Digital Commons Network^™

Dnp Final Report: Improving Length Of Stay Outcomes Using Structured Barrier Rounds: A Quality Improvement Project, Martha Kwamboka Apella

DNP Final Reports

Prolonged length of stay (LOS) in the acute care setting is a challenging issue driven by multiple factors. Increased LOS is associated with mortality, hospital-acquired infections, patient safety events, functional impairment, decreased quality of life, social isolation, and increased cost of care. The causes of increased LOS in the medical-surgical unit are unclear, necessitating an evidence-based project to address the problem. The purpose of this quality improvement initiative was to implement structured interdisciplinary barrier rounds and evaluate their effect on LOS, opportunity days, and estimated cost of care in a medical-surgical unit. The facility complex care coordinator (CCC) was identified …

Kras-Independent Factors Drive Pi3k Signaling And Circumvent The Necessity Of Kras-Driven Pi3k Activation In Pdac, Lucas Christopher Bialousow

MUSC Theses and Dissertations

Pancreatic ductal adenocarcinoma (PDAC) has one of the lowest five-year survival rates among cancers and is characterized by near-ubiquitous occurrence of oncogenic KRAS mutations. Oncogenic KRAS activates several downstream pathways, including ERK 1/2 MAPK and PI3K, which are critical for PDAC. However, accumulating evidence suggests that PI3K activity can be maintained independent of oncogenic KRAS. The high prevalence of KRAS^G12R in PDAC challenges the prevailing model of KRAS-driven PI3K activation, as this mutant is defective in direct engagement with PI3Kα. These observations raise important questions regarding how PI3K signaling is sustained in PDAC. Here, we investigated KRAS-independent mechanisms that …

Dupilumab For Patients With Allergic Fungal Rhinosinusitis, Amber U Luong, Joshua M Levy, Sarah K Wise, Joseph K Han, Mamoru Yoshikawa, Luo Zhang, Rodney Schlosser, Prerna Ranganathan, Paula Dakin, Jennifer Maloney, George D Yancopoulos, Andrew P Fontenot, Neelam A Phadke, Lacey R Robinson

The Brown Foundation: Institute of Molecular Medicine

Background: Allergic fungal rhinosinusitis (AFRS) is a severe subtype of chronic rhinosinusitis characterized by fungal hypersensitivity and accentuated type 2 inflammation. Dupilumab-a fully human mAb blocking IL-4/13, approved for type 2 inflammatory diseases, including chronic rhinosinusitis with nasal polyps-may benefit patients with AFRS.

Objective: We sought to understand the effect of dupilumab in AFRS.

Methods: In this phase 3 trial, patients with AFRS age ≥6 years were randomized to dupilumab or matched placebo for 52 weeks. The primary end point was Lund-Mackay computed tomography score, quantifying sinus opacification, at 52 weeks. Secondary end points were multiplicity-controlled and hierarchically tested.

Results: …

Effects Of Non-Surgical Periodontal Therapy On Dental Plaque Microbiome, Qingguo Wang, Bing-Yan Wang, Derek Wilus, Hua Xie

Faculty, Staff and Student Publications

Periodontitis, a chronic inflammatory disease affecting approximately 40% of U.S. adults aged 30 years and older, is characterized by dysbiosis of the dental plaque microbiome. However, although scaling and root planing (SRP) is the cornerstone of periodontal treatment, its effects on the taxonomic composition and functional potential of the dental plaque microbiome remain incompletely understood. In this study, we used whole-metagenome shotgun sequencing to characterize taxonomic composition and functional potential in dental plaque microbiomes collected from 39 patients with Stage II or III generalized periodontitis before and 3–4 months after SRP. Consistent with clinical improvement, periodontal therapy significantly reduced probing …

Availability Of Cannabinoid-Infused Products In Corner Stores In Franklin Park, Allentown, Abigale Brosious, Joselyn Correa-Melendez Dhsc, Mph, Kimberly C. Brown Md

Research Scholars

No abstract provided.

