Medicine and Health Sciences Commons^™

Use Of Simulation Involving Standardized Patients As An Education Program To Increase Nurse Confidence In Caring For Patients With Drug And Alcohol Problems, Brandy G. Mathews

DNP Projects

Purpose: The purpose of this pilot project was to test the effectiveness of a simulation exercise using standardized patients on nurses’ perceived confidence in caring for patients with drug and alcohol problems.

Method: The project was a mixed methods pre-test and posttest design to assess whether simulation using standardized patients was effective in improving nurses’ confidence in caring for patients with problematic drug and alcohol use issues. Qualitative data was obtained by interviewing participants using a semi structured interview.

Results: All nurses reported a positive experience as a result of participating in the simulation exercises. Use of simulation as …

Implementing Sbar Training With Acute Care Nurses, Maureen Murray

DNP Projects

Background In 1999, the Institute of Medicine reported 98,000 deaths in US hospitals due to medical errors. The Joint Commission posits 70% of sentinel events are rooted in communication errors. The US military and aviation industry had developed structured communication tools to reduce communication error and shared this with healthcare in the form of the Situation Background Assessment Recommendation (SBAR) tool. The Joint Commission recommends use of the SBAR tool.

Objective Formal training on SBAR was not present at one acute care facility, constituting a gap between evidence and practice. This practice improvement project aimed to close this evidence-practice gap. …

Piloting An Intervention To Improve Continuity In Lung Cancer Patients, Stacy L. Richey

DNP Projects

Purpose: Kentuckians facing a lung cancer diagnosis are at greater risk for care fragmentation due to the complexities associated with the diagnosis, staging and treatment of the disease combined with multiple health disparities such as advanced age, multiple comorbid conditions, low socioeconomic status, geographic isolation, and low literacy levels. Transitioning from primary to specialist care can be especially difficult for these patients. The main purpose of this paper was to determine the feasibility and effect of a nurse-led, multidimensional intervention designed to improve relational (RC), informational (IC), and management continuity (MC) across the primary to secondary care interface, as well …

Assessment Of Depression Screening In Women’S Primary Care Clinic, Susanna Gorton

DNP Projects

Purpose: The purpose of this practice inquiry project was to evaluate provider adherence to depression screening documentation in the ambulatory electronic health record (AEHR) before and after changing locations of the depression screening questions within the AEHR. Provider knowledge about depression screening and barriers related to depression screening were also examined.

Methods: A retrospective chart review was completed for patients seen for an annual exam by a physician provider in a women’s primary care clinic. Data collected included demographic data, co-morbid conditions, depression screen documentation (PHQ-2 & PHQ-9), and interventions documented. A questionnaire was sent to providers in the primary …

Prevention Of Medical Non-Adherence In University Of Kentucky Cardiothoracic Transplant Patients, Lisa L. Yearsley

DNP Projects

Background: The population focus is the University of Kentucky cardiothoracic transplant patients. This population is chronically ill and in end-stage organ failure. Literature suggests depression in a cause and consequence of non-adherence in chronically ill patients, especially in the transplanted population. The third leading cause of organ rejection is non-adherence with medical treatment. Because the availability of organs is low and the demand is high, it is imperative to thoroughly screen patients medically and psychosocially using evidence-based tools. Transplant psychosocial listing criteria are not well standardized compared to medical listing criteria to identify appropriate transplant candidates. Standardized assessment tools present …

Childhood Immunization Tracking Practices By Healthcare Providers, Erin E. Clarke

DNP Projects

Childhood immunizations protect children from life-threatening illnesses and are one of the most profound measures of the quality of pediatric primary care, however immunization rates for children under three years old still fall below national goals for up to date coverage. In addition to preventing children from getting serious illnesses, childhood vaccines prevent 21 million hospital visits, prevent 732,000 deaths, and save 1.38 trillion dollars in societal costs. Despite the many benefits of vaccines and the national recommendations, nearly 25% of children ages 19-35 months fall short of receiving all recommended vaccines. Kentucky demonstrates vaccination rates below the national average …

Do Call-Backs Help Patients Post Stroke, Taylor E. Clark

DNP Projects

Aim and Objective: To determine if the implementation of a post-discharge call-back intervention for patients discharged home from the hospital after stroke was associated with a decrease in 30-day readmissions and improved patient satisfaction.

