Medicine and Health Sciences Commons^™

Investigating The Mechanisms By Which Gut Microbiome Dysbiosis Contributes To The Autoimmune Response In Multiple Sclerosis, Abigail Houtrouw

Honors Theses

This literature review explores the multifaceted relationship between gut microbiome (GM) dysbiosis and multiple sclerosis (MS), highlighting key themes that advance understanding of disease pathogenesis and therapeutic potential for treatments targeting the gut. The review underscores the immune system dysregulation in MS, emphasizing the roles of T cells, B cells, and microglia in neuroinflammation and demyelination. Historically, MS pathogenesis was thought to be driven mainly by T-cell dysregulation, but current research highlights the additional roles of B-cells and microglia, the resident immune cells of the central nervous system (CNS). Additionally, this literature review identifies GM alterations and dysbiosis as critical …

Implementation Of An Institution-Specific Checklist To Improve Compliance With Discharge Round Completion In A Neonatal Intensive Care Unit, Lee A. Lawson

Student Scholarly Projects

Practice Problem: Effective discharge planning for premature infants in the NICU requires collaboration and coordination among multidisciplinary interprofessional (IP) teams. Ineffective communication during care transitions is a well-documented contributor to adverse patient outcomes, including prolonged hospitalization.

PICOT: For multidisciplinary, interprofessional teams in the NICU (P), how does the introduction of an institution-specific discharge checklist (I), compared to the current unit discharge process (C), affect multidisciplinary, interprofessional team compliance with completing weekly discharge rounds (O) within 6 weeks (T)?

Evidence: The reviewed literature supported the use of a discharge checklist tool to facilitate effective team communication and care coordination with parents …

Anesthesia Informed Consent: An Objective Structured Clincial Examination, Joshua Powell

Doctoral Projects

Informed consent is a fundamental component of anesthesia practice and is recognized as professional Standard IV by the American Association of Nurse Anesthesiology (AANA). Despite its importance, anesthesia providers often face challenges in effectively obtaining consent from patients. Within The University of Southern Mississippi (USM) Nurse Anesthesia Program (NAP), a need was identified to strengthen student competency in conducting anesthesia informed-consent discussions. This project developed and implemented an Objective Structured Clinical Examination (OSCE) as a standardized, evidence-based approach to teach and assess informed-consent skills in alignment with the American Association of Nurse Anesthesiology (AANA, 2019) standards. The intervention was designed …

The Effectiveness Of A Chronic Care Management Program On Hospitalization Rates And Quality Of Life In Chronic Kidney Disease Patients, Sophie Burris

Doctoral Projects

Chronic Kidney Disease (CKD) is a progressive condition that distinctively affects underserved rural communities due to limited access to healthcare, provider shortages, and transportation barriers. Chronic Care Management (CCM) has emerged as a patient-centered, initiative-taking approach that emphasizes care coordination and self-management support. The purpose of this doctoral project was to evaluate the impact of implementing a CCM program in Caucasian females over the age of 40 with CKD residing in an underserved rural community post hospitalization. The Chronic Care Model (CCM) is the framework that guides the doctoral project which compared outcomes in patients enrolled in a CCM program …

Implementing The Steadi Fall Risk Screening Initiative Within A Primary Care Setting To Improve Patient Safety, Haleigh Marie Brown

Doctoral Projects

Falls among older adults are a significant public health issue and the leading cause of injury-related illness and death in people aged 65 and older. While evidence-based guidelines exist and awareness of fall risks has increased, many primary care settings do not use standardized fall risk screening protocols. This gap results in missed opportunities for early identification and prevention. To address this need, the Centers for Disease Control and Prevention (CDC, 2019) created the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) Toolkit, which offers healthcare providers a structured approach to assess, manage, and reduce fall risk.

This doctoral project aims …

Point-Of-Care Gastric Ultrasound For Preoperative Assessment Of Gastric Contents: An Objective Structured Clinical Examination, Joshua Mann, Michael Sykes

Doctoral Projects

Pulmonary aspiration remains a leading cause of anesthesia-related mortality. The current nil per os (NPO) guidelines are proving unreliable in the presence of delayed gastric emptying due to comorbidities and the increasing use of glucagon-like peptide-1 (GLP-1) agonists. Gastric point-of-care ultrasound (POCUS) use provides a non-invasive, evidence-based, and cost-effective approach to assess gastric content and volume directly. However, limited formal training exists for advanced practice registered nurses (APRNs), and this lack of training contributes to the lack of its utilization. This doctoral project evaluated the effectiveness of an educational intervention that incorporated a didactic lecture as well as a hands-on …

