Medicine and Health Sciences Commons^™

An Implementation Roadmap For Establishing Remote Infectious Disease Specialist Support For Consultation And Antibiotic Stewardship In Resource-Limited Settings, Robin L.P. Jump

Faculty Scholarship

Infectious Disease (ID)-trained specialists, defined as ID pharmacists and ID physicians, improve hospital care by providing consultations to patients with complicated infections and by leading programs that monitor and improve antibiotic prescribing. However, many hospitals and nursing homes lack access to ID specialists. Telehealth is an effective tool to deliver ID specialist expertise to resource-limited settings. Telehealth services are most useful when they are adapted to meet the needs and resources of the local setting. In this step-by-step guide, we describe how a tailored telehealth program can be implemented to provide remote ID specialist support for direct patient consultation and …

Engagement Journalism In Action: Supporting New Yorkers With Long Covid, Sarah Luft

Capstones

What do asthma and long COVID have in common? 1 in 13 U.S. adults are living with them. This report is a recap of my efforts to address the information needs of New Yorkers with long COVID as a student in CUNY's Craig Newmark Graduate School of Journalism engagement program. For my final project, I partnered with THE CITY, a nonprofit news outlet serving New Yorkers, to expand the MISSING THEM project. The report details the what, why, and how of my engagement reporting process, including a community engagement framework, a service journalism series, and lessons to carry forward. You …

Careers Lost To Long Covid, Emily Sauchelli

Capstones

Americans have had to adjust to new lifestyles as a result of the lingering symptoms associated with long COVID. Many have had no choice but to leave the workforce. Those with long COVID are putting the career paths they intended for themselves behind them, due to their inability to keep up with their jobs as a result of their lingering symptoms. Accommodations and resources on how those with long COVID can reenter back into the workforce are coming at a slow pace, as employers are not recognizing how to help those with long COVID stay and thrive in the workplace. …

Empowering Nurses To Recognize Post-Stroke Depression In The African American Community, Deidra Frisbie, Robin Simon

Doctor of Nursing Practice Projects

African Americans (AA) have the highest prevalence of stroke and death compared to other racial groups in the United States. Post-stroke depression (PSD) affects approximately 1/3 of all stroke patients and is underdiagnosed in the African American community.

Aim: By using a mHealth mobile app and a Psychiatry provider list at discharge, PSD can be identified, and interventions initiated, thus decreasing the sequela of PSD in AA.

Methods: Nurses were provided education on PSD, expressions of depression in African-Americans, cultural humility, implicit bias, and the importance of the nurse's role in developing a therapeutic relationship.

Results: Quantitative analysis revealed the …

Increasing Hpv Vaccination In Adolescents, Emily Martin, Emily Hartmann

Doctor of Nursing Practice Projects

Human papillomavirus virus (HPV) is a sexually transmitted disease that can negatively affect both males and females by leading to cervical, vaginal, vulvar, anal, penile, and oropharyngeal cancer. Vaccinating against HPV using the Gardasil vaccine is an effective method to prevent HPV, however, vaccination rates are still unacceptably low in adolescents ages 11 to 14. Pediatric providers should encourage and strongly recommend HPV vaccines to all adolescents. Addressing and easing parental hesitancy is a key component to improving vaccine acceptance. The setting for the project was a rural pediatric office in southern Illinois where HPV vaccination rates are lower than …

Retention Of New Nurses In The Cardiovascular Operating Room, Hannah Shufeldt

Doctor of Nursing Practice Projects

Background

In January of 2020, a hospital in Springfield, Illinois started the year with seven full-time circulating nurses in the cardiovascular operating room (CVOR). Three of those nurses left before the end of the year and an additional four nurses were hired. In January of 2021, the CVOR began the year with eight nurses. Five of these nurses left by the end of the year and seven more were hired, one of which left before the end of 2021. This department has struggled to retain nurses, with a turnover rate of 42.9% in 2020 and 62.5% in 2021.

