Medicine and Health Sciences Commons^™

“Teen Health” Empowers Informed Contraception Decision-Making In Adolescents And Young Adults, Christina Lepore

Yale Medicine Thesis Digital Library

Adolescents and young adults (AYAs), here defined as aged 13-25 years, face uniquechallenges in accessing sexual and reproductive health information. Interactive internet resources provide a free, private and personalized opportunity to help AYAs make informed contraception choices. We designed an original website called “Teen Health” to provide age-appropriate and evidence-based SRH education to AYAs, as well as an interactive contraception education tool (CET). We introduced “Teen Health” to AYAs in a clinical setting and observed trends in contraception preference after website exposure. We hypothesized that “Teen Health” would support informed contraception decision-making.

A convenience sample of AYAs were recruited from …

Regulation And Payment Of New Medical Technologies, Osman Waseem Moneer

Yale Medicine Thesis Digital Library

Our health care system should promote the development and useof innovative medical products, while simultaneously discouraging the marketing and adoption of unsafe or unnecessary products. In the United States, two federal agencies within the Department of Health and Human Services are responsible for administering policies directed toward these aims. The Food and Drug Administration (FDA) evaluates safety and effectiveness for market authorization of medical technologies while the Centers for Medicare & Medicaid Services (CMS) determines whether coverage is “reasonable and necessary” for its beneficiaries. Through a series of three investigations, this thesis evaluates federal policies for the regulation and payment …

The Presence Of Mood And/Or Anxiety Disorders Does Not Affect Success Of Weight Management Therapies In Metabolic Dysfunction- Associated Steatotic Liver Disease, Bryan Bollinger

Yale Medicine Thesis Digital Library

Metabolic dysfunction-associated steatotic liver disease (MASLD) and resultant steatohepatitis (MASH) have been linked to psychiatric comorbidities. The treatment of MASLD/MASH primarily relies upon weight loss, where achieving a 7% total body weight loss is recommended to improve steatohepatitis. We aimed to determine whether likelihood of achieving a 7% total body weight loss (TBWL) in MASLD/MASH patients was significantly different in the presence of a mood and/or anxiety disorder in an interdisciplinary clinic that integrates weight management and hepatology care.We conducted a single center retrospective cohort study of MASLD/MASH patients segregated into those with an ICD-10 diagnosis of a mood and/or …

The Flame, 2023-2024, Mennonite College Of Nursing

The Flame (1985-present)

The Flame is a newsletter of Illinois State University's Mennonite College of Nursing

Unveiling The Therapeutic Garden Experience For People With Schizophrenia At A Rehabilitation In North Texas, Jeevita Sai Paspuneti

Landscape Architecture Masters & Design Theses - Archive

Therapeutic gardens have numerous benefits, including pain reduction, improved attention, stress reduction, and medical reduction (Urban et al.,2018). Green spaces have been shown to improve the physical, mental, social, and emotional health and well-being of those staying in healthcare facilities (Urban et al.; Greening,2022). Since the 1980s, research studies have discussed the therapeutic benefits of landscape design at healthcare facilities and the importance of sustainable practices in high-performance landscape design. Many successful and expensive landscape projects have been designed and constructed on hospital sites using healing gardens or sustainable strategies (Kaplan et al. S., 1989). However, researchers suggest additional empirical …

Improving Heart Health In African Americans Using A Cardiovascular Disease Bundle, Loretta N. Bennam

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Cardiovascular disease (CVD) is a significant cause of mortality in the United States of America. Risk factors include abnormal low-density lipoprotein (LDL) cholesterol, physical inactivity, and unhealthy diets. African American (AA) adults have higher mortality rates from CVD than other demographics. In Houston, Texas, age-adjusted death rates for CVD per 100,000 population by race in AAs were 111, 85.0 in Whites, 62.9 in Hispanics, and 49.5 in Asians. This project evaluated the impact of using a CVD bundle over an eight-week period on cholesterol medication adherence, physical activity, and heart disease knowledge and was titled Improving Heart Health in African …

