Medicine and Health Sciences Commons^™

Prevention Of Icu Delirium Through Implementation Of A Sleep Promotion Bundle, Victoria Bennett

Master's Theses and Capstones

Background: Intensive care unit (ICU) delirium is the prevalence of delirium in ICU patientswho do not have a history of drug/alcohol abuse, an admission for a mental status change, or anadmission to the ICU for less than 24 hours. Serious adverse outcomes have been linked to thepresence of ICU delirium resulting in overall longer hospital lengths of stay, longer duration ofmechanical ventilation, higher rates of mortality, and long-term neuropsychological deficits afterdischarge. At the site of this quality improvement project, the prevalence of ICU delirium was92.3% in a population determined to be high risk using the PRE-DELIRIC screening tool. Aim: The …

Using Shock Index As A Predictor Of Icu Readmission: A Quality Iimprovement Project, Melissa Sykes

Master's Theses and Capstones

Background: Adverse events will occur in one-third of patients discharged from the intensivecare unit (ICU) and evidence shows that ICU readmissions increase a patient’s length of stay,
mortality, hospital costs, and nosocomial infections, as well as decrease long-term survival.Specific predictive factors that will accurately predict which patients are at risk of adverseevents requiring readmission are needed.Aim: The specific aim of this project was to identify if shock index (SI) values higher than 0.7at the time of transfer from the ICU are a useful predictor of ICU readmission.Methods: Using the Plan, Do, Study, Act (PDSA) framework, a retrospective chart review wasperformed …

Aldrete Discharge Scoring: Appropriate For Post Anesthesia Phase I Discharge?, Laura P. Dowling

Master's Theses and Capstones

Background: Advances in anesthesia and surgical techniques, along with an increase in managed care, have led to an increase in ambulatory surgeries. The post-anesthesia discharge criteria used for inpatient care may not be appropriate for ambulatory care patients

Aim: This quality improvement project was aimed at examining whether or not the patient length of stay (LOS) in Phase I of post anesthesia care was appropriate. The global aim was to right-size post anesthesia care Phase I length of stay for adult upper extremity surgical patients.The first step was to assess the effectiveness of the PACU discharge criteria. The specific aim …

Improving Emergency Response In The Outpatient Clinic Setting, Matte Horton

Master's Theses and Capstones

Background: Effective triage, assessment, and activation of necessary systems in emergent situations of clinical instability is vital in reducing morbidity and mortality of patients in any clinical setting. When medical emergencies occur outside of the hospital, organized and expedited transfer to a higher level of care reduces the potential for adverse events, lasting deficits, and patient death. Aim: The aim of this project was to identify weaknesses in the emergency response system in the community-based outpatient clinic setting and to propose solutions. Methods: The “Swiss Cheese” theoretical framework was used to do a root cause analysis of two clinical scenarios. …

An Updated Rounds Checklist To Increase Appropriate Use Of Telemetry Monitoring, Hattie Miller

Master's Theses and Capstones

Background: Telemetry monitoring is an essential tool to monitor cardiac electrical activity. Its overuse is costly in time and resources and leads to subsequent testing and treatments that are not necessary for the patient and, in addition, healthcare staff is burdened with work that is potentially not clinically useful.

Aim: The global aim of increasing efficiency in telemetry use starts with the local improvement to facilitate nurse-physician communication of telemetry patients during

Methods: This study with pre and post data collection looked at the results of quantitative data, collected in May-July 2015, on the number of patients with telemetry and …

Be Seen And Heard Being Clean: A Patient-Centered Approach To Hand Hygiene At Concord Hospital, Ashley Pinkham

Master's Theses and Capstones

Background: Regular hand washing is recognized as the most effective means to combat the spread of infectious illness; however hand washing behavior amongst health care workers (HCW’s) is inconsistent. Furthermore, measurement of hand washing behavior is subject to bias.

Aim: This quality improvement project aimed to remove the Hawthorne effect and improve the behavior of HH at Concord Hospital.

Methods: A quasi-experimental, pre-posttest design was used to evaluate HH rates on a 32 bed med-surge unit at Concord Hospital. Baseline data was collected for 30 days by asking patients if they had seen or heard staff cleaning their hands. Using …

Engaging Patients To Improve Documentation Of Oral Intake On A Cardiac Telemetry Unit: A Quality Improvement Initiative, Timiny A. Mosher

Master's Theses and Capstones

Background Information
It is important for patients with heart failure to have awareness of their intake & output to effectively manage their disease. There is evidence that tracking intake & output is a component of missed nursing care resulting in discrepancies between the actual patient intake and what is documented in the patient’s electronic health record (EHR).

