Medicine and Health Sciences Commons^™

Engaging Patients With Dementia In The Acute Care Setting: A Quality Improvement Initiative For Staff, Andrea Lee

DNP Scholarly Projects

Caring for dementia patients in the acute care setting can be challenging. Staff is trained to manage the acute illness and the symptoms of dementia can impact that care. Training for the care and management of the patient with dementia is not routinely provided for the acute care setting. According to the Alzheimer’s Association (2018), 5.7 million people are living with Alzheimer’s Dementia with the numbers projected to continue to rise. Training in the management of symptoms can alleviate stress and complications for not only the patient but staff members as well. The goal of this project is to educate …

An Empirical Pilot Study Examining The Relationship Between Intention To Participate In Food Security Efforts And Childhood Socioeconomic Status Among Conference Attendees, Liana Dixon

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Hunger is a global public health issue and finding a solution is a priority for the United Nations. The United Nations Sustainable Development Goal 2.2 calls for ending hunger, achieving food security, improving nutrition, and promoting sustainable agriculture for all people by 2030. The Universities Fighting World Hunger (UFWH) Summit, originating with the United Nation’s originated World Food Programme (WFP) and Auburn University, convenes attendees annually to share their own knowledge and ideas about how to “fight hunger,” as well as benefit from others knowledge and ideas. An important factor in tackling hunger and achieving health is addressing poverty and …

Monitoring Opioid Use In Cancer Survivors: Implementation Of Screening, Brief Intervention, And Referral To Treatment (Sbirt) In A Clinical Setting, Jennifer M. Dolly Prothro

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Kentucky is a disparate state, ranking as one of the top states in incidence, prevalence, and mortality for both opioid use disorders (OUD) and cancer. Due to the high volume of both diseases in the state, there is a rising concern about the overlap of these two populations. Cancer and its’ treatment are known to cause chronic pain, defined as daily pain lasting 3 months or longer. Generally, chronic pain patients of any type are known to experience higher rates of opioid misuse (21-28%) and opioid dependence (8-12%) than the general population (4.1%, 0.9% respectively). The risk of OUD must …

Implementing Centeringpregnancy, A Group Prenatal Care Model, In Hamilton County, Ohio, Morgan Avery

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Target Population and Need

Hamilton County, Ohio exhibits high rates of poverty, unemployment, and negative health outcomes. Specifically, Hamilton County continues to perform poorly in maternal and child health outcomes such as infant mortality, low birth weight, gestational diabetes, and preterm birth rates. Many people in the community exbibit poor health behaviors such as inadequate prenatal care, drug use during pregnancy, and smoking during pregnancy.

Program Approach

The Hamilton County Health Department intends to implement an evidence based group prenatal care program, CenteringPregnancy, in three health centers around Hamilton County in an effort to reduce poor maternal and child health …

An Ecological Approach To Understanding Lethal Violence In The Us Using Stream Analogy, Jacqueline Seals

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

ABSTRACT OF CAPSTONE

Background: Lethal violence, homicides and suicides, is a growing issue in the US. Historically homicides and suicides have been studied separately, but with stream analogy of lethal violence homicides and suicides are both currents of lethal violence, just branching in opposite directions. The purpose of this study is to understand which county-level factors increase risk of lethal violence.

Methods: This ecological study combined open-source datasets to create one dataset of socioeconomic risk factors of lethal violence. Counties with 10 or more lethal violent deaths were included (n=2751). Negative Binomial models examined the relationship between risk factors and …

Decreased Risk Of Colorectal Cancer Among Patients With Type 2 Diabetes Receiving Chinese Herbal Medicine: A Population-Based Cohort Study, Jing-Siang Jhang, Hanoch Livneh, Shu-Yi Yang, Hui-Ju Huang, Michael W. Y. Chan, Ming-Chi Lu, Chia-Chou Yeh, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Objectives Patients with type 2 diabetes have a higher risk of colorectal cancer (CRC), but whether Chinese herbal medicines (CHMs) can reduce this risk is unknown. This study investigated the effect that CHMs have on CRC risk in patients with type 2 diabetes. Research design and methods This cohort study used the Taiwanese National Health Insurance Research Database to identify 54 744 patients, newly diagnosed with type 2 diabetes, aged 20–70 years, who were receiving treatment between 1998 and 2007. From this sample, we randomly selected 14 940 CHMs users and 14 940 non-CHMs users, using propensity scores matching. All …

