The Use Of Appreciative Inquiry In Identifying Pueblo Core Values, Kristyn N. Yepa

Doctor of Nursing Practice Scholarly Projects

This study used appreciative inquiry to identify core values or concepts essential to the Jemez Pueblo community to inform an evaluation framework used by community strength-based programs in Jemez Pueblo. Key informant interviews and a focus group were conducted in Jemez Pueblo with key program staff and tribal leaders. The audio recordings were transcribed and analyzed using inductive reasoning to identify core values. In addition, grounded theory was used to develop a conceptual model from the themes generated from the analysis. The PICOT question was, "Can the Appreciative Inquiry method help uncover core values of a Pueblo community?"

Nurse Driven Antibiotic Stewardship, Dr. Judy Liesveld R. White

Doctor of Nursing Practice Scholarly Projects

Abstract

Antibiotic use has increased tremendously and has led to antimicrobial resistance. Because it is a growing problem across healthcare systems around the world, healthcare systems and organizations must combat the detrimental effects of inappropriate use of antibiotics. The development of antibiotic stewardship programs is crucial to providing high quality, safe patient care. The work ofthis project intends to form a basic understanding ofa nurses' role as a member of the antibiotic team. Most healthcare systems have operated by a pharmacy driven antibiotic team concept and have just recently included nurses as a missing component to a full functioning team. …

Bromodomains In Human-Immunodeficiency Virus-Associated Neurocognitive Disorders: A Model Of Ferroptosis-Induced Neurodegeneration, Adonis Sfera, Karina G. Thomas, Christina V. Andronescu, Nyla Jafri, Dan O. Sfera, Sarvin Sasannia, Carlos Zapata-Martin Del Campo, Jose E. Campo Maldonado

School of Medicine Publications

Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) comprise a group of illnesses marked by memory and behavioral dysfunction that can occur in up to 50% of HIV patients despite adequate treatment with combination antiretroviral drugs. Iron dyshomeostasis exacerbates HIV-1 infection and plays a major role in Alzheimer’s disease pathogenesis. In addition, persons living with HIV demonstrate a high prevalence of neurodegenerative disorders, indicating that HAND provides a unique opportunity to study ferroptosis in these conditions. Both HIV and combination antiretroviral drugs increase the risk of ferroptosis by augmenting ferritin autophagy at the lysosomal level. As many viruses and their proteins …

Human Macrophages Exhibit Gm-Csf Dependent Restriction Of Mycobacterium Tuberculosis Infection Via Regulating Their Self-Survival, Differentiation And Metabolism, Abhishek Mishra, Vipul K. Singh, Chinnaswamy Jagannath, Margaret Sunitha Selvaraj, Selvakumar Subbian, Blanca I. Restrepo, Marie-Claire Gauduin, Arshad Khan

School of Medicine Publications

GM-CSF is an important cytokine that regulates the proliferation of monocytes/macrophages and its various functions during health and disease. Although growing evidences support the notion that GM-CSF could play a major role in immunity against tuberculosis (TB) infection, the mechanism of GM-CSF mediated protective effect against TB remains largely unknown. Here in this study we examined the secreted levels of GM-CSF by human macrophages from different donors along with the GM-CSF dependent cellular processes that are critical for control of M. tuberculosis infection. While macrophage of different donors varied in their ability to produce GM-CSF, a significant correlation was observed …

Treatment For Mild Chronic Hypertension During Pregnancy, Alan T Tita, Methodius Tuuli, Et Al.

2020-Current year OA Pubs

BACKGROUND: The benefits and safety of the treatment of mild chronic hypertension (blood pressure, <160/100 mm Hg) during pregnancy are uncertain. Data are needed on whether a strategy of targeting a blood pressure of less than 140/90 mm Hg reduces the incidence of adverse pregnancy outcomes without compromising fetal growth.

