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Implementing The Brief Confusion Assessment Method (Bcam) Delirium Screening Tool In An Emergency Department, Carolina Van Dalen

Master's Projects and Capstones

Problem: Persons with delirium have an elevated risk of falls. Thus, falls and delirium are inextricably linked. Both should be routinely screened for older adults.

Context: A 40-bed Emergency Department (ED) in the East San Francisco Bay area of Northern California and the first site among all acute care hospitals in the organization to implement the Brief Confusion Assessment Method (bCAM) delirium scoring tool within the Electronic Health Record (EHR).

Interventions: An EHR toolkit for delirium screening using bCAM was developed, tested, and implemented in the ED.

Measures: The outcome measure was the percentage of patients with a reported fall …

Reducing Healthcare-Acquired Pneumonia In A Geriatric Long-Term Care Facility, Jacob R. Magsalin

Master's Projects and Capstones

Problem: Healthcare-acquired pneumonia (HAP) is a nosocomial infection that poses a serious threat in geriatric long-term care facilities due to its high morbidity and mortality.

Context: This evidence-based quality improvement project seeks to reduce the incidence of HAP in a geriatric long-term care facility in the San Francisco Bay Area by utilizing findings

from existing literature.

Interventions: Key interventions include improving and standardizing oral care techniques and promoting education on HAP prevention to allow patients and their families to be more proactive in preventing this complication.

Measures: Outcome measures include HAP diagnosis rates after implementation, any costs saved for the …

Development Of A Haptic System For Robot-Assisted Femur Fracture Surgery, Fayez H. Alruwaili

Theses and Dissertations

Robot-assisted surgery has emerged within the field of surgical technology, driven by the need for greater accuracy and speed in the ongoing evolution of healthcare. This advancement has influenced numerous areas requiring enhancements to achieve optimal surgical results. However, surgical robotics tends to lack the surgeon’s connection to the operation, creating a gap in the intuitive skill set required for successful operations. The gap is seen through the lack of sense of touch, which may result in tissue damage and additional injury when the robot interacts with the patient. Furthermore, challenges faced during femur fracture surgery have positioned robot-assisted surgery …

Reclaiming Healing Spaces: A Phenomenological Study On The Transformative Power Of Outdoor Therapy From The Lived Experiences Of Black Clinicians Working With Black Clients, Lynn Murphy

Dissertations

This phenomenological study involved assessing the experiences of Black therapists who engaged Black clients in outdoor therapeutic contexts. The study was founded on the existing literature that shows the quality of the therapeutic relationship is pivotal for client retention and the Western standards that have historically favored treatment within indoor environments. To contextualize this research, a comprehensive literature review was commenced, covering topics such as the decolonization of therapy, the historical and present-day relationship between Blacks and the outdoors in the United States, sedentary lifestyles, the psychological benefits of time spent in nature, various types of outdoor therapy, and the …

Infertility’S Impact On Couples’ Functioning, Elizabeth Sanders

Dissertations

Historically, infertility has been a taboo topic of discussion and is often avoided in conversation because of the stigmatization of the diagnosis. According to the World Health Organization (2022), infertility affects 186 million individuals globally. However, there seems to be a gap in the research as it pertains to the psychological well-being and treatment of men and women diagnosed with this condition. While it has become less of a feared topic, it still is not discussed or researched enough, thus further exacerbating the gap in research on mental health and treatment options. The following dissertation completed a critical review of …

Stability Of Long Multiple-Rod Constructs And Dual-Rod Constructs In The Thoracic Spine: A Biomechanical Cadaveric Study, Brandon J. Herrington

Electronic Thesis and Dissertation Repository

Spinal fusion to correct spinal deformity is typically performed with a 2-rod construct spanning the targeted area of fusion. More evidence is starting to emerge around the utility of multiple-rod constructs (typically 3 or more rods) to increase the stiffness and stability of a spinal fusion construct. Much of this work has focused on the lumbar spine, and little has been published around how these constructs behave in a long construct spanning the thoracic spine. The purpose of this thesis is to compare the stability of a two-rod (dual-rod) construct (DRC) to a four-rod (multiple-rod) construct (MRC) in cadaveric thoracic …

Teaching Advanced Surgical Technique Using Peer-Reviewed Multimedia: An Assessment Of Technical Competence In Cadaveric-Based Simulation, Pocharapong Jenjitranant

Electronic Thesis and Dissertation Repository

Nerve-sparing Retroperitoneal lymph node dissection (RPLND) is a complex and rare surgical procedure where trainees have limited exposure. We have created facilitator-led video learning material to teach this procedure. Ten urology trainees were tasked with performing one-half (unilateral portion) of a nerve-sparing RPLND on human cadavers before and after watching the video material. Their surgical performance was assessed quantitatively and video-recorded for further qualitative assessment by a blinded expert surgeon.

