Medicine and Health Sciences Commons^™

Evaluation Of Potassium Status In Heart Failure Patients: A Case Control Study, Sreedharan Nair Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: Hyper and hypokalemia is a common ionic imbalance in patient with heart failure. Increased death and hospital stay is common in patients with HF and chronic kidney disease (CKD) who have hypokalaemia. The majority of the intracellular cation is potassium which is necessary to retain a normal charge difference between the intracellular and extracellular spaces. It often happens as a complication of certain diseases or drugs. As hyper or hypokalaemia are potentially hazardous and frequent complication in heart failure patient it is important to identify patients who are at increased risk for hypo and hyperkalaemia. Objectives: The objective of …

Mid-Atlantic Ethics Committee Newsletter, Winter 2019

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Balance And Strength Interventions For An Older Individual With Peripheral Polyneuropathy: A Case Report, Hanna Geib

Case Report Papers

Background and Purpose: Peripheral polyneuropathy (PPN) is a condition resulting from damage to the peripheral nervous system, causing sensory abnormalities (e.g. tingling, burning, and loss of sensation) occurring distally to proximally. Individuals with PPN experience proprioceptive sensory loss and muscle weakness, resulting in decreased functional mobility. A common cause of PPN is diabetes mellitus, however 20-25% of cases are deemed idiopathic. Interventions of balance training and lower extremity strengthening have been shown to have a small positive effect on the progression of PPN. The purpose of this case report is to describe the physical therapy (PT) management of an elderly …

A Systematic Review Of Cases Of Meningitis In The Absence Of Cerebrospinal Fluid Pleocytosis On Lumbar Puncture, Michelle Troendle, Alexis Pettigrew

Emergency Medicine Publications

Background: Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. However, meningitis may occur in the absence of pleocytosis on CSF.

Areas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. Further, there is little available literature on the subject.

Methods: Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. …

Targeting Intracellular Calcium Stores Alleviates Neurological Morbidities In A Dfp-Based Rat Model Of Gulf War Illness, Laxmikant Deshpande, Edna Santos, Kristin Phillips, Robert Blair

Neurology Publications

Gulf War Illness (GWI) is a chronic multi-symptom disorder afflicting the veterans of the First Gulf War, and includes neurological symptoms characterized by depression and memory deficits. Chronic exposure to organophosphates (OP) is considered a leading cause for GWI, yet its pathobiology is not fully understood. We recently observed chronic elevations in neuronal Ca2+ levels ([Ca2+]i) in an OP- diisopropyl fluorophosphate (DFP) based rat model for GWI. This study was aimed at identifying mechanisms underlying elevated [Ca2+]i in this DFP model and investigating whether their therapeutic targeting could improve GWI-like neurological morbidities. Male Sprague-Dawley rats (9-wks) were exposed to DFP …

A Competency-Based Approach To Faculty Development, Betsy Ripley Md, Jean Bailey Phd, Kenneth Warren Edd, Katherine J T Henderson Med

Publications from the Office of the Dean

Background—Faculty development at the Virginia Commonwealth University School of Medicine (VCU SOM) has previously focused on enhancing teaching and learning in the medical and clinical education settings. While this work is important, this narrow focus does not address all facets a faculty member’s role. To broaden their programming, the VCU SOM faculty development team adopted a competency-based approach to the development and planning of faculty development activities.

Summary of work—The Senior Associate Dean for Faculty Affairs completed a research project focused on successful medical faculty who promote through the tenure process and advance in their careers. She identified …

Electronic Nicotine Delivery Systems: Vaping Away Gum Tissue, Christina Tulloch, Denise Thieleman

Dental Hygiene Student Scholarship

Objective: Conventional cigarettes have shown severe toxicity on immune cells and wound healing in the periodontium, but little is known about the comparative effects of vaping or electronic cigarettes. In a substantial shift away from conventional cigarettes, vaping and e-cigarette sales have increased nearly 600% since 2017. If current conventional cigarette users are to transition to a less detrimental alternative, the evidence must demonstrate if electronic nicotine delivery systems can be deemed safer than conventional options.

