Implementing A Standardized Nursing Communication Tool To Improve Inpatient Nursing Communication, Ashley D. Nator

Dissertations

Implementing a Standardized Nursing Communication Tool to Improve Inpatient Nursing Communication

Ashley D. Nator

B.S. Nursing, University of Missouri-St. Louis, 2018

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice with an emphasis in Family Nurse Practitioner

August 2022

Advisory Committee

Cathy Koetting, PhD, DNP, APRN, CPNP, PMHS, FNP-C

Chairperson

Sarah Jackson, DNP, APRN, FNP-C

Amy Terbrock, MSN, PCCN, SCRN, RN

Copyright, Ashley D. Nator, 2021

Original: 08/2021 Revised: 09/2021, 10/2021, 04/2022

Abstract

Problem: Patient handovers occur among nurses more than 4,000 times …

Reducing Catheter-Associated Urinary Tract Infections In The Pediatric Intensive Care Unit, Maria Smith

Dissertations

Problem: CAUTIs (catheter-associated urinary tract infections) are a common hospital-acquired condition (HAC) that increase length of hospital stays, hospital costs, and risk for patient mortality. CAUTI rates in a PICU increased in 2021 from the year 2020. A rapid cycle PDSA revealed nurses were not using soap and water for foley catheter care, which is the recommended cleanser by the Centers for Disease Control and Prevention (CDC).

Methods: An observational descriptive design was used to evaluate foley catheter cleaning and CAUTI rates. PICU nurses completed behavior surveys regarding foley catheter cleaning practices. An education intervention occurred when nurses answered anything …

Current Trends In The Reconstruction And Rehabilitation Of Jaw Following Ablative Surgery, Jane J Pu, Samer G Hakim, James C Melville, Yu-Xiong Su

Faculty, Staff and Student Publications

The reconstruction and rehabilitation of jaws following ablative surgery have been transformed in recent years by the development of computer-assisted surgery and virtual surgical planning. In this narrative literature review, we aim to discuss the current state-of-the-art jaw reconstruction, and to preview the potential future developments. The application of patient-specific implants and the "jaw-in-a-day technique" have made the fast restoration of jaws' function and aesthetics possible. The improved efficiency of primary reconstructive surgery allows for the rehabilitation of neurosensory function following ablative surgery. Currently, a great deal of research has been conducted on augmented/mixed reality, artificial intelligence, virtual surgical planning …

Antibody Response To Sars-Cov-2 Vaccination In Patients With Lymphoproliferative Disorders And Plasma Cell Dyscrasias: Anti-Lymphoma Therapy As A Predictive Biomarker Of Response To Vaccination, Carol Gung, Regina Mcguire, Mercy George, Abdullateef Abdulkareem, Katherine A Belden, Pierluigi Porcu, Ubaldo Martinez-Outschoorn, Adam F Binder, Inna Chervenova, Onder Alpdogan

Department of Medical Oncology Faculty Papers

We retrospectively analyzed SARS-CoV-2 vaccination antibody responses in a cohort of 273 patients with lymphoproliferative disorders or plasma cell dyscrasias who were seen at a single tertiary cancer center. Semi-quantitative anti-spike protein serologic testing was performed with enzyme immunoassay method. We found that the antibody response rate to SARS-CoV-2 vaccination was 74.7% in our patient cohort with no difference based on gender, age or race. The highest response rate was found in patients with Multiple Myeloma (MM) (95.5%). The response rates found in Diffuse Large B-Cell Lymphoma (DLBCL), Chronic Lymphocytic Leukemia (CLL), and Low-Grade Non-Hodgkin Lymphoma (LG-NHL) were 73.2%, 61.5% …

Aligning The American Health Information Management Association Entry-Level Curricula Competencies And Career Map With Industry Job Postings: Cross-Sectional Study, Susan H Fenton, David T Marc, Angela Kennedy, Debra Hamada, Robert Hoyt, Karima Lalani, Connie Renda, Rebecca B Reynolds

Faculty, Staff and Student Publications

BACKGROUND: The field of health information management (HIM) focuses on the protection and management of health information from a variety of sources. The American Health Information Management Association (AHIMA) Council for Excellence in Education (CEE) determines the needed skills and competencies for this field. AHIMA's HIM curricula competencies are divided into several domains among the associate, undergraduate, and graduate levels. Moreover, AHIMA's career map displays career paths for HIM professionals. What is not known is whether these competencies and the career map align with industry demands.

