Medicine and Health Sciences Commons^™

The Association Of Lower Medication Adherence And Increased Medical Spending, Ryan A. Fuchs

Capstone

Medical prescribing is a common occurrence in daily clinical practice. According to the Centers for Disease Control and Prevention, in 2015-2016 45.8% of the U.S. population used prescription drugs in the past 30 days. (CDC, 2019) Although drug therapy can be effective in treating disease, full benefits are often not realized because many patients do not take their medications as prescribed. There is quite a bit of research out there about non-adherence to medication. Some studies focus on the financial impacts of non-adherence, but most of the studies examine the reasons for medication non-adherence. A gap exists in ...

Evaluating Medical Student Confidence And Competency Related To Dermatologic Morphology And The Effect Of An Educational Module And Summary Document, Grant Starkey

MD Honors Theses

Abstract

Background: Non-dermatologist physicians perform ~60% of visits related to the primary diagnosis of a dermatological condition, yet dermatology education and training are extremely limited within medical school making up 0.23-0.3% of the curricula. This data points to the possible need for further educational resources for medical students regarding dermatology. In 2007, the American Academy of Dermatology (AAD) created a curriculum for medical students to use while on a dermatology clerkship to supplement their medical school curriculum. The goal of this study is to evaluate current University of Nebraska Medical Center (UNMC) medical student’s confidence and ability ...

Interrogating Race And Place-Based Inequities In Hiv And Covid-19, Rohan Khazanchi

MD Honors Theses

Over the last four years, I have developed a research focus examining the intersections of race, place, and health. My M.D. Honors Thesis reflects a snapshot of these efforts. In this collection of brief research reports, I leverage area-based measures to investigate structural inequities in three contexts: the HIV epidemic in our hyperlocal community, the early stages of the COVID-19 pandemic, and clinical trials for novel COVID-19 therapeutics. I apply novel social epidemiologic tools to measure and explore disparate outcomes. And, in reflecting upon my findings, I discuss concrete implications for clinicians, researchers, and policymakers alike.

Chapter 1: Neighborhood-Level ...

Evaluation Of Nurse Delirium Screening And Intervention For Hospitalized Older Adult Hip Fracture Patients, Mary Onyarin

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Delirium is associated with longer hospital stays, increased mortality, high medical costs, and poorer functional outcomes (Oh et al., 2014; Robinson & Eiseman, 2008). This project evaluated the use of the Confusion Assessment Method (CAM) tool to screen hospitalized older adult hip fracture patients for delirium. This project also measured the effectiveness of the implementation of the Hospital Elder Life Program (HELP) volunteers as a non-pharmacological intervention to alleviate delirium. This project was implemented on the Orthopedic/Neurological unit of a Midwest tertiary care hospital.

Methods: The study had a retrospective, descriptive design. The investigators evaluated the use of the ...

Compassion Fatigue In Nebraska Medicine Icu Nurses, Jena M. Mcfadden, Jessica M. Harms

Doctor of Nursing Practice Projects: College of Nursing

Abstract

Objective: As caregivers in high-pressure and demanding environments, critical care/intensive care unit (ICU) nurses are at risk for compassion fatigue. The purpose of this study is to explore compassion fatigue and compassion satisfaction levels within ICU specialty nursing at Nebraska Medicine during COVID.

Aims: Four aims were considered throughout the course of the study: 1. How do overall compassion fatigue (CF) and satisfaction (CS) at Nebraska Medicine’s ICU’s compare with national norms? 2. How do (CF) and (CS) levels (mild, moderate, severe) differ between the Intensive Care Units?3. Do years of experience correlate with compassion ...

Identifying Moral Distress In Emergency Nurses, Sarah Taylor

Doctor of Nursing Practice Projects: College of Nursing

Abstract Moral Distress (MD) is an ongoing reality for emergency department (ED) nurses and often emerges when caring for patients at the end of life. Repeated exposure to MD can result in resignation from the nursing profession. This study measured moral distress using the Measure of Moral Distress for Healthcare Professionals (MMD-HP) survey tool. The goal was to identify stressors known to cause moral distress, measure the frequency of their occurrence during the COVID-19 pandemic, and analyze the correlation to influence ED nurses to leave the position. The MMD-HP ranks the frequency of occurrence of stressful situations leading to moral ...

