Medicine and Health Sciences Commons^™

Improving Patients’ Perception Of Provider Trust And Communication With Birth Plans, Christelle Reeves, Nicole Tenzel, Timothy Kremer

North Texas GME Research Forum 2024

Objective: Birth plans are an effective tool for a pregnant person to express their desires and expectations for labor and postpartum. Shortcomings of birth plans can be found whenever there is a lapse in communication between provider and patient. In the management of labor and emergent situations, it has been observed by patients that obstetric providers can communicate in authoritarian and dismissive manners. In response to this, birth plans were developed to serve as a guide in these scenarios. Birth plans allow a pregnant person to design a thoughtful plan of action with their healthcare provider before giving birth, rather …

A Rare Case Of Invasive Adenocarcinoma Of The Duodenum And A Bovel Biliary Stent: A Case Report, Sabastiana Sanz, Nasima Mehraban, Bradley Gustafson, Amjad Awan

North Texas GME Research Forum 2024

Adenocarcinoma of the duodenum is a rare but aggressive malignancy making up less than 0.5% of gastrointestinal cancer cases (Tuan et al., 2023), (Cloyd, 2016). We present a rare case of invasive adenocarcinoma of the first part of the duodenum and major papilla that required complex biliary stenting. A 72-year-old male was admitted to our hospital for further workup of gastrointestinal bleeding and 30-pound weight loss. Through imaging it was noted he had lymphadenopathy and biliary dilation. Patient underwent multiple gastrointestinal procedures and was endoscopically found to have a circumferential mass within the ampulla. After unsuccessful cannulation during endoscopic retrograde …

Effect Of The Intern Survival Book Handbook In Medical City Fort Worth Family Medicine Residency Program, Nancy Sang, Harry Pham, Tammy Nguyen, Zara Soomro, Patrick Feng, Ali Al-Nahi

North Texas GME Research Forum 2024

Background: The optimization of medical training is a critical concern amid dynamic shifts in both medical and societal landscapes. Research indicates that a substantial proportion of medical trainees experience stress, anxiety, and depression, with an estimated depression rate of 29% among medical residents, compared to 8% among nonphysicians. Furthermore, the suicide rate among physicians is twice that of the general population. Difficulty in adapting to new environments, responsibilities, and training levels exacerbate these challenges. This study evaluates the efficacy of "The Intern Survival Handbook" in mitigating stressors among new trainees, enhancing their work performance, and promoting overall mental health. Methods: …

Analysis Of Ecmo Usage In Trauma Patients At A Major Level 1 Trauma Center, April Miller, Megan Post, Crescens Pellachia, John Bini, Morgan Collom

North Texas GME Research Forum 2024

INTRODUCTION: ECMO has been used for decades in patients where adequate oxygenation could not be achieved using traditional efforts. Despite its increasing use in the trauma setting, there is a lack of published data to support its use and safety. This review will seek to answer among trauma patients who receive ECMO what their common demographics, injuries, co-morbidities, outcomes and adverse events are. METHODS: This is a single-center retrospective chart review conducted at an Level 1 trauma center between 2020 and 2023. Designation as trauma and ECMO utilization were the inclusion criteria. Patients under age 18 and non-trauma ECMO patients …

Polypharmacy And Potentially Inappropriate Prescribing In Geriatric Population, Maryam Burney, Barry Brown, Victoria Nguyen, Garrett Furth, Ambreen I. Ahmed, Abigail Hulsizer

North Texas GME Research Forum 2024

Polypharmacy is a ubiquitous concern among patients, especially geriatric patients, who are at a higher risk of clinical burden. It is associated with an increase in healthcare costs, decreased functional status, and adverse drug events, contributing to geriatric syndromes, such as falls, cognitive decline, and urinary retention. Geriatric care is multi-tiered, requiring assistance and care from a thorough physician who is attune to the potential risks of medications that are commonly prescribed. Smaller communities, often with less resources and clinical providers and with an aging population, especially at the hospital setting, are vulnerable to oversights when it comes to medication …

