Medicine and Health Sciences Commons^™

Factors Informing Referral Of Adult Patients To Palliative Care Services In A Tertiary Facility In Kenya: Physicians' Perspective, Donnah A. Opiyo

Master of Medicine in Family Medicine

Background The growing burden of chronic diseases underscores the urgent need for palliative care integration into healthcare systems worldwide. Despite its benefits, palliative care remains underutilized due to various barriers, including health system limitations, institutional challenges, infrastructure gaps, and individual provider factors. However, limited research has explored the specific factors influencing physicians' decisions to refer patients to palliative care. This study sought to fill that gap by examining the key determinants shaping referral practices in a tertiary facility in Kenya.

Design and Methods This exploratory qualitative study examined 22 physician specialists from five departments at Aga Khan University Hospital, Nairobi. …

Specificity Of Interaction Of Antimicrobial Peptide With Cell Membrane, Srishhti Kumar Jha

Pharmaceutical Sciences (MS) Theses

Antimicrobial resistance (AMR) is an increasing global health threat due to its rising incidence worldwide. Resistant microbial infections have become difficult to treat and pose serious risks to patients. In 2019, AMR was responsible for approximately 1.27 million deaths globally, with numbers continuing to rise. The World Health Organization (WHO) has highlighted the urgent need for new antibiotics with novel mechanisms of action and low toxicity to combat this issue. Antimicrobial peptides (AMPs) represent a promising solution. These peptides exhibit broad-spectrum antimicrobial activity and rapid killing kinetics, reducing the likelihood of resistance development. AMPs primarily target bacterial cell membranes. Their …

Incidence Of Peripheral Intravenous Cannula Complications And Associated Factors Among Paediatric Patients At A Tertiary-Care Referral Hospital, Vanessa Minsari Ogega

Master of Medicine in Paediatrics and Child Health

Introduction: Peripheral intravenous catheters (PIVCs) are widely used in clinical practice and are a major source of procedure-related pain in children. Their use is associated with complications including occlusion, dislodgement, infiltration, extravasation, phlebitis, and, rarely, bloodstream infections.

Objectives: To determine the incidence and risk factors associated with PIVC complications among paediatric patients aged 1 day to 18 years at Aga Khan University Hospital, Nairobi. The study also assessed the average survival time of PIVCs.

Methods: A prospective cohort study was conducted on 320 PIVCs among 192 children admitted between August and October 2024. Data collected included patient demographics, clinical characteristics, …

Kenyan Dietitians’ Knowledge Of Ketogenic Dietary Therapies For Drug-Resistant Epilepsy, Pauline Samia, Violet Naanyu, Perry Ndila, Helen Cross, Richard Idro, Paul Boon, Jo Wilmshurst, Stanley Luchters

Paediatrics and Child Health, East Africa

Background: Ketogenic dietary therapy (KDT) has been proven to be efficacious for people with drug-resistant epilepsy. However, it is rarely utilized in low-resource settings. Due to the complexity of implementation, dietitians play a crucial role in managing KDT.

Methods: We conducted a cross-sectional survey of 253 out of the 1,000 registered dietitians. We assessed their knowledge of and interest in further training in KDT.

Results: Most participants were female (78%), with a median age of 33 years (IQR=28–38). A total of 171 (67.6%) reported knowledge of KDT. However, only 13 respondents (7.6%) answered all five knowledge-specific questions correctly. A …

Interview With Former Chairman Of Cardiology E. Berry Hey, Jr. Md, Caitlin Moss

Historic Narratives

No abstract provided.

Polyphenols For The Mitigation Of Vascular Calcification; In Vitro And In Vivo Studies, Abdullah Altuhami

All Theses

Globally, cardiovascular diseases, in most cases associated with calcification, are the main cause of death. However, currently, the only effective cure is to undergo surgery to augment or receive a healthy donor heart, which could be very difficult due to the long waiting list and the associated risks. The possibility of body rejection of the foreign organs is attributed to immunoreaction or the risk of infection, since the donor must be on immunosuppressant drugs that lower the body's immunity and facilitate the body's acceptance of the new organ as one of its own. Taking that into consideration, using tissue-engineered vascular …

Improving Antipsychotic Compliance By Addressing Client Experience Of Metabolic Syndrome, Lurinda N. Paulsen

Doctor of Nursing Practice

Abstract

Purpose: This project was undertaken to increase medication adherence in clients diagnosed with mental illnesses that necessitate the use of antipsychotic (second generation, atypical or first generation, typical) medications.

