Abstract The prevalence of diabetes in the United States in 2015 was 30.3 million people; which is the equivalent of 9.4% of the population. It is a major contributor to morbidity and mortality. Depression is often underdiagnosed in these patients, which contributes to poor self-management and poor health outcomes. In a large primary-care practice on the East Coast, there is no guideline for depression screening in the diabetic population. Focusing on this specific primary care setting, the research question addressed the underdiagnoses of depression in diabetic patients. The project evaluated the prevalence of depression among patients diagnosed with diabetes by using the U.S. Preventative Services Task Force (USPSTF) depression screening tool called the Patient Depression Questionnaire. The Grove Model for Implementing Evidence-Based Guidelines in Practice Framework was used in systematically integrating the new practice guideline of screening all diabetes patients for depression. The framework involves identifying the practice problem, locating, and collecting the most well-founded evidence, and evaluating the quality of the evidence-based guideline of screening all diabetes patients for depression. To answer the project question, 135 diabetic patients in a primary care outpatient setting completed the Patient Depression Questionnaire. Descriptive statistics was used to describe the sample and determine the frequency of scores throughout the sample of patients. Ranges of scores and percentages were computed using frequency distribution. Of these 135 diabetic patients, 63.7% showed some level of depression ranging from mild to severe, which was undiagnosed prior to the administration of the screening tool. As a result of the project, recommendations were made to the site to implement the use of the depression screening tool as policy.

Osteoporosis is one of the most common diseases experienced in the older adult population. This condition is not only costly to manage and treat, particularly so when osteoporotic fractures occur, but also negatively impacts functional health and health-related quality of life for many individuals. This indicates the need for more to be done to prevent osteoporosis from developing initially. While bone mineral density (BMD) testing recommendations are in place for women aged 65 and older and men aged 70 and older to diagnose osteoporosis, there currently are no BMD testing recommendations for preventive or screening purposes in the general, healthy, adult population. One potential screening tool for bone strength is a peak vertical jump test. Peak vertical jump height can be used as a proxy for lower body muscle power, which has been identified as an influential factor in determining bone mass and geometry, both of which are critical aspects of bone strength. This study ascertained the relationship between muscle power and bone strength, as well as the capacity of a peak vertical jump test to identify young adults with below-average areal BMD (aBMD). A total of 303 young adults (18 to 22 years, n=136 males, n=167 females) participated in these cross-sectional analyses. DXA was used to assess aBMD for total hip and femoral neck, and DXA images were used to calculate femoral neck section modulus (FN Z) values. Peripheral quantitative computed tomography (pQCT) was used to assess indices of bone strength at the tibia. Cortical bone area (CoA) and density-weighted polar section modulus strength-strain index (SSIp) were assessed at the 38% midshaft site, and bone strength index (BSI) was assessed at the 4% midshaft site. Lower body muscle power was predicted using peak vertical jump height and the Sayers et al. (1999) equation. Data were analyzed using Pearson bivariate and partial correlations to examine associations among bone strength outcomes and muscle power. Logistic regression was used to examine the probability of below-average bone strength based on muscle power. Receiver Operating Characteristic (ROC) curve analysis was used to show the tradeoff between sensitivity and specificity and to display the accuracy of a peak vertical jump test as an assessment tool for aBMD. Logistic regression indicated the odds ratio of below-average height-adjusted femoral neck aBMD decreased 5.4% for females and 3.6% for males per 50 Watts of power. ROC curve analysis showed the best sensitivity-specificity trade-off for identifying individuals with and without below-average aBMD was 5,038 Watts in males (sensitivity = 73.7%; specificity = 62.4%; AUC = 0.709, 95%CI = 0.572 - 0.847) and 3,261 Watts in females (sensitivity = 71.4%; specificity = 58.9%; AUC = 0.708, 95%CI = 0.586 - 0.829). These cut off values correspond to a vertical jump height of 54.39 cm and 36.16 cm for males and females, respectively. Taken together, the results of these analyses suggest acceptable sensitivity and specificity and moderate discriminate ability for using a measure of muscle power, assessed with a peak vertical jump test, to identify young adults with below-average aBMD.

Due to the continuous growth of patients with mental disorders, it has been a strenuous job to look after each patient and tailor the appropriate treatments for them on time. The thesis proposes a design science framework in the form of an IT artefact to prioritize the patients with mental disorders, considering the severity of the situation. The IT arte-fact will be using expert’s knowledge to design a self-assessment screen-ing tool that will evaluate the criticality of a patient’s mental health. This tool will also incorporate the psychometric scale DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure, Adult electronically to de-termine what will be the next stage in the process of patients’ treat-ments. The process of prioritizing patients is prolonged and remains to be tedious at the hospital and also there is always a possibility of miss-ing some information while carrying out the job manually. The self-assessment system will serve two goals. It will shorten the initial screen-ing process and also the likelihood of any human error. The system is not meant to replace healthcare professionals but to build a bridge be-tween the patients and the doctors to make everyone’s life more orga-nized. The results indicate that it is possible to create a framework and the relevant prototype with the help of expert’s knowledge that can prioritize patients with mental disorders. It also demonstrates that the system can digitalize DSM-5 Self-Rated Level 1 Cross-Cutting Symp-tom Measure, Adult scale to determine possible problem domains for further diagnosis.

