Improving First Dose Administration Of The Hpv Vaccine For Adolescents In A Pediatric Primary Care Clinic, Scarlett Mikesell-Pierce

DNP Projects

BACKGROUND: Nationwide more than 90% of cervical cancer cases are caused by the human papilloma virus (HPV). Cervical cancer can be largely prevented by administration of the HPV vaccine for children before becoming sexually active. However, vaccination rates in the United States, remain low at 60%, and only 39.7% through series of completion, despite the strong evidence to support the effectiveness of the HPV vaccine. Research indicates a clinician’s recommendation, providing information and opportunity for discussion about the vaccine are strong motivators for parents to vaccinate their children, regardless of ethnicity. This study addresses the barriers to parent/caregiver intent to …

A Modified Screening Tool To Evaluate Risk Of Unanticipated Return Visits To The Emergency Department In The Geriatric Population, Tabitha Riley

DNP Projects

Purpose: To compare the Modified Screening Tool for Identifying at Risk Seniors (mSTIRS) against the Triage Risk Screening Tool (TRST) and the Identification of Seniors at Risk (ISAR) for predictive value and assess the relationship between presenting complaint with unanticipated return visit (URV) occurrence in geriatric patients.

Design: A prospective, observational study conducted at a large academic medical center. Descriptive statistics and psychometric analyses were used to analyze the association between demographics, clinical data, and to evaluate the modified screening tool.

Methods: 38 geriatric participants in the Emergency Department (ED) were enrolled and 21 completed the study. The screening tools …

Nurse Driven Enteral Nutrition Protocol For Mechanically Ventilated Patients, Deena Shewekah

DNP Projects

Introduction: Delayed enteral nutrition in critically ill patients increases the risk of complications and poor outcomes. Current evidence-based guidelines recommend initiation of enteral nutrition within 24-48 hours of intensive care unit (ICU) admission. The quality improvement (QI) project aim was to examine whether enteral nutrition was initiated within 24- 48 hours of mechanical ventilation after implementation of QI intervention in order to determine practice change.

Methods: The QI protocol was introduced to the Cardiovascular ICU (CVICU) at UK Chandler Hospital (UKHC) nurses via an education session. A post-education electronic survey identified the nurse’s understanding of the protocol. To identify nursing …

The Effects Of Scheduling Acetaminophen And Methocarbamol Administration On Postoperative Opioid Use And Related Side Effects Among Cardiac Surgery Patients, Whitney Jamison

DNP Projects

The Effects of Scheduled Acetaminophen and Methocarbamol Administration on Postoperative Opioid Use and Related Side Effects Among Cardiac Surgery Patients

ABSTRACT

Purpose

Opioid therapy is commonly prescribed to combat surgical pain in hospitals across the United States and is associated with many negative side effects including dependence and nausea. The purpose of this study was to retrospectively examine the effects of scheduling acetaminophen and methocarbamol administration postoperatively throughout the cardiac surgery patients’ hospital stay. Through retrospective chart reviews, the aims of postoperative opioid use, postoperative opioid use according to hospital length of stay, antiemetic use, and opioid prescription at discharge …

The Effects Of Mindfulness Practices On Nurse Leader Resiliency, Kimberly Blanton

DNP Projects

Background: The purpose of this study was to evaluate if brief Mindfulness Based Stress Reduction (MBSR) sessions can improve nurse leader resilience and overall mindfulness.

Conceptual Framework: Two different conceptual frameworks, Jean Watson’s theory of caring and Albert Bandura’s theory of self-efficacy, were used to guide this project. Watson’s theory of caring is defined as healing of the mind, body, and spirit. This theory supports caring for oneself while caring for others. Bandura’s theory focuses on the belief that individuals can influence their own lives.

