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Present Tense Love: How To Stay Close Amidst A Changing Mind, Brit Fleck

Public Health Theses

This thesis examines how long-term partners sustain intimacy when one partner lives with dementia. Through an Appreciative Inquiry (AI) workshop with four couples from the Empowering Partnership Network—a joint initiative of the Yale Social Gerontology Lab and the Livewell Institute—this research explores how relationships adapt and endure amidst cognitive change. Drawing on Irene Smith’s Touch Awareness methodology and theories of relational autonomy, the study challenges dominant deficit-based narratives by highlighting the enduring capacity for meaningful connection. Participants described intimacy as grounded in embodied practices, daily rituals, and what they called the “third body”—a shared relational space that transforms rather than …

Exploring Communication In Pediatric Oncology And Parental Bereavement Outcomes: A Mixed Methods Study, Na Ouyang

Yale Graduate School of Arts and Sciences Dissertations

The first two years after a child’s death, defined by parents as early bereavement, are a particularly vulnerable period for parents. More than 40% of bereaved parents report severe, prolonged grief symptoms during early bereavement. High-quality parent-clinician communication, which is delivered honestly, clearly, and with sensitivity, helps parents make informed decisions about medical care, address their complex needs during their child’s end-of-life (EOL), and is related to lower severity of prolonged grief symptoms many years after a child’s death. However, research rarely focuses on the parent experience in early bereavement, and little is known about which specific components of parent-clinician …

Prevalence, Management, And Outcomes Associated With Obstructive Sleep Apnea In The Medical Icu, Madeline Lilly Ehrenberg

Yale Medicine Thesis Digital Library

The prevalence of Obstructive Sleep Apnea (OSA) in the general adult population has been estimated to be between 9-17% in women and 25-30% in men. However, the prevalence of OSA among medical intensive care unit (MICU) patients is unknown. A 2015 systematic review by Knauert et al demonstrated the associations of OSA with many chronic diseases commonly seen in MICU patients (for instance, hypertension, type II diabetes mellitus, and congestive heart failure). This same review also shed light on the gaps in knowledge surrounding OSA, including underdiagnosis, undertreatment, and lack of research. Given the overall prevalence of OSA and the …

Improving The Reporting And Tracking Of Hospital-Acquired Pressure Injuries, Melinda Rosado

Yale School of Nursing Digital Theses

Hospital-acquired pressure injuries (HAPIs) affect millions of patients a year, impacting patient safety and creating a significant financial burden for healthcare systems. Inadequate reporting and tracking of HAPIs lead to delays in care, inaccurate data reporting and missed opportunities for quality improvement. This is in large part due to a lack of training and education around HAPIs, poor communication of injuries during hand-off and a lack of system integration. A process improvement program to improve the reporting and tracking accuracy of HAPIs was piloted on two post-surgical units in a large urban cancer center. This initiative combined comprehensive training via …

Clinical Predictors Of Fluid-Responsive Acute Kidney Injury, Cindy Khanh Nguyen

Yale Medicine Thesis Digital Library

CLINICAL PREDICTORS OF FLUID-RESPONSIVE ACUTE KIDNEY INJURY

Cindy Khanh Nguyen, Abinet M. Aklilu, Yu Yamamoto, Bashar A. Kadhim, Claudia Coronel-Moreno, Francis P. Wilson. Section of Nephrology, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT.

Specific Aims: We aimed to explore and identify common clinical variables that may be helpful in selecting patients who will benefit from volume challenge when the fluid-responsiveness of AKI is unclear.

Methods: Our study is a retrospective secondary analysis of a clinical trial that prospectively enrolled adult patients at Yale-New Haven Hospital with AKI defined by the 2012 Kidney Disease: Improving Global …

The Effect Of Slow Tempo Music Listening On Incidence Of Delirium In Skilled Nursing Facilities, Sarah Róise Hartman

Yale School of Medicine Physician Associate Program Theses

Delirium is a syndrome characterized by acute fluctuations in cognition and inattention that significantly affects older adults due to increased age and cognitive impairment. In hospital settings, music listening has shown to be a feasible and effective intervention used to decrease delirium incidence. However, music listening interventions targeting delirium in skilled nursing facilities have not been studied. The objective of this study is to compare music listening to usual care in skilled nursing facilities as a method to decrease incident delirium development. Specifically, this will be a randomized control trial comparing daily slow tempo music listening to usual skilled nursing …

Health-Related Social Needs Before And After Critical Illness Among Medicare Beneficiaries, Tamar A. Kaminski

