Digital Commons Network^™

Addressing Provider Burnout With Ai Scribe Technology In Mental Health Practice Settings, Dillon Boland, Kayla Harvey

International Nursing Research Congress (INRC)

Background: Burnout is on the rise and contributes to critical patient care errors, poor patient perception of care, and a reduction in provider life satisfaction^1,2. Some primary causes of burnout among healthcare providers are the escalating administrative burdens and extensive screen time associated with electronic health records (EHR) and other documentation tasks³. AI-assisted charting has shown promising results in improving provider satisfaction, increasing time with patients, reducing administrative workload, reducing EHR interface time, increasing patient satisfaction, and reducing provider self-reports of fatigue and dread⁵.

Purpose: This project aims to examine the effect of the …

The Physical Activity Effect On Lowering Blood Pressure In Adults: A Meta-Analysis Of Rct Studies, Talato Kabore, Tanja Baum Low, Kay Yang, Taqialdeen Zamil

International Nursing Research Congress (INRC)

Background: Prehypertension is a silent major contributor to the world's burden of cardiovascular diseases. Individuals with prehypertension may progress to cardiovascular diseases (Barone Gibbs et al., 2021; Nesnawy et al., 2024; Kariuki et al., 2024). Different combinations of physical activity interventions lowered blood pressure among prehypertensive adults worldwide. Therefore, this meta-analysis evaluated the pooled effects of multiple physical activity interventions on reducing blood pressure among prehypertensive adults.

Methods: A meta-analysis performed sixteen RCT studies. Among the 1,419 adult participants, 881 men and 538 women. Random effects models were used to evaluate heterogeneity in the study. A funnel plot and a …

From Pedagogical Crisis To Partnership: Experiences Of A Student-Teacher Partnership Approach, Linda Murphy, Michael Dowling

Teaching and Learning Together in Higher Education

No abstract provided.

Political Science And Education Policy: A Florida Student's Perspective On Pedagogical Partnership, Ben Gordon

Teaching and Learning Together in Higher Education

No abstract provided.

Introduction: The Framing Perspectives Student And Faculty Partners Bring To Their Work, Amy Reyes, Alison Cook-Sather, Asma Zulfiqar, Anna Santucci, Bonnie Mullinix, Sharon Ultsch

Teaching and Learning Together in Higher Education

No abstract provided.

How Many Symmetries Of The Regular N-Gon Are Even?, Thi Mai Khoi Ha

Rose-Hulman Undergraduate Mathematics Journal

One of the simplest classes of finite groups used as a source of counterexamples in a first course of modern algebra is the class of finite dihedral groups. Among the subgroups of dihedral group, finding subgroups of index 2 is of interest in part because these subgroups are normal subgroups. In this article, we use the representations of the symmetries of the dihedral groups as permutations of the vertices and determine concretely all its subgroups of index 2. Under this representation or embedding, the article determines the intersection of the dihedral group with the corresponding alternating groups when they are …

Incremental Increases Between Successive Integers When Raised To The Nth Power, Sutton J. Olesen

Rose-Hulman Undergraduate Mathematics Journal

For thousands of years, the beautiful field of number theory has captivated mathematicians with its elegant simplicity. Positive integers continue to reveal properties and relationships that are a joy to uncover, and in this paper, we investigate a pattern involving exponents and factorials while exploring some common notations in the field of number theory. Combinatorics, the field dealing with the mathematics of counting and arranging, also holds a presence in this paper. Pascal’s Triangle–the foundation of binomial expressions, also comes into play due to its tight relationship with combinatorics. Pascal’s Identity, the property that builds the triangle, becomes very useful …

Practice Patterns In The Management Of Pemphigus – An International Survey Study, Idy Tam, Gabriela Cobos, Zachary M. Schwager, Erin X. Wei

The Lahey Journal

Introduction: Anti-CD20 therapy (rituximab) has emerged as an effective and disease modifying treatment for pemphigus, especially in early disease. However, significant variability exists around the clinical application of this therapy.

