Medicine and Health Sciences Commons^™

Emerging Biomimetic Drug Delivery Nanoparticles Inspired By Extracellular Vesicles, Viswanathan Sundaram, Santosh Aryal

Pharmacy Faculty Publications and Presentations

Nanoparticles (NPs) made up of cellular components such as extracellular vesicles (EVs) with a biomimetic outlook have emerged as a revolutionary approach in nanomedicine, providing significant benefits for targeted drug administration, immunotherapy, monitoring therapeutic response, and diagnostic applications. Utilizing the distinctive characteristics of natural cell membranes, membrane proteins, and cellular contents, these biomimetic NPs acquire essential biological functions from their source and biogenesis, including immune evasion, extended circulation, and target recognition, rendering them optimal candidates for therapeutic applications. This review offers a comprehensive examination of the methodologies of EVs infused with synthetic.

Exploring Veteran And Non-Veteran Nursing Student Satisfaction Utilizing Marginality And Financial Stress, Juanita Nickols

Nursing Theses and Dissertations

It is widely recognized that there is a nursing shortage in the U.S. due to a growing aging population, nurses retiring, and a low nursing school capacity. Nursing schools can ameliorate part of this shortage by devising ways to increase nursing student success and graduation rates. This three-manuscript paper aims to present various ideas to help nursing schools in this endeavor. A relatively unstudied population is the veteran nursing student (VNS), the focus of this paper. The first chapter, Chapter 2: A Concept Analysis of Overload: Implications for Undergraduate Nursing Students Success, discusses the concept of overload so the …

The Evaluation Of Anti-Factor Xa Levels In Hospitalised Patients Receiving Low Molecular Weight Heparin (Lmwh): A Prospective Study, Tandzile Thandwayinkosi Simelane

Master of Medicine in Clinical Pathology

Background 

Patients admitted to the hospital have been reported to have coagulation abnormalities due to various factors including immobilisation, preexisting disease, and current illness. The overall incidence of venous thromboembolism (VTE) in critically ill patients varies from 15% to well over 50%, even with the use of prophylactic measures in most patients. Low molecular weight heparin (LMWH) and unfractionated heparin (UFH) are the recommended drugs for VTE prophylaxis in inpatient care. Although not standardly recommended, the laboratory can offer monitoring of anti-Factor Xa using the gold standard method of chromogenic anti-Factor X assay. The anti-Factor Xa levels are notably affected …

Gender Differences In The Associations Between Developmental Disabilities And Anxiety And Depression Symptoms Among U.S. Children: Insights From The 2021 National Health Interview Survey, Gloria Wang, Muyiwa Ategbole, Xingguang Luo, Kesheng Wang, Chun Xu

Health & Biomedical Sciences Faculty Publications

Background: Limited research has explored the associations between developmental disabilities and symptoms of anxiety and depression among U.S. children during the COVID-19 pandemic.

Objective: This study investigates the associations between developmental disabilities and symptoms of anxiety and depression among U.S. children and examines whether these associations differ by gender.

Methods: The analysis included 6092 children aged 5-17 from the 2021 National Health Interview Survey (NHIS). Key risk factors for anxiety and depression symptoms included attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disability (ID), learning disability (LD), and developmental delay (DD). Weighted multivariable logistic regression (MLR) was conducted to evaluate …

Chronic Illness Education 2025: Dealing Anxiety In Teenage, Aida Mouzoon, Emily Crisan, Emma Saito, Feeda Elahresh, Hussan Ali, Jackson Bennett, Noah Rollison, Shihabaldean Shalabi

Patient Education Projects

No abstract provided.

Chronic Illness Education 2025: Hypertension And The Case Of Mrs.Dash, Brandon Brown, Charlotte Turner, Connor Mcginnis, Jacob Airas, Maria Awad, Pranav Nair, Shruthi Sunilkumar, Yusra Sannah

Patient Education Projects

No abstract provided.

