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Prevalence, Reporting, And Management Of Interstitial Lung Abnormalities And Incidental Findings On Lung Cancer Screening, Tian Wei Yu

Yale Medicine Thesis Digital Library

Background: Low dose computed tomography for lung cancer screening frequently identifies incidental findings. The most frequent and consequential thoracic and upper abdominal incidental findings include interstitial lung disease (ILD), interstitial lung abnormalities (ILA), emphysema, coronary artery calcification, aortic calcification, aortic aneurysm, and adrenal lesions. Many of these abnormalities carry prognostic and therapeutic implications. However, the prevalence of these findings, variation in reporting practices, and downstream management within integrated health systems remain incompletely characterized, particularly for ILA and ILD.

Research Aims: We aimed to quantify the prevalence of selected incidental findings on lung cancer screening CT across a large multi-hospital health …

Measles Vaccine Hesitancy Improvement Bundle To Improve Vaccination Rates In A Rural Outpatient Clinic, Ramie Malone

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction

Despite the Centers for Disease Control and Prevention's recommendations to vaccinate children against measles, a decline in measles vaccination rates has been observed at a rural family medicine clinic. While numerous factors contribute to the decline in vaccination rates—including parental doubts about the necessity of vaccination, concerns about vaccine side effects, and insufficient education—the latter remains a fundamental underlying cause of suboptimal vaccination coverage.

Objectives

This project focused on surveying, educating, and boosting parents' confidence in measles vaccines for children under five to raise the measles vaccination rate.

Methods

This project used a pre- and post-intervention bundle over an …

Reducing 30-Day Readmission Rates In Patients With Heart Failure, Charles Mccoy

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Globally, heart failure affects approximately 54 million individuals and has reached pandemic levels, contributing to elevated 30-day readmission rates (Sa et al., 2024). Background: In the United States, 30-day readmission rates range from 18% to 20%, with similar rates across all states. The current rate was documented as 29% at the study setting hospital. Objective: Implement a Quality Improvement project based on education, evidence-based order sets, and referral to palliative care to reduce 30-day readmission rates among adults with heart failure. Methods: Nursing staff completed education specific to heart failure, and patients received the American Heart Association Self-Check assessment. …

Ask, Advise, And Act: A Smoking Cessation Bundle For Cancer Patients, Crystal Tencate

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Smoking is the number one cause of preventable illness and death in the United States. For patients undergoing cancer treatment, continued tobacco use poses serious risks. In surgical oncology, smoking is associated with poorer treatment outcomes, increased postoperative complications, delayed wound healing, and higher mortality. For patients requiring reconstructive surgery, smoking-related complications can be devastating, sometimes resulting in significant wound complications or loss of the reconstruction. Despite these well-established risks, smoking cessation interventions are not consistently integrated into clinical practice.

To address this gap, a quality improvement project was implemented to strengthen smoking cessation efforts among advanced practice providers (APPs) …

Nursing Bundle To Improve Quality Metrics For Postoperative Patients, Kristine G. Coronado

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Postoperative pulmonary complications and inconsistent implementation of preventive nursing interventions remain significant challenges on acute care surgical units. The purpose of this quality improvement project was to reduce postoperative respiratory failure, hospital readmissions, and length of stay while improving nursing compliance with evidence-based interventions. A nursing care bundle, RISE—Respiratory therapy (structured, nurse-guided incentive spirometry), Incentivize movement (early ambulation), Sit up (head-of-bed elevation ≥30 degrees), and Eliminate germs (twice-daily oral care)—was implemented on an acute care surgical ward in South Texas. Nursing compliance with the preventative measures and patient outcomes were compared between pre- and post-implementation cohorts. Following implementation, nursing compliance …

Improving Asthma Management In Schools: A Comprehensive Approach To Education, Environmental Enhancements And Asthma Action Plans, Yesenia Trevino

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Asthma contributes to school absenteeism, especially in underserved communities. This project aimed to enhance asthma management at a South Texas elementary school through staff and student education, monthly air filter changes, and personalized Asthma Action Plans (AAPs).

Methods

A quality improvement project at a South Texas elementary school involved 40 asthmatic students over eight weeks, using the Plan-Do-Study-Act (PDSA) framework. It included staff and student education, air filter maintenance, and facilitation of Asthma Action Plans (AAPs). Pre/post surveys, custodial logs, AAP audits, and attendance were analyzed, with paired t-tests used to assess changes (N=32).

