Open Access. Powered by Scholars. Published by Universities.®

Alternative and Complementary Medicine Commons™

Open Access. Powered by Scholars. Published by Universities.®

Dominican University of California

Discipline
Keyword
Publication Year
Publication
Publication Type

Articles 1 - 30 of 34

Full-Text Articles in Alternative and Complementary Medicine

Comparing Nurse-Led Holistic Pain Relief Strategies And Sole Pharmacological Use In Enhancing Maternal Satisfaction, Reducing Pain, And Lowering Obstetric Interventions During Childbirth, Jessica C. Moore Jan 2026

Comparing Nurse-Led Holistic Pain Relief Strategies And Sole Pharmacological Use In Enhancing Maternal Satisfaction, Reducing Pain, And Lowering Obstetric Interventions During Childbirth, Jessica C. Moore

Nursing | Senior Theses

Background: Childbirth has become heavily reliant on pharmacological management and obstetric interventions such as epidural use, labor induction, and cesarean deliveries (C-sections) even among low-risk pregnancies. While necessary in some cases, excessive reliance on pharmacological interventions can negatively impact the experience of birthing as a whole. Non-pharmacological interventions (NPIs) such as breathing techniques, positioning, hydrotherapy, massage, aromatherapy and continuous support have shown to be effective in reducing pain and supporting physiologic labor. The gaps in education and lack of standard implementation result in inconsistent application in practice. Purpose: This research proposal aims to evaluate the effectiveness of nurse-led NPIs compared …


The Effectiveness Of Botulinum Toxin Injections In The Management Of Chronic Neck And Shoulder Myofascial Pain: A Nursing Perspective, Jia Zhou Jan 2025

The Effectiveness Of Botulinum Toxin Injections In The Management Of Chronic Neck And Shoulder Myofascial Pain: A Nursing Perspective, Jia Zhou

Nursing | Senior Theses

Abstract

Background

Chronic neck and shoulder myofascial pain has long been challenging patients and medical professionals due to its limited response to traditional therapies on top of high recurrence. Physical therapy, oral analgesics, and trigger point injections have only provided partial or short-term relief. As a result, botulinum toxin type A injections have been explored as an alternative treatment. Previous studies have shown promising short-term outcomes, but concerns regarding long-term safety, cost-effectiveness, and potential adverse effects, particularly in older adults, have remained unresolved. These gaps have highlighted the need for comprehensive evaluation from both clinical and nursing perspectives.

Objective

The …


The Impact Of Complementary Therapies On Postpartum Pain Relief Among Mothers Of Multiples, Jewel Thomas Jan 2025

The Impact Of Complementary Therapies On Postpartum Pain Relief Among Mothers Of Multiples, Jewel Thomas

Nursing | Senior Theses

The process of recovery after birth can be an arduous process for many women. Many patients experience discomfort that affects their quality of life. Especially for mothers who give birth to twins or triplets, there is additional need for support in this crucial time as they are more likely to develop postpartum complications. Current management for postpartum pain include pain control medications and heat/cold therapy. The purpose of this proposal is to examine if complementary therapies such as aromatherapy and music therapy decreases the postpartum pain levels in mothers of multiples. This paper proposes an experimental trial, in which a …


Impact Of Whole Foods Diet On Cognitive Functions In Children From Low-Income Families With Attention Deficit Hyperactivity Disorder (Adhd), Jasmine Le Jan 2025

Impact Of Whole Foods Diet On Cognitive Functions In Children From Low-Income Families With Attention Deficit Hyperactivity Disorder (Adhd), Jasmine Le

Nursing | Senior Theses

Purpose

Current studies have examined dietary interventions for ADHD, emphasizing the value of good nutrition, the lack of nutritional foods in schools, and the difficulties low-income families have finding healthy options. Nutritious food has been shown to enhance cognitive abilities, yet many low-income households still lack access to it. This quantitative research will provide vital information for nurses and healthcare professionals on how they can assist these populations.

Methods

A quantitative randomized controlled design study will be conducted, with students separated into an experimental and control group. The objective will be to evaluate the effects of nursing nutrition education and …


The Effectiveness Of Botulinum Toxin Injections In The Management Of Chronic Neck And Shoulder Myofascial Pain: A Nursing Perspective, Jia Zhou Jan 2025

The Effectiveness Of Botulinum Toxin Injections In The Management Of Chronic Neck And Shoulder Myofascial Pain: A Nursing Perspective, Jia Zhou

Nursing | Student Research Posters

No abstract provided.


