Digital Commons Network^™

Demographic Representation In Clinical Trials Of Pharmacotherapy Fertility Treatments In Women With Polycystic Ovary Syndrome (Pcos): A Cross-Sectional Analysis, Kendall Watanabe

Public Health Theses

ABSTRACT: Background: While Polycystic Ovary Syndrome (PCOS) is a medical condition that impacts women of childbearing age, prior research has shown that women of color are at a disproportionately higher risk. The goal of this meta research project is to closely model a systematic process to assess demographic characteristics of participants recruited and enrolled in clinical trials and RCTs in PCOS-related research studies. Methods: An exhaustive electronic database search was performed through Ovid MEDLINE, PubMed, Scopus, Ovid Embase, and Web of Science to identify studies that focused on PCOS-related infertility. Out of the 2,883 records identified in the initial search …

Nurses, Politics And Policy: Moving A Critical Initiative Forward Through Education, Inspiration And Motivation For Political Activity, Elizabeth Clark

Yale School of Nursing Digital Theses

Texas has the highest rate of uninsured and underserved residents in the United States. Texas also is one of the most restricted states for advanced practice registered nurses (APRN) to practice. As shown in other states, one means of obtaining full practice authority for APRNs is by gaining more of a nursing presence in the legislature. This project created a program to educate, motivate and inspire Texas nurses for political involvement. The project was completed in collaboration with the Texas Nurses Association. 78 nurses participated in surveys focusing on nurses’ attitudes and opinions, knowledge level, mental preparedness for political involvement …

Assessing Risk For Right Heart Failure After Left Ventricular Assist Device Implantation, Mary-Ann Lombardi Cyr

Yale School of Nursing Digital Theses

The lives of more than six million people in the United States are negatively impacted by the diagnosis of Advanced Heart Failure. Financial burden, repeated hospitalizations, and declining quality of life account for poor outcomes. Implantation of a left ventricular assist device (LVAD) has offered the promise of improved financial, clinical, and functional outcomes for those awaiting or ineligible for heart transplantation. Right Heart Failure (RHF), however, threatens positive outcomes as it remains the leading cause of mortality and morbidity following LVAD placement. Despite extensive research, there is no comprehensive tool for RHF risk assessment and stratification for this population. …

Creating A Welcoming, Inclusive, And Affirming Primary Care Environment For Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex And Asexual Patients, Samantha Korbey

Yale School of Nursing Digital Theses

The LGBTQIA+ community has long faced disparities in healthcare which have had significant consequences including increased cancer risk factors and poorer health outcomes when compared to the cisgender, heterosexual community. Interventions are needed to increase the knowledge and cultural competency of providers, to create welcoming and safe spaces for LGBTQIA+ patients, and to encourage disclosure of sexual orientation and gender identity (SOGI).

The purpose of this DNP project was to adapt, implement, and evaluate an evidence-based model for creating an affirming, inclusive, culturally competent, and safe primary care environment for LGBTQIA+ patients within a family practice center. This quality improvement …

A Standardized Transition To Practice Program For Novice Advanced Practice Registered Nurse(S) In A Federally Qualified Health Center Setting, Taína R. Lopez-Cartagena

Yale School of Nursing Digital Theses

Novice Advanced Practice Registered Nurses in Federally Qualified Health Centers are expected to assimilate to the autonomous clinician role rapidly and meet the threshold of clinical expertise required for their new role. Mentorship is widely demonstrated in the literature as an important resource during onboarding and transition. Mentorship and social support facilitate appropriate novice Advanced Practice Registered Nurse role transition and attainment. This project employs a literature review, surveys and interviews of Advanced Practice Registered Nurses and the implementation of a transition-to-practice program in a federally qualified health center. Results of this project indicate that a structured transition-to-practice program can …

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 …

Estimating The Burden Of Covid-19 Associated Hospitalizations In Connecticut, Ann Basting

Public Health Theses

The number of COVID-19 related hospitalizations that occur in a particular area is dependent on a variety of sociodemographic and clinical factors, but the percentage of hospitalizations that are identified in that region varies based on the type and quality of surveillance system that is utilized. In Connecticut, an active surveillance system called the COVID-19–Associated Hospitalization Surveillance Network (COVID-NET) conducts COVID-19 associated hospitalization surveillance in two of Connecticut’s eight counties. The other counties in Connecticut rely on a passive surveillance system which could be subject to underreporting. To evaluate possible underreporting, positive SARS-CoV-2 test rates obtained from the Connecticut Department …

