Medicine and Health Sciences Commons^™

Navigating Medical Ambiguity: A Patient's Perspective On Communication, Timing, And Risk, J. Hansen

Patient Experience Journal

This essay recounts the experience of navigating re-vaccination decisions after an initial diagnosis of vaccine-associated myocarditis. A diagnosis later contested by other specialists. It is not a tale of medical error, but of diagnostic ambiguity and divergent clinical reasoning. My intent is to show how, in the absence of consensus, a patient was compelled to assume a central role in adjudicating between competing medical narratives. Recommendations are offered to make medical advice more available to patients and bridge a growing gap between medicine and the public.

Human Experience, The Boarding Crisis, And Moral Injury-A Call To Action, Thom Mayer, Wendy Dean

Patient Experience Journal

Patient experience has evolved to a broader definition of human experience, including workforce experience, and community experience. Hospital boarding is a common, pervasive problem facing healthcare, which threatens all levels of human experience, from patient experience, to workforce experience (moral injury and burnout in healthcare professionals), and community experience (delayed and denied access to care for patients, Emergency Medical Services, and even interhospital transfers. Effective system leadership across the systems and processes of healthcare, as well as stakeholder and boundary management, will be essential to deliver acceptable human experience, in addition to solutions to smooth surgical flow, improve discharge systems, …

Human Experience: A Catalyst For Global Connection, Jason A. Wolf

Patient Experience Journal

As I think about the state of play in our world today, I find we have two choices in how we react. One is with a sense of despair driven by the intentional efforts to disconnect humanity being perpetuated by some. The other, with a sense of hope, that even in the face of these forces, there are those that strive relentlessly to foster connection and opportunity. I find the path forward in holding the tension of pragmatic idealism – that we can dream, with big and noble goals, while recognizing our path forward must be grounded in practical and …

Optimizing Glycemic Control In Type Ii Diabetes: Continuous Glucose Monitoring : A Scoping Review, Sarah Poe, Bsn, Rn, Bailey Li, Bsn, Rn, Tracy Mcclinton, Dnp, Aprn, Ag-Acnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Individuals with Type II diabetes mellitus (T2DM) experience increased risk of cardiovascular disease and higher mortality rates relative to non-diabetic populations. Continuous glucose monitoring (CGM) enables more precise analysis of glucose patterns and trends compared to conventional self-monitoring of blood glucose (SMBG). CGM provides frequent measurements and generate meaningful metrics, such as time in range (TIR), time above range (TAR), and time below range (TBR), allowing evaluation of glucose stability and variability. Despite these advantages, evidence comparing CGM and SMBG remains inconsistent. This scoping review aims to evaluate how CGM compares with SMBG across reported outcomes, including TIR, TAR, …

Efficiency Rx: Emr Training For Resident Wellness, Calder Dorn, Do, Tom Chau, Md, Mba, Facp, Shelley Schoepflin Sanders, Md, Facp

Books, Presentations, Posters, Etc.

Introduction: Physician burnout affects nearly 60% of physicians during their careers, leading to increased medical errors, reduced care quality, higher turnover, and lower patient satisfaction. ii. The widespread use of Electronic Medical Records (EMRs) has been identified as a key contributor, with poor usability, inbox overload, and documentation burden reducing direct patient interaction among cited factors iii. Institutions like UCHealth, OHSU, CHOP, and Mayo Clinic have implemented strategies that improved EMR confidence and reduced burnout vi. While Providence offers training to all providers, there are no initiatives specifically targeted to internal medicine (IM) residents. Methods: Providence St. Vincent Medical Center …

Evaluating The Screening And Referral Process For The Use Of Phq-9 Screening Tool In Middle-School Aged Students: A Scoping Review, Kaythi Soe, Msn, Pmhnp-Bc, Fnp-Bc, Margaret Harvey Phd, Acnp-Bc, Fhrs, Sharon Little Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

No abstract provided.

Improving Recognition Of Chronic Kidney Disease In A Federally Qualified Health Center Through A Quality Improvement Initiative, Rachel Monroe, Evan Saulino, Kathleen Mckenna

Books, Presentations, Posters, Etc.

