Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Teach-Back Method To Reduce Chf Readmissions: A Scoping Review, Briyanna Evans Bsn, Rn, Bre'yocha Dewalt Bsn, Rn, Ccrn, Jessica Mabry Bsn, Rn, Kailee Garrett Bsn, Rn, Crystal Stephens Bsn, Rn, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background

The purpose of this scoping review is to evaluate the effectiveness of the teach-back method on education as it relates to congestive heart failure readmission rates. Congestive heart failure (CHF) is the most common cause of hospitalizations among those 65 years and older in the United States. CHF readmission rates in Tennessee are higher than the already elevated national average. The current literature suggests a need to reduce 30-day readmissions, improve patient outcomes, and enhance self-efficacy in patients with CHF. The research proposes a correlation between high readmission rates and poor knowledge retention of patients with CHF, but small …

Efficacy Of Distraction Therapy In Reducing Needlestick Pain In Pediatrics: A Scoping Review, Ashlan Ritchie Bsn, Rn, Anne Evans Bsn, Rn, Charlotte Isabel Bsn, Rn, Michelle Rickard Dnp, Cpnp-Ac, Chppn, Bmtcn

Doctor of Nursing Practice Projects

Purpose/Background

Pediatric pain management is often overlooked due to time constraints and lack of resources or education on interventions used, such as distraction or pharmacological therapy. Lack of pain management leads to patient and caregiver distress, as well as an increased number of attempts to perform the procedure. This scoping review evaluates the efficacy of distraction therapy compared to nonopioid pharmacological interventions for acute needlestick pain in children ages 6 to 12 years; patient and caregiver levels of distress were also evaluated in most studies.

Methods

The UTHSC (University of Tennessee Health Science Center) Library database was searched for full-text …

The Nature Of The Diagnostic Process, Louw Feenstra, J.H.Paul Wilson

Health Professions Education

There is no abstract for this article type.

Case Series: Continued Remission Of Ptsd Symptoms After Discontinuation Of Prazosin, Christie Richardson, Jonathan Yuh, Jing Su, Martin Forsberg

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Post-traumatic stress disorder is a debilitating chronic illness that affects 6 out of 100 adults after a severe trauma. The alpha-adrenergic antagonist prazosin, which is prescribed off-label for flashbacks and nightmares due to trauma, is often continued indefinitely due to reports of symptoms returning upon discontinuation. There is no standard guidance for a trial of discontinuation of prazosin due to intolerance or side effects. In this case series, three patients are started on prazosin leading to remission of trauma-related symptoms, and symptoms continue to remit after treatment for an average of about 2 years followed by discontinuation of the medication. …

Patient And Provider Experience With Artificial Intelligence Screening Technology For Diabetic Retinopathy In A Rural Primary Care Setting, Brian M. Nolan, Emma R. Daybranch, Kerri Barton, Neil Korsen

Journal of Maine Medical Center

Introduction: The development of autonomous artificial intelligence for interpreting diabetic retinopathy (DR) images has allowed for point-of-care testing in the primary care setting. This study describes patient and provider experiences and perceptions of the artificial intelligence DR screening technology called EyeArt by EyeNuk during implementation of the tool at Western Maine Primary Care in Norway, Maine.

Methods: This non-randomized, single-center, prospective observational study surveyed 102 patients and 13 primary care providers on their experience of the new screening intervention.

Results: All surveyed providers agreed that the new screening tool would improve access and annual screening rates. Some providers also identified …

The Effects Of Exosomal Derived Tsg-6 On Microglia Activation, Jonathan A. Martinez, Rajashekhar Gangaraju Md

Longitudinal Scholar's Project

Following a traumatic brain injury, microglia become overactive for long periods and display pathologic behavior. We have shown that concentrated conditioned media from adipose tissue-derived mesenchymal stem cells (MSC-CCM) can suppress microglial activation. In this pilot study, we evaluated the efficacy of exosomes containing TNF-stimulated gene 6 (TSG6) derived from MSC-CCM on decreasing microglial activation in vitro via phagocytic activity and pro-inflammatory microglial gene expression.

