Medicine and Health Sciences Commons^™

Decreasing Burdensome Transitions In Hospice Care By Increasing Nursing Visits, Kristin S. Rivers

Doctor of Nursing Practice Projects

Background: Burdensome transitions occur when hospice patients discontinue hospice services to seek hospital treatment, often disrupting end-of-life goals and creating distress for patients and caregivers. These transitions continue to rise throughout the country, highlighting the need for strategies to support patients in remaining at home throughout the dying process.

Purpose: This quality improvement project aimed to decrease hospital transitions by increasing nursing visits for hospice patients at high-risk for burdensome transitions.

Project Design: This quality improvement project used a Plan-Do-Study-Act methodology to form and implement an intervention to reduce burdensome transitions. Patients were already identified as low or high-risk …

The Neurophysiological Basis Of Cognitive Impairment And Brain Fog In Migraine: A Literature Review, Manny Edward Campos

MEDI 9331 Scholarly Activities Clinical Years

Migraine is a prevalent neurological disorder characterized by recurrent headaches and a range of neurological symptoms. This review examines the neurophysiological mechanisms linking migraine pathophysiology to cognitive impairment and the subjective experience of brain fog. The review synthesizes findings from neuroimaging, electrophysiology, and experimental models. Key mechanisms, including cortical spreading depression, neuroinflammation, neurotransmitter imbalances, and hemodynamic alteration,s are discussed. The review identifies the neuroanatomical structures and networks involved and describes the patterns of cognitive change observed across the migraine spectrum. Cognitive impairment and brain fog are significant aspects of migraine, extending beyond the headache phase. A distributed network of brain …

Measures Of Muscle Strength, Rate Of Force Development, And Fatiguability Across The Menstrual Cycle, Cassidy Wisler

All NMU Master's Theses

BACKGROUND: Hormone fluctuations and inconsistencies across the menstrual cycle paired with a shortage of literature on female physiology in exercise have made understanding on female exercise performance troublesome. Performance-based research has fallen behind and the increase in women participation and current evidence does not warrant general guidance on modulating specific exercise across the menstrual cycle. PURPOSE: The purpose of this study was to determine the effects of estrogen and progesterone on muscle strength, rate of force development, and fatiguability. METHODS: Nineteen recreationally active and eumenorrheic females (25.3 ± 5.8 yrs, 73.4 ± 12.2 kgs) volunteered to participate in the study. …

The Effect Of Ischemic Preconditioning On Rock Climbing Performance, Jordan Fleury

All NMU Master's Theses

Rock climbing involves isometric contractions of the finger flexors, limiting forearm blood flow and causing ischemia-induced fatigue. Ischemic preconditioning (IPC) has been shown to improve time to failure (TTF) during climbing-specific tasks, though its mechanisms remain unclear. The purpose of this study was to assess the effects of IPC on hemodynamics and muscle oxygenation during a finger flexor endurance test. This study assessed the effects of IPC on TTF, brachial artery blood flow (BF), vessel diameter (VD), and tissue saturation index (TSI). Variables were measured before (BL1) and after intervention (BL2), and throughout a finger-flexor fatiguing task (FT), including TSI …

Quality Of Life Outcomes Following Total Temporomandibular Joint Replacement: A Systematic Review Of Long-Term Efficacy, Functional Improvements, And Complication Rates Across Prosthesis Types, Luis Eduardo Almeida, Samuel Zammuto, Louis G. Mercuri

School of Dentistry Faculty Research and Publications

Introduction:

Total temporomandibular joint replacement (TMJR) is a well-established surgical solution for patients with severe TMJ disorders. It aims to relieve chronic pain, restore jaw mobility, and significantly enhance quality of life. This systematic review evaluates QoL outcomes following TMJR, analyzes complication profiles, compares custom versus stock prostheses, explores pediatric applications, and highlights technological innovations shaping the future of TMJ reconstruction.

