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Title: Improving perioperative nausea and vomiting prophylaxis protocol compliance
Creator: Franz, Allison
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Postoperative nausea and vomiting (PONV) is a significant concern in anesthesia practice. Evidence-based guidelines have sought to provide recommendations on identifying patients at risk for PONV and mitigating its effect with multimodal antiemetic strategies. An anesthesia department within a large teaching hospital uses the Anesthesiology Performance Improvement and Report Exchange guidelines to identify and manage patients at risk for PONV. These guidelines are intended to integrate best...
Show morePostoperative nausea and vomiting (PONV) is a significant concern in anesthesia practice. Evidence-based guidelines have sought to provide recommendations on identifying patients at risk for PONV and mitigating its effect with multimodal antiemetic strategies. An anesthesia department within a large teaching hospital uses the Anesthesiology Performance Improvement and Report Exchange guidelines to identify and manage patients at risk for PONV. These guidelines are intended to integrate best practices into anesthetic care and improve overall surgical outcomes. The anesthesia department currently has a PONV protocol in place that aligns with the guidelines but has not achieved their compliance benchmark. This evidence-based quality improvement project describes interventions proposed to increase compliance with the PONV protocol. To address poor PONV compliance, an anonymous survey was developed to assess anesthesia provider's current familiarity with the new PONV guidelines and identify misconceptions. A visual feedback system was implemented using a preliminary confidential list that anonymizes staff. This allowed individual providers to identify their own performance in relation to their peers in a non-punitive way. The results of this quality improvement project demonstrate that the proposed interventions increased departmental compliance.
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Title: Development and implementation of an enhanced recovery after surgery protocol for women undergoing a mastectomy
Creator: Braun, Michael
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: This evidenced-based practice initiative includes the development and implementation of an evidence-based enhanced recovery after surgery (ERAS) guideline with a specific focus on the incidence of postoperative nausea and vomiting (PONV) and opioid administration in the postoperative setting. The clinical question was in adult women, age 18 years or greater, undergoing a mastectomy procedure, does the implementation of an ERAS guideline lower the incidence of PONV and reduce morphine...
Show moreThis evidenced-based practice initiative includes the development and implementation of an evidence-based enhanced recovery after surgery (ERAS) guideline with a specific focus on the incidence of postoperative nausea and vomiting (PONV) and opioid administration in the postoperative setting. The clinical question was in adult women, age 18 years or greater, undergoing a mastectomy procedure, does the implementation of an ERAS guideline lower the incidence of PONV and reduce morphine milligram equivalent (MME) requirements in a post-anesthesia care unit (PACU)? Patients undergoing breast cancer surgery have multiple risk factors and the reported incidence of PONV reaches up to 80%. Over half of post-surgical breast cancer patients develop neuropathic pain syndromes. A mastectomy ERAS guideline was developed then applied to the perioperative course of 22 patients. It was found that following an ERAS guideline reduced the incidence of PONV by 17% and reduced the average MME by 13.5 equivalents. Project implications include potential cost savings, reduced PACU length of stay, and improved patient outcomes.
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Title: Increasing point of care testing for glycated hemoglobin A1c levels in a family health clinic
Creator: Wielgos, Elizabeth
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Background: Adults with type 2 diabetes mellitus (DM) have and continue to increase significantly within the United States (U.S.). The current recommended glycated hemoglobin A1c (HbA1c) goal for a nonpregnant healthy adult is a value of 7% to lower the risk of DM-related complications (American Diabetes Association [ADA], 2021). Because a goal of 7% may not be feasible in many cases due to other variables, each person with diabetes should have an individualized goal and treatment plan based...
Show moreBackground: Adults with type 2 diabetes mellitus (DM) have and continue to increase significantly within the United States (U.S.). The current recommended glycated hemoglobin A1c (HbA1c) goal for a nonpregnant healthy adult is a value of 7% to lower the risk of DM-related complications (American Diabetes Association [ADA], 2021). Because a goal of 7% may not be feasible in many cases due to other variables, each person with diabetes should have an individualized goal and treatment plan based on their health history and age (ADA, 2021). Compared to a lab draw, which can take hours to days before the provider can see the results, point of care testing (POCT) is more convenient because it produces results in minutes. Purpose: The goal of this quality improvement project was to enhance patient outcomes by introducing an algorithm to ensure that patients with diabetes were effectively managed according to the American Diabetes Association's current recommendations using POCT. Results: The data were subjected to Chi-square and T-tests, but no statistical significance was found. However, analysis of the data revealed many findings consistent with clinical significance. Conclusion: After analysis of the data from this quality improvement (QI) project, findings showed there was a positive correlation between POCT for HbA1c and an increase in values <9%. It was recommended staff continue to apply the algorithm to analyze the long-term outcomes of utilizing POCT for HbA1c in the family medicine clinic.
