Medicine and Health Sciences Commons^™

How Do Food Shopping Behaviors Differ Between High-Income And Low-Income Shoppers In The Grand Rapids Metropolitan Area?, Alison M. Cooney

Masters Theses

Background: The social determinants of health and health equity are influenced by access, environment, and socioeconomic status (SES). Health inequities are preventable and can be avoided with systemic policy change surrounding the distribution of wealth and resources. Few studies have researched the differences in different income levels and the influence income has on food shopping behaviors.

Objective: The purpose of this study was to investigate the differences in food shopping behaviors between high-income and low-income shoppers living in the same zip code. Subjects Sixty-eight individuals who live in the 49341 zip code which represents a small city in Kent County, …

A Standardized Unit Based Process For Obtaining Heart Failure Patient Weights, Lesli E. Teed

Master's Projects

Introduction: A CNL student-led process improvement process improvement project was proposed to help improve the accuracy of Heart Failure patient weights on a geriatric specialty unit. Cardiology voiced a preference for patients to be weighed using electronic standing scales rather than in-bed scales to improve accuracy. A literature review revealed that in-bed scale weights were less accurate due to inconsistencies in zeroing the bed prior to obtaining the weight, not removing excess patient care equipment and bed linens, and not ensuring that the patient was wearing a minimal amount of clothing.

Methods: Electronic standing scales were purchased, current practice state …

Implementing Purposeful Rounding As A Quality Improvement Project To Improve Patient Satisfaction In The Emergency Department, Kersten O'Brien

Master's Projects

Purpose: The purpose of this paper is to describe a quality improvement project to develop and implement a purposeful rounding protocol to improve patient satisfaction and call light rates which affect both patient and nursing staff satisfaction in the emergency department (ED). Importantly, patient satisfaction scores in the ED tend to be low but high scores are related to improved competitive advantage, reimbursement rate, patient outcomes, and nursing staff interruptions.

Methods: A literature review was conducted to determine best practices. Using the lean process and the Plan-Do-Study-Act (PDSA) model, this information was used to identify opportunities for improvement and to …

Meta-Analysis Of The Association Between Acute Particulate Matter Exposure And Cardiovascular Disease, Issa El-Kildani

Masters Theses

Cardiovascular disease, which involves a wide range of conditions, including narrowed or blocked coronary arteries, has remained the leading cause of death in the United States for over 50 years. The majority of cardiovascular conditions are preventable, which can be identified through risk factors. However, maintaining healthy life choices can be difficult for most Americans, as the vast majority live in populated urban cities. Urban life can pose hazardous conditions to individuals, especially air pollution. Air pollution includes gaseous pollutants, such as carbon monoxide, nitrogen oxides, ozone and sulfur dioxide, and particulate matter. Of these pollutants, particulate matter has become …

From The Dinner Pot To Smoking Pot; How A Better Understanding Of Cannabidiol In Crayfish Could Alleviate Anxiety And Modulate Hunger, Christopher Michael Timmer

Masters Theses

Anxiety affects approximately 1/3 of the US population and presents in many different forms, ranging from social to panic disorders. It also presents with high comorbidity for other mental disorders. One treatment is Selective Serotonin Reuptake Inhibitors (SSRIs) which allow for increased activation of serotonin (5-HT) receptors. SSRIs come with an extensive list of side effects, which can fail to maintain quality of life. Cannabidiol (CBD) is a cannabis derived compound which has been shown to decrease anxiety by activation of multiple subtype 5-HT amine receptors. CBD has few side effects, is not psychoactive, and exhibits anti-psychotic properties. The current …

Creating A Quality Improvement Toolkit To Identify & Address Gaps In The Care Of Older Adults With Hip Fracture, Amanda J. Covell

Doctoral Projects

Introduction: Traumatic hip fracture remains a major cause of disability, decline, and mortality for adults over 65. Gaps remain in the consistency of care and services hip fracture patients receive during hospitalization and post-discharge, leading to adverse outcomes, including MI, surgical site infection, poorly managed pain, and increased mortality. To help address these inconsistencies, the AAOS released updated clinical practice guidelines for management of hip fracture care in the elderly in 2014. These guidelines examine the entire hospitalization process for this population and set forth evidence-based standards to assist with improving outcomes for hip fracture patients.

