Medical Education Commons^™

Rn Managed Warfarin Therapy Improves Patient Outcomes, Beth Ormsby, Stacee Marvin, Viktoria Leblanc, Ashley Harris

Nursing Research and EBP Day 2022

Warfarin, an oral anticoagulant, is a “high-risk” medication with narrow therapeutic range and risks for serious complications if not carefully managed. Therapeutic effect is determined using a blood test called the International Normalized Ratio (INR). Evidence shows a higher percentage of Time in Therapeutic Range (TTR) decreases the risk of adverse events including bleeding, hemorrhagic stroke, and death. An optimal TTR is 60 – 70% or higher. Improving TTR by 2.5 - 5% could significantly impact outcomes.

It was hypothesized that an algorithm based approach to Warfarin management by a consistent team of RN’s would improve TTR and outcomes.

To …

A Depression Screening Protocol For Acute Stoke Patients: A Quality Improvement Project, Celia Mcintosh

Nursing Research and EBP Day 2022

Background: Depression after stroke is common and is associated with poor functional recovery, suicidal ideation, decreased quality of life, and increased mortality. Despite this knowledge, poststroke depression (PSD) is often underdetected and thus undertreated. PSD is clinically important for the caregiver, the family, and the stroke survivor. Inconsistencies in screening and treatment practices may further contribute to these negative outcomes.

Purpose: The purposes of this evidence-based clinical scholarship project were to (1) determine the efficacy of an evidence-based depression screening protocol in improving early detection and treatment of PSD and (2) identify if there were any relationships between the protocol …

Nurse Driven Early Mobility In The Intensive Care Unit: Mobility Protocol And A Designated Mobility Champion, Intensive Care Unit, Newark-Wayne Community Hospital, Newark, Ny

Nursing Research and EBP Day 2022

Decreased mobility in hospitalized patients can lead to various health consequences, including increased morbidity and mortality. In the Intensive Care Unit (ICU), patients are not mobilized as frequently or as often as possible. Barriers to mobilization include limited resources such as time and staffing, perceived risk, and insufficient training in safe patient handling. This quality improvement initiative aimed to increase out-of-bed mobility in ICU patients, address activity orders at interdisciplinary rounds, and trial a designated mobility champion. The America Association of Critical-Care Nurses (AACN) Early Progressive Mobility (EPM) protocol and Bedside Mobility Assessment Tool (BMAT) were adopted and used to …

Assessing Primary Care Rns Impact On Quality Patient Care, Elizabeth Carreira

Nursing Research and EBP Day 2022

The purpose of this work was to examine how a large multi-site primary care based organization established an organizational structure that supported the determination, definition, measurement, and reporting of nursing sensitive indicators (NSIs) specific to ambulatory care nursing. NSIs capture the value of care provided by nurses and are a critical component of ANCC Magnet designation. The organization considered that successful pursuit of Magnet designation in an all ambulatory organization would involve establishing a framework to report NSIs that included defining nursing units and NSIs meaningful to the organization.

A multidisciplinary team led by nursing was established to examine and …

Development Of Share: Supportive Holistic Anxiety Reducing Experience In Critical Care, Benjamin Lindsay, Judith V. Treschuk

Nursing Research and EBP Day 2022

The purpose of this research/EBP was to develop an evidence-based Interdisciplinary Family-Centered Communication and Support Program in the Surgical/Neuro Intensive Care Unit intended to provide the support that family members and patients need when admitted to the Surgical/Neuro Intensive Care Unit.

It was hypothesized that there is a way to support patients and their family members during their admission to the RGH SICU/NCCU through evidence-based practice decreasing their anxiety and dissatisfaction with communication with the interdisciplinary team. To test the hypothesis, an electronic literature review was completed in March 2021 and May 2021 for the most current research on family-centered …

Nicu Discharge Readiness, Sarah Kiley, Megan Adams, Jennifer Pacheco-Leyva, Paula Sedita, Brooke Swinton, Michele Wells

Nursing Research and EBP Day 2022

After days, weeks or months in the neonatal intensive care unit (NICU), families can be overwhelmed by the discharge preparation and the transition to home. Literature supports that inadequate preparation for discharge from the NICU increases family anxiety, risk for hospital readmission and emergency room visits, as well as infant care issues at home such as feeding difficulty. This quality improvement project was identified to improve and enhance discharge readiness in the NICU.

The project started with the development of a discharge readiness committee. After reviewing the literature, the committee met to identify areas in need of improvement which included …

Development And Implementation Of An Ambulatory Nursing Shared Governance Council, Patricia K. Fioravanti, Maria Larner

Nursing Research and EBP Day 2022

The purpose of this work was to research, develop, and implement an ambulatory nursing shared governance council (ANSGC) to support the pursuit of Magnet designation within the Primary Care and Specialty Institute (PCASI) ambulatory care nursing environment at Rochester Regional Health. PCASI is comprised of over 115 practices located throughout 8 counties. Literature supports shared governance as a mechanism to increase nurse engagement, nurse retention, improve patient outcomes and promotes partnership between front line nurses and administration. Nursing Shared Governance is a pillar of the American Nurses Credentialing Center (ANCC) Magnet culture and a critical component of Magnet designation.

