Digital Commons Network^™

In The Surgical Patient Requiring Neuromuscular Blockade, Is There An Increased Incidence Of Postoperative Adverse Respiratory Events With Rocuronium Or Vecuronium?, Martha Claudine Boos

Doctoral Projects

It is estimated that up to 45% of surgical patients will have postoperative residual neuromuscular blockade (NMB) upon arrival to the postanesthesia care unit (PACU), and incomplete recovery can impair upper airway function and contribute to adverse respiratory events (Nagelhout & Plaus, 2014). This retrospective cohort study examined whether there was an increased incidence of postoperative adverse respiratory events with the neuromuscular blocking agents Rocuronium or Vecuronium. Inclusion criteria included any surgical patient ages 18-65 receiving NMB agents Rocuronium or Vecuronium during the procedure. Exclusion criteria included any surgical patient ages 18-65 with ASA classification > 4, any emergent cases, any …

The Incidence Of Early Stage Postoperative Nausea And Vomiting Following The Use Of Nitrous Oxide And Prophylactic Antiemetic Therapy: Implications For Clinical Practice, James Sullivan

Doctoral Projects

Nitrous oxide (N₂O) is a volatile agent currently used during the induction and maintenance of general anesthesia. Since it’s discovery in 1786 by Dr. Priestly, it is the oldest volatile agent to find continued use in current practice (Kossick, 2014). In conjunction with its extensive history is the debate regarding its emetic properties. Numerous studies have investigated the effect of nitrous oxide to produce postoperative nausea and vomiting (PONV) with varying and often conflicting results. Generally speaking, nitrous oxide is theoretically an emetic and is believed to be associated with PONV (Tramer, Moore, & McQuay, 1996). This has …

Decreasing The Incidence Of Postoperative Delirium In The High Risk Elderly Population: A Plan For Translating Best Practice Guidelines Into Anesthesia Practice, Meredith Gomes

Doctoral Projects

Postoperative delirium is a potentially life-threatening change in cognition that occurs approximately 24 to 72 hours after surgery and is a frequent complication affecting the elderly population. The development of this postoperative complication has been found to increase mortality and morbidity, prolong hospital stays, and has also been associated with a steady decline in cognition. With the number of individuals 65 years or older predicted to increase over the next two decades and the incidence of postoperative delirium potentially affecting over 50% of postsurgical elderly patients, preventive anesthetic methods must be investigated. In early 2015 the American Geriatric Society published …

Using A Cost Benefit Analysis To Support The Development Of A Comprehensive Business Model For A Pre-Filled, Pre-Labeled, Pre-Diluted, Sterilely Packaged, Ready-To-Use, Syringe-Based Anesthesia Delivery System, Lance B. Kennedy

Doctoral Projects

The foundation of Certified Registered Nurse Anesthetists’ (CRNAs) entire profession is built on the ability to provide anesthetic services using a variety of medications in the safest, most efficient, cost-effective way possible. The purpose of this capstone is to address, via a comprehensive cost benefit analysis, whether pre-filled syringe drug trays are a more cost-effective way to address problems as compared to vial-filled drug trays and to implement the necessary transitions in order to improve outcomes. There are a number of identifiable problems related to anesthesia medication delivery via vial-filled medication, including increased cost of healthcare, decreased patient safety to …

Is Dexamethasone 4mg A More Effective Anti-Emetic Than Dexamethasone 8mg For The Prevention Of Early Post-Operative Nausea And Vomiting In Women Undergoing Laparoscopic Gynecological Surgery?, Steven B. Doyle

Doctoral Projects

Postoperative nausea and vomiting (PONV) is a common problem in the surgical setting. It affects as much as 20 to 80 percent of patients undergoing surgery (D'souza, Swami, & Bhagwat, 2011). PONV can lead to increased patient costs and recovery time by causing the patient to stay in the healthcare facility for a longer period of time. A retrospective cohort study was completed to examine whether or not there was a significant difference between patients who received 4mg and 8mg of dexamethasone in the incidence of PONV. All patients studied received ondansetron intraoperatively as their primary anti-emetic. English speaking patients …

Would Not-For-Cause Randomized Drug Testing Reduce The Incidence Of Drug Misuse Among Certified Registered Nurse Anesthetists?, Katy G. Gavin

