Medical Specialties Commons^™

Improving The Chemotherapy Experience Through Telephone Communications: The Follow-Up Phone Call, Kathy Keener, Msn, Rn, Ocn

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Dnase1l3 Inhibition To Improve Anti-Tumor Immune Responses, Michael J. Gough, Marka R Crