Medicine and Health Sciences Commons^™

Confluence, Vol. 4, Iss. 2, Full Issue

The Confluence

No abstract provided.

Exploring The Role Of Occupational Therapy In The Delivery Of Trauma-Informed Services To Hospital-Based Clients Ot, Frank Czuba

Journal of Applied Disciplines

Hospitalization can traumatize clients and impact overall health outcomes, leading to increased hospital readmission rates and resulting in a negative impact for both clients and providers. Limited information exists regarding how hospital-based occupational therapists evaluate and address trauma, even though incorporating trauma-informed principles into professional practice can enhance the occupational therapy process. The study explored the comprehension and perceived significance of trauma-informed tenets among occupational therapists delivering services in hospital-based settings. A quantitative research study with an exploratory design was implemented to explore how occupational therapists (OT) understand and utilize trauma-informed practices with their clients in a hospital setting. An …

Advancing Screening For Intimate Partner Violence In Pregnant Individuals Throughout The Perinatal Period To Prevent Adverse Pregnancy And Maternal Outcomes, Emilia R. Valdez

Nursing | Senior Theses

Background: Intimate Partner Violence experienced by pregnant individuals contributes to adverse pregnancy outcomes and maternal health. A mother’s exposure to Intimate Partner Violence (IPV) can affect their ability to carry a healthy pregnancy to term (38 – 40 weeks gestational age) and places them at risk for comorbidities including; Preterm birth, Intrauterine Growth Restriction, Low Birth Weight/ Small for Gestational Age, Premature Rupture of Membranes and Miscarriage. The incidence of IPV screening is not accessible to all pregnant individuals due to healthcare providers lack of education, time constraints in the workplace, bias and discomfort towards IPV. The implementation of IPV …

The Relationship Between Registered Nurse Burnout, Organizational Engagement, And Quality Outcomes In Acute Care Hospitals, James E. Parsons

Theses, Dissertations and Capstones

Registered Nurse (RN) burnout remains a significant challenge in acute care hospitals, with far-reaching consequences for staff well-being, organizational performance, and patient care outcomes. Characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, burnout among RNs contributes to decreased job satisfaction, increased turnover, and compromised care quality. Despite extensive research on burnout, few studies have integrated theoretical frameworks such as the Theory of Reasoned Action (TRA) with large-scale, nationally representative data to empirically test how burnout influences organizational engagement and healthcare quality outcomes.

This quantitative, non-experimental study examined relationships among RN burnout, organizational engagement, and patient care …

Michigan Oral Health Coalition - A Great Cause, Chris Gorecki Dds

Journal of the Macomb Dental Society

This article features a monthly column from the Macomb Dental Society Executive Director, Dr. Christopher Gorecki.

The article enumerates how "timely access to coordinated dental care makes a meaningful difference." In it Dr. Gorecki highlights the ways in which local specialists and the Michigan Oral Health Coalition (MOHC) pursue optimal oral health for all Michigan residents—especially those who face barriers to care.

Causal Effect Estimates Of Online E-Cigarette Marketing Exposure On Future E-Cigarette Harm Perception And Use, Paul T. Harrell, Nicholas T. Williams, Kara E. Rudolph, Rachel Ayala Guzman, Ateeqa Ijaz, Nicole Rychagov, Aaron Null, Silvia S. Martins

Department of Pediatrics Faculty Publications

Background

Globally, over 10 million youth use e-cigarettes; United States use, in particular, dramatically rose in the late 2010's, exceeding year-over-year increases from any other substance in over four decades. This rise has been partially attributed to youth online e-cigarette marketing exposure, but has not been appropriately studied.

Methods

We examined youth data from the Population Assessment of Tobacco and Health (PATH) spanning the dramatic increase period (Waves 4, 4.5, and 5; 2016-2019). We estimated average risk differences (RD) for Wave 5 e-cigarette harmfulness perception and use comparing all youth versus no youth reporting past-month online e-cigarette marketing exposure in …

Burnout And Workforce Outcomes Among Registered Nurses, Madeline Willcoxen

Theses, Dissertations and Capstones

Purpose: The purpose of this study was to examine the relationship between staffing and organizational support interventions and workforce outcomes among registered nurses providing direct patient care in hospital settings. The study focused on three measurable outcomes: emotional exhaustion, absenteeism, and annual nurse turnover. The population included hospital-based registered nurses, and the comparison involved standard staffing and support conditions.

