Medicine and Health Sciences Commons^™

Improving Outcomes By Implementing A Pressure Ulcer Prevention Program (Pupp): Going Beyond The Basics, Amparo Cano, Debbie Anglade, Hope Stamp, Fortunata Joaquin, Jennifer A. Lopez, Lori Lupe, Steven P. Schmidt, Daniel L. Young

Physical Therapy Faculty Research

A multidisciplinary process improvement program was initiated at the University of Miami Hospital (UMH) in 2009 to identify the prevalence of hospital-acquired pressure ulcers (HAPU) at the institution and to implement interventions to reduce the incidence of HAPU. This deliberate and thoughtful committee-driven process evaluated care, monitored results, and designed evidence-based strategic initiatives to manage and reduce the rate of HAPU. As a result all inpatient beds were replaced with support surfaces, updated care delivery protocols were created, and monitored, turning schedules were addressed, and a wound, ostomy, and continence (WOC) nurse and support staff were hired. These initial interventions …

Understanding The Irony: Canadian Gay Men Living With Hiv/Aids, Their Catholic Devotion, And Greater Well-Being, Renato M. Liboro, Richard T.G. Walsh

Psychology Faculty Research

Nine Canadian Catholic HIV-positive gay men were interviewed to obtain a better understanding of why and how they were able to persevere in their faith despite their religion’s teachings against homosexuality and contributions to the stigmatization of HIV/AIDS. By examining the lived experiences and personal perspectives of the participants, the study aimed to explore and elucidate the significant role of Catholicism and the Catholic Church both as a continued source of marginalization and oppression, as well as strength and support, for Canadian gay men living with HIV/AIDS today.

Obstetrician-Gynecologists’ Knowledge Of Health Disparities And Barriers Among American Indian/Alaska Native Women In Washington State, Katherine M. Jones, Greta B. Raglan, Sophia M. Lannon, Jay Schulkin

Journal of Health Disparities Research and Practice

Background: Health disparities between American Indian/Alaska Native (AI/AN) women and other races/ethnicities have long been noted. Obstetricians-Gynecologists (Ob-Gyn) play a significant role in well-woman care and are often the first and most frequent point of medical contact for women, particularly among minority and low-income women.

Objective: This study aimed to assess Ob-Gyns’ knowledge, beliefs, and practices related to health disparities among AI/AN women.

Method: A self-administered questionnaire, consisting of questions about knowledge, beliefs, and practices of health disparities among AI/AN women, was mailed to 722 members of The American College of Obstetricians and Gynecologists (ACOG) practicing in the state of …

Disparities In Hospital Services Utilization Among Patients With Mental Health Issues: A Statewide Example Examining Insurance Status And Race Factors From 1999-2010, Viann N. Nguyen-Feng, Hind A. Beydoun, Michael K. Mcshane, James D. Blando

Journal of Health Disparities Research and Practice

There exist many disconnects between the mental and general health care sectors. However, a goal of the Affordable Care Act (ACA) of 2010 is to change this by improving insurance access and the intersection of mental and general health care. As insurance status intersects with race, the present study examines how race, insurance status, and hospital mental health services utilization differ across groups within the state of New Jersey. The present study aims to determine trends in hospital mental health care utilization by insurance status and race from 1999 to 2010. The rate of self-pay for mental health disorders in …

Factors Influencing Hpv Vaccine Use Among Racially Diverse Female College Students, Timmerie F. Cohen, Jeffrey Legg

Journal of Health Disparities Research and Practice

Abstract

Objective. This study describes Human Papillomavirus (HPV) vaccination rates and possible factors influencing vaccination utilization rates in a diverse population of college women 18-26 years old.

Methods. The National College Health Assessment survey provided a large diverse sample size (N=67,762) in which to perform descriptive and binary logistic regression analysis. Demographic characteristics were analyzed as potential barriers to HPV vaccination. Additionally, lack of certain health behaviors were explored as potential barriers to HPV vaccination.

Results. In this study, White/non-Hispanic women had a higher HPV vaccination rate when compared to minority women. Binary regression analysis demonstrated that minority …

Modeling Bmi, Dietary Habits, And Physical Activity Among Ethnically Diverse Urban College Students, Hollie Jones, Nicholas Freudenberg, Lorraine Mongiello

Journal of Health Disparities Research and Practice

Objectives The objective of this research study was to examine the relationship between BMI, physical activity, dietary habits, and student demographic factors (age, ethnicity, income, immigration, and sex). Given the association between overweight and obesity and the inequitable burden of chronic health conditions among ethnic minority populations, a deeper understanding of the socioeconomic, gender, age, and racial/ethnic variation in BMI, physical activity, and dietary habits is needed. The shifting demographics of urban college populations make urban college campuses an important setting for addressing the lifetime health needs of ethnically diverse urban populations.

