Medicine and Health Sciences Commons^™

Updates In Contemporary Management Of Singleton Pregnancies Complicated By A Short Cervix, Moti Gulersen, Vincenzo Berghella, Eran Bornstein

Department of Obstetrics and Gynecology Faculty Papers

Singleton pregnancies complicated by a short cervical length (≤25 mm) are at significantly increased risk for spontaneous preterm birth. Several treatment strategies aimed at reducing this risk and improving perinatal outcomes have been evaluated, including vaginal progesterone, cervical cerclage, and cervical pessary. This review summarizes the latest evidence regarding the efficacy of these interventions. Vaginal progesterone and/or cervical cerclage have been identified as proven evidence-based practices for preterm birth prevention and improve neonatal outcomes. Vaginal progesterone reduces the risk of preterm birth < 35 weeks by 27% (relative risk 0.73, 95% confidence interval 0.58-0.90). Cervical cerclage has been shown to reduce the risk of preterm birth < 35 weeks by 30% (relative risk 0.70, 95% confidence interval 0.55-0.89) in patients with a short cervical length and prior preterm birth. In contrast, recent data suggest that cervical pessary should no longer be considered a management option for these patients. A continued focus on individualized, evidence-based approaches remains essential to optimizing outcomes in this high-risk population.

Kid Power: Mastering Asthma Management To Keep Hospitals Away!, Kriste L. Moret

Master's Projects and Capstones

Problem: Pediatric asthma remains a leading cause of preventable hospitalizations, particularly in California’s Central Valley, where environmental and health disparities worsen symptoms. Many children are discharged without understanding their Asthma Action Plan (AAP) or feeling confident in symptom management.

Context: On a unit in a community hospital in this high-risk region, asthma-related admissions persisted. Gaps in discharge education highlighted the need for a structured intervention. The Institute for Healthcare Improvement (IHI) Model for Improvement (MFI) guided this effort.

Intervention: A nurse-led, developmentally appropriate asthma education bundle was implemented. Teaching began on admission and was reinforced using teach-back, color-coded AAPs, culturally …

Best Practices To Prevent Nurse Burnout And Reduce Turnover In The Hospital, Bernice Marie Yale

Master's Projects and Capstones

Abstract

Problem Nursing is facing a crisis in workforce well-being, and trends indicate signs and symptoms of burnout. Increasing turnover rates, emotional exhaustion, staff depersonalization, and team disengagement have resulted in a perceived toxic environment in a hospital-based microsystem.

Context A 4-month project was initiated to improve morale and communication. Several assessment tools were utilized to foster a high-performing team and reinforce principles of Watson’s theory of caring.

Interventions Optimization of required daily leader rounds to encourage patient participation, and monthly 1:1 “direct report” rounds (n=65) were conducted to assess well-being, workplace stressors, and promote job satisfaction.

Measures To improve …

Dosimetric Comparison Of Organ-At-Risk Constraints Across Multi-Resolution Levels In Eclipse Planning Optimization, Ji Hyun Jeon

Masters Projects

Background: In inverse treatment planning, the timing of applying organ-at-risk (OAR) constraints during the optimization process can influence dosimetric outcomes. This study investigates the effects of introducing OAR constraints at different stages of the multi-resolution optimization process within the Eclipse Treatment Planning System (TPS).

Purpose: To determine the optimal resolution level for applying OAR constraints that achieves the best dosimetric balance between target coverage and normal tissue sparing.

Methods: Thirteen prostate cancer treatment plans were generated using an anonymized pelvic CT dataset from The Cancer Imaging Archive. All plans were developed in GVSU Virtual Eclipse TPS using the Photon Optimizer …

Botulinum Toxin For The Treatment Of Motor Tics In Children: A Case Series, Ethan Edmondson, Mariam Hull, Sukru Aras, Mered Parnes

