Digital Commons Network^™

Impact Of Implementing An Updated Cervical Cancer Screening Protocol In The Primary Care Setting, Teri A. Koch

Evidence-Based Practice Project Reports

Cervical cancer is one of the most common types of cancer among women globally. Current screening methods by clinicians include cytology sampling, high-risk human papillomavirus sampling, or co-testing with both methods. These tests may detect cell changes before they become cancerous, yet the uptake of these methods has decreased in recent years (Aginga, 2022; Office of Disease Prevention and Health Promotion, 2023; Popalis et al., 2022; Sung et al., 2021). The primary purpose of this evidence-based practice project was to determine if the implementation of an updated cervical screening protocol improved the linkage of abnormal results to appropriate clinical follow-up …

A Multi-Modal Intervention To Improve Identification, Management, And Prevention Of Early Childhood Caries In The Primary Care Setting, Rieley M. Hull

Evidence-Based Practice Project Reports

Early childhood caries (ECC) is the most prevalent chronic childhood disease and, if untreated, can lead to significant long-term health and social consequences, posing a substantial healthcare burden (AAPD, 2023; ADA, 2023; USPSTF, 2021; WHO, 2022). This evidence-based practice (EBP) project aimed to implement a multi-modal intervention to reduce ECC risk factors, prevent new dental caries, and halt the progression of existing dental caries. Conducted in a pediatric primary care setting in West Michigan, the project included patients five and under who received an oral examination and dental caries risk assessment following the AAP’s guidelines. Based on their oral health …

Analyzing Healthcare As A Right, Instead Of A Privilege, Saidt Gutierrez

Undergraduate Research Symposium Podium Presentations

Healthcare is a fundamental necessity, yet in many countries including the United States, it remains a privilege rather than a right. This research examines the benefits of universal healthcare by analyzing its impact in countries that have successfully implemented healthcare such as Canada, the United Kingdom, and Germany. This study evaluates the healthcare accessibility, cost efficiency, and health outcomes in these countries against the U.S. This finding will suggest that universal health care leads to lower overall healthcare costs, improve public health, and reduce financial burdens on individuals. By ensuring healthcare as a right, rather than a privilege, the U.S …

Costing Care: Unpacking The Drivers Of Medicaid Spending For Nicu Admissions In Nevada, Vidhani Goel, Ana L. Reyes, Bertille Assoumou, Dodds P. Simangan, Farooq Abdulla, Deborah A. Kuhls

Undergraduate Research Symposium Podium Presentations

Overview This study examines how maternal and neonatal factors influence Medicaid spending for NICU admissions in Nevada, with an emphasis on identifying cost-driving health disparities. Approach: A retrospective analysis was conducted using linked data from Nevada’s Birth Registry and Medicaid claims (2015–2021). Infant records were analyzed using univariate and bivariate statistics, and logistic regression models identified associations between maternal/neonatal characteristics and above-median Medicaid spending. Cost trends were assessed using NICU case costs, annual growth rates, and year-to-year fluctuations. Key Objectives: Analyze trends in NICU-related Medicaid spending over a seven-year period. Identify maternal and neonatal characteristics linked to higher NICU costs. …

Beyond The Nursery: Unraveling Maternal And Neonatal Factors Associated With Nicu Admissions In Nevada (2015–2021), Vidhani Goel, Ana L. Reyes, Bertille Assoumou, Dodds P. Simangan, Farooq Abdulla, Deborah A. Kuhls

Undergraduate Research Symposium Podium Presentations

Overview

This project focuses on investigating the relationship between maternal medical conditions, socioeconomic factors, and NICU admission levels among Medicaid beneficiaries in Nevada.

Approach:

•A retrospective analysis was conducted using linked data from the Birth Registry and Nevada Medicaid Claims from 2015 to 2021.

•Infant records were analyzed using univariate and bivariate statistical methods, with a significance level set at 5%.

•Logistic regression models were used to examine associations between maternal characteristics and NICU admission levels.

Key Objectives:

•Analyze NICU admission trends among Medicaid beneficiaries.

•Identify maternal health risk factors linked to NICU admissions.

•Examine neonatal characteristics influencing NICU admissions.

Leukemia And Thyroid Cancer In Relation To Reca Boundaries, Cora Marinos

Undergraduate Research Symposium Posters

A total of 1,054 test were conducted by the United States between 1945 and 1992. This is more Atomic tests than all other countries combined. Of those tests 928 were conducted at the Nevada Test Site located 65 miles from Las Vegas, Nevada.