Empowering Birth: Comparing Nurse-Led Holistic And Pharmacologic Pain Relief Approaches​, Jessica C. Moore Jan 2025

Empowering Birth: Comparing Nurse-Led Holistic And Pharmacologic Pain Relief Approaches​, Jessica C. Moore

Nursing | Student Research Posters

Childbirth is often described as one of the most meaningful experiences in a woman’s life. During this time, effective pain management is essential not only for reducing discomfort, but also for improving maternal satisfaction and minimizing unnecessary obstetric interventions. While childbirth is frequently approached as a purely physical process, it is inherently holistic, influenced by cultural, social, psychological, and emotional factors.

Growing evidence highlights the value of incorporating and educating patients and providers on non-pharmacologic strategies such as breathing techniques, massage, aromatherapy, hydrotherapy, positioning ,ambulation, and continuous emotional support.

For example, a study in Sweden that found that a group …


The Implementation Of Ketamine-Assisted-Psychotherapy On Healthcare Workers Suffering From Workplace-Related Ptsd Due To Covid-19, Ziluolan Zou Dec 2024

The Implementation Of Ketamine-Assisted-Psychotherapy On Healthcare Workers Suffering From Workplace-Related Ptsd Due To Covid-19, Ziluolan Zou

Nursing | Student Research Posters

During the coronavirus disease 2019 (COVID-19) pandemic, healthcare workers were exposed to a deadly disease with limited knowledge and personal protective equipment, subjected to long hours, forced to ration care due to limited critical care resources and ventilators, and isolated from their families due to fear of spreading the virus. These factors further compounded the occupational stress associated with being a healthcare worker. The literature shows that the physical, mental, and emotional challenges frontline healthcare workers faced during the COVID-19 pandemic had lasting impacts on their mental health. The prevalence of mental health illnesses, such as post-traumatic stress disorder, among …


Chronic Atopic Dermatitis: Symptom Management Using Moisturizers Among Asian American Pediatrics, Ethan J. Brillantes Jan 2024

Chronic Atopic Dermatitis: Symptom Management Using Moisturizers Among Asian American Pediatrics, Ethan J. Brillantes

Nursing | Senior Theses

Background: Atopic Dermatitis (AD), also commonly known as eczema, affects 31.6 million (10%) of the United States Population, with 13% being Asian American or Pacific Islander. A cure is not present for AD; however, the best way to treat AD is with symptom management. While there are many pharmacological treatments that aid with symptom management such as topical or oral corticosteroids, there are also non pharmacological treatments such as moisturizers that can aid with symptom relief of AD as well. Objective: The literature review explores moisturizer use and other non pharmacological methods for symptom management of AD and provides understanding …


Empowering Low-Income Women With Breast Cancer: Promoting Acupuncture At Community Health Fairs, Katrina Ramos Jan 2024

Empowering Low-Income Women With Breast Cancer: Promoting Acupuncture At Community Health Fairs, Katrina Ramos

Nursing | Senior Theses

While research has explored the positive effects of acupuncture on cancer and cancer treatment symptoms, a notable gap exists in understanding its impact on lower-income populations. These individuals encounter barriers to accessing acupuncture, such as limited availability, cost, and provider knowledge. This longitudinal study aims to assess the impact of community health fairs, featuring acupuncture information for breast cancer and chemotherapy-induced symptoms, on the acceptance and utilization rates of acupuncture among low-income women with breast cancer. Collaborating with the Women’s Cancer Resource Center and a local non-profit integrative cancer care clinic in Oakland, we will conduct a three-day health fair …


Unleashing Wellness: Exploring The Impact Of Pet Therapy On Anxiety Reduction, Quality Of Life, And Treatment Adherence In Pediatric Oncology Patients, Karina Brouwer Jan 2024

Unleashing Wellness: Exploring The Impact Of Pet Therapy On Anxiety Reduction, Quality Of Life, And Treatment Adherence In Pediatric Oncology Patients, Karina Brouwer

