Medicine and Health Sciences Commons^™

Improving Inr Monitoring In Outpatient Cardiology: A Quality Improvement Initiative To Enhance Anticoagulation Safety, Antonette Atori

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement (QI) project aimed to reduce uncaptured INR results by 5% over 12 weeks in an outpatient cardiovascular clinic by implementing a standardized tracking workflow.

Background

Suboptimal anticoagulation management in outpatient settings can lead to uncaptured International Normalized Ratio (INR) results, delayed therapy adjustments, and increased risk of bleeding or thromboembolic events.

Methodology

Guided by the Plan-Do-Study-Act (PDSA) framework, a pre–post intervention design was used. Interventions included an electronic medical record (EMR)-based tracking system using a reminders inbox for overdue results and nurse-led follow-up phone calls. Data was collected from the EMR and analyzed using descriptive statistics, …

Abortion Politics And Policy: Stigma And Access In The Silver State, Celene Fuller

Lincy Institute Events

In the aftermath of the Supreme Court’s Dobbs v. Jackson Women’s Health Organization (2022) overturning Roe V. Wade, states have taken divergent paths in regulating access to abortion services. In 2024, Nevada voters overwhelmingly passed Question 6 proposing to codify abortion rights into the state constitution. In November 2026, Question 6 will again be on the ballot for final confirmation. If it passes, these rights will be protected from future legislative action.

Despite Nevadans’ strong support for abortion rights, the state’s dearth of abortion providers limits access to these services. As this lecture explores, both providers and individuals seeking abortions, …

Intraoperative Liposomal Bupivacaine Is Associated With Reduced Opioid Use And Enhanced Recovery After Total Knee Arthroplasty: A Multicenter Registry Study, Mitchell Ng, Jennifer Lin, Andrew Spitzer, Vinod Dasa, Adam Rivadeneyra, David Rogenmoser, Andrew Concoff, Mary Digiorgi, Joshua Urban, William Mihalko, Michael Mont

Rothman Institute Papers

BACKGROUND: With an annual volume of total knee arthroplasties (TKAs) in the United States projected to exceed 1.5 million by 2050, optimizing perioperative pain control and facilitating early discharge remain clinical priorities. This study evaluated the effectiveness of liposomal bupivacaine (LB) vs conventional bupivacaine/ropivacaine in opioid-naïve patients undergoing primary TKA, comparing/contrasting: (1) pain score improvements, (2) opioid usages, (3) functional recoveries, and (4) hospital lengths of stay.

METHODS:  Data from the Innovations in Genicular Outcomes Research (iGOR) registry were used to identify patients undergoing unilateral primary TKA between September 2021 and December 2024. Two hundred twenty-five patients were analyzed, 42 …

Powering Up Clinical Scholarship In Santa Fe Family Medicine, Evelyn Wang

HSLIC Faculty and Staff Instructional Resources

This presentation introduces family medicine residents and faculty in Santa Fe to clinical scholarship pathways, highlighting research question formulation, literature search strategies, full-text access tools, and HSLIC services that support evidence-based practice, quality improvement, and publication.

Use Of The Casper Test As An Admissions Test For Predicting Academic And Clinical Performance In Student Registered Nurse Anesthetists: A Predictive Correlational Study, Barbara A. Acord

Doctoral Dissertations and Projects

This quantitative, non-experimental, predictive correlational study examined the extent to which CASPer test scores predict academic and clinical performance among student registered nurse anesthetists (SRNAs). Certified registered nurse anesthetists (CRNAs) provide over 80% of anesthesia services in the United States, showing the importance of effective admissions processes to identify candidates most likely to succeed academically and clinically. Traditional admissions criteria in nurse anesthesia programs largely prioritize grades and may underrepresent non-cognitive attributes associated with student success. A convenience sample used a medium effect size, power of .8, and alpha level of .05, with G*Power calculated to be 85 participants 2nd …

Indicators Of Fontan Circulatory Failure In Pediatric Patients: A Scoping Review Of Early Clinical And Hemodynamic Factors, Marina Mcmahon

Student Works

Structured Summary

a. Background/Introduction:

For patients with single ventricle congenital heart disease, the Fontan procedure is the definitive palliative procedure. Although advancements have been made in the surgical technique and management, the Fontan circulation is inefficient and prone to progressive dysfunction. Elevated central venous pressure, non-pulsatile pulmonary blood flow, and reduced cardiac output can lead to many complications, and eventual failure. These conditions can lead to protein losing enteropathy, plastic bronchitis, and hepatic fibrosis which often indicate advanced decline. Though a known problem, there is a lack of standardized criteria to guide optimal intervention timing of Fontan revision prior to …

Culturally Tailored Materials For Smoking Cessation And Hiv Care Adherence Among Hispanic Adults: Protocol For Content Development And Formative Evaluation, Lorra Garey, Jacqueline J Charles, Ashley L Ruiz, Rodrigo Castillo-Avilés, Virmarie Correa-Fernández, Marshall K Cheney, Thomas P Giordano, Michael J Zvolensky

Faculty, Staff and Students Publications

Background: Hispanic people with HIV who smoke cigarettes experience unique stressors (eg, stigma), which contribute to health disparities. Anxiety sensitivity (AS) may worsen mood management problems, which are a leading barrier to smoking cessation. Interventions targeting AS can improve HIV-specific outcomes and smoking cessation. However, no prior research has culturally tailored an AS reduction program to improve quality of life among Hispanic people with HIV who smoke. The research team previously developed a mobile health (mHealth) intervention addressing AS reduction, smoking cessation, and HIV care management for Black people with HIV who smoke. Building on this work, this study represents …

Associate Degree Program Administrator Perceptions Of Clinical Dishonesty, Cynthia Moore Swineford

Doctoral Dissertations and Projects

The purpose of this hermeneutic phenomenological study was to explore the perceptions of associate degree nursing program administrators regarding faculty reporting of dishonest clinical behaviors by pre-licensure nursing students. Aristotle’s theory of virtue ethics guided this examination of how administrators interpret ethical responsibility, leadership influence, and professional accountability related to clinical dishonesty. The central research question asked, “What are the perceptions of associate degree program administrators regarding faculty reporting of dishonest student behaviors in clinical settings?” The sample included 11 associate degree nursing program administrators from programmatically accredited nursing programs in three mid-Atlantic states. Data were collected through semi-structured interviews, …

The Impact Of Nutritional Education On Hemoglobin Levels In Adolescent Cross-Country Runners, Phillip L. Hardy

Doctoral Dissertations and Projects

Iron deficiency and anemia have been documented in adolescent endurance athletes, particularly female runners, due to increased physiological demands during growth and sustained training stress. However, limited research has examined seasonal hemoglobin progression in high school cross-country athletes while simultaneously examining outcomes during participation in structured nutrition education. Therefore, the purpose of this longitudinal quantitative study was to examine hemoglobin levels, dietary iron intake, and nutrition knowledge among adolescent cross-country runners across a competitive season during participation in a four-session, nutrition education program delivered from August 2025 through November 2025. Participants included 44 high school runners from northwest Georgia who …

An Exploration Of The Prioritization And Application Of Self-Care For Mental Health Therapists Working Within Mississippi Gulf Coast Community Mental Health Organizations: A Phenomenological Study, Elizabeth Lynn Leyva

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenological study was to explore the prioritization and application of self-care for mental health therapists working within Mississippi Gulf Coast community mental health organizations. The theory guiding this study was Milton Rokeach’s belief system theory, which examined the significant impact of beliefs, attitudes, and values on decision-making regarding clinician self-care in personal and professional realms. The central research question for this study asked how mental health therapists in community mental health organizations described their experiences of prioritizing and applying self-care during and outside of therapy practice. There were three subquestions to support the central research …

Impact Of The Menstrual Cycle On Female Endurance Athletes' Performance, Julia M. Monk

Doctoral Dissertations and Projects

Background: During different phases of the menstrual cycle, a female endurance athlete will experience some physiological and fatigue variables. This study aims to analyze whether the differences in variables, specifically an increase in heart rate and fatigue, impacts endurance performance. Method: 20 endurance-trained, runners performed a maximal treadmill test in each of the phases of the menstrual cycle: early follicular phase (days 2–3, ± 1 day), mid-follicular phase (days 10–12, ± 1 day), and luteal phase (days 21–22, ± 1 day). Heart rate was measured before, during, and immediately after the test as well as time to exhaustion and the …

