Trem2: Gene Expression And Role In Alzheimer’S Disease, Henry Snider

Theses and Dissertations--Medical Sciences

Genetic mutations in the TREM2 gene are highly correlated with risk of Alzheimer’s disease, but alternative splicing patterns of TREM2 transcripts have not been fully described. Characterization of TREM2 alternative splicing will be of significant use to the scientific community as the field of Alzheimer’s disease research progresses. The goal of this study was to fully describe splicing patterns in TREM2, as different splicing isoforms of genes can alter express and/or function of the final protein. Human blood and anterior cingulate cortex brain tissue from 61 individual donors was processed and used for PCR and quantitative PCR as well as …

Opioid Use Disorder Treatment With Buprenorphine: Analysis Of Treatment Utilization And Associated Outcomes In Kentucky, Feitong Lei

Theses and Dissertations--Epidemiology and Biostatistics

Opioid use disorder (OUD) is chronic opioid use that results in clinically significant suffering, impairment, or even death. The opioid epidemic in the United States has become a public health and economic crisis, affecting patients' well-being and the nation's overall health and welfare. Eastern Kentucky was among the first regions affected by the opioid crisis, and Kentucky has historically ranked among the top five states for age-adjusted drug overdose mortality rate.

There are three medications (buprenorphine, methadone, naltrexone) approved by the U.S. Food and Drug Administration to treat OUD. As a partial opioid agonist, buprenorphine is a safe medication for …

Building Tools For Improved Modulation Of The Human Gabaa Receptor, A Central Nervous System Target For The Treatment Of Anxiety, Garrett Edward Zinck

Theses and Dissertations--Pharmacy

In the U.S., anxiety is recognized as an increasing range of mentally and physically debilitating psychiatric health disorders with significant economic repercussions. Over the last 20 years, several novel anti-anxiety therapies have entered the drug development pipeline, but none have made it to market.

The work in this dissertation focused on structurally modifying valerenic acid (VA), a structurally unique carboxylated sesquiterpene acid found in Valeriana officinalis. VA is putatively reported to have allosteric modulatory activity of the human GABA_A receptor, a ligand-gated ion channel responsible for attenuating neurotransmissions. Structural modeling of VA’s GABA_A receptor interaction suggests that …

Studies Toward The Development Of An Improved Countermeasure For Synthetic Opioid Overdose, Sidnee L. Hedrick

Theses and Dissertations--Pharmacy

One of the most prominent opioid analgesics in the United States is the high potency agonist fentanyl. It is used in the treatment of acute and chronic pain and as an anesthetic adjuvant. When used inappropriately, however, ingestion of just a few milligrams of fentanyl or other synthetic opioid can cause opioid-induced respiratory depression (OIRD), often leading to death. Currently, the treatment of choice for OIRD is the opioid receptor antagonist naloxone. Recent reports, however, suggest that higher doses or repeated dosing of naloxone (due to recurrence of respiratory depression) may be required to fully reverse fentanyl-induced respiratory depression, rendering …

Investigating The Physical Stability Of Amorphous Pharmaceutical Formulations, Travis W. Jarrells

Theses and Dissertations--Pharmacy

Amorphous formulations, including amorphous solid dispersions (ASDs), consisting of the active pharmaceutical ingredient (API) intimately mixed in a polymeric matrix, are an attractive formulation approach to improve drug delivery, dissolution, and solubility. However, an amorphous API in an ASD is in a higher energy state compared to the crystalline drug and results in most ASDs being inherently unstable. The polymer helps to stabilize the amorphous drug against crystallization such that the resulting homogenous mixture maintains its solubility advantage relative to the crystalline form. One challenge of ASDs is that the presence of impurities including crystals or residual solvent, variations in …

Liposomal Technologies To Improve Gene Delivery, David Nardo Padron

Theses and Dissertations--Pharmacy

Lipid based nanoparticles (LBNs) are used in myriad applications in medicine from small molecule drug delivery to mRNA vaccines. A major contributing factor to the development of the field has been the ongoing development of novel compounds that retain the functionality of natural lipids but expand upon them through inclusion of functional moieties that can be applied to specific scientific and biomedical questions. In the body of this dissertation, an extensive overview of LBNs is provided, focusing primarily on their use in immune modulation. The research presented herein begins with the synthesis of a novel class of lipids based on …