Chronic Illness Education 2025: Prevention And Management, Alyusuf Elnaggar, Brenna Hairston, Carly Ghanem, Fatima Bhatti, James Wairagu, Lucy Yu, Najeeb Baig, Ryan Murphy

Patient Education Projects

No abstract provided.

Chronic Illness Education 2025: Risk Factors And Prevention Of Cardiovascular Disease, Christopher Matti, Clayton Kramm, Ghala Alhasan, Hadi Elmenini, Julia Miller, Maxine Kugelmas, Moshood Osinusi, Nievalinda Strong

Patient Education Projects

No abstract provided.

A Risk Score To Predict Recurrent High Intensity Inpatient Resource Utilization For Children With Medical Complexity., Charles Maloy, Jessica L. Bettenhausen, Y Raymond Chan, Leah Jones, Kathryn Kyler, Laura Plencner, Jessica Markham, Jacqueline Walker, Smit Shah, Sian Best, Jonathan Ermer, Shelby Chesbro, Maria Newmaster M.D., Henry T. Puls

Posters

Background Children with medical complexity (CMC) use a greater amount of inpatient resources and stand to benefit from unique care models and coordination. However, hospital resources can be limited, and a better understanding of which CMC are high resource users could improve hospital and staff planning. Objective: To develop a risk score predictive of recurrent high intensity inpatient utilization among CMC. Methods: We conducted a retrospective cohort study of children < 18 years old with ≥3 complex chronic conditions (CCC) discharged from one of 48 children’s hospitals in the Pediatric Health Information System during 2021 and 2022. To reflect CMC typically cared for by a general medical service, children with cardiac procedures, dialysis, oncology, or transplant CCCs, and index hospitalization mortality were excluded. We used multivariable logistic regression to determine factors present on the index hospitalization associated with ≥5 hospitalizations or ≥3 hospitalizations with one lasting ≥25 days within any 365-day period (high inpatient utilization) in 2021-2023. We developed risk scoring system using model coefficients and defined the optimal risk score cutoff to maximize sensitivity and specificity. We then applied the risk score cutoff to children discharged to determine (a) ratio of predicted:actual CMC with recurrent high resource use and (b) the total predicted daily volume on 50th, 75th, and 90th percentile days for each hospital. Results: Of 44,432 included children , 9,596 (21.6%) had high inpatient utilization (Table). Children under 1 year of age had the highest odds of high inpatient utilization (OR 2.26 [95% CI: 2.16, 2.37]) and all CCC and technology groups (except metabolic) met statistical significance (Figure 1). The optimal risk score cutoff was 29 and predicted 17,411 (39.2%) CMC as high inpatient resource utilizers; the predicted:actual ratio of CMC with high inpatient utilization was 1.81. The mean daily census of the 50th, 75th, and 90th percentiles across hospitals was 28 CMC with recurrent high utilization (± 17), 34 (±18), and 39 (±19; Figure2). Conclusions: It is feasible to develop a risk score predictive of recurrent high inpatient utilization among CMC. There is substantial variability in volume of CMC with high utilization between pediatric hospitals. The risk score cutoff values can be modified to suit different applications and institution-specific objectives. These applications could include a dedicated service line or staffing. Alternatively, this could identify patients who would benefit from more formal handoff from inpatient to outpatient providers.

The Back Page: Commentary: Going Non-Par: My Perspective, And 10 Lessons I’Ve Learned, Robert Antolak Dds

The Journal of the Michigan Dental Association

Dr. Robert Antolak shares his experience and ten lessons from transitioning his dental practice to a non-participating (non-par) status with insurance in January 2025, driven by declining reimbursements and the need to prioritize patient care. He highlights the unfairness of lower PPO reimbursements for newer dentists. Key lessons include securing a trusted coach, early patient communication, building a financial safety net, ensuring full team buy-in, committing with faith, tightening billing systems, frequent patient reminders, advocating for patients, creating an in-office payment plan (not percentage discounts), and clearly articulating the "why". Though revenue initially dropped, he anticipates full recovery, aiming to …