Faculty, Staff and Students Publications

Tic disorders, including Tourette syndrome, are characterized by brief, repetitive, and patterned movements or vocalizations. Botulinum neurotoxin (BoNT) has emerged as a therapeutic option for motor tics, particularly when oral medications are insufficient or poorly tolerated. This retrospective cohort study evaluated the safety and effectiveness of botulinum neurotoxin injections in 50 pediatric patients (aged 7-18 years) with motor tic disorders treated at a tertiary pediatric movement disorders clinic between May 2019 and January 2024. Botulinum neurotoxin injections were tailored to individual symptomatology. Overall, 64% of patients reported improvement in tic severity, 36% noted no change, and 6% worsened. Response did …

Associations Between Social Drivers Of Health And Breast Cancer Stage At Diagnosis Among U.S. Black Women, Mollie Barnard, Bo Qin, Marc Emerson, Etienne Holder, Matthew Dunn, Shromona Sarkar, Nuo Xu, Yutong Li, Christine Ambrosone, Elisa Bandera, Julie Palmer, Melissa Troester, Terry Hyslop

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

U.S. Black women have disproportionately high breast cancer mortality, partly due to later-stage diagnoses. We examined how social drivers of health (SDOH) relate to stage at diagnosis by analyzing data from 4,995 breast cancer survivors in the Black Women's Health Study, Carolina Breast Cancer Study, and Women's Circle of Health Studies. SDOH were self-reported and stage was ascertained from medical records. We used polytomous logistic regression to estimate odds ratios (ORs) for diagnosis at stages III/IV or II versus stage I (referent), adjusting for age, insurance status, and income. Meta-analyzed results indicated that underutilization of screening mammography (OR = 3.21, …

Sport Specific Postural Deviations: An Analysis Of Influence, Intervention, And Long Term Postural Health In Athletes, Thomas J. Mcguire Jr.

Doctoral Dissertations and Projects

This dissertation investigated sport-specific postural deviations in college-aged individuals aged 18–21 by comparing those who participated in a high school sport for at least four consecutive years with their non-athletic peers. The study aimed to identify prevalent postural deviations and explore their implications for long-term musculoskeletal health. Drawing from biomechanical and ergonomic literature, the study employed a quasi-experimental static-group comparison design to evaluate 60 participants (30 athletes, 30 non-athletes) using the PostureScreen mobile app. Postural deviations were measured in both the frontal and sagittal planes across four regions: head, shoulders, pelvis, and knees. Independent samples t-tests were conducted to examine …

Mental Health Provider Education On The Benefits Of Telepsychiatry To Increase Knowledge And Promote Adoption To Improve Organizational Efficiency, Standards Of Care, And Revenue Generation., Jada Eugene

Doctoral Dissertations and Projects

The study implemented an educational intervention on the benefits of telehealth among mental health providers to improve their level of knowledge and promote technology adoption to improve organizational efficiency, revenue generation, and standards of care. The clinical question was: Among mental health providers, does an educational intervention on the benefits of telehealth, compared to no education, enhance knowledge of telepsychiatry consultations and promote adoption to improve organizational efficiency, standards of care, and revenue generation? Utilizing the Iowa Model of EBP, the researcher implemented a pilot study using the quasi-experimental design. Knowledge, telehealth usability, revenue generation, and standards of care were …

Sulfated Dietary Fiber Protects Gut Microbiota From Antibiotics, Fuqing Wu, Xiaoqian Annie Yu, David Angeles-Albores, Susan E Erdman, Eric J Alm

Faculty, Staff and Student Publications

Background: Antibiotics, while essential for combating pathogens, also disrupt commensal bacteria, leading to gut microbiota imbalance and associated diseases. However, strategies to mitigate such collateral damage remain largely underexplored.