Accumulative family risk factors can have a detrimental impact on young children's social emotional development and future school readiness. Identifying family risk and resilience factors can be a first step in linking families to needed services. Programs that serve families and children need a brief and valid screening tool that can quickly assess family strengths and needs. This study examined the validity and utility of the Environmental Screening Questionnaire (ESQ), a brief caregiver report of the family's situation. Participants included 324 parent/child (ages 3-60 months) dyads from a sample of programs that serve at-risk families (n = 72) and an online sample of caregivers (n = 252). Results from data analyses evaluating the validity and utility were promising. Validity was investigated by examining convergent validity using the Parenting Stress Index-Short Form. Caregivers from the online sample who had more family risk factors, as identified in the ESQ, were more likely to have elevated levels of stress (r = .23). Moreover, children from families with increased risk factors tended to have higher scores on the Ages and Stages Questionnaire: Social Emotional (ASQ:SE) for two age intervals, 6 and 48 months, for the online sample. Utility data were gathered from caregivers and program staff. Results suggest the ESQ is an effective and useful screening measure that can help professionals identify areas of resource need, organize referral information, and monitor family outcomes. Caregivers found the ESQ to be helpful in understanding personal areas of risk and how risk and resilience factors can affect children's social emotional development. This study assisted in developing preliminary "red flag" risk factors that may be useful to programs serving families and children. Testing of the "red flags" is discussed for future research. / 10000-01-01

Mental health care is critical and while governments are trying to increase awareness of the problem the available resources is not sufficient to confront the growing problem. The thesis proposes a design theory, using Gregor and Jones’s (2007) ‘Anatomy of a Design Theory’ framework, for the current mental illness dilemma that all societies are facing. The proposed solution is one of using information systems, together with domain knowledge and conventional instruments from the field of psychology to create a general screening tool. The design theory takes an ontological approach to defining the domain’s knowledge, using the MINI instrument along with expert knowledge to form the basis of the artifact. The artifact consists of four main entities: Background Information, Screening Questions, Pre-Requisite Questions and Other Questions. The thesis discusses the theoretical rationale for the screening took and then presents an instantiation of the artifact. This tool would be able to screen any person (with the exception of the mentally handicapped) to ascertain if they have a mental disorder as defined in the DSM-IV.

Magister Public Health - MPH / Despite the effectiveness and scale-up of antiretroviral treatment (ART), HIV-Associated neurocognitive disorders (HAND) still persist. Currently no gold standard tool exists to detect all forms of HAND, including major and minor cognitive impairments. In light of this, a newly developed screening tool was conceptualised, namely the Quick Paediatric Neurocognitive Screening tool (QPNST). The QPNST has been developed to detect HAND in perinatally HIV-infected children aged 5-10 years.

This dissertation describes the development of a system for the automated, high-throughput screening of organic reactions. This system utilizes a liquid handling robot for reaction mixture preparation combined with desorption electrospray ionization mass spectrometry (DESI-MS) for reaction mixture analysis. With an analysis speed of ~1 second per reaction mixture, this system is capable of screening thousands of reactions per hour. Reaction mixtures are prepared in 384-well microtiter plates using a liquid handling robot. A sample of each reaction mixture (50 nL) is then transferred to a PTFE coated, glass slide using a pin tool. By offsetting the placement of the pin tool during each transfer, up to 6,144 unique reaction mixtures can be placed on each slide. The slide is then transferred to the DESI stage by a robotic arm, and the DESI-MS analysis begins, taking as little as 7 minutes for 384 reaction mixtures. We utilize a scheduling software to control each component of the system, which automates the entire process from reaction mixture preparation to DESI-MS analysis. In order to efficiently analyze and visualize the extremely large data sets generated by the system, we developed a custom software suite to automatically process each data set. We have used this system to screen several classes of industrially relevant reactions including Suzuki coupling, nucleophilic aromatic substitution, reductive amination, and Sonogashira coupling. We have validated both positive and negative results from the system using flow chemistry, and we have observed excellent agreement between the two methodologies. By being capable of screening thousands of reactions per hour, requiring only microliter quantities of reaction mixtures, and consuming less than a milliliter of solvent during the DESI-MS analysis, this system significantly reduces the time and costs associated with organic reaction screening.

A Quality Improvement project to initiate the Confusion Assessment Method (CAM) delirium screening tool at a Skilled Nursing Facility and Rehabilitation Center in East Tennessee -- by S. Joseph Jadav, Doctor of Nursing Practice Candidate at East Tennessee State University. Purpose/Aims: The aim of this project is to implement a delirium screening protocol in a skilled nursing and rehabilitation facility which will aid in early detection of signs and symptoms of delirium in older adults. This early detection followed by an early intervention can help reduce costs and decrease mortality rates with better outcomes. Processes: A CAM screening is conducted on each patient (male & female) for delirium for a period of four weeks. Data collection will comprise of the number of patients assessed and the total number of positive and negative delirium cases. It was determined that the proposed activity is not research involving human subjects according to United States Department of Health and Human Services (DHHS) regulations by the university’s Institutional Review Board (IRB). Results: The project is currently in the data collection phase. Limitations: Refusal to participate either by the patient or family in the screening. Conclusions: While nearly 80% of delirium cases in an acute care setting go undetected or undiagnosed, this project to implement a delirium screening protocol in a skilled nursing facility is even more imperative in early detection and early intervention.

