Medicine and Health Sciences Commons^™

Current Management Of Acute Hyperglycemia: Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome, Cary Bedinghaus

Nursing Student Class Projects (Formerly MSN)

The purpose of this poster is to review and promulgate current best practices in management of the two forms of hyperglycemic crises: diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Reviews of literature showed large agreement on efficacious protocols in acute hyperglycemic treatment, while also noting wide prevalence of the disorder. Given the high human and financial cost of hyperglycemia, the dissemination of high quality, evidence-based interventions, to the widest possible audience participating in patient care, is imperative. This poster outlines signs and symptoms, basic pathophysiology, and implications for the treatment team with emphasis placed on areas of settled best …

Analisis Hubungan Faktor Psikososial Terhadap Stres Kerja Dan Perilaku Berisiko Karyawan Di Pt X, Aji Putro, Dadan Erwandi, Abdul Kadir

National Journal of Occupational Health and Safety

The death rate due to elevators in the world at 1999-2009 was 263 people, caused by 57% falling, 18% being pinched, 17% falling by objects, and 9% other causes. One of the efforts to prevent accidents was to analyze psychosocial factors that caused work stress and at-risk behavior that can lead to work accidents. This study aimed to determine the relationship of psychosocial factors to work stress and the at-risk behavior of employees at PT. X is engaged in the elevator and escalator sector. This research method was a descriptive quantitative, cross-sectional study with 200 people. Psychosocial factors related to …

Caldag-Gefi Mediates Striatal Cholinergic Modulation Of Dendritic Excitability, Synaptic Plasticity And Psychomotor Behaviors., Jill R. Crittenden, Shenyu Zhai, Magdalena Sauvage, Takashi Kitsukawa, Eric Burguière, Morgane Thomsen, Hui Zhang, Cinzia Costa, Giuseppina Martella, Veronica Ghiglieri, Barbara Picconi, Karen A. Pescatore, Ellen M. Unterwald, Walker S. Jackson, David E. Housman, S. Barak Caine, David Sulzer, Paolo Calabresi, Anne C. Smith, D. James Surmeier, Ann M. Graybiel

Department of Neuroscience Faculty Papers

CalDAG-GEFI (CDGI) is a protein highly enriched in the striatum, particularly in the principal spiny projection neurons (SPNs). CDGI is strongly down-regulated in two hyperkinetic conditions related to striatal dysfunction: Huntington's disease and levodopa-induced dyskinesia in Parkinson's disease. We demonstrate that genetic deletion of CDGI in mice disrupts dendritic, but not somatic, M1 muscarinic receptors (M1Rs) signaling in indirect pathway SPNs. Loss of CDGI reduced temporal integration of excitatory postsynaptic potentials at dendritic glutamatergic synapses and impaired the induction of activity-dependent long-term potentiation. CDGI deletion selectively increased psychostimulant-induced repetitive behaviors, disrupted sequence learning, and eliminated M1R blockade of cocaine self-administration. …

An Investigation Of New Medications Initiation During Ambulatory Care Visits In Patients With Dementia, Alexandra Wallem, Ashley I. Martinez, Lauren Vickers, Michael Singleton, Daniela C. Moga

Pharmacy Practice and Science Faculty Publications

Background
There is currently insufficient data describing how new medications are provided to older adult ambulatory patients with dementia in the United States (US).

Objectives
To describe characteristics of ambulatory care visits for adults ≥ 65 years old and investigate differences in prescribing of new medications between patients with and without dementia.

Methods
We conducted a population-based cross-sectional study using the 2016 National Ambulatory Medical Care Survey (NAMCS) in the US. Non-perioperative ambulatory care visits of patients ≥ 65 years old with sampling weights were used to provide national estimates of visits. Baseline characteristics were compared between visits for patients …

Kidney Recovery In Patients With Acute Kidney Injury Treated In Outpatient Hemodialysis Or Rehabilitation Facilities, Melissa Jordan, Victor M. Ortiz-Soriano, Aaron Pruitt, Lauren Chism, Lucas J. Liu, Nourhan Chaaban, Madona Elias, B. Peter Sawaya, Jin Chen, Javier A. Neyra

Internal Medicine Faculty Publications

Rationale & Objective: Since January 2017, patients with acute kidney injury requiring dialysis (AKI-D) can be discharged to outpatient dialysis centers for continued hemodialysis (HD) support. We aimed to examine the rate of kidney recovery, time to recovery, and hospitalization-related clinical parameters associated with kidney recovery in patients with AKI-D.