Small Intestinal Bacterial Overgrowth Testing Strategies, Carla Bonczak

Doctor of Nursing Practice Scholarly Projects

Small Intestinal Bacterial Overgrowth (SIBO) is an overgrowth of bacteria in the small intestine. Symptoms such as bloating, abdominal pain and discomfort, malabsorption, nausea, constipation, or diarrhea overlap with several common GI complaints. SIBO affects millions of people worldwide. Many providers are not aware of SIBO or the guidelines that standardize testing and diagnosing.

The Final Scholarly Project (FSP) was based on a literature review that discovered evidence-based literature on SIBO testing strategies such as gut aspirate and culture, clinical symptom presentation, breath testing, nutrient challenge test, and scintigraphy with either lactulose or hydrogen breath testing. To implement the project, …

Meta-Narrative Review Of Possible Impacts Of Genetic Screening On Treatment Of Breast Cancer, Toqa Al Alawi, Sheza Khan, Ivey Knebel, Steven Luong, Vilma Sanchez, Kamilah Walker-Charles

Research Methods Poster Session 2023

Objective: To examine the impacts of genetic screening on the treatment of breast cancer, in relation to differences, outcomes and decisions in treatment plans or surgery in patients that performed genetic screening versus those that did not.

Background: Genetic screening technology has become commercially available, yet standard preventative care for breast cancer has no genetic screening involved. Genetic screening in breast cancer treatment is performed, but its usage is not standardized.

Methods: Findings were synthesized using the meta-narrative review style to examine articles retrieved from searches of digital databases PubMed and the M.D. Anderson Scholarly Library.

Discussion: Articles were selected …

Chewed Versus Swallowed Ticagrelor In P2y12 Inhibitor-Naïve Patients Undergoing Percutaneous Coronary Intervention, Thomas F. Wilson, Muddasir Ashraf, M. Fuad Jan, Tonga Nfor, Louie Kostopoulos, Joaquin Solis, Jayant Khitha, Ahmad Khraisat, Anthony C. Defranco, Tanvir Bajwa, Suhail Q. Allaqaband

Journal of Patient-Centered Research and Reviews

Purpose: Dual antiplatelet therapy is standard for patients undergoing percutaneous coronary intervention (PCI) with stents. Traditionally, patients swallow the loading dose of a P2Y12 inhibitor before or during PCI. Time to achieve adequate platelet inhibition after swallowing the loading dose varies significantly. Chewed tablets may allow more rapid inhibition of platelet aggregation. However, data for this strategy in patients with stable ischemic heart disease or non-ST-elevation acute coronary syndrome (NSTE-ACS) are less robust.

Methods: In this single-center prospective trial, 112 P2Y12-naïve patients with stable ischemic heart disease or NSTE-ACS on aspirin therapy and who received ticagrelor after coronary angiography but …

Symptom Management Care Pathway Adaptation Process And Specific Adaptation Decisions, Emily Vettese, Farha Sherani, Allison A. King, Lolie Yu, Catherine Aftandilian, Christina Baggott, Vibhuti Agarwal, Ramamoorthy Nagasubramanian, Kara M. Kelly, David R. Freyer, Etan Orgel, Scott M. Bradfield, Wade Kyono, Michael Roth, Lisa M. Klesges, Melissa Beauchemin, Allison Grimes, George Tomlinson, L. Lee Dupuis, Lillian Sung

School of Medicine Faculty Publications

BACKGROUND: There is substantial heterogeneity in symptom management provided to pediatric patients with cancer. The primary objective was to describe the adaptation process and specific adaptation decisions related to symptom management care pathways based on clinical practice guidelines. The secondary objective evaluated if institutional factors were associated with adaptation decisions. METHODS: Fourteen previously developed symptom management care pathway templates were reviewed by an institutional adaptation team composed of two clinicians at each of 10 institutions. They worked through each statement for all care pathway templates sequentially. The institutional adaptation team made the decision to adopt, adapt or reject each statement, …