Methods: By compiling data from the PubMed database, the most recent perspectives on new smoking methods and effects of usage on periodontal tissues were …

Oil Pulling: Fact Or Fad?, Cassandra N. Cooper

Dental Hygiene Student Scholarship

Problem: There is a greater need in today’s world for better oral care across all populations. In developing countries, the tradition of oil pulling has provided an affordable and accessible alternative to antimicrobial rinse agents. Western society has taken note of this and oil pulling has emerged as the latest oral hygiene fad.

Methods: This review of literature used the following databases: PubMed, CINAHL and Google Scholar to identify relevant research articles. Search terms included oil pulling, coconut oil, sesame seed oil, oil swishing, oral health, periodontitis, gingivitis, and bacterial adherence. The studies reviewed used previously validated data collection methods …

Dental Dam Utilization By Dentists In An Intramural Faculty Practice, Terence A. Imbery, Caroline K. Carrico

General Practice Publications

Objectives: From casual observation of our colleagues, only a few individuals use the dental dam for operative procedures in their faculty practice. The purpose of this study was to obtain faculty perceptions of the dental dam, quantify its utilization in their intramural faculty practice, and determine the factors that influence dental dam usage.


Materials and Methods: A survey containing 11 questions was sent to 19 faculty members who teach full time and maintain an intramural dental practice involving operative dentistry. Thirty electronic dental health records of the 19 providers were reviewed to gather the following information from restorative procedures they …

"Associations Of Qol, Socioeconomic Status And Health Insurance Type Among Patients With End-Stage Renal Disease: Association With Outcomes.", Prasanna Kumar Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: HRQOL, socioeconomic status (SES) factors andpenetration ofinsurance play a main role in affecting the patients’ QOL and the diseased population is linked with increased prevalence of end stage kidneydisease in view of disease progression in chronic kidney disease (CKD). However, not much studies were performed in India with respect to QOL, SES factors and insurance in ESKD patients.Objective: To investigate the association of SES and health insurance type in ESKD patients with maintenance HD and non-dialysis patients, and also to investigate the QOL in them.Methodology:A prospective study was performed on ESKD patients with dialysis and without dialysis in nephrology …

Community-Based Occupational Therapy Practice Among Older Adults: A Delphi Study, Kristin Domville

Occupational Therapy Program Student Theses, Dissertations and Capstones

This capstone project explores the socio-political environment of current and potential community-based occupational therapy (OT) services among community-dwelling older adults, including the current state of community-based OT practice and the current awareness of OT’s potential impact on health and wellness among community-dwelling older adults. The goal is to identify how to increase the presence of OT in community settings to decrease the occupational injustice among the older adult population. The research method used is the Delphi Method, an anonymous structured communication between experts in the field of community-based OT practice and the older adult population. Experts, provided real-world knowledge and …

Occupation-Based Practice In Occupational Therapy, Sarah Psillas

Occupational Therapy Program Student Theses, Dissertations and Capstones

Background: The positive impact of occupation and well-being has been documented throughout the literature, however, the direct link of using occupation-based practice (OBP) and improvement of client outcomes has not been well established. This research study considered what OBP is, what the constructs are that comprise it, and how facilitators and barriers impact its use. Results: Results of this grounded theory study included four main constructs of occupation-based practice (actual occupation, meaningful and purposeful value, therapeutic intent, and engaged participation) as well as the theory of OccupationalTherapist’s Dynamic Use of Occupation-Based Practice. This theory explains the dynamic process that a …

Creating Confident And Connected Families: A Program To Improve Parental Self-Efficacy In The Neonatal Intensive Care Unit, Kelly Simpson

Occupational Therapy Program Student Theses, Dissertations and Capstones

Infants in the Neonatal Intensive Care Unit (NICU) require life sustaining intervention for weeks to months after birth. This intervention is remarkably stressful for both the infant, who is ill-equipped to handle life outside the womb, and for the parents who are filled with fear and stress due to the illness of their son or daughter. The experience of hospitalization can lead to stress, shame, anxiety, and even post-traumatic stress disorder for families of NICU infants. Knowledge about the unique stressors, challenges, and needs for support of preterm infants has proven helpful to boost confidence and feelings of wellbeing within …

Effect Of Aflibercept On Macular Retinal Layers And Peripheral Non Perfusion In Subjects With Proliferative Diabetic Retinopathy, Swetha Bindu Velaga

Student Theses, Dissertations and Capstones

Background: The relation between UWF fluorescein angiography (FA) and retinal non-perfusion were studied previously. The relationship between retinal thickness and retinal non-perfusion in subjects with diabetic retinopathy has not been studied using SD-OCT and UWF. Thus, in this current study we used SD-OCT to visualize the individual layers of retina and to evaluate whether the extent of non-perfusion is correlated with macular retinal layer thickness in subjects with PDR with no diabetic macular edema.

