Heparin Vs. Saline: Evaluating Evidence-Based Best Practice For Maintaining Patency Of Implanted Ports, Shannon D. Murdock

Master's Theses and Capstones

Background Implanted ports are frequently used for central venous access in the adult oncology population. Maintaining patency of these ports is important for continuing uninterrupted treatment and supportive care for oncologic patients. Historically, heparin solution has been used as a locking solution for implanted ports to prevent occlusion. However, evidence shows that 0.9% sodium chloride (normal saline or NS) as a lock solution is equally effective as heparin solution at maintaining implanted port patency and poses less risk to patients.

Local Problem In an ambulatory adult oncology clinic serving Seacoast New Hampshire, a gap was identified between clinical practice where …

Implementing Change: The Use Of Minocycline-Rifampin Impregnated Central Venous Catheters In Central Line Associated Blood Stream Infection Prevention In Critically Ill Patients, Shawn B. Murray

Master's Theses and Capstones

Introduction: At a large academic healthcare facility in the northeast a Gap Analysis was conducted finding quality improvement opportunities for central line associated blood stream (CLABSI) prevention in critically ill patients. Review of literature reveals the use of minocycline-rifampin impregnated (MNRI) central venous catheters (CVCs) as being an effective intervention in CLABSI prevention.

Methods: Several assessments were conducted regarding the implications of updating the facilities practice to reflect this evidence including AHRQ Gap Analysis Tool, a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, Stakeholder Feedback, and Resource Allocation.

Results: Facilitators and barriers were identified in implementing this …

Streamlining The Postpartum Educational Process For Safe And Equitable Patient Care: A Quality Improvement Initiative, Shea N. Cook

Master's Theses and Capstones

Abstract

BACKGROUND:

Postpartum discharge education is essential in the care of mothers, newborns, and their families as they transition from the hospital setting to home. The U.S Department of Health and Human Services has identified postpartum discharge education content as a public health priority to reduce physical and mood-related postpartum complications. Over half of all serious morbidity and mortality complications occur after a postpartum patient leaves the hospital. It is essential that hospitals utilize the best evidence-based practices to maximize the impact of patient education during maternity care in the hospital.

LOCAL PROBLEM:

Within the given microsystem there is a …

Enhancing Nurses' Self-Efficacy In Smoking Cessation Counseling To Improve Patient- Centered Care At A Federally Funded Urgent Care Center: A Quality Improvement Initiative, Adam N. Waller Ii

Master's Theses and Capstones

Background: It is well documented that there is a high prevalence of Veteran tobacco use in the United States. Additionally, providing smoking cessation counseling in an emergency setting is beneficial. The broader Veteran Affairs (VA) macrosystem has a plethora of smoking cessation resources available for Veterans. Within a VA Urgent Care Center (UCC) a quality improvement initiative was conducted that focused on increasing registered nurses (RNs) self-efficacy in providing smoking cessation counseling. Prior to this quality improvement (QI) project, smoking cessation did not occur in this UCC. If RNs have higher self-efficacy more smoking cessation counseling will occur.

Methods …

Utilization Of The Broset Violence Checklist For Early Identification Of Aggressive And Violent Behavior To Improve Unit Safety: A Quality Improvement Initiative, Emily Sharretts

Master's Theses and Capstones

BACKGROUND: There continues to be an increase in workplace violence nationally in the healthcare setting which jeopardizes patient and staff safety. Liu et al. (2019) found about 59% of health care workers experience workplace violence. Kafle et al. (2022) emphasizes the link between workplace violence and increased levels of nurse burnout and therefore decreased job satisfaction.

LOCAL PROBLEM: The microsystem assessment revealed that there was no risk assessment tool to identifying early aggressive or violent patient behavior.

METHODS: The Plan-Do-Study-Act (PDSA) framework was used for this quality improvement project to reduce workplace violence on this unit.

