Digital Commons Network^™

Improving Outpatient Medication Reconciliation And Reducing Adverse Drug Events: Development Of A New Process, Marisa Kristine Blake-Raut

Yale School of Nursing Digital Theses

AbstractImportance: Prescribed medications can pose risks to patient safety. In the United States, persons aged over 65 account for nearly 450,000 annual emergency department (ED) visits, and they are seven times more likely to require hospital admission than younger persons (Centers for Disease Control and Prevention, 2022). Medication reconciliation (MR) errors are more likely to affect those older than 65, but can be prevented by using standardized MR criteria that identify medications with higher risks for adverse drug events (ADEs) (O’Mahoney, 2020). Objective: The DNP project goal was to create and implement a risk stratified medication reconciliation (RSMR) intervention process …

My Identi T: Improving Mental Health Outcomes Through Group Support In Pre-Treatment Transgender Teens, Jill Day

Yale School of Nursing Digital Theses

Transgender youth (TGY) are at an increased risk for depression, anxiety, and suicidality; delaying transition can worsen this. Nationally, gender programs have waitlists beyond a year. In conservative states, providers are fewer in number, and legislation may prohibit services. Thus, gender programs rely on mental health and primary care providers to assist youth who express a strong desire to be a gender other than that assigned at birth, and who endure protracted wait times to start treatment. This DNP project developed and implemented an evidence-based, gender-affirming peer support group to improve patient experience and mental health outcomes by providing information …

Relationship-Centered Communication In Breast Cancer Screening: An Interdisciplinary Training Model, Patricia Aideen Ducharme

Yale School of Nursing Digital Theses

Breast cancer screening is essential for early detection and reducing disease progression. However, its underuse contributes to late-stage diagnoses, adverse health consequences, and reduced survival rates. Research has shown that high-quality communication significantly influences women's adherence to breast cancer screening, leading to earlier detection and better health outcomes. However, many healthcare providers receive no formal communication skills training. Healthcare providers who undergo relationship-centered communication (RCC) training demonstrate stronger interpersonal relationships, which result in increased provider-patient satisfaction, more efficient healthcare teams, and improved quality of patient care. To date, most RCC studies have focused predominantly on the physician-patient relationship rather than …

Establishing An Infrastructure For Nursing Innovation In A Large Urban Magnet®Hospital, Gregory Parsons Eichelzer

Yale School of Nursing Digital Theses

Problem and Context: Despite nursing's potential to contribute valuable solutions to healthcare challenges, dedicated nursing innovation development programs are scarce. This scarcity, compounded by a lack of nursing leadership competencies in fostering innovation, inhibits nurses' ability to translate innovative ideas into clinical practice effectively.

Intervention: This Doctor of Nursing Practice (DNP) project addressed this gap by establishing a structure, process, and technology access based on industry-standard for nursing innovation in the inpatient setting.

Aims and Methods: The project aimed to establish a structure, process, and technology access based on industry-standard for nursing innovation in the inpatient setting, to implement and …

Implementation Of A Transition Shock Prevention Workshop To Promote Satisfaction And Confidence Among New To Practice Nurse Practitioners, Denis L. Hawkins

Yale School of Nursing Digital Theses

For decades nurse researchers such as Patricia Benner and Margaret Flinter have focused on the challenges of role transition in nursing (Benner, 2004; Flinter, 2010). Role transition from RN to NP can be a daunting experience. Many new-to-practice nurse practitioners experience a phenomenon known as Transition Shock which is described as disproportionate feelings of anxiety and doubt that can consume personal energy during the initial period of role adjustment (Duchscher, 2009). Literature demonstrates that feelings of transition shock can be influenced by factors such as readiness for learning, unwelcoming environments, and the learning curriculum (Barnes, 2015; Duchscher, 2008; MacClellan, et. …

Implementation And Evaluation Of Perinatal Educational Video Series – Postpartum Hemorrhage, Daileann Lamara Hemmings

Yale School of Nursing Digital Theses

Abstract

Implementation and Evaluation of Perinatal Educational Video Series –Postpartum Hemorrhage Per the Centers for Disease Control and Prevention (2021), 700 women die each year due to pregnancy related complications in the United States. Black women (Erickson, 2020) have a 26.6% higher risk for morbidity resulting from postpartum hemorrhage (PPH) and a five times higher risk of mortality. Education can serve as a tool to increase knowledge, promote a mother’s ability to identify the onset of a risk and report signs and symptoms of PPH that could otherwise lead to complications or death. ​ This DNP pilot project developed and …