METHODS: In this open-label, multicenter, randomized trial, we assigned pregnant women with mild chronic hypertension and singleton fetuses at a gestational age of less than 23 weeks to receive antihypertensive medications recommended for use in pregnancy (active-treatment group) or to receive no such treatment unless severe hypertension (systolic pressure, ≥160 mm Hg; or diastolic pressure, ≥105 mm Hg) developed (control group). The primary outcome was a composite of preeclampsia with severe features, medically indicated preterm birth at less than 35 weeks' gestation, placental abruption, or fetal …

Holmium Laser Unroofing Of Ureterocele And Removal Of Hundreds Of Stones From An Adult Duplicated Kidney: Case Report, Claire Berger, Paul Chialastri, Young Son, Benjamin A. Fink, Mark E. Quiring, Thomas J. Mueller, Robert Barsky

Research Day

Objective:

This case study presents an adult with complete unilateral duplication of the renal collecting system and ureterocele who developed upper pole hydronephrosis secondary to urolithiasis which was ultimately treated with holmium laser ablation.

Case Presentation

A 49-year-old female presented to the emergency department (ED) with left flank pain. Non-contrast computerized tomography (CT) imaging revealed complete duplication of the left renal collecting system with severe upper pole hydronephrosis and multiple urolithiasis measuring approximately 5.9 x 2.2 x 1.7 centimeters (cm) in the left distal ureter. A distal left ureteral 3.3 x 2.3 x 2.3 cm ureterocele was also seen in …

Characterizing Prednisone Regimens For Treatment Of Cardiac Sarcoidosis, Sarah Adams, Jonathan Salas, Abhijit Bhattaru, Chaitanya Rojulpote, Paco Bravo

Research Day

INTRODUCTION:

Corticosteroids are the mainstay treatment for cardiac sarcoidosis (CS), which manifests clinically in about 5% of sarcoid patients. Current comparisons of steroid regimens in CS focus on starting dose and rarely describe taper rates or expected cumulative exposure. This study characterizes several prednisone regimens for CS to strengthen frameworks for defining treatment goals.

METHODS:

We queried a registry of 1,403 patients referred to the Hospital of the University of Pennsylvania for positron emission tomography (PET) investigation of CS. We performed chart reviews of 98 patients with myocardial inflammation on initial PET who were treatment naïve, initiated on prednisone for …

Implementation Of Robotic Gynecologic Surgery In A Rural Setting: Impact On Presence Of Assistant Surgeon And Route Of Hysterectomy, Alexandra Mcquillen, Natasha Alligood-Percoco, Angela Huggler

Research Day

Objective: Robot-assisted hysterectomy allows the surgeon improved visualization, range of motion, and ergonomics which in some cases may obviate the need for an assistant surgeon. In rural hospitals where physician shortages remain a major barrier to care, reducing the number of surgeons necessary to perform hysterectomy would be of significant consequence. We sought to evaluate the impact of robotic surgery on the need for an assistant surgeon at time of hysterectomy at a rural community hospital.

Methods and Procedures: We performed a retrospective chart review of hysterectomies performed at a rural community hospital by general gynecologists, focusing on the 12-month …

The Effect Of Preoperative Opioid Education On Patient’S Postoperative Opioid Usage Following Hip Arthroscopy: A Randomized, Prospective Trial, Jamie Henzes, Emma E. Johnson, Anya Hall, Joseph Brutico, Donghoon Lee, Shyam Brahmabhatt, Fotios Tjoumakaris, John Salvo

Research Day

Introduction: Over the past twenty years, opioid usage has continued to rise significantly, resulting in what many have termed an “opioid epidemic”. Several studies have noted that patients are routinely over-prescribed opioids following common surgical procedures, resulting in a large number of unused and therefore readily available opioid pills. Additionally, the highest reported age population for illicit drug usage is in individuals ages 20-39 years old, which is the same group that commonly undergoes hip arthroscopy. A previous study in patients undergoing arthroscopic rotator cuff repair demonstrated that patients who received pre-operative opioid education consumed significantly less opioids 3 …

