Medicine and Health Sciences Commons^™

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 …

A Case Of Medication-Induced Diffuse Alveolar Hemorrhage In Neurofibromatosis Type 1, Ashar Mahmood, Liz Palmer, Rebecca Schuyler, Svitlana Sharpovalova, Bilal Nadeem, Mukesh Mehta, Salman Muddassir, Nikolay Mitzov, Monicka S. Felix

West Florida Division GME Research Day 2020

• Amiodarone, an antiarrhythmic and apixaban, an anticoagulant have been associated with diffuse alveolar hemorrhage (DAH).
• Cases have been documented demonstrating DAH in the setting of amiodarone and apixabantreatment, however there are few cases examining DAH in combination therapy.
• We present a case of diffuse alveolar hemorrhage in the setting of amiodarone and apixaban treatment for paroxysmal atrial fibrillation.
• NF1 is know to have higher risk for major bleeds due to their friable vasculature.

Diaphragmatic Paralysis: A Presentation Of Spontaneous Chest Pain And Shortness Of Breath, Donna Dorriz, Hilary Lois, Candace Wise, Brady Dehart

Capital Division GME Virtual Research Day 2020

Chest pain accounts for approximately 7.6 million annual visits to emergency departments (ED) in the United States and can include a broad differential1. The workup warranted includes extensive testing with the goal of demonstrating a reassuring cardiopulmonary status. When preliminary chest pain workup is negative, the subtle features of common primary symptoms can provide insight into other less common etiologies. This case looks to highlight the rare presentation of a relatively healthy middle age male with complaint of chest pain and shortness of breath, worsened with exertion and supine position. When standard cardiopulmonary workup was negative, further specialty testing was …

A Rare Cause Of Pneumoperitoneum, Robert Zusman, George Michael, Anna E. Augustin, My Myers, Dudith Pierre-Victor

West Florida Division GME Research Day 2020

Pneumoperitoneum is most commonly associated with a perforated viscus. When free air is seen on imaging, the most common course of action is an emergent exploratory laparotomy. However, pneumoperitoneum may not always be indicative of a perforated bowel. In the case described below, we will discuss a patient who developed acute peritonitis and pneumoperitoneum after undergoing chest compressions during cardiopulmonary resuscitation (CPR) and positive pressure mechanical ventilation.

New Dentist News (May 2020), Ada Committee On The New Dentist

New Dentist News

New Dentist News offers timely information on scientific, social, educational, political and economic developments affecting new dentists. This collection is historical and items may not reflect current standards. For up-to-date information contact the ADA. The New Dentist News was alternately titled ADA Lifeline, 1997-June 2001.

Effects Of Latinx Parental English Proficiency On Stress, Maria Alvarez Pineda

Student Research Posters

In the United States, patients who have Limited English Proficiency (LEP) report having more problems communicating with their children’s doctors (Eneriz-Wieme et al., 2014) and experiencing more discrimination (Zhang et al., 2012) which can lead to increased psychological distress (Torres et al., 2012). The goal of this study was to determine if level of English Proficiency is related to stress levels and discrimination among Latinx parents. Participants consisted of 22 Latinx parents (86.4% Mexican and 90.9% female) in the San Francisco Bay Area. The Acute Stress Appraisals scale (Mendes, et al., 2007) measured parents' stress levels before and after an …

The Scoop, Vol. 7 Issue 2, May 2020, Health Sciences Library

Volume 7

Reporting the latest from your Health Sciences Library.

Inspire : Vol 3, Issue 5, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message From The Chair
• Medicine at National and International Forums
• Featured Faculty: Dr Aamir Hameed “Success is a fight between you and yourself”
• What Are Academics Around the World Reading This Month?
• Publications

Development Of Drive-Through And Mail-In Systems For Obtaining Surveillance Respiratory Specimens In A Pediatric Cystic Fibrosis Center, Ellen Meier, Paula Capel, Christopher M. Oermann

Posters

Routine surveillance cultures are an essential part of health maintenance for people with cystic fibrosis (CF). The Cystic Fibrosis Foundations (CFF) recommends that respiratory cultures be obtained every three months. The CF Care Center at Children’s Mercy Kansas City (CMKC) also obtains respiratory cultures when there is an acute change in respiratory symptoms. The COVID-29 pandemic resulted in ambulatory clinic closures and an inability to obtain surveillance respiratory cultures. A creative solution for obtaining respiratory cultures was needed during the pandemic.

