Medicine and Health Sciences Commons^™

A Period Seroprevalence (Sars-Cov-2) Survey In Mhccn Cancer Healthcare Workers (Hcws) Providing Patient Care During The Height Of The Outbreak: A Registry Study (Initial Progress), Jill Prescott, Caroline Knight, Erin Hobart, Jamie Saunders, Kimberly Caron, Sandra Neptune, Patty Brown, Lisa Lemire, Anne Breggia, Susan L. Guierin-Staples, Lee Lucas, Paul Han, Rachit Kumar, Robert Carlson, Scot Remick

Costas T. Lambrew Research Retreat 2021

Introduction: There is little information on the basic epidemiologic and serologic profile(s) of the novel SARSCoV- 2 coronavirus especially in HCWs employed in rural settings. We embarked on a period seroprevalence study in the MaineHealth Cancer Network (MHCCN) to document Covid-19 exposure in our rural cancer care workforce. Our fundamental hypothesis is that despite implementing procedures to safeguard patients and the use of appropriate PPE in the care of known source patients/PUIs in both the inpatient and outpatient cancer care settings a small, but not insignificant number of cancer care providers (hereafter referred to as cancer HCWs) will have evidence …

Exploration Of Telemedicine For The Delivery Of Substance Use Disorder Treatment During The Covid-19 Pandemic, Rebecca Bell, Hannah Loeb, Michael Kohut, Eric Anderson, Kinna Thakarar, Rebecca Hutchinson

Costas T. Lambrew Research Retreat 2021

No abstract provided.

The Evaluation Of An Amino Acid- Oral Re-Hydration Solution (Enterade®) To Improve Quality Of Life In Solid Tumor Cancer Patients By Reduction Of Chemotherapy Related Diarrhea, Holly Chitwood

DNP Projects

Background: Chemotherapy related diarrhea (CRD) is a common adverse effect of many chemotherapy agents used to treat cancer. CRD negatively affects quality of life (QOL) for cancer patients and often results in treatment delays, hold, dose reductions, and hospitalizations affecting morbidity and mortality. Proper management of CRD with novel therapeutics is needed to improve the quality of life and patient outcomes for this population.

Purpose: The purpose of this study was to evaluate the use of a proprietary amino acid-oral rehydration solution (AA-ORS) known as Enterade® to reduce the severity of CRD, to improve patient reported QOL among patients over …

Equine West Nile Virus In Kentucky: Characteristics Of Historical Testing And Analysis Of Causal Factors, Kaelyn Short

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

As the arbovirus with the highest incidence in both humans and horses in the United States, West Nile Virus (WNV) presents a significant risk to the equine population of Kentucky. Widespread infection has the potential to cause a significant economic impact to the state and long-term health complications for the horses. To better understand the burden of equine WNV, historical diagnostic testing archives the University of Kentucky Veterinary Diagnostic Lab were analyzed along with environmental and census data collected from additional sources. A total of 2146 test results were analyzed utilizing descriptive statistics, chi-square tests of independence, and binary logistic …

Secular Trends In Low Birth Weight And Preterm Birth Disparity Between Infants Born To Teenage And Adult Mothers: An Exploratory Analysis, Elizabeth Edwards

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction. Increased risk of preterm birth and low birthweight for infants born to teenage mothers (15-19), when compared to infants born to adult mothers (20-29), is well documented in the United States. Trends in preterm birth and low birthweight are also well documented over time. Examination of the difference in incidence of preterm birth or low birthweight between infants born to teenage mothers and to adult mothers over time is not present in the literature. This study aimed to fill this gap in the literature and determine how preterm birth and low birthweight differences have changed over time.

