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A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, Robert G. Michaud, Lesley B. Gordon 2020 Tufts University School of Medicine - Maine Track Program

A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, Robert G. Michaud, Lesley B. Gordon

Journal of Maine Medical Center

Introduction: Rectus sheath hematomas (RSH) generally occur due to damage to the inferior epigastric artery. They are rare causes of abdominal pain or acute blood loss anemia, but are an important diagnostic consideration because they can be cryptic and are potentially fatal.

Clinical Findings: An 85-year-old female who had been admitted to the hospital for 10 days with a myasthenia crisis was found to be abruptly hypotensive with a tender abdominal mass in the left lower quadrant subtly crossing midline. She was on prophylactic anticoagulation during her hospitalization.

Main diagnosis, therapeutics, interventions, and outcomes: The patient was initially stabilized with ...


Is Rocky Mountain Spotted Fever Transmitted In Maine?, Eric J. Ray 2020 Maine Medical Center

Is Rocky Mountain Spotted Fever Transmitted In Maine?, Eric J. Ray

Journal of Maine Medical Center

Introduction:

Tickborne disease occurs worldwide with recent recognition of changes in tick vector distributions. Rocky Mountain Spotted Fever (RMSF) is already widespread across the United States; however, it is being monitored for introduction to non-endemic areas.

Clinical Findings:

A 65-year-old male with a history of psoriatic arthritis on adalimumab and local tick exposures but no known recent bites presented to the emergency department with fevers, myalgias, arthralgias, and a maculopapular rash of unclear etiology. Initial testing showed transaminitis, worsened chronic thrombocytopenia, and slight neutropenia with absolute neutrophil count 2,330 (reference value: 2,400-7,600 cells per µL); however, he ...


A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula 2020 Winona State University

A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula

Nursing Masters Papers

Abstract

Delirium is a complex syndrome resulting from compounding effects of acute illness, comorbidities, and the environment. It results in adverse outcomes: elevated mortality rates, length of stay, readmissions, institutionalization, long-term cognitive changes, and diminished quality of life. The rate of iatrogenic delirium is astounding, ranging from 10%-89%. There are no curative treatments; thus, primary prevention is the key. The purpose of this literature review is to identify and critique the research for the accuracy of risk stratification and feasibility in practice. Support for interventions that prevent delirium is mounting; however, interventions are resource-intensive and often not implemented. Researchers ...


Efficacy Of Allopurinol In Cardiovascular Diseases: A Systematic Review And Meta-Analysis, Waqas Ullah, Shristi Khanal, Rozi Khan, Bikash Basyal, Samavia Munir, Artem Minalyan, M. Chadi Alraies, David L. Fischman 2020 Abington Jefferson Health

Efficacy Of Allopurinol In Cardiovascular Diseases: A Systematic Review And Meta-Analysis, Waqas Ullah, Shristi Khanal, Rozi Khan, Bikash Basyal, Samavia Munir, Artem Minalyan, M. Chadi Alraies, David L. Fischman

Abington Jefferson Health Papers

Background: Given current evidence, the use of allopurinol for the prevention of major cardiovascular events (acute cardiovascular syn-drome (ACS) or cardiovascular mortality) in patients undergoing cor-onary artery bypass graft (CABG), after index ACS or heart failure remains unknown.

Methods: Multiple databases were queried to identify studies com-paring the efficacy of allopurinol in patients undergoing CABG, after ACS or heart failure. The unadjusted odds ratio (OR) was calculated using a random effect model.

Results: A total of nine studies comprising 850 patients (allopurinol 480, control 370) were identified. The pooled OR of periprocedural ACS (OR: 0.25, 95% confidence interval (CI ...


Initial Evaluation Of A Wellness Game, Bing Parkinson MD, Bruce St. Amour DO 2020 HCA Healthcare

Initial Evaluation Of A Wellness Game, Bing Parkinson Md, Bruce St. Amour Do

Capital Division Virtual Research Day 2020

Physician wellness has recently been a topic of significant national interest.1-8 The term “wellness” has many definitions, and was best defined by Around et al. 1 as “one’s personal recipe for thriving and not just surviving.” Wellness refers to interconnected dimensions of physical, mental, and social well-being that extend beyond the absence of illness. Wellness has traditionally been measured in the negative sense by assessing rates of burnout, emotional exhaustion, and depersonalization. It is known that physician burnout is at its highest point during residency1, 4, 5 and burnout is linked to many negative outcomes including: substance ...


