Medicine and Health Sciences Commons^™

The Challenge Of Preventing A Rare But Potentially Devastating Iatrogenic Exposure To Variant Creutzfeldt-Jakob Disease: An Ambi-Directional Observation With Policy Intervention, Ritambhara Pandey, Devesh Rai, Julie Giles, Maryrose Laguio-Vila, Emil Lesho

Advances in Clinical Medical Research and Healthcare Delivery

Although rare, patients with variant Creutzfeldt-Jakob Disease (vCJD) in their differential diagnosis of progressive dementia and movement disorder could continue to present to hospitals for care. However, U.S.-based infection control guidelines do not fully address the possibility of vCJD. After near-misses involving increasing numbers of patients with clinical findings and epidemiologic risks compatible with vCJD, or exposures to chronic wasting disease, we sought to improve recognition and prevention of iatrogenic spread of these prion-related diseases.

Improving Value (Low Cost, Optimal Clinical Outcome, Patient Satisfaction) In A Skilled Nursing Facility: A Quality Improvement (Qi) Project, Nirajan Adhikari, Joseph Mwesige, Lester Kirchner

Advances in Clinical Medical Research and Healthcare Delivery

Improving the value of care with reduced cost without compromising the quality is utmost important in the modern era of medical practice. An attempt was made in the nursing facility to observe an outcome with a plan to implement in much larger scale in the larger facility in future. In the 7-month period of this ambi- directional study, the focus was on minimizing unnecessary daily laboratory orders and to observe the reduction in the cost without adverse effect on length of stay in the nursing facility and hospitalization from the nursing facility.

The Role Of Coronary Artery Disease In Demand Mediated Myocardial Infarction: A Retrospective Study From A Community Hospital, Amr Salama, Nikhil Mehta, Abdullah Abdullah, Ruth Kouides, Jeremiah Depta, Ryan Hoefen, Richard Alweis

Advances in Clinical Medical Research and Healthcare Delivery

Type 2 Myocardial Infarction (T2MI) is an increasingly recognized clinical entity due to the availability of highly sensitive troponin assays for patients admitted due to common medical diagnoses. However, there is little epidemiological data on the significance and long-term prognosis of T2MI, which occurs secondary to an increase in myocardial oxygen demand and/or a decrease in myocardial blood flow. Arrhythmia, hypoxia, and sepsis are the major etiologies for T2MI. Therefore, sepsis was the identified area of interest for the study giving how common it is in a community hospital. We studied the cardiac workup of patients with elevated troponin in …

Emergency Medicine Journal Club, David Gibbs, Dylan Norton

Advances in Clinical Medical Research and Healthcare Delivery

In this column, we provide a brief review of important papers recently published that relate to the field of Emergency Medicine. The goal is to provide the busy clinician a bullet-like summary of the study, focusing on the research question, methods, results, limitations, and bottom line interpretation.

An Integrated Multispecialty Curriculum For Point-Of-Care Ultrasound, Carina M. Brown, Karl Fields, Duncan Vincent, Alison Rumball, Joshua Zavitz, Shane Hudnall, Caroline Iskander, Alexander Raines

Advances in Clinical Medical Research and Healthcare Delivery

Point-of-care ultrasound is increasingly recognized as a valuable tool for physicians practicing in a variety of specialties. Currently there is no standard curricula or assessment model for training primary care specialty residents in the use of ultrasound. This article presents a multispecialty experience in developing a list of 11 core Pediatric, 13 core Family Medicine and 22 core Internal Medicine ultrasound scans based on best available evidence for their clinical use.

Osteopathic Medical Students’ Perceptions Of Their Medical Education Due To Covid19, Kaitlyn Thomas, Richard Terry

Advances in Clinical Medical Research and Healthcare Delivery

Objective: The SARS-CoV-2 (COVID19) pandemic has led to unprecedented changes in medical education globally. Published reports on these changes have given some insight as to both positive and negative effects for specific medical schools though none have looked at osteopathic education. Our study attempts to examine the effect of COVID19 more formally on osteopathic medical students’ perception of their medical education in the third and fourth years of medical training.

Methods: Third- and fourth-year medical students at Lake Erie College of Osteopathic Medicine (LECOM) completed electronic surveys regarding their experiences with changes in medical education due to the COVID19 …

Community And Provider Acceptability Of The Covid-19 Vaccine: A Systematic Review And Meta-Analysis, Christian Akem Dimala, Benjamin Momo Kadia, Hai Nguyen, Anthony Donato

Advances in Clinical Medical Research and Healthcare Delivery

Background:

The novel coronavirus disease (COVID-19) vaccines may help control the current pandemic but would require immunization levels that would achieve herd immunity. This study aimed to quantify current COVID-19 vaccine acceptance rates, as well as characterize the determinants, enablers and barriers to vaccine acceptability across the globe by synthesizing published evidence.

