Medicine and Health Sciences Commons^™

Enhancing Anxiety Identification In Adult Patients, Wonda Crump

Walden Dissertations and Doctoral Studies

In this Doctor of Nursing (DNP) project, I focused on implementing a staff education program for anxiety screening at a health and wellness clinic. Mental health conditions, particularly anxiety disorders, are common in primary care settings. Research shows that anxiety affects millions of adults, yet many cases remain undiagnosed. The practice problem that I identified was that many patients with anxiety disorders were going undiagnosed during regular clinic visits. The clinic had no standard process for screening anxiety, and staff members had a knowledge deficit on the proper use of anxiety assessment tools. This gap in practice led to missed …

Impact Of Dialysis On Medication Pharmacokinetics, Rachel Marie Bounds

Walden Dissertations and Doctoral Studies

This doctoral project was a staff education initiative to improve nurses’ knowledge and comfort with dialysis-specific medication management. The project addressed a practice gap in which nurses at the clinical site had limited knowledge of medication administration for patients with end-stage renal disease. These patients have altered pharmacokinetics and high medication burden, which increases the risk of adverse drug events. Inappropriate management of medications during dialysis can lead to hypotension, ineffective treatment, and glucose instability, making this a critical nursing practice issue. The project answered the practice-focused question of whether a structured educational intervention would improve nurses’ knowledge and comfort …

Staff Education To Enhance Provider Knowledge On Lifestyle Modification For Hypertension Management, Chinyere Maria Assumpta Ofoegbu

Walden Dissertations and Doctoral Studies

Summary A doctor of nursing practice (DNP) staff education project was designed to enhance healthcare providers' knowledge of lifestyle interventions for hypertension management. At the practice site, primary healthcare providers were not regularly integrating lifestyle counseling. The practice-focused question guiding this project was: In primary care providers, how does implementing an evidence-based lifestyle education training program for hypertension management affect provider knowledge? An in-person educational session was provided to ten (10) healthcare practitioners who voluntarily participated. Pre- and post-training knowledge assessments was the analytical techniques employed to examine changes in provider comprehension of lifestyle-based hypertension care. Descriptive statistics and paired-sample …

Multidisciplinary Approach To Reducing Healthcare-Associated Infections: A Dnp Project, Jovinsky Jonaldo Eliscard

Walden Dissertations and Doctoral Studies

Healthcare-associated infections are increasingly common in healthcare facilities due to multiple concerns, including negligence, human error, and poor conditions. According to Chuwa (2024), secondary infections are a significant threat to patient safety and wellness, reducing an organization’s ability to realize clinical objectives. The facility is a large healthcare provider operating numerous hospitals and care homes across the United States. The organization continues to report increased infection rates across its branches owing to a lack of standardized infection prevention and control protocols, reducing its efficiency and appeal. Internal audits point to inconsistencies in general sanitation, cleanliness, and hygiene. The organization also …

Cancer Literacy And Social Determinants Of Health: An Epidemiological Analysis Of Trust, Digital Engagement, And Healthcare Utilization In Cancer Information Seeking, Kimberly Leeann Hazel

Walden Dissertations and Doctoral Studies

The rise of online health information has increased access to cancer resources but also amplified misinformation, creating trust gaps that threaten prevention, treatment, and health equity. This study examined how trust in cancer information sources, online information-seeking, and healthcare perceptions relate among U.S. adults. Guided by the health information seeking behavior, the socioecological model, and the structural influence model of health communication, data from the 2022 Health Information National Trends Survey (N = 6,197) were analyzed with logistic regression, mediation, and moderation modeling, controlling for demographics. Trust in government agencies predicted greater cancer information seeking (odds ratio [OR] = 1.94, …

National Survey Of Physical Therapists’ Participation As Health Educators In Physical Activity Promotion Among Older Adults, Casey Nicole Mokres

Walden Dissertations and Doctoral Studies

Physical inactivity among older adults remains a major national and global public health concern linked to preventable morbidity, mortality, and rising healthcare costs. Physical therapists are uniquely positioned to promote physical activity (PA) through health education, yet their engagement in this role is not well defined. This quantitative cross-sectional study examined associations between clinical practice factors—years of experience, board certification status, and practice setting—and three domains of the theoretical domains framework (knowledge, skills, and behavioral regulation) related to PA promotion among older adults. The framework guided identification of behavioral and contextual factors influencing therapists’ delivery of PA promotion interventions. Data …

Factors Affecting The Level Of Grief Experienced By Men Whose Female Partner Died In The United States, Keona C. Lee

