Digital Commons Network^™

Making Diagnostic Uncertainty Visible At Intensive Care Unit Transitions: A Narrative Review Of Diagnostic Pause Strategies, Raha West, Ahmed Elhaddad, Behrad Baharlo, Parind Patel

HCA Healthcare Journal of Medicine

Background

Diagnostic error is a significant patient safety issue in critical care. However, it is often difficult to detect during ongoing care. Patients in the Intensive Care Unit (ICU) often have incomplete histories, overlapping symptoms, changing physiology, and concurrent issues. During ICU transitions, patient diagnoses are often reported without clear information on diagnostic confidence, potential alternative diagnoses, pending results, or triggers needing review.

Methods

This clinical narrative review explored diagnostic uncertainty at ICU transitions, specifically those during ICU-to-ward transfers or unplanned escalations to the ICU. A targeted literature search identified studies of adult ICU diagnostic errors, ICU transition safety, ICU-PAUSE …

Beyond Bed Numbers: A Proposed Quality Improvement Framework For Reviewing Icu Acuity, Workload, And Medical Staffing, Raha West, Ahmed Elhaddad, Behrad Baharlo, Parind Patel

HCA Healthcare Journal of Medicine

Background

Intensive care unit (ICU) medical staffing is often planned using bed numbers or fixed ratios. These counts do not describe the work required when patients deteriorate, urgent tasks overlap, or clinicians have duties outside the unit. A structured review could help teams discuss whether available cover can meet these demands.

Methods

We undertook a targeted narrative synthesis of adult ICU staffing guidance, acuity and workload measures, physician workload studies, and capacity-strain research available through 8 September 2026. We examined study settings, findings, and limitations to inform the framework domains. The authors proposed the review prompts and response options. No …

Brief, Handoff, Backbrief, Forecast, Review: A Communication Cycle For Safer Trauma And Surgical Intensive Care Unit Transitions, Constantine Stephens, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Safety in trauma and surgical critical care is inseparable from the reliability of communication at transitions of care. Handoffs are recurrent, high-risk moments in which teams transfer not only information but responsibility, prioritization, uncertainty, and contingency planning; failures at these points propagate into omissions, delayed escalation, and preventable harm to patients and strain on the workforce. Structured handoff tools improve completeness and clarity but inconsistently change hard clinical endpoints, and tools alone do not create the culture of safety on which high-reliability organizations (HROs) depend. This narrative review synthesizes civilian handoff research, human-factors and HRO theory, situation-awareness, psychological safety, trauma …

Bathrooms As A Patient Safety Blind Spot In Emergency Departments: A Narrative Review And Nursing Practice Framework, Carmelo Villani

HCA Healthcare Journal of Medicine

Background

Emergency department (ED) bathrooms preserve privacy and dignity but interrupt direct observation. Risks described across clinical publications and professional guidance include falls, unrecognized deterioration, overdose, hazardous ingestion, infection, inaccessible environments, and unmet elimination needs. This review integrated those risks and translated them into a nursing practice framework.

Methods

For the structured narrative review, PubMed/MEDLINE, CINAHL Plus, and Scopus were searched on July 30, 2026, without date, language, age, or publication-type filters. Backward and forward citation chasing and a targeted search for professional documents supplemented database searching. Publications were categorized by ED relevance and synthesized thematically. Professional guidance was analyzed …

From Restraint To Calm: A Narrative Review Of Nonpharmacologic Alternatives To Physical Restraints In Adult Acute Care And Introduction Of The Calm Bedside Restraint Alternatives Framework, Elizabeth Card, Brandi Puet

HCA Healthcare Journal of Medicine

Background

Nurses and health care workers are dedicated to creating a therapeutic environment for healing. Sometimes, physical restraints may be used to ensure safety in patients exhibiting violence, confusion, or agitation, or in patients with life-saving medical devices. While the regulatory requirements for use of physical restraints are well developed, this is not the case with alternatives to using restraints, and many nurses may lack clarity on the best practice for identification and application of alternatives to physical restraint use.