Nonfatal Strangulation And Intimate Partner Violence Decision Tree Protocol, Joy Martin

Yale School of Nursing Digital Theses

AbstractNonfatal Strangulation and Intimate Partner Violence Decision Tree Protocol Problem and Context Nonfatal strangulation (NFS) is the ultimate form of power and control in intimate partner violence (IPV). Native American women are at an increased risk of intimate partner violence. Symptoms of strangulation are frequently missed by first responders. Victims often decline medical examination. Victims of nonfatal strangulation can have significant long term complications and increased morbidity throughout their lives. Intervention or Innovation This project provided educational training sessions to first responders within a Native American community in the Southwestern United States to increase knowledge and comfort when responding to …

Retaining New Graduate Nurses: Creating A Model Inpatient Transition To Practice Program In A Large Healthcare System, Amanda Jane Richards

Yale School of Nursing Digital Theses

Abstract

Retaining New Graduate Nurses: Creating a Model Inpatient Education to Practice Program in a Large Healthcare SystemPurpose: The purpose of this study is to address the persistent challenge of high turnover rates among New Graduate Nurses (NGNs) by implementing and evaluating a Dedicated Education Unit (DEU) model in a large hospital. The DEU aims to provide intensive support and training to NGNs during their transition to clinical practice, with a focus on improving retention rates and enhancing patient care quality. Background: New Graduate Nurse turnover rates have reached alarming levels, impacting healthcare organizations' stability and patient outcomes. Traditional postgraduate …

Moral Distress: The Importance Of Support For Black And Brown Nurses After Encountering Racism From Patients And Peers In The Acute Care Setting, Marsha Sinanan

Yale School of Nursing Digital Theses

Purpose: This DNP project developed and implemented an online training program to support Black and Brown nurses’ post-racism encounters in the acute care inpatient setting. Background: Nationally, it is estimated that 25% of nurses experience mistreatment by patients each year, but many fail to report these episodes (Campbell, 2016). The retention of Black and Brown nurses is essential, as cultural congruence or shared experiences among patients and members of their healthcare team can, be an important bridge for promoting safety and the best clinical outcomes (Moceri, 2014). Methods: Approximately 400 RNs were invited to participate in a 15-minute online training …

The California Bridge Model For Emergency Department-Initiated Medication-Assisted Treatment For Opioid Use Disorder: Adaptations For Perinatal Hospital Services, Devin C. Thomas

Yale School of Nursing Digital Theses

Background: Poor access to gender-specific, pregnancy-focused medication-assisted treatment for perinatal opioid use disorder greatly contributes to adverse outcomes for pregnant patients, infants, and society, at large. It is well established that Emergency Department-initiated pharmacotherapy for opioid use disorder is safe, effective, and can be rapidly adopted by hospital systems to improve access to care for people who misuse opioids. Like the Emergency Department, perinatal hospital services are well positioned to serve as critical access points in the treatment of perinatal opioid use disorder. However, concerns such as lack of training, workflow inefficiencies, and bias act as barriers to co-located, integrated …

Copd C.A.R.E. Connect: A Systems Trajectory To Reducing Copd Readmissions In A Large National Healthcare Institution, Jennifer Mariano

Yale School of Nursing Digital Theses

COPD is the third principal diagnosis accounting for 30-day all-cause readmission,14.4% of rehospitalization are due to acute exacerbation and occur within 3 days after discharge. Readmission exposes the patient to risks of medical errors and hospital-acquired infection. An interprofessional care program for COPD patients called “COPD C.A.R.E. (Control Avoidable REadmissions) Connect” was established within the medical surgical unit at this large national healthcare institution. The program utilized frontline expert collaboration to provide inpatient COPD-specific healthcare teachings, promote self-care, and ensure the timeliness of post-discharge care. The project aimed to adapt an interprofessional care service for hospitalized COPD inpatients to reduce …

Lack Of Association Of A1c With Postoperative Complications In Children With Type 1 Or Type 2 Diabetes, Grace Kim, Mckenna C Richards, Abigail B Smith, Kathleen M Strybos, Xiaofan Huang, Kristen Staggers, Stephen A Stayer, Rahul G Baijal

Faculty, Staff and Students Publications

Not meeting recommended A1C targets may be associated with postoperative complications in adults, but there are no studies reporting on the relationship between preoperative A1C and postoperative complications in children with type 1 or type 2 diabetes. The objective of this study was to determine whether elevated A1C levels were associated with an increased incidence of postoperative complications in children with diabetes presenting for elective noncardiac surgery or diagnostic procedures. It found no such association, suggesting no need to delay elective surgery in children with diabetes until A1C is optimized.

