Medicine and Health Sciences Commons^™

Executive Summary: Driving The Southern Nevada Health Economy Forward, Tripp Umbach

Policy Briefs and Reports

The University of Nevada, Las Vegas (UNLV) plans to develop an integrated academic health center within the Las Vegas Medical District (LVMD).1 The academic health center includes UNLV’s five health science schools and mental and behavioral health, which is distributed among several colleges (medicine, liberal arts, urban affairs, and education) in the university. University Medical Center (UMC), a major teaching hospital, will also be an important driver of the academic health center. For the purposes of this report, UNLV’s medical and health science entities along with UMC are referred to collectively as the UNLV Academic Health Center.

Driving The Southern Nevada Health Economy Forward: Benefits Of A Transformational Unlv Academic Health Center, Tripp Umbach

Policy Briefs and Reports

The University of Nevada, Las Vegas (UNLV) plans to develop an integrated academic health center within the Las Vegas Medical District (LVMD). The academic health center includes UNLV’s five health science schools and mental and behavioral health, which is distributed among several colleges (medicine, liberal arts, urban affairs, and education) in the university. University Medical Center (UMC), a major teaching hospital, will also be an important driver of the academic health center. For the purposes of this report, UNLV’s medical and health science entities along with UMC are referred to collectively as the UNLV Academic Health Center. Additional academic health …

Differential Patterns And Outcomes Of 20.6 Million Cardiovascular Emergency Department Encounters For Men And Women In The United States., Zahra Raisi-Estabragh, Ofer Kobo, Ayman Elbadawi, Poonam Velagapudi, Garima Sharma, Renee P Bullock-Palmer, Steffen E Petersen, Laxmi S Mehta, Waqas Ullah, Ariel Roguin, Louise Y Sun, Mamas A Mamas

Division of Cardiology Faculty Papers

Background We describe sex-differential disease patterns and outcomes of >20.6 million cardiovascular emergency department encounters in the United States. Methods and Results We analyzed primary cardiovascular encounters from the Nationwide Emergency Department Sample between 2016 and 2018. We grouped cardiovascular diagnoses into 15 disease categories. The sample included 48.7% women; median age was 67 (interquartile range, 54-78) years. Men had greater overall baseline comorbidity burden; however, women had higher rates of obesity, hypertension, and cerebrovascular disease. For women, the most common emergency department encounters were essential hypertension (16.0%), hypertensive heart or kidney disease (14.1%), and atrial fibrillation/flutter (10.2%). For men, …

Predicting At-Risk Opioid Use Three Months After Ed Visit For Trauma: Results From The Aurora Study, Brittany E. Punches, Uwe Stolz, Caroline E. Freiermuth, Rachel M. Ancona, Samuel A. Mclean, Stacey L. House, Francesca L. Beaudoin, Xinming An, Jennifer S. Stevens, Donglin Zeng, Thomas C. Neylan, Gari D. Clifford, Tanja Jovanovic, Sarah D. Linnstaedt, Laura T. Germine, Kenneth A. Bollen, Scott L. Rauch, John P. Haran, Alan B. Storrow, Christopher Lewandowski, Paul I. Musey Jr., Phyllis L. Hendry, Sophia Sheikh, Christopher W. Jones, Michael C. Kurz, Nina T. Gentile, Meghan E. Mcgrath, Lauren A. Hudak, Jose L. Pascual, Mark J. Seamon, Erica Harris, Anna M. Chang, Claire Pearson, David A. Peak, Roland C. Merchant, Robert M. Domeier, Niels K. Rathlev, Brian J. O'Neil, Leon D. Sanchez, Steven E. Bruce, Robert H. Pietrzak, Jutta Joormann, Deanna M. Barch, Diego A. Pizzagalli, Jordan W. Smoller, Beatriz Luna, Steven E. Harte, James M. Elliott, Ronald C. Kessler, Kerry J. Ressler, Karestan C. Koenen, Michael S. Lyons

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use.

