Medicine and Health Sciences Commons^™

Disparities Among Black Women In Maternal Health, Josefina Teresa Estrada

Nursing | Senior Theses

The literature shows that Black women face many disparities in terms of health care access and the quality of care. These obstacles could negatively affect the health of the mother and their child. This paper includes a literature review and proposed research study. The objective of this research study is to identify the outcomes of Black women compared to White women and other women of color in terms of maternal health. A literature review is provided in order to identify how race affects the following factors: obstacles that limit access to healthcare, rates of obtaining prenatal care, postpartum outcomes and …

The Effects Of Doula Care On Birth Outcomes And Patient Satisfaction In The United States, Lynae Carlson

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The visitor policies related to the COVID-19 pandemic limited doula care and called into question the importance of doulas in the birth process. While the Cochrane Systematic Review presents compelling evidence of the benefits of continuous birth support on outcomes ranging from shorter labors to higher 5-minute Apgar scores, there are gaps in literature that exclusively focus on continuous support from doulas. The literature review aims to determine both qualitative and quantitative outcomes of doula care on the mother and baby during the labor and post-partum periods, focusing on specific aggregates, such as adolescents, women with low incomes, and women …

Nursing Perceptions For Utilizing Essential Oil Application In Labor And The Effect Of Targeted Education, Joni R. Beckham

Electronic Theses and Dissertations

This Doctor of Nursing Practice project was implemented to determine how a nurse’s perception of aromatherapy influences their decision to provide aromatherapy for patients during labor and the effect of targeted education on a nurse’s perception. The purpose of this project was to determine how nurses view the use of aromatherapy resources at their disposal and the likelihood that they would offer the intervention to their patients. This project provided education to increase nurses’ confidence in providing optimal care to patients using a traditional and holistic avenue of aromatherapy while determining if education can positively influence nurses to support essential …

Improving Sexually Transmitted Infection Knowledge In Community College Students: A Path To Prevention, Rebecca F. Halford

Electronic Theses and Dissertations

This DNP project was conducted to identify gaps in knowledge focusing on sexually transmitted infections within Texas and Region one. The research study gathered data from first-year nursing students who have chosen to participate in a sexually transmitted infection-focused educational module. Participants were first-year nursing students and understood the research study was strictly voluntary with no forms of compensation. Currently, the curriculum in the nursing program at which the study took place does not focus on sexually transmitted infections and is directed to speak minimally on the subject. This is a contributing factor to why the rise in sexually transmitted …

Relation Of Breastfeeding Duration With Blood Pressure And Arterial Stiffness, Lohita Kollipara, Abbi Lane-Cordova, Xuewen Wang

Senior Theses

Background: The purpose of this analysis was to investigate the effects of differing breastfeeding duration on vascular function.

Methods: A study was designed to explore the breastfeeding patterns of 79 participants who delivered a singleton fetus 6 months-3 years ago and were aged 18-45 years old. Participant breastfeeding and dietary habits were self-reported using surveys. Breastfeeding groups were established by following the American Association of Pediatric guidelines on breastfeeding duration: Women who did versus did not breastfeeding for 6 months continuously. Blood pressure was measured using a standard oscillometric cuff, while SphygmoCor® technology was used to measure pulse wave velocity. …

Physiological State Determinants Of Maternal Cortisol Signaling And Its Impact On Offspring Quality And Fitness, Sydney Currier

Electronic Theses and Dissertations

Assessing the intergenerational effects of maternal stress is important for predicting how offspring will respond to changing environments. The overall aim of my thesis was to quantify the effects of maternal state on maternally derived egg cortisol and determine whether this variation in egg cortisol impacts Chinook salmon offspring performance and fitness in a sex-specific way. I quantified within-female changes in maternal energetics and reproductive metrics that I linked to egg quality and ultimately embryo survival. I found egg cortisol increases with increasing maternal plasma cortisol, and increases further as plasma cortisol levels rise with each day that eggs are …

