Medicine and Health Sciences Commons^™

Incidence And Factors Associated With Nonalcoholic Fatty Liver Disease Among Patients With Rheumatoid Arthritis, Ani K. John

Walden Dissertations and Doctoral Studies

Nonalcoholic fatty liver disease (NAFLD) has become one of the most common hepatic diseases worldwide, making the diagnosis and management of NAFLD an emerging public health issue. Theories associated with NAFLD surmise that inflammation may be the root cause, along with the complex interplay of other chronic conditions such as obesity, metabolic syndrome, diabetes, dyslipidemia, and cardiovascular disease (CVD). It is unknown if other inflammatory conditions such as rheumatoid arthritis (RA), along with the use of methotrexate (MTX), might confer increased risk for NAFLD. Longitudinal data collected from a retrospective cohort of 17,481 adult RA patients in the United States …

Medical Community Distrust And The Influenza Vaccination Rates Of Black Americans, Kenyatte Irby Winston

Walden Dissertations and Doctoral Studies

Black Americans experience influenza vaccination rates that are lower than the rates of other ethnic groups. Low influenza vaccination rates among the Black community are associated with higher influenza infection rates, influenza-related hospitalizations, and higher influenza mortality rates. There is a belief within the Black American community that the medical establishment does not have the Black American patient in its best interest, leading to feelings of distrust. The purpose of this study was to determine if the distrust of the medical community is a relevant factor in the low influenza vaccination rates of Black Americans aged 18 and older in …

The Experience Of Being Unsheltered In Atlanta, Ikeranda Smith

Walden Dissertations and Doctoral Studies

In the United States, it is estimated that millions of adults are homeless. Some individuals choose not to use homeless shelters or are ineligible for their use. Researchers have indicated that many unsheltered homeless are men over the age of 45 years. The purpose of this phenomenological study was to examine the experiences with social services providers among unsheltered men. Understanding the social networks of unsheltered homeless and the use of spirituality or faith as a resource for coping was also examined, as a significant gap exists in the research on unsheltered homeless. Face-to-face, in-depth interviews were conducted with 8 …

The Association Of Cancer Development In Patients With Systemic Lupus Erythematosus, Rose Michelle Coley

Walden Dissertations and Doctoral Studies

The Association of Cancer Development in Patients with Systemic Lupus Erythematosus by

Rose Michelle Coley

MPH, Walden University, 2011

BS, University of Mount Olive, 2008

Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Public Health

Walden University

March 2016

Both cancer and autoimmune diseases have been associated with numerous factors that may independently lead to the development of either disease. When these factors overlap the difficulty in assessing association is compounded. The numerous factors that are thought to cause systemic lupus erythematosus (SLE), which leads to the development of cancer, makes the study …

Barriers To Exclusive Breastfeeding Among Mothers During The First Four Weeks Postpartum, Jessy V. Thomas

Walden Dissertations and Doctoral Studies

According to the World Health Organization, breastfeeding is natural and the most effective way of nourishment to feed infants and young children to ensure child health and survival. Currently, the World Health Organization, the American Academy of Pediatrics, and other health organizations recommend exclusive breastfeeding during the first 6 months of life. Although exclusive breastfeeding has been shown to reduce the occurrence of adverse health outcomes to the infant and mother, the duration of exclusive breastfeeding remains relatively low in the United States. The theory of planned behavior was used as a theoretical framework for this study. The purpose of …

Nurses' Knowledge Of Pain Assessments And Reassessments Impacts Hospitalized Patients' Reporting Of Pain, M. Michele Potter Williams Williams

Walden Dissertations and Doctoral Studies

Ineffective pain management can prolong a patient's length of stay and increase cost of care. Inadequate pain control decreases the patient's quality of life and contributes to poor health outcomes. A recent record audit showed that documentation of pain reassessments occurred only 20% of the time within an hour after administering pain medication. Furthermore, nurses may have insufficient knowledge regarding pain assessments and reassessments or hold irrational fears about addiction leading to inadequate treatment of pain. The purpose of this quality improvement project was to evaluate the effectiveness of an educational program for acute care nurses for the assessment and …

Improving Communication Between Cancer Patients And Providers During A 15-Minute Office Visit: A Systematic Review Of The Literature, Dr. Tammy Elizabeth Manganelli

Walden Dissertations and Doctoral Studies

Patients undergoing chemotherapy treatments for cancer often experience adverse side effects, including cognitive deficits. These deficits impact the patient's ability to communicate effectively with their oncology provider. Ineffective communication can adversely affect patient outcomes and decrease patient-provider satisfaction. The resulting poor communication can contribute to poor patient outcomes. This systematic literature review focused on assistive communication tools that could be used in an outpatient oncology setting to improve patient-provider communication. The literature review findings led to the development of a resource for providers that includes 15 communication tools that can be used to assess and improve communication in cancer care. …

