Medicine and Health Sciences Commons^™

Effect Of An Electronic Order Set On Newborn Hepatitis B Immunization Rates, Daniel Pedersen, Angelina Rodriguez, Olu Oyesanmi, Heather Schramm, Michael King

HCA Healthcare Journal of Medicine

Objective

Hepatitis B is an infectious deoxyribonucleic acid virus which can cause significant morbidity and mortality. There is no current definitive treatment, however in the United States immunization is widely available. A paper published by the Advisory Committee on Immunization Practices/Centers for Disease Control (ACIP/CDC) in 2018 made updated recommendations regarding vaccination practices in the United States. The most notable change made was that all healthy newborns weighing ≥2000 g with a negative hepatitis B-status mother should receive hepatitis B immunization within 24 hours of birth. This quality improvement project studied the effect of the electronic medical record newborn admission …

Covid-19: Race For Vaccine, L. Hayley Burgess, Jason J. Braithwaite, Emily Singleton, Aaron M. Young, Mandelin K. Cooper

HCA Healthcare Journal of Medicine

The world is in the midst of a pandemic from COVID-19, a disease caused by the virus SARS-CoV-2. Despite broad mitigation efforts, new cases continue with 74 million cases and 1.6 million deaths worldwide. Regardless of previous research efforts, there is no commercially available vaccine for any coronavirus. Novel vaccine development has historically taken at least 10 years from discovery to availability with only a 6% market entry probability.

With the global impact, there is an urgency to expedite a vaccine to protect the population. The U.S. government launched Operation Warp Speed with the goal to produce and deliver 300 …

Importance Of Awareness Of Adverse Drug Reaction Reporting During The Covid-19 Pandemic, Heather Ellis, Hale Z. Toklu

HCA Healthcare Journal of Medicine

Health care professionals hold the responsibility of reporting any adverse drug reactions in order to learn about new therapy and how best to safely care for our patients. The information derived from case publications and FDA MedWatch reports are essential to accumulate information and increase awareness for the possible risks of new drugs.

Informing Strategy To Ensure Detection: Perceptions Of Coronavirus Testing In A Southeastern U.S. Urban Homeless Population, Colleen Bell, Theodore Bosi, Barbara L. Gracious

HCA Healthcare Journal of Medicine

Introduction: Attitudes of those in the homeless population toward testing, particularly during a pandemic, are critical to understand, so that they and their communities may be safely triaged and protected. Homeless persons are more likely to be exposed during viral epidemics, and have greater vulnerability for more severe viral illness, due to greater medical comorbidities. The literature reflects a dearth of published papers describing the perceptions, interest, and motivations of homeless people to seek or receive viral testing, despite their status as a high-risk population.

Methods: A quality improvement project consisting of a cross-sectional survey took place at 8 SARS-CoV-2 …

Covid-19 Needs Assessment And Support For Primary Care Practices In Western North Carolina, Sheri Denslow, Jill Fromewick, Kacey Scott, Jesse Bossingham, Brian Cass, Bryan Hodge, Erica L. Richman, Tammy Garrity, Kathleen Mottus, Jacqueline R. Halladay

HCA Healthcare Journal of Medicine

Background: It is critical to ensure that Primary Care Providers (PCPs) have adequate personal protective equipment (PPE), supplies, training, staffing, and contingency planning during pandemics, particularly in rural areas. In March 2020, during the onset of the COVID-19 pandemic, the Mountain Area Health Education Center (MAHEC), in collaboration with the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill, rapidly created and conducted a needs assessment of PCPs in western North Carolina (WNC).

Methods: A group of twenty volunteers conducted a telephone survey of PCPs in a 16 county region of WNC. Practices were asked about their …

Acute Ischemic Stroke As The Presenting Feature Of Covid-19 In The Young And Pregnant, Nermila A. Ballmick, Jiri F. Kubac, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left …

Neuropsychiatric Presentation Of Covid-19: A Case Report Of Disinhibition In An Acute Sars-Cov-2 Infection, I. Jack Abramson, Kristy A. Fisher, Clara V. Alvarez, Jacqueline Horan Fisher

HCA Healthcare Journal of Medicine

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) viral infection is notable for a high degree of symptom diversity. Emerging evidence suggests viral invasion of the central nervous system; therefore, serious neurological and psychiatric manifestations are anticipated. We present the case of a 67-year-old male physician with a history of stable Bipolar Disorder for decades, hospitalized for persistent COVID-19 symptoms with documented positive serology, who presented with new and acute onset neuropsychiatric symptoms of disinhibition proximate the viral infection. We postulate neuroinvasion as the putative origin of the patient’s psychiatric instability. Further investigation is needed to expand upon our understanding of the …

Fear-Based Barriers To Care In The Covid-19 Pandemic, Christopher Ott

HCA Healthcare Journal of Medicine

COVID-19 has made patients afraid to engage with providers in-person to manage acute, chronic and preventive non-COVID-related health care needs. As health care providers, we must continue to do everything within our power to address our patients’ fear of our infrastructure and the increasing barriers they are experiencing to accessing the care that they need.