According to the Centers for Disease Control and Prevention, prescribers should evaluate risk factors related to opioid use prior to initiation of opioid medication. The practice problem in this DNP project was that providers failed to consistently assess patients with complaints of pain for risk of opioid misuse and/or abuse prior to initiating opioid medication. An opioid risk-assessment screening tool (ORAST) has the potential to identify patients at high risk for opioid misuse and/or abuse. The purpose of this Doctor of Nursing Practice project was to identify and introduce an ORAST and then develop a policy to guide providers in its use in an ambulatory care clinic. Rosswurm and Larrabee's model for evidence-based practice served as the framework that helped guide project development. Evidence in the literature review supported The Opioid Risk Tool (ORT) as the most appropriate tool for the clinic. An 11-member project team voted unanimously for the ORT and to develop a policy to guide the use of the tool in the clinic. The ORT and its policy were evaluated by the team using the AGREE II Instrument. The team agreed that the ORT and its policy should be implemented into their practice setting (64% strongly agreed and 36% moderately agreed). A summative evaluation supported the Doctor of Nursing Practice student leadership of the project. Use of an ORAST has the potential to create positive social change by reducing the number of prescribed opioid by assisting providers in determining a patient's plan of care based on the patient's level of risk for prescription opioid misuse and/or abuse. Patient outcomes may be improved through reduction in opioid misuse and/or abuse.

Huvuddelen av den svenska ambulanssjukvården har idag begränsat med verktyg för att effektivt kunna identifiera patienter med sepsis. Laktat ackumuleras i blodet vid syrebrist i kroppens vävnader vilket kan uppstå i samband med sepsis. Prehospital laktatbestämning kan vara en metod för att ge ambulanssjuksköterskan underlag för bedömning av patienter med sepsis. Ambulanssjuksköterskan är skyldig att arbeta patientsäkert och med evidensbaserade metoder. Prehospital laktatbestämning är en metod som bör bygga på en god vetenskaplig grund för att kunna anses vara evidensbaserad.  Syftet var att beskriva det vetenskapliga underlaget för nyttan med prehospital laktatbestämning hos patienter med sepsis.  Litteraturstudie valdes som metod och data samlades in via databaserna Cinahl, PubMed och SweMed+. Tolv artiklar kunde inkluderas, vilka alla var originalartiklar, skrivna på svenska eller engelska och publicerade mellan år 2007 och 2017. Sökorden kombinerades med hjälp av booleska sökoperatorer. Det insamlade materialet analyserades genom textanalys vilket mynnade ut i fyra teman där gemensamma mönster och regelbundenheter identifierades i de olika artiklarna.  Resultatet efter genomförd textanalys bestod av fyra teman; laktat och allvarlig sjukdomsutveckling, laktatbestämning kopplat till mortalitet, laktatbestämning bidrog till tidigare identifiering och snabbare behandling av sepsis samt nyttan med laktatbestämning kunde inte styrkas.  Slutsatsen var att resultatet tydde på att prehospital laktatbestämning kunde bidra till tidigare identifiering av patienter med sepsis och att det fanns en koppling till mortalitet. Dock ansågs det vetenskapliga underlaget vara alltför begränsat för att metoden med säkerhet skulle kunna anses vara evidensbaserad och därmed patientsäker. / Most of the Swedish ambulance service has limited access to screeningtools for efficiently identifying patients with sepsis. Lactate does accumulate in the blood as a result of hypoxia of the bodily tissues, which may occur during sepsis. Prehospital lactate reading might be a method for assisting ambulance personnel in assessing patients with sepsis. The ambulance nurse must work according to patient safety and use evidence based methods. Prehospital lactate reading is a method which should rely on a solid scientific basis to be considered as evidence based.  The aim of this study was to describe the scientific basis for the benefit of prehospital lactate reading in patients with sepsis.  The method chosen was a systematic literature review and data were collected via three databases; Cinahl, PubMed and SweMed+. A total of twelve scientific articles were included, all original articles written in swedish or English and published between year 2007 and 2017. The keywords were combined using boolean search operators. The material was analyzed using content analysis which resulted in forming of four themes where patterns and regularities were identified from the included studies.  The result consisted of four themes; lactate and poor outcome, lactate reading associated to mortality, lactate reading contributed to early identification and reduced time to treatment of sepsis and finally; the benefit of lactate reading could not be proven.  As conclusion, the result indicated that prehospital lactate reading could improve identification of septic patients and there was an association to mortality. There was not enough research available to strongly consider the method of prehospital lactate reading to be evidence based.