Medicine and Health Sciences Commons^™

Emotional Display Rules Of Deaf Culture, Nicholas M. Gala, Lawrence Pick

JADARA

Emotional display rules refer to the expression of culturally prescribed and socially acceptable emotions across different people and situations (Wu & Schulz, 2020). The display rules among hearing adults across several cultures are well defined and depend on the type of emotion, the individuals involved in the exchange, and the situation. Regarding Deaf culture in the United States, this minoritized group may follow unique display rules (Hosie et al., 2000), but there has been almost no research conducted with this population and the existing studies have focused on youth. The present study explores perceived emotional expressions among a sample of …

Development Of Ecls Transport Checklist, Laura Hatton, Lakshmi Raman, Donna Taylor, Margarita Ramos

2024

QUALITY

Purpose: To develop a tool that will prevent complications related to transporting patients on ECLS thereby improving positive outcomes.

Background: In 2021, a patient on ECLS was transported from the unit to acquire imaging. The usual practice was to obtain an X-ray to confirm cannula placement after a transport. However, the X-ray was not obtained when the patient got back to the unit and unbeknownst to the team, the patient’s cannula had significantly moved despite visualization of intact sutures. The change in cannula position was not discovered until the morning X-ray that was taken several hours later. When the …

Cease The Alarms: A Nurse-Led Bundled Approach To Alarm Management, Annie Tolliver

2024

EBP

Practice Problem:The use of audible alarms to monitor pediatric patients is crucial to patient care. Alarms notify nurses of potentially life-threatening situations. However, increasing non-actionable alarms can cause desensitization. This leads to ignoring and mismanaging alarms, ultimately putting patients at serious risk. For those caring for the sickest pediatric patients, strategies for reducing non-actionable alarms to mitigate alarm fatigue are needed to enhance patient safety.

Literature/Evidence:A review of the literature highlighted emerging evidence-based practice supporting the use of the CEASE bundle for nurse-led alarm management, as outlined in a quasi-experimental research study. Multiple systematic reviews substantiate the …

Mindful Cleanliness: Resetting Expectations For Environmental And Personal Hygiene To Reduce The Clabsi Rate In A Level Iv Nicu, Rebecca Palmer, Kymeyone Lanehart, Jerithea Tidwell, Sushmita Yallapragada, Jeanne Gaines, Courtney Campbell

2024

QUALITY

Background
/="/">CLABSIs place patients at high risk for mortality and morbidity, increasing length of stay, and additional costly and detrimental therapeutic interventions. Our NICU historically had a better than national average CLABSI rate, however, since 2022, our CLABSI rate spiked to above average. During this timeframe the unit experience higher census and acuity leading to increased workload and needs of patients and staff. In 2022, the CLABSI rate spiked from 0.53 in 2021 to 1.04 and 1.12 CLABSIs/1000 line days in 2022 and 2023, respectively.

Methodology
/="/">Utilizing Quality Improvement methodology allowed identification of the root cause of …

Got Questions? Call Us: Utilizing Telephone Triage To Help Pediatric Patients After Discharge, Susan Webber, Ann Gosdin

2024

EBP

Background: Discharge follow-up programs help to reduce avoidable readmissions and unnecessary returns to the emergency department. Our organization lacked a clearly defined post-inpatient discharge process for patients on the hospitalist service. Information on the after-visit summary (AVS) includes follow-up appointment instructions and lists the main hospital phone number. Primary care providers often refer patients back to the hospital for questions related to the hospital stay. Post-discharge follow-up phone calls are labor-intensive, hard to sustain, and may not meet the patient’s needs. We sought a technology solution to assist and engage families post-discharge.

