Medicine and Health Sciences Commons^™

Symptom Burden And Healthcare Utilization In Pulmonary Arterial Hypertension, Catherina Anne Madani Phd

Dissertations

Background: Pulmonary arterial hypertension (PAH) is a rapidly progressive disease. There is currently no cure; thus treatment is aimed at prolonging survival, improving functional status (FS), and symptom mitigation. Symptom burden (SB) can impact quality of life (QOL), and lead to increased healthcare utilization. Palliative care (PC) has been associated with higher QOL, decreased depression, aggressive care, and mortality. The Institute of Medicine's (IOM) recent report supports earlier integration of PC for people living with serious illness. Detection of patients at high risk for heavy SB may help to identify patients who could benefit from earlier integration of PC into …

Patients With Advanced Lung Cancer: Quality Of Life And Perception Of Dyspnea, Barbara A. Roces Phd, Msn, Np, Rn

Dissertations

Background: Dyspnea perception can be defined as a multidimensional experience of breathing discomfort, influenced by physiological, psychological, social, and environmental factors, that includes secondary psychological and behavioral responses and cannot be defined only by physical objective abnormalities (Mularski et al., 2010). Dyspnea is the most common and distressing symptom in patients with advanced lung cancer and decreases one's quality of life (QOL) (Smith et al., 2001). Furthermore, dyspnea has been found to interfere with physical activities such as walking, work, and psychological activities such as disposition, taking pleasure in life, relationship with others, and sleep (Tanaka, Akechi, Okuyama, Nishiwaki, & …

Patient Care Technology And The Nurse-Patient Relationship, Belinda M. Toole Phd, Msn, Rn

Dissertations

Background: Technological devices are increasingly used in healthcare and their proliferation has providers questioning the impact on the patient-provider relationship. Technological device integration has been studied in the primary care setting, less extensively in the acute care setting. The impact of device use on the nurse-patient relationship in acute care setting required further study, particularly with nursing's history of holistic practice incorporating caring and presence. Objectives: The study purpose was to explore the patient's perceptions of nurse caring and presence when technological devices were used in care delivery in the acute care setting. Specific aims were: 1) to describe the …

Skin Cancer Risk Perception And Sunscreen Use In Adolescent Female Soccer Athletes, Cheryl L. Butera Phd, Msn, Aprn, Fnp-Bc, Np-C, Phn

Dissertations

Over 3.5 million cases of skin cancer are diagnosed annually in the United States. In adolescent females ages 15-19, melanoma is the second most common form of cancer. The greatest risk factor for skin cancer is ultraviolet rays from the sun. Research has shown that sunscreen use is protective of all skin cancers, especially melanoma. The purpose of this study was to obtain perceptions about risk of skin cancer and sunscreen use among 13- to 18-year-old adolescent female club soccer athletes as a basis for effective interventions to improve sunscreen use in this population. The Health Belief Model was employed …

Increasing Patients’ Knowledge In Transmission Of Bacterial Vaginosis And Its Treatment Regimens, Debra Garner

Dissertations

Research has shown bacterial vaginosis to be one of the most common vaginal disorders in women of child bearing age (Chen, Tian, & Beigi, 2009; Centers for Disease Control, 2012; Menard, 2011). Each year many women are seen by their gynecologist, sexually transmitted infection (STI) clinics, and emergency rooms (ER) for complaints of having malodorous discharge (Bradshaw, et al., 2005). Several STI’s and adverse pregnancy outcomes have been attributed to women having bacterial vaginosis (Bradshaw, et al, 2005; Chen, et al.2009; Elkins, & Mayeaux, 2010). Women are predisposed to bacterial vaginosis by the use of wearing non cotton underwear, douching, …

Provider Perception Of Patient Satisfaction If Antibiotics Are Not Given For Upper Respiratory Infection, Robyn Doniel Drake

Dissertations

The purpose of this project was to assess if advanced practice nurse practitioners perceived patient satisfaction of patients seen in Metropolitan Retail Clinics was improved after educational materials were given to explain when antibiotics work. I hypothesized that provider perception of patient satisfaction would decrease unnecessary prescribing of antibiotics after providing patient education? This project used questionnaires to collect data from control and intervention groups to demonstrate a gain in provider perception if patient satisfaction after education was given in the intervention group. The results of this project did not reveal to the primary investigator what was originally assumed, that …

