Medicine and Health Sciences Commons^™

Simulation Based Clinical Systems Testing Of A Pediatric Ed To Improve Staff And Process Readiness For Pediatric Hypoglycemia, Kevin Meilak Md, Christopher S. Kennedy

Posters

Background: Hypoglycemia is the most common metabolic disorder in children in pediatric emergency department (ED) settings 1. Children may present with nonspecific symptoms, or asymptomatically2. So identification/treatment is very challenging. Delayed recognition and under treatment can lead to poor patient outcomes including seizure, coma, and death. Simulation-based clinical systems tests (SbCSTs) are useful to detect gaps/latent safety threats (LSTs) in system design.3-5


Objective: Our aim was to use SbCSTs combined with rapid cycle training to test system function for ED treatment of hypoglycemia.3-5. The research questions were in 2 frames: 1. Can SbCSTs identify gaps/LSTs and recommendations for improvement and …

Assessing The Effects Of Social Determinants On Serious Safety Events, Lisa L. Schroeder, Jessi Van Roekel, John Cowden

Posters

Background: We have long known that various social determinants of health (SDH) such as race, gender, socioeconomic status and others can affect health outcomes, such as readmission rates and mortality. To our knowledge, the impact of SDH on safety events has not been studied.


Objective: We sought to understand the role that social determinants may play in contributing to safety events at our institution and to incorporate this information into the creation of corrective action items following the serious safety event.


Design/Methods: The Clinical Safety team partnered with the Office of Equity and Diversity to develop a standard question regarding …

Online Echocardiography Modules For Pediatric Cardiology Fellows, Sarah Studyvin, Doaa Aly, Laura Kuzava, Tyler Johnson, Alison Samrany, Nitin Madan, Sanket Shah

Posters

Background: Adequate echocardiographic (echo) education is integral to successful cardiology training. Online education is proven to be effective in other specialties, but pediatric echo training data are lacking. Our aim was to design and assess the role of a novel online module-based curriculum to enhance pediatric cardiology fellows’ echo education.

Methods: Four interactive modules, focused on principles and interpretation of a normal echo, were delivered to fellows. Content included high quality 2D and 3D echo clips (Fig 1A) as well as interactive quizzes (Fig 1B) and could be accessed from a phone, tablet, or computer. All fellows completed pre- and …

Fentanyl-Induced Wooden Chest Syndrome Masquerading As Severe Respiratory Distress Syndrome In Covid-19, Grace Judd, Rachael Starcher, David Hotchkin

Providence Portland Medical Center Internal Medicine 2021

Case Presentation

History •47 yo M with no PMH presented with fever and respiratory distress •Admitted for COVID-19 pneumonia Hospital Course •Intubated for moderate acute respiratory distress syndrome (ARDS) on hospital day 11 •Fentanyl infusion started •Hypoxia improved within 36 hrsbut plateau pressures consistently >30 cm H2O despite minimizing dead space •Trial of airway pressure release ventilation worsened hypercarbia •Bronchoscopy w/o mucous plugging, airway collapse, or purulent secretions •Lung compliance worsened (Pplat=50 on 4 cc/kg) w/o change in oxygenation •Developed suspicion for wooden chest syndrome (WCS) and discontinued fentanyl Outcome •Pplatnadired at 16 within one hour after stopping fentanyl •Pt …

Evaluating The Caprini Risk Assessment In An Inpatient Rehabilitation Facility, Alissa Payne, Kelsey Boersma, Sarah Nechuta

Masters Projects

Deep vein thrombosis (DVT) is an often underdiagnosed disease that can be life threatening for individuals. Currently, the best practice approach to assess the risk of venous thromboembolism (VTE) in patients within a rehabilitation hospital is unknown. We examined how well the Caprini risk assessment (CRA) score predicts VTE events (deep vein thrombosis (DVT), pulmonary embolism (PE)) within an inpatient rehabilitation hospital. Between January 2015 and October 2020, VTE events, the CRA Score, and risk factors were collected from a chart review conducted at Mary Free Bed Rehabilitation Hospital (MFB) among 3,091 patients. Results from the unadjusted logistic regression model …

The Effectiveness Of The More Than Sad School Based Gatekeeper Training Program, Guy Diamond, Lawrence Ogunkua, Matthew B. Wintersteen, Tita Atte, Perri Rosen, Robert Gallop