Objectives: Five of the …

Video Education For Improved Education Of Newly Diagnosed Multiple Sclerosis Patients, Theresa Mccrumb

Doctoral Projects

Anxiety and depression are prevalent in multiple sclerosis (MS) patients, especially those newly diagnosed. Receiving a diagnosis of MS can be overwhelming and impact patients in multiple areas including physical issues, cognitive changes and anxiety and depression (Kantor, Bright & Burtchell, 2017). This anxiety and depression can cause patients to be less engaged in their plan of care and thereby reduce their quality of life (Rieckmann, et al., 2015). According to the Multiple Sclerosis Association of America (MSAA), four of 10 MS patients are diagnosed with depression and anxiety, with the highest incidence at diagnosis (Multiple Sclerosis Association of America, …

The Perceived Effects Of Occupational Therapy Interventions For Those Who Recently Transitioned From Homelessness To Permanent Housing, Sydney Krol, Madison Muir, Katie Johnson, Kristin Hazlett, Kaelyn Hughs

Community Based

OBJECTIVE. The study's objective was to examine the perceived effects of occupational therapy services for families who have recently transitioned to permanent housing from a period of homelessness.

METHOD. The study used a qualitative research design. One family received occupational therapy interventions administered by occupational therapy student researchers. Exit interview was audio recorded and transcribed.Themes and codes were derived from the transcription.

RESULTS. Three themes and seven codes were identified, which encompassed the participants perception of the intervention. The themes were lifestyle transformation, mindset development, and client centered care. The codes were organization and planning, roles and routines, goal progression, …

Barriers And Facilitators To Voting For People With Disabilities In Michigan Rural Communities, Christian Aguilar-Quiroz, Kaylyn Brzys, Chris Paclibar, Kyle Witte

Community Based

Objective: In this study, we sought to investigate and obtain data on the perceived barriers and facilitators that rural Michigan residents with disabilities face throughout the voting process.

Method: We conducted two separate focus groups in two different rural areas of Michigan asking a series of semi-structured questions about the participants’ voting experiences. We obtained recorded interviews, qualitative data, of their answers to these prepared questions.

Results: Physical accessibility was limited by poor lighting for people with low vision problems and a lack of accommodations for those who are not able to stand for a prolonged time while waiting in …

Occupation-Based Learning Modules In Preparation For Parole: A Program Evaluation, Alisha Cheyne, Gabrielle Martino, Elizabeth Vander Wall, Natalie Wallace

Community Based

A qualitative research study was conducted that examined occupational therapy students’ fieldwork rotation at Muskegon Correctional Facility, where they implemented a 15-week pre-parole program. One focus group with three participants was conducted. Transcription, coding, and theming followed, providing five themes; restriction, OT perceptions, learning styles, future needs, and relationships. Results showed areas of needs within this population, ways occupational therapy can address this need, and general improvements that can be made to pre-release programs.

Exploratory Study Of Children With Sensory Processing Disorder (Spd) Without An Autism Spectrum Disorder (Asd) Diagnosis, Breanna Williams, Lauren Brown, Kendall Grzywa, Emma Green

Pediatrics

The purpose of this study was to explore the prevalence of children with sensory processing disorder (SPD) without an autism spectrum disorder (ASD) diagnosis. Examples of these diagnoses include attention deficit hyperactivity disorder (ADHD), cerebral palsy (CP), posttraumatic stress disorder (PTSD), Oppositional Defiant Disorder (ODD), and Reactive Attachment Disorder (RAD). This was an exploratory descriptive study that gathered quantitative data through the Sensory Processing Measure (SPM) Home Form. The SPM Home Form was provided by occupational therapy (OT) students and completed by the child’s caregiver. The scores fell into three interpretive ranges: Typical, Some Problems, and Definite Dysfunction. Researchers hypothesized …

Caregiver Perspective On Sensory Diet And Therapeutic Listening For Children With Autism Spectrum Disorder And/Or Sensory Processing Disorder, Mikayla M. Brett, Lynette Zulquairnain, Katlyn Ribant

