Student Research Poster Presentations showcase innovative research by Misericordia students across all disciplines.
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How Nurse Migration is Negatively Affecting Source Countries
Kasen M. Heim
Nurse migration has become an increasingly favorable transition for international nurses whom wish to pursue a heightened level of clinical experience. Despite the direct benefits specific to the nurse related to this transition it is undeniable that source countries are suffering from immense short staffing as a result. In order to decrease the migration of nurses from their source countries government officials and accredited nursing organizations should adopt more advanced education and training programs to encourage continued practice of international nurses within their own country.
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Perceptions of Physical Activity in those with Visual Impairment
Derek Hendershot, Joseph Grasso, Steven Hernandez, Jonathan Buck, and Maureen Rinehimer
Background: Physical inactivity is a significant health issue facing the American population. This is even more prevalent in those with disabilities, such as a visual impairment. There is limited research into how persons with visual impairments perceive their own physical activity. We attempt to gain insight into this in order to better structure exercise programs for those with visual impairments.
Objective: To gain better insight into the perceptions regarding exercise and physical activity in persons with visual impairments in order to better inform healthcare and exercise professionals.
Design: This will be a 20 question survey study that will use convenience sampling to obtain participants.
Participants: Participants will be visually impaired persons receiving services from Northeast Sight Services in Northeastern Pennsylvania. At least 20 participants will be recruited.
Survey: Survey will be administered either digitally via SurveyMonkey or physically via a paper copy. There will be 20 questions utilizing a Likert scale. Questions will focus on current activity levels, comfort with exercise, confidence in performing physical activities other than exercise, and perceptions around increasing activity level.
Measurements: Descriptive statistics will be utilized to analyze results.
Limitations: Limitations could include limited geographical area, limited sample size, and limited accessibility to the survey.
Conclusions: The results could provide valuable information about how persons with visual impairments perceive exercise and physical activity. This would allow healthcare and exercise professionals to make exercise more salient to those with visual impairments.
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The Effects of Exercise Interventions for Patients with Venous Lower Limb Ulcers: A Systematic Review
Jordan Hoffman, Christian San Pedro, and Sabrina Mendez
The Effects of Exercise Interventions for Patients with Venous Lower Limb Ulcers: A Systematic Review
Student Researchers: Christian San Pedro, SPT Jordan Hoffman, SPT Sabrina Mendez, SPT
Mentored by: Kristen Karnish, PT, MPH, DEd, GCS, CEEAA
Background:
Approximately 30 million Americans are affected by vascular disease with greater numbers world wide. Chronic wound care is costly, as seen by the 1.5 billion dollars Medicare spent treating wounds in 2014. Vascular disease can predispose individuals to lower limb ulcers, chronic wounds, necrosis, and amputation. In patients with chronic wounds, exercise has been hypothesized to decrease healing times by triggering cortisol release and increasing blood flow to the tissue. The purpose of this study was to evaluate the effects of exercise on wound healing, functional status and quality of life for patients with lower limb venous wounds.
Methods:
An article search was conducted between August 2020 and September 2020 and again in February 2021. Databases, PEDRO, Medline, and PubMed, were searched using the terms “Venous Ulcer” or “Venous Leg Ulcer” and “physical therapy” or “physiotherapy” or “rehabilitation” or “exercise” and “lower leg”. Articles were also obtained from forward search of included articles. Inclusion criteria included: peer reviewed articles, publication between 2015-2020, randomized controlled trials, and PEDro score ≥ 4/10. Nine articles were included based on the inclusion criteria. Articles addressed the effects of exercise on wound healing, functional outcomes, and quality of life.
Results:
Wound healing measures included healing rates, wound size, and PUSH scores. Wound healing rates and PUSH scores of the exercise groups showed significant improvement when compared to control groups, however ulcer size measurements between exercise and control groups were not significantly different. Functional outcome measures included: ankle ROM, strength, and gait outcome measures. Ankle ROM measurements between control and exercise groups were not significantly different overall with some outliers, while strength measurements between control and exercise groups were not significantly different. Gait measures between control and exercise groups were not significantly different at final assessment. Quality of life measures included pain scales and quality of life questionnaires. Quality of life questionnaires showed no significant differences and no trends between exercise and control groups, however pain scores showed significant improvement within intervention groups and significant difference when comparing exercise and control groups.