Result: In this study, we found that fucoidan, a marine polysaccharide derived from brown seaweed, provides broad-spectrum growth protection against multiple classes of antibiotics for human gut microbial isolates in vitro and for fecal communities ex vivo. This protective effect is dependent on the structural integrity, molecular weight, and sulfur content of the polysaccharide. Transcriptomic analysis showed that while fucoidan had minimal impact on baseline gene expression, it counteracted about 60% …

Development Of A Customizable Web-Based Dashboard For Remote Blood Pressure Monitoring: Feasibility And Usability Implementation Study, Joshua Wollen, Thuy Nguyen, Charles Coton, Gina Dewildt, Gabretta Cooksey, Audrey Cohen, Nicholas Hoang, Munachi Okpala, Michael Gonzalez, Mengxi Wang, Chigozirim Izeogu, Elmer Bernstam, Charles Green, Sean Savitz, Jose-Miguel Yamal, Anjail Sharrief

Faculty, Staff and Student Publications

Background: Effective blood pressure (BP) management is essential for several disease states, including secondary stroke prevention. Remote BP monitoring used in combination with an electronic data capture (EDC) system offers potential for improved BP control for patients. While such systems currently exist, there are many patient-, provider-, and system-specific challenges these systems currently do not address. In addition, such systems are rarely described transparently and comprehensively in the literature with enough detail to be reproduced by other clinicians.

Objective: This study aims to describe the development and design of a web-based EDC system tailored for remote BP monitoring and management …

Evaluating The Effectiveness Of The Comprehensive Unit-Based Safety Program In Reducing Hospital-Acquired Infections, Peta Ann Anderson

Walden Dissertations and Doctoral Studies

This doctoral project is an evaluation of a quality improvement initiative that applied a mixed method approach to evaluate the impact of the Comprehensive Unit-based Safety Program (CUSP) on hand hygiene (HH) compliance and healthcare-associated infection rates. The project was conducted in the United States of America (USA), Florida in an acute care hospital. The practice problem addressed was the persistent low adherence to HH protocols among healthcare staff, a critical issue in nursing practice due to its direct link to preventable patient harm. Quantitative data demonstrated a substantial reduction in infection rates following the implementation of the CUSP program. …

Staff Education To Improve Stroke Management Knowledge Among Medical-Surgical Emergency Department Overflow Staff Nurses, Andrea Terri Branch

Walden Dissertations and Doctoral Studies

Summary This quality improvement initiative aimed to enhance stroke knowledge through an evidence-based staff education program for medical-surgical emergency department (ED) overflow nurses. The impetus for the project stemmed from recognition of the need for enhancing prompt response and communication during acute stroke events. Variations in stroke knowledge among nursing staff contributed to delays in recognizing and responding to stroke symptoms. The practice-focused question guiding this Doctor of Nursing Practice (DNP) project addressed whether the implementation of an evidence-based stroke education program could improve nursing knowledge. The purpose of the project was to evaluate whether an evidence-based stroke education program …

Staff Education To Address Medication Noncompliance In Outpatient Behavioral Health Settings, Elmase Nicolas Toussaint

Walden Dissertations and Doctoral Studies

This quality improvement project is a staff education initiative designed to address psychotropic medication noncompliance in an outpatient behavioral health clinic setting. The project arose from the identification of a significant gap in staff knowledge and confidence related to medication adherence strategies. Medication noncompliance in psychiatric care is associated with symptom exacerbation, increased hospitalization, and poorer patient outcomes, making it a critical issue in nursing practice. The practice-focused question guiding the project was: In an outpatient behavioral health clinic setting, does implementing a structured staff education program improve staff knowledge and confidence in addressing medication noncompliance? Analytical strategies included a …

Implementation Of A Triage System For The Residents At A Residential Facility To Improve Triage Assessment Skills Of The Staff As Well As Improve The Level And Timeliness Of Care, Andrew J. Choi Rn, Neha Gopal Rn, Andres N. Padilla Rn, Dana Son

Master's Projects and Capstones

Triage is an integral part of the clinical process which involves assessing patients and determining their level of care in order to get them appropriate, timely treatment. Several countries utilize a standardized triage system with established criteria to aid staff in their decision-making during assessments (Peta et al., 2023). The Nursing and Residential Triage (NaRT) tool, from the Manchester Triage System (MTS), was shown to enhance staff clinical assessment skills and help avoid inappropriate ED transfers during a study among older adults in a residential facility (Markey et al., 2024). For this project, the main issue identified at the residential …

Enhancing Patient Safety: Fall Prevention Through Video Education, Fithawit T. Zere

Master's Projects and Capstones

Abstract

Problem: Globally, hospital falls remain a leading cause of injuries, increased costs, short and long-term disability and emotional impact on patients/families. Despite required prevention measures, a local hospital experienced rising fall rates during 2024 (n=71);13 of these occurred in the Med-telemetry microsystem. Although multiple strategies and financial investments occurred, nursing compliance with the fall prevention “bundle” remained suboptimal.