METHODS: Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed …

Hospital Nursing Factors Associated With Decreased Odds Of Mortality In Older Adult Medicare Surgical Patients With Depression, Aparna Kumar, Douglas Sloane, Linda Aiken, Matthew Mchugh

College of Nursing Faculty Papers & Presentations

Background: Depression is common, costly, and has deleterious effects in older adult surgical patients. Little research exists examining older adult surgical patient outcomes and depression and the potential for nursing factors to affect these outcomes. The purpose of this study was to determine the relationship between hospital nursing resources, 30-day mortality; and the impact of depression on this relationship.

Methods: This was a retrospective cohort study employing a national nurse survey, hospital data, and Medicare claims data from 2006-2007. The sample included: 296,561 older adult patients, aged 65-90, who had general, orthopedic, or vascular surgery in acute care general hospitals …

Effect Of Wearing Masks In The Hospital On Patient-Provider Interaction: “They (Providers) Need To Stay Safe For Their Family And Keep Us Safe.”, Jana L. Wardian, Mikayla Peralta, Chad Vokoun, Sarah E. Richards

Patient Experience Journal

Since March 2020 when the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic was widespread in the U.S., masks became a primary form of protection for healthcare workers when caring for patients. While wearing masks was not a new phenomenon in the health field, there is little known on how the use of them affects the patient-provider relationship. This study explored the experience of wearing masks on the patient-provider relationship in the hospital. This qualitative study involved interviews with both providers and patients at an academic hospital in the Midwest. At the time of this study, in July 2021, hospital …

Emergency Department Communication In Persons Living With Dementia And Care Partners: A Scoping Review, Christopher R Carpenter, Jesseca Leggett, Fernanda Bellolio, Marian Betz, Ryan M Carnahan, David Carr, Michelle Doering, Jennie Chin Hansen, Eric D Isaacs, Deborah Jobe, Kathleen Kelly, Nancy Morrow-Howell, Beth Prusaczyk, Bob Savage, Joe Suyama, Allan S Vann, Kristin L Rising, Ula Hwang, Manish N Shah

Department of Emergency Medicine Faculty Papers

OBJECTIVES: To synthesize published research exploring emergency department (ED) communication strategies and decision-making with persons living with dementia (PLWD) and their care partners as the basis for a multistakeholder consensus conference to prioritize future research.

DESIGN: Systematic scoping review.

SETTINGS AND PARTICIPANTS: PLWD and their care partners in the ED setting.

METHODS: Informed by 2 Patient-Intervention-Comparison-Outcome (PICO) questions, we conducted systematic electronic searches of medical research databases for relevant publications following standardized methodological guidelines. The results were presented to interdisciplinary stakeholders, including dementia researchers, clinicians, PLWD, care partners, and advocacy organizations. The PICO questions included: How does communication differ for …

Predictor Of Hospital Closure In The United States, Haniyeh Shariatmadari

UNLV Theses, Dissertations, Professional Papers, and Capstones

Hospital closures have recently been more common and a crucial concern in the United States since they can influence many aspects of patients' health conditions. This situation has led many scholars to investigate the adverse effect of hospitals closure. Previous research has well documented the effects of a hospital closure. However, there is a lack of studies on the predictor of a hospital closure. To fill this gap, the objective of this longitudinal study is to explore organizational and market factors associated with hospital closure. We used Data from the American Hospital Association (AHA), the Centers for Medicare and Medicaid …

Patterns And Predictors Of Smoking By Race And Medical Diagnosis During Hospital Admission: A Latent Class Analysis, Amanda M. Palmer, Benjamin A. Toll, Georges J. Nahhas, Kayla Haire, Brandon T. Sanford, Kenneth Micheal Cummings, Alana M. Rojewski

Health Behavior Research

Hospital-based tobacco treatment programs provide tobacco cessation for a diverse array of admitted patients. Person-centered approaches to classifying subgroups of individuals within large datasets are useful for evaluating the characteristics of the sample. This study categorized patients who received tobacco treatment while hospitalized and determined whether demographics and smoking-related health conditions were associated with group membership. Chart review data was obtained from 4854 patients admitted to a large hospital in South Carolina, USA, from July 2014 through December 2019 who completed a tobacco treatment visit. Smoking characteristics obtained from the visit interview were dichotomized, and then latent class analysis (LCA) …