These tests spread nuclear fallout throughout the United States causing the people in nearby communities to become sick. The public outcry spurred the passing of the Radiation Exposure Compensation Act in 1990 (RECA) It’s scope of coverage was broaded in 2000. Despite many groups fighting for further expansion, the Act expired in June of 2024.

Of the …

Stress And Glucose Regulation In Adults At Risk For Type 2 Diabetes Mellitus: A Secondary Analysis From A Randomized Controlled Trial, Sophia Lysne, Regina Dispa, Brenna Way, Bea Francene Pilnade, Donya Shahamati, Romina Ballesteros, Christopher Acosta, Keren Morales, Esther Adaji, Ohis Egbaidomeh

Undergraduate Research Symposium Posters

Type 2 Diabetes Mellitus (T2DM) is a major public health concern, significantly increasing the risk of cardiovascular diseases (CVDs). Additionally, prediabetes is a critical precursor, as it elevates the risk of developing both T2DM and CVDs. (2)

Recent literature reveals among individuals with severe perceived stress, there is a higher likelihood of HbA1c% levels meeting the criteria for prediabetes (5.7– 6.4%) as compared to those with lower perceived stress. (3)

Studies show that psychological stress has hyperglycemic effects in individuals with T2DM, suggesting that stress is associated with poorer blood glucose control. (4)

Behavioral Responses To The Medicare Part D Coverage Gap And Its Closure, Selene Urbatsch

Theses and Dissertations

The author examines how exposure to the Medicare Part D coverage gap affects future prescription drug use and whether the closure of the gap under the Affordable Care Act (ACA) altered beneficiary behavior. Using 2007–2019 MEPS data, the analysis compares Part D enrollees to similarly aged, privately insured individuals, producing first-differences and difference-in-differences estimates. Before the ACA, exposure to the gap was associated with 4.9 fewer prescription fills relative to comparable non-Part D individuals. After the ACA, the effect fell to a reduction of 2.2 generic fills, with no significant decline in branded use. Sudden out-of-pocket cost increases prompted sharp …

Out From Under: Stories Of Endometriosis, Prisca Edwards

Theses and Dissertations

Six individuals. One diagnosis. In Out From Under, people living with endometriosis gather for an art-centered workshop. Through collage and conversation, they transform isolating medical experiences into paths of connection and collective healing.

Endometriosis affects approximately one in ten women of reproductive age, yet diagnosis is often delayed by nearly a decade. During this time, many suffer from debilitating symptoms without adequate care or accessible treatment. Out From Under explores the lived experience of endometriosis through the lens of socially engaged documentary filmmaking. Participants share their medical histories, emotions, and frustrations in a structured yet open environment designed for intimacy, …

Dnp Final Report: Improving Adherence With Cms Sep-1 Sepsis Bundle In The Emergency Department, Emmanuel Bernards

DNP Final Reports

Adherence to the CMS SEP-1 Sepsis bundles is critical to sepsis management and leads to lower sepsis mortality, lower incidence of readmission, reduced length of hospital stay, and improved patient outcomes. This medical center has struggled to meet the required 71% adherence rate set by the Center for Medicaid and Medicare, representing the benchmark of acceptable care of sepsis patients. Therefore, the following PICOT question arises: among the hospitals’ ED physicians and nursing staff (P), how does a multimodal approach consisting of education, visual reminders, and audit and feedback (I) compared to a single approach (education) (C) affect adherence to …

Pediatric Asthma Subspecialty Referral Practices In Rural Maine, Paras Patnaik, John Dipalazzo, James Bohnhoff

Costas T. Lambrew Research Retreat 2025

Over 7.2 million children in the United States have asthma.

• >300,000 asthma-related ED visits & hospitalizations yearly
• Both PCP’s and pediatric asthma subspecialists (allergist/immunologists and pediatric pulmonologists) provide long-term asthma care

Examining Demographic, Geographic, And Temporal Patterns Of Melanoma Incidence In Texas From 2000 To 2018: Retrospective Study, Kehe Zhang, Madison M Taylor, Jocelyn Hunyadi, Hung Q Doan, Adewole S Adamson, Paige Miller, Kelly C Nelson, Cici Bauer

Faculty, Staff and Student Publications

Background: Melanoma currently ranks as the fifth leading cancer diagnosis and is projected to become the second most common cancer in the United States by 2040. Melanoma detected at earlier stages may be treated with less-risky and less-costly therapeutic options.

Objective: This study aims to analyze temporal and spatial trends in melanoma incidence by stage at diagnosis (overall, early, and late) in Texas from 2000 to 2018, focusing on demographic and geographic variations to identify high-risk populations and regions for targeted prevention efforts.

