Medicine and Health Sciences Commons^™

Key Epigenetic And Signaling Factors In The Formation And Maintenance Of The Blood-Brain Barrier, Jayanarayanan Sadanandan, Sithara Thomas, Iny Elizabeth Mathew, Zhen Huang, Spiros L Blackburn, Nitin Tandon, Hrishikesh Lokhande, Pierre D Mccrea, Emery H Bresnick, Pramod K Dash, Devin W Mcbride, Arif Harmanci, Lalit K Ahirwar, Dania Jose, Ari C Dienel, Hussein A Zeineddine, Sungha Hong, Peeyush Kumar T

Faculty, Staff and Student Publications

The blood-brain barrier (BBB) controls the movement of molecules into and out of the central nervous system (CNS). Since a functional BBB forms by mouse embryonic day E15.5, we reasoned that gene cohorts expressed in CNS endothelial cells (EC) at E13.5 contribute to BBB formation. In contrast, adult gene signatures reflect BBB maintenance mechanisms. Supporting this hypothesis, transcriptomic analysis revealed distinct cohorts of EC genes involved in BBB formation and maintenance. Here, we demonstrate that epigenetic regulator's histone deacetylase 2 (HDAC2) and polycomb repressive complex 2 (PRC2) control EC gene expression for BBB development and prevent Wnt/β-catenin (Wnt) target genes …

Training Staff Members And Caregivers On Utilizing Allen Cognitive Levels To Aid Individuals Living With Alzheimer's And Dementia To Maintain Activities Of Daily Living, Kristy Boyd

Student Capstone Papers

This capstone is about training caregivers and staff members on utilizing the Allen Cognitive Levels to help individuals living with Alzheimer's and Dementia to maintain their ADLs.

Chronic Disease Management In A Nurse Practitioner-Led Clinic: An Interpretive Description Study, Natalie Floriancic, Anna Garnett, Lorie Donelle Phd, Rn, Fcan

Publications

Introduction

Objective

The Importance Of Parent And Clinician Stakeholder Input-Guiding The Guidelines On Pediatric Hypertension, Carissa M. Baker-Smith

Department of Medicine Faculty Papers

No abstract provided.

Somethin' I'M Tryin' To Work On, Ian P. Summers

Capstones

A filmmaker tells the story of the night he nearly committed suicide. Traveling from his home in Brooklyn, Ian tells three of his closest friends, Drake, Alec and Matt, about how they unknowingly helped him through the most difficult time in his life.

https://www.youtube.com/watch?v=87iUM31s-Eg

Journey To Baby-Friendly: Standardizing Patient Breastfeeding Education In The Postpartum Microsystem, Emily Korwin

Master's Projects and Capstones

Problem Low breastfeeding rates remain a global challenge and a cause of adverse infant health outcomes despite the benefits of exclusive breastfeeding. In response, UNICEF and the WHO developed the Baby-Friendly Hospital Initiative (BFHI) to promote, protect, and support breastfeeding for infant growth and development. Context Hospital A is a mid-size hospital in Northern California. It has 24 labor, 13 antepartum, and 33 postpartum beds and serves a diverse population of patients. Intervention After a literature review, microsystem assessment, stakeholder survey, and root cause analysis, a standardized infant feeding nurse patient education checklist was developed and aligned with Baby-Friendly teaching …

Msw Portfolio, Andrea E. Anderson

Graduate Student Portfolios, Professional Papers, and Capstone Projects

The portfolio narrative includes a brief introduction to my academic journey including field related work. The ten social work competencies are used as a guide while I reflect on the required appendices, theoretical frameworks and orientation to practice throughout the narrative.