OBJECTIVE: The primary aim of this study is to analyze HIM job postings on …

Direction Of Attentional Focus In Prosthetic Training: Current Practice And Potential For Improving Motor Learning In Individuals With Lower Limb Loss, Szu-Ping Lee, Alexander Bonczyk, Maria Katrina Dimapilis, Sarah Partridge, Samantha Ruiz, Lung-Chan Chien, Andrew Sawers

Physical Therapy Faculty Research

Objective:

Adopting an external focus of attention has been shown to benefit motor performance and learning. However, the potential of optimizing attentional focus for improving prosthetic motor skills in lower limb prosthesis (LLP) users has not been examined. In this study, we investigated the frequency and direction of attentional focus embedded in the verbal instructions in a clinical prosthetic training setting.

Methods:

Twenty-one adult LLP users (8 female, 13 male; 85% at K3 level; mean age = 50.5) were recruited from prosthetic clinics in the Southern Nevada region. Verbal interactions between LLP users and their prosthetists (mean experience = 10 …

Evidence-Based Intervention (Ebi) Mapping: A Systematic Approach To Understanding The Components And Logic Of Ebis, Timothy J Walker, Maya Foster, Jacob Szeszulski, Derek W Craig, Patricia Dolan Mullen, Maria E Fernández

Faculty, Staff and Student Publications

BACKGROUND: Despite the development of numerous evidence-based interventions (EBIs), many go unused in practice. Hesitations to use existing EBIs may be due to a lack of understanding about EBI components and what it would take to adapt it or implement it as designed. To improve the use of EBIs, program planners need to understand their goals, core components, and mechanisms of action. This paper presents EBI Mapping, a systematic approach based on Intervention Mapping, that can be used to understand and clearly describe EBIs, and help planners put them into practice.

METHODS: We describe EBI Mapping tasks and provide an …

Evidence-Based Intervention (Ebi) Mapping: A Systematic Approach To Understanding The Components And Logic Of Ebis, Timothy J Walker, Maya Foster, Jacob Szeszulski, Derek W Craig, Patricia Dolan Mullen, Maria E Fernández

Faculty, Staff and Student Publications

BACKGROUND: Despite the development of numerous evidence-based interventions (EBIs), many go unused in practice. Hesitations to use existing EBIs may be due to a lack of understanding about EBI components and what it would take to adapt it or implement it as designed. to improve the use of EBIs, program planners need to understand their goals, core components, and mechanisms of action. This paper presents EBI Mapping, a systematic approach based on Intervention Mapping, that can be used to understand and clearly describe EBIs, and help planners put them into practice.

METHODS: We describe EBI Mapping tasks and provide an …

Dissecting The Treatment-Naive Ecosystem Of Human Melanoma Brain Metastasis, Jana Biermann, Johannes C Melms, Amit Dipak Amin, Yiping Wang, Lindsay A Caprio, Alcida Karz, Somnath Tagore, Irving Barrera, Miguel A Ibarra-Arellano, Massimo Andreatta, Benjamin T Fullerton, Kristjan H Gretarsson, Varun Sahu, Vaibhav S Mangipudy, Trang T T Nguyen, Ajay Nair, Meri Rogava, Patricia Ho, Peter D Koch, Matei Banu, Nelson Humala, Aayushi Mahajan, Zachary H Walsh, Shivem B Shah, Daniel H Vaccaro, Blake Caldwell, Michael Mu, Florian Wünnemann, Margot Chazotte, Simon Berhe, Adrienne M Luoma, Joseph Driver, Matthew Ingham, Shaheer A Khan, Suthee Rapisuwon, Craig L Slingluff, Thomas Eigentler, Martin Röcken, Richard Carvajal, Michael B Atkins, Michael A Davies, Albert Agustinus, Samuel F Bakhoum, Elham Azizi, Markus Siegelin, Chao Lu, Santiago J Carmona, Hanina Hibshoosh, Antoni Ribas, Peter Canoll, Jeffrey N Bruce, Wenya Linda Bi, Praveen Agrawal, Denis Schapiro, Eva Hernando, Evan Z Macosko, Fei Chen, Gary K Schwartz, Benjamin Izar

