Medical Specialties Commons^™

Enhancing Prenatal Breastfeeding Education To Improve Breastfeeding Rates, Angela Maietta

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Reducing Overutilization Of Telemetry On A Medical-Surgical Unit, Melrose Melgar

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

An Order Set For Maternity Patients With Potential Opioid Use Disorder, Katrina Munoz

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Improving Confidence Level Of The New Graduate Level Nurse And Nurse Fellows With Managing The Cardiac Arrest Patient, Charles Pfeiffer, Belinda N. Leos

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

The Effect Of Sleep Meditation Applications On Insomnia In Registered Nurses And Certified Nurse Assistants, Jaiden Tanaleon, Amy Hughes

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Use Of Agitation Scale Decision Scoring Grid To Improve Care Of Agitated/Anxious Patients In Dsu, Carmyle Seville, Angelica Taneca

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Early Recognition Of Sepsis-Induced Hypotension In Dsu, Rebeca Zamora

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Impact Of Emergency Care Center Specialized Immediate Management Nurse On Quality Metrics, Jo Zarnegar

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Early Mobility And Delirium Prevention For Intensive Care Unit Patients At Kingman Regional Medical Center, Lyndsey R. Lehman Ms, Otr/L

Masters Projects

Over five million patients are admitted to the intensive care unit (ICU) annually in the United States, with 50-70% of those developing debilitating physical, cognitive, and mental health issues. Occupational therapy (OT) is a holistic profession that provides evidence-based interventions to improve ICU patients’ function and participation in daily occupations by addressing early mobility and delirium. A needs assessment performed for the Kingman Regional Medical Center (KRMC) ICU revealed a lack of knowledge about early mobility and delirium prevention among nursing staff, underutilization and limited understanding of OT services, and KRMC-specific barriers impacting patient care. This author designed and implemented …

Hypothermia In Patients With Traumatic Injuries: An Integrative Review, Andrew P. Gribble, David J. Saucedo

Master's Projects

Abstract

Background: An estimated 30-50% of severely injured patients with traumatic injuries will experience hypothermia. As a result of hypothermia, several clinical manifestations such as impaired coagulation, dissociation of the oxygen curve, cardiac arrhythmias, reduced cardiac output and death. Little evidence has been published promoting specific patient re-warming protocols and the best rewarming methods, active versus passive. Few studies have focused on the pre-hospitalization treatment for hypothermia and the overall effectiveness of interventions to mitigate hypothermia to reduce morbidity and mortality. Given this knowledge, the aim of this integrative review (IR) is to research and evaluate current practices regarding hypothermia …

Impact Of Participation In Cardiac Rehabilitation Post Myocardial-Infarction: An Integrative Review, Zoie Maynard, Mallory Stinson

Master's Projects

As one of the most common causes of hospitalization, the prevalence of myocardial infarction is indisputable Since this condition is so ubiquitous, a treatment protocol is initiated with methods to help patients modify their lifestyle, treat their underlying disease process, educate them to prevent reoccurrence, and improve their healthcare outcomes. This protocol relies heavily on the use of cardiac rehabilitation. Despite the implementation of this treatment protocol, the concern for recurrence and rehospitalization remains. The goal of this integrative review is to determine how participation in cardiac rehabilitation post-myocardial infarction impacts healthcare outcomes including rates of rehospitalization and depression. The …

Health Literacy And Perceived Control: Intermediary Factors In The Relationship Between Race And Cardiovascular Disease Risk In Incarcerated Men In The United States, Jennifer L. Miller, Misook L. Chung, Lovoria B. Williams, Alison R. Connell, Zyad T. Saleh, Abdullah S. Alhurani, Alison L. Bailey, Mary Kay Rayens, Debra K. Moser

UK CARES Faculty Publications

Background: Black race, inadequate health literacy, and poor perceived control are predictors of increased cardiovascular disease (CVD) risk. The purpose of this study was to explore the relationships among race, health literacy, perceived control, and CVD risk while controlling for known risk factors in incarcerated men. Methods: We included data from 349 incarcerated men to examine race and CVD risk (Framingham Risk Score) using a serial mediation model with health literacy and perceived control using 95% confidence intervals (CIs) from 5000 bootstrap samples. Results: Of the participants (age, 36 ± 10; education, 12 ± 2; body mass index, 28.3 ± …

Socio-Economic Disparities In Prenatal Prognosis And Intervention Accessibility, Simona Raluca Iacoban, Madalina Piron Dumitrascu, Camil Laurentiu Bohiltea, Ioan Dumitru Suciu, Silviu Cristian Voinea, Nicolae Suciu

