DigitalCommons@The Texas Medical Center
Not a member yet
41791 research outputs found
Sort by
CRC Station: Improving Colorectal Cancer screening rates in primary care
No full textPurpose: To improve colorectal cancer (CRC) screening completion rates among eligible patients at a primary care clinic, located in Houston, Texas, by optimizing the medical assistant (MA) workflow and addressing systemic and patient-level barriers.
Background: The project site is a Federally Qualified Health Center that provides comprehensive and inclusive care to diverse and underserved populations, including those with low income, living with HIV/AIDS, experiencing homelessness, and uninsured. Despite the availability of non-invasive screening methods like the fecal immunochemical test (FIT), CRC screening rates remain suboptimal due to workflow inefficiencies, patient barriers, and inconsistent follow-up.
Methodology: A multifactorial intervention was implemented to streamline MA workflow and enhance patient engagement. Key components included the use of a standardized narrative script for CRC education, collection education demonstration using an interactive model, and weekly MA-led audits to track test returns, make reminder calls, and review lab results. Additionally, a return-by-sticker system was introduced to serve as the first reminder for patients to return FIT kits. The initially planned prepaid postage return option was excluded due to financial constraints.
Results: FIT screening data showed variable completion rates over the first three months of implementation. In January, 25 FITs were ordered with a 40% completion rate (10 returned). In February, 21 were ordered with a 43% completion rate (9 returned). In March, 21 were ordered, but only five were returned, reflecting a 24% completion rate. These trends highlight early successes, but some workflow or patient challenges may still not be being addressed.
Implications for Practice:Standardized workflow modifications and enhanced patient education can positively impact colorectal cancer screening rates. Ongoing monitoring and adaptive strategies are crucial for maintaining momentum. This model may be replicated in other FQHCs to strengthen preventive care delivery for high-risk, underserved populations. By addressing both workflow and patient-level barriers, similar FQHCs can replicate these strategies to improve CRC screening rates and advance preventive care among vulnerable populations
Implementation Of The Pressure Injury Prevention Care Bundle At A Home Based Hospice Program: A Quality Improvement Project
Full text linkAbstract
Purpose: This Doctor of Nursing Practice project was created to improve the prevention of pressure injuries in hospice patients receiving care through a Home-based Hospice and Palliative program. The project focused on introducing a standard set of care steps (a care bundle), enhancing caregiver education, and tailoring interventions to meet each patient’s unique needs, with the goal of improving overall patient outcomes.
Background: Pressure injuries remain a common and serious problem in hospice care, especially among patients who are immobile or confined to bed. Although effective prevention methods are known, inconsistent use of these methods, limited caregiver training, and poor documentation have continued to prevent success in many hospice settings. These wounds cause pain, increase infection risk, and reduce quality of life, making prevention especially important in end-of-life care.
Methodology: The project used an evidence-based, phased approach to introduce the Pressure Injury Prevention Care Bundle. This included planned training sessions for staff, creating uniform documentation practices, and establishing procedures to record when patients refused care. The project was guided by recognized frameworks such as the Consolidated Framework for Implementation Research (CFIR), the Iowa Model of Evidence-Based Practice, and the Plan-Do- Study-Act (PDSA) cycle. Data were collected through audits measuring compliance and documentation quality, as well as through caregiver feedback to understand challenges and successes.
Results: After implementation, caregiver adherence to prevention protocols increased from 60% to 85%. Documentation practices became more consistent and thorough. Personalized care planning encouraged greater patient participation. The introduction of formal protocols for recording care refusals ensured that care decisions respected patient wishes, which in turn increased caregiver confidence and patient satisfaction.