Department of Psychiatry and Human Behavior Faculty Papers

Schools have the unique opportunity to identify and refer youth at risk for suicide. School-based gatekeeper training programs aim to improve staff’s ability to talk to students about mental health concerns and refer them for an assessment. Unfortunately, progress in evaluating the available programs has been limited. In fact, the popular and widely used More Than Sad program has received no rigorous evaluation to date. This study sets out to evaluate the effectiveness of the More Than Sad program in a quasi-experimental, wait-list control design with a large number of school personnel, across geographically diverse communities. Fourteen school districts with …

Medicare-Paid Naloxone: Trends In Non-Metropolitan And Metropolitan Areas, Chris Delcher, Yue Cheng, Minji Sohn, Jeffery C. Talbert, Patricia R. Freeman

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Medicare pays for the largest share (> 30%) of naloxone dispensed from retail pharmacies in non-metropolitan areas.
• Medicare-paid dispensing has grown since 2013, but from 2017-2018 dispensing growth in non-metropolitan areas slowed considerably compared to metropolitan areas (42% v 121%, respectively).
• As of 2018, the rate of naloxone dispensing to Medicare enrollees in metropolitan areas was approximately double that in non-metropolitan areas (4.9 v 2.9 per 1,000 enrollees, respectively).

Where Are They Now? Spanish Utilization And Career Direction Of Graduates Of A Pediatric Bilingual Continuity Clinic, Jodi Dickmeyer, Katie Mcanany, Sarah Stone, John Cowden

Posters

Background: The Clínica Hispana de Cuidados de Salud (CHiCoS) Program was created in 2009 to prepare bilingual (English-Spanish) pediatric residents to independently give safe, effective care to Spanish-speaking families. By providing 1:1 support from a culture and language coach over three years of residency, CHiCoS has improved residents’ cultural and linguistic skills and families' perceptions of care. The effects of such training on residents’ future careers have not been formally studied.


Objective: To describe the careers of former CHiCoS residents, the impact of culture and language training on their practice, and opportunities for post-CHiCoS cultural and language training.


Design/Methods: In …

Covid-19: Exploring The Probability Of Disease Extinction - A Modeling And Simulation Study, Donald Porchia

Electronic Theses and Dissertations, 2020-2023

There are two distinct topics considered in this dissertation. The first is the formulation of a compartmental model using reactive social distancing in which disease transmission changes as a function of the state variables of the model; in this case, the cumulative incidence. The model assumes a single strain epidemic of Covid-19 in the United States and is used to estimate the cumulative number of deaths due to the epidemic where incidence data is used to calibrate and validate the model. The second topic concerns the use of the stochastic threshold to determine disease persistence or extinction. The Covid-19 pandemic …

Economic And Cost-Effectiveness Analysis Of The Community-Level Interventions For Pre-Eclampsia (Clip) Trials In India, Pakistan And Mozambique, Jeffrey N. Bone, Asif R. Khowaja, Marianne Vidler, Beth A. Payne, Mrutyunjaya B. Bellad, Shivaprasad S. Goudar, Ashalata A. Mallapur, Khatia Munguambe, Rahat Qureshi, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: The Community-Level Interventions for Pre-eclampsia (CLIP) trials (NCT01911494) in India, Pakistan and Mozambique (February 2014-2017) involved community engagement and task sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the incremental costs and cost-effectiveness of the CLIP intervention overall in comparison to standard of care, and by PIERS (Pre-eclampsia Integrated Estimate of RiSk) On the Move (POM) mobile health application visit frequency.
Methods: Included were all women enrolled in the three …

When Your Patient Does Know Best: A Lesson In Geriatrics, Daphne Sy, Jeff Youker

Providence St. Vincent Internal Medicine 2021

Introduction

An athletic elderly woman presented to the emergency department (ED) with subjective leg weakness, most notably while climbing stairs. The patient’s insistence that we acknowledge her change in functional status prompted a workup that exposed an active pauci-immune crescentic glomerulonephritis. She was diagnosed with an unusual presentation of granulomatosis with polyangiitis (GPA) which was discovered in time to initiate treatment and prevent renal failure.

Case Report

A 77 year-old woman with a past medical history of chronic kidney disease (CKD) and biopsy-negative pulmonary nodules presented to the ED with a unique complaint: she could no longer climb multiple stairs …

Avoiding Rash Decisions: A Guide To Adverse Cutaneous Drug Reactions, Caleb Freeman, Tom Chau

Providence St. Vincent Internal Medicine 2021

No abstract provided.

