LAIR: Lenoir-Rhyne Academic Institutional Repository
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How does an Exercise Protocol Affect Balance and Functional Mobility in a Person with Mid-Stage Parkinson’s Disease?
Get PDFExercise can treat various symptoms of Parkinson’s Disease (PD). Balance and functional mobility are often impaired in people with PD, and both aerobic and resistance training have demonstrated potential improvements in these variables. It is hypothesized that 12 weeks of exercise will result in measurable improvements in balance and functional mobility. Purpose: To investigate the effects of an exercise protocol on the physical performance of a mid-stage Young Onset Parkinson’s Disease (YOPD) subject. Methods: A male YOPD subject (age 68) followed a 12-wk exercise protocol. The protocol consisted of cycling, balance exercises, mobility exercises, stretching, and resistance training. The subject was assessed pre-, mid-, and after the 12 weeks. Assessments included grip strength (GS), Sit to Stand (STS), Timed Up and Go (TUG), and Berg Balance Scale (BBS). Results: For GS, minor improvements (R hand +2.4%, L hand +5.3%) occurred between baseline and 12 weeks. The subject’s STS test scores decreased by 7.1% from baseline to 12-weeks. From baseline to 12-weeks, TUG improved by 29.5%. From baseline to 12-weeks, the subject improved his BBS score by 20%. Conclusion: The results, apart from the STS test, support the hypothesis that the exercise protocol implemented would show measurable improvement in balance and functional mobility. Improvements may be due to the central nervous system being retrained, muscular hypertrophy, and/or the training relating to the assessments
CINAHL Ultimate
Get PDFThe Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ultimate is a subscription aggregate health and allied health sciences database available exclusively from EBSCO. CINAHL Ultimate is the premier product in a lineup of five tiered versions including CINAHL; CINAHL with Full Text; CINAHL Plus with Full Text; and CINAHL Complete. The database is widely used by educators, students, researchers, and practitioners. CINAHL Ultimate is valued for its substantial indexing of publications core to the nursing and allied health field, use of the MeSH structure for subject headings, and numerous options for advanced searching specific to the needs of the health sciences. The collection indexes over 3,800 journals beginning in 1937, with 925 being offered full-text from non-open access journals and with a substantial number with no embargo. In particular, the amount of full-text, peer reviewed journals with no embargo available from non-open access sources is a significant upgrade from CINAHL Complete, and one that may very likely justify the additional investment. Value-added features include accredited continuing education modules, evidence-based care sheets, and quick lessons. With contributing publishers from 73 countries, the majority hail from the United States and the United Kingdom. Some potential drawbacks for those considering CINAHL Ultimate may be the lack of video-based continuing education content, source material beyond academic journals, and limited emphasis on international perspectives that may be more evident in competitors such as ProQuest’s Nursing & Allied Health Premium or MEDLINE Ultimate
Distinguishing Depression from Burnout: Implications for Impactful Interventions for Long-Term Improvement
Get PDFAbstract: Burnout is typified by a sense of exhaustion, cynicism, and lack of professional efficacy that occurs pursuant to an individual experiencing prolonged stress and a perceived inability to meet the demands of their job over time. Burnout can be difficult to differentiate from clinical depression, and fear of stigma from disclosing a mental illness in academia can be a potential barrier to seeking necessary interventions. However, correctly identifying and providing the appropriate interventions to manage burnout versus depression can have a significant impact on the well-being of both the individual and their work organization. This chapter explores the manifestation of burnout in academic librarians, ways in which librarians can better determine if they are experiencing burnout or depression, recommended interventions based upon this distinction, and reasons why making this determination is so critical for both librarians and librarianship
School-Based Initiative for Early Recognition of Depression Among Middle School Students
Get PDFThe purpose of this project is to determine if a Patient Health Questionnaire (PHQ)-9 is useful in identifying, evaluating, and lowering depression in middle school students. Nurses will administer the Patient Health Questionnaire which consists of nine close-ended questions. The questions will be scored zero to 27. Any positive result (score greater than ten) will be referred to a school counselor for further workup. School counselors will then determine if there is a need to refer students for treatment with a mental health provider or primary care provider
Lung Cancer Screening
Get PDFBackground: Lung cancer is the leading cause of cancer-related deaths in the United States (Rajupet et al., 2017). The US Preventive Service Task Force (USPSTF) recommends annual screening for lung cancer with low dose computed tomography (LDCT) in adults aged 50 to 80 years, who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years (US Preventive Services Task Force [USPSTF], 2021). Despite these guidelines, lung cancer screening is underutilized (Coughlin et al., 2019). Incomplete documentation of smoking history creates a significant challenge for determining candidates eligible for lung cancer screening (Carter-Harris et al., 2017).
