Digital Commons Network^™

Building Adult-Gerontology Acute Care Nurse Practitioner Student Competencies For Telemental Health Treatment Through Simulation, Amy Dievendorf Dnp, Aprn, Fnp-Bc, Agacnp-Bc, Phyllis Raynor Phd, Aprn, Pmhnp-Bc, Beverly Baliko Phd, Rn, Pmhnp-Bc, Abbas Tavakoli Drph, Mph, Me

Publications

Depressive disorders are common mental health conditions that are often undiagnosed or undertreated. Adult-Gerontology Acute Care Nurse Practitioners (AGACNPs) are educated in the management of acute and critically ill patients but are often uncomfortable identifying and treating mental health conditions. Telehealth instruction is useful in mental healthcare and is required as part of the AGACNP’s efficient patient care competencies. This article reports findings from a mental health-focused telehealth instructional activity integrated into an existing AGACNP curriculum. This instructional activity was designed to introduce students to telehealth delivery and build AGACNP competencies using telehealth technology to assess patients with depressive mood …

Fall Prevention In The Lobby Of The Emergency Department At Sutter Medical Center Sacramento, Tanya Rodriguez Duarte, Vaneza Espino, Roshni Hayer, Yajari Mendoza

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background: In 2024, Sutter Medical Center Sacramento (SMCS) reported 17 patient falls in the Emergency Department (ED) lobby, with 94% (n = 16) occurring in the triage area. Patients awaiting placement after triage are not classified as admitted and thus are not included in CMS’s inpatient fall reporting program. However, due to the known safety risk, SMCS ED leadership began tracking lobby falls locally and partnered with University of the Pacific nursing students to address this issue.. Aim: This quality improvement project aimed to reduce the incidence of falls in the ED lobby through enhanced fall risk identification, timely reassessment, …

Physical Therapy Direct Access To Unrestricted Access In The State Of Michigan- Is Michigan Ready To Embrace Change? A Policy Analysis, Erica M. Fernandes, Mary D. Lagerwey, Kieran Fogarty

Michigan Journal of Public Health

Michigan’s Direct Access Provision of 2015 (Enrolled Senate Bill No. 690, 201), which aimed to increase patient access to physical therapy and reduce waiting times, has created hurdles for patient access and for physical therapy as an autonomous profession. The purposes of this policy analysis were: 1) to analyze the Direct Access (DA) policy including examining existing challenges resulting from implementation, 2) provide recommendations for implementing an alternative policy, and 3) outline the benefits of the alternative policy. The DA policy with provisions was examined using the Patton and Sawicki (1993) framework, which provides a basic approach that …

A Qualitative Study Of Health Priorities Of People With Dementia And Care Partners In Emergency Department And Hospital Care In A Public Safety-Net Setting, Anita Chary, Sumin Yoon, Victor Lara, Annika Bhananker, Michelle Suh, Kei Ouchi, Maura Kennedy, Aanand D Naik

Faculty, Staff and Student Publications

Background: Over half of the people with dementia visit the emergency department (ED) each year. Little is known about how people with dementia and their care partners conceptualize or communicate about health outcome goals or care preferences during acute care episodes.

Participants and setting: We conducted interviews with 14 Hispanic people with dementia and 19 care partners recruited from a public safety net hospital system in the southeastern United States. Participants were community-dwelling and had recently visited the ED.

Methods: We used a qualitative study design informed by phenomenology and guided by the patient priorities care (PPC) framework. Interviews elicited …

Artificial Intelligence Biomarker Detects High-Risk Childhood Asthma Subgroup For Respiratory Infections And Exacerbations, Young J Juhn, Chung-Il Wi, Euijung Ryu, Katherine S King, Sunghwan Sohn, Elham Sagheb, Greg Jenkins, David Watson, Miguel A Park, Sergio E Chiarella, Hirohito Kita, Mir Ali, W Charles Huskins, Elizabeth H Ristagno, Imad Absah, Charles Grose, Kathy Ihrke, Elizabeth A Krusemark, Thanai Pongdee, Björn Nordlund, Carla M Davis, Robert J Pignolo, Hongfang Liu

Faculty, Staff and Student Publications

Background: Asthma is associated with an increased risk of acute respiratory infections (ARI). Little is known about whether natural language processing (NLP)-powered digital biomarkers can identify a high-risk asthma subgroup for ARI during early childhood.

