Medicine and Health Sciences Commons^™

Prevalence Of Metabolic Comorbidities And Viral Infections In Monoclonal Gammopathy, Mansen Yu

Yale Medicine Thesis Digital Library

Monoclonal gammopathy (MG) encompasses a spectrum of related diseases, with monoclonal gammopathy of undetermined significance (MGUS) being the most prevalent, serving as a precursor of smoldering and clinical multiple myeloma. While the association between gammopathies, metabolic conditions and antigenic stimulation has long been recognized, the precise mechanism remains unclear. Prior research has shown that a subset of MGUS and MM is driven by chronic antigenic stimulation of B cells by endogenous lipids and exogenous microbial antigens. The aim of this study is to assess the prevalence of metabolic comorbidities and viral infections in a large population with monoclonal gammopathy, providing …

Racial Disparities In Behavioral Crisis Care: Investigating Restraint Patterns In Emergency Departments, Erika Chang-Sing

Yale Medicine Thesis Digital Library

AbstractImportance: Black patients were more likely than White patients to be brought to the hospital by police, and they were also more likely to be restrained and sedated during behavioral crises in emergency departments (EDs). Although the perils of policing mental health conditions for Black individuals are recognized, it is unclear whether or to what extent police transport mediates the relationship between Black race and physical restraint use in emergency departments. Hispanic/Latino patients were less likely than White patients to be restrained in Emergency departments but more likely to be brought to the hospital by police. They were also less …

Preoperative Psychosocial Risk Burden Among Patients Undergoing Major Thoracic And Abdominal Surgery, Emily Park

Yale Medicine Thesis Digital Library

Objective: Patient-related, biological risk factors such as age, diabetes, and smoking are associated with worse outcomes and increased postoperative complications rates in patients. However, not much is known about the effects of psychosocial risk factors on surgical outcomes. This study aimed to characterize the psychosocial risk burden in patients undergoing major surgery for malignant and benign conditions. Methods: A prospective, comprehensive psychosocial risk assessment of adult patients undergoing major thoracic or abdominal surgery within the Yale New Haven Health system was conducted from July 2023 to December 2023. The study was delivered over telephone, and was comprised of validated survey …

Scares: A Clinician Guide To Spinal Cord Awareness, Response, And Emergency Support Creation And Implantation Of Scares Protocol Among Hospitalist Advanced Practice Providers, Brittany Biega

DNP Scholarly Projects

While they are more common in patients with oncological disease and trauma, SCE still exist among patients without these comorbidities. Less has been established regarding care protocols in this population. The absence of standardized procedures has been linked to preventable, adverse patient outcomes, including cases of permanent damage due to delayed treatment. This project employs Lean Six Sigma methodologies and Johns Hopkins Evidence- Based Practice to devise a robust SCE protocol, aimed at standardizing care and improving patient outcomes. A multidisciplinary team including general medicine, neurology, neurosurgery, and neuroradiology developed “Spinal Emergency Management Guidelines” protocol, which was implemented within the …

The Impact Of Multidisciplinary Just-In-Time Training On Confidence In The Delivery Of Care In The Humanitarian And Disaster Response Environment, Jennifer Verstreken

DNP Scholarly Projects

Background: Team Rubicon International deploys emergency medical teams with little targeted training on the health and illness patterns common to the geographic region and the type of disasters to which they respond, such as cholera, malaria, and malnutrition. These high-risk, low-incidence illnesses are infrequently seen in Western medical practices. Medical, nursing, and paramedical training programs address these illness patterns in the curriculum. Still, a lack of consistent exposure to the care and treatment of patients with these illnesses can lead to a lack of knowledge and confidence in delivering appropriate care.

Purpose: This quality improvement project aimed to determine if …

Assessing Barriers And Facilitators To School Nurse Recommendations Of Human Papillomavirus Vaccination, Amy E. Dark

DNP Scholarly Projects

Background Vaccine hesitancy among students and caregivers is a pervasive challenge for educational leadership and school health staff, leaving the school community at risk for vaccine preventable disease. The human papillomavirus (HPV) vaccine is an underutilized primary prevention strategy against six HPV related cancers.

Purpose The purpose of this quality improvement (QI) project was to measure the effect of an evidence-based educational intervention and facilitated role play on the knowledge and confidence of school nurses (SNs) when discussing HPV vaccination.