Decreasing Unintentional Pregnancies For Tennesseans, Paula M. Todd

Electronic Theses and Dissertations

In 2018, 49% of all pregnancies in the United States were unintended, with women with a lower- income status being five times more likely to experience an unplanned pregnancy. Tennessee has a high rate of unintended pregnancies, particularly among the uninsured, low-income, and rural teen populations; some 22% of these unintended pregnancies end in abortion. Oral or transdermal contraceptives that are affordable and accessible for women of childbearing age can reduce unintentional pregnancies. The addressed gap in clinical practice was that contraceptives are not currently available over the counter in Tennessee pharmacies without a prescription, which necessitates a costly medical …

Is There An Increased Risk Of Delirium Among Patients With Overactive Bladder Treated With Newer Anticholinergic Medication Compared To A Beta-3 Agonist?, Khaled Ashraf Etaby

Electronic Thesis and Dissertation Repository

ABSTRACT

Objective

To determine if there is an increased risk of delirium among patients with overactive bladder (OAB) started on anticholinergic medication compared to beta-3 agonist.

Methods

We conducted a population-based, retrospective, matched weight cohort study using administrative data from Ontario, Canada from January 2016 until March 2020. We matched 13865 new users of Oxybutynin to 33097 new users of newer anticholinergic medications (Solifenacin, Tolterodine, Trospium, Darifenacin and Fesoterodine), and to 56062 new users of beta-3 agonist medication (Mirabegron); all of the included medications are only for the treatment of OAB. Matching weights (an extension of the propensity score weighting) …

The Role Of Ifitm3 In The Immune Response Of Brca-Deficient High Grade Serous Ovarian Carcinoma, Han Cun

Dissertations & Theses (Open Access)

Background: Prior studies showed that BRCA-deficient high grade serous ovarian carcinoma (HGSOC) had increased tumor infiltrating lymphocytes (TILs) compared to BRCA-wildtype (WT). To better understand the underlying immune mechanism in these tumors, a preliminary transcriptome analysis was performed on a set of microdissected HGSOC tumor specimens with BRCA1-mutation, BRCA2-mutation, or WT. This demonstrated an upregulation of IFITM3, an essential gene in modulating immune function. Based on these findings, we hypothesized that BRCA-deficient HGSOC have increased DNA damage leading to upregulation of IFITM3 and subsequent increase in antigen presentation and T-cell activation.

Methods: Following IRB approval, preliminary transcriptome analysis was performed …

Umbilical Cord Clamping: How Timing Affects Infant Health Outcomes, Lauren Snell

Theses and Graduate Projects

The timing of umbilical cord clamping is commonly seen as an innocuous act. Many providers simply cut the cord as soon as they see fit without consideration as to what the impacts of this may be. Early umbilical cord clamping was initially considered a preventative measure for postpartum hemorrhage, but this myth has since been debunked. Now, the practice is still commonly implemented, but for reasons unknown. Delaying the clamping of the umbilical cord is thought to not only provide no risk to the mother but provide benefit to the newborn in relation to their fetal to adult physiologic transition. …

Maternal Lifelong Western Diet Consumption Impacts Placental And Brain Development In The Term Guinea Pig Fetus, Carlene H. Cihosky

Electronic Thesis and Dissertation Repository

Both metabolic and cognitive dysfunction can originate from fetal reprogramming precipitating from adverse conditions experienced in utero. Of note is the western diet (WD), which is associated with maternal energy imbalances that may hinder fetal development through altered placental function. Brain-derived neurotrophic factor (BDNF), a growth factor that supports the placenta and developing brain, is responsive to such energy imbalances. This study sought to investigate the impact of lifelong maternal WD consumption on fetoplacental development, focusing on relations between placental changes, and fetal growth and neurodevelopment in a guinea pig model. Maternal WD consumption resulting in a lean metabolically …

A Novel In Vitro Method For Pelvic Floor Dysfunction In Pcos Women, Ruben Vila

University Honors Theses

Background:

Poly Cystic Ovary Syndrome and Pelvic Floor Dysfunction are reproductive diseases with comorbidities whose novel relationship deserves further investigation.

Methods:

Levator Ani Muscle/Paravaginal Attachment was dissected from female Rhesus Macaque and subjected to tissue dissociation. Cells were treated with serum level hormones E2, T, and DHT. PCR, ICC, and IHC were used, followed by statistical analysis.

Results:

RNA analysis show differences in relative expression for endpoints ER, PR, AR, Ki-67, Col1A, and Vimentin. IHC along with ICC showed expression and localization in vivo.

