Digital Commons Network^™

The Effect Of Body Mass Index On Graft Function And Kidney Transplant Outcomes, Morgan Galle

Theses & Dissertations

Background: When determining eligibility for kidney transplantation, body mass index (BMI) is often a debatable criterion for transplant due to the clinical indication, an elevated BMI has adverse effects on kidney transplant outcomes. There is a current gap in research on the effect BMI has on kidney transplant outcomes.

Purpose: The purpose of this study was to determine the role BMI plays in post-kidney transplant clinical outcomes including delayed graft function, new onset diabetes after transplant, wound complications, hospital length of stay, albumin, and readmissions to the hospital from initial hospitalization and at six months following kidney transplantation. The primary …

Evaluation Of Upper Airway Changes Following Surgical Removal Of The Adenoids Using 3-D Cone Beam Ct, Christopher C. Schultz

Theses & Dissertations

Purpose: The purpose of this study was to evaluate the changes in volume, cross-sectional area and depth of the upper airway following the surgical removal of the adenoids.

Materials and Methods: 16 patients were diagnosed with hypertrophic adenoids and referred for surgical removal. Pre-surgical and post-surgical CBCT scans were taken on each patient. Volume measurements of the total airway, oropharynx and nasopharynx were recorded. In addition, cross-sectional areas and airway depths at the posterior nasal spine (PNS) and cervical vertebrae 2 were recorded. 15 patients diagnosed with no or mild adenoid hypertrophy were treated as the control group. The controls …

Examining Employee Knowledge Of The Jennie Edmundson Hospital Active Shooter Policy, Mallory W. Darais

Theses & Dissertations

Nationally, there has been a large increase in the number of active shooter events within healthcare facilities such as hospitals. Due to this increase, government organizations have recently released documents to guide healthcare facilities on implementing active shooter policies and updating emergency operation plans. Currently, recommendations from government entities such as the Federal Bureau of Investigation and the Department of Homeland Security suggest the “Run, Hide, Fight” approach during an active shooter incident. Jennie Edmundson Hospital, located in Council Bluffs, Iowa, and affiliated with the Methodist Health System, currently has an active shooter policy in place. Data was collected from …

Association Between Recipient’S Preexisting Antibodies And Allograft Vasculopathy And Mortality In Heart Transplant Patients, Hoang Tran, Lorena Baccaglini, Jane L. Meza, Brian D. Lowes

Theses & Dissertations

Objectives: To evaluate the role of preexisting Angiotensin II receptor type I antibodies (AT1RAb) and anti-HLA antibodies in predicting mortality and cardiac allograft vasculopathy (CAV) among heart transplant patients.

Methods: In this retrospective cohort study, we included 114 adults who received heart transplant from January 1^st, 2007 to December 31, 2014 and were followed up at Nebraska Medicine. 48 hours pre-transplant sera sample were used to detect antibodies. A cutoff of 10UL/ml was used for AT1RAb positive and mean fluorescence intensity of 3,000 and 1,500 were used for anti HLA class I and class II, respectively. Patients were …

Effect Of Diabetes Self-Management Education On Glycemic Control, Compared To Usual Care In Type 2 Diabetic Patients At The Family Medicine Clinic, Aga Khan University Hospital Nairobi, Catherine Wanjiku Gathu

Theses & Dissertations

Background: Globally, the magnitude of disease burden associated with diabetes is high. Poor glycemic control contributes greatly to this burden, especially in the occurrence of related complications. The value of Diabetes Self-Management Education (DSME) is evident in literature, and has been recommended as a way of optimizing glycemic and metabolic control and averting early onset of diabetes complications. Usual care involves spontaneous sharing of information during medical consultations without planned structure or defined time frame. In the African setting, the effect of DSME, and how it compares to usual care, is yet to be fully explored.

Objective: To compare the …

Duty Hour Limitations And Educational Outcomes: Perspectives From A Community Hospital-Based Family Medicine Residency Program, Maria Eliza Marquise

Theses & Dissertations

In 2003, the Accreditation Council for Graduate Medical Education and the American Osteopathic Association introduced new models that established limits on residents’ duty hours in training programs across the United States (Miulli & Valcore, 2010; Philibert & Taradejna, 2011); more stringent limitations were implemented in 2011. If these physician training programs decreased the time residents’ spent in a formal learning environment and utilized experiential learning as one teaching method, did the duty hour limitations affect the residents’ learning outcomes? The purpose of this ex post facto, quantitative study was to determine if there were differences in ITE (In-Training Examination) scores …

