To address the need for a patient decision aid for refractive eye surgery, EyeChoose, a web-based tool, was developed. The tool provides patient education, assists in selection of a specific surgical modality, generates customized recommendations, and links patients to local surgeons, explicitly targeting the population of college students. I conducted a focus group interview for the needs assessment. I designed a scoring algorithm to provide a customized recommendation of surgical modalities based on a patient’s medical history and personal preferences. I completed a prototype implementation of the tool. Initial data from a validation study indicated that the system achieved 99.18% accuracy in its recommendation of a surgical modality. An evaluation of usefulness and usability, conducted via survey and focus group, also illustrated highly positive responses. Fourteen of sixteen statements in the survey received more than 80% of positive responses. I further examined the two statements that received less than 80% of positive responses to determine whether the responses varied by race, ethnicity, sex, and medical history. The focus group liked the application and found it useful for their needs. Their responses clarified features of the application that users liked/found beneficial and features that users did not like/did not find beneficial. These recommendations will be integrated into the tool as the next step. Future research is required to implement the tool in naturalistic settings and to examine the generalizability of the findings to other populations.

Emergency Medical Services (EMS) first response personnel treat urgent and immediate

illnesses and injuries in prehospital settings, and transport patients to definitive care if needed. EMS originated during warfare. The practice of rescuing wounded soldiers started during the Byzantine Empire, and developed along with other medical advances to the present day. Civilian EMS in the United States grew rapidly starting in the 1960s. Following the landmark National Research Council white paper of “Accidental Death and Disability: The Neglected Disease of Modern Society”, the nation addressed the key issues and problems faced in delivering emergency medical services. Today, colleges and universities often sponsor EMS organizations to serve populations concentrated in complex campuses. These are collectively known as Collegiate-Based Emergency Medical Services (CBEMS). By September 2018, there were 252 registered CBEMS organizations in the United States. Most are affiliated with the National Collegiate Emergency Medical Services Foundation (NCEMSF), which advocates, encourages, and provides support for CBEMS organizations. A survey repeating prior work (1996 and 2005) was sent to all NCEMSF registered CBEMS organizations, and 24 responded. The survey included questions on demographics, response capacities, coverage, organization, and logistics information. Locally, Arizona State University Student Emergency Medical Services (SEMS at ASU) began as an all-student-run volunteer organization in 2008. In 2018, SEMS at ASU became ASU EMS, as an official subdivision of the ASU Environmental Health Safety (EH&S) Department. This study summarizes the history of EMS, investigates the current status of CBEMS organizations and traces the history of ASU EMS from a volunteer group to an official department.

Background: This paper details the development of screening and education tools for finding Social Determinants of Health (SDH) in Maricopa County’s vulnerable population. SDH is known as structural or physical differences that hinder everyone to have an equal opportunity for improved health, and one of the steps to overcome the differences is through understanding what SDHs are prevalent in the targeted community, so that the community can develop the needed resources. SDH screening process was developed in collaboration with Student Health Outreach for Wellness (SHOW), a student-run organization whose aim is to provide healthcare for underserved populations. SHOW has a unique multi-disciplinary approach of treating each of their patients, and this screening is planned to be implemented during the treatment.
Methods: A literature review was conducted and SDH screening tool were adapted from known SDH screeners, such as Health Leads, PRAPARE, and CLEAR, to fit to the general population that SHOW serves. Training was also developed to educate the student volunteers who will be conducting the SDH screening and included necessary education about the population and the importance of SDH in general. Training materials include a practice scenario, a resources guide, SMART goal sheet, an introduction to the resource guide, and a process flowchart.
Outcomes: This project consists of different versions of screening tools, a training presentation, activities, handouts, and implementation ideas required to succeed in accurate SDH determination.

The medical field is one that depends on human interaction. I have noticed through my love of both English Literature and Medicine that one of the best ways to connect people, is by sharing their stories. To accomplish this, I interviewed eleven physicians to understand their human story. From those interviews, I worked to emulate their voices, to create a chapter for each of them. Through this, I was able to understand what they personally went through to get to where they are today. This has allowed me to better understand the field I plan to be in.

Currently, refugee women’s access to healthcare is a major topic of research. Refugee women face many barriers when attempting to access healthcare, and this paper aims to complete a systematic review of the results of studies published from 2009 to 2019 that investigate what specific best solutions have been put in place globally to combat struggles refugee women face while trying to obtain healthcare, identify common underlying themes, and see how these solutions can be applied to countries caring for refugees. Twelve total articles were reviewed and four main themes emerged: women’s care, mental health, health professional perspective, and community. From these four main themes, three crucial ideas emerged: culturally competent care, team-based care, and trust between patient and provider. The results showed that to improve access to healthcare for refugee women: health professionals must receive cultural sensitivity training to provide culturally competent care, team-based care must be implemented to improve patient adherence and satisfaction, and trust between the patient and provider is key to allowing refugee women feel safe enough to seek out healthcare. Culturally competent team-based care based on physician-patient trust needs to be more thoroughly adapted globally to provide care that is sensitive and empowering for refugee women, and all patients. However, these strategies will need to be further studied to determine their impact on refugee women’s health literacy & healthcare experience.