Incorporating A Clinical Pharmacist In An Outpatient Palliative Care Team, Crystal Rim, Sharon Leigh, Linda Desitter, Mary Grant, Dana Nguyen

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2020

Title: Incorporating a clinical pharmacist in an outpatient palliative care team

Crystal Rim, PharmD; Sharon Leigh, PharmD, BCPS; Linda De Sitter MD, MPH; Mary Grant, ANP; Dana Nguyen, PharmD

Palliative care is a growing field in medicine that focuses on delivering care that improves quality of life for patients with serious illnesses. Often, the goals of palliative care differ from traditional goals of medicine. Currently, there is limited data demonstrating the integration of pharmacists in the palliative care setting. The purpose of this quality improvement is to evaluate the clinical pharmacist’s role within an outpatient palliative care team when performing …

Impact Of Academic Detailing On Clinical Pharmacy Specialist Involvement In Medication Assisted, Lindsey M. Bartos, Kristin A. Tallman, Dara L. Johnson

Providence Pharmacy PGY2 Program at Providence Medical Group 2020

Title: Impact of academic detailing on clinical pharmacy specialist involvement in medication assisted treatment for opioid use disorder in a primary care setting

Lindsey Bartos, PharmD; Kristin Tallman, PharmD, BCPS, BCACP; Dara Johnson, PharmD, BCPP, BCACP

Introduction: Opioid prescribing and opioid overdose deaths have increased steadily since the 1990s, reaching a 6-fold increase between 1999 and 2017. The opioid crisis, as it became known, was declared a public health emergency in 2017. In 2018 alone, an estimated two million people had a diagnosed opioid use disorder (OUD). The use of medication-assisted treatment (MAT) for OUD reduces the use …

Impact Of Pharmacist-Led Appointments For Hypertension Management In A Primary Care Setting: A Retrospective Analysis, Anne Marie Thibodeaux, Christine Doran, Ben Rosati

Providence Pharmacy PGY2 Program at Providence Medical Group 2020

Impact of pharmacist-led appointments for hypertension management in a primary care setting: a retrospective analysis

Introduction: High blood pressure is a major risk factor for heart disease and stroke, two of the leading causes of death for Americans.1 Evidence supports the idea that pharmacist-led hypertension management can result in overall blood pressure reduction; however, it remains unclear whether pharmacist-led initiatives can also improve performance metrics.2-5

Research question: Can pharmacist-led appointments for blood pressure management positively impact hypertension metrics?

Study design: Retrospective chart review

Methods: Primary outcome data was measured via metric inventory, defined as percentage of …

Evaluation Of Transitional Care Interventions From A Decentralized Clinical Pharmacist In A Small Inpatient Geriatric Psychiatry Unit, Nathan Wong, Michael Brown

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2020

Evaluation of Transitional Care Interventions from a Decentralized Clinical Pharmacist in a Small Inpatient Geriatric Psychiatry Unit

Nathan Wong, PharmD; Michael Brown, RPh, BCPS, BCPP

Background: Transitioning between healthcare settings increases the risk for medication errors. A systematic review of 26 studies comparing various medication reconciliation interventions demonstrated consistent reductions in adverse drug events. Intensive pharmacist involvement and focus on high risk populations were the most successful. ¹ Geriatric and behavioral health populations are especially vulnerable with polypharmacy and cognitive impairment often complicating the picture. Providence Milwaukie Hospital (PMH) houses a small unit tailored to provide mental health care …

Empowering Caregivers To Recognize, Support, And Treat Opioid Use Disorder: An Interdisciplinary Assessment Of Knowledge, Attitudes, And Comfort Level Pre And Post-Education, Annette Sprankle, Mika Michaels

Providence Pharmacy PGY1 Program at Providence Medford 2020

Author: Annette Sprankle, PGY1 Pharmacy Resident, PMMC

Title: Empowering caregivers to recognize, support, and treat opioid use disorder: an interdisciplinary assessment of knowledge, attitudes, and comfort level pre and post-education

Background: Substance use disorder affects approximately one in every four hospitalized patients. These patients are often treated for the admitting medical issue without addressing their substance use disorder. A hospital admission provides an opportunity to connect patients to the medical system. Evidence demonstrates that starting medication-assisted treatment in the hospital reduces the risk of overdose upon discharge, rate of hospital readmission, length of stay, and hospital expenditures.