Aim

The aim of this quality improvement project was to engage patients in monitoring their intake by using teach-back and patient engagement techniques to track their own oral fluid intake throughout the day.

Methods
The Plan-Do-Study-Act (PDSA) model was used as the framework …

Implementing A Checklist & Hourly Huddles To Increase Situational Awareness During The Second Stage Of Labor-A Perinatal Quality Improvement Project, Kelly Knowles

Master's Theses and Capstones

Background: Current management of the second stage of labor often follows tradition-based routines rather than evidence-based practices. A lack of situational awareness and tunnel vision can limit medical decision-making. Northern New England Perinatal Quality Improvement Network (NNEPQIN) has listed Second Stage Situational Awareness as a priority initiative. Standardized checklists are useful for maintaining situational awareness. Regular debriefings using a standardized tool have been shown to improve communication and team based care, which generally leads to improved patient outcomes. Based on this evidence, developing a standardized checklist including regular hourly care team “huddles” is valuable and could result in improved birth …

Climate Change Implications For Health-Care Waste Incineration Trends During Emergency Situations, Emilia Mmbando Raila

Walden Dissertations and Doctoral Studies

Healthcare waste (HCW) incineration practices in the global South countries are among the major sources of black carbon (BC) emissions or smoke. This study analyzes HCW incineration trends during emergency situations and smoke from HCW incineration processes in Haiti. The study was prompted by the current arguments about the climate change and the growing health effects associated with BC emissions. The conceptual framework was based on both adverse health effects from BC emissions exposure and climate change potential of BC emissions. Therefore, the goal was to determine whether cardboard HCW sharps containers emit lower BC emissions to the atmosphere during …

Type 2 Diabetes Prevention Program In The Medical Office Clinic, Jovita Chibuzo Ezirim

Walden Dissertations and Doctoral Studies

The challenge of diabetes prevention is to reduce the financial and human costs of diabetes by preventing new cases and enacting social change. African Americans and Hispanics Americans have a high incidence of Type 2 diabetes because of factors that place them at risk for prediabetes. The purpose of this project was to plan the implementation and evaluation of a Type 2 diabetes prevention program in a medical office clinical setting. The clinic of interest was located in the downtown area of the city and provided care mostly to African American population. The Iowa model of evidence-based practice formed the …

Exploring Strategies For Implementing Barcode Medication Administration Systems, Julie A. Frederick

Walden Dissertations and Doctoral Studies

The number of medication errors associated with preventable deaths in healthcare facilities remains at a high rate for healthcare leaders. Practices of medication delivery remain similar to those 10 years ago. Hospitals that have implemented barcoding medication administration systems have reported a decrease in medication errors ranging from 60% to as high as 93%. Despite this utility of barcoding, only 50% of U.S. hospitals have implemented barcode medication administration. This comparative case study explored the strategies hospital leaders used to implement barcode medication administration systems, utilizing the sociotechnical theory for a conceptual framework. Face-to-face, semistructured interviews were used to identify …

The Distribution Of Type 1 Diabetes Onset In The United States By Demographic Factors, Margaret Beckstrand

Walden Dissertations and Doctoral Studies

Type 1 diabetes (T1D) is a chronic and lifelong condition, often diagnosed in childhood. Patients with T1D are at elevated risks of associated health complications, comorbidities, and mortality. Occurrence, clinical presentation, and complications related to T1D differ by age of onset, ethnicity, and gender. The last reported population-based estimates regarding the burden of T1D in children using the National Health and Nutrition Examination Survey (NHANES) were published in 2008, and these estimates were not well stratified by age of onset, ethnicity, and gender. The purpose of this study was to examine these demographics within the conceptual framework of the hygiene …

Health Literacy And The Level Of Hypertension In Urban Latinos, Marlene Rosetta Glashen