An Exploration Of The Effect Of Covid Restrictions On Maternity Care In Uganda, Hellen Kyakuwaire, Grace Edwards, Ahmed Mohammed Sarki

Journal of Asian Midwives (JAM)

Background: Uganda responded aggressively to the worldwide spread of COVID-19 by imposing a total lockdown, which forbade movement of the whole population, including pregnant women and other vulnerable groups. This phenomenological study explored pregnant women’s experiences during the total lockdown in Uganda and identified factors that influenced the quality of healthcare for pregnant women during the lockdown.
Methods: Thirty-two newly delivered women were selected across a wide geographical area to represent rural and urban areas. The sample was selected from women who had given birth at the selected health facilities from March 18, 2020, to April 30, 2020. …

The Effects Of Midwifery Students’ Simulation Training In Perineal Repair: A Quasi-Experimental Study, Zahra Sadat Pajohideh, Solmaz Mohammadi, Fatemeh Keshmiri, Azam Honarmandpour, Azam Jahangirimehr

Journal of Asian Midwives (JAM)

Background: The decrease in normal deliveries and episiotomies in midwifery practice has reduced the experience of midwifery students in perineum repair. This study examined the effect of perineal repair simulation training on the clinical skills of midwifery students by designing, implementing and evaluating simulation models in procedural education.
Methods and materials: This quasi-experimental study was conducted on 60 midwifery students in intervention and control groups at Shoushtar, Iran, from September 2018 to August 2021. The intervention group received simulation training before entering the formal clinical education courses, while the control group took part in workplace-based training. The clinical repair skills …

The Impact Of The Covid-19 Pandemic On Maternity Care Services: Lived Experiences Of Midwives In Indonesia, Mergy Gayatri, Oluwadamilare Akingbade, Indhar Wahyu Wira Harjo, Adepegba Folasade Rebecca, Salako Faith Adebola

Journal of Asian Midwives (JAM)

Background: There have been fundamental changes in global maternity care in response to the COVID-19 pandemic across the globe. However, there are limited studies in Indonesia that have explored the changes experienced by midwives in various health facilities during the COVID-19 pandemic.
Method: A qualitative phenomenological study was conducted among midwives with at least three years of clinical experience in midwifery practice and practicing at different levels of healthcare. Semi-structured interviews were conducted through WhatsApp or Phone calls, as face-to-face interviews were impossible during the pandemic. Data were analyzed using thematic analysis.
Results: In total, 24 midwives …

The Relationship Between Sleep Quality And Physical Fitness Toward The Menstrual Cycle In High School Students, Surya Adi Saputra, Raja Mohammed Firhan Bin Raja Azidin, Alifia Candra Puriastuti, Dessy Amelia, Zumroh Hasanah, Anggi Renawati

Journal of Asian Midwives (JAM)

Background: Sleep is essential for maintaining physical fitness and overall health, as it helps the body recover from intense physical activity and maintains endurance. Physical fitness is determined by heredity, gender, age, body composition, activity, and exercise. Adequate sleep positively impacts overall health, while poorer sleep can negatively affect the body. Teenagers often prefer excessive screen time and oversleep, which can affect their sleep quality. Physical fitness is related to physical activity, and the more often an individual engages in physical activities, the better their fitness. This condition can also impact reproductive health, as hormonal disorders can affect the menstrual …

Knowledge, Attitudes, And Practices Of Healthcare Workers Regarding Early Childhood Development: A Mixed-Methods Study At Secondary Care Maternal And Child Care Hospitals In Karachi, Pakistan, Sarosh Hirani, Shelina Bhamani, Hajra Malik, Samira Lakhani, Adeeb Kanji, Khairunnissa Hooda

Journal of Asian Midwives (JAM)