Context: Thirteen falls resulted in $182,000 in 2024. A quality improvement (QI) project was initiated over 12 weeks after routine audits revealed inconsistency in application of several components of the required bundle: particularly, the fall prevention video upon admission.

Interventions: A …

Lead Like Jesus For Healthcare - Improving The Culture Of Healing Through Biblical Leadership Training, James Michael Jones

Doctoral Dissertations and Projects

Lead Like Jesus is a 501(c)(3) ministry founded in 1999 that aims to reshape leadership through the teachings and example of Jesus Christ. The organization promotes leadership development that integrates servant leadership principles into a transformational leadership model, applying these ideas in secular settings where success is often linked to authority, control, and power. The principles behind the Lead Like Jesus movement are rooted in the Scriptural accounts of Jesus' life and teachings, emphasizing a leadership style characterized by humility, empathy, and genuine care for others. A review of offerings from professional associations, consulting firms, and other sources of leadership …

Changing Hearts And Minds: Educating Medical Students To Transform Knowledge And Attitudes Toward Organ Donation, Matilin G. Rigsby

Doctoral Dissertations and Projects

The national organ shortage is exacerbated by physicians who, contrary to federal mandates, do not refer patients with organ donation potential in a timely fashion. Whereas United States medical school curricula widely omit organ donation-related topics, literature demonstrates that educating future physicians significantly improves those students’ ability to understand and positively perceive donation, influencing their willingness to refer donor candidates. Therefore, the purpose of this study is to determine if an educational module among fourth-year medical students at Texas A&M University College of Medicine Dallas Campus affects those students’ perceived knowledge and attitudes toward organ donation. The researcher administered a …

Phenomenology Of Dissociation During (R/S)-Ketamine/(S)-Ketamine Therapy For Depression, Daniel William Cable

Doctoral Dissertations and Projects

The purpose of this study was to explore the dissociative experiences of patients who are receiving ketamine-assisted therapy for depression. This research was guided by the principles of phenomenological inquiry and focused on the subjective experiences of individuals and sought to explore the nuances of dissociative experiences and offer insight into its potential therapeutic implications.

The research used a qualitative methodology involving participants who have experienced ketamine-assisted therapy for depression. The setting was a controlled clinical environment where the therapy sessions were conducted. To collect data, open-ended, semi-structured interviews as well as follow-up interviews were conducted with the participants in …

Building Culture And Enhancing Patient Safety: A Readability Analysis Of Internal Healthcare Communications, Trevor M. Kinsey

Doctoral Dissertations and Projects

Effective internal communication is essential to creating a shared organizational safety culture, improving knowledge diffusion, and delivering high quality patient care. This study examined the readability of internal healthcare communications, including policies, procedures, and internal newsletter articles, at a mid-sized healthcare system in Michigan. Readability significantly influences cognitive load, information retention, and knowledge diffusion. Poor readability hinders these items, limiting engagement and knowledge transfer. By utilizing established readability tools, including the Flesch Reading Ease and Flesch-Kincaid Grade Level scales, this quantitative, cross-sectional study aimed to determine whether internal healthcare documents meet the readability standards recommended by the American Medical Association. …

Telepsychiatry In The Management Of Chronic Mental Illness: A Quantitative Study, Jason Andrew Lam

Doctoral Dissertations and Projects

The use of emergency departments for chronic mental illness is a growing problem and contributes to overcrowding. Preventing psychiatric patients from using an ED for their chronic mental illness is a key part of reducing this problem. Telepsychiatry allows patients to access psychiatric care from wherever it is convenient to them with shorter wait times for appointments. This study compared emergency department use between in-person and telepsychiatry utilizers to determine if one group had fewer occurrences than the other. Through an anonymous online survey, data was collected and analyzed using quantitative analysis techniques. This study concluded that patients using telepsychiatry …