Using The 4ms Framework To Prevent Falls, Gina L. Edgeworth

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Hospital falls are rising in inpatient facilities, requiring analysis and a plan of action to address the ongoing falls. A strategy taken among facilities is implementing a 4Ms Framework that allows the nurse to address what matters to the patient and assess their mentation, medications, and mobility upon admission. With an increase in falls on a med-surg unit, it was found that there was no straightforward process for addressing the needs and concerns of patients and no assessment of medications, mobility, or mentation for those aged 65 years and older. This knowledge gap prevents nurses from providing a structured framework …

Home Blood Pressure Monitoring Bundle For Hypertension Outcomes In Adult Patients Receiving Care In Public Health Clinics, Christine Jennifer Victorian

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Hypertension (HTN) that is not adequately controlled leads to cardiovascular disease, stroke, and heart disease. It affects 116 million adults (47%) in the United States (U.S.). The HTN compliance rate in a South Texas public health clinic was 64%, below the national benchmark of 76%. Home blood pressure monitoring (HBPM) was recommended in a joint statement by the American Heart Association (AHA) and the American Medical Association (AMA). Literature evidence revealed that the HBPM bundle increased BP control (< 140/90 mmHg) compliance.

Methods: A quality improvement (QI) bundle was initiated to address the low HTN compliance rate from a quality management perspective. …

Creation Of A Structured Rapid Response Team And Early Rrt Activation, Elizabeth Amaka Azie

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Cardiac arrest, unanticipated admissions to the intensive care unit (ICU), and mortality account for about 50% of serious inpatient adverse events (Ko et al., 2020). Efforts to prevent in-hospital cardiopulmonary resuscitation (CPR) require a system to identify deteriorating patients and include an appropriate interventional response, such as a rapid response team (Andersen et al., 2019). A well-structured rapid response team (RRT) has five categories that include team structure, organizational culture, expertise, communication, and teamwork (Jackson, 2017). A community hospital in Texas has been challenged in its attempts to have a well-structured RRT and had an increase in cardiac arrest. A …

Implementing A Cardiovascular Bundle For Hypertension In Black Adults 18 Years And Older, Florence I. Chinwuba Dnp

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Hypertension (HTN) occurs in all ethnicities in the United States, but the prevalence in Black adults is disproportionate due to unhealthy dietary patterns and physical inactivity lifestyle behavior. This quality improvement strategic effort strived to educate Black adults on HTN to curb the health disparity. The quality improvement project focused on using a Dietary Approaches to Stop Hypertension (DASH) diet and physical exercise to reduce blood pressure in Black adults 18 years and older with hypertension. A one-group pre-test-post-test design was used in this project. The Plan-Do-Study-Act framework was utilized. The program was eight weeks in duration. All the participants …

Impact Of A Discharge Bundle On Boarding Hours In Acute Care Hospitals, Monica L. Herrera

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

The national epidemic of boarding hours in the emergency departments prompted the implementation of a discharge bundle in an acute care hospital. This bundle included an ADT nurse, discharge orders written prior to 11AM, and EVS shifting employee hours. Initial findings indicated a reduction in boarding time by 126 minutes.

Clinical Practice Guideline For The Management Of Depression In Primary Care, Estrella Catherine Villarreal

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: The prevalence of depression poses a significant challenge in primary care, emphasizing the urgent need to address this issue during patient visits. Primary care providers are at the forefront of managing depression, yet they encounter difficulties in screening, diagnosing, assessing, and treating this complex condition. Clinical guidelines serve as valuable tools for primary care providers and practices, offering support in identifying and addressing depression effectively. An evidence-based approach to treating depression in primary care, with a focus on collaborative interventions with behavioral health to enhance depression management for American Indian/Alaskan Native (AI/AN) communities.

Methods: The descriptive analysis was conducted …

Using The Electronic Medical Record To Improve Nurse Workload, Sharon C. Le Roux

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background

Equitable nurse-patient assignments have been associated with improved nurse well-being, patient satisfaction and outcomes. Despite this, in an academic medical center in the southwestern United States, there is no standardized process to create equitable nurse-patient assignments.

Objectives

The aim of this project was to improve inpatient oncology nurse well-being and satisfaction through the implementation of an EMR based nurse-patient assignment tool.

