An Assessment To Determine The Need For A Palliative Care Team To Improve Patient Satisfaction And Decrease Healthcare Costs, Nathalie Weis

DNP Projects

Abstract

Objective: The purpose of this project was to determine if there is a need for a palliative care team (PCT) to which primary care medical professionals can refer patients. The specific objectives of this project were: 1. To assess the knowledge of primary care providers regarding palliative care. 2. To assess the value and need for palliative care from the PCPs’ perspective. 3. To evaluate the current ED utilization data for adults with serious chronic illness.

Methods: This was a descriptive study that involved an analysis of ED visit data for chronic illness, and a survey all …

Evaluating The Effect Of A Nurse Navigator In Increasing Colorectal Screening, Christine Njogu

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effectiveness of a nurse navigator in increasing colorectal (CRC) screening in primary care setting.

METHODS: This was a descriptive retrospective study of the effect of nurse navigators in increasing colorectal screening in primary care settings within Jefferson county and its surrounding counties. The sample consisted of 200 patient chart reviews for the period of September 1st through December 31st, 2017. Rates of colorectal screening were compared in those who received a nurse navigator call and those who did not.

RESULTS: Overall screening rates were 44.6%. A distinct increase in screening …

The Evaluation Of The Impact Of Controlled Substance Patient Education In The After Visit Summary On Patient Knowledge Of Controlled Substance Medication, Marie Honeycutt

DNP Projects

The use of opioids is associated with risks for misuse, abuse, addiction and diversion, which are directly related to increased healthcare utilization, increased healthcare cost, and poor patient outcomes. The purpose of this study was to evaluate the impact of controlled substance (CS) patient education that was implemented into the electronic medical record. The objectives were to 1.) assess whether patients received the CS after visit summary (AVS) and 2.) assess differences in pain management knowledge between those who received the AVS and those who did not. Methods This descriptive correlational designed study examined the differences in pain management knowledge …

An Examination Of Primary Care Providers’ Assessment And Plan Of Care For Children And Adolescents Who Are Overweight Or Obese, Kevin Pinto

DNP Projects

Background: Childhood and adolescent obesity rates have more than tripled since the 1970s. Currently in the United States, one in five children is obese (6-19 years of age). It is important to identify children and adolescents who are overweight or obese because early intervention may help to reduce the long-term implications of obesity. The purpose of this project was to examine how often pediatric primary care providers diagnosed overweight or obesity and created a plan of care for children 6-17 years of age who were overweight or obese. Facilitators and barriers to diagnosing and creating a plan of care were …

A Process Improvement Project To Increase Referral And Documentation Rates For Diabetic Retinopathy Screening, Debra Ann Bryant Taylor

DNP Projects

Abstract

Background: Approximately 5.3 million Americans, aged 18 and over, carry a diagnosis of diabetic retinopathy (DR). By the year 2050 this number is expected to triple without effective healthcare intervention. Approximately 4.8% of the global blindness is attributable to DR, a silent, progressive, microvascular complication of diabetes. Best practice dictates immediate screening at time of diagnosis of Type II Diabetes Mellitus (T2DM) and biennial screenings thereafter, yet this need is often unmet.

Purpose: This study is a continuation of a process put into place by Dr. Michelle Campbell in October 2017 at the Norton Community Medical Associates Mount Washington …

Evaluation Of The Crafft Substance Use Screening Tool In Primary Care, Leanne Coleman

DNP Projects

PURPOSE: The purpose of this research study was to evaluate the use of the CRAFFT tool within a pediatric primary care setting. The specific objective was to assess the frequency of documentation of substance use screening, counseling, and/or intervention before and after the implementation of the CRAFFT tool.