Development Of Zafirlukast Derivatives Active Against Porphyromonas Gingivalis, Kaitlind C. Howard

Theses and Dissertations--Pharmacy

Periodontal diseases are inflammatory diseases that can lead to damage of the soft tissue and bone supporting the teeth. Gingivitis is the reversible early stage of gum disease, which consist of gums that bleed when brushing or flossing teeth. When left untreated, the preventable but irreversible late stage of periodontal disease, periodontitis, can lead teeth to loosen or even fall out. Oral bacterial species, such as the Gram-negative anaerobic pathogen Porphyromonas gingivalis trigger these inflammatory diseases through oral dysbiosis. P. gingivalis is a keystone pathogen, meaning that the damage caused by P. gingivalis is not proportional to its abundance. Treatment …

The Relative Contribution Of Liver And Intestine In Reverse Cholesterol Transport, Rupinder Kaur

Theses and Dissertations--Pharmacy

Despite decades of advances in research, death due to cardiometabolic disease remains the largest contributor to mortality in the US. While present therapies oppose “forward cholesterol transport,” and atherosclerotic plaque progression, they do not remove cholesterol from established atherosclerotic plaques. Reverse cholesterol transport (RCT) is the active process of mobilizing peripheral cholesterol for excretion through the hepatobiliary (transhepatic cholesterol elimination, THCE) or intestinal (transintestinal cholesterol elimination, TICE) pathways. Currently, there are no clinically approved therapeutics that target RCT. Elucidation of the mechanisms that govern RCT and TICE, and the subsequent identification of novel targets is of importance. The present work …

Evaluating The Role Of Mmp9 In Hyperhomocysteinemia Induced Cerebrovascular Pathology, Alexandria Linton

Theses and Dissertations--Neuroscience

Vascular contributions to cognitive impairment and dementia (VCID) is one of the leading causes of dementia, along with Alzheimer’s disease (AD), and often manifests as a comorbidity of AD. Elevated plasma homocysteine, known as hyperhomocysteinemia (HHcy), is a risk factor for VCID; however, the mechanism underlying the connection between HHcy and development of VCID pathology remains elusive. Understanding this mechanism would reveal novel therapeutic targets with the potential to be disease modifying, which are a critical need for a disease that lacks any approved treatment. Previous studies from our lab have strongly associated neuroinflammation and blood brain barrier (BBB) dysregulation …

A Content Analysis Of Reddit Comments Discussing Fibroadenoma Appraisal And Decision Making, Hayley Marie Kay Stahl

Theses and Dissertations--Communication

Though fibroadenomas are clinically benign in most cases, clinical research suggests that these lesions can cause diagnosis-related physical health complications and psychological distress. However, this research is limited and should be investigated further. Thus, this study aimed to explore how patients appraise their fibroadenoma diagnosis uncertainty. Additionally, this study sought to determine if a correlation existed between appraisal and decision making as well as identify the factors that influence the most common treatment decision: removal. Data was retrieved from Reddit discussions for a content analysis. These discussions were then qualitatively analyzed using codebooks associated with this study’s research questions. Findings …

A Pilot Randomized Controlled Trial Of Smoking Cessation Induction Treatment For Rural, Underserved Cancer Survivors Across The Continuum Of Motivation To Quit, William Bowling

Theses and Dissertations--Psychology

The United States’ smoking prevalence has decreased substantially, but this public health improvement is unevenly distributed across the population. A promising individual-level approach to cancer control equity is to develop more acceptable and efficacious interventions that are widely disseminated to rural and other disadvantaged cancer survivors. Smoking cessation induction focuses not on long-term abstinence, but on engaging people in the process of making quit attempts and may be ideal for hard-to-reach populations. The aim of this pilot randomized controlled trial was to evaluate the feasibility and acceptability of a smoking cessation induction intervention designed for rural cancer survivors. The treatment …

Caring For Ourselves Before We Care For Others: A Mindfulness-Based Intervention For Acute Care Nursing Staff, Kent Brouwer

DNP Projects

Background: Acute care nursing staff have recently faced increasing rates of anxiety, stress, emotional exhaustion, and burnout. Nursing burnout is directly linked to patient outcomes, nurse retention, and the resilience of our nurses. Therefore, it is in the best interest of hospital organizations to focus efforts on the well-being of the nursing workforce. A recent innovative technology to prevent burnout teaches mindfulness through the utilization of smartphone applications. There is limited evidence regarding the implementation and impact of brief mindfulness interventions on intra-professional acute care providers.

