Digital Commons Network^™

Balanced Scorecard In Healthcare Facilities: A Ten-Year Review Of Strategies To Improve Organizational Effectiveness, Larasati Tunggadewi, Sofa Dewi Alfian, Auliya A Suwantika

Pharmacology and Clinical Pharmacy Research

The Balanced Scorecard (BSC) has increasingly been adopted as a strategic performance management framework within healthcare organizations. Evidence from the past decade shows varied implementation outcomes, shaped by institutional readiness, leadership commitment, and the maturity of health information systems. This narrative review synthesizes findings from 47 scientific articles selected through a systematic screening process, covering studies conducted in hospitals, primary health centers, and pharmacy units in Indonesia, Morocco, Iran, China, and other countries. The studies employed case study and descriptive cross-sectional designs using both quantitative and qualitative approaches. Overall, BSC implementation contributed to improvements in service performance across the financial, …

Exploring Protein-Protein Interactions: A Promising Avenue For Biomarker And Anti-Tb Drug Development, Rajwa Dwifauza Suryanto, Maritsa Widati Aqila Rumawan, Imam Adi Wicaksono

Pharmacology and Clinical Pharmacy Research

In 2023, tuberculosis (TB) reached its highest incidence with 8.2 million new cases reported by the World Health Organization (WHO). The virulence of Mycobacterium tuberculosis (MTB) is strongly governed by protein-protein interactions (PPIs) that regulate essential processes such as cell wall biosynthesis, immune evasion, and persistence. This study aims to map and analyze the mechanisms of key PPIs in MTB using a scoping review approach. Data was retrieved from PubChem and related literature with the keyword ``PPIs Network TB''. Our findings highlight crucial PPI-driven mechanisms, including the role of DprE1/DprE2 in arabinogalactan synthesis, VapB4/VapC4 in stress response and self-toxicity, ESX-1 …

Global Study On Newborn Hospitalization And Parental Experiences (Hope): Rationale And Design Of A Multinational Cross-Sectional Mixed-Methods Online Survey, Hope Study Working Group, Julia Hoffmann, Ruth Kemper, Helmut Hummler, Ayse Düzenli, Luc J I Zimmermann, Silke Mader, Christina Tischer, Jos Latour

School of Nursing and Midwifery

INTRODUCTION: Newborns who are born too soon, too small or sick are a vulnerable group who require special/high-dependency/intensive care after birth. Infant and Family-Centred Developmental Care (IFCDC) is an integrated healthcare approach that prioritises and values parental/familial involvement and participation by fostering competencies in essential newborn care skills and thus parental empowerment. There is a paucity of data globally on the IFCDC practice and the challenges faced by parents/caregivers during hospitalisation and post-discharge and the potential country-specific support.

OBJECTIVE: The primary objective of the HOPE study (Global Study on Newborn HOspitalization and Parental Experiences) is to assess parents'/caregivers' experiences, needs …

Hyperdynamic Microtubule-Based Structural Changes In Monocyte-Derived-Neuronal-Like Cells From Patients With Schizophrenia, Alfredo Bellon, Alonso Cortez-Resendiz, Lauren N Forrest, Omar Elmarasi, Janani Iyer, Anjali Iyer, Chachrit Khunsriraksakul, Dajiang Liu, L Elliot Hong, Therese M Jay, Marie-Odile Krebs, Anne Hosmalin

Faculty, Staff and Student Publications

A consistent postmortem finding in schizophrenia (SCZ) is reduction in dendrites' size. However, neurons with larger dendritic trees have also been encountered. In vitro experiments with neurons and neuronal-like cells coming directly from patients with SCZ showed similar results, evidencing at times more extensions and at others less arborizations. The process of extending and retracting neuronal outgrowths depends on microtubules polymerization and depolymerization. The possibility that microtubule polymerization/depolymerization is related to defects in the neuronal structure comes from several microtubular anomalies reported in SCZ such as its abnormal distribution in the cytoplasm, irregular shape of microtubules and even absence of …

