Medicine and Health Sciences Commons^™

An Enhanced Enrollment Process To Impact Appointment Compliance In The Hf-Optimize Clinic, Carolyn Coons, Teri Diederich, Kyana Holder

Doctor of Nursing Practice Projects: College of Nursing

Background The HF-Optimize clinic showed improved utilization of guideline-directed medical therapy (GDMT) along with improved clinical outcomes from 2018 to 2020. Appointment compliance was poor with only 44% of patients completing all HF-Optimize visits. Missed appointments led to worse health outcomes, fragmented care, and provider inefficiencies. Interventions to improve appointment compliance are vital to improving heart failure outcomes. Objective The purpose of this quality improvement project is to evaluate the impact that an enhanced enrollment process has on appointment compliance in a culturally diverse, adult population referred to the HF-Optimize clinic at Nebraska Medicine. Methods This prospective quality improvement project …

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 research about …

Assessing The Methodology, Prevalence, And Associated Factors For Adverse Childhood Experiences (Aces) Among Children And Adolescents In The United States, Kiara L. Lyons

Theses & Dissertations

To comprehensively capture the risk and protective factors of ACE exposure and ACE-related outcomes, we propose to consider a social-ecological model framework. The concept of the Social-Ecological Model was originally introduced in the 1970s by psychologist Urie Bronfenbrenner and designed to theoretically capture the multifaceted influence different personal, social, and environmental factors have on health behaviors and outcomes. Additionally, this would help to determine what prevention and intervention methods would be more appropriate to implement. This conceptual framework had five system levels: microsystem (individual), mesosystem (interpersonal), exosystem (community context), macrosystem (societal and cultural influences), and chronosystem (internal and external elements …

Transcranial Direct Current Stimulation Of Frontal/Occipital Cortices Modulates Neural Correlates Of Cognition In Healthy Young Adults, Yasra Arif

Theses & Dissertations

An exponential rise in the use of transcranial direct current stimulation (tDCS) to modify the human brain and behavior has been observed over the last 20 years, with studies often yielding mixed outcomes. Such heterogeneity is partially attributed to the lack of a concise understanding of the underlying mechanisms. Though considered to exert modulatory effects by changing neuronal membrane polarization and synaptic efficacy, the interactive effects of offline tDCS and the neural underpinnings of cognition, both at the regional and network-level, are yet to be fully understood. Using High-Definition tDCS (HD-tDCS), Magnetoencephalography (MEG), a range of well-established cognitive paradigms, and …

The Usability And Feasibility Of A Nursing Evidence-Based Comorbidity Educational Website For An Urban Mental Health Assertive Community Treatment (Act) Program, Andrea Brudigan, Laurie Sewell-Muller, Kokuvi Sena Tsogbevi

Doctor of Nursing Practice Projects: College of Nursing

Objective: Serious mental illness (SMI) causes an increased risk for comorbidities like heart disease, obesity, metabolic syndrome, and diabetes. Many times, these comorbidities are due to side effects of antipsychotics and poor self-management from low insight and other symptoms of mental illness. This project aims to enhance client care enrolled in an Assertive Community Treatment (ACT) program by providing evidence-based resources tailored to clients with SMI, providing ACT team members with support to promote healthy behaviors in clients.

Methods: A website was developed that provides printable, easy-to-read, evidence-based resources that address physical comorbidities. The ACT team integrated these resources into …

Frailty Determination And Responsiveness In Left Ventricular Assist Devices, Sarah Schroeder

Theses & Dissertations

Frailty, the state of being vulnerable with susceptibility to decreased age-related physical reserve, is found in 56-79% of adults with end-stage HF receiving durable left ventricular assist device (dLVAD) therapy. Frailty increases risk of adverse events, including increased mortality in the dLVAD population, but less is known about depression, quality of life (QOL), cognition and frailty responsiveness. Therefore, we aimed to describe and compare frailty (5-Meter Walk Test, 5MWT), depression (Patient Health Questionnaire-9, PHQ-9), quality of life (EQ5D Visual Analog Scale, EQ-5D VAS) and cognition (Trailmaking B) from pre- to 12-months post-dLVAD We also compared demographics, clinical characteristics, and post-dLVAD …