Methods: A systematic literature review was conducted following PRISMA 2020 guidelines. Studies published between 2015 and 2026 were identified using PubMed, CINAHL, Scopus, and PsycINFO databases. Inclusion criteria required quantitative studies examining staffing or organizational support interventions among registered nurses in …

Chronobiology Of Meal Timing In Early-Stage Hypertension: A Controlled Feeding Pilot Study Investigating The Effects On Renal And Vascular Function, Natalie J. Bohmke, Brittany Barton, Patrice Wiecek, Paula Rodriguez-Miguelez, Dave L. Dixon, Youngdeok Kim, Salvatore Carbone, Danielle L. Kirkman

EVMS School of Health Professions Faculty Publications

Lifestyle intervention is critical for young adults with early-stage hypertension. A Western diet has negative effects on kidney function and blood pressure; however, time-of-day effects are understudied. We hypothesized that consumption of a Western-style meal that is misaligned with the endogenous circadian rhythm would have adverse effects on blood pressure, kidney function, and vascular function. Ten young adults with elevated blood pressure or stage 1 hypertension (means ± SD: 26 ± 8 yr, 50% female) underwent a randomized crossover, isocaloric controlled feeding intervention. Participants were allocated to receive a Western-style meal high in sodium, sugar, and saturated fat in the …

Enhancing Military Health System Organizational Efficiency And Quality Of Care Through A Social-Ecological Framework, Eric L. Peipelman

College of Graduate Studies: Theses & Dissertations

Timely and fair adjudication of incivility-related actions within the Department of Defense (DoD) and Military Health System (MHS) is increasingly crucial for maintaining accountability, mission readiness, and quality of care. Ongoing delays in resolving workplace complaints and inefficiencies in resource-heavy adjudications highlight the need to shift from reactive complaint handling toward proactive civility promotion and transparent decision-making. This Integrated Learning Experience (ILE) introduces the Peipelman Civility Discussion and Assessment Toolkit (PCDAT)—a comprehensive, evidence-based framework designed to improve civility, optimize resources, and enhance communication, even in the MHS. Based on the Social-Ecological Model (SEM) and adapted from the Workplace Power and …

Enhancing Hospital Length Of Stay Using Ai Agent Modular Capabilities, Dami Fred

Theses and Dissertations

Hospital Length of Stay (LOS) analysis is essential for managing hospital efficiency and financial performance, yet the analytical depth required remains inaccessible to many organizations due to technical and resource constraints. This thesis introduces the AI Agent Modular Capabilities (AIAM) framework, which decomposes LOS analysis into discrete, codifiable capabilities integrated into a single skill activatable with one prompt. Seven AI Agent Modular Capabilities were developed using a Work Breakdown Structure and tested against a simulated hospital scenario across three successive skill versions. Results demonstrate that the packaged AIAM skill produces comprehensive, consistent, multi-section LOS analyses from a single interaction, outperforming …

Performance Outcomes Of Critical Access Hospitals: A Resource Dependence Theory Evaluation Of Change Of Ownership Versus Independence, Colette Christina Martin

Theses, Dissertations and Capstones

Critical Access Hospitals (CAHs) play a vital role in sustaining healthcare access in rural communities, yet many face persistent financial and operational constraints. A change in hospital ownership is frequently seen as a strategy to sustain these hospitals, improve access to capital, supplement administrative infrastructure, and leverage system-level expertise. However, empirical evidence regarding the effectiveness of acquisition for CAHs remains limited and mixed. Guided by Resource Dependence Theory (RDT) and the Balanced Scorecard framework, this study examines whether ownership change is associated with differences in financial performance, utilization, staffing, and quality outcomes among CAHs.