Results

There was 71.9% …

Starting Strong: Improving Mmr Vaccination Rates In Kindergartners, Regina Bryan

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

During the 2023–2024 academic year, measles, mumps, and rubella (MMR) vaccination coverage among kindergarten students in this school district did not meet the Healthy People 2030 target, thereby elevating the risk of disease outbreaks. This quality improvement project aimed to improve MMR vaccination initiation and completion through coordinated, school-based interventions.

Methods

Guided by the Plan-Do-Study-Act framework, an eight-week immunization bundle was implemented across 14 elementary schools in South Texas. Interventions included reminder calls, multilingual education, districtwide communication, and a partnership with a nonprofit clinic that provides free or reduced-cost vaccines through on-site and community clinics. Pre- and post-intervention …

Ambient Listening: Using Artificial Intelligence To Transcribe Provider Office Visits, Odia Russette

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Electronic health record (EHR) documentation burdens contribute to increased “pajama time” or after–hours charting, reduced job satisfaction, and provider burnout. Provider burnout leads to provider and critical access point losses. Ambient–listening artificial intelligence (AI) technologies have emerged as a possible tool to reduce charting burdens; however, evidence from outpatient wellness settings remains limited.

Local Problem: At an urban adult wellness clinic in Texas with limited resources for completing tasks, in-clinic and after-hours “pajama time” charting burdens contributed to provider fatigue, job dissatisfaction, and burnout.

Methods: A quality improvement (QI) project using the Plan-Do-Study-Act (PDSA) framework implemented an AI ambient …

A Quality Improvement Project To Decrease Medication Prior Authorization Approval Times, Amena Guinn Babers

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Medication prior authorization requirements add to administrative burden, increase labor costs, and delay patient access to treatment in outpatient specialty settings. This bottleneck directly influences nursing workload and economic performance.

Purpose: To evaluate the fiscal and performance significance of implementing an electronic prior authorization (ePA) process, standardized tracking tools, and staff education in a small orthopedic clinic.

Methods: A pre–post quality improvement design was used. Descriptive statistics and inferential analyses (independent‑samples t tests and Mann–Whitney U tests) were conducted to compare time to approval, staff hours worked, satisfaction scores, and medication pickup timeframes.

Results: Significant reductions were observed in …

Improving Discharge Delays Through A Real-Time Durable Medical Equipment Tracking System And Enhanced Interdisciplinary Communication, Shonda Houston

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Timely hospital discharge is essential for patient safety, satisfaction and hospital efficiency. Discharge delays, particularly those related to durable medical equipment (DME), increase length of stay (LOS), strain hospital resources and negatively impact patient outcomes. Evidence suggests that structured discharge planning and improved interdisciplinary communication reduce these delays.

Problem: On an acute care stepdown unit inconsistent DME tracking and poor communication among nurses, case managers, physicians, physical therapist, and DME vendors were identified as contributors to prolonged patient stays.

Methods: Guided by the Iowa Model of Evidence- Based Practice a real-time manual DME tracking system and …

Inpatient Stroke Quality Improvement, Briyawna N. Wyatt

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inpatient nursing documentation for stroke care is essential for meeting quality metrics, maintaining continuity, and supporting timely decisions. Gaps can lead to inconsistent care, metric failures, and reduced staff confidence. This quality improvement initiative aimed to improve metric compliance, documentation consistency, and nursing knowledge and satisfaction. A three-part intervention included targeted education, a standardized documentation verification form, and ongoing feedback from stroke champions. Outcomes measured were metric compliance, knowledge (pre/posttests), documentation completeness (Venous Thromboembolism (VTE), education, Modified Rankin Scale), and staff satisfaction. Results showed significant improvement in nursing knowledge (p < .005), reduced metric fallouts, and better documentation across all indicators. Staff satisfaction increased by about 20%. Overall, combining education, standardized tools, and continuous feedback improved documentation practices, enhanced compliance with stroke metrics, and increased nursing knowledge and satisfaction, supporting better care processes and patient outcomes.

Empowering Patient Engagement In Effort To Reduce Readmissions, Derinda Hugaboon, Msn, Rn

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Hospital readmissions among Medicare beneficiaries remain a major quality concern and are often associated with social determinants of health (SDOH) and care transition gaps. Targeted discharge interventions that address self‑management needs and follow‑up barriers may reduce avoidable readmissions. Objective: To reduce readmissions by implementing a bundled intervention addressing social determinants of health (SDOH), care‑transition gaps, and inadequate post‑discharge primary care follow‑up. Methods: Medicare Advantage (MA) members aged ≥45 were included. A total of 249 members accounted for 275 overall admissions during the project period; 191 admissions (69.5%) received at least one intervention component (informational discharge packet, face‑to‑face encounter, and/or …

School Of Biological Sciences News, 2026, School Of Biological Sciences, Illinois State University

School of Biological Sciences News

Alumni newsletter of Illinois State University's School of Biological Sciences.

