Digital Commons Network^™

From “Fixer” To “Facilitator”: A Clinical Review Of Shared Medical Appointments As A Strategy For Workforce Sustainability, Barbara A. Slusher

Lynchburg Journal of Medical Science

Clinician burnout remains a significant threat to workforce sustainability, particularly in resource-constrained settings managing complex chronic diseases. While shared medical appointments (SMAs) have demonstrated clear benefits in patient satisfaction and access, their impact on clinician well-being and professional fulfillment is less clearly defined. This review evaluates whether participation in SMAs improves clinician satisfaction and mitigates burnout by facilitating a conceptual transition from isolated “Fixer” to collaborative “Facilitator.”

A targeted literature search of PubMed, the Cochrane Library, and Google Scholar identified peer-reviewed publications examining shared medical appointments and clinician-centered outcomes, including burnout, clinician satisfaction, and workforce sustainability. …

Exploring Social Cognitive Learning In Simulation-Enhanced Interprofessional Education: A Case Study, William Nicholas Vasios Iii

Doctoral Dissertations and Projects

The purpose of this single-case design study is to explore the impact of observational and vicarious learning during simulation-enhanced interprofessional education (Sim-IPE) on the confidence and perceived self-efficacy of nursing students and IM residents at a southeastern university. Guided by Bandura’s social cognitive learning theory, which addresses the personnel, behavioral, and environmental factors of Sim-IPE, while answering the central research question: How does observational and vicarious learning during Sim-IPE impact participant confidence and perceived self-efficacy? This qualitative single-case study was conducted at a university in the southeastern United States, using data collected through visual confidence analog scale surveys, interviews, and …

Implementation Readiness For National Cancer Survivorship Care Standards, Christiane J. El Khoury, Meera Gupta, Maryem Shirzadi, Heidi Dowst, Martha Mims, Maysa Abu-Khalaf, Hoda Badr

Kimmel Cancer Center Faculty Papers

IMPORTANCE: Cancer survivorship care is a growing public health priority, yet delivery remains variable across health systems. The National Standards for Cancer Survivorship Care provide a framework for high-quality care, but little empirical evidence exists regarding health system readiness to implement these standards in routine practice.

OBJECTIVE: To assess implementation readiness for the National Standards for Cancer Survivorship Care and identify perceived barriers to implementation.

DESIGN, SETTING, AND PARTICIPANTS: This real-time Delphi survey study was conducted from January to March 2025 at a National Cancer Institute-designated comprehensive cancer center. Participants were multidisciplinary experts involved in cancer survivorship care delivery, care …

2026 Focused Update Of The Saudi Heart Association Guidelines On Best Practices In The Management Of Chronic Coronary Syndromes, Owayed Alshammeri, Halia Alshehri, Shukri Alsaif, Mirvat Alasnag, Fatema Qaddoura, Fahad Alqahtani, Yosra Abdulahad A Turkistani, Walid Alharbi, Adel Tash, Mohammad Alshehri, Khalid Al Faraidy, Waleed Alhabeeb

Journal of the Saudi Heart Association

Background: Chronic coronary syndromes (CCS) continue to impose a substantial clinical and economic burden in Saudi Arabia. Since publication of the 2022 Saudi Heart Association (SHA) CCS guidelines, important advances have emerged in diagnosis, pharmacotherapy, cardiometabolic risk reduction, antiplatelet management, and revascularization. This 2026 focused update selectively revises and clarifies key recommendations to reflect these advances within the Saudi context.

Methods: A multidisciplinary SHA expert panel conducted a structured review of randomized trials, meta-analyses, and relevant international guidance published since 2022. Updates were restricted to areas with substantive new evidence or evolving clinical practice. Recommendations were formulated through expert consensus …

Two-Thirds Return But Performance Suffers: Acl Reconstruction Outcomes Across Elite European Women's Soccer Leagues, Haneef Khan, Forest Rodriguez, Amina Khan, Ashley Rosenberg, Stephen Marcaccio

Student Papers, Posters & Projects

PURPOSE: To analyse return-to-play (RTP) rates, timing and performance outcomes following anterior cruciate ligament (ACL) reconstruction (ACLR) in elite European women's soccer players across the top five leagues.

