Public Health Commons^™

A Comprehensive Evidence-Based Educational Initiative For Improving Hand Hygiene, Lyanna L. Chan

Master's Projects and Capstones

Abstract

Problem: Healthcare-associated infections (HAIs) are a persistent concern in assisted living facilities, often resulting from inconsistent hand hygiene practices. Although national guidelines exist, adherence remains suboptimal, especially where staff training and compliance monitoring are limited.

Context: This project took place in a 53-bed assisted living facility without a formal system to track or reinforce hand hygiene. The aim was to improve staff knowledge and promote infection prevention through education.

Interventions: A Clinical Nurse Leader (CNL) led an evidence-based hand hygiene education program. The intervention included interactive training, visual reminders, personal sanitizers, and leadership support during clinical huddles.

Measures: Pre- …

Dual-Function Polyester Nanoparticles For Amplified Anti-Inflammatory Effects, Ingrid M Heyns, Abiodun T Wahab, Raghu Ganugula, David Sheikh-Hamad, M N V Ravi Kumar, Meenakshi Arora

Faculty, Staff and Students Publications

This study investigates a dual-acting drug delivery system using naringenin (NAR) as a folate receptor ligand to enhance intestinal uptake and encapsulated NAR for combating inflammation. The dual-acting systems were tested in vitro on cisplatin-induced human kidney-2 cells and in vivo in a mouse model of cisplatin-induced acute kidney injury (AKI). NAR-loaded passive nanoparticles [P2Ns(NAR)] and dual-acting systems [P2Ns-NAR(NAR)] showed notable advantages over unformulated NAR, reducing the required dose by up to 57 and 79%, respectively. These nanoparticles modulated immune responses, restored T cell function, and shifted macrophage polarization from proinflammatory M1 to tissue-repairing M2. In addition, P2Ns-NAR(NAR) alleviated AKI …

Chlamydia And Gonorrhea Infections In Genital And Extragenital Samples Among Men And Women, Kristal J. Aaron, Charlotte A. Gaydos, Edward W. Hook, Max Chernesky, Jeanne Moncada, Stephanie N. Taylor, Harold C. Wiesenfeld, Kenneth H. Mayer, Matthew R. Golden, Alexander Boutwell, Barbara Van Der Pol

School of Medicine Faculty Publications

Background For people who have anal and/or oral sex, many programs recommend genital and extragenital (defined here as anorectal and oropharyngeal) screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) to identify all potential sites of infection. Methods We assessed genital and extragenital CT and NG prevalence among people reporting extragenital sexual exposure. Results Among 343 gay and bisexual men who reported sex with men (GBMSM), 42 (12.2%) had CT with positivity of 3.5%, 9.3% and 1.8% in the genital, anal, and oral samples, respectively. In this same group, 55 (16.0%) had NG with positivity of 5.2%, 8.5%, and 7.6% …

Enumerating Escherichia Coli (E. Coli) Concentrations And Evaluating Optical Brighteners As A Potential Indicator Of Human Wastewater Contamination In La Nana Bayou, Banita Creek, And Their Tributaries, Nacogdoches, Texas, Swastika Acharya, Matthew Mcbroom, Yuhui Weng, Yanli Zhang

Electronic Theses and Dissertations

La Nana Bayou was added to the Texas 303(d) list in 2000 after it failed to meet water quality standards set by the Texas Commission on Environmental Quality (TCEQ) for primary contact recreation due to elevated Escherichia coli (E. coli) levels. E. coli is a bacterial species commonly found in the intestines of humans and warm-blooded animals. It serves as an indicator of fecal contamination in freshwater, though its presence alone cannot identify the contamination source. Optical brighteners (OBs), chemicals found in laundry detergents, cleaning agents, toilet papers, and clothing, are unique to human wastewater. This study aimed …

Advancing Workforce Development In Digital Health: A Regional Model From The Gcc, Manal Almalki, Osama El-Hassan, Jawad Ahmed, Amr Jamal, Mowafa Househ, Evelyn Hovenga, Paul Barach

