Internal Medicine Commons^™

The Outcome Of A Multidimensional Intervention Strategy For The Management Of Generalized Anxiety Disorder In An Internal Medicine Setting, Nicholas Davidson

Evidence-Based Practice Project Reports

Anxiety disorders are very prevalent in the United States. The most common type, Generalized Anxiety Disorder (GAD), affects 6.8 million adults every year. GAD can cause significant deficits in a person’s ability to function, decrease their quality of life and increases a person’s risk of attempting suicide. The purpose of this evidence-based practice (EBP) project was to improve the outcomes of adults diagnosed with GAD in an internal medicine setting by implementing a protocol composed of a combination of interventions. A thorough literature search was conducted to find the best available evidence to support the project. A total of 11 …

Diet, Exercise, Self-Monitoring, Technology, And Motivational Interviewing For Weight Loss In Adults, Ashleigh D. Warburton

Evidence-Based Practice Project Reports

Obesity, an epidemic in the United States (US), affected 42.4% of adults as of 2017-2018 (Hales, 2020). Comorbidities associated with obesity, such as cardiovascular disease, cancer, and diabetes (Orringer et al., 2020), are some of the leading causes of death in the US (Kochanek et al., 2020). The purpose of this evidence-based practice (EBP) project was to answer the following PICOT question: In adult patients aged 19 years or older who are considered overweight or obese as measured by body mass index (BMI) of ≥ 25 kg/m2 (P), how effective is diet and exercise combined with self-monitoring, a phone application, …

Mortality After Transcatheter Aortic Valve Replacement For Aortic Stenosis Among Patients With Malignancy: A Systematic Review And Meta-Analysis, Muhammad U Siddiqui, Omar Yacob, Joey Junarta, Ahmed K Pasha, Farouk Mookadam, Mamas A Mamas, D L Fischman

Division of Internal Medicine Faculty Papers & Presentations

Background: With advancements in cancer treatment, the life expectancy of oncology patients has improved. Thus, transcatheter aortic valve replacement (TAVR) may be considered as a feasible option for oncology patients with severe symptomatic aortic stenosis (AS). We aim to evaluate the difference in short- and long-term all-cause mortality in cancer and non-cancer patients treated with TAVR for severe AS.

Methods: Medline, PubMed, and Cochrane Central Register of Controlled Trials were searched for relevant studies. Patients with cancer who underwent treatment with TAVR for severe AS were included and compared to an identical population without cancer. The primary endpoints were short- …

The Efficacy Of Tailored Text Messages To Improve Medication Adherence And Lifestyle Changes For Patients With Type 2 Diabetes Mellitus, Vanessa B. Silverio

Evidence-Based Practice Project Reports

Type 2 diabetes mellitus (T2DM) is a chronic disease characterized by increased amounts of glucose in the blood, and is the seventh leading cause of death in the United States (United Health Foundation [UHF]), 2021). T2DM can be effectively treated with medication and behavioral lifestyle modifications. Even small improvements in glycemic control can reduce the risk for debilitating complications such as heart disease, stroke, kidney disease, sepsis, and retinopathy (Wang et al., 2021, Haider et al., 2019). The purpose of this evidence-based practice (EBP) project was to identify the most effective intervention for improving medication adherence, lifestyle changes, and hemoglobin …

Left Ventricular Outflow Tract Thrombus In A Patient With Covid-19-A Ticking Time Bomb: A Case Report., Hamza Zahid Ullah Muhammadzai, Nathaniel Rosal, Muhammad Arslan Cheema, Donald Haas

COVID-19 Papers, Posters, and Presentations

Background: Coronavirus disease 2019 (COVID-19) is a manifestation of severe acute respiratory syndrome coronavirus 2, which results in many different complications including left ventricular (LV) thrombi.

Case summary: We present a 30-year-old female presenting with chest pain and shortness of breath. Patient had an extensive history including heart failure with an ejection fraction 15-20% and COVID-19 2 months ago. Echocardiogram revealed a 3.3 cm ×  1.7 cm LV thrombus which was not present 4 months ago before her diagnosis of COVID-19. The LV thrombus embolized resulting in an embolus extending from the distal infrarenal abdominal aorta to the common iliac …

Case Report: Covid Arm (Covid Vaccine Arm), Joseph Pagano, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

We report the case of a 38-year-old male physician who was vaccinated with the Pfizer vaccine. He experienced arm pain and swelling on the vaccinated arm as well as systemic symptoms, including fever, chills, headache and weakness. The systemic symptoms improved after the use of oral prednisone. A review of the literature on the COVID vaccine is presented.