Subacute Defibrillator Lead Associated Right Ventricular Perforation In A Young Individual With Non-Ischemic Cardiomyopathy: A Unique Clinical Case, Jackson V. Littlejohn, Aditya Sharma, Marisha R. Sharma, Kamran Rizvi

North Texas GME Research Forum 2024

Pacemaker-lead associated complications are often documented in elderly populations with ischemic heart disease. Acute perforations within 24 hours of implantation are the most common, and immediate life-threatening complications are most likely to occur during an acute perforation. Subacute perforations between 1 day and 30 days after implantation are less common and carry a lower risk of life-threatening complications. Here, we present a unique case of subacute right ventricular perforation in a young individual with non-ischemic cardiomyopathy, challenging the conventional understanding of such an occurrence. Further adding to the intrigue of our case, the patient had recurrent hospital visits both before …

An Unusual Presentation Of Tapinarof-Induced Folliculitis, Ysabelle Martinez, Christian J. Scheufele, Christopher Wong, Stephen E. Weis

North Texas GME Research Forum 2024

Introduction: Tapinarof 1% cream is a novel non-steroidal topical medication recently FDA-approved for plaque psoriasis. Tapinarof’s non-steroidal mechanism allow for longer treatment periods without topical corticosteroid side effects e.g. skin atrophy, hypopigmentation, telangiectasias, and striae. Adverse events identified during pivotal trials may not be completely defined before widespread clinical use. This case reports a new presentation of folliculitis with tapinarof use. Case Presentation: A 25-year-old female with trisomy-21 presented for a rash on her left lower leg. The eruption began one year earlier. The eruption was not associated with pruritus, joint pain or nail changes. A clinical diagnosis of …

Bridging The Gap For Hiv Education In Primary Care Setting, Oregon Mcdiarmid, Lindsay Porter

North Texas GME Research Forum 2024

No abstract provided.

Myelodysplastic Syndrome With An Unusual De-Novo Gata1 Mutation In An Elderly Caucasian Male: A Case Report, Minh-Triet Nguyen, Maryam Fallahi, Talha Riaz

North Texas GME Research Forum 2024

Myelodysplastic syndrome (MDS) is a disorder of blood cell proliferation that has been shown to have multiple risk factors for pathogenesis. One risk factor well documented in existing literature is a mutation in GATA-binding factor 1 (GATA1) which is classically seen in younger individuals with Down syndrome. However, in our case report, we present an unusual presentation of MDS with a de novo GATA1 mutation in a 75-year-old male with no history of Down syndrome, who initially presented with isolaterombocytopenia. A 75-year-old male presented for evaluation of unexplained asymptomatic thrombocytopenia found incidentally on outpatient laboratory evaluation. Further evaluation of the …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Steroid Atrophy, Marshall Hall, Ysabelle Martinez, Wenqin Du, Christian Scheufele, Christopher M. Wong

North Texas GME Research Forum 2024

Introduction: Topical steroids are commonly prescribed first-line medications for various inflammatory and autoimmune dermatologic conditions. Their widespread use raises the importance of proper use. Topical steroids have well-known side effects including skin atrophy, redness, striae, and telangiectasias. These side effects have not been well documented in patients of various skin tones. Primary care clinicians must recognize topical steroid side effects and their appearance in various skin tones. This paper will focus on representing skin atrophy, the most common steroid side effect, in a variety of Fitzpatrick skin types. Case Presentation: We present a series of images illustrating skin atrophy …

Bilateral Corticosteroid Atrophy Mimicking Morphea En Coup De Sabre: A Case Report, Christopher M. Wong, Jade Pool, Rafael Do Valle, Cassandra Kenny, Dustin V. Wilkes