Walden Dissertations and Doctoral Studies

Grief is an emotional reaction to the loss of a loved one through death. Although grief is a universal human experience, its perspective is unique, and research has often ignored the varied experiences of racial/ethnic and cultural groups, particularly men of color in the United States. The purpose of this quantitative study was to measure the level of grief experienced by men whose female partner died and to determine whether ethnicity, having a prior mental health diagnosis, social support, and traumatic or anticipated loss significantly impacted their level of grief. The study was guided by the social-ecological model to explain …

Staff Education Project For Nursing Staff At An Adult Mental Health Clinic To Address Inconsistencies And Inadequacies In Suicide Risk Screening, Grace Oluwasade Awodele

Walden Dissertations and Doctoral Studies

This staff education initiative was designed for nursing personnel at an adult mental health clinic, aiming to address inconsistencies and inadequacies in suicide risk screening practices among health care providers. Despite regular patient interactions, staff frequently lack the necessary knowledge, confidence, and standardized tools to identify individuals at risk for suicide, leading to missed opportunities for early intervention. The existing gap in practice jeopardized patient safety, led to preventable harm, and highlighted the need for evidence-based screening protocols, such as the Ask Suicide-Screening Questions (ASQ) tool, to facilitate timely, equitable, and effective suicide prevention in nursing practice. The project focused …

Circumciser Type And The Type Of Female Genital Mutilation/Cutting Prevalence For Girls Ages 0-14 Years In Ethiopia, Jean-Pierre Ramazani Abedi

Walden Dissertations and Doctoral Studies

Despite ongoing eradication efforts, female genital mutilation and cutting (FGM/C) remains a major public health and human rights concern in Ethiopia. This quantitative study was conducted to examine how circumciser type (traditional cutter, birth attendant, or health professional) influences FGM/C prevalence and severity among girls ages 0–14, considering the moderating effects of residence and mothers’ FGM status, while controlling for age and income. Guided by the social ecological model and using 2016 E Ethiopian Demographic Health Surveys data, analysis indicates a significant association between circumciser type and FGM/C type (χ² (2, N = 1,553) = 6.86, p = .032), which …

Staff Education To Improve Patient Safety Using Standardized Medication Transcription Verification, Beloved Martey

Walden Dissertations and Doctoral Studies

This staff education project was a quality improvement initiative aimed at reducing medication transcription errors by implementing a standardized verification protocol. The project addressed the critical practice problem of transcription-related medication errors, which contribute to wrong medication administration, adverse drug events, and patient harm. The practice-focused question was: How does implementing a staff education program on standardized medication transcription verification processes in healthcare institutions affect the rate of wrong medication administration compared to traditional transcription methods without education? The project was implemented over 8 weeks in an outpatient clinic with 20 participants (8 prescribers and 12 nurses). The primary data …

The Efficacy Of Cgrp Antagonists Versus Other Non-Migraine Specific Medications As Prophylactic Treatment For Episodic And Chronic Migraine, Lauryn C. Hutto

The PA Department Journal of Medical Science

Introduction: Migraines are a disabling neurological condition affecting 12-15% of the population. Migraines are characterized by a unilateral throbbing headache lasting between 4 and 72 hours, often accompanied by photophobia, phonophobia, nausea, or vomiting. Until the approval of the first CGRP antagonist, Erenumab, in May 2018, the prophylactic treatment for migraines relied on non-migraine-specific medications, such as antihypertensives and antiepileptics. Studies have been done to determine the efficacy and safety of the new medications, but few have directly compared them to older non-migraine-specific medications used for prevention. The purpose of this paper is to compare the efficacy of CGRP …

The Role Of Conjunctive Hyperbaric Oxygen Therapy In Decreasing Amputations In Those With Diabetic Foot Ulcers: A Clinical Review, Jazmyne D. Smith

The PA Department Journal of Medical Science

Diabetic Foot Ulcers (DFU) are a common complication of Diabetes Mellitus, which is the most common cause of amputations in the US. The purpose of this clinical review is to analyze the impact of Hyperbaric Oxygen Therapy on reducing amputations and improving healing rates in DFUs. PubMed was searched using the key terms “Diabetic Foot Ulcer,” “Amputation,” and “Hyperbaric Oxygen Therapy.” With the addition of filters, Mesh terms, and Boolean operations, 18 results were yielded. The inclusion and exclusion criteria narrowed the search to 6 articles, which were used for this review. The 6 articles included in this study were …

Pharmacologic Therapy Versus Catheter Ablation For Atrial Fibrillation, Jahkarius Hargrove

The PA Department Journal of Medical Science

Introduction- Atrial fibrillation is a common type of cardiac arrythmia that affects many people across the world. Patients with atrial fibrillation are at high risk for complications and poor outcomes. Stroke is the most prominent complication of atrial fibrillation if left untreated. The purpose of this clinical review is to analyze which modality is a better first line treatment, antiarrhythmic drug therapy or catheter ablation for long term management of this arrythmia.

