Background:Varying protocols among sexual assault nurse examiner (SANE) programs lead to inconsis... more Background:Varying protocols among sexual assault nurse examiner (SANE) programs lead to inconsistent patient care and indicate that evidence-based recommendations are not being utilized. To address this problem, an evidence-based treatment protocol designed to improve care provided to patients who have experienced sexual assault was implemented at an outpatient rape crisis center (RCC). In addition to implementing the new protocol, a SANE education program was provided.Methods:Retrospective chart reviews were conducted. A total of 21 protocol components were examined pre- and post-implementation of the quality improvement project. Additionally, a knowledge quiz and self-efficacy tool were administered before, immediately after, and 3 months after the SANE education program.Results:Before implementation, the overall compliance with the 21 protocol components was 42.1% for RCC exams and 17.9% for hospital exams. After implementation, the overall compliance increased to 85.3% for RCC ...
This project explored potential barriers to implementing an EMS Naloxone leave behind program in ... more This project explored potential barriers to implementing an EMS Naloxone leave behind program in the greater Chattanooga area. EMS providers were surveyed on knowledge & attitudes related to opioid use & Naloxone administration
instructed on how to utilize the video-visit application. Video visits began the day after discha... more instructed on how to utilize the video-visit application. Video visits began the day after discharge and were made every other day for a total of 2 weeks. In each visit, we assessed current medications, oral fluid intake, urine output, food intake, flatus/bowel movements, use of spirometer, daily activity, fever, and surgical wound appearance. Video call providers utilized a script designed to provide a consistent structure to each visit. Specific patient answers triggered either an intervention (done by video call providers) or a “red flag”, prompting video call providers to contact the attending surgeon for further management. The primary outcome was to assess the feasibility of post discharge video visits by number of completed calls as well as patient adherence to the post-operative care plan. Secondary outcomes were the impact upon the rate of thirty-day hospital readmission measured by comparing readmission rates to matched controls done before the study period. RESULTS: Out o...
99mTechnetium sestamibi scans (MIBI) can provide negative or inaccurate results in patients with ... more 99mTechnetium sestamibi scans (MIBI) can provide negative or inaccurate results in patients with biochemical primary hyperparathyroidism. Reliance on MIBI as a diagnostic modality rather than as a localization tool leads to misdiagnosis and inappropriate care. The aim of this study was to determine the impact of negative MIBI scans on referral patterns and surgical intervention. Adults with MIBI scans at our institution from January 1, 2011, to May 31, 2017, were retrospectively reviewed. Data collected include demographics, study date and results, ordering physician specialty, pre/postoperative laboratories, and operative and final pathology. Statistical analysis was performed with SPSS v24 (IBM Corp., Armonk, NY). Three hundred fifty-seven patients had a MIBI scan; 10 were excluded for incomplete data or incorrect diagnosis. One hundred eighty-six were interpreted as positive (53.6%) and 161 were interpreted as negative (46.4%). Of the 186 positive MIBI scans, 135 (72.6%) were see...
Utilizing our standardized approach to air leak reduction (STAR) protocol has led to a continual ... more Utilizing our standardized approach to air leak reduction (STAR) protocol has led to a continual decrease in the need for inpatient recovery following lobectomy. Although next day discharges do occur, the current literature hasn't addressed their safety. We analyzed our STAR dataset to study this group and their outcomes. A retrospective review of prospectively collected data from the STAR dataset was performed. Characteristics were compared between patients discharged on postoperative day (POD) 1 and those with longer admissions. Outcome data was analyzed. From June 2010 through June 2017, 390 patients underwent lobectomy and met study criteria. Of these, 150 (38%) were discharged on POD 1 versus 240 (62%) who were discharged later (mean LOS 3.9 days). There was no increase in morbidity, mortality or 30-day readmission between the two groups. Distinguishing characteristics of the POD 1 group included more non-smokers, use of a minimally invasive technique, and a lower incidence...