Background: Stroke is a leading cause of death and disability in the United States (American Stroke Association, 2015). Several studies have examined various post-discharge interventions, including a call to the patient and/or family after their return home, to determine the benefit to patients, if any (Zolfaghari, Mousavifar, Pedram & Haghani (2012). Understanding and anticipating patient needs and removing barriers post-stroke may decrease readmission rates …

Increasing Healthcare Providers’ Documentation Of Advance Directives In A Primary Care Setting, Ashley Wellman

DNP Projects

Background: Advance directives (ADs) are a proactive, patient-centered tool to facilitate communication about end-of-life wishes between patients, family members, and healthcare providers. Increased importance on ADs is now emphasized in primary care settings; however, findings from recent studies indicate poor documentation of AD discussions or decisions in primary care.

Purpose: To assess current AD documentation practices in an internal medicine primary care department and to explore provider perceptions of facilitators and barriers for discussion and documentation of end-of-life preferences.

Methods: This descriptive study was conducted in three phases: 1) assessment of current state of AD documentation by retrospective chart review …

Improving Indoor Air Quality For Children In Rural Kentucky, Denerica L. Curry

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Community interventions directed towards improving indoor air quality for children are often implemented after exposure has occurred and focuses on parental smoking cessation. Our proposed project will intervene during the prenatal stage prior to exposure and continue to support families 6 months postpartum. Infants are at an increased risk of secondhand smoke exposure due to the amount of time they spend in the home and proximity to the smoker. We hypothesize that by enhancing care of the current home visitation model to include an early intervention we will increase the amount of smoking bans in the home and decrease maternal …

Vocal Function Exercises For Normal Voice: The Effects Of Varying Dosage, Maria H. Bane

Theses and Dissertations--Communication Sciences and Disorders

The primary purpose of this investigation was to explore the effects of variable doses of home practice Vocal Function Exercises (VFEs) on attainment of pre-established maximum phonation time (MPT) goals in individuals between the ages of 18 and 25 with normal voice. A secondary purpose was to monitor for potentially toxic effects of high doses of VFEs. Three experimental groups completed a six-week VFE protocol and practiced twice daily. The low dose group performed each exercise once, the traditional group twice, and the high dose group four times. Results indicated significant change in VFE MPT for all three groups and …

Chronic Pancreatitis, Pain, And Anxiety In An Alcohol And High Fat Mouse Model, Tiffanie Clinkinbeard

Theses and Dissertations--Gerontology

Homeodynamic space (HDS) shrinks as vulnerability increases with aging and repeated damage to the cells. HDS is lost in alcoholic pancreatitis patients due to overconsumption of alcohol, smoking, and high fat diets. Etiologically relevant animal models for study of chronic pancreatitis (CP) are needed. In order to begin filling this gap a central purpose of this dissertation research was to examine relationships between the alcohol and high fat diet (AHF) and pancreatitis with attention to hypersensitivity and anxiety-like behaviors. The AHF diet induced pancreatitis described here etiologically mimics human risk factors of AHF consumption for advancement to alcoholic CP.

In …

The Role Of Fat Grafting And Adipose-Derived Stem Cells In Breast Reconstruction, Krishna S. Vyas

Theses and Dissertations--Clinical and Translational Science

Fat grafting is a common surgical procedure that involves the transfer of fat from one area of the body to another in order to improve contour deformities, such as in breast reconstruction. Advantages of the technique include using autologous tissue rather than a foreign body and the added benefit of having liposuction to remove fat from an undesirable location. Although adipose tissue could be the ideal soft tissue filler, fat grafting is plagued by tremendous variability in long-term retention, with volume survival rates of 20-80%, resulting in suboptimal outcomes and repetitive procedures.

The mechanisms contributing to long-term fat graft survival …

Use Of High-Fidelity Simulation Training For New Cardiothoracic Intensive Care Unit Nurses, Bryan Boling

DNP Projects

Critical care nursing is one of the most challenging, high-stress fields in healthcare. This is especially true for nurses in the highly specialized environment of the cardiothoracic intensive care unit (CTICU). The experience level of nurses in critical care is positively linked with patient outcomes; however, with older nurses retiring or moving away from the bedside and younger nurses increasingly moving into advanced practice or management and leadership roles it is becoming more difficult to maintain a high degree of nursing experience in the ICU. Simulation training has been used to provide safe, effective training, and it is even possible …

Meaningful Use: Secure Electronic Messaging And The Use Of Mychart, Dava O. Helton

DNP Projects

Purpose: The purpose of this project was to understand providers’ views of electronic messaging through MyChart and find out the essential tools needed to comply with Stage 3 criteria of Meaningful Use. The objectives were to: 1) Discover providers’ current thoughts/opinions about electronic messaging, 2) Identify perceived benefits and barriers to using secure electronic messaging between providers and patients, and 3) Discover the perceived essential tools needed to meet Stage 3 criteria.

