Medicine and Health Sciences Commons^™

Implementation Of An Advance Care Planning Protocol To Increase Advance Directive Completion Rates, Christine Engle

Evidence-Based Practice Project Reports

Advanced directives (AD) allow an individual to retain autonomy in end-of-life decisions and can prevent unnecessary costs and treatments associated with aggressive life-prolonging measures. As of 2017, only an estimated 36.7% of the United States adult population had a form of advance directive documented (Yadav et al., 2017). The purpose of this evidence-based project was to determine if implementation of an advanced care planning (ACP) protocol would increase ACP discussions, AD completion, and result in a modification in stage of change or behavior. The Transtheoretical Model (TTM) and Stetler Model of evidence-based practice were used as the framework to guide …

Investigating The Therapeutic Potential Of Targeting Lrrc15 In Endometrial Cancer, Christopher Pathoulas

All College Thesis Program, 2016-2019

Endometrial cancer is the most common gynecological malignancy and accounts for 6% of all cancers in women. In 2018, there were an estimated 63,280 new cases of endometrial cancer resulting in 11,350 deaths. In advanced stages, aggressive forms of endometrial cancer are able to invade the peritoneum and metastasize to the omentum and bowel. Shridhar et al. have identified leucine rich repeat containing 15 (LRRC15), a protein involved in cell adhesion and interactions with the extracellular matrix (ECM), as a potential therapeutic target due to its significantly higher expression in ovarian cancer tumors that have metastasized to the omentum and …

Nurses' Attitudes And Understanding Of The Suicidal Patient, Cheryl Lemmon

Doctor of Nursing Practice Scholarly Project

Motivation / Problem statement: While not all suicides are predictable, there are reasonable guidelines for identifying those individuals at risk and reducing risk for high-risk individuals. There is, however, an apparent gap in best practice as there is a continual climb in suicide statistics. The aim of this project is to survey emergency department nurses to discover their attitudes and understanding of suicide. The purpose is to better understand the phenomenon, and guide education initiatives, as nurse professionals are in a key position of prevention when working with these patients.

Methods / Procedure / Approach: A non-probability, purposive and voluntary …

Crispr/Cas9 Driven Eradication Of Hiv-1 In Infected Human Genome, Sydney Loechler

Senior Seminars and Capstones

Once infected with HIV-1, the host immune system is incapable of ridding itself of the virus. HIV-1 uses latent viral reservoirs (LR) within CD4+ T cells to replicate. Within these reservoirs, HIV-1 is able to go into a latent state where it cannot be detected by the host's immune system or current HIV-1 treatments. By utilizing viewing assays and CRISPR-Cas9, there may be a possibility to identify, isolate, and then cut out HIV-1 from an infected cell. Two possible viewing assays have been proposed and studied in recent research. PCR assays are quicker and easier to administer while viral outgrowth …

Empathy In Aging, Morgan Kranz, James Charles Arendt

Honors Theses

Empathy in Agingis a project exploring how to show compassion for the inevitable aging process. This form of care is physical and mental. The concept for this work comes from my time working as a nursing assistantin a nursing home. Through my experiences, this project explores what I took away through observation and interaction

Fat For Life: The Development Of A Low-Carbohydrate High-Fat Dietary Toolkit For Type 2 Diabetes In Rural Southeast Kansas, Curtis Beall

Doctor of Nursing Practice Scholarly Project

The purpose of this project was to identify the feasibility of a low-carbohydrate high-fat (LCHF) diet in less affluent type 2 diabetics in rural Southeast Kansas, specifically, Crawford County. The author assessed this through the identification of the resources offered in Crawford County, and ultimately, the development of an LCHF dietary toolkit utilizing these resources. The toolkit offers an array of LCHF resources including compliant foods, grocery prices, shopping lists, phone applications, books, internet websites and blogs, accountability forums, and fitness centers. Upon completion of the dietary toolkit a select few healthcare providers directly involved with diabetes in Crawford County …

A Pre And Post Survey To Evaluate Patient Perception Of Group Diabetes Self-Management Education In Rural Health Clinics, Stormy Carter

Doctor of Nursing Practice Scholarly Project

Diabetes is a significant clinical issue in the primary care setting. Providers struggle to overcome barriers to facilitate therapeutic interventions for populations served. The specific aim of this study was to assess group diabetes self-management education from a patient perspective. Evaluation of diabetes knowledge and confidence of diabetes management was conducted in rural primary care clinics. This study utilized a one-group pretest-posttest design to patients receiving group diabetes self-management education in Southeast Kansas rural primary care clinics by a certified diabetes educator. The surveyed population included individual’s ages 18-65 with prediabetes, type 1, or type 2 diabetes who received DSME …