Diagnostic Accuracy Of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review And Meta-Analysis., Waqas Ullah, Sohaib Roomi, Hafez M. Abdullah, Maryam Mukhtar, Zain Ali, Ping Ye, Donald C. Haas, Vincent M. Figueredo 2020 Abington Jefferson Health

Diagnostic Accuracy Of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review And Meta-Analysis., Waqas Ullah, Sohaib Roomi, Hafez M. Abdullah, Maryam Mukhtar, Zain Ali, Ping Ye, Donald C. Haas, Vincent M. Figueredo

Abington Jefferson Health Papers

Background: Fractional flow reserve (FFR) is considered the gold standard for diagnosis of coronary artery disease (CAD). Stress Cardiac magnetic resonance (SCMR) has been recently gaining traction as a non-invasive alternative to FFR.

Methods: Studies comparing the diagnostic accuracy of SCMR versus FFR were identified and analyzed using Review Manager (RevMan) 5.3 and Stata software.

Results: A total of 28 studies, comprising 2,387 patients, were included. The pooled sensitivity and specificity for SCMR were 86% and 86% at the patient level, and 82% and 88% at the vessel level, respectively. When the patient-level data were stratified based on ...


Pasteurella Multocida Bacteremia Secondary To Multiple Cat Scratches, Charles Boadu MD, Andrea Hernandez MD, Bassem Zeidan MD, John T. Young MD, Johnathan Frunzi MD 2020 HCA Healthcare

Pasteurella Multocida Bacteremia Secondary To Multiple Cat Scratches, Charles Boadu Md, Andrea Hernandez Md, Bassem Zeidan Md, John T. Young Md, Johnathan Frunzi Md

West Florida Division Virtual Research Day

Pasteurella multocida(P. multocida)is part of the normal gastrointestinal and upper respiratory flora of domestic and wild animals such as dogs, cats, rabbits, opossums, boars, tigers, lions and horses (1, 2). Transmission of P. multocidais usually through scratches and bites leading to infections of the soft tissue and skin (3,4). P. multocida bacteremia is rare, but occurs in individuals with major risk factors including chronic pulmonary disease, diabetes mellitus, end state renal disease (ESRD), and an immunocompromised state (3,4). Non traumatic infections of P. multocida in immunocompromised individuals,are more likely to require care in the intensive ...


Impact Of Order Set Use On Stroke Care, Bilal Nadeem MD, Edward Waseleski DO, Meryem Maras-Casey MD, Sabih Alam MD, Adnan Faruqui MD, Michael Gutierrez MD, Maruthsakhi Molugu MD, Christina Oricompil MD, Ashar Mahmood MD, Katherine Torralba MD, Fatima Agha MD, Nour Tlimat MD, Olu Oyesanmi, Irina Davis, Salman Muddassir MD, Nikolay Mitzov MD 2020 HCA Healthcare

Impact Of Order Set Use On Stroke Care, Bilal Nadeem Md, Edward Waseleski Do, Meryem Maras-Casey Md, Sabih Alam Md, Adnan Faruqui Md, Michael Gutierrez Md, Maruthsakhi Molugu Md, Christina Oricompil Md, Ashar Mahmood Md, Katherine Torralba Md, Fatima Agha Md, Nour Tlimat Md, Olu Oyesanmi, Irina Davis, Salman Muddassir Md, Nikolay Mitzov Md

West Florida Division Virtual Research Day

  • A case control study on stroke patients was recently completed for a quality improvement (QI) investigation.
  • The objective was to determine if the use of either Hemorrhagic or Ischemic Stroke Order Set had an effect on the length of stay (LOS) or adherence to current stroke guideline recommendations


A Case Of Pott's Disease: Typical Presentation Of An Uncommon Disease In The United States, Neha Patel MD, Ravi Patel MD, Marek Krysztofiak MD, K V. Sundaresh MD 2020 HCA Healthcare

A Case Of Pott's Disease: Typical Presentation Of An Uncommon Disease In The United States, Neha Patel Md, Ravi Patel Md, Marek Krysztofiak Md, K V. Sundaresh Md

West Florida Division Virtual Research Day

Pott’s disease (PD), also known as tuberculosis spondylitis, is a rare disease of the spine which is typically caused by extraspinal infection. The basic lesion in Pott's disease is a combination of osteomyelitis and arthritis, usually affecting more than one vertebra. The anterior aspect of the vertebral body adjacent to the subchondral plate is commonly involved. Spinal TB can include any of the following: progressive bone destruction leading to vertebral collapse and kyphosis, cold abscess formation (due to extension of infection into adjacent ligaments and soft tissues), spinal canal narrowing by abscesses, granulation tissue or direct dural invasionresulting ...


