Public Health Commons^™

Medically Tailored Meals As A Prescription For Treatment Of Food-Insecure Type 2 Diabetics, Leslie J. Rabaut

Journal of Patient-Centered Research and Reviews

Type 2 diabetes mellitus is an immense burden to the health of our population and to our current health care system, and the weight of this burden is only projected to multiply in coming years. A nutritious diet is an indispensable aspect of diabetes treatment, and the lack of access to food engenders poor disease-state control, which correlates with increased health care utilization. Interventions aimed at improving access to food through medically tailored meals (MTMs) have demonstrated effectiveness in improving the health of food-insecure type 2 diabetic patients and reducing health care costs. Further studies are necessary to increase the …

Improving Bronchiolitis Care Across Multiple Care Settings Using A Deimplementation Bundle, Amanda Nedved, Kathleen Berg, Troy Richardson, Amanda Montalbano, Matthew B. Johnson

Posters

Despite the availability of a bronchiolitis CPG; variation in care practices still existed at our institution. The aim of our quality improvement (QI) project was to increase overall adherence with our institutional CPG in patients 60 days to 24 months of age diagnosed with bronchiolitis in the urgent care centers (UCC), emergency departments (ED), and general inpatient units from a baseline of 40.9% to 60% by the end of two bronchiolitis seasons.

Total And Free Plasma Bilirubin And Clinical Outcomes In Severe Hyperbilirubinemia, Sean M. Riordan, Jean-Baptiste Lepichon, Steven Shapiro, Tina Slusher, Fatima Abdullahi, Hafsat M. Suleiman, Victor C. Pam, Mamu B. Samuel, Christopher S. Yilgwan, Christian Isichei, Idris Y. Mohammed

Posters

Acute bilirubin encephalopathy (ABE) and kernicterus spectrum disorder (KSD) have become relatively uncommon in high income countries but remain a major cause of morbidity and mortality in low- and middle-income countries. To better understand the relationship between free (Bf) and total (TB) bilirubin levels and the development of ABE and KSD we followed infants born in three large tertiary centers in northern and central Nigeria (Jos, Kano and Zaria).

Pain Management For Intrauterine Device Insertion And Endometrial Biopsy, Michelle Lipton-Carroll

Evidence-Based Practice Project Reports

Intrauterine device (IUD) insertions and endometrial biopsies (EMB) can be painful in office gynecological procedures. In the clinical setting used for this evidence-based project (EBP) it was noted there was no consistent pain management being used for these procedures. For this EBP project a protocol for pain management during IUD insertions and EMBs was developed and implemented into this clinical setting. The protocol was created from an exhaustive literature search, which yielded six pieces of high-level evidence of good quality. The evidence supported the use of a 1% lidocaine paracervical block prior to IUD insertion and a 2% lidocaine intrauterine …

Improving Antimicrobial Stewardship Programs In Small Community Hospitals Through An Assessment And Feedback Model, Philip Chung, Kate Tyner, Scott Bergman, Terry Micheels, Mark Rupp, Michelle Schwedhelm, Maureen Tierney, Muhammad Salman Ashraf, Trevor Van Schooneveld

Posters and Presentations: Nebraska ASAP

Small community hospitals often lack expertise and resources for antimicrobial stewardship program implementation. Using an assessment-and-feedback model, Nebraska ASAP performed onsite assessment of antimicrobial stewardship efforts in 5 small community hospitals and provided facility specific feedback on implementation/augmentation of antimicrobial stewardship program. As a result of this model, participating small community hospitals were able to increase the number of antimicrobial stewardship core elements implemented while reducing antibiotic use and incidence of CDI.

