Digital Commons Network^™

Comparative Efficacy Of Intravenous Ketamine And Lidocaine Infusions For Pain Management In Sickle Cell Vaso-Occlusive Crisis (Voc), Akhil Tumpudi Md

Rowan-Virtua Research Day

Sickle cell disease (SCD) is a hereditary hemoglobin disorder characterized by vaso-occlusion and recurrent acute painful crises, which are the leading cause of hospitalization in affected individuals (1,2). Opioids remain the primary treatment for vaso-occlusive crisis (VOC) pain but are associated with adverse effects, tolerance, and risk of dependence, prompting investigation into opioid-sparing adjuncts (1,2). Intravenous ketamine, an NMDA receptor antagonist, has shown modest opioid reduction in randomized and observational studies, though pain score improvements are inconsistent (3–6). Intravenous lidocaine, a sodium channel blocker, has also demonstrated potential opioid-sparing effects in retrospective cohorts with limited evidence of analgesic superiority (7–9). …

Cold Agglutinin Disease A Case On Diagnostic Pitfalls And Decision-Making Strategy, Portia Shaheed, Shefali Waghray Do, Te Du Md, Phd

Rowan-Virtua Research Day

Cold agglutinin disease is a rare subtype of autoimmune hemolytic anemia (AIHA) characterized by complement-mediated hemolysis triggered by cold temperatures. Because of its rarity and variable presentation, cold agglutinin disease is frequently underrecognized, often leading to extensive and sometimes unnecessary diagnostic evaluations. By recognizing cold agglutinin disease as a differential diagnosis in patients with recurrent admissions for hemolysis, clinicians can avoid unnecessary workups, consults, and distress for their patients.

Coherent Breathing As A Stress-Reduction Intervention, Ete Kwegang

Walden Dissertations and Doctoral Studies

No abstract provided.

Improving Hypertension Control Among Middle-Aged, Black, Female Patients Through Staff Education On Evidence-Based Joint National Committee Guidelines, Afolake Oyinlola

Walden Dissertations and Doctoral Studies

No abstract provided.

Implementation Of The Phq-9 For Early Detection Of Depression In Older Adults, Elsie Kumba Kamara

Walden Dissertations and Doctoral Studies

No abstract provided.

Improving Engagement In Community Activities At Whitetail Springs Memory Care Community, Kylie T. Klavon

Public Health Capstone Projects

The purpose of this project, in collaboration with Whitetail Springs Memory Care Community, is to encourage consistent attendance and engagement among residents and staff in community activities, thereby enhancing residents’ well-being through greater meaningful engagement. This was done by assessing communication gaps between the clinical and activities teams, developing an educational infographic and scheduling template, and conducting an interactive presentation introducing these deliverables. This project was facilitated by observing current engagement and communication procedures at Whitetail Springs. After observations, brief interviews were conducted with the Life Enrichment Director and the Health Services Director to understand where each team needs support …

Developing A Comprehensive Resource Guide For Caregivers Within The Area Agency On Aging, Aiden R. Murphy

Public Health Capstone Projects

This project developed a new universal caregiver resource guide for caregivers within the Area Agency on Aging, in order to improve resource navigation and workflow efficiency. Resources were collected, verified, and organized into a new, streamlined guide via the ARIA chatbot, covering multiple needs. Caregiver resources were collected and verified by the capstone student and mentor, Michael Kroeker, and organized into a centralized knowledge base within the ARIA chatbot. A mixed methods evaluation was conducted utilizing a 5-point Likert scale with three quantitative questions and one open-ended qualitative question. The data was given to the SeniorLine staff, who wanted to …

Using Group Activities To Improve Engagement And Help Alleviate Loneliness Among Older Adults At Macedonia Face, Taylor Corcoran

Public Health Capstone Projects

Introduction: Social isolation and loneliness are increasing public health concerns due to their association with heightened risk for chronic disease and their disproportionate impact on Black older adults (BOA). This project was designed to develop, implement, and evaluate the effectiveness of culturally relevant, low-cost activities on engagement rates among older adults during unscheduled program periods at the Macedonia Family Community Enrichment Center (FACE).