From Talking The Talk To Walking The Walk: Reflection On Dartmouth Health's Care Experience Week, Rosie Bartel, Corey Kimpson, Tanya Lord, Victoria Lyons, Tony Serge, Brant Oliver

Patient Experience Journal

This article explores the participation of expert members from the Beryl Institute's Global Patient and Family Advisory Board (GPFAB) during Dartmouth Health's Care Experience Week, under the theme ``From Talking the Talk to Walking the Walk.'' This week aligns with the national Patient Experience Week. The Patient Family Advisor (PFA) presenters and authors of this article have shared their lived experience locally, nationally, and internationally through conferences, webinars, podcasts, videos, blogs, white papers, journal articles, books, and in many other ways for and as PFA members of a multitude of healthcare organizations co-create change that improves outcomes for all human …

Inaccessibility And Performative Inclusivity: Higher-Weight Francophone And Newcomer Adults' Experiences In A Canadian Atlantic Province, Andrea E. Bombak, Norma Chinho, Kathleen O'Keefe, Sumaiya Akhter, Lisa Thomson, Courtney Burk, Lee Turner

Patient Experience Journal

Weight stigma research is needed in diverse populations. Two populations that may experience compromised healthcare in New Brunswick, Canada's only officially bilingual province (English/French), are Francophone New Brunswickers and newcomers to Canada. As such, this study explores the experiences of higher-weight (Body Mass Index ≥ 30) adults (≥ 18 years of age) who also identify as primarily Francophone or as having moved to Canada ≤ 5 years ago in and out of healthcare contexts. Participants were interviewed according to a semi-structured interview guide face-to-face, by telephone, or video-call two times, at 2-to-3-month intervals. Interviews included questions about experiences and effects …

Beliefs Regarding Patient Experience In The Emergency Department Among Individuals With Sickle Cell Disease, Elizabeth A. Ibiloye, Gloria N. Odonkor, Ayobami A. Aiyeolemi, Jamie C. Barner, Carolyn M. Brown, Hyeun Ah Kang, Benita A. Bamgbade

Patient Experience Journal

Individuals with sickle cell disease (SCD) frequently experience intense, unanticipated pain episodes known as vaso-occlusive events (VOEs), which often require emergency department (ED) treatment. However, they often report suboptimal experiences in the ED. Using the Theory of Planned Behavior (TPB), this study aimed to elicit salient beliefs regarding SCD patient experience in the ED. Three virtual focus group sessions were conducted with individuals with SCD recruited through a Texas SCD Association and Rare Patient Voice. Nine open-ended questions were used to elicit participants' behavioral, normative, and control beliefs regarding ED use when experiencing VOEs. Qualitative analysis was performed using a …

Ethnopharmacology, Phytochemistry, And Pharmacological Potential Of Philenoptera Laxiflora: An Emerging African Medicinal Plant For Drug Discovery, Albashir Tahir

Al-Mustaqbal Journal of Pharmaceutical and Medical Sciences

Medicinal plants remain an important source of therapeutic agents and play a significant role in modern drug discovery. Philenoptera laxiflora (Fabaceae) is a tropical African plant widely used in traditional medicine, but the scientific evidence supporting its therapeutic potential remains fragmented. This review aims to comprehensively summarize the current knowledge on the ethnomedicinal uses, phytochemical composition, pharmacological activities, and toxicological profile of P. laxiflora, while highlighting research gaps and future directions for drug discovery. A comprehensive literature search was conducted using electronic scientific databases, including PubMed, Google Scholar, Scopus, Web of Science, and ScienceDirect. Relevant publications on the ethnobotany, …

An Exploration Of Drivers Of Sepsis Outcomes In Racial And Ethnic Minority Populations, Matthew Moritz, Omar Pandhair, Shelley Schoepflin Sanders

Books, Presentations, Posters, Etc.

