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Dental Caries Screening for Food Insecure Children
Full text linkBackground. Dental caries is the most common childhood disease, disproportionally impacting minorities, and socio-economically disadvantaged children. Food insecurity impacts 23.6% of children in Texas; the majority being African American and Hispanic. Food insecurity screening rates are abysmal. Dental caries and food insecurity are significantly correlated and likely syndemic. Purpose. Implement oral examination and the “Hunger Vital Sign” screening tool in detecting dental caries and food insecurity at an urban pediatric urgent care center. Evidence. Food insecure children experience adverse health outcomes, impaired long-term health outcomes, developmental and cognitive delays, psychosocial delays, and oral health deficiencies including caries and malabsorption of nutrients. Objectives. Screen 75% of patients seen at a local urgent care center for food insecurity. 100% of patients screening positive received an oral examination. Written mitigation strategies would be provided for all patients screening positive. Methods. The validated Hunger Vital Sign was utilized to screen for food insecurity and an oral exam was performed by a licensed, board-certified Pediatric Nurse Practitioner for those patients screening positive. Results. Results revealed an 88.2% screening rate (135 patients out of 153 total patients), 31.8% positive food insecurity rate and 76.7% dental caries co-morbidity rate. Mitigation strategies were deployed for 100% of patients screening positive. Implications. Dental caries and food insecurity screening can be accomplished at any level of pediatric care. Mitigation strategies can improve oral health in children and provide food resources for families
Preserving the Force: A Quality Improvement Project to Reduce the Risk of Opioid Use Disorder in the Military
Full text linkMilitary service members incur combat and noncombat related injuries which may lead to acute or chronic pain. Treatment of these conditions with opioids may place them at risk for opioid use disorder (OUD). Opioid related overdoses among the military community increased by 50% from 2010 to 2019. The Sole Provider Program (SPP) is recommended to address the risks of OUD among Veterans receiving care at military installations. The goal of this evidence-based project was to ensure that all persons who receive opioid prescriptions at a military facility were evaluated for inclusion into a SPP and prescribed naloxone. Objectives included: 1) Develop policy to outline the SPP program and staff/provider roles. 2) Use the Analyze Prescription Monitoring Program Utilizer Report to identify patients who meet SPP criteria. 3) Develop educational materials and educate clinic staff and providers on the SPP. 4) Educate patients on SPP, pain management and naloxone use. The Plan Do Study Act model was used to implement the evidence-based quality improvement project. Project outcomes are as follows: 1) SPP policy approved at all levels. 2) 43 patients alerted as high risk for OUD, 11 recommended for SPP, 19 required naloxone prescriptions. 3) Patient educational materials developed and approved. 4) 45% of providers trained, education adopted and uploaded to virtual platform for mandatory completion. Advanced Practice Registered Nurses manage and prescribe opioids in the military setting and should play a key role in development and implementation of the SPP
Improving Post-Discharge Engagement of Mental Health Patients in the Veterans Affairs South Texas Healthcare System
Full text linkDischarge from a hospital is a high-risk period for mental health patients, as 20% experience an adverse event within 30 days of discharge. Poor discharge engagement can lead to complications for recovery, which include an increased risk for readmissions, longer length of stay, increased risk for suicide, and death. Hospital stays cost the United States $377.5 billion dollars per year; there is pressure for hospitals, health plans, and providers to examine the admission and discharge processes to improve healthcare delivery, transition of care, and patient health outcomes. At a South Texas VA, 67.66% of mental health patients attended all their discharge appointments, far below the VA’s national benchmark of 85%.