Methods: This project used a mixed methods approach over a 4-week implementation period. Three activities were introduced by the student facilitator, including UNO!, Name That Tune (NTT), and coloring pages. Engagement was measured by comparing the …

Medication-Assisted Treatment For Patients With Substance Use Disorder And Depression: A Scoping Review, Josiane Deguenon Bsn-Rn, Elisabeth Fritz Bsn-Rn, Jesse Jean Bsn-Rn, Tucker Mckinney Bsn-Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

Substance use disorder (SUD) frequently co-occurs with depression and increases relapse risk and healthcare utilization. Although medication-assisted treatment (MAT) is an evidence-based intervention for SUD, outcomes for adults with co-occurring depression remain inconsistently reported due to variation in study designs, treatment settings, and measures. This scoping review examines evidence on MAT use among adults with co-occurring depression and SUD and summarized reported clinical and healthcare utilization outcomes.

Methods

From August 2023 to November 2025, a scoping literature review was conducted on PubMed/MEDLINE, CINAHL, and the Cochrane Library, using MeSH search terms and Boolean operators to link the concepts defined …

Dropping Into The Expressive Art Therapy: A Community Engagement Arts Based Project, Sydney C. Smith, Meg Chang

Expressive Therapies Theses

This community engagement capstone explores how expressive arts practices (EXAP) may complement surf-based programming by supporting reflection, empathy, and meaning-making among participants. Research has demonstrated that surf therapy can promote emotional well-being, resilience, and social connection through embodied engagement with the ocean and supportive community environments. Integrating expressive arts practices within surf-based programs may extend these benefits by providing opportunities for reflection, creative expression, and interpersonal exchange. Grounded in expressive arts therapy (EXAT) theory and arts-based research (ABR) paradigms, this project examines how creative expression can support relational and emotional experiences within surf therapy settings. Using an arts-informed community engagement …

Focal Status Epilepticus In A Patient With Responsive Neurostimulation: A Rare Complication And Management Insights, Ana Leticia Fornari Caprara Md, Jamir Pitton Rissardo, Pranaya Gade, Estefania Joselinne Alba-Rodriguez Md, Eric P. Nagele Md, Salman Assad Md, Islam Fayed Md, Evren Burakgazi-Dalkilic Md

Rowan-Virtua Research Day

Introduction: Responsive neurostimulation (RNS) is an established therapy for drug-resistant focal epilepsy, yet device-related complications during acute seizures remain underreported. We describe a case of focal status epilepticus in a patient with RNS, illustrating the interplay of possible device malfunction, systemic illness, and medication nonadherence. Case Report: A 39-year-old man with drug-resistant focal epilepsy and schizoaffective disorder, status post right frontal craniotomy and RNS implantation, presented with focal status epilepticus after several days of antiseizure medication (ASM) nonadherence, febrile illness, vomiting, and urinary tract infection (UTI). On admission, he was lethargic with frequent focal seizures (< 30 s) characterized by left head turn, left arm followed by bilateral arm tonic stiffening, and impaired awareness. Continuous EEG confirmed focal status epilepticus. Family declined intubation. A ketamine bolus (20 mg) followed by infusion (0.25–0.5 mg/kg/hr) for 24 hours achieved seizure cessation. Despite broad ASM therapy (phenytoin, zonisamide, perampanel, levetiracetam, clorazepate, cenobamate, carbamazepine, clonazepam, lacosamide), seizures persisted until RNS interrogation revealed high lead impedance; the device was deactivated. ASM doses were optimized, PEG tube placed for consistent delivery, and UTI treated. He stabilized and was discharged to rehabilitation. Conclusion: This case highlights the need for comprehensive evaluation in RNS patients presenting with focal status epilepticus. Device malfunction, systemic illness, and inconsistent ASM adherence can synergistically worsen seizure control. Multidisciplinary management including neurocritical care, device troubleshooting, and nutritional support was pivotal for recovery.

Data-Driven Analysis Of Lecture Capture Transcript Accuracy Of The Biomedical Foundations Course Using Automated Speech Recognition, Eleni Papadopoulos, Shaniece Lawrence, Steve Garwood, Dawn Shell, Jacqueline A. Giacobbe

Rowan-Virtua Research Day

To increase the accessibility and utility of lecture capture recordings, schools may utilize automated speech recognition (ASR) to generate closed-captions and transcripts. But, how accurate are these systems? This study analyzed 50 ASR-generated transcripts using word error rate (WER) and further sought to determine factors that impact accuracy. Only 19 of 50 (38%) transcripts met the 99% accuracy standard required by the Americans with Disabilities Act (ADA). The lecturer's accent was the most significant factor affecting accuracy, though medical jargon also presented a challenge. These findings suggest system improvements and manual review are necessary to ensure students receive accurate information.

