Medicine and Health Sciences Commons^™

Influencing Adults With Tbi One Ot Skill At A Time, Kala Powell

MOT Student Capstones

This capstone incorporated the skills and knowledge of an occupational therapy (OT) professional into the program at Hinds Feet Farm (HFF), a residential facility housing individuals with traumatic brain injury (TBI). The purpose of the project was to improve the staff members' knowledge and understanding of three areas of need affecting the members' 4 safety and participation in daily occupations. The identified areas of need included: (I) improving cognitive functions; (2) increasing knowledge of nutrition; and (3) learning relaxation techniques to reduce stress. This project was also intended to improve the staffs confidence in choosing and implementing activities addressing each …

The Response To Intervention Model And Occupational Therapy Input: A Strategic Plan To Promote Education About The Value Of Occupational Therapy, Decision Malting And Intervention Among Regular Education Teachers, Tanya Tucker-Hyatt

MOT Student Capstones

Occupational therapy can provide valuable input within the Response to Intervention (RtI) model in the public school setting. Staff education about occupational therapy's scope of practice within RtI is a tier 1 strategy. This present study used a pretest-posttest design in order to compare data about the knowledge base for kindergarten and first grade teachers' regarding occupational therapy and Rtl. A continuing education PowerPoint was developed that outlined the holistic, yet client-centered approach used by occupational therapists within Rtl. Additionally, decision trees that direct strategy implementation for visual-motor, visualperceptual, and fine-motor coordination difficulties were developed. A survey by occupational therapy …

Justifying The Use Of Touch Screen Devices For Use In The Skilled Nursing Setting As A Viable Occupational Therapy Intervention Tool With The Geriatric Population, Ashley Stanley

MOT Student Capstones

The use of technology and touch screen devices as occupational therapy intervention tools is minimal within the geriatric population. There is little research available for functional applications that address activities of daily living and instrumental activities of daily living. A descriptive single group pre and post-test survey was conducted to justify introducing the use of touch screen devices in the skilled nursing setting as an occupational therapy intervention tool within the geriatric population. A total of 7 individuals participated in the pre-presentation questionnaire, attended the PowerPoint presentation, and completed the post-presentation questionnaire. The questionnaire sought information regarding participant demographics, years …

Program Implementation Of Using Bathing Checklist To Increase Client Performance During Bathing, Specifically With Home Health Aides, Whitney Weber

MOT Student Capstones

The bathing checklist program was implemented for five months in a home health care setting with clients who received occupational therapy and home health aide services. This program's main intention was to help clients become more independent with bathing by the occupational therapy discharge utilizing the home health aide to achieve this goal. The bathing checklist complied of 18 steps of bathing and an educational sheet to inform the client and caregivers of the program. At occupational therapy discharge, the bathing checklist was removed from the home for data collection. From the participating clients, IO out of 11 were more …

B1ending Of Worlds: A Massage And Occupational Therapy Intervention In-Service, Brandon S. Scott

MOT Student Capstones

The purpose of the Blending of Worlds capstone project is to provide an educational in-service to promote the use of complementary interventions, such as massage techniques, during occupational therapy practice with pediatric patients. It was hypothesized that intervention was underutilized in occupational therapy and could benefit clients in achieving occupational therapy goals. By creating this educational in-service, therapists would be educated on how massage would be part of an occupational therapist's scope and show connections to its practical application as a part of occupational therapy practice. It also provides evidenced based research to support the use of the intervention and …

Validation Of A Caregiver Guide Booklet, Carla Shepherd

MOT Student Capstones

Increasing the physical activity level for those with an intellectual disability (ID) is clearly supported in research and includes crucial relationships between community partners and caregivers. One local community partner was utilized to implement a program for ID individuals and their caregivers which included education and training, the use of a caregiver guide booklet, and monitoring member engagement during physical activity. The project resulted in benefits to caregivers by increasing their knowledge in the process involved in supporting the member, increasing their knowledge of the facility, and increasing their knowledge of the member as related to physical activity. Members experienced …

A Guide For Caregiver Self Stress-Management, Allison Huffman

MOT Student Capstones

This capstone project aims to investigate alternative approaches for home health occupational therapy practitioners to educate caregivers on self stress-management techniques. The demographics of the caregivers are female adults caring for an elderly ill spouse or friend in the caregiver's home. Literature reviewed supports the efficacy of using complementary and alternative medicine (CAM) to manage stress (i.e. lavender essential oil, mindfulness-based stress reduction (MBSR), and yoga). The guide was designed by the occupational therapy student with the objective to provide occupational therapy practitioners in the home health setting a guide that is evidence-based and follows health literacy standards. The objectives …

