Medicine and Health Sciences Commons^™

Astrocyte Spatial Distribution Affects Growth Dynamics Of Breast Cancer Brain Metastases: An Agent-Based Modeling Study, Rupleen Kaur

Biology and Medicine Through Mathematics Conference

No abstract provided.

Modeling And Control Of Drug Resistance In Cancer Dynamics, James Greene

Biology and Medicine Through Mathematics Conference

No abstract provided.

Reaction-Diffusions System Simulated On Irregular Shapes And Surfaces Model Petal Spot Patterns In Monkeyflower Hybrids, Emily Simmons, Arielle M. Cooley, Joshua R. Puzey, Gregory D. Conradi Smith

Biology and Medicine Through Mathematics Conference

No abstract provided.

Approach To Pivie In Pediatrics: Standardization For Early Detection, Jamie Green, Jill Gregory, Elizabeth Murphy, Jessica Miller, Nicole Manchester, Frank Harris, Meaghan Wildes, Cecilia Inman, Jenn Paradis, Faye Weir

Operations Transformation

PIVIE (Peripheral Intravenous Infiltration & Extravasation) can have devastating effects, especially in the pediatric population. The condition may disrupt vasculature severe enough for permanent skin and tissue loss that can lead to impaired limb function due to severe scarring. Problem: No standardized process existed either to prevent or review these events at Barbara Bush Children’s Hospital at Maine Medical Center prior to the study. PIVIEs were measured through the event reporting platform and only severe PIVIEs were being documented in this report. All infiltrations (1-4 on the infiltration scale) should be measured for accurate benchmarking. Occurrences in the electronic medical …

Smart Meetings, Morgan Forster, Arthur Durity, Cathy Cole

Operations Transformation

A one year look at how the CHA executive team focused on opportunities to have fewer yet more productive meetings! In this presentation we will discuss the details that help shape improvement around the challenge of too many meetings and share the results from lessons learned at PBMC and Waldo.

An Integrated Review: Outpatient Care And Management Of Fever And Neutropenia Among The Pediatric Oncology Population, Sarkis Makarovich

DNP Qualifying Manuscripts

Abstract

In the pediatric population, comprehensive cancer treatment and its associated side effects significantly impact their physical and emotional well-being. Though chemotherapy drugs are valuable agents against cancer cells, they also damage healthy dividing cells, such as bone marrow, thus weakening the immune system. Febrile neutropenia (FN) and associated infections remain the most critical complications of the extensive chemotherapy regimen and can threaten life if not appropriately addressed. Appropriate primary evaluation and treatment of FN in children with cancer includes administering proper broad-spectrum antibiotics. Ongoing research has focused on improving quality of life (QoL); yet, FN has persisted as the …

What Can Pharmacists Do To Reduce Drug Abuse?, Saul E. Alvarado-Rosario

College of Pharmacy Student Research

This review paper provides an overview of the current status of substance abuse, involving both illicit drugs and medically regulated medications. Although global statistics are considered, the primary focus is the substance abuse crisis within the United States. Through review of experimental and observational peer-reviewed articles, this report examines the definition of substance abuse, demographic impacts, and governmental interventions, with particular emphasizes on the role of the pharmacy profession and individual pharmacists in addressing this widespread issue.

The Effect Of Slow Tempo Music Listening On Incidence Of Delirium In Skilled Nursing Facilities, Sarah Róise Hartman

Yale School of Medicine Physician Associate Program Theses

Delirium is a syndrome characterized by acute fluctuations in cognition and inattention that significantly affects older adults due to increased age and cognitive impairment. In hospital settings, music listening has shown to be a feasible and effective intervention used to decrease delirium incidence. However, music listening interventions targeting delirium in skilled nursing facilities have not been studied. The objective of this study is to compare music listening to usual care in skilled nursing facilities as a method to decrease incident delirium development. Specifically, this will be a randomized control trial comparing daily slow tempo music listening to usual skilled nursing …

Effect Of Empagliflozin In Adult Patients With Metabolic Dysfunction-Associated Steatohepatitis, Peilin Austin Liu

