Lighthouse Guild

Introduction: Post-acute care (PAC) facilities across Montana, Nebraska, and North Dakota participated in the American Heart Association’s (AHA) Tri-State Mission: Lifeline Stroke PAC Initiative, a quality improvement initiative focused on improving stroke rehabilitation across Midwest states from 2022 to 2024. Participating facilities agreed to implement evidence-based practice outlined by AHA’s PAC Stroke Program Standards. Purpose: The Tri-State Mission: Lifeline Stroke PAC Initiative aimed to assist facilities to implement evidenced-based care and track key performance measures and outcome metrics to facilitate ongoing quality improvement. 15 skilled nursing facilities, 7 inpatient rehabilitation facilities, and 15 critical access hospitals participated across three states with emphasis on developing programs in rural communities. Methods: Participating facilities collected quarterly data for six clinical measures and three outcome metrics detailed in the PAC stroke program standards. Data was entered on the Quality and Certification Tool (QCT) platform to track progress and compare to other sites in the initiative. Group data was reviewed with facilities each quarter on virtual learning collaboratives. Results: Positive improvements were reported in four measures: percentage of patients with aphasia receiving speech therapy, patients receiving comprehensive stroke education, patients with impaired mobility who are on a VTE prophylaxis plan, and patients receiving a phone call within 3 business days of discharge. Performance remained consistent in two measures: percentage of patients receiving a depression screening and patients that had an admission assessment completed by an MD or APP in the first 24 hours. Outcome metrics of average length of stay, number of patients, and discharge disposition remained consistent. Conclusion: Focused quality improvement efforts can positively impact key measures and metrics in post-acute stroke programs. While positive trends were observed in four measures, further evaluations need to be done with larger patient volumes and extended periods of time.

Introduction: Black disabled women face disproportionality high rates of maternal morbidity and mortality in the United States. This review synthesizes academic and community perspectives to assess how ableism and racism shape obstetric care and maternal health outcomes, identifying gaps for policy and practice reform. Methods: Using an intersectional ecological framework, we conducted a narrative review of peer-reviewed and gray literature on how racism and ableism shape obstetric care for Black disabled women. We searched PubMed, Google Scholar, and targeted sources for studies published in the last 25 years that addressed maternal health outcomes, barriers, or structural racism and ableism. Included sources encompassed qualitative studies, epidemiologic analyses, community reports, and policy analyses that examined barriers across the obstetric care continuum. Results: One hundred and fifteen sources were included in this review. Barriers to obstetric care for Black disabled women include: (1) maternal care deserts and inaccessible facilities; (2) inadequate preconception and prenatal care; (3) provider bias, surveillance, and reproductive coercion; (4) gaps in provider knowledge and training on disability and culturally congruent care; and (5) policy failures, such as weak disability rights enforcement, Medicaid nonexpansion, restrictive reproductive laws, and absent intersectional data. These barriers are rooted in racism and ableism, which intersect to cause care delays and denials, fuel mistrust, and increase risks of severe maternal morbidity and mortality. Discussion: Obstetric inequities for Black disabled women are rooted in the intersecting structures of racism and ableism that shape policy, access to care, and clinical culture. Yet, this intersection remains underexamined in research, leaving critical gaps in knowledge and action. Closing these gaps requires intersectional, community-led research and policy reforms—expanding Medicaid, enforcing accessibility, mandating provider training, collecting intersectional data, and investing in inclusive care grounded in disability and racial justice.

A significant proportion of epilepsy patients are resistant to conventional treatments. Functional mushrooms such as Reishi ( Ganoderma lucidum ) and Lion’s Mane ( Hericium erinaceus ) have recognized health benefits, including neuroprotective and anti-seizure effects. This mixed-methods study investigates the use of these mushrooms as adjunctive therapies for epilepsy among 19 participants, including caregivers on behalf of a minor. The majority (n = 14) met criteria for drug-resistant epilepsy (DRE). Participants completed surveys and structured interviews addressing functional mushroom use, quality of life (QoL), sleep quality, health outcomes, seizure activity, and caregiver burden. Qualitative data underwent thematic content analysis. Compared with the general population, participants utilizing functional mushrooms noted comparable scores in physical health, psychological health, social relationships, and environmental health. Self-report responses indicated improvements in seizure control, including reduced seizure frequency and severity, cognitive and developmental outcomes, and overall quality of life since starting use of functional mushrooms. Caregivers emphasized both benefits and ongoing challenges in managing epilepsy. Functional mushrooms are a sustainable and widely available resource, and the findings presented here suggest they could complement existing treatments for epilepsy, particularly in DRE, though further clinical trials are needed to establish efficacy, optimize dosing, and clarify mechanisms of action. • Functional mushrooms (Reishi and Lion’s Mane) were associated with reduced seizure severity and frequency in individuals with epilepsy, including drug-resistant cases. • Participants reported improvements in quality of life, cognitive functioning, and developmental outcomes, aligning with both quantitative and qualitative findings. • Caregivers noted reduced stress and burden when seizure severity decreased, pointing to broader family benefits. • A subset of participants with drug-resistant epilepsy showed signs of clinically meaningful improvement, with some likely to achieve seizure freedom. • Findings highlight the need for larger, controlled clinical trials to establish efficacy, dosing, and safety of functional mushrooms as adjunctive epilepsy treatments.