Predictors Of Kidney Transplant Receipt And Medicare Costs For Patients, Parisa Asgarisabet

Dissertations and Theses (Open Access)

Background: The objectives of this study were to first understand whether a dialysis center’s ownership status modified the association between informing end-stage renal disease (ESRD) patients about transplantation options and patients’ transplantation status; and second, to understand whether Medicare’s Prospective Payment System (PPS) implementation affected the cost of care for ESRD patients from Medicare’s perspective.

Method: This study used the United States Renal Data System (USRDS) data containing information on all ESRD patients in the US, linked to Medicare claims. To address the first objective, a multi-level analysis using mixed effect multinomial logistic regression model was conducted with …

The Role Of Neural Precursor Cell Expressed Developmentally Down-Regulated Protein 9 In Enhanced Aggressiveness Of Hexavalent Chromium Transformed Bronchial Epithelial Cells, Peter Van Wie

Theses and Dissertations--Toxicology and Cancer Biology

Hexavalent chromium (Cr(VI)) is classified as a confirmed human carcinogen by the International Agency for Research and Cancer (IARC) and by the U.S. Environmental Protection Agency (EPA). Chronic exposure to (Cr(VI)) causes malignant cell transformation in human bronchial epithelial BEAS-2B cells. These Cr(VI)-transformed cells exhibit a highly aggressive phenotype including increased migration, invasion, and angiogenesis. The Cas family protein neuronal precursor developmentally down regulated protein 9 (NEDD9/Cas-L/HEF1) was dramatically overexpressed in Cr(VI)-transformed cells compared to normal BEAS-2B cells. Knockdown of NEDD9 by its shRNA reduced migration and invasion in vitro measured by migration and invasion assays. shNEDD9 reduced tumor formation …

Public Health Implications Of Early Marriage, Prachi Joshi, Bettye Apenteng, Tilicia Mayo-Gamble

Eagles Talking About the Public’s Health

No abstract provided.

Applying The Socio-Ecological Model To Improving Maternal Mental Health In Georgia, Kim Harris, Janet Choongo, Joanne Chopak-Foss

Eagles Talking About the Public’s Health

No abstract provided.

Feasibility Of Long Acting Pre-Exposure Prophylaxis (Prep) In Rural Communities, William Mase, Ellie Purdy

Eagles Talking About the Public’s Health

No abstract provided.

Strategies Health Care Leaders Use To Implement Strategic Change Initiatives Successfully, Sophia F. Brown

Walden Dissertations and Doctoral Studies

Health care organizations lose a significant competitive edge when leaders fail to align strategic change initiatives with necessary operational activities. Health care leaders who struggle to maintain a competitive edge are at high risk for failure. Pettigrew and Whipp's content, process, and context strategic change management and Hoshin Kanri (HK) program deployment models constituted the composite conceptual framework for this study. The purpose of this qualitative multiple case study was to explore strategies health care leaders use to implement strategic change initiatives successfully. The participants comprised of 4 strategic change leaders from 2 health care organizations in Manhattan, New York, …

Contraception And Sexual Health Counseling In Adolescent And Young Adult Female Cancer Patients, Sarah Hadassah Abelman

Yale Medicine Thesis Digital Library

Introduction:

Adolescent and young adult women undergoing cancer treatment face unique reproductive health risks. The objectives of this study were to assess the prevalence of sexual health counseling and contraception use in the oncology setting, and to identify factors associated with these outcomes.

