Medicine and Health Sciences Commons^™

Predictors Of Nutritional Counseling Among Adolescents By Physicians In California, Jean Kigozi

Walden Dissertations and Doctoral Studies

The prevalence of obesity in the United States was stable at 17% from 2011-2014 among approximately 13 million children and adolescents 12-19 years of age, according to the Centers for Disease Control and Prevention. Nutritional counseling has been recommended, and while most physicians agree that it is necessary, it is not happening consistently. The purpose of this study was to examine the association between dietary intake, physical activity, and body mass index (BMI) characteristics of youth 12-17 years old in California and the receipt of nutritional counseling. Social cognitive theory guided this quantitative cross-sectional analysis of archived data from 814 …

Stress Reduction Strategies For Improving Private Security Officer Performance, Khalil Ibrahim Al-Mulla

Walden Dissertations and Doctoral Studies

The impact of occupational stress on employees' health and work performance costs U.S. companies $300 billion annually; work-related stress is an issue for private security organizations all over the world. The purpose of this single case study was to explore strategies private security organizational leaders used to mitigate private security officers' occupational stress. The study participants were 4 leaders of a private security organization in Bahrain who had a minimum of 5 years of experience in the private security field and had addressed occupational stress successfully. The human capital theory was the conceptual framework used for this study. Data were …

Nurse Manager Span Of Control And The Impact On Employee Engagement, Jene' M. Kendall

DNP Projects

PURPOSE: The purpose of this study was to assess nurse manager span of control in medical- surgical, intermediate care, and progressive care units at Norton Healthcare and determine correlations between nurse manager span of control and employee engagement.

METHODS: For this descriptive, correlational study, the researcher analyzed data to identify relationships in span of control and employee engagement data for 19 nurse managers leading 23 inpatient care units. A survey to evaluate the role of the nurse manager and the assistant nurse manager also was done.

RESULTS: The average span of control for nurse managers was 52.2 full time equivalent …

Impact Of Advanced Practice Providers (App) Care Models And Outcomes In Primary Care, Kathleen Exline

DNP Projects

Background: The Affordable Care Act, an aging population, and the increased burden of caring for the chronically ill are factors that have resulted in a significantly increased demand on primary care. This has prompted the strategy to utilize advanced practice providers (APPs) to supplement primary care physicians. Due to the inconsistency of a defined national model and measurement system, the impact of APP utilization in healthcare is not clear.

Purpose: The purpose of this project was to examine the use of APPs in primary care. The study involved a review of the current utilization of APPs, an evaluation of the …

The Evaluation Of Advanced Practice Providers Practice Patterns And Delivery Of Care Models In The Specialty Practice Environment, Katherine W. Rogers

DNP Projects

Background: Advanced Practice Providers (APPs), specifically Nurse Practitioners (NP) and Physician Assistants (PA), have been utilized in healthcare for decades to improve access to care for patients. Norton Healthcare’s largest population of APPs is in specialty practices. The expansion of APPs into the medical group has been rapid and without evaluation of value and role identification.

Purpose: The purpose of this study is to evaluate Advanced Practice Provider (APP) practice patterns and care delivery models within specialty practices in a large medical group. The outcome of the study will help to identify trends in practice and areas where …

Cesarean Births Rates After Implementation Of Labor Management Guidelines, Margie Allyn Bridges

Walden Dissertations and Doctoral Studies

Cesarean birth rates are associated with increased maternal morbidity. This project evaluated a quality improvement (QI) initiative implemented to reduce cesarean births among Nulliparous Term Singleton Vertex (NTSV) obstetric populations, the largest contributor to cesarean births. Variations in labor management practice contribute to cesarean birth rate; implementation of labor management bundles have been endorsed to influence practice- and system-level changes in the promotion of vaginal births. The problem addressed in this project was an organizational NTSV cesarean section rate of 30%. The purpose of the project was to use secondary data to evaluate a previously implemented labor management bundle at …

Examining Trauma Exposure, Organizational Climate, And Job Outcomes In Child Welfare, Shano Rodgers

