Medicine and Health Sciences Commons^™

Implementing A Heart Failure Education Program For Bedside Nurses In The Acute Care Setting, David L. Morrow

UNLV Theses, Dissertations, Professional Papers, and Capstones

Heart failure is a chronic disease in which a weakened heart is no longer able to deliver adequate blood flow to supply the body with needed oxygen and nutrients. Heart failure is the most common reason for hospitalization in the United States for patients age 65 and over, accounting for over 1,000,000 hospital admissions annually. Due to the chronic nature of this debilitating condition and associated symptoms, patients discharged from the hospital with a diagnosis of heart failure are at high risk for readmission. Effective self-care behaviors have been shown to reduce readmissions and improve quality of life for these …

A Guide For Outcomes Evaluation And Sustainability Of A Dedicated Education Unit Within An Academic-Practice Partnership, Jennifer Pfannes

UNLV Theses, Dissertations, Professional Papers, and Capstones

The Dedicated Education Unit (DEU) has emerged as an innovative approach to providing a positive, high-quality, collaborative clinical learning environment that fosters the growth and learning of undergraduate nursing students. Additionally, the DEU model has demonstrated success in beginning to bridge the education-practice gap, tackling the faculty shortage, and easing the new graduate transition from education to practice; however, developing, evaluating and sustaining an economically successful DEU takes thoughtful,

strategic planning. The challenging nature of developing and sustaining a DEU that mutually benefits both the academic and clinical partner over time, reveals the need for more guidance to secure long-term …

A Group Development Program Based On Transformational Leadership To Improve Team Performance, Anne-Marie Schenk

UNLV Theses, Dissertations, Professional Papers, and Capstones

As reimbursement models move from volume-based to value-based, organizations increasingly depend on meeting patient outcome goals in order to achieve their budgetary targets. Leadership teams are a vital part of healthcare organizations and their performance is crucial to the overall organization’s performance. The organization of interest saw a group of strong individual leaders struggle with outcome production due, in part, to overall team dysfunction. To address this need, this DNP project is a group development program, based on the concepts of transformational leadership. As functional groups and transformational leaders are known to drive outcomes, when implemented, this program’s goal is …

Factors Associated With Food Insecurity Among Individuals, Aged Sixty And Older, In Clark County, Nv, Lisa M. Segler

UNLV Theses, Dissertations, Professional Papers, and Capstones

Food insecurity is defined as a lack of consistent access to enough food for an active, healthy life. In Nevada, an estimated 80,000 individuals, aged 60 years or older, were food insecure in 2016. The primary aim of this study was to identify factors that are associated with food insecurity in older adults, aged sixty and older, in Clark County, NV. The secondary aim of this study was to identify which factors interact with each other to explain food insecurity among individuals aged sixty and older, in Clark County, NV. A secondary data analysis was conducted using data collected by …

An Exploration Of Nursing Communication Competence During The Handoff Report, Megan Elizabeth Smith

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction Nurse handoff reporting is a crucial time for communication exchange in healthcare settings. During the handoff report, patient information is exchanged between senders and receivers transferring responsibility for care with the main purpose of providing accurate and timely information about the patient. The Joint Commission reports that shortcomings related to communication can be directly related to an increase in patient care errors, with approximately 80% of medical errors resulting from miscommunication during the handoff process. Numerous intervention studies focus on standardizing information, developing physical locations and environments for ideal handoffs, and creating tools for structured information exchange between different …

Changes In Hippocampal-Anterior Cingulate Cortex Interactions During Remote Memory Recall, Ryan A. Wirt

UNLV Theses, Dissertations, Professional Papers, and Capstones

Spatial memory is an important cognitive process that relies on extensive neural networks throughout the brain. The hippocampus (HC) is important for the formation of these memories but over time, in a process referred to as consolidation, recall becomes increasingly reliant on other brain areas. The anterior cingulate cortex (ACC), a region within the medial prefrontal cortex, is important for spatial learning, spatial working memory, and remote memory recall, but the mechanisms underlying recall processes are still unknown. To better understand the role of the ACC and HC during memory recall, we introduced rodents into a series of spatially and …