Best Practice Guidelines For Therapeutic Intervention Of Disruptive Behaviors In The Preschool And Kindergarten Classrooms For All Peers In The Regular Education Environment For Academic Success, Crystal Mccain

MOT Student Capstones

Awareness of disruptive behavior in the classroom and how it effects the academic learning environment has become a concern for parents and educators as the classroom sizes continue to grow. By identifying techniques to better manage classroom behavior, we can reduce teacher and student stress and increase opportunities for academic success. The purpose of this study is to provide a good understanding of what disruptive behavior is and the role the occupational therapist can play, to provide educators with behavior management techniques that can be implemented into the kindergarten and preschool environment, to identify how disruptive behavior is affecting the …

Preparing Now For Successful Living In The Future, Karen T. Johnson

MOT Student Capstones

Purpose: The main purpose of this capstone project was to develop an introductory community education for how to prepare and seek out solutions that will enable the aging adult to increase their choices about where they live with age. It targets baby boomers within Durham County, ages 52-70 as they consider retirement, might be recently retired, considering relocation, or caring for loved ones. The secondary purpose of this capstone project was to facilitate increased awareness of how occupational and physical therapists can more routinely educate and provide resources for clients in order to promote productive aging. Procedures: The method for …

Fostering Parent To Foster Child Relationships-One Play Session At A Time: Development Of A Workshop For Easing Transitions And Improving Behaviors, Marlo C. Broyles

MOT Student Capstones

This report includes a review of literature to support development of a workshop to teach strategies for building relationships between foster parents and the children in their care. A search of the literature included locating peer-reviewed, evidence-based literature demonstrating how behaviors exhibited by foster children can make relationship building with the foster parents difficult. Successful strategies from the literature was reviewed to find supporting evidence for creation of the workshop. The literature provided evidence that abused and neglected children demonstrate poor behaviors that will affect their development, contribute to attachment issues with family and peers, produce sensory deficits, and children …

The Impact Of The Lsvt Big Program On Perceptions Of Fall Risks And Safety For Clients With Parkinson's Disease, Sarah Jackson

MOT Student Capstones

Parkinson's Disease is a common, neurodegenerative condition that can be a disabling, often causing injury and impairing quality of life. The purpose of this study was to determine the effectiveness of the LSVT program by increase safety and decrease falls for clients with Parkinson's Disease. Using the Modified Falls Efficacy Scale, consisting of fourteen occupations performed inside and outside the home rated their confidence levels on a visual 0 analog scale of 0-10. Data was collected from therapists on most used and top five assessments along with the benefits of the MFES when completing the interventions and plan of care. …

Broadband And Mobile Internet Services In Nonmetropolitan Nebraska, Rebecca Vogt, Cheryl Burkhart-Kriesel, Randolph Cantrell, Bradley Lubben, L. J. Mcelravy

Rural Futures Institute: Publications

A recent Pew Research Center survey revealed that home broadband adoption has plateaued in the United States. In addition, there has been an increase in adults who use a smartphone to access the Internet but do not have traditional broadband service in their home. Given these national trends, how do rural Nebraskans access the Internet? Are they accessing the Internet from their cell phones? Are they subscribing to high-speed Internet services at home? How satisfied are they with their Internet services? How important do they feel Internet access is for various items? This paper provides a detailed analysis of these …

A Guide For Occupational Therapy Professionals Using "Budding" Occupational Therapy Strategies: A Nature Approach, Jessie R. Gentz

MOT Student Capstones

The purpose of"Budding" Occupational Therapy Strategies: A Nature Approach was to develop a guide with sample activities and explanations to better understand why and how nature works. The guide provides a sample of nature based activities for occupational therapists working with children with sensory processing disorders to better understand how simple it is to incorporate natural materials and natural environments into treatment sessions to improve a child's occupational performance. The activities integrate plants, animals, the outdoors and everyday materials into treatment planning to improve performance skills by addressing the various components of the occupational therapy practice framework (OTPF). The guide …

Importance Of Hereditary And Selected Environmental Risk Factors In The Etiology Of Inflammatory Breast Cancer: A Case-Comparison Study., Roxana Moslehi, Elizabeth Freedman, Nur Zeinomar, Carmela Veneroso, Paul H. Levine

Epidemiology Faculty Publications

BACKGROUND: To assess the importance of heredity in the etiology of inflammatory breast cancer (IBC), we compared IBC patients to several carefully chosen comparison groups with respect to the prevalence of first-degree family history of breast cancer.

