Medicine and Health Sciences Commons^™

A Response Team Approach To Reducing Restraint Use In The Emergency Department, Sarah Place

Doctor of Nursing Practice Scholarly Projects

Assaults on staff are doubling in the healthcare field, and due to the urgent need to secure the environment, the use of restrictive measures is at times, the safest choice. The following project examined the implementation of a Behavioral Emergency Response Team approach in an Emergency Department, and the effects it had, on reducing the use of violent restraints, assaults on staff, and increase confidence of staff in managing difficult situations. An anonymous survey was used to measure staff confidence while handling agitated patients, and an event report was used that identified if de-escalation techniques were employed to assist in …

Improving The Discharge Process In A Post-Acute Care, Skilled Nursing Facility To Decrease Hospital Readmissions, Shantoria W. Parker

Doctor of Nursing Practice Scholarly Projects

Problem: Older adults recently discharged from a skilled nursing facility (SNF) (often referred to as short-stay facilities) experience a period of vulnerability while transitioning back into the community, placing them at increased risk of adverse events, including hospital readmissions (Anderson et al., 2021). Completing a timely appointment (within 7 days) with primary care providers following discharge into the community reduces patients’ risk of preventable hospital readmissions (RHI, 2023) through interventions aimed at promoting coordinated care and safe transitions (Patel et al., 2019). However, more than 50% of readmitted patients failed to visit a primary care provider's (PCP) office between SNF …

Early Palliative Care Screening Among Solid Tumor Oncology Patients, Kaitlin Lothe

Doctor of Nursing Practice Scholarly Projects

While there are extensive benefits of integration of early palliative care, referral to this specialty tends to occur late in the disease course after some form of suffering has already occurred (Hausner et al., 2021). The purpose of this DNP student’s quality improvement project was to improve care coordination and increase rate of palliative care referrals of solid tumor oncology patients through implementation of an evidence-based trigger tool for palliative care screening. Participants were recruited from a 36-bed inpatient adult medical oncology unit where identified patients meeting criteria were included in the study. Data for this study included participant demographics, …

Implementation Of “The Pause” To Promote Clinician Wellness, Aishia Shonta Jennings

Doctor of Nursing Practice Scholarly Projects

Clinicians experience work-associated trauma after unsuccessful resuscitation efforts and may internalize the trauma unless it is addressed. The purpose of this DNP project was to conduct a pilot to determine whether “The Pause” is a practice that could be adopted throughout the organization to promote clinician well-being after patient resuscitation efforts, often called a “code blue” event. The model for this evidence-based practice change is the six-step Rosswurm and Larrabee (1999) model. Data analysis included six measures: the number of code blue events that occurred during the implementation period, the number of code blue events that were unsuccessful in patient …

Patient Outcomes Following The Implementation Of A Cardiogenic Shock Algorithm, Alana E. Hall

Doctor of Nursing Practice Scholarly Projects

Problem Statement: ST-elevated myocardial infarction (STEMI) is one of the leading causes of cardiogenic shock (CS) associated with increased in-hospital mortality. Despite multiple efforts to improve outcomes, mortality remains high.

Purpose: This quality improvement project aimed to analyze the impact of a cardiogenic shock algorithm on survival to discharge for STEMI patients.

Methods: A CS algorithm was implemented at a cardiac catheterization laboratory on October 3, 2022. Using the Plan-Do-Study-Act quality improvement framework, data was retrospectively collected on patients presenting with a STEMI who meet CS criteria to determine if there was improved survival to discharge after implementing …

Impact Of A Toolkit On Fall Prevention In An Acute Midsized Rehabilitation Facility In The Southeast, Shantai D. Allen

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Older people in hospitals may face a greater risk of falls due to the use of medication, lower body weakness, and some difficulty with balance and walking. Over the past five years, there has been a steady increase in the prevalence of falls with the targeted unit reporting over 5 falls per 1000 patient days, which is higher than the national average. Purpose: The purpose of this project was to decrease falls and decrease falls with injuries in this patient population. Methods: The project employed a pre-post intervention design that measured fall incidence in the targeted unit after …

Implementation Of A Nurse Driven Urinary Catheter Protocol: A Quality Improvement Project For Adult Patients, Jamie H. Dagenhart

