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Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

Sex Differences In Allergic Asthma Responses Of Mice Prenatally Exposed To Wood Smoke, Adelynne Walley

Undergraduate Theses, Professional Papers, and Capstone Artifacts

No abstract provided.

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Final Scholarly Project: Evidence-Based Practice Guidelines For The Perioperative Management Of Blood Glucose Levels In The Cardiac Surgery Patient, Chelsey Benner

Doctor of Nursing Practice Scholarly Projects

Cardiovascular disease is the leading cause of mortality worldwide, necessitating a high demand for cardiac surgery. A unique stressor for cardiac surgery is an increased surgical stress response involving hyperglycemia. Perioperative hyperglycemia contributes to adverse postoperative outcomes following cardiac surgery. Current evidence examines blood glucose control and its effect on adverse postoperative outcomes, including sternal wound infections, acute kidney injury, prolonged mechanical ventilation, and an increased length of stay in the intensive care unit. Despite the link between hyperglycemia and poor postoperative outcomes, most facilities lack standardized guidelines for the perioperative management of blood glucose levels in cardiac surgery patients. …

Development Of Clinical Practice Guidelines For Incorporating Paravertebral Blockade For Thoracic Surgery Adult Patients, India Hutchison

Doctor of Nursing Practice Scholarly Projects

Thoracic surgery is considered one of the most painful surgical procedures due to its severity and the duration of the procedure. Pain is detrimental to the patient experience, and poor patient satisfaction results in revenue loss for hospitals. Maintaining adequate pain control after surgery is crucial in preventing pulmonary complications such as atelectasis and respiratory failure that prolong patient recovery. It is the responsibility of the anesthesia provider to ensure adequate pain control throughout the perioperative experience. Although current evidence-based data shows that regional anesthesia provides superior thoracic postoperative pain control, the current practice continues to be the utilization of …

Development Of Evidence-Based Practice Guidelines For Utilizing Erector Spinae Plane Blockade For Patients Undergoing Cardiac Surgery, Gabrielle Metoyer

Doctor of Nursing Practice Scholarly Projects

In the United States, the aging population and high rates of cardiovascular disease leads to increased cardiothoracic surgeries. Analgesia for cardiac surgeries often involves high-dose opioids. However, with an ever-increasing opioid epidemic and adverse effects on the postoperative healing process, recent literature seeks to decrease opioid consumption by utilizing alternative methods of analgesia. The American Association of Nurse Anesthetists recommends the use of regional anesthesia techniques to reduce the incidence of undertreated postoperative pain that can occur from opioid-sparing methods of analgesia. This project aims to create an evidence-based analgesia guideline for adult patients undergoing cardiac surgery. Interventions will include …

Final Scholarly Project: The Administration Of Transversus Abdominis Plane Blocks In Patients Undergoing Anesthesia For Open Ventral Hernia Repairs, Brennon Pinion

Doctor of Nursing Practice Scholarly Projects

Ventral hernia repairs are the only definitive treatment for umbilical or abdominal hernias. These procedures are prevalent and often lifesaving but also carry high risks of adverse effects. Some of the problems that follow include postoperative ileus, increased opioid use, and prolonged length of stay. Due to the rate of complications, there was a need to improve these outcomes. One way to improve outcomes is to implement superior anesthetic techniques. This Final Scholarly Project (FSP) followed the Plan-Do-Study-Act (PDSA) model to conduct evidence-based practice (EBP) and quality improvement (QI) sections. The plan phase included a thorough literature search and analysis …

Evidence-Based Practice Guidelines For Perioperative Use Of Dexmedetomidine In Pediatric Congenital Cardiac Surgery, Kayla Thomsen