The Effects Of Implementing A Smartphone Application To Improve Asthma Self-Management In Adults, Lindsay J. Humpfer

Evidence-Based Practice Project Reports

Asthma is one of the most common chronic diseases, affecting 20.4 million adults in the United States (CDC, 2018). While asthma can generally be controlled, patients having an exacerbation may experience missed days of work and school, limitations in daily activities, decreased enjoyment of life, and decreased productivity at home, work, and school (MarcanoBelisario et al., 2013). Therefore, the purpose of this project was to improve patients’ overall asthma control and asthma-related quality of life by encouraging self-management through patient education and the implementation of a mobile smartphone application. A total of 26 adult primary care patients with asthma participated …

Developing Technologically Advanced Research In Low- And Middle-Income Countries, Isa Abdulkadir, Tina Slusher, Fidelia Bode-Thomas, Sean Riordan, Jean-Baptiste Lepichon, Laila Hassan, Shehu Abdullahi, Akinyemi Ofakunrin, Stephen Oguche, Steven Shapiro, William Ogala

Posters

This poster presents a collaboration between a group of scientists in Nigeria and the USA in developing a genomic research project and the solutions adopted in tackling the ethical implications and partnership equity and ownership of such a project.

Information And Readiness Build Resilience: The Role Of The Disaster Information Management Research Center, Stacey J. Arnesen, Florence Chang

Collaborative Librarianship

The National Library of Medicine (NLM) established the Disaster Information Management Research Center (DIMRC) in 2008 based on its history of providing health information for disaster preparedness, response, and recovery. The NLM long range plan (Charting a Course for the 21st Century: NLM's Long Range Plan 2006-2016) called for creation of a center to show "a strong commitment to disaster remediation and to provide a platform for demonstrating how libraries and librarians can be part of the solution to this national problem". NLM was urged to "ensure continuous access to health information and effective use of libraries and …

Changing Healthcare Provider And Parent Behaviors In The Pediatric Post‐Anesthesia‐Care‐Unit To Reduce Child Pain: Nurse And Parent Training In Postoperative Stress (Np‐Tips), Brooke N. Jenkins, Michelle Fortier, Robert S. Stevenson, Mai Makhlouf, Paulina Lim, Remy Converse, Zeev N. Kain

Psychology Faculty Articles and Research

Background

Children who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain.

Methods

In Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically‐based intervention which was then evaluated by experienced nurses (N = 8) and parents …

Comparing Psychiatric Care Experiences Shared Online With Validated Questionnaires; Do They Include The Same Content?, Rebecca Baines, John Donovan, Samantha Regan De Bere, Julian Archer, Ray Jones

Patient Experience Journal

Patient feedback is considered integral to patient safety and quality of care. However, limited research has compared the content of validated questionnaires with subjective patient experiences shared online. The aim of this study was to therefore identify and compare the content of psychiatric care experiences shared online with validated questionnaires. All research was conducted in co-production with a volunteer mental-health-patient-research-partner. We analysed all reviews published on the United Kingdom’s leading health and social care feedback platform Care Opinion, between 2005-2017 that discussed adult psychiatric care and compared findings with two validated questionnaires (ACP360 and General Medical Council patient feedback questionnaire). …

Patient Perception Of Telephone Follow-Up After Resection For Colorectal Cancer: Is It Time For An Alternative To The Out-Patient Clinic?, Marcus Gilmartin, Nicholas Leaver, George Hall, Helena Fawdry, Seung Lee, James Nicholson, Ramya Kalaiselvan, Raj Rajaganeshan

Patient Experience Journal

The economic reality of modern healthcare provides a timely reminder to clinicians of their duty to provide outstanding and cost-effective care. Although multiple guidelines outline investigation, management and surveillance of colorectal cancer, none advocate a particular delivery method. Nurse-led telephone follow-up in multiple specialties has demonstrated equivalent clinical outcomes and patient satisfaction when compared to traditional outpatient department follow-up. This paper aims to compare nurse-led telephone and outpatient follow-up, following surgical resection of colorectal cancer (CRC), focusing on patient perceptions. This cross-sectional study distributed adapted patient satisfaction questionnaire (PS-Q 18) to patients undergoing surveillance following CRC resection via either nurse-led …

Type 2 Diabetes Mellitus (T2dm) “Remission” In Non-Bariatric Patients 65 Years And Older, Srikanth Tangelloju, Bert B. Little, Robert J. Esterhay, Guy Brock, A. Scott Lajoie

Faculty and Staff Scholarship

Objective: To analyze the factors associated with type 2 diabetes mellitus (T2DM) “remission” in non-bariatric Medicare patients 65 years and older.