Walden Dissertations and Doctoral Studies

Exposure to traumatic situations is routine for child welfare workers in California, and the attrition rate for newly hired social workers in some states is estimated to be nearly 50% in the 1st year of employment. Prior research has indicated that reasons for dissatisfaction included dysfunctional organizational climate and culture. The purpose of this study was to examine the extent to which trauma exposure contributed to secondary traumatic stress and intent to quit and to examine the degree to which organizational climate moderated the exposure among direct service child welfare employees. Kurt Lewin's field theory, Figley's theory of secondary traumatic …

A Structured Weight Loss Program To Combat Obesity In Women, Tara English

Walden Dissertations and Doctoral Studies

Rates of obesity and the associated comorbidities continue to increase for women in the United States. Despite information available, efforts at weight loss are often unsuccessful because women lack integral knowledge of how to approach the various components essential for weight loss. This doctoral project was created to address the practice question of whether obesity can be reduced through a step-wise weight loss program that identifies essential elements to reduce weight in menopausal age women. Guided by the information-motivation-behavioral skills model, this project led 17 volunteer participants from a Northwest, Florida primary care clinic through 6 weeks of protocols supplemented …

Targeted Nanoparticle Delivery For In Utero Treatment Of Congenital Disorders, Valerie Luks

Yale Medicine Thesis Digital Library

Congenital disorders represent a large unmet clinical need with significant morbidity and premature mortality resulting from mutations and anomalies that can be diagnosed, and eventually treated, in utero. Nanoparticles (NP) have been used as versatile protective vessels for the delivery of a variety of therapeutic agents. Importantly, the potency of NPs can be amplified by modifications to the molecular composition as well as to the delivery to allow targeting to specific tissues. We hypothesize that optimization of NP targeting both by nanoparticle modification and the route of administration can increase overall uptake in specific cells and tissues of interest. To …

Altered Brain Functional Connectivity Varies By Form Of Craniosynostosis, Alexander Haosi Sun

Yale Medicine Thesis Digital Library

This study uses functional MRI (fMRI) to study long-term neurocognitive sequelae of nonsyndromic craniosynostosis (NSC), and understand if these aberrations vary by form of synostosis. Twenty adolescent participants with treated NSC (10 sagittal (SSO), 5 right unilateral coronal (UCS), 5 metopic (MSO)) were matched to controls by age, gender, and handedness. A subgroup of MSO was classified as severe metopic synostosis (SMS) based on the endocranial bifrontal angle. Resting-state fMRI was acquired in a 3T Siemens TIM Trio scanner, and data was motion- corrected, cluster-corrected with nonparametric permutation tests, and analyzed with BioImage Suite. SSO had decreased intrinsic connectivity compared …

The Evaluation Of A Breast Cancer Screening Decision Aid In The Community Setting., Kimberly Gibbons

DNP Scholarly Projects

Breast cancer screening (BCS) has been recommended to women by healthcare providers as well as professional organizations and non-profit awareness organizations for over four decades. Recently, attention is being paid to quantification of the actual benefits and harms of BCS with mammography. The harms include overdiagnosis, overtreatment and mandate of mammography screening that may not be in alignment with the individual values and preferences of women ages 40-69. This evidence translation project developed a resource for practice that was evaluated by community participants for alignment with personal value and preference-based educational needs about BCS. This project piloted a clinical practice …

Reduction Of Antipsychotic Use In Patients With Dementia Residing In Nursing Homes, Marysarah Frank

DNP Scholarly Projects

Abstract

Residents of nursing homes diagnosed with dementia have long been treated with psychotropic drugs for the symptoms of behavioral disturbances that are frequently associated with major neurocognitive disease. Specifically, the antipsychotic drugs have been widely used in this population. Despite a lack of evidence, antipsychotic rates have shown up to 25% of dementia patients in nursing homes (NH) are prescribed these drugs. This off-label use is not FDA approved for behavioral symptoms of dementia and the drugs have been given a black box warning related to the risk of serious and potentially irreversible side effects and even an increased …

Decreasing Duration Of Mechanical Restraint Episodes By Increasing Registered Nurse Assessment And Surveillance In An Acute Psychiatric Hospital, Diane Allen

DNP Scholarly Projects

Background

Application of mechanical restraints is a high-risk emergency measure that requires psychiatric intensive care in order to assure patient safety and expedite release at the earliest opportunity. While current regulations require that trained staff continuously observe restrained individuals, assessment by a registered nurse is required only once an hour. This project builds on research that demonstrated a regulatory change requiring more frequent registered nurse assessments led to decreased duration of mechanical restraint episodes in an acute psychiatric hospital.