Background: Medication compliance in the treatment of schizophrenia, schizoaffective disorder, and bipolar disorder is essential to ensure consistent medication levels and symptom stabilization. There are many reasons clients stop taking their medications, and symptoms of metabolic syndrome are often a cause for self-discontinuation. Metabolic syndrome is a cluster of symptoms including obesity, hypertension, hyperglycemia, hypoalphalipoproteinemia, and/or hypertriglyceridemia, which increases risk for cardiovascular disease and diabetes.

Methods: This project was completed …

Exploring The Effect Of Social Determinants Of Health (Sdoh) Factors On The Time To Kidney Transplant Evaluation Completion For African American End Stage Renal Disease (Esrd) Patients, Kesha Levesque

MUSC Theses and Dissertations

Purpose – The purpose of this dissertation is to investigate the relationship between demographics and Social Determinants of Health (SDOH) variables on diagnostic testing time completion in patients being evaluated for kidney transplant waitlisting.

Aims - Compared to White Americans, African Americans who are eligible to receive a kidney transplant are less likely to complete the required testing in order to be placed on the kidney transplant waiting list which puts African Americans at risk for morbidity and mortality due to prolonged exposure to dialysis. The COVID-19 pandemic was directly associated with a decrease in the number of patients placed …

Navigating Childhood Asthma Care In Kenya: Barriers Identified By Children And Their Caregivers, Joan Ahimbisibwe, Roselyter Riang’A, Angela Migowa, Samuel Otido

Paediatrics and Child Health, East Africa

Background: Asthma is one of the most common chronic conditions in children, with significant morbidity and mortality, especially in Africa. Achieving adequate asthma control in children remains challenging because of gaps between standard recommended management strategies and actual treatment practices. This study explored barriers to asthma management as perceived by children and their caregivers in a private tertiary care setting in Kenya.

Methods: An exploratory phenomenological qualitative study was conducted at Aga Khan University Hospital (AKUH), Nairobi. Children aged 6–18 years with a confirmed diagnosis of asthma and their caregivers were recruited. The participants had been receiving treatment for at …

Dissecting The Heterogeneous Effects Of Opioid Prescribing Limit Laws On Pediatric Mortality: A Multidimensional And Negative Binomial Modeling Approach, Francine R. Vega

Dissertations and Theses (Open Access)

Opioid prescribing for children and adolescents continues to be a significant health crisis in the United States. Early naïve exposure to opioid prescriptions has been linked to later misuse, opioid use disorder, and death. In response to the crisis, many states have implemented opioid prescribing limit laws (OPLLs) aimed at reducing exposure to opioids. These laws vary widely in their approach, including differences in dosage restrictions, prescription duration limits, informed consent requirements, educational provisions, and whether they offer explicit protections specifically for minors. Despite their widespread adoption, there is limited understanding of how heterogeneity in legal regulations affects outcomes for …

Rethinking Health Systems Responsiveness In Low–And Middle-Income Countries, Meesha Iqbal

Dissertations and Theses (Open Access)

Health systems responsiveness (HSR) refers to a health system’s ability to meet legitimate non-health expectations of the population. Traditionally, HSR has been conceptualized across eight domains: respect for dignity, autonomy, confidentiality, prompt attention to health needs, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. However, as the expectations of populations in high-income countries (HICs) and low- and middle-income countries (L&MICs) differ significantly due to diverse social and cultural contexts, the conceptualization of HSR also varies. We conducted a systematic review of literature to adapt and contextualize the HSR framework for L&MICs based …