Factors Associated With Emergency Hospitalization Of Kidney Disease Patients In A National Hospital Kenya., Dorcus Miyombe

MSc in Advanced Practice Nursing

Introduction: Emergency hospitalizations among End Stage Kidney Disease (ESKD) is a major global health burden, with low- and middle-income countries in sub-Saharan Africa (SSA), experiencing the highest rates of morbidity and mortality. Limited resource, economic burden, and insufficient health infrastructure were the main challenges. Emergency hospitalizations at Kenyatta National Hospital remains high due to systemic gaps and poor continuity of care. Prerenal, intrarenal, post-renal injuries, as well as any combination of these, are the primary causes of ESKD. There are stipulated guidelines for ESKD patients’ management however, realization of these goals has not been achieved leading to hospitalization KDIGO …

Community Health Promoters’ Experiences In Mitigation Of Cardiovascular Diseases In Lari Sub-County - Kiambu County, Kenya, Emily Njeri Muchina

MSc in Advanced Practice Nursing

Background: Cardiovascular diseases (CVDs) are a rising public health issue in low- and middle-income countries, including Kenya, where there is an escalation of their deaths and preventable risk factors. Community health promoters (CHPs) have a crucial role in the prevention of CVDs. Yet, low knowledge of CVD prevention and low detection of CVD risk factors characterise most underserved communities in Kenya. Little has been documented about CHPs' experiences in mitigating CVDs despite the presence of multilevel barriers and facilitators that can shape their experiences.

Aim: To gain an in-depth insight into the experiences of CHPs in mitigating CVD …

Predictors Of Complications Among Adult Patients Diagnosed With Type 2 Diabetis Mellitus At Thika Level Five Hospital, Kenya, Bernard Wambua Mbithi

MSc in Advanced Practice Nursing

Introduction: Despite advances in the management of Type 2 diabetes mellitus (T2DM), anecdotal reports from Thika Level Five Hospital indicate that patients still present with diabetes mellitus-associated complications. Therefore, this research aimed to determine the predictors of complications among adult patients diagnosed with T2DM in the hospital.

Methodology: Analytical cross-sectional design was utilized in this research. To select the respondents, purposive sampling was used to recruit six nurse managers and their deputies (making a total of 12 nurses), while 294 patients in the clinic were recruited using systematic sampling. Purposive sampling was also used to recruit 15 patients …

Staff Education To Implement Phq-9 Depression Screening Among Adults, Sharon C. Nwanne-Temple

Walden Dissertations and Doctoral Studies

Abstract Depression remains one of the most prevalent and underdiagnosed mental health conditions globally, resulting in substantial morbidity, diminished quality of life, and increased healthcare costs. The purpose of this Doctor of Nursing Practice (DNP) project was to improve early detection of depression among adults in a primary care setting through a structured staff education program on the use of the Patient Health Questionnaire-9 (PHQ-9) screening tool. A mixed-methods quality improvement design guided implementation over a six-week period with nine clinical staff participants, including nurses, medical assistants, and providers. The educational intervention comprised a PowerPoint presentation, interactive discussion, and post-training …

Improving Patient Access To Providers By Optimizing Message Center Workflow, Serena Valino

Walden Dissertations and Doctoral Studies

This project was an evaluation of a quality improvement initiative that addressed the practice problem of having large volumes of unanswered messages within the patient portal. To increase patient access to the healthcare provider, a literature search was conducted using the practice-focused question: Can standardization of patient portals improve the message turnaround time? In January 2024, a scoping review of nursing message center pools determined 79 pools lacked standardized names and established workflows for 37 ambulatory clinics. Pool names were identified for each clinic and listed using an Excel spreadsheet. Clinic pool members were isolated, and it was determined by …

The Role Of Fast-Food Consumption, Residential Fast-Food Exposures, And Urinary Essential Trace Heavy Metals In Colorectal Cancer (Crc) Outcomes., Jeevan Adhikari

Electronic Theses and Dissertations

Background: Colorectal cancer (CRC) is a public health concern. Within the United States (US), fast-food consumption and environmental exposure to heavy metals have increased. The impact of fast-food consumption frequency from fast-food restaurants, residential fast-food exposures, and urinary essential trace heavy metals in relation to CRC outcomes have not yet been rigorously evaluated in the US. Methods: Within the LEAPS-CRC study, we used geographic information systems (GIS) and logistic regression to study the association of fast-food consumption, residential proximity to a fast-food outlet, and urinary essential trace metals with CRC incidence. Additionally, within Kentucky Cancer Registry (KCR) CRC cases, the …

