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Stroke and ST-Segment Elevation Myocardial Infarction Care in Rural North Idaho
No full textBackground: Rural communities exhibit disproportionately high mortality rates, particularly due to chronic health conditions, strokes, and ST-segment myocardial infarctions (STEMI). Contributing factors include geographical barriers, limited access to specialist services, and minimal exposure to such cases. In North Central Idaho, St. Mary’s Health, a critical access hospital, serves a predominantly aging population and is located over an hour from the nearest percutaneous coronary intervention (PCI) or stroke-capable facility. These delays in recognizing clinical conditions or activating appropriate clinical pathways adversely affect patient outcomes. Purpose: The purpose of this quality improvement initiative was to enhance the knowledge and confidence of emergency room and prehospital personnel regarding stroke and STEMI protocols at St. Mary's Health, utilizing simulation-based educational methods. Methods: Guided by the Institute for Healthcare Improvement’s Plan-Do-Study-Act (PDSA) framework, simulation sessions were utilized to mock stroke and STEMI cases, followed by targeted education and facilitated debriefings. Pre- and post-intervention surveys assessed staff knowledge and confidence in recognizing symptoms and implementing protocols. Quantitative data were analyzed using paired t-tests and descriptive statistics. Results: Seven participants completed both the pre- and post-surveys, while eleven participants completed at least some portion of the survey. Confidence in recognizing acute stroke symptoms increased by 200% (p=0.008), and confidence in identifying a STEMI increased by 600% (p<0.001). There was unanimous support for continuing simulations, with limited exposure to cases identified as the primary barrier to knowledge acquisition.
Conclusions: Simulation-based education significantly enhanced staff confidence and competence in managing time-critical emergencies within rural settings. Regularly scheduled simulation sessions support continuous professional development and have the potential to reduce door-to-needle and door-to-balloon times, thereby improving patient outcomes. Expanding this program to additional rural hospitals in Idaho could further mitigate disparities in emergent stroke and STEMI care between urban and rural populations.
Advancing Primary Care: Continuous Glucose Monitoring in Type 2 Diabetes Management
No full textBackground: CGM technology provides accurate, real-time glucose data, improving glycemic control, reducing glycosylated hemoglobin (HbA1c), and enhancing patient engagement. Despite evidence-based recommendations, CGM remains underutilized in primary care, often due to limited provider familiarity with prescribing and educating patients on device use. Barries include knowledge gaps, time constraints, and uncertainty regarding insurance coverage. Providers at this primary care clinic identified a knowledge gap but have interest in CGM utilization for their T2DM patients. Purpose: The purpose of this DNP quality improvement project was to increase healthcare provider (HCP) knowledge, confidence, and intended implementation of continuous glucose monitoring (CGM) in adults with type 2 diabetes mellitus (T2DM) and to identify additional learning needs at a Southwest, urban primary care clinic. Methods: Using the Chronic Care Model (CCM) and the Plan-Do-Study-Act (PDSA) framework, an approximately 15-minute asynchronous, online educational session was delivered via email to providers at a Southwest, urban primary care clinic. The presentation covered American Diabetes Association (ADA) aligned pharmacotherapy, CGM metrics, device selection, and patient education. An online, anonymous post-intervention survey was utilized to assess changes in knowledge, confidence, and intent to implement CGM, and identified future learning needs to facilitate utilization. Results: Of the five eligible providers, four (80%) completed the asynchronous, online presentation and post-intervention survey. All respondents had selected they had prior experience with CGM, and four (100%) respondents reported increased knowledge and confidence in educating patients about CGM use and prescribing CGM for appropriate adults T2DM patients. Three (75%) respondents selected that they intended to prescribe more CGM after viewing the presentation and one (25%) responded selected they were neutral. Barriers identified included insurance coverage, data interpretation, and time. Facilitators identified included the asynchronous nature of the presentation and information gained from the presentation. Conclusions: This quality improvement project effectively improved provider knowledge, confidence, and intent to prescribe CGM for appropriate T2DM patients at a Southwest urban primary care clinic. The findings of this QI project align with existing literature, especially the barriers and facilitators, investigating CGM use in the primary care setting. Recommendations for further projects include targeting education for insurance coverage and CGM data interpretation while keeping the asynchronous nature of the presentations
THE POWER IN PATIENT STORIES: TRACING WOMEN’S HEALTH HISTORY THROUGH NARRATIVE MEDICINE