Methods:

After institutional review board approval, a retrospective chart review was conducted of female patients ages 15-25 receiving cancer treatment at Yale New Haven Hospital from 2013-2018. Univariate and multivariate analyses were used to assess the relationship between patient variables and the outcomes of counseling and contraception use. Additionally, with institutional review board approval, a cross-sectional survey …

Characterization Of The Macular Choriocapillaris In Dry Age-Related Macular Degeneration Using Swept-Source Optical Coherence Tomography Angiography, Phillip X. Braun

Yale Medicine Thesis Digital Library

The purpose of this study was to characterize further, using swept-source (SS-) optical coherence tomography angiography (OCTA), the relationship between dry age-related macular degeneration (AMD) and the macular choriocapillaris (CC), which may have pathophysiologic and therapeutic implications. It included (1) a topographic analysis to determine if there is a significant relationship between dry AMD stage and macular CC perfusion, and (2) an investigation of the predictive value of macular CC perfusion with respect to geographic atrophy (GA) growth rate.

Study design was retrospective and cross-sectional. A database of 6x6 mm fovea-centered swept-source OCTA images of the CC from eyes with …

Natural History Of Thoracic Aortic Aneurysm Associated With Bicuspid Aortic Valve, Thais Faggion Vinholo

Yale Medicine Thesis Digital Library

Hypothesis: Thoracic aortic aneurysm (TAA) is a silent but virulent disease. Bicuspid aortic valve (BAV) is the most common congenital heart disease. The association between BAV and ascending TAA (ATAA) is well described. However, the guidelines for surgical management to treat patients with thoracic aortic aneurysms associated with bicuspid aortic valve (ATAA-BAV) remains controversial. We hypothesized that the surgical management of patients with ATAA-BAV should not differ from the management of those who have ATAA with a trileaflet aortic valve (TAV). Additionally, we suspected that BAVs that are free of stenosis and regurgitation can be spared in the setting of …

Aging With Hiv: Biomarkers Of Inflammation And Incident Rheumatologic Disease, Jennifer Leslie Simon Hanberg

Yale Medicine Thesis Digital Library

Chronic Human Immunodeficiency Virus (HIV) infection results in multimorbidity and shortened lifespan. Inflammation and immune dysfunction contribute to these outcomes. The aim of this thesis is (1) to investigate the utility of two inflammatory biomarkers evaluated in other settings (neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)) for prognostication in patients living with HIV (PLWH) and comorbid inflammatory states; and (2) to compare the frequency and severity with which rheumatologic disease states occur in PLWH to demographically and behaviorally similar uninfected individuals (“controls”).

Three cohorts were created from the Veterans Aging Cohort Study. In each cohort, patients were stratified by presence …

Acute And Chronic Liver Disease: Lessons Learned From Retrospective Cohort Studies, Ysabel C. Ilagan-Ying

Yale Medicine Thesis Digital Library

Current trends in liver disease are changing due to increased access to pharmacotherapies and the worsening burden of obesity. Large, observational cohort studies are a common tool in clinical and epidemiological research to determine risk for patients that may have experienced an exposure of interest. Past studies have largely examined risk factors for liver disease in patients with cirrhosis or fatty liver disease. We utilized retrospective cohort studies in a disease-agnostic approach and aimed to characterize risk for two increasingly prevalent populations: patients with severe acute liver injury and those with liver fibrosis progressing to hepatocellular carcinoma (HCC).

First, we …

Differential Response To Rituximab In Anti-Achr And Anti-Musk Positive Myasthenia Gravis Patients, Tess Litchman

Yale Medicine Thesis Digital Library

Response to immunomodulatory therapies in myasthenia gravis (MG) can be variable. A subset of MG patients remains refractory to conventional agents. B-cell targeted therapy with rituximab has demonstrated a durable response in treating refractory myasthenia gravis (MG). This study compares the response to rituximab between patients with acetylcholine receptor autoantibody positive (AChR+) and muscle-specific kinase autoantibody positive (MuSK+) MG.

This retrospective study included 33 patients with either AChR+ or MuSK+ MG who were treated with rituximab from 05/31/2003 to 05/31/2017. Pretreatment and post-treatment immunotherapy regimens, clinical symptoms, and examination findings were evaluated.