College of Population Health Faculty Papers

This study examines the evolution of ZIMAM's role in the Gulf Cooperation Council's (GCC) taskforce on workforce development in digital healthcare. Established in 2016 and formalized as a non-profit organization in 2023, ZIMAM integrates international best practices, regional insights, and innovative strategies to develop a scalable digital health knowledge and skills framework. ZIMAM's methodology includes competency mapping aligned with the Skills Framework for the Information Age (SFIA), stakeholder engagement, and iterative validation to ensure relevance and adaptability. Key ZIMAM initiatives encompass the development of governance structures, capacity-building workshops, annual conferences, and recognition programs such as the ZIMAM-ELSEVIER Digital Health Awards. …

Demographic And Clinical Predictors Of Metabolic Dysfunction-Associated Steatotic Liver Disease And Advanced Fibrosis In The United States, Gail Fernandes

Walden Dissertations and Doctoral Studies

Metabolic dysfunction-associated steatotic liver disease (MASLD; formerly nonalcoholic fatty liver disease-related liver fibrosis) is a growing public health problem in the United States. The purpose of this study was to assess the prevalence of MASLD-related advanced fibrosis in the United States and assess whether type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) were independent risk factors for MASLD-related advanced fibrosis. This study was a quantitative cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2011 to 2020, grounded in the social ecological theory. Participants (N = 21,829) were included if they were ≥18 years, excluded if …

Proactive Planning For Contextual Fit: The Role Of The Implementation Premortem, Guillermo M Wippold, Kaylyn A Garcia, Ariel Domlyn, Dylan Wong, Maria E Fernandez

Faculty, Staff and Student Publications

Background: Implementation failure is a major barrier to program success. It is widely acknowledged that context matters-individual, community, and organizational norms, values, environment, and priorities influence successful program implementation. A mismatch between how the program was intended to be delivered and the constraints of the context in which it was delivered is a major cause of implementation failure. The barriers to implementation are usually understood after a program has failed. Although there are tools that can help accommodate for, or overcome, contextually-driven sources of implementation failure, there remains a significant gap - a tool and structured approach to analyze data …

Amputation Trends Among People Who Use Drugs In The Context Of Philadelphia’S Increasingly Xylazine Adulterated Drug Supply, Rose Laurano, Monika Pogorzelska-Maziarz, Traci C. Green, Sara Beachy, Kristin L. Rising, Jeffrey K. Hom, Megan K. Reed

Jefferson Center for Connected Care Faculty Papers

BACKGROUND: Xylazine-adulterated fentanyl has rapidly spread across the United States and has been increasingly detected in overdose deaths in Philadelphia, PA through medical examiner reports, clinical testing, and widescale drug checking. Xylazine use has been associated with wounds which may lead to amputation, but the extent of this outcome has not been explored.

METHODS: Utilizing the 10th revision of the International Classification of Diseases (ICD-10) codes, we conducted a de-identified retrospective analysis of data for patients identified with opioid related disorders (ICD-10 code F11) admitted to four different hospitals in Philadelphia, PA between 2018 and 2023. Exposure to xylazine use …

Partnership, Collaboration, And Co-Production To Improve Patient Experience Beyond Conducting Surveys – Lessons From The Quebec Model, Canada, Marie-Pascale Pomey, Catherine Wilhelmy, Myriam Fournier-Tombs, Vincent Dumez, Cécile Vialaron, Monica Nelea Iliescu, Karina Prevost, Simon Courtemanche, Louise Normandin, Geneviève David

Patient Experience Journal

Objective: The objectives of this article are to present how, in the province of Quebec (Canada), healthcare and service partnerships have been implemented, to take stock of the current situation and to suggest ways to continue strengthening the model over the coming years, in Quebec and elsewhere in the world. Methods: Three methods were mobilized: (1) a review of the literature and reports published in recent years on implementations of partnerships in Quebec; (2) a survey sent to the persons responsible for partnerships in Quebec’s health and social services establishments; and (3) a working committee comprised of patient experts, partnership …