METHODS: We reviewed ACL injuries sustained by female professional soccer players across the Bundesliga, Women's Super League, Primera División Femenina, Serie A Women and Première Ligue between 2007 and 2025. Players were included if they had a confirmed ACL injury requiring ACLR and one season of performance data pre- and post-injury. Players were excluded if the injury occurred during their rookie season or after the 2023 season. Data were collected from Soccerdonna.de …

Knowledge Of Parents About Thalassemia In Tabuk City: A Cross-Sectional Study, Sawsan Mohammed Alblewi, Amirah M. Alatawi, Ehab Mahmoud Hanafy, Faisal Mayudh Althobaiti, Abdulelah Hamad Al-Balawi, Faisal Mohammed Alamrani, Yazeed Mahmoud Ajwah, Omar Muslih Albalawi, Mohammed Majed Alquayr, Sultan Ibrahim Alhamdi

Makara Journal of Health Research

Background: Thalassemia is a common inherited blood disorder and remains a significant public health concern in Saudi Arabia. Parental knowledge is essential for effective prevention, screening, and early intervention. This study aimed to assess the knowledge of thalassemia among parents in Tabuk City, Saudi Arabia, and identify factors associated with knowledge levels.

Methods: A cross-sectional study was conducted among 392 parents residing in Tabuk City between March and May 2025. Data were collected using a validated Arabic questionnaire distributed online. Knowledge was assessed using 21 items covering general thalassemia knowledge, thalassemia major, carrier status, and prevention. Knowledge levels …

“Something Else To Focus On”: Perinatal Havening And Stress Coping In Pregnant Black Women, Brittany L. Ferrell Young

WUSM Theses and Dissertations – All Programs

Black women in the United States experience maternal mortality at more than three times the rate of white women, a disparity driven by chronic stress rooted in structural racism rather than individual behavior or biology. Accessible, culturally responsive tools for managing stress during pregnancy remain scarce. This mixed-methods pilot feasibility study examined Perinatal Havening, a self-administered psychosensory technique, as a stress management intervention for pregnant Black women. Guided by Lazarus and Folkman's Transactional Theory of Stress and Coping, the study addressed three questions: how Black women experience acute and chronic stress during pregnancy, the acceptability and preliminary influence of Perinatal …

Fall Risk In Community-Dwelling Adults: A Comparison Of English And Spanish-Speaking Individuals, Jesus D. Gomez

Dissertations, 2020-current

Falls are a leading cause of injury-related mortality among middle-aged and older adults. Although vestibular dysfunction, hearing loss, behavioral factors, and social determinants of health have been associated with increased fall risk, few studies have examined these relationships. Furthermore, limited research in audiology and vestibular science has investigated fall-risk vulnerability among Spanish-speaking individuals.

This study aimed to: (1) estimate the prevalence of fall risk among community-dwelling adults and compare prevalence between English-speaking and Spanish-speaking participants; (2) assess the prevalence of previously undiagnosed benign paroxysmal positional vertigo (BPPV) and compare prevalence between language groups; and (3) develop predictive models of fall …

Impact Of Stress & Fatigue On Cardiovascular Function In Young Pilots: A Thematic Review, Swarna Manoj

Discovery Day - Daytona Beach

Impact of Stress & Fatigue on Cardiovascular Function in Young Pilots: A Thematic Review   Authors: Swarna Manoj, Scott Ferguson   Keywords: pilot, stress, fatigue, heart rate variability (HRV), cardiovascular disease (CVD) Aviation is expanding globally and young pilots are the major workforce, yet FAA protocols require mandatory ECG only from age 35, with annual cardiac screening after age 40. Over the past five years, a pattern of sudden cardiac arrests in pilots particularly aged 30-40 has urged safety concerns. Despite the existing literature examining fatigue, burnout, stress, sleep hygiene and circadian disruption, only few studies systematically examine how these factors impact …

Pre-Implementation Factors For Active Music Engagement (Ame): Barriers And Facilitators To Integrating An Evidence-Based Dyadic Intervention Into Pediatric Oncology Care., Kristin M. Story, Elizabeth Harman, Kristin Stegenga, Jelena Golubovic, Sheri L. Robb