Methods: We used melanoma incidence data from all 254 Texas counties from the Texas Cancer Registry (TCR) …

Parental Vaccine Hesitancy And The Decision To Vaccinate Children Against Covid-19, Jessica Mckee

Walden Dissertations and Doctoral Studies

While there is a significant body of literature regarding vaccine hesitancy, there is a gap in the literature on its impact to parents’ decisions to vaccinate their children against a pandemic pathogen. The purpose of this study was to examine the relationship between parental vaccine hesitancy, measured using the health belief model (HBM) theoretical framework constructs of the Vaccine Hesitancy Scale (VHS; the degree to which an individual trusts in vaccine efficacy, safety, the reliability and trustworthiness of vaccine programs, community impact, perceived risks, and the importance of childhood vaccinations), and parents’ decision to vaccinate their children against COVID-19 with …

Patient-Clinician Communication In The Appalachian Region: A Scoping Review, Kawther Al Ksir, Hadii M. Mamudu, Chidiebube J. Ugwu, Emily K. Flores, Tracy Fasolino, Holly Wei, Rick L. Wallace, Florence M. Weierbach

Journal of Appalachian Health

Introduction: Effective communication between patients and clinicians is a critical component of quality health care, influencing disease prevention, management, and outcomes. In regions with unique socioeconomic and geographic challenges, communication barriers can further exacerbate health disparities. Understanding the factors that facilitate or hinder patient-clinician communication is essential for developing targeted interventions that improve health care delivery.

Purpose: This review explores the existing literature on patient-clinician communication concerning cardiovascular disease (CVD) in the Appalachian Region with the aim to understand existing gaps and interventions.

Methods: PubMed and Web of Science databases were utilized to conduct a systematic search. The Population, Concept, …

Time And Location: Physical Activity Trends In Parents And Children In A Rural Region During Covid-19, Brooke C. Towner, Robert Broce, Rebecca A. Battista

Journal of Appalachian Health

Introduction: COVID-19 restrictions altered the structure of the school and workday for families with children and led to changes in active transportation. Continued restrictions impacted access to many community locations and led to changes in physical activity (PA) behavior.

Purpose: The objectives of the study were to describe the changes in the 1) amount of PA time per day, 2) frequency of PA, and 3) sitting time. Information about how PA changed for parents and children during the COVID-19 pandemic will have potential implications for education, public health, and recreation management.

Methods: This cross-sectional study enlisted participants via an online …

Improving Hospital Discharges Before Noon: Implementation Of A Vida (Very Important Discharge Appointment), Nadia Paul

Evidence-Based Practice Project Reports

Delays in hospital discharge can negatively affect hospital throughput and bed capacity, resulting in increased length of stay and boarding of patients in off-unit locations which causes concerns for patient safety and potential harm (Rutherford et al., 2017). The purpose of this DNP project was to determine if the implementation of a very important discharge appointment (VIDA) would increase the number of hospital discharges occurring before noon (DBN) each day. This project was implemented at a 350-bed academic medical center in East Central Indiana. A 25-bed, adult medical unit served as the pilot unit. In total, 538 patients were included …

Frontier Healthscapes: Competing Narratives Of Disease, Environment, And Wellbeing In Early Minnesota, Aidan Reynolds

Geography Honors Projects

Across settler societies, health narratives were shaped by evolving tensions between lay and expert knowledge, frameworks of disease causation, and perceptions of the environment as both a source of health and a threat. In the decades following Euro-American settlement (1860-1900), Minnesota became a focal point for these debates, with its landscape fostering complex and competing narratives on health, wellbeing, and disease. This paper explores how public health discourse developed in Minnesota through the perspectives of institutions, the public, and economic interests. Combining environmental history with critical discourse analysis of archival materials, this study examines shifts within the Minnesota State Board …

Promotion Of Women’S Preventative Health Behaviors For Breast And Cervical Cancer, Shelby Lopez

Doctor of Nursing Practice Scholarly Project

Women’s health prevention is typically not a significant topic for discussion. Health prevention measures are often discussed after a new diagnosis, rather than being a proactive approach toward improving women’s health. Breast and cervical cancer continue to be prevalent today and, to decrease the number of women diagnosed with late-stage cancer, this scholarly project will focus on improving the participation in prevention behaviors among women 18-45 years of age, but also acknowledge the role self-efficacy and perception of health behaviors has on the participation in prevention measures. Pender’s Health Promotion Model will help acknowledge how social-behavioral factors affect prevention behaviors. …