Thyroid And Cardiovascular Diseases, Si̇nem Başak Tan Öksüz, Mustafa Şahi̇n

Turkish Journal of Medical Sciences

The thyroid gland is one of the major regulator organs of hemostasis in the human body, controlling the function of numerous systems. Thyroid hormones exert a modulating effect on particularly cardiovascular system, ensuring optimal functioning within the normal range. Triiodothyronine (T3), as an active form of thyroid hormones, is mainly responsible for this effect via both genomic and non-genomic mechanisms. It has been reported that overt thyroid disorders are associated with a number of cardiovascular diseases and cardiac mortality. While hyperthyroidism appears to be related to atrial fibrillation and heart failure, the most pronounced cardiovascular complication of hypothyroidism seems to …

Practicing Responses To Acute Clinical Troubles: Initiative Through Clinical Education (P.R.A.C.T.I.C.E.) To Improve Medical Emergency Response Increasing Nurse Confidence And Preparedness Through Low-Stakes Clinical Education, Lauren Castelblanco Rn, Viviana Lopez Rn, Nosa Odiase Rn, Everly Pompa Rn

Master's Projects and Capstones

A newly established pediatric outpatient infusion center in Los Angeles does not have immediate access to a Code Blue Team or a Rapid Response Team, and instead relies on the Staff Assist protocol to manage medical emergencies. Via direct interviews, registered nurses at the infusion center report feeling underprepared and lacking confidence to respond to medical emergencies that must be escalated to code blue. Microsystem assessment tools determined the root cause to be limited clinical exposure and limited opportunities for skills development. To address the nurses' concerns, Practicing Responses to Acute Clinical Troubles: Initiative through Clinical Education (P.R.A.C.T.I.C.E.) was implemented …

Journey To Baby-Friendly Designation: Standardizing Infant Feeding Education, Jasmine Geronimo Ibay

Master's Projects and Capstones

Problem The influence of formula companies in hospitals has caused a decrease in national breastfeeding rates, increasing risks of adverse health outcomes among infants. In response, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched the Baby-Friendly Hospital Initiative (BFHI) in 1991 to support breastfeeding practices for infant development and eliminate commercial interests of formula companies from hospitals. Context The quality improvement (QI) project was conducted at Hospital A’s Birth Center, serving a diverse population of patients in the greater East Bay of Northern California. The microsystem has 24 labor beds, 13 antepartum beds, and 33 …

Chronic Disease Screening And Detection In Vulnerable Populations, Courtney J. Seman, Hussein Hadid, Tania Jaimes, Robert Walls

Master's Projects and Capstones

This quality improvement project aims to address gaps in chronic disease screening by implementing standardized protocols for diabetes, hypertension, vision impairment, and scoliosis within the University of San Francisco (USF) Nurse-Led Clinic in Orange County. Problem: The clinic identified a lack of screening practices, which limited early detection and intervention for two specific vulnerable populations. Context: The clinic serves two high-risk groups: older adults, including formerly homeless individuals, and children in two local grade schools. These populations face significant healthcare disparities, making early detection of chronic conditions critical. Interventions: Guided by Kotter’s Change Theory, the project developed and implemented evidence-based …

Improving Anesthesia Technician Workflow: Implementation Of A Standardized Checklist And Formal Handoff Communication Tool To Enhance Management Of The Pediatric Portable Anesthesia Lockers Recommendation, Megan Shayna Sosnick Msel, Rn

Master's Projects and Capstones

Objective: The surgical department of a well-known Bay Area medical center faces substantial challenges in supply management. These challenges include inconsistent stocking, disorganized storage, and an inefficient ordering process. These logistical issues impact patient care negatively, increase supply costs, and weaken team morale and communication. U.S. hospitals spend $83 billion annually on medical supplies, with $25.4 billion wasted on preventable material expenses (Balkhi et al., 2022). Aim and Methods: This quality improvement project aims to train 80% of anesthesia technicians in proper stocking procedures for portable pediatric anesthesia lockers within three months. Interventions include the implementation of a standardized …

Reducing The Incidence Of Nosocomial Aspiration Pneumonia In Adult Oncology Patients Through Improved Compliance With Oral Hygiene Protocols, Rickey Maung

Master's Projects and Capstones

Objective: Oncology patients undergoing chemotherapy are at increased risk of mucosal barrier injuries and aspiration pneumonia, with current aspiration pneumonia rates exceeding target levels. Enhanced oral hygiene protocols and improved compliance have been shown to reduce these complications in this vulnerable population.