PCASI …

Licensed Practical Nurses Working To Maximum Scope Of Practice, Lindsey Sippel, Lauren Sicker, Jessie Schiffhauer, Kristee Aliten

Nursing Research and EBP Day 2022

BACKGROUND: Nurses on 4800, a medical-surgical unit, were feeling overwhelmed by an increasing patient load due to Registered Nurse (RN) vacancies. No not only was staff morale at a low, but the staff was concerned about the impact on patient care. Nursing staff on 4800 consists of RNs as well as Licensed Practical Nurses (LPNs). As the team contemplated the high nurse:patient ratio, they identified that LPNs were not working to the full scope of their practice. The team began to wonder if ensuring that LPNs could work at the highest level of their scope of practice if this would …

Evidence-Based Practice Liaisons: Supporting Ebp Across The Health System, Tami A. Hartzell, Susan Stell

Nursing Research and EBP Day 2022

No abstract provided.

Peer Review, Robert Ferguson

CHED Talks

No abstract provided.

Monkey Pox: Ignored Or Emerging Pathogen, Karoll J. Cortez

CHED Talks

No abstract provided.

Shared Language Builds A Foundation For Health Equity, Deborah Stamps, Ebony Caldwell, Ajda Ince

Advances in Clinical Medical Research and Healthcare Delivery

Achieving Health Equity requires developing a shared language that allows people to understand diversity in various contexts. For instance, shared language allows us to discuss diversity issues concerning gender identity, just as much as it allows us to discuss diversity issues concerning citizenship, race, or sexual attraction. This article sets out five key terms that form the foundation of a shared language: Diversity, Equity, Inclusion, Cultural Humility, and Cultural Responsiveness. The five key terms provide a solid foundation for efforts to further expand our shared language around diversity, such as a glossary defining terms like gender identity, race.

Patient-Centered Care: Disease Vs. Illness, Frantz Duffoo

CHED Talks

No abstract provided.

“Hiccups” With Covid-19 Management, Yong W. Lee, Jacob Psomiadis, Sarah Akbani, Marvin Lopez-Medal, Aisha Miller

Advances in Clinical Medical Research and Healthcare Delivery

Hiccups, medically referred as singultus, is a condition that results from involuntary contraction of the diaphragm and intercostal muscles. Singultus is usually a self-limiting condition which typically lasts less than 48 hours but in rare cases, can persist greater than 48 hours. This is a case of a 48 year-old male who was prescribed dexamethasone for COVID-19 but developed intractable singultus for two weeks. Patient was unable to tolerate diet due to intractable singultus leading to vomiting. He underwent various non-pharmacological maneuvers and pharmacotherapy without resolution. Dexamethasone- induced hiccups have been reported as an under recognized side effect of dexamethasone. …

Emergency Medicine Journal Club, David Gibbs, Dylan Norton, Kyle Barbour

Advances in Clinical Medical Research and Healthcare Delivery

In this column, we provide a brief review of important papers recently published that relate to the field of Emergency Medicine. The goal is to provide the busy clinician a bullet-like summary of the study, focusing on the research question, methods, results, limitations and bottom line interpretation.

Physician And Patient Moves In The Hospital Do Not Move Patient Satisfaction: A Single-Center Retrospective Analysis, Basil George Verghese, Nagesh Jadhav, Walter A. Polashenski, Carl H. Reynolds

Advances in Clinical Medical Research and Healthcare Delivery

Background. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey for measuring patient's experiences at US hospitals. There is a shift towards geographically assigning patients and physicians. However, its impact on patient satisfaction scores has not been studied.

Objective: Examine the correlation between patient experience and overall hospital rating with the number of physicians seen and the number of times the patient was moved during a hospitalization.

Methods: A retrospective observational study was performed using select HCAHPS & Press Ganey survey questions to assess physician satisfaction scores and overall hospital rating and recommendation scores.

Results: There …

Hallway Medicine: Hospital Overcrowding And The Impact On Patient Care, Patrick Corey

CHED Talks

Goals:

• Examine how ED metrics have been affected with overcrowding.
• Discuss how boarding affect patient care outcomes.
• Identify potential solutions.

When #Playaparttogether Takes A Dark Turn, Richard Alweis

CHED Talks

This is an M&M style presentation involving a case of internet gaming disorder. It focuses on the neurology and pathology of internet addictions, as well as screening tools.

Building A Culture Of Research In Your Program, Richard Alweis

CHED Talks

This presentation describes potential interventions to create a culture of research in a community health system department or program that does not have that culture (but needs to develop it).

Trauma Induced Coagulopathy, Patrick Corey

Rochester General Hospital Grand Rounds

Goals:

• Discuss how traumatic events affect coagulation of patient

• Steps ED doctor can take to prevent and treat coagulopathy

• New technology and how it can help guide trauma care

How Did We Get This Far?, Hemant Kalia, Richard Alweis, Christina Goodermote, Elizabeth Mamo, Farrah Qadri

Advances in Clinical Medical Research and Healthcare Delivery

No abstract provided.