Nursing | Senior Theses

Pet therapy is a complementary intervention that involves the interaction between a person and animal, with the focus of improving psychological well-being within diverse populations. In particular, children with oncological disorders have increases in anxiety and stress levels, therefore it is imperative to study the impact of animal interventions within this population. This literature critique explores the impact of pet therapy interventions on anxiety, stress, and quality of life perceptions in pediatric oncology patients. This research proposal will investigate how animal therapy interactions within pediatric oncology patients influence their anxiety levels and perceptions of quality of life and how these …


Unleashing Wellness: Exploring The Impact Of Pet Therapy On Anxiety Reduction, Quality Of Life, And Treatment Adherence In Pediatric Oncology Patients, Karina Brouwer Jan 2024

Unleashing Wellness: Exploring The Impact Of Pet Therapy On Anxiety Reduction, Quality Of Life, And Treatment Adherence In Pediatric Oncology Patients, Karina Brouwer

Nursing | Student Research Posters

Pet therapy is a complementary type of therapeutics in which a person and animal have a guided interaction with the purpose of helping someone cope with physical and/or mental illness. Animal-assisted therapy is used in numerous settings and has been shown to reduce stress, lower blood pressure and heart rate, and decrease anxiety and depression (Husson University, 2022). In particular, pediatric oncology patients have enormous amounts of stress in their lives, which leads to increased anxiety and decreased quality of life (Children's Cancer Cause, 2023). While evidence shows that integrating pet therapy in pediatric oncology patients produces significant benefits on …


Complementary Therapies For Postpartum Mothers Of Multiples, Jewel Thomas Jan 2024

Complementary Therapies For Postpartum Mothers Of Multiples, Jewel Thomas

Nursing | Student Research Posters

There are many systemic changes that happen to the body after giving birth. Special consideration should be given to recovery during the postpartum period. Common physical symptoms during postpartum are breast engorgement and nipple pain, vaginal bleeding, soreness in perineal area, cramping during uterine involution, increased sweating usually at night, constipation, and hair loss (Cleveland Clinic, 2024). A vulnerable population is women experiencing a multiple pregnancy, such as those carrying twins or triplets. These women are more likely to experience gestational diabetes, gestational hypertension, anemia and/or postpartum hemorrhage (University of Rochester Medical Center, 2024). Amidst this crucial time, advocating for …


Assessing Disparities In Culturally Competent Care In Ethnic Burn Patients, Min Kang Jan 2024

Assessing Disparities In Culturally Competent Care In Ethnic Burn Patients, Min Kang

Nursing | Student Research Posters

One of the most debilitating injuries one can suffer is a burn. It is even worse when certain individuals can not access the high quality care such as immigrants. With immigration rates increasing over the last several decades, these populations often lack the proper medical care that they deserve. The overarching theme in this population is that they face challenges in attaining positive patient outcomes due to cultural differences.

  • Lack of Culturally Competent Care in Burn Care
  • Addressing Cultural Safety and Quality of Care in Burn Injury Management
  • Analyzing Disparities in Access to Culturally Competent Burn care


Whole Foods Diet On Cognitive Functions In Children From Low-Income Families With Attention Deficit Hyperactivity Disorder (Adhd), Jasmine Le Jan 2024

Whole Foods Diet On Cognitive Functions In Children From Low-Income Families With Attention Deficit Hyperactivity Disorder (Adhd), Jasmine Le

Nursing | Student Research Posters

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurological disorder that has become increasingly prevalent in adolescents worldwide. This disorder often impairs academic performance, emotional regulation, and ability to navigate daily tasks effectively. It usually persists from childhood to adulthood (Hemamy et al., 2021).

Although conventional treatments such as medication and therapies are used for symptom management, many low-income families do not have the resources or education to access medical help, which may lead them to seek alternative treatments. Emerging research suggests that modifying diet to incorporate whole foods, foods rich in essential nutrients and minutely processed foods, may play a major role …


Determining Effects Of Holistic And Pharmaceutical Treatment Routes Taken By Physicians For Patients With Polycystic Ovary Syndrome, Erendira Martinez Jan 2023

Determining Effects Of Holistic And Pharmaceutical Treatment Routes Taken By Physicians For Patients With Polycystic Ovary Syndrome, Erendira Martinez

Nursing | Senior Theses

Background

Polycystic ovarian syndrome is a hormonal disorder that affects women all over the world. Though a newly recognized diagnosis, that has not been researched extensively, it is clear that this reproductive and metabolic hinderance debilitates many aspects of women’s lives, negatively impacting their quality of life.

