Family Medicine Commons^™

Covid-19 In The Setting Of Hiv And Severe Hemophilia A: A Case Report, Ryan Wilson, Chae Ko, Rahul Kashyap

HCA Healthcare Journal of Medicine

Introduction

A hyperactive immune response is the driving force behind severe Coronavirus disease 2019 (COVID-19). Complications of severe COVID-19 include acute respiratory distress syndrome, acute respiratory failure, and increased risk of venous thromboembolism (VTE). The management of patients with COVID-19 includes respiratory support, decreasing immune response to the virus to prevent the progression of disease, and anticoagulation to prevent VTE.

Case Presentation

We present the case of a patient with a history of human immunodeficiency virus (HIV) and hemophilia A admitted with COVID-19. This case demonstrates the difficulties present when managing COVID-19 in patients with specific comorbidities. Anticoagulation is a …

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 …

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

North Texas 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 …

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

North Texas Research Forum 2024

No abstract provided.

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

North Texas 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, …

Current Trends In School Nursing In Musculoskeletal Injuries And Concussions, Christoffer Amdahl, Hans Drawbert, Sadra Forati, Joshua Allen, Sana Qureshi

North Texas Research Forum 2024

Background: School nurses are on the front lines of assessing, identifying and treating school age children with a number of health complications. Implementing nursing services in schools have previously demonstrated improved medical care costs for students, less productivity loss for parents, and less productivity loss for teachers. As a result, nursing services in schools provide a cost-beneficial investment of public money, and warrant both financial support from policy makers as well as educational support from local healthcare services. Communicable disease, asthma, musculoskeletal injuries, concussions are common conditions seen in school aged children and a fundamental understanding of these issues …

Improving Documentation Of Patients' Physical Activity In The Outpatient Setting, Jordan Price, Syed Abbas, William Bass, Rigoberto Hernandez, Abdullah Shuaib

North Texas Research Forum 2024

Background: There is vast data on the health benefits of physical activity (PA) and the serious health consequences that are associated with a sedentary lifestyle. Research suggests that physicians who have meaningful conversations about exercise with their patients can be effective at increasing their patients' PA. In order to measure the effects of these discussions, the clinician must be able to document the baseline and subsequent PA of their patients. Our project seeks to improve the assessment and documentation of patient PA. Methods: Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team was created to identify ways to improve documentation …

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

North Texas 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 …

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: …

Identifying Critical Factors In Facilitating The Application Of The Team Stepps Curriculum For Improved Patient Safety In Two Area Skilled Nursing Facilities, Nancy Sang, Jennifer Severance, Sarah Ross

North Texas Research Forum 2024

Background: Skilled Nursing Facilities (SNFs) play a crucial role in long-term care for a progressively frail patient demographic. Surveys of SNF staff reveal poorer levels of safety culture compared to their hospital counterparts. Quality of clinical care delivery in SNF remains inconsistent and insufficient evidence-based process of care. Studies demonstrate that team functioning and communication are crucial in changing the clinical practice methods in SNF. TeamSTEPPS is a curriculum designed to enhance team performance in healthcare settings by addressing patient safety issues and improving safety culture. In this study, we implemented the TeamSTEPPS curriculum at two SNFs and obtained staff …

Pediatric Advance Life Support, Monique Edwards, Lance Mwangi

Gulf Coast Division Research Day 2024

No abstract provided.

An Interesting Case Of Hypothyroidism In The Critical Care Setting, Lance Mwangi, Ladi Larry

Gulf Coast Division Research Day 2024

No abstract provided.

Improving Competence And Confidence In Outpatient Management Of Major Depressive Disorder, Anish Pal, Pavan Anand, Brett M. Garrett

Gulf Coast Division Research Day 2024

No abstract provided.

Introduction To Atls And Emergency Preparedness, Leon Gu, Urvashi Firozi, Pradeep D'Souza

Gulf Coast Division Research Day 2024

No abstract provided.

Phenytoin Toxicity And Hypoglycemia - Case Study, Daniel Khashchuk, Natarajan Venkatayan

Gulf Coast Division Research Day 2024

No abstract provided.

Thoracic Spine Lesion With Paralysis: A Rare Presentation Of Plasmacytoma, Daniel Khashchuk, Natarajan Venkatayan

Gulf Coast Division Research Day 2024

No abstract provided.

On The Discontinuation Of Enteral Feeding In Head And Neck Cancer: A Case Report, Kyle Fisk, Ana Sanchez

HCA Healthcare Journal of Medicine

Introduction

The goal of palliative care is to preserve the quality of life or patient “comfort” in patients with serious diseases. Palliative care providers serve a wide range of patients: from those who seek curative treatment to those who are actively dying. Given this range, palliative care must mirror the dynamic goals of the patient at different stages of life and treatment. Throughout these stages, a goal of the palliative care provider would be to avoid hastening death; however, this often leads to clinical decisions that directly pit the patient’s comfort against the patient’s life span. This is most salient …

Proton Pump Inhibitor Use And Adverse Effects In South Atlantic Hospitals, Nicholas D'Angelo, Ramyar Sigarchy, Anthony Esswein, Sidra Asrar

HCA Healthcare Journal of Medicine

Background

Proton pump inhibitors (PPI) have transformed the management of acid-related gastrointestinal disorders, becoming one of the top-selling medications in the United States. There is no doubt that PPIs have a significant therapeutic impact on patients with gastroesophageal reflux disease and gastrointestinal bleeding. However, evidence is mounting that PPIs are overprescribed, leading to more patients possibly experiencing adverse effects. There is a great deal of ongoing debate surrounding the significance and impact of these adverse effects.

