Medicine and Health Sciences Commons^™

Perception Of Pediatric Readiness Across A Health System's Emergency Departments, Rebekah L. Sabo

Doctoral Dissertations

The recent pandemic and pediatric respiratory syncytial virus surge have reinvigorated pediatric care readiness conversations. National strategies and associations exist to guide health systems in improving the quality of emergency care offered to pediatric populations by first assessing readiness for care. These research strategies center on survey implementation and staff engagement in general emergency departments with the goal to improve staff readiness to care for pediatric patients that may present for treatment. What impact would developing a consolidated pediatric readiness program that includes: pediatric emergency care coordinator designation for each emergency department, pediatric readiness education and committee engagement have on …

Deprescribing Proton Pump Inhibitors In A Rural Health Clinic, Jason Thomas Barney

Doctoral Dissertations

Background: Proton pump inhibitors (PPIs) have been extensively prescribed for gastrointestinal pathologies, contributing to $14 billion in annual expenditure in the United States alone. Inappropriate PPI prescriptions, affecting 48% of adults, raise concerns about prolonged usage and associated health risks. Addressing these issues is vital, considering the significant impact of PPIs on patient health and healthcare costs.

Local Problem: A Midwestern clinic grapples with inappropriate and unnecessary PPI use among patients. In response, a comprehensive deprescribing intervention combining a provider algorithm with patient education was implemented to reduce PPI usage that was medically unnecessary.

Methods: A literature …

Comparative Analysis Of Rectum Delineation: Inter-Observer Agreement Among Treatment Planners Versus Auto Segmentation In A Single Institution, Haley Douglas

Culminating Experience Projects

Abstract

Introduction

The past 20 years have seen a continuous rise in the cancer patient population, resulting in staffing shortages, longer wait times for patients, and potentially lower-quality care. Artificial intelligence has been incorporated into the healthcare system and has provided ease with understaffing. Using AI technology to delineate structures can reduce planning time and variation between planners. The objective of this research is to assess the level of consistency in the rectum boundary delineation performed by different dosimetrists working at a single institution, as compared to the performance of the AutoContour software. This analysis will help determine the efficacy …

The Quality Of Life In Assisted Living Facilities In Grand Rapids, Nina Alpers

Honors Projects

This research study looked at the quality of life of residents in assisted living facilities in Grand Rapids. The purpose of this study is to consider the life satisfaction of residents of assisted living facilities in Grand Rapids and explore the determinants that can make their time spent at assisted living facilities as enjoyable as possible. This study highlighted the voices of the residents in assisted living facilities by doing a qualitative study using an interview-styled approach that asked the residents about a variety of topics, such as routines, feelings, values, personal facts, health status, care provided, relationships, and views …

Comparative Retrospective Study Of Proton Arc Planning With Elsa Algorithm And Impt With Monte Carlo Algorithm With Raystation Treatment Planning System, Matthew L. Carpenter Ms, Msha, Bsrt(R)(T)

Culminating Experience Projects

Proton arc therapy (PAT) will become widely available soon. It is crucial to determine if this technique and the associated calculation algorithms provided by treatment planning system vendors compete favorably with established proton therapy techniques like intensity modulated proton therapy (IMPT) and the Monte Carlo dose calculation algorithm used to compute IMPT doses in today’s clinic. RaySearch Laboratories have produced a modified Monte Carlo algorithm called ELSA.

ELSA stands for early layer spot assignment and is RaySearch Laboratories proposed solution to reduce optimization time during treatment planning for PAT. This research study will look at proton plan robustness to determine …

Dosimetric Evaluation Of Left-Sided Chest Wall Vmat Treatment With And Without Jaw Tracking; Dose Comparison Of Left Anterior Descending Artery Versus Heart Mean Dose, Jacqueline J. Emus

Culminating Experience Projects

Radiation therapy has significantly improved breast cancer survival rates; however, it can still lead to long-term side effects, particularly affecting the heart. Left-side breast cancer patients face higher risks due to the proximity of the heart to the treatment area. To mitigate cardiac toxicity, various strategies, including jaw tracking and Volumetric Modulated Arc Therapy (VMAT), have been proposed. This study investigates the dosimetric impact of VMAT plans with and without jaw tracking on the left anterior descending artery (LAD) dose and heart mean dose in post-mastectomy breast cancer patients. Ten patients previously treated with VMAT were evaluated, and the results …