Yale Medicine Thesis Digital Library

Health-Related Social Needs (HRSNs), such as financial strain, food insecurity, social isolation, and transportation disadvantage, are unmet social needs associated with poor health outcomes and increased healthcare utilization. In qualitative work, survivors of the intensive care unit (ICU) report financial strain; however, little is known about food insecurity, social isolation, and transportation disadvantage after critical illness. The objectives of this study were twofold: (1) to ascertain changes in three HRSNs—food insecurity, social isolation, and transportation disadvantage—from the year before critical illness to the year following discharge among older adult survivors of critical illness, and (2) to evaluate demographic, pre-admission, and …

Survival Outcomes In T3 Laryngeal Cancer Based On Staging Features At Diagnosis, Vickie Jiaying Wang

Yale Medicine Thesis Digital Library

Stage T3 laryngeal cancer is defined by the presence of vocal cord fixation and/or invasion into any of the following: pre-epiglottic space, paraglottic fat, post-cricoid space, or inner cortex of the thyroid cartilage. These cancers are usually treated with chemoradiation rather than upfront total laryngectomy. To our knowledge, no studies have directly compared differences in survival among the varied features within the T3 staging category. This study aims to determine how the presence of each of these staging features impacts overall and laryngectomy-free survival.Patients with clinically-diagnosed T3 laryngeal squamous cell carcinoma seen at our institution between 2010-2021 were retrospectively identified. …

Apollon’S Gift: Musical Therapy From Asklepieia To Bīmāristāns, Chihiro Larissa Tsukamoto

Yale Graduate School of Arts and Sciences Dissertations

This dissertation examines the history of music’s use for healing purposes in Antiquity and the Middle Ages and explores the contributions of Islamic medicine on historical musical therapy. It begins in ancient Greece with an examination of polytheistic ancient Greek music and medicine, moves to the role of music in Byzantine healing institutions after the Christianization of Greece, and to its role in bīmāristāns during the Abbasid, Mamluk, and Ottoman periods. Ultimately, it seeks to describe how music was used therapeutically in ancient Greek, Byzantine, and Islamic institutions of healing. Several ancient Greek philosophers believed music could affect the body, …

Specificity And Regulation Of Sodium Channel Trafficking: Exploring A Novel Therapeutic Strategy For Pain, Grant Philip Higerd-Rusli

Yale Graduate School of Arts and Sciences Dissertations

The burden of pain is significant and current pain treatments are often ineffective. Opiate use has led to an epidemic, requiring alternative pain medications that are more effective and non-addictive. Voltage-gated sodium channel NaV1.7 is preferentially expressed in pain-sensing neurons. Mutations in NaV1.7 can cause disorders ranging from intense pain to complete painlessness in humans, suggesting that its inhibition could provide analgesia without CNS side-effects or addictive potential. Indeed, existing non-selective NaV channels blockers prevent pain, but their utility is limited due to serious side-effects caused by inhibition of NaV isoforms expressed in the heart and brain. Selective inhibition of …

Adherence To Tumor Board Recommendations In Patients With Hepatocellular Carcinoma, Yueming Cao

Yale Medicine Thesis Digital Library

Hepatocellular carcinoma (HCC) is a heterogeneous disease that typically arises in the setting of chronic liver disease, making treatment selection complex. Multidisciplinary liver tumor boards (MDLTB) have been shown to improve outcomes in patients with HCC. However, in many cases, patients evaluated by MDLTBs ultimately do not receive the board’s recommended treatment. In this paper, we performed a single-site, retrospective cohort study of patients with HCC who were evaluated by an MDLTB. We examined adherence to the MDLTB’s recommendations and in cases of discordant treatment, evaluated the underlying cause. We found that most patients’ therapies were adherent to the MDLTB’s …

Evaluating Environmental Risk Factors For Community-Associated C. Difficile Infection In New Haven County, Connecticut, 2016-2021, Hannah Liat Litwak

Public Health Theses

Background: Clostridioides difficile infection (CDI) is classified as an urgent threat to public health and has been increasing in incidence and severity. CDI is commonly considered hospital- acquired; however, rates of community-associated CDI (CA-CDI) have been increasing and now make up more than 50% of cases reported. Risk factors for CA-CDI exposure are poorly understood and inadequately studied. This study uses regression to evaluate if community characteristics are associated with CA-CDI incidence at the census tract level in New Haven County. The goal is to determine if where someone lives in proximity to these potential risk factors may contribute to …

Reducing 30-Day Readmission Rates For Copd Patients: A Care Standardization & Quality Improvement Project, Oana Raluca Randolph