Methods This QI project was performed using a brief educational presentation with facilitated role play and a pre/post survey design. …

Implementation Of An Electronic New Patient Intake Questionnaire (E-Npiq) In A Child Development Clinic: A Quality Improvement Project, Wilma Hyde

DNP Scholarly Projects

BACKGROUND: A rural academic medical center child development clinic in New Hampshire experienced high volumes and inefficient workflows, causing delays in care. With a referral rate at 5-fold capacity, the need to create an efficient intake process that allowed for triage and data collection was apparent.

PURPOSE: Institute an integrated electronic new patient intake questionnaire (e-NPIQ) to improve work efficiency.

METHODS: A literature review on barriers and enablers for patient uptake of electronic questionnaires guided best practices for workflow redesign. The project instituted an integrated e-NPIQ while simultaneously creating a standardized new patient intake process. A mixed methods approach analyzed …

Sharksrx Newsletter Spring 2024, Nova Southeastern University

NSU Sharks Rx

No abstract provided.

Association Between Fine Particulate Matter And Eczema: A Cross-Sectional Study Of The All Of Us Research Program And The Center For Air, Climate, And Energy Solutions, Gloria Chen

Yale Medicine Thesis Digital Library

A chronic inflammatory skin disease characterized by disruption of the epidermal barrier, eczema has increased in prevalence in tandem with industrialization. Ambient air pollution is a ubiquitous exposure resulting from industrial processes that includes fine particulate matter with aerodynamic diameter measuring less than 2.5 µm (PM2.5). Studies on the potential association between PM2.5 and eczema have produced conflicting results. The objective of this study was to determine the risk of eczema with exposure to PM2.5 in a diverse national cohort of American adults.

In this cross-sectional study, eczema cases were identified via electronic health records (EHR) in the All of …

Healthcare Expenditure On Atrial Fibrillation In The United States: The Medical Expenditure Panel Survey 2016-2021, Claudia See

Yale Medicine Thesis Digital Library

Introduction: Atrial fibrillation (AF) is the most common cardiac arrythmia affecting up to 6 million people in the United States (US). With an aging population and increased detection through self-monitoring devices, AF prevalence will substantially rise in the future. AF often co-exists with other comorbidities and is associated with significant morbidity and healthcare costs. AF management has also been evolving with increased use of anti-arrhythmics, newer anticoagulants, and procedures to maintain sinus rhythm. In this backdrop, our study aims to provide a contemporary national assessment of AF costs using the Medical Expenditure Panel Survey (MEPS), the largest all-payer nationally representative …

Reproductive Risk Factors For Stroke, Haylee Canadas

Student Research Design & Innovation Symposium

Polycystic ovary syndrome (PCOS) and endometriosis are common chronic reproductive disorders occurring in reproductive aged women. Some studies have suggested that these conditions are potential risk factors for certain chronic diseases, such as stroke. However, the literature on this issue is minimal, and available information is outdated. This project proposes a study exploring the association between PCOS, endometriosis, and stroke.

Association Of Race, Ethnicity, And Gender To Disparities In Functional Recovery And Social Health After Major Lower Limb Amputation: A Cross-Sectional Pilot Study, Sheila M. Clemens, Kiarri N. Kershaw, Zoran Bursac, Szu Ping Lee

Physical Therapy Faculty Publications

Objective: To assess if evidence of disparities exists in functional recovery and social health post-lower limb amputation.

Design: Race-ethnicity, gender, and income-based group comparisons of functioning and social health in a convenience sample of lower limb prosthetic users.

Setting: Prosthetic clinics in 4 states.

Participants: A geographically diverse cohort of 56 English and Spanish speaking community-dwelling individuals with dysvascular lower limb amputation, between 18-80 years old.

Interventions: None.

