Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Multidisciplinary Management For Large And Difficult Choledocholithiasis: The Role Of Choledochotomy, Jilpa Shah, Balu Chandra

North Texas Research Forum 2024

Extracranial carotid artery aneurysm is a rare sequela of atherosclerosis, trauma, and conditions of chronic inflammation. Standard treatments include antiplatelet medications, open resection, or endovascular stenting. Transcarotid artery revascularization (TCAR) has become a well-recognized alternative treatment in the past few decades. This case study documents the first reported case of Horner’s syndrome post-TCAR for an internal carotid artery (ICA) aneurysm. A 68 year-old male with intermittent double vision was referred to vascular surgery clinic with brain CT angiography showing a 9mm saccular aneurysm with dissection flap of the right cervical ICA. Prior attempts by neuro-interventional radiology were unsuccessful due to …

Association Of Glucagon-Like Peptide-1 Receptor Agonist Treatment With Perioperative And Postoperative Complications In Patients Undergoing Elective Bariatric Surgery, Justin Sanchez, Enith Espinosa, Sean Sojdie, Michael Green, Lauren Wonderly

North Texas Research Forum 2024

Glucagon-like peptide receptor agonists (GLP-1 RA) are FDA-approved medications for the treatment of type 2 diabetes mellitus, and obesity, and are also beneficial in cardiovascular risk reduction. However, due to known GLP-1 RA adverse effects, notably delayed gastric emptying, the ASA has implemented GLP-1RA guidelines aiming to minimize potential complications related to GLP-1 RA use in patients undergoing procedures requiring general anesthesia. With the ever-increasing number of patients being prescribed GLP-1 RAs, more research needs to be conducted to investigate their potential impact in other areas of healthcare. This retrospective study aims to compare surgical outcomes before and following the …

Colon Adenocarcinoma Mimicking Acute Appendicitis In A 28-Year-Old, Bridget Kowalczyk, Edward Pingenot, Vivek Bansal

Gulf Coast Division Research Day 2024

No abstract provided.

Delays In Chest Compressions During Ems Cpr: A Retrospective Review Of Cardiac Ultrasound Vs Carotid Views During Ohca, Himanshu Gupta, Ryan Richardson, Casey Patrick, James Seek, Nick Smith, Kevin Crocker, Josh Rasco, Robert Dickson

Gulf Coast Division Research Day 2024

No abstract provided.

Foreign Body Removed Through Laparotomy: A Case Report And Literature Review, Kayla Nguyen, Duyen Quach, David Ortiz, Dominique Norris, Srinivas Ramireddy, Jody Smith

Gulf Coast Division Research Day 2024

No abstract provided.

Comparison Of 3 Treatments For Fractures Of The Humeral Shaft, Neil Werthmann, Mason Poffenbarger, John Riehl

North Texas Research Forum 2024

INTRODUCTION: Over the past 40 years, surgical treatment for humeral shaft fractures has become more common. The purpose of the study was to evaluate complication rates seen with different treatments for humeral shaft fractures. Nerve injury (NI), infection, deep vein thrombosis (DVT), and nonunion (NU) were the specific complications investigated. METHODS: A retrospective database review was performed looking at all patients with humeral shaft fractures. Data was analyzed for complication rates for non-surgical (NS) treatment, open reduction internal fixation (ORIF), and intramedullary nailing (IMN). Inclusion criteria were: 1) patients ages of 18 to 89 and 2) those with humeral shaft …

Development And Validation Of A Novel Skin Pigment Scale, Christina Guo, Henry Lim, Christopher Wong, Christian Scheufele, Michael Carletti, Michele L. Mccarroll, Stephen Weis

North Texas Research Forum 2024

Background: Precise description of the skin is a pillar of dermatology. For dermatologists, skin pigment is akin to a ‘vital sign’ in that it represents a basic, yet illuminating, piece of information for each patient. The current method used to describe skin color is the Fitzpatrick scale. The Fitzpatrick scale was designed to measure skin burning and the scale is inadequate for precise measurement of skin color in a diverse population. The prevalence of its use perpetuates harmful and outdated structures and contributes to health disparity. For those reasons, there is a critical need for initiatives that evaluate the current …

Partial Anomalous Pulmonary Venous Return: To Fix Or Not To Fix?, Akshaj Pole, Jennifer Austin, Amnah Andrabi