Methadone-Associated Qt Prolongation: The Importance Of Early Recognition And Monitoring In The Emergency Department, Uma Murrugappan, Kelsey Murray, James Espinosa Md, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 43-year-old female with cervical cancer and bilateral percutaneous nephrostomy tubes receiving high-dose methadone maintenance therapy who presented to the emergency department with bilateral flank and abdominal pain. She denied cardiac symptoms. Electrocardiogram obtained during evaluation revealed marked QT prolongation (QTc 596 ms) following recent methadone dose escalation. The patient was placed on continuous cardiac monitoring and intravenous magnesium was ordered. While intravenous access was being obtained, she developed polymorphic ventricular tachycardia consistent with torsades de pointes and became pulseless. Advanced cardiac life support was initiated including defibrillation and magnesium administration, with return of spontaneous …

Case Report: Termination Of Svt Using A Modified Vagal Maneuver With A 10-Cc Syringe, Romina Noormohammadi, Kelsey Murray, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Supraventricular tachycardia (SVT) is a common cardiac arrhythmia encountered in emergency departments and is characterized by a rapid regular rhythm originating above the ventricles. Initial management of hemodynamically stable SVT typically includes vagal maneuvers followed by pharmacologic therapy such as adenosine if non-pharmacologic methods fail. However, vagal maneuvers are frequently unsuccessful due to improper patient execution or insufficient vagal stimulation. We present the case of a 76-year-old female with a history of gastroesophageal reflux disease (GERD), hypertension (HTN), and hyperlipidemia (HLD) who presented with palpitations and was found to have SVT at 156 beats per minute on electrocardiogram. A Valsalva …

Not All That Scratches Is Infection: Sweet Syndrome Mimicking Cat Scratch Disease, Clara Keum, Neelesh R. Parikh

Rowan-Virtua Research Day

Sweet syndrome, or acute febrile neutrophilic dermatosis, is a rare inflammatory condition characterized by painful erythematous skin lesions, neutrophilic dermal infiltration on histopathology, and rapid response to corticosteroid therapy. Although classically associated with fever and leukocytosis, atypical presentations without systemic symptoms are increasingly recognized, often leading to diagnostic confusion.

The clinical presentation of Sweet syndrome frequently overlaps with infectious processes such as cellulitis, particularly when lesions involve the lower extremities. This overlap may result in misdiagnosis and delayed appropriate treatment. Distinguishing between infectious and inflammatory etiologies is critical, as management strategies differ significantly.

We present a case of Sweet syndrome …

The Tensile Gallbladder Sign: A Case Report Of Acute Gangrenous Cholecystitis Diagnosed By A Rare Computed Tomography Finding, Lan D. Ngo, Trent R. Malcolm

Rowan-Virtua Research Day

Acute cholecystitis is one of the most common causes of acute abdominal pain in the emergency department, accounting for approximately 200,000 hospitalizations annually in the United States (Gallagher & Charles, 2022) Ultrasound is the established first-line imaging modality for suspected cholecystitis. However, compute tomography (CT) is increasingly obtained for undifferentiated abdominal pain and offers complementary, operator-independent evaluation.  The tensile gallbladder fundus sign is defined on CT as the absence of fundal flattening by the anterior abdominal wall due to elevated intraluminal pressure.

Case Report: Anaphylaxis-Induced Cardiac Arrest Leading To Multiorgan Failure, Dhruvin Patel, Russell Mordecai, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Anaphylaxis is a severe, life-threatening hypersensitivity reaction that can rapidly progress to cardiovascular collapse and cardiac arrest. Cardiac arrest due to anaphylaxis is uncommon but associated with significant morbidity and mortality. Survivors often face complex critical care courses, including multiorgan dysfunction and challenges in neurologic prognostication following hypoxic-ischemic brain injury.