Context: The microsystem under review comprises six oncology units within Hospital A, a major medical center in California. Aspiration pneumonia, frequently linked to mucosal barrier injuries, poses a significant threat to patient safety and increases treatment costs and complications in oncology care. Recognizing the critical need to address this issue, an aspiration pneumonia task force has prioritized efforts …

Implementation Of A Food Security Program To Reduce Hypertension At A Primary Care Clinic, Maribel Ballesteros

Master's Projects and Capstones

The food security program aims to reduce hypertension and food insecurity by increasing access to fresh fruits and vegetables. Although food insecurity is a growing public health issue, the food security program experienced significantly low enrollment compared to projected values. The quality improvement project was conducted in an adult medicine department in a primary care clinic in San Francisco serving the Latinx community. To address the issue of low program enrollment, a comprehensive educational food security program flyer was developed containing program information, including frequently asked questions. The flyer aimed to increase program enrollments by increasing program education. Fifty flyers …

Improving Performance And Documentation Of The Bedside Mobility Assessment Tool, Joseph P. Chellew

Master's Projects and Capstones

Objectives: Decreased patient mobility is associated with negative health outcomes including decreased functional capacity, pressure injuries, deep vein thrombosis, and bloodstream infections (Yasmeen et al., 2020). Early and increased mobilization mitigates these complications and is associated with positive outcomes (Wang et al., 2020). The Bedside Mobility Assessment Tool 2.0 (BMAT) is a mobility assessment that guides the selection of equipment to safely mobilize patients (Boynton et al., 2020). Aim: This quality improvement project aims to increase BMAT documentation compliance by 10% in three medical-surgical units at Hospital A where only 31.3% of patients were assessed per day using the BMAT. …

Increasing Access To Fresh Fruits And Vegetables At An Urban Clinic: A Quality Improvement Project, Jordan Michael Leahy

Master's Projects and Capstones

The microsystem setting for this quality improvement project is an adult health unit at one of five safety net clinics housed within a macrosystem in a large urban setting in Northern California serving a low-income, predominantly Hispanic population. Professionals involved in the delivery of the food security program include patient support services, medical assistants, case managers, health promoters, registered nurses, and providers. With enrollment in clinic’s food security program significantly lower than program goals, clinical site stakeholders sought to identify and address gaps in delivery. This quality improvement aimed to improve the screening process to increase the percentage of eligible …

Improving Mood Scores With Social Robot Dog ‘Pupper’ In Pediatric Cardiovascular Patients, Alyssa Lopez

Master's Projects and Capstones

Objective Pediatric hospitalization has been shown to increase the risk of developmental delays, social isolation, and mental health disorders. Consequently, decreased happiness also results from hospitalization, leading to reduced motivation and less engagement in their care. Aim The aim of this project is to improve the mood of pediatric patients aged 3-25 years by 50% from the patient’s baseline level within one month, from October 16, 2024 to November 13, 2024, on a pediatric cardiac step down unit by utilizing a social robot dog to motivate patients in engaging in their care. Methods Twelve participants between the ages 4-18 years …

Implementing Donna Wright’S Competency Model For Enhancing Nursing Professional Development In Pediatric Perioperative Units, Justin C. Chu

Master's Projects and Capstones

Background Hundreds of thousands of deaths occur in hospitals annually due to preventable adverse events. As literature shows nurse competency is positively associated with improved patient outcomes, it is the mission of any healthcare organization to continually improve staff competency. Bay Area Children’s Hospital X is looking to adopt the Donna Wright Competency Model (DWCM) to change the way they approach this process, transitioning from traditional methods of manager-selected competencies to a collaborative, shared governance approach. Objectives Utilizing the DWCM, the project goal is to enhance competencies among 90 nurses in pediatric perioperative units. The ultimate goal is to create …

Sleep To Heal: Creating A Quiet At Night Environment, Victor Marie V. Blardony

Master's Projects and Capstones

Problem: Noise in hospitals disrupts patient well-being, recovery, and satisfaction. A 120-bed community hospital in South San Francisco consistently scored below the national average for nighttime quietness (Medicare, 2023).

Context: Over six months, a multidisciplinary committee launched the Quiet at Night (QAN) Program, focusing on the high-acuity telemetry unit. The program utilized Kotter’s 8 Steps Model and the Institute for Healthcare Improvement Model for Improvement (MFI) to tackle nighttime noise issues.

