Medicine and Health Sciences Commons^™

Clinical Decision Making: A Case Study Of The Effects Of Evidence Based Medicine And Past Empirical Experience In The Emergency Department, Olivia Zeman-Renner

Theses/Capstones/Creative Projects

With a growing number of medical malpractice suits and the passage of policy that focuses on patient advocacy, an emphasis has been placed on research regarding the decision-making processes of physicians in everyday practices. Over the past decades, scholars have looked to specific clinical decision-making philosophies, how they can be implemented into practice, and the effects of such implementation, but little research has been done into the culmination of decision-making philosophies on a day-to-day basis. By focusing on single-case study of a Midwestern Emergency Department and asking Attending physicians to self-report their decision-making philosophies, this study serves as a transition …

Current Challenges Facing Physical Therapists In Urban Nebraska, Mark A. Carter

Theses/Capstones/Creative Projects

Previous research regarding the analysis of the current healthcare professional workforce has been done in the state of Nebraska in order to determine to magnitude of healthcare resource deficits among different counties and populations, and research has shown that deficits are severe in the field of physical therapy primarily in rural counties. Consequently, the flow of patients to more urban areas in order to receive care has challenged physical therapists with accounting for the deficits in rural Nebraska. It is known that these issues as well as challenges regarding insurance and lack of interprofessionalism has led to complications in patient …

Prevalence Of Suspicious Mammographic Calcification In Newly Diagnosed Breast Cancer Patients At The Aga Khan University Hospital, Nairobi., Mariam Abdullahi Omar

Master of Medicine in Imaging and Diagnostic Radiology

Introduction: The most common cancer affecting women in Kenya is breast cancer with an incidence of 40.3 per 100 000 at risk population in 2018(1) while Nairobi has a higher incidence of (ASR 51.7 per 100,000) (2).This constitutes a major public health problem so early diagnosis plays a major role in mortality reduction and improving prognosis of breast cancer(3). Mammography is the most sensitive technique for detecting non palpable lesions. Over the decades it has been shown that in the USA there has been significant reduction in breast cancer mortality by 40% due to screening mammogram (4). On mammography the …

The Predictive Value Of Urine Dipstick Glucose Test In The Screening For Gestational Diabetes Mellitus In A Tertiary Private Hospital In Kenya, Janet Maranga

Master of Medicine in Clinical Pathology

Background: Worldwide, there is no consensus on the best approach to diagnose gestational diabetes mellitus (GDM) and though oral glucose tolerance testing (OGTT) is considered the gold standard, practices in the administration and interpretation of the test differ depending on the guidelines in use. Previous studies have questioned the utility of glycosuria as a screening test for GDM. Since the studies were conducted, there have been diagnostic threshold changes that might impact its utility. Justification: Diagnostic cut-offs of OGTT used in GDM diagnosis have evolved over time necessitating re-evaluation of glycosuria. The study was aimed at re-assessing the utility of …

A Review Of First Year Fellow Endoscopic Skills And Time To Proficiency, Antoinette Adjowa O. Walker, Dalya El Tawil, Jennifer Colombo, Nicholas Clark, Kimberly J. Reid

Posters

Through this quality improvement project, we have assessed the current fellows' upper endoscopy skill level during their first year and determined that the time to achieving proficiency is significantly longer than desired. The goal is to prepare new fellows for endoscopy prior to the beginning of their rotations with a curriculum that includes assigned reading materials, videos, and simulated endoscopic cases, to promote safety and increase satisfaction of patients by improving the readiness, skill level, and the confidence of first year inexperienced fellows.

Who Codes In The Nicu: An Analysis Of Demographics And Factors That Place Neonates At Higher/Lower Risk Of A Serious Code Event And Prognosis Post-Code, Danielle N. Gonzales, Ashley K. Sherman, Jennifer Dremann, Staci Elliott, Amelia Gute, Amber Bellinghausen, Jessica Brunkhorst, Danielle Reed

Posters

This study analyzed resuscitation events in a level IV neonatal intensive care unit from 2012-2017 to determine whether there are identifiable differences between those who have a rapid response event and those with a short or long code and determine factors post-event that may impact survival to discharge.

