Medicine and Health Sciences Commons^™

Education Of Heparin Per Pharmacy Guidelines To Increase Compliance, Safety, And Pharmacists’ Management Of Heparin Infusions, Christopher Truong, Braxton Mehl

Providence Pharmacy PGY1 Program at Providence Medford 2020

Presentation Title: Education of heparin per pharmacy guidelines to increase compliance, safety, and pharmacists’ management of heparin infusions

Authors: Christopher Truong, PharmD and Braxton Mehl, PharmD, BCCCP

Facility: Providence Medford Medical Center

Background: Element of Performance 4 of The Joint Commission’s National Patient Safety Goal 03.05.01 requires that hospitals have a written policy that addresses the need for baseline and ongoing laboratory tests to monitor and adjust anticoagulant therapy. Our hospital has a written Anticoagulation Management General Operating Policy for heparin orders managed through nursing or pharmacy. Currently, most heparin orders are nurse-managed and have resulted in lab and dosing …

Sola Dosis Facit Venenum: Understanding Severity Of Tca Intoxication, Sean Brachvogel, Justin Osborn, Tanya Page

Milwaukie Family Medicine 2020

The Dose Makes the Poison, or does it? Judicious Management of TCA Intoxication.

Author(s): Sean Brachvogel, MD, MPH; Justin Osborn, MD; Tanya Page, MD

Context/background: Tricyclic antidepressants (TCAs) have been mostly supplanted by SSRIs in the treatment of depression, however they remain a mainstay of chronic pain management.¹ Untreated suicide attempts with a TCAs carry a 70% fatality rate, which drops dramatically to 3% with hospitalization.² As such, maintaining healthcare provider recognition and management of TCA toxicity is of lifesaving importance.

Objective: Here we describe a case report in which alcohol ingestion masked the severity of an accidental …

Pd-1 And Pd-L1 Inhibitors: A Single Center Medication Assistance Program (Map) Experience, Sarah Tu, Shuntao Cai

Earle A. Chiles Research Institute Fellowship Program 2020

PD-1 and PD-L1 Inhibitors: A Single Center Medication Assistance Program (MAP) Experience

Sarah Tu, PharmD and Shuntao Cai, PharmD, BCOP

Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, USA

Background: PD-1 and PD-LI inhibitors are a large component of the growing immuno-oncology field and every year there are increasing studies investigating potential indications for these agents. This IRB approved retrospective chart review examines patients in the Medication Assistance Program (MAP) within a large tertiary medical center who are on PD-1 and PD-L1 medications due to financial barriers and/or non-FDA approved regimens (unlabeled indications). This study seeks to evaluate …

Bacterial Load In Virtual Reality Headsets, Benjamin Creel

Honors Theses

Virtual reality technology is a rapidly growing field of computer science. Virtual reality utilizes headsets which cover the user’s eyes, nose, and forehead. In this study, I analyzed the potential for these headsets to become contaminated with bacteria. The nosepieces and foreheads of two HTC Vive VR headsets of the Department of Computer Science of the University of Mississippi were sampled over the course of a seven-week Immersive Media (CSCI 447) course. Serial dilutions were performed, and samples were plated on various culture media. Following incubation, counts of bacteria were determined. DNA was extracted from bacterial growth on plates from …

A Study Of The Antioxidant Versus Pro-Oxidant Nature Of The Amyloid Beta Peptide And An Analysis Of The Natural Products, Isorhamnetin And Narignenin, As Antioxidants, Kaylee Holmes

Honors Theses

Alzheimer’s disease is a neurodegenerative disorder with no cure. Due to the widespread effects of this disease, abundant research efforts have gone towards finding a cure. The amyloid beta (Ab) peptide has been shown to be a potential cause of the disease due to destructive effects on tissues that it can have both by itself and through reactive oxygen species (ROS) generation. This study was performed in order to assess the structural properties of Ab₄₂monomers, fibrils and oligomers, to assess the antioxidant versus pro-oxidant behavior of the Ab peptide, and to assess the antioxidant nature of the natural …

