Medicine and Health Sciences Commons^™

Improving Compliance With Preoperative Antibiotic Protocols For Cardiac Implanted Electronic Devices: A Quality Improvement Project, James Kaup

DNP Projects

Abstract

Background

Cardiac implantable electronic device infections remain a serious complication of permanent pacemaker implantation despite evidence-based infection prevention guidelines.

Local Problem

An academic electrophysiology laboratory identified inconsistent guideline-concordant antibiotic selection despite consistently high compliance with recommended antibiotic timing.

Methods

A nurse-led, quasi-experimental pre-post quality improvement project evaluated implementation of a standardized preoperative antibiotic prophylaxis protocol. Data from 36 permanent pacemaker implantations (16 pre-intervention, 20 postintervention) were analyzed.

Interventions

The intervention included a standardized antibiotic protocol, multidisciplinary staff education, and performance feedback.

Results

Guideline-concordant antibiotic selection improved from 37.5% to 95.0% (χ² = 11.27, P = .001). Antibiotic timing remained …

Implementing A Standardized App-Led Multidisciplinary Medication Review And Reconciliation To Improve Medication Safety Before Systemic Cancer Therapy: An Ambulatory Oncology Quality Improvement Initiative, Sarah R. Hines

DNP Projects

Background

Adult patients initiating systemic cancer therapy frequently present with pre-existing polypharmacy related to chronic comorbidities and cancer-related symptom management. The addition of anticancer therapies and supportive care medications further increases medication burden and the risk of medication-related harm. Although national organizations and institutional policies recommend comprehensive medication review before treatment initiation, implementation remains inconsistent in ambulatory oncology practice.

Purpose

To implement and evaluate a standardized Advanced Practice Provider (APP)-led multidisciplinary medication review and reconciliation process designed to identify medication medication-related safety risks before initiation of systemic cancer therapy in adult oncology patients receiving care in an ambulatory infusion center. …

Food Insecurity In Older Adults With Cancer, Page Laborde

Senior Honors Theses and Projects

Food insecurity is a growing concern among older adults and is associated with poor health outcomes, particularly among those with cancer. Community-based programs such as Meals on Wheels may help address these challenges, but their role in supporting older adults with cancer is not well understood. This study examined the association between recent non-skin cancer diagnosis and food insecurity, as well as relationships with Meals on Wheels participation. A cross-sectional analysis was conducted using secondary data from Rounds 9 through 14 of the National Health and Aging Trends Study (NHATS), a nationally representative sample of U.S. adults aged 65 and …

Politics Of A Silent Pandemic: Antimicrobial Resistance And State Capacity In India And Nigeria, Mia Kelly

CMC Senior Theses

Antimicrobial Resistance (AMR) has emerged as one of the most pressing yet widely underestimated health threats of the 21st century; this thesis explores the potentially devastating global impact of this “silent pandemic”, exposing how deeply health outcomes depend on political choices, regulatory capacity, and economic constraints. Although the danger of spreading drug-resistant pathogens is now widely acknowledged in both the scientific and political communities, states differ in their abilities to contain the issue, with low- and middle-income countries facing the greatest obstacles to national action plan implementation. This thesis investigates these disparities through a comparison of India and Nigeria, two …

Pillpetz: A Smarter Way To Encourage Medication Adherence In Children, John H. Begley

CMC Senior Theses

Medication adherence is usually framed as a problem of patient behavior, but this thesis argues that it is equally a problem of design. Children who take daily medication face barriers that adults often do not: developing executive function, dependence on caregivers, shifting school and home routines, privacy concerns, and stigma around being perceived as different. The standard prescription bottle, by contrast, was designed primarily for dispensing efficiency, safety, and accidental ingestion prevention—not for sustained daily use by a developing child.

This thesis proposes PillPetz, a smart pill case and digital companion that uses routine, play, dose confirmation, and caregiver-connected support …

Modulating Oran Nitrate-Reducing Bacteria To Enhance Nitric Oxide Bioavailability As A Therapeutic Target For Atherosclerosis, Donovan C. Davidson

CMC Senior Theses

Atherosclerosis remains the primary driver of global cardiovascular disease, yet clinical interventions are largely restricted to high-cost, invasive procedures only after it has reached a critical stage. Recent research has identified a connection between the oral microbiome and vascular health via the enterosalivary nitrate-nitrite-nitic oxide (NO) pathway. Oral nitrate-reducing bacteria (ONRB) drive the synthesization of NO by reducing dietary nitrate into nitrite, which is then converted into bioavailable NO. NO is a potent vasodilator that maintains endothelial health by suppressing inflammation through inhibiting the expression of adhesion molecules VCAM-1 and ICAM-1. However, this pathway is easily compromised by dysbiotic oral …

