Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Background: Due to arduous demands of graduate education, advanced practice nursing (APN) students who are classified as adult learners are at risk for suffering sleep deprivation. Factors contributing to sleep deprivation include stress, expected academic challenges, and everyday life stressors. Purpose: This study investigated if APN students’ grade-point average (GPA), gender, and employment status predicted levels of daytime sleepiness. Theoretical Framework. The psychological well-being model selected for this study was consistent with the theory that sleep is a resource essential to well-being; adequate sleep is the resource needed to optimally manage stressful life demands. Methods. Bivariate and multiple regression were employed to examine the relationship between GPA, gender, and employment status with daytime sleepiness on a sample of APN students (N = 123) in their second academic year. The Epworth Sleepiness Scale and a demographic questionnaire were used to record data on GPA, gender, and employment status. Results. Results showed ESS and GPA were negatively correlated and statistically significant (r = -.24, p < .05). This indicates that as the tendency for sleepiness increased, GPA decreased, thereby supporting the alternative hypothesis. Although not statistically significant, employed participants reported greater daytime sleepiness, as did women. Conclusions: When GPA, gender, and employment were combined, multiple correlation showed a statistically significant shared variance of 8% with daytime sleepiness, due primarily to the correlation between GPA and daytime sleepiness. The effect size of shared variance was between small and medium with respect to magnitude of importance.

Background: Caring for patients with malignancies and presenting hyperglycemia has been an ongoing problem that needed to be addressed. The Endocrinologist Society and the Joint British Diabetes Societies for Inpatient Care suggested a change in the process by which patients in this population are managed. Purpose: The purpose of this project was to implement evidence-based practice guidelines for managing steroid-induced hyperglycemia focusing on the interdisciplinary team and adaptation of nurses who care for patients with malignancies. Theoretical Framework: The theoretical framework selected for this project was Roy’s Adaptation Model. Methods: This project used a mixed method approach, with a triangulation design and incorporation of focus groups and a survey to evaluate the multidisciplinary team adaptation. Results: The results indicated that 93% of the team reported positive perceptions of adaptation to the change in blood glucose monitoring with this patient population. Dietary staff expressed some concern with their change in procedures to support the steroid-induced hyperglycemia protocol. Conclusion: This project demonstrated that the healthcare team can adapt to changes, that changes are difficult but needed to improve patients’ outcomes. The pursuit of evidence-based practice involves ongoing appraisal of current standards of care with patient outcomes for consideration of the need for change or a paradigm shift.

Background: Obesity is a significant healthcare problem in modern American society. It has led to decreased longevity of employees and decreased productivity in day-to-day duties of healthcare workers. There are more negative attributes to obesity than positive, regardless of the race affected. One of the leading causes of death in 2012 was cardiovascular disease. Due to poor dietary choices, the promotion of sedentary lifestyle has led to complications of obesity such as high blood pressure and diabetes. Major improvements can be made within a community that acknowledges the risks of obesity and seeks to implement preventive programs. Increasing one’s physical activity and implementing healthier dietary choices leads to a reduction in cardiovascular diseases. Purpose: The purpose of this quality improvement project was to develop an evidence-based obesity prevention program for the healthcare facility staff to increase physical activity within the workplace. Theoretical Framework: Health Belief Model Theory. Methods: The investigator used a quasi-experimental approach using a pretest/posttest design. Results: The results of the data analysis revealed positive perception changes in acceptance to the implementation of physical activity in the workplace. Within two weeks of the project completion, the investigator noted a 69.23 percent increase in the implementation of physical activity in the work and home setting, and an 84.62% change in the manner individuals made food choices, with a median percentage rate of 96.2 for awareness of obesity, overweight health status, and cardiovascular disease risk factors. Conclusion: The evidence-based worksite obesity prevention initiative provides support and acceptance for the implementation of physical activity in the work setting.

Currently, a microalbumin urine test is an annual test for diabetic patients recommended by the American Diabetes Association, but primary care providers are not ordering the tests. This may be, in part, attributable to the fact that there are no guidelines for ordering microalbumin urine tests. The purpose of this capstone project was to assess providers' compliance in identifying the need for the microalbumin urine test for patients with diabetes, to develop evidence-based guidelines for monitoring and ordering microalbumin urine tests, and to evaluate providers' compliance. Rogers's theory of the diffusion of innovation provided the framework for this capstone project. A quantitative, descriptive design using a non-parametric paired t-test was used. Data was collected pre- and post-evidence based practice guidelines implementation in electronic health records. The mean monthly percentage of diabetic patients given microalbumin urine tests pre-implementation was 66.86 (SD = 4.25; 95% CI = (64.17, 69.56). The mean monthly percentage of diabetic patients given microalbumin urine tests post-implementation was 73.53 (SD = 2.58; 95% CI = (70.32, 76.73). SPSS version 23 (IBM Corp., Armonk, NY). The two sample t-test was statistically significant, t (15) = -3.232, p = 0.006). The introduction of evidence-based practice guidelines for ordering microalbumin urine tests improved provider compliance.