Introduction: Early childhood development (ECD) is a critical period that lays the foundation for a child's future growth and overall well-being. Healthcare settings play a significant role in shaping these developmental outcomes. However, there is limited research evaluating healthcare professionals' knowledge, attitude, and practices on ECD in Pakistan. This study aims to assess the awareness, attitudes, and practices of healthcare providers working in secondary hospitals regarding ECD.
Methods: A sequential explanatory mixed-methods approach was used. The study initially recruited healthcare workers, including physicians, nurses, trainees, and midwives from two secondary care hospitals. Participants completed the Caregiver Knowledge of Child Development …

Peer Mentorship Of Midwifery Faculty In Bangladesh: A Process Evaluation, Pronita Raha, Joy Kemp, Farida Begum, Rowsan Ara, Vibhavendra S. Raghuvanshi, Nabila Purno, Daniel Novak, Hoque Emdadul Hoque

Journal of Asian Midwives (JAM)

Development of midwifery faculty is key to strengthening quality midwifery education. This article presents a process evaluation of a peer mentorship programme, implemented between 2021 and 2023, for around 370 midwifery faculty in Bangladesh, including 40 newly deployed faculty. 20 peer mentors, prepared by international midwifery faculty, conducted quarterly visits to public midwifery education institutions (MEIs) to provide mentorship support to midwifery faculty and to monitor the quality of midwifery education. A digital community of practice was also created. Data were collected with a checklist based on the World Health Organization (WHO) midwifery educator competencies and entered into a digital …

Effects Of World Health Organization’S Educational Interventions On Clinical Competency Of Community Midwives In Managing Postpartum Hemorrhage, Afifah Abu-Ul-Hayat, Sarfaraz Masih, Madiha Mukhtar

Journal of Asian Midwives (JAM)

Background: Postpartum hemorrhage (PPH) is considered to be one of the most important causes of maternal mortality especially in low resource countries such as Pakistan. Community midwives (CMWs) have a very important role in the provision of midwifery care and their clinical competency are very crucial for the handling of PPH. This study evaluates the effect of a World Health Organization (WHO)-based educational intervention on the clinical competency of CMWs in Hazara Town, Quetta, in managing PPH.
Objective: This study aimed to determine the effectiveness of a WHO based educational intervention on improving the clinical competency of CMWs in managing …

Perceptions Of Risky Sexual Behavior Among Female Students: A Qualitative Analysis Of Contributing Factors, Consequences, And Prevention Strategies, Leila Bozorgian, Fatemeh Ansari, Fatemeh Janipour, Solmaz Mohammadi

Journal of Asian Midwives (JAM)

Background: Risky behaviors among young people are a significant concern for societies worldwide, leading to physical and psychosocial damage. Despite efforts to raise awareness about such risky behaviors over the past two decades, their prevalence continues to rise. Therefore, this study aimed to explain perceptions of the prevalence of risky sexual behaviors among female students.
Methods: A qualitative descriptive study using a conventional content analysis approach was conducted from August to mid-September 2024 in Yasoj, Iran. The study participants were selected using purposive sampling. The data were collected using semi-structured interviews conducted with 18 female students. Data collection …

Development And Validation Of Risk Assessment Tools For Hypertensive Disorder In Pregnancy, Vanitha K, Hepsibah Sharmil, Vijayalakshmi Kandasamy

Journal of Asian Midwives (JAM)

Aims and Background: Hypertensive disorders in pregnancy (HDP) have significant impact on both mothers and newborns leading to complications such as Eclampsia, Preterm delivery, Renal and cardiac problems, Intra Uterine Growth Retardation (IUGR) and Intra Uterine Fetal Death (IUFD). Early screening of hypertensive disorders in pregnancy is essential in the prevention and management of these complications. This research study aims to develop and validate a risk assessment tool for hypertensive disorders in pregnancy.
Materials and methods: A mixed-method research was carried out from December 2023 to December 2024 consisting of two steps. Step one involved the development of …

Research On Traditional Family Values Incorporating Data Enhancement And Transfer Learning, Qiaoling Chen, Hao Wang, Xiaomin Li

Journal of Scientific Information Research

[Purpose/significance] This research conducts in-depth exploration and knowledge discovery of ancestral hall couplets, a critical carrier of traditional family ethics, to facilitate their adaptive inheritance in contemporary society while introducing innovative perspectives and methodologies to the field.