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Pediatric cancer treatment is a difficult and distressing experience that often results in sustained, interrelated distress in young children and parents, and traumatic stress symptoms for some parents. Few evidence-based interventions address this dyadic distress. Active Music Engagement (AME) is a manualized, evidence-based music play intervention that significantly reduces distress in child/parent dyads and mitigates traumatic stress and improves well-being among highly distressed parents and those experiencing sociodemographic risk. Successfully integrating AME into standard care requires a systematic understanding of implementation factors. This study aimed to identify site-specific barriers and facilitators that influenced successful AME delivery during a recently …

Race And Ethnicity And Overall Survival In Pediatric Acute Myeloid Leukemia, Daniel J. Zheng, Long Khuong, Catherine Aftandilian, Kira Bona, Emi H. Caywood, Caitlin W. Elgarten, Brian T. Fisher, Cody-Aaron L. Gathers, Taumoha Ghosh, M. Monica Gramatges, Gary Hettinger, Meret R. Henry, Yuan-Shung V Huang, Yimei Li, Kelly Maloney, Amir Mian, Tamara P Miller, Arunkumar Modi, Rajen Mody, Regina M. Myers, Haley Newman, Jose Ortiz, Alix E. Seif, Caroline Smith, Jamie Stokke, Naomi Winick, Jennifer J. Wilkes, Victor Wong, Richard Aplenc, Kelly D. Getz

Department of Pediatrics Faculty Papers

IMPORTANCE: Hispanic and non-Hispanic Black (hereafter, Black) children with acute myeloid leukemia (AML) have historically experienced worse survival outcomes compared with non-Hispanic White (hereafter, White) children. Understanding specific intermediate pathways underlying these outcome disparities is a critical step to directing interventional efforts and resources.

OBJECTIVE: To compare survival outcomes by race and ethnicity in a large contemporary cohort of pediatric patients with AML and to examine presentation acuity, frontline organ toxic effects, and relapse as potential mediators of any observed outcome disparities.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was analyzed from April 2025 to January 2026 and included …

Fatigue And Circadian Disruption In Long-Haul Ferry Pilots: Human Factors Challenges And Mitigation Strategies, Parneet Makkar

Discovery Day - Daytona Beach

Fatigue and circadian rhythm disruption present significant human factors challenges in long-haul aviation operations, particularly for ferry pilots (pilots responsible for transporting aircraft long distances between locations) who often travel across multiple time zones before beginning flight duties. Circadian rhythms regulate the human sleep-wake cycle and are closely tied to cognitive performance, alertness, and coordination. Rapid travel across time zones can disrupt these rhythms, producing symptoms commonly associated with jet lag such as sleep disturbances, fatigue, and reduced cognitive functioning. For ferry pilots, long travel periods and irregular schedules may increase the likelihood of fatigue before flight operations even begin. …

Dichoptic Therapy Versus Patching – State Of Literature Review, Eve Miller

inSIGHT

Amblyopia is the most common cause of vision loss in children. A meta-analysis performed by Hu et al. 2022 estimated the global prevalence of amblyopia to be 1.36%.¹ Amblyopia is defined as a reduction in best-corrected visual acuity (BCVA) of one or both eyes caused by abnormal neurologic development in the critical period of visual development. Amblyopia may result from unequal refractive error, strabismus or ocular pathology.² Despite treatment of these inciting factors, suppression of one eye remains, resulting in unequal vision. The clinical consequences of untreated amblyopia include permanent reduction in vision in the affected eye and …

Insight, Volume 6, Issue 1, 2026

inSIGHT

Contents

7 - Novel Treatments for Keratoconus
By Caroline Paik

12 - Novel Advancements in Glaucoma Surgery
By Eshani Ragam

16 - Dichoptic Therapy versus Patching – State of Literature Review
By Eve Miller

24 - GLP-1 Receptor Agonists and Ocular Risk
By Saharsh Satheesh

33 - Home-use OCT for Neovascular Age- Related Macular Degeneration
By Sneh Shah

40 - Implementation of Artificial Intelligence in Retinoblastoma Diagnosis
By Zana Moldavsky

Relationship Identification Between Triggers And Changes In The Brain And The Overall Human Electrophysiology During Migraines, Dominic Sandell, Jonah Dematto, Gianpiero Lara, Jasmine Rosales, Legacy Wilson, Zachary Young