Objectives:

  • Discover the effects of physician determined treatment routes on patients with polycystic ovarian syndrome.
  • Explore insufficiency of research conducted regarding different routes of treatments for patients with polycystic ovarian syndrome.

Methods

A literature review was performed of primary research studies, utilizing databases provided by Dominican University of California. Six articles were reviewed …


Video Game Therapy For Adhd Managment, Wilhelm Alec Sison Beroncal Jan 2023

Video Game Therapy For Adhd Managment, Wilhelm Alec Sison Beroncal

Nursing | Student Research Posters

Attention Deficit Hyperactivity Disorder (ADHD) stands out as the most common childhood neurodevelopmental disorder, leading to functional challenges in various aspects of the daily lives of affected young individuals (Bul et al., 2016).

There is no current cure for ADHD, however effective treatments are available through medications. The FDA has authorized two types of medications for managing ADHD in children as young as 6 years old: stimulants, such as methylphenidate and amphetamine (e.g. Adderall), and non-stimulant options including Strattera, Intuniv, Kapvay, and Qelbree (U.S. Food and Drug Administration, 2023).

The choice of treatment is highly individualized to meet the specific …


Empowering Low-Income Women With Breast Cancer: Promoting Acupuncture At Community Health Fairs, Katrina Ramos Jan 2023

Empowering Low-Income Women With Breast Cancer: Promoting Acupuncture At Community Health Fairs, Katrina Ramos

Nursing | Student Research Posters

No abstract provided.


Chronic Atopic Dermatitis: Symptom Management Using Moisturizers Among Asian American Pediatrics, Ethan J. Brillantes Jan 2023

Chronic Atopic Dermatitis: Symptom Management Using Moisturizers Among Asian American Pediatrics, Ethan J. Brillantes

Nursing | Student Research Posters

Background: Atopic Dermatitis (AD), also commonly known as eczema, affects 31.6 million (10%) of the United States Population, with 13% being Asian American or Pacific Islander. A cure is not present for AD; however, the best way to treat AD is with symptom management. While there are many pharmacological treatments that aid with symptom management such as topical or oral corticosteroids, there are also non pharmacological treatments such as moisturizers that can aid with symptom relief of AD as well. Objective: The literature review explores moisturizer use and other non pharmacological methods for symptom management of AD and provides understanding …


Effects And Outcomes Of Different Laboring Positions And The Influence From Societal Norms, Amberlyn Heskett Dec 2022

Effects And Outcomes Of Different Laboring Positions And The Influence From Societal Norms, Amberlyn Heskett

Nursing | Senior Theses

Background

Within labor and delivery, every birth is different. Alarmingly, the U.S. has the highest maternal mortality rate, including death during labor, among developed countries (World Health Organization, 2022). Many maternal deaths may be preventable.

In the U.S., the use of forceps, vacuum-assisted birth, episiotomies, and emergency C-sections are common for women during childbirth. Even though some laboring positions may assist birthing more than others, there often is resistance to allowing various positions due to outside influences, including societal norms, hospital management, and healthcare professional training. Women in labor are vulnerable and look to their nurses for support during the …


Exploring The Efficacy Of Herbal & Medicinal Plants Native To China And Thailand As A Complementary & Alternative Treatment In Mitigating Mild-To-Moderate Covid-19 Symptoms, Jiramanee Apiwansri May 2022

Exploring The Efficacy Of Herbal & Medicinal Plants Native To China And Thailand As A Complementary & Alternative Treatment In Mitigating Mild-To-Moderate Covid-19 Symptoms, Jiramanee Apiwansri

Nursing | Senior Theses

Background

In December 2019, the World Health Organization (WHO) was informed of an outbreak of an unknown cause of pneumonia-like symptoms in residents concentrated in Wuhan, China; this marked the start of China’s epidemic, which transformed into a pandemic affecting all continents of the world. The cause of the pneumonia-like symptoms was found to be due to the growth and development of the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which spreads through an infected person’s respiratory droplets through activities such as talking, coughing, and sneezing. With COVID-19 vaccine manufacturers available worldwide, even the economically and technologically forward countries …


The Physiological Benefits Of A Plant-Based Diet On Cardiovascular Health, Jenevieve Petray Dec 2021