Methods. Natality …

Colorectal Cancer Differences In Staging And Survival: Appalachian And Non-Appalchian Kentuckians, Ripley Lucas

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Colorectal cancer is the third most commonly diagnosed cancer in the United States. Historically, the Appalachian region of Kentucky has experienced disparities in colorectal cancer screening and survival as compared to both the non-Appalachian region of the state and the United States. The aim of this paper is to investigate the differences in cancer staging and survival after diagnosis in Appalachian and non-Appalachian Kentuckians. The present time period of study is a retrospective, population-based cohort with data taken from the Kentucky Cancer Registry. Binomial logistic regression and Cox proportional hazards models were used to estimate unadjusted and adjusted odds ratios …

Accumbens Cholinergic Interneurons Mediate Cue-Induced Nicotine Seeking And Associated Glutamatergic Plasticity, Jonna M. Leyrer-Jackson, Michael Holter, Paula F. Overby, Jason M. Newbern, Michael D. Scofield, M. Foster Olive, Cassandra D. Gipson

Family and Community Medicine Faculty Publications

Nicotine, the primary addictive substance in tobacco, is widely abused. Relapse to cues associated with nicotine results in increased glutamate release within nucleus accumbens core (NAcore), modifying synaptic plasticity of medium spiny neurons (MSNs), which contributes to reinstatement of nicotine seeking. However, the role of cholinergic interneurons (ChIs) within the NAcore in mediating these neurobehavioral processes is unknown. ChIs represent less than 1% of the accumbens neuronal population and are activated during drug seeking and reward-predicting events. Thus, we hypothesized that ChIs may play a significant role in mediating glutamatergic plasticity that underlies nicotine-seeking behavior. Using chemogenetics in transgenic rats …

Applying Mixed-Effects Modeling To Behavioral Economic Demand: An Introduction, Brent A. Kaplan, Christopher T. Franck, Kevin Mckee, Shawn P. Gilroy, Mikhail N. Koffarnus

Family and Community Medicine Faculty Publications

Behavioral economic demand methodology is increasingly being used in various fields such as substance use and consumer behavior analysis. Traditional analytical techniques to fitting demand data have proven useful yet some of these approaches require preprocessing of data, ignore dependence in the data, and present statistical limitations. We term these approaches “fit to group” and “two stage” with the former interested in group or population level estimates and the latter interested in individual subject estimates. As an extension to these regression techniques, mixed-effect (or multilevel) modeling can serve as an improvement over these traditional methods. Notable benefits include providing simultaneous …

The Role Of Knowledge In End-Of-Life Decision-Making By Older Persons, Laura Van Dyck

Yale Medicine Thesis Digital Library

As physicians, we aim to support our patients to engage in and make end-of-life medical decisions. Ideally, patients engage in advance care planning (ACP) to direct their care if they become incapable of participating in decision-making. For many patients, however, their first encounter with end-of-life care—e.g. code status—occurs at hospital admission. This thesis describes two studies: the ACP Study and Code Status Study. The ACP Study examines ACP knowledge and its relationship to engagement. This study utilizes baseline data from 921 participants age 55 years enrolled in the STAMP randomized controlled trial, including a knowledge scale consisting of 7 questions …

Large Scale Organizational Intervention To Improve Emergency Department Throughput In A Community Hospital, Karen Elliott

DNP Scholarly Projects

Abstract

BACKGROUND: Emergency Department boarding is a well-documented systemic problem across the country. ED-2b, the time from decision to admit a patient to Emergency Department departure, is specified by the Joint Commission as a quality measure for Emergency Department boarding. ED-2b metrics have been a longstanding challenge at this community hospital outside the nation’s capital. The aim of this study was to reduce median ED-2b times by 10% compared to fiscal year 2020 (FY20). To accomplish the reduction in time, a multidisciplinary throughput committee was developed with subsequent action plans designed to improve Emergency Department throughput.

METHODS: The Plan Do …

Improving Emr Usability And Clinical Efficiency Using An Immunization Tool For School Nurses In A Primary School Setting, Cathy Loiselle

DNP Scholarly Projects

BACKGROUND: School nursing has a foundation in population health and an essential role within the community, which needs to be structured by the developing field of health informatics in order to compete and communicate with all stakeholders. This quality improvement project specific aim was to improve the electronic medical record (EMR) usability and clinical efficiency.

METHODS: A school district with three elementary, one high and one middle school was chosen, using the school information system (SIS)/EMR currently in place at each school health office. The school health staff participating in this project included 5 registered nurses and 5 clinic assistants. …

Impact Of Audit And Feedback On Timing Variation In The Point Of Care Glucose Collection-Insulin Administration Workflow: A Quality Improvement Study, Paula S. Hudon

DNP Scholarly Projects

BACKGROUND: Multiple roles contribute to the point of care glucose collection and insulin administration workflow. Diabetes care associations and safety advocates provide recommendations since the time-action profile of prandial insulin requires knowledge and performance to deliver insulin safely.