INTERVENTIONS:After completion …

Promoting Safety Of Medication Administration And Reducing Medication Errors Using Photographic Patient Identification In An Inpatient Psychiatric Setting: A Quality Improvement Initiative, Kyla Kelly

Master's Theses and Capstones

Abstract

Background: Medication errors pertaining to patient wristband workarounds in a behavioral and mental health inpatient unit can affect patient outcomes, safety and can even be fatal. The proper verification of the five rights of medication administration, patient acuity, diagnosis, and unit staffing can impact the need for patient wristband workarounds to occur. Improving staff and patient education and reducing the need for wristband workarounds through the utilization of patient photographic identification significantly reduces the number of medication errors relating to wristband workarounds during the medication administration process. Additionally, a significant reduction in the time it takes to administer medications …

Implementation Of A Multipronged Approach To Improve Pre-Operative Efficiency And First Case On Time Start Performance, Melyssa A. Stokes

Master's Theses and Capstones

Background: Surgical services are an important source of revenue and important economic driver of hospital systems. Surgical services account for approximately 42% of a hospital’s annual revenue, however, it also constitutes 40% of facility operating costs (Gupta, et al., 2022 & Morel & Gomez, 2021). Despite the high costs associated with surgical services delays remain a significant issue across the nation. On-time starts for the first surgical cases of the day is a key performance metric tracked by surgical facilities to determine efficiency. Currently, 50 – 90% of first surgical cases are delayed throughout the United States and the most …

A Review Of Alternative Proteins For Vegan Diets: Sources, Physico-Chemical Properties, Nutritional Equivalency, And Consumer Acceptance, Rutwick Surya Ulhas, Rajeev Ravindran, Alok Malviya, Anushree Priyadarshini, Brijesh K. Tiwari, Gaurav Rajauria

Articles

Alternate proteins are gaining popularity as a more sustainable and environmentally friendly alternative to animal-based proteins. These proteins are often considered healthier and are suitable for people following a vegetarian or vegan diet. Alternative proteins can be recovered from natural sources like legumes, grains, nuts, and seeds, while single cell proteins (mycoproteins), and algal proteins are being developed using cutting-edge technology to grow fungus, yeast and algal cells in a controlled environment, creating a more sustainable source of protein. Although, the demand for alternative protein products is increasing, there still happens to be a large gap in use among the …

The Complicated Existence Of Psychedelic Drugs, Corinne Stonebraker

Quill & Scope

No abstract provided.

Preclinical Impressions, Conor Prendergast

Quill & Scope

No abstract provided.

Nasal Accumulation And Metabolism Of Δ9-Tetrahydrocannabinol Following Aerosol (‘Vaping’) Administration In An Adolescent Rat Model, Alexa Torrens, Christina M Ruiz, Maricela X Martinez, Alex Mabou Tagne, Pritam Roy, Dakota Grimes, Faizy Ahmed, Valeria Lallai, Victoria Inshishian, Malia Bautista, Yen-Chu Chen, Marilyn A. Huestis, Aditi Das, Christie D Fowler, Stephen V Mahler, Daniele Piomelli

Institute of Emerging Health Professions Faculty Papers

Passive aerosol exposure to Δ9-tetrahydrocannabinol (THC) in laboratory animals results in faster onset of action and less extensive liver metabolism compared to most other administration routes and might thus provide an ecologically relevant model of human cannabis inhalation. Previous studies have, however, overlooked the possibility that rodents, as obligate nose breathers, may accumulate aerosolized THC in the nasal cavity, from where the drug might directly diffuse to the brain. To test this, we administered THC (ten 5-s puffs of 100 mg/mL of THC) to adolescent (31-day-old) Sprague-Dawley rats of both sexes. We used liquid chromatography/tandem mass spectrometry to quantify the …

Incorporating Genomic Analysis In The Clinical Practice Of Hepatology, David Hun Chung

Yale Medicine Thesis Digital Library

In the past two decades, whole-exome sequencing has been successfully demonstrated as an indispensable instrument in uncovering the genetic etiology underlying numerous types of unexplained liver disease. Characterization of these illnesses into distinct molecular disease entities has revolutionized understanding of pathophysiology and has translated into improved guidance on management, treatment and prognosis for patients. However, hepatologists have been slow to welcome the technology into their mainstream clinical practice, largely due to inadequate training in genomic medicine. There thus remains a pressing need to create various forums through which clinicians can gain better appreciation for the value of genetic analysis in …

Integrating A Functional Assessment Tool For Chronic Pain In Primary Care, Amanda Blanche Parent

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Chronic pain is prevalent in the United States. Frequently, rural primary care providers must manage patients’ chronic pain and any associated long-term opioids. Best evidence-based practices recommend, and in some cases state guidelines require, periodic functional assessment, for which the CDC endorses the PEG assessment scale.