RATIONALE: Race and ethnicity affect sepsis outcomes in unclear ways. Existing data is conflicting, with some studies suggesting minority patients do worse, while others did not show a difference in outcomes between these groups. We sought to investigate whether inequalities exist in sepsis outcomes for different racial and ethnic groups in our large hospital system and to characterize how they may manifest. METHODS: We performed a retrospective cohort study of adults diagnosed with sepsis and discharged from any of Providence’s 52 hospitals between January 1 and December 31, 2023. We grouped patients into ten different race/ethnicity groups including White, Black, …

A Rare And Fatal Complication Of Herpes Simplex Virus (Hsv) Infection, Natalie Bolton, Jeffrey Youker

Books, Presentations, Posters, Etc.

Introduction: Hemophagocytic Lymphohistiocytosis (HLH) is a rare syndrome characterized by overactive immune activation, cytokine storm, and uncontrolled hemophagocytosis. Primary HLH is familial and most often seen in infants, whereas secondary HLH occurs more frequently in adults and is triggered by infections, malignancies, or autoimmune disorders. Clinically, secondary HLH often mimics sepsis but fails to respond to standard therapies, contributing to delayed diagnosis and treatment. Without timely intervention, HLH can result in extensive tissue damage, multiorgan failure, and death. In rare cases, central nervous system (CNS) involvement may occur, manifesting as histiocytic infiltration that can be misinterpreted as malignancy or infection. …

Evaluating Outcomes Of Long-Acting Injectable Antiretrovirals For Hiv Treatment And Pre-Exposure Prophylaxis In A Pharmacist-Managed Clinic Setting, Kaitlin Repass, Pharmd, Melissa Yokoyama, Pharmd, Farnaz Khoshnahad, Pharmd, Bcacp, Char Hunt, Pharmd, Ms, Bcacp

Books, Presentations, Posters, Etc.

No abstract provided.

Hydroxocobalamin In Septic Shock Management – Should It Be Introduced Sooner?, Linh Tang Taylor, Md, Cameron Miles Long, Md, Omar Pandhair

Books, Presentations, Posters, Etc.

Introduction: Treating sepsis involves timely antibiotics, adequate fluid resuscitation, and vasopressor support if shock develops. Plasma concentrations of nitric oxide and hydrogen sulfides are elevated in early sepsis, contributing to vasoplegia,1 a pathology that isn’t addressed by vasopressors. High-dose hydroxocobalamin (vitamin B12) does, and therefore, has long been explored as a potential adjunct to vasopressors, though no consensus or official guidelines for its use have been published. Case Report: A 26-year-old man who was diagnosed with acute myeloid leukemia a few months prior presented to the emergency room for fever, weakness, and emesis. He was found to be profoundly hypotensive …

A Fatal ‘Sepsis’: Intravascular Large B-Cell Lymphoma In Disguise, Jennifer L. Wong, Do1, Jared A. Shipley, Md2, Christine Johnson, Md3

Books, Presentations, Posters, Etc.

Introduction: Intravascular large B-cell lymphoma (IVLBCL) is a rare, aggressive subtype of non-Hodgkin lymphoma characterized by selective proliferation of neoplastic cells within small vessel lumina. Cases in Western countries more commonly involve the central nervous system or skin, whereas patients in Eastern regions often present with hemophagocytic syndrome or medullary disease. The absence of lymphadenopathy, low circulating tumor burden, and subtlety of morphologic clues contribute to delays in diagnosis. By presentation, most have advanced disease, and a substantial proportion are diagnosed only at autopsy. We report a unique case with mixed features who manifested respiratory involvement and ultimately suffered cardiovascular …

Puzzling Papules: Uncovering The Etiology Of A Rash In A Returning Traveler, Lisa Stampke, Md, Shahana Baig-Lewis, Md

Books, Presentations, Posters, Etc.

