Medical Specialties Commons^™

Mindfulness Based Stress Reduction Increases Pathology Resident Self Wellness, Kaitlin Collura, Md, Phd, Joanna Chan, Md

Department of Pathology, Anatomy, and Cell Biology Posters

Stress during medical residency is a common, complex issue influenced by time demands, level of social support, and environmental factors. Increased stress levels can lead to resident burnout, and may contribute to the high rates of depression and suicide seen among physicians. In 2015, the ACGME began a campaign to promote resident wellness by calling on programs to implement strategies to develop resiliency, identify problems, and promote wellbeing. Mindfulness based stress reduction (MBSR) strategies have been shown to decrease burnout, improve mood, and increase compassion in healthcare providers. We implemented a wellness retreat to educate residents on the principles of …

The Write Stuff - Autumn 2019 (Vol.16, No.4), Research Medical Library

Write Stuff 2019

• Scientific Publications and the Research Medical Library join forces, expand services
• Incorporating sex as a biological variable in NIH grant applications
• Hyperlinks in NIH grant applications
• Altmetrics: Looking beyond citation analysis to measure impact
• Guidelines for reporting your research methods to improve reproducibility and rigor
• Unusual terms used in scientific writing and publishing: Core Grant

Vital Signs, Fall 2019, Boonshoft School Of Medicine

Vital Signs

A thirty-two page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, alumni profiles, class notes, and more.

Safe Sleep In The Nicu, Ashley Mirabile, Barb Haney, Dianne Wilderson, Beckie Palmer, Ashley Domsch, Eugenia K. Pallotto

Posters

Goal: To evaluate a staff education program on approach to improve in the rate of eligible NICU infants in safe sleep in a busy 84-bed level IV NICU.

Outcome Measures; Improve safe sleep compliance for eligible patients to 90% or greater by December 2019.

Process Measures: Audits from bedside RNs showing compliance with safe sleep.

Planned Intervention: In December of 2018 a multidisciplinary work group brainstormed and implemented best practice safe sleep education for staff and parents. September 2019 a Safe Sleep Educational Toolkit was made available for staff.

Results: Safe Sleep compliance has gone from 53% to 90% in …

General Anesthetic Induction Sequence High Fidelity Simulation: Determining Efficacy Among Novice Student Registered Nurse Anesthetists, Alex Wilkie, Steven Urbick, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background High Fidelity Simulation (HFS) is used across multiple health professions. Despite the wide variety of clinical experiences that Student Registered Nurse Anesthetists (SRNA) possess prior to training, the induction sequence to a General Anesthetic (GA) is a daunting task. Although the efficacy of HFS has been widely studied within undergraduate nursing programs, there are no studies published determining the efficacy of HFS on SRNA training. The purpose of this study was to determine the efficacy of simulation training amongst entry-level SRNA’s and examine any individual participant factors that may influence clinical performance within HFS.

Methods • Human subjects were …

Comparisons Of Preoperative Blood Pressures In Surgical Patients, Brian Stacy, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Surgical patients expect anesthesia providers to provide high quality care. Blood pressure variability must be mitigated by establishing the patient’s blood pressure baseline and sustaining it through surgery. A consensus has not been established on which blood pressure measurement should be used as the patient’s baseline. Blood pressures before surgery in multiple care settings have been shown to vary. This may result in differences in drug and fluid administration, depending on the blood pressure considered baseline by the anesthesia provider. The purpose of this observational evidence-based practice project was to compare mean blood pressures leading up to surgery among …

Comparison Of Ondansetron, Dexamethasone, And Its Combination In The Prevention Of Postoperative Nausea And Vomiting, Alina Palanchuk, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Postoperative nausea and vomiting remains a common and unpleasant side effect for patients following surgery. Uncontrolled PONV can result in prolonged hospital stays, unanticipated hospital readmissions, and decreased patient satisfaction. The Apfel score identifies and counts independent risk factors for PONV; females, non-smokers, postoperative opioid use, and history of PONV or motion sickness. Rates of PONV increases as the number of risk factors increase. The primary intervention to decrease PONV is administration of prophylactic antiemetics. Research supports the use of combination antiemetic therapy for patients with a high number of risk factors. The purpose of this evidence based practice …