Context/background: Chronic kidney disease (CKD) affects approximately 15% of adults in the United States, yet nearly 90% of affected individuals are unaware of their diagnosis. Early identification in primary care enables interventions such as blood pressure optimization, renin –angiotensin system blockade, and kidney -protective medications that can significantly delay disease progression and postpone dialysis. Screening and diagnosis gaps disproportionately affect high -risk populations, including Latinx patients and immigrant agricultural workers commonly served in federally qualified health centers (FQHCs). National CKD screening rates among patients with diabetes or hypertension remain low, leaving many high -risk individuals unscreened for kidney disease. Improving …

Home-Based Vs Clinic-Based Stool Testing For Detecting Early Cancer Markers: A Scoping Review, S. Elizabeth Brock, Jacqueline Giles, Sydney James, Cha'landria Mccall, Bobby Bellflower Dnsc, Nnp-Bc-Faanp, Fnap, Faan

Doctor of Nursing Practice Projects

Purpose/Background 

Colorectal cancer (CRC) remains a significant public health concern in the United States, with screening rates below national targets due to persistent socioeconomic and structural barriers, particularly among underserved populations. Stool-based screening modalities offer accessible alternatives to colonoscopy, and emerging evidence suggests that home-based delivery models may improve screening uptake; however, implementation strategies vary and comparisons between home-based and clinic-based approaches remain limited. This scoping review examines current evidence on strategies that support CRC screening uptake, with a focus on stool-based modalities, including fecal immunochemical testing (FIT), fecal occult blood testing (FOBT), and multitarget stool DNA testing (mDNA), and …

How Does Cognitive Behavioral Therapy (Cbt) And Antipsychotics Compare To Antipsychotics Alone Impact Inpatient Length Of Stay: A Scoping Review, Morgan E. Johnson, Hailey M. Wade, Y'Esha V. Williams-Click, Rocquell Duncan, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Background

Psychosis in adults is a serious psychiatric condition that often necessitates inpatient hospitalization for stabilization and the initiation of medication. Untreated psychosis can lead to poor outcomes, including longer hospital stays, loss of occupational functioning, and a decreased quality of life. While antipsychotic medications are typically the first line of treatment, they can have severe side effects, which may lead to patients discontinuing their use. Cognitive Behavioral Therapy (CBT) for psychosis is an evidence-based intervention that targets maladaptive behaviors associated with the condition. CBT may improve treatment responses when used alongside antipsychotic medication. However, there is limited research on …

Moving Toward Standardization Of Breast Cancer Screening: A Scoping Review Comparing Uspstf And Acs Recommendations For Women Aged 40–74, Gerita F. Perry, Krystal D. Hester-Smith, Bobby Bellflower Dnsc, Nnp-Bc, Faan, Faanp, Fnap

Doctor of Nursing Practice Projects

Purpose 

To compare U.S. Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) breast cancer screening guidelines for women aged 40–74, and to recommend adopting one consistent, standardized guideline in practice. Standardization can improve care continuity, patient adherence, reduce anxiety, support early detection, and lower mortality.

Background 

Breast cancer is the second leading cause of cancer-related death amongst women. The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. The ACS recommends an annual mammogram. Differences between the two organizations for screening emphasize the need for a common alignment to reduce breast cancer mortality. As breast …

Recovery Instruction Improvement Project, Jonathan Eyestone, Katy Germundson

Publications 2026-present

No abstract provided.

Organizational Governance Capacity And Organizational Resilience In Hospitals: A Cross-Sectional Study, Leyla Afşar, Selim Yazıcı

Makara Journal of Health Research

Background: This study aims to examine the relationship between organizational governance capacity (OGC) and organizational resilience (OR) in hospitals, with a focus on cross-institutional differences.

Methods: A cross-sectional study was conducted among 1,143 employees from six hospital types in Istanbul, including university, Ministry of Health (state, training and research, and city), and private hospitals. Validated scales were used to measure OGC and OR. Data were analyzed using descriptive statistics, nonparametric tests, and structural equation modeling (SEM) to assess the relationships between these dimensions.

Results: Private hospitals demonstrated the highest levels of both OGC and OR (70%), followed …

Knowledge Of Parents And Guardians Of Computed Tomography Examinations And Radiation Risks In Children In Malaysia, Nur Maisarah Ali Wahab, Nur Hamizah Mohd Zainudin

Makara Journal of Health Research

Background: Early exposure to computed tomography (CT) imaging during childhood increases cancer risk, emphasizing the critical need to minimize unnecessary imaging in pediatric patients. This study aimed to assess parents and guardians’ knowledge about CT examinations and their associated risk following pediatric CT.