Purpose

The purpose of this project was to implement and evaluate a practice change that required increased frequency of registered nurse …

Implementation Of A Physical Activity Group At A Community Mental Health Center: A Pilot Quality Improvement Project To Reduce Depressive Symptoms In Adolescents With Major Depressive Disorder, Nancy Gallagher

DNP Scholarly Projects

Major Depressive Disorder is a debilitating illness that affects millions of Americans, including adolescents. The majority of adolescents with Major Depressive Disorder (MDD) do not receive treatment. There may be a variety of reasons for this including stigma, access to care, and potential adverse reactions. People suffering from MDD are known to be at high risk for suicide. Lack of treatments adds the risk of suicide for adolescents with MDD. Identifying and implementing treatment options that are more acceptable and accessible are of the utmost importance. Although there is limited research regarding exercise/physical activity, depressive symptoms, and adolescents with MDD, …

A Program To Prepare Frontline Nurse Leaders For Peer Review, Suzanne K. Murdock

DNP Scholarly Projects

Introduction: The purpose of nursing peer review is to assess the quality of nursing care against established standards, identify strengths and weaknesses in practice, and identify knowledge gaps. Studies of nurse peer review predominantly focuse on staff nurse attitudes and knowledge after an educational intervention and barriers to implementation. Frontline nurse leaders (FLNL) can influence adoption of new practices such as peer review.

Purpose: The purpose of this project was to engage frontline nurse leaders in a role specific peer review program, preparing them to support their staff in the implementation of peer review in the future and providing an …

Reproductive Health And Fertility Among Transgender Adolescents: A Knowledge And Attitudes Survey, Aimee Alphonso

Yale Medicine Thesis Digital Library

The goal of this study was to determine the knowledge and attitudes of transgender adolescents regarding fertility and future parenthood. We developed and administered a cross-sectional questionnaire to a convenience sample of 23 transgender and gender non-conforming adolescents (mean age 16.2 ± 2.6) who attended the Yale Pediatric Gender Program between October 2016 and August 2017. Our results indicate that transgender adolescents have a basic understanding of reproductive health and fertility (mean total knowledge score of 3.78 ± 0.80 out of 5). Knowledge scores were significantly higher in participants with previous information about gender-affirming hormone therapy (GAH; p

On The Efficacy Of High-Dose Ascorbic Acid As Anticancer Treatment: A Literature Survey, Florentin Smarandache, Victor Christianto

Branch Mathematics and Statistics Faculty and Staff Publications

Vitamin C (ascorbic acid, ascorbate) has a controversial history in cancer treatment. Emerging evidence indicates that ascorbate in cancer treatment deserves re-examination. As research results concerning ascorbate pharmacokinetics and its mechanisms of action against tumor cells have been published, and as evidence from case studies has continued to mount that ascorbate therapy could be effective if the right protocols were used, interest among physicians and scientists has increased.

Risk Factors Associated With Opioid Misuse Among Military Personnel, Brittany Sullivan, Mark Bonica, Chris Armijo, Anne Jamieson, Semra Aytur

Honors Theses and Capstones

Risk Factors Associated with Opioid Misuse Among Military Personnel

Opioid overdoses are increasing among military personnel. Opioids are a class of drugs that include heroin, synthetic opioids, and pain relievers. Almost half of all Veterans returning from deployment in Afghanistan and Iraq have chronic pain; one in six veterans turn to opioids for pain relief.

Veterans between the ages of eighteen and fifty-three are five times as likely to have a Substance Use Disorder and two times as likely to have Post-Traumatic Stress Disorder in contrast to the general public.