Purpose: The purpose …

Clinical Pharmacist-Led Intervention To Improve Statin Metric For Secondary Prevention At Providence Medical Group – Southern Oregon Region, Chloe Nguyen, Judy Wong, Karen White

Providence Pharmacy PGY2 Program at Providence Medical Group 2020

Clinical Pharmacist-Led Intervention to Improve Statin Metric for Secondary Prevention at Providence Medical Group – Southern Oregon Region

Chloe Nguyen, PharmD, Judy Wong, PharmD, BCACP, and Karen White, PharmD, BCACP

Background: Currently, there is a gap in meeting the statin metric at Providence Medical Group in Southern Oregon Region. The purpose of this project is to identify intervention strategies to improve statin metric for secondary prevention among patients with clinical atherosclerotic cardiovascular disease (ASCVD).

Methods: This quality improvement project was approved by the system’s Institutional Review Board. Patients at least 18 years of age with diagnosis of clinical ASCVD not …

Project Nurture: An Educational Model For Substance Use Disorder Treatment During & After Pregnancy: Saving Lives, Saving Money, Saving Families, And Training Future Doctors, Roxanne Thomas, Brenda Brischetto, Josh Reagan, Daniel Ruegg

Milwaukie Family Medicine 2020

BACKGROUND: • 25% of women presenting for prenatal care are using substances. • Substance Use Disorders (SUDs) in pregnancy are associated with preterm birth, intrauterine growth restriction, placental abruption, increased risk of C-section. • Infants exposed to in utero illicit substances have higher likelihood of being small for gestational age, experiencing a neonatal opioid withdrawal syndrome that requires prolonged NICU hospitalization, and are at higher risk of developmental delay. • Societal costs of SUDs in pregnancy include worsening mental illness, increased utilization of the foster care system, early death secondary to overdose, and associated financial burdens. • The nature of …

Quality Improvement: Improving Depression Screening Rates At Pmg Southeast Family Medicine Clinic, Elizabeth Deyo, Edward Kim, Tyler Nelson, Roxanne Thomas, Jemie Walrod, Nicholas Wolfgang, Ben Pederson

Milwaukie Family Medicine 2020

Introduction: Major depressive disorder is one of the most common mental health problems encountered by primary care providers in the U.S. For people age 12 and older, prevalence is estimated at eight percent. The economic cost of depression has been estimated at $210.5 billion per year, attributed to both costs to the work place and medical costs. People who experience depression are at greater risk for suicide, an otherwise preventable death if depression can be recognized and adequately treated. For these reasons, depression screening has become an essential function within primary care practices both within Providence and nation-wide.

Manual Scalp Cooling In Early Stage Breast Cancer: Value Of Caretaker Training And Patient-Reported Experience To Optimize Efficacy And Patient Selection, Manaz Rezayee, Nikki Moxon, Staci Mellinger, Amanda Y Seino, Nicole E. Fredich, Tracy L. Kelly, Susan Mulligan, Patrick Rossi, Ijeoma Uche, Walter Urba, Alison Conlin, Janet Ruzich, David B Page

Earle A. Chiles Research Institute Fellowship Program 2020

Title:

Manual scalp cooling in early stage breast cancer: value of caretaker training and patient-reported experience to optimize efficacy and patient selection

Authors:

Manaz Rezayee¹, BS Nicole Moxon¹, RN Staci Mellinger¹, RN Amanda Y. Seino¹ Nicole E. Fredrich¹ Tracy L. Kelly¹ Susan Mulligan², MA Patrick Rossi³, MD Ijeoma Uche¹, MD Walter J. Urba¹, MD PHD Alison K. Conlin¹, MD MPH Janet Ruzich¹, DO David B. Page¹, MD

Background:

Alopecia is an emotionally distressing common adverse effect of …

Effect Of A Pharmacist-Led Antimicrobial Stewardship (Ams) Program On Outpatient Fluoroquinolone Prescribing In The Elderly, Katie Larue, Chelsea Mannebach, Bonnie Jiron

Providence Pharmacy PGY2 Program at Providence Medical Group 2020

Title: Effect of a pharmacist-led antimicrobial stewardship (AMS) program on outpatient fluoroquinolone prescribing in the elderly

Authors: LaRue, Katie PharmD; Mannebach, Chelsea PharmD, BCPS, BCACP; Jiron, Bonnie, PharmD, BCACP

Introduction: The Center for Disease Control and Prevention, the Society of Infectious Diseases Pharmacists, and American Pharmacists Association recognize the need for outpatient AMS programs and the important role pharmacists play in appropriate prescribing. Fluoroquinolones (FQ) pose many risks, highlighted by U.S Food and Drug Administration safety warnings, including aortic dissection, hypoglycemia, mental health side effects, and tendonitis, along with the risk of Clostridium difficile infections, particularly in …

