Medicine and Health Sciences Commons^™

Improving Patient Satisfaction With Discharge And Recovery Preparedness, Leanne N. Davis

Doctoral Dissertations and Projects

The Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS-CAHPS) survey is a standardized tool healthcare organizations utilize to measure patient perceptions of care. The survey results are linked to reimbursement by many insurers, making it prudent for health systems to work toward increasing patient satisfaction with their care. This evidence-based practice project followed the Iowa Model of Evidence-Based Practice to implement a quasi-experimental pilot that would determine whether providing written and verbal patient discharge education in both the preoperative phase of care and the postoperative phase of care compared to only the postoperative phase of care …

Remind: Raising Awareness Of Nurse Burnout Using An Educational Intervention, Emily Louise Missimer

Doctoral Dissertations and Projects

Burnout is an international occupational phenomenon that can negatively impact one’s physical, emotional, and psychological well-being. Although burnout affects all occupations, professionals working in the healthcare field are known to be at high risk for occupational burnout secondary to factors such as high-stress environments, critically ill patients, increased patient care requirements, frequent exposure to mortality, and shiftwork with long hours, among other factors. Of the subgroup of healthcare providers, it is also widely known that nurses who have a high exposure to death, such as hospice nurses, are at an even higher risk for occupational burnout. At a hospice care …

Active Transport Enables Protein Condensation In Cells, Gaurav Chauhan, Edward G Wilkinson, Yaning Yuan, Samuel R Cohen, Masayuki Onishi, Rohit V Pappu, Lucia C Strader

2020-Current year OA Pubs

Multiple factors drive biomolecular condensate formation. In plants, condensation of the transcription factors AUXIN RESPONSE FACTOR 7 (ARF7) and ARF19 attenuates response to the plant hormone auxin. Here, we report that actin-mediated movement of cytoplasmic ARF condensates enhances condensation. Coarse-grained molecular simulations of active polymers reveal that applied forces drive the associations of macromolecules to enhance phase separation while giving rise to dense phases that preferentially accumulate motile molecules. Our study highlights how molecular motility can drive phase separation, with implications for motile condensates while offering insights into cellular mechanisms that can regulate condensate dynamics.

2025 Prep Symposium Agenda, School Of Medicine

Postbaccalaureate Research Education Program in Biomedical Sciences (PREP)

No abstract provided.

M6a Modification Is Incorporated Into Bacterial Mrna Without Specific Functional Benefit, Klara Szydlo, Leonardo Santos, Thomas W. Christian, Sunita Maharjan, Amir Dorsey, Isao Masuda, Jingxuan Jia, Yuan Wu, Weixin Tang, Ya-Ming Hou, Zoya Ignatova

Department of Biochemistry and Molecular Biology Faculty Papers

N 6-Methyladenosine (m6A), the most abundant modification in eukaryotic messenger RNAs (mRNAs), has also been found at a low level in bacterial mRNAs. However, enzyme(s) that introduce m6A modification on mRNAs in bacteria remain elusive. In this work, we combine deep-sequencing approaches that identify m6A sites with in vitro biochemical studies to identify putative m6A methyltransferases that would modify Escherichia coli mRNAs. We tested four uncharacterized candidates predicted to encode proteins with putative methyltransferase domains, whose deletion decreased the m6A level. However, in vitro analysis with the purified putative methyltransferases revealed that none of them installs m6A on mRNA. Exposure …

Vegf In Diabetic Retinopathy And Age-Related Macular Degeneration, Andrew Callan, Justin Z. Heckman, Giani Tah, Samantha Lopez, Laura Valdez, Andrew Tsin

School of Medicine Publications

Vascular endothelial growth factor (VEGF) plays a key role in angiogenesis throughout the human body, influencing countless physiological and pathological processes, including tumor growth, preeclampsia, and retinal diseases such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). In DR, VEGF promotes retinal neovascularization and intraretinal fluid accumulation, leading to complications like diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Regular intravitreal anti-VEGF injections are commonly used to manage PDR and DME, though repeated treatments are often required, and efficacy can be limited. AMD, a major cause of vision loss in older adults, is characterized by either dry or …