Methods: A cross-sectional survey was conducted among parents and guardians who accompanied their children to a private hospital radiology department for CT examinations. The survey enquired about their socio-demographic, knowledge of CT examinations, and their radiation risks. Data were analyzed using descriptive analysis and the Kruskal-Wallis test.

Results: A total of 144 responses were …

Examination Of Health-Seeking Behavior In Individuals With Chronic Diseases, Dilan Aktepe Coşar, Hatice Demirağ, Aynur Cin

Makara Journal of Health Research

Background: Chronic illnesses are long-term, noncommunicable diseases that significantly affect daily life. In addition to physical symptoms, they can reduce quality of life by causing psychological effects such as anxiety and depression. Patients often seek health information to better manage their condition.

Methods: This study aimed to examine the level of health information-seeking behavior among individuals with chronic diseases and the factors influencing this behavior. The sample group for this descriptive study consisted of 306 individuals with chronic illnesses who visited X Hospital in northeastern Türkiye between April 1, 2024, and February 1, 2025. All individuals completed a …

Optimizing Costs & Efficiency With Heartcode Complete: A Quality Improvement Project, Jessica Bryant

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This quality improvement project aimed to implement HeartCode Complete (HCC), a simulation-based BLS training platform, at a 154-bed community hospital. The goal was to replace instructor-led BLS training, improve training efficiency, reduce costs, increase certification compliance, and enhance staff satisfaction.

BACKGROUND

Maintaining competency in CPR is a regulatory requirement for healthcare providers. Traditional instructor-led BLS training requires scheduled classes, instructor availability, and staff time away from clinical duties, contributing to certification delays and operational inefficiencies. Simulation-based training platforms offer self-directed learning with real-time feedback.

METHODOLOGY

This quality improvement project used Lean Six Sigma principles and Plan-Do-Study-Act cycles to guide …

Improving Pneumococcal Immunization Counseling In Children With Systemic Lupus Erythematous, Sarah Dettmann

Doctoral Dissertations & Projects

Background: Pediatric patients with systemic lupus erythematosus (SLE) face elevated risk for invasive pneumococcal disease, yet fewer than 10% are estimated to be current on pneumococcal vaccine (PCV) recommendations.

Local Problem: This quality improvement (QI) project aimed to develop and implement a standardized pneumococcal immunization screening and counseling process in a pediatric rheumatology clinic.

Method: Three consecutive PDSA cycles guided implemention across a nine-week intervention period using a pre-post quasi-experimental design.

Interventions: A multicomponent strategy was employed, including a PCV decision algorithm, EHR Smart Phrase, PCP referral template, and patient education brochure.

Results: Pre-implementation PCV counseling was documented …

Psychological Safety In Health Care: A Prerequisite For High Reliability, Sonali Thosani

Advances in Cancer Education and Quality Improvement

This paper presents a viewpoint on how psychological safety contributes to patient safety, teamwork, and high reliability.

Kobayashi Maru, Daniel Mahoney

Advances in Cancer Education and Quality Improvement

This poem invites the reader to consider the uncertainty of facing an unwinnable situation. Kobayashi Maru is a reference to a fictional leadership test from Star Trek, designed to confront participants with a no-win scenario. While the test is famously “beaten” by the show’s hero, this piece aspires to depict the often unwinnable circumstance of caring for a child with incurable illness. The reader is provided space to consider how the balance of emotions and values may shift when read through the eyes of a parent, clinician, or observer.

The Weight Of The White Coat, Jonathan Cunningham

Advances in Cancer Education and Quality Improvement

This is a poem reflecting on the mission of the medical provider through the image of the white coat.

Beyond Boundaries: A Model For Boosting Staff Retention And Morale Through Career Mobility, Tiffany Hughes, Abigail Caudle, Robert Ghafar, Brandon Freudensprung, Paloma Vasquez

Advances in Cancer Education and Quality Improvement

Retention and morale in health care are strategic imperatives that directly influence patient care, quality outcomes and operational stability. At The University of Texas MD Anderson Cancer Center, we found a significant gap in the career advancement opportunities for our clinical and administrative staff. Employees lacked visibility into career growth pathways, leaving them disengaged and increasing the overall turnover rate. In response, our division launched a structured, transparent Career Mobility Model to provide employees with the clarity and tools needed for advancement. This model integrates career mapping, shadowing programs, and leader-led career conversations, all of which led to measurable gains …

