Health and Medical Administration Commons^™

A Program To Treat Hepatitis B In North Korea: A Model Of Antiviral Therapy In A Resource-Poor Setting, Marcia Ann Kilsby, Alice Unah Lee, Heidi Linton, David C. Hilmers

Faculty Publications

Despite the well-proven, safe and effective therapies for hepatitis B infection, delivery of treatment remains a significant challenge in resource-poor settings. Geopolitical and economic restrictions present additional difficulties in providing care in North Korea. However, treatment of patients with chronic hepatitis B remains a top priority for both the North Korean Ministry of Public Health and international agencies working in North Korean hepatitis healthcare facilities. Working in partnership, a path was created to institute this much-needed program. A consortium of United States and Australian humanitarian non-governmental organizations along with generous individual and corporate donors working in concert with local and …

How To Translate Self-Management Support Tools Into Clinical Practice, Matthew J. Simpson, Jeanette M. Daly, Douglas H. Fernald, John M. Westfall, Leann C. Michaels, Barcey T. Levy, David L. Hahn, Lyle J. Fagnan, Donald E. Nease Jr.

Journal of Patient-Centered Research and Reviews

Purpose: Patient self-management is an inevitable part of the work of being a patient, and self-management support (SMS) has become increasingly important in chronic disease management. However, the majority of SMS resources available in the Agency for Healthcare Research and Quality SMS Resource Library were developed without explicit collaboration between clinicians and patients.

Methods: Translation of SMS tools derived from the library into primary care practices occurred utilizing boot camp translation in four different practice-based research networks (PBRNs). The typical model of boot camp translation was adapted for the purpose of the Implementing Networks’ Self-management Tools Through Engaging Patients and …

Adapting Boot Camp Translation Methods To Engage Clinician/Patient Research Teams Within Practice-Based Research Networks, Lyle J. Fagnan, Matthew J. Simpson, Jeanette M. Daly, Leann C. Michaels, David L. Hahn, Barcey T. Levy, Douglas H. Fernald, John M. Westfall, Donald E. Nease Jr.

Journal of Patient-Centered Research and Reviews

Purpose: Boot camp translation is a proven process to engage community members and health professionals in translating and disseminating evidence-based “best practices” models for health prevention and chronic illness care. Primary care practice improvement studies, particularly involving patient-driven change, as seen with self-management support (SMS), require engaged practice teams that include patients. Models of engagement such as boot camp translation may be effective.

Methods: Four geographically dispersed practice-based research networks (PBRNs) from the Meta-LARC consortium engaged 16 practices to form SMS implementation teams involving a clinician, care manager, and 2 patients in each team. Our study adapted the boot camp …

Infections Not Fought: Antibiotic Resistance In Underserved Communities, Derek Lillestolen

Senior Honors Theses

In 1928, the profound effects of penicillin were discovered and antibiotic treatments became extremely popular. Broad-spectrum antibiotics, like tetracyclines, have been since branded as cure-all prescriptions and used profusely in the Western World and abroad. Due to ignorance of specific biochemical mechanisms and the misuse of antibiotics these drugs inadvertently allowed the rise in prevalence of antibiotic resistant strains of certain bacteria as the century progressed. Now, the specific genetic causes and mechanisms of antibiotic resistance are being understood, but the fight against antimicrobial resistance is far from over. In the United States, thousands of fatalities are caused annually by …

Abstracts From The 24th Annual Health Care Systems Research Network Conference, April 11–13, 2018, Minneapolis, Minnesota

Journal of Patient-Centered Research and Reviews

Founded in 1994, the Health Care Systems Research Network (HCSRN) is a consortium of 18 research centers that are housed in community-based health systems. The organization's annual conference serves as a venue for research teams to disseminate scientific findings, stimulate new collaborations, and share insights about conducting research in real-world care-delivery settings. Abstracts accepted for presentation at HCSRN 2018 are published within this supplement of the Journal of Patient-Centered Research and Reviews.

Public Hospitals Matter, Herbert L Fred

The Texas Heart Institute Journal

Recent events in this country pose major concerns. Police shoot unarmed blacks, gun-wielding malcontents ambush policemen, white supremacists march, gays are murdered, gender inequality pervades our workforce, and sexual harassment and abuse are surfacing in many segments of our society. In reaction, various social movements have sprung up, including Black Lives Matter, White Lives Matter, Blue Lives (policemen) Matter, Gay Lives Matter, Girls for Gender Equity (GGE), #MeToo, and Time's Up. To that list, I add another battle cry: Public Hospitals Matter.