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Title: A quality improvement project addressing perioperative glycemic guideline adherence
Creator: Caldwell, Samuel Q.
Date: 2021
Collection: Doctor of Nursing Practice Projects
Description: A quality improvement project was conducted within the surgical department of a mid-Michigan hospital following concerns for lack of adherence to current protocols regarding perioperative glycemic management and not meeting statistical expectations. Project stakeholders and initiators configured protocol simplification and educational meetings in hopes to improve protocol adherence and statistical improvement for preoperative glycemic management. Literature synthesis and evidence-based...
Show moreA quality improvement project was conducted within the surgical department of a mid-Michigan hospital following concerns for lack of adherence to current protocols regarding perioperative glycemic management and not meeting statistical expectations. Project stakeholders and initiators configured protocol simplification and educational meetings in hopes to improve protocol adherence and statistical improvement for preoperative glycemic management. Literature synthesis and evidence-based directives drove the project implementation and goals. A three month implementation period was tracked and data was queried with the assistance of stakeholders at the project site and overall comparisons and attributions were drawn. Post-implementation and data collection, data was compiled into a formal conclusive presentation to both the project site as well as the Michigan State University College of Nursing addressing successes and short-falls of the overall project. Retrospective conclusions were drawn and recommendations for future quality improvement projects regarding this topic were discussed in order to continue the quality improvement process.
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Title: Increasing breast cancer self-awareness and screening in a vulnerable population through faith-based community outreach
Creator: Carpenter, Lauren J.
Date: 2021
Collection: Doctor of Nursing Practice Projects
Description: Breast cancer is one of the leading cancer diagnoses for women in the United States. Certain vulnerable populations are at an increased risk for breast cancer mortality, including homeless and African American women. Providing healthcare navigation, cancer education, and connecting with faith-based communities has shown to increase cancer screening rates and knowledge in these vulnerable populations. The purpose of this QI project was to provide breast cancer screening education and access to...
Show moreBreast cancer is one of the leading cancer diagnoses for women in the United States. Certain vulnerable populations are at an increased risk for breast cancer mortality, including homeless and African American women. Providing healthcare navigation, cancer education, and connecting with faith-based communities has shown to increase cancer screening rates and knowledge in these vulnerable populations. The purpose of this QI project was to provide breast cancer screening education and access to care with the goal of increasing breast cancer screening rates and breast self-awareness among at-risk women in a midwestern Michigan community attending faith-based organizations. The project was implemented at three different faith-based communities, including a community soup kitchen serving homeless people and two predominantly African American churches. An educational presentation was created to deliver tailored breast cancer information. Participants were also provided the opportunity to be enrolled for a free mammogram. The intervention was delivered virtually via a PowerPoint presentation on a secure zoom session. Enrollment forms were provided for eligible participants to be screened with a mammogram. Participant's attitudes, knowledge, and confidence towards breast cancer screening were measured before and after the intervention with surveys. A statistically significant increase in participant's knowledge regarding breast cancer screening was found among the 15 total participants. This project demonstrates that education in conjunction with faith-based communities can increase breast cancer knowledge and screening in vulnerable populations to reduce breast cancer mortality.
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Title: Improving advance care planning and advance directive rates in primary care through a multidisciplinary approach
Creator: Johnson, Vanessa N. (Vanessa Nichole-Castillo)
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Background and Review of Literature: Lack of advance care planning (ACP) leads to unwanted treatments and suffering for patients, along with increased healthcare costs. Certain vulnerable populations are at increased risk for unnecessary suffering, including those with high emergency department (ED) utilization rates and one-year prognoses. Providing ACP education to providers and utilization of the multidisciplinary team has been shown to increase ACP and advance directive (AD) rates in...