Discovery Day - Daytona Beach

One of the most common neurological conditions in the world is migraines; nearly 1/4th of the working population suffers from this condition and exhibits a large variety of triggers. The current treatment method for migraine uses few different medications for all migraines, regardless of triggers. Our hypothesis is that there is a specific relationship between the triggers of migraines and the electrical changes in the brain during migraines. It is known that electrical activity in the brain occurs during migraines; it is unclear whether these changes differ across triggers. The study incorporates two different data collection methods: electrophysiological tests (Electroencephalogram …

Deaths Of Despair Among Cancer Survivors In Rural/Urban Appalachia (2000-2022), Jason Semprini, Anders Erickson, Nosa Osazuwa-Peters

Journal of Appalachian Health

Introduction: Rising deaths of despair (premature deaths from suicide, overdose, alcohol, and violence) in adults under age 65 persist across the United States, especially in Appalachia. People diagnosed with cancer may face elevated risks of such deaths due to pain, psychosocial distress, and financial hardship.

Purpose: Deaths of despair trends were compared among adults with cancer across Appalachian and non-Appalachian regions, stratified by sex and rurality.

Methods: Analyzing SEER-21 Incidence-Based Mortality data (2000–2022), deaths caused by suicide, cirrhosis of the liver, or accidents (includes overdose) were identified among adults aged 20–64 years. Annual mortality rates per 100,000 total population were …

The Effect Of Snris On Pilot Reaction Time In Simulated Flight, Isabella Owen, Aidan Roach, Micah Henry, Casey Tressler

Discovery Day - Daytona Beach

Many aviators who are prescribed serotonin and norepinephrine reuptake inhibitors (SNRI) or selective serotonin reuptake inhibitors (SSRI) to treat mental health disorders such as major depressive disorder, general anxiety disorder, or post-traumatic stress disorder must halt their duties for a set amount of time. This is due to aviation authorities having data that suggests SNRIs and SSRIs lead to inhibitions in mental processes that can cause crashes or death. Most of the research that has been conducted examined the effects of SSRIs on individuals without mental health disorders in non-flight settings. This study will explore the effect SNRIs have on …

Effects Of Sleep Duration And Perceived Stress Of Reaction Time In Undergraduate Students, Caitlin Wescott, Edna Urrutia, Ryan F. Rednick, David Still

Discovery Day - Daytona Beach

Sleep deprivation and psychological stress are common among undergraduate students and can negatively affect cognitive performance. Reaction time is an important indicator of attention and processing speed and plays a critical role in both everyday activities, such as driving, and high-performance environments where rapid responses are required. This study aims to examine how sleep duration and perceived stress levels influence reaction time in undergraduate students. Participants will report their sleep duration and perceived stress levels through short surveys and wearable sleep data, while reaction time will be measured using a standardized computerized reaction time test. By comparing reaction time across …

Establishment Of A Specialized Pectus Clinic: Referral Patterns, Diagnostic Characteristics, And Early Management Experience At A University Hospital, Zeead M. Alghamdi

Saudi Medical Journal

Objectives: To describe the establishment and early impact of a dedicated pectus clinic at a university hospital, focusing on patient characteristics, referral pathways, clinical presentation, and initial management strategies. Methods: A retrospective observational study was conducted at a university hospital between January 2020 and April 2025, with 153 patients included in the final analysis. Data collected included demographic characteristics, referral sources, clinical presentation, deformity type, and treatment options. Descriptive statistical analysis was performed. Results: The mean patient age was 18.3 (range 1–44) years, with males accounting for 83.9% of cases. Pectus carinatum was the most common diagnosis (48.1%), followed by …

Disengagement And Reconnection: Investigating The Role Of Purpose And Identity Seeking Across Career Stages In Healthcare, Charmel Renee Jeffery

Radiologic Sciences

Purpose To examine the generational purpose gap in healthcare by identifying the psychological and environmental factors underlying early-career disengagement and late-career reconnection.

Method An integrative literature review was conducted using four academic databases. An artificial intelligence (AI)-assisted thematic synthesis was applied to extract and organize findings within a standardized analytic matrix. To ensure accuracy and rigor, all AI-generated outputs were validated against the original source data.