Methods

Two trained reviewers searched PubMed, Google Scholar, and professional health care organizations’ websites guided by a search strategy and …

A Digital Safety Detection And Control System For Proactive Risk Management, Karla Miller, Jennifer Lee Mcalister, Keri Melson, Gita Nadimpalli, Becca Moore, Brett Powell, Kenneth E. Sands, Mary Catherine Harris, Cali Cerami, Shanna Arnold Egloff, Yauheni Solad, Randy Fagin

HCA Healthcare Journal of Medicine

Patient safety remains a defining dimension of health care quality, yet systems rely on retrospective assessment after harm has occurred, limiting visibility into upstream risks, including process failures and near misses. This challenge underscores the need for an approach that unifies fragmented safety activities to support proactive safety risk management. We describe a phased pilot implementation and evaluation framework of a Digital Safety Detection and Control System (DSDC) within a large integrated health care system to operationalize enterprise-wide patient safety. The DSDC integrates governance, human oversight, and digital capabilities across 4 operational phases: detection, triage, investigation, and learning. These capabilities …

Pharmacovigilance As An Act Of Awareness And Mindfulness, Mahima Silas, Hale Z. Toklu

HCA Healthcare Journal of Medicine

The term “pharmacovigilance” defines the activities related to the collection, detection, assessment, monitoring, and prevention of adverse reactions due to pharmaceuticals. While it is often framed as a technical and regulatory discipline, it can also be understood through a more reflective lens as a form of mindfulness practice. At its core, pharmacovigilance requires a way of thinking that closely mirrors mindfulness, including sustained attention, openness to uncertainty, and deep awareness of human experience. Viewing pharmacovigilance in this way reframes it not just as a safety mechanism, but as a thoughtful, patient-centered approach to medicine.

Unheard Voices: Reducing Psychological Barriers To Publication In Nursing Research, Caryn R. Alper

HCA Healthcare Journal of Medicine

Despite their interest in clinical inquiry, many nurses face psychological barriers, including imposter syndrome (IS), that prevent them from engaging in research and disseminating their findings. This editorial explores how psychologically safe work environments can help counter these barriers through supportive leadership, respect, and mentorship to strengthen skills and confidence and reduce vulnerability in scholarly work. Normalizing self-doubt and creating environments where nurses feel safe asking questions and testing ideas can help more nurses recognize the value of their expertise and contribute their voice to the base of evidence.

Psychological Safety Is Everyone’S Work: A Call To Practice, Education, And Leadership In Nursing, Gina Rivera

HCA Healthcare Journal of Medicine

Psychological safety is essential to nursing practice, education, and leadership because it enables individuals to speak up, ask questions, report concerns, and learn from mistakes without fear of humiliation or blame. In health care settings, psychological safety supports patient safety by encouraging error reporting, timely escalation, and interprofessional collaboration. For nurses, it strengthens teamwork, accountability, well-being, and retention in complex, high-pressure environments. In nursing education, psychological safety allows students to admit uncertainty, engage in feedback, and develop clinical judgment across simulation, clinical, didactic, and online learning spaces. This article argues that psychological safety is often discussed separately across practice, academia, …

No Place For Workplace Violence, Ryan Sledge

HCA Healthcare Journal of Medicine

Workplace violence in health care is often discussed as an employee safety issue, but that framing misses a larger operational reality. Violent incidents affect the individuals involved, but they also disrupt care delivery, strain teams, reduce patient safety, contribute to health care worker burnout, and expose organizational conditions that leaders cannot afford to ignore. Incident reports rarely tell the full story. In many settings, aggressive behavior becomes normalized to the point that staff stop reporting much of what they experience. This creates a false sense of awareness and visibility. This editorial argues that health care leaders should approach workplace violence …

Safer Together: A Special Nursing Issue Focusing On Safety In Health Care, Tracy A. Ortelli, Lori M. Brodie

HCA Healthcare Journal of Medicine

Safety is a shared responsibility dependent upon the collective efforts of health care professionals, educators, leaders, organizations, and systems. This special nurse-led issue of the HCA Healthcare Journal of Medicine highlights scholarly works addressing education, clinical practice, and health care workforces. We are informed about safety through research, clinical reviews, case-based learning, and education. This issue was created to inspire the entire health care workforce to pursue continuous improvement to make health care safer together.

