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A Quality Improvement Project to Increase Eye Care Screenings and Recommendations for Patients With Type II Diabetes Mellitus
Get PDFType 2 diabetes affects more than 90 million people and is a major cause of reduced vision and blindness in the United States (Lu et al., 2016). Without proper preventative measures, T2D damages the microvascular within the retina causing diabetic retinopathy (Lima, Cavalieri, Lima, Nazorio, & Lim, 2016). Despite the success of early detection and the availability of diabetic retinopathy screenings, many people diagnosed with T2D do not complete the recommended routine eye exam (Lu et al., 2016). Healthy People 2020’s (HP2020) (2016) target goal for annual dilated eye exams for patients with T2D is 58%. At baseline, only 2% of patients received eye care screenings & referrals within the host Internal Medicine clinic. The purpose of this quality improvement project was to increase the number of eye care screenings performed and referrals completed in non-WellMed patients over the age of 18 diagnosed with T2D. The primary objective was to increase eye care screenings and ophthalmology referrals and educate patients and staff regarding diabetic retinopathy. The intervention included staff training, a patient education handout, and the development of a provider protocol checklist. Between June 12 and August 4, 2017, 76 patients met the inclusion criteria. Following the intervention, 40 patients (53%) received a complete eye care assessment, 29 patients (38%) were recommended to an ophthalmologist, and 33 patients (43%) received patient education handouts. Results suggest that a combination of staff training, patient education, and assistance with the assessment and referral process can influence provider’s adherence to recommended care
Improving Vaccination Rates in Adults with Type II Diabetes in a Family Practice Setting: An Evidence-based Quality Improvement Project
Get PDFThe purpose of this evidenced-based quality improvement project is to implement processes to facilitate providers’ adherence to the American Diabetes Association (2017), American Association of Clinical Endocrinologist (2015), and American College of Endocrinology (2015) immunization guidelines for adults with type II diabetes. Presently, diabetes is the 7th leading cause of death in the United States contributing to serious complications throughout the body as a result of poor glucose control. Adults with diabetes are at increased susceptibility to infectious disease because of hyperglycemia, poor glucose control, and decreased immunity. A protocol was created using The Four Pillars Transformation Program ™ to align provider practices at a family practice clinic with recommended guidelines. Interventions aimed at improving recommended vaccination rates in adults with type II diabetes mellitus include standing orders for all immunizations, a vaccine clinic that operates simultaneously during office hours, vaccine needs screening, patient education, flyers, electronic medical record alerts, an appointed immunization champion, and quality improvement meetings. At project completion 62% of eligible patients had been screened for vaccine need and 62% received education. Ten weeks post project implementation, 64% of the eligible patients had been vaccinated with pneumococcal polysaccharide vaccine 23, 86% pneumococcal conjugate vaccine, 89% tetanus, and 54% herpes zoster. Thirty-seven out of 49 (76%) eligible patients who received education received all recommended vaccines indicating a need for continued work on staff and patient education that will facilitate patient consent for recommended vaccines
Effect of Postprandial Walking on the Glycemic Effect of a Meal: Type I Diabetes
Get PDFThis study was conducted to determine if 15 minutes of postprandial light walking has an effect on the glycemic response to a Boost® beverage in individuals with type 1 diabetes. Seven participants, 22.3 + 4.3 yrs, with type 1 diabetes completed the two days of data collection. On day 1, participants measured baseline fasting blood glucose (BG) with a glucometer, consumed a Boost® beverage, and sat quietly, repeating BG measurements 15, 30, 60, 90, and 120 minute. On day 2, participants repeated the protocol, but walked 15 minutes at a light pace (50-60% max HR) immediately after beverage consumption. The difference between peak and baseline BG was significantly lower on the walking day compared to the sedentary day (6.4 + 1.2 vs 4.0 + 2.4, respectively, P \u3c .05) as was the iAUC (468.6 + 94.5 mmol/L/120min vs 241.1 + 155.8 mmol/L/120min, P \u3c .05). In conclusion, light walking for 15 minutes postprandially can blunt the spike in BG and overall glycemic response to a breakfast beverage in young adults with type 1 diabetes
English Language Learners: English Language Proficiency Level Effect on Testing
Get PDFThe No Child Left Behind Act of 2001 served as a refueling agent for education reform. It added the mandate of Title I, which focuses on aid for disadvantaged students. NCLB mandates that states set high academic standards with quantifiable goals. This challenge has been highlighted for states because subpopulations, such as English Language Learners and students with special needs, have become focus groups in trying to bridge the achievement gap. The purpose of this correlation research study was to determine the correlation between the students’ English Language Proficiency level and their performance on the STAAR reading assessment. There was a strong positive correlation between the student’s English Language Proficiency level in reading and the student’s reading STAAR scores. ELL students with a higher English language proficiency level tend to score higher on the reading STAAR assessment
