Inflammation is often a protective reaction against harmful foreign agents. However, in many disease conditions, the mechanisms behind the inflammatory response are poorly understood. Often times, the inflammation causes adverse effects, such as joint pain, abdominal pain, fever, fatigue, and loss of appetite. Thus, many treatments aim to inhibit the inflammatory response in order to control adverse symptoms. Such treatments include TNFα inhibitors. However, a major risk associated with drugs inhibiting tumor necrosis factor alpha (TNFα) is serious infection, including tuberculosis (TB). Anti-TNFα therapy is used to treat patients with Crohn’s disease, for which the risk of tuberculosis may be even more concerning. Recent literature suggests Crohn’s might involve Mycobacterium avium subspecies paratuberculosis (MAP), an intracellular TB-like bacterium. This study seeks to investigate the risk of developing TB in patients with Crohn’s disease treated with TNFα inhibitors. A meta-analysis synthesized existing evidence. Evidence came from published randomized, double-masked, placebo-controlled trials of TNFα inhibitors for treatment of adult Crohn’s disease. Twenty-three trials were identified, including 5,669 patients. The risk of tuberculosis was significantly increased in anti-TNFα treated patients, with a risk difference of 0.028 (95% confidence interval [CI], 0.0011-0.055). The odds ratio was 4.85 (95% CI, 1.02-22.99) when all studies were included and 5.85 (95% CI, 1.13-30.38) when studies reporting zero tuberculosis cases were excluded. The risk of tuberculosis is increased in patients with Crohn’s disease treated with TNFα inhibitors. The medical community should be alerted about this risk and the potential for TNFα inhibitor usage favoring granulomatous infections and worsening the patient condition.

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Simulation and experiential training have been incorporated into medical school training for decades. The utilization of medical simulations has become an invaluable tool in healthcare education and training. However, circumstances such as limited resources, geographical constraints, or global health crises may hinder the feasibility of conducting in-person medical simulations. In these scenarios, virtual medical simulations emerge as a compelling alternative. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience. As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, the research was interested in understanding students’ perceptions of virtual and in-person experiential learning activities. The primary goal of this study is to compare medical students’ perceptions of the quality and value of in-person versus virtual experiential learning during their pediatric clerkship.

The healthcare sector is pivotal, offering life-saving services and enhancing well-being and community life quality, especially with the transition from paper-based to digital electronic health records (EHR). While improving efficiency and patient safety, this digital shift has also made healthcare a prime target for cybercriminals. The sector's sensitive data, including personal identification information, treatment records, and SSNs, are valuable for illegal financial gains. The resultant data breaches, increased by interconnected systems, cyber threats, and insider vulnerabilities, present ongoing and complex challenges. In this dissertation, we tackle a multi-faceted examination of these challenges. We conducted a detailed analysis of healthcare data breaches using the VERIS (Vocabulary for Event Recording and Incident Sharing) dataset. We delve into the trends of these breaches, investigate the attack vectors, and identify patterns to inform effective mitigation strategies. We conducted a spatiotemporal analysis of the VERIS and the Office of Civil Rights (OCR) datasets. We explored the geographical and temporal distribution of breaches and focused on the types of targeted assets to decipher the attackers' motives. Additionally, we conducted a detailed analysis of hospitals' online presence, focusing on their security and performance features. By comparing government, non-profit, and private hospitals in the U.S., we examined their security practices, content, and domain attributes to highlight the differences and similarities in the digital profiles of these hospital types. Furthermore, we expand our scope to include a comparative sector-based study investigating data breaches across various critical sectors. This broader view provides a contextual understanding of the healthcare sector's unique vulnerabilities compared to other sectors. Overall, this dissertation contributes fundamental insights into healthcare data breaches and hospitals' digital presence and underscores the urgent need for enhanced understanding and implementation of robust security measures in this vitally important sector, striving for a balance between technological advancement and data security.

