Improving Access and Early Identification of Anxiety Disorders through Annual GAD-7 Screening in High Schools: A Scoping Review

Background: Anxiety disorders affect nearly one-third of adolescents in the United States, yet many cases remain undiagnosed due to inconsistent screening and limited access to school-based mental health services. The Generalized Anxiety Disorder 7-item (GAD-7) questionnaire is a validated screening tool, but its routine use in high school settings is not well established. Purpose: This scoping review aimed to synthesize current evidence on the use of the GAD-7 in high schools to support early identification of anxiety disorders and improve access to mental health care. Methods: A comprehensive literature search was conducted using PsycINFO, ERIC, PubMed, CINAHL, and Google Scholar. Inclusion criteria focused on peer-reviewed studies involving adolescents aged 13–18, use of the GAD-7, and relevance to school-based screening. Ten studies met the inclusion criteria and were critically appraised. Data were extracted on population characteristics, screening practices, outcomes, and implementation factors. Results: Findings indicate that anxiety disorders are highly prevalent among adolescents, with higher rates observed in females and those exposed to social and economic stressors. The GAD-7 demonstrated strong reliability and validity across diverse populations. School-based screening using the GAD-7 was associated with improved identification and referral of at-risk students; however, actual engagement with mental health services remained limited. Schools were identified as critical access points for early detection, though gaps persist in referral systems and service utilization. Conclusions: Annual GAD-7 screening in high schools shows promise for improving early identification of anxiety disorders. However, screening alone is insufficient without integrated referral pathways, adequate resources, and coordinated mental health support. Future research should focus on implementation strategies and outcomes related to screening programs, including referral rates, treatment engagement, and academic impact

Intraoperative Aspiration Risk Reduction of Diabetic Patients Through Gastric Ultrasound: A Scoping Review

Purpose/Background Patients with diabetes mellitus are significantly more prone to delayed gastric emptying, which can increase their risk for aspiration events in the operating room despite following standard fasting guidelines set by the American Society of Anesthesiologists (ASA). Using point-of-care gastric ultrasound, trained providers can quickly and accurately evaluate gastric volumes and risk-stratify patients based on these findings. However, these methods have not been clearly assessed in the diabetic population. The purpose of this scoping review is to map the existing evidence on the use of gastric ultrasound findings among adult patients with diabetes undergoing anesthesia. Methods A scoping review was conducted in accordance with PRISMA-ScR guidelines. MEDLINE, CINAHL, Embase, and Cochrane Library databases were searched from project inception through March 2025. Inclusion criteria were adult surgical patients with diabetes mellitus, preoperative gastric ultrasound, and reported fasting times. Of 612 identified records, 487 remained after duplicates were removed. After full-text review and title/abstract screening, 18 studies met the inclusion criteria. These 18 studies were classified as 12 prospective observational studies, four randomized controlled trials, and two retrospective cohort studies. A total of 1,146 patients were included. Results Across all studies, 28.4% (326/1,146) of diabetic patients met ASA fasting guidelines and demonstrated a “full stomach” on gastric ultrasound. Compared with non-diabetic controls, diabetic patients had significantly higher rates of increased gastric volume (odds ratio 2.31, 95% CI 1.74-3.07; p\u3c 0.001). Mean gastric volumes in diabetic patients ranged from 1.6 to 2.4 mL/kg, exceeding the cited aspiration risk threshold of 15 mL/kg. After identification of high-risk patients, anesthetic plans were altered in 21-48% of cases, either through delaying surgery or modified airway strategies. Implications for Nursing Practice Evidence from this scoping review suggests that ASA fasting guidelines are insufficient in completely reducing aspiration risk in patients with diabetes. Preoperative gastric ultrasound can identify increased gastric volume in these patients, enabling appropriate adjustments to their anesthetic plan

