Evaluating Stroke Recognition And Prehospital Quality Metrics In Emergency Dispatch: A Retrospective Cohort Study Comparing Mimics And Confirmed Strokes, Nedim Leto, Elisabeth Farbu, Paul Barach, Conrad Arnfinn Bjørshol, Martin Kurz, Soffien Ajmi, Annette Fromm, Christopher Kalhagen Bjerkvig, Thomas Lindner

College of Population Health Faculty Papers

OBJECTIVES: Accurate identification of acute stroke by the Emergency Medical Dispatch Centre (EMDC) is essential for timely treatment and efficient resource use. However, stroke mimics-conditions resembling stroke can often lead to overtriage, complicating emergency care. We aimed to quantify EMDC stroke overtriage and compare characteristics of stroke mimics with confirmed stroke cases.

DESIGN: Retrospective cohort study.

SETTING: Patients with suspected stroke identified by the EMDC in Western Norway between 1 January 2021 and 31 December 2022.

PARTICIPANTS: A total of 8,261 patients with EMDC suspected stroke were included. Stroke suspicion was determined using the Norwegian Medical Priority Dispatch System, which …

Early Life Exposure To Antibiotics Increases The Risk Of Myopia: A Retrospective Cohort Study, Peng-Tai Tien, Chang-Ching Wei, Sheng-Chun Lin, Ping Ping Meng, Yu-Te Huang, Jamie Jiin-Yi Chen, Ming-Yen Wu, Ying-Hsiu Shih, Tzu-Ju Hsu, Fuu-Jen Tsai, Yao-Chien Wang, Hui-Ju Lin, Lei Wan

BioMedicine

Background

Myopia is a growing health issue, expected to affect nearly half of the global population by 2050. Genetic predisposition and early environmental influences both play crucial roles in the development of myopia. Identifying modifiable risks and early interventions is critical. Antibiotics, commonly given to young children, may disrupt gut microbiota, which has been linked to ocular diseases in humans and animals.

Aim We aimed to investigate the association between antibiotic use in early life and the risk of developing myopia.

Methods Retrospective cohort study using data from a national health insurance database examined children aged three years or younger, …

Extending Sbar To Sbar-A: A Practice-Based Framework For Dnp Clinical Scholarship, Cynthia Plonien

Nursing Faculty Publications & Presentations

The SBAR (Situation, Background, Assessment, Recommendation) framework is widely used to structure communication in healthcare settings. However, its traditional use emphasizes information exchange rather than practice change. Doctor of Nursing Practice (DNP) education requires translation of evidence into action through measurable practice change and leadership engagement. This manuscript introduces SBAR-A, an adaptation of the SBAR framework that adds an “Action” component requiring application of evidence-based interventions. SBAR-A integrates planning, leadership, and the application of knowledge to practice. This framework provides a structured approach for bridging communication and practice change within DNP clinical scholarship.

Molecular Classification And Association With Survival Outcomes In High-Intermediate And High-Risk Early-Stage Endometrial Cancers: Ancillary Analysis Of Gog-0249, Lindsay Kuroki, Danielle Enserro, Heather Lankes, Kyle Strickland, Rebecca Previs, Aine Clements, Matthew Powell, Ann Klopp, Elena Ratner, Paul Disilvestro, Casey Cosgrove, Guilherme Henrique Cantuaria, Nicola Spirtos, Michael Carney, Mitchell Edelson, Gottfried Konecny, Penny Anderson, Christopher Tarney, Britt Erickson, Meredith Newton, Krishnansu Tewari, Premal Thaker, David Warshal, Amy Armstrong, Xun Clare Zhou, Angeles Alvarez Secord

Abington Jefferson Health Papers

OBJECTIVE: Determine whether mismatch repair (MMR) and p53 expression predict recurrence-free survival (RFS) and overall survival (OS) in early-stage endometrial cancer (EC) patients treated with vaginal cuff brachytherapy plus chemotherapy (VCB/C) versus pelvic radiation therapy (RT).