Yale School of Nursing Digital Theses

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that affects millions of Americans and accounts for close to 700,000 hospitalizations per year. On average, about 20% of patients hospitalized for acute exacerbation of COPD are readmitted to the hospital within 30 days of discharge. The quality of care delivered to COPD patients is often suboptimal and fragmented, contributing to unfavorable patient outcomes, and high rates of readmissions. The purpose of this DNP project was to reduce 30-day readmissions and improve quality of care by developing and implementing a standardized Discharge Care Bundle for COPD patients in the …

Bulletin Of Yale University School Of Nursing 2023-2024, Yale School Of Nursing

Yale School of Nursing Bulletins and Catalogues

Series 119, Number 16

September 5, 2023

Musculoskeletal Outcomes Among Older Adults Following Hospitalization For Covid-19: A Pilot Study, Clara Ming Hei Wong

Public Health Theses

Background Older individuals are at high risk for musculoskeletal impairment following hospitalization due to decreased neuromuscular function and bone mineral density (BMD) arising from illness itself, and external factors such as immobilization and changes in nutritional status. To address the knowledge gap regarding the longitudinal impact of COVID-19 on musculoskeletal outcomes, this thesis aimed to study the relationship between COVID-19 severity and physical functional, incidence of falls and fractures in older adults. Secondarily, in a subset of patients we examined the relationship between COVID-19 severity and osteoporosis- and sarcopenia-related measures. Methods This study analyzed data from the VALIANT study and …

Comparative Impact Of Network Adequacy Standard Strategies On Medicaid Recipient Cvd Outcomes: A Computer Simulation Modeling Study, Sreeja Kondeti

Public Health Theses

Context: Medicaid managed care network adequacy standards vary widely across states and are not typically informed by scientific evidence. The comparative efficacy of these standards for protecting the health of the Medicaid population has not yet been comprehensively researched.Objective: The aims of this study are to construct simulation modeling methods to approach this policy problem and to determine which numeric values for network adequacy standards are most effective for producing favorable health outcomes for Medicaid recipients who develop CVD. Design and Setting: A continuous-time Markov model was used to simulate the natural history of cardiovascular disease, using a cohort that …

Epidemiology Of Covid-19 Hospitalizations In New Haven And Middlesex Counties, Connecticut, July - September 2021, Caroline Mary Mcwilliams

Public Health Theses

Abstract:Background. This thesis explores the epidemiology of COVID-19 hospitalization among residents of New Haven County and Middlesex County, Connecticut from July - September 2021 with an emphasis on quantifying racial/ethnic and SES disparities. Two previous studies, the first conducted from March - May 2020 and the second conducted from July - December 2020, used COVID-NET Surveillance data from New Haven and Middlesex counties to explore the same questions. This thesis will compare findings with these previous studies to better understand how the epidemiology of COVID-19 hospitalization and racial/ethnic and SES disparities have changed in New Haven and Middlesex counties. Methods. …

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. …

Bulletin Of Yale University School Of Nursing 2022-2023, Yale School Of Nursing

Yale School of Nursing Bulletins and Catalogues

Series 118, Number 16

September 5, 2022

Development, Implementation And Evaluation Of Medical Decision Support Systems Based On Mortality Prediction Algorithms From An Operations Research Perspective., Junchao Ma

Yale Graduate School of Arts and Sciences Dissertations

Wide implementation of electronic health record systems provides rich data for personalized medicine. One topic of great interest is to develop methods to assist physicians in prognosis for example mortality. While many studies have reported on various new prediction models and algorithms there is relatively little literature on if and how these new prediction methods translate into actual benefits. My dissertation consists of three theses that aims at filling this gap between prognostic predictions and clinical decisions in end-of-life care and intensive care settings. In the first thesis, we develop an approach to using temporal trends in physiologic data as …

Clinical Treatment Human Disease Networks And Comparative Effectiveness Research: Analyses Of The Medicare Administrative Data, Hao Mei

Yale Graduate School of Arts and Sciences Dissertations

As the nation’s largest healthcare payer, the Medicare program generates an unimaginable vast volume of medical data. With an increasing emphasis on evidence-based care, how to effectively handle and make inferences from the heterogeneous and noisy healthcare data remains an important question. High-quality analysis could improve the quality, planning, and administrations of health services, evaluate comparative therapies, and forward research on epidemiology and disease etiology. This is especially true for older adults since this population’s health condition is generally complicated with multimorbidity, and the healthcare system for older adults is riddled with administrative and regulatory complexities. Taking advantage of the …

Bulletin Of Yale University School Of Nursing 2021-2022, Yale School Of Nursing

Yale School of Nursing Bulletins and Catalogues

Series 117, Number 15

September 5, 2021

Physician Burnout: An Assessment Of Impact, Drivers And Design Of Prevention Programs, David Dupee