Residential Segregation And Breast Cancer In Louisville: Impact Of Race And Contextual Factors On Advanced-Stage Diagnosis, Delayed Treatment, And Disease-Specific Mortality., Toheeb Ajani Mustapha

Electronic Theses and Dissertations

Female breast cancer (BC) remains the most commonly diagnosed non-skin cancer and the second leading cause of cancer death among U.S. women. Despite advances in detection and treatment, substantial inequities in BC outcomes persist, driven in part by structural forces such as residential segregation. This dissertation examined the relationship between residential segregation, BC outcomes, and key contextual factors in Louisville, Kentucky. Using data from the Kentucky Cancer Registry, American Community Survey, CDC’s Population-Level Analyses and Community Estimates, and the National Neighborhood Data Archive, the study tested two hypotheses: (1) higher Black/low-income segregation is associated with elevated risks of adverse BC …

Increasing Histidyl Dipeptides In Skeletal Muscle Preserves Muscle Mass And Function In Heart Failure., Mamata Hiraman Chaudhari

Electronic Theses and Dissertations

Introduction: Heart failure is a systemic disease associated with multiple comorbidities, such as skeletal muscle wasting and cardiopulmonary disease. Muscle wasting in heart failure patients is a severe comorbidity associated with decreased exercise capacity and poor quality of life. Previous reports show that oxidative stress is increased in the skeletal muscle of heart failure patients, which can directly lead to muscle wasting. However, antioxidant intervention in these patients was unable to improve cardiac function and consequently had no effect on muscle wasting. Although oxidative stress is the primary driver of skeletal muscle atrophy, no attempt has been made to examine …

A Multilevel Analysis To Evaluate Variability In Sdoh Clusters Within Rurality And Its Effects On Cancer-Specific And All-Cause Mortality In The Us., Stephie Ann Abraham

Electronic Theses and Dissertations

Social determinants of health (SDOH) factors have consistently been shown to impact all-cause and cancer-specific mortality. Area-level SDOH factors that coexist to form “high-risk” clusters are more prevalent in rural than urban areas. However, heterogeneity within rural and urban areas may contribute to variations in SDOH factors that could influence higher mortality rates and is not considered in other studies. The primary objective of this study was to utilize ecological and individual-level data to determine if the composition of SDOH clusters within counties in the rural-urban continuum contributes to differences in all-cause (AC) and cancer-specific mortality rates of lung and …

Understanding Social And Cognitive Influences In Medical Students' Learning Processes For Step 1: An Interpretivist Case Study., Ashley Elaine Triplett

Electronic Theses and Dissertations

This qualitative interpretivist case study explores, at a singular institution, medical students’ perspectives on the social and cognitive factors influencing the learning process as students prepare for the Step 1 examination. While prior research regarding medical students Step 1 preparation have focused primarily on wellness, stress, and career outcomes, limited studies have examined medical students' lived experiences to navigate what occurs during the learning process while they prepare for this critical exam. Utilizing a qualitative case study approach, this dissertation draws on fourteen student interviews, seven that passed Step 1 on their first attempt, and seven that failed. Findings reveal …

The Effect Of Shared Decisions On Intertemporal Choice, Rosemarie M. Davidson

Masters Theses

Substance use disorders are a significant public health concern, and improving treatment outcomes requires a better understanding of the behavioral processes that influence drug consumption. Delay discounting, or the tendency to overvalue immediate reinforcers, is reliably more severe among individuals with substance use disorders. Recent work suggests that shared decision-making may increase tolerance for delayed rewards; however, prior studies used procedures that confounded delay to token delivery with delay to token exchange, limiting conclusions. The present study evaluates delay discounting across individual and social decision-making contexts using a traditional delay discounting paradigm.

Ten undergraduate participants completed sessions involving choices between …

A Change In Practice: Improving Uti Management In A Long-Term Care Facility By Implementing Rapid Urinary Culture Collection Protocols To Enhance Timely Treatment And Reduce Hospitalizations, Tania Ojeda

Doctor of Nursing Practice

ABSTRACT

Background: Urinary tract infections (UTIs) remain a leading cause of morbidity among elderly residents in long-term care facilities, where diagnosis is frequently delayed due to atypical presentation, cognitive impairment, and inconsistent urine specimen handling. Purpose: This quality improvement (QI) project aimed to improve the timeliness and accuracy of UTI management in a memory care facility through standardized evidence-based protocols. Objectives: The project sought to ensure that: (a) 100% of staff would be educated on the protocol; (b) 100% of residents with suspected UTIs would have urine sent for urinalysis and culture within 8 hours of symptom onset; (c) 100% …