Adverse Childhood Experiences As Predictors Of Perceived Health: Assessing The Ace Pyramid Model Using Multiple-Mediation, Phillip Hughes, Tabitha L. Ostrout

HCA Healthcare Journal of Medicine

Background: Adverse Childhood Experiences (ACEs) have been shown to contribute to a litany of mental and physical health problems, including several chronic diseases and death, via a model known as the ACE pyramid. Many of the results of ACEs in the ACE pyramid are known contributors to poor perceived health, which has significant health implications. Despite these results, a possible link between ACEs and perceived health has not been examined to date. Based on the temporal order of the ACE pyramid, we believe any relationship between ACEs and perceived health will be mediated by other components of the model.

Methods: …

Non-Obstetric Vulvar/Paravaginal Hematoma In An Adolescent Female With Scleroderma: An Opportunity For Intimate Partner Violence Intervention, Amanda Burnham, Jo Cooke-Barber, Stephen Thacker, Donna Evans, David Carney, William Boswell

HCA Healthcare Journal of Medicine

A 15-year-old female presented to the emergency department with swelling and pain in her left labial region as well as urinary retention after intercourse. This was the patient’s first time having sexual intercourse and the patient stated that her boyfriend “kneed” her in the labia. A CT scan of the pelvis revealed a large vulvar/external hematoma measuring 6 x 10 x 7 cm which extended into the vaginal vault. This case is the first of a vulvar hematoma reported in a pediatric patient with scleroderma. This case was complicated by the fact that our patient claimed her boyfriend intentionally “kneed” …

Cosmetovigilance: A New Concept For Residency Curriculum, Jennifer Jones, Hale Z. Toklu

HCA Healthcare Journal of Medicine

Primary care physicians need to incorporate “cosmetovigilance” into their post-graduate curriculum to increase their residents’ awareness of the adverse reactions induced by the use of cosmetic products, as well as promoting good reporting behavior.

Geriatrics In Clinical Practice And Beyond: Brain Health, The Sixth Vital Sign?, Nannette Hoffman

HCA Healthcare Journal of Medicine

Brain health in middle age and geriatric patients will take on greater importance for health care practitioners in our aging society. This article discusses various approaches clinicians can use for their patients to promote and improve brain health. These are generally the same lifestyle adoptions for cerebrovascular disease and cardiovascular disease prevention: weight management, exercise, and blood pressure and cholesterol lowering. Social stimulation and cognitive activities may also be important for the elderly.

The Other Epidemic, Bruce Deighton

HCA Healthcare Journal of Medicine

The epidemic level of opioid abuse in the U.S. population continues to present a major challenge to our society and to the medical profession. Medical education has a significant role in improving screening, diagnosis, appropriate treatment and management of opioid use disorder. Addressing the problem of overprescribing opioids through physician education, surveillance and opioid management has resulted in significant improvement, translating to fewer overdose deaths from prescription opioids. Graduate medical education can increase access to care by training more addiction medicine specialists, and training other physicians to prescribe buprenorphine and provide access to medically assisted care.

A Rare Case Of Leprosy In West Florida, Adrian Lugo, Taylor Studsrud, Nemer Dabage, James Demaio

West Florida Division GME Research Day 2020

• Leprosy is caused by acid-fast bacilli of the M. leprae complex, which includes M. leprae and M. lepromatosis.
• Transmission in the U.S. is rare, but has been documented in hunters who handle wild ninebanded armadillo.
• The origins of M. leprae infection among armadillos, the geographic range of the infected animals, and the potential risks infected armadillos present to people have been topics of concern.
• The infection originated amongst armadillos decades before they were ever used in leprosy research, and numerous surveys have confirmed that armadillos in the southern United States are a large natural reservoir for M. leprae; its prevalence …

