Medicine and Health Sciences Commons^™

เภสัชจลนศาสตร์ประชากรของยาเมอโรพีเนมในผู้ป่วยทารกขั้นวิกฤต, วัลย์ลิกา ยนต์วิเศษ

Chulalongkorn University Theses and Dissertations (Chula ETD)

วัตถุประสงค์: เพื่อวิเคราะห์หาค่าพารามิเตอร์และปัจจัยที่มีผลต่อค่าพารามิเตอร์ทางเภสัชจลนศาสตร์ของยาเมอโรพีเนมในผู้ป่วยเด็กทารกขั้นวิกฤต วิธีดำเนินการศึกษา: การศึกษาเชิงวิเคราะห์แบบเก็บข้อมูลไปข้างหน้า ในผู้ป่วยเด็กทารกขั้นวิกฤตอายุ 1 เดือน ถึง 2 ปี ที่ได้รับยาเมอโรพีเนมในการรักษา ณ โรงพยาบาลจุฬาลงกรณ์ สภากาชาดไทย ระหว่างวันที่ 4 กุมภาพันธ์ พ.ศ. 2563 ถึง 4 กุมภาพันธ์ พ.ศ. 2564 จำนวน 35 ราย ข้อมูลระดับยาในรูปอิสระของเมอโรพีเนมในเลือด จำนวน 160 ตัวอย่าง ถูกวิเคราะห์ด้วยเครื่อง high-performance liquid chromatography with ultraviolet (HPLC-UV) และนำมาสร้างแบบจำลองทางเภสัชจลนศาสตร์ประชากรโดยใช้โปรแกรม nonlinear mixed-effects modeling (NONMEM) ทดสอบความถูกต้องของแบบจำลองโดยการทดสอบภายในด้วยวิธี bootstrap analysis และวิเคราะห์กราฟ prediction-corrected visual predictive check (pcVPC) เพื่อประเมินความถูกต้อง แม่นยำในการทำนายของแบบจำลองสุดท้าย ผลการศึกษา: แบบจำลองทางเภสัชจลนศาสตร์แบบ one-compartment model with first-order elimination มีความเหมาะสมกับการศึกษานี้ อัตราการกำจัดยาและปริมาตรการกระจายยาของประชากรมีค่าเท่ากับ 1.33 ลิตรต่อชั่วโมง และ 2.27 ลิตร ตามลำดับ ปัจจัยที่มีผลต่ออัตราการกำจัดของยาเมอโรพีเนม คือ น้ำหนัก และอัตราการกำจัดของครีเอตินิน ส่วนปัจจัยที่มีผลต่อปริมาตรการกระจายของยาเมอโรพีเนม คือ น้ำหนัก ค่าความผันแปรระหว่างบุคคลของอัตรากำจัดยาและปริมาตรการกระจายยาเปรียบเทียบระหว่างแบบจำลองพื้นฐานและแบบจำลองสุดท้าย พบว่า มีค่าลดลงอย่างมีนัยสำคัญทางสถิติ ผลการประเมินแบบจำลอง พบว่า แบบจำลองสุดท้ายมีความถูกต้อง แม่นยำ และสามารถนำมาทำนายได้ดี สรุปผลการศึกษา: การศึกษานี้ได้พัฒนาและทดสอบความถูกต้องของแบบจำลองทางเภสัชจลนศาสตร์ประชากรของยาเมอโรพีเนมในผู้ป่วยเด็กทารกขั้นวิกฤต โดยพบว่า น้ำหนัก และอัตราการกำจัดของครีเอตินิน เป็นปัจจัยร่วมที่มีผลต่อค่าพารามิเตอร์ทางเภสัชจลนศาตร์ของยาเมอโรพีเนมอย่างมีนัยสำคัญทางสถิติ แบบจำลองทางเภสัชจลนศาสตร์ประชากรที่ได้จากการศึกษานี้สามารถนำมาเป็นแนวทางในการปรับขนาดยาเมอโรพีเนมให้เหมาะสมกับผู้ป่วยแต่ละรายในกลุ่มประชากรผู้ป่วยเด็กทารกขั้นวิกฤตที่มีลักษณะประชากรใกล้เคียงกับการศึกษานี้

