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Exploring Health Professional Student-Led Interventions To Address Gaps In Common Non-Communicable Disease (Ncd) Screening, Management, And Self-Care Education In Ghana., Brian Amu Fleischer

Yale Medicine Thesis Digital Library

BackgroundNon-communicable diseases (NCDs) are expected to become Africa's leading cause of death by 2030. In Ghana, with its limited healthcare resources, hypertension is already the leading cause of death, contributing to 15.3% of total deaths. Student-run free clinics (SRFCs) have become essential components of healthcare systems worldwide, offering primary medical care to underserved populations. This study explores the feasibility of health professional student-led interventions in addressing gaps in NCD screening, early management, and self-care education in Ghana.

MethodsThis research employed an exploratory sequential design, combining qualitative and quantitative phases. Six focus group discussions (FGDs) with 48 health professional students at …

Predictors Of Adverse Outcomes In Adolescent Idiopathic Scoliosis And The Impact Of A Quality Improvement Initiative, Astrid C. Hengartner

Yale Medicine Thesis Digital Library

Posterior Spinal Fusion (PSF) is a common surgical intervention for severe cases of adolescent idiopathic scoliosis (AIS). However, prolonged hospital stays due to delayed ambulation and extended transition from intravenous (IV) to oral analgesics are significant concerns. In this study, we investigate the risk factors for delayed ambulation and prolonged transition to oral analgesics, and their respective impacts on hospital length of stay (LOS). Additionally, we explore the impact of a multidisciplinary Quality Improvement (QI) spine conference initiative on perioperative outcomes for patients undergoing PSF for AIS.This retrospective cohort analysis was carried out on 126 adolescents who underwent elective PSF …

Trends In Missing Race And Ethnicity Data In A National Surgical Database, Kevin Gao Hu

Yale Medicine Thesis Digital Library

Accurate data collection on race and ethnicity is critical to detecting and characterizing disparities in surgical care. This study explores the prevalence and impact of missing race and ethnicity data in the National Surgical Quality Improvement Project Pediatric (NSQIP Pediatric) database. NSQIP Pediatric from 2016-2020 was assessed for patients who were missing data for race (RM), ethnicity (EM), or both (BM). Changes in proportion of RM, EM, and BM patients were assessed with Cochran-Armitage tests. Surgical outcomes were modeled using linear mixed-effects models, treating CPT codes as random effects. Models were bootstrapped with 1000 iterations for each outcome. Of 596,571 …

The Effects Of New Onset Medicare Eligibility At Age 65 On Access To Surgical Care At A Large Non-Profit Health System, A Single-Center Regression Discontinuity Analysis, Amanda R. Jankelovits

Yale Medicine Thesis Digital Library

ASSOCIATION OF MEDICARE ELIGIBILITY ON SURGICAL CARE ACCESS, A REGRESSION DISCONTINUITY DESIGN

Amanda Jankelovits, Julian Zhao, Hugo He, Hung-Mo Lin, Robert B. Schonberger, Department of Anesthesiology, Yale University, School of Medicine, New Haven, CT

The widespread onset of Medicare eligibility at age 65 has expanded access to healthcare, particularly among those previously uninsured. However, disparities in healthcare coverage still exist, especially for underrepresented minorities and low-income individuals. In this analysis, we utilize a regression discontinuity design to understand the effects of new onset Medicare eligibility at age 65 on access to surgical care at a large non-profit health system, focusing …

Maternal Prenatal Anxiety And Child Epigenetic Aging: A Longitudinal Analysis From Childhood To Mid-Adolescence, Shashwat Kala

Yale Medicine Thesis Digital Library

The developmental origins of health and disease posits that in utero exposures and early life experiences increases susceptibility to a host of pathologies. Maternal psychopathology, specifically maternal prenatal anxiety, has been studied as an in utero stressor that can affect childhood development and epigenetic aging. In the current study, we analyzed the longitudinal effects of maternal prenatal anxiety on epigenetic aging, assessed sex-specific effects, and tested the contribution of cellular heterogeneity to these findings. Using the longitudinal Basal Influences on Baby Development (BIBO) cohort, we performed a mixed model for repeated measures to determine how prenatal and postnatal anxiety (State-Trait …

