Digital Commons Network^™

An Interdisciplinary Code Sepsis Team To Improve Sepsis Bundle Compliance In The Emergency Department, Jill M. Delawder

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Purpose: Sepsis is one of the leading causes of mortality with over 700,000 hospitalizations and 200,000 deaths annually. Various tools exist to aid in the early identification and treatment of sepsis including electronic alert systems, standardized order sets, nurse-initiated protocols and specialty trained teams. Despite available guidelines, mortality rates for severe sepsis and septic shock are near 50%.

Methods: The aims of this rapid cycle quality improvement project were 1) to develop and implement an interdisciplinary team to address early implementation of evidence-based sepsis bundles in the emergency department and 2) to compare sepsis bundle compliance three months pre-and three …

Use Of Telemedicine To Improve Cpap Non-Adherence In Patients With Obstructive Sleep Apnea, A Pilot Study, Kristin L. Hanger

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

The aim of this project is to improve continuous positive airway pressure (CPAP) non-adherence in patients newly diagnosed with obstructive sleep apnea. Obstructive sleep apnea (OSA) is caused by recurrent collapse of the upper airway during sleep. Untreated, OSA is associated with co-morbidity and decreased quality of life. The standard for OSA treatment is CPAP. Adherence to CPAP is not optimal. Applying telemedicine technology to monitor adherence of CPAP treatment, allows for early intervention. Prior research has shown mixed results with use of telemedicine on non-adherence rates.

This is a pilot study using telemedicine to monitor adherence data to …

An Analysis Of Interprofessional Rounds Effect On Readmission Rates And Patient Satisfaction, Cynthia Atkinson

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Evidence supports an interprofessional approach to patient care reduces readmissions, mortality, costs, and length of stay while simultaneously increasing communication, collaboration, and satisfaction of care providers and patients (Vazirani, S., et al, 2005). The health care team in an acute care setting, especially direct patient care providers such as nurses and ancillary disciplines must assess the discharge needs of patients from admission to the hospital until discharge disposition (Zakzesky, Klink, McAndrew, Schroeter, & Johnson, 2015). The purpose of this study was to determine if interprofessional rounds improved patient satisfaction and reduced readmission rates. The interprofessional team consisted of the hospitalists, …

Effects Of A Crisis Intervention Team Assessment Center On Emergency Department Length Of Stay, Carlissa Lam

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Introduction: Emergency departments are overburdened with mental health patients who lack adequate access to behavioral health resources. The influx of patients has led to an increased length of stay in the emergency department for patients who are being evaluated for mental health concerns. Overcrowding can lead to delays in treatment, undesirable medical events, and patient mortality. Crisis Intervention Team (CIT) models bring law enforcement, mental health providers, emergency departments, and individuals with mental illness together to improve care for patients in crisis. They have been instrumental in identifying patients in crisis and transporting them to a Crisis Intervention Team Assessment …

Improving Lead Screening In A Pediatric Practice: A Quality Improvement Project, Audrey Myers

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

Background: Detectable lead levels in children’s blood have been associated with increased cognitive difficulties, attention deficits, and poorer academic performance. Children enrolled in Medicaid have higher rates of elevated blood lead levels, yet requirements to test all children at age 1 and 2 who are enrolled in Medicaid are not being met. Nationally, 34% of children enrolled in Medicaid do not undergo proper blood lead level screening. The aim of this project was to increase required blood lead level screening rates for children with Medicaid insurance at a private pediatric practice in the Shenandoah Valley in Virginia.

Methods: The …

Outcomes Of Implementing The Chronic Disease Self-Management Program (Cdsmp) In The Kurdish Community, Chinor Fattahi

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: The incidence of chronic diseases signifies a need to redesign the U.S. healthcare system to better support minority individuals. This project examined the impact of the chronic disease self-management program (CDSMP) workshop in the Kurdish community. The literature shows many positive outcomes of CDSMP workshops, including improvements in physical health, self-efficacy, depression, communication with providers, as well as reduced emergency department visits and hospitalizations. This results in healthcare cost savings for our local communities and our nation. The literature is limited on managing chronic diseases in the Kurdish population, a growing refugee population in the United States and central …

Improving Breastfeeding In Rural Tanzania Using Bardach’S Policy Analysis Methodology, Katherine Skiff