Objective: We assessed whether a digital biomarker could identify a high-risk subgroup of childhood asthma for ARI.

Methods: We applied validated NLP algorithms for Predetermined Asthma Criteria (NLP-PAC) and Asthma Predictive Index (NLP-API) to electronic health records of the 1997-2016 Mayo Clinic Birth Cohort. We categorized the cohort into 4 subgroups: both criteria positive (NLP-PAC+/NLP-API+), PAC positive only (NLP-PAC+), API positive only (NLP-API+), and both …

From Awareness To Action: Improving Advanced Directives With The Five Wishes In College Aged Young Adults, Dina M. Giovanetti

Electronic Theses and Dissertations 2020 - Present

This quality improvement project aimed to increase early education, initiation, documentation, and completion rates of advance directives (ADs), specifically the Five Wishes, among college-aged young adults (18–24 years old) in a concierge primary care setting. The project addressed the low engagement and completion rates of ADs in this population, which can result in inadequate end-of-life care planning. The initiative involved training all staff members through collaborative instruction, informational sessions, and personalized provider-patient discussions. A convenience sample of eligible patients was identified via chart review. Inclusion criteria included English-speaking young adults aged 18–24, regardless of comorbid conditions who were members of …

Efficacy Of Platelet Rich Plasma Versus Placebo For Improvement In Olfactory Function In Adults With Olfactory Dysfunction: A Systematic Review And Meta-Analysis, Ali B Jafar, Ghabrielle Almeida, Fatima Al Mousawi, Eric Delgado Rendon, Amber U Luong

Faculty, Staff and Student Publications

Background: Olfactory dysfunction significantly impairs quality of life. Conventional treatments such as corticosteroids and olfactory training offer limited and inconsistent efficacy. Platelet-rich plasma (PRP), a biologically active agent, has shown potential regenerative effects in olfactory neuroepithelium. This study systematically evaluates the efficacy of PRP compared to placebo in improving olfactory function.

Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines and was registered in PROSPERO (CRD 420251045079). The databases searched included PubMed, Scopus, Embase, Central, and Web of Science. Seven studies (four RCTs, three non-RCTs) involving 789 patients were included. Subjective and objective outcomes were extracted and …

The First Year Of Assisted Dying In New Zealand Through The Lens Of Healthcare Professionals Not Directly Involved In The Process, Waqas Arshad, Aida Dehkhoda, Melissa Carey, David B. Menkes, Nicholas Hoeh, Frederick Sundram, Rosemary Frey, Gary Cheung

Research outputs 2022 to 2026

Background: New Zealand’s End of Life Choice Act 2019 was enacted in 2021, allowing terminally ill people experiencing unbearable suffering to request assisted dying if they are expected to die within six months. Healthcare professionals not directly involved in assisted dying provision may have unique perspectives on implementation, yet this remains under-explored. Methods: This qualitative study was conducted between June and November 2022. We used purposive and snowball sampling to recruit potential participants through various sources, including the Ministry of Health’s assisted dying training and communication email list. A multidisciplinary research team developed a semi-structured interview guide. The individual interviews …

Public Views Towards Lifespan, Healthspan, And Healthy Longevity Medicine In Singapore: A Qualitative Study From The Healthy Longevity (Helo) Initiatives, Belinda Wang, Anna Szucs, Elena Sandalova, Zhi Meng Lim, E. J. Horberg, Paul A. O’Keefe, Louis Island, Sonny Rosenthal, Andrea B. Maier