Methods: In this survey-based study among bullous disease experts, we investigated practice patterns surrounding the use of rituximab in the management of pemphigus. Anonymized surveys were sent to physician members of the internation Pemphigus and Pemphigoid Foundation. Topics of inquiry included the use of rituximab first line in newly diagnosed pemphigus, rituximab dosing regimen, use of concomitant steroid sparing agents, criteria for retreatment, and the use of antimicrobial prophylaxis.

Results: …

Instagram In The Clinic: A New Challenge For Patient–Physician Communication, Jayashree Ravikumar

Journal of Community Hospital Internal Medicine Perspectives

This letter reflects on a growing trend observed in clinical practice: patients increasingly consult social media for guidance on various medical conditions before visiting their physicians. The piece highlights the opportunities and risks associated with this behavior, particularly in community hospital settings, and emphasizes the importance of clinician guidance and digital health literacy

Elevated Creatine Kinase As A Marker For Aggressive Gi Malignancy, Ramya Vasireddy, Joseph Atarere, Jeffrey Iding, Abhinav Sankineni

Journal of Community Hospital Internal Medicine Perspectives

Klatskin tumor is a rare and aggressive biliary malignancy with a poor prognosis. We present a 72-year-old male with a history of COPD and severe non-ischemic cardiomyopathy who presented with jaundice, pruritus, and fatigue. Laboratory findings revealed marked hyperbilirubinemia and elevated liver enzymes, along with significantly increased creatine kinase (CK). Imaging studies and ERCP confirmed the diagnosis of perihilar cholangiocarcinoma, Bismuth class III, with adenocarcinoma pathology. Despite palliative stent placement, the patient’s bilirubin levels remained elevated, and CK peaked at 45,000 units/L. Due to his advanced disease and comorbidities, he was not a candidate for surgical or systemic therapy and …

Unveiling The Unexpected: Duodenal Ulcer As A Manifestation Of Breast Cancer Metastasis, Emmanuel Gbadehan, Mohammad Abubaker, Parth Adrejiya, Khwaja Haq, Teresa Varghese, Joy Chaudhari, Gurkeerat Singh, Ashok Kanugula

Journal of Community Hospital Internal Medicine Perspectives

Breast cancer typically metastasizes to the lymph nodes, lungs, bones, and liver. However, gastrointestinal (GI) involvement is exceedingly rare, particularly presenting as duodenal ulcers. Such metastases often mimic primary GI malignancies, leading to nonspecific symptoms like abdominal pain, anorexia, bleeding, and vomiting, which can delay accurate diagnosis. Early recognition through appropriate diagnostic evaluations is crucial to prevent disease progression. We report a unique case of an 86-year-old woman with multiple comorbidities who presented with multiple gastrointestinal ulcers. Further investigation revealed these lesions to be manifestations of metastatic breast cancer. This case underscores the importance of considering metastatic breast cancer in …

Unveiling An Uncommon Complication: Pleural Effusion Secondary To Pioglitazone Use, Ranjana Chimauriya, Abhinandan Chittal, Khalid Malik, Tiffany Dumont, Christopher James Haas

Journal of Community Hospital Internal Medicine Perspectives

Pioglitazone, a peroxisome proliferator-activated receptor gamma (PPAR-γ) agonist, is used in the treatment of type 2 diabetes mellitus by reducing insulin resistance. While peripheral edema and fluid retention are well-documented adverse effects, isolated pleural effusion in the absence of heart failure is rare. We present the fourth reported case of a woman in her 60s with type 2 diabetes who developed recurrent left-sided pleural effusion after the initiation and dose escalation of pioglitazone. The effusion resolved completely following discontinuation of the drug. This case underscores the importance of early recognition of drug-induced pleural effusion and timely cessation of the offending …

Ileal Diverticulitis Leading To Small Bowel Obstruction: A Rare Case Of Ileal Diverticular Disease, Immanuel Raju Tullimalli, Vishnu Saivardhan Reddy Palyam, Srinath R. Allala, Nabil Badro, Sumanth Kumar Bandaru

Journal of Community Hospital Internal Medicine Perspectives

While small bowel diverticulosis, particularly, ileal diverticulitis is rare and often asymptomatic, it can lead to chronic vague symptoms or acute complications. Acute presentations may mimic appendicitis, small bowel obstruction, or colonic diverticulitis but can also appear with atypical symptoms, making diagnosis challenging. In many cases, definitive diagnosis relies on imaging such as abdominal CT, which can identify features like extraluminal air or mass lesions, though surgical exploration may be required in complex cases.

