Medical Specialties Commons^™

Recommendations For Effective Documentation In Regional Anesthesia: An Expert Panel Delphi Consensus Project, Hassan M Ahmed, Benjamin P Atterton, Gillian G Crowe, Jaime L Barratta, Mark Johnson, Eugene R. Viscusi, Sanjib Adhikary, Eric Albrecht, Karen Boretsky, Jan Boublik, Dara S Breslin, Kelly Byrne, Alan Ch'ng, Alwin Chuan, Patrick Conroy, Craig Daniel, Andrzej Daszkiewicz, Alain Delbos, Dan Sebastian Dirzu, Dmytro Dmytriiev, Paul Fennessy, H Barrie J Fischer, Henry Frizelle, Jeff Gadsden, Philippe Gautier, Rajnish K Gupta, Yavuz Gürkan, Harold David Hardman, William Harrop-Griffiths, Peter Hebbard, Nadia Hernandez, Jakub Hlasny, Gabriella Iohom, Vivian H Y Ip, Christina L Jeng, Rebecca L Johnson, Hari Kalagara, Brian Kinirons, Andrew Kenneth Lansdown, Jody C Leng, Yean Chin Lim, Clara Lobo, Danielle B Ludwin, Alan James Robert Macfarlane, Anthony T Machi, Padraig Mahon, Stephen Mannion, David H Mcleod, Peter Merjavy, Aleksejs Miscuks, Christopher H Mitchell, Eleni Moka, Peter Moran, Ann Ngui, Olga C Nin, Brian D O'Donnell, Amit Pawa, Anahi Perlas, Steven Porter, John-Paul Pozek, Humberto C Rebelo, Vicente Roqués, Kristopher M Schroeder, Gary Schwartz, Eric S. Schwenk, Luc Sermeus, George Shorten, Karthikeyan Srinivasan, Markus F Stevens, Kassiani Theodoraki, Lloyd R Turbitt, Luis Fernando Valdés-Vilches, Thomas Volk, Katrina Webster, T Wiesmann, Sylvia H Wilson, Morné Wolmarans, Glenn Woodworth, Andrew K Worek, E M Louise Moran

Department of Anesthesiology Faculty Papers

Background and objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia.

Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live …

Memory T Cell Populations In Human Leukemia, Sara Mcelroy, Fang Tao, John Szarejko, John M. Perry

Posters

Background Incorporating the immune system into cancer management is an area of robust research. Treatment modalities aimed at activating cytotoxic T cells against malignancies include immune checkpoint inhibitors, bispecific T-cell engagers, and chimeric antigen receptor (CAR) tumor-specific T cells. Most anti-cancer T cell research is narrowly focused, but knowledge about the nature of diverse sub-populations of T cells in cancer, particularly memory T cells, is vital prior to potential incorporation into therapies. T memory stem cells (Tscm) are of interest due to their longevity and powerful abilities of self-renewal and creating the full spectrum of memory CD8+ T cells, including …

Validation Of The Kiswahili Version Of The Migraine Disability Assessment Scale In Dar Es Salaam, Tanzania, Aliasger Nagri

Master of Internal Medicine

Background: Migraine is a chronic paroxysmal neurological disorder characterized by multiphase attacks of head pain and many neurological symptoms. The MIDAS is a five (5) question-based questionnaire used in clinical practices to identify the disability caused by migraine at work, school, household or social life; with a score indicating little or no disability (0-5), mild disability (6-10), moderate disability (11-20), and severe disability (21+). Translated versions of the MIDAS scale in a number of languages has been validated. Translating and validating the Kiswahili version of the MIDAS questionnaire is essential and needed to ensure its comparability to the original English …

The Quality Of Primary Care Performance In Private Sector Facilities In Nairobi, Kenya: A Cross-Sectional Descriptive Survey, Gulnaz Mohamoud, Robert Mash

Family Medicine, East Africa

Background: Integrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is paucity of informa- tion on the performance of these key elements and such information is needed to improve service delivery. Therefore, the study aimed to evaluate the quality of primary care performance in private sector facilities in Nairobi, Kenya.