METHODS: In the GOG-0249 trial, 601 patients with high-intermediate risk (HIR) early-stage EC were randomized to VCB/C (carboplatin/paclitaxel for 3 cycles) or pelvic RT. Molecular subgroups, deficient MMR (dMMR), p53 wildtype (p53wt), p53 abnormal (p53abn), were determined by immunohistochemistry. Five-year RFS and OS were analyzed using Kaplan-Meier curves and Cox proportional hazards models, adjusting for lymphadenectomy, planned VCB, and treatment group.

RESULTS: Among 315 …

Modulate Obesity And Related Metabolic Complications For Yielding Improvements In Ibd Outcomes (Modify-Ibd): Consensus On Obesity And Cardiometabolic Comorbidities In Inflammatory Bowel Disease Using Systematic Reviews And The Rand/Ucla Appropriateness Method, Jalpa Devi, Sami Samaan, Priya Sehgal, Mouhand Mohamed, Matthew Vincent, Shannon Coombs, Michelle Doering, Edward L. Barnes, Amanda M. Johnson, Andres J. Yarur, Parakkal Deepak

Division of Gastroenterology and Hepatology Faculty Papers

INTRODUCTION: Obesity and related cardiometabolic comorbidities, including hypertension, dyslipidaemia, diabetes, metabolic dysfunction-associated steatotic liver disease and atherosclerotic cardiovascular disease, are increasingly prevalent among individuals with inflammatory bowel disease (IBD). These conditions influence disease activity, therapeutic response, surgical outcomes and overall quality of life, yet evidence remains fragmented. The Modulate Obesity and relateD metabolic complIcations For Yielding improvements in IBD outcomes (MODIFY-IBD) initiative aims to synthesise evidence and generate consensus recommendations to guide practice and future research in this area. This study describes a protocol for a structured evidence synthesis and Research And Development/University of California, Los …

Acidic Extracellular Ph-Induced Pth Secretion In Male Mouse Parathyroids Is Ogr1-Dependent, Yanmei Yang, Mengcun Chen, Mingshu Cui, Elisabeth Lashbrooks, Bin Wang

Center for Translational Medicine Faculty Papers

The role of extracellular acidity in regulating PTH secretion in cultured mouse parathyroid glands (PTGs) has not been studied to date, largely because of the technical difficulty of isolating mouse PTGs. We hypothesized that acidic extracellular pH directly stimulates PTH secretion through activation of a proton-sensing receptor, specifically ovarian cancer G protein-coupled receptor 1 (OGR1, also known as GPR68). To test this, we developed a method to reliably identify and isolate PTGs from male mice by administering 5-aminolevulinic acid, which induced selective fluorescence in these glands. Using this model, we demonstrate that acidic extracellular pH significantly stimulates PTH secretion in …

Internalized Homophobia As An Influence On Participation In Hiv Prevention Among Young Men Who Have Sex With Men (Ymsm), Kasey I. Brazee

Honors Scholar Theses

Stigma is a known barrier to accessing preventative services for human immunodeficiency virus (HIV), however, the types of stigmas involved in this relationship remain not well defined. Homophobia, or negative attitudes directed towards homosexuality, is a particularly important type of stigma considering the disproportionate effect of HIV on men who have sex with men (MSM). Young MSM (YMSM) are especially impacted, making them a key population in the context of HIV prevention research.  Internalized homophobia, which refers to homophobia that one directs towards themselves, is under researched regarding its role in participating in HIV prevention. In this study, we aimed …

Acidic Extracellular Ph-Induced Pth Secretion In Male Mouse Parathyroids Is Ogr1-Dependent, Yanmei Yang, Mengcun Chen, Mingshu Cui, Elisabeth Lashbrooks, Bin Wang

Center for Translational Medicine Faculty Papers

The role of extracellular acidity in regulating PTH secretion in cultured mouse parathyroid glands (PTGs) has not been studied to date, largely because of the technical difficulty of isolating mouse PTGs. We hypothesized that acidic extracellular pH directly stimulates PTH secretion through activation of a proton-sensing receptor, specifically ovarian cancer G protein-coupled receptor 1 (OGR1, also known as GPR68). To test this, we developed a method to reliably identify and isolate PTGs from male mice by administering 5-aminolevulinic acid, which induced selective fluorescence in these glands. Using this model, we demonstrate that acidic extracellular pH significantly stimulates PTH secretion in …