Evaluation Of The University Of Nebraska Medical Center’S 4ms Geriatric Training Program At Nebraska Medicine Midtown, Holly M. Sesker

Capstone

In 2015, the Health Resources and Services Administration (HRSA) created the Geriatrics Workforce Enhancement Program (GWEP) to address geriatric workforce challenges and improve the health outcomes of older adults. The GWEP redefines care delivery through a movement for age-friendly healthcare guided by evidence-based practices that align with the 4Ms: What Matters, Medication, Mentation, and Mobility. The 4Ms identify the key issues that should drive the decision-making and care for every older adult. 4Ms training sessions were conducted at the Nebraska Medicine Midtown Clinic and evaluated through a cross-sectional survey administered to both residents (trainees) and attendings (trainers). Data was collected ...

The Impact Of Simulation-Based Mastery Learning For Central Venous Catheter Dressing Changes With Staff Nurses At A Nebraska Critical Access Hospital, Paige Pavlik, Michaela Haddock

Doctor of Nursing Practice Projects: College of Nursing

Abstract

Purpose

The purpose of this pilot feasibility study was to assess if a simulation-based mastery learning (SBML) intervention on central venous catheter (CVC) dressing changes by staff nurses at Nemaha County Hospital could further develop staff nurses’ central line care skills by increasing their knowledge of a central line dressing change, improving their comfort level and learning self-efficacy with central line care, determining if there is a relationship between knowledge, learning self-efficacy and comfort in the clinical area, and assessing nurses’ satisfaction on the SBML intervention. The clinical research questions being explored are, “Will nurses in a Nebraska critical ...

Reflective Journaling Intervention To Impact Self-Awareness, Professional Health, And Overall Well-Being In Nurses, Brittany M. Langan, Katherine Keppen

Doctor of Nursing Practice Projects: College of Nursing

Background. Burnout among nurses has been on the rise and was exacerbated with the pandemic. Reflective journaling after work may be a strategy to decrease feelings of burnout. Reflective journaling, as an intervention, has been shown to improve self-awareness, compassion fatigue, and burnout among nurses. The purpose of this study was to pilot a 4-week reflective journaling intervention in hospital-based nurses and describe participant professional quality of life, self-awareness, and overall well-being.

Theoretical Framework. The Theory of Reasoned Action (TRA) was chosen as the theoretical framework because it identifies the belief that performing a particular behavior will lead to a ...

Testicular Torsion Education: Improving Awareness Among Boys And Their Caregivers Regarding The Urgency Of Evaluating Scrotal Pain, Abby Taylor

Capstone Experience

Introduction: Testicular torsion is a urologic emergency that requires prompt medical evaluation and surgical intervention. The length of time from onset of the torsion to evaluation in the emergency department is often delayed due to lack of knowledge of the urgency of the situation amongst boys and their caregivers. We hypothesize that an animated educational video will increase awareness of the condition and prompt urgent evaluation in the emergency department.

Methods: A 5-minute animated educational video was created following a boy, Danny, as he develops testicular torsion. Four population groups: boys, parents, school nurses, and pediatricians, completed group-specific pre- and ...

Randomizer Utilizing R Shiny, Cali R. Savage

Capstone Experience

Currently, many published animal experiments fail to include concise information regarding randomization (Festing, 2014). By not including randomization efforts in published research, the ability for one to accurately reproduce a study’s results is greatly diminished. This can be seen in randomization efforts that may be difficult to reproduce, such as poor randomization techniques and lack of documentation. Therefore, the creation of the Randomizer utilizing software R to create a user-friendly program that can enable University of Nebraska Medical Center (UNMC) researchers, among others, to create randomization schemes for research involving mice, other animal, or human subjects, and enhance documentation ...

Atrazine Levels In Rural Nebraska Counties And Parkinson's Disease, Muhammad Zahid

Capstone Experience

Parkinson's disease (PD) is a multifactorial disorder, connecting both genetic susceptibility and environmental risk factors. Several epidemiological and experimental studies support the evidence that pesticides exposure is positively associated with enhancing neurodegenerative diseases. The high amount of atrazine used in Nebraska and increased PD cases led us to evaluate the association between the long-lived water-soluble pesticide atrazine and PD in Nebraska counties. A person's exposure to atrazine may come from inhalation, dermal absorption, and ingestion. Three types of atrazine data covering 1992 to 2017 were used for this study: applied atrazine, atrazine in surface water, and atrazine in ...

