Medicine and Health Sciences Commons^™

“Well, Don’T Walk Around Naked... Unless You’Re A Girl”: Gender, Sexuality, And Risk In Jamtronica Festival Subcultural Scenes, Kaitlyne A. Motl

Theses and Dissertations--Sociology

The purpose of this study was to explore emerging issues surrounding gendered fear, threat, and violence perpetration at music festivals – particularly events that feature a synthesis of jam band and electronic dance music acts – a genre termed jamtronica by its fans. Though gendered violence perpetration and prevention have been widely studied within other party-oriented settings (i.e., sexual violence perpetration on college campuses), very little research exists to address how wider disparities of gender and sexuality permeate a community whose members frequently claim the scene’s immunity from external inequalities.

In this three-year multi-sited ethnography, I incorporate participant observations, group …

Vascular Cognitive Impairment And Dementia: The Importance Of Mixed Pathologies From Mouse Models To Humans, Alex Marian Helman

Theses and Dissertations--Molecular and Cellular Biochemistry

Age-related neurologic disease is a significant and growing burden on our society. Although the largest share of research effort has typically been devoted to the common neurodegenerative illnesses (such as Alzheimer’s disease, or AD), the reality is that nearly all cases of neurodegenerative disease possess elements of mixed pathology. Vascular contributions to cognitive impairment and dementia (VCID) is a complex form of dementia, combining aspects of vascular disease and other forms of dementia, such as Alzheimer’s disease. This pathology is heterogeneous and can include cerebral amyloid angiopathy (CAA), hemorrhages, white matter infarcts, and changes to the neurovascular unit. Given the …

The Function Of Erbin, A Scaffold Protein, As A Tumor Suppressor In Colon Cancer, Payton D. Stevens

Theses and Dissertations--Molecular and Cellular Biochemistry

Erbin belongs to the LAP (leucine-rich repeat and PDZ domain) family of scaffolding proteins that play important roles in orchestrating cell signaling. Here, we show that Erbin functions as a tumor suppressor in colon cancer. Analysis of Erbin expression in patient specimens reveals that Erbin is downregulated at both mRNA and protein levels in tumor tissues. Functionally, knockdown of Erbin disrupts epithelial cell polarity and increases cell proliferation in 3D culture. In addition, silencing Erbin results in an increase in the amplitude and duration of signaling through Akt and RAS/RAF pathways. Moreover, Erbin-loss induces epithelial-mesenchymal transition (EMT), which coincides with …

Controlling Platelet Secretion To Modulate Hemostasis And Thrombosis, Smita Joshi

Theses and Dissertations--Molecular and Cellular Biochemistry

Upon vascular injury, activated blood platelets fuse their granules to the plasma membrane and release cargo to regulate the vascular microenvironment, a dynamic process central to platelet function in many critical processes including hemostasis, thrombosis, immunity, wound healing, angiogenesis etc. This granule- plasma membrane fusion is mediated by a family of membrane proteins- Soluble N-ethyl maleimide Attachment Receptor Proteins(SNAREs). SNAREs that reside on vesicle (v-SNAREs) /Vesicle-Associated Membrane Proteins(VAMPs) interact with target/t-SNAREs forming a trans-bilayer complex that facilitates granule fusion. Though many components of exocytic machinery are identified, it is still not clear how it could be manipulated to prevent …

Cetuximab Plus Carboplatin And Paclitaxel With Or Without Bevacizumab Versus Carboplatin And Paclitaxel With Or Without Bevacizumab In Advanced Nsclc (Swog S0819): A Randomised, Phase 3 Study, Roy S. Herbst, Mary W. Redman, Edward S. Kim, Thomas J. Semrad, Lyudmila Bazhenova, Gregory Masters, Kurt Oettel, Perry Guaglianone, Christopher Reynolds, Anand Karnad, Susanne M. Arnold, Marileila Varella-Garcia, James Moon, Philip C. Mack, Charles D. Blanke, Fred R. Hirsch, Karen Kelly, David R. Gandara

Markey Cancer Center Faculty Publications

Background

EGFR antibodies have shown promise in patients with advanced non-small-cell lung cancer (NSCLC), particularly with squamous cell histology. We hypothesised that EGFR copy number by fluorescence in-situ hybridisation (FISH) can identify patients most likely to benefit from these drugs combined with chemotherapy and we aimed to explore the activity of cetuximab with chemotherapy in patients with advanced NSCLC who are EGFR FISH-positive.