METHOD: The practice site chose to implement an evidence based adolescent substance use screening tool (CRAFFT Tool) to improve practice. This practice improvement project utilized a descriptive design with a review of electronic medical records before and after a substance use screening tool was implemented. Two hundred medical records were reviewed, 100 …

The Effect Of A Provider Education Program On Tobacco Use In An Adult Population In The Primary Care Setting, Sunita Gurung

DNP Projects

PURPOSE: The purpose of this study was to evaluate the effectiveness of an education session to promote adherence to the United States Preventive Services Task Force (USPSTF) recommendation and Clinical Practice Guidelines for Treating Tobacco Use and Dependence by providers.

METHODS: A retrospective and prospective record review was used to evaluate an education session for providers in tobacco use screening, providing cessation counseling, prescribing medication for tobacco cessation, and sending out referrals for tobacco cessation at one primary care clinic in Louisville, KY. Education sessions were held from August 1, 2018 to August 14, 2018. The sample consisted of 200 …

The Impact Of The Nurse Practitioner In Pre-Admission Testing: A Comparative Review, Laurel A. Robinson

DNP Projects

Abstract

PURPOSE: The purpose of this study was to compare the efficiency of pre-admission testing (PAT) surgical clinic pre and post implementation of the APRN for patient assessment. Cancellation and delay occurrences for scheduled surgeries will be compared during two time periods on patients on the surgical schedule at Norton Women and Children’s Hospital (NWC).

METHODS: This study was a single-center, pre and post implementation retrospective comparative study of the impact of the NP led PAT unit at Norton Women and Children’s Hospital (NWC) in terms of delay and cancellation rates for day-of-surgery. The sample consisted of 411 patients for …

Risk For Depression In Coronary Heart Disease Patients Meriting Post-Coronary Artery Bypass Graft Screening; Feasibility Of Nurse-Led Cognitive Behavioral Therapy Among Patients With Depressive Symptoms, Joy L. Coles

DNP Projects

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) project was to implement depression screening with the Patient Health Questionnaire-9 (PHQ-9) among patients with Coronary Heart Disease (CHD) who have undergone a Coronary Artery Bypass Graft (CABG) and demonstrate the feasibility of a nurse-led Cognitive Behavioral Therapy (CBT) intervention.

METHODS: A non-experimental pre-test and post-test design was completed to screen for depression among patients post CABG in the Cardiovascular Intensive Care Unit (CVICU) at a University Hospital using the PHQ-9. A sample of 21 patients were identified and selected from a convenience sample by pulling every eligible record from …

Diabetes-Related Distress Screening: A Survey Of Primary Care Providers' Knowledge, Attitudes, And Practices In Treating Patients With Difficulty Meeting Glycemic Goals., Michele Patrice Paxton

DNP Projects

A patient with diabetes is two to three times more likely to be depressed than the general population. Furthermore, the combination of diabetes and depression is associated with increased morbidity and mortality. However, research has shown that treatment for depression does not correlate with lower HbA1c levels or a decrease in morbidity and mortality. Recently, a body of evidence has shown that increased HbA1c levels and depression are associated with the emotional burden of managing diabetes. The emotional burden is caused by the constant behavioral and mental demands of managing the disease and the worry and fear of the impending …

Methods To Improve Interprofessional Collaboration In Administrative Dyads, Julie Lee Hudson

DNP Projects

Abstract

PURPOSE: The primary objective of this project was to determine if specific interventions, to include education, rounding, and regular meetings, improved collaboration and communication for nurse/physician dyads working in acute care hospital administrative roles.

METHODS: The study employed a prospective pre-test and post-test comparison of participants’ scores on a validated survey tool. This tool (JeffSATIC) measured perception of collaboration between nurses and physicians. The objective was to evaluate the differences in these scores in participants before and after an intervention.