North Texas GME Research Forum 2024

Introduction: Corticosteroids affect numerous downstream cytokines to exert anti-inflammatory and immunosuppressive effects. Intralesional corticosteroid injection provides several advantages, including bypassing the stratum corneum to deliver a higher concentration of drug locally, while reducing systemic exposure. Intralesional corticosteroids are used in a variety of dermatologic conditions, and suboccipital steroid injection has been described as a novel treatment for cluster headaches. Case Presentation: A 52-year-old Caucasian female presented to the outpatient dermatologic clinic with indented skin lesions on the scalp and forehead for six weeks. The indentation started on her left frontal scalp and spread down gradually to her forehead and temple. …

Increasing Online Reviews And New Patients In Clinic With Qr Codes, Tristan Fun, Danielle Ford

North Texas GME Research Forum 2024

Introduction: Patient census at the Medical City Internal Medicine Grand Prairie clinic has been lower comparatively to other HCA Healthcare clinics. Although the cause can be multifaceted, the clinic’s online presence (e.g. Google Maps) is minimal. One initial issue with the clinic’s online presence was the lack of reviews on the Google page for the clinic. One way to increase online reviews is to provide Quick Response (QR) codes in the clinic for patients to scan on their smartphone. The goal of this project is to increase the number of Google reviews for the clinic through QR codes to at …

Acute Mesenteric Ischemia In Patients With Covid-19, Tristan Fun, Natalie Hurlock, Danielle Ford

North Texas GME Research Forum 2024

Introduction: Patient with COVID-19 are more likely to have thrombotic events, including deep vein thrombosis (DVT), pulmonary embolism (PE), and disseminated intravascular coagulation (DIC). There have been many case reports of patient with acute mesenteric ischemia (AMI) in the setting of COVID-19. Incidences of AMI occur in about 0.1% of acute hospital admissions. Short term mortality from AMI range from 26-86%. Therefore, early diagnosis and treatment are essential, yet diagnosis is difficult and AMI can often go unrecognized as a cause of death. This study attempted to establish the risk of patients with COVID-19 having acute mesenteric ischemia and compare …

Multidisciplinary Simulation-Based Trauma Education For General Surgery Interns, Jennifer Austin, April Miller, Jeremiah Avarana, Alicia Lay

North Texas GME Research Forum 2024

Introduction: According to the American Society of Gastroenterology Endoscopy (ASGE), choledocholithiasis is defined as the presence of gallstones in biliary tree. Choledocholithiasis is concomitantly present in approximately 1 to 10 percent of patients with cholelithiasis. Choledocholithiasis can be described as small <15 >mm, large >15 mm, and difficult due to anatomic location, impaction, or unusual hardness/ shape. Choledocholithiasis is managed endoscopically with large balloon papillary dilation, cholangioscopy-guided intraductal laser and electrohydraulic lithotripsy (EHL), and escalation to laparoscopic common bile duct exploration, if endoscopic procedures fail. Thus far, there are sparse studies that show the requirement of choledochotomy in large and …

Development And Validation Of A Novel Skin Pigment Scale, Christina Guo, Henry Lim, Christopher Wong, Christian Scheufele, Michael Carletti, Michele L. Mccarroll, Stephen Weis

North Texas GME Research Forum 2024

Background: Precise description of the skin is a pillar of dermatology. For dermatologists, skin pigment is akin to a ‘vital sign’ in that it represents a basic, yet illuminating, piece of information for each patient. The current method used to describe skin color is the Fitzpatrick scale. The Fitzpatrick scale was designed to measure skin burning and the scale is inadequate for precise measurement of skin color in a diverse population. The prevalence of its use perpetuates harmful and outdated structures and contributes to health disparity. For those reasons, there is a critical need for initiatives that evaluate the current …

Implementation Of Viz.Ai Augmented Intelligence Software To Reduce Door To Puncture Times And Patient Outcomes At A Comprehensive Stroke Center, Cody Bryant, Brandon Womack, Mason Patel, Sanjay Sharma

North Texas GME Research Forum 2024

Introduction: Endovascular therapy (EVT) in the form of mechanical thrombectomy is the mainstay of treatment for acute large vessel occlusion (LVO) ischemic stroke, but its efficacy is highly time sensitive. It is crucial that stroke centers continue to implement process improvements that aim to streamline stroke workflow. Viz.AI is a platform that uses artificial intelligence to automatically detect LVOs with computed tomography (CT) imaging. It provides immediate access to the CT images as well as a platform for centralized communication through the mobile application. We sought to determine if the implementation of Viz.AI at our comprehensive stroke center improved stroke …