Background:There have been impressive advancements made in preventing and treating HIV. However, the impacts have not been experienced equally across demographics in England. African born persons, in particular women of Black African ethnicity, continue to be disproportionately affected by HIV. HIV prevention campaigns have often overlooked social, cultural, and structural factors that shape access to HIV prevention.Objectives:This paper explores how women of African and Caribbean heritage understand HIV within their social networks, and how they perceive HIV and sexual health services. This insight is needed to develop more inclusive and effective approaches to HIV prevention.Design:This study adopted a participatory action research framework, acknowledging lived experience as a basis of knowledge.Methods:Focus groups and one-to-one interviews were used to collect qualitative data from a local community women’s group between June 2021 and November 2021. In total, 23 women of African and Caribbean heritage participated in this study. Four women opted to take part in a one-to-one interview, and 19 women participated in one of five focus groups. Data were analysed using an applied thematic analysis.Results:Three key themes emerged from the data. Enduring fear of HIV rooted in past lived experiences: Fear of HIV derives from traumatic lived experiences, which have shaped trust in health care services in England and limited the acceptance of information about HIV treatment, such as U=U (Undetectable = Untransmittable). Responsibility for HIV transmission and prevention: There was a low perception of HIV acquisition risk, shaped by personal circumstances and stigmatising beliefs. For those acknowledging they may be at risk of HIV acquisition attributed this to the behaviour of their male partners. Motivation to change attitudes and reduce stigma: Participating in this study provided a safe space for women to share their experiences of HIV, ask questions, and learn new information, revealing focus groups as an effective method of raising awareness and reducing stigma.Conclusions:Multiple factors shape the understanding of HIV and uptake of HIV prevention among women of African and Caribbean heritage. Local, community-specific, and participatory HIV prevention interventions are needed to understand and respond to these factors.

For students with Autism Spectrum Disorder (ASD), independent activity completion and transitions may prevent students from engaging in important activities. The current study compared an iPad-based visual schedule to an analog visual activity schedule. Across a single-subject ABCABC design, three elementary-aged children with ASD completed tasks with no activity schedule, an analog activity schedule, and an electronic activity schedule. The researchers counted the number of activities completed and prompts delivered before task initiation along with the amount of time between the first prompt and task initiation. Two students showed an increase in independent activity schedule following-behavior during the iPad phase. All students showed a decrease in latency when using either type of schedule as compared to hearing verbal prompts only.

The purpose of this paper is to discuss student's perspectives on the congruence of problem-based learning (PBL) and recovery-oriented practice (ROP) and the effectiveness of the PBL approach used to teach ROP in a postgraduate nursing module. The recovery-oriented practice module was part of Postgraduate Diploma in Mental Health Nursing. The study used a mixed methods methodology. Data were collected using a survey and focus group from 33 students who completed the module as part of a Higher Diploma in Mental Health Nursing in 2022. Survey data were analysed using descriptive statistics. Interview data were analysed using thematic analysis. In the survey, 100 % of students strongly agreed, or agreed, that they had a better understanding of the subject after completing the module. 81 % strongly agreed or agreed that PBL was an effective way to learn about ROP. 96 % of students agreed that they had learned considerably from individuals with lived experience during the module with regards to ROP. The focus group found five congruencies between PBL and ROP: (1) co-production; (2) self-direction; (3) development of self-awareness; (4) teamwork;and (5) strength-based approach. Firstly, there is congruence between PBL and ROP as both processes share five common key elements. Secondly, students perceived PBL as an effective approach for teaching the knowledge, skills and attitudes needed in ROP. The third argument is that students learned from the individuals with lived experience about crucial elements of recovery-oriented practice that books could not teach them.

The Medical Model of Addiction represents one of the most consequential paradigm shifts in modern medicine, redefining addiction from a moral or social failing into a chronic, relapsing medical disorder grounded in neurobiology, genetics, and clinical science. By conceptualizing addiction as a disease involving dysregulation of brain reward, motivation, memory, stress response, and executive control circuits, this model has reshaped diagnostic systems, legitimized pharmacologic and behavioral interventions, and catalyzed the development of Addiction Medicine as a recognized medical specialty. This article provides a comprehensive, clinically oriented, and neurobiologically grounded examination of the Medical Model of Addiction. It traces the historical evolution of the disease concept, examines the neurobiological and genetic mechanisms underlying addictive behavior, reviews contemporary diagnostic and therapeutic frameworks, and critically evaluates ethical, social, and policy implications. While acknowledging ongoing critiques regarding medicalization, agency, and responsibility, this review argues that the Medical Model remains indispensable for evidence-based treatment, integration of addiction care into mainstream medicine, and the development of effective public health responses to substance use disorders.