Medicine and Health Sciences Commons^™

Implementation And Program Evaluation Pilot Study: Educating Health Care Providers About Protecting Population Health During Climate Change., Christine Fasching Maphis

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Recommendations regarding the need to prepare nurses and other health care providers (HCPs) for the health impacts of climate change (CC) have grown ubiquitous in the literature. Timely, efficient and sustainable strategies by the health care industry are necessary. Failure to act is predicted to result in catastrophic and lethal population health consequences. A growing body of research identifies related knowledge gaps and supports HCP competencies and best practice interventions to mitigate adverse population health impacts of CC. A social ecological framework and the PRECEDE-PROCEED approach were employed to develop and evaluate a series of online webinars designed to equip …

The Use Of Life-Like Robotic Animals In The Acute Care Setting To Assist In The Care Of Patients With Dementia, Abby Denby

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The purpose of this pilot project was to describe the effect of life-like robotic animals on the nurses’ ability to provide care, patients’ level of agitation, use of antipsychotic medications, restraint and sitter use for patients with dementia in an acute care setting. Nurses report challenges and feelings of helplessness while caring for patients with dementia. Dementia may cause depression, agitation, aggression (physical or verbal) and a decrease quality of life. Animal Assisted Therapy (ATT) is a growing therapy in many healthcare settings but there is a lack of literature specifically related to the use of AAT in the acute …

What Methods Can The Health Care Industry Implement To Reduce Energy Consumption And Waste Production From Patient Care To Limit Greenhouse Gas Emissions?, Danielle H. S. Good

Senior Honors Projects, 2020-current

Purpose: Climate change is a growing issue all around the world and has negative impacts on the environment and human health. The health care industry is a significant contributor to greenhouse gas emissions amplifying climate change. Health care establishments are in place to improve health but are inadvertently harming it at the same time. Methods:A review of the literature was conducted to determine the impact the health care industry has on climate change and what can be done to limit the impacts on the environment. Resources were collected from trusted organizations databases such as Healthcare Without Harm, …

Facemasks For Source Control: Testing Influenza Transfer To Bedside Tables, Adriane M. Biggio

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Abstract

The idea of using facemasks for source control is not new. The concept has been published since 1918 during the Spanish Flu. However, there is limited research testing human subjects on the effectiveness of facemasks in preventing influenza transfer or transmission. The objective of this study was to answer the question, “In influenza-positive Veterans, what is the effect of facemask wearing in comparison to not wearing a facemask on influenza transfer to bedside tables measured for two hours per condition over a ten-week time frame during the 2019/2020 influenza season?” A quasi-experimental evidence-based project pilot study design was used. …

Pulling Heart Strings: Quality Improvement Algorithm For Temporary Epicardial Pacing Wire Removal Post Cardiac Surgery, Jessica Norman

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The placement of temporary epicardial pacing wires (TEPW) is considered standard practice post cardiac surgery and is dependent on the patient’s cardiac function intra-operatively and their electrophysiologic profile after weaning from cardiopulmonary bypass (Reade, 2007; Elmistekawy et al, 2016). Complications associated with TEPW removal include myocardial damage, infection, perforation, tamponade, disruption of anastomoses, ventricular arrythmias, and death (Bojar, 2009; Carroll et al, 1998;Timothy & Rodeman, 2004). Currently there is no standard practice on the removal of TEPW and there is wide variation in removal practices involving patients who are routinely on medications such as dual antiplatelet therapies and systemic anticoagulation. …

Postpartum Depression: Educating The Provider And Staff About The Importance Of Screening, Referrals, Follow-Up And Adherence To The Maternal Mental Health Safety Bundle Toolkit, Natalie Regis

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Background: Postpartum depression (PPD) affects approximately 10%-20% of women after childbirth. PPD is a disabling condition that can have serious health implications on mothers and their infants. Experts estimated that only 50% of women with PPD are diagnosed. Lack of education about screening practices can cause the disorder to go undiagnosed and untreated.

