2020-05-23_Michigandaily_Covidmap, Michigan Department Of Health & Human Services

Daily Michigan COVID-19 Update

The "WHERE WE STAND WITH COVID-19" map was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., Monday - Saturday.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled.

The image contained a map, indicating total cases by county, and also provides statistics on Total Confirmed Cases, Total COVID-19 Deaths, Daily Confirmed Cases, and Daily COVID-19 Deaths. There …

Peer-Led Education Expedites De-Prescribing Proton Pump Inhibitors For Appropriate Veterans, Mary H. Bowman

Doctor of Nursing Practice Final Manuscripts

Costly proton pump inhibitors (PPIs) have been widely prescribed since the 1990’s for prevention and treatment of ulcers and gastroesophageal reflux disease (GERD). Evidence published since 2012 demonstrates risks associated with taking PPIs longer than eight weeks. Primary care providers (PCPs) mostly de-prescribe PPIs for persons not meeting criteria for long term use. Many patients resist discontinuation.

A three-month evidenced based practice (EBP) education project was conducted by a nurse practitioner to improve PCP peer de-prescribing successes with appropriate patients in an outpatient California based veteran Primary Care Clinic. Fifteen PCPs were pretested about usual care practices between two comparable …

Reducing The Rate Of Falls In Hospice Patients: A Fall Prevention Pilot Program, Allison Floyd

Doctor of Nursing Practice Final Manuscripts

Background and Evidence Problem: As the population ages, there is an increase in the incidents of falls. Falls are the predominant cause of both nonfatal and fatal injuries among adults aged 65 years and older (Bergen et al., 2016). Extensive research has been conducted in fall prevention in hospitals, skilled nursing, and rehabilitation units. End-of-life care in a hospice setting presents a greater challenge in risk identification and prevention of falls. A local hospice had 457 falls between July 2018 to mid-March 2019 with a lack of consistent, detailed, fall education and documentation.

Evidence-Based Practice Intervention: Utilizing the American Geriatrics …

Screening For Post-Menopausal Osteoporosis In Women Ages 30-64 Review Of A Pilot Program In Primary Carescreening For Post-Menopausal Osteoporosis In Women Ages 30-64 Review Of A Pilot Program In Primary Care, Elaine Henson

Doctor of Nursing Practice Final Manuscripts

The risk of an osteoporotic hip fracture is greater than the combined risks of breast cancer, myocardial infarction, and stroke, yet research shows less than 25% of women are being screened. Post-menopause, either surgical or natural, is a risk factor for osteoporosis. Nurse practitioners are in an excellent position to lead the way in osteoporosis screening. This article presents findings in a recent osteoporosis screening program in a primary care office.

Utilizing Telehealth Technology To Reduce Social Isolation And Depression In Seniors, Bohan Farrell

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Social isolation in the elderly has been identified as a risk factor for poor mental and physical health, as well as higher rates of mortality, depression, and cognitive decline. Loneliness is the unpleasant experience that occurs when a person’s network of social relationships is deficient in some important way, either quantitatively or qualitatively. Depression is a mental condition characterized by feelings of severe despondency and dejection, typically with feelings of inadequacy and guilt, and accompanied by lack of energy and disturbance of appetite and sleep. Physically, lonely people have more disorders, such as sleeping problems, stomach pain, and …

Implementing A Basal-Bolus Insulin Regimen Via A Manual Insulin Pump Device, Helen Stearns

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose:The purpose of this evidence-based practice project is to decrease glycated hemoglobin (HgbA1C) levelsby initiating use of a manual insulin pump in patients with Type II Diabetes Mellitus (T2DM) with poor glycemic control who are on multiple daily insulin injections (MDII).

