Digital Commons Network^™

The Need For Innovative Changes In The Jp Drain, Devin Williams, Bs, Elizabeth Simon, Bs, Krishna Koka, Bs, Spencer Haber, Bs, Andrew Newman, Md

Phase 1

Introduction: The Jackson Pratt (JP) Drain removes surgical site fluid postoperatively. It prevents surgical site complications, however mastectomy and breast reconstruction patients report varying states of pain and quality of life (QOL) during use. The anterior chest wall is densely innervated and drain placement is not precisely controlled. We hypothesize that placement variation contributes to inconsistent patient outcomes. This prospective cohort study aims to understand the impact of drain placement on pain and QOL.

Methods: The drain sites of 30 patients undergoing breast reconstruction or mastectomy and screened for exclusion criteria are measured intraoperatively using anatomical landmarks. A validated pain …

The Need For Innovative Changes In The Jp Drain, Elizabeth Simon, Bs, Spencer Haber, Bs, Devin Williams, Bs, Krishna Koka, Bs, Andrew Newman, Md

Phase 1

Introduction: The Jackson-Pratt (JP) drain has been used post-mastectomy since 1980; however, little research has been done regarding the quality of life (QOL) associated with drains. How might we help JP drain patients following mastectomy have increased QOL during drain use? We hypothesize that specific drain placement locations relative to anatomical body wall landmarks correlate with QOL.

Methods: This is a prospective cohort study of thirty female sex patients undergoing breast mastectomy or reconstruction needing bilateral drains and excludes patients with significant confounding variables that interfere with pain data. The surgeon measures the JP drain location after placement in the …

Designing A Multilingual Instructional Language Tool For Patient Communication In Interventional Radiology, Samuel Almodóvar, Ahlam Houssein, Gregg Khodorov, Md, Mba, Sahib Sohal, Md, Robert Pugliese, Pharmd, David Dwyer, Md

Phase 1

Introduction: Current efforts to provide language-inclusive radiological care fall short, resulting in suboptimal imaging, increased procedural time, and greater radiation exposure. Inadequate language accessibility results in poor communication, suboptimal care, and increased patient dissatisfaction. A digital language tool was developed to provide patient instructions during interventional radiology (IR) procedures, addressing this gap and enhancing patient care.

Methods: Observations were carried out to better understand workflow during IR procedures and identify how to incorporate the tool. We conducted interviews with IR physicians, nurses, and technologists to gather common procedural phrases and patient instructions. Spanish and Mandarin were selected because they are …

Aura Vena, Bassem Fayek, Isaac Kravatz, Robert Pugliese, Pharmd

Phase 1

Introduction: Peripheral intravenous (IV) access remains a common problem faced across healthcare, leading to significant healthcare losses in terms of working hours, resources, as well as patient pain and discomfort. At Thomas Jefferson University Hospital’s (TJUH) infusion center, many healthcare workers utilize hot towels and disposable heat packs to warm patients’ arms if IV access is difficult- a wasteful solution that provides limited heating.

Methods: Nurses at TJUH’s infusion center were interviewed to define the problem and identify optimal product requirements for healthcare workers. In conjunction with market research, a heat-warming sleeve is designed and created. The design of the …

Local Rulemaking, Zachary D. Clopton, Marin K. Levy

Duke Law Journal

Any case heard in a United States federal court must adhere to a set of rules—or rather, a few different sets of rules. Regardless of the subject matter of the suit, the parties (and the judge) must follow the relevant Federal Rules. But that is not all. Parties bringing the case must also comply with local rules—those important rules that govern litigation in the space between and around the Federal Rules. These district- and circuit-specific rules govern highly consequential aspects of federal litigation, such as how cases will be assigned to judges, how those cases will then be managed, and …

The End Of Means-End Scrutiny, Francesca Procaccini

Duke Law Journal

It is black-letter law that courts apply means-end scrutiny to evaluate laws that burden constitutional rights. Not anymore. Discreetly and pervasively, the Supreme Court has ousted means-end scrutiny from constitutional law. It has done so through a series of smaller and seemingly unconnected doctrinal incursions, including the introduction of history and tradition tests, the transformation of equality doctrines, and the embrace of formalist rules to govern constitutional law.