El estudio se centra en el desarrollo de una aplicación móvil de navegación en interiores basada en realidad aumentada (RA) para mejorar la experiencia de los pacientes en el Hospital Regional Docente Las Mercedes. El objetivo principal es proporcionar información en tiempo real sobre la ubicación y detalles de áreas de interés dentro del hospital. Para lograrlo, se desarrolló una aplicación que traza rutas eficientes a los puntos de interés y ofrece información relevante sobre las áreas del hospital. La precisión de la aplicación se evaluó para garantizar su viabilidad, logrando reducir el tiempo de navegación a menos de 20 segundos y la incorporación de 301 puntos de interés. La determinación de rutas fue considerada aceptable por el 71% de los usuarios, mientras que el acceso preciso se logró en el 91% de las pruebas realizadas. Sin embargo, un 9% de las pruebas no resultaron efectivas. Este proyecto destaca la utilidad de la realidad aumentada en entornos de salud, ofreciendo una solución innovadora para mejorar la orientación y experiencia de los pacientes dentro del hospital. / The study focuses on the development of an indoor augmented reality (AR)-based mobile navigation application to enhance the patient experience at the Las Mercedes Regional Teaching Hospital. The main objective is to provide real-time information about the location and details of areas of interest within the hospital. To achieve this, an application was developed that maps efficient routes to points of interest and provides relevant information about hospital areas. The accuracy of the application was evaluated to ensure its feasibility, achieving a navigation time reduction to less than 20 seconds and the incorporation of 301 points of interest. Route determination was deemed acceptable by 71% of users, while precise access was achieved in 91% of tests conducted. However, 9% of the tests were not effective. This project highlights the utility of augmented reality in healthcare environments, offering an innovative solution to enhance patient orientation and experience within the hospital.

The benefits of using electronic medical records (EMRs) have been well documented; however, despite numerous financial benefits and cost reductions being offered by the federal government, some healthcare professionals have been reluctant to implement EMR systems. In fact, prior research provides evidence of failed EMR implementations due to resistance on the part of physicians, nurses, and clinical administrators. In 2010, only 25% of office-based physicians have basic EMR systems and only 10% have fully functional systems. One of the hindrances believed to be responsible for the slow implementation rates of EMR systems is resistance from healthcare professionals not truly convinced that the system could be of substantive use to them. This study used quantitative methods to measure the relationships between six constructs, namely computer self-efficacy (CSE), perceived complexity (PC), attitude toward EMR (ATE), peer pressure (PP), anxiety (AXY), and resistance to use of technology (RES), are predominantly found in the literature with mixed results. Moreover, they may play a significant role in exposing the source of resistance that exists amongst American healthcare professionals when using Electronic Medical Records (EMR) Systems. This study also measured four covariates: age, role in healthcare, years in healthcare, gender, and years of computer use. This study used Structural Equation Modeling (SEM) and an analysis of covariance (ANCOVA) to address the research hypotheses proposed. The survey instrument was based on existing construct measures that have been previously validated in literature, however, not in a single model. Thus, construct validity and reliability was done with the help of subject matter experts (SMEs) using the Delphi method. Moreover, a pilot study of 20 participants was conducted before the full data collection was done, where some minor adjustments to the instrument were made. The analysis consisted of SEM using the R software and programming language. A Web-based survey instrument consisting of 45 items was used to assess the six constructs and demographics data. The data was collected from healthcare professionals across the United States. After data cleaning, 258 responses were found to be viable for further analysis. Resistance to EMR Systems amongst healthcare professionals was examined through the utilization of a quantitative methodology and a cross-sectional research measuring the self-report survey responses of medical professionals. The analysis found that the overall R2 after the SEM was performed, the model had an overall R2 of 0.78, which indicated that 78% variability in RES could be accounted by CSE, PC, ATE, PP, and AXY. The SEM analysis of AXY and RES illustrated a path that was highly significant (β= 0.87, p < .001), while the other constructs impact on RES were not significant. No covariates, besides years of computer use, were found to show any significance differences. This research study has numerous implications for practice and research. The identification of significant predictors of resistance can assist healthcare administrators and EMR system vendors to develop ways to improve the design of the system. This study results also help identify other aspects of EMR system implementation and use that will reduce resistance by healthcare professionals. From a research perspective, the identification of specific attitudinal, demographic, professional, or knowledge-related predictors of reference through the SEM and ANCOVA could provide future researchers with an indication of where to focus additional research attention in order to obtain more precise knowledge about the roots of physician resistance to using EMR systems.

