Medical Specialties Commons^™

Occupational Therapy's Role In Maternal Mental Health Within Transition From Nicu To Home, Victoria Briltz, Becki Cohill, Susan Macdermott

San Marcos, Fall 2019

The purpose of this capstone project is to identify OT’s role in maternal mental health following the transition home from a NICU setting. This capstone project focused on mothers’ roles, routines, and environment during the transition from the NICU to home. Mothers may feel unprepared for the discharge home when their babies are ready to leave the NICU (Boykova, 2016). Occupational therapists address occupational performance through skilled interventions for women during the perinatal period; however, there is a lack of evidence guiding occupational therapy for providing services for maternal wellness (Slootjes, 2016). This capstone project will help share information, ideas, …

What Is Congenital Talipes Equinovarus?, Cornelia Lieb-Lundell

San Marcos, Fall 2019

An estimated 80% of clubfoot cases occur in low to middle-income countries. Incidence of clubfoot is estimated to be 1-1.5 per 1000 births, and male to female occurrence is 3:1. (1) Left untreated, this congenital anomaly becomes a “neglected clubfoot” and can result in lifelong hardships including limited ambulation related to gait deviations, pain, foot deformities and an inability to wear shoes. Without treatment, this health condition can lead to functional limitations with limited independence in activities of daily living and participation restrictions within the family and community related to decreased mobility. (2)

The intervention presented is the main components …

Lifestyle Management For Individuals With Vestibular Disorders, Michelle Pock, Becki Cohill, Susan Macdermott

San Marcos, Fall 2019

Individuals with vestibular disorders have concerns that impact lifestyle including limiting activities of daily living, limiting participation in social events, difficulty driving, and difficulty working (Cohen, 2014). Occupational therapists are able to help individuals with vestibular disorders by task analyzing symptom provoking activities, assessing the impact of symptoms on occupations, providing adaptations, and providing ways to modify environments (Gronski, Neville, Kannenberg, & Cohen, 2017). While occupational therapists are qualified to provide services to sustain and improve the occupational performance of individuals with vestibular disorders, occupational therapy is not well represented in this area particularly in addressing lifestyle components for vestibular …

The Effect Of Aquatic Interventions In Combination With Early Start Physical Therapy Services On Gross Motor Development In A Male Child With Down Syndrome, Roxanne Mueller

San Marcos, Fall 2019

Introduction: Aquatic therapy has been used in various patient populations as a modality to facilitate motor control and manage tonicity.^1-3 Despite the variety of literature addressing individuals with Down syndrome (DS) and aquatic therapy, there has been little described about the effects of aquatic therapy on early gross motor development in children with DS.

Purpose: The purpose of this case study is to examine whether aquatic physical therapy interventions combined with early start physical therapy influence gross motor developmental delay in a child with DS.

Case Description: The patient is a 31-month-old boy with diagnosis of …

Severe Hypophosphatemia In A Patient With A Relapsing Lymphoma, Xiaoying Deng, Md, Phd, Edgar Guzman-Suarez, Md, Anju Yadav, Md, Rakesh Gulati, Md

Department of Medicine Posters

Hypophosphatemia in cancer patients is commonly ascribed to chemotherapy, renal wasting or malnutrition from anorexia and poor PO intake. We report a case caused by rapid cancer cell proliferation. 61-year-old woman with history of marginal zone lymphoma diagnosed in 2017 who presented with fatigue, poor oral intake and undetectable phosphate levels (Phos) for 5 days. Her outpatient medications included Acyclovir 400 mg by mouth daily, Allopurinol 100 mg PO daily and Enoxaparin 60 mg under the skin every 12 hours. Blood work revealed phosphate levels less than1 mg/dl (normal 2.4-4.5mg/dl). Her intact PTH level was normal. Her phosphate level further …

Standardizing Aminoglycoside Induced Ototoxicity Monitoring, Claire Elson, Christopher M. Oermann, Stephanie Duehlmeyer, Ellen Meier