Decreasing Hospital Readmission With Post-Hospital Discharge Primary Care Clinic Appointments, David Snodgrass

Doctoral Projects

ABSTRACT

The Centers for Medicare and Medicaid Services (CMS) continue to apply costly financial penalties for hospital readmission. Hospital readmission can stem from multiple causes which can lead to poor health outcomes or increased healthcare financial costs. However, with the use of an implemented 14-day post-hospital follow-up appointment with a primary care provider, hospital readmission could be reduced, and patient care improved. The multiple factors that can lead to hospital readmission include non-adherence to medication, socioeconomic factors, patient-related factors, condition-related factors, or health system-related factors. Through the implementation of post-hospital discharge follow-up visits within 14 days of discharge, hospital readmissions …

Comparison Of Hemodynamic Responses Between Conventional And Virtual Reality Therapies In Patients With Heart Failure Admitted To An Emergency Room, Angélica Bologna Raposo, Alice Haniuda Moliterno, João Pedro Lucas Neves Silva, Rafael Varago Favri, Ana Paula Coelho Figueira Freire, Francis Lopes Pacagnelli

All Faculty Scholarship for the College of Education and Professional Studies

This study aimed to evaluate and to compare the acute response, due to semi-immersive virtual reality (VR) and conventional therapies (CT), of hemodynamic parameters in hospitalized individuals admitted to an emergency unity for heart failure (HF). This is a viability study with 11 individuals subjected to sessions with and without VR. At CT, stretching, active or active-assisted exercises, and fractional inspiration were performed. In VR therapy (VRT), VR box glasses were used to promote VR relaxation associated with CT. The hemodynamic parameters evaluated were heart rate, systolic and diastolic blood pressure, oxygen saturation, and double product. To analyze them, Student’s …

Disruption Of Library Services Due To Hospital Cyberattack: A Case Study, Alice Stokes

University Libraries Faculty and Staff Publications

Cyberattacks on healthcare organizations increased dramatically in 2020 and 2021. The University of Vermont Medical Center suffered an attack in October 2020, during the second wave of the COVID-19 pandemic. The disruption to hospital computer systems had wide ranging impacts, including loss of online access to the medical library for nearly three months. Library staff worked to reduce impacts and increase access for hospital employees until full access was restored. This case study offers lessons learned and resources for health sciences libraries planning for a potential cyberattack.

The Use Of Patient Experience Data For Quality Improvement In Hospitals: A Scoping Review, Lauren Cadel, Michelle Marcinow, Harprit Singh, Kerry Kuluski

Patient Experience Journal

In this paper we identified what was reported in the literature on qualitative and quantitative approaches used to capture and improve patient experiences in a hospital setting. For inclusion, articles were required to describe an embedded strategy for capturing patient experiences that was used to inform quality improvement in a hospital setting. Articles also had to be published in English between January 2004 and December 2020. Six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Health and Psychosocial Instruments and Cochrane Library) and grey literature (relevant hospital and government websites) were searched. All articles were screened by two reviewers and any disagreements were …

Promotion Of Covid-19 Va(X)Ccination In The Emergency Department-Procovaxed: Study Protocol For A Cluster Randomized Controlled Trial., Robert M Rodriguez, Kelli O'Laughlin, Stephanie A Eucker, Anna Marie Chang, Kristin L. Rising, Graham Nichol, Alena Pauley, Hemal Kanzaria, Alexzandra Gentsch, Cindy Li, Herbie Duber, Jonathan Butler, Vidya Eswaran, Dave Glidden

Department of Emergency Medicine Faculty Papers

Background: We conducted in-depth interviews to characterize reasons for COVID-19 vaccine hesitancy in emergency department (ED) patients and developed messaging platforms that may address their concerns. In this trial, we seek to determine whether provision of these COVID-19 vaccine messaging platforms in EDs will be associated with greater COVID-19 vaccine acceptance and uptake in unvaccinated ED patients.