RESULTS: This study sought to discover if specific interventions impacted scores on a tool measuring collaboration among dyad pairs. …

Coverage And Prior Authorization Policies For Medications For Opioid Use Disorder In Medicaid Managed Care, Michael S. Spencer, Karina L. Walters, Heidi L. Allen, Christina M. Andrews Ph.D., Audrey Begun, Teri Browne Ph.D., Msw, John D. Clapp, Diana Dinitto, Peter Maramaldi, Darrell P. Wheeler, Bradley J. Zebrack, Edwina Uehara

Faculty Publications

More than 60 million Americans experience devastating one-two punches to their health -- they have inadequate access to basic health care while also enduring the effects of discrimination, poverty, and dangerous environments that accelerate higher rates of illness. Innovative and evidence-based social strategies can improve health care and lead to broad gains in the health of our entire society.

Pancreatic Cancer Associated With Obesity And Diabetes: An Alternative Approach For Its Targeting, Ramesh Pothuraju, Satyanarayana Rachagani, Wade M. Junker, Sanjib Chaudhary, Saraswathi Viswanathan, Sukhwinder Kaur, Surinder K. Batra

Journal Articles: Biochemistry & Molecular Biology

BACKGROUND: Pancreatic cancer (PC) is among foremost causes of cancer related deaths worldwide due to generic symptoms, lack of effective screening strategies and resistance to chemo- and radiotherapies. The risk factors associated with PC include several metabolic disorders such as obesity, insulin resistance and type 2 diabetes mellitus (T2DM). Studies have shown that obesity and T2DM are associated with PC pathogenesis; however, their role in PC initiation and development remains obscure.

MAIN BODY: Several biochemical and physiological factors associated with obesity and/or T2DM including adipokines, inflammatory mediators, and altered microbiome are involved in PC progression and metastasis albeit by different …

Facile Synthesis Of Ligand-Free Iridium Nanoparticles And Their In Vitro Biocompatibility, Anna L. Brown, Hayden Winter, Andrea M. Goforth, Gaurav Sahay, Conroy Sun

Chemistry Faculty Publications and Presentations

High-density inorganic nanoparticles have shown promise in medical applications that utilize radiation including X-ray imaging and as radiation dose enhancers for radiotherapy. We have developed an aqueous synthetic method to produce small (~ 2 nm) iridium nanoparticles (IrNPs) by reduction of iridium(III) chloride using a borohydride reducing agent. Unlike other solution-based synthesis methods, uniform and monodispersed IrNPs are produced without the use of surfactants or other solubilizing ligands. These nanoparticles are highly crystalline as observed by X-ray diffraction and high-resolution transmission electron microscopy (TEM). In vitro metabolic toxicity assays using hepatocyte and macrophage cells demonstrate that both IrNPs and iridium(III) …

Dentin Microshear Bond Strength Of Various Luting Agents To Zirconia-Reinforced Lithium Silicate Ceramics, Natthapong Itthipongsatorn

Chulalongkorn University Theses and Dissertations (Chula ETD)

Statement of problem. Performance of adhesive and resin luting cements used to bond zirconia-reinforced lithium silicate ceramics (ZLS) to dentin has not been well established. Purpose. To examine microshear bond strength (µSBS) of etch-and-rinse adhesive system, universal adhesive and self-adhesive resin cement that were used to bond ZLS to dentin. Material and Methods. Vita Suprinity® (VS, Vita Zahnfabrik) and Celtra® Duo (CD, Dentsply Sirona) blocks were sectioned into 36 and 72 microbars (1×1×3 mm3) respectively. All VS were crystallized, while half of CD were additionally fired and defined as fired-Celtra® Duo (FCD). The others were defined as unfired-Celtra® Duo (UCD). …

The Peri-Implant Soft Tissue Reactions And Cytokine Expressions Around Different Abutment Materials : Randomized Controlled Clinical Trial, Prapaphan Jaikla

Chulalongkorn University Theses and Dissertations (Chula ETD)