All measurements showed significant improvement after the exposure to the intervention. This included the percentage of lymph node mass resected, mean total OSATS global rating and procedure-specific scales as well …

Interventional Radiology's Exploration Into Artificial Intelligence, Raymond Nguyen

Master's Projects and Capstones

Background: Artificial intelligence (AI) has become more prominent in our daily lives in recent years. This includes various aspects of healthcare. Interventional radiology (IR) is one of these specialties that has taken strides in understanding how AI can be leveraged for patient care. This literature review aims to understand what areas will be most impacted by AI in IR and how it will influence both the patient and interventional radiologist.

Methods: Twenty-six publications from 2019-2024 were selected from PubMed and Scopus. Publications were sourced through a combination of keywords, subject headings (MeSH terms), and citation searching.

Results: This literature review …

Trauma Systems In Canada: Evolution, Challenges, And Strategies For Improving Trauma Care For Rural Patients, Richard C. Chaulk

Electronic Thesis and Dissertation Repository

This thesis explores the development and current state of trauma systems in Canada, emphasizing the challenges and disparities faced by patients who are injured in rural areas. With trauma being the leading cause of death for Canadians under 40, effective trauma systems are crucial. However, patients injured in rural and remote areas face significant barriers to timely and adequate trauma care, resulting in increased morbidity and mortality. This body of work aims to evaluate some of these disparities and propose strategies for improvement.

The concept of organized trauma systems has its roots in ancient wartime practices, evolving significantly over centuries. …

Evaluation Of An Advanced Practice Clinician Onboarding Program, Sophia Robinson

Student Scholarly Projects

Practice Problem: This project aimed to evaluate the effectiveness of a mentorship-based onboarding program versus a standard program without mentorship.

PICOT: The PICOT question that guided this project was (P), In newly hired APCs did the inclusion of mentorship in the onboarding process (I) lead to higher levels of general self-efficacy compared to standard orientation practices lacking mentorship (C), within an 8-week timeframe (T)?

Evidence: Nine articles were reviewed, revealing that standardized mentorship, structured orientation, and tailored support for professional development are critical strategies to boost confidence and retention among healthcare professionals.

Intervention: A standardized onboarding program that incorporated …

Cycle Syncing: Optimizing Women's Quality Of Life, Megan Francois

Theses and Graduate Projects

A woman’s hormones are in constant fluctuation throughout the menstrual cycle. This 28-day, on average, fluctuation can cause major shifts in mood, cognition, exercise tolerance, and nutrition needs. Because of this, there is potential to optimize quality of life if each phase is synced with diet, exercise, and complementary medicine utilizing holistic methods. Implications for further research include a need for additional longitudinal and prospective studies. Factors that need to be addressed include further analysis of the windows of vulnerability over the menstrual cycle according to female hormone fluctuations, effects of hormonal contraceptives, and effects of pathology on the cycle.

Can Simultaneous Integrated Boost Provide Better Dosimetric Coverage Compared To Sequential Boost In Prone Breast Treatment Of Large Breast Volumes?, Kinze Kraft

Culminating Experience Projects

Introduction: This study investigates the dosimetric differences between sequential boost (SeB) and simultaneous integrated boost (SIB) techniques in prone breast radiotherapy for patients with large breast volumes, utilizing a 3D-CRT planning technique. Prone positioning in radiotherapy has shown to be effective in reducing heart and lung doses, yet limited research exists to compare overall plan quality between SeB and SIB using this technique. This analysis aims to evaluate whether SIB provides better dosimetric coverage and reduced dose to organs at risk (OARs) compared to SeB in prone breast radiotherapy.

