Medicine and Health Sciences Commons^™

Certified Midwives: An Exploration Of Their Impact On Maternal Health Outcomes – A Comprehensive Literature Review, Heather Hollister

Capstone Experience: Master of Public Health

Maternal health outcomes in the United States have been consistently worse than other high-income countries, with a disproportionate impact on women of color. Midwives have long played an important role in maternal health worldwide. The literature review examines the evidence for midwives as key contributors to improving maternal health outcomes. The paper reviews the existing literature on midwifery, including the impact on maternal health, labor and delivery outcomes, and patient satisfaction. Electronic searches were conducted through Cochrane Library, CINAHL, Medline and Embase. Articles were screened according to inclusion and exclusion criteria including that they must be a randomized study; participants …

A Policy Evaluation For California’S Care Act And The Application Of The Social Determinants Of Health, Adelina Mercedes Lang

Capstone Experience: Master of Public Health

In 2022, California passed a legislative bill, SB 1338: the Community Assistance, Recovery, and Empowerment (CARE) Act, which created a new statewide procedure for treating mentally ill homeless adults diagnosed with psychotic disorders through a court-ordered CARE plan. SB 1338 intends to alleviate the mental health and homeless crisis. This capstone project provides an early assessment of SB 1338 using a modified formative policy evaluation methodology, including a scoping literature review and applying a policy assessment using the CDC's Policy Evaluation Framework. A stakeholder survey was also applied to gather stakeholders' perspectives on SB 1338. The literature review supported the …

Complicated Extubation In A Patient With An Obstructing Tracheobronchial Thrombus, Milan Terzic, Daniel Aintabi, Omar Hegazy

Graduate Medical Education Research Journal

Endotracheal intubation is an effective and rapid technique used as a standard practice for airway management. Airway injury or complications could be a significant cause of morbidity and mortality for patients. Tracheobronchial obstruction secondary to thrombus formation are life threatening complications of traumatic intubations. We present a case of complicated extubation resulting in cardiac arrest in a patient with an obstructing tracheobronchial thrombus. The patient, an 83-year-old female, with atrial fibrillation presented for neck pain. During CT imaging, she developed ventricular fibrillation cardiac arrest. Return of spontaneous circulation (ROSC) was achieved after three cycles of compressions and defibrillation and the …

To Screen Or Not To Screen: Prostate Cancer In Liver Transplant Candidates, Patrick Twohig, Jared Schober, Timothy Mccashland, Thoetchai Peeraphatdit

Graduate Medical Education Research Journal

Prostate cancer screening is a controversial topic in the general population and is even more contested among liver transplant candidates. Not only should transplant programs be concerned about the risk of false positive screening results but also the competing risks of death and the diagnostic and therapeutic effects of true prostate cancer, which often does not cause significant morbidity or mortality in organ transplant recipients. Our letter highlights a best-practices approach to prostate cancer screening in transplant candidates using available research and consensus guidelines.

Rare Streptococcus Intermedius Central Nervous System Septic Emboli: A Case Report And Review Of Literature, Jonathan Herskovitz, Cristina J. Torres, Bryan Walker, Jasmine R. Marcelin

Graduate Medical Education Research Journal

We report a case of a male in his thirties who presented with rapidly progressive encephalopathy, mediastinal abscess, and multiple ring-enhancing lesions throughout the brain. Extensive evaluation revealed Streptococcus intermedius septic emboli to the brain from dental sources via a right-to-left anatomic shunt. The patient completed an 11-week course of IV antibiotic therapy after which he made a near complete recovery. We provide a comprehensive review of the literature with Streptococcus intermedius CNS septic emboli and source of infection.

Interventions For Care Partners Of Adults With Dementia: A Systematic Review, Makenzie Kay Homan, Azia Marie Ourada, Reannon Taylor Rieber, Grace Delaney Tynan

Student Systematized Reviews: Occupational Therapy

Interventions for Care Partners of Adults with Dementia: A Systematic Review

PURPOSE: It is estimated that 8.5 million people are informal care partners for people with dementia (Friedman et al., 2015), which is a challenging role associated with emotional strain, anxiety and depression, increased care partner burden, poorer quality of life (QoL), financial strain, and lack of support (Hellis & Mukaetova-Ladinska, 2023). It is important for occupational therapy practitioners (OTPs) to use the most effective interventions that can be implemented to preserve informal care partners’ health, wellbeing, and quality of life (QoL) (Hellis & Mukaetova-Ladinska, 2023). The purpose of this …