Methods

The IOWA Model-Revised for evidence-based practice was used as the basis for this project. Data collected included demographics, the Well-Being Index Survey, perception of satisfaction with manual workload tool, along with knowledge and use of the …

Intravenous Contrast Extravasations Of Ct Contrast Media Prevention Bundle, Shakerra T. Brown

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Contrast extravasations pose significant risks during intravenous contrast media imaging procedures, with potential adverse outcomes ranging from minor skin irritation to severe tissue necrosis. Despite technological advancements and procedural safeguards, contrast extravasations remain a concern in healthcare settings. A comprehensive needs assessment at our institution revealed a notable incidence of contrast extravasations, highlighting the need for targeted interventions to mitigate risk and enhance patient safety. This project aims to explore the complexities of contrast extravasations, examining contributing factors, associated complications, and current prevention and management strategies to inform evidence-based practices and improve patient outcomes. This Doctor of Nursing Practice (DNP) …

Guideline For Creating A Support Group For Adults With Down Syndrome Who Suffer With Prolonged Grief, Brandon Chace Warman

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Adults with Down syndrome process and express their grief differently from the general population. There are a multitude of support groups and organizations for individuals grieving a loss and experiencing prolonged grief but there are none that exist for people with Down syndrome. This project develops a guideline for creating support groups aimed at adults with Down syndrome who experience prolonged grief. Fifty-one pieces of literature from all over the world were reviewed to formulate recommendations that were graded by seven stakeholders. These recommendations were then used to develop a guideline for creating support groups for this population. Analysis of …

Chronic Kidney Disease Nutritional Management: Developing A Guideline, Benjamin L. Wallace

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

The global prevalence and incidence of those with chronic kidney disease (CKD) are unknown. Thirty-seven million adults are estimated to have CKD and need nutritional assessment, education, and management to prevent further kidney damage and mortality (Centers for Disease Control and Prevention, 2022; United States Renal Data System, 2022). Maintaining the nutritional requirements for CKD is listed as a global concern in the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Nutrition in CKD 2020 (Ikizler et al., 2020). After a review of more than 50 publications, five recommendations were developed and proposed. A team of multidisciplinary stakeholders, …

Implementation Of Prognosticator Algorithm For Initiation Of Serious Illness Discussions And Improving The Rate Of Palliative And Hospice Referrals, Joy Isebor

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Context: Early serious illness conversations related to end-of-life and goals of care with seriously ill patients have been associated with improving patients' outcomes and quality of care (Bernacki et al., 2015). However, initiating these serious illness discussions has been challenging in the home-based primary care setting.

Objectives: To train and support home-based primary care clinicians in integrating best practices in serious illness discussions and decision-making engagement among patients sixty-five and older with serious illnesses, optimize the alignment between patient goals and the medical care they receive, improving their quality of life and the rate of palliative care and hospice referrals. …

Guideline For Screening Of Trichomonas Vaginalis Infections In The Correctional Setting, Nahirobi J. Madrid Antunez

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Objective: This guideline project focused on creating a screening guideline for T. vaginalis that would benefit healthcare providers in a correctional healthcare setting for incarcerated females entering the facility.

Methods: A literature review was conducted. The PubMed and MEDLINE search engines, were used to obtain medical, biomedical and life sciences literature, and CINAHL for nursing and allied health resources, Governmental agency sites, such as the Centers for Disease Control and Prevention (CDC), were also explored. Guideline recommendations were extrapolated from the literature review, and then rated by, stakeholders.

Results: Several overarching themes were identified. Screening of asymptomatic women for T. …

Obesity Management Guideline For The Correctional Setting, Rumi Y. Sato

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Obesity can cause multiple chronic conditions, including cancer and death. Los Angeles jail primary care clinics do not address obesity management despite health hazards, rising costs, and high obesity rates in correctional facilities. The Centers for Medicare and Medical Services (CMS) obesity-management guidelines are over ten years old and outdated. The aim of this Doctor of Nursing Practice (DNP) project was to update the CMS obesity-management guideline with the newest intense behavioral therapy (IBT) evidence to assist the correctional multidisciplinary healthcare team. This project took place in a Los Angeles correctional facility's primary care clinic. A detailed literature review gathered …

