Medicine and Health Sciences Commons^™

Incorporating Genomic Analysis In The Clinical Practice Of Hepatology, David Hun Chung

Yale Medicine Thesis Digital Library

In the past two decades, whole-exome sequencing has been successfully demonstrated as an indispensable instrument in uncovering the genetic etiology underlying numerous types of unexplained liver disease. Characterization of these illnesses into distinct molecular disease entities has revolutionized understanding of pathophysiology and has translated into improved guidance on management, treatment and prognosis for patients. However, hepatologists have been slow to welcome the technology into their mainstream clinical practice, largely due to inadequate training in genomic medicine. There thus remains a pressing need to create various forums through which clinicians can gain better appreciation for the value of genetic analysis in …

Surgical Outcomes Following Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis, Wyatt Benajmin David

Yale Medicine Thesis Digital Library

Surgical Outcomes Following Posterior Spinal Fusion for Adolescent Idiopathic ScoliosisWyatt B. David and Michael DiLuna. Section of Pediatric Neurosurgery, Department of Neurosurgery, Yale University, School of Medicine, New Haven, CT. Hospital size has previously been shown to impact outcomes in adult spine surgery. However, there is a paucity of studies assessing the impact of hospital size on outcomes in adolescent spine surgery. Furthermore, gender-based differences have been suggested in disease progression and outcomes of adolescent idiopathic scoliosis (AIS), though only a few studies have investigated these disparities. The aim of this study was to determine the impact of hospital size …

International Academic Partnerships In Orthopaedic Surgery, Michael Jesse Flores

Yale Medicine Thesis Digital Library

Abstract: INTERNATIONAL ACADEMIC PARTNERSHIPS IN ORTHOPAEDIC SURGERY. Michael J. Flores. Department of Orthopaedics & Rehabilitation, Yale University, School of Medicine, New Haven, CT.

Introduction: Orthopaedic-related disease (ORD) is one of the leading health challenges faced worldwide and is a significant cause of global morbidity and mortality, especially in low- and middle-income countries (LMICs). In recent years, international orthopaedic outreach to address the global burden of ORD has received greater attention due to initiatives such as the Lancet Commission on Global Surgery (LCGS). Many strategies have been considered to address the global burden of ORD, most commonly though volunteer trips by …

Incarcerated Patients Have Higher Mortality After Trauma: An Unreported Healthcare Disparity, Harry Newmanplotnick

Yale Medicine Thesis Digital Library

While the U.S. has the highest incarceration rate in the world, at nearly 1% of the adult population, or over 2 million people, insight regarding health disparities in this population remains limited, particularly for traumatic injuries and surgical care. Our aims with this paper were two-fold. First, we sought to perform the largest national database analysis of criminal-justice system involved (CJI) trauma patients (specifically incarcerated patients). Second, we planned to investigate if incarceration status was associated with differences in a variety of outcomes after trauma for U.S. adults.To accomplish these aims we analyzed data from the National Trauma Data Bank …

Almajiri Health; A Scoping Review On Disease, Health Literacy And Space For Participatory Research, Muzzammil Imran Muhammad

Yale Medicine Thesis Digital Library

Introduction

Almajirai are male children who leave the care of their parents to learn the Qur’an and study Islam under the tutelage of a Mallam or Imam at a Tsangaya. Almajiranci refers to the system of education based on this relationship between almajiri and mallam, and which was the dominant mode of education in precolonial Hausaland – Northern Nigeria and Southern Niger. This system remains widespread and popular in both countries. In recent years, discourse around almajirai has featured prominently in media from and about this region, and has associated almajiranci with non-participation in formal education, abuse, poverty, and underdevelopment. …

More Than Meets The Eye: Improving Recognition Of Child Abuse In Emergency Departments, May Shum

Yale Medicine Thesis Digital Library

Background: Child abuse guidelines exist to help emergency department (ED) providers evaluate injured children for suspected child abuse. Little is known about the impact of these guidelines on provider decision-making in pediatric (PED) and community EDs (CEDs). Objective: To evaluate the impact of a child abuse guideline in pediatric and community EDs through three primary studies: 1. To examine guideline adherence and the appropriateness of decision-making by CED providers. 2. To determine the impact of the guideline on differences in evaluations of infants for abuse between a PED and three CEDs. 3. To implement and assess the use of a …