Increasing Human Papillomavirus Vaccination Among Adolescents Through Parent Targeted Cancer-Prevention Education, Shannon Duncan

Doctor of Nursing Practice Scholarly Project

INCREASING HUMAN PAPILLOMAVIRUS VACCINATION AMONG ADOLESCENTS THROUGH PARENT TARGETED CANCER-PREVENTION EDUCATION

An Abstract of the Scholarly Project by

Shannon Leigh Duncan

The purpose of this study was to determine if parent targeted HPV education emphasizing the cancer-prevention benefits of vaccination increased initiation of the Gardasil 9 series among adolescents attending Pittsburg Community Middle School (PCMS). This project was completed in conjunction with the Southeast Kansas Community Health Center (SEK CHC) and consisted of providing HPV and Gardasil 9 education to the parents/legal guardians of the students enrolled at PCMS one week prior and during the 2018 parent-teacher conference sessions. An …

Increasing Providers' Intent To Perform E-Cigarette Screening In The Adolescent Population, Andrea Hight

Doctor of Nursing Practice Scholarly Project

Youth e-cigarette use has increased significantly in recent years. E-cigarette use has many negative health effects supported by the literature including increased risk of respiratory infections, nicotine addiction, and the potential for cancer. E-cigarette screening creates an opportunity for patient education and counseling, as well as potentially decreases e-cigarette use. However, healthcare providers do not regularly screen adolescents for e-cigarette use. According to previous studies, the main barrier to e-cigarette screening is healthcare providers’ knowledge regarding e-cigarette health effects. This project sought to increase healthcare providers’ intent to screen for e-cigarette use in the adolescent population, through the provision of …

Autism Screening Knowledge And Practice In Southeast Kansas, Briana M. Laforge

Doctor of Nursing Practice Scholarly Project

Autism spectrum disorder (ASD) is classified as a neurodevelopmental disorder characterized by delays in social communication and interaction as well as restricted repetitive behaviors, interest, and activities. According to the most recent reports from the CDC (2018), it is estimated that 1 in 68 children are diagnosed with some form of ASD in the United States. Research has shown that early identification and intervention can significantly improve outcomes in those individuals diagnosed. As a result of this research, the American Academy of Pediatrics (AAP) has recommended routine screening on all children for ASD at the age of 18 months and …

Provider Awareness Associated With Lifestyle Interventions And Adult Obesity, Reilly Tackett

Doctor of Nursing Practice Scholarly Project

The obesity epidemic cannot be solved through a single solution. A complex problem like obesity requires an intricately designed approach, comprised of both behavioral and environmental changes (Centers for Disease Control, 2015). Obese adults who attempt to alter their lifestyles often experience barriers to success. One such barrier is a provider who may be unfamiliar with evidence-based lifestyle interventions. Research suggests large variances both in provider knowledge levels and practice recommendations associated with adult obesity. This study’s purpose was; to determine if provider recommendations reflected clinical practice guidelines (CPG) associated with adult obesity, to measure current levels of provider knowledge, …

Knowledge And Attitudes Of Registered Nurses On Palliative Care, Amy Marpu

Doctor of Nursing Practice Scholarly Project

The purpose of this DNP scholarly project (SP) was to evaluate the knowledge and attitudes of registered nurses (RN) regarding palliative care (PC) before and after an educational presentation. This SP strived to answer these questions: What is the current knowledge in RNs of PC and end of life (EOL) patients before and after the education presentation? What is the anxiety level RNs feel regarding medication administration and symptom management in PC and EOL patients before and after the educational presentation?