A Cell Culture Model To Study Tobacco Associated Oral Cancer Progression And Treatment Resistance, Amanda Busch

Theses & Dissertations

Head and Neck Squamous cell carcinoma is the 6^th most common cancer in the world. Risk factors for HNSCC include alcohol and tobacco consumption, infection with Human Papilloma Virus, and exposure to environmental toxins. Unlike many other cancers, the incidence of HNSCC is growing, yet the treatment options and outcomes have not been significantly improved for decades. An increased understanding of the molecular mechanisms of these cancers is needed for improvement in early diagnosis, enhanced treatment effectiveness, and cancer prevention. 4-nitroquinoline 1-oxide (4NQO) is a well-tested, tobacco mimicking, carcinogen. 4NQO produces similar histological and chemical changes found in human …

Exploring The Influence Of Contextual Factors And The Caregiving Process On Burden, Quality Of Life, And Outcomes Of Heart Failure (Hf) Dyads After A Hospital Discharge Guided By The Individual And Family Self-Management Theory (Ifsmt): A Mixed Method Study, Tamara Bernard

Theses & Dissertations

ABSTRACT The purpose of this study is to explore the influence of contextual factors and caregiving process characteristics on proximal outcomes of the patient and caregiver after discharge from the hospital. The long-term goal of this research is to reduce caregiver burden and improve patient outcomes. Heart failure (HF) is an increasingly common chronic illness with unique caregiving needs and a high rate of hospital readmissions. Caregiver burden has been researched extensively in other areas of medicine such as oncology and dementia and has been reported for stable chronic HF patients in an outpatient setting. However, there is little research …

Grip Characterization Of Protective Gloves, Doris Burns

Theses & Dissertations

In 2014, ASTM International (ASTM), one of the world's largest international standards developing organizations, published a new test method on glove grip performance. This method was adopted by the National Fire Protection Association (NFPA) in some of their specification standards. The method utilized hand torque instead of the pull method previously used by the NFPA to determine the Percent Bare Hand Control Value (%BHCV). The %BHCV, compares torque results of a gloved hand versus a bare hand. In developing this new test method, only four males and one female participated; therefore, it is unclear if statistical significance was attained. In …

Polymeric Chloroquine In Metastatic Pancreatic Cancer Therapy, Rubayat Islam Khan

Theses & Dissertations

Hydroxychloroquine (HCQ) is an established drug that has been used for the treatment of multiple diseases, including malaria, rheumatoid arthritis, and lupus erythematosus. Several recently published studies have highlighted its beneficial use in various types of cancers, and a plethora of clinical trials are currently evaluating its use in cancer therapies, wherein some of the results look promising. The preclinical studies to date suggest HCQ can work effectively in conjunction with traditional cancer treatments, as it has been shown to sensitize tumor cells to a wide range of chemotherapeutic agents. Polymeric HCQ (PCQ), a macromolecular multivalent version of HCQ, has …

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

Capstone Experience

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 research about …

Process Evaluation Of A Community Asset Mapping Protocol For Diabetes Prevention And Management, Andrea Peterson

Capstone Experience

Prediabetes and type 2 diabetes mellitus (DM) are highly prevalent conditions with new diagnoses occurring each year (Centers for Disease Control and Prevention, 2022a). Type 2 DM negatively impacts many aspects of life, to include social, financial, cultural, and everyday living. Asset mapping is a useful tool to build upon existing resources to help community members identify and expand services based on understanding the interconnected systems that influence type 2 DM prevention, screening, education, and care management. An Asset Mapping Protocol was created and piloted through a rural community coalition in Nebraska. The protocol includes an activity for community stakeholders …

Program Planning On Social Determinants Of Health For Rural Nebraska, Athena H. Ramos, Maria H. Cantu Hines

Capstone Experience

Social determinants of health (SDOH) are non-health factors that impact health in both direct and indirect ways. Research into SDOH and their effects has been extensive in recent years and has been further documented by the COVID-19 pandemic. Despite the wealth of the literature on the SDOH, awareness of these important factors is not prevalent among community residents. Rural communities are as subject to the impact of SDOH just as their urban counterparts and experience additional complexities related to geography and topography.

