Medicine and Health Sciences Commons^™

Perceptions Of Middle Ear Squeeze Crowd Sourcing Web Site Vs Diver Comparison, Anthony Shadiack, Derek Pride, J Banks, Mike Flynn

South Atlantic Division GME Research Day 2022

No abstract provided.

Congenital Non-Union Of C1 Leading To Quadriplegia Following A Roller Coaster Ride, Kelly Champlin, Saptarshi Biswas

South Atlantic Division GME Research Day 2022

No abstract provided.

Bilateral Renal Infarcts From Blunt Trauma In A Healthy Young Female Patient. Clinical Dilemmas, Diagnostic Conundrum And Management., Kelly Champlin, Austin Mccrea, Saptarshi Biswas

South Atlantic Division GME Research Day 2022

No abstract provided.

Suspected Blow To The Chest? Investigate It!, Parisa Biazar, Catherine Mitchell, David I. Rosenberg

South Atlantic Division GME Research Day 2022

No abstract provided.

Implementation Of Standardized Protocols For Office Blood Pressure Measurement, Steven Nevers, Alice Tran, Carol Gambrill, Anush Pillai

Gulf Coast Division GME Research Day 2022

No abstract provided.

A Rare Case Of Ibrutinib-Induced Panniculitis In A Patient With Chromic Lymphocytic Leukemia, Elise Weisert, Kevin Dimas, Michelle Hebert, Nawaf Alrehani

Gulf Coast Division GME Research Day 2022

No abstract provided.

Thyroid Steal Syndrome Secondary To Active Hyperthyroid State, Harrison Humphries, Johnathon Chung, Reza Pirzadeh, Wesley Jones, Mohamad Ezzeldin

Gulf Coast Division GME Research Day 2022

No abstract provided.

Improving Code Status Discussion And Documentation For Patients 65 Years Or Older At Hca Fl Osceola Hospital, Taylor Murphy, Mark Duros, Faris Matanes, Keishla Garcia Fernandez, Raj Shah, Olga Karasik

North Florida Division GME Research Day 2022

No abstract available.

Palliative Privacy, Lina Fernandez, Jarratt Burton Banks, Stephen Meyer

South Atlantic Division GME Research Day 2022

No abstract provided.

Unusual Case Of Isolated Pancreatitis Secondary To Blunt Abdominal Trauma, Haroutiun Hamzoian, Reuben Plasencia, Ndifreke Ekpa, Elias Georg

Gulf Coast Division GME Research Day 2022

No abstract provided.

Sporadic Creutzfeldt-Jakob Disease After Receiving The Second Dose Of Pfizer-Biontech Covid-19 Vaccine, Andrea J. Folds, Melanie-Belle Ullrich, Sann Htoo, Anjeza Chukus

Internal Medicine

No abstract provided.

A Vista Of Kahana Bay, Haryashpal Bhullar

HCA Healthcare Journal of Medicine

This is a picture of Kahana Bay in Honolulu, HI I took when I was visiting my friend stationed at Tripler Army Medical Center last year. Like me, he is a Psychiatry resident and I had not seen him in over a year, so meeting him was quite meaningful to me as we had so much more to talk about. Having this vista behind us while we climbed and shared stories made for one of the best hikes of my life. I often look at this photo and realize the freedom we had to fly to all sorts of beautiful …

Corona, Syed Anjum Khan

HCA Healthcare Journal of Medicine

We all are witnessing unprecedented pain and suffering, enduring unsurpassed tribulations. As a doctor working in an intensive care unit each day, I carry the burden of my patients and their families, my coworkers, my own family and friends. I never think about myself, the burden on my soul.

Yet I believe there will be a better tomorrow. A new day, where COVID times will be remembered with tears in our eyes yet a comfort in our smile that it’s past.

Primary Care Practices In Western North Carolina: Adaptation To The Covid-19 Pandemic And Ongoing Challenges, Hannah R. Friedman, Joseph Konstanzer, Erica Richman, Brian Cass, Bryan Hodge, Sheri Denslow, Jacqueline Halladay

HCA Healthcare Journal of Medicine

Introduction

The COVID-19 pandemic has created unique challenges for primary care practices while also highlighting their importance in the pandemic response. To understand primary care practice needs, a survey was conducted of practices in Western North Carolina.