Peer Mentoring, Camaraderie, And Support (Pmcs) Of Southern New Jersey: Suicide Prevention Using Human Experience And Social Determinants Of Health, Ali A. Poorani, Matthew Jacobs, Patrick Carney, Jaclyn Tomasetti

Patient Experience Journal

Suicide prevention is a high priority for Veterans Health Administration (VHA). Recent data show an increase in suicide rates, especially among Veterans that had not used VHA health services and nor had received any VHA benefits. Meanwhile, data collected for the past two decades reveals a decline in suicide rates among Veterans who were recent VHA users with mental health or substance use disorders. The objective of the Peer Mentoring, Camaraderie, and Support (PMCS) Program was to explore novel ways to reengage and reintegrate Veterans into their earned VA healthcare benefits, and examine the effectiveness of this new initiative by …

“All Together”: A Case Study Demystifying Patient And Public Involvement (Ppi) In Brief Psychological Interventions Within A Community Mental Health Service For Adults In The Uk, Molly H. Nadel, Katherine Parkin, Stephanie Casey, Rachel Maciag, Alice Xie, Mu-Yin Chang, Youngsuk Kim

Patient Experience Journal

The importance and value of involving patients and the public in the decision-making processes within services designed to support them, and research projects aimed at understanding and improving those services, have long been established. This is often referred to as Patient and Public Involvement (PPI). However, establishing good quality involvement work in practical terms is often less well understood and therefore, the uncertainty surrounding this can lead to hesitation by clinicians in practice. In this paper, we will share our lessons learned and the practical outcomes of PPI when applied in an NHS community mental health service for adults. We …

The Implementation Of A Telehealth Patient Advisory Council In A Network Of Federally Qualified Health Centers, Jessica Korins, Lisa Schaffer, Nandini Shroff

Patient Experience Journal

Patient input is recognized across the healthcare field as essential for tailoring innovations and quality improvement initiatives to meet the needs of intended patient populations. This paper describes the implementation of a patient advisory council (PAC) established to provide feedback on telehealth innovations and quality improvement initiatives at a network of federally qualified health centers (FQHCs) in New York State (NYS). We report on the implementation process, success and challenges, and reflections shared by PAC members regarding their experiences.

Understanding Online Reviews Of Geriatricians: Correlations Within A Dataset Of 53,210 Physician Reviews, Yizhong Wu, Eric Reuben Smith, Nick Shaffer, Hanh Dieu Trinh, Becky Powers

Patient Experience Journal

Introduction: Online reviews are increasingly influential in how patients find and choose physicians. Patients appreciate the transparency of online reviews, and they offer an avenue for physicians to receive feedback. This cross-sectional study aims to provide insight into correlations between provider level information such as wait times or physician demographics, and the reviews patients submit online for geriatricians.

Methods: ParseHub software was used to extract and pool data from 6,631 provider profiles categorized under “geriatric medicine” on the popular open-source physician review website Healthgrades.com. Physician race or ethnicity was modeled by profile last name based on 2010 US census data. …

Family-Centered Care In Pediatric And Neonatal Intensive Care Units: A Systematic Review Of Effects On Parental Satisfaction And Length Of Stay, Vincenzo Andretta, Valentina Cerrone, Veronica Strini, Angela Prendin

Patient Experience Journal

Background: Family-centered care (FCC) is essential in pediatric and neonatal intensive care units (PICUs), potentially increasing parent satisfaction and reducing length of hospital stay, but evidence of its effectiveness is inconsistent. Objective: To assess the effects of FCC interventions on parent satisfaction and length of hospital stay in PICUs. Methods: A systematic review was conducted, with 17 studies meeting the established inclusion criteria. The McMaster tool was used to assess the methodological quality of studies, along with an assessment of risk of bias. Results: The review identified a wide range of FCC interventions, including promoting parental …