Conclusions:

A novel in vitro model was created from macaque Levator Ani Muscle/Paravaginal Attachment for Pelvic …

Reshaping African American Women's Birthing Experience, Kiana Bulloch

Global Honors Theses

In the United States, African American women are two to three times more likely to die from pregnancy-related complications than any other race or ethnic group. The high maternal mortality rate has continued to be a global problem. The maternal mortality rate (MMR) is a universal measurement of registered maternal deaths due to birth or pregnancy-related complications. The U.S. has continued to have an MMR well above the global average despite establishing interventions in socio-economic gaps. In an effort to decrease MMR, the United Nations proposed a global plan to decrease maternal mortality by 75% as one of the eight …

Female Infertility In The United States And India: An Analysis Of Treatment Barriers And Coping Strategies, Devneet Singh

Honors Theses

This research studies barriers to accessing fertility treatment in the United States (U.S.) and India, as well as the coping strategies infertile women use. Barriers include reproductive health knowledge, cost, and politics, while coping is affected by cultural stigma, family, and religion. These two countries were chosen for their different cultural contexts, healthcare systems, and political infrastructure. Ten fertility specialists across both countries were interviewed as expert informants. Reproductive health knowledge was the most important barrier to accessing care in both countries, with similar gaps in understanding when and what type of care to utilize, though social media can educate …

Increasing Vaccination Rates In Pregnancy Using A Multifaceted Approach Including Patient Education And Reminder/Recall Interventions, Jas Tiara Mcgee

Evidence-Based Practice Project Reports

Given the global tragedy that this most recent pandemic has caused, more attention has been given to the devastating outcomes that the spread of infectious disease outbreaks can have. Similar to those with comorbid conditions, pregnant women are also extremely vulnerable to infectious diseases, as disease manifestation does not only affect the mother, but the fetus as well. Thus, the prevention of both the influenza virus and pertussis are two major goals when providing care for this population. Preventing both of these disease processes during the intrapartum period helps to ensure optimal wellness for both mother and baby and overall …

Education Combined With Reminder Strategies To Improve Cervical Cancer Screening Rates, Christina E. Mclean

Evidence-Based Practice Project Reports

Cervical cancer is the second most common cancer among women worldwide and a leading cause of death in some countries (Jayasekara, 2020). Approximately 13,800 cases of cervical cancer were diagnosed in the U.S. last year, and about 4,290 women died (American Cancer Society [ACS], 2020). Regular cervical cancer screening (CCS) reduces morbidity and mortality, but screening rates are low in the U.S. and at the project site (ACS. 2020). The purpose of this evidence-based practice (EBP) project was to increase CCS at a Federally Qualified Health Center (FQHC) with six clinic locations in Northwest Indiana; the primary project site was …

Guided Imagery And Sentinel Lymph Node Biopsy Pain, Brandy Alicia Kirk

Evidence-Based Practice Project Reports

The standard of care in the treatment for women diagnosed with breast cancer includes identification and biopsy of the sentinel lymph nodes (SLN) of the breast (Chaterjee et al., 2017; Kneece, 2017). The process of identifying the SLNs involves radioisotope injections into or near the areola. Because this area is highly sensitive, women report this procedure to be considerably painful. The purpose of this evidence-based practice (EBP) project was to determine if the provision of a 5-minute session of guided imagery (GI), as a complementary alternative medicine, prior to SLN injections was effective in mitigating reports of procedural pain. A …

Carrier Screening For Women Undergoing Elective Oocyte Cryopreservation (Eoc): A Look At Practice Among Reproductive Endocrinologists At An Academic Fertility Clinic, Melissa Manuelli

Human Genetics Theses

Elective oocyte cryopreservation (EOC) is a process involving freezing and banking oocytes with the intention to be used in the future for pregnancy. Cryopreserving oocytes allows women to enhance their reproductive autonomy by reducing the effects of age-relatedfertility decline. Similarly, expanded carrier screening (ECS) completed prior to conception allows women to consider their full range of reproductive options including in-vitro fertilization (IVF) with preimplantation genetic testing (PGT), use of donor gametes, and prenatal testing and diagnosis. In this retrospective chart review, we examine carrier screening practices for 106 EOC patients, and an age-matched control group of 106 IVF patients who …