Advancing The Anesthesia Workforce: The Md Anderson Anesthesia Technology Fast Track Program, Miranda M. Phillips, Mary Sizemore, Sally Raty, Tanveer Khan, Homero Lozano

Advances in Cancer Education and Quality Improvement

The Anesthesia Technology Fast Track Program (ATFTP) at The University of Texas MD Anderson Cancer Center was initiated in 2024 to mitigate a significant national deficit of trained anesthesia technologists. This 40-hour continuing education program, developed in accordance with the American Society of Anesthesia Technologists & Technicians’ (ASATT) Practical Experience Pathway, assists experienced yet non-certified anesthesia technicians in obtaining the Certified Anesthesia Technologist (Cer.A.T.T.) credential. The fully online, asynchronous 10-week CEU program is tailored for working professionals. The course focuses on patient safety, evidence-based practice, and certification preparedness and concludes with two extensive practice examinations and an ASATT CEU requirement–aligned …

Clinical Medical Emergency Team Training Simulation (Cmetts): An Interprofessional Simulation For Medical Students And Nursing Residents, Allan John R. Barcena, Marvin R. Bernardino, Dominic Karl M. Bolinas, Kitz Paul D. Marco, Toni Edwards, Shelita Kimble, James Cavalier, Marites P. Melancon, Jillian R. Gunther

Advances in Cancer Education and Quality Improvement

Effective teamwork and communication are critical during medical emergencies, particularly in oncology, yet health care professionals are often trained separately, creating challenges for interprofessional collaboration. Evidence-based frameworks like Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) offer structured tools to optimize team performance. This study describes a simulation-based program, the Clinical Medical Emergency Team Training Simulation (CMETTS), designed to instill foundational teamwork skills in early-stage learners. First-year medical students and newly graduated nursing residents participated in an interprofessional simulation involving medical emergency scenarios followed by structured debriefing sessions guided by TeamSTEPPS principles. We evaluated the program’s effectiveness …

Lessons Learned For Improving Trainee Engagement And Utilization Of Education And Training Materials For Cancer Research, Katerina M. Santiago, Tania Galindo, Michaela A. Dinan

Advances in Cancer Education and Quality Improvement

Background: A core component of the National Cancer Institute Cancer (NCI) Cancer Center Support Grant requires cancer centers to coordinate research career enhancement and related activities. The Yale Cancer Center, an NCI-designated comprehensive cancer center, established the Cancer Research Training and Education Coordination (CRTEC) component in 2016. In response to the needs of trainees, CRTEC has developed several initiatives that we have identified and described here as best practices to engage and support trainees.

Methods: We had 2 aims to improve engagement: 1) increasing our visibility and trainee awareness of CRTEC and nurturing bidirectional communication and 2) offering …

Centralizing Communication Intake To Improve Workflow Visibility And Engagement: A Quality Improvement Project In A Cancer Center's Education Division, Menatalla El-Sharkawi, Mohamed Ait Aiss

Advances in Cancer Education and Quality Improvement

Background: In large or complex organizations, multiple teams may be charged with managing different components of a project, initiative, or administrative assignment. When these teams have overlapping needs for information, the absence of a structured intake and tracking process can limit transparency, reduce efficiency, and hinder coordination across communication channels.

Methods: Drawing on principles of strategic communications and project management, we created a structured and centralized information sharing process for teams within the education division of a comprehensive cancer center. The intervention included workflow redesign, development of a standardized intake system, and use of real-time dashboard analytics to support operation …

Icu Decision Tool Impact On Rebound Hyperglycemia, Daniel J. Donovan, Emily Highsmith, Sonya Khan, Michelle Horng

Advances in Cancer Education and Quality Improvement

Hyperglycemia, defined as a blood glucose level ≥180 mg/dL in the hospitalized patient, is linked to negative outcomes including longer hospital stays, increased infection risk, and higher morbidity and mortality rates. In addition to critically ill patients with diabetes, hyperglycemia can develop in individuals without diabetes due to factors such as steroid use, continuous tube feedings, and an elevated stress response. Patients who have uncontrolled hyperglycemia are often placed on continuous insulin infusions (CII), but rebound hyperglycemia frequently occurs after CII discontinuation if the maintenance insulin regimen (MIR) is insufficient. Implementation of a MIR decision support tool integrated within an …

Mapping The Evidence On The Maternal–Fetal Triage Index (Mfti): A Scoping Review, Taylor Harris, Kelsey Downie, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

