Medicine and Health Sciences Commons^™

Characterizing Health Risks In Privately-Supplied Drinking Water Due To Agricultural Practices In Rural Western Kentucky, Karen Schroeder Card

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

At least 400,000 people in Kentucky rely on private water wells or springs for drinking water. 551 households that rely on private water wells for drinking water were surveyed in 2009 about adverse health outcomes, including selected cancer incidence, adverse birth outcomes, and yearly incidence of diarrheal illness. Survey recipients were drawn from a population of well owners in the Jackson Purchase Region of Kentucky whose wells were tested for nitrate-nitrogen (NO3-N), triazine pesticides, and E. coli or total coliforms, by Kentucky Geologic Survey within the previous 15 years. 214 questionnaires were returned and matched to water quality data for …

Evaluations Of Patients’ Appointment Duration By Type In An Ophthalmology Practice, Brittany U'Wren

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective: The Affordable Care Act expanded health care coverage and provided more access to physicians, resulting in potentially longer wait times. Large portions of ophthalmology patients are on Medicare. Two thirds of the expansion populations were Hispanic or African Americans, which have higher rates of eye disease. Another contributoring factor leading to the increase for eye care is the surge of baby boomers. More specifically, these are individuals reaching sixty-five and are beginning to utilize Medicare. Access to care has increased but the capacity of the practice has not. An important goal, therefore, is to maximize efficiency of current …

Improving Nurses' Knowledge Of Stroke, James Trone Mcdaniel

Walden Dissertations and Doctoral Studies

Stroke is a devastating disease. Stroke care has advanced greatly in the past 20 years with innovations in radiologic imaging, development of tissue plasminogen activator (tPA), organized systems of care, telestroke, and best practice guidelines via Get with the Guidelines Stroke (GWTGS). However, stroke remains the 5th leading cause of death in the United States. To provide current and quality care for stroke patients, nurses need ongoing stroke education. Additionally, stroke centers must provide a sustainable stoke education program to their nurses to keep their knowledge current. Guided by Rosswurm and Larrabee's model, this quality improvement project addressed whether an …

Systematic Review: Barriers That Prevent Compliance With Hydroxyurea In Sickle Cell Disease, Uchechukwu Imegi

Walden Dissertations and Doctoral Studies

Sickle cell disease (SCD) is a blood disorder that is inherited from both parents and affects millions of people globally. The symptoms of SCD may be debilitating and pose a significant challenge to nursing care. Hydroxyurea (HU), the Food and Drug Administration (FDA) approved treatment for SCD in adults is reportedly effective, but its usage is still minimal among adolescents with SCD. The purpose of this systematic review was to evaluate existing literature on the barriers to HU use in adolescents with SCD. The Johns Hopkins Nursing Evidence-based Practice (JHNEBP) Rating Scales guided this study. An extensive electronic search of …

The Impact Of The Sentinel Initiative And Faers Surveillance System On Consumer Safety, Sonia Batra

Walden Dissertations and Doctoral Studies

The U.S. Food and Drug Administration (FDA) uses the FDA Adverse Event Reporting System (FAERS) to monitor adverse events resulting from pharmaceutical drug use. However, this system has limitations such as not allowing real-time data collection. To address these limitations, the FDA launched the Sentinel Initiative in 2008. This comparative case study was conducted to describe perceptions of investigating the efficacy of the Sentinel Initiative compared with the FAERS. The study was based on the theory of preemption as it emphasized the need for efficient means for providing unquestionable proof that consumers suffered adverse drug effects. The sample included interivews …

Reducing Length Of Hospital Stay For Intellectually Disabled Psychiatric Patients With Chronic Medical Problems, Joseph Wigwe

Walden Dissertations and Doctoral Studies

Length of hospital stay (LOS) is a major indicator for measuring efficient care. Intellectually disabled psychiatric patients (IDPP) with chronic medical problems have longer LOS due to challenges faced by providers in jointly managing both psychiatric and medical problems. The purposes of this study were to understand the significance of LOS for IDPP, create an intervention toolkit to reduce LOS, establish the content validity of the toolkit, and recommend its implementation. The items of the toolkit are pharmacology, somatic, rehabilitation, psychosocial, and monitoring patients' psychiatric and medical symptoms across care domains. The toolkit was created from the constructs of the …