Objectives : Stable peri-implant soft tissue around transmucosal zone are the crucial factor for long-term success and survival of dental implants. The aim of this study was to evaluate the expression of proinflammatory cytokines and chemokine around 3 types of abutment materials : titanium (Ti), zirconium oxide (Zr) and gold alloy (Au). Methodology : 15 dental implants were enrolled in this study. Clinical parameters and peri-implant crevicular fluid (PICF) were collected at weeks 4, 6, 8 and 10. The soft tissue characteristics were demonstrated using plaque assessment score and mucosal condition score. Cytokine levels were determined by enzyme-linked immunosorbent assay …

Anticancer Effects Of Mansonone G Derivative On Human Colorectal Cancer Cells, Savinee Chanvijit

Chulalongkorn University Theses and Dissertations (Chula ETD)

Mansonone G (MG), 1,2-naphthoquinone, isolated from the heartwood of Mansonia gagei Drumm (Chan-Cha-Mod), exhibited several pharmacological effects including anti-bacterial, anti-estrogenic and anti-adipogenic effects. However, anticancer activity of MG and its derivatives on colorectal cancer (CRC) has never been investigated. Therefore, the objective of this study was to investigate the cytotoxic effect of MG and its derivatives and to determine the mechanism(s) underlying cytotoxicity of the most potent MG derivative on two CRC cell lines, HCT-116 cells carrying p53 wild-type and HT-29 cells carrying p53 mutant. In the present study, MG and its derivatives could inhibit viability of HCT-116 and HT-29 …

Effect Of Different Polishing Systems, Forces, And Durations On Surface Roughness And Phase Transformation Of Monolithic Zirconia, Songsak Munkongsujarit

Chulalongkorn University Theses and Dissertations (Chula ETD)

This study aimed to determine the effect of polishing systems, forces and durations on the surface roughness and phase transformation of zirconia. 72 pieces of fully sintered zirconia size 7 x 5 x 4 mm were fabricated with CAD/CAM, then divided into nine groups depending on the polishing systems and forces. All specimens were ground with fine diamond bur as the control, and initial surface roughness (Ra) was measured. The samples were then polished with one of the zirconia polishing systems (Diazircon or Komet ZR) or porcelain polishing system (Ceramaster), with forces at 1, 2 and 3 newtons. The polishing …

Physicochemical, Biopharmaceutical And Anti-Hepatocellular Carcinoma Properties Of Curcumin Diethyl Disuccinate, Chawanphat Muangnoi

Chulalongkorn University Theses and Dissertations (Chula ETD)

Curcumin ( Cur) has been reported for an anticancer activity by inducing apoptosis. However, the poor oral bioavailability of Cur due to chemical instability limits itself for further development as a chemotherapeutic agent. Previously, a succinate ester prodrug of Cur named as curcumin diethyl disuccinate (CurDD) has been designed and synthesized to enhance chemical stability of Cur. In this study, physicochemical and biopharmaceutical properties as well as in vitro and in vivo anti-hepatocellular carcinoma activities of CurDD were investigated and compared with those of Cur. CurDD could improve the stability of Cur in buffer pH 7.4 and simulated gastrointestinal fluids. …

Development Of In Situ Gel Containing Asiaticoside-Cyclodextrin Complex For Periodontal Tissue Regeneration, Hay Man Saung Hnin Soe

Chulalongkorn University Theses and Dissertations (Chula ETD)

Asiaticoside (AS) is active herbal compound isolated from Centella asiatica. It has the potential benefit in promoting type I collagen (COL I) synthesis and osteogenic differentiation in human periodontal ligament cells. However, it has low aqueous solubility which may hamper the bioavailability. Thus, the main objective of this study was to develop the thermoresponsive in situ gels containing AS by using cyclodextrin (CD). To determine the solubility enhancement of AS, phase-solubility profiles were investigated and revealed that CDs enhanced the aqueous solubility of AS. Hydroxypropyl-beta-CD (HPβCD) and sulfobutyl-ether-beta-CD (SBEβCD) were selected due to highly solubilization enhancement of AS. The mucoadhesive …