Exploring The Journey To Heart Failure Diagnosis In Uganda, Teimur Kayani

Yale Medicine Thesis Digital Library

This study sought to explore the healthcare journeys of patients recently diagnosed with heart failure (HF) in Uganda. Using a semi-structured guide developed in collaboration with Ugandan colleagues, we conducted in-depth interviews with 19 patients diagnosed with HF within the past three months across four regional referral hospitals in Uganda. Interviews were conducted in the participant’s preferred language (English, Luganda, Lugbara, Lugisu, or Swahili) using trained research assistants (RAs) and were recorded, transcribed verbatim, and thematically analyzed using the socioecological framework (SEM) to capture individual, interpersonal, community, and systemic-level barriers to HF care.Findings revealed a total of 11 themes spread …

Investigating The Cooccurrence Of Papillary Thyroid Carcinoma Among Patients With Oncocytic Pathology: Is There Evidence Of Causation?, Forest Seely Mahoney

Yale Medicine Thesis Digital Library

Thyroid neoplasms, both benign and malignant, significantly contribute to healthcare burden in the United States. Oncocytic neoplasms (ON), previously classified as Hürthle-cell neoplasms and comprising oncocytic adenoma (OA) and oncocytic carcinomas (OC), represent a rare subset of follicular cell-derived thyroid pathology, accounting for 3–7% of all thyroid malignancies. OC are considered more aggressive with worse prognosis due to higher rates of recurrence as well as inherent resistance to radioactive iodine, the first line of adjunct therapy for well-differentiated thyroid cancers. Conversely, papillary thyroid carcinoma (PTC), another follicular cell-derived thyroid cancer, constitutes over 90% of thyroid cancer cases and is characterized …

International Structural Magnetic Resonance Imaging Of Cortical Thickness In Older Adults With Bipolar Disorder, Rebecca Brynn Marks

Yale Medicine Thesis Digital Library

The presentation of bipolar disorder (BD) seems to change over the course of a lifetime. In older adults, BD seems to pose novel challenges including decreased cognitive functioning, psychiatric and medical comorbidities, increased susceptibility to medication side effects, and possibly even a shift toward more depressive symptoms. Despite these clinical findings, research into older adults with BD has lagged behind that of adolescents and young adults. As the global population ages, so too do individuals with BD. In fact, it is predicted that by 2030, 50% of patients with BD will be over the age of 60. This emphasizes why …

Individual-Level Variables Associated With Non-Medical Opioid Use Among Us Adults In 2021-22, Max Moss

Yale Medicine Thesis Digital Library

Recent changes to the US opioid overdose epidemic have been driven by the spread of illicitly-manufactured opioids and complex patterns of multi-substance use. This study provides updated analyses of opioid use epidemiology among US adults, which are needed to guide new research and interventions. We conducted a cross- sectional study of data from the National Survey on Drug Use and Health, 2021-22. Using nationally-representative estimates weighted to 255,053,169 adults, multivariable logistic regression models determined odds of mutually exclusive past-year opioid use categories (non-medical use of pharmaceutical opioids [NMUPO], heroin use, or both) across demographic, socioeconomic, and clinical variables. Prevalence of …

Pre-Admission Sleep Of Patients In The Intensive Care Unit: A Retrospective Observational Study, Siddhi Nadkarni

Yale Medicine Thesis Digital Library

The medical intensive care unit (ICU) can be a challenging place for patients to get adequate sleep. Multiple environmental and pathophysiological factors can cause sleep deprivation in the ICU, which have been associated with adverse short and long-term outcomes. Although various factors have been hypothesized to impact quality of sleep in the ICU, research on the nature of patients’ pre-ICU sleep is very limited. Understanding the role that pre-ICU sleep plays in sleep quality in the ICU has the potential to inform public health measures to improve sleep and risk stratify critically ill patients. The objective of this study is …