Promoting Increased Consumption Of Fruits And Vegetables In Older Adults Through Self-Efficacy And Social Cohesion, Ashley Lynn Nelson

Doctor of Nursing Practice Scholarly Project

The purpose of this scholarly project was to design and offer a nutrition education program on fruit and vegetable consumption to a group of rural adults aged 65 and older. It was hypothesized that the nutrition program would directly motivate older adults to increase dietary consumption of fruits and vegetables. The project utilized the Health Promotion Model as the theoretical framework. To incorporate this project into a quantitative design, the methodological design that was applied is a non-experimental or observational design. This project included a four-week educational program in the Spring of 2023 that provided information on the importance of …

Stress And Burnout Among Icu Nurses, Jaspreet Kaur

2025 Spring Honors Capstone Projects - Archive

Burnout is a significant occupational hazard for Intensive Care Unit (ICU) nurses. High patient acuity, staffing shortages, and long shift hours increase stress and diminish well-being among nurses, affecting patient care outcomes. This study examined the prevalence of stress and burnout among ICU nurses to identify contributing factors and potential interventions. An anonymous online survey was conducted among 110 ICU nurses, utilizing the Maslach Burnout Inventory (MBI) and the Perceived Stress Scale(PSS). Findings revealed that 42.5% of nurses reported high emotional exhaustion, while 37.5% felt they had little to no control at work. The most frequently cited workplace stressors were …

Health Care Delivery Of Asthma In Health Care Systems Across The World: A Comparison Of Three Health Systems, Megan T. Hui

2025 Spring Honors Capstone Projects - Archive

Asthma remains a significant health concern globally, with healthcare delivery varying across different systems. This study aims to compare asthma care within three healthcare system: the Beveridge model (United Kingdom), the Bismarck model (Switzerland), and the National Health Insurance model (Canada) focusing on cost, quality, and accessibility. This study used a systemic review, gathering published evidence from the Organization for Economic Cooperation and Development (OECD) Data Explorers that explicitly met eligibility criteria for asthma treatment and outcomes. Evidence from government reports, public health databases, and peer-reviewed literature were analyzed. Kissick’s Iron Triangle framework was applied to assess the inherent trade-offs …

Understanding The Impact Of Language Barriers And Visit Duration On Caregiver Satisfaction In Pediatric Primary Care, Gavin Miller

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Children from households that speak languages other than English (LOE) face barriers in accessing healthcare, leading to poorer health outcomes. Language barriers contribute to these disparities, often resulting in diminished communication between providers and families. Visit duration may play a key role in facilitating effective communication and improving patient satisfaction.

Purpose: This study examines how language barriers affect caregiver satisfaction in pediatric primary care, and whether visit duration mediates this relationship. We hypothesized that caregivers from LOE households would have comparable visit durations to English-preferring caregivers but report lower satisfaction due to receiving less information within that time. …

A Review Of Studies Assessing Modifiable Risk Factors For Dementia Among Family Caregivers In The United States Based On Behavioral Risk Factorsurveillance System (Brfss), Shruthi Ranjithkumar

2025 Spring Honors Capstone Projects - Archive

Caregivers of individuals with Alzheimer's Disease and Related Dementia (ADRD) face an increased risk of developing dementia due to advanced age and modifiable risk factors. The 2024 Lancet Commission Report identified 14 such risk factors, whose mitigation could reduce dementia cases by 45%. Despite this, research on modifiable dementia risk factors among ADRD caregivers remains limited. This study investigates whether peer-reviewed studies utilizing Behavioral Risk Factor Surveillance System (BRFSS) data assess modifiable dementia risk factors among ADRD caregivers. A PubMed search retrieved 27 relevant articles, which were analyzed for risk factors identified by the Lancet Commission, including traumatic brain injury, …

Healthcare Utilization Patterns, Associated Factors, And Readmission Rates Among Children With Sickle Cell Disease., Daniya Mohammed Sabrah

Electronic Theses and Dissertations

Sickle Cell Disease (SCD) is common in Saudi Arabia, with a prevalence rate of 2.3%. It is an expensive disease to manage due to the extensive utilization of healthcare resources, including hospital readmissions, extended hospital stays, and frequent emergency department visits, which cost approximately $395 million annually in U.S. dollars. The primary objective of this study was to conduct a systematic literature review of healthcare utilization and cost of patients with SCD, following the PICO framework and PRISMA guidelines. The second aim utilized count models, including the negative binomial and Poisson, to identify factors associated with emergency, inpatient, and outpatient …

The Impact Of Public Health Authority On Emergency Response In State Health Departments, Jessica L. Baggett

Dissertations: Doctor of Public Health

Background

Public health authority plays a crucial role in enabling state health officials to implement emergency response measures such as isolation, quarantine, and vaccination campaigns. However, legislative changes following the COVID-19 pandemic have significantly curtailed these authorities in many states, raising concerns about the ability of public health officials to respond effectively to future health crises. The erosion of public health authority has highlighted gaps in the legal literacy of health officials and underscored the need for enhanced training in navigating political and legal challenges.