Doctor of Nursing Practice Scholarly Projects

Introduction: Studies have shown a relationship between management and use of indwelling urinary catheters on catheter days and catheter-associated urinary tract infections (CAUTIs), in adult patients in intensive care units (ICUs). Globally, increases in catheter days and CAUTI rates have led to poor patient outcomes, increased lengths of hospital stay, and increased hospital costs. In efforts to inhibit these adverse effects, institutions have developed protocols specific to reducing CAUTIs in hospitalized patients. This paper argues that a multifaceted nurse driven indwelling urinary catheter protocol will positively influence number of catheter days and change in practice, in the proposed institutional settings. …

Assessing Organizational Readiness For Evidence-Based Practice (Ebp) Change For The Implementation Of A Postoperative Neuropathic Mastalgia (Pnm) Scale Among General Surgery Ambulatory Practices, Jessica Terry Gonzalez

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Assessing postoperative neuropathic mastalgia (PNM) among oncology breast surgical patients is not commonly performed using a surgery specific pain scale at large South Carolina healthcare organization and is historically misdiagnosed, mismanaged, despite representing a common and significant complication (Gong et al., 2020; Humble et al., 2015; Mejdahl et al., 2019). Studies show that early identification of patients with neuropathic-specific pain following breast cancer-related surgery facilitates better pain management and patient outcomes (Pereira et al., 2017; Sipilä et al., 2012). Assessing organizational readiness to adopt Evidence-Based Practice change is recommended to facilitate the identification of potential barriers to implementation …

Increasing Hpv Vaccination Uptake In Female College Students Aged 18-26, Gabrielle B. Scott

Doctor of Nursing Practice Scholarly Projects

Human papillomavirus (HPV) is the most common sexually transmitted infection in the world. Most people infected with HPV remain asymptomatic, but infections may result in several types of cancer. Three HPV vaccines are available with the recommended initiation of vaccination between 11–12 years, but the vaccine may be administered to females through 45 years old. Despite HPV vaccine efficacy, vaccination rates among college-age students remain low, particularly in certain geographical areas such as the Southeastern United States. This project aimed to increase HPV vaccination uptake among females between the ages of 18-26 in the Women’s Health Clinic through patient education …

Optimizing The Utility Of Anorectal Manometry For Diagnosis And Therapy: A Roundtable Review And Recommendations, Satish S C Rao, Gregory S Sayuk, Et Al.

2020-Current year OA Pubs

BACKGROUND & AIMS: Anorectal manometry (ARM) is a comprehensive diagnostic tool for evaluating patients with constipation, fecal incontinence, or anorectal pain; however, it is not widely utilized for reasons that remain unclear. The aim of this roundtable discussion was to critically examine the current clinical practices of ARM and biofeedback therapy by physicians and surgeons in both academic and community settings.

METHODS: Leaders in medical and surgical gastroenterology and physical therapy with interest in anorectal disorders were surveyed regarding practice patterns and utilization of these technologies. Subsequently, a roundtable was held to discuss survey results, explore current diagnostic and therapeutic …

Recent Economic Intimate Partner Violence And Posttraumatic Stress Symptoms Among A Racially And Ethnically Diverse Sample Of U.S. Women Experiencing Intimate Partner Violence, Tiara C. Willie, Kamila A. Alexander, Laurel Sharpless, Jessica L. Zemlak, Megan V. Smith, Trace S. Kershaw

College of Nursing Faculty Research and Publications

Posttraumatic stress disorder (PTSD) is a prevalent consequence of physical and sexual intimate partner violence (IPV); however, little is known about the unique contributions of economic IPV. Furthermore, women’s economic self-sufficiency may explicate the potential relationship between economic IPV and PTSD symptoms. Guided by the Stress Process Theory and Intersectionality, this study examined associations between economic IPV and women’s PTSD symptoms and assessed economic self-sufficiency as a mediator. Participants were 255 adult women experiencing IPV recruited from metropolitan Baltimore, MD, and the state of CT who participated in two different studies. Participants completed surveys on IPV, economic self-sufficiency, and PTSD. …

Predicting Stringent Quantiferon-Tb Gold Plus Conversions In Contacts Of Tuberculosis Patients, Sheng-Wei Pan, Donald G. Catanzaro, Marva Seifert, Rehan Syed, Naomi Hillery, Mei-Lin Ho, Valeriu Crudu, Elena Tudor, Nelly Ciobanu, Alexandru Codreanu, Antonino Catanzaro, Timonthy C. Rodwell

Biological Sciences Faculty Publications and Presentations

Objectives

Methods

Results

Sustained Antidepressant Effect Of Ketamine Through Nmdar Trapping In The Lhb, Shuangshuang Ma, Christopher J Lingle, Et Al.