Journal of Mind and Medical Sciences

Objectives. This study aimed to assess the impact of socio-economic factors on prenatal care accessibility and outcomes and to evaluate the effectiveness of specialized integrative prenatal care in mitigating these disparities. Materials and Methods. A prospective cohort study was conducted between 2020 and 2023 in Bucharest, Romania, involving 100 pregnant women. Participants were equally divided into two groups that received standard and specialized prenatal care. Data were collected through structured interviews, medical record reviews, and standardized questionnaires at multiple time points during pregnancy and postpartum. Results. Women receiving integrative care had longer gestation periods (37.8 vs. 37.6 weeks), higher average …

Nursing And Supply Chain As Critical Partners In Enterprise-Level Efforts To Prevent Hemodialysis Associated Central Line-Associated Blood Stream Infections: A Case Study, Dana L. Blayney, Julia Moody, James Pittman, Noah Zanville, Missy Pennington, Sarah A. Fraker, E. Jackie Blanchard

HCA Healthcare Journal of Medicine

Background

Preventing central line-associated bloodstream infections (CLABSIs) remains a critical national focus for health care facilities. This notion is particularly true for patients undergoing hemodialysis (HD), where the associated mortality rates for HD-CLABSI range from 12% to 25%. Studies show that the use of central venous catheter (CVC) end caps coated with antiseptic agents, such as chlorhexidine gluconate (CHG) on HD-CVCs, can reduce the incidence of CLABSIs. However, issues ranging from difficulty finding and maintaining an adequate (and fully standardized) supply of CHG-impregnated HD end caps and ensuring consistent practice by clinicians can prevent the use of this valuable tool. …

Inpatient Falls: Epidemiology, Risk Assessment, And Prevention Measures. A Narrative Review, Taylor Locklear, Jeannie Kontos, Callaham A. Brock, Alexander B. Holland, Rachel Hemsath, Anna Deal, Shannon Leonard, Carsten Steinmetz, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Patient falls are a common inpatient dilemma and comprise the largest category of preventable adverse events in hospitalized patients. These events place a clinical burden on the patient, such as increased morbidity and reduced quality of life, in addition to an economic burden on the hospital system. Fall prevention strategies have the opportunity to decrease inpatient health care costs and length of stay. Several risk factors have been identified that contribute to inpatient falls and several strategies have been identified to minimize this risk. These risk factors are typically characterized as intrinsic and extrinsic factors. Intrinsic factors include characteristics such …

Revitalizing Emergency Rooms Nationally: Strategies And Insights, Jeffin Dejanovich, Noah Zanville

HCA Healthcare Journal of Medicine

Throughout the United States, the post-COVID-19 pandemic period has been marked by profound disruption to health care operations, coordination, and care capacity. These disruptions have been especially serious in the emergency room (ER) setting. While intensely challenging, the post-pandemic period has also presented opportunities for health care systems to approach classic challenges facing the ER with fresh eyes. In this editorial, the authors discuss key strategies being used to help revitalize ERs nationally and reflect on future challenges and directions.

Social Determinants Of Health Curriculum For The Pediatric Clerkship, Caroline Roth, Amy Prudhomme, Kayla Griese, Robbie Beyl, Jessica Patrick-Esteve

School of Medicine Faculty Publications

Introduction: Education on social determinants of health (SDH) aligns with national standards for medical education. However, there are minimal existing resources targeted to medical students specific to the care of the pediatric population. We designed a case-based curriculum on SDH for third-year medical students on their pediatric clerkship to address this deficit. Methods: Third-year medical students on their pediatric clerkship received a case-based flipped classroom educational series on SDH in four 10-minute segments. Students completed voluntary and anonymous surveys delivered via an electronic survey tool before and after completion of the curriculum. Surveys were a self-assessment of knowledge and skills …

“It Is What It Is” – The Lived Experience Of Women With Breast Cancer Undergoing Axillary Lymph Node Dissection, Eva Vikhe Patil, Anna Forsberg, Carina Wennerholm, Jenny Drott

Journal of Patient-Centered Research and Reviews

Purpose: The lived experience of women undergoing axillary procedures as part of their breast cancer (BC) treatment remains unexplored. This lack of in-depth understanding could hamper implementation of person-centred care, which is concerning because BC is the most common form of cancer in women. The aim of this study was therefore to explore the lived experiences of women undergoing axillary lymph node dissection (ALND) due to BC.