Background: Uncontrolled hyperglycemia is associated with a myriad of complications and co-morbidities that are generally associated with vascular changes that include nephropathy, neuropathy, blindness, stroke, and heart disease (Winter et al., 2015). Coronary artery disease and cerebrovascular disease alone accounts for approximately 65% of the deaths in diabetic patients (Molinaro & Dauscher, 2017). Achieving and maintaining therapeutic …

Nurse Practitioner-Led Obstructive Sleep Apnea Screening In Patients With An Implantable Cardiac Monitor, And Confirmed Or Suspected Atrial Fibrillation, Yarlenis Miranda, Lisa Alvarez, Mehran Moussavian, Joseph Burkard

Doctor of Nursing Practice Final Manuscripts

Background: Obstructive sleep apnea (OSA) has been linked to heart disease and vice versa. Millions of Americans suffer from this chronic sleep condition, and a great number of those affected are unaware they have it. According the American Sleep Apnea Association, 80% of patients who fall in the moderate to severe OSA category are undiagnosed. Evidence suggest that untreated OSA can lead to atrial fibrillation (AF), and other cardiovascular problems. These cardiovascular complications can increase the mortality and morbidity of patients who suffer from this sleep syndrome.

Purpose of Project: The goal of the project was to provide OSA screening …

Calm: A Mindfulness Mobile App For Stress Reduction In The Workplace, Gizzele Valencia

Doctor of Nursing Practice Final Manuscripts

This evidence-based pilot (EBP) project was implemented to decrease stress among employees who work in a financial-based occupational health setting. According to the American Psychological Association’s (APA) Stress in America online survey, 64% of survey-respondents reported that work is a significant source of stress (2018). Mindfulness meditation is a spiritual practice that helps a person acknowledge how to experience emotions and events without judgment (Luken & Sammons, 2016). A mobile app-guided mindfulness program could reduce perceived stress and increase mindfulness levels. These practices might improve work productivity, decision-making skills, organizational relationships, self-care, and perspective taking development (Jayawardene, Lohrmann, Erbe, & …

It's More Than Just "Baby Blues" - Screening For Postpartum Depression In A Pediatric Setting, Breanna M. Lazar, Martha G. Fuller

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Postpartum depression (PPD) is estimated to affect up to 1 out of 7 women. Evidence and American Academy of Pediatrics (AAP) guidelines support maternal screening for PPD in a pediatric setting during well-child visits. The pediatric office is frequently visited during the first year of life and is a suitable setting to perform screening.

Aims of Service Change: Implement AAP recommended PPD screening at a busy primary care practice in Southern California using the Patient Health Questionnaire (PHQ-9).

Details of Innovation: In this pilot project, mothers (who were not patients of the pediatric practice) consented to be screened …

Bridging The Gap: Improving Hospital Discharge Through Utilization Of A Priority Care Clinic, Kristian Jamerson

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Poorly coordinated care often results in poor health outcomes. Best practices in academic literature recommend effective programs that consist of comprehensive discharge planning, complete and timely communication of information, medication reconciliation, patient and caregiver education using the teach-back method, open communication among providers, and prompt follow-up visits with an outpatient provider after discharge. Using a priority care clinic (PCC) for follow-up is one approach to decrease hospital readmissions.

Purpose: To implement an evidence-based program utilizing a PCC to facilitate post-discharge transition-in-care and reduce hospital readmissions.

Evidence-based Intervention: A PCC assists patients in their transition of care from the …

Eating For Two Without Eating Too Much: Optimizing Gestational Weight Gain, Sandra Pope

Doctor of Nursing Practice Final Manuscripts

This evidence-based pilot project was implemented to optimize gestational weight gain (GWG) among women enrolled for prenatal care at a private practice. Evidence from meta-analyses and large studies show: 1) an association between excess GWG and increased risk of fetal macrosomia and increased cesarean delivery; 2) 66% of women do not know their healthy GWG target; 3) a 20% reduction in excess GWG in women receiving diet or exercise interventions or both. In addition, visual plotting of weight gain has helped overweight adults reduce and maintain weight loss over a one-year period. Nutrition assessment using a validated nutritional screening questionnaire …

A Dnp-Led Educational In-Service To Increase Depression Screening In Primary Care, Shaylyn White

Doctor of Nursing Practice Final Manuscripts

Background: Depressive disorders are a major contributor to disability in the United States and worldwide. They are associated with multiple comorbid conditions including cardiovascular disease, obesity, stroke, and premature mortality. In the US, only 4.2% of primary care patients are being screened for depression and approximately 50% of cases of major depression are being missed.