A Mechanical Etiology Of Lateral Patellofemoral Arthritis, Nancy Park

Yale Medicine Thesis Digital Library

The relationship between anatomic risk factors for patellar instability and patellofemoral cartilage loss in the general population remains unclear. This study aimed to determine whether common measures of patellar instability are associated with lateral patellofemoral cartilage loss. A secondary objective was to evaluate the inter- and intra-rater reliability of 21 anatomical landmarks, initially placed using an artificial intelligence algorithm and subsequently verified with human input. We analyzed 389 non-weight-bearing computed tomography scans of knee joints from participants enrolled in the Multicenter Osteoarthritis Study. Baseline and 2-year follow-up knee magnetic resonance images were scored for patellofemoral cartilage morphology using the magnetic …

Tigit And Gdf-15 As Biomarkers And Targets In Renal Cell Carcinoma Resistant To Immune Checkpoint Inhibitors, Oscar Norberto Perales

Yale Medicine Thesis Digital Library

Immune checkpoint inhibitors have become the standard of care treatment for local and systemic clear cell renal cell carcinoma (RCC). However, a subset of patients fail these therapies due to the development of disease refractory to such treatments. Therefore, it is imperative that we study the potential mechanisms of resistance to immune checkpoint inhibition within the tumor microenvironment. Likewise, establishing biomarkers indicative of treatment resistance may benefit clinicians and patients when it comes to the initial selection of treatment. Moreover, biomarkers of resistance might also serve as potential drug targets. In this study we analyzed expression of TIGIT and GDF-15, …

Generative Artificial Intelligence In Clinical Decision Support - Quantitative And Qualitative Analyses, Niroop Rajashekar

Yale Medicine Thesis Digital Library

The application of artificial intelligence (AI) in medicine has the potential to enhance clinical practice. One area of active investigation is clinical decision support systems (CDSS) that supplement physician decision-making. While AI-CDSS development has accelerated, little is known about how physicians and medical students interact with these tools in simulated clinical environments. This study investigates how physician and medical student teams interact with a large language model (LLM)-augmented CDSS, GutGPT, designed to support the management of upper gastrointestinal bleeding (UGIB). GutGPT combines a risk-prediction machine learning model (with an interactive dashboard), trained on data from Yale New Haven Hospital, with …

Cutaneous Fungal Infections In The United States: A Cross-Sectional Analysis Of National Surveys, Sarah Lee Spaulding

Yale Medicine Thesis Digital Library

Superficial cutaneous fungal infections (SCFIs), caused by yeasts, dermatophytes, and nondermatophyte molds, are prevalent skin conditions with substantial economic and quality-of-life implications. This study aimed to evaluate trends in the prevalence of SCFIs in the United States between 2005 and 2016, using data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS).We performed a cross-sectional analysis of outpatient visits with SCFIs diagnoses, identified through the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9-CM and ICD-10-CM). Diagnoses included conditions such as tinea unguium, tinea pedis, and candidiasis of the skin …

Prognostic Factors In Active Surveillance Of Low-Risk Prostate Cancer: A Future Of Tailored Surveillance, Vinaik Mootha Sundaresan

Yale Medicine Thesis Digital Library

PROGNOSTIC FACTORS IN ACTIVE SURVEILLANCE OF LOW-RISK PROSTATE CANCER: A FUTURE OF TAILORED SURVEILLANCE.

Vinaik M. Sundaresan and Michael S. Leapman. Department of Urology, Yale University, School of Medicine, New Haven, CT.

As most Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions on MRI harbor Gleason grade (GG) group ≥2 disease on biopsy, optimal management of patients with imaging-biopsy discordance remains unclear. To estimate grade misclassification, we evaluated the incidence of Gleason upgrading among patients with GG1 disease in the setting of a PI-RADS 5 lesion.