Methods: A cross-sectional descriptive study using an adapted Primary Care Assessment Tool for the Kenyan context …

Cu And Ni Co-Sputtered Heteroatomic Thin Film For Enhanced Nonenzymatic Glucose Detection, Brianna Barbee, Baleeswaraiah Muchharla, Adetayo Adedeji, Abdennaceur Karoui, Kishor Kumar Sadasivuni, Mizaj Shabil Sha, Aboubakr M. Abdullah4, Gymama Slaughter, Bijandra Kumar

Bioelectrics Publications

In this work, we report a wafer-scale and chemical-free fabrication of nickel (Ni) and copper (Cu) heteroatomic Cu–Ni thin films using RF magnetron sputtering technique for non-enzymatic glucose sensing application. The as-prepared wafer-scale Cu–Ni thin films exhibits excellent electrocatalytic activity toward glucose oxidation with a 1.86 μM detection limit in the range of 0.01 mM to 20 mM range. The Cu–Ni film shows 1.3- and 5.4-times higher glucose oxidation activity in comparison to the Cu and Ni electrodes, respectively. The improved electrocatalytic activity is attributed to the synergistic effect of the bimetallic catalyst and high density of grain boundaries. The …

Integrating Pharmacists In Hfref Outpatient Care To Improve Use Of Guideline-Directed Medical Therapy, Roy Robertson Md, Mindy Flanagan Phd, Kris Howard Pharmd, Elizabeth Meisberger Pharmd, Emily Keltner Bs, Ma, Lovekirat Singh Ms, Carly Daley Phd, Shauna Wagner Bsn, Rn, Tammy Toscos Phd, Michael Mirro Md, Facc, Fhrs, Faha

Health Services and Informatics Research

Background: Guideline directed medical therapy (GDMT) is the cornerstone of reducing mortality and morbidity in patients with heart failure with reduced ejection fraction (HFrEF); however, uniform prescribing remains low. There is potential for multidisciplinary care teams, including pharmacists, to improve GDMT use in outpatient care for patients with HFrEF. Investigation is needed to understand the impact of pharmacists in outpatient HFrEF care on GDMT prescribing.

Objectives: To examine the impact of integrating a pharmacist into an outpatient cardiology setting on GDMT prescription rates during HFrEF-related clinic visits.

Methods: This retrospective chart review study examined cardiology clinic visits (HF clinic, “general …

Effects Of Increased Levels Of Relaxin Hormone In Women During Pregnancy In Relation To Spondylolisthesis: A Literature Review, Joselin R. Guerrero Rapalo

Honors Theses

No abstract provided.

Wearing An Apple A Day Won’T Keep The Doctor Away: Diagnosing Wolff-Parkinson-White Syndrome With An Apple Watch, Grace Judd, Jason Heino

Providence Portland Medical Center Internal Medicine 2022

No abstract provided.

To Flash Or Not To Flash, Christy Overly

The Eleanor Mann School of Nursing DNP Capstone Projects

In 2015, healthcare-associated infection (HAI) prevalence survey found that there were an estimated 110,800 surgical site infections (SSIs) associated with inpatient surgeries in 2015. Consequently, instruments and implants sterilized by immediate use steam sterilization (IUSS) have been found to increase the patient’s risk for an SSIs. Due to these risks, the Joint Commission (TJC) determined that organizations should implement evidenced-based protocols to reduce IUSS use. A needs assessment revealed a gap in care in that the increasing SSI rates appeared to be correlated with the misuse of IUSS at the physician owned surgical hospital in Tulsa, Oklahoma. This Doctor of …

Development Of A Nurse Practitioner Driven Program For Cardiology Providers To Increase Knowledge And Awareness Of Neurodevelopmental Assessment Needs In Children With Congenital Heart Defects, Michele Readman