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Appropriate breastfeeding has the potential to have the broadest impact on childhood survival in children under five years (U5Y) compared to all other preventive interventions. The World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) recommend that all facilities providing maternal services and newborn care have a written policy addressing breastfeeding that is routinely disseminated to staff. Shirati hospital, in rural Tanzania, does not have a breastfeeding policy. Bardach’s 8-Fold Pathway for policy analysis methodology (adapted by Collins for health policy) was used to evaluate three promising breastfeeding policies to improve compliance with this recommendation. They include …

Can The Implementation Of Interprofessional Rounds Improve Hospital Throughput Efficiency?, Rebecca Howdyshell

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

Efficient throughput processes are a vital part of providing cost effective, safe, quality patient care. Research has shown interprofessional rounds can have success at improving throughput processes. A rural, not-for-profit, 255 bed hospital in a Mid-Atlantic State was experiencing issues with throughput/patient flow. The aims of this quality improvement project were 1). to implement Interprofessional Rounds on the Progressive Care Unit (PCU); 2). To design and build a working Interprofessional Rounds template into meditech to guide Interprofessional Rounds and streamline discharge documentation; 3). to increase the amount of discharge orders entered between 0700 and 1300 by ten percent; and …

Effects Of Equine Assisted Activity On Children And Adolescents With Autism Spectrum Disorder, Briana Ciampi, Jeffrey M. Roy

Physician Assistant Capstones, 2016 to 2019

Background: Autism spectrum disorder (ASD) encompasses a spectrum of disorders which are characterized as having impaired communication skills, social skills and repetitive behaviors or body movements.^1,2 Since every individual with ASD presents with different challenges, treatment modalities for ASD are quite diverse. Equine Assisted Activities (EAA) to include therapeutic horseback riding (THR) is a treatment modality that has been utilized more in recent years for children and adolescents with ASD, as it is thought the connection between the individual and the horse can facilitate emotional, behavioral, and cognitive growth.³ Objective: To determine the effectiveness of Equine Assisted Activity …

Effect Of Npo Status On Aspiration Risk In Pediatric Patients Undergoing Procedural Sedation, Stacey Waldron, Kelsey Woycik

Physician Assistant Capstones, 2016 to 2019

Objective:To conduct a review of literature to determine if no solid food or liquids by mouth for more than or less than six hours impacts the incidence of pulmonary aspiration during procedural sedation in pediatric patients. Methods: A PubMed search was conducted utilizing the following terms: “sedation, fasting, and aspiration” and “NPO, pediatrics, and pre-procedural.” Filters included: “within five years,” “review articles,” and “English.” Articles were then screened and assessed for eligibility based on pediatric population, NPO status, procedural sedation, and risk of pulmonary aspiration. Results: Two prospective observational studies and one retrospective review were selected. Beach et al. …

The Effect Of Opioid Overdose Education And Naloxone Distribution Programs On Opioid-Related Mortality, Blake Rogers, Sharon P

Physician Assistant Capstones, 2016 to 2019

Objective: To determine the effectiveness of opioid overdose education and naloxone distribution (OEND) program implementation in reducing opioid-related overdose mortality. Methods: A PubMed search was conducted using the terms “opioid overdose prevention community naloxone,” yielding 80 records, 36 of which were screened. The remaining 44 articles were reviewed for eligibility, resulting in three articles chosen for the study. Results: An interrupted time-series analysis by Walley et al., and two retrospective cohort studies by Albert et al. and Rowe et al. were analyzed. Conclusion: Studies by Walley et al. and Albert et al. demonstrated a positive association between OEND program implementation …

Long Term Outcomes Of On-Pump Cabg Versus Off-Pump Cabg, Christopher Fetrow, Jessalyn Dickerson

Physician Assistant Capstones, 2016 to 2019

Objective: Assess the long-term outcomes including mortality, revascularization and myocardial infarction events to determine whether off-pump CABG is more effective for patients compared to on-pump CABG procedures.