METHODS: IBC cases (n = 141) were compared to non-inflammatory breast cancer cases (n = 178) ascertained through George Washington University (GWU) with respect to the prevalence of first-degree family history of breast cancer and selected environmental/lifestyle risk factors for breast cancer. Similar comparisons were conducted with subjects from three case-control studies: breast cancer cases (n = 1145) and unaffected controls (n = …

Interruptions Of Antiretroviral Therapy In Children And Adolescents With Hiv Infection In Clinical Practice: A Retrospective Cohort Study In The Usa., Natella Rakhmanina, Kam S Lam, Jaclyn Hern, Heather A. Young, Alex Walters, Amanda D. Castel

Epidemiology Faculty Publications

INTRODUCTION: Changes in combination antiretroviral therapy (cART) throughout childhood challenge the continuity of paediatric HIV treatment. This study aimed to evaluate the prevalence of treatment interruption (TI), including lamivudine (3TC) monotherapy, and the relationship of TI to virologic and immunologic parameters in HIV-infected paediatric patients.

METHODS: Nested within a prospective observational study of a city-wide cohort of HIV-infected persons in the District of Columbia, this sub-study collected retrospective data on antiretroviral therapy, enrolment (endpoint) and historic (lifelong) CD4 counts and HIV RNA viral load (VL) of the paediatric cohort. TI was defined as interruption of cART ≥4 consecutive weeks. Data …

Arsenic In Drinking Water And Lung Cancer Mortality In The United States: An Analysis Based On Us Counties And 30 Years Of Observation (1950-1979)., Hamid Ferdosi, Elisabeth K Dissen, Nana Ama Afari-Dwamena, Ji Li, Rusan Chen, Manning Feinleib, Steven H Lamm

Epidemiology Faculty Publications

Background. To examine whether the US EPA (2010) lung cancer risk estimate derived from the high arsenic exposures (10-934 µg/L) in southwest Taiwan accurately predicts the US experience from low arsenic exposures (3-59 µg/L). Methods. Analyses have been limited to US counties solely dependent on underground sources for their drinking water supply with median arsenic levels of ≥3 µg/L. Results. Cancer risks (slopes) were found to be indistinguishable from zero for males and females. The addition of arsenic level did not significantly increase the explanatory power of the models. Stratified, or categorical, analysis yielded relative risks that hover about 1.00. …

Direct Measurement Of Bisphenol A (Bpa), Bpa Glucuronide And Bpa Sulfate In A Diverse And Low-Income Population Of Pregnant Women Reveals High Exposure, With Potential Implications For Previous Exposure Estimates: A Cross-Sectional Study., Roy R. Gerona, Janet Pan, Ami R. Zota, Jackie M. Schwartz, Matthew Friesen, Julia A. Taylor, Patricia A. Hunt, Tracey J. Woodruff

Environmental and Occupational Health Faculty Publications

BACKGROUND: Bisphenol A (BPA) is a ubiquitous, endocrine-disrupting environmental contaminant that increases risk of some adverse developmental effects. Thus, it is important to characterize BPA levels, metabolic fate and sources of exposure in pregnant women.

METHODS: We used an improved liquid chromatography-tandem mass spectrometry (LC-MS/MS) analytic method to directly and simultaneously measure unconjugated BPA (uBPA), BPA glucuronide and BPA sulfate in the urine of a population of ethnically and racially diverse, and predominately low-income pregnant women (n = 112) in their second trimester. We also administered a questionnaire on dietary and non-dietary sources of exposure to BPA.

RESULTS …

An Analysis Of Water Collection Labor Among Women And Children In 24 Sub-Saharan African Countries., Jay Graham, Mitsuaki Hirai, Seung-Sup Kim

Environmental and Occupational Health Faculty Publications

BACKGROUND: It is estimated that more than two-thirds of the population in sub-Saharan Africa (SSA) must leave their home to collect water, putting them at risk for a variety of negative health outcomes. There is little research, however, quantifying who is most affected by long water collection times.