Enhancing Chronic Kidney Disease Awareness And Early Identification Through Community Health Worker Education In Rural Arkansas, Samantha L.M. Smith

Walden Dissertations and Doctoral Studies

The doctoral project was focused on improving staff education and development to prevent chronic kidney disease (CKD) through community health worker (CHW) education. The practice problem was the delayed identification of CKD risk factors and late referral to nephrology services, particularly among rural and underserved populations. Because CKD often progresses without symptoms, early education and awareness are critical to improving outcomes and reducing disease progression. The purpose of the project was to develop and implement a structured CKD educational curriculum for CHWs to improve their confidence in kidney health, CKD risk factors, prevention strategies, early identification, and referral awareness. The …

Loss Of Nemp1 Disrupts Female Meiosis And Activates A Conserved Atm-Chk2 Checkpoint, Bilal Ahmad Hakim, Yonit Tsatskis, Ling Zhang, Esther Choi, Ying Zhang, Didier Hodzic, Que Wu, Muyun Zhang, Maryam Pashaei, Kyungwon Ha, Jannette Rusch, Julie A Brill, Miguel Angel Brieño-Enríquez, Andrea Jurisicova, Helen Mcneill

2020-Current year OA Pubs

Female germ cells must preserve the integrity of their genome and generate genetic diversity via meiotic recombination. This challenging process is error prone. Highly conserved checkpoint pathways detect errors in recombination and DNA damage, inducing the death of defective oocytes. Nuclear Envelope Membrane Protein (NEMP) homologs are highly conserved proteins critical for fertility in flies, worms, fish and mice. They localize to the inner nuclear envelope where they provide mechanical support. However, why NEMP homologs are specifically required for fertility is still unclear. Using both Drosophila and mouse models, we establish that loss of NEMP homologs leads to activation of …

Pengaruh Buerger Allen Exercise Terhadap Sirkulasi Ekstremitas Bawah Pada Pasien Luka Kaki Diabetik, Jannaim Jannaim, Ridha Dharmajaya, Asrizal Asrizal

Jurnal Keperawatan Indonesia

The Influence of Buerger Allen Exercise on Lower Extremity Circulation in Patients with Diabetic Foot Ulcer. Diabetic footulcer (DFU) is a complication of diabetes caused by impaired venous and arterial blood circulation. Buerger allen exercise is a modality therapy with active postural movement. This study aims to assess the effect of buerge rallen exercise on the circulation of lower extremities in DFU patients. The study design was pre experimental pretest and posttest without control. The sampling technique was consecutive sampling and the large sample of 43DFU patients, analysis data was using Wilcoxon test. Increased circulation is measured using the Ankle …

Dnp Final Report: Enhancing Self-Regulated Learning And Metacognition For First-Semester Undergraduate Nursing Students, Carla S. Biondillo

DNP Final Reports

Background. First-year undergraduate nursing students often struggle to adapt their learning strategies to the higher-order thinking and clinical reasoning demands of nursing education. Ineffective study habits, low academic self-efficacy, and limited self-regulated learning (SRL) skills are consistently identified as predictors of attrition, which ranges from 20–50% nationally and internationally.

Purpose. At an academic medical center in rural East Texas, first-semester students report academic overwhelm and inadequate study strategies, consistent with national trends. A structured, evidence-based faculty coaching intervention targeting SRL and metacognition was found to be feasible within the collaborative, student-centered organizational culture.

Methods. A quality improvement (QI) design …

Dnp Final Report: Community-Based Advance Care Planning Education For Older Adults: A Quality Improvement Project, Teresa Hill

DNP Final Reports

Background: Advance care planning (ACP) supports patient autonomy and promotes care aligned with individual values and preferences. Despite these benefits, fewer than half of adults aged 50–80 have completed formal ACP documentation, and community-dwelling older adults rarely engage in ACP before serious illness, representing a persistent gap in early engagement.

Purpose: This quality improvement (QI) project evaluated the effectiveness of a community-based ACP educational intervention in improving ACP knowledge, confidence, and engagement among older adults.