Pediatrics

Due to the high prevalence of Autism Spectrum Disorder (ASD) and Sensory Processing Disorder (SPD), there is a high demand for more research on effective interventions in order to improve quality of life and engagement in meaningful occupations for individuals with ASD and/or SPD. Sensory Diet (SD) and Therapeutic Listening © (TL) are interventions commonly utilized with individuals with ASD and/or SPD, however, there is limited research on their combined use. The purpose of this study is to determine the effectiveness of the combined occupational therapy (OT) interventions of SD and TL on the occupational performance of children with ASD …

Microbial Experience Influences Tumor- Infiltrating T Lymphocytes, Hanna Groeber

Masters Theses

Immune cells, including T cells, have been used for anti-cancer therapy with varying degrees of success. One potential reason for immunotherapy failures in clinical trials may be that typical specific pathogen free (SPF) mice do not accurately replicate human microbial experience, which has important influence on shaping the adaptive immune response. Recently, several previous studies have shown that the immune system of SPF mice more closely resembles newborn human immunity, whereas immune systems from mice exposed to diverse pathogens more closely reflect adult human immunity.

To study the impact of microbial experience on the immune response, we have adopted a …

Dosimetric Effect When Treating Multiple Lesion Srs Using Vmat With And Without Jaw Tracking, Mindy Bui

Culminating Experience Projects

The main purpose of this study was to determine if jaw tracking or non-jaw tracking is the superior technique for patients with multiple brain metastasis that are treated with Volumetric Modulated Radiation Therapy (VMAT) Stereotactic Radiosurgery (SRS). Doses to the organs at risk (OAR) and the target volumes were analyzed using the dose volume histogram (DVH) and dose statistics for each plan. The goal of this study included analyzing the dosimetric effect on the organs at risk and the normal tissue when using jaw tracking versus non jaw tracking. The pros and cons for each technique were identified as well …

Dosimetric Comparison Of Hypofractionated Prostate Radiation With Simultaneous Integrated Boost And Conventional Fractionation With Sequential Boost, Kristina Sammon

Culminating Experience Projects

Introduction: Hypofractionated treatment delivery regimens are associated with better overall long-term disease control for prostate cancer. For patients with high-risk disease, there may be an indication for treatment of the surrounding pelvic lymph nodes for better over-all disease control. In order to achieve a hypofractionated regimen with treatment to the surrounding pelvic lymph nodes a simultaneous integrated boost technique is employed. There are concerns regarding achievability of target dose coverage and limitation of dose to the surrounding organs at risk with this fractionation.

Methods: This study is a retrospective dosimetric analysis of 7 randomly selected patients with high-risk prostate cancer. …

The Air Gap Effect Between A Bolus And The Skin Surface For Chest Wall Irradiation, Marisa Clark

Culminating Experience Projects

Planning technique and bolus choice are important aspects in planning chest wall irradiation (CWI). Many previous studies have tested various combinations of photon energies, electron energies, bolus types and sizes, air gaps sizes, and treatment methods. This study aims to assess the effect of smaller, clinically relevant air gap sizes on specific chest wall treatments using a variety of common bolus types. Due to the Covid-19 pandemic, no data was able to be collected and was instead fabricated by the researcher. Four different treatment plans were created on a phantom patient using various energies of photons (6MV and 10MV) and …

A Comparison Between Rectal Dose In Prostate Radiotherapy Patients Treated With Spaceoar Hydrogel Present Versus Patients Treated Without Spaceoar Hydrogel., David Desano

Culminating Experience Projects

Introduction: External beam radiation therapy is a common treatment option for prostate cancer patients with localized disease. Radiation-induced side effects associated with the rectum can impact a patient’s ability to complete treatment or affect the quality of life years after radiation treatment. Spaceoar hydrogel has been developed to reduce radiation dose to nearby pelvis structures, and therefore decreasing potential side effects.

Methods: A total of 20 patients who received definitive radiation therapy to the prostate and seminal vesicles were selected and placed into 2 groups (10 spaceoar, 10 non-spaceoar). The individuals’ age ranged from 60 to 79 years old with …

An Exploration Of Leadership Qualities Demonstrated During Level Ii Fieldwork, Amy Maurer, Summer Besteman, Jessica Mooney, Katelyn Campbell

Education

Background. Occupational therapy (OT) students are expected to demonstrate leadership qualities throughout their Level II Fieldwork experiences; however, it has been reported that students lack this quality. The purpose of this project was to identify the leadership characteristics that master’s-level OT students demonstrate and develop during their Level II Fieldwork experiences.

