Medicine and Health Sciences Commons^™

Implementation Of Lymphedema Education Toolkit For Nurse Coordinators, Heather Gee

Master's Projects and Capstones

Problem: Lymphedema is a chronic condition that develops secondary to cancer treatments such as chemotherapy, radiation, and surgical removal of affected lymph nodes. This swelling in patient’s limbs can cause discomfort and limit mobility, however lymphedema is often not detected until later stages, delaying treatment and patient education.

Context: This quality improvement project was conducted at Hospital S Women’s Cancer Center, an outpatient center specializing in advanced treatments for breast and gynecological cancers. This center has a multidisciplinary team focusing on both the medical and surgical aspects of oncology treatment.

Interventions: An evidence-based lymphedema education toolkit was created for nurse …

Standing Posterior Trunk Rotation With Adaptive Proprioceptive Toss, Jennifer Elvir

Electronic Theses and Dissertations

Parkinson’s disease (PD) is a remarkably individualized disease. Nearly every person’s trajectory is unique. One person may experience tremor at an early stage of the disease, while another may experience tremor at a later stage or even not at all. For all PD patients, for certain can expect increasing difficulty as the disease progresses. Parkinson’s disease is responsible for the loss of dopamine which displays itself most notably through motor and cognitive symptom disruption. Although Parkinson’s is a chronic and progressive condition that is irremediable, significant strides have been facilitated to help control and manage the trajectory of the disease. …

The Impact Of Telestroke Services On Diagnosis, Patient Outcomes, And Treatment, Dustin Baum

Theses, Dissertations and Capstones

Introduction: In 2011, an estimated 20% of U.S. residents lacked timely access to stroke care. As of 2019, that number plummeted to 4% of patients. A reason for this improved access was the implementation of telestroke services. Telestroke services have utilized remote stroke specialists to help guide local emergency department physicians in reviewing imaging, diagnosing, treating, or transferring patients appropriately.

Purpose: The purpose of this research was to analyze the impact of telestroke implementation in the hospital setting. The study hypothesized the implementation of telestroke services in the hospital setting maintained an accurate stroke diagnosis, decreased inappropriate hospital transfers, reduced …

Decreasing Surgical Complications In Diabetic Patients, Bandana Mahato

DNP Qualifying Manuscripts

Executive Summary

Objective: This manuscript aims to determine if controlling diabetes prior to undergoing low back surgery could decrease complications and disability.

Contexts: Despite the overwhelming information on the complications of uncontrolled diabetes, patients continue to have elevated HgA1C before having surgery. Furthermore, there is a plethora of data showing uncontrolled diabetic patients will have higher complications after surgery, yet patients continue to have elective surgery despite having unchecked diabetes. There are no clear guidelines for primary care providers or surgeons on when they should allow patients to have elective surgery. Therefore, it is vital that HgA1c needs to be …

The Shared Contributions Of The Capsule, Labrum, And Bone On The Suction Seal Of The Hip, Alexander J. Hoffer

Electronic Thesis and Dissertation Repository

The hip capsule, labrum, and bone contribute to hip stability. Abnormalities in these structures are associated with pain and microinstability. Previous studies have quantified the individual stabilizing roles of the capsule and labrum and have associated cam over-resection with decreased hip stability.

The first objective of this thesis was to identify the relative biomechanical contributions of the capsule, labrum, and bone to the hip suction seal, as a representation of hip stability. The second objective was to assess the effectiveness of a labral reconstruction in restoring the suction seal after a cam over-resection.