This Article provides a complete and interconnected critique of the numerous doctrinal transformations that together comprise the larger constitutional revolution of ending means-end scrutiny. It tracks how this upheaval now touches nearly …

Supervising The Omnipresent Casino: Evaluating The Role Of State And Local Regulation In Stemming Youth Addiction To Sports Gambling, Matthew Connor Flink

Duke Law Journal

Since 2018, state legalization of sports betting and the industry’s corresponding proliferation has driven an epidemic of youth addiction. Current state legislation and regulations do little to combat youth addiction. Many legal scholars emphasize the value that a federal regulatory regime would provide to reign in youth sports betting. This Note explores the value that state and local government can have in the sports gambling space. To illustrate the unique importance of state and local legislation and regulation of sports betting, this Note analogizes to another addictive product with a history of youth addiction: nicotine.

Nicotine has been a regulatory …

"The Persistent And Muddy Dispute": How The Facial/As-Applied Distinction Creates Problems For Constitutional Litigants, Sean P. Wilson

Duke Law Journal

The distinction between facial and as-applied challenges continues to play a central role in constitutional litigation, including at the Supreme Court. Yet, the distinction and its related rules have long suffered from a lack of doctrinal clarity and consistency. This Note sets out a descriptive taxonomy of three problems facing constitutional litigants because of the murkiness surrounding the facial/as-applied distinction.

First, the “Doctrinal-Test Problem” refers to the fact that many constitutional doctrines appear to require the courts to engage in facial adjudication, even if a litigant wishes to bring an as-applied claim. Thus, as-applied litigants are forced into facial challenges, …

Journal Staff

Duke Law Journal

No abstract provided.

Mapping The Pathology Competencies For Medical Education (Pcme) To The Sidney Kimmel Medical College’S Jeffmd Gi Curriculum, Emma Sanders, Alexander Macnow, Md, Mhpe

Phase 1

Introduction/Purpose: Sidney Kimmel Medical College’s competency-based curriculum, JeffMD, is structured around SMART objectives. However, evaluation of the alignment of these objectives against the PCME, a collection of graduation competencies published by the Association for Academic Pathology, has not yet been performed. This study investigated how comprehensively the GI/Liver block of the JeffMD curriculum addresses the corresponding PCME learning objectives, thereby piloting a pathology curriculum map and allowing evaluation of this curriculum.

Methods: In this study, a curriculum map was created of all learning events covered within the JeffMD GI/Liver block. Each learning event was cross-matched with competencies within the gastrointestinal …

Patient Perceptions Of Medicare Annual Wellness Visits: Findings From A Pilot Survey, Payton Mccready, Amy Cunningham, Susan Parks

Phase 1

Purpose

Medicare Annual Wellness Visits (AWVs) were introduced in 2011 to promote preventive care among Medicare beneficiaries, yet patient satisfaction remains understudied. Participating in the  Age-Friendly Health Systems Initiative, Jefferson Health’s Center for Healthy Aging (CHA) is redesigning its AWVs to align with Age-Friendly principles. This study aimed to obtain baseline data on Medicare patients’ familiarity, experience, and satisfaction with AWVs in a geriatrics practice before implementing the redesigned model.

Methods

This cross-sectional survey was conducted in July 2025 at Jefferson Health’s CHA, a geriatrics practice serving about 2,000 Medicare patients. Eligible participants were Medicare-enrolled CHA patients. An eight-item survey …

Understanding The Benefits Of Sustainable Ir Fellowship To A Large Public Hospital In Kenya, Abigael Gebremariam, Kevin Anton

Phase 1

In 2021, Kenya had 10 interventional radiologists for a population of about 54 million. RAD-AID, a non-profit organization improving global radiology, partnered with the University of Nairobi and Kenyatta National Hospital to establish the first IR fellowship program in Kenya in 2021. Through the program, the number of practicing IRs in Kenya has nearly doubled; however, their practice is limited by capital and supply resources. This study will demonstrate the benefit of the program to the hospital system and the patient population in Kenya.