A Questionnaire Assessing Attitudes And Readiness For Hiv Pre-Exposure Prophylaxis Therapy For Community Members At-Risk For Hiv Acquisition In Liberia, Yishak Bedaso

Yale Medicine Thesis Digital Library

AbstractA Questionnaire Assessing Attitudes And Readiness For HIV Pre-Exposure Prophylaxis Therapy For Community Members At-Risk For HIV Acquisition In Liberia Yishak Bedaso;1 Jessica Tuan, MD, MS;2 Yassah M. Barclay-Korboi;3 Onyema Ogbuagu MBBCh, FACP, FIDSA4 Affiliation: 1. Yale School of Medicine, New Haven, CT, USA 2. Columbia University Vagelos College of Physicians and Surgeons, Department of Infectious Diseases, New York, NY, USA 3. JFK Memorial Hospital, Monrovia, Liberia. 4.Yale Antivirals & Vaccines Research Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; Despite how effective Pre-exposure prophylaxis (PrEP) is in preventing HIV, uptake among women in sub-Saharan …

Estimating Prep And Voluntary Medical Male Circumcision Prevalence In Three High Hiv Burden Countries, Rose Grace Bender

Yale Medicine Thesis Digital Library

Understanding the impact of specific biomedical interventions is crucial for optimizing HIV prevention strategies. In this study, we estimate of the prevalence of voluntary medical male circumcision (VMMC) and lay out a framework for estimating preexposure prophylaxis (PrEP) in the three high-burden sub-Saharan African countries of Malawi, South Africa, and Zimbabwe. For VMMC, we use a cohort-based simulation framework to model circumcision prevalence in all males over time, allocating VMMC count data to cohorts over time. Model outputs are compared with survey and campaign data, and two parameters, the initial background circumcision prevalence and the age distribution of VMMC procedures, …

Infrainguinal Revascularization Outcomes And Frequency Of Reinterventions Using National Registries, Warren James Carter

Yale Medicine Thesis Digital Library

Lower extremity revascularization (LER) is central to the management of peripheral arterial disease (PAD), especially in patients with the most severe form of disease, chronic limb threatening ischemia (CLTI). Conduit selection is critical for durability of infrainguinal bypass with single segment greater saphenous vein (SSGSV) now widely accepted as the gold standard conduit. Published studies of initial LER have largely focused on the durability of the procedures by examining major amputation and reintervention as primary outcomes in addition to mortality. Even though reinterventions are common after LER, differences in the magnitude and frequency of reintervention after initial revascularization have not …

Epidermal Differentiation Disorders Across The Lifespan: Growth, Ophthalmologic, And Perinatal Manifestations, Caroline Echeandia-Francis

Yale Medicine Thesis Digital Library

Epidermal differentiation disorders (EDDs) are a heterogeneous group of inherited skin diseases characterized by impaired epidermal barrier function, scaling, and erythema. Although substantial progress has been made in identifying the genetic causes of EDD, long-standing clinical observations—including impaired growth, ectropion, and increased rates of preterm birth—remain poorly characterized across genotypes. The prevalence, severity, and clinical significance of these manifestations have not been systematically evaluated in large, genotype-stratified cohorts, limiting the ability to provide anticipatory guidance and tailored clinical care. This thesis seeks to (1) characterize growth trajectories in children with EDD and determine genotype-specific patterns of growth impairment; (2) assess …

Regional Inequities In Colon Cancer Surgical Care: Treatment Delay Patterns Across U.S. Facilities, Rushabh Hemang Doshi

Yale Medicine Thesis Digital Library

AbstractBackground/Scientific Premise: Colon cancer represents a significant public health burden in the United States, ranking as the third most common and second deadliest cancer. Timely surgical resection is critical for optimal survival in non-metastatic disease, yet persistent racial, insurance, and geographic disparities in access to care may contribute to treatment delays. While treatment delay has been established as a critical quality metric, regional variation in surgical delays for colon cancer and how patient-level disparities manifest across different U.S. regions remain poorly understood. Understanding these geographic patterns is essential, as healthcare systems, patient populations, access barriers, and state-level policies differ substantially …