Intraoperative Hypotension In Non-Cardiac Surgery Patients At Providence Sacred Heart Medical Center, Genna Ledrew, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Intraoperative Hypotension (IOH) during non-cardiac surgery is a common side effect of anesthesia that is associated with acute kidney injury (AKI), myocardial injury (MI), mortality, and other adverse outcomes1,3,4. These risks increase as the duration and severity of IOH exposure increase3,4. Blood pressure is a modifiable risk factor of mortality and organ damage that can be readily treated by the anesthesia provider2 . Limiting IOH can improve patient outcomes and produce monetary savings5 . The objective of this project is to report the incidence of IOH at a large tertiary teaching hospital, and extrapolate the risks of mortality and …

Hyperoxia: Current Practice Of Oxygen Delivery During General Anesthesia, Christa Kirby, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background While supplemental oxygen is routinely administered during anesthesia to prevent oxygen desaturation and optimize tissue oxygenation, oxygen delivery practices after intubation are largely unknown. Compiled evidence suggests limiting intraoperative fraction of inspired oxygen (FiO2) to below 60%. The deleterious effects of hyperoxia and the mortality benefit of conservative oxygen administration are being demonstrated in contemporary critical care literature. The lack of consensus guidelines and high level evidence on the topic of intraoperative oxygen delivery begs the question to what degree are patients being exposed to hyperoxia during general anesthesia. The purpose of this evidence-based practice project was to better …

Ultrasound Simulation For Regional Anesthesia, Kayla Brown, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Regional anesthesia is an essential skill in the practice of Nurse Anesthesia, and future employment demands expertise. Literature supports the addition of simulation training to existing didactic and apprenticeship education to improve clinical expertise. The purpose of this project was to trial simulation training, focused on anatomical visualization with ultrasound for regional anesthesia, as a means to improve student performance and confidence.

Methods • Facility project approval and exemption determination by IRB. • Hands-On Test: Ultrasound to obtain visualization for axillary (cohort 1), interscalene (cohort 2) block on live-model. Expert CRNA observed performance to determine if image was clinically …

Intraoperative Opioid Administration Among Cancer Patients, Amanda Barrett, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Cancer prevalence continues to rise. In vitro and in vivo studies have demonstrated that opioid receptor agonists may be associated with poor outcomes for cancer patients. Laboratory studies have shown that opioids cause immunosuppression; tumor cell progression, recurrence and metastasis. The surgical environment further decreases immune function, causes an inflammatory response and promotes cancer cell mobilization. Anesthesia providers are in a unique position to influence postoperative outcomes. Opioid free anesthetic delivery is a growing trend amongst anesthesia providers and is supported by the literature. The purpose of this project is to compare intraoperative opioid administration rates for patients with …

Sugammadex Versus Neostigmine: Operating Room Time And Cost, Annie Benscheidt, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background The choice of neuromuscular blockade reversal agents impacts cost and operating room time. Currently, the two medications used to reverse neuromuscular blockade are Neostigmine and Sugammadex. These medications differ in both cost and pharmacologic profiles which effect the time and predictability of reversal (Carron, Zarantonello, Tellaroli, & Ori, 2016). Evaluating cost and time differences in reversal using Sugammadex and Neostigmine helps anesthesia providers select the appropriate medication. This evidence based practice project examined the difference in case length and operating room and reversal agent costs in cases using Sugammadex and Neostigmine at Providence Sacred Heart Medical Center.

Methods • …

2019-2020 Pediatric Subspecialty Trainees, Children's Mercy Hospital

Residents and Fellows Portraits

Photo composites of the graduate pediatric trainees in allergy/immunology, child abuse pediatrics, child neurology, clinical child psychology, developmental-behavioral pediatrics, epilepsy; headache medicine; hospice & palliative care, laboratory genetics & genomics, neonatal-perinatal medicine, pediatric adolescent gynecology, pediatric anesthesiology, pediatric bioethics, pediatric cardiology, pediatric clinical pharmacology, pediatric critical care medicine, pediatric cardiac congenital surgery; pediatric dentistry, pediatric emergency medicine, pediatric EM/child abuse; pediatric endocrinology, pediatric gastroenterology, pediatric hematology/oncology, pediatric hospital medicine, pediatric infectious diseases, pediatric nephrology, pediatric ophthalmology, pediatric optometry, pediatric otolaryngology, pediatric pulmonology, pediatric rehabilitation, pediatric sports medicine, pediatric surgery, pharmacy, sleep medicine, pediatric residency and med/peds residency.

