Digital Commons Network^™

Corporate Practice Of Medicine Evasion By Private Equity Firms, Peter A. Stokes

Student Works

No abstract provided.

Let’S Negotiate: Analyzing The Impact The Inflation Reduction Act’S Drug Price Negotiation Program May Have On The Pharmaceutical Industry, Kristen Liu

Student Works

No abstract provided.

War Courts: Fdr, National Security, And The War On Terrorism, Harvey Gee

Dickinson Law Review (2017-Present)

No abstract provided.

Therapeutic Roles For Alkaline Phosphatases To Target Intestinal Dysfunction In Mouse Models Of Experimental Sepsis And Ischemic Stroke, Rhiannon V. Macom

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Therapeutic Roles for Alkaline Phosphatases to Target Intestinal Dysfunction in Mouse Models of Experimental Sepsis and Ischemic Stroke

Rhiannon V. Macom

Stroke is a disease that primarily affects the brain; however, ongoing research continues to show that stroke has far reaching systemic effects that can affect both short- and long-term recovery. The gastrointestinal tract has been shown to be affected post-stroke, and these effects are likely due to the bidirectional communication between the gut and the brain via the gut-brain-axis. Alkaline phosphatases (APs) are common membrane bound enzymes that are known to have a role in mitigating inflammation. The …

“The Culture - I Wish It Were Less Intense And More Joyful And Full Of Life”: A Youth Participatory Action Study On Teen Mental Health And Wellness, Marna Wolak

Doctoral Dissertations

Studies indicate that a grave mental health crisis is disproportionately impacting female-identified youth. While school districts have made attempts to address this problem, those most impacted - young people - have frequently found their voices overlooked by adults seeking solutions. Therefore, this Youth Participatory Action Research (YPAR) study, grounded in humanizing and liberatory pedagogy, examines how high school-aged students in an urban school district understand and define their experiences with mental health challenges and suggest strategies and interventions for improved wellness. Two sets of research questions guide this study: 1) Primary questions: What are youth perspectives about how their mental …

“What We Say Matters”: Reducing Drug Use Stigmatization By Healthcare Professionals Through A Narrative-Based Awareness Campaign, Adam M. Traugott

DNP Projects

Background: Stigma towards substance use has been identified as a contributor to poor care and health outcomes amongst people who use drugs (PWUD), a vulnerable population. Healthcare worker stigma negatively affects the outcomes of individual patients and may have greater public health implications. Methods of addressing drug-use stigma have previously been implemented in a variety of clinical settings. Presenting the lived experience of PWUD to healthcare workers via emotionally compelling narratives has been found to be an effective means of stigma reduction.

Purpose: This study utilized two psychometrically validated tools to measure (1) the baseline prevalence of drug use stigma …

Recognizing And Responding To Moral Distress: Using Transformational Leadership To Increase Nurse Leader Thriving, Miriam Dowling-Schmitt

DNP Scholarly Projects

Background: Moral distress, burnout, and compassion fatigue in acute care nurses has increased significantly since the Covid-19 pandemic and has been associated with high levels of nursing turnover and increased costs to healthcare systems. Nurse leaders at the study organization had never received education on recognizing and responding to moral distress. Nursing engagement scores were low at the study organization in the areas of leadership support and well-being investment in nurses.

Problem Description: Between 2017 and 2021 job satisfaction for nurses with direct patient care responsibilities decreased in 20 of 21 categories according to the Bureau of Health Workforce. High …

Improving The Reporting And Tracking Of Hospital-Acquired Pressure Injuries, Melinda Rosado

Yale School of Nursing Digital Theses

Hospital-acquired pressure injuries (HAPIs) affect millions of patients a year, impacting patient safety and creating a significant financial burden for healthcare systems. Inadequate reporting and tracking of HAPIs lead to delays in care, inaccurate data reporting and missed opportunities for quality improvement. This is in large part due to a lack of training and education around HAPIs, poor communication of injuries during hand-off and a lack of system integration. A process improvement program to improve the reporting and tracking accuracy of HAPIs was piloted on two post-surgical units in a large urban cancer center. This initiative combined comprehensive training via …