This capstone project aims to raise awareness, provide education, and assist with tools and resources, to empower rural …

School-Based E-Cigarette Education Curriculum, “Team No Vaping”: Impact On Knowledge Of E-Cigarettes, Harm Perception, And Media Literacy Among Middle/High School Students, Niran Tamrakar

Capstone Experience

E-cigarettes are the most used tobacco products among middle/high school students. Youth e-cigarette use is at an epidemic level. While school-based vaping prevention programs exist, there is limited evidence on the effectiveness of such programs. To address vaping prevention among this vulnerable population, University of Nebraska Medical Center (UNMC) in collaboration with the Tobacco Education & Advocacy of the Midlands (TEAM) developed and implemented a school-based e-cigarette education curriculum, “TEAM No Vaping.” This study evaluated the impact of the “TEAM No Vaping” program on increasing the knowledge, harm perception, and susceptibility to e-cigarettes, and vaping media literacy for vaping prevention …

A Systematic Literature Review On The Capability Of Sio₂-Np’S Exposure To Exacerbate Parkinson’S (Pd) Pathology And The Risk Factors For Biomedical Applications In Pd, Seth Abdallah

Capstone Experience

Silica Dioxide nanoparticles (SiO₂-NP) have become increasingly ubiquitous in industry, which has stimulated research into the potential toxicity of these compounds. Recent studies have explored the association between amorphous silica nanoparticle exposure and the potential for neurotoxicity. Additionally, research has been conducted in the application of SiO₂-NP’s in theranostics and as drug directing agents , which based on current literature may be contraindicated for individuals with conditions such as Parkinson's Disease (PD) which is characterized by neuroinflammation. The following literature review will discuss evidence for silica dioxide nanoparticle exposure to induce neurotoxicity which may exacerbate neurodegenerative diseases such as PD. …

An Analysis Of Climate Factors And Their Relationship With Lyme Disease And West Nile Virus In California From 2011 To 2020, Emma Dubas

Capstone Experience

The World Health Organization estimates that approximately one-sixth of illnesses and disabilities suffered worldwide are due to vector-borne diseases, and more than half of the world’s population is at risk. Additionally, vector-borne diseases have significant socioeconomic impacts and inflate health inequities, with the greatest burden on poor populations. Lyme disease is the top tick-borne disease in the state of California and West Nile virus (WNV) is the top mosquito-borne disease in the state of California. Vector-borne diseases have a high sensitivity to climatic factors. Research shows that ongoing trends of increasing temperature and varying weather conditions will weaken recent global …

Environmental Cleaning Evaluation Project For Rural Tribal Health Center, Brad Strait

Capstone Experience

This Tribal health clinic is located on reservation land and serves a community of approximately 1,550 members located over 64,000 acres located in Nevada and California. The clinic offers general health practice and podiatry at its central clinic with satellite offices located off-reservation offering dentistry, optometry, and behavioral health. The clinic is operated by Tribal staff and partners with the Indian Health Service (IHS) for environmental survey on an annual basis for compliance with Accreditation Association for Ambulatory Health Care (AAAHC) standards. While this clinic only offers outpatient services, the disinfection and cleaning protocols are an important step in limiting …

Barriers To Healthcare Access For Refugees And Immigrants With Limited English Proficiency In Nebraska: A Systematic Review Of The Literature, Mawada Mohammed

Capstone Experience

Refugees and immigrants in the United States from a multitude of backgrounds are impacted by limited English proficiency (LEP), resulting in a health disparity. LEP in vulnerable populations can create obstacles in healthcare. In healthcare settings LEP patients experience adverse health events such as longer hospital stays, negative drug reaction, and patient dissatisfaction (Berdahl & Kirby, 2019). The following project aims to identify barriers for refugees and immigrants with limited English proficiency (LEP) in primary healthcare settings in Nebraska. The project utilized a systematic literature review using peer-reviewed and gray literature. The research was conducted utilizing databases: PsycINFO, PubMed, Google …

Hispanic/Latino Mothers Of Children With Developmental Disabilities: Identifying Factors Associated With Practicing Self-Care And Mental Health Outcomes, Jessica Gutierrez