Risk factors that have been shown to increase the probability …

Nsu Sharks Rx-Winter, 2018, Nova Southeastern University

NSU Sharks Rx

No abstract provided.

The U.S. Science And Technology “Triple Threat”: A Regulatory Treatment Plan For The Nation’S Addiction To Prescription Opioids, Michael J. Malinowski

Journal Articles

No abstract provided.

The Role Of Endothelial Nitric Oxide Synthase (Enos) Coupling Status During Acute Hyperglycemia As Determined By Real-Time Measurements Of Blood Nitric Oxide And Hydrogen Peroxide In Rat, Matthew Bertolet

PCOM Biomedical Studies Student Scholarship

Acute hyperglycemia can impair vascular endothelial function in non-diabetic subjects in addition to diabetic patients. Decreased endothelial-derived nitric oxide (NO) bioavailability and increased concentrations of reactive oxygen species (ROS), such as superoxide (SO) and hydrogen peroxide (H202), are the major characteristics of vascular endothelial dysfunction. Normally, vascular endothelial function depends on NO production from coupled endothelial NO synthase (eNOS) in the presence of 5,6,7,8- tetrahydrobiopterin (BH4). By contrast, 7,8-dihydrobiopterin (BH2, Oxidized form of BH4) and/or lack ofL-arginine (coupled eNOS substrate) causes eNOS uncoupling to produce SO, which can be quickly converted to H202. The role of eNOS uncoupling in acute …

Pre-Operative Education For Total Knee Replacement: A Pilot Survey, Renee Causey-Upton, Dana M. Howell, Patrick H. Kitzman, Melba Custer, Emily V. Dressler

Physical Therapy Faculty Publications

Purpose: The structure of preoperative education programs used nationally for patients prior to total knee replacement (TKR) surgery has not been identified previously, thus hospitals across the United States lack a common standard for this preoperative education to ensure best patient outcomes. The purpose of this pilot survey study was to describe the content, providers, and delivery methods currently utilized to deliver preoperative education for total knee replacement in the United States. Method: Data were collected using an online survey developed by the authors based on review of literature and 3 preoperative programs and was distributed through the Research Electronic …

First Trimester Serum Biomarkers To Predict Gestational Diabetes In A High-Risk Cohort: Striving For Clinically Useful Thresholds, Siobhan M. Corcoran, Natalie Achamallah, John O'Loughlan, Philip Stafford, Pat Dicker, Fergal D. Malone, Fionnuala Breathnach

Articles

Objectives: Screening and diagnosis of gestational diabetes (GDM) has been a source of controversy. The prevalence has increased in line with an obesity epidemic and a trend towards delayed child-bearing. Treatment of even modest glycaemic impairment in pregnancy has been shown to be beneficial in preventing its clinical sequalae. However the cumbersome nature and timing of the oral glucose tolerance test coupled with debate around universal versus risk factor based screening have been problematic. This group aimed to investigate a panel of biomarkers which have shown promise in the literature to predict GDM from the first trimester in a group …

Detection Of “Xisco” Gene For Identification Of Streptococcus Pneumoniae Isolates, Francisco Salvà-Serra, Gwendolyn Connolly, Edward Moore, Lucia Gonzales-Siles

Articles

We describe a PCR-assay differentiating Streptococcus pneumoniae from closely-related species of the Mitis group of the genus Streptococcus and identification of pneumococcus clinical isolates, based on the “Xisco” gene discriminatory marker. The complete “Xisco” gene sequence was observed in all S. pneumoniae genomes analyzed and absent in all non-pneumococcus genomes.

