Health and Medical Administration Commons^™

The Implications Of Ferroptosis In Antibiotic Resistance, Marysol Hohl

Senior Honors Theses

Bacterial infections in the United States are becoming increasingly resistant to existing antibiotic treatments. Due to projected increases in resistance and the recent decrease in novel antibacterials, experts have determined that the United States is in the “post-antibiotic era.” The scientific community has failed to resolve resistance despite the continual discovery of new antibiotic compounds. In the past decade, a novel form of cell death called ferroptosis has been implicated in antibiotic treatment by employing the use of nanotechnology. This literature review will describe the problem of bacterial resistance and demonstrate how current research is pioneering a new age of …

Utilizing Stakeholder Input Within The Tennessee Heart Health Network To Improve Cardiovascular Health Outcomes In Tennessee, Abigail C. Bennett

Longitudinal Scholar's Project

Background: Tennessee ranks sixth nationwide for most deaths related to heart disease. The Tennessee Heart Health Network (TN-HHN), an initiative coordinated by the Tennessee Population Health Consortium (TN-PHC), was created to combat this issue. The TN-HHN is a statewide network of primary care practices, health systems, and academic centers committed to implementing patient-centered outcomes research (PCOR) approaches to demonstrably improve cardiovascular disease (CVD) health outcomes and health equity across Tennessee.

Objective: Evaluate stakeholder experiences in participating in the Network in an effort to assess partner satisfaction and improve the TN-HHN as a whole.

Methods: Eligible stakeholders were invited via …

The Effectiveness Of Disinfection Protocols In Osteopathic Family Medicine Offices, Riley Phyu, Harrison A Patrizio, Thomas Boyle, Todd Schachter

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

CONTEXT: Healthcare-associated infections (HAIs) pose a substantial public health threat. Despite significant strides to curb HAIs in hospital environments, outpatient settings have not received the same degree of attention. Given their emphasis on holistic, patient-centered care, osteopathic family medicine offices are pivotal in both disease prevention and comprehensive patient treatment. The importance of simple yet effective disinfection protocols, such as thorough cleaning between patient appointments, cannot be overstated in these settings because they are integral to minimizing disease transmission.

OBJECTIVES: This study aims to assess the effectiveness of the current disinfection protocols in osteopathic family medicine offices.

METHODS: A cross-sectional …

Implementation Of An Evidence-Based Diabetic Screening Tool In Rural Belizean Communities, Morgan Lee Taylor, Annelyse Caffrey

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Significance/Background: Type II Diabetes Mellitus (TIIDM) is a growing epidemic in Belize. The prevalence is increasing yearly, responsible for considerable health complications and deaths. Rates are much higher in Belize than in any other developing Central American country, and many rural citizens are undiagnosed and untreated. Access to healthcare is complex, and travel is often required in rural areas. Primary care visits in Belize are significantly less than in surrounding North and Central American countries. As a result, chronic illnesses such as TIIDM often go undiagnosed among children, adolescents, and adults- leaving TIIDM a leading cause of death in Belize. …

The Effectiveness Of Disinfection Protocols In Medical School Osteopathic Manipulative Medicine Labs., Harrison A. Patrizio, Riley Phyu, Thomas Boyle, Todd Schachter

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

CONTEXT: In light of the COVID-19 pandemic, healthcare-associated infections have taken center stage. Healthcare has adjusted workflows to accommodate for more robust disinfecting regiments to help protect the community. This has resulted in the need for medical institutions to reevaluate the current disinfection protocols down to the student level. The osteopathic manipulative medicine (OMM) laboratory provides an optimal avenue for assessing the effectiveness of medical students' ability to clean examination tables. With OMM laboratories having a high level of interaction, adequate disinfection is important for the health and safety of students and teaching faculties.