PROBLEM: Variation of practice in relation to the time that point of care glucose was collected and meal and insulin administration assessments were completed failed to meet parameters.

PURPOSE: A quality improvement project aimed to test the effect audit and feedback has on rapid acting insulin administration and point of care glucose collection practice at meals.

METHOD: Audit and feedback, a knowledge …

Improving Employee Mental Health: Addressing Depression At The Workplace, Gerald G. Chia Dr.

DNP Scholarly Projects

Abstract Background: Depression is a serious mental health challenge in the US. As frontline workers who are responsible for taking care of a myriad of patients daily, health workers are usually exposed to depressive situations which eventually results in them developing the mental health condition. The purpose of the current project was, therefore, to develop an intervention which helps to improve employee mental health in healthcare settings with focus on depression and examine workplace factors which influence depression among employees of the Outpatient Mental Health Clinic in Washington District of Columbia. Methods: A pre-intervention survey was conducted among 43 employees. …

Improving The Diagnosis Of Major Depression In A Primary Care Practice Using The Patient Health-9 Questionnaire, Chukwudi C. Orji

DNP Scholarly Projects

Abstract

Background: Major depression is a serious health problem that affects both children and adults. It is a leading cause of disability worldwide. Most cases of major depression are treated in primary care settings. Many cases of major depression presenting in primary care are missed. Many PCPs do not routinely use screening tools. The aim of this project is to improve the diagnosis of major depression in adults in a primary care practice through routine use of the Patient Health Questionnaire-9 (PHQ-9) during initial encounter with patients and during follow-up visit for patients who are receiving treatment for depression to …

Improving Care Transitions For Individuals With Suicide Risk After Discharged From Acute Unit, Maureen Ndu

DNP Scholarly Projects

Background: Suicide is a public health problem and the 10th leading cause of death in the US. Suicide accounted for more than 47,5000 deaths in the US in 2017, translating to about 130 suicide deaths each day. An average of 20 veterans commits suicide each day compared to 93 suicides in the general population in the US. Individuals with suicide risks are 300 times at an increased rate of suicide death in the first week and 200 times in the first month of hospital discharge. Nurses are in a strategic position to improve the care transition of individuals with suicide …

Measuring Vastus Medialis Cross-Sectional Area With Panoramic Ultrasound Over Time, Kaitlin Minnehan, Elizabeth Scharnetzki, Kaitlyn Chin, Christina Holt, William Dexter

Costas T. Lambrew Research Retreat 2021

Panoramic ultrasound detected a statistically significant decrease in the VM CSA of participants after 70 days of bedrest without exercise.

A Comparison Of Health Habits Between Nursing And Non Nursing Majors, Reilly K. Gilmour

Honors Theses and Capstones

No abstract provided.

Estimated Glomerular Filtration Rate And The Racial Multiplier: Clinical Implications And Current Attitudes, Brittney A. Spooner

Honors Theses and Capstones

Chronic kidney disease (CKD) is associated with high morbidity and mortality and has high and increasing incidence worldwide. CKD is characterized by a reduction in glomerular filtration rate (GFR), but as GFR is difficult to measure directly, estimated glomerular filtration rate (eGFR) equations have been created to measure serum creatinine levels as a function of GFR. Some eGFR equations contain a racial multiplier that increases the eGFR of black patients, causing a spurious increase in reported kidney function. This study included a literature search that collected information on the rationale behind the multipliers usage and a survey that gathered information …

Evaluating Clinician Features And Reporting Decisions On Performance In The Merit-Based Incentive Payment System, Christopher Robert Han

Yale Medicine Thesis Digital Library

The Merit-Based Incentive Payment System (MIPS) is the largest change to physician reimbursement in decades. We sought to examine clinician participation and performance of clinicians to better understand the relationship between clinician features and reporting decisions on MIPS scores and payment adjustments.