Topoisomerase I Inhibitory Compounds From The Roots Of Paphiopedilum Callosum, San Yoon Nwe

Chulalongkorn University Theses and Dissertations (Chula ETD)

Paphiopedilum callosum (Rchb.f.) Stein belongs to the Orchidaceae family. The phytochemistry and bioactivity of this plant have not been previously reported. In this study, the chromatographic separation of methanolic extract of P. callosum roots was bioassay-guided by a yeast cell-based assay. One new compound, 3′-hydroxy-2,6,5′-trimethoxystilbene (PC1) and five known compounds including 3′-hydroxy-2,5′-dimethoxystilbene (PC2), 3-methylethergalangin (PC3), galangin (PC4), 2,3′-dihydroxy-5,5′-dimethoxystilbene (PC5) and 2,3′-dihydroxy-5′-methoxystilbene (PC6) were isolated. The chemical structures of these isolated compounds were elucidated and identified on the basis of analysis spectroscopic (ESI-MS, NMR and IR), as well as comparison with those reported in the literature. Their topoisomerase I poison activity …

Gene Expression Of Bcl2a1 และ Cxcl9 In Soft Tissue Covering Bone Grafting Materials, Borwonluk Taveedach

Chulalongkorn University Theses and Dissertations (Chula ETD)

This study was to assess the expression of Bcl2a1 and Cxcl9 genes in soft tissues covering bone grafted with demineralized freeze-dried bone allograft (DFDBA) and deproteinized bovine bone mineral (DBBM) in comparison with ones covering without grafting. The animals were randomly separated into three groups of treatment. Calvarial defect models were created on parietal bones. Bare defect models without bone graft as a control group. After one and three months, animals were sacrificed. Soft tissues covering the defected area were collected by punch technique. RNA was isolated and proceeded to Real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR). Statistical analysis …

Fracture Resistance Of Non-Ferruled Endodontically Treated Teeth Restored With Different Fiber Post And Core Methods After Five Years Fatigue Loading, Puriwat Malakorn

Chulalongkorn University Theses and Dissertations (Chula ETD)

The aim of this study was to compare the fracture resistance and failure mode of non-ferruled ETT restored with different fiber post and core methods after five years in vitro fatigue loading. Forty-eight uniradicular lower first premolar teeth were decoronated, endodontically treated and prepared for the post space. The prepared specimens were divided into four groups (n=12): single fiber-reinforced composite (FRC) post and flowable resin composite core (Group I), FRC post with an accessory fiber post and flowable resin composite core (Group II), resin composite relined FRC post and resin composite core (Direct anatomic post)(Group III), and resin composite relined …

Knowledge, Attitude And Practice Of Voluntary Blood Donation Among University And College Students In Yangon, Myanmar, Aye Chan Oo

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Blood can save millions of lives in different clinical settings. According to WHO, blood transfusion services should target young voluntary blood donors as the potential source of sustainable blood supply. As a developing countries, Myanmar have challenges in providing timely and adequate blood supply to patients in need. For effective voluntary donor recruitment, understanding knowledge, attitude and practice towards blood donation among young university and college students is important. The aim of the study is to determine the practice of voluntary blood donations and its associated factors and to find out the reasons for not donating blood among the …

Factors Affecting Utilization Of Family Planning Services Among Married Women Of Reproductive Age Living In The Rural Area Of Kayin State, Myanmar, Sabai Tun

Chulalongkorn University Theses and Dissertations (Chula ETD)

The rewards of promoting family planning services not only restricted to improving maternal or child health but also significantly advanced the fitting occasion to gain higher educational status, better employment, empowerment and greater socioeconomic status especially for girls and women. The main purpose of this study was to assess the utilization proportion of family planning services for contraception and to determine the factors affecting the utilization of contraception among 388 married women of reproductive age living in the rural area of Hpa-an Township, Kayin state, Myanmar. The data was collected by face to face interview in this quantitative cross-sectional descriptive …