Prevalence Of Diabetes Mellitus, Hypertension, And Dyslipidemia In Student-Run Screening Clinics For Rural Communities In The Sierra Norte Of Puebla, Mexico, Sean Navin, Daniel M. Tomaszewski

Pharmacy Faculty Articles and Research

Background: The growing prevalence of hypertension (HTN), diabetes mellitus (DM), and in Mexico highlights the need for preventative health care services. Rural communities worldwide lack access to such services. The purpose of this study was to describe the prevalence of HTN, DM, and dyslipidemia in student-run screening clinics in rural communities of the Sierra Norte of Puebla, Mexico to better understand the role the clinics play for the patients served.

Methods: Data were collected from patients from rural, Mexican towns participating in free pharmacy student-run screening clinics. Patients consented to have their de-identified information pooled for re-search. Screenings …

Bermuda: Public Health Insurance, Maxwell Mead

Global Public Health

Bermuda, a British island territory located in the remote North Atlantic, remains a serviceable country to its citizens. However, it still lacks a national healthcare system: marking it as a difficult country to live in. Despite acknowledging this issue, Bermudan officials have made few attempts to fix the problem. This, in turn, has made Bermuda the highest annual spender on health per capita in the world at $11,952. As such, the cost of living is rather high in Bermuda, sitting at a full 94.86% higher than the cost of living in the United States. All of this makes affording healthcare …

Palau: Obesity, Tavia Weis

Global Public Health

Located in the heart of the Western Pacific Ocean is a large group of small islands that make up the country of Palau. Known for its growing tourism, beautiful landscapes, and cultural beliefs. Although the country is developing, the current health issue of obesity is a growing concern. With almost half of the population obese and the other half in jeopardy, the rising concerns of the obesity epidemic have taken global news and brought the attention of major countries to try and fix these rising issues. This public health brief will discuss the problems of obesity in Palau and the …

The Effectiveness Of Interventions And Bundles For Central Line-Associated Bloodstream Infections In The Neonatal Intensive Care Unit, Mohamad Alhamwi

Honors Undergraduate Theses

Introduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing CLABSI in NICUs.

Methods: A systematic literature search was conducted using CINAHL Plus with Text, Cochrane Database of Systematic Reviews and MEDLINE from January 2008 up to 2018. There were multiple …

Implementing Lean Daily Management System To Improve Cvor First Case On-Time Starts, Haley Borchers, Kelly Fehlhafer, Barbara Mueller, Jessica Nichols, Sarah Talken, Mary Hunter, Kenneth Sam

Posters

No abstract provided.

Six-Year Experience Of Influenza Vaccination As A Condition Of Employment For A Large Regional Health Care System, John R. Brill, Mark Hermanoff, Angela Tonozzi, Mary Jo Capodice, Jennifer Farrar, Zarina Dawoodbhai

Journal of Patient-Centered Research and Reviews

Background: Influenza remains a significant contributor to morbidity and mortality in the United States. Health care workers (HCW) can be both victims and vectors of influenza. Influenza vaccination of HCW is protective for both caregivers and patients, but voluntary programs generally fail to achieve rates recommended by the Centers for Disease Control and Prevention. Despite a complex, multifaceted influenza program initiated in 1996 that included significant education and promotion as well as free on-site vaccination, annual Aurora Health Care caregiver immunization rates remained in the mid-70s until adoption of a “condition of employment” strategy in 2011.

Purpose: Discuss the annual …

Reducing Medication Errors In Pneumonia Patients During Transitions Of Care, Laressa Bethishou, Noah Fang, Lisa Shieh

Pharmacy Faculty Articles and Research

Purpose: At Stanford Health Care, as part of a hospital-wide initiative to reduce pneumonia readmission rates, an interdisciplinary collaborative effort was created between physicians and transitions of care (ToC) pharmacists to optimize discharge planning and medication management for pneumonia patients. The purpose of this study was to describe the impact of the ToC pharmacist in identifying and reducing medication errors on discharge for pneumonia patients.