Research Design and Methods: A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if the individual had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in “remission” if they had no T2DM related claims for more than 12 …

Examining The Impact Of Race And Rurality On Health Differences Among Overweight Youth Accessing Pediatric Endocrinology Care, Kelsee Halpin, Janelle R. Noel-Macdonnell, Yun Yan

Journal of Health Disparities Research and Practice

Methods: This study examines the impact of race and rurality on health differences, including prevalence of prediabetes and type 2 diabetes (T2D), among overweight children accessing pediatric endocrine specialty care. Cross-sectional analysis of overweight/obese youth 10 to 18 years of age receiving pediatric endocrinology consultation for weight gain, hyperglycemia, and/or T2D from 2013 to 2016 at a Midwest tertiary pediatric center.

Results: The 722 patients were 42% white, 25% black, 22% Hispanic; 88% lived in urban areas and 12% in rural areas. Rurality was determined using zip code approximation of Rural-Urban Commuting Area (RUCA) codes. After adjusting for confounders, black …

3 Cm Researchers Honored With Endowed Chairs, Children's Mercy Hospital

Our Story Continues

Susan Abdel-Rahman, PharmD received the Marion Merrell Dow/Missouri Chair in Pediatric Clinical Pharmacology. Shao Jiang, MD received the Frederick J. McCoy Endowed Chair in Plastic Surgery and Craniofacial Research. Cy Nadler, PhD received the Josh Barnds and Stella Carlson Endowed Professorship for Autism.

Validity Of An Atopic Dermatitis Outcome Measure For Real-World Clinical Practice, Christina Topham, Dylan Haynes, Molly Brazil, Eric Simpson

OHSU-PSU School of Public Health Annual Conference

Introduction: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in the United States. AD is associated with reduced quality of life and substantial financial costs, making it burdensome at an individual and population level. Disease severity outcome measures are validated tools to assess severity and therapeutic response. Recent consensus statements have identified gold-standard outcome measures for AD in clinical trials, but further work is needed evaluating outcome measures feasible for clinical practice.

Objective: To investigate the validity and feasibility of the product of investigator global assessment and body surface area (IGA x BSA) as an outcome measure …

Expanding International Health Curriculum For The Internal Medicine Residency At Mmc, Brian King, Hassan Mahmoud, Anthony Pastore

Thinking Matters Symposium Archive

While internal medicine residents at Maine Medical Center provide care for many refugees and immigrants, there is not a formal international health curriculum to equip residents to care for this vulnerable population. Since 2002, 3,793 refugees have arrived in Maine for resettlement. Our aim was to survey residents about their interest in added international health instruction and design an educational curriculum for these physicians.

Metabolism During Pregnancy And Postpartum: How Does It Change And What Factors Influence It?, Kristin Yoho

Masters Theses & Specialist Projects

PURPOSE: Pregnancy is a physically impactful process in a woman’s life. During this time, a woman will gain weight and research has shown that many women will retain some extra weight after delivery. Because of this, recovery in the postpartum period is pivotal to avoiding the implications of weight retention. The postpartum period is vastly understudied in both the research and medical communities and this gap between pregnancy and postpartum research needs to be bridged. Therefore, the purpose of this study was to investigate metabolic changes from pregnancy to postpartum and to study how factors such as sleep and breastfeeding …

La Adherencia A Las Recomendaciones De Sueño Seguro Por Parte De Las Enfermeras En Unidades De Cuidado Intensiva Neonatal (Ucin) De Hospitales Públicos Y Privados En El Gran Buenos Aires / The Adherence To Safe Sleep Recommendations By Nurses In Neonatal Intensive Care Units (Nicus) Of Public And Private Hospitals In Grand Buenos Aires, Joelle M. Schauer

Independent Study Project (ISP) Collection

El Síndrome de Muerte Súbita de Lactante (SMSL) es “la muerte de un niño menor de 1 año que ocurre, aparentemente, durante el sueño y no puede ser explicada luego de una investigación exhaustiva, que incluye una autopsia completa, la investigación de las circunstancias de la muerte y la revisión de la historia clínica" (Jenik et al., 2015, p. 2). La Academia Americana de Pediatría (AAP) tiene recomendaciones sobre las prácticas del sueño seguro que pueden disminuir el riesgo de SMSL y otras Muertes Súbitas Inesperadas Infantiles (MSII).