Leadership Development In Nursing: Planning From The Bedside To The Executive Suite, Janet C. Wright

UNLV Theses, Dissertations, Professional Papers, and Capstones

Nurses comprise the largest portion of the healthcare sector workforce over 4 million professional nurses licensed in the United States (National Council of State Boards of Nursing, 2019). Leading within a vast workforce such as nursing requires the nurse leader to have the expertise of the nursing profession along with leadership and business skills to maintain competitiveness in the complex healthcare industry. Consequences of effective leadership include improved patient outcomes, decreased staff turnover, and decreased costs to the organization related to patient outcomes and turnover costs. These results suggest the importance for organizations to ensure their leaders are properly trained …

Dental Age Estimation Of A Southern Nevada Hispanic Non-Adult Population Employing The London Atlas To Evaluate Archival Orthodontic Cone Beam Computed Tomography (Cbct) Images, Haley Buchanan

UNLV Theses, Dissertations, Professional Papers, and Capstones

Age estimation is of societal importance for legal, forensic, and clinical reasons. The London Atlas of Human Tooth Development and Eruption, hereafter referred to as the London Atlas, was introduced as an improved method for determining dental age estimation. The London Atlas was developed from panoramic images of 528 living British Caucasian and Bangladeshi males and females aged 2 to 24 years and panoramic images of 176 archival human skeletal remains, aged 32 in utero to 2 years old, from two specimen collections (AlQahtani, Hector, & Liversidge, 2010). Further investigation is warranted to determine validity of the atlas’s use in …

Health Literacy Intervention For Low Income Uninsured Population, Laura Larson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Health literacy (HL) requires basic skills in writing, reading, numeracy, and communication all within a health context (Berkman et al., 2011). HL is a critical element for individuals to take an active role in managing their health. The National Assessment of Adult Literacy found only 12% of adults had a “proficient” HL level. Hispanics were found to be at greatest risk for lower HL than all other ethnic groups (Kutner, Greenberg, Jin, & Paulsen, 2006). Low HL can lead to poor health outcomes including: decreased utilization of preventative services, difficulty in managing chronic conditions, and increased disparities in access …

Development Of A Breast Cancer Survivorship Care Toolkit, Lauren Elaine Scott

UNLV Theses, Dissertations, Professional Papers, and Capstones

A breast cancer survivor’s journey does not end with treatment. After treatment, most breast cancer survivors go on to face many life-long physical and mental challenges caused by their cancer and treatment. Once active cancer treatment is completed, patients enter the next important step in cancer care, cancer survivorship. Cancer survivorship is a comprehensive approach to post-oncology management that promotes the best outcomes for survivors as they transition from oncology care to primary care; and new breast-cancer survivorship guidelines have emerged. Research suggests that primary care NPs’ lack of awareness of the current 2016 American Cancer Society/American Society of Clinical …

A State Of Uncertainty: An Analysis Of Recent State Legislative Proposals To Regulate Preventive Services In The United States, Maxim Gakh, Cody Cris, Prescott Cheong, Courtney Coughenour

School of Public Health Faculty Research

This policy brief examines preventive services state legislation trends in the United States during uncertainty regarding the Affordable Care Act (ACA), which requires certain coverage of 4 evidence-based preventive services categories without additional patient costs under §2713. We used a legal mapping approach to search for and analyze state legislation related to preventive services proposed or enacted over a 25-month period of ACA uncertainty. We screened 1231 bills and coded the 76 screened-in bills. Next, we determined their characteristics and examined trends. Bills originated in 28 states, and 69.7% were not enacted. Only 3.9% contained requirements contingent on ACA modifications. …

