Theses and Dissertations, Capstones, and Directed Research

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Electronic theses and dissertations, and graduate and undergraduate Capstones and Directed Research.

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A Quality Improvement Initiative to Explore Barriers Facing Associate Degreed Nurses Obtaining a Bachelor’s Degree [paper]
(2021-12) Gersbach, Kendal; Garcia, Theresa
In 2010, the Institute of Medicine recommended that 80% of nurses in the workforce be BSN-prepared by the year 2020 (IOM, 2010). As shown by multiple surveys, the United States did not meet this recommendation by the year 2020. In 2018, a survey conducted by the U.S. Department of Health and Human Services using The National Center for Health Workforce Analysis team reported that only 63.9% of the RNs surveyed held a BSN degree (U.S. Department of Health and Human Services, 2019). The question remains to what is preventing more ADN-prepared nurses from advancing their degree to BSN and beyond. This project aims to identify barriers ADN nurses perceive when enrolling in or completing a bachelor’s degree.
A Quality Improvement Initiative: Implementing a Standardized Education Protocol to Improve the Blood Culture Collection Process in a Rural Hospital Setting [paper]
(2023-12) Heredia, Edward R.; Cropley, Stacey
Blood culture contamination represents a deviation from the quality standard of care and has financial ramifications for hospital organizations. Skoglund et al. (2019) determined that the direct and indirect hospital costs associated with a contaminated blood culture were $12,824 compared to $8,286 for a negative blood culture. Preventing a single blood culture contamination results in a cost savings of $4,538. Blood cultures are widely considered necessary and essential laboratory tests performed to diagnose severe infections (Doern et al., 2020). Blood cultures are collected by a registered nurse or a health technician with phlebotomy certification. The most common indicator of blood culture contamination is directly linked to the improper collection of blood culture specimens. Cases are classified as false positives when the automated blood culture system produces a signal and detects no microorganisms (Ebihara et al., 2019). Financial ramifications of contaminated false positives include unnecessary hospitalization, extended length of stay and risk of associated hospital-acquired conditions, additional diagnostic tests, various costly clinical procedures, and increased work for clinical staff (Steed, 2017). A study by Lalezari et al. (2020) found the median length of stay in patients with a contaminated blood culture was 2 days longer than the median length of stay in patients with a negative culture. In the United States (U.S.), 4% of hospitalized patients will die from a hospital-acquired infection (Shalini & Abiselvi, 2015). Given that blood culture contamination is directly linked to the specimen collection process, this quality improvement project will target the blood culture collection procedure and implement an evidence-based intervention to ensure that the proper blood culture collection procedure is practiced, and that the procedure adheres to the facility's improved protocol. This quality improvement project will standardize and improve the blood culture collection procedure at Crane Memorial Hospital due to detected inconsistencies with staff improperly obtaining blood culture specimens, and the quality improvement project will explore the effectiveness of implementing an evidence-based standardized education protocol to add consistency and accuracy to the blood culture specimen collection process.
A Systematic Review Examining Patient and Provider Attitudes Toward Use of Medication for Opioid Use Disorder [paper]
(2023-12) Trejo, Anyssa; Page, Tracey
Introduction: Despite drastically rising rates of opioid overdose related deaths, rigid opinions of both patients and providers against the use of medication for opioid use disorder persist in the face of well-established evidence indicating that medication for opioid use disorder is the gold standard of care. The purpose of this systematic review of the literature is to examine the source and effect of negative perceptions and to make recommendations to providers to improve treatment and outcomes for this population. Methods: A systematic review of the literature was conducted to identify the source and extent of perceptions of both patients with opioid use disorder and their providers regarding medication for opioid use disorder. The Neuman Systems Model was used to guide the review to see the patient as a system with many parts that responds to environmental stressors and to bring providers’ focus back to the client’s well-being. Results: Seven articles were included to identify two major themes describing patient and provider attitudes toward medication for opioid use disorder. The first theme identified was that providers and patients carry negative perceptions toward medication for opioid use disorder. The second theme indicated that medication for opioid use disorder is perceived as a replacement drug by providers and patients. Discussion: It is apparent that there is a negative view towards medication for opioid use disorder by both healthcare providers and patients struggling with opioid use disorder. Negative attitudes upheld by healthcare providers and patients continue to prevent access to effective treatment for those struggling with opioid use disorder.