Dehydrated Hereditary Stomatocytosis Causing Sever Ascites Leading To Pulmonary Hypoplasia And Respiratory Insufficiency In A Neonate, Michael D. Mcdowell Jr, Christopher M. Oermann

Posters

Care Presentation: EM is a 32.5-week EGA infant who was born with sever congenital ascites (following repeated prenatal paracentesis) identified on prenatal ultrasound. Initial chest-abdomen imaging is shown in Figure 1. He required CPAP at delivery but was weaned of high flow nasal cannula with intermittent episodes of prolonged intubation during repeat paracentesis. Paracentesis demonstrated simple ascites rather than chylous fluid. Lymphangiograms demonstrated transient lymphatic leakage with resolution. Genetic evaluation revealed a pathogenic mutation in the PIEZO 1 gene for autosomal dominant DHS. This disorder had reduced penetrance and variable expressivity and symptoms range for absence of clinical features to …

Gonadotropin Releasing Hormone (Gnrh) Agonist Improves Hyperandrogenism In An Adolescent Female With A Novel Insulin Receptor Gene Mutation, Emily Paprocki, Romina Barral, Heidi Vanden Brink, Maria E. Lujan, Tania S. Burgert

Posters

We describe a case of an adolescent female with Type A insulin resistance whose severe hirsutism and hyperandrogenism were improved with leuprolide, despite extreme hyperinsulinemia. Ovarian volume decreased in association with the resolution of hyperandrogenism, consistent with ovarian size reflecting hyperandrogenism in adolescents.

This case allowed us to examine the frequently debated bidirectional relationship between insulin and hyperandrogenism, often deemed independent of gonadotropin activity.

Fetal Ventricular Measurement In Determination For Intrauterine Closure Of Myelomeningoceles, Paige Lundy, Emanuel Vlastos, Paul A. Grabb

Posters

Prenatal closure of myelomeningoceles for fetuses with ventricular width of greater than 15 mm at the time of intrauterine screening (19-25 weeks) has been discouraged, but little is documented regarding the details of ventricle measurement, modality, and timing. This study concludes that ultrasound and MRI provide different results in regards to fetal ventricle size. If treatment recommendations are going to be offered or withheld based on the 15 mm "rule" the method of fetal imaging must be taken into account.

How Undocumented Latino Parents’ Legal Status Affects Their U.S. Citizen-Children’S Health, Karla Garcia Hernandez

Senior Theses

The purpose of this paper is to review studies that have assessed how undocumented parents’ legal status have affected their United States citizen-children’s health. This issue involves nurses from different specialties, such as pediatric nursing, mental health nursing and community health nursing. Eight articles were reviewed in regard to how parental legal status affects the child’s access to healthcare services, the child’s physical health and the child’s mental health. The articles revealed that citizen-children of undocumented parents had limited access to health care services, had poorer health, and had higher chances of having mental health illnesses. The paper provided implementations …

“-Itis & -Itis”: Immune Checkpoint Inhibitors Toxicity Management, Timothy E. Byun

Books, Presentations, Posters, Etc.

No abstract provided.

Socioeconomic Inequality In Life Expectancy In India, Miqdad Asaria, Sumit Mazumdar, Samik Chowdhury, Papiya Mazumdar, Abhiroop Mukhopadhyay, Indrani Gupta

Journal Articles

Introduction Concern for health inequalities is an important driver of health policy in India; however, much of the empirical evidence regarding health inequalities in the country is piecemeal focusing only on specific diseases or on access to particular treatments. This study estimates inequalities in health across the whole life course for the entire Indian population. These estimates are used to calculate the socioeconomic disparities in life expectancy at birth in the population. Methods Population mortality data from the Indian Sample Registration System were combined with data on mortality rates by wealth quintile from the National Family Health Survey to calculate …

Perceptions Of Adult Patients Accessing Telehealth In An Urban Medical Group, Katharine Shepherd West

Doctoral Projects

Problem: Although implementation of in-patient electronic healthcare records is nearly complete in the United States, this achievement has not translated into consumer-to-business telehealth in the primary care setting. Because there are few studies that describe how and why patients select telehealth, the aim of this study was to learn about perceptions of adult patients in an urban setting when telehealth options are available. Research questions included a) How do patients select any type of appointment? b) How do patients perceive and use telehealth options? c) How and when might telehealth be useful in the future?