Methods- Pubmed was searched with a specific search strategy using key terms “cardiac”, “Arrythmia”, “Antiarrhythmic agents”, “radiofrequency ablation”, and “surgical operation”. Operators and filters such as …

Comparing Autografts And Bioengineered Skin Equivalents In The Management Of Severe Burns, Madison Hill

The PA Department Journal of Medical Science

INTRODUCTION: Severe burns are associated with high morbidity, mortality, and treatment costs, often requiring surgical intervention to restore the skin barrier and prevent complications like infection and hypothermia. Autologous skin grafting is the current gold standard for burn wound closure but may not be feasible in cases of large TBSA injuries with limited donor sites. Bioengineered skin equivalents, including acellular dermal substitutes and cell-based therapies, offer potential benefits in wound healing and scar quality while reducing donor site morbidity. This review evaluates the effectiveness of autografts compared to bioengineered skin equivalents in severe burn management, with a focus on healing …

Extracorporeal Shockwave Therapy For Plantar Fasciitis Pain Reduction, Nathan J. Lopez

The PA Department Journal of Medical Science

Introduction: Plantar fasciitis (PF), aka plantar heel pain (PHP), is a degenerative and debilitating musculoskeletal condition that is prevalent across various populations. There is some debate concerning the hierarchy of second-line treatment options. The purpose of this article is to compare the efficacy, as it relates to pain reduction, of extracorporeal shockwave therapy (ESWT) and other invasive, non-surgical interventions (injections, dry needling, etc.).

Methods: PubMed was searched using a specific search strategy with key terms "extracorporeal shockwave therapy" and "plantar fasciitis". Operators and filters were then applied to narrow results to 4 relevant and quality articles for review. …

Prevention Of The Recurrence Of Skin Cancer With The Use Of Nicotinamide, Ryan A. Reibling

The PA Department Journal of Medical Science

Introduction: Skin cancer is the most common form of cancer worldwide, caused by the accumulation of UV ray exposure that people are exposed to daily. The treatment options for skin cancer are costly and inconvenient, with a high chance of recurrence in different sun-exposed areas. Nicotinamide, a form of vitamin B3, has shown promising outcomes in reducing the chance of recurrent in high-risk individuals. The purpose of this review is to examine recent literature on the effectiveness of nicotinamide supplementation in lowering the risk of skin cancer recurrence compared to individuals who do not take it.

Methods: A comprehensive PubMed …

Post-Surgical Prognostic Outlook Comparison Of Off-Pump Vs. On-Pump Cabg Procedures, Tanner A. Hendricks

The PA Department Journal of Medical Science

Introduction: Coronary artery disease in the United States had 680,981 deaths in 2023 alone with 400,000 CABG procedures being done. Coronary artery bypass grafting is a procedure in which coronary arteries occluded by fatty plaques are revascularized to restore blood flow to the myocardium. There are two effective options for this procedure, one being the on-pump approach, and the other being off-pump. Both methods carry risks, such as stoke and MI, as well as benefits, but the question of which carries the better outlook on mortality and complications is up for debate. The purpose of this paper is to study …

Safety And Efficacy Of Stroke Prevention With Warfarin Vs. Direct Oral Anticoagulants In Patients With Atrial Fibrillation: A Clinical Review, Kenneth L. Gentry

The PA Department Journal of Medical Science

Introduction: Atrial fibrillation is one of the most common cardiac arrhythmias in adults. This condition greatly increases a patient’s risk for ischemic stroke and is responsible for one-third ischemic strokes. Current international guidelines recommend the use of oral anticoagulants for stroke prevention in patients with atrial fibrillation. The purpose of this review is to analyze the current literature directly comparing the safety and efficacy of direct oral anticoagulants and warfarin at preventing stroke.