Yale School of Medicine Physician Associate Program Theses

Metabolic dysfunction-associated steatohepatitis is a severe form of liver disease marked by fat accumulation, inflammation, and scarring, often advancing to cirrhosis. Currently, there are limited therapies to treat this condition. Empagliflozin, a Sodium-glucose cotransporter 2 Inhibitor, that blocks renal reabsorption of glucose, has shown efficacy in reducing liver fat accumulation. However, there are currently no large-scale studies have investigated the effect of empagliflozin in treating metabolic dysfunction-associated steatohepatitis using histological findings. We propose a randomized controlled trial to study the effect of empagliflozin on the resolution of Metabolic dysfunction-associated steatohepatitis. We will recruit participants with histology-confirmed metabolic dysfunction-associated steatohepatitis and …

Effect Of A Multispecies Probiotic With Fluconazole On Oral Candidiasis In Subjects With Hiv, Nicole Romaneschi

Yale School of Medicine Physician Associate Program Theses

Oropharyngeal candidiasis is the most prevalent opportunistic infection among people living with HIV. Fluconazole is the recommended treatment for the disease in immunocompromised patients, but its efficacy is waning with growing resistance of candida, the yeast that causes candidiasis. Studies have shown that probiotics decrease oral candida load, but research about the use of probiotics in HIV-positive individuals with oropharyngeal candidiasis is limited. This study will investigate whether probiotics taken with fluconazole lead to increased remission of oropharyngeal candidiasis signs and symptoms in subjects with HIV when compared to fluconazole monotherapy. Participants will be treated with a two-week fluconazole course …

The Effects Of Acupuncture On Retention Among Patients With Opioid Use Disorder On Methadone, Joshua Horowitz-Benoit

Yale School of Medicine Physician Associate Program Theses

The opioid crisis has resulted in an unprecedented loss of life in the United States and around the world and contributes to the socioeconomic devastation of various underserved and minoritized communities. Methadone is an evidence based, Food and Drug Administration approved treatment that reduces cravings and blunts the euphoric effects of illicit opioids. The drop-out rates from methadone programs, especially in the first 6 months of treatment, remain high. Acupuncture is a millennia old component of traditional Chinese medicine that has been shown to aid in a variety of disease states, including opioid use disorder. The objective of this study …

This (Dis)Abled Person: Professional Receptiveness Towards Future Slps With Disabilities, Billy Allen

Theses & Honors Papers

With increasing levels of diversity within the United States, having the field of speech-language pathology better reflect and represent the changing demographic shifts in society is critically important. Little attention has been given toward the prospect of individuals with disabilities serving in the field despite focused efforts to increase the presence of professionals from racial, ethnic, and cultural backgrounds. This study investigated the receptiveness of practicing speech-language pathologists (SLPs) or communication sciences and disorders (CSD) graduate faculty towards the prospect of individuals with disabilities working as SLPs within the field or entering graduate-level CSD programs. A survey collecting quantitative data …

Transition To Adult Care For Bleeding Disorders: Building A Multidisciplinary Tool, Leslie Larson, Ekaterina Funk, Dana Grass, Felicia Munster, Eric Larsen, Louise Baca, Glen Roy, Sara Artinyan

Operations Transformation

Youth with chronic illnesses often have poorer health outcomes after transitioning to adult care. Maine Health Bleeding Disorders is a Health Resources and Services Administration (HRSA) grant funded Hemophilia Treatment Center (HTC) that serves patients with congenital bleeding disorders. We provide multidisciplinary specialty care throughout the lifespan which includes pediatric and adult hematologists, family nurse practitioners, nurses, physical therapists, social worker, dietitian, genetic counselor, and research coordinator. In 2022, HRSA mandated all federally funded HTCs increase by 25 percent from baseline the number of individuals ages 12 to 26 years seen in a comprehensive clinic that have a health care …