The Experiences Of University Health Science Students Participating In A Short-Term Medical Mission Trip, Peggie L. Williamson

Doctoral Dissertations and Projects

The purpose of this qualitative descriptive phenomenological study was to explore the experiences of university health science students who participated in a short-term medical mission trip (STMMT). Student participation in a STMMT was generally defined as active involvement in an 8-day healthcare initiative undertaken by supervised university health science students who provided medical care and education to underserved regions. Purposeful criterion and convenience sampling were used to select ten participants from a group of university health science students registered for a STMMT to Belize in 2025. The two theories guiding this study were Husserl’s Transcendental Theory, designed to provide a …

Growth, Maturation, And Selection Of Elite Youth Ice Hockey Players, Ryan Podell

Doctoral Dissertations and Projects

Maturity status may influence the selection of elite youth ice hockey teams in the United States. Assessing biological maturity status could provide insight into the prevalence of maturation related selection biases. Thus, the purpose of this study was to establish normative maturity status ranges, determine if maturity or relative age effect selection biases existed, and compare levels of agreement between methods to predict maturity status for elite youth ice hockey players in the United States. Part one of this study assessed the biological maturity status and birth months for 126 athletes, ranging 9-16 years of age, from an elite youth …

Staff Education To Increase Staff Knowledge On Pressure Injury Prevention, Sunita Khati

Walden Dissertations and Doctoral Studies

Pressure injuries (PIs) are unfortunate events that can impact all healthcare system stakeholders. In-patient nursing units such as medical surgical (med surg) units are facing challenges in nursing practice in initiating prevention measures and reducing the incidents of hospital-acquired pressure injuries (HAPIs). The nursing staff’s lack of knowledge can lead to nursing practice issues, poor patient outcomes, and be costly. The purpose of this Doctor of Nursing Practice (DNP) staff education project was to educate nursing staff in initiating pressure injury (PI) prevention measures to avoid HAPI events in the hospital. The practice-focused question examined if providing education to med …

Falls Risk And Prevention: Improving Staff Knowledge, Ashley Vargas Delarosa

Walden Dissertations and Doctoral Studies

Objective This project aimed to enhance nursing staff knowledge and engagement in evidence-based fall prevention strategies, addressing the practice problem of inconsistent staff education and the absence of a standardized fall prevention protocol, contributing to high patient fall rates in acute care settings. Design The project employed an educational session both in-person and online. A pre- and post-test education design, utilizing knowledge assessments (pre-test and post-test) and qualitative feedback to evaluate the impact of a structured education program on nursing staff knowledge related to fall prevention. The education module focused on risk assessment tools, including the Morse Fall Scale, and …

The Impact Of Culturally Grounded Breastfeeding Programs On Black Maternal And Infant Outcomes: A Scoping Review, Kelsey B. Green

Master's Projects and Capstones

Abstract

Background: The lack of culturally grounded breastfeeding programs and understanding of their impact on Black breastfeeding initiation, duration, and health outcomes hinders improving Black breastfeeding rates in the U.S.

Research aim: This scoping review examines the impact of culturally grounded breastfeeding programs on Black mothers' and infants' health, and factors contributing to their success.

Methods: A scoping review of the literature was conducted using the CINAHL and SCOPUS databases. In the end, 34 scholarly articles were chosen for this review because they examined the impact of culturally grounded breastfeeding programs on Black breastfeeding rates and health outcomes.