Purpose: The purposes of this quality improvement (QI) project were 1). To increase the provider and staff knowledge about the importance of screening with the implementation of a standardized screening tool 2). To increase PPD screening rates to 100% 3). To increase appropriate referrals to mental …

A Program Evaluation Of Violence Prevention Task Force To Address Type Ii Workplace Violence Utilizing Precede/Proceed Model, Stephanie Autry

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Aim: The primary aim of this project was to complete a program evaluation of the institution’s Violence Prevention Task Force. Evaluation allowed for assessment of outcomes including 1). decrease in assaultive incidents; 2). decrease in assaults leading to injury; 3). increase in team member reporting of assaultive incidents; and 4). demonstrate the program’s adherence to published guidelines on workplace violence prevention.

Background: Violence against healthcare workers has been an increasing problem in our nation’s healthcare system. Type II workplace violence is defined as patient, family member, or visitor as the perpetrator directing violent/aggressive behavior towards healthcare worker and is described …

Watchman Compared To Warfarin In Reducing Risk Of Stroke In Patients With Non-Valvular Atrial Fibrillation, Peyton Parrish, Matt Isherwood

Physician Assistant Capstones, 2020-current

Objective: To determine if the WATCHMAN device is as efficacious as warfarin for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) using a systematic review. Methods: Pubmed and Google Scholar databases were used to evaluate clinical trials using the search terms atrial fibrillation, watchman, warfarin, and stroke prevention. Results: Three studies met inclusion criteria, with 2 being randomized control trials (RCT), and 1 being a prospective cohort study. Reddy et al found that after 3.8 years of follow-up, patients with percutaneous closure of Left atrial appendage (LAA) met criteria for both non-inferiority and superiority, compared with warfarin for preventing …

Efficacy Of Fecal Microbiota Transplant In Conjunction With Oral Vancomycin For The Treatment Of Recurrent Clostridium Difficile, Abigayle Afflick, Jackson Laboue

Physician Assistant Capstones, 2020-current

Objective: To determine the effectiveness of fecal microbiota transplant in addition to traditional therapy of oral vancomycin for the treatment of recurrent Clostridium difficile infections. Methods: Google Scholar was searched to identify randomized control trials using the terms vancomycin, fecal transplant, c. diff, and recurrent. Results: Three studies met inclusion criteria and two found a statistically significant benefit to the addition of fecal microbiota transplant to vancomycin therapy. Cammarota, et al. reported a 90% cure rate when administering fecal microbiota transplant in addition to vancomycin as opposed to a 26% cure rate with vancomycin alone with a P value …

Angiotensin Ii In The Treatment Of Distributive Shock, An Old Theory Revitalized, Jennifer D. Leach, Daniel P. Curran

Physician Assistant Capstones, 2020-current

Objective: To assess whether or not angiotensin II in combination with current treatment has a favorable outcome in the treatment of distributive shock in terms of decreasing duration of vasopressor usage, increasing mean arterial pressure (MAP) above 65 mmHg, and improving mortality.

Design: Systematic Literature Review

Methods:Searches were conducted in PubMed, Google Scholar, and the James Madison University Library Database for the key terms angiotensin II, shock, septic shock, vasodilatory shock, distributive shock, blood pressure, double-blind, humans, and vasoconstrictor agents. Search results were filtered by year, for animal trials, irrelevant therapies, meta-analysis, retrospective studies, and case studies. Only original …

Evaluation Of Hyperhomocysteinemia In The Progression Of Parkinson's Disease, Marisa A. Ducach, Pritpal S. Saggu

Physician Assistant Capstones, 2020-current

Abstract:

Objective:To assess the prevalence of hyperhomocysteinemia in Parkinson’s Disease (PD) and if this elevated serum level can be used as a predictive biomarker in risk assessment for the progression of cognitive decline in PD.

Design:Systematic Literature Review

Methods:A literature search was conducted through Google Scholar and Pubmed using phrases such as, “Parkinson's Disease”, and “homocysteine”, “Parkinson’s progression. Three articles, measuring serum homocysteine levels and cognitive functioning in PD patients, were selected, analyzed, and compared to assess for a relationship between homocysteine levels and cognitive decline in PD.

Results: Elevated homocysteine levels are associated with worse cognitive …

Induction Of Hypothermia In Patients With Traumatic Brain Injury, Frank Hadden, Courtney Lennix

Physician Assistant Capstones, 2020-current

Common Abbreviations:

TBI = Traumatic Brain Injury

Glasgow Outcome Scale = GOS

Glasgow Outcome Scale Extended = GOSE

Objective: To determine whether hypothermia induction improves long-term morbidity and mortality in patients with severe traumatic brain injury

Methods: A search was conducted using PubMed database and the search terms “induced hypothermia” and “traumatic brain injury”. Studies were excluded if the publication dates were over 10 years old, children were the population being studied, and the researchers were looking at other independent variables.