Development And Implementation Of A Scholarly Curriculum For Internal Medicine Residents And Subspecialty Fellows, Yuri Matusov, Hawas Kaderi, Liza Raffi, Louie Cao, Jacqueline Lee, Mariko Ishimori, Odelia Cooper

Graduate Medical Education Research Journal

Background. To create and assess the efficacy of a standardized curriculum for trainees in the core competency of critical appraisal of medical literature.

Methods. We implemented a 10-hour scholarly lecture curriculum, in 1-hour blocks, over 1 academic year for postgraduate trainees in internal medicine (IM) and IM subspecialties at a single major academic medical center. The aims of the curriculum were to increase trainee comfort with clinical research methodology, to place this methodology in the context of historical and current ethical challenges, to provide trainees with guidance on how to conduct clinical research at the institutional level, and to provide …

Asteroid Hyalosis Mimicking Vitreous Hemorrhage On Point-Of-Care Ultrasound Following Blunt Ocular Trauma: A Case Report, Obiaara Ukah, Jared Marx

Graduate Medical Education Research Journal

Background. Ocular complaints account for approximately 1.5% of emergency department (ED) visits, and point-of-care ultrasound (POCUS) is a valuable tool for evaluating posterior chamber pathology, including vitreous hemorrhage (VH), retinal detachment, and vitreous detachment. However, benign conditions may mimic these pathologies and create diagnostic uncertainty. We describe a case of asteroid hyalosis (AH), a benign vitreous condition that was initially mistaken for vitreous hemorrhage on ocular POCUS following blunt ocular trauma. This case highlights an uncommon sonographic mimic of VH and contributes to the emergency medicine literature by emphasizing ultrasound features that may help distinguish AH from true posterior chamber …

Kaposi Sarcoma And Hhv-8-Associated Multicentric Castleman Disease: A Case Report, Kari Shad, Avry Logeman, Trevor C. Van Schooneveld, Emily Dyer

Graduate Medical Education Research Journal

Background. Multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder characterized by generalized lymphadenopathy, systemic inflammatory symptoms, and distinctive histopathologic findings. HHV-8-associated MCD is typically observed in patients with human immunodeficiency virus (HIV) infection or other states of profound immunosuppression. In contrast, HHV-8-associated disease in immunocompetent individuals is uncommon and associated with higher mortality rates.

Case. This is a case of a patient who presented with progressive fatigue, weakness, anorexia, and a chronic cough for four months following a trip to Mexico. Initial workup revealed anemia and thrombocytopenia, negative HIV status, and prominent bilateral axillary and mediastinal lymphadenopathy, which was …

Emergent Endovascular Therapy For Malignant Superior Vena Cava Syndrome Complicated By Extensive Central Venous Thrombosis: A Case Report, Austin Johnson, Andrew Mezher, Ehab Saad Aldin, Lei Yu

Graduate Medical Education Research Journal

Background. Superior vena cava (SVC) syndrome is a potentially life-threatening condition caused by obstruction of venous return through the SVC, most commonly due to malignancy. Although endovascular therapy (ET) has emerged as an effective treatment for rapid symptom relief, malignant SVC syndrome complicated by extensive central venous thrombosis and respiratory failure remains a high-acuity presentation requiring urgent intervention. This case highlights the role of emergent ET as a life-saving bridge to definitive oncologic treatment in critically ill patients.