Using Medicare Cost Reports, the American …

From State House To World Health Assembly: The Distinct Missions Of National And International Leadership In Oral Healthcare, Robert A. Faiella Dmd, Mmsc., Mba, William R. Calnon Dds, Facd

Journal of the American College of Dentists

Leadership in oral healthcare has long been treated as a skill assimilated over time through experience rather than intentionally defined, taught, and assessed. Unlike clinical practice, education, research, and infection control, leadership in oral healthcare lacks consistent standards despite its critical role in integrating these systems and guiding the profession’s future. As healthcare becomes increasingly collaborative and global, dentistry must deliberately develop leadership capabilities at multiple levels. This article examines leadership at the national and international levels, using the American Dental Association’s role within U.S. and global health and dental organizations as examples. It explores why these leadership contexts require …

Long-Lasting Impact Of Public Health Dentistry, Michal Herman Dds, Facd

Journal of the American College of Dentists

This article reflects on the enduring impact of public health dentistry through the author’s 25-year professional journey serving underserved and marginalized communities. It examines persistent barriers to equitable oral health care, including workforce shortages, inadequate insurance coverage, racial disparities, and limited access in rural and low-income populations. Drawing on experiences in nonprofit and community dentistry, the article highlights the importance of mentorship, advocacy, leadership, and community engagement in addressing oral health inequities. It argues that public health dentistry represents a form of professional altruism grounded in service and social responsibility, and calls on dental professionals to expand access, support workforce …

Tele-Psychiatry Adoption And Its Effect On Rural Mental Health Service Availability, Anna Heineman, Kaylee Canterbury, Taylor Carpenter

Theses, Dissertations and Capstones

Purpose of study: This study examined the association between tele-psychiatry implementation and mental health service availability in rural healthcare settings. The analysis compared tele-psychiatry to traditional in-person psychiatric care among rural populations, focusing on access and utilization outcomes, including time to first psychiatric appointment, number of completed visits, and appointment no-show rates.

Methods: A qualitative literature review following a systematic approach was conducted using peer-reviewed articles published between 2016-2026. Databases included PubMed, ProQuest Health, CINAHL, Journal of Medical Internet Research, and the National Library of Medicine, with Google Scholar used as a supplemental source. The review followed PRISMA …

What Is A Standard? Perspectives On Acd’S Standards For Leadership In Oral Healthcare, N. Karl Haden Phd, Facd

Journal of the American College of Dentists

The American College of Dentists’ new Standards for Leadership in Oral Healthcare mark the first attempt in dentistry to articulate standards specifically for leadership, complementing the broader orientation offered by the Ethics Handbook for Dentistry. This article explores the basic question, “What is a standard?” Close reading of the document indicates at least three distinct but related senses of the term: an expectation, a norm, and a guiding principle. The article offers an interpretation of how these three senses fit together coherently. Referencing the Handbook, the article argues that the leadership standards are most impactful only when habituated, when practiced …

American College Of Dentists Team Leadership Standards, Julie Connolly Dds Mph Ms Facd, Sreenivas Koka Dds Ms Phd Mba Mas Facd Fcgdent

Journal of the American College of Dentists

Leadership standards elevate the profession of dentistry by establishing how leaders can be effective and impactful. The American College of Dentists presents 10 carefully curated team leadership standards that serve as guiding principles for team leaders in dental settings. When these standards are followed, leaders increase the likelihood of creating and sustaining a high-performing, mission-focused team. The importance of each standard is described and, where appropriate, examples are provided.

Standards For Leadership In Oral Healthcare: Applying Local And Regional Standards In Practice, Teresa A. Dolan Dds, Mph, Facd, Robin Henderson Dds, Facd

Journal of the American College of Dentists

The dental profession has well-established standards governing clinical practice, education, and research, yet has lacked comparable standards to guide leadership behavior. The American College of Dentists (ACD) Standards for Leadership in Oral Healthcare Task Force developed a comprehensive framework spanning four levels: 1) core; 2) team; 3) local and regional; and 4) national and international. This article describes the local and regional standards, which include 10 standards organized into three themes—Building Foundation, Leading with Purpose, and Developing Others—and their application through interactive workshops at the ACD Spring Leadership Conference 2026. Using structured role-playing exercises, Section leaders and Regents stress-tested the …

J Am Coll Dent 2026 92 2b

Journal of the American College of Dentists

This special issue of the Journal of the American College of Dentists responds to a growing but long-underrecognized demand for humanities and ethics in dental education, practice, and scholarship. It emerges from the work of the National Collaborative on Humanities and Ethics in Dentistry (NCHED), a multi-institutional partnership formed in 2023 to address the persistent exclusion of dentistry from broader health humanities conversations. Through national webinars and scholarly collaboration, NCHED has demonstrated substantial interest in ethical reflection, historical analysis, narrative inquiry, and the arts as essential to understanding oral health and dental care.

