Medicine and Health Sciences Commons^™

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

North Texas 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 …

2024 North Texas Research Forum Program, Hca Healthcare

North Texas Research Forum 2024

No abstract provided.

Cyanide Toxicity Induced By Apricot Kernel Consumption: A Case Report, Jatin Sadarangani, Vaishnavi Singh, Benjamin K. Kingsly

North Texas Research Forum 2024

Functional foods are food items that should be consumed as part of a regular diet in order to provide advantages beyond what are typically referred to as traditional nutritional benefits. Furthermore, in order to support the better function claim or the decreased illness risk claim, these positive outcomes must be scientifically proven. Foods with particular health benefits have been referred to as "superfoods" more recently. Superfoods are conceptually defined as foods with high biological value because of their high concentration of bioactive components and high concentration of nutrients, as well as their high bioavailability and bioactivity in the body. As …

Rare Rectal Lipoma Case Report, Victoria Nguyen, Sean Sojdie, Kunal Elete, Justin Richardson, Long Hoang

North Texas Research Forum 2024

INTRODUCTION: Colonic lipomas are rare, benign non-epithelial lesions of the gastrointestinal (GI) tract that predominantly affect elderly females and often found in the ascending colon. They are least common in the rectum, with a prevalence of 3.4%. Lipomas can grow to cause abdominal pain, bleeding, or obstruction. We report an incidental finding of a rectal lipoma in a patient presented with rectal bleeding. CASE: A 70 year-old male with a history of migraines presented to the hospital for two weeks of rectal bleeding and syncopal episode prior to arrival. Patient had visited the emergency department two weeks prior, but hemoglobin …

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

North Texas 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 …

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

North Texas 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 …

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

North Texas 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: …

Comparing Large Language Models Accuracy In Following Interval Surveillance Colonoscopy Guidelines, Olufemi Osikoya, Gregory Brennan

North Texas Research Forum 2024

Introduction: Providing pathology results and appropriate recommendations after resection of colon polyps is mandatory. Large language models (LLMs) such as ChatGPT and Google Bard, have shown promise in clinical workflows such as pathology results letters. We tested whether LLMs could provide appropriate surveillance recommendations based on current guidelines from the US multi-society task force for post-colonoscopy follow-up. Methods: Our aim was to compare the accuracy of ChatGPT 3.5, ChatGPT 4, and Google Bard in providing appropriate interval surveillance recommendations. An example prompt being “Write a patient pathology result letter after a colonoscopy with one tubular adenoma polyp (< 10mm) resected. Include recommendations for when the next surveillance colonoscopy should be completed.” Seventeen different post polypectomy surveillance queries and responses were analyzed (correct, partially correct, incorrect) compared to USMSTF guidelines. Results: When …

Quality Improvement Project: Compliance Of Antenatal Testing In Patients With Class Iii Obesity, Isabella L. Sciacca, Timothy Kremer, Nicole Tenzel

North Texas Research Forum 2024

The prevalence of obesity in women of reproductive age (20 to 39) in the US is 39.7%. It has been estimated that one-quarter of pregnancy complications are attributable to maternal obesity. Comprehensive prenatal care is imperative to achieving positive health outcomes. This quality improvement (QI) initiative aimed to improve antenatal fetal surveillance rates in patients with class III obesity. Evidence based interventions to test fetal wellbeing were implemented and examined over a 7 month time period to evaluate physician compliance of the standard of care for antenatal surveillance starting at 34 weeks gestation. Following implementation of this initiative, compliance with …

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

North Texas 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%), …

Primary Resection Of Duodenal Neuroendocrine Tumor With Suspected Lymph Node Metastasis: A Case Report, Raleigh Payton, David Bassa, Furrukh Jabbar, Hassan Ahmed

North Texas Research Forum 2024

Introduction: Duodenal neuroendocrine carcinomas are an uncommon variant of Neuroendocrine tumors (NETs) that are typically non-functional with locoregional spread at the time of diagnosis. Management of these tumors is dependent on size, grade, stage, functional status and location.

