Medicine and Health Sciences Commons^™

Sex Differences In Allergic Asthma Responses Of Mice Prenatally Exposed To Wood Smoke, Adelynne Walley

Undergraduate Theses, Professional Papers, and Capstone Artifacts

No abstract provided.

Final Scholarly Project: Evidence-Based Practice Guidelines For The Perioperative Management Of Blood Glucose Levels In The Cardiac Surgery Patient, Chelsey Benner

Doctor of Nursing Practice Scholarly Projects

Cardiovascular disease is the leading cause of mortality worldwide, necessitating a high demand for cardiac surgery. A unique stressor for cardiac surgery is an increased surgical stress response involving hyperglycemia. Perioperative hyperglycemia contributes to adverse postoperative outcomes following cardiac surgery. Current evidence examines blood glucose control and its effect on adverse postoperative outcomes, including sternal wound infections, acute kidney injury, prolonged mechanical ventilation, and an increased length of stay in the intensive care unit. Despite the link between hyperglycemia and poor postoperative outcomes, most facilities lack standardized guidelines for the perioperative management of blood glucose levels in cardiac surgery patients. …

Analysis Of Clinical Outcomes And Cost Effectiveness Of Neuromuscular Blocking Drug Reversal In Patients Classified As Obese, Trevor Mack

Doctor of Nursing Practice Scholarly Projects

Obesity predisposes patients to heightened risks of adverse outcomes following surgery, including residual neuromuscular blockade and postoperative complications. The administration of non-depolarizing neuromuscular agents (NMBAs) is fundamental for muscle relaxation and optimal surgical conditions. However, the subsequent reversal of these blockers with agents like sugammadex or neostigmine is crucial to mitigate these risks. While sugammadex is recognized as a clinically superior choice due to its rapid and more complete reversal, its extensive use is often limited by cost, presenting challenges in obese patients who already face increased susceptibility to complications. This project evaluates the cost-effectiveness of sugammadex versus neostigmine in …

Development Of Evidence-Based Practice Guidelines For Utilizing Erector Spinae Plane Blockade For Patients Undergoing Cardiac Surgery, Gabrielle Metoyer

Doctor of Nursing Practice Scholarly Projects

In the United States, the aging population and high rates of cardiovascular disease leads to increased cardiothoracic surgeries. Analgesia for cardiac surgeries often involves high-dose opioids. However, with an ever-increasing opioid epidemic and adverse effects on the postoperative healing process, recent literature seeks to decrease opioid consumption by utilizing alternative methods of analgesia. The American Association of Nurse Anesthetists recommends the use of regional anesthesia techniques to reduce the incidence of undertreated postoperative pain that can occur from opioid-sparing methods of analgesia. This project aims to create an evidence-based analgesia guideline for adult patients undergoing cardiac surgery. Interventions will include …

Development Of Evidence-Based Clinical Practice Guidelines For Pediatric Preoperative Anxiety, Whitney R. Stant

Doctor of Nursing Practice Scholarly Projects

Preoperative anxiety is a problem that occurs frequently in pediatric patients. Preoperative anxiety creates physical and psychological changes that impact a child’s surgical experience. Pediatric patients who experience preoperative anxiety may also experience prolonged postoperative care, long-term psychological complications, and increased postoperative pain. Sedating medications are often administered to prevent and treat preoperative anxiety. Commonly, midazolam is administered intranasally to prevent preoperative anxiety. Midazolam increases the risk of cognitive impairment and respiratory depression. Dexmedetomidine is an effective alternative to midazolam. Dexmedetomidine is a highly selective alpha-2 agonist and provides arousable sedation without respiratory depression. Dexmedetomidine is safe and effective at …

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Development Of Clinical Practice Guidelines For Incorporating Paravertebral Blockade For Thoracic Surgery Adult Patients, India Hutchison