Improving Outpatient Pneumococcal Vaccination Rates In Patients Age <65, Evan Nardone, MD, Mark Mallozzi, MD, Alvin George, MD, Christine Kurian, MD, Omar Safdar, MD, Timothy Kuchera, MD 2020 Thomas Jefferson University

Improving Outpatient Pneumococcal Vaccination Rates In Patients Age <65, Evan Nardone, Md, Mark Mallozzi, Md, Alvin George, Md, Christine Kurian, Md, Omar Safdar, Md, Timothy Kuchera, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Objectives

  • To increase pneumococcal vaccination rates for patients 19-64 at JHAP to reach 70% over 3 months.
  • To increase resident knowledge of indications for pneumococcal vaccination in patients 19-64 by 25% over 3 months


#Team-Based Approach To Sedation Management In Patients With Sars Cov-2 Aka Covid-19 In The Medical Icu, Hadiatou Barry, MD, MPH, Franklin Thelmo, DO, Atsoufi Amewuame-Kpehor, MD 2020 Abington Jefferson Health

#Team-Based Approach To Sedation Management In Patients With Sars Cov-2 Aka Covid-19 In The Medical Icu, Hadiatou Barry, Md, Mph, Franklin Thelmo, Do, Atsoufi Amewuame-Kpehor, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

The COVID-19 pandemic has led to a proliferation of patients developing ARDS and requiring prolonged supportive care on mechanical ventilation. As a result, patients need elevated levels of sedation, often on multiple agents for a period greater than typically seen in an ICU population. As a result of this high sedation phenomenon, patients are developing higher rates of expected complications including severe constipation, neurocognitive delay, ICU myopathy, poor sedation weaning, and high pain control requirements. These complications lead to an increased rate of mortality in a population that is already very high and decreases the rate of successful extubation and ...


Jefferson Internal Medicine Associates (Jima) Patient Triage Initiative, Mary White, Alexandra Leto, Barry Ziring, MD 2020 Thomas Jefferson University

Jefferson Internal Medicine Associates (Jima) Patient Triage Initiative, Mary White, Alexandra Leto, Barry Ziring, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

HOW MIGHT WE:

  1. Contact patients to triage them for in-person versus virtual visits and teach them to use telehealth quickly?
  2. How might we screen patients who are coming to the office for COVID-19 symptoms and exposures?


Changing Internal Medicine Residents’ Perspective On Social Determinants Of Health, Daniel Tran, DO, Hiba Ansari, DO, Layla Barrera, DO, Magdala Chery, DO 2020 Rowan University/Jefferson Health

Changing Internal Medicine Residents’ Perspective On Social Determinants Of Health, Daniel Tran, Do, Hiba Ansari, Do, Layla Barrera, Do, Magdala Chery, Do

House Staff Quality Improvement and Patient Safety Conference (2020-)

Background: Social determinants of health (SDOH) shape the conditions of a person’s daily life and include factors such as housing, occupation, education, safety and income. While physicians are aware of the inequalities that exists in healthcare, not all physicians feel adequately able to address such concerns. Understanding of factors that contribute to the development and perpetuation of inequities in health care must be developed at the medical education training level.

Objectives: Evaluate internal medicine residents’ understanding of SDOH and implement a curriculum on health disparities in order to improve their comfort in addressing social needs.

Methods: A survey regarding ...


Assessing Internal Medicine Resident Comfort With Obtaining Consent For Autopsies, Zach French, Kelly Hughes, Edward Wang, Elizabeth Braden 2020 Thomas Jefferson University

Assessing Internal Medicine Resident Comfort With Obtaining Consent For Autopsies, Zach French, Kelly Hughes, Edward Wang, Elizabeth Braden

House Staff Quality Improvement and Patient Safety Conference (2020-)

Objective

We aim to increase resident comfort and knowledge of the autopsy process by 20% based on average survey response scores


Dieulafoy Lesion In The Jejunum: A Rare Cause Of Massive Gastrointestinal Bleeding, Olubunmi Oladunjoye, Adeolu Oladunjoye, Lydia Slater, Asad Jehangir 2020 Reading Hospital-Tower Health

Dieulafoy Lesion In The Jejunum: A Rare Cause Of Massive Gastrointestinal Bleeding, Olubunmi Oladunjoye, Adeolu Oladunjoye, Lydia Slater, Asad Jehangir

Reading Hospital Internal Medicine Residency

No abstract provided.