Methodology: This study employed a descriptive, pretest-posttest single site comparative design. Sixty-six nursing leaders from …

Don't Just Check The Box: Check Your Athlete's Heart: Adding A 12-Lead Ecg To Pre-Participation Screening To Identify High Risk Of Sudden Cardiac Arrest In Male High School Athletes, Shannon King

DNP Projects

PURPOSE: Sudden cardiac arrest (SCA) continues to be the leading cause of death in male high school athletes participating in competitive sports. There is gap in the current preventative screening practice of history and physical alone. The purpose of this project is to evaluate adding a 12-lead electrocardiogram (ECG) to pre-participation screening captures cardiac abnormalities that identify male athletes at a higher risk for developing SCA. METHODS: A descriptive secondary analysis design to determine the incidence of cardiac abnormalities detected with the addition of a 12-lead ECG during pre-participation screenings (annual sports physical) of high school-aged male athletes. The study …

Improving Assessment, Documentation, And Ordering Of Diabetic Retinopathy Screenings In A Primary Care Clinic, Lauren N. Motto

DNP Projects

Abstract

BACKGROUND: Diabetes mellitus (DM) is the leading cause of new blindness in American adults. As the number of people with type 2 diabetes continues to increase, the total number of people affected by diabetic retinopathy (DR) will continue to rise. Improved access to screening for DR, followed by treatment, if necessary, can reduce the progression to vision loss. Despite national recommendations, less than half of Americans with DM complete annual diabetic retinopathy screenings (DRS).

PURPOSE: The purpose of this project was to improve assessment, education, documentation, and ordering of DRS for patients with a diagnosis of type 1 and/or …

The Effect Of A Virtual Child Passenger Safety Educational Intervention On Uk Pediatric Residents' Self-Reported Knowledge, Confidence, And Anticipatory Guidance Beliefs, Brooklyn Johnson

DNP Projects

Background: Motor vehicle crashes are the leading cause of death in children. Car safety seats (CSS), when used properly, have been proven to reduce injuries and deaths in children during motor vehicle accidents. The leading cause of car seat misuse is parental lack of knowledge about proper car seat use and best practice recommendations. Studies have shown that pediatric primary care providers have variable knowledge of the most updated car safety seat recommendations and are not consistently educating parents about child passenger safety during well child checks.

Objective: To evaluate UK pediatric residents' self-reported knowledge, confidence, and anticipatory guidance beliefs …

Device Related Concerns Pertaining To Primary Caregivers Of Lvad Patients, Nicole Smith, Carissa Smith

DNP Projects

Abstract

PURPOSE: The purpose of this project was to focus on caregiver education with an emphasis on caregiver concerns regarding the LVAD; additionally, evaluating the efficacy of an educational video acknowledging those device-related concerns identified by caregivers. The goal of this project is to improve caregiver knowledge and decrease the rate of device related concerns among the primary caregivers.

METHODS: This project is a single center cross-sectional, pre-post-test implementation design to determine the efficacy of device related concerns education on primary caregivers’ knowledge and concerns. A 16-point device related concerns scale was designed to appraise primary caregiver concerns. The scale …

3d Printing Of Bone Spurs Before Surgical Removal During Total Knee Arthroplasty, Chris Li, Jeffrey Henstenburg, Md, Katelyn Koons, John Paul Prodoehl, Matthew Chadwick, Lauren Schlegel

Phase 1

Background: In the United States, total knee arthroplasty (TKA) is the most common performed orthopedic surgery, with over 700,000 cases per year. Overall, 21-25% underwent revision due to instability. Incorrect soft tissue balancing during the procedure can lead to improper alignment, flexion, and extension. Visualization of osteophytes in a 3D manner prior to removal is difficult and poses significant risks for improper balancing on TKA. The purpose of the study is to determine whether the utilization of 3D osteophyte models is beneficial to Orthopaedic surgeons in the course of care, specifically with regard to improving outcomes, decreasing complication rates, and …

Anxiety And Depressive Symptoms Pre-Trauma As A Predictor Of Dissociative Symptoms Post-Trauma – An Aurora Study, Vishal Swaminathan

Phase 1

Introduction: Increased states of anxiety or depression may lead to increased occurrences of dissociative behavior, justifying the need to validate pre-traumatic cognitive states as a predictor of dissociation post-trauma. Early prediction can lead to medical intervention for high-risk patients and prevent potential adverse sequalae. The AURORA Study evaluates biomarkers and neuropsychological sequelae in patients immediately following traumatic events. We predict patients who suffered from depressive symptoms and anxiety prior to the traumatic event will experience increased dissociative symptoms post-trauma.