Methods:

A systematic search of PubMed, Embase, and the Cochrane Library was conducted throughout April 2025 in accordance with PRISMA 2020 guidelines. Sixty-four studies were included, comprising 2387 patients. Results: Primary outcomes assessed were QoL improvement, pain reduction, and …

Preventing Hospital-Acquired Pressure Injuries Using Turn Teams And Verbal Reminders, Joyce O. Blaboe

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Hospital-acquired pressure injuries (HAPIs) are a preventable, yet persistent issue in healthcare, particularly in the pulmonary and infectious disease unit of a Northeastern U.S. hospital. HAPIs prolong hospital stays, increase healthcare costs, and pose potential legal risks. Despite implementing evidence-based protocols, including the leaf patient monitoring system, the hospital reported six avoidable HAPIs cases in the early fiscal year 2025.

Aim: The quality improvement (QI) project aimed to reduce HAPIs incidents by 10% within 12 weeks by introducing turn teams and verbal reminders to enhance existing protocols.

Evidence Review: Regular turning and repositioning are essential to HAPIs prevention. Additionally, …

Patient-Centered Approach To Decrease Length Of Stay, Erika Beck

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Unmet social needs contribute to hospital readmissions and extended inpatient stays, placing strain on care coordination and hospital throughput. Social Determinants of Health (SDOH), such as housing instability, lack of transportation, or food insecurity, are often unaddressed in clinical workflows. At the project site, a gap in effectively integrating SDOH into the discharge planning process led to delayed discharges and increased length of stay (LOS). Additionally, 41.20% exceeded the Geometric Mean Length of Stay (GMLOS), surpassing the organizational benchmark of 40.17%. Gaps in standardized assessment and communication of SDOH data limited the ability to plan timely discharges and connect …

Enhancing Diabetes Care In Adult Patients With Type 2 Diabetes In An Outpatient Setting, Osayanmo Ojo

All Doctor of Nursing Practice (DNP) Scholarly Projects

Type 2 diabetes mellitus (T2DM) is a prevalent chronic condition associated with significant morbidity, particularly among underserved populations. This Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to improve diabetes care among adult patients with poorly controlled T2DM (A1C > 9%) in an outpatient primary care clinic by increasing referrals to the Diabetes Self-Management Education (DSME) program. Guided by the Plan-Do-Study-Act (PDSA) cycle and the OhioHealth Change Management (OHCM) model, the project implemented structured interventions including standardized DSME referral workflows, electronic health record (EHR) prompts, provider education, and culturally tailored communication strategies.

The 12-week initiative targeted 68 eligible patients. …

Implementing A Fast-Track Pathway For Low Acuity Patients To Reduce Patient Length Of Stay In The Emergency Department, Dawnyel Donaldson

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Overcrowding and prolonged wait times in emergency departments (ED) negatively affect patient safety, outcomes, and satisfaction. Hospital A, a Level 1 trauma center with over 52,000 annual ED visits, consistently exceeded the national ED length of stay (EDLOS) benchmark of 6 hours, averaging 6.7 hours, with left without being seen (LWBS) rates at 2.89%, surpassing the 2% target. Low-acuity Emergency Severity Index (ESI) level 4 and 5 patients contributed to congestion due to inefficient triage processes and lack of alternative care pathways, delaying timely access to care.

Aim of the Project: The project aimed to implement an evidence-based fast-track …

Optimizing Transfer Classification: Enhancing Accuracy And Reducing Readmission Rate Penalties For Cardiovascular Care In Short-Term Rehab, Aeshia Hicks

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: In a short-term rehabilitation (STR) setting, misclassification of planned hospital transfers as unplanned readmissions among elderly cardiovascular patients inflated CMS-reported readmission rates, distorted performance metrics, and led to financial penalties under the Hospital Readmissions Reduction Program (HRRP). A gap analysis revealed a 14% misclassification rate, significantly higher than the CMS benchmark of 8.65%, which was attributed to inconsistent documentation and a lack of standardized classification criteria.