Methods

Phase 2 of a primary care needs assessment was administered to 63 practices in Western North Carolina over the course of six weeks, from July 23 to August 31, 2021.

Results

Most practices were operating with normal hours, though some still operated with reduced hours. Many practices reported insufficient personal protective equipment (PPE) supplies. While most practices provided at least some care …

An Assessment Of The Diagnostic Value In Syncope Workup: A Retrospective Study, Ashan T. Hatharasinghe, Kayvon Etebar, Ryan Wolsky, Hossein Akhondi, Napatkamon Ayutyanont

HCA Healthcare Journal of Medicine

Background

Patients with syncope often undergo costly testing, despite current guidelines and data supporting the contrary.

Objective

To determine the diagnostic value through positivity rate of electrocardiogram (EKG), computed tomography (CT) of the brain, magnetic resonance imaging (MRI) of the brain, transthoracic echocardiogram, nuclear and pharmacologic cardiac stress test, tilt table test and carotid ultrasound in patients diagnosed with syncope.

Methods

This is a retrospective study of 10,036 adults presenting to the emergency department or hospitalized with a primary diagnosis of syncope at 8 acute care facilities in the southwest United States from January 1, 2019, to December 31, 2019. …

Pharmacy-Led Medication Reconciliation Program Reduces Adverse Drug Events And Improves Satisfaction In A Community Hospital, L. Hayley Burgess, Joan Kramer, Carley Castelein, Joseph M. Parra, Victoria Timmons, Samantha Pickens, Sarah Fraker, Christopher Cameron Skinner

HCA Healthcare Journal of Medicine

Background

Pharmacy-led medication reconciliation identifies and corrects medication errors that can potentially cause moderate to severe harm. This research sought to identify the impact of pharmacy-led medication reconciliation on patient outcomes and describe the changes in healthcare workers’ perceptions of the program.

Methods

A pharmacy-led admission medication reconciliation program pilot started in July 2019, and a discharge medication reconciliation proof of concept was tested in September 2020 at a 432-bed hospital. The following periods were compared: August 2018 to February 2019 (pre-program implementation) and August 2019 to February 2020 (post-program implementation). Endpoints included patient outcomes, workforce productivity and interdisciplinary healthcare …

Jacuzzi-Induced Pneumoperitoneum: Case Report And Literature Review, Obteene Azimi-Ghomi, Dieter Brummund, Vasiliy Ovakimyan, Gerardo Kahane

HCA Healthcare Journal of Medicine

Radiographically-detected pneumoperitoneum in the setting of acute onset abdominal pain is a classic case among surgical emergencies. The spectrum of etiology ranges from benign to catastrophic, and the ability to differentiate depends in large part on the history and physical exam findings. Included among non-surgical types of pneumoperitoneum are (1) post-operative, (2) diagnostic/experimental, (3) gynecologic tract air entry, (4) the difference in intra- and extra-alveolar pressures, pneumothorax-associated and (5) miscellaneous. Jacuzzi-induced pneumoperitoneum is an extremely rare form of non-surgical pneumoperitoneum. We discuss a case of a 32-year-old female presenting with pneumoperitoneum and acute onset abdominal pain secondary to vaginal insertion …

Epidural Anesthesia For Cesarean Section For Parturient With Recently Diagnosed Asymptomatic Chiari Malformation Type I: A Case Report, Ashie Kapoor, Jon Halling

HCA Healthcare Journal of Medicine

Chiari malformations (CMs) are congenital defects of the brain and skull that result in inferior displacement of the cerebellum. There are four types of CMs distinguished by the severity of the anatomic defects and parts of the brain that protrude beyond the foramen magnum. Of these types, CM Type I (CMI) is the least severe. It is characterized by the downward displacement of the cerebellar tonsils beyond the foramen magnum by more than 5 millimeters and goes into the cervical spinal canal. CMI is the most common type with an incidence of 0.1-0.5% in the general population and a predominance …

Steroid-Refractory Lichenoid Eruption Associated With Pembrolizumab In A Patient With Non-Small Cell Lung Cancer, Leon Kou, Sanjay Agarwal, Alyssa Miceli, Logan Kolb, Karthik Krishnamurthy, Shawn Schmieder

HCA Healthcare Journal of Medicine

Programmed cell death receptor 1 (PD-1) inhibitors are promising and effective treatments for various cancers. Cutaneous adverse events, such as lichenoid drug eruptions, are well-known common side effects associated with PD-1 inhibitors. Lichenoid drug eruptions associated with PD-1 inhibitors show rapid improvement with high potency topical steroids and do not require cessation of the offending drug. We present the case of an 84-year-old female with progressive pembrolizumab therapy-associated lichenoid eruption that was resistant to several treatments and ultimately required discontinuation of pembrolizumab and treatment with methotrexate to resolve. This report includes histological findings of the pembrolizumab-associated lichenoid eruption.

