Digital Commons Network^™

Iceland: Depositors' And Investors' Guarantee Fund, Adam Kulam

Documents

No abstract provided.

Swiss Banks' And Securities Dealers' Depositor Protection Association, Ezekiel Vergara

Documents

No abstract provided.

Annual Report 2021 & Annual Performance Statement 2021-2022, Central Bank Of Ireland

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No abstract provided.

A Nurse-Driven Protocol To Increase Metabolic Screening And Interventions For Inpatients On Antipsychotic Medications, James Thomas Demarco

Yale School of Nursing Digital Theses

Patients on antipsychotic medications are at higher risk of developing metabolic syndrome; nevertheless, metabolic screening for patients on antipsychotics is suboptimal. This project implemented a nurse-driven protocol on inpatient psychiatric units to increase metabolic screening compliance rates. The literature on improving metabolic screening as well as the clinical use of nurse-driven protocols were used to develop a protocol. The initial implementation of the protocol showed no change in screening rate; however, when the protocol was updated to include nursing leader involvement, metabolic screening increased. Nurses’ perception of the nurse-driven protocol was examined and found a negative perception and no change …

Reducing Unnecessary Primary Cesarean Sections: A Quality Improvement Project, Jennifer L. Suess

Yale School of Nursing Digital Theses

Background: The cesarean section (CS) is the most common surgical procedure in the United States and while often necessary and life-saving, brings higher risk of morbidity and mortality for both patient and neonate than vaginal birth (Boyle et al., 2013; Lagrew et al., 2018). CS rates in nulliparous, term, singleton, vertex (NTSV) patients vary dramatically, from 7.1% to 69.9%, throughout US birthing facilities but can be safely reduced via the implementation of evidence-based safety bundles that aim to reduce variation in care (Council on Patient Safety in Women’s Health Care, 2020; Kozhimannil et al., 2013). Local Problem: A large birthing …

Implementing A Peer And Mentor Transition Support Program For New Graduate Psychiatric Nurse Practitioners, Christina Maroone

Yale School of Nursing Digital Theses

New graduate Psychiatric Mental Health Nurse Practitioners (PMHNPs) face challenges during the transition to practice that can lead to emotional distress and decreased productivity. To address this issue, a New Graduate PMHNP Transition Program was developed to provide mentorship, peer support, and education during the transitional period. This program aimed to improve role clarity, prevent burnout, and improve self-confidence for new graduate PMHNPs. The program consisted of individual mentorship, peer support groups, and educational modules relevant to the new graduate transition PMHNP to practice. The program was implemented with twenty new graduate PMHNPs, who reviewed the curriculum on transition to …

Latvian Privatization Agency 2021 Report, Latvian Privatization Agency

Documents

No abstract provided.

Educational Program For Caregivers Of Children With Tympanostomy Tube Otorrhea: Impact On Caregiver Self-Efficacy And Clinical Outcomes, Wendy Lord Mackey

Yale School of Nursing Digital Theses

There is an overuse of oral antibiotics and acute care visits conducted to treat children with uncomplicated tympanostomy tube otorrhea (TTO), a condition easily identified by the child’s caregiver who can then independently initiate treatment with ototopical antibiotic drops (TAD). Yet, some caregivers seek urgent medical attention for children with TTO, which often results in mismanagement of the condition including the administration of oral antibiotics. This quality improvement initiative involved the development and implementation of an educational program for caregivers of children with tympanostomy tubes (TT). Resources for caregivers included a web-based instructional video, informational pocket-card, and a post-operative text …

Sepsis Discharge Program: An Interdisciplinary Approach To Reduce Sepsis Readmissions, Rex Daniel Demetria Lomboy