Planning For Children In Disasters: Education And Strategies For The Best Outcomes, Mark X Cicero, Nichole R Davis, Allison Marie Henning, Steven Krug

Faculty, Staff and Students Publications

No abstract provided.

Choice Of Adjuvant And Antigen Composition Alters The Immunogenic Profile Of A Sars-Cov-2 Subunit Vaccine, William R Lykins, Jeroen Pollet, Jessica A White, Brian Keegan, Leroy Versteeg, Ulrich Strych, Wen-Hsiang Chen, Raodoh Mohamath, Gabi Ramer-Denisoff, Sierra Reed, Samuel Beaver, Alana Gerhardt, Emily A Voigt, Mark A Tomai, Robert Sitrin, Robert K M Choy, Frederick J Cassels, Peter J Hotez, Maria Elena Bottazzi, Christopher B Fox

Faculty, Staff and Students Publications

Introduction: Since their introduction, adjuvanted recombinant subunit vaccines against COVID-19 have played a pivotal role in protecting global populations. Optimizing the immune response's quality, amplitude, and durability to these vaccines depends on the appropriate adjuvant choice and dose in combination with the selected antigen.

Methods: Here, we employed a preclinical mouse model to study the adaptive humoral and cellular immune responses to a SARS-CoV-2 receptor binding domain (RBD) antigen formulated with one of four different immune agonists [GLA, 3M-052, CpG-1826 (CpG), and dmLT], in combination with one of two different immune-stimulating formulations, a stabilized squalene emulsion (SE) or aluminum hydroxide …

Continuing Education And Professional Development: Unifying Opportunities For Genetic Counselors Globally, Kathleen D Valverde, Tiffiney R Hartman, Sara L Reichert, Robin L Bennett, Martha Dudek, Debra Duquette, Daniel Riconda, Nancy J Cox, Gail P Jarvik, Sarah H Elsea, Elizabeth M Mcnally, Kim C Worley, Daniel J Rader

Faculty, Staff and Students Publications

No abstract provided.

Research Considerations For Prospective Studies Of Patients With Coma And Disorders Of Consciousness, Lorenzo Tinti, Thomas Lawson, Erika Molteni, Daniel Kondziella, Verena Rass, Tarek Sharshar, Yelena G Bodien, Joseph T Giacino, Stephan A Mayer, Moshgan Amiri, Susanne Muehlschlegel, Chethan P Venkatasubba Rao, Paul M Vespa, David K Menon, Giuseppe Citerio, Raimund Helbok, Molly Mcnett

Faculty, Staff and Students Publications

Disorders of consciousness are neurological conditions characterized by impaired arousal and awareness of self and environment. Behavioural responses are absent or are present but fluctuate. Disorders of consciousness are commonly encountered as a consequence of both acute and chronic brain injuries, yet reliable epidemiological estimates would require inclusive, operational definitions of the concept, as well as wider knowledge dissemination among involved professionals. Whereas several manifestations have been described, including coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state, a comprehensive neurobiological definition for disorders of consciousness is still lacking. The scientific literature is primarily observational, and studies-specific aetiologies lead to …

Editorial: Epilepsy And Alzheimer’S Disease: Shared Pathology, Clinical Presentations, And Targets For Treatment, Beth Leeman-Markowski, Jeannie Chin, Dominique Leitner, Keith Vossel

Faculty, Staff and Students Publications

No abstract provided.

Laminar Multi-Contrast Fmri At 7t Allows Differentiation Of Neuronal Excitation And Inhibition Underlying Positive And Negative Bold Responses, Xingfeng Shao, Fanhua Guo, Junghwan Kim, David Ress, Chenyang Zhao, Qinyang Shou, Kay Jann, Danny Jj Wang