El objetivo de esta investigación es analizar la adherencia a estas recomendaciones …

El Rol De Los Agentes Sanitarios Para Mejorar El Acceso A La Salud Sexual Y Reproductiva Para Mujeres En San Carlos, Mendoza. / The Role Of Agentes Sanitarios In Improving Access To Sexual And Reproductive Health For Women In San Carlos, Mendoza., Laura Hult

Independent Study Project (ISP) Collection

Introducción: Es evidente que Argentina tiene un enfoque que atiende a la salud sexual y reproductiva, dado que tiene cobertura universal y la ley de Programa Nacional de Salud Sexual y Procreación Responsable que establece un estándar de cuidado para toda la población. Sin embargo, cobertura universal no implica acceso universal, el cual que está determinado por el transporte, el idioma y la cantidad de recursos de la región. En lugares como San Carlos, Mendoza, donde no hay transporte regular y hay pocos recursos, existe inequidad en la salud, lo que puede aumentar las tasas de embarazos no intencionales y …

Internamente Solo: Escuchando Y Resistiendo La Soledad De Adultos Mayores En La Araucanía, Chile / Internally Alone: Hearing And Resisting The Loneliness Of Seniors In La Araucanía, Chile, Grace Ellrodt

Independent Study Project (ISP) Collection

Research Question: Which current patterns drive or diminish loneliness among seniors of the Region of the Araucanía in the city of Temuco and surrounding rural communes?

Objectives: Understand and interpret the roots and the antidotes of the loneliness phenomenon experienced by seniors in Temuco and surrounding communes in the present moment.

Identify and analyze the drivers of pathological elder loneliness in structural, intermediary, and proximal factors.

Highlight the perspectives and narratives of seniors, community leaders, and health resources with respect to strategies to reduce the crisis.

Background: Currently, the population of seniors has risen and will continue to rise in …

Health On The Move: Health-Seeking Behavior Of Changpa Nomads In Ladakh, India, Maya Lubeck-Schricker

Independent Study Project (ISP) Collection

The goal of this study is to understand the health-seeking behavior of Changpa nomads in the Changthang region of Ladakh, India including what health issues these communities face, what they do when they fall sick, any preventative health behavior they implement, as well as the health infrastructure available to them. Very little literature exists on the health seeking-behavior of people in South Asia in general, much less among nondominant lifestyles such as that of nomadic or semi-nomadic people. As such, this research hopes to move towards closing that knowledge gap by conducting and analyzing 26 in depth semi-structured interviews and …

Where Do We Go From Here?: Two Key Informants' Perspectives On How To Address Conscientious Objection In Top Provision In South Africa, Talia Parker

Independent Study Project (ISP) Collection

This perspectives research endeavor examines the barriers to TOP access that arise from conscientious objection through the conflicting network of rights and legislation in South Africa. While previous research has evidenced the demonstrable barriers to accessing TOP care in South Africa, this project aims to push the existing literature and the field as a whole one step further to interrogate how to move forward within the realities of conscientious objection.

To do so, I conducted interviews with key informants in the field of reproductive healthcare provision, research, and activism in Cape Town on their perspectives about the practice of conscientious …

Characterizing Systems Of Reporting And Mitigating Anthrax Outbreaks Near Mto Wa Mbu, Monduli District, Tanzania, Megan Levy

Independent Study Project (ISP) Collection

Northern Tanzania has experienced several anthrax outbreaks in the recent past. In Monduli district, an outbreak in 2016 prompted an organization of district officials to create an updated outbreak response action plan. The pastoralist community is often affected by these outbreaks due to their frequent direct contact with cattle and herds’ proximity to wild species potentially affected by the disease. This characterization of the existing systems of reporting and mitigating anthrax outbreaks was accomplished through structured interviews with ward and village officers, local veterinarians, and members of the pastoralist community in Monduli district near Mto wa Mbu. The purpose of …

Cancer Management In Kenya - Awareness And The Struggles Patients Face To Access Treatment, Care & Support, Ashley Nmoh