Improving Patients' Confidence In Self-Care Management And Preventing Hospital Readmission Within 30 Days Of Discharge In The Heart Failure Population, Kelly Carroll

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Heart failure (HF) is a chronic, progressive condition and a leading cause of hospital admissions nationwide. The 30-day readmission rate for HF patients is approximately 23.4%, contributing to increased morbidity, mortality, and significant healthcare costs. Each HF-related readmission is estimated to result in a financial loss of $15,789 per patient due to reduced reimbursement from both private and public insurers. This underscores the critical need for timely follow-up care, particularly within the first 30 days post-discharge.Without adequate follow-up and patient education, many individuals lack the confidence and knowledge necessary for safe and effective self-management in the outpatient setting, …

Policy Proposal For Integrating Pediatric Mental Health Into Nursing Practice In Uganda, Giselle S. Perez

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Mental health disorders affect over 1 in 7 individuals aged 10 to 19 globally. In low- and middle-income countries like Uganda, limited access to mental health specialists and pervasive stigma exacerbate the gap in care. Nurses, often the first point of contact, typically lack adequate pediatric mental health training. The proposal aims to address this gap by equipping nurses with the knowledge and competencies to identify, intervene, and support children with mental health disorders. Purpose: This proposal advocates for implementing targeted, continuing education in pediatric mental health for Ugandan nurses. The goal is to enhance the quality of …

Beyond The Bmi: An Educational, Family-Centered Approach To Identifying Risk For Childhood Obesity, Michelle J. Mak

Doctor of Nursing Practice Final Manuscripts

Background: In the United States, the increasing prevalence of obesity has caused public health concerns. From 2017 to 2020, 14.7 million children ages 2 to 19 were considered obese. The main parameter for diagnosis is a body mass index (BMI) at or above the 95th percentile on the growth chart. Additionally, overweight is defined as a BMI between the 85th and 95th percentiles. At a pediatric primary care clinic in San Diego, CA, over a third of patients are considered overweight or obese. Obesity comorbidities can include type 2 diabetes, hypertension, and hyperlipidemia. Overweight adolescents have a 70% likelihood of …

From Fee For Service To Outcome Based Care: A Policy Proposal To Reduce Provider Burnout In Assertive Community Treatment, Amanda M. Thompson

Doctor of Nursing Practice Final Manuscripts

Purpose: This project examines the impact of the fee-for-service (FFS) reimbursement models on provider burnout within Assertive Community Treatment (ACT) programs and proposes a hybrid reimbursement framework that integrates case-rate and outcome-based payment structures. The goal is to enhance care quality, improve provider retention and optimize patient outcomes by addressing financial and administrative inefficiencies inherent in the current model.

Background: Mental illness affects over 59 million U.S. adults with serious mental illness (SMI) presenting significant challenges in healthcare delivery. ACT is an evidence-based, multidisciplinary approach designed to provide intensive, community-based psychiatric care to individuals with serious mental illness (SMI). However, …

Whole Genome Sequencing Identifies Monogenic Disease In 56.1% Of Families With Early-Onset Steroid-Resistant Nephrotic Syndrome, Eman Ramadan

Pharmacy

Genetic causes of steroid-resistant-nephrotic-syndrome (SRNS) represent a rapidly growing number of monogenic diseases. The reported diagnostic yield of various studies applying genetic panels and exome-sequencing to diagnose SRNS is usually < 30%. We performed genome-sequencing in a cohort of Egyptian SRNS patients. We recruited 47 SRNS patients belonging to 41 unrelated families [28 males/19 females; median (range): 6 (0.5-22 years)]. We established a pipeline for genome sequencing, bioinformatics analysis, variant curation and protein modeling at the Egypt Center for Research and Regenerative Medicine (ECRRM). Disease-causing variants were detected in 27/47 patients (57.4%) belonging to 23/41 families (56.1%), including nine novel variants in NPHS1, NPHS2, COL4A3, MYO1E, NUP93, PLCE1, PODXL, SMARCAL1 and WT1. Novel variants were confirmed by Sanger sequencing and were segregated in families of affected patients. NPHS2 was the most common causative gene in 8/23 (34.8%) of confirmed families, followed by NPHS1, WT1, and SMARCAL1 in 2/23 families (8.7%) each. All detected missense variants were evaluated through protein modeling and were predicted deleterious. Our study expanded the spectrum of SRNS disease-causing variants and revealed a monogenic cause in 56.1% of investigated families. In our cohort, no deep intronic or regulatory variants were detected by genome-sequencing. Pursuing genetic diagnosis in SRNS patients is crucial to inform clinical decision making, genetic counseling, transplantation strategy and prenatal diagnosis thus improving clinical outcome of affected patients.