North Texas Research Forum 2024

Patient is a 56-year-old male with a past medical history of type 2 diabetes, hypertension, prior MVA with chest trauma, and coronary artery disease with 2 prior stents in the obtuse marginal and right coronary artery who was brought to the ED for severe chest pain. Patient was immediately taken to the cath lab for cardiac intervention. Patient was identified to have 90-95% stenosis of his left circumflex but was unable to be stented due to tortuosity of the vessel and tight lesion. Due to patient’s multivessel coronary artery disease and newly diagnosed diabetes, patient was referred to cardiothoracic surgery …

Retrospective Review Of Adverse Events After Treatment Of Non-Melanoma Skin Cancer With Image-Guided Superficial Radiation Therapy, Marshall Hall, Henry Lim, Jason Pham, Alyssa Forsyth, Wenqin Du

North Texas Research Forum 2024

No abstract provided.

Colovaginal Fistula In A Patient Without A Hysterectomy, Austin Moore, Mollie Ahn, Anthony Macaluso

North Texas Research Forum 2024

Introduction: A majority of case reports and review studies exploring the incidence of colovaginal fistulas typically involve patients of older age with a history of both a hysterectomy and at least one episode of symptomatic diverticular disease. Colovaginal fistulas rarely occur in patients who have not had a prior hysterectomy. Case Description: A 52 year old female presented to colorectal surgery clinic with a history of multiple episodes of sigmoid diverticulitis who now had passage of air and stool from her vagina. She was confirmed to have evidence of a colovaginal fistula from her sigmoid colon to her …

Comparing Large Language Models Accuracy In Following Interval Surveillance Colonoscopy Guidelines, Olufemi Osikoya, Gregory Brennan

North Texas Research Forum 2024

Introduction: Providing pathology results and appropriate recommendations after resection of colon polyps is mandatory. Large language models (LLMs) such as ChatGPT and Google Bard, have shown promise in clinical workflows such as pathology results letters. We tested whether LLMs could provide appropriate surveillance recommendations based on current guidelines from the US multi-society task force for post-colonoscopy follow-up. Methods: Our aim was to compare the accuracy of ChatGPT 3.5, ChatGPT 4, and Google Bard in providing appropriate interval surveillance recommendations. An example prompt being “Write a patient pathology result letter after a colonoscopy with one tubular adenoma polyp (< 10mm) resected. Include recommendations for when the next surveillance colonoscopy should be completed.” Seventeen different post polypectomy surveillance queries and responses were analyzed (correct, partially correct, incorrect) compared to USMSTF guidelines. Results: When …

Geometric Favre-Racouchot Syndrome Following Image-Guided Superficial Radiation Therapy, Marshall Hall, Cecilia Nguyen, Christian Scheufele, Christopher M. Wong, Stephen E. Weis

North Texas Research Forum 2024

Introduction: Favre-Racouchot Syndrome is a cutaneous disease characterized by nodules, cysts, and comedones located in sun-exposed areas of the face. It is most commonly found on the bilateral temporal and periorbital skin. Favre-Racouchot Syndrome is most associated with chronic sun exposure. It occurs more commonly in cigarette smokers. It has been rarely associated with radiation therapy. It has not been reported after image-guided superficial radiation therapy or in a geometric pattern. Case presentation: We present the first two recorded cases of Favre-Racouchot Syndrome occurring in the setting of image-guided superficial radiation therapy. Both patients presented with well-demarcated geometric plaques with …

Disseminated Coccidioidomycosis Discovered Through Skin Biopsy In A Pregnant Patient From Mexico, Henry Lim, Christina Guo, Marshall Hall, Christian Scheufele, Christopher M. Wong

North Texas Research Forum 2024

Introduction: Coccidioidomycosis is an infection caused by the organism Coccidioides immitis, a fungus endemic to the southwestern United States, Mexico, Central and South America. The presentation of coccidioidomycosis can range from symptoms resembling a simple upper respiratory infection, such as cough, to more severe systemic symptoms including fever, malaise, and chills. Cutaneous lesions of coccidioidomycosis demonstrate a large heterogeneity of clinical manifestations but are significant as they may be the presenting sign of disseminated disease. While usually confined to the lungs, extrapulmonary coccidioidomycosis can occur in about 1 in 200 patients, most commonly associated with immunocompromised status. Pregnancy is an …

