Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Increasing statin utilization in patients at high risk of atherosclerotic cardiovascular disease in remote physiological monitoring program(Montana State University - Bozeman, College of Nursing, 2023) Ottemoeller, Christopher Michael; Chairperson, Graduate Committee: Lindsay BenesStatement of the problem: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide costing the United States an estimated $200 billion a year. Dyslipidemia, a leading risk factor for ASCVD, is well controlled by statin medications. Despite high efficacy, low cost, and a favorable safety profile, statins are underutilized. A healthcare facility in Montana aimed to increase utilization of statins in high-risk populations through pharmacist chart reviews. Methods: The quality improvement case manager at the healthcare facility conducted a review of patient charts to identify those at high risk for ASCVD who were not receiving statin therapy based on MIPS #438 recommendations. The case manager identified patients that would benefit from a statin and referred them to a pharmacist for a medication chart review. The pharmacist then called the patient to complete a medication chart review and sent recommendations for medication changes to the patient's primary care provider (PCP). Results: Twenty-two patients were initially identified for statin therapy with 13 deemed eligible. Six of them (46%) agreed to a pharmacist chart review and were contacted by the pharmacist, all of whom agreed to statin therapy. The pharmacist made an average of two additional medication changes recommendations per review. Thus far, three patients followed up with their provider and started statin and one patient completed a repeat lipid panel. Conclusion: Pharmacist outreach can increase statin utilization in patients at high-risk of ASCVD. Further research should focus on improving statin tolerability and ability to contact patients.Item Putting the vital in vitality: establishing the link between the phenomenological experience of vitality and patterns of blood pressure in the laboratory and daily life(Montana State University - Bozeman, College of Letters & Science, 2020) Tintzman, Courtney Suzanne; Co-Chairs, Graduate Committee: Neha John-Henderson and Ian M. HandleyHistorically, much attention has been paid to the potentially harmful effects of unhealthy behaviors and poorly regulated emotion on cardiovascular health, but a growing area of research focuses on whether positive psychological states, such as vitality, may also affect cardiovascular risk. Vitality--characterized by feelings of aliveness and energy--has been theorized to reduce risk for development of cardiovascular disease by a) directly regulating biological systems, and indirectly, by regulating negative emotional states that may lead to poor physiological responses. Existing literature focuses on prospective cardiovascular outcomes, but the current studies examine ways in which vitality may relate to cardiovascular health prior to development of cardiovascular disease. The current project extends existing literature by assessing the relationship between vitality and blood pressure, an informative, short-term indicator of cardiovascular health. Two studies hypothesized that vitality would provide more effective regulation of blood pressure in two different contexts. Study I (N = 126) examined the hypothesized relationship between vitality and blood pressure within the context of a laboratory stress paradigm. Vitality was measured upon entrance to the laboratory, and blood pressure was measured before, during, and after a speech task. Following a model proposed by Kuzbansky and Thurston (2007), vitality was hypothesized to directly, and also 'indirectly' through the reduction of cognitive and somatic anxiety about the stress task, predict more highly regulated reactivity and faster recovery from a psychosocial stressor. Results failed to support predictions: vitality did not predict patterns of blood pressure reactivity and recovery to a stressor, directly nor indirectly. Study II (N = 100) utilized ecological momentary assessment to investigate the hypothesized relationship between vitality and blood pressure in daily life. Participants completed daily measures of vitality and perceived stress, and ambulatory blood pressure was captured every four hours. In support of the hypotheses, vitality and perceived stress emerged as a significant predictors of blood pressure across time, suggesting that vitality may directly and indirectly affect blood pressure. These findings add to a growing area of research that suggest vitality as an important factor in cardiovascular health. Limitations and implications for future research are discussed.Item Preeclampsia and increased risk of cardiovascular disease: a practice guide for providers(Montana State University - Bozeman, College of Nursing, 2020) Toole, Brielle Ashli; Chairperson, Graduate Committee: Sandra Benavides-VaelloCardiovascular disease (CVD) is the leading cause of death among women, however this disease is preventable and treatable. Extant evidence has established that women with a history of preeclampsia are at an increased risk for developing CVD later in life, and yet preeclampsia is under-recognized as a risk factor for CVD. This is due to a knowledge gap amongst healthcare providers, and subsequently providers are not adequately educating their patients with a history of preeclampsia about their CVD risk and reducing