Doctor of Nursing Practice Scholarly Projects

Tachyarrhythmias are common postoperatively in the congenital cardiac surgery population. About 1% of the population is born with congenital heart disease (CHD), with 50% of patients undergoing surgery for CHD experiencing arrhythmias. Complications can arise from postoperative arrhythmias, including hemodynamic instability and myocardial depression, having catastrophic health repercussions. Despite the high prevalence and complications, there is no standard practice for postoperative tachyarrhythmia prevention in the chosen population, and prevention is at the provider's discretion. However, literature exploring the effects of dexmedetomidine notes promising results for using the drug for postoperative tachyarrhythmia prevention. The project aims to address the lack of …

Final Scholarly Project: Enhanced Recovery After Surgery (Eras) Guidelines For Pancreaticoduodenectomies, Rebecca Wheeler

Doctor of Nursing Practice Scholarly Projects

A pancreaticoduodenectomy, or Whipple procedure, is the only curative option for pancreatic cancer. For those eligible for tumor resection, the Whipple procedure is a difficult surgery for both the patient and provider. Complications following pancreaticoduodenectomy are numerous and include infection, delayed gastric emptying, high hospital costs, and pancreatic fistulas. Enhanced Recovery After Surgery (ERAS) protocols exist to provide evidence supporting standardization of practices that lead to the improvement of these patient outcomes. An ERAS protocol for the pancreaticoduodenectomy, first established in 2012, is inconsistently implemented in healthcare facilities. Researchers collected data involving the use of the Whipple procedure ERAS guidelines …

Guidelines For Intraoperative Use Of Quantitative Neuromuscular Monitoring, Alex Thompson

Doctor of Nursing Practice Scholarly Projects

Chemical paralysis with neuromuscular blocking agents is common practice in anesthesia. Adequate reversal of these medications is essential for postoperative recovery and return to physiologic baseline. Inadequate reversal may lead to residual paralysis and respiratory complications such as hypoxemia, upper airway obstruction, atelectasis, and pneumonia. Quantitative neuromuscular monitoring was introduced as an objective measure of adequate recovery from neuromuscular blockade. The American Society of Anesthesiologists recommends utilizing quantitative neuromuscular monitoring before tracheal extubation in their 2023 practice guidelines, as the research involving quantitative neuromuscular monitoring shows a reduction in postoperative residual paralysis rates and adverse respiratory complications postoperatively. In this …

Analysis Of Clinical Outcomes And Cost Effectiveness Of Neuromuscular Blocking Drug Reversal In Patients Classified As Obese, Trevor Mack

Doctor of Nursing Practice Scholarly Projects

Obesity predisposes patients to heightened risks of adverse outcomes following surgery, including residual neuromuscular blockade and postoperative complications. The administration of non-depolarizing neuromuscular agents (NMBAs) is fundamental for muscle relaxation and optimal surgical conditions. However, the subsequent reversal of these blockers with agents like sugammadex or neostigmine is crucial to mitigate these risks. While sugammadex is recognized as a clinically superior choice due to its rapid and more complete reversal, its extensive use is often limited by cost, presenting challenges in obese patients who already face increased susceptibility to complications. This project evaluates the cost-effectiveness of sugammadex versus neostigmine in …

Development Of Evidence-Based Clinical Practice Guidelines For Pediatric Preoperative Anxiety, Whitney R. Stant

Doctor of Nursing Practice Scholarly Projects

Preoperative anxiety is a problem that occurs frequently in pediatric patients. Preoperative anxiety creates physical and psychological changes that impact a child’s surgical experience. Pediatric patients who experience preoperative anxiety may also experience prolonged postoperative care, long-term psychological complications, and increased postoperative pain. Sedating medications are often administered to prevent and treat preoperative anxiety. Commonly, midazolam is administered intranasally to prevent preoperative anxiety. Midazolam increases the risk of cognitive impairment and respiratory depression. Dexmedetomidine is an effective alternative to midazolam. Dexmedetomidine is a highly selective alpha-2 agonist and provides arousable sedation without respiratory depression. Dexmedetomidine is safe and effective at …

Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes

Doctor of Nursing Practice Scholarly Projects

Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …

Clinical Guidelines For The Perioperative Management Of Patients With Aortic Stenosis Undergoing Noncardiac Surgery, Owen Diehl