Methods: A qualitative study design …

The Effect Of Basal Bolus Insulin Administration Vs. Sliding Scale Insulin On Glycemic Control In Patients With Type 2 Diabetes Mellitus At A Community Hospital, Meriam Signo

Doctoral Projects

Evidence of effective insulin delivery by nurses can help prevent fluctuating plasma glucose levels of Type 2 diabetes mellitus (T2DM) in the hospital setting. Information leading to better diabetes care using either basal bolus insulin administration (BBI) or sliding scale insulin (SSI) is essential for safe blood sugar values. The purpose of this project was to measure patient glycemic control after the implementation of BBI vs. SSI during a patients’ stay in the hospital. This study was a quantitative, retrospective exploratory chart review of T2DM in medical-surgical units at a Northern California community hospital. The data were collected from routine …

Identifying Perceived Barriers To Primary Health Care Access In Rural, Medically Underserved Areas, Suzanne Hewitt

Doctoral Projects

Persons living in rural areas designated as having primary care provider shortages often lack access to timely and appropriate levels of care, frequently forcing them to forego care, delay treatment, or seek care in an emergency department for non-urgent complaints. This qualitative study reviewed evidence-based research and data generated from two focus groups sessions to generate a body of distinctive knowledge of the barriers to primary healthcare access as perceived by members of this rural, medically-underserved area of northern California. The theme that was identified, through conventional qualitative content analysis, as most prevalent among subjects was the inability to schedule …

Nurses’ Perception Of Discharging The Medically Complex Pediatric Patient, Stacie Camille Licon

Doctoral Projects

The purpose of this study is to query the nurses for their perceptions of the barriers and facilitators of discharging medically complex pediatric patients from a freestanding children’s hospital in central California. Using a mixed methods research design via an online survey, 90 nurses identified 3 distinct themes that act as barriers. Those barriers include: 1) knowing the plan of care, 2) time, and 3) disposition of the family. Several implications for improving the discharge process for medically complex patients and overcoming the identified barriers include strategies to improve multidisciplinary communication, implementation of a Family Learning Center, use of video …

Identifying Predictors Of Airway Complications In Conscious Sedation Procedures, Rosemary Bray

Doctoral Projects

Problem: Conscious sedation procedures are complicated by unanticipated airway compromise and obstruction. The STOP-Bang questionnaire (University of Toronto, 2012) is a validated obstructive sleep apnea (OSA) screening questionnaire used as a pre-procedure evaluation tool to assess a patient’s risk for OSA. There are four verifiable, objective questions and four subjective questions. This study examines to what extent the STOP-Bang score question variables reliably predict airway complications during conscious sedation procedures.

Method: The method was a retrospective review of data from the electronic medical record (EMR) of patients who had conscious sedation for endoscopy procedures. The individual questions of the STOP-Bang …

Caring For The Pediatric Neurofibromatosis Type-1 Patient: Improving Nursing Knowledge Through An Innovative Educational Tool, Samantha Ingerick

Doctoral Projects

Standardized nursing education can help equip nurses with appropriate skills needed to care for certain patient populations. Pediatric neurofibromatosis type-1 (NF1) patients have unique health needs, and often seek care at institutions where no NF1 training has been provided. The purpose of this project was to explore existing nursing NF1 knowledge and knowledge perception in a pediatric oncology infusion center within a large bay area children’s hospital, a location where nurses have varied NF1 education and have recently been asked to care for this population. Malcolm Knowles’ adult learning theory was used to design an NF1 educational tool for nurses. …

Tisagenlecleucel Model-Based Cellular Kinetic Analysis Of Chimeric Antigen Receptor-T Cells., Andrew M. Stein, Stephan A. Grupp, John E. Levine, Theodore W. Laetsch, Michael A. Pulsipher, Michael W. Boyer, Keith August, Bruce L. Levine, Lori Tomassian, Sweta Shah, Mimi Leung, Pai-Hsi Huang, Rakesh Awasthi, Karen Thudium Mueller, Patricia A. Wood, Carl H. June

Manuscripts, Articles, Book Chapters and Other Papers

Tisagenlecleucel is a chimeric antigen receptor-T cell therapy that facilitates the killing of CD19+ B cells. A model was developed for the kinetics of tisagenlecleucel and the impact of therapies for treating cytokine release syndrome (tocilizumab and corticosteroids) on expansion. Data from two phase II studies in pediatric and young adult relapsed/refractory B cell acute lymphoblastic leukemia were pooled to evaluate this model and evaluate extrinsic and intrinsic factors that may impact the extent of tisagenlecleucel expansion. The doubling time, initial decline half-life, and terminal half-life for tisagenlecleucel were 0.78, 4.3, and 220 days, respectively. No impact of tocilizumab or …

