Medicine and Health Sciences Commons^™

New-Onset Psychosis Following Covid-19 Infection In A Patient With No Psychiatric History: A Longitudinal Case Report., Matthew Runyan, Jay Fawver, Amanda Coupe, Michelle Drouin

Health Services and Informatics Research

BACKGROUND: Viral infection, including COVID-19, has been implicated as a potential cause of various neurobehavioral issues. An increasing number of case reports suggest that current or recent COVID-19 infection may cause new onset of psychotic symptoms in some individuals, potentially related to viral inflammation or infection of the nervous system.

CASE PRESENTATION: A 26-year-old woman with no psychiatric history presented with severe psychotic symptoms days after recovery from a mild COVID-19 infection. No other etiologies for psychosis were identified via diagnostic testing, review of medical history, or interviews with family. Her symptoms persisted for approximately two months, requiring three inpatient …

Evaluation Of Piperacillin/Tazobactam Utilization In Suspected Urinary Tract Infections At A Community Hospital, Adam P. Yagodinski, Jamie Gaul Pharmd, Bcps, Dana Lorber Pharmd, Bcps, Alissa Keillor Pharmd

Parkview Pharmacy Department

Poster presentation completed at ASHP Midyear Clinical Conference & Exhibition.

Objective: Evaluate and characterize the utilization of piperacillin/tazobactam in patients with a suspected urinary tract infection (UTI) at a community hospital in Fort Wayne, Indiana.

Medication Use Evaluation Of Angiotensin Ii, Kevin Baumgartner Pharmd, Dustin D Linn Pharmd, Bcccp, Michael Todt Pharmd

Parkview Pharmacy Department

Poster presentation completed at ASHP Midyear Clinical Conference & Exhibition

Background: Angiotensin II is a vasopressor agent used for septic shock and has been found to effectively raise the blood pressure in patients who did not respond to other conventional high dose vasopressors. Angiotensin II’s wholesale acquisition cost (WAC) of $1800 per vial creates a significant financial burden for health care institutions. A limited warranty manufacturer program replaces angiotensin II vials in patients not achieving an increase in mean arterial pressure (MAP) of at least 10 mmHg or to >65mmHg within the first 3 hours of initiation.

Objective: Evaluate compliance …

Impact Of Pharmacist-Led Direct Oral Anticoagulant Monitoring On Appropriate Medication Use, Bhavika Patel Pharmd, Kenneth Wiley Pharmd, Bcacp, Alicia Sawmiller Pharmd, Bcacp

Parkview Pharmacy Department

Poster presentation completed at ASHP Midyear Clinical Conference & Exhibition.

Background: Direct oral anticoagulants (DOACs) are the preferred treatment for patients with venous thromboembolism and atrial fibrillation and are an attractive alternative to vitamin K antagonists in multiple indications for long-term anticoagulation. Although DOACs require less frequent clinical monitoring than vitamin K antagonists and their standardized dosing is often more convenient for patients, these medications still require monitoring. Medication adherence, monitoring renal function, hepatic function and drug interactions are important safety concerns for managing patients on DOAC therapy. Previous studies have shown pharmacist can impact monitoring, dosing and adherence to …

Evaluation Of Therapies For Treatment Of Hyponatremia, Laura Fischer Pharmd Candidate, Jennifer Sposito Pharmd, Blake Burton Pharmd, Bcps, Jamie Gaul Pharmd, Bcps

Parkview Pharmacy Department

Poster presentation completed at ASHP Midyear Clinical Conference & Exhibition.

Objective: Characterize the use and assess the efficacy of tolvaptan and urea in the treatment of patients who were admitted to the hospital with chronic hyponatremia.

Safety Of 10,000 Unit Unfractionated Heparin Boluses For Acute Myocardial Infarction In The Emergency Department, Emma Pastula Pharmd, Sarah Meeks Pharmd, Amber Ooley Pharmd, Bcps, Bcccp, Sarah Ferrell Pharmd

Parkview Pharmacy Department

Poster presentation completed at ASHP Midyear Clinical Conference & Exhibition.

The purpose of this retrospective chart-review study is to evaluate the safety and efficacy of a 10,000 unit unfractionated heparin bolus in the emergency department prior to PCI. • The primary objective was percentage of ACT values within goal range of 250-300 seconds. • Secondary objectives included major bleeding rate, weight-based UFH bolus dose in comparison to guideline recommended bolus dose, percentage of initial ACT values within goal range, protamine use, and need for additional UFH boluses.