Methods

We did this open-label, phase 3 study (SWOG S0819) at 277 sites in the USA and Mexico. We randomly assigned (1:1) eligible patients with treatment-naive stage IV NSCLC to receive paclitaxel (200 mg/m ²; every …

Nanoparticle Orientation To Control Rna Loading And Ligand Display On Extracellular Vesicles For Cancer Regression, Fengmei Pi, Daniel W. Binzel, Tae Jin Lee, Zhefeng Li, Meiyan Sun, Piotr G. Rychahou, Hui Li, Farzin Haque, Shaoying Wang, Carlo M. Croce, Bin Guo, B. Mark Evers, Peixuan Guo

Markey Cancer Center Faculty Publications

Nanotechnology offers many benefits, and here we report an advantage of applying RNA nanotechnology for directional control. The orientation of arrow-shaped RNA was altered to control ligand display on extracellular vesicle membranes for specific cell targeting, or to regulate intracellular trafficking of small interfering RNA (siRNA) or microRNA (miRNA). Placing membrane-anchoring cholesterol at the tail of the arrow results in display of RNA aptamer or folate on the outer surface of the extracellular vesicle. In contrast, placing the cholesterol at the arrowhead results in partial loading of RNA nanoparticles into the extracellular vesicles. Taking advantage of the RNA ligand for …

The Effect Of An Educational Intervention On The Blood Culture Contamination Rate In Acutely Ill Adults, Kandace Vanhoozer

DNP Projects

PURPOSE: The purpose of this project was to assess the knowledge of nurses that collect blood culture specimens at University of Louisville Hospital and to implement an educational intervention among those nurses. It was expected that the educational intervention implemented for this project would increase nurses’ knowledge regarding the proper technique for blood culture specimen collection and decrease in the rate of contaminated blood cultures.

METHODS: This study included a prospective pre- and post-test of nursing knowledge followed by an educational intervention as well as a retrospective comparison of the pre- and post-education blood culture contamination rates.

RESULTS: Of the …

Impact Of Kamishibai Card Process On Central Venous Line Maintenance Bundle Compliance, Julia B. Frith

DNP Projects

Background: Central venous line (CVL) maintenance “bundles” have been developed and implemented at Norton Healthcare to decrease central line-associated bloodstream infections. While maintenance bundle audits are performed and compliance scores are reported to frontline providers and institutional leaders, the traditional audit process does not capture the factors underlying noncompliance.

Methods: A retrospective evaluation of the implementation of the Kamishibai Card process for CVL maintenance bundle compliance in the NCH PICU was performed using a pre- and post-test design. Pre-implementation and post-implementation data was compared to assess the change in compliance with the individual CVL maintenance bundle components as well …

Impact Of A Leadership Development Program On Perceptions Of Structural Empowerment, Leadership Self-Efficacy, And Staff Nurse Clinical Leadership, Matthew E. Proud

DNP Projects

BACKGROUND: In order to serve as full partners on the interdisciplinary health care team: nurses at all levels must develop essential leadership competencies Organizations need to identify the essential leadership competencies required for bedside nursing staff and develop programs to enhance these competencies. Leadership competencies in areas such as managing change can help bedside nursing staff improve care delivery and quality outcomes.

PURPOSE: The purpose of this project was to evaluate the impact of an established leadership development program on participants’ perceptions of structural empowerment, leadership self-efficacy, and staff nurse clinical leadership in one university health system.

METHODS: The pilot …

Evaluation Of A Critical-Care Pain Observation Tool Quality Initiative, Caissy A. Goe

DNP Projects

Background: Patients unable to self-report pain are at increased risk for inadequate pain management and less than optimal outcomes. The implementation of behavioral pain scales, such as the Critical-Care Pain Observation Tool (CPOT), have demonstrated an improvement in pain management and patient outcomes.

Local Problem: A lack of the routine use of behavioral pain scales for mechanically ventilated patients unable to self-report pain was identified as a significant barrier to optimal pain and agitation management.

Methods: A retrospective pre and post design was used to evaluate the effectiveness and impact of a CPOT quality initiative on the management of pain, …

Evaluating The Effectiveness Of Norton Cancer Institute’S Prompt Care Clinics, Stephanie L. Fred

DNP Projects

Purpose: The purpose of this project was to evaluate outcomes of implementation of the Norton Cancer Institute (NCI) Prompt Care Clinics (PCCs), to include number of emergency room (ER) visits and number of inpatient admissions. A second purpose of the study was to identify presenting symptoms for patients seen in the NCI PCCs and compare the average charge per case for patients seen in the ER or NCI PCCs with the same diagnosis.