Factors Associated With Maternal Wellbeing At Four Months Post-Partum In Ireland, Annemarie E. Bennett, John Kearney

Articles

This study aimed to examine factors associated with maternal wellbeing at four months post-partum in the Irish context. Socio-demographic, health behaviour and infant feeding data were collected in pregnancy, at birth and at 17 weeks post-partum. Maternal distress, body image and resilience were measured at 17 weeks post-partum. Binary logistic regression predicted maternal distress and statistical significance was taken at p < 0.05. One hundred and seventy-two women were followed-up in pregnancy, at birth and at 17 weeks post-partum. Three in five (61.6%, n106) initiated breastfeeding. At 17 weeks post-partum, 23.8% (n41) were exclusively or partially breastfeeding and over a third (36.0%, n62) of all mothers were at risk of distress. In multivariate analyses, independent predictors of distress included: low maternal resilience (p < 0.01, odds ratio (OR): 7.22 (95% confidence interval [CI]: 2.49–20.95)); unsatisfactory partner support (p = 0.02, OR: 3.89 (95% CI: 1.20–12.65)); older age (p = 0.02, OR: 1.11 (95% CI: 1.02–1.21)); and breastfeeding (p = 0.01, OR: 2.89 (95% CI: 1.29–6.47)). Routine assessment of emotional wellbeing and targeted interventions are needed to promote a more healthful transition to motherhood among women in Ireland.

Experiences Of Australian Men Diagnosed With Advanced Prostate Cancer: A Qualitative Study, Suzanne K. Chambers, Melissa K. Hyde, Kirstyn Laurie, Melissa Legg, Mark Frydenberg, Ian D. Davis, Anthony P. Lowe, Jeff Dunn

Research outputs 2014 to 2021

Objective To explore men's lived experience of advanced prostate cancer (PCa) and preferences for support. Design Cross-sectional qualitative study applying open-ended surveys and interviews conducted between June and November 2016. Interviews audio-recorded and transcribed verbatim and analysed from an interpretive phenomenological perspective. Setting Australia, nation-wide. Participants 39 men diagnosed with advanced PCa (metastatic or castration-resistant biochemical progression) were surveyed with 28 men subsequently completing a semistructured in depth telephone interview. Results Thematic analysis of interviews identified two organising themes: lived experience and supportive care. Lived experience included six superordinate themes: regret about late diagnosis and treatment decisions, being discounted in …

Reducing Arsenic Exposure From Private Well Water In The United States: The Use, Effect, And Potential Of Testing Requirements, Sara Flanagan

Dissertations and Theses

Over 45 million Americans drink from unregulated private well water of unknown quality. Arsenic is the most concerning groundwater contaminant for health because of its toxicity and widespread natural occurrence. Most residential wells in arsenic-affected areas have not been tested for arsenic; the success of community programs and efforts to motivate testing is limited by a range of psychological, situational, and socioeconomic barriers. However, testing only acts as screening and does not reduce exposure without effective and consistent actions to follow. Given the limitations in relying on individual well owners to be aware, willing, and capable of testing their water, …

Acceptability Study And Pilot Rct Of A Guide To Understanding Reproductive Health For Ladeez (Gurhl) Code: An Hiv Risk Reduction App Intervention For Black And Latina Young Women In New York City, Sonia K. Gonzalez Gladstein

Dissertations and Theses

Background: Young Black and Latina women suffer from higher sexually transmitted disease (STD) incidences than White women, increasing their susceptibility to contracting human immunodeficiency virus (HIV). The adoption and widespread usage of mobile devices has contributed to the public’s ability to access available information at all hours, including information on sexual and reproductive health (SRH). Despite a growing body of mobile health literature, there is limited understanding of how mobile-based sexual and reproductive health interventions for use by young adult Black and Latina women could improve sexual health knowledge and connection to clinical care.

Methods: This pilot randomized controlled trial …

Education And Prevention Of Stress And Ptsd In Prehospital Care Providers, Adriana Goad

A with Honors Projects

The field of prehospital emergency care is one full of unpredictability, high physical demand, and mental stress. EMTs and Paramedics are called to the unknown to treat whatever they come upon with the limited supplies and equipment that can be found in their trauma bag and ambulances. Some calls may be rewarding as they save the life of a patient, or they can be run of the mill as they get a call for a person not feeling well. Some calls, though, do not end in a relaxed drop off at the ED and back to the station for the …

Components Of The X-Ray Circuit, Savannah Burkhalter

A with Honors Projects

This video identifies the components of an x-ray circuit.