Using publicly available data from the Centers for Medicare and Medicaid Services (CMS), we examined 2018 clinician participation and performance in the MIPS. We analyzed aggregate MIPS score performance as well as payment adjustment results stratified by clinician specialty, reporting affiliation, practice size, and the CMS special status designating rural or health profession shortage area (HPSA). Using linear …

Heat Stress In Urban Environments: A Case Study Of Heat Vulnerability In New Haven, Ct, Logan M. Howard

Library Map Prize

A place-based understanding of heat and its behavior is necessary for appropriately preparing our cities and protecting the most vulnerable populations from this urgent climate and public health threat. This paper aims to identify the areas in New Haven, CT that have the highest autumnal temperature exposure and sensitivity to provide evidence for developing mitigation and adaptation measures. Original temperature data was collected using a bike-mounted Smart T sensor and then compared with data on land cover and water proximity. These heat exposure estimates were analyzed with 2019 Census data on age, income, race, and ethnicity, for 19 census tracts …

Simulation Based Team Training In Surgery - A Review, Syed Muhammad Nazim, Qamar Riaz

Section of Urology

The healthcare environment in surgery is complex, dynamic and often ambiguous. Besides subject knowledge and technical skills, other competencies, such as team work, communication skills and situation awareness, are required to ensure better patient-related outcome. Teams that demonstrate poor non-technical skills make more technical errors, often resulting in patient morbidity or mortality. Different hospital-based locations, such as operating rooms, intensive care units, emergency rooms and surgical wards, are the areas where poor team dynamics prevail. Simulation-based team training is a strategy to provide inter-professional training and experiential learning opportunities for surgeons, anaesthetists and allied health professionals. It helps them to …

Allicin Stimulates The Phosphorylation Of Enosser1177 Via A Pi3k-Dependent Mechanism In Type-I Diabetic Donor Coronary Artery Endothelial Cells, Hunter Alberto Vásquez

PCOM Biomedical Studies Student Scholarship

INTRODUCTION: The World Health Organization (WHO) indicates that deaths from noncommunicable diseases (NCDs) are projected to increase to approximately 52 million by the year 2030. Of these NCDs, cardiovascular diseases (CVDs) constitute the number one cause of death globally and are the major source of morbidity and mortality associated with diabetes mellitus (DM). CVD manifests early in individuals with DM by way of vascular dysfunction, characterized by depressed nitric oxide (NO) production. As such, interventions to mediate the comorbidities associated with DM are being investigated.

OBJECTIVES: The primary objective of this study was to investigate the mechanism of …

The Effect Of Cardiopulmonary Disease On Lymph Node Hyperplasia And Structural Deviations, Yuhyun Kang

PCOM Biomedical Studies Student Scholarship

INTRODUCTION: According to the Centers for Disease Control and Prevention, cardiac and pulmonary disease consistently rank on the top leading causes of death in the United States. Therefore, the different pathologies of the heart and lungs are studied extensively in the medical community. Current research hints at the possible association between the lymphatic system's dysfunction and cardiopulmonary disease's pathological progression. However, the effect of cardiopulmonary disease on the lymph nodes is not well known. A better understanding of the possible pathological changes to the lymphatic system associated with cardiopulmonary disease could help guide medical interventions.

OBJECTIVE: This study aims to …

Reproducibility And Discriminant Validity Of The Posterior Shoulder Endurance Test In Healthy And Painful Populations, Neil A. Evans, Suzanne Konz, Arthur J. Nitz, Timothy L. Uhl

Physical Therapy Faculty Publications

OBJECTIVE: This investigation measured the reproducibility and discriminant validity of the Posterior Shoulder Endurance Test (PSET) on painful and non-painful populations.

DESIGN: Reliability and validity study.

SETTING: Laboratory setting.

PARTICIPANTS: Thirty subjects (male = 11; female = 19).

MAIN OUTCOME MEASURES: Time to failure (TTF) was the primary outcome measure to determine reliability of the PSET. Discriminant validity identified with receiver operator characteristic (ROC) curves utilized TTF separately in men and women since they used different loads.

