Medicine and Health Sciences Commons^™

The Functional Outcome Of Direct Lateral Approach For Fixation Of Proximal Humeral Fractures: A Case Series From A Tertiary Care Hospital, Mujahid Jamil, Irfan Anwer, Muhammed Tabish Saleem, Ahmed Abdul Habib Khan, Mohammad Zohaib Nawaz Khan

Section of Orthopaedic Surgery

Displaced proximal humeral fractures warrant surgical fixation for early rehabilitation and better functional outcome. These fractures are traditionally fixed by delto pectoral surgical approach. Direct lateral approach has recently gained interest as it involves less soft tissue dissection and is particularly helpful in certain fracture patterns. However, there have been concerns of axillary nerve damage with this approach. We report a case series of proximal humerus fractures fixed by direct lateral approach from our institution. All displaced Type 2 and 3 fractures were included in our study. Pathological and comminuted Type 4 fractures and fractures with ipsilateral clavicle or elbow …

Responding To Crisis: Farmer Mental Health Programs In The Extension North Central Region, Shoshanah Inwood, Florence Becot, Andrea Bjornestad, Carrie Henning-Smith, Andrew Alberth

Counseling and Human Development Faculty Publications

A number of current events are exacerbating farm stress. Extension and farm organizations have mobilizedresponses to an emerging mental health crisis among farmers. To evaluate these responses, we conducted anonline scan of resources to present a baseline typology of current mental health programs and response effortsin the 12-state Extension North Central Region. We classified responses by type of program, target audience,and delivery format. We identified the need to train mental health counselors and state suicide hotlineresponders on farm issues and farm culture.

Can Cmws Sustain Quality Services And High Coverage As Private Providers In Chitral? A Three-Year Prospective Qualitative Study, Rafat Jan, Arusa Lakhani, Salma Rattani, Laila Lalji, Kiran Mubeen, Mehtab Q. Jaffer

Journal of Asian Midwives (JAM)

Background: The maternal and neonatal mortality ratesof Chitral district of Pakistan are among the highest in the country. One of the factors that found to havepositive impact on maternal and newborn health indicators is the availability ofquality skill birth attendance because the majority of the poor women cannot access facility-based maternity care. Therefore, in 2006, the Government of Pakistan (GOP) has initiated a program to train and deploy Community Midwives (CMWs) to support safe pregnancies and births. The Aga Khan Health Service’ Pakistan, initiated the Chitral Child Survival Program (CCSP) in partnership with the National Maternal Neonatal and Child Health …

Hiv-Related Discriminatlon And Cervical Cancer Screening In Zambia, Crystal J. Cazier

Dissertations and Theses (Open Access)

Background: The Republic of Zambia has the third-highest incidence of cervical cancer in the world, where approximately 700,000 women over age 15 are living with HIV. Women living with HIV (WLHIV) are at increased risk for cervical cancer. While literature suggests that discrimination is a barrier to HIV care, no studies have explored if discrimination experienced in HIV clinics is related to cervical cancer screening using nationally representative datasets. Objective: The primary objective of this study was to examine whether perceived discrimination by healthcare workers due to HIV status is related to having been screened for cervical cancer among WLHIV. …

La Priorización De Comportamientos Para Mejorar Programas De Cambio Social Y De Comportamiento Durante Una Emergencia De Salud Pública: Un Llamado A La Acción, Breakthrough Research

Poverty, Gender, and Youth

A medida que los especialistas en desarrollo internacional continúan trabajando en los desafíos de la salud pública y nuevas enfermedades emergentes, es de suma importancia la priorización de comportamientos. Este breve informe tiene como objetivo argumentar por qué es importante la priorización de comportamientos para fortalecer los programas de cambio social y de comportamiento (CSC). El documento finaliza con un llamado a la acción a que diferentes actores interesados aboguen por y participen en procesos que prioricen comportamientos como parte del diseño, planificación y adaptación de programas de cambio social y de comportamiento.

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As the international development community continues …

Effect Of Education About Pediatric Immunization Schedule And Vaccine Administration On Family Medicine Clinic Providers And Clinical Staff Knowledge And Confidence, John Matthew Derfelt

Doctor of Nursing Practice Scholarly Project

Significance: In this original research, the purpose of this project is to compare and promote increased pediatric immunization knowledge among healthcare providers and clinic staff of a family medicine clinic. In turn, there is greater compliance with the Centers for Disease Control and Prevention’s (CDC) recommended immunization schedule and adherence to vaccinations against the 17 vaccine-preventable diseases.