Research Collection College of Integrative Studies

Introduction: Healthy Longevity Medicine (HLM) offers a strategy to reduce the healthspan-lifespan gap, yet public perspectives remain unclear. This study refines the Healthy Longevity (HELO) framework through a qualitative exploration of public views towards lifespan, healthspan, and HLM.Methods: Individuals living in Singapore participated in semi-structured group or individual discussions to explore (a) their understanding of lifespan and healthspan, (b) motivational factors for health behaviours, and (c) their awareness of HLM. Sampling maximised variation across age, sex, and ethnicity. Data obtained through 13 discussions were analysed with a mixed, inductive-deductive approach employing the HELO framework.Results: Thirty-six participants (mean age = 49.4 …

Postinactivity Exercise Training Improves Sarcopenia Traits In 40–60-Year-Old Women Regardless Of Fortified Milk Supplementation, Joanne Trezise, Ricardo M. Lima, Sally D. Poppitt, Aaron C. Fanning, Amanda Devine, Anthony J. Blazevich

Research outputs 2022 to 2026

Background: The term sarcopenia was introduced to describe the age-related decline in muscle mass, but current definitions also include measures of muscle strength and function. Menopause increases sarcopenia risk and may exacerbate the adverse effects of physical inactivity. Exercise training is a potent stimulus to restore muscle health, and nutritional supplementation can further improve the outcomes. The purposes of this study were to examine the changes in a set of sarcopenia-related phenotypes induced by a 14-day step-reduction period followed by a 12-week exercise training programme, with or without fortified milk supplementation in healthy 40–60-year-old females, and to determine whether menopausal …

Decorin Deficiency Promotes D-Galactose-Induced Skeletal Muscle Atrophy And Fibrosis By Regulating Itgb1/Akt/Mtor Signalling Pathway, Xiaoqin Luo, Mengxue Zhang, Lili Chen, Ruichang Wang, Jiabing Lian, Zhe Yang, Renato V. Iozzo, Jin Wang, Yan Zhang, Xiuli Bi

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Primary sarcopenia is an age-associated disorder with progressive and generalised loss of skeletal muscle strength and mass. Skeletal muscle fibrosis is one of the significant pathological manifestations of age-associated sarcopenia. Decorin, a small dermatan-sulfate proteoglycan, participates in extracellular matrix assembly. In numerous studies, the involvement of decorin is not restricted to matrix structural proteins, and it also affects a diverse variety of biological functions like cell growth, adhesion, migration, proliferation and differentiation. Additionally, it modulates the process of inflammation and fibrillogenesis. Based on these preclinical evidences, we hypothesised that decorin may potentially play an important role in skeletal muscles …

A Model For Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 20, Satheesh Gunaga, Christopher R Carpenter, Maura Kennedy, Lauren T Southerland, Alexander X Lo, Sangil Lee, Kirby Swan, Fabrice Mowbray, Rachel M Skains, Teresita M Hogan, Martin F Casey, Kei Ouchi, Naomi R George, Kerstin De Wit, Cameron J Gettel, Katherine Selman, Luna C Ragsdale, Anita N Chary, James D Van Oppen, Glenn Arendts, Charles L Maddow, Katherine M Hunold, Katren R Tyler, Danya Khoujah, Ula Hwang, Shan Liu

Faculty, Staff and Students Publications

The original consensus-based Geriatric Emergency Department (GED) Guidelines, published in 2014, established a framework of core principles for delivering high-quality, age-appropriate emergency care for older adults. In response to significant advances in geriatric emergency medicine research and evolving clinical priorities, we developed the GED Guidelines 2.0 to ensure continued relevance, clinical utility, and evidence-based rigor. This concept paper describes the systematic and iterative process undertaken to update the guidelines, including the formation of multidisciplinary working groups and the application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Unlike the original GED Guidelines, our approach prioritized methodological transparency, …

Plasma Metabolomic And Proteomic Signatures Of Blood Pressure Management After Bariatric Surgery Among Adolescents, Shudi Pan, Zhenjiang Li, Juan Pablo Lewinger, Jesse A Goodrich, Hongxu Wang, Sarah Rock, Carmen Chen, Todd M Jenkins, Stephanie Sisley, Stephen R Daniels, Douglas I Walker, Max T Aung, Erika Garcia, Rob Mcconnell, Sandrah P Eckel, Michele A La Merrill, Tanya L Alderete, Zhuanghua Chen, Frank D Gilliland, Thomas H Inge, David V Conti, Justin R Ryder, Lida Chatzi

Faculty, Staff and Students Publications

Background: Emerging omics approaches, including metabolomics and proteomics, can be integrated into obesity treatment for better blood pressure management. We tested whether preoperative metabolomic and proteomic profiles predict long-term elevated blood pressure (EBP) changes better than known risk factors in adolescents undergoing bariatric surgery.