Empiric Treatment For Suspected Malaria In The United States: A Case Report., Jonathan C. Li, Emma Lundsmith

Division of Internal Medicine Faculty Papers & Presentations

Malaria in the United States is rare and most commonly presents among returning travelers from endemic areas. Diagnosis is classically dependent on a positive blood smear or polymerase chain reaction (PCR) test. The objective of this case report is to highlight a case of suspected malaria in a high-risk individual with negative diagnostic testing where a trial of empiric treatment was initiated based on clinical presentation after a thorough discussion of risks and benefits. However, empiric treatment based on a single case is limiting. We present a case of a 56-year-old man with extensive travel history throughout Asia, who presented …

Promoting Resilience In Self-Management (Prism): Adverse Childhood Experiences And Impacts On Emotion Regulation, Kasey Ann Macedo

Honors Scholar Theses

PRISM (Promoting Resilience in Self-Management) is a mindfulness-based intervention that aims to strengthen emotion regulation skills among individuals by employing cognitive behavioral therapy components. The purpose of the current study is to identify the relationship between adverse childhood experiences (ACEs) and depression, as well as to examine the changes in emotion regulation strategies of participants by comparing pre and post test data. The participants were voluntarily recruited from the Cornerstone Foundation, a homeless shelter, food pantry, and community center in Vernon, CT. The 13 participants completed PRISM through four weeks of two-hour workshop sessions in a small-group format. Results indicate …

Description Of The Attitudes, Knowledge And Beliefs On Marijuana In Undergraduate Students Compared To Nursing Undergraduate Students, Maifrak Sobrino

Honors Scholar Theses

Introduction: The use of marijuana has drastically increased over the years. Not only is marijuana being used to treat personal symptoms, but some women use marijuana to manage pregnancy-related symptoms.

Objective: To discover the knowledge, attitudes, and beliefs of marijuana in the undergraduate student population at the University of Connecticut.

Method: A cross sectional study conducted through Qualtrics using a 15-questions survey, including 5-point Likert scale questions and 5 yes/no questions.

Result: Forty-nine non-nursing students completed the survey. Non-nursing students in comparison to the population as a whole agreed that marijuana use was okay (M = 3.959, SD = …

Attitudes, Knowledge And Beliefs On Marijuana Use In Pregnant Women In Undergraduate Nursing Students, Jordyn Witkins

Honors Scholar Theses

Introduction: Due to the decriminalization of marijuana use by states in the United States, marijuana use has drastically increased in the general populations and in women who are pregnant. During prenatal care, nurses provide education about pregnancy and fetal development.

Objective: This study explore the attitudes, knowledge and beliefs of undergraduate nursing students on marijuana use for individuals and during pregnancy.

Method: The study design was cross-sectional survey with 15-question survey using Likert scale and yes/no questions. Nursing students and non-nursing undergraduate students responses were compared.

Results: Sixty-four nursing students (female, n=50) completed the survey. Nursing students in comparison to …

Birth Across Borders: Migueleña Maternal Experience In Palm Beach County, Florida, Inbal Mazar

Maya America: Journal of Essays, Commentary, and Analysis

Dangers for pregnant Maya women in San Miguel Acatán, a highland hamlet in Huehuetenango, Guatemala are exceptionally high. Those who migrate to Palm Beach County, Florida also face significant risks during pregnancy. However, conceptualizing migrants as vulnerable and non-agentive dismisses the opportunity to explore other dimensions of migrant women experiences. Interviews with Migueleña mothers and midwives and health professionals and advocates in both regions revealed resilience strategies Migueleña migrants create and employ as they navigate linguistically and culturally foreign medical systems. The support they provide each other results in more positive maternal experiences under arduous circumstances. Over time, Migueleñas are …

The Effects Of Fatigue On Lower Extremity Neuromuscular Control, Matthew Thomas Marcen

Theses and Dissertations

Lower extremity injuries and pathologies are amongst the most common issues recreational athletes face. Fatigue is a factor that may impact how the lower extremity performs on a neuromuscular level. Neuromuscular control is a vital aspect of athletic performance and everyday life, that when hindered, may produce pathological results. The research is contradictory on whether or not fatigue produces a significant impact during neuromuscular performance. The purpose of this study is to assess neuromuscular control following a lower extremity fatigue protocol.