Results: The results from all three randomized control trials showed that the induction of hypothermia did not show effectiveness …

Short Term Effects Of Electronic Cigarettes On Pulmonary Function In Healthy Adult Smokers When Compared To Conventional Cigarette Use, Kayleen Lynch, Rachel Bastianelli

Physician Assistant Capstones, 2020-current

Background: Electronic cigarettes (e-cigarettes) first appeared on the U.S. market in 20071 , but to date, little is known about their safety. Concern about long term adverse effects on overall health continues to increase as we explore the potential of e-cigarettes to aid in smoking cessation practices. E-cigarettes have gained popularity and support through this idea that by using them to help patients quit smoking, the benefits of ultimately abstaining from tobacco use will outweigh the harms associated with e-cigarette use¹ . While the idea of reducing tobacco usage by any means possible remains the goal for most providers, …

Transcatheter Vs. Surgical Aortic Valve Replacement In Patients At Intermediate Surgical Risk, Nichole M. Bonzano, David M. Milligram

Physician Assistant Capstones, 2020-current

Abstract

• Objective: To compare the safety and efficacy of transcatheter aortic valve replacement (TAVR) to surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic stenosis at intermediate surgical risk.
• Design: Systematic literature review.
• Methods Literature searches were done in PubMed and Scopus search engines using key terms: TAVR, trans-catheter aortic valve replacement, SAVR, surgical aortic valve replacement, severe aortic stenosis, and intermediate risk. Filters included primary research only. Inclusion criteria were articles which studied an intermediate risk patient population (STS-PROM 3-15%), primary research, and compared outcomes of TAVR and SAVR in patients with severe aortic stenosis requiring replacement. …

Efficacy Of Mdma-Assisted Psychotherapy In The Treatment Of Chronic Ptsd, Alexis Coleman, Nicole Blixt

Physician Assistant Capstones, 2020-current

Objective: To assess the effectiveness of MDMA-assisted psychotherapy in treating patients with chronic refractory PTSD using a systematic review.

Methods: Literature search was performed on PubMed and PsychINFO using search terms “PTSD” and “MDMA” to identify randomized control trials within the past 10 years.

Results: Two out of the three studies found statistically significant data in the treatment of refractory PTSD. Mithoefer, M. et al and Ot’alora, M. et. al found a statistically significant decrease in CAPS-IV total scores, decrease in depression symptoms, decreased in dissociative symptoms, and increase in sleep quality.

Conclusion: The use of …

Efficacy Of Pulmonary Ultrasound Compared To N-Terminal Prohormone Brain Natriuretic Peptide As A Diagnostic Tool For Congestive Heart Failure In Patients Presenting With Acute Dyspnea In The Emergency Setting, Leah Krohn, Michael Burns

Physician Assistant Capstones, 2020-current

Objective: To determine the efficacy of using pulmonary ultrasound as a diagnostic tool in acute dyspnea of undetermined cause compared to the use of serum N-Terminal prohormone Brain Natriuretic Peptide (NT-proBNP) in the diagnosis of heart failure.

Design: Systematic literature review

Methods: Searches were conducted in PubMed and Scopus using the terms pulmonary ultrasound and congestive heart failure and studies within the last 10 years. Studies that used pulmonary ultrasound compared to BNP as a marker for the diagnosis of heart failure were included.

Results: All three studies found that the use of pulmonary ultrasound was a more specific …

Routine Versus Selective Episiotomies Causing Severe Perineal Tears, Hannah Brown, Anneliese Trader

Physician Assistant Capstones, 2020-current

Objective: To determine if the use of routine episiotomies decreases the rate of severe perineal tears in comparison to selective episiotomies during vaginal delivery. Methods: PubMed and Google Scholar were used to generate a set of random control trials which all had the objective of comparing severe perineal tears in routine compared to selective episiotomies during vaginal delivery. Three trials were reviewed and included in this study. Results: The results of each trial were not all statistically significant in the rate of severe perineal tears when comparing the two interventions. However, a downward trend of third-degree perineal tears amongst …

Mindfulness Based Stress Interventions In Physician Assistant Programs, Lucas Vance

Physician Assistant Capstones, 2020-current

Mindfulness based interventions (MBI) have been used successfully in a variety of venues from the treatment of chronic pain to reducing stress in the workplace. The benefits of MBI programs that have been studied range from self-reported anxiety, depression, and empathy levels to levels of cortisol¹ to amygdala changes seen on magnetic resonance imaging.² MBI programs have been studied in pre-medical, medical, and graduate schools, as well as, nursing programs, and generalized healthcare cohorts.