Cardiac Resynchronization Therapy: A Review, Caique M Ternes, Jitae A Kim, Anirban Basu, Kenneth A Ellenbogen, Mihail G Chelu

Faculty, Staff and Students Publications

Importance: Heart failure (HF) affects more than 64 million individuals worldwide, and acute HF is associated with 1-year mortality rates of 23.6% in North America and Europe. Cardiac dyssynchrony from conduction system disease may cause HF progression, particularly in patients with left ventricular (LV) systolic dysfunction.

Observations: Electrical dyssynchrony in HF most commonly presents as left bundle-branch block and affects 20% to 30% of patients with reduced LV ejection fraction (LVEF). Cardiac resynchronization therapy, which includes biventricular pacing and conduction system pacing, restores synchronous ventricular contraction and is recommended for patients with symptomatic HF despite optimal medical therapy, LVEF of …

Migrainous Thoracalgia In A Patient With Chronic Migraine And Coronary Vasospasm: A Case Report, Dean Zeldich, Victor S. Wang, Cyril David, Clinton Lauritsen, Claire E.J. Ceriani

Department of Neurology Faculty Papers

Migrainous thoracalgia (MT) refers to chest pain (CP) potentially arising from a neurologic etiology, often temporally linked to migraine. We present a 57-year-old woman with chronic migraine who developed recurrent CP typically following migraine attacks. Despite multiple cardiac evaluations, including cardiac MRI and catheterizations, she was diagnosed with fibromuscular dysplasia, spontaneous coronary artery dissection, and coronary microvascular disease. Her CP partially responded to nitroglycerin and improved modestly with migraine control using ubrogepant and calcium channel blockers. During admission for refractory migraine, she received intravenous lidocaine, magnesium, ketorolac, and neuroleptics, resulting in several months of CP remission despite brief migraine relief. …

Expert Recommendations To Strengthen Chikungunya Outbreak Surveillance And Reporting For Traveler Health Protection, Daniel C. Payne, Karoun H. Bagamian, Jeffery Goad, Nathan D. Grubaugh, Michael A. Johansson, Moritz U. G. Kraemer, Eyal Leshem, Francesca F. Norman, Alfonso J. Rodríguez-Morales, Henrik Salje, Stephen Thomas, Scott C. Weaver, Lindsey A. Laytner, Rebecca Sturgis, Suzanne K. Scheele, Davidson H. Hamer

Pharmacy Faculty Articles and Research

Chikungunya, a debilitating mosquito-borne disease caused by chikungunya virus, has surged dramatically in the past two decades. Chikungunya outbreaks can intensify rapidly, with infections posing a significant endemic health burden in tropical/subtropical areas and for travelers. Health professionals require timely and accurate outbreak information to adequately protect travelers and assess chikungunya risk. However, detection is often insufficient in the areas most susceptible to outbreaks, leading to diagnostic and reporting delays. Consequently, travelers are often unaware of increased chikungunya infection risk at their destination. We assessed chikungunya surveillance and reporting resources, and we developed expert recommendations for traveler health protection. Because …

A Multi-Agent Large Language Model Framework To Automatically Assess Performance Of A Clinical Ai Triage Tool, Adam Flanders, Yifan Peng, Luciano Prevedello, Robyn Ball, Errol Colak, Prahlad Menon, George Shih, Hui-Ming Lin, Paras Lakhani

Department of Radiology Faculty Papers

Radiology reports can be used as a surrogate for performance of clinical AI tools. Radiology reports were analyzed by an ensemble of eight open-source LLM models and a internal version of GPT-4o using a single multi-shot prompt that assessed for presence of ICH. Performance of the open-source models, consensus of models and GPT-4o were compared to human report review. Three ideal consensus LLM ensembles were tested for rating the performance of the triage tool. The capability of each LLM varied. The highest AUC performance was achieved with llama3.3:70b and GPT-4o. Using MCC the ideal combination of LLMs were: Full-9 Ensemble, …

Experiences Of First-Generation Immigrant Parents In Caring For Children With Type 1 Diabetes, Nahel Kibreab

Walden Dissertations and Doctoral Studies

No abstract provided.