Methods: This study employed a pre-post implementation retrospective review of NCI patient electronic medical records (EPIC) to examine the effectiveness of the NCI PCCs on …

Antibiotic Prescribing For Treatment Of Acute Pediatric Illnesses By Advanced Practice Nurses, Deborah J. Whitehurst

DNP Projects

Antibiotic over-prescribing by physicians for the treatment of acute respiratory tract illnesses have been examined in a variety of settings. Different studies have examined nurse practitioner (NP) prescribing practices both in the United States and various international settings. There have been limited studies specifically examining antibiotic prescribing practices in the pediatric population. However, no studies were found which compared population specific NP groups. The purpose of this study was to understand differences in antibiotic prescribing practices among advanced practice pediatric providers.

The goal of this project was to describe and compare antibiotic prescribing practices of pediatric nurse practitioners (PNP) and …

Health Literacy In A Primary Care Setting, Ashley Newman

DNP Projects

BACKGROUND: Low health literacy is prevalent in the United States. As a result, the Agency for Healthcare Research and Quality (AHRQ) developed universal health literacy precautions to improve patient understanding of health information. Using universal precautions and specific tools, such as teach-back, has been shown to decrease morbidity and improve patient outcomes.

PURPOSE: The purpose of this quality improvement project is to assess provider knowledge of health literacy in a primary care setting. A secondary purpose is to assess the use of patient education material for patients with diabetes, hypertension, and hyperlipidemia that meet universal precautions.

METHODS: This study was …

Evaluation Outcomes Of A Modified Early Warning System For Early Identification Of Sepsis In The Adult Population Requiring Acute Care, Gavin M. Turpin

DNP Projects

Objectives: To examine the use of a Modified Early Warning System (MEWS) for sepsis identification and evaluate its effects on treatment and outcomes for those patients diagnosed with sepsis after admission, during their stay at an acute care facility.

Design: A retrospective chart audit was conducted on the electronic medical records (EMRs) of patients who developed, and were diagnosed with, sepsis post admission. Specifically, a retrospective separate sample pretest posttest design was used to examine the accuracy of the MEWS, differences in outcomes (ICU days, length of hospital stay, qSOFA Score and mortality rates), and treatment initiation time (fluid resuscitation, …

Assessment Of The Need For Provider Education On Screening For Depression In Patients With Select Dermatologic Problems, Sarah B. Zerhusen

DNP Projects

PURPOSE: The purpose of this project is to evaluate the knowledge, attitudes, perceptions, skills, and self-efficacy of dermatology providers’ assessment of depression in patients with chronic skin disease to determine the need for continuing education programs.

METHODS: This is a single practice, multi site, quantitative correlational design study to assess provider use, comfort, and proficiency of screening and discussion of depression in patients suffering from plaque psoriasis and atopic dermatitis. Data was collected through the use of a questionnaire dispensed in January of 2018. The sample consisted of 23 dermatology providers in a dermatology practice with clinics in Louisville, Lebanon, …

The Evaluation Of A Multi-Hospital System Nurse Residency Program On New Graduate Nurse Retention And Engagement, Julie N. Wolford

DNP Projects

PURPOSE: The purpose of this evaluation project was to determine the effectiveness of the Norton Healthcare new graduate nurse residency program on retention and engagement of newly- licensed registered nurses.

METHODS: This study was a retrospective pre-test, post-test design of the impact of the nurse residency program on turnover and engagement for the participants in the first year of the Norton Healthcare Nurse Residency Program. Engagement was evaluated using the Utrecht Work & Well-being Survey (UWES). Return on investment was also evaluated for the first year of the program. The sample included 791 newly-licensed registered nurses hired between January 2014 …

Pediatric Delirium: Development Of A Standard Of Practice In A Cvicu And Picu Setting, Frances Gililand

DNP Projects

Pediatric delirium remains a significant cause of morbidity in pediatric critical care resulting in longer lengths of stay and increased healthcare costs that may extend beyond critical illness. Prevalence rates of pediatric delirium in pediatric intensive care settings are 20%. Not all children’s hospitals regularly assess for pediatric delirium. At the time of this project, the assessment of pediatric delirium was not a standard of practice at John Hopkins All Children’s Hospital (JHACH). Examining provider’s experience, knowledge and self-efficacy of pediatric delirium was the primary aim of this project. The secondary aim was to use information obtained through the first …

An Evaluation Of Provider Adherence To Acute Bronchitis Quality Measures In Adults, Rachel L. Lazar

DNP Projects

Background: Acute bronchitis management continues to be mistreated. Evidence based practice guidelines do not support antibiotic therapy for the treatment of acute bronchitis. Providers are encouraged to prescribe antitussives, suppressants and inhaler medications for the treatment of acute bronchitis symptoms, including cough.