Purpose: This project aims to determine if …

Nicu Team Nursing Model: Purposeful Collaborative For Positive Outcomes, Kymeyone Lanehart, Rebecca Palmer, Jerithea Tidwell, Lisa Mason, Sharica Whitten, Katie Doerge, Sushmita Yallapragada

2024

INNOVATION

Background: In 2013, an elevated CLABSI rate as high as 3.4 indicated that a specialized team approach would be necessary to improve quality care and patient outcomes. Development of a unique blood stream infection (BSI) team, that focused specifically on managing central lines, was successful and later expanded in to focus on other quality metrics. In 2015, the team was re-named safety and quality (SAQ). In 2016, the NICU utilized the team model by developing an internal transport team (ITT) to complete internal transports for procedures. The SAQ and ITT groups merged in 2019 to improve efficiency in the …

Evaluation Of Supplemental Oxygen Use In The Acute Care Cardiology Unit And Opportunities For Standardizing Practice, Melanie Walsh, Alexandra Birely, Sarah Mahmalji, Sonali S. Patel

2024

RESEARCH

Purpose:
Oxygen delivery via nasal cannula is a standard therapy in hospitalized pediatric patients; however, it can have adverse effects in certain populations, such as infants with cardiac shunting physiology1,2. An oxygen-air blender can be used via standard nasal cannula to provide the lowest amount of fraction of inspired oxygen (FiO2) in order to reduce harm2. A recent Pediatric Acute Care Cardiology Collaborative (PAC3) Hospital Survey indicates that 88% of participating acute care cardiology units (ACCU) provide blended oxygen to patients, however, indications for use are not well-established3,4. A local ACCU nursing staff survey revealed mixed use of blended …

Timeliness Of “Red Event” Reviews: Optimizing “Cardiac-Multidisciplinary Assessment Of Performance” (C-Map) Rounds With Morbidity And Mortality Review, Andrea Torzone, Glenda Moate, Linn Groom, Mary Hart, Erin Hunter-Mcphan, Christa Conley, Kimberly Moore, Sarah Zoretic, Priya Bhaskar, Nicholas Andersen, Ryan Butts, Yousef Arar

2024

QUALITY

Background:
/="/">Review of Morbidity and Mortality (M&M) events within Heart Centers (HC) is critical for improving patient care. Timely review is important to maintain transparency and accuracy in recall and produce actionable items to reduce the likelihood for similar occurrences. Cardiac-Multidisciplinary Assessment of Performance (C-MAP) rounds and M&M Selection Committee were initiated July 2020 to review surgical patient outcomes, team performance, and events deviating from expected course. M&M selection committee consists of physicians, advanced practice nurses, and quality improvement consultants to determine patients appropriate for review at M&M conference. We aim to analyze timeliness of review following patient …

Exploration Of Central Venous Catheter Protective Devices In The Pediatric Population: A Mixed Methods Study, Lindsey Flores, Quineka Smith, Maria Leal, Melissa Ruffini

2024

RESEARCH

Purpose:
/="/">In the pediatric population, about 25% of the catheters are reported to have issues such as CLABSI, line dislodgement, contamination, or catheter breaks. The primary purpose of this study is to explore caregiver and nurse satisfaction of pediatric patients with CVCs that utilize a wearable protective device with specific aims to determine parent’s perception of the feasibility while wearing the device. Wearable devices are an extra measure utilized among pediatric patients for nurses and parents to further protect the CVC dressing and catheter from complications. A single site study found that utilizing a wearable device reduced line …

New Approach To Professional Governance In Ambulatory, Brittney Saldierna, Katelyn Tinkey, Diana Sarmiento

2024

INNOVATION

Shared Governance Committees have involved frontline staff in driving change for many years. However, they often involve significant input from leaders, making frontline staff feel like their opinions don't matter as much. Professional Governance Committees emphasize that frontline staff should be the primary drivers of change without significant influence from leaders. Leaders should focus on removing barriers to the frontline staff's vision and ensuring that all changes comply with policies and regulations.