Implications: This project demonstrates that combining structured training, evidence-based care steps, and attention to individual patient needs can successfully reduce pressure injuries in home hospice environments. Maintaining these gains requires continued leadership support and regular monitoring. The strategies used in this project may be adapted to other care settings to improve patient safety and quality of life
From Clicks to Clarity: Advanced Searching in CINAHL
No full textTake your CINAHL search to the next level. Learn practical techniques for combining Subject Headings, keywords, and filters to create strong, effective search strategies that support your evidence-based research
New Resource: PsycTESTS
No full textAPA PsycTESTS is now available through the TMC Library. Each record includes detailed test information, permissions for use, and—when available—full-text tests and supporting documentation
Prevalence of Clinically Relevant Nightmares and Their Differences by Sex and Diagnosis in Psychiatric Inpatients
No full textNightmares have been shown to be associated with numerous forms of psychopathology, but the vast majority of this research has taken place in the general population and very little is known about their relation with psychopathology in those requiring inpatient hospitalization. In a sample of 1170 voluntarily admitted psychiatric inpatients, this study explores the frequency of reported nightmares in psychiatric inpatients with the aim of examining the prevalence of psychiatric diagnosis in those with and without clinically relevant nightmares. Participants completed the Disturbing Dream and Nightmare Severity Index (DDNSI) and the Structured Clinical Interview for DSM Disorders (SCID-5) at admission. G-squared analyses were conducted and odds ratios computed to examine for differences between those with and without clinically relevant nightmares. Clinically relevant nightmares were endorsed by 29.4 % of the respondents on the DDNSI. Participants reporting clinically relevant nightmares had higher rates of several forms of psychopathology including Generalized Anxiety Disorder, Post-Traumatic Stress Disorder, Anorexia, and Substance Use Disorder, though they were less likely to have a diagnosis of Major Depressive Disorder. Nightmare rates were also significantly different by sex. These findings replicate and extend previous research for differences in clinically relevant nightmares in individuals with psychiatric disorders and highlight the importance of integrating evidence-based nightmare assessment and intervention within inpatient psychiatric settings to improve the outcomes of our most psychiatrically vulnerable
Lessons Learned From an Epic Transformation of a Radiation Oncology Department in Guatemala: Keys to Success
No full textPurpose: We describe the radical modernization of a radiation oncology department in a developing country, Guatemala, from 2015 to the beginning of 2024. The Instituto de Cancerología y Hospital Dr. Bernardo del Valle S (INCAN) is the only public radiotherapy clinic serving patient referrals from the Ministry of Public Health and Social Assistance program.
Methods and materials: We describe the state of the radiation oncology department in 2015 versus 2024 while chronicling its gradual transformation. This multifaceted collaboration involved academic centers, government agencies, International Atomic Energy Agency (IAEA), industry, and nonprofits and continues to this day. We analyze the infrastructure, staff, radiotherapy equipment, physics equipment, patient careCo-60 decommissioning, and educational initiatives.
Results: We graphically illustrate the impact of these changes in treatment delivery time, consults, follow-up visits, CT simulations, new patients treated in each linear accelerator, new patients treated with 2D, 3D, IMRT/VMAT, and superficial techniques, new patients treated with 2D LDR, 2D HDR, or 3D techniques, causes of linear accelerator downtime, and weekly patients on treatment. We provide a figure of the various sequential and parallel steps to modernize a radiation oncology department. We describe the complexities of radioisotope repatriation and safe disposal. We provide a comprehensive table of wisdom pearls regarding project governance, team, education, finances, culture, and language. We also discuss the impact of artificial intelligence in contouring.