A Systematic Review of Common Symptoms Associated with Urinary Tract Infections in the Elderly [paper]
(2022-12) Woodall, Lynn; Garcia, Theresa
Introduction: Urinary tract infections (UTIs) are a common infection seen in primary care. There are many key predictive factors including age, gender, comorbidities, and symptom presentation that can be used to quickly identify UTIs for rapid treatment to be implemented. Methods: This systematic review of literature was guided by Dorothea Orem’s Self Care Deficit Theory, and by using databases including CINAHL, PubMed, and Medline to gather and evaluate articles for relevance and guidance. A Rapid Critical Appraisal Tool was used to further screen these articles for relevance and validity through a screening process with inclusion criteria to include or exclude articles for the review. The articles reviewed were used to answer the clinical PICOT question presented and the articles were presented in the form of an evidence synthesis table to give a side-by-side comparison of the research. Results: Six cohort studies were ultimately included and used based on relevance, to show strong evidence that there are many key predictive factors of UTI in the elderly population that a provider can assess for in their practice to identify and quickly treat before complications occur. All six studies were able to support the clinical question presented. Discussion: Based on the studies reviewed, there is evidence that improvements can be made in identification and rapid treatment of UTIs in the elderly with further quality improvement projects, more research into the signs and symptoms noted in a larger population with the key focus on identification prior to having positive confirmation of urinary tract infection.
A Systematic Review on The Supplementation of Zinc to Treat Depression [paper]
(2023-12) Strunck, Kaymee M.; Garcia, Theresa; Page, Tracey
As rates of depression continue to increase and current pharmacological first – line treatments are not producing high levels of remission alternative treatment options should be investigated. While links between zinc and depression date back to the 1980’s little is known about the effects of zinc supplementation on depressive symptoms. To answer this question a systematic review was conducted to determine if current literature supported the supplementation of zinc to treat depressive symptoms. CINAHL, PubMed, and MEDLINE Complete were searched for relevant literature addressing the relationship between zinc and depression. Seven articles were identified that met inclusion criteria and included three randomized control trials (Gosh et al., 2022; Sarris et al., 2019; Yosaee et al., 2020), three cross-sectional studies (Li et al., 2018; Mousa & Al-Diwan, 2023; Nakamura et al., 2019) and one cohort study (Jung et al., 2017). The total sample size across studies was 18,942. Results yielded that increasing zinc in the diet via supplementation improved symptoms of depression as evidenced by a decrease in self-reported depressive symptoms and individuals who reported consuming an adequate amount of zinc in the diet reported a decrease in depressive symptoms. There was also an association between low serum zinc detected in blood and worse depressive symptoms. Findings from this review suggest that increasing zinc in the diet can decrease depressive symptoms and that low levels of zinc in the diet are related to increased depressive symptoms. Future studies should include RCT’s on larger populations of patients diagnosed with MDD and explore zinc as a monotherapy for depression to determine if zinc alone could be a primary, secondary, or tertiary treatment for depressive symptoms.
Alternative Treatment for ADHD: A Systemic Review of Polyunsaturated Fat Supplementation Interventions in Children [paper]
(2023-12) Rutherford, Mikhaila; Littlefield, Amber
Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that is usually diagnosed in childhood. The primary treatment is the use of stimulant medications. Alternative treatments have also been developed but not rigorously scientifically tested. One alternative treatment that has received publicity recently is a dietary intervention of supplementing children with polyunsaturated fatty acids, commonly known as omega-3 and omega-6/fish oil. Current scientific literature presents conflicting findings regarding the efficacy of fatty acid treatment of ADHD symptoms. This systematic review aims to summarize current randomized controlled trials that examined the use of fatty acids in the management of various cognitive and behavioral factors related to inattention, hyperactivity and impulsivity in children with ADHD symptoms. Methods: The author obtained evidence from articles published between 2017 and 2022 from CINAHL, PubMed, ScienceDirect, and Medline. Papers eligible for inclusion included: full-text, peer-reviewed randomized controlled trials. Quality assessment was conducted, using Melnyk and Fineout-Overholt’s Rapid Critical Appraisal Checklists. Results: Of the 647 papers identified, 8 studies met the inclusion criteria. Common themes were 1) Omega-3 & 6 polyunsaturated fat supplementation has mild impact on a variety of ADHD symptoms and 2) Omega-3 & 6 polyunsaturated fat supplementation has very few adverse side effects. Discussion: Results suggest that fatty acid supplementation may have mild to moderate positive effects of children’s ADHD symptoms and that there are minimal side effects associated with using them for this purpose.