A Practice Improvement Project To Improve Knowledge And Perceptions Of Palliative Care Among Patients With Heart Failure And Cancer In The Acute Setting Using Video Enhanced Education, Crystal F. Spellman

DNP Projects

Background: Clear communication of the purpose and benefits of palliative care can reduce barriers to acceptance of such services for patients and families. The purpose of this practice improvement project was to assess and improve knowledge and perceptions of palliative care among patients with a diagnosis of heart failure and cancer in the acute setting using a video enhanced education intervention. Methods: This practice improvement project took place at a 555 bed teaching hospital. 18 patients referred to an inpatient palliative care consult service in the acute care setting with a diagnosis of either heart failure or cancer participated. …

Embodied Creative Arts Therapy Interventions With Trauma: A Qualitative Study, Brian Timothy Harris

Expressive Therapies Dissertations

With the primary purpose to extend therapists’ knowledge base, open dialogue on treatment efficacy, and stimulate creative yet effective interventions, this two-phase qualitative study pursued the guiding research question, How do creative arts therapists use embodied interventions in the treatment of psychological trauma? Phase One of the study was conducted with music therapists who had extensive experience with trauma and reported on their experiences with and awareness of embodied trauma treatment through a broad spectrum of creative modalities. Phase Two was grounded in theories of body awareness and creative arts therapy applications and included therapists specializing in music, dance/movement, art, …

Adlerian Psychotherapists' Perspectives Of Using Psychodrama In The Treatment Of Neurotic Clients, Anabella Shaked

Expressive Therapies Dissertations

The purpose of this study was to explore Adlerian psychotherapists’ perspectives on using psychodrama in the treatment of neurotic clients, its therapeutic value, and the training requirements to implement a psychodramatic intervention. The study explored whether and how the use of psychodrama affected therapists, clients, and the therapeutic process. Forty-five Adlerian psychotherapists attended a single psychodrama workshop designed to train them to implement a psychodramatic intervention previously used in a pilot study. Following the workshop, 21 participants implemented the psychodramatic intervention with 42 clients previously assessed as neurotic. Following the workshop and implementation of the psychodramatic intervention, participants completed a …

Art Therapy Using Possible Selves And Digital Media For Individuals With Alcohol Addiction In Korea, Sojung Park

Expressive Therapies Dissertations

The primary purposes of this mixed methods study were to (a) examine whether using an art therapy intervention based on the theory of possible selves enhanced the motivation for change among individuals with alcohol addiction in Korea, and (b) to explore the study participants’ lived experiences of the self as it emerged from the specific art therapy intervention. This study consisted of three distinct theoretical frameworks: the transtheoretical model (TTM); the theory of possible selves; and art therapy—which bridged the two aforementioned theories. A total of seven participants completed five individual sessions each, creating a series of possible future selves …

Developing A Dance/Movement Therapy Approach To Qualitatively Analyzing Interview Data, Tomoyo Kawano

Expressive Therapies Dissertations

The objective of this research was to develop a model for an embodied-artistic approach to analyzing interview data that could contribute to an enhanced narrative account and/or offer an alternate perspective. A new model was formulated by adapting and/or critically applying a combination of previously developed analytical frameworks. Dance/movement therapy (DMT) skills that encompass ways of listening through an embodied, empathic, aesthetic manner; and a movement observation and assessment tool, Laban Movement Analysis (LMA) were at the core of this explicatory process. The researcher’s movement preferences were identified in the preparatory phase with a certified movement analyst (CMA) as a …

The Effect Of Personal Portrait Photographs On Cultural Attitude Among Jewish And Arabic Expressive/Art Therapists In Israel, Varda Serok-Jeppa

Expressive Therapies Dissertations

The purpose of this research was to offer young expressive therapists in Israel, a country with a complex cultural narrative, a tool that might enhance ethno-cultural empathy competencies. The research question was: What is the effect of Personal Portrait Photographs on cultural attitude among Jewish and Arabic expressive/art therapists in Israel? A qualitative arts based study based in constructivist empirical phenomenology was executed collecting data via photo elicitation, through use of portrait photographs of faces of women wearing three religious head dresses: Jewish, Muslim and Christian. The photographs were revised to portray participants’ faces in the portrait photo. Participants were …