Introduction: There are an estimated 1.8 billion people that travel internationally every year [1]. Approximately 22-64% of those acquire an infectious disease during or after returning home that is not endemic to their home country [1]. This is especially concerning in our current political climate and declining vaccination rates in the United States which places more patients at risk for preventable diseases [2]. These factors present a unique challenge in diagnosing and treating a symptomatic returning traveler. Case Description: A 25-year-old incompletely vaccinated male returned from Kenya after volunteering for 5-weeks in a rural hospital. He was in his usual …

Hepatic Schistosomiasis: An Unexpected Culprit Behind The Hepatic Mass, Jin Yun Do, Udip Dahal Md, Kenneth Flora, Md

Books, Presentations, Posters, Etc.

Introduction: Schistosomiasis is the second most common parasitic infection worldwide and is associated with significant morbidity and mortality. We present an unusual case of hepatic schistosomiasis presenting as a hepatic mass. Case Description: A 78-year-old male with no prior hepatobiliary disease with an incidental finding of a hepatic lesion on postoperative abdominal CT imaging after an endovascular aneurysm repair. He lived in China until immigrating to the United States over 50 years ago. Previously hospitalized for abdominal pain and diarrhea, at which time he was told he had an infection in his liver. Details of treatment are unknown. He has …

Closing The Gap: Standardizing Sepsis Management To Address Racial Disparities Across Oregon Providence Hospitals, Jennifer Wong, Do, Shelley Schoepflin Sanders, Md, Facp

Books, Presentations, Posters, Etc.

Introduction: Sepsis is a time-sensitive, life-threatening medical emergency affecting approximately 1.7 million adults annually in the United States, contributing to nearly 270,000 deaths and over $24 billion in healthcare expenditures. Delays in recognition and initiation of treatment can significantly increase mortality. Previous studies have identified persistent racial disparities in sepsis care, including lower rates of recognition as the principal diagnosis and delayed antibiotic initiation for Black patients compared with White patients. In alignment with Providence’s mission to provide compassionate, equitable care, Oregon Providence hospitals implemented a standardized “Sepsis Order Set” in all Emergency Departments (ED) to reduce treatment delays and …

Idiopathic Systemic Capillary Leak Syndrome With Shock And Compartment Syndrome Due To Influenza A, Jobe Ashby, Md, Katelyn Bobrowski, Do, Ryan Best, Md

Books, Presentations, Posters, Etc.

INTRODUCTION: Idiopathic systemic capillary leak syndrome (ISCLS) is a rare, poorly understood condition that leads to extreme pathology with severe but predictable complications. First described in 1960, ISCLS has been identified in about 260 case reports and is marked by a triad of hypotension, hypoalbuminemia, and hemoconcentration often preceded by upper respiratory tract infection. It is divided into distinct phases of prodrome, extravasation, and recovery. We present a case of a middle-aged woman who presented with influenza A infection and developed ISCLS needing ICU level care for shock and bilateral upper extremity compartment syndrome. DESCRIPTION: Our patient is a 49-year-old …

Sepsis Transitional Care Management: A Phone Call To Reduce Readmission Health Inequity, Linh Tang Taylor, Md, Erica Leser, Ms, Alyssa Nelson, Michelle Schoepflin Sanders, Md

Books, Presentations, Posters, Etc.

Introduction: Sepsis accounts for 52% of hospital admissions in the United States and is the leading cause of death among hospitalized patients1 . However, disparity exists among sepsis survivors with race being reported as a determinant of recovery2 . Such disparity exists in Providence Oregon 8 hospitals: Providence Black patients have higher sepsis readmission rates than White (12.93% vs 11.65%). Using modified community-based participatory research, data analysis, and stakeholder interviews, we identified one potential root cause of the disparity: Black patients being readmitted are not receiving our system's Transitional Care Management (TCM) services. We aim to eliminate the Black/White sepsis …

Ofatumumab Associated Legionella Pneumonia In A Young Multiple Sclerosis Patient, Jobe Ashby, Omar Panhair

Books, Presentations, Posters, Etc.