The Impact of Culture on Hispanic Entrepreneurs as Mediated by Motivation, Challenge, and Success
Get PDFIn the modern economic environment, demographic shifts in U.S. population resulting from changing immigration, changing economic policies and environments, and growing socioeconomic disparity, scholarly research examining the business behavior of specific groups and the impact of behavior on the broader marketplace is valuable and necessary. Hispanic entrepreneurs, when compared to both minority and non-minority business-owners, started and flourished in successful business ownership at a greater growth rate than any other group (Davila, Mora, & Zeitlin, 2014). Since the beginning of the 21st century, Hispanic entrepreneurs have become a measurable economic force. The cultural experience of the Hispanic entrepreneur is important to examine to understand the phenomenon of this growth. Rooted in both cultural and entrepreneurial theory, this research study identified the key cultural factors that influenced 20 Texas Latino entrepreneurial leaders and examined the impact of their cultural experience on their motivations, challenges, and successes as related to the pursuit of enterprise creation
Exploring the Educational Experiences of Students of Mexican Descent with Deferred Action for Childhood Arrivals Status
Get PDFIn 2012, an Executive Order created DACA, providing some youth with undocumented citizenship status access to post-secondary options and a way to avoid deportation. With DACA, a student population previously hidden and lacking entrée became more visible and gained ways to seek post-secondary options. The newness of this population created a lack of research about students who have experienced the transition from having undocumented to DACA immigration status. Researchers, educational practitioners, and non-profit organizations needed knowledge of how this impacted their student identity development and how they navigated education processes. This study examined the unique strategies these students used to negotiate their student experiences and how this influenced their student identity development. This study can be important for 2 reasons: (a) these students with DACA status voiced their experiences; and, (b) education practitioners, non-profit organizations, and legislators can increase knowledge of the concerns and impact DACA played on their identity formation. The purpose of this study was to describe the educational experiences of students of Mexican descent with DACA status and the impact of those experiences on the student identity development of these college students. The theoretical framework for this study was bioecological systems theory. Qualitative research methods were used with a narrative inquiry design. Data were gathered through interviews and arts-based research activities with 4 purposefully selected participants. Three layers of data analysis were used including 5 phases of data analysis, analyzing while transcribing, and the Developmental Research (DRS) sequence. This produced six domains: (1) Mexico schooling versus U.S. schooling; (2) openings versus barriers; (3) law breakers versus law followers; (4) obscured versus visible; (5) detours versus gateways; (6) dreams versus realities. Findings showed 6 strategies participants’ used to negotiate their educational experiences and form their student identity development: (1) Maintain memories of Mexico in native language and with knowledge there is no return; (2) Accept unique immigration circumstances fully and with clear cognizance; (3) Find creative ways to avoid detection; (4) Blend in until it is safe to expose undocumented status; (5) Cast aside confinements of undocumented status and enjoy new freedoms of having DACA while accepting remaining struggles; (6) Limit the scope of future planning while staying aware of precarious situation. Recommendations included 3 ways to better assist these students. Conclusions were: (1) Their educational experiences were unique due to their immigration status and the time and context; (2) Their student identity was impacted, not formed; (3) The strategies were general, yet some tactics were unique; (4) The impact on student identity was demonstrated in the strategies, an interactive process of acting upon the environment with agency; an iterative process which influenced their development
Civic Engagement and Service Learning for Medical Students: A Phenomenological Study of Transformation
Get PDFService learning is an effective academic technique that emphasizes integration of course instruction with outside community service and allows for a more enriched learning experience by promoting critical reflection. With medical students encountering a growing diversity in patients, service learning is essential in linking academic learning with their community experiences. This study was conducted at a local medical school using service learning programs in underserved communities. The purpose of this study is to understand the experience medical students had in a service learning program involved in some underserved communities. This study implemented a phenomenological research design in which semi-structured interviews were used to collect information. Spradley’s Developmental Research Sequence implemented both domain and taxonomic analysis. This study revealed that medical students were able to gain skills in leadership, clinical practice, compassion, and a greater understanding of the social realities of the underserved. Community service, serving communities, student learning and institutional support emerged as themes that contributed to student transformation. The potential of this study would provide insights that may help other medical school service learning programs contribute to developing a sense of lifelong civic engagement