Conclusions:
Exercise is an effective adjunct intervention when treating patients with venous leg ulcers. Physical activity can aid in speeding up the healing process and can lead to better functional and quality of life outcomes. Even modest movement and activity was beneficial to aid in the rehabilitation and healing of those with venous leg ulcers, however further research is required to determine the most effective interventions to be provided by physical therapists.
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PROTOCOL: The Effects of Medical Cannabis on Pain and Quality of Life in Individuals with Parkinson’s Disease and/or Chronic Pain
Hailey S. Inge, Jenna M. Hiryak, Patrick DeMichele, Olivia J. Meyer, and Maureen Pascal
Background: The opioid epidemic has led medical professionals to research alternative methods of pain reduction. There is limited evidence concerning the usage of medical cannabis and its effect on the symptoms associated with Parkinson’s disease and/or reduction of chronic pain. Pain is subjective and neurologically derived, therefore, an association of quality of life differentiation upon individuals with chronic illnesses such as Parkinson’s disease and chronic pain can add to the research of whether medical cannabis is an appropriate alternative treatment to influence pain perception.
Objective: The aim of this study is to identify a correlation between medical cannabis and Parkinson’s disease and/or Chronic pain.
Design: This is a descriptive design study carried out through means of an electronic survey. Paper copies of the survey will also be made available for participants who prefer a paper copy.
Setting: The participants will be obtained from customers that shop at Ethos Cannabis Dispensary in Wilkes Barre, Pennsylvania. Analysis will be performed at Misericordia University in Dallas, Pennsylvania.
Participants: We hope to obtain 100 participants to complete our survey that are current prescription medical cannabis users and have been diagnosed with Parkinson’s disease and/or Chronic pain.
Measurements: The primary outcome measures included in our survey are the LISAT-11 and the Wong-Baker Pain Faces Scale. The LISAT-11 is a quality of life questionnaire and the Wong-Baker Pain Faces Scale is a pain questionnaire. Participants will be asked to rank their current quality of life using medical cannabis as well as their pain perceptions both before and after medical cannabis usage.
Limitations: Limitations include a small sample size of participants to complete the survey and knowledge of any other means of pain reduction the individual may be utilizing paired with Medical Cannabis.
Conclusion: This study will describe differences in quality of life and pain perceived by medical cannabis users with Parkinson’s disease and/or Chronic pain at Ethos Dispensary before and after they started using medical cannabis.
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The Effects of Rolipram, a Selective Phosphodiesterase Inhibitor, on Immortalized Schwann Cell Proliferation, AKAP95 and Cyclin D3 Expression
Kyle P. Kenney, Mary Pistack, and Angela Asirvatham
Schwann cells are a vital component of the Peripheral Nervous System and aid in the repair of axons following injury. The regulation of Schwann cell growth in vitro is facilitated by heregulin, a neuron-secreted growth factor, and an unknown mitogen that activates the cyclic adenosine monophosphate (cAMP) pathway. The abundance of intracellular cAMP is regulated by a family of enzymes called phosphodiesterases (PDEs). PDE inhibitors such as rolipram have therapeutic potential in various disorders and function by increasing the levels of intracellular cAMP. A-Kinase anchoring proteins (AKAPs), a family of scaffolding proteins that belong to the cAMP/Protein Kinase A (PKA) pathway are known to bind both PDE and PKA to regulate cAMP concentration in cardiac myocytes. Previous studies have shown that AKAP95, a nuclear AKAP, known for scaffolding cyclins, is essential for Schwann cell growth. Based on these reports, it was hypothesized that increasing the concentration of rolipram would elicit a dose-dependent increase in Schwann cell proliferation by augmenting the expression of AKAP95 and cyclin D3. Immortalized Schwann cells were cultured with no mitogens, 12.5 ng/mL heregulin, 1 µM of forskolin (a pharmacological activator of cAMP), heregulin + forskolin, and various doses of rolipram at 0, 0.5, 1, 5, 10, 25, and 50 µM for 12 or 24 hours. Using the MTT assay, preliminary results indicate that cells incubated for 12 hours and 24 hours exhibited the highest rate of proliferation at a dose of 5µM and 10 µM rolipram, respectively. Meanwhile, immunoblot analysis revealed that in cells treated with heregulin + forskolin, the expression of cyclin D3 and AKAP95 was highest when incubated with 25 µM and 50 µM of rolipram, respectively. These results suggest that increasing the concentration of cAMP by inhibiting phosphodiesterases augments Schwann cell proliferation by amplifying the expression of proteins regulating cell division.