Purpose

The …

Implementation Of Written Discharge Instructions For Common Diagnoses In The Urgent Care Setting, Melissa Kulp, Kristin Elmore

Doctor of Nursing Practice Projects

Abstract

Discharge instructions are an important tool providers use to communicate information to patients about their medical diagnosis after they return to their home environments. When patients understand and follow discharge instructions there are improved outcomes, fewer callbacks, and decreased return visits. The purpose of this quality improvement project were (a) to develop and distribute discharge instructions at or below a sixth-grade reading level, (b) on common diagnoses appropriate for a rural community, (c) decreased the need for subsequent office visits, and (d) decreased call volumes at a rural walk-in clinic. A large-scale literature review was conducted to determine the …

Dexmedetomidine As An Adjunct Therapy To Neuraxial Anesthesia In Labor And Delivery, Anthony Nungesser

Doctor of Nursing Practice Projects

In 2011, the Centers for Disease Control (CDC) declared the opioid crisis an epidemic, and in 2017 it was declared a public health emergency. In labor and delivery, neuraxial anesthesia has been used for over a hundred years to provide pain relief for parturients. Although many alternatives have been studied, opioids are the most frequently used local anesthetic adjuvants, and their use in neuraxial blocks has evolved over the last 50 years (Swain et al., 2017). While neuraxial opioids have proven to be an effective adjunct for pain relief, they are associated with undesirable side effects as well as the …

Assessment Of Caregiver Burden In A Memory Loss Clinic, Andrea Perkins

Doctor of Nursing Practice Projects

Background: Over 131,000 people in Illinois identify themselves as caregivers of someone with memory loss. The family caregiver may provide care including, but not limited to, assistance with activities of daily living, financial responsibilities, behavior management, and scheduling, and transportation to medical appointments. The care provided by the caregivers may lead to caregiver burden symptoms of depression, anxiety, and perceived stress. Purpose: Health care providers at a central Illinois memory clinic are not currently completing formal assessments of caregiver burden. This quality improvement project was done to determine if the current memory loss program services provide enough support …

The Effect Of Standardized Patient Education On 30-Day Hospital Readmissions For Heart Failure Patients In The Outpatient Setting, Lurie Dimalanta

Master's Projects and Capstones

Problem: Heart failure (HF) is the second leading condition of hospital readmissions. Evidence shows that patient education on self-care and disease management can help reduce and prevent 30-day hospital readmissions. Registered nurse case managers (RN CMs) can help improve patients' ability to self-manage their condition and prevent 30-day hospital readmissions by applying a standard approach to patient education.

Context: The Integrated Care Management (ICM) is an outpatient department that provides post-discharge patient calls. The ICM RN CMs utilized various HF patient education tools for patient teaching. The organization’s HF task force developed health-literate patient resources to be used …

Using Wearable Sensors To Measure Goal Achievement In Older Veterans With Dementia, Jennifer Freytag, Ram Kinker Mishra, Richard L Street, Angela Catic, Lilian Dindo, Lea Kiefer, Bijan Najafi, Aanand D Naik

Faculty, Staff and Students Publications

Aligning treatment with patients’ self-determined goals and health priorities is challenging in dementia care. Wearable-based remote health monitoring may facilitate determining the active participation of individuals with dementia towards achieving the determined goals. The present study aimed to demonstrate the feasibility of using wearables to assess healthcare goals set by older adults with cognitive impairment. We present four specific cases that assess (1) the feasibility of using wearables to monitor healthcare goals, (2) differences in function after goal-setting visits, and (3) goal achievement. Older veterans (n = 17) with cognitive impairment completed self-report assessments of mobility, then had an …

Deciphering The Mechanism And Function Of Hsp100 Unfoldases From Protein Structure, Grace Lee, Rebecca S Kim, Sang Bum Lee, Sukyeong Lee, Francis T F Tsai

Faculty, Staff and Students Publications

Hsp100 chaperones, also known as Clp proteins, constitute a family of ring-forming ATPases that differ in 3D structure and cellular function from other stress-inducible molecular chaperones. While the vast majority of ATP-dependent molecular chaperones promote the folding of either the nascent chain or a newly imported polypeptide to reach its native conformation, Hsp100 chaperones harness metabolic energy to perform the reverse and facilitate the unfolding of a misfolded polypeptide or protein aggregate. It is now known that inside cells and organelles, different Hsp100 members are involved in rescuing stress-damaged proteins from a previously aggregated state or in recycling polypeptides marked …

Transcranial Direct Current Stimulation Of Frontal/Occipital Cortices Modulates Neural Correlates Of Cognition In Healthy Young Adults, Yasra Arif