Aim of the Project: To reduce transfer misclassification by 20% through the implementation of a standardized electronic health record (EHR) template and targeted staff education, thereby improving CMS compliance and documentation integrity in …

The Impact Of A Nurse Navigator On The Completion Of Medicare Annual Wellness Visits, Nanette L. Snyder

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Despite being a covered service designed to support individualized prevention planning, the Medicare Annual Wellness Visit (MAWV) remains underutilized at a rural Federally Qualified Health Center (FQHC). Barriers include low patient awareness, inconsistent outreach, and a reactive scheduling process that excludes patients without upcoming appointments. These issues limit the FQHC’s ability to meet preventive care goals and sustain performance in value-based reimbursement models.

Aim of the Project: This quality improvement project evaluates the impact of implementing a nurse navigator on MAWV completion. The intervention incorporates proactive scheduling and cohort engagement to address barriers related to awareness, access, and outreach. …

Evidence-Based Pain Management Bundle For Pediatric Postoperative Orthopedic Patients, Samantha Firmstone

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Postoperative pain management in pediatric orthopedic patients is often inconsistent due to variability in provider practices and a lack of standardized protocols. At a Central Texas pediatric orthopedic clinic, all patients received opioid prescriptions post-knee surgery regardless of procedure severity, leading to frequent caregiver calls for clarification. This practice revealed a critical gap in preoperative education and multimodal pain management strategies, contributing to patient safety concerns and increased clinic workload.

Aim of the Project: The primary aim of the project was to improve pain control, reduce opioid reliance, and decrease postoperative pain-related follow-up calls by implementing a standardized, evidence-based …

Improving Hospital Throughput Through Flash Rounds And Standardized Discharge Readiness Assessments, Erin D. Dobda

All Doctor of Nursing Practice (DNP) Scholarly Projects

• Problem: The target hospital faced serious throughput challenges, with emergency department overcrowding and discharge inefficiencies impacting patient outcomes and organizational performance. Discharge order to depart times exceeded the 90-minute benchmark, averaging 154 minutes, while 41.2% of patients exceeded the geometric mean length of stay (GMLOS) target of 40.17%. Gaps included inconsistent discharge planning, poor communication, and limited follow-through on barriers.
• Aim of the Project: The project aimed to improve hospital throughput by reducing GMLOS and discharge order to depart times on Unit A. This was achieved through implementation of proactive, evidence-based interventions to streamline discharges, reduce delays, and support safe …

Implementing The Patient Health Questionnaire-2 To Improve Referral Rates To Mental Healthcare Through Routine Depression Screening, Kelly Murakata

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Primary care settings often encounter patients with depression symptoms, characterized by feelings of sadness, lack of interest in activities, and functional impairment, impacting quality of life. At the project site, the PHQ-9 was only used during annual or new patient visits, resulting in low screening rates of 12% and a 33% referral rate. The lack of routine screening led to missed opportunities for mental health referrals and detection of depression.

Aim of the Project: The aim of the project was to increase mental health referral rates through early identification of depression symptoms by implementing routine PHQ-2 screens.

Review of …

Improving Depression Screening For Young Adults In Outpatient Settings, Addie Smith

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Depression among young adults aged 25 to 35 years in the United States has been among the second highest at 19.9%. Depression underdiagnosis stems from many patient-level causes, including a lack of standardized screening, inadequate provider education, and stigma of mental illness. Untreated depression results in low quality of life, comorbidities, suicidality, and socioeconomic issues.

Aim of the Project: The aim of this project was to address the gap in practice by implementing a standardized screening process for young adults to enhance diagnoses and increase screening rates.