Methods: This study includes survey data collected at ED’s from survivors (n = 666) of traumatic motorized vehicle collisions (MVC) at …

Dual Mobility Bearing Articulations Result In Lower Rates Of Dislocation After Revision Total Hip Arthroplasty., Zachary Kozick, William Li, Matthew Sherman, Camilo Restrepo, Md, Eric B. Smith, Md, P. Maxwell Courtney, Md

Phase 1

Introduction: The purpose of our study is to directly compare the rates of instability after revision total hip arthroplasty (THA) between a modular dual mobility (DM) and a conventional polyethylene single-bearing surface.

Methods: We retrospectively reviewed a consecutive series of patients who underwent revision THA from 2012 to 2016 at a single institution with a minimum of 2 years of follow-up. Rates of re-revision, dislocation, complications, and short-form (SF-12) scores were compared between the DM and single-bearing groups. To control for confounding variables, a multivariate logistic regression analysis was performed.

Results: Of the 267 revision THA patients, 94 patients …

Amelioration Of The Neuroinhibitory Local Environment After Ischemic Injury Through In Situ Astrocyte-To-Neuron Conversion, Abhinav K. Rao, Yu-Chen Chen, Ning-Xin Ma, Zi-Fei Pei, Susan Keefe, Emma Yellin, Miranda Chen, Fu-Han Yang, Xiao-Song He, Gong Chen

Phase 1

Ischemic injury in central nervous system (CNS) often causes severe neuronal loss and activates glial cells. We showed earlier that NeuroD1-mediated astrocyte-to-neuron (AtN) conversion can regenerate a substantial proportion of neurons (~40% of the total) and reconstruct the ischemic injured neural circuits. In this study, we focus on glial changes and blood vessel recovery following AtN conversion. Specifically, we found that ectopic expression of NeuroD1 in the reactive astrocytes after ischemic injury significantly reduced glial reactivity, as shown by less hypertrophic morphology, along with reduced secretion of neuroinhibitory factors such as CSPG and LCN2. As for microglia, we found less …

Is Facet Joint Distraction A Cause Of Postoperative Axial Neck Pain After Acdf Surgery?, Nathan Houlihan, Srikanth N. Divi, Md, Dhruv K.C. Goyal, John J. Mangan, Md, Justin D. Stull, Md, Matthew S. Galetta, Jeffrey A. Rihn, Mark F. Kurd, Md, D. Greg Anderson, Md, Alan S. Hilibrand, Md, Alexander R. Vaccaro, Md, Phd, Mba, Christopher K. Kepler, Md, Mba, Gregory D. Schroeder, Md, Joseph K. Lee, Md

Phase 1

Introduction: Intervertebral distraction in anterior cervical discectomy and fusion (ACDF) has been postulated to injure the degenerative facet joints posteriorly and increase postoperative pain and disability. This study aims to determine if there is a correlation between the amount of facet distraction and postoperative patient reported outcomes.

Methods: A retrospective cohort analysis of patients undergoing ACDF for degenerative pathologies was performed. Each patient received lateral cervical spine x-rays at the immediate postoperative time point and were split into groups based on the amount of facet distraction measured on these films: Group A: < 1.5 mm; Group B: 1.5-2.0 mm; and Group C: > 2.0 mm. Patients reported outcome measures were obtained …

Surgical Pulmonary Embolectomy Outcomes For Acute Pulmonary Embolism, Nicholas D. D'Antonio, Jae Hwan Choi, Md, Thomas J. O'Malley, Md, Elizabeth J. Maynes, Md, Matthew P. Weber, Ms, Martín Mellado, Md, Frances M. West, Md, Taki Galanis, Md, Carin F. Gonsalves, Md, Gregary D. Marhefka, Md, Bharat K. Awsare, Md, Geno J. Merli, Md, Vakhtang Tchantchaleishvili, Md

Phase 1

Introduction: Acute pulmonary embolism (PE) is associated with significant mortality. Surgical embolectomy is a viable treatment option; however, it remains controversial due to variable outcomes. This review investigates patient outcomes following surgical embolectomy for acute PE.