Results Two primary themes emerged. Early-career healthcare workers commonly experienced disengagement associated with destiny beliefs, while later-career professionals demonstrated renewed purpose and resilience despite ongoing stressors.

Discussion The findings revealed a pronounced generational divide …

Impact Of Music On Patient Comfort During Mr Scans: A Literature Review, He Yan

Radiologic Sciences

Purpose To investigate the influence of auditory stimuli on patient comfort levels during magnetic resonance (MR) imaging, with particular emphasis on indicators of distress, duration of patient positioning, and utilization of emergency signaling devices.

Method An integrative literature review was undertaken utilizing peer-reviewed research articles sourced from journals within the fields of radiology, music therapy, and clinical practice. A comprehensive search was conducted across databases such as PubMed, ScienceDirect, SpringerLink, and Oxford Academic employing keywords including MR anxiety, music therapy, and patient comfort.

Results The body of literature consistently indicated that auditory stimuli significantly mitigate patient anxiety and distress in …

Impact Of Artificial Intelligence On The Roles And Career Trajectories Of Radiologic Technologists, Carolina Esquivel

Radiologic Sciences

Purpose To examine how artificial intelligence (AI) is influencing the roles, responsibilities, and career trajectories of radiologic technologists by identifying emerging challenges and opportunities associated with AI integration in medical imaging.

Method A systematic literature review was conducted using PubMed and CINAHL to identify peer-reviewed studies published between 2016 and 2026. Eligible studies examined AI applications in medical imaging and their effects on workforce roles, education, collaboration, and professional practice. Findings were synthesized using thematic analysis.

Results Three primary themes emerged: (a) workflow efficiency and protocol optimization through AI-assisted imaging processes; (b) professional skill development and evolving responsibilities related to …

Administrative And Clinical Impacts Of Theranostic Program Expansion In Nuclear Medicine, Karmela Kljajic Pascual

Radiologic Sciences

Purpose To synthesize current evidence on theranostic trials, nuclear medicine clinical workflow models, and organizational readiness, with a focus on how healthcare organizations and medical imaging leaders are adapting to the rapid expansion of theranostic services.

Method A comprehensive search was conducted across Scopus, PubMed, MEDLINE, and Google Scholar. Inclusion criteria required peer‑reviewed articles published between 2002 and 2026 addressing nuclear medicine leadership, theranostic implementation, workflow design, and organizational factors influencing theranostic program development. Exclusion criteria removed editorials, blog posts, and nonpeer‑reviewed sources.

Results Four major themes emerged: workforce and staffing demands, infrastructure and resource requirements, regulatory and administrative pressures, …

Interpreting Continuous Glucose Monitoring Through Metabolic Physiology: A Framework For Precision Nutrition In Type 2 Diabetes, Jitendra D. Belani

College of Pharmacy Faculty Papers

Background: Type 2 diabetes is characterized by substantial interindividual variability in postprandial glucose responses, yet continuous glucose monitoring (CGM)-derived glucose patterns are commonly described using quantitative metrics without sufficient consideration of the physiological mechanisms that generate them. Objective: To develop a physiology-based framework for interpreting CGM-derived glycemic phenotypes in relation to dietary exposures and individual metabolic characteristics, thereby supporting precision nutrition in adults with type 2 diabetes. Methods: A structured narrative review of the literature was conducted using PubMed to identify studies examining CGM, postprandial glucose regulation, dietary exposures, metabolic physiology, and precision nutrition. Evidence was synthesized within a predefined …

An Update On The Role Of Multimodal Analgesia In Perioperative Pain Management, Whitney N. Kuwamoto, Grace C. Eddy, Edward R. Mariano, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

Multimodal analgesia has become a foundational principle of acute perioperative pain management and enhanced recovery and involves the application of nonpharmacologic, pharmacologic, and/or interventional techniques. The overall goal of this approach is to apply a combination of different modalities that target discrete points along the pain pathway and thereby avoid the overreliance on opioids and associated side effects. Since our review in 2018, there have been significant developments that have prompted an updated review of multimodal analgesia. In this article, we identify and summarize important trends that influence the current approach to acute perioperative pain management as well as provide …