Ten human cadaveric hips were tested in …

Implementation Of A Vestibular Disorder Screening Tool In An Urgent Care, Kathleen A. Probst

Dissertations

Implementation of a Vestibular Disorder Screening Tool in an Urgent Care

Kathleen A. Probst

M.S.N., University of Missouri-Columbia, 2007

B.S.N., University of Missouri-Columbia, 2004

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice

August 2023

Advisory Committee

Susan Dean-Baar, PhD, RN, CENP, FAAN

Chairperson

Jennifer Vines, DNP, MSN, RN

Troy Dinkel, MD

Copyright, Kathleen A. Probst, 2023

Abstract

Problem: Vestibular disorders disrupt everyday living and can cause reduced quality of life. Guidelines developed to screen for vestibular disorders are not efficient to use …

A Multimodal Intervention Treatment Plan For Adults With Generalized Anxiety Disorder In Primary Care, Morgan Cullings

Evidence-Based Practice Project Reports

Generalized anxiety disorder (GAD) is a debilitating psychological condition that affects 3.1% of the American population and is one of the leading causes of disability (Anxiety and Depression Association of America, 2022; Baxter, 2014). The purpose of this evidence-based practice project was to implement a multimodal intervention to decrease GAD symptoms in adults in the primary care setting. The PICOT question that guided this project was: In adults, over the age of 18, who have been diagnosed with generalized anxiety disorder (GAD), does the combination of digital cognitive behavioral therapy (CBT) through a smartphone application, lifestyle modification education, and pharmacotherapy …

A Biomechanical Comparison Of A Subacromial Balloon Spacer, Superior Capsular Reconstruction, And A Rigid Subacromial Spacer In A Massive Irreparable Rotator Cuff Cadaveric Model, Devin Ferguson

Electronic Thesis and Dissertation Repository

Massive irreparable rotator cuff tears are a common cause of pain and disability. Several different treatments exist; however, they are associated with poor clinical outcomes and survivorship in younger patients without glenohumeral arthritis. The purpose of this thesis was to compare the impact of a subacromial balloon spacer, superior capsular reconstruction, and a rigid subacromial implant on the glenohumeral kinematics and mechanical efficiency of a massive rotator cuff deficient shoulder. The results indicate that each surgical state improves the glenohumeral kinematics of a massive irreparable rotator cuff tear. The subacromial implant leads to mild overcorrection of humeral head translation. No …

The Distribution Of Cardiovascular Risk Factors And The Association With Cadre Amongst Healthcare Workers At A Tertiary University Hospital In Nairobi City, Kenya, Emma Andrea Khabure

Theses & Dissertations

Introduction: According to the World Health Organization (WHO), non-communicable diseases such as stroke, contribute to about 70% of the top ten causes of mortality in the world. The growing burden of Cardiovascular (CVD) risk factors has also been noted to affect the health workforce. According to the Ministry of Health in Kenya employing the WHO STEPS survey, 27% of Kenyans are either overweight or obese. Few studies have been done in Kenya to highlight the prevalence and impact of cardiovascular risk factors amongst healthcare workers. The variety of findings and paucity of data bring about the need to evaluate this …

Functional Status Among Patients With Established Copd Attending Tertiary Hospitals In Dar Es Salaam, Tanzania, Peter M. Tumbo

Theses & Dissertations

Background

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable non communicable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development. It is associated with a lot of risk factors such as smoking, biomass fuel use for cooking and air pollutants in general.

Objectives

The primary objective of this research was to determine the functional status of patients with COPD. The secondary objectives were to determine the factors influencing …

Enhancing The Quality Of Life For Senior Citizens: A Facilitator’S Guidebook For Mindful Music And Movement, Shannon Sexton

Mindfulness Studies Theses

Music appreciation and enjoyment enhance well-being throughout the lifespan. The challenges and constraints that people experience as they age can lead to lack of access to music, decreased physical activity, and fewer avenues for creative expression. Group music and movement interventions created for older populations offer opportunities for social connection and improved quality of life. Mindful practices add further benefit when combined with these interventions. Current available programs are scarce and most often do not encompass mixed modalities. In addition, the benefits of these programs do not show long-term sustainability. The purpose of this thesis is to explore the effects …

Quality Of Life And Sexual Function Of Women With Endometriosis At The Aga Khan University Hospital Nairobi, Edna Mohere Chacha

Theses & Dissertations

Introduction: Endometriosis is a benign, chronic condition that affects up to ten percent of women of childbearing age. It’s marked by the presence of endometrial tissue outside the uterine cavity (Giudice, 2010). It is a health condition with wide-ranging and pervasive sequelae making it a significant health concern requiring appropriate action (Rush & Misajon, 2018). We observed that there was a paucity of data relating to how endometriosis impacted on female sexual function and quality of life in sub-Saharan Africa, Kenya included.