I Felt More Confident That It Would Work For Me: A Grounded Theory Of Person-Centered Interprofessional Collaboration Based On Patients’ Lived Experiences, Katherine Hope Morgan, Cristina S. Barroso, Kathleen Conroy Brown, Michael R. Bleich, Soghra Jarvandi, Elizabeth B. Strand, Shaun Rowe

Patient Experience Journal

Interprofessional collaboration (IPC) is considered the highest standard of practice for delivering care to patients with multiple, complex, and chronic conditions. Despite reported benefits of IPC, the voice of the care receiver and how or whether they experience IPC is underexplored. Our objective was to examine patients’ experiences with IPC in two rural primary care settings in the U.S., where the burden of multiple chronic conditions (MCCs) is coupled with lower life expectancies and reduced access to care. We used a semi-structured interview to assess patients’ experiences within 72 hours after an IPC healthcare visit. This study, conducted in two …

Role Of Patient-Reported Measures (Prms) In Addressing Ethical Challenges During Telemedicine Consultation: A Narrative Review, Asiya Attar, Kasturi Shukla

Patient Experience Journal

Introduction: Telemedicine has revolutionized medical care delivery by emphasizing on Patient-Centred Care (PCC). Patient Reported Measures (PRMs) can assist in providing PCC since it assesses the treatment outcomes and patient experience. However, using PRMs is not just limited to gauging clinical efficiency; it can also play a role in addressing the ethical challenges in telemedicine. Yet this aspect of PRMs remains underexplored. Method: Literature search was conducted using a combination of keywords from the Google Scholar, Scopus, and Web of Science databases. 126 peer-reviewed journal articles in English from 2015 to 2024 were screened, and 34 relevant full-text …

Understanding Patient Experiences: A Qualitative Study On Communication And Cultural Competence In Multiple Sclerosis Care, Vaishnavi Sridharan, Charee Thompson, Rola Mahmoud, Minnatallah N. E. Eltinay, Chungyi Chiu

Patient Experience Journal

Objective: Effective communication is crucial in multiple sclerosis (MS) care, influencing patient satisfaction, self-management, and health outcomes. This study explores the experiences of people with MS (PwMS) regarding communication with healthcare providers and between providers within healthcare systems. Methods: This qualitative study analyzed open-ended responses from 590 participants in a national cross-sectional survey. Thematic content analysis was conducted to explore MS patients’ experiences with healthcare communication and care delivery. Results: Three major themes emerged: (1) Patient-provider communication, where 62.9% of participants reported positive experiences, citing responsiveness and empathy, while 37.1% noted issues such as inattentiveness and rushed consultations. (2) …

“Why Should Anyone Want To Make Things Better For Me Particularly?” – A Qualitative Exploration Of Care Opinion And Nhs Care Improvements, Emma Berry, Zoe Skea, Marion K. Campbell, Louise Locock

Patient Experience Journal

Care Opinion is an online platform which enables people to share anonymous feedback (known as “stories”) about their experiences of UK healthcare. In Scotland, this platform has official government backing, though healthcare organisations are not obliged to use it. Care Opinion staff review and edit these stories, acting as moderators. Healthcare staff are invited to respond to stories and are encouraged to use it for healthcare improvement. However, the number of changes made and registered on the platform is relatively small. This paper brings together findings from interviews with story authors (those sharing experiences), NHS staff and Care Opinion moderators …

Psychosocial Dimensions Of Living With Hep B: Notes From The Field: The Lived Experience Of A Mother Raising A Daughter With Hepatitis B, Julie Gerhardt

Patient Experience Journal

What follows is based on the interweaving of three points of view each of which contributes to an understanding of the experience of living with Hepatitis B: (i) as the mother of a daughter who was diagnosed with HBV at 5 months and who still, at age 22, carries traces of the surface antigen in her blood; (ii) as a participant in the Hepatitis B Foundation’s (HBF) “Storytellers” program in which those impacted by the disease meet with others to share experiences and narrate a short video posted on the HBF website; and (iii) as a PhD research psychologist-turned-psychoanalyst interested …

My Husband Didn’T Have To Die: A Doctor Reflects On All That Went Wrong With Her Husband’S Care In One Of The Nation’S Top Medical Centers, Joanna A. Cooper

Patient Experience Journal

The outcomes of complex care are never predictable. Despite this, reflecting on my husband’s care and his untimely death, I am certain that his fate would have been different with better communication, attention to detail, collaboration, and measures of curiosity, humility, and compassion.