Methods: Electronic search was performed to identify articles reporting surgical embolectomy for treatment of PE. 32 studies were included comprising 936 patients. Demographic, perioperative, and outcome data were extracted and pooled for systematic review.

Results: Mean patient age was 56.3 [95% CI 52.5; 60.1] years and 50% [46; 55] were male. 82% had right ventricular dysfunction [62; 93], 80% [67; 89] had unstable …

The Effect Of Reflection Rounds On Medical Students’ Empathy, Erica Westlake, Jennifer Desantis, Med, Fred Markham, Md

Phase 1

Background: A decline in empathy has been noted in medical students in medical education and training. This decline raises concerns because empathic physician-patient interactions positively impact health outcomes and patient satisfaction. We tested the hypothesis that Reflection Rounds would increase empathy scores of third-year medical students.

Methods: Third-year students entering their Family and Community Medicine (FCM) clerkship completed the Jefferson Physician Scale of Empathy – Student Version (JPSE-S) at the onset of their clerkship; students at the Jefferson Campus site were assigned to the experimental group and students at Affiliate Sites were assigned to the control group. The experimental group …

An Investigation Of Anki Flashcards As A Study Tool Among First Year Medical Students Learning Anatomy, Tanvi Rana, Chaiya Laoteppitaks, Md, Guiyan Zhang, Md, Phd, Gregory Troutman, Shruti Chandra, Md

Phase 1

Purpose: Anatomy is a challenging course in medical school, in part because of the vast number of facts that must be memorized. Current literature suggests the value of spaced repetition in the learning of factual information, and online tools such as Anki flashcards have been developed to facilitate it. The purpose of this study is to investigate the role of curriculum-specific Anki flashcards as a study tool for first year medical students learning anatomy.

Methods: A set of Anki flashcards was created for the anatomy thread of the first block (i.e. back, pectoral, shoulder, vertebral regions) of the JeffMD curriculum …

Developing An Online Critical Care Electroencephalography Curriculum For Epilepsy And Neurophysiology Fellows, Brooke Hancock, Anne Woehling, Nathanael Lee, Md, Connie Tang, Md, Allyson Pickard, Md, Andres Fernandez, Md

Phase 1

Purpose: This project aims to create an Electroencephalography (EEG) curriculum that synthesizes the teachings of current publications and faculty expertise within a single digital platform. The goal is to remedy the unmet need for a centralized resource for learners to use when learning EEG interpretation.

Methods: The target learner population is epilepsy and neurophysiology fellows. The platform will be accessible from any computer, tablet, or phone, allowing for mobile, self-paced learning to take place. To date, the curriculum outline has been designed with extensive literature review and collaboration from other institutions, and two pilot modules have been completed using the …

Helping Continuing Care Retirement Communities Determine The Best Level Of Care For Each Patient, Sopuru Ezeonu, Nicholas Safian, Grant Schultheis, Austin Klein, Danielle Snyderman, Md

Phase 1

Background: Continuing Care Retirement Communities (CCRCs) consists of various neighborhoods and care spaces for senior adults. The neighborhoods are organized and residents are housed based on “levels of care” (LOC), Independent, Assisted, and Nursing. During scheduled interprofessional meetings, the CCRC leadership has the critical task of understanding the residents’ needs and assigning them to the appropriate LOC. Currently, the process of completing this task lacks the necessary structure, which engenders challenges in making recommendations in a systematic way. This project seeks to offer the CCRC interprofessional team a structured approach to determine which LOC and its resources would best serve …

3d Printing Of Knee Models To Decrease Or Time And Reduce Revisional Surgery In Total Knee Arthroplasty (Tka), Lauren Schlegel, John Paul Prodoehl, Matthew Chadwick, Chris Li, Katelyn Koons, Jeffrey Henstenburg, Md