Interfraction Variability Of Breathing Amplitude Of Patients Undergoing Sbrt Lung Treatment And The Potential Impact On Dosimetry, Christian Padilla Gallegos

Culminating Experience Projects

Abstract

Introduction

The study investigated the consistency of free breathing planning margins for fractionated SBRT treatment in the lung. The study compared breathing motion from the average CT (AVE CT) scan to the Cone Beam Computed Tomography (CBCT) from each treatment session. Various breathing techniques were also discussed, including deep inspiration breath hold (DIBH), gated breathing, abdominal compression (AC), and free breathing (FB). Free-breathing may lead to overdosing on surrounding healthy tissue if significant changes in breathing amplitude occur. Abdominal compression or breath hold may reduce abnormal breathing movement if erratic breathing occurs. The study's aim was to ensure the …

A Retrospective Comparison Of Dose Distribution Within Density Override And Avoidance Structures In Volumetric Arc Therapy Prostate Plans With Hip Prosthetics: A Dosimetric Evaluation, Jared Richard Brinkman

Culminating Experience Projects

Introduction

Prostate cancer is one of the most common cancers among men, and its incidence is a significant health concern. The optimal radiation treatment for prostate cancer patients needs to be tailored to reduce toxicities to organs at risk within the treated area. This study aims to retrospectively evaluate the dose distribution to organs at risk (OARs) in patients with hip prosthetics for volumetric modulated arc therapy (VMAT) prostate cancer plans.

Methods

The study included ten prostate cancer patients with at least one prosthetic hip who received VMAT plans at a Midwest Radiation Oncology Center. Various data points, including target …

Enhancing Long-Term Outcomes: Implementing Community Engaged Research To Augment Substance Use Disorder Treatment, Kevin M. Quinn

Masters Theses

The Universal Evaluation Tool is an intuitive self-assessment instrument to enhance long-term treatment outcomes for Guiding Light’s residential addiction rehabilitation program. Designed as a versatile method for collecting primary data, the Universal Evaluation Tool can be administered to clients at any point during the recovery program (i.e., intake to discharge). The data collected from the survey can be used as a framework to guide treatment decisions, develop personalized care plans, offer insight into a client’s progress, and collect baseline data (e.g., sociodemographic characteristics) on a treatment population for use in grant applications.

A pilot study to generate preliminary data was …

What Effect Does Flexible Work Arrangements Have On Efficiency And Job Satisfaction In Medical Dosimetry?, Michelle Walters

Culminating Experience Projects

Abstract

The purpose of this research study is to determine new trends in the medical dosimetry profession that relate to when and where work is being completed. It is also of interest to understand efficiencies within radiation oncology departments as well as how medical dosimetrists work arrangements impact job satisfaction. A voluntary survey of current medical dosimetrists was conducted which asked close-ended questions about simulation to treatment time frames, employment type, hours worked, departmental efficiency and perceived job satisfaction. It was established that the resulting 185 responses provided statistically significant results. Greater than half of participants answered yes to either …

Quantitative Benefits Of Reducing The Inferior Border Of Right-Sided Free Breathing Intact Breast Treatment Plans Regarding Liver Dose, Shelby Handshue

Culminating Experience Projects

Introduction

Breast cancer is a prevalent disease in the United States, affecting approximately one in eight women during their lifetime (Leaver & Washington, 2010). Advancements in medical treatments have evolved from mastectomy to a multidisciplinary approach. Radiation therapy plays a crucial role in preventing local recurrence after breast conserving surgery. Traditionally, whole breast irradiation has been administered over 25-28 fractions to a total dose of 45-50 Gray (Gy), followed by a boost of 5-8 fractions to the tumor bed. In recent times, hypofractionation, which involves a shorter treatment schedule of 15-16 fractions to a total dose of 42.5 Gy, followed …

A Dosimetric Comparison Of Coplanar And Non-Coplanar Beam Arrangement For Apbi Treatment Techniques, Reuben Granger

Culminating Experience Projects

Abstract

Introduction

Breast cancer is a prevalent malignancy among women in the United States, necessitating a variety of treatment strategies. Accelerated Partial Breast Irradiation (aPBI) has emerged as an effective treatment technique for early-stage breast cancer, offering reduced treatment duration and potential benefits in terms of cosmesis and patient convenience. One of the critical factors influencing the success of APBI is the choice of beam arrangement during radiation delivery. This research paper presents a dosimetric comparison of coplanar and non-coplanar beam arrangements for APBI treatment techniques.