Show moreBackground and Review of Literature: Lack of advance care planning (ACP) leads to unwanted treatments and suffering for patients, along with increased healthcare costs. Certain vulnerable populations are at increased risk for unnecessary suffering, including those with high emergency department (ED) utilization rates and one-year prognoses. Providing ACP education to providers and utilization of the multidisciplinary team has been shown to increase ACP and advance directive (AD) rates in these vulnerable populations within primary care. Purpose: The purpose of this QI project was to increase the percentage of robust ACP conversations and the completion and documentation of ACP/ADs in the electronic medical record (EMR). Methods: The project was implemented at a primary care clinic in a midwestern Michigan community. DNP students attended an informational meeting regarding the organization's EMR-based ACP tool. An educational session regarding robust ACP was held for providers, a decision tree was developed to both guide ACP appointments with a specialist and ensure proper documentation into the EMR, and scripting was created to help guide ACP conversations. Implementation Plan/Procedure: Members of the multidisciplinary team utilized the intervention. Data collection included the percentage of empaneled patients with a durable power of attorney for healthcare (DPOAH) on file, the total number of robust ACP conversations completed, and the number of patients on the population health targeting list were collected. Post-intervention, an online survey was used to assess the provider's attitudes, knowledge, and confidence towards the decision tree. Implications/Conclusion: The intervention produced positive outcomes, which included an increase in completed and documented ACP/AD and provider knowledge regarding ACP.
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Title: Perinatal depression screening program evaluation
Creator: Murphy, Maeghan
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Perinatal mood and anxiety disorders (PMADs) are extremely common and can occur unpredictably during and after pregnancy. If left untreated, PMADs can be detrimental to the long-term health of both mothers and infants. The Edinburgh Postnatal Depression Scale (EPDS) is an effective and well-accepted screening method for identifying PMADs. The findings from a literature review emphasized the clinical importance of screening as well as the value of a quality improvement approach. The objective...
Show morePerinatal mood and anxiety disorders (PMADs) are extremely common and can occur unpredictably during and after pregnancy. If left untreated, PMADs can be detrimental to the long-term health of both mothers and infants. The Edinburgh Postnatal Depression Scale (EPDS) is an effective and well-accepted screening method for identifying PMADs. The findings from a literature review emphasized the clinical importance of screening as well as the value of a quality improvement approach. The objective of this Doctor of Nursing Practice (DNP) project was to analyze the PMAD screening practices at a busy women's health clinic in Metro Detroit by conducting an in-depth chart review. Data gathered from this evaluation was utilized by clinic leadership to better serve patients by addressing current screening deficits within the practice. Specific areas of improvement identified by this evaluation included the need to increase the percentage of EPDS screens completed at the initial obstetric (OB) visit and ensuring behavioral health referrals were being made when patients have a positive screen.
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Title: Challenges to agricultural financing in Mali
Creator: Konare, Kadidia
Date: 2001
Collection: Electronic Theses & Dissertations
Description: In Mali, like in many Sub-Saharan countries, inadequate access to credit has remained a central concern for farmers and a key constraint to the modernization and diversification of their activities. The commercial banks' limited participation in agricultural financing and the hard terms and conditions for obtaining individual loans have penalized many smallholders and small traders. The vast majority of these people have little to no access to financial services, limiting their productivity,...
Show moreIn Mali, like in many Sub-Saharan countries, inadequate access to credit has remained a central concern for farmers and a key constraint to the modernization and diversification of their activities. The commercial banks' limited participation in agricultural financing and the hard terms and conditions for obtaining individual loans have penalized many smallholders and small traders. The vast majority of these people have little to no access to financial services, limiting their productivity, income, investment and overall quality of life. Inadequate regulatory/legal frameworks, monetary policies, inappropriate agricultural loan evaluations and threats to sound microfinance activities are constraining agricultural financing in Mali.
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Title: Characteristics and use of first lactation records in young sire evaluation
Creator: Powell, Rex Lynn
Date: 1968
Collection: Electronic Theses & Dissertations