This study was a randomized a controlled trial. Twenty-one recreationally active subjects, 10 males and 11 females, between the …

Sti & Prep Updates, Marshal Miller, Md, Aahivs, Sunny Lai, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Apply key findings from the DISCOVER trial to PrEP clinical decision-making
• Understand the gaps in PrEP research for cisgender women and adolescents
• Understand the use of on-demand pre-exposure prophylaxis
• Review Current treatment recs and emerging data on Gonococcal and Chlamydial infection
• Discuss diagnostic and management options for non-gonococcal urethritis

A Marker Of Systemic Inflammation Or Direct Cardiac Injury: Should Cardiac Troponin Levels Be Monitored In Covid-19 Patients?, Bassam Atallah

Faculty Scholarship

No abstract provided.

College Of Public Health News, Georgia Southern University

College of Public Health: News & Publications

• Recent Articles on COVID-19

Disparity In Physician Recognition Of Qt Interval Duration And Associated Mortality, Supraja Thunuguntla, Mohammed Rizwan, Charles Mild

School of Medicine Publications

Background

QT interval prolongation is associated with all-cause mortality (1,2). American Heart Association/American College of Cardiology (AHA/ACC) recommends considering QTc interval above 99th percentile as abnormally prolonged, to prevent Torsade de Pointes (TdP).

Methods

This is a retrospective chart review of 291 EKG’s (162 unique), from patients visiting our facility at Valley Baptist Medical Center (Harlingen) from January 2016 to March 2020. All EKG’s were read, the measured QT interval was corrected for heart rate using the Bazett formula. Simple descriptive statistics were created with all variables considered: patient age, gender, interpreting physician, report/ documentation of long QT, presence of …

Special Issue – July/August 2020: Sustaining A Focus On Human Experience In The Face Of Covid-19, Patient Experience Journal

Patient Experience Journal

At this critical time in our shared history, we are faced with a powerful challenge, the rapid impact of COVID-19 on our healthcare systems and community. With that acknowledgement, we are refocusing our 2020 special issue of Patient Experience Journal (PXJ) to address Sustaining a Focus on Human Experience in the Face of COVID-19. Submissions received for our initially planned special issue on patient & family experience in behavioral health will remain in review and consideration for future issues of PXJ.

There are heroic efforts taking place minute-by-minute to address the clinical and personal needs of patients, while also …

Patient Experience Journal Awards: Celebrating Our 2019 Recipients, Patient Experience Journal

Patient Experience Journal

In association with The Beryl Institute, Patient Experience Journal introduced the inaugural Patient Experience Journal (PXJ) Awards. The annual awards celebrate important contributions to the literature and articles of impact in research and practice. They also introduce groundbreaking authors who are working to expand evidence and insights on patient experience and the human experience in healthcare. The winners are selected from the articles published in PXJ and chosen by the Editorial Board of the journal. The award categories are shared and recipients introduced.

How Do Health Systems Approach Patient Experience? Development Of An Innovative Elective Curriculum For Medical Students, Jordan Silberg Md, Michael Bennick Md, Ma, Agaf, Facp, Cpxp, Kelly Caverzagie Md, Facp, Fhm, Sarah Richards Md, Facp

Patient Experience Journal

Medical students currently learn about patient-centered care and practice communication skills via a variety of curricula. However, there is little in the published literature describing a standardized approach for training future physicians how health systems approach and work to improve patient experience. The [Anonymous1 and Anonymous2] Schools of Medicine designed a plan to pilot a two-week elective for medical students in their clinical years. The curriculum is designed to help students understand and appreciate the key elements of the patient experience across the continuum of care and prepare students to impact the patient experience either as a practicing physician and/or …

Development And Reliability Of A Patient Experience Inventory Tool For Hospitals, Agnes Barden, Nicole Giammarinaro, Natalie Bashkin, Larry Lutsky