Methods: This exploratory pilot case study surveyed 34 individuals by using an educational tool with information regarding the current CDC-recommended pediatric vaccination schedule. Prior to reviewing the educational material, the participant tested their baseline knowledge about vaccination scheduling and immunization administration. …

Chapter 14: Hospice And End-Of-Life Care, Sally Pelon, Brandon Youker, M. Paola Leon

Books and Contributions to Books

This chapter explores end-of-life issues and concerns as well as the hospice movement’s role in assisting terminally ill individuals. Specific social work assessment and interventions tools are offered considered as well as controversial issues in end-of-life care.

Driving Sustainment: Quality Management Packages, Lynn Weddle

Articles, Abstracts, and Reports

Tired of revisiting the same problems? Quality Management Packages are an approach to sustain change around complex quality outcomes such as hospital acquired infections so that the problems remain solved.

Ulnar Collateral Ligament Reconstruction With Traditional Docking Compared To Novel Surgical Techniques, Kayley D. Guy, Brendon P. Mcdermott, Kaitlin Gallagher, Tyrone Washington

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Ulnar Collateral Ligament Reconstruction (UCLR) is a surgical procedure on one of the main ligaments that provides normal stability for the elbow joint against excessive valgus stress. Damage to this ligament is common in athletes performing overhead throwing activities, primarily baseball players, due to excessive valgus stress during the throwing motion. The most common form of treatment for this type of injury is reconstructive surgery of the ligament, especially if athletes wish to return to sport participation. This type of surgery is extremely invasive and requires extensive post-operative rehabilitation in order to facilitate return to play. To date, many …

Clinical Interventions Documented By Appe Students: Results From A Pilot Study, Elizabeth Laughlin, Bsps, Danielle Mayer, Pharmd, Bcacp, Sarah Lynch, Pharmd, Bcacp

College of Pharmacy Posters

Primary Objective: Evaluate the types of drug therapy problems identified by student pharmacists and the results of these interventions.

Secondary Objective: Evaluate trends in trends of what type of interventions are identified and how they are defined.

Sighting Acute Myocardial Infarction Through Platelet Gene Expression., Giuliana Gobbi, Cecilia Carubbi, Guidantonio Malagoli Tagliazucchi, Elena Masselli, Prisco Mirandola, Filippo Pigazzani, Antonio Crocamo, Maria Francesca Notarangelo, Sergio Suma, Elvezia Paraboschi, Giuseppe Maglietta, Srikanth Nagalla, Giulia Pozzi, Daniela Galli, Mauro Vaccarezza, Paolo Fortina, Sankar Addya, Adam Ertel, Paul Bray, Stefano Duga, Carlo Berzuini, Marco Vitale, Diego Ardissino

Department of Cancer Biology Faculty Papers

Acute myocardial infarction is primarily due to coronary atherosclerotic plaque rupture and subsequent thrombus formation. Platelets play a key role in the genesis and progression of both atherosclerosis and thrombosis. Since platelets are anuclear cells that inherit their mRNA from megakaryocyte precursors and maintain it unchanged during their life span, gene expression profiling at the time of an acute myocardial infarction provides information concerning the platelet gene expression preceding the coronary event. In ST-segment elevation myocardial infarction (STEMI), a gene-by-gene analysis of the platelet gene expression identified five differentially expressed genes: FKBP5, S100P, SAMSN1, CLEC4E and S100A12. The logistic regression …

Implementing A Result Notification And Referral System In A Nurse-Led Wellness Center, Christine Bollom

Doctor of Nursing Practice

Cervical and breast cancer screenings reduce the risk of morbidity and mortality for American women. In 2017, about 70% of U.S. women over the age of 21 obtained a Papanicolaou (Pap) test, which screens for cervical cancer. African American women have a cervical cancer screening rate of 74.6% and Hispanic women have a rate of 68.6%. The cervical cancer screening rates decrease to 51% for women who are uninsured (Centers for Disease Control and Prevention, 2017). In the United States, 50% of women older than 40 are current on their screening mammogram. African American women have a screening mammogram rate …

Surviving Sepsis: A Treatment Process Improvement In High Volume Emergency Departments, Brittney Burns

Doctor of Nursing Practice

Sepsis is the 3rd leading cause of death in the United States, accounting for approximately 270,000 deaths annually (CDC, 2017). It is the number one cause of death in hospitals, the number one cause of hospital readmissions, and the costliest diagnosis in the hospital setting (Fingar & Washington, 2015; Torio & Andrews, 2015). This quality improvement project aimed to increase the percentage of antibiotics administered within 1 hour for sepsis patients. Mortality rates significantly decrease when this goal is met (Howell & Davis, 2017). There is an 8% increase in mortality risks with every hour that passes with elevated lactic …