[Method/process] We constructed a hierarchical classification system for traditional family values by synthesizing academic consensus, then developed the Annotation Keyword Data Enhancement(AK-DA-SKB-TC) model using idiomatic allusions with annotated keywords as source data and couplets as target data. Leveraging transfer learning, we achieved automated family tradition classification for couplets, followed by rigorous reliability validation. Multi-dimensional analysis of classification results uncovered evolutionary patterns and contextual …

Moving Drives You Crazy, Michelle C. Dziurgot

The Journal of the Michigan Dental Association

The Editor-in-Chief shares her frustrating experience moving a dental office. Key challenges included dental insurances dropping the practice from networks during recredentialing, causing denied claims for 30-60 days despite no changes to tax ID or NPI. State regulations also required new payments for radiation tubes, rather than crediting previous payments, despite a reduction in equipment. Furthermore, dental supply companies and movers did not take responsibility for broken equipment during the move. Despite these "insane and archaic" hurdles, most patients transitioned, and the article concludes with a comprehensive resource list for practice address changes

Mda Services: Cut Costs, Not Care: Solving Your Staffing Challenges With Medva, Reva Darling

The Journal of the Michigan Dental Association

The MDA has endorsed MEDVA, a virtual assistant staffing solution, to help members improve operational efficiency and reduce administrative burdens in dental practices. MEDVA provides experienced, HIPAA-compliant, non-clinical human professionals for tasks such as appointment scheduling, insurance verification, and billing. This partnership aims to address high turnover and rising overhead by offering cost-effective staffing solutions. MDA members receive special benefits, including a discounted hourly rate of $9.75, which is significantly lower than average Michigan rates for similar in-person roles. MEDVA’s service includes access to trained virtual assistants, proprietary technology, and a client success team

Implementing A Team-Based Approach To Reduce Blood Culture Contamination Rates In The Emergency Department: A Quality Improvement Initiative, Melissa Lockhart

Doctor of Nursing Practice Projects

Background: Blood culture contaminations (BCC) present significant risks to patients, including adverse drug reactions and the exacerbation of antibiotic resistance. BCC can also result in millions of dollars in financial burdens for hospitals due to the need for follow-up testing, treatment complications, and antibiotic stewardship efforts. At this facility, the contamination rate in the emergency department (ED) consistently exceeds the national benchmark of 3%. Contributing factors include high patient turnover and increased nursing workloads, which can lead to shortcuts in essential practices such as hand hygiene and skin disinfection before collection.

Purpose: This project aimed to evaluate whether implementing a …

National Patient Safety Goals: Reducing Health Care Disparities In Adult Patients With Alcohol Misuse, Jolie M. Carpenter

Doctor of Nursing Practice Projects

Background: An estimated 76 million people worldwide suffer from alcohol use disorder, accounting for almost two million deaths annually. The Joint Commission has made it a requirement to screen all patients admitted to an inpatient facility for health-related social needs, including alcohol use. By doing so, outpatient resources can be provided appropriately.

Purpose: The facility of interest does not currently have a discharge follow-up protocol. The purpose of this project was to implement an evidence-based protocol to follow-up one week after discharge to determine if patients accessed the community resources provided for alcohol use disorder and to determine whether the …

Unsuitable Underlying Cause-Of-Death Statements: Implementation And Evaluation Of A Structured Process For Healthcare Providers Certifying Natural Causes Of Death In An Outpatient Setting, Naida Rutherford

Doctor of Nursing Practice Projects

Background: Accuracy in death certification is crucial for effective public health initiatives. Inaccuracies in unsuitable Underlying Cause-of-Death (UCOD) statements can distort mortality statistics, influence health policy, and impact resource allocation. In South Carolina, changes in the death registration process and the introduction of an unsuitable cause-of-death list highlighted an urgent need for structured training among certifiers to enhance accuracy in death documentation.

