Medicine and Health Sciences Commons^™

Chewing Gum And Saliva Substitute For The Treatment Of Thirst In Heart Failure: A Crossover Trial, Alison Robb

Yale School of Medicine Physician Associate Program Theses

No abstract provided.

Provider Training On Positional Maneuvers To Diagnose And Treat Benign Paroxysmal Positional Vertigo, John D’Agata

Yale School of Medicine Physician Associate Program Theses

Dizziness and vertigo presentations comprise 2.5 percent of all emergency department visits, with benign paroxysmal positional vertigo being the most common type of vertigo in adults over the age of fifty. The Dix-Hallpike test and Canalith Repositioning Procedure are simple bedside maneuvers to effectively diagnose and treat this type of vertigo; however, many providers are uncomfortable or lack experience performing these maneuvers. We aim to compare the effectiveness of two different teaching strategies to improve the clinical skills of emergency department providers on these maneuvers. We will randomly assign 100 emergency medicine providers to either didactic or a combination of …

Meditation Interventions In Subjects With Amnestic Mild Cognitive Impairment, Emily K. Richards

Yale School of Medicine Physician Associate Program Theses

The prodromal stage of Alzheimer’s Disease, amnestic mild cognitive impairment, is characterized by subjective and objective memory impairment beginning with episodic memory. Few treatments have been identified to effectively slow disease progression to dementia. Meditation is an emerging novel treatment to improve deficits in subjects with these progressive cognitive impairments. Meditation and other novel treatments are critical for prolonging patients’ independence, reducing caregiver burden, and healthcare costs. This study will examine the effectiveness of an eight-week intervention using two meditation methods and two control groups on cognition and mood in participants with amnestic mild cognitive impairment. The primary outcome is …

Effect Of Peritoneal Dialysis On Weight Change In Pediatric Patients, Lindsey Belliveau

Yale School of Medicine Physician Associate Program Theses

Obesity is associated with lower transplantation rate and higher mortality in pediatric end stage renal disease patients. Glucose-based peritoneal dialysis is the preferred method of dialysis for these patients, a therapy that can cause systemic glucose absorption. It is unknown whether this absorption leads to weight change in pediatric patients. We propose to examine whether Peritoneal Dialysis is associated with weight change in pediatric End Stage Renal Disease patients. We will prospectively observe a cohort of children aged 2-17 who are starting peritoneal dialysis. We will measure weight change after one year of dialysis, and compare these measurements to historical …

Iron Intake In Children With Attention-Deficit/Hyperactivity Disorder And Restless Legs Syndrome, Olivia Rojas

Yale School of Medicine Physician Associate Program Theses

Growing evidence supports an association between attention-deficit/hyperactivity disorder (ADHD) and restless legs syndrome (RLS) in children. Prior research suggests that in some patients iron deficiency is an underlying cause of pathological changes in the dopaminergic system of the brain that modulates these disorders. However, the underlying cause of such iron deficiency has not yet been identified. We propose to determine the prevalence of low serum ferritin levels, a marker of reduced iron stores, in children with comorbid ADHD and RLS, and if diet is associated with their diagnosis and observed blood iron levels. A case-control study will examine a sample …

Transitioning Of Hiv-Infected Children From Pediatric To Adult Care: A Jamaican Case Study, Flavia De Souza

Yale Medicine Thesis Digital Library

Successful public access to antiretroviral therapy in resource-limited settings (RLS) has resulted in survival of HIV perinatally infected children into adulthood. There are few studies on transition of care in RLS, where 90% of HIV-infected children reside. We aimed to characterize the current landscape of the transfer process of HIV-infected adolescents in one such RLS, Jamaica. We conducted in-depth interviews of 18 HIV-infected adolescents in pediatric care and 21 health care providers. We analyzed the data using the grounded theory approach. Five themes emerged: 1. Pediatric clinics were like families who provided care-taking and developmental support in addition to HIV …

Retrospective Assessment Of Treatment With T-Dm1 After Pertuzumab In Her2-Positive Metastatic Breast Cancer, Hannah Elizabeth Dzimitrowicz