End The Glow!, Roli Kushwaha, Anthony Furiato, Justin Mcnamee

West Florida Division GME Research Day 2020

Aortic dissection (AD) is part of a group of acute aortic syndromes consisting of intramural aortic hematoma, penetrating aortic ulcer, and aortic rupture. On its own, the incidence is ~3 to 8 cases per 100,000 per year, and up to 25% of cases are missed. The in-hospital mortality when treated is 27%, and with a 2% increase in mortality/hour. Imaging modalities like CT angiography, TEE, and MRA have made improved diagnosis of the disease, but are costly, potentially harmful, time consuming, and require patient stability when in use (1). The key question we have as emergency department providers is if …

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

West Florida Division GME Research Day 2020

A case control study of 118 patients from Oak Hill Hospital between the months of August 2019 and January 2020 was recently completed for a hospital research quality improvement study. 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 when compared to its disuse. Results indicate use of either the Hemorrhagic or Ischemic Stroke Order Set led to a decreased length of stay and an increased adherence to current stroke guideline recommendations. Limitations of the study included …

Effect Of An Electronic Order Set On Newborn Hepatitis B Immunization Rates, Daniel Pedersen, Angelina Rodriguez, Michael King, Heather Schramm

West Florida Division GME Research Day 2020

No abstract provided.

Transitioning To Value-Based Diabetes Care: A Call For Action Derived From Primary Care Providers In South Florida, Francois Sainfort, Julie A. Jacko, Johannes Vieweg

HCA Healthcare Journal of Medicine

Background: In Florida, 2.4 million people have diabetes and 5.8 million are pre-diabetic. Not only has the prevalence of diabetes doubled over the past 20 years from 5.2 in 1992 to 11.2 in 2014, but the Centers for Disease Control and Prevention expects 1 out of every 3 adults will have diabetes by the year 2050. In addition, in every year since 1996, Florida well exceeds the national levels in terms of prevalence of diabetes, and the gap is getting wider. A study was conducted to gather information from key physician stakeholders as to how to address unmet needs of …

The Role Of Nutrition In Promoting Gut Health And Treating Chronic Illness Through The Attenuation Of Inflammation, Allison Dalton

HCA Healthcare Journal of Medicine

Over the millennia, the human body and microorganisms such as bacteria, viruses, archaea, protozoa and parasites have coevolved together forming an intimate relationship. These microorganisms are found on the skin, in the mouth, genitourinary tract and most abundantly in the large intestine of the digestive tract. States of microbial dysbiosis contribute to chronic inflammation, which can lead to the pathogenesis and progression of numerous diseases. Micro- and macro-nutrients as well as dietary patterns like the Mediterranean diet can help improve health outcomes.

Differences In Outcomes Of St-Segment Elevation Myocardial Infarction In African American Women Versus Women From Other Races: A United States National Study., Tasleem Katchi, Sanja Virani, Shaun Smithson, Bryan Curry

Cardiology

No abstract provided.

A Comparison Of Models For Evaluation And Transfer Of Patients With Suspected Large Vessel Occlusions, Edward Jauch, Parita Bhuva, Alex Schneider, Jason Thurman, Josh Lewis, Kathryn Mccarthy, Debra Philpot, Robin Jones, Albert Yoo, Don Frei

Neurology

Introduction: Mechanisms for the hospital identification of patients with suspected large vessel occlusions (LVO) vary widely based on referring and receiving stroke center resources. We compared processes for identifying patients with suspected LVO who may be candidates for endovascular therapy (EVT) at non-EVT hospitals and the criteria for interfacility transport to Comprehensive Stroke Centers (CSC) for potential EVT. Methods: Data were obtained from 4 CSC which serve distinct geographic regions, ranging from rural to urban environments, over a continuous 12 month period of time beginning year 2018. Patients transferred from all referring hospitals to these facilities were considered regardless of …

Seek And You Shall Find: Is Routine Duplex Ultrasound Screening For Deep Vein Thrombosis In Trauma Warranted?, Ashley Thompson Md, Krista Miller Md, Tatiana R. Eversley-Kelso Mph, Eric Shaw Phd, James Dunne Md, Heather Macnew Md, Facs

General Surgery

See additional files

Reinventing The Tradition Of Morbidity And Mortality Conference: Turning Anecdotes Into Databases, Tandis Soltani Md, Key Yan Tsoi Md, Alexandra Csortan, Aidan Charles Md, Darwin Ang

General Surgery

See attached.