Maternal morbidity and mortality remain persistent challenges in the United States, with obstetric triage serving as a critical point of entry for timely recognition and management of high-acuity maternal-fetal conditions. Despite recommendations for acuity-based triage models, many obstetric units continue to rely on non-specific emergency triage tools, such as the Emergency Severity Index (ESI), which inadequately account for pregnancy-specific physiological changes and fetal status. To address these limitations, the Association of Women’s Health, Obstetric and Neonatal Nurses developed the Maternal-Fetal Triage Index (MFTI), a five-level obstetric-specific triage tool. Although the MFTI has been increasingly adopted in clinical practice, the …

Examining Racial And Ethnic Differences In Quality Of Care Between Home And In-Center Hemodialysis, Sukhman Bains

2026 Symposium

Home hemodialysis (HHD) offers improved flexibility and clinical outcomes compared to in-center hemodialysis. However, its use remains limited, particularly among racial and ethnic minority populations disproportionately affected by end-stage renal disease (ESRD). This systematic review analyzed seven retrospective cohort studies (2004–2025) to assess disparities in HHD utilization and outcomes. Minority patients were significantly less likely to initiate HHD, with adjusted odds ratios ranging from 0.45 to 0.70, while no disparities were observed within Canada’s universal healthcare system. Although HHD was associated with lower mortality, this finding is likely influenced by selection bias, as HHD patients tended to be younger and …

Transforming Patient Safety And Care Practices Through Interprofessional Education, Kaleena Ramirez, Claudia C. Tamara, Jennifer Sells, Karen Clatt, Banan Abuharb, Mary Coolbaugh-Murphy, Iris Culwell, Anca Fumurescu, Mary Gust, Lori Simmons, Delores Whiteing, Annie Koenig, Sara Martinez, Wilton Muriithi, Shaun T. Caldwell, Susan Lee, Mary Sizemore, Kimberly Ann H. Krumwiede

Advances in Cancer Education and Quality Improvement

As healthcare increasingly relies on interdisciplinary teams to deliver safe and effective care, the development of interprofessional collaboration competencies among students in health care professions has become an educational priority. In response, The University of Texas MD Anderson Cancer Center School of Health Professions integrated a longitudinal interprofessional education curriculum to foster collaborative practice readiness and prepare students for team-based interdisciplinary environments that ensure safe and patient-centered care. The curriculum was guided by the Interprofessional Education Collaborative 2016 and 2023 core competencies for interprofessional collaborative practice, reinforced with the Real Colors® Personality Instrument and Team Strategies and Tools to Enhance …

Viral Hepatitis Screening In Early Breast Cancer Patients Receiving Cancer Therapy: A Quality Improvement Initiative, Katherine Klein, Jessica Hwang, Vicente Valero, David Ramirez, Jaime Kaushik

Advances in Cancer Education and Quality Improvement

American Society of Clinical Oncology guidelines recommend screening all patients for hepatitis B virus (HBV) and hepatitis C virus (HCV) before initiation of cancer therapy. Cancer patients receiving cancer therapy represent a vulnerable population, and reactivation of undetected hepatitis virus can lead to devastating consequences. At MD Anderson Cancer Center, rates of hepatitis screening for all cancer patients have been historically low. The overall aim of this quality improvement (QI) study was to increase rates of HBV and HCV screening to at least 50% in early-stage breast cancer patients before cancer therapy in the Breast Medical Oncology clinic at MD …

Interprofessional Education Development In An Oncology-Focused Healthcare Institution, Mary Sizemore, Michael Morris, Mohamed Ait Aiss, Gregory Botz, Jolyn Taylor, Joshua Kuban, Diane C. Bodurka

Advances in Cancer Education and Quality Improvement

Background: Despite growing recognition of the value of interprofessional education (IPE), most IPE work has focused on undergraduate learners, leaving a critical gap in postgraduate and clinical environments. This report describes a phase 1, formative, pre-implementation quality improvement (QI) initiative to establish an institution-wide IPE program at an oncology center without a traditional medical school.

Methods: We used a developmental, multiphase mixed methods design integrating 3 inputs: (1) Virtual Interprofessional Teaching and Learning (VITAL) faculty-development feedback, (2) IPE Steering Committee feedback, and (3) simulation evaluation used as an applied context (not the sole focus). Surveys were administered to VITAL participants, …