Main Outcomes Measures: Primary outcomes included 2 physical performance measures, the Timed Up and Go test and 2-minute walk test, and thirdly, the Prosthetic Limb Users Survey of Mobility. The PROMIS Ability …

Erratum: Toward Standardization, Harmonization, And Integration Of Social Determinants Of Health Data: A Texas Clinical And Translational Science Award Institutions Collaboration - Corrigendum, Catherine K Craven, Linda Highfield, Mujeeb Basit, Elmer V Bernstam, Byeong Yeob Choi, Robert L Ferrer, Jonathan A Gelfond, Sandi L Pruitt, Vaishnavi Kannan, Paula K Shireman, Heidi Spratt, Kayla J Torres Morales, Chen-Pin Wang, Zhan Wang, Meredith N Zozus, Edward C Sankary, Susanne Schmidt

Faculty, Staff and Student Publications

This corrects the article "Toward standardization, harmonization, and integration of social determinants of health data: A Texas Clinical and Translational Science Award institutions collaboration" in volume 8, e17.

Predicting Endothelium-Dependent Diastolic Function (Fmd)And Its Correlation With The Degree Of Coronary Artery Disease (Cad) And Plaque Vulnerability For Cardiovascular Events, Guangming Zhang, Jing Yang, Hanghang Xing, Hongning Yin, Guoqing Gu

Faculty, Staff and Student Publications

OBJECTIVE: This study aims to investigate the correlation between vascular endothelium-dependent diastolic function (FMD) and the degree of coronary artery disease (CAD), plaque vulnerability, and its predictive value for cardiovascular events.

METHODS: Initially, patients (n=100) who were admitted from January 2020 to January 2021 and intended to undergo percutaneous coronary intervention (PCI) were selected. Further, FMD in all patients was determined before the procedure and divided into a high-FMD group (≥4.2%) and a low-FMD group (

RESULTS: No significant differences were observed concerning general information, number of coronary arteries-associated branches, lesion type, involvement of the left main stem (LM), the …

Implementing A Nurse-Driven Protocol To Reduce Routine Gastric Residual Monitoring: A Quality Improvement Project, Alondra N. Abreu Carlo

Master's Theses and Capstones

The American Society for Enteral and Parenteral Nutrition (ASPEN) and the Society for Critical Care Medicine (SCCM) updated the Adult Patient Enteral Nutrition Guidelines in 2016. These updates included discontinuing routine gastric residual monitoring due to its contribution to poor patient outcomes and mentioning the lack of evidence proving its relevance to gastric motility. Per ASPEN and SCCM, best practice suggests monitoring patients for intolerance symptoms and then checking gastric residual volume (GRV) if symptoms are present. If the GRV is greater than 500ml and intolerance symptoms are present, the recommendation is to perform further assessment, potentially leading to stopping …

Educational Interventions To Improve Icu Nurses’ Knowledge And Confidence Related To Pressure Injuries: A Quality Improvement Initiative, Benjamin R. Maltais

Master's Theses and Capstones

Background: The prevalence of pressure injuries (PI) in critical care is highest amongst inpatient units, and are associated with significant complications, decreased quality of life, increased cost of hospitalization, and poor patient care (Agency for Healthcare Research and Quality, 2019; Cox et al., 2022; Gorecki et al., 2014; Mervis & Phillips, 2019). Similarly, many PI are considered to be avoidable (Pittman et al., 2019). Despite an increase in focus on PI awareness and prevention, there still remains a challenge for patients in critical care units. In addition, research has indicated that nurses’ lack of basic knowledge of PI (risk assessment, …

Having The Opportunity To Give Kids A Smile, Alianna Mbanda

A with Honors Projects

The author describes their experience working as a dental hygienist for the Parkland community event called Give Kids a Smile.

Preserving Oral Health, Khrystyna Vyprynyuk, Renata Budny

Publications and Research

No abstract provided.

Restorative Materials And Maintenance Protocols, Renata Budny, Khrystyna Vyprynyuk

Publications and Research

No abstract provided.

Giving People The Words To Say No Leads Them To Feel Freer To Say Yes, Rachel Schlund, Roseanna Sommers, Vanessa K. Bohns

Articles

We examine how to structure requests to help people feel they can say no (or yes) more voluntarily. Specifically, we examine the effect of having the requester provide the request-target with an explicit phrase they can use to decline requests. Part of the difficulty of saying no is finding the words to do so when put on the spot. Providing individuals with an explicit script they can use to decline a request may help override implicit scripts and norms of politeness that generally dictate compliance. This should make individuals feel more comfortable refusing requests and make agreement feel more voluntary. …