2020-Current year OA Pubs

Ketamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist

A Systematic Review And Meta-Analysis Of Resting-State Fmri In Anxiety Disorders: Need For Data Sharing To Move The Field Forward, André Zugman, Laura Jett, Chase Antonacci, Anderson M. Winkler, Daniel Samuel Pine

School of Medicine Publications

Highlights

• There are numerous studies investigating rs-fMRI and anxiety; however, the methodologies are inconsistent.

• Anxiety patients show hypoconnectivity between the amygdala and the medial prefrontal cortex.

• This finding is not robust against possible publication bias. Thus, no strong findings manifest in available literature.

• More studies are needed with standardized methods and larger sample sizes.

Abstract

Anxiety disorders are among the most prevalent psychiatric disorders. Neuroimaging findings remain uncertain, and resting state functional magnetic resonance (rs-fMRI) connectivity is of particular interest since it is a scalable functional imaging modality. Given heterogeneous past findings for rs-fMRI in anxious individuals, we characterize patterns …

Transcarotid Versus Transaxillary Access For Transcatheter Aortic Valve Replacement With A Self-Expanding Valve: A Propensity-Matched Analysis., Keith B Allen, Daniel Watson, Amit N Vora, Paul Mahoney, Adnan K Chhatriwalla, Jonathan G Schwartz, Antoine Keller, Nishtha Sodhi, Daniel Haugan, Michael Caskey

Heart and Vascular Articles

UNLABELLED: Transaxillary access has been the most frequently used nonfemoral access route for transcatheter aortic valve replacement (TAVR) with a self-expanding valve. Use of transcarotid TAVR is increasing; however, comparative data on these methods are limited. We compared outcomes following transcarotid or transaxillary TAVR with a self-expanding, supra-annular valve.

METHODS: The Transcatheter Valve Therapy Registry was queried for TAVR procedures using transaxillary and transcarotid access between July 2015 and June 2021. Patients received a self-expanding Evolut R, PRO, or PRO + valve (Medtronic) and had 1-year follow-up. Thirty-day and 1-year outcomes were compared in transcarotid and transaxillary groups after 1:2 …

Outcomes In High-Risk Pulmonary Embolism Patients Undergoing Flowtriever Mechanical Thrombectomy Or Other Contemporary Therapies: Results From The Flame Study., Mitchell J Silver, C Michael Gibson, Jay Giri, Sameer Khandhar, Wissam Jaber, Catalin Toma, Bushra Mina, Terry Bowers, Lee Greenspon, Herman Kado, David M Zlotnick, Mithun Chakravarthy, Aaron R Ducoffe, Paul Butros, James M Horowitz

Heart and Vascular Articles

BACKGROUND: Hemodynamically unstable high-risk, or massive, pulmonary embolism (PE) has a reported in-hospital mortality of over 25%. Systemic thrombolysis is the guideline-recommended treatment despite limited evidence. The FLAME study (FlowTriever for Acute Massive PE) was designed to generate evidence for interventional treatments in high-risk PE.

METHODS: The FLAME study was a prospective, multicenter, nonrandomized, parallel group, observational study of high-risk PE. Eligible patients were treated with FlowTriever mechanical thrombectomy (FlowTriever Arm) or with other contemporary therapies (Context Arm). The primary end point was an in-hospital composite of all-cause mortality, bailout to an alternate thrombus removal strategy, clinical deterioration, and major …

Operative Technique For A Successful Laparoscopic En-Bloc Resection Of Gastrogastric Fistula Following Roux-En-Y Gastric Bypass., Krishna Patel, Jordyn Perdue, Jaya Varre, Vinnie Serapiglia, Anthony Rizzo, Thomas Sonnanstine

Surgery Articles

Gastrogastric fistulas are rare complications following Roux-en-Y gastric bypass surgery and are characterized by a fistulous connection between the gastric pouch and the remnant stomach. The presentation is often variable and a high-index of suspicion must be maintained for accurate and timely diagnosis. In this case report, we provide a detailed review of the technical steps taken to successfully resect a gastrogastric fistula en-bloc laparoscopically with an unremarkable post-operative course.