Methods

The study includes 15 patients with left-sided breast cancer. The patients underwent two …

Dosimetric Comparison Of Glioblastoma Radiotherapy Treatment Plans On A Low-Field Mri-Guided Linear Accelerator Compared To Conventional C-Arm Linear Accelerator, Emily J. Moats

Culminating Experience Projects

Introduction

MRI-guided radiation therapy has proven to provide many benefits such as real-time tracking, dose escalation, and the ability to perform online adaptive therapy. The objective of this study is to compare curative treatment plans for glioblastoma tumors on a low-field MR-guided linac vs a C-Arm linac and evaluate if they are comparable in terms of coverage, organ at risk sparing, delivery time, and deliverability.

Methods

This is a retrospective study that consisted of 15 previously treated patients who received radiation therapy for glioblastoma on a C-Arm linac. The CT simulation data that was used for the original treated plans …

Effects Of Dietary Phytoestrogens On Spermatogenesis And Male Reproductive Tract In Mice, Trenton A. Dalm

Masters Theses

Increases in infertility over the past 50 years are linked to environmental exposures to endocrine disrupting chemicals (EDCs). One type of EDC is phytoestrogens, commonly found in soy-based diets and foods such as cauliflower, tofu, and broccoli. Phytoestrogens may bind estrogen receptors and have positive or negative effects on receptor signaling. The developing male reproductive tract is potentially susceptible to endocrine disruptors leading to changes in adult reproductive function and possibly infertility. We hypothesized that dietary phytoestrogen exposure would have a dose dependent effect with the high diet yielding the lowest sperm count and worst performance compared to the medium …

A Quantitative Dosimetric Comparison Of Dibh Vmat And Static-Imrt Apbi Treatments: Evaluating Large Left Sided Lumpectomy Cavities Located Near The Chest Wall, Christopher Jordan Clifton

Culminating Experience Projects

Abstract

Introduction

The main purpose of this study was to determine whether there was a significant difference between the dose distributions when comparing static-IMRT and VMAT plans for patients with large left sided lumpectomy cavities located near the chest wall while utilizing DIBH. Thorough planning and statistical analysis was performed to determine whether there was a clear advantage for either treatment technique to better benefit patient outcomes.

Methods

Ten female patients with large left sided lumpectomy cavities were selected to be retrospectively planned using both static-IMRT and VMAT plans. Each patient fell within the ASTRO eligibility criteria for APBI treatments. …

A Further Investigation Into The Use Of The Auto 500 Normal Tissue Objective Setting To Compare Hyperarctm And Rapidarctm Planning Using Dosimetric Rings For Single Brain Lesion Stereotactic Radiosurgery: A Retrospective Study., Ndipnu B. Lima

Culminating Experience Projects

One of the most important organs in the body is the brain; It controls numerous functions vital for everyday life. Due to the compactness of the brain, introducing even the smallest abnormal growth can cause cranial pressure resulting in symptoms such as loss of vision, headaches, reduction of memory and seizures¹. Brain lesions can present as cancerous, noncancerous, or metastatic. Treatment options for cranial lesions are dependent on the pathology, histology, and stage of the tumor: with chemotherapy, surgery, and radiation therapy being the most common. A few radiation therapy techniques include 3D conformal radiation therapy (3DCRT), gamma …

A Dosimetric Comparison Of Jaw Tracking Versus Non-Jaw Tracking Using 6mv Vmat Treatment Beams In Prostate Patients With Involved Lymph Nodes, Rebecca Todd

Culminating Experience Projects

Introduction:

Jaw tracking is the process of the collimator jaws dynamically following the multileaf collimators during modulated therapy. Jaw tracking can be used throughout the dosimetry treatment planning process for IMRT and VMAT treatment plans. It can reduce a patient’s OAR dose by reducing low dose spillage from MLC interleaf leakage. This study aims to investigate if jaw tracking reduces OAR dose while maintaining PTV coverage in prostate patients with involved lymph nodes using 6MV VMAT treatment planning technique.