Digital Health Literacy, Vaccine Information Sources, And Vaccine Acceptance Among Parents In Ontario: Quantitative Findings From A Mixed Methods Study, Sarah Ashfield, Lorie Donelle Phd, Rn, Fcan, Panagiota Tryphonopoulos, Ève Dubé, Maxwell Smith

Faculty Publications

Parents make important vaccination decisions for their children and many variables affect parents’ decisions to accept or decline vaccines. Parents are tasked with locating, understanding, and applying information to inform health decisions often using online resources; however, the digital health literacy levels of parents are unknown. The purpose of this study was to investigate parents’ digital health literacy levels, their sources for vaccine information, and analyze how demographics, digital health literacy, health literacy, parental attitudes and vaccine beliefs, trust, and vaccine information sources predict vaccine acceptance. Quantitative findings of a mixed methods study that examined parental vaccine decision making across …

Asthma And Peak Flow Assessments Based On Nhlbi Asthma Guidelines, Julia Gliceria Almario Regalado

Doctor of Nursing Practice (DNP) Projects

Background: Asthma exacerbations are consequences of poor asthma control. Asthma guidelines-grounded interventions can improve adherence to asthma guidelines and assessments in primary care settings. The goals of asthma management are to optimize asthma control, minimize the risk of asthma exacerbations, and minimize the adverse effects of asthma medications.

Local Problem: A primary care practice in Northern California had frequent office visits for acute asthma symptoms. Ongoing asthma control monitoring is a key performance indicator of high-quality asthma care.

Methods: The quality improvement evidence-based observational project examined the effectiveness of interventions. The pre-and post-survey assessments collected clinician knowledge and adherence, and …

Nurse-Led Telehealth Visits For Patients With Multiple Sclerosis During The Covid-19 Pandemic And Beyond, Eun Hye Kim

Doctor of Nursing Practice (DNP) Projects

Background: Nearly one million individuals are affected with Multiple Sclerosis (MS) in the United States, and it was estimated the annual economic burden of multiple sclerosis in the U.S. at over $85.4 billion in 2022.

Problem: During the outbreak of COVID-19, the number of nurse-led patient education sessions has decreased due to the conversion of in-person clinic visits to telehealth visits. Despite the widespread use of telehealth for MS patients post-COVID-19 pandemic, limited data is available about the use of nurse-led telehealth visits with a standardized workflow.

Method: A quality improvement project was implemented at the MS clinic in Northern …

Fostering Interprofessional Collaboration In Community College Mental Health Centers: A Quality Improvement Project, Sara Jane Hamilton

Doctor of Nursing Practice (DNP) Projects

Background The worsening mental health rates among college students in the United States highlight the critical need for campuses to have high-quality comprehensive mental health centers (MHC). This necessity is particularly urgent in community college MHCs, which often lack these attributes. Local Problem An MHC within a large California community college recently introduced telepsychiatry services and is considering integrating a Psychiatric Mental Health Nurse Practitioner (PMHNP) into their team. However, knowledge gaps and limited interprofessional education (IPE) may hinder effective collaboration within the team. Methods A comprehensive literature review was conducted to assess current research on IPE, community college mental …

Implementing Diabetic Eye Care Education For Healthcare Professionals, Misun Serena Moser

Doctor of Nursing Practice (DNP) Projects

Background: Diabetic retinopathy (DR) is the most common cause of diabetic eye complications and a leading cause of preventable vision loss in American adults. Skaggs et al. (2017) reported that DR screening prevents vision loss by 95%. The evidence reports that only 60% of people with diabetes have attended the recommended DR screenings (Flaxel et al., 2020). Emerging evidence supports patient education about diabetic eye care and its guidelines by health care professionals (HCPs) as the main facilitator to accomplish this goal (Khair et al., 2020; Moinul et al., 2020). Healthcare professionals are pivotal in encouraging or discouraging DR screening …

Education For Primary Care Providers On Advance Care Planning, Lindsey Ward

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) is a discussion of a patient’s end-of-life healthcare wishes. Its purpose is to indicate these wishes clearly should the patient be unable to make their decisions known to providers and family members due to a sudden health decline or medical emergency. Healthcare providers, specifically nurse practitioners, physician assistants, and physicians in the primary care setting, are well-positioned to facilitate these conversations with their older adult patients. However, research states that limited provider knowledge of and confidence in implementing ACP are significant barriers to its application in practice.