To compare perioperative outcomes in patients undergoing robotic hysterectomy and extraction of s... more To compare perioperative outcomes in patients undergoing robotic hysterectomy and extraction of specimen via mini-laparotomy (RHML) versus open hysterectomy (OH) when uterus weighs more than 250 g. To study the factors determining the length of hospital stay in 2 groups. A retrospective analysis of all hysterectomies performed for uterus weighing more than 250 g from the year 2012 to 2015 was conducted. A total of 140 patients were divided into 2 groups based on the type of surgery; RHML (n = 82) and OH (n = 58). Mini-laparotomy consisted of a customised incision connecting 2 left lateral port sites for specimen extraction after completing the hysterectomy robotically. Patient factors and perioperative outcomes were compared using Student's t tests and Chi-square analysis. Mean length of stay (RHML = 1.4 days; OH = 3.4 days), estimated blood loss (EBL) (RHML = 119.9 ml; OH = 547.5 ml) and operative time (RHML = 191.5 min; OH = 162.8 min) were significantly different. No signific...
OBJECTIVE: To assess the knowledge gaps in residents of three disciplines to both accurately diag... more OBJECTIVE: To assess the knowledge gaps in residents of three disciplines to both accurately diagnose polycystic ovary syndrome (PCOS) and use lifestyle modification counseling with adolescents who have PCOS. METHODS: A 21-question survey was administered several months before and then 2 weeks after an interactive didactic session with resident physicians in Pediatrics, Family Medicine, and OBGYN at Erlanger Health System, to assess knowledge of disease mechanism, knowledge of treatment options, focus of counseling, adequacy of resources, and potential barriers to counseling. Basic descriptive and frequency analyses were conducted on all items. EVALUATION: Most residents, regardless of specialty, did not feel confident diagnosing PCOS in adolescents and this confidence decreased after the didactic session, presumably with increased knowledge of the complexity of PCOS. Although more than two thirds of residents acknowledged lifestyle modification as first-line management, most spent ...
Background:Varying protocols among sexual assault nurse examiner (SANE) programs lead to inconsis... more Background:Varying protocols among sexual assault nurse examiner (SANE) programs lead to inconsistent patient care and indicate that evidence-based recommendations are not being utilized. To address this problem, an evidence-based treatment protocol designed to improve care provided to patients who have experienced sexual assault was implemented at an outpatient rape crisis center (RCC). In addition to implementing the new protocol, a SANE education program was provided.Methods:Retrospective chart reviews were conducted. A total of 21 protocol components were examined pre- and post-implementation of the quality improvement project. Additionally, a knowledge quiz and self-efficacy tool were administered before, immediately after, and 3 months after the SANE education program.Results:Before implementation, the overall compliance with the 21 protocol components was 42.1% for RCC exams and 17.9% for hospital exams. After implementation, the overall compliance increased to 85.3% for RCC ...
This project explored potential barriers to implementing an EMS Naloxone leave behind program in ... more This project explored potential barriers to implementing an EMS Naloxone leave behind program in the greater Chattanooga area. EMS providers were surveyed on knowledge & attitudes related to opioid use & Naloxone administration
instructed on how to utilize the video-visit application. Video visits began the day after discha... more instructed on how to utilize the video-visit application. Video visits began the day after discharge and were made every other day for a total of 2 weeks. In each visit, we assessed current medications, oral fluid intake, urine output, food intake, flatus/bowel movements, use of spirometer, daily activity, fever, and surgical wound appearance. Video call providers utilized a script designed to provide a consistent structure to each visit. Specific patient answers triggered either an intervention (done by video call providers) or a “red flag”, prompting video call providers to contact the attending surgeon for further management. The primary outcome was to assess the feasibility of post discharge video visits by number of completed calls as well as patient adherence to the post-operative care plan. Secondary outcomes were the impact upon the rate of thirty-day hospital readmission measured by comparing readmission rates to matched controls done before the study period. RESULTS: Out o...