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Metallic Artifact Reduction Capabilities of Dual-Energy Computed Tomography (DECT)
Kevin Kinney
This project explains the artifact reduction capabilities of dual-energy computed tomography (DECT) systems, and how to maximize this when imaging patients with metallic hardware, such as spinal implants. Implants consisting of titanium alloys, cobalt alloys, or stainless steel, present difficulties when imaging due to their likelihood to cause significant shading and streaking image artifacts. These artifacts are mainly the result of beam hardening and photon starvation from the x-ray beam’s interaction with dense, metallic structures. Dual-energy image acquisition allows for the potential to utilize basis material decomposition to virtually simulate a single energy acquired image. This process, known as monoenergetic extrapolation, significantly reduces beam hardening artifacts; however, the problem of photon starvation still poses an issue. To combat this, dual-energy acquired images must be further processed through additional artifact reduction software to produce optimal images for diagnosis. A study comparing DECT images reconstructed with an iterative metal artifact reconstruction algorithm (DE iMAR), DECT images reconstructed with a virtual monochromatic imaging algorithm (DE Mono+), and DECT images reconstructed with a combination of DE iMAR and DE mono+ (DE iMAR Mono+), was analyzed concluding that CT technologists should utilize DE iMAR Mono+ when imaging patients with metallic implants to produce optimal images.
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The Public's Perception of Medical Ultrasound
Bailey Klein and Michelle Anderson
Ultrasound (sonography) is a primary imaging modality predominantly used in the Diagnostic Radiology department to aid in the findings of internal pathological conditions. Sonography has been used for medical diagnosis since the early 1970’s; however, in comparison to other imaging modalities, it is relatively young and evolving. Since Ian Donald’s discovery in obstetrical ultrasound, there has been a significant growth in Maternal and Fetal Medicine as well as an explosion in the use of non-medical obstetrical imaging, better known as keepsake or entertainment ultrasound. Unlike all other imaging examinations, in obstetrics, family members accompany the patient for viewing where the sonographer can provide narrative on the fetal anatomic structures but not give a diagnosis. The sonographer does not interpret or make the diagnosis of the case, therefore they can not share any results with the patient. Ultrasound’s historical and progressive development of use, slow development of formal education, lack of requirement of national certification, and minimal research to support any bioeffects when used for medical purposes, stereotypes of what the role of ultrasound is and the role of the sonographer stereotypes are in existence. Derived from these stereotypes, a survey was designed to assess the public’s understanding and perception of diagnostic medical ultrasound and the role of the sonographer. The responses from the survey contradicted the researchers’ hypothesis; however, results indicate the opportunity to improve the public’s knowledge.
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Do Quality Improvement Projects Improve Health Outcomes?
Stephanie Kolodzieski
Quality improvement projects play an important role in healthcare by improving the quality and safety of care that patients receive. A specific quality improvement project about catheter-associated urinary tract infections (CAUTI) was evaluated to determine if the quality of care improved after a multi-faceted CAUTI prevention educational program was offered to nurses on hospital units with high rates of CAUTI. The results showed that this quality improvement project did improve health outcomes by resulting in decreased rates of CAUTI. This is a key finding because nurses play a major role in preventing CAUTI among hospitalized patients.
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Are QIP's Improving Healthcare Outcomes?