Implementation Of The Modified Severity Assessment Scale (Msas) For Alcohol Withdrawal In An Inpatient Psychiatric Unit, Grace R. Lindsey

Doctor of Nursing Practice

Background: Alcohol withdrawal is a potentially life-threatening condition frequently seen in psychiatric inpatient settings, especially among individuals with co-occurring alcohol use disorder and mental illness. The Clinical Institute Withdrawal Assessment for Alcohol Scale-revised, while widely used, depends on patient self-report, making it less effective for individuals with altered mental status or psychosis.

Purpose: This quality improvement project implemented the Modified Severity Assessment Scale, an objective, observation-based alcohol withdrawal protocol, in an inpatient psychiatric setting to improve safety, treatment accuracy, and care standardization.

Objectives: The project focused on ensuring full staff adoption of the protocol, reducing intensive care unit transfers …

Examining And Addressing Increased Hospital Inpatient Falls Rates At An Urban Community Hospital, Juan Lira

Doctor of Nursing Practice

Abstract

Background: Falls are the leading cause of reported injuries within the hospital setting. Injuries from falls occur in about20-45% of the time and is the leading cause of injury and injury death among the adult population. Inpatient falls are associated with an additional $14,0000 per occurrence and a prolonged hospitalization by 6.3 days. Increased falls rates affect hospitals rating, accreditation and reimbursements. This hospital is experiencing inpatient falls that exceed national average and corporate goals.

Purpose: The purpose of this project is to reduce the hospital falls rate by 10% within 90 days of initiating evidence-based evaluation and facility-wide …

Implementation Of An Information Sheet For Pediatric Patients With Autism Spectrum Disorder In An Inpatient Setting To De-Escalate Aggressive Behaviors And Reduce Seclusion Rates, Megan R. Castro

Doctor of Nursing Practice

Introduction: Research shows that most seclusion events in pediatric psychiatric settings involve pediatric patients with neurodevelopmental disorders, particularly autism spectrum disorder (ASD). A lack of provider expertise contributes to elevated seclusion rates, highlighting the need for evidence-based, ASD-informed care.
Purpose: To reduce seclusion events within a pediatric psychiatric facility in South Texas, by implementing an evidence-based intervention upon admission that could decrease aggressive behaviors and the likelihood of requiring seclusion. Evidence summary: Literature and guidelines underscore the importance of identifying sensory triggers and calming strategies at admission. Collaborative care and personalized interventions, such as a patient information sheet that identifies …

Implementing A Cardiac Catheterization Pre-Procedure Protocol To Decrease Avoidable Same-Day Cancellations, Christina C. Perry

Doctor of Nursing Practice

Background and significance of the problem: Pediatric congenital heart defect patients are amongst the sickest hospital population. These patients require planned palliation in the cardiac catheterization lab (cath lab), which has a limited number of providers and appointments available. In the cath lab, the percentage of avoidable same-day cancellations for interventional procedures was found to be greater than 30%, representing significant resource utilization opportunities.

Purpose: The purpose of this project was to develop and implement a standardized, evidence-based pre-procedure protocol to decrease avoidable same-day cath lab cancellations.

Goals and objectives: The goals of this project were a 10% decrease in …

John Henryism And The African American Experience: An Exploration Of Risk And Protective Factors And Health Outcomes, Joseph L. Twitdy

All-Inclusive List of Electronic Theses and Dissertations

Racial discrimination has been tied to adverse mental and physical health outcomes among African Americans. In the face of this adversity, African Americans have developed strategies for coping with everyday experiences of discrimination. One such coping method is based on the concept of John Henryism. The folktale of John Henry tells the story of an African American steel-driver racing against a steam-powered drill to clear a path for trains through a mountain. Although John Henry wins the race, he later dies due to exhaustion, ultimately passing with his hammer in his hand. The psychological concept of John Henryism (JH) refers …

Quality Of Life And Mental Health: A Qualitative Exploration Of Perceived Factors That Impact Older Adults, Chasiti Herring

All-Inclusive List of Electronic Theses and Dissertations

Enhancing quality of life and well-being is a universal phenomenon across the lifespan. As the population ages, older adults are in great need of supportive services to enhance quality of life and their ability to manage their mental health. The purpose of this study is to examine the quality of life (QoL) of older adults. This study aimed to provide valuable research in the area of QoL through the exploration of perceived factors that impact the older adult population. This exploratory qualitative research study consisted of 10 older adult participants between the ages of 65 and 95. Research recruitment prioritized …

Implementing Pain Curricula In Prelicensure Physical Therapy Education: Faculty Perspectives And Experiences, John D. Kiesel

All-Inclusive List of Electronic Theses and Dissertations

The impact of pain on society has implications for individuals’ well-being and the overall health of society. Despite the high prevalence of pain, many new healthcare providers often lack the confidence and skills to manage patients with pain effectively. This phenomenological research study aimed to understand the lived experiences of faculty responsible for developing and delivering pain education to prelicensure physical therapy students. A secondary purpose was to examine the barriers that exist from the perspective of faculty members with subject matter expertise in pain education to implementing effective pain education in prelicensure curricula. Prelicensure pain education is essential for …

Assessing U.S. Fatal & Nonfatal Injury Trends By Worker Age, Alexander Mcdaniel

All-Inclusive List of Electronic Theses and Dissertations

Occupational injuries and fatalities in the United States have declined over time; however, meaningful differences by worker age remain a concern for employers and safety professionals. Younger workers often experience higher non-fatal injury rates due to limited experience and developing hazard-recognition skills, while older workers face increased risk of severe and fatal outcomes related to age-associated physical changes. The purpose of this study was to analyze long-term injury and fatality trends by age group and determine whether differences exist over time. National injury data from the Census of Fatal Occupational Injuries (1992–2023) and the Survey of Occupational Injuries and Illnesses …

Athletic Participation Among Students And Its Correlation To Increased Outcomes In Academic Performance, Benjamin Carl Anderson

All-Inclusive List of Electronic Theses and Dissertations

This quantitative study investigated the correlation between student participation in athletic-based extracurricular activities and academic performance among high school students in rural Indiana. The research sought to determine whether athletic involvement contributes to academic success indicators such as PSAT and SAT scores, and school attendance. The study looked at how athletics can serve as a lever for improving academic outcomes and supporting students in meeting the criteria for postsecondary readiness. Key research questions explored the influence of gender, ethnicity, grade level, and attendance on academic performance within the subset of students participating in athletics. A review of the literature supported …

An Objective Structured Clinical Examination (Osce) For Spinal Anesthesia Utilizing Landmarks And Ultrasound Guidance, Ashley Craven, Marli Gray

Doctoral Projects

Spinal anesthesia, a critical regional anesthetic technique, is frequently administered by Certified Registered Nurse Anesthetists (CRNAs) for a variety of surgical procedures, especially those involving areas below the umbilicus. However, CRNAs' experience with spinal blocks may vary when transitioning to new hospital environments, necessitating continued education and skill assessment. This doctoral project aims to address the knowledge gaps through the development of an Objective Structured Clinical Examination (OSCE) specifically designed for CRNAs.

The OSCE incorporates current best practices and research on spinal anesthesia, offering CRNAs an instructional framework for administering spinal blocks using both traditional landmark techniques and ultrasound guidance. …

An Objective Structured Clinical Examination (Osce) For Axillary Nerve Blocks Using Ultrasound-Guidance And Landmark Techniques, Bailee Ladner, Hannah Wallace

Doctoral Projects

The purpose of this doctoral project was to create an informative educational and evaluation tool on axillary brachial plexus nerve blocks using ultrasound-guided and landmark techniques for Certified Registered Nurse Anesthetists (CRNAs). CRNAs can use this in the clinical setting to help improve understanding and performance of axillary brachial plexus blocks. Axillary brachial plexus blocks are beneficial in providing analgesia throughout the perioperative period while minimizing risks associated with general anesthesia. Additionally, axillary blocks have a more desirable safety profile than other peripheral nerve blocks, such as supraclavicular nerve blocks. Local anesthetic systemic toxicity (LAST), due to accidental vascular puncture, …

Across The Pond, Across The Waistline: A Comparative Look At The Childhood Obesity Crisis In The United States And United Kingdom, Samantha N. Eales

Honors College Theses

Childhood obesity is no longer just a local concern; it’s a global epidemic shaping the health of future generations. This paper compares how two similar nations with drastically different healthcare systems, the United States and the United Kingdom, tackle this growing crisis. Although both countries struggle with fast food culture, sedentary lifestyles, and targeted marketing, their health policy strategies differ dramatically. The U.S. leans on community programs and education, while the U.K. enforces stronger national regulations and advertising restrictions. By examining nutrition, physical activity, and policy, this thesis explores what each country does well and where they fall short. It …