Walden Dissertations and Doctoral Studies

Health literacy (HL) plays a significant role in health care communication and patient compliance. Low health literacy leads to noncompliance with health instructions, poor health choices, failure to participate in recommended health screenings, frequent hospitalizations, and higher health care costs. Using the health belief model (HBM) as the conceptual framework, this quantitative, cross-sectional study addresses a gap in the literature related to the research questions of this study. The research questions are: (a) Is there a relationship between HL and the level of hypertension (HTN) in hypertensive urban Latinos?, and (b) Will HL predict the level of control of HTN …

Short- And Moderate-Duration Static Stretching Do Not Decrease Vertical Jump Performance When Performed With A Complete, Sport-Specific Warm-Up, Alvin M. Goh

Theses : Honours

Background: Research has shown that static stretching may improve muscle flexibility as well as minimise soft tissue injury. However, recent studies have recommended the removal static muscle stretching from pre-exercise routines due to its deleterious effect on physical performance. Nonetheless, research has shown a duration-dependent effect of static stretching, with total muscle stretch durations < 45 s having little influence on subsequent sporting performance. Furthermore, some evidence indicates that muscle stretching may not influence performance when a sport-specific warm-up follows the stretching component. However, this protocol has not been implemented in most studies.

Purpose: The purpose of the present study was to compare the effects of shorter (5 s) and longer (30 s) periods of static stretching to dynamic stretching on vertical jump performance in sub-elite athletes when the stretches are completed early in a complete pre-exercise routine. It …

Early Maladaptive Schemas In An Australian Adult Alcohol Dependent Clinical Sample: Differences Between Men And Women, Diana Lanie Janson

Theses : Honours

Recent literature suggests that there are widespread differences between men and women’s Early Maladaptive Schemas (EMSs) and that EMSs are highly prevalent in alcohol dependent populations. The present study examined differences between men and women’s EMSs in an Australian clinical sample who had sought treatment specifically for alcohol dependence. A total of 111 men and 114 women completed the Young Schema Questionnaire – Long Form (YSQ-L3) between 2012 and 2015 in order to assess them on 18 EMSs. Despite previous findings suggesting that women report higher levels on a number of EMSs the present study found that women only scored …

Identifying The Enablers And Barriers To Community Participation Amongst Older Adults, Nicole Papageorgiou

Theses : Honours

The older adult population in Western Australia (WA) has significantly increased over the last decade and continues to grow, highlighting the importance of maintaining their health, wellbeing and independence. This may be achieved by facilitating active ageing, enabling older adults to continue to live meaningful and fulfilling lives, contribute positively to society, and lower the demand on costly health and human services. Conversely, a lack of social engagement and community participation may hinder healthy ageing and lead to social isolation, which is adversely related to the quality of life and health status of older adults. Occupational participation is critical to …

Construct Validity Of The Developmental Test Of Visual-Perception Third Edition (Dtvp-3) In Western Australian Primary School Children, Kirsten Clarke

Theses : Honours

Visual perception is the ability to identify, organise, make meaning of and provide sense to what is seen in the world in which we live. Visual perceptual skills continuously develop in primary school children as seen in academic performance. If visual perceptual difficulties are unaddressed, the cumulative academic result can be detrimental throughout life. Thus, visual perceptual difficulties must be identified using tests that possess sound measurement properties to allow for early intervention. The purpose of the research was to determine the construct validity of the Developmental Test of Visual Perception Third Edition (DTVP-3). The DTVP-3 was designed and standardised …

A Comparative Acoustic Examination Of Infant Cries: Children At High Risk Versus Low Risk For Autism Spectrum Disorder Development, Ildiko Eva Bruz

Theses : Honours

Background: Early interventions for individuals with Autism Spectrum Disorders (ASD) have shown positive gains in children who enter therapy at a young age. However, commencement of early intervention is often hindered by challenges with diagnosis. Due to the complex nature of ASD, the age of detection can range from 2 years old into adulthood. This highlights the need for methods of early detection. Previous research has found infants at risk for ASD to present atypical cry characteristics, possibly as a result from damage to the brainstem. In particular, measures of fundamental frequency appear to be the most sensitive to …

Early Intervention Of Parent-Infant Interactions In Preterm Infants: A Systematic Review, Stacey Osborne