Doctor of Nursing Practice Final Manuscripts

Children diagnosed with congenital heart defects are at increased risk for neurodevelopmental delays. Timely referral of patients to a neurodevelopmental clinic for initial evaluation and referrals to support services can improve learning outcomes, provide early intervention for neurodevelopmental disorders, and mediate factors affecting low quality of life. Nationally, a substantial proportion of pediatric cardiologists are not referring children for neurodevelopmental evaluation. A review of patient referrals to a Cardiac Neurodevelopmental Clinic within an urban children’s hospital demonstrated an opportunity to improve provider awareness and knowledge of referral recommendations. Using the Iowa Model of Evidence-Based Practice to Promote Quality Care, an …

Renal Angina Index As A Predictor Of Acute Kidney Injury In Critically Ill Children, Athul Shelly Kooliyath

Master of Medicine in Paediatrics and Child Health

Background: Acute kidney injury is associated with increased morbidity and mortality in hospitalized children. In the critically ill,DR WILLIAM M MACHARIA acute kidney injury (AKI) is prevalent and difficult to diagnose. Using conventional methods, AKI is often missed thus delaying the diagnosis up to 48 hours after initial injury. Though some biomarkers that identify AKI early have been identified, they may still be insufficient due to prohibitive costs. Renal angina index is used to identify ongoing renal injury. It is a product of the clinical state and the estimated glomerular filtration rate (eGFR) of a patient during admission to a …

Feasibiity And Acceptability Of Tele-Neurology Services At A Regional Tertiary Referral Centre: A Prospective Study., Fazal Yakub

Master of Medicine in Internal Medicine

Background: Neurological diseases are a leading cause of morbidity and mortality worldwide with a great burden lying in Sub-Saharan Africa. The paucity of neurologists in the region makes neurological care disproportionately inaccessible. Utility of tele-medicine is low cost, time efficient, convenient, reducing the carbon footprint and ultimately increasing health care access. Objective: We identified whether the concept of tele-neurology was feasible within our setup for patients with stable neurological diseases while establishing the cost effectiveness, efficiency, convenience and the carbon footprint burden. Methods: We conducted a prospective cross-sectional study. New patients were triaged by the neurologist based on guidelines from …

Hiv Among Cancer Patients: Prevalence And Cancer Description By Hiv Status, Diana Wambui Muturi

Master of Medicine in Internal Medicine

Background: Antiretroviral therapy (ART) has resulted in a higher life expectancy of persons living with Human Immunodeficiency Virus (PLHIV) leading to an aging population at risk for non-AIDS defining cancers (NADCs) rather than AIDS-defining cancers (ADCs). Identification of HIV-cancer comorbidity through diagnostic HIV testing of patients presenting for cancer care is not offered routinely. The HIV prevalence among cancer patients in Kenya is undefined. In addition, the spectrum of malignancies in PLHIV has not been well characterized outside of ADCs. Objective: Our primary objective was to determine the prevalence of HIV among patients with cancer. Secondary objectives were to determine …

Inducing Alternative Forms Of Cell Death In Multidrug Resistant Ovarian Cancer, Chloe Reese Kotrba

Undergraduate Honors Thesis Collection

Ovarian cancer remains the deadliest gynecological cancer for women today. In 2021, an estimated 21,410 new cases of ovarian cancer were diagnosed in the US, and approximately 13,770 of these women will not survive the disease[2]. This malignancy’s low survival rate is attributed to late diagnoses, as well as the cancer’s tendency to recur after chemotherapy treatment due to acquired drug resistance. The standard of care for this disease includes surgery and chemotherapy. One of the commonly used chemotherapeutic drugs is cisplatin, which works by inducing a programmed form of cell death known as apoptosis. However, many ovarian cancer tumors …

Increasing Opioid Abuse Screening In Primary Care Clinic: An Evidence-Based Quality Improvement Project, Carlos Milla

DNP Projects

Introduction

To address substance abuse multiple organizations recommend increase drug abuse screening as part of routine health care. CAGE AID is five-question tool used to screen for drug and alcohol use, answering yes to two or more questions indicates further assessment is advised. Unfortunately, most primary care centers do not use screen for substance abuse using validated instrument tools such as the CAGE-AID tool.