A Dramatic Presentation Of Plasmablasticlymphoma In Untreated Hiv, Joshua Genstler, Alex Schafir

Providence St. Vincent Internal Medicine 2021

No abstract provided.

Are Elevated Inflammatory Markers And Acute Phase Reactants Associated With More Severe Disease In Covid 19 Patients?, Joanna Bove, Robert Kim, Shelley Sanders

Providence St. Vincent Internal Medicine 2021

Introduction Inflammatory markers and acute phase reactants (from here referred to as “markers”) are associated with COVID-19 infection and may be able to predict disease severity.1,2We collected markers including d-dimer (ug/mL), ferritin (ng/mL), CRP (mg/dL), and creatinine kinase (CK) (IU/L) on admission and periodically throughout the hospital stay for 50 patients admitted with COVID-19 infection. We hypothesized that higher levels of markers at admission and during hospitalization are associated increased severity of disease, such as ICU admission and placement on mechanical ventilation.

Methods From March to May 2020, we identified 50 patients admitted to Providence St. Vincent Medical Center with …

A Case Of Succinylcholine-Induced Postoperative Myalgia, Nancy Ha, Stephanie Griffith

Providence St. Vincent Internal Medicine 2021

Introduction

Succinylcholine is a commonly used depolarizing neuromuscular blocking agent in anesthesia for relaxation of the skeletal muscles during endotracheal intubation. It is ideal for use in shorter surgical cases and situations where a rapid sequence intubation is warranted due to its quick onset and short duration of action. One documented side effects of succinylcholine is postoperative myalgia, which was first described in the literature in 1952.

Case Report

An 88 y.o. male presented two days following transurethral resection of a bladder mass with complaints of diffuse myalgias that were severely limiting activity. The pain was greatly exacerbated by any …

When Two Isn’T Better Than One: A Case Of Severe Hyponatremia From Combination Thiazide Diuretic And Arb Therapy, Jillian Catral, Emily Hitchcock

Providence St. Vincent Internal Medicine 2021

Introduction

Thiazide diuretics and angiotensin II receptor blockers (ARB) are common medications for hypertension and are widely used together to counteract thiazide-induced hypokalemia •Thiazide-associated hyponatremia (TAH) is fairly common. There are also multiple case series in the literature of severe hyponatremia in elderly pts attributed to initiation of a thiazide-ARB combination, even when the thiazide dose was low. This is a unique case of hyponatremia in which ARB on thiazide therapy seems to have precipitated severe hyponatremia.

Case Report This is a 74-year-old female with a history of essential hypertension with intolerance to several antihypertensive medications, post-operative hyponatremia after laminectomy …

Aplastic Anemia Secondary To Sars-Co-V-2, Maya Wernick, Stacy Lewis, Christie Moore

Providence St. Vincent Internal Medicine 2021

No abstract provided.

Overloadipine–Emerging Therapies To Treat Refractory Shock, Stephanie Barayuga, Irene Hendrickson

Providence St. Vincent Internal Medicine 2021

Introduction

Refractory vasodilatory shock develops from uncontrolled vasodilation and hyporesponsivenessto vasopressors. •Management of calcium channel blockers (CCB) toxicity can be difficult because it can result in refractory vasodilatory

Case Presentation

•21-year-old male with history of depression and prior suicide attempts presented after intentional ingestion of amlodipine (300 mg) and metformin (150 tablets of 1000 mg). •Presented with slightly altered mentation and hypotension, then quickly deteriorated and required intubation and high vasopressor requirements. •Transferred to PSVMC for consideration of venoarterialextracorporeal membrane oxygenation (VA-ECMO). Since he was hyperdynamic on echocardiogram, our team did not feel he would benefit from VA-ECMO. •His vasopressor …

Financial Impact Of A Regional Antimicrobial Stewardship Cost Saving Initiative In A Large Integrated Health Care System, Van Nguyen, Colton Taylor, Alyssa B Christensen, Brent Footer

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Since 2017, antimicrobial stewardship is a Centers for Medicare & Medicaid Services (CMS) and The Joint Commission (TJC) requirement for all acute care hospitals, critical access hospitals, and nursing care centers. •Given the current evidence supporting the utilization of extended-infusion beta-lactams, the system transitioned all its acute care facilities within the region to extended-infusion piperacillin/tazobactam (TZP) in March 2016 •According to Bauer et al, the median length of stay and hospital costs were significantly less for patients admitted to the ICU who received extended-infusion cefepime for bacteremia and/or pneumonia