The Write Stuff - Summer 2019 (Vol. 16, No. 3), Research Medical Library

Write Stuff 2019

• Using Research Resource Identifiers (RRIDs) to enhance rigor and reproducibility
• Court ruling sheds light on publishing giant OMICS International
• Manuscript presentation tips to improve the peer review process
• How to insert Greek letters, symbols, and other special characters in Word documents
• Changes to Plan S give researchers and publishers time to adapt
• Unusual terms used in scientific writing and publishing: Hanging indent

Scanning For Qi: Resident And Sonographer Driven Improvement Of Radiology Resident Ultrasound Technique, Brian Blumhof, Md, Corinne Wessner, Bs, Rdms, Rvt, Kristen Mcclure, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objective

The aim of this structural QI project is to improve the educational ultrasound curriculum , thus improving overall resident confidence and technical ability in acquiring diagnostic quality sonographic images.

Comparing resident confidence levels and performance against their initial benchmarks as well as against yearly cohorts, we plan to create a long standing addition to the radiology residency at Jefferson, with plans to include additional ultrasound examinations as the curriculum becomes more robust.

Stakeholders include not only the radiology residency, which would benefit from improved resident education and knowledge, but also the hospital and ultimately patients, who stand to benefit …

Getting Rid Of Stupid Stuff (Gross) Committee: Residents Dedicated To Streamlining Epic-Related Workflow, Nkosi H. Alvarez, Md, Christina L. Jacovides, Md, Brian M. Till, Md, Walker Lyons, Md, Keyur Patel, Md, Richard Zheng, Md, Adam Johnson, Md, John Kairys, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

• Identify specific mechanisms for submitting and implementing improvements to the Epic environment
• Standardize high-use order sets
• Incorporate high-value modular components into existing order sets
• Create new order sets to streamline resident workflows
• Improve communication between stakeholders

Optimizing Resident Clinic Efficiency Through Process Flow Analysis, Michael Abendroth, Md, Mba, Saumya Copparam, Md, Qiang Zhang, Phd, Rose Costello, Ma, Tara Uhler, Md, Robert Bailey, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Abstract

Introduction: Clinic process inefficiencies cause lengthy visit and wait times, which frustrate patients and providers and limit clinic capacity

Objective: To identify process inefficiencies and assess process flow interventions

Methods: Prospective, consecutive series of resident clinic visits over a 3-week period after transferring refraction from tech to resident. Personnel recorded the time spent waiting for and undergoing each clinic process. The clinic also piloted a “Fast Track” from registration to resident for appropriate established patients.

Results: Patients spent 53% of the visit waiting, primarily for the tech. Transferring refraction from tech to resident decreased the wait for tech …

A Review Of First Year Fellow Endoscopic Skills And Time To Proficiency, Antoinette Adjowa O. Walker, Dalya El Tawil, Jennifer Colombo, Nicholas Clark, Kimberly J. Reid

Posters

Through this quality improvement project, we have assessed the current fellows' upper endoscopy skill level during their first year and determined that the time to achieving proficiency is significantly longer than desired. The goal is to prepare new fellows for endoscopy prior to the beginning of their rotations with a curriculum that includes assigned reading materials, videos, and simulated endoscopic cases, to promote safety and increase satisfaction of patients by improving the readiness, skill level, and the confidence of first year inexperienced fellows.

The Write Stuff - Spring 2019 (Vol.16, No.2), Research Medical Library

Write Stuff 2019

• Setting up a writing critique group
• NIH clarifies terminology regarding rigor of the prior research
• Scientific Publications’ grant proposal editing service
• European Plan S aims to mandate open access by 2020
• NIH tip: Check your funding opportunity announcement 30 days before submitting your grant application
• Unusual terms used in scientific writing and publishing: “Blinded” peer review and clinical trials

Vital Signs, Winter 2019, Boonshoft School Of Medicine

Vital Signs

A thirty-two page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, alumni profiles, class notes, and more.