A Fatal Case Of Covid-19 Pneumonia In A Fully Vaccinated Heart Transplant Recipient, Agastya D. Belur, Diana Otero, Christina Dunbar Matos

The University of Louisville Journal of Respiratory Infections

The development and administration of mRNA vaccines against SARS-CoV-2 are seeing lower numbers of COVID-19 cases and fatalities among fully vaccinated, immunocompetent adults. We present a case of fatal COVID-19 pneumonia in a heart transplant recipient who had received two doses of mRNA COVID-19 vaccine before the Centers for Disease Control and Prevention had recommended additional doses.

Covid-19, Vaccination, And Heart Transplantation, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Death Exposure Influence On Medical Students’ Attitudes Toward End-Of-Life Care, Sara J. Barlow, Nelia Alfonso, Jason A. Wasserman

Posters

INTRODUCTION
Advance directives help guide individuals and their families in making end-of-life decisions that physicians must respect and carry out on behalf of patients to provide optimal care that aligns with their wishes. The facilitation of end-of-life care and the application of advance directives are impacted by physicians’ attitudes and knowledge regarding this topic. Current studies focus on the perspective that practicing physicians have toward advance directives. Our goal is to examine the end-of-life preferences of medical students at Oakland University William Beaumont (OUWB) School of Medicine before and after clinical exposure to better appreciate how and when opinions regarding …

Improving Osteoporosis Screening Rates Of Women In A Primary Care Setting, Kristine E. Davis

Evidence-Based Practice Project Reports

Osteoporosis is caused by caused by low bone mass, microarchitecture disruption and increase in skeletal fragility (Rosen & Drezner, 2021). This disease presents as a silent disease without any clinical manifestations and increases risk for bone fracture. The purpose of this Evidence-Based Practice (EBP) project was to increase screening rates for osteoporosis in the female population by mailing a patient reminder letter to the home of qualifying patients in the primary care setting and to determine if mailing a patient reminder letter would increase screening rates. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare professionals (JHEBP) model was used …

Back To The Basics With Smart Goals: A Multimodal Intervention For Adults Who Have Type 2 Diabetes, Alyssa L. Snyder

Evidence-Based Practice Project Reports

Diabetes, the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2020a) and the ninth leading cause of death worldwide (World Health Organization [WHO], 2020), has increased by 70% over the last two decades (WHO, 2020). Type 2 diabetes (T2D), the most prevalent type accounting for 90% to 95% of diagnosed cases (CDC, 2020a), affects individuals of all ages and often results in major health problems including stroke, heart attack, and kidney disease. The purpose of this patient-centered, evidence-based practice (EBP) project was to evaluate the effectiveness of a multimodal intervention on hemoglobin …

Walking Is Worthy: Walking For Hypertension, Ashleigh Y. Peterson

Evidence-Based Practice Project Reports

Elevated blood pressure (BP), or hypertension (HTN), can cause a cascade of detrimental effects to the body. It is associated with increased risk of stroke, angina, myocardial infarction, heart failure, peripheral artery disease, end-stage renal disease, and abdominal aortic aneurysms (Whelton et al., 2018). HTN is also a major risk factor for the development of cardiovascular disease (CVD), which is the United States’ (U.S.) leading cause of death in men and women (U.S. Preventive Services Task Force [USPSTF], 2020). The PICOT question for this project was: does an eight-week (T) structured walking program utilizing a smartwatch for step counts and …

Angiotensin Receptor Blockers Associated Enteropathy- Brief Report, Falgun Gosai, Neha Gosai

Journal of Community Hospital Internal Medicine Perspectives

The current literature has shown equivocal results regarding the association of Olmesartan and other angiotensin receptor blockers (ARBs) use and the presence of Celiac sprue-like enteropathy (CSLE). Various factors affecting the association are- patient population under study, geographic area, and duration of use of medication. Various case reports/ case series and observational studies have shown the mixed results regarding an association. We have tried to answer a question what exists in the literature regarding the angiotensin receptor blockers related sprue like enteropathy.

The Racial Divide: A Follow Up Study On Racial Disparity Amongst Covid-19 Survivors In An Urban Community, Christopher Millet, Emily Racoosin, Spandana Narvaneni, George Horani, Sherif Roman, Alisa Farokhian, Arslan Chaudhry, Sohail Chaudhry, Yezin Shamoon, Humberto Jimenez, Patrick Michael, Jin Suh

Journal of Community Hospital Internal Medicine Perspectives

Background Studies have shown that COVID-19 has had a disproportionate effect on minority groups in both the clinical and social settings in America. We conducted a follow up study on patients previously diagnosed with COVID-19 one year ago in an urban community in New Jersey. The purpose of the study was to evaluate the socioeconomic impact of COVID-19 as well as assess for receptiveness towards COVID-19 vaccination amongst various ethnic groups.

