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Reducing anesthesia related regulated medical waste: a quality improvement study
Get PDFThis quality improvement project explored the issue of improper disposal of medical waste produced by anesthesia team members in operating rooms (ORs) and the negative impact this has on healthcare’s contribution to environmental waste production
Mentorship in midwifery: examining the role of the American College of Nurse Midwives in supporting newly certified midwives
Get PDFEarly-career attrition is common in the midwifery profession, with 30% of midwives leaving clinical practice within 5 years of certification, and nearly 50% leaving within 10 years. Literature on midwives in their first year of practice suggests that opportunities for mentorship increases retention of midwives in the profession. Little is known about mentorship opportunities available to new midwives at the local level. This DNP project utilized a mixed-methods approach to gather information about mentorship opportunities facilitated by American College of Nurse-Midwives (ACNM) Affiliate chapters. Semi-structured interviews were conducted with ACNM state-level leaders regarding mentorship, professional burnout, and member engagement. 25% of Affiliates interviewed had current mentorship programs, 15% had previous mentorship programs, 15% had active plans for mentorship, and 45% had no current, prior, or plans for mentorship. Affiliate leaders expressed barriers to mentorship included lack of funding and resources, lack of capacity at the Affiliate level, and lack of engagement from membership. Attrition from the midwifery profession has far-reaching implications on a healthcare system already experiencing a paucity of obstetric providers and maternal mortality rates exceeding other well-resourced countries. ACNM support for mentorship for midwives transitioning from student to practitioner is one possible tool for retaining midwives in the workforce
Improving clinician preparedness to address Xylazine use within the Veteran population: a quality improvement project
Get PDFXylazine, a non-opiate animal tranquilizer, has emerged as the most prevalent adulterant in illicit drugs and is contributing to overdose deaths. Xylazine is unregulated by the FDA and presents unique challenges to healthcare providers due to its severe psychological and physiological effects. This quality improvement project aimed to enhance clinician preparedness to address xylazine exposure within the Veteran population served by a large metropolitan Veterans Affairs Medical Center in the Northwestern United States
Comparing quality of care in self-managed versus facility-managed medication abortion in a global context
No full textEquitable access to high-quality abortion care varies based on legal restrictions, social determinants of health, and stigma. This dissertation investigated individuals’ experiences of abortion quality of care, follow-up care seeking, and provider referral practices in facility- and self-managed medication abortion contexts in six low- and middle-income countries. The findings highlight gaps in information provision and underscore the importance of measuring quality to meet individuals’ care needs. This study also suggests that pharmacy and community health workers may expand access and bridge gaps between health systems and self-managed support networks
Clathrin mediated endocytosis in Alzheimer's Disease: using biomarkers to uncover disease mechanism
Get PDFClathrin mediated endocytosis (CME) is emerging as a critical player in the development and progression of AD in multiple brain cell types. CME is an important intersection between early neuronal dysfunction via Aβ1-42 accumulation and downstream effects that contribute to neuronal viability, such as synaptic vesicle recycling deficits and disruption of AMPAR regulation. Not only is Aβ1-42 produced following CME of APP, but internalization of multiple forms of extracellular Aβ1-42 contribute to downstream neuronal pathology. In astrocytes and microglia, which are heavily involved in clearance of extracellular Aβ1-42 in the brain, CME disruptions reduce internalization of Aβ1-42. Ultimately, CME appears to be involved in dysfunction in multiple cell types across early and late stages of AD. Thus, elucidating the mechanisms of CME and how their disruption is related to AD pathogenesis or neuroprotection in each brain cell type would both lead to a better understanding of AD mechanisms and potentially point to novel targets for the treatment or prevention of AD. In this dissertation work, I have begun to assess CME in the context of AD, using human post-mortem samples and the 5xFAD AD mouse model
Using a person-centered approach to assess Medicaid coverage for gender-affirming care
Get PDFThis study evaluated the national landscape of Medicaid gender-affirming care policies, identified state environments associated with policies' person-centeredness, and described wage dynamics relative to gender-affirming care receipt. The study used a mixed-methods, community-engaged approach, and found promising examples of person-centeredness in policy design and significant and meaningful increases in average wages following gender-affirming care receipt