A Paradoxical Internal Hernia At Brolin's Anti-Obstruction Stitch Following Roux-En-Y Gastric Bypass: A Case Report., Krishna Patel, Vinnie Serapiglia, Anthony N Rizzo, Jaya Varre, Thomas Sonnanstine

Surgery Articles

Internal hernias are a rare but morbid complication following Roux-en-Y gastric bypass surgery. The incorporation of Brolin's anti-obstruction stitch has historically demonstrated a significant reduction in the incidence of internal hernias following Roux-en-Y gastric bypass. We present an ironic and unique case of a patient with small bowel herniation into a defect between Brolin's stitch and the stapled closed common enterotomy of the jejunojejunostomy and technical considerations to decrease internal hernias at this site in the future.

Mild Biceps Tendonitis May Be Managed Nonoperatively During Shoulder Arthroscopy., Jonathan J Light, Wihan Du Plessis, Matthew H Adsit, Alexander T Eckstrom, Amanda B Firoved, Justin W Griffin, Kevin F Bonner

Surgery Articles

PURPOSE: The purposes of this study were to determine whether patients with mild biceps tendonitis required revision surgery after the biceps tendon was not surgically treated, while addressing concomitant pathology, and to evaluate whether preoperative groove pain affected patient-reported outcomes.

METHODS: Patients who underwent shoulder arthroscopy between 2015 and 2018 by a single surgeon for rotator cuff pathology, debridement, and distal clavicular excision (DCE), with or without subacromial decompression (SAD), and where the biceps tendon was not surgically addressed were retrospectively identified. Inclusion criteria were mild LS (< 50% hyperemic appearing biceps tendon arthroscopically), and a minimum 2-year follow-up. The primary outcome measure was the incidence of revision surgery. Secondary outcomes included American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), pain level, and satisfaction scores. Two sample

RESULTS: Sixty-four of 69 eligible subjects (93%) were evaluated at a minimum …

The Diagnostic Process Of Spinal Post-Traumatic Deformity: An Expert Survey Of 7 Cases, Consensus On Clinical Relevance Does Exist, Erin E.A. De Gendt, Lori M. Benneker, Andrei F. Joaquim, Mohammad El-Sharkawi, Gaurav R. Dhakal, Frank Kandziora, Jin Tee, Richard J. Bransford, Emiliano N. Vialle, Alexander R. Vaccaro, Eugen C. Popescu, Rishi M. Kanna, David W. Polly, Klaus J. Schnake, Pedro Berjano, Sergey Ryabykh, Marko Neva, Claudio Lamartina, Dominique A Rothenfluh, Stephan J. Lewis, Sander. P.J Muijs, F. Cumhur Oner

Rothman Institute Papers

STUDY DESIGN: Survey of cases.

OBJECTIVE: To evaluate the opinion of experts in the diagnostic process of clinically relevant Spinal Post-traumatic Deformity (SPTD).

SUMMARY OF BACKGROUND DATA: SPTD is a potential complication of spine trauma that can cause decreased function and quality of life impairment. The question of when SPTD becomes clinically relevant is yet to be resolved.

METHODS: The survey of 7 cases was sent to 31 experts. The case presentation was medical history, diagnostic assessment, evaluation of diagnostic assessment, diagnosis, and treatment options. Means, ranges, percentages of participants, and descriptive statistics were calculated.

RESULTS: Seventeen spinal surgeons reviewed …

The Pornography Industry's Disinformation Campaign On Addiction Recovery Resources, Darryl Mead

Dignity: A Journal of Analysis of Exploitation and Violence

As pornography became increasingly popular online, many unsuspecting consumers reported adverse effects. These included sexual dysfunctions, such as lack of response with real partners, delayed ejaculation, erectile difficulties, and sexual compulsivity. Some pornography consumers began congregating in online self-help portals (forums and websites) to assist one another in quitting or reducing problematic pornography use. The popularity of the self-help resources and their potential to dampen the profits of a lucrative industry resulted in disinformation campaigns run by individuals connected to the pornography industry. In this article, I examine how a paper containing significant inaccuracies about the people organising the online …

Rare Variants Found In Multiplex Families With Orofacial Clefts: Does Expanding The Phenotype Make A Difference?, Kimberly K Diaz Perez, Sydney Chung, S Taylor Head, Michael P Epstein, Jacqueline T Hecht, George L Wehby, Seth M Weinberg, Jeffrey C Murray, Mary L Marazita, Elizabeth J Leslie

Faculty, Staff and Student Publications

Exome sequencing (ES) is now a relatively straightforward process to identify causal variants in Mendelian disorders. However, the same is not true for ES in families where the inheritance patterns are less clear, and a complex etiology is suspected. Orofacial clefts (OFCs) are highly heritable birth defects with both Mendelian and complex etiologies. The phenotypic spectrum of OFCs may include overt clefts and several subclinical phenotypes, such as discontinuities in the orbicularis oris muscle (OOM) in the upper lip, velopharyngeal insufficiency (VPI), microform clefts or bifid uvulas. We hypothesize that expanding the OFC phenotype to include these phenotypes can clarify …