Yale Medicine Thesis Digital Library

Burnout merits close study, with particular attention paid to means of quantifying institutional impact, reducing provider burnout burden, and measuring said burden. This study utilized economic and qualitative analyses to indicate institutional impact. It modified and piloted an intervention for attending level physicians. It also proposes a novel wellness program for resident physicians based off of triumphs and gaps in literature. Lastly, it utilizes survey comparison to track overall changes in burnout rate at Yale New Haven Hospital (YNHH). Overall, the cost of physician burnout at YNHH was estimated to range between $171 and $233 million annually. Reducing physician burnout …

Preauthorizations In Orthopaedic Surgery: An Analysis Of A Single Institution’S Spine Center, Kareem Jamal Kebaish

Yale Medicine Thesis Digital Library

Introduction

Preauthorizations are frequently required by commercial insurers before patients can undergo magnetic resonance imaging (MRI) of the spine. In addition to the administrative burden, such processes can lead to delays in care. The current study assessed the rates and eventual disposition of preauthorizations required prior to spine MRIs ordered from an academic spine center.

Methods

Patients from a single academic institution’s spine center who were covered by commercial insurance and referred for a spine MRI between January 2013 and December 2019 were included in the analysis. The requirement for preauthorization and eventual disposition of each of these studies was …

Conscious Sedation Medication Choice Does Not Affect Outcomes After Transcatheter Aortic Valve Replacement, Diane Rm Somlo

Yale Medicine Thesis Digital Library

Conscious Sedation (CS) has become a mainstay option for anesthesia in Transcatheter Aortic Valve Replacement (TAVR), but there has been limited investigation into the effect of CS medication choice on patient outcomes. This study aimed to assess whether the CS medications used in TAVR were associated with primary outcomes, including hospital length of stay (LOS), mortality, or need for post-operative permanent pacemaker. This retrospective, observational study included 272 patients who underwent TAVR with CS at a tertiary teaching hospital between September 2014 and December 2017. Patient and procedure data were collected from the STS/ACC Transcatheter Valve Therapy Registry and chart …

Creating An Integrated Opioid Policy For Multi-State Hospice Practices: Improving Opioid Compliance And Patient Safety, Manjeet Kaur

Yale School of Nursing Digital Theses

Abstract End of life (EOL) symptom management is the cornerstone of hospice care. Hospice patients, especially advanced cancer patients, have an increased need for pain and symptom management towards end of life. For those patients at EOL, opioids are the mainstay treatment to relieve intractable and breakthrough pain. Due to opioid regulatory changes over the past few years, there has been more confusion than clarity among the hospice & palliative care practitioners prescribing opioids for EOL pain management. Healthcare practices across the country are realigning their policies to the opioid prescription rule changes. It is imperative for hospice providers to …

Consider Palliative Care: A Decision Aid To Improve Palliative Care Knowledge, Meg Schultheiss

Yale School of Medicine Physician Associate Program Theses

Palliative care enhances a patient’s quality of life by managing symptoms and psychosocial needs and facilitating advanced care planning. Engagement with palliative care improves satisfaction with care in patients and the informal caregivers identified by patients. However, palliative care is underutilized because many patients and their informal caregivers have limited knowledge about palliative care. Decision aids effectively educate patients and informal caregivers in a variety of clinical settings. We propose a randomized clinical trial that will test the effectiveness of a decision aid for informal caregivers considering palliative care. Specifically, we will match informal caregivers to a decision aid and …

The Association Between Opioid Prescriptions And Suicidal Ideation In Iraq And Afghanistan Veterans, Nicholas Drews

Yale School of Medicine Physician Associate Program Theses

Suicide among United States veterans is a serious public health concern. Among the known risk factors for suicidal ideation and suicide among veterans are mental health conditions, including post-traumatic stress disorder and depression, and opioid use disorder. Opioid prescriptions continue to rise in the United States, so does opioid use disorder and overdose deaths. However, it is not known if opioid prescriptions are associated with an increased risk of suicidal ideation in veterans A retrospective cohort study is proposed to determine whether opioid prescribing at Veterans Affairs hospitals and health centers correlates with rates of suicidal ideation. Veterans prescribed opioids …

Public Law 116-136: The Coronavirus Aid, Relief, And Economic Security Act (The “Cares Act”), U.S. Congress

Documents

No abstract provided.

Coronavirus Aid, Relief, And Economic Security Act (Cares Act), U.S. Congress

Documents

No abstract provided.