Not Biological, But Built: Structural And Metabolic Pathways Driving Black Maternal Health Disparities In The United States, Alexandra I. Umegboh

CMC Senior Theses

Black infants in the United States are more than twice as likely to die before their first birthday than white infants, a disparity often attributed to genetics, behavior, or individual health choices. However, this idea is challenged by a key contradiction: African immigrant women consistently experience better birth outcomes than U.S.-born Black women despite being similarly racialized. This thesis investigates the origins of this reproductive advantage and the factors contributing to its decline over time. By drawing on epidemiological data, metabolic health research, and literature on African diasporic healing traditions, it argues that the “healthy immigrant effect” is not biological, …

Intermittent High-Fat, High-Sugar Access During Adolescence Drives Binge-Restriction Feeding And Reduced Weight Gain In A Food Unpredictability Model, Calvin G. Miller

CMC Senior Theses

Food insecurity affects nearly 48 million Americans and 318 million people worldwide, with very low food security disrupting normal eating habits through “feast-or-famine” episodes characterized by cycles of food overconsumption followed by restriction. This dietary pattern alters dopamine signaling within the mesocorticolimbic system — brain circuitry intimately linked to reward processing. This system includes the ventral tegmental area (VTA) and prefrontal cortex (PFC). Overstimulation can be promoted through sporadic high-fat, high-sugar diet (HFHSD) exposure, promoting dopamine neuron architecture alterations and binge-eating behavior. Adolescence represents a vulnerable window, as mesocorticolimbic dopamine projections undergo maturation during this period. Though evidence links food …

From Imbalance To Phenotype: Neurodevelopmental Alterations In Trisomy 21, Andrew Yuan

CMC Senior Theses

Down syndrome (DS), caused by Trisomy 21, is the most common genetic cause of intellectual disability. Individuals with DS consistently show reduced brain volume, decreased cortical thickness, and lasting impairments in learning, memory, and executive functioning. These neuroanatomical changes emerge during fetal development and are accompanied by chronic immune dysregulation due to the triplication of four interferon receptor genes on chromosome 21. Although decreased neuron progenitor proliferation has been known to contribute to these phenotypes, the precise timing and cellular mechanisms underlying disruptions in neurogenesis remain not fully understood. This study used immunohistochemistry to examine human fetal cortical tissue from …

Music Interventions For Critically Ill Patients: Evaluating Effects Of Music On Psychoemotional Symptoms In Critically Ill Patients Receiving Respiratory Support, Allyson Crighton

Honors Undergraduate Theses

Critically ill adults receiving respiratory support in intensive care units (ICUs) frequently experience psychoemotional disturbances such as agitation, anxiety, and delirium, which contribute to prolonged ventilation, increased sedative use, and adverse patient outcomes. While pharmacologic management remains standard practice, associated risks including oversedation and delirium highlight the need for safe, complementary interventions. Emerging evidence suggests that music-based interventions may offer a non-invasive, cost-effective strategy to reduce psychological or emotional distress in this vulnerable population. This integrative literature review examined the effects of music interventions, including passive music listening and structured music therapy, on agitation and related psychoemotional outcomes in critically …

Parenting Stress And Its Association With Parental Technoference: An Integrative Literature Review, Emily S. Machuca

Honors Undergraduate Theses

Introduction: Today, digital devices are a part of daily life, but can serve as a distraction that interrupts important relationships, a process referred to as technoference. In the context of parenting, device use during child interactions may reduce parental attentiveness and engagement, with potential implications for child development and behavior. Parenting stress may influence how and why parents engage with digital devices in the presence of their children. However, the association between parenting stress and parental technoference remains unclear in the current literature. This integrative literature review aimed to synthesize existing evidence examining the relationship between parenting stress and parental …

Examining The Effectiveness Of Icu Diaries In Reducing Post–Intensive Care Syndrome (Pics) Psychological Symptoms: A Rapid Review Of United States–Based Studies, Lananh Tran

Honors Undergraduate Theses

Background: The growing recognition of Post-Intensive Care Syndrome (PICS) has prompted investigation into interventions, such as ICU diaries, to mitigate the long-term psychological effects of PICS. Intensive care unit (ICU) diaries – journals written by clinicians and loved ones during an ICU admission – are a tool that can help patients reconstruct the events of their critical care experience. Entries in the diary may include clinical updates, explanation of treatments, and encouraging words from loved ones or staff. Previous research in European countries found ICU diaries may be effective in reducing psychological effects post ICU admission.