OBJECTIVES: This study will evaluate the …

Implementation Of A Virtual Interprofessional Icu Learning Collaborative: Successes, Challenges, And Initial Reactions From The Structured Team- Based Optimal Patient-Centered Care For Virus Covid-19 Collaborators, Simon Zec, Nika Zorko Garbajs, Yue Dong, Ognjen Gajic, Christina Kordik, Lori Harmon, Marija Bogojevic, Romil Singh, Yuqiang Sun, Vikas Bansal, Linh Vu, Kelly Cawcutt, John M. Litell, Sarah Redmond, Elly Fitzpatrick, Kirstin J. Kooda, Michelle Biehl, Neha S. Dangayach, Viren Kaul, June M. Chae, Aaron Leppin, Mathew Siuba, Rahul Kashyap, Allan J. Walkey, Alexander S. Niven

Jefferson Hospital Staff Papers and Presentations

IMPORTANCE: Initial Society of Critical Care Medicine Discovery Viral Infection and Respiratory illness Universal Study (VIRUS) Registry analysis suggested that improvements in critical care processes offered the greatest modifiable opportunity to improve critically ill COVID-19 patient outcomes. OBJECTIVES: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative was created to identify and speed implementation of best evidence based COVID-19 practices. DESIGN, SETTING, AND PARTICIPANTS: This 6-month project included volunteer interprofessional teams from VIRUS Registry sites, who received online training on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury approach, a structured and systematic method …

The Effectiveness Of Increasing Frequency Of Central-Line Dressing Changes And Monitoring On Clabsi Rates: A Scoping Review, Jacob Schmidt, Bsn, Rn, Ccrn, Georgia Brown, Bsn, Rn, Laura Dickey, Agpcnp-C, Lauren Faulkner, Bsn, Rn, Margaret Harvey, Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Abstract

Purpose/Background

Central lines provide many benefits to critically ill patients; however, there are additional risks with them, including central line-associated bloodstream infections (CLABSIs). CLABSIs place patients at increased risk for morbidity and mortality, longer length of stay, and higher medical costs. Studies evaluating various methods of reducing CLABSIs have been performed. This scoping review was completed to determine the effectiveness of frequent central-line dressing changes and increased monitoring on the incidence of central-line associated blood stream infections in adults with central-lines.

Methods

An extensive database search through the University of Tennessee Health Science Center (UTHSC) Online Library was performed …

Factors Associated With Suicide Mortality Among Childbearing-Aged Individuals: A Case-Control Study, Katerina A. Furman, Amy Loree Phd, Leah Hecht Phd, Katerina Furman Md Candidate, Lyuba Gavrilova Bs, Hsueh-Han Yeh Phd, Catherine Frank Md, Brian Ahmedani Phd

Medical Student Research Symposium

Purpose: Examine pregnancy-related, demographic, psychosocial and healthcare utilization factors among childbearing-aged individuals who were pregnant, postpartum or who experienced pregnancy loss

Methods: Data from nine health care systems in the Mental Health Research Network was included in this sample. A case-control study design was used in which 290 childbearing-age individuals who died by suicide (cases) from 2000-2015 were matched with 10 childbearing-age individuals from the same healthcare system and enrolled during the same time period who did not die by suicide (n=2,900). Conditional logistic regression was used to analyze associations between pregnancy/postpartum/pregnancy loss status and suicide.

Results: …

Implementation Of A Smoking Cessation Program In A Multidisciplinary Clinic, Lori Prewitt Moore, Shannon Harris

DNP Manuscripts

Tobacco use remains the solitary, most preventable cause of death and secondary disease among patients in the United States (US). Health-related smoking costs are in an excess of $300 billion yearly (CDC, 2018). Addressing this global, public health concern is vital in order to attempt to reduce unnecessary smoking-related comorbid conditions and death. This project is important to scholarly nursing practice in order to reduce smoking-related Chronic Obstructive Pulmonary Disease (COPD) exacerbations, reduce carbon monoxide (CO) levels, and reduce dyspnea on exertion (DOE) among current primary care smokers. The expectations of this project are for the doctoral of nursing practice …

Outcomes Of Directly Observed Therapy In People Living With Hiv Who Experience Homelessness And Substance Use Disorder, Mara C. Clawson

Doctor of Nursing Practice (DNP) Projects

Background: Antiretroviral directly observed therapy, in which nurses or other allied health professionals provide patients with daily medication, is an evidence-based solution for viral load suppression in people living with HIV who experience homelessness. Purpose: This quality improvement project aimed to assess the outcomes of antiretroviral directly observed therapy at one urban clinic caring for people living with human immunodeficiency virus who experience homelessness and substance use disorder. Methods: Data was collected from the electronic health record for the antiretroviral directly observed therapy patient cohort (n = 33); 10 of them were surveyed. Fisher exact tests determined nonrandom associations between …