Online Social Media And Applications Use Engaing In Sexual Risk Behaviors Among Hiv Infected Men Who Have Sex With Men In Bangkok, Thailand, Sasithorn Bureechai

Chulalongkorn University Theses and Dissertations (Chula ETD)

The purpose of this study is to identify the pattern of social media use and risky sexual behavior of men who have sex with men in Bangkok, Thailand by using a mixed method.This is a cross-sectional study based upon quantitative and qualitative data collection. The target population is Bangkok MSM aged over 15 who visit a research institute for consultancy. The data collection took 6 months from June to November 2018, and the subjects participating in this study total at 201. All subjects respond to a set of close-end and open-end questions. The data is analyzed with SPSS V.22 with …

Analysis Of Ncd Clinic Plus Program Among Hypertensive Patients In Kongra Hospital Patthalung Province Thailand: A 2014-2017 Secondary Data Analysis, Supaporn Promjeen

Chulalongkorn University Theses and Dissertations (Chula ETD)

Introduction: NCD Clinic Plus Program has been implemented in 2014 hospitals in Thailand since 2014. In 2015, Kongra Hospital, located in Patthalung province, is the best of small hospital or first-level hospital in Thailand and receives NCD Clinic Plus Award, The success of NCD Clinic Plus program was evaluated only the function of medical personnel. However, the patients’ outcomes have not been yet evaluated after program implementation since 2014. Objective and Method: This research aims, to access percentage of control and uncontrol blood pressure of patients during 2015-2017 and to find associated factors of control and uncontrol blood pressure of …

Promoting Physical Activity And Healthy Eating Behaviorby Nurse Coaching Through Line Application Among Overweight Women In Community, Phayathai District, Bangkok Thailand:A Randomized Controlled Trial, Yuphaporn Hongchuvech

Chulalongkorn University Theses and Dissertations (Chula ETD)

The prevalence of overweight and obesity is increased rapidly and becoming a public health problem in many countries of the world including Thailand. Overweight increases the risk of several NCDs. The prevalence of overweight was higher in female than male. The imbalance between energy intake and energy expenditure were the common cause of overweight. The aim of this study was to evaluate the effect of health promotion program by nurse coaching through LINE application to improve knowledge, perception, and practice of physical activity and healthy eating behavior, body composition, blood pressure, and blood glucose among overweight women. A randomized controlled …

Follicular Responsiveness To Equine Chorionic Gonadotropin In Cat Species: Study In In Vitro Culture, Ajjima Chansaenroj

Chulalongkorn University Theses and Dissertations (Chula ETD)

Equine chorionic gonadotropin (eCG) has been commonly used to induce estrus in several felid species. However, the mechanisms by which this gonadotropin regulates cat folliculogenesis are still unclear. In this present study, we investigated 1) the in vitro responsiveness of cat ovarian follicles at different follicle developmental stages to various eCG concentration; 2) tiger antral follicle responsiveness to eCG; 3) the influence of eCG combination with insulin-like growth factor I (IGF-I) and/or stem cell factor (SCF) on cat ovarian follicles at different developmental stages. Study 1, the isolated follicles from the ovaries of 22 cats were classified into three developmental …

Application Of Needle-Free Injection Technology For Foot And Mouth Disease Vaccination Via Intradermal Route, Sirirat Wataradee

Chulalongkorn University Theses and Dissertations (Chula ETD)

Foot and mouth disease (FMD) is an endemic disease in Thailand and caused severe economic loses. In order to prevent and control disease, the vaccination program is routinely administered for 2-3 times a year via subcutaneous route (SC). Even though, the vaccination is performed regularly, the outbreaks have often reported. The outbreaks occur due to the failure of number of immunity animal in population or herd immunity. The limitation of vaccine distribution to all animal population and difficulty of cattle restraint are forcible several farmers to failing to vaccinate their animals. Based on previous studies, the intradermal route (ID) can …