Health and Medical Administration Commons^™

Evaluating A1c Reduction In Patients With Diabetes Receiving Pharmacy Intervention, Christopher R. Evans, Kirsten Held, Stephanie Thomas, Jeanne Spencer

Advances in Clinical Medical Research and Healthcare Delivery

Introduction: Diabetes affects 34 million Americans and is the 7th leading cause of death in the United States. According to the American Diabetes Association (ADA) the A1c goal for most patients is less than 7%; however, in patients at risk for hypoglycemia or with complications that goal can be increased up to less than 8%. Management of diabetes with diet and exercise is essential, but insufficient for most patients and pharmacologic intervention is necessary to achieve therapeutic goals. Reducing A1c is associated with lower cardiovascular risk and a reduction in diabetes-associated complications. Previous studies have shown that pharmacist management of …

"When They See Someone Who Is Poor, They Step On Them": The Social Determinants Of Health Among Survivors Of Sex Trafficking In Cambodia, James P. Havey, Glenn M. Miles, Lim Vanntheary, Nhanh Channtha, Hanni Stoklosa

Dignity: A Journal of Analysis of Exploitation and Violence

Social determinants of health (SDH) are defined as the non-medical yet health-affecting conditions of a person’s life. They include such considerations as working conditions, discrimination, and access to health services. The aim of this study was to explore the SDH impacting those who have survived sex trafficking in Cambodia. This study employed a mixed methods, secondary analysis, focusing on 52 survivors of sex trafficking in the Butterfly Longitudinal Research Project from 2010 through 2019. Participants described myriad social determinants of health, including: gender, age, relationship status (marriage), ethnicity, national identification documentation (statelessness), social class, formal education, vocational training, occupation, and …

Does Exercise Prevent Gestational Diabetes Mellitus In Pregnant Women? A Clin-Iq, Olivia Lust, Tana Chongsuwat, Elizabeth Lanham, Ann F. Chou, Elizabeth Wickersham

Journal of Patient-Centered Research and Reviews

Excessive weight gain during pregnancy has been on the rise globally, leading to increased prevalence of gestational diabetes mellitus (GDM). A diagnosis of GDM often leads to pregnancy and infant-related complications. Regular exercise may have the potential to prevent GDM. However, evidence surrounding the utility of exercise during pregnancy as an effective risk reduction intervention has been mixed. This clinical inquiry examined the role of regular exercise during pregnancy in preventing GDM in both obese and normal-weight women and analyzed specific aspects of exercise that make it an effective preventive measure. The review of evidence included 3 meta-analyses, 3 systematic …

Increasing Staff Awareness And Screening Practices For Adverse Childhood Experiences At A Primary Care Clinic, Kayla Wright

Doctor of Nursing Practice Projects

Adverse childhood experiences (ACEs) are present in approximately 60% of the adult population in the United States. There is a correlation between adverse childhood experiences and chronic health conditions as adults. Despite the evidence showing this correlation, there is a lack of screening for ACEs in the primary care setting. Many primary care providers and staff are unaware of ACEs or the correlation with chronic health conditions and substance abuse and, therefore, do not understand how to or recognize the benefits of screening in primary care. With education for providers and staff, primary care is the ideal setting to perform …

Formulation Of Coffee Extract As Polymeric Nanoparticles And Studying Their Potential Biological Activities, Nouran Sharaf

Theses and Dissertations

Coffee extract was prepared and optimized (by solvent extraction) and subsequently entrapped into PLGA nanoparticles using single emulsion-solvent evaporation method (using Design Expert software). Dynamic Light Scattering, Scanning Electron Microscope, Fourier Transform-Infrared Spectroscopy and Folin Ciocalteau assay were used to characterize the NPs and to aid in selecting the optimum formulation conditions. The optimized NPs were in-vitro evaluated for their antimicrobial (by agar-well diffusion method), antioxidant (by DPPH assay) and anticancer (by MTT assay) activities. Finally, the release rate study was conducted for the NP sample showing the highly promising results.