Yale School of Nursing Digital Theses

The social and economic burden associated with sepsis readmission remains a global healthcare issue. Sepsis survivors are at higher risk for physical debilitation, readmission, and death, yet despite advanced sepsis prevention and interventions, post-sepsis care and sepsis readmission reduction efforts, remain scant. Sepsis readmission costs ($500M /year) are more than the annual cost of acute myocardial infarction ($142M /year) and heart failure ($229M/year) combined. The overall goal of this DNP project was to reduce sepsis readmissions for patients identified as high risk for readmission using a standardized, safe discharge program (SDP) and implement it using a dynamic interdisciplinary collaborative approach. …

Implementation Of A Medication Adherence Protocol In A Large Urban Safety Net Hospital, Carlie Martinez

Yale School of Nursing Digital Theses

Medication nonadherence has a deleterious effect on patients with chronic health conditions, as it contributes to poorer health outcomes and increased healthcare spending. This Doctor of Nursing Practice project sought to improve medication adherence in at-risk patients by enhancing patient-provider communication and improving health literacy in a large, urban, safety net hospital. Utilizing a multi-prong approach, patients were provided with a visual aid – a pill card, in conjunction with the teach-back method, to improve systolic blood pressure (SBP), diastolic blood pressure (DPB) and Hemoglobin A1c (HbA1c) over a 6-month period. Twenty-three patients participated in the project. Participant demographics, attitudes …

Embedding Licensed Independent Providers In A Va Regional Clinical Contact Center, Bonnie Sommers-Olson

Yale School of Nursing Digital Theses

Inappropriate attendance in US emergency departments (ED) account for up to 40% of all ED visits. Overcrowding can lead to poorer outcomes for patients in the ED, including a higher rate of triage to non-monitored area and longer timeframes to physician initial assessment. Additionally, the cost for unnecessary ED care is two to three times greater than care is in an Urgent Care or Clinic and cost billions of dollars in the U.S. yearly. Licensed Independent Providers (LIP); Medical Doctors and Nurse Practitioners were embedded into a VHA VISN registered nurse telephone triage system. Protocols were developed for additional opportunities …

Adoption Of Teamstepps® To Promote Collaboration And Problem-Solving: A Pilot Training Program For Clinical Nursing Leaders, Manvir Nijjar

Yale School of Nursing Digital Theses

Quality improvement, a concept implemented by Florence Nightingale in the 19th century, is now deeply embedded in United States healthcare policy from licensure to payment models (Nightingale, 1863). The culture of safety and the emphasis on process improvement is engrained in high reliability organizations, fostering an environment of collective mindfulness and collective enactment to prevent error. To achieve high quality, healthcare organizations must bridge the core competencies of communication, collaboration, and problem solving taught in pre-licensure and translate them in inter-professional practice using evidence-based approaches. Nurses and nursing leaders must be equipped with the right problem-solving tools to drive efficiency, …

Improving Treatment Outcomes For Veterans With Ptsd And Sleep Disturbance, Gia Santoro

Yale School of Nursing Digital Theses

Evidence-based treatments for post-traumatic stress disorder (PTSD) improve overall symptoms, but sleep disturbance often persists. Insomnia and obstructive sleep apnea (OSA) frequently co-occur with PTSD and contribute to the overall sleep disturbance. Successfully treating the sleep disturbance that occurs in the context of PTSD, including insomnia and OSA when present, will improve sleep, decrease PTSD symptoms, and enhance quality of life. This DNP project adapted an assessment and treatment protocol for veterans with PTSD and sleep disturbance for use in an outpatient veterans Affairs (VA) PTSD clinic. The protocol was implemented in a patient education and treatment-planning group for veterans …

Use Of Teach-Back During Informed Consent In Cancer Clinical Trials, Christa Varnadoe

Yale School of Nursing Digital Theses

Five percent of the 1.8 million patients diagnosed with cancer in the United States (US) enroll annually in a clinical trial (American Cancer Society, 2021; Institute of Medicine Committee on Cancer Clinical Trials; National Cancer Institute Cooperative Group Program, 2010). Flawed research consent practices are detrimental to patient safety and costly to the US Healthcare system (Eisenberg et al., 2012; Unger et al., 2019). Well-trained nurses are imperative to conducting rigorous, reproducible, and quality research (Brandt et al., 2011). Programs designed to educate nurses on how to implement comprehensive communication strategies confidently during the Cancer Clinical Trials (CCT) consent process …