Locating Liability For Medical Ai, W. Nicholson Price Ii, I. Glenn Cohen

Articles

When medical AI systems fail, who should be responsible, and how? We argue that various features of medical AI complicate the application of existing tort doctrines and render them ineffective at creating incentives for the safe and effective use of medical AI. In addition to complexity and opacity, the problem of contextual bias, where medical AI systems vary substantially in performance from place to place, hampers traditional doctrines. We suggest instead the application of enterprise liability to hospitals—making them broadly liable for negligent injuries occurring within the hospital system—with an important caveat: hospitals must have access to the information needed …

Use Of Artificial Intelligence In Drug Development, Louise C. Druedahl, Nicholson Price, Timo Minssen, Dipl Jur, Ameet Sarpatwari

Articles

Considerable focus has been placed on the health care applications of artificial intelligence (AI). Already, machine learning, a subset of AI that involves “the use of data and algorithms to imitate the way that humans learn” has been used to predict diseases, while AI-powered smartphone apps have been developed to promote mental health and weight loss. Owing in part to such successes, the market for AI in health care has been forecasted to increase more than 1000% between 2022 and 2029, from $13.8 billion to $164.1 billion. One area of substantial promise is drug development, which is poised to benefit …

Mechanistic Insight Into Maternal Electronic Cigarette Exposure And Its Effect On Offspring Cerebrovascular And Neurocognitive Health, Amber Victoria Mills

Graduate Theses, Dissertations, and Problem Reports (ETD)

Electronic cigarettes (Ecigs) have replaced smoking within the last decade as the preferred nicotine delivery system because of their advertising to the younger populations. Marketing has sold the idea that use of Ecigs are safer than smoking and this messaging has resonated with youth and other vulnerable populations such as pregnant women. Despite over 2.8 million children under 18 (Annual National Youth Tobacco Survey) deciding to vape, there is little information about what this will do to the next generation. Further, it is that same population that will soon reach an age when they will want to have children. There …

Implementing Best Practice Methods Of Endotracheal Tube Cuff Inflation In The Operating Room, Katherine Zeiger Brown

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Use of manometers, inflating the endotracheal tube (ETT) cuff with a 5-mL syringe, displaying the pressure-volume loop (PV-L) on anesthesia machines, and auscultating with a stethoscope over the trachea have been shown effective in preventing ETT cuff overinflation in the operating room (OR). Purpose: The aims of this project were to implement and evaluate a best practice guideline for ETT cuff inflation in the OR. Methods: This project was conducted in several ORs at J.W. Ruby Memorial Hospital, in Morgantown, West Virginia. Participants included anesthesiologists, certified registered nurse anesthetists (CRNAs), student registered nurse anesthetists, residents, and medics. The ETT …

Regulation Of Diabetic Cardiomyopathy Through Mitochondrial Import Of Long Non-Coding Rnas, Andrew Dodge Taylor

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: The leading cause of mortality in patients with diabetes mellitus is heart failure. When mitochondrial health and function is disrupted, cardiac contractile function is compromised. Therefore, understanding mitochondrial regulation may benefit predicting and countering diabetic cardiomyopathy. MicroRNAs (miRNAs) play a crucial role in diabetic cardiac mitochondrial protein expression. Long noncoding RNAs (lncRNAs) have been shown to regulate miRNAs, but not in the mitochondrion. Additionally, it has yet to be confirmed if lncRNAs utilize the same mechanisms for mitochondrial import that miRNAs use, or if lncRNA presence in the mitochondrion fluctuates in diabetic mitochondria like miRNA presence does. The …

Analysis Of Macular Pigment Carotenoids In Human Blood Serum Of Glaucoma Patients As A Measure Of Ocular Health: A Raman Spectroscopic Study., Joy Udensi, Ekaterina Loskutova, James Loughman, Hugh J. Byrne

Datasets

Carotenoids are a major component of the human diet and have been widely studied for their antioxidant, and vision protection roles in the human body, and dietary supplementation is promoted in particular for ocular health. An initial trial (European Nutrition in Glaucoma Management (ENIGMA)), which assessed macular pigment optical density (MPOD) as well as ocular structural, functional and perceptual parameters before and after the 18-month supplementation of glaucoma patients with macular pigment (MP) carotenoids (lutein, zeaxanthin, meso-zeaxanthin), confirmed supplementation significantly improved the clinical ocular health of participants. Blood contains all major dietary carotenoids, presenting it as a suitable and efficient …

