Medicine and Health Sciences Commons^™

The Effectiveness Of The Biopatch Disc In Decreasing Mrsa In Peripherally Inserted Intravenous Catheters, Ketha Franklin

Walden Dissertations and Doctoral Studies

Methicillin-resistant Staphylococcus aureus (MRSA), drug-resistant bacterial infection, is a pressing global health care issue that decreases patients’ quality of life and places a high burden on health care delivery systems. The purpose of this quality improvement evaluation project was to evaluate an infection prevention management program derived from evidence-based research to decrease the incidence of MRSA in peripherally inserted intravenous catheters (PIVs) in acute care settings through the utilization of the Biopatch disc. The practice-focused question addressed whether the use the Biopatch disc over a 6-month period in acute care would coincide with a reduction of the incidence of MRSA …

Evaluating Integrated Treatment On Recidivism For Female Offenders In Criminal Justice System, Oyin T. Popoola

Walden Dissertations and Doctoral Studies

The burden of co-occurring disorders (CODs) among offenders in the criminal justice system (CJS) in the United States, particularly among the female population, is threatening the communities. About 80% of women in the CJS were diagnosed and treated for CODs, and 63% tend to be rearrested. The study examined the possible influence of CODs, integrated treatment of CODs, and gender, on recidivism while controlling for other demographic factors. The study was based on the conceptual framework of integrated dual disorder treatment (IDDT) and feminist criminology theory. Cross-sectional quantitative study design was applied on a secondary dataset from the 2017 Treatment …

Utilization And Impact Of Peer-Support Programs On Police Officers’ Mental Health, Beth A. Milliard

Walden Dissertations and Doctoral Studies

Police officer suicides rates hit an all-time high in the province of Ontario, Canada, in 2018. Sadly, this statistic is somewhat unsurprising, as research has shown that police officers suffer from higher rates of mental health disorder diagnoses compared the general public. One key reason for the elevated levels of suicide and other mental health issues among police officers is the stigma associated with seeking help. In an attempt to address these serious issues, Ontario’s police services have begun to create internal peer-support programs as a way of supporting their members. The present research explores the experiences of police officers …

Congestive Heart Failure And Strategies To Improve Quality Of Life, Esther Akunna Okorie

Walden Dissertations and Doctoral Studies

Congestive heart failure is a global, chronic, progressive, and debilitating disease affecting mostly older adults. The multiple complications associated with the health issue led to readmissions and markedly reduced ability of heart failure (HF) patients to perform the self-care management of the problem. Nurses are responsible for providing a standardized quality education for patients; however, nurses at the project site lacked adequate skills and knowledge to bridge the gap in HF self-care management education. The project was guided by health belief model and self-care deficit with the goal of boosting the staff knowledge and confidence with providing patient HF self-care …

Strategies To Reduce Costs Associated With Hospital Readmissions, Almunzer Zakaria

Walden Dissertations and Doctoral Studies

Hospital administrators struggle to reduce hospital readmissions to improve hospital performance. Reducing costs of readmissions is important to hospital administrators because it may lead to an inability to meet budget requirements. Grounded by complex adaptive systems and business process quality management principles, the purpose of this qualitative single case study was to explore strategies nonprofit hospital administrators use to reduce costs associated with hospital readmissions. Participants included 4 successful hospital administrators at 1 hospital in Doha, Qatar, who have responsibility for overseeing readmissions. Data were collected using semistructured face-to-face interviews and organizational documents. Traditional text analysis was used to identify …

Sexual Orientation, Body Mass Index, And Methamphetamine Use Among Chicago Youth, Nileshkumar Panchal

Walden Dissertations and Doctoral Studies

Drug use and obesity are two of the most challenging health-related issues that young people face. Obesity, substance abuse, and drug addiction lead to brain dysfunction, which can decrease the quality of life and academic performance as well as increase the vulnerability of developing chronic diseases. To date, there has been little research to determine whether sexual orientation influences the relationship between body mass index (BMI) and methamphetamine use. Focusing on youth, the relationship between BMI, methamphetamine use, and sexual orientation were examined in this study through secondary data analysis of the Youth Risk Behavioral Surveillance System in Chicago. Guided …