How To Conduct Clinical Trials In Children: A Tutorial., Valentina Shakhnovich, Christoph P. Hornik, Gregory L. Kearns, Jaylene Weigel, Susan M. Abdel-Rahman

Manuscripts, Articles, Book Chapters and Other Papers

Despite a growing interest in, and commitment to, implementing pediatric clinical trials, approximately one in every five trials in children fails because of inappropriate study design, suboptimal experiment planning, or inadequate participant enrollment. This tutorial, presented from the perspectives of seasoned pediatric investigators, an experienced research coordinator, and an established pediatric clinical trials network, is designed to provide practical guidance for successfully implementing pediatric clinical trials at an academic center or another comparable institution.

Health-Related Quality Of Life In Glomerular Disease., Pietro A. Canetta, Jonathan P. Troost, Shannon Mahoney, Amy J. Kogon, Noelle Carlozzi, Sharon M. Bartosh, Yi Cai, T Keefe Davis, Hilda Fernandez, Alessia Fornoni, Rasheed A. Gbadegesin, Emily Herreshoff, John D. Mahan, Patrick H. Nachman, David T. Selewski, Christine B. Sethna, Tarak Srivastava, Katherine R. Tuttle, Chia-Shi Wang, Ronald J. Falk, Ali G. Gharavi, Brenda W. Gillespie, Larry A. Greenbaum, Lawrence B. Holzman, Matthias Kretzler, Bruce M. Robinson, William E. Smoyer, Lisa M. Guay-Woodford, Bryce Reeve, Debbie S. Gipson, Curegn Consortium

Manuscripts, Articles, Book Chapters and Other Papers

There is scant literature describing the effect of glomerular disease on health-related quality of life (HRQOL). The Cure Glomerulonephropathy study (CureGN) is an international longitudinal cohort study of children and adults with four primary glomerular diseases (minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and IgA nephropathy). HRQOL is systematically assessed using items from the Patient-Reported Outcomes Measurement Informative System (PROMIS). We assessed the relationship between HRQOL and demographic and clinical variables in 478 children and 1115 adults at the time of enrollment into CureGN. Domains measured by PROMIS items included global assessments of health, mobility, anxiety, fatigue, and sleep …

Preparation And Evaluation Of Single-Stranded Dna Aptamer-Based Immunological Adjuvant In Broiler Chickens, Adil Sabr Al-Ogaili

Graduate Theses and Dissertations

Mineral oils and metal salts are commonly used as adjuvants to enhance acquired immunity. Recently, monoclonal antibodies (MAbs) and recombinant peptides agonist CD40 receptor have shown remarkable promise for induction of rapid and robust immune responses. Limitations of this approach MAb production costs and multiple administrations due to anti-MAb immune responses. Here we demonstrate the development of a unique and sophisticated DNA aptamer-based alternative for CD40-directed delivery of universal antigens as an alternative in chickens, and potentially other vertebrate species. This receptor, expressed by antigen-presenting cells, acts as a costimulatory molecule for activated T helper lymphocytes. After initially selecting for …

Himmelfarb Library Liaison Letter - May 2019, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

Pro-Anorexia Website Harm, Jane C. Silva Ramirez

Journal of Critical Issues in Educational Practice

This paper explores the nature of websites that glorify eating disorders, or EDs. These websites are often referred to as “pro-ED” (pro-eating disorder), “pro-ana” (pro-anorexia), or “pro-mia” (pro-bulimia). For the purpose of this paper, only pro-ED, pro-ana, and pro-recovery website research were the focus. Scholarly articles found in California State University San Bernardino’s database were used to distinguish the different ways that these websites help and cause harm to individuals. Articles about pro-ED and pro-ana websites helped prove harmful to individuals, claiming the disorder as a “lifestyle”. It also showed the support these communities feel when interacting through blogs, comments, …

A Hidden Markov Factor Analysis Framework For Seizure Detection In Epilepsy Patients, Mahboubeh Madadi