Smaller Right Ventricle Results In Poorer Exercise Performance In Young Patients With Repaired Tetralogy Of Fallot, Christiane Mhanna, Katerina Kourpas, Takeshi Tsuda

Department of Pediatrics Faculty Papers

BACKGROUND: Severe right ventricular (RV) dilatation and exercise intolerance are considered indications for pulmonary valve replacement in surgically repaired tetralogy of Fallot (rTOF).

METHODS AND RESULTS: Cardiopulmonary exercise testing (CPET) and cardiac magnetic resonance (CMR) were performed in rTOF patients with pulmonary insufficiency (PI). Oxygen pulse (OP), calculated as oxygen consumption (V̇O

CONCLUSIONS: A smaller RV was associated with worse exercise performance, indicating exercise intolerance is independent of RV dilatation in young rTOF with PI and represents a unique pathological entity responsible for reduced exercise performance.

A Disorder-Aware Computational Framework To Identify Structurally Tractable Targets In Proliferative Vitreoretinopathy, Mak B. Djulbegovic, Nedym Hadzijahic, David J. Taylor Gonzalez, Michael Antonietti, Sidra Zafar, Ajay E. Kuriyan

Wills Eye Hospital Papers

OBJECTIVE: Proliferative vitreoretinopathy (PVR) remains a major cause of failure after rhegmatogenous retinal detachment repair and lacks effective pharmacologic therapies. Although epithelial-mesenchymal transition (EMT) is central to PVR pathogenesis, the structural determinants governing the tractability of EMT regulators, particularly those involving intrinsic disorder, remain poorly defined. We developed a disorder-aware, artificial intelligence-enabled computational framework to evaluate EMT-associated proteins in PVR and prioritize structurally tractable regulators for structure-based targeting.

DESIGN: A computational, hypothesis-generating study employing an in silico screening and structural modeling pipeline.

SUBJECTS: No human subjects or biological specimens were included. The dataset comprised 25 EMT-associated proteins implicated in PVR, …

Staff Education To Reduce The Incidence Of Pressure Injury In Medical-Surgical Inpatients, Francis Omelu

Walden Dissertations and Doctoral Studies

No abstract provided.

Implementation Of A Language-Concordant Follow-Up Protocol To Reduce Percutaneous Nephrostomy Tube Complications: An Evidence-Based Practice Project, Marisol Ornelas

Loma Linda University Electronic Theses, Dissertations & Projects

Purposes/Aims: Complications of percutaneous nephrostomy tubes (PCN) are common after discharge. Language barriers place patients at higher risk for misunderstanding discharge instructions. This evidence-based project evaluated whether a bilingual follow-up protocol three days post-discharge reduces PCN complications in patients.

Methodology: This project utilized the Johns Hopkins Nursing Evidence-Based Practice Model. The project leader reviewed the literature, synthesized the evidence, and developed a standardized PCN discharge training and bilingual PCN follow-up protocol.

Implementation: Unit nurses received training to standardize the PCN discharge process. Nurses educated PCN patients using the standardized process at the time of discharge. Three days …

Improving Nursing Compliance With Pressure Injury Prevention In Postoperative Patients In The Cardiovascular Intensive Care Unit, Chingyi Lam

Doctor of Nursing Practice Final Project Abstract

Pressure injuries acquired in the hospital continue to be a major concern in patient safety among critically ill populations. The purpose of the quality improvement project was to improve nursing compliance with pressure injury prevention strategies among postoperative patients in a cardiovascular intensive care unit (CVICU). Patients who undergo cardiovascular surgery are at a high risk of developing pressure injuries due to immobility, sedation, vasopressors, and prolonged positioning on their backs. The quality improvement project was carried out in a 37-bed CVICU using the Institute for Healthcare Improvement (IHI) Model for Improvement and Plan–Do–Study–Act (PDSA) cycles. Data on nursing repositioning …