Using The Adam Questionnaire In Primary Care To Identify Hypoandrogenism In Males Aged 40 Years Or Older, Jeremy Burns

Doctor of Nursing Practice

Testosterone replacement therapy (TRT) has been shown to improve the symptoms of metabolic syndrome by reducing Hemoglobin A1C, belly fat, cholesterol, and blood pressure (Cunningham, 2015). The ultimate goal for testosterone-deficient patients is to have an improved quality of life by starting TRT. This quality improvement project was conducted at a small primary care clinic in South Texas. The project was started by screening 84 male patients ≥ 40 years of age using the Androgen Deficiency in Aging Males (ADAM) questionnaire. The ADAM questionnaire was considered positive for anyone who answered “yes” to 3 or more questions or “yes” to …

Implementation Of Ace Inhibitor Regimen In Patients With Type 2 Diabetes Mellitus, Rita Chukwurah

Doctor of Nursing Practice

The incidence of type 2 diabetes has increased dramatically and is associated with many problems, including chronic kidney disease. The purpose of this quality improvement project was to implement two evidence-based guidelines that may detect chronic kidney disease and slow its progression in patients with type 2 diabetes by implementing angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy according to evidence-based guidelines from the American Diabetes Association. Patients with type diabetes were screened for microalbuminuria and eGFR of < 60 mL/min/1.73 m². Based on lab results, the provider recommended either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to patients with as …

Improving Provider Adherence To Guidelines And Screening For Adult Depression In Primary Care, Amber Crenshaw

Doctor of Nursing Practice

The purpose of this QI project was to improve provider adherence to the Institute for Clinical Systems Improvement (ICSI) Guidelines for Adult Depression in Primary Care to enhance the screening, diagnosis, treatment, and management of adult major depressive disorder (MDD). MDD is a widespread, disabling, and treatable psychiatric disorder that is primarily treated and managed by primary care providers (PCPs). Untreated depression is prone to become chronic and can lead to pain, suffering, disability, increased morbidity and mortality, and premature death, with serious repercussions for the individual and society. Universal and routine screening in primary care for depression in adults, …

Evidence-Based Foot Care For Persons With Type 2 Diabetes, Nicole Gutierrez

Doctor of Nursing Practice

Unmanaged Type 2 diabetes leads to macrovascular changes that affect the lower extremities, thereby damaging the sensory nerve fibers and leading to diabetic peripheral neuropathy. These patients may not be able to feel pain, heat, or cold in their lower extremities and often describe feelings of numbness and tingling. This sensory deficit may lead to the development of diabetic foot ulcers which often result in amputation. These preventable foot complications may be identified promptly with adequate diabetic foot exams. Comprehensive diabetic foot examinations reduce the occurrences of foot complications associated with uncontrolled glucose management and improves health outcomes for patients …

A Quality Improvement Initiative To Improve Depression Screening In Prenatal And Postpartum Mothers, Britanni Greene

Doctor of Nursing Practice

Screening for depression during the prenatal and postpartum period is essential. The United States has the highest mortality rate in the developed world, with mental health complications being 1 of the top 5 reasons women expire within the 1st year of childbirth. The purpose of this quality improvement project was to increase depression screening during the gestational and postpartum periods in an obstetric and gynecological clinic. An administration schedule was created to administer the Edinburgh Postnatal Depression Scale (EPDS). The EPDS was administered during the initial prenatal, 32-weeks prenatal, and 6-week postpartum appointments. Women scoring 10 or higher on the …

Quality Improvement Initiative To Increase Comprehensive Eye Exams In Patients With Diabetes, Julia Khoury

Doctor of Nursing Practice

Diabetic retinopathy is the most common microvascular complication associated with poorly controlled diabetes. Yet, only 60% of the diabetic population receives an annual eye examination by an eye specialist. Retinal imaging increases surveillance of retinopathy, however, it does not take the place of a comprehensive eye examination by an ophthalmologist or optometrist. The aim of this quality improvement project was to increase comprehensive eye examinations in patients with diabetes aged 18 to 75 years in a family practice that recently purchased a retinal imager. This quality improvement project occurred over a 10-week period. Project objectives included increasing comprehensive dilated eye …

Implementing A Cognitive Impairment Care Planning Toolkit To Enhance Dementia Care: A Quality Improvement Project, Raquel Garcia-Priestly