Methods: This quality improvement project (QI) utilized a pre-intervention and post-intervention survey to determine the impact on providers’ knowledge, attitude, or clinical practice at a rural primary clinic in North Carolina. This project focused on the deployment of the lung cancer screening tool into the electronic health record (EHR) over a three-month period. A chart review was performed on patients aged between 50 to 80, with a current or former smoking history prior. Then, again after implementing the screening tool to determine if smoking documentation and lung cancer screening referrals improved.
Findings: Overall, the project demonstrated a significant difference in smoking history documentation and LDCT referrals, when incorporating a lung cancer screening tool into the EHR. The surveys revealed a weak correlation of providers’ knowledge, attitude, and clinical practice between the pre and post interventions.
Conclusion: The uptake of lung cancer screening guidelines remains low (USPSTF, 2021). Wider adherence to these guidelines will require better documentation of smoking history for providers to determine if individuals are eligible (Li et al., 2018). While this project did not reveal a significant difference in the providers’ knowledge, attitude, and clinical practice, it demonstrates improved smoking history documentation and LDCT referrals
Analyzing Psychosocial Distress Screenings: A Quality Improvement Project that Modifies the Frequency of Screenings
Get PDFBackground/Purpose: Distress is a multifactorial unpleasant experience that can interfere with the patients’ ability to cope with cancer. Research has recognized the effectiveness of interventions in the ability to reduce distress and positively impact patient outcomes. Therefore, the American College of Surgeon’s Commission on Cancer (ACSCoC) mandated that all cancer centers screen for distress to maintain and/or receive accreditation. The frequency of distress screening is up to the discretion of the cancer center; however, it is recommended to screen for distress at every medical visit. Due to this, cancer centers have implemented protocols that vary widely in their screening characteristics. This lack of consistency complicates the interpretation of research results that are intended to better understand and manage this issue. Therefore, more research is needed to determine the specific aspects of the distress screening process that need to be modified to achieve optimal patient outcomes. Methods: This quality improvement project (QI) took place at a local radiation therapy office in western North Carolina, where the facility’s protocol was to administer the National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problem List only at the initial visit. In this project, the nursing staff administered the NCCN Distress Thermometer and Problem List once a week for a three-month period, to see if there would be improvement in the facility’s ability to recognize and address psychosocial distress among their patients. The results were then gathered from a retrospective chart review and compared to the existing documentation collected from a designated three-month period. Findings: The results of the two-tailed Mann-Whitney U Test were significant and indicate that increasing the frequency of psychosocial distress screenings does provide a significant improvement in the recognition of psychosocial distress. Conclusion: Despite the limitations, the study does provide evidence that increasing the frequency of psychosocial distress screenings can improve a facility’s ability to recognize and address patient distress
Quality Improvement in Primary Care using the STOPP/START Criteria
Get PDFAdverse drug reactions (ADRs) in older people is a public health issue and is increasingly a problem in the care of the geriatric population. Polypharmacy and potentially inappropriate medications (PIM) are recognized risk factors for ADRs, which commonly cause adverse clinical outcomes in older people. The goal of this project is to assess if the application of the screening tool of older people’s prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria in a primary care practice for all patients age 65 and older will reduce the use of PIM in the geriatric population. The STOPP/START criteria is an evidence-based tool that can be used to facilitate a medication review for older adults