Methodology: Retrospective chart review was conducted on patients discharged with a pneumonia diagnosis between December 2015 to Feb 2016. Patients were stratified based on whether they received ToC pharmacist medication review vs. standard …

Managing The Cost Of Diabetes, Laressa Bethishou

Pharmacy Faculty Articles and Research

"This is of concern to health care providers because inadequate management of diabetes results in short- and long-term complications. Patients with diabetes and no health insurance have fewer physician visits and are prescribed fewer medications for management of their diabetes. Patients with diabetes make up 11.9% of all emergency department visits in the United States.Hispanic and non-Hispanic blacks are at greater risk for developing diabetes and serious associated health complications, including chronic kidney disease. This may be attributed to a combination of genetics, diet, and exercise. However, access to health care resources may also play an important role."

Gender Differences In Virologic Response After Antiretroviral Therapy In Treatment-Naïve Hiv-Infected Individuals: Results From The 550 Clinic Hiv Cohort Study., Andrea Reyes-Vega, Alejandra Loban, Kavitha Srinivasan, Stephen P. Furmanek, Conner English, Mary Bishop, Cathy Spencer, Daniel Truelove, Julio A. Ramirez, Anupama Raghuram, Paula Peyrani

Faculty and Staff Scholarship

Background

Controversy still exists regarding gender differences in virologic response between treatment-na•ve HIV-infected individuals. The objective of this study was to evaluate gender difference in virologic and immunologic response to antiretroviral therapy in treatment-na•ve HIV-infected individuals. Methods

This was a retrospective, observational study of treatment-na•ve HIV-infected individuals managed at the 550 clinic who started antiretroviral therapy (ART) between January 1st, 2010 and December 31, 2015. Patients with available viral load and CD4 counts before and one year after initiating ART were included in this study. Virologic suppression was defined as < 48 HIV-1 RNA copies/mL, and mmunologic recovery was defined as a CD4 count increase of at least 150 cells/mm3. Dichotomous variables were reported in number and percentages and analyzed using Chi-squared tests and Fisher’s exact (whichever was appropriate). Continuous variables were reported as median and interquartile range (IQR) and analyzed using Wilcox rank-sum tests. Multivariate analyses performed were logistic regressions with adjustment for other covariates. P value <0.05 was considered statistically significant. R version 3.3.2 was used for the statistical analysis. Results

A total of 70 women and 90 men were included …

Improving Cardiology Patient Flow In Nuclear Medicine, Kelly Haar, Hannah Sullivan, Kathryn Laverdiere, Nuclear Medicine Department, Haley Pelletier, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

MaineHealth Maine Medical Center

At baseline, a nuclear medicine department found it difficult to complete cardiac stress tests within scheduled times. Using the performance improvement process, a nuclear medicine department looked to improve patient experience related to wait times for this test.

Two goals were identified and a root cause analysis was initiated. After identifying some process issues, two KPIs were developed to address them.

A root cause analysis identified some processing issues and two KPIs were instituted to address them.

As a result, one outcome was to hire an additional physician assistant to address the barrier of inadequate cardiology coverage. Next steps include …

Cancer Center Regional Benchmarks For Psychosocial Care, Desiree R. Azizoddin

Loma Linda University Electronic Theses, Dissertations & Projects

The American College of Surgeons (ACoS) Commissions on Cancer (CoC) formulated and implemented standard 3.2 for Psychosocial Distress Screening. This standard requires that all accredited cancer centers evaluate psychosocial distress and provide appropriate triage and intervention for all cancer patients. Over the past decade, Loma Linda University Medical Oncology Center (LLUMOC) administration, physicians, nurses, psychosocial care staff, and chaplaincy collaborated to implement a psychosocial screening and referral program throughout cancer patient services. This current research includes qualitative analysis assessing strengths and barriers of the psychosocial program at LLUMOC from the perspective of LLUMOC providers and two directors of Supportive Care …

The Effect Of Bundled Interventions On Prevention Of Hospital Acquired Clostridium Difficile Infection, Kaitlin Kendys