An Interprofessional Quality Incident Review Team: Effects on Reporting and Resolution [paper]
(2019-12) Burgoon, Courtney; Dolan, Diana; Willson, Pamela
Background: Since the Institute of Medicine's (IOM) report, To Err is Human, there has been increased focus on patient safety, to include use of incident reporting systems for gathering data to improve knowledge and decrease e1rnrs in the hospital. With increased pain and suffering, and cost associated with errors, the justification for these processes are clear. It is known that underreporting of incidents continues. There is a need for reporting systems, with available research focusing on organizational safety culture, ba1Tiers to reporting, and the acceptance of reporting systems in practice. Process improvement methods to increase incident reporting, and resolution of incidents is lacking in literature. Method: A descriptive repeated measures quality improvement project was undertaken at baseline, 3-months, and 6-months post intervention. Quality metrics were number of patient safety incidents and time to resolution of incident review. The intervention consisted of the development of An Interdisciplinary Quality Incident Review Team (QIRT) at a 147 bed acute care hospital in central Texas, U.S. A. The QIRT process, involved education of staff and managers on the new processes of reporting, evaluating, and completing incident reports. Results: Implementation of the QIRT process resulted in an increase in overall reporting of patient safety incidents in the categories of medication errors, hospital, nursing, and safety. At 3- months and 6-month post intervention, incident reports increased by 41% (n=21) and 59% (n=30). Hospital Incidents made up greatest increase in rep01i types, while Medication Errors had the fewer rep01is. Time to resolution of Nursing Incident reviews had the largest decrease in resolution time with an average of 11 days. Nursing Incident reporting demonstrated that consistency lead to sustainability over time, as the number of reported incidents continued to increase during the 6-month follow-up. Conclusions: Implementation of the QIRT, including educational materials and expectations for nursing staff and managers, increased incident reporting in all areas. Education regarding rep01iing, awareness ofrep01ied events, and follow-up from the QIRT were shown to increase reporting across the organization. Nursing incident rep01is were the only category where the time from the incident was reported, to resolution of the incident in the rep01iing system decreased.
Barriers and Outcomes for Low-income Women with Mental Illness During Post-Partum: A Systematic Review [paper]
(2023-12) Bibles, Sharmelle; Littlefield, Amber
Introduction: Maternal mortality among low-income mothers in the United States (U.S.) is steadily increasing (Eckert, 2020). The risk for developing mental illness is higher among middle- and low-income households, where 1 in 4 women report depression during pregnancy and 1 in 5 report having postpartum depression (Awini et al., 2023). Several research studies have examined social determinants of health (SDOH) impact on mental healthcare treatment among pregnant and post-partum women. However, gaps in the literature suggest that more research is needed to examine mental health outcomes for mothers and babies with untreated mental illness during the post-partum period. This systematic literature review aims to identify barriers to healthcare, patient outcomes, and helpful interventions for post-partum women with mental illness in low-income communities. Methods: The author extracted data from articles between 2018 and 2023 via CINHAL, Pubmed, and Psychinfo electronic databases. An ancestry search strategy was also used for data collection. Articles selected for this study meet inclusion criteria: (1) primary research articles, (2) published in English, (3) published in a peer-reviewed journal, (4) published within the last five years, and (5) addressed or related to barriers and outcomes for low-income, post-partum women with mental illness. The Rapid Quality Critical Appraisal Tool, adapted by Melnyk and Fineout-Overholt (2019), was used to appraise and evaluate quality of the literature. Results: 1,512 articles were identified, and seven studies met inclusion criteria. Five common themes were identified across studies as barriers for low-income post-partum women in need of mental healthcare: (1) lack of social and community support, (2) lack of transportation and community resources, (3) lack of financial assistance and income, (4) lack of provide education (understanding) and advocacy (5) lack of mental health education. Discussion: Results suggest a critical need for multiple stakeholders to address the complex barriers and social determinants of health that result in poor outcomes for low-income postpartum women with mental illness.