Theses : Honours

Every year approximately 15 million babies are born preterm. These infants are at an increased risk of language, and other developmental delays due to their immature brain development and higher incidence of brain abnormalities. They also have poorer health outcomes in the early stages of life which may go on to hinder successful parent-infant interactions. Successful parent-infant interactions are important for infant developmental outcomes such as language, cognition and behaviour. While interventions targeting the promotion of positive interactions have been found to have positive effects in a number of populations to date, interactions involving preterm infants have not been explored. …

Interactions Between A Speech Pathologist And People With Aphasia In The First 6 Weeks Post Stroke: A Qualitative Study Of Assessment Experiences, Penelope Judith Wood

Theses : Honours

This study examines clinician and client interactions in the context of an acute care unit in a small urban Western Australian Hospital. The study involved audiovisual recordings and observations of assessment sessions, and in-depth interviews with the assessing Speech Pathologist and her clients. Analysis used Discourse Analysis of assessment sessions and Thematic Analysis of interviews. There is growing evidence as to how less formal non-traditional assessment might be more supportive of people with aphasia—for instance, by using concepts and techniques drawn from Dynamic Assessment and principles of Adult Learning. Surveys of Australian and New Zealand Speech Pathologists reflect a move …

Indirect Approaches: A Systematic Review Of Paediatric Dysphagia Interventions, Bianca Piano

Theses : Honours

Background and purpose: Dysphagia can be described as difficulty within the oral, pharyngeal and/or oesophageal phases of deglutition and occurs in approximately 80% of children with developmental disabilities, according to the American Speech and Hearing Association (2015). It occurs when there is impairment to the motor and/or sensory aspects of swallowing, due to a range of disorders affecting the voluntary and reflexive components of deglutition. The ability to swallow safely is essential in preventing medical complications, sustaining life and maintaining social participation. Paediatric interventions can be categorized into three broad approaches; direct, indirect and mixed. At present, two systematic reviews …

A Comparison Of Combined Overlap Block Fuzzy Cognitive Maps (Cobfcm) And Combined Overlap Block Neutrosophic Cognitive Map (Cobncm) In Finding The Hidden Patterns And Indeterminacies In Psychological Causal Models: Case Study Of Adhd, Hojjatollah Farahani, Florentin Smarandache, Lihshing Leigh Wang

Branch Mathematics and Statistics Faculty and Staff Publications

In spite of researchers’ concerns to find causalities, reviewing the literature of psychological studies one may argue that the classical statistical methods applied in order to find causalities are unable to find uncertainty and indeterminacies of the relationships between concepts.

In this paper, we introduce two methods to find effective solutions by identifying “hidden” patterns in the patients’ cognitive maps. Combined Overlap Block Fuzzy Cognitive Map (COBFCM) and Combined Overlap Block Neutrosophic Map (COBNCM) are effective when the number of concepts can be grouped and are large in numbers. In the first section, we introduce COBFCM, COBNCM, their applications, and …

The Research Circle - A Place For Interdisciplinary Learning, Sharing And Networking To Develop Facilitators Of Evidence-Based Practice, Martina Ingeborg Reinhold, Sango Otieno

Internet Journal of Allied Health Sciences and Practice

Health Professional programs incorporate the principles and methods of clinical research and evidence based medicine (EBM) into their curriculum to encourage evidence based practice in health care. However, many faculty that join health profession programs do so after having worked in clinical practice for some time with limited experience in clinical research and EBM making successful guidance of students difficult for some. This study describes implementation of the Research Circle at Grand Valley State University, where faculty from diverse disciplines such as physician assistant, physical therapy, occupational therapy, speech pathology, radiology, and dietetics came together to share and learn basic …

Clinical Guidelines In Sports Medicine: Am I Reading A Guideline Or A Consensus Statement: What’S The Difference? Does It Matter?, Zuzana Machotka, Luke Perraton, Karen Grimmer

Internet Journal of Allied Health Sciences and Practice

Introduction: The integration of research evidence into clinical practice is one of the most challenging aspects of sports medicine. The time required to search library databases and read multiple systematic reviews represents a significant barrier to many clinicians. Clinical guidelines and consensus statements provide a summary of best practice for clinical conditions, and provide clinical recommendations. In sports medicine, the terms clinical guideline and consensus statement are often used interchangeably; however, important differences exist between these resources. The aims of this review were to identify the clinical guidelines published in key international sports medicine journals over the last five years, …

The Bunkie Test: Descriptive Data For A Novel Test Of Core Muscular Endurance, Jason Brumitt