OBJECTIVES: This study aims to a) describe gender differences in water collection labor among both adults and children (< 15 years of age) in the households (HHs) that report spending more than 30 minutes collecting water, disaggregated by urban and rural residence; and b) estimate the absolute number of adults and children affected by water collection times greater than 30 minutes in 24 SSA countries.

METHODS: We analyzed data from the Demographic Health Survey (DHS) and the Multiple Indicator Cluster Survey (MICS) (2005-2012) to describe water collection labor in 24 SSA countries.

RESULTS: Among households spending more than …

Redrawing The Us Obesity Landscape: Bias-Corrected Estimates Of State-Specific Adult Obesity Prevalence., Zachary J Ward, Michael W. Long, Stephen C Resch, Steven L Gortmaker, Angie L Cradock, Catherine Giles, Amber Hsiao, Y Claire Wang

Prevention and Community Health Faculty Publications

BACKGROUND: State-level estimates from the Centers for Disease Control and Prevention (CDC) underestimate the obesity epidemic because they use self-reported height and weight. We describe a novel bias-correction method and produce corrected state-level estimates of obesity and severe obesity.

METHODS: Using non-parametric statistical matching, we adjusted self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS) 2013 (n = 386,795) using measured data from the National Health and Nutrition Examination Survey (NHANES) (n = 16,924). We validated our national estimates against NHANES and estimated bias-corrected state-specific prevalence of obesity (BMI≥30) and severe obesity (BMI≥35). We compared these results with previous …

Legal Space For Syringe Exchange Programs In Hot Spots Of Injection Drug Use-Related Crime., Sean T Allen, Monica S. Ruiz, Jeff Jones, Monique M Turner

Prevention and Community Health Faculty Publications

BACKGROUND: Copious evidence indicates that syringe exchange programs (SEPs) are effective structural interventions for HIV prevention among persons who inject drugs (PWID). The efficacy of SEPs in supporting the public health needs of PWID populations is partially dependent on their accessibility and consistent utilization among injectors. Research has shown that SEP access is an important predictor of PWID retention at SEPs, yet policies exist that may limit the geographic areas where SEP operations may legally occur. Since 2000 in the District of Columbia (DC), SEP operations have been subject to the 1000 Foot Rule (§48-1121), a policy that prohibits the …

Optimising Text Messaging To Improve Adherence To Web-Based Smoking Cessation Treatment: A Randomised Control Trial Protocol, Amanda L. Graham, Megan A. Jacobs, Amy M. Cohn, Sarah Cha, Lorien C. Abroms, George D. Papandonatos, Robyn Whittaker

Prevention and Community Health Faculty Publications

Introduction Millions of smokers use the Internet for smoking cessation assistance each year; however, most smokers engage minimally with even the best designed websites. The ubiquity of mobile devices and their effectiveness in promoting adherence in other areas of health behaviour change make them a promising tool to address adherence in Internet smoking cessation interventions. Text messaging is used by most adults, and messages can proactively encourage use of a web-based intervention. Text messaging can also be integrated with an Internet intervention to facilitate the use of core Internet intervention components.

Methods and analysis We identified four aspects of a …

Smoking Cessation Support For Pregnant Women: Role Of Mobile Technology., Christina L Heminger, Jennifer M. Schindler-Ruwisch, Lorien C. Abroms

Prevention and Community Health Faculty Publications

BACKGROUND: Smoking during pregnancy has deleterious health effects for the fetus and mother. Given the high risks associated with smoking in pregnancy, smoking cessation programs that are designed specifically for pregnant smokers are needed. This paper summarizes the current landscape of mHealth cessation programs aimed at pregnant smokers and where available reviews evidence to support their use.

METHODS: A search strategy was conducted in June-August 2015 to identify mHealth programs with at least one component or activity that was explicitly directed at smoking cessation assistance for pregnant women. The search for text messaging programs and applications included keyword searches within …

Role Of Elosulfase Alfa In Mucopolysaccharidosis Iva., Debra S. Regier, Pranoot Tanpaiboon

Pediatrics Faculty Publications

Mucopolysaccharidosis type IVA (MPS IVA or Morquio A) is an autosomal recessive lysosomal storage disease which results in a striking skeletal phenotype, but does not negatively impact the intellect of the patient. MPS IVA has a phenotypic continuum that ranges from a severe and rapidly progressing form to a slowly progressive form. The clinical diagnosis is often made in the preschool years based on abnormal bone findings on physical examination and dysplasia on radiographic imaging. Supportive care has been the mainstay in caring for patients. Orthopedic physicians often form the core of the care team due to the early and …