Purpose

The purpose of this evidence-based practice (EBP) project is to implement the CAGE-AID Substance abuse screening tool by nurse practitioners students in a family clinic located in Bridgeport in order to increase to number of …

Implementation Of A Nurse Driven Palliative Care Consult: A Quality Improvement Project, Socnite Sebourne-Francis

DNP Projects

Background: Palliative care consult (PCC) is an approach that can improve the quality of life and symptom management of patients facing life-threatening illnesses. At a 20-bed medical oncology unit in Connecticut, patients with poor prognosis and worsening symptoms have high re-admission rates within 30 days of post-hospital discharge; yet healthcare providers fail to initiate PCC.

Purpose: This project hypothesizes how implementing a nurse-driven PCC on admission or hospital stays compared to the timing of a physician to a physician PCC improves a plan of care for oncology patients? Will it result in a decrease in 30-day re-admission rates? The …

Improving Specialist Referrals In Outpatient Primary Care: An Evidence-Based Practice Quality Improvement Project, Kimberly Gaznabie

DNP Projects

Background: In the United States, more than a third of patients receive specialty referrals per year, constituting more than half of outpatient visits. Patients require efficient, immediate referrals for specialty-based treatment plans and the prevention of worsening conditions.

Purpose: This evidence-based practice improvement project aimed to improve the specialty-provider referral system for a community-based outpatient primary care clinic.

The Use Of Telemedicine In Primary Care To Improve Medication Adherence: Quality Improvement Project, Chadae S. Haffenden-Morrison

DNP Projects

Introduction: Lack of medication adherence, a major issue in healthcare, can be costly to the healthcare system and result in poor patient outcomes. Wong et al. (2020) noted that enhanced involvement with health care professionals using the Telemedicine platform can improve a patient’s medication adherence as well as decrease the use of emergency services and hospitalizations. Telemedicine allows the healthcare provider, to contact the patient through a mobile phone or computer to provide education and reinforcement regarding medication adherence.

Purpose: The purpose of this project was to improve medication adherence and health outcomes, by piloting a quality improvement project using …

Enhancing Depression Screening For The Adolescent Population In The Pediatric Emergency Department By Utilizing The Patient Health Questionnaire: A Quality Improvement Project, Chelsea Alvarez

DNP Projects

Background:

Mental health disparities make up 16% of the global burden of disease and injury in people ages 10-19. Many cases of mental health are unidentified and left untreated. Failure to address mental health disorders in children can lead to poor outcomes of health and well-being. Evidence-based practice supports the utilization of screening tools such as the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adolescents ages 12-18 years.

Objectives:

By implementing the PHQ-9 in the pediatric emergency department, the goals for this quality improvement project were to increase staff knowledge on the PHQ-9, improve staff screening compliance, and to …

Implementing A Patient Reported Outcome Measure For Patient With Anemia Of Chronic Kidney Disease (Ckd) In The Outpatient Setting, Marissa Finger

DNP Projects

Introduction: Chronic kidney disease (CKD) is a growing public health concern in the United States. People with CKD suffer from many symptoms that cause distress and low quality of life (QoL). Research has found an association between symptom burden in patients with CKD and the disease's worsening progression. There is little data on ways to monitor and address CKD symptoms routinely.

Purpose: The purpose of this project was to identify symptoms related to advancing kidney disease using patient-reported outcome measures (PROMs) through IPOS-Renal survey and implement a nurse-driven protocol to manage patient reported symptoms.