RESULTS: There were 25/30 subjects (painful = 12; non-painful = 13) tested a second time. ICC, SEM, and MDC90 ranged respectively from 0.77, …

The Injustice Of Unfit Clinical Practice Guidelines In Low-Resource Realities, Nanna Maaløe, Anna Marie Rønne Ørtved, Jane Brandt Sørensen, Brenda Sequeira Dmello, Thomas Van Den Akker, Monica Lauridsen Kujabi, Hussein Kidanto, Tarek Meguid, Ib Christian Bygbjerg

Obstetrics and Gynaecology, East Africa

To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation …

Addressing Health Literacy For Improved Outcomes: A Focus On Pregnancy, S.L. Killeen, I. Brown, A.A. Geraghty, F.M. Mcauliffe

Articles

Health literacy influences how messages are received and understood by patient or population groups. In Europe, incomprehension of health information is common, affecting the ability of many individuals to make informed decisions about their health. In addition, incomprehension of health information may impact the effectiveness of interventions and subsequently, health outcomes. In this article, we illustrate the importance of health literacy in the context of maternity services, a time during which, health interventions affect both maternal and child health. Through this, we suggest that health literacy should be recognised in healthcare settings as a tool to facilitate behaviour change. To …

A Pilot Study Using Asynchronous Case Discussion And Reflection To Provide Interprofessional Education To Physician Assistant And Physical Therapy Students, Erin Mccallister, Emily Weidman-Evans

Internet Journal of Allied Health Sciences and Practice

Purpose: The purpose of this study was to examine the effects an asynchronous interprofessional education (IPE) activity had on graduate healthcare students’ beliefs regarding IPE, as measured by the Readiness for Interprofessional Learning Scale (RIPLS). Methods: All first-year physician assistant and physical therapy students participated in a collaborative four-week online case discussion. Students who consented to participate in the research component filled out a pre- and post-activity RIPLS questionnaire. Responses were matched by an individualized, student-generated number to protect students’ identity. Only matched scores were analyzed. Results: The total score as well as the Teamwork and Professional Identity …

Cost Outcomes Of Physical Therapist Providers Compared To Primary Care Providers In The Treatment Of Musculoskeletal Patients In A Military Treatment Facility: A Retrospective Chart Review”, Troy E. Mcgill, Debra F. Stern, Morey J. Kolber, John Mcgee

Internet Journal of Allied Health Sciences and Practice

Purpose: The purpose of this study was to compare the cost of physical therapist (PT) management of patients with musculoskeletal (MSK) disorders to management by traditional primary care managers (PCMs); medical doctors (MDs), doctors of osteopathic medicine (DOs), advanced registered nurse practitioners (ARNPs), and physician assistants (PAs). Methods: This is a retrospective study of electronic medical records using an exploratory, non-experimental, cross-sectional, and quantitative design method. The records of patients with MSK disorders were assessed at an Air Force military medical clinic for 18 months from January 2016 through June 2017. Results: PT management of MSK patients resulted in a …

Towards Digestible Digital Health Solutions: Application Of A Health Literacy Inclusive Development Framework For Peripartum Depression Management, Alexandra Zingg, Tavleen Singh, Sahiti Myneni

Faculty, Staff and Student Publications

Women of low income and education have lower levels of peripartum depression (PPD) literacy, limiting their ability to recognize symptoms and make informed healthcare decisions. Existing digital solutions and underlying development frameworks for PPD lack an integrative approach addressing health literacy and related disparities. Therefore, we develop an integrative framework for digital content engineering in PPD self-management consisting of (a) user needs analysis, (b) inclusion of eHealth literacy principles (science and health literacy), and (c) mapping user needs to the Behavioral Intervention Technology model. Results revealed that perinatal women seeking mental health care prefer information in multisensory formats, and knowledge …

Cross-Vendor Ct Image Data Harmonization Using Cvh-Ct, Md Selim, Jie Zhang, Baowei Fei, Guo-Qiang Zhang, Gary Yeeming Ge, Jin Chen

Faculty, Staff and Student Publications

While remarkable advances have been made in Computed Tomography (CT), most of the existing efforts focus on imaging enhancement while reducing radiation dose. How to harmonize CT image data captured using different scanners is vital in cross-center large-scale radiomics studies but remains the boundary to explore. Furthermore, the lack of paired training image problem makes it computationally challenging to adopt existing deep learning models. We propose a novel deep learning approach called CVH-CT for harmonizing CT images captured using scanners from different vendors. The generator of CVH-CT uses a self-attention mechanism to learn the scanner-related information. We also propose a …