Yale Medicine Thesis Digital Library

T-DM1/ ado-trastuzumab emtansine, the most recent addition to the HER2-targeted therapies approved to treat HER2-positive metastatic breast cancer (MBC), is an antibody-drug conjugate with a favorable side effect profile. T-DM1 is currently approved for patients with HER2-positive MBC who previously received trastuzumab and a taxane. Since the trial resulting in T-DM1 approval was conducted, the standard first-line therapy for metastatic HER2-positive breast cancer has changed from trastuzumab and a taxane to a three-drug combination of trastuzumab and a taxane plus pertuzumab. Due to the timing of these approvals, there is no clinical trial or observational data on the activity of …

Assessment Of Specific T-Cell Receptor Engagement Without Necessity For Identification Of The Relevant Antigen, Harib Hassan Ezaldein

Yale Medicine Thesis Digital Library

Individual cancers, even of the same cell type, express unique arrays of distinctive tumor antigens, requiring accurate laboratory measurement of induced immunity against them problematic. Fluorescently tagged reagents (dextramers) that selectively engage clonal T-cell receptors (TCR) can cytofluorographically quantify both frequency and avidity antigen-specific T-cells, but cannot be synthesized without prior identification of the relevant antigen. Since clinically evident tumors may contain as many as 300 unique point mutations capable of generating a large number of uniquely antigenic proteins, and since procurement of such information for each cancer is currently unrealistic, it is presently only possible to assess responses to …

Identification Of Novel Therapeutic Small-Molecule Inhibitors Of Dna Double-Stranded Break Repair, Vikram Jairam

Yale Medicine Thesis Digital Library

Mammalian cells mainly utilize two DNA repair pathways to repair double stranded breaks (DSB): homologous recombination (HR) and non-homologous end joining (NHEJ). While HR utilizes homologous DNA sequences as a template for repair, NHEJ processes and re-ligates the ends of the breaks. NHEJ is further sub-divided into a DNA-PK-dependent canonical pathway, and alternative pathways, which are more mutagenic. These pathways are essential for cell survival after ionizing radiation, and thus have become important therapeutic targets for radiosensitization. Our group recently performed multiple high-throughput small molecule screens for novel DSB repair inhibitors. These studies identified numerous selective NHEJ and HR inhibitors, …

Ethical Challenges In Student Global Health Research Projects, Katherine Rebecca Standish

Yale Medicine Thesis Digital Library

U.S. students are participating in global health electives and research in low- and middle-income countries (LMIC) in increasing numbers, yet the significant ethical challenges they face have not been well documented. We conducted a mixed methods study of graduate, health professional and undergraduate students at a research-focused university about their experiences conducting global health research activities, focusing on ethical challenges and support for addressing those challenges. An online, structured questionnaire was completed by 123 participants, and in-depth, semi-structured interviews were conducted with 17 participants and analyzed using the constant comparison method. Among questionnaire respondents, 31% reported a significant or moderate …

Emergency Medical Services Utilization And Interventions By Paramedics During A Blizzard, Shalom Sokolow

Yale Medicine Thesis Digital Library

EMERGENCY MEDICAL SERVICES UTLIZATION AND INTERVENTIONS BY PARAMEDICS DURING A BLIZZARD.

Shalom Sokolow (Sponsored by Sandy Bogucki). Department of Emergency Medicine, Yale University, School of Medicine, New Haven, CT.

On February 8th, 2013, southern Connecticut was struck by a powerful blizzard. Emergency Medical Services (EMS) crews experienced significantly increased call volume along with increased response and transport times. This study examined which types of EMS calls increased or decreased during the storm and whether paramedics performed more or fewer advanced life support (ALS) interventions.

EMS calls were differentiated by call type and analyzed to determine which types increased or decreased …

Creation Of Novel Inducible Cell Line To Study Alveolar Rhabdomyosarcoma, Kaoru Takasaki

Yale Medicine Thesis Digital Library

CREATION OF NOVEL INDUCIBLE CELL LINE TO STUDY ALVEOLAR RHABDOMYOSARCOMA. Kaoru Takasaki, Ranjini K. Sundaram, Ranjit S. Bindra. Departments of Therapeutic Radiology and of Pathology, Yale University, School of Medicine, New Haven, CT.