Methods: This is a cluster-randomized controlled trial (RCT) evaluating our COVID-19 vaccine messaging platforms in seven hospital EDs (mix of academic, community, and safety-net EDs) in four US cities. Within each study site, we randomized 30 1-week periods to the intervention and 30 …

Domestic Violence And Abuse In The Healthcare Setting, Madison Garrett, Michaela Franklin, Tiffany Gragg, Nicholas Stuckwish

Epsilon Sigma at-Large Research Conference

Introduction and Background: Domestic violence and abuse (DVA) is a growing global concern that affects patients encountered by nurses. DVA is defined as anything that is used to establish and maintain control over another person. The occurrence of DVA has ongoing negative consequences for patients related to their safety, especially if nurses are not properly trained to detect and control the situation.

Purpose Statement: For all registered nurses, does ongoing training opportunities and implemented universal screening processes on DVA, as compared to inadequate training and generalized screening processes, lead to effectively detecting DVA and providing better emotional, physical, and safety …

Knowledge And Practices Regarding Standard Precautions For Infection Control Among Nurses Working At A Public, Tertiary Care Hospital Islamabad, Pakistan, Samina Yasmeen, Tazeen Saeed Ali, Wardah Khalid, Zohra Kurji, Shair Muhammad Hazara, Shahzad Bashir

School of Nursing & Midwifery

Introduction: To protect patients and healthcare providers from healthcare-associated infections (HAIs), standard precautions have been promoted universally. Nurses are the forefront force in patient care; therefore, evidence-based and up to date knowledge and practices can play a vital role in helping nurses apply standard precautions (SPs).
Methods: The analytical cross-sectional study design was used. Through purposive sampling, the data were collected from 320 nurses, via, a self-administered questionnaire, from April to May 2017, from a public tertiary level hospital in Islamabad. The validity and reliability of each section was established. Mean and standard deviation were computed for continuous variables’ whereas; …

Basal-Plus Insulin Regimen: Helping Patients With Diabetes Mellitus Type 2 To Maintain Blood Glucose Levels During Hospitalization, Marcia Watts Hammons

Cohort X

Diabetes mellitus type 2 (DM2) patients are at risk of episodes of fluctuating blood glucose levels when in the hospital. On admission at the target practice site, the home dose of oral hypoglycemic medication is typically stopped and replaced with sliding-scale insulin therapy. Hyperglycemia among the hospital population of DM2 patients is common, causing delayed healing times, increased length of stay, increased costs, and other medical detrimental factors. A doctor of nursing practice project was based on the findings from a randomized controlled trial of a basal-plus insulin protocol that lowered the mean blood glucose level for noncritically ill hospitalized …

Sleep Disruptions Within The Hospital, Faith Walls

Senior Honors Theses

The circadian rhythm is a complex and interwoven system within each human being that creates an internal clock each day. However, patients in all hospital settings continue to have their sleep disrupted by many factors. Seep being disrupted in the hospital patients can develop serious complications. To this day, the issues causing have not been adequately assessed and therapeutically intervened with consistency within nursing practice. Using the Whittemore and Knalf Framework, this integrative review will examine the literature on aspects of inpatient care that contribute to circadian disruptions within hospitals. By doing so, the research can be built upon with …

The Rationale Behind And Impact Of One Hospital’S Provision Of Secondary School Athletic Training Services: A Five-Year Case Study, Caroline E. Faure Edd; Atc

Internet Journal of Allied Health Sciences and Practice

Purpose: Sports-related injuries are common and often require physician or hospital care. Since the advent of concussion laws in fifty states, hospitals across the country have come forward to partner with secondary schools in the provision of sports medicine healthcare. The outreach agreements are consistent: Hospitals hire athletic trainers (ATs) and then outsource them to schools. ATs help mitigate risk in sports programs. Onsite at the schools daily, ATs provide immediate evaluation and treatment for injuries that occur and render decisions regarding the appropriateness of an injured athlete’s return to participation. The goal of this case study was to describe …

Performance Improvement For Rural Hospitals: Front Line-Driven Change To Decrease Transfer Time From Ed To Inpatient Admission, Chasatie Whitley, Eddie Perez-Ruberte, Linda Kimsey, Bettye Apenteng

Research & Practice Briefs

Highlights: A recent performance improvement project undertaken by a Georgia Critical Access Hospital (CAH) demonstrates the potential for use of Plan-Do-Study-Act (PDSA) techniques to improve operations in the area of patient transfers from Emergency Department (ED) to Inpatient Ward. Implemented process improvement, including visual tracking of inpatient hold in the ED and bedside handoff led to reductions in admission decision to ED departure time and delayed or omitted ED admission orders.

