Digital Commons Network^™

Same-Day Cancellation Reduction In An Ambulatory Surgery Unit, Anthone Dalit Vengersammy

Master's Projects and Capstones

Problem: Same-day surgical cancellations in the outpatient surgery setting remain a significant operational and patient care challenge. Preventable cancellations negatively affect patient experience, operating room efficiency, staff productivity, and healthcare costs. 

Context: A microsystem and organizational culture assessment identified several factors contributing to same-day cancellations, including unclear preoperative instructions, incomplete medical clearance, inconsistent patient education, lack of standardized workflows, unclear staff responsibilities, and communication gaps among interdisciplinary teams. SWOT and gap analyses were used to identify opportunities for improvement and guide intervention planning.

Interventions: Quality improvement interventions were implemented through iterative Plan-Do-Study-Act (PDSA) cycles. Strategies included revising preoperative patient instructions, …

Addressing Obesity In Rural Health Clinics, Morgan P. Trusley

Student Scholarly Projects

Practice Problem: According to the Centers for Disease Control and Prevention (CDC), more than 2 in 5 adults in the United States are obese (CDC, 2024a). In a rural primary care clinic in South Carolina, approximately 70% of patients are obese and there is no current intervention in place to help educate and guide these patients in weight loss strategies.

PICOT: In obese adults over the age of 18 at a rural health clinic with a Body Mass Index (BMI) greater than or equal to 30, does implementing weekly virtual and in person multicomponent behavioral intervention educational sessions compared to …

Improving Fluoride Varnish Application Rates In A Pediatric Primary Care Microsystem, Roman G. Roxas

Master's Projects and Capstones

Problem

Childhood caries is a preventable public health issue disproportionately affecting the underserved. National guidelines recommend fluoride varnish (FV) application during well‑child visits. In California, fewer than 15% of children under age six received FV. In a pediatric primary care clinic, baseline performance was 11% in 2025.

Context

A six‑month quality improvement project was implemented. Key barriers included reduced team cohesion, workflow variability, unclear roles, and underutilized electronic health record (EHR) prompts.

Interventions

The change package standardized medical assistant–led workflows, activated EHR prompts, and provided targeted education. Leadership reinforcement through regular huddles supported adoption, consistency, and team engagement.

Measures

Outcome …

Conceptual Framework And Key Considerations For Field-Based Infrastructure In Food Is Medicine Research, Shreela V Sharma, Colleen Tewksbury, Christopher R Long, Colleen Spees, Ronit A Ridberg, Reshma Gupta, Erin P Ferranti, Naomi Tice, Eric Peterson, Brian Levine

Faculty, Staff and Student Publications

In 2023, the American Heart Association launched the Healthcare by Food (HCXF) initiative to establish a rigorous evidence base for Food Is Medicine (FIM) programs, so that patients with acute or chronic disease could access FIM programs as a covered benefit under their health insurance. The HCXF initiative is engaging in research, advocacy, and education to support the development and testing of interventions that improve health outcomes. The HCXF initiative launched 9 task forces aligned with research progress, including the Field-Based Infrastructure task force designed to examine broader questions to help support either earlier or later stages of the HCXF …

Public Perceptions Regarding Surveillance Of Lyme Disease In Tennessee, Shaheena Yasmin Asad

Walden Dissertations and Doctoral Studies

Lyme disease (LD), a tick-borne illness, has been a growing concern in the state of Tennessee. Studies have established environmental concerns regarding a growing tick population and identified a gap between reported cases and disease burden in Tennessee. Despite this information, it remains classified as a low-incidence reporting state, raising concerns about underreporting that indicate an ineffective current surveillance system. Because the public perception regarding surveillance of LD is unknown, the purpose of this qualitative study was to explore how adults in Tennessee perceived LD as a credible public health threat within the context of the current surveillance system. Guided …

A Multifaceted Surgical Suite Quality Improvement Initiative, George Tazvitya Mhosira

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project focuses on modernizing an acute care hospital’s surgical suite, enhancing environmental safety, and supporting the growing complexity of surgical care. As surgical procedures become more advanced, the physical environment must evolve to maintain sterile technique and reduce microbial presence. Current operating room configuration, characterized by overcrowding and outdated ventilation systems, introduces environmental risks that compromise patient safety and limit perioperative efficiency. Modernization is essential to align the surgical environment with contemporary safety expectations and organizational performance goals. The proposed initiative includes a comprehensive renovation and expansion of surgical spaces, integrating advanced air decontamination technologies, …

Consistent Phq-9 Administration At Mental Health Watch Initiation And Discharge In A Correctional Setting, Gouni Aicha Bouraima