Methods: A needs assessment was performed through a provider survey. Providers at primary care offices with reliable Wi-Fi were approached about the project. Volunteer participants were given a …

Evaluation Of Serum Vitamin D Levels In Older Adults Who Fall And Sustain A Fracture: A Retrospective Chart Review, Suzanne L. Pilon

DNP Projects

Purpose: This practice inquiry project was designed to (i) evaluate serum vitamin D levels in individuals aged 65 years and older who had fallen and sustained a fracture and (ii) identify if the serum vitamin D levels were within therapeutic range.

Background: Older adults are at increased risk of falling and sustaining a fracture as a result of falls. Vitamin D has been shown to be effective in fall prevention yet vitamin D is deficient in the older population worldwide. Evaluating current serum vitamin D levels in older adults who fall and sustain a fracture may provide additional insight in …

A Study Of Provider Practices In The Screening, Diagnosis, And Treatment Of Childhood Overweight And Obesity In A Rural Eastern Kentucky Clinic, Ashley R. Healy

DNP Projects

Objectives: The purpose of this study is to assess the current practices of providers for overweight and obese children at well visits, and how the demographics of age, sex, race, ethnicity, primary language spoken, insurance type, and provider type influence the care provided to overweight and obese children at the study site, which is a rural primary care clinic in eastern Kentucky.

Methods: This study is a retrospective design auditing well child charts (n = 571) from the study site over a two year period. Charts were audited for the data points of age, sex, race, ethnicity, primary spoken language, …

The Effect Of Varying Bisphosphonate Treatment On Changes In Bone Microdamage In Osteoporotic Women, Stefanie L. Pagano

Theses and Dissertations--Biomedical Engineering

Bisphosphonates (BPs) are used for the treatment of osteoporosis. This study evaluated changes in bone microdamage with BP treatment duration. Fifty-one iliac crest biopsies were obtained from Caucasian women, ages 41 to 87 years, who were previously diagnosed and treated for osteoporosis with oral BPs for 1-16 years duration. Patients diagnosed with any disease, drug, or substance abuse that may affect bone metabolism were excluded.

Bone samples were sectioned, stained, and histologically examined using light and fluorescence microscopy. Bone area, number and length of microcracks were quantified. Following adjustment for age, BMD, BV/TV, trabecular thickness, and turnover, regression analysis revealed …

Cerebrovascular Risk Factors, Arteriolar Sclerosis, And Cognitive Decline In The Kentucky Appalachian “Stroke-Belt”, Omar M. Al-Janabi

Theses and Dissertations--Medical Sciences

The relationship between cerebrovascular disease (CVD) risk factors and cognitive impairment or dementia has been widely studied with significant variability in findings between groups. We hypothesized that chronic small vessel injury in the form of arteriolar sclerosis, measured quantitatively using MRI to measure total white matter hyperintensity (WMH) volumes, would identify specific association of CVD risk factors and patterns of cognitive decline, associated with mild cognitive impairment of the cerebrovascular type, that represent the core features of vascular cognitive impairment in our cohort.

A Cross-sectional analysis of clinical and quantitative MRI data on 114 subjects with normal cognitive function (n=52) …

The Effect Of Digital Media On Emergent Literacy Skills: A Systematic Review, Ciera B. Mills

Theses and Dissertations--Communication Sciences and Disorders

This review examines the effectiveness of digital media on emergent literacy skills, specifically alphabet knowledge, print awareness, and phonological awareness, on children birth to four. A systematic search of the literature identified 13 studies that met the pre-determined inclusion criteria. Two independent raters evaluated each study for methodological quality and assigned appropriate levels of evidence based on ASHA levels of evidence. Results found that specific features of digital media can lead to positive effects on emergent literacy skills. A checklist with the highlighted features was created to guide clinicians, parents, and others in making decisions about the true educational quality …

Modeling Dementia Risk, Cognitive Change, Predictive Rules In Longitudinal Studies, Xiuhua Ding

Theses and Dissertations--Epidemiology and Biostatistics

Dementia is increasing recognized as a major problem to public health worldwide. Prevention and treatment strategies are in critical need. Nowadays, research for dementia usually featured as complex longitudinal studies, which provide extensive information and also propose challenge to statistical methodology. The purpose of this dissertation research was to apply statistical methodology in the field of dementia to strengthen the understanding of dementia from three perspectives: 1) Application of statistical methodology to investigate the association between potential risk factors and incident dementia. 2) Application of statistical methodology to analyze changes over time, or trajectory, in cognitive tests and symptoms. 3) …

Evaluating A Bystander Intervention Program On Reproductive Coercion: Using Quasi-Experimental Design Strategies To Address Methodologic Issues In Randomized Community Prevention Trials, Catherine P. Starnes

Theses and Dissertations--Epidemiology and Biostatistics

Community (or cluster) randomized trials are trials in which communities or groups of individuals (clusters) are randomized to receive the intervention of interest. Community randomized trials frequently more closely resemble a natural experiment than a randomized controlled trial (RCT) following intervention allocation. In particular, the effects of non-compliance can pose methodologic challenges in estimating the intervention effect which may require a quasiexperimental approach in order to minimize bias.

The motivating example to illustrate these issues is the Green Dot High School (GDHS) study. The GDHS study was a longitudinal, cluster-randomized controlled trial designed to assess the effectiveness of a bystander …

Analysis Of Kentucky Medicaid Managed Care Versus Fee-For-Service Systems: Medication Adherence In Patients With Prevalent Chronic Diseases, Catherine K. Herren

Theses and Dissertations--Pharmacy

Objectives: Managed care organizations reduce healthcare costs and may improve patient health outcomes by encouraging better control of prevalent chronic diseases. The purpose of this study was to determine whether changing from a fee-for-service program to a capitated managed care program improved medication adherence for Medicaid patients in Kentucky with hypertension, hypercholesterolemia, or type 2 diabetes.

Methods: We conducted a quasi-experimental study of patients enrolled in Kentucky Medicaid to evaluate the impact of transitioning to capitated managed care in November 2011. Medication adherence was measured using the proportion of days covered (PDC) method. Multivariable analyses measured the adjusted …

Elucidating Proteasome Catalytic Subunit Composition And Its Role In Proteasome Inhibitor Resistance, Kimberly C. Carmony

Theses and Dissertations--Pharmacy

Proteasome inhibitors bortezomib and carfilzomib are FDA-approved anticancer agents that have contributed to significant improvements in treatment outcomes. However, the eventual onset of acquired resistance continues to limit their clinical utility, yet a clear consensus regarding the underlying mechanisms has not been reached.

Bortezomib and carfilzomib are known to target both the constitutive proteasome and the immunoproteasome, two conventional proteasome subtypes comprising distinctive sets of catalytic subunits. While it has become increasingly evident that additional, ‘intermediate’ proteasome subtypes, which harbor non-standard mixtures of constitutive proteasome and immunoproteasome catalytic subunits, represent a considerable proportion of the proteasome population in many cell …

Acute Kidney Injury In Patients Treated With Vancomycin And Piperacillin-Tazobactam: A Retrospective Cohort Analysis, Wilbur Cliff Rutter

Theses and Dissertations--Pharmacy

Empiric antimicrobial therapy often consists of the combination of Gram-positive coverage with vancomycin (VAN) and Gram-negative coverage, specifically an anti-pseudomonal beta-lactam, such as piperacillin-tazobactam (PTZ). Nephrotoxicity is commonly associated with VAN therapy; however, recent reports demonstrate increasing nephrotoxicity rates among patients treated with the combination of VAN and PTZ. This study evaluated the effect of the VAN/PTZ combination on acute kidney injury (AKI), as defined by the RIFLE criteria, compared to VAN and PTZ monotherapies.