Methods: In this prospective longitudinal multicenter, randomized study a total of 36 eyes of thirty six subjects were included in final analysis. Subjects with any history …

Practice Makes The Deficiency Of Global Motion Detection In People With Pattern-Related Visual Stress More Apparent, Jana Wegrzyn

Student Theses, Dissertations and Capstones

Pattern-related visual stress (PRVS) refers to the perceptual difficulties experienced by some individuals when exposed to high contrast striped patterns. People with PRVS were reported to have reduced sensitivity to global motion at baseline testing and the difference disappears at a second estimate. The present study was to investigate the effect of practice on global motion threshold in adults with and without PRVS. Methods: A total of 101 subjects were recruited and the Wilkins & Evans Pattern Glare Test was used to determine if a subject had PRVS. The threshold to detect global motion was measured with a random dot …

Long Term Efficacy Of A Supraciliary Micro-Stent Combined With Cataract Surgery In The Treatment Of Glaucoma, Michael Robert Mcfarland

Student Theses, Dissertations and Capstones

Purpose: The purpose of this study is to evaluate the long-term efficacy of supraciliary micro-stent implantation in combination with phacoemulsification in the treatment of mild-moderate primary open angle glaucoma (POAG). Methods: Retrospective data of patients previously enrolled in the “Study of an Implantable Device for Lowering Intraocular Pressure in Glaucoma Patients Undergoing Cataract Surgery” (COMPASS trial), in which patients with mild-moderate POAG had undergone either cataract surgery alone or cataract surgery combined with implantation of a supraciliary micro-stent, were collected. Eligible patients had since exited the trial and had 5-8 years of postoperative data available. The primary outcome measure was …

A Clinical Documentation Practice Improvement To Increase Insurance Reimbursement, Allison R. Hamilton

Student Theses, Dissertations and Capstones

Background: The National Institute Mental Health (2015) estimated there were about 44.7 million people diagnosed with a serious mental illness and 62.9% of those diagnosed were without mental health services. The loss of services was due to unemployment, reoccurring hospitalization, inabilities to care for themselves, and lack of participation in societal norms (World Health Organization [WHO], 2014). According to Insel (2011/2015), the U.S. cost of mental healthcare was an estimated $57.5 billion in 2006. This cost was not due to actual care but associated with the economic burden of job loss and the excessive use of community resources. The Affordable …

Relationship Between Emotional Intelligence And Resilience Among Newly Licensed Registered Nurses Transitioning To The Professional Role, Lee Fong-Hong

Student Theses, Dissertations and Capstones

Background: With the current nursing shortage there are fewer experienced nurses and more newly licensed registered nurses (NLRNs) in the workplace. This shortage may be due in part to inconsistencies between role expectations learned in school and the practice environment. These inconsistencies may make it challenging to transition from nursing school into professional healthcare organizations. Nurses with certain person-level traits, including resilience and emotional intelligence, may be more likely to make a successful transition into practice. Findings may improve our understanding of what person-level traits are important for making the successful transition to the workforce. Purpose: The current study explored …

Improved Use Of Interact To Decrease 30-Day Readmissions From A Skilled Nursing Facility, Folasade Omobowale Adewunmi

Student Theses, Dissertations and Capstones

Background: The rising cost of health care in relation to rehospitalizations continues to be a challenge. Medicare 30-day readmissions have an annual estimated cost of $17.4 billion. Irrespective of these costs and the continued improvement in the quality of care, skilled nursing facilities (SNF) still face high readmission rates. Purpose: The purpose of this quality improvement project was to enhance SNF care processes by improving the utilization of the electronic medical record software program “INTERACT” to increase early identification and treatments of patients to minimize 30-day hospital readmissions. Theoretical Framework: The theory of planned behavior by Icek Azjen was used. …

