Medicine and Health Sciences Commons^™

A Descriptive Mixed-Methods Study Examining Resilience And Transitioning To Adulthood Among Emerging Adults With Disabilities, Jennifer E. Mannino

Theses & Dissertations

Transitioning to adulthood is not without challenges. The move away from family influence towards independence and self-determination is filled with uncertainty. As emerging adults (18-29) transition to adulthood they will encounter various challenges related to their new adult roles (Arnett & Tanner, 2005; Jensen & Arnett, 2012). Increased challenges and vulnerabilities in transitioning are evident among emerging adults with disabilities because they face additional challenges related to their disability over and above what all others of this developmental stage experience (Betz & Redcay, 2002; Blomquist, 2007; Faux & Nehring, 2010; King, Baldwin, Currie & Evans, 2005; Murray, 2003; National Research …

Correlating Coworker Relations, Employee Involvement, And Leadership With Associate Commitment In Select Healthcare Companies Using A Mixed Sequential Explanatory Design, Kimberly Ann Lee

Theses & Dissertations

Increasing patient demands and decreasing reimbursement require better efficiency and effectiveness in health care systems and, subsequently, in health care teams. These environmental and societal factors are further complicated by the complex initiatives set forth by the Affordable Care Act (2010). In this study, the researcher sought to examine and identify the strongest variables of health care teaming and to explore resulting themes through the perception of groups of health care associates. This mixed sequential explanatory design first examined the relationships between coworker relations, employee involvement, and leadership with associate commitment and with each other. An existing database of associate …

Investigating Infection Control Behaviors In Nurses, Elizabeth L. Beam

Theses & Dissertations

Nurses are trained in the use of personal protective equipment (PPE) and have access to policies and procedures to use in their daily work, but errors in technique during patient care are common. The purpose of this study was to better understand the infection control behaviors that nurses demonstrate in practice. The project described nursing behaviors related to basic airborne and contact precautions using personal protective equipment (PPE) in a simulated care environment. The specific aims were to 1) identify infection control behaviors by nurses which may or may not adhere to clinical standards for isolation practice while performing clinical …

A Comparative Effectiveness Secondary Data Analysis: Selected Short Term Economic And Clinical Outcomes Of Rapid Surgical Intervention In The Geriatric Fracture Population, Susan Elizabeth Dries

Theses & Dissertations

The percentage of the U.S. population that is over 65 years of age is expected increase to over 20% by 2040. Within that geriatric population, 50% of women and 20% of men will experience osteoporotic fractures. The cost of their care is estimated in billions of dollars annually. The outcomes from osteoporotic fractures account for more morbidity than all cancers, except lung cancer, combined.

Rapid surgical intervention protocols, which reduce the time between fracture and surgical repair, are intended to improve outcomes and reduce costs. The protocols require intense care coordination and their effectiveness has not been unequivocally established. This …

A Narrative Analysis Of The Stories Of Mothers Who Have Parented A Child Diagnosed With Hodgkin's Disease And Is Currently In Early Survivorship, Jennifer M. Darcy

Theses & Dissertations

With the growing number of survivors of childhood cancer in the United States, it has been essential for research to look more closely at the challenges these “children” and their families face later in life as they live to adulthood. While much has been written about childhood cancer survivors and their parents independently, there are unique struggles that a mother and a childhood cancer survivor face as a dyad. A diagnosis of cancer falling on one’s child is undoubtedly a life altering event. Examining the dyadic relationship over time offers a unique perspective to understanding the parenting experience with a …

Psychometric Validation Of The Family Nurse Caring Belief Scale In A Neonatal Nursing Population, Eileen P. Magri

Theses & Dissertations

Statement of the Problem Many studies have explored the concept of family-centered care (FCC) as the framework in which the nurse recognizes and incorporates the family into the care of the patient. Implementation of FCC in the Neonatal Intensive Care Unit (NICU) has not been clearly or consistently described in the literature and is often included with Pediatric Intensive Care Units (PICU). The Family Nurse Caring Belief Scale (FNCBS) was developed to measure nurses’ beliefs regarding provision of family-sensitive care to families in crisis that incorporate concepts important to care for a family unit. Initial psychometric evaluation of the FNCBS …

The Relationship Between Weight Locus Of Control, Self-Rated Abilities For Health Practices, Selfcompassion And Weight Loss Outcome Among Adults Post-Bariatric Surgery, Gina M. Kearney