Bridging Images And Language In Radiology: A Comprehensive Prisma Systematic Review Of Transformer Vision-Language Models And Clinical Readiness, Mohammad T. Khasawneh Dr., Sadaf Tabatabaee

Systems Science and Industrial Engineering Student Scholarship

Transformer vision-language models (VLMs) promise end-to-end automation of radiology reporting and related multimodal tasks. However, evidence remains fragmented across datasets, architectures, evaluation practices, and levels of clinical validation, limiting fair comparison and safe translation into practice. Following PRISMA 2020/PRISMA-S, search engines including PubMed, IEEE Xplore, Web of Science, and Google Scholar were systematically searched for peer-reviewed, English-language studies published between 2019 and 2025 that used paired radiology images and free-text reports. Dual reviewers screened records and extracted data using a locked schema covering datasets, modalities, architectures, training objectives, evaluation metrics, and indicators of clinical readiness. Free-text model descriptions were normalized …

Brain Age Prediction In Generalized Anxiety Disorder Using A Convolutional Neural Network, Corey Richier, André Zugman, Anita Harrewijn, Elise M Cardinale, Parmis Khosravi, Moji Aghajani, Willem B Bruin, Kevin Hilbert, Narcis Cardoner, Daniel Porta-Casteràs, Marta Cano, Savannah Gosnell, Ramiro Salas, Andrea P Jackowski, Pedro M Pan, Giovanni A Salum, Karina S Blair, James R Blair, Mohammed R Milad, Katie L Burkhouse, K Luan Phan, Heidi K Schroeder, Jeffrey R Strawn, Katja Beesdo-Baum, Neda Jahanshad, Sophia I Thomopoulos, Jared A Nielsen, Jordan W Smoller, Jair C Soares, Benson Mwangi, Mon-Ju Wu, Giovana B Zunta-Soares, Michal Assaf, Gretchen J Diefenbach, Paolo Brambilla, Eleonora Maggioni, David Hofmann, Thomas Straube, Carmen Andreescu, Rebecca B Price, Gisele G Manfro, Federica Agosta, Elisa Canu, Camilla Cividini, Massimo Filippi, Milutin Kostić, Ana Munjiza Jovanovic, Brenda Benson, Gabrielle F Freitag, Ellen Leibenluft, Grace V Ringlein, Kathryn Werwath, Hannah Zwiebel, Hans J Grabe, Sandra Van Der Auwera, Katharina Wittfeld, Henry Völzke, Robin Bülow, Nicholas L Balderston, Monique Ernst, Lilianne R Mujica-Parodi, Helena Van Nieuwenhuizen, Hugo D Critchley, Elena Makovac, Matteo Mancini, Frances Meeten, Cristina Ottaviani, Gregory A Fonzo, Martin P Paulus, Murray B Stein, Raquel E Gur, Ruben C Gur, Antonia N Kaczkurkin, Bart Larsen, Theodore D Satterthwaite, Jennifer Harper, Michael T Perino, Chad M Sylvester, Qiongru Yu, Patrick Mcclure, Francisco Pereira, Ulrike Lueken, Dick J Veltman, Paul M Thompson, Nynke A Groenewold, Janna Marie Bas-Hoogendam, Dan J Stein, Nic J A Van Der Wee, Anderson M Winkler, Daniel S Pine, Chelsea K Sawyers

Faculty, Staff and Student Publications

Higher predicted brain age difference has been associated with several psychiatric disorders. Generalized anxiety disorder (GAD) is associated with markers of accelerated aging. In this study, we determined brain predicted age difference (PAD) in individuals with GAD and healthy controls (HC) as well as group differences in PAD variability using voxel-wise structural MRI. The training dataset included 3511 controls, and the testing dataset included 1595 individuals with GAD and 4552 HC from the ENIGMA-Anxiety GAD Working Group. A convolutional neural network model using four input modalities per subject and a model ensemble approach was used to predict brain age. The …

Surgical Site Infection Prevention And Education With Breast Reconstruction Patients - An Evidence-Based Practice Project, Monica Gaspard