The Association Between Social Needs Care Coordination And Social Needs Status Amongst Patients In A Federally Qualified Health Center, Autumn Nobles

Yale Medicine Thesis Digital Library

Social needs screenings within healthcare systems have grown more common with increasing discourse around the contribution of systemic determinants to health outcomes. These screenings have been used to describe the prevalence of social needs within communities but have not been evaluated for the impact that they and the interventions to which they are attached may have on health outcomes. Here we evaluate social needs screenings and their potential impact on patient health at a federally qualified health center in New Haven, Connecticut. We describe the baseline needs at the facility, evaluate change in reported social needs among patients undergoing screening, …

Understanding Perceptions Of New-Onset Type 1 Diabetes Education In A Pediatric Tertiary Care Center, Gabriel Betancurvelez

Yale Medicine Thesis Digital Library

Background: Youth newly diagnosed with type 1 diabetes (T1D), and their families, require intensive education on the management of this chronic condition during this overwhelming period. Traditionally, our center conducts training in person during a hospital admission.

Methods: We studied family perceptions of our current patient education methods in an effort to elucidate strategies to augment education in the post-pandemic environment, where provider time in the room and visitation rules may limit face-to-face encounters.

Results: 25 families completed the survey (distributed to 156 in total, with approximately 21% response rate). The mean age at diagnosis was 9.52 ± 4.29 years …

Factors Influencing Decision For Contralateral Prophylactic Mastectomy Versus Unilateral Mastectomy, Julian Huang

Yale Medicine Thesis Digital Library

Background: Rates of contralateral prophylactic mastectomy (CPM) are increasing despite falling rates of contralateral breast cancer and controversy over survival benefit of the procedure. We investigated why and how patients choose to undergo CPM, with focus on the roles of financial burden, decision-making resources, and active participation in decision-making.

Methods:Female unilateral breast cancer patients older than 18 years old who had undergone mastectomy (with or without CPM) coming in to the Yale Breast Center for a follow-up or post-operative visit between June and August 2017 were approached with an opportunity to participate in this survey study. Chart review was completed …

Family Dyads, Emotional Labor, And The Theater Of The Clinical Encounter: Co-Constructive Patient Simulation As A Reflective Tool In Child And Adolescent Psychiatry Training, Isaiah Thomas

Yale Medicine Thesis Digital Library

Patient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric medicine and child psychiatry is rare and generally does not reflect the child-caregiver dyad or the longitudinal aspects of this care and does not provide learners an opportunity to engage with and reflect on these dynamics. We organized a series of 7 observed patient simulation sessions with a cohort of 7 senior child and adolescent psychiatry fellows as an educational opportunity. In these sessions, we utilized the previously described co-constructive patient simulation …

"Come On. I Need An Answer." A Mixed-Methods Study Of Barriers And Disparities In Diagnostic Odysseys, Zeyu Tang

Yale Medicine Thesis Digital Library

Background: The boom of next generation DNA sequencing over the past decade has improved our ability to provide accurate genetic diagnoses for children with previously undiagnosed diseases, in turn leading to important advances in management and prognostication. Even given this progress, two areas of ongoing need are the accurate definition of further novel genetic diseases and to make genetic expertise and diagnostics widely available to children and families who have frequently endured grueling diagnostic odysseys. The Pediatric Genomics Discovery Program (PGDP) at Yale is an advanced genomics program focusing on both these areas, enrolling over 700 patients since its inception …

“I Was Reaching Out For Help And They Did Not Help Me”: Mental Healthcare In The Carceral State, Anna Grace Preston

Yale Medicine Thesis Digital Library

Background: Despite the limitations the carceral environment may impose on mental wellness, mental healthcare is increasingly becoming a carceral endeavor. Over the course of the last several decades, prisons and jails have become the de facto mental healthcare provider for thousands of incarcerated individuals. Furthermore, practices like mandated mental healthcare for supervised individuals further broaden the population experiencing mental healthcare within the criminal legal system at large. This study examines the perspectives of nine individuals who experienced mental healthcare within the carceral state, whether in prison or on parole or probation, with a special focus on how attributes of the …