No full textThis honors thesis explores narrative medicine and narrative journalism through research, a book review and historical analysis. It highlights the pioneering work of Dr. Rita Charon, a physician and literary scholar who founded the Division of Narrative Medicine at Columbia University. Narrative medicine, a field that emphasizes the importance of storytelling in healthcare, seeks to foster more empathetic and personalized interactions between patients and medical professionals by encouraging an understanding of the broader context behind the reasons patients seek care. Dr. Charon's approach to patient care serves as the foundation for this exploration. This thesis examines the role of narrative medicine in enhancing doctor-patient relationships and medical education. The honors thesis also draws connections between narrative medicine and narrative journalism. Narrative journalism, a genre of literature that combines factual reporting with storytelling techniques, offers a more immersive and emotive way of reporting. By exploring Charon’s application of narrative techniques to healthcare and comparing them with narrative journalism practices, the thesis investigates how both disciplines rely on the art of storytelling. By including a review of All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today, this thesis highlights both the power of patient stories in healthcare and how delving deeper into patient stories can help the medical community provide higher quality care. By focusing on the way in which storytelling fosters empathy, understanding, and connection, I seek to illustrate how narrative practices can improve patient care and the way patient stories are told and received.Honors thesis completed in the School of Journalis
THE IMPACTS OF MENOPAUSE ON BONE HEALTH AND SKELETAL PHYSIOLOGY
No full textPostmenopausal osteoporosis is a prevalent yet often overlooked condition that significantly impacts the health and well-being of women after menopause. This research examines the physiological, psychological, and social implications of osteoporosis in postmenopausal women, focusing on the changes in bone density due to decreased estrogen levels. The study highlights the stage of menopause, also known as perimenopause, and the stage after, also known as postmenopause. It also highlights early menopause, postmenopausal osteoporosis, the economic burden, quality of life, prevention, treatment, awareness, and solutions. Additionally, the research addresses the barriers to seeking medical attention, including insufficient education, societal stereotypes, and the stigma surrounding menopause. The findings suggest that early detection, preventative measures, and comprehensive education are crucial in reducing the incidence of fractures and improving the quality of life for affected individuals. Through a review of current treatments, including hormone replacement therapy, bisphosphonates, and lifestyle interventions, this paper provides insights into effective management strategies and properly understanding the mechanisms behind menopause. By increasing awareness and access to appropriate care, we can mitigate the long-term impacts of postmenopausal osteoporosis and enhance the overall health of women in this stage of life
Sex Based Differences in Young Athletes Contributing to Musculoskeletal Injuries and Recovery
No full textMost athletes begin their sport(s) from a young age which is great for their emotional, mental, and physical development. The problem arises between male and female athletes when they reach the age of puberty because the mechanisms of their bodies change. Parents, coaches, and athletes alike need to be educated. Adolescent athletes need to be educated about how changes to their bodies affect their training. Males and females should be taught to train differently. For this literature, articles were found from search engines and databases such as Google Scholar, Google, and the University of Arizona online libraries.The key words searched for were: adolescent, athlete, sex, male, female, concussion, joints, puberty, hormones, recovery, biological/physiological differences. Adolescents in particular are more at risk for injury compared to older, more experienced adults. One factor is differences in neurotransmitters. Higher levels of dopamine lead to risk-taking. Risk-taking behavior can increase the chances of injury. This is common in both adolescent male and female athletes. The majority of biological differences between males and females can be attributed to hormone differences and their wide ranging physiological effects. Male bodies are dominated by testosterone. Female bodies experience hormone fluctuations of estrogen, progesterone, luteinizing hormone, and follicle-stimulating hormone. Estrogen and progesterone are the main female hormones. The physiological differences become noticeable once puberty begins. These musculoskeletal differences manifest as increased flexibility in females and greater speed and strength in males. Females experience more personal variation in musculoskeletal performance due to the menstrual cycle
BEST PRACTICE RECOMMENDATIONS TO REDUCE COMMUNICATION DIFFICULTIES IN HEALTHCARE FOR DEAF PATIENTS
No full textThis thesis explores research on deaf patients and how they view their experiences in a hospital setting and proposes evidence based recommendations for interventions such as providing interpretation accommodations and education to healthcare professionals. Over 50 million people in the United States have a hearing disability where people are either hard of hearing or completely deaf (James et al., 2022). Evidence based recommendations enable healthcare professionals to provide patients with the highest quality of care. The recommendations for caring for deaf patients include providing proper interpretation accommodations upon admission to the hospital and throughout all aspects of care to ensure effective communication and understanding. Additional recommendations call for the implementation of an electronic order set to create a structured outline to follow during care and incentivizing the continuing education of providers and nurses to become familiar with American sign language. These interventions aim to increase patient satisfaction and understanding and decrease the communication gap deaf populations struggle with within the healthcare field. The final chapter includes the implementation proposal using the Plan-Do-Study-Act cycle to evaluate and refine the intervention. Nurses should remain committed to continuing educational efforts by staying current on research to provide the greatest care for all patients