This Ambulatory System has created a unique structure in which the Ambulatory Council (AC) is the overarching structure for nine other councils. These councils meet monthly and …

High Reliability Pediatric Heart Centers: Always Working Toward Getting Better, Andrea Torzone, Alexandra Birely

2024

QUALITY

Background
As provision of care reaches a new complexity in pediatric cardiology, programs are called upon to evaluate how they can bring their teams into the future of pediatric cardiac care. High reliability principles support high-quality care and improve outcomes, thus should be embraced to guide continuous improvement. Although much has been written about high reliability in healthcare, it has not been explored within pediatric heart centers. The purpose of this review is to examine high reliability through the lens of a contemporary pediatric heart center, elaborating on key concepts and proposed considerations for maintaining a high reliability heart …

Management Of Failure To Thrive In An Infant With Unrepaired Congenital Heart Disease: A Case Study On Energy And Nutrient Dense Formula, Alexandra Birely, Sarah Dundas

2024

EBP

Introduction: Infants with congenital heart disease (CHD) are at risk for malnutrition and failure to thrive (FTT). Preoperative nutritional status impacts postoperative outcomes; thus nutrition should be optimized before surgery. Unrepaired infants have higher energy requirements & fluid restrictions, posing challenges in promoting growth for surgery. Energy and nutrient-dense formula has successfully treated FTT in the postoperative phase, however, evidence is limited in unrepaired infants.

Case Description: The case presented is a 4-month ex-36 week infant, past medical history significant for CHD with large ventricular septal defect (VSD), atrial septal defect (ASD), pulmonary stenosis and solitary kidney. Following discharge …

Rise Of The New Grad: Early Engagement Of New Graduate Nurses In Professional Governance, Annie Tolliver, Katie Fields

2024

INNOVATION

Background: Traditionally, new graduate nurses (GNs) are advised to gain experience before participating in Nursing Professional Governance (NPG). NPG is a structure that empowers nurses to be decision-makers regarding the nursing practice environment. We identified GNs had minimal knowledge of and engagement in NPG. An innovative process was developed to involve GNs in NPG, challenging the traditional approach.

Literature: Substantial evidence supports that nurses engaged in NPG are empowered to make decisions, leading to better patient outcomes and increased professional satisfaction. Research shows GNs’ dedication and professional satisfaction are tied to their ability to embed into the organizational culture …

Owning Your Practice Through Evidence-Based Practice (Ebp) - Transformational Leadership Strategies That Create The Foundation For Ebp Enculturation, Sara Moore, Kathleen Ellis, Zara Sajwani-Merchant, Lindsey Patton

2024

INNOVATION

Background: Nursing Research and Evidence-Based Practice (NREBP) is central to advancing nursing science and integrating nursing practices supported by scientific inquiry to improve health outcomes and quality of care^1,4. The gap between what nurses know and what they do can have life-altering consequences^2,7 . The degree to which nurses base their practice behaviors on research, EBP competence, and use of EBP skills is sub-optimal and is directly influenced by organizational and institutional barriers³. Common barriers to implementing EPB behavior change include organizational culture, leadership, networks and communication, resources, evaluation, monitoring and feedback, and availability …

Midline Catheter Implementation: Expanding Vascular Access Options In A Level Iv Nicu To Decrease Vascular Injury, Kymeyone Lanehart, Rebecca Palmer, Jeri Tidwell, Sushmita Yallapragada, Courtney Campbell, Lebanon David, Katie Doerge

2024

EBP

Background: PIV catheters are the most placed device in the NICU requiring frequent attempts, with a brief duration due to complications which indicate removal before completion of treatment. PIVs used for treatment have a patient safety risk of PIVIE; the severity can be mild, moderate, or severe depending on the swelling and tissue damage. PIVIE rates are one of the patient quality outcomes and are increasing in the NICU. Considering the increased risks of long-term consequences from tissue injury associated with PIVs, MCD may improve quality and patient outcomes.

Problem: PICOT question: (P)For eligible neonates in a level IV …

Optimized Pain Management Protocol For Pediatric Needlestick Procedures: Boosting Team Coordination And Pain Relief, Dhanu N. Bhandari

2024

EBP

PICOT Question:Among clinical staff in the Integrated Therapy Unit (ITU), how does the implementation and education of a standardized set of topical anesthetic agents affect staff consistency with the new pain management procedure over six months compared to existing inconsistent practices?