Exposure To And Impact Of Unhealthy Food Marketing On Adolescents And Young Adults: A Narrative Review And Research Agenda, Nicholas Freudenberg, Rositsa Ilieva

Publications and Research

Consumption of unhealthy food has become a leading cause of premature deaths and preventable illnesses around the world. Research shows that marketing by the companies that produce, distribute, and sell unhealthy foods and beverages is associated with increased consumption of these products. To date, however, limited research has focused on the cumulative exposure and impact of various modes of marketing employed to reach distinct populations. In this narrative review, we summarize 25 years of scientific evidence and findings from 108 empirical studies and 19 systematic and scoping reviews of various forms of unhealthy food marketing to adolescents (aged 13 to …

Neuroanatomical And Morphometric Differences In Children Who Stutter, Mohammad A. Khan

Honors Scholar Theses

Childhood-Onset Fluency Disorder commonly known as stuttering is a neurodevelopmental speech disorder characterized by disruptions in speech fluency. While genetic and neurobiological factors are implicated, the structural brain differences underlying stuttering remain unclear. This study investigated neuroanatomical alterations in children who stutter (CWS) compared to typically fluent children (TFC), focusing on gray matter volume, cortical thickness, and surface area in speech-related regions; the Inferior Frontal Gyrus, Middle Temporal Gyrus, and Pre-motor Operculum. High-resolution MRI data from 100 children (48 CWS, 52 TFC) aged 3–12 years were analyzed using FreeSurfer. Group comparisons revealed no statistically significant differences in cortical thickness, surface …

Staff Education On Gad-7 Screening Tool Implementation, Sandra Oghomwen Osemwonta

Walden Dissertations and Doctoral Studies

As a staff educational project, I addressed a critical issue in nursing practice. In many clinical settings, medical personnel are unprepared to use screening instruments such as the Generalized Anxiety Disorder 7-Item (GAD-7) tool because they do not possess the requisite expertise, which often leads to missed or delayed identification of anxiety symptoms. Timely and accurate mental health assessments are essential for effective patient care and improved clinical outcomes. Does an educational program of a Psychiatric outpatient clinic increase staff knowledge and confidence in using the General Anxiety Disorder (GAD-7) tool, compared to baseline knowledge before training? was the central …

A Review Of Medical Ethics In Orthopaedic Surgery: Current Foci And Future Considerations, Ryan X Lam, Zhi Mei Sonia He, Ruhi Thapar, Maggie Wang, Dion G Birhiray, Matthew Milad, Lara Ouellette, Umar Ghilzai, Tucker J Cushing, M Brent Price, Brenden B Ronna, Omar H Atassi, Christopher H Perkins, John R Dawson, William M Granberry, Melvyn A Harrington, Douglas R Dirschl, Lorenzo R Deveza

Library Staff Publications

Medical ethics education is a required component of orthopaedic surgery resident training per the Accreditation Council for Graduate Medical Education (ACGME) guidelines, although no standardized curriculum currently exists.

Beyond the 4 principles of bioethics (autonomy, beneficence, nonmaleficence, justice), additional ethical concepts relevant to orthopaedic care include utilitarianism, deontology, virtue ethics, moral intuitionism, microethics, and narrative ethics.

Ethical themes identified in the literature relevant to orthopaedic surgery include the ethics involved in medical decision-making, use of new technologies, caring for vulnerable patients, performing high-stakes procedures, the impacts of trainee status on patient care, and patient attitude regarding conflict of interest.