Comparison Of Clinical Pharmacist Versus Nurse Led Medicare Annual Wellness Visits In The Primary Care Clinic Setting, Payton Waltz Pharmd, Erin Copi Pharmd, Bcacp, Rachel Steele Pharmd, Bcacp

Parkview Pharmacy Department

Poster presentation completed at ASHP Midyear Clinical Conference & Exhibition.

Objective: To characterize the impact of a primary care pharmacist completing Medicare Annual Wellness Visits by determining:

• Primary: The rate of overall care gap closure by pharmacist-led versus nurse-led visits.

• Secondary: The percentage of recommended care gap opportunities during pharmacist-led versus nurse-led visits and the number of pharmacist made medication interventions during AWVs.

Impact Of Specialty Pharmacy Services On Pneumococcal Vaccination Rates In A Large Inflammatory Bowel Disease Population, Jessica Offerle Pharmd, Tara Jellison Pharmd, Mba,Fashp, Michele Walters Pharmd, Bcps, Bcidp, Toni Zahorian Pharmd, Bcacp

Parkview Pharmacy Department

Poster presentation completed at ASHP Midyear Clinical Conference & Exhibition.

Objective: The purpose of this study is to assess the impact of clinical specialty pharmacy services and education on compliance with vaccine recommendations in subjects with IBD.

Continued Use Of Proton Pump Inhibitors And Risk For Recurrence Of Clostridium Difficile Infection-A Retrospective Study, Cecilia Schowe Pharmd Candidate, Breia Leavell Pharmd Candidate, Cole Luty Pharmd

Parkview Pharmacy Department

Poster presentation completed at ASHP Midyear Clinical Conference & Exhibition.

Objective: To determine if the continued use of proton pump inhibitors leads to an increased risk of recurrent Clostridium difficile infections.

Evaluation Of Rituximab Use At Parkview Health, Sarah Stopczynski Pharmd Candidate, Jesse Christman Pharmd, Bcop, Kristen Christman Pharmd, Bcps, Jamie Gaul Pharmd, Bcps

Parkview Pharmacy Department

Poster Presentation completed at ASHP Midyear Clinical Conference & Exhibition.

Objective: Characterize the use of rituximab at Parkview Health by differentiating between inpatient and outpatient use as well as evaluate indications for use, incidence of documented infusion reactions, and biosimilar use.

Characterizing Appropriate Use Of Octreotide Continuous Infusions For Gastroesophageal Bleeding, Austin Harris Pharmd, Curtis Stump Pharmd, Luke Keller Pharmd, Bcps, Bcccp

Parkview Pharmacy Department

Poster Presentation completed at ASHP Midyear Clinical Conference & Exhibition.

Objective: To characterize the appropriate use of octreotide infusions for gastroesophageal bleeding at a community hospital system to pursue guideline-driven standardization of care.

Evaluation Of Intravenous Loop Diuretic Use In Acute Decompensated Heart Failure In A Community Hospital, Catherine Eichler Pharmd, Cole Luty Pharmd, Kris Howard Pharmd, Aacc

Parkview Pharmacy Department

Poster presentation completed at ASHP Midyear Clinical Conference & Exhibition

Objective: To characterize the use of intravenous loop diuretics in patients hospitalized with fluid overload secondary to acute decompensated heart failure (ADHF) within the heart failure service of a community hospital

Characterization Of Vancomycin Use At A Community Hospital, Caleb Hoppe Pharmd Candidate, Jamie Gaul Pharmd, Bcps, Christina Ford Pharm, Bcpsd

Parkview Pharmacy Department

Poster presentation completed at ASHP Midyear Clinical Conference & Exhibition.

Objective: To characterize the use of vancomycin medication therapy at a non-profit community hospital (Parkview Regional Medical Center) in preparation for a potential change to AUC:MIC dosing and monitoring.