Prevalence Of K13 Mutant Malaria Parasites In Busia, Uganda, Ahmed Elzamzami

Yale Medicine Thesis Digital Library

Artemisinin derivatives form the backbone of all antimalarial combination therapies usedworld-wide. Resistance to this critical drug class is a growing problem in the highest malaria transmission regions of the world. First detected in southeast Asia, independent mutations conferring partial resistance to artemisinin’s have now emerged in East Africa.27, 32 Retrospectively, these mutations have been detected as early as 2016 in Uganda.36 Previous work by the Parikh lab highlights the efficacy of 3-day vs 5-day artemether-lumefantrine treatment regimen for uncomplicated malarial episodes in Busia, Uganda in 2019.41 Infections were followed and classified as recrudescent, a reinfection, SBP1 slow clearing, or an …

Influence Of Demographics On Research Participation In Female Patients Undergoing Ambulatory Surgery, Tiana Fernandez

Yale Medicine Thesis Digital Library

Background: Historically, research on women and minorities has consisted of unethical experimentation, human rights violations, and crimes against humanity. Numerous examples can be found throughout the past two centuries, including the exposure of pregnant women to radioactive iron in the Tennessee-Vanderbilt Nutrition Project (TVNP), failure to treat cervical carcinoma in situ in the Unfortunate Experiment, surgical experimentation on female slaves by Dr. J. Marion Sims, failure to treat syphilis in the Tuskegee Syphilis Study, intentional exposure to and subsequent failure to treat sexually transmitted diseases in Guatemala, collection of biospecimens from Henrietta Lacks, and nontherapeutic experimentation on minority children in …

Repurposing Ezetimibe As A Therapeutic For Parkinson's Disease: Evaluating The Therapeutic Potential And Probing For A Mechanism, Brian Hilton

Yale Medicine Thesis Digital Library

Neurologic disease is the leading cause of disability globally and Parkinson’s disease (PD) has been the fastest growing neurologic brain disease over the last several decades. Despite the immense burden of PD on patients and society, there has yet to be an efficacious disease-modifying therapy. Investigation of candidate pharmaceuticals that have already been approved by the FDA for other conditions might provide an expedited path to the advent of disease-modifying therapy. There is a rich history of drug repurposing for symptomatic therapy for PD, with amantadine as the preeminent example. In order to identify candidate therapeutics for possible repurposing, an …

Rns-Based Early Prediction Of Antiseizure Medication Efficacy, Joshua Hobbs

Yale Medicine Thesis Digital Library

Drug-resistant focal epilepsy accounts for a significant portion of patients with epilepsy. These patients many times experience persistent seizures despite several ASM (anti-seizure medication) trials. RNS (Responsive neurostimulation) has demonstrated efficacy in reducing seizure frequency in patients that are resistant to drug trials, and provide continuous intracranial electroencephalographic monitoring. This longitudinal data may offer an opportunity to identify potential early biomarkers of ASM trial effectiveness, which could lead to quicker optimization of pharmacological therapy. This study in particular evaluated whether early changes in RNS-detection of seizure activity can predict a clinical response to ASMs in patients with drug-resistant focal epilepsy. …

Associating Inflammatory Dermatoses And Gynecological Disorders Using The National Institutes Of Health’S All Of Us Research Program, Christine Myriam Hodelin

Yale Medicine Thesis Digital Library

There remains a gap in the knowledge about the relationship between inflammatory disorders and common gynecological disorders, despite significant quality of life concerns for both. We examined the association between hidradenitis suppurativa (HS) and endometriosis, and the association between atopic dermatitis (AD) and uterine leiomyomas, both with a cross-sectional study using electronic health record and survey data from the National Institutes of Health’s All of Us Research Program.

The All of Us Research Program has a large United States-based cohort and focuses on traditionally underrepresented populations in research. We compared cases and controls, all assigned female at birth, using Pearson’s …

Facial Harmony And Gender Congruence: Patient-Reported Outcomes Of Gender-Affirming Facial Surgery Using The Gender-Q And Gpsq, Helia Hosseini

Yale Medicine Thesis Digital Library

Background:Gender-affirming facial surgery (GAFS) addresses gender dysphoria by aligning facial features with gender identity, with historical emphasis on refining the upper facial third to render patients more attractive and feminine. The GENDER-Q, a novel patient-reported outcome measure (PROM), evaluates aesthetic, functional, and psychosocial outcomes, complementing the Gender Preoccupation and Stability Questionnaire (GPSQ) to assess effects of GAFS in this study. Methodology: Survey data from 86 patients was analyzed using GENDER-Q and GPSQ scores. Higher GENDER-Q scores indicated improved outcomes, whereas lower GPSQ scores reflected reduced gender dysphoria. Pre- and post-operative outcomes were compared using paired and unpaired t-tests. Spearman’s correlation …