To improve post-discharge engagement, an interdisciplinary, quality improvement project was conducted on the inpatient mental health units at one of two VA hospitals in South Texas from May 2023 through July 2023. A review of literature identified best practices regarding the discharge of mental health patients as engagement of patients, families, and/or support persons; clinician communication along the transition of care, administration of long-acting injectables, and the utilization of Peer Support Specialists (PSS). After 11 weeks of implementation, data on 62 inpatient charts showed a 3% increase in PSS referrals and an overall 5% increase in post-discharge engagement for FY-23 Quarter 3. The results of the project promote quality care by increasing knowledge on evidence-based practices that support effective discharge planning. Results may also ameliorate the potential adverse events experienced by mental health patients post-discharge and decrease healthcare costs
The Impact of COVID-19 on Hispanic Restaurants in South-Central Texas: A Qualitative Study
Full text linkResearch Focus. The COVID-19 pandemic generated a major crisis for the restaurant industry in 2020 and 2021. The nationwide shutdown resulted in widespread restrictions on social gatherings, significantly impacting this industry. Hispanic businesses were not immune to this crisis, and its impact had profound effects on small businesses.
Most of the research in this field has primarily concentrated on small businesses and entrepreneurship under favorable circumstances, highlighting factors such as entrepreneurial drive, maximizing profits, taking risks, developing ideas, and promoting fair competition. Consequently, the current body of research is insufficient and fails to address the specific experiences of minority small business owners in South Central Texas during a crisis, such as a pandemic.
This phenomenological study aimed to investigate how Hispanic small business restaurant owners in South Central Texas experienced the pandemic and what strategies they implemented during this crisis. The study utilized the Organizational Learning Theory and Protection Motivation Theory as theoretical frameworks to better understand the effects on operational and financial aspects during COVID-19 and what actions these small businesses implemented to survive during the pandemic.
Research Method. The study postulated three research questions. The first question asked, What were the most common motivational drivers that were the catalyst for Hispanic small business restaurant owners to remain open during the COVID-19 pandemic?” The second question addressed the following: What were the most common organizational learning factors that influenced Hispanic small business restaurant owners during the COVID-19 pandemic? The third and final question asked, What financial resources and operational strategies do Hispanic small business restaurant owners use to adapt during a crisis such as the COVID-19 pandemic? The participants were taken from a selective sample of Hispanic business owners from various markets across South Central Texas (Bexar County, Comal County, Guadalupe County). Ethical acquisition of narrative data was ensured through one-on-one semi-structured interviews with each participant and analyzed using NVivo software. An analysis of the strategic leadership used during the pandemic resulted in five themes. Seven additional themes were revealed when examining the experiences Hispanic small business restaurant owners faced during the COVID-19 pandemic.
Research Findings. The study’s findings assert that many Hispanic small business restaurant owners were able to navigate the stressful circumstances brought about by the pandemic, in large part due to the support received from the community. The primary factor that influenced Hispanic-owned restaurants during the COVID-19 pandemic was their ability to adjust to difficult conditions to sustain their operations. The study revealed that restaurants that successfully modified their operations to mitigate the pandemic\u27s effects were able to continue their business activities.
Conclusions From Research. The study’s findings validate the theoretical framework that Hispanic small business restaurant owners adapted to the challenges of COVID-19. They achieved this by recognizing motivational factors, incorporating organizational learning elements, and implementing operational strategies to sustain their operations. The study highlights the crucial role of financial resources and adaptable and proactive operational strategies to continue operations during a crisis such as a pandemic. This study provides valuable insights into the comprehensive nature of crisis management for small businesses, particularly by exploring the motivations of restaurant owners to survive during challenging times. The findings of this study have the potential to assist small business restaurant owners in acquiring knowledge and formulating sustainable business strategies
Understanding the Significance of Building a School in Belize Through Action Research