The project employed a retrospective and comparative analysis of IR services at a large public hospital …

The Evaluation Of Therapeutic Communication In Competency Based Nursing Education, Tracy J. Perron, Chelsea Lebo, Mary Louise Thomas, Romy Zemer

Creating Healthy Work Environments (CHWE)

Therapeutic communication is an essential part of nursing care. Therapeutic communication (TC) is the process of using verbal and nonverbal communication to connect with patients.TC is holistic, patient-centered and involves aspects of the physiological, psychological, environmental and spiritual care of the patient. Poor communication in the healthcare setting can lead to poor patient outcomes such as, decreased adherence to treatment, patient's dissatisfaction, inefficient use of resources and even death. Studies have shown that nurses lack communication skills due to a variety reasons from inadequate training, the lack of understanding of the importance of patient-centered communication, and the increased generational use …

What Is Your Preference? Creating A Healing Culture Through Employee Feedback, Julia W. Millspaugh, Mildred Ortu Kowalski, Sunnie A. Mortimer, Catherine C. Errico

Creating Healthy Work Environments (CHWE)

Stress levels are high for healthcare employees. The negative impact of employee burnout is well-documented within healthcare (Shanafelt et al., 2020; U.S. Department of Health and Human Services Office of the U.S. Surgeon General, 2022). A healthy work environment that optimizes the health and wellbeing of nurses is paramount to providing quality care to patients (Mabona et al., 2022). There is an immediate need for brief, feasible, and rapidly scalable interventions while at work to promote wellbeing for our healthcare workers (Putrino et al., 2020). There is no singular tool or one-size-fits-all approach that holds the answer to wellbeing. Wellbeing …

Responding To Workplace Violence, Penny A. Sauer

Creating Healthy Work Environments (CHWE)

Workplace violence against healthcare workers has increased in the past five years (pre-pandemic) (Brigo et al., 2022; Odes et al., 2023; Sari et al., 2023), with no indication that the violence will return to pre-pandemic levels. In the United States, two nurses are assaulted in the acute care setting every hour (ANA, 2022), but this number is likely much more significant as 40%- 80% of WPVs go unreported.

WPV has been a persistent problem in healthcare for decades. The World Health Organization, Joint Commission, Occupational Safety and Health Administration (OSHA), and many professional practice organizations have statements and recommendations about …

The Escape Room Challenge: Integrating Diversity, Equity, Inclusion Initiatives To Promote A Healthy Work Environment, Teresa D. Welch

Creating Healthy Work Environments (CHWE)

Academic nurse leaders nationally face the constant challenge of incorporating diversity, equity, inclusion, and accessibility (DEIA) initiatives and promoting healthy work environments (HWE) standards with limited resources. This presentation describes a professional development offering for academic nurse leaders via an “escape room” approach.

An escape room is a themed challenge event where players collaborate to find clues, complete tasks, and solve various puzzles. The aim is to achieve a specific, time-bound goal, usually to escape from somewhere. Escape rooms help participants develop the knowledge, experience, and skills to overcome complex challenges (Parker & Welch, 2021; Adams et al, 2018; Brown …

Survivors Of Sexual Trauma: Abortion Experiences Of Black Women In The Southern United States, Katie Grace Geter

Walden Dissertations and Doctoral Studies

Women who experience both sexual trauma and abortion within their lifetime are highly likely to struggle with serious mental health symptoms; however, social work students and practitioners lack education and knowledge on how to serve these women. Recent events, including the uprising of gender and race related movements, COVID-19, heightened political division, and increased governmental control on abortion rights also impact social-work practice. Acknowledging intersectionality, the purpose of this qualitative study was to explore the experiences of abortion for Black women in the Southern United States who have a history of sexual trauma. The experiences of 6 Black women with …

Staff Education On Preventing Benzodiazepines Related Falls In Older Adults, Dafnee Gilles

Walden Dissertations and Doctoral Studies

In geriatric psychiatric setting, falls rates are higher than general wards and could reach up to 13-25 falls per 1000 hospital days. High use of benzodiazepines in older adults is a major cause of increased falls despite recommendations to avoid its prescription to the population. This DNP staff education project focused on training nurses working in an 80 bed capacity geriatric psychiatric facility on best evidence based practice of preventing falls associated with use of BZDs. The identified practice issue was knowledge deficit on evidence based best practices to prevent falls in older adults under BZDs medications. The project aims …

