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Jejunal Limb Sizing in Pediatric Patients with Gastrojejunal Tubes
No full textGastrojejunal (GJ) tubes are commonly used for enteral access in the pediatric population; however, there is currently no standardized approach for determining appropriate jejunal limb length during placement or replacement. The primary objective of this study was to evaluate the relationship between patient characteristics (age, height, and weight) and jejunal limb length. A secondary aim was to develop a guideline for sizing jejunal limbs during pediatric GJ tube placement. A retrospective review of 531 GJ tube events from 2018 to 2024 at a single institution was conducted. Analysis revealed a statistically significant difference between patient age, weight, and height and jejunal limb length. Based on these findings, a pediatric-specific jejunal limb-sizing guideline was developed, stratified by patient weight. Further research, including multicenter data collection, is needed to validate the guideline and advance standardization of jejunal limb length selection for pediatric GJ tube placement
Implementing a Multidisciplinary Discharge Checklist
No full textDelays in hospital discharges impact hospital throughput, bed availability, and patient outcomes. This project aimed to reduce discharge delays, enhance patient flow, and optimize resource utilization on the Cardiovascular Surgery Progressive Care Unit (CVS PCU) through the development and implementation of a multidisciplinary discharge checklist (MDC). The checklist was intended for use by nurse practitioners, physician assistants, registered nurses (RNs), social workers, and desk operation specialists (DOS). The effectiveness of the intervention was assessed through a retrospective chart review, comprised of a total of 139 patients, comparing discharge times before and after the use of the MDC. Staff surveys were conducted to gain feedback on the impact of the MDC on discharge efficiency, team coordination, and staff satisfaction. Prior to implementation, 17.9% of discharges were completed by noon, compared to 9.72% following the intervention. Although the findings of this project note a slight increase in discharge delays and a lower percentage of patients discharged by noon, the secondary findings—such as a prolonged discharge process following discharge order—provided valuable insights for future projects. This quality improvement project demonstrates the need for a standardized, team-based approach to streamline the discharge process, improve communication among healthcare team members, and enhance patient flow
Shared Medical Appointments for Rural Adults with Type 2 Diabetes
No full textType 2 diabetes mellitus (T2DM) is a growing epidemic in the United States that disproportionately impacts rural residents. Adopting healthy lifestyle changes can enhance the well-being of those with T2DM. Shared medical appointments (SMAs) offer a way to provide the necessary support and time to implement these lifestyle changes. This quality improvement project aimed to evaluate the feasibility and effectiveness of SMAs focused on lifestyle interventions for adults in a rural family practice clinic. The quality improvement project was conducted at a single site, assessing one group using a pre- and post-test design. Participants included rural adults receiving T2DM management at the family practice clinic with a hemoglobin A1C of ≥ 7.5%. Over 12 weeks, one participant attended four out of the six scheduled SMAs. This participant experienced a decrease in hemoglobin A1C levels from 10.5% to 8.6% and showed improvement on the Diabetes Empowerment Scale during the 12 weeks. By 24 weeks, their hemoglobin A1C level further decreased to 8.0%. The participant and provider reported high satisfaction scores for the SMAs. This project identified challenges and barriers to implementing SMAs. The results suggest that SMAs could enhance the quality of care for patients with T2DM in rural family practice clinics. Future studies should concentrate on overcoming recruitment and participation barriers for SMAs in rural areas
How Fiber Impacts Biomarkers in Individuals With Metabolic Dysfunction Associated Steatotic Liver Disease: A Meta-analysis
No full textMetabolic Dysfunction Associated Steatotic Liver Disease (MASLD) is a form of liver disease that affects a significant percent of the world's population. The only treatment for this disease is through lifestyle management with changes to diet and exercise. Dietary fiber has been shown to be an important part of helping reduce all cause mortality. The aim of this meta-analysis is to determine the overall effect of a high fiber diet compared to a control diet in liver enzyme markers and metabolic risk factors in individuals with MASLD. Databases PubMed and CINAHL were searched for randomized control trials with a high fiber diet and control diet that were conducted between 2014 and 2024, had participants with MASLD/ Non-Alcoholic Fatty Liver Disease (NAFLD) and with the outcomes measurements of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and body mass index (BMI). Data was compiled and random effects models were conducted using the metafor package in R Studio using the mean change in variables between the baseline and post-intervention. The p values were considered significant at a level of <0.05. There was a total search result of 21 articles, of which three studies that included a total of 151 participants were analyzed. The dietary fiber averages for the high fiber groups were 21.93 6.32 to 33.06 9.09 grams, the dietary fiber averages for the control groups were 10 to 22.26 9.50 grams. The pooled effect estimate AST was statistically significant [SMD: 0.39; 95% CI: 0.07 to 0.72; p = 0.0172]. The pooled effect estimate for BMI was not significant [SMD: 0.16; 95% CI: -0.16 to 0.47; p = 0.3327] and also non-significant for ALT [STD: 0.25; 95% CI: -0.07 to 0.58; p = 0.1235] in high fiber compared to control diets.This data indicates that a high fiber intake compared to a control diet shows a beneficial effect in lower AST levels, while there was not a significant difference in the effects on ALT and BMI
Social Work Capstone Organizational Assessment: Catholic Charities St. Lawrence Community Services (SLCS)
No full textClinician Perception on Cybernetic Use for Intensive Care Unit Delirium Detection