Ofatumumab is the only anti-CD20 IgG1κ human monoclonal antibody therapy for relapsing forms of multiple sclerosis (MS) that patients can self-administer subcutaneously. Anti-CD20 agents are biologic therapies that carry an increased risk of serious infections, but rarely Legionellosis. We present the case of a young man taking ofatumumab for his MS who developed Legionella pneumoniae pneumonia. A 30-year-old man with MS diagnosed two years prior, stable on ofatumumab, presented with fevers, cough, and hemoptysis. A week earlier, he developed fevers and myalgias after administering ofatumumab, but these symptoms persisted longer than usual. Though initial vital signs were normal, he appeared …

Gent-Le Dosing: Evaluating The Safety Of Gentamicin At Higher Doses For Late Preterm And Term Neonates, Jason Hector, D. Erin Wilson, Aiyana Ooki-Knutson, Jennifer Conley

Books, Presentations, Posters, Etc.

Abstract: In June 2024, Providence St Joseph Health updated the standard gentamicin dose in the Pediatric and Neonatal Aminoglycoside protocol from 4 mg/kg to 5 mg/kg every 24 hours for late preterm and term neonates. This project aims to evaluate late preterm and term neonatal patients who received gentamicin for empiric sepsis coverage within the first seven days of life, at 4 mg/kg/dose or 5 mg/kg/dose, to assess the safety of the standardized 5 mg/kg dosing for late preterm and term neonates after the protocol change. This study is a multicenter retrospective pre-/post-intervention analysis at a multistate health system spanning …

The Impact Of Covid-19 On Playwork: Five Years On, Pete King

International Journal of Playwork Practice

In 2020, at the start of the March 2020 COVID-19 lockdown in the United Kingdom, a study was undertaken with 23 participants exploring the impact this may have on playwork and playwork practice.  That project started an 18-month longitudinal study between March 2020 and September 2022.  COVID-19 was five years ago, and this final study aimed to explore the current impact on playwork and playwork practice.  In total, 8 interviews were undertaken, and the results constructed 4 main themes regarding the continuing effects of COVID-19: 1) Community Engagement, 2) Emotional Regulation, 3) Outdoors, and 4) Health and Safety.  The findings …

Perceptions Of Rural Large Animal Owners On Cost And Distance As Barriers To Veterinary Medicine, Alyssa Dalleske

Honors College Theses

Access to veterinary care remains a significant issue in rural communities due to financial, geographic, and access barriers. Limited access to veterinary care can have an impact on animal welfare and an economic impact for producers. This study aimed to assess factors influencing access to veterinary services, including cost, distance to clinics, perceived value of care, and availability of mobile veterinary professionals. The survey was distributed to rural large animal owners using social media, and gained 20 participants. It collected data on perceived barriers within their communities. The survey results indicated that cost of care and distance to veterinary clinics …

Global Research On Palm Oil Diseases And Infections: A Bibliometric Analysis, Fahmi Achmad Saputra, Indria Puti Mustika, Anna Safarida, Catur Sriherwanto, Nicky Rahmana Putra

Makara Journal of Technology

The sustainability of global palm oil production faces significant threats from a range of diseases and infections affecting palm oil crops. This study presents a comprehensive bibliometric analysis to map the scientific landscape and evolution of research related to palm oil diseases over the past decade. Using data from the Scopus database, 366 relevant documents were analyzed using R and VOSviewer to uncover trends in publication volume, citation impact, prolific authors, country contributions, and keyword co-occurrence networks. The findings reveal a strong research concentration on G. boninense, highlighting its critical role as a persistent pathogen in oil palm plantations. Emerging …

Care Among Crisis: Trauma And Building Resiliency With Wildfire Respondents, Zurisadai A. Inzunza, Monika Scherer, Maximus Balliet, Zoe Hollingsworth, Adrienne Martinez-Hollingsworth

Creating Healthy Work Environments (CHWE)

In January 2025, over 230 employees were rapidly deployed from a Federally Qualified Health Center (FQHC) system to support the medical and social needs of Eaton wildfire evacuees at the Pasadena Convention Center (PCC). Of the thousands of Pasadena and Altadena residents displaced, many of the employees were directly impacted. As environmental disasters are becoming more frequent, organizations can implement measures to reduce the psychological impact by promoting coping strategies to improve mental wellbeing for nursing professionals.^1,2