Grief On The Margins: The Death Of A Family Member To Substance Use, Adair Shaw

Theses and Dissertations (Comprehensive)

Despite Canada's high death rates from substance use, there is limited research on the sociopsychological impact on families, who often face stigma and disenfranchised grief. This study explores how family members make meaning of a substance-related death. Through qualitative inquiry, eleven family members were interviewed on their experience of grief from substance death. The imprint of losing a family member to mental illness and substance use is fraught with intergenerational grief, ambiguity, prolonged mental-emotional distress, and relationship challenges. Substance death was also associated with stigma, social withdrawal, and shame for many participants. However, grievers reconstructed the socially prescribed negative perceptions …

Opioid Use Among Rural Medicare Beneficiaries, Yvonne Jonk Phd, Heidi O'Connor, Karen Pearson Mlis, Ma, Zachariah Croll Mph, Deborah Thayer, John Gale Ms

All Maine Rural Health Research Center Publications

Nationally, approximately 30% of Medicare Part D benefi-ciaries (13.4 million) had at least one opioid prescription in 2018, with over 350,000 beneficiaries receiving high dosages ≥120 morphine milligram equivalents (MME) /day.1 The CDC recommends avoiding dosages ≥90 MME/day.2 In 2019, state rates of Part D beneficiaries receiving opioid prescriptions have been as high as 42% (e.g., Ala-bama).1 Data from the 2015-2016 Medical Expenditure Panel Survey indicate that adults aged 65 and older living in rural areas were more likely than their urban counter-parts to obtain four or more opioid prescriptions during the year (11.1% versus 6.2%).

Informal Caregivers Connecting On The Web: Content Analysis Of Posts On Discussion Forums, Michelle L. Foster, Chinenye Egwuonwu, Erin Vernon, Mohammad Alarifi, M. Courtney Hughes

Faculty Articles, Papers, and Other Scholarship

Background: About 53 million adults in the United States offer informal care to family and friends with disease or disability. Such care has an estimated economic value of US $600 million. Most informal caregivers are not paid nor trained in caregiving, with many experiencing higher-than-average levels of stress and depression and lower levels of physical health. Some informal caregivers participate in web-based forums related to their caregiving role.

Objective: This study aimed to explore how informal caregivers use easy-to-access caregiving web-based forums, including the types of information they share and seek from others. It also aimed to gain insights into …

"You Sure Feel Like You're Alone, Kind Of Flailing Away Out There": Family Caregiver Perspectives Of Caring For An Individual With Glioblastoma Multiforme, Christy Muasher-Kerwin, Abby Baumbach, Yujun Liu, M. Courtney Hughes

Faculty Articles, Papers, and Other Scholarship

Objectives

Glioblastoma multiforme (GBM) is the most common and aggressive form of brain cancer. Family caregivers of individuals with GBM must navigate a wide range of their care recipients’ physical, cognitive, and psychosocial deficits to provide effective care, which is both mentally and physically demanding. This study aimed to investigate the perspectives of family caregivers of GBM patients about the barriers and challenges they encounter when providing care to their care recipients. Methods

Nineteen current and former family caregivers for individuals with GBM participated in semi-structured interviews from October 2023 through January 2024. We conducted interviews virtually and used applied …

Hnsc 3314 Human Encounters With Death And Bereavement, Tracy Wong

Open Educational Resources

Individual and societal attitudes concerning death and life. How attitudes about death influence the quality of life and health in the West. Impact of technology on the care of the dying. Medical concerns in the treatment of the terminally ill. The bereavement process. Holistic impact of death and bereavement.