Case Report: Bilateral Pneumothorax Following T2–T5 Medial Branch Nerve Block, Jenna Rapone Md

Rowan-Virtua Research Day

Bilateral pneumothorax is an uncommon but clinically significant complication of thoracic spinal interventions. We report the case of a 20-year-old female with underlying scoliosis who developed acute pleuritic chest pain, dyspnea, and persistent cough immediately following bilateral T2–T5 medial branch nerve block injections performed in an outpatient pain management setting.  Thoracic medial branch blocks are generally considered low-risk procedures; however, the proximity of the pleura to posterior thoracic elements places patients at risk for iatrogenic pleural injury, particularly in individuals with altered spinal anatomy such as scoliosis. This case underscores the importance of maintaining a high index of suspicion for …

Acute Appendicitis With Concomitant Testicular Torsion, Thuc Vu, Clara Keum, Swet Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

This case report presents a 13-year-old male who presented to the emergency department with diffuse abdominal pain radiating to the right lower quadrant, accompanied by nausea and decreased appetite. Diagnostic evaluation revealed right-sided testicular torsion concurrent with acute appendicitis. Although acute appendicitis represents the most common surgical emergency in the pediatric population, clinicians must maintain a broad differential diagnosis to identify potential concomitant acute pathologies, including testicular torsion in this scenario.

Sonidegib (Lde225) Reduces Inflammatory Signaling And Preserves Taste Buds In A Sepsis Mouse Model, Ashlyn Mcclelland, Murod Khikmatov, Archana Kumari, Gabrielle Audu, Isaiah Nawaz, Kingsley Yin

Rowan-Virtua Research Day

Background:

Sepsis triggers a complex and widespread inflammatory response that disrupts multiple organ systems, including the taste organ. Loss of taste is a symptom recognized in sepsis survivors and has the potential to contribute to further complications such as anorexia. Prior work from our lab demonstrated that cecal ligation and puncture (CLP) in mice induces immune cell infiltration and alters taste bud morphology in the fungiform papillae located in the anterior tongue. We hypothesize that similar deleterious effects occur in the circumvallate papillae (CVP) of the posterior tongue and that the usage of the smoothened inhibitor, sonidegib, could reduce these …

Acute Ischemic Stroke In Hemoglobin Sc Sickle Disease Requiring Emergent Exchange Transfusion And Neurocritical Transfer, Julian Coz, Trent Malcolm, Andrew Iskandar, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Acute ischemic stroke is a well-recognized complication of sickle cell disease (SCD), with historical estimates suggesting that up to 11% of patients experience an overt stroke by early adulthood. Stroke represents a hematologic and neurologic emergency requiring rapid reduction of the circulating hemoglobin S (HbS) fraction to prevent infarct progression. The American Society of Hematology recommends emergent exchange transfusion within two hours of presentation for patients with acute neurologic deficits [1,3].

Management is particularly nuanced in hemoglobin SC (HbSC) disease. Compared with hemoglobin SS disease, patients with HbSC typically have higher baseline hemoglobin concentrations, increasing blood viscosity and the risk …

An Unusual Cause Of Generalized Weakness: Cns Toxoplasmosis, Christopher Dellmyer, Danielle Kusmaul, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

No abstract provided.

Case Report: Vertebral Artery Dissection After Cervical Manipulation, Devin Hoover, Emily Bolinger, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report the case of a 22-year-old female who presented with dizziness and vomiting after recent cervical manipulation who was diagnosed with a dissection of the vertebral artery. Dizziness can have a variety of causes including vascular etiologies, cerebellar and brainstem lesions, ocular problems, trauma, and others. In the setting of a known trauma and acute vestibular symptoms, it is prudent to consider vascular injuries.

Persistent Hypotension Following Viral Illness- Pocus For Pericardial Effusion, Peter Killian, Kelsey Murray, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

A pericardial effusion is defined as a build up of fluid in the pericardial space, the lining around the heart. Normal physiologic fluid can consist of approximately 15-50mL in an otherwise healthy adult . Larger amounts of fluid can be detected on radiographs, but are able to be seen on ultrasound when just exceeding physiologic conditions . Here we report a case of persistent hypotension assessed by point of care ultrasound (POCUS) in order to lead to a diagnosis.