The succeeded NP sample, in terms of the most …

Development And Validation Of Machine Learning-Based Race-Specific Models To Predict 10-Year Risk Of Heart Failure: A Multicohort Analysis, Matthew W Segar, Byron C Jaeger, Kershaw V Patel, Vijay Nambi, Chiadi E Ndumele, Adolfo Correa, Javed Butler, Alvin Chandra, Colby Ayers, Shreya Rao, Alana A Lewis, Laura M Raffield, Carlos J Rodriguez, Erin D Michos, Christie M Ballantyne, Michael E Hall, Robert J Mentz, James A De Lemos, Ambarish Pandey

Faculty, Staff and Students Publications

BACKGROUND: Heart failure (HF) risk and the underlying risk factors vary by race. Traditional models for HF risk prediction treat race as a covariate in risk prediction and do not account for significant parameters such as cardiac biomarkers. Machine learning (ML) may offer advantages over traditional modeling techniques to develop race-specific HF risk prediction models and to elucidate important contributors of HF development across races.

METHODS: We performed a retrospective analysis of 4 large, community cohort studies (ARIC [Atherosclerosis Risk in Communities], DHS [Dallas Heart Study], JHS [Jackson Heart Study], and MESA [Multi-Ethnic Study of Atherosclerosis]) with adjudicated HF events. …

Feasibility And Acceptability Of Using Mobile Health Apps In Underserved Patients With Diabetes, Jieyu Luo

Theses and Dissertations (ETD)

Introduction. Diabetes mellitus is a condition with a growing morbidity and mortality burden. An estimated 30 million adults currently live with diabetes, with each individual spending over $9500 annually on medical care. The successful management of diabetes is a lifelong endeavor. This involves balancing a variety of factors including diet, medications, and glucose monitoring. It has been well established that successful control of diabetes depends largely upon patients’ daily lifestyle habits and activities. Not all patients, however, have the resources necessary for effective diabetes management. Health disparities lead to a higher rate of diabetes development in minority and poor populations. …

Laser-Assisted Tooth Extraction In Patients With Impaired Hemostasis, Elena Larionova Dr., Ekaterina Diachkova Dr., Elena Morozova Prof., Albert Davtyan Dr., Svetlana Tarasenko Prof.

BioMedicine

Introduction: The provision of efficient dental care to patients with hemostatic disorders is tied to difficulties and problems such as prolonged bleeding after or during surgical manipulation.

Aim: This study aims to increase the efficiency of oral surgery in patients with thrombocytopenia with the use of erbium laser on different stages of tooth extraction.

Methods: Patients (n = 96) were selected for tooth extraction on an outpatient basis: patients with confirmed thrombocytopenia (age 44 ± 15.4, 19–74) were included in the 1st group, and patients without impaired hemostasis (age 47.6 ± 15.3, 19¬81) were included in the …

Weight Reduction Motivation In Osteoarthritis Patients Through Nurse Practitioner Driven Education And Follow-Up: A Pilot Project, Caoilfhionn Mulvey, Martha Fuller Phd

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: The ultimate goal of this short-term pilot project is for

overweight or obese osteoarthritis patients to increase their knowledge on the benefits of

weight loss and physical activity. Research shows that for every kilogram of weight lost,

2.2–4.0 kilograms of weight is taken off of the joint and could reduce joint pain up to

thirty to fifty percent and improve quality of life. Following education from the provider,

patients will understand the correlation of osteoarthritis symptom management with

weight loss.

EBP Model/Frameworks: This project utilizes the Iowa Model of Evidence-Based

Practice to Promote Quality Care. This addresses …

Understanding Older Adults Living In Medically Underserved Areas Perspectives Regarding Type 2 Diabetes Care Received, Christopher Rogers

Seton Hall University Dissertations and Theses (ETDs)

Older adults with type 2 diabetes living in medically underserved areas (MUAs) have unique health and social needs that must be taken into consideration when supporting their type 2 diabetes treatment and management care. Effective treatment and management of type 2 diabetes for older adults living in MUAs requires incorporating the preferences, desires, needs, values, and goals of the person at the center of the care into his/her care plan. Shifting care to be conducive to the treatment and management goals and plans co-created with older adults living in MUAs based on their individual physical, psychological, social, and spiritual preferences, …

Effects Of Social Determinants Of Health In Progression To Type 2 Diabetes, Folabi I. Ariganjoye

Applied Research Projects

The prevalence of prediabetes and diabetes in the United States and around the world has increased faster than expected in the last 30 years. The economic burden this costs a nation can be astronomic both in terms of expense and loss in productivity. One-third of U.S. adults, 86 million people, have prediabetes. Effective management is needed that can reach these 86 million, and others at high risk, to reduce their progression to diagnosed Type 2 diabetes. After the literature review, there was not enough literature to support how these led to the progression to diabetes. The abundant literature is centered …

The Application Of Point-Of-Care Ultrasound In Ed Intubations And Airway Access: A Systematic Review, Frank Wheeler, James Espinosa, Alan Lucerna, Jeffrey Gardecki