Necrotizing Fasciitis – Time Is Of The Essence, Jeffrey Sun, Edward Kim

Milwaukie Family Medicine 2020

Necrotizing fasciitis (NF) is a life threatening rapidly progressive soft tissue infection that carries a high mortality rate. There are approximately 500-1,500 cases per year in the United States with a mortality rate of up to 18-20%. Without surgical intervention, the mortality rate is near 100%. NF can be characterized by tissue involvement, polymicrobial or monomicrobial etiology, or site of infection. The most common risk factor includes diabetes (reported in up to 60% of cases), IV drug use history, malnutrition, and chronic alcohol abuse. In about 50% of group A streptococcus cases, there is an associated streptococcal toxic shock syndrome …

Does Street Medicine Improve Access To Healthcare?, Lauren Smith

Student Research Poster Presentations 2020

No abstract provided.

Implementation And Evaluation Of Pulmonary Arterial Hypertension Clinical Program And Pharmacist Education At A Health-System Specialty Pharmacy, Timothy Cao, Adam Saulles, Tara Berkson

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Timothy Cao, PharmD, PGY-1 Pharmacy Resident

Preceptors: Adam Saulles, PharmD, CSP, BCACP and Tara Berkson, PharmD, BCACP

Providence Health and Services, Portland, Oregon

Implementation and evaluation of pulmonary arterial hypertension clinical program and pharmacist education at a health-system specialty pharmacy

Pulmonary Arterial Hypertension (PAH) is a progressive, debilitating, and costly disease, often resulting in poor prognosis when treatment is inadequate. With an exponential growth of specialty therapies, clinical pharmacists in specialty pharmacies are well-equipped to play an integral role in improving patient care outcomes and reducing overall healthcare costs. By incorporating a PAH-specific clinical program as part of the specialty …

Evaluation Of A Two-Way, Hipaa-Compliant Text-Messaging Platform In A Health System Specialty Pharmacy, Dj Clark, Adam Saulles, Tara Berkson

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

PDJ Clark, PharmD, PGY1 Pharmacy Practice Resident
Adam Saulles, PharmD, CSP, BCACP; Tara Berkson, PharmD, BCACP

Providence Health and Services, Portland, Oregon

Evaluation of a two-way, HIPAA-compliant text-messaging platform in a health system specialty pharmacy

Specialty medications, including those used to treat Multiple Sclerosis (MS), represent a growing proportion of prescription drug expenditures in the United States. MS is a chronic, progressive condition that requires maintenance therapy with disease-modifying medications. Many patients with MS rely on specialty pharmacies to obtain, dispense, and perform the necessary monitoring for these complex medication regimens. A study performed in 2017 by Munsell et al, …

Clinical Impact Of An Hiv Specialist Pharmacist Collaborative Practice Agreement: A 1-Year Retrospective Review Of Interventions, Rebekah Bartholomew, Geoffrey L'Heureux, Brent Footer

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Title: Clinical Impact of an HIV Specialist Pharmacist Collaborative Practice Agreement: a 1-year Retrospective Review of Interventions

Purpose/Background:

HIV continues to be one of the most complex disease states for patients and providers to manage. With new medications and guidelines being routinely updated, ensuring that patients are on optimal anti-retroviral therapy (ART) throughout their lives can be difficult. Previous studies on pharmacist-led HIV services have shown that utilizing a pharmacist to manage ART is beneficial. The purpose of this study is to add to that body of evidence by analyzing the clinical impact of a nascent collaborative practice agreement for …

Pd-1 And Pd-L1 Inhibitors: A Single Center Medication Assistance Program (Map) Experience, Sarah Tu, Shuntao Cai

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

PD-1 and PD-L1 Inhibitors: A Single Center Medication Assistance Program (MAP) Experience

Sarah Tu, PharmD and Shuntao Cai, PharmD, BCOP

Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, USA

Background: PD-1 and PD-LI inhibitors are a large component of the growing immuno-oncology field and every year there are increasing studies investigating potential indications for these agents. This IRB approved retrospective chart review examines patients in the Medication Assistance Program (MAP) within a large tertiary medical center who are on PD-1 and PD-L1 medications due to financial barriers and/or non-FDA approved regimens (unlabeled indications). This study seeks to evaluate …