Methods: A nurse facilitator trained in the Five Wishes framework delivered a structured, 60-minute ACP workshop at a senior center in North Texas. A pre–post …

Risk Factors For Metabolic Syndrome Among U.S.-Born And Non-U.S.-Born Hispanics In The United States, Banessa Maldonado

Walden Dissertations and Doctoral Studies

Current knowledge regarding risk factors for metabolic syndrome (METS) among Hispanic individuals of Mexican descent remains limited. Using data from NHANES 2017–2020, this study compared factors contributing to METS and included U.S.-born and non-U.S.-born Hispanic adults of Mexican descent aged ≥ 18 years living in the USA (N = 949) with assessed METS. Grounded in the social ecological model and social determinants of health, this research evaluated dietary habits, lifestyle patterns, and acculturation processes using multivariate logistic regression and stratified analyses. Educational attainment was associated with METS, but the association was not statistically significant in adjusted models p = 0.528. …

Locoregional Therapy Pressure-Enabled Drug Delivery For Liver Cancers, Thomas Eggleston, Bassem Fayek, Jacqueline Kowalke, Mina Makary

Student Papers, Posters & Projects

Hepatic malignancies account for a substantial portion of global cancer mortality, with hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (IHC), and metastatic liver disease representing the most common diagnoses. While surgical resection and liver transplantation remain curative options for eligible patients, most patients are diagnosed at stages unsuitable for surgery. This has shifted medical management towards locoregional therapies (LRTs) which are often catheter-directed. Of these interventions, the use of conventional end-hole catheters for therapeutic infusion has been a mainstay of treatment, but this method is constrained by retrograde particle escape and elevated tumoral interstitial fluid pressure. Together, these factors limit drug penetration …

When Should You Worry About Pediatric Snoring?, Sarah Gubara, Samira Naime

Pediatrics in Practice: A CME Podcast

My child snores — when is it a problem? Snoring and obstructive sleep apnea are the focus here. Samira Naime, MD, Pediatric Pulmonologist and Sleep Medicine Physician at Children's Mercy, explains how to spot worrying signs, when to try allergy treatment or nasal steroid and when to consider a sleep study. She also covers which labs allow outside ordering and when referral to sleep medicine is appropriate.

Click here to stream the podcast episode.

Parental Enculturation And Child Well-Being In Immigrant Families: Examining Peer Relationship Difficulties And Emotional Symptoms In Asian American Youth, Yuxin Yu

LSU Master's Theses

Parents with immigration backgrounds face the dual challenges of maintaining their heritage culture while supporting their children’s adaptation to the mainstream culture. Although previous studies stressed both acculturation and enculturation, these two processes can compete and even conflict, leading to the important question for parents: Does parental enculturation influence children’s peer relationships and emotional functioning? This study examines the associations between parental enculturation and the social and emotional adaptation of Asian American youth by focusing on peer relationship difficulties and emotional symptoms. Participants included 75 Asian American parents of children aged 4 to 17, who completed measures of parental enculturation …

Snap Into Better Pediatric Neuro Assessments, Irene Chacko, Nayelli Fuentes, Annie Mazon Kellejian, Claire Ring, Ibrahim Shaikh

2025

No abstract provided.

Perimenopause And Menopause: Understanding Utahns' Experiences, Cris Meier, Moth Huenemann, Cara Murray, Ashley Yaugher

All Current Publications

The first stage of menopause, known as perimenopause, is signaled by fluctuating or declining hormone levels, irregular menstruation, and the onset of symptoms such as hot flashes and mood changes. Menopause follows this phase, which is 12 consecutive months when no menstrual cycles occur in combination with hormone decline and experiencing additional symptoms (e.g., hot flashes, sleep disturbances).To better understand Utahns’ needs and preferences during menopause, Utah State University Extension researchers conducted a needs assessment to inform programming creation and delivery. This report details the results, identifying survey participants, women's sources of information, symptoms, and symptom management.

Trust, Participation, And Power: Community Perspectives From The Equity In Public Health Initiative, Shaniece Criss, Roger S. Abim-Karmon, Jody Teel, Vanessa Rodríguez, Adia Bennon, Sally Wills, Sarah Gonzales, Dalmondeh D. Nayreau, Vaishnavi Bharadwaj, Hannah G. Kim, Jennifer Woollery, Melissa Fair

Health Sciences Publications

Health disparities arise from unequal power relations shaping resource allocation, governance, and community agency. Community power is a key mechanism for addressing disparities. This study examines how visible, hidden, and invisible power operate within a U.S. county to inform inclusive governance. We conducted seven focus groups with Black and Hispanic residents (n = 68) and sixteen semi-structured interviews with elected officials, government staff, and advocacy leaders in Greenville County, South Carolina. Data were collected between March and December 2024. Transcripts were collaboratively coded in NVivo and analyzed using thematic analysis guided by Heller et al.’s Three Faces of Power …