Trends, Predictors, And Cerebrovascular Outcomes Of Vertebral Artery Injury In Cervical Fractures, Rahul Jayaram

Yale Medicine Thesis Digital Library

Background and Scientific Premise: Cervical spine trauma is a common emergencydepartment presentation, and vertebral artery injury (VAI) is a potentially occult but serious complication associated with posterior circulation stroke. Identification of patients at risk remains challenging due to subtle presentations, variable screening practices, and limited prior data. Research Aims: The aims of this study were to characterize temporal trends in VAI detection among adult patients presenting to the emergency department with cervical spine fractures between 2010 and 2022, identify independent demographic, clinical, and injury-related predictors of VAI, and evaluate the association between VAI and ischemic stroke within ninety days of …

Cross-Sectional Analysis Of The Hepatitis C Care Cascade Among People Who Use Drugs In New Haven, Ct, Thomas Shaifer Jones

Yale Medicine Thesis Digital Library

People who use drugs (PWUD) are at high risk of contracting Hepatitis C Virus (HCV) and often face significant barriers in accessing healthcare. Treatment of HCV is highly effective, but previous studies show low rates of successful treatment in practice due to multiple points of failure along the treatment cascade. Harm reduction and outreach programs such as syringe services programs (SSPs) and drug treatment programs including medication for opioid use disorder (MOUD) have emerged as possible points of leverage in advancing people through the cascade of care. To better understand how people who use drugs access HCV treatment and elucidate …

Tone Matters: Advancing Equity Through A Pilot Intervention To Increase Exposure Of Clinical Findings In Skin Of Color, Lamley Amanuah Lawson

Yale Medicine Thesis Digital Library

Background: The ability to accurately recognize cutaneous manifestations of disease is a foundational clinical skill. However, current undergraduate medical education heavily relies on lighter skin tone prototypes, leaving trainees underprepared to diagnose conditions in patients with melanin-rich skin.Research Aims: This study aimed to evaluate the efficacy of a brief, targeted, visually comparative digital intervention by measuring its impact on medical students' immediate diagnostic accuracy and self-reported clinical confidence in identifying dermatologic conditions across a diverse range of skin tones. Hypothesis: We hypothesized that a brief, targeted digital educational intervention featuring side-by-side visual comparisons of dermatologic conditions across a range of …

Joint Venture: Curriculum Design, Implementation And Evaluation For A Novel Interdisciplinary Musculoskeletal Medicine Elective, Arielle Richey Levine

Yale Medicine Thesis Digital Library

Background / Scientific Premise: Musculoskeletal medicine is underrepresented in medical education in the United States and internationally; however, it represents an increasingly critical area of patient care. Educational initiatives targeting this area of medicine are complex given its interdisciplinary nature and the challenges faced when adding new material to medical curricula. The application of medical education principles to tackle this challenge remains an area open for further investigation in terms of efficacy and reported student experience.

Research Aims: This research aims to understand the needs for improved MSK education at Yale School of Medicine, design an intervention to address the …

Frailty And Functional Decline After Elective Endovascular Abdominal Aortic Aneurysm Repair, Judy Li

Yale Medicine Thesis Digital Library

Background: Frailty can be used to estimate perioperative and long-term mortality risk in octogenarians undergoing elective endovascular abdominal aortic aneurysm repair (EVAR). Its association with functional decline, an important surrogate of quality of life in older adults, has not been well studied in this population. We aimed to evaluate whether preoperative factors such as frailty are associated with one-year functional decline after elective EVAR in octogenarians and to compare the performance of three different frailty assessments.

Methods: The Vascular Quality Initiative (VQI) database was queried for octogenarians who underwent elective EVAR for an asymptomatic infrarenal abdominal aortic aneurysm (AAA) (2014 …

Mr Perfusion In Acute Ischemic Stroke And Neurovascular Conditions: Utilization, Diagnostic Yield, And Implications For Management From An 11-Year Health System Analysis, Richard Julian Lozano

Yale Medicine Thesis Digital Library

Purpose: Cerebral ischemic infarct results in a rapidly developing core of infarcted brain tissue surrounded by hypoxic but potentially salvageable tissue known as a penumbra. MR perfusion (MRP) is an uncommonly used technique that can be used to define ischemic core and penumbra; its utilization, diagnostic yield, and impact on management, however, are not well-described. This study aims to delineate the use of MRP in acute ischemic stroke and related neurovascular conditions.Methods: This retrospective study examines approximately 11 years of patient encounters (January 1, 2014- November 11, 2024) from a single health system to identify all cases where MR perfusion …