Rhabdomyosarcoma (RMS) is a group of relatively rare mesenchymal malignancies classically associated with skeletal muscle and most frequently seen in the pediatric population. While chemotherapy, radiation, and surgical resection can confer long-term event-free survival rates of up to 85-95%, the prognosis for alveolar rhabdomyosarcoma (ARMS), particularly those positive for either the t(2;13) PAX3-FOXO1 or t(1;13) PAX7- FOXO1 translocation, is significantly worse. As such, the development of therapies …

Student Perspectives On Interprofessional Education: Implications For Curriculum Development, Jacob Alan Weatherly

Yale Medicine Thesis Digital Library

Background

The Yale Schools of Medicine and Nursing and the Yale Physician Associate (PA) Program are collaborating to implement an interprofessional curriculum. Although healthcare organizations have called for interprofessional education (IPE), such initiatives have been difficult to implement. Per the Kern framework of curriculum development, design and implementation is likely to be more successful if a needs assessment is done as the first step.

Objective

To better understand healthcare professional students’ perspectives about IPE as part of a needs assessment for developing an IPE curriculum.

Methods

Because little is known about stakeholder perceptions of IPE, we used a qualitative, content …

Effects Of Race, Socioeconomic Factors On Emergency Management Of Threatened And Early Pregnancy Loss, Connie Yu Heng Cheng

Yale Medicine Thesis Digital Library

Our study aims to determine the effects of race, insurance, and hospital characteristics on the management of threatened abortion and early pregnancy loss. In this retrospective cohort study using the National Hospital Ambulatory Medical Care Survey, patient record files from 2002-2010 with diagnoses of threatened abortion, hemorrhage in pregnancy, or incomplete, inevitable, or unspecified spontaneous abortion were examined using logistic regression. Primary outcomes were rates of admission and active management, defined as surgical termination or use of abortifacients misoprostol or Cytotec. Covariates included race/ethnicity, age, insurance, and hospital location, ownership, and metropolitan status.

Of 5,882,623 ED visits for threatened abortion …

Insulin Dependence Heralds Adverse Events After Hip And Knee Arthroplasty, Matthew Webb

Yale Medicine Thesis Digital Library

ABSTRACT

Background – Total hip arthroplasty (THA) is one of the most frequently performed orthopaedic procedures. As the prevalence of diabetes mellitus (DM) continues to increase the burden of its sequelae and associated surgical complications have also increased. For these reasons, it is important to understand the associations between DM and the rates of perioperative adverse events in patients with DM who will undergo THA.

Methods – The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database records perioperative adverse events as well as patient factors including demographics and comorbidities. Patients who underwent THA between 2005 and …

Clinical Conditions And Cardiac Function: Correlations With Left Atrial Fibrosis By Mri In Subjects With And Without Atrial Fibrillation, Karl Grunseich

Yale Medicine Thesis Digital Library

The purpose of this study was to evaluate the clinical conditions and cardiac functions associated with left atrial (LA) fibrosis by late gadolinium enhancement (LGE). LA LGE has been found to be associated with various measures of cardiac functions, procedural outcomes, and adverse events in patients who already have atrial fibrillation (AF). Assessment of LA fibrosis by LGE in patients without AF has largely been unexamined and comparison of these patients to those with AF could prove useful. This study was a retrospective chart and imaging review of 137 consecutive subjects imaged with a 3D LGE sequence at one institution …

Modified Extracorporeal Photopheresis As An Immunotherapy In Murine Melanoma, Aaron Nathaniel Vassall

Yale Medicine Thesis Digital Library

Extracorporeal Photochemotherapy (ECP) is a widely used immunotherapy for cutaneous T cell lymphoma, as well as an immunomodulatory treatment for graft versus host disease (GVHD) and rejection of allografts. We hypothesized that ECP’s physiologic induction of large-scale monocyte-to-dendritic antigen presenting cell (APC) conversion is mechanistically responsible for both its anti-cancer effect and its tolerogenic impact in the transplant setting. To interrogate this possibility in an experimental system, we developed an ECP device that is scalable from mouse to man and tested its capacity to produce APCs that, when advantageously tuned and tumor antigen-loaded, can limit the growth of otherwise lethal …