The Role Of Physical Activity In Older Adults And Practical Intervention, Se Won Lee, Rebecca Patel, Bryan Werner, Ji Won Yoo, Timothy Tiu

HCA Healthcare Journal of Medicine

Physical inactivity (PI), defined as not meeting guidelines for physical activity beyond baseline daily living activities, is common among older adults (age 65 and older) and contributes to increased morbidity, increased mortality and increased health care spending. Understanding the clinical impact of PI on common medical conditions among older adults will help primary care physicians (PCPs) to educate these patients successfully. Physical activity and exercise are effective in the primary and secondary prevention of chronic diseases that can lead to physical impairments, disability and/or premature death. Physical activity and exercise have been shown to improve cognitive dysfunction and painful musculoskeletal …

Endometriosis And Pelvic Pain In The Adolescent: Delayed Diagnosis Leading To Long-Term Suffering And The Need For Intervention, Latashia-Lika Lelea

OB-GYN

No abstract available.

Music And Medicine, Sanjana Sundara Raj Sreenath

HCA Healthcare Journal of Medicine

This digital artwork, titled “Music and Medicine”, explores the role of holistic patient care as well as the important role of music as a therapeutic tool. Patients often seek connection and belonging during illness, and music serves as a powerful tool in healing. The important role of music in minimizing anxiety and improving mental wellbeing has been brought to the forefront during the Covid pandemic, given the drastic increases in depression and anxiety levels during this time.

Hand Hygiene And Hospital-Acquired Infections During Covid-19 Increased Vigilance: One Hospital’S Experience, Alexander Kong, Carlos S. Botero Suarez, Bebe Rahamatalli, Jennifer Shankweiler, Olga Karasik

HCA Healthcare Journal of Medicine

Background

Hospital-acquired infections are associated with increased morbidity, mortality, costs and length of stay. Prior studies have linked increased hand hygiene compliance with reduced hospital-acquired infection rate. With the increased vigilance for personal and institutional hygiene practices during the COVID-19 pandemic, we hypothesized increased hand hygiene compliance and, as a result, decrease in hospital-acquired infections in our hospital.

Methods

Hand hygiene compliance data was provided by the hospital’s Quality Department. We queried and empirically analyzed local hospital-acquired infection data obtained from our Quality Department and the National Healthcare Safety Network. We compared local hand hygiene compliance rates before and after …

Characteristics Contributing To A Pharmacy Services Excellence Model In A Large Health System, L. Hayley Burgess, Sara Fletcher, Mandelin K. Cooper, Elizabeth Wiggins, Susan S. Horton, Joan S. Kramer

HCA Healthcare Journal of Medicine

Objective

To identify characteristics that contribute to and promote a pharmacy services center of excellence model in a large health system.

Methods

In 2019, a survey was conducted of 161 acute care pharmacy departments of health system-affiliated hospitals. Information captured included pharmacy practice models, pharmacist resource allocation, training of pharmacy residents, postgraduate training and pharmacist certifications. Results were combined with clinical pharmacy metric performance and centralized electronic data to identify features of top performing pharmacy departments.

Results

Survey results were received from 141 of 161 affiliated hospitals (88%). Hospitals with 100 to 299 beds comprised 54% (n = 16 of …

Patient Characteristics And Emergency Treatment Orders In Three Florida Inpatient Psychiatric Units, France M. Leandre, Hong Liang, Sarah Fayad, Michael Johnson

HCA Healthcare Journal of Medicine

Background

Florida law defines emergency treatment orders (ETOs) as an immediate administration of psychotropic medications to a person to expeditiously treat symptoms that may present an immediate danger to the safety of the person or others.1 There is currently little information on who receives ETOs. In this study, we aim to explore correlations between patients’ demographics and administering ETOs in order to understand this cohort, which could allow for improved services and alternative interventions.