Faculty, Staff and Student Publications

Melanoma brain metastasis (MBM) frequently occurs in patients with advanced melanoma; yet, our understanding of the underlying salient biology is rudimentary. Here, we performed single-cell/nucleus RNA-seq in 22 treatment-naive MBMs and 10 extracranial melanoma metastases (ECMs) and matched spatial single-cell transcriptomics and T cell receptor (TCR)-seq. Cancer cells from MBM were more chromosomally unstable, adopted a neuronal-like cell state, and enriched for spatially variably expressed metabolic pathways. Key observations were validated in independent patient cohorts, patient-derived MBM/ECM xenograft models, RNA/ATAC-seq, proteomics, and multiplexed imaging. Integrated spatial analyses revealed distinct geography of putative cancer immune evasion and evidence for more abundant …

Lncrna-Associated Genetic Etiologies Are Shared Between Type 2 Diabetes And Cancers In The Uae Population, Roberta Giordo, Rida Gulsha, Sarah Kalla, George A Calin, Leonard Lipovich

Faculty, Staff and Student Publications

Numerous epidemiological studies place patients with T2D at a higher risk for cancer. Many risk factors, such as obesity, ageing, poor diet and low physical activity, are shared between T2D and cancer; however, the biological mechanisms linking the two diseases remain largely unknown. The advent of genome wide association studies (GWAS) revealed large numbers of genetic variants associated with both T2D and cancer. Most significant disease-associated variants reside in non-coding regions of the genome. Several studies show that single nucleotide polymorphisms (SNPs) at or near long non-coding RNA (lncRNA) genes may impact the susceptibility to T2D and cancer. Therefore, the …

Structural And Electrical Remodeling Of The Sinoatrial Node In Diabetes: New Dimensions And Perspectives, Lina T. Al Kury, Stephanie Chacar, Eman Alefishat, Ali A. Khraibi, Moni Nader

All Works

The sinoatrial node (SAN) is composed of highly specialized cells that mandate the spontaneous beating of the heart through self-generation of an action potential (AP). Despite this automaticity, the SAN is under the modulation of the autonomic nervous system (ANS). In diabetes mellitus (DM), heart rate variability (HRV) manifests as a hallmark of diabetic cardiomyopathy. This is paralleled by an impaired regulation of the ANS, and by a pathological remodeling of the pacemaker structure and function. The direct effect of diabetes on the molecular signatures underscoring this pathology remains ill-defined. The recent focus on the electrical currents of the SAN …

Community Engagement Education In Academic Health Centers, Colleges, And Universities, Chyke A. Doubeni, David Nelson, Elizabeth Gross Cohn, Electra Paskett, Seleshi Ayalew Asfaw, Mehek Sumar, Syed M. Ahmed, Rhonda Mcclinton-Brown, Mark L. Wieland, Anita Kinney, Sergio Aguilar-Gaxiola, Lisa G. Rosas, Cecilia M. Patino

Publications and Research

Community engagement (CE) is critical for advancing health equity and a key approach for promoting inclusive clinical and translational science. However, it requires a workforce trained to effectively design, implement, and evaluate health promotion and improvement strategies through meaningful collaboration with community members. This paper presents an approach for designing CE curricula for research, education, clinical care, and public health learners. A general pedagogical framework is presented to support curriculum development with the inclusion of community members as facilitators or faculty. The overall goal of the curriculum is envisioned as enabling learners to effectively demonstrate the principles of CE in …