Case. A 58-year-old male with squamous cell carcinoma of the lung presented with acute respiratory failure, facial and upper extremity swelling, and …

Strategies For Building Relationships In The Secondary English Language Arts Classroom, Emily S. Nipper

Journal of Educational Research and Practice

Building positive relationships with students is at the forefront of good teaching practices. While secondary teachers in the English language arts (ELA) classroom are increasingly overwhelmed with demands to improve literacy and test scores, positive relationships can help students feel supported in the classroom and more engaged in learning, which can help prevent them from demonstrating negative behaviors. Drawing on research on developing and valuing positive relationships in secondary classrooms, this article translates research into practice by examining how teachers can use discipline-specific strategies to foster supportive and positive relationships with students.

Ruth Mae Mott Bc 1938 Collection Finding Aid

Finding Aids

No abstract provided.

Battle Of The Bots: Comparison Of Artificial Intelligence Chatbots In A Literature Review Of Randomized Controlled Trials In Urology, Linda M. Huynh, Madeline Helm, Nick Staab, Anthony Fadel, Jordan Walsh, John Glassman, Christopher M. Deibert

Graduate Medical Education Research Journal

Background. Use of language-learning model-based artificial intelligence (AI) chatbots in literature reviews has not been explored. The present study seeks to evaluate and compare the quality of reference lists and scientific discussion provided by ChatGPT (Chat Generative Pre-Trained Transformer) (4o vs. 4) and Google Gemini.

Methods. ChatGPT (4o-mini, paid vs. 4o, free) and Google Gemini were given prompts to identify, discuss results of, and provide related references to nine specific randomized controlled trials in urologic practice. Reference lists and associated discussion were graded using modified DISCERN criteria. Hallucination rates for unverifiable references were calculated; GPT-2 Output Detector and Sapling AI …

Learning By Peer Teaching Basic Life Support: A Prospective Randomized Controlled Study In Medical Students, Tushar Kumar, Dewesh Kumar, Vandana Sharma, Shio Priye

Graduate Medical Education Research Journal

Background. Cardiopulmonary Resuscitation (CPR) is a vital emergency procedure performed in case of cardiac arrest or respiratory insufficiency. However, this basic yet important skill is lacking in many undergraduate students. We aim to evaluate the impact of a teaching-learning method, “learning by teaching,” among medical undergraduate students for cardiopulmonary resuscitation.

Methods. A total of 49 undergraduate medical students in the 3rd-year Bachelor of Medicine and Bachelor of Surgery (MBBS) were divided into 2 groups in a 1:1 ratio, namely, the teaching group (Group T) and the non-teaching group (Group NT). The intervention was done after the hands-on workshop on Life …

Iatrogenic Popliteus Tendon Injury During Total Knee Arthroplasty, Saswat Samant, Bibhudutta Sahoo, Saurav Narayan Nanda, Suman Mishra, Satya Ranjan Patra, Himanshu Mishra

Graduate Medical Education Research Journal

Background. The popliteus tendon (PT) plays a role in knee unlocking and posterolateral stability, yet the clinical impact of its iatrogenic injury during total knee replacement (TKR) remains poorly defined. This study aimed to evaluate the outcomes of patients with documented intraoperative PT injury during posterior-stabilised TKR.

Methods. A retrospective review was conducted on 111 varus knees undergoing posterior-stabilised TKR. Among these, seven cases (6.3%) of intraoperative PT injury were identified. The cohort had a mean age of 71 years and an average preoperative varus deformity of 14°. PT repair was performed in two of the seven injured cases.