Barriers in Seeking Treatment for Perinatal Depression in Low-Income African Americans: A Systematic Review [paper]
(2022-12) Basa, Jessica; Garcia, Theresa
Introduction: Perinatal depression is a mood disorder that can occur during pregnancy and within four weeks of childbirth. Individuals at the greatest risk for perinatal depression include low-income African American and Hispanic women. African American women are least likely to seek psychiatric treatments for perinatal depression. Current literature presents conflicting findings as to the existence of racial and ethnic differences in screening and treatment for perinatal depression. This systematic review aimed to summarize and categorize the barriers faced by low-income, pregnant Black/African American women that discourages treatment engagement for depression. Methods: The author abstracted evidence from articles published between 2008 and 2021 from CINAHL, PubMed, and ScienceDirect electronic databases and ancestry search strategy. Papers eligible for inclusion included: full-text, peer-reviewed studies, and a focus on the barriers for low-income, pregnant African Americans in seeking treatment for depression. Quality assessment was conducted, using Melnyk and Fineout-Overholt’s Rapid Critical Appraisal Checklists. Results: Of 8,715 papers identified, 7 studies met the inclusion criteria. Common themes were 1) avoidance of psychiatric medications with greater preference for faith-based interventions and 2) time constraints and costs as significant barriers to treatment for perinatal depression in this population. Discussion: The results suggest the need to include faith-based approaches to appeal more to African American women, ask more culturally sensitive questions, integrate mental health services in obstetric clinics, and offer virtual appointments and/or options for mothers to bring their children for easier convenience.
Bedside Educational Tool: Improving Patient Education and Nursing Documentation [paper]
(2019-12) David, Katie; Willson, Pamela; Dolan, Diana
Background: The purpose of the Bedside Educational Tool (BET) project was to increase patient discharge knowledge by expanding Krames education selections recorded in the discharge and maintained in the Electronic Health Record (EHR). Methods: A descriptive pre- post-comparison evidence-based improvement project was unde1iaken to determine if cueing with a collaborative patient point-of-care educational tool facilitated nurse-patient education and discharge documentation. To establish a baseline, chart audits of patients discharged from a 32-bed medical-surgical unit within a large 378 bed acute care hospital for a consecutive 18-day period was performed. Three instruments were used in this project 1) Bedside Educational Tool (BET), 2) Nurse Usability and Usefulness Survey, and the 3) Patients Discharge Record from the hospital. Implementation consisted of initiation of the BET sheet and nursing education regarding documentation of Krames selections. Audited discharge records compared the Krames education selections in the EHR from 101 pre implementation charts to 129 post-implementation charts. Results: All nurses on the pilot unit 41 (100%) participated in the implementation of the BET. 37 (90.24%) nurses on the unit participated in the BET project HealthStream education. EHR Krames educational documentation increased after implementing the BET tool by 96% and the number of Krames items selected per patient increased 229%. Nurses surveyed found the BET tool both easy to use and successful in the development of the collaborative patient-centered education. Conclusions: In hospitalized patients, the introduction of a patient-nurse bedside education collaborative tool (BET) increased collaborative patient-centered education and the Krames education selections recorded in the discharge plan and the final EHR.