Title: Comparative effects of colchicine and various nucleic acid salts upon somatic mitosis
Creator: Powell, Shirley Susan
Date: 1951
Collection: Electronic Theses & Dissertations

Title: Inactivation of infectious bronchitis virus infectivity by para-chloromercuribenzoate
Creator: Powers, Charles Donald
Date: 1965
Collection: Electronic Theses & Dissertations

Title: Staff development of case workers in the Ingham County Bureau of Social Aid, Michigan, from 1944 to 1954
Creator: Pollard, Rhoda Beatrice
Date: 1955
Collection: Electronic Theses & Dissertations

Title: Minimum embedding dimension from the perspective of persistent homology
Creator: Sukhu, Christopher Lloyd
Date: 2019
Collection: Electronic Theses & Dissertations
Description: "We investigate the use of 1-dimensional persistence diagrams to determine minimum embedding dimension. In particular, we test the claim that persistence diagrams look qualitatively the same once the correct dimension is reached. In some cases, this appears to not be true so we turn to a quantitative measure, the bottleneck distance, to see if the persistence diagrams are close once the minimum embedding dimension is attained. In some instances, we see that the persistence diagrams fail to...
Show more"We investigate the use of 1-dimensional persistence diagrams to determine minimum embedding dimension. In particular, we test the claim that persistence diagrams look qualitatively the same once the correct dimension is reached. In some cases, this appears to not be true so we turn to a quantitative measure, the bottleneck distance, to see if the persistence diagrams are close once the minimum embedding dimension is attained. In some instances, we see that the persistence diagrams fail to converge experimentally under the bottleneck distance. The main issue appears to be that it is difficult to explicitly characterize the persistent homology of delay embeddings of arbitrary time series. Instead we restrict to periodic time series where there exists such an explicit characterization. We apply Fourier analysis to see that that number of peaks in the frequency spectrum of a delay embedded time series is related to the minimum embedding dimension. Moreover, we give a method to filter out less significant peaks while not altering the persistent homology much, with respect to the bottleneck distance."--Page ii.
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Title: The effectiveness of mirror imitation training on the generalization of imitation skills for children with autism spectrum disorder
Creator: Galimberti, Anjela Janai
Date: 2019
Collection: Electronic Theses & Dissertations
Description: "The ability to imitate is a foundational skill related to multiple aspects of social, play, and language development in children. However, many children with autism spectrum disorder (ASD) do not imitate as effectively as their typically developing peers and therefore need direct instruction to acquire imitative repertoires. The current study investigated the effectiveness of Mirror Imitation Training: a relatively novel instructional procedure which uses a mirror as a tool to teach...
Show more"The ability to imitate is a foundational skill related to multiple aspects of social, play, and language development in children. However, many children with autism spectrum disorder (ASD) do not imitate as effectively as their typically developing peers and therefore need direct instruction to acquire imitative repertoires. The current study investigated the effectiveness of Mirror Imitation Training: a relatively novel instructional procedure which uses a mirror as a tool to teach imitation skills. Three children with autism spectrum disorder who did not demonstrate a generalized imitation repertoire despite exposure to conventional imitation training methods were selected for participation. For all three participants, mirror imitation training was effective at producing skill acquisition across two sets of imitation targets and increased responding to the remaining untrained sets of imitation targets. Supplemental findings also showed 2 of the 3 participants required fewer sessions to criteria on set 2 after meeting criterion for their set 1 with MIT. These findings identify mirror imitation training as a promising teaching method to promote generalized imitation skills in children with ASD who do not demonstrate generalized imitation skills when taught with more traditional methods of imitation instruction."--Page ii.
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Title: Inheritance of palm patterns in man
Creator: Pocklington, Clare P.
Date: 1937
Collection: Electronic Theses & Dissertations

Title: Private label and national brand prepared foods : a pilot study of the relationship of space allocation to net profit
Creator: James, Gordon D.
Date: 1962
Collection: Electronic Theses & Dissertations

Title: Packaged convenience and education : key to the revitalization of the produce department
Creator: Ihlenfeld, Terry M.
Date: 1960
Collection: Electronic Theses & Dissertations

Title: A comparison of two mediation analysis methods with sequential mediators
Creator: Bennett, Kyle
Date: 2019
Collection: Electronic Theses & Dissertations
Description: "Two methods for mediation analysis with sequential mediators were compared using multiple simulation scenarios. The performances of each method were assessed using three key metrics: relative bias, root mean square error, and coverage. The methods shared both similarities and key differences and some modification and adjustment were necessary to perform comparable simulations across the scenarios. Overall performance was assessed primarily using relative bias, where each simulated effect...
Show more"Two methods for mediation analysis with sequential mediators were compared using multiple simulation scenarios. The performances of each method were assessed using three key metrics: relative bias, root mean square error, and coverage. The methods shared both similarities and key differences and some modification and adjustment were necessary to perform comparable simulations across the scenarios. Overall performance was assessed primarily using relative bias, where each simulated effect estimate was compared to a "true" effect generated by simulating from a theoretical super population. Simulation scenarios included correctly specified models using both methods and various mis-specified estimation models by incorrectly specifying a critical parameter in the model to assess the performance and robustness of each mediation analysis method. The results of the simulations suggest that one method was particularly more resilient to mis-specification of the model over the other, and that proper specification of the marginal structural model is also critical to minimizing bias and maximizing coverage."--Page ii.
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