Interventions/Setting: Over a three-month period at …

Ilae Classification And Definition Of Epilepsy Syndromes With Onset In Neonates And Infants: Position Statement By The Ilae Task Force On Nosology And Definitions, Sameer M. Zuberi, Elaine Wirrell, Elissa Yozawitz, Jo M. Wilmshurst, Nicola Specchio, Kate Riney, Ronit Pressler, Stephane Auvin, Pauline Samia, Edouard Hirsch

Paediatrics and Child Health, East Africa

The International League Against Epilepsy (ILAE) Task Force on Nosology andDefinitions proposes a classification and definition of epilepsy syndromes in theneonate and infant with seizure onset up to 2 years of age. The incidence of epi-lepsy is high in this age group and epilepsy is frequently associated with significantcomorbidities and mortality. The licensing of syndrome specific antiseizure medi-cations following randomized controlled trials and the development of precision,gene- related therapies are two of the drivers defining the electroclinical pheno-types of syndromes with onset in infancy. The principal aim of this proposal, con-sistent with the 2017 ILAE Classification of the Epilepsies, is …

Adolescent Connectedness: A Scoping Review Of Available Measures And Their Psychometric Properties, Ezra Too, Esther Chongwo, Adam Mabrouk, Amina Abubakar

Institute for Human Development, East Africa

Introduction: Adolescent connectedness, a key component of positive youth development, is associated with various positive health outcomes. Several measures have been developed to assess this construct. However, no study has summarized data on the existing measures of adolescent connectedness. We conducted this scoping review to fill this gap. We specifically aimed to: (i) identify the existing measures of adolescent connectedness, (ii) determine the most frequently used measures among the identified measures, and (iii) summarize the psychometric properties of these measures with a keen interest in highlighting their cross-cultural utility and validity.

Methods: We searched CINAHL, Embase, PsycInfo, PubMed, …

Methodology For Classification And Definition Of Epilepsy Syndromes With List Of Syndromes: Report Of The Ilae Task Force On Nosology And Definitions, Elaine C. Wirrell, Rima Nabbout, Ingrid E. Scheffer, Taoufik Alsaadi, Alicia Bogacz, Jacqueline A. French, Edouard Hirsch, Satish Jain, Sunao Kaneko, Pauline Samia

Paediatrics and Child Health, East Africa

Epilepsy syndromes have been recognized for >50 years, as distinct electroclini-cal phenotypes with therapeutic and prognostic implications. Nonetheless, noformally accepted International League Against Epilepsy (ILAE) classification ofepilepsy syndromes has existed. The ILAE Task Force on Nosology and Definitionswas established to reach consensus regarding which entities fulfilled criteria for anepilepsy syndrome and to provide definitions for each syndrome. We defined an ep-ilepsy syndrome as “a characteristic cluster of clinical and electroencephalographicfeatures, often supported by specific etiological findings (structural, genetic, met-abolic, immune, and infectious).” The diagnosis of a syndrome in an individualwith epilepsy frequently carries prognostic and treatment implications. Syndromesoften have age- …

International League Against Epilepsy Classification And Definition Of Epilepsy Syndromes With Onset In Childhood: Position Paper By The Ilae Task Force On Nosology And Definitions, Nicola Specchio, Elaine C. Wirrell, Ingrid E. Scheffer, Rima Nabbout, Kate Riney, Pauline Samia, Marilisa Guerreiro, Sam Gwer, Sameer M. Zuberi, Jo M. Wilmshurs

Paediatrics and Child Health, East Africa

The 2017 International League Against Epilepsy classification has defined a three- tiersystem with epilepsy syndrome identification at the third level. Although a syndromecannot be determined in all children with epilepsy, identification of a specific syn-drome provides guidance on management and prognosis. In this paper, we describethe childhood onset epilepsy syndromes, most of which have both mandatory seizuretype(s) and interictal electroencephalographic (EEG) features. Based on the 2017Classification of Seizures and Epilepsies, some syndrome names have been updatedusing terms directly describing the seizure semiology. Epilepsy syndromes beginningin childhood have been divided into three categories: (1) self- limited focal epilepsies,comprising four syndromes: self- …

A Community-Based Approach To Cervical Cancer Prevention In Western Kenya: An Ampath Feasibility Project, Elkanah Omenge, Philip Tonui, Kapten Muthoka, Stephen Kiptoo, Titus Maina, Mercy Agosa, Aaron Ermel, Yan Tong, Darron Brown

Obstetrics and Gynaecology, East Africa

Objectives: Centralized programs have been ineffective in reducing the burden of cervical cancer among Kenyan women. A community-based pilot study was initiated to screen Kenyan women for cervical cancer and to vaccinate their children against human papillomavirus (HPV).