Survival After Emergency Clamshell Thoracotomy With Bilateral Atrial Appendage Injuries, Jennifer Austin, Enrique Alvarez, Alicia Lay, Christian Minshall

North Texas GME Research Forum 2024

INTRODUCTION: The probability of survival is poor in patients who require a resuscitative thoracotomy, reported in the literature to be 9-20%. Outcomes are worse in patients who have suffered blunt trauma compared to penetrating trauma reported between 2-7%. Many studies have been done to evaluate clinical predictors of survival versus mortality. We present a case of high-mechanism blunt trauma with a high injury severity score of 34 who survived after an emergency clamshell thoracotomy with full neurological recovery.

CASE PRESENTATION: This case highlights a 28-year-old male who arrived as a transfer to a level 1 trauma center following high mechanism …

The Role Of Ercp In Post Covid-19 Cholangiopathy: A Systemic Review Of Published Case Reports, Olufemi Osikoya, Gregory Brennan

North Texas GME Research Forum 2024

Introduction: Post COVID-19 cholangiopathy (CC) is a rare complication of COVID-19 infection. It is characterized by abnormal elevation of serum alkaline phosphatase, with evidence of bile duct injury (via imaging or biopsy) in the absence of other causes. Not much is known regarding the role of ERCP in post COVID-19 cholangiopathy. We sought to better understand the findings, interventions and outcomes in patients with CC undergoing ERCP. Methods: We searched Pubmed, Scopus and Embase from December 2019 to present. Search words included "post-Covid-19 cholangiopathy," and “ERCP.” Data on patient characteristics, COVID-19 infection, imaging, ERCP fluoroscopic findings, ERCP interventions, …

Mcs Assisted High Risk Multi-Vessel Percutaneous Intervention In Cardiogenic Shock Patient With Lv Thrombus, Amanpreet Kaur, Akhil Gade, Srinivasan Rajaganapathy, Ruben Abreu, Victor Delprincipe

North Texas GME Research Forum 2024

Background: Acute coronary syndrome patients presenting with Cardiogenic shock carry a very high mortality risk >70% without appropriate intervention in a timely fashion. Here we present a patient requiring an axial pump mechanical circulatory support despite having an apical thrombus. Case report: 55-year-old male with past medical history of type 2 diabetes mellitus and medication noncompliance was transferred from outside facility for high risk ACS with EKG showing ST segment elevation in inferior and anterolateral leads. Lab showed hsTroponin more than 125K, BG 556, HCO3 17, and Beta hydroxybutyrate of 41.87 indicating DKA. Emergent coronary angiography showed mid LAD artery …

Case Report: Unilateral Internuclear Ophthalmoplegia As First Manifestation In Multiple Sclerosis, Imaad Zaman, Tyler Adame, Steven Do, Kien Nham, Azeem Muhammad

North Texas GME Research Forum 2024

Multiple Sclerosis is an inflammatory disorder of the central nervous system secondary to myelin degeneration. The disease is mediated by reactive lymphocytes where the spinal cord, brain and optic nerves are attacked. Diagnosis of MS is made clinically and confirmed via MRI with T2 hyperintensities. On presentation, a 26-year-old female with no significant past medical history presented with frequent headaches and blurry vision. There was right eye nystagmus on L lateral gaze with CN III deficits with absent medial rotation. MRI Head presented with a classic presentation of T2 hyperintensities in the subcortical and deep white matter. Further confirmed with …

Osteopathic Manipulative Treatment (Omt) Utilization In The Primary Care Setting, Ceferino Cruz, Afsha Rais