Purpose: Implementation of a nurse practitioner-led educational intervention, discussing when, why, and how to screen utilizing the PHQ-2 and PHQ-9 screening tools, with the medical assistant staff in order to increase compliance with annual screening.

EBP Model/Frameworks: The Iowa model was used to guide implementation …

Assessing The Need For Standardized Pre-Chemotherapy Education: An Outpatient Oncology Clinic Initiative, Spana Patel

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: In a diverse southern California outpatient oncology clinic, assess the need for standardized pre-chemotherapy education for newly diagnosed cancer patients to aid in the improvement of health literacy, self-management of side effects, satisfaction, and reduction of anxiety.

Background: Cancer patients often feel anxious, overwhelmed, and confused by the abundance of information and medical jargon that they must digest. One southern California outpatient oncology clinic identified the need for consistent, standardized procedure in providing chemotherapy education and assessing treatment knowledge in newly-diagnosed cancer patients as evidenced by: inconsistent attendance in educational classes and or appointments, inability to articulate treatment …

Using Short Message Services (Sms) To Reduce No-Show Rates An Evidence-Based Practice Project, Matthew Rocklage

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: No-shows (NS) are correlated with reduced treatment efficacy, increased financial burden on medical institutions, and early treatment termination for therapy. NS occur for a variety of reasons and appointment compliance within outpatient mental health clinics has a wide variance with clinics reporting no-shows ranging from 15% to 50%. This section of the project is a continuation started by an earlier USD DNP student Fernando Serrano, in which the projects aims were expanded beyond the participation of nurse practitioners only to now include marriage family therapists (MFT), psychologists and medical residents, and to address the NS rates clinic-wide. One …

Optimizing Dry Skin Management Utilizing Np Led Phone Follow-Up, Christine Vazquez Bsn, Rn, Dnp - Fnp/Agnp Student

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project is to evaluate the impact of a healthcare provider-led standardized dry skin protocol for outpatient geriatric patients to promote overall well-being and improve quality of life.

Background: Current literature supports using the dry skin protocol to help primary care teams identify patients that require xerosis cutis skin care, particularly of the lower extremities. The primary focus of this project will be timely detection of patients with the dry skin condition that will be identified with the standardized Overall Dry Skin (ODS) scale. When the patient meets the ODS criteria, a timely discussion will be …

Empowering Newly Diagnosed Patients With Hypertension In Reducing Complications Through Self-Managed Care, Ana Pacis

Doctor of Nursing Practice Final Manuscripts

Background: High blood pressure affects millions of people, including children and adults. According to the Centers for Disease Control and Prevention (CDC), about 1 in every 3 adults or approximately 75 million American adults are affected with high blood pressure. High blood pressure often does not cause any signs and symptoms, which is why it is also known as the “silent killer,” and many people are not aware that they have elevated blood pressure (AHA, 2017). If high blood pressure is not controlled, it can lead to other heart diseases such as stroke. It can also cause other health problems, …

Effect Of Differences In Month And Location Of Measurement In Estimating Prevalence And Trend Of Wasting And Stunting In India In 2005-2006 And 2015-2016, Emily M. Madan, Edward A. Frongillo Jr., Sayeed Unisa, Laxmikant Dwivedi, Robert Johnston, Abner Daniel, Praween K. Agrawal, Sila Deb, Ajay Khera, Purnima Menon, Phuong H. Nguyen

Faculty Publications

Background: Child undernutrition in India remains widespread. Data from the National Family Health Survey 3 and 4 (NFHS-3 and NFHS-4) suggest that wasting prevalence has increased while stunting prevalence has declined. Objective: The objectives of this study were to do the following: ) describe wasting and stunting by month of measurement in India in children surveys, and ) test whether differences in the timing of anthropometric data collection and in states between survey years introduced bias in the comparison of estimates of wasting and stunting between NFHS-3 and NFHS-4. Methods: Data on wasting and stunting for 42,608 and 232,744 children …

The Supplemental Impact Of Telephone-Based Lifestyle Modification Counseling In An Outpatient Weight Loss Clinic, Leslie Rangel Gonzalez Bsn, Rn, Karen Macauley Phd, Dnp, Fnp-Bc, Gnp-Bc, Tony Rosales Dnp, Rn, Cns, Fnp-Bc

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of the project is to implement effective, convenient, and efficient weight loss counseling in today’s fast-paced mobile society. The project will reinforce current physical activity guidelines in correlation with the clinic’s standard dietary guidelines and pharmacological interventions. Patient adherence and motivation will be supported through lifestyle modification counseling via telephone.