Research question: The aim …

Investigation Of Genx Exposure To Pathways Associated With Colorectal Cancer Risk, Emily J. Ferguson

Theses and Dissertations--Toxicology and Cancer Biology

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants widely detected in drinking water and food sources, resulting in chronic human exposure. Among these compounds, hexafluoropropylene oxide dimer acid (HFPO-DA), commonly known as GenX, has been introduced as a short-chain replacement for legacy PFAS such as perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA). Although GenX is believed to be a safer alternative, emerging research suggests it can still affect human health.

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer-related death in the United States, highlighting the need to better understand environmental …

Production, Characterization, And Diagnostic Application Of Monoclonal Antibodies Against The N-Protein Of Avian Metapneumovirus Subgroup B, Ravi Gupta

Electronic Theses and Dissertations

Avian metapneumovirus (aMPV) is a respiratory pathogen that causes Turkey Rhinotracheitis (TRT) in turkeys and Swollen Head Syndrome (SHS) in chickens. The infection leads to facial swelling, nasal discharge, reduced egg production, and poor growth. This virus is classified into four subgroups: aMPV-A, B, C, and D, with two other novel subgroups, in which aMPV-A, B, and C are most prevalent in the commercial flocks. In early 2024, aMPV-A and B outbreaks have been reported in the US, resulting in severe economic losses. An economic assessment estimates around $112 million in losses in Minnesota and up to $434 million in …

Strong Foundations: Supporting Mental Well-Being In School-Age Youth, Skylar Simpson

Occupational Therapy | OTD Capstone Projects

School-age youth in the United States increasingly face stressors that disrupt their overall mental well-being, highlighting a need for accessible preventative interventions. To address this gap, this doctoral capstone project developed a program titled Strong Foundations: Supporting Mental Well-Being in School-Age Youth, an evidence- and occupation-based program consisting of various interventions designed to enhance the well-being of youth attending a San Francisco Recreation and Park (SFRPD) community-based summer camp. Through embedding occupational therapy-based programming into an environment that currently lacks dedicated mental well-being promotion methods, the Strong Foundations aims to foster mental well-being among school-age youth through occupational engagement that …

Access Resource Guide For Bay Area Cultural Arts Organizations Developed In Collaboration With People With Intellectual And Developmental Disabilities, Clarissa Junio

Occupational Therapy | OTD Capstone Projects

Background: Hidden access barriers persist within cultural arts organizations. As a result, people with IDD continue to experience reduced levels of community participation, limiting the associated benefits to health, well-being, and quality of life. Organizational-level occupational therapy (OT) consultation can address barriers and expand organizational capacity to meet the needs of people with IDD.

Purpose: The project aimed to strengthen organizational capacity of Bay Area cultural arts organizations and expand existing accessibility resources by co-developing a resource guide centered on lived experience to maximize community social participation for people with IDD. The guide was disseminated to cultural arts …

The Role Of Occupational Therapy In Developing Aquatic Programs For Children Diagnosed With Autism, Giavanna Stavros

Occupational Therapy | OTD Capstone Projects

There is a need for inclusion in therapeutic aquatic programming for children diagnosed with autism (ASD), as their increased participation in aquatic interventions and activities promotes safety and well-being for this population. Pediatric occupational therapists (OTs) are vital to fill this gap in skill, as pediatric OTs consistently work with children diagnosed with ASD (Jaicks, 2024), and core principles of the occupational therapy (OT) profession include enhancing one’s safety and well-being (American Occupational Therapy Association (AOTA), 2025). Children diagnosed with ASD must have the opportunity to engage in swimming and aquatic therapy, as this population is at a higher risk …

Sensory Modulation For Adults With Developmental Disabilities: An Occupational Therapy Approach For Adult Day Programs, Aveen Dulai

Occupational Therapy | OTD Capstone Projects

This occupational therapy (OT) doctoral capstone project focused on the development and implementation of a proactive sensory modulation program with the use of Assistive Technology (AT) for adults with Developmental Disabilities (DD) at an adult day program. Adults with DD have diverse needs such as - motor, communication, behavioral, cognitive, and sensory processing challenges. These varying abilities often require AT and environmental adaptations to afford meaningful participation in occupations.  Providing customized and accessible programing for adults with DD arediversity, equity, inclusion, justice and accessibility (DEIJA) issues (Kripke, 2018). Often, adult day programs are limited in OT services, including accessible sensory …