Reliability Of Colour And Hardness Clinical Examinations In Detecting Dentine Caries Severity: A Systematic Review And Meta-Analysis., Larry Hon, Ahmed Mohamed, Edward Lynch

Dental Medicine Faculty Research

Dental caries is the most common human infectious disease and is caused by microorganisms producing acids, resulting in changes in dental tissue hardness and colour. However, the accuracy and reliability of dentine colour and hardness as indicators for carious lesion severity has never been assessed in a systematic review. By applying strict criteria, only seven papers (five randomized control trials and two diagnostic studies) were considered for full text qualitative and quantitative assessment. Only three studies produced high quality evidence and only four articles were considered for meta-analysis, as these provided log10 colony forming units (CFU) data from caries biopsies …

Uptake And Persistence Of Bacterial Magnetite Magnetosomes In A Mammalian Cell Line: Implications For Medical And Biotechnological Applications., Jefferson Cypriano, Jacques Werckmann, Gabriele Vargas, Adrana Lopes Dos Santos, Karen T. Silva, Pedro Leao, Fernando P. Almeida, Dennis A. Bazylinski, Marcos Farina, Ulysses Lins, Fernanda Abreu

Life Sciences Faculty Research

Magnetotactic bacteria biomineralize intracellular magnetic nanocrystals surrounded by a lipid bilayer called magnetosomes. Due to their unique characteristics, magnetite magnetosomes are promising tools in Biomedicine. However, the uptake, persistence, and accumulation of magnetosomes within mammalian cells have not been well studied. Here, the endocytic pathway of magnetite magnetosomes and their effects on human cervix epithelial (HeLa) cells were studied by electron microscopy and high spatial resolution nano-analysis techniques. Transmission electron microscopy of HeLa cells after incubation with purified magnetosomes showed the presence of magnetic nanoparticles inside or outside endosomes within the cell, which suggests different modes of internalization, and that …

Social Vs. Practical Problems In Attaining A Colonoscopy: Different Patient Profiles?, Barbara A. Curbow, Evelyn C. King-Marshall, Nora Mueller, Travis Hyams, Shahnaz Sultan, Thomas J. George Jr

Journal of Health Disparities Research and Practice

Background: Colonoscopy is an effective procedure for identifying precancerous polyps and cancerous lesions, but it is unlike other cancer screening tools in that it requires sedation and thus assistance from at least one other individual. The intent of this paper was to identify logistical problems in completing the colonoscopy and to examine their relationships with sociodemographic characteristics.

Methods: All eligible patients (n = 2500) from two academic-affiliated colonoscopy centers (one free standing, one hospital-based) were invited to participate in an onsite, pre-colonoscopy survey; patients agreeing to participate (n = 1841, RR = 73.6%) received a $5.00 gift card. Multiple correspondence …

Prescription Medication Misuse Among American Indians In The Midwestern Us, Charley S. Lewis, Jordyn Gunville, Ryan Goeckner, Brian Chase, Lauren Clark, Jianghua He, Won S. Choi, Christine M. Daley

Journal of Health Disparities Research and Practice

Background: Prescription medications, particularly opioids, are often abused rather than used as intended by the prescribing physician. This is well-documented, though little data are available on American Indians. Misuse of other prescription medications is far less documented, but does occur and can have wide-spread effects.

Methods: We used a cross-sectional survey of American Indians in the Midwestern US (N=361) to begin to understand misuse of prescription medications, not necessarily to get high, but for any reason. Participants were recruited for this touchscreen computer-based survey at powwows, health fairs, and other community events through a convenience sample. We asked questions …

Cancer Risk Factors And Screening Behavior Among Korean Americans In The Sf Bay Area, Nhayoung Hwang, Hyunju Kim, Eugenia Yoo, Denny Cha, Winston Tseng Phd, Susan L. Ivey Md, Mhsa

Journal of Health Disparities Research and Practice

Background: Korean Americans (KA) have the highest prevalence of death from cancer among Asian American ethnic groups in the U.S. This KA prevalence rate is also substantially higher than that of non-Hispanic whites, yet little is known about their cancer risk factors. This paper is one of the first studies to explore cancer risk factors and screening behaviors of Korean Americans in the San Francisco Bay Area.