Ethical …

International Reputation Of ‘Manipal Journal Of Medical Sciences’, B. V. Murlimanju, Krishnananda R.V. Prabhu

Manipal Journal of Medical Sciences

NIL

Increasing Advance Directive Completion: A Future Initiative For All, Hilda A. Lince

Doctor of Nursing Practice Final Manuscripts

Abstract

Problem Statement: Healthcare providers focus on delivering quality and patient-centered care. Yet, without any direction, healthcare providers treat patients as a full code until someone can speak on the patient’s behalf. Therefore, it is crucial that patients make their wishes known.

Description of Innovation: On a cardiac step-down unit, registered nurses were educated on the PREPARE advance directive. Upon admission to the unit, patients were asked if they had an advance directive. If the patient did not have an advance directive, they were educated on the importance of having an advance directive. Then they were given the PREPARE …

Staff Education On Importance Of Medication Adherence For Patients Living With Schizophrenia, Sonia Obehi Okojie

Walden Dissertations and Doctoral Studies

This DNP project aimed to address the lack of staff knowledge regarding medication adherence in patients with schizophrenia to better support these patients and to address a critical organizational knowledge gap. Schizophrenia is a chronic illness that impacts quality of life and medication noncompliance, often causing relapses and hospitalization. Evidence has shown that medication compliance improves symptoms, reduces hospital visits, and leads to better overall disease outcomes. A review on the project site indicated a wide knowledge deficit for the staff on interventions to enhance compliance to medication regimens by schizophrenia patients. It is an important issue to address in …

Renal Denervation Improves Cardiac Function And Exercise Duration In A Miniswine Model Of Heart Failure With Preserved Ejection Fraction, David J. Lefer, Thomas E. Sharp, Amy L. Scarborough, Amelia G. Haydel, Sanjiv J. Shah, Zhen Li, Traci T. Goodchild

School of Medicine Faculty Publications

Aims: Overactivity of the sympathetic nervous system is a common underlying mechanism in development and progression of several heart failure with preserved ejection fraction (HFpEF) comorbidities. Decreasing renal sympathetic nerve activity using catheter-based renal denervation (RDN) systems have shown efficacy in treating resistant hypertension and cardiac dysfunction in heart failure with reduced ejection fraction. The purpose of this study was to determine if modulation of renal sympathetic nerve activity by RDN improves cardiac function and exercise tolerance in a clinically-relevant minipig model of cardiometabolic HFpEF. Methods and results: Multiple HFpEF comorbidities were induced in adult female Göttingen minipigs by mineralocorticoid …

Mental Health And The Role Of Social Support In The Lives Of Vulnerabilized Sexual Minority Women, Jennifer L. Glick, Megan G. Nguyen, Aimee K. Huang, Kamila A. Alexander, Danielle German

School of Public Health Faculty Publications

Introduction Sexual minority women (SMW; women who self-identify as lesbian, queer, etc., as well as heterosexually-identified women who experience attraction to romantic or sexual partnerships with women) and vulnerabilized women (those marginalized due to structural forces such as housing insecurity, violence, sex exchange, drug use, or HIV positive status) experience a range of mental health challenges compared to their heterosexual and general population counterparts. General populations studies show a positive relationship between social support and mental health; less is known about SMW experiencing intersecting multi-layered vulnerabilities. This study characterizes mental health stressors, identifies social support sources and forms, and explores …

Cost-Effective Solutions For High-Throughput Enzymatic Dna Methylation Sequencing, Amy Longtin, Marina M. Watowich, Baptiste Sadoughi, Rachel M. Petersen, Sarah F. Brosnan, Kenneth Buetow, Qiuyin Cai, Cayo Biobank Research Unit, Vanderbilt University, Michael D. Gurven, James P. Higham, Heather M. Highland, Yi-Ting Huang, Hillard Kaplan, Thomas S. Kraft, Yvonne A. L. Lim, Jirong Long, Amanda D. Melin, Michael J. Montagne, Jamie Roberson, Kee Seong Ng, Michael L. Platt, India A. Schneider-Crease, Jonathan Stieglitz, Benjamin C. Trumble, Vivek Venkataraman, Ian J. Wallace, Jie Wu, Noah Snyder-Mackler, Angela Jones, Alexander G. Bick, Amanda J. Lea