Study Design: Single-center prospective cohort study.

Setting & Participants: 111 adult patients who were admitted to the University of Kentucky Hospital, experienced AKI-D, and were discharged with need of outpatient HD.

Exposure: Hospitalization-related clinical parameters were evaluated.

Outcome: Kidney recovery as a composite of being alive and no longer requiring …

Primary Leiomyosarcoma Of The Distal Tibia: A Case Report., Sachin Dheer, Pamela Gekas, Faith Schick, Homyar Karanjia, Nicholas Taweel

Department of Radiology Faculty Papers

The authors present an unusual case of a leiomyosarcoma of the distal tibia. Leiomyosarcoma tumors typically originate from smooth muscle tissue. It is rare for it to derive from bone and even rarer to be found in a bone of the lower limb. Given this extreme rarity in addition to nonspecific findings on plain film radiographs and magnetic resonance imaging (MRI), biopsy was needed in this case. It was only through immunochemistry staining that a definitive diagnosis was made. As such, this case is an illustrative example of an aggressive, though rare, primary lesion of the bone which should be …

Decreasing Floor Morphine Equivalents Per Day Rates In The Mother/Baby Department, Jessica Welsh

Master's Projects and Capstones

Problem: Cesarean sections (C/S) are among the most common operations in the United States and result in moderate visceral and somatic pain. Historically, C/S pain has been treated with opioid pain relievers. The U.S. Department of Health and Human Services declared the misuse of opioids an epidemic in 2017, leading healthcare providers and organizations to look inward at how opioids are prescribed and used at all levels of patient care.

Context: A microsystem assessment on a 60-bed mother/baby unit indicated one of the highest average opioid administration rates per day for postoperative C/S patients in the organization’s region for the …

Patient Reported Outcomes In Sickle Cell Disease Examined Within A Conceptual Model, Swapandeep Mushiana, Marsha Treadwell Phd, Sherif M. Badawy Md, Ms, Liliana Preiss Phd, Allison King Md Mph Phd, Barbara Kroner Phd, Yumie Chen Bs, Jeffrey Glassberg, Victor Gordeuk Md, Nirmish Shah Md, Angie Snyder Phd Mph, Theodore Wun Md

Doctoral Dissertations

Objective: To examine the relations between patient reported outcomes (PROs) within a conceptual model for adults with sickle cell disease (SCD) ages 18 – 45 years enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry. We hypothesized that patient and SCD related factors and barriers to care would independently contribute to functioning as measured using the PRO domains. Additionally, pain and other SCD related complications are expected to impact the relation between the variables. Methods: Participants completed a 48-item survey that included socio-demographics and PRO measures, such as social functioning, pain impact emotional distress, and cognitive functioning. …

Asthma Pathophysiology, Tyler Wolpert

Nursing Student Class Projects (Formerly MSN)

This poster will examine the pathophysiology of Asthma, explore signs and symptoms of the disease, and review different treatment modalities. The Doctorate of Nursing (DNP) prepared nurse should be able to identify signs and symptoms of the disease and be prepared to manage the disease from a medical standpoint, as well as with behavior modification. The economic burden of asthma on healthcare yearly is over $82 billion. It is pertinent that continued research is done in the field of asthma to reduce the economic impacts of the disease, as well as to help improve patient outcomes on people living with …

Effect Of Microbiome Alterations On The Progression & Treatment Of Nonalcoholic Fatty Liver Disease, Rachelle Virgin

Nursing Student Class Projects (Formerly MSN)

Nonalcoholic fatty liver disease (NAFLD) is the presence of hepatic steatosis that is not caused by alcohol consumption, viruses, or medications (Sivell, 2019). Fatty liver can become more inflamed and lead to nonalcoholic steatohepatitis (NASH) and possibly progress to cirrhosis and liver failure (Sheka et al., 2020). As rates of obesity and type 2 diabetes rise, healthcare providers can expect to see this disease more prevalently in practice. It can be difficult to provide timely healthcare because there are usually no signs or symptoms present with NAFLD (Mayo Clinic, 2020). This poster discusses the importance of recognizing comorbidities and risk …

Parkinson's Disease And Anesthesia, Anthony Brusadin

Nursing Student Class Projects (Formerly MSN)

Parkinson’s disease is one of the most common neurodegenerative disorders in the world and is rapidly growing. With the global population living longer there will be more people that develop Parkinson’s like the average person’s life expectancy increases. With no cure and only treatment and management of the symptoms, it is important for research to continue to find better treatment options and potentially a cure. In the world of anesthesia patients with Parkinson’s are more difficult to manage with sedation medication because of the lower dopamine levels the patient has. It is important to stay updated on how to prepare …

Cardiogenic Shock, Kourtney Crum

Nursing Student Class Projects (Formerly MSN)

Cardiogenic shock is a leading cause of mortality in critical care units globally, despite advances in research and medical management. This shock state is caused by an initial insult directly to the heart, including myocardial infarction, ventricular failure, or valve dysfunction. The purpose of this poster is to provide an overview of pathophysiology, signs and symptoms, clinical classifications, and management options for cardiogenic shock.