Objectives: The primary goal of this empirical investigation was to determine the quality of life of women who …

A Long-Term Follow-Up Of The Stability Study: Multicenter Rct Comparing Anterior Cruciate Ligament Reconstruction With And Without Lateral Extra-Articular Tenodesis In Individuals At High Risk Of Graft Failure, Katelyn M. Inch

Electronic Thesis and Dissertation Repository

One hundred and ninety-six patients at the Fowler Kennedy Sport Medicine Clinic (FKSMC) undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) were randomized as part of the multi-center STABILITY study to receive either an isolated ACLR or ACLR with a lateral extra-articular tenodesis (LET). The STABILITY study followed these patients up to two years postoperative, and a long-term follow-up protocol was initiated afterwards. Eighty-two patients from this center were seen at three, five and seven years postoperative as part of a long-term follow-up. Our primary outcome was a composite outcome of instability and graft failure. Secondary outcomes included patient-reported outcome measures …

The Clinical Value Of Oculomotor Assessments Across The Continuum Of Concussion, Dillon Richards

Electronic Thesis and Dissertation Repository

Concussions are complex conditions that are difficult to manage medically. Variations in symptom presentation, intricate neurophysiological processes, and the availability of a variety of possible assessment tools may contribute to this complexity. Clinicians must use a broad approach, employing both subjective symptom assessment and objective assessments to confirm a diagnosis and/or monitor progression and recovery. Oculomotor function after concussion may be an important indicator of injury, given the interconnectedness of oculomotor function, vestibulo-ocular and visual systems, and even cognition. Oculomotor function may be assessed objectively or indirectly using patient-reported symptom checklists as part of subjective assessments. One way of objectively …

Total Hip Arthroplasty In Young Patients, Aaron G. Chen

Electronic Thesis and Dissertation Repository

Total hip arthroplasty (THA) is the gold standard in treatment of hip arthritis yet is often avoided in young patients due to concerns of inferior survivorship. We aim to explore the role of THA in young patients and assess whether these historical concerns are valid in contemporary THA by presenting the results of: (1) a systematic review and meta-analysis of the current literature, (2) a retrospective database review, and (3) a retrospective population-based study. We found excellent long-term survivorship with modern THA in young patients, demonstrating greater than 90% revision-free survival up to 15 years. Factors that may increase risk …

Biomechanical Characterization Of Semi-Rigid Constructs And The Potential Effect On Proximal Junctional Kyphosis In The Thoracic Spine, Chloe Cadieux

Electronic Thesis and Dissertation Repository

Long spinal fusions are the mainstay of treatment in adult spinal deformity; however, proximal junctional kyphosis (PJK) is a common and potentially catastrophic complication that can occur following this procedure. It has been hypothesized that using semi-rigid constructs at the superior aspect of the instrumentation may decrease this complication. The objective of this thesis was to determine if there is a biomechanical advantage between various semi-rigid constructs utilized in long spinal fusions to help decrease the risk of PJK. Nine human cadaveric spines (T1 – T12) instrumented with the standard all-pedicle-screw construct (APS) were compared to various semi-rigid constructs including …

Intensive, Interprofessional Therapy: A Case Approach, Emma C. Schrotenboer

Honors Theses

This research looks at the impacts of intensive, interprofessional therapy for children with disabilities. There is very little literature currently published on this topic, although what is available generally finds that more intense therapy is more beneficial. The child who was studied was a camper at Adam’s Camp therapy camp, a week-long program that involves six hours of therapy each day with therapists from five different fields. Her progress over the week, as well as her retention of skills several weeks later, were determined by pre- and post-camp surveys sent to the mother and the therapists’ notes from during the …

Multimodal Approach To Chronic Pain Management And Prevention Of Opioid Use Disorder, Hannah Elston