Summary: A 66-year-old male presented with an incidental finding of low grade 3 centimeter duodenal NET on esophagogastroduodenoscopy (EGD) located in the second segment of the duodenum with evidence of lymphadenopathy on staging scans. In patients with suspected lymph node metastases, the first choice for curative intent is a pancreaticoduodenectomy (PD), also known as Whipple Procedure. We achieved surgical resection with free …

Case Report: Streptococcus Gallolyticus Prosthetic Joint Infection, Jeffrey Dickerson, Liza Salloum, Amaan Sheikh, Madhukanth Reddy, Bryan Youree

North Texas Research Forum 2024

Streptococcus gallolyticus, part of the Streptococcus bovis/Streptococcus equinus complex (SBSEC) formerly known as Group D streptococi, is strongly associated with colorectal cancer and infective endocarditis. Its appearance in septic arthritis is rare, and its role in septic arthritis has not been as thoroughly investigated. We present the case of a 69 year old male with a history of atrial fibrillation and hypertension who was admitted to our hospital after undergoing a right knee replacement in 2023 with a chief complaint of right knee pain, fever, and chills. Arthrocentesis and blood cultures were performed, and the patient was started on …

Horner’S Syndrome, A Rare Complication Of Transcarotid Artery Revascularization, Mollie Ahn, April Miller, Shonda Banegas, Edic Stephanian

North Texas Research Forum 2024

Extracranial carotid artery aneurysm is a rare sequela of atherosclerosis, trauma, and conditions of chronic inflammation. Standard treatments include antiplatelet medications, open resection, or endovascular stenting. Transcarotid artery revascularization (TCAR) has become a well-recognized alternative treatment in the past few decades. This case study documents the first reported case of Horner’s syndrome post-TCAR for an internal carotid artery (ICA) aneurysm. A 68 year-old male with intermittent double vision was referred to vascular surgery clinic with brain CT angiography showing a 9mm saccular aneurysm with dissection flap of the right cervical ICA. Prior attempts by neuro-interventional radiology were unsuccessful due to …

Multidisciplinary Management For Large And Difficult Choledocholithiasis: The Role Of Choledochotomy, Jilpa Shah, Balu Chandra

North Texas Research Forum 2024

Extracranial carotid artery aneurysm is a rare sequela of atherosclerosis, trauma, and conditions of chronic inflammation. Standard treatments include antiplatelet medications, open resection, or endovascular stenting. Transcarotid artery revascularization (TCAR) has become a well-recognized alternative treatment in the past few decades. This case study documents the first reported case of Horner’s syndrome post-TCAR for an internal carotid artery (ICA) aneurysm. A 68 year-old male with intermittent double vision was referred to vascular surgery clinic with brain CT angiography showing a 9mm saccular aneurysm with dissection flap of the right cervical ICA. Prior attempts by neuro-interventional radiology were unsuccessful due to …

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

North Texas 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 …

Implementing A Standardized Screening Algorithm For Iron Deficiency Anemia In Pregnancy, Ariel Moskowitz, Nicole Tenzel, Joshua Mangels, Lyndsay Millican

North Texas Research Forum 2024

OBJECTIVE: Anemia in pregnancy is a global health problem and complicates >40% of pregnancies. Anemia is associated with significant maternal and fetal complications including low birth weight, preterm delivery, postpartum hemorrhage, ICU admissions, need for blood transfusion, and maternal morbidity. The American College of Obstetricians and Gynecologists (ACOG) and the CDC recommend screening for anemia at the first prenatal visit and again between 24 and 28 weeks gestation. The aim of this quality improvement project is to improve compliance of screening for anemia in pregnancy amongst the providers of Medical City Women's Care. METHODS: Using the Plan-Do-Study-Act (PDSA) quality improvement …

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 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 …

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

North Texas 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. …

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

North Texas 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 …

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 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 …

Improving Clostridium Difficile Detection At Medical City Arlington: A Quality Improvement Project, Bremmy Alsbrooks, Nur-Alhuda Shahub, Shabaz Mallick, Jesse Brown

North Texas Research Forum 2024

INTRODUCTION: Hospital acquired Clostridium difficile infection are one of the costliest hospital acquired infections. Over the past year, there were 19 C diff cases. Reasons for this uptick in cases from previous years could be waiting too long for collection (where a patient has C diff on admission, but does not receive testing until several days later), antibiotics, environmental (for example, using the same toilet brush to clean bathrooms on the floor as well as the bathroom in a C diff patient's room, cleaning high touch areas less than two times during the day, etc.), or staff education. From our …

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

North Texas 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 …

Partial Anomalous Pulmonary Venous Return: To Fix Or Not To Fix?, Akshaj Pole, Jennifer Austin, Amnah Andrabi