Problem: At a primary care clinic in Midtown …

Increasing The Optimal Usage Of The Gad-7 And Phq-9 Screening Tools To Better Detect Co-Occurring Disorders In An Alcohol Use Disorder Clinic, Lauren Swansick

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Co-occurring disorders include substance use disorders and mental health conditions. These disorders affect 21.5 million individuals. Mental health screening tools, such as the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7), are effective in screening individuals for depressive and anxiety mental health conditions within addiction settings.

Problem: Of those with an anxiety disorder, 20-40% will be diagnosed with an alcohol use disorder (AUD). Depressive disorders are the most common mental health conditions that can occur alongside an AUD. A literature review revealed that the PHQ-9 and GAD-7 are used in addiction treatment settings; however, not as …

Development Of An International Standard Set Of Outcomes And Measurement Methods For Routine Practice For Infants, Children, And Adolescents With Epilepsy: The International Consortium For Health Outcomes Measurement Consensus Recommendations, Martha Sajatovic

Faculty Scholarship

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy, and their representatives to develop minimum sets of standardized outcomes and outcome measurement methods for clinical practice. Using modified Delphi consensus methods with consecutive rounds of online voting over 12 months, a core set of outcomes and corresponding measurement tool packages to capture the outcomes were identified for infants, children, and adolescents with epilepsy. Consensus methods identified 20 core outcomes. In addition …

Educating Pediatric Registered Nurses On The Administration Of Prolonged Intravenous Antibiotics, Kasandra Rezler

Master's Projects and Capstones

Abstract

Problem According to Children’s Hospital A's incident reporting system, 50% of problems related to prolonged intravenous antibiotics were classified as administration issues. When mistakes are made in this process, the antibiotic is then delivered at the wrong rate or the wrong time, which is problematic. Additionally, findings from a needs assessment survey highlight a critical need for targeted interventions, such as an educational video, to reduce administration errors associated with prolonged IV antibiotics. Context Within Children’s Hospital A, the microsystems targeted by this quality improvement project consist of inpatient pediatric patient care units (PCU) 300, 360, and 400. Children’s …

Liver Acox1 Regulates Levels Of Circulating Lipids That Promote Metabolic Health Through Adipose Remodeling, Dongliang Lu, Anyuan He, Min Tan, Marguerite Mrad, Amal El Daibani, Donghua Hu, Xuejing Liu, Brian Kleiboeker, Tao Che, Fong-Fu Hsu, Monika Bambouskova, Clay F. Semenkovich, Irfan J. Lodhi

2020-Current year OA Pubs

No abstract provided.

Multiple Myeloma Patients With A Long Remission After Autologous Hematopoietic Stem Cell Transplantation, Oren Pasvolsky, Zhongya Wang, Denái R Milton, Mark R Tanner, Qaiser Bashir, Samer Srour, Neeraj Saini, Paul Lin, Jeremy Ramdial, Yago Nieto, Guilin Tang, Partow Kebriaei, Yosra Aljawai, Hina N Khan, Hans C Lee, Christine Ye, Krina K Patel, Sheeba K Thomas, Robert Z Orlowski, Elizabeth J Shpall, Richard E Champlin, Muzaffar H Qazilbash

Faculty, Staff and Student Publications

Autologous stem cell transplantation (autoHCT) is considered standard of care for newly diagnosed multiple myeloma (MM). Although most patients eventually progress after autoHCT, a small proportion achieve a durable response. In this retrospective study we included 1576 patients, 244 (15%) of whom were long-term responders (LTR), defined as having a progression-free survival (PFS) of ≥8 years after transplant. Patients in the LTR group were younger than the non-LTR group (median age 58.4 vs. 59.5 years; p = 0.012), less likely to have high-risk cytogenetics (4% vs. 14%; p < 0.001), more often had