Graduate Theses and Dissertations

Approximately 1% of the world population suffers from epilepsy. Continuous long-term electroencephalographic (EEG) monitoring is the gold-standard for recording epileptic seizures and assisting in the diagnosis and treatment of patients with epilepsy. Detection of seizure from the recorded EEG is a laborious, time consuming and expensive task. In this study, we propose an automated seizure detection framework to assist electroencephalographers and physicians with identification of seizures in recorded EEG signals. In addition, an automated seizure detection algorithm can be used for treatment through automatic intervention during the seizure activity and on time triggering of the injection of a radiotracer to …

Effectiveness Of Adaptive Utensils On Hand And Finger Range Of Motion In Individuals With Rheumatoid Arthritis, Lauren Yeager

Honors Theses

Individuals with Rheumatoid Arthritis (RA) often experience functional deficits that impair range of motion (ROM) in their hands and fingers. Daily tasks like opening jars and eating become more difficult and painful for individuals with RA because they lack the grip strength and adequate ROM to perform these activities. Because of this, efforts have been made to accommodate decreasing functionality due to decreased ROM. Adaptive utensils are currently being explored as a potential aid for hand and finger functional deficits. This study sought to quantify the ROM needed for individuals with RA to grip the handles of adaptive utensils of …

Diagnostic Accuracy Of Multi-Parametric Mri In Diagnosis Of Clinically Significant Prostate Cancer, Mariah Obino

Master of Medicine in Imaging and Diagnostic Radiology

Background: Traditionally, the diagnosis of prostate cancer has been based on an elevated prostate specific antigen or an abnormal digital rectal examination and confirmed histologically following prostate biopsy. This has led to a number of men without cancer or with clinically insignificant disease undergoing unwarranted prostate biopsies and suffering consequent complications. Pre-biopsy multi-parametric MRI plays a vital role in determining men with clinically significant cancer who need biopsy and those with a negative MRI who can safely avoid an unwarranted biopsy. Whereas studies on the value of multi-parametric MRI have been done elsewhere, there is variation in prevalence of prostate …

The Force Of Magnetism: Nursing-Library Collaborations To Support Magnet, Barbara (Basia) Delawska-Elliott, Helene Anderson, Marla London

Books, Presentations, Posters, Etc.

Background: The ANCC Magnet model is built on 5 Model Components and 14 Forces of Magnetism. The Components and Forces, including Transformational Leadership, Structural Empowerment, Exemplary Professional Practice, New Knowledge, Innovation & Improvement, and Empirical Quality Results (Models), and Professional Development, Quality Improvement, Nurses as Teachers, and Quality of Care (Forces) encourage and recognize professional growth, care improvement, and knowledge dissemination. Familiarity with searching professional literature and information literacy are key skills needed to grow Magnetism. This presentation will describe a collaboration between Magnet leadership and the library to build programs designed to support Magnet values and outcomes.

Description: Magnet …

Something’S In The Water: A Look At How Creativity And Innovation Can Prevent Future Water Crises, Tristan Holiday-Nowden

Creativity and Change Leadership Graduate Student Master's Projects

The purpose of this project is to raise awareness and create a level of consciousness about water, unlike anything we have seen in the past. This project presents a synthesis of current writings and ideologies from the fields of Environmental Science and Water Research. As well as think pieces and informative news articles from various publications.

To illustrate the damaging effects of water contamination, water pollution, and water scarcity; Flint, Michigan will serve as a case study. After diagnosing and defining the problem using the Creative Problem Solving (CPS) framework. This project will explore the challenge and look at the …

Defects In Fetal Mouth Movement And Pharyngeal Patterning Underlie Cleft Palate Caused By Retinoid Deficiency., Regina Friedl

Electronic Theses and Dissertations

Cleft palate is a common birth defect. Etiologic mechanisms of palate cleft include defects in palate morphogenesis, mandibular growth, or spontaneous fetal mouth movement. Cleft palate linked to deficient fetal mouth movement has been demonstrated directly only in a single experimental model of loss of neurotransmission. Here, using retinoid deficient mouse embryos, we demonstrate directly for the first time that deficient fetal mouth movement and cleft palate occurs as a result of mis-patterned development of pharyngeal peripheral nerves and cartilages. Retinoid deficient embryos were generated by inactivation of retinol dehydrogenase 10 (Rdh10), which is critical for production of …