Combination Thromboembolism Prevention Prophylaxis, Karma Davis

MSN Capstone Projects

Venous thromboembolism (VTE) is a leading cause of preventable hospital death in the United States (Centers for Disease Control and Prevention, 2022). The correct selection of VTE prophylaxis in hospitalized patients is critical in stopping increased length of stays, incurring extra costs, and preventing deaths. Currently, the single modality of pneumatic compression sleeves (ICD) are often utilized for inpatient deep vein thrombosis prevention. ICDs are an easy, quick way for physicians to meet the requirement for VTE prevention in both general medical patients and those in the critical care unit. However, patients may remove or refuse this type of prevention …

Hepatitis C Virus Screening Strategies To Improve Early Identification And Treatment: ​ A Scoping Review​, Megan Elizabeth Lyons, Rn, Bsn, Ccrn, Thomas Tyler Bennett, Rn, Bsn, Ccrn, Felicia Ann Gray-Hamilton, Rn, Bsn, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background

Hepatitis C virus (HCV) is the most common bloodborne infection in the United States (Ludden et al., 2022). Sadly, over half of the individuals living with chronic HCV are unaware of their condition (Halket et al., 2022). Due to rising numbers, HCV screening guidelines have been updated to recommend that every adult be screened at least once (Patel et al, 2021). Despite these guidelines, screening rates remain low. This scoping review aims to examine current research on HCV screening and strategies to improve early diagnosis and treatment.

Methods

This review began with a literature search using CINAHL and PubMed …

Contrast-Enhanced Cardiac Magnetic Resonance Imaging With A Manganese-Based Alternative To Gadolinium For Tissue Characterization Of Acute Myocardial Infarction, Benjamin P. Bonner, Salva R. Yurista, Jaume Coll-Font, Shi Chen, Robert A. Eder, Anna N. Foster, Khoi D. Nguyen, Peter Caravan, Eric M. Gale, Christopher Nguyen

School of Medicine Faculty Publications

BACKGROUND: Late gadolinium enhancement cardiac magnetic resonance imaging is an effective and reproducible method for characterizing myocardial infarction. However, gadolinium-based contrast agents are contraindicated in patients with acute and chronic renal insufficiency. In addition, several recent studies have noted tissue deposition of free gadolinium in patients who have undergone serial contrast-enhanced magnetic resonance imaging. There is a clinical need for alternative forms of magnetic resonance imaging contrast agents that are acceptable in the setting of renal insufficiency. METHODS AND RESULTS: Three days after 80 minutes of ischemia/reperfusion of the left anterior descending coronary artery, cardiac magnetic resonance imaging was performed …

Poor Seizure Control Among Children Attending A Tertiary 8 Hospital In South Western Uganda – A Retrospective Study [Response To Letter], Martha Sajatovic

Faculty Scholarship

No abstract provided.

The Effects Of A Blood–Brain Barrier Penetrating Erythropoietin In A Mouse Model Of Tauopathy, Joshua Yang, Weijun Ou, Nataraj Jagadeesan, Juste Simanauskaite, Jiahong Sun, Demi M. Castellanos, David H. Cribbs, Rachita K. Sumbria

Pharmacy Faculty Articles and Research

Erythropoietin (EPO), a hematopoietic neurotrophin, is a potential therapeutic for Alzheimer’s disease (AD) but has limited blood–brain barrier (BBB) permeability. EPO fused to a chimeric transferrin receptor monoclonal antibody (cTfRMAb) enters the brain via TfR-mediated transcytosis across the BBB. We previously showed that cTfRMAb-EPO is protective in a mouse model of amyloidosis, but its effects on tauopathy are not known. Given that amyloid and tau pathology are characteristics of AD, the effects of cTfRMAb-EPO were studied in a tauopathy mouse model (PS19). Six-month-old PS19 mice were injected intraperitoneally with either saline (PS19-Saline; n = 9) or cTfRMAb-EPO (PS19-cTfRMAb-EPO, 10 mg/kg; …

Evaluation Of Concussion Assessment Tools For Collegiate Athletes, Jacqueline D. Villanueva Arevalo, Emily R. Brown

Student Scholar Showcase

BACKGROUND: Due to the increase in sports-related concussions in the United States, there is a rising concern about concussion assessments in collegiate athletes with regard to long term vestibular ocular motor dysfunction and post-concussion syndrome.