Full text linkResearch Focus. In Central America, the country of Belize shares its border with Guatemala and Mexico. These countries, with El Salvador and Honduras, are known as the most dangerous areas in our world outside active war zones (Dudlry, 2012; Edwards & Gill, 2002; UNODC, 2019). Crime is the largest contributor to instability in the region and creates a dangerous environment that must be reduced. Reduction of crime can correlate to an increase in available educational opportunities (Edwards, 2002; OSAC, 2019). The U.S. government conducts foreign humanitarian programs that increase educational opportunities in hope of reducing crime and stabilizing the region (Foreign Humanitarian Assistance, 2019). The humanitarian assistance program builds schools to increase educational opportunities in remote areas. Minimal research exists from the stakeholders’ point of view on the significance of building schools in remote areas. Research Methods. Utilizing the stakeholders\u27 point of view, this qualitative action research study was designed to help community and international stakeholders improve the school building process. Leavy (2017) and Stringer (2014) explained that qualitative methods are useful for understanding and explaining individuals\u27 experiences as they happen. Herr and Anderson (2015) agree that qualitative methods are appropriate for obtaining an in-depth understanding of the phenomena from personal experiences. The research design was centered on action research. Action research is a qualitative research method that seeks to understand complex dynamics involved in social context (Stringer & Aragón, 2021). This research study followed an international non-profit organization, Global Aid Consultants, and stakeholders through a new school building process in a remote area of Belize. The 20 research participants included parents, school faculty, community leaders, and international stakeholders of the school building process. The research data was collected through interviews, photographs from the research site, and key documents. The collected data was analyzed using grounded theory thematic analysis (Charmaz, 2014; Miles, Huberman, & Saldaña, 2020). Document photography (Margolis & Pauwels, 2011; Wang & Burris, 1997) and Feminist Theory (Code, 201) were used as guides throughout the study. Research Results/Findings. The thematic analysis method was used to analyze the data using the grounded theory. The three data sources of interviews, photographs, and documents were analyzed. The data analysis procedures were framed in four steps to better understand the research questions. The four steps were (1) identifying codes in the data, (2) creating categories of codes, (3) reviewing the categories and synthesizing them to generate themes through analytic memoing, and (4) applying the emerging themes to the research questions. The analysis identified over 600 codes that were grouped into 30-35 categories that emerged from the data. The categories were synthesized and merged into seven themes. The seven themes were applied to the research questions. The first research question, “How do the stakeholders perceive (feel, view, act) the new school?” was answered with the themes of “Motivation for School” and “Safe Learning Environment.” The second research question, “From the stakeholders’ perception, how did building a new school impact the community?” was answered with the themes of “Creates Opportunities,” and “Grows the Community.” The last research question, “From the stakeholders’ perception, how can the school building process be improved?” was answered with the themes of “Partners are Needed,” “Schools Cost Money,” and “Communication is Key.” These emerged themes were supported by the research data, literature, and my philosophical worldview. Conclusions From Research. This research study highlighted insights into understanding the process of building a new school in Belize and its immediate impact on the local community. After careful reflection and interpretation of the findings, two key theoretical models emerged. Both theoretical models were generated from insights grounded in my research using real world data (Charmaz, 2014) and from feminist theory which helps those who are marginalized to be heard (Code, 2014).
In the first model, key concepts for building a school, it was found that to build and complete a school it takes partners with resources who communicate together in an environment they support to create developmental change. Developmental change occurs when stakeholders assist communities to develop the capability and capacity to address a problem. For example, in this research a new school was built that increased the outlook for the community. The new school building process requires many stakeholders with unique skills and monetary assets to complete the project. Moreover, the community’s involvement and investment in the process is necessary. Each of the key findings of building a school were found to have a supporting relationship to each other.