Methods: A retrospective analysis was conducted on data from ten patients …

Comparative Plan Analysis: Helical Tomotherapy Vs. Linac Vmat For Lower Extremity Sarcomas, Marie E. Dibona

Culminating Experience Projects

Abstract

Introduction

Soft tissue sarcomas (STS) affect about 13,500 people annually in the United States, and those in the lower extremities present unique challenges in radiation therapy due to the wide variability in tumor sizes, sometimes exceeding 30cm. Traditional treatment involves C-Arm linear accelerators using Volumetric Modulated Radiation Therapy (VMAT), which provides precise targeting while sparing nearby organs. Helical Tomotherapy (HT) is another option, delivering radiation in a helical pattern with a binary MLC for a uniform dose distribution. However, no studies have compared VMAT and HT for lower extremity sarcomas of different sizes. This study aims to compare these …

Retrospective Dosimetric Comparison Of Radiation Therapy Treatment Using Hybrid-Vmat Technique For Esophageal Cancer, Colleen Cozzie

Culminating Experience Projects

Abstract

Introduction

Esophageal cancer is the fifth most common gastrointestinal cancer in the United States. As oncology treatment includes radiation as a standard of care, it is vital to examine effective treatment delivery options. Understanding the dosimetric differences between VMAT and hybrid-VMAT can help providers choose the most appropriate care plan for patients undergoing esophageal irradiation. The purpose of this study was to evaluate if VMAT or hybrid-VMAT delivery would be the superior planning method for patients with planning target volumes greater than ten centimeters. Adequately covering the tumor volume while sparing dose to adjacent critical structures is the goal …

The Efficacy Of Common Prosthetic Joint Infection Prevention Strategies: A Systematic Review, Cameron Jennings

Theses and Graduate Projects

Thousands of total hip and knee arthroplasty patients suffer from prosthetic joint infections every year, making them a leading cause of arthroplasty failure. As the number of these procedures continues to grow, so will the healthcare and socio-economic burden of prosthetic joint infections. A comprehensive search for up-to-date literature was completed via the PubMed database, identifying eighteen retrospective and prospective cohort studies that focused on the four prosthetic joint infection prevention methods of interest. Tobacco use cessation of all forms is an efficacious prosthetic joint infection prevention strategy. The common practices of withholding intra-articular injections prior to surgery, using prophylactic …

A Quantitative Investigation Into Isotropic Variations Of Treatment Planning Isocenters To Model Patient Misalignment During Radiation Therapy Delivery And Its Impact On Evaluated Dose Metrics For Hypofractionated Dibh Left Breast Cancer Patients, Mckenzie Gemeiner

Culminating Experience Projects

Introduction

This research was conducted for carcinoma of the left breast without nodal involvement using the 3D deep inspiration breath hold (DIBH) treatment technique. Limiting dose to healthy tissues is crucial in radiation treatment planning. The impact of dosimetric uncertainty due to isotropic variations on constraints and goals is often overlooked. This study investigates dose metric differences due to inherent patient misalignment modeled by isotropic variations in treatment planning.

Methods

10 patient subjects were randomly selected with carcinoma of the left breast without nodal involvement, each using the 3D hypofractionated, deep inspiration breath hold (DIBH) technique. All plans had 24 …

A Quantitative Investigation Into The Daily Variation Of Bladder And Rectum Volumes Among Prostate Cancer Patients Receiving Radiation And When It Violates Dose Constraints At Any Given Fraction., Joseph Pape

Culminating Experience Projects

When planning radiation therapy treatments for prostate cancer, the bladder and rectum are important organs at risk (OAR). The purpose of this retrospective study was to establish guidelines for bladder and rectal volumes for men receiving hypofractionated radiation therapy to their prostate and seminal vesicles. Ten patients were included in the study and radiation doses to the bladder and rectum were recorded based on the daily change in the OAR volumes. The bladder and rectal volumes were contoured on each patient’s daily treatment CBCT and those volumes were compared to that on the treatment planning CT. The results showed that …

Increasing Operating Room Efficiency Through Decreased Turnover Times, R. Keith Wolfskill

Student Scholarly Projects

The Operating Room (OR) is the financial engine of the modern hospital or surgical center. Over 40% of the hospital's cost is invested in the OR, but the facility recoups a monetary return of around 60-70%. Turnover time is a crucial factor in reducing costs. Uncontrolled, it can inflate operating costs, but when managed effectively, it can boost surgeon, patient, and staff satisfaction, enhance patient safety, and significantly reduce operational costs. The literature underscores the importance of reducing the time between operating room turnovers to improve OR efficiency. A key strategy that research consistently shows to be effective is the …

A Comparative Analysis Of Helical Tomotherapy Planning With Active Versus Total Bone Marrow Sparing Using Dual-Energy Computed Tomography, April E. Premo

Culminating Experience Projects

Purpose: This study aims to compare helical tomotherapy (HT) plans using active bone marrow (ABM) sparing contouring versus traditional bone marrow (BM) sparing contouring using dual-energy computed tomography (DECT) in the treatment of gynecologic (GYN) cancers. The goal is to evaluate the effects of using ABM contours in optimization on organs at risk (OAR) and planning target volumes (PTVs).