Improving Lesion Diameter Reporting On Skin Biopsy Requisition Forms: A Quality Improvement Project, Christopher Wong, Christian Scheufele, Marshall Hall, Henry Lim, Daniel A. Nguyen

North Texas Research Forum 2024

Background: Skin biopsy requisition forms (SBRFs) are the primary communication tool between dermatologists and dermatopathologists. Diameters of biopsied skin lesions are frequently omitted on SBRFs. This quality improvement project aimed to increase the rate of reporting diameters of neoplasms on SBRFs from an academic dermatology outpatient clinic to greater than 65% within three years. Methods: The Plan-Do-Study-Act model was utilized. An initial audit was performed for SBRFs of biopsies obtained between July 1, 2021, and February 4, 2022 (“Cycle 1”). On February 4, 2022, the authors discussed societal guidelines for lesion diameter reporting on SBRFs (“Intervention A”). Cycle 2 prospectively …

Polypharmacy And Potentially Inappropriate Prescribing In Geriatric Population, Maryam Burney, Barry Brown, Victoria Nguyen, Garrett Furth, Ambreen I. Ahmed

North Texas Research Forum 2024

Polypharmacy is a ubiquitous concern among patients, especially geriatric patients, who are at a higher risk of clinical burden. It is associated with an increase in healthcare costs, decreased functional status, and adverse drug events, contributing to geriatric syndromes, such as falls, cognitive decline, and urinary retention. Geriatric care is multi-tiered, requiring assistance and care from a thorough physician who is attune to the potential risks of medications that are commonly prescribed. Smaller communities, often with less resources and clinical providers and with an aging population, especially at the hospital setting, are vulnerable to oversights when it comes to medication …

Implementing Auc Monitoring In A Pharmacist-Managed Vancomycin Dosing Protocol: A Retrospective Cohort Study, Brandon L S Robinson, Blake Bennie, Mahmoud Nasiri, Kieu Nguyen, Reba Forbess, Mallory Gessner-Wharton, Cassie Robertson

HCA Healthcare Journal of Medicine

Background

Consensus guidelines on the therapeutic drug monitoring of vancomycin published in 2020 recognize that using the calculated area-under-the-curve (AUC) to guide dosing maximizes clinical efficacy and minimizes risk when compared to traditional trough-based dosing. The purpose of this study was to determine whether AUC monitoring results in reduced acute kidney injury (AKI) rates in adult patients receiving vancomycin for all indications.

Methods

In this study, patients 18 years or older who received pharmacist-managed vancomycin therapy were selected using pharmacy surveillance software from 2 timeframes. Patients were excluded if they received less than 48 hours of therapy or had unstable …

Anti-Factor Xa Level Monitoring For Enoxaparin Prophylaxis And Treatment In High-Risk Patient Groups, Lucie Sikes, Kipson Charles, Abigail Antigua, Rima Patel, Selina Imboywa, Pheba Cherian

HCA Healthcare Journal of Medicine

Monitoring anti-factor Xa levels is a controversial topic in the inpatient setting due to resource utilization and unclear conditional guideline recommendations regarding this practice. Enoxaparin dosing in certain high-risk patient populations such as those with low body weight, obesity, renal insufficiency, and pregnancy has not been determined. The objective of this review was to assess the safety and efficacy of enoxaparin monitoring via anti-factor Xa levels in high-risk patient populations.

The PubMed database was searched for articles related to low-molecular-weight heparin monitoring. Randomized controlled trials and meta-analyses that evaluated the safety and efficacy of enoxaparin prophylaxis and treatment in patients …

Monitoring Concordance In The Management Of Transfusing Blood Components In Cirrhotic Patients For Paracentesis With Evidence-Based Guidelines, Joseph Kim, Gregory Moses

North Texas Research Forum 2023

Initiative to decrease unnecessary hemostatic agent transfusion in cirrhotic patients undergoing paracentesis: a resident-led approach quality improvement project to prevent transfusion overuse. Currently, there is no official guideline placed in the hospital for the administration of a hemostatic agent such as fresh frozen plasma in the setting of an elevated international normalized ratio, which paradoxically is an anticipated finding in cirrhotic patients. This process leads to unnecessarily prolonging the duration of the hospital course due to delays in performing the interventional procedures and interruptions in scheduling. The goal of this project is to educate and provide physicians with the most …