Sars-Cov-2 (Covid-19), Matthew Baker

Nursing Student Class Projects (Formerly MSN)

SARS-CoV-2 (COVID-19) emerged in the fall of 2019 and impacted millions of people worldwide deeming it a global pandemic. The virus primarily impacts the respiratory system, but has shown to affect other organ systems such as the kidneys, heart, and brain. Respiratory failure leading to Adult Respiratory Distress Syndrome (ARDS) associated with COVID-19 requires ventilatory support and possibly prone therapy to increase lung volumes and prevention of atelectasis. There are several treatment modalities for mild and severe cases of COVID-19 that range from antivirals to vaccine development. COVID-19 is a complex virus that can vary from mild to severe cases …

A Nomenclature For Echinoderm Genes., Thomas R Beatman, Katherine M Buckley, Gregory A. Cary, Veronica F Hinman, Charles A Ettensohn

Faculty Research 2021

Echinoderm embryos and larvae are prominent experimental model systems for studying developmental mechanisms. High-quality, assembled, annotated genome sequences are now available for several echinoderm species, including representatives from most classes. The increased availability of these data necessitates the development of a nomenclature that assigns universally interpretable gene symbols to echinoderm genes to facilitate cross-species comparisons of gene functions, both within echinoderms and across other phyla. This paper describes the implementation of an improved set of echinoderm gene nomenclature guidelines that both communicates meaningful orthology information in protein-coding gene symbols and names and establishes continuity with nomenclatures developed for major vertebrate …

Development Of A Combined Feedforward-Feedback Quality Control System For Extended-Release Granules Using A Quality By Design Approach, Yuxiang Zhao

Electronic Theses and Dissertations

Objectives

For a fluid bed film coating process to consistently deliver quality products, its control system needs to be robust against the variability of input materials and environmental disturbances. Presently, limited studies have been reported to understand the effects and interactions of the material attributes, environmental variables, and process parameters on the product in vitro drug dissolution. A control system can be developed with a proper understanding of the coating process, by adjusting the process parameters in feedback and feedforward manners to compensate for the undesired effect caused by disturbances, and ensure consistent product quality.

Methods

The control system was …

Deception Of Resistance And The Effects On Muscular Fitness And Perceived Exertion, Tyler Mchenry

Electronic Theses and Dissertations

Resistance training has been a popular tactic that individuals have used to increase muscular fitness for decades. Muscular fitness includes muscular endurance, strength, and power. However, limitations such as self-efficacy and the Central Governor Theory may influence individual maximal performance ability. One training tactic that has been rarely researched is the deception of resistance during exercise, which is assumed to increase performances in all aspects of muscular fitness and improvements in perceived effort. Inconsistent results have been concluded from previous studies that have examined the same topic. Therefore, the purpose of this study was to investigate the effect of resistance …

The Impact Of A Structured Civility Educational Module And Cognitive Rehearsal Training (Crt) On Job Satisfaction And Turnover In Rural Healthcare Employees: A Quality Improvement Pilot Project, Laurel Matthews

Doctor of Nursing Practice (DNP) Manuscripts

Incivility is a top-cited stressor resulting in decreased job satisfaction and turnover. Uncivil behaviors jeopardize patient safety through poor communication and team ineffectiveness. This project aimed to determine if a structured civility educational module with CRT positively impacted job satisfaction and turnover of healthcare employees.