Doctoral Projects

Healthcare providers have easy access to drugs of various types and strengths, often times highly addictive drugs, all the while working long hours in high stress environments. Studies show that anesthesia providers, among other healthcare providers, are at highest risk for drug misuse. There are numerous ways substance abuse and addiction among anesthesia providers could be decreased significantly or prevented completely including, but not limited to, education, routine mental health evaluations, stress coping through exercise, debriefing sessions, and mentoring. This project focused on prevention through randomized not-for-cause drug testing. After an exhaustive review of the literature was performed, implications for …

Does The Use Of A Regional Nerve Block Decrease The Incidence Of Post Operative Nausea And Vomiting, Decrease Pain Scores, Or Decrease Discharge Time Compared To General Anesthesia Alone?, Donald Lane Whitney

Doctoral Projects

Problem Statement: The use of regional anesthesia in orthopedic surgeries has been shown to decrease the rate of postoperative nausea and vomiting (PONV), postoperative pain, and decrease postoperative discharge time. However, some healthcare facilities continue to provide anesthesia for these procedures without the use of regional anesthesia techniques.

Purpose: The purpose of this capstone project was to determine if the addition of a regional anesthetic technique would be beneficial to the patient and cost efficient to the healthcare facility.

Methods: A retrospective chart review was conducted and data collected on the population of interest. Inclusion criteria were patients undergoing orthopedic …

The Effectiveness Of A Preoperative Multimodal Antiemetic Regimen On Reducing Early Postoperative Nausea And Vomiting In Total Joint Arthroplasty Patients, Jerry Mosley

Doctoral Projects

Postoperative nausea and vomiting (PONV) occurs frequently in all types of surgeries including after total joint orthopedic procedures. The resulting PONV can lead to many unwanted occurrences including immobilization, distress, and many serious adverse health complications. These unwanted occurrences may then lead to increased cost to the patient and healthcare facility. Administration of a preoperative multimodal regimen known to reduce PONV has the potential to reduce such unwanted anesthetic side effects influencing a reduction in overall healthcare cost. The purpose of this study is to determine the effectiveness of the preoperative kit which includes the administration of metoclopramide, famotidine, ondansetron, …

Utilization Of A Focus Group To Evaluate The Perceived Stress Levels And Coping Mechanisms Of Student Registered Nurse Anesthetists, Cillora Hicks

Doctoral Projects

Each year, thousands of Student Registered Nurse Anesthetists (SRNAs) matriculate into a nurse anesthesia educational program, confronted with unforeseen challenges and stressors. Although a certain amount of stress is essential to stimulate learning, excessive stress can have dire consequences in delaying a students’ academic and clinical progression. The purpose of this Capstone Project was to explore and describe the perceptions of 12 SRNAs relevant to their stress levels and coping behaviors in the management of academic and personal stress. The clinical research questions guiding the study examined the stress levels and coping behaviors of the SRNAs as measured by the …

The Use Of An Intraoperative Forced Air Warming Device Alone Versus Warmed Intravenous Fluid Infusion And Forced Air Warming Versus Warmed Intravenous Fluid Alone In Patients Undergoing Open Intra-Abdominal Surgery, Charlie Adderley

Doctoral Projects

Patients undergoing open abdominal surgery with general anesthesia are at increased risk for adverse outcomes associated with disturbances in thermoregulation during the intraoperative phase of the surgical experience. The purpose of this quantitative capstone project was to examine and compare the differences between the use of an intraoperative forced air-warming device and a forced air warming device plus warmed intravenous fluid (IVF) in the management of postoperative hypothermia, as measured by the postoperative temperatures of patients undergoing open abdominal surgery. A comparative retrospective chart review was performed using two groups to assess the effectiveness of preventing postoperative hypothermia in this …

The Regional Study Of Sleep-Related Behaviors Of Nurse Anesthetists: Personal And Professional Implications: A Replication Study, Jarrod Fontenelle

Doctoral Projects

Universally, anesthesia providers are expected to be knowledgeable, astutely responding to clinical challenges while maintaining a prolonged vigilance for administration of safe anesthesia and critical care. A fatigued anesthetist is the consequence of cumulative acuity manifesting as decreased motor and cognitive powers. This results in patient harm, impaired judgement, late and inadequate responses to clinical changes, poor communications, and medical errors. With increased expectations and medical-legal claims, anesthesiologists work to provide efficient and timely services, but are rendered sleep deprived themselves. It is the right time to address the issue of the health of anesthesia providers and the profession. The …

Phenylephrine Versus Ephedrine: Safest Vasopressor For The Neonate During Caesarean Section, James S. Hale Jr.

