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Lapses In Care Among Patients With Proliferative Diabetic Retinopathy: A Mixed-Methods Study, Serina Sera Applebaum

Yale Medicine Thesis Digital Library

Proliferative diabetic retinopathy (PDR) affects approximately 7% of individuals with diabetes and requires consistent follow-up to prevent irreversible vision loss. Despite this, lapses in PDR care are common, but poorly characterized. We conducted a two-phase mixed-methods evaluation, including a quantitative retrospective national cohort study of individuals with PDR, followed by a qualitative study investigating participant perspectives on their own lapses in PDR care. In the quantitative component, we used data from 13 academic health systems in the Sight Outcomes Research Collaborative (SOURCE) Repository between 2008 and 2023 to identify adults aged ≥18 with PDR and ≥6 months of ophthalmic follow-up. …

Two-Level Anterior Cervical Spine Intervention: A Comparative Analysis Of Existing Techniques, Philip Prakash Ratnasamy

Yale Medicine Thesis Digital Library

Background/Scientific Premise: There is growing utilization of surgical intervention for two-level degenerative cervical spine pathology. Multiple treatment options exist. The gold standard remains two-level anterior cervical discectomy and fusion (ACDF), in which the degenerative or herniated cervical discs are removed through an anterior approach to decompress neural elements, followed by fusion of the two involved interspaces to restore stability and alignment. More recently, cervical disc arthroplasty (CDA) has emerged as a viable treatment option for two-level cervical spine pathology, in which the surgeon removes the diseased intervertebral discs and replaces them with artificial discs to reconstruct the segments following decompress …

Level Of Evidence And Cost Considerations In United States Clinical Practice Guidelines, 2019-2023, Omar Qureshi

Yale Medicine Thesis Digital Library

BackgroundClinicians rely on clinical practice guidelines (CPGs) to fulfill a dual mandate: practicing evidence-based medicine and ensuring cost-conscious stewardship of resources. However, it remains unclear whether modern CPGs provide the guidance necessary to meet these goals. Specifically, the extent to which recommendation strengths align with evidence quality and the prevalence of cost-related guidance within U.S. medical society CPGs remains unknown.

Research Aimsa) To examine the distribution of SOR and LOE ratings for recommendations offered by United States medical societies through CPGs and evaluate concordance between SOR and LOE ratings for CPG recommendations. Additionally, assess whether there are recommendation-level, guideline-level, or …

Automated Cerebral Autoregulation Monitoring With Machine Learning, Matteo Rosati

Yale Medicine Thesis Digital Library

Background - Current methods of identifying patients in the neurological intensive care unit (NeuroICU) with disrupted cerebral autoregulation rely on statistical methods that require significant time to produce predictions. There is a need for faster algorithms that can minimize the secondary damage caused by disrupted autoregulation in these patients.

Research Aims - We aim to develop a machine learning (ML) model that determines whether a patient is outside optimal autoregulatory limits using continuously recordable and minimally invasive physiologic data gathered in the NeuroICU.

Hypothesis - We hypothesize we can use ML techinques to ingest physiologic data in short time windows …

The Spectrum Of Cutaneous And Systemic Manifestations Associated With Anti-Pm/Scl, Sabrina Maariyah Saeed

Yale Medicine Thesis Digital Library

Anti-PM/Scl is a rare anti-nuclear autoantibody first identified in patients with polymyositis and the scleroderma/myositis overlap syndrome. Due to its low prevalence, the clinical manifestations associated with anti-PM/Scl remain incompletely understood. This study aims to further delineate the phenotype associated with anti-PM/Scl. Anti-PM/Scl positive patients treated at Yale New Haven Health Systems between 2012 and 2024 were retrospectively identified. Chart review was conducted to characterize demographics, skin findings, and extracutaneous manifestations associated with the antibody. Anti-PM/Scl was detected in 64 of the 2867 patients tested. Fifty-seven of these patients met inclusion criteria (i.e. sufficient availability of medical records and age …

Predictive Modeling Of Transfusion After Cranial Vault Remodeling For Pediatric Craniosynostosis, Paul Serrato

Yale Medicine Thesis Digital Library

Background: Cranial vault remodeling (CVR) for pediatric craniosynostosis is associated with postoperative blood transfusion, yet determinants of transfusion risk remain incompletely defined. Estimating transfusion risk preoperatively could support more personalized blood management planning for this population.Research Aims: To evaluate whether supervised machine learning models can reliably predict postoperative transfusion risk following CVR compared to traditional logistic regression and to identify the most informative predictors of those models. Hypothesis/Question: We hypothesized that ensemble machine learning approaches (e.g. random forest, extreme gradient boosting) would match or outperform logistic regression in predicting transfusion by leveraging nonlinear associations and higher-order interactions across patient, procedural, …

Disparities In Utilization Of Glp-1 Receptor Agonists And Sglt2 Inhibitors Across Social Determinants Of Health: A Systematic Review And Meta-Analysis, Nisarg Shah

Yale Medicine Thesis Digital Library

Background: SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA) significantly reduce cardiovascular and metabolic risk in type 2 diabetes, cardiovascular disease, and obesity. Yet real-world utilization remains inconsistent, and emerging evidence suggests that social determinants of health (SDOH) may contribute to unequal access and prescribing.Research Aims: The extent and drivers of these disparities have not been systematically characterized, so we conducted a systematic review and meta-analysis to assess whether SDOH—socioeconomic status (SES), insurance status, education, geography, and neighborhood deprivation index (NDI)—and demographic factors—race and sex—are associated with differential utilization of SGLT2i or GLP-1RA. Question: To what extent are SES, insurance …