Results. …

Ritualidad, Memoria Y Cosmovisión: Ámbitos De La Tradición Sonora Entre Los Mayas Peninsulares, Juan Carrillo González

Journal of Maya Heritage

El presente trabajo se centra en esclarecer los contenidos estructurales de la tradición sonora entre los mayas peninsulares a través del análisis del pensamiento mítico y las prácticas ceremoniales. Estos elementos, al enmarcarse en un contexto de larga duración, abren asimismo la posibilidad de esclarecer la correlación entre pasado y presente de la confección instrumental especializada realizada por los artesanos indígenas peninsulares, así como la preservación de distintas convenciones de la musicalidad que han permanecido articuladas a la cosmovisión. La investigación conjuga distintos hallazgos que se desprenden de la compilación de fuentes documentales primarias, relatos provenientes de viajeros decimonónicos y …

The Effects Of Pediatric Asthma On Daily Activities And Family Life In Cache Valley, Utah: Exploring Parental Perceptions Of Air Quality, Saeed Ahmad, Mehmet Soyer, Landon Lloyd, Mayu Mecham

Transforming Communities

Asthma is one of the main chronic health conditions affecting children living in Cache Valley, Utah particularly due to poor air quality during the winter season. It is very important to understand how families manage asthma both within and outside the household. Therefore, this research brief highlights how parents are managing pediatric asthma, and how asthma influences daily activities and family life. It is based on a qualitative study that extracted the data from 20 in-depth interviews with parents of asthmatic children. Participants were recruited through purposive snowball sampling. Data were collected through an interview guide that included some basic …

Specialist Perspectives On West Virginia Medicaid Coverage Requirements For Semaglutide: A Qualitative Study Of Perceived Barriers In A Rural State, Yongjia Deng, Katherine Shepherd, Kanith Farah, Jenna Sizemore, Treah Haggerty, Laura Davisson

Marshall Journal of Medicine

Introduction

The WV Medicaid Drug Utilization Review Board approved a policy limiting prescriptions of Wegovy for cardiovascular risk reduction to cardiologists, vascular surgeons, and neurologists or those in consultation with them. This qualitative study explored specialists’ perspectives on the policy and its perceived implications for patient access to care and clinical practice in rural West Virginia.

Methods

To assess the perceived impact of this policy, we conducted semi-structured interviews with eight WV-based neurologists, cardiologists, and vascular surgeons between September 2024 and June 2025, while the original prescribing restrictions were in effect. Interview data were analyzed using thematic analysis to identify …

Systemic Treatment Considerations For Psoriasis In Alpha-Gal Syndrome: A Case Report And Ingredient Review, Emily Saurborn, Ian Depew, Madelyn Ross, Mckenzie Lambiotte, Shane Cook

Marshall Journal of Medicine

Background: Psoriasis is a chronic skin condition characterized by an overactive immune system, leading to increased keratinocyte proliferation and angiogenesis. Treatment ranges from topical solutions to systemic therapy and lastly, biologics. However, the latter options are typically manufactured with mammalian-derived ingredients. Alpha-gal syndrome (AGS) is an acquired IgE-mediated hypersensitivity reaction to galactose-alpha-1,3-galactose, an enzyme required for digesting carbohydrates in mammalian products. In addition to dietary avoidance of mammalian products, patients with AGS may need to avoid certain medications due to their formulations.

Case Presentation: We present a case of a 53-year-old female with a severe alpha-gal allergy evaluated in the …

Development Of Raynaud’S Phenomenon Following A Crush Injury: A Case Report, Scott Suddarth Md, Matthew Epperly, Robert Levi Snedegar

Marshall Journal of Medicine

Raynaud’s phenomenon is a vasospastic disorder characterized by episodic vasoconstriction of the distal extremities, typically triggered by cold exposure or emotional stress. While primary Raynaud’s is usually symmetric, secondary forms may arise from systemic, vascular, or occupational causes potentially resulting in unilateral or asymmetric presentation. Post-traumatic Raynaud’s phenomenon is rarely reported and is generally limited to transient, distal involvement.