The Use Of A Mobile Application And Text Messaging Platform To Improve Adherence To Medications In Solid Organ Transplant Patients, Lindsay M. Bruce

Capstone Experience

Poor adherence to medication regimens is responsible for 30-70% of all medication-related hospital admission in the United States and can be calculated to cost approximately $100 billion per year (Burra et al., 2011). The purpose of this pre-post cohort analysis is to measure the impact of using a mobile phone application and text messaging service on the medication possession ratio (MPR), a measure of adherence, among solid organ transplant patients who fill at Nebraska Medicine Outpatient Pharmacy. These interventions make it more convenient for patients to request refills, for pharmacy staff to send push notifications, and automatic refill and/or ...

The Effect Of Post-Traumatic Stress Disorder On First Responders Following A Disaster: A Literature Review, Briar Butner

Capstone Experience

First responders work in a high-stress environment that can potentially produce traumatic situations. This includes aiding in the recovery and response efforts of critical events such as a disaster. A significant risk factor for developing post-traumatic stress disorder symptoms is people who have been through a disaster (National Institute of Mental Health, 2019). This literature review aims to search for evidence on PTSD in first responders following a disaster, identify the factors associated with the development of PTSD, and make recommendations on best practices to reduce or mitigate the incidences of PTSD. The search was conducted in three academic databases ...

Evaluating First Responder Personal Preparedness In Douglas County, Nebraska's Volunteer Fire And Emergency Medicine Service, Kylie Johnson

Capstone Experience

In disaster response, it is essential for first responders to focus on their disaster role. Lack of personal preparedness at home could hinder a responder’s ability to focus their attention on their response role (13). Personal conflict, such as that caused between family duties and response duties, in a disaster can be mitigated through several means. One mitigation tactic is preparedness education and support offered by the responder’s organization. While the importance of responder personal preparedness cannot be understated, there is a lack of baseline data on the topic related to Nebraska responders.

To assess the state of ...

Utilizing Re-Aim To Assess Adolescent Weight Loss Interventions: A Systematic Review, Jordan Mccullough

Capstone Experience

Adolescent overweight/obesity is an ongoing concern for public health professionals. One out of every five adolescents are overweight, and one out of every three is at risk. Adolescent overweight/obesity is associated with a higher chance of overweight/obesity, premature death, and disability in adulthood. A 2018 systematic review by Moores et al. compared the effectiveness of community-based treatment programs for adolescents (13-17 years) who are overweight and obese by comparing pre-program to post-program changes in weight-related measurements and health-behavior changes. While looking at the effectiveness of a program provides valuable information, other elements (i.e., representativeness of participants ...

Evaluation Of The University Of Nebraska Medical Center’S 4ms Geriatric Training Program At Nebraska Medicine Midtown, Holly M. Sesker

Capstone Experience

In 2015, the Health Resources and Services Administration (HRSA) created the Geriatrics Workforce Enhancement Program (GWEP) to address geriatric workforce challenges and improve the health outcomes of older adults. The GWEP redefines care delivery through a movement for age-friendly healthcare guided by evidence-based practices that align with the 4Ms: What Matters, Medication, Mentation, and Mobility. The 4Ms identify the key issues that should drive the decision-making and care for every older adult. 4Ms training sessions were conducted at the Nebraska Medicine Midtown Clinic and evaluated through a cross-sectional survey administered to both residents (trainees) and attendings (trainers). Data was collected ...

Misinformation And Vaccine Hesitancy Determinants: The Significance Of Framed Public Health Messaging, Alexandra I. Todd

Capstone Experience

In 2020, the SARS-CoV-2 (COVID19) outbreak effectively disrupted worldwide operation for months, leading to tremendous economic loss and adverse health outcomes. While countries grappled to control the virus and scientists worked around the clock to deliver a vaccine in record time, a pubic health communication crisis emerged. The spread of false and misleading information, also known as misinformation, has proved to be a barrier in the fight against COVID19 and its vaccination effort. Many factors including the rise of social media, distrust of government, polarization of news sources, and fragmented media have created an environment susceptible to misinformation. Utilized correctly ...