Rowan-Virtua Research Day

Intubation is an essential procedure performed on a routine basis in the emergency room. Unsuccessful intubations are associated with deleterious outcomes. A systematic review was performed to investigate the accuracy of point of care ultrasound (POCUS) in successful Endotracheal Tube (ET) tube confirmation, utilizing ultrasonography, identification of the cricothyroid membrane utilizing ultrasound, and dynamically during use of ultrasonography in the process of intubation. This review demonstrated high sensitivity and specificity for ultrasound confirmation of ET tube placement, high success rate in ultrasound-guided intubation, and lower than expected accuracy in identifying the cricothyroid membrane. Ultrasonography should be considered for ET tube …

Abstracts From The 2021 Health Care Systems Research Network Annual Conference

Journal of Patient-Centered Research and Reviews

The Health Care Systems Research Network (HCSRN) is comprised of 19 not-for-profit health systems with embedded research departments. The network’s annual conference serves as a forum for member institutions to highlight research findings, explore new collaborations, and share insights and opportunities. Abstracts accepted for oral and poster presentation at the 2021 HCSRN Conference are published in this supplement of Journal of Patient-Centered Research and Reviews, the official scientific journal of the annual conference.

Effectiveness Of Ehr-Depression Screening Among Adult Diabetics In An Urban Primary Care Clinic, Filipina C. Schnabel Md, Mph, Msn, Fnp-Bc, Danielle Aldridge Msn, Fnp-C, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR).

Methods We conducted a retrospective chart review on patients …

Supply, Demand, And Quality: A Three-Pronged Approach To Blood Product Management In Developing Countries, Kyle L. Gress, Karina Charipova, Ivan Urits, Omar Viswanath, Alan D. Kaye

Journal of Patient-Centered Research and Reviews

While transfusion of blood and blood products is instinctively linked to the provision of emergent care, blood and blood products are also routinely used for the treatment of subacute and chronic conditions. Despite the efforts of the World Health Organization and others, developing countries are faced with a three-part problem when it comes to access to and delivery of transfusions: insufficient supply, excessive demand, and inadequate quality of available supply. Developing countries rely heavily on replacement and remunerated donors rather than voluntary nonremunerated donors due to concerns regarding donation- and transfusion-transmitted infection as well as local and cultural beliefs. While …

Preprocedure Covid-19 Testing In Early Phase Of Pandemic, Renuka Jain, Bradley Kruger, Robert Citronberg, Stacie Kroboth, Ana Cristina Perez Moreno, Bijoy K. Khandheria

Journal of Patient-Centered Research and Reviews

The COVID-19 pandemic led to a nationwide shutdown of elective medical procedures. Upon resumption of services, preprocedure nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was introduced for all patients requiring surgical or other aerosol-generating procedures. We investigated preprocedure COVID-19 testing in one of the largest U.S. health systems. Patients included in this retrospective, observational study were asymptomatic and scheduled for a procedure or surgery. All patients underwent a nasopharyngeal swab test for SARS-CoV-2 performed 24–72 hours prior to a planned procedure. Clinical demographics, type of procedure, test results, and subsequent procedure status were evaluated. Of 38,608 …

C17: Programmed Cell Death Ligand- 1 Expression As A Prognostic Indicator In Oral Squamous Cell Carcinoma, Dr. Samar Saeed Khan

Annual Research Symposium

No abstract provided.

Regional Variations In Heart Failure Quality And Outcomes: Get With The Guidelines-Heart Failure Registry, Luke C Cunningham, Gregg C Fonarow, Clyde W Yancy, Shubin Sheng, Roland A Matsouaka, Adam D Devore, Hani Jneid, Anita Deswal

Faculty, Staff and Students Publications

Background

Regional patient characteristics, care quality, and outcomes may differ based on a variety of factors among patients hospitalized for heart failure (HF). Regional disparities in outcomes of cardiovascular disease have been suggested across various regions in the United States. This study examined whether there are significant differences by region in quality of care and short‐term outcomes of hospitalized patients with HF across the United States.

Methods and Results

We examined regional demographics, quality measures, and short‐term outcomes across 4 US Census Bureau regions in patients hospitalized with HF and enrolled in the GWTG‐HF (Get With The Guidelines–Heart Failure) registry …

The Benefits Of A More Physically Active Workforce In The Corporate World, Dillon M. Billingham-Hemminger, Jacob D. Locke

Senior Theses

With the ever-expanding knowledge of the benefits of physical activity and good general health for all aspects of our lives, it should be quite surprising that activity levels are declining at accelerating rates. After taking a deeper look into the probable cause for this phenomenon, it becomes clearer that the increasing pressures of workplace culture are leading to more sedentary lifestyles.