Methods In this cross-sectional non-experimental study, we used …

Addressing Disparities In Access To Information For Hispanic Families Of Children With Special Health Care Needs, Suzanne M. Bronheim, Sandra Soto, Bruno J. Anthony

Journal of Health Disparities Research and Practice

Objectives: Utilizing a diffusion of innovation (DOI) framework, the study seeks to increase access to information for Hispanic families of children with special health care needs (SHCN) by increasing their use of Family-to-family Centers (F2Fs) in their states. Methods: Focus groups were implemented of both English-speaking and Spanish-speaking Hispanic families in two states with a confirming Delphi procedure exploring factors within DOI framework related to using F2Fs and the nature of current family communication networks. Results: Families seeking information at key change points turn to formal sources, although Spanish-speaking families, noted that due to language barriers, they also turned to …

Personal, Family, And Peer Correlates Of General And Sport Physical Activity Among African American, Latino, And White Girls, Susan C. Duncan, Lisa A. Strycker, Nigel R. Chaumeton

Journal of Health Disparities Research and Practice

This study examined associations between personal, family, and peer variables on objectively measured physical activity (PA), and sports participation, of African American, Latino, and white girls. Specific variables included barriers efficacy, parent PA, parent support of PA, the home exercise environment, friends’ PA, and friends’ support of PA. The sample comprised 372 girls (mean age = 12.03 years; SD = 1.81; n = 128 African American, n = 120 Latino, and n = 124 white). Data were analyzed using multiple-sample structural equation models (by ethnicity), controlling for age, household income, body mass index, and physical development. Girls’ moderate to vigorous …

The Self-Reported Sexual Behaviors Of Single Older African Americans, Victoria Foster, Patricia C. Clark, Marcia M. Holstad

Journal of Health Disparities Research and Practice

Abstract

African Americans are disproportionally affected by HIV/AIDS, but little is known about the risky sexual behaviors of older African Americans. This cross-sectional, comparative study, investigated the self-reported sexual behaviors of sexually active older African Americans. The nonrandom sample (N = 78) included single African American men (59%) and women (41%), 50-74 years of age. Participants were recruited from various community sites, and data were collected with a standard sexual history questionnaire. Participants reported practicing risky behaviors such having unprotected oral, anal, and vaginal sex (96.5%), and having multiple sex partners (37.2%). There were several significant gender differences such …

Concordance Of The Montreal Cognitive Assessment With Standard Neuropsychological Measures, Sally J. Vogel, Sarah J. Banks, Jeffrey Cummings, Justin B. Miller

School of Medicine Faculty Research

Introduction: The concordance of the Montreal cognitive assessment (MoCA) with more comprehensive neuropsychological measures remains unclear. This study examined the individual MoCA domains with more comprehensive and commonly used neuropsychological measures to determine the degree of overlap. Methods: Data included individuals seen in an outpatient neurology clinic specializing in neurodegenerative disease who were administered the MoCA and also underwent neuropsychological assessment (n = 471). A principal component analysis with varimax rotation was completed using the MoCA domain scores and comprehensive neuropsychological evaluation measures. Results: Four factors emerged accounting for 55.6% of the variance: (1) visuospatial/executive functioning; (2) memory; (3) attention; …

Improving Influenza And Tdap Vaccination During Pregnancy: A Cluster-Randomized Trial Of A Multi-Component Antenatal Vaccine Promotion Package In Late Influenza Season, A. T. Chamberlain, K. Seib, K. A. Ault, E. S. Rosenberg, Paula M. Frew, M. Cortés, E. A. S. Whitney, R. L. Berkelman, W. A. Orenstein, S. B. Omer

Environmental & Global Health Faculty Research

Background Evidence-based interventions to improve influenza vaccine coverage among pregnant women are needed, particularly among those who remain unvaccinated late into the influenza season. Improving rates of antenatal tetanus, diphtheria and acellular pertussis (Tdap) vaccination is also needed.

