Medicine and Health Sciences Commons^™

Medication-Assisted Treatment For Patients With Substance Use Disorder And Depression: A Scoping Review, Josiane Deguenon Bsn-Rn, Elisabeth Fritz Bsn-Rn, Jesse Jean Bsn-Rn, Tucker Mckinney Bsn-Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

Substance use disorder (SUD) frequently co-occurs with depression and increases relapse risk and healthcare utilization. Although medication-assisted treatment (MAT) is an evidence-based intervention for SUD, outcomes for adults with co-occurring depression remain inconsistently reported due to variation in study designs, treatment settings, and measures. This scoping review examines evidence on MAT use among adults with co-occurring depression and SUD and summarized reported clinical and healthcare utilization outcomes.

Methods

From August 2023 to November 2025, a scoping literature review was conducted on PubMed/MEDLINE, CINAHL, and the Cochrane Library, using MeSH search terms and Boolean operators to link the concepts defined …

Dropping Into The Expressive Art Therapy: A Community Engagement Arts Based Project, Sydney C. Smith, Meg Chang

Expressive Therapies Theses

This community engagement capstone explores how expressive arts practices (EXAP) may complement surf-based programming by supporting reflection, empathy, and meaning-making among participants. Research has demonstrated that surf therapy can promote emotional well-being, resilience, and social connection through embodied engagement with the ocean and supportive community environments. Integrating expressive arts practices within surf-based programs may extend these benefits by providing opportunities for reflection, creative expression, and interpersonal exchange. Grounded in expressive arts therapy (EXAT) theory and arts-based research (ABR) paradigms, this project examines how creative expression can support relational and emotional experiences within surf therapy settings. Using an arts-informed community engagement …

Focal Status Epilepticus In A Patient With Responsive Neurostimulation: A Rare Complication And Management Insights, Ana Leticia Fornari Caprara Md, Jamir Pitton Rissardo, Pranaya Gade, Estefania Joselinne Alba-Rodriguez Md, Eric P. Nagele Md, Salman Assad Md, Islam Fayed Md, Evren Burakgazi-Dalkilic Md

Rowan-Virtua Research Day

Introduction: Responsive neurostimulation (RNS) is an established therapy for drug-resistant focal epilepsy, yet device-related complications during acute seizures remain underreported. We describe a case of focal status epilepticus in a patient with RNS, illustrating the interplay of possible device malfunction, systemic illness, and medication nonadherence. Case Report: A 39-year-old man with drug-resistant focal epilepsy and schizoaffective disorder, status post right frontal craniotomy and RNS implantation, presented with focal status epilepticus after several days of antiseizure medication (ASM) nonadherence, febrile illness, vomiting, and urinary tract infection (UTI). On admission, he was lethargic with frequent focal seizures (< 30 s) characterized by left head turn, left arm followed by bilateral arm tonic stiffening, and impaired awareness. Continuous EEG confirmed focal status epilepticus. Family declined intubation. A ketamine bolus (20 mg) followed by infusion (0.25–0.5 mg/kg/hr) for 24 hours achieved seizure cessation. Despite broad ASM therapy (phenytoin, zonisamide, perampanel, levetiracetam, clorazepate, cenobamate, carbamazepine, clonazepam, lacosamide), seizures persisted until RNS interrogation revealed high lead impedance; the device was deactivated. ASM doses were optimized, PEG tube placed for consistent delivery, and UTI treated. He stabilized and was discharged to rehabilitation. Conclusion: This case highlights the need for comprehensive evaluation in RNS patients presenting with focal status epilepticus. Device malfunction, systemic illness, and inconsistent ASM adherence can synergistically worsen seizure control. Multidisciplinary management including neurocritical care, device troubleshooting, and nutritional support was pivotal for recovery.