Synergy Between Natural Antimicrobials Against Eschericha coli Bacteriophages
No full textHousehold and industrial disinfectants are often used without consideration of their fate and transport after use. Disinfectant products are well known for their convenience and efficiency. However, they can potentially create hazardous chemical byproducts ranging from carcinogens to ecological degradation. To minimize these effects, alternative methods of sanitation using naturally occurring antimicrobials have been proposed and developed. These antimicrobials include complex organic molecules, essential oils (EOs), and inorganic acids. This research focused on organic acids and essential oils from various plant species that have been demonstrated in previous studies to have antiviral, antifungal, and antibacterial properties. To determine the effectiveness and possible synergy between combinations of these natural products, a series of experiments targeting bacteriophages with three different capsid and genomic characteristics were conducted including MS2 (ssRNA icosahedral), ?X174 (ssDNA icosahedral) and PR772 (dsDNA icosahedral with encapsulating membrane) bacteriophages with Escherichia coli hosts. The greatest degree of synergy for the substances tested was observed for several antimicrobial combinations against MS2 and PR772. Citric acid (1.0%) paired with either cinnamaldehyde (1.0%-3.0%) or carvacrol (0.1%-0.5%) had the greatest synergy and effectiveness against both MS2 and PR772 (increase in efficacy ranging from 0.80 to >3.42 log greater reductions than an additive effect). ?X174 was more resistant to most antimicrobials than both PR772 and MS2, and exhibited little synergy with most antimicrobial combinations, possibly because of its stable circular genome; however, several combinations were found with moderate yet significant synergistic increases in efficacy of 0.27 to 0.50 log greater reductions than an additive effect. The combination of carvacrol with cinnamaldehyde was the least effective with antagonism observed against PR772 and a likely only additive effect against the other two viruses, possibly due to the competition of both antimicrobials for the same site on the viral genome. Finding synergy as opposed to additive effects is important for reducing the volume of products used for sanitation
TACOMA POWER PUBLIC SAFETY POWER SHUTOFF ASSESSMENT TOOL
No full textWildfires are quickly becoming one of the more prominent natural hazards to the Pacific Northwest in the United States of America. Power companies and utilities across the West Coast have adopted practices to better manage their role within their respective communities throughout all phases of Emergency Management. Washington State Department of Natural Resources has asked all utilities to draft a Wildfire Mitigation Plan, to include PSPS practices. This project aims to identify what happens when a wildfire is approaching Tacoma Power’s service territory under Public Safety Power Shutoff (PSPS) conditions, and the information needed to fight the fire in the event the water purveyor is an energized source. Emergency Management teams need access to this kind of information to be better prepared when coordinating resources to fight fires encroaching into urban areas. This project developed a Geographic Information System (GIS)-based application based on identifying areas of impact in the event of a PSPS, specifically on water purveyors throughout the Tacoma Power service territory. Information gathered from this assessment tool supports the Wildfire Mitigation Plan and process for Tacoma Power.This item is part of the MS-GIST Master's Reports collection. For more information about items in this collection, please contact the UA Campus Repository at [email protected]
Soil Health – Nitrogen Reactions and Availability
No full textThis article, published in the VegIPM Newsletter (Vol. 15, No. 23), examines nitrogen cycling in soils, focusing on mineralization and immobilization. Silvertooth explains how microbial processes govern nitrogen availability and stresses the importance of these transformations for fertilizer efficiency.Documents in the Arizona Pest Management Center collection are made available by the Arizona Pest Management Center (APMC) and the University Libraries at the University of Arizona. For more information about items in this collection, please contact https://acis.cals.arizona.edu/about-us/arizona-pest-management-center
Healing in the Halls: Exploring Trauma-Informed Practices of School Psychologists
No full textChildhood trauma is widespread and can lead to various challenges, including academic difficulties, behavioral issues, mental health problems, neurobiological effects, and social-emotional struggles. School psychologists are in a unique position to address childhood trauma effectively. They can raise awareness about the impact of trauma, lead the implementation of trauma-informed practices in educational settings, conduct trauma-informed assessments, and promote interventions that consider the effects of trauma, including disciplinary practices. The current study explored the experiences of school psychologists in relation to trauma-informed practices through semi-structured, one-on-one interviews. This study identified key themes related to defining trauma and trauma-informed practices, student risk factors for trauma, including the disproportionality of trauma and the need to consider it as a social justice issue, the incorporation of trauma-informed assessments, the levels of training and preparedness for delivering these practices, and school psychologists’ perceptions of individual, school, and systemic barriers to providing these services