Medicine and Health Sciences Commons^™

Comparison Of Cultural Self-Efficacy Between Urban And Rural Nurse Educators, Denise Rene Morris

Walden Dissertations and Doctoral Studies

Integration of an inclusive educational environment requires nursing faculty to embrace a transformational change in academics. The cultural interactions of an educator teaching in an urban district may differ from the relations experienced by a rural nurse educator. The purpose of this quantitative study, guided by Bandura’s social cognitive theory, was to determine whether there is a difference between the cultural self-efficacy scores of nurse faculty teaching in a rural location compared to those in an urban location as well as whether the demographics of age, ethnic background, and years in the nursing profession predict cultural self-efficacy scores. Nursing faculty …

Associations Of Atopic Dermatitis With Neuropsychiatric Comorbidities, Ryan Fan

Yale Medicine Thesis Digital Library

There is incomplete understanding of the association of atopic dermatitis (AD) with neuropsychiatric disorders. This case-control study using the National Institutes of Health All of Us Research Program database aims to evaluate the odds of various neuropsychiatric conditions in patients with AD in a large, diverse cohort of adults in the United States. Comorbidities were compared between cases and controls using statistical hypothesis testing and odds ratios were generated using logistic regression in univariable and multivariable analyses.

In a cohort of 13,433 AD cases with 53,732 matched controls (4:1), patients with AD were more likely to have a diagnosis of …

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 …

The Impact Of Cannabidiol In Patients With Early Psychosis: A Randomized Controlled Trial, Sreeja Kodali

Yale Medicine Thesis Digital Library

We aimed to study the effects of cannabidiol (CBD) in out-patients with early psychosis on clinical metrics of psychosis and cognition and on psychophysiological electroencephalogram (EEG) metrics of psychosis. Adult outpatient subjects with a primary psychotic disorder within approximately five years of psychosis onset were enrolled in a four-week, two-period, randomized, placebo-controlled crossover trial (clinicaltrials.gov NCT02504151). Subjects were randomized in a one-to-one ratio to receive either CBD (oral 800 mg/day) or placebo in the first of two treatment periods in a randomized, double-blind manner. Primary outcome measures assessed were psychosis symptoms measured using the Positive and Negative Syndrome Scale (PANSS); …

Mental Health Service Use Among Immigrant And U.S. Born Asian American Pacific Islanders, Hieronimus Loho

Yale Medicine Thesis Digital Library

Introduction: In the United States, Asian American/Pacific Islander (AAPI) people, and in particular AAPI immigrants, utilize mental health services at consistently lower rates than other ethnic populations, even when adjusting for perceived need or actual diagnoses. Methods: This study used data from the restricted version of the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III) to compare Immigrant AAPIs, U.S. born AAPIs and U.S. born non-Hispanic Whites on mental health service utilization rates as well as examine differences in sociodemographic, behavioral, and psychiatric/substance use disorder (SUD) diagnostic characteristics that may account for these differences. Effect sizes were …

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 …

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 …

Radiomics: A Methodological Guide And Its Applications To Acute Ischemic Stroke, Emily Avery

Yale Medicine Thesis Digital Library

The field of radiomics provides a quantitative approach to medical imaging, wherein a large number of features extracted from medical images are used to detect clinically relevant information that is invisible to the naked eye. This increasingly prevalentmethodology has facilitated improvements in the speed and efficacy of clinical decision-making across specialties. One area where radiomics can make a particular impact is acute stroke imaging. As “time is brain” in acute stroke triage, automated tools for patient evaluation have significant potential to improve outcomes by providing timely, objective data. The present work aimed to create radiomics models from admission CT angiographic …

Young Adults With Adhd And Their Involvement In Online Communities: A Qualitative Study, Callie Marie Ginapp

Yale Medicine Thesis Digital Library

Attention-deficit/hyperactivity disorder (ADHD) is a common condition that frequently persists into adulthood. Yet, diagnostic criteria for ADHD may not fully reflect how the condition presents in adults. Adults with ADHD have unmet needs and have been found to struggle with interpersonal relationships and stigma about their diagnoses. Online communities are frequently used by adults with ADHD and may be an avenue for building relationships and managing symptoms. We aimed to use qualitative methods to better understand the symptomatology of ADHD in young adults, how young adults with ADHD navigate relationships, the perceived impacts of ADHD online communities, and what adults …

Sociodemographic And Insurance Disparities In Urologic Oncology Care Access And Surgical Outcomes, Folawiyo Laditi