North Texas GME Research Forum 2024

INTRODUCTION: Osteopathic Manipulative Treatment (OMT) is a skillset used to help diagnose and treat patients with a wide range of musculoskeletal complaints and can also be used as adjunctive treatment modalities for other organ systems. The project is designed to increase OMT usage across 3 clinical sites in our residency program to improve the quality of care provided to our patients. OBJECTIVES: Integrate OMT review into longitudinal clinical education. Address the shortage of faculty members that can precept OMT across all three sites. METHODS: The metrics being tracked are various OMT CPT codes ranging from 98925 to 98929 …

A Common Complaint With An Unexpected Diagnosis: A Case Of Mycobacterium Avium Complex Pulmonary Abscesses, Maryam Fallahi, Mark Cheneler, Qazi Haider, Madhukanth Reddy

North Texas GME Research Forum 2024

Introduction: Mycobacterial infections are an atypical organism for pulmonary infections. These infections are classically separated in tuberculous (MTB) and nontuberculous (NTM) groups due to their differing pathogenicity and microbiologic therapy regimens. MTB is typically treated with a 4-drug therapy known as RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) however NTM is typically treated with 3- or 4-drug therapy with a backbone of rifampin, macrolide, and ethambutol. Due to the long courses of therapy required for NTM, stringent diagnostic criteria of clinical, radiologic, and microbiologic findings are required. Despite meeting all 3 criteria for diagnosis, not every patient is a candidate for …

Type Ii Diabetes And Keto Diet In Family Medicine Clinic: A Case Report, Dante Paredes, Karos Torres, Joshua Moton

North Texas GME Research Forum 2024

The management of patients with high cardiac risk profiles who require insulin therapy for diabetes can be challenging due to the potential adverse effects of insulin on cardiovascular health. In order to achieve remission of type 2 diabetes mellitus (T2DM) and discontinue the need for insulin, weight loss has long been recognized as a valuable approach. The goal for this case was to implement dietary and lifestyle changes in a safe and efficient manner to induce remission of T2DM, without increasing the sympathetic load often associated with fully dosed ketogenic and other fasting strategies. This case report highlights the successful …

Impact Of Vertical Zone Redesign: One Hospitals Experience, Zachary Shields, Enrique Alvarez-Ventura, Curtis Johnson

North Texas GME Research Forum 2024

Background: Crowding in the emergency department has been a prevalent issue for decades, however, over the last few years, crowding and the number of patient visits in EDs have been higher than normal. Many factors influenced this, including the COVID-19 pandemic. Emergency departments around the country have been at a loss in improving patient flow and time in the ER. Literature has demonstrated some possible methods with varying results, but there has not been significant research on the subject.

Methods: After reviewing the literature, we designed a system where patients were stratified between different groups using the triage system. …

Surgical Margin Analysis In Early-Stage Cervical Cancer: An Hca Retrospective Study, Chrystal Stallworth, Abel Moron, Nicole Tenzel, Timothy Kremer, Michele Mccarroll

North Texas GME Research Forum 2024

Objective: This study aimed to compare surgical margin analysis on final pathology in robotic assisted approach hysterectomy vs. all other approaches in early-stage cervical cancer.

Methods: Patients with clinical early-stage disease who underwent total and radical hysterectomy from the years 2018-2023 were categorized into robotic assisted approach group (RAH) vs all other approaches including laparoscopic hysterectomy (LAH), laparoscopic assisted vaginal hysterectomy (LAVH), and open hysterectomy (TAH). Fisher’s exact test was used for analysis of the primary outcome measure.

Results: A total of 92 patients met inclusion criteria. Mode of surgery included: 83 RAH (90.2%), 6 LAH (6.5%), 2 TAH (2.17%), …

Association Of Glucagon-Like Peptide-1 Receptor Agonist Treatment With Perioperative And Postoperative Complications In Patients Undergoing Elective Bariatric Surgery, Justin Sanchez, Enith Espinosa, Sean Sojdie, Michael Green, Lauren Wonderly