Choice Of God/Higher Power, Perceptions Of God/Higher Power, Religious Beliefs And Behaviors, And Social Support As Predictors Of Length Of Sobriety, Satisfaction With Life, And Quality Of Life Among People Recovering From Alcohol Addictions In Three Midwestern States, Carlton Martin

Dissertations

Problem

An estimated 12.7% of the US population meet the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) (American Psychiatric Association, 1994) criteria for Alcohol Use Disorder (AUD). The annual cost to the society, including emergency room visits, lost days at work, and accidents on the road is in the billions. The impact of this disorder on the family, the community, and the individual is immeasurable. A growing body of literature supports an association between religious and spiritual beliefs and behaviors and recovery from alcohol addiction. This project is an investigation of this association. The goal is to offer some …

Melatonin For The Treatment Of Sepsis: The Scientific Rationale, Ruben Manuel Luciano Colunga Biancatelli, Max Berrill, Yassen H. Mohammed, Paul E. Marik

Bioelectrics Publications

Sepsis affects 30 million people worldwide, leading to 6 million deaths every year (WHO), and despite decades of research, novel initiatives are drastically needed. According to the current literature, oxidative imbalance and mitochondrial dysfunction are common features of septic patients that can cause multiorgan failure and death. Melatonin, alongside its traditionally accepted role as the master hormonal regulator of the circadian rhythm, is a promising adjunctive drug for sepsis through its anti-inflammatory, antiapoptotic and powerful antioxidant properties. Several animal models of sepsis have demonstrated that melatonin can prevent multiorgan dysfunction and improve survival through restoring mitochondrial electron transport chain (ETC) …

Diagnosing Mild Traumatic Brain Injury Using Saliva Rna Compared To Cognitive And Balance Testing, Steven D. Hicks, Cayce Onks, Raymond Y. Kim, Kevin J. Zhen, Jayson Loeffert, Andrea C. Loeffert, Robert P. Olympia, Gregory Fedochak, Samantha Devita, Aakanksha Rangnekar, John Leddy, Mohammad N. Haider, Zofia Gagnon, Callan D. Mcloughlin, Matthew Badia, Jason Randall, Miguel Madeira, Aaron M. Yengo-Kahn, Justin Wenzel, Matthew Heller, Hallie Zwibel, Aaron Roberts, Samantha Johnson, Chuck Monteith, Michael N. Dretsch, Thomas R. Campbell, Rebekah Mannix, Christopher Neville, Frank Middleton

Rehabilitation Sciences Faculty Publications

BACKGROUND: Early, accurate diagnosis of mild traumatic brain injury (mTBI) can improve clinical outcomes for patients, but mTBI remains difficult to diagnose because of reliance on subjective symptom reports. An objective biomarker could increase diagnostic accuracy and improve clinical outcomes. The aim of this study was to assess the ability of salivary noncoding RNA (ncRNA) to serve as a diagnostic adjunct to current clinical tools. We hypothesized that saliva ncRNA levels would demonstrate comparable accuracy for identifying mTBI as measures of symptom burden, neurocognition, and balance.

METHODS: This case‐control study involved 538 individuals. Participants included 251 individuals with mTBI, enrolled …

Saliva Microrna Biomarkers Of Cumulative Concussion, Steven D. Hicks, Robert P. Olympia, Cayce Onks, Raymond Y. Kim, Kevin J. Zhen, Gregory Fedorchak, Samantha Devita, Aakanksha Rangnekar, Matthew Heller, Hallie Zwibel, Chuck Monteith, Zofia Gagnon, Callan D. Mcloughlin, Jason Randall, Miguel Madeira, Thomas R. Campbell, Elise Fengler, Michael N. Dretsch, Christopher Neville, Frank A. Middleton

Rehabilitation Sciences Faculty Publications

Recurrent concussions increase risk for persistent post-concussion symptoms, and may lead to chronic neurocognitive deficits. Little is known about the molecular pathways that contribute to persistent concussion symptoms. We hypothesized that salivary measurement of microribonucleic acids (miRNAs), a class of epitranscriptional molecules implicated in concussion pathophysiology, would provide insights about the molecular cascade resulting from recurrent concussions. This hypothesis was tested in a case-control study involving 13 former professional football athletes with a history of recurrent concussion, and 18 age/sex-matched peers. Molecules of interest were further validated in a cross-sectional study of 310 younger individuals with a history of no …

What The Covid-19 Crisis Is Telling Humanity, David Wiebers, Valery Feigin

Animal Sentience

The planet is in a global health emergency exacting enormous medical and economic tolls. It is imperative for us as a society and species to focus and reflect deeply upon what this and other related human health crises are telling us about our role in these increasingly frequent events and about what we can do to prevent them in the future.