Purpose: To integrate the PEG assessment scale into a rural, primary care practice and evaluate sustainability in following best evidence-based practice guidelines.

Methods: A one-year retrospective chart review determined the baseline quality and frequency of functional assessment. A pre-implementation survey was distributed to providers to assess knowledge of opioid prescribing guidelines and their …

Analyzing Pediatric Department Documentation Of Patient Social Needs With Icd-10 Z-Codes, 2019-2020, Oluwatofunmi Jummie Akinwunmi

Public Health Theses

The 10th revision of the International Classification of Diseases (ICD-10) allows healthcare professionals to document social needs with ICD-10 Z-codes. Data derived from documentation of ICD-10 Z-codes can be leveraged to identify at-risk populations for targeted intervention. However, there remains concern for underutilization of these codes particularly in the pediatric population. We sought to examine the documentation of ICD-10 Z-codes in the pediatric outpatient setting of the largest Connecticut hospital network by specialty type and age group. We examined deidentified electronic health records of pediatric outpatient patients from 2019-2020. We used descriptive statistics to measure the proportion of patients with …

Does Environmental Testing Of C. Difficile Predict Whether A Patient Is Positive With C. Difficile?, David Caccese

Public Health Theses

Clostridioides difficile is a major public health threat and frequent cause of healthcare-associated infections. Hospitals have struggled to control C. difficile due in part to the challenge of identifying asymptomatic C. difficile carriers and because of C. difficile’s ability to survive on environmental surfaces for long periods. Asymptomatic carriers and environmental surfaces can contribute to C. difficile transmission. Screening of all patients for C. difficile upon hospital admission is not feasible and asymptomatic patients may not be accepting of surveillance testing. Thus, this study examines whether sampling the patient’s room environment once they have been admitted can indicate a patient …

A Dna-Extraction-Free Method For The Molecular Detection Of Streptococcus Pneumoniae Carriage In Saliva, Tzu-Yi Lin

Public Health Theses

Pneumococcal carriage is a prerequisite for pneumococcal disease and surveillance of carriage is crucial for evaluating and informing vaccination strategies. In recent years, molecular methods have improved the sensitivity of pneumococcal carriage detection as compared to the gold standard culture-based method. However, nucleic acid extraction from samples collected is resource-intensive, limiting scalability for extensive surveillance, particularly in low-resource settings. We previously developed a saliva-based PCR test for SARS-CoV-2, having identified that nucleic acid extraction can be omitted and replaced with a simple enzymatic lysis or heat treatment step without compromising the accuracy and efficiency of testing. Here, we compared pneumococcus …

Interrupted Time Series Analysis To Evaluate Regional Greenhouse Gas Initiative Health Impacts, Julia Sweatman

Public Health Theses

Abstract

Background & Aims: Fossil fuel combustion emits a spectrum of ambient air pollutants, with the most harmful health effects seen from particulate matter 2.5 μm or less in diameter (PM2.5). Pricing carbon can reduce PM2.5 emissions and yield co-benefits for public health. The Regional Greenhouse Gas Initiative (RGGI) is a cooperative carbon pricing initiative among twelve states aiming to curb carbon dioxide emissions from the power sector. This preliminary analysis explores methodological approaches to quantify the health benefits associated with PM2.5 changes after RGGI was first implemented in 2009.