Phase 1

Project Background: Osteophytes are a common problem, affecting 2% of the United States population. For many elderly people, these osteophytes will cause them to seek medical attention. Due to the 2-D nature of MRIs and CT scans, it can be difficult to gain a complete understanding of the complicated soft tissue structures surrounding the joint when performing a Total Knee Arthroplasty(TKA). Without proper removal of osteophytes and correct soft tissue balancing, there is an increased rate of revisional surgery. By utilizing a 3-D model preoperatively and within the OR, surgeons can visualize various aspects of the knee to determine what …

Electronic Health Records: All That They’Re Chalked Up To Be?, Mac Williams, Meghan Gannon, Phd

Phase 1

Introduction. The United States faces a challenge: how to improve access to healthcare with an aging physician workforce. An aging baby boomer population prompts higher medical demands, further heightening this challenge. Although measures to increase the longevity of practice for older physicians could help address this challenge, the federal government has lacked to create such policy.

Methods. This study looked at the role of electronic health records and the American Recovery and Reinvestment Act in the ability of primary care physicians to continue practice through in-depth qualitative interviews. A total of N=5 interviews were conducted in-person and remotely using a …

A Quality Improvement Initiative To Reduce Time To Antibiotics In Oncologic Neutropenic Fever, Jordan Villars, Adam Binder

Phase 1

Introduction: This paper documents a Quality Improvement (QI) initiative using Plan-Do-Study-Act (PDSA) cycles to decrease time to antibiotics (TTA) in oncologic neutropenic fever (NF) patients in a large tertiary-care academic medical center to the national guideline target of 60 minutes.

Methods: We measured baseline NF TTA across hospital units in the summer of 2018 and analyzed factors underlying delays in antibiotic treatment. We then developed a multi-disciplinary team to implement four proposed interventions:

1. Ensure that oncology floors are appropriately stocked with antibiotics required for initial NF treatment
2. Implement a nursing based order set for treatment of new NF cases. …

Narrative Medicine: A Reflective Writing Workshop Series For Interprofessional Healthcare Students At Thomas Jefferson University, Carly S. Slater, Ma, Ms, Brooke Salzman, Md, Rosemary Frasso, Phd, Cph

Phase 1

Introduction: Narrative medicine (NM) teaches reflective writing and close reading to help healthcare professionals think critically about themselves and others in order to offer more effective, empathic care. Few reports of NM methods document its value to facilitating collaboration and communication across students of different professional backgrounds. This study examines the effects of NM workshops on Thomas Jefferson University interprofessional healthcare students, and their utility to achieving these aims: 1) supporting thoughtfulness, mindfulness, and curiosity; 2) supporting the development and use of narrative in understanding the lives/contexts for self and others; 3) improving interactions and communication with others in professional …

The Role Of The Uncinate Margin In Pancreaticoduodenectomy For Pancreatic Ductal Adenocarcinoma: A Survival Analysis, David Nauheim, Richard Zheng, Md, Jonathan Bassig, Matthew Chadwick, Christopher Schultz, Harish Lavu, Md, Facs, Jordan R. Winter, Md, Facs, Charles J. Yeo, Md, Facs, Adam C. Berger, Md, Facs

Phase 1

Introduction: Positive margins during pancreaticoduodenectomy for pancreatic cancer portend worse survival, but additional resection of the uncinate margin is typically unfeasible without major vascular reconstruction. The survival benefit of resecting additional neck or bile duct margins in the face of a positive uncinate is also unknown. We examined the impact of re-resection of these margins on survival.