Botulinum Toxin Type A Injections For Refractory Abdominal Dystonia: A Case Report, William J. Naber Ii, Jodi M. Wilhelm, Kurt A. Kuhlman, Gabriel Howard

Graduate Medical Education Research Journal

Background: A 58-year-old male with chronic bilateral treatment resistant abdominal spasms secondary complications of ascites/ alcoholic cirrhosis. Spasms would occur 4-5 times/day, lasting minutes to hours despite a 2-year course of therapeutic and pharmacological interventions. Due to treatment refraction, 6 uniformly spaced botulinum toxin type A (BTX-A) injections were placed per side, using electromyography for audible intramuscular syringe placement confirmation, while visual confirmation was made via ultrasound. During the initial trial, 6 evenly spaced injections were performed bilaterally, uniformly distributing 80U/side. Injections began bilaterally just medial to the junction of the inferior rib cage border/ anterior axillary line and progressed …

Graduate Medical Education – A Look Back, Vicki Hamm

Graduate Medical Education Research Journal

N/A

Occupational Therapy Feeding Interventions In The Neonatal Intensive Care Unit: A Systematic Review, Karly Boehm, Lindsey Brechbill, Johana Cedillo, Sara Mengler, Allyson Thomas

Student Systematized Reviews: Occupational Therapy

No abstract provided.

Occupational Therapy Interventions To Improve Functional Cognition In Older Adults After Stroke: A Systematic Review, Brady A. Harrison, Alexa A. Preissler, Emilea R. Rogers, Allison D. Singh

Student Systematized Reviews: Occupational Therapy

PURPOSE Cerebral vascular accidents (CVA) are a leading cause of cognitive impairment in the United States, and 80% of CVA survivors experience new or worsening impairment (Knight-Greenfield et al., 2019; Zhang et al., 2021). Functional cognition is vital to an individual’s participation in occupations that are necessary and meaningful to them. Occupational therapy practitioners play a unique role in addressing functional cognition through intervention planning and implementation. The purpose of this study is to understand the most effective occupational therapy interventions addressing functional cognition in older adults post CVA.

DESIGN We conducted a systematized review of articles pertaining to occupational …

Effectiveness Of Occupational Therapy Interventions To Enhance Occupational Performance For Survivors Of Domestic Abuse: A Systematic Review, Mackenzie R. Post, Aubrianna Hohensee, Taylor Fisher, Amanda Malashock

Student Systematized Reviews: Occupational Therapy

TITLE: Effectiveness of Occupational Therapy Interventions to Enhance Occupational Performance for Survivors of Domestic Abuse: A Systematic Review

PURPOSE: An average of 20 people per minute experience domestic abuse in the United States (Black et al., 2011). People who experience abuse have poor physical and mental health outcomes which can include depressive symptoms, substance use, developing chronic disease, chronic mental illness, and injury (Coker et al., 2002). Occupational practitioners are equipped to address this issue because they have specific training on life skills, lifestyle management, adaptive coping strategies, time management, and personal values, which can help minimize the negative health …

Occupational Therapy Interventions That Influence Quality Of Life Of Care Partners Of Children With Developmental Disabilities: A Systematic Review, Alaina Akey, Maggie Alsup, Madison Cockerill, Sydney Wondra

Student Systematized Reviews: Occupational Therapy

TITLE: Occupational Therapy Interventions that Influence Quality of Life of Care Partners of Children with Developmental Disabilities: A Systematic Review

PURPOSE: In the United States, 1 in 6 children have one or more developmental disabilities (Center for Disease Control and Prevention, 2022). Children with developmental disabilities require a higher level of care and support in comparison to their typically developing peers (Akyurek et al., 2023). Due to this increased need for assistance, care partners may experience greater psychological, physical, social, and financial hardships that can impact their overall quality of life (Murphy et al., 2006). Although the scope of occupational …

How Long Does It Take To Master Laryngeal Visualization Using Flexible Nasolaryngoscopy In Children?, Kieran Boochoon, Julina Ongkasuwan, Annie Ahn, Mary Musso, Yi-Chun Carol Liu

Graduate Medical Education Research Journal

Background: To assess when residents become proficient in performing flexible nasolaryngoscopy (FNL) in the pediatric population.

Objective: To objectively evaluate the quality of FNL by year of residency training.