Small bowel diverticula are structural outpouchings of the intestinal wall, typically located on the mesenteric border, and are more common in men with a male-to-female ratio …

Vancomycin-Induced Immune Hemolytic Anemia – A Case Report And Literature Review, Yilin Song, Meher Ali, Rukhsar Shaikh, Ashley Bersma, Harsh Y Patel

Journal of Community Hospital Internal Medicine Perspectives

Drug-induced immune hemolytic anemia (DIIHA) is a rare complication of drug treatment. The clinical presentation involves rapid dropping of hemoglobin secondary to hemolysis leading to potentially fatal consequences. Over 100 drugs have been reported to cause DIIHA, most commonly cephalosporins. Here, we present a case of vancomycin-induced immune hemolytic anemia. The diagnosis was challenging due to the limited reports of hemolytic anemia induced by vancomycin in the setting of multiple antibiotic administration history. Hemolysis improved after vancomycin cessation and diagnosis was made with positive serological confirmation. Literature review was performed with four reported cases of vancomycin-induced immune hemolytic anemia identified …

Severe Hyponatremia Presenting With Mild Symptoms And Multifactorial Etiology, Nathaniel Lin, Muhammad Cheema, Usman Fahim, Abdullah Ali, Andrew Weber

Journal of Community Hospital Internal Medicine Perspectives

Hyponatremia is a common electrolyte disturbance; however, serum sodium level of 99 mEq/L without severe symptoms or known duration is rare and noteworthy. We report a case of an 87-year-old female who presented with fatigue, decreased appetite, and mild emesis for the past 2 days in which blood work revealed a serum sodium level 99 mEq/L. The etiology of hyponatremia in an elderly patient may be complex due to higher likelihood of co-morbid medical conditions. Additionally, syndrome of inappropriate antidiuretic hormone (SIADH) can pose a diagnostic challenge as fewer than 50% of patients have typical lab results that confirm the …

An Incredible Impact Of Antibiotics On Leukostasis, Ranjana Chimauriya, Chiranjibi Mainali, George John Pyrgos, Christopher James Haas

Journal of Community Hospital Internal Medicine Perspectives

Leukostasis is characterized by respiratory or neurological issues in the context of hyperleukocytosis, secondary to elevated blood viscosity and WBC plugs (aggregates of mature leukocytes or leukemic blasts physically obstructing the microvasculature leading to impaired tissue perfusion and organ dysfunction).It is rare in Chronic Lymphocytic Leukemia (CLL) unless WBC > 500,000/µL. A 67-year-old female presented with severe respiratory distress and altered mental status. She was diagnosed with Streptococcus pneumoniae meningitis and pneumonia. Laboratory diagnostics demonstrated hyperleukocytosis (WBC >440,000/µL) and CLL confirmed by flow cytometry. Imaging showed bilateral acute brain infarcts. After 12 days of antibiotic therapy, her WBC dropped to 40,000/µL, …

Bilateral Pulmonary Embolism With Bi-Atrial Cardiac Thrombi Entrapped In A Patent Foramen Ovale, Denise Mourad, Fahd Eissa Mohamed, Yashi Ballal, Elie Mrad, Natasa Petreska, Sachin Singh, Paritharsh Ghantasala

Journal of Community Hospital Internal Medicine Perspectives

Bi-atrial thrombi with bilateral pulmonary embolism (PE) through a patent foramen ovale (PFO) is rare and life-threatening, requiring urgent management due to embolization risk. We present a 53-year-old female with left lower extremity extensive deep vein thrombosis (DVT), bilateral PE, and bi-atrial thrombi straddling a PFO. She underwent thrombectomy, PFO closure, and pulmonary embolectomy but later experienced recurrent DVT and PE. Anticoagulation was limited due to bleeding risk given a recent neurosurgery. Literature lacks clear guidelines for managing such cases necessitating individualized treatment. This case highlights the complexity of bi-atrial thrombi with PFO and the need for further research to …