Longitudinal Modeling Of Early Hiv Burden In The Central Nervous System, Victor Diego Armengol

Yale Medicine Thesis Digital Library

The dynamics of plasma HIV replication during early infection including establishment of a viral set-point are well-known. However, the course of HIV in the central nervous system (CNS) after initial entry of HIV into this compartment is less understood. Using longitudinal samples, we modeled the natural history of HIV RNA in the cerebrospinal fluid (CSF) and plasma during early HIV prior to initiation of antiretroviral treatment (ART). Participants with primary HIV infection (PHI, within 12 months of initial infection) were enrolled in prospective studies with paired longitudinal sampling of blood and CSF conducted in San Francisco, USA, and Gothenburg, Sweden …

Predictors Of Very Late Onset Infection In Kidney Transplant Recipients At Least Ten Years Post Transplant, Harry Cheung

Yale Medicine Thesis Digital Library

Although there have been improved outcomes for kidney transplant recipients, infection is still a leading cause of morbidity and mortality for long-term kidney transplant survivors (LTKS). This thesis and study aims to investigate the epidemiology of very late onset infections (>10 years post-transplant), or VLOI and clinical markers that can predict these infections.

A single-center, retrospective study of a cohort of patients (≥18 years old) who underwent kidney transplantation between 2003-2009 and survived for at least 10 years post transplantation was conducted. The primary outcome studied was the occurrence of VLOI. The data collected included transplant data, patient co-morbidities, …

Amd3100 Administration For The Treatment Of Asherman’S Syndrome In A Murine Model, Pablo Antonio Delis

Yale Medicine Thesis Digital Library

Statement of Purpose

1. Optimize a murine model of Asherman’s Syndrome.2. Assess fertility outcomes in mild Asherman’s Syndrome model mice treated with AMD3100. 3. Determine timing of peak serum and uterine levels of CXCL12 after AS induction. 4. Identify an optimal time point for AMD3100 administration in AS.

Sleep Apnea In Veterans With Schizophrenia: Estimating Prevalence And Impact On Cognition, Stephen Edward Ghazikhanian

Yale Medicine Thesis Digital Library

The cognitive impairments of schizophrenia drive the functional disability of the illness but are difficult to treat. One barrier to effective cognitive interventions may be medical illnesses that compromise cognition and are over-represented in people with schizophrenia. Obstructive sleep apnea (OSA) is treatable, causes reversible impairments in many cognitive domains also affected by schizophrenia, and is likely under-diagnosed in people with schizophrenia. We have estimated the prevalence of OSA in schizophrenia, both by self-report and with a predictive model, and characterized the associations between OSA and cognition and functional capacity in schizophrenia, using a large dataset of 3942 patients with …

Arid1a Deficiency As A Biomarker For Sensitivity To Ionizing Radiation And Atr Inhibition In Gynecologic Malignancies, Jessie Li

Yale Medicine Thesis Digital Library

ARID1A DEFICIENCY AS A BIOMARKER FOR SENSITIVITY TO IONIZING RADIATION AND ATR INHIBITION IN GYNECOLOGIC MALIGNANCIESJessie Y. Li, Shari Damast, MD (Department of Therapeutic Radiology, Yale University, Yale School of Medicine, New Haven, CT), and Gloria Huang, MD (Section of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, Yale School of Medicine, New Haven, CT) Objective: ARID1A, which encodes a protein that participates in the SWI/SNF chromatin remodeling complex, is frequently mutated in ovarian and endometrial malignancies. The emergence of the role of ARID1A in gynecologic cancer progression reveals potential implications for therapeutic targets. Our primary purpose …

The Role Of The Nmda Receptor In Shaping Cortical Activity During Development, Jacob Michael Kayle Lister