ESI Publications

Characterizing DNA methylation patterns is important for addressing key questions in evolutionary biology, development, geroscience, and medical genomics. While costs are decreasing, whole-genome DNA methylation profiling remains prohibitively expensive for most population-scale studies, creating a need for cost-effective, reduced representation approaches (i.e., assays that rely on microarrays, enzyme digests, or sequence capture to target a subset of the genome). Most common whole genome and reduced representation techniques rely on bisulfite conversion, which can damage DNA resulting in DNA loss and sequencing biases. Enzymatic methyl sequencing (EM-seq) was recently proposed to overcome these issues, but thorough benchmarking of EM-seq combined with …

Untargeted Proteomics Enables Ultra-Rapid Variant Prioritisation In Mitochondrial And Other Rare Diseases, Daniella H Hock, Nikeisha J Caruana, Liana N Semcesen, Nicole J Lake, Luke E Formosa, Sumudu S C Amarasekera, Tegan Stait, Simone Tregoning, Leah E Frajman, Adam M Bournazos, David R L Robinson, Megan Ball, Boris Reljic, Bryony Ryder, Mathew J Wallis, Anand Vasudevan, Cara Beck, Heidi Peters, Joy Lee, Natalie B Tan, Mary-Louise Freckmann, Mitomdt Diagnostic Network For Genomics And Omics, Vasiliki Karlaftis, Chantal Attard, Paul Monagle, Amanda Samarasinghe, Rosie Brown, Weimin Bi, Monkol Lek, Robert Mcfarland, Robert W Taylor, Michael T Ryan, Sandra T Cooper, Zornitza Stark, John Christodoulou, Alison G Compton, David R Thorburn, David A Stroud

Faculty, Staff and Students Publications

Background: Only half of individuals with suspected rare diseases receive a genetic diagnosis following genomic testing. A genetic diagnosis allows access to appropriate care, restores reproductive confidence and reduces the number of potentially unnecessary interventions. A major barrier is the lack of disease agnostic functional tests suitable for implementation in routine diagnostics that can provide evidence supporting pathogenicity of novel variants, especially those refractory to RNA sequencing.

Methods: Focusing on mitochondrial disease, we describe an untargeted mass-spectrometry based proteomics pipeline that can quantify proteins encoded by > 50% of Mendelian disease genes and > 80% of known mitochondrial disease genes in clinically …

Multicomponent Parenteral Lipid Emulsions Do Not Prevent Liver Injury In Neonatal Pigs With Obstructive Cholestasis, Greg Guthrie, Caitlin Vonderohe, Valeria Meléndez Hebib, Barbara Stoll, Douglas Burrin

Children’s Nutrition Research Center Staff Publications

Biliary atresia (BA) is a pediatric liver disease that often necessitates parenteral nutrition (PN) to support growth due to impaired liver function. While soy-based lipid emulsions (SLE) are commonly used in PN, they may contribute to cholestatic liver injury. In contrast, mixed lipid emulsions (MLE) show promise in preventing cholestasis in infants without BA, potentially by restoring bile flow. However, their effectiveness in patients of complete bile duct obstruction, as seen in BA, remains uncertain. To explore the potential benefits of MLE in BA, we utilized a neonatal pig model of bile duct ligation (BDL). Pigs underwent either BDL or …

The Joint Association Of Diet Quality And Sleep Regularity With Incident Cardiovascular Disease In The Multi-Ethnic Study Of Atherosclerosis, Kaitlin S Potts, Claire Veldkamp, Alexis C Wood, Erin D Michos, Raymond Noordam, Tianyi Huang, Susan Redline, Heming Wang

Children’s Nutrition Research Center Staff Publications

Background/objectives: Diet quality and sleep regularity both influence cardiovascular disease (CVD) risk and may influence each other, but there is scarce evidence for their joint or interacting associations in relation to CVD. We assessed these associations in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods: Participants free of CVD with valid diet and sleep measures in 2010-2013 were included and followed through 2020 for detection of incident CVD (188 events detected over 8.8 years among 1782 participants; 55% women). Sleep timing and duration regularity were assessed via the intra-individual SD of sleep onset time and duration across 5- to 7-day actigraphy. …

Staff Education On Documentation For Hospice Registered Nurses, Sharon Spencer Cunningham