A Rare Association Of Takotsubo Cardiomyopathy With Neuroleptic Malignant Syndrome, Waqas Ullah, Muhammad Arslan Cheema, Ammar Ashfaq, Maryam Mukhtar, Zain Ali, Mamoon Ur Rashid, Vincent Figueredo 2020 Abington Jefferson Health

A Rare Association Of Takotsubo Cardiomyopathy With Neuroleptic Malignant Syndrome, Waqas Ullah, Muhammad Arslan Cheema, Ammar Ashfaq, Maryam Mukhtar, Zain Ali, Mamoon Ur Rashid, Vincent Figueredo

Abington Jefferson Health Papers

Neuroleptic malignant syndrome is a potentially fatal neurological condition secondary toantipsychotic medication. It is characterized by distinctive clinical findings and autonomicdisturbances. NMS has not been associated with Takotsubo cardiomyopathy (TCM).

TCM is an abnormal response to physiological stressors resulting from the autonomicabnormalities which at times can mimic myocardial infarction (MI). We present a unique caseof a 54-year-old female with bipolar disease presenting with lithium and haloperidol-inducedNMS complicated by TCM. The purpose of this case is to make clinicians aware of this rareassociation.


A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser 2020 Valparaiso University

A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser

Evidence-Based Practice Project Reports

In 2015, approximately 30.3 million Americans, including 10.5% of the population of Minnesota, had been diagnosed with diabetes mellitus (American Diabetes Association, 2019). Increased risk of diabetic complications including neuropathy, retinopathy, nephropathy, cardiovascular disease, and chronic wounds has been associated with an elevated hemoglobin A1C (HgA1C). Formal diabetic education has been shown to be a cost-effective intervention to reduce HgA1C. The Office of Disease Prevention and Health Promotion published an objective within HealthyPeople 2020 that seeks to increase the percentage of diabetics receiving formal diabetic education in the United States from 46.9% of adults to 58.4 ...


Efficacy Of A Mobile Application In A Chronic Kidney Disease Population, Jennifer R. Zamora 2020 Valparaiso University

Efficacy Of A Mobile Application In A Chronic Kidney Disease Population, Jennifer R. Zamora

Evidence-Based Practice Project Reports

Chronic kidney disease (CKD) is associated with high healthcare costs, poor health outcomes and low quality of life (Donald et al., 2018). The US CKD prevalence is 15%, costing Medicare $79 billion in 2016 (United States Renal Data System, 2018). Self-management could reduce CKD burden (Jeddi, Nabovati, and Amirazodi, 2017). Mobile technology offers a low-cost, ease-of-access platform for chronic disease self-management (Whitehead & Seaton, 2016), potentially slowing disease progression and improving health outcomes (Jeddi, 2017). The purpose of this project was to utilize a CKD-specific mobile application, CARELogiQ, to facilitate symptom management; increasing patient satisfaction and decreasing hospitalizations and ER visits over three months. A five-database literature review yielded six high-quality articles; three level I, two level II, and one level III evidence based on JHNEBP (Dang & Dearholt, 2017). Evidence ...


Provider-Led Intervention For Overweight Or Obese African American Women Ages 18-65 With A Bmi 25 Kg/ M₂, Tonya A. Harvey 2020 Valparaiso University

Provider-Led Intervention For Overweight Or Obese African American Women Ages 18-65 With A Bmi 25 Kg/ M₂, Tonya A. Harvey

Evidence-Based Practice Project Reports

Overweight and obese African American women tend to suffer most from the impacts of diseases, health disparities, disabilities, and decreased qualities of life (Sutton et al., 2016). Most weight loss programs are not culturally specific, despite the benefits of dietary changes and increased physical activity for all groups. The purpose of this EBP project was to implement a provider-led program including lifestyle, dietary, and activity components to decrease weight, BMI, waist circumference and blood pressure in African American women. The Iowa Model of Evidence-Based Practice to promote quality care was used to guide the EBP project, aimed to address obesity ...


Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn 2020 Valparaiso University

Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn

Evidence-Based Practice Project Reports

Diabetes is a complex, chronic illness, and a leading cause of morbidity and mortality (ODPHP, 2019). Gaps in diabetes care exist between clinical guidelines and interventions provided in the clinical setting (ADA, 2015; Chauhan et al., 2017; Renders et al., 2001; Worswick et al., 2013). Improved diabetes management strategies and interventions among healthcare providers are essential to close the quality gap. The purpose of this evidenced-based practice (EBP) project was to prompt providers to adhere to diabetes care guidelines using a paper point-of-care reminder over a 12-week period. Provider performance rates covering four specific guidelines were measured: HbA1c, microalbuminuria, diabetic ...


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