Breast Cancer Risk Among Transgender Individuals Undergoing Gender Affirming Hormone Therapy: A Systematic Review [paper]
(2023-12) Brown, Tiffany Nacole
Introduction: This review addresses the breast cancer risk among transgender individuals undergoing gender-affirming hormone therapy, a crucial but understudied aspect in transgender healthcare. Focusing on gender affirmation, transgender individuals often face healthcare challenges, leading to gaps in broader health concerns like cancer screening. This research, framed by Dorothea Orem's Self-Care Deficit Nursing Theory, aims to fill this gap, comparing the incidence of breast cancer in transgender populations to cisgender counterparts. Methods: A thorough search was conducted in MEDLINE Complete, PubMed, and CINAHL Ultimate from 2013 to 2023. Search terms included transgender, trans, breast cancer, malignancy, tumor, gender affirming therapy, hormone therapy. Studies focusing on transgender individuals undergoing hormone therapy were included, with exclusions for non-English articles and those published before 2013. Results: From 681 articles identified, rigorous screening led to eight studies meeting inclusion criteria. These studies offered a comprehensive view of breast cancer incidence in transgender individuals undergoing gender affirming hormone therapy. Notably, transgender women on estrogen therapy had a higher breast cancer incidence compared to cisgender men, yet lower than cisgender women, while transgender men on testosterone therapy showed similar rates to cisgender men. Discussion: The findings suggest a need for personalized breast cancer screening strategies tailored to transgender individuals. The review emphasizes healthcare providers' role in initiating breast health discussions and the importance of adapting clinical guidelines to transgender individuals' unique needs. Acknowledging the current literature's limitations, the review advocates for more research, policy reform, and advocacy to ensure inclusive and affirming healthcare for the transgender population.
Can an Emergency Department Triage Protocol Initiative Reduce the Length of Stay in Low-Acuity Patients? [paper]
(2023-05) Daemen, Cynthia
The purpose of this quality improvement project was to decrease emergency department (ED) length of stay (LOS) for low acuity patients. Overcrowded hospital Emergency Departments (ED) and long length of stays (LOS) can result in decreased quality of care and increased mortality. In addition, ED patients with long wait times and length of stays can negatively impact patient satisfaction scores, increase the likelihood for patient safety incidents, and increase overall cost of care. A patient’s LOS is the amount of time that is spent in total number of minutes from their arrival to their discharge from the ED. A patient’s wait time and LOS can be affected by several factors such as the number of patients in the department, ED admission holds, and staffing census. Triage is the area where most patients seeking ED care are screened and the nurse determines where the patient will be assigned. While often the ED cannot control holds or staffing, the triage time can be shortened using approved triage protocols to improve flow and decrease the number of patients in the department. This quality improvement project implemented an educational initiative to increase use of existing triage protocols and LOS for low acuity patients in a Level II trauma facility in Central Texas. The 12-month pre-intervention average LOS for patients seen in 2022 was 115 minutes and the average percentage of nurses using and documenting a triage protocol was 4.5%.
Education of Hypertensive Young Adults to Improve Health Habits: A Systematic Review [paper]
(2023-12) Martin, Breena E.; Page, Tracey
Introduction: The goal of this review is to determine if providing a specific format of education to young adults would improve overall health habits and self-efficacy. The focus of this research was specifically on young adults with hypertension. The goal of this research is to stratify long term risks associated with uncontrolled hypertension and to evaluate if this intervention will improve these outcomes when started in young adulthood. Methods: A systematic review of literature was conducted across seven studies. Primary outcomes evaluated across studies were improvements in self-efficacy and lifestyle habits. A conceptual framework was utilized as a guide to research and all articles studied were evaluated based on this method. Results: Evidence from research showed that there is overall improvement in lifestyle changes and health habits when e-health education is implemented into practice. This format of education promotes individuals to become more self-efficacious and follow healthier lifestyle choices. Discussion: Early intervention and modification of lifestyle risk factors improves health outcomes however, more research is recommended for the young adult population with hypertension.
Effect of Telehealth on Mental Health Therapy [paper]
(2021-12) Daniel, Alison; Patel, Stephanie
This literature review assesses if therapy delivered via telehealth is comparable to face-to-face therapy. Telehealth is on the rise due to the COVID-19 pandemic and continues to be used daily across the United States. Method: A literature search of articles focusing on how telehealth affects patient outcomes and satisfaction. Articles were found through UpToDate, Texas State University Library, and PubMed. Results: Telehealth was as successful as face-to-face therapy based on studies. Barriers and benefits were identified during the review. Barriers include connection issues, hearing/visual impairment, and impaired communication. Benefits of telehealth include accessibility, reduced commute time, and cost-effectiveness. Discussion: Therapy via telehealth is comparable to face-to-face in most circumstances. More research should be done on varying psychiatric illnesses and their severity. A training or certification course could be beneficial to educate providers on laws, techniques, and strategies to improve telehealth experiences for patients.