Purpose

The purpose of this study was to evaluate …

Health Disparities In Black, Latinx, And Native Populations Compared To Caucasians: A Retrospective Descriptive-Analysis Of Care Focused On Hypertensive Emergency, Non-St Segment Elevation Myocardial Infarction (Nstemi), And Cerebrovascular Accident (Cva)., Jonathan Aguilar Roa, Evon Anukam

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Health disparity is a sum of differences in healthcare seen in underserved populations of the United States. 1 • Differences include incidence, prevalence, mortality, burden of disease, and other adverse health conditions • According to ASHP, health disparities continue to be a major public health problem confronting the U.S. health care systems. 2 • Evidence suggests that health disparities can be in part due to differences in the quality of care for different racial and ethnic groups. 2 • All the different disparity factors have been shown to lead to different health outcomes that do not favor Black, …

Fixed Dose Prothrombin Complex Concentrate Versus Weight-Based Dose For Warfarin Reversal, Peter Martsin, Bryce Winn

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

•4 Factor Prothrombin Complex Concentrate (4F-PCC) reverses anticoagulation of warfarin with weight-based dosing criteria supplied by manufacturer. INR must be processed before 4F-PCC is prepared. This regimen provides additional cost and delay of treatment to the patient as well as cost to the hospital and pharmacy department. •Fixed dose regimens of 4F-PCC have been described in literature1,2-4as having similar performance in achieving target INR compared to weight-based dosing, and can potentially have a decreased rate of thromboembolic events (TEE) compared to weight-based dosing, although large randomized-control trials on the comparison have not been conducted. •Fixed dosing of 4F-PCC is …

Evaluation And Implementation Of A New Phenobarbital Protocol For Alcohol Withdrawal Management In The Emergency Department, Sarah J. Kim, Sara Clark, Joshua L. Floyd

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Alcohol withdrawal syndrome can lead to substantial health care costs and mortality. • Although historically benzodiazepines (BZDs) are considered the mainstay treatment for alcohol withdrawal, some studies have shown that phenobarbital may be the safer and preferred alternative option. • Advantages of phenobarbital are its mechanism of action, more predictable pharmacokinetics, and greater therapeutic index. • A prospective study by Rosenson et al. 2012 found that a single 10 mg/kg IV dose of phenobarbital versus standardized lorazepam protocol resulted in decreased ICU admissions (8% vs. 25%). • A retrospective study by Tidewell et al. 2018 demonstrated shorter hospital …

Evaluation Of Provider Adherence To Antibiotic Selection Following The Implementation Of Antimicrobial Stewardship Committee Recommendations For The Empiric Treatment Of Hospitalized Adults With Urinary Tract Infections, James E. Watkins, Alyssa B Christensen, Brent Footer

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Urinary tract infections (UTIs) are one of the most common indications for prescribing antibiotics in the inpatient setting. • Recent literature suggests that not all patients are prescribed empiric antibiotics that are adherent to Infectious Diseases Society of America (IDSA) guidelines. • Arguably the most positive, predictable impact on provider adherence to guideline-based treatment regimens is achieved when evidence-based recommendations are made easily accessible. • The causative organism at the time of diagnosis and initiation of antibiotic therapy for a UTI is generally unknown: patients are often prescribed broad-spectrum therapy that may be unnecessary. • Inappropriate treatment of …

A Comparative Study Of The Imis (Osha) And Lims (Irsst) Exposure Databases, Philippe Sarazin, France Labrèche, Jacques Lesage, Jérôme Lavoué

Rapports de recherche scientifique

Une bonne connaissance des niveaux d’exposition des travailleurs aux contaminants chimiques est fondamentale dans un programme de maîtrise, de prévention et de gestion des risques associés à ces substances. Au Québec, l’Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) administre un système de gestion de l’information du laboratoire (LIMS – Laboratory Information Management System). Cette banque de données électronique contient l’ensemble des résultats d’analyse liés à l’évaluation de l’exposition telle que mesurée par les équipes de santé au travail depuis 1985. Les données du LIMS sont intéressantes pour établir des portraits d’exposition. Cependant, leur interprétation est …