Methods: Ninety-five pediatric FNL’s were performed by otolaryngology residents and pediatric otolaryngology fellows (postgraduate year [PGY] 1 – 6). Three pediatric otolaryngologists rated the FNL videos (anonymized and without sound) using the Modified Cormack-Lehane scoring system (MCLS). Data analysis was performed using two-way ANOVA and Tukey-Kramer adjustment.

Results: Overall, there was a significant difference in the quality of the FNL based on the year of training (p

Conclusion: The quality …

Discordant Cardiopulmonary Resuscitation At An Academic Midwest Medical Center- Prevalence And Solutions, Jeremy Payne, Anne Skinner, David Gannon, Jenenne A. Geske

Graduate Medical Education Research Journal

Background: Code status orders are important features of patient-centered clinical decisions, patient autonomy, and end-of-life care. Despite proper documentation of “do not resuscitate” (DNR) code status, hospitalized patients may be subjected to cardiopulmonary resuscitation (CPR) efforts that go against their wishes.

Purpose: The objective of this study was to identify and describe the population of hospitalized patients receiving discordant resuscitation efforts at a Midwest academic medical center utilizing electronic health records (EHR).

Method: The study included EHR records between 01/01/2011 and 01/01/2021 for hospitalized patients 19 years and older who experienced cardiac arrest (ICD-10 I46) and were documented as DNR. …

Does Implementation Of A Lifestyle Medicine Curriculum Affect Student Wellness During Doctor Of Physical Therapy Education?, Betsy J. Becker, Kathleen G. Volkman, Tessa Wells, Nicole M. Sleddens, Teresa Cochran

Posters and Presentations: Physical Therapy

Background

Current healthcare environments amplify the need for educational systems to forge healthy workforces to withstand stressors. Our study examines the effects of embedding a lifestyle medicine curriculum on student wellness in a Doctor of Physical Therapy (DPT) Program, simultaneously preparing students to implement lifestyle medicine with future patients and communities.

Methods

In a DPT program, we implemented a lifestyle medicine curriculum grounded within the Social-Ecological Model. This framework emphasizes student success in the program’s pre-clinical phases, creates a purposeful “ripple effect” threading wellness strategies among peers, patients, and communities, and emphasizes wellness as a clinician over the 32-month curriculum. …

Exploring First Semester Allied Health Students’ Transition To Graduate School Through The Lens Of Occupational Adaptation, Carly E. Williams, Jessica N. O'Brien, Rebecca E. Dodick, Jillian M. Bell, Jennifer O. Knauth, Lorrie A. George-Paschal, Nancy Krusen, Jacquie Rainey

Innovations in Health Sciences Education Journal

The purpose of the study was to examine experiences of students transitioning into graduate allied health programs within a public university in the United States. Researchers assessed students’ occupational adaptation as well as factors that facilitated and inhibited their transition. Researchers collected data using the Relative Mastery Scale (RMS) (George-Paschal, Krusen, & Fan, 2022) and a researcher-developed transition survey. Participants included 129 students from three allied-health professions. Researchers conducted a mixed ANOVA to explore differences in RMS ratings across three disciplines. There was a statistically significant increase in RMS ratings over time for all disciplines and statistically significant differences between …

Systematic Review Of Needlestick Injuries In The Operating Room: A Case For Surgical Glove Redesigning, Shalmali Mirajkar, Zachary Bauman, Bethany Lowndes

EMET Projects

Background: Sharps or needlestick injuries (NSI) occur in roughly 15% of surgeries and are largely preventable. With such injuries, healthcare workers have a high risk of exposure to blood borne pathogens. Despite the implementation of several prevention measures such as double gloving and using blunt suture needles, there is still a high prevalence of NSIs. The aim of the current study is to conduct a systematic review to identify the most vulnerable parts of the hand for needlestick injuries, the most common tasks during which injuries occurred, and the most common instrument associated with the injury.

Methods: A …

Design And Synthesis Of Small Molecule Drugs For Cns Disorders, Kirsten T. Tolentino

Theses & Dissertations

Dopamine (DA) is an important neurotransmitter for the regulation and long-term function of the central nervous system (CNS). DA binds to Dopamine Receptors (DR) to stimulate or inhibit adenyl cyclase production to further elicit a pharmacological response. DRs were cloned, and it was determined that there are two families separated by their function and five total subtypes distinguished by their amino acid structure. The Dopamine 4 receptor (D4R) is the second least studied subtype but has high expression in the frontal cortex, amygdala, hippocampus, hypothalamus, globus pallidus, substantia nigra pars reticula, and thalamus. Dopamine signaling and transmission, especially in the …