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background. Chronic pain (CP) is a major public health problem that affects one-third of the population and can interfere with the activities of daily life and cause decreased quality of life. Patients with CP have been increasingly prescribed opioids, contributing to the rise in the opioid epidemic. Due to the long-term nature of CP, the use of opioids as the sole treatment for CP can cause tolerance and increased dosages overtime which can lead to addiction and potentially overdose. Therefore, CP treatment should include multimodal approaches to treatment to prevent opioid misuse, opioid use disorder (OUD), and overdose. Multimodal treatments …

Adequacy Of Pain Management Among Advanced Cancer Patients With Solid Tumors Attending Palliative Care Centers In Dar Es Salaam, Judith Mwijage

Theses & Dissertations

Background: Cancer pain is a universal undesirable symptom among cancer patients that if not addressed causes suffering and impedes quality of life of both the patients and their family. Observational studies available have shown increase in palliative care programs in Tanzania but there is dearth of information regarding the adequacy of pain control among patients with cancer after the initiation of these programs and improvement of the available interventions.

Objectives: This study aimed to determine adequacy of pain management among advanced cancer patients with solid tumors as well as factors affecting adequate Cancer Related Pain management.

Methods: We conducted a …

Feasibiity And Acceptability Of Tele-Neurology Services At A Regional Tertiary Referral Centre: A Prospective Study., Fazal Yakub

Theses & Dissertations

Background: Neurological diseases are a leading cause of morbidity and mortality worldwide with a great burden lying in Sub-Saharan Africa. The paucity of neurologists in the region makes neurological care disproportionately inaccessible. Utility of tele-medicine is low cost, time efficient, convenient, reducing the carbon footprint and ultimately increasing health care access.

Objective: We identified whether the concept of tele-neurology was feasible within our setup for patients with stable neurological diseases while establishing the cost effectiveness, efficiency, convenience and the carbon footprint burden.

Methods: We conducted a prospective cross-sectional study. New patients were triaged by the neurologist based on guidelines from …

An Analysis Of The Psychological And Physical Effects Of A Physical Activity Program During In-Patient Pediatric Cancer Treatment, Zoë Winters

Undergraduate Theses

There is limited published research regarding the use of physical activity in cancer treatment programs, and even fewer in pediatric treatment plans; however, there is a common consensus that following the conclusion of cancer treatment an individual’s physical fitness has been majorly impacted. The inactivity that commonly coexists with cancer treatment often results in extended periods of time in rehabilitation programs and decreased independence. Along with the physical detriments caused by inactivity, increased dependence on others often brings about feelings of helplessness that can further cause emotional detriments. It has however been demonstrated in previous research that adding physical activity …

The Effectiveness Of Therapeutic Interventions For The Management Of Vulvodynia: An Integrated Literature Review, Arianna Cohen

Honors Undergraduate Theses

Problem: Vulvodynia, an unexplained vulvar pain, is a medical condition affecting women of all ages, races, and ethnicities and causes pain levels ranging from very mild discomfort to extreme suffering.

Purpose: The purpose of this study was to explore women’s knowledge toward seeking care for vulvodynia and to explore the different types of treatments prescribed after diagnosis. The secondary purpose of this review was to describe the treatments most effective in reducing pain caused by vulvodynia.

Methods: A review of the literature was conducted using articles from 2001 to 2021 that focused on diagnosis of vulvodynia and the relief of …

ผลของการออกกำลังกายเพื่อลดภาวะกระดูกสันหลังค่อมแบบหลายมิติต่อมุมส่วนโค้งของกระดูกสันหลังระดับอก ความแข็งแรงของกล้ามเนื้อแอ่นหลังและความสามารถการทรงตัวขณะเดิน ในผู้หญิงที่มีภาวะกระดูกสันหลังค่อมจากท่าทางที่ไม่เหมาะสม, ปัญญภรณ์ หมายดี

Chulalongkorn University Theses and Dissertations (Chula ETD)