Posters

Aminoglycoside (AG) antibiotics are essential for the treatment of cystic fibrosis (CF) lung infections. Pseudomonas aeruginosa. Nontuberculous mycobacteria. Monitoring is critical secondary to potential nephrotoxicity and ototoxicity. Children’s Mercy Kansas City (CMKC), standardized nephrotoxicity monitoring in 2016. Observed variable ototoxicity monitoring practices. Prevalence of ototoxicity, 2016 CFF Patient Registry, 1.1% in pediatric patients (less than or equal to 18 years). 2.2% in pediatric and adult population. National Institute of Deafness and Other Communication Disorders, 13% in US population equal to or less than 12 years old. A standardized AG induced ototoxicity monitoring algorithm (AIOA) was developed and implemented at CMKC …

How To Use Peanut Ige Levels To Predict Challenge Outcomes In The Pediatric Population, Nalin U.G., Jay Portnoy, Jodi Shroba, Salman Aljubran

Posters

Introduction: The accepted clinical practice is to consider oral challenge when peanut IgE levels are 2.0 kUA/L or less in patients with a history of a major reaction or less than 5.0 kUA/L in patients with only sensitization. Certain populations are predisposed to having increased IgE levels, and these patients are often not offered challenges due to elevated numbers.

Methods: We reviewed unidentified patients information from January 2017 to July 2019 on peanut IgE levels and oral challenge outcomes through REDCap database. A ROC using SPSS from IBM was used and the points from the ROC curve were used to …

Poem Perceptions: A Survey Of Gastroenterologists And The Treatment Of Achalasia In The Philadelphia Region, Rebecca Loh, Md, Alexander Schlachterman, Md

Department of Medicine Posters

Introduction

Peroral endoscopic myotomy (POEM) is a relatively new innovate technique that has been shown to be an effective treatment for achalasia. Despite studies demonstrating its effectiveness as a less invasive therapy, POEM is still not as widely implemented as the traditional Heller myotomy for the treatment of achalasia. We aimed to explore the barriers that may impact implementation of POEM and to assess the regional perception of POEM amongst gastroenterologists in an urban setting.

Effect Of Nutritional Intervention On Patients With Gastroparesis, Emily Rubin, Rd, Melissa Viscuso, Rd, Kamal Amer, Md, Joseph Yoo, Md, Anthony Dimarino, Md, Stephanie Moleski, Md

Division of Gastroenterology and Hepatology Posters

Study Aims

• Utilize the PAGI-SYM survey as an assessment tool in following clinical symptoms of patients with GP.
• Determine if a formal consultation with a Registered Dietitian (RD) provided benefit to patients documented gastroparesis.

Does Perioperative Use Of Renin-Angiotensin System Inhibitors Improve Patient Outcomes In Cardiac Surgery?, Qian Ding, Mark Berguson, Zugui Zhang, Hong Liu, Huang Nie, Jordan E. Goldhammer, Rohinton J. Morris, Jianzhong Sun

Department of Anesthesiology Posters

• 2011 ACCF/AHA Guidelines for CABG: Uncertain about the safety of the preoperative administration of ACE inhibitors or ARBs in patients on chronic therapy and the safety of initiating ACE inhibitors or ARBs before hospital discharge
• 2014 ESC Guidelines: ACE inhibitors might be stopped 1 to 2 days before CABG to avoid the potential deleterious consequences of perioperative hypotension
• Guidelines state that ACE inhibitors or ARBs should be initiated postoperatively in CABG patients who were not receiving them preoperatively if they have an LVEF ≤40%, hypertension, diabetes, or CKD (Level of Evidence: A)
• There is still a lack of large clinical …

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 …

Wellness Initiative Program And Effect On Pathology Resident Burnout Rate, Kaitlin Collura, Md, Phd, Michelle Nagurney, Md, Joanna Chan, Md

Department of Pathology, Anatomy, and Cell Biology Posters

Increasing rates of physician burnout are reported across many medical specialties, including Pathology. In 2014, 52.5% of pathologists experienced symptoms of burnout compared to 37.6% in 2011. Suicide and depression rates in physicians are also higher than the average population. As a result, the ACGME began a campaign, in 2015, to foster resident wellness. The campaign calls for strategies to develop resiliency, identify problems, and promote well-being. While wellness initiatives may not change underlying mental illness, they may mitigate environmental factors that can exacerbate mental illness or suicidal behavior. Here we report results from a recently implemented resident wellness initiative …