Competitive swimmers frequently injure their shoulders. The risk factors for shoulder injuries in competitive swimmers have not been clearly identified. The primary purposes of this study were to describe the characteristics of female collegiate swimmers at the onset of a swim season, identify the risk factors of shoulder injury in female collegiate swimmers, characterize the swim volume of female collegiate swimmers, and determine if swim volume is a predictor of shoulder injury. A prospective longitudinal cohort multi-center design was utilized. Female collegiate swimmers [n=53, mean age=19.3+/– 1.2] from four NCAA Division II universities were recruited to participate in this study. Preseason screening data that included demographics and sport history, swimming characteristics, and a musculoskeletal assessment was collected on 106 shoulders. Participants completed a weekly survey to track exposure data over the course of the season. Shoulder injury data was also collected. A shoulder injury was defined as swimming-related shoulder pain that resulted in one or more limited or modified athletic practices or competitions. Female swimmers reported a history of shoulder pain in 18/106 (17.0%) shoulders, and 14/106 (13.2%) of swimmers presented with obvious scapular dyskinesis at preseason. No differences in shoulder characteristics were found between swimmers with a history of shoulder pain and those without and those with obvious dyskinesis compared to those with normal scapular motion. There was a positive correlation between anterior glenohumeral laxity and shoulder external rotation range of motion (r=0.37, p Previous injury was the sole predictor of new shoulder injury in the group studied. Further research into the predictors of shoulder injury in female collegiate swimmers is warranted.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Introduction: Low-intensity lasers are one type of alternative therapeutic modality that are being used for their health-promoting effects. To date, no study has directly linked the benefits of this therapy when applied to known auricular acupuncture points to an objective biologic measurement, such as the stress hormone cortisol. The purpose of this pilot study was primarily to measure the concentration of cortisol in saliva in healthy adult subjects before and after laser therapy to known auricular acupuncture points and secondarily to survey the level of anxiety using the Beck Anxiety Inventory (BAI) and perceived stress using a Visual Analogue Scale (VAS). Methods: 25 (20 experimental and 5 control) healthy adult subjects were recruited. In this double blind design, participants were randomly divided into either an experimental group in which active laser therapy was administered or a placebo group in which the inactive probe was used. All participants completed a pre-VAS survey and a BAI survey. Baseline cortisol measurements were ascertained by participants chewing on a Salivette brand cotton roll. Bilateral laser auricular acupuncture was performed using the Asah 301 Unilaser to auricular acupuncture points (Shenmen, Adrenal, Addiction, Appetite, and Lung) for 27 seconds each. Saliva was collected immediately after treatment, ten minutes after and then twenty minutes after treatment. A post-VAS survey was then completed. Saliva was collected, frozen and stored and then later thawed and centrifuged. A cortisol specific ELISA was conducted to determine the cortisol concentration found in each participant's saliva at each time point. VAS and BAI survey were analyzed. Results: A dependent two-tailed t-test found that there was a statistically significant difference in cortisol concentration (p < 0.0001) between baseline and twenty minutes after treatment for the experimental group whereas there was no statistically significant difference (p = 0.79) for the placebo group. This was confirmed by the Friedman Test (p = 0.000) and the Wilcoxon Matched Pair Sign Rank Test (p = 0.003). No correlations were found between the VAS, BAI, and cortisol concentrations using the Pearson correlation coefficient. Conclusions: This pilot study demonstrated that cortisol concentration can be decreased by laser auricular acupuncture over the time period studied.

Introduction: The purpose of this study was to measure the displacement of defined dental structures, as a result of superimposition of cephalometric images across paired time-points by both digital and analog methods. The magnitudes of such displacements across three methods of superimposition were compared to each other and to a reference method constructed by registering superimposed cephalometric images on tantalum markers implanted in the study participants' maxillae. The defined dental structures were: 1) First molar mesial contact point; 2) First molar apical root bisection; 3) Central incisor root apex; 4) Central incisor crown incisal edge. Methods: Lateral cephalograms of 22 patients containing tantalum implants from the Mathews acquisition group were digitized, traced and superimposed using analog (implant and structural) and digital (Dolphin and QuickCeph) methods. Superimpositions were exported to Adobe Photoshop where they were scaled and displacement of defined dental landmarks measured using a Cartesian coordinate system. A random-effects, generalized linear model with Bonferroni adjustment was used to compare the different methods. Results: The structural method (p < 0.01) showed statistically significant differences versus the implant method and demonstrated the smallest 95% confidence interval range compared to Quick Ceph and Dolphin (0.45mm, 0.75mm, and 0.95mm, respectively). The four structural method landmarks demonstrated statistically significant differences versus the implant method (p

This paper investigated the sensitivity, specificity, accuracy, and precision of laser fluorescence and tactile probing for the detection of subgingival calculus. The gold standard for subgingival calculus detection has always been tactile probing. In this study 27 teeth were collected and 108 surfaces investigated, one tooth was excluded (group #13) where no calculus was observed on any surface, and three surfaces because of subgingival root caries to avoid confounding data, which left a total of 101 surfaces of 26 extracted teeth that meet the investigation criteria. The presence of subgingival calculus was observed on 75 tooth surfaces (74.25%). There was a correlation between tooth surface and the presence of calculus. Subgingival calculus was from most to least frequently observed on the Distal surface (92.0%), Lingual surface (76.9%), Mesial surface (70.8%) and Facial surface (57.7%). The amount of laser fluoresce increased according to the amount of subgingival calculus. There was a correlation between the amount of subgingival calculus and the amount of laser fluorescence. The tactile probing had a similar sensitivity compared to laser fluorescence for the detection of subgingival calculus. The laser fluorescence was more specific compared to tactile probing for the detection of subgingival calculus. The tactile probing had a similar accuracy compared to laser fluorescence for the detection of subgingival calculus. The laser fluorescence had more precision compared to tactile probing for the detection of subgingival calculus. These results show that by using both tactile probing and laser fluorescence the sensitivity, specificity, accuracy, and precision of detecting subgingival calculus can be increased. An increase in the sensitivity, specificity, accuracy, and precision of detecting subgingival calculus could help in the diagnosis and treatment of patients suffering from gingival recession and periodontal disease.