Methods: A survey instrument was created using items from the California Health Interview Survey (CHIS) from 2009-2012, which were translated into Korean. A cross-sectional survey assessing the prevalence of cancer risk factors and …

Restricted Access And Delays To Hcv Treatment Among Medicaid Patients In Louisiana, Morris M. Kim, Keanan M. Mcgonigle

Journal of Health Disparities Research and Practice

Background: Many people living with chronic Hepatitis C Virus (HCV) have seen delays in accessing treatment or been denied entirely due to Medicaid restrictions requiring patients to meet certain criteria prior to receiving approval for medication pre-authorization.

Methods: This study identified a cohort of Medicaid-insured patients with chronic HCV infection within New Orleans, LA. Patient medical records were reviewed and information regarding HCV care was gathered. This study sought to determine the degree to which HCV care was delayed for this population and describe common reasons for prior-authorization denials for direct-acting antiviral (DAA) medications.

Results: For this population of Medicaid-insured …

Examining The Impact Of Race And Rurality On Health Differences Among Overweight Youth Accessing Pediatric Endocrinology Care, Kelsee Halpin, Janelle R. Noel-Macdonnell, Yun Yan

Journal of Health Disparities Research and Practice

Methods: This study examines the impact of race and rurality on health differences, including prevalence of prediabetes and type 2 diabetes (T2D), among overweight children accessing pediatric endocrine specialty care. Cross-sectional analysis of overweight/obese youth 10 to 18 years of age receiving pediatric endocrinology consultation for weight gain, hyperglycemia, and/or T2D from 2013 to 2016 at a Midwest tertiary pediatric center.

Results: The 722 patients were 42% white, 25% black, 22% Hispanic; 88% lived in urban areas and 12% in rural areas. Rurality was determined using zip code approximation of Rural-Urban Commuting Area (RUCA) codes. After adjusting for confounders, black …

Nutrient And Food Group Intakes Of Low-Income Pregnant Women By Race/Ethnicity, Alla M. Hill, Danielle L. Nunnery Phd, Rdn, Ldn, Alice Ammerman Drph, Jigna M. Dharod Phd

Journal of Health Disparities Research and Practice

In an exploratory study, a convenience sample of 148 pregnant women was recruited from a WIC clinic in the southeast region of the U.S. to: 1) Examine and compare daily nutrient and food group intakes of WIC pregnant women to national guidelines, and; 2) Determine racial/ethnic differences in nutrient and food group intakes among WIC pregnant women. Women were selected for the study if they were: ≥ 18 y, in 2^nd trimester of pregnancy, and if they spoke English or Spanish as a first language. Upon recruitment, participants were interviewed to collect information on their socio-demographics, including race/ethnicity. Additionally, …

Utilization Of Media-Driven Technology For Health Promotion And Risk Reduction Among American Indian And Alaska Native Young Adults: An Exploratory Study, Todd M. Sabato

Journal of Health Disparities Research and Practice

Across the developmental spectrum, American Indian and Alaska Native (AI/AN) adolescents and young adults experience considerable behavioral and mental health disparities, including substance abuse, depression, and engagement in sexual behaviors which enhance risk of pregnancy and sexually transmitted infections. Health-focused interventions utilizing digital and media technology hold significant promise among tribal communities, as they have the capacity to eliminate geography-based barriers. Utilizing a sample of 210 self-identified AI/AN students attending tribal colleges, this study identified the most effective technologies and intervention strategies, as well as health seeking patterns and preferences, which may impact implementation and sustainable use in tribal settings. …

Five-Year Trend In Diabetes Clinical Care And Self-Management Among Adults With Diabetes In West Virginia: 2010-2014, Ranjita Misra 2934168, Usha Sambamoorthi

Journal of Health Disparities Research and Practice

Objective: To examine the five-year trend in clinical care and diabetes self-management activities among adults living in the Appalachian state of West Virginia.