Theses & Dissertations

Overweight and obesity have become growing threats to our nation’s health. Bariatric surgery, although its incidence has been reported to have reached a plateau, remains the most effective weight loss therapy available for the extremely (morbidly) obese. However, significant weight regain is often observed and evidence of weight loss maintenance has not been clearly or consistently demonstrated. Through the use of Self-Determination Theory as a theoretical underpinning and guiding model, the purpose of this study was to examine the relationship between psychological variables (weight locus of control, self-rated abilities for health practices, and self-compassion) and weight loss outcome (downward change …

Prevalence Of Significant Liver Fibrosis In Patients With Hiv Monoinfection Compared To Those With Hiv-Hepatitis B Coinfection As Assessed By Shear Wave Elastography, Samuel Nguku

Theses & Dissertations

Background: Liver disease is an emerging management problem in human immunodeficiency virus (HIV) infected patients. The incidence of chronic Hepatitis B infection, which accelerates the progression of chronic liver disease and development of liver fibrosis, is ten times higher in patients with HIV than the general population. Staging of liver fibrosis provides essential information in management of these patients.

Objective: To determine the prevalence of significant liver fibrosis in patients with HIV mono-infection versus those with HIV-HBV co-infection as assessed with shear wave elastography (SWE).

Methods: This was a cross-sectional study whereby HIV infected patients attending the HIV clinic at …

A Study Of Authentic Leadership Adopting The Job Demands And Resources Approach In Predicting Work-Related Flow And Job Performance, Yiqing Wang

Theses & Dissertations

The authentic leadership model posits that authentic leaders can foster personal development of their subordinates in order to produce better job outcomes. The current study has investigated authentic leadership using the job demands and resources (JD-R) approach to examine how leaders’ authenticity can empower employees in terms of resources-building (e.g. PsyCap, supervisor support); and to examine how these resources can offset negative stressors (e.g. work overload, emotional demands) so that employees may achieve a peak psychological state of flow (Bakker, 2005, 2008) and better job performances. To date, very few studies have tried to explain authentic leader behaviors in the …

The Effect Of A Preanaesthesia Clinic Consultation On Adult Patient Anxiety In Aga Khan University Hospital; A Cohort Study, Anthony Kamau

Theses & Dissertations

Background: Preoperative anxiety is a common perioperative complication, according to studies done it is seen in approximately 11-80% of adults undergoing surgery. Various pharmacological and non pharmacological techniques have been used to reduce preop anxiety.

One of the goals of the preanaesthesia clinic is to allay anxiety. Literature shows that a preanaesthesia clinic evaluation reduces anxiety however b current studies done on anxiety and the preanaesthesia clinic have not quantified this reduction.

Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward.

Study Design: A cohort and before – after study …

Prediction Of Breast Tumor Size By Ultrasound: A Comparison With Pathology, David Toyis Wanyonyi

Theses & Dissertations

Background: Tumor size is one of the most important prognostic factors in breast cancer and its accurate assessment is critical in planning appropriate treatment. Although histology is often regarded as the definitive way of establishing tumor size, radiological techniques, particularly ultrasonography, are usually relied upon to give an estimate of the tumor size for prognostication and treatment planning. Correlations between mammography, ultrasonography, magnetic resonance imaging (MRI) and pathology size have been performed in different populations with varying results however no prospective study has been done to establish the agreement between sonographic tumor size and histopathological tumor size in our …

Surgical Site Infection Rates In Breast Cancer Surgery At A University Hospital In Nairobi, Kenya, Andrew Nyangau Nyaoncha

Theses & Dissertations

Back ground: Surgical site infections (SSI)following breast cancer surgery remain a significant cause of morbidity with the use of single dose pre-operative antibiotic prophylaxis. As a result the use of peri-operative antibiotics is common and unregulated, with no knowledge of the infection outcomes with their use.

Objectives: To establish the SSI outcomes with the use of peri-operative antibiotic prophylaxis, evaluate the common risk factors for SSI development and assess for other important outcomes following breast cancer surgery.

Methods: A prospective surveillance study for patients undergoing breast cancer surgery using the National Nosocomial Infections Surveillance (NNIS) system.

Analysis: Analysis for the …

Comparison Of Cardiometabolic Risk Profile Between Hiv Patients On Art And Those Who Are Art Naïve, Erick Kimani Njenga

Theses & Dissertations

Background: Metabolic syndrome comprises of a set of aggregated risk factors that include: hypertension, central obesity, impaired fasting glucose, hypertriglyceridemia and low HDL-C (1)The is a noted increase in the prevalence of the metabolic syndrome cardiovascular risk factors in the HIV population.