Mentoring, Job Satisfaction, Job Dissatisfaction, And Organizational Commitment Among Graduate Nurses, Abisola Adeyomibo Santos

Theses & Dissertations

Shortage of bedside nurses has been researched for a long time. Many researchers have referred to different shortage percentages, but the American Nurse Association stated that the shortage of bedside nurses would increase in the range of 29% to 36% by 2020. It is also reported that a large number of newly graduated, newly hired nurses leave within one year as compared to newly hired experienced nurses. The purpose of this correlational study was to evaluate the influence of mentoring, mediating job satisfaction, job dissatisfaction, and, therefore, organizational commitment, on nurses who completed the nurse residency program between January 2010 …

The Knowledge, Attitude, And Self-Reported Behaviors Of Psychiatric Nurses Towards Obese Psychiatric Patients On Atypical Anti-Psychotic Medications, Marcia D. Williams-Hailey

Theses & Dissertations

Background/Purpose: Obesity has continued to increase over the years with increase in morbidity and mortality. The advancement of psychiatric treatment has resulted in a higher prevalence of obesity among the psychiatric population related to the side-effects of the newer atypical anti-psychotics. This study addresses nurses’ attitudes towards obesity and people who are obese, focusing on psychiatric patients. Negative attitudes and low knowledge about psychiatric patients on atypical anti-psychotics can interfere with psychiatric nurses’ therapeutic potential to support patients with health promotion behaviors. The purpose of this study was to develop an instrument to measure the knowledge, attitudes, and self-reported behavior …

The Relationship Between New Nurses Who Volunteer And The Caring Behavior New Nurses Exhibit In The Practice Setting, One Year Post Graduation, Nicolette Fiore-Lopez

Theses & Dissertations

Volunteering is engaged in by millions world-wide and nurses comprise a significant portion of those who provide their professional talents, unpaid, to the underserved in local, national and international efforts. Nurses who have engaged in volunteer activities anecdotally describe personally transforming experiences gained through their efforts and for many nurses volunteering becomes part of their professional mandate. Although many social disciplines have studied volunteering, to date there has been a paucity of research on nurses who volunteer. The purpose of this study was to describe the characteristics of novice nurses who volunteer and determine the influence of volunteering and associated …

The Impact Of Technology-Enhanced Learning Activities On Nursing Student Engagement In The Classroom, Alicia A. Stone

Theses & Dissertations

Educating student nurses in the present environment requires professors to stay current with new methodologies as well as innovations in technology. The question is how to address both the impact of technology and the skills of clinical reasoning, and keep the students involved in the material. If there can be integration of each aspect through the use of technology-enhanced learning activities on the internet and preparation to approach the issue, then perhaps this can increase success. This is a quasi-experimental intervention study that explored the impact of a case study blogging assignment on the engagement of students enrolled in a …

The Lived Experience Of Observant Jewish Nursing Students: A Phenomenological Study, Toby Bressler

Theses & Dissertations

Background: With expanding cultural diversity in the United States (U.S. Department of Health and Human Services, 2009), it is essential to increase the diversity of the nursing profession to match the patients who are being cared for in our healthcare system (IOM, 2003; Sullivan Commission, 2004). Despite improvements to the demographic composition of the nursing workforce in recent decades, the nursing workforce has remained predominantly homogeneous and to meet the current and future health needs of the public while providing culturally relevant care, the nursing workforce needs to increase its diversity (IOM, 2010). This demographic shift creates a social imperative …

Association Between Socioeconomic Status And Bmi Among People With Schizophrenia And Bipolar Disorder, Nicholas Guenzel

Theses & Dissertations

Background: Many health disparities among individuals with schizophrenia and bipolar disorder are due to obesity-associated diseases. Several causes of obesity have been discovered, but few risk factors are known. In the general public, low socioeconomic status (SES) is associated with obesity.

Objective: Examine the relationship between SES and body mass index (BMI) among people with schizophrenia and bipolar disorder.