Cause: It is human behavior that is responsible for the vast majority of zoonotic diseases that jump the species barrier from animals to humans: (1) hunting, capture, and sale of wild animals for human consumption, particularly in live-animal markets; …

Beyond Borders: Nigerian Diaspora, Men's Experiences Of Intimate Partner Violence, Christiana Ifeyinwa Chineme

Walden Dissertations and Doctoral Studies

Culture and social structures are factors in the way people view or think of intimate partner violence (IPV). A significant gap exists in the current literature regarding whether changes exist in IPV experience because of continuous and direct contact between individuals from different cultural origins. Despite the increasing emphasis on the social and structural determinants of IPV-related behaviors, research and interventions lag on how people view IPV while they live in their native country and when they migrate and are exposed to a different culture and social structure. The purpose of this qualitative phenomenological research was to explore the IPV …

Rethinking Global Governance To Address Zoonotic Disease Risks: Connecting The Dots, Kelley Lee

Animal Sentience

Large-scale changes in human behaviour are urgently needed to prevent future pandemics involving zoonotic diseases such as COVID-19. However, this will not happen to the required degree, and with sufficient speed, without a major shift in how humanity collectively governs itself. Alongside a shift in focus from individual behaviours to the structural conditions underpinning the world economy that shape human behaviours, effective global governance presses us to connect more dots than ever before. The One Health approach is an important starting point but we need to go much further.

Risk Factors Of Infant Mortality Disparity In Indian River County, Florida, Cecilia Miguelina Escorbore

Walden Dissertations and Doctoral Studies

Infant mortality in the United States is a great concern to families, communities, and professionals in the public health field. More concerning is the infant mortality racial disparity, prevalent throughout the United States. The purpose of this study was to explore risk factors of infant mortality disparity in Indian River County (IRC), Florida. Using socioecological theory as the theoretical framework, this study explored whether there is an association between infant mortality among Black infants and geographic location as well as measures of socioeconomic status (age, educational level, health insurance status, and marital status) associated with infant mortality among Black infants …

An Educational Activity For Primary Care Providers Treating Older Veterans With Sexually Transmitted Infections, Beatrice Fannie Grant

Walden Dissertations and Doctoral Studies

AbstractComprehensive sex education is an effective method of promoting sexual health. Because primary care providers conduct the initial health need assessment of veterans, it is important that providers understand how to approach the subject of sexual health and the prevention of sexually transmitted infections. The purpose of this evidence-based project was to implement and evaluate an educational activity for primary care providers. The health belief model was used as theoretical framework. This project was introduced to a federal primary care clinic in the Mid-Atlantic United States. Twenty-five participants completed a pretest prior to the start of the educational activity that …

Access To Health Insurance And Health-Seeking Behavior In A Nigerian Suburban Community, Charles Olalekan Mensah

Walden Dissertations and Doctoral Studies

The purpose of this study was to understand the effects of access to health insurance on the healthcare-seeking behavior of the population in four suburban communities in Rivers State, Nigeria. The conceptual framework of the study is based on Anderson's behavioral model of health services use. The study looked at how access to health insurance affects the healthcare seeking behavior and the preventive care seeking behavior of the study population. Two-hundred and seventy participants were surveyed using the Health Care Access and Utilization Survey (HCAUS) questionnaire. Data were analyzed using descriptive statistics (frequencies and percentages) and bivariate logistic regression. Respondents …

Mothers With Diabetes And The Effects Of The Disease To Their Offspring, Rachel Smart-Fadairo

