Medicine and Health Sciences Commons^™

Implementation Of A Training Program In The Use Of The Electronic Medical Record To Improve Performance On Quality Measures And Reduce Burnout Among Healthcare Providers, Mary Monica Nara

UNLV Theses, Dissertations, Professional Papers, and Capstones

Rapid adoption and implementation of the electronic medical record (EMR) in health care has contributed to worsening burnout among healthcare providers (HCPs), particularly primary care physicians. Other HCPs such as nurse practitioners (NPs) and physician assistants (PAs) who provide primary care have been equally affected by the increased clerical burden related to the increasing documentation requirements from payers and are at risk for burnout. Rates of burnout in NPs are currently not well known. Burnout has been linked to decreased quality of care for patients. Inadequate training and lack of skills in the use of the EMR have contributed to …

Comparison Of Digital Treatment Setups And Final Treatment Outcomes Of Class Ii Division 1 Malocclusions Treated With Premolar Extractions, Sogol Shantiyai

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: This study aimed to determine whether there are differences between pre-orthodontic treatment dimensions when compared to the virtual treatment simulations and actual orthodontic treatment outcomes in Class II malocclusions treated with two or four premolar extractions.

Introduction: The use of intraoral scanners has become commonplace in orthodontic practices, giving practitioners the ability to scan and assess maxillary and mandibular dental morphology and occlusal relationships chairside and in real-time. Practitioners can use virtual treatment planning to evaluate different extraction patterns, visualize potential non-extraction outcomes using interproximal reduction, and alter anchorage strategies based on the amount of retraction or protraction required …

Patients Enabled, Engaged, And Empowered: Implementation Of A Mobile Patient Engagement Technology, Jud Simonds

UNLV Theses, Dissertations, Professional Papers, and Capstones

Patient engagement technologies present an opportunity to enhance the patient experience by providing patient access to information throughout the entire, often complex, continuum of care. Growing evidence indicates that a lack of patient engagement is a significant contributor to preventable deaths. In contrast, engaging patients in their healthcare can positively affect patient outcomes and the overall patient experience. Unfortunately, traditional patient care models involve face to face patient-provider interactions, thereby limiting reach and impact. Exploring new roles for information technology (IT) within healthcare can contribute to addressing barriers encountered in more traditional healthcare models. Innovative IT solutions can assist patients …

Depressive Symptoms As A Moderator Of Diurnal Trends In Reward Seeking, Erick Albert William Rogers

UNLV Theses, Dissertations, Professional Papers, and Capstones

Anhedonia, a cardinal symptom of a major depressive episode, is the decreased motivation to seek rewards. Individuals with depressive symptoms tend to report reduced positive affect, a distal measure of reward motivation, and engage in less reward-motivated behavior (i.e., reward seeking). However, diurnal rhythms may also influence reward-seeking. Both self-reported positive affect and behavioral measures of reward-seeking increase from the morning to the afternoon and then decreased in the evening. Therefore, the aim of this study was to examine whether reward-seeking varied across time of day and whether anhedonia moderated variation. Overall, reward-seeking did not vary across time of day. …

Hdr Brachytherapy For Skin Cancer Using H.A.M. Applicator, Timothy Richard Thatcher

UNLV Theses, Dissertations, Professional Papers, and Capstones

Skin cancer is the most common type of malignancy affecting both men and women in the United States. A majority of these cases are nonmelanoma skin cancers (NMSC) such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The goal of any skin cancer treatment is to cure the lesion itself while also preserving function and optimizing superficial cosmesis. High dose rate (HDR) brachytherapy provides an alternative to superficial x-ray or electron beam for skin cancer treatment. Utilizing an Iridium 192 source soldered to the end of a wire, surface dose can be administered at predetermined positions with sharper …

A Comparison Of Lateral Cephalometric And Arch Dimension Changes In Patients With Class Ii Malocclusions Treated With 2-Premolar And 4-Premolar Extraction Patterns, Melissa Marie Ven Dange

UNLV Theses, Dissertations, Professional Papers, and Capstones

The aim of this study is to gather and analyze data representing detailed changes in model and cephalometric variables that will support clinicians in the premolar extraction decision- making process during camouflage treatment of class II dental patients. It is expected that the models, as measured by intra-arch dimensions, overjet, overbite, and mandibular crowding, and cephalometric radiographs, evaluated by their anteroposterior skeletal discrepancy, incisor inclinations, dental and skeletal vertical positions, and soft tissue characteristics, will significantly differ from within the same treatment group, pre-treatment to post-treatment, and between treatment groups. This retrospective study evaluated the model and cephalometric changes in …