Faculty, Staff and Students Publications

A major challenge for human neuroimaging using functional MRI is the differentiation of neuronal excitation and inhibition which may induce positive and negative BOLD responses. Here, we present an innovative multi-contrast laminar functional MRI technique that offers comprehensive and quantitative imaging of neurovascular (CBF, CBV, BOLD) and metabolic (CMRO2) responses across cortical layers at 7T. This technique was first validated through a finger-tapping experiment, revealing ‘double-peak’ laminar activation patterns within the primary motor cortex. By employing a ring-shaped visual stimulus that elicited positive and negative BOLD responses, we further observed distinct neurovascular and metabolic responses across cortical layers and eccentricities …

Dimensionality Reduction And Nearest Neighbors For Improving Out-Of-Distribution Detection In Medical Image Segmentation, Mckell Woodland, Nihil Patel, Austin Castelo, Mais Al Taie, Mohamed Eltaher, Joshua P Yung, Tucker J Netherton, Tiffany L Calderone, Jessica I Sanchez, Darrel W Cleere, Ahmed Elsaiey, Nakul Gupta, David Victor, Laura Beretta, Ankit B Patel, Kristy K Brock

Faculty, Staff and Students Publications

Clinically deployed deep learning-based segmentation models are known to fail on data outside of their training distributions. While clinicians review the segmentations, these models tend to perform well in most instances, which could exacerbate automation bias. Therefore, detecting out-of-distribution images at inference is critical to warn the clinicians that the model likely failed. This work applied the Mahalanobis distance (MD) post hoc to the bottleneck features of four Swin UNETR and nnU-net models that segmented the liver on T1-weighted magnetic resonance imaging and computed tomography. By reducing the dimensions of the bottleneck features with either principal component analysis or uniform …

The Maternal Gut Microbiome In Pregnancy: Implications For The Developing Immune System, Omry Koren, Liza Konnikova, Petter Brodin, Indira U Mysorekar, Maria Carmen Collado

Faculty, Staff and Students Publications

The gut microbiome has important roles in host metabolism and immunity, and microbial dysbiosis affects human physiology and health. Maternal immunity and microbial metabolites during pregnancy, microbial transfer during birth, and transfer of immune factors, microorganisms and metabolites via breastfeeding provide critical sources of early-life microbial and immune training, with important consequences for human health. Only a few studies have directly examined the interactions between the gut microbiome and the immune system during pregnancy, and the subsequent effect on offspring development. In this Review, we aim to describe how the maternal microbiome shapes overall pregnancy-associated maternal, fetal and early neonatal …

Diminished Tmem100 Expression In A Newborn With Acinar Dysplasia And A Novel Tbx4 Variant: A Case Report, Przemyslaw Szafranski, Silvia Patrizi, Tomasz Gambin, Bushra Afzal, Emily Schlotterbeck, Justyna A Karolak, Gail Deutsch, Drucilla Roberts, Paweł Stankiewicz

Faculty, Staff and Students Publications

Acinar dysplasia (AcDys) of the lung is a rare lethal developmental disorder in neonates characterized by severe respiratory failure and pulmonary arterial hypertension refractory to treatment. Recently, abnormalities of TBX4-FGF10-FGFR2-TMEM100 signaling regulating lung development have been reported in patients with AcDys due to heterozygous single-nucleotide variants (SNVs) or copy-number variant (CNV) deletions involving TBX4, FGF10, or FGFR2. Here, we describe a female neonate who died at 4 hours of life due to severe respiratory distress related to AcDys diagnosed by postmortem histopathologic evaluation. Genomic analyses revealed a novel deleterious heterozygous missense variant c.728A>C (p.Asn243Thr) in TBX4 that arose …

Advances In Nanoprobes For Molecular Mri Of Alzheimer’S Disease, Parag Parekh, Andrew A Badachhape, Eric A Tanifum, Ananth V Annapragada, Ketan B Ghaghada

Faculty, Staff and Students Publications

Alzheimer's disease is the most common cause of dementia and a leading cause of mortality in the elderly population. Diagnosis of Alzheimer's disease has traditionally relied on evaluation of clinical symptoms for cognitive impairment with a definitive diagnosis requiring post-mortem demonstration of neuropathology. However, advances in disease pathogenesis have revealed that patients exhibit Alzheimer's disease pathology several decades before the manifestation of clinical symptoms. Magnetic resonance imaging (MRI) plays an important role in the management of patients with Alzheimer's disease. The clinical availability of molecular MRI (mMRI) contrast agents can revolutionize the diagnosis of Alzheimer's disease. In this article, we …

Safety And Efficacy Of Intravenous Sotalol Following Congenital Heart Surgery, Ellis Rochelson, Maria Gutierrez, Santiago O Valdés, Katherine Lemming, Taylor S Howard, Tam Dan N Pham, Christina Y Miyake, Vicken Asadourian, Raajen Patel, Jeffrey J Kim

Faculty, Staff and Students Publications

No abstract provided.

