Theses and Dissertations at Montana State University (MSU)
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Item Quality improvement project to improving diabetic retinopathy screening in a primary care provider's practice(Montana State University - Bozeman, College of Nursing, 2023) Rummel, Cody Alan; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughBACKGROUND: Diabetic retinopathy (DR) continues to be the leading cause of blindness among the working-age population. The aim of this study was to improve DR screening (DRS) rates within primary care through the implementation of a patient questionnaire and follow-up intervention. The study was conducted at a rural primary care provider's office. METHODS: SEIPS 3.0 model was used specifically, and the journey map was applied during diabetes office visits to assess processes and influences impacting DRS. An intervention supported by current evidence was created to address identified barriers to screening. INTERVENTION: The project lead and healthcare providers collaboratively created a DRS questionnaire and new process (i.e., record and fax) to be implemented during every diabetic mellitus follow-up visit. RESULTS: Of the 17 patients with diabetes, 15 (88%) received the DRS paperwork. Three (20%) had not completed their DRS, and 12 had. 11 of the 12 had current ophthalmology notes and the EMR was updated. Request of information (ROI) was faxed to ophthalmologists for the patients who did not have a current DRS note or had not completed DRS. Two ROIs were returned with DRS date. During the project, 87% of patients evaluated had their DRS date entered into the EMR, and office-wide there was a 13% increase in total DRS rates. CONCLUSIONS: Action to address low DRS rates needs to address the multifaceted barriers that make standardizing DRS difficult. This project led to improvements in DRS rates, but the site eluded to not continue the new process. Prolonged interactions may identify barriers to sustaining the new process.Item Pupil response as a measure of preparatory control of attention in anticipation of deception(Montana State University - Bozeman, College of Letters & Science, 2024) Brennan, Evan Michael; Chairperson, Graduate Committee: Keith A. HutchisonDeception is generally considered to be more cognitively demanding than telling the truth, driving research interest in the relationship between deception and cognitive ability. Few studies have explored the preparatory attentional state occurring after the decision to be dishonest is made, but before the content of the question is known to the deceiver. Participants in the current study were given "Truth" or "Lie" prompts several seconds before being asked questions about autobiographical information that they answered according to the prompt. Cue-evoked pupillary responses, or the changes in participants' pupils during the fixation period between the prompt and question presentation, served as an objective physiological measure of this preparatory state of attention. To assess cognitive ability, several tasks assessing working memory capacity and attentional control were also administered to determine their relationship with pupil response. Aligned with results from a former study, it was hypothesized that pupil diameter would be greatest in anticipation of "Lie" trials, that working memory capacity and attentional control would be negatively correlated with the proportion of errors committed and positively correlated with pupil size in the final few seconds of the fixation interval, and that pupil diameter variability across the fixation interval would be positively correlated with the proportion of errors committed. Results showed a general pattern of constriction in pupil diameter in the fixation interval, which opposed results from previous studies, and did not provide support for the main hypotheses. Lie trials where participants committed an error displayed a significant decrease in pupil diameter across the fixation interval relative to accurate lie trials. Possible reasons for general pattern of pupil constriction are given, prompting a retesting of the hypotheses under better experimental conditions. It is still possible that there is a general pattern of pupil dilation in this preparatory period.Item Investigation of the cellular pathology underlying the optic neuropathy in a mouse model of familial Dysautonomia(Montana State University - Bozeman, College of Agriculture, 2023) Schultz, Anastasia Mardell; Chairperson, Graduate Committee: R. Steven Stowers; This is a manuscript style paper that includes co-authored chapters.Familial dysautonomia (FD) is a rare, recessive, progressive autosomal disorder that affects the nervous system. This neurological disorder is caused by a splice mutation in the Elongator complex I (ELP1) gene. The mutation results in a tissue-specific reduction of ELP1 protein due to unstable mRNA targeted for nonsense-mediated decay. ELP1 is a highly conserved scaffolding protein and core subunit of the six-subunit Elongator complex required for normal translation, neuronal development, and survival. Insufficient ELP1 leads to the developmental death of neurons in the peripheral and autonomic nervous systems in addition to central and peripheral nervous system neurodegeneration. Patients suffer from congenital and progressive neuropathies, such as cardiovascular dysfunction, reduced peripheral sensory function, poor growth, and digestive and respiratory problems. Outside of the risk of death in early adulthood, one of the most debilitating conditions affecting patients' quality of life is progressive blindness marked by continual loss of retinal ganglion cells (RGCs). Within the FD community, there is a concerted effort to develop treatments to prevent the loss of RGCs, thereby improving patients' quality of life. This study aims (1) to elucidate mechanisms underlying the death of RGCs in the absence of Elp1 and (2) to obtain pre-clinical intervention data that can eventually be translated into therapeutics for rescuing RGCs in FD. Using histology and confocal microscopy in conjunction with biochemistry, this study provides evidence for disrupted cellular homeostasis and inflammation preceding RGC death, and as the disease progresses, the retinal cells fail to mount a correct stress response to restore neuronal homeostasis. Furthermore, this study provides first-of-its-kind pre-clinical data using targeted gene therapies to rescue RGCs. Understanding the biological crosstalk and signaling mechanisms underlying the death of RGCs in the absence of Elp1 will allow for more targeted and effective therapeutics that will benefit not only the FD community but also individuals affected by other retinal diseases and neurological diseases that result from a faulty Elongator complex. This study provides a novel characterization of the FD retina and establishes baseline methods to further investigate rescuing RGCs.Item Macular degeneration, glaucoma, and diabetic retinopathy : a continuing education program(Montana State University - Bozeman, College of Nursing, 1999) Lewis, Amy Sarah; Chairperson, Graduate Committee: Jean Ballantyne