Review of the Evidence: A comprehensive review of the evidence …

Improving Colorectal Cancer Screening Referrals In A Rural Health Clinic, Kysha Mcbee

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Colorectal cancer is the second leading cause of cancer death in the United States. Preventive screening for colorectal cancer has been associated with early detection and improved 5-year survival rates. The referral rates for colorectal cancer screening at the practicum site were 17.7%, well below the national benchmarks of 71.8%.

Aim of the Project: The aim of this project was to increase the screening referral rates in adults aged 45 to 75 years by 50% over a ten-week period by implementing an evidence-based toolkit.

Review of the Evidence: Literature review highlighted barriers to colorectal cancer screening, such as knowledge …

Optimizing Pressure Injury Prevention: Implementation Of The Sskin Bundle In Acute Care, Joycelyn Mccall

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Hospital-acquired pressure injuries (HAPIs) contribute to increased morbidity, extended hospitals stay, and significant healthcare costs. At the project site in northwest, Indiana, HAPI rates averaged 6.29%, which significantly higher than the national benchmark of 2.24%. Inconsistencies in documentation, a lack of standardized preventive practices, and variable staff engagement contributed to these increased rates. Despite the use of the Braden Scale, staff inconsistently implemented preventive interventions.

Aim of the Project: The aim of the project is to reduce HAPI incidence by 30% over 10 weeks by implementing the surface, skin inspection, keep moving, incontinence/moisture management, and nutrition (SSKIN) bundle and …

Reducing Emergency Department Length Of Stay, Chelsea Zigan

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Rising Emergency Department (ED) volumes and Registered Nurse (RN) shortages have led to overcrowding, delayed care, and inefficiencies. In 2023, patient visits exceeded budget projections by 14% for six months. From July to December 2024, discharged patients’ average ED length of stay (LOS) exceeded the three-hour target by over one hour, left without being seen (LWOBS) rates surpassed the 1% benchmark for five months, and diversion hours increased, restricting ambulance admissions. These issues strained nursing resources, reduced care quality, and heightened risks of complications and financial losses, emphasizing the need for a redesigned care model to optimize staff roles …

Improving Medication Nonadherence In Clients With Attention Deficit Hyperactivity Disorder Using Medication Reminder Applications, Christian Durand

All Doctor of Nursing Practice (DNP) Scholarly Projects

At an outpatient clinic in Southern California, a 77% medication adherence rate was observed in August 2024 among clients with ADHD. Medication nonadherence in ADHD clients may result in difficulty reaching therapeutic levels, leading to adverse outcomes, such as family disruptions, substance addiction, injuries, criminal occurrences, and even suicide. The project aims to reduce the number of ADHD clients who are noncompliant with their medications and surpass the national benchmark of 80% medication adherence. Evidence has suggested that MRAs may improve medication nonadherence among ADHD clients. Current research has supported the use of MRAs for various chronic diseases including diabetes …

Implementing An Evidence-Based Transitional Care Toolkit To Reduce Postpartum Readmissions In Women With Chronic Conditions, Cassidy La Fleur

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Postpartum women with preexisting chronic conditions are at increased risk of hospital readmissions due to fragmented care transitions and poor follow-up adherence. At the project site, the 30-day postpartum readmission rate was 10%, exceeding the national benchmark of 7.15%. Gaps in standardized discharge planning and limited patient engagement were identified as contributing factors.

Aim of the Project: The aim of this quality improvement (QI) project was to reduce 30-day postpartum readmissions in women with chronic health conditions by implementing an evidence-based transitional care toolkit within a women’s outpatient clinic.