Yale Medicine Thesis Digital Library

Background:While there has been much improvement in urologic cancer care, disparities in access and outcomes persist. These disparities can be attributed to several factors, including insurance status, access to quality healthcare, healthcare utilization, and sociodemographic determinants of health such as patient race. Disparities in patient access and surgical outcomes remain important areas of improvement in urologic oncologic outcomes. To develop strategies to improve healthcare access and understand the effects of sociodemographic factors on patient mortality outcomes, we characterized access to new urologic cancer care for patients with Medicaid insurance in the United States and we assessed the incidence and risk …

Comparison Of The Bone Bruise Patterns In Contact And Non-Contact Acute Anterior Cruciate Ligament Injuries, Jay Thomas Moran

Yale Medicine Thesis Digital Library

Background: Bone bruises are commonly seen on magnetic resonance imaging (MRI) in acute anterior cruciate ligament (ACL) injuries and can provide insight into the underlying mechanism of injury. There are limited reports that have compared the bone bruise patterns between contact and non-contact mechanisms of ACL injury.

Purpose: (1) To examine and compare the number and location of bone bruises in contact and non-contact ACL injuries. (2) To test the reliability of our proposed bone bruise mapping scheme.

Study Design: Case-Control Study, Level of Evidence, 3.

Methods: Three hundred twenty patients who underwent ACL reconstruction surgery from 2015 to 2021 …

Diagnosis Of Polycystic Ovary Syndrome And Non-Hispanic Black Race Are Predictive Of Hypertension In Reproductive Age Women -Analysis Of Real World Electronic Medical Record Data, Nyerovwo Okifo

Yale Medicine Thesis Digital Library

Objective: The primary objective was to examine if blood pressure (BP) indices are higher and if the prevalence of hypertension (HTN), indices of metabolic syndrome (MetS) and severe obesity are greater in women diagnosed with polycystic ovary syndrome (PCOS) versus age comparable Controls without PCOS diagnosis. The secondary objective was to examine if Non-Hispanic Black (NHB) race and Hispanic ethnicity were relevant to the relationship between PCOS diagnosis and outcomes. Methods: This was a case-control study based on retrospective analysis of cross-sectional data available in the electronic health record (EHR) of an academic tertiary care health care system. Utilizing ICD-10 …

“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 …

Single-Cell Transcriptomic Atlas Reveals Molecular Drivers Of Human Inner Ear Development, Amar H. Sheth

Yale Medicine Thesis Digital Library

Introduction: Improving the therapeutic landscape for hearing loss necessitates an improved understanding of inner ear biology. Historically, our molecular understanding of inner ear physiology has lagged behind our knowledge of mechanistic understanding of signal transduction due to the rare, diverse, and fragile cell types of the inner ear. However, recent advances in high-throughput sequencing have allowed us to decode the molecular underpinnings of physiologic changes in the murine inner ear. Herein, we single-cell RNA sequence fetal tissue and present a comprehensive atlas of the developing human inner ear. Harnessing newer approaches in computational analysis, we delineate diversity of cell types …

Lipid Profiles Help Explain Protection From Atherosclerosis In Ascending Aortic Aneurysm Patients, Gabe Weininger

Yale Medicine Thesis Digital Library

Multiple indicators including low coronary artery calcium score, low carotid intimal media thickness, and low rates of myocardial infarction have previously suggested that ascending thoracic aortic aneurysm (ATAA) disease is protective against systemic late atherosclerosis. However, the mechanism of this paradoxical, protective effect is still unknown and may provide valuable insights into the fundamental pathophysiology of both ATAAs and atherosclerosis. Our aim was to investigate whether ATAA patient lipoprotein levels may help explain this anti-atherogenic phenomenon. To investigate this research question, we carried out a large case-control study in which we compared lipoprotein levels between 532 matched pairs of isolated …

“Have You Been Vaccinated For Hpv?” - Piloting A Novel Brief Educational Intervention In Otolaryngology Clinics To Improve Patient Knowledge Of Oropharyngeal Cancer And Promote Human Papilloma Virus Vaccination, Samipya Kafle

Yale Medicine Thesis Digital Library

Introduction; The incidence of HPV-associated oropharyngeal squamous cell carcinoma(OPSCC) has increased significantly over the past several decades, however public awareness of HPV’s role in head and neck cancer remains markedly low. There is evidence to suggest that addressing this knowledge gap through patient education initiatives may help increase HPV vaccination rates. To this end, we introduce a brief educational intervention into routine otolaryngology clinic visits to increase patient knowledge of the link between HPV and oropharyngeal cancer, and to encourage HPV vaccination. We aimed to test the feasibility of a simple, in- office intervention and to assess its efficacy in …