Design: A secondary analysis of the Collaborative Psychiatric Epidemiology Surveys dataset. The psychiatric group (N=480) included individuals with symptoms of schizophrenia or bipolar disorder. Those reporting no symptoms were controls (N=5,161). Childhood SES variables included mother and father education and profession, …

Association Between Adverse Events In Childhood And Bmi Among People With Schizophrenia And Bipolar Disorder, Nicholas Guenzel

Theses & Dissertations

Background: People with schizophrenia and bipolar disorder die significantly earlier than members of the general public (16-18 years and 12-13 years, respectively). Diseases associated with obesity such as diabetes, heart disease, and stroke account for much of this discrepancy. People with mental illness often have difficulty losing weight despite intensive interventions. As a result, nurses caring for patients with mental illness need to monitor their weight diligently and implement individualized interventions to promote achieving or maintaining a healthy weight. Because intensive interventions come with some risk and expense, programs must target individuals with the most potential to develop obesity. In …

Risk Factors For Agricultural Injury: An Evaluation Using Systematic Review And Injury Surveillance, Rohan Mahadeo Jadhav

Theses & Dissertations

Purpose- Agriculture is the most hazardous industry in the United States. The effectiveness of intervention programs for injury prevention can be improved by acquiring knowledge of risk factors for occupational injury in agricultural operators. The landscape of agriculture is changing in the U.S. Agricultural populations, environments and risk factors are changing as well with the changes in the structure of farms and ranches. The objective of this study was to identify significant risk factors for agricultural injury based on the literature and three years of injury surveillance data covering seven U.S. states. Methods- We conducted a systematic review of reported …

Physical Activity Behaviors Of Prehypertensive And Stage I Hypertensive African American Women, Hope Jackson

Theses & Dissertations

The purpose of this study was to describe the physical activity (PA) behaviors and PA biomarkers of prehypertensive and stage I hypertensive African American women (AAW) and to examine the relationships between PA and personal factors and selected behavior-specific influences (perceived barriers to and interpersonal support for PA). Pender’s Health Promotion Model was the conceptual framework for the study.

A cross sectional design and convenience sample were used. Personal factors examined were: systolic and diastolic blood pressure [BP], body mass index [BMI], and waist circumference. Other variables measured were: International Physical Activity Questionnaire, 400 meter walk test, Borg perceived exertion …

Understanding Access To Health Information: The Role And Measurement Of Social Location, Megan S. Kelley

Theses & Dissertations

The purpose of this research is to explore how application of social location theory may improve data collection on health information access in order to better inform and improve the effectiveness of health communication and messaging. This dissertation proposes a framework to understand how people obtain health information based on the idea of social location, Ritzer and Bell’s (1981) levels of social reality, and Dahlberg & Krug’s (2002) social ecological model. This research addressed the extent to which three studies of health information access support the use of such a framework, and if so, how its application could improve our …

Determinants Of Patient Activation In Hospitalized Multimorbid Patients, Myra S. Schmaderer

Theses & Dissertations

Post-hospitalization care transition is a vulnerable time for multimorbid patients. Self-management challenges happen due to acute symptoms and complex new treatment plans. Literature suggests higher activated patients have better outcomes; however, there is little research that identifies determinants that predict patient activation in the multimorbid hospitalized patient. Understanding predictive factors will facilitate planning interventions that promote self-management of multimorbid conditions. The purpose of this dissertation was to identify determinants that predict patient activation in patients with multimorbidity at discharge from the hospital.

A descriptive, predictive research study was conducted with 200 hospitalized multimorbid patients discharged to home. Their mean age …

Roles Of Serum Lycopene In The Prevalence And Mortality Of Metabolic Syndrome In The Adult Population, Guang-Ming Han

Theses & Dissertations

Metabolic syndrome (MetS) is a cluster of metabolic disorders, including increased fasting glucose, blood pressure, plasma triglyceride, reduced high-density lipoprotein cholesterol and abdominal obesity. It leads to an increased risk of cardiovascular disease and diabetes. The growing prevalence of MetS is strongly related to the increasing prevalence of overweight/obesity. As an antioxidant, lycopene can reduce the risk of MetS. However, it is unclear whether lycopene has similar effects among overweight/obese individuals and whether lycopene can reduce the risk of mortality among individuals with MetS. The purpose of this study was to explore the roles of lycopene in the prevalence and …

The Impact Of Gasoline Prices On Medical Care And Costs Of Motor Vehicle Injuries, He Zhu

Theses & Dissertations

Background Traffic safety has placed a tremendous economic and social burden on individuals and nations. Gasoline prices have been linked to traffic safety in the recent studies. Higher gasoline price may prompt people to reduce expenses by changing travel distance and frequency, transportation mode, or driving behaviors.

Objective This study aims to examine the relationship of gasoline prices to hospital utilization and cost for motorcycle and non-motorcycle motor vehicle injuries in the United States.