Clinical Impact Of Number Of Lymph Nodes Dissected On Postoperative Survival In Node-Negative Small Cell Lung Cancer, Shinkichi Takamori, Takefumi Komiya Md, Emily Powell Phd

PCI Publications and Projects

Objectives: Small cell lung cancer (SCLC) is a lethal histologic subtype of lung cancer. Although the Commission on Cancer recommends pathological examination of at least 10 lymph nodes dissected (LNDs) for resected early-stage non-small cell lung cancer, its survival benefit of LNDs in patients with early-stage SCLC is unknown.

Methods: The National Cancer Database was queried for SCLC patients with clinical stage I-II and clinical N0, NX disease per AJCC 7th edition who had undergone lobectomy between 2004 and 2017. Overall survival of SCLC patients by the number of LNDs was compared using Log-rank tests. Univariate and multivariable Cox proportional …

Closing The Experience Complexity Gap Using Peripheral Iv Education, Taylor N. Daughtery Msn, Rn, Cv-Bc, Cphq, Melinda M. Webb Bsn, Rn, Va-Bc, Stephani Schultz Bsn, Rn, Cmsrn

Nursing Publications

Poster Presented at the Nursing Research Symposium, 2022

Introduction

At Parkview Health System, a gap in peripheral IV (PIV) insertion education was identified. • PIV insertion is not a curriculum priority in nursing school. • In practice, IV insertion needs to be completed in a timely manner to avoid care delays. • An aversion to starting PIVs, by new and seasoned nurses, create unique barriers to PIV insertion. • Experienced nurses may not be well versed in placing IVs due to the availability of a hospital IV team. To close the experience complexity gap and incorporate all learning styles, the …

Postoperative Vital Signs: Traditional Versus Evidence Based, Linda Otis Bsn, Rn

Nursing Publications

Poster Presented at the Nursing Research Symposium 2022.

Problem: Post operative vital signs Did not guide the nurse to identify postoperative complications. Purpose: The purpose of the study is to compare the current standard post-operative nursing vital signs and assessment routine to an evidence based algorithm(TRAX) drive routine. The Trax algorithm is initiated by nursing assessments which then determine the frequency and tye of postoperative vital signs

No Evidence Support For Intake/Output Documentation, Kristen Schultis Bsn, Rn

Nursing Publications

Poster Presented at the Nursing Research Symposium 2022.

Objective: Upon the change of Dekalb hospital as a Parkview hospital, adoption of policies and standards were in process. • The standard of care for intake/output (I/O) documentation was found to be every 8 hours at defined time periods of 6am, 2pm and 10pm in the hospital setting. • The reality of nursing practice with electronic documentation facilitates ‘real-time’ documentation of I/O, so the question was raised as to why should we wait until 6a, 2pm, and 10pm do document I/O?

The purpose of this project was to determine best practice for …

Utilizing Clinical Nurse Specialists To Improve Care & Management Of Suprapubic Catheters, Andrea D. Conley Msn, Rn, Agcns-Bc, Mscrn, Michele Kadenko-Monirian Msn Rn Ccrn Cnrn Accns-Ag Agcns-Bc, Janette Richardson Msn, Rn, Agcns-Bc, Ccrn

Nursing Publications

Poster presented at Nursing Research Symposium 2022.

Purpose:

Utilize the Advance Practice Registered Nurse (APRN) knowledge and skill of the CNS in management of chronic SPT to decrease unnecessary consults to urology for routine SPT exchanges and maintenance • Streamline SPT consults to decrease urology workload as the CNS will assess the patient and identify any urgent needs that require urology • This will allow urology to focus on acute and emergent patient needs • CNS consults for SPT management and exchange will also decrease time to patient catheter exchange

The Misperceptions Of Palliative Care, Sara Lake M.S., B.S, Beth Schultz Phd, Dnp, Rn

Nursing Publications

Poster Presented at the Nursing Research Symposium 2022.

Palliative care is comfort care aimed at relieving pain and symptoms caused by a serious illness, regardless of the patient’s prognosis, age, or stage of disease. (Yoost & Crawford, 2020) The problem is that there are often multiple factors that act as barriers to the integration of palliative care. What are those factors, and how can we overcome them to ensure positive patient outcomes? This literature review summarizes previous research and the suggestions for improving the understanding of palliative care by patients and providers. There are common themes among the articles selected …

Self-Proning In Non-Intubated Patients With Covid-19: A Strategy To Avoid Intubation, Jan Powers Phd, Rn, Ccns, Ccrn, Ne-Bc, Fccm, Sue Chubinski Phd, Rn, Npd-Bc, Cmsrn, Michele Kadenko-Monirian Msn Rn Ccrn Cnrn Accns-Ag Agcns-Bc, Stephani Schultz Bsn, Rn, Cmsrn, Christina Lung Msn, Rn, Cmsrn, Tammy Carman Ad, Rn

Nursing Publications

Poster presented at Nursing Research Symposium 2022.