Retention Of The Newly Licensed Registered Nursing Workforce Post-Coronavirus (Covid-19): Establishing A Trauma-Informed Wellness Program, The Registered Nurse Residency Script For The Future (Rnrx) (© Maryellen Hope Kosturko, 2022), Maryellen Hope Kosturko

Yale School of Nursing Digital Theses

Retention of newly licensed registered nurses (NLRNs) is crucial to the future success of a thriving nursing workforce. It is well-established that most NLRNs experience stress as they transition from school to work environments leading some to leave the workforce or nursing altogether within their first two years post-graduation. The novel Coronavirus virus (Covid-19) pandemic exacerbated this problem as NLRNs experienced increased stress, fear, exhaustion, uncertainty, and dissatisfaction, further threatening the future of the nursing workforce. The aim of this project was to develop and implement a trauma-informed wellness program in an acute care inpatient hospital, The Registered Nurse Residency …

Using Community-Based Screening To Quantify The Relationship Between Hiv And Hypertension In A Rural South African Community, Jessica Ainooson

Public Health Theses

Background: Over the past three decades, the prevalence of hypertension has increased in sub-Saharan Africa, paralleling the HIV/AIDS epidemic. The aim of this study is to assess the relationship between HIV status and elevated blood pressure in a rural South African community. Methods: A secondary analysis was conducted from a community-based screening program providing TB/HIV/blood pressure/glucose screening in the rural sub-district of Msinga, KwaZulu-Natal, South Africa from 2011 - 2017. Descriptive analyses were used to characterize the frequency of measured and self-reported hypertension, HIV status, and sociodemographic variables. Multivariable logistic regressions were used to estimate the relationship between HIV status …

Identification And Correction Of Normalized Deviance In Healthcare Systems To Prevent Healthcare-Associated Infections And Improve Patient Outcomes, Elliana Sophia Barbell

Public Health Theses

Introduction: In healthcare, normalized deviance is characterized by the steady transition away from standard practice toward variations in practice behaviors. This deviation presents minorly at first and is accepted to save time and increase efficiency. However, initial evaluations of innocuity do not represent actual safety. While the deviant practice may not cause immediate patient harm, its alignment with additional system weak points has the potential to lead to poor patient outcomes, including the development of healthcare-associated infections (HAI). One behavior that may influence HAI development and patient outcomes is hair removal during preoperative skin preparation.Methods: An observational study of hair …

Women's Beliefs In Gender Equality And Its Association With Gender Based Violence In Conflict Afflicted Regions Of Uganda, Aishwarya Bhattacharya

Public Health Theses

Gender Based Violence such as Intimate Partner Violence and exposure to armed conflict are exacerbated in Conflict settings and can negatively impact health outcomes among women. Although a significant amount of research has looked at how men’s beliefs in gender equity and male stereotypes can impact engagement in violence against women, there is a dearth of research analyzing how women’s beliefs can impact their exposure to armed violence or IPV. We use the adapted version of the Gender-Equitable Men survey in a population of 606 women and adolescent girls in conflict afflicted regions of Northern Uganda to a) look at …

Caregiver Experiences Of Social Need And Promotion Of Support In The Pediatric Setting: A Qualitative Study, Meghan Patricia Casey

Public Health Theses

Children are vulnerable to the long-term health impacts of unmet family needs within social determinants of health like income, food security, housing, and transportation. Efforts have grown to recognize and respond to these challenges in the pediatric setting through social needs screening and other interventions. Previous research has extensively described the pediatric provider perspective on this work. However, less is known about how caregivers experience interactions surrounding social needs in the healthcare setting and which factors may influence these perceptions. To address these gaps in knowledge, this qualitative study examined semi-structured interviews of 20 caregivers who participated in a pediatric …