Increasing Serious Illness Conversations In Patients At High Risk Of One-Year Mortality Using Improvement Science: A Quality Improvement Study, Kanishk D. Sharma, Sandip A. Godambe, Prachi P. Chavan, Agatha Parks-Savage, Marissa Galicia-Castillo

Department of Family and Community Medicine Faculty Publications

Background: Serious illness conversation (SIC) in an important skillset for clinicians. A review of mortality meetings from an urban academic hospital highlighted the need for early engagement in SICs and advance care planning (ACP) to align medical treatments with patient-centered outcomes. The aim of this study was to increase SICs and their documentation in patients with low one-year survival probability identified by updated Charlson Comorbidity Index (CCI) scores. Methods: This was a quality improvement study with data collected pre- and post-intervention at a large urban level one trauma center in Virginia, which also serves as a primary teaching hospital to …

Canine-Assisted Spiritual Care Handbook: Integrating Facility Dogs Into Professional Chaplaincy Practice, Ann M. Snowberger

Doctor of Ministry

This project's researcher finds that Spiritual Care Facility Dog Teams (dog handlers and their dogs) lack resources and practical guides to advance Canine-Assisted Spiritual Care (CA-SC) in healthcare and facility settings. The Canine-Assisted Spiritual Care Handbook offers a comprehensive guide for establishing and sustaining CA-SC programs. It promotes standardized terminology, ethical practices, and interdisciplinary collaboration. By featuring practical tools, case studies, and training plans, the handbook supports the professional development of chaplains. Its holistic framework enhances spiritual, emotional, and physical wellness, while emphasizing the well-being of both handlers and their working dogs. The handbook’s focus on program sustainability and real-world …

Family Perceptions Of End-Of-Life Care For Terminally Ill Individuals In The Intensive Care Unit, Yunju Kim

Honors Undergraduate Theses

The Intensive Care Unit (ICU) provides specialized care for critically ill individuals, but despite aggressive treatments, the risk of mortality remains high. Transitioning from life-saving interventions to end-of-life care (EoLC) can be emotionally challenging for families and the healthcare team. Fear of EoLC can lead to a continuation of futile treatments, leading to ethical conflicts, emotional distress, and unnecessary suffering. The primary purpose of this literature review is to explore incongruencies in family expectations for EoLC in terminally ill individuals in the ICU in the transition of care from life-saving measures to EoLC. The secondary purpose of this literature review …

Improving Safe And Effective Management Of Pain At Home, Alayna V. Olivarez

Honors Undergraduate Theses

Pain is the most common clinical symptom in individuals with a cancer diagnosis. Additionally, home is the preferred place for cancer care which introduces numerous challenges for cancer pain management. The primary purpose of this literature review is to identify support interventions to enhance pain control, prevent exacerbations in pain, and optimize quality of life in individuals with cancer transitioning from the acute care setting to home. The secondary purpose of this review is to analyze patient-specific barriers influencing self-efficacy of pain management and overall health outcomes in the target population. A systematic literature search was conducted using CINAHL, EBSCOhost, …

Songwriting In Music Therapy Clinical Practice, Kinneret Rivka Weiss

Senior Honors Theses and Projects

Songwriting is a technique used in music therapy practice that has been documented since 1950, and has been used in a clinical setting in many countries where music therapy is a fully developed profession. There are many different types of therapeutic songwriting experiences used in music therapy practice, to accommodate for the many different needs and abilities of clients. Additionally, therapeutic songwriting is used to help achieve many goals, and is used in a wide variety of settings. These settings include the pediatric hospital, a setting given particular attention in this paper. This paper will also include the author’s own …

In The Wake Of Change, Kelly Nichole Clair

Senior Honors Theses and Projects

My senior project, In the Wake of Change, is a creative work which I choreographed and presented at the American College Dance Association, the EMU Undergraduate Research Symposium, and the EMU Dance Program student concert, “Crossroads.” The goal for this work was to present my explorations with choreographic methods such as repetition, movement based off the letters of words, and matching musical phrases with movement phrases, on as many stages as possible. I will dive into detail regarding my process, choices, and the piece’s narrative. I will describe the choreography process of the piece and the symbolism behind certain sections, …

Proximity To Cancer Rehabilitation And Exercise Oncology By Geography, Race, And Socioeconomic Status, Kathryn H. Schmitz, Kathryn Demanelis, Mary E. Crisafio, Mary A. Kennedy, Anna L. Schwartz, Anna Campbell, Jessica Gorzelitz, Kelley C. Wood, Christopher M. Wilson, Raymond L. Scalise, Alex Vincent

Research outputs 2022 to 2026

Background: Cancer rehabilitation and exercise oncology (CR/EO) have documented benefits for people living with and beyond cancer. The authors examined proximity to CR/EO programs across the United States with respect to population density, race and ethnicity, socioeconomic status, and cancer incidence and mortality rates.