Methods:

A systematic review and meta-analysis of studies was performed on studies assessing the acceptability of a COVID-19 vaccine published between November 1^st, 2019, and November 30^th, 2020. PubMed, Embase and Cochrane central were searched for eligible studies. Data extracted from retained studies was …

The Reel Deal: The Stacked Benefits Of A Reel Mower, John K. Hix, Simone Bailey

Advances in Clinical Medical Research and Healthcare Delivery

"Mow-lawning" is a colloquial term referred to actively cutting grass using a reel mower, typically at a faster than normal pace in order to maximize exercise benefit and minimize time, with the emphasis on the physical action of mowing and only secondarily on the resulting lawn care. While mow-lawning remains relatively uncommon in the United States, adoption of this practice by those healthy enough to engage in the level of exercise required can deliver a number of benefits that improve environmental, safety, and personal goals simultaneously. The stacking of so many benefits in one practice deserves more attention and promotion.

Omental Tuberculosis In A Patient With Alcoholic Liver Cirrhosis-The Diagnostic And Treatment Dilemma, Ekta Tirthani, Mina Said

Advances in Clinical Medical Research and Healthcare Delivery

Alcoholic cirrhosis is frequently complicated by spontaneous bacterial peritonitis (SBP) due to the translocation of gut bacteria. However, in immigrants to the USA from parts of the world with high tuberculosis burden, a high degree of clinical suspicion of tuberculous peritonitis should be maintained when a patient presents with symptoms similar to SBP. We describe a case of a 45-year-old Nepali man with a history of alcohol abuse who immigrated to the USA six years prior and presented to the hospital with abdominal pain, night sweats, fevers, and a 10 kg weight loss. A CT scan revealed abdominopelvic ascites, liver …

Subacute Thyroiditis Secondary To Moderna Covid-19 Vaccine: A Case Report Of A Rare Manifestation, Mayank Patel, Marika Shahid, Ahmad Khawaja, Chibuzor Ejike, Kavitha Vemuri

Advances in Clinical Medical Research and Healthcare Delivery

The SARS-CoV-2 led to a global pandemic, infecting millions of lives within only a short period of time. The symptoms of the disease vary with a subset of the population developing debilitating sequelae. Through the emergency use authorization (EUA), multiple vaccines have been released against the novel virus in record time. Long term and rare sequelae from the vaccine are poorly understood. DeQuervain’s subacute thyroiditis is a self-limiting and painful inflammation of the thyroid gland usually associated with viral infections. We report a rare case of subacute thyroiditis in a healthy 46-year-old woman presenting with a painful swelling in the …

The Upfront Cost Of Translating Graduate Medical Education Into A Virtual Platform, Ronak Mistry, Alex Glaser

Advances in Clinical Medical Research and Healthcare Delivery

Graduate medical education was drastically disrupted by the COVID-19 pandemic. With a halt on all in-person educational sessions in response to the need for social distancing, residency programs across the country scrambled to develop virtual curricula with some difficulty, given the limited guidance to creating online learning platforms prior to the onset of the pandemic. In-person Socratic discussions have always been the cornerstone of internal medicine training. Here, we discussed our experiences of translating the in-person model and to a virtual platform, highlighting the upfront financial burden that doing so can have. Time will need to pass before we can …

The Transitional Year Internship: Five Classes Of Former Interns Reflect On Their First Clinical Year, Hana L. Haver, Kush K. Patel, Robert Chow

Advances in Clinical Medical Research and Healthcare Delivery

Objective:

The clinical internship (postgraduate year-1), which precedes many advanced residency training programs, are traditionally fulfilled by a transitional year (TY) or preliminary year of training in medicine or surgery. TY programs can take place in a variety of settings, ranging from community hospitals to large academic medical centers. In the present study, we sought to evaluate if resident physicians who completed a community hospital-based TY internship felt prepared for their subsequent specialty residency training.

Methods:

A cross-sectional survey was adapted and distributed to resident physicians who completed their TY internship at a university-affiliated community hospital in Baltimore, Maryland, between …

Preparing Internal Medicine Trainees For Independent Practice: A Pilot Simulation Program On Emotional Intelligence, Deborah Maier, Nagesh Jadhav, Christina Goodermote, Richard Alweis

Advances in Clinical Medical Research and Healthcare Delivery

Introduction: Emotional intelligence (EI) is the ability to monitor emotions and use this knowledge to guide one’s thinking and actions. EI shapes the physician’s bedside manner and leads to a better doctor-patient relationship. Higher physician EI is inversely proportional to feelings of burnout and increases resiliency to the stresses of the profession. Given the increasing levels of physician burnout, there has been a call to incorporate the development of emotional intelligence into medical education. However, little guidance exists on best practices in incorporating EI training into graduate medical education.

