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Stalin\u27s Collectivization: Effects of Failure
Get PDFCollective farming had a major impact on Soviet History, especially when it comes to economics, loss of life, and the creation of a nation. The government, under Joseph Stalin, pushed for the idea of collective farming, with great cost to the soviet people, and eventually abandoned it as a major disappointment and a failure
Losing Face-to-Face Selling in a Digital World: An Empirical Investigation of Relationship Selling in the Independent Insurance Agency
Get PDFOver the past 20 years, our economy has transformed into a service-based economy as opposed to the previous industrial-based economy. The service industry is growing and rapidly becoming one of the primary sectors of the economy. Relationship selling is crucial to the service industry, especially the property and casualty insurance market—because it involves complex, highly intangible services. Even though consumers use the internet before reaching out to an insurance agent, this does not mean relationship selling is unnecessary. With complex products like property and casualty insurance, relationship selling is crucial to grasp what consumers truly need and understand. The purpose of this dissertation is to examine the impact of market orientation, relationship selling, and the relationship sales cycle that is involved in the process. Empirical results provide compelling evidence for the important roles of market orientation and relationship selling to the independent agent to run a successful and competitive business. Digitalization has become more prevalent, and independents agent must also adapt for their sustainability. Findings from this research could also be utilized in other service industry fields
Investigating Relationships Between Muslim High School Students’ School Belonging and Career Decision-Making
Get PDFMuslim Americans have been subjected to systemic oppression and unjust experiences, such as discrimination, racism, hate crimes, and stereotypes, for generations in the United States. Although ample research has investigated relationships between systemic oppression in society and its impacts on marginalized students in public school environments, little research has directly investigated Muslim students\u27 school experiences. Additionally, studies and scholarship have explored the long-term impacts of systemic oppression on marginalized groups to develop a comprehensive understanding of minority groups’ experiences in the United States. This study investigated Muslim students’ experiences in public high schools regarding their sense of belonging and other long-term experiences related to their career decision-making. Given the marginalized status of Muslim students, the social experiences investigated in this research are aimed to include the influences of systemic racism and discrimination. Using a sample of 180 Muslim students who attend public schools in the United States, we conducted a quantitative, descriptive, and multivariate correlational design to explore the relationship between perceived discrimination, sense of belonging, and career decision-making self-efficacy. Findings revealed that higher levels of perceived discrimination suggested lower levels of sense of belonging. Additionally, lower levels of sense of belonging correlated with lower self-efficacy in career decision-making
Daily SBAR Sheet for Pediatric Patients with Central Lines
Get PDFProblem: The patient’s daily central line Theraworx baths were not being documented and completed at a mid-Missouri teaching hospital. After completing a retrospective chart review for 2022, 8.35% (n=90) of daily central line Theraworx baths were documented. Daily central line baths decrease central line-associated bloodstream infections (CLABSI), prolonged hospital stays, and costs.
Methods: The quality improvement (QI) project utilized a pilot retrospective and prospective pre-post-design. A retrospective chart review on daily central line Theraworx baths was conducted on patients two years and older within the pediatric service line who had a central line. A situation, background, assessment, and recommendation (SBAR) sheet was created and filled out by the nursing staff daily. Data collected during the QI project was the daily central line baths SBAR sheet marked as completed or not completed, the type of bath, and the number of CLABSIs within the pediatric service line.
Results: The pediatric service line had 46.19 % (n=103) of daily central line Theraworx baths documented out of 223 central line days. The SBAR sheet improved daily central line Theraworx baths in patients two years and older by 453.17%, showing clinical significance. A statistically significant (P
Implications for Practice: Utilizing a daily central line Theraworx bath reminder within the pediatric service line could continue to increase the completion and documentation rates of Theraworx baths and decrease CLABSI rates
The Caregiver of the Child with Cerebral Palsy: The Unnoticed Victim
Get PDFThe purpose of this study was to better understand the overall quality of life (QoL) in the primary caregiver who provides care to the child or adolescent, aged 0-17 with mild, moderate, or severe Cerebral Palsy (CP). This study aligned with a nonexperimental or observational design and examined the severity level of CP and the QoL in the mother and/or father.