A Cooking Skills Intervention For Long-Term Weight Loss In Young Adults With Intellectual Disabilities: Rationale And Design For A Randomized Trial., Lauren T. Ptomey, Jessica C. Danon, Delwyn Catley, Richard A. Washburn, Amy Bodde, Francisco J. Diaz, Brian C. Helsel, Anna M. Rice, Joseph R. Sherman, Madison Koester, Walker S. Mckinney Ph.D., Joseph E. Donnelly

Manuscripts, Articles, Book Chapters and Other Papers

Young adults with intellectual disability (ID) are an underserved population with a high prevalence of obesity, obesity-related health conditions, and reduced ability to complete instrumental and basic activities of daily living (I/ADLs). After leaving the structured environment of public school, many young adults with ID spend more time at home or in day programs, begin living more independently, or enter the workforce. These transitions may increase reliance on fast or processed foods and reduce opportunities for physical activity, contributing to accelerated weight gain. Previous research has demonstrated clinically meaningful short- and long-term weight loss (18-24 months) in adults with mild-to-moderate …

Association Between Stress Mindset, Psychological Symptoms, And Psychosocial Risk In Liver Transplant Patients, Sarah Kay Brill

Dissertations

Psychosocial functioning is a central component of liver transplant evaluation, yet less is known about how cognitive factors, such as stress mindset, relate to transplant readiness. The present study examined the association between stress mindset and psychosocial risk, as well as its relationship with depressive symptoms, anxiety, and perceived stress among patients undergoing liver transplant evaluation. Patients included 62 adults completing standard pre-transplant assessment measures, including the Stress Mindset Measure–Specific (SMM-S), Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Perceived Stress Scale (PSS). Hierarchical logistic regression analyses indicated that stress mindset was …

Small But Mighty: How Can Pediatric Psychologists Harness The Power Of Digital Single-Session Interventions?, Christina Amaro, Alexandra Monzon, Melissa Alderfer, Kimberly Canter, Michael Amylon, Stephanie Fooks-Parker, Jessica Schleider, Susana Patton, Katie Devine

Department of Pediatrics Faculty Papers

OBJECTIVE: Single-session interventions (SSIs) are an innovative, scalable approach for addressing the unmet behavioral and mental health needs of pediatric patients and their families. Specifically, digital SSIs, which are self-guided and delivered online, offer a low-cost and accessible approach but are currently underutilized in pediatric psychology.

METHODS: This topical review aims to describe SSIs broadly and the specific need for digital SSIs, explore potential applications within pediatric psychology, outline future directions and considerations, and present two examples of community-engaged digital SSI design.

RESULTS: SSIs evidence small to medium effects across a range of mental health concerns, including distress, anxiety, and …

Emergency Medical Services Mental Health: Causes Of Providers Leaving The Industry, Brian C. Selke

Graduate Theses and Dissertations (2019 - present)

Employee resilience and mental health have become critical concerns in Emergency Medical Services (EMS) as workforce shortages increasingly threaten staffing stability and patient care. National Registry of Emergency Medical Technicians (NREMT) data indicates that more than 30% of eligible EMS providers did not recertify between 2020 and 2023, raising concerns about workforce sustainability. This study examines EMS providers’ intentions to leave the profession and identifies workplace factors associated with turnover. A statewide survey of more than 1,200 licensed EMS providers in Alabama was analyzed using regression techniques to evaluate the relationship between workplace conditions and turnover intentions. Results demonstrate that …

"I Can See Where This Is Taking Me": Medical Students' Perceptions Of Humanities Courses At Aga Khan University, Kenya, Catherine Gathu, Marthaclaire Zammit, Urvi Saboo, Robert Opoka

Family Medicine, East Africa

Background Humanities courses in medical training are increasingly recognized as essential for developing empathetic, reflective and socially responsive physicians. Although well-established globally, their integration into medical education in African contexts remains limited. In Kenya, humanities are often peripheral within curricula dominated by biomedical sciences and clinical medicine. Aga Khan University (AKU), Nairobi, has introduced a novel medical curriculum that embeds seven core humanities courses as central components of the initial phase of its MBChB program. This study explored students’ perceptions and lived experiences of these humanities courses.

Methods A retrospective descriptive study using an embedded mixed-methods design was conducted among …