Prone positioning improves oxygenation in patients experiencing respiratory distress. It is used to decrease mortality in mechanically ventilated patients diagnosed with acute respiratory distress syndrome. However, very little evidence has addressed use of prone positioning in nonintubated patients. The purpose of this study was to assess the impact of early self-proning on oxygenation in patients who had or were suspected of having coronavirus disease (COVID-19).

The goal was to improve oxygenation to avoid escalation to the intensive care unit (ICU) and the need for invasive mechanical ventilation

Weighted Blanket Versus Traditional Perioperative Practices On Anxiety And Pain In Elective Surgery Patients: A Randomized Controlled Trial, Danielle Payne , Msn, Bsbio, Rn, Jaime Vinson Bsn, Rn, Hn-Bc, Jan Powers Phd, Rn, Ccrn, Brandon T. Mcdaniel Phd, Cherise Sevier, Cynthia Marshall, Sue Sell

Nursing Publications

Poster presented at Nursing Research Symposium 2022.

Introduction: Perioperative anxiety is common in surgical patients and has been linked to poor patient outcomes. A weighted blanket may offer an alternative to or enhancement of anti-anxiety medications by activating a physiological response through the vagal system. This response successfully decreases anxiety and agitation in other patient populations but had not been studied in this population. This randomized study assessed the effectiveness of a weighted blanket for the reduction of presurgical anxiety and pain as well as post-surgical restlessness and nausea.

Creating The Stroke Compliance Report For System Wide Use, Staci Howard Bsn, Rn, Samantha Baker Bsn, Rn

Nursing Publications

Poster presented at Nursing Research Symposium 2022.

Purpose/Aim: The aim of this project was to create an all encompassing stroke core measure report in one easy to access location which would decrease time spent completing audits.

Problems: • Feedback regarding audit tool determined it to be cumbersome and tedious • Each audit required nurse leader to enter each patient record to search for the information • Completion of the audit took a considerable amount of time which removed the nurse leader from the bedside and patient care.

Interactive Sepsis Education Program Improves Nurses' Knowledge And Impact On Patient Outcomes., Jennifer Rechter Msn, Rn-Bc, Agcns-Bc, John P. Klein, Rachel Buckholz, Jan Powers Phd, Rn, Ccrn, Emily R. Plant

Nursing Publications

Sepsis is a life-threatening organ dysfunction triggered by a dysregulated host response to infection. Sepsis education is a key initiative to assist nurses and patient care technicians to improve their skills in recognizing a patient in decline with escalating care concerns. This study demonstrated increased knowledge of sepsis through completion of an evidence-based computer learning program.

Synchronized Diaphragmatic Stimulation For Heart Failure With A Reduced Left Ventricular Ejection Fraction Using The Visone System: A First-In-Patient Study With Extended Population, Ana Jorbenadze Md, Lee R. Goldberg Md, Tamaz Shaburishvili Md, Michel Zuber Md, Michael Mirro Md, Facc, Fhrs, Faha, Marat Fudim Md,Mh

Parkview Heart Institute

Highlights

• Synchronized diaphragmatic stimulation (SDS) is a new extra-cardiac HFrEF therapy
• SDS impacts intrathoracic pressure and pericardial restraint•
• SDS exhibits a favorable safety profile over 1 year of chronic use
• Exercise tolerance and QOL improved with SDS over 1 year
• Early results will soon be validated in a randomized control trial

Abstract

Background

Diaphragmatic Function In Cardiovascular Disease: Jacc Review Topic Of The Week., Husam M Salah, Lee R Goldberg, Jeroen Molinger, G Michael Felker, Willard Applefeld, Tienush Rassaf, Ryan J Tedford, Michael Mirro Md, Facc, Fhrs, Faha, John G F Cleland, Marat Fudim