Background: The prevalence of obese adults in the United States (US) increased from 33.7 percent in 2007-2008 to 39.6 percent in 2015-2016. Abnormal or excess weight gain may further impair health, as it correlates with the development of multiple preventable comorbidities such as cardiovascular disease, …

Audiocommunicator Reminder Phone Calls To Increase Attendance Of Well Child Visits, Taylor L. Wisner Barojas, Martha G. Fuller, Alison M. Schurman

Doctor of Nursing Practice Final Manuscripts

Background: The American Academy of Pediatrics recommends six well child checks (WCC) between 2 to 15 months. A large pediatric clinic in Southern California has an attendance rate of 86% and a very mobile population. Reminder phone calls have been shown to improve WCC attendance.

Aims of Service Change: Improve WCC attendance to >90%. As an interim step, we implemented a pilot project and measured responses to AudioCOMMUNICATOR™ reminder calls.

Outcome: In two months 148 calls were made, the majority,74%, went unanswered. 26% were able to schedule an appointment or discharge from the clinic.

Discussion: Reminder calls provide a simple …

Cystic Fibrosis Transmembrane Conductance Regulator Modulator Therapies In Cystic Fibrosis: A Retrospective Evaluation Of A Nationwide Specialty Pharmacy Database, Zumi Mehta

Electronic Theses and Dissertations

Background: Cystic fibrosis (CF) is a progressive, genetic disorder caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Patients with CF experience excessive mucus build up and infections leading to complications in the pancreas, lungs, and other organs. There has been a paradigm shift in the treatment of CF with the introduction of CFTR modulator therapies and given their high acquisition cost, assessing their economic burden along with the adherence rate of patients is imperative. Objective: (i) To assess the utilization of CFTR modulator therapies in a specialty pharmacy CF patient population and (ii) to calculate …

Homeless Canadians’ Perspectives On Homelessness In Calgary, Edith N. Ahajumobi, Peter B. Anderson

Journal of Social, Behavioral, and Health Sciences

Since the 1990s, homelessness has increased in Canada, but the strategies of the government and public health service providers to manage the situation have had limited success. Researchers have also noted the lack of inclusion of those experiencing homelessness in homelessness research to better understand and develop a solution to the issue. In the present study, this is addressed through inclusion of homeless participants from diverse backgrounds. The purpose of this phenomenological study, framed by social cognitive theory, reciprocal determinism, and symbolic interaction, was to understand homelessness from the perspectives of people who do not have homes. Data were collected …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Skin And Soft Tissue Infections In The Emergency Department, Nicole Martinez

Dissertations

Background/Purpose: Skin and soft tissue infections (SSTI) represent a diverse group of infections varying in clinical presentation and degree of severity. The International Classification of Diseases codes for patients presenting with cellulitis or abscess account for $5.5 billion in annual health care costs and 1.4% of all hospital admissions nationally. Data are needed to inform admission and management decisions. The purpose of this study is to examine relationships among sociodemographic, physical examination findings, and treatment modality and management in patients with SSTIs.

Theoretical/Conceptual Framework: Web of Causation Theoretical Framework explores multiple causative factors treated with equal prominence, thus …

Barriers And Facilitators To Opioid Use Treatment And Recovery Services During Pregnancy, Loralie Woods

Dissertations

Purpose: To identify barriers and facilitators to opioid use treatment and recovery services among pregnant and nonpregnant women who misuse opioids.