Strengthening Communication And Collaboration Between The Student Support Triad (Teachers, Caregivers, And Health Professionals) In Schools, Jasmine E. Henley

Occupational Therapy | OTD Capstone Projects

Teachers, caregivers, and health professionals, who are key stakeholders that form a student support triad, each face a range of challenges and barriers that impact their ability to communicate and collaborate with one another, therefore impacting the student and their ability to access and participate in meaningful occupations. Though these challenges and barriers for each stakeholder are well-documented individually, there is limited evidence on solutions to strengthen communication across the triad and solutions that center the student and their engagement in meaningful occupations. This project aims to bridge this gap, despite the greater systemic barriers, by developing remedial solutions that …

Sensory Friendly Summers: Designing Inclusive Camp Experiences For Children With Sensory Processing Challenges, Isandla Blanc

Occupational Therapy | OTD Capstone Projects

Children with sensory processing challenges may experience barriers to participation in everyday activities. While summer camps offer opportunities for social development, play, and growth, staff may have limited training and resources to support children with different sensory needs. This can create challenges to participation and inclusion within traditional summer camp environments. The purpose of this capstone project was to develop, implement, and evaluate a staff training program aimed at increasing staff understanding of sensory processing and providing practical strategies to support campers with sensory processing challenges.

A project-level needs assessment was conducted through informal staff conversations, observations of daily camp …

Occupational Therapy’S Role In Promoting An Accessible Playground Environment For Parents With Physical Disabilities, Molly M. Busby

Occupational Therapy | OTD Capstone Projects

Limited implementation of the Americans with Disabilities Act (ADA) accessibility standards and concepts of universal design in the playground environment restrict parents with physical disabilities' engagement in the co-occupation of visiting the playground with their children. The outdoor playground environment promotes the child’s physical, social, emotional, and cognitive development and has positive benefits on the mental health of the parent. Local community park organizations have the power to make accessibility changes to playgrounds in the community but often they lack the knowledge to do so. The purpose of this capstone project is to facilitate increased inclusivity and physically accessible playground …

A Digital Resource To Support Occupational Therapy Fieldwork Students And New Graduates In Applying Occupation-Based Practice In Inpatient Adult Settings, Alyssa Vessel

Occupational Therapy | OTD Capstone Projects

Occupation-based practice is a core concept within the occupational therapy profession. However, Level II fieldwork students and new graduate occupational therapists may struggle to translate their knowledge of occupation-based practice into clinical practice. This doctoral capstone project aimed to support the implementation of occupation-based practice in adult inpatient settings by developing a website with educational and practical resources. Stakeholder needs and existing evidence on barriers and supports to occupation-based practice informed project development. A questionnaire was distributed to Level II fieldwork students, while discussions with new graduate occupational therapists provided an informal needs assessment. Findings guided the development of website …

Evaluating The Impact Of Telemedicine-Based Medication Education On Glycemic Control In Adult Male Veterans With Type 2 Diabetes Mellitus, Megan N. Calter

West Chester University Graduate Theses, Dissertations, and Final Projects

Veterans experience disproportionately high rates of type 2 diabetes mellitus (20.5% vs 11.6% nationally), driven by military-related factors such as PTSD, deployment-related obesity, and service-connected disabilities. At a large urban primary care clinic, 28% (40/141) of veterans with type 2 diabetes mellitus had persistently elevated HbA1c levels of ≥8%, indicating a high risk for diabetes-related complications. This quality improvement project aimed to reduce the proportion of veterans with HbA1c of ≥8% by implementing tailored telemedicine-based medication education, leveraging underutilized virtual care infrastructure to address access barriers and improve diabetes self-management. Participants received two 30-minute telemedicine medication and disease management education …

A Pull Toward Independence: Improving Pessary Removal Ease And Patient Independence Using Dental Floss, Stephanie Haly

West Chester University Graduate Theses, Dissertations, and Final Projects

Pelvic Organ Prolapse and Stress Urinary Incontinence are the most common medical conditions for prescribing a vaginal pessary. Treating these conditions is vital to improve patient outcomes and quality of life. Treatment options vary from surgical options to less invasive alternatives. Due to various reasons, a patient might opt to avoid surgical management which leaves a vaginal pessary as the next best treatment option. Barriers to pessary self-management are seen frequently and can reduce patient independence and compliance. This quality improvement project sought to answer the following research question: In women using vaginal pessaries for pelvic organ prolapse or stress …