Intraprofessional Nursing Communication And Collaboration: Apn-Rn-Patient Bedside Rounding, Rita M. Herm-Barabasz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Executive Summary

Leading advisory agencies have long advocated that health care must be safe and effective (Institute of Medicine [IOM], 2001). In order for health care to be safe and effective, good communication and collaboration are essential. Research has found that in health care, poor communication and teamwork failures are the major contributors to adverse events (Cornell, Townsend-Gervis, Vardaman, & Yates, 2014; The Joint Commission, 2011; O’Leary, 2012). Such communication-related adverse events can cause avoidable injury, loss of life, and financial devastation. In light of advanced practice nurses’ (APN) increasing contribution in care management, and in order to ensure delivery …

A Comparison Of The Effects Of Different Doses Of Gabab Receptor Ligands On Spatial Learning And Memory And Memory Flexibility, Chelcie Heaney

UNLV Theses, Dissertations, Professional Papers, and Capstones

The principal inhibitory neurotransmitter in the brain, gamma amino-butyric acid (GABA), mediates several types of learning and memory. Of the two main receptor subtypes for GABA, the in vivo role of GABAB receptor in learning and memory is less well characterized and the current data often conflict. Based on the current literature, it is unclear, for instance, whether enhancing GABAergic activity via the GABAB receptor could be beneficial for or detrimental to learning and memory. Hippocampally-dependent learning and memory tasks are of particular interest due to their clinical relevance to patients with schizophrenia or Alzheimer’s disease, who exhibit impaired performance …

The Impacts Of A Smoking Ban On Gaming Volume And Customers' Satisfaction In The Casino Industry In South Korea, Sojeong Lee

UNLV Theses, Dissertations, Professional Papers, and Capstones

A growing number of countries have legislated smoke-free policies in enclosed public areas and have extended the policies to hospitality facilities. However, some states and countries exempt gaming areas from the smoking law fully or partially. Anti-smoking policy is controversial for a number of reasons, such as smokers’ strong opposition, government ordinance, public health, and economic anxiety. Casino management may worry that a smoking ban policy will result in a significant decline of casino revenue because the break for smoking may interfere with continuing play.

This thesis examined a smoking ban impacts on gaming volume and customers’ satisfaction in the …

Comparing Functional Motor Control And Gait Parameters In Children With Autism To Those Of Age-Matched Peers Who Are Typically Developing, Patricia Stevenson, Samantha Novotny, Jillian May, Christopher Ancell

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to compare motor performance of children with Autism Spectrum Disorder (ASD) to that of age-matched peers who are typically developing (TD) on motor control tasks plus symmetry and variability of gait parameters across four walking conditions. A sample of convenience of children with ASD (n=6) and peers who are TD (n=6) were recruited. Motor control was assessed using initiation and completion times on the Timed Up and Go (TUG) test. Gait parameters were collected using a computerized walkway under four trial conditions: 1) walking at self-selected velocity (SSV); 2) walking during a tray-carrying task …

The Effects Of Instruction On Landing Strategies In Female College-Aged Dancers And Non-Dancers: A Pilot Study, Brittany Keating, Jason Pyfer, Kimberly Vialpando

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background Female athletic participation has increased over the past decade and with it the prevalence of knee injuries. Current research demonstrates an increased risk of anterior cruciate ligament (ACL) injury for female athletes. However, a number of studies have pointed out that ballet and modern dancers exhibit a lower incidence of ACL injuries despite the fact that they perform jumping and landing frequently.

Objective The objective of this study was to examine how dance experience and instruction affect the lower extremity biomechanics during drop landings. Specifically, lower extremity joint alignment and muscle activation of gluteus maximus and gluteus medius were …

The Effects Of Enhanced And Decreased Expectations On Balance Performance In Those With And Without Parkinson’S Disease, Joshua Ostrander, Granuaile Parrish, Jacob Blood

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: It has been reported individuals typically perform well on a task when enhanced expectancy was provided prior to task performance. It has also been reported people with Parkinson’s disease (PD) are especially susceptible to pre-task placebo cuing and suggestion. Evidence of this susceptibility has been previously demonstrated through brain imaging studies and with demonstration by individuals with PD improved balance performance.