Review of the Evidence: Evidence supports the use of structured, …

Improving Provider Documentation For Procedure Authorizations: A Nursing Perspective On Enhancing Outcomes And Compliance, Juli Legg

All Doctor of Nursing Practice (DNP) Scholarly Projects

Insurance denials resulting from non-standardized documentation and communication gaps in the prior authorization process adversely impacted financial performance and patient care within the electrophysiology (EP) department of a large Midwest academic medical center. High denial rates for costly procedures revealed a need for improved alignment with payer medical necessity criteria. This quality improvement (QI) project aimed to enhance provider documentation, reduce denials, improve care delivery, and increase revenue by implementing standardized documentation templates. A review of the literature supports that standardized documentation and clinical decision support tools enhance consistency, reduce errors, and improve prior authorization success rates. Guided by the …

Integrating Kangaroo Care Into Cesarean Delivery Practices: A Pathway To Enhanced Health Outcomes, Julia Swords

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Cesarean deliveries often interrupt early mother-infant bonding, delaying the initiation of breastfeeding and limiting opportunities for skin-to-skin contact. Despite national guidelines promoting immediate postpartum contact, cesarean-born infants receive kangaroo care (KC) at significantly lower rates than those born vaginally. Prior to this project, only 2% of cesarean births at the project site received KC, highlighting a significant gap in care delivery.

Aim of the Project: The aim was to evaluate the feasibility and impact of implementing kangaroo care during cesarean deliveries in a community hospital to improve neonatal outcomes and adherence to evidence-based postpartum practices.

Review of the Evidence: …

Preventing 30-Day Rehospitalization In Congestive Heart Failure Utilizing Transitional Care Teams, Esther Baminrin

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Congestive Heart Failure (CHF) continues to be a prevalent and challenging health issue, contributing significantly to hospital readmissions within the first 30 days of patients transitioning to home health care. Rehospitalization affects the patient's quality of life and the agency's revenue, as reimbursements are paused when patients are hospitalized during the first 30 days of admission to a home health agency. The agency experienced a 22% rehospitalization rate within a year, slightly higher than the national average of 10%.

Aim of the Project: The primary objective of this project was to decrease rehospitalization of patients with CHF within the …

Fall Prevention In Long-Term Care, Steven Zissler

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls among older adults residing in long-term care facilities continue to rise, resulting in injuries that contribute to adverse outcomes, a reduced quality of life, and increased healthcare costs. Despite existing safety interventions, falls persist, indicating a gap in effective, sustainable fall prevention strategies. Repeated failures to reduce falls among adults aged 65 years and older highlight the need for a structured, evidence-based approach aimed at addressing this critical patient safety issue.

Aim of the Project: The aim of this project was to reduce falls and fall-related injuries by 25% for older adults residing in a long-term care facility …

Reducing Catheter-Associated Urinary Tract Infections In The Intensive Care Unit, Rosa Shiffman

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Catheter-associated urinary tract infections (CAUTIs) remain among the most common healthcare-associated infections in intensive care units (ICUs), contributing to increased morbidity, prolonged hospital stays, and elevated healthcare costs. Despite established prevention guidelines, inconsistent practices in catheter removal and gaps in daily necessity reviews persist. At the project site’s 24-bed ICU, the CAUTI rate was 1.9 per 1000 catheter days, which exceeds the national benchmark of 1.0. Gaps in consistent assessment of necessity and delays in removal contributed to an elevated infection risk.

Aim of the Project: This project aimed to reduce CAUTI rates in the ICU through evidence-based interventions …

Effect Of Standardized Phone Call Protocol On The Achievement Of Target Hba1c Levels, Felicia Choyce

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

Type 2 Diabetes Mellitus is a common chronic illness with far-reaching health and financial consequences. At the project’s primary care clinic, the average hemoglobin A1c among adults with Type 2 Diabetes Mellitus was 9.6%, exceeding the recommended clinical goal of less than 7% (American Diabetes Association, 2023). The absence of a standardized follow-up protocol and inconsistent use of health literacy-based communication contributed to persistent hyperglycemia and failure to reach target HbA1c levels. These factors indicated an urgent need for an evidence-based intervention.

