Doctor of Philosophy

dissertationFunctional vitamin B12 (cobalamin) deficiency is a subtle, progressive clinical disorder affecting 6-23% of elderly adults. Its symptoms, including fatigue, mood disturbances, and decreased strength, are vague and erroneously attributed to aging. Detection of cobalamin deficiency in elderly adults is confounded by clinical heterogeneity and lack of standardization in metabolic tests. Whereas some patients are asymptomatic with slightly altered metabolite profiles, others develop severe clinical outcomes. Better understanding of biologic factors contributing to cobalamin deficiency heterogeneity in older adults is needed. This is a candidate gene association study evaluating the relationship between genetic variation in the cobalamin-transport molecules (transcobalamin II and its receptor) with cobalamin-related outcome parameters in 795 research participants of the Women's Health and Aging 1 and 2 Studies. Research participant DNA was whole genome amplified and genotyped using the iPLEX Sequenom mass spectroscopy platform. Relationships between genotypes and clinical parameters were assessed using two-way analysis of variance and two-way analysis of covariance, on the fixed factors, race and Single Nucleotide Polymorphism genotype. Results of the dissertation research generated several genetic associations that are useful for further hypothesis testing and clinical validation research. In the transcobalamin II gene, two missense variants were associated with homocysteine and methylmalonic acid levels (rs9621049, rs35838082), two intronic variants were associated with serum cobalamin and homocysteine levels (rs4820888, rs4820887), and one missense variant was associated with mean corpuscular volume (rs11801198). A cluster of SNPs in the promoter region of the transcobalamin II gene was associated with the physical performance parameters, hand grip strength, and walking speed. In the transcobalamin II-receptor gene, a missense coding SNP (rs2336573) was associated with mean serum cobalamin concentrations. Scientific advances responsible for the technology used in this dissertation are being incorporated into healthcare. The tailoring of treatment to an individual's genetic make-up is termed Personalized Medicine. To assist nursing professionals in understanding and preparing for use of these technologies, four elements of Personalized Medicine are reviewed, including 1) discovery of novel biology that guides clinical translation mechanisms, 2) genetic risk assessment, 3) molecular diagnostic technology, and 4) pharmacogenetics and pharmacogenomics. Opportunities for nursing profession engagement are addressed

Precision health: A nursing perspective

Precision health refers to personalized healthcare based on a person's unique genetic, genomic, or omic composition within the context of lifestyle, social, economic, cultural and environmental influences to help individuals achieve well-being and optimal health. Precision health utilizes big data sets that combine omics (i.e. genomic sequence, protein, metabolite, and microbiome information) with clinical information and health outcomes to optimize disease diagnosis, treatment and prevention specific to each patient. Successful implementation of precision health requires interprofessional collaboration, community outreach efforts, and coordination of care, a mission that nurses are well-positioned to lead. Despite the surge of interest and attention to precision health, most nurses are not well-versed in precision health or its implications for the nursing profession. Based on a critical analysis of literature and expert opinions, this paper provides an overview of precision health and the importance of engaging the nursing profession for its implementation. Other topics reviewed in this paper include big data and omics, information science, integration of family health history in precision health, and nursing omics research in symptom science. The paper concludes with recommendations for nurse leaders in research, education, clinical practice, nursing administration and policy settings for which to develop strategic plans to implement precision health

Reducing Annual Hospital and Registered Nurse Staff Turnover—A 10-Element Onboarding Program Intervention

Employee turnover is a key metric and performance indicator when evaluating the fiscal and operational effectiveness of any health-care facility. This article outlines a turnover analysis and onboarding program performance improvement initiative used by a 187-bed community hospital in the Washington DC metropolitan area to reduce staff turnover. Using an evidence-based approach, we evaluated facility staffing statistics, exit survey data, research literature, and industry exemplars. We identified presence of severe turnover for hospital and nursing staff employed less than one year (new hires), with 2009–2012 annual new-hire losses ranging from 28.8% to 49.6%. Exit survey data identified only 50% to 62% of new employees who felt that: hospital orientation provided necessary information for successful employment; they had people to go to with concerns; and they had a realistic understanding of their job. Therefore, a 10-element program intervention was designed to strengthen and standardize the new employee onboarding process. Program elements focused heavily on retooled onboarding communications, including frequent new-hire interactions with managers and regular support from assigned high-performing colleagues. Post program implementation, overall annual hospital turnover decreased from 18.2% to 11.9% and new-hire turnover losses decreased from 39.1% to 18.4.%, which was statistically significant between measurement periods (Wilcoxon signed ranks test, Z  = −2.06, p  = .04). Implementing a standardized onboarding format that was specifically tailored to support new-hire employees allowed our hospital to rapidly reverse unsustainable turnover increases. The successful reduction in hospital and nurse turnover we achieved was rooted in multidisciplinary engagement of institutional stakeholders, managerial collaboration across departments, and strong support from executive hospital leadership

Recent Advances in Systems and Network Medicine: Meeting Report from the First International Conference in Systems and Network Medicine

The First International Conference in Systems and Network Medicine gathered together 200 global thought leaders, scientists, clinicians, academicians, industry and government experts, medical and graduate students, postdoctoral scholars and policymakers. Held at Georgetown University Conference Center in Washington D.C. on September 11-13, 2019, the event featured a day of pre-conference lectures and hands-on bioinformatic computational workshops followed by two days of deep and diverse scientific talks, panel discussions with eminent thought leaders, and scientific poster presentations. Topics ranged from: Systems and Network Medicine in Clinical Practice; the role of -omics technologies in Health Care; the role of Education and Ethics in Clinical Practice, Systems Thinking, and Rare Diseases; and the role of Artificial Intelligence in Medicine. The conference served as a unique nexus for interdisciplinary discovery and dialogue and fostered formation of new insights and possibilities for health care systems advances

Recent Advances in Systems and Network Medicine: Meeting Report from the First International Conference in Systems and Network Medicine.

The First International Conference in Systems and Network Medicine gathered together 200 global thought leaders, scientists, clinicians, academicians, industry and government experts, medical and graduate students, postdoctoral scholars and policymakers. Held at Georgetown University Conference Center in Washington D.C. on September 11-13, 2019, the event featured a day of pre-conference lectures and hands-on bioinformatic computational workshops followed by two days of deep and diverse scientific talks, panel discussions with eminent thought leaders, and scientific poster presentations. Topics ranged from: Systems and Network Medicine in Clinical Practice; the role of -omics technologies in Health Care; the role of Education and Ethics in Clinical Practice, Systems Thinking, and Rare Diseases; and the role of Artificial Intelligence in Medicine. The conference served as a unique nexus for interdisciplinary discovery and dialogue and fostered formation of new insights and possibilities for health care systems advances