Case Report: Necrotizing Pneumonia, Veroneka Mikhail Md

Rowan-Virtua Research Day

Necrotizing pneumonia is an uncommon but severe complication of community-acquired pneumonia (CAP), characterized by progressive parenchymal liquefaction, cavitation, and destruction of normal lung architecture, and associated with significant morbidity and mortality. Clinicaly, early presentations may be indistinguishable from uncomplicated pneumonia (pna), with fever, cough, pleuritic chest pain, and dyspnea, which can delay recognition in the emergency department. Differential diagnosis for these symptoms is broad and includes uncomplicated pneumonia, septic emboli, lung abscesses, and pleural effusion. However, patients effected with necrotizing pneumonia often exhibit more severe systemic toxicity, rapid progression of respiratory failure, and hemodynamic instability. In this case report, we …

Surviving Ph 7.0: Rapid Interprofessional Collaboration In Severe Metformin-Associated Lactic Acidosis With Refractory Shock, Karl J. Schlicht Md, Amaani Faizal, Vincent Macolino, Julian Coz

Rowan-Virtua Research Day

Metformin-associated lactic acidosis (MALA) is a rare but life-threatening complication with mortality rates of 30-50%. Although metformin is the most widely prescribed antidiabetic medication, severe MALA requiring emergent hemodialysis remains uncommon, with an estimated incidence of 2-9 cases per 100,000 patient-years. Risk factors include acute kidney injury, dehydration, and tissue hypoxia. Early hemodialysis initiation is independently associated with improved survival. This case highlights how rapid interprofessional collaboration from the emergency department to the intensive care unit enabled in a patient presenting with profound acidemia and survival multiorgan dysfunction

A Survey-Based Analysis Of The Use Of Lifestyle Medicine In Clinical Practices Of South Jersey, Zehra Jaffri

Rowan-Virtua Research Day

Chronic diseases are the leading cause of death and disability in the United States and are largely driven by modifiable lifestyle factors. Lifestyle Medicine (LM) is an evidence-based medical specialty that uses therapeutic lifestyle interventions—including nutrition, physical activity, stress management, sleep, substance use reduction, and healthy relationships—to prevent, treat, and reverse many chronic conditions. Despite strong evidence supporting lifestyle interventions, LM use in routine primary care remains inconsistent due to barriers such as limited visit time, inadequate clinician training, lack of reimbursement, and difficulty sustaining behavioral change. This study evaluates how often lifestyle counseling is discussed in South Jersey primary …

Rethinking Gout Through An Inflammatory Lens, James Espinosa, Alan A. Lucerna

Rowan-Virtua Research Day

This review reframes gout not as a static disease of urate deposition, but as a dynamic inflammatory phenomenon. The emphasis is on immune activation, threshold behavior, and systemic inflammatory context rather than isolated joint pathology.

From Clinical Observation To Scholarly Question Academic Curiosity As A Professional Virtue In Emergency Medicine Introducing The Mindful Observation → Curious Inquiry → Clinical Structuring → Scholarly Sharing (Moccs) Model, James Espinosa, Alan A. Lucerna

Rowan-Virtua Research Day

Emergency Medicine generates continuous clinical observations, yet many potentially meaningful insights never progress beyond informal reflection. This poster reframes every day shift observations as the ecological foundation of scholarly inquiry. Conceptual Framework: We propose a simple, repeatable process to lower the activation energy for academic engagement The Mindful Observation → Curious Inquiry → Clinical Structuring → Scholarly Sharing (MOCCS) Model. This model centers disciplined noticing as a professional virtue. By naming and normalizing the “hmmm” and “huh?” moments, this approach validates frontline clinical wisdom, democratizes scholarly participation, and restores intellectual joy within high-stress clinical environments. Conclusion: Curiosity is not hierarchical. …

Brief Review : Listening Closely--Stethoscopes, Hygiene Gaps, And The Unfinished Work Of Healthcare-Associated Infection Prevention, James Espinosa, Swet Patel, Robin Lahr, Sergey Medlenov, Russell Mordecai, James Lee, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Healthcare-associated infections (HAIs) remain a persistent patient safety challenge. While hand hygiene has received sustained institutional focus, stethoscope hygiene remains inconsistently addressed despite longstanding evidence of contamination. Stethoscopes function as portable, patient-to-patient devices that may serve as under-recognized fomites in emergency and inpatient settings. Prior pilot work demonstrated that clinicians were unable to reliably distinguish between disposable and standard stethoscopes, and that perceived acoustic degradation from a diaphragm barrier was minimal. These findings suggest that acoustic concerns may not represent a primary barrier to hygiene-enhancing strategies. This brief review examines the literature surrounding stethoscope contamination and cleaning behavior, frames the …