A Comprehensive Literature Review Of Recruitment And Retention Strategies For Primary Care Providers In Rural Communities, Christian Folken

Capstone Experience

Workforce trends within the United States indicate a growing crisis in the availability and distribution of primary care providers. Rural communities have been disproportionately affected by the lack of primary care providers. The gap in available primary care services in rural areas severely affects the population health outcomes of these communities. There is a critical need for rural healthcare systems to effectively understand and implement recruitment and retention strategies of primary care providers to meet the needs of their patients and community. The goal of this paper is to provide a centralized resource of evidence-based strategies regarding the recruitment and ...

Respiratory Syncytial Virus (Rsv) Laboratory Surveillance And Mortality In Nebraska, 2016 – 2021, Derek Bumgardner

Capstone Experience

Respiratory syncytial virus (RSV) is a common respiratory virus affecting children and adults. The United States RSV peak season occurs regularly between October to May, but in April 2021, an unexpected United States interseason RSV epidemic ensued. RSV laboratory testing has changed in the United States due to increased use of nucleic acid amplification testing (NAAT) rather than antigen-based testing, affecting how RSV seasonal epidemics are determined. Nebraska linked RSV laboratory and death certificate data (2016-2021) were used to calculate crude, specific and adjusted RSV case and mortality rates by age, sex, race, and ethnicity. A Cochran – Armitage test for ...

A Systematic Literature Review Of The Use Of Technology As An Emergency Preparedness Tool To Control And Contain The Covid-19 Pandemic, Alyssa Spartz

Capstone Experience

Various tools and strategies have been utilized in response to the COVID-19 pandemic. In addition to preexisting measures, novel mechanisms and methods have also been developed since the COVID-19 pandemic began to address several different needs worldwide. Technology, for example, has served as a unique and multifunctional tool to aid with controlling and containing the pandemic. While studies and reviews have been conducted to analyze specific types of technology, such as digital applications, a gap in the literature currently exists that fails to comprehensively understand and compare how multiple types of technology were implemented to address the COVID-19 pandemic. This ...

Helping Our Heroes: An Evaluation Of Mental Health And Organizational Policies Surrounding Suicide Prevention And Postvention Strategies For Nebraska First Responders, Maria S. Mickles

Capstone Experience

Suicide is ranked as one of the leading causes of death in the United States. Over 40,000 individuals die by suicide each year (Stanley, Hom, & Joiner, 2016; Vigil et al, 2021), and, in 2020, it was ranked in the top 9 causes of death for all ages (10-64), and second for those 10-14 and 25-34 years of age (Centers for Disease Control and Prevention, 2022). These statistics disproportionately reflect first responders (i.e., firefighters, dispatchers, law enforcement, EMS, paramedics, etc.), as they die by suicide more than the general public (National EMS Management Association, 2016). Within their line of work of ...

Assessing Nutritional Health Knowledge In Sharing Clinic Patients With Diabetes, Minden Huntrods

Capstone Experience

Effective diabetes prevention and management relies on nutritional behaviors, thus a basic level of health knowledge is important for patients with diabetes and their caregivers in their quest to acquire acute glycemic control and minimize negative health outcomes (Ley et al., 2014). The purpose of this study was to assess the nutrition-related health knowledge of patients living with diabetes who are seen at the UNMC Sharing Clinic by use of a verbal questionnaire. This nutritional health knowledge assessment was a quantitative, prospective, survey-based study utilizing descriptive statistics. Approximately 86% of patients were proficient in food group and nutritious foods knowledge ...

Assessing Meat Processing Workers’ Attitudes And Concerns Regarding Covid-19 Vaccination, Karen Schmeits

Capstone Experience

The COVID-19 pandemic has impacted industries across the globe. Specifically, for meat processing (meatpacking) facilities, the pandemic has changed the way facilities operate, how the workers perform tasks, and how workers perceive their health. The development of an FDA approved COVID-19 vaccine brought hope to meat processing employers and workers. However, little research has been conducted to know how meat processing workers feel about vaccines generally and how they perceive the COVID-19 vaccine. The purpose of this cross-sectional study was to investigate preventive vaccine determinants and attitudes and concerns specifically regarding the COVID-19 vaccine. Surveys were conducted with 128 meat ...