Methods: An interrupted time series analysis was performed to compare …

A Retrospective Cohort Study: Association Of Sex And Race Differences On 30-Day Retention In Addiction Treatment For Substance Use Disorders After Discharge, Bingning Wang

Public Health Theses

Objective: Little is known about the association of sex and racial differences in accessing SUD treatment. little is known whether these disparities continue despite hospitalization. The main objective was to determine the association of race and sex differences on 30-day retention in addiction treatment for all substance use disorders after discharge. Design: A Retrospective Cohort Study using the Yale Addiction Medicine Consult Service databaseSubjects: Patients with SUD who were hospitalized at Yale New Haven Hospital from Oct 26th, 2018 to Jun 30th, 2021 are eligible, which has 2557 observations. Methods: Mixed effect multivariable logistic regression for sex and racial differences …

Using Clinical Workflow Assessment Frameworks For Process Improvement Of Patient-Provider Communication In A Primary Care Office, Madeline Morris

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

The purpose of this project was to assess the current workflow for addressing the needs of patients between face-to-face healthcare visits at a primary care clinic in Northern New England. The assessment served as a framework to inform recommendations for process improvement interventions. Workflow was mapped using Lean’s value stream map (VSM) tool. Observational data and retrospective chart review were performed to collect information on time to complete tasks, equipment used, and personnel involved in each patient request. Key patterns in workflow variation, guided by theoretical frameworks of system constraints, were identified. Finally, a team brainstorming session was organized with …

Improving Communication Between Community Care Settings And Primary Care, Kristin Morgan

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background

In older patients with more complex and chronic health concerns, consistency and continuity of care is essential. Patients often live in assisted living residences or independently with support from programs such as Support and Services at Home (SASH), so nurses are available to address concerns and assist with certain aspects of care. Effective inter-professional communication is essential, but communication of assessments and coordinating care with participants’ primary care providers is complex.

Purpose

Improve efficiency and clarity of care-related communication for patient and care team by developing a system that standardizes and streamlines workflow and addresses current concerns.

Methods

At …

Fatty Acid Therapy And Implications For Spinal Cord Injury Treatment: A Literature Review, Philippe J. Dentino

MEDI 9331 Scholarly Activities Clinical Years

Introduction: Spinal Cord Injuries (SCI) are catastrophic injury to spinal neurons that cause a tremendous socioeconomic and public health burden on individuals globally. The role of fatty acids in treatment of SCI is not well understood and poorly standardized across treatment provision. This review seeks to explore the role of fatty acids in neurorecovery and propose emerging themes in SCI treatment with fatty acids.

Methods: A PICO was designed and online databases were searched for relevant articles. A total of 55 studies were deemed appropriate for the review and summarized into thematic elements including ) Cellular Transport 2) Neuroprotection 3) …

Recommendations For Climate Adaptation To Preserve Connecticut Drinking Water Quality And Quantity, Matthew Salvatore Di Vitto

Public Health Theses

Climate change impacts drinking water both directly and indirectly. Increases in temperature, drought frequency, and precipitation are among the climate impacts which currently and are projected to affect water quality and quantity in the continental United States. These impacts limit access to clean and abundant water sources by damaging habitat, spreading toxic substances via runoff and favoring the growth of harmful algal blooms. States can learn from one another to adopt best practices and policies to increase water resilience around the country. This paper explores how Connecticut can employ strategies from the States of New York, New Jersey, Massachusetts, Minnesota, …

Psychological Resilience In U.S. Military Veterans: Results From The 2019-2020 National Health And Resilience In Veterans Study, Michael Georgescu

Public Health Theses

Psychological resilience is the most common response following exposure to traumatic life events. To date, most research has focused on factors associated with adverse post-trauma mental health outcomes rather than understanding those associated with psychological resilience. In particular, little is known about factors associated with resilience in veterans, despite their high rates of trauma exposure, such as combat and military sexual trauma. To address this gap, we used a discrepancy-based psychiatric resilience (DBPR) analytic approach to operationalize resilience and to identify modifiable health and psychosocial factors associated with resilience in a nationally representative sample of U.S. veterans (N = 4,069). …

Cleft Lip And Depression In Adults: A Multi-Ancestry Mendelian Randomization Study, Anne Lyon Havlik

Public Health Theses

Background: Clefting of the lip with or without cleft palate (CLP) is the most common congenital craniofacial abnormality globally, affecting one in 700 live births. Traditional observational studies suggest an increased risk of adult depression among subjects with CLP, but these studies are subject to residual confounding.Objective: We aimed to address residual confounding by evaluating the association between the genetically-predicted risk of CLP on the risk of adult depression in a Mendelian randomization framework. Methods: We used single-nucleotide polymorphisms strongly associated with CLP as genetic instruments. Genetic associations with adult depression were extracted from separate studies. Three ancestry groups were …