Men In A Female-Dominated Profession: The Lived Experiences Of Ghanaian Male Nurses In The United States, Daniel Kwadjo Frimpong

Educational Studies Dissertations

Minority men are less than two percent of the total nursing workforce in the United States. The small presence of minority men in the nursing profession presents a challenge to healthcare providers as patients are much more responsive and open-minded to healthcare providers of the same cultural and ethnic backgrounds. This qualitative study was designed to explore the lived professional experiences of Ghanaian male nurses in the United States to shed light on the barriers minority men encounter in the nursing profession in order to make suggestions relating to strategies to appropriately support minority men in their nursing practice. This …

Justice And Care: Decision Making Of Medical School Student Promotions Committees, Emily Paige Green

Educational Studies Dissertations

Accreditation standards for allopathic medical schools in the United States require that each institution have in place a mechanism by which student progress through the curriculum is monitored. These entities, referred to here as promotions committees, make important decisions in a high stakes medical education environment. Yet little is currently known about how promotions committee members make decisions about students who experience academic failures and lapses in professional behavior. Using the work of Lawrence Kohlberg and Carol Gilligan on moral development as a theoretical basis, the purpose of this study was to elucidate committee members’ perceptions of the role of …

Do Perceptions Of Classroom Physical Activity Breaks Vary By Size Of School District?, Tyler Patterson, Kailey Snyder, Danae M. Dinkel, Connie Schaffer, Jung-Min Lee

Research Presentations

Background: Classroom physical activity (PA) breaks offers a way for schools to increase children's PA, improve time on-task, and improve academic scores. Professional development delivery models, technology infrastructure, and opportunities for collaboration are influenced by school district size. These factors may impact teachers' perceptions of instructional issues, including PA. However, little is known on how the size of school districts may impact teachers' perceptions of classroom PA. Purpose: The purpose of this study was to explore if teachers' perceptions of classroom PA vary based on district size. Method: Sixty teachers from five school districts (1 large public, 3 medium …

Reliability Of Dexa On Body Composition In Korean Athletes, Hyun-Sung An, Hyun-Sung Gwak, Seoung-Ki Kang, Jung-Min Lee

Research Presentations

PURPOSE: The purpose of this study was to assess the reliability of DEXA for measuring body composition in Korean Athletes.

METHODS: Twenty-nine athletes (n=29) registered for the college athlete program voluntarily participated in the study. Participants’ height and weight were measured, and BMI (Body Mass Index) was calculated before the participants’ body composition was measured. Muscle mass (kg), lean mass (kg), bone mineral density (BMC) (g·cm-2), and total fat mass (kg) of each participant was assessed by DEXA lunar DPX-L (GE Lunar, Madison, USA) for four times within a day to examine the difference by time frames. Four trials consist …

Validity Of Wearable Fitness Trackers On Sleep Measure, Alyssa Keill

Research Presentations

Wearable trackers that detect sleep offer users a way to track their sleep quality and patterns without the use of expensive equipment. Few studies have tested the validity of these trackers on sleep measure. PURPOSE: To examine the validity of the Actigraph GT9X (AG), SenseWear Mini Armband (SW), Basis Peak (BP), Fitbit Charge HR (FB), Jawbone UP3 (JU), and Garmin Vivosmart (GV) for estimating sleep variables as compared with a sleep diary. METHODS: 78 healthy individuals participated in the study. Group 1 (n= 38) and wore the AG, SW, BP, and FB or Group 2 (n = 40) …

Examining The Validity Of Fitbit Charge Hr Tm For Measuring Heart Rate In Free-Living Conditions, Jung-Min Lee, Hyun-Sung An, Seoung-Ki Kang, Youngdeok Kim

Research Presentations

Optical blood flow sensors (i.e. photoplethysmographic techniques) have recently been utilized in wearable activity trackers. The Fitbit Charge HRTM (FBHR) is one of the widely recognized wearable activity trackers that utilizes Fitbit’s proprietary PurePulse optical heart rate (HR) technology to automatically measure wrist-based HR. Despite its increasing popularity, however, no study to date has addressed the validity of FBHR for measuring HR in free-living conditions. PURPOSE: The purpose of this study was to examine the validity of FBHR for measuring HR using a chest strap Polar HR monitor (PHR) as a reference measure in free-living conditions. METHODS: Ten …