Determinants Of Clinical Supervisor Self-Efficacy In Substance Use Disorder Counseling, Victoria A. Nagel

Walden Dissertations and Doctoral Studies

Substance use disorder counselors face increasing challenges in responding to a growing and more severely affected population, often presenting with co-occurring mental health conditions and complex clinical needs. Clinical supervision plays a critical role in supporting counselor development, yet little is known about the factors that contribute to clinical supervisors’ self-efficacy in providing supervision for alcohol and drug counselors. The purpose of this quantitative correlational study was to examine whether years of counseling experience, years of substance use disorder (SUD) counseling experience, years as a clinical supervisor, professional counseling credentials, and supervisory credentials predicted self-efficacy among clinical supervisors. This study …

Staff Education To Improve Knowledge On Early Recognition Of Staff Burnout In Nurses Working In Long-Term Care, Geraldine Ndeng Akonwah

Walden Dissertations and Doctoral Studies

This doctoral project was a practice-based staff education project aimed at educating nurses concerning early burnout recognition. The educational intervention was chosen to promote awareness and knowledge related to the concept of burnout and self-care among nurses employed in a long-term care facility. The practice problem addressed was the high prevalence of nurse burnout and the limited ability of nurses to recognize early signs of burnout. The problem is significant in nursing practice as burnout is detrimental to the clinical judgment, patient safety, job satisfaction and staff retention. The guiding question of the project was as follows: Does a staff …

Staff Education Project Staff Education To Integrate Nutrition Into Mental Health Care In An Acute Medical Setting, Yolene Auguste

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a staff education initiative designed to support the implementation of a protocol that integrates nutrition and mental health screening in an acute medical setting. The practice problem addressed inconsistent identification of nutrition-related needs and mental health concerns, along with variable follow-through on referral pathways, limiting holistic care and contributing to unmet needs during and after hospitalization. Nutrition and mental health are bidirectionally related, with dietary quality and lifestyle factors influencing mental health outcomes and overall well-being (Dubois & Giroux, 2025). The practice-focused question guiding this project was: In adult patients receiving care …

Improving Nursing Knowledge Of Medication Adherence In Bipolar Disorder, Abisola Omobolanle Disu

Walden Dissertations and Doctoral Studies

The purpose of the project was to improve staff knowledge using a structured educational intervention. The project was guided by the Johns Hopkins evidence-based practice model. Approximately 30 relevant articles were identified, with 20 meeting inclusion criteria and levels of evidence ranging from Level I to V, indicating moderate overall strength of evidence. The educational intervention consisted of a single, in-person, staff education session delivered to 11 outpatient mental health staff members. I administered a project-developed pre- and postknowledge assessment to evaluate participants’ knowledge change. De-identified data were analyzed using descriptive statistics. Results demonstrated increased staff knowledge, with mean scores …

Invisible Man: Mental Health Providers And How Implicit Bias Manifests When Treating African American Men, Jamila Kali Robinson

Walden Dissertations and Doctoral Studies

African American men continue to face disproportionate barriers to engagement, accurate diagnosis, and equitable nonbiased treatment in mental health settings. The purpose of the qualitative narrative inquiry was to explore how implicit bias and sociocultural assumptions manifest among mental health providers who diagnose and treat African American men. Bronfenbrenner’s ecological systems theory, which considers the influences of all the systems that shape an individual’s lived experiences, was the study’s theoretical framework. Semi-structured interviews were conducted with five licensed mental health providers who worked in large hospital systems, private practice, or community-based clinics. The interview data were analyzed using Braun and …

Exploring Strategies For Leadership In Small Businesses, Edward B. King

Walden Dissertations and Doctoral Studies

Small businesses face challenges in maintaining leadership continuity. Unstable leadership transitions can jeopardize business survival. Business leaders are concerned with selecting qualified succession leadership to avoid increased business costs and operational disruptions. Grounded in replacement planning theory, the purpose of this qualitative pragmatic inquiry project was to identify and explore successful strategies used by business leaders in small Oklahoma enterprises to select qualified leadership successors. The participants were six leaders of small businesses in the U.S. state of Oklahoma who had successful strategies for selecting qualified leadership successors. Data were sourced from semistructured interviews and publicly available organizational documents. Thematic …