this risk. There are no specific guidelines regarding long-term care or screening for CVD in women with a history of preeclampsia, so a guideline needs to be developed to assist providers in caring for this high-risk population. The first aim of this project is to develop a guideline for providers to use in practice while caring for women with a history of preeclampsia, and the second aim is to enhance providers' knowledge of the link between a history of preeclampsia and increased CVD risk later in life so they can provide improved, evidence-based care. This project used a pre-survey, educational content with dissemination of two practice guidelines in different formats and a patient educational handout, and post-survey approach. The project targeted healthcare providers who care for women with a history of preeclampsia at a small rural hospital. Providers who participated in this project did have knowledge of the link between preeclampsia and increased CVD later in life, but were not applying this knowledge to their practice, as they neither took a thorough pregnancy history from their patients in regards to preeclampsia nor provided counseling to women with a history of preeclampsia about their increased risk of CVD. Providers who reviewed the guideline presented in this project found it helpful and had or planned to implement a practice change because of the guideline. The practice guideline developed was an effective tool to help the providers in this project implement evidence-based care into their practice, and the patient handout was an additional resource they could use to educate their patients with a history of preeclampsia.Item The efficacy of the coronary patient's hospital record in research(Montana State University - Bozeman, College of Professional Schools, 1970) Sprague, Mildred Grow; Chairperson, Graduate Committee: Rita M. DarraghItem An evaluative study of the myocardial infarction patients' expressions of their needs and their responses about the health teaching they received(Montana State University - Bozeman, College of Professional Schools, 1969) Pesanti, Linda CatherineItem A descriptive survey of coronary nursing education among professional nurses in Montana(Montana State University - Bozeman, College of Professional Schools, 1968) Oka, Betty McDougallItem A survey of a selected number of myocardial infarction patients to determine their needs upon leaving the coronary care unit(Montana State University - Bozeman, College of Professional Schools, 1972) Foley, Mary Kaye ParkerItem A comparison between swimming and jogging using selected cardiovascular efficiency tests(Montana State University - Bozeman, 1969) Jenkins, Rodney D.Item A descriptive survey of rural emergency room nurses' knowledge and role perception of advanced cardiac life support(Montana State University - Bozeman, College of Nursing, 1980) Ellis, Daniel JosephItem Postprandial effects of soy isoflavones on low-density lipoprotein oxidative resistance with a high carbohydrate meal(Montana State University - Bozeman, College of Education, Health & Human Development, 2003) Miller, Bobbi Jo; Chairperson, Graduate Committee: Christina Gayer CampbellCardiovascular disease (CVD) encompasses a wide array of health problems including atherosclerosis which results in 50% of all cardiac deaths. Currently the American Heart Association developed the Step I guidelines for reducing the risk of CVD limits total fat to ≤30% of total energy, saturated fat to <10% of total energy, and cholesterol to < 300 mg/day. Reducing dietary fat generally decreases plasma cholesterol however carbohydrate (CHO) content typically rises accompanied by increasing plasma triacylglycerol (TC). Elevated TG may possibly be a risk factor for CVD, referred to as “CHO-induced hypertriacylglycerolemia” (HPTG). The disease process of atherogenesis has been hypothesized by Zilversmit as a postprandial phenomenon based on the formation of chylomicron remnants, low-density lipoproteins (LDL), and the uptake of these cholesterol and TG rich molecules by arterial cells. Oxidation of LDL and phagocytic immune system cells have been implicated in the mechanism involving fatty streaks and occlusion of the arterial lumen. The isoflavones diadzein and genistein in soy-protein have been associated with oxidative resistance of LDL due to their antioxidant activity. The purpose of this study was to determine if the oxidative resistance of postprandial LDL is enhanced with the consumption of a meal containing 39.0 g of soy protein (80 mg aglycone isoflavones) vs 39.9 g milk protein (0 mg aglycone isoflavones) in combination with a high carbohydrate meal. Fifteen healthy male subjects participated in a double-blind, crossover feeding study in the Nutrition Research Lab (NRL) at Montana State University. Subject’s height, weight, and baseline blood draw were completed before consuming the challenge meal consisting of 2 high carbohydrate muffins and a soy or milk protein shake (899 calories, 22% fat, 58.6% CHO, 19.4%). Blood samples were collected by venipuncture postprandially at hours 2, 4, and 6. Isolated LDL was subjected to ex vivo copper-induced oxidation. Initial absorbance, lag time, and propagation rate were calculated for each time point. Results indicated no significant difference (p>0.05) between the protein treatments or their interaction on LDL oxidation parameters. Additional research is needed to ascertain the function of soy in prevention of CVD, specifically in the postprandial state.