Prenatal Dietary Education, Using The Midwifery Model, In Ireland Vs The United States, Allison Erby

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Prenatal dietary education is a very important component of care in healthy pregnancies, but more than that, dietary education can be an indicator of the value a healthcare provider places on holistic care or preventive medicine. The United States and Ireland are compared in this study because they represent high intervention vs. low intervention approaches, respectively, to obstetric care. Healthcare professionals from the United States and Ireland perceive the most important nutrients and method of receiving those differently. Maybe the most telling contrast, healthcare professionals in Ireland perceive food as the way pregnant women should receive vital nutrients, but healthcare …

The Impact Of Menstrual Hygiene Management Interventions On Adolescent Female’S School Attendance In Middle- And Low- Income Countries: A Systematic Review Of The Literature, Mckenzie Canon

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: Menstruation is an ongoing biological process that affects a large portion of the population and requires consistent health and medical care. However, menstruation does not affect women and girls equally in resource-poor communities and girl-unfriendly schools, particularly in low- and middle-income countries. Without proper menstrual hygiene management (MHM) and menstrual health and hygiene (MHH), girl’s attendance at school is reported to decline or cease altogether. Providing the proper resources to fulfill women’s and girl’s menstrual hygiene needs may impact female’s attendance rates at school, and furthering women’s education is fundamental in advancing female’s equality world-wide.

Purpose: The purpose of …

Exploring Attitudes Towards Newly Approved Therapeutics In Prenatal Genetic Counseling Practice, Charlotte Close

Human Genetics Theses

Cystic fibrosis (CF) care has rapidly evolved over the past decade due to the introduction of CFTR modulators and continued quality improvement efforts, yet research from 2013 suggests that prenatal genetic counselors often did not feel knowledgeable discussing newer CF treatments with patients and expressed the need to refer to a CF specialist (Elsas, 2017). Given that the intervening years have allowed for collection of long-term data about CFTR modulators and that the recently approved modulator Trikafta (tez/elx/iva) is available to 90% of the CF population, it is appropriate to re-evaluate the status of prenatal genetic counselors’ awareness of and …

Genetic Testing In Pregnancies With Ultrasound Anomalies: Exploration Of Factors That Influence Uptake, Lukas D. Kruidenier

Dissertations & Theses (Open Access)

Prenatal genetic diagnostic and screening tests have been rapidly evolving over the past decade with the introduction and expansion of cell free DNA screening (cfDNA) and the use of chromosomal microarray (CMA) as a first-line test for evaluation of fetal anomalies. Understanding patient motivations for or against expanded genetic testing options is paramount, therefore this study aimed to ascertain the patient perspective. Ninety-nine patients with an ultrasound anomaly participated in an anonymous, cross-sectional, research survey assessing coping strategies, factors influencing the genetic testing decision, and demographic variables. After multivariable analysis, the desire for directive counseling regarding testing was correlated with …

Efficacy Of Nerve Blocks On Immediate Post Caesarean Delivery Functionality, Dorothy Makena

Theses & Dissertations

Introduction; Caesarean section is becoming increasingly common and is one of the most performed procedures globally. It is a major surgery accompanied by moderate to severe pain. Pain impacts negatively on functionality of the mother in terms of daily activities like self-care, newborn care and mobility. A post caesarean section mother therefore requires effective and safe pain relief to improve functionality, for effective breastfeeding and to reduce the risk of venous thromboembolism. Abdominal plane nerve blocks have been studied widely in the recent past and have been shown to be effective as part of multimodal post caesarean analgesia. This study …

Disparities In Access To Assisted Reproductive Technology Among Hispanic Women In The United States, Madison Gallagher

Honors Thesis

Infertility is a health problem that affects approximately 7 million women in the United States (Ethics Committee of the American Society for Reproductive Medicine, 2015). Due to the high costs of reproductive medicine and infertility treatment, these services tend to be expensive and have limited accessibility without full insurance coverage. Emerging literature outlines the disparities in access to proper treatment for reproductive complications. These existing studies highlight that many minority populations in the United States experience increased challenges regarding access to reproductive medicine and infertility treatment. Among these minority groups are Hispanic women, who are more likely to require reproductive …

Intrapartum Guidelines For Nurse Midwives, Tanya Owens

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Intrapartum Guidelines for Nurse-Midwives