A multimethodology, cross-sectional study design was used. The participants were currently enrolled in the RN-BSN program at PSU. These …

The Usability And Acceptability Of An Electronic Clinical Decision Support Tool For Antibiotic Selection For Common Pediatric Infections In Outpatient Rural Healthcare Clinics, Samantha Simpson

Doctor of Nursing Practice Scholarly Project

The purpose of this project was to determine the potential role, usability and acceptability of an electronic clinical decision support tool (ECDST) for optimizing antibiotic prescribing practices for pediatric patients in outpatient rural healthcare clinics. Providers working with pediatric patients at Community Health Center of Southeast Kansas were asked to use the ECDST to complete two case studies. Following completion of the case studies, participants completed two standardized surveys regarding usability and mental workload of the ECDST. The ECDST used in this project was found to require a low mental demand, have a high usability value, and was accepted as …

Long-Term Experience With Apremilast In Patients With Psoriatic Arthritis: 5-Year Results From A Palace 1-3 Pooled Analysis., Arthur Kavanaugh, Dafna D Gladman, Christopher J Edwards, Georg Schett, Benoit Guerette, Nikolay Delev, Lichen Teng, Maria Paris, Philip Mease

Articles, Abstracts, and Reports

BACKGROUND: The efficacy and safety of apremilast were assessed in patients with psoriatic arthritis (PsA) in three phase III clinical trials with similar designs (PALACE 1, 2, and 3).

METHODS: Following a 24-week, randomized (1:1:1 to apremilast 30 mg twice daily, 20 mg twice daily, or placebo), double-blind phase and a 28-week blinded active treatment phase, patients could receive apremilast in open-label extension studies for an additional 4 years. Eligible adult patients had active PsA for ≥ 6 months and three or more swollen joints and three or more tender joints despite prior treatment with disease-modifying anti-rheumatic drugs.

RESULTS: A …

Exploring Maternal Factors Linked To Weight Status In Salvadorian Infants, Carmen M. Kiraly, Melanie Turk, Melissa Kalarchian, Cheryl Shaffer

Electronic Theses and Dissertations

Background: Obesity rates in the US have risen dramatically, especially among Hispanic adults and children. Because of the high prevalence of overweight and obesity in Latino children by preschool age, it is prudent to examine maternal factors potentially linked to weight status during an infant’s first year of life. The literature on risk factors of child obesity has focused primarily on children of Mexican descent, and little research exists for other Latino populations, such as Salvadorans. Objective: To investigate maternal physiologic and infant feeding factors associated with infant overweight and/or obesity in a sample of Salvadoran mother-infant dyads. Methods: A …

The Lived Experience Of Recovery Following Transoral Robotic Surgery (Tors) For Head And Neck Cancer, Katharine Mahalik

Electronic Theses and Dissertations

Abstract

Ongoing advances in minimally invasive surgical techniques, such as transoral robotic surgery (TORS), has enabled select patients with head and neck cancer to receive treatment that results in less disfigurement and dysfunction compared with traditional approaches. While TORS research has focused mainly on functional surgical outcomes, a need exists to understand recovery following TORS from the patient perspective. A hermeneutic phenomenological approach was used to recruit patients who had recently undergone TORS at a major academic health system in northeastern US. Data were collected using audio-recorded telephone interviews and field notes and analyzed concurrently. Participants included 17 HNCS (12 …

Hepatitis C Treatment In High Risk Patients: Implementation Of A Successful Community Focused Program, Annie Pedlar, Jodie Sandhu Dnp, Fnp-C

Doctor of Nursing Practice (DNP) Projects

Background: The city of San Francisco boasts a high rate of hepatitis C infection (HCV) among IV drug users indicating the need for a hepatitis C treatment program. It is estimated that over two-thirds of people who are actively infected with HCV are IV drug users (EndHepCSF, 2017), and in 2017 the San Francisco Department of Public Health (SFDPH) estimated that there are 22,500 active people who inject drugs (PWID) in SF (SFDPH, 2017). With the presence of a wide population of IV drug users in SF there is an identified need for intervention to treat this high-risk patient …

Effects Of An Alcohol And Std Educational Intervention On Alcohol And Std Knowledge, Alcohol Expectancies, And Beliefs On Negative Consequences Of Sexual And Drinking Behaviors In College Athletes, Kimberly Van Ness

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

College students have increased susceptibility towards alcohol use and high-risk behaviors which remains a concern across U.S. college campuses. A subgroup of the college student population with higher rates of alcohol consumption, binge drinking, and alcohol-related consequences including high-risk sexual behaviors is college athletes. It is of importance that college athletes are knowledgeable of responsible alcohol use, healthy sexual behaviors, and the risk of negative sexual consequences that can occur with alcohol use. The purpose of this study is to assess alcohol and STD knowledge, alcohol expectancies on sexual vulnerability and coercion, and beliefs on negative consequences of sexual and …