Nutrition, Appetite And Weight Loss In Elders Living In Long-Term Care Facilities, Karene Marie Goodman

Dissertations

Abstract Elders living in long-term care facilities often experience weight loss. Weight loss in elders has been shown to increase their risk of death. Existing research has identified numerous factors associated with appetite and weight loss in elders. Dementia, depression, acute and chronic illness, and medications have all been identified as potential causes of decreased appetite and weight loss in elders. Only a few nutritional and appetite assessment tools exist, and these tools are not widely used in long-term care facilities. The purpose of this descriptive study was to validate the Simplified Nutritional Appetite Questionnaire (SNAQ), an appetite assessment tool …

Influence Of Resources, Resource Loss, And Coping Response On Food Management Practices And Food Security, Simone Perette Camel

Dissertations

Food insecurity has been associated with compromised health and wellness. Current literature regarding coping strategies and practices employed by the food insecure often describes food management and acquisition practices, and/or the riskiness of these practices. Material and personal resources such as income, time, self-efficacy, and social support have been identified as predictors or influencers of food security status. In this study, the Conservation of Resources theory was used to conceptualize resources and resource loss as they relate to food practices and food security. It was hypothesized that the level of resources would influence food security status and the adaptive food …

Fluorine Containing Uv-Curable Materials For Advanced Transport Applications, James Thomas Goetz

Dissertations

The characterization of structure, thermal, gas transport, and free volume properties of two unique UV cured polymeric systems are studied and reported. In the initial pursuit of waterproof high water vapor transport membranes, it became apparent that the UV curing of fluorinated materials yielded routes to develop unique materials that fundamentally challenge conventional models for free volume and light gas transport behavior. UV-curing provides a means to rapidly “lock-in” morphologies that are accessible in the small molecule, monomer phase but rapidly become kinetically inaccessible when constraints such as covalent bonding and cross linking limit motion in the polymer system. This …

Dispositional Optimism: Modeling Cardiovascular Disease Mortality With Traditional Risk Factors And A Psychosocial Personality Trait, Kiana Ramisi Luckett Robinson

Dissertations

Despite increased awareness of clinical risk factors for cardiovascular disease (CVD), heart disease remains a physical and economic burden to African Americans. The aim of this study was to investigate the relationship between dispositional optimism, a psychosocial personality trait, and CVD mortality, based on immediate cause of death. A cross-sectional design was used to examine the predictive value of dispositional optimism in CVD mortality concomitant with traditional CVD risk factors. The traditional CVD risk factors of interest consisted of body mass index, waist circumference, systolic and diastolic blood pressures, total cholesterol, and C-reactive protein. Also, aggregated mortality data for optimists …

The Counselor Experience In Counseling Clients Who Have Been Sexually Assaulted, Carrie J. Tremble

Dissertations

Despite sexual assault being the second highest reported violent crime in the United States, the literature regarding the experience of counselors who counsel clients who have been sexually assaulted is limited. This qualitative study explored and described the lived experiences of 9 counselors who, in the last five years, have provided counseling services to at least five clients who had been sexually assaulted when they were at least 18 years of age. The phenomenological data analysis approach of Moustakas (1994) was utilized to guide the data collection and analysis. Through in-depth, semi-structured interviews, the participants were able to share their …

Efficacy Of Parent-Child Interaction Therapy With The Use Of In-Room Coaching, Cassie Shacklett Reeve

Dissertations

One significant consequence of oppositional and defiant behavior is an increase in negative interactions between caregivers and the child exhibiting those behaviors (Greene & Doyle, 1999). Parent-Child Interaction Therapy (PCIT) is an empirically supported treatment that targets the development of a nurturing parent-child relationship along with teaching effective discipline strategies to decrease child noncompliance (Bodiford-McNeil & Hembree-Kigin, 2010). The purpose of the present study was to evaluate the efficacy of PCIT when modified by utilizing strictly in-room coaching. This type of research would allow for expanded use of this empirically supported treatment into community agencies and clinics which do not …