Implementing A Culturally Sensitive Intervention For Haitian Patients Non-Adhering To Hypertensive Medications, Guilaine Gabriel-Percinthe

Student Theses, Dissertations and Capstones

Background: The pervasiveness of hypertension (HTN), morbidity, and mortality in Haitians immigrants are frightening. Nonadherence with hypertensive medications, disease management, lifestyle modifications, and cultural and spiritual beliefs, including prayer; faith healing; use of herbal teas; and a diet that is deficient in potassium, rich in sodium, high in fat, cholesterol, and carbohydrates result in increased prevalence of HTN and disability in the Haitian community. Purpose: The purpose of this quality improvement project was to examine the existing system for adherence to hypertensive medications, standardized clinical practice guidelines, identify patients at risk for nonadherence to hypertensive medications, disease management, medical follow-up, …

Lived Experience Of Post-Licensure Nurses In A Perioperative Clinical Rotation, Amy Stahley

Student Theses, Dissertations and Capstones

A projected deficit in the perioperative workforce of 32,000 perioperative nurses retiring by 2024, creates an inability to meet the nursing needs of the United States population. The need for experienced perioperative nurses has been increasing while the availability of nurses with perioperative education has been decreasing. The purpose of this phenomenological study was to explore the lived experience of post-licensure nurses who participated in a perioperative clinical rotation within their baccalaureate nursing program and did that experiential experience affect the recruitment and employment for perioperative nursing to halt the impending shortage. The integrations of Kolb’s experiential learning theory and …

An Educational Initiative To Promote Self-Care Practices In Hispanic Adults With Type 2 Diabetes, Geralde S. Bridges

Student Theses, Dissertations and Capstones

Background: Type 2 diabetes (T2D) has become pandemic and is predicted to increase among Americans. Hispanic Americans are at high risk for the disease. T2D is a causative factor in many chronic illnesses among adults in the United States. A major contributing factor to poor adherence to diabetes treatment plans is knowledge deficit related to the disease, its management, and its complications. Therefore, education in self-care practices is critical in diabetes management.

Purpose: The purpose of this evidence-based quality improvement project (QIP) was to promote self-care practices among T2D Hispanic patients through a diabetes self-management education (DSME) program. The project …

Use Of Evidence-Based Test Development In Pre-Licensure Nursing Programs: A Descriptive Study Of Faculty Beliefs, Attitudes And Values, Richild Berrick

Student Theses, Dissertations and Capstones

Background: Effective testing in pre-licensure nursing programs is a challenge in nursing education. Implementing evidence-based test development is essential to successful assessment of students’ competence and preparation for licensure. Purpose: Identifying the beliefs, attitudes and values of nursing faculty will contribute to the use of best practices in student assessments, ultimately contributing to increased retention of competent students and increasing the workforce within the healthcare industry. Theoretical Framework: This study is based on Rokeach’s theory of beliefs, attitudes and values. Methods: A quantitative descriptive research methodology was used in this study using survey data collection. A purposive, non-probability, convenience sample …

Emergency Department Nurses: Post Code Pause, Lynn Alice Hauck

Student Theses, Dissertations and Capstones

Background: The consistent witnessing of death and critical incidents takes an emotional toll on the emergency department (ED) nurses. In addressing critical incident events, research has shown us that debriefing nurses after a traumatic event helped reduce stress and, in turn, decreased staff turnover in the ED at an acute care facility (Hirschinger, Scott, & Hahn-Cover, 2015). Purpose: The purpose of this DNP project was to implement a Post Code Pause (PCP) debriefing tool in conjunction with the hospital’s Unit Practice Council (UPC) members and the ED direct patient care nurses for use after adult and pediatric cardiopulmonary resuscitation (CPR), …

Baccalaureate Nurses’ Experiences And Understanding Of Adults Living With Sickle Cell Disease, Shelia Ann Reid