Deep Brain Stimulation Of The Subcallosal Cingulate Gyrus In The Treatment Of Treatment Resistant Depression, Megan Caravas, Melanie Sov

Physician Assistant Capstones, 2020-current

Objective: a systematic review to determine the efficacy of deep brain stimulation (DBS) targeting the subcallosal cingulate gyrus (SCG) for the treatment of treatment resistant depression (TRD). Methods: PubMed database was utilized in a search for clinical randomized control trials that were completed after the year 2000, using the terms deep brain stimulation, treatment resistant depression, and subcallosal cingulate gyrus. Results: Three clinical trials were chosen based on specific inclusion criteria as noted in the PRISMA flow chart (Chart 1). The results of the three articles showed various discrepancies. Two of the three studies demonstrated some statistical significance in reduction …

Diagnostic Accuracy Of Mcmurry’S Test In The Diagnosis Of Meniscal Tears, Jessica Smyth, Hartwell Rainey

Physician Assistant Capstones, 2020-current

No abstract provided.

Lactobacillus Reuteri In The Management Of Infantile Colic, Katherine Evans, Helena Gaitan

Physician Assistant Capstones, 2020-current

Objective: To determine if Lactobacillus reuteri is an effective treatment for infantile colic by reviewing existing literature and performing a systematic analysis. Design: Systematic literature review. Methods: The PubMed database was searched using the terms “Lactobacillus reuteri” and “colic.” The yielded results were refined to only include human clinical trials published within the past 10 years. Results: Chau et al., Savino et al., and Szajewska et al. each found that the average crying times were significantly shorter for the L. reuteri group than they were for the probiotic group on days 7, 14, and 21. All …

Galcanezumab As A Treatment For The Prevention Of Migraines, Jacob Brown, Chelsea Weedon

Physician Assistant Capstones, 2020-current

Objective: To determine the effectiveness of subcutaneous galcanezumab as a preventative treatment for chronic migraines via a systematic review. Methods: JAMA and PubMed databases were searched using the terms galcanezumab and migraines in order to survey resulting patient clinical trials. Results: The 3 studies reviewed here all showed a statistically significant decrease in migraine headache days (MHDs) per month when using galcanezumab. Stauffer, et al. showed a mean decrease in MHDs of 4.7 and 4.6 for the 120mg and 240 mg doses of galcanezumab vs. 2.8 for placebo⁹ . Rosen, et al. showed a mean monthly 100% response rate …

The Examination Of Morpho-Syntactic Production In Bahamian Children Exposed To Bahamian Creole English And English, Danielle Moss

Dissertations, 2020-current

Purpose. Information on the morpho-syntax development of children who speak varieties of Bahamian English, such as Bahamian Creole English (BCE), remains understudied. Therefore, speech-language pathologists (SLPs) assessing the expressive language of children who speak BCE encounter challenges in making clinical judgments of language difference, developmental errors, and language disorder because they are unable to judge the morpho-syntactic features of this creole to the rules of another variety of Bahamian English, standard English (SE¹), as both varieties, BCE and SE, are independently rule-governed. This dissertation study investigated the morpho-syntax of typically developing four and six-year-old Bahamian children who speak …

The Effects Of Exercise On Breastmilk Composition And Supply: A Critical Literature Review, Jewell Mcroy

Masters Theses, 2020-current

It is well established that breastfeeding provides dual benefits to both the mother and the infant and is the preferred method of providing nutrients to infants essential for growth and development. Participating in regular physical exercise is also well-supported by research to be beneficial to one’s overall health and quality of life. Currently there are no physical activity guidelines developed for women who are postpartum and breastfeeding. An online database search was conducted; three articles met the inclusion criteria and were included within the review. Studies were included if there were direct measures of human breastmilk composition, supply/volume, and included …