We conducted a single-institution retrospective analysis to identify patients with GG1 prostate cancer …

The Use Of Biologic Agents In Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors, Kailyn Valido

Yale Medicine Thesis Digital Library

Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape in the field of oncology due to their effective antineoplastic properties for various cancers. Though revolutionary in cancer treatment, their use is limited by various immune-related adverse events (irAE). Cutaneous immune-related adverse events (cirAE) are the most common type of irAE and encompass a spectrum of dermatological manifestations. These include lichenoid reactions, psoriasiform eruptions, eczematous dermatitis, immunobullous disorders, granulomatous reactions, pruritus (with or without a primary eruption), vitiligo, and severe cutaneous adverse reactions such as Stevens–Johnson syndrome and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome.

The standard approach in …

Changes In Healthcare Coverage And Access To Eyecare Among Low-Income Adults After Medicaid Expansion, Elliott Vanderford

Yale Medicine Thesis Digital Library

Introduction: Access to quality eyecare is important for early diagnosis and prevention of vision loss. Understanding the role of Medicaid expansion (as a result of the Affordable Care Act) in improving eye health outcomes has the potential to guide health policy and address disparities in vision care in the United States. Here, we investigate the impact of Medicaid expansion on access to eyecare among low-income adults across the United States.

Methods: Survey data was extracted from the National Health Interview Survey (NHIS) for the years 2010 through 2018 for adults aged 18-64 years with a family income less than 125% …

Neighborhood-Level Variation In The Effectiveness Of And Participation In An Intensive Health Behavior And Lifestyle Treatment Program For Pediatric Obesity, Grace Wang

Yale Medicine Thesis Digital Library

Bright Bodies (BB) is a family-based intensive health behavior and lifestyle treatment (IHBLT) for pediatric obesity, with demonstrated efficacy and real-world effectiveness. Our study involved two aims: 1) to assess the extent to which real-world effectiveness varied by participants’ neighborhood characteristics, and 2) to evaluate the impact of the COVID-19-associated transition of BB to virtual delivery on participant engagement, particularly for those disadvantaged by inequities in social determinants of health. To achieve Aim 1, we included first-time BB participants 2008-2018 who had an initial BMI ≥85th percentile and available addresses. Addresses were geocoded using ArcGIS Pro and assigned a Child …

Macrophage Migration Inhibitory Factor And D-Dopachrome Tautomerase As Biomarkers And Key Modulators Of Tumor Progression In Head And Neck Cancer And Melanoma, Caroline Naomi Valdez

Yale Medicine Thesis Digital Library

Macrophage Migration Inhibitory Factor (MIF) and its homolog D-dopachrome Tautomerase (DDT) are pro-inflammatory cytokines implicated in tumor progression across multiple cancers. Both MIF and DDT act through canonical CD74 and non-canonical CXCR2/4/7 signaling pathways, which contribute to immune suppression and tumor progression. Elevated MIF levels are associated with metastasis and poor prognosis in HNC and contribute to immune checkpoint inhibitor (ICI) resistance in melanoma. DDT’s role in cancer is not well understood. This study aims to evaluate the expression and therapeutic potential of MIF and DDT inhibition, focusing on their ability to modulate immune responses and improve survival outcomes as …

Bipolar Disorder Among Individuals With Atopic Dermatitis: A Case-Control Study In The All Of Us Research Program, Mitchel Wride

Yale Medicine Thesis Digital Library

Background: Atopic dermatitis has been associated with psychiatric comorbidities.Objectives: To characterize the association between atopic dermatitis and bipolar disorder with a case-control study of the NIH All of Us Research Program. Methods: Utilizing Systemized Nomenclature of Medicine diagnostic codes, we identified cases of atopic dermatitis. Four age, sex, and race/ethnicity matched controls were found for each case using propensity score matching. After controlling for age, sex, race/ethnicity, income, smoking status, and depression, the relationship between atopic dermatitis and bipolar disorder was evaluated using logistic regression. Results: We identified 13,431 atopic dermatitis cases with 53,724 matched controls. Participants with atopic dermatitis …