Methods:

This is a quantitative study of 10 patients. For each patient, two plans were created, one plan using a non-jaw …

A Comparison Of Hypofractionated Radiation Therapy Breast Plans For Large Breasted Patients - Hybrid 3d Conformal, And Volumetric Modulated Arc Therapy Vs Standard Hypofractionated 3d Conformal, Kelsie Wentland

Culminating Experience Projects

Abstract

Introduction

Patients with a large breast volume are more at risk of adverse skin effects with radiation therapy. Studies concerning these patients are very limited, especially in regard to comparison of planning techniques. While traditional tangent 3D conformal radiation therapy has been the standard of care, recent literature has shown possible benefits of hybrid planning for average breast volume patients. Little has been studied regarding breast cancer patients with large breast volumes and the possible benefits of hybrid planning of this patient demographic. Creating a hybrid plan could have the benefits of both different treatment modalities to provide a …

Dosimetric Significance Of Manual Density Overrides In Oropharyngeal Cancer, Thomas Lo Greco

Culminating Experience Projects

Kilovoltage computed tomography plays a crucial role in radiotherapy planning. However, the presence of high-density metallic objects can introduce streaking artifacts in CT scans, resulting in inaccurate dose calculations by the treatment planning software. Previous studies have explored manual density overrides and artifact reduction algorithms individually to enhance dose calculation accuracy, but their combined application on patient plans within a treatment planning system remains unexplored.

This research aims to assess the necessity of manual density overrides when an artifact reduction algorithm is already employed to address dental artifacts in oropharyngeal cancer treatment plans. A total of 20 previously treated volumetric …

Sleep Issues Of Older Adults: Lived Experience And Occupational Performance, Emily Angell, Anna Johnston, Adriana C. Mallett, Cassidy Ward, Rachel Wiltse

Culminating Experience Projects

Introduction: Sleep issues are prevalent among older adults which can affect occupational performance; however, there is a gap in the research in examining lived experiences of this population. This research may provide insight into these areas concerning this population.

Method: This qualitative phenomenological study was conducted via semi-structured interviews which were recorded. No identifiable information was collected during data collection. The inclusion criteria of the study sample were as follows: (a) aged 65 years or older; (b) have sleep issues or self-perceived sleep issues; (c) community-dwelling; (d) English is primary language; (e) live in West and Central Michigan. Exclusion criteria …

Improving Health Prevention Screening In A Rural Health Clinic, Shawn M. Mcnally

Culminating Experience Projects

Background: Health prevention screening has recently been highlighted in many initiatives from leading countries around the world. Breast cancer screening, cervical cancer screening and osteoporosis screenings are among the highest objectives for many of these initiatives as national health agencies focus on reducing morbidity and mortality by early detection.

Local problem: Baseline quality metrics reported for one clinic show the appropriate ordering of these health screenings is below the national benchmarks and the organizational benchmarks.

Methods: The project was designed as a quality improvement project based in a critical access region serving a rural population.

Interventions: The project intervention …

Influences Of Chronic Stress On Irritable Bowel Syndrome, Anxiety, Depression, And The Microbiome, Julia A. Semaan

Masters Theses

IBS effects approximately 5% of the world’s population with symptoms ranging from unexplainable constipation to daily abdominal pain. Though treatment options are available and have been proven beneficial for certain individuals, discovering the root cause of IBS has been difficult to accomplish due to the variety of symptoms that differ from case to case. This study aims to increase understanding of the influence that chronic stress has on irritable bowel syndrome, anxiety, depression, and the microbiome in the college-age population since this group is likely to experience daily stressors, anxiety- and depressive-like thoughts, as well as IBS symptoms. Current research …

Adolescent Depression Management: An Inner City Federally Qualified Health Center Program Evaluation, Aurora Wernette

Culminating Experience Projects

Background: Within the state, approximately 119,000 adolescents aged 12-17 have depression, and it is estimated that 57.8% do not receive any mental health care (National Alliance on Mental Illness [NAMI], 2021).

Objectives: The purpose of this program evaluation is to evaluate the management of adolescent depression. This evaluation focused on adolescent depression screening rates, medication prescribing and adherence, counseling referrals and initiation, barriers to treatment, follow-up visits, and parent feedback about the care received.