Yale Medicine Thesis Digital Library

Currently, it is estimated that neuropsychiatric disorders will affect 20-25% of humans in their lifetime. These disorders are a major cause of mortality, suffering, and economic cost to society. Within this broad class, neurodevelopmental disorders (NDDs), including intellectual disability, autism spectrum disorder, and schizophrenia, are estimated to affect 2-5% percent of the world population. Devastatingly, we lack fundamental treatments for NDDs, which have proved some of the most imposing disorders to understand scientifically. The challenge is twofold: first, NDDs affect the most complex aspects of human cognition; second, pathogenesis begins early in neural circuit development, but we lack predictive biomarkers …

Risk Factors For Venous Thromboembolism In Children After Surgery In General & Specific To Orthopaedics, Elbert Johann Mets

Yale Medicine Thesis Digital Library

Venous thromboembolism (VTE, including deep venous thrombosis and pulmonary embolism) was studied in children undergoing surgery in general, and those specifically undergoing orthopaedic surgery. Due to the low overall incidence of VTE in this population, VTE chemoprophylaxis is not routinely recommended. However, understanding and quantifying risk factors can help define the risk/benefit considerations of these practices.

The study populations were identified from 2012-2016 National Surgical Quality Improvement Project Pediatric (NSQIP-P) database. Patient demographics, comorbidity factors, and 30-day postoperative outcomes were defined. The populations were then dichotomized into those that did and not have VTE diagnosed in the first 30 postoperative …

Cryoablation Of Congenital Venous Malformations: A Systematic Review, Alexander Moushey

Yale Medicine Thesis Digital Library

ABSTRACT

ObjectiveTo perform a meta-analysis of cryoablation in the treatment of venous malformations, analyzing the technical success, clinical outcomes, including change in volume of lesion and pain scores, and safety of this procedure.

Materials and MethodsVenous malformations (VMs) are a common slow-flow type congenital vascular malformation made up of a “mass-like” network of dysplastic venous structures. A systematic review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A search in PubMed and Google Scholar for clinical studies utilizing percutaneous cryoablation of VMs was performed and all relevant articles were then manually reviewed. Prospective, retrospective …

Influence Of Neoadjuvant Chemotherapy Regimen On Breast Reconstruction Outcomes, Olamide Olawoyin

Yale Medicine Thesis Digital Library

Background: Neoadjuvant chemotherapy (NACT) provides a survival advantage in breast cancer. Prior to mastectomy, NACT shrinks tumor size and improves pathological response in breast cancer. Evidence to date has evaluated the impact of chemotherapy on autologous breast reconstruction outcomes as a binary variable. In this study, we evaluate the effect of specific NACT regimens and dosage on the rate of post-operative complications after autologous breast reconstruction. We also evaluate the effect of NACT on circulating immune cells that orchestrate wound healing.Methods: Following IRB approval, patients who underwent NACT and microvascular breast reconstruction at Yale New Haven Hospital between 2013 and …

A Nationwide Assessment Of Disparities In Primary Cleft Lip Repair, Connor J. Peck

Yale Medicine Thesis Digital Library

Purpose: This study examined the impact of patient race or ethnicity on the likelihood of experiencing delays to surgery, post-operative surgical complications, or prolonged hospital stays following primary cleft lip (CL) repair.Methods: Patients who underwent CL repair were identified from two large national databases: the Kids Inpatient Database (KID) and the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Primary outcomes were defined as treatment after 6 months of age, the presence of any surgical complication, and a hospital stay greater than 1 day. Chi-squared analyses were performed to compare outcomes across patients of different race/ethnicity, followed by multivariable logistic …

Biomechanical Properties Of Posterior To Anterior Lag Screw Insertion In Fibular Supination-External Rotation Fractures And Effect Of Engaged Cortical Thickness, Adam Sahlstrom

Yale Medicine Thesis Digital Library

The fracture pattern of supination-external rotation injury of the fibula is often reducible by lag screw fixation. This thesis is designed to evaluate biomechanical differences between lag screws inserted from an anterior to posterior direction and from a posterior to anterior direction and if the thickness of the anterior and posterior fibular cortices were similarly correlated. 5 donor-matched pairs of cadaver fibula were harvested and submitted to material testing following 3.5-mm cortical screw insertion from either an anterior to posterior direction or a posterior to anterior direction and screw insertion torque and axial pullout strength were measured. Computed tomography images …

Pre-Operative Urinary Tract Infection And 30-Day Outcomes In Neurosurgery, James Yoon

Yale Medicine Thesis Digital Library

Urinary tract infections (UTIs) are the most common bacterial infection in the United States, placing significant demands on our healthcare system already constrained by rising costs and limited resources. While patient complications occur in all areas of surgery, the issue around neurosurgical patients deserves special attention as treatment of surgical site infections in neurosurgery is the most expensive among all surgical specialties. Complication rates are also disproportionately higher in patients over 65 years old, which are noteworthy in caring for our aging patient population.

