Showing items related by title, author, creator and subject.

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  Implementing a Mobility Scale to Increase Postoperative Mobility Levels

  Marasa, Mary C.; Bundy, Elaine Y. (2021-05)

  Problem: Gynecologic oncology treatment plans often involve invasive surgeries that put patients at risk for complications and long hospital admissions. Enhanced Recovery After Surgery protocols improves outcomes for gynecologic oncology patients, especially when patients are compliant with getting out of bed on postoperative day zero. At an urban Mid-Atlantic hospital, 3% of gynecologic oncology patients got out of bed on postoperative day zero and the average length of stay was 2 days between February 2018 and January 2020. Delaying postoperative mobility increases the risk for longer hospital stays. Purpose: The purpose of this quality improvement project is to implement the Johns Hopkins Highest Level of Mobility (JH-HLM) scale with defined goals to increase postoperative mobility levels and decrease the length of hospital stay for postoperative gynecologic oncology patients. Methods: Quantifiable mobility goals were defined for postoperative patients based on the JH-HLM scale. The nursing staff was educated about the mobility goals and JH-HLM scale through unit presentations, email communication, and annual competencies. Mobility documentation was standardized in the electronic health record. Education materials were disseminated to the inpatient oncology unit, post-anesthesia care unit, rehabilitation department, and patients. Patient age, diagnosis, type of surgery, mobility levels, and length of stay were collected through chart reviews for 3 weeks before implementation and during the 12-week implementation period. Run charts were used to analyze the data. Results: Results showed that average mobility documentation increased (10% to 46%). There was an increase in mobility levels on postoperative day zero (6% to 33%) and by discharge (13% to 45%). The average length of stay during the 3-week pre-implementation period was 1.6 days and after implementation it was 1.8 days. These results were not statistically significant. Conclusion: Findings suggest that quantifying and standardizing mobility goals may increase postoperative mobility levels. However, more investigation is needed to demonstrate statistical significance. Length of stay was not decreased and was likely impacted by a variety of factors. Further investigation of improving mobility documentation, decreasing data variability, and increasing compliance is warranted.
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  Mobile Element Discovery and Activity in Human Populations and Diseases

  Gardner, Eugene James; Devine, Scott E. (2017)

  Approximately 45% of the human genome is occupied by Mobile genetic Elements (MEs). Small subsets of these are still active and belong to three different families: L1, Alu, and SVA. These active families can generate new copies known as Mobile Element Insertions (MEIs), which can be polymorphic in humans. There remain several open- ended questions as to which MEs are generating the vast majority of new MEIs, and if they are in fact active prior to, and can initiate, tumorigenesis. To investigate active MEs in these two scenarios, I designed a computational algorithm to find polymorphic MEIs in human whole genome sequencing (WGS) data: the Mobile Element Locator Tool (MELT). As part of the 1000 Genomes Project (1KGP), I used MELT to discover over 22,500 polymorphic MEIs. Using this data in combination with Neanderthal, Denisovan, and Chimp WGS, I investigated the population dynamics of ME activity in the great ape lineage. To evaluate the possibility of L1 playing a dynamic role in cancer tumorigenesis, we screened ten colorectal cancer cases for somatic L1 activity. In one of these cases, we discovered a somatic L1 insertion into the tumor suppressor gene APC, causing this particular cancer case. Follow-up studies revealed that a population-specific L1 element was responsible for the generation of this insertion, and was active in the normal soma. Overall, through the development of new computational and sequencing tools, my work demonstrates that distinct families of MEs are generating the majority of new MEIs in human genomes, that a subset of these elements are stratified by population, and that somatically active L1s can initiate cancer.
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  Symposium on Home and Community Based Care 2023, 6th Annual: Implementing Mobile Text-messaging to Improve Well Visit Rates in Early Head Start Programs

  Kirwin, Martine; McGinty, Kelsey; Clemence, Meagan (2023-04-17)