99mTechnetium sestamibi scans (MIBI) can provide negative or inaccurate results in patients with ... more 99mTechnetium sestamibi scans (MIBI) can provide negative or inaccurate results in patients with biochemical primary hyperparathyroidism. Reliance on MIBI as a diagnostic modality rather than as a localization tool leads to misdiagnosis and inappropriate care. The aim of this study was to determine the impact of negative MIBI scans on referral patterns and surgical intervention. Adults with MIBI scans at our institution from January 1, 2011, to May 31, 2017, were retrospectively reviewed. Data collected include demographics, study date and results, ordering physician specialty, pre/postoperative laboratories, and operative and final pathology. Statistical analysis was performed with SPSS v24 (IBM Corp., Armonk, NY). Three hundred fifty-seven patients had a MIBI scan; 10 were excluded for incomplete data or incorrect diagnosis. One hundred eighty-six were interpreted as positive (53.6%) and 161 were interpreted as negative (46.4%). Of the 186 positive MIBI scans, 135 (72.6%) were see...
Utilizing our standardized approach to air leak reduction (STAR) protocol has led to a continual ... more Utilizing our standardized approach to air leak reduction (STAR) protocol has led to a continual decrease in the need for inpatient recovery following lobectomy. Although next day discharges do occur, the current literature hasn't addressed their safety. We analyzed our STAR dataset to study this group and their outcomes. A retrospective review of prospectively collected data from the STAR dataset was performed. Characteristics were compared between patients discharged on postoperative day (POD) 1 and those with longer admissions. Outcome data was analyzed. From June 2010 through June 2017, 390 patients underwent lobectomy and met study criteria. Of these, 150 (38%) were discharged on POD 1 versus 240 (62%) who were discharged later (mean LOS 3.9 days). There was no increase in morbidity, mortality or 30-day readmission between the two groups. Distinguishing characteristics of the POD 1 group included more non-smokers, use of a minimally invasive technique, and a lower incidence...
To compare perioperative outcomes in patients undergoing robotic hysterectomy and extraction of s... more To compare perioperative outcomes in patients undergoing robotic hysterectomy and extraction of specimen via mini-laparotomy (RHML) versus open hysterectomy (OH) when uterus weighs more than 250 g. To study the factors determining the length of hospital stay in 2 groups. A retrospective analysis of all hysterectomies performed for uterus weighing more than 250 g from the year 2012 to 2015 was conducted. A total of 140 patients were divided into 2 groups based on the type of surgery; RHML (n = 82) and OH (n = 58). Mini-laparotomy consisted of a customised incision connecting 2 left lateral port sites for specimen extraction after completing the hysterectomy robotically. Patient factors and perioperative outcomes were compared using Student's t tests and Chi-square analysis. Mean length of stay (RHML = 1.4 days; OH = 3.4 days), estimated blood loss (EBL) (RHML = 119.9 ml; OH = 547.5 ml) and operative time (RHML = 191.5 min; OH = 162.8 min) were significantly different. No signific...
OBJECTIVE: To assess the knowledge gaps in residents of three disciplines to both accurately diag... more OBJECTIVE: To assess the knowledge gaps in residents of three disciplines to both accurately diagnose polycystic ovary syndrome (PCOS) and use lifestyle modification counseling with adolescents who have PCOS. METHODS: A 21-question survey was administered several months before and then 2 weeks after an interactive didactic session with resident physicians in Pediatrics, Family Medicine, and OBGYN at Erlanger Health System, to assess knowledge of disease mechanism, knowledge of treatment options, focus of counseling, adequacy of resources, and potential barriers to counseling. Basic descriptive and frequency analyses were conducted on all items. EVALUATION: Most residents, regardless of specialty, did not feel confident diagnosing PCOS in adolescents and this confidence decreased after the didactic session, presumably with increased knowledge of the complexity of PCOS. Although more than two thirds of residents acknowledged lifestyle modification as first-line management, most spent ...
The development of expertise and training processes involved in cultivating a rich perceptual sen... more The development of expertise and training processes involved in cultivating a rich perceptual sense of divine presence among Evangelical Christians is a topic of recent investigation. Two key psychological factors— absorption and theory of mind—have been identified within this literature, which potentially interact to facilitate this development (Luhrmann, 2012). No studies currently exist testing the interplay between these constructs in general or their relationship outside of the Christian tradition in specific. The current study extends this research by linking these constructs with a self-report measure of mystical experience and an ethnographic description of the consecration of the Isha, Adiyogi Abode, with a group of " more spiritual than religious, " meditators and followers of the Yogi and mystic, Sadhguru (SG).
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