The Differential Expands: Ataxia From Paraneoplastic Cerebellar Degeneration, Dominic Thomas, Md, Amy Dechet, Md

Poster Presentations

No abstract provided.

Retrospective Review Of Phenobarbital Versus Lorazepam For Alcohol Withdrawal Syndrome In The Emergency Department, Spencer Hayashi, Savita Bathija, Pharmd, Bcemp, Paul Vanemmerik, Nishat Mujeeb, Chris De Las Alas

Books, Presentations, Posters, Etc.

Abstract: According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in the US, alcohol use contributes to up to five million emergency department (ED) visits annually. Alcohol withdrawal syndrome (AWS) is a serious and potentially life-threatening condition that can lead to complications such as hallucinations, seizures, and delirium tremens. For many years, the standard treatment for AWS has been symptom-triggered benzodiazepines, often dosed based on symptom scoring tools such as the Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) Score. In recent years, the use of phenobarbital for AWS management has gained popularity, and studies investigating its safety and …

Clinical Outcomes Associated With Mrsa Naat Utilization., Shannon B. Leighton, Pharmd, Emily Fox, Greg Tallman

Books, Presentations, Posters, Etc.

Abstract: A recent analysis by the Oregon Regional Antimicrobial Stewardship Program demonstrated that across the Oregon region, MRSA NAAT from the nares have a high negative predictive value (NPV) of 99.4%. These findings were consistent when stratified by culture site. The high NPV suggests that MRSA NAAT nasal swabs can be useful in promoting de-escalation (e.g., discontinuation) of anti-MRSA treatment. Few studies have evaluated if use of the MRSA NAAT influences anti-MRSA treatment de-escalation, and even fewer have assessed important clinical outcomes related to MRSA NAAT utilization and de-escalation. The goal of this study is to evaluate the frequency of …

A Clot To Worry About: Venous Thromboembolism In Severe Ulcerative Colitis, Jin Yun, Do, Donald Lum

Books, Presentations, Posters, Etc.

Introduction: Patients with inflammatory bowel disease (IBD) have an estimated three-fold higher risk of venous thromboembolism (VTE) compared to the general population. We present a case of a 19-year-old female with phlegmasia curelea dolens and massive pulmonary embolism in the setting of severe ulcerative colitis. Case Presentation : • 19-year-old female with iron deficiency anemia and three-month history of hematochezia, recently started on oral contraceptive pills. • Presented with acute left lower extremity pain, swelling, and cyanosis concerning for phlegmasia curulea dolens and compartment syndrome. • Underwent emergent thrombectomy, venoplasty, and fasciotomies. • Post-operatively, course complicated by obstructive shock and …

The Protective And Pathological Role Of The Spleen In Malaria, Julie Hwang, Md, Amy Dechet

Books, Presentations, Posters, Etc.

Case Presentation: • Background: There were 241 million cases of malaria globally. Compared to 2,000 cases in the U.S. Splenomegaly has previously been used to determine the severity of malaria. This is a rare case of hyper reactive malarial splenomegaly (HMS) due to chronic plasmodium ovale • 23 year-old female with gradually worsening left upper quadrant abdominal pain of 1 month. Pain sharp and stabbing in quality, no alleviating or aggravating factors. Associated with subjective early satiety and 10 Ibs weight loss, generalized weakness, shortness of breath • PMH: Schistosomiasis 2008,unclear if treated • Soc: Born in Congo and immigrated …

Not Just A Biblical Disease: Hansen’S Disease (Leprosy) Oregon’S Unique Differential, Zach Taylor, Justin Jin, Andrea Roast, Amy Dechet

Books, Presentations, Posters, Etc.

Background: Hansen’s disease (leprosy) is caused by a gram-positive, acid-fast bacilli called Mycobacterium leprae. It is very slow growing and has an indolent disease process. The disease is more prevalent in underdeveloped countries with poor access to care including Brazil, India, sub-Saharan Africa, and the Pacific Islands including Micronesia and the Philippines. However, it is becoming in creasingly common in the United States, specifically in areas with high levels of immigration from Micronesia. Case: Our patient was a 35-year-old Micronesian man who presented with 7 days of non-traumatic right hand pain with progressive swelling. He migrated to US from Micronesia …

Don’T Poke The Bear: Pheochromocytoma Unmasked By Covid-10, Taylor Virtue, Andrea Roast

Books, Presentations, Posters, Etc.