Evidence-Based Practice Project Reports

Clostridium difficile infection (CDI) rates have steadily increased in hospitalized patients due to the change in epidemiology. Approximately 13 of every 1,000 inpatients are either infected or colonized with C. difficile (CDC, 2013). CDI rates continue to rise due to the hyper-virulent strain of C. difficile and length of therapy needed to treat CDI. The average cost for a single inpatient CDI is more than $35,000, and the estimated annual cost burden for the healthcare system exceeds $3 billion (Walsh, 2012). The purpose of this evidence-based project (EBP) was to reduce hospital-acquired CDI rates over a 3-month period-oftime from November …

Healthcare Provider And Patient Knowledge, Attitudes And Practices (Kap) Regarding Zika Virus, Quinton Katler, Prachi Godiwala, Charles Macri, Beth Pineles, Aileen Chang, Homa Ahmadzia

GW Research Days 2016 - 2020

Introduction:

Zika virus emergence in the western hemisphere has prompted the critical need for tailored risk counseling. Our team created a KAP survey in order to assess provider and patient awareness of Zika virus symptoms, transmission, treatment, and current and future concerns in order to inform local risk counseling efforts.

Methods:

The cross-sectional survey was issued in Medical Faculty Associates (MFA) clinics and via online link to healthcare providers and community members. The REDCap Data Collection tool was used to capture responses with subsequent SAS data analysis.

Results:

A total of 172 responses were collected. Most respondents (97%) were aware …

Maximizing Health Outcomes In A Medical Home For Children With Medical Complexity: The Beacon Program., Ingrid Larson, Amber Hoffman, Michael Artman

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

In-Hospital Outcomes And Hospitalizations For Acute Rheumatic Heart Disease: A United States National Study, Srikanth Yandrapalli, Abdallah Sanaani, Zeeshan Solangi, Merita Shehu, Sachin Sule, Wilbert S. Aronow

NYMC Faculty Posters

No abstract provided.

Chagas Heart Disease: A United States National Study, Srikanth Yandrapalli, Prakash Harikrishnan, Abdallah Sanaani, Wilbert S. Aronow, Sachin Sule, Alan L. Gass, Chhaya Aggarwal, William H. Frishman, Gregg C. Fonarow, Gregg M. Lanier, Howard A. Cooper, Julio Panza

NYMC Faculty Posters

No abstract provided.

Nationwide Trends In Inpatient Admissions Of Pulmonary Hypertension In The United States From 2000 To 2013, Rutuja R. Sikachi, Sonu Sahni, Dhruv Mehta, Abhishek Agarwal, Abhinav Agrawal

Touro College of Osteopathic Medicine (New York) Publications and Research

Introduction: Pulmonary Hypertension (PH) is a disorder of the pulmonary vasculature with high mortality and bears a large economic burden on the healthcare system. We conducted a review of the largest inpatient database in the United States and analyzed the trends in hospitalizations due to PH from the turn of the century (2000) to 2013 to evaluate the rate of hospitalizations and determine the cost and mortality associated with PH.

Material and methods: We analyzed the National Inpatient Sample Database (NIS) for all patients in which PH (Primary or Secondary) or cor pulmonale was the primary discharge diagnosis …

Actionable Patient Safety Solution (Apss) #3c: Improve Prevention Of Severe Hypoglycemia, Jerika Lam, Steven Barker, Michael Ramsay, Ariana Longley, Joe Kiani

Pharmacy Faculty Articles and Research

This report presents a plan of action for introducing a "program to reduce errors in the recognition and treatment of [severe hypoglycemia]".

Racial And Ethnic Differences In Receipt Of Immediate Breast Reconstruction Surgery: Do Hospital Characteristics Matter?, Jaya Shankar Khushalani

Theses and Dissertations

Immediate Breast Reconstruction Surgery (IBRS) is associated with better quality of life among women who undergo a mastectomy. Despite insurance coverage for IBRS, utilization of IBRS remains low. Data from publicly available sources for 2010-2012 are used to examine the association between hospital characteristics receipt of IBRS by patients. Minority-serving status, low bed size, for-profit ownership, non-teaching status, high competition, low density of plastic surgeons in the market and non-metropolitan location are associated with lower likelihood of receipt of IBRS.