Methods: We included 108 participants from the Teen-LABS (Teen-Longitudinal Assessment of Bariatric Surgery). Plasma untargeted metabolomics (via liquid chromatography with high-resolution mass spectrometry) and Olink proteomics were assessed pre surgery. An elastic net model with stability selection was used to identify features predictive of EBP reductions 5 years post surgery. Models including identified metabolites, proteins, and …

Factors Influencing Turnover Intention Among Registered Nurses In Thailand: A Preliminary Study, Vachira Posai, Associate Professor Chanokporn Jitpanya, Rn, Ms, Ph.D., Assistant Professor Wisarut Srisinthorn, Md, Associate Professor Paramee Thongsuksaid, Md

Chulalongkorn Medical Journal

Background: The global nursing shortage impacts healthcare systems. Understanding factors influencing nurses' turnover intentions is essential for developing effective retention strategies.

Objective: To identify predictors of turnover intention among nurses, focusing on variables such as age, number of children, years of nursing experience, monthly personal income, burnout, emotional labor, job stress (assessed through effort, reward, and overcommitment), nurse-practice environment, work-family conflict, and work engagement.

Methods: A secondary data analysis was conducted using data from a multicenter, longitudinal study involving 1,005 nurses from two public hospitals in Thailand. Data collection instruments included a demographic questionnaire, the Burnout Assessment Tool, the Emotional …

Interventions To Enhance Care Partner Performance And Participation In Alzheimer's And Neurocognitive Disorders: A Systematized Review, Ainslie Suyko, Addison Werner, Elizabeth A. Stacy, Danielle M. Westmark, Stacy Smallfield, Molly A. Whitlow

Student Systematized Reviews: Occupational Therapy

Purpose: Care partners of people with Alzheimer’s disease (AD) and related neurocognitive disorders (NCDs) often experience disrupted routines, reduced self-care, and limited participation in meaningful occupations. Occupational therapy (OT) supports care partners’ engagement in health-promoting activities and sustainable caregiving (Rhodus et al., 2023). This systematized review examined interventions that enhance care partner performance and participation.

Design: Peer-reviewed, English-language articles were included if they involved adult care partners of individuals with AD or NCDs, implemented an intervention within the scope of OT, and used quantitate research designs.

Method: A total of 319 articles from MEDLINE, CINAHL, and Scopus were screened; 61 …

Family Caregivers' Perspectives On Challenges And Support Needs In Hospital-Based Palliative Care For Persons Living With Dementia, Jung Kwak, Anita Chary, Sarah Stayer, Kwaku Duah Oppong, Sumin Yoon, Snehal Patel, Elizabeth A Kvale

Faculty, Staff and Students Publications

Palliative care needs of hospitalized persons living with dementia (PLWD) and their family caregivers remain poorly understood. This mixed-methods study explored caregivers' perspectives on challenges and support needs when hospitalized PLWD received specialist palliative care consultations. Thirty-two caregivers were recruited from two hospitals; 18 completed interviews and surveys, and 14 completed surveys only. Participants were racially and ethnically diverse (19% Black or African American, 34% Latino or Hispanic). Most identified as women (65%) and adult children (56%). Commonly reported challenges included managing health issues (59%), emotional distress (56%), and decision-making (47%). Thematic analysis of interviews revealed three themes: the value …

Implementing Evidence-Based Strategies For Falls Prevention, Gregory Njong

Walden Dissertations and Doctoral Studies

Older adults are particularly susceptible to post-fall injuries and loss of independence. This project was implemented to decrease the number of resident falls within a long-term care setting by enhancing the knowledge and daily routine of direct-care personnel. Falls remain one of the most frequent and severe safety concerns. Although policies on fall prevention are in place, workers often inconsistently incorporate risk evaluation and fail to identify all the causes of a fall. The purpose of this project was to determine whether a structured educational program could raise the level of knowledge about fall-prevention and provide safer care practices. The …