Small Rna Signatures Of Acute Ischemic Stroke In L1cam Positive Extracellular Vesicles, Michael A Lopez, Ying Si, Xianzhen Hu, Valentyna Williams, Fuad Qushair, Jackson Carlyle, Lyndsy Alesce, Michael Conklin, Shawn Gilbert, Marcas M Bamman, Matthew S Alexander, Peter H King

Faculty, Staff and Student Publications

Duchenne muscular dystrophy (DMD) is an X-linked recessive disease characterized by skeletal muscle instability, progressive muscle wasting, and fibrosis. A major driver of DMD pathology stems from aberrant upregulation of transforming growth factor β (TGFβ) signaling. In this report, we investigated the major transducers of TGFβ signaling, i.e., receptor Smads (R-Smads), in DMD patient skeletal muscle and observed a 48-fold increase in Smad8 mRNA. Smad1, Smad2, Smad3, and Smad5 mRNA were only minimally increased. A similar pattern was observed in the muscle from the mdx5cv mouse. Western blot analysis showed upregulation of phosphorylated Smad1, Smad5, and Smad8 …

Tp53 Copy Number And Protein Expression Inform Mutation Status Across Risk Categories In Acute Myeloid Leukemia, Mehrnoosh Tashakori, Tapan Kadia, Sanam Loghavi, Naval Daver, Rashmi Kanagal-Shamanna, Sherry Pierce, Dawen Sui, Peng Wei, Farnoosh Khodakarami, Zhenya Tang, Mark Routbort, Carol A Bivins, Elias J Jabbour, L Jeffrey Medeiros, Kapil Bhalla, Hagop M Kantarjian, Farhad Ravandi, Joseph D Khoury

Faculty, Staff and Student Publications

Mutant TP53 is an adverse risk factor in acute myeloid leukemia (AML), but large-scale integrated genomic-proteomic analyses of TP53 alterations in patients with AML remain limited. We analyzed TP53 mutational status, copy number (CN), and protein expression data in AML (N = 528) and provide a compilation of mutation sites and types across disease subgroups among treated and untreated patients. Our analysis shows differential hotspots in subsets of AML and uncovers novel pathogenic variants involving TP53 splice sites. In addition, we identified TP53 CN loss in 70.2% of TP53-mutated AML cases, which have more deleterious TP53 mutations, as well as …

Teaching Quality Improvement: The Use Of Education Theories Across The Medical Education Spectrum., Sugeet Jagpal, Abra Fant, Riccardo Bianchi, Andrew Kalnow

Medical Education Articles

It is well recognized that the principles and practices of patient safety and quality improvement (QI) need to be included in medical education. The implementation of patient safety and QI learning experiences at the undergraduate medical education (UME) and graduate medical education (GME) levels has been variable. Consistent teaching of QI across the UME-GME-continuing medical education (CME) spectrum may result in a systemic change of improved patient care and patient safety in clinical practice. We propose using education theories to frame the development of QI curricula for a longitudinal integration in medical education and clinical practice. The basic principles of …

Microbial Liberation Of N-Methylserotonin From Orange Fiber In Gnotobiotic Mice And Humans, Nathan D Han, Daniel Webber, Stacey Marion, Michael J Barratt, Andrew C Heath, Et Al.

2020-Current year OA Pubs

Plant fibers in byproduct streams produced by non-harsh food processing methods represent biorepositories of diverse, naturally occurring, and physiologically active biomolecules. To demonstrate one approach for their characterization, mass spectrometry of intestinal contents from gnotobiotic mice, plus in vitro studies, revealed liberation of N-methylserotonin from orange fibers by human gut microbiota members including Bacteroides ovatus. Functional genomic analyses of B. ovatus strains grown under permissive and non-permissive N-methylserotonin "mining" conditions revealed polysaccharide utilization loci that target pectins whose expression correlate with strain-specific liberation of this compound. N-methylserotonin, orally administered to germ-free mice, reduced adiposity, altered liver glycogenesis, shortened gut transit …