Objective: The overall objective of this project is to evaluate the management of adults diagnosed with acute bronchitis in a limited services clinic.

Methods: A retrospective chart review was conducted on patients in a limited services clinic. The chart review assessed patients aged 18-64 with a diagnosis of acute bronchitis from July 1, 2016- June 30, 2017.

Results: …

Implementation Of The Stop Bang Screening Instrument For Obstructive Sleep Apnea Within The Intensive Care Unit And 5 East Cardiac Unit, Michael T. Lush

DNP Projects

BACKGROUND: Recent studies have found that OSA without the use of CPAP is an independent risk factor for cardiovascular disease and hypertension, which can lead to myocardial infarction (MI) and cerebral vascular accident (CVA) or stroke. This increases patient morbidity and mortality rates as well as medical costs. In those suffering from a myocardial infarction (MI) or cardiovascular accident (CVA), an important intervention is proper screening for the presence of OSA while in the acute care setting. The STOP BANG screening instrument is a simple yet effective tool in assessing for sleep apnea symptoms with a respective sensitivity of 93% …

Improving Fall Risk Assessment And Documentation: A Qi Project, Ashley N. Kohari

DNP Projects

BACKGROUND: Unintentional falls commonly arise and can cause significant harm including fractures, head injuries, and death. Assessing each patient for falls and performing a fall risk assessment is recommended by the American Geriatrics Society and the Center for Disease Control and Prevention, and is mandated for institutional reimbursement. Fall risk assessment has been shown to decrease the rate of falls and healthcare costs.

PURPOSE: The purpose of this quality improvement project was to improve compliance for fall risk screening and documentation to meet MACRA requirements in a family medicine clinic.

OBJECTIVES: The objectives for this project were: 1. Conduct PDSA …

Assessment Of Alcohol Withdrawal Syndrome Incidence And Identification Of Other Correlating Risk Factors In Patients Admitted Through The Emergency Department, Hannah Young

DNP Projects

PURPOSE: The purpose of this project was to measure adherence rates to the current alcohol use screening process, and identification of correlations of alcohol use and outcomes in patients admitted to Norton Hospital, via the emergency department.

METHODS: The study design is a retrospective descriptive evaluation, of adherence to the current alcohol use screening process, and associations among age, gender, ethnicity, length of stay, number of ICU days, restraint use days, level of care at admission (ICU, TCU, LLM/tele, MS), incidence of AWS/DTs, and activation of the CIWA protocol among the adult inpatient population of Norton Hospital’s downtown campus, admitted …

Intensive Care Admissions: Predicting Palliative Care Needs In The First 24 Hours, Ashton R. Miller

DNP Projects

PURPOSE: The purpose of this retrospective analysis was to determine the proportion of intensive care admissions that required palliative care services during the same admission assessed by an investigator-developed palliative care screening tool. This study also analyzed the screening tool for the number of criteria producing the highest sensitivity and specificity for a palliative care consult occurring during the same hospital stay.

METHODS: Retrospective data collection and analysis were performed by randomly selecting 110 patients records from a report obtained through the electronic health record, Epic. The sample was drawn from patients admitted to a medicine intensive care unit (2A) …

Scheduling Practices Of Acute Care Rn’S And Nurse Fatigue: Assessment And Development Of An Educational Program For Nurse Managers, Miranda Adkins

DNP Projects

PURPOSE: The purpose of this project is to develop an evidence-based organizational fatigue climate assessment to understand the current culture as it relates to nurse fatigue. This study includes the use of a fatigue measurement scale and the development of a fatigue reduction educational program for nurse managers.

METHODS: Using a cross-sectional survey design, data assessing organizational climate and actual fatigue levels among nurses employed at Saint Joseph East Hospital was obtained through an electronic questionnaire. Results were used to create a workplace fatigue educational program for nurse managers. The target sample consisted of 361 acute-care registered nurses for a …

Evaluation Of A Staff Resilience Program In A Pediatric Intensive Care Unit, Stacy Flanders

DNP Projects

Background: Compassion fatigue (CF) and secondary traumatic stress (STS) is prevalent in intensive care nurses, especially in pediatric intensive care nurses (PICU). CF/STS leads to burnout, reduced employee engagement, and nursing turnover.