Factors Associated With Incarceration Of Adolescents With Learning Disabilities, Sabine Silien Charles

Walden Dissertations and Doctoral Studies

Incarceration of adolescents in the United States has grown substantially during the last 3 decades with nearly 53,000 adolescents held every day in correctional facilities. Many researchers have raised concerns about the greater percentage of adolescents with learning disabilities (LDs) in the juvenile system. In the state of Washington, one study in residential placements showed approximately 20% of youth incarcerated had a diagnosed LD. The purpose of this quantitative cross-sectional study was to use the therapeutic change, length of stay, and recidivism in incarcerated juvenile offenders in Washington state, 2008–2015 data set to examine possible factors associated with incarceration of …

African American Maternal Mortality In The United States: A Quantitative Analysis Of Chronic Disease And Maternal Deaths, Glory Inyang

Walden Dissertations and Doctoral Studies

African American women have higher rates of chronic disease including diabetes and cardiovascular related disease compared to White women and are 3 to 4 times more likely to die during childbirth, more than any other ethnic group in the United States. . When African American women become pregnant these conditions may influence their maternal health outcomes. This study aimed to determine difference in pregnancy related death associated with chronic conditions between African American women and White women. Based on secondary/archival data from the Center for Disease Control and Preventions' 2017 National Center for Health Statistics Mortality Multiple Cause Files a …

New Graduate Residency Programs, Shareen Estelle Taylor

Walden Dissertations and Doctoral Studies

Nurses are the largest group of healthcare providers in most acute care hospitals, and the demand for registered nurses is expected to grow by 15% by 2026. The new graduate registered nurse (NGRN) is the supply that will fill the shortage; however, NGRNs are reportedly lacking in the ability to connect the lessons learned in the classroom with real patient care, unprepared for necessary skills, emotionally stressed, and have a high first-year turnover rate. Strategies such as nurse residency programs are needed to support NGRNs as these new nurses’ transition from academics to clinical practice. The purpose of this project, …

Impact Of Nurse Education Program On 30-Day Readmissions Among Ischemic Stroke Patients, Mariana Tsucuneli

Walden Dissertations and Doctoral Studies

Unplanned 30-day readmissions among patients diagnosed with ischemic stroke (IS) is a significant public health problem in the United States. The Affordable Healthcare Act introduced financial penalties and incentives for facilities to encourage the adoption of care plans aimed at reducing 30-day readmissions rates for stroke and 5 other illnesses. Therefore, facilities with high rates of 30-day readmissions for IS patients are penalized by the Centers for Medicare and Medicaid services in addition to receiving poor scores on the quality of care they provide. This project was a staff education program aimed to improve postacute stroke transitional care and reduce …

Assisting Psychiatric Nurses In Managing Work Stress And Decreasing Callouts And Absenteeism, Prisca Njume

Walden Dissertations and Doctoral Studies

Management and reduction of work stress is important in promoting nurses' well'€being. Understanding how to decrease stress levels may allow nurses to provide better care, improve patient outcomes, and experience increased job satisfaction. The focus of this project was to empower psychiatric nurses to manage work-related stress and decrease callouts and absenteeism. Person-environment fit theory, job demand-control (support) theory, the job demands-resources model, and the effort-reward imbalance model were used to inform the project. Pretest and posttest data were collected from 61 nurses using the Perceived Stress Scale. Deidentified retrospective and prospective data of the number of callouts were also …

Practice Improvement: Intimate Partner Violence Screening Implementation, Enitan Salawu

Walden Dissertations and Doctoral Studies

Intimate partner violence (IPV) is a significant public health problem in the United States and worldwide. A recent U.S. crime report indicated that close to half of all homicides involve women victims of current or former intimate partners. The purpose of this doctoral project was to develop a training program to educate clinicians in the primary care setting on IPV screening. Participants received education on the Hurt, Insult, Threaten, Scream (HITS) screening tool to identify IPV survivors with available referral resources. The practice-focused question involved clinicians' level of knowledge regarding using the HITS tool kit to screen for IPV in …