Resonant Disruptions: Understanding Canadian Nurses’ Practice With Youth Survivors Of Sexual Exploitation, Danielle E. Giebelhaus, Andrew Estefan Phd, Rpn

Dignity: A Journal of Analysis of Exploitation and Violence

The sexual exploitation of youth is a global concern. Youth survivors of sexual exploitation present to and require healthcare services, but most nurses do not feel effectively equipped to care for this population. There is currently little nursing literature to guide nurses in their practice with youth survivors. In this article, we report on a qualitative, hermeneutic study undertaken to explore nursing practice with youth survivors of sexual exploitation. Hermeneutics is concerned with understanding, and is a helpful way to conduct research when little is known about a topic. In this study, we asked the research question, “How might we …

Delusional Parasitosis With Depression, Hypertension And Migraine, Mouli Mandal, M Kishor, Mr Murali

Digital Journal of Clinical Medicine

Delusional Parasitosis (DP) , also known as Ekbom Syndrome, is a psychiatric disorder characterised by the unshakeable belief of infestation by parasites, insects or other organisms, despite the absence of objective medical evidence.
This case report presents a 49 year old female with a history of chronic headaches, progressively worsening insect crawling sensations. She was initiated on treatment and supportive psychotherapy.
This case highlights the importance of a thorough multidisciplinary approach in managing Delusional Parasitosis, emphasising the need to differentiate between primary and secondary forms, address the potential medical and psychiatric comorbidities, and implement appropriate pharmacological and psychotherapeutic interventions.

New Dentist News (August 2025), Ada Committee On The New Dentist

New Dentist News

New Dentist News offers timely information on scientific, social, educational, political and economic developments affecting new dentists. This collection is historical and items may not reflect current standards. For up-to-date information contact the ADA. The New Dentist News was alternately titled ADA Lifeline, 1997-June 2001.

A Guide To Sexual Intimacy Following Spinal Cord Injury, Jillian M. Olenick

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2025

A Guide to Sexual Intimacy Following Spinal Cord Injury is a two-part manual that was created to increase the knowledge related to how sex can be impacted following a spinal cord injury. The first manual was created as a guide for individuals with spinal cord injuries and their partners to enhance their knowledge on how their spinal cord injury may impact their sexual functioning. The second manual was created as a guide for occupational therapy practitioners to use as a resource when addressing sex with their clients following a spinal cord injury. Each manual provides information related to sexual intimacy, …

Large-Scale Copy Number Variant Analysis In Genes Linked To Parkinson’S Disease, Zied Landoulsi, Katja Lohmann, Eva-Juliane Vollstedt, Emily Wedgwood-Benn, Lisa-Marie Niestroj, Björn-Hergen Laabs, Sebastian Sendel, Alexander Balck, Max Borsche, Dennis Lal, Anne Grünewald, Norbert Brüggemann, Andre Franke, Andrew Hicks, Meike Kasten, Kirsten E Zeuner, Lara M Lange, Wolfgang Lieb, Brit Mollenhauer, Heike Pawlack, Peter P Pramstaller, Amke Caliebe, Inke R König, Patrick May, Christine Klein

Faculty, Staff and Student Publications

Genetic studies of Parkinson's disease (PD) have focused on single nucleotide variants (SNVs), with limited attention to copy number variants (CNVs). This study investigates CNVs in PD using candidate PD-related genes and genome-wide approaches. We identified CNVs from the ProtectMove project genotyping data of 2364 PD patients and 2909 controls using PennCNV. We validated 119 of 137 detected CNVs in PD-related genes (87%) using MLPA/qPCR, including 104 in PRKN, six in PARK7, four in SNCA, and others in LRRK2, RAB32, and VPS35. CNVs were present in 2.4% of patients and 1.5% of controls. Notably, 0.9% of patients carried potentially disease-causing …

Management Approaches To Spastic Gait Disorders, Sheng Li, Tulsi Pandat, Bradley Chi, Daniel Moon, Manuel Mas