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction and Background

Breast cancer is a disease characterized by abnormal cell growth that develops from interactions including genetics, environment, and cellular functions (Taurin & Alkhalifa, 2020). Breast cancer is common in women, and breast reconstruction is a main course of treatment (Taha et al, 2023). One in eight women may have breast cancer in their lifetime (Tedesco & Loerzel, 2020). In the United States, 151,641 breast reconstruction surgeries were reported in 2022 by the American Society of Plastic Surgery (Perez et al., 2024). The infection rate after breast reconstructive surgery can be as high as 25% and occurs within …

Associations Between Neighborhood Disadvantage, Cannabis Use, And Patient-Reported Outcomes Among Patients With Cancer, Brittney Greene, Shilpa Ghosh, Craig Colder, Salimah Meghani, Brooke Worster, Rebecca Ashare

Kimmel Cancer Center Faculty Papers

INTRODUCTION: Cannabis use is proliferating among oncological populations. However, research is limited on whether cannabis routes and sources are associated with neighborhood disadvantage and whether it moderates the relationship between neighborhood disadvantage and patient-reported outcomes (PROs). This analysis evaluates the relationship between neighborhood disadvantage and cannabis source and route, and their association with PROs.

METHODS: Analyses included 106 patients with cancer from varying levels of neighborhood disadvantage. Logistic regressions tested the association of neighborhood disadvantage with cannabis source (i.e., regulated vs. unregulated) and route (i.e., inhaled vs. consumed/other formulations). Multilevel regressions tested the association of neighborhood disadvantage with PROs (e.g., …

Updated Trends In The Global Prevalence And Burden Of Mental Disorders, 1990–2023: A Systematic Analysis For The Global Burden Of Disease Study 2023, Damian F. Santomauro, Paul Anthony Miller, Jamileh Shadid, Sarah Wulf Hanson, Anh Vo, Darius Jake Roy, Hailey Hagins, Ana M. Mantilla Herrera, James G. Scott, Holly E. Erskine, John J. Mcgrath, Hasan Aalruz, Hedayat Abbastabar, Nadin M.I. Abdel Razeq, Ahmed Abdelrahman Abdelgalil, Ali Abdolizadeh, Deldar Morad Abdulah, Abisola Esther Abdulmalik, Meklit Girma Abebe, Mesfin Abebe, Habtamu Abebe Getahun, Roberto Ariel Abeldaño Zuñiga, Olifan Zewdie Abil, Richard Gyan Aboagye, Shady Abohashem, Abdullahi Tunde Aborode, Moaz Elsayed Abouelmagd, Mohammad T. Abuawwad

All Works

Background The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Methods Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual …

Postpartum Depression: A National Crisis Calling For Federal Support, Sarah A. Stallsworth

Doctor of Nursing Practice Final Manuscripts

Postpartum depression (PPD) is the leading cause of maternal mortality in the United States, yet it remains significantly underdiagnosed and undertreated. Despite decades of research illuminating its prevalence and detrimental consequences, federal intervention has been limited.  States retain responsibility to address the issue and possess inconsistent and limited legislation.  The purpose of this paper is to propose adding PPD screening as a National Performance Measure (NPM) within the Title V Maternal and Child (MCH) block grant. MCH is a longstanding and resourceful program that provides states funds to address maternal mental health needs. This proposal suggests leveraging a PPD NPM …

Improving Medication Adherence In Mental Health Patients: A Quality Improvement Project, Ryan Oh

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction / Aims

Medication adherence among patients with mental health conditions is essential for quality of life, health outcomes, and longevity (Stewart et al., 2022). This quality-improvement project investigates whether a medication reminder app, supported by healthcare staff, effectively improves adherence and how it influences patients' perceptions of their health management.