Understanding And Quantifying Bioaerosol Fate Within The Aerobiological Pathway: Physical Transport, Environmental Decay, And Mitigation, Sean Kinahan

Theses & Dissertations

The recent COVID-19 pandemic has highlighted the need for better tools to understand and characterize phases of the aerobiological pathway, a model for understanding how infectious bioaerosols are sourced, generated, transported, deposit, and affect human health. This dissertation presents validation of methodologies for studying transport of airborne biological agents and variations on their consequences, especially focusing on their physical and chemical fate. Chapter 1 focuses on a parallel comparison of two methods of aging bioaerosols in real-world outdoor environments with complex sunlight, atmospheric chemistry, and pollutants. Both capture on microfibers and the use of Goldberg rotating drums to keep a …

A Pilot Randomized Controlled Trial Evaluating Peer Recovery Coaches For Addiction Recovery Among Indigenous Americans, Nicholas Guenzel

Theses & Dissertations

Addiction is a common and devastating problem among many Indigenous American (IA) groups around the United States. Too few IA health care providers are available to deliver care in a way that leverages IA values and traditions to support addiction recovery. Peer recovery coaches (PRCs) are individuals who have lived experience of addiction and have received specialized training in helping others in recovery. IA PRCs hold significant potential in helping to fill the gap of culturally-specific support in addiction. In this feasibility trial, we recruited a total of 120 adult (≥19 years) IAs with a substance use disorder through Facebook …

Design, Synthesis, And Evaluation Of Novel Peptidomimetics As Neurolysin Activators For The Treatment Of Ischemic Stroke., Md. Shafikur Rahman

Theses & Dissertations

Stroke is the world's second-leading cause of death and disability. Ischemic stroke (IS), a primary subtype of stroke, has ineffective and limited treatment options, resulting in a significant unmet medical need for novel therapies. Tissue plasminogen activator (tPA) is the sole FDA-approved medication now in use; however, it has a narrow therapeutic window (3 to 4.5 h). Unfortunately, few individuals have this opportunity to be diagnosed with stroke in time to begin therapy with tPA. Additionally, treatment with tPA can have major adverse effects, such as bleeding, which can exacerbate the consequences of a stroke on the brain. To overcome …

Identification Of Immune Biomarkers In Thyroid Cancer, Anupam Kotwal

Theses & Dissertations

Thyroid cancer is the most common endocrine malignancy, estimated to be the second most common cancer in women by 2030. The frequency of differentiated thyroid cancer (DTC), the most common subtype of thyroid cancer, is higher in patients with autoimmune thyroid disease but the influence of the immune milieu on thyroid carcinogenesis remains unclear. To address this gap in knowledge, we performed clinical and translational experiments to identify immune biomarkers for the occurrence and prognosis of DTC. Multiparameter flow cytometry of peripheral blood from 32 adults found advanced thyroid cancer either at presentation or during the disease-course to be associated …

Association Of Inflammatory Markers And Growth Factors With Radiographically Assessed Wound Healing Of Extraction Sockets, Sasha Mohammadi

Theses & Dissertations

The purpose of this prospective cohort pilot study was to investigate the association of the periodontal status and inflammatory markers from the gingival crevicular and wound fluid with the healing outcomes following tooth extraction. The central research hypothesis is that extraction sites and the adjacent teeth that exhibit increased markers of inflammation, or decreased growth factors, at baseline or 2 weeks will be associated with reduced healing outcomes observed radiographically 3 months following surgery. Nine patients at the UNMC College of Dentistry who were seeking care to extract a posterior tooth due to advanced periodontal bone loss, non-restorable caries or …

Factors Associated With The Difficulty Of Computerized Tasks Among Office-Based Physicians In The United States, Khalid Alshehri

Theses & Dissertations

Computerized tasks represent an essential component of the modern health care services. A substantial part of these computerized tasks performed by physicians are made for documenting clinical care through Electronic Health Records (EHRs) and using Prescription Drug Monitoring Programs (PDMPs). While these computerized tasks have positively impacted the care provided by physicians, difficulty-based barriers to using these electronic tools were identified. Given the potential unfavorable roles that difficulty-based barriers can play in the provision for health care, it is important to examine factors associated with these barriers. Thus, the core objective of this study is to examine factors associated with …

Understanding Healthcare Worker Experiences And Personal Protective Equipment (Ppe)-Related Skin Reactions/Injuries During The Covid-19 Pandemic: A Mixed Methods Approach, Susan Solmos