Safety Of Early Discharge And Abbreviated Nimodipine Course In Patients With Good-Grade Aneurysmal Subarachnoid Hemorrhage, Patrick R. Toyota, Alexander D. Rebchuk, Michael A. Rizzuto, Hugh Mchugh, Kelsey Cruz, Charles S. Haw, Gary J. Redekop, Peter Gooderham

Department of Neurosurgery Faculty Papers

Aneurysmal subarachnoid hemorrhage (aSAH) remains a devastating cerebrovascular emergency associated with substantial morbidity and mortality. Current guidelines recommend 14-21 days of inpatient monitoring and a 21-day course of nimodipine following aSAH. This retrospective study evaluates early outcomes early discharge (≤14 days post-ictus) and an abbreviated nimodipine course in highly selected patients with good-grade aSAH managed under a standardized institutional protocol. Consecutive patients enrolled in the Vancouver Ruptured Aneurysm Database (VRAD) at Vancouver General Hospital between 2022 and 2025 were included. Inclusion criteria were good-grade aSAH (WFNS Grade I-III) and discharge home within 14 days of ictus. The primary outcome was …

Pathogenic Myeloid Phenotypes Drive Disease Pathology In A Novel Human Neurohistiocytosis Model, Shivakumar Rajamanickam, Samantha Trescott, Samantha Mak, Anna S Warden, Amanda M Wilpitz, Bing Xia, Celina Nguyen, Hilda Ding, Jennifer Picarsic, Christopher K Glass, Carl E Allen, Nicole G Coufal

Faculty, Staff and Students Publications

Innate immunity is increasingly recognized as a driver of neurodegeneration, although pathogenic mechanisms are incompletely understood. Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplastic disorder caused by activating somatic mutations in MAPK pathway genes, most commonly BRAFV600E, in myeloid precursors. A subset of patients with LCH develop progressive neurodegeneration (LCH-ND). We generated a human induced pluripotent stem cell (iPSC) model from patients with somatic hematologic mosaicism for BRAFV600E. Brain macrophages/microglia from LCH iPSCs exhibit unique disease-specific pathogenic features. Stepwise differentiation identified hematopoietic progenitors as hyperproliferative, whereas brain macrophages were apoptosis resistant. Through application of cerebral organoids and a humanized …

Enhancing Staff Knowledge Of Prenatal Depression Screening And Follow-Up Protocols, Gladys Ajohmbu Esunji

Walden Dissertations and Doctoral Studies

This staff education project addressed inconsistent staff knowledge of prenatal depression screening and follow-up protocols in an outpatient behavioral health practice serving prenatal patients. Prenatal depression is a nursing practice concern because delayed identification and inconsistent follow-up may affect maternal well-being, infant outcomes, family functioning, and timely access to behavioral health support. The practice-focused question was: According to the evidence, among clinical staff in an outpatient maternal mental health setting, what is the impact of structured staff education on adherence to prenatal depression screening on follow-up protocol knowledge? The purpose was to improve clinical staff knowledge through a structured education …

What Is Volunteer Services?, Anaya Freeman, Denyelle Buck Bba, Karla Bachl Mba, Shrm-Cp, Cavs, Cdvs

Research Scholars

No abstract provided.

Exploring The Role Of Medical Interpreters In Patient Care, Polina Baba, Joumana De Santiago

Research Scholars

No abstract provided.

Health Effects Of Adolescent Vaping, Marco Ashraf Fekry, Kimberly D. Smith Rrt-Accs

Research Scholars

No abstract provided.

Upper Macungie Township Lifestyle Center Assessment, Anthony Pino, Dana Levano Ms, Brielle Gregoli Ms

Research Scholars

No abstract provided.

The Process Of How Products Get To The Patient In The Hospital: Supply Chain At Lehigh Valley Hospital, Nisayr Santiago, Esther Indah Ba, Marc Curcio As, Bs, Daniel Patrie Mba, Pmp, Cmrp, Cpht, Stephanie Morrison

Research Scholars

No abstract provided.