Using Text Messages To Reduce Pediatric No-Show Rates In Primary Pediatric Care, Kelly A. Rexford-Hudson

West Chester University Graduate Theses, Dissertations, and Final Projects

Pediatric appointment no-show rates lead to fragmented care, missed preventative services, delayed immunizations, and reduced clinic efficiency. Children who miss well-child and follow-up visits are at increased risk for unmanaged chronic conditions and gaps in developmental surveillance. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate whether bilingual text message reminders would decrease no-show rates in a pediatric primary care clinic. Led by the Plan-Do-Study-Act framework and Bronfenbrenner's Ecological Model, this intervention consisted of two manual text message reminders, delivered in English and Spanish, at 7 days and 2 days before scheduled appointments during a …

Updating Order Set Review Policy To Improve Adherence To Evidence-Based Practice In A Multi-Hospital System, Corynne Lurie

West Chester University Graduate Theses, Dissertations, and Final Projects

Ensuring that clinical order sets reflect current evidence-based practice is essential to delivering safe, high-quality, and consistent patient care across health systems. In multi-hospital organizations, maintaining alignment across facilities presents additional challenges, including variability in workflow, stakeholder involvement, and policy adherence. This quality improvement project evaluated the existing order set review process within a three-hospital health system to determine whether current policies effectively support system-wide needs and promote best practices. Guided by Lewin’s Change Theory, a qualitative descriptive design was used to assess current workflows and gather feedback from stakeholders involved in order set development and review. Survey data, with …

Assessing The Mentorship Role In Neonatal Outcomes, Patricia Juhline Brunner

West Chester University Graduate Theses, Dissertations, and Final Projects

The complex environment of neonatal intensive care requires a skilled, engaged nursing workforce to maintain high‑quality outcomes. Structured mentorship is an evidence‑based strategy shown to enhance professional engagement and support improved clinical outcomes. This Doctor of Nursing Practice quality improvement project aimed to evaluate the impact of a structured clinical mentorship program on evidence‑based practice beliefs, nurse engagement, and selected neonatal outcomes in a Level III academic intensive care nursery.

Guided by the Donabedian model, the project evaluated structure through mentorship design and preparation, process through mentor–mentee interactions and workflow integration, and outcomes through nursing and patient metrics. Lewin’s change …

Examining The Flow State In College Football, Nicholas R. Reynolds Jr., Selen Razon

West Chester University Graduate Theses, Dissertations, and Final Projects

The flow state, first defined by Csikszentmihalyi (1990) as a state of total absorption in an activity characterized by effortless control, heightened focus, and peak functioning, has been well-documented in sport but has received limited attention in the context of college football. This study examined the flow state experiences of varsity football players at West Chester University, including their awareness of the concept, the frequency and subjective nature of their experiences, the strategies they use to reach this state, and their perceptions of its relationship to team success. A researcher-developed survey was administered to team members during the offseason, yielding …

Geriatric Trauma Care: Closing The Gap Between Current Practice And Evidence-Based Data, Coleen Dever

West Chester University Graduate Theses, Dissertations, and Final Projects

Trauma care for older adults, ages 65 and older, poses challenges for trauma centers and emergency departments. This age group accounts for nearly 20% of the population and is expected to continue growing, underscoring the need for rapid, efficient management after injury. Complex medical conditions and medications, such as anticoagulants, can worsen injuries even from low-energy mechanisms like a ground-level fall (GLF). As a result, trauma centers develop protocols to identify patients at the highest risk of serious injury and to allocate resources for assessment and treatment. Across the country, trauma centers have updated protocols to include anticoagulant use as …

Legislating Equity: A Qualitative Policy Analysis Of Healthcare Access And Health Literacy In Medically Underserved Communities In New Jersey, Korlu Y. Howard

West Chester University Graduate Theses, Dissertations, and Final Projects

Access to healthcare has always been a major policy challenge in the United States and contributes to ongoing disparities. Reform efforts have focused on expanding insurance coverage, yet less attention has been focused on whether the healthcare system is navigable. This study examines three New Jersey statutes using Kingdon’s Multiple Streams Framework and the Health Equity Framework. The purpose of this examination is to better understand how statutory language shapes healthcare access. The findings show that access is primarily structured through coverage requirements, procedural protections, and established legal rights. At the same time, these systems often involve added complexity, requiring …