Doctor of Nursing Practice Scholarly Projects

Aortic stenosis (AS) is a common valvular disorder that causes left ventricular (LV) outflow obstruction. The prevalence of AS may increase with the aging population and the widespread availability of diagnostic capabilities like echocardiography. With the increasing patient population diagnosed with AS, the chance of encountering these patients during noncardiac surgery (NCS) increases. Performance of anesthesia is challenging in patients with AS due to the pathophysiological consequences of AS and the hemodynamic changes associated with anesthesia. The patient with AS presenting for NCS is at an increased risk of perioperative major adverse cardiac events (MACEs). This project aimed to determine …

Implementation Guidelines For Total Hip And Total Knee Arthroplasty To Reduce The Incidence Of Deep Vein Thrombosis And Subsequent Pulmonary Embolism, Mitchell Mccorkle

Doctor of Nursing Practice Scholarly Projects

With patients living longer, the orthopedic sector has given rise to joint prostheses as a treatment for those experiencing osteoarthritis (OA). With the increase of these procedures, there is also an increased risk of deep vein thrombosis (DVT) and subsequent pulmonary embolus (PE) following these surgical procedures. The orthopedic medical community and anesthesia providers aim to decrease DVT and PE risk through multiple modalities. The anesthesia focuses on reducing DVT, and PE involves a multimodal approach to each anesthetic. Modalities used for the multimodal approach involve peripheral nerve blocks (PNB), neuraxial spinal anesthesia, early mobilization, postoperative nausea and vomiting (PONV) …

Use Cases For Art Therapy Intervention In Clinical Psychedelic Praxis, Kaitlin Maud

Expressive Therapies Capstone Theses

Psychedelic medicine has existed for thousands of years as a traditional, sacred practice and is now in varying stages of legalization for clinical application in the United States. Psychedelic-Assisted Therapy uses specific psychoactive substances to facilitate altered states of consciousness in which clients have access to unconscious material and there is a greater cognitive openness to new perspectives and possibilities. Art Therapy is a modality of psychotherapy with decades of data to support its clinical efficacy in treating mental illness and other chronic conditions. A review of the literature shows a range of use cases for art in the context …

How Music Is Used To Facilitate Communication In Speech-Language And Music Therapy For Children With A Diagnosis Of Autism Spectrum Disorder, Anna Mcgreevy

Honors College Theses

The goal of this research was to determine how music is being used in speech and music therapy sessions for children with a diagnosis of autism spectrum disorder, to discover the most common targets of these therapy sessions, and to examine the anatomical and physiological constructs that support the inclusion of music. This study was a review of literature, and included research from a variety of articles, several written in the past 25 years. Overall, results showed that music-based speech interventions such as Melodic Based Communication Therapy and Developmental Speech and Language Training, as well as music therapy interventions, are …

Functional Analysis Of Chromatin Remodeler Csb In Parp1/2- Mediated Oxidative Dna Lesion Repair, Rabeya Bilkis

Biomedical Sciences ETDs

The ATP-dependent chromatin remodeler Cockayne syndrome protein B (CSB) is essential for maintaining genome integrity. Mutations in CSB are the primary cause of Cockayne syndrome (CS), a premature aging disorder with severe sun sensitivity and neurodevelopmental symptoms. However, the precise mechanisms underlying the disease etiology remain poorly understood. Given the critical roles of oxidative stress in aging and neurodegenerative disorders, this research sought to determine the mechanisms of CSB’s functions in oxidative DNA damage repair.