“For Haitian Culture, Being Older [Is] A Blessing”: Perceptions Of Aging, Elderhood, And Dementia In A Haitian Born Sample, Melissa K. Eustache

USF Tampa Graduate Theses and Dissertations

This thesis investigates how first-generation Haitian immigrants in the United States understand and interpret dementia within the intersecting contexts of culture, migration, and biomedicine. While dementia is constructed as a pathological “loss of self” and a public health epidemic, in American biomedical and popular discourse, this study examines how Haitian-born individuals—socialized within a non-Western cultural and spiritual framework—make sense of cognitive decline and impairment in ways that diverge from Western biomedical narratives. Guided by theoretical orientations from medical anthropology, including Mark Nichter’s idioms of distress, Margaret Lock’s local biologies, and neuroanthropology, this research explores how cultural models of illness, aging, …

Improving Staff Knowledge And Competency In Saint Louis University Mental Status Dementia Screening, Arteece Noel Crum

Walden Dissertations and Doctoral Studies

Summary Early recognition of cognitive decline is vital to improving outcomes and maintaining patient safety across healthcare settings. The Saint Louis University Mental Status (SLUMS) screening tool assists nurses in detecting early cognitive changes; however, inconsistent administration and interpretation of the screening tool can reduce its effectiveness. A gap in staff knowledge regarding scoring, education-level adjustments, and documentation accuracy was identified at the practice site. To address this gap in practice, I developed and implemented a staff education program focusing on SLUMS administration and evidence-based clinical response to abnormal scores. The practice-focused question guiding this Doctor of Nursing Practice project …

“Better Than Any Medicine:” Understanding How Therapy Dogs Support Patients Presenting With Mental Health And Substance Use Concerns In An Emergency Department Setting, Alexandria R. Pavelich, Colleen A. Dell, James Stempien, Holly Mckenzie, Aimee Hozack, Jane Smith, Alexis Rowsell, Janet Gunderson, Elizabeth Pease

Patient Experience Journal

In Canada, emergency departments have a large number of patients with mental health and substance use concerns passing through their doors. Our research aim was to assess the impact that therapy dog visits may have for patients presenting with mental health and/or substance use concerns to an emergency department based in Saskatoon, Saskatchewan. Working alongside an active patient advisory group and community-based therapy dog program volunteers, our mixed method approach utilizing ethnography, surveys, and interviews showed that therapy dog visitation had a beneficial impact on both patients and staff, thus improving the overall patient experience. Our study displays how the …

Improving Retention Of Newly Hired Nurses In Home Care, Chidi D. Ihezue

Walden Dissertations and Doctoral Studies

In the home care setting, there is an increasing need for home care services due to aging populations and the rising prevalence of chronic diseases, as well as a scarcity of qualified home care staff to meet the health needs of patients in this setting. A home care agency's onboarding program, particularly its capacity to deliver comprehensive orientation and robust mentoring for new nurses, plays a crucial role in supporting the retention of newly employed nursing staff within the home care environment. Research indicates that without ongoing support and close monitoring, newly hired nurses may disengage during the onboarding and …

Advancing Delirium Detection Through The Open Health Natural Language Processing Consortium And The Evolve To Next-Gen Accrual To Clinical Trials Network, Sunyang Fu, Min Ji Kwak, Jaerong Ahn, Zhiyi Yue, Shreyas Ranganath, Joseph R Applegate, Andrew Wen, Liwei Wang, Chenyu Li, Michele Morris, Kelly M Toth, Timothy D Girard, John D Osborne, Richard E Kennedy, Nelly-Estefanie Garduno-Rapp, Phillip Reeder, Justin F Rousseau, Chao Yan, You Chen, Mayur B Patel, Tyler J Murphy, Bradley A Malin, Chan Mi Park, Heling Jia, Sandeep Pagali, Allyson K Palmer, Jennifer St Sauver, Sunghwan Sohn, Elmer V Bernstam, Shyam Visweswaran, Yanshan Wang, Hongfang Liu

Faculty, Staff and Student Publications

Background: Delirium is often underdiagnosed in clinical practice and is not routinely coded for billing. While manual chart review can identify delirium, it is labor-intensive and impractical for large-scale studies. Natural language processing (NLP) can analyze unstructured text in electronic health records (EHRs) to extract meaningful clinical information.