Specialized Astrocytes Mediate Glutamatergic Gliotransmission In The Cns, Roberta De Ceglia, Ada Ledonne, David Gregory Litvin, Barbara Lykke Lind, Giovanni Carriero, Emanuele Claudio Latagliata, Erika Bindocci, Maria Amalia Di Castro, Iaroslav Savtchouk, Ilaria Vitali, Anurag Ranjak, Mauro Congiu, Tara Canonica, William Wisden, Kenneth Harris, Manuel Mameli, Nicola Mercuri, Ludovic Telley, Andrea Volterra

Biomedical Sciences Faculty Research and Publications

Multimodal astrocyte–neuron communications govern brain circuitry assembly and function. For example, through rapid glutamate release, astrocytes can control excitability, plasticity and synchronous activity of synaptic networks, while also contributing to their dysregulation in neuropsychiatric conditions. For astrocytes to communicate through fast focal glutamate release, they should possess an apparatus for Ca2+-dependent exocytosis similar to neurons. However, the existence of this mechanism has been questioned owing to inconsistent data and a lack of direct supporting evidence. Here we revisited the astrocyte glutamate exocytosis hypothesis by considering the emerging molecular heterogeneity of astrocytes and using molecular, bioinformatic and imaging approaches, together with …

Heart Failure Readmissions After Cardiac Surgeries: Navigating The High-Risk Terrain, Waqas Ullah, Indranee Rajapreyar, Yevgeniy Brailovsky

Division of Cardiology Faculty Papers

No abstract provided.

Plasma Metabolomic Profiles Of Plant-Based Dietary Indices Reveal Potential Pathways For Metabolic Syndrome Associations, Fabian Lanuza, Tomas Meroño, Raul Zamora-Ros, Nicola P. Bondonno, Agnetha L. Rostgaard-Hansen, Alex Sánchez-Pla, Berta Miro, Francesc Carmona-Pontaque, Gabriele Riccardi, Anne Tjønneland, Rikard Landberg, Jytte Halkjær, Cristina Andres-Lacueva

Research outputs 2022 to 2026

Background and aims: Plant-based dietary patterns have been associated with improved health outcomes. This study aims to describe the metabolomic fingerprints of plant-based diet indices (PDI) and examine their association with metabolic syndrome (MetS) and its components in a Danish population. Methods: The MAX study comprised 676 participants (55% women, aged 18-67 y) from Copenhagen. Sociodemographic and dietary data were collected using questionnaires and three 24-h dietary recalls over one year (at baseline, and at 6 and 12 months). Mean dietary intakes were computed, as well as overall PDI, healthful (hPDI) and unhealthful (uPDI) scores, according to food groups for …

Disentangling Sex Differences In Ptsd Risk Factors: A Systematic Overview And Multiple Mediation Analysis The The Aurora Study, Stephanie Haering, Antonia V. Seligowski, Sarah Linnstaedt, Vasiliki Michopoulos, Stacey L. House, Francesca Beaudoin, Xinming An, Thomas C. Neylan, Gari Clifford, Robert A. Swor

Articles

No abstract provided.

Increasing Efficiency And Confidence Of Nurse In Admission Of Burn Patient, Tanisha Boodie Bsn, Mph, Jessica Campbell Bsn

Vizient/ AACN Nurse Residency Program™ EBP Projects

No abstract provided.

Rover Wound Care Documentation, Pooja Vachhani Adn, Rn, Rebecca Matz Adn, Rn, Caitlin Coffman Adn, Rn, Kristen Regni Adn, Rn, Kayley Fry Bsn, Rn

Vizient/ AACN Nurse Residency Program™ EBP Projects

No abstract provided.

Blood Culture Contamination, Erin Boyle Rn, Shaneah Cozze Rn, Nicole Costello Bsn, Rn, Kaitlyn O'Brien Bsn, Rn

Vizient/ AACN Nurse Residency Program™ EBP Projects

No abstract provided.

Improving Hiring Practices To Increase Diversity And Equity At An Academic Health Sciences Library, Ruth Bueter, Brian Mcdonald, Jolinda Thompson, Lionel Williams

Himmelfarb Library Faculty Posters and Presentations

No abstract provided.