Association Between Baseline Prostate Mri Pi-Rads And Risk Of Gleason Upgrade During Active Surveillance, Shayan Smani

Yale Medicine Thesis Digital Library

Background: Active surveillance (AS) is the preferred management strategy for men with favorable-risk prostate cancer, aiming to avoid overtreatment while preserving oncologic safety. However, a meaningful proportion of patients experience Gleason Grade Group (GG) upgrading during follow-up, reflecting either biological progression or baseline misclassification. Multiparametric prostate magnetic resonance imaging (MRI), interpreted using the Prostate Imaging–Reporting and Data System (PI-RADS), is well established for detecting clinically significant prostate cancer at diagnosis, yet its prognostic role during AS remains incompletely defined. Specifically, whether baseline PI-RADS scores independently predict the risk of GG upgrading among men managed with AS has not been systematically …

“Treatment Not Tents:" The Medicalization Of Homelessness In California’S 2022-2025 Legislative Agenda, Elana R. Straus

Yale Medicine Thesis Digital Library

Modern homelessness emerged in the 1980s due to political choices that cut the social safety net and decreased the availability of affordable housing. Medicalized views of homelessness that frame homelessness as driven by individual pathology, particularly mental illness and addiction, emerged in research, media, and politics at this time. Homelessness has persisted since and remains particularly high in regions, including California, where the housing markets are most constrained. In this context, California advanced multiple legislative changes between 2022 and 2025 that increased pathways to involuntary treatment and criminal-legal control over people experiencing homelessness. In this thesis, I demonstrate how legislators …

What You See Is What You Learn: National Variation In Emergency Medicine Residency Environments, Carlisle Topping

Yale Medicine Thesis Digital Library

Background: The evolution of Emergency Medicine (EM) residency programs over the past two decades has been marked by significant growth and changes in clinical practice environments. Concerns have emerged regarding whether recently founded programs, non-teaching status programs, and for-profit institutions provide adequate training for EM residents. This study evaluates EM training programs using clinical education outcomes such as clinical volumes, acuity exposure, and board pass rates based on key program characteristics including founding year, teaching status, hospital ownership, and program duration.Methods: We conducted an observational analysis of linked datasets encompassing EM residency data from the Accreditation Counsil for Graduate Medical …

Evaluating Outcomes Of Coronary Revascularization In Solid Organ Transplantation Candidates, Joshua Stephen Vogel

Yale Medicine Thesis Digital Library

BackgroundKidney and liver transplantation significantly improve life expectancy and quality of life in patients with end-stage renal disease (ESRD) or end-stage liver disease (ESLD). Due to the scarcity of organs, transplant centers face high scrutiny of outcomes and employ thorough preoperative evaluation for potential candidates. Patients with ESRD and ESLD often have high comorbidity burdens, including coronary artery disease (CAD), and since transplant is a major surgery, evaluating and reducing cardiac risk is a key component of preoperative evaluation and optimization. However, the role of coronary revascularization in transplant candidates with stable CAD is uncertain, leading to variation in clinical …

Discoid Lupus: Retrospective Analysis Of Epidemiology, Clinical Features, Autoimmunity Profiles, And Treatment Patterns, Aster Workineh

Yale Medicine Thesis Digital Library

Cutaneous lupus erythematosus (CLE) produces lifelong morbidity through visible, functionally consequential skin disease and accrued damage. In discoid lupus erythematosus (DLE), alopecia and dyspigmentation at hair-bearing and cosmetically sensitive sites are frequently cited as major drivers of reduced quality of life1,2. Despite this burden and the risk of progression to systemic lupus erythematosus (SLE), CLE has no FDA-approved therapy, and treatment evidence remains limited by the small number of CLE-specific datasets and trials focused on CLE-trials. Many therapeutic decisions for CLE are extrapolated from SLE despite the fact that CLE subtypes differ in morphology, histopathology, and reported immune signatures3,4. We …

The Strength Of Association Between Surrogate Markers And Clinical Outcomes Used By The Fda For Chronic Disease Indications, Samuel Yoon

Yale Medicine Thesis Digital Library

The U.S. Food and Drug Administration (FDA) has traditionally required the use of clinical outcome measures as clinical trial endpoints to support the approval of new drugs. However, clinical outcome trials are typically large, lengthy, and expensive. To expedite this process, Congress has enacted several regulatory programs to facilitate FDA approval of new drugs on the basis of surrogate markers, endpoints that are reasonably likely to predict clinical benefit, as trial endpoints. However, the evidence demonstrating the validity and reliability is mixed, creating uncertainty for patients and physicians about the true clinical benefits of new drugs approved on the basis …

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 …

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) …

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 …

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 …

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, …

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 …

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 …

A Spatial Transcriptomic Atlas And Cellular Lineage-Based Analysis Of Chondroblastoma, Will Jiang

Yale Medicine Thesis Digital Library

Chondroblastoma is a benign primary bone tumor with controversial cellular origin. Although bearing the name “chondroblastoma”, this musculoskeletal tumor has faced controversy as to whether chondroblasts are chondrocytes. Moreover, its cellular composition can make it difficult to distinguish amongst its mimics including giant cell tumor of bone, chondrosarcoma, and chondromyxoid fibromas.

This thesis aims to characterize the transcriptomic expression atlas of human chondroblastoma to better define the gene expression profile and diagnostic expression markers of chondroblastoma. Secondarily, this thesis aims to identify the lineage progression and cellular composition of chondroblastoma using spatial and temporal patterning analysis.

Histologically confirmed samples of …