Methods: The PubMed database was searched for the following key terms: vitamin k antagonist, direct oral anticoagulants, stroke, and atrial fibrillation. Boolean operators and MeSH terms …

Efficacy Of Metformin Compared To Insulin In The Management Of Gestational Diabetes, Sarah Mchale

The PA Department Journal of Medical Science

Intro: Gestational diabetes (GDM) is a condition in which pregnant women are unable to use insulin effectively, leading to increased levels of glucose in the body. Although insulin has traditionally been a first-line pharmacologic treatment for GDM, metformin is increasingly being explored as an alternative. The purpose of this clinical review is to analyze whether metformin could be a safe and effective oral antihyperglycemic option compared to insulin in the treatment of GDM.

Methods: PubMed was searched with a specific search strategy using the key terms “insulin,” “metformin,” “gestational diabetes,” and “blood glucose.” Operator and filters narrowed results to 19 …

Efficacy Of Zuranolone Use For Postpartum Depression, Diana G. Welliver

The PA Department Journal of Medical Science

Introduction: Postpartum depression is a major form of depression that occurs anytime within the first year after a woman gives birth. It is characterized by low moods, increased feelings of sadness and anxiety, and a decreased interest in one’s baby. It is commonly treated with the use of selective serotonin reuptake inhibitors (SSRIs), which present with negative side effects and have a long duration of onset. The purpose of this study is to evaluate the efficacy of zuranolone, a fast-acting neuroactive steroid and GABA-A receptor modulator, on its ability to reduce symptoms of postpartum depression.

Methods: The PubMed database was …

Deep Brain Stimulation For The Management Of Non-Motor Symptoms Related To Parkinson’S Disease, Kyla A. Wallaszek

The PA Department Journal of Medical Science

Introduction: Deep brain stimulation (DBS) is a modern neurosurgical technique where electrodes are implanted in specific brain areas and deliver electrical impulses in order to help regulate abnormal brain activity. DBS is used for the management of several neurological conditions and was approved by the FDA for the treatment of Parkinson’s disease in 2003. The purpose of this review is to analyze the effectiveness of DBS for the management of the non-motor symptoms related to Parkinson's disease.

Methods: PubMed was searched using the key terms “Parkinson disease,” “deep brain stimulation,” “voice,” “sleep,” “mood,” “cognition,” and “dysphagia.” Operators and filters narrowed …

Labor Induction Versus Expectant Management In Postterm Pregnancy: A Clinical Review, Marisa Putrasahan

The PA Department Journal of Medical Science

Introduction: Postterm pregnancy is associated with increased morbidity and mortality of infant and mother. Current practice varies in the management of late- and postterm pregnancies, with much discussion surrounding the risks and benefits of the intervention options provided to pregnant patients. This study aims to review literature comparing the effectiveness of induction of labor (IOL) with elective management (EM) in reducing adverse perinatal and maternal outcomes for pregnant patients approaching postterm.

Methods: A literature search was performed on PubMed using key terms “late term pregnancy,” “induction of labor,” and “expectant management.” Operators and additional search filters narrowed results …

Outcomes Of Surgical Versus Transcatheter Aortic Valve Replacement: A Clinical Review, Grace Stang

The PA Department Journal of Medical Science

Introduction: Surgical aortic valve replacement (SAVR) has been the predominant

treatment for aortic stenosis (AS) for decades. However, transcatheter aortic valve replacement (TAVR) is becoming increasingly popular. Originally, TAVRs were only performed on patients who were deemed high-risk for surgery and would have died without the valve replacement. The purpose of this paper is to determine if TAVR or SAVR has better health outcomes for all patients no matter their surgical risk.

Methods: A search via PubMed database was done using the key words “aortic stenosis”, “surgical aortic valve replacement”, “transcatheter aortic valve replacement”, and “mortality.” Additional search filters were …

Efficacy And Safety Of Semaglutide In Adults Without Diabetes Who Are Overweight Or Obese, Rebecca Petty

The PA Department Journal of Medical Science

INTRODUCTION:

Obesity is associated with an increased risk of cardiovascular and metabolic disorders and contributes to the leading cause of death in the US — heart disease. Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have recently emerged as a treatment option for obesity. The purpose of this clinical review is to evaluate the efficacy and safety of semaglutide in adults without diabetes who are overweight or obese.

METHODS:

PubMed was searched using a precise search strategy and the key terms “semaglutide,” “weight loss,” and “without diabetes.” Results were filtered and narrowed using specific inclusion and exclusion criteria. Four high-quality studies were …

“Ecmo Anticoagulation: Should We Consider Bivalirudin Over Heparin?”, Confidence Paul

The PA Department Journal of Medical Science

Introduction: Extracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to prevent thrombotic events within the circuit. The use of unfractionated heparin has been the traditional anticoagulant of choice. Bivalirudin, a direct thrombin inhibitor, offers an alternative that has theoretical and observed benefits. The purpose of this clinical review is to evaluate whether bivalirudin provides superior safety and efficacy compared to UFH in ECMO patients.

