Medicine and Health Sciences Commons^™

Exploring The Patients’ And Family Members’ Perspectives On Home-Based Palliative Care, Nadia Sultan Ali

Theses & Dissertations

Background: Home health care is considered as a partial substitute for institutional long-term care, because patients and families with known poor prognoses prefer to stay home with their loved ones and people mostly cannot bear the cost of care at the hospital. Therefore, the importance of home-based palliative care is raised via a shared and coordinated model for saving lives through care.
Purpose: To explore patients' and family members' perspectives and experiences of receiving home-based palliative care services.
Method: This was a qualitative exploratory study conducted in Karachi, targeting patients and family members receiving home-based palliative care services. The data …

Prevalence Of Depression In Patients With Cardiovascular Diseases, Faryal Ghafoor

Theses & Dissertations

Background: Approximately 17.3 million individuals across the globe lose their lives to cardiovascular diseases (CVD), with a majority of these cases occurring in low-to-middle-income countries. The incidence of cardiovascular disease in Pakistan is 918 cases per 100,000 individuals. Depression frequently impacts the health, expenses, and prognosis of patients with cardiovascular disease.
Purpose: This study aimed to determine the prevalence of depression among CVD patients at Aga Khan University Hospital, Karachi, and explore the influence of co-morbidities, marital status, age, and educational background on one's status, regarding depression.
Method: A quantitative descriptive cross-sectional study was conducted at the Aga Khan University …

Comparison Of Physical Activity Levels Among School-Age Adolescents In The Rural And Urban Areas Of District Swat Kpk, Pakistan- An Analytical Cross-Sectional Study, Imran Uddin

Theses & Dissertations

Background: Obesity and overweight represent significant global public health concerns. Young adolescents are in particular increasingly experiencing obesity and overweight due to their sedentary lifestyles, excessive electronic media use, and lack of physical activity (PA). This trend is linked to the development of non-communicable diseases in later life. Moreover, data regarding the lack of PA is available in Pakistan, but a gap exists in the comparative analysis of physical activity levels between rural and urban adolescents. Rural and urban areas exhibit distinctions in both geographical settings and technological advancements, potentially influencing the PA levels of their respective inhabitants.
Purpose: The …

Factors Hindering The Care Of Geriatric Patients Admitted In A Tertiary Care Hospital In Karachi, Pakistan, Muhammad Shoaib

Theses & Dissertations

Background: Older adult’s patient care presents multiple challenges to nurses due to their growing numbers worldwide. According to WHO in 2020 the number of older adults aged 60 and above is one billion and by 2050 this population will be doubled. The current geriatric population of Pakistan is above eight million and is estimated to reach twenty-seven million by 2050. This increasing trend of the geriatric population poses a greater challenge to the compromised healthcare systems in Pakistan, healthcare workers especially nurses struggle hard due to limited resources, lack of knowledge regarding geriatric, and the frailty of older patients, to …

The Experiences Of Nurses Regarding Practice Change In Maintaining Nine Months Clabsi-Free Medical Intensive Care Unit: A Qualitative Study At A Tertiary Care Hospital, Karachi, Pakistan, Safia Islamuddin

Theses & Dissertations

Background: CLABSI’s are serious healthcare-associated infections resulting from central venous catheters which are predominantly used in ICUs. Nurses, as frontline caregivers, play a critical role in preventing CLABSIs. Their views often highlight the importance of strict protocols, vigilance, and teamwork to minimize CLABSI risks, enhancing patient safety. Studies in low-middle countries like, Pakistan till yet have focused on investigation CLABSI incidents, knowledge of it and associated factors. From a unit with a long-term record of being free from CLABSIs can offer valuable insights into identifying best practices, replicating them, and understanding the obstacles involved in achieving a CLABSI-free environment.
Objectives: …

Experiences Of Indigenous Women With Maternal Nutrition In Climate Change (Cold Weather) In Rural Bajaur, Khyber Pakhtunkhwa, Pakistan: Implications For Maternal-Infant Health, Ihsan Ullah