Tuberculosis Phenotypic And Genotypic Drug Susceptibility Testing And Immunodiagnostics: A Review, Kizil A. Yusoof, Juan Ignacio Garcia, Alyssa Schami, Andreu Garcia-Vilanova, Holden V. Kelley, Shu-Hua Wang, Adrian Rendon, Blanca I. Restrepo, Marcel Yotebieng, Jordi B. Torrelles

School of Medicine Publications

Tuberculosis (TB), considered an ancient disease, is still killing one person every 21 seconds. Diagnosis of Mycobacterium tuberculosis (M.tb) still has many challenges, especially in low and middle-income countries with high burden disease rates. Over the last two decades, the amount of drug-resistant (DR)-TB cases has been increasing, from mono-resistant (mainly for isoniazid or rifampicin resistance) to extremely drug resistant TB. DR-TB is problematic to diagnose and treat, and thus, needs more resources to manage it. Together with+ TB clinical symptoms, phenotypic and genotypic diagnosis of TB includes a series of tests that can be used on different specimens to …

Treatment Disparities In Emergency Medical Services: The Influence Of Race/Ethnicity, Obesity, And English Proficiency, Jamie Kennel

Dissertations and Theses

Different treatment in healthcare settings provided to different social groups of people may lead to disparities in health, quality of life, and life span. Despite the critical role among healthcare services that Emergency Medical Services (EMS) provides disproportionately for marginalized communities, it remains unclear if and to what extent treatment disparities take place in the pre-hospital setting. Guided by the theoretical frameworks of social worth, aversive racism, and stigma, this study utilizes medical chart data from three different public and private datasets to investigate treatment disparities by Emergency Medical Service providers for racial minority, obese, and limited English proficiency patients. …

Long-Term Follow-Up For The Development Of Subsequent Malignancies In Patients Treated With Genetically Modified Iecs, David H M Steffin, Ibrahim N Muhsen, Laquisa C Hill, Carlos A Ramos, Nabil Ahmed, Meenakshi Hegde, Tao Wang, Mengfen Wu, Stephen Gottschalk, Sarah B Whittle, Premal D Lulla, Maksim Mamonkin, Bilal Omer, Rayne H Rouce, Andras Heczey, Leonid S Metelitsa, Bambi J Grilley, Catherine Robertson, Virginia Torrano, Natalia Lapteva, Adrian P Gee, Cliona M Rooney, Malcolm K Brenner, Helen E Heslop

Faculty, Staff and Students Publications

Subsequent malignancies are well-documented complications in long-term follow-up of cancer patients. Recently, genetically modified immune effector (IE) cells have shown benefit in hematologic malignancies and are being evaluated in clinical trials for solid tumors. Although the short-term complications of IE cells are well described, there is limited literature summarizing long-term follow-up, including subsequent malignancies. We retrospectively reviewed data from 340 patients treated across 27 investigator-initiated pediatric and adult clinical trials at our center. All patients received IE cells genetically modified with γ-retroviral vectors to treat relapsed and/or refractory hematologic or solid malignancies. In a cumulative 1027 years of long-term follow-up, …

Extracellular Domain Of Pept1 Interacts With Tm1 To Facilitate Substrate Transport, Jiemin Shen, Miaohui Hu, Xiao Fan, Zhenning Ren, Corinne Portioli, Xiuwen Yan, Mingqiang Rong, Ming Zhou

Faculty, Staff and Students Publications

Mammalian peptide transporters, PepT1 and PepT2, mediate uptake of small peptides and are essential for their absorption. PepT also mediates absorption of many drugs and prodrugs to enhance their bioavailability. PepT has twelve transmembrane (TM) helices that fold into an N-terminal domain (NTD, TM1–6) and a C-terminal domain (CTD, TM7–12), and has a large extracellular domain (ECD) between TM9–10. It is well-recognized that peptide transport requires movements of the NTD and CTD, but the role of the ECD in PepT1 remains unclear. Here we report the structure of horse PepT1 encircled in lipid nanodiscs and captured in the inward-open apo …

