27392 research outputs found
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Sidney Lawton Smith Bookplate Commissioned for Marlborough Public Library
No full texthttps://digital.sandiego.edu/bookplates-artists-smith/1031/thumbnail.jp
Sidney Lawton Smith Bookplate Commissioned for Bangor Public Library (1 of 6)
No full texthttps://digital.sandiego.edu/bookplates-artists-smith/1016/thumbnail.jp
Sidney Lawton Smith Bookplate Commissioned for The Newberry Library
No full texthttps://digital.sandiego.edu/bookplates-artists-smith/1033/thumbnail.jp
Margaret Ely Webb Bookplate Commissioned for Kathleen Louise Eddy
No full texthttps://digital.sandiego.edu/bookplates-artists-webb/1013/thumbnail.jp
Margaret Ely Webb Bookplate Commissioned for Alice
No full texthttps://digital.sandiego.edu/bookplates-artists-webb/1015/thumbnail.jp
Evaluating the Implementation of Biplane Ultrasound Probes for Guided Peripheral Intravenous Access in the Emergency Department
Get PDFBackground: Single plane ultrasound (US) probes are currently standardized for initiating US guided peripheral intravenous (USGPIV) access for difficult intravenous access (DIVA) patients in the emergency department (ED). Emerging literature reveals the increased efficacy of biplane US probes for USGPIV access with an improved success rate of up to 36.6%.
Purpose of Project: Implement best practice recommendations by integrating one biplane US probe for USGPIV access at a Level 1 Trauma Center ED in Southern California after training ten registered nurses (RN) on its use. The project aimed to improve patient outcomes, department flow, RN education, and utilization of US devices for peripheral intravenous (PIV) insertion.
PICO(T): Does implementing biplane US probes for USGPIV access for adult patients in the ED affect RN utilization, patient outcomes, and department flow over a six month period compared to baseline US probes?
Methods: A brief educational module with online and in-person training components was integrated for ten previously US certified ED RNs. After developing and implementing a property function in the electronic medical record (EMR), RNs were able to chart their use of biplane probes for USGPIVs. Following education, RNs were provided access to a single biplane probe for live implementation with DIVA patients in the ED at their own discretion on thirteen randomized day shifts over a six month period. Data was then collected and analyzed retrospectively using EMR reports.
Results: Utilization of the biplane method improved outcomes compared to the single plane method resulting in a 23.8% reduction in the average number of attempts required to obtain access, 80% decrease in subsequent critical care vascular access placement, and 33.1% decrease in length of stay (LOS). Patients who received biplane USGPIVs required greater time until access was obtained. After in-person training, there was an increase in the rate of both single plane and biplane US probe use compared to baseline. A cost benefit analysis (CBA) and return on investment (ROI) were calculated, indicating a significant cost reduction with continued implementation of biplane US probes.
Conclusion: Biplane US probes for USGPIV access in the ED setting improved patient outcomes and may result in significant cost reduction compared to single plane US probes
Biblical Literacy and the Creative Mind
Get PDFBiblical Literacy and the Creative Mind will explore interpretation tracing the history of English literature back to biblical aspirations and its continued profound influence on Western human perspectives. It will examine the decline in adults reading literary texts and the diminishing number of English majors among prospective students. I am arguing for poetic interpretations over hermeneutic ones, which analyze what is structurally in a sentence to make a reader feel a certain way. I will use the theory of intertextuality, meaning a text comprises the consumption of past texts, to aid my argument. This theory underscores the importance of celebrated and historic texts that form the basis of the Western Canon and why they should be required for readers and writers. I will explore the notion of literary authority, the Bible, and elucidate its profound significance in literature and education. Drawing on specific literary examples, I will explore interpretative engagement with texts, like the concept of close reading, symbolism, and metaphors. Many contemporary undergraduate educations have sidelined these aspects of English literary history. Ultimately, this essay will argue for grounding English literature in a common-sense poetic approach and examine how some theories can rupture the major’s prestige
Implementing Animal-Assisted Therapy During Psychiatric Intakes
Get PDFIntroduction: The purpose of this evidence-based project is to determine if Animal-Assisted Therapy (AAT) causes improvements in veterans’ feelings of anger, anxiety, depression, and suicidality in the acute psychiatric setting during psychiatric evaluations. The project aims to provide veterans with an additional way to experience short-term relief from symptoms while discussing their symptomology with mental health providers.
Background: The prevalence of depression is 20% higher in veterans than in that of the general population. Similarly, it has been shown that 23% of all veterans using VA care have had PTSD at some point in their lives. In the Psychiatric Emergency Clinic (PEC) at the VA in La Jolla, PTSD, depression, anxiety, and substance use disorder are among the most common diagnoses. These patients often struggle with mood lability, anxiety, and avoidance, making it difficult for providers to get a thorough history to guide recommendations. Utilizing animal assisted therapy (AAT) during the appointment may put patients at ease and provide a comforting distraction when discussing emotionally triggering subjects.
Methods: This project evaluates self-reported feelings of anger, anxiety, depression, and suicidal urges in 15 veterans both immediately before and immediately after a psychiatric intake where AAT took place. Using the Brief Mood Survey, veterans rated their symptoms in each category on a scale of 0-5. The Brief Mood Survey (BMS) was utilized to determine baseline pre-intervention mood scores, and a post-intervention survey was administered to determine the efficacy of the intervention when compared to baseline.
Results: The BMS scores, which included 5 subscales per category for depression, anger, and anxiety and 2 subscales for suicidal urges, were used to evaluate the efficacy of AAT during psychiatric intakes. The results showed improvements in post-intervention scores compared to pre-intervention scores in all categories, with the most significant improvements seen in the areas of anger and suicidal urges.
Evaluation: The marked improvements that were observed in all mood categories on the BMS suggest that AAT is effective as a supplemental intervention for utilization during psychiatric intakes in the acute psychiatric setting
The Lopsided Law of Medical Conscience
Get PDFWe’re used to hearing about conscientious refusal: when physicians or pharmacists deny services they deem sinful or wrong, in violation of hospital policies or malpractice laws. Less familiar is conscientious provision: when clinicians supply care that their employer or state restricts. America’s conscience regime often protects refusers categorically: they get conscience without conditions or consequences. But doctors with heartfelt reasons to supply care their institution or government forbids? For them, conscience is no defense.
This radical asymmetry is indefensible and unjust. Both refusers and providers resist workplace rules and legislative directives at odds with their sincere moral convictions. Both sometimes appeal to religion, and conscience clauses protect secular claims just the same anyway. Nor is the conscientious delivery of routine medication and many other treatments that much more expensive for third parties to accommodate, compared with the cost that exempting such care’s conscientious denial incurs to businesses and colleagues left to fill in the gaps, and especially to patients, who might not be able to access treatment elsewhere in the face of widespread refusals.
Conscience protections shouldn’t be absolute for refusers and absent for providers. There may be practical or expressive reasons to treat certain service denials differently than certain expressions of conscience to deliver care. But the same basic commitments should govern the measure of space that a principled regime affords to each. Legal protections for medical conscience ought to attend to the individual claimant’s moral integrity, to larger interests in social pluralism, and to the impact of accommodation on others—not simply whether a claimant would refuse care or provide it