Methods: Patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy from 2006-2015. Pancreatic neck, bile duct, uncinate, and duodenal frozen section margins were assessed before and after resection of positive margins. Kaplan-Meier survival curves were compared with log-rank tests. Multivariable Cox regression was used to …

A Module-Based Novel Approach To Electrocardiogram Interpretation For Emergency Medicine Residents, Alexandra Koutsoubis, Emily Fishbein, Jennifer White, Md

Phase 1

Purpose: In the Emergency Department, accurate ECG interpretation is essential as many conduction abnormalities are treatable and can lead to death if inaccurately diagnosed. Learning how to read a 12-lead ECG is part of medical education, taught through the following approach: rate, rhythm, axis. In the ED, this tedious approach doesn’t relay important information that should be garnered from the ECG with accuracy. Currently, resources for residents to improve ECG interpretation skills are limited. The purpose of the study was to design a module that teaches an accurate way of interpreting an ECG, that allows for pragmatic, pattern recognition of …

The Effect Of The Surgery Rotation Sequence On Surgery And Emergency Medicine Nbme Scores, Anna Lin, Gerald Isenberg, Md, Chaiya Laoteppitaks, Md

Phase 1

Purpose: Within a school, the formerly fourth year emergency medicine clerkship was added to the third year curriculum in a sequence with general surgery and surgical subspecialty clerkships. Together, a student can be placed in any permutation of the three clerkships, but a student will take the Surgery and EM NBME exam after the completion of the respective clerkship regardless of the order of clerkships. The purpose of this project was to look to see if there was a significance difference in NBME scores between four different sequences of clerkships and to see if sequence of a third year student’s …

Investigating Chronic Illness In Pathways To Housing Clients, Joshua Malerich, Lara Weinstein, Md, Dph

Phase 1

Approximately 553,000 individuals were homeless in the US each night in 2017, each at significant risk for substance use disorder, severe mental illness, and untreated chronic disease. Housing First (HF) is an evidence-based model for reaching high risk homeless individuals by providing a personal home to clients without the requirement for abstinence. HF has been shown as effective as other frameworks in remission of substance use, connectedness in the community, and client perceived quality of life, but there is a gap in the literature regarding the impact of HF services on clinical measures of chronic health, which could help further …

An Educational Workshop To Improve Neurology Resident Knowledge And Understanding Of Burnout, Substance Abuse, And Mood Disorders, Shiori Tomatsu, Ryan Donaghy, Patrick Kerns, Md, Phd, Courtney White, Md

Phase 1

Problem: Many medical residents are at risk for burnout, mood disorders, and substance abuse. We created an educational activity composed of an online module (OM), an interactive role-playing session (AL), and a video practicum (VP) to inform neurology residents on the aforementioned risks and available support resources. This project evaluates the efficacy of these tools.

Methods: PGY2 and PGY3 neurology residents were given OM. In addition, the PGY2 residents participated in AL. Three surveys were given to assess their knowledge about burnout before completing the module (Sur1), after AL session (Sur2), and after watching VP(Sur3).

Outcomes: More PGY2 residents scored …

Motivational Interviewing For Cpap Adherence, Caitlin Green, Grayton Downing, Cindy Cheng, Md, Phd

Phase 1

Background: Continuous Positive Air Pressure (CPAP), is the gold standard for obstructive sleep apnea (OSA) treatment. If left untreated, patients with OSA can experience serious and potentially life-threatening consequences. However, patient CPAP adherence is an ongoing problem, as compliance rates are historically low (typically 30-60%). Engaging patients in motivational interviewing (MI) by trained providers could promote increased CPAP adherence.

Question/Purpose: Assess CPAP compliance in patients who receive motivational interviewing compared to a control attention intervention.

Methods: A team of medical students were trained in MI interviewing techniques through a novel training protocol. The training protocol includes reading articles and watching …

Assessing Student Opinion On Autopsy As A Supplement To Medical Education, Wing Fei Wong, Joanna Chan, Md

Phase 1

Purpose: Medical schools in the United States have decreased use of autopsy as a teaching tool in undergraduate medical education (UME). However, there are no recent data to understand how undergraduate medical students (UMS) value autopsies in their education, thus limiting suggestions for improving UME. This study aims to assess UMS opinion regarding autopsies as a supplement to their medical curriculum: is autopsy important and how?

Methods: This was a questionnaire study targeted to UMS at Sidney Kimmel Medical College. The questionnaire contained 51 closed- and open-ended questions (e.g. multiple choice, Likert scale, free response), and was distributed electronically. Data …