This paper looks at the benefits of physical activity on people and on corporations, specifically workplace disease prevention and wellness programs, to see if there exists a mutualistic relationship between the two. For people, physical activity was consistently found …

Dnp Final Report: Breaking The Cycle: Care Coordination Interventions And Sickle Cell Readmissions, Naphtali Edge

DNP Final Reports

Background

Approximately 100,000 people in the United States are affected by Sickle Cell Disease (SCD). Sickle Cell Disease represents the second highest readmitting diagnosis at Houston Methodist Hospital. The purpose of this study is to determine the impact of implementing care coordination interventions to reduce hospital readmissions of patients with SCD.

PICOT

In adult patients with SCD in the acute care hospital setting, how does care coordination intervention compared to no care coordination intervention affect the readmission rate for patients with SCD over a 3 – 6-month period?

Body of Evidence

Eleven studies were critical appraised and included in the …

Do Needle Exchange Programs Cause More Harm To Injection Drug Users And Compromise The Safety Of The Communities In Which They Are In Place?, Amber L. Payne

Theses, Dissertations and Capstones

Needle Exchange Programs (NEP) are put in place in regions in the US, where illegal injectable drug use is prevalent, in order to decrease the amount of blood borne diseases by at least 10%, such as Hepatitis C and Human Immunodeficiency Virus (HIV), being spread throughout the drug-using community. People and Healthcare Professionals in these communities have questioned if NEPs have caused more harm to the drug users and if they have compromised public safety due to incorrect disposal of syringes.

During a study in 2011, the spread of blood borne diseases in areas where NEPs were present, decreased among …

Effects Of The Needle Exchange Program Implemented In West Virginia, Amber Graves, Anthony B. Uriarte, Katherine Duty

Theses, Dissertations and Capstones

Introduction: West Virginia has had a recent spike in infectious diseases such as HIV and hepatitis due to increased rates of injectable drug use. The rising costs associated with such diseases have been a cause for concern in the sector of healthcare and public health. In the state, the exchanging of dirty needles has resulted in the spread of bloodborne pathogens, however, the implementation of needle exchange programs has sought to decrease the rates of infection, improve health outcomes, and lower healthcare costs. However, there is a question as to the effectiveness of such programs.

Purpose of Study: …

Disparities In The 2009 Swine Flu Pandemic And Covid-19: A Literature Review, Yusuf Amawi

Honors Undergraduate Theses

The purpose of this thesis was to identify causes of disparities in affliction (infection) and mortality for minority populations (Blacks, Hispanics, Asians, and American Indian/Alaskan Natives) during the Swine Flu (H1N1) and COVID-19 (Sars-Cov-2) Pandemics. A literature review was conducted gathering peer-reviewed journal articles related to racial and socioeconomic disparities in affliction and mortality during both pandemics. The model of Blumenshine et al. (2008) was used as a guide for the analysis of this thesis, and measures of exposure, susceptibility, and treatment were hypothesized as causes for the disparities experienced by the minority populations during the two pandemics. Ultimately, it …

Reducing Turnaround Time From Pathology Collection To Patient Awareness In Gastroenterology Practice, Adrianna Hyams

DNP Scholarly Projects

Background: Means of improving the turnaround time from specimen completion to the patient being notified of results are not well known or researched. The aim of this study is to decrease the turnaround time (TAT) from when the specimen is collected to the time the patient is notified from 4 weeks to 2 weeks. This quality improvement project took place in a privately owned gastroenterology office in southern Indiana.

Methods: An exhaustive literature review was completed to determine the best means of improving pathology TAT. The Plan Do Check Act (PDCA) method of quality improvement was used for this project. …

Potential Perioperative Complications Due To Difference In Timing Of Systemic Heparinization During Ruptured Aneurysm Coiling, Rouzbeh Kotaki, Ameer E. Hassan, Wondwossen G. Tekle

MEDI 9331 Scholarly Activities Clinical Years

Potential Perioperative Complications Due To Differences in Timing Of Systemic Heparin Distribution During Ruptured Aneurysm Coiling

Introduction:

In general, systematic heparin anticoagulation is standard in regards to neurovascular intervention. When coiling ruptured aneurysms, many neurointerventionalists have their own protocol as to timing of systemic heparinization. There is ample research and literature reviewing the frequency of perioperative events, predictors and outcomes, as well as the efficacy in the use of anticoagulants and/or antiplatelets before, during, and after neurovascular procedures to prevent adverse outcomes. However, there currently exists a dearth of research in regards to timing of distribution of heparin intraoperatively and …

The Relationship Between Insurance And Health Outcomes Of Diabetes Mellitus Patients In Maryland: A Retrospective Archival Study, Soo-Hoon Lee, Samuel L. Brown, Andrew A. Bennett

Management Faculty Publications

Background

Past studies examining the health outcomes of diabetes mellitus (DM) patients found that social determinants of health disparities were associated with variabilities in health outcomes. However, improving access to healthcare, such as health insurance, should mitigate negative health outcomes. The aim of the study was to explore the association between four types of health insurance, namely, Medicare Fee-For-Service (FFS), Medicare Managed Care (MC), Private FFS, and Private MC plans, and the health outcomes of DM patients, controlling for patients’ social determinants of health.

Methods

This is a retrospective cross-sectional archival record study to explore the relationships between types of …

Heart Failure 30-Day Readmission Frequency, Rates, And Hf Classification, Yolanda R. Brown, Twonia M. Goyer, Margaret C. Harvey

Doctor of Nursing Practice Projects

30 Day Hospital Readmission Rates, Frequencies, and Heart Failure Classification for Patients with Heart Failure

Background Congestive heart failure (CHF) is the leading cause of mortality, morbidity, and disability worldwide among patients. Both the incidence and the prevalence of heart failure are age dependent and are relatively common in individuals 40 years of age and older. CHF is one of the leading causes of inpatient hospitalization readmission in the United States, with readmission rates remaining above the 20% goal within 30 days. The Center for Medicare and Medicaid Services imposes a 3% reimbursement penalty for excessive readmissions including those who …

Using Preliminary Data And Prospective Power Analyses For Mid-Stream Revision Of Projected Group And Subgroup Sizes In Pragmatic Patient-Centered Outcomes Research, Elizabeth A. Tolley Md, Satya Surbhi Md, James E. Bailey Md

Faculty Publications and Presentations

Pragmatic clinical trials are commonly used in patient-centered outcomes research to assess heterogeneity of treatment effects. Patient-Centered Outcomes Research Institute (PCORI) methodology standards for assessing heterogeneity of treatment effects are extremely rigorous, but their implementation in real-world settings can be difficult. Predicting recruitment effectiveness and subgroup characteristics is often challenging and may require mid-stream revision of projected group and subgroup sizes. Yet, little real-world data are available to demonstrate methodologically valid approaches to address situations where such revisions are necessary. These data were used for mid-stream revision of group and subgroup sizes in the Management of Diabetes in Everyday Life …

Patient-Centered Implementation Of Statin Therapy In Patients With Type 2 Diabetes, Giovanna P. Favarato

Doctor of Nursing Practice

Heart disease is the leading cause of morbidity and mortality in Americans with type 2 diabetes mellitus. The American Diabetes Association recommends statins and lifestyle modifications for all patients with type 2 diabetes mellitus for the prevention of atherosclerotic cardiovascular events. A patient-centered approach to primary prevention is encouraged, yet there are no specific instructions regarding implementation. The Statin Choice Decision Aid is a tool designed to facilitate shared decision-making between the patient and the provider in the clinical setting. The 2018 American College of Cardiology/American Heart Association guidelines for the primary prevention of atherosclerotic cardiovascular disease for patients with …

Inferior St-Elevation Myocardial Infarction Presenting When Urgent Primary Percutaneous Coronary Intervention Is Unavailable: Should We Adhere To Current Guidelines?, Yochai Birnbaum, Glenn N Levine, John French, Juan Carlos Kaski, Dan Atar, Mahboob Alam, David Hasdai, Hani Jneid, Barry F Uretsky

Faculty, Staff and Students Publications

The pivotal studies that led to the recommendations for emergent reperfusion therapy for ST-elevation myocardial infarction (STEMI) were conducted for the most part over 25 years ago. At that time, contemporary standard treatments including aspirin, statin, and even anticoagulation were not commonly used. The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines and the 2017 European Society of Cardiology guidelines give a class I recommendation (with the level of evidence A) for primary percutaneous coronary intervention (pPCI) in patients with STEMI and ischemic symptoms of less than 12 h. However, if the patient presents to a hospital …