Stress And Coping In Food-Insecure African Americans In Clark County, Nevada, Johanna Andrews

UNLV Theses, Dissertations, Professional Papers, and Capstones

African Americans have the highest rates of food insecurity than any other racial/ethnic group in the nation as a result of poverty, low household income, unemployment, food injustice, food mirages, and racial segregation. This consistent uncertainty in food access demonstrably results in poor mental health outcomes for food-insecure African Americans. Thus, the Transactional Model of Stress and Coping provides a theoretical framework to investigate how African Americans cope with food insecurity. The purpose of this study was to evaluate processes of coping with food insecurity and determine their impact on emotional well-being for African Americans in Clark County, Nevada. A …

The Relationship Between Tree Canopy And Social Capital On Physical Activity In Unlv Students, Melissa Bartshe

UNLV Theses, Dissertations, Professional Papers, and Capstones

Despite the numerous health benefits, rates of physical activity are low, especially among the college student population. Neighborhood tree canopy is one aspect of the built environment that has been shown to positively impact physical activity. Social capital has also been correlated with higher rates of physical activity. The sprawling urban design and arid desert climate of Las Vegas pose unique challenges to both tree canopy and social capital. Additionally, the relationship between tree canopy, social capital, and physical activity is understudied in the college student population. The purpose of this study was to assess the relationship of tree canopy …

Assessing The Health And Financial Burden Of Neonatal Abstinence Syndrome Among All Payer Inpatient Pediatric Discharges In Nevada, Kavita Batra

UNLV Theses, Dissertations, Professional Papers, and Capstones

Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome among neonates born to drug-dependent mothers. NAS poses a significant health and fiscal challenge nationally, with its incidence increasing by a factor of six (1.20 to 6.7 per 1,000 hospital births/year) along with the concomitant rise in health care cost from 2000-2016. Besides national data, it is critical to quantify NAS at the state-level to identify the target areas for prevention. Given the higher opioid prescribing rates among pregnant women in Nevada, it is critical to assess the health and financial magnitude of NAS in the state. The objectives of this …

Oral Localization Of Scardovia Wiggsiae, Graydon Ramos Carr

UNLV Theses, Dissertations, Professional Papers, and Capstones

Early childhood caries is one of the most prevalent diseases in the United States among children. The formation of caries is a complex, multifactorial process that is still being studied. Researchers have thought for years that Streptococcus mutans was the primary causative agent of early childhood caries. The recent discovery of a novel cariogenic pathogen, Scardovia wiggsiae and its significant contribution to the etiology of early childhood caries has led oral health researchers to re-evaluate this microorganism and its link to this disease. While there have been several projects undertaken within the University of Nevada, Las Vegas School of Dental …

Utilizing Breathing Techniques To Maximize Training Performance, Peyton Cater

UNLV Theses, Dissertations, Professional Papers, and Capstones

Anaerobic exercise causes metabolic acidosis to occur in the muscle, which is unfavorable for sustaining high intensity activity, as fatigue starts to set in. In order to compensate for the onset of fatigue produced by an acidic environment, respiratory alkalosis, induced by hyperventilation, can be performed to mitigate these effects. In contrast, research has shown that slowing down the breath rate, such as a two second inhale and three second exhale, has led to an increase in performance outcomes. Purpose: To investigate power output and the physiological responses after implementation of different breathing techniques during the recovery periods of intermittent …

Transitioning For Success: A Pilot Program For New Nurse Graduates In A Pediatric Intensive Care Unit, Valerie Charisa Barboa

UNLV Theses, Dissertations, Professional Papers, and Capstones

Global nursing shortages, increasingly complex patients, and rapidly evolving medical knowledge and technology make it necessary for today’s new graduate nurse (NGN) to enter practice with an already well developed set of skills (clinical judgment, technical skills, and a sound knowledge base). The protracted nursing shortage has prompted health care organizations to hire NGN’s directly into intensive care units (ICU), a rare, and previously unheard-of occurrence. Many NGN’s are unprepared for the highly complex, critically unstable patient in the ICU or the fast paced, independent, yet simultaneously collaborative nature of the ICU workplace. These deficits can quickly compromise patient safety …

Improving Type 2 Diabetes Mellitus In The Older Adult Population Utilizing Shared Medical Appointments In Primary Care Setting, Mailo Brantner