Theses & Dissertations

Background: Pakistan is one of the countries that is most susceptible to the effects of climate change. The country’s Northern regions have experienced several extreme cold weather events, including floods, heavy snowfall, and heavy rains, in recent years, significantly impacting maternal and infant health. Indigenous child-bearing age women in the northern rural areas are the most vulnerable populations experiencing food insecurity, disruptive food systems, increasing food prices, and disrupting food production due to climate change exacerbation.
Aim of the study: The study aimed to explore the experiences of indigenous women with maternal nutrition in harsh winter caused by climate change …

Nursing Faculty Perspective On Simulation Based Education: A Qualitative Exploratory Study At Public And Private Nursing Schools In Karachi, Pakistan, Saira Mehboob Ali Lalani

Theses & Dissertations

Background: Simulation-based education (SBE) provide novice and proficient student nurses a platform to learn and practice skills in a simulated environment, to become safe and competent nurses. This pedagogy is especially beneficial for those studying healthcare-related domains, as it permits students to gain hands-on expertise that is much more real and facilitating than the traditional methods of teaching. The role of nursing faculty is crucial in this process. Purpose The purpose of this study was to investigate the perceptions of nursing faculty members regarding SBE, as well as the facilitators and barriers of SBE.
Research Methods: An exploratory qualitative research …

Stress And Its Associated Factors In Mothers With Preterm Infants In A Private Tertiary Care Hospital Of Karachi, Pakistan, Salima Akbar

Theses & Dissertations

Background: Preterm births are the leading cause of death worldwide. Preterm births not only have devastating effects on the new born, but they also have psychological effects on the mothers. Identifying stress related to preterm births, and the factors associated with the stress among mothers with preterm infants is of great importance, for providing sound care to the newborns and their mothers. This study aimed to assess the level of stress and the factors associated with increased level of stress among mothers with preterm infants, in a tertiary care hospital in Karachi, Pakistan.
Purpose: The study aimed to answer the …

Experiences Of Sexual And Reproductive Health Among Women Undergoing Haemodialysis In Pakistan: A Descriptive Phenomenological Study, Misbah Zafar

Theses & Dissertations

Background: Sexual and reproductive health is an essential component of a woman’s life that includes respectful and satisfying sexual relationships without coercion and violence, as well as couples' decisions about whether and when to have children. Reproductive-age women undergoing haemodialysis experience numerous sexual and reproductive health challenges as a consequence of their physical and psychological health conditions, negatively impacting their overall well-being. However, they are reluctant to seek assistance from healthcare professionals despite having many sexual and reproductive health issues. Concerning this, it was necessary to explore in-depth, the phenomenon of lived experiences of sexual and reproductive health among reproductive-age …

The Knowledge, Experiences, And Barriers Associated With Male Involvement In Family Planning At Lal Qila, District Dir (Lower), Kpk, Pakistan: A Descriptive Exploratory Study, Jalal Khan

Theses & Dissertations

Background: Pakistan is one of the world’s most populous countries with a high growth rate. The overgrowth in population negatively affects the country’s socioeconomic progress in many aspects, like education, housing, employment, and health. Family Planning (FP) is the best way to reduce the fertility rate and control population overgrowth through contraception. FP positively impacts the mother's health and the productive results of every pregnancy.
Purpose: This study aims to explore the knowledge, experiences, and barriers associated with male involvement in family planning.
Method: A qualitative exploratory design was used with a purposive sampling technique to explore the perceptions of …

Concept Of Health-Related Quality Of Life Among People With Heart Failure In Karachi, Pakistan, Anny Ashiq Ali

Theses & Dissertations

Background: Non-communicable diseases (NCDs), including cardiovascular diseases, are a leading cause of global mortality. The mortality rate for cardiovascular diseases is on the rise, with 80 % to 86 % of fatalities, particularly in low- and middle-income countries, including Pakistan. Among NCDs, heart failure (HF) is a condition for which there is no cure, and patients rely on supportive treatments to maintain their quality of life. HF not only affects physical well-being but also has far-reaching consequences on the emotional, social, and cognitive aspects of life. In the context of Pakistan, where unique healthcare, sociocultural, and economic factors prevail, the …