Purpose: The purpose of this project was to evaluate the impact of a staff resilience program on nursing turnover, employee engagement and improved compassion satisfaction/ resilience among nurses in a PICU.

Methods: A retrospective pre-test and post-test design was used to evaluate the impact on turnover and engagement after implementation of the staff resilience program. Comparison of RN turnover and engagement results pre-implementation were compared to RN turnover …

Evaluating The Relationship Between Tobacco Use And Pain Perception Using The Global Pain Scale (Gps) In Opioid Dependent Adults: A Retrospective Analysis, Kristina Robinson

DNP Projects

Background: Chronic pain, smoking, and opioid use, contribute to a significant economic burden in the United States. Chronic pain affects all aspects of life, and is influenced by the use of cigarettes and opioids alike. Researchers suggest that there is a higher use of cigarettes and opioids in individuals with chronic pain. Chronic pain can promote smoking and smokers are more likely to use opioids. With the evidence that patients who smoke a higher number of cigarettes per day report higher pain, it is possible that smoking may be a stress-reducing behavioral response related to pain. Moreover, higher frequency and …

Impact Of Education On Provider Knowledge And Screening Practices Related To Childhood Obesity, Natalie B. Fulk

DNP Projects

PURPOSE: The purpose of this study was to evaluate the effect of a provider education program on BMI screening practices and provider knowledge related to childhood obesity by implementing an educational intervention to advanced practice providers in a primary care clinic setting.

METHODS: A pretest/posttest design was used to examine changes in provider knowledge about BMI screening practices in children and adolescents, and lifestyle recommendations after a brief educational intervention was provided. A retrospective chart review was used to assess the screening and management practices for an elevated BMI percentile and provider documentation of lifestyle recommendations.

RESULTS: A total of …

Increasing Influenza Vaccination Rates In A Primary Care Clinic: A Quality Improvement Study, Cassandra R. Roshel

DNP Projects

Background

According to the most recent CDC statistics, the influenza virus kills between 12,000 and 56,000 people per year in the United States. Although influenza vaccination is recommended each year, only about half of all Americans are actually receiving the vaccine annually. The goal of this quality improvement project was to increase influenza vaccination rates at a large academic medical center in Kentucky. At baseline, there was no standardized screening protocol in place prior to this study.

Methods

This study implemented a pre-test post-test design to evaluate the impact of a process change intervention on vaccination status from September 1, …

An Evaluation Of The Effects Of A Diabetes Self-Management Education Program On The Hba1c In Patients With Type 2 Diabetes, Katherine Schoo

DNP Projects

Introduction

Diabetes has become an epidemic in the United States. More than 30.3 29 million Americans are living with the disease, while an additional 84.1 million Americans are living with prediabetes (Centers for Disease Control and Prevention [CDC], 2018). Standards set forth by the American Diabetes Association (ADA) describe comprehensive and individualized self-management education and treatment as part of their guidelines for the management of diabetes (ADA, 2018). The “Active Steps for Diabetes” program is an example of a diabetes self-management education (DSME) program that supports national recommendations made by the ADA.

Methods

This study was a retrospective descriptive pre- …

The Effect Of An American Heart Association Telephone Follow-Up Intervention On Knowledge And Self-Efficacy In Rural Heart Failure Patients, Haley Fuller

DNP Projects

Background: An increased national and local prevalence of heart failure fostered a review of the evidence to identify best practice interventions focusing on improving self-care and knowledge. Heart failure remains a leading cause of 30-day readmission in the United States and in Madisonville, Kentucky, the site of study. A review of the literature emphasized improving transitions from hospital to home with a multi-dimensional approach. Self-care and knowledge were identified as major determinants to adequately prepare a patient to manage this chronic disease. A pre- and post quasi experimental study was performed at a rural hospital in Kentucky. Objective: The goal …

Using Rapid Cycle Improvement To Improve Weight Management In Family Medicine, Kelly Mccormick

DNP Projects

PURPOSE: The purpose of this quality improvement project was to improve rates of nutrition screening and weight management in a Family and Community Medicine Clinic.

METHODS: This study was among several quality improvement projects being conducted at a Family and Community Medicine Clinic aimed at improving patient outcomes and quality measures for reimbursement beginning in 2019. Rapid cycle quality improvement was used to identify problems, implement changes, and evaluate workflow at the clinic in order to improve rates of compliance in BMI screening and documentation of weight management plans. Three PDSA cycles were completed. Activities included observation, staff education, visual …