Do We Choose What We Desire? – Persuading Citizens To Make Consistent And Sustainable Mobility Decisions, Christopher Lisson, Margeret A. Hall

Interdisciplinary Informatics Faculty Proceedings & Presentations

A dilemma in urban mobility with tremendous effects on citizens’ wellbeing is the unconscious antipode between their short- and long-term goals. People do not anticipate all consequences of their modal choices and thus make decisions that might be incoherent with their desires, e.g. taking their own car due to convenience but causing a congested city. Omnipresent Information Systems on smartphones provide the necessary information and coordination capabilities to support people for sustainable and individually coherent mobility decisions on a mass scale. Building upon extant work in travel behavior and social psychology, a framework is proposed to coordinate research efforts in …

Application Of Organ Clearance To Estimation Of The In Vivo Hepatic Extraction Ratio, Reza Mehvar

Pharmacy Faculty Articles and Research

Organ clearance, which has been derived from the organ blood flow and extraction ratio (E), has been extensively used by clinical pharmacologists to explain the pharmacokinetics of many drugs in health and disease. For example, the extent of hepatic clearance or E (E_h) of drugs would determine their response to changes in the liver blood flow and/or activities of the metabolizing enzymes. Although E_h may be obtained directly by cannulating internal blood vessels, the method is invasive. Therefore, indirect methods have been used to estimate E_h from the peripheral blood concentration-time data after intravascular administration of …

Atresia Of The Descending Aorta In A Young Woman Requiring Bypass Graft, Ammarah Mashhood, Taimur Asif Ali, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Congenital aortic atresia is a malformation accounting for 4 - 6% of all congenital heart diseases in children. Left ventricular outflow obstruction due to atresia is common at the aortic valve but rarely has atresia been identified in the descending aorta. We report the case of a 25-year woman who was evaluated for headache and uncontrolled hypertension. CTscan chest showed a short atretic segment in the descending aorta at the isthmus, distal to the takeoff of the subclavian artery. She underwent surgery; a 22 mm Dacron graft was taken and jump graft was placed between the arch of the aorta …

Effectiveness Of An Evidence-Based Case Management Intervention On Reducing Diabetesrelated Emotional Distress In A Hispanic Medicare Advantage Population, Mari Nickovich-Finley

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

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Increasing Provider Efficacy On Metabolic Monitoring, Johnes Monyoncho

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Second-generation antipsychotics (SGAs), the mainstay of treatment for persons with serious mental illnesses (SMI), have been linked to obesity and metabolic syndrome. There is an urgent need for providers to adhere to clinically applicable guidelines for screening and monitoring metabolic disturbances in this population. 2 Methods: A randomized retrospective chart review of 60 patient records, one group pre-test data without a comparison group was performed following initiation of SGAs, 6 months before the intervention. This was repeated after a 3-month intervention which involved implementation of a recommended schedule for metabolic monitoring. The intervention included provision of monitoring equipment (weighing …

A Heath Intervention To Improve Medication Adherence In Patients With Epilepsy, Ronnie Tobias

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Epilepsy is a chronic disease and it is estimated that between 30% and 60% patients are non-adherent with their antiepileptic drugs (AEDs) therapy. This project aimed to assess if health education improves medication adherence in patients with epilepsy. Methods: This quality improvement (QI) project used a pre-test and post-test study design, 25 participants were recruited with epilepsy from the Epilepsy Foundation in Houston, Texas using the convenience sampling method. Data were gathered using the Morisky Medication Adherence Scale (MMAS-8). 3 Results: The findings revealed statistically significant differences in the pretest and posttest score distributions. The distribution of MMAS-8 scores …

Sms-Text To Improve Medication Compliance Among Hypertensive African-Americans, Daytral Brown

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Hypertension, the second leading cause of end-stage renal disease (ESRD), affects approximately 40% of African-Americans (Mansyur, Pavlik, Hyman, Taylor, & Goodrick, 2009). One well-known barrier to hypertension management among African-Americans is poor medication compliance (Ephraim et al., 2014; Solomon et al., 2015). The purpose of this project was to evaluate the effect of SMS-text messages on antihypertensive medication compliance and hypertension knowledge among hypertensive African-Americans with a known history of antihypertensive medication noncompliance. Methods: African-Americans (n=25), with a known history of hypertension and medication noncompliance, received 12 twice weekly SMS-text messages relating to hypertension knowledge and medication compliance. A …