Promoting Shared Decision Making Through Patient Education Of Labor Inductions, Lenora W.Y. Low

Walden Dissertations and Doctoral Studies

The induction of labor is medically indicated for many conditions in which delivering the baby outweighs the risk of continuing the pregnancy. Patients admitted for the induction of labor require adequate information to actively participate in decision making that affects their plan of care. The purpose of this quality improvement project was to improve the quality of healthcare delivery and promote patient engagement by providing consistent education using a teaching tool. The project question addressed the impact of a labor-induction teaching tool on improving patient education, participation, and overall satisfaction. The Plan-Do-Study-Act (PDSA) model was used to plan, implement, and …

Decreasing Surgical Site Infections In Vascular Surgery Patients, Charlene Knight Little

Walden Dissertations and Doctoral Studies

Postoperative surgical site infections are common complications in the operating room. Infections prolong hospital stays, heighten costs, and increase morbidity and mortality. The purpose of this evidence-based quality improvement project was to develop policy, program, and practice guidelines to prevent surgical site infections in vascular surgery patients. Rosswurm and Larrabee's change model was used to develop materials using the best evidence for the recommended practice changes. The Plan, Do, Check, Act model was selected to guide quality improvement. The project goal was to decrease the surgical site infection rate to below the national average. Products of the project include policy, …

A Plan For The Implementation And Evaluation Of Diet Education In Type 2 Diabetes, Soy Ramsumeer

Walden Dissertations and Doctoral Studies

Abstract

Type 2 Diabetes Mellitus (T2DM) is the seventh leading cause of death in the United States with a projected increase of 552 million people worldwide who will be affected with this illness by 2030. The need to address this issue is vital to prevent complications and reduce healthcare spending. The DNP project is aimed at planning and designing a nutritional education program tailored toward specific ethnic groups in order to increase knowledge in making healthy food choices. This project is intended to educate Registered Nurses (RNs) on nutrition so that they can offer dietary knowledge to T2DM patients. Additional …

Complexity Of Prostate Cancer Diagnosis In African American Men In The United States, Adam B. Sumlin

Walden Dissertations and Doctoral Studies

Researchers have identified higher incidence rates and mortality rates among African American men (AAM) diagnosed with prostate cancer than they have among urban African American men. This quantitative descriptive study was conducted to measure the association between advanced stage and grade of prostate cancer, demographic location, and prostate specific antigen (PSA) levels over a 5-year period in AAM and European American men (EAM) in rural versus urban communities. This study addressed 4 research questions concerning cancer grade, cancer stage, age, geographic location, PSA level, and the impact that each of these variables had on prostate cancer diagnosis in AAM in …

Breastfeeding Education For Women With Diabetes, Pregnancy-Induced Hypertension And Multiple Gestations, Oluwapelumi Adefunmike Adeboyejo

Walden Dissertations and Doctoral Studies

Breastfeeding is considered a public health concern due to increased maternal/infant mortality and morbidity rates associated with persistent low rates in breastfeeding. Providing early breastfeeding education for women with diabetic, pregnancy-induced hypertension and multiple gestations can result in higher persistence rates and a decrease in maternal and infant mortality and morbidity rates. This quality improvement project provided early prenatal breastfeeding education for women with diabetes, pregnancy-induce hypertension and multiple gestations at a private clinic in Long Beach, Southern California. Evidence-based literature reviews were conducted through CINAHL and Medline (2009-2014). The descriptive study used for the project was made up questionnaires …

Comparison Of Neovascular Age-Related Macular Degeneration Populations In The United States, Susan Lynette Coultas

Walden Dissertations and Doctoral Studies

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the United States in people who are 50 and older. The safety and efficacy of aflibercept for the treatment of late stage neovascular AMD (NAMD) has been demonstrated by clinical trials among several populations; however, it is unclear whether all NAMD patients respond in the same manner as was studied in the clinical trials. The purpose of this study was to examine if populations of patients treated with aflibercept for the treatment of NAMD were significantly different from one another in terms of health characteristics, treatment regimens, …

Diabetes Mellitus Type 2: A Quality Improvement And Patient Safety Initiative, Remeliza Navarrete Tukay

Walden Dissertations and Doctoral Studies

The purpose of the quality improvement (QI) project was to examine the relationship between amended nursing education concerning diabetes mellitus (DM) Type 2 self-care management incorporating Tune in, Explore, Assist, Communicate, and Honor (TEACH) and Motivational Interviewing (MI) strategies and techniques and the Glycosylated hemoglobin (HgbA1C) of veteran patients with uncontrolled diabetes. The target sample included the 2 licensed practical nurses and 2 registered nurses assigned to 2 primary care teams, and the 10 purposively sampled patients with uncontrolled DM Type 2 from each team. The nurses' competencies were measured through descriptive comparison before and after nursing education implementation using …