Data-Driven Analysis Of Lecture Capture Transcript Accuracy Of The Biomedical Foundations Course Using Automated Speech Recognition, Eleni Papadopoulos, Shaniece Lawrence, Steve Garwood, Dawn Shell, Jacqueline A. Giacobbe

Rowan-Virtua Research Day

To increase the accessibility and utility of lecture capture recordings, schools may utilize automated speech recognition (ASR) to generate closed-captions and transcripts. But, how accurate are these systems? This study analyzed 50 ASR-generated transcripts using word error rate (WER) and further sought to determine factors that impact accuracy. Only 19 of 50 (38%) transcripts met the 99% accuracy standard required by the Americans with Disabilities Act (ADA). The lecturer's accent was the most significant factor affecting accuracy, though medical jargon also presented a challenge. These findings suggest system improvements and manual review are necessary to ensure students receive accurate information.

Methadone-Associated Qt Prolongation: The Importance Of Early Recognition And Monitoring In The Emergency Department, Uma Murrugappan, Kelsey Murray, James Espinosa Md, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 43-year-old female with cervical cancer and bilateral percutaneous nephrostomy tubes receiving high-dose methadone maintenance therapy who presented to the emergency department with bilateral flank and abdominal pain. She denied cardiac symptoms. Electrocardiogram obtained during evaluation revealed marked QT prolongation (QTc 596 ms) following recent methadone dose escalation. The patient was placed on continuous cardiac monitoring and intravenous magnesium was ordered. While intravenous access was being obtained, she developed polymorphic ventricular tachycardia consistent with torsades de pointes and became pulseless. Advanced cardiac life support was initiated including defibrillation and magnesium administration, with return of spontaneous …

Case Report: Termination Of Svt Using A Modified Vagal Maneuver With A 10-Cc Syringe, Romina Noormohammadi, Kelsey Murray, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Supraventricular tachycardia (SVT) is a common cardiac arrhythmia encountered in emergency departments and is characterized by a rapid regular rhythm originating above the ventricles. Initial management of hemodynamically stable SVT typically includes vagal maneuvers followed by pharmacologic therapy such as adenosine if non-pharmacologic methods fail. However, vagal maneuvers are frequently unsuccessful due to improper patient execution or insufficient vagal stimulation. We present the case of a 76-year-old female with a history of gastroesophageal reflux disease (GERD), hypertension (HTN), and hyperlipidemia (HLD) who presented with palpitations and was found to have SVT at 156 beats per minute on electrocardiogram. A Valsalva …

Not All That Scratches Is Infection: Sweet Syndrome Mimicking Cat Scratch Disease, Clara Keum, Neelesh R. Parikh

Rowan-Virtua Research Day

Sweet syndrome, or acute febrile neutrophilic dermatosis, is a rare inflammatory condition characterized by painful erythematous skin lesions, neutrophilic dermal infiltration on histopathology, and rapid response to corticosteroid therapy. Although classically associated with fever and leukocytosis, atypical presentations without systemic symptoms are increasingly recognized, often leading to diagnostic confusion.

The clinical presentation of Sweet syndrome frequently overlaps with infectious processes such as cellulitis, particularly when lesions involve the lower extremities. This overlap may result in misdiagnosis and delayed appropriate treatment. Distinguishing between infectious and inflammatory etiologies is critical, as management strategies differ significantly.

We present a case of Sweet syndrome …

The Tensile Gallbladder Sign: A Case Report Of Acute Gangrenous Cholecystitis Diagnosed By A Rare Computed Tomography Finding, Lan D. Ngo, Trent R. Malcolm

Rowan-Virtua Research Day

Acute cholecystitis is one of the most common causes of acute abdominal pain in the emergency department, accounting for approximately 200,000 hospitalizations annually in the United States (Gallagher & Charles, 2022) Ultrasound is the established first-line imaging modality for suspected cholecystitis. However, compute tomography (CT) is increasingly obtained for undifferentiated abdominal pain and offers complementary, operator-independent evaluation.  The tensile gallbladder fundus sign is defined on CT as the absence of fundal flattening by the anterior abdominal wall due to elevated intraluminal pressure.