Novel Treatments For Adolescent Vaping Cessation: Are We There Yet?, Jasleen Kaur, Amanda Rossi, Sofia Adams, Mariginder Singh Varowal, Lakshit Jain, Mohsin Raza, Zouina Sarfraz

Journal of Community Hospital Internal Medicine Perspectives

E-cigarette use among adolescents is a growing public health concern, driven by discreet designs, appealing flavors, and social influences. Despite high addiction rates, most teen users express a desire to quit, though evidence-based cessation tools remain limited. Behavioral interventions, including tech-based programs like This Is Quitting and smokeSCREEN, show promise. Pharmacotherapy, particularly varenicline, may support quitting, though its role in adolescents is still under investigation. Pediatricians must address this issue through empathetic, multifaceted approaches that combine education, behavioral support, and emerging treatments to curb early nicotine dependence and its long-term health consequences.

Malabsorption Of Thyroid Hormone After Small Bowel Resection, Nathaniel Lin, Marilyn Temkin, Ella Rosenbloom, Alan Kaell

Journal of Community Hospital Internal Medicine Perspectives

Hypothyroid patients on stable long-term oral levothyroxine (T4) dosage are at risk of developing overt hypothyroidism after small bowel (SB) resection. This can happen despite equivalent peri-operative intravenous (IV) supplementation and resumption of preoperative oral T4 dosage when post-operative oral medication is tolerated. This situation is not specifically addressed in any of the major guidelines for T4 oral replacement in this setting and may be underrecognized, leading to diagnostic and management challenges.

Methotrexate Toxicity Management In Polymyalgia Rheumatica: A Case Report, Devi Meghana Kotharu, Sai Diksha Vutukuru, Prafullkumar Patel, Athmananda Nanjundappa, Sumanth Kumar Bandaru

Journal of Community Hospital Internal Medicine Perspectives

Methotrexate (MTX) is an anti-folate drug with anti-inflammatory and anti-proliferative properties. Low-dose methotrexate (10-25mg/week) is widely recognized as a safe and effective treatment for various autoimmune disorders. While toxicity from low dose methotrexate is uncommon it can lead to severe complications like pancytopenia. We present a case of a 68-year-old male with a history of steroid-resistant Polymyalgia Rheumatica on methotrexate (20 mg weekly) and prednisone. He presented to the emergency room with oral mucosal lesions and reduced oral intake. Upon evaluation, he was found to have pancytopenia and transaminitis, raising concern for methotrexate toxicity. Treatment included folinic acid rescue therapy …

Isolated Gastrointestinal Kaposi’S Sarcoma: A Case Report, Sandesh R. Parajuli, Maya Pillai, Bidisha Baral, Fikru Merechi, Anish Paudel

Journal of Community Hospital Internal Medicine Perspectives

Introduction Kaposi sarcoma (KS) is an AIDS-defining malignancy of the vascular endothelium. Gastric KS without skin lesions is rare. We present a case of a newly diagnosed HIV-positive male with gastric KS in the absence of dermatological involvement.

Case Description A 25-year-old male with no prior medical history presented with intermittent headaches, weakness, nausea, and abdominal fullness. Examination revealed temporal wasting, conjunctival pallor, and oral thrush. There were no skin manifestations. He was newly diagnosed with human immunodeficiency virus (HIV) (CD4/µL, viral load 276,000 copies/mL) complicated by cryptococcal meningitis and CMV colitis and had lesions suggestive of KS on esophagogastroduodenoscopy …

Concurrent Histoplasmosis & Blastomycosis In A Young Woman, Gizem Reyhanoglu, Mohsan Khan, Andrea Venturini

Journal of Community Hospital Internal Medicine Perspectives

Background:

Histoplasmosis capsulatum and Blastomyces dermatitidis are fungi that are uniquely distributed across the United States. Co-infection with both fungi remains uncommon. The literature review of coinfection was limited to three cases. Only two cases were recorded in humans. Infection can yield symptoms ranging from asymptomatic to life-threatening. On radiographic imaging, diffuse reticulonodular infiltrates with hilar or mediastinal lymphadenopathy can be seen. Management depends on the severity of the disease and the patient’s immune state.