Outpatient Breast Cancer Screening Documentation, Christoffer A. Amdahl, Jeremy Smith

North Texas Research Forum 2023

Introduction: Over 264,000 cases of breast cancer are diagnosed annually within the United States, with 99% of them being in women. Regarding prevention of this terrible disease, early detection of such cancers through screening mammography has up to a 20% reduction in breast cancer mortality. Therefore, the USPSTF recommends screening of women who are 50-74 years of age via mammography at average risk of breast cancer every two years. The goal of this study was to measure, track, and increase compliance with these screening recommendations within the Medical City resident clinics.

Method: Family medicine residents working were presented with a …

A Case Of An African American Female Presenting With Idiopathic Granulomatous Lobular Mastitis, Wendy Timirau, Esra Sari, Maham Shahid, Nilmarie Guzman, Augusto Villegas

South Atlantic Division Research Day 2023

No abstract provided.

Timing Of Dual Antiplatelet Therapy (Dapt) Initiation Post Mechanical Thrombectomy With Stent Placement In Acute Ischemic Sroke, Mallory R. Stringer, Eric Shaw, Osman Perez, Emily G. Bowers

South Atlantic Division Research Day 2023

No abstract provided.

Calciphylaxis, A Case Series: The Importance Of Early Detection, Nikita Sijapati, Suy Sen Hung Fong, Omar Ansari, Subhasis Misra, Edgar Mercado, My Myers, Vijay Narasimha

HCA Healthcare Journal of Medicine

Introduction

Calciphylaxis is a rare disorder that involves the formation of cutaneous, subcutaneous, and vascular calcifications. Although it is predominantly seen in patients with end-stage renal disease (ESRD), it has also been reported in patients without chronic kidney disease. The presence of multiple risk factors, a poorly understood mechanism, high mortality, and the lack of standardized treatment make calciphylaxis an important subject.

Case Presentation

We describe the clinical presentation, disease course, and management of 3 patients with calciphylaxis and also provide a literature review. In all 3 patients, the diagnosis was confirmed histologically, and the management involved the continuation of …

A Retrospective Study Comparing Mortality Rates Between Vaccinated And Unvaccinated Kidney Transplant Recipients, Anaam Fayyaz, Judy Pozzerle, Suresh Antony

Central & West Texas Research Day 2023

No abstract provided.

Crochetage Pattern: An Electrocardiographic Warning Sign For Scuba Divers, Sarah Crawford

West Florida Division Research Day 2023

No abstract provided.

Investigating Association Between Sociographic Factors And Rates Of Urine Drug Screening In Patients Admitted To Labor And Delivery: A Retrospective Analysis, Erin Manglardi, Donna Boucher

North Florida Division Research Day 2023

No abstract provided.

Are We “Pushing” Our Patients Toward Addiction? A Preliminary Post-Cesarean Survey To Quantify Narcotic Requirements For Pain Control, Aliya Nurani, Mikalah Maury, Merritt Mcgowan, Stephanie Tootle, Anthony Royek, Eric Shaw

South Atlantic Division Research Day 2023

No abstract provided.

A Standardized Protocol For Remote Outpatient Blood Pressure Management, Nicholas Dorsey, Justin Taylor, Elvira Mercado

North Florida Division Research Day 2023

No abstract provided.

Reducing Unnecessary Cbcs On The Inpatient Resident Service: Interviewing Stakeholders To Identify Underlying Causes, Feras Al-Moussally, Zara Bashir, Jorge Rodriguez, Ashlee Sidhu, Brain Murr, Liliana Franco, Jorge Restrepo, Ashwini Komarla

North Florida Division Research Day 2023

No abstract provided.

Operative Management Of Grade V Liver Injury After Blunt Trauma: A Case Report, Laura Mena Albors, Garret Perry, Samantha Reiss, Darwin Ang

North Florida Division Research Day 2023

No abstract provided.

Illicit Drug Use Patterns In Myrtle Beach, S.C. From 2017-2022, Michelle Fowler, Mark Plexousakis, Meg Riley, Blaine Rourke, Erin Artigiani, Amy Billing, Margaret Hsu, Ebonie Massey, Eric Wish

South Atlantic Division Research Day 2023

No abstract provided.