Methods: All adolescents who did not have previously diagnosed depression or developmental delay were included in this program evaluation., A weekly manual chart review was used …

Reducing Medical Errors For Patients With Substance Use Disorders With A Medical Information Card, Michael V. Hughes

Doctoral Dissertations

Background

Approximately 98,000 Americans perish annually due to medical errors and adverse events associated with the limited access to or incomplete pertinent patient health information (Centers for Disease Control and Prevention [CDC], 2022; Obrien et al., 2021). Pertinent patient health information includes patients’ allergies, current medications, current medical diagnosis, blood type, insurance, and emergency contact. The purpose of this project was to examine the efficacy in using File of Life cards in reducing medical errors among patients with substance use disorders (SUDs), and the perception of patients and healthcare providers ease of use, satisfaction of using the File of Life …

Improving Breastfeeding Rates In A Rural And Medically Underserved Community, Kaylie D. Waters

Culminating Experience Projects

Background: The Centers for Disease Control and Prevention reports national breastfeeding rates that are inconsistent with the recommendation of exclusive breastfeeding for the first six months of life (CDC, 2020). The rate of infants receiving any breastmilk by six months of age in a rural Midwest County is only 16% in contrast to 55% nationally (CDC, 2020; XXXXX, 2021). This discrepancy was addressed by evaluating breastfeeding status in that Midwest community followed by strategies to improve breastfeeding rates.

Methods: A multi-intervention quality improvement project was implemented using the SEIPS framework. The project evaluated the effectiveness of documenting breastfeeding status in …

Formalized Diabetes Self-Management Education In A Safety-Net Clinic, Emanpreet Kaur

Culminating Experience Projects

Diabetes is a complex and chronic illness requiring continuous medical care with multifactorial risk reduction strategies (American Diabetes Association [ADA], 2021). More than 37 million Americans are suffering from diabetes and 90% of them have Diabetes Mellitus Type 2 (DMT2) (Centers for Disease Control and Prevention, 2021). The purpose of this article is to review the background, an organizational assessment, a literature review, and the results of the quality improvement project that took place at a safety-net clinic in the Midwest. This project included 16 patients and data was analyzed through descriptive statistics. Results include improved hemoglobin (Hg) A1c, Body …

Brining Point-Of-Care Ultrasound To A Rural Primary Care Clinic, Caleb E. Migda

Culminating Experience Projects

Background and Objectives: In the rural primary care setting, the process for outpatient

ultrasound testing has multiple steps, all of which provide opportunities for delay in testing and diagnosis. Point-of-care ultrasound (POCUS) is a solution that allows the physician to perform same-day ultrasound in the primary care clinic. The objective of this program development project was to implement POCUS in a rural primary care clinic to reduce time to testing and diagnosis for those patients requiring ultrasound testing.

Methods: A 3-month chart audit was conducted to examine the average length of time required to complete ultrasound testing in the outpatient …

Improving Utilization Of Clinical Pharmacy Services In A Health Professional Shortage Area, Samantha E. Tallman

Culminating Experience Projects

Background: Integration of clinical pharmacy specialists (CPS) into primary care has increased over the last decade. CPS are highly educated advanced practice providers and specialize in chronic disease and medication management, and offer additional support to both patients and PCPs. Despite their extensive training and expertise, the role of CPS is often unknown or misunderstood amongst PCPs and results in the underutilization of CPS services. As a result, referrals to their service remain low. The purpose of this quality improvement project is to increase referrals to embedded CPS and identify encounter types by associated diagnoses.

Objectives: Develop and implement a …

Comparing The Health Care Resource Utilization And Medication Adherence Of People With Epilepsy And People With Diabetes By Insurance Status, Nikole Hoffman, Gerald Shoultz, Sarah Nechuta

Culminating Experience Projects

Background: Epilepsy is one of the most common neurological diseases worldwide; diabetes is a chronic metabolic disease that affects how the body produces and uses insulin. Prescribed medications are vital for controlling these and other chronic diseases by minimizing severe health issues, which can be affected by insurance type and status. Consequences of non-adherence include uncontrolled blood glucose in people with diabetes and uncontrolled seizures in people with epilepsy. We aimed to compare the healthcare resource utilization and medication adherence of people with epilepsy and people with diabetes by insurance status. Methods: Data was from the 2021 National …

Improving Adherence To Annual Retinal Screening Among Adult Diabetics In Rural Midwest, Sarah Hunger

Doctoral Dissertations

Background: Diabetic retinopathy (DR) affects millions of people worldwide and is a main cause of preventable blindness. Experts recommend annual retinal screenings on all diabetic patients. Studies show continuing trends of non-adherence, as well as significant barriers to screenings. Recommendations to overcome barriers and methods to improve adherence among diabetics are topics of interest among healthcare providers. The purpose of this project was to increase annual retinal screening adherence among adult diabetics at a privately owned primary care practice in the rural Midwest.

Methods: Staff and 59 patients, chosen through convenience sampling were involved. Pre- and post- implementation surveys were …