3,113 research outputs found
Thomas Jefferson Health System Medical Legal Partnership
Introduction: Medical-legal partnerships (MLPs) provide civil legal services in concert with healthcare services to mitigate complex social conditions with health-harming effects. Currently, there are 333 MLPs in 46 states. Thomas Jefferson Health System (TJHS) does not have a systemwide MLP. (Magee Rehabilitation Hospital does have an MLP used by qualifying Magee patients). This project sought to identify the core components of an MLP and to demonstrate the value an MLP would provide TJHS.
Methods: Assessed existing literature. Interviewed an existing MLP director. Patients from the Jefferson Hospital Ambulatory Practice (JHAP) clinic completed a written survey regarding health-harming social-legal issues. Entered survey data into Excel and analyzed using descriptive statistics.
Results: Six common core components of all MLPs were identified. Existing MLPs have demonstrated a reduction in readmission rates, decreased inpatient and emergency department visits, and recovery of payments for unreimbursed clinical services. Patients report improved health when unmet civil legal needs are addressed. Results of the JHAP clinic survey are pending, but preliminarily many patients appear to have social-legal issues.
Conclusions: This project demonstrates that a TJHS MLP program could improve patient health and reduce overutilization of the health system. Over time the cost of the program would potentially be offset by the recovery of healthcare dollars. TJHS patients appear to have social-legal issues that negatively impact their health and could be addressed through legal remedies. Based on the analysis, an Opportunity Assessment was generated. Critical next steps are to draft a business plan and identify potential funding
Innovative approaches to generational instruction: Welcoming the NeXters via the Hybrid
Students currently entering highereducation were born between 1980-2000 and are often referred to asNeXters, Millennials, or Generation Y.
An undergraduate nursing corecurriculum course was developed andimplemented using a constructivistpedagogy approach whichcharacterizes generationaldistinctiveness to optimize learningand student satisfaction
Validation and noise robustness assessment of microscopic anisotropy estimation with clinically feasible double diffusion encoding MRI
Purpose: Double diffusion encoding (DDE) MRI enables the estimation of microscopic diffusion anisotropy, yielding valuable information on tissue microstructure. A recent study proposed that the acquisition of rotationally invariant DDE metrics, typically obtained using a spherical â5âdesign,â could be greatly simplified by assuming Gaussian diffusion, facilitating reduced acquisition times that are more compatible with clinical settings. Here, we aim to validate the new minimal acquisition scheme against the standard DDE 5âdesign, and to quantify the proposed method's noise robustness to facilitate future clinical use. /
Theory and Methods: DDE MRI experiments were performed on both ex vivo and in vivo rat brains at 9.4 T using the 5âdesign and the proposed minimal design and taking into account the difference in the number of acquisitions. The ensuing microscopic fractional anisotropy (ÎŒFA) maps were compared over a range of bâvalues up to 5000 s/mm2. Noise robustness was studied using analytical calculations and numerical simulations. /
Results: The minimal protocol quantified ÎŒFA at an accuracy comparable to the estimates obtained by means of the more theoretically robust DDE 5âdesign. ÎŒFA's sensitivity to noise was found to strongly depend on compartment anisotropy and tensor magnitude in a nonlinear manner. When ÎŒFA < 0.75 or when mean diffusivity is particularly low, very high signalâtoânoise ratio is required for precise quantification of ”FA. /
Conclusion: Our work supports using DDE for quantifying microscopic diffusion anisotropy in clinical settings but raises hitherto overlooked precision issues when measuring ÎŒFA with DDE and typical clinical signalâtoânoise ratio
Impact of Opioid-Free Anesthesia Versus Opioid-Based Anesthesia on Time to Extubation: A Scoping Review
Purpose/Background
Opioids during surgery have been clinically proven to lengthen the time between intubation and post-op extubation. Increased time to extubation is associated with negative patient outcomes. This scoping review aims to evaluate the use of ketamine with opioid free analgesia (OFA) versus traditional opioid usage and its outcomes on extubation times.
Methods
From September 2021 to November 2021, we conducted a literature search using the University of Tennessee Health Science Centerâs (UTHSC) online library. Through the PubMed, CINAHL, Medline, and Cochrane databases, we identified seventy-one articles that matched our criteria. Of those articles, we selected twenty-five to undergo rapid critical appraisal (RCA). We then chose ten articles that were critically appraised and were from peer-reviewed sources. Finally, we constructed an outcome synthesis table and level of evidence table to synthesize the results of those ten articles.
Results
Ten articles were chosen for this scoping review. Nine articles show that the use of ketamine decreases the time to extubation, with five proving to be statistically significant. Four articles demonstrated a decrease in ICU length of stay in days with the ketamine-based anesthesia group. Five articles found a significant decrease in postoperative opioid consumption in the ketamine-based anesthesia group. The results demonstrate that there is evidence favoring the use of ketamine and opioid free anesthesia to decrease extubation times, decrease ICU lengths of stay, and decrease postoperative opioid consumption.
Implications for Nursing Practice
This scoping review has demonstrated that ketamine, when used as a perioperative adjunct for pain control, will reduce opioid usage and times to extubation. Implementation of routine ketamine administration should be considered in populations that may have prolonged intubation times
On Inflation with Non-minimal Coupling
A simple realization of inflation consists of adding the following operators
to the Einstein-Hilbert action: (partial phi)^2, lambda phi^4, and xi phi^2 R,
with xi a large non-minimal coupling. Recently there has been much discussion
as to whether such theories make sense quantum mechanically and if the inflaton
phi can also be the Standard Model Higgs. In this note we answer these
questions. Firstly, for a single scalar phi, we show that the quantum field
theory is well behaved in the pure gravity and kinetic sectors, since the
quantum generated corrections are small. However, the theory likely breaks down
at ~ m_pl / xi due to scattering provided by the self-interacting potential
lambda phi^4. Secondly, we show that the theory changes for multiple scalars
phi with non-minimal coupling xi phi dot phi R, since this introduces
qualitatively new interactions which manifestly generate large quantum
corrections even in the gravity and kinetic sectors, spoiling the theory for
energies > m_pl / xi. Since the Higgs doublet of the Standard Model includes
the Higgs boson and 3 Goldstone bosons, it falls into the latter category and
therefore its validity is manifestly spoiled. We show that these conclusions
hold in both the Jordan and Einstein frames and describe an intuitive analogy
in the form of the pion Lagrangian. We also examine the recent claim that
curvature-squared inflation models fail quantum mechanically. Our work appears
to go beyond the recent discussions.Comment: 14 pages, 2 figures. Version 2: Clarified findings and improved
wording. Elaborated important sections and removed an unnecessary section.
Added references. Version 3: Updated towards JHEP version. Version 4: Final
JHEP versio
Inflation with Non-minimal Gravitational Couplings and Supergravity
We explore in the supergravity context the possibility that a Higgs scalar
may drive inflation via a non-minimal coupling to gravity characterised by a
large dimensionless coupling constant. We find that this scenario is not
compatible with the MSSM, but that adding a singlet field (NMSSM, or a variant
thereof) can very naturally give rise to slow-roll inflation. The inflaton is
necessarily contained in the doublet Higgs sector and occurs in the D-flat
direction of the two Higgs doublets.Comment: 13 pages, 1 figur
- âŠ