Samantha Kropa
oOn average, a hospital patient is subject to at least one medication error per day (FDA, 2019) oThe U.S. Food and Drug Administration (FDA) receives more than 100,000 U.S. reports each year associated with a suspected medication error. (FDA, 2019) oNational Medicines Information Center found that there is 1 medication error in every five doses, reporting a 500% increase in medication errors in the past decade. (NMIC, 2016)
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Effects of Nitrogen and Phosphorus Input on Lake Louise, Dallas, Luzerne County, PA
Hailey Kubiski and Cosima Wiese
The runoff of nitrogen and phosphorus can be detrimental to a lakes health and ability to support life (Baker, et al. 2007). Eutrophication is a product of large amounts of nitrogen and phosphorous in lakes (Rice and Horgan, 2017). The purpose of this study is to examine if large amounts of nitrogen and phosphorus are present in Lake Louise. The proposed research question is: Are there high concentrations of nitrogen and phosphorus in and around Lake Louise? The null hypothesis of this study is that there will be no significant difference in nitrogen and phosphorus concentrations in areas in and around Lake Louise. The data gathered allowed us to reject the null that there will be no significant difference in nitrogen and phosphorus concentrations in areas in and around Lake Louise. The data shows a trend that the fluctuations in pH, DO, NO3, and NH4 are affected by the time of year, rather than the site. More sampling and gathering of data must be done to properly conclude why Lake Louise is having algae and sediment issues.
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Effects of Invasional Meltdown on Community Structure in Marine Ecosystems in the Damariscotta Estuary of Maine
Kate Lazzeri
Basibiont organisms form the foundation of marine ecosystems by providing additional space for new species to settle on as epibionts. Invasive epibionts may take advantage of this new basibiont presence, which leads to many harmful effects on native organisms such as competition for both resources and food. In some cases, invasive species facilitate recruitment of other invasive organisms, a phenomenon referred to as invasional meltdown, but it is not known if invasion of new basibionts increases invasive epibiont occurrence. The purpose of this study is to answer the following research questions: 1) does the invasion status of the basibiont alter the frequency of invasive epibiont settling compared to native epibionts, and 2) are there any differences in epibiont diversity on native and invasive basibionts? Per the invasional meltdown phenomenon, it is expected that increased invasion will attract more invasive species into the community. The samples used in this study were gathered from floating docks in Walpole, Maine. All sample specimens used in this study were identified by species and classified by invasion status. For the basibiont specimen the species name, size, and mass were determined. For epibiont specimen, the species name and mass were determined. Analysis of variance, Shannon Diversity Index and other analytical tests were carried out using R studio. While there was no difference in proportion of epibionts that were invasive on the two types of basibionts, there was a significantly more diverse assemblage of epibionts on native basibionts. This is important as we consider how the presence of invasive epibionts structure marine communities. The presence of invasive and native species on invasive basibionts will help us predict future settlement patterns, and determine how newly present invasive species may alter the marine ecosystem.
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Comparing 2D vs 3D Mammography in Breast Imaging
Kelsey Little
This project offers a comparison of 2D digital mammography (DM) and 3D digital breast tomosynthesis (DBT) to determine if one is more superior than the other in breast imaging. Types of mammography exams, different projections, breast cancer, equipment definitions, advantages, and disadvantages are also discussed. Breast cancer is one of the most common and most treatable types of cancer detected in women. Equipment is frequently evolving to better improve image quality and patient comfort. DM takes a stationary image of the compressed breast at one angle while DBT takes images in slices at multiple angles. This allows for better visualization of cancers from the surrounding breast tissue. This research indicates that 3D does have some advances compared to 2D imaging, but there is not a significant difference between their diagnostic capabilities. When DBT is used diagnostically, cancers are more visible, benign biopsies are reduced, less additional views are needed, and there is increased sensitivity and specificity. Since mammography equipment is always changing, further research may be necessary to compare 3D and 2D mammography in breast imaging.