Patient Experience Journal

This study explores the development and reliability testing of the newly developed Patient Experience Inventory for Hospitals (PXI-H). Created as an organizational self-assessment patient experience tool, it guides healthcare leaders in evaluating attitudes and behaviors as well as structures and programs impacting patient experience within a hospital setting. The PXI-H is organized within four pillars: Leadership, Education and Development, Data and Analytics and Patient-and-Family Centeredness, which were determined to be internally consistent based on examining coefficient alphas and the item-total correlations. Principal component analysis also determined items with highest loadings aligned onto the pillars in which there were assigned, confirming …

Deploying An Improvement Strategy Across A Rapidly Expanding Health System: A Framework For Repeatability And Cost-Effectiveness, Steve Meth Jd, Ms, Jan Gnida Cpxp, Karla Cardoza, Elizabeth Nikels

Patient Experience Journal

With nearly 40,000 employees and physicians spread across 14 states, a robust system was needed to engage front line teams at the point of care to meaningfully enhance patient and family communication practices in Prime Healthcare, an award-winning, community hospital system with 45 hospitals. Among its key elements, Prime’s system-wide road map for deploying relationship-centered communication tools involved identification of and investment in frontline champions, education that was synchronized with leader-deployed digital rounding, and online self-reflection modules that promoted true behavior change. This economical and easy-to-follow road map is shared for others seeking a high return on investment from their …

Implementing Inter-Professional Patient-Family Centered Plan Of Care Meetings On An Inpatient Hospital Unit, Nicolas Hernandez, Alice Fornari, Sage Rose, Leanne Tortez

Patient Experience Journal

Inpatient plan of care meetings support efforts to encourage collaborative practice and patient-family centered care and result in an effective strategy to enhance communication and patient satisfaction. Clinical team members participated in patient/family centered plan of care meetings at a community hospital in a selected inpatient unit with full time hospitalist physicians. Quantitative data were gathered pre/post implementation from the external Hospital Consumer Assessment of Health Care Providers (HCAHPS) survey. HCAHPS data were collected independently, specifically for questions related to communication between patients, family members/guardians and the medical team and also the effects of care transition. There was a slow …

Patient Education In The Hospital-At-Home Care Context, Heli Vaartio-Rajalin, Linda Nyholm, Lisbeth Fagerström

Patient Experience Journal

The objective of this study is to describe adult patients’ and their family caregivers’ experiences of patient education in the hospital-at-home care context. Methods included a cross-sectional descriptive study including three hospital-at-home units in Finland. Adult, non-palliative patients (n = 27) and their family caregivers (n = 18) were interviewed pairwise by telephone, and the data analyzed with inductive thematic content analysis. COREQ guidelines were used to plan and guide the study design. Results concluded both patients and family caregivers seemed to have quite similar knowledge expectations, which only differs slightly from findings in other in- or outpatient contexts. In …

Finding Common Threads: How Patients, Physicians And Nurses Perceive The Patient Gown, Christy M. Lucas, Cheryl Dellasega

Patient Experience Journal

Evidence-based care is standard practice in medicine, but the patient gown has fallen outside the scope of scholarly research. The current gown renders a patient vulnerable, diminishing patients’ sense of identity, agency, and dignity with its one-size-fits-none design. The impact on providers is similarly neglected. Our objective was to explore how patients and providers derive meaning from patient gowns. A convenience sample at an academic medical center was interviewed utilizing a standardized framework developed by a medical student and two PhD-prepared researchers with experience in qualitative methods. The study was inductive in nature, seeking to understand perceptions of the patient …

Is There A Correlation Between The Patient-Doctor Relationship Questionnaire And Other Patient-Reported Experience Measures?, Amanda I. Gonzalez, Joost T.P. Kortlever, Léon Rijk, David Ring, Laura E. Brown, Lee M. Reichel

Patient Experience Journal

Patient reported experience measures (PREMs) can quantify the quality of the patient-clinician relationship, which is associated with adherence and improved health. However, the scales used to assess PREMs have large ceiling effects, which limits our ability to learn and improve. This study assessed the correlation of four PREMs: the patient-doctor relationship questionnaire (PDRQ), a measure of perceived empathy, a measure of satisfaction with the visit, and a measure of communication effectiveness. We also assessed ceiling effects. We prospectively enrolled 103 new and return patients in this cross-sectional study. Patients completed a demographic questionnaire, the PDRQ, Jefferson Scale of Patient Perceptions …