A pretest using the Workplace Civility Index (WCI) and investigator generated questions determined current civility behaviors, notable civility issues, and attitudes surrounding job satisfaction and turnover. The interactive, virtual modules highlighted dilemmas regarding incivility and their consequences to patient care. During CRT, the participants responded to filmed, uncivil conflicts using provided frameworks to curate civil …

Effectiveness Of The Purewick External Urinary Collection Device In A Long-Term Acute Care Hospital: A Program Evaluation, Charlotte Sheppard

Doctor of Nursing Practice (DNP) Manuscripts

In December 2017 a 77 bed Long Term Acute Care Hospital (LTACH) added PureWick External Urinary Collection Devices (ECD) to their Hospital Acquired Infection (HAI) Bundle. The PureWick ECD is utilized in the female patient population when urinary management is necessary and can be achieved without an indwelling urinary catheter.The PureWick ECD is a flexible wick like external catheter that allows for collection of urine through the hospital wall suction system. A program evaluation was performed relative to a program beginning in January, 2018 through September 2020 to determine if the implementation of the PureWick ECD reduced the catheter associated …

Improving Progressive Care Nurses’ Confidence And Performance During In-Hospital Cardiac Arrest (Ihca): A Continuous Quality Improvement Initiative, Katelyn Barley

Doctor of Nursing Practice (DNP) Manuscripts

The literature is clear regarding the benefits of high-quality cardiopulmonary resuscitation (CPR) in relation to patient outcomes. The American Heart Association (AHA) guidelines recommend immediate initiation of chest compressions and defibrillation as soon as possible to increase the chance of survival from cardiac arrest. The development of automatic external defibrillators (AEDs) have increased the survival rates of out-of-hospital cardiac arrest, however rates of survival from in-hospital cardiac arrest (IHCA) have not improved over the past several decades despite an increase in resuscitation research.

This project was to develop a system of quality improvement related to patient outcomes from IHCA. The …

Use Of A Remote Patient Home Telemonitoring System (Engage Practice Solutions) In A Rural Health System To Decrease Rural Patients’ Utilization Of Acute Healthcare Services: A Quality Improvement Project, Christopher Baker

Doctor of Nursing Practice (DNP) Manuscripts

Individuals in rural areas of the U.S. have less healthcare access in large part due to access barriers, and include travel and wait time, distance to a provider, cost, transportation, and social and cultural components. Rural individuals have been found to be in poorer health and have higher rates of being uninsured and having chronic disease. These disparities lead to rural individuals requiring more expensive acute care once they are at the point of receiving care. A significant burden is placed on the individual and health system. The rates of emergency department (ED) use in rural areas increased 70% from …

University Student Health Services Covid-19 Pandemic Response: A Program Evaluation, Joy Dougherty

Doctor of Nursing Practice (DNP) Manuscripts

The COVID-19 pandemic began in China in December 2019, and continued to spread globally throughout the following months. The impact of the virus led to Universities nationwide closing their campuses. Strategic COVID-19 master plans were created to ensure that students, faculty, and staff could return to a safe environment for the fall semester. The role of University Student Health Services (SHS) departments became critical.

The SHS team incorporated telemedicine visits along with new policies, procedures, protocols, and guidelines to maximize the safety of the students, faculty, and staff upon their return to campus. This program evaluation focused on the strengths …

An Evalution Of Sepsis Initiatives To Reduce The Severity Of Severe Sepsis In A Two-Hospital System, Rosemary Reiner

Doctor of Nursing Practice (DNP) Manuscripts

Sepsis is the most expensive clinical condition to treat, with a very high mortality rate (Torio & Moore, 2016). The goal of sepsis treatment is to intervene as early as possible utilizing established criteria. Several evidence-based approaches in the literature address early identification of sepsis, decreasing sepsis severity and reducing morbidity and mortality. Clinical Decision Support (CDS) are tools within certified electronic health records that provide clinicians with patient-specific knowledge presented at appropriate times that enhance decision-making and improve patient outcomes (Villegas & Moore, 2018). Electronic sepsis alerts are examples of CDS that are developed to monitor changes indicative of …

"Program Evaluation On The Use Of The Screening, Brief Intervention And Referral To Treatment (Sbirt) Process In Primary Care Physician Offices", Lisa Sanchez-Navarro

Doctor of Nursing Practice (DNP) Manuscripts

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an early screening intervention tool for individuals with non-dependent substance use, which is employed to identify and provide care before a patient needs extensive specialized treatment. SBIRT can be used in primary care settings, to methodically screen individuals who might not seek help for a substance use issue (Centers for Medicare & Medicaid Services, [CMS], 2020). Gaps in using the SBIRT screening process were identified within the insurance organization’s PCP practices, therefore, a program evaluation was completed to: (a) determine whether Primary Care Physicians (PCPs) were using the SBIRT process, (b) …

Patient Portal Use, Health Information Technology Self-Efficacy, Electronic Health Literacy, And Self-Management Among Patients With Heart Failure: A Cross Sectional Study, Pamel Kallmerten