Enhancing Access To Alcohol Use Disorder Pharmacotherapy And Treatment In Primary Care Settings: Adapt-Pc., Hildi J Hagedorn, Randall Brown, Michael Dawes, Eric Dieperink, Donald Hugh Myrick, Elizabeth M Oliva, Todd H Wagner, Jennifer P. Wisdom, Alex H S Harris

Health Policy and Management Faculty Publications

BACKGROUND: Only 7.8 % of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation …

Enhancing Access To Alcohol Use Disorder Pharmacotherapy And Treatment In Primary Care Settings: Adapt-Pc., Hildi Hagedorn, Randall Brown, Michael Dawes, Eric Dieperink, Donald Hugh Myrick, Elizabeth Oliva, Todd Wagner, Jennifer P. Wisdom, Alex Harris

Health Policy and Management Faculty Publications

BACKGROUND: Only 7.8 % of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation …

Building Capacity In Implementation Science Research Training At The University Of Nairobi., George O Osanjo, Julius O Oyugi, Isaac O Kibwage, Walter O Mwanda, Elizabeth N Ngugi, Fredrick C Otieno, Wycliffe Ndege, Mara Child, Carey Farquhar, Jeremy Penner, Zohray Talib, James N Kiarie

Health Policy and Management Faculty Publications

BACKGROUND: Health care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science.

METHODS: This paper describes how the University of Nairobi leveraged resources from the Medical Education Partnership to develop an institutional program that provides training …

Workforce Planning And Development In Times Of Delivery System Transformation, Patricia Pittman, Ellen Scully-Russ

Health Policy and Management Faculty Publications

Background

As implementation of the US Affordable Care Act (ACA) advances, many domestic health systems are considering major changes in how the healthcare workforce is organized. The purpose of this study is to explore the dynamic processes and interactions by which workforce planning and development (WFPD) is evolving in this new environment.

Methods

Informed by the theory of loosely coupled systems (LCS), we use a case study design to examine how workforce changes are being managed in Kaiser Permanente and Montefiore Health System. We conducted site visits with in-depth interviews with 8 to 10 stakeholders in each organization.

Results

Both …

A New Look At Care In Pregnancy: Simple, Effective Interventions For Neglected Populations, Stephen Hodgins, James M. Tielsch, Kristen Rankin, Amber Robinson, Annie Kearns, Jacquelyn Caglia

Global Health Faculty Publications

Background

Although this is beginning to change, the content of antenatal care has been relatively neglected in safe-motherhood program efforts. This appears in part to be due to an unwarranted belief that interventions over this period have far less impact than those provided around the time of birth. In this par, we review available evidence for 21 interventions potentially deliverable during pregnancy at high coverage to neglected populations in low income countries, with regard to effectiveness in reducing risk of: maternal mortality, newborn mortality, stillbirth, prematurity and intrauterine growth restriction. Selection was restricted to interventions that can be provided by …

Uncertainty In Nursing: The Impact On Practice And Leadership, Sarah R. Orde

Theses and Graduate Projects

Nurses experience uncertainty in practice due to the fast paced, complex nature of the healthcare system. Uncertainty in nursing practice has a direct influence on patient care, as well as personal well-being of the nurse, and his or her engagement and retention in the workplace. This paper describes a project intended to help nurses identify and cope with uncertainty in practice on an adult medical inpatient unit at a major Midwestern healthcare facility. The project is illustrated through a conceptual model of coping with uncertainty as guided by Margaret Newman's Theory of Health as Expanding Consciousness (HEC). The model identifies …

Reclaiming Our Sacredness As Nurse Healers, Lani L. Hollenbeck

Theses and Graduate Projects

The nurse-patient relationship encompasses the richness of being in a relationship with another human being. When viewed through a healthcare lens a patient's health, illness, and healing are often defined by procedural testing, diagnosis, and a plan for treatment. Within the community of professional nurses, it is known that healing involves more than an attempt to physically repair the human body. The use of nursing theory, caring science, and recognition of the patient in their wholeness guides nursing practice. Nurses incorporate the use of experiential wisdom (metis) in caring for the life force of another human being in the effort …