Case Report: Anaphylaxis-Induced Cardiac Arrest Leading To Multiorgan Failure, Dhruvin Patel, Russell Mordecai, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Anaphylaxis is a severe, life-threatening hypersensitivity reaction that can rapidly progress to cardiovascular collapse and cardiac arrest. Cardiac arrest due to anaphylaxis is uncommon but associated with significant morbidity and mortality. Survivors often face complex critical care courses, including multiorgan dysfunction and challenges in neurologic prognostication following hypoxic-ischemic brain injury.

Case Report: Bilateral Pneumothorax Following T2–T5 Medial Branch Nerve Block, Jenna Rapone Md

Rowan-Virtua Research Day

Bilateral pneumothorax is an uncommon but clinically significant complication of thoracic spinal interventions. We report the case of a 20-year-old female with underlying scoliosis who developed acute pleuritic chest pain, dyspnea, and persistent cough immediately following bilateral T2–T5 medial branch nerve block injections performed in an outpatient pain management setting.  Thoracic medial branch blocks are generally considered low-risk procedures; however, the proximity of the pleura to posterior thoracic elements places patients at risk for iatrogenic pleural injury, particularly in individuals with altered spinal anatomy such as scoliosis. This case underscores the importance of maintaining a high index of suspicion for …

Acute Appendicitis With Concomitant Testicular Torsion, Thuc Vu, Clara Keum, Swet Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

This case report presents a 13-year-old male who presented to the emergency department with diffuse abdominal pain radiating to the right lower quadrant, accompanied by nausea and decreased appetite. Diagnostic evaluation revealed right-sided testicular torsion concurrent with acute appendicitis. Although acute appendicitis represents the most common surgical emergency in the pediatric population, clinicians must maintain a broad differential diagnosis to identify potential concomitant acute pathologies, including testicular torsion in this scenario.

Sonidegib (Lde225) Reduces Inflammatory Signaling And Preserves Taste Buds In A Sepsis Mouse Model, Ashlyn Mcclelland, Murod Khikmatov, Archana Kumari, Gabrielle Audu, Isaiah Nawaz, Kingsley Yin

Rowan-Virtua Research Day

Background:

Sepsis triggers a complex and widespread inflammatory response that disrupts multiple organ systems, including the taste organ. Loss of taste is a symptom recognized in sepsis survivors and has the potential to contribute to further complications such as anorexia. Prior work from our lab demonstrated that cecal ligation and puncture (CLP) in mice induces immune cell infiltration and alters taste bud morphology in the fungiform papillae located in the anterior tongue. We hypothesize that similar deleterious effects occur in the circumvallate papillae (CVP) of the posterior tongue and that the usage of the smoothened inhibitor, sonidegib, could reduce these …

Acute Ischemic Stroke In Hemoglobin Sc Sickle Disease Requiring Emergent Exchange Transfusion And Neurocritical Transfer, Julian Coz, Trent Malcolm, Andrew Iskandar, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Acute ischemic stroke is a well-recognized complication of sickle cell disease (SCD), with historical estimates suggesting that up to 11% of patients experience an overt stroke by early adulthood. Stroke represents a hematologic and neurologic emergency requiring rapid reduction of the circulating hemoglobin S (HbS) fraction to prevent infarct progression. The American Society of Hematology recommends emergent exchange transfusion within two hours of presentation for patients with acute neurologic deficits [1,3].

Management is particularly nuanced in hemoglobin SC (HbSC) disease. Compared with hemoglobin SS disease, patients with HbSC typically have higher baseline hemoglobin concentrations, increasing blood viscosity and the risk …

An Unusual Cause Of Generalized Weakness: Cns Toxoplasmosis, Christopher Dellmyer, Danielle Kusmaul, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

No abstract provided.

Case Report: Vertebral Artery Dissection After Cervical Manipulation, Devin Hoover, Emily Bolinger, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report the case of a 22-year-old female who presented with dizziness and vomiting after recent cervical manipulation who was diagnosed with a dissection of the vertebral artery. Dizziness can have a variety of causes including vascular etiologies, cerebellar and brainstem lesions, ocular problems, trauma, and others. In the setting of a known trauma and acute vestibular symptoms, it is prudent to consider vascular injuries.