Impact of Nitrous Oxide Analgesia on Labor Experience

Purpose/Background Nitrous oxide (N₂O) has re-emerged in the United States as a labor analgesia option that supports mobility, autonomy, and patient-centered care. As nurses increasingly support low-intervention and physiologic birth approaches, understanding the effectiveness and safety of nitrous oxide for low-risk laboring individuals is essential. This scoping review examines current evidence on nitrous oxide use during labor, focusing on maternal pain management, satisfaction, and neonatal outcomes to inform evidence-based nursing and midwifery practice. Methods A scoping review was conducted using PubMed, CINAHL Complete, and the Cochrane Library between September and October 2023. Inclusion criteria consisted of English-language studies published within the past ten years involving low-risk laboring individuals aged 18 years or older. Eligible designs included systematic reviews, randomized controlled trials, controlled trials, observational studies, and a clinical audit. Thirty articles were screened using the Rapid Critical Appraisal (RCA) tool, and eight met all inclusion criteria. Data were extracted using a standardized charting framework capturing study characteristics, intervention details, comparison groups, and maternal and neonatal outcomes. Results: Across the eight included studies, nitrous oxide consistently provided moderate but meaningful pain relief, improved coping, reduced anxiety, and enhanced maternal satisfaction. Participants valued rapid onset, self-administration, and preservation of mobility. Reported maternal side effects, including nausea and dizziness, were mild and transient. Neonatal 3 outcomes, such as Apgar scores and respiratory adaptation, were comparable between users and non-users, demonstrating reassuring safety. Nitrous oxide functioned as both a primary analgesic and a bridging option, with conversion to epidural reflecting expected analgesic limitations rather than dissatisfaction. Variability in use was primarily attributed to institutional resources and provider training. Implications for Nursing Practice: Results provided in this scoping review support nitrous oxide as a safe, accessible, and patient-centered labor analgesic for low-risk individuals. Nurses and midwives play a key role in patient education, administration, and environmental safety. Expanding standardized training and institutional support may enhance the integration of nitrous oxide into individualized, evidence-based maternity care

Home-Based vs Clinic-Based Stool Testing for Detecting Early Cancer Markers: A Scoping Review

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 their delivery models among adults aged 45 years and older. Methods  This scoping review adhered to PRISMA-ScR guidelines. Eligible evidence included studies and guidelines reporting on CRC screening uptake using stool-based modalities (FIT, FOBT, or mDNA) and related implementation strategies. Peer-reviewed literature and authoritative sources were identified through structured searches and supplementary materials. Records were screened using predefined eligibility criteria, with independent data extraction into a structured charting table capturing study characteristics, screening modality, interventions, and screening outcomes. Results  Following duplicate removal and screening, 14 studies were included. Most demonstrated increased CRC screening compliance and improved early detection, particularly when stool-based testing was paired with educational interventions, reminders, or navigation support. Socioeconomic barriers to screening participation were commonly identified. In contrast, outcomes related to harm, cost-effectiveness, and patient satisfaction were inconsistently reported. Implications for Nursing Practice  Overall, findings indicate that stool-based screening is most effective when paired with patient-centered strategies, including mailed outreach and culturally responsive education

The Effects of Sugammadex vs. Neostigmine on Intraoperative Heart Rate in Pediatric Patients Under Two Years: A Scoping Review