Acrometastasis As A Rare Presentation Of Diffuse Malignancy, Jeremy Reich, Jonathan Boyce, Lee Kripke

Research Day

Cancer metastasis to the bone distal to the knee or elbow, also known as acrometastasis, is a rare but known finding in diffuse malignancy. We report a case of acrometastasis to the left second phalanx in a 70-year-old woman with a history of invasive breast carcinoma that was in remission for four years. On initial encounter in the emergency department, she had pain and swelling over the proximal (PIP) and distal interphalangeal (DIP) joints with a lytic appearance on radiographs. A subsequent Adler PET scan demonstrated previously unknown metastatic disease in the right lower lung, mediastinal and hilar lymph nodes, …

Trends In Patient Outcome Scores In Orthopaedic Oncology: A Systematic Review, David Le, Kelsey Martin, Sean C. Clark, Tae Won B. Kim

Research Day

Introduction: The field of orthopaedic oncology has trailed in defining trends in reported outcome measures (ROMs) over the last decade. Although the Musculoskeletal Tumor Society (MSTS) Score is a well-recognized ROM, new ROMs developed and established in literature have created difficulty in identifying the standard ROM within the field. The aim of our study is to identify trends in the use of ROMs in orthopaedic oncology over time, as well as the frequency and distribution among specific pathologies and orthopaedic journals.

Methods: A systematic review was conducted of all original articles reporting on topics relating to orthopaedic oncology in five …

Paralumbar Compartment Syndrome, A Rare Sequela Of Deadlifting, Mark Lagreca, Anthony Viola, Aakash Patel, Timothy Horan, Thomas Falconiero, Brian Danshaw, Scott Rushton

Research Day

Introduction: Compartment syndrome is a well known phenomenon that is most commonly reported in the extremities. However, paralumbar compartment syndrome is rarely described in available literature. The authors present a case of paralumbar compartment syndrome after high intensity deadlifting.

Methods: The patient is a 53 year old male who was diagnosed with paralumbar compartment syndrome one day after performing high intensity deadlifting and subsequently treated emergently with fasciotomies. The patient’s medical records were thoroughly reviewed at the presenting institution. A complete review of the current literature regarding ‘paralumbar’ or ‘paraspinal’ compartment syndrome was also performed.

Results: The patient’s paralumbar compartment …

Investigating The Relationship Between Preoperative Laboratory Values And Postoperative Complications In Radical Nephrectomy Patients., Sage Grenz, Benjamin Fink, Emiley O'Pry, Young Son, Thomas Mueller

Research Day

INTRODUCTION: Cancer involving the kidney and/or renal pelvis is one of the more frequent causes of cancer in the United States with a prevalence of more than 10 per 100,000. Radical nephrectomy is a common treatment modality for renal cell carcinoma. In an effort to optimize patient safety, many preoperative parameters are used to evaluate and assess a patient's overall health. These include, but are not limited to, patient comorbidities, tumor anatomy, and standard laboratory values. Unfortunately, the literature surrounding these values, among other preoperative laboratory values, in relation to postoperative surgical outcomes is limited. The purpose of this study …

Prognostic Value Of Posterior Tilt Angle In Determining Outcome Of Internal Fixation Of Nondisplaced Femoral Neck Fractures, Christopher Talone, Efstratios Papadelis, Yash Chaudhry, Hunter Hayes, Mitesh P. Shah

Research Day

INTRODUCTION: As the population continues to age there is expected to be an increase in prevalence of femoral neck fractures. The standard tool for guiding treatment decisions in femoral neck fractures is the Garden Classification, which is based around the severity of displacement. Garden I and II fractures display minimal displacement and suggest internal fixation as the preferred surgical option rather than arthroplasty.