Doctor of Nursing Practice Scholarly Projects

Thoracic surgery is considered one of the most painful surgical procedures due to its severity and the duration of the procedure. Pain is detrimental to the patient experience, and poor patient satisfaction results in revenue loss for hospitals. Maintaining adequate pain control after surgery is crucial in preventing pulmonary complications such as atelectasis and respiratory failure that prolong patient recovery. It is the responsibility of the anesthesia provider to ensure adequate pain control throughout the perioperative experience. Although current evidence-based data shows that regional anesthesia provides superior thoracic postoperative pain control, the current practice continues to be the utilization of …

Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes

Doctor of Nursing Practice Scholarly Projects

Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …

Final Scholarly Project: The Administration Of Transversus Abdominis Plane Blocks In Patients Undergoing Anesthesia For Open Ventral Hernia Repairs, Brennon Pinion

Doctor of Nursing Practice Scholarly Projects

Ventral hernia repairs are the only definitive treatment for umbilical or abdominal hernias. These procedures are prevalent and often lifesaving but also carry high risks of adverse effects. Some of the problems that follow include postoperative ileus, increased opioid use, and prolonged length of stay. Due to the rate of complications, there was a need to improve these outcomes. One way to improve outcomes is to implement superior anesthetic techniques. This Final Scholarly Project (FSP) followed the Plan-Do-Study-Act (PDSA) model to conduct evidence-based practice (EBP) and quality improvement (QI) sections. The plan phase included a thorough literature search and analysis …

Clinical Guidelines For The Perioperative Management Of Patients With Aortic Stenosis Undergoing Noncardiac Surgery, Owen Diehl

Doctor of Nursing Practice Scholarly Projects

Aortic stenosis (AS) is a common valvular disorder that causes left ventricular (LV) outflow obstruction. The prevalence of AS may increase with the aging population and the widespread availability of diagnostic capabilities like echocardiography. With the increasing patient population diagnosed with AS, the chance of encountering these patients during noncardiac surgery (NCS) increases. Performance of anesthesia is challenging in patients with AS due to the pathophysiological consequences of AS and the hemodynamic changes associated with anesthesia. The patient with AS presenting for NCS is at an increased risk of perioperative major adverse cardiac events (MACEs). This project aimed to determine …

Chronic Stressors, Obesity Pathogenesis, And The Moderating Effect Of Internalized Weight Stigma; A Quantitative, Illinois Study, Karyn Byrne

Dissertations

The obesity epidemic is a ‘wicked’ problem with a complex web of determinants and outcomes. While generally higher for minoritized populations, prevalence rates manifest in surprising, nonlinear patterns. There is no consensus regarding treatment protocols or mitigation efforts, except that current efforts remain largely ineffective. Much research evidence that a profusion of determinants of health support obesity pathogenesis through various physiological processes and mechanisms, including the allostatic load, mitochondria functioning, the gut microbiome, and epigenetics. Intervening to support markers of the allostatic load (immunity, inflammation, and metabolic health) may provide a more effective treatment outcomes than traditional approaches, which tend …

Animation As Therapy For Mental Health Treatment Across Diverse Populations And Contexts, A Literature Review, Daneile Tabana

Expressive Therapies Capstone Theses

Scientific research has explored and identified the beneficial relationship between health and creative expression, recognizing art therapy as a source of healing. Animation has been newly recognized as an art therapy medium with potential for therapeutic healing and increased psychological well-being. This review of the literature on animation therapy explores the history of the modality’s interaction with the population observed and the effects of animation on the cognitive processes, discusses current theoretical orientations and treatment options for treating a range of conditions that affect mood, thinking, and behavior with animation therapy, and considers culturally informed and client-centered practices alongside traditional …

Effect Of Insufficient Sleep On Activity Limitation: Results From The Brfss 2022 Survey, Jonathan Meyer

Capstone Experience

Objective: To determine whether insufficient sleep (less than 7 hours per night) is associated with activity limitation (14 days or more of poor mental or physical health interfering with everyday activities) in Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2022. Methods: BRFSS is a nationally representative cross-sectional survey of non-incarcerated US adults. The exposure of interest was insufficient sleep, and the outcome of interest was activity limitation. Other demographic variables used in a final weighted adjusted analysis include age >65 years, race/ethnicity, gender, marital status, income, and total physical inactivity. Results: The weighted prevalence of insufficient sleep for …