Interventions: Quiet hours were established from 8:30 p.m. to 6:00 a.m. Patients were provided an “Enhanced Sleep Menu” that included a sleep sound machine and “sleep kits” (eye masks …

Beat The Clock: Improving First Case On-Time Starts (Fcots) In The Ambulatory Surgery Unit (Asu), Myrna M. Bernardo

Master's Projects and Capstones

Abstract

Problem: A local Bay Area hospital Ambulatory Surgery Unit (ASU) strives to maintain the first case on-time starts (FCOTS) at 90%. Optimal FCOTS compliance enhances operating room (OR) efficiency, resource utilization, and patient outcomes. Data from January 2022 to December 2023 shows that ASU’s FCOTS remains at a monthly average rate of 67%. This project focuses on closing the 23% gap by achieving 73% FCOTS compliance in the first quarter to progressively achieve the unit 90% goal or higher.

Context: The five ASU ORs handle a daily volume of 25-35 cases. An interdisciplinary team conducted a root cause analysis …

A Supervised Machine Learning Statistical Design Of Experiment Approach To Modeling The Barriers To Effective Snakebite Treatment In Ghana, Eric Nyarko, Edmund F. Agyemang, Ebenezer Kwesi Ameho, Louis Agyekum, José María Gutiérrez, Eduardo Alberto Fernandez

School of Mathematical & Statistical Sciences Faculty Publications

Background

Snakebite envenoming is a serious condition that affects 2.5 million people and causes 81,000–138,000 deaths every year, particularly in tropical and subtropical regions. The World Health Organization has set a goal to halve the deaths and disabilities related to snakebite envenoming by 2030. However, significant challenges in achieving this goal include a lack of robust research evidence related to snakebite incidence and treatment, particularly in sub-Saharan Africa. This study aimed to combine established methodologies with the latest tools in Artificial Intelligence to assess the barriers to effective snakebite treatment in Ghana.

Method

We used a MaxDiff statistical experiment design …

Parent And Primary Care Clinician Perceptions About Pediatric Hypertension, Abbas H. Zaidi, Erica Sood, Sarah De Ferranti, Samuel Gidding, Varsha Zadokar, Jonathan Miller, Anne Kazak

Department of Pediatrics Faculty Papers

IMPORTANCE: Despite published guidelines and a prevalence of pediatric hypertension of approximately 3%, less than 25% of affected children are identified, with 60% not receiving any intervention despite detection. Understanding the knowledge and perceptions of parents or caregivers and health care teams is crucial to identify factors that may contribute to these unacceptably low detection rates.

OBJECTIVE: To examine the knowledge and perceptions of parents and health care teams regarding pediatric hypertension to identify common themes contributing to low hypertension detection.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study, interviewed parents of children diagnosed with hypertension who did not follow up …

Transforming Care: Elevating Oral Hygiene Compliance To Combat Nosocomial Aspiration Pneumonia In Adult Oncology Patients, Karina Larrea

Master's Projects and Capstones

Objective Aspiration pneumonia is a preventable, yet common complication in oncology patients undergoing chemotherapy, steered by suboptimal compliance with oral hygiene protocols and elevated susceptibility due to mucosal barrier injuries. Despite its major impact on healthcare costs and morbidity, compliance with evidence-based practices remains inadequate. Aim This project aimed to decrease nosocomial aspiration pneumonia rates from 1.5% to 1.3% by enhancing oral hygiene compliance from 41% to 70% over a 12-week period. Methods Proposed interventions included implementing paired oral hygiene order sets into electronic medical records, once-per-shift cues, staggered patient education sessions, and staff education on standardized protocols. Pre-intervention data …

Integrating The Bedside Mobility Assessment Tool (Bmat): Increasing Compliance With Assessments And Charting In Medical Surgical Units, Khaterah Sayed

Master's Projects and Capstones

Objective: Decreased patient mobilization is associated with poor patient recovery and increased hospital costs. Complications include decreased functional capacity, pressure injuries, deep vein thrombosis, and infections. Aim: The Bedside Mobility Assessment Tool (BMAT) is a mobility assessment tool designed to help healthcare providers safely mobilize patients (Boynton et al., 2020). In a 244-bed California hospital, preliminary data from three medical-surgical units indicate an average daily patient census of 23.7 of which only 31.3% were assessed using the BMAT. This quality improvement intervention aims to increase compliance with the BMAT by 10%. Interventions: Over a six-week period, staff received …