Background:Effective pain management during pediatric needlestick procedures is critical but often neglected, leading to immediate distress and long-term issues like needle phobia. Research shows that proper pain management not only reduces pain but also improves patient satisfaction and clinical outcomes. However, inconsistent use of strategies like topical anesthetics has hindered optimal care. This project aimed to …

Administration Of Naxitamab In High-Risk Neuroblastoma Patients To Manage Adverse Reactions, Lauren Brown, Nikki Marshall, Diamond Wright

2024

INNOVATION

Neuroblastoma is the most common extracranial solid tumor in children with approximately 700 cases diagnosed yearly. Children treated with traditional therapies experience a recurrence rate over 50%, increasing the chances of poor clinical outcomes. Integrating anti-disialoganglioside-2 (GD2) monoclonal antibodies like Naxitimab have significantly improved patient outcomes. However, there is no standardized process between pediatric institutions to administer the drug while managing adverse drug reactions. Naxitimab received accelerated approval from the US Food and Drug Administration for children over age one with relapsed/refractory high-risk Neuroblastoma. Approximately half of the patients receiving Naxitimab encountered acute adverse events (AEs). Different institutions manage …

Exploration Of Decedent Care Practices Among Pediatric Hospitals In The United States, Mayra Garcia, Kim Mccarthy, Kiele Samuel, Kathleen Ellis, Lisa Jones, Joe Don Cavender, Ryan Campbell, Chelsea Reynolds, Jesse Leos, Pauline Chen

2024

RESEARCH

Purpose:
Pediatric deaths in hospitals profoundly affect both staff and families, underscoring the need for clear decedent care processes and specialized training to navigate emotional and procedural challenges. Cooling rooms and reflection spaces, which provide families with more time for memory-making and help ease the emotional burden of separation, have been shown to offer significant support. However, these facilities are less common in the U.S., highlighting the necessity for further research in this area. The purpose of this study was to explore the decedent care (DC) practices in pediatric hospitals in the United States.

Methods:
Participants were recruited via …

From Identification To Action: Nurses Respond To Human Trafficking, Misty Daugherty, Jill Hanks, Alison Kell, Annie Tolliver, Katie Fields, Lily Velez

2024

INNOVATION

Background: In 2022, nurses from a pediatric healthcare system hosted a Human Trafficking Conference to educate healthcare providers on the identification of human trafficking victims. In post-conference surveys, participants reported a gap in their ability to respond once a human trafficking victim was identified. The conference planning committee reconvened in 2023 to address this gap and shifted from a didactic presentation to application and simulation.

Purpose: Research shows in our home state, there are about 313,000 people being trafficked, up to 50% of them being youth. It is estimated that up to 88% of human trafficking victims encounter healthcare …

The Use Of Storybook Implementation For Patient Education Tools, Jennifer Brown

2024

EBP

Practice Problem: For children with growth delay and their parents, how can implementation of storybooks with images, compared to disease specific handouts, increase understanding and knowledge of the disease and treatment as well as decrease anxiety? It was identified that parents and patients coming to the Endocrine Clinic for growth delay, did not always fully understand the reasons for the growth evaluation or causes of growth delay.

Literature/Evidence: Literature was retrieved, appraised, and synthesized to define best practices to create storybooks. Best practices included, using storybooks that include images, co-creation with intended audience. Using storybooks for patient education …

Understanding Necrotizing Enterocolitis Endotypes And Acquired Intestinal Injury Phenotypes From A Historical And Artificial Intelligence Perspective., Alain Cuna, Navin Kumar, Venkatesh Sampath

Manuscripts, Articles, Book Chapters and Other Papers

Necrotizing enterocolitis (NEC) remains a devastating disease in preterm and term neonates. Despite significant progress made in understanding NEC pathogenesis over the last 50 years, the inability of current definitions to discriminate the various pathophysiological processes underlying NEC has led to an umbrella term that limits clinical and research progress. In this mini review, we provide a historical perspective on how NEC definitions and pathogenesis have evolved to our current understanding of NEC endotypes. We also discuss how artificial intelligence-based approaches are influencing our knowledge of risk-factors, classification and prognosis of NEC and other neonatal intestinal injury phenotypes.