Improving The Performance Of Hirep Lattice Simulations Software By Exploiting The Cpu Hardware Architecture Details And Algorithm Characteristics, Md Rahman

School of Engineering, Computing and Mathematics Theses

In the scientific exploration of Quantum Chromodynamics (QCD)—the theory governing the strong interaction among quarks and gluons—large-scale numerical simulations are per formed using the framework of lattice gauge theories. Lattice Gauge Theory (LGT) simulations involve the formulation of gauge field theories on a space-time lattice. HiRep is a simulation suite designed for running lattice simulations, leveraging high-performance computing platforms. HiRep is designed to be flexible enough to study a wide range of strongly interacting systems, particularly those pertinent to novel physics investigations at CERN’s Large Hadron Collider (LHC). However, improving the execution time of HiRep is a challenging and non-trivial …

Explainable Deep Learning For Medical Imaging Classification, Megan Courtman

School of Engineering, Computing and Mathematics Theses

Machine learning is increasingly being applied to medical imaging tasks. However, the "black box'' nature of techniques such as deep learning has inhibited the interpretability and trustworthiness of these methods, and therefore their clinical utility. In recent years, explainability methods have been developed to allow better interrogation of these approaches.This thesis presents the novel application of explainable deep learning to several medical imaging tasks, to investigate its potential in patient safety and research. It presents the novel application of explainable deep learning to the detection of aneurysm clips in CT brains for MRI safety. It also presents the novel application …

Data Security And User Authentication In Public Cloud Computing Environments, Nelson Vasconcelos Soares Dos Santos

School of Engineering, Computing and Mathematics Theses

Cloud computing has become a prevalent paradigm for organisations and individuals, offering a range of services and resources that enable the efficient management, processing and storage of large quantities of data. However, despite its numerous advantages, cloud computing also presents significant challenges related to data security and user authentication. The distributed nature of cloud environments, coupled with the relinquishment of control over data to cloud service providers, has raised concerns regarding data vulnerability to various types of attacks, such as data breaches, malware injection, and denial of service. Moreover, traditional password and token-based authentication methods have been shown to be …

Pop-Up Books, Magic, And Health, John Kilburn

School of Art, Design and Architecture

No abstract provided.

Welcoming 2024: Supporting Students' Well-Being, Eric A Storch, Rick Yang

Faculty, Staff and Students Publications

No abstract provided.

Gut Pathobiont Enrichment Observed In A Population Predisposed To Dementia, Type 2 Diabetics Of Mexican Descent Living In South Texas, Lisa M Matz, Nisarg S Shah, Laura Porterfield, Olivia M Stuyck, Michael D Jochum, Rakez Kayed, Giulio Taglialatela, Randall J Urban, Shelly A Buffington

Faculty, Staff and Students Publications

Type 2 diabetes (T2D) is a common forerunner of neurodegeneration and accompanying dementia, including Alzheimer's Disease (AD), yet the mechanisms underlying this comorbidity remain unresolved. Individuals of Mexican descent living in South Texas have increased prevalence of comorbid T2D and early onset AD, despite low incidence of the APOE-ε4 risk variant among the population and an absence of a similar predisposition among relatives residing in Mexico - suggesting a role for environmental factors in coincident T2D and AD susceptibility. We therefore sought to test if differences in gut community structure could be observed in this population prior to any AD …

Evaluating The Implementation Of A Relationship-Centered Communication Training For Connecting With Patients In Virtual Visits, Rachyl Pines, Marie C. Haverfield, Stephanie Wong Chen, Ethan Lee, Cati Brown-Johnson, Merisa Kline, Barbette Weimer-Elder

Faculty Research, Scholarly, and Creative Activity

The use of telehealth, specifically virtual visits, has increased and adoption continues. Providers need effective training for how to communicate with patients to develop a connection during virtual visits. This article describes the implementation and evaluation of a course called Mastering Presence in Virtual Visits. Results show that although providers perceive lack of time, technology issues, and lacking experiential knowledge as barriers to enacting course behaviors, the course was feasible and acceptable. Following the course, providers rated key course behaviors as helpful for practice, and 80.7% of providers were likely to recommend the course to a colleague. The course shifted …