Methods: Women were educated about cervical cancer prevention at community meetings. Women then provided self-collected vaginal swabs for oncogenic HPV testing using the Roche Cobas Assay. All women were then referred to the local clinic for Visual Inspection with Acetic Acid (VIA). Women were offered the quadrivalent HPV vaccine for their children if and when it became available for the …

It Is Not A Boerhaave! A Case Of Spontaneous Pneumothorax, Imran Khan, Rukma R Govindu, Hussam Ammar

Faculty, Staff and Student Publications

Spontaneous pneumothorax is a pneumothorax that is not caused by trauma or an apparent precipitating factor. This report presents a case of a 91-year-old man with no history of lung disease who developed pneumothorax after two days of persistent nausea and vomiting. He was misdiagnosed as a case of Boerhaave's syndrome. A chest computed tomography with iohexol oral contrast showed no evidence of esophageal rupture, and an upper endoscopy revealed a small gastric ulcer and no gastric outlet obstruction. The patient was managed conservatively; his spontaneous pneumothorax, nausea, and vomiting resolved.

Applying Mci-062, A Novel Pan-Ras Inhibitor, To Treat Kras-Mutant Lung Cancer, Richard Fu

Honors Theses

RAS is a prevalent oncogene that is mutated in 27% of human cancers. Gain-of-function RAS mutations activate multiple downstream pathways, including the RAS-RAF-MEK-ERK and PI3K/AKT/mTOR pathways, which are critical in tumorigenesis and cancer cell proliferation. RAS proteins such as KRAS, a member of the RAS protein family, and their downstream effectors are attractive targets for cancer therapy since their mutations act as frequent drivers in lung, colorectal, and pancreatic cancers. However, RAS proteins have relatively smooth surfaces that lack traditional binding pockets, making inhibitors specific to RAS difficult to create. Recently, a novel small molecule pan-RAS inhibitor named MCI-062 was …

Necrotizing Enterocolitis Rates In Preterm Infants, Alexis Howard

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Breast milk and donor human milk is used in the prevention of necrotizing enterocolitis (NEC) in preterm infants born prior to 37 weeks gestation and those with very low birth weight. This process occurs through direct breast feeding and tube feeding. The aim of this study was to compare the use of breast milk and donor milk to the use of formula feed in preterm infants. A systematic review was conducted using articles collected from CINAHL and PubMed and was guided by PRISMA guidelines. A total of 15 studies that met criteria were analyzed by purpose, variables, study design, population …

Pediatric Seizure Management With Ketogenic Diet, Lydia Beller

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Seizure disorders can be life altering and debilitating, especially for developing children. Children who have seizure disorders often require social, emotional, educational, and behavioral adjustments for children. Most medication regimes do not achieve complete management of seizure frequency and intensity. For children, seizure disorders can lead to unsuccessful education experiences, low self-esteem, severe injury, and difficulties with social skills and engagement. Discovering that a dietary means can reduce their frequency and intensity is groundbreaking. The ketogenic diet is a high protein, high fat, and almost no carbohydrate diet. The ketogenic diet is an effective non-pharmacological method for treating epilepsy (Karimzadeh, …

Multimodal Approach To Chronic Pain Management And Prevention Of Opioid Use Disorder, Hannah Elston

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background. Chronic pain (CP) is a major public health problem that affects one-third of the population and can interfere with the activities of daily life and cause decreased quality of life. Patients with CP have been increasingly prescribed opioids, contributing to the rise in the opioid epidemic. Due to the long-term nature of CP, the use of opioids as the sole treatment for CP can cause tolerance and increased dosages overtime which can lead to addiction and potentially overdose. Therefore, CP treatment should include multimodal approaches to treatment to prevent opioid misuse, opioid use disorder (OUD), and overdose. Multimodal treatments …