Doctoral Projects

One of the most common side effects of spinal anesthesia is the development of hypotension. Data collected has determined that 80% of parturients that undergo spinal anesthesia for this mode of delivery experience hypotension (Chestnut et al., 2014).

Hypotension, if sustained and severe, can lead to fetal hypoxia, neonatal depression or injury, and decreased uteroplacental perfusion. Hypotension can also cause severe health issues for the parturient including apnea, altered level of consciousness, cardiac arrest, and pulmonary aspiration. This systematic review of the literature was conducted to determine whether the administration of phenylephrine or ephedrine was safer for the neonate to …

A Pilot Study Of Propofol As An Anti-Emetic In Laparoscopic, Gynecologic Surgery Patients, Flem-Flam Aaron Flemister

Doctoral Projects

The goal of this project was to use sub-hypnotic doses of propofol to decrease post operative nausea and vomiting (PONV) rates in the immediate post-operative period in females, ages 18-65, undergoing laparoscopic gynecologic surgery.

PONV is one of the largest complications of anesthesia affecting 20-30% of all surgical patients. Risk factors associated with PONV are female gender, laparoscopy, general anesthesia, opioids, volatile agents, and post-operative pain; all of which are frequently encountered. The incidence of PONV can prolong recovery time, delay discharge, increase patient cost, decrease patient satisfaction, and can cause significant medical complications. Propofol has previously demonstrated anti-emetic properties; …

Comparison Of Outcomes In Heart Bypass Patients Undergoing Insertion Of An Internal Jugular Vein Central Line By Ultrasound Compared To Traditional Landmark Technique, Sayha Ol Ma

Doctoral Projects

Patients that undergo heart bypass surgery require central line placement from a healthcare provider. To place this device one must use either ultrasound guided or landmark technique. Using ultrasound guided compared to landmark technique may reduce complications. The goal of this project was to determine if ultrasound use of central line placement is a safer practice compared to using the traditional technique.

A retrospective chart review was performed to compare internal jugular central line placement by ultrasound with the traditional landmark placement to evaluate results related to patient outcomes. Data from fifty health records were analyzed using chi-square. The complications …

The Use Of Peer Mentoring To Decrease Stress In Student Registered Nurse Anesthetists, Elise G. Head

Doctoral Projects

Nurse anesthesia programs throughout the nation are extremely competitive with strict admissions criteria and demanding curriculum. Students enrolled in these programs, termed Student Registered Nurse Anesthetists (SRNAs), experience high average daily stress levels throughout their enrollment in a nurse anesthesia program (NAP). This quantitative study examined whether there is a decrease in SRNA average daily perceived stress when peer mentoring is employed. Inclusion criterion was all SRNAs enrolled in a single 3 year, post-baccalaureate Doctor of Nursing Practice (DNP) NAP at a comprehensive Carnegie research university with Southern Regional Education Board-Level 1 designation. Fifty-six SRNAs were surveyed using a modified …

Cerebral Oximetry Readings In The Sitting Position Versus Supine Position For Patients Undergoing General Anesthesia, Christopher Turner

Doctoral Projects

Problem: Inadequate cerebral blood flow is a significant risk for patients undergoing surgery in the sitting position. Placing the patient in a sitting position may cause a drop in pressure at the level of the brain when compounded with induction and maintenance of general anesthesia. These changes may cause a decrease in cerebral blood flow and oxygenation. Inadequate perfusion for a prolonged period of time could produce negative neurological consequences in the short and long term postoperative period.

Purpose: The purpose of this project is to determine if there is a significant drop in cerebral oximetry, from baseline, when patients …

The Effects Of Consistent Exercise On Work Productivity Among Anesthesia Providers, Samuel K. Self

Doctoral Projects

Studies have been done that link various measurements of workplace productivity with varying levels of individual health. A thorough literature review examined the research to find any significant relation between regular exercise (as defined by the American Heart Association) and an improvement in workplace productivity among anesthesia providers. A Qualtrics survey was used to measure specific results regarding exercise activity and work productivity from anesthesia providers. This group included 53 certified registered nurse anesthetists and anesthesiologists. Descriptive analysis, Chi-square test of Independence, Fisher’s Exact test, and Cramer’s V test were all used to analyze the data. One significant correlation was …