Nurses’ Perceptions Regarding The Use Of The Nursing Process; A Descriptive Qualitative Study At Hayatabad Medical Complex, Peshawar, Pakistan, Kashif Khan

Theses & Dissertations

Background: The Nursing Process (NP) is a comprehensive approach to care, integrating nursing intuition, goal-oriented tasks, patient-centered care, critical thinking, and evidence-based practice (EBP). It aims to enhance patient outcomes and well-being by identifying, treating, and preventing health problems. Widely acknowledged as a valuable instrument in healthcare, it emphasizes the crucial function of nursing. This study fills the gap in the literature by exploring nurses' perspectives on the utilization of the NP in Pakistan.
Purpose: The study aimed to explore nurses' perceptions regarding the use of the nursing process and to identify the barriers and facilitators to its implementation in …

Exploring The Lived Experience Of Significant Other Caregivers Providing Care To Partners Surviving A Spinal Cord Injury, Lisa Ann Lumley

Theses & Dissertations

According to the World Health Organization, 250,000 to 500,000 people worldwide have suffered a spinal cord injury. Significant others may become caregivers responsible for meeting the needs of the dependent partner. The focus of this study is on significant other caregivers’ experiences providing care for partners after a spinal cord injury. The effects of stress from providing care may be detrimental to caregivers' psychological and physical well-being. Psychological distress, such as anxiety and depression in caregivers, is a significant public health issue that affects the quality of life for millions of individuals. There is a lack of studies focusing on …

Exploring The Experiences Of Mothers Who Attended The Kangaroo Mother Care Facility In A Tertiary Care Hospital In Swat, Pakistan: A Descriptive Qualitative Study, Muhammad Nasir

Theses & Dissertations

Background: Globally, four million neonates die yearly, and the substantial reasons for the deaths are low birth weight and being preterm. The neonate mortality rate was 18 per thousand live births in the year 2021, which means that approximately 7000 deaths occur worldwide daily. Pakistan is among the top ten countries with many preterm births.
Purpose: To explore the mother’s experiences with KMC, and the motive is that it will reduce the neonate's mortality rate by preventing preterm babies from hypothermia.
Method: A qualitative descriptive study design was used to explore the mothers’ experiences who attended the KMC facility. The …

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 …

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 …

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 …

The Importance Of Contrast Sensitivity, Color Vision, And Electrophysiological Testing In Clinical And Occupational Settings, Frances Silva

Theses & Dissertations

Visual acuity (VA) is universally accepted as the gold standard metric for ocular vision and function. Contrast sensitivity (CS), color vision, and electrophysiological testing for clinical and occupational settings are warranted despite being deemed ancillary and minimally utilized by clinicians. These assessments provide essential information to subjectively and objectively quantify and obtain optimal functional vision. They are useful for baseline data and monitoring hereditary and progressive ocular conditions and cognitive function. The studies in this dissertation highlight the value of contrast sensitivity, color vision, and cone specific electrophysiological testing, as well as the novel metrics obtained with potential practical clinical …

The Efficacy Of Analgesic Subdissociative Dose Ketamine In Trauma Casualties Treated By U.S. Military Special Operations Medical Professionals In A Prehospital Environment, Darin Schwartz

Theses & Dissertations

Research Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty …

Effect Of Computerized Cognitive Training In Persons With Multiple Sclerosis, Sam Jack

Theses & Dissertations

Between one million and 1.75 million persons with multiple sclerosis (PwMS) worldwide are estimated to suffer from cognitive impairment. Unfortunately, there is currently no consensus on the best treatment for cognitive impairment in PwMS. Finding non-pharmacological interventions to mitigate cognitive decline is essential to ensure that quality of life for PwMS matches our ability to treat and mitigate their physical symptoms of MS. Computerized cognitive training has emerged as a potential option for PwMS suffering from cognitive impairment. The objective of this study was to determine the effectiveness of computerized cognitive training with BrainHQ on changes in cognitive impairment for …