Theses & Dissertations

An exponential rise in the use of transcranial direct current stimulation (tDCS) to modify the human brain and behavior has been observed over the last 20 years, with studies often yielding mixed outcomes. Such heterogeneity is partially attributed to the lack of a concise understanding of the underlying mechanisms. Though considered to exert modulatory effects by changing neuronal membrane polarization and synaptic efficacy, the interactive effects of offline tDCS and the neural underpinnings of cognition, both at the regional and network-level, are yet to be fully understood. Using High-Definition tDCS (HD-tDCS), Magnetoencephalography (MEG), a range of well-established cognitive paradigms, and …

Implementing A Health Services Google Classroom In A High School Setting, Christina M. Wilkinson

Master's Projects and Capstones

Abstract

Problem: The present study investigated the use of Google Classroom and the impact of providing students with basic self-care information on nurse office visit times.

Context: A School nurses are often responsible for multiple schools and a large population of students. These demands pose challenges for school nurses to appropriately serve the student population.

Interventions: Disseminate basic health information on self-care to students via Google Classroom.

Measures: The outcome measure is to make nurse’s office visits less than ten minutes. The data source being chart reviews and the target is 80% of students. The process measure is to increase …

Increasing Colorectal Cancer Screening Rates In The Psychiatric Inpatient Unit, Diane R. Ventura

Master's Projects and Capstones

Increasing Colorectal Cancer Screening Rates in the Psychiatric Inpatient Unit

Abstract

Problem: Colorectal cancer is one of the leading cancer deaths in the United States. The Psychiatric Inpatient Unit has a colorectal cancer screening compliance rate of 40% compared to the statewide average of 80%.

Context: The Psychiatric Inpatient Unit is a 58-bed inpatient intermediate care facility mental health program in Northern California. Upon review of the EMR, most PIU nurses give verbal instructions and patient education on colorectal cancer screenings when due. Still, no printed handout was provided to the patients upon review of the EMR.

Intervention: Review of …

Usp<800> Hazardous Drug Safe-Handling In The Medical-Surgical Microsystem: A Cnl Quality Improvement Project, Ananda T. Le

Master's Projects and Capstones

Problem: The USP General Chapter <800> guidelines protect healthcare workers from hazardous drugs (HD) and are enforceable by hospital regulatory organizations. Hospitals should increase their safe handling and administration of these drugs to be compliant and protect their workers. This quality improvement project aimed to improve nurse compliance with the safe handling of USP <800> drugs on the medical-surgical microsystem within 16 weeks.

Context: This clinical nurse leader (CNL) quality improvement project was implemented on two medical-surgical microsystems in a San Francisco Bay Area hospital system.

Interventions: The team conducted passive observational data collection and active observation in the form of a …

United States Pharmacopeia General Chapter <800>: Improving Safe Handling And Administration Of Hazardous Drugs, Courtney Clark

Master's Projects and Capstones

Problem: This quality improvement project is dedicated to increasing the safe handling and administration of United States Pharmacopeia (USP) General Chapter Hazardous Drugs (HDs) within the Medical/Surgical unit to minimize the risk of exposure to patients, healthcare personnel, and the environment.

Context: The quality improvement project was implemented in two Medical/Surgical units in Hospital A in the San Francisco Bay Area. The patient population of these units has the highest receipt of HDs outside of a traditional Hematology/Oncology unit.

Intervention: The proposed intervention is the use of active and passive observation to assess compliance with USP protocols within the two …

Decreasing Hospital Acquired Pneumonia In Adult Patients, Samantha M. Flaherty

Master's Projects and Capstones

This Northern California Hospital holds to high-performance standards. It exists to provide high-quality care, aspiring to improve its members' health and lives while continually advancing its practice—pioneering preventive medicine, conducting comprehensive research, and driving innovative care (“Northern California Hospital,” 2022). By gathering and measuring data and analyzing adverse and advantageous patient outcomes, this Northern California Hospital's Quality Outcomes Department is able to identify gaps between the present and the intended goals. The quality department implements changes by working with care teams and providers to minimize the void between goals, making future patient care optimal.