Methods: A pretest-posttest design with a midpoint evaluation was utilized in this pilot study. …

Evaluating Providers’ Knowledge, Attitudes And Intentions Toward Assessing Pregnancy Desires In Women Of Childbearing Age, Sydney Hahn

DNP Projects

Abstract

Background: Unintended pregnancies account for over half of all pregnancies in the United States. Unintended pregnancies can lead to abortion, socioeconomic difficulties, medical complications, psychological issues, and political issues. Unintended pregnancies are potentially harmful to both the mother and the baby. Healthy People 2030 listed reducing the number of unintended pregnancies as one of their family planning objectives.

Purpose: The purpose of this DNP project was to evaluate providers’ knowledge, attitudes, and intentions toward assessing pregnancy desires in women of childbearing age. Methods: The study was a one-group pre/post intervention design. The data was gathered via a convivence sample …

Patient Transitions Between Acute And Post-Acute Care Organizations: Can Nursing Communication Prevent Patient Readmission?, Penny Gilbert

DNP Projects

Preventing Patient Readmission

Background and Review of Literature: Communication is the foundation of patient safety. As patients move from the acute to post-acute care setting, risk for insufficient communication rises. Research demonstrates a vast array of communication hand-off tools currently exist for and between different care arenas. No one tool has been standardized for patients transitioning from acute to post-acute care settings. The Institute of Medicine (IOM) and The Joint Commission (TJC) have published multiple documents discussing communication plagues within health care resulting in readmission.

Purpose: The purpose of this project is multifaceted: 1) identifying current nursing communication practices between …

Huddle Implementation In The Perioperative Setting, Tina Thomas

DNP Projects

Background: Communication is essential for safe and effective patient care. In the perioperative setting, information sharing is critical to care coordination. Lack of communication between caregivers can lead to medical errors. Evidence shows that huddles lead to increased communication, satisfaction, and engagement between team members resulting in better patient outcomes. Huddles are short, less than 10-minute gatherings that focus on the daily schedule, identify potential obstacles, explain unique needs, and discuss preceding day issues.

Objectives: This project aimed to evaluate the effectiveness of huddles on employee satisfaction, engagement, and communication of healthcare workers while also determining if huddles were …

The Effect Of An Educational Intervention On Attitudes Toward Behavioral Health Patients Among Medical Floor Nurses: A Pilot Study, Caroline C. Bowman

DNP Projects

Background: Stigma towards behavioral health patients by healthcare workers can create barriers to quality care for patients. Addressing these negative attitudes towards behavioral health patients can improve health outcomes and reduce healthcare costs. Current evidence-based practice for tackling stigmatizing attitudes include interventions to improve mental health education among healthcare providers to promote improved patient outcomes.

Purpose: The goal of this project was to enhance medical floor nurses' attitudes toward behavioral health patients by delivering a web-based educational intervention on recognition and management of behavioral health disorders. The aims of the project were to: 1.) Assess nurses' stigma toward behavioral health …

Effects Of Tailored Colorectal Cancer Patient Education On Colorectal Cancer Screening Rates In An Urban Kentucky Clinic, Brittany Pittman Hardcorn

DNP Projects

Background: Colorectal cancer (CRC) is one of the leading causes of death among Americans and Kentuckians. Most colorectal cancers are slow-growing, making regular colorectal cancer screening increasingly important to decrease morbidity and mortality. Although of this importance, there is low screening rates. Thus, the need to explore all colorectal screening options.

Purpose: The purpose of this project was to increase the number of patients screened for colorectal cancer by providing education on colorectal cancer and screening options in a primary care setting.

Methods: The design of the study was a 2 group quasi-experimental practice improvement project using a post-test educational …

Effectiveness Of A Web-Based Smoking Cessation Training Program For Health Care Professionals Within An Acute Psychiatric Facility, Allie Carmichael

DNP Projects

Background: Tobacco use is the leading preventable cause of death and disease in the United States, with the prevalence remaining especially high among people with mental illness. Mental health providers often lack training in smoking cessation and feel uncomfortable addressing the issue with this patient population. Studies show that educational training offered to providers can lead to increased knowledge that improves the provider’s confidence and attitude about delivering smoking cessation treatment to patients. Mental health professionals must receive training on smoking cessation treatment modalities so they can effectively provide holistic care needed for recovery for patients with mental illness.