North Texas Research Forum 2024

Patient is a 56-year-old male with a past medical history of type 2 diabetes, hypertension, prior MVA with chest trauma, and coronary artery disease with 2 prior stents in the obtuse marginal and right coronary artery who was brought to the ED for severe chest pain. Patient was immediately taken to the cath lab for cardiac intervention. Patient was identified to have 90-95% stenosis of his left circumflex but was unable to be stented due to tortuosity of the vessel and tight lesion. Due to patient’s multivessel coronary artery disease and newly diagnosed diabetes, patient was referred to cardiothoracic surgery …

Systemic Storm: Multi-Organ Septic Emboli In Acute Aortic Valve Endocarditis, Jilpa Shah, Akshaj Pole, Amnah Andrabi

North Texas Research Forum 2024

According to the Infectious Disease Society of America (IDSA), Infective endocarditis (IE) is an infection of the endocardial surface of the native valve, prosthetic heart valve, or an implanted cardiac device such as a permanent pacemaker or a defibrillator. IE is a rare fatal disease with an incidence rate of 3 to 10 cases per 100,000 people, predominantly in males over the age of 50 years in developed countries. Septic emboli are a serious sequelae of infective endocarditis with commonly affecting brain, spleen, kidneys, and lung. Usually, initial management includes tapered long term antibiotics with surgical evaluation for possible valve …

Discharge Implementation Project: Ascertaining If Discharge Implementation Orders Overall Improves Discharge Metrics At A Texas Hospital, Zachary Paras, Omar Nawab, Komthorn Cunvong, Jackson V. Littlejohn

North Texas Research Forum 2024

There are several factors preventing discharges out of the hospital within 24 hours that ultimately affects metrics for both hospital systems and physicians. These factors include pending labs, imaging, or procedures; pending placement approval at a facility outside of the hospital upon discharge; notification of family and caretakers; secured funding for devices and medicines; and others. In an attempt to mitigate preventable extra days spent in the hospital once a patient is medically ready for discharge, a Texas hospital implemented a discharge order set for providers to utilize that informs all involved parties including case management, PT/OT, social work, nurses, …

A Retrospective Study On The Effect Of Raas Pathway Inhibitors At Decreasing The Risk Of Acute Coronary Syndrome In Hypertensive Patients With Rheumatoid Arthritis As Compared To Other Antihypertensives, Yousuf Sherwani, Asad Risvi, Senthil Thambidorai

North Texas Research Forum 2024

Rheumatoid arthritis (RA) is a chronic multi-system inflammatory disease of which is characterized by articular and extra-articular involvement. Patients with RA have a higher risk of mortality when compared with the general population, which is due predominantly to increased cardiovascular disease. Due to the higher incidence of CVD and MI in RA patients it has been postulated that enhanced systemic inflammation plays an important role in the pathogenesis of CVD in RA patients. Previous studies have shown that ant inflammatory medication such as systemic steroids and immune blockers have been shown to decrease the risk of MI in patients with …

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 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 …

A Challenging Diagnosis Of Intestinal Tuberculosis Mimicking Crohn's Disease, Justin Sanchez, Gabriel Gonzales, Monte Troutman

North Texas Research Forum 2024

Intestinal tuberculosis (ITB) is an underrecognized disease that shares many clinical, radiologic, endoscopic, and pathologic features with Crohn's disease, making differentiation difficult. This poses a significant problem as initiation of immunosuppressives for an assumed diagnosis of CD in a patient with ITB can lead to exacerbation of infection and life-threatening consequences. A 30-year-old Nepali man with a medical history only significant for Raynaud disease presented with a febrile illness, right lower quadrant abdominal pain, and productive cough over the course of a month. He immigrated from Nepal 3 years prior to presentation, denying other risk factors or specific symptoms of …

Retrospective Review Of Adverse Events After Treatment Of Non-Melanoma Skin Cancer With Image-Guided Superficial Radiation Therapy, Marshall Hall, Henry Lim, Jason Pham, Alyssa Forsyth, Wenqin Du

North Texas Research Forum 2024

No abstract provided.

Crusted Scabies: A Case Report, Marshall Hall, Philip Oh, Michael Carletti, Stephen E. Weis

North Texas Research Forum 2024

Introduction: Scabies is a parasitic dermatologic condition that often presents as an extremely pruritic rash. A rare and highly contagious variant of scabies is crusted scabies, formerly known as Norwegian scabies. Crusted scabies presents with hyperkeratotic papules and plaques, most commonly on the palms and soles. Due to the variety of presentations seen in scabies, it can be difficult to diagnose. Case presentation: Case 1: An 89-year-old male with a history of dementia, anxiety, and benign prostatic hyperplasia presented with a 2-month history of a generalized pruritic rash. He lived in a memory care center. The physical exam showed an …