Faculty, Staff and Student Publications

Spastic gait presents clinically as the net mechanical consequence of neurological impairments of spasticity, weakness, and abnormal synergies and their interactions with the ground reaction force in patients with upper motor neuron syndromes and with some neuromuscular diseases. It is critical to differentiate whether the primary problem is weakness or spasticity, thus better understanding different phenotypes of spastic gait disorders. Pelvic girdle abnormality plays a pivotal role in determining the clinical presentation of gait disorders, since it determines the body vector and compensatory kinetic chain reactions in the knee and ankle joints. Knee joint abnormality can be a mechanical compensation …

Patient-Specific Preoperative Plans Can Optimize Femoral Head Coverage And Range Of Motion After Periacetabular Osteotomies, Shuyang Han, Carey A Clark, Nicholas J Dunbar, Madison Brenner, Alexis H Aboulafia, Alfred A Mansour Iii, Philip C Noble

Faculty, Staff and Student Publications

Background: The goal of a periacetabular osteotomy is to increase the coverage of the femoral head, primarily in the antero-lateral region, through rotation of the acetabulum in three anatomical planes. The present study was undertaken to determine whether specific combinations of lateral rotation, anterior rotation, and anteversion of the acetabular fragment can be targeted to provide the best balance between femoral head coverage and joint motion.

Methods: Three-dimensional patient-specific hip models were reconstructed from preoperative computerized tomography scans of 15 patients diagnosed with hip dysplasia. Each model was placed in a standard coordinate system with neutral pelvic tilt and femoral …

Exploring Ict Adoption In Teaching And Learning Of Science: A Case Of Senior Teachers In Kenya, David Odhiambo, Winston Edward Massam, Fredrick Mtenzi

Institute for Educational Development, East Africa

This study was conducted in Homa Bay Sub County, Kenya to explore the adoption of ICT among senior teachers, aged between 45-60 years, in teaching and learning of science. A qualitative research approach using a case study design was employed. Eight secondary school senior teachers of science, 2 females and 6 males, within Homa Bay Sub County were purposefully selected. Semi structured interviews were conducted one-on-one basis followed by classroom observation and document analysis. Analysis of the data revealed that senior teachers of science generally integrate ICTs in planning, assessment and in classroom teaching; however pedagogical preferences and teacher’s workload …

Evaluating Quadrupedal Locomotion In Bats: A Geometric Morphometric Comparison Of Vertebral Adaptations Across Mammals, Jessica Upham

Electronic Theses and Dissertations

Flight is the primary locomotion of bats, while quadrupedal locomotion is not often observed and is widely variable among bats. Frugivorous bats in Pteropodidae are more efficient climbers than frugivorous bats in Phyllostomidae and insectivorous bats in Vespertilionidae, while phyllostomids and vespertilionids are better at walking on horizontal surfaces. The aim of this study is to investigate whether bats with differing modes of nonflight locomotion also exhibit disparity in thoracolumbar vertebral morphology. Using geometric morphometrics, we compared the thoracolumbar vertebral shapes of these bat families with other terrestrial and arboreal mammals. The results revealed distinct vertebral shapes among bat families …

Strength Beyond Cancer: An Occupational Therapy Guidebook For African American Breast Cancer Survivors, Taihia A. Wilson

Student Capstone Papers

This capstone project aims to explore the nuanced and often underrepresented experiences of African American women (AAW) who have survived breast cancer (BC), with a specific focus on the recovery phase. By examining the physical, cognitive, and psychosocial obstacles encountered during survivorship, the project seeks to highlight significant gaps in care and support. The primary goal of this project is to develop an accessible and culturally responsive guidebook that provides healthy strategies to enhance quality of life (QoL), promote occupational wellbeing, and empower AAW to manage their overall health beyond treatment. This paper will begin by presenting the background and …

Genetic Study Of Von Willebrand Factor Antigen Levels ≤ 50 Iu/Dl Identifies Variants Associated With Increased Risk Of Vwd And Bleeding, Rachel K. Friedman, Adam S. Heath, Jennifer E. Huffman, James T. Baker, Natalie R. Hasbani, Sarah A. Gagliano Taliun, Ming-Huei Chen, Tom Howard, Joanne E. Curran, John Blangero

School of Medicine Publications

Background: von Willebrand disease (VWD) is a common inherited bleeding disorder caused by low levels or activity of circulating von Willebrand factor (VWF). Genetic susceptibility to VWF antigen (VWF:Ag) below normal (≤50 IU/dL) in the general population is underexplored.