Purpose/Aim: Utilization of EI simulation as a pedagogical instrument to increase …

A Pilot Study Of Knee And Hip Osteoarthritis Patient Experience With Telemedicine During The Covid-19 Pandemic, Rondy M. Lazaro, Kyle J. Smith, Mohammad H. Bawany, Nathan Barford, Jennifer H. Paul

Advances in Clinical Medical Research and Healthcare Delivery

Objective: The purpose of this pilot study is to examine patients' experience and satisfaction using telemedicine for knee and hip osteoarthritis care during the COVID-19 pandemic.

Methods: Adult patients seen via telemedicine for knee and/or hip osteoarthritis pain completed surveys through the REDCap online platform or pen/paper evaluating their experiences and satisfaction with telemedicine, assessed using yes/no and Likert scale questions. Demographic information was collected from the electronic medical record (EMR).

Results: 32 subjects (9 males, 23 females, mean age 63.2 years [SD = 12.2 years]) completed surveys. 90.6% of subjects stated that they were satisfied with the audio/video quality …

Trial By Fire: Impact Of Rapid Expansion Of Telemedicine In A Large Community Health System, Scott Stratton-Smith, Cole Nardi, Benjamin Snyder

Advances in Clinical Medical Research and Healthcare Delivery

Background: Our community-based health system transitioned to a largely telehealth-based approach under the pressure of the COVID-19 pandemic. Limited implementation of telehealth had begun in 2018, but provider and patient reluctance and inadequate reimbursement prevented widespread adoption at the time. The pandemic accelerated our system’s telehealth efforts.

Results: In February 2020, video technology was rarely utilized, with the organization averaging fewer than 10 video visits per month. In April 2020, our providers used it for over 30% of all visits in our system, accounting for over 30,000 visits. Before COVID-19, fewer than 20 of our providers had performed a direct-to-patient …

Clinical Presentation Of Covid-19 Disease In Two Rural New York Counties, Richard Terry, Sadaf Mughal, Vidhya Reddy, Tina Burt

Advances in Clinical Medical Research and Healthcare Delivery

Purpose

To analyze the phenotypic expression of Coronavirus infection (COVID-19) among patients residing in the Chemung and Schuyler counties of New York State.

Method

A retrospective review of medical records was performed between March 16, 2020 to April 16, 2020. Sixty- five patients presenting with symptoms of COVID-19 infection were included in this IRB-exempt study. Presence of infection was confirmed using reverse transcriptase polymerase chain reaction (RT- PCR) from nasopharyngeal swab samples, as per Centers for Disease Control and prevention (CDC) guidelines.

Results

Patients varied in age from 13 to 82 years, with nearly equal proportion of females (51%) vs …

Colonic Gallstone Obstruction, Abdoulaziz Toure M.D, Mitchell Witkowski, Vithal Vernenkar D.O, Brian Watkins Md, Ms, Facs, Prasad V. Penmetsa M.D

Advances in Clinical Medical Research and Healthcare Delivery

This report discusses a case of a 79-year-old Caucasian female who presented with large bowel obstruction. A significant CT findings of cholecystocolic fistula and an impacted gallstone at the junction of the descending and sigmoid colon. We present a case of colonic gallstone obstruction that was treated with endoscopic lithotripsy. This interventional approach is effective in stable elderly patients with high surgical risk and in patients with significant comorbidities.

A Rare Case Of Upper Arm Compartment Syndrome In A Patient On Anticoagulant Therapy, Zi Tan, Ammar Ahmed, Amr Khalifa, Roy Trumbo

Advances in Clinical Medical Research and Healthcare Delivery

Background Compartment syndrome is the condition when elevated pressures within an osseofascial compartment cause vascular and neurological compromise, leading to muscle ischemia and possible necrosis if left untreated. It commonly occurs after a traumatic event (e.g., crush injury, fracture, trauma); however, compartment syndrome can still happen spontaneously and in any compartment of the body.

The objective of this case report is to present the signs and symptoms of upper arm compartment syndrome, which is a rare site for compartment syndrome, along with a review of the diagnosis and treatment.

Case Report A 62-year-old man receiving anticoagulant therapy for atrial fibrillation …

Why Are We Doing This?, Richard Alweis, Hemant Kalia

Advances in Clinical Medical Research and Healthcare Delivery

The editors of the journal explain the rationale for founding a new journal and the goals of the journal.