Theses & Dissertations

Personal protective equipment (PPE)-related facial skin reactions/injuries occurred in 75.13% of healthcare workers during the COVID-19 pandemic. Critical appraisal of cross-sectional studies identified methodological gaps as the majority of survey questions were not content-validated and those that were lacked descriptions of methods and psychometrics for the survey questions/tool. The aims of this dissertation study were to describe the nature, severity, and distribution of selfie captured PPE-related facial injuries using a validated tool (quantitative) and describe the contextual factors associated with PPE-related facial injuries and what factors influence nurses and Health Care Workers (HCWs) to share their experiences (qualitative). The setting …

The Co-Oncogenic Function Of Ecdysoneless Protein With Erbb2 In Mammary Epithelial Cells, Benjamin B. Kennedy

Theses & Dissertations

The Ecdysoneless (ECD) protein is highly evolutionarily conserved and ubiquitously expressed across human tissues. ECD has established roles in cell cycle regulation, embryogenesis, cell survival, and RNA biogenesis. ECD mRNA and protein are overexpressed in breast cancer, and its overexpression correlates with poor patient survival, especially in ErbB2/HER2-positive breast cancer. This thesis work investigates the co-oncogenic role of ECD in ErbB2-driven oncogenesis using immortalized mammary epithelial cells. Here, we show that ECD and ErbB2 overexpression in immortalized human mammary epithelial cells increases cancer traits, such as invasion, migration, and anchorage independent growth. Significantly, ECD+ErbB2 co-overexpression further enhanced all oncogenic traits. …

Overcoming Resistance Mechanisms To Cdk4/6 Inhibitor Treatment Using Cdk6-Selective Protac, Sarah Truong

Theses & Dissertations

Hormone receptor-positive (HR+) breast cancer (BC) constitutes approximately 75% of all breast cancer patients. These tumors rely on hormones, estrogen and progesterone, for their proliferation. The interaction between the hormones and their respective receptors enhances cyclin D expression, which results in the persistent activation of CDK4 and CDK6. The CDK4/6-cyclin D complex engages in a phosphorylation cascade that ultimately allows the cells to proceed past the G1/S checkpoint of the cell cycle. Inhibition of CDK4/6 has been shown to trigger cell cycle arrest, inhibit tumor growth, and induce apoptosis. Currently, there are three FDA-approved CDK4/6 inhibitors (CDK4/6i). A limitation of …

Exploiting Vulnerabilities In The Ras-Rac Signaling Pathway For The Selective Targeting Of Pancreatic Cancer Cells, Neha Chaudhary

Theses & Dissertations

Deregulation of the KRas (Kirsten rat sarcoma virus) GTPase is one of the early hallmarks of Pancreatic Cancer (PC). The most common genetic alteration found in PC are mutations in the KRas protein that block its ability to hydrolyze GTP to GDP and resulting in higher levels of GTP-bound KRas, its active form. Pancreatic tumors driven by oncogenic mutants of KRas tend to be addicted to the oncogene, to the extent that its repression leads to the induction of cell death. This addiction to the KRAS oncogene makes the KRas protein an ideal target for cancer therapy. However, the globular …

Understanding The Compositional And Contextual Factors Influencing Maternal Health Experiences And Outcomes, Tambudzai P. Ndashe

Theses & Dissertations

Despite being preventable, adverse maternal health outcomes continue to be a problem in the United States, which fares worse at preventing these issues than other industrialized nations. Although our understanding of the factors that play a role in the etiology of adverse maternal health outcomes has improved over time, there is still a lot left to understand regarding the role of contextual factors, the upward trajectory of outcomes such as severe maternal morbidity (SMM), and the disproportionate impact of adverse maternal health outcomes on non-Hispanic Black women. This thesis attempted to evaluate the factors that influence procedure-related severe maternal morbidity …

Reducing Oral Health Disparities: Effectiveness Of Preventive Dental Care On Treatment Use, Expenditures And Determinants Of Service Utilization, Rashmi Lamsal

Theses & Dissertations

Given the importance of oral health in maintaining the general health and well-being of an individual, this dissertation includes three independent studies examining dental care utilization and expenditures among adults in the U.S. The first study examines the effectiveness of preventive dental visits on treatment utilization and expenditures among adults aged 18 and above. The second study focuses on the impact of paid sick leave on different types of dental services utilization among working adults aged 18-64. Finally, the last paper compares the differences in dental care utilization and related expenditure between foreign-born and US-born adults with diabetes. The paper …