Improving Adherence To Atypical Antipsychotic Agent Screening Guidelines In Pediatric Patients: A Quality Improvement Project Within An Integrated Community Mental Health Setting, Elishia Riffle

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Approximately 14% - 20% of children and adolescents have a mental health problem (Harrison, Cluxton-Keller, and Gross, 2012). Atypical Antipsychotic Agents (AAA) are used to treat behavioral, emotional, and mental health problems in children and adolescents. A discrepancy between best practices and actual practices exist. Objective: To increase adherence, above baseline, to recommended screening guidelines in children, ages 4-18, prescribed Atypical Antipsychotic Agents over 12 weeks. Results: Aggregate comparison of the mean ranks of scores were tested with the Mann-Whitney U test, U = 1,087.5, n1 = n2 = 70, total N =140, p < .001. All seven variables were observed and tested using the Chi Square with Fisher's Exact tests and are significant at or above 99% confidence (p < 0.01). Conclusion: Educating the Mental Health Provider (MHP) on the recommended screening guidelines and implementing a checklist had a measurable effect on increasing adherence to the recommended screening guidelines.

Electrophysiological Changes In Patients With Liver Cirrhosis In A Tertiary Care Hospital In Karachi, Pakistan, Om Parkash, Ghulam Rehman Mohyuddin, Adil Ayub, Irfan Nazir, Arslan Arif Maan, Saeed Hamid

Section of Gastroenterology

Background: Electrophysiological changes in cirrhosis are well known but least investigated especially in our country hence we wanted to see electrophysiological changes especially QT interval in cirrhotic patients.

Methods: A cross-sectional study was conducted at Aga Khan University Hospital Karachi (AKUH) in which medical records (duration 2008-2010) of cirrhotic patients were reviewed.

Results: Three hundred and eighty cirrhotic patients' charts were studied, 227 (59.7 %) were male and mean age of this cohort was 52.8±12.6 years. The most common cause for CLD was Hepatitis C (CHC) in 260 (68.4%), NBNC in 56(14.7%) and HBV in 51 (13.4%). Only 225 …

A Debriefing Technique In High-Fidelity Patient Simulation And Competent Decision-Making Abilities Among Nursing Students, Trena Seago

Theses and Dissertations--Curriculum and Instruction

Nursing faculty are utilizing high-fidelity patient simulation (HPS) with debriefing to help engage nursing students in making competent clinical decisions. This quasi-experimental study examined the use of HPS with debriefing and students’ ability to make nursing care decisions using standardized exams. The experimental group received debriefing after HPS and the control group did not receive debriefing after HPS. The pre- and post-test assessed participants’ ability to make clinical care decisions. The analysis of the pre-test and post-test HESI scores showed that there was no significant difference between the two groups.

Lifestyle Contributors To Cardiovascular Disease Risk, Adam J. Berrones

Theses and Dissertations--Kinesiology and Health Promotion

Aortic stiffness is an independent risk factor that has prognostic value regarding future cardiovascular disease (CVD) events such as myocardial infarction, strokes, and heart failure. Although death rates due to coronary heart disease have declined in recent years, the leading global killer remains CVD and prevalence is still high. Understanding lifestyle contributors associated with aortic stiffness would provide the public with insight into targeting key health-related behaviors.

The purpose of this observational study was to examine the association of physical activity, physical function, and dietary quality as independent factors contributing to aortic stiffness in apparently healthy middle aged men. Fifty-two …

The Effect Of Curcumin On Cardiovascular Health In Obese Men, Marilyn S. Campbell

Theses and Dissertations--Kinesiology and Health Promotion

Cardiovascular disease is the leading cause of death in the United States, and conventional treatment often emphasizes pharmaceutical approaches. Research has recently started exploring non-pharmaceutical approaches, including nutritional interventions. This research study was conducted to test the effectiveness of a novel nutritional approach, curcumin, on the improvement of cardiovascular health in young, obese males (BMI≥30 kg/m²). This study included 22 men, matched based on BMI and randomly assigned to the intervention (n=11) or placebo group (n=11). The intervention consisted of 12 weeks of curcumin supplementation (1.0 g/day) with fenugreek added to enhance the curcumin bioavailability; the placebo consisted …