Methods

Adult patients (aged 18-80) diagnosed with mental health disorders were identified at Orange County Health and Psychology Associates (OCHPA) in February 2026. All patients completed a PAM-10 survey both before and after the intervention, a mobile app called MyTherapy. Clinic staff received training on using MyTherapy to assist …

Implementing Cbt-I Coach App Education During Initial Psychiatric Evaluations At The Va Pec: A Provider-Facing Quality Improvement Initiative, Sarah J. Kang

Doctor of Nursing Practice Final Manuscripts

Objective: This evidence-based practice project aims to increase provider implementation of gold standard insomnia treatment, Cognitive Behavioral Therapy for Insomnia (CBT-I), by integrating CBT-I Coach app education into initial psychiatric evaluations within a VA psychiatric emergency clinic (PEC).

Background: Insomnia is highly prevalent among veterans and commonly co-occurs with PTSD, depression, and anxiety. National guidelines from the VA, DoD, and American Academy of Sleep Medicine endorse CBT-I as first-line treatment. Despite this, pharmacotherapy is the dominating intervention in psychiatric emergency settings. The CBT-I Coach app offers evidence-based CBT-I as a free, VA-developed digital tool, but it remains underutilized in acute …

Closing The Detection Gap: Early Recognition Of Hospital Onset Sepsis With News2, Anthony Bernardo

Doctor of Nursing Practice Final Manuscripts

Sepsis is the leading cause of in-hospital death and the most expensive inpatient condition in the United States, yet federal quality policy still relies on outdated Systemic Inflammatory Response Syndrome (SIRS) criteria in the Centers for Medicare & Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1), creating fragmented, inequitable recognition of hospital-onset sepsis across U.S. acute-care hospitals. This health policy analysis evaluates the National Early Warning Score 2 (NEWS2) as an evidence-aligned replacement for SIRS-based SEP-1 trigger criteria within a hybrid governmental-organizational policy strategy for adult acute care inpatients. Guided by Kingdon's Multiple Streams Framework and an …

Improving Nurse Competency In Vascular Occlusion Prevention And Management, Arielle Victoria Madayag

Doctor of Nursing Practice Final Manuscripts

Background: Vascular occlusion is a rare, but serious complication of dermal filler injections that can lead to severe adverse outcomes, including tissue necrosis and vision loss. As the demand for minimally invasive cosmetic procedures increases, proper nurse education and preparedness in managing vascular complications remain essential to ensuring patient safety.

Purpose: To evaluate the effectiveness of a structured educational session combined with simulation-based training on nurses’ knowledge, confidence, and clinical competency in recognizing and managing vascular occlusion associated with dermal filler injections.

Methods: A pretest-posttest educational intervention design was used. Four registered nurses (N=4) employed at a medical spa participated …

Enhancing Primary Care Provider’S Knowledge And Use Of Long-Acting And Oral Naltrexone In The Management Of Opioid And Alcohol Use Disorder, Ariana Juarez-Moncada

Doctor of Nursing Practice Final Manuscripts

Abstract

Objective: This evidence-based project aimed to enhance primary care provider knowledge and prescription rates of naltrexone and long-acting injectable (LAI) naltrexone in a community healthcare setting.

Background: Naltrexone and LAI naltrexone pharmacotherapy is shown to reduce use of alcohol and opioids and improve client retention in patients with alcohol use disorder (AUD) and opioid use disorder (OUD) (Bahji et al., 2020; Morley et al., 2024; Murphy et al., 2022).

Methods: A 30-minute in-service was provided to 14 family practice providers at the clinic. The prescription rate of naltrexone and LAI naltrexone was evaluated for the baseline period of February …

Empowering Recovery: Implementing Ace Screenings To Enhance Care For Patients With Substance Use Disorders, Joshua Wolf

Doctor of Nursing Practice Final Manuscripts

Objective: This evidence-based practice project evaluated the impact of implementing adverse childhood experience (ACE) screenings for patients with substance use disorders (SUDs) in an outpatient community behavioral health clinic.

Background: ACEs are strongly associated with an increased risk of developing SUDs, chronic medical comorbidities, and negative treatment outcomes. Despite consistent evidence supporting the need for identification of ACEs and implementing trauma-informed care, standardized ACE screening is not routinely incorporated into outpatient SUD treatment, potentially limiting the identification of the need for education and referrals.

Methods: The ACE Questionnaire for Adults was implemented during routine psychiatric visits for patients diagnosed with …