This paper describes Social Determinants of Health and the implementation of a screener. Social Determinants are structural drivers in an individual's life that affect their status of health. A screener's potential effectiveness at a student-run interdisciplinary clinic was also explored in the paper through the analysis of Student Health Outreach for Wellness (SHOW). SHOW's framework allows for a unique implementation of the screener because of the vulnerable population it serves, and the flexibility of the organization's structure. Its interdisciplinary nature allows for the SDOH screener to be integrated into its process more easily, especially with the presence of disciplines such as social work. A Social Determinants of Health questionnaire can be an important instrument to increase effectiveness in patient care by acknowledging each patient's situation more comprehensively, and moving forward with the most appropriate care plan. Among a vulnerable population such as those experiencing homelessness, an SDOH screener can identify key areas of focus that patients need addressed in order to improve their health status. A literature review was conducted to observe previous screener structures and questions. A model screener and best practices are provided as a guide for other clinics to use and adapt in their own settings. The domains of the sample screener questionnaire are tailored to serve populations with housing insecurity. The hope is to move forward with this screener after further modification of the questions, resources associated to each, and its prospective connection to the EHR system. The screener is planned to be executed at the SHOW clinic in Fall of 2018. In conclusion, a social determinants of health screener should be implemented in interdisciplinary clinics in a similar manner to SHOW's approach, to shift the focus of healthcare toward patient-centered care.

The goal of my study is to test the overarching hypothesis that art therapy is effective because it targets emotional dysregulation that often accompanies significant health stressors. By reducing the salience of illness-related stressors, art therapy may improve overall mood and recovery, particularly in patients with cancer. After consulting the primary literature and review papers to develop psychological and neural mechanisms at work in art therapy, I created a hypothetical experimental procedure to test these hypotheses to explain why art therapy is helpful to patients with chronic illness. Studies found that art therapy stimulates activity of multiple brain regions involved in memory retrieval and the arousal of emotions. I hypothesize that patients with chronic illness have a reduced capacity for emotion regulation, or difficulty recognizing, expressing or altering illness-related emotions (Gross & Barrett, 2011). Further I hypothesize that art therapy improves mood and therapeutic outcomes by acting on the emotion-processing regions of the limbic system, and thereby facilitating the healthy expression of emotion, emotional processing, and reappraisal. More mechanistically, I propose art therapy reduces the perception or salience of stressors by reducing amygdala activity leading to decreased activation of the hypothalamic-pituitary-adrenal (HPA) axis. The art therapy literature and my hypothesis about its mechanisms of action became the basis of my proposed study. To assess the effectiveness of art therapy in alleviating symptoms of chronic disease, I am specifically targeting patients with cancer who exhibit a lack of emotional regulation. Saliva is collected 3 times a week on the day of intervention: morning after waking, afternoon, and evening. Stress levels are tested using one-hour art therapy sessions over the course of 3 months. The Perceived Stress Scale (PSS) assesses an individual's perceived stress and feelings in past and present situations, for the control and intervention group. To measure improvement in overall mood, 10 one-hour art sessions are performed on patients over 10 weeks. A one-hour discussion analyzing the participants' artwork follows each art session. The Spielberger State-Trait Anxiety Inventory (STAI) assesses overall mood for the intervention and control groups. I created rationale and predictions based on the intended results of each experiment.

Healthcare systems and health insurance are both concepts implemented in every country to provide access to the general population. Countries undergo healthcare reforms in order to increase the performance of the system. In 2010, the Affordable Care Act (ACA) was introduced in the United States to increase coverage and create a more inclusive health insurance market. For comparison, the recent reforms in Chile and Singapore were observed as points to determine what concepts work well and what can be implemented in the U.S. system. Unlike the United States, Chile and Singapore completely altered the system that was previously in use. In Chile, the reforms began in the 1970s and made two more major changes in 1973 and early 2000s. Singapore began its reform in the 1960s and created the medical savings account system that is still in use today. To analyze the system further, the medical professions of neurology, physician assistants and optometry were compared in each country. In regards to neurology, the coverage of services in Chile and Singapore are similar in that select medical procedures are covered. In contrast, the United States offers coverage on a case-by-case basis. For physician assistants, such a profession does not exist in Chile or Singapore. In the United States, the profession is rapidly expanding, and coverage is offered for most services provided. Optometry is a stand-alone profession in both the U.S. and Singapore. The services provided by the optometrists are selectively covered by insurance, depending on whether it is considered a medical problem. Chile covers the services often provided by optometrists, however, the ophthalmologist is the provider, as optometry does not exist. This study concluded that the U.S. should continue to provide a more inclusive healthcare system that includes vision and dental care. The U.S., like Singapore, should also adopt a more integrative system. Under this system, patient care would be provided in a way that professionals specializing in the care are included in every step of the process.