Methods: To identify genetic variants influencing VWF:Ag levels ≤50 IU/dL, we performed a genome-wide association study in 926 cases with VWF:Ag levels ≤50 IU/dL and 12,846 controls from 7 studies from the TOPMed program. We then examined whether genome-wide significant findings were also associated with clinical diagnosis of VWD in 5 biobanks with 708 VWD cases and 1,286,069 controls, and with …

Summit Max: A Randomized Trial Of The Super Large Bore Hipoint Reperfusion System Versus Vecta System For Aspiration Thrombectomy., Thanh N Nguyen, Guilherme Dabus, Ben Mcguinness, James Caldwell, Ryan Priest, Ansaar T Rai, Osama O Zaidat, Bradley A Gross, Ricardo Hanel, Shane Lee, Shazam Hussain, Hamza Shaikh, Mohamad Abdalkader, Ronald Budzik, Craig Kilburg, Keith Woodward, Marco Colasurdo, Jesse Liu, Albert J Yoo, Priyank Khandelwal, Sohyun Boo, Phong Vu, Eugene Lin, Mohammad Almajali, Jasmeet Singh, Alhamza Al-Bayati, Michael J Lang, Michael Abraham, Ameer E Hassan, Peter Pema, Coleman Martin, Ramesh Grandhi, Daniel A Tonetti, Harry R Hixson, Amin Aghaebrahim, Eric Sauvageau, Santiago Ortega-Gutierrez, Dileep R Yavagal, Esteban Cheng-Ching, Jane Khalife, Italo Linfante, Volodymyr Vulkanov, Jazba Soomro, Johanna T Fifi, Lucien Maidan, Alexander Copelan, Clemens M Schirmer, Mark Bain, Gabor Toth, Mahesh Jayaraman, Roberta Novakovic-White, Sudhakar Satti, Nicolas Villelli, Pascal Jabbour, Matthew Page, Davina J Mcallister, Robert Araujo Contreras, Edgar A Samaniego, David S Liebeskind, Steven W Hetts, Raul G Nogueira, Joey English, Ajit S Puri

Neuroscience Articles

BACKGROUND: Rapid and complete recanalization is a primary goal in the endovascular treatment of large vessel occlusion stroke. The effectiveness and safety of super large bore aspiration catheters (0.088″ inner diameter) for the treatment of large vessel occlusion stroke have not been demonstrated in a randomized trial.

METHODS: SUMMIT MAX (A Prospective, Randomized, Controlled, Interventional Clinical Trial to Evaluate the Safety and Effectiveness of the Route 92 Medical MonoPoint Reperfusion System for Aspiration Embolectomy in Acute Ischemic Stroke Patients) was a prospective, randomized, controlled, open-label clinical trial of patients with internal carotid artery and middle cerebral artery M1 occlusions, comparing …

Changing The Perceived Pain Intensity In Populations With Spinal Cord Injury And With Health Disparities (Happiness): Protocol For A Feasibility Study, Ann Van De Winckel, Lin Zhang, Leslie R. Morse, Brianna Woodliff, Gladys Maestre, Kelsey Baker

School of Medicine Publications

Background: Chronic neuropathic pain affects 69% of adults with spinal cord injury (SCI). Medication, as a primary treatment, has insufficient benefits and significant risks for addiction and adverse effects. Of the available mind and body approaches, Qigong is the most accessible for adults with SCI, with evidence for effectiveness in reducing pain. Still, there is insufficient evidence to make recommendations for adults with SCI. Thus, the feasibility of Qigong in SCI needs to be established. We previously demonstrated feasibility in a pilot study, in which 18 non-Hispanic White adults with SCI completed a 12-week remote Qigong program. However, three additional …

Reentry For Formerly Incarcerated Individuals: A Focus On Workforce Reentry And Recidivism In Appalachia, Margaret E. Francisco

Electronic Theses and Dissertations

Formerly incarcerated individuals face challenges to successful reentry, a critical component of reducing recidivism and improving public health outcomes. These challenges are particularly acute in rural Appalachia, where structural disadvantages such as limited economic opportunities, healthcare access, and public transportation intersect with stigma and systemic barriers related to prior incarceration. This dissertation addresses these gaps through a mixed-methods examination of reentry and recidivism, grounded in public health frameworks and focused on the unique context of rural Appalachia.