Methods: Studies were found using PubMed with the search term, “on and off pump CABG” which yielded 1736 studies. After assessing for records within 5 years the search was narrowed to 370 articles and then down to 353 because some articles were not available in full-text. Our search was then divided into first looking at randomized control trials and meta-analysis availability from the 353 articles meeting our criteria. After narrowing our search for …

Pupillometry As A Test Of Infant Word Recognition, Amy Vinyard

Masters Theses, 2010-2019

Pupillometry holds great promise as a tool for infant language research but has not yet been used to probe word recognition. The goal of the described study was to design a functioning method that can later be used to test the possibility of using pupil dilation as a gauge of word recognition in 11-month-olds. To do this, we used the methods of an existing study (The Role of Accentual Pattern in Early Lexical Representation, Vihman, Nakai, DePaolis, & Hallé 2004) with modifications. Our method ran a one-sided head turn preference paradigm with the addition of an eye tracker for pupil …

Long-Term Proton Pump Inhibitor Use And Effect On Risk Of Fractures, Hannah Messer, Alison K. Conforto

Physician Assistant Capstones, 2016 to 2019

Objective: To conduct an analysis of literature that examined the effects of long-term proton pump inhibitors (PPIs) in adults 50 years and older on fracture risk. Methods: A literature search of the PubMed database using the terms “long-term use of PPIs” AND “fractures” Results: All 3 studies reported a statistically significant increased risk of fracture associated with long-term use of PPIs in both men and women over 50. None of the studies showed an increased risk of fracture with short-term PPI use. Conclusions: Health care providers should be informing their patients of the potential risk associated …

Community-Acquired Pneumonia In Adults: Diagnostic Reliability Of Physical Examination Techniques And Their Teaching In Academia, Amber Tordoff, Lauren A. Williams

Physician Assistant Capstones, 2016 to 2019

Background: Chest physical examination techniques are taught in academia, but their usefulness in the evaluation and diagnosis of patients in the clinical setting is controversial. Objective: To investigate the accuracy of physical examination techniques and their reliability in diagnosing community acquired pneumonia (CAP) and suggest a modified teaching approach to be used in academia. Design: Systematic Literature Review. Methods: Database search of PubMed and Google Scholar using the search terms “prediction of pneumonia in adults” and “prediction rule for pulmonary infiltrates.” Filters were implemented to include articles that only dealt with human subjects and were full text. Articles …

Probiotics As An Adjunct Treatment To Standard Therapy In Ulcerative Colitis, Melissa Maloof, Grace Berardini

Physician Assistant Capstones, 2016 to 2019

Objective: To determine the effectiveness of probiotics in addition to traditional therapy for patients with ulcerative colitis (UC) using a systematic review. Methods: PubMed and Cochrane Library databases were queried to evaluate patient clinical trials within the past five years using the search terms probiotics and ulcerative colitis. Results: Three trials met inclusion criteria. Two of three studies found no significant improvement in their primary endpoint with probiotics. Yoshimatsu, et al. found that after one year 56.6% of the placebo group remained in remission, whereas 69.5% of the probiotic group remained in remission (p>0.05).⁹ Tursi, et …

Vitamin C In The Treatment Of Septic Shock, Alyson O. Shaughnessy, Matthew Tieszen

Physician Assistant Capstones, 2016 to 2019

Objective:To assess the efficacy of improving outcomes of septic shock treatment with the addition of Vitamin C to standard treatment compared to standard therapy alone. To assess whether or not Vitamin C has a favorable outcome in the treatment of septic shock in terms of decreasing duration of vasopressor usage, reducing duration of intensive care unit (ICU) stay, and improving mortality.

Design: Systematic literature review.

Methods: Searches were conducted in PubMed and Google Scholar using the terms ascorbic acid, sepsis, septic shock, and vasopressors. In PubMed the following filters were used: humans only, clinical trials, studies within the past …

Ethyl Chloride Spray For Injection Site Analgesia, Ryan T. Pyles, Mackenzie N. Kappe

Physician Assistant Capstones, 2016 to 2019

Objective: To determine if ethyl chloride spray provides adequate analgesia prior to injections. Design: Systematic literature review. Methods: A search was conducted in both Pubmed and Scopus using search terms ethyl chloride and injection. The Pubmed search was narrowed to include studies within a 10-year publication range. Articles were excluded based on: population age range, date of publication, and if ethyl chloride was used in conjunction with another analgesic. There were no relevant articles in the Scopus search. Results: Franko O, Stern P. demonstrated that there was no statistically significant improvement in anxiety or pain perceived with ethyl chloride treatment …