Interaction Of Aβ42 With Membranes Triggers The Self-Assembly Into Oligomers, Siddhartha Banerjee, Mohtadin Hashemi, Karen Zagorski, Yuri L. Lyubchenko

Journal Articles: Pharmaceutical Sciences

The self-assembly of amyloid β (Aβ) proteins into oligomers is the major pathogenic event leading to Alzheimer's disease (AD). Typical in vitro experiments require high protein concentrations, whereas the physiological concentration of Aβ is in the picomolar to low nanomolar range. This complicates the translation of results obtained in vitro to understanding the aggregation process in vivo. Here, we demonstrate that Aβ42 self-assembles into aggregates on membrane bilayers at low nanomolar concentrations - a pathway in which the membrane plays the role of a catalyst. Additionally, physiological ionic conditions (150 mM NaCl) significantly enhance on-membrane aggregation, leading to the rapid …

Confirmation And Identification Of Biomarkers Implicating Environmental Triggers In The Pathogenesis Of Type 1 Diabetes, Robert Z. Harms, Katie R. Ostlund, Monina S. Cabrera, Earline Edwards, Marisa Fisher, Nora Sarvetnick

Journal Articles: Surgery

Multiple environmental triggers have been proposed to explain the increased incidence of type 1 diabetes (T1D). These include viral infections, microbiome disturbances, metabolic disorders, and vitamin D deficiency. Here, we used ELISA to examine blood plasma from juvenile T1D subjects and age-matched controls for the abundance of several circulating factors relevant to these hypotheses. We screened plasma for sCD14, mannose binding lectin (MBL), lipopolysaccharide binding protein (LBP), c-reactive protein (CRP), fatty acid binding protein 2 (FABP2), human growth hormone, leptin, total adiponectin, high molecular weight (HMW) adiponectin, total IgG, total IgA, total IgM, endotoxin core antibodies (EndoCAbs), 25(OH) vitamin D, …

The President's Emergency Plan For Aids Relief And Adult Mortality: A Replication Study Of Hiv Development Assistance Effects In Sub-Saharan African Countries, Nicholas A. Hein, Danstan Bagenda, Jiangtao Luo

Journal Articles: Anesthesiology

The US budget for global health funding, which was by far the largest of similar funding in the world, increased from US $1.3 billion in 2001 to more than US $10 billion in recent years. More than 54% of this funding was allocated to the Global Fund to Fight HIV/AIDS through the US President's Emergency Plan for AIDS Relief (PEPFAR) in Africa. However, recent studies indicate contradictory results regarding the effectiveness of PEPFAR. One by Bendavid, Holmes, Bhattacharya, and Miller shows positive effects of PEPFAR in reducing adult mortality in Africa, while another by Duber, Coates, Szekeras, Kaji, and Lewis …

Mesenchymal Stem Cell-Derived Extracellular Vesicles: Challenges In Clinical Applications, Austin Gowen, Farah Shahjin, Subhash Chand, Katherine E. Odegaard, Sowmya V. Yelamanchili

Journal Articles: Anesthesiology

Stem cell therapy has garnered much attention and application in the past decades for the treatment of diseases and injuries. Mesenchymal stem cells (MSCs) are studied most extensively for their therapeutic roles, which appear to be derived from their paracrine activity. Recent studies suggest a critical therapeutic role for extracellular vesicles (EV) secreted by MSCs. EV are nano-sized membrane-bound vesicles that shuttle important biomolecules between cells to maintain physiological homeostasis. Studies show that EV from MSCs (MSC-EV) have regenerative and anti-inflammatory properties. The use of MSC-EV, as an alternative to MSCs, confers several advantages, such as higher safety profile, lower …