In the first aim, we investigated how CSB participates in PARP1/2-mediated oxidative DNA repair. We showed that PARP1 and PARP2 recruit CSB to oxidized chromatin …

Assessing Knowledge, Confidence, And Attitude Toward Virtual Care And Telehealth Among Graduate Nursing Students, Natasha Asante

Doctor of Nursing Practice Scholarly Projects

In response to the COVID-19 pandemic, telehealth and virtual healthcare modalities have become primary care delivery methods. The American Academy of Ambulatory Care Nursing (AACN) and the American Association of Nurse Practitioners (AANP) support using virtual care and telehealth technology in health care services. Although most healthcare institutions utilize telehealth to provide care, emerging research highlights the lack of telehealth training in Advanced Practice Nurse (APRN) education. However, no standard curriculum requirements mandate graduate nursing programs to train APRN students in telehealth or virtual health modalities. Due to the lack of training for APRNs, it can be very challenging for …

Animation As Therapy For Mental Health Treatment Across Diverse Populations And Contexts, A Literature Review, Daneile Tabana

Expressive Therapies Capstone Theses

Scientific research has explored and identified the beneficial relationship between health and creative expression, recognizing art therapy as a source of healing. Animation has been newly recognized as an art therapy medium with potential for therapeutic healing and increased psychological well-being. This review of the literature on animation therapy explores the history of the modality’s interaction with the population observed and the effects of animation on the cognitive processes, discusses current theoretical orientations and treatment options for treating a range of conditions that affect mood, thinking, and behavior with animation therapy, and considers culturally informed and client-centered practices alongside traditional …

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 …

Effect Of Insufficient Sleep On Activity Limitation: Results From The Brfss 2022 Survey, Jonathan Meyer

Capstone Experience

Objective: To determine whether insufficient sleep (less than 7 hours per night) is associated with activity limitation (14 days or more of poor mental or physical health interfering with everyday activities) in Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2022. Methods: BRFSS is a nationally representative cross-sectional survey of non-incarcerated US adults. The exposure of interest was insufficient sleep, and the outcome of interest was activity limitation. Other demographic variables used in a final weighted adjusted analysis include age >65 years, race/ethnicity, gender, marital status, income, and total physical inactivity. Results: The weighted prevalence of insufficient sleep for …

Investigation Of Study Strategies In Undergraduate Preparation For The Mcat And Optimizing Preparation According To Current Medical Students, Makayla Gordon

Theses/Capstones/Creative Projects

The Medical College Admission Test (MCAT) is a pivotal assessment for aspiring medical students, serving as a measure of undergraduate readiness in preparation for this huge advancement in their academic careers. Success on the MCAT requires content mastery, but to do that, strategic study approaches that are tailored to the individual, and comprehension of the test’s unique format and demands are essential. It is a common misconception that there are limited ways to study for the MCAT, while also sacrificing a legitimate understanding of the content. This project investigates further into identifying effective study methods for MCAT preparation with promise …

Strength And Endocrine Adaptations From The Combined Use Of Accentuated Eccentric Loading And Cluster Sets During A Strength Endurance Training Block, Kurt Mcdowell

Electronic Theses and Dissertations

The purpose of this study was to investigate the chronic effects of accentuated eccentric loading (AEL) paired with cluster sets (CS) on dynamic and maximal strength, the endocrine system, and body composition. Seventeen recreationally active subjects (male = 11, females = 6, age = 23.05 ± 4.07, height = 172.09 ± 9.98, body mass = 81.29 ± 22.18, back squat to body mass ratio = 1.55 ± 0.33, bench press to body mass ratio = 1.06 ± 0.28) participated in one familiarization week, 2 weeks of testing, and 4 weeks of training. A strength-endurance block (4 wks) was used for …

Acute Effects Of Multi-Joint Eccentric Exercise On Lower Extremity Muscle Activation Measured During Land And Water Walking, Brayden Worley

All Graduate Reports and Creative Projects, Fall 2023 to Present

Although prior literature has established the preliminary clinical benefits of aquatic exercise across various clinical populations, there is a need to explore the potential for including aquatic-based movement as a key component of a multi-modal approach toward improving mobility and reducing fall risk. Eccentric exercise may complement aquatic exercise given that movements performed in water immersion tend to be low impact. Eccentric exercise may also improve the passive stiffness of lower extremity extensors, which gives an additional rationale for the potential of eccentric exercise to reduce fall risk when combined with aquatic exercise. There may also be an acute response …