Introduction: Pheochromocytomas are tumors of the adrenal gland which produce excess catecholamines. The classic clinical triad is paroxysmal headache, diaphoresis, and tachycardia. The rare incidence makes this a challenging diagnosis which is even more challenging in the environment of the COVID-19 pandemic. Case Presentation: Setting: Establishing care visit at a primary care office Demographic: 42 year old male Medical history: Previously well-controlled hypertension, prediabetes HPI: • Weeks of profound, persistent fatigue and lightheadedness after the resolution of acute symptoms (fever, chills) from COVID-19 infection. Denies any headaches or palpitations. • Meticulously measuring vital signs at home. He has noticed that …

Tobacco Cessation Email Outreach In A Primary Care Setting, Katie Berry, Md, Meera Jain

Books, Presentations, Posters, Etc.

Background: . • Tobacco use remains the #1 cause of preventable death in the United States • Providence Health and Patient Education Program offers resources for tobacco cessation (eg. Virtual classes), but few patients access these services • Xealth® is a digital healthcare technology company contracted with Providence that aims to provide digital content to improve patient care and resources to analyze data • Study purpose: Assess if digital outreach to patients helps engagement in tobacco cessation services • Our clinic was a pilot clinic to develop the intervention and assess efficacy prior to roll out to all Providence Medical …

Tuberculous Myositis In The Leg Musculature, Tho Nguyen, Md

Books, Presentations, Posters, Etc.

Introduction - The majority of active Mycobacterium tuberculosis cases are pulmonary, but extrapulmonary tuberculosis (TB) can account for up to 30% of active cases. Cases of tuberculosis myositis are rare and account for less than three percent of active cases and diagnosis is often delayed due to its rarity. We present a case of TB myositis and discuss the difficulties in diagnosis Case - Patient is an 82-year-old Vietnamese speaking female with hypertension and hyperlipidemia who presented for acute onset of nausea and vomiting in setting of three-month history of recurrent left lower extremity (LLE) swelling without systemic symptoms such …

A Case Of Kaposi's Sarcoma With Dyspnea, Claire Higgins, Md, Brinton Clark, Md, Mph

Poster Presentations

Introduction: Kaposi’s sarcoma is an AIDS-defining malignancy that is rare in era of widely accessible anti-retroviral therapy (ART), with an incidence of 481 per 100,000 person years. We present a case of a 43-year-old man with HIV/AIDS and disseminated Kaposi’s sarcoma who presented for evaluation of months of worsening dyspnea on exertion which had progressed to dyspnea at rest. Case Presentation: •43-year-old man with a 10 years history of HIV/AIDS, historically non-adherent to ART, who was diagnosed with extensive Kaposi's sarcoma involving the hard palate, airway, and bones one year prior. •He has been treated with ART and doxorubicin chemotherapy …

A Vexing Case: A Newly Discovered Autoinflammatory Disease, Ashley Edwards, Md, Caroline Mcculley, Md

Poster Presentations

Introduction: Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) Syndrome is a recently recognized adult-onset autoinflammatory disease that can lead to potentially lifethreatening multi-system inflammation with estimated prevalence of up to 1 in 5,000 males over the age of 50. Given its significant morbidity and mortality and high prevalence, increased awareness of this condition is of foremost importance. Herein we outline a case of VEXAS syndrome. Case Presentation: Mr. N is a 73-year-old male with a past medical history significant for hypertension and recent episode of uveitis who first presented to the hospital for significant unintentional weight loss, fevers, and abdominal …

Acute Care Staff Interactions With Chaplains To Discuss Personal, Non-Work-Related Stressors, Gary Weisbrich, Teresa Rangel

Central Division Nurse Clinical Inquiry Conference

No abstract provided.

Moral Injury, Moral Resilience, And The Healthy Work Environment Among Icu Nurses: A Secondary Analysis, Angie Shemwell, Sarah Sumner

Central Division Nurse Clinical Inquiry Conference

No abstract provided.