Doctor of Nursing Practice

Background: Alzheimer’s is the most expensive disease in the United States with costs reaching $277 billion a year and affecting 5.7 million Americans. By 2050, 14 million Americans will have Alzheimer’s disease and related dementias (ADRD). This burdensome disease not only affects the individual, but also those who are responsible for their care, making it extremely complex to manage. Purpose: To systematically integrate the Alzheimer’s Association’s Cognitive Impairment Care Planning Toolkit in an outpatient mental health clinic to enhance care by effectively addressing the needs of patients with ADRD and of their caregivers. Objectives: Increase the number of patients with …

An Evidence-Based Intervention To Reduce The Use Of Physical Restraints In A Female Adolescent Population At An Inpatient Psychiatric Unit, Mambo Ndingwan

Doctor of Nursing Practice

The use of physical restraints within psychiatric units is problematic since it raises a range of legal, ethical, and clinical questions (American Psychiatric Nurses Association, 2014). The use of physical restraint has become a common practice in many psychiatric units despite the negative effects associated with its use. Selecting strategies such as verbal de-escalation to manage aggressive psychiatric inpatients shows promise with patients when used by providers and staff in mental health facilities. The purpose of this evidence-based project was to introduce and train staff to utilize the Modified Overt Aggression Scale (MOAS) and verbal de-escalation in psychiatric units in …

Managing Childhood Obesity In A Primary Care Clinic, Linda Nnajiofor

Doctor of Nursing Practice

Background: Childhood obesity and overweight have increased health burdens on health care systems, and contribute to chronic diseases such as diabetes, heart disease, asthma, and cancer. Childhood obesity is very complex for healthcare providers to manage in primary care settings.

Purpose: To improve childhood overweight and obesity approach and management in a selected primary care practice (Clinic A) in a large east Texas urban community.

Objectives: 1. Increase the percentage of children and adolescents ages 2 to 19 years seen in Clinic A, who received adequate weight management and obesity counseling, to 75%. 2. Increase the number of referrals to …

Improving Residential Asthma Assessment Strategies Within A Low Socioeconomic Community, Monica Ramirez

Doctor of Nursing Practice

Background: Nationally, there are currently 6 million children under the age of 18 with asthma. There are a variety of social determinants and in-home environmental triggers that can contribute to the development of or exacerbation of asthma in children. Therefore, it is important to recognize and improve the needs of children with asthma in older homes and in households with a lower socioeconomic status.

Aim: The aim of this project was to decrease the number of in-home environmental asthma triggers within at-risk homes in San Antonio, Texas.

Purpose: The purpose of this evidence-based practice project was to improve asthma outcomes …

Implementing A Tracking And Referral Follow-Up Process To Increase Screening Colonoscopy Adherence Within A Primary Care Setting, Stephanie Villanueva

Doctor of Nursing Practice

Within the United States, colorectal cancer is the fourth most common cancer diagnosed in both women and men. The American Cancer Society approximated that 97,220 new colon cancer cases and 43,030 rectal cancer cases would occur within 2018. Overall, it was estimated there were approximately 50,630 colorectal cancer deaths in 2018. Despite recommended guidelines, reported screening rates are only 31% to 55%, well below the goal of 75% set by the American Cancer Society. The purpose of this project was to increase preventative colorectal cancer screening referrals and completion of colonoscopies for qualified individuals age 50–75 years within a family …

A Quality Improvement Initiative To Facilitate Provider Adherence To Type Ii Diabetes Mellitus Guidelines, Yazmin Valencia

Doctor of Nursing Practice

Background:A significant number of individuals with type 2 diabetes mellitus do not receive comprehensive diabetes care management to maintain optimal health.

Purpose:This project was designed to facilitate provider adherence to the type 2 diabetes mellitus evidence-based practice standards of care. A primary care practice needs assessment indicated opportunities to improve care management processes which promote adherence to current clinical practice guidelines.

Methods:This 10-week quality improvement project provided the clinical staff and provider with the necessary tools to implement best practices of diabetes care. Objectives assessed throughout project implementation included the design and use of an electronic health …

Winning The Battle And The War Against C. Difficile, Emily Villegas

Articles, Abstracts, and Reports

In 2016 Providence St. Patrick Hospital Serious Infection Rate (SIR) for Hospital Acquired C. difficile Infections (HACDI) was well above the acceptable standard. Several departments were working independently of each other to develop and implement interventions. However, these efforts did not result in sustained improvement and in some cases there where downstream consequences that made the problem worse.