Methods: Twelve women with a mean age of 59 years were interviewed about their lived experiences of axillary procedures as part of their BC treatment. The interviews were recorded, transcribed verbatim, and analysed …

Churning The Tides Of Care: When Nurse Turnover Makes Waves In Patient Access To Primary Care, Kelley Arredondo, Ashley M Hughes, Houston F Lester, Trang N D Pham, Laura A Petersen, Lechauncy Woodard, Richard Sorelle, Cheng Rebecca Jiang, Frederick L Oswald, Daniel R Murphy, Hilary N Touchett, Joshua Hamer, Sylvia J Hysong

Faculty, Staff and Students Publications

BACKGROUND: Team-based primary care (PC) enhances the quality of and access to health care. The Veterans Health Administration (VHA) implements team-based care through Patient Aligned Care Teams (PACTs), consisting of four core members: a primary care provider, registered nurse (RN) care manager, licensed vocational nurse, and scheduling clerk. RNs play a central role: they coordinate patient care, manage operational needs, and serve as a patient point of contact. Currently, it is not known how varying levels of RN staffing on primary care teams impact patient outcomes.

OBJECTIVE: This study aims to empirically assess how the stability of RN staffing within …

A Nurse-Driven Screening Process To Increase Icu Palliative Care Utilization, Sara L. Stock

Doctor of Nursing Practice Final Project Abstract

Purpose

A scholarly project aimed to increase palliative care by 25% for intensive care unit patients in eight weeks by integrating nurse-driven screening process into multidisciplinary rounds.

Background

Palliative care provides valuable mental, emotional, and spiritual support for patients and families. These benefits are available to any patient with a disease process causing symptoms affecting quality of life. Palliative care is falsely equated with hospice care, leading to further delay. The original referral model relied only on intensivist identification of eligibility The project was implemented in a 20-bed medical and surgical ICU in a community hospital in the Houston area. …

Improving Adherence Amongst Post-Stroke Patients In The Outpatient Setting, Olivea Adetu

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This quality improvement (QI) project aimed to enhance medication adherence and follow-up rates through structured, personalized phone calls to recently discharged post-stroke patients. The project was implemented at an outpatient neuroscience clinic in Greater Houston.

BACKGROUND

Low medication adherence and poor attendance at the first neurology follow-up appointment among post-stroke patients contribute to increased morbidity and higher risk of recurrent stroke. Despite receiving discharge instructions, many patients do not consistently take their prescribed medications or attend their initial neurology visit.

METHODOLOGY

Guided by the Plan-Do-Study-Act (PDSA) cycle, this project engaged a medical assistant to call recently discharged stroke patients …

Prazosin As An Adjuvant To Increase Effectiveness Of Duloxetine In A Rat Model Of Oxaliplatin-Induced Peripheral Neuropathy, Monica A. Wagner, Naji Ayyash

Faculty Scholarship

Objectives: Duloxetine, the only American Society of Clinical Oncology (ASCO) treatment recommended for chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors, is not effective for 40% of survivors. This study examined the ability of a duloxetine-prazosin combination to prevent the development of allodynia and hyperalgesia in a rat model of oxaliplatin-induced peripheral neuropathy (OPIN). Methods: Female (n = 24) and male (n = 41) rats were started on duloxetine (15 mg), prazosin (2 mg), or a duloxetine-prazosin combination one week prior to administration of the chemotherapy drug, oxaliplatin, and continued the duloxetine-prazosin combination for 32 days. Behavioral testing for mechanical allodynia …

Increasing The Frequency Of Behavior Assessment To Reduce Physical Restraint, Breanne N. Ford

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project was to implement a system that routinely assesses for behavior changes in psychiatric patients presenting to the emergency department to improve staff intervention of escalating behaviors and decrease physical restraint use.

Background: The project was implemented in a 45-bed emergency department in a community-based hospital affiliated with a large hospital system in Houston, Texas.

Methodology: The project utilizes the Behavioral Activity Rating Scale (BARS) to assess patients' behaviors at routine intervals throughout shifts and a comfort cart that houses several non-pharmacological intervention items to use to de-escalate adverse behaviors. The staff …

Evaluation Of Supplemental Oxygen Use In The Acute Care Cardiology Unit And Opportunities For Standardizing Practice, Melanie Walsh, Alexandra Birely, Sarah Mahmalji, Sonali S. Patel

2024

RESEARCH

Purpose:
Oxygen delivery via nasal cannula is a standard therapy in hospitalized pediatric patients; however, it can have adverse effects in certain populations, such as infants with cardiac shunting physiology1,2. An oxygen-air blender can be used via standard nasal cannula to provide the lowest amount of fraction of inspired oxygen (FiO2) in order to reduce harm2. A recent Pediatric Acute Care Cardiology Collaborative (PAC3) Hospital Survey indicates that 88% of participating acute care cardiology units (ACCU) provide blended oxygen to patients, however, indications for use are not well-established3,4. A local ACCU nursing staff survey revealed mixed use of blended …

High Reliability Pediatric Heart Centers: Always Working Toward Getting Better, Andrea Torzone, Alexandra Birely