A Phenomenological Study On The Lived Experiences Of Military Spouses With Secondary Traumatic Stress Who Are Married To Veterans Diagnosed With Ptsd, Trisha R. Perry

Doctoral Dissertations and Projects

The purpose of this hermeneutical phenomenological study was to understand the lived experiences of Secondary Traumatic Stress (STS) in military spouses whose partners have Post-Traumatic Stress Disorder (PTSD). The theory guiding this study was Lazarus and Folkman’s Transactional Model of Stress and Coping (TMSC). The central research question was: What are the lived experiences of STS in spouses married to a service member with PTSD? Additional sub-questions addressed changes in worldview, marital satisfaction, and daily functioning. Criterion and snowball sampling were used to select participants who were married to service members with PTSD for the study. Following the hermeneutical phenomenological …

Inhibition Of Epac1 Prevents Neuronal Death Mediated By Diesel Exhaust Particles In Ferroptotic Cell Death Conditions, Hong Yan, Leshan Zhang, Ana L Manzano-Covarrubias, Phoeja S Gadjdjoe, Anja Land, Christina H J T M Van Der Veen, Teresa Mitchell-Garcia, Heba A Fayyaz, Marco Venema, Christoffer Åberg, Marieke Van Der Hart, Frank Lezoualc'h, Xiaodong Cheng, Amalia M Dolga, Martina Schmidt

The Brown Foundation: Institute of Molecular Medicine

Air pollution is a growing hazard to global health. Epidemiological studies have reported a potential role of air pollutant exposure in the development or aggravation of neurodegenerative diseases. However, the underlying mechanisms are ill-defined. Ferroptosis is an iron- and reactive oxygen species (ROS)-dependent form of cell death that drives neuronal loss in neurodegenerative diseases. Our previous studies reported the involvement of adenosine 3',5'-cyclic monophosphate (cAMP) and EPAC (exchange protein directly activated by cAMP) in ferroptotic cell death. Here, we investigated the effects of diesel exhaust particles (DEP) in mouse hippocampal (HT22) neuronal cells. Our data showed that toxicity induced by …

Mechanisms Of Binding And Immune Escape Resistance For Broadly Neutralizing Antibodies Targeting Distinct Conserved Sars-Cov-2 Spike Epitopes: A Hierarchical Approach Integrating Mutational Profiling And Energy Landscape Analysis, Mohammed Alshahrani, Will Gatlin, Max Ludwick, Lucas Turano, Brandon Foley, Gennady M. Verkhivker

Mathematics, Physics, and Computer Science Faculty Articles and Research

The continued evolution of SARS-CoV-2 has enabled an escape from most monoclonal antibodies, yet a subset of broadly neutralizing antibodies targeting three newly identified super-conserved RBD epitopes—SCORE-A, SCORE-B, and SCORE-C—retains remarkable activity against even the most recent JN.1-derived sublineages. Here, we employed an integrated computational framework combining conformational dynamics, mutational scanning, MM-GBSA binding energetics, and frustration profiling to dissect the molecular mechanisms by which XGI antibodies achieve broad neutralization and resistance to immune escape. Structural analysis revealed that all three SCORE epitopes share a common architecture: a highly conserved, minimally frustrated core that provides stable anchoring, flanked by peripheral regions …

The Right Time For A Synapse To Change: Windows And Mechanisms Of Multiday Training Trials, Rong-Yu Liu, Yili Zhang, Roberta Calvo, Paul Smolen, John H Byrne

Faculty, Staff and Student Publications

Although learning over multiple days is more effective than a single day of training, the underlying cellular mechanisms of repeated training trials remain poorly understood. With a combination of empirical and computational approaches, we determined a critical time window for a second stimulus block of a multiday training protocol to augment long-term synaptic facilitation (LTF) of the Aplysia sensorimotor synapse and long-term enhancement of neuronal excitability (LTEE), two cellular correlates of learning and memory. A second stimulus block delivered 24 h after the first block significantly enhanced LTF and LTEE, but was without effect at 18 or 32 h. This …

Rosai-Dorfman Disease In A Rare Cardiac Presentation: Left Ventricular Mass Causing Ventricular Tachycardia, Motaz Al Yafi, Swetha Pasala, Valentina Robila, Cory Trankle, Bharadhwaj Kolipakkam, Patricia Nicolato

Faculty, Staff and Student Publications

Background: Rosai-Dorfman disease (RDD) is a rare, benign histiocytic disorder that most often presents with nodal involvement. Cardiac involvement is exceedingly uncommon and poses significant diagnostic and therapeutic challenges.