Molecular Targets For Breast Cancer Therapy, Hamidreza Montazeri Aliabadi

Pharmacy Faculty Articles and Research

"Breast cancer is by far the most common cancer in women, and for a while, it surpassed lung cancer as the most diagnosed cancer, regardless of gender, in 2020 [1]. Chemotherapy and hormone therapy are still the first line of treatment, despite extensive research in molecularly targeted drugs. Therefore, triple negative breast cancer (TNBC) is still known as the most challenging type for treatment due to the limited identified targets. Inherent and acquired resistance are still major hurdles in breast cancer therapy, which further highlights the importance of identifying new molecular targets in this battle. The inherent resistance of unresponsive …

Integrating Data-Driven And Mechanism-Driven Modeling In Drug Discovery And Hepatotoxicity Evaluation, Xuelian Jia

Theses and Dissertations

The pharmacological activities and hepatotoxicity significantly influence the success or failure of new drugs during drug discovery and development. Traditional experimental methods, such as animal models, are costly and time-consuming for chemical testing. There is a great need to develop in vitro and computational modeling to help identify the pharmacological activities and hepatotoxicity potential in the early stage of drug discovery and safety evaluation. In this dissertation, new computational models and associated modeling frameworks were described for predicting the biological profile and hepatotoxicity of chemicals. Firstly, a novel data mining and Quantitative Structure-Activity Relationship (QSAR) workflow was developed to construct …

Ao Spine-Dgou Osteoporotic Fracture Classification System: Internal Validation By The Ao Spine Knowledge Forum Trauma, Julian Scherer, Andrei Joaquim, Alex Vaccaro, Rishi Kanna, Mohammad El-Sharkawi, Masahiko Takahata, Mohamed M. Aly, Gaston Camino-Willhuber, Ulrich Spiegl, Cumhur Oner, Jose A. Canseco, Ratko Yurac, Lorin Michael Benneker, Eugen Cezar Popescu, Richard Bransford, Harvinder Cezar Chhabra, Frank Kandziora, Marko H. Neva, Klaus John Schnake

Rothman Institute Papers

Study Design: Cross-sectional survey.

Objectives: Injury classifications are important tools to identify fracture patterns, guide treatment-decisions and aid to identify optimal treatment plans. The AO Spine-DGOU Osteoporotic Fracture (OF) classification system was developed, and the aim of this study was to assess the reliability of this new classification system.

Methods: 23 Members of the AO Spine Knowledge Forum Trauma participated in the validation process. Participants were asked to rate 33 cases according to the OF classification at 2 time points, 4 weeks apart (assessment 1 and 2). The kappa statistic(κ) was calculated to assess inter-observer reliability and intra-rater reproducibility. The …

Doctors’ Day Celebration And Integration Of Homoeopathy With Mainstream Healthcare, Subhash Kaushik

Indian Journal of Research in Homoeopathy

National Doctors' Day is observed in India on July 1st to commemorate the birth and death anniversary of Bharat Ratna Awardee, Dr. Bidhan Chandra Roy, a distinguished physician, freedom fighter, and former Chief Minister of West Bengal, India . This year’s theme for National Doctors' Day was, "Healing Hands, Caring Hearts," highlights the commitment, compassion, and empathy that doctors bring to their practice, underscoring their vital role in saving and enhancing lives. Practised for over a century in India, Homoeopathy has long been known for its role in enhancing the lives of people, in terms of gentle, holistic healing and …

Homoeopathy In Bipolar Affective Disorder: A Review Of Research Evidence, Deepthi Gilla, K.P. Deepak, Sreeja Kr Nair, K.C. Muraleedharan

Indian Journal of Research in Homoeopathy

Background: Bipolar affective disorder (BPAD) is an episodic, chronic psychiatric disorder characterized by fluctuations in mood state and energy. It affects more than 1% of the world’s population. BPAD causes cognitive and functional impairment and raised mortality, particularly death by suicide. At present, although alternative therapies are not the first-line treatment of mood disorders, there is emerging evidence showing that such treatments are effective. Objective: The objective of this review is to synthesize existing research evidence and literature to determine the usefulness of homoeopathic medicines in the management of manic and depressive episodes of BPAD. Materials and Methods: Two authors …