Public Health Policy: An Ethical Analysis Of Quarantine, Dina Alqahtani

Electronic Theses and Dissertations

As a public health measure quarantine has both historical and contemporary significance both in the United States and abroad. On the surface it represents a low-cost, low-tech way in which the spread of disease can be mitigated as its core requirement is that those who may have been exposed to an infectious agent are kept away from those who have not been exposed to that agent for enough time to determine whether or not infection has been spread. This has been utilized for centuries with both limited questions and scattered, inconsistent, or impossible to achieve oversight and goals. In understanding …

The Development Of Hybrid Process Control Systems For Fluidized Bed Pellet Coating Processes, Hanzhou Feng

Electronic Theses and Dissertations

The conventional basic control for pharmaceutical batch processes has several drawbacks. The basic control often uses constant process settings discovered by trial and error. The rigid process operation provides limited process understanding and forgoes the opportunities of process optimization. Product quality attributes are measured by the low efficient off-line tests, therefore these cannot be used to monitor and inform the process to make appropriate adjustments. Frequent reprocessing and batch failures are possible consequences if the process is not under effective control. These issues raise serious concerns of the process capability of a pharmaceutical manufacturing process.

An alternative process control strategy …

The Ethical Challenge Of Conflicts Of Interest In Healthcare, Fahad Alhazmi

Electronic Theses and Dissertations

Conflicts of interest are prevalent across all walks of society, and unfortunately, the healthcare industry is not immune to these impediments. Conflicts of interest arise when the objective of upholding a patients’ interest collide with the physicians’ secondary goals and is mostly but not always related to monetary gain.

To avoid conflict of interest, it is advisable for medical practitioners to weigh the pros and cons that their actions would inflict. Medical practices whose benefits outweigh the associated risks are ethically upright hence avoid conflict of interest.

Each section proposes solutions for the conflicts of interest encountered at the disparate …

Modeling And Prediction Of Amorphous Solid Dispersion Formation Using A Molecular Descriptor, Kevin Deboyace

Electronic Theses and Dissertations

Poor aqueous solubility of an active pharmaceutical ingredient (API) is a significant hurdle during drug development. Delivering a drug in its amorphous solid-state is a potential method to overcome this issue, since the amorphous form has increased apparent aqueous solubility. However, the amorphous state is only metastable, and is thermodynamically driven to recrystallize. As a result, pure amorphous drugs are seldom used in marketed products. Intimately mixing a drug in its amorphous form with a polymer, known as an amorphous solid dispersion (ASD), has the potential to significantly extend the physical stability of the amorphous form, while maintaining the benefit …

Deletion Of P38Α Mapk In Microglia Blunts Trauma-Induced Inflammatory Responses In Mice, Josh M. Morganti, Danielle S. Goulding, Linda J. Van Eldik

Sanders-Brown Center on Aging Faculty Publications

Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in the USA and other developed countries worldwide. Following the initial mechanical insult, the brain’s primary innate immune effector, microglia, initiate inflammatory signaling cascades and pathophysiological responses that can lead to chronic neuroinflammation and neurodegenerative sequelae. The p38α MAPK signaling pathway in microglia is a key contributor to inflammatory responses to diverse disease-relevant stressors and injury conditions. Therefore, we tested here whether microglia p38α contributes to acute and persistent inflammatory responses induced by a focal TBI. We generated conditional cell-specific knockout of p38α in microglia using a CX3CR1 …

The Effect Of Meditation On Stroke-Survivor Resilience: Secondary Analysis Of Existing Data, Mary Love

Dissertations and Theses (Open Access)

Purpose: To test the effect of meditation on resilience of community-dwelling stroke survivors, and to identify resilience predictor variables in these survivors.

Methods: Sub-study with secondary analysis of existing data from the parent study, MEditatioN for post stroke Depression (MEND). Paired samples t-test was used to evaluate the effect of meditation on resilience of stroke-survivors (n=20) in the intervention group. Bivariate analysis and general linear modeling (GLM) were used to identify demographic, clinical, and psychological predictor variables of baseline resilience for all stroke survivors (n=34).