Preventing Hiv And Hsv-2 Through Knowledge And Attitudes: A Replication Study Of A Multi-Component Community-Based Intervention In Zimbabwe, Fang Yu, Nicholas A. Hein, Danstan S. Bagenda

Journal Articles: Anesthesiology

INTRODUCTION: Approximately two-thirds of HIV-infected individuals reside in sub-Saharan Africa. The region accounts for 68% of the new HIV infections occurring worldwide with almost one-half of these infections being among young adults aged 12-24 years. Cowan and colleagues conducted a community-based, multi-component HIV intervention aimed at youth in rural Zimbabwe. Despite some changes in knowledge and attitudes, the community-based intervention did not affect the prevalence of HIV or HSV-2. We selected this frequently cited study for replication since it incorporates individual-, community-, and structural- level intervention components that are often considered in global HIV/AIDS prevention programs. Additionally, the intervention could …

Long Non-Coding Rna Profiling Of Pediatric Medulloblastoma, Varun Kesherwani, Mamta Shukla, Don W. Coulter, J. Graham Sharp, Shantaram Joshi, Nagendra K. Chaturvedi

Journal Articles: Genetics, Cell Biology & Anatomy

BACKGROUND: Medulloblastoma (MB) is one of the most common malignant cancers in children. MB is primarily classified into four subgroups based on molecular and clinical characteristics as (1) WNT (2) Sonic-hedgehog (SHH) (3) Group 3 (4) Group 4. Molecular characteristics used for MB classification are based on genomic and mRNAs profiles. MB subgroups share genomic and mRNA profiles and require multiple molecular markers for differentiation from each other. Long non-coding RNAs (lncRNAs) are more than 200 nucleotide long RNAs and primarily involve in gene regulation at epigenetic and post-transcriptional levels. LncRNAs have been recognized as diagnostic and prognostic markers in …

Alkalinizing Agents: A Review Of Prescription, Over-The-Counter, And Medical Food Supplements., Karen L. Stern, Noah Canvasser, Michael Borofsky, Vanessa M. Gleason, Guido Kamphuis, Marawan M. El Tayeb, Ryan Hsi, Kymora B. Scotland

Jefferson Hospital Staff Papers and Presentations

Introduction

Kidney stones affect 1 in every 11 people in the United States each year. There is a significant high recurrence rate without a stone prevention protocol. Alkali citrate is beneficial in decreasing stone recurrence, but due to the cost and gastrointestinal side effects there is a low adherence rate. This study aims to serve as a review of some of the most commonly used alkalizing over‐ the‐ counter supplements that are advertised to prevent and treat kidney stones.

Methods

Data was gathered by a comprehensive online literature search and company inquiries for kidney stone prevention supplements. An additional informal …

Revisiting Caroli Syndrome In A Tanzanian Patient, Casmir Wambura, Sharma, Munishi, Salim Suran

Faculty of Health Sciences, East Africa

Caroli disease and Caroli syndrome are two rare congenital diseases of the intrahepatic bileducts. Caroli syndrome is characterized by the saccular dilatation of intrahepatic bile ductsassociated with congenital hepatic fibrosis. It is rarely diagnosed in childhood. We herebydescribe a case of Caroli syndrome in a young Tanzanian female who had abdominal pain anddistension since childhood. Her history suggested the presence of portal hypertension possiblyfrom congenital hepatic fibrosis. The diagnosis was reached based on ultrasound, computedtomography (CT) scan of the abdomen, and magnetic resonancecholangiopancreatography (MRCP)

Outcomes Of Inpatients Hospitalized With Community Acquired Pneumonia, Jamila Nambafu

Master of Medicine in Internal Medicine

Background: The morbidity from lower respiratory tract infections has varied between age groups and from region to region. In sub-Saharan Africa, pneumonia remains the most frequent reason for adult hospitalization, with approximately 4 million episodes and about 200,000 deaths every year. Some of the attributable factors have been HIV pandemic, pulmonary tuberculosis, and poor socio-economic status. Objective: The main objective was to determine the morbidity of community-acquired pneumonia in patients admitted to a tertiary hospital in Nairobi, Kenya, between May 2019, and March 2020. The results are anticipated to help in informing protocols for the evaluation and treatment of community-acquired …