Effectiveness of Interprofessional Collaboration with Pharmacists on Medication Adherence: A Systematic Review [paper]
(2023-12) Fulk, Melanie; Littlefield, Amber
Introduction: Medication adherence is a growing healthcare concern. Medication adherence can impact a patient’s health, affect their overall care and causes an increase in healthcare costs. Pharmacists are one of the easiest accessible members of the healthcare team and should be used to their full potential. Methods: A systematic review of literature was conducted using three online search engines. Inclusion and exclusion criteria were developed. Seven articles were used, and an evidence synthesis table was created. Results: Evidence from this research demonstrates pharmacist involvement improves medication adherence. It also demonstrated pharmacist involvement has an overall positive effect on patient care. Discussion: Pharmacist involvement positively impacts patient outcomes. Further research needs to be conducted to determine best practice on improving medication adherence. Pharmacists should be utilized to the fullest extent of their licenses in the care of patients.
Effectiveness of Prolonged Exposure Therapy vs. Cognitive Processing Therapy in Veterans with Post-Traumatic Stress Disorder: A Systematic Review Systematic Review [paper]
(2023-12) Crook, Raven M.; Page, Tracey
Introduction: Traumatic events, especially in combat veterans, can lead to post-traumatic stress disorder (PTSD), impacting mental health and overall functioning. This systematic review compares the effectiveness of two evidence-based trauma-focused psychotherapies, prolonged exposure therapy (PE) and cognitive processing therapy (CPT), in treating PTSD among recent military campaign veterans. Both PE and CPT are endorsed in the current VA/DoD guideline, with PE involving the gradual exploration of trauma memories and CPT addressing negative thoughts. Methods: Utilizing Neuman's Systems Theory, this systematic review examines eight diverse study designs, encompassing quasi-experimental trials, retrospective studies, and randomized controlled trials. A systematic literature review was conducted using specific search terms across seven databases. The selection process resulted in eight relevant articles. Results: PE emerges slightly more effective in six studies, while two studies suggest a slight advantage for CPT. Factors influencing outcomes include treatment timing, session completion, and patient choice. Both therapies exhibit positive impacts on veterans, emphasizing adaptability and individualized approaches. Discussion: This systematic review addresses the urgency of effective treatments for veterans with PTSD, exploring the advantages and limitations of PE and CPT. The findings give evidence of the importance of individualized approaches and highlight the need for further research to inform personalized interventions.
Effects of Delayed Antibiotic Prescribing vs. Immediate or No Antibiotic for URI's in Primary Care: A Systematic Review [paper]
(2022-12) Duong, Lanh T.; Garcia, Theresa
Introduction: Delayed antibiotic prescription (DAP) is an evidence-based intervention to fight the global issue of antibiotic resistance. Evidence of its benefits for treating respiratory tract infections (RTIs) have long existed in literature but never fully accepted. This paper’s purpose is to evaluate new evidence and the overall effects of DAP on patients with upper respiratory infections in the primary care practice. Methods: This systematic review of the literature was guided by the PARIHS model to investigate patient outcomes and satisfaction rates with delayed antibiotic prescription compared to immediate and no prescription when treating RTI symptoms. JSTOR Journals, Health Source, OVID, CINAHL, Cochrane, PubMed, and MEDLINE were databases used in gathering the literature. Articles were screened with an inclusion criterion. A Rapid Critical Appraisal Tool was used to score articles on its relevance and validity to answer the PICOT question. Articles’ quality appraisal score of less than four were excluded from this review. Scores are illustrated in the Evidence Synthesis Table. Results: Five randomized controlled trials and three cohort studies were analyzed. Study findings overall revealed that DAP reduces antibiotic use, and no significant difference was seen in symptom severity through all prescribing approaches. Interestingly, only two of the three studies found that DAP is related to higher patient satisfaction. Discussion: DAP can be used safely in most patients with acute RTIs. However, more research is needed in the United States to give a better generalizability to the population.