The Little Things: Exploring Perceptions And Experiences Of Client And Family-Centred Care Through Photovoice, Sonia Nizzer, Stacey Ryan, Sandra M. Mckay

Patient Experience Journal

Healthcare in Canada is undergoing a paradigm shift, moving away from a prescriptive approach to care delivery to one that prioritizes clients and their families at the center of their care. In the homecare sector, this approach is commonly referred to as client- and family-centred care (CFCC), a philosophy emphasizing the need for point-of-care providers to partner with those receiving care and their families in a way that is respectful and attuned to their individual needs and goals. This philosophy helps homecare agencies like VHA Home HealthCare deliver care to families that embraces what is most important to them. At …

Using Shared Mental Models To Conceptualize Patients As Professionals, Decision-Makers, Collaborators, And Members Of Interprofessional Healthcare Teams, Umair Majid

Patient Experience Journal

Patient engagement has become the buzz-phrase of 21^st Century health care. Around the world, healthcare systems involve patients in a wide range of activities including drug development, research, and policy design. There are strong institutional pressures for patient engagement in healthcare activities that have been bolstered by ethical imperatives and social and organizational benefits from patient engagement. There is a trend to center efforts to cultivate engagement initiatives that are meaningful to patients and family. However, these efforts are characterized by multiple challenges, for example, tokenism and the lack of organizational support. These barriers may persist in healthcare professionals’ …

Patient Feedback: Listening And Responding To Patient Voices, Simon J. Radmore, Kathy Eljiz, David Greenfield

Patient Experience Journal

The study aim was to identify key strategies to improve organisational systems and care experiences, to confront the challenges of achieving effective patient feedback throughout a large healthcare organisation. A mixed methods exploratory approach was used. Purposive and snowball sampling, semi-structured interviews with key stakeholders, and document analysis of existing feedback processes was utilised. The setting was a large metropolitan Local Health District in Sydney, Australia. Data was examined using thematic and content analysis. Participants identified no single feedback process was able to adequately gather all feedback necessary to reflect the patient experience. Patient feedback processes that are most useful: …

Measuring Patient-Centered Care For Specific Populations: A Necessity For Improvement, Sara C. Handley Md, Msce, Ingrid M. Nembhard Phd, Ms

Patient Experience Journal

The measurement of patient-centered care (PCC) is a fundamental component of assessing and improving health care quality. There are a variety of PCC measures available which have been tailored to different health care conditions and settings. These distinct measures are valuable given the diversity of health conditions and contexts encountered in the health care system. However, the type of patient has received significantly less attention when measuring PCC despite the multitude of unique patient populations that exist. Specific patient populations raise several core challenges for PCC measurement to which researchers and practitioners need to attend: identifying what principles to measure, …

Paying It Forward: A Cancer Survivor And His Wife Share Their Reflections And Recommendations As A Patient And Caregiver, Justin Sandler

Patient Experience Journal

I grew up in the north suburbs of Chicago and had a relatively normal childhood but not necessarily an easy one. Shortly after graduating from Indiana University, I moved out west and have been working in the entertainment industry ever since. My life has been a beautiful and interesting adventure with twists and turns I could have never predicted.

In 2016 it seemed like everything was really coming together. I had been happily married to my wife and business partner Mary Lou Sandler since 2011, and we had been growing our photography/film production studio for as many years. I was …

The Essential Nature Of Experience In A Time Of Crisis And Beyond, Jason A. Wolf

Patient Experience Journal

As we have engaged with community members around the world, the last few weeks have provided a unique window into the face of this crisis as we have seen not only the deadliest days on record, but have also had some of the most hopeful conversations at the same time. While we are and still will face challenges in the weeks to come, we too have seen humanity elevated in profound and powerful ways. While it can be offered with little argument that things will never be the same, in moving forward, we too can assert and I believe, that …