UNLV Theses, Dissertations, Professional Papers, and Capstones

The overall management of Type 2 diabetes mellitus (T2DM) and its comorbidities is complex and costly. The American Diabetes Association (ADA, 2019c) recommends the use of team-based care and self-management tools to optimize the management of T2DM. Unfortunately, there is a national shortage of endocrinologists and certified diabetes educators (Stewart, 2008) along with a primary care provider shortage (Simmons & Kapustin, 2011). Thus, it is essential to implement a care model to increase efficiency while also promoting patient knowledge and self-management of T2DM to improve health outcomes. An example of an innovative care model is the shared medical appointment (SMA), …

Assessing The Cost-Benefit Of Hiring A Deu-Prepared Rn Graduate: Does It Help Reduce Organizational Costs?, Tonya D. Bryant

UNLV Theses, Dissertations, Professional Papers, and Capstones

Costs associated with training new nurses from the time of hire to the time of independent practice can cost organizations nearly $100,000 per nurse (Acuna, Yoder, Madrigal-Gonzalez & Yoder-Wise, 2017; Silvestre, Ulrich, Johnson, Spector, & Blegan, 2017; Trepanier, Early, Ulrich & Cherry, 2012). New-hire costs for a dedicated education unit (DEU)-prepared newly qualified newly hired nurse (NQNHN) may be prohibitive for some hospitals when considering the cumulative amount of time and costs dedicated to training these specially prepared nurses who have previous clinical and organizational experience from their time as nursing students within the organization over the duration of their …

Investigating Attitudes And Beliefs Of University Students Aged 18 To 24 Years That Influence Their Decision To Take Pre-Exposure Prophylaxis Medication, Philip Danquah

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Contemporary research findings affirm that young adults aged 18 to 24 years have high prevalence of new HIV infections. Pre-Exposure Prophylaxis (PrEP) medication is the latest strategy in HIV prevention. Rates of PrEP uptake or use have been negligible among university students aged 18 to 24 years, especially among racial and ethnic minority students.

Objective: The objective of this study is to investigate the attitudes and beliefs that influence the uptake of PrEP medications and the HIV risk behaviors associated with the willingness to take PrEP medications among university students aged 18 to 24 years attending the University of …

3d Upper Airway Analysis Of Skeletal Class I, Ii, And Iii Adults With High Or Low Risk For Excessive Daytime Sleepiness, Alexander Dao

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: To investigate the differences in ethnicity, BMI, sex, total airway volume, minimum cross-sectional area, airway shape, and hyoid bone position in high risk for excessive daytime sleepiness vs low risk for excessive daytime sleepiness in skeletal class I, II, and III patients

Introduction: Obstructive Sleep Apnea (OSA) is an underdiagnosed medical condition with many negative consequences on a patient’s overall health (Dempsey, J.A., Veasey, S.C., Morgan, B.J., & O’Donnell, 2010). OSA is defined as the occurrence of at least 5 instances per hour of sleep during which breathing temporarily stops (Motamedi, McClary, & Amedee, 2009). Undiagnosed OSA could lead …

The Impact Of Culturally-Tailored Education On Knowledge And Behavior Related To Screening And Lifestyle Management Of Blood Pressure In African Immigrants, Sarah Erskine

UNLV Theses, Dissertations, Professional Papers, and Capstones

The number of African Immigrants in the United States is increasing. The prevalence of hypertension among Blacks, including African Immigrants are high. In addition to the increased susceptibility to hypertension, lack of disease awareness and unhealthy lifestyle are documented barriers to achieving adequate blood pressure control. The purpose of this project was to determine the impact of implementing a 30-minute, culturally-tailored, evidence based educational session on hypertension to promote knowledge and initiate behavior change in African Immigrants. This was a descriptive, cross-sectional study. Blood pressures were measured and survey instruments such as the Hypertension Evaluation of Lifestyle and Management scale …

The Implementation Of A Respiratory Syncytial Virus Prevention And Awareness Pamphlet In The Daycare Setting, Kaylie Marie Humphreys

UNLV Theses, Dissertations, Professional Papers, and Capstones

Respiratory Syncytial Virus (RSV) is the number one cause of bronchiolitis in children under five years of age and regretfully the number one cause of hospitalization in the first year of life. RSV leads to over three million hospitalizations, two million outpatient visits, and 200,000 deaths in the pediatric population globally each year. While no vaccine is currently available to prevent the spread of RSV, efforts must be shown in spreading awareness of strategies utilized in infection prevention such as hand hygiene and properly covering a cough or sneeze.