Purpose

The purpose of this study is to assess legal literacy among state health officials, …

Implementing Early Detection Of Cognitive Impairment In Primary Care To Improve Care For Older Adults, Nicole R. Fowler, Katherine A. Partrick, James Taylor, Michael Hornbecker, Malaz Boustani, Jeffrey L. Cummings, Tim Macleod, Michelle M. Mielke, Jared R. Brosch, Chinedu Momoh

Brain and Mind Institute

Primary care is the ideal setting for early detection of mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD), as it serves as the primary point of care for most older adults. With the growing aging population, reliance on specialists for detection and diagnosis is unsustainable, highlighting the need for primary care-led assessment. Recent research findings on successful brain health prevention strategies, AD diagnostic tools, and anti-amyloid treatments empower primary care to play a central role in early detection and intervention. Primary care-focused resources are being developed, including tools for cognitive assessments and materials designed to educate patients …

Prescription For Progress: A Retention Plan To Heal The Dying Nurse Workforce, Margaret Curd

Senior Honors Theses

The United States is currently facing an unprecedented nursing shortage which stems from many variables, including a lack of clinical rotation sites for students, increased burnout among current nurses, and a growing retiring workforce. Rising nurse turnover rates negatively impact patient outcomes, which should concern all levels of management. One specific hospital facing such an impact is Advocate Christ Medical Center in Oak Lawn, Illinois. This thesis seeks to address their substandard staffing ratios in an extensive, holistic strategic retention plan. Metrics for proving the plan’s success are provided alongside a discussion of proper calculations for each.

Knowledge, Attitudes, And Practices Regarding Antimicrobial Resistance And Antimicrobial Stewardship Among Healthcare Workers In Outpatient Medical Centers In Kenya: A Qualitative Study, Mary Kaniu, Wahu Gitakah, Rupali Jain, Ann Munyare, Rodney Adam, Aliza Monroe Wise

Paediatrics and Child Health, East Africa

Objective: Antimicrobial resistance (AMR) is a major global health threat with a projected 10 million deaths globally by 2050. Antimicrobial stewardship (AMS) programs are coordinated efforts involving doctors, nurses, pharmacists, and other healthcare providers. Understanding knowledge, attitudes, and practices of health providers is pivotal for implementing strategies to curb the spread of AMR. The aim of this study was to evaluate knowledge, attitudes, and practices surrounding AMR and AMS among healthcare workers in Kenya.

Design: A qualitative study using in-depth semi-structured interviews

Setting: 12 private outpatient clinics in Kenya.

Participants: Healthcare workers including administrators and clinicians. …

Adherence To Follow-Up Among High-Risk Nicu Patients, Iryna Muryn, Susan Mbullah Ndimah, Lisa Renee Eiland, Tara Lozy

Rowan-Virtua Research Day

Background:

Preterm infants, especially those ≤32 weeks' gestational age (GA) are at increased risk of vision and hearing loss. Risks of both vision and hearing loss can be ameliorated and in some cases prevented by conscientious screening, follow up and treatment. Universally, infants ≤32 weeks are cared for in neonatal intensive care units and there is considerable confidence that screenings and treatment occur according to established guidelines. At hospital discharge, follow up responsibility shifts to infant caretakers likely resulting in reduced compliance.

Objective:

We aimed to determine if preterm infants at risk for vision and hearing loss, attended follow up …

Mental Health Crisis Of Medical Staffs During The Pandemic – How Has The Covid-19 Impacted Health Care Workers’ Mental Status, Yue Chen

Rowan-Virtua Research Day

The COVID-19 pandemic has waged a relentless battle against humanity, but amidst the physical toll lies a hidden front: the war on the mental health of our healthcare workers (HCWs).

Previous reviews have demonstrated a potential prevalence of mental health problems among HCWs, but these reviews necessitate updating and inclusion of more studies, along with a comparative analysis of pre- and post-pandemic backgrounds. Therefore, the aim of my study is to deliver updated prevalence estimates for mental health concerns among HCWs in the aftermath of the COVID-19 pandemic.

The results show not only a drastic increase in the percentage of …