Methods: The study involved creating HT plans for GYN cancer patients, utilizing both ABM and BM contouring techniques. DECT was used to distinguish between active and inactive bone marrow. Dosimetric comparisons were made between BM and ABM sparing plans. Statistical analyses …

Plan Comparison Of Hybrid Dynamic Conformal Arc Therapy (Hdcat) And 3-Dimensional Conformal Radiation Therapy (3dcrt) In Palliative Treatment Of Thoracic Spine Tumors, Maria Juchartz

Culminating Experience Projects

Abstract

Introduction

When cancer spreads from its place of origin to a new location, it is termed ‘metastatic’. Metastatic cancer is often not curable, however palliative care can be given. One common method of palliation is in the form of radiation therapy. A common site of metastasis is in the thoracic spine, which has several nearby organs that can make treatment planning difficult. These treatments often consist of three-dimensional conformal radiotherapy methods. The purpose of this study was to compare the traditional 3DCRT techniques to a hybrid dynamic conformal arc technique. HDCAT has been used in previous studies, however none …

Women's Experience Of Cancer Treatment During Covid-19 On The Texas-Mexico Border, Kayla E. Castañeda

Nursing Theses and Dissertations

The COVID-19 pandemic exposed existing racial, ethnic, socioeconomic, geographic, and gender disparities in cancer care and highlighted the need for more research in understudied populations. No studies have elucidated the experience of women living on the Texas-Mexico border receiving cancer treatment during the pandemic. This study explored the lived experience of receiving cancer treatment during the COVID-19 pandemic in 2020 for women living on the Texas-Mexico border and identified participants' self-identified unmet needs while receiving cancer treatment during the COVID-19 pandemic on the Texas-Mexico border. Following IRB approval and informed consent, ten women living on the Texas-Mexico border who received …

A Retrospective Comparison Between Analytical Anisotropic Algorithm (Aaa) And Acuros Xb (Axb) Calculation Algorithms Concerning The Left Anterior Descending Coronary Artery Radiation Dose In Left Breast Cancer Patients Utilizing Deep Inspiration Breath Hold, Melissa Wilkinson

Culminating Experience Projects

Abstract

Background: Minimizing radiation exposure to the left anterior descending coronary artery (LAD) is crucial during left-sided breast cancer radiation therapy to prevent cardiac complications. Dose calculation algorithms can significantly impact the estimated LAD dose. This study investigates the differences between the Anisotropic Analytical Algorithm (AAA) and Acuros XB (AXB) algorithms in LAD dose calculations.

Methods: Thirty patients treated with radiation therapy after breast-conserving surgery were included. Dosimetric data for LAD, including mean and maximum dose, was calculated using AAA and AXB algorithms. The results were compared using statistical analysis.

Results: Statistically significant reductions in mean LAD dose were observed …

A Retrospective Quantitative Investigation Into Prostate Radiation Treatment Among Patients With Rectal Gas At Simulation, And How It Affects Planning: A South Florida Context., Soufiane Mansouri

Culminating Experience Projects

This study examines the effect of Hounsfield Unit (HU) correction of air in rectal tissue on dose distribution during prostate cancer radiation therapy planning. Ten patients treated between 2023 and 2024, of which received 70 Gray (Gy) in 28 fractions, were retrospectively analyzed. Inclusion criteria included the presence of rectal gas during simulation and noncompliance with pre-simulation preparation instructions. Statistical tests, including a standard t-test and a sign test, were used to compare dose planning without HU correction to planning with HU-corrected rectal gas to tissue, focusing on differences in rectal doses and planned target volume doses. Radiation therapy plans …

Enriching The Pcos Lifestyle, Callie Coleman

Electronic Theses and Dissertations

Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting approximately 4 – 20% of women worldwide. It is associated with insulin resistance, fertility problems, and an increased susceptibility to chronic conditions through multiple inflammatory pathways. Women with PCOS are also at increased risk for disordered eating. The Mediterranean diet is associated with decreased inflammation and risk of chronic conditions, and intuitive eating principles are associated with decreased disordered eating patterns. The purpose of this study was to determine if a six-week nutrition education workshop incorporating information and skills related to both the Mediterranean lifestyle and intuitive eating principles can improve …