2024

QUALITY

Background
As provision of care reaches a new complexity in pediatric cardiology, programs are called upon to evaluate how they can bring their teams into the future of pediatric cardiac care. High reliability principles support high-quality care and improve outcomes, thus should be embraced to guide continuous improvement. Although much has been written about high reliability in healthcare, it has not been explored within pediatric heart centers. The purpose of this review is to examine high reliability through the lens of a contemporary pediatric heart center, elaborating on key concepts and proposed considerations for maintaining a high reliability heart …

World Allergy Organization (Wao) Diagnosis And Rationale For Action Against Cow's Milk Allergy (Dracma) Guideline Update – Xi – Milk Supplement/Replacement Formulas For Infants And Toddlers With Cma – Systematic Review, Antonio Bognanni, Ramon Firmino, Stefania Arasi, Derek Chu, Alexandro Chu, Siw Waffenschmidt, Arnav Agarwal, Piotr Dziechciarz, Andrea Horvath, Rose Kamenwa

Paediatrics and Child Health, East Africa

Background: Cow's milk allergy (CMA) is the most complex and common food allergy in infants. Elimination of cow's milk from the diet and replacement with a specialized formula for infants with cow's milk allergy who cannot be breastfed is an established approach to minimize the risk of severe allergic reactions while avoiding nutritional deficiencies. Given the availability of multiple options, such as extensively hydrolyzed cow's milk-based formula (eHF-CM), aminoacid formula (AAF), hydrolyzed rice formula (HRF), and soy formula (SF), there is some uncertainty regarding which formula might represent the most suitable choice with respect to health outcomes. The addition of …

Decreasing Utilization Of Indwelling Urinary Catheters, Stacie Lomibao Fujimoto

Articles, Abstracts, and Reports

Increased utilization and prolonged dwell times of indwelling urinary catheters (IUCs) are directly related to the risk of catheter-associated urinary tract infections (CAUTIs)- the fifth most common type of healthcare associated infection (HAI). The National Health and Safety Network (NHSN) uses the Standardized Utilization Ratio (SUR) metric to measure and compare device utilization in acute care hospitals across the nation. The national target SUR benchmark is 1.0, and a SUR under 1.0 indicates less device usage than NHSN predicts on an inpatient unit. In 2022 a Neuro Med-Surg unit experienced an overall SUR of 1.047 with 2 CAUTIs observed. A …

Depressive Symptoms And Sleep Quality Mediate The Relationship Between Race And Quality Of Life Among Patients With Heart Failure: A Serial Multiple Mediator Model, Jia-Rong Wu, Debra K. Moser, Chin-Yen Lin, Ambrose A. Chiang, Barbara Riegel

UK CARES Faculty Publications

Background: Black patients with heart failure (HF) report worse quality of life (QoL) than White patients. Few investigators have examined mediators of the association between race and QoL, but depressive symptoms and sleep quality are associated with QoL.

Objective: The aim of this study was to determine whether depressive symptoms and sleep quality are mediators of the relationship between race and QoL among patients with HF.

Methods: This was a cross-sectional study. We included 271 outpatients with HF. Self-reported race (White/Black), depressive symptoms (Patient Health Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), and QoL (Kansas City Cardiomyopathy Questionnaire) were collected …

Patient Denial Of Myocardial Infarction In The Prehospital Phase: Prevalence And Correlates, Mona A. Abed, Amani A. Khalil, Debra K. Moser

UK CARES Faculty Publications

Background: Limited knowledge exists regarding patients' denial of myocardial infarction (MI) before hospitalization for an MI. Objective: The aim of this study was to determine the prevalence and correlates of denial of MI in the prehospital phase of a confirmed MI. Methods: This secondary analysis included 166 hospitalized patients (mean [SD] age, 54.1 [10.5] years) who developed MI outside a healthcare facility and had high congruence between their experienced and expected symptoms. Measurements included the Denial subscale of the Brief COPE Inventory, the modified Response to Symptoms Questionnaire, and a Likert scale measuring perceived risk for MI. Patients who arrived …

Evaluation Of An Advanced Practice Clinician Onboarding Program, Sophia Robinson

Student Scholarly Projects

Practice Problem: This project aimed to evaluate the effectiveness of a mentorship-based onboarding program versus a standard program without mentorship.

PICOT: The PICOT question that guided this project was (P), In newly hired APCs did the inclusion of mentorship in the onboarding process (I) lead to higher levels of general self-efficacy compared to standard orientation practices lacking mentorship (C), within an 8-week timeframe (T)?

Evidence: Nine articles were reviewed, revealing that standardized mentorship, structured orientation, and tailored support for professional development are critical strategies to boost confidence and retention among healthcare professionals.

Intervention: A standardized onboarding program that incorporated …