Patient-Centered Language During Peripartum Bedside Reports, Krystal H. Nguyen

Master's Projects and Capstones

Problem Using complex medical language that excludes the patient can result in lower patient satisfaction, increased miscommunication, and heightened anxiety for patients. Hospital A’s peripartum mesosystem currently does not have a training on the use of patient-centered language during labor and delivery (L&D) patient transfers to postpartum (PP). Context Hospital A is an urban tertiary care medical center located in the Bay Area, with its peripartum mesosystem consisting of 35 L&D and postpartum beds distributed across two floors. Intervention Through analysis of stakeholder engagement, an ongoing literature review and a mesosystem needs assessment, potential barriers to implement patient-centered language in …

Food Security And Its Impact On Hypertension In Urban Communities, Lauren M. Nobriga

Master's Projects and Capstones

The Quality Improvement Team proposed an intervention to increase enrollment in the Food Security Program, a six-month initiative that provides vouchers redeemable for fruits and vegetables. Long-term impacts of this Program include an improved food economy and enhanced patient disease management autonomy. This project aimed to increase the percentage of eligible adult medicine clinic patients enrolled in the Food Security Program by 25%, or 11 patients per month, based on the mean enrollment for the first four months of the Program (May to August) of nine patients. The intervention was based on bi-monthly performance reports, making the goal include enrolling …

The Impact Of Adverse Childhood Experiences And Allostatic Load On Premature Birth Rates: A Literature Review, Roxane J. Scherek

Master's Projects and Capstones

This paper examines the relationship between Adverse Childhood Experiences (ACEs), allostatic load, and the likelihood of women giving birth prematurely in the United States and Canada. I searched multiple databases exploring this association, identifying nineteen articles published between 2004 and 2024. The literature highlights that racism and discrimination are a cause of chronic stress, and that this stress, and implicit bias, are both implicated in preterm birth. While ACEs scores have been found to be associated with preterm birth, the results for allostatic load are mixed. The results suggest that more attention should be paid to mitigating the stress associated …

Reducing Heart Failure Readmissions Through Standardized Daily 1:1 Education, Neil R. Carlos

Master's Projects and Capstones

Problem: In 2023, a Northern California hospital's Cardiac Procedure Unit (CPU) admitted 100 heart failure patients, with 24 readmissions primarily due to inadequate self-management education. These admissions cost over $8.4 million, highlighting the urgent need for better patient education to reduce readmissions and healthcare expenses.

Context: A quality improvement initiative was launched in the CPU that handles pre- and post-cardiac care, including for heart failure patients. The unit's focus on urgent care and other priorities resulted in insufficient patient education regarding heart failure.

Intervention: From January to June 2024, the initiative implemented daily personalized teach-back education sessions on self-management. These …

Reducing Healthcare-Acquired Pneumonia In A Geriatric Long-Term Care Facility, Jacob R. Magsalin

Master's Projects and Capstones

Problem: Healthcare-acquired pneumonia (HAP) is a nosocomial infection that poses a serious threat in geriatric long-term care facilities due to its high morbidity and mortality.

Context: This evidence-based quality improvement project seeks to reduce the incidence of HAP in a geriatric long-term care facility in the San Francisco Bay Area by utilizing findings

from existing literature.

Interventions: Key interventions include improving and standardizing oral care techniques and promoting education on HAP prevention to allow patients and their families to be more proactive in preventing this complication.

Measures: Outcome measures include HAP diagnosis rates after implementation, any costs saved for the …

Enhancing Communication And Reducing Near Misses Through Comprehensive Handoff Tools At A Residential Nursing Facility, Sabrina Guralnik, Sophia Nguyen, Gabriela Benelyahu, Giselle Peyus

Master's Projects and Capstones

Our quality improvement project at Regina House addresses communication gaps during patient handoffs, which have led to missed or delayed care. The research underscores the critical role of effective communication in patient safety, particularly for vulnerable populations in nursing homes. Current handoff practices at Regina House are inconsistent, especially among Certified Nursing Assistants, resulting in frequent reporting errors and communication disparities.

To enhance patient safety and care continuity, this project introduces a standardized handoff tool and an incident reporting system, aligning with Regina House’s goal of improving care quality. Over three months, CNAs will receive training on the tool, with …