Postmenopause: Understanding Utahns' Experiences, Cris Meier, Moth Huenemann, Cara Murray, Ashley Yaugher

All Current Publications

The first stage of menopause, known as perimenopause, is signaled by fluctuating or declining hormone levels, irregular menstruation, and the onset of symptoms such as hot flashes and mood changes. Menopause follows this phase, which is 12 consecutive months when no menstrual cycles occur in combination with hormone decline and experiencing additional symptoms (e.g., hot flashes, sleep disturbances).To better understand Utahns’ needs and preferences during and after menopause, Utah State University Extension researchers conducted a needs assessment to inform programming creation and delivery. This report details the results, identifying survey participants, women's sources of information, symptoms, and symptom management.

Performance Evaluation Of The Xpert® Hcv Test On Fingerstick Blood In A Prospective Observational Clinical Study At Clia-Waived Sites In The United States, Jennifer R Havens, L Madeline Mccrary, Et Al.

2020-Current year OA Pubs

BACKGROUND: A major barrier to hepatitis C virus (HCV) elimination in the United States is the lack of a point-of-care test to confirm the presence of HCV RNA. The purpose of this clinical trial was to evaluate the performance of the Xpert® HCV test at CLIA-waived sites in the United States.

METHODS: Participants at risk and/or with signs/symptoms of HCV infection provided fingerstick blood that was tested on the Xpert® HCV test and venous blood tested using the cobas® HCV and Elecsys® Anti-HCV II tests. Fingerstick blood was collected at CLIA-waived sites by individuals self-trained on collection procedures.

RESULTS: Participants …

The Best Of Both Worlds: How Combining A Large Language Model And A Rule-Based Algorithm Makes Catheter-Associated Urinary Tract Infection Surveillance More Efficient, Joshua Nordman, Claire Najjuuko, Nicholas Jeschke, Rachael E Snyders, Maria Cristina Vazquez Guillamet, Hilary Babcock, Patrick Reich, Andrew Atkinson, Jonas Marschall, Abby Sung, Et Al.

2020-Current year OA Pubs

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) surveillance is critical for patient safety. Many healthcare systems use electronic algorithms to flag candidate infection events but still require manual chart review to confirm CAUTI cases. We evaluated the use of a large language model (LLM) to enhance CAUTI surveillance.

METHODS: We analyzed 919 potential CAUTI cases flagged by the electronic surveillance algorithm at Barnes-Jewish Hospital from 2021 to 2024. These cases were previously classified as 291 CAUTIs and 628 non-CAUTIs by trained infection preventionists (IPs). Several approaches for applying the National Healthcare Safety Network (NHSN) CAUTI definition after extracting clinical data from …

Personalizing Modern Heart Failure Therapy In Hfref: Bridging Evidence, Clinical Practice, And Future Perspectives, Ehsan Shahverdi, Amin Shahverdi, Sendooran Shahi, Carsten Schneider, Mathias Lange, Shadi Kamali

Journal of the Saudi Heart Association

Background

Heart failure with reduced ejection fraction (HFrEF) remains a major cause of morbidity, mortality, and healthcare utilization worldwide despite substantial therapeutic advances. Over the past three decades, randomized clinical trials have established four foundational pharmacologic pillars of guideline-directed medical therapy (GDMT): renin–angiotensin system inhibition or angiotensin receptor–neprilysin inhibition, evidence-based beta-blockers, mineralocorticoid receptor antagonists, and sodium–glucose cotransporter 2 inhibitors. However, real-world implementation of these therapies remains suboptimal.

Objectives

To provide a contemporary state-of-the-art review of current evidence supporting GDMT in HFrEF, examine unresolved challenges in sequencing and optimization, and propose a practical phenotype-based framework to support individualized treatment decisions

. …

What Factors Do Patients Consider When Choosing A Hand Surgeon?, Monik Debkowska, Jeremy Ruskin, Brian Lynch, Samuel Caradonna, David Komatsu, Edward Wang, Samantha Muhlrad

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: Many patients find themselves frustrated wasting time and money when searching for the right hand specialist, only to be referred to a different one. There has been little research evaluating patient decision making when choosing a hand surgeon. Specialists would benefit from learning how to optimize their practice to reach their appropriate patient population for maximum benefit and minimum resource waste, both for the patients and physicians. We therefore conducted a survey study to evaluate which factors patients consider important when choosing a hand surgeon, and if these factors differ based on patient demographics. Our hypothesis is that patients …