Case summary: A 51-year-old woman presented with shortness of breath and palpitations and was found to have monomorphic ventricular tachycardia. Imaging revealed a left ventricular mass, and biopsy confirmed RDD. The lesion was surgically excised with cryoablation and CorMatrix reinforcement. The patient recovered uneventfully and remains disease free 25 months postoperatively.

Discussion: RDD with cardiac involvement has been reported in only approximately 25 cases, with very few affecting the left ventricle. …

A Qualitative Case Study Exploring The Relationship Between Nutritional Awareness, Behavioral Outcomes, And The Prevention Of Early Risk Factors Of Hypertension And Cardiovascular Disease In Elementary School Students: Perceptions Of Parents And Educators In Hull-Daisetta Independent School District, Shante Monique Espree

Doctoral Dissertations and Projects

The purpose of this case study was to explore the relationship between nutritional awareness and observed behavioral outcomes among elementary school students, with a secondary focus on how these factors may contribute to early risk indicators for hypertension and cardiovascular disease. This study was situated within Hull-Daisetta Independent School District (ISD), Texas and centered on the perspectives of both parents and educators. The theory guiding the study was the Social Cognitive Theory (Bandura, 1986) as it emphasizes the role of observational learning, social influence, and behavior change in health-related interventions. This framework supported the exploration of how nutritional awareness shapes …

Acute Effects Of Olympic Lifting Post-Activation Potentiation On Baseball Pitching Velocity And Ball Flight: A Crossover Study, Brent Hauser Pourciau

Doctoral Dissertations and Projects

This quantitative study evaluated the acute effect of an Olympic lifting-based post-activation potentiation (PAP) warm-up on fastball performance in collegiate baseball pitchers. Using a randomized, counterbalanced within-subjects crossover design (N = 13), each participant completed two warm-up conditions in a single indoor session: (a) a standard dynamic baseball warm-up and (b) the same standard warm-up followed by a brief Olympic-lifting PAP sequence (1 x 3 clean pulls at 80% predicted one-repetition maximum [1RM], 1 x 3 power cleans at 80% predicted 1RM, and 1 x 3 power jerks at 60% predicted 1RM, with 2-minute rests between sets) and a 3-minute …

The Impact Of Cognitive Behavioral Therapy In Enhancing Employee Well-Being And Performance In The Workplace, Chris M. Garcia

Doctoral Dissertations and Projects

This study investigates the lived experiences of clinical administrative professionals in healthcare settings who have undergone Cognitive Behavioral Therapy (CBT) training. The importance of this study lies in addressing significant gaps in existing literature, particularly the long-term outcomes of CBT training in healthcare workplace settings and the necessity of tailoring these training to diverse work environments. The purpose of the study is to explore how CBT training influences the mental health, job performance, and overall well-being of these professionals.

Employing a Transcendental Phenomenology approach, the study will conduct in-depth interviews with clinical administrative professionals in various healthcare settings. The sample …

The Effect Of A Mass Casualty Incident Adult Hyper-Realistic Simulation On Nurse Confidence Levels And Satisfaction Of Nurses: A Quasi-Experimental Study, Melodie Ann Nutter

Doctoral Dissertations and Projects

The purpose of this quantitative quasi-experimental study was to examine registered nurses (RNs) satisfaction and confidence levels after experiencing hyper-realistic simulations using a mass casualty incident (MCI) simulation method. With the world seeing a rise in MCI events, nurses often become one of the first professional medical providers to interact with the affected individuals. To fill this gap in education, the introduction of intensive hyper-realistic simulation training plays a vital role and provides an advanced perspective on the ever-increasing MCIs in today’s healthcare environment. This quasi-experimental study, using the Wilcoxon rank test and paired, assessed the satisfaction and confidence levels …