Methods: This study used a cross-sectional design with data from the Behavioral Risk Factor Surveillance System in 2010 (N=685) and 2014 (N=958), among noninstitutionalized adults with diabetes. Five-year trend in recommended diabetes clinical care, diabetes self-management activities and diabetes education was analyzed after adjusting for sex, education, income, insurance, age, obesity, comorbid hypertension, race and lifestyle behaviors (exercise and smoking).

Results: A significant increase in percentage of adults with 2 or more A1C tests was …

Native American Weight Loss Movement: Pilot Test Of A Culturally Tailored Weight Loss Program For American Indians, Christine M. Daley, Jason W. Hale, Shelley Bointy, Kelly Berryhill, Joseph Lemaster, Byron J. Gajewski

Journal of Health Disparities Research and Practice

American Indians (AIs) have higher rates of obesity than other racial/ethnic groups, placing them at heightened risk for cardiovascular diseases, diabetes, and certain cancers. Culturally appropriate weight loss interventions may be the key to reducing risk. The most successful program used in AI communities has been the Diabetes Prevention Program (DPP), which limits enrollment to individuals with a clinical diagnosis of pre-diabetes. The purpose of this pilot project was to modify and culturally tailor a weight loss intervention to AI communities in Kansas to improve weight loss related behaviors among those who do not qualify for the DPP. The Native …

A Resistance Exercise Set For A Total Body Workout For Adults With Intellectual Disabilities, A Pilot Study, Thessa Hilgenkamp, Stijn Weterings, Alyt Oppewal, Florien M. M. Van Eeden

Physical Therapy Faculty Research

Background: Resistance training has beneficial effects on fitness levels, cardiovascu‐lar disease risk, risk of sarcopenia and on performing activities of daily living. The focus of this study is to design a total body resistance exercise set for adults with intellectual disabilities (RESID) with minimal equipment required and to test its feasibility. Method: The RESID was selected in an expert meeting, and its feasibility was deter‐mined in a cross‐sectional pilot study. The feasibility was determined with comple‐tion rate, correct execution of exercises and the participant’s experience. Results: The expert group (n = 7) selected seven exercises for the RESID. The partici‐pants …

Two-Stage Optimal Designs With Survival Endpoint When The Follow-Up Time Is Restricted, Guogen Shan, Hua Zhang

School of Public Health Faculty Research

Background: Survival endpoint is frequently used in early phase clinical trials as the primary endpoint to assess the activity of a new treatment. Existing two-stage optimal designs with survival endpoint either over estimate the sample size or compute power outside the alternative hypothesis space. Methods: We propose a new single-arm two-stage optimal design with survival endpoint by using the one-sample log rank test based on exact variance estimates. This proposed design with survival endpoint is analogous to Simon’s two-stage design with binary endpoint, having restricted follow-up. Results: We compare the proposed design with the existing two-stage designs, including the two-stage …

Dietary Fiber Intake And Glycemic Control: Coronary Artery Calcification In Type 1 Diabetes (Cacti) Study, Arpita Basu, Amy C. Alman, Janet K. Snell-Bergeon

Kinesiology and Nutrition Sciences Faculty Research

Background: Dietary fiber has been recommended for glucose control, and typically low intakes are observed in the general population. The role of fiber in glycemic control in reported literature is inconsistent and few reports are available in populations with type 1 diabetes (T1D). Methods: Using data from the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study [n = 1257; T1D: n = 568; non-diabetic controls: n = 689] collected between March 2000 and April 2002, we examined cross-sectional (baseline) and longitudinal (six-year follow-up in 2006–2008) associations of dietary fiber and HbA1c. Participants completed a validated food frequency questionnaire, and …

Rethinking Health Services Measurement For Indigenous Populations, Angela Mashford-Pringle, Ian Ring, Fadwa Al-Yaman, John Waldon, Michelle Chino

School of Public Health Faculty Research

Indigenous people around the world experience shorter life expectancy, poorer health outcomes, and on average have less social capital, than non-Indigenous people in their respective countries. While national goals are to lower mortality and morbidity rates of Indigenous people, much evidence exists that indicates there is almost no Indigenous involvement in data collection, policy development, program implementation and development and measurement of services. A more holistic and culturally relevant framework is presented to improve services and outcomes for Indigenous populations.