The indicted Northern California Hospital focuses …

Implementation Of Staff Education To Standardize Use Of Positions During The First Stage Of Labor, Kelsey Jo Koch

Master's Projects and Capstones

The aim of this project was to assess whether supplemental education on labor positioning for Labor and Delivery nurses would increase the nurses’ confidence in utilizing patient positioning to promote fetal descent and progress labor. Previous research suggests that upright, mobile positions during the first stage of labor have various benefits, including reduced cesarean rates, shorter lengths of labor, and less epidural usage. However, a major barrier to maximizing these benefits is a gap in knowledge among Labor and Delivery nurses, resulting in inconsistent use of various positions. This improvement project addresses this problem at a large community hospital in …

Aerosols In Orthodontics: Characterization Of Particle Size And Travel Distance, Donte Jochum-Nesbitt

Theses & Dissertations

Introduction: Aerosol production is a key contributor to occupational risk and disease transmission in the dental clinic. These aerosols can host harmful pathogens, such as SARS-CoV-2. Considering the 2020 pandemic, researchers endeavored to bolster the existing body of literature related to disease transmission via aerosols and droplets to provide better recommendations for infection control. This investigation aims to support that mission by characterizing the risk to orthodontic professionals and patients based on aerosolized particle size and travel distance. Methods: The experimental protocol used in this study was validated through a smaller scale pilot study in 2021. High- and Low-risk orthodontic …

Essential Protections For Essential Workers: Ethical Considerations For Infection Prevention And Control, Abigail E. Lowe

Theses & Dissertations

Prior to the COVID-19 pandemic, ethical guidance for workers during epidemics and pandemics centered on healthcare workers, which meant there was not guidance to address critical contextual issues for many on the frontlines of the pandemic. Meat processing workers are a key example of workers deemed essential during the COVID-19 pandemic and facing conditions of elevated risk without adequate public health guidance or resources to control disease spread. Meat processing workers are an underserved, resource-limited, and vulnerable workforce that face occupational health and safety risks. Meat processing and other essential workers have heightened health disparities due to the social determinants …

Nanofabrication For Precision Vaccinology, Karen Zagorski

Theses & Dissertations

Vaccines are among the most effective and safe therapeutics known to mankind. Historically the approach to the creation of new vaccines has been dominated by empirical research, trial, and error. This thesis focuses on the more modern, rational approaches to vaccinology based on the current understanding of the inner workings of the immune system. We used nanotechnology for the generation of novel immunogens, addressed several challenges, and characterized the immune responses.

The preparation, characterization, and troubleshooting of several vaccines against dimeric amyloid beta are covered in chapters 4-6. Despite being ultimately unsuccessful, this part provided a deeper understanding of the …

Targeted Therpeutics For Prostate Cancer, Behind The Scenes Of Psma & Cysteine Protease Trapping Mechanism, Alireza Basiri

Theses & Dissertations

In an attempt to increase the residence time of PSMA-targeted theranostics inside the prostate cancer cells and tumors, we designed and prepared a CPTA-PSMATA resembling PSMA-617 by adding a well-known cysteine protease inhibitor (E-64) to the conjugate. Lysosomal proteases, including cysteine, serine, and aspartic families of hydrolytic enzymes, are expressed in high concentrations in the lysosomes and are responsible for the catabolism of proteins inside the cell [165, 278]. We proposed that after successful internalization of the PSMA-targeted conjugates into the cells, they will be conveyed to the endolysosomes. In these endolysosomal compartments, the E-64 moiety will covalently bind to …

A Cell Culture Model To Study Tobacco Associated Oral Cancer Progression And Treatment Resistance, Amanda Busch

Theses & Dissertations

Head and Neck Squamous cell carcinoma is the 6^th most common cancer in the world. Risk factors for HNSCC include alcohol and tobacco consumption, infection with Human Papilloma Virus, and exposure to environmental toxins. Unlike many other cancers, the incidence of HNSCC is growing, yet the treatment options and outcomes have not been significantly improved for decades. An increased understanding of the molecular mechanisms of these cancers is needed for improvement in early diagnosis, enhanced treatment effectiveness, and cancer prevention. 4-nitroquinoline 1-oxide (4NQO) is a well-tested, tobacco mimicking, carcinogen. 4NQO produces similar histological and chemical changes found in human …