Research has shown that volunteer responders who are highly motivated report lower levels of burnout.³ There is a gap in research …

Capitalizing On Crisis: A Statistical Analysis Of Federal Funding And The Surge In White-Collar Criminal Activity During The Covid-19 Pandemic, Lee R. Gibson

Doctoral Dissertations and Projects

The COVID-19 pandemic ushered in a new era that has forever changed how people work, communicate, and socialize. The pandemic also brought one of the most significant influxes of financial assistance to individuals, businesses, educational institutions, and state and local governments that has ever been seen. This massive infusion of cash, which was orchestrated and managed by the federal government, was instituted in a manner that provided quick relief with little ability for oversight, resulting in every assistance program experiencing high rates of fraudulent activity. This project aims to understand if the levels of white-collar crime increase during a disaster, …

Examining The Relationship Of Telehealth Use Between Zoom Fatigue And Psychological Well-Being, And The Moderating Role Of Social Support Seeking And Work-Life Boundaries Among Remote Therapists, Angelia M. Worley

Doctoral Dissertations and Projects

During the COVID-19 pandemic, mental health therapists rapidly transitioned to telehealth services. In addition, therapists experienced a significant increase in client demand, leading to larger caseloads and longer waitlists. In the post-pandemic context, many therapists have continued to deliver services via telehealth, either fully remote or in a hybrid format. However, there is limited research on the relationship between telehealth intensity and therapist wellness. The purpose of this correlational study was to examine the relationship between telehealth intensity (duration, frequency, and burstiness) and wellness outcomes, specifically, synchronous telehealth fatigue (STF; therapist-related Zoom fatigue) and psychological well-being (PWB). Furthermore, this study …

Unmasking The Murmur: Native Pulmonic Valve Endocarditis By Streptococcus Mitis In A Patient Without Classic Risk Factors, Nathan Fletcher, Ruben Martinez, Daniel Graber, Mitali Roy

Advocate GME

Introduction: Infective endocarditis (IE) of the native pulmonic valve is exceedingly rare. Reported cases most commonly involve Staphylococcus aureus and occur in patients with intravenous (IV) drug use or congenital valvular disease.

Case Description: A 50-year-old woman with coronary artery disease and a secundum atrial septal defect (ASD) presented after one week of rigors, dyspnea, chest pain, and vomiting. Initial evaluation showed leukocytosis (14.3 K/mcL) and unremarkable vital signs. A previously undocumented high-pitched murmur was noted at the left upper sternal border. Blood cultures drawn in the emergency department grew Streptococcus species at 19 hours, and empiric IV ceftriaxone was …

Salmonella Seeding: Cavitary Pneumonia In The Setting Of Bronchopleural Fistula, Hannah Runnoe, Megan Elmes, Zachary Sedor-Schiffhauer, Essam Mekhaiel, Frances Boly, Saira Ajmal

Advocate GME

No abstract provided.

Metastatic Masquerade: A Tragic Case Of Tuberculosis Meningitis Masquerading As A Metastatic Brain Lesion Complicated By Cardiac Arrest, Hannah Runnoe, Rusheek Rawal, Rachel Morris, Radhika Huliyar, Dana Mueller

Advocate GME

No abstract provided.

Expanding The Mutation Spectrum Of Non-Syndromic Retinitis Pigmentosa In Consanguineous Pakistani Families: Unraveling Novel Pathogenic Variants In Rp1, Pde6b, And Prcd Genes For Precision Diagnosis, Tayyaba Shan, Nimra Mukhtar, Sayyed Hammad Ullah, Asad Ullah, Asfandyar Ahmad Khan, Yumei Li, Meng Wang, Raeesa Tehreem, Amtul Aziz, Kiran Afshan, Rui Chen, Sabika Firasat

Faculty, Staff and Students Publications

No abstract provided.