Persistent Hypotension Following Viral Illness- Pocus For Pericardial Effusion, Peter Killian, Kelsey Murray, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

A pericardial effusion is defined as a build up of fluid in the pericardial space, the lining around the heart. Normal physiologic fluid can consist of approximately 15-50mL in an otherwise healthy adult . Larger amounts of fluid can be detected on radiographs, but are able to be seen on ultrasound when just exceeding physiologic conditions . Here we report a case of persistent hypotension assessed by point of care ultrasound (POCUS) in order to lead to a diagnosis.

Case Report: Necrotizing Pneumonia, Veroneka Mikhail Md

Rowan-Virtua Research Day

Necrotizing pneumonia is an uncommon but severe complication of community-acquired pneumonia (CAP), characterized by progressive parenchymal liquefaction, cavitation, and destruction of normal lung architecture, and associated with significant morbidity and mortality. Clinicaly, early presentations may be indistinguishable from uncomplicated pneumonia (pna), with fever, cough, pleuritic chest pain, and dyspnea, which can delay recognition in the emergency department. Differential diagnosis for these symptoms is broad and includes uncomplicated pneumonia, septic emboli, lung abscesses, and pleural effusion. However, patients effected with necrotizing pneumonia often exhibit more severe systemic toxicity, rapid progression of respiratory failure, and hemodynamic instability. In this case report, we …

Surviving Ph 7.0: Rapid Interprofessional Collaboration In Severe Metformin-Associated Lactic Acidosis With Refractory Shock, Karl J. Schlicht Md, Amaani Faizal, Vincent Macolino, Julian Coz

Rowan-Virtua Research Day

Metformin-associated lactic acidosis (MALA) is a rare but life-threatening complication with mortality rates of 30-50%. Although metformin is the most widely prescribed antidiabetic medication, severe MALA requiring emergent hemodialysis remains uncommon, with an estimated incidence of 2-9 cases per 100,000 patient-years. Risk factors include acute kidney injury, dehydration, and tissue hypoxia. Early hemodialysis initiation is independently associated with improved survival. This case highlights how rapid interprofessional collaboration from the emergency department to the intensive care unit enabled in a patient presenting with profound acidemia and survival multiorgan dysfunction

A Survey-Based Analysis Of The Use Of Lifestyle Medicine In Clinical Practices Of South Jersey, Zehra Jaffri

Rowan-Virtua Research Day

Chronic diseases are the leading cause of death and disability in the United States and are largely driven by modifiable lifestyle factors. Lifestyle Medicine (LM) is an evidence-based medical specialty that uses therapeutic lifestyle interventions—including nutrition, physical activity, stress management, sleep, substance use reduction, and healthy relationships—to prevent, treat, and reverse many chronic conditions. Despite strong evidence supporting lifestyle interventions, LM use in routine primary care remains inconsistent due to barriers such as limited visit time, inadequate clinician training, lack of reimbursement, and difficulty sustaining behavioral change. This study evaluates how often lifestyle counseling is discussed in South Jersey primary …

Rethinking Gout Through An Inflammatory Lens, James Espinosa, Alan A. Lucerna

Rowan-Virtua Research Day

This review reframes gout not as a static disease of urate deposition, but as a dynamic inflammatory phenomenon. The emphasis is on immune activation, threshold behavior, and systemic inflammatory context rather than isolated joint pathology.