Evaluating The Impact Of Routine Enteral Iron Fortification On Gastrointestinal Dysbiosis In Premature Infants, Matthew Van Ormer

Theses & Dissertations

The gastrointestinal microbiome in preterm infants bears significant influence on optimal outcomes – dysbiosis is shown to substantially increase the risk of the life-threatening necrotizing enterocolitis, whereas optimal microbiome composition improves nutrient digestion and immune function. Iron is a vital nutrient especially during the perinatal window of rapid hemoglobin production, tissue growth, and foundational neurological development. However, excess colonic iron exhibits potent oxidation capacity and alters the competitive environment of microbes – potentially facilitating the proliferation of pathological bacterial strains in the gut. Of note, breastfed preterm infants routinely receive iron fortification starting at 14 days of life and are …

Variations In Source And Pattern Of Arterial Supply To The Trigeminal Ganglion With Clinical Relevance, William S. Srinivasan

Theses & Dissertations

The trigeminal ganglion (TG) is known to receive its arterial supply from branches of the internal carotid artery (ICA), middle meningeal artery (MMA), accessory meningeal artery (AMA), or superior cerebellar artery (SCA). Existing information about the prevalence and patterns of blood supply to the TG is limited despite their high clinical relevance to basicranial surgeries. The objective of this study is to investigate the source and pattern of arterial supply to TG and discuss their clinical relevance. Left and right TG were examined on 75 embalmed human cadavers from an ethically approved anatomical donor program. A literature review was conducted, …

Cystic Duct Morphology And Heister Valves: A Cadaveric Study, Cierra R. Goerish

Theses & Dissertations

Continued occurrence of cholelithiasis, gallstones, commonly results in cholecystectomy, removal of the gallbladder. Having a comprehensive anatomical, histological, and physiological knowledge of the biliary apparatus is imperative in clinical medicine today. Additionally, the functionality of cystic duct (CD) Heister valves (HV) has been speculatory since being reported in 1732. This study summarizes the morphology, orientation, and variability of the gross biliary system and provides data to help justify HV functionality.

Cadaveric dissection was utilized for gross observation and analysis of the biliary system. The angulation of the CD was found primarily as an acute angle; however, obtuse angulation could be …

Mechanisms Of Mutated Myosin Vb Mediated Cholestasis In Microvillus Inclusion Disease, Melissa S. Holzapfel

Theses & Dissertations

Microvillus inclusion disease (MVID) is a constitutive intestinal epithelial disease which causes definitive intestinal failure and cholestatic liver disease primarily caused by mutations in the Myosin Vb gene. Genotype-clinical phenotype associations suggest that the progression of liver disease can be predicted through a correlation between myosin Vb residual function and variable retention of bile salt transport machinery in intestinal enterocytes and liver hepatocytes. We proposed that aberrant distribution of bile salt transport proteins disrupts enterohepatic regulation of bile acids and contributes to the progression of cholestatic liver disease. To investigate the genotype-phenotype correlation, samples from MVID patients were evaluated for …

Use Of Pre-Transplant Cmi To Predict Infection And Mortality Post-Cardiac Transplantmortality Post-Cardiac Transplant, Chetaj A. Mahabir

Theses & Dissertations

This paper discusses a study investigating the relationship between the cell-mediated immunity (CMI) level before cardiac transplant and the incidence of infection and mortality after the transplant. CMI is an important measure of a person's immune system. The study included 126 patients who underwent cardiac transplants between September 2011 and January 2020. Out of these, 21 patients had a low CMI level (<225), and 105 had a high CMI level (≥ 225) before transplant. The mean CMI level in the low CMI group was 175.3, while in the high CMI group, it was 479.9. The two groups were similar except for the lower white cell count and cardiac output in the CMI< 225 groups and the higher Caucasian demographic in the CMI≥ 225 groups. The study concludes that patients with lower CMI levels before cardiac transplant have a higher risk of infection (p=0.052) and mortality (p=0.005) one year after the transplant. The risk of dying for patients with CMI <225 is 12.9 times the risk of dying for patients with CMI ≥ 225 after adjusting for the other covariates in the model. However, this study has some limitations including its retrospective nature, small sample size, and single-center design. Further studies are needed to replicate these findings and investigate the optimal immunosuppressive regimens based on baseline CMI levels.