Safe Opioid Prescribing At Discharge, Taylor Goodman, Elva Van Devender, Luetta Jones, Courtney Barber

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Safe Opioid Prescribing at Discharge Taylor Goodman, PharmD; Elva Van Devender, PharmD; Luetta Jones, PharmD; Courtney Barber

Background/Purpose: The opioid epidemic has led to devastating consequences, especially in Oregon, with an average of five Oregonians dying each week from opioid overdose. Opioid prescriptions at discharge are correlated with future continued opioid use. United States providers prescribe more opioids both inpatient and at discharge than other countries, and Oregon providers wrote more opioid prescriptions per person than the national average. Oversupplying prescription opioids can lead to reservoirs of unused medication, creating opportunities for non-medical use and overdose. Pharmacy interventions have …

Development And Implementation Of Take-Home Naloxone Kit For Patients Admitted To The Emergency Department Of A Large Tertiary Care Hospital, Myung Seon (Amy) Song, Pamela Levine, Katharine F. Marshall, Chelsea Harmon

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Title: Development and implementation of take-home naloxone kit for patients admitted to the emergency department of a large tertiary care hospital

Authors: Myung Seon (Amy) Song, PharmD; Pamela Levine, PharmD, BCPS; Katharine F. Marshall, MD; Chelsea Harmon, PharmD Candidate 2020

Background/Purpose: In 2017, the United States Department of Health and Human Services (HHS) declared the opioid epidemic as a public health emergency as more than 70,000 people died from drug overdoses. Approximately 75% percent of unintentional opioid-overdose deaths occurred outside of a medical setting. In order to combat the opioid crisis, the US Surgeon General urged prescribers and pharmacists …

Impact Of Real-Time Antimicrobial Stewardship Team Intervention Versus Conventional Microbiology Reporting On Time To Appropriate Antimicrobial Therapy In Patients With Enterobacterales Bacteremia, Scott C. King, Alyssa B Christensen, Brent Footer, Timothy G. Shan, Kim Health, Ivor Thomas, Margaret Oethinger

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Scott C. King

Alyssa B. Christensen, Brent W. Footer, Timothy G. Shan, Kim Health, Ivor Thomas, and Margret Oethinger

Impact of real-time antimicrobial stewardship team intervention versus conventional microbiology reporting on time to appropriate antimicrobial therapy in patients with Enterobacterales bacteremia.

Introduction:

The benefit of rapid laboratory speciation combined with real time antimicrobial stewardship team (AMT) interventions has been shown to improve patient outcomes and decrease hospital costs. The Providence Oregon region conducts direct from blood culture matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) identification, which results in decreased time to organism identification. The MALDI-TOF identification has allowed the AMT …

Evaluation Of Late-Onset Sepsis Antibiotic Utilization And Revision Of Empiric Late-Onset Sepsis Antibiotic Prescribing Guidelines, Alex Creevan, Sara Clark, Anavice Jimenez, Michael Garcia

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Alex Creevan, PharmD

Michael Garcia, PharmD, Angela Roberti, PharmD, Sara Clark, PharmD, Anavice Jimenez, PharmD Candidate

Providence St. Joseph Health, Portland, OR

Evaluation of late-onset sepsis antibiotic utilization and revision of empiric late-onset sepsis antibiotic prescribing guidelines

Neonatal late-onset sepsis (LOS) is commonly defined as an infection occurring after the first 72 hours of life. Late onset sepsis is a common complication of prolonged admission to the neonatal intensive care unit (NICU) and is a major cause of morbidity and mortality. Due to risks associated with LOS, empiric antibiotics can be inappropriately prescribed, which may lead to multi-drug resistant bacteria, …

Standardizing Specialty Pharmacist Follow-Up Frequency In Patients Prescribed Inflammatory Disease-Modifying Therapies, Rochelle Castrillo, Linda Huynh, Tara Berkson, Adam Saulles

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Submission Category Specialty Pharmacy

Purpose Specialty medications for inflammatory conditions have demonstrated decreased effectiveness, safety, and quality of life, largely attributable to inadequate medication adherence. Furthermore, with poorer health outcomes, patients face greater healthcare costs associated with exacerbations, flares, and hospitalizations. Monitoring for non-adherence, side effects, and health status changes is essential for patients diagnosed with inflammatory conditions. The benefit of a standardized pharmacist clinical follow-up assessment is currently lacking in specialty pharmacy literature. This study will implement a standardized pharmacist follow-up frequency guide and determine its clinical value and utility for patient safety and therapeutic goals in newly established …