Purpose/Background Neuromuscular blockade (NMB) reversal is a critical component of anesthesia care, particularly in infants under two years of age who have immature autonomic regulation and heightened vagal tone, predisposing them to bradycardia. Neostigmine, the traditional reversal agent, is associated with parasympathomimetic effects such as bradycardia, requiring anticholinergic co- administration. Sugammadex, a selective relaxant binding agent, offers rapid and predictable reversal of aminosteroidal neuromuscular blocking agents with less cholinergic side effects. Although the safety profile of sugammadex is well established in older pediatric populations, limited evidence exists regarding its cardiovascular effects in infants under two years of age. Methods A scoping review was conducted using the databases CINAHL, PubMed, Cochrane Library, Scopus, and Google Scholar. Studies published between 2009 and 2025 evaluating intraoperative heart rate outcomes following NMB reversal with sugammadex or neostigmine in pediatric patients aged 0–24 months were included. Eligible study designs comprised randomized controlled trials, retrospective cohort studies, observational studies, and meta-analyses. The primary outcomes of this review included intraoperative heart rate trends, incidence of bradycardia, and need for anticholinergic rescue medications. Secondary outcomes included time to achieve a train-of-four (TOF) ratio of 0.9 and overall recovery characteristics. Results Seven studies met inclusion criteria. Across all study designs, sugammadex demonstrated superior intraoperative hemodynamic stability compared to neostigmine. Sugammadex wasconsistently associated with a lower incidence of bradycardia, reduced need for anticholinergic rescue agents, and faster recovery to a TOF ratio of 0.9. No clinically significant arrhythmias or adverse cardiovascular events were attributed to sugammadex. In contrast, neostigmine use was frequently associated with transient bradycardia related to its cholinergic effects. Findings were consistent in demonstrating a significant decreased risk of bradycardia with sugammadex. Implications for Nursing and Nurse Anesthesia Practice The findings of this scoping review support sugammadex as a safer and more hemodynamically stable alternative to neostigmine for neuromuscular blockade reversal in infants under two years of age. For nurse anesthetists, preferential use of sugammadex may reduce the risk of intraoperative bradycardia, decrease reliance on anticholinergic rescue medications, and promote safer emergence from anesthesia. Incorporating sugammadex into standardized pediatric anesthesia protocols can enhance cardiovascular safety and optimize perioperative outcomes in this pediatric popul

Optimizing Glycemic Control in Type II Diabetes: Continuous Glucose Monitoring : A Scoping Review

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, TBR, HbA1c, hypoglycemic patterns, and device- related effects. Methods We conducted a literature search from August 2023 through December 2024, using PubMed, CINAHL, and MEDLINE. The PRISMA guidelines guided the search strategy. Search terms included continuous glucose monitoring, self-monitoring of blood glucose, glycemic control, time above range, time below range, hypoglycemia, and type II diabetes. Fourteen relevant articles were identified, of which eleven met the criteria. Results Eleven articles were selected based on our inclusion criteria, including four systematic reviews, three RCTs, and four controlled trials without randomization. When considered collectively, the evidence indicates a consistent pattern favoring CGM over SMBG. Across all 11 studies, CGM showed lower HbA1c levels, with multiple studies demonstrating reduced glycemic variability, improvements in TIR, and fewer hypoglycemic events. While most studies evaluated outcomes over a 3–6-month period, two indicated improvements over a 12-month period, suggesting results may be maintained over a longer period. Implications for Nursing Practice The evidence overall suggests that CGM provides more effective glycemic control than SMBG in adults aged 30-65 years. Nurse practitioners and other clinicians should consider adopting CGM over SMBG, as it is associated with reductions in HbA1c, more favorable time- in-range profiles, and reduced hypoglycemia

How Does Cognitive Behavioral Therapy (CBT) and Antipsychotics Compare to Antipsychotics Alone Impact Inpatient Length of Stay: A Scoping Review

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 the effects  of combining CBT with antipsychotics in inpatient settings. The purpose of this scoping review is to evaluate whether the combination of CBT with antipsychotic medication, compared to antipsychotics alone, affects the length of inpatient stays and clinical outcomes in adults diagnosed with psychosis Methods This scoping review utilized a structured literature search of the UTHSC library databases, including CINAHL, EBSCOhost, Elsevier, Google Scholar, and PubMed, covering publications from 2015 to 2025. Studies comparing cognitive behavioral therapy combined with antipsychotics versus antipsychotics alone in hospitalized adults were screened using predefined inclusion criteria to evaluate the impact on length of stay. Results The literature search identified 1,213 articles. Five studies met inclusion criteria. Overall, results were mixed; however, several studies supported improved psychotic symptom control when cognitive behavioral therapy (CBT) was used in combination with antipsychotic medication. Although length of stay was not directly measured, improvements in symptoms and patient engagement suggest a likely reduction in hospitalization time. Implications for Nursing Practice Evidence supports that including CBT in combination with antipsychotics in treatment planning for inpatients with psychosis would allow nurses to deliver higher quality patient- centered care and positively impact patient outcomes by reducing symptom severity and length of stay