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Stereotactic Body Radiotherapy: Prostate Cancer
Monica Mahon
Stereotactic Body Radiotherapy: Prostate Cancer
Monica Mahon
Dr. Elaine Halesey, Ed.D., R.T.(R)(QM)
Abstract
Stereotactic body radiotherapy (SBRT) is a special type of radiation therapy that uses very high precise radiation to treat cancerous cells and the treatments are only a total of about five fractions. Prostate cancer is very common in men around the age of 66 and is treated with radiation therapy. Prostate cancer’s high sensitivity to radiation, the use of continuous motion monitoring, and the time efficiency of SBRT are reasons why it should be used to treat prostate cancer. By using continuous motion monitoring along with the SBRT treatment, it allows for very precise treatment. This research discusses the treatment planning, average dose, and procedural set up for SBRT when treating prostate cancer. Along with the benefits of SBRT, previous studies were analyzed and concluded SBRT is a safe and efficient way to treat low-risk, intermediate risk, and lymph node positive prostate cancer.
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Computed Tomography of Cardiac Malignancies
Nicholas Malloy
Cardiac malignancies are tumors that develop in the heart; they are commonly asymptomatic, hard to locate and associated with a poor prognosis. The size and location of the tumor in the heart often play a role in the early or late discovery of the tumor. Cardiac malignancies can be either benign, such as cardiac myxoma or rhabdomyoma, or malignant, such as cardiac lymphoma or angiosarcoma. Fortunately, the advancement of imaging modalities—especially computed tomography—has improved early detection rates of cardiac tumors. Computed Tomography provides optimal spatial resolution for detection of malignancies and is typically more readily available than most modalities. Computed Tomography is typically less expensive than Magnetic Resonance and is more flexible to patients that are either claustrophobic or have contraindications for MRI such as a pacemaker. Computed Tomography also excels in showing how the heart is affected by the tumor and the type of tumor that may be present. Multi-detector computed tomography is typically preferred due to its exceptional detail and its ability to counter respiratory motion. The treatment of cardiac malignancies is often challenging due to the lack of evidence-based standards of care, however, the patient has some options. The patient may either undergo chemotherapy or radiation therapy, surgical resection or heart transplantation for younger patients. Computed Tomography plays an important role by demonstrating the precise location of the tumor as well as how it is affecting the surrounding heart tissue: this helps the physician in planning chemotherapy as well as a surgical resection if needed.
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The Recognition of Traumatic Brain Injuries as a Risk Factor for Dementia in Military Veterans: A Systematic Review
Julie Maroni and Jessica M. Monday
Purpose/Hypothesis: The prevalence of traumatic brain injuries has increased over time. Following a TBI, neurodegeneration occurs which predisposes individuals to other neurological conditions such as dementia. The purpose of this study is to demonstrate the relationship between TBIs and the occurrence of dementia in military veterans.
Number of subjects: Not applicable
Materials/Methods: CINAHL complete and APA PsychInfo were searched electronically between the years 2000 and 2020 in August of 2020. A second search was conducted in January of 2021 to include any new and updated research. Search terms included concussion, mild traumatic brain injury, mild tbi, mtbi, traumatic brain injury, TBI, dementia, alzheimers, military, veterans, soldiers, armed forces, VA, and veterans affairs. The search was narrowed to include only academic journals in English. Selection of articles were determined by the authors that agreed upon the inclusion of TBI, dementia, and military population. Access to full text articles were gained through the inter-library loan, One Search, and the databases above via Misericordia University. Hand searching occurred to gain access to articles that were identified in the reference of established matrix articles.
Results: 172 articles were identified through electronic search. Based on inclusion criteria, 8 articles were included in the systematic review. Two other articles were included following a hand search. All studies were retrospective including cohort and case control studies.
Conclusion: Nine of ten articles identified traumatic brian injuries are a risk factor for the development of dementia in military members. Two articles identified there was no relationship between the severity of a TBI and risk factors for developing dementia. Four articles reported an increased risk for dementia when other risk factors combined with TBI were involved. Four articles determine there is a greater risk for late onset dementia than early onset dementia when sustaining a TBI at any age.
Clinical Relevance: By understanding the risk factor of dementia following TBIs health care providers can screen for dementia and treat as needed. The better understanding there is of this relationship the better prevention, management, and treatment can be implemented to decrease this silent epidemic.