Improving Health Data For Indigenous Populations: The International Group For Indigenous Health Measurement, Michelle Chino, Ian Ring, Lisa Jackson Pulver, John Waldon, Malcolm King

School of Public Health Faculty Research

Health disparities between Indigenous and non-Indigenous populations exist in many countries, including those with well-developed statistical systems. The need to improve the measurement and understanding of Indigenous health disparities led to the formation of the International Group for Indigenous Health Measurement (IGIHM), composed of Indigenous and non-Indigenous, government and non-government, statisticians, researchers and health professionals. Since its founding in 2005, the IGIHM has pursued activities to improve health measurement, which in turn have been used for improving the health of Indigenous populations and enhancing Indigenous health knowledge and data.

Rethinking Health Services Measurement For Indigenous Populations, Michelle Chino Dr, Angela Mashford-Pringle, Ian Ring, Fadwa Al-Yaman, John Waldon

School of Public Health Faculty Research

Indigenous people around the world experience shorter life expectancy, poorer health outcomes, and on average have less social capital, than non-Indigenous people in their respective countries. While national goals are to lower mortality and morbidity rates of Indigenous people, much evidence exists that indicates there is almost no Indigenous involvement in data collection, policy development, program implementation and development and measurement of services. A more holistic and culturally relevant framework is presented to improve services and outcomes for Indigenous populations.

Undergraduate Nursing Students’ Knowledge Of Aging, Attitudes Toward And Perceptions Of Working With Older Adults In Kathmandu Nepal, Saruna Ghimire, Nitisha Shrestha, Karen E. Callahan, Dhirendra Nath, Binaya Kumar Baral, Nirmale Lekhak, Devendra Raj Singh

School of Public Health Faculty Research

Objectives: This study aims to examine Nepalese undergraduate nursing students’ knowledge of aging, attitudes towards older adults and perceptions of working with older adults, and to assess differences in these outcomes by socio-demographic characteristics as well as type of nursing program. Methods: A cross-sectional study was conducted among 385 undergraduate nursing students in six nursing colleges located in the Kathmandu Valley. Knowledge of aging, attitudes toward older adults and perceptions of working with older adults were assessed using standardized tools, the Palmore Facts on Aging Quiz, Kogan's Attitudes towards Older People Scale, and Nolan's Intent to Work with Older People …

Undergraduate Nursing Students Knowledge Of Aging, Attitudes Toward And Perceptions Of Working With Older Adults In Kathmandu Nepal, Saruna Ghimire, Nitisha Shrestha, Karen E. Callahan, Dhirendra Nath, Binaya Kumar Baral, Nirmala Lekhak, Devendra Raj Singh

Nursing Faculty Research

Objectives:This study aims to examine Nepalese undergraduate nursing students’knowledge of aging,attitudes towards older adults and perceptions of working with older adults, and to assess differences inthese outcomes by socio-demographic characteristics as well as type of nursing program.Methods:A cross-sectional study was conducted among 385 undergraduate nursing students in sixnursing colleges located in the Kathmandu Valley. Knowledge of aging, attitudes toward older adults andperceptions of working with older adults were assessed using standardized tools, the Palmore Facts onAging Quiz, Kogan's Attitudes towards Older People Scale, and Nolan's Intent to Work with Older PeopleQuestionnaire, respectively.Results:The mean knowledge scores on older adults and aging …