Recent literature indicates the rate of revision surgery following internal fixation of Garden I and II fractures is approximately 20%. Originally proposed by Palm et al, Posterior Tilt Angle (PTA) is a radiographic measurement that evaluates the …

Covid Vaccine Adr Survey, Frederick J. Goldstein, Demetria Ruhl, Hannah Griffiths, Steven Weaner, Rebecca Weaner, Pankhuri Walia, Nathalia Galvis

Research Day

Introduction

This study is designed to analyze experiences of the PCOM Philadelphia community regarding COVID19 vaccination. While previous studies have examined specific adverse reactions to this treatment, the present survey allowed participants to indicate which vaccine they received (Pfizer-BioNTech, Moderna mRNA-1273, or J&J/Janssen) and how many doses, as well as demographic information, underlying health conditions, prior COVID infection and symptoms, and any reaction to the COVID vaccination. Prior COVID infection is taken into consideration in this survey, as previous research has indicated that 70% of people who had not been previously infected reported Pfizer vaccine side effects, while 95% of …

Timing And Outcomes Of Hip Fracture Surgery During The Covid-19 Pandemic, Sherrie Wang, Makenzie Chambers, Kelsey Martin, Pietro M. Gentile, Rock Hwang, Rakesh Mashru, Kenneth Graf, Henry Dolch

Research Day

Introduction: The effects of delayed surgical repair for traumatic hip fractures have been widely discussed in the literature, and there exists a strong association between surgical timing and patient outcomes. The COVID-19 pandemic placed a significant burden on health care systems throughout the world, with hospitals reallocating both human and physical resources to care for the critically ill. The purpose of this study is to investigate if the strain placed on hospital systems by COVID-19 and the changes to hospital operational models negatively impacted time to surgery, as well as morbidity and mortality rates of hip fractures.

Methods: A retrospective …

Herpes Simplex Encephalitis After Covid-19 Infection, Kurt Knepley, Robert Paschall

Research Day

A gentleman in his 60’s presented to the hospital with dyspnea, fever, and hypoxia. He was diagnosed with Covid-19 pneumonia and treated with BiPAP, oxygen, dexamethasone, enoxaparin, budesonide, and albuterol. His hospital stay lasted 33 days. He was discharged home on oxygen and steroids. He returned to the hospital 3 days later with altered mental status. He was diagnosed with HSV encephalitis and treated with 2 weeks of acyclovir. Although his HSV resolved, he suffered temporal lobe necrosis and lasting neurologic dysfunction.

HSV is the most common cause of encephalitis. HSV encephalitis can occur in a host co-infected with SARS-CoV-2 …

Early Medical Education Exposure To Diversity, Equity, Inclusion, And Justice, Maayra Butt, Natalie Santucci, Kerin M. Claeson

Research Day

INTRODUCTION: The United States currently stands as an epicenter for different identities noting variations across people in ethnicity, religion, gender, and socioeconomic status. Further intersectionality among these identities creates a diverse population of individuals subsequently reflected in the field of healthcare, one of the largest systems that encompass modern society. Medical education plays a notable role in the progression of healthcare as students are the early implementers of future healthcare systems. While it is known that early exposure to cultural humility and diversity allows students to learn and grow as future providers, exposure during professional training is often limited.

OBJECTIVES: …

Wernicke Encephalopathy Following Gastric Bypass: A Case Report, Sarah Glisan, Nazim Khan

Research Day

Bariatric surgery is used as a treatment for morbid obesity and often results in rapid weight loss. This procedure has been associated with postoperative nutritional deficiencies. Neurological complications due to nutritional deficiencies include Wernicke encephalopathy, a disorder that affects the central and peripheral nervous system due to thiamine (vitamin B1) deficiency. Wernicke encephalopathy can lead to irreversible consequences if not treated early. Here, we present a case of a 40-year-old woman that developed Wernicke encephalopathy two months after gastric bypass surgery, with additional findings of flat affect and concurrent polyradiculopathy. Her diagnosis was delayed due to unique symptoms and an …

Barriers To Recruitment For A Thc Study, Fred Goldstein, Devon Player, Joseph Radakovitz, Catherine Linh, Garrett Douglas, Ben Moran, Nathalia Galvis