Barriers To Timely Disclosure Of Hiv Serostatus: A Qualitative Study At Care And Treatment Centres In Dar Es Salaam, Tanzania, Neelam Akber Ismail

Master of Family Medicine

Introduction: Disclosure of HIV status is important for HIV prevention and maintenance of health for People living with HIV (PLWHIV), their spouses and the community. Despite the benefits of disclosure, there are PLWHIV who delay in disclosing their status thus increasing the risk of transmission of the disease. Objective: This study aimed at determining the barriers to timely disclosure of HIV serostatus among HIV seropositive individuals in Dar es Salaam and what motivated them to disclose. Methods: A qualitative descriptive study using in depth individual interviews was conducted. Ten participants attending the care and treatment centres took part. Qualitative content …

Effect Of Conventional Or High Protein Dry Distillers Grains Plus Solubles In Either Dry- Rolled Or Steam- Flaked Corn Based Diets On Finishing Performance Of Steers, Lauren A. Ovinge, L.J. Mcphilips, B.M. Boyd, Galen E. Erickson

Nebraska Beef Cattle Reports

A 2 × 3 factorial finishing study evaluated feeding 0 or 30% high protein distillers grains or conventionally produced distillers in either steam- flaked or dry- rolled corn based diets. Feeding conventional distillers grains in dry rolled corn based diets resulted in improved feed conversion, with no difference between high protein distillers grains as compared to conventional DDGS when included in dryrolled corn diets. In steam flaked corn- based diets, feeding high protein distillers and conventional distillers tended to increase feed conversion. Feeding conventional distillers or high protein distillers grains resulted in greater DMI and ADG as compared to diets …

Structural Equation Modeling To Detect Correlates Of Childhood Vaccination: A Moderated Mediation Analysis, Abraham Degarege, Karl Krupp, Vijaya Srinivas, Boubakari Ibrahimou, Purnima Madhivanan

Journal Articles: Epidemiology

OBJECTIVES: This study used a health belief theory derived framework and structural equation model to examine moderators, mediators, and direct and indirect predictors of childhood vaccination.

METHODS: A secondary analysis was conducted using data collected from a cross-sectional survey of a random sample of 1599 parents living in urban and rural areas of Mysore district, India. Applying two-stage probability proportionate-to-size sampling, adolescent girls attending 7th through 10th grades in 23 schools were selected to take home a questionnaire to be answered by their parents to primarily assess HPV vaccine intentions. Parents were also asked whether their children had received one …

Evaluating Cardiac Anatomy As A Predictor For Success After Pulmonary Vein Isolation For The Treatment Of Atrial Fibrillation, Paul Richter, Evan Rochlis, Ethan Halpern

Phase 1

Introduction: Atrial Fibrillation is a condition characterized by the production of ectopic beats by the heart. One common treatment for Atrial Fibrillation is catheter guided pulmonary vein isolation (PVI), however this treatment is only effective in around 60-70% of the population. Our research hopes to elucidate a link between cardiac anatomy and successful treatment of A-fib by pulmonary vein isolation.

Methods: The medical records for 78 consecutive patients who underwent PVI for atrial fibrillation at Jefferson from July 2013 to March 2016 were gathered. Included in these charts were ECG-gated cardiac CT angiogram and two-year follow up history. Different variables …

The Efficacy And Safety Profile Of Netarsudil 0.02% In Glaucoma Treatment: Real-World Outcomes, Eric Shiuey, Ms, Melih Ustaoglu, Md, Carina Sanvicente, Md, Reza Razeghinejad, Md, L. Jay Katz, Md, Jonathan Myers, Md, Daniel Lee, Md

Phase 1

Introduction: More effective glaucoma medications are necessary as medication intolerance and non-adherence remain problematic. Netarsudil is a newly FDA-approved Rho kinase inhibitor. We hypothesize that netarsudil will safely reduce intraocular pressure (IOP) compared to baseline even while other glaucoma medications are used.