Honey Vs. Silver Sulfadiazine In The Reepithelialization Of Partial-Thickness Burn Wounds, Andi Diamond, Monica Bowler

Physician Assistant Capstones, 2020-current

Objective: To determine whether silver sulfadiazine (SSD) should remain the gold standard of initial burn wound treatment or if it should be replaced with an alternative treatment that allows for faster skin cell regrowth. Methods: Database search of PubMed and Google Scholar were used to evaluate patient clinical trials with the search terms “burn”, “honey”, and “silver”. Results: Three trials met inclusion criteria. All three of the studies found significant improvement in their primary endpoint with the use of honey. The first study showed the honey group to have healing time of 13.47 ± 4.06 days and …

Policy Analysis: Appropriate Opioid Prescribing Practices For Post-Surgical Patients, Joan S. Daversa

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The pervasiveness of legally prescribed opioids in the United States has led to increased post-surgical patients succumbing to opioid dependence. There is a vast disparity in pain management practices across clinical settings. The lack of well-defined policies specifying opioid prescribing practices for post-surgical patients has created inconsistency among providers. This situation creates a risk for misuse and long-term opioid dependence for patients. This policy analysis aims to implement an evidence-based opioid prescribing policy for post-surgical patients to improve current opioid prescribing practices and implement a best practice culture to reduce excessive opioid practices. Collins (2005) health policy analysis adapted from …

Using The Model For Improvement To Address Invasive Hemodynamic Safety Concerns In Critical Care, Selena Truban

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Abstract

The use of invasive catheters to monitor hemodynamic readings is common in the critical care setting and requires the use of specialized equipment. Variation in equipment set-up impacts operational efficiency and creates the potential for improper patient treatment based on inaccurate readings. The methodology of setting up and maintaining hemodynamic pressure lines in the critical care units lacked structural and processional measures, creating the potential for patient harm. Multimodal strategies, guided by the Model for Improvement, were used to increase the use of evidence-based methods for setting up and maintaining invasive hemodynamic lines in the critical care units. A …

Therapeutic Potential Of A Ketogenic Diet In The Treatment Of Major Depressive Disorder, Jordan A. Murrin

Masters Theses, 2020-current

Major depressive disorder (MDD) is the second most common mental health condition and a leading cause of disability in the world. It is theorized that MDD develops from a combination of biological, psychological, and social stressors. The condition is typically treated using pharmaceuticals and psychotherapy. However, not all individuals with MDD have access to or choose to use these treatments, or may prefer to incorporate therapeutic lifestyle changes such as exercise, sleep, and healthy eating. Even with treatment, MDD can alter brain structure and function, leading to the development of comorbid mental health and chronic metabolic conditions like obesity, cardiovascular …

Measuring Listening Effort Using Physiological, Behavioral And Subjective Methods In Normal Hearing Subjects: Effect Of Signal To Noise Ratio And Presentation Level, Lakshmi Magudilu Srishyla Kumar

Dissertations, 2020-current

The main objective of the study is to compare the effectiveness of pupillometry, working memory and subjective rating scale —the physiological, behavioral, and subjective measures of listening effort— at different signal to noise ratios (SNR) and presentation levels: when administered together. Eleven young normal hearing individuals with mean age of 21.7 years (SD=1.9 years) participated in the study. The HINT sentences were used for speech perception in noise task. The listening effort was quantified using peak pupil dilation, working memory, working memory difference, subjective rating of listening and recall effort. The rating of perceived performance, frustration level and …

Return To School 1 Year After Traumatic Brain Injury: A Study Using The Traumatic Brain Injury Model Systems National Database, Kathryn Tarnai

Masters Theses, 2020-current

For many individuals, recovery from moderate to severe brain injuries involves returning to a level of pre-injury productivity. Specifically, previous research has focused extensively on factors predicting return to employment, where students are inconsistently categorized with those in competitive employment. Moreover, research dedicated to return to school for students in secondary and tertiary education is largely qualitative; very few studies have utilized predictive modeling on a sample composed solely of students. For this study, a model including days of post-traumatic amnesia (PTA), length of stay (LOS), rehabilitation discharge Disability Rating Scale (DRS) scores, and educational level was used to predict …