Portable Magnetic Resonance Imaging Safety, Comfort, And Compatibility With Mobile Vehicular Platforms, Jacob Howard

Yale Medicine Thesis Digital Library

Magnetic Resonance Imaging (MRI) has evolved rapidly since its early days of imaging vials of water and mice when it was known as “zeugmatography”. As advancements in semiconductors increase computational power and algorithmic techniques stretch what we can do with this power, MRI capability is advancing beyond the conventional restraints of room-bound scanners. Low-field magnetic resonance imaging (LF-MRI) that utilizes magnets typically 1/10th the size of traditional magnets has opened the door to mobilizing this imaging modality and increased flexibility in scanner design. With these developments, a new generation of portable MRI (pMRI) is beginning its use in the hospital …

Sharing Unexpected News After Traumatic Death: A Modified Delphi Study, Kirsten Lalli

Yale Medicine Thesis Digital Library

BackgroundGlobally, violence against healthcare workers in Emergency Departments (EDs) is alarmingly common and increasing in prevalence. While workplace violence is possible in any patient encounter, disclosure of traumatic deaths to family and friends may be uniquely high-risk.

Research AimsThe objective of this study is to establish consensus guidelines with multidisciplinary staff to improve safety in the emergency department of a large, urban, Level I trauma center when disclosing traumatic deaths.

HypothesisInterdisciplinary professionals in an emergency department can create consensus around best practices to improve safety in the ED when disclosing traumatic deaths.

MethodsWe conducted this study using a modified Delphi …

Evidence-Based Optimization Of Healthcare Utilization And Supportive Care For Patients With Acute Myeloid Leukemia, Cameron Joseph Hunter

Yale Medicine Thesis Digital Library

Acute myeloid leukemia (AML) care underwent a paradigm shift in 2017 with the development of a number of targeted therapies and less-intensive treatments. This changed expectations for survival and treatment course, particularly for those who are inappropriate candidates for intensive therapy due to frailty, comorbidities or disease-specific features. This period has also seen an evolution of healthcare system models that ultimately deliver sub-specialty care for patients with AML, including the rise of the academic center-affiliated community practices that may care for patients with this uncommon and high-stakes disease. These novel therapies and healthcare models also beget a lack of standardization …

Culture-Free Whole Genome Sequencing Of Mycobacterium Tuberculosis From Clinical Specimens, Chaney Christine Kalinich

Yale Medicine Thesis Digital Library

Tuberculosis (TB) is a leading cause of infection-related mortality worldwide, causing an estimated 1.13 million deaths in 2022. The majority of infections can be successfully treated with antibiotics, but the prevalence of drug-resistant TB and a lack of rapid and cost-effective drug susceptibility tests for many key antibiotics is a significant barrier to treatment. Whole-genome sequencing of Mycobacterium tuberculosis can be used for drug susceptibility testing and can provide valuable insight into transmission patterns. However, M. tuberculosis is slow to grow, meaning traditional sequencing methods which require culture can take many weeks to return results, greatly limiting the potential clinical …

State Regulation And Implementation Landscapes Of Iv Hydration Spas, Anishaa Sivakumar

Yale Medicine Thesis Digital Library

Over the past decade, the number of IV hydration spas in the United States has grown. These facilities offer IV infusions of hydration solutions and other supplements but are exempted from most routine FDA oversight as compounding pharmacies. Instead, state governments are predominantly responsible for regulation and oversight. Descriptive data was collected on state-level policies governing IV hydration spas and through website review and secret shopper calls performed for facilities in each state and DC. While 31 states have issued some form of IV spa guidance, policies varied widely and only 4 state policies addressed governance, prescriber credentials, dispensing practices, …