Holding Space: An Effective Intervention For When Hope Wanes, Annette Lane, Marlette Reed, Rose Schroeder

Patient Experience Journal

Holding space is a person-centered, non-judgmental approach to working with clients. This approach goes beyond listening to client concerns; it entails deep listening and being present, developing trust with clients, and helping them connect goals with values. Within this brief account, the concept of holding space is described. What it is and is not is explained. Examples of holding space are woven throughout in order illustrate this concept. Finally, implications for professionals are provided.

The Art Of Diagnosis: How To Actively Participate In Your Healthcare, Vladislav Ilin, Daniel J. Morgan, Brad Peckler

Patient Experience Journal

Diagnosing illness is one of the most complex and error-prone aspects of healthcare, yet patients are rarely equipped with the knowledge or tools to engage in the process actively. This article demystifies diagnosis by explaining how doctors formulate differential diagnoses, the limitations of medical testing, and the cognitive and systemic factors that contribute to diagnostic errors. Drawing on real-world examples, the article highlights the crucial role of clear communication and collaborative decision-making between patients and clinicians. It offers practical, evidence-based strategies for patients to prepare for consultations, communicate their symptoms effectively, and ask key questions that promote accurate diagnosis. By …

Taking Time And Making Space For Patient And Caregiver Partners, R. Hamilton, L. Hives

Patient Experience Journal

Patient and caregiver engagement is a paramount element to ensure the voice of lived experience is integrated and prioritized in research. However, what it looks like to actually participate in authentic patient and caregiver engagement can be challenging without understanding the experience of our patient and caregiver partners. I had the honour of interviewing a patient and caregiver partner who bestowed rich guidance about what it means to deliver excellent patient and caregiver engagement in research. Themes of the interview included taking time to collaborate, being mindful and giving gratitude, actively listening to partner voices, leading alongside patient and caregiver …

From Fear To Hope: How Communication Transformed Our Pregnancy Journey A Personal Narrative On The Critical Role Of Healthcare Communication In Patient Experience, Valan. P, Pulidindi Venugopal

Patient Experience Journal

This article emphasises the transformative potential of compassionate healthcare communication, particularly in the context of pregnancy loss. This personal narrative illustrates how varying communication approaches can significantly alter patient experiences, transforming anxiety-laden medical encounters into empowering partnerships with healthcare providers. A ten-month journey through pregnancy after a devastating miscarriage revealed the profound impact of communication quality on both clinical outcomes and emotional healing. The narrative contrasts three distinct communication environments: dismissive administrative systems that induce unnecessary stress, insensitive support staff during vulnerable moments, and a physician whose empathetic approach fundamentally transforms the entire pregnancy experience. Through a detailed examination of …

Why We Need A Patient-Centered Innovation Renaissance: A Horizontal And Vertical Integration Of Knowledge To Transform Care Pathways, Pieter Vandekerckhove, Benjamin H.L Harris, Louis J. Koizia, Ashok Handa, Chris Brainard, Steven Howard

Patient Experience Journal

We are at a pivotal moment. The future of healthcare innovation can no longer be defined solely by technological advancement or institutional efficiency. While digital tools, therapies and platforms continue to evolve, they must be embedded within a broader transformation, one that places the human experience at the centre of how we design, deliver and evaluate care. This patient-centred renaissance calls for the integration of both horizontal and vertical forms of knowledge: connecting services across the care continuum. From the literature and our experience, an unexpected byproduct of co-production with patients in health innovation and care delivery is a reduction …