Effects of Gender-Affirming Care on Depression and Suicidality in Transgender and Gender Non-Conforming Youth: A Systematic Review [paper]
(2022-12) Medic, Lejla; Garcia, Theresa
Due to the increased burden of depression and suicidality carried by the transgender and gender non-conforming youth population, legislative patterns limiting gender-affirming care, and recent increase in primary research on gender-affirming care in youth, a systematic review was conducted to address these trends. This review, guided by the Perceived Chronic Social Adversity Theory, began by searching databases PubMed, CINAHL, and Ovid Medline for full text, peer reviewed articles on the topic published between 2017 and 2022. Utilizing the Newcastle-Ottawa Scale, only studies with a score of 7 and above, indicating high quality, were included. An evidence synthesis table was used to extract pertinent information from the included articles. Data analysis was conducted to find overarching themes between the intervention, gender-affirming care, and the measured outcomes, depression and suicidality, in transgender and gender non-conforming youth. Two themes were synthesized from the evidence: gender-affirming care is associated with decreased depressive symptoms/suicidality and support of gender identity is associated with less psychological distress. Based on these findings, healthcare providers should educate legislators as well as the community of this evidence, oppose bills that limit healthcare access, oppose bills that increase social adversity among this population, and support the use of the evidence-based guidelines already published by numerous professional medical organizations.
Evaluating the Effectiveness of the Personal Diabetes Questionnaire in the Primary Care Setting [paper]
(2019-05) Wisco, Carolyn; Urbanosky, Staci; Fisher, Roger; Benavente, Viola
Type 2 diabetes mellitus (T2DM) is a chronic illness managed daily by patients themselves. Poorly controlled diabetes is associated with micro- and macrovascular complications leading to increased morbidity. The Personal Diabetes Questionnaire (PDQ) is a reliable and valid tool that has not been tested in primary care and provides a comprehensive evaluation of knowledge, perceived barriers, and motivational aspects in T2DM self-management. The study aims were to evaluate T2DM self-management of patients in primary care as measured by the PDQ and explore the relationships between perceived barriers and readiness to change and patient self-reported glycated hemoglobin values (HbA1c). A cross-sectional, pilot study was conducted in a convenience sample from south central Texas, N=11. The PDQ assesses four behavioral domains by 13 subscales: blood glucose control, diet, medications, and physical activity. The SPSS software was used for statistical analysis and correlation coefficient techniques were applied to determine significant associations between study variables. Overall, subscales demonstrated good internal consistency (Cronbach’s α=0.56-0.82). No statistically significant correlations existed between HbA1c and participant perceived barriers or readiness to change. Participants were reportedly preparing or actively trying to lose weight and perceived few barriers to completing self-care activities. While participants reported well managed diabetes, their self-management was suboptimal regarding diet behaviors, glucose monitoring, and physical activity. Participants reported optimal diabetes medication adherence. The PDQ remains a valuable tool that can be used by primary care providers to facilitate optimal, patient-centered self-management evaluation and education and minimize diabetes complications.
Exploring the Therapeutic Potential: A Systematic Review of 3,4-Methylenedioxymethamphetamine (MDMA) in the Management of Post-Traumatic Stress [paper]
(2023-12) Hensley, Melissa; Littlefield, Amber
This systematic review examines the current state of research on the use of 3,4-methylenedioxymethamphetamine (MDMA) as an adjunct to psychotherapy for the treatment of Post-Traumatic Stress Disorder (PTSD). The study explores the historical context of MDMA, its pharmacological mechanisms, and the rationale for its potential therapeutic effects in addressing PTSD symptoms. A thorough examination of clinical trials, randomized controlled trials, and observational studies reveals promising results in terms of safety and efficacy. The review highlights the neurobiological and psychological mechanisms through which MDMA may facilitate the therapeutic process, including enhanced emotional regulation, increased empathy, and improved introspection. Key findings from recent clinical trials, such as the Multidisciplinary Association for Psychedelic Studies (MAPS)-sponsored Phase 3 trials, are presented and discussed. Safety considerations, including potential adverse effects and risk mitigation strategies, are addressed to provide a balanced perspective. The review also discusses the legal and ethical implications surrounding the use of MDMA in therapeutic settings. Additionally, the potential impact of this emerging treatment modality on existing PTSD treatment paradigms and healthcare practices is explored. Overall, this review supports the growing body of evidence suggesting that MDMA-assisted therapy holds promise as a novel and effective approach for individuals suffering from PTSD. While further research is needed to establish long-term safety and efficacy, the findings underscore the potential of MDMA-assisted therapy to contribute to the evolving landscape of mental health treatments for PTSD.

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