Conclusion: The transformation of the INCAN radiation oncology department in Guatemala is a testimony to many\u27s hard work, vision, and perseverance for the betterment of Guatemalan patients while facing incredible financial hardship. We hope that what we have learned in the past nine years will help others achieve even greater success in a shorter time
AI Tools for Students
No full textDiscover how to harness the power of artificial intelligence to navigate the rapidly expanding landscape of medical literature in this bite sized 30-minute session. You will learn how to utilize relevant AI tools like ChatGPT, Gemini, and Consensus to enhance your ability to develop effective search strategies and interpret information while strictly adhering to academic and ethical standards. Perfect for students who want to incorporate AI within their research workflow
Il-18 Metabolically Reprograms Car-Expressing Natural Killer T Cells and Enhances Their Antitumor Activity
No full textInvariant natural killer T cells (NKTs) have intrinsic anti-tumor properties that make them promising candidates for chimeric antigen receptor (CAR) immunotherapies. Transgenic cytokine expression can enhance cellular therapy potency, and we hypothesized that co-expressing IL-18 alone or with IL-15 would boost CAR-NKT therapeutic potential. To test this, we generated retroviral constructs expressing IL-15 and/or IL-18 with an inducible caspase 9 safety switch and co-transduced them with a GD2-specific CAR into human NKTs. Co-expression of IL-18 or IL-15/IL-18 increased CAR-NKT cytotoxicity, proliferation, and cytokine secretion in vitro compared to IL-15 alone. IL-18 also enhanced GPC3.CAR and CD19.CAR NKT activity against hepatocellular carcinoma and B cell leukemia cells, respectively. In a metastatic neuroblastoma model, IL-18-expressing GD2.CAR-NKTs controlled tumors more effectively than IL-15-only cells, but mice in the IL-15/IL-18 group developed severe toxicities not observed in the IL-18-only group. Mechanistically, IL-18 induced a transcriptional program distinct from IL-15, marked by lower exhaustion signatures and enrichment of metabolic pathways. Finally, targeted metabolomics showed that IL-18 drives broad metabolic reprogramming in CAR-NKTs including increased oxidative phosphorylation, glycolysis, glutaminolysis, and purine metabolism. These findings support the use of IL-18 in developing the next generation of cytokine-armed CAR-NKT cancer immunotherapies
Ophiobolin a Impacts Mitochondrial Redox Biology in an Epithelial-Mesenchymal Transition (EMT)-Specific Manner
No full textBreast cancer progression is facilitated by the epithelial to mesenchymal transition (EMT), generating cancer cells with enhanced metastatic capacity and resistance to chemotherapeutics. The fungus-derived sesterterpenoid natural produce compound, ophiobolin A (OpA), possesses nanomolar cytotoxic activity and a high therapeutic index, although its molecular targets and mechanism of action are not well characterized. Herein, we utilized a model of mammary epithelial cells and breast cancer cell lines with and without EMT features to characterize the mechanism of selectivity towards EMT(+) cells by OpA. Proteins interacting with OpA in EMT(+) cells, including mitochondrial glutathione transporter SLC25A40, were identified through via mass spectrometry. We utilized trans-mitochondrial cybrids to determine that mitochondria mediate sensitivity to OpA. Furthermore, we report effects on glycolysis, oxidative metabolism, and disruption of metabolite abundance in the TCA cycle. Antioxidant mechanisms are activated by OpA in EMT(+) cells via the NRF2-ARE pathway, verified by decreased cytotoxicity in EMT(+) cells pretreated with the NRF2 activator CDDO. Collectively, we conclude that OpA selectivity toward EMT is mediated by the mitochondria, and at sub-cytotoxic levels, generates a metabolic shift leading to cell death countered by antioxidant mechanisms
Improving CPR Quality in the Emergency Department by Implementing Data Driven Debriefs
No full textPurpose
The purpose of the quality improvement project was to evaluate the effectiveness of implementing a data driven debrief tool to improve the average compressions in target in adult cardio-pulmonary resuscitation (CPR) events.
Results
In FY23 prior to implementation the average compressions in target was only 1.65%. During the implementation phase of the project the average compressions in target reached 41% (n=3). In addition, the staff provided positive feedback regarding the tool and the integration in the workflow.
Background
The project was completed in a tertiary academic medical center emergency room. All adult CPR events within the emergency department utilizing the Zoll R series defibrillator were included.
Implications
The data driven debrief tool will continue to be utilized within the department and data will continue to be tracked. Results during the implementation phase suggest a positive impact from incorporating data into debriefs.
Methodology
The plan, do, study, act method was utilized for project implementation. The unit multidisciplinary staff were introduced to the debrief tool in unit huddles and staff meetings. The charge nurses were taught how to complete the tool when there was not nursing leadership on site ensuring twenty-four-hour implementation. The debrief tool was developed to include the team going over the compression data to include the average compression in target