Chatting For Change: Insights Into And Directions For Using Online Peer Support Groups To Interrupt Prolonged Workplace Sitting, Ekaterina Uetova, Lucy Hederman, Dympna O'Sullivan, Robert J. Ross, Marily Oppezzo

Conference papers

Prolonged sedentary behavior and insufficient physical activity increase the risk for non-communicable diseases. Online peer support groups, driven by the widespread use of mobile phones and social media, have gained popularity among people seeking health condition management advice. This position paper examines the role of online peer support groups within a behaviour change intervention, MOV’D (Move Often eVery Day), which promotes physical activity and reduces sedentary behavior in the workplace. We conducted a thematic analysis of post-study interviews from two randomized control trials to identify the benefits and limitations of online peer support groups and provide recommendations for improvement. We …

Quantitative Raman Analysis Of Human Blood Serum Of Glaucoma Patients Supplemented With Macular Pigment Carotenoids., Joy Udensi, Ekaterina Loskutova, James Loughman, Hugh J. Byrne

Datasets

Carotenoids have been widely studied for their high dietary, antioxidant, and vision protection roles in the human body. Blood contains all major dietary carotenoids and hence presents as a suitable and efficient substrate for the estimation of dietary carotenoids in vivo. Following the 18-month supplementation of open angle glaucoma patients with macula pigment carotenoids (Lutein, Zeaxanthin and Meso-Zeaxanthin) in the European Nutrition in Glaucoma Management (ENIGMA) trial, Raman spectroscopic analysis of the pre-supplementation baseline and 18-month supplemented blood serum carotenoids from participants was carried out, to investigate the systemic impact of supplementation in the blood and explore a more direct …

Chemical Synthesis Of Sensitive Dna, Komal Chillar

Dissertations, Master's Theses and Master's Reports

Over the past decades, researchers have tried various chemical methods to synthesize modified oligodeoxynucleotides (ODNs, i.e. short segments of DNAs). Traditional ODN synthesis methods require strong basic, and nucleophilic conditions for the deprotection and cleavage of the ODN from the solid support. However, the sensitive ODNs containing labile functionalities are vulnerable to such harsh conditions. Sensitive ODNs have a wide range of applications in research and pharmaceuticals. To synthesize sensitive ODNs, researchers devised different strategies but no practical methods have been developed. To overcome these challenges, we developed alkyl Dim alkyl Dmoc technology. This innovative technology uses weakly basic and …

Stigma And Efficacy Beliefs Regarding Opioid Use Disorder Treatment And Naloxone In Communities Participating In The Healing Communities Study Intervention, Nicky Lewis, Barry Eggleston, Redonna K. Chandler, Dawn Goddard-Eckrich, Jamie E. Luster, Dacia Beard, Emma Rodgers, Rouba A. Chahine, Philip M. Westgate, Shoshana N. Benjamin, Janae Holloway, Thomas Clarke, R. Craig Lefebvre, Michael D. Stein, Donald W. Helme, Jennifer Reynolds, Sharon L. Walsh, Darcy Freedman, Nabila El-Bassel, Kara Stephens, Anita Silwal, Michelle R. Lofwall, Janet E. Childerhose, Hilary L. Surratt, Brooke N. Crockett, Amy L. Farmer, James L. David, Laura Fanucchi, Judy Harness, Ben Wilburn, Kelli Bursey, Kristin Mattson, Sarah Mann, Rebecca D. Jackson, Aimee Shadwick, Katherine Calver, Deborah Chassler, Jennifer Kimball, Nancy Regan, Jeffrey H. Samet, Rachel Sword-Cruz, Michael D. Slater

Biostatistics Faculty Publications

Background The HEALing Communities Study (HCS) included health campaigns as part of a community-engaged intervention to reduce opioid-related overdose deaths in 67 highly impacted communities across Kentucky, Massachusetts, New York, and Ohio. Five campaigns were developed with community input to provide information on opioid use disorder (OUD) and overdose prevention, reduce stigma, and build demand for evidence-based practices (EBPs). An evaluation examined the recognition of campaign messages about naloxone and whether stigma and efficacy beliefs regarding OUD treatment and naloxone changed in HCS intervention communities.

Methods Data were collected through surveys offered on Facebook/Instagram to members of communities participating in …