The second key concept was the school’s immediate effect on the community model. How does the new school impact the community is one of the most frequent questions asked by others, including stakeholders. According to the research, the local, national, and international stakeholders believe the new school provided a “safe learning environment” where the community is “motivated for school” that “creates opportunities” and “grows the community.” To increase the success of the new school, it was important for the community to develop motivation to utilize its full potential. Motivation is an integral part in education and a key component in learning; however, the environment must be available. A safe and secure environment in a community that has the infrastructure to support education will ensure the creation of new opportunities. Role models, teachers, and peers introduce students to new opportunities and ideas that otherwise would not be available. The newfound opportunities can lead to economic growth and rewards for the person and community. The new school is a good example of creating something through a common vision where the community has grown both physically and intellectually from the school building process. It takes parents, teachers, principals, practitioners, policy makers, and government agencies at the local, national, and international levels to make a project like this possible
The Importance of Contrast Sensitivity, Color Vision, and Electrophysiological Testing In Clinical and Occupational Settings
Full text linkVisual acuity (VA) is universally accepted as the gold standard metric for ocular vision and function. Contrast sensitivity (CS), color vision, and electrophysiological testing for clinical and occupational settings are warranted despite being deemed ancillary and minimally utilized by clinicians. These assessments provide essential information to subjectively and objectively quantify and obtain optimal functional vision. They are useful for baseline data and monitoring hereditary and progressive ocular conditions and cognitive function. The studies in this dissertation highlight the value of contrast sensitivity, color vision, and cone specific electrophysiological testing, as well as the novel metrics obtained with potential practical clinical applications for visual function and perception evaluation in patients in various settings.
The first study aimed to design a clinically expedient method to combine color CS and color naming (CN) into a single, multi-metric test of color vision, the Color Contrast Naming Test (CCNT). This was accomplished by comparing and validating it with the standardized computerized Cone Contrast Test (CCT; Innova Systems, Inc.). Color vision deficient (CVD) and color vision normal (CVN) findings showed a strong correlation between the CCNT CS and the standard CCT. Furthermore, CCT CS showed distinct scores in 50% of CVDs, while the CCNT composite score (mean of CS and CN) showed distinct scores in 70% of CVDs, showing better potential discrimination of CVD color abilities. This novel metric has potential applications for identifying hereditary or progressive CVD severity and capabilities.
The second study focused on electrophysiological diagnostics, specifically cone specific visual evoked potentials (VEPs), to objectively measure long-term neural adaptive responses to color-correcting lenses (CCLs). Dr. Werner and colleagues determined that extended wear (for 12 days) of color-correcting lenses improved red-green color perception in hereditary CVD even without wearing CCLs. Furthermore, Dr. Rabin and colleagues were able to objectively measure both immediate short-term (baseline, 4, 8, 12 days) and long-term (3, 6, 12 months) improvements of color perception status post-CCL removal with cone specific VEPs – something that has never been done before. The novel findings from both studies support the notion that neural adaptive changes can occur over short- and longer-term periods despite minimal daily wear time. More importantly, this further supports the value of suprathreshold cone VEPs to objectively assess color vision function in both clinical and occupational settings.
Most dry eye studies use measures of tear quality and volume coupled with standard clinical tests such as high contrast visual acuity (VA), while fewer studies have investigated the effects of dry eyes on low contrast vision. The final study was designed to determine the impact of Meibomian Gland Dysfunction (MGD) dry eye on high and low-contrast vision, including both black/white (luminance) and cone specific color vision. A primary intent was to determine if these novel metrics improved following minimal meibomian gland (MG) expression. The computerized CCNT and CCT (cone and black/white) tests used in this study confirmed that minimal MG expression improved low contrast performance for long (L cone) and short (S cone) wavelength-sensitive cones. These improvements were most significant using throughput (CS/response time) and CCNT composite scores, both novel metrics for potential use in dry eye diagnosis, treatment, and management. Physical optics, including decreased destructive interference in the stroma, most detrimental with red light, and increased scattering by subtle epithelial, endothelial, and/or tear film defects, most detrimental for blue light, could each decrease retinal image contrast most evident with L and S cone CS.