Optimizing Care Teams From The Start, Vanessa Casillas, Ryan Dix

Articles, Abstracts, and Reports

Traditionally, the onboarding plan for a new provider is focused on the new employee. But what happens when the success of your role is largely impacted by the relationships you have with others on the interdisciplinary care team? Interprofessional relationships are a key element of Behavioral Health Consultant (BHC) success in their role and the earlier they can start being developed the better. This presentation will identify strategies to help management teams create effective onboarding plans for the BHC that facilitate smooth adoption of integrated principles and launch successful interdisciplinary collaboration across the care team.

Pedia: Prioritization Of Exome Data By Image Analysis., Tzung-Chien Hsieh, Martin A Mensah, Jean T Pantel, Dione Aguilar, Omri Bar, Allan Bayat, Luis Becerra-Solano, Heidi B Bentzen, Saskia Biskup, Oleg Borisov, Oivind Braaten, Claudia Ciaccio, Marie Coutelier, Kirsten Cremer, Magdalena Danyel, Svenja Daschkey, Hilda David Eden, Koenraad Devriendt, Sandra Wilson, Sofia Douzgou, Dejan Đukić, Nadja Ehmke, Christine Fauth, Björn Fischer-Zirnsak, Nicole Fleischer, Heinz Gabriel, Luitgard Graul-Neumann, Karen W Gripp, Yaron Gurovich, Asya Gusina, Nechama Haddad, Nurulhuda Hajjir, Yair Hanani, Jakob Hertzberg, Konstanze Hoertnagel, Janelle Howell, Ivan Ivanovski, Angela Kaindl, Tom Kamphans, Susanne Kamphausen, Catherine Karimov, Hadil Kathom, Anna Keryan, Alexej Knaus, Sebastian Köhler, Uwe Kornak, Alexander Lavrov, Maximilian Leitheiser, Gholson J Lyon, Elisabeth Mangold, Purificación Marín Reina, Antonio Martinez Carrascal, Diana Mitter, Laura Morlan Herrador, Guy Nadav, Markus Nöthen, Alfredo Orrico, Claus-Eric Ott, Kristen Park, Borut Peterlin, Laura Pölsler, Annick Raas-Rothschild, Linda Randolph, Nicole Revencu, Christina Ringmann Fagerberg, Peter N Robinson, Stanislav Rosnev, Sabine Rudnik, Gorazd Rudolf, Ulrich Schatz, Anna Schossig, Max Schubach, Or Shanoon, Eamonn Sheridan, Pola Smirin-Yosef, Malte Spielmann, Eun-Kyung Suk, Yves Sznajer, Christian T Thiel, Gundula Thiel, Alain Verloes, Irena Vrecar, Dagmar Wahl, Ingrid Weber, Korina Winter, Marzena Wiśniewska, Bernd Wollnik, Ming W Yeung, Max Zhao, Na Zhu, Johannes Zschocke, Stefan Mundlos, Denise Horn, Peter M Krawitz

Faculty Research 2019

PURPOSE: Phenotype information is crucial for the interpretation of genomic variants. So far it has only been accessible for bioinformatics workflows after encoding into clinical terms by expert dysmorphologists.

METHODS: Here, we introduce an approach driven by artificial intelligence that uses portrait photographs for the interpretation of clinical exome data. We measured the value added by computer-assisted image analysis to the diagnostic yield on a cohort consisting of 679 individuals with 105 different monogenic disorders. For each case in the cohort we compiled frontal photos, clinical features, and the disease-causing variants, and simulated multiple exomes of different ethnic backgrounds.

RESULTS: …

The Alliance Of Genome Resources: Building A Modern Data Ecosystem For Model Organism Databases., Alliance Of Genome Resources Consortium, Carol J Bult, Judith A. Blake, Brian R Calvi, J. Michael Cherry, Valentina Difrancesco, Robert Fullem, Kevin L Howe, Thom Kaufman, Chris Mungall, Norbert Perrimon, Mary Shimoyama, Paul W Sternberg, Paul Thomas, Monte Westerfield

Faculty Research 2019

Model organisms are essential experimental platforms for discovering gene functions, defining protein and genetic networks, uncovering functional consequences of human genome variation, and for modeling human disease. For decades, researchers who use model organisms have relied on Model Organism Databases (MODs) and the Gene Ontology Consortium (GOC) for expertly curated annotations, and for access to integrated genomic and biological information obtained from the scientific literature and public data archives. Through the development and enforcement of data and semantic standards, these genome resources provide rapid access to the collected knowledge of model organisms in human readable and computation-ready formats that would …

Editorial Perspective For Systematic Review On C5 Palsies., Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.