Educating School Nurses To Improve Bowel Continence In Children With Spina Bifida, Mckinley J. Waugh, Tracy L. Brewer, Lisa Wagoner

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Children born with spina bifida, a neural tube defect, can have associated loss of bowel control resulting in bowel incontinence. The National Patient Spina Bifida Registry found that 87% of those living with spina bifida had bowel incontinence, and less than 30% were bowel continent (Sawin et al., 2015; Wiener et al., 2017). Unfortunately, providers may never start a child living with spina bifida on a bowel management program. Evidence suggests that children with spina bifida should begin a bowel management program early, using a stepwise approach. School nurses, who interact with children living with spinal bifida while attending school, …

Screening For Social Determinants Of Health To Improve Care In Pediatric Patients With Recurrent Urinary Tract Infections: A Scoping Review, Emily Gray Msn, Fnp-C, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Purpose: To describe what is known about how SDoH screening impacts adherence to treatment in pediatric patients with recurrent UTIs.

How Did The Dietary Habits Of Patients With Chronic Medical Conditions Change During Covid-19?, Sahil K. Patel, Adarsh Gupta

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

CONTEXT: Previous studies have examined the changes in the dietary habits of general populations during the COVID-19 pandemic but have not focused on specific populations such as those with chronic medical conditions (CMCs). Prior to major vaccination efforts, 96.1% of deaths were attributed to patients with preexisting CMCs, thus it is important to examine how this population has endured changes.

OBJECTIVES: The purpose of this study was to identify differences in dietary habits, lifestyle habits, and food attitudes between those with CMCs compared to the populations without chronic medical conditions (non-CMCs) since the beginning of the COVID-19 pandemic.

METHODS: An …

Exploratory Analysis Of Outpatient Visits For Us Adults Diagnosed With Lupus Erythematosus: Findings From The National Ambulatory Medical Care Survey 2006–2016, Salena Marie Preciado, Khaled A. Elsaid, Souhiela Fawaz, Lawrence Brown, Enrique Seoane-Vazquez, Marc Fleming, Yun Wang

Pharmacy Faculty Articles and Research

The study aims to assess office-based visit trends for lupus patients and evaluate their medication burden, chronic conditions, and comorbidities. This cross-sectional study used data from the National Ambulatory Medical Care Survey (NAMCS), a survey sample weighted to represent national estimates of outpatient visits. Adult patients diagnosed with lupus were included. Medications and comorbidities that were frequently recorded were identified and categorized. Descriptive statistics and bivariate analyses were used to characterize visits by sex, age, race/ethnicity, insurance type, region, and reason for visit. Comorbidities were identified using diagnosis codes documented at each encounter. There were 27,029,228 visits for lupus patients …

Efficacy Of Various Interventions For Achieving Target Hba1c Levels For Patients With Type Ii Diabetes Mellitus And On Exogenous Insulin, Caitlin S. Welch, Archie Troxel

Longitudinal Scholar's Project

Objective: To learn the rates at which patients at UT Family Medicine–St. Francis (UTFM–SF) with type II diabetes mellitus are being prescribed recommended medications—namely metformin, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide 1 receptor agonists (GLP1RAs)—whether these rates correspond to the severity of hyperglycemia (as indicated by HbA1C level). A secondary goal of the study was to investigate if HbA1C levels are being checked at recommended intervals.

Methods: A retrospective chart review was conducted using records of patients seen at the clinic in the previous four years between the ages of 18 and 65 who had visits with ICD …

Feasibility And Effectiveness Of A Prehabilitation Program Prior To Breast Cancer Surgery: A Critically Appraised Topic, Emma Choi, Alissa Lee, Kayla Woods, Morgan Mills, Carol Houston

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of our project is to determine the feasibility and effectiveness of a prehabilitation (prehab) program for patients undergoing breast cancer surgery as compared to only receiving post-surgical rehabilitation. Our clinical mentor has recently obtained certification as a lymphedema specialist and is assisting with the opening of an outpatient mastectomy clinic through the Methodist University systems. Through our research process, we critically appraised two Level II articles, two Level III articles, and one Level IV article. Positive outcomes related to the feasibility were identified, however there is limited significant evidence supporting the effectiveness of the intervention. We recommend using …

Effect Of Early Mobilization On Length Of Hospital Stay In Covid-19 Patients: A Critically Appraised Topic, Ashlee Hodges, Anna Claire Briscoe, Anna Beth Willoughby, Carlton Hubbard, Nathan Smith

Master of Occupational Therapy Student Critically Appraised Topics

For this project, we created a critically appraised topic to study the effects of early mobilization on length of hospital stay in COVID-19 patients in the ICU.