Diagnostic Effectiveness Of Lead Avr As A Stemi Equivalent, Phung Vu, Karen Hayes

Physician Assistant Capstones, 2016 to 2019

Background: Acute coronary syndrome (ACS) encompasses a collection of three acute processes related to myocardial ischemia. These include: unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of ACS. Unlike the other 11 leads, lead augmented Vector Right (aVR) has been long neglected until recent years. Recent investigations have shown that an analysis of ST-segment shift in lead aVR provides useful information on the coronary angiographic anatomy and risk stratification in ACS. This implies that the use of lead aVR can be …

Effects Of A Robotic Cat On Agitation And Quality Of Life In Individuals With Dementia In A Long-Term Care Facility, Jillian Nicole Marsilio, Samantha Virginia Mckittrick, Lisa Renee Umbell, Melissa Ann Garner, Sharon Maiewski, Jeanne Wenos

Physician Assistant Capstones, 2016 to 2019

Study Objective: The purpose of this study is to determine whether introducing a robotic companion cat into a long term care facility may improve affect and, subsequently, increase participation for residents with dementia, and to determine potential benefits for caregiver roles and relationships with individuals with dementia.

Background: The number of people with dementia is growing, and the behavioral and psychological side effects are negatively affecting the quality of life for these people as well as their caregivers. Additional research is needed to help develop and confirm the use of nonpharmacological treatment for dementia with therapeutic robots.

Study Subjects: Research …

The Mckenzie Method And Treatment Of Low Back Pain, Sylvia Meyer, David Harrison

Physician Assistant Capstones, 2016 to 2019

Objective: To compare the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) exercise program to other treatment modalities for reducing pain, disability, and improving function in patients complaining of low back pain. Design: Systematic literature review. Methods: Searches were conducted in PubMed and Google Scholar using terms “McKenzie Method”, “mechanical diagnosis and therapy”, “low back pain”, “spinal manipulation”, “physical therapy”, and “placebo”. Results: In Machado et al., a statistically significant difference was found between MDT and using a first line approach (advice, reassurance, and over the counter (OTC) analgesics) regarding pain; however, it did not meet the pre-established level of …

Comparison Of The Rowland Universal Dementia Assessment Scale And Mini-Mental State Examination For Dementia Detection, Lauren Fry, Daniel Wolfe

Physician Assistant Capstones, 2016 to 2019

Objective: To assess the ability of the Rowland Universal Dementia Assessment Scale (RUDAS) in comparison to the Mini-Mental State Examination (MMSE) to detect signs of dementia in a diverse elderly population. Design: Systematic literature review. Methods: Searches were done in PubMed, utilizing the terms MMSE, RUDAS, and dementia. Results: Using the keywords mentioned on PubMed,two articles met the inclusion and exclusion criteria: Limpawattana et al and T. R. Nielsen et al. One other article was found by searching under the “Related Articles” section on PubMed: D. Basic et al. Conclusion: The RUDAS performs just as well as …

Cervical Cytology Versus Primary Hpv Testing As Screening Tests For Cervical Dysplasia, Erin Shea, Biniam Abraham

Physician Assistant Capstones, 2016 to 2019

Background: Cervical cancer is the fourth most common cancer among women, accounting for 10% of all female cancers and 7.5% of all cancer deaths worldwide.^1,2 Human papillomavirus (HPV) has been detected in up to 99.7% of cervical cancers, making it the primary risk factor for the development of cervical cancer.³ Current guidelines recommend a screening test which includes a combination of cervical cytology as well as HPV co-testing in women over the age of 30, with HPV testing not recommended in women younger than the age of 30.¹¹ The Food and Drug Administration has approved primary HPV …

Effectiveness Of High-Fidelity Human Patient Simulation In Learning To Manage Medically-Complex Infants, Erin Clinard

Dissertations, 2014-2019

Survival of preterm and medically-complex infants has dramatically increased over the past thirty years due to significant advances in medical care and technology, however the developmental costs of survival are substantial. Comprehensive care of premature babies is critical and there is a need for more neonatal therapists, including speech-language pathologists (SLPs), with the knowledge and confidence to provide that care.