Developing A Decision Tree To Address Behavioral And Psychological Symptoms Of Dementia In The Primary Care Setting, Lolita Tramel

Yale School of Nursing Digital Theses

AbstractDeveloping a Decision Tree to Address Behavioral and Psychological Symptoms of Dementia in the Primary Care Setting There are 55 million people living with dementia worldwide. In the United States, there are approximately 7.2 million people living with Alzheimer’s dementia and these numbers are expected to rise. The U.S. Department of Health and Human Services (2022) identified there is a shortage of behavioral health clinicians nationwide. As the population ages, demand for behavioral health clinicians will be high and supply will remain low. Primary care providers (PCPs) will be required to see an influx of dementia patients despite finding it …

Evaluation Of Genetic Testing For Thoracic Aortic Disease, Adrian Ricardo Acuna Higaki

Yale Medicine Thesis Digital Library

AimsThoracic aortic disease (TAD), including aneurysms and dissections, present a significant global health challenge due to its typically asymptomatic nature until the onset of critical complications that come with high morbidity and mortality. Effective risk stratification is crucial for early identification and management of patients and their families who are at heightened risk of disease progression. This study aims to evaluate the effectiveness of current genetic testing guidelines for patients with thoracic aortic aneurysms. Methods The study evaluated genetic tests for TAD from 2012 to 2023 in patients aged 18 and older with a thoracic aorta diameter greater than 4 …

Provider-Patient Alliance And Trauma Among Pregnant Patients With Opioid Use Disorder, Molly Doernberg

Yale Medicine Thesis Digital Library

The goal of this project was to compare the provider-patient relationship among pregnant patients with opioid use disorder (OUD) who did or did not have a history of moderate to severe trauma. The hypothesis was that patients with a trauma history would self-report worse relationships with their providers. This was an exploratory analysis of data from 169 patients enrolled in the Support Models for Addiction Related Treatment (SMART) trial. Trauma history, defined as probable post-traumatic stress disorder (PTSD), was determined by a score ≥31 on the PTSD Checklist for DSM-5 (PCL-5). The provider-patient relationship, collected at 26±4 weeks of pregnancy, …

Superficial Cervical Plexus Block And Quality Of Recovery After Thyroidectomy: A Randomized Controlled Trial, Anita Jegarl

Yale Medicine Thesis Digital Library

Purpose: To investigate the effect of the superficial cervical plexus block (SCPB) on the quality of recovery of patients undergoing thyroidectomy with an Enhanced Recovery After Surgery protocol

Methods: This double-blind randomized controlled trial recruited adult patients undergoing thyroidectomy to be randomized to receive pre-incisional bilateral SCPB with either 0.25% bupivacaine or saline. All enrolled participants completed a baseline Quality-of-Recovery 40 (QoR-40) survey prior to surgery, and another QoR-40 survey on postoperative day (POD) 1. Their electronic health records were reviewed to obtain information on secondary outcomes such as intraoperative analgesics administered, post-anesthesia care unit (PACU) duration of stay, incidence …

Effect Of Hormone Exposure And Menopausal Status On Microvascular Dysfunction And Vasospasm, Haleigh Tianna Larson

Yale Medicine Thesis Digital Library

EFFECT OF HORMONE EXPOSURE AND MENOPAUSAL STATUS ON MICROVASCULAR DYSFUNCTION AND VASOSPASM

Haleigh T. Larson and Samit M. Shah. Section of Cardiology, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT

Background: Cardiovascular disease (CVD) is the leading cause of mortality among women in the United States. Ischemic heart disease (IHD) represents a sizeable fraction of CVD that affects women, and ischemia with no obstructive coronary artery disease (INOCA) affects approximately two-thirds of women with IHD. INOCA is characterized by myocardial ischemia symptoms, such as chest pain, without significant epicardial coronary artery obstruction. Up to 50% of …