This work includes three studies. First, a PRISMA-guided systematic review synthesized qualitative research on barriers and facilitators to employment following incarceration. Findings highlighted …

Genotype Distribution Of Human Papillomavirus Among Women With Cervical Cancer Stratified By Hiv Status In Tanzania, Alita Mrema, Mamsau Ngoma, Emmanuel L. Lugina, Atukuzwe Kahakwa, Chacha Josiah Mwita, Salama Iddy, Eulade Rugengamizi, Kandali Samwel, John Ngowi, Salum J. Lidenge, Charles Wood, Julius Mwaiselage

School of Medicine Faculty Publications

Background Cervical cancer (CC) is the leading cancer among women in Tanzania, especially among those between the ages of 15 and 44. The prevalence of high-risk Human papillomavirus (HR-HPV)-16/18 women in the general population at any given time is 3.3%. HR-HPVs 16 or 18 are the primary cause of CC. The distribution of HPV genotypes among women with CC according to HIV status is unknown in Tanzania. This study aimed to determine the HPV genotype distribution according to HIV status among women with CC in Tanzania. Methods This cross-sectional study was done at Ocean Road Cancer Institute (ORCI) in Tanzania …

Gastric Sarcina Ventriculi: A Report On Two Cases, Yaomin Chen, Yu Liu, Zhiyan Fu

School of Medicine Faculty Publications

: Sarcina ventriculi is a rare Gram-positive coccus that thrives in acidic environments such as the human stomach. It has been increasingly identified in individuals with delayed gastric emptying and has been reported in association with various gastric disorders. However, its exact pathogenic role is not fully understood and remains controversial. : We present two cases of patients, one with a small bowel obstruction and the other with epigastric pain, both diagnosed with Sarcina ventriculi infection by histological examination of gastric biopsies. The patients were managed with a combination of antibiotics and a proton pump inhibitor, resulting in symptom resolution …

Extracorporeal Membrane Oxygenation (Ecmo) Neuromonitoring And Acute Brain Injury, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Rebounds Reconsidered: Exploring Perceived Causes And Consequences Of People's Beliefs About Rebound Relationships, Hunter Krampe

All-Inclusive List of Electronic Theses and Dissertations

Romantic breakups are common and can significantly impact emotional well-being. Many individuals enter rebound relationships despite the prevailing belief that these relationships are disingenuous or unhealthy. While limited empirical research exists, some studies suggest rebound relationships may have positive effects, contradicting common advice. This study examined perceptions of rebound relationships, assessing whether individuals who entered a new relationship shortly after a breakup (3 weeks) were perceived more negatively than those who waited longer (3 months). Using a 2x2 experimental design, participants rated targets on emotional state, personality traits, and expected relationship stability. Results indicated that rebounders were not perceived as …

Sad Music Listening: What Is It Good For? An Exploratory Study Of Motivations For Listening To Sad Music, Ariel Gelfand

All-Inclusive List of Electronic Theses and Dissertations

This study sought to bolster research related to the function of sad music listening. Music listening is a common coping strategy for individuals attempting to cope with and manage different emotional states, including negative or sad moods and emotions. Research surrounding self-reported reasons or motivations for listening to sad music outlines several factors that appear to serve as mood-management strategies. However, there are discrepancies among these motivations across research, which thus far has consisted of qualitative interviews of participants. (Garrido & Schubert, 2011; Saarikallio & Ekkila, 2007; Van den Tol & Edwards, 2013). Additionally, it is unclear whether listening to …