North Texas GME Research Forum 2024

Glucagon-like peptide receptor agonists (GLP-1 RA) are FDA-approved medications for the treatment of type 2 diabetes mellitus, and obesity, and are also beneficial in cardiovascular risk reduction. However, due to known GLP-1 RA adverse effects, notably delayed gastric emptying, the ASA has implemented GLP-1RA guidelines aiming to minimize potential complications related to GLP-1 RA use in patients undergoing procedures requiring general anesthesia. With the ever-increasing number of patients being prescribed GLP-1 RAs, more research needs to be conducted to investigate their potential impact in other areas of healthcare. This retrospective study aims to compare surgical outcomes before and following the …

2-Methyl-2-Butanol (2m2b) Ingestion Related Toxicity, Elizabeth Diaz, Darshan B. Bhatty, Ngoc Vu, Sathish Karmegam

North Texas GME Research Forum 2024

2-methyl-2-butanol known as Tert-amyl alcohol (TAA) was previously used in the past for its hypnotic, anticonvulsant, and sedative properties.1 Both ethanol and 2M2B stimulate GABA-A receptors causing similar CNS effects.1 Animal studies have shown that toxicity is greater than 2-pentanol, 3-methyl-1-butanol, and ethanol1. 2M2B is replacing ethanol due to its low cost per dose, high potency, and does not produce a hangover as it is not metabolized to aldehydes.1 This case report describes the clinical course of a patient after intoxication with 2M2B and bringing awareness as it is difficult to confirm diagnosis since there are no specific clinical features …

Angioedema Linked To Combination Pill Trandolapril/Verapamil, Aadil Bhutta, Sana Khan, Monica Dhiman, Udit Bhatt, Akinjide Onifade

North Texas GME Research Forum 2024

Angioedema is the swelling of deeper layers of skin caused by a build-up fluid, oftentimes due to the culmination of immune system activation against allergens. There are several causes of angioedema, including animal dander, exposure to various foods, insect bites, and medications such as Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs). This swelling primarily presents periorbital and periorally, however can also less-commonly affect the airway. Angioedema can be life-threatening if involving the throat and larynx given the potential of respiratory airway compromise. This case presents a patient who had been on an ACE-ARB for almost 2 decades, …

Disseminated Coccidioidomycosis Discovered Through Skin Biopsy In A Pregnant Patient From Mexico, Henry Lim, Christina Guo, Marshall Hall, Christian Scheufele, Christopher M. Wong, Michael Carletti, Stephen Weis

North Texas GME Research Forum 2024

Introduction: Coccidioidomycosis is an infection caused by the organism Coccidioides immitis, a fungus endemic to the southwestern United States, Mexico, Central and South America. The presentation of coccidioidomycosis can range from symptoms resembling a simple upper respiratory infection, such as cough, to more severe systemic symptoms including fever, malaise, and chills. Cutaneous lesions of coccidioidomycosis demonstrate a large heterogeneity of clinical manifestations but are significant as they may be the presenting sign of disseminated disease. While usually confined to the lungs, extrapulmonary coccidioidomycosis can occur in about 1 in 200 patients, most commonly associated with immunocompromised status. Pregnancy is an …

Improving Lesion Diameter Reporting On Skin Biopsy Requisition Forms: A Quality Improvement Project, Christopher Wong, Christian Scheufele, Marshall Hall, Henry Lim, Daniel A. Nguyen, Stephen Weis, Michael Carletti, Dustin Wilkes

North Texas GME Research Forum 2024

Background: Skin biopsy requisition forms (SBRFs) are the primary communication tool between dermatologists and dermatopathologists. Diameters of biopsied skin lesions are frequently omitted on SBRFs. This quality improvement project aimed to increase the rate of reporting diameters of neoplasms on SBRFs from an academic dermatology outpatient clinic to greater than 65% within three years. Methods: The Plan-Do-Study-Act model was utilized. An initial audit was performed for SBRFs of biopsies obtained between July 1, 2021, and February 4, 2022 (“Cycle 1”). On February 4, 2022, the authors discussed societal guidelines for lesion diameter reporting on SBRFs (“Intervention A”). Cycle 2 prospectively …