Faculty Publications - College of Physical Therapy

The Bunkie test, a functional performance test consisting of 5 test positions (performed bilaterally), has been used to assess aspects of muscular function. Current performance measures are based on clinical recommendations. The purpose of this study was to report normative data for a healthy population. One hundred and twelve subjects (mean age 25.9±4.5 years) were recruited from a university setting. Subjects completed a demographic questionnaire prior to testing. Hold times for each position was measured in seconds. Subjects were able to hold many of the positions for a mean score of approximately 40 seconds.There were no side-to-side differences in test …

Weight-Bearing Asymmetry In Individuals Post-Hip Fracture During The Sit To Stand Task, Janet A. Kneiss, Tiffany N. Hilton, Josh Tome, Jeff R. Houck

Faculty Publications - College of Physical Therapy

Background: Individuals post hip fracture decrease force on the involved limb during sit to stand tasks, creating an asymmetry in vertical ground reaction force. Joint specific differences that underlie asymmetry of the vertical ground reaction force are unknown. The purpose of this study was to compare differences in vertical ground reaction force variables and joint kinetics at the hip and knee in participants post-hip fracture, who were recently discharged from home care physical therapy to controls.

Methods: Forty-four community-dwelling older adults, 29 who had a hip fracture and 15 elderly control participant’s completed the sit to stand task on an …

From Lucy To Kadanuumuu: Balanced Analyses Of Australopithecus Afarensis Assemblages Confirm Only Moderate Skeletal Dimorphism, Philip L. Reno, C Owen Lovejoy

PCOM Scholarly Works

Sexual dimorphism in body size is often used as a correlate of social and reproductive behavior in Australopithecus afarensis. In addition to a number of isolated specimens, the sample for this species includes two small associated skeletons (A.L. 288-1 or "Lucy" and A.L. 128/129) and a geologically contemporaneous death assemblage of several larger individuals (A.L. 333). These have driven both perceptions and quantitative analyses concluding that Au. afarensis was markedly dimorphic. The Template Method enables simultaneous evaluation of multiple skeletal sites, thereby greatly expanding sample size, and reveals that A. afarensis dimorphism was similar to that of modern humans. A …

Literature Review Of Emissions Control And Research And Development Externalities, Luke Vandermale

Honors Projects

As concern over climate change garners attention the question of whether it is happening gives way to what policymakers should do about it. The question of policy is an economic one. This research is necessary because climate change, left unchecked, threatens to permanently change our environment.

In Economic terms, CO₂ emissions would be described as an externality. The industries that produce the pollutant do not pay for the damages they inflict on the environment. Economists have deliberated on such externalities before. In a classic experiment, Plott argued that policy measures to internalize these externalities were necessary. That is, policies …

Promoting Social Interaction Skills To Influence The Transition To Employment For Youth With Autism Spectrum Disorders, Jennifer Susan Lange

Honors Theses and Capstones

Autism Spectrum Disorders (ASD) affect one in 68 children in the United States and are characterized by deficits in social interaction. Decreased social interaction skills limit youth with ASDs’ ability to obtain and maintain a job. Acquisition of needed social interaction skills must occur during high school years as part of youths’ transition program. The Therefore, the purpose of this qualitative study was to consider ways to facilitate social interaction to influence the transition to employment. The specific aims of the study were to explore strategies currently used to facilitate social skills, identify social skills currently targeted, and identify other …

Mcl1 Enhances The Survival Of Cd8+ Memory T Cells After Viral Infection, Jingang Gui, Zhuting Hu, Ching-Yi Tsai, Tian Ma, Yan Song, Amanda Morales, Li-Hao Huang, Ethan Dmitrovsky, Ruth Craig, Edward Usherwood

Dartmouth Scholarship

Viral infection results in the generation of massive numbers of activated effector CD8+ T cells that recognize viral components. Most of these are short-lived effector T cells (SLECs) that die after clearance of the virus. However, a small proportion of this population survives and forms antigen-specific memory precursor effector cells (MPECs), which ultimately develop into memory cells. These can participate in a recall response upon reexposure to antigen even at protracted times postinfection. Here, antiapoptotic myeloid cell leukemia 1 (MCL1) was found to prolong survival upon T cell stimulation, and mice expressing human MCL1 as a transgene exhibited a skewing …