Objective: This study was designed to further previous studies’ results for improved task performance with enhanced expectancy. The purpose of this study was to investigate if the pre-task verbal delivery of enhanced expectancy, decreased expectancy and no expectancy …

Comparing Usability And Variance Of Low- And High Technology Approaches To Gait Analysis In Health Adults, John Mcconnell, Brian Silverman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: The purpose of this study was to compare the usability, reliability, and objectivity of four tools that represented varying gait analysis technologies used in clinical practice and/or research. Low technology clinical tools included the Gait Abnormality Rating Scale (GARS-M) and the Rancho Los Amigos Observational Gait Analysis (Rancho OGA). High technology tools included the GAITRiteÒ computerized walkway, and the APDM Mobility LabÔ wearable sensor system.

Subjects: 74 healthy adults ages 18-41 years (mean = 24.82, SD = 4.39) 33 males and 40 females.

Methods: Subjects were instructed to walk at a self-selected speed for two minutes …

Four Weeks Of Minimalist Style Running Training Reduced Lumbar Paraspinal Muscle Activation During Shod Running, Stephanie Barton, David Brown, Talia Joyce

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Research has shown that the risk of low back dysfunctions in runners is related to the increased mileage of distance running. Repetitive shock loading of the spinal structures during running has been indicated as one of the important biomechanical mechanisms underlying such injury. Acute changes in foot strike pattern, like those seen during minimalist style running, have been shown to lead to modifications in lumbar range of motion. Minimalist style running could lead to changes in lumbar biomechanics and muscle activation, potentially reducing the loading on the musculoskeletal structures of the lower back. However, the long term …

Nurse Managers' Hiring Selection Of Newly Licensed Rns: A Grounded Theory Approach, Susan Adamek

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this research study was to construct a substantive grounded theory regarding how acute care nurse managers select the newly licensed RNs (NLRNs) they hire. This is important because a good selection process can reduce expensive employee turnover and improve teamwork on units. There has been extensive research regarding interventions that improve the retention of NLRNs after they are hired, such as residency programs, preceptors, mentors and support groups, but there is very little in the literature about the processes or preferences nurse managers use to select the right candidates to be hired. A constructivist grounded theory approach …

Changes In Sprint Kinetics Or Kinematics Following Static Or Dynamic Stretching, Kristyne Bartel

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to determine the effects of static or dynamic stretching on hip kinematics and kinetics during intermittent sprinting. To achieve this aim, intermittent sprint athletes were asked to complete either a static or dynamic stretch, followed by a repeated-sprint protocol. Hip joint kinematics and performance measures were evaluated during the sprint, including changes that occurred in these variables over the course of the sprint protocol. In addition, hip flexion torque was measured with an isokinetic dynamometer. Ten male (age = 25±2.3 years, 175±3.2 cm, 76.2±2.7 kg) and female (age = 20±1 years, 166±1.3 cm, 60±1.1 …

Increasing Comfort With End-Of-Life Discussions, Theresa Catherine Berton

UNLV Theses, Dissertations, Professional Papers, and Capstones

End-of-life discussions and advanced care planning are part of the healthcare process, and within the scope of practice for providers. Despite the evidence supporting the effectiveness of these conversations, the system falls short. Talking about death is never easy. At times, it is difficult for healthcare providers to approach the topic with patients who are living with serious life-limiting illness. Reports in the end-of-life literature reveal that healthcare professionals avoid discussions about preparations for end-of-life care due to feeling unprepared, and a lack of framework for such discussions. Purpose: The purpose of this doctoral project was to improve the quality …

The Design, Build, And Validation Of A Hybrid Tower Used To Conduct Helmet Impact Tests, Darren Benn

UNLV Theses, Dissertations, Professional Papers, and Capstones

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) was established to enlist research directed towards the reduction of head injuries in organized sports. The function of the test methods developed by NOCSAE is to provide the blueprint for reliable and repeatable procedures to measure the evaluation of various types of protective sports headgear and projectiles. In addition, the methods also govern hardware such as testing apparatus and data acquisition instrumentation. In helmet testing, the method dictates whether the impact is induced by a projectile system or by a drop tower system with an anvil at the base. Altogether, …

Understanding The Experience Of Medicare Advantage Patients In A Health Maintenance Organization, Curtis E. Boldman

UNLV Theses, Dissertations, Professional Papers, and Capstones

This study was conducted using a single Health Maintenance Organization in Las Vegas, NV to determine the key drivers and attributes of quality in the patient experience for Medicare Advantage holders. The purpose of this study was to investigate these perceptions of quality to assist the provider in identifying the areas in their treatment process which could be refined in order to better serve their customer base. With the recent changes in healthcare laws, patient satisfaction is now a key determinant in the financial compensation providers receive for services performed.