Methods: This retrospective observational study was conducted on glaucoma patients seen at the Wills Eye Hospital Glaucoma Service who received netarsudil 0.02% between March and September of 2018. Intraocular pressure (IOP, via Goldmann applanation tonometry) and best corrected visual acuity (BCVA, via Snellen visual acuity charts) comparisons between baseline and 1- and 3-month follow-up visits were performed …

Conjunctival Melanoma: Features Based On The Fitzpatrick Skin Type (Fst) In 540 Patients At A Single Ocular Oncology Center, Sunihidi Ramesh, Antonio Yaghy, Lauren A. Dalvin, Sara E. Lally, Jerry A. Shields, Carol L. Shields

Phase 1

Background: The Fitzpatrick skin type (FST) is a classification system for skin pigmentation that has been used to stratify risk for cutaneous melanoma; however, it has not yet been explored in the context of conjunctival melanoma. Herein, we examine FST and its association with the clinical features of conjunctival melanoma.

Methods: A retrospective review was conducted on 540 medical records of patients with pathologic diagnosis of conjunctival melanoma. The patients were categorized according to the FST classification based on their external facial photographs at presentation. This includes: Type I (white skin color), Type II (fair skin color), Type III (average …

Middle Fossa Extension Of Posterior Fossa Meningiomas Is Associated With Poorer Clinical Outcomes, David Morgan, Donald Y. Ye, Md, Michael P. Baldassari, Omaditya Khanna, Md, Aria Mahtabfar, Md, Tyler Henry, Haley Wendt, David W. Andrews, Md, Christopher J. Farrell, Md, James J. Evans, Md, Kevin D. Judy, Md

Phase 1

Introduction: Progression of posterior fossa meningiomas (PFMs) can lead to extension into the middle cranial fossa. Pre-operative imaging allows for quantification of middle fossa extension (MFE). We aimed to determine the clinical impact of MFE on surgical and clinical outcomes during resection of PFMs.

Methods: Craniotomies for meningiomas performed at a large single center academic institution from January 2012 to December 2018 were identified. Preoperative MRI and CT imaging was reviewed to determine the presence of MFE of posterior fossa meningiomas and correlated to post-operative outcomes.

Results: 65 PFMs were identified and mean follow-up was 28.8 ± 20.1 months. 13/65 …

Early Perioperative Fluid Benchmarking To Predict Pancreaticoduodenectomy (Pd) Outcomes, David Moskal, Carrie D. Walsh, Sofia Duque, Charles Yeo, Md, Facs, Harish Lavu, Md, Facs

Phase 1

Introduction: PD is a complex operation associated with a marked systemic inflammatory response and significant fluid shifts. Establishing a benchmark for ideal perioperative fluid management is critical to optimising PD patient recovery.

Methods: In this retrospective study, we evaluated perioperative fluid data for patients undergoing PD. We compared an optimal benchmark group who were discharged home by postoperative day five (≤5day) to a group of patients with an in hospital recovery greater than ten days (≥10day).

Results: Seventy-six patients who underwent PD between June 2015 and November 2016 were evaluated. The ≤5day group had a significantly lower intraoperative fluid administration …

Meta-Analysis Of Repair Techniques For Mixed Nerve Damage, Grant Jones, Zachary J. Herman, Asif Ilyas

Phase 1

BACKGROUND: Injuries to the upper extremity are common and can occur with trauma, surgery, or compression. Particularly, injuries that result in complete transection often require surgical intervention in attempt to restore function and quality of life. Classically, nerve autografts have been used as the gold standard to repair these peripheral lesions. An alternative to the autologous nerve graft is the use of the processed nerve allograft. limited research exists in comparing sensory and motor outcomes of allograft nerve repair in the upper extremity with data for autograft repair. In this systematic review and meta-analysis, we set out to cumulate results …