The unexpectedly strong response to the call …

A Quality Improvement Project To Decrease Medication Prior Authorization Approval Times, Amena Guinn Babers

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Medication prior authorization requirements add to administrative burden, increase labor costs, and delay patient access to treatment in outpatient specialty settings. This bottleneck directly influences nursing workload and economic performance.

Purpose: To evaluate the fiscal and performance significance of implementing an electronic prior authorization (ePA) process, standardized tracking tools, and staff education in a small orthopedic clinic.

Methods: A pre–post quality improvement design was used. Descriptive statistics and inferential analyses (independent‑samples t tests and Mann–Whitney U tests) were conducted to compare time to approval, staff hours worked, satisfaction scores, and medication pickup timeframes.

Results: Significant reductions were observed in …

Evaluating The Burnout Mitigating Effects Of A Structured Mentorship Program In Newly Hired Advanced Practice Providers, Melissa Soper

DNP Projects

Importance: Burnout is a leading driver of clinician intent to leave, lower productivity, increased medical errors, and increased resource use.

Objective: The purpose of this project was to evaluate the effects of an evidence-based mentorship program on newly hired advanced practice providers’ (APPs’) level of stress, burnout, and professional fulfillment.

Results: At baseline, APPs demonstrated higher stress levels, moderate professional fulfillment, and low burnout. Outcomes showed improvement at the end of a mentorship program.

Conclusion: Longitudinal studies with larger sample sizes are needed to determine the true effect of a 6-month mentorship intervention on APP burnout, stress, and professional fulfillment.

Artificial Intelligence–Enabled Revenue Cycle Management And Financial Performance In Healthcare Organizations, K’Reesa Webster

Theses, Dissertations and Capstones

The purpose of this review was to examine how artificial intelligence–enabled revenue cycle management (AI-enabled RCM) systems have been associated with financial performance outcomes in healthcare organizations. A literature review following a systematic process consistent with PRISMA 2020 guidelines was conducted to identify quantitative studies published between 2015 and 2026. Eligible studies were required to report at least one financial outcome related to claim denial rate, days in accounts receivable, or operating margin. Twenty-seven studies met all inclusion criteria. Findings across these studies indicated that AI-enabled RCM systems have been associated with lower denial rates, shorter accounts receivable timelines, and …

Psilocybin-Assisted Therapy And Alcohol Use Disorder, Zoe R. Evans

Theses, Dissertations and Capstones

This current paper has studied whether the psilocybin-assisted treatment has been linked with meaningful shifts in three clinical outcomes among adults 18 years old and above diagnosed with alcohol use disorder (AUD): percentage of heavy drinking days, abstinence rates, and neural responsiveness to alcohol-related cues. A literature review following a systematic approach was performed using guidelines from PRISMA 2020 based on four databases, namely PubMed and PsycINFO, and Scopus and CINAHL, where peer-reviewed articles published between 2015 and 2026 were included. A semi-structured professional interview with a clinical researcher in the Division of Addiction Sciences of Marshall University was also …

Is Being A Shareholder ‘In Name Only’ A Problem?, Daniel Schulte Jd

The Journal of the Michigan Dental Association

This column addresses the legal risks for Michigan dentists entering "shareholder in name only" agreements with non-dentist entities. Michigan law requires dental practices to be owned by licensed dentists to ensure professional control over public healthcare. Arrangements where management companies or manufacturers can reclaim stock for a nominal fee effectively strip the dentist of true ownership. This lack of control can lead to ethical conflicts, such as pressure to sell specific appliances regardless of professional judgment. Engaging in such schemes may endanger a dentist's license by thwarting state laws intended to protect clinical independence.