Maternal Adipocyte Connexin43 Gap Junctions Affect Breastmilk Lactose Levels And Neonate Growth In Mice, Mingyang Huang, Anying Song, Xi Chen, Sarah Ishtiaq, Chunmei Wang, Darryl L Hadsell, Qiong A Wang, Yi Zhu

Faculty, Staff and Students Publications

Simple Summary

Breastfeeding offers many health benefits for both mothers and infants. However, overnutrition and a steady increase in obesity in the U.S. has made it harder for many mothers to produce and express breastmilk. Moreover, the quality of breastmilk from obese mothers is frequently compromised in that it contains fewer nutrients and more inflammatory components. In this study, we used mice to model this phenomenon. We found that short-term high-fat feeding at the start of breeding reduces litter size and pups’ body weight. It also impairs adipocyte remodeling during lactation. Connexin43 is the primary building block for gap junctions …

Lipid Absorption And Overall Intestinal Lymphatic Transport Are Impaired Following Partial Small Bowel Resection In Mice, Emily J Onufer, Rafael S Czepielewski, Yong-Hyun Han, Cathleen M Courtney, Stephanie Sutton, Anne Sescleifer, Gwendalyn J Randolph, Brad W Warner

2020-Current year OA Pubs

Short bowel syndrome (SBS) is associated with diminished levels of serum fats caused by unknown mechanisms. We have shown that mesenteric lymphatics remodel to a more primitive state one week after small bowel resection (SBR); therefore, this study focuses on the effect of chronic lymphatic remodeling and magnitude of resection on intestinal lipid uptake and transport. C57BL6 and Prox1 creER-Rosa26

Relative Contributions Of Six Lifestyle- And Health-Related Exposures To Epigenetic Aging: The Coronary Artery Risk Development In Young Adults (Cardia) Study, Kyeezu Kim, Yinan Zheng, Brian T Joyce, Hongmei Jiang, Philip Greenland, David R Jacobs, Kai Zhang, Lei Liu, Norrina B Allen, John T Wilkins, Sarah N Forrester, Donald M Lloyd-Jones, Lifang Hou

2020-Current year OA Pubs

BACKGROUND: DNA methylation-based GrimAge acceleration (GrimAA) is associated with a wide range of age-related health outcomes including cardiovascular disease. Since DNA methylation is modifiable by external and behavioral exposures, it is important to identify which of these exposures may have the strongest contributions to differences in GrimAA, to help guide potential intervention strategies. Here, we assessed the relative contributions of lifestyle- and health-related components, as well as their collective association, to GrimAA.

RESULTS: We included 744 participants (391 men and 353 women) from the Coronary Artery Risk Development in Young Adults (CARDIA) study with blood DNA methylation information at CARDIA …

An Assessment Of Isometric Muscle Strength And The Hamstring: Quadriceps Ratio Among Males Trained With Free Weights Vs. Machines, Geferson Honorato Da Silva, Alex Souto Maior

Baltic Journal of Health and Physical Activity

Introduction. The purpose of this study was to assess the isometric muscle strength (IMS) of the knee extensors and flexors, bilateral asymmetry (BA) and the hamstring: quadriceps ratio (H:Q ratio) between the dominant leg (DL) vs. the non-dominant leg (NDL) of males trained with free-weights vs. machines. Material and Methods: Thirty males were recruited and separated into two groups: Free-weights (n = 15) and Machines (n = 15) groups. All study participants performed the IMS testing for knee extensors and flexors in the DL and NDL using a commercially available load cell. The highest value obtained from the three trials …

Understanding How High Levels Of Noise Affect The Equine Auditory System, Shelby Brown

Ursidae: The Undergraduate Research Journal at the University of Northern Colorado

Abstract

Mounted shooting is becoming a very popular sport within the equestrian community, exposing many horses to extreme levels of noise that the animals would not be exposed to otherwise. I selected this project because it is important for me to know how this hobby that I personally enjoy is impacting the health and well-being of my equine partners. Veterinarians can provide an elementary answer by clapping and checking for a physical reaction. However, that does not tell the client much other than the animal responded to one auditory cue.