Traumatic Brain Injury (Tbi): The Progressive Neurodegeneration And Mental Health Decline In United States Veterans, Andrew R. Wiener

PCOM Capstone Projects

Since the year 2000, the Defense and Veterans Brain Injury Center reported 414,000 documented cases of traumatic brain injuries (TBIs) among individuals serving in the United States Armed Forces (Defense and Veterans Brain Injury Center, 2020). Traumatic events to the head as a result from car accidents, falls, explosions, and gunshot wounds can lead to a disruption of normal cognitive functioning. Roughly 80% of diagnosed TBIs are mild in nature, commonly referred to as concussions, and can range from mild, moderate, severe, and penetrating (O’Neil et al., 2013). However due to the difficulty of diagnosing a TBI most cases go …

Sars-Cov-2 Infection’S Link To Behavior: A Review Of Coronaviruses And The Potential For Sars-Cov-2 To Damage The Brain’S Structure And Function, Grace Anne Wilgucki

PCOM Capstone Projects

Human Coronaviruses were discovered in the 1960s and were found to be a cause of the common cold, inducing mild symptoms on those infected (Santacroce et al., 2020). However, due to adaptation and co-evolution, more dangerous variations of Coronaviruses emerged in the early 2000s, causing severe infection of the respiratory tract (Ye et al., 2020). Notably, the outbreaks of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) were devastating, as these HCoVs could inflict respiratory disease that can be fatal (Wong et al., 2016). Most recently, the emergence of a new strain of Human Coronavirus has taken …

Vitamin Deficiency And Depression, Maddison Jeffries

PCOM Capstone Projects

Depression, or major depressive disorder, has affected how people think, feel, and behave. As well as psychological problems, depression has also been a comorbid factor in other emotional and physiological disorders. The actual cause of depression is unknown. Researchers have worked to understand the connections and conditions a person may experience for depression to develop. One commonly researched path to depression is vitamin deficiency. A variety of vitamins like B6, B12, folate, and vitamin D have been linked extensively to depression as a possible cause. A continuation of research expands into how a deficiency of these vitamins causes depression. Low …

Neurological And Psychological Effects Of Covid-19 On Cognitive Impairment, Saba Mufti

PCOM Capstone Projects

Increasing evidence suggests that individuals affected with COVID-19 may be at high risk for developing long-term neurological consequences (Heneka et al., 2020). Psychological stress may also increase risk in cognitive impairment, which can lead to mental fatigue. However, research studies suggest that there is a relationship between physiological and psychological factors affecting cognitive function (Scott et al., 2015). The mechanistic understanding of neurological symptoms in patients affected with COVID-19 regarding whether they emerge from mental illness or directly from the invasion of SARS-CoV-2 into the central nervous system is limited (Mahammedi et al., 2020). Factors affecting the brain can lead …

The Neuroplasticity Of Depression: How Antidepressants And Cognitive Behavior Therapy (Cbt) Can Reverse Depression, Vahid Harbi

PCOM Capstone Projects

Depression is a complex disorder influenced by biological, psychological, and environmental factors (Santarelli et al., 2016). Depression is one of the most common forms of mental illness worldwide (WHO, 2021), yet the pathogenesis of depression and the mechanism of how antidepressants reverse depression remain unclear (Liu et al., 2017). The symptoms of depression are evident to most individuals, but the symptoms’ persistent nature remains a mystery to most. The four primary regions of the brain involved in depression are the Prefrontal Cortex (PFC), hippocampus, amygdala, and Anterior Cingulate Cortex (ACC) (Hayley et al., 2013). This review presents the prevailing literature …

A Systematic Review Of Late Effects, Current Models Of Follow-Up In Three Pennsylvania Health Network Settings, And Survivor Care Plans For Brain Neoplasm Survivor, Megan Elizabeth Donlick

PCOM Capstone Projects

Introduction: Brain neoplasm survival rates have increased substantially in developed countries due to modern medical interventions, research, and enhanced therapeutic options. As the second leading cause of pediatric cancers, this has been a topic of interest within the field of public health. With mortality decreasing, scientists are now focusing the lens on the long-term outcomes of survivors, coined “survivorship” and subsequent late effects. These effects are the combined neurocognitive, psychological, and social deterioration and deficits experienced due to the brain pathology itself or exposure to associative treatments. This phenomenon is now appearing frequently in the literature. The aim of this …