Methods: The study is a cross-sectional survey that enrolled 157 HIV positive patients over a 4 month period that were either newly diagnosed (HIV ART naïve) or were on ART from both the inpatient and outpatient setting. Data of their anthropometric, cardiovascular risk factors and clinical characteristics were collected with the aid of a standardized questionnaire and serum …

Prevalence And Clinical Characteristics Of Venous Thromboembolism At The Aga Khan University Hospital, Nairobi, Felix Mutuma Riunga

Theses & Dissertations

Aim: To determine the prevalence of venous thromboembolism in patients presenting to the Aga Khan University Hospital, Radiology Department for lower limb compression ultrasonography with doppler and CT pulmonary angiography. In those found to have venous thromboembolism, the distribution of risk factors as described by Wells, the pattern of clinical presentation, the pattern of initial therapy, the length of hospital stay, major bleeding episodes and in hospital mortality were described.

Design: Prospective survey

Background: Venous Thromboembolism is a major cause of morbidity and mortality worldwide and its occurrence locally, as well as its clinical characteristics needs to be described in …

The Incidence Of Early Upper Extremity Disability After Axillary Surgery In Patients With Early Breast Cancer, Karen Mbaabu

Theses & Dissertations

Background: The treatment of early breast cancer includes surgical removal of the tumor as well as evaluation of the axillary lymph node status. Axillary lymph node surgery, both sentinel lymph node biopsy and axillary lymph node dissection, is associated with upper arm morbidity that has been relatively understudied. The impact of this upper arm limitation has a direct effect on the patients’ quality of life. Determining the degree to which our patients experience this disability will enable the breast cancer unit to develop a prospective surveillance rehabilitative program.

Objectives: The objectives of the study were to determine the …

The Utility Of A Tablet Computer Device In Comparison To A Standard High Resolution Monitor For Reporting Ct Kub Images, Kenneth Kiriinya Ibeere

Theses & Dissertations

Background: The latest technological developments in the field of digital medical imaging have facilitated the transfer of the power and utility of the personal computer to mobile computing devices. One of these that have been used in diagnostic imaging is a tablet computer. Mobile tele-radiology using a tablet computer device is an apt extension of imaging services, for after-office-hours consultation. It is crucial to determine the diagnostic accuracy of these portable computer devices in order to determine safety for use in diagnostic image interpretation without compromising patient care.

Objective: To find out the diagnostic accuracy of urolithiasis (urinary tract calculi) …

A Randomized Control Trial Comparing Weight Adjusted Dose Versus Fixed Dose Prophylactic Phenylephrine Infusion On Maintaining Systolic Blood Pressure During Caeserean Section Under Spinal Anaesthesia, Lucy Wambui Mwaura

Theses & Dissertations

Background: Spinal anaesthesia is the standard of care for elective caesarean delivery. Its advantages over general anaesthesia include: decreased blood loss, reduced postoperative pain and faster recovery time. Despite these advantages, the sympathetic blockade induced by spinal anaesthesia results in 80 percent incidence of hypotension without prophylactic management. This hypotension can cause: nausea, vomiting, cardiovascular collapse or even loss of consciousness in the mother, and fetal acidosis.

Current evidence supports co-loading with intravenous fluids in conjunction with the use of vasopressors as the most effective way to prevent and treat the hypotension. Phenylephrine is the accepted vasopressor of choice in …

A Double-Blind Randomized Controlled Trial Comparing Effectiveness Of 0.2% Topical Nifedipine Versus 0.2% Topical Glyceryl Trinitrate In The Treatment Of Chronic Anal Fissure, Mark Michael Wekundah Siboe

Theses & Dissertations

Background: The medical management of chronic anal fissure varies among clinicians because no single treatment has yet approached an overall healing rate similar to lateral sphincterotomy. However, chemical sphincterotomy has the advantage of not carrying the presumed high risk of faecal incontinence.

Glyceryl Trinitrate is commonly used in our practice with varied response.

This study set out to evaluate the effectiveness of a locally compounded preparation of 0.2% topical Nifedipine in the treatment of chronic anal fissure and to compare the investigational product to 0.2% Glyceryl Trinitrate in overall healing rate and relieving pain.