Background: The Georgia Southern Flex Team, funded by the Georgia State Office of Rural Health, assists the state’s CAHs in pursuing financial and operational excellence. Under an ongoing grant, …

The Environment Under The Knife: A Review Of Current Eco-Surgical Strategies And Recommendations For Pakistan, Russell Seth Martins, Edward Anthony Joseph, Javeria Tariq, Namrah Aziz, Saulat H. Fatimi

Medical College Documents

The healthcare sector at its core is based on the fundamentals belief to do no harm and bring about betterment in the lives of the people. Paradoxically, hospitals are one of the leading contributors to pollution, greenhouse gas (GHG) emissions and toxic waste material worldwide. Surgical care delivery is quite resource intensive, consuming significant amount of energy and equipment as well as producing large quantities of waste. With climate change being a global priority, it is crucial that hospitals re-evaluate the environmental impact of such practices. The current review was planned to identify areas of improvement in surgical care in …

Public's Perceptions Of Early Mobility And Exercise In The Hospital And Intensive Care Unit: A Prospective Descriptive Survey, Amy Toonstra Pt, Dpt, Sydney Chelstrom Spt, Emily Ciesynski Spt, Mackenzie Dockendorf Spt, Brandon Hixson Spt

DPT Capstone Posters

Introduction

• 50% Amount of barriers to early mobility related to patient factors₁
• 25% Rate of physical therapy nontreatment or patient refusal₂
• Is lack of knowledge about benefits of activity a cause for these phenomena?

Objective

To evaluate public opinion on importance and safety of early mobility and exercise for individuals in the hospital and intensive care unit (ICU).

Participants

186 adults were recruited at the Minnesota State Fair in the University of Minnesota Driven to Discover Building to participate in the survey.

Methods

• Survey
• Adapted from previous validated survey₃
• 11 items
• 5 point Likert scale
• Established content …

Policies That Support Emergency Department Staff In Providing Behavioral Health Care, Lizabeth Lepp Hennig

Walden Dissertations and Doctoral Studies

A significant portion of individuals with a behavioral health (BH) condition return to emergency departments (ED) seeking care, resulting in reduced quality of care, and contributing to disproportionate healthcare costs. Care can be improved and return visits to the ED reduced where behavioral health care and follow-up care planning are provided as part of their treatment. However, policies expected to create declines in ED use for behavioral conditions are typically in short duration or are difficult to use given other funding and policy constraints. With little known about how policy is supporting the engagement of ED staff who are critical …

Reducing Hospital Noise Levels Through Nursing Staff Education, Althea Sanders

Walden Dissertations and Doctoral Studies

AbstractNoise levels can negatively affect a patient’s hospital experience. Increased noise levels in the hospital can trigger sleep disturbance and affect the length of recovery for patients; the increased noise levels can also cause increased anxiety and exhaustion for nursing staff members. Due to a gap in nursing practice related to nurses’ knowledge to safely reduce noise levels, this project addressed if nursing staff education on noise reduction could increase the knowledge among nursing staff members to use specific strategies to reduce noise levels in an intensive care unit (ICU) setting. The purpose of this project was to educate eight …

Locating Uncertainty In Hospital Leader Sensemaking And Sensegiving Of Organizational Change: A Single Case Study, Sara E. Barry

Antioch University Full-Text Dissertations & Theses

Leaders planning strategic change face significant ambiguity and uncertainty due to the complex, fast-paced, and volatile nature of organizational life. What one leader sees as an opportunity, another may view as a threat depending on their past experiences, their existing mental models, and their perceptions of uncertainty. Sensemaking and sensegiving theories provide a framework for how leaders retrospectively make sense of new and disorienting information through recursive cycles of interpretation, action, and learning, and seek to influence the meaning-making of others towards a shared vision of the strategic change. Despite decades of research using these theories, studies have yet to …

Exploring Orthopaedic Patients’ Experiences Of Hospital Discharge: Implications For Nursing Care, Rosemary Saunders, David Dineen, Karen Gullick, Karla Seaman, Renee Graham, Sandra Finlay

Research outputs 2022 to 2026

Background

Nurses play a key role in providing discharge education. With the increased demand for orthopaedic surgery and subsequent fast‐track surgical programmes resulting in reduction in hospital length of stay, obtaining patient feedback about discharge is important to inform nursing practice of discharge.