The Write Stuff - Winter 2019 (Vol.16, No.1), Research Medical Library

Write Stuff 2019

• Grant Writers' seminars return in March
• How to disagree with an NIH research grant proposal review
• Using Publons to track and show peer reviews
• Journal initiatives aim to improve transparency and reproducibility
• New NIH videos demystify the grant review process
• NIH launches new version of NIH Data Book including 2018 funding statistics
• Unusual terms used in scientific writing and publishing: Sentence case and title case

Graduate Medical Education Annual Report 2018-2019, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, fellowship programs, medical students, continuing medical education, and library services.

Cyberbullying: A Resource For School-Aged Children, Adolescents, And Parents In Milton, Vermont, James K. Rohwer

Family Medicine Clerkship Student Projects

Cyberbullying occurs when harmful words or actions by one or more persons are intentionally and repeatedly directed against another person in the digital world through text message, social media, e-mail, apps, online video games, forums, etc. Today, more children and adolescents are connected to the internet than ever before, which puts them at risk of becoming victims of cyberbullying. Many victims, as well as parents of victims, may not be familiar with the resources that are available to them in the areas in which they live when concerns of cyberbullying arise. Therefore, the goal of this project was to create …

Patient Guide To Access Quality Health Information Online, Danielle Wall

Family Medicine Clerkship Student Projects

A large percentage of patients use online search engines to access health information. However, there is a large amount of health information online that is unregulated and not evidence-based. As a result patients may acquire health information that is incorrect which may negatively affect patient-provider relationships and patient's healthcare. A brochure was created to highlight safe practices for accessing health information online.

A Quick Guide To Eating Healthy With Type Ii Diabetes, Caleb Lee Watkins

Family Medicine Clerkship Student Projects

Diabetes is becoming increasingly more prevalent in the U.S. and in the state of Vermont. With an increased prevalence of diabetes and a worsening obesity crisis, the total cost of diabetes management is increasing as well. The population around Bellows Falls, VT has not been spared from this epidemic. Many patients in this region have struggled to make and maintain lifestyle changes, particularly surrounding diet and exercise. Therefore, a one-page, double-sided handout was created to provide easily digestible information to patients about managing their diabetes through proper nutrition.

Improving Patient Educational Materials For A Suboxone Clinic In Southeastern Vermont, C. Wesley Cubberley

Family Medicine Clerkship Student Projects

Access to medical treatment for opioid use disorder plays a significant role in the ability of a community to support a person's recovery. In Springfield, VT, community workers and providers are attempting to organize a Suboxone (buprenorphine + naloxone) clinic in order to bridge the significant geographic and socioeconomic gaps implicit to this rural community's location. In order to garner interest and increase awareness of this forthcoming project, a short, accessible educational flyer was developed with the input of the health center's staff for future use.

Accessing Opioid Use Disorder Resources In Vermont, Wendy Hou

Family Medicine Clerkship Student Projects

A handout listing contact information for opioid use disorder resources in Vermont.

Educating Parents On Newborn Health And Safety, Jenna Rose Dafgek

Family Medicine Clerkship Student Projects

More than 90% of unintentional injuries in children aged 5 years or younger occur in and around the home. Recommended infant care practices are below national target goals. Adherence to these recommendations increases when parents receive appropriate advice from multiple sources, including physicians. The goal of this project was to identify major newborn health and safety concerns. These concerns included car safety, safe sleep practices, and lead exposure. Educational handouts specific for age ranges spanning from first week of life to 1 year old were created for parents to address these issues.

Intimate Partner Violence: Improving Screening Rates In The Primary Care Setting, Alexandra E. Churchill

Family Medicine Clerkship Student Projects

The high prevalence of intimate partner violence (IPV) has led to recommended screening for all women of child-bearing age. Implementing validated screening tools within routine wellness visits at primary care offices facilitates awareness and patient support through identification and resource referral.

Increasing Bicycle Safety In South Burlington, Sam Epstein

Family Medicine Clerkship Student Projects

While there are many mixed use lanes in South Burlington, many people still do not use bicycle travel to get to work or the store. This occurs for many reasons, but one reason may be that people are not comfortable riding on roads. There is also a lack of bicycle friendly transportation between Burlington and South Burlington. This simple and easy to read handout provides tips on how to ride bicycles safely as well as a map of the existing bike and pedestrian friendly roads in SB.