Method. This study utilized an online survey tool, Qualtrics, to understand the perceptions of Fieldwork Educators (FWEds) who have taken a Level II Fieldwork student within the past five years. A code-recode procedure was used to analyze open-ended questions. The frequency and mode of responses were used to report …

Older Adults’ Perspectives On Occupational Supports In Alternative Housing Communities, A'Via Coleman, Lisa Goolsby, Kara Lurvey, Elizabeth Von Achen, Heather Veverica

Older Adult

The Problem: Many older adults in the United States wish to age in place but may find their current living environment is not suitable as they age. Alternative housing supports may improve the ability of older adults to live in their own home and community safely while performing necessary occupations.

The Resolution: Alternative housing communities offer a variety of supports that older adults value having access to, even if they are not always utilized including transportation, social interaction, volunteer opportunities, home maintenance, an accessible location, and the togetherness of community.

The Determination Of Phosphorylation Of Nato3 By Pka, Miranda M. Regenold

Masters Theses

One of the leading regulators of neuronal cell differentiation in the CNS is the family of basic helix–loop–helix (bHLH) transcription factors. One of these proteins, Nato3, is associated with the formation of dopaminergic neurons. Transcription factors can be regulated by kinase activity, and in order to detect the associated change of phosphorylation of Nato3, we have generated Nato3 with specific epitope tags that allow for the detection and isolation of the Nato3 protein. Through subcloning techniques and a successful transformation of the Nato3 gene with the sequences of the 3X-Flag epitope and the Myc epitope into the pcDNA3.0 vector, we …

Evidence-Based Policy And Procedure Review System, Meredith A. Stokes

Doctoral Projects

Policies and procedures guide practice and the care of patients in every field of healthcare. Incorporating best practice evidence into clinical practice is a critical step towards providing safer patient care and improved patient outcomes. The challenge has been finding a way to incorporate best practice evidence into policies and procedures. Accordingly, an evidence-based project to answer the following clinical practice question was proposed: What is an evidence-based strategy for reviewing, updating, and disseminating policies and procedures for office staff at a cancer treatment organization? Through the use of Donabedian’s Model for Quality Improvement, student created tools, and an evidence-based …

Honoring Patient Do Not Resuscitate Wishes And Reducing Harm During Transitions Of Care: A Quality Improvement Project, Emily L. Kraus

Doctoral Projects

Objectives: The quality improvement project objectives were to honor documented Do Not Resuscitate wishes in emergency departments by examining and improving workflow during primary care to emergency department transitions. A location for advance care planning documentations was designated for advanced directives, yet not utilized.

Methods: Mixed method, pre-/post-comparison, and thematic design examined clinicians and patients in a primary care office and two emergency departments in a Midwest healthcare system. Data was collected from patient records, clinician surveys, and observation of workflow. Descriptive statistics, frequency counts and non-parametric tests were used to analyze data.

Results: Patient charts were audited (N=261 [pre=124; …

Evaluation Of The Integration Of Behavioral Health Services Into Primary Care, David B. Vander Ark

Doctoral Projects

Background: Primary care providers are increasingly challenged with managing individuals with behavioral health needs. Evidence suggests that integrating behavioral health services into primary care can improve individual health outcomes and can improve access to behavioral health services.

Objectives: The purpose of this project is to evaluate key outcomes following the evidencebased integration of behavioral health services into a primary care practice.

Methods: Using the Collaborative Practice Model as the implementation model, the behavioral health leadership team added a licensed social worker to a primary care practice on a pilot basis. The social worker offers short-term solution-focused therapy, focusing on depression …

Self-Monitoring Of Blood Pressure In Community – Dwelling Senior Adults, Laura N. Love

Doctoral Projects

Unregulated hypertension is a public health concern. Hypertension is a chronic disease affecting adults across the lifespan. Although hypertension is easy to diagnose and treat, rates of blood pressure control continue to be low (AHA, 2017). Because of this, it is imperative to employ novel strategies for blood pressure control; especially in high risk populations. The purpose of this evidence-based, project was to determine whether self-monitoring of blood pressure (SMBP) improves knowledge about hypertension, while also increasing the frequency of SMBP. Another outcome of interest was a reduction in mean systolic blood pressure for the cohort. The project enrolled participants …