Abstract

Intrapartum clinical practice guidelines for certified nurse-midwives (CNMs) can improve quality of care and patient outcomes. Such improvements, however, often relate to the level of rigor in guideline development to assure quality and utilize the most recent and best evidence. This quality improvement project, introduced in three phases, aims to align existing clinical practice guidelines with national clinical practice guidelines and standards of care for certified nurse-midwives providing care in an intrapartum hospital setting. Phase One of this project will review existing clinical practice guidelines for midwifery care, accomplished by appraising 28 intrapartum guidelines. Phase …

“Warm Handoff” To Increase Enrollment In A Maternal Infant Health Program, Samantha Worthem

Doctoral Projects

Introduction: In a Midwest Health Department’s (HD) Maternal Infant Health Program (MIHP), infant death rate has been on a steady incline at 4.8 deaths per 1,000 in 2019 (Michigan Department of Community Health, 2020). Implementation of a “warm handoff” between the local HD and Michigan Department of Health and Human Services (MDHHS) was created to increase enrollment and visits. During warm handoffs, health care providers work together within the same setting to provide evaluation and care to patients and clients (Musselman et al., 2018).

Methods: This program evaluation reviewed data retrospectively from March 31 to September 30, for 2019 and …

Functional Role Of Dream And Dyrk1a In High-Grade Serous Ovarian Cancer Cell Dormancy, Pirunthan Perampalam

Electronic Thesis and Dissertation Repository

High-grade serous ovarian cancer (HGSOC) is the most common form of ovarian cancer. The majority of women are disproportionately diagnosed at an advanced stage (stage III-IV) of the disease when tumours have progressed beyond the ovaries or fallopian tubes and into the peritoneal cavity. Survival rates at late-stage are as low as 25% and chemoresistant disease recurrence is common, affecting up to 90% of patients. Multicellular clusters called spheroids contribute to dormancy, chemoresistance, and metastases and are a major challenge to treatment of HGSOC. Spheroid cells undergo reversible quiescence to evade chemotherapy in a process mediated by the mammalian DREAM …

Standardizing Gynecological Triage Care Through The Implementation Of Protocols, Lucille V. Mcdermott, Margaret Aitken

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Ambulatory telephone triage is critical to ensuring that patients receive assessment of acute complaints, advice and treatment in a timely manner. Protocols and standing orders help guide nurses in assessment and treatments for patients. Standing orders allow nurses to order medications under the guidance of protocols. The aim of this project was to establish protocols in order to increase nurse autonomy, decrease burden on providers, provide standardized care to patients and consensus for triage nurses.

Methods: The confidence of the nurses and needs of providers was assessed through Likert scale before and after surveys. Protocols and standing orders for …

Utilizing Patient-Derived Epithelial Ovarian Cancer Tumor Organoids To Predict Carboplatin Resistance, Justin W. Gorski

Theses and Dissertations--Clinical and Translational Science

The development of patient-derived tumor organoids (TOs) from epithelial ovarian cancer tumor obtained at the time of primary or interval debulking surgery has the potential to play an important role in precision medicine.

Here, we utilize TOs to test front-line chemotherapy sensitivity and to investigate genomic drivers of carboplatin resistance. We developed six high grade serous epithelial ovarian cancer tumor organoids from tissue obtained during debulking surgery (2 neoadjuvant carboplatin exposed, 4 chemo-naïve). Each organoid line was screened for sensitivity to carboplatin at four different doses (100, 10, 1 and 0.1µM). Cell viability curves and resultant EC50 values were determined …

Uptake And Determinants Of Cervical Cancer Screening Among Health Care Workers In Aga Khan University Hospital, Nairobi Kenya., Doreen Moraa Osoro

Theses & Dissertations

Background: The cancer burden has been rising globally. The reported incidence of cervical cancer is 13.1 / 100,000 globally and 40 / 100,000 in Kenya. Up to 88% of all cervical cancer deaths have been reported in lower to middle-income countries. In comparison, developed countries had up to two to four times lower rates of cervical cancer incidence and mortality. The burden of cancers attributable to carcinogenic infections has potentially modifiable risk factors, for which prevention tools already exist. There is a gap in the implementation of evidence-based interventions including primary prevention with the HPV vaccine and secondary prevention with …