Translating A Pediatric Weight Management Intervention Into Medically Underserved Areas, Caitlin Golden

Theses & Dissertations

Despite substantial prevention and treatment efforts, childhood obesity remains a pressing public health concern. Disparities persist in obesity prevalence among children of lower socioeconomic status, racial and ethnic minority groups, and those residing in rural areas. The vast majority of efficacious pediatric weight management interventions (PWMIs) have been based in larger cities and urban areas delivered through inter-disciplinary teams in a hospital or medical center, and the degree to which these or other efficacious PWMIs have been translated to, and are feasible in, typical rural or micropolitan areas is unclear. This dissertation describes a dissemination strategy and a systematic approach …

Secondary Data Analysis: Predictors Of Employment Among Young Adults With Cerebral Palsy, Eduardo Santos Del Rosario

Theses & Dissertations

Young adults with cerebral palsy have lower employment rates as compared to young adults in general, as they may be confronted with complex interactions between cognitive delays, physical impairments, activity limitations, participation challenges, and personal and/or societal barriers as they progress to adulthood. These challenges are clear, the solutions, less so. Understanding the predicting factors of employment is vital to future generations of this population. The purpose of this study is to identify predictor variables and examine the relationship of those variables to employment. It has explored existing Rehabilitation Services Administration (RSA-911) data through the lens of the International Classification …

A Psychometric Validation Of The Provider Responses, Treatment, And Care For Trafficked People Instrument, Shaneke O. Pryce

Theses & Dissertations

Background

Human trafficking (HT) is often referred to as modern-day slavery, where force, fraud, or coercion is used to lure an individual into a life of labor or sexual exploitation. Although trafficked persons commonly interface with the healthcare setting, they are often unidentified and returned to the trafficked population. Previous studies have shown that while in captivity, trafficked persons have accessed medical care on various occasions, seeking treatments ranging from minor ailments to more severe ones at emergency departments, primary care clinics, and specialized clinics for sexual and reproductive health (Chisolm-Straker et al., 2016; Lederer &Wetzel, 2014). The inability to …

Medicare Shared Savings Performance: Three-Year Pandemic Analysis, Bryan Adams

Theses & Dissertations

The Centers for Medicare and Medicaid's (CMS) Office of Actuary predicts that U.S. national health expenditures will surpass U.S. gross domestic product per capita by 1.1% annually until 2028, totaling $6.2 trillion in healthcare spending. A significant portion of this spending, 36%, is attributed to Medicare and Medicaid. To address this issue, CMS has implemented the Medicare Shared Savings Program (MSSP) to assist Accountable Care Organizations (ACOs) in reducing healthcare costs and improving the quality of care for beneficiaries. The main objectives of this dissertation are twofold. Firstly, it aims to investigate the relationship between various factors, such as quality …

How To Collaborate And Not Just Coexist: An Explanatory Sequential Mixed Methods Study On The Impact Of A Physician And Nurse Interprofessional Education Program On The Development Of Early Career Pediatrician Communication Skills And Collaborative Behaviors Once In Practice, Elizabeth L. Wueste

Theses & Dissertations

Healthcare organizations are challenged to build and develop interprofessional (IP) teams capable of delivering effective patient care (Tang et al., 2018). Historically, these multiple professional roles are not formally educated together but are all expected to work in unison once they enter practice (El-Hanafy, 2018). This lack of relational foundation has led to age-old conflict between the physician and nurse roles on the care team (Stein et al., 1990). This conflict has been attributed to a lack of role definition or an overemphasis on hierarchical structures, poor communication, and the inability of physicians to collaboratively work with their nurse counterparts …