Moving Toward Standardization of Breast Cancer Screening: A Scoping Review Comparing USPSTF and ACS Recommendations for Women Aged 40–74

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 cancer awareness, treatment, and technology advance, it is essential to provide consistent recommendations for early diagnosis and mortality reduction. Addressing inconsistent screening intervals is essential to improving diagnostic outcomes and reducing mortality. Method  A scoping literature review was conducted from August to November 2023 to identify evidence comparing USPSTF and ACS breast cancer screening recommendations. Searches were performed in PubMed, MEDLINE, Embase, CINAHL, Scopus, and the Cochrane Library using relevant keywords. Eleven articles met inclusion criteria and were appraised using The Ohio State University rapid critical appraisal tool. Findings were synthesized using an outcome‑focused synthesis table. Results  Most studies we used supported initiating screening at age 40, with evidence favoring more frequent mammography for early detection. However, no statistically significant difference was found between annual and biennial screening outcomes. Across the literature, emphasis on shared decision-making, patient-centered communication, and concerns regarding overdiagnosis and false positives revealed a persistent gap between guideline recommendations and clinical practice. Implications for Nursing Practice  Variability in screening guidelines contributes to disparities in early detection. Standardized recommendations improve patient education, support shared decision‑making, and strengthen continuity of care. Nursing leadership remains essential for policy advocacy and implementing screening standards that enhance preventive health outcomes

2025 Laurie Glass, PhD Storytelling Session

Dr. Laurie Glass, Professor Emeritus at the University of Wisconsin- Milwaukee College of Nursing and Director of the Center for Nursing History, tells stories about Margaret Newman and Martha Rogers

Mapping the Evidence on the Maternal–Fetal Triage Index (MFTI): A Scoping Review

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 extent and quality of evidence supporting its measurement properties and clinical impact remain unclear. The purpose of this scoping review was to map and synthesize the existing evidence on the implementation, reliability, validity, and clinical outcomes associated with the use of the MFTI. Methods A scoping review was conducted in accordance with PRISMA-ScR guidance. Searches were independently conducted by two reviewers across PubMed, CINAHL, the Cochrane Library, ClinicalKey, and Google Scholar between October 2023 and November 2025. Eligible studies included quantitative, qualitative, mixed-methods, validation, descriptive, and quality- improvement designs evaluating obstetric triage tools, with a focus on the MFTI. Studies were limited to English-language publications involving pregnant persons in obstetric or hospital triage settings. Data were charted using standardized evidence tables and synthesized descriptively to identify patterns in implementation outcomes, measurement properties, and clinical relevance. Results Ten studies met the inclusion criteria. Across diverse clinical settings, implementation of the MFTI was consistently associated with decreased triage times, improved prioritization, enhanced workflow efficiency, and more transparent interdisciplinary communication. Foundational studies demonstrated strong content validity of the MFTI using item-level and scale-level content validity indices, while broader reviews supported content validity using the COSMIN framework. However, evidence supporting reliability was limited and methodologically inconsistent. Several studies emphasized that structured education and organizational support were critical to consistent triage scoring. While direct maternal and neonatal morbidity and mortality outcomes were rarely measured, improved early recognition of high-acuity conditions, including severe hypertension, was reported. Persistent gaps included limited multicenter research, underrepresentation of diverse clinical environments, and insufficient psychometric validation. Implications for Nursing Practice Findings support the MFTI as a promising standardized obstetric triage tool that improves timeliness and prioritization of care when implemented with adequate training and institutional support. In nursing practice, adopting the MFTI may enhance clinical decision-making, improve workflow efficiency, and facilitate early identification of high-risk maternal-fetal conditions. However, the limited reliability evidence underscores the need for continued evaluation, ongoing staff education, and rigorous multicenter research to strengthen the tool’s psychometric foundation. Advancing standardized obstetric triage practices has important implications for promoting safe, equitable, and high-quality maternal care