Electronic Theses and Dissertations

Background: By the year 2030, the prevalence of heart failure (HF) is anticipated to rise by 46%, impacting over 8 billion persons. Self-management of HF is key to maintaining a healthy lifestyle and quality of life. Yet many have sub-optimal self-management skills necessitating innovative strategies to enhance self-management. An innovative strategy to support the person with HF is the use of health information technology (HIT) such as a patient portal (PP). Additionally, self-efficacy and health literacy are important to self-management of HF. Further understanding is needed of the relationship between PP use, HIT self-efficacy (HIT SE), electronic health literacy …

The Role Of Mek1/2 And Mek5 In Melatonin-Mediated Actions On Osteoblasts And Osteoclasts Differentiation, Bone Formation, Bone Microarchitecture, And Bone Biomechanics, Fahima Akter Munmun

Electronic Theses and Dissertations

Melatonin, the main endogenous hormone to entrain the circadian system, is not limited to its role in regulating the sleep-wake cycle; rather, it affects a wide variety of systems involving antioxidant, anti-inflammation, blood pressure regulation, seasonal reproduction, ovarian physiology, and immune function. Driven by the diversity of its action, melatonin for a long time has also been studied in the field of bone and mineral research both clinically and pre-clinically. Exogenous administration of melatonin in clinical trials in perimenopausal women (MOPS; NCT01152580); or postmenopausal women with osteopenia (MelaOST; NCT01690000 and MOTS; NCT01870115) confirmed improvement of bone mineral density (BMD) (MelaOST; …

Towards A "Universal Chemical Biology Toolbox" For Tackling Human Diseases, Christopher Swank

Electronic Theses and Dissertations

A lack of new drug targets and drug mechanisms, coupled with drug-pipeline attrition, represent significant problems in oncology drug discovery. Towards addressing this challenge, “fully-functionalized small-molecule probes” (FFSMPs) have been established, which are compounds that can be immediately used as “bait” to capture their protein targets under the same assay conditions used for oncology-based phenotypic screening. Specifically, each FFSMP library member contains one or more structural-diversity elements to promote interactions of the probe with different protein targets in living cells, an electrophile or photoreactive functional group for covalent attachment of the probe to interacting proteins via affinity or photoaffinity labeling, …

Technological Change And The Practice Of Healthcare Communication: Implications For Patient-Centered Care, From A Communication Ethics Perspective, Emmalee Torisk

Electronic Theses and Dissertations

Written in a historical moment marked in many ways by the COVID-19 pandemic and the changes it has wrought, including the increased availability and use of telehealth services, this project attempts to consider the implications of the continued integration of technology into health care, centering on the following essential question: How do technological changes affect the contemporary practice of healthcare communication, particularly that which occurs between the patient—the consumer of health care—and their provider? This dissertation thus considers the ways in which such linkages of technology and health care seem to fit into a larger shift within health care …

Measuring Routine Childhood Vaccination Coverage In 204 Countries And Territories, 1980–2019: A Systematic Analysis For The Global Burden Of Disease Study 2020, Release 1, Natalie C. Galles, Patrick Y. Liu, Rachel I. Updike, Stephen S. Lim, Jonathan F. Mosser, Asma Tahir Awan, Gbd 2020, Release 1, Vaccine Coverage Collaborators

Environmental & Global Health Faculty Research

Background: Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods: For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific …

Measuring Routine Childhood Vaccination Coverage In 204 Countries And Territories, 1980–2019: A Systematic Analysis For The Global Burden Of Disease Study 2020, Release 1, Natalie C. Galles, Patrick Y. Liu, Rachel L. Updike, Nancy Fullman, Jason Nguyen, Sam Rolfe, Ismaeel Yunusa, Et Al.

Faculty Publications

Background

Methods

Engaging Middle School Students And Parents/Guardians Via Structured Virtual Media On Food Allergy And Anaphylaxis Awareness: A Quality Improvement Project, Jodi Licata

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

Background and Significance: More than 40% of children with food allergies have experienced anaphylaxis, a life-threatening condition (Food Allergy Research & Education [FARE], 2021). Anaphylactic reactions require immediate treatment with an intramuscular injection of epinephrine by a health care professional or by a self-injectable epinephrine auto-injector device. If anaphylactic symptoms are not promptly recognized and treated, fatal consequences may occur (FARE, 2021). Repeated education, training, and a supportive social environment, specifically with adolescents, have been found to facilitate self-management with food-induced anaphylaxis (Comberiati et al., 2019). Purpose: In this quality improvement project, virtual education interventions to increase food allergy …