Results: Culturally …

Immunomodulatory Effects Of Gold Nanoparticles: Impacts On Immune Cells And Mechanisms Of Action, Khadijeh Koushki, Prapannajeet Biswal, Geraldine Vidhya Vijay, Mahvash Sadeghi, Sajad Dehnavi, Ngoc Tuyet Tra, Sai Kumar Samala, Mahdieh Yousefi Taba, Arjun Balaji Vasan, Emily Han, Yuri Mackeyev, Sunil Krishnan

Faculty, Staff and Student Publications

Traditional anti-inflammatory medications-such as corticosteroids, biological agents, and non-steroidal anti-inflammatory drugs-are commonly employed to mitigate inflammation, despite their potential for debilitating side effects. There is a growing need for alternative next-generation therapies for symptomatic, unchecked, and/or detrimental inflammation with more favorable adverse effect profiles. The long history of use of gold salts as anti-inflammatory agents and the more recent exploration of gold nanoparticle (AuNP) formulations for clinical indications suggest that the targeted delivery of nanoparticles to inflammatory sites may be a promising approach worth investigating. Coupled with peptides that specifically target immune cells, AuNPs could potently counteract inflammation. Here, we …

Exploring Factors Affecting The Adoption And Use Of Digital Health Technologies Among Older Adults With Cancer: A Qualitative Study, Misun Hwang, Youmin Cho, Katie Gahn, Heidi Mason, Milisa Manojlovich, Yang Gong, Yun Jiang

Faculty, Staff and Student Publications

Purpose: Although digital health technologies (DHTs) are promising to improve health outcomes in older adults with cancer, the low adoption and limited use remain significant gaps in their effective digital health care. Little is known about their concerns about adopting and using DHTs in routine life, particularly in the continued use phase. This study aims to explore factors affecting the initial adoption and continued use of DHTs among older adults with cancer.

Methods: A secondary analysis of qualitative data was conducted based on interviews with 21 older adults (≥ 65 years) with breast, prostate, lung, or colorectal cancer. The transcripts …

Racial And Ethnic Disparities In Receipt Of Guideline-Concordant Pancreatic Cancer Care Among Older Adults In The United States, Joshua Herb, Kai-Ping Liao, John K Lin, Kever A Lewis, Sharon H Giordano, Matthew H G Katz, Rebecca A Snyder

Faculty, Staff and Student Publications

Purpose: Patients racialized as Black experience a higher mortality from pancreatic cancer (PC). Worse survival outcomes may relate to differences in delivered treatment. This study examined differences in receipt of guideline-concordant care (GCC) among older adults with PC according to race and ethnicity.

Methods: Patients 65 years and older with incident PC racialized as non-Hispanic White (NH-White) or racialized as NH-Black or of Hispanic ethnicity were identified in the SEER-Medicare database from 2004 to 2019. The primary outcome was receipt of stage-specific GCC. Multivariable logistic regression identified factors associated with GCC. Oaxaca-Blinder decomposition examined the contribution of measured and unmeasured …

Improving The Medication Communication Domain Of The Hospital Consumer Assessment Of Healthcare Providers And Systems Survey In A Pediatric Hospital, Bailey N. Godwin

Doctoral Dissertations and Projects

Patient education is a key responsibility of nurses. Providing education is the most effective when the teach-back method is used in combination with tangible education materials. Patient satisfaction in the pediatric setting is measured using the Child Hospital Consumer Assessment of Healthcare Providers and Systems survey (Child-HCAHPS). This evidence-based practice project aimed to improve patient/caregiver satisfaction scores for medication education on the Child-HCAHPS survey through comprehensive medication education and improved usage of patient education materials at discharge. Three pediatric units within an academic health institution in central North Carolina were identified for participation in the intervention by their managers and …

Use Of Single Bout Exercise On Symptoms Of Burnout In Secondary Teachers, Robert A. Campos

Doctoral Dissertations and Projects

Increased levels of stress, anxiety, and burnout among educators within the United States educational system have contributed to elevated attrition rates and diminished student outcomes. This study investigates the effects of single-bout exercise sessions on reducing of burnout, specifically emotional exhaustion, depersonalization, and lack of personal achievement among secondary public-school teachers. Using the Maslach Burnout Inventory – Educators Survey (MBI-ES), this correlational study used a repeated-measures design in which 36 secondary teachers participated in a control (no exercise), aerobic exercise, and anaerobic exercise sessions. Pre- and post-exercise session scores were analyzed to evaluate the immediate effects on burnout elements. Findings …