Methods This was a prospective cohort study consisting of patients who had recovered from COVID-19 one year prior. The patients included in the study had a confirmed COVID-19 diagnosis …

Neurosyphilis: A Monkey Among Men, Cameron Rowe Do, Nathan Buckley Do, Bhaskar Chhetri Md, Suresh Paudel Md

Journal of Community Hospital Internal Medicine Perspectives

Neurosyphilis is the progression of the untreated sexually transmitted infection caused by Treponema pallidum. When the initial infection is not adequately treated, progression of primary syphilis can lead to a wide variety of serious health sequelae. While neurosyphilis can appear up to 10-30 years after the initial infection, syphilis can invade the nervous system at any stage of infection and can imitate symptoms of many other diseases. This variety of symptoms is why syphilis has been called “The Great Pretender” or “The monkey among diseases” (12). This is a case report of an 83-year-old female with a history of multiple …

Development Of A Community Hospital Medicine Affiliated Inpatient Rotation For Family Medicine Residents - A Collaborative Success, David M. Gallagher, Anthony J. Viera, William E. Bynum, Poonam Sharma, John W. Ragsdale, Jeffrey Eschbach, Lalit Verma

Journal of Community Hospital Internal Medicine Perspectives

Background: Hospitalists perform key roles as inpatient educators for family medicine residents. For the past decade, Duke University Family Medicine Residency Program had its inpatient family medicine resident rotation at non-Duke facilities.

Objective: The authors describe the steps taken in 2020 to develop an inpatient Duke family medicine rotation at a North Carolina community hospital, Duke Regional Hospital, and provide outcomes data.

Methods: Duke Family Medicine Residency and Duke Regional Hospital Medicine collaborated in addressing key issues to develop an inpatient rotation for family medicine residents. Performance metrics of patients cared for by both the family medicine inpatient resident team …

Exploring The Effects Of Mindfulness Based Stress Reduction On Pre-Clinical Medical Students: A Qualitative Methods, Longitudinal Pilot Study, Alyssa Heintschel, Scott Sabbagh, Patrick Herndon, Michael Moussa, Ruth Lerman

Posters

INTRODUCTION
Mindfulness Based Stress Reduction has become an increasingly popular practice in healthcare-affiliated populations. MBSR is a course designed to promote mindfulness and awareness within oneself through a combination of formal and informal practices. Studies suggest healthcare workers are at higher risk of experiencing stress and burnout; this is prevalent among pre-clinical medical students due to the rigorous nature of medical school coursework. The primary objective of this study is to evaluate the effectiveness and feasibility of implementing an MBSR program to facilitate improvements in key areas of mental health among medical students throughout their training.

Prediabetes As A Risk Factor For Major Adverse Cardiovascular Events, Muhammad A. Waheed, Ramy Mando, Adrian Michel, Alexandra Halalau

Posters

INTRODUCTION
Major adverse cardiac events (MACE) have been shown to be associated with Type II diabetes mellitus (DM) as it is a proinflammatory process. Some DM inflammatory markers may be present in prediabetes (pDM). Yet, the clinical relationship between pDM and MACE has not been well studied. Thus, this study’s primary goal is to see if pDM increases one’s risk for MACE.

Investigating The Effectiveness Of A Mindfulness Based Stress Reduction Course Within Healthcare: A Qualitative Methods Study, Patrick Herndon, Michael Moussa, Alyssa Heintschel, Scott Sabbagh, Ruth Lerman

Posters

INTRODUCTION
Mindfulness practice has emerged as a promising means to address stress in healthcare workers (HCW). Virtually all HCW studies of the standardized, validated Mindfulness Based Stress Reduction (MBSR) curriculum have been conducted using homogeneous (HCW only) populations. This work examines the novel approach of comparing the effects of heterogeneous MBSR classes: HCW, oncology patients and family members (HCW-HE) as compared to homogeneous classes HCW and their family members only (HCW-HO)

Patient Perceptions Of Their Health Care Teams And Preferences For Making Decisions Regarding Medical Care, Veronica F. Williams, Nelia Afonso

Posters

INTRODUCTION
Beaumont Hospital values patient and family-centered care, but a clear understanding of how patients perceive their health care teams and prefer to make decisions regarding their medical treatment have not been well-described. It is necessary to understand patients’ preferences regarding various factors that impact their medical care in order to foster an effective health care environment. The primary goal of this study is to determine how patients’ care teams impact the ways in which they make decisions regarding their medical treatment. A secondary goal is to determine the individuals, both inside and outside of the health care setting, that …