Walden Dissertations and Doctoral Studies

Summary Documentation is a part of a daily task that all nurses undertake. Its purpose is to provide validation of care rendered to patients. In the hospice setting, nurses’ documentation is crucial, as it supports whether a patient qualifies to receive hospice services. If proper documentation is not recorded, patients can lose services and organizations can face a loss of revenue and potential fines. At a hospice organization in the Southeast United States, there was little emphasis of the importance of documentation that adheres to guidelines set by Centers for Medicare and Medicaid Services (CMS). Therefore, nurses’ documentation lacked the …

Post-Recovery Viral Shedding Shapes Wastewater-Based Epidemiological Inferences, Tin Phan, Samantha Brozak, Bruce Pell, Stanca M Ciupe, Ruian Ke, Ruy M Ribeiro, Anna Gitter, Kristina D Mena, Alan S Perelson, Yang Kuang, Fuqing Wu

Faculty, Staff and Student Publications

Background: The prolonged viral shedding from the gastrointestinal tract is well documented for numerous pathogens, including SARS-CoV-2. However, the impact of prolonged viral shedding on epidemiological inferences using wastewater data is not yet fully understood.

Methods: To gain a better understanding of this phenomenon at the population level, we extended a wastewater-based modeling framework that integrates viral shedding dynamics, viral load data in wastewater, case report data, and an epidemic model.

Results: Our results indicate that as an outbreak progresses, the viral load from recovered individuals gradually becomes predominant, surpassing that from the infectious population. This phenomenon leads to a …

Increasing Depression Risk Screening In Hospice And Palliative Care Patients, Elizabeth Kanini Michaels

Walden Dissertations and Doctoral Studies

This doctoral project was conducted as a staff education project. The practice problem involved inconsistent depression risk screening in hospice and palliative care patients. It was crucial to address this, as depression can be pervasive in this population. The practice-focused question was, For registered nurses who work in a palliative or hospice care unit, does education on depression risk screening increase depression screening rates as compared 12 weeks before to 12 after the education? The project aimed to improve depression risk screening rates through staff education. The Johns Hopkins nursing evidence-based practice model was used to assess 13 supporting articles …

Prearrival Phone Call Initiative To Decrease Procedural Cancellations And Delays, Fazali Nkoloma

Walden Dissertations and Doctoral Studies

This doctor of nursing practice project evaluation of an organizational quality improvement initiative focused on evaluating the effectiveness of implementing a prearrival phone call process for interventional radiology patients scheduled for procedures requiring moderate sedation or anesthesia. Adherence to NPO guidelines is crucial for patient safety before moderate sedation and anesthesia. The practice problem identified was the number of procedures that were canceled or delayed because of patient nonadherence with NPO guidelines. The practice-focused question that guided this project was, Can the implementation of prearrival phone calls in the preprocedural radiology surgical services help improve patient adherence with NPO protocol …

Staff Education To Improve Patient Outcomes And Treatment Compliance Through Use Of Motivational Interviewing In The Mental Health Setting, Rachel Nardi

Walden Dissertations and Doctoral Studies

Summary: Treatment noncompliance is a significant problem within the realm of mental health care. Recurrent noncompliance increases symptom severity, the likelihood of a crisis, and the burden placed on mental health care resources. Motivational interviewing (MI) is an evidence-based practice (EBP) demonstrated through extensive research to positively affect patient outcomes. Teaching MI to mental health care providers is one option organizational leaders can choose to address treatment noncompliance. In order for MI to become standard nursing practice, a method of education must be developed and implemented. This necessitates the identification of effective education delivery methods. A staff education project was …

Staff Educational Program On The Patient Health Questionnaire-9 Depression Screening Tool In A Psychiatric Outpatient Clinic, Chinwe Genevive Nwaigwe

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) staff education project focused on improving the knowledge and confidence of psychiatric outpatient clinic staff in administering and interpreting the Patient Health Questionnaire-9 (PHQ-9), a critical tool for depression screening. Given the high prevalence of depression and disparities in mental health care, inconsistent PHQ-9 use can lead to delayed diagnoses and unequal access to treatment. Addressing this gap is both a clinical priority and a matter of social justice. I delivered a 2-hour educational program for 17 staff members to improve screening practices. The session included a PowerPoint presentation, role playing, and an interactive …