PURPOSE: Due to varying practices in concussion diagnosis, this systematic review analyzed three concussion diagnostic instruments, The King Devick, Screening Concussion Assessment Tool (SCAT-5), and Vestibular Oculomotor Screening Tool (VOMS), to determine the most appropriate instrument(s) for reducing vestibular ocular-motor dysfunction and post-concussion symptoms in collegiate athletes.

METHODS: Nested Knowledge was used to identify articles from PubMed, Europe Pubmed Central, and ClinicalTrials.gov databases. Key search …

Clabsi Prevention Methods, Noah Heine, Talon Cockrel

Scholars Week

Infection and the risk thereof is one of the major concerns regarding patient outcomes in the health care facility. One of the interventions with the highest causes of infection is the use of central lines. These lines provide necessary venous access for medication administration but can cause infections called CLABSI or Central Line Acquired Bacterial Infection. The purpose of our article was to research CLABSI prevention methods and provide a new policy using these safe effective methods. These new methods include the use of stat locks for central line securement, using antimicrobial lines, and flushing/locking the central line with a …

A Matched Cohort Study Of Open Thoracostomies Performed By Ground Medics, Alison Smith, Angelo Ciaraglia, Benjamin Axtman, Cj Winckler, David Wampler, Maxwell Braverman, C. Patrick Shahan, Rachelle Babbitt Jonas, Michael Shiels, Brian Eastridge, Ronald Stewart, Susannah Nicholson, Donald Jenkins

School of Medicine Faculty Publications

Background: Tension pneumothorax resulting from chest trauma is a rapidly fatal condition that requires prompt treatment. Prehospital open thoracostomy (POT) is a potentially lifesaving intervention that can be performed in the field to treat tension pneumothorax. However, the results from POT performed by ground EMS providers have not been well-studied. The objective of this study was to compare outcomes for patients with chest trauma who underwent POT performed by ground EMS providers with a matched cohort who did not undergo this procedure in the field. Methods: A retrospective chart review of consecutive adult patients presenting to a Level I trauma …

The Effects Of Specialized Pro-Resolving Mediator Lipoxin A4 On Pseudomonas Aeruginosa Biofilms And Interactions With Monocytes, Julianne M. Thornton

Graduate School of Biomedical Sciences Theses and Dissertations

Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic pathogen known as a major cause of hospital-acquired secondary infections, commonly causing chronic respiratory infections in immunocompromised individuals, especially those with cystic fibrosis, and often found in wound infections. P. aeruginosa uses the quorum sensing pathway to readily form protective biofilms, which reduce the efficacy of antibiotics and access by host immune cells to eradicate the pathogen. Specialized pro-resolving mediators (SPMs) are lipids endogenously produced by the host immune response to infection to aid in infection resolution. One SPM, Lipoxin A4 (LxA4), has been shown to be a robust quorum sensing inhibitor.

The …

Will Clinical Decision Support Mechanisms Reduce The Amount Of Unnecessary Computed Tomography?, Andrea Ciarmello

Dissertations and Theses

Clinical Decision Support Mechanisms (CDSMs) are to patient safety. When used in Radiology, CDSMs can improve radiation dose, quality assurance, and patient care. When paired with the electronic health record, CDSMs provide clinicians with patient-specific data that will help lower healthcare costs and improve patient outcomes. This study demonstrates how introducing clinical decision support mechanisms in electronic health record software will help improve unnecessary CT scans and hinder patient radiation exposure. The ordering physician can now consistently and reliably choose the proper scan each time.