Capstone Experience

Caring for a child with developmental disabilities can be challenging, exhausting, and overwhelming for many parents. The level of care that a child with disabilities requires can be intense, resulting in stress and negatively impacting caregivers' mental health. Many Hispanic/Latino mothers of children with developmental disabilities are not practicing self-care or using support services; thus, the mothers may experience high stress, depression, and anxiety. Previous research studies have found adverse psychological effects such as high levels of stress, depression, and anxiety. This quantitative study sought to identify the gaps and barriers Hispanic/Latino mothers of children with developmental disabilities encounter when …

Evaluating How Physical Activity Affects The Perception Of Resilience In Box Butte County, Nebraska, Eric Pulver

Capstone Experience

Physical activity is one of the modern hallmarks for good health in individuals and the public, in general. Resiliency is a growing concentration in all levels of disaster preparedness where the focus is on how to deal with the growing number of disasters stemming from global climate change. This research project’s aim is to look at the possible relationships between physical activity and resiliency in a rural Nebraska population. This was done with the use of a cross-sectional study utilizing a fifteen-question survey to gather demographics, assess the amount of physical activity, and then apply a perception of resilience tool …

An Epidemiological Synthesis Of Emerging And Re-Emerging Zoonotic Disease Threats In Cameroon, 2000-2022 And Community Stakeholder Mapping, Nancy Tahmo

Capstone Experience

Introduction: Population factors such as urbanization, socio-economic, and environmental factors are driving forces for emerging/re-emerging diseases in Cameroon, and the effects of these are experienced differently across demographics. Indigenous rainforest communities in the Congo Basin, for example, suffer worse health outcomes compared to neighboring communities, like the Pygmies, who have a life expectancy of 22 years less than neighboring Bantus. It is important to characterize the risk of exposure of these vulnerable communities and map out, through a systematic review, descriptive epidemiological data around zoonoses, to inform preparedness and research efforts.

Methods: Following the PRISMA guidelines, a protocol was registered …

Evaluating How The Impacts Of Climate Change On Arizona's Water Supply Will Influence Public Health, Patricia Wrona

Capstone Experience

Over the last century, Arizona’s climate has increased more than 1.1 to 1.4 degrees Celsius or 2 to 2.5 degrees Fahrenheit. The temperature in Arizona is expected to increase an additional 2.2°C to 2.8°C in the next 40 years. Climate change poses various health and environmental hazards for the residents of Arizona. One of the most significant impacts is on water supply. As temperatures continue to rise in the desert, the demand for water will increase while the water supply will reduce. A literature review and program evaluation were conducted to evaluate how the impacts of climate change on Arizona’s …

Health Effects Of Neonicotinoids On An Agricultural Community, Jocelyn Rodriguez-Paar

Capstone Experience

Mead, Nebraska, a small United States agricultural community consisting of approximately 600 people, was accidentally exposed to high amounts of neonicotinoids when AltEn, an ethanol plant that used neonicotinoid coated corn and soybean seeds for biofuel, was discovered not disposing of the toxic byproduct safely. Coincidentally, there was also a leak in their wastewater system that also contaminated the nearby areas. Although neonicotinoids are not considered highly dangerous with low dose exposures, large dose exposures can cause symptoms similarly to nicotine poisonings, such as difficulty breathing, vomiting, nausea, hypertension, tachycardia, and lethargy (Imamura, T. et al., 2010). Neonicotinoid poisoning can …

Urban/Rural Disparities Of Thyroid Cancer Using The Integrated Cancer Repository For Cancer Research (Icare2), Sunita Regmi

Capstone Experience

Abstract:

Background and objective: Multiple studies have shown that the place of residence and the distance to travel from one's residence to nearby health care providers impact cancer diagnosis and treatment. The stage of cancer at the time of diagnosis is paramount for cancer treatment and affects survival. Disparities in cancer treatment exist which affect the outcome disproportionately to certain segments of the population. To date, much of the focus has been on the racial and socioeconomic disparities in the management of thyroid cancer. The effect of geography and location (urban-rural status) on thyroid cancer stage diagnosis has …

Identifying & Addressing Barriers To Child Care For Formerly Incarcerated Mothers, Joanne Bird