Acute Changes In Inflammatory Biomarkers Expression Following Cosmetic Surgery With Use Of Compression Garment, Michael James Sanchez

Open Access Theses & Dissertations

BACKGROUND: Inflammation is an acute phase response to physiological conditions such as infection, tissue injury, and tissue stress and malfunction (Medzhitov, 2008). Inflammation caused by surgical trauma (tissue injury) elicits a myriad of responses by the patient that is experienced far past the operation. It is estimated that American individuals will undergo nine surgeries throughout an 85 year lifespan (Lee & Gawande, 2008). Focus on surgical recovery modalities has grown over the past few decades. The use of compression garments (CG+) following surgery has been shown to be successful in preventing deep vein thrombosis, pulmonary embolisms, as well as aiding …

Vesicle-Associated Membrane Proteins In Airway Mucin Secretion, Boxuan Yang

Dissertations & Theses (Open Access)

Mucus plays a vital role in shielding the lungs against harmful substances such as particles, pathogens, and chemicals inhaled from the environment. It captures these harmful elements, and ciliary action helps to expel them from the lungs. Paradoxically, malfunctioning of mucus induces the development of various respiratory illnesses, including asthma, cystic fibrosis, chronic obstructive pulmonary disease (COPD), and interstitial lung diseases. Despite extensive research on controlling mucin production and hydration, the process of secretion is not yet fully comprehended.

Mucin undergoes regulated secretion at two rates: a low baseline rate and a high stimulated rate. Over the past 25 years, …

A Clinical Comparison With The Flattening Free Filter Technique For Lung Stereotactic Body Radiotherapy Using Functional Lung Planning, Addison Gucwa

Culminating Experience Projects

Abstract

Introduction

Lung cancer remains the leading cause of cancer incidence and mortality worldwide. Advances in stereotactic body radiation therapy have demonstrated survival rates comparable to surgery, however, they come with a higher risk of developing radiation pneumonitis. The aim of this study was to explore the possibility of minimizing the risk of lung toxicities after stereotactic body radiation therapy to lung tumors with the use of functional lung planning and flattening filter free beams.

Materials and Methods

This retrospective study analyzed treatment planning data from ten patients previously treated with SBRT for inoperable lung tumors. Functional lung volumes were …

A Retrospective Quantitative Comparison Of Auto-Planning Vs. Manual-Planning For Large Breast Patients, Olivia R. Smiley

Culminating Experience Projects

Breast cancer is the most prevalent cancer among women in the United States, with many patients undergoing whole breast irradiation (WBI) following lumpectomy. Dosimetrists face challenges in planning WBI for patients with large breasts due to issues related to hotspots, dose uniformity, and extended planning times. Auto-planning tools like EZFluence, which use artificial intelligence, offer potential improvements in planning efficiency and dose distribution. This retrospective quantitative study compares auto-planning using EZFluence with manual planning for 10 large breast patients, aiming to reduce hotspots, achieve a more homogeneous dose, minimize doses to organs at risk (OARs), reduce monitor units (MUs), and …

The Use Of Np-110, A Rhamm Peptide Mimetic, Reduces Capsule Fibrosis In A Novel Rodent Model Of Radiation-Induced Capsular Contracture, Kathryn Minkhorst

Electronic Thesis and Dissertation Repository

Capsular contracture is a common complication of breast implant reconstructive surgery, which can be particularly devastating in the setting of post-mastectomy radiation. The objective of this thesis was to evaluate the effect of RHAMM function-blocking peptide mimetic NP-110 on a novel rodent model for radiation-induced capsular contracture. The model consisted of female rats who underwent surgery to place a 2cc silicone implant under the right fourth mammary fat pad. Animals received local injection of 100ug of NP-110 or scrambled control peptide followed by 26Gy of targeted ionizing radiation. Clinically, NP-110 treated animals showed decreased post-radiation fibrotic change. Masson’s trichrome and …

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard

Dissertations

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. If undiagnosed or untreated, ADHD can lead to severe psychosocial issues such as academic failure, substance abuse, unplanned pregnancy, and incarceration. The financial burden in the U.S. from diagnostic errors creates an immense, rising fiscal impact. Early diagnosis and management are crucial to prevent these complications.

Females with ADHD, particularly those with the inattentive subtype, often face diagnostic challenges due to symptom masking and over-compensation. This results in poorer cognitive functioning and self-esteem compared to males with ADHD. ADHD is linked to autonomic nervous …