Walden Dissertations and Doctoral Studies

This staff education project addressed inconsistent Patient Health Questionnaire-9 (PHQ-9) administration and documentation at mental health watch initiation and discharge in a correctional setting. A baseline audit showed 42.1% PHQ-9 documentation compliance (8 of 19 charts), below the 90% organizational benchmark, limiting objective depression severity data needed for clinical decision-making and safe transitions. The practice-focused question was: Among nurses working with incarcerated individuals at mental health watch initiation and discharge, what is the impact of staff education on nurses’ knowledge of PHQ-9 screening protocols? The purpose was to implement structured staff education to improve nurses’ knowledge of PHQ-9 trigger points, …

Improving Suicide Risk Identification Through Standardized Implementation Of The Columbia–Suicide Severity Rating Scale (C-Ssrs) In An Adult Outpatient Behavioral Health Setting, Mirabel Ngwe Boma

Walden Dissertations and Doctoral Studies

Suicide risk may fluctuate throughout treatment, making ongoing assessment essential for timely identification and intervention. At the project site, an adult outpatient behavioral health practice, the Columbia–Suicide Severity Rating Scale (C-SSRS) was administered consistently at intake but inconsistently at follow-up visits, creating gaps in suicide risk reassessment and documentation. The purpose of this quality improvement project was to evaluate the effect of standardized implementation of the C-SSRS during intake and follow-up visits on suicide risk screening compliance over a 9-week period. The practice-focused question asked how standardized implementation of the C-SSRS, compared with current practice, affected suicide risk screening compliance …

Implementation Of Visual Bed Indicator Lights To Improve Fall Prevention Processes, Andrea Leffew

Master's Projects and Capstones

Problem: Inpatient falls remain a significant patient safety concern associated with preventable patient harm, prolonged hospitalization, and increased healthcare costs. Routine fall bundle validations identified inconsistent adherence to safe bed configuration practices, such as beds left raised and bed alarms turned off.

Context: A 3-month quality improvement project was implemented on a 20-bed medical-surgical telemetry unit within an integrated healthcare delivery system at a 130-bed community hospital in Northern California, which was experiencing an increase in inpatient falls and fall-related sentinel events.

Interventions: Implementation of bed-monitoring technology with visual indicator lights that provided real-time feedback on bed configuration.

Measures: The …

Sense Of Purpose As The Guiding Light In Nursing Practice: A Grounded Theory Study, Kathleen Casler

Theses & Dissertations

Problem: As a prosocial profession, individuals may enter the practice of nursing because of an interest in helping and caring for others. However, over time, nurses may be challenged with experiences of burnout that can impact both their relationship with the profession and patient outcomes.

Background/Significance: A sense of purpose has been associated with positive physical, behavioral, and psychological outcomes. In a professional context, a sense of purpose may provide support for navigating complex work environments. It is currently not known what nurses’ experience of sense of purpose may be in relation to nursing practice and how their sense of …

Emergency Nurses' Perceptions Of Interpersonal Empathy When Caring For Department Superusers, Makeba K. Cavette

Walden Dissertations and Doctoral Studies

Compassion fatigue syndrome (CFS) is a significant challenge for healthcare professionals, particularly nurses in the emergency department (ED), due to the demanding, high-pressure nature of their work environment and their increased exposure to human suffering. The purpose of this qualitative phenomenological descriptive study, guided by Nursing Theory of Personal Empathy, was to describe the meaning of ED nurses' interactions with superuser patients and how these interactions affect ED nurses' empathy and susceptibility to developing CFS. A purposive sample of 8 ED nurses with at least 3 years of experience as ED staff nurses working with superuser patients participated in semistructured …

A Proposal For A Program To Deliver Equitable Nursing Assignments, Laporsha Glover

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was conducted at an inpatient rehabilitation hospital that provides comprehensive interdisciplinary rehabilitation services for adults. Due to the diverse clinical needs of the rehabilitation patient population, nursing workload varies considerably based on patient acuity, functional status, cognitive impairment, medical complexity, and the intensity of nursing interventions required. This creates a practice gap that contributes to inequitable nursing assignments. A comprehensive literature search was conducted using PubMed, CINAHL, Cochrane Library, and Google Scholar. Nine studies were critically appraised using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Evidence Appraisal Tools (Bissett et al., 2025). The …

Improving Adolescent Antidepressant Medication Adherence In An Outpatient Psychiatric Clinic Through Teach-Back And Motivational Interviewing, Sandra Ajao