This project aimed to present this education to a target population …

Analysis Of Palatal And Upper Airway Dimensions In Patients With Excessive Daytime Sleepiness: A Retrospective Cone-Beam Computed Tomography Study, Daniel Jarrett

UNLV Theses, Dissertations, Professional Papers, and Capstones

Excessive Daytime Sleepiness (EDS) is the measure of ones propensity to fall asleep during normal daily activities. It has been reported in 20%-50% of adults in the United States and is the most frequent symptom of patients presenting to sleep clinics. EDS is the result of both primary hypersomnias such as narcolepsy and idiopathic hypersomnia and, more commonly, secondary hypersomnias such as sleep deprivation, psychiatric conditions, medications, illegal substances, and obstructive sleep apnea (OSA).

The etiology of OSA is multifactorial. Collapsibility of the upper airway is influenced by both neuromuscular tone and craniofacial anatomy. Common predisposing factors for small airways …

Creating A Structural Empowerment Culture: A Professional Development Module For The Novice Nurse Leader, Beth A. Hock

UNLV Theses, Dissertations, Professional Papers, and Capstones

Nursing leadership shoulders the responsibility for the performance of their nurses (McNeeseSmith, 1992). When a nurse leader creates a culture of structural empowerment, the work environment is more likely to produce higher quality patient outcomes and highly satisfied healthcare consumers. Novice nurse leaders are often ill-equipped early in their careers to forge a structural empowerment culture. Unfortunately, education programs to address the developmental needs related to structural empowerment do not seem to exist. Incorporating the theoretical underpinnings from Kanter theory (1977, 1993) and the Donabedian model (1966) to create an educational tool for the novice nurse leader in learning how …

Physical Therapy Nontreatment Events With Primary Physical Therapist, Stephen Johnson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Physical therapy improves prognosis reduces stay and is generally helpful in aiding recovery from a wide range of ailments. Nontreatment rates occur for multiple reasons and are also related to the personalities of physical therapists.

Methods: We used data from a research project involving physical therapy at an acute care facility in our community. Our study focused on the retrospectively determined primary physical therapist for each patient. We used the chi-squared tests to compare nontreatment rates between days of the week and disease type and the reasons for nontreatment events. Repeated-measure models were used to evaluate the effect of …

A Comparison Of Orthodontic Intraoral Scan Results Between Staff And Volunteers, Andrew Lee

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: This pilot study is the first to assess and compare a trained staff’s intraoral scan to a clinical examination by comparing the overbite, overjet, Angle canine and molar classification, and gingival health. The second part of this study is to determine if the self-scan scan from a patient is as reliable to the staff’s scan. Introduction: Orthodontic treatment is usually provided over a sequence of appointments. During each appointment, the doctor clinically evaluates the patient, analyzes the progress and provides adjustments to continue with the treatment. The most common clinical criteria evaluated are overbite, overjet, upper and lower midlines, …

Targeting Natural Killer Cells For Improved Immunity And Control Of The Adaptive Immune Response., Stephen Pierce, Eric S. Geanes, Todd Bradley

Manuscripts, Articles, Book Chapters and Other Papers

Natural killer (NK) cells are critical for targeting and killing tumor, virus-infected and stressed cells as a member of the innate immune system. Recently, NK cells have also emerged as key regulators of adaptive immunity and have become a prominent therapeutic target for cancer immunotherapy and infection control. NK cells display a diverse array of phenotypes and function. Determining how NK cells develop and are regulated is critical for understanding their role in both innate and adaptive immunity. In this review we discuss current research approaches into NK cell adaptive immunity and how these cells are being harnessed for improving …

Impact Of Slco1b1 Genetic Variation On Rosuvastatin Systemic Exposure In Pediatric Hypercholesterolemia., Jonathan B. Wagner, Susan M. Abdel-Rahman, Andrea Gaedigk, R Gaedigk, Geetha Raghuveer, Vincent S. Staggs, Leon Van Haandel, J Steven Leeder

Manuscripts, Articles, Book Chapters and Other Papers

This study investigated the impact of SLCO1B1 genotype on rosuvastatin systemic exposure in hypercholesterolemic children and adolescents. Participants (8-21 years) with at least one allelic variant of SLCO1B1 c.521T>C (521TC, n = 13; 521CC, n = 2) and wild type controls (521TT, n = 13) completed a single oral dose pharmacokinetic study. The variability contributed by SLCO1B1 c.521 sequence variation to rosuvastatin (RVA) systemic exposure among our pediatric cohort was comparable to previous studies in adults. RVA concentration-time curve from 0-24 hours (AUC

Three-Dimensional Facial Morphology In Cantú Syndrome, Helen I Roessler, Kathleen Shields, Dorothy K Grange, Nine V A M Knoers, Gijs Van Haaften, Peter Hammond, Mieke M Van Haelst