Research Day

Due to ongoing efforts to increase inclusion of under-represented racial and ethnic minorities in clinical studies, researchers have conducted studies to gain greater understanding as to why members of these groups have had limited enrollment. 1 Previous research indicated a widespread lack of trust in the medical community regarding clinical studies, particularly in populations of color due to knowledge of the Tuskegee study.2 Specifically, to date, there appears to be no investigation which explores reasons for hesitation to volunteer to participate in a study utilizing delta-9-tetrahydrocannabinol (THC) to reduce chronic neuropathic pain. Our PCOM IRB-approved project will attempt to uncover …

Outcome Of Newborn Hearing Screening Program In A Tertiary Care Centre, South India., S. Sija, V. K. Gireeshan, V. T. Ajith Kumar Professor And Head Of The Department, T. V. Rajesh Additional Professor

Journal of Early Hearing Detection and Intervention

Objective

To determine the coverage and outcome of Universal Newborn Hearing Screening (UNHS) Program in Government Medical College Manjeri, South India. To study the prevalence of hearing loss (HL) among those children screened, to describe the characteristics of confirmed cases, and the status of speech and language development acquired by them at follow up.

Design

Hospital based retro prospective study.

Methods

Data were collected from all newborns who underwent Universal Newborn Hearing Screening (UNHS) over a four-year period (November 2014 to October 2018). Cases with confirmed hearing loss were studied by pre-structured questionnaire and telephonic interview. Speech and language …

Usability And Feasibility Of A Spoken Language Outcome Monitoring Procedure In A Canadian Early Hearing Detection & Intervention Program: Results Of A 1-Year Pilot, Olivia Daub, Barbara Jane Cunningham, Marlene P. Bagatto, Janis Oram Cardy

Journal of Early Hearing Detection and Intervention

Abstract

Purpose: Best practice recommendations for Early Hearing Detection and Intervention (EHDI) programs include routine spoken language outcome monitoring. The present article reports on pilot data that evaluated the usability and feasibility of a spoken language outcome monitoring procedure developed for Ontario’s Infant Hearing Program (IHP). This procedure included both Program-level monitoring using omnibus language tests from birth to 6;0 and individual vulnerability monitoring of key domains of spoken language known to be at risk in children who are deaf/hard-of-hearing.

Methodology: Speech-language pathologists (SLPs) in the IHP piloted the new procedures for one year and provided feedback on the procedure …

Association Between Craniofacial Anomalies And Newborn Hearing Screening Fail Rate, Kaitlyn Sheapp, Ruth S. Marin, Larry Medwetsky

Journal of Early Hearing Detection and Intervention

Purpose: Increased knowledge of the prevalence of various craniofacial anomalies and their associated risks for hearing loss can help guide 1) development of evidence-based practice regarding detection and documentation of risk factors at birth and 2) health care professionals to make appropriate recommendations for follow-up testing and monitoring.

Method: Records were reviewed for 39,813 infants born at Adventist HealthCare Shady Grove Medical Center and White Oak Medical Center between January 1, 2014 and December 31, 2019 to determine the association between the presence of craniofacial anomalies and newborn hearing screening fail rates, as well as the prevalence of confirmed hearing …

Adaptation Of The Conditioned Assessment Of Speech Production In Spanish, Alliete R. Alfano, Daniel Gonzalez, David J. Ertmer

Journal of Early Hearing Detection and Intervention

Purpose: The purpose of this article is to describe the adaptation of the Spanish adaptation of the CASP.

Method: The authors adapted each segment into Spanish, then had 41 participants complete a survey to determine if each adapted segment was representative of the Spanish phonologic system. Thirty-six children (half with typical hearing, half with hearing loss) completed the CASP in English and Spanish. Paired samples t-tests were run to compare English and Spanish CASP scores between children with hearing loss and those with typical hearing.