From Clinical Observation To Scholarly Question Academic Curiosity As A Professional Virtue In Emergency Medicine Introducing The Mindful Observation → Curious Inquiry → Clinical Structuring → Scholarly Sharing (Moccs) Model, James Espinosa, Alan A. Lucerna

Rowan-Virtua Research Day

Emergency Medicine generates continuous clinical observations, yet many potentially meaningful insights never progress beyond informal reflection. This poster reframes every day shift observations as the ecological foundation of scholarly inquiry. Conceptual Framework: We propose a simple, repeatable process to lower the activation energy for academic engagement The Mindful Observation → Curious Inquiry → Clinical Structuring → Scholarly Sharing (MOCCS) Model. This model centers disciplined noticing as a professional virtue. By naming and normalizing the “hmmm” and “huh?” moments, this approach validates frontline clinical wisdom, democratizes scholarly participation, and restores intellectual joy within high-stress clinical environments. Conclusion: Curiosity is not hierarchical. …

Brief Review : Listening Closely--Stethoscopes, Hygiene Gaps, And The Unfinished Work Of Healthcare-Associated Infection Prevention, James Espinosa, Swet Patel, Robin Lahr, Sergey Medlenov, Russell Mordecai, James Lee, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Healthcare-associated infections (HAIs) remain a persistent patient safety challenge. While hand hygiene has received sustained institutional focus, stethoscope hygiene remains inconsistently addressed despite longstanding evidence of contamination. Stethoscopes function as portable, patient-to-patient devices that may serve as under-recognized fomites in emergency and inpatient settings. Prior pilot work demonstrated that clinicians were unable to reliably distinguish between disposable and standard stethoscopes, and that perceived acoustic degradation from a diaphragm barrier was minimal. These findings suggest that acoustic concerns may not represent a primary barrier to hygiene-enhancing strategies. This brief review examines the literature surrounding stethoscope contamination and cleaning behavior, frames the …

Brief Review: Does Red Hair Phenotype Affect Propofol Pharmacokinetics Or Pharmacodynamics?, James Espinosa, Frank Wheeler, Robin Lahr, Sergey Medlenov, Alan Lucerna

Rowan-Virtua Research Day

Background: A persistent belief within Emergency Medicine and perioperative culture suggests that individuals with red hair require altered anesthetic dosing. While early studies demonstrated increased requirements for certain volatile anesthetics in red-haired individuals, this association is frequently generalized to propofol without clear supporting evidence.

Objective: To review current literature regarding the relationship between red hair phenotype (and MC1R variants) and propofol pharmacokinetics (PK) and pharmacodynamics (PD).

Methods: A focused narrative review of controlled human studies and relevant clinical outcome data evaluating propofol PK and PD in red-haired individuals.

Results: Evidence supporting altered anesthetic requirement in red-haired individuals primarily derives from …

Air Quality, Atmospheric Pressure, And Migraine Presentations In The Emergency Department, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Migraine is a leading cause of Emergency Department (ED) visits and global disability. Weather has long been reported by patients as a trigger, yet the literature remains inconsistent. Prior ED-based data demonstrated an association between higher mean barometric pressure and increased migraine presentations, without a relationship to short-term pressure change. Because high-pressure systems are frequently associated with atmospheric stagnation and pollutant accumulation, air quality may represent a biologically plausible mediator.

Objective: To examine the relationship between air quality and ED migraine presentations within the existing body of literature and to explore whether air quality may help explain previously observed …

Medical Clearance For Behavioral Health Patients In The Emergency Department: A Conceptual Overview Of Practice Variability, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Patients presenting to the emergency department (ED) with behavioral health complaints frequently undergo medical clearance prior to behavioral health evaluation or admission. Substantial variability appears to be found in laboratory utilization, documentation language, and interdepartmental workflow.

Objective: To provide a conceptual overview of variability in medical clearance practices and to synthesize existing guideline recommendations and literature regarding routine laboratory testing in low-risk psychiatric patients.

Methods: Narrative review of professional policy statements, selected peer-reviewed studies, and operational considerations influencing emergency physician practice patterns.