Case Description:

A 35-year-old female with a medical history significant for HIV and substance use disorder presented to the hospital with severe lower abdominal pain, …

Thyrotoxicosis Triggering Takotsubo Cardiomyopathy And Acute Coronary Syndrome: A Case Of Severe Cardiovascular Manifestations In Hyperthyroidism, Raiyan Ali, Nathaniel Lin, Taha Siddiqui, Mohit Sharma

Journal of Community Hospital Internal Medicine Perspectives

Hyperthyroidism can lead to serious cardiovascular complications, including arrhythmias, high-output heart failure, and myocardial ischemia. Thyrotoxicosis, a hypermetabolic emergency, may mimic or exacerbate acute coronary syndrome (ACS) and, though rare, has been associated with takotsubo cardiomyopathy. We present a case of a 54-year-old thyrotoxic female without significant cardiovascular history who presented with atypical chest pain complicated by both takotsubo cardiomyopathy and myocardial infarction. This case not only emphasizes the diagnostic challenge posed by thyroid-induced cardiac dysfunctions but also highlights the importance of multidisciplinary management in these patients.

Fecaloma In Chronic Opioid-Induced Constipation: A Fatal Case Of Stercoral Colitis, Claudia Georges, Simardeep Singh, Eskandar Alex Yazajiadepartment Of Medicine, Medstar Health Georgetown University (Baltimore) Program, Baltimore, Md, Usa

Journal of Community Hospital Internal Medicine Perspectives

Stercoral colitis (SC) is a rare and potentially lethal condition characterized by severe colonic inflammation resulting from fecal impaction. This disorder is more prevalent among the elderly and vulnerable groups, especially those on chronic opioids. Our case study involves a 56-year-old male with a history of chronic opioid use who faced an acute colonic obstruction due to longstanding constipation. Despite receiving surgical treatment, the patient dies from ischemic bowel complications and multiorgan failure. The case accentuates the complexities of diagnosing and treating stercoral colitis, highlighting the critical need for early identification and proactive therapeutic intervention to prevent fatal outcomes.

Investigation Of The Optimal Length Of Discharge Summaries In Care Transitions: A Cross-Sectional Study, Taku Harada, Shintaro Kosaka, Aki Morishima, Seitaro Iguchi

Journal of Community Hospital Internal Medicine Perspectives

Introduction

Discharge summaries are essential documents that support continuity of care during patient transitions between inpatient and outpatient settings. They help ensure that crucial clinical information is conveyed accurately and completely. However, while their clinical significance is well established, there is little consensus on the optimal format, particularly in terms of length and structural clarity. Excessively brief summaries may omit key details, while overly lengthy ones can hinder efficient information transfer. Despite varied suggestions in the literature—ranging from half a page to four pages—empirical data on physician preferences are limited.

Methods

We conducted a cross-sectional, web-based survey among physicians who …

Fluid Resuscitation Choice And Its Effect On Plasma Chloride And Acute Kidney Injury In Severe Acute Pancreatitis: A Randomized Study Of Normal Saline Vs. Balanced Crystalloids (Physiomax), Mandip Singh Bhatia, Ritu Attri, Ashok Kumar Pannu, Atul Saroch, Saurabh C Sharda, Neeraj Singla, Sakshi Mehta

Journal of Community Hospital Internal Medicine Perspectives

Background: Acute pancreatitis (AP) is a potentially fatal gastrointestinal condition, often associated with organ failure and acute kidney injury (AKI). Early fluid resuscitation with Normal saline (NS) may lead to hyperchloremia and AKI, which prompted interest in using balanced crystalloids. However, the optimal choice of crystalloid fluid remains uncertain. This study aimed to compare the effects of NS versus Physiomax on plasma chloride levels and AKI incidence during early resuscitation in patients with predicted severe AP (pSAP).