Emergency Nurses’ Perspectives On Workload, Stress, And Violence In The Context Of The U.S. Nursing Shortage, Wanda Marie Haynes

Walden Dissertations and Doctoral Studies

The nursing shortage is a critical global issue that significantly impacts emergency nurses (ER), leading to increased workloads, psychological stress, and heightened exposure to workplace violence (WPV). This phenomenon raises concerns among healthcare administrators and nurse leaders who seek strategies to improve retention and ensure quality patient care. The purpose of this qualitative study was to explore the meaning of workload, stress, and WPV among ER nurses during the U.S. nursing shortage. Guided by Herzberg’s two-factor theory, the study employed a phenomenological approach to capture nurses’ lived experiences. Data were collected through semi-structured interviews with eight ER nurses from diverse …

Staff Education To Improve Antipsychotic Medication Adherence, Okikiola Oluwabunmi Ogunbunmi

Walden Dissertations and Doctoral Studies

Non-adherence to antipsychotic medication among patients with schizophrenia and other severe mental illnesses is a critical issue, contributing to high rates of relapse, rehospitalization, and increased healthcare costs. Despite the necessity of these treatments, patients often struggle with compliance due to lack of insight, side effects, or complex regimens. The project aimed to evaluate how structured staff education interventions increase knowledge and confidence among healthcare providers, regarding medication adherence strategies, including the use of Long Acting Injectable (LAI) antipsychotics and the “teach-back” methods. Staff education programs typically utilize evidence-based tools, pre-and post-intervention assessments, and training sessions to enhance knowledge on …

“I Plead Ignorance”: Autonomous Weapons And Criminal Liability For Not Knowing The Knowable, Jonathan Kwik

International Law Studies

This article argues that the unpredictability and unintuitive behavior of modern artificial intelligence provide more opportunities for users of autonomous weapon systems (AWS) to remain ignorant of risks posed by their systems to protected entities on the battlefield, and that this ignorance can be maintained even in iterative situations featuring a prior civilian casualty event. It demonstrates this theorem through illustrative targeting scenarios, before formalizing the argument through a model showing the evolution of an AWS-user’s mens rea as they receive notice of a prior incident, and choose to pursue—or not pursue—an inquiry. This analysis reveals a perverse incentive structure, …

Current Developments Of Psychological Research And The Use Of Ai, Tilo Strobach, Farid Pazhoohi

School of Psychology

No abstract provided.

Effects Of A Student-Delivered Glycemic Load Education Program (Jeffgl) On Depression, Emily La, Cindy Cheng

Phase 1

Introduction/Purpose: Previous studies have demonstrated that diabetes is linked to mental health disorders, including depression. In our student-delivered education program, Jefferson Glycemic Load (JeffGL), we aim to investigate the effects of glycemic load patient education on depression in diabetic and prediabetic patients. We hypothesize that participants will demonstrate reduced depression scores compared to baseline, measured using the Patient Health Questionnaire-9 (PHQ-9), after participation in JeffGL.

Methods: Over four weeks with long-term follow up, thirty overweight or obese patients with prediabetes or diabetes recruited from Jefferson’s Department of Family Medicine will participate in one-on-one and group Zoom sessions weekly concerning topics …

Analysis Of Predictive Variables For Atrial Fibrillation Detection In Patients With Cryptogenic Stroke, Paranshu Shah, Cindy Fang, Avinash Saraiya, Behzad Pavri

Phase 1

Introduction: Underlying atrial fibrillation (AF) is commonly screened for in patients with stroke of unknown cause, cryptogenic stroke (CS), using implantable loop recorders (ILRs). However, the risk factors correlated with AF detection after CS are poorly identified. Thus our goals were to elucidate which characteristics correlate with AF detection in patients with CS and to investigate if there is an age below which ILR implantation is clinically irrelevant.

Methods: We conducted a retrospective cohort study on patients with CS who underwent ILR implantation at TJUH from 4/2019-4/2021 (n=282). Exclusion criteria were < 6 months of follow-up data, ILR placement >1 year after CS, or pre-existing AF (n=64). Demographics …