Nitrous Oxide Administration In General Anesthesia Patients, Kaley Smith, Karen Colorafi, Kenn Daratha, Braden Hemingway

Central Division Nurse Clinical Inquiry Conference

Abstract:

Background:

Nitrous oxide is an inexpensive and fast-acting gas used in a variety of inpatient and outpatient perioperative settings to hasten the onset of and emergence from general anesthesia. Problematically, nitrous oxide has been identified as a risk factor for postoperative nausea and vomiting (PONV), one of the most common adverse events after anesthesia. Unresolved PONV is linked to increased pain, wound dehiscence, aspiration, and longer stays in the recovery area and/or hospital. An Apfel Simplified Risk Score can be calculated to predict PONV based on four patient characteristics: female sex, non-smoker, history of PONV or motion sickness, and …

Rates Of Postoperative Pneumonia In Healthy Adults Receiving Neostigmine Versus Sugammadex: A Multi-Center Evidence-Based Practice Project, Kirstie Gorthy, Braden Hemingway, Karen Colorafi, Kenn Daratha

Central Division Nurse Clinical Inquiry Conference

Abstract:

Background

Residual neuromuscular blockade increases morbidity and mortality following surgery with general anesthesia and paralysis. Optimal antagonism of pharmacologic muscle relaxation is critical to avoiding residual weakness and subsequent pneumonia. The clinical question that guided the investigation of the evidence was, ‘Among healthy adults requiring neuromuscular blockade during general anesthesia for elective, noncardiac surgery, does the use of sugammadex compared to neostigmine for reversal of neuromuscular blockade influence the rate of postoperative pneumonia within seven days?’

Purpose

The primary purpose of this evidence-based practice project was to describe the rates of pneumonia among healthy adults antagonized with neostigmine or …

Factors That Influence Receiving An Instrumental Assisted Birth: An Evidence-Based Project, Douglas Nanu, Madison Schatz, Gabriel Alemayehu, Teresa Rangel

Central Division Nurse Clinical Inquiry Conference

No abstract provided.

A Team Mentor Project To Reduce Turnover On A Cicu, Sarah Evans

Central Division Nurse Clinical Inquiry Conference

Abstract:

Background

From 2022-2023, a 28-bed cardiac care intensive unit (CICU) employing 120 Registered Nurses (RNs) hired 63 RNs, including 3 new graduates and 32 new-to-specialty, following significant turnover. Nurses in the CICU frequently face complex situations, leading to emotional distress and potential turnover if coping resources are not provided. Research suggests that pairing a new CICU nurse with an experienced mentor to help cope with complex situations can significantly increase confidence and resiliency and reduce emotional distress and turnover. On our CICU, nurses are assigned a preceptor for 12-20 weeks to orient to CICU-specific competencies without an emphasis on …

Implementing A Mentorship Program On A Medical/Oncology Unit, Nicole Frye, Stephanie Perreiah, Jenna Vansanford

Central Division Nurse Clinical Inquiry Conference

Abstract:

Title: Implementing a Mentorship Program on a Medical/Oncology Unit Background: New-to-specialty acute care nurses are generally assigned a preceptor to demonstrate complex competencies within 90 days of hire. However, providing inpatient nursing care presents psychosocial stressors not well-addressed by preceptors which can contribute to burnout and turnover. Participating in a mentorship program addressing psychosocial nursing stressors following competency-focused preceptorship may reduce burnout and turnover. A medical-oncology unit of a 200-bed urban hospital lacked a mentorship program and Unit-Based Council (UBC) members worked to implement and evaluate this resource. Purpose: To evaluate barriers and facilitators of participation in a new …

The Mindfulness Minute For Caregiver Wellbeing, Veronica Silva, Trisha Saul

Articles, Abstracts, and Reports

Purpose {What): Research has shown a correlation between stress and job burnout. The Minute Project was developed as a simple tool for caregivers to reduce stress. Our intention is that when stress is reduced, burnout will also be reduced. This tool can be used anytime throughout the day to help our caregivers. Significance {Why): The wellbeing of caregivers in a hospital setting have been challenged over the past 2-3 years. Research has shown that mindfulness practices have an impact on stress levels by activating the parasympathetic nervous system. Given the limited education resources, we felt that addressing the stress levels …

Role Of A Multidisciplinary Pulmonary Embolism Response Team And Impact Of Interventional Therapy In The Management Of Patients With Intermediate-High Risk Pulmonary Embolism, Juan N Pulido, Robert Fletcher, Michelle A. Poitevin, Kristina Pratt, Paul P Huang, Eric J Lehr, George P Pappas

Articles, Abstracts, and Reports

Background: Despite emerging interventional options for pulmonary embolism (PE), the mortality rate for intermediate high-risk PE (IHR-PE) remains high and the optimal therapeutic approach unclear due to a lack of robust outcomes data. We describe the outcomes of patients presenting with IHR-PE managed by a multidisciplinary PERT program with all available reperfusion options.