Occupational Therapy’S Role In Oncology: Returning To Work During And After Treatment, Annamarie Scheidell, Otas, Stephanie Sloane, Bs, Ms, Otas, Sara Loesche, Ms, Otr/L, Cht

School of Continuing and Professional Studies Posters

Medical advances have improved the five-year survival rate for patients diagnosed with cancer and some late-stage cancers that once were terminal have now become manageable, chronic conditions. Because of this, more individuals with cancer as well as survivors of cancer are re-entering the workforce. Resuming the role of worker is considered an important step in recovery for many. Occupational therapy (OT) can play an important role in facilitating a successful transition back to work for both cancer patients and survivors.

Improving Nicu Discharge Readiness Through Standardization Of Preparatory Practices, David Carola

Department of Pediatrics Posters

Global Aim

Critical transitions of care for every newborn will meet the Institute of Medicine STEEEPS criteria: Safe, Timely, Efficient, Effective, Equitable, Patient and Family Centered1, and Socially Responsible

SMART Aim

We aim to increase our average discharge readiness score by 4 points by August 1st of 2020

Patients Living With Hiv Infection Are Less Likely To Receive The Correct Statin Intensity For Cardiovascular Disease Risk Reduction, Jason J. Schafer, Pharmd, Mph, Roshni Emmons, Pharmd, Bcps, Nick V. Hastain, Pharmd, Todd Miano, Pharmd, Phd

College of Pharmacy Posters

• Patients living with HIV (PLWH) are at high risk for atherosclerotic cardiovascular disease (ASCVD)
• Eligible PLWH should receive statins for ASCVD risk reduction according to current guidelines
• Studies suggest that statins are underprescribed in PLWH, but comparisons to uninfected patients and assessments of statin intensity have not occurred

Objective

To determine the influence of HIV infection on appropriate statin prescribing for ASCVD risk reduction

Reflux, Apnea And The Impact On Discharge, Michele Savin, Dnp, Nnp-Bc, Kaitlin Kenaley, Md, Maureen Moffet, Msn, Rula Nassar, Md

College of Nursing Posters

Decisions made about timing of discharge can be subjective. Definitions of significant bradycardia are multiple, and interventions are variable.

This necessitates an informed discussion with parents about the natural course of apnea, bradycardia and reflux.

The physiology of gastroesophageal reflux and respiratory control have intermingled confounding variables.

Critical thinking is required to educate and support families, however a paucity of research exists. Risks and benefits of pharmacologic and nonpharmacologic interventions should be evaluated.

Nurses need increased confidence in understanding how to approach the preterm infant with apnea and/or reflux as well as how to interact with families to support discharge …

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.

Pcom Georgia Do Class Of 2024 Composite Sheet, Philadelphia College Of Osteopathic Medicine

Class Composite Sheets

PCOM Georgia DO Class of 2022 student portraits, matriculating Fall 2019.

Neurotransmitter, Fall 2019, George Washington Institute For Neuroscience Neurological Institute, George Washington University Hospital

Neurotransmitter

No abstract provided.

Pcom Georgia Do Class Of 2023 Composite Sheet, Philadelphia College Of Osteopathic Medicine

Class Composite Sheets

PCOM Georgia DO Class of 2023 student portraits, matriculating Fall 2019.

Labrad : Vol 45, Issue 3 - October 2019, Aga Khan University Hospital, Karachi

LABRAD

• Therapeutic Drug Monitoring for Antibiotics in Infections
• Biomarkers of Sepsis
• Serum Procalcitonin Level - Marker of Bacterial Infection
• Bone Marrow Findings in Malaria
• Antibiogram: A Clinicians’ Reference for Antibiotic Selection
• Laboratory Diagnosis of Meningitis
• Detection of Pneumocystis Jirovecii by PCR
• Microbiology Quiz
• Radiology Pathology Correlation- Orthopedic Pathology
• Role of Imaging in the Diagnosis and Management of Hepatic Abscess
• The Best of the Past
• Microbiology Quiz’s Answer
• Polaroid

Clabsi Prevention Through Prevention Huddles And Clabsi Risk Assessment And Prevention Form In Electronic Medical Record, Tara Benton, Barb Haney, Lacey Bergerhofer, Yolanda Ballam, Kaitlyn Hoch

Posters

Our aim is to increase the awareness of high risks for central line associated bloodstream infection (CLABSI) and decrease the CLABSI rate with the implementation of CLABSI prevention huddles and an electronic medical record (EMR) "CLABSI Risk Assessment and Prevention" form.