Results: The increase in stroke-survivor resilience scores from baseline (mean 3.46, SD=.81) to intervention completion …

A Multifaceted Approach To Antibiotic Stewardship In The Outpatient Clinical Setting For Bronchitis, Elizabeth A. Weaver

Evidence-Based Practice Project Reports

Antimicrobial resistance is a world-wide health crisis (Infectious Disease Society of America [IDSA], 2016; World Health Organization [WHO], 2017) expedited by the overuse/inappropriate use of antibiotics. In the outpatient setting it has been determined that approximately 60% of antibiotic therapies are prescribed (Centers for Disease Control and Prevention [CDC], 2016). Antibiotic stewardship is the coordinated effort to improve the use of antibiotic therapies, minimize misdiagnosis and delayed diagnosis and select appropriate antibiotic drug regimens (IDSA, 2016). The purpose of this evidence-based practice project was to evaluate the effects of an antibiotic stewardship program (presentation, survey collection, bimonthly e-mail reminders, patient …

Use Of Smartphone Application To Facilitate Weight Loss And Promote Accountability In Obese And Overweight Patients, Angela M. Turner

Evidence-Based Practice Project Reports

In 2015, the U.S. Department of Health and Human Services published a National Health and Nutrition Survey (NHANES) on obesity from 2011 through 2014. From the survey, it was determined that the prevalence of obesity in the U.S. was 36% in adults and 17% in young adults/children (Ogden et al., 2015). Lifestyle modifications including moderation of caloric intake and increased exercise have been shown to be effective for both prevention and treatment of obesity. The purpose of this evidence-based practice (EBP) project involved the design, administration, and evaluation of a technology-assisted weight loss intervention to address the health problem of …

Health Literacy Screening To Increase Antihypertensive Medication Adherence, Boyann Bonjean

Evidence-Based Practice Project Reports

Hypertension contributes to the risk of developing cardiovascular disease (CVD), stroke, heart attack, and chronic kidney disease (CKD) (Abegaz et al., 2016; Weir, 2014; Whelton et al., 2017). Evidence indicates that 30 to 50% of people who are prescribed antihypertensive medication therapy are nonadherent (Hedna et al., 2015). Non-adherence to antihypertensive medications is a major contributor to hypertension treatment failure (Al Ghurair et al., 2012; Hu, 2016; Whelton et al., 2017). Evidence has shown that low health literacy may impact antihypertensive therapy (Slade, 2017). The purpose of this EBP project was to provide an organizational change by implementing a health …

An Ethical Analysis Of Reproductive Justice In The Context Of The Egenics Movement In The United States, Bernetta Welch

Electronic Theses and Dissertations

The history of forced sterilization and the American cultural agreement with this practice robbed women of color of control of their own bodies, destinies, and communities. Negative eugenics as genetic proof of low intelligence, low possibility, and low productivity fed the system of compulsory sterilization even though the science proved faulty and incorrect. As advances in medical technology and genetic science increases, eugenics is making a return into the American psyche. Vulnerable populations which include women of color make reproduction and the subsequent control of their bodies vulnerable once again.

The Reproductive Justice Movement is a collaboration of organized women …

The Effect Of Functional Movement Control On Patient-Reported Outcomes In Individuals With Non-Arthritic Hip Pain, Ryan Mcgovern

Electronic Theses and Dissertations

Purpose: Both the single leg squat test and step-down test assess for deficiencies relating to the hip and surrounding musculoskeletal structures and could be useful in the evaluation of functional movement control for individuals with non-arthritic hip pain. The purpose of this study is to determine if individuals with non-arthritic hip pain that improve functional movement control during the single leg squat test and step-down test have better patient-reported outcomes than those that do not improve, following the implementation of a rehabilitation intervention and a standardized home-exercise program.

Subjects: Forty-six individuals (31 females; 15 males) with a mean age of …

The Effects Of Learning Mindfulness Based Stress Reduction On Psychosocial Variables And Hba1c In Adolescents With Type 1 Diabetes, Denise Van Sant - Smith

Electronic Theses and Dissertations

ABSTRACT

THE PHYSIOLOGICAL AND PSYCHOSOCIAL EFFECTS OF AN ONLINE MINDFULNESS BASED STRESS REDUCTION INTERVENTION ON ADOLESCENTS WITH TYPE 1 DIABETES

By

Denise E. Van Sant – Smith

Date: 4-5-2019

Dissertation Supervised by Linda Goodfellow, PhD, RN, FAAN

Background: Stress has been shown to increase glucose levels through a sympathetic physiological response resulting in a release of chemicals such as adrenalin and cortisol, a response which results in an even greater need for insulin. Adolescents with Type 1 Diabetes may not be able to change or decrease the amount of stress in their lives but they may be able to …