Unpacking And Re-Imagining Dental Ethics With Anti-Oppressive And Interdisciplinary Praxis, Eleanor Fleming Phd, Dds, Mph, Ficd, Facd

Journal of the American College of Dentists

Dental ethics are assumed to be neutral in their intent. With a social contract grounded in liberalism and assumptions centering whiteness, the resulting ethics reinforce hierarchy, otherness, and inequities. Because concepts and practices are rarely neutral, dental ethics is embedded with biases, which results in it falling short of the demands of the 21st century and exacerbating health inequities rather than supporting efforts for health justice. This manuscript invites the reader to reflect critically and re-imagine dental ethics using anti-oppressive and interdisciplinary praxis. For the improvement of public health, the narrowing of inequities, and a functioning oral health system, the …

Should More Teams "Trust The Process" Of Tanking?, Eduardo G. Minuci, Alexander Cardazzi, Candon Johnson

Economics Faculty Publications

In many professional sport leagues, the worst-performing teams receive higher probability of earning top draft picks. This provides teams incentives to purposefully lose, or "tank," if they are not likely to contend for the playoffs or championships. We evaluate the effectiveness of tanking to improve team outcomes by examining the most explicit tanking case in the NBA: the "Trust the Process" Philadelphia 76ers. Using synthetic control, we demonstrate that tanking caused the 76ers to be more successful in terms of winning and operating income. However, only operating income had a plausibly positive present value when calculating discounted present values.

Pawpulse Dog Collar, Sean Graham, Hailey Barger, Connor Mulichak, Addison Towne, Kieran Nolan

Williams Honors College, Honors Research Projects

PawPulse is revolutionizing pet care through innovative technology that enhances pet health, safety, and well-being. Combining advanced hardware designs, AI-driven analytics, and IoT integrations, PawPulse offers a comprehensive ecosystem that empowers pet owners with actionable insights into their pets' health and activity. As a global leader in pet health technology, PawPulse integrates features like real-time health monitoring, predictive analytics, and location tracking into a seamless mobile app experience.

This project examines the growth and scaling strategies of PawPulse, focusing on critical areas such as Information Systems, Analytics, and Legal frameworks. It details the company's strategic evolution from a startup to …

The Financial Effects Of Clinically Significant Readmissions In Florida Hospitals, Brian Patrick Cotton

Doctor of Business Administration Dissertations

This study examines how the financial performance of hospitals in the state of Florida impacts the quality of care. This study used data from 2017-2019 to evaluate how the number of hospital readmissions – a proxy for care quality – are associated with and vary in relation to the stability of the financial resources held by the hospital. The Hospital Readmission Reduction Program (HRRP), a Medicare value-based purchasing program, uses a mandatory pay-for-performance process that was initiated to decrease the 30-day hospital readmission rate. Hospitals with high readmissions are held accountable and financially encouraged to increase their quality of care …

First-Job Contract Review Cheat Sheet, Johanna Jones-Morris, Ashlee Martellacci

Teaching and Learning Resources

This cheat sheet helps first-time employees understand what to review before signing an employment contract. It highlights job duties, compensation, scheduling, employment terms, benefits, restrictive clauses, worker classification, and common red flags so that individuals can ask informed questions and recognize potentially unfair or unclear terms.

Self-Leadership And Perceptions Of Artificial Intelligence: A Single-Case Study, Patrik Garren

Graduate Theses, Dissertations, and Problem Reports (ETD)

The purpose of this single-case qualitative project is to uncover how self-leadership’s behavioral and cognitive strategies influence perceptions of Artificial Intelligence (AI) and AI adoption. While existing literature acknowledges that there is an association between self-leadership, technology’s perceived usefulness and ease of use, as well as comfort with AI preparedness and its professional impact, there is limited research on how self-leadership shapes perceptions of AI and AI adoption in real-life contexts. To fill this gap in contemporary literature, this project analyzes qualitative semi-structured interviews with 25 healthcare professionals involved in the implementation of ‘AI Model 1’ at their mid-sized United …

A Multi-Study Examination Of Student-Athlete Mental Health And Mental Health Service Delivery In Mid-Major College Athletic Programs, Grace Louis

Graduate Research Theses & Dissertations

Student-athlete mental health has become a central priority in intercollegiate athletics, with the NCAA emphasizing its Mental Health Best Practices (2016) and strengthening and expanding these standards through updated recommendations in 2024. These efforts reflect a broader cultural shift toward recognizing the unique psychological stressors faced by college athletes, including performance pressure, identity foreclosure, high time demands, and transitions both into and out of sport (Moreland et al., 2018; Hughes & Leavey, 2012). Additionally, student-athletes frequently delay or avoid help-seeking due to stigma, time constraints, identity-protective behaviors, cultural norms emphasizing toughness, and limited mental health literacy (Gulliver et al., 2012; …