The Physiological Benefits Of A Plant-Based Diet On Cardiovascular Health, Jenevieve Petray

Nursing | Senior Theses

Cardiovascular disease (CVD) is increasingly more prevalent in today’s society and is attributed to an alarming percentage of American hospitalizations and deaths. Americans are unhealthier than ever before, and the main contributor is the Western diet. Diet is a double-edged sword that can offer benefits or detriments to one’s health. CVD encompasses numerous diagnoses originating from various underlying physiological alterations. These alterations are downstream effects of increased body weight and BMI, increased cholesterol levels, decreased insulin sensitivity and increased arterial plaque buildup. Research shows that a plant-based diet has the potential to manage and reverse all fundamental physiological alterations that …


Complementary And Alternative Medicine: The Effects Of Aromatherapy On New And Expectant Mothers, Heather Tran May 2021

Complementary And Alternative Medicine: The Effects Of Aromatherapy On New And Expectant Mothers, Heather Tran

Nursing | Senior Theses

Complementary and alternative medicine (CAM) is vastly expanding and is now being used in the clinical setting as an effective management of various symptoms. Pregnancy, labor, and the postpartum period can be beautiful yet overwhelming moments in a woman’s life. The symptoms that are usually accompanied along this journey include nausea, vomiting, anxiety, pain, fatigue, stress and more. Aromatherapy has been proven to be a safe and natural, non-pharmacological method in reducing these symptoms that may make it harder for the mother to enjoy her pregnancy. This holistic approach to treatment is inexpensive, noninvasive, does not require a prescription from …


The Effects Of Moderate-Severe Plaque Psoriasis On Patient Well-Being And Prevention Of Flares, Glenn Devera Dec 2020

The Effects Of Moderate-Severe Plaque Psoriasis On Patient Well-Being And Prevention Of Flares, Glenn Devera

Nursing | Senior Theses

Psoriasis is a chronic skin condition that is indicated by red, patchy and scaly skin that can be painful when irritated. Patients with psoriasis have an increased risk for a number of chronic diseases. Despite the expansion of treatments for moderate-to-severe psoriasis over the last decade, patients may still find that treatment strategies are not as successful, leaving them dissatisfied with their treatments. A relationship built upon trust between the nurse and the patient diagnosed with psoriasis may serve to help ensure optimal care. A comprehensive literature review was performed and found that best practices for patient management need to …


Fecal Microbiota Transplantation And Gut Microbiome Effects On Psychiatric Illnesses, Mona Seresht Jun 2020

Fecal Microbiota Transplantation And Gut Microbiome Effects On Psychiatric Illnesses, Mona Seresht

Physician Assistant Studies | Student Authored Articles

Despite the medical advances that have been made in regards to mental health, psychiatric medications, and alternative therapies, many patients continue to suffer day in and day out, unable to live the type of life they desire. Many times, the medication route includes many episodes of trial and error, side effects, and no significant improvement in actual symptoms. Therapy, although effective, typically necessitates a supplemental medication for the best results. Fecal microbiota transplantation (FMT) is a method where feces from a healthy donor is transferred to an affected patient, typically via colonoscopy. Theoretically, this alters the gut microbiome in a …


An Investigation Of Treatments For The Prevention Of Metabolic Complications For Women Suffering From Polycystic Ovarian Syndrome: Diet, Exercise, Weight Reduction And Herbal Remedies, Brenda Martinez-Puente May 2020

An Investigation Of Treatments For The Prevention Of Metabolic Complications For Women Suffering From Polycystic Ovarian Syndrome: Diet, Exercise, Weight Reduction And Herbal Remedies, Brenda Martinez-Puente

Nursing | Senior Theses

The purpose of this research study is to compare the views of traditional versus alternative treatments available to women with Polycystic Ovarian Syndrome (PCOS) suffering from metabolic complications. Alternative treatments include diet, exercise, herbal remedies, or any combination of the three. Pharmacological interventions for the conditions associated with PCOS such as metformin, used to control glucose levels, and clomiphene, used to treat infertility. Through the literature review, articles show herbs and plant products to have similar mechanisms of actions as the pharmacological interventions, but with less side effects. For example, cinnamon was shown to increase insulin sensitivity and pomegranate juice …