Walden Dissertations and Doctoral Studies

Antidepressant medication adherence among adolescents is a significant concern in outpatient psychiatric care. Adolescents may miss doses because of stigma, forgetfulness, side effects, limited understanding of medication instructions, or inconsistent caregiver support. The purpose of this Doctor of Nursing Practice project was to improve antidepressant medication adherence and adherence-focused communication among adolescents in an outpatient psychiatric clinic through staff education on teach-back and motivational interviewing. The practice-focused question examined how teach-back combined with motivational interviewing, compared with usual care, affected medication adherence and depressive symptoms during the implementation period. Staff education included use of a previsit questionnaire, structured visit script, …

Staff Education To Improve Whiteboard Utilization To Focus On Nurse Communication And Patient Experience On A Medical-Surgical Unit, Charline J. Bethea

Walden Dissertations and Doctoral Studies

Inconsistent use of standardized whiteboards in patient rooms may contribute to ineffective nurse communication and lower patient experience scores. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether an evidence-based staff education program improved nursing knowledge, intent to use standardized whiteboards, and whiteboard utilization on a medical-surgical unit. Guided by the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) instructional design model, the intervention included a standardized educational presentation, pre- and post-education knowledge assessments, a workflow integration guide, competency validation, and weekly compliance audits. Thirty-five staff members, including registered nurses and patient care technicians, participated in the project. Following …

Implementation Of Standardized Suicide Risk Screening With Staff Education In An Outpatient Psychiatric Clinic, Gwendoline Nfotiog

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project was a quality improvement staff education initiative focused on improving suicide risk screening and documentation in an outpatient psychiatric clinic. Inconsistent use of validated screening tools and documentation practices created risks for missed identification of patients at risk for suicide. Addressing this gap was essential to improve patient safety and support evidence-based behavioral healthcare. In the project, I examined whether implementing standardized suicide risk screening with staff education would improve screening and documentation consistency over 12 weeks. The purpose was to increase staff knowledge, screening compliance, and documentation accuracy. Pre- and postimplementation chart audits, …

Unfolded Protein Response As A Therapeutic Target: 4-(Heptyloxy)Phenol Induces Programmed Cell Death In Ewing Sarcoma, Nenggang Zhang, Mary Perez, Gaye N Jenkins, Terzah M Horton, Scott R Gilbertson, Debananda Pati

Faculty, Staff and Students Publications

Ewing sarcoma is a rare and aggressive pediatric malignancy with limited therapeutic options, particularly for relapsed or refractory cases, highlighting the urgent need for innovative treatment strategies. In this study, we identify endoplasmic reticulum stress (ERS) and the unfolded protein response (UPR) as critical therapeutic vulnerabilities in Ewing sarcoma and introduce 4-(heptyloxy)phenol (AC-45594) as a novel small-molecule agent that exploits these stress pathways. AC-45594 selectively inhibited the growth of Ewing sarcoma cells among 13 cancer and 6 noncancerous cell lines, demonstrating marked tumor specificity. Structure-activity relationship studies revealed that both the phenolic hydroxyl group and an optimal alkoxy chain length …

Hematological, Inflammatory, And Oxidative Stress Biomarker Profiles In Substance Abuse Combinations: A Comprehensive Evidence-Based Review, Teif Naif Freeh Alenezi, Samia Soliman Barghash

Saudi Toxicology Journal

A potential risk of polysubstance use in relation to substance abuse can involve the development of intricate pharmacological interactions affecting the immune system and oxidative stress responses of the body. The current review aims to present a synthesis of the existing literature about hematologic, inflammatory, and oxidative stress markers associated with three patterns of polysubstance use: (1) stimulants and cannabis, (2) stimulants/depressants and CNS depressants, and (3) multi-drug complex usage. This review explores markers such as a neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), eosinophil-to-lymphocyte ratio (ELR), total oxidant …

Effectiveness Of The Smart Me-De Digital Program On Health Literacy And Glycemic Control In Newly Diagnosed Type 2 Diabetes, Nongnaphat Rungnoei, Siriporn Kruttakart, Natthapan Phianthanyakam, Pakaporn Klinhom, Umaporn Nokpaet, Jintipa Sirikunwiwat, Burong Jaitham

Journal of Health Research

Background: Individuals newly diagnosed with type 2 diabetes often have limited knowledge and self-management skills, leading to poor glycemic control and increased complications. This study evaluated the effectiveness of the Smart ME-DE Digital Program in improving health literacy and glycated hemoglobin levels among newly diagnosed individuals with type 2 diabetes.