Results: Evidence suggests that routine laboratory testing in psychiatric patients has low diagnostic yield and rarely changes …

Reset To Learn For Ite And Boards: The Neurobiology Supporting The Advantage Of Micro-Breaks During Content-Dense Lectures--And Why Continuous (No Micro-Breaks) Test-Bank Studying And Test-Taking ("Plowing Through") Is Suboptimal, James Espinosa, Robin Lahr, Swet Patel, James Lee, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Background: Working memory is a limited-capacity system vulnerable to saturation during sustained cognitive effort. In medical education, board review lectures, intensive test-bank studying, and prolonged examination sessions require extended executive control engagement. Emerging evidence from cognitive neuroscience suggests that brief, intentional cognitive disengagement ('micro-resets')  of even 90 seconds may restore working memory efficiency and improve encoding, integration, and retrieval. This applies to brief breaks during content-dense lectures (needs support of lecturer), during test bank use for preparation as well as for test-taking. Objective: To propose a neurocognitive framework explaining why structured micro-breaks of even 90 seconds can enhance learning during …

The Neurobiology Of Interruptions In Emergency Medicine: The Case For Informed Interruption Management In Support Of Cognitive Stability In High-Reliability Clinical Environments, James Espinosa, Henry Schuitema, Alan Lucerna

Rowan-Virtua Research Day

Background: Interruptions are ubiquitous in Emergency Departments (EDs) and have been associated with task delay, multitasking, and increased error risk. While operational and human-factors impacts are well described, the underlying neurocognitive mechanisms remain underexplored. Not all interruptions are avoidable.  However,  interruptions in emergency medicine represent neurocognitive destabilization events that can degrade task representation and increase vulnerability to error during task resumption. Recognizing the neural mechanisms underlying interruptions reframes their management as a systems-level patient safety priority. The aim is not elimination of clinically necessary communication, but thoughtful reduction, prioritization, and design that protects cognitive stability.

Objective: To synthesize cognitive neuroscience …

Protecting The Protectors: Supporting Emergency Department Security Officer Wellness: A Brief Conceptual Review And Research Agenda, James A. Espinosa Md, Paul Sarnese, Alan Lucerna

Rowan-Virtua Research Day

Background: Workplace violence in emergency departments (EDs) has been widely studied, yet the occupational wellness of ED security officers has received comparatively limited focused attention in emergency medicine literature.

Objective: To conceptually examine the role of ED security personnel within the emergency care environment and outline a research agenda addressing their wellness.

Discussion: Security officers frequently respond to behavioral crises, assist with restraint events, and help maintain safety for patients, visitors, and staff. These duties include vigilance between events, sudden physical exertion, and exposure to aggression. ED security work often follows a recognizable rhythm: baseline vigilance, rapid escalation response, physical …

Wildfires And Emergency Department Respiratory Surge: Brief Review, Systems Forecasting Implications And Recommendations For Research, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Wildfire smoke produces abrupt increases in PM2.5 and Air Quality Index (AQI) levels. Event-based and multi-season studies demonstrate short-term increases in asthma-related Emergency Department (ED) visits, with additional evidence supporting increased utilization for broader respiratory disease and chronic lower respiratory disease (including COPD) (Reid et al., 2016; Liu et al., 2015; Stowell et al., 2025; CDC, 2023).

Objective: To synthesize current evidence linking wildfire smoke to ED respiratory surge and to propose a systems forecasting model that translates environmental signals into structured operational stabilization within a complex adaptive system (CAS).

Methods (Review & Model Development): Narrative synthesis of event-based …

Procedural Narration As An Important Cognitive Adjunct To Analgesia: Naming And Neurobiologically Grounding An Established Emergency Medicine Practice, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Experienced emergency physicians routinely provide real-time verbal guidance during procedures. Although widespread and intuitive, this practice has not been commonly conceptualized within pain neuroscience.

Objective: To name and mechanistically ground procedural narration as a form of cognitive analgesia, and to promote its intentional use and teaching in Emergency Medicine.

Methods: Narrative review integrating predictive coding theory, placebo/nocebo research, affective neuroscience, descending inhibitory pathway literature, and attentional modulation studies.

Results: Procedural narration reduces uncertainty, aligns expectation with sensation, modulates limbic threat processing, engages prefrontal cortical regulation, and supports descending inhibitory control of nociception.

Conclusion: Procedural narration is not a novel …