The multi-million-dollar medical uniform industry has not utilized advancements in garment and textile technology that could positively impact the protection of healthcare professionals and patients. In most cases the uniforms meet basic requirements – they clothe the professional in a recognizable way. Little innovation in design, function and performance, has been applied to these garments. This is particularly evident in the case of the stereotypical white lab coat worn by many physicians, despite evidence indicating that these lab coats may carry contamination and play a role in the spread of deadly bacteria. Healthcare Associated Infections (HAIs) are among the most serious problems facing modern medical care, costing millions of lives and dollars annually worldwide. This research investigates the design and use of the physician’s lab coat – an immediately recognizable symbol of Western medicine. The research identifies the medical, functional, cultural and symbolic roles of the lab coat within the hospital environment and beyond, to the larger the global society. This thesis examines the extent to which the design of medical wear can impact the effect of hospital-acquired infections, support doctor/patient relationships and enhance the performance and behavior of the healthcare professional by envisioning a future lab coat which offers increased protection for physician and patient, aids in communication and enhances the performance of the doctor by utilizing digital technologies incorporated into the lab coat whereby the lab coat becomes the only tool necessary for the physician.

For decades, healthcare access and quality in central and southern Appalachia have trailed the rest of the country. Entrenched poverty and low educational attainment compound healthcare problems. This study examines the healthcare obstacles women encounter in southern and central Appalachia and analyzes how technology use, such as Internet searching and social media affect women’s healthcare decisions. Data were analyzed from four focus groups conducted with women from the region. Results indicate that seeing a physician or not did not influence women’s propensity to search the Internet for health-related information or to seek support through social media sites. Additionally, women reported facing many barriers including trust in local physicians, access, availability, cost, and quality of healthcare. These issues often impede women’s access to preventative care and place burdens on their health and an already strained healthcare system.

Our modern health care system requires technology that can deal with multidisciplinary and complex processes, operations, and situations. The EHR, by far, is one of the greatest health information technology innovations that satisfy these requirements because of its efficiency and the effectiveness of its features. This study sought to develop an in-depth understanding of how underserved patients' perspectives about their health and illness, can contribute to greater use of the EHR. It also sought to improve their health outcomes and maintain sustainable change in the lives of the underserved. A quantitative non-experimental design study was conducted over a 6-week period outside of three different internal medicine clinics, one in the Northwestern and the two others in the Southeastern regions of Washington, DC. Surveys were distributed directly to patients coming out of these health clinics, and participants sent their responses via mail. Data collection included 215 surveys out of 560, but, only 155 fit the overall study categories. A strong level of significance in the relationships between clinical outcome measures and the EHR was identified at a 95% confidence interval. There were considerable health determinants that demonstrated the essence of patients' perspectives and the need for its incorporation into health outcomes measures for the underserved populations. The study also identified sets of environmental health predictors which acted as facilitators and contributors to a holistic health management model designed to contribute to the needs of the underserved communities. The holistic health model and the individual care plan model derived from the study are applicable at the level of the underserved population. It can help achieve sustainable health outcomes that will save lives and promote better health.

This thesis study evaluates access to care at an internal medicine unit with solely semi-private rooms at Baystate Medical Center (BMC). Patients are divided into two types: Type I patient consumes one bed; Type II patient occupies two beds or an entire semi-private room as a private space for clinical reasons, resulting in one empty but unavailable (blocked) bed per Type II patient. Because little data is available on blocked beds and Type II patients, unit-level hospital bed planning studies that consider blocked beds have been lacking. This thesis study bridges that gap by building a single-stream and a two-stream discrete micro-simulation model in Excel VBA to describe unit-level bed queue dynamics at hourly granularity in the next 48-hour time horizon, using historical arrival rates and census-dependent discharge rates, supplemented with qualitative results on complexity of patient-level discharge prediction. Results showed that while we increase additional semiprivate beds, there was notable difference between the traditional single-stream model and the two-stream model concerning improvement in bed queue size. Possible directions for future research include patient-level discharge prediction considering both clinical and nonclinical milestones, and strategic redesign of hospital unit(s) considering overflows and internal transfers.