Walden Dissertations and Doctoral Studies

The purpose of this phenomenological was to understand the lived experiences of mothers who were diagnosed with gestational diabetes mellitus and had a child who had been diagnosed with a speech disorder. Despite educational and medical interventions having increased to reduce gestational diabetes, the growing incidence of gestational diabetes signals a disconnect between education, intervention, and prevention. Previous studies have shown that mothers with gestational diabetes mellitus can experience high- risk pregnancies. The long-term effects of the disease on the mother and her newborn child in terms of soaring healthcare cost, loss of work productivity, education, and the emotional health …

Public Stigma, Familiarity With Mental Illness, And Attitudes Toward Seeking Mental Health Services, Eugenia Combie-Knowles

Walden Dissertations and Doctoral Studies

Public stigma and adverse beliefs and attitudes toward individuals with mental illness can negatively influence help seeking. The purpose of this quantitative cross-sectional study was to assess associations and the effect of stigmatized attitudes toward mental illness and familiarity with mental illness on help-seeking attitudes in three community health clinics in the Bahamas. Attribution theory and theory of planned behavior provided the framework for the study. Data were collected from a convenience sample of 366 individuals who completed a self-administered questionnaire consisting of sociodemographic questions, the Attribution Questionnaire that assessed stigmatizing attitudes and beliefs toward individuals with mental illness, and …

Structural Predictors Of Lights And Sirens Use By Emergency Medical Services, Justin Alex Sleffel

Walden Dissertations and Doctoral Studies

Ambulances regularly respond to scenes and transport patients while using lights and sirens (L&S), which are associated with an increased risk of vehicle crashes. The use of L&S persists, despite the risks, which impact emergency medical service (EMS) workers, patients, and other drivers and pedestrians on U.S. roadways. To understand the factors associated with ambulance crashes while using L&S, this study applied the Donabedian model to the problem. The purpose of this study was to investigate the association between 3 organizational structural factors—organizational type, organizational status (staffing model), and level of service—and ambulance crash rates while using L&S. This study …

Flipped Classroom Approach To A Critical Care Educational Program For New Graduates, Deborah Ann Smithers

Walden Dissertations and Doctoral Studies

Of the new graduate registered nurses hired to work in critical care areas, a few percent do not receive a formal critical care orientation. Furthermore, there is a high attrition rate of new graduates hired to work in high acuity patient care units. Many resign before their first work anniversary due to a lack of education and training. An initiative was put forth by critical care administration, at the study site, to critical care clinical leadership to significantly revise a critical care educational offering known as critical care core. The revision would allow for the satisfaction of the novice nurses …

Implementing A Diabetes Optimization Protocol For Elective Surgery Patients, Barbie Denise Harbaugh

Walden Dissertations and Doctoral Studies

Diabetes is a recognized risk factor for postoperative infection, acute renal failure, ileus, and lengthy hospital stay. Optimal screening, management, and scheduling of elective surgery for diabetic patients has been shown to improve quality care, decrease complications, and increase the efficiency and lower the costs of preoperative patient care. However, surgery cancellations are common due to inadequate preoperative glycemic control and poor intraoperative glycemic control, which is a recognized risk factor for perioperative or postoperative complications. There were no clinical practice guidelines or optimization protocols for elective surgery patients at a small rural hospital in the Northeast United States. The …

Disparities In The Qulaity Of Bariatric Care Among African American Women, Tracey S. White

Walden Dissertations and Doctoral Studies

Improving the quality of health care in the United States has been an ongoing challenge for decades. As health care providers seek to provide unsurpassed levels of health care, disparities continue to exist among races. Racial and ethnic disparities in the quality of health care persist that affect African American women disproportionally. The purpose of this study was to explore the lived experiences of African American women with regard to quality health care following bariatric surgery. Using a phenomenological approach, semistructured interviews were conducted with 10 African American women who had suboptimal weight loss outcomes following bariatric surgery. Data from …

Comparison Of Affordable Care Act And Ryan White Coverage On Treatment Compliance, Engagement, Affordability, And Health Status For People Living With Hiv/Aids, Todd Blum