In this report, we present a 38-year-old female with Ehlers-Danlos Syndrome and Postural Orthostatic Tachycardia Syndrome (POTS) who developed unilateral Raynaud’s phenomenon following a crush injury to her right foot. She experienced intermittent discoloration and coldness extending to the mid-shin, occurring …

Subtle Gastric Involvement By Metastatic Breast Carcinoma During Helicobacter Pylori Evaluation: A Diagnostic Pitfall And Case Report, Mustafah Qureshi, Yanina Nikolaus

Marshall Journal of Medicine

Gastric metastases from breast carcinoma are well documented in the literature; however, they may present with extremely subtle clinical, endoscopic, and histologic findings, creating a significant diagnostic challenge. We report a case of metastatic breast carcinoma identified in a routine gastric biopsy obtained to evaluate for Helicobacter pylori infection during esophagogastroduodenoscopy performed as part of the metastatic workup, in a patient with known metastatic disease approximately 10 years after the patient’s initial breast cancer diagnosis. Endoscopic examination showed mildly congested mucosa with thickening of the gastric folds and subtle wall stiffness, but without a discrete mass lesion. Histologic examination revealed …

The Indonesian Propensity To Morally Disengage Scale Short Form: Adaptation And Psychometric Evaluation, Maryam Abidah Masykuroh, Fivi Nurwianti

Psychological Research on Urban Society

Research on moral disengagement has evolved beyond its original focus on children and adolescents to encompass adult populations. Accumulating evidence demonstrates that moral disengagement predicts various antisocial behaviorsamong emerging adults, including findings from Indonesian samples. The present study contributes to this literature by adapting a concise Indonesian version of the moral disengagement measurement scale. This adaptation offers methodological advantages by increasing research flexibility and enabling the examination of broader nomologicalnetworks surrounding moral disengagement, including its antecedents and outcomes. This study adapted the brief 8-item The Propensity to Morally Disengage Scale (S-PMD), which operationalizes Bandura’s eight cognitive mechanisms of moral disengagement. …

Religious Beliefs And Behaviors Of Generation Z, James Knapp

Discernment: Theology and the Practice of Ministry

Research focused on the religious beliefs and behaviors of Generation Z has been increasing but the number of studies that have produced generalizable findings has been extremely limited.  The purpose of this study is to address the scarcity by analyzing responses given by GenZers to eight questions from the General Social Survey which is a well-respected, nationally representative data set.  After discussing the findings and comparing them to responses given by Millennials and GenXers, recommendations are provided for ministry leaders who work with members of Generation Z.

Ministry With Children: Navigating An Expanding And Deepening River Of Thought And Practice, Ron Bruner

Discernment: Theology and the Practice of Ministry

Parents and church leaders live in a unique moment in the life of the church that creates a powerful opportunity: shaping ministry with children in ways that more faithfully serve God’s ongoing purposes. A convergence of several important ongoing conversations unique to our time connects scholars, practitioners, and parents interested in children's spiritual well-being. These tributaries in thought include (1) an emerging theological vision of children, (2) improved understanding of the physical, mental, and spiritual capabilities of children, (3) developing research into the relational ecologies of family, church, and generations, and (4) ongoing developments in children’s ministry leadership, practice, and …

Dyslexia: A Beginner’S Guide For Criminal Justice, Forensic Mental Health, And Legal Professionals, Jerrod Brown Ph.D., M.A., M.S., M.S., M.S., Amy Guillot, Morgan Rutkowski, Jeremiah B. Schimp, Jonathan Q. Ward, Kimberly Dodson, Shelley Mydra Dmft, Lmft, Amanda Fenrich, Joshua Kirven, Bettye Sue Hennington, Matthew Peacock, Janina Cich, Nicole Kimberley-Staeheli

Forensic Scholars Today

Dyslexia is a heritable, neurobiological learning disorder that persistently interferes with reading, spelling, and writing and is distinct from intellectual, visual, or hearing impairments. Although an estimated 15% to 20% of the general population may show symptoms of dyslexia, studies report that 41% to 62% of incarcerated individuals display dyslexia-related characteristics. This beginner’s guide introduces dyslexia for criminal justice, forensic mental health, and legal professionals. It reviews diagnostic considerations, including the distinction between dyslexia and low literacy, the varied cognitive profiles of dyslexia, and the influence of co-occurring conditions such as attention-deficit/hyperactivity disorder. The article frames the link between dyslexia …