Methods: This cross-sectional study was conducted in 2022–2023. Online searches were initiated to identify CR/EO programs. Geocoding was used to obtain latitudinal and longitudinal geospatial coordinates. Demographic data were abstracted from the 2020 5-year American Community Survey. Cancer incidence and mortality data were obtained from the Centers for Disease Control and Prevention. US 2013 Rural-Urban Continuum …

Prognostic Value Of Neutrophil-To-Lymphocyte Ratio, Platelet-To-Lymphocyte Ratio, And Lactate Dehydrogenase Level In Melanoma Patients Treated With Immune Checkpoint Inhibitors, Wynne Wijaya, Muhammad Adnan Khattak, Afaf Abed, Tarek Meniawy, Michael Millward, Elin Gray, Oliver Oey

Research outputs 2022 to 2026

Introduction: Metastatic melanoma carries a poor prognosis. Immune checkpoint inhibitors (ICIs) have improved outcomes, but responses remain variable, highlighting the need for simple prognostic biomarkers. Inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lactate dehydrogenase (LDH) reflect tumour burden and inflammation, though their clinical utility is unstandardised. Methods: We retrospectively analysed 103 metastatic melanoma patients treated with anti-PD-1 monotherapy at two centres in Western Australia (2014–2020). Baseline NLR, PLR, and LDH were assessed within 30 days pre-treatment. Outcomes included clinical benefit, progression-free survival (PFS), and overall survival (OS). Results: Poor ECOG performance status (PS ≥2) (RR 2.39, …

Frailty Indices In Patients Undergoing Functional Neurosurgical Procedures: A Systematic Review, Carmelo Venero Jr., Joanna M. Roy, Nirbha Ghurye, Akshay Warrier, Muhammad Usman Khalid, Niels Pacheco-Barrios, Farhan A. Mirza, Christian A. Bowers

Neurosurgery Faculty Publications

Introduction: Functional neurosurgery covers a wide array of neurological disorders with an equally vast array of treatment modalities, including neuromodulation, decompressive, and ablative therapies for disparate pathologies such as pain, neuromodulation, disconnection, and refractory epilepsy. One of the most common functional treatments is deep brain stimulation for movement disorders and select psychiatric diseases. Functional neurosurgery treats patients with reduced quality of life from pathological neuronal pathways. Optimal patient selection by preoperatively identifying high-risk patients is critical for avoiding as many operative complications as possible, in addition to managing complications better once they occur. Frailty indices have demonstrated superior discrimination in …

Death, End-Of-Life Doulas, And Art:
Exploring Connections Between Death Competency And Art Making, Jill K. Hoefgen

Art Therapy | Master's Theses

Death in the United States is often viewed as a medical event rather than the natural course of life, which results in avoidance of planning for the inevitable. The emergence of Hospice in the 1970s, Medical Aid in Dying (MAID) laws in several states, and the positive death movement have demonstrated a shift in attitudes and priorities about death and dying. Since the early 2000s, end of life doulas (EOLDs) have emerged as practitioners who help people plan for and transition to death. Emotional and existential coping skills are components that emerge from death work, and these elements can be …

A Parting Repast, Debra D. Dowden-Crockett

Theses and Dissertations

Both the thesis document and exhibition comprise the story of my journey through grief, examination of loss, contemplation of death, and transformation through acceptance and relinquishment. I conflate art and emotion to put form to the complex human experience of watching a loved one die, having to say a last goodbye, and the mourning that ultimately follows.