Stability Study Of Homoeopathically Potentised Arsenicum Album In Hydrolytic Amber Glass Class Ii And High-Density Polyethylene Terephthalate Over Twelve Months, Marcia Pietroluongo, Thiago Frances Giuimarães, Thais De Barros Fernandes, Ana Paula Dos Santos Matos, Fortune Homsani, Adriana Passos Oliveira, Alessandra Lifsitch Viçosa, Carla Holandino Quaresma

Indian Journal of Research in Homoeopathy

Background: The Brazilian Homoeopathic Pharmacopoeia (BHP) recommends using glass amber Type I, II, or III as a primary container for storing homoeopathic liquid medicines. Although the glass has advantages, there are some disadvantages, such as fragility, weight, and the presence of silicate particles, which have been described as critical components involved with the generation of silicon microparticles detected in homoeopathic solutions. Objectives: The present study aimed to investigate the stability of hydroalcoholic solutions of Arsenicum album dynamised in two different vials: class II hydrolytic amber glass and amber high-density polyethylene terephthalate (PET). Materials and Methods: Two potencies of the Arsenicum …

A Pragmatic, Open-Label Study To Evaluate The Response Of Homoeopathic Treatment In Vitiligo, Divya Taneja, Renu Mittal, R. Bhuvaneswari, Akshaya Kumar Prusty, P. S. Chakraborty, Bharti Wadhwa, Lipipushpa Debata, Ashish P. Shivadikar, Nidhi Mahajan, Vaishali Shinde, Uttam Singh, Siva Prasad Goli, Renu Bala, Pooja Kumari, Anil Khurana, Raj Kumar Manchanda

Indian Journal of Research in Homoeopathy

Background: Homoeopathy is commonly used by patients suffering from vitiligo. The treatment response needs to be assessed on standardised scales in pragmatic settings. Objective: The study aimed to evaluate response to homoeopathic treatment in vitiligo severity and quality of life using the vitiligo area scoring index (VASI) score, Vitiligo European Task Force (VETF) score and dermatological life quality index (DLQI) score. Materials and Methods: This study was undertaken in dermatology outpatient departments at 11 research institutes of the Central Council for Research in Homoeopathy. Participants, in the age group 18–60 years, any gender, presenting with at least one vitiligo skin …

Polycystic Ovarian Syndrome And Homoeopathic Management: A Case Series, Padmalaya Rath, Priya Gautam, Amiyananda Dev Goswami, Shib Narayan Jana

Indian Journal of Research in Homoeopathy

Introduction: Polycystic ovary syndrome (PCOS) is a disorder of chronically abnormal ovarian function and hyperandrogenism (abnormally elevated androgen levels). It is manifested by irregular menstrual cycles, polycystic ovaries, acne, excess unwanted hair growth, obesity, etc. PCOS can affect a female’s fertility. The global prevalence of PCOS varies from 5% to 18%, with an average prevalence of 276·4 cases per 100,000 people in Europe. The prevalence of PCOS in India ranges from 3.7 to 22.5% depending on the population studied. Case Summary: This is a case series of five patients suffering from PCOS, assessed on the basis of intermenstrual duration, acne …

Ichthyosis Vulgaris Successfully Treated With Individualised Homoeopathic Medicine Dulcamara 200c – An Evidence-Based Case Report, Lalith Singh, Raja Manoharan, Sukanya Mitra, Rajib Purkait

Indian Journal of Research in Homoeopathy

Introduction: Ichthyosis vulgaris (IV) is a hereditary condition that often manifests in infancy but can also exist from birth. It is a recalcitrant disorder relapses often and even shows the least response to various therapeutic options. Extensive literature review have revealed a dearth of appropriate evidence-based documentation on treatment of ichthyosis in Homoeopathy. Case Summary: This is a case of IV in a 20-year-old male, manifested as widespread scaling and itching since childhood. Following homoeopathic principles, Dulcamara 200C was prescribed. Outcome related to impact on daily living (ORIDL) scale was used to evaluate the patient-reported outcome measure subjectively, and the …