Methods: This single center retrospective study included EMR data from patients that were a part of the multidisciplinary PERT program from January 2012 to June 2023. PERT was activated if risk of death was intermediate or higher. The simplified pulmonary embolism severity index (sPESI) and Bova score …

Outcomes Of Patients With Intermediate Risk Pulmonary Embolism Treated With A Multidisciplinary Pulmonary Embolism Response Team. The Emergent Role Of Percutaneous Catheter Thrombectomy And The Importance Of Cardiac Surgery Engagement, Juan N Pulido, Robert Fletcher, Michelle A. Poitevin, Kristina Pratt, Paul P Huang, George P Pappas, Eric J Lehr

Articles, Abstracts, and Reports

Background: Management of Intermediate Risk Pulmonary Embolism (IRPE) remains controversial due to the dynamic nature of the disease and the lack of correlative outcomes with large clot burden. We describe the outcomes of patients presenting with IRPE managed by a multidisciplinary Pulmonary Embolism Response Team (PERT).

Methods: This single center retrospective study included EMR data from patients that were a part of the multidisciplinary PERT program from January 2012 to June 2023. PERT was activated if risk of death was intermediate or higher. The simplified pulmonary embolism severity index (sPESI) and Bova score were used as risk stratification tools. Patients …

Poster: Moral Injury & Nurse Work Performance Following The Covid-19 Surges, Annette Callis, Trisha Saul, Ross Bindler

2023 South Division Nursing Research Conference

No abstract provided.

Clinical Practice Panel: Diabetes Mellitus Management In A Medical-Surgical Unit, Jane Tajonera

2023 South Division Nursing Research Conference

No abstract provided.

Poster: Improving Emergency Department Belongings Inventory Electronic Medical Record Documentation, Shanekia Garrett, Stefanie Lai, Jairo Pagan, Wendy Lu, Katie Whitehead

2023 South Division Nursing Research Conference

Improving Emergency Department Belongings Inventory Electronic Medical Record Documentation Rates Background: Electronic Medical Record (EMR) education and training for RNs should be multifaceted and targeted to the RN clinical workflow. Input from direct care RNs is essential to ensure EMR education is relevant and effective. Shared Governance at a community hospital identified quality and safety concerns among inpatient RNs. RNs reported that belongings inventories were not consistently documented in the EMR for Emergency Department (ED) admissions. Hospital policy requires belongings inventory EMR documentation for all admitted patients. An audit of charts for ED admissions over three months revealed only 5% …

Keynote: Escaping A Code Stroke: Impact Of Escape Room Methodology On Nurses’ Attitudes Towards Acute Stroke Management Guidelines, Diana D. Tai

2023 South Division Nursing Research Conference

No abstract provided.

Poster: Eliminating Hospital Acquired Pressure Injuries (Hapis) In The Intensive Care Unit, Luzbel Diaz

2023 South Division Nursing Research Conference

No abstract provided.

Poster: Nicu Reading Club: Promoting Early Reading In The Nicu, Hsiang-Fen Su, Irma Duke, Roxanne Arcinue

2023 South Division Nursing Research Conference

No abstract provided.

Clinical Practice Panel: Improvements In Pediatric Food Insecurity Screening; A Qi Project To Increase Pediatric Food Insecurity Screening, Casey Katzman, Brandy Rachel Frye, Hsiang-Fen Su

2023 South Division Nursing Research Conference

No abstract provided.

Clinical Practice Panel: Stand By Me: Using An Enhanced Recovery After Surgery (Eras)Checklist To Guide Early Mobility Of Postoperative Craniotomy Patients On A Progressive Care Unit, Alyssa Mooney, Jerome Codilla, Joanna Arraiza, Sohl Chapman, Nkiru Chukwudi, Ronald Rosales

2023 South Division Nursing Research Conference

No abstract provided.

Poster: Clinical Practice Panel: Don't Skip A Beat, Follow The Sheet! Designing A Clinical Care Map For Open Heart Patients In The Icu, Danielle Fogel, Nico Vargas

2023 South Division Nursing Research Conference

No abstract provided.