While the adverse effects of a post-operative UTI have been well described in the surgical literature, …

Factors Impacting Trauma-Specific Quality Of Life Following Injury: A Multi-Center Assessment In Lebanon, Ali Elreichouni

Yale Medicine Thesis Digital Library

Objective: Injuries account for a large portion of the global burden of disease, representing over 10% of all disability adjusted life years (DALYs). This study analyzes the economic impact of injury for those experiencing moderate-to-severe injury in Beirut, Lebanon. It further examines the impact of different demographic and socioeconomic factors on trauma-specific quality of life 1-2 years following injury.

Methods: This was a prospective cohort study following patients 1-2 years after being treated for injury at one of three hospitals in Beirut, Lebanon. Patients interviewed by phone. In addition to questions on financial impact, access to healthcare, and socioeconomic status, …

Changing Selection And Epistasis On Drivers Over Tumorigenesis In Primary And Metastatic Prostate Cancer, Alexander Yang

Yale Medicine Thesis Digital Library

Background: Many attempts have been made to characterize and describe the driver genes and mutations responsible for prostate cancer tumorigenesis. We have quantified the cancer effect size—a direct measurement of the survival advantage a mutation confers—for 2699 primary and metastatic prostate tumor samples. Our measure of cancer effect treats tumorigenesis as an evolutionary process, subject to positive and negative selective pressures. We have applied this metric in a stage-specific manner to elucidate which mutations are selected for as prostate cancer develops.Methods: We analyzed 2699 prostate cancer tumor exomes, genomes, and panel sequences (1648 primary tumors and 1051 metastatic samples). The …

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. …

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 …

Enhancing The Assessment Of Suicidal Ideation In The Long-Term Care Environment: A Quality Improvement Project, Carissa Ann Tufano

Yale School of Nursing Digital Theses

Abstract Despite high rates of depression and risk factors for suicide, there is a knowledge deficit and lack of protocol surrounding the assessment of suicidal ideation in the long-term care setting. Although studies examining suicide in the long-term care setting are lacking, the prevalence of suicidal ideation is high. This DNP quality improvement project addressed this problem by creating a suicide assessment and management inservice for frontline clinical staff at a skilled nursing facility in Connecticut. The inservice integrated use of an adapted suicide assessment algorithm and a suicide screening tool, the P4 Screener. A SAMHSA toolkit was utilized as …

Reinterventions In Peripheral Arterial Disease: Claudication Versus Chronic Limb-Threatening Ischemia - A Retrospective Study And Review Of The Literature, Alaa Mohamedali

Yale Medicine Thesis Digital Library

ObjectivePatients with peripheral artery disease (PAD) present with claudication or chronic limb threatening ischemia (CLTI). CLTI patients have a more advanced stage of atherosclerosis and increased comorbidities compared to claudicants, and are at an elevated risk of major amputation and mortality after lower extremity revascularization (LER). However, the frequency of reinterventions for claudication and CLTI have not been compared. Our hypothesis is that patients with CLTI undergo more frequent reinterventions to prevent major amputation compared to patients with claudication.

MethodsA single-center retrospective chart review of consecutive patients undergoing LER for PAD in 2013-2015 was performed. Patients were stratified based on …

Data From The Bcrp On Required And Actual Reserves, Banco Central De Reserva Del Perº / Central Reserve Bank Of Peru

Documents

No abstract provided.

Introduction To The Efta Court, European Union: Courts: European Free Trade Association States (Efta): Court Of Justice

Documents

No abstract provided.

Jmd/Usd Currency, Yahoo Finance

Documents

No abstract provided.