Methods: A single-center, prospective, randomized study was conducted between November 2022 and December 2023 at PGIMER, Chandigarh, India. 112 patients with pSAP were …

Reassessing D-Dimer Cut-Offs For Pulmonary Embolism: A Path Toward Safer And More Cost-Effective Diagnosis, Amer Abu-Shanab, Montaser Alrjoob, Zain Albdour, Alaa Alkhatib, Apurva Ketkar, Ahmad Al-Alwan, Charmee Vyas, Husam Bader, Sohini Sarkar, Doantrang Du

Journal of Community Hospital Internal Medicine Perspectives

Background

Pulmonary embolism (PE) is a life-threatening condition requiring early and accurate diagnosis. The Wells and Geneva scores, along with D-dimer testing, are key tools in assessment. However, the standard D-dimer cut-off of 0.5 mg/mL, while highly sensitive, has low specificity, leading to excessive imaging. This study examines whether modifying the D-dimer threshold can improve diagnostic efficiency and reduce unnecessary testing.

Methodology

This retrospective study analyzed 878 patients who underwent computed tomography pulmonary angiography (CTPA) at Monmouth Medical Center from January 2022 to December 2023. Statistical analysis, including ROC curve assessment, was conducted using IBM SPSS, with significance set …

Role Of Addiction Medicine Consultation Service In A Community Hospital: Evaluation Of The Novel Service, Srikrishna Varun Malayala, Wesley Cervantes Perez, Rukshar Thapa, Archie Madan, Kushagar Singla, Pragyat Singh, Pelash Kumar, Akshay Thaper

Journal of Community Hospital Internal Medicine Perspectives

Objectives: Fewer than 2,500 physicians nationwide are certified in addiction medicine. Inpatient addiction hospitalist services have been shown to improve patient outcomes, but their capabilities and impact are underexplored in community hospitals. This study evaluates the role of an addiction medicine hospitalist service in enhancing patient outcomes in two community-based hospitals.

Methods: A retrospective chart review was conducted on patients who received care from addiction medicine service in two hospitals. The data were collected within the first 120 days of the establishment of service. The reason for consultation, substances used, types of management, impact on transition of care, readmissions and …

The Impact Of Covid-19 On Alcohol-Related Morbidity And Mortality: A Multicenter Study, Abhinav K. Rao, Erica Paulos, Nancy Crossley, Don C. Rockey

Journal of Community Hospital Internal Medicine Perspectives

Background:

During the COVID-19 pandemic, there was a rise in alcohol (ethanol) use nationwide. In this study, we investigated the effect of COVID-19 on alcohol-related hospital outcomes.

Methods:

Deidentified claims data spanning 2018 through 2022 from HCA’s Enterprise Data Warehouse (South Atlantic Division) were examined. The population included adults aged > 18 years who had an encounter at an HCA facility and a diagnosis of alcohol use disorder or alcohol-related illnesses. Two time frames were evaluated: 2018-2019 (pre- COVID-19) and 2021-2022 (COVID-19). Statistical analyses were performed to evaluate LOS, home discharge, and mortality.

Results:

Of the 72,575 patients (26,678 during the …

Practical Pre-Rotation Resources Enhance Knowledge And Attitude Towards Discharge Planning For Medical Students, Ho-Man Yeung

Journal of Community Hospital Internal Medicine Perspectives

Interdisciplinary discharge planning is known to be a difficult subject for medical students to comprehend given its convoluted nature. There is no standardized curriculum for students and there is a large variety between every inpatient rotations. Internal Medicine in particular sees variety of patients with unique psychosocial challenges. We previously proposed tools that are simple and specifically designed for learners and students including pyramid of discharge needs and disposition flow chart. Our current work examines the efficacy of using these resources by fourth year medical students during their subinternship rotation. Between May and September 2023, 54 students completed the rotation. …