Guideline To Decrease Nursing Turnover In Intensive Care Units, Carol L. Mention

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Turnover rates of registered nurses working in intensive care units continue to increase significantly after the pandemic. Many nurses have left the profession due to the increased workload and stress during and after the COVID-19 pandemic. Having staffing challenges and turnover can affect the outcome of this patient population. Intensive care nurses experience workplace violence at an increasing volume. Also, robust nurse onboarding and training programs can help decrease turnover rates. The current national guideline does not address these concerns about nursing turnover. A guideline project was performed to identify needed recommendations based on evidence for stakeholders to …

Bundle For Left Ventricular Assist Device (Lvad) In The Ed, Tina Morris

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Purpose

Left Ventricular Assist Device (LVAD) is a high-risk, low-volume patient population with admission rates of up to 72%. The purpose of this study was to provide a care bundle to increase the knowledge of the emergency department (ED) staff and decrease the door to consult times to the advanced heart failure (AHF) team for LVAD patients presenting to the ED at a level I trauma center in Texas.

Methods

In collaboration with emergency clinical staff, the project team implemented a bundle that included a pathway for the LVAD patients upon presentation to the ED, targeted education for clinical staff …

Developing Toolkit For Adults With Autism Spectrum Disorder In An Oncology Outpatient Clinic, Brittany J. Johnson Dnp, Fnp-C

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Autistic adults are at higher risk of being diagnosed with co-occurring health conditions, and yet they are a vulnerable group for disparities in access and outcomes. One of the key barriers to better outcomes is poor patient-provider communication. This study the use of AASPIRE’s AHAT communication toolkit as a channel between healthcare workers and autistic adults to facilitate their appointments within the outpatient oncology department, as well as assessing healthcare providers’ knowledge and self-efficacy in caring for the patients. Sixteen healthcare providers (12 registered nurses and four patient care assistants) completed pre and post intervention surveys and utilized the AHAT …

Glutamate Optimization As A Treatment For Depression: A Clinical Guideline, Luisa Angeles Collins Villares

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Based on the use of drugs to treat hypertension and tuberculosis for depression, the monoamine hypothesis led to the development of antidepressants in 1952. Serotonin was recognized as a deficiency associated with depression in 1967. As a fine-tuning orchestration of neurotransmitters and neuromodulators, the glutamate system became known using Spravato in 2019 and Auvelity in 2022. In this pilot study, mental health experts rated the importance of 24 science-based recommendations to optimize glutamatergic therapy in depression for a proposed guideline on a Likert scale from zero to four. The results were analyzed using a non-parametric predictive modeling method called Chi-Square …

Biomechanics, Strength, And Physical Function After Surgical Repair Of Rotational Ankle Fractures, Benjamin Brightwell

Theses and Dissertations--Kinesiology and Health Promotion

Ankle Fractures account for approximately 9% of all lower extremity fractures and incidence continues to rise. Up to 53% of ankle fractures require surgical intervention. Impaired physical function is one of the most reported and observed lasting effects of surgically repaired ankle fractures. Additionally, limited physical capacity and function have been identified as the primary threats to health-related quality of life after surgical repair of ankle fractures. These impairments to physical capacity and functionality can last longer than 5 years after surgery. Since surgery typically successfully restores stability and congruency of the talocrural joint, these poor long-term outcomes are an …

Understanding Intention And Behavior Of Practicing Yoga Through The Lens Of Theory Of Planned Behavior Specifically In Rural Communities; A Qualitative Study, Shelley Meyer

Theses and Dissertations--Kinesiology and Health Promotion

While there are known health benefits for participating in yoga, little has been studied on the intention and behavior for why individuals practice yoga especially through a theoretical lens and intense qualitative thematic analysis. Targeting the rural community considers other extenuating circumstances experienced by rural residents that can impact yoga participation in rural areas. Interviews were used to gain insight into a holistic viewpoint with the rich data bringing clarity to an individual’s thought process (of intention) to incorporate yoga (behavior) in their daily life. Utilizing the Theory of Planned Behavior as the theoretical framework for developing interview questions allowed …