Results: All segments were adapted as needed into Spanish. There was no statistical difference between …

Improving Newborn Hearing Screening Through Collaboration And Communication, Mary Duncan, Marissa Schuh, Shannon Haynes, Anita Taylor, Gwen Moreland, Raleigh Jones, Matthew Bush, Jennifer Shinn

Journal of Early Hearing Detection and Intervention

Purpose: Hearing loss is the number one birth defect among children. There are significant consequences of delayed diagnosis and failure to obtain timely intervention, particularly for a child’s speech and language development. Design and implementation of successful newborn hearing screening (NHS) programs can be challenging. The purpose of this paper is to demonstrate improved efficiency and effectiveness of a large NHS program through the implementation of a team approach engaging both ambulatory and hospital services.

Methodology: A Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was used to develop an improved NHS program focused on improving patient care. The SWOT analysis …

“It Gives Me Confidence”: Caregiver Coaching From The Perspective Of Families Of Children Who Are Deaf Or Hard Of Hearing, Dorie Noll, Sheila Moodie, Ian D. Graham, Beth Potter, Elizabeth M. Fitzpatrick

Journal of Early Hearing Detection and Intervention

Caregiver coaching is utilized in early intervention services with families of children who are deaf or hard of hearing to increase caregivers’ skills and confidence in supporting their child’s language development, but few studies have examined coaching from the perspective of the caregivers. The purpose of this study was to increase understanding of caregivers’ experiences of coaching in the context of listening and spoken language intervention services. Using semi-structured, qualitative interviews, this study examined 13 caregivers’ perspectives at three intervention sites in the US and Canada. Results indicate that caregivers perceive that practitioner characteristics, expectations, and the evolution of the …

Hearing Screening In North Carolina's Nicu And Well-Baby Nurseries: Impact Of Jcih 2019 And Covid-19, Jackson Roush, Shannon Culbertson, Chloe Gratzek, Jane Khin, Alexandra Mccormick, Stephanie Ortega, Madison Rock, Kathryn Sobon, Jenna Van Bosch, Hannah Siburt, Marcia Fort

Journal of Early Hearing Detection and Intervention

Purpose: Over an 18-month period in 2020–2021, the North Carolina Early Hearing Detection and Intervention (EHDI) program in collaboration with the North Carolina Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program conducted a statewide examination of newborn hearing screening practices in North Carolina’s 24 Neonatal Intensive Care Units (NICU) and 86 well-baby nurseries to determine how current protocols and procedures conform to those recommended by the Joint Committee on Infant Hearing (JCIH) in its Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. The COVID-19 pandemic emerged during the study period and motivated …

Diet, Exercise, Self-Monitoring, Technology, And Motivational Interviewing For Weight Loss In Adults, Ashleigh D. Warburton

Evidence-Based Practice Project Reports

Obesity, an epidemic in the United States (US), affected 42.4% of adults as of 2017-2018 (Hales, 2020). Comorbidities associated with obesity, such as cardiovascular disease, cancer, and diabetes (Orringer et al., 2020), are some of the leading causes of death in the US (Kochanek et al., 2020). The purpose of this evidence-based practice (EBP) project was to answer the following PICOT question: In adult patients aged 19 years or older who are considered overweight or obese as measured by body mass index (BMI) of ≥ 25 kg/m2 (P), how effective is diet and exercise combined with self-monitoring, a phone application, …

Coronavirus Update 5-11-22, The Coronavirus Planning Team

University Briefings & Virtual Events

With the end of the semester, we have shut down the COVID dashboard. We will evaluate the need for it in the future based on the status of the virus.

Is Tai Chi A Beneficial Treatment For Anxiety In The Elderly Community?, Carolyn Kenney

Honors Projects in Applied Psychology

This study attempted to explore the relationship between tai chi practice and anxiety in the elderly population. The mental health disorder that I looked at was anxiety, as the elderly often experience anxiety related to contributing factors such as mental and physical decline. Anxiety among the elderly is a great concern as there is an increase in the world’s population of individuals aged 65 years or older. This will directly impact health care prices as more resources will have to be distributed to this age population. One solution to this problem is tai chi. Tai chi is a cost-effective way …