[Review] Carol Gigliotti. The Creative Lives Of Animals. New York University Press, 2022. 289 Pp. Isbn 9781479815449, Wendy Woodward

Animal Studies Journal

[Review] Carol Gigliotti. The Creative Lives of Animals. New York University Press, 2022. 289 pp. ISBN 9781479815449

Accelerated Forgetting In People With Epilepsy: Pathologic Memory Loss, Its Neural Basis, And Potential Therapies, Sarah Ashley Steimel Phd

Dartmouth College Ph.D Dissertations

While forgetting is vital to human functioning, delineating between normative and disordered forgetting can become incredibly complex. This thesis characterizes a pathologic form of forgetting in epilepsy, identifies a neural basis, and investigates the potential of stimulation as a therapeutic tool. Chapter 2 presents a behavioral characterization of the time course of Accelerated Long-Term Forgetting (ALF) in people with epilepsy (PWE). This chapter shows evidence of ALF on a shorter time scale than previous studies, with a differential impact on recall and recognition. Chapter 3 builds upon the work in Chapter 2 by extending ALF time points and investigating the …

Pharmacology For National Board Examination, Krina Shah

Dugoni School of Dentistry Student Scholarly Works

This pharmacology study guide is designed to provide students preparing for the National Boards exam with a clear and concise visual aid in the form of systemic flow charts. Each flow chart is organized by drug class and includes information on the mechanism of action, indications, contraindications, dosages, and common adverse effects for each drug within the class. By using this study guide, students can easily navigate through the complex world of pharmacology and feel confident in their ability to succeed on the pharmacology section of the National Board exam. The study guide for pharmacology is significant in several ways. …

Medical Marijuana Knowledge And Attitudes: A Survey Of Dental And Dental Hygiene Faculty And Students, Dara Szyliowicz, Andrew Young, Yesha Golwala

Eberhardt School of Business Faculty Datasets

Background:

Medical Marijuana (MM) use is increasing, requiring healthcare professionals, such as dentists, to possess a working knowledge of MM. Previous studies have indicated that MM education is lacking in current healthcare education.

Methods:

A 50-question survey was created to assess, in detail, dental and dental hygiene faculty and students knowledge, practice, and attitudes toward MM, and to identify possible correlations between responses. The survey was modeled after a previous survey conducted amongst practicing pharmacists. All faculty dentists, faculty dental hygienists, students and residents at the Arthur A. Dugoni School of Dentistry, University of the Pacific, were invited by email …

Warm Land Surface Temperatures And Eastern Asian Homo, Robert Patalano, Hong Yang

Biological and Biomedical Sciences Department Faculty Journal Articles

Climate change and hominin evolution are inextricably linked. Pleistocene climate variability, for example, is thought to have had major influences on hominin morphology, brain size, and diversity. However, clear cause-and-effect relationships between specific climatic events and major evolutionary occurrences are difficult to establish due to temporal and spatial gaps in paleoclimatic, paleoenvironmental, and archaeological records. A new branched GDGT paleotemperature record from the Lantian Basin of Central China (Lu et al., 2022), a location known for the earliest hominin presence in East Asia, illustrates warm land surface temperatures over a two-million-year period between 2.6 and 0.6 Ma, a critical time …

Evaluating A Rapid Response Team Performance To Implement Best Practice In Rapid Response Team Protocol, Pansy Samuel

Doctor of Nursing Practice Projects

Background

Rapid Response Teams (RRT) provide clinical resources to improve patient safety outcomes at healthcare institutions. This team promptly responds to deteriorating patient conditions to prevent further deterioration and reduce mortality rates. Rapid response teams do not always perform optimally. Reasons for this performance failure include breakdowns in communication, team dynamics, or other variables that can often be adjusted when the team members understand the role these variables play in undermining the performance of the RRT. An understanding of the perceptions of the RRT members regarding their roles and potential areas of improvement did provide valuable data that was utilized …