Theses and Dissertations at Montana State University (MSU)
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Item Post-prandial serum concentrations of Trimethylamine-N-oxide in overweight and obese adults with low and high systemic inflammation(Montana State University - Bozeman, College of Education, Health & Human Development, 2018) Wilson, Stephanie Michelle; Chairperson, Graduate Committee: Mary P. MilesPurpose: Elevated trimethylamine-N-oxide (TMAO) levels have been implicated in the development of atherosclerosis. The impact of a high-fat meal on the post-prandial TMAO response in healthy overweight and obese adults was explored, accounting for additional variables that may affect the rate of TMAO conversion. Methods: Forty overweight and obese men and women participated in a high-fat meal challenge containing 50 g fat. Blood samples were collected at fasting and hourly in the 4 hours after meal ingestion and tested for concentrations of TMAO, liver enzymes, lipids, creatinine, insulin, and inflammatory markers. An initial mixed-effects model was constructed to analyze TMAO changes in participants who classified as having low or high levels of systemic inflammation accounting for factors that may influence TMAO concentrations. Backward refinement of the initial model was performed based off p-values. Results: Model refinement found that the log TMAO response was best explained by inclusion of estimated glomerular filtration rate (eGFR), insulin over time, a linear interaction between time and inflammation phenotype, and random effects on subject. Log TMAO after the meal was not different between inflammation phenotypes (p = 0.33). Estimated GFR was the most important determinant in the log TMAO response (p = 0.03), with lower log TMAO observed with higher eGFR values. In conclusion, serum TMAO concentrations during a high fat-meal challenge were strongly determined by eGFR, but not by fasting inflammation status.Item Use of ultrasound guidance during cannulation of arteriovenous fistulas or arteriovenous grafts(Montana State University - Bozeman, College of Nursing, 2018) Luehr, Alice Anne; Chairperson, Graduate Committee: Teresa SerightIndividuals who require renal replacement therapy overwhelmingly choose outpatient hemodialysis. In December, 2013, 62.5% of these patients were using an arterial venous fistula (AVF) and 15% were using an arterial venous graft (AVG) for their hemodialysis access (National Institute of Diabetes and Digestive and Kidney Diseases, 2015). Appropriate cannulation techniques are an essential element in access preservation and prevention of access-related complications. Missed cannulations of AVFs result in damage to the fistula (Lee, Barker, & Allon, 2006). Ultrasound-guided cannulation has proven to be an effective technique for the placement of peripheral venous catheters (IVs) and for placement of central venous dialysis catheters (CVCs) (Brannam, Blaivas, Lyon, & Flake, 2004). The purposes of this scholarly project were to determine if ultrasound-guided cannulation of AVFs/AVGs decreased the number of missed cannulations, to determine staff and patient perceptions regarding cannulation, and to implement a quality-improvement project (QIP). The QIP consisted of creating an ultrasound-guided policy and procedure, training program, and competency evaluation at a hospital-based dialysis facility. Analysis of 53 electronic health records (EHRs) determined the number of missed cannulations in relation to the purchase and availability of a bedside ultrasound machine and implementation of the QIP. Likert scale surveys were distributed to staff and patients to determine familiarity with ultrasound-guided cannulation and perceptions concerning access cannulation. Results: Staff surveys demonstrated a need for policy and procedure, training, and competencies for ultrasound guided cannulation. Patient surveys demonstrated a need for more consistent ultrasound use and showed increased patient satisfaction with cannulation experience when ultrasound guidance was utilized. EHR data revealed a 53% reduction in the number of missed cannulations after the purchase and availability of a bedside ultrasound machine for ultrasound-guided cannulation. Conclusion: Implementation of an ultrasound-guided cannulation policy and procedure, training program, and competency helped guide staff with this cannulation technique. Further research is needed to determine if ultrasound guided cannulation should be classified as a best practice technique.Item Cellular inflammatory response of rainbow trout to PKX(Montana State University - Bozeman, College of Agriculture, 1988) MacConnell, Elizabeth