The Flame, 2022-2023, Mennonite College Of Nursing

The Flame (1985-present)

The Flame is a newsletter of Illinois State University's Mennonite College of Nursing

Improving Veteran’S Care Outcomes With The Implementation Of Care Coordination, Katrina Ann Canady

Walden Dissertations and Doctoral Studies

AbstractAstute care coordination is essential to eliminating fragmented care, duplication of services, medication errors, and unnecessary emergency rooms visits. This Doctor of Nursing practice project was a quality improvement (QI) initiative that addressed the gap in practice regarding RN care managers who were not consistently performing care coordination as outlined by the office of community care at the project site. The purpose of the project was to evaluate the effectiveness that an educational intervention had on the RN care managers’ abilities to perform care coordination. The care coordination model (CCM) served as the project framework because it provides a systematic …

African American Baby Boomers’ Lived Experiences In Skilled Nursing Facilities For Post-Acute Care Admissions, Dr. Charles A. Fraiser

Walden Dissertations and Doctoral Studies

AbstractPrevious studies have examined the quality of elderly healthcare offered in skilled nursing facilities (SNFs) among older adults, in general, but the studies have not emphasized ex-periences unique to African America baby boomers and the factors they consider when making SNF-related decisions for post-acute care. The purpose of the study was to exam-ine the lived experiences of African American baby boomers who are currently in or have been treated in SNFs for post-acute care to learn about their decisions to select an SNF. Andersen’s behavioral model of health services served as the conceptual framework. A descriptive phenomenological qualitative design was …

Improving Advanced Practice Registered Nursing Knowledge Of Shingles Management, Kyla Gilbert

Walden Dissertations and Doctoral Studies

AbstractShingles is a viral infection that can adversely impact patients if not promptly treated. In the project facility, a gap in practice was identified when a 6-month facility chart review noted a delay in shingles diagnosis 60% of the time. It is important for the Advanced Practice Registered Nursing (APRN) to be knowledgeable regarding diagnoses and best practices for treatment of shingles. However, the local facility had no available education on shingles. The practice-focused question asked whether APRN knowledge of shingles could be improved through staff education. The doctoral project provided shingles education to address the identified knowledge gap. The …

Fall Prevention On The In-Patient Neurological Stroke Unit, Syvol Letwan Middleton

Walden Dissertations and Doctoral Studies

AbstractThe purpose of this quality improvement (QI) evaluation project was to decrease patient falls on a neurological stroke unit. This unit had the most falls throughout the hospital system. The unit averaged 50-60 falls per year with an average of 4.75 falls per month. Guided by Neumann’s system model, the project targeted those patients at the highest risk for falling related to deficits post-stroke and post-neurological disease process. Staff were informed about Last fall, Express needs, Awareness of safety, and Frequency of bowel and bladder (LEAF) to determine if this tool could decrease falls in the neurological stroke population patients. …

Nutrient Pollution And Chlorophyll-A As A Precursor To Harmful Algal Blooms And Cyanotoxins In Rehabilitated Machado Lake, California, Michael E. Shiang

Walden Dissertations and Doctoral Studies

Algal blooms result in the formation of cyanotoxic conditions in a freshwater lake causing severe detrimental impacts to community and public health. Nitrogen, phosphorous, and ammonia stimulate the growth of phytoplankton biomass and algae, as measured by chlorophyll. This retrospective quantitative research study, grounded in the socioecological model, examined the relationship between nutrient pollutants and chlorophyll-a (Chl-a) that forecast harmful algal blooms, a precursor to cyanotoxins. A former impaired lake, Machado Lake in California, provided an ideal setting to assess relationships among nutrient indicators and Chl-a post-lake rehabilitation. Correlation and multiple regression analyses were performed to determine if a relationship …

Nurses’ Experiences With Trauma-Informed Care In Patients With Psychological Trauma, Ade J. Vinton

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic increased the need for research and discussions about trauma, trauma-informed care (TIC), and care delivery processes. Little is known about how nurses recognize, assess, treat, and support patients who experience trauma although knowledge of TIC is important for delivering care to trauma survivors. The purpose of this qualitative descriptive study was to explore nurses’ perceptions of TIC principles and their experiences delivering care to patients with psychological trauma. Harris and Fallot’s TIC theory was used to guide the study. Purposeful sampling was used to recruit ten nurses for individual semi structured interviews using open-ended questions conducted via …