Background: Over 130 Americans die daily after overdosing on opioids. Women have not been immune from opioid use disorders (OUDs), with a 4-fold increase from 1999-2010. The prevalence of opioid use among pregnant women increased from 1.5 per 1,000 hospital deliveries to 6.5. Although the annual National Surveys on Drug Use and Health (NSDUH) has provided information on risk factors for OUD related to socioeconomic and demographic factors, no studies using this data have identified barriers to opioid use …

Pain And Spiritual Distress At End Of Life, Kathryn Lee Robinson

Dissertations

Purpose: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice.

Background/Rationale: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Research is needed to examine the relationships between physical pain, spiritual distress, and other relevant variables specific to …

Utilization Of Peer-Led Education To Enhance Advance Care Planning And Advance Directive Completion, Jenna Juenger

Doctor of Nursing Practice Final Manuscripts

Background: The integration of advance care planning (ACP) and palliative care (PC) into oncology plays a critical role in symptom management and quality of life. Studies reveal a large subset of oncology patients with unmet needs regarding ACP and advance directive (AD) completion. Successful ACP helps to promote congruent medical treatment with patients’ values and preferences and motivates patients to complete ADs.

Objective: An evidence-based practice project was conducted to assess the effectiveness of peer-led education to nursing staff to improve ACP and AD completion among inpatient oncology and PC patients

Design: A standardized survey created from the …

Recommended Syphilis And Hiv Testing After Positive Sti Testing, Katherine Cayce Monaghan Rn, Bsn

Doctor of Nursing Practice Final Manuscripts

Background: Historically primary and secondary syphilis were seen primarily among men who have sex with men and rates among women remained low and rarely increased. Recent research shows that between 2013–2017, the primary and secondary syphilis rate increased 72.7% in the U.S. and 155.6% among women. Patients diagnosed with syphilis have a two to five fold increased risk of acquiring human immunodeficiency virus (HIV). Additionally, positive testing for other sexual transmitted infections (STI) might be indicators of high risk sexual behaviors and exposures that place a person at greater risk for acquiring syphilis and HIV. A southern California university student …

Screening For Iron-Deficiency Anemia In The Pediatric Population (Ages 1-17) In Gonaïves, Haiti, Cara Rose Fratianni

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this pilot project is to screen for iron-deficiency anemia in pediatric patients (ages 1-17) in a primary school in Gonaïves, Haiti. Patients with anemia will be treated with oral supplemental iron for a period of four weeks according to WHO guidelines (WHO, 2011). All students will be treated empirically for helminths per WHO guidelines, unless treated elsewhere in the last six months (WHO, 2017). Nutritional status will also be assessed using MUAC according to WHO guidelines (2017).

Background Summary: Malnutrition contributes significantly to the problem of iron-deficiency anemia, with one in four children exhibiting stunting …

Iron-Deficiency Anaemia (Ida): Socio-Cultural Misconceptions Intersect The Health Of Vulnerable Populations In Developing Countries, Samantha G. Alarcon Basurto

University Honors Theses

Iron is a mineral that the human body uses to make hemoglobin, a protein that red blood cells need to carry oxygen from the lungs to all parts of the body. The lack of adequate iron in the blood is known as iron deficiency, which if experienced in greater proportions, can lead to anaemia. Iron-deficiency anaemia is generally understood as a nutritional deficiency that can be treated by diets of food rich in iron content or the ingestion of iron supplements; yet lack of information, restricted access to bioavailable iron-rich foods, minimal awareness of anaemia’s detrimental effects on children’s cognitive …

Sex Differences In Prevalence And Psychophysiological Profiles Of Adhd, Mckenzie Figuracion

University Honors Theses

Background: Considerable research has been dedicated to understanding the etiology of Attention-Deficit/Hyperactivity Disorder (ADHD), but the focus has been on a homogeneous subset of the population, and multiple groups go underserved when it comes to support. Previous findings suggest differences in ADHD diagnosis and referral rates based on sex, but it is less clear whether neurophysiological sex differences exist. The current study examines the effect of expert consensus diagnostic practices on rates of diagnosis in males and females, and evaluates sex differences in potential neurophysiological markers of ADHD.

Methods: 860 children and adolescents (Males=519; ADHD=516) were recruited for a longitudinal …