Overall, 11,650 patients were analyzed, with 1,647 (14.1%) AKI cases occurring. AKI was significantly more frequent in the VAN/PTZ group (21%) compared to either monotherapy …

Development Of New Biological Nanopores And Their Application For Biosensing And Disease Detection, Shaoying Wang

Theses and Dissertations--Pharmacy

Nanopore technology has recently emerged as a new real-time single molecule sensing method. The current dominant technologies, such as mass spectrometry and immunoassay, for protein analysis is still slow and complex, which can’t meet the urgent need and fields of use. Development of a highly simple, portable and sensitive detection system for pathogen detection, disease diagnosis, and environmental monitoring is in great need. Membrane embedded Phi29 connector nanopore, the first protein nanopore coming from bacteriophage, was mainly focusing on DNA and RNA translocation in previous studies. Here, Phi29 connector nanopore was first time established for antibody detection by engineering Epithelial …

Probing The Functional Relevance Of Reactive Hippocampal Neurogenesis In A Model Of An Alcohol Use Disorder, Chelsea Rhea Geil Nickell

Theses and Dissertations--Pharmacy

Alcoholism, or alcohol use disorders (AUDs), represent a major public health concern both locally and globally. Critically, excessive alcohol consumption results in neurodegeneration in brain regions such as the hippocampus which is known for its role in learning and memory. Recovery of hippocampal volume loss has been observed after prolonged abstinence, but the mechanisms underlying this process are not well understood. Adult neurogenesis is thought to contribute to this recovery since after alcohol exposure a reactive increase in adult neurogenesis is observed. This reactive neurogenesis (the process by which brain insult results in a compensatory increase in neurogenesis) may represent …

Rna Nanotechnology For Next Generation Targeted Drug Delivery, Fengmei Pi

Theses and Dissertations--Pharmacy

The emerging field of RNA nanotechnology is developing into a promising platform for therapeutically application. Utilizing the state-of-art RNA nanotechnology, RNA nanoparticles can be designed and constructed with controllable shape, size for both RNA therapeutics and chemical drug delivery. The high homogeneity in particle size and ease for RNA therapeutic module conjugation, made it feasible to explore versatile RNA nanoparticle designs for preclinical studies.

One vital module for therapeutic RNA nanoparticle design is RNA aptamer, which can enable the RNA nanoparticles find its specific target for targeted drug delivery. A system of screening divalent RNA aptamers for cancer cell targeting …

Vena Cava Filter Utilization And Retrieval: A Quality Of Care Issue, Joshua Brown

Theses and Dissertations--Pharmacy

Vena cava filters (VCFs) are mechanical devices implanted in the inferior vena cava to trap thrombi from travelling to the pulmonary circulation, resulting in pulmonary embolism. VCFs are available as permanent or non-permanent, retrievable devices and are generally indicated for use in patients unable to receive systemic anticoagulation or at exceedingly high risk for pulmonary embolism (PE). Retrievable devices allow for removal of the VCF once the contraindication to anticoagulation or high risk of PE has abated. Since the introduction of retrievable VCFs in the early 2000’s, use of VCFs has increased three-fold, with >85% of all VCFs placed being …

Investigating Mechanisms Determining Cancer Cell Sensitivity To Carfilzomib And Novel Strategies To Overcome Resistance, Lin Ao

Theses and Dissertations--Pharmacy

Proteasome inhibitors (PIs) are a class of FDA-approved anti-cancer agents which includes the first-generation PI bortezomib (BTZ) and second-generation carfilzomib (CFZ). Drug resistance is a major challenge in PI therapy with no solution currently available. While a few resistance mechanisms had been proposed for BTZ, little was known about CFZ resistance before the start of our studies. In this dissertation work, we investigated multiple mechanisms contributing to CFZ resistance—alterations in the drug transporter activity, metabolic stability, and proteasome activity profiles—and evaluated potential strategies to overcome CFZ resistance.

We observed marked upregulation of the drug efflux transporter P-glycoprotein (P-gp) in our …

Looking To The Future Of Stroke Treatment: Combining Recanalization And Neuroprotection In Acute Ischemic Stroke, Michael E. Maniskas

Theses and Dissertations--Neuroscience

Stroke is the 5^th leading cause of death in the U.S. with 130,000 deaths and around 800,000 affected annually. Currently, there is a significant disconnect between basic stroke research and clinical stroke therapeutic needs. Few animal models of stroke target the large vessels that produce cortical deficits seen in the clinical setting. Also, current routes of drug administration, intraperitoneal and intravenous, do not mimic the clinical route of intra-arterial drug administration. To bridge this divide, we have retro-engineered a mouse model of stroke from the current standard of care for emergent large vessel occlusion (ELVO) stroke, endovascular thrombectomy, to …