Purpose …

Improving The Healthcare Transition For Adolescents With Asthma: Implementing A Transition Readiness Assessment, Andrea Pauley

DNP Projects

BACKGROUND: Asthma is the most common pediatric chronic disease in the United States and adolescence represents the highest prevalence among all age groups. Transition planning is recommended for all adolescents, especially those with special health care needs (SHCN). Only 17% of adolescents with SHCN receive adequate transition planning.

PURPOSE: The purpose of this study was to implement the Transition Readiness Assessment Questionnaire (TRAQ) for adolescents age 12 years and older with asthma to identify the current level of transition readiness and identify factors associated with readiness.

METHODS: This study was an exploratory, cross-sectional design to evaluate and describe participants’ level …

The Use Of A Pediatric Palliative And Hospice Education Module To Enhance The Knowledge And Practice Of Emergency Room Providers, Morgan Garrett

DNP Projects

Background: Palliative and hospice care resources are underutilized in pediatric patients with chronic and life-limiting illnesses. One contributing factor is the lack of formalized education for medical providers regarding the differences and scope of palliative and hospice care models. Without adequate education about these services, providers are not able to effectively utilize otherwise available resources to provide holistic care.

Purpose: The purpose of this study was to assess the current perception of knowledge among providers pertaining to pediatric palliative and hospice care. The study investigated improvements in educational outcomes in ten categories after participation in a web-based training. A secondary …

Effectiveness Of Substance Use Disorder Education On Knowledge And Attitudes Among Entry-Level Obstetric Nurses, Kathryn Hughes

DNP Projects

Background: Substance use disorder (SUD) among pregnant women is a significant public health concern in the United States, particularly in Kentucky. Nursing curriculum has not kept pace with the escalating public health crisis regarding SUD. Graduating nurses joining the obstetric field are often not prepared to meet the unique care needs of this vulnerable population.

Purpose: The purpose of this DNP project was to pilot an educational intervention embedded with content regarding SUD with entry-level obstetric nurses that were enrolled in the nurse residency program at UK HealthCare.

Methods: This project used a quasi-experimental pretest – posttest design. Participants completed …

Implementation Of Education And Use Of A Screening Tool To Assess Palliative Care Needs In The Critical Care Setting, Megan Stoeckinger

DNP Projects

Purpose: The purpose of this study was to measure palliative care knowledge, attitudes, perceived empowerment, and familiarity of the Supportive Palliative Care Indicators Tool (SPICT) among critical care nurses and advanced practice providers (APPs) before and after viewing a web-based educational video on an adult medicine intensive care unit (MICU).

Methods: This study was a one group pre- and post- implementation assessment using a web-based educational video and electronic surveys. The population included critical care nurses and advanced practice providers (APPs). This study spanned the timeframe between January 2022 and March 2022.

Results: Paired t-tests comparing pre-intervention …

Evaluation Of A Beverage Educational Intervention For Latino Parents Of Infants And Children Ages Nine Months To Five Years, Natalie Chelf

DNP Projects

Background: The Latino population has the highest rate of childhood obesity in the United States. Sugar-sweetened beverage (SSB) consumption has a positive correlation with increased rates of childhood obesity. Current research shows a deficit in culturally sensitive methods to reduce SSB consumption in the pediatric Latino population.

Purpose: The purpose of this project is to empower parents of Latino infants and young children with the knowledge to reduce or eliminate the consumption of SSBs in their child’s diet.

Methods: The project was a one group pre-test post-test quasi-experimental study design occurring in one pediatric outpatient clinic. The Information-Motivation-Behavioral Skills (IMB) …

Evaluation Of A Process Change On Mammography Screening Rates In A Family And Community Medicine Clinic, Christina Rademaker

DNP Projects

Abstract

Background and Significance: Breast cancer is the 2^nd leading cause of cancer death among women worldwide. Mammography is a screening approach used in the detection of breast cancer and proven to help reduce mortality. Only 72.8% of eligible American women have been screened for breast cancer within the past 2 years. One urban family and community medicine clinic (FCM) fell below the national average with a rate of 60.9%; as a result, they implemented an evidence-based strategy to improve mammography rates within the clinic.