“Those Boxes Do Not Hold Me”: Using Narrative Health Experiences Research To Learn From Patients And Care Partners Beyond Surveys, Rachel Grob, Barbara Warren, Erika Cottrell, Njeri Grevious, Sara Knight, Mark Schlesinger, Kate Clegg Smith, Nancy Pandhi

Patient Experience Journal

Stories are fundamental to how we understand individual beliefs and experiences, as well as collective mindsets and institutional practices. Volunteered narratives are abundant, especially on the interweb. We in the health experiences research community, however, are challenged to develop effective, equitable approaches to moving beyond surveys by hearing and responding to not just dominant voices, but also those whom research has historically ignored, silenced, or objectified. In this commentary, we describe one such approach: the Database of Individual Patient Experiences (DIPEx) methodology as adapted by the Health Experiences Research Network (HERN) for use in the U.S. context since 2015. We …

Mastering The Art Of Listening: The Human Experience Superpower, Jason A. Wolf

Patient Experience Journal

As human beings we do not live in isolation. Our existence is framed in the context of others. We are a part of families and teams, communities and countries; all which provide us with ideas and information, most delivered through the interactions we have with others. The very definition of experience itself conveys this as it opens with the words, “the sum of all interactions.”¹ Every experience that we have is impacted by interactions with others. This give and take of connection is the breath of our humanity. Through it we transfer thoughts and beliefs, words and emotions. Moments …

Changing Hearts And Minds: Educating Medical Students To Transform Knowledge And Attitudes Toward Organ Donation, Matilin G. Rigsby

Doctoral Dissertations and Projects

The national organ shortage is exacerbated by physicians who, contrary to federal mandates, do not refer patients with organ donation potential in a timely fashion. Whereas United States medical school curricula widely omit organ donation-related topics, literature demonstrates that educating future physicians significantly improves those students’ ability to understand and positively perceive donation, influencing their willingness to refer donor candidates. Therefore, the purpose of this study is to determine if an educational module among fourth-year medical students at Texas A&M University College of Medicine Dallas Campus affects those students’ perceived knowledge and attitudes toward organ donation. The researcher administered a …

Associations Between Social Drivers Of Health And Breast Cancer Stage At Diagnosis Among U.S. Black Women, Mollie Barnard, Bo Qin, Marc Emerson, Etienne Holder, Matthew Dunn, Shromona Sarkar, Nuo Xu, Yutong Li, Christine Ambrosone, Elisa Bandera, Julie Palmer, Melissa Troester, Terry Hyslop

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

U.S. Black women have disproportionately high breast cancer mortality, partly due to later-stage diagnoses. We examined how social drivers of health (SDOH) relate to stage at diagnosis by analyzing data from 4,995 breast cancer survivors in the Black Women's Health Study, Carolina Breast Cancer Study, and Women's Circle of Health Studies. SDOH were self-reported and stage was ascertained from medical records. We used polytomous logistic regression to estimate odds ratios (ORs) for diagnosis at stages III/IV or II versus stage I (referent), adjusting for age, insurance status, and income. Meta-analyzed results indicated that underutilization of screening mammography (OR = 3.21, …

Maternal Mortality In Zambia: Associations With Health Services Utilization, Birth Spacing, And Province, Selina Mubwanga

Walden Dissertations and Doctoral Studies

Maternal mortality remains one of the leading public health issues in Zambia characterized by elevated maternal mortality rates among women of reproductive age. This research study investigated the effect of birth spacing, province type and location, and maternal health services utilization on maternal deaths among women in the Lusaka, Eastern, Central, and North-Western provinces of Zambia. The theoretical underpinning of this investigation drew upon the social-ecological systems framework. Using secondary data from the 2018 Zambia Demographic and Health Survey (ZDHS) of 1,868 women aged 15–49 years, the study adopted a quantitative, descriptive, cross-sectional research design. Binary logistic regression analysis revealed …