Independent Study Project (ISP) Collection

The amount of cancer cases in Africa, and Kenya specifically, are rising at an alarming rate. This study was conducted to determine the challenges that patients with cancer in Kenya face to access treatment, care and support. Thirty-nine cancer patients were interviewed and thirty cancer patients filled out a questionnaire about their experiences of having cancer in Kenya. In addition, twenty key informants were interviewed including doctors, caregivers, cancer NGO executives, a researcher, a psychologist, a National Health Insurance Fund official and a director from the Ministry of Health. A breast cancer awareness survey was also administered to fifty-nine women …

Increasing Screening And Education For Human Trafficking In The Obstetric Department, Chibwe Caroline Powell

Doctoral Projects

Background: Human Trafficking, is a human rights violation with global public health implications. HT is associated with multiple health problems. Healthcare providers working in obstetrics departments are in a unique position to interact with trafficked persons. Lack of specific HT screening tools, training and education have been identified as barriers to recognizing HT victims.

Objectives: The purpose of this quality improvement project was to increase victim identification and referrals by improving screening through implementation of an interdisciplinary screening tool into the EHR workflow and providing HT education.

Methods: This project examined the impact of implementing a HT screening tool and …

Implementation Of Evidence-Based Chronic Non-Malignant Pain Management Protocol For Primary Care, Jenny E. Kipp

Doctoral Projects

Chronic pain is the most prevalent health condition in the United States and is the most common reason people seek healthcare (Chang, Daubresse, Kruszewski & Alexander, 2014). In 2012, health care providers wrote 259 million prescriptions for opioid pain medications despite little change in self-reported pain prevalence (Centers for Disease Control and Prevention (CDC) 2016; Chang et al., 2014). Initiatives to prevent the under treatment of pain have resulted in overreliance on opioids to treat pain. As a consequence of opioid centric prescribing, an opioid epidemic has evolved with devastating consequences such as dependence, addiction and overdose deaths related to …

Predictors Of Good Functional Outcome At Discharge In Stroke Patients With Depression In The Fl-Pr Collaboration To Reduce Stroke Disparities, Amy Starosciak

All Publications

No abstract provided.

Abstracts From The 25th Annual Health Care Systems Research Network Conference, April 8–10, 2019, Portland, Oregon

Journal of Patient-Centered Research and Reviews

The Health Care Systems Research Network (HCSRN) is made up of nonprofit health systems with embedded research departments whose scientists are dedicated to public domain research. The network’s annual conference serves as a forum for research teams to disseminate study findings, stimulate new collaborations, and share insights about conducting research in real-world care settings. Abstracts accepted for presentation at HCSRN 2019 are published in this supplement of Journal of Patient-Centered Research and Reviews, the official scientific journal of the conference.

My Body, Their Choice: Childbearing Attitudes And Practices In Jamkhed, Maharashtra, Sienna Sewell

Independent Study Project (ISP) Collection

Understanding the beliefs and practices of women and their families during pregnancy and childbirth is fundamental to the creation of successful public health interventions that target maternal and infant mortality. This study explores the childbearing practices of women in rural Jamkhed, as well as the social and economic factors that influence family planning, reproductive health-seeking, and delivery. Interviews and quantitative surveys were conducted with women in villages that have partnered with the Comprehensive Rural Health Project (CRHP) to examine how and why women access prenatal care during pregnancy. The influence of CRHP’s “Jamkhed Model” on healthcare access is considered in …

Exploring Mobility Help-Seeking Behavior Among People With Physical Disabilities: A Case Study Of Jaipur Foot, Alex Podell

Independent Study Project (ISP) Collection

It is estimated that as many as 90 million people living in India experience some sort of disability (The World Bank, 2007). As India’s population keeps growing and aging, not only will the medical aspects, but also the societal impacts of disability need to be brought to the forefront of discussion, developmental strategy, and policy implementation. This study sought to analyze factors influencing the process of seeking help from formal and informal sources for people with physical disabilities. Data was collected from 10 people with physical disabilities receiving a variety of mobility aids from the NGO, Bhagwan Mahaveer Viklang Sahayata …