Finland Vs. The United States: Similarities And Differences In Kindergarten, Rebecca L. Ulrich

Honors Theses

Understanding successful educational systems and the qualities they incorporate is imperative in the quest for student achievement. Finland is known worldwide for their success in the classroom and its educators do a great job preparing young students for primary education in their Kindergarten classrooms. Kindergarten is a very important grade for young students. It prepares them for grades to come and introduces them to a school setting. By using qualitative research methods and comparing and contrasting of published data, Finland’s kindergarten system and three kindergarten teachers who represent the typical kindergarten milieu in Lamar County, Mississippi will be analyzed through …

Mississippi Teachers’ Perception Of Merit Pay, Diana M. Stephens

Dissertations

Teachers are the center of increasing student achievement and student motivation, therefore a way to motivate teachers must be implemented. Although most teachers are motivated intrinsically for their love of teaching, external motivation could add another component to teacher success. Merit pay is one way to provide an external motivator to change teaching strategies in order to increase student achievement. This study measured teachers’ perceptions in Mississippi who are involved in the merit pay pilot program. There are four school districts participating in the pilot program and two of those school districts were surveyed for this study, a central Mississippi …

Robert Frost’S New Hampshire, Philip Larkin’S England, And Seamus Heaney’S Ireland: Non-Urban Place And Democratic Poetry, Faisal I. Rawashdeh

Dissertations

In Anglo-American Modernist poetry, place is reduced to an analogue for the cultural degradation brought forth by the disruptive experience of modernity. This demotion stands in sharp contrast to the representation of place as a center of value in the poetry of Robert Frost, Philip Larkin, and Seamus Heaney. In this dissertation, I shall explain this value in terms of its connection to a particular cultural substance which Frost, Larkin, and Heaney deem foundational for their non-ideological terms of belonging to place. Frost embraces New England vernacularism first as the basis for his egalitarianism and second as the core substance …

Development Of Dual-Cure Hybrid Polybenzoxazine Thermosets, Jananee Narayanan Sivakami

Dissertations

Polybenzoxazines are potential high performance thermoset replacements for traditional phenolic resins that can undergo an autocatalytic, thermally initiated ring - opening polymerization, and possess superior processing advantages including excellent shelf-life stability, zero volatile loss and limited volumetric shrinkage. The simplistic monomer synthesis and availability of a wide variety of inexpensive starting materials allows enormous molecular design flexibility for accessing a wide range of tailorable material properties for targeted applications. Despite the fact, once fully cured, benzoxazines are difficult to handle due to their inherent brittleness, leaving a very little scope for any modifications. The motivation of this dissertation is directed …

Dual-Interval Spaces: Interrelations Between Interval Classes 1 And 5, Local Pitch Centers And Form In Dmitri Shostakovich's Piano Sonata No. 1, Op. 12, Tae Young Hong

Master's Theses

Dmitri Shostakovich’s Piano Sonata No. 1, written in 1926, is one of his most complex and lengthy works for piano. In contrast to the conservative style used in his critically-acclaimed Symphony No. 1, Op. 10, composed a year earlier, the sonata employs a highly modernistic idiom which predominated the composer’s output in the late 1920’s. The musical surface of the sonata was crafted by an extensive use of interval classes 1 and 5 which serve as the primary means of structuring pitch material.

This paper examines the surface combinations of two interval classes as well as their interaction with …

Gut Microbiota Of Migratory Passerines At Stopover, William Bagley Lewis

Master's Theses

Although the gut microbiota provides many beneficial functions to animal hosts, relatively little is known about the gut microbiota of passerines. It is likely that gut microbes are especially important during the migratory phase; however gut atrophy experienced during prolonged migratory flight may cause disruptions of the stable microbiota. Fecal samples were collected from several species of passerine after crossing the Gulf of Mexico during spring migration and before crossing during fall, and microbiota communities were analyzed using next-generation sequencing. Despite showing large inter-individual variation, a core microbiota composed largely of Firmicutes and Proteobacteria was identified in all birds. Microbiota …

Bioarchaeological Analysis Of Oak View Landing (40dr1): An Archaic Population In The Kentucky Lake Reservior, Katy D. Grant-Mclemore

Master's Theses

The biocultural examination of the Archaic population recovered at Oak View Landing (40DR1) investigates the lifeways and adaptations of prehistoric people as they reflect sociopolitical and subsistence strategies.

