’s experience.

Early Follow-Up Phone Calls To Reduce 30-Day Readmissions For Stroke Patients Discharged To Home, Olivia Gruder, Md, John Allred, Md, Frank Anzelmi, Md, Judy Diep, Md, Belle English, Md, Aniket Natekar, Md, Priyadarshee Patel, Md, Louis Porreca, Md, Sanskruti Patel, Md, Shaista Alam, Md, Rodney Bell, Md, Robin Dharia, Md, Elan Miller, Md, Diana Tzeng, Md, Fred Rincon, Md< Msc, Facp

Health Equity and Quality Improvement (HEQI) Summit

Patients admitted to the acute stroke unit with minor neurologic deficits are frequently discharged directly to home rather than to a rehabilitation center. Data from our tertiary care comprehensive stroke center has shown that in a 7-month period, 37% of patients admitted to the stroke unit were discharged home versus discharged to rehab or other location. Our average 30-day readmission rate for home discharges is 5.14%. More than 30% of these readmitted patients had been discharged on a Thursday or Friday on their index admission. When discharged home, patients typically are tasked with several responsibilities including but not limited to …

Developing A Home Based Chemotherapy Model, George Xiangyun Ye, Nathan Handley, Md, Mba, Maria Piddoubney, Pharmd, Gloria Espinosa, Pharmd, Judith Alberto, Pharmd, Adam Binder, Md

Health Equity and Quality Improvement (HEQI) Summit

Lessons Learned

• Based on our criteria, most medications can be administered in the home setting.
• A major barrier to administration at home is stability of medications at room temperature. This issue can be addressed by transporting and storing the medication in a refrigerated container.
• Expectedly, injectable drugs and medications with short infusion times that are stable at room temperature would be easiest to administer at home.

Strengthening The Synapse Between Outpatient Neurological Care And Inpatient Referral, T. Y. Chuang, M. Braslavsky, E. Isaac, M. Rehman, C. S. White, S. Thummalapenta, P. Kerns, D. Rose, E. Wong

Health Equity and Quality Improvement (HEQI) Summit

Objective

The goal of this project is to investigate if established neurology patients are appropriately referred to the emergency room. We suspect that there are patients that could be more effectively triaged to prevent unnecessary visits to the emergency department. If this is the case, implementing an intervention such as offering expedited visits or contingency plan, may reduce non-emergent inpatient consultative services5. This would also improve outpatient communication and decrease utilization of both ER and patient resources.

Simple Frameshifts In Mis Postoperative Pain Management Significantly Reduce Opiate Prescriptions, L. Glick, D. Wong, T. M. Han, J. Y. Leong, A. Uhr, J. R. Mark, M. J. Mann, E. J. Trabulsi, C. D. Lallas, T. Chandrasekar

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• The intervention aimed to reduce narcotics provided to patients after MIS by reducing number of narcotic prescriptions and amount prescribed by 25% without affecting patientreported pain scores
• Usage measured in Morphine Equivalent Doses (MED)
• MED and pain score assessed at 3 time points: post-op day 1 (POD1), discharge (D/C) and follow-up (FU) apt
• Pre- and Post-intervention cohorts - Month 1 (Pre-intervention): 21 patients and Month 2 (Post-intervention): 30 patients