Contrast sensitivity, color vision, and cone specific electrophysiological testing are non-optimally and infrequently utilized in basic, clinical, applied, and translational research or occupational settings. These studies showed provocative results within their respective categories and confirmed their validity and importance for identifying and monitoring ocular conditions and neural adaptive or cognitive functions. Furthermore, novel metrics such as throughput and CCNT composite scores serve as potential tangible and practical visual function and perception assessment standards
Program Development and Expansion of a Clinician-Driven Wound Care Program at an Outpatient Wound Care Center
Full text linkProblem. Patients with chronic wounds often present with additional physical and emotional problems because healing of chronic wounds may require months to resolve. Practitioners develop treatment plans based on their own training and clinical expertise, but unfortunately, there are no universal guidelines to inform the management of chronic wounds. Expanding multi-factorial assessments and interventions could improve patient outcomes. The purpose of this project was to implement a wound care protocol for outpatient wound care clients based on a nutritional and psychological self-assessment. Methods. A patient-completed checklist, done on arrival to the clinic, triggered clinician-driven protocol interventions addressing mental health and nutritional needs. Data comparisons of the before-and-after intervention included the scores of the Wound-QoL-14 subscale \u27 Psyche\u27, the scores of Mini Nutritional assessment (MNA), and wound sizes. For evaluating the outcomes of before-and-after intervention, the Wilcoxon signed-rank test was used to analyze the scores of subscale Psyche and the scores of MNA. Wound sizes were analyzed using the paired-sample t-test. Results. Forty-one patients were involved in this project. Approximately 50.5% and 46.3% of patients were identified at high psychological and nutritional risk, respectively. After 4 weeks, comparisons of before and after intervention scores demonstrated statistically significant improvement in both the psychological and nutritional subscales. Additionally, there was a significant decrease in wound sizes. Conclusion. With an increasing volume of patients seen in this facility, clinician tools can help streamline the assessment of factors that caused poor wound healing. Assessment tools that trigger clinician-driven interventions support the standardized application of evidence-based care recommendations
A Quality Improvement Project to Screen for Food Insecurity in Adults With Anxiety or Depression
Full text linkBackground Food insecurity is the limited availability and inconsistent accessibility of healthy foods (Coleman-Jensen et al., 2022a). Food insecurity contributes to mental health problems. Individuals with food insecurity have greater odds of screening positive for depression and anxiety (Wolfson et al., 2021). The Hunger Vital Sign™ screening tool is a 2-questions evidence-based tool used to identify food insecurity (Hager et al., 2010). Purpose. Implement the Hunger Vital Sign™ tool at a non-profit behavior health clinic to identify food insecurity in adults who screened positive for anxiety or depression, offer resources for them to obtain nutritious food, and provide additional information on healthy foods to clients with chronic conditions. Interventions. 1) educate stakeholders on the Hunger Vital Sign™ tool, 2) screen clients with symptoms of anxiety or depression for food insecurity, 3) provide resources for nutritious foods to clients who screen positive, and 4) provide information on healthy living to clients with chronic conditions. Outcomes. Screening for food insecurity increased from zero to use in all clients with signs of depression or anxiety. All but two of the five objectives for this project were met. The project revealed that of the clients who screened positive for food insecurity, 71.43% also suffered from anxiety or depression. Implications for Practice. This initiative can improve mental health outcomes by reducing food insecurity using an evidence-based screening tool and providing resources for clients to access nutritious and inexpensive food to help them live healthy lives
Lyme Disease Neuroretinitis: A Case Report and Review of Immunologic Workup
Full text linkBackground: Lyme disease is an infection caused by a bacterial spirochete of the borrelia genus. The human vector is from a tick bite by an infected tick of the ixodes genus, commonly referred to as the deer tick or black legged tick. The incidence of Lyme disease is increasing in the United States. Once infected, Lyme disease manifestations usually depend on the stage of infection with late stage infection often causing debilitating illness.1
Case Report: Neuroborreliosis refers to borrelia, causing neurological infection and can occur as acute or late manifestation of Lyme disease. Neuroretinitis is a rare but reported manifestation of neuroborreliosis. Lyme diagnosis requires a two-step serologic test to meet CDC guidelines for Lyme confirmation.1 Testing may be negative early in disease but may turn positive as the disease progresses.