Audiological Evaluation Of Persons With Dementia: A Systematic Review, Yehudis Hoch

Dissertations, Theses, and Capstone Projects

Background: Dementia and hearing loss are both prevalent, age-related conditions and recent research has established a correlation between the two. Audiological evaluations of persons with dementia are important due to a likely comorbidity of dementia and hearing loss, the detrimental effect that hearing loss has on cognition and cognitive tests, and because the similar presentation of the two conditions can cause hearing loss to be overlooked. Hearing loss intervention is critical for this population due to the positive effects that amplification has on cognition, social engagement, and listening effort. Despite the importance of hearing assessment and intervention, audiological evaluation of …

Development Of The Hearing Emotion/Activity Restrictions On Teenagers (Heart), Robin G. Axelrod

Dissertations, Theses, and Capstone Projects

DEVELOPMENT OF THE HEARING EMOTION/ ACTIVITY RESTRICTIONS ON TEENAGERS (HEART)

By: Robin Axelrod

Advisor: Barbara Weinstein

Background:

The Hearing Handicap Inventory for the Elderly is a self-assessment tool used to assess and quantify the impact of hearing loss on emotional and social wellness in the geriatric population. However, there is not an existing version for the teenage population. Hearing loss has the potential to impact social, emotional, and academic domains in the daily lives of teenagers with hearing loss. In this study, a new self-assessment tool called the Hearing Emotion/ Activity Restrictions on Teenagers (HEART) was created and distributed via …

Vestibular Correlates Of Cochlear Implantation, Danielle Lewis

Dissertations, Theses, and Capstone Projects

Previous research has illustrated that vestibular dysfunction is the most prevalent complication of cochlear implant (CI) surgery. There is substantial evidence of both short- and long-term vestibular dysfunction following CI surgery. The objective of this survey was to determine CI recipients’ expectation and satisfaction with their audiologists’ counseling regarding the possible vestibular effects of cochlear implantation. Survey participants included unilateral and bilateral adult CI recipients recruited through the NYC chapter of the Hearing Loss Association of America (HLAA), audiology-related Facebook groups, and Linked-In. The first 25 participants were offered a $20 Amazon gift card upon completion of the survey. The …

The Effect Of Personal Listening Devices On Subjective Hearing Status, Esther Feldman

Dissertations, Theses, and Capstone Projects

Long term or brief exposure to loud noise can trigger the onset of noise-induced hearing loss which can lead to a temporary (TTS) or permanent (PTS) shift in hearing threshold. Occupational noise, or recreational noise such as music can contribute to shifts in hearing levels. Listening to music in person at a concert or when listening on earphones/earbuds and streaming from a smartphone can produce sound pressure levels (SPL) high enough to lead to PTS, TTS, and associated symptoms. A survey of adults was conducted to gain insight into onset of self-perceived temporary hearing loss and tinnitus after short term …

The Impact Of Sport-Related Concussions On The Vestibular System Utilizing The Vestibular Ocular Motor Screening (Voms) Tool: A Systematic Review For Audiologists, Tina M. Ceriello

Dissertations, Theses, and Capstone Projects

Objective: This systematic review aims to analyze vestibular side effects of sport-related concussions (SRCs) based on differences such as age, gender, and/or sport when using the VOMS tool, and how audiologists may adapt practice for such individuals who have sustained SRCs.

Methods: A comprehensive search identified relevant articles using Google Scholar, ASHAWire, and other databases through the City University of New York (CUNY) Mina Rees Library website. Studies were included if SRCs were evaluated using the complete seven-item VOMS tool and had 25 or more participants. Studies were excluded if concussions were not sport-related, brain injuries were more severe than …

Positron Emission Tomography In Oncology And Environmental Science, Samantha Delaney

Dissertations, Theses, and Capstone Projects

The last half century has played witness to the onset of molecular imaging for the clinical assessment of physiological targets. While several medical imaging modalities allow for the visualization of the functional and anatomical properties of humans and living systems, few offer accurate quantitation and the ability to detect biochemical processes with low-administered drug mass doses. This limits how physicians and scientists may diagnose and treat medical issues, such as cancer, disease, and foreign agents.