Aim

To explore patients’ experiences of discharge from hospital following orthopaedic surgery.

Methods

A descriptive qualitative study was undertaken with a sample of 34 patients discharged following orthopaedic surgery at a private acute Australian hospital. Individual semistructured telephone interviews were conducted and analysed using inductive thematic analysis.

Findings

From the analysis, patient experiences have been described in …

Scoping Review: Konsep Layanan Kedokteran Olahraga Di Rumah Sakit, Bunga Listia Paramita, Dumilah Ayuningtyas

Jurnal Keolahragaan

Kedokteran olahraga berperan penting dalam pelaksanaan "exercise is medicine". Sayangnya, Indonesia belum memiliki dasar kebijakan yang kuat tentang layanan kedokteran olahraga di rumah sakit sebagai salah satu dukungan kesehatan bagi atlet dan siapa saja yang ingin aktif berolahraga. Penelitian ini bertujuan untuk memetakan konsep layanan kedokteran olahraga di rumah sakit mulai dari jenis layanan, personel, bangunan dan infrastruktur, dan peralatan dengan menggunakan metode scoping review berdasarkan Preferred Reporting Items for Systematic Reviews and Meta-Analyze Extensions for Scoping Reviews melalui Pubmed, Google Cendekia, Springeropen, Direktori Open Access Journal, dan Portal Garuda. Hasilnya dikelompokkan dengan pendekatan klasifikasi rumah sakit umum …

Perceived Preparedness Of Healthcare Workers To Cope With Covid-19 Pandemic In Hail Region Hospitals, Kingdom Of Saudi Arabia: A Cross-Sectional Study, Farhan Alshammari, Evalynn Rondilla, Abdalkarem Asharari, Fahad Alshammari

Makara Journal of Health Research

Background: All hospitals must have emergency plans because they play a crucial role in providing critical care. This study assesses the perceived hospital preparedness of healthcare workforces to cope with the COVID-19 pandemic regarding their demographic characteristics.

Methods: This study utilized a descriptive, cross-sectional design to investigate the preparedness of hospital and healthcare workers in the city of Hail, Saudi Arabia. A convenience and snowball sampling method was used. A total of 330 healthcare workers participated in the study, which utilized a Google Form survey and was adapted from the Centers for Disease Control and Prevention (CDC). Descriptive …

Increasing Lactation Consultant Support To The Mch Unit, Daniella Grace Mcclendon

Master's Projects and Capstones

Problem: Breastfeeding is the most beneficial feeding choice for newborns and one of the best ways for mothers to bond with their newborns. In the current Maternal Child Health (MCH) unit, exclusive breastfeeding rates have fallen lower than the unit’s goal of 82%.

Context: Exclusive breastfeeding, when a newborn consumes only human breastmilk, is not always an easy process to initiate immediately after birth and in the early postpartum period. On this specific unit, there is not enough lactation consultant support to provide all patients on the unit.

Interventions: This project considers adding additional lactation consultants to support the MCH …

Decreasing Patient Fall Rates In The Microsystem, Kevin Dwayne Sanchez Camaya

Master's Projects and Capstones

Abstract

Problem: Falls are considered never events, yet continuously occur in the inpatient setting. Falls,

especially falls with injuries, impact the patients, the staff, and the hospital. Falls cause extended lengths of stay, affect the morale of the patients and the staff, and are non-reimbursable events.

Context: There have been an increased rate of falls within a medical/surgical/telemetry unit

microsystem at a Northern California hospital despite standardized screening and prevention tools. The unit can house up to 52 patients and is the designated Covid unit of the hospital at the time of this project.

Interventions: The interventions include optimizing the …