It is important to understand how firearm exposure could affect …

Role Of Myocardial Strain Imaging By Echocardiography For The Early Detection Of Anthracyclines-Induced Cardiotoxicity, Reham Selmy Rasheed, Hatem El Sokkary, Mahmoud Zaki El Amrosy, Mohammed El Setiha, Mai Mohammed Abd El Moneim Salama

Journal of the Saudi Heart Association

Objective: To investigate the role of myocardial strain imaging by echocardiogram for detecting anthracycline-induced cardiotoxicity early. Methods: Fifty patients had transthoracic echocardiogram and/or cardiological consultation before, during, and after taking anthracyclines. GE Vivid E9 Ultrasound System was used for echocardiographic examination and myocardial strain imaging. All patients were assessed three times: on the first visit; before starting anthracycline medication, on the second visit; three months later and on the third visit; six months later. Results: Cardiotoxicity occurred in 4 patients at the end of the research. There was a statistically significant association between percentage change in left ventricular global longitudinal …

Assessment Of Value Of Three Dimensional Transesophageal Echocardiography Versus Conventional Two Dimensional Transesophageal Echocardiography In Guiding Transcatheter Closure Of Atrial Septal Defects And Patent Foramen Ovale, Eman H. El Doklah, Sahar A. Elshedoudy, Ayman M. El Saied, Hanan K. Kassem, Magdy M. El Masry

Journal of the Saudi Heart Association

Objective: To evaluate the benefit of using three-dimensional transesophageal echocardiography (3DTEE) over conventional two-dimensional transesophageal echocardiography (2DTEE) in evaluation of various morphological features of atrial septal defect (ASD) and patent foramen ovale (PFO) during transcatheter closure. Methods: This is an observational cross sectional study including 115 patients (45 PFO and 70 ASD patients) who underwent 2D/3DTEE guided transcatheter closure from April 2019 to October 2021 in cardiology department, Tanta university hospital. Results: 70 ASD patients were divided into two groups; the pediatric age group (18 patients, mean age 9.05± 3.51 years) and the adult group (52 patients, mean age 39.3±10.15 …

Radiological Appearance Of Appendicular Osteosarcoma: A Case Report, Dr. Bathreenathh B, Dr. Vikram Patil, Dr. Anupama C

Radiology Teaching Files

A 42yr old male patient with complaints of on and off pain of right shoulder and arm since 3months. No e/o weight loss and loss of appetite. No e/o fever. No e/o discharging sinus/ superficial swelling over the right arm.

2022-07-06_Michiganoverview_Covidvaccinestats, Michigan Department Of Health & Human Services

Michigan COVID-19 Vaccine Data

The COVID Vaccine Dashboard page was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus/resources/covid-19-vaccine/covid-19-dashboard.

First-dose tracker above is for entire Michigan Population. Coverage maps below are for age 5+.

Previously reported numbers of administered vaccine doses may change as new data are received. A possible lag in reporting vaccine doses will result in increases in numbers previously reported.

This report is created by the Michigan Department of Health and Human Services Division of Immunization from data reported to the Michigan Care Improvement Registry (MCIR).

The dashboard contained the tabs Primary Series Doses Administered, Primary Series Doses by Vaccine, …

Evaluation Of A Process Change Using An Updated Sedation Protocol, Rachel Allen

Dissertations

Problem: Pediatric delirium is continuing to increase intensive care environments and for patients who require mechanical ventilation and continuous sedative medications. Delirium is harmful to the patient creating lasting neurologic and mental health issues along with prolonged hospitalization and increased healthcare cost

Method: For this quality improvement (QI) project, a descriptive observational study was used to evaluate the implementation of a sedation protocol for patients who are mechanically ventilated and on continuous sedative medications. This was completed with the use of retrospective chart reviews three months prior to implementation and three months after the new protocol was implemented. Nurses were …