A comprehensive bioarchaeological analysis was conducted on the adult individuals (18 males, 16 females, 16 of indeterminate sex) excavated from a multiple occupation site located along the Tennessee River in Decatur County, Tennessee. Skeletal indicators used to understand biocultural phenomena were assessed macroscopically on cranial and postcranial elements. Furthermore, mortuary data, for adults and subadults, were used to determine any patterns of preferential treatment at death.

Results from this study indicate that …

The Vascular Flora Of Wayne County, Mississippi, Daniel M. Mcnair

Master's Theses

The vascular flora of Wayne County, Mississippi, was surveyed from 2013–2015, and the species of native and naturalized plants are listed. In total, 1,135 species were identified from field collections, previously collected herbarium specimens, and field observations. These belong to 556 genera and 165 families. Four of these species represent first recorded occurrences in the state of Mississippi: Blyxa aubertii Rich., Gomphrena serrata Pav. ex Moq., Isoetes valida (Engelm.) Clute, and Polypogon interruptus Kunth. GPS coordinates are given for important collection sites representing the diversity of plant communities in the county. All voucher specimens from the survey are deposited in …

Staging Sex Or Fighting Foreignness? Marlowe's Edward Ii As Xenophobic Drama, James D. Baker

Master's Theses

Christopher Marlowe’s drama Edward II has long been known for its representation of a close male, arguably homosexual, friendship between King Edward II and his favorite, the French Piers Gaveston, as well as their union’s negative effects on the court. Indeed much criticism exists on the common belief that the characters’ relationship is problematic in early modern England both because the two characters are male and because there is an obvious class divide. However, critics have seemed to overlook Gaveston’s being French, even in light of the massive immigration to England during the late sixteenth and early seventeenth centuries. This …

Maternal Effects And Offspring Behavior: Potential Contributors To The Lack Of Recruitment In Mississippi Gopher Tortoises (Gopherus Polyphemus), Aaron L. Holbrook

Master's Theses

Federally threatened in Mississippi, gopher tortoise (Gopherus polyphemus) populations within the state have strongly variable recruitment and are generally in decline. Hatching success is significantly lower in Mississippi than in any other part of the species’ range , and most hatchlings die within the first year. There are few refuges where survival and hatching success is high. Here I compare two populations that differ in recruitment and offspring survival for differences in corticosterone. Corticosterone is a hormone that influences both energy availability and is released in elevated levels during stressful events, like living in poor quality habitat. Prolonged corticosterone elevation …

High Resolution Melt Analysis Of Samples With Differential Dna Methylation To Identify Tissue Source Of Origin, Stephanie M. Ledgerwood

Master's Theses

In Forensic Science casework, identifying the source of a tissue can assist in crime scene reconstruction. Currently, presumptive testing methods to identify tissue type are utilized in crime scene laboratories, but there is a need for a more reliable confirmatory test for tissue type identification. High Resolution Melt (HRM) analysis is an innovative technology that has the potential to determine tissue types through variations in DNA methylation patterns. Recently, DNA methylation patterns have been found to correspond with specific tissue types in particular regions of DNA. Two markers, B_SPTB_03 and DDX4 have been effective in differentiating sperm from other tissue …

Burial Chronological Sequencing Of The Colonial Maya Cemetery At Tipu, Belize Using Fluoride Ion Analysis, Nicole Musselwhite

Master's Theses

This thesis ascertains the sequence of burials using fluoride ion electrode analysis at the colonial cemetery at Tipu, Belize in order to explore demographic and other cultural effects associated with European contact. The cemetery at Tipu in west central Belize, dating from within the first century of Spanish contact, has provided one of the largest and best preserved Maya skeletal series, with over 500 burials recovered. While this series has undergone vast amounts of analysis, there has yet been an analysis conducted to view how patterns changed over time. This is of interest given the rapid culture change associated with …

Achieving Relationships, Frederick C. Melancon

Master's Theses

These stories attempt to follow John Gardner’s instruction to create a dream that will engage the reader. Mirroring the goal that an author has to create a relationship with his audience, each story in turn focuses on emotional details that convey the characters’ feelings of isolation or, alternatively, inclusion in their communities. In the first story, a young man tries to recreate his father’s king cake. In the next, a middle school girl fixates on her relationship with her sister. Trying to recapture the memory of a lost daughter, a man searches for the perfect nectar snowball. A mom, then, …