Methods

We conducted a study in 9 HCA hospitals in the southeastern United States to determine the number of patients who started on PPIs …

Does Brief Intervention In The Form Of A Lecture Improve Resident Knowledge About Hep C Screening?, Mary Dacosta, Evelyn Chicas, Kiana Clem, Shelby Collymore

North Texas Research Forum 2023

The prevalence for hepatitis C during 2013-2016 was about ~2.4 million. Screening helps to prevent chronic hepatitis C or start early curative treatment. USPSTF recently changed their guidelines in 2021 for Hepatitis C screening to now include all asymptomatic patients from ages from 18-79 years old without liver disease. Screening usually includes the Hepatitis C Antibody test. Further testing includes Hepatitis C mRNA PCR if screening test is positive. High risk patients should have periodic screening. Since the change, this project was done to ensure the appropriate screening and testing thereafter was done, as well as appropriate communication and documentation. …

Outpatient Breast Cancer Screening Documentation, Christoffer A. Amdahl, Jeremy Smith

North Texas Research Forum 2023

Introduction: Over 264,000 cases of breast cancer are diagnosed annually within the United States, with 99% of them being in women. Regarding prevention of this terrible disease, early detection of such cancers through screening mammography has up to a 20% reduction in breast cancer mortality. Therefore, the USPSTF recommends screening of women who are 50-74 years of age via mammography at average risk of breast cancer every two years. The goal of this study was to measure, track, and increase compliance with these screening recommendations within the Medical City resident clinics.

Method: Family medicine residents working were presented with a …

Phq -9 Utilization In The Primary Care Setting, Michael Armstrong, Ramisa Rahman, Ceferino Cruz Iv, Afsha Rais Kaisani

North Texas Research Forum 2023

INTRODUCTION: The Patient Health Questionnaire-9 (PHQ-9) is a tool used to help diagnose depression and assess a patient’s response to treatment. Quality metric (QM) 371 is a measure of PHQ-9 utilization in patients with depression, and Medical City Family Medicine tracks QM 371 in order to improve the quality of care provided to our patients. This project sought to assess utilization of the PHQ-9 in our clinical practice. At the time of this QI project’s inception, QM 371 was reporting at 0%.

METHODS: Our intervention was to give an educational presentation regarding depression, the PHQ-9, as well as how to …

Case Of Shiga-Toxin Producing E. Coli Dysentery In Adult Patient In The Absence Of Diarrhea, Diana Roy

North Texas Research Forum 2023

This is a unique case of a 38 year old Caucasian female with no significant medical history who presented to the hospital with complaint of 3 days of abdominal pain, nausea/vomiting, dark red formed stool, and fever (TMax 102F), as well as dizziness, body aches and throat pain. She reported eating meatloaf with her daughter two days before symptom onset, and daughter was reported to be ill as well. Upon initial exam, patient was found to have temp 100F, was hypotensive and tachycardic with lactate of 4.2. FOBT was positive. Significant lab values include creatinine 3.39 (baseline normal), hemoglobin of …

Moped Mayhem And A Crash Course In Blood Pressure Problems, Jordan Phelps, Marc Poirier, Sydney Koenig

South Atlantic Division Research Day 2023

No abstract provided.

Quality Improvement: Improving Discussion And Documentation Of Advance Directives In An Outpatient Setting, Amanda Brenner, Elizabeth J. Bogaty, Anjan Parghi

South Atlantic Division Research Day 2023

No abstract provided.

Interstitial Lung Disease Due To Underlying Sjogren's Syndrome, Ryan E. Johnson, Elizabeth Bogaty, Chamonix Kinimaka, Marilian Canals-Rivera

South Atlantic Division Research Day 2023

No abstract provided.

A Case Of Aquagenic And Cholinergic Urticaria, Marilian A. Canals Rivera, Kyle Rauch, Amanda Brenner, Victoria Charry

South Atlantic Division Research Day 2023

No abstract provided.

A Standardized Protocol For Remote Outpatient Blood Pressure Management, Nicholas Dorsey, Justin Taylor, Elvira Mercado

North Florida Division Research Day 2023

No abstract provided.

Standardized Training To Improve The Quality Of Screening Diabetic And Hypertension-Related Opthalmoscopic Exams, Ashley Faye, Pradeep D'Souza, Elizabeth Suniega

Gulf Coast Division Research Day 2023

No abstract provided.

A Case Of Phlegmasia Cerulea Dolens, Stefanie Navarrete

East Florida Research Day 2023

Introduction: This is the case of a patient presenting with phlegmasia cerulea dolens after recent travel with concurrent extensive pulmonary emboli. Patient’s symptoms progressed quickly, atypically, and he did not have known common risk factor for the extent of his disease.

Case Description: The patient is a 78-year-old Caucasian male who presented to the emergency department complaining of left leg swelling and mild pain that began 1 day prior. Patient flew in 3 weeks prior from Scotland. On exam, patient was found to have extensive erythema and ecchymosis of left leg. On admission, venous ultrasound showed complete extensive thrombosis of …