Impact Of Opioid-Free Anesthesia Versus Opioid-Based Anesthesia On Time To Extubation: A Scoping Review, Mary K. Connor Rn, Bsn, Srna, Dexter Browning Rn, Bsn, Srna, Ariel Clark Rn, Bsn, Srna, Erica B. Gates Rn, Bsn, Srna, Madison T. Mccaskill Rn, Bsn, Srna, Dwayne L. Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Opioids during surgery have been clinically proven to lengthen the time between intubation and post-op extubation. Increased time to extubation is associated with negative patient outcomes. This scoping review aims to evaluate the use of ketamine with opioid free analgesia (OFA) versus traditional opioid usage and its outcomes on extubation times.

Methods

From September 2021 to November 2021, we conducted a literature search using the University of Tennessee Health Science Center’s (UTHSC) online library. Through the PubMed, CINAHL, Medline, and Cochrane databases, we identified seventy-one articles that matched our criteria. Of those articles, we selected twenty-five to undergo rapid …

Effects Of Coordinated Reset Deep Brain Stimulation Of Subthalamic Nucleus On Parkinsonian Gait In The Non-Human Primate Model, Kanon Nakajima

Neuroscience Honors Projects

Parkinson’s Disease (PD) is a neurodegenerative disorder that affects over 10 million people worldwide. Deep Brain Stimulation (DBS) has been a successful treatment for advanced PD, however, can be accompanied with current spread related side effects. Coordinated Reset (CR) DBS is a novel therapeutic approach that could reduce the risk of side-effects by using lower current. Previous research has shown therapeutic effects of CR DBS on PD motor symptoms including akinesia, bradykinesia, rigidity, and tremor that sustained after stimulation cessation (i.e., carryover effect), however its effect on gait dysfunction is unknown even though it can be one of the most …

Evaluating The Efficacy Of Medication-Assisted Treatment For First Episode Psychosis: A Scoping Review, Chanel Thomas Msn, Aprn, Fnp-Bc, Rn-Bc, Alexandra Wittenberg Bsn, Rn-Bc, Anttrenika Anderson Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that individuals with substance use disorder (SUD) receive medicated-assisted treatment (MAT), as a complete approach to substance use treatment (SAMHSA, 2019). However, treatment measures using combination treatment for SUD in individuals experiencing first episode psychosis (FEP) are seldom used. This scoping review assesses the efficacy of MAT in conjunction with antipsychotics compared to the use of antipsychotic monotherapy for FEP individuals on hospital readmission rates.

Methods

The authors conducted a literature review utilizing PubMed, EBSCO, Elsevier, Google Scholar, PsychINFO, and Medline from August 2020 to November 2022. Key phrases …

A Design, Development, And Evaluation Of Bio-Patch For Myocardial Tissue Repair, Yaya Zhang

Theses and Dissertations (ETD)

Introduction. Ischemic heart disease (IHD) is a major concern of human health issue. The structural repair and functional recovery of injured hearts is a major challenge in the clinical setting. Preclinical studies over last 10 years have demonstrated the potential of using stem cells to treat IHD, but the efficacy of this therapy is jeopardized by uncontrollable migration and low survival of the injected stem cells. An approach based on tissue engineering enabling target-specific stem cell delivery such as cardiac patches has emerged as an alternative solution for stem cell therapy for IHD. It employs scaffold materials to engulf various …

Molecular And Cellular Investigations Of Prader-Willi Syndrome, Anna K. Victor

Theses and Dissertations (ETD)

Prader-Willi syndrome (PWS) is a complex multigenic neurodevelopmental disorder resulting in hypotonia, developmental delay, hypogonadism, sleep dysfunction and childhood onset obesity affecting 1 in 10,000 to 30,000 individuals. PWS is an imprinting disorder that is caused by a loss of expression of maternally imprinted genes in the 15q11.2-q13 region including NDN, MAGEL2, SNRPN/SNURF, and a cluster of snoRNAs. The majority of cases are caused by inheriting a paternal allele deletion of this region (65-75%) and a smaller number are caused by chromosome 15 maternal uniparental disomy (UPD) (20-30%) or imprinting center defects (1-3%). Here, we used dental pulp stem cells …