Median MGFA Class of II at baseline improved …

Cbpr 2.0 - A Community-Based Participatory Research Approach To Program Scaling In Maternal Mental Health: Responding To Community Risk Factors For Maternal Depression While Replicating New Haven Moms To Bridgeport And New York City, Sonia Taneja

Yale Medicine Thesis Digital Library

“Community-Based Participatory Research 2.0” refers to a methodologic framework describing the process of scaling the New Haven MOMS Partnership, an existing participatory intervention, to new sites in Bridgeport, Connecticut and New York City.

Following a community-based participatory approach to the process of program differentiation within implementation science, informal team canvassing identified core components of the program: neighborhood hub sites, community mental health workers, and utilization of incentives. Community needs assessments were prepared, distributed, and analyzed to identify flexible program components. Assessments were tailored to specific communities and included the Center for Epidemiologic Studies-Depression Scale (CES-D), the Oslo-3 perceived social support …

How Exposure To Mass Incarceration Is Associated With The Wellbeing Of Individuals And Families, Ram Sundaresh

Yale Medicine Thesis Digital Library

Mass incarceration in America has far-reaching effects on individuals and their families. Although a large body of evidence has described the effects of incarceration on specific physical and social outcomes, there is almost no research on its effects on broader wellbeing, a more holistic measure of lived experience that can more sensitively reflect social welfare and structural vulnerability. The goal of this thesis is to assess the association between exposure to the American system of mass incarceration and wellbeing. We examine individual-level exposure to the broader criminal legal system (CLS), including police stops, arrests, and incarceration, and family-level exposure to …

Lifestyle Factors Associated With Neoadjuvant Chemotherapy Outcomes In Breast Cancer, Ilana Usiskin

Yale Medicine Thesis Digital Library

Lifestyle factors such as lower BMI, higher levels of physical activity, and increased fruit and vegetable intake, have been shown to benefit breast cancer survival, but the association between these factors and the pathologic complete response (pCR) to chemotherapy, has not been studied. We investigated whether lifestyle factors including BMI, physical activity, diet and alcohol use are associated with pCR from neoadjuvant chemotherapy for breast cancer treatment. Secondarily, we assessed whether the relative dose intensity (RDI) of neoadjuvant chemotherapy is associated with pCR.

We conducted a retrospective study of women treated with neoadjuvant chemotherapy for stage I-III breast cancer between …

The Development And Validation Of A Novel Ichthyosis Severity Assessment Instrument, Qisi Sun

Yale Medicine Thesis Digital Library

Abstract: THE DEVELOPMENT AND VALIDATON OF A NOVEL ICHTHYOSIS SEVERITY ASSESSMENT INSTRUMENT. Qisi Sun, Amy Paller, Keith A. Choate. Department of Dermatology, Genetics & Pathology, Yale University School of Medicine, New Haven, CT.

Ichthyosis clinical trials require reliable, validated severity assessments to identify appropriate subjects and quantify treatment outcomes. There is no validated scale to measure ichthyosis severity across the entire body. We aim to create and validate a comprehensive and user-friendly instrument to measure total body ichthyosis severity in adults and children.We divided the body into 10 regions to score special regions of interest. Likert scales (0-4) were established …

The Flame, 2020-2021, Mennonite College Of Nursing

The Flame (1985-present)

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

Risks For Hiv Infection Among Adolescent Girls And Young Women In Mozambique, Isabelle Casavant

Walden Dissertations and Doctoral Studies

Adolescent girls and young women (AGYW) living in Sub-Saharan African countries constitute 17% of the population, yet they account for one third of all new human immunodeficiency virus (HIV) infections. To prevent HIV infections among AGYW, it is necessary to understand why they are disproportionally infected. The purpose of the dissertation was to identify risk for HIV among AGYW living in a southern district of Mozambique. The analysis was driven by the Modified Socio Ecological Model and performed using a quantitative dataset collected for the Chokwe Combination Prevention of HIV (N=3354). Logistic regression analysis was conducted to assess whether an …