Participation In Mindfulness-Based Stress Reduction Therapy On The Immune Function Of Survivors Of Breast Cancer: A Literature Review And Pilot Study For Clinical Practice, Bianca Marteja May 2020

Participation In Mindfulness-Based Stress Reduction Therapy On The Immune Function Of Survivors Of Breast Cancer: A Literature Review And Pilot Study For Clinical Practice, Bianca Marteja

Nursing | Senior Theses

A review of current literature presented in this work suggests that MBSR participation results in NKCA, T-cell and B-cell restoration as well as a reduction in inflammatory biomarkers. While results from these studies are statistically significant, they are, however, relatively small. Furthermore, the reliability and one’s ability to generalize study findings from this literature review is limited by consistently small sample sizes, high attrition, differing forms of MBSR application, and inconsistent adherence to MBSR home practices.

The distribution of a 10-point survey using likert scales occured in a pilot study associated with the aforementioned literature review; this survey evaluated registered …


Flowers Or Flora?: Understanding The Effects Of Probiotics On Depression, Nicole Collopy Dec 2019

Flowers Or Flora?: Understanding The Effects Of Probiotics On Depression, Nicole Collopy

Senior Theses

The human gut is populated with hundreds of types of bacteria and fungi. In North America, both intestinal and mood disorders are prevalent, presenting health problems that challenge health care professionals and patients alike. A scholarly literature review was conducted to explore this important relationship.

The investigation of the literature revealed that there is an association between gut health disorders and mood disorders, mainly anxiety and depression. This is due to bi-directionality between the brain-gut pathways, meaning that gastrointestinal health may have an effect on mental health and vice versa.

This connection between gut and mood can have substantial implications …


Flowers Or Flora?: Understanding The Effects Of Probiotics On Depression, Nicole Collopy Jan 2019

Flowers Or Flora?: Understanding The Effects Of Probiotics On Depression, Nicole Collopy

Student Research Posters

Chances are, we all know someone who has had their life affected by depression and anxiety; and we have all experienced these feelings on some level. What if the key to unlocking these problems lied within every one of us -- inside of our gut? The research topic being explored is the relationship between gut health and mood disorders. The question of interest is: Does the use of probiotic supplementation have an effect on feelings of depression?

Connection between gut health and mental health is significant as approximately 6.7% of adults in the U.S. suffer from major depressive disorder. There …


Identification Of Substrate-Selective Histone Deacetylases And Their Inhibitors That Mediate Her2 Transcript Stability, Mariah Alejo May 2018

Identification Of Substrate-Selective Histone Deacetylases And Their Inhibitors That Mediate Her2 Transcript Stability, Mariah Alejo

Dissertations, Masters Theses, Capstones, and Culminating Projects

Breast cancer is the most common malignancy diagnosed in women. 15-20% of these cancers overexpress the HER2 (ERRB2) oncoprotein. HER2-positive breast cancers are generally aggressive and are associated with poor prognosis. Unfortunately, only a mere 30% of HER2-positve patients respond to therapies when they are used as a single agent. Combining therapeutics can potentially lead to synergy and improved anticancer efficacy, and there is clearly a need for the development of new HER2-directed therapeutics. Newer approaches include the utilization of histone deacetylase (HDAC) inhibitors. It has been observed that HDAC inhibitors can induce the rapid decay of oncogenic transcripts such …


Measuring The Outcomes Of Therapeutic Listening In Children With Learning And Developmental Disabilities, Hannah Tashjian, Donielle Hair, Phoebe Taasan May 2018

Measuring The Outcomes Of Therapeutic Listening In Children With Learning And Developmental Disabilities, Hannah Tashjian, Donielle Hair, Phoebe Taasan

Dissertations, Masters Theses, Capstones, and Culminating Projects

Anecdotal reports of the Therapeutic Listening ®-Quickshifts (TL-Q) technique report positive effects on child behavior but the individualized approach requires further supporting evidence. TL-Q is an individualized sound-based program used to facilitate sensory processing skills and is believed to improve interpersonal, social, and cognitive skills (Frick & Hacker, 2001). This study examines the use of a standardized protocol to measure the specific outcomes of the TL-Q program using a practice-based evidence (PBE) approach for the purpose of aggregating data for clinical practice. The protocol was used to measure the outcomes of the TL-Q program in a convenience sample of 23 …