I examine the rituals surrounding death, the role of memory, and the symbolic presence of food as a shared experience of both mourning and nourishment, the intimate moments of mourning, and the gradual process of finding peace and closure.

Featuring works from a …

Age And Saving Lives In Crisis Standards Of Care: A Multicenter Cohort Study Of Triage Score Prognostic Accuracy, Michael Hermsen, Patrick G. Lyons, Govind Persad, Alice F. Bewley, Chengsheng Mao, Kaveri Chhikara, Anoop Mayampurath, Matthew Churpek, Monica E. Peek, Yuan Luo, William F. Parker

Publications

No abstract provided.

Facilitators, Barriers, And Strategies For Supporting Shared Decision-Making With People With Intellectual Disability: A West Australian Primary Healthcare Professional Perspective, Kathryn Teale, Abigail Lewis, Rachel Skoss

Research outputs 2022 to 2026

Background: Shared decision-making between patients and primary healthcare professionals positively impacts health outcomes. However, people with intellectual disability face additional barriers and require supported shared decision-making (SSDM) to participate. Little is known about how healthcare professionals use SSDM with this population. This paper explores the facilitators and barriers experienced, and strategies/resources employed by healthcare professionals working with people with intellectual disability. Method: Ten purposively sampled primary healthcare professionals participated in semi-structured interviews. This descriptive qualitative study used content analysis. Findings were compared with a proposed model of factors influencing triadic (the person with intellectual disability, their caregiver and the healthcare …

The Perspectives Of Provisionally Registered Psychologists On Voluntary Assisted Dying In Australia: An In-Depth Qualitative Investigation, Ker-Ni Vivienne Heng, Eyal Gringart

Research outputs 2022 to 2026

In Australia, voluntary assisted dying (VAD) is now widely legalised, and VAD uptake is on the rise. Thus, the demand for psychological support in the context of VAD is expected to grow. Despite their relevant expertise, psychologists remain underrepresented in end-of-life (EOL) literature and practice. The current in-depth qualitative study examined the perspectives of 20 provisionally registered psychologists in Australia on VAD, using reflexive thematic analysis grounded in social constructionism. Four main themes (‘Values’, ‘Fit-for-Role’, ‘Exposure’, and ‘Contributions’) and 14 sub-themes were generated from the data. Participants supported availing VAD for terminally ill patients and expressed the potential for its …

Advancing Person-Centred Care Through Palliative Care Wa’S Acp Workshops: The Longer-Term Impact, Gertrude G. Phiri, Emma Gunner, Philip Bafile, Davina Porock

Research outputs 2022 to 2026

Planning for end-of-life and associated decision-making is one of global significance as it impacts the quality of care in palliative care settings, including ensuring that personal preferences are honoured. It is a priority for the Australian health system to use Advance Care Planning (ACP) as it is an effective tool for individuals and their families to make their personal preferences known and implemented. The aim of this project was to evaluate the longer-term impact of the Palliative Care Western Australia (PCWA) ACP workshops. Semi-structured, open-ended questions were used to collect data from 21 participants. Reflexive thematic analysis was used to …

Clinical Predictors Of Fluid-Responsive Acute Kidney Injury, Cindy Khanh Nguyen

Yale Medicine Thesis Digital Library

CLINICAL PREDICTORS OF FLUID-RESPONSIVE ACUTE KIDNEY INJURY

Cindy Khanh Nguyen, Abinet M. Aklilu, Yu Yamamoto, Bashar A. Kadhim, Claudia Coronel-Moreno, Francis P. Wilson. Section of Nephrology, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT.

Specific Aims: We aimed to explore and identify common clinical variables that may be helpful in selecting patients who will benefit from volume challenge when the fluid-responsiveness of AKI is unclear.

Methods: Our study is a retrospective secondary analysis of a clinical trial that prospectively enrolled adult patients at Yale-New Haven Hospital with AKI defined by the 2012 Kidney Disease: Improving Global …

Visions Of Durango, Suleman Saleem

English Honors Papers

No abstract provided.