A promising alternative to extant invasive procedures and suboptimal imaging modalities to assess the nature of a biological environment is the use of positron emission …

Blunt Cerebrovascular Injury (Bcvi): Universal Cta Neck Screening At Level 2 Trauma Center, Tamine Gogel

Doctor of Nursing Practice Projects

Blunt Cerebrovascular Injury (BCVI) refers to injuries to the vessels supplying blood to the brain, primarily carotid and vertebral arteries, and can result from trauma, resulting in stroke by vessel dissection, thrombus formation, embolization, and hemorrhage. Timely identification is crucial for effective intervention and improved outcomes. This doctoral project proposes the implementation of universal screening using Computed Tomography Angiography (CTA) of the neck during initial workup for blunt force trauma at a Level II ACS-verified trauma center. The primary objective is to mitigate potential delays in diagnosing and treating BCVI, thereby reducing the likelihood of complications. Patients ≥ 15 years …

Evidence-Based Practice Guidelines: Anesthesia For Total Knee And Hip Arthroplasty, Amanda Kleinfelder

Doctor of Nursing Practice Scholarly Projects

Abstract

Total knee and hip arthroplasty are the two most common orthopedic surgeries in the United States. Traditional perioperative practice is multidisciplinary, with each professional, including anesthesia, making decisions based on their current knowledge or past experience. Postoperative complications pose a threat to any patient undergoing a surgical procedure. Enhanced Recovery After Surgery (ERAS) protocols were developed to streamline best practice guidelines during the perioperative period. ERAS pathways aim to decrease postoperative complications, accelerate recovery after surgery, decrease narcotic use and promote early mobilization and discharge from the hospital. The aim of this project is the development of evidence-based practice …

Enhancing Newer Nicu Nurse Confidence With Resuscitation Through High-Fidelity, In-Situ Crisis Resource Management, Karen Rose

Doctor of Nursing Practice Final Manuscripts

Neonatal resuscitation is a low-volume, high-risk occurrence. Given the infrequency of resuscitation, newer neonatal intensive care unit (NICU) nurses may have little to no exposure to neonatal resuscitation events. This can lead to a lack of confidence in resuscitation skills, contributing to burnout, poor patient outcomes, and the potential for nursing turnover. This evidence-based practice project, guided by the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care, focused on enhancing the perceived confidence in neonatal resuscitation skills among newer NICU nurses. To achieve this, multidisciplinary, high-fidelity, in-situ neonatal resuscitation crisis resource management (CRM) simulated events were implemented. …

Implementing An Abnormal Involuntary Movement Scale At An Outpatient Mental Health Clinic, Amanda Ghamsari

Doctor of Nursing Practice Final Manuscripts

Background: Movement disorders caused from psychotropic medications affect an estimated 500,000 people in the United States. These disorders bring an added cost for treatment to the patient, cause emotional distress, and may hinder daily life. Overall health and additional medication costs were increased for these patients by $25,879 per patient per year compared to patients without a movement disorder.

Purpose of Project: To address the issue, the team of mental health providers at an outpatient clinic assess their mental health patients at start of care and at follow up visits utilizing the Abnormal Involuntary Movement Scale. With the goal of …

Reducing Inpatient Falls Utilizing Multimodal Standardized Patient Education: An Evidence-Based Practice Project, Sheryl Almandrez

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: This project aims to utilize multimodal standardized patient education as an evidence-based practice intervention to reduce inpatient falls.

Background: In 2022, Kaiser Foundation Hospital (KFH) San Diego had 116 falls. Inpatient falls with injury account for the second-highest Joint Commission (TJC) sentinel event and California Department of Public Health (CDPH) adverse events. These injuries include lacerations, subdural hematoma, subdural hemorrhage, hip fractures, and wrist fractures. The Centers for Medicare and Medicaid Services (CMS) have also stopped reimbursing hospitals for the care provided after patients have sustained a fall with injury.