Design: Single centre, parallel, double-blind …

Psychosocial Factors Associated With Exclusive Breastfeeding Among Pregnant Women On Follow Up In A Tertiary Maternity Hospital, Cornelia Akinyi Ochola

Theses & Dissertations

Introduction: Exclusive breastfeeding during the first six months of life is the ideal form of infant feeding. Health benefits of exclusive breastfeeding to infant and mother are well documented in literature. Despite this, the rate of exclusive breastfeeding in the first six months of infants‘ life in Kenya remains low. National nutrition strategy for maternal, infant and young child has set its 2017 target for exclusive breastfeeding at 80% from 32%. To achieve this target, new strategies are needed to complement current exclusive breastfeeding initiatives. Application of theory of planned behaviour model was used to determine the psychosocial factors associated …

The Heart Weight–Body Weight Coefficient In Kenyans Aged 14 Years And Above, Mbayah Etabale

Theses & Dissertations

Background: The heart size has traditionally been assessed using absolute reference weights. But the heart weight (HW) has been shown to depend on one’s body size hence a better measure is the ratio of the HW to the body weight (BW) – the HW-BW coefficient. Initially noted to be 0.43% and 0.40% in males and females respectively, recent studies have shown an increase of up to 0.51%.

Objective: To determine the HW-BW coefficient in Kenyans aged 14 years and above.

Methods: One hundred and four deceased Kenyans aged 14 years and above, with no heart or chronic lung disease, were …

Racecadotril For The Treatment Of Severe Acute Watery Diarrhoea In Children Admitted To The Kenyatta National Hospital - A Randomised Double Blinded Placebo Controlled Trial, Jaspreet Singh Gharial

Theses & Dissertations

Background: Diarrhoeal disease is the second most common cause of death in children under 5 years of age in Kenya. Treatment with Oral Rehydration Solution (ORS), elemental zinc and continued feeding (as recommended by the World Health Organisation) led to a significant reduction in mortality in the 1970s and 1980s, which has slowed since then. Adjunctive treatments have however, not gained much popularity either due to modest improvements in morbidity and mortality or unacceptable adverse effect profiles. Racecadotril, an enkephalinase inhibitor, has been used for over 2 decades in parts of Europe but is only recently gaining recognition in …

The Prevalence Of Malaria And Assessment Of The Uptake Of Malaria Prevention Measures In Blood Donors In Two Regional Blood Transfusion Centres In Kenya, Valerie Magutu

Theses & Dissertations

Transfusion transmitted malaria is one of the most common transfusion transmissible infections and is a threat to blood safety and malaria control in Sub-Saharan African countries where malaria is endemic. The majority of healthy adults living in malaria endemic areas have some degree of immunity to the disease and an asymptomatic low-level parasitaemia is known to exist in a subset of this population. Blood donors recruited from the population are screened using a donor-selection criteria that includes age, weight, self-declared well-being and measurement of vital signs but not history of recent malaria infection or treatment. The Kenya National Blood Transfusion …

Perceived Barriers Among Pregnant Women Towards Cervical Cancer Screening, Visavilwa Vincent Lamuka

Theses & Dissertations

Background: Cervical cancer remains the most common cancer in women in Eastern Africa in general and Tanzania in particular. However, to a large extent cervical cancer is preventable by effective screening programmes as has been demonstrated in many developed countries. Developing countries lack formal national screening programmes. Screening is usually mainly done opportunistically.

Objective: To assess the perceived barriers to uptake of cervical cancer screening among pregnant women attending antenatal clinics in two hospitals in Dar es Salaam.

Methodology: This was a qualitative study, conducted at two hospitals in Dar es salaam, a government facility (Amana District Hospital) and a …

Androgen Receptor Expression And Associated Clinico-Pathologic Features In Primary Breast Cancer From Kenya, Joshua Kibera Chege

Theses & Dissertations

Introduction: Breast cancer is a heterogeneous group of diseases classified into various subtypes according to clinical, histological and molecular features as well as by the expression of prognostic and predictive biomarkers. New biomarkers are being studied which may be therapeutic targets in various breast cancer subtypes particularly triple-negative breast cancer. Recent studies show that androgen receptor (AR) expression can be used as a prognostic marker and there is evidence that anti-androgen therapy may be beneficial in oestrogen receptor negative breast cancer. Retrospective studies show that patients with breast cancers co-expressing androgen receptor and oestrogen receptor have a favourable prognosis and …

One Year Symptom Severity And Health-Related Quality Of Life Changes Among Patients Undergoing Uterine Fibroid Embolisation, Charles Muriuki Mariara

Theses & Dissertations

Background: The main aim of treatment of symptomatic fibroids by various modalities including uterine fibroid embolisation is to alleviate symptoms and ultimately improve the quality of life. The efficacy of this modality of treatment in women with significant fibroid burden and large uterine volumes is not clear.