Capstone Experience

As women’s incarceration rates have risen significantly in recent decades, gender-specific programs are needed to meet the needs of formerly incarcerated mothers (FIM). Although child care can be difficult to access for many families, this marginalized population faces unique obstacles to accessing child care. In order for FIM to be employed and reintegrate, they must be able to access child care; however, FIM experience unique barriers to securing child care services. This policy brief aims to identify the special considerations FIM face, as well as to explore why existing programs are not meeting their specific needs. A literature review was …

The Merit Of Inclusion: A Policy Review Examining The Convergence Of Special Education And Inclusions Policies With Compensatory Medicaid Policies In The Wake Of The Covid-19 Pandemic, Corbyn Baggett

Capstone Experience

On March 11, 2020, the World Health Organization (WHO) formally recognized the novel coronavirus (COVID-19) outbreak as a global pandemic. This global issue compelled governments to announce careful virus containing policies in order to prevent further spread and control of the disease. Although it has been proven that measures like social isolation could aid in scaling the spread of illness, the resulting extended school closures that occurred in response to an increased number of COVID-19 outbreaks posed significant challenges for all students, but especially those students with special needs. The unpredictable nature of COVID-19 at the outset of the pandemic …

Descriptive Epidemiology Of West Nile Virus In Nebraska, 2005-2021, Luke Murphy

Capstone Experience

Objectives: West Nile virus (WNV) is a mosquito-borne flavivirus that is naturally sustained in a Culex mosquito-bird-mosquito transmission cycle and can cause disease in birds, equines, and humans. Most human infections with WNV are asymptomatic; however, West Nile fever (WNF), or West Nile neuroinvasive disease (WNND) can develop and be fatal in some circumstances. Between 2005 and 2021 there have been over 1,800 cumulative cases of WNV in Nebraska, which currently ranks as fourth in the United States for reported cases. WNV cases are a mandatory reportable disease in Nebraska through an electronic reporting system managed by the Nebraska Department …

The Risk Factors Of Long Covid In The Acute Covid And Solid Organ Transplant Retrospective Cohorts, Ahmed Nyandemoh

Capstone Experience

Background: Coronavirus disease 2019 (COVID-19) in solid organ transplant (SOT) patients is associated with more severe outcomes than non-immunosuppressed hosts. The risk factors for developing the long COVID in acute COVID remain unknown, and the survival outcomes of long COVID in SOT patients remain understudied.

Methods: We developed several retrospective cohorts. This project included all patients identified with acute COVID in the National COVID Collaborative Cohort Registry from July 1, 2020, to June 30, 2022.

Patients with long COVID were compared to those without long COVID in the acute COVID cohorts. Similarly, we compared the patient demographic with long COVID …

Impact Of Coalition Building To Promote Maternal Infant Health Equity In The District Of Columbia, Maryland, And Virginia, Sydney J. Turner

Capstone Experience

The health of women and babies is critical to creating a healthy world. Stratified data shows the overwhelming rates at which Blacks are affected more than Whites. Literature has shown that leveraging partnerships and community engagement are critical components of decision-making and can positively impact the health of communities. Through a direct observational study, the Community Coalition Action Theory was used to analyze the current structure of the March of Dimes Maternal Infant Healthy Equity Coalition. The study aimed to identify strengths and gaps and subsequently provide recommendations to advance the coalition work and promote maternal and infant health equity …

From Zoom To The Clinic: Unique Student Challenges In Physical Therapy Clinical Education, Amy Both, Jaclyn Catherine Carson, Matthew B. Garber, Heather Marie Mack, Nicole M. Sleddens

Posters and Presentations: Physical Therapy

While the abrupt shift in PT education (PTE) brought on by the pandemic created opportunities for educational innovation, it also brought relational separation and fragmented learning due to lockdowns, social distancing, face masks, and communication limited to virtual platforms. Academic programs increased use of virtual learning, rearranged curriculum, reduced lab and simulated learning time, and provided fewer, if any, opportunities for service learning and patient contact. Clinic sites paused clinic education experiences or hosted fewer students to maintain social distancing and limit disease exposure. As PTE returns to more typical curricular schedules and practices, it is important to be aware …