Methods: PubMed was searched with a specific search strategy using key terms “Extracorporeal membrane oxygenation” AND “indirect anticoagulants” AND “deep vein thrombosis”. Operators and filters narrowed the results to four relevant, quality articles for review.

Results: In …

Effects Of Angiotensin-Converting Enzyme Inhibitors And Angiotensin Receptor Blockers On Covid-19 Outcomes In Severely Ill Patients, Madison L. Edwards

The PA Department Journal of Medical Science

Introduction: Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the virus SARS-CoV-2 and can cause debilitating illness in vulnerable patient populations. The purpose of this clinical review is to analyze the effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the clinical course and severity in COVID-19 adult patients.

Methods: PubMed was searched with a specific search strategy using key terms “adult,” “COVID-19,” and “RAAS inhibiting medications.” Specific operators and filters narrowed the results to a total of five relevant, quality articles for review.

Results: Two articles were randomized controlled trials that directly compared the continuation of …

Comparison Of Vagal Maneuvers And Antiarrhythmics On Adult Patients Presenting With Supraventricular Tachycardias (Svt), James S. Ng

The PA Department Journal of Medical Science

INTRODUCTION: SVT is a well-known and potentially life-threatening arrhythmia, with vagal maneuvers and/or antiarrhythmic drugs often attempted for first-line conversion. The purpose of this clinical review is to analyze the relative effectiveness and success rates of these specific maneuvers and medications.

METHODS: The following PubMed database search was performed:“((vagal maneuver*) OR (valsalva)) AND (pharmacologic) ((medication) OR (medical therapy) OR (adenosine) OR (beta blocker*) OR (calcium channel blocker*) OR (anti-arrhythmic*) OR (anti arrhythmic*) OR (antiarrhythmic)) AND ((SVT) OR (supraventricular tachycardia))”. Filters were then applied and article titles/abstracts reviewed, resulting in a final selection of five articles for review.

RESULTS:. The most …

The Effects Of A Gluten-Free Diet On Patients With Hashimoto’S Thyroiditis, Chandler Blackburn

The PA Department Journal of Medical Science

Introduction: Hashimoto’s thyroiditis is a chronic autoimmune inflammatory condition of the thyroid gland. Hashimoto’s occurs in five percent of the American population and is the most common cause of hypothyroidism in the US. There are various comorbidities associated with Hashimoto’s, which treatment can help mitigate some of those risks. The purpose of this paper is to evaluate if a gluten-free diet, as an adjunct treatment, can lower autoimmune related antibodies while improving thyroid labs levels.

Methods: PubMed was searched for clinical reviews using key terms “Hashimoto’s disease”, “hypothyroidism”, “gluten”, and “anti-TPO antibodies”. Operators and additional filters narrowed down search results …

Monotherapy Versus Combination Levothyroxine And Liothyronine In The Treatment Of Hypothyroidism, Anne F. Thomas

The PA Department Journal of Medical Science

Introduction: Primary hypothyroidism is a common condition where the thyroid gland cannot produce free thyroxine (T4), leading to low serum levels of it. For this reason, it is often treated directly with monotherapy synthetic T4 or as a combined synthetic T4/T3. The purpose of this clinical review is to analyze the effectiveness of T4 monotherapy versus T4/T3 combination therapy in normalizing TSH values and improving symptoms in adults with hypothyroidism.

Methods: A specific search strategy in PubMed was used to conduct the research, incorporating key terms such as “hypothyroidism,” “levothyroxine,” “liothyronine,” and “TSH.” Four quality articles were left for final …

Modern Approaches To Mental Health: App-Based Cbt Versus Traditional Psychotherapy, Samira Shende

The PA Department Journal of Medical Science

Background: Digital mental health tools are becoming widely used as flexible alternatives to in-person therapy. A key question is how effective they are compared to traditional therapy for people with depression and anxiety.

Objective: To compare how effective digital interventions, like app-based CBT or telehealth, are compared to in-person psychotherapy in reducing symptoms of depression and anxiety in adults.

Methods: A structured PubMed search was conducted using specific search terms, limited to English-language randomized controlled trials, systematic reviews, and meta-analyses published between 2020 and 2025. After screening 116 articles, four high-quality studies were selected for review.

Results: Of the four …