Political Freedom and Revolution: A Look Into the Space of Freedom Opened and Closed in Petrograd, 1917
Get PDFThe February Revolution of 1917 toppled the regime of Tsar Nicholas II which resulted in his abdication. Subsequently, a power vacuum was created and this newly emptied political space, once filled by the Tsar and now bereft of power or authority, opened up a potentially new opportunity of freedom. This freedom, defined differently from the mainstream interpretation of the word, allowed individuals and groups alike to act in a way that was outside of restrictions that governance creates. Upon the abdication by Nicholas II, a Provisional Government was immediately established that looked to maintain the authority that the Tsar once held. The political void was filled over the span of a few days as the Provisional Government established themselves as the legal governing body over the Russian Empire. However, throughout the course of 1917, their authority was contested by the Petrograd Soviet of Workers and Soldiers Deputies. This Soviet, represented by deputies who were elected by the workers and soldiers of Petrograd, eventually seized total authority for itself in October. At this moment, the freedom that Russia had momentarily seen in February was reinstated. Vladimir Lenin, leader of the Bolshevik majority within the Soviet at the time of the October Revolution, closed off this space of freedom once again, and this time for good, when he shut down the democratically elected Constituent Assembly in November and seized complete power and authority for himself and his Bolshevik party
Improving T2DM Outcomes in Primary Care
Get PDFBackground: In the United States (US), over 34 million Americans have diabetes mellitus and 90% -95% of these individuals have Type 2 diabetes mellitus (T2DM) (Centers for Disease Control and Prevention [CDC], 2021). In March 2018 the American Diabetes Association (ADA) estimated the annual costs of diabetes in the US had risen from 327 billion in 2018 – a 26% increase in five years (ADA, 2018). To help reduce these healthcare expenditures and improve the health of
individuals with T2DM, participation in Diabetes Self-Management Education and Support (DSMES) programs is fundamental due to its potential to help individuals reduce their hemoglobin A1C up to 1%, reduce diabetes complications, reduce hospital admissions and improve their quality of life (CDC, 2018).
Objective: To increase primary care provider participation in the establishment of diabetes selfmanagement goals for patients diagnosed with T2DM.
Methods: Participating providers completed the Assessment of Primary Care Resources and Supports for Chronic Disease Self-Management (PCRS) survey before and after project implementation to assess for gaps in the provision of care regarding T2DM management. The Diabetes Self-Management Questionnaire (DSMQ) was used to assist providers in establishment of self-management goals for patients diagnosed with T2DM for a three-month period.
Results: All participating providers completed the PCRS prior to and following implementation of
project. During implementation, 86 patients were seen for follow-up of T2DM and the DSMQ was
initiated with all 86 patients.
Discussion: The DSMQ served as a valuable tool to assess patients' self-care behaviors and eased the establishment of diabetes self-management goals. The providers will continue to implement the DSMQ for all patients diagnosed with T2DM. A future goal of the practice is to include a smart phrase link in the electronic medical record platform for review of the DSMQ at every visit for patients diagnosed with T2DM
Encouraging Nurse Autonomy Through Skills Validation to Increase Dysphagia Screenings in Adults
Get PDFGlobally as well as in the United States, dysphagia is a prevalent problem (Abu-Snieneh & Saleh, 2018; American Speech-Language-Hearing Association, 2020). Nurses primarily assess dysphagia risks and implement initial screenings as a means of secondary prevention pertaining to aspiration. There are multiple screening tools but limited data to create a standard protocol for nurse-led dysphagia screening leading to inconsistent screening, documentation, and screening techniques (Abu-Snieneh & Saleh, 2018; Dysphagia Screen - Patient Population, The Joint Commission, 2016). The purpose of this project was to determine if skills validation regarding the nurse-administered bedside swallow evaluation will help close practice gaps