Objective: To determine the change in symptom severity and health-related quality of life among patients who have undergone uterine fibroid embolisation for treatment of symptomatic uterine fibroids.

Setting: Aga Khan University Hospital, Nairobi

Methods: A prospective before and after study (observational) of patients undergoing uterine fibroid embolisation. Prior to embolisation, study participants underwent …

Association Between Parity And Rubella Seropositivity Among Older Reproductive-Age Women, Ibtisam Salim Awadh

Theses & Dissertations

Background: Rubella virus when it infects a non-pregnant adult or child usually causes a mild febrile rash illness. However, infection in the first 12 weeks of pregnancy causes miscarriages, stillbirths or foetal anomalies known as congenital rubella syndrome (CRS). Factors associated with rubella immunity include age and parity. No studies have been done to isolate the association of parity independent of age.

Objectives: To determine the seroprevalence of rubella IgG antibodies among nulliparous and multiparous women of the same age-group attending various clinics in Aga Khan University Hospital, Nairobi,

Design: A cross-sectional study of women attending a tertiary hospital, Nairobi, …

An Assessment Of Whether Medical Doctors Have The Knowledge That Would Enable Them To Competently Deliver Tobacco Cessation Services, Miriam Miima Khamonya

Theses & Dissertations

Background: Tobacco use is the leading cause of preventable morbidity and mortality globally. The international community recognizes this epidemic and compelling evidence exists on the significant contribution of the health care provider in propagating the success of tobacco cessation. The World Health Organization highlights minimal implementation of tobacco control policies by Tanzania despite a rise in tobacco use prevalence. Medical doctors’ competence is a reflection on our commitment to tobacco cessation service delivery.

Main Objectives: To assess whether medical doctors have the knowledge that would enable them to competently deliver tobacco cessation services.

Specific Objectives

1. To assess medical …

Incidence And Risk Factors For Acute Myocardial Injury After Non-Cardiac Surgery At The Aga Khan University Hospital Nairobi, Salim Said Ahmed

Theses & Dissertations

Aim: To determine the incidence and risk factors for acute myocardial injury after non-cardiac surgery at Aga Khan University Hospital Nairobi.

Design: Prospective cohort study

Background: Myocardial injury is the most common major cardiovascular complication in patients undergoing non-cardiac surgery. Large numbers of intermediate-risk and high-risk cardiac patients will be undergoing surgery as the population grows older, and thus myocardial injury after non-cardiac surgery could be a rising problem.

Patients and Setting: Adult participants undergoing intermediate and high risk non-cardiac surgery at the Aga Khan University Hospital Nairobi were evaluated for incidence and risk factors for myocardial injury after non-cardiac …

Hospital-Acquired Malnutrition In Children In A Tertiary Care Hospital, Del-Rossi Sean Quadros

Theses & Dissertations

Introduction: Hospital-acquired Malnutrition occurs as a result of reduction in food intake, increased dietary loss and/or increased calorie requirements as a result of disease-induced high catabolic state. A child's nutritional status often deteriorates after admission to the hospital resulting in longer duration of hospital stay and increased risk of complications, which also increases treatment cost. Hospital-acquired Malnutrition is usually assessed using anthropometric measurements and/or serum pre-albumin.

Objectives: This study sought to investigate the incidence of Hospital-acquired Malnutrition using anthropometric measurements and to determine diagnostic utility of serum pre-albumin in predicting weight change. A secondary objective was to identify …

Understanding The Barriers To Contraceptive Use In Hiv-Positive Women Of Child Bearing Age In Dar-Es-Salaam, Tanzania, Tabitha-Alexandria Njeri Nyanja

Theses & Dissertations

Title: Understanding the barriers to contraceptive use among HIV-positive women of child bearing age in Dar-es-Salaam, Tanzania- a multi-site study

Purpose: The purpose of this study was to explore the perceived barriers to contraceptive use and identify the factors that influence contraceptive choice, as well as the relationship of these among HIV-positive women living in an urban population in Dar-es-Salaam Tanzania.

Goals and Objectives: To determine the perceived barriers to contraceptive use among HIV-positive women of child-bearing age attending the Care Treatment Centres (CTCs) Tanzania and in the President’s Emergency Plan for AIDS Relief (PEPFAR) supported CTCs within Dar-es-salaam. …