Updates In The Pharmacologic Prophylaxis And Treatment Of Invasive Candidiasis In The Pediatric And Neonatal Intensive Care Units, James Hunter Fly, Seerat Kapoor, Kelly Bobo, Jeremy S. Stultz

Faculty Publications

Purpose of review The goal of this review was to provide an update on the prevention and treatment options for invasive candidiasis (IC) in the neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU).

Recent findings Studies have further validated the use of fluconazole for IC prophylaxis among high-risk patients in the NICU. It remains unclear if prophylaxis leads to resistance development and the ideal dosage regimen is still not clear. Recent studies have been published comparing caspofungin and micafungin to amphotericin B and illustrated similar efficacy outcomes in the NICU. Micafungin now has approval from the United …

Health Equity & Obesity Management: An Improvement Project In A Federally Qualified Healthcare Center In Central Harlem, Brianna Bouchez

Doctor of Nursing Practice Scholarly Projects

Description of the problem: Obesity is a growing healthcare problem worldwide with extraordinary costs to the individual's health and the healthcare system. Individuals most affected by obesity include socioeconomically disadvantaged individuals, often with limited resources to seek specialized care.

Available knowledge: Various weight-loss interventions exist but access and success rates vary. Weight loss is often modest and additional factors such as social determinants of health, health literacy, and patient motivation are all factors important to the success of an intervention.

Specific Aims: The purpose of this quality improvement project was to improve self-regulatory weight loss behaviors and increase weight loss …

Dexmedetomidine Vs. Propofol In Postoperative Delirium Prevention, Jaclyn Burnett Rn, Srna, Montana Betts Rn, Srna, Christhian De Ochoa Rn, Srna, Maciej Chec Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative delirium (POD) is an acute neurological condition affecting large numbers of surgical patients in various practice settings. Patients suffering from this condition face postoperative complications, increased lengths of stay, and tremendous financial burden. Understanding the contributing factors for POD, and how adjustments in intraoperative agents can prevent or reduce the incidence, is a crucial aspect of anesthesia practice. This scoping review will examine associations between POD and the intraoperative use of propofol versus dexmedetomidine with general anesthesia.

Methods Studies in this review were limited to peer-reviewed literature, published in medical and nursing journals within the last five years. …

Implementing A Stroke Process Improvement Group To Reduce Time To Thrombectomy In Patients With Acute Ischemic Stroke At Greenwich Hospital, Victoria Merrill

DNP Projects

Introduction: Delays in door to skin puncture time for patients with ischemic stroke are associated with worse clinical outcomes. The following quality improvement study was conducted at Greenwich Hospital which aimed to decrease door to skin puncture time for endovascular stroke treatment. Greenwich Hospital began its new stroke program in January 2020 and opened thrombectomy capable interventional radiology (IR) services. Delays to door to skin puncture times existed with average time being 100 minutes with a goal time of 90 minutes or less for 50% or more of patients directly arriving to the hospital and 60 minutes or less for …

Prevention Of Diabetes-Related Hospital Readmission Following Initial Diagnosis Of Diabetes In Patients Over The Age Of Fifty: A Scoping Review, Nathan Miller Dnp, Agacnp, Fnp, Jasmine Harris Dnp, Fnp, Michael Clardy Dnp, Agacnp, Diana Dedmon Dnp, Acnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background: By reviewing multiple studies related to the treatment of patients with new diagnoses of diabetes, this scoping review will endeavor to determine which interventions, when implemented for patients over 50 years old which are newly diagnosed with type 2 diabetes, can decrease the likelihood of hospital readmission related to diabetes within 90 days when compared with those patients who did not receive or participate in follow-up.

Methods: For resources to be eligible to review they had to be from 2015 or after. Studies selected included patients over the age of 50 newly diagnosed with type 2 diabetes subject to …