Structural And Inhibitory Studies On (I)Two Mycobacterium Tuberculosis Enzymes Essential For Capsular Glucan Biosynthesis And Mrna Degradation: (Ii) Hantann Virus L-Protein Endonuclease Domain, Hettiarachchige Thilina D. Jayasinghe

Theses & Dissertations

Mycobacterium tuberculosis (Mtb) is the pathogenic bacterium species that causes Tuberculosis (TB). Understanding the major biosynthetic pathways responsible for cell viability is essential in developing new drugs against Mtb. The first two projects will reflect our approach in identifying inhibitors against Mtb GlgE, Mtb GpsI, and characterization of protein inhibitor interactions using X-ray crystallography.

The enzyme GlgE plays an essential role in the α-glucan biosynthesis pathway in Mtb cells. These α-glucans are one of the major structural units in the Mtb capsule. GlgE catalyzes the elongation of α-glucan by transferring maltose from maltose-1-phosphate (M1P) to the non-reducing end …

Structural And Biochemical Studies Of Three Enzymes Involved In Amino Acid Metabolism To Develop Novel Drugs, Yahani Pankaja Jayasinghe Arachchige

Theses & Dissertations

Intrinsic drug resistance in bacteria predates the clinical use of antibiotics. Additionally, heterogeneous metabolic states and the ability of many bacteria to form biofilms further enhances bacterial survival during infection and exacerbates treatment challenges. This necessitates the identification of novel drugs against new drug targets. These studies focus on the development of compounds targeting enzymes in Mycobacterium tuberculosis (Mtb) and Staphylococcus aureus that avoid intrinsic antibiotic defenses. The Mtb-encoded homoserine transacetylase enzyme (HTA) catalyzes the first step of the methionine biosynthesis pathway that produces methionine and S-adenosyl methionine. These compounds are shown to be essential for both dormant …

Narrative Review: Food Image Use For Machine Learnings’ Function In Dietary Assessment And Real Time Nutrition Feedback And Education, Jason Fee

Masters Theses, 2020-current

Technology has played a key role in advancing the health and agriculture sectors to improve obesity rates, diseasecontrol, food waste, and overall health disparities. However, these health and lifestyle determinants continue to plague theUnited States population. While new technologies have been and are currently being developed to address these concerns, they may not be practical for the general population. Utilizing machine learning advancement in food recognition using smartphone technology may be a means to improve the dietary component of nutrition assessments while providing valuable nutrition feedback. This narrative review was conducted to assess the current state of the literature on …

Wellness That Doesn’T Work. When Lifestyle Apps Lead To Disordered Eating., Aurelie G. Muntzel

Capstones

Fitness and dieting are nothing new, but what makes the latest generation of dieting apps that pair with smart watch devices which track your nutrition and biometric data so different is how much easier they can lead you towards disordered eating. This capstone explores how corporate incentives drive diet apps to co-opt the language of wellness discourse in order to attract the Gen Z market, while selling a product that equates healthiness to a number on a scale.

Standardizing Handoff Report In A Medsurg Telemetry Floor, Brandon Tyler Thompson

Master's Projects and Capstones

Problem: Hospital A’s 9^th floor telemetry units lacked a standardized method of handoff and required investigation. Current practices were evaluated, and an intervention was designed based on weak communication areas. Context: Using a 5 P’s assessment the key stakeholders included unit nurses, the nursing director, nurse educators, and unit nurse managers, and the patients were medsurg telemetry patients. The process included handoff in care and the pattern evaluated was methods of reporting with the purpose of providing high quality evidence-based patient centered care. A SWOT analysis revealed strong teamwork, interdisciplinary collaboration, and proficiency in health record technologies as strengths …

Nurse-Led Education On Oral Chemotherapy Medications, Carmen Lucia Glick Alonso

Master's Projects and Capstones

Problem: Breast cancer is one of the leading causes of cancer death among women in the United States. Annually, around 264,000 breast cancer cases are diagnosed in women and 2,400 in men (Centers for Disease Control and Prevention, 2022). According to the American Cancer Society, the risk of a woman in the United States being diagnosed with breast cancer in their life is around 13% (2022).

Context: Along with a cancer diagnosis comes the need to introduce patient education about new oral chemotherapy treatments. As a treatment team member, the oncology nurse plays a vital role in this …