Instituting A Behavioral Wellness Program And Updating A Clinical Pathway For Economically Disadvantaged Overweight And Obese Adults In A Community Health Center: A Clinical Scholarship Project, Kimberly D. Buck

Dissertations

This project is intentionally instituted in an underserved community in an attempt to bridge the gap of health disparities in a population that would otherwise not have access to such programs. The purpose of this clinical scholarship project is to work with the Midwestern health center to encourage weight loss as well as to promote healthy lifestyles and reduce risk factors among economically disadvantaged persons by: (a) starting a wellness program that incorporates both behavioral and physical health using principles of motivational interviewing and health coaching, and (b) updating a clinical pathway for persons with a body mass index twenty-five …

Nurse Practice Environment And Peripheral Intravenous Infiltrations In A Pediatric Hospital On The Magnet Journey, Jannise Topacio Baclig Phd

Dissertations

Background: Characteristics such as quality patient care, excellence in nursing, and innovations in professional nursing practice shape a health care organization into a "magnet" organization. Magnet designation is a key aspect of nursing, which places pressure on healthcare organizations to commit to nursing excellence and patient care should they take the challenge of attaining this prestige. With growing focus on quality and safety, nursing needs to remain diligent in ensuring a healthy work environment that not only supports the profession, but also sustains exceptional patient outcomes. The purpose of this research study was to describe the relationship of the nurse …

Spatial Mapping Of Macular Pigment Optical Density And Its Relationship To Contrast Sensitivity And Glare Disability, Christopher Michael Putnam

Dissertations

This dissertation explored the relationship of the macular pigment optical density (MPOD) spatial profile with measures of contrast sensitivity (CS), glare disability (GD), relative glare disability (RGD) and intraocular light scatter. A novel device capable of measuring MPOD across the central 16 degrees of retina along 8 principle meridians using customized heterochromatic flicker photometry (cHFP) at eccentricities of 0, 2, 4, 6 and 8 degrees was built. MPOD was calculated as both discrete and integrated values at all measured retinal loci. CS was measured using vertical grating stimuli of 3, 6 and 9 cycles per degree (cpd) also presented at …

Safety Hazards Education For Mothers Who Are Homeless: Target Teaching To Improve Knowledge Of Safety Hazards For Children Under Five Years Of Age, Susan Halpern Fliesher

Dissertations

The leading cause of morbidity and mortality in children in the U. S. is unintentional injury (Center for Disease Control Child Injury Report, 2000 to 2006), but there is little information about homeless mothers with children and child unintentional injury. Frencher et al. (2010) compared lower socioeconomic families with children with housing to homeless families with children, and found that unintentional injury was 13% higher among homeless children. Mothers who are homeless often need to navigate a variety of temporary housing and may lack understanding of child safety hazards in strange environments, limiting their ability to ensure their children’s safety …

Breast Cancer Presentation Delay Among Women In The United Arab Emirates, Yusra E. Elobaid

Dissertations

Breast cancer is the commonest type of malignancy in the United Arab Emirates (UAE) with more than 65% of women diagnosed at an advanced stage. Routine clinical screening has aided in the early detection of breast cancer. However, more than 71% of breast tumors are self-detected. Therefore, exploring factors influencing delayed presentation to treatment after self-detection of breast tumors by Emirati and Arab women in the UAE is essential for improving the survival and the development of effective and targeted health intervention programs. This project explores the reasons behind delayed presentation to treatment by symptomatic women. It uses several approaches, …

Oncolytic Tanapoxvirus Expressing Flic Causes Regression Of Human Colorectal Cancer Xenografts In Nude Mice, Steven J. Conrad

Dissertations

Cancers of the colon and rectum are a significant cause of morbidity and mortality worldwide and existing therapies often perform poorly for individuals afflicted with advanced stage disease. Oncolytic virotherapy is an emerging therapeutic modality which shows great promise for addressing this serious medical need. Herein we describe the in vivo testing of recombinant variants of the tanapoxvirus (TPV), a virus endemic to equatorial Africa which causes a mild and self-limiting disease in humans. Recombinant tanapoxviruses were made deleted for the 66R gene, the 2L gene, or both. Some of the recombinants were armed with mouse chemotactic protein 1 (m …