Conclusion: Presented is a case where treatment decisions were made based on equivocal Lyme testing results
“No Ways Tired”: Exploring the Lived Experiences of African American Women Who Pursue Their PhD After the Age of 50: An Interpretive Phenomenological Analysis
No full textResearch Focus. Historically, African Americans are an underrepresented group in higher education. Since the groundbreaking court decision in the case of Brown vs. Board of Education (1954), African American women have fought to have their voices heard and their presence validated on their own terms, particularly in higher education (Collins, 2009). African American women are often unseen in colleges and universities (Zamani, 2003). In recent years, research has revealed great strides in African American enrollment at every level of higher education. According to NCES (2018), African Americans are more likely to receive doctorates at the age 41 or older and African American women represented 66% of all African American doctorate degrees earned. Although there is a significant increase of African American women returning to pursue a PhD after 50, their lived experience is under-researched and largely unknown.
The purpose of this qualitative study was to explore the lived experiences of African American women who pursue their PhD after the age of 50 at a 4-year, faith-based institution of higher education in the southwestern region of the U.S. Black Feminist Thought (BFT) and intersectionality provided the appropriate framing to help understand the complexities of negotiating multiple intersecting identities as the women navigate agency within their academic environment. BFT specifically speaks to the importance of giving voice to the African American women who are often unseen, unheard, and undervalued as legitimate theorists and producers of knowledge (Collins, 2009). Intersectionality provided insight on the complexities of the multiple and intersecting identities of race, gender, and age. A few concepts from endarkened feminism contributed to the historical space that honors the wisdom and spirituality of women of the African diaspora, and the adult stages of human development added insight and deeper understanding of how age plays a significant role in the life shifts of older, African American in pursuit of their PhD later in life.
Research Methods. A qualitative study was an appropriate fit to gain greater understanding of African American women who chose to participate in this advanced academic endeavor at this time in their lives. Creswell and Creswell (2018) asserted that a qualitative approach is useful “if a concept or phenomenon needs to be explored and understood because little research has been done on it or because it involves an understudied sample” (p. 19). I used purposeful sampling to identify four participants who self-identified as an African American woman, at least 50 years old, born and raised primarily in the U.S., and currently pursuing their PhD or completed their PhD within the past five years at the time of this study. To gain a rich, detailed, first-person account of how each participant makes sense of their experiences and the meaning they ascribe to them, I utilized Interpretive Phenomenological Analysis (IPA) to collect and analyze data. Data collection consisted of two separate, in-depth, semi-structured interviews via Zoom web-conferencing, a pre-interview demographic questionnaire, artifact sharing, observation, field notes, memo writing, and researcher journaling. As my goal was to become immersed in each participant’s unique lived experiences, and in conjunction with IPA’s recommendation for novice researchers, I chose to manually transcribe the audio recording of the eight interviews. I continued the manual process throughout the analysis. Using IPA’s 6-step guidelines to analyze the data resulted in the emergence of 7 superordinate themes and 20 subthemes.
Research Results/Findings. Despite challenges, setbacks and tensions they encounter along their academic journey, findings revealed that African American women aged 50 and over are intentional, determined, and committed to completing their PhD program. Findings included areas concerning the importance of having a strong support network, sense of belongingness, wholeness, mentorship and collaboration, being change agents and positive role models. Findings also revealed the significance of exercising their spiritual faith, leaving an educational legacy, providing a potential roadmap for others to follow and honoring the power in and of the PhD process. In addition, based on their personal lived experiences, participants shared perspectives on how the institution might improve on current support structures going forward, particularly for its older, female African American PhD students.
Conclusions From Research. Extant literature suggests that when non-Historically Black Colleges and Universities strive to understand the underlying complexities experienced by older, female African American students, it opens opportunities to provide support that helps enable their academic success. Conducting this qualitative research study from the perspective of the women who are experiencing the phenomenon greatly expands and enhances academic literature. This study adds to the limited body of research specific to this subpopulation, contributes to a greater understanding of their lived experiences as PhD students and expands the knowledge base on how this subpopulation constructs meaning associated with those experiences in academic spaces. Findings from this study could potentially assist university efforts in facilitating the success of this subgroup as well as contribute to recruitment and enrollment strategies specific to this growing subpopulation