Manufacturing Of Aligned Electrospun Nanofiber Yarns For Their Enhanced Mechanical And Piezoelectric Properties, Adaugo Mary-Frances Enuka

Theses and Dissertations

Electrospinning is a widely used technique for producing nanofibers with diverse applications. This method uses polymer solutions and strong electric fields to generate nano-sized fibers with unique properties. This study presents a novel manufacturing approach that enables the production of electrospun poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP) nanofiber yarns using an automated parallel track system and an adjustable roll-to-roll collector. This research examines the impact of an automated post-drawing system on the polymer chain orientation, crystallinity, tensile strength, morphology, and piezoelectric properties of PVDF-HFP nanofiber yarn. The results reveal that the post-drawing process significantly improves molecular alignment, increases tensile strength, and enhances the …

Assessing The Effects Of Repetitive Mild Traumatic Brain Injury On Risk/Reward Decision Making And Catecholamine Associated Proteins, Christopher Knapp

Theses and Dissertations

Mild traumatic brain injury (mTBI) disrupts cognitive processes that influence risk taking behavior; however, the effects of repetitive mild injury (rmTBI) or whether these outcomes are sex specific are unknown. Risk/reward decision making is mediated by the prefrontal cortex (PFC), which is densely innervated by catecholaminergic fibers. Aberrant PFC catecholamine activity has been documented following TBI and may underlie TBI-induced risky behavior. Here, we exposed rats to sham (no injury), single, or three closed-head controlled cortical impact (CH-CCI) injuries to characterize the effects of rmTBI on 1) risk/reward decision making behavior using a probabilistic discounting task (PDT) and 2) levels …

Potent And Selective Small Molecule Mcl-1 Inhibitor Demonstrates Anti-Myeloma Activity And Overcomes Chemotherapy Resistance, Omar Sami Faleh Al-Odat

Theses and Dissertations

Despite a record number of clinical studies investigating various anti-myeloma treatments, the 5-year survival rate for multiple myeloma (MM) patients in the US is only 55%, and nearly all patients relapse. Poor patient outcomes demonstrate that myeloma cells are "born to survive” which means they can adapt and evolve following treatment. Thus, new therapeutic approaches to combat survival mechanisms and target treatment resistance are required. Importantly, Mcl-1, anti-apoptotic protein, is required for the development of MM and treatment resistance. This study looks at the possibility of KS18, a selective Mcl-1 inhibitor, to treat MM and overcome resistance. Our investigation demonstrates …

Speech & Language Services: Examining The Experiences Of Deaf / Hard Of Hearing People, Milayna N. Barker

University Honors Theses

The purpose of this study is to examine the experiences of Deaf and Hard of Hearing (HoH) adults and parents of Deaf/HoH children related to speech and language services, and their recommendations for service providers. Historically, professionals have focused on the development of speech and aural/oral skills of Deaf and HoH people. As such, when working with families of newly-identified children with hearing loss, hearing professionals may be ill-equipped to provide culturally-responsive, fully inclusive information and education regarding communication options and opportunities.

Method: This study used a qualitative research design to examine participant experiences related to speech and language services …

The Cost Of Healthy Eating, Diana Prychyna

University Honors Theses

Background: Each year in the United States, 15-20% of 1 million visits to the Emergency Department for Acute Heart Failure result in home discharge, with patients often experiencing adverse health outcomes within 30 days. The study, Get With the Guidelines in Emergency Department Patients With Heart Failure, utilized 'Self-Care Coaches' who meet participants via telehealth calls to discuss self-care maintenance after discharge as a strategy to mitigate adverse health outcomes; and offer provisions of resources, including a cookbook by the American Association for Heart Failure Nurses (AAHFN).

During telehealth calls, we observed gaps in self-care for retired older adults (62+), …