Testing A Model Of Maladaptive Perfectionism And Depression Symptoms: The Roles Of Emotional Disclosure, Emotion Regulation Strategies, Adult Attachment, And Shame, Angela M. Garrison

Dissertations

Previous research has supported a link between maladaptive perfectionism and higher levels of depression symptoms. However, researchers have not yet investigated the ways in which emotion regulation processes may mediate this relationship. Therefore, the primary purpose of this study was to evaluate emotional disclosure, emotional avoidance, and rumination as mediators of the relation between maladaptive perfectionism and depression symptoms. Additionally, this study also investigated the role that insecure attachment orientations play in the relationship between maladaptive perfectionism and use of particular emotion regulation strategies. Further, the role of shame in the emotion regulation processes of individuals with higher levels of …

Biophysical Characterization Of The First Four Metal-Binding Domains Of Human Wilson Disease Protein, Alia V.H. Hinz

Dissertations

Wilson disease protein (WLNP) is a P_1b-type ATPase crucial for maintaining copper homeostasis in humans. Mutations in this protein result in the autosomal recessive disorder Wilson disease, a condition characterized by copper accumulation in the liver and brain. WLNP provides copper for incorporation into cuproproteins and exports excess copper into the bile for excretion. There are six metal-binding domains (MBDs) in WLNP, found within the first 650 amino acids of this 1,465 amino acid protein. Though each MBD has a different amino acid sequence, all MBDs possess a similar ferredoxin fold with a conserved hydrophobic core and a …

Correlational Studies Of Organophosphate Levels And Endocrine Disruption, Immunomodulation, And Altered Glucose Homeostasis In A Human Population Study, Carrie Mckean

Dissertations

Organophosphate (OP) pesticides have become the most widely used insecticides since the removal of organochlorine pesticides (“Ch4 Organophosphate Insecticides.pdf,” n.d.) and are generally the most toxic of all pesticides to vertebrates (Soltaninejad & Abdollahi, 2009). As a result, ongoing research has been aimed at further understanding potential health effects from exposure.

The aim of this dissertation research project is to investigate and characterize correlations of OP body burden with human health effects. This research involves an investigation into three pertinent areas concerning OP exposure: thyroid disruption, altered hematology biomarkers, and alterations of glucose homeostasis. Data under investigation come exclusively from …

Relative Roles Of Host Exposure And Parasite Establishment In Producing Patterns Of Infection Using Eptesicus Fuscus (Chiroptera: Vespertilionidae) And Its Helminths As A Model System, Elizabeth Warburton

Dissertations

Parasite abundance and community structure could vary depending on conditions that are both extrinsic and intrinsic to the host. Variation in parasite burden, resulting from heterogeneous exposure to parasites or heterogeneous establishment of parasites in the host, often drives transmission dynamics. Changes in parasite community structure influence parasite species diversity and thus, diversity of infection within a single host or entire host population. I sought to quantify relative roles of exposure and establishment in producing patterns of infection using bats, Eptesicus fuscus, and their helminths. I utilized subsets of data from bats captured in 16 colonies from three states …

Quantitative Measurement Of Reciprocal Social Behavior Among Toddlers Aged 18 To 24, Rebecca Sarah Light-Pearlman

Dissertations

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that starts in early childhood. It is characterized by impairments in reciprocal social behavior, impaired language, and stereotypic behavior/restricted interests (Pine, Luby, Abbacchi, & Constantino, 2006). One in 68 children is affected by ASD (Centers for Disease Control and Prevention, 2014). The prevalence of ASD is rapidly increasing. New estimates show a 23% increase in the number of cases since 2009 and a 78% increase in case numbers since 2007 (CDC, 2013). The purposes of this project were to: (a) establish normative parameters of reciprocal social behaviors, among toddlers aged 18 to …

Validation Of The Transportation Burden Questionnaire Among Family Caregivers Of Older Adults, Bryant James Price

Dissertations

Because family caregivers provide a substantial amount of informal care to dependent loved ones, the potential burden such care may place on family members is an important area for clinical research and intervention. While the provision of transportation is recognized in the literature as a caregiving task and a component of global burden, few studies, to date, have addressed this as a distinct concern for measurement and intervention. The purpose of this study was to determine if an item set focused specifically on transportation burden would be additive to accepted global measures of burden in a volunteer sample of caregivers. …