The project was implemented at KFH-San Diego …

Human Trafficking And Resources Provision In The Ed, Kathryn Patrick

Doctor of Nursing Practice Projects

Human trafficking is both a human rights violation and a national health crisis. Despite nearly 165,000 identified cases in the United States since 2007, studies hypothesize that many more victims remain undetected despite up to 88% of trafficked persons interacting with the healthcare system during the time they are being trafficked. The lack of identification of these victims has often been attributed to healthcare providers' lack of knowledge regarding human trafficking indicators and lack of confidence in how to address trafficking situations when they are encountered. Emergency department care providers of a 500-bed central Illinois hospital received education and resource …

Analyzing The Cognitive Complexity Of The Questions On The Advanced Placement Computer Science Principles Exam, Lauren Zirpoli

Seton Hall University Dissertations and Theses (ETDs)

This convergent parallel mixed methods study with qualitative and quantitative content analysis was conducted to analyze and describe the cognitive complexity of the publicly released Advanced Placement Computer Science Principles Exam questions compared to the language of higher-order thinking found in research literature. Hess’ Cognitive Rigor Matrix was used to determine the frequency and percentage of questions categorized as higher-order thinking within each cell of the matrix. The qualitative method consisted of content analysis of the language of each question analyzed, followed by deductive coding, and culminated with categorizing the depth and type of thinking required on Hess’ Cognitive Rigor …

Initiating Access To Palliative Care Earlier In Pediatric Oncology Patients, Anita Sharma

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Pediatric oncology patients should be referred to palliative care early but despite research indicating the clear benefits, there is still a delay in referring patients. One of the reasons include lack of understanding amongst providers on what palliative care is. Palliative care provides symptom management, emotional support and helps the patient and family with difficult decision making.

Objectives: This project aimed to increase the number of early referrals to palliative care. The Pediatric Palliative Care Screening Tool (PaPas) was utilized to help identify the triggers which should prompt the referral.

Methods: A chart review of patients diagnosed with …

Artistic Expression Of Medical Experiences Of Mothers Of Color: Perspectives Using Art Therapy, Lauren Barrett

Expressive Therapies Dissertations

The purpose of this study was to qualitatively examine perspectives of mothers of color living in the US and their experiences in the healthcare system through art therapy. The study aimed to further identify personal narrative experiences of mothers of color navigating the healthcare system, promote individual voices, and acknowledge disparities impacting those within marginalized communities. The participants in this study included a total of eight identified mothers of color (non-White) living in the US. Participants took part in four weeks of consecutive art therapy sessions either in 60-minute group or individual virtual meetings. One art therapy directive was provided …

Embodied Co-Regulation: A Neuroregulatory-Informed Dance/Movement Therapy Transition Intervention Method For Arousal Regulation For Adolescents In A Partial Hospitalization Program, Anamaria Guzman

Expressive Therapies Capstone Theses

This thesis introduces a novel Dance/Movement Therapy (DMT) approach, focusing on nervous system arousal regulation during transitions between therapy groups. The core of the method involves a brief 5-minute exercise designed to modulate arousal levels, encompassing alertness and energy, aiming to establish a baseline homeostasis. Rooted in Polyvagal Theory and Developmental Neurobiology, the approach assumes the co-regulation of nervous systems within a group therapeutic setting. Two primary outcomes are self-assessed: 1) somatic experiences documented through narratives and 2) nervous system biodata measured using the Flowtime headband monitoring of brainwaves, heart rate, and other biomarkers. Results indicated that all six sessions …

Dance/Movement Therapy: A Novel Approach For Latino Males With Incarceration Histories In Sud Treatment, Aletia Egipciaco

Expressive Therapies Capstone Theses

This paper investigates how open clients would be to participating and engaging in Dance/Movement Therapy (DMT) sessions at a residential SUD facility. The questions asked were (1) What level of engagement would clients have and (2) How would they engage in DMT group sessions at a residential substance use disorder facility? A program lasting 8 weeks, aimed at facilitating DMT group sessions, was conducted at a residential SUD facility twice a week. The objective was to assess participant engagement levels and observe their involvement in the DMT sessions. Residents of the facility were invited voluntarily to attend the DMT groups. …