การพัฒนาการออกกำลังกายเพื่อลดภาวะกระดูกสันหลังค่อมแบบหลายมิติ (MHCE) เพื่อแก้ไขปัญหาที่ครอบคลุมถึงการเปลี่ยนแปลงของความยาวกล้ามเนื้อข้อสะโพกที่ต่อเนื่องมาจากการเกิดภาวะกระดูกสันหลังค่อม ส่งผลให้การส่งต่อข้อมูลประสาทรับรู้ความรู้สึกในข้อสะโพกเพื่อควบคุมการทรงตัวบกพร่อง จึงทำให้ผู้ที่มีภาวะกระดูกสันหลังค่อมสูญเสียการทรงตัวได้ง่าย วัตถุประสงค์ของการศึกษาเพื่อศึกษาความแตกต่างของผล MHCE และการออกกำลังกายเพื่อลดภาวะกระดูกสันหลังค่อมรูปแบบที่แนะนำในปัจจุบัน (CHCE) เป็นเวลา 8 สัปดาห์ ต่อการเปลี่ยนแปลงของมุมส่วนโค้งของกระดูกสันหลังระดับอก (TKA) ความยืดหยุ่นของกระดูกสันหลังระดับอก ความแข็งแรงของกล้ามเนื้อแอ่นหลัง ความยาวของกล้ามเนื้องอสะโพก (Hip flexor) และกล้ามเนื้อเหยียดข้อสะโพกร่วมกับงอเข่า (Hamstrings) การรับรู้ตำแหน่งของข้อสะโพก (JPS) และการทรงตัวขณะเดินในผู้หญิงที่มีภาวะกระดูกสันหลังค่อมจากท่าทางที่ไม่เหมาะสม ผู้เข้าร่วมวิจัยถูกสุ่มแบ่งเป็นกลุ่ม MHCE และกลุ่ม CHCE กลุ่มละ 18 คน ได้รับการตรวจประเมินก่อนและหลังออกกำลังกาย ผลการศึกษาพบว่า ทั้ง 2 กลุ่ม มีค่า TKA ความยืดหยุ่นของกระดูกสันหลังระดับอก ความแข็งแรงของกล้ามเนื้อแอ่นหลัง ความยาวของกล้ามเนื้อ Hamstrings และความสามารถการทรงตัวขณะเดินแตกต่างอย่างมีนัยสำคัญทางสถิติก่อนและหลังออกกำลังกาย ส่วนค่า JPS มีความแตกต่างอย่างมีนัยสำคัญทางสถิติเฉพาะกลุ่ม MHCE (P<.05) และกลุ่ม MHCE มีค่า TKA ลดลงมากกว่ากลุ่ม CHCE อย่างมีนัยสำคัญทางสถิติ (P<.05) สรุปว่า MHCE สามารถลดมุมส่วนโค้งของกระดูกสันหลังระดับอกและพัฒนาการรับรู้ตำแหน่งของข้อสะโพกได้ดีกว่า CHCE ส่วนการเพิ่มความยืดหยุ่นของกระดูกสันหลังระดับอก เพิ่มความแข็งแรงของกล้ามเนื้อแอ่นหลัง เพิ่มความยาวกล้ามเนื้อ Hamstrings และการพัฒนาความสามารถการทรงตัวขณะเดิน การออกกำลังกายทั้ง 2 แบบทำได้ไม่แตกต่างกัน

Effective Pharmacological And Non-Pharmacological Treatments For Sleep Disturbances And Fatigue In Patients Who Have Experienced A Mild To Severe Traumatic Brain Injury, Mika Muras

Theses and Graduate Projects

Background: In the United States alone, an estimated 1.5 million people sustain a head injury every year.1 With improved recognition of traumatic brain injuries by healthcare providers, the number of patients diagnosed with a traumatic brain injury (TBI) is only increasing. Unfortunately, many patients who sustain a TBI, regardless of the severity, experience sleep disturbances, insomnia, fatigue, and daytime sleepiness.