Travel-Time Disparities In Access To Proton Beam Therapy For Cancer Treatment, Todd Burus, Alexander D. Vanhelene, Michael K. Rooney, Krystle A. Lang Kuhs, W. Jay Christian, Christopher Mcnair, Sanjay Mishra, Arnold C. Paulino, Grace L. Smith, Steven J. Frank, Jeremy L. Warner

Markey Cancer Center Faculty Publications

IMPORTANCE Proton beam therapy is an emerging radiotherapy treatment for patients with cancer that may produce similar outcomes as traditional photon-based therapy for many cancers while delivering lower amounts of toxic radiation to surrounding tissue. Geographic proximity to a proton facility is a critical component of ensuring equitable access both for indicated diagnoses and ongoing clinical trials.

OBJECTIVE To characterize the distribution of proton facilities in the US, quantify drive-time access for the population, and investigate the likelihood of long commutes for certain population subgroups.

DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study analyzed travel times to proton facilities in …

Optimization Of Triage Documentation In A Large Urban Emergency Department, Monica Reynoso-Prieto

Master's Projects and Capstones

Problem California ranks ninth nationwide in terms of longest emergency department wait times. The project aims to reduce patient triage times by refining the workflow of triage documentation, achieved through strategic rearrangement of triage documentation questions. Context This quality improvement project took place in the emergency department of a large urban Bay Area hospital. Intervention The intervention was implementation of changes to the triage documentation based on staff feedback from an opinion survey, such as: elimination of redundant questions, consolidation of related categories, and logical reorganization of triage topics. Measures Measures used in the project were triage times and pre …

Refining Triage Documentation Practices In A Metropolitan Emergency Department, Jack A. Moody

Master's Projects and Capstones

Problem California ranks ninth nationwide for its lengthy emergency department wait times, presenting a pressing challenge for healthcare facilities. Context This quality improvement project, set in the emergency department of a large urban hospital in the Bay Area, aimed to address this issue by targeting workflow efficiency through the reduction of triage times. Intervention The intervention centered on implementing changes to the triage documentation, informed by staff feedback obtained through an opinion survey. Proposed modifications included the elimination of redundant questions, consolidation of related categories, and a logical reorganization of triage topics. Measures Key measures utilized in the project included …

Increasing Adherence To A Nurse-Driven Removal Protocol To Reduce Indwelling Urinary Catheter Days, Hannah K. Brosnan

Master's Projects and Capstones

Problem

Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs.

Context

The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area.

Interventions

Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

Enhancing Pain Documentation In Medical Surgical Units: Integrating Supportive Tools With Pain Nursing Education, Mariana Arias

Master's Projects and Capstones

Problem: Pain management in in-patient care, particularly involving opioids, is critical due to the associated risks. Proper pain assessment is essential to ensure safe medication administration and mitigate adverse effects.

Context: This quality improvement (QI) project aimed to improve opioid assessment and documentation rate above 90% compliance in two medical-surgical units, focusing on bedside nurses who play a crucial role in patient safety and effective pain management.

Interventions: A baseline survey provided nurses' understanding on compliance criteria and assessment timing. Interventions included visual reminders, informational posters, and instructions on how to access individual compliance reports.

Measures: A post intervention survey …

Enhancing Peripartum Care Through Standardized Nurse Knowledge Exchange, Gabriela Ochoa

Master's Projects and Capstones

Problem Inconsistent handoff practices during patient transfers can cause mistakes and adverse outcomes. Hospital A's peripartum unit has no set policy for Nurse Knowledge Exchange (NKE) during transfers. This project will introduce a standard handoff guide to enhance communication and prevent harmful results after patient transfers.

Context The quality improvement project was conducted in a peripartum mesosystem within an urban hospital in Northern California. This specific area of the hospital comprised 21 postpartum rooms and nine laboring rooms.

Intervention The project involved a methodical strategy that encompassed engaging stakeholders, conducting a literature review, and analyzing data to pinpoint areas for …