Methods

This retrospective study examined data from 1,460 adult patients who were admitted to an acute inpatient psychiatric unit from January 2015 to December 2017 and …

The Influence Of Hospital Site On Emergency Physician Press Ganey Scores, Dietrich Jehle, Brian Doherty, Lexus Dickson, Melville C. O'Brien, Casey Wilson, Scott Gutovitz

HCA Healthcare Journal of Medicine

Background

The use of physician satisfaction scores to evaluate emergency medicine physicians’ performance and compensation is controversial. Prior studies have shown that the clinical environment may influence scores. This study compared satisfaction scores for the same physician at different emergency departments (ED). Differences in their individual score may indicate the ED environment could be as important as the physician’s interaction.

Methods

Press Ganey satisfaction scores were obtained for physicians at three EDs—Grand Strand, South Strand and North Strand—between July 2018 and June 2019. Included physicians worked at all 3 facilities and had at least 6 patient satisfaction surveys at each …

A Case Report Of Dissociative Amnesia Involving “Detective Work”, Muhammad Sharifi, Ana Turner, Traci Fuglestad, Colleen Bell

HCA Healthcare Journal of Medicine

Dissociative amnesia is a rare psychiatric disorder presenting with sudden retrograde memory impairment and inability to recall autobiographical information that is inconsistent with normal forgetting. This case report discusses dissociative amnesia with dissociative fugue in a middle aged male that led to him becoming homeless. Because of his autobiographical forgetting, he was unable to access services, and we present here the distinctive “detective work” needed to not only help treat his symptoms, but also help him legally establish who he is and gain access to housing. This patient is unique in that he only began psychiatric treatment in his late …

Ecthyma Gangrenosum And Panniculitis Secondary To Acute Pseudomonas Myositis Without Bacteremia, Heather Gosnell, Matthew Burke, Joseph Shnouda

HCA Healthcare Journal of Medicine

Introduction

Ecthyma gangrenosum (EG) is a relatively uncommon cutaneous manifestation of an underlying Pseudomonas aeruginosa infection and is clinically described as necrotic with gangrenous ulcers surrounded by erythematous halos. Cases of EG may occur in the absence of bacteremia and have been increasingly reported in literature. Here we present a patient with features of both EG and panniculitis, despite the lack of underlying bacteremia.

Clinical Findings

A 57-year-old male presented to the emergency department with unrelenting right-sided lower back pain and an “itchy and painful” rash of four to five day duration. The patient had an extensive history of intravenous …

Induction Of Hypopituitarism Following Ipilimumab/ Nivolumab Therapy Followed By Radiation In The Treatment Of Metastatic Scalp Melanoma, Joshua K. Salabei, Dhaval Upadhyay, Sripal A. Padam

HCA Healthcare Journal of Medicine

Immune checkpoint inhibitors (ICI) are antagonistic antibodies that block specific immune checkpoint molecules, such as cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death protein (PD-1) and its ligand PD-L1. With FDA approval, the use of these checkpoint inhibitors has led to long-lasting tumor responses. However, by stimulating the immune system, checkpoint inhibitors can cause immune-related adverse events involving the endocrine organs, among others. Pituitary dysfunction (hypophysitis) leading to secondary adrenal insufficiency, or primary adrenal insufficiency caused by immune checkpoint inhibitors, have been documented. In this report, we present a case of a 70-year-old man with scalp melanoma with metastasis to …

A Rare Diagnosis Of Strongyloides Stercoralis In The Pleural Cavity, Fatemeh Rhana Mousavi, Emon Alavi, Nick A. Hirad

HCA Healthcare Journal of Medicine

Strongyloides stercoralis is a soil-transmitted helminth that causes strongyloidiasis, a chronic parasitic infection in humans. S. stercoralis is one of several worm species that cause soil-transmitted helminthiasis, a neglected tropical disease. Herein, we discuss a 78-year-old female residing in a nursing home presenting with abdominal pain and shortness of breath. During a thoracentesis, physicians found multiple rhabditoid larvae consistent with S. stercoralis. However, before the procedure, a serial assessment of stool sample was performed and failed to demonstrate a parasitic infestation. Many of those infected with S. stercoralis are asymptomatic. Lack of symptoms and low sensitivity in traditional parasitological …