United States Immigration Law As A Social Determinant Of Health: A Mixed-Methods Systematic Review, Natalia Castellanos González

Public Health Theses

Background: Rapidly changing immigration policies and anti-immigrant rhetoric have impacted the services available and the health outcomes of undocumented immigrants. Research focusing on the health of noncitizens usually employs a cultural frameworks approach, focusing on individual behaviors or outcomes rather than structural barriers and limitations. This analysis is not adequate for explaining the origins of community-level and structural inequities, and there are existing gaps in research documenting the ways in which policies and changes impact immigrants’ health-seeking behaviors and overall health. Methods: This thesis employed a mixed methods-mixed research synthesis approach to carry out a systematic review. Article selection followed …

Breast Cancer Patient Preferences In Patient-Provider Discussions, Lauren Cueto

Public Health Theses

Objectives. To examine breast cancer patient preferences in patient/provider communication methods during prognostic and treatment side effect conversations in an exploratory survey study.

Methods. A sample of 28 breast cancer patients receiving care from Yale New Haven Hospital Smilow Cancer Center completed an in-person, scenario-based survey between February-April 2022. Utilizing Smilow Cancer Center’s breast cancer repository, breast cancer patients who had a routine medical oncologist visit during the study period were recruited. Mann-Whitney U tests, univariate logistic regression, ordinal logistic regression, Wilcoxon Signed-Rank Tests, and qualitative analyses were utilized to determine patient preferences of communication methods that maximize patient understanding …

Circadian Factors And Cancer Survivorship: A Mini Review, Jiaqi Cui

Public Health Theses

Circadian clocks are molecular clocks that govern the temporal control of physiology to preserve homeostasis. The disruption of the circadian rhythm is important in carcinogenesis and aids the development of cancer hallmarks. On the other hand, carcinogenic activities disrupt circadian rhythms directly. In cancer treatment, pharmacological regulation of core clock genes is a novel approach. The use of circadian biology in cancer research opens up new avenues for improving cancer treatment effectiveness. This mini-review provides an overview of relationship between circadian factors including circadian gene expression, circadian genotype, circadian disruption and circadian gene methylation and the cancer survivorship. The review …

On The Same Page? Agreement Between Older Adults And Emergency Clinicians Regarding Desired Outcomes And Its Association With Return Hospital Visits, Hollie Dowd

Public Health Theses

Objectives. To develop a framework for as well as examine the relationship between patient-clinician agreement on what matters to older adults in the emergency department (ED) and 30-day ED return visits.Methods. A sample of 45 emergency department patients aged 70+ and their emergency clinicians were separately asked about the patient’s desired outcomes for their ED visit. Thematic analysis of interview transcripts was conducted and dyadic agreement for each of the identified themes was recorded, then a percent agreement composite score was calculated. 30-day ED return visits were tallied and additional sociodemographic and clinical data was accumulated. Descriptive, bivariate, and multivariate …

Support Or Interference: Relational Influences On Mother’S Exclusive Breastfeeding Practices In Ghana, Georgiana Esteves

Public Health Theses

Childhood malnutrition is a challenge that needs to be understood as a global health threat. Exclusive breastfeeding (EBF) is recognized as the best practice to improve a child’s growth and cognitive development in the first months of life. The World Health Organization recommends EBF until 6 months. Mothers need family support to adhere to EBF practices. This study aimed to understand the interpersonal level relational influences of fathers, grandmothers, and other family members on the mother-child dyad adherence to EBF practices, as well as document community and societal influences on EBF. This study took place in the Central Region of …

Exploring Climate Policy And Health Perspectives In Samoa: A Mixed Methods Study, Erika-Ann Fumiko Kim