Student Theses, Dissertations and Capstones

Background: Sickle cell disease (SCD) is a chronic, genetic blood disorder with most treatment interventions geared toward the acute phase of the disease, which often leads to fragmented care. In Canada, the teaching of SCD occurs without a genetic competency, resulting in miscommunication, misunderstanding, and inadequate nursing care. Purpose: This investigator examined baccalaureate nurses’ experiences and understanding of working with adults living with SCD. Methods: A semi-structured interview guide was used to explore baccalaureate nurses' experiences and understanding of working with young adults living with SCD. Results: Lindseth and Norbergs’ (2004) interpretation of Ricoeur’s hermeneutic interpretative phenomenological approach was used …

Factors Affecting The Outcome Of The National Council Licensure Examination Among Nontraditional Learners From Associate Degree Nursing Programs, Angela Cristina Gaud

Student Theses, Dissertations and Capstones

Background. The composition of student population in higher education is a reflection of a globalized society and current socioeconomic conditions. Characteristics of nontraditional adult learners have a significant impact in the achievement of their academic goals. A more diverse composition of students enrolled in nursing programs poses an important challenge to NCLEX-RN pass/fail outcomes. Studies that explore or predict the factors associated with NCLEX-RN performance amongst nontraditional adult learners after graduation are limited.

Purpose. This study analyzed how the demographic, social, and psychological factors observed in the characteristic profile of the nontraditional adult learner are related to NCLEX-RN performance for …

Increasing Hospice Nurses’ Knowledge And Improving Attitudes On Pain Assessment In Dementia Patients, Lyn Marie Peugeot

Student Theses, Dissertations and Capstones

Background: Patients with dementia have difficulty articulating pain due to cognitive deficits incommunication, sensation, and overall physical decline due to the aging and disease process. Patients who have dementia are considered at-risk for uncontrolled pain due to under-assessment, under-treatment, or untreated pain. Current research notes gaps exist in pain assessment among nurses’ due to knowledgedeficits and attitudes on pain assessment for dementia patients. Barriers regarding the utilization of evidence-based behavioral pain assessment tools are related to nurses’ knowledge deficit and skills competency.

Purpose: The purpose of this evidence-based practice (EBP) project was to increase hospice nurses’ knowledge and improve attitudes …

Handoff Communication Among Senior Nursing Students: A Phenomenological Study, Juanita Hanley-Gumbs

Student Theses, Dissertations and Capstones

Despite discussions in health care regarding poor communication and its link to patient safety, it was revealed in the literature that many student nurses are inadequately prepared to conduct handoff communication. Student nurses have difficulty in this area due to limited or no experience with the handoff process, which jeopardizes patient safety. The purpose of this research study was to understand how senior nursing students make meaning of their lived experiences with handoff communication. The guiding research question for this study is: How do senior nursing students make meaning of their lived experiences with handoff communication during the change-of-shift report …

Technostress In Nursing And The Big Five, Paula Hope Jackson

Student Theses, Dissertations and Capstones

Information about technostress is scant in the nursing literature even with the ubiquitous amount of technology used in thehospital setting as well as the Big Five personality traits. The purpose of this study is to determine the prevalence of technostress among hospital nurses and to examine the relationship between technostress and nurses’ personality traits measured by the Big Five Inventory -- openness to experience, consciousness, extraversion, agreeableness, and neuroticism (OCEAN). The Technostress Creator instrument developed by Tarafdar, Tu, Ragu-Nathan, and Ragu-Nathan (2007) was utilized to identify the percentage of technostress in the five subscales of techno-overload, techno-invasion, techno-complexity, techno-insecurity, and …

Increasing Self-Efficacy And Bystander Cpr Rates: A Train-The-Trainer Program, Amanda Constantino

Student Theses, Dissertations and Capstones

Background: The majority of cardiac arrests occur outside of the hospital, yet a significant portion of the population are not trained to provide bystander cardiopulmonary resuscitation (BCPR). BCPR initiated during an out-of-hospital cardiac arrest (OHCA) has numerous benefits and increases positive patient outcomes and survival rates. There is currently a lack of structured training programs that focus on increasing BCPR training rates for OHCA, therefore, the number of individuals trained in BCPR remains low within communities despite evidence showing the clear benefits.

Purpose: The purpose of this evidence-based project was threefold: (a) to increase the number of community members within …