For research question 1, regression results indicated that the overall model did not significantly predict the mother’s and father’s QoL [R2 = .000, R2 adj = -.012, F(1,80) = .003, p = .957]. Regression results indicated that the overall model did not significantly predict the mother’s mental and physical QoL [R2 = .002, R2adj = -.007, F(1,111) = .268, p = .606]. Regression results indicated that the overall model did not significantly predict the father’s mental and physical QoL [R2 = .000, R2adj = -.011, F(1,86) = .024, p = .877].
For research question 2, there was an association between the number of hours spent providing healthcare and the CP severity description, x2 (16) = 77.79, p 2 (12) = 39.49, p2 (4) = 25.20, p2 (4) = 11.08, p=.026. Regression results indicated an overall model of two indicators (day-to-day emotional care and day-to-day emotional care from the health care provider) that significantly predicted the total score of the mother [R2 = .163, R2adj = .085, F(1, 9) = 2.081, .039]. Regression results indicated an overall model of one indicator (caregiver(s) employment status) that significantly predicted the total score of the father [R2 = .145, R2adj = .042, F(1, 9) = 1.411, .199]
Screening for Food Insecurity in a Suburban Pediatric Urgent Care
Get PDFProblem: Screening for Social Determinants of Health (SDOH), including food insecurity (FI) should be done on a regular basis at a child’s pediatrician. Many children in the state of Missouri do not have a pediatrician or do not regularly see their pediatrician and are therefore never being screened for FI.
Methods: This observational descriptive quality improvement (QI) project utilized a prospective observational analysis to implement a voluntary FI screening tool in a pediatric only urgent care. The project sampled pediatric patients aged two days to 21 years of life. All participants were given local resources after completing the screening. The project included a staff education phase, implementation phase, and data collection and analysis phase. The project used plan-do-act-study method to evaluate limitations.
Results: 261 families were screened over a one-month period with 33% of the screenings being positive for FI. Two two-tailed, independent t-tests were performed to assess a correlation between a child being food insecure and the child seeing a pediatrician in the last 12 months. The results were not significant with p values of 0.98% and 0.52%
Implications for Practice: A FI positivity rate of 33% suggests screening for SDOH should be done outside of a child’s pediatrician and families should be better connected to resources when they do screen positive for FI
Predicting Outcomes in Early Treated Spinal Muscular Atrophy (SMA)
No full textBackground:Early treatment of infants with spinal muscular atrophy (SMA) improves outcomes. Newborn screening allows for early treatment of infants with SMA, even before signs of the disease are evident. In spite of early identification and treatment, newborn screen and prenatally-identified infants with SMA may still suffer effects of their disease. Approximately half of infants have significant gross motor developmental delays, while others meet developmental milestones on time. There is no current objective method to identify early-treated infants with SMA at risk for gross motor delays who might benefit from modifications to current treatment practices.Objectives:This multicenter project reports real world data on outcomes of early-treated infants with SMA.Methods:Retrospective chart review of all newborn screen identified or prenatally diagnosed children with SMA who were treated with nusinersen or onasemnogene abeparvovec at
Results: Sixty-five patients, 36 with two SMN2 copies, 28 with three SMN2 copies, and one with four SMN2 copies, were included. Twenty-seven patients (41.5%), most with two SMN2 copies, had SMA symptoms by initial treatment. Forty-six (71%) received initial treatment with onasemnogene abeparvovec, and 19 (29%) with nusinersen. Infants with two SMN2 copies had greater frequency of gross motor delays than those with \u3e=three SMN2 copies. No child required permanent ventilation or total nutrition via tube feeds, but seven required nocturnal non-invasive ventilation and seven utilized both oral and tube feedings. Thirty-one received sequential or combination treatments, including 15 adding treatment with nusinersen or risdiplam due to SMA symptoms or suboptimal outcome following onasemnogene abeparvovec.
Conclusions: This study contributes to the limited literature on real world outcomes of early treated infants with SMA, including if baseline pre-treatment CHOP INTEND score can predict gross motor delays in this population
Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit
Get PDFExtubation Readiness Test in a Pediatric Cardiac Intensive Care Unit
Abstract
Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.
Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample to include children aged neonate to 18 years of age admitted to the pediatric cardiac ICU who were mechanically ventilated with non-cyanotic single ventricle heart defects. Data collected from Oct 2022-May 2023 and included cardiac defect/admission diagnosis, ERTs used, number of extubation failures, and length of intubation.
Results: A (N=77) patients met criteria for an ERT to be administered during the data collection period. Pre implementation (Oct 22-Dec 22) of ERT a (n=40) and post implementation (Feb 23-May 23) (n=37) met criteria for an ERT to be administered. In the post implementation (n=37; 100%) had an ERT performed. There was a (n=2; 5%) extubation failure rate pre-implementation and (n=0; 0%) extubation failures in the post implementation group.
Implications for Practice: ERTs should be used in the cardiac ICU to prevent extubation failure, potentially decrease length of mechanical ventilation, and aide clinicians in identifying patients ready for liberation from mechanical ventilation earlier
Implementation of a Vestibular Disorder Screening Tool in an Urgent Care
Get PDFImplementation of a Vestibular Disorder Screening Tool in an Urgent Care
Kathleen A. Probst
M.S.N., University of Missouri-Columbia, 2007
B.S.N., University of Missouri-Columbia, 2004
A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree
Doctor of Nursing Practice
August 2023
Advisory Committee
Susan Dean-Baar, PhD, RN, CENP, FAAN
Chairperson
Jennifer Vines, DNP, MSN, RN
Troy Dinkel, MD
Copyright, Kathleen A. Probst, 2023
Abstract
Problem: Vestibular disorders disrupt everyday living and can cause reduced quality of life. Guidelines developed to screen for vestibular disorders are not efficient to use in the emergency department and are not utilized by some providers due to lack of confidence and training. Patients who present to the emergency department with vestibular disorder symptoms are often left undiagnosed, therefore leading to lack of referrals for vestibular therapy (VT).
Methods: A vestibular screening tool (VST) was introduced to a convenience sample of providers working in an urgent care setting. This quality improvement project analyzed quantitative descriptive data, both retrospective and prospective, comparing the number of VT referrals in patients with a vestibular disorder diagnosis. This project also compared provider confidence levels to diagnosis and refer patients with vestibular disorders.
Results: Comparison of the number of VT referrals made from the retrospective (n=121, 30.58%) and prospective (n=126, 34.92%) data suggest no significant relationship. There was a significant difference in the mean rank for provider confidence level from before and after the VST was introduced (U=838, z = -1.98, p = 0.047).
Implications for Practice: Introduction of a VST in an urgent care setting can increase provider confidence level in diagnosing patients with a vestibular disorder and referring to VT
Use of serial smartphone-based assessments to characterize diverse neuropsychiatric symptom trajectories in a large trauma survivor cohort
Get PDFThe authors sought to characterize adverse posttraumatic neuropsychiatric sequelae (APNS) symptom trajectories across ten symptom domains (pain, depression, sleep, nightmares, avoidance, re-experiencing, anxiety, hyperarousal, somatic, and mental/fatigue symptoms) in a large, diverse, understudied sample of motor vehicle collision (MVC) survivors. More than two thousand MVC survivors were enrolled in the emergency department (ED) and completed a rotating battery of brief smartphone-based surveys over a 2-month period. Measurement models developed from survey item responses were used in latent growth curve/mixture modeling to characterize homogeneous symptom trajectories. Associations between individual trajectories and pre-trauma and peritraumatic characteristics and traditional outcomes were compared, along with associations within and between trajectories. APNS across all ten symptom domains were common in the first two months after trauma. Many risk factors and associations with high symptom burden trajectories were shared across domains. Both across and within traditional diagnostic boundaries, APNS trajectory intercepts, and slopes were substantially correlated. Across all domains, symptom severity in the immediate aftermath of trauma (trajectory intercepts) had the greatest influence on the outcome. An interactive data visualization tool was developed to allow readers to explore relationships of interest between individual characteristics, symptom trajectories, and traditional outcomes (http://itr.med.unc.edu/aurora/parcoord/). Individuals presenting to the ED after MVC commonly experience a broad constellation of adverse posttraumatic symptoms. Many risk factors for diverse APNS are shared. Individuals diagnosed with a single traditional outcome should be screened for others. The utility of multidimensional categorizations that characterize individuals across traditional diagnostic domains should be explored