Public Health Theses

Background: Greenhouse gas emissions have driven human-induced climate change, bringing several impacts to small island nations in the Pacific. Samoa, a small island developing state located in the south Pacific Ocean, is at disproportionate risk from impacts of climate change such as rising surface temperatures, rising sea levels, increases in frequency and degree of heavy precipitation events, and increases in the frequency of droughts. Simultaneously, Samoan populations possess a high prevalence of non-communicable diseases such as diabetes, heart disease, and hypertension. For multiple decades, the Government of Samoa has framed climate change as a key issue that threatens the lives, …

Oiremos: The Development, Implementation, And Evaluation Of A Holistic Health Curriculum For A Hispanic Youth Enrichment Program, Margaret Cavendish Kellogg

Public Health Theses

In the spring of 2021, as the Covid-19 pandemic continued to exacerbate health inequities and virtual learning dragged on, I developed and implemented an educational health-promotion intervention for a small group of Hispanic youth in collaboration with a New Haven Latinx social services non-profit, Junta for Progressive Action. The bilingual, culturally-responsive health curriculum wove together engaging activities related to physical, emotional, mental, social, and community health, promoting participants’ socio-emotional learning and equipping them with destigmatizing vocabulary and skills they could use to advocate for their needs. The curriculum was grounded in social and behavioral theories and was informed by participants’ …

How Medical Student Perceptions Of Faulty Interactions Influence Burnout, Meghan Elizabeth Lindsay

Public Health Theses

Objective: To assess the relationship between the perceptions of student-faculty interactions and self-reported burnout scores during professional medical education. Design: Cross-sectional study. Setting: 140 accredited US medical schools by the Association of American Medical Colleges in 2016 and 2017. Participants: 26,464 of 30,651 graduating medical students who completed the Association of American Medical Colleges’ Graduation Questionnaire in 2016 and 2017 and who had complete questionnaires for all aspects of our related measures. Main outcome measures: Exploratory factor analysis was used to identify latent constructs underlying 14 measured students’ perception of faculty interaction variables and develop factor based scales. The association …

The Politics Of Sexuality Education Policy In Texas, Caroline Alexandra Magee

Public Health Theses

This thesis applies social science research, historical and cultural analysis, and legislative review to understand the relationship between Texas’s school-based sexuality education policies and public health and, in so doing, lay the groundwork for policy change that will better promote sexual and reproductive health, health equity, and health justice in Texas. The thesis first situates Texas state-level sexuality education policy within a larger US political, historical, and legal context, highlighting the key roles of race, class, gender, and sexuality stereotypes and of “morality politics.” It then examines the political history of Texas sexuality education debates within this national context, revealing …

“I Still Have My Sorrows With Me.” A Qualitative Study Exploring How Nepali Adults Engage In Meaning-Making Following Suicide Experiences, Risika Mohanty

Public Health Theses

Background: Of all the global reported suicides, 78% of them occur in low and middle-income countries and 39% specifically occur in the Southeast Asia region. Nepal’s suicide rate was ranked 8th in the world by WHO estimates in 2014, with the third-highest suicide rate for females. While we know of certain suicide risk factors pertaining to Nepal, we have yet to understand how individuals make meaning of life following suicide experiences. Purpose: This study uses a narrative thematic analysis approach to understand how adults with lived experiences of suicide (ALES) navigate their internal and interpersonal lives following their suicide experience. …

A National Assessment Of Racial And Ethnic Disparities In Cleft Lip Repair, Connor J. Peck

Public Health Theses

AbstractPurpose: This study examined the impact of patient race/ethnicity on the likelihood of experiencing delays to surgery, post-operative surgical complications, and prolonged hospital length of stay (LOS) following primary cleft lip (CL) repair. Methods: Patients who underwent CL repair were identified in the 2006-2012 Kids’ Inpatient Database. Primary outcomes were defined as treatment after 6-months-old, presence of any surgical complication, LOS >1 day, and total hospital charges. Multivariable analyses were performed to adjust for sociodemographic and clinical characteristics that might account for differences in outcomes. Results: There were 5927 eligible patients with cleft lip: 3724 White, 279 Black, 1316 Hispanic, …