Parkview Heart Institute

In addition to the diaphragm's role as the primary respiratory muscle, it also plays an under-recognized role in cardiac function. It serves as a pump facilitating venous and lymph return, modulating left ventricular afterload hemodynamics and pericardial pressures, as well as regulating autonomic tone. Heart failure (HF) is associated with diaphragmatic changes (ie, muscle fiber atrophy and weakness, increased ratio of type I to type II muscle fibers, and altered muscle metaboreflex) that lead to diaphragmatic dysfunction with subsequent symptomatic manifestations of HF. Herein, it is proposed that targeting the diaphragm in patients with HF via inspiratory muscle training or …

Systemic Amyloidosis Presenting As Adrenal Insufficiency And Multi-Nodular Goiter, Aqsa Khan Md, Emily B. Schroeder Md

Internal Medicine Residency

Poster Presented at ACP Indiana Chapter 2022 Annual Scientific Meeting, October 2022.

Case Presentation: A 69-year-old male presented to the Endocrinology clinic after multiple hospital admissions for severe orthostatic hypotension, weight loss, edema and generalized weakness. On physical exam, he was found to have orthostatic hypotension and large goiter.

Designing Displays Of Cardiac Implantable Electronic Device Sensor Data With Patients Who Have Heart Failure With Reduced Ejection Fraction, Carly Daley Phd, Shauna Wagner Bsn, Rn, Ryan Ahmed Ms, Romisa Rohani Ghahari Phd, Tammy Toscos Phd, Michael Mirro Md, Facc, Fhrs, Faha

Health Services and Informatics Research

Background: Cardiac implantable electronic devices (CIEDs) are important life-saving and therapeutic devices for patients with heart failure with reduced ejection fraction (HFrEF). These devices capture a multitude of data, including factors that have potential to indicate worsening heart failure. Patients may be interested to monitor sensor data from their device as part of heart failure self-care, and are key stakeholders in designing visualizations and displays for interpretation of the data.

Objectives: The objective of this study was to explore the presentation of HF-related CIED sensor data in a small participatory design session with people who have HFrEF and CIEDs.

Methods: …

Papillary Thyroid Cancer In A Patient With Germline Ttn Mutation, Payal Shukla Md, Ms, Emily B. Schroeder Md

Internal Medicine Residency

Poster Presented at the ACP Indiana Chapter 2022 Annual Scientific Meeting, October 2022.

Case Presentation:

• A 60-year-old male presented with new onset atrial fibrillation and hyperthyroidism.

• His past medical history was significant for germline TTN mutation and recurrent ventricular tachycardia status post implantable cardiac defibrillator placement.

• He had been treated with amiodarone for two and a half years and had stopped the medication eight months prior to presentation.

• Laboratory workup was done (table 1) and an ultrasound of the thyroid gland showed a multinodular goiter with subcentimeter cysts and a right lower lobe nodule.

• A …

"Crypto Syphilis" Cryptogenic Stroke As The Presentation Of Neurosyphilis In Young Adults, Priya Hotwani Md, Matthew Bartock Do, Emily B. Schroeder Md, Munyaradzi Chakabva Md

Internal Medicine Residency

Poster Presented at the ACP Indiana Chapter 2022 Annual Scientific Meeting, October 2022.

Case Presentation: A young adult man in his 30s with a history of tobacco and methamphetamine use presented to the emergency department with a three day history fo aphasia, right sided facial droop and confusion.

Lymph Node Dissections And Survival In Sublobar Resection Of Non-Small Cell Lung Cancer ≤ 20 Mm., Shinkichi Takamori, Takefumi Komiya Md, Mototsugu Shimokawa, Emily Powell Phd

PCI Publications and Projects

BACKGROUND: A randomized trial of lobectomy versus segmentectomy for small-sized (≤ 20 mm) non-small cell lung cancer (NSCLC) showed that patients who had undergone segmentectomy had a significantly longer overall survival (OS) than those who had lobectomy. More attention is needed regarding the required extent of thoracic lymphadenectomy in patients with small-sized NSCLC who undergo sublobar resection.

METHODS: The National Cancer Database was queried for patients with clinically node-negative NSCLC ≤ 20 mm who had undergone sublobar resection between 2004 and 2017. OS of NSCLC patients by the number of lymph node dissections (LNDs) was analyzed using log-rank tests and …