Aim of the Project:
The aim of this project was to reduce HbA1c levels among adults with …

Persistent Imbalance: Women’S Representation In North American Pediatric Cardiology Leadership Roles.Persistent Imbalance: Women’S Representation In North American Pediatric Cardiology Leadership Roles, Alaina K. Kipps, Audrey C. Marshall, Neha Bansal, Holly Bauser-Heaton, Nadine Choueiter, Devyani Chowdhury, Aarti Dalal, Molly Ehrlich, Lindsay R. Freud, Supriya S. Jain, Pei-Ni Jone, Kristin Laraja, Dalia Lopez-Colon, Sonal T. Owens, Christina Ronai, Ritu Sachdeva, Corey Stiver, Nicole Sutton, Terrie Vasilopoulos, Jennifer Co-Vu

Department of Pediatrics Faculty Papers

BACKGROUND: Despite recent gender parity of physicians entering pediatric cardiology, representation of women leaders lags their male colleagues.

OBJECTIVES: We sought to better understand the variation in women in leadership roles in pediatric cardiology.

METHODS: The gender of physicians in 16 prespecified leadership positions was collected by survey between July 2022 and January 2023 from pediatric cardiology programs with >5 cardiologists in North America. We analyzed the association of women leaders with center size (based on surgical volume), geographic region, presence of categorical fellowship program, and gender of division chief and department chair.

RESULTS: Across 99 centers, a median of …

Characterization Of Lactobacilli-Containing Catheter Segments Developed By Using Selective Laser Sintered Mold., Caden Maners

Master of Engineering Theses

Catheter-associated urinary tract infections (CAUTIs) are a major healthcare burden with current prevention strategies offering limited success. This study presents a novel, self-coating biomaterial approach using a silicone-based bioink embedded with thermally sensitive probiotic strains (L. crispatus, L. rhamnosus, and L. reuteri). Catheter segments were fabricated via bio-injection molding using 3D-printed CAD molds. These Lactobacilli, selected for their probiotic and antimicrobial potential, serve as a non- antibiotic strategy to reduce infection risk. These segments were evaluated for mechanical strength (Shore A hardness), thermal stability (TGA/DSC), porosity and bacterial presence (SEM), biofilm formation (crystal-violet assay), as well as mass retention in …

Dsk2-Mediated Degradation Of F-Box Protein Lao1 And Class I Tcps Modulates The Nitrogen Starvation Response, Yuanyuan Li, Shuyang Cheng, Xu Jin, Ruoxuan Wu, Yiyi Guo, Dezhi Wu, Jie Dong

Publications

Plants have evolved intricate strategies to cope with various abiotic stresses. Ubiquitin-mediated protein degradation plays a key role in plant development as well as abiotic stress tolerance. In this study, we identify LAO1, an F-box protein with unknown function, as a negative regulator of plant fitness during nitrogen starvation. DOMINANT SUPPRESSOR OF KAR 2 (DSK2) interacts with and mediates the autophagic degradation of LAO1 protein during nitrogen starvation. The loss of LAO1 improves the fitness of an autophagy-deficient mutant, atg5-1, under nitrogen starvation. Intriguingly, mutations in DSK2 facilitate rather than reduce plant growth after nitrogen starvation. This unexpected effect of …

Identification Of Milk And Milk Product Adulteration By Molecular Methods, Isam Shaker Haza, Saad Sabah Fakhry

Al-Esraa University College Journal for Medical Sciences

The polyacrylamide gel electrophoresis sodium dodecylsulfate (SDS-PAGE) has been extensively used to separate native and denaturalized proteins. In various countries this has been useful to detect milk adulteration with whey, which is a fraud according to the current legal standards. The presence of glycomacropeptide (GMP) constitutes a marker of adulteration. It is released to the serum due to the hydrolysis of --casein peptide catalyzed by rennin incheese elaboration. In this work, the GMP detection was standardized as a pasteurized milk adulteration index, by means of GMP isolation with sequential precipitation in trichloroacetic acid at 24% and 50%, treatment with ethanol-ether …