Improving Blood Pressure Control Among Patients Diagnosed With Hypertension In A Primary Care Setting, Eriko Apriliando

Doctoral Projects

Hypertension affects over 38% of adults or approximately 103 million Americans, costing around $131 billion annually in treatment and loss of productivity. It is also an independent risk factor for coronary events, heart failure, stroke, and end-stage renal disease contributing to 410,624 United States (U.S.) deaths in 2014. The American Heart Association (2016) has released the Measure Accurately, Act Rapidly, and Partner with Patient (MAP) protocol in order to address this issue. This project focused on implementing parts of the MAP protocol. The purpose was to improve blood pressure (BP) control of patients diagnosed with hypertension in a primary care …

Implementation Strategies To Reduce Hospital Readmission Rates In Adults With Sepsis: A Quality Improvement Project, Erin Kucharek

Doctoral Projects

Background: Sepsis is a concern in healthcare, as patients are 2 to 3 times more likely to be readmitted to the hospital than those with other illnesses. Readmitted patient with sepsis costs the healthcare system $3.5 billion dollars per year. Effective care coordination is a tool that decreases readmission rates in other illnesses and is likely applicable to those with sepsis. The purpose of this quality improvement project was to determine if primary care provider follow-up appointments, increased home care utilization, and patient education would reduce sepsis readmissions.

Methods: The Transitional Care Model guided project design and The Kotter Model …

Utilization Of Patient Toolkit And Discharge Algorithm For Providers To Reduce Readmission Due To Repeat Ground Level Fall, Sara Karl

Doctoral Projects

Introduction. Falls are the leading cause of injury and injury death in adults over the age of 65. A retrospective examination at Level 1 trauma center in the Midwest found that 19.4% (118/605) of older adults admitted with a ground level fall were readmitted with a subsequent fall and injury. The aim of this quality improvement initiative is to determine if the implementation of an evidenced based patient toolkit and a discharge algorithm for providers will reduce outpatient falls. The objective was to reduce hospital readmission due to repeat fall.

Methods: The design of this project was mixed methods, observational, …

Increasing Annual Retinal Exams Among Patients With Type 2 Diabetes, Afokoghene H. Odhu

Doctoral Projects

The Center for Disease Control and Prevention (CDC, 2017) reports that approximately 30 million people in the United States (US) have diabetes. Approximately 8 million have diabetes retinopathy (DR) (CDC, 2018). DR is the leading cause of vision impairment in type 2 diabetes patients. Left untreated, DR can result in loss of vision and blindness (Hernández, Simó-Servat, Bogdanov, & Simó, 2017). The US spends approximately $500 million dollars annually in the treatment of diabetes-related blindness (CDC, n.d.). Early detection and management of DR through tight glycemic control, aggressive blood pressure and lipid management is essential to preventing complications of the …

Implementation Of Early Mobility In The Pediatric Cardiac Intensive Care Unit, Kelly Lubbers

Doctoral Projects

Patients admitted to pediatric intensive care units and pediatric cardiac intensive care units often experience prolonged periods of immobility due to critical illnesses and surgical interventions. Many pediatric intensive care unit survivors develop physical and developmental disabilities that have long-lasting impacts into childhood and adulthood. Early mobility may be one aspect to mitigate the risks associated with pediatric intensive care unit admissions. Early mobility protocols have shown to be a safe and feasible intervention to encourage mobility in pediatric patients. This quality improvement project developed and implemented an infant holding tool to promote the mobilization of infant patients admitted to …

The Impact Of A Pediatric Nurse Residency Program On Newly Licensed Registered Nurses At Six Months, Amy Rohn

Doctoral Projects

Background: Newly licensed registered nurses (NLRNs) face challenges as they transition from the academic setting to professional practice. These challenges can leave NLRNs feeling dissatisfied and vulnerable in their new positions. Nurse residency programs (NRPs) are an effective way to provide support for the NLRN.

Objectives: The purpose of this project was to evaluate the impact of a newly implemented NRP on NLRNs at six months related to their perception of support, patient safety, stress, communication/leadership, and professional satisfaction.

Methods: The project setting was a large midwestern children’s hospital. The sample consisted of twenty-six NLRNs who participated in the NRP …