Methods Data on inpatient hospitalization for motor vehicle injuries were obtained from the 2001-2010 Nationwide Inpatient Sample, which is part of the Healthcare Costs and Utilization …

Respiratory Function Amongst Asymptomatic Hiv Positive And Hiv Negative Clients At Aga Khan University Hospital, Nairobi, Noah Kipkemei Murbiy

Theses & Dissertations

Background: Spirometry is used to asses respiratory function abnormalities. This is usually in reference to a validated normal range unique to a particular gender, race, age, weight and height. Majority of persons are usually asymptomatic until the expected FEV1 has decreased by 50%. Early intervention on the abnormalities even in this asymptomatic group has been shown to retard the rate of pulmonary deterioration. An unpublished audit at the Aga Khan University Hospital, Nairobi, revealed that majority of newly diagnosed HIV positive persons were admitted at the Critical Care Units with a pulmonary cause which later resulted in poor outcomes. This …

A Grounded Theory Study Of How Parents Made The Decision About Residential Group Home Placement For Their Adult Child With Intellectual/Developmental Disabilities, Laura A. Sardinia-Prager

Theses & Dissertations

Background: The parent caregivers of a child with an Intellectual Disability/Developmental Disability (ID/DD) face lifelong challenges that may at some point involve the decision about residential group home placement of the adult child. In the course of the child’s lifetime, the parents who have provided care may need to consider a safe alternative. The decision about residential group home placement of the adult child can be the result of numerous factors. Objective: The purpose of this qualitative inquiry was to investigate the phenomenon of how the parent caregivers made the decision for residential group home placement for their adult child …

Comparison Of Cardiovascular Risk Profiles Amongst Newly Diagnosed Cancer Patients And Non-Cancer Patients At The Aga Khan University Hospital Nairobi, Majid Lingani-Ncube Sikosana

Theses & Dissertations

Background: Non-Communicable Diseases (NCDs) are fast becoming the leading causes of morbidity and mortality in Low and Middle-income countries (LMIC) with cancers and cardiovascular diseases (CVDs) becoming the most prominent. CVD can be prevented if appropriate measures of screening and treatment of modifiable risk factors are addressed. This may translate to reduced risk of CVDs and some cancers in the long term. Increasing evidence exhibits common risk factors for both CVDs and cancer and that CVDs and their risk factors when present in cancer patients may worsen the overall outcome.

Objectives: The primary objective was to determine and compare …

Fall Prevention Among Older Adults Living In The Community, Clarissa Silva Lopez

Theses & Dissertations

Older adults are within the fastest population growth rate in the United States, and as the population ages, the potential for falls increases (DHHS, 2011). This was a mixed-method explanatory study that investigated the perceptions of older adults regarding the usefulness, adequacy, and positive experience of fall information among older adults living in the community when received from healthcare professionals during physician’s office visits. The research questions were: 1. What is the relationship among perceptions of usefulness, adequacy, and positive experience of fall information among older adults? 2. Is there a difference in the perceptions of usefulness and adequacy among …

An Assessment Of The Relationship Between The Hospital Chief Executive Officer’S Leadership Behaviors And Hospital Success, Newton J. Courtney

Theses & Dissertations

The health care delivery system in the United States has received increased attention over the last 2 decades. Concerns of access, choice, cost, and quality have been in the forefront. This study was conducted to assess the leadership behaviors of hospitals’ chief executive officers and how they impact the performance of hospitals. Two instruments were used to collect the data for the study: the Multifactor Leadership Questionnaire (MLQ-5X; Avolio & Bass, 2004) and a demographics questionnaire. A correlational research design was used to measure the degree of association between variables related to hospital CEOs, the hospitals they represented and hospital …

Prevalence Of Vitamin D Deficiency In Exclusively Breastfed Infants At The Aga Khan University Hospital, Nairobi, Nusrat. A. Said

Theses & Dissertations

Introduction: Vitamin D deficiency in infants is a recognized cause of rickets. In the last few years, evidence has emerged of its association with lower respiratory tract infections, food allergy, type 1 diabetes, schizophrenia and various other extra skeletal health effects. Exclusively breastfed infants are especially vulnerable to vitamin D deficiency due to their dependence on previous trans-placental transfer of vitamin D from the mother, dietary vitamin D from breast milk and cutaneous synthesis of vitamin D on exposure to sunlight. The worldwide epidemic of Vitamin D deficiency in pregnancy and the low content of vitamin D in breast milk …