Walden Dissertations and Doctoral Studies

The Ryan White HIV/AIDS Program (RWHAP) provides HIV care to uninsured people living with HIV/AIDS (PLWHA). Although the RWHAP has helped PLWHA achieve a viral suppression rate of 84%, this does not meet the 90% target goals under the U.N. 90-90-90 plan to end the AIDS epidemic. The Affordable Care Act (ACA) was enacted to enhance access and health status, but outcomes have not been measured for PLWHA. The purpose of this quantitative correlational cross-sectional study was to determine whether PLWHA enrolled in an ACA qualified health plan (ACAQHP) achieved improved health status compared to PLWHA enrolled in the RWHAP. …

Homelessness And Hiv Risk: Experiences, Perceptions, And Beliefs Of Transgender Youth, Darcia Bryden-Currie

Walden Dissertations and Doctoral Studies

Human ImmunodeficiencyVirus (HIV) continues to be a public health concern in the United States, with increased rates of infection among transgender youth. The phenomenon of homelessness is also a significant challenge for transgender youth. Gender expression often results in stigma, and discrimination, many trans youth experience poverty, rejection, and low self-esteem, which are precursors to homelessness. The purpose of this qualitative phenomenological study was to explore the influence that homelessness has on sexual risk associated behaviors in transgender youth. The theoretical framework that guided this study was Bandura’s social cognitive theory. The research questions sought to explore how this population …

Cannabis As A Safer Alternative To Opioid Management Of Chronic Pain, Loren Nedelman

Walden Dissertations and Doctoral Studies

Chronic pain affects approximately 100 million American adults and costs the United States upwards of $635 billion each year in medical treatments and lost productivity. Opioid prescription for pain has increased exponentially over the past several years, with the CDC estimating 20% of prescriptions lasting longer than 3 months for patients with noncancerous pain. Opioid addiction has become a national public health crisis with mortality surpassing 100,000 deaths annually due to overdose. As States have begun to deregulate the use of cannabis and cannabis derivatives for medical purposes; oversight and regulation by the federal government on its use as a …

Food Advertisements And Access To Primary Care And The Impact On Family Food Decisions Made By Women, Linda Soriano-Copelin

Walden Dissertations and Doctoral Studies

Women are responsible for preparing family meals in 71% of American households. The meal choices that women make has an impact on lifestyle choices for themselves and their family. The purpose of this research was to evaluate the extent to which food advertisements and access to primary care influence a woman’s food-making choices. The first question focused on how exposure to food advertisements on television may impact the food choices of women. The second question asked how food advertisements affect women’s eating habits. The third question asked how access to primary care impacts food decisions. The theoretical framework integrated the …

Improving The Ethical Use Of E-Health And Emr, Josephine Tafie

Walden Dissertations and Doctoral Studies

Improving the Ethical Use of E-health and EMR

by

Josephine Tafie

MS, Walden University

BS, Washington Adventist University

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2020

Abstract

The healthcare industry is experiencing ethical problems with the integration of new technological applications, such as e-health and electronic medical records (EMRs) in service delivery. Thus, the purpose of this capstone project was to conduct a systematic literature review to determine the best practices that are well suited to a large urban hospital, to ensure patients’ privacy with the continued use …

Family Members’ Lived Experiences Of Chronic Migraine, Elizabeth Biddle

Walden Dissertations and Doctoral Studies

Chronic migraine (CM) is a growing phenomenon in the United States and has been recognized as a disabling headache disorder. CM negatively affects the quality of life not only of CM sufferers but also their family members. The lived experiences of the family member of CM sufferers has not been sufficiently investigated. The purpose of this study was to gain in-depth insight into the lived experiences of family members who lived with CM sufferers. The phenomenological approach, guided by the social support theory, was used to investigate the lived experiences of family members who live with CM sufferers through open-ended …

Strengthening Mental Health Awareness Of University Students Using An Online Training Module, Lavern Rosemarie Bourne

Walden Dissertations and Doctoral Studies

Canadian youth pursuing postsecondary education are facing a major mental health crisis. There are substantial gaps between the diagnosis and treatment of mental illnesses. The purpose of this study was to evaluate whether a web-based mental health educational intervention was an effective tool with which to increase mental health awareness and help-seeking behaviors of university students. The theory of planned behavior, the help-seeking model, and the technology acceptance model were the theories that guided this study. Using a quantitative quasi-experimental research design, data were collected from 329 undergraduate students in the Faculty of Health Sciences at a university in Eastern …