Racial and ethnic minorities are less likely to receive IBRS. A mixed effects logistic regression model with interactions between Black/Hispanic …

Identifying Complexity In Infectious Diseases Inpatient Settings: An Observation Study, Don Roosan, Charlene Weir, Matthew Samore, Makoto Jones, Moom Roosan, Gregory J. Stoddard, Guilherme Del Fiol

Pharmacy Faculty Articles and Research

Background
Understanding complexity in healthcare has the potential to reduce decision and treatment uncertainty. Therefore, identifying both patient and task complexity may offer better task allocation and design recommendation for next-generation health information technology system design.

Objective
To identify specific complexity-contributing factors in the infectious disease domain and the relationship with the complexity perceived by clinicians.

Method
We observed and audio recorded clinical rounds of three infectious disease teams. Thirty cases were observed for a period of four consecutive days. Transcripts were coded based on clinical complexity-contributing factors from the clinical complexity model. Ratings of complexity on day 1 for …

Abstracts From The 22nd Annual Health Care Systems Research Network Conference, April 13–16, 2016, Atlanta, Georgia

Journal of Patient-Centered Research and Reviews

This proceedings supplement includes selected abstracts presented at the 22nd annual conference of the Health Care Systems Research Network (HCSRN), held April 13–16, 2016, in Atlanta, Georgia. The HCSRN connects the resources and capabilities of research departments from its member health care systems. Collectively, the organization represents more than 1,900 scientists and research staff from an array of disciplines such as epidemiology, economics, disparities, outcomes and quality assessment, trials and genomics.

Surveillance, Epidemiological, And Virological Detection Of Highly Pathogenic H5n1 Avian Influenza Viruses In Duck And Poultry From Bangladesh, Wahedul Karim Ansari, Md Safiullah Parvej, Mohamed E. El Zowalaty, Sally Jackson, Stephen A. Bustin, Adel K. Ibrahim, Md Tanvir Rahman, Han Zhang, Mohammad Ferdousur Rahman Khan, Md Mostakin Ahamd, Md. Fasiur Rahman, Marzia Rahman, Khm Nazmul H. Nazir, Sultan Ahmed, Md Liakot Hossenn, Md Abdul Kafi, Mat Yamage, Nitish C. Debnath, Graba Ahmed, Hossam Ashour, Md Masoud, Ayman Noreddin, Md B. Rahman

Pharmacy Faculty Articles and Research

Avian influenza viruses (AIVs) continue to pose a global threat. Waterfowl are the main reservoir and are responsible for the spillover of AIVs to other hosts. This study was conducted as part of routine surveillance activities in Bangladesh and it reports on the serological and molecular detection of H5N1 AIV subtype. A total of 2169 cloacal and 2191 oropharyngeal swabs as well as 1725 sera samples were collected from live birds including duck and chicken in different locations in Bangladesh between the years of 2013 and 2014. Samples were tested using virus isolation, serological tests and molecular methods of RT-PCR. …

The Emerging Zika Pandemic: Enhancing Preparedness, Lawrence O. Gostin, Daniel Lucey

Georgetown Law Faculty Publications and Other Works

The Zika virus (ZIKV), a flavivirus related to yellow fever, dengue, West Nile, and Japanese encephalitis, originated in the Zika forest in Uganda and was discovered in a rhesus monkey in 1947. The disease now has “explosive” pandemic potential, with outbreaks in Africa, Southeast Asia, the Pacific Islands, and the Americas. Since Brazil reported Zika virus in May 2015, infections have occurred in at least 20 countries in the Americas. Puerto Rico reported the first locally transmitted infection in December 2015, but Zika is likely to spread to the United States. The Aedes species mosquito (an aggressive daytime biter) that …

Ketogenic Diet Decreases Emergency Room Visits And Hospitalizations Related To Epilepsy., Husam R. Kayyali, Anastasia Luniova, Ahmed Abdelmoity

Manuscripts, Articles, Book Chapters and Other Papers

Background. Approximately, one-third of patients with epilepsy are refractory to pharmacological treatment which mandates extensive medical care and imposes significant economic burden on patients and their societies. This study intends to assess the impact of the treatment with ketogenic diet (KD) on reducing seizure-related emergency room visits and hospitalizations in children with refractory epilepsy. Methods. This is a retrospective review of children treated with the KD in one tertiary center. We compared a 12 months' period prior to KD with 12 months after the diet was started in regard to the number of emergency department (ED) visits, hospitalizations, …