Development Of Iron Oxide Nanozyme For Cancer Therapy, Zhongchao Yi

Theses and Dissertations--Biomedical Engineering

Cancer therapies that leverage reactive oxygen species (ROS) have shown potential for cancer inhibition due to their ability to induce oxidative stress in tumor cells. Iron oxide nanoparticles (IONPs) have garnered significant attention as a promising platform for ROS-dependent disease treatment, owing to their remarkable biocompatibility and Fenton catalytic activity. However, the low catalytic activity of IONPs has been a major hurdle in their clinical translation. To overcome this challenge, IONPs of different compositions are examined for their Fenton reaction under pharmacologically relevant conditions in this work. The results show that wüstite (Fe_1-xO) nanoparticles exhibit higher catalytic activity …

Modulating The Mtor Pathway Using Inducible Retrogradely Transported Aavs As A Novel Approach To Improve Motor Recovery In Spinal Cord Injury, Christopher Bosse-Joseph

Theses and Dissertations--Medical Sciences

Spinal cord injury poses multiple regeneration barriers, including neuronal-intrinsic and extrinsic factors. Overcoming these barriers has stood as a longstanding challenge in neuroscience. A well-studied mechanism to promote spinal cord regeneration and locomotor recovery is activating the PI3K/mTOR pathway by knocking out phosphatase and tensin homolog protein (PTEN). PTEN knockout (PTEN-KO) studies have traditionally used adeno-associated virus (AAV) viral vectors to improve functional recovery. The use of traditional AAV serotypes to induce PTEN-KO has shown promise to improve functional recovery in rodent models; however, these approaches show significant limitations for translational utility. Firstly, the use of traditional AAV serotypes to …

The Role Of Intracellular Growth During The Systemic Spread Of Listeria Monocytogenes, Jamila S. Tucker

Theses and Dissertations--Microbiology, Immunology, and Molecular Genetics

Listeria monocytogenes is a facultative intracellular pathogen transmitted through the consumption of contaminated food products. Typically, infections range from mild, self-limiting gastroenteritis to life-threatening systemic infections; however, the events that occur in the gut to allow for this spread are unclear.

The focus of my thesis aims to determine how L. monocytogenes escape the mesenteric lymph nodes (MLN), the final barrier to systemic spread for both commensal and pathogenic bacteria in the gut. I have shown that intracellular replication of L. monocytogenes in an as-yet-unidentified cell type is essential for the colonization and dissemination of the bacteria from the MLN. …

The Effect Of Estrogen And A Mitochondrial Uncoupling Prodrug On Traumatic Brain Injury-Induced Dysfunction In Mice., Olivia J. Kalimon

Theses and Dissertations--Neuroscience

A large percent of both clinical and pre-clinical traumatic brain injury (TBI) studies report better outcomes females after severe injury compared to males. Mitochondrial dysfunction is a well-characterized driver of secondary injury and an attractive neurotherapeutic target; though, there is limited research available on mitochondrial dysfunction in females. However, a few studies have shown total mitochondria from the cortex of females appear protected from TBI-induced bioenergetic dysfunction. These results were replicated in these studies so further characterization was performed. Additionally, protein expression of some oxidative phosphorylation (OXPHOS) complexes were elevated in the uninjured cortex of females relative to uninjured males, …

Contributions Of The Replication Initiator Protein Dnaa To Physiology And Virulence Of The Lyme Disease Spirochete, Andrew Krusenstjerna

Theses and Dissertations--Microbiology, Immunology, and Molecular Genetics

Borrelia burgdorferi, the etiological agent of Lyme disease, is the most prevalent vector-borne disease in the United States. The spirochetal population is naturally maintained by consistently cycling between Ixodid ticks and small vertebrates. To survive within these diverse niches, B. burgdorferi has evolved a unique physiology and regulatory network to sense and respond to environmental fluxes. Replication is a hallmark of the Lyme spirochete’s enzootic life cycle, specifically at the nymphal tick-to-vertebrate interface. The mechanisms and regulatory schema for the basic cellular processes in B. burgdorferi, or indeed any member of the phylum spirochaetota, are largely unknown. The central hypothesis …