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 …

Improving Care Of The Small Baby, Beckie Palmer, Abdebayo Oshodi, Brandy Huitt, Kaylee Hurt, Pamela Kliethermes, Trudy Koons, Patricia Lanzer, Ashley Mirabile, Allyson Owen, Christian Anthony Schneider, Betsi Anderson, Steven Olsen

Posters

Hierarchy of Aims:

• Global Aim: Create a Small Baby Unit for infants admitted to our NICU that arebirth, in which 90% of our patients are admitted to F pod on day of admission, by March 2019
• Interim Aim: Staff 80% of our micropremie patients with a Small Baby Team nurse from admission until >32 weeks by May 2019.
• Sub Aim: Increase rates of developmentally appropriate care (2 person cares, kangaroo care compliance) by 50% by August 2019.

Improving Malnutrition Identification In The Outpatient Setting, Kristi Thaete, Karen Stephens

Posters

Identification of Pediatric Malnutrition in Outpatient Clinics is the First Step to Allowing Registered Dietitian (RD) Involvement in the Improvement of Patient Care.

Pediatric Surgery Opioid Prescription Follow-Up, Gadison Quick, Nathaniel Aviles, Gabriel Melgarejo, Hunjung Choi, Elizabeth Edmundson

Posters

This quality improvement project is assisting general and orthopedic surgeons in gaining greater clarity when prescribing opioids for specific surgical procedures. Additional surgical services are being added to the project fall of 2019. Opioid prescribing patterns are, and will continue to be, key to all prescribing providers within our organization.

A Multifaceted Approach To Improve Quarterly Visit Rates At A Pediatric Cystic Fibrosis Care Center, Paula Capel, Jessica Banks, Micaela Mckenna, Ashley Andrews, Christopher M. Oermann

Posters

Standard quality improvement methodology was used to improve quarterly visit rates among cystic fibrosis patients at Children's Mercy Kansas City Cystic Fibrosis Center.

• A family-centered, team-based approach was adopted
• A change in culture led to sustained improvement

Improved quarterly visit rates should drive improvement in outcomes including pulmonary function and nutritional status.

Collaboration Between Rheumatology Clinic And Specialty Pharmacy To Positively Impact Patient Experience And Hospital Stewardship, Alaina Linafelter, Julia G. Harris, Robert Herr, Stephanie Quinn, Ashley M. Cooper

Posters

Biologic medications are commonly utilized to treat pediatric rheumatic diseases. Being high-cost, most third-party payers require dispensing through a specialty pharmacy. Children's Mercy Hospital Specialty Pharmacy (CMH SP) started acceting patients in March 2015.

The number of patients benefited by the superior service of CMH SP has risen steadily, leading to high patient satisfaction and financial benefits for the hospital.

Increasing Kangaroo Care In A New Small Baby Unit, Dianne Wilderson, Barb Haney, Ashley Mirabile, Beckie Palmer, Jenny Heltzer, Erin Keith-Chancy Bsn,Ccrn, Brooke Smith, Christian Anthony Schneider, Abdebayo Oshodi

Posters

Project Aim: Increase the percent of eligible patients receiving kangaroo care from 19% to 30% by September 2019.

Results:

113 staff completed education

OT consults completed on all SBU patients

20 kangaroo wraps purchased

Kangaroo care rate in NICU increased from 19% (prior to SBU) to 36% (Post SBU opening).

Conclusion: Due to increased multidisciplinary awareness of importance of kangaroo care in the SBU more parents are completing kangaroo care.