Purpose: The purpose of this study was to evaluate the implementation of a telephone …

Improving Pediatric Providers’ Intent For Safe Sleep Anticipatory Guidance With An Electronic Educational Intervention, Lindsay Hamilton

DNP Projects

Background: Sudden Infant Death Syndrome or SIDS is the fourth leading cause of infant mortality in the United States. There is no definitive cause of death pertaining to SIDS, but certain risk factors have been identified that increase the risk of SIDS in an infant. While safe-sleep education during the prenatal time of parenthood is important, it is also essential to continue this education comprehensively in the primary care setting and in any other exposure the family has to healthcare.

Objective: The objective of this study is to evaluate the self-reported knowledge of University of Kentucky Children’s Hospital Pediatric Residents’, …

Improving Smoking History Screening And Documentation To Increase Lung Cancer Screenings In Primary Care Clinics, Destinee R. Rein

DNP Projects

BACKGROUND: In the United States, lung cancer has the highest mortality rate of all other cancers among men and women. Kentucky is ranked 50th among all states, leading the nation in new lung cancer cases each year. Lung cancer screening using Low dose Computed Tomography (LDCT) can reduce lung cancer-related morbidity and mortality. Lack of smoking history documentation to identify eligible patients is a major contributing factor to low national screening rates. Obtaining complete smoking history remains the most important technique in identifying candidates for lung cancer screening.

PURPOSE: The purpose of this quality improvement project was to evaluate …

Evaluating The Use Of A Diet Screening Tool For Diabetes And Weight Management In Primary Care, Christie Mcbride

DNP Projects

Background: Type 2 diabetes mellitus is a prominent disease and leading cause of death in the nation. Many complications can develop when glucose levels are poorly controlled. When patients receive education and support in diabetes self-management, including individualized dietary interventions, it leads to improved glycemic control.

Purpose: The purpose of this quality improvement (QI) project was to evaluate the incorporation of a diet recall tool, Starting the Conversation (STC), in the standard care for diabetic patients with abnormal body mass index (BMI). The study aimed to examine: (1) patient opinion of the intervention and (2) healthcare provider satisfaction with use …

The Effect Of A Web-Based Training On Suicide Knowledge, Attitudes, And Health Access Behaviors Of Behavioral Health Nurses Regarding Suicide Prevention, Marc Woods

DNP Projects

Background: Nurses, critical to the health care delivery system, experience a variety of psychological stressors that predispose them to suicide risk. Recent studies have verified elevated suicide risks in nurses when compared to the general population. There is limited understanding regarding the effectiveness of various strategies to reduce risk factors and increase protective factors for suicide among nurses.

Purpose: The purpose of this study was to evaluate if a web-based education module can improve the knowledge, attitudes, and ratings of willingness to access help related to suicide prevention in behavioral health nurses.

Conceptual Framework: Ajzen’s theory of …

Social Media Use And Mental Health: An Educational Intervention To Reduce Depression And Anxiety In Adolescents, Natalie Catlett

DNP Projects

Background: Most adolescents spend a great deal of their time using various social media platforms. However, excessive and maladaptive social media use is correlated with worsening symptoms of depression and anxiety among adolescents.

Objective: This project aimed to determine whether an educational intervention could help decrease overall time spent using social media and improve mood and mental health outcomes among adolescents with depression or anxiety disorders.

Methods: This was a quasi-experiment with a pretest and posttest design. An educational intervention about the relationship between social media use and symptoms of depression and anxiety among adolescents and strategies to minimize risk …

Using The Samscore Questionnaire To Increase Skin Cancer Risk Screenings At Adult Patient Annual Exams, Taylor Abner

DNP Projects

Background: Malignant melanoma has become an increasingly prevalent problem in the United States. The earlier a skin cancer is identified, the better the outcome. There are conflicting recommendations about screening for skin cancer but in general identifying high risk patients is important and it is not being achieved in primary care.

Purpose: The purpose of this study is to evaluate use of the SAMScore Questionnaire to determine high risk patients at adult annual visits.

Methods: This was a multi-phased study with a quasi-experimental design that took take place at a family and community primary care clinic in central Kentucky. Baseline …