Local Public Health Legal Landscape Report, Christina Hitz

Capstone Experience

This report provides a framework for understanding and examining local public health authority and implications of proposed legislative changes, specifically whether a shift is occurring in public health authority from the executive to the legislative branch. It compares the public health governance and legal infrastructure of states making a shift in 2021 relative to Nebraska’s current and proposed public health infrastructure and provides a synopsis of the legal context for and the scope of local public health authority currently in Nebraska. Three resources were used to create two tables to compare both states with legislative changes in 2021 indicating ...

Developing A Curriculum To Combat Loneliness As A Public Health Concern In Businesses, Sophia Yelkin

Capstone Experience

Loneliness has been considered a public health epidemic affecting people across the world. Elderly populations have historically been considered most at risk for loneliness, but it is becoming evident that loneliness is not so selective. Younger generations show more signs and symptoms of loneliness than older generations. This often overlooked condition is attributable to decreased mental and physical health and can weaken performance in the workplace.

This capstone project creates a concise curriculum addressing loneliness for dissemination in the workplace, ensuring appropriate health literacy for the priority population. Understanding the pervasive nature of loneliness, identifying symptoms, and methods to counteract ...

Housing To Health: A Literature Review Analyzing Housing Pathways And Policy Initiatives, Evan P. Lesser

Capstone Experience

Housing is a vital aspect of an individual’s ability to enjoy a healthy lifestyle. It is so integral that the United Nations has stated that housing is a human right and extends beyond just basic shelter where housing should provide a certain level of structural integrity of the infrastructure, security, affordability, and access to surrounding resources. Existing research studying the relationship between housing and health outcomes suggest those with poor housing exhibit higher levels of chronic conditions such as asthma, heart disease, and diabetes, and higher chances of accidents within the home. The goal of this literature review, which ...

A Survey And Analysis Of Educational Materials Addressing The Health Consequences Of Drinking Nitrate Contaminated Water In Medical Clinics Located In The Most At-Risk Areas Of Nebraska: Are Healthcare Providers Equipped To Protect And Educate Their Patients?, Laura Nagengast

Capstone Experience

Background: Eighty five percent of Nebraskans rely heavily on groundwater sources, including private wells, as their primary source of drinking water. Nitrate is one of the most common chemicals found in private well water. Numerous studies demonstrated the serious human health consequences from prolonged nitrate exposure. Therefore, due to the potential health risks, this project aimed to identify and evaluate the existing knowledge and awareness among healthcare providers as well as the educational materials in medical clinics in Nebraska related to health effects of drinking nitrate contaminated water.

Methods: An 8 multiple choice question survey was developed using Microsoft Forms ...

Financial Analysis Of New Medicare And Medicaid Guidelines, Reimbursement Rates, And Increased Enrollment On Four Nebraska Clinics, Jamilah J. Abdul-Hakim

Capstone Experience

Government health insurance plans such as Medicaid and Medicare were created with the intention of providing elderly, low-income, or disabled citizens with affordable and quality health insurance through government-contracted providers (Baicker et al., 2013). Medicare is a government health insurance program that provides healthcare to United States citizens 65 years and older, regardless of their income or past medical history. Medicaid was implemented as an assistance program to provide health insurance for low-income Americans and their families. Medicaid is administered by each state independently, which creates variation in reimbursement rates, services, and structure. (Grabowski, 2007).

Providers accepting Medicare and Medicaid ...

Weight Gain Trajectory Over Five Years For Adult Primary Care Patients In Nebraska, Elizabeth M. Morris

Capstone Experience

INTRODUCTION: The continued rise in the prevalence of adult obesity in the United States is a public health concern. Several studies have identified the increasing rates of obesity, its impacts, and the factors leading to obesity. Some researchers have made obesity prevalence projections at the national and state levels. This study aims to fill the critical gap in real-time weight data trends among primary care adult patients in Nebraska. The main goal of this study is to determine and analyze the weight trajectory of adults in Nebraska over the past five years and determine if the trends vary among age ...