Purpose: For the purposes of this systematic review, the focus will be primarily on the comparison of nonpharmacological treatments of sleep disturbances or fatigue secondary to a TBI. In addition, the focus will include recent studies on pharmacological …

Theta Burst Brain Stimulation In Painful Diabetic Neuropathy Patients: Investigating Neural Mechanisms, Bhushan Thakkar

Theses and Dissertations

Chronic pain (CP) is a significant contributor to disability and disease burden globally. In 2019, approximately 50.2 million adults (20.4% of the US population) experienced chronic pain, contributing to $560-635 billion in direct medical costs. In addition, the worldwide prevalence of diabetes mellitus has reached epidemic proportions and is set to increase to 629 million by 2045. Almost 50% of patients with diabetes present with diabetic neuropathy (DN), and one in five patients with diabetes presents with painful DN (pDN) which is the most common cause of neuropathic pain (NP) in the US. Symptomatic treatment is the mainstay of management …

Tummy Time In Infancy: Real-World Assessments And Associations With Developmental Outcomes In Early Childhood, Ketaki Inamdar

Theses and Dissertations

Tummy time or awake, supervised, prone play is an important developmental play position in infancy. Engaging in more than 15 minutes of tummy time per day is associated with a lower risk of plagiocephaly, lower body mass index, and achievement of higher motor scores in full-term and at-risk preterm infants. However, there are significant gaps in the measurement of tummy time in current literature. Conventionally used subjective parent reports have not been validated against gold standard direct observation, and the feasibility and real-world validity of objective solutions such as wearable sensors has not been examined in full-term and at-risk preterm …

Femoroacetabular Impingement Syndrome: Evaluating Postoperative Rehabilitation Progress And Return To Sport Readiness, Trevor A. Day

Electronic Thesis and Dissertation Repository

Femoroacetabular impingement syndrome (FAIS) is a common cause of non-arthritic hip pain and reduced physical activity in active young adults. It is defined as a motion-related disorder of the hip with a triad of symptoms, clinical signs, and imaging findings that represents symptomatic premature contact between the proximal femur and the acetabulum. There are two anatomical morphologies that can cause FAIS, cam, and pincer, and is a challenging clinical pathology. Patients typically undergo hip arthroscopy to repair damage to the joint and recess the bone causing the impingement. These procedures can result in positive outcomes for the patient, like reduced …

Platelet-Rich Plasma Vs. Traditional Surgical And Nonsurgical Interventions For Rotator Cuff Tendinopathies, Nick Slingerland

Theses and Graduate Projects

Background: Rotator cuff tendinopathies present as one of the most common musculoskeletal injuries of the upper extremity. The rotator cuff consists of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis with the supraspinatus the most injured of the group. Over time, variations regarding treatment through surgical or nonsurgical interventions have remained constant. In recent years, the use of platelet-rich plasma (PRP) as an additional alternative has become popular to promote healing and improve functionality of the shoulder. The purpose of this clinical review using various study designs is to assess if the platelet-rich plasma injections are more effective when …

What Treatment And Prevention Options Are The Most Effective For Elbow, Knee, And Plantar Tendinopathies?, Cody Lawson

Theses and Graduate Projects

Objective: Tendinopathies of the upper and lower extremity are one of the most common injuries in athletes and non-athletes in the United States. This literature review aimed to determine the most effective preventions and treatments for patients with tendinopathies.

Methods: A literature search was conducted primarily through Google Scholar and PubMed, for articles related to effective preventions and treatments for tendinopathies.

Discussion: Based on the literature review, there were multiple effective treatments and preventative measures for tendinopathies in the upper and lower extremity. The most effective preventative measures consisted of risk factors, dynamic warmups, and prevention programs. Treatments were broken …

Pain Reduction In Chronic Lumbar Patients Using Spinal Cord Stimulation, David Botros

Theses and Graduate Projects

Background: Spinal cord stimulation (SCS) is commonly used to treat chronic neuropathic pain. A common indication for the SCS is failed back surgery syndrome (FBSS). There are many interventional approaches to treating lumbar pain; however, the SCS may provide the greatest benefit in terms of health care utilization and overall pain relief to the patient.

Objective: The goal of this paper is to assess the effectiveness of SCS compared to conventional therapies such as physical therapy, oral medications, radiofrequency ablations (RFA), epidural steroid injections (ESI), and intrathecal pain pumps (IT pain pump) in patients with chronic lumbar pain due to …