A Rare Case Of Severe Amlodipine-Induced Gingival Overgrowth: A Case Report, Marika Shahid, Yong W. Lee, Gande Li, Chisom Mogbo, Roger Vega

Advances in Clinical Medical Research and Healthcare Delivery

Gingival overgrowth, or gingival hyperplasia is the hypertrophy of periodontium caused by local systemic diseases or medications. These medications can be broadly categorized into three main groups including immunosuppressants, anticonvulsants, and calcium channel blockers (CCBs). Amlodipine-induced gingival overgrowth (AIGO) is a less documented phenomenon. This is a unique case of 68-year-old African American woman who developed severe AIGH after taking amlodipine for three years for essential hypertension. The gingival overgrowth happened over a period of two weeks and was so extreme that the patient was unable to approximate her lips or tolerate any oral intake. Labs, images, and biopsies were …

Emergency Medicine Journal Club, David Gibbs, Dylan Norton

Advances in Clinical Medical Research and Healthcare Delivery

In this column, we provide a brief review of important papers recently published that relate to the field of Emergency Medicine. The goal is to provide the busy clinician a bullet-like summary of the study, focusing on the research question, methods, results, limitations, and bottom line interpretation.

An Integrated Multispecialty Curriculum For Point-Of-Care Ultrasound, Carina M. Brown, Karl Fields, Duncan Vincent, Alison Rumball, Joshua Zavitz, Shane Hudnall, Caroline Iskander, Alexander Raines

Advances in Clinical Medical Research and Healthcare Delivery

Point-of-care ultrasound is increasingly recognized as a valuable tool for physicians practicing in a variety of specialties. Currently there is no standard curricula or assessment model for training primary care specialty residents in the use of ultrasound. This article presents a multispecialty experience in developing a list of 11 core Pediatric, 13 core Family Medicine and 22 core Internal Medicine ultrasound scans based on best available evidence for their clinical use.

The Unicorn: The Journey For Black Doctors, Amber Robins-Hickson Md,Mba

Advances in Clinical Medical Research and Healthcare Delivery

No abstract provided.

Osteopathic Medical Students’ Perceptions Of Their Medical Education Due To Covid19, Kaitlyn Thomas, Richard Terry

Advances in Clinical Medical Research and Healthcare Delivery

Objective: The SARS-CoV-2 (COVID19) pandemic has led to unprecedented changes in medical education globally. Published reports on these changes have given some insight as to both positive and negative effects for specific medical schools though none have looked at osteopathic education. Our study attempts to examine the effect of COVID19 more formally on osteopathic medical students’ perception of their medical education in the third and fourth years of medical training.

Methods: Third- and fourth-year medical students at Lake Erie College of Osteopathic Medicine (LECOM) completed electronic surveys regarding their experiences with changes in medical education due to the COVID19 …

The Pleasures And Perils Of Medical Publishing, Richard Alweis

CHED Talks

No abstract provided.

Medical Professionalism: Evolution And Application, Melvin Blanchard

CHED Talks

Learning Objectives:

• Be able to define professionalism
• List the problem areas in medical professionalism
• Explain core principles that guide in problem areas

Omental Tuberculosis In A Patient With Alcoholic Liver Cirrhosis-The Diagnostic And Treatment Dilemma, Ekta Tirthani, Mina Said

Advances in Clinical Medical Research and Healthcare Delivery

Alcoholic cirrhosis is frequently complicated by spontaneous bacterial peritonitis (SBP) due to the translocation of gut bacteria. However, in immigrants to the USA from parts of the world with high tuberculosis burden, a high degree of clinical suspicion of tuberculous peritonitis should be maintained when a patient presents with symptoms similar to SBP. We describe a case of a 45-year-old Nepali man with a history of alcohol abuse who immigrated to the USA six years prior and presented to the hospital with abdominal pain, night sweats, fevers, and a 10 kg weight loss. A CT scan revealed abdominopelvic ascites, liver …

Subacute Thyroiditis Secondary To Moderna Covid-19 Vaccine: A Case Report Of A Rare Manifestation, Mayank Patel, Marika Shahid, Ahmad Khawaja, Chibuzor Ejike, Kavitha Vemuri

Advances in Clinical Medical Research and Healthcare Delivery

The SARS-CoV-2 led to a global pandemic, infecting millions of lives within only a short period of time. The symptoms of the disease vary with a subset of the population developing debilitating sequelae. Through the emergency use authorization (EUA), multiple vaccines have been released against the novel virus in record time. Long term and rare sequelae from the vaccine are poorly understood. DeQuervain’s subacute thyroiditis is a self-limiting and painful inflammation of the thyroid gland usually associated with viral infections. We report a rare case of subacute thyroiditis in a healthy 46-year-old woman presenting with a painful swelling in the …