Maximizing Doctor-Patient Communication Of A Positive Hiv/Aids Test Result: A Best Practices Approach, Vikki Yashandra Spann

Dissertations

The purpose of this study was to examine healthcare practitioner (HCP) communication of a positive human immodeficiency syndrome/acquired immunodeficiency syndrome (HIV/AIDS) test result in an effort to find best practices. The population of this study included healthcare practitioners who had to disclose a positive HIV/AIDS status to a patient. Data from specific accounts recalled by the healthcare practitioners were analyzed using grounded theory approach. The first research question was concerned with the strategies used by healthcare practitioners. The results indicated that there are two primary strategies used in HIV/AIDS disclosure: strategic interactive facilitation and strategic interactive force. The second and …

Efficacy Of Mantram Repetition Program On Sleep In Veterans With Posttraumatic Stress Disorder, Lindsay Cosco Holt Phd

Dissertations

Posttraumatic Stress Disorder (PTSD) affects over seven million (3.5%) of the US adult population. In 2011, 476,515 veterans were currently seeking treatment for PTSD. Statistics show that 87% of veterans with PTSD report sleep disturbances and 52% experience frequent nightmares, making sleep the second most common reason why veterans seek mental health care upon return from deployment (Germain et al., 2006). Studies have sought to find a link between PTSD and sleep, and the importance of sleep in the recovery process, but there is a gap in the research on sleep disturbances and interventions for improvement in veterans with PTSD. …

Gestational Weight Gain Patterns, Hope R. Farquharson Phd

Dissertations

Background: Managing gestational weight gain (GWG) remains a global health priority as obesity among women of childbearing age and their children have been linked to excessive GWG. Excessive GWG has been linked to increased rates of cesarean sections, preterm births, hypertensive disorders, gestational diabetes, large for gestational age newborns, postpartum weight retention, long-term obesity for the woman and her children. Conversely, adverse outcomes resulting from weight gain below recommendation could potentially include preterm births, increased rates of neonatal intensive care admission, and newborn morbidity and mortality. Previous studies indicate the need for healthcare providers to help women gain within the …

Is Combat Exposure Predictive Of Higher Preoperative Stress In Military Members?, Eric J. Bopp Phd

Dissertations

Since September 11, 2001, the United States has been engaged in large-scale combat operations exposing numerous military service members to stressful, traumatic, and threatening environments. As a result, many of these individuals have experienced significant psychological problems, such as anxiety, depression, and posttraumatic stress disorder (PTSD), as well as physiological alterations, such as cardiovascular changes and neuroendocrine disturbances. The preoperative experience may be perceived as stressful, often increasing in magnitude as the patient progresses through the preoperative period. Military anesthesia providers frequently provide anesthetic care to military members with a history of combat exposure. Anecdotally, it is not uncommon for …

Identification Of Posttraumatic Stress Disorder Symptoms In Post-Icu Patients, Heather Warlan Phd, Rn, Ccrn

Dissertations

Background: Patients receiving critical care are experiencing post-traumatic stress syndrome (PTSS) as a result of life-saving interventions received in the intensive care unit (ICU). PTSS is associated with poor patient outcomes and decreased quality of life compared to post-ICU patients without PTSS. Personal and clinical characteristics that place patients at higher risk for PTSS are still being examined. It is also unknown to what extent patients are being screened for ICU-induced PTSS. Objectives: This body of work aims to examine the risk factors associated with ICU-related PTSS and describe the screening experiences of patients who recently received care in an …

Delirium Rate And Risk Factors In Palliative Care Outpatients And Caregiver Coping Strategies, Sarah Deur Livermore Phd, Fnp

Dissertations

Background: Delirium causes suffering and in terminal illness undermines important goals to die at home. Improved knowledge about delirium among palliative outpatients can lead to improved patient outcomes through early identification and treatment in the home. Conversely, a missed diagnosis leads to costly hospital admissions, and is the most common reason to seek long-term care placement (Breitbart & Alici, 2008). Medicare stresses the importance by listing it as a common cause of falls among non-reimbursed hospital events. Prior evaluation of outpatient delirium rate was 14% among demented community dwelling elders (Steis, Evans, et al., 2012a). It is hypothesized that frail, …