Nurses’ Aesthetic Responses And Emotional Judgements To Senior Leaders’ Symbolism, Lucinda A. Easler

Walden Dissertations and Doctoral Studies

Stress can be heightened during a merger; understanding how acute care nurses who work in a hospital undergoing a merger, experience senior leaders’ use of symbolism may help to promote hospital and leader sustainability. Executive symbolism unfolds into aesthetic experience, normally considered a response to art, with few studies of its existence and benefit to organizational life. The purpose of this phenomenological-hermeneutic study guided by Parker’s aesthetic theory was to examine acute care nurses’ emotional responses and experiences with senior leaders’ use of executive symbolism in the midst of the organizational change. Interviews with 11 acute care registered nurses were …

Lived Experience Of Parenting Nurses Pursuing A Doctorate: A Phenomenological Inquiry, Jaimee Feldstein

Walden Dissertations and Doctoral Studies

The need for more doctoral prepared nurses is evident; data indicate that less than 1% of nurses hold doctoral degrees, yet, little is known about student persistence in doctoral nursing programs. Even less is known about doctoral nursing students navigating an online learning environment while balancing parenthood. The purpose of this phenomenological study, guided by Rovai’s composite persistence model, was to explore the embedded meanings in the experiences of parenting nurses pursuing their doctoral degrees at an online university. Ten female parenting nurses who completed a doctorate within the last 2 years were interviewed and shared the key factors that …

Job Self-Efficacy, Alexithymia And Secondary Traumatic Stress Among Correctional Officers, Paulette Andrea Gayle

Walden Dissertations and Doctoral Studies

Correctional officers work in a volatile environment and are regularly exposed to inmates’ violence or cruelty. These factors negatively affect their job performance, contribute to physiological and mental health issues that could result in secondary traumatic stress (STS) symptoms. Researchers have identified job self-efficacy and alexithymia traits as mitigating factors against elevated stress. Other researchers have identified the traits as strongly associated with mental health illnesses. The purpose of this quantitative study, using a convenience sampling strategy, was to determine whether job self-efficacy and alexithymia traits were predictors of STS among a sample of 79 correctional officers working for Her …

Effects Of Government Regulations And Reimbursement Policies On Home Health Administration In Illinois., Sally Nwafor

Walden Dissertations and Doctoral Studies

Recent changes in government regulations and reimbursement policies threaten the financial viability and the ability of home health agencies to provide the necessary services. There is a gap in knowledge about the effect of the changes in healthcare policies on the administration of home health businesses in Illinois. The purpose of this study was to bridge the knowledge gap by investigating the effect of the regulatory and policy changes on home health administration in Illinois. The research question focused on the challenges that home health administrators face due to the changes in government regulation and reimbursement policies, and the strategies …

Evaluating The Impact Of Nurse Leader Professional Development, Celeste Rogers Romp

Walden Dissertations and Doctoral Studies

A health care organization’s success is impacted by its leaders’ knowledge, confidence, and training. A quality improvement (QI) project was undertaken by a 300-bed acute care medical center to determine the impact of providing nurse leaders with education and training in increasing the leader’s knowledge and confidence in their role and in improving nursing satisfaction, catheter-associated urinary tract infection (CAUTI) rates, and fall rates. The FOCUS-PDSA QI model and the nurse manager leadership collaborative learning domain framework were used to guide the QI project and its evaluation. There were four primary sources of evidence. A nurse leader professional development pre- …

Evaluation Of A Shared Governance Model, Gorda Peters-Joseph

Walden Dissertations and Doctoral Studies

AbstractShared governance (SG) has been defined as a style of management in which frontline staff and managers work together to improve clinical practice. Guided by the PLAN-DO-STUDY-ACT cycle, the purpose of this project was to evaluate the implementation of the SG model for pediatric services in a US acute care hospital. The practice question explored whether the implementation of the SG model would demonstrate improvements in nurse satisfaction using the culture of safety survey, a change in nurse staff turnover reported as numbers hired, retired, resigned, or transferred, and changes in patient satisfaction measured by survey scores from the Hospital …