Interventions to Increase Diabetes Self-Management Education Referral and Attendance
Get PDFDespite the proven benefits of diabetes self-management education (DSME), referral and attendance remains suboptimal. DSME has the ability to encourage self-care behavior, improve clinical outcomes, and improve quality of life in a cost-effective manner. The American Diabetes Association recommends that all people with diabetes receive DSME in order to facilitate the knowledge, skills, and ability necessary for diabetic self-care. The Office of Disease Prevention and Health Promotion, Healthy People 2020, set a national diabetic patient education attendance target goal of 62.5% for adults. The purpose of this quality improvement project is to increase referral and attendance to DSME in type-2 diabetic patients. Interventions included: electronic medical record modifications, educating staff on ADA recommendations/Healthy People 2020 target goals, providing information material about DSME to patients, and scheduling diabetes self-management education appointments. The project was conducted at a Northwest San Antonio family practice clinic where baseline DSME referral rate was 5.8% and baseline DSME attendance rate was 1.5%. Two-hundred eligible patient electronic medical records were retrospectively reviewed in order to determine referral and attendance rates pre-/post-intervention. Interventions took place between June 1 to July 31, 2017. Post-intervention, the average referral rate increased to 31% and the average attendance rate increased to 11%. An independent sample t-test found that interventions were statistically significant for referrals; but not statistically significant for attendance
Increasing Depression Screenings in Adults With Advanced Non-Surgical Heart Failure Using 2013 ACCF/AHA Recommendations and Healthy People 2020 Target Goals
Get PDFThe purpose of this evidence-based practice project was to increase depression screenings in adults with non-surgical advanced heart failure using reliable and valid tools, 2013 American College of Cardiology Foundation/American Heart Association recommendations, and Healthy People 2020 Target Goals as a method to identify and facilitate appropriate mental health referral, patient education, and follow-up for depressive symptoms. Interventions took place June 5, 2017, through August 10, 2017. This intervention project involving 246 adults with advanced heart failure demonstrated that an evidence-based intervention for depression screenings increased the number of patients screened from 5% to 44%. At project completion, 65% of patients received patient education, 80% were offered a referral for further evaluation, and 81% were scheduled for follow-up. Of the 108 patients screened, 30% had positive Patient Health Questionnaire-2 screenings and 16% had scored on the Patient Health Questionnaire-9 ≥ 10. The analysis of the Patient Health Questionnaire-9 demonstrated that questions 1, 3, 4, and 6 had higher rates of occurrence in a largely Hispanic population of adults with non-surgical advanced heart failure. An analysis of the data demonstrated higher rates of depressive symptoms in patients with a New York Heart Association functional class III (51%) and class C (84%). This project also found that patients with advanced-stage heart failure and depressive symptoms were younger, had higher brain natriuretic peptide levels, and lower left ventricular ejection fractions compared with studies that include all stages of heart failure
An Investigation of the Levels of Pro-Inflammation Cytokines in the Brain of Autoimmune Lewis Rats
Get PDFRheumatoid arthritis (RA) is a chronic inflammatory joint disease, which can cause cartilage and bone damage, as well as disability. A reported symptom of RA includes tissue inflammation disease and cognitive dysfunction. This study aimed to compare the concentration of selected cytokines in the cerebral cortex, hippocampus, hypothalamus, amygdala, and cerebellum of Lewis rats. Age and sex-matched Lewis rats were separated into two groups: control and adjuvant-induced RA. Twenty-eight days after the adjuvant injection, groups were sacrificed and brains dissected using the stereotaxic atlas of Paximos and Watson as a guide. Pro-inflammatory cytokines IL-1β, IL-6, and IL-23, plus the anti-inflammatory IL-10 were measured by enzyme-linked immunosorbent assays (ELISA) in tissue homogenates. The results indicate that RA increased the concentration of pro-inflammatory cytokines and anti-inflammatory cytokine IL-10 in the amygdala and cerebellum, and IL-6 also increased in the cerebral cortex, hippocampus, and hypothalamus. This data provides evidence that adjuvant-induced RA alters the inflammation status of these brain regions. The results are useful in the development of novel drug therapies for the millions of RA patients at risk of developing mood changes, memory loss, and other cognitive deficits