All-Inside Endoscopic Zone 1 Flexor Hallucis Longus Transfer: A Cadaveric Feasibility Study., Kevin D Martin, Yi Wei, Adam G F Smith, Franco Piscitani, Luke M Martin, Brian Steginsky, Brian Tscholl, Nathaniel A Bates

Surgery Articles

BACKGROUND: Endoscopic flexor hallucis longus (FHL) tendon transfer addresses chronic Achilles tendon ruptures. Traditional percutaneous plantar incisions gain FHL length but risk neurovascular injury. This study evaluated the feasibility of an all-inside endoscopic FHL zone 1 tenotomy and transfer technique, which avoids plantar incisions by using zone 1 of the FHL tendon. We hypothesized that this technique would (1) provide sufficient tendon length, (2) avoid neurovascular damage, and (3) securely anchor the FHL tendon without tunnel blowout.

METHODS: Ten cadaveric all-inside endoscopic zone 1 FHL tendon transfers were performed without fluoroscopic guidance. Specimens were independently assessed post hoc by 2 …

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.

A League Of Her Own: The Comeback After Collison, Ashley Otto, Do, Mbs, Carly Day, Md

Jefferson Hospital Staff Papers and Presentations

Initial History

During a college softball game, the left fielder (patient A) and center fielder (Patient B) collide while attempting to catch a fly ball. Patient A immediately lost consciousness and Patient B screamed in pain grabbing her right leg. The athletic trainer (AT) and student athletic trainer access and triage the players. Upon the AT's arrival, Patient A became conscious, appeared confused, denied distress, and complained of jaw pain. Patient B continued to have upper right leg pain. Both athletes are helped off the field and the on-call physician is asked to come to the field.

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 …

Staff Educational Impact On School-Based Mental Health Services: A Scoping Review, Daniel J. Kim, Di'yana Fisher, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

            Trends are consistently increasing among adolescents in regard to mental health diagnoses and suicide risks, which emphasizes the necessity for early identification via school-based psychiatric screenings. The Patient Health Questionnaire-9 (PHQ-9) has proven effective in uncovering symptoms of depression; variable application and limited staff knowledge continue to be substantial hurdles. This scoping review examined the influence of staff education and training on the efficacy of school-based psychiatric screening.

Methods

            PubMed, CINAHL, Medline, Elsevier, Google Scholar, and JAMA were utilized to conduct this scoping review. Peer-reviewed studies published between 2020 and 2025 were included if they involved adolescents aged 13-18, …

Score Data 2026, M. Barnard, T. Johnson, A. Ford-Wade, M. Godfrey, C. Compretta, E. Dehon, B. Wade

Faculty and Student Publications

This data file includes data for four years of Project SCORE implementation.

Transesophageal Echocardiogram Training For Student Registered Nurse Anesthetists, Sophie Hesse, Annie Krippene, Christian Shelton

Doctor of Nursing Practice (DNP) Student Projects

Background and Significance: Transesophageal echocardiography (TEE) is a vital diagnostic tool in perioperative care. At Barnes-Jewish College Goldfarb School of Nursing (GSON), Student Registered Nurse Anesthetists (SRNAs) formerly received limited TEE instruction, consisting primarily of didactic content. This quality improvement project aimed to enhance SRNA proficiency in TEE by integrating online and simulation-based training.

Review of Literature Findings: Simulation-based education has been shown to improve knowledge, skill, and confidence compared to lecture-only methods (Bloch et al., 2017; Chenkin et al., 2023; Pezel et al., 2023; Weber et al., 2019; Zhao et al., 2021).

Methods: Guided by the Iowa Model and …

Preventing Information Loss During Icu To Or Handoff, Jenna Alfeldt, Kristen Hoffer, Ashley Miles, Amanda Schwarztrauber

Doctor of Nursing Practice (DNP) Student Projects

Background and Significance: Inconsistent ICU to OR handoff practices create conditions for information loss, threatening patient safety and continuity of care. Communication errors contribute to an estimated 250,000 fatalities and $20 billion in annual U.S. healthcare costs.

Review of Literature Findings: A thorough literature review revealed that standardized handoff procedures are shown to improve communication and team dynamics.

Methods: This quality improvement (QI) project implemented a standardized handoff process using the Handoff Reference Tool when transferring patients from the Intensive Care Unit (ICU) to the Operating Room (OR) in a large academic medical center. Pre- and post-implementation …