2020-Current year OA Pubs

Cantú syndrome (CS) was first described in 1982, and is caused by pathogenic variants in ABCC9 and KCNJ8 encoding regulatory and pore forming subunits of ATP-sensitive potassium (K

Clinical Features, Diagnosis And Management Of Covid-19 Patients In The Outdoor Setting, Bushra Jamil

Department of Medicine

In a brief span of a few months, coronavirus disease (COVID-19) pandemic has brought a major paradigm shift in operation of clinical services around the world. Infection may be mild, moderate or severe; many remain asymptomatic. High burden of non-communicable and communicable diseases theoretically puts Pakistani population at increased risk of severe COVID-19 infection. Considering the universal risk of infection, the outpatient services in Pakistan need to be redesigned. Starting with risk assessment of the facility and provision of a dedicated telephone connection, structure and workflow need to be redesigned in order to minimise risk of exposure to healthcare professionals, …

New Horizons: Covid-19 And The Burden Of Neuropsychiatric Illness In Pakistan, Ali M. Hashmi, Haider Ali Saleem

Medical College Documents

This manuscript reviews the current state of knowledge about the burden of mental illness and assesses the impact of COVID-19 illness on mental health in Pakistan. For this we analyzed secondary data obtained from the Institute of Health Metrics and Evaluation. The Global Burden of Disease (GBD) study draws from a wide range of data sources to quantify global and regional effects of a disease. We also did a literature search on the effects of COVID-19 illness on mental health and the psychosocial effects of COVID-19 and other Corona virus related illnesses such as SARS-CoV and MERS-CoV. Data from the …

Vasopressor Treatment And Mortality Following Nontraumatic Subarachnoid Hemorrhage: A Nationwide Electronic Health Record Analysis, George Williams, Vahed Maroufy, Laila Rasmy, Derek Brown, Duo Yu, Hai Zhu, Yashar Talebi, Xueying Wang, Emy Thomas, Gen Zhu, Ashraf Yaseen, Hongyu Miao, Luis Leon Novelo, Degui Zhi, Stacia M Desantis, Hongjian Zhu, Jose-Miguel Yamal, David Aguilar, Hulin Wu

Faculty, Staff and Student Publications

OBJECTIVE: Subarachnoid hemorrhage (SAH) is a devastating cerebrovascular condition, not only due to the effect of initial hemorrhage, but also due to the complication of delayed cerebral ischemia (DCI). While hypertension facilitated by vasopressors is often initiated to prevent DCI, which vasopressor is most effective in improving outcomes is not known. The objective of this study was to determine associations between initial vasopressor choice and mortality in patients with nontraumatic SAH.

METHODS: The authors conducted a retrospective cohort study using a large, national electronic medical record data set from 2000-2014 to identify patients with a new diagnosis of nontraumatic SAH …

The Benefits Of Alternative Therapies On Adult Mental Health, Sara Bryan

Electronic Theses and Dissertations

The purpose of the following descriptive pre and post study was to collect and analyze data to determine if there are benefits to alternative therapies on adult mental health. Three types of alternative therapies were studied: aromatherapy, recreation therapy, and yoga. A literature review was conducted and pre and post questionnaires were administered. Frequencies and averages were run which showed that participants were mostly Caucasian, with an average age of 31 years and most diagnosed with depression and anxiety. Participants showed decreased levels of anxiety and depression after attending both aromatherapy and yoga classes. Participants showed decreased anxiety levels after …

Association Of Visceral Adipose Tissue And Subclinical Atherosclerosis In Us-Born Mexican Americans But Not First Generation Immigrants, Clarence Gill, Miryoung Lee, Kristina Vatcheva, Nahid Rianon, Beverly Smulevitz, David D. Mcpherson, Joseph B. Mccormick, Susan P. Fisher-Hoch, Susan T. Laing

School of Mathematical & Statistical Sciences Faculty Publications

BACKGROUND: Excess visceral adipose tissue (VAT) is a primary driver for the cardiometabolic complications of obesity; VATassociated cardiovascular disease risk varies by race, but most studies have been done on Non-Hispanics. This study aimed to evaluate the clinical and metabolic correlates of VAT, its association with subclinical atherosclerosis, and the factors affecting this association in Mexican Americans.

METHODS AND RESULTS: Participants (n=527) were drawn from the Cameron County Hispanic Cohort (CCHC), on whom a carotid ultrasound to assess carotid intima media thickness and a dual-energy X-ray absorptiometry scan to assess for VAT were obtained. Those in the highest quartiles of …