Educating Nurses On Mental Fatigue, Tawanna Ann Canty

Walden Dissertations and Doctoral Studies

Education correlates with nurse performance and avoiding mental fatigue. This project attempted to answer the question, “Educating nurses on mental fatigue will increase knowledge” focusing on educating rehabilitative nurses regarding mental fatigue. The project was guided by the Analysis, Design, Develop, Implement, and Evaluate model. Twenty rehabilitative nurses were administered a pretest consisting of 10 multiple-choice test questions. They received education on mental fatigue through PowerPoint presentations and handouts. After completing the education, participants were administered a posttest with the same 10 questions. An evaluation tool consisting of six questions was completed measuring an increase in knowledge after the posttest. …

Organizational Factors Of Emergency Room Fast-Track Admission Duplicate Data Entry Errors In An Alabama Health System, Shannon Harris

Walden Dissertations and Doctoral Studies

Inaccurate patient information resulting from duplicate record data entry errors can compromise patient safety. Emergency room (ER) visits in the United States have increased by 15% over the last decade, and the increase has prompted hospitals to implement fast-track admissions in the ER to mitigate overcrowding and expedite the admission process for patients with low-acuity symptoms. Although duplicate record data entry errors occur frequently in ER admissions, there is a lack of information about fast-track ER admissions and the predictors of different types of confirmed duplicate record data entry errors. This correlational quantitative study examined the associations between work shift …

Association Between Antidepressant Adherence And Major Depressive Disorder Complications, Philip Lisinge

Walden Dissertations and Doctoral Studies

Despite evidence that antidepressants are more effective at treating major depressive disorder (MDD) symptoms, there is growing evidence that MDD management is still hampered by nonadherence to antidepressant treatment regimens. Researchers have suggested that MDD, if untreated, might lead to MDD-related complications, but other researchers have argued that adherence to antidepressants can lead to these same MDD-related complications. This quantitative cross-sectional study used primary data collected from 298 volunteers to examine the association between MDD-related complications and antidepressant adherence to clarify these diverging opinions. The study’s objective was to provide evidence to accept or reject the premise that antidepressant adherence …

Impact Of An Outpatient Chronic Care Model On Uninsured Inpatient And Emergency Department Utilization, Jamie L. Judd

Walden Dissertations and Doctoral Studies

Healthcare systems incur significant uncompensated costs due to uninsured chronic disease patients’ overutilization of urgent and emergent emergency care. This study was important because there was very little literature addressing the impact of the chronic care model (CCM) on reducing uncompensated healthcare system costs regarding patients with chronic disease. The purpose of the study was to investigate whether the Healthy Education Lifestyles Program (HELP) was of any significance to healthcare system’s cost of uninsured chronic disease patients. The theoretical foundation for the study was the CCM espoused by Wagner and colleagues. The research questions were to determine significant differences in …

Generalized Anxiety Disorder Symptoms Stratified By Age In Primary Care, Robin E. Mccoy

Walden Dissertations and Doctoral Studies

Little is known as to the age-related presentation of somatic complaints of those diagnosed with generalized anxiety disorder in primary care settings. A retrospective medical records review sought to identify the affective symptoms of generalized anxiety disorder (GAD) by age as recorded by primary care providers and to test the association of these symptoms by age. Guided by Engle’s (1977) biopsychosocial (BPS) model, a large administrative claim database system was used to derive a sample of 1,336, including 500 patients diagnosed with generalized anxiety disorder between 2018 to 2021. Binary logistics regression, one-way ANOVA, chi-square, correlation, and logistical regression with …

A Quantitative Study On Molecular Cluster Detection In Virally Suppressed Communities, Mariska Belinda Osborne-Wells

Walden Dissertations and Doctoral Studies

Viral suppression within human immunodeficiency virus (HIV) care and treatment planning is the gold standard of care for most providers when engaging with their patients. In many settings, the patient has received a positive lab that is indicative of HIV antibodies being detected; this in turn means they need additional medical attention to manage the infection. Upon receiving linkage to care services and attending an initial appointment, an initial genetic sequence is usually completed to assess the patient’s strain of HIV and how antiretroviral medications may antagonize or complement the HIV strain. It is possible that access, bias, and colorism …