Data was collected by doing patient intercepts outside of the …

Slip, Trip And Fall Risk Among Elderly Men And Women Living In The Hawaii Adult Foster Care Home System, Michelle Echauz Ching

UNLV Theses, Dissertations, Professional Papers, and Capstones

Adults 65 years of age and older (hereby referred to as “elderly”) are one of the fastest growing populations in the United States (U.S.). A major public health concern affecting the elderly population is unintentional injuries, particularly slips, trips, and falls (STFs). While there is extensive research on STFs among the elderly living in the community and long-term health care facilities, little to no research is found on STFs among the elderly living in community-based health care facilities. Research has also shown that STFs are caused by the interaction between multiple risk factors. Therefore, the purpose of this quasi-experimental study …

Reliability Of A Multisegment Foot Model In Shod Running, Austin Coupe

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to determine kinematic and marker placement reliability of the Leardini multisegment foot model (LMFM) for tracking foot kinematics during barefoot and shod running without alteration of footwear. Eleven participants, five males (25.6±5 yrs, 73±15.8 kg, 1.75±0.05m) and six females (22.5±2.9 yrs, 66.6±7.2 kg, 1.71±0.05 m) granted institutionally approved written consent to participate. Three-dimensional motion capture (10 Vicon T40-S cameras) was used to capture kinematic data at 200Hz. Kinetic data was captured with an in-ground force platform (Kistler Instruments AG, Switzerland Model 9281B 60x40cm, 2000Hz). Participants were instructed to run at 3.5m/s ±5%. Velocity was …

Athletes’ Perceptions Of Athletic Trainers Quality Of Care, Chadley Foster

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to explore student athletes’ perceived satisfaction of care from certified and licensed athletic trainers (ATC) and satisfaction of care between full time and graduate student ATCs at University of Nevada, Las Vegas (n=61). Studies identify satisfaction as a method to measure quality of care and its influence on many aspects of athletes’ success including health outcomes. This is the first study that evaluated multiple aspects of care including type and length of sport participation, academic class status, number of ATCs seen, primary ATC (graduate or full time), number of interactions with primary ATC, injury, …

Patient Service Quality And Health Maintenance Organizations: Not An Oxymoron, Jessica Mcbeath

UNLV Theses, Dissertations, Professional Papers, and Capstones

Today’s quality movement in health care has driven the importance of patient satisfaction and experience across the industry. While the subject is of huge interest to researchers and health care companies, many struggle to identify a unified list of attributes that are applicable globally. Due to the industry’s uniqueness, it becomes necessary to understand the population and specific attributes for each. In review of previous service quality research, this study presents many dimensions and attributes for application. Using existing service quality framework 5Qs, this study provides unique findings correlated to existing literature and presents actionable items.

Purpose: The purpose of …

Comparison Of Muscle Latencies For Diabetic Neuropathy Patients Versus Healthy Controls During A Perturbed Balance Task, Kyle Mefferd

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to compare muscle latencies for patients diagnosed with diabetic neuropathy versus healthy controls during a perturbed balance task, with a secondary purpose to distinguish postural control strategies the groups used based on the muscle latencies. Five participants diagnosed with diabetic neuropathy (DN; 4 male, 99.7 ± 7.95 kg, 176 ± 9.58 cm, 46.6 ± 16.55 years) and 5 healthy control (HC; 4 male, 100.36 ± 12.61 kg, 173.76 ± 9.66 cm, 47 ± 13.42 years) participants were recruited. Participants granted institutionally approved written consent before participating. Delsys Trigino Wireless EMG sensors were placed on …

Survival Of The Fittest: The Role Of Linguistic Modification In Nursing Education, Brenda Strauch Moore

UNLV Theses, Dissertations, Professional Papers, and Capstones

This project’s long term goal was to improve English-as-a-Second-Language (ESL) nursing student retention. Improving the quality of multiple choice exams is a first crucial step. ESL students find multiple-choice exams to be one of the most challenging aspects of nursing school. One reason for this is the presence of linguistic errors in exam questions. Linguistic errors include: irrelevant question content, poor sentence structure, and culturally biased words or phrases. Non-ESL students are less affected because exams are written in their native language. Linguistic modification, as part of best practices in item writing, removes these types of errors. The U.S. Department …