Purpose: The purpose of this project was to implement a standardized training program for healthcare providers certifying natural causes of death and assessing the impact of reducing the unsuitable underlying cause-of-death inaccuracies in an outpatient hospice setting.

Project …

Implementing A Screening Tool To Increase Palliative Care Referrals For Patients With Metastatic Cancer, Rebecca N. Hegwood

Doctor of Nursing Practice Projects

Background: Palliative care (PC), when prescribed early for patients with metastatic cancer, has proven beneficial to the oncology patient and family by improving quality of life, decreasing stressors, and preventing premature discontinuation of therapy.

Purpose: This Doctor of Nursing quality improvement project aimed to determine if implementing a screening tool for patients newly diagnosed with metastatic cancer would increase PC referrals.

Project Design: The Five Item Palliative Care Screening Tool evaluated patients with a new metastatic cancer diagnosis. Secondary data was used to initiate a PC referral if the patient scored a five or greater on the screening tool. Project …

Implementation Of A Triage Assessment Area To Decrease Left Without Being Seen Rates In The Emergency Department, Margaret Mary T. Steed

Doctor of Nursing Practice Projects

Background: Left without being seen (LWBS) is a concern for emergency departments (EDs) nationwide. LWBS involves patients who sign into the ED and leave prior to being seen by a medical provider. LWBS has been linked to increased wait times in the ED.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project is to aid with decreasing LWBS rates in a local ED. Many tools aid with decreasing LWBS rates, including nurse-initiated protocols and standardized order sets. Despite available tools, LWBS rates remain elevated at 0.95% for the local ED.

Project Design: The evidence-based DNP quality improvement project …

Increasing Colorectal Cancer Screening Rates For Patients Without Insurance, Andrea F. Day

Doctor of Nursing Practice Projects

Background: Colorectal cancer is a leading cause of cancer-related death in the United States (U.S.), ranking as second most prevalent overall. Despite many initiatives, screening rates remain low, especially among clinic patients without insurance. The lack of an evidence-based screening protocol exacerbates these issues and increases the risk of advanced cancer and death. Initial data showed that 0% of patients were screened according to recommended guidelines.

Purpose: The project implemented a standard screening protocol to increase colorectal cancer screening rates in a rural Alabama free clinic for patients ages 45-64 lacking insurance.

Project Design: This quality improvement …

Improving The Detection Of Refractive Errors In First And Third Graders, Tameka J. Bolden

Doctor of Nursing Practice Projects

Background: Vision is a crucial component of the learning process, with academic tasks being heavily dependent on visual acuity. Undetected or diagnosed visual impairments can significantly alter a student’s educational performance and overall development. Currently, in Alabama, kindergarten, second, and fourth grade students are the only students to receive routine vision screenings; therefore, regular screening for visual acuity and eye issues is critical for school health programs. Early screening, diagnosis, and correction of refractive errors prevent permanent visual impairment and support academic success by reducing educational barriers and delayed cognitive impairment.

Purpose: This project aims to improve the early detection …

Influenza And Chronic Obstructive Pulmonary Disease: Correlating Adult Immunization With Exacerbation Reduction After Implementation Of The Global Initiative For Obstructive Lung Disease Recommendations In A Rural Clinic, Jessica Semyonova

Doctor of Nursing Practice Projects

Background: Patients with chronic obstructive pulmonary disease (COPD) may experience exacerbations of the disease, leading to disease progression, decreased lung function, increased mortality, and decreased quality of life. However, one of the clinician’s best tools in preventing exacerbations may be the distribution of annual influenza immunizations.

Purpose: This project aimed to determine whether implementing an influenza vaccination protocol would increase influenza vaccination uptake and decrease COPD exacerbation rates.

Project Design: An influenza vaccination protocol was implemented over an eight-week period. During that time, data was gathered and compared to data from the previous year when a vaccination …