Methods: To support national integration of NLP for EHR-based delirium identification across different institutions, we launched the Delirium Interest Group within the national Evolve to Next-Gen Accrual to Clinical Trials (ENACT) NLP Working Group. This paper outlines our initial efforts to standardize, evaluate, and translate an NLP-based delirium detection model into the …

Trends In Private Equity Acquisitions Of Assisted Living Facilities., Jennifer N. Bunker, Yashaswini Singh, Gauri Gadkari, John Bowblis, Lindsey Smith, Paula Carder, Sean Huang, Momotazur Rahman, Kali S. Thomas

Institute on Aging Publications

This cross-sectional study examines trends in private equity acquisitions of assisted living facilities across the US.

Reducing Delirium In Older Adults: The Role Of Quiet Hours During Hospitalization, Kelly Hermawan Bsn, Rn

Nurse Residency

In older adults how does the implementation of quiet hours compared to no quiet hours affect the incidence of delirium as measured by positive cam score during hospitalization?

Estimating Daily Air Quality Exposure Of The Aging And Dementia Population, Wan-Tai Michael Au-Yeung, Moiz Usmani, Ryan Ramphul, Chao-Yi Wu, Hiroko Dodge, Joel Steele, Zachary Beattie, Jeffrey Kaye

Faculty, Staff and Student Publications

Background

To understand the effect of air quality on cognition, air quality measurements should reflect real-world exposure. Currently, air quality exposure is derived from outdoor air quality monitors despite older adults spending most of their time indoors.

Objective

To examine if there are discrepancies between indoor particulate matter 2.5 (PM2.5) at older adults’ personal residences, PM2.5 levels measured with nearest outdoor public air monitors, and remotely accessed gridded ensemble air quality data.

Methods

PM2.5 levels collected in older adults’ residences, collected from the nearest outdoor public air quality monitors and ensemble data from Hazardous Air Quality Ensemble System (HAQES) were …

Alterations In Cardiovascular Parameters In 5xfad Murine Model, Andrea G Marshall, Dominique Stephens, Kit Neikirk, Sepiso K Masenga, Bryanna Shao, Amber Crabtree, Zer Vue, Heather K Beasley, Edgar Garza-Lopez, Estevão Scudese, Benjamin I Rodriguez, Han Le, Steven Damo, George E Taffet, Okwute M Ochayi, Ronald Mcmillan, Jeremiah M Afolabi, Vernat Exil, Ashton Oliver, Vineeta Sharma, Pamela Martin, Amadou Gaye, Chanel Harris, Briar Tomeau, Lacara Bell, Markis Hamilton, Taneisha Gillyard, Railyn Webster, Marcus Jackson, Prem Prakash, Shanilah Frierson, Chandravanu Dash, Margaret Mungai, Annet Kirabo, Jennifer A Gaddy, Nelson Wandira, Antentor Hinton, Anilkumar K Reddy

Faculty, Staff and Students Publications

Alzheimer's Disease (AD) is a global health issue, affecting over 6 million people in the United States, with that number expected to increase as the population ages. As a neurodegenerative disorder that affects memory and cognitive functions, it is well established that AD is associated with cardiovascular risk factors beyond only cerebral decline. In this study, we measured hemodynamic parameters related to cardiovascular and cerebrovascular function in 5xFAD mice with AD and their littermates. Specifically, we measured cardiovascular pulse wave velocity parameters, a marker of arterial stiffness and cardiovascular risk, and cerebrovascular pulse wave velocity, a novel technique to measure …