Nursing Administration And Faculty Perceptions Of Their Self-Efficacy With Active Learning Methods, Lindsey Ann Helm

Walden Dissertations and Doctoral Studies

A lack of active teaching was identified in a small, rural college in a midwestern state, resulting in negative course evaluations that referenced students’ learning preferences as not being met. This qualitative case study was aligned with Bandura’s theory of self-efficacy to explore the perceptions of nursing administrators and nursing faculty about their teaching methods and self-efficacy regarding the implementation of active learning strategies. A purposeful sampling method was used to select a total of 8 participants: 6 nursing faculty and 2 nursing administrators. Selection criteria included nurse educators and administrators who had worked at the college within the last …

Impact Of Race-Related Stress And Intraracial Microaggressions On Self-Efficacy Of African Descendants, Samina Long

Walden Dissertations and Doctoral Studies

Race-related stress such as ancestral trauma and experiences of out- and in-group microaggressions can be intergenerationally transmitted from parent to child. The current study was conducted to address the need for research on race-related trauma and out- and in-group discrimination by providing evidence-based research on whether African descendants experiencing and witnessing race-related stress and intraracial microaggressions results in low self-efficacy. The purpose of this quantitative, multiple regression design was to explore the relationships among race-related stress, intraracial microaggressions, and self-efficacy, which may provide clarity on the psychological impact of these stressors. This study addressed the question of whether race-related stress …

Planned Behavior And Congolese Physicians’ Practice: Predicting Advanced Preventive Health Services Provision, Jean-Clément Milabu Mumbusi

Walden Dissertations and Doctoral Studies

The provision of preventive services, health promotion, and health maintenance has become the cornerstone of primary care practice in the United States and other Western countries to prevent morbidity and premature mortality and to increase the quality and years of a healthy life. Unfortunately, the delivery of these advanced preventive health services (APHS) has been sporadic in the Democratic Republic of Congo, a country with poor health indicators. The purpose of this cross-sectional mixed-method study was to apply Ajzen’s theory of planned behavior (TPB) to predict the intention of Congolese primary care physicians (PCPs) in the provision of APHS. Using …

Sex Bias In The Diagnosis Of Chronic Obstructive Pulmonary Disease, Olga Ivan Belitchenko Ryan

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, disability, and cost globally and in the United States. Various sources point to women experiencing greater morbidity, increased health care resource use and higher incidence of mortality resultant from COPD. While exact causality is not fully understood, it is possible that social bias towards COPD in women impacting screening and timely diagnosis may be a contributing factor. This current investigation involved the social ecological model. In this cross-sectional secondary analysis of Behavioral Risk Factor Surveillance System, 2017 data, differences in screening through use of breathing testing among 6334 …

Medical Skepticism And Diabetes Management In African Americans, Pamela Bouyer

Walden Dissertations and Doctoral Studies

Type 2 diabetes (T2DM) in African Americans is a manageable disease, and self-management interventions reduce complications and hospital stays. However, in the African American population, traditional T2DM self-management interventions do not produce long-term effects on lifestyle and behavior changes. Researchers have analyzed the barriers and interventions associated with the disease, but the problem still exists. Medical skepticism may influence T2DM management and health outcomes in African Americans. However, there is scarce literature addressing the relationship between medical skepticism and health outcomes (eye and kidney problems). The purpose of the study is to assess the relationship between medical skepticism and outcomes …

Enhancing Nurse- Patient Communication Through Commit To Sit, Cherrielyn E. Quiambao

Walden Dissertations and Doctoral Studies

The patient experience is considered by healthcare policy experts as one of the essential components of healthcare quality. The project site implemented a program called “Commit to Sit” to help promote direct bedside communication with patients. This quality improvement project examined the impact of the Commit to Sit program on patient experience in an acute care setting. The purpose of this evaluation focused on determining whether communication between the frontline nurses and patients improved through the implementation of “Commit to Sit” campaign on a pilot unit in a community hospital. The Duffy’s Quality Caring Model was utilized because it encourages …