No full textDelirium affects up to 80% of intensive care unit (ICU) patients and can lead to long-term cognitive impairment, making early detection vital. This qualitative study investigates ICU clinicians' perceptions of a cybernetic artificial intelligence (AI) system that uses computer vision to detect early signs of delirium by analyzing patient behaviors and expressions. Conducted in three ICUs of a large Midwestern hospital, this study includes interviews with clinicians to explore ethical concerns such as patient privacy, informed consent, algorithmic bias, and the impact of AI on patient care. Gregory's Constructivist Theory of Perception guides the analysis, recognizing that clinicians' views are shaped by their experiences and biases. Using Notably AI software, researchers identified themes including the need for informed consent, concerns about fairness for minority patients, and appreciation for AI's potential to alleviate the burden of delirium care. While the study highlights the promise of AI in improving patient outcomes, it also underscores the importance of addressing ethical issues to ensure responsible integration into clinical practice. Limitations include sample bias and limited generalizability, but the findings offer valuable insights for refining AI tools and guiding future research
The Effectiveness of a Nurse Mentorship Program on Job Satisfaction and Retention
No full textNurse turnover continues to pose significant challenges to healthcare organizations, impacting workforce stability, patient outcomes, and financial performance. Mentorship has been identified as an evidence-based strategy to enhance job satisfaction and retention among nurses. This Doctor of Nursing Practice (DNP) project evaluated the effectiveness of the Supporting and Nurturing Development (S.A.N.D.) program, an established nurse mentorship program, in improving nurse job satisfaction and retention at a large community hospital in the Midwest. A program evaluation design, guided by the logic model framework, was used, incorporating focus groups and digital surveys to explore the program's long-term impact 2.5 years after implementation. Participants (N=18) included registered nurses who served as mentors or mentees across seven clinical areas. Qualitative data were analyzed thematically using NVivo software to identify recurring patterns and insights. Four primary themes emerged: direct positive influences, tangential benefits, future considerations, and job retention. Findings indicated that mentorship fostered professional confidence, emotional support, a sense of belonging, and job satisfaction, contributing positively to workforce stability. Despite limitations such as a small, homogenous sample and single-system participation, results demonstrated that structured mentorship programs can strengthen organizational culture, promote engagement, and improve retention. Continued leadership support, protected mentor time, and integration into professional development initiatives are recommended to ensure long-term sustainability and workforce resilience
Improving Blood Pressure Measurement Technique of Staff in an Ambulatory Cardiology Clinic
No full textAccurate blood pressure measurement is vital in diagnosing and managing hypertension. Often, healthcare providers — including medical assistants, nurses, advanced practice providers, and physicians — have knowledge gaps and misperceptions about the importance of adhering to evidence-based guidelines for performing accurate blood pressure measurements. Research indicates that training interventions can enhance knowledge and skill in proper blood pressure measurement. An educational intervention was developed in accordance with guidelines established by the American Heart Association and the American Medical Association. Pre- and post-test questionnaires were used to evaluate the success of the training intervention. Three months following the intervention, staff observations were conducted to assess the retention of knowledge and skills. The pre- and post-test intervention scores were compared to assess improvements over time. The mean difference between pre- and post-test intervention scores was 0.5 (SD = 1.17). Normality testing indicated that the distribution of the score differences was not normal (Kolmogorov-Smirnov test, p = .039). Given this, a nonparametric Wilcoxon Signed-Rank Test was used to assess the change in scores from pre- to post-intervention (p = .27), which was not statistically significant; however, a trend toward improvement was observed. Observation data revealed that staff retained their skills three months after training. These findings support existing, albeit limited, evidence that ongoing training and monitoring programs yield positive outcomes in staff knowledge and skills related to blood pressure measurement. Training on blood pressure measurement should be included in annual educational review programs to further support accurate diagnosis and management of hypertension
Data Repository for Successful Bariatric Post-Surgical Outcomes
No full textA retrospective chart review project on patients who underwent bariatric surgery was conducted within two Midwestern hospitals, a community hospital, and a large academic center hospital. The project examined the following variables: smoking status, sex, age, administration of post-induction ketamine, an intra-operative lidocaine infusion, and intra-operative fentanyl administration to determine if there was any significant relationship with successful post-operative outcomes after bariatric surgery. This was defined as a 10% or more reduction from pre-surgical bodyweight within 6 months post-surgically. The average change from pre-surgical weight to 6 months post-surgical was 4.57% in the community hospital and 3.88% in the academic hospital. Of the randomly sampled participants from both institutions, only 6 of the 100 met the threshold for success of 10% or more weight loss. In addition, the difference between the two hospitals was statistically insignificant, with a p-value of .33. No statistical significance was found between post-surgical success and sex, age, or smoking status. Clinically interesting findings were that the community hospital used more opioids at higher doses. Fentanyl was used in 47 of the 50 samples and the dose was 47% higher than the academic hospital. They also had 70% more post-operative nausea and vomiting p = .004. Despite the academic hospital having a 50% longer time in the post-anesthesia-care unit, the total hospital length of stay was nearly identical. This study presents a broad starting point for further project designs