Thrombi From Stroke Due To Cardioembolic Etiology Have Higher Cd11b-Positive Cells Compared To Large Artery Atherosclerosis, Carson Finger, Gomana Emara, Gabriel S Chiu, Kelly Li, Sunil Sheth, Chunfeng Tan, Maria Parekh, Mehmet Enes Inam, Deepa Dongarwar, Bharti Manwani

Faculty, Staff and Student Publications

Identifying the underlying etiology of ischemic stroke is crucial for implementing effective stroke prevention measures. In the era of thrombectomy, ischemic stroke thrombus composition has gained considerable interest in the recent years. However, only a limited studies have analyzed the inflammatory milieu of the thrombus in association with stroke etiology. Atrial Fibrillation (AF), a common etiology of large strokes, is difficult to detect, but is known to be an inflammatory disease with a dominance of CD11b cell types (characterizes bone marrow derived myeloid cells such as monocytes, neutrophils, macrophages, and natural killer cells) in the atria. We hypothesized that thrombi …

Subjective Excessive Daytime Sleepiness And Frailty Progression In Veterans Over 50 With Insomnia, Mona Amirmazaheri

Walden Dissertations and Doctoral Studies

Frailty is common in aging veterans and linked to adverse outcomes. This retrospective cohort study of 6,824 veterans with insomnia examined whether excessive daytime sleepiness, sleep treatments, and PTSD affected frailty progression over four years. Frailty was measured using a validated index, with models adjusted for demographics and comorbidities, including chronic coronary insufficiency. Manuscript 1 showed that a higher Epworth Sleepiness Scale (ESS) score (range 0-24) was independently associated with a higher frailty index (FI) (p < .001). A clinical threshold of ≥11 indicated EDS and greater odds of frailty worsening compared to scores <11 (adjusted odds ratio (aOR) = 1.16, 95% CI [1.02, 1.32], p = .021). There was no significant interaction between ESS and time, suggesting that sEDS reflects persistently elevated frailty levels rather than accelerated decline. Manuscript 2 showed that nonpharmacologic sleep interventions were protective, while pharmacotherapy was associated with increased frailty risk. Cognitive behavioral therapy for insomnia was associated with lower odds of frailty worsening (aOR = 0.31, 95% CI [0.19, 0.53], p < .001), and continuous positive airway pressure therapy also reduced risk (aOR = 0.55, 95% CI [0.39, 0.76], p < .001). In contrast, sleep medications were associated with increased odds of frailty progression (aOR = 1.16, 95% CI [1.02, 1.32], p = .021). Manuscript 3 showed that PTSD was not associated with baseline frailty levels but showed a significant time interaction (B = 0.001, p = .008), indicating modest acceleration of frailty progression among affected veterans. Findings support positive social change through early sEDS screening and trauma-informed, nonpharmacologic sleep care to reduce frailty in veterans.

Staff Education On Oral Health To Night Shift Staff, Uzoamaka Mbionwu

Walden Dissertations and Doctoral Studies

Hospital-acquired pneumonia (HAP) remains the most common hospital-acquired infection in the United States, with nonventilated adult patients particularly at risk. This doctoral project focused on improving oral care practices among night shift nursing staff on a medical-surgical unit to reduce the risk of HAP. The practice gap identified was the inconsistent and inadequate delivery of oral hygiene during night shifts, primarily due to staff knowledge deficits, time constraints, and a lack of standardized procedures. The project was guided by the Johns Hopkins Evidence-Based Practice model and addressed the following question: In adult patients on a medical-surgical unit, will staff education …

Staff Education Project To Reduce Falls In Assisted Living Through Improved Caregiver Knowledge, Attitude, And Skill, Crystal Morrow

Walden Dissertations and Doctoral Studies

Wisconsin has the highest death rates from falls in the nation. In a brief, the Wisconsin Aging Advocacy Network indicated that most falls among individuals over 65 occur in residential settings. Further, a significant number of elderly people will fall each year, resulting in hospitalizations or fatalities. The purpose of this project was to provide staff education in one Wisconsin assisted living facility to effectively improve knowledge, attitude, and skill among frontline staff for fall prevention management. A formal Fall Education Day was provided to improve knowledge and shape positive attitudes among staff. A pretest-posttest design was used to measure …