Students in graduate SLP programs often receive little clinical experience or dedicated coursework in pediatric feeding and swallowing, especially with medically-complex infants. However, hands-on and experiential learning can support the development of the necessary foundational knowledge and confidence of students …

The Art Of Couple Satisfaction, Kristy Koser

Dissertations, 2014-2019

ABSTRACT

It is estimated 10-15% of women aged 20-45 or 1 in 4 to 6 couples are unable to get pregnant after one year of trying to conceive. This failure to conceive within 12 months without contraception meets the requirements for a diagnosis of infertility (Association for Reproductive Medicine [ASRM], 2014). With such a large percent of the United States population navigating the world of fertility treatment, the field of mental health must also evolve, offering new areas of specialty to address this specific client population. Couples face significant concerns while undergoing fertility treatment as they cope with complex decision-making, …

Hematological Changes In Response To A Drastic Increase In Training Volume In Recreational Cyclists, Jessie Axsom

James Madison Undergraduate Research Journal (JMURJ)

Changes in blood volume contribute to improvement in oxygen utilization (VO2max) with chronic endurance exercise training. Although hematological changes resulting from long-term endurance training have been well documented, it has not been well established whether an increased volume of endurance training preferentially affects plasma volume or red blood cell volume. To answer this question, I studied seven female and four male recreational cyclists before and after exposure to drastic increases (632%) in training volume. Following the 10-week training period, the mean hematocrit (Hct) of the 11 subjects who completed the study significantly (p0.05) correlated with the change in self-reported weekly …

Establishing Effective Amplitude Criterion For Transcranial Direct Current Stimulation, Lindsey Michele Schwenger

Senior Honors Projects, 2010-2019

My honors project will document and reflect on my experiences as a member of a research team that is studying transcranial direct current stimulation (tDCS) as a treatment for dysphagia, or difficulty swallowing, which affects a vast, diverse group of individuals. There is substantial need for more efficient and effective rehabilitation strategies used to restore abilities and reduce the risks associated with dysphagia. Recent studies have addressed these risks by exploring tDCS as a treatment for central nervous system damage caused by stroke, traumatic brain injury, and Parkinson's disease. Research has recently been conducted to test its effectiveness, but has …

Behavioral Audiometry Testing In Drosophila Melanogaster, Amanda Cascio

Senior Honors Projects, 2010-2019

The genetic make up of Drosophila melanogaster aligns closely enough to humans for them to function as models for the study of hearing loss and disorders (Albert & Göpfert, 2015; Duyk et al., 1997). The purpose of this project was to design a computer automated program capable of quickly assessing the hearing of flies based on their suppression of courtship behaviors in the presence of an audible stimulus. We were unable to document the male courtship song due to low frequency noise present in our sound attenuating booth. We continued the experiment using a spectrum of fly noise unassociated with …

Comparing Two Naturalistic Pragmatic Assessments: The Celf-5 Pragmatic Activities And The Yale In Vivo Pragmatic Protocol (Yipp), Rebecca Reid

Senior Honors Projects, 2010-2019

Pragmatics, or the social use of language, is a dimension of communication skills that is very difficult to assess due to its dependence on cultural norms, situational context, and speaker differences. Of the current methods for evaluating pragmatic language skills in children, the literature most frequently recommends naturalistic assessment because it allows the clinician to most closely simulate a real-life interaction. Despite these recommendations, limited information exists to guide clinicians in making decisions about which activities yield the most representative pragmatic language sample. This preliminary study compared two naturalistic pragmatic assessments, the Pragmatic Activities from the Clinical Evaluation of Language …

Design Of A Homeopathic Solution For Chronic Cough, Jacob Ziemke

Senior Honors Projects, 2010-2019

Chronic cough is most commonly defined as a cough that persists for more than eight weeks and is estimated to affect more than 30 million people in the United States at any given time. Diseases contributing to the onset of chronic cough include asthma, pulmonary fibrosis, lung cancer, postnasal drip, gastroesophageal reflux disease (GERD), and bronchitis, and may include lifestyle choices such as smoking. For those who seek medical advice, pharmaceuticals and speech therapy are two common methods of combating chronic cough but serve to mask the symptoms rather than treat the problem; frequently, chronic cough is misdiagnosed or cannot …