Investigation Of Clinically Relevant Fluconazole Resistance Mechanisms In The Fungal Pathogen Candida Parapsilosis, Laura Anne Doorley

Theses and Dissertations (ETD)

Invasive candidiasis is a severe fungal infection associated with significant morbidity and mortality, particularly among the critically ill and immunocompromised. Candida parapsilosis is the most common non-albicans species causing invasive Candida infections in pediatric and neonatal populations worldwide and is particularly common in the countries of South America, Western Asia, Mediterranean Europe, and Southern Africa. For many of these countries, fluconazole and other triazoles are the first line antifungal agents used for effective treatment of invasive Candida infection. Until recently, rates of fluconazole resistance among C. parapsilosis isolates were relatively low, therefore the determination of clinically relevant resistance mechanisms in …

Vascular Mechanisms Of Rhabdomyolysis-Induced Acute Kidney Injury, Jeremiah Moyinolu Afolabi

Theses and Dissertations (ETD)

In patients with rhabdomyolysis, the overwhelming release of myoglobin into circulation is the primary cause of kidney injury. Myoglobin causes direct kidney injury as well as severe renal vasoconstriction. An increase in renal vascular resistance (RVR) results in renal blood flow (RBF) and glomerular filtration rate (GFR) reduction, tubular injury, and acute kidney injury (AKI). The mechanisms that underlie rhabdomyolysis-induced AKI are not fully understood but may involve the local production of vasoactive mediators in the kidney. Myoglobin stimulated endothelin-1 (ET-1) production in proximal tubular cells, an effect driven by NADPH oxidase-dependent oxyradical generation. Rats subjected to glycerol-induced rhabdomyolysis also …

Modulation Of Cerebral Artery Smooth Muscle Bk Channel Function By Neurosteroids, Kelsey Caroline Cleland North

Theses and Dissertations (ETD)

Voltage-gated and Ca2+ activated K+ channels of large conductance (BK) channels are essential for many key physiological processes, such as controlling the contraction of smooth muscle, including cerebrovascular smooth muscle. Importantly, BK channels are made up of a homotetramer of α subunits which associate with accessory β subunits. These β subunits alter the activity of the channel; this modulation is subunit-specific. Moreover, these accessory subunits have tissue-specific expression, such that the β1 subunit is highly expressed within cerebrovascular smooth muscle and greatly increases the open probability of BK channels. Increased BK channel open probability is linked to increased dilation of …

Multimorbidity In Diverse Populations: Stratified Analysis Of Race/Ethnicity, Age, Obesity, And Healthcare Costs, Manal Alshakhs

Theses and Dissertations (ETD)

This research aims to fill an essential gap in understanding how Body Mass Index (BMI) cutoffs relate to multimorbidity across races in the United States (US). Given the significant and growing rates of obesity and multimorbidity, as well as the known differences in healthy fat distribution among different races, this is an important area of research. BMI is a widely used but imperfect measure of obesity, as it does not account for differences in body composition. However, it is still used as a diagnostic tool. It is vital to ensure that the cutoffs used to define obesity are appropriate for …

Impacts Of Habitat, Resource Addition, And Predator Exclusion On Rodent Community Structure And Hantaviruses In The Neotropics, Briana Spruill-Harrell

Theses and Dissertations (ETD)

Understanding how climate and human land use change impacts trophic interactions is essential in the face of ongoing biodiversity loss and the continued emergence of RNA viruses and zoonosis. Human land use changes such as agricultural expansion, deforestation, and habitat degradation all have been linked to zoonotic disease emergence. Despite these commonalities, our mechanistic understanding of what drives them is lacking. Moreover, genomic surveillance in wildlife populations is critical for risk assessment and mitigation. Herein, using data collected from field studies within the Reserva Natural del Bosque Mbaracayú (RNBM), a protected area of the Interior Atlantic Forest (IAF), I examined …