Methods: A quasi-experimental study was conducted with seventy participants recruited from diabetes clinics at three hospitals in a central province of Thailand. They were selected using simple random sampling and matched by gender, age, and baseline HbA1c levels, and allocated to an experimental or comparison group. The experimental group received …

Clinical Utility Of An Fda-Authorized Artificial Intelligence Imaging Platform In Interstitial Lung Disease Diagnosis, Arjun Prakash Tambe, Ryan Boente, Gautam George, Fayez Kheir, Omid Tahamtani Omran, Kavitha Selvan

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

Background/Objectives: The diagnosis of interstitial lung disease (ILD) is challenging and frequently delayed. Clinically accessible and minimally invasive diagnostic tools are needed to expedite the diagnosis of ILD while minimizing risk to patients. Fibresolve is an imaging artificial intelligence (AI) tool recently approved by the Food and Drug Administration (FDA) for use in ILD diagnosis and made available to clinicians. The objective of this study was to describe its utility in clinical practice. Methods: We conducted a prospective, observational study of patients across the United States (US) in whom Fibresolve was utilized during routine clinical practice between July 2024 and …

Reply To “Comment On Primary Care Providers' Perspectives On Telehealth Medicare Annual Wellness Visits For Older Adults In Midwestern Health System”, Vaibhavi Mone, Jungyoon Kim

Health Services and Informatics Research

No abstract provided.

Responsivity Education Reflection Packet For Multigenerational Caregivers, Natalie Holsky

Honors Projects

Caregivers play an essential role in supporting their child’s language development. Through everyday routines, caregivers have countless opportunities to foster strong language skills. Extensive research has examined the influence of caregiver input on language development. Comparatively little research has explored how historical trends in parenting advice across generations may shape caregivers’ use of language facilitation practices. The purpose of my honors project was to examine how generational parenting trends could inform the development of a clinic-to-home language facilitation resource. This resource was designed to help caregivers incorporate language facilitation strategies into everyday routines to increase language-rich interactions at home. A …

Quality Improvement Project: Advancing Personalized Depression Care In Outpatient Psychiatry, Jillian K. Benoit

Doctor of Nursing Practice Projects

Depression is a leading cause of disability worldwide, yet inconsistent use of evidence-based assessment and treatment strategies contributes to gaps in the quality of psychiatric care. A needs assessment at a community outpatient psychiatric clinic identified inconsistent documentation of measurement-based care (MBC), shared decision-making (SDM), and patient education during depression treatment. The purpose of this quality improvement project was to evaluate whether implementation of MBC and SDM improved depression treatment documentation among psychiatric providers over a 4-week period. Guided by Lewin’s Change Theory and implemented using the Iowa Model of Evidence-Based Practice as the implementation framework, this quantitative one-group pretest-posttest …

Improving Exam Scores: Alternative Next Generation Questions In Curriculum, April Morgan

Doctor of Nursing Practice Projects

Evidence identifies clinical judgment deficits among newly licensed nurses, supporting the integration of the National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (NCJMM) and Next Generation NCLEX (NGN) strategies. Inconsistent NGN implementation and Assessment Technologies Institute (ATI) Comprehensive Predictor performance established the local problem. This quality improvement project evaluated the impact of implementing NCJMM-aligned NGN instructional strategies, including unfolding case studies and bow-tie questions, on students’ first-attempt achievement of the ATI Comprehensive Predictor benchmark and faculty outcomes. The primary aim was to increase the percentage of students achieving the ATI Comprehensive Predictor benchmark of 76.2% on …

Standardizing Hypertension Care In An Occupational Medicine Clinic: A Quality Improvement Project, Carolyn Duncan

Doctor of Nursing Practice Projects

Hypertension remains a leading modifiable risk factor for cardiovascular disease, and inconsistent implementation of evidence-based hypertension management may contribute to variability in patient education, documentation, and follow-up care. This quality improvement project evaluated an evidence-based educational program and a standardized hypertension management workflow, based on the 2025 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines, in an occupational medicine clinic. Guided by the Iowa Model of Evidence-Based Practice, Kotter's 8-Step Change Model, and the Plan-Do-Study-Act framework, the intervention aimed to impact staff self-efficacy, documentation of lifestyle education, and follow-up appointment scheduling. A quantitative quasi-experimental pre-post design was used with …

Assessing The Impact Of Knowledge-Based Planning On Dosimetric Performance In Adaptive Prostate Sbrt Planning, Kayla Kenny

Masters Projects

Daily adaptive prostate stereotactic body radiation therapy (SBRT) is now feasible with advances in adaptive radiotherapy and automated optimization. However, the dosimetric quality of Ethos Intelligent Optimization Engine version 2 (IOE v2) automated plans may vary because optimization is based on user-defined templates rather than patient-specific dose guidance. This retrospective study evaluated whether integrating RapidPlan knowledge-based planning (KBP)–derived optimization objectives into the Ethos IOE v2 adaptive planning workflow improved dosimetric quality for prostate SBRT. Fifteen intact prostate SBRT patient datasets were evaluated. For each patient, three plans were generated: a baseline Ethos IOE v2 reference plan (Ref), a plan incorporating …

Effect Of Hydrogel Rectal Spacers On Bladder Wall And Regional Substructure Dose In Prostate Cancer Patients Undergoing Volumetric Modulated Arc Therapy With Simultaneous Integrated Boost: A Retrospective Planning Study, Geronimo Sosa

Masters Projects

Purpose: Hydrogel rectal spacers reduce rectal dose during prostate radiotherapy, but their effect on bladder wall dose is not well characterized, particularly with volumetric modulated arc therapy with simultaneous integrated boost (VMAT-SIB). This study evaluated the effect of spacer placement on whole and regional bladder wall dose.

Methods: Twenty-nine patients treated with VMAT-SIB (70 Gy in 28 fractions) were analyzed retrospectively: 9 with and 20 without a spacer. The bladder wall was defined as the whole bladder minus a 3-mm inner margin. Primary endpoints were D0.03 cc and D1 cc; secondary endpoints included D2 cc, D3 cc, D10 cc, volume-based …

Sex-Aware Causal Inference Assessment Of The Immune System In Complex Neurodegenerative Diseases, Frida Lona-Durazo, Ross P Byrne, Marc-Olivier Pilon, Michael D Greicius, Marie-Pierre Dubé, Michael E Belloy, Russell L Mclaughlin, Sarah A Gagliano Taliun

2020-Current year OA Pubs

Sex differences, in terms of prevalence, symptoms and disease progression, are established in the aetiology of complex neurodegenerative diseases, including amyotrophic lateral sclerosis, Parkinson's disease and Alzheimer's disease, but the underlying biology driving these differences remains poorly understood. There is emerging evidence from genetic and functional analyses affirming the role of the immune system in such diseases, but a thorough assessment of sex differences in the link between the immune system and neurodegenerative diseases remains lacking. Here, we applied a robust causal inference approach, two-sample Mendelian randomization, to evaluate the causal effect of immune-related protein levels on three neurodegenerative diseases …

Nextlongiso: A Comprehensive Nextflow Pipeline For Multi-Dimensional Long-Read Rna-Seq Analysis, Jiang Tan, Yuqing Wu, Yidan Sun

2020-Current year OA Pubs

SUMMARY: Long-read RNA sequencing technologies, including Pacific Biosciences (PacBio) and Oxford Nanopore Technologies (ONT), enable direct characterization of full-length transcripts and transcriptome complexity. However, analysis of long-read RNA-seq data remains fragmented across multiple tools, limiting the ability to obtain a unified view of transcript structure, expression, and regulatory variation in long-read transcriptomes. We present NextLongIso, a scalable and reproducible Nextflow pipeline that enables coordinated analysis of multiple layers of transcript regulation. Rather than focusing solely on transcript reconstruction, NextLongIso integrates transcript discovery with downstream regulatory analyses to jointly characterize alternative splicing, isoform switching, transcript boundary dynamics (including alternative promoters and …

Integrating Oncology Into Entry-Level Physical Therapist Curricula, Shana Harrington, Christopher M. Wilson, Morgan Zaranec, Lori Boright

Oncology Rehabilitation in Practice

Print issue available for $25.

Background: Cancer and its treatments commonly result in adverse effects that impair function, well-being, and quality of life, necessitating access to skilled physical therapists (PTs). Although oncology is an essential component of physical therapist practice, entry-level education in cancer rehabilitation has historically been limited. In 2025, the Essential Competencies for Physical Therapy Entry-Level Education in Oncology were developed through a mixed-methods, modified Delphi process, establishing 19 competencies across six domains and defining minimum expectations for new graduates. To support translation of these competencies into academic curricula, a practical implementation resource was needed.

Purpose: To …

A Poetic Call For And A Reflection And Commentary On Clarity, Understanding, Hope, Courage, And Compassion, Carroy U. Ferguson

Psychology Faculty Publication Series

Finding a published poem I had written as a teenager, titled “The Heavens Weep.” this article uses that poem as the basis for a commentary that reflects on the state of the world today (2026),  As a commentary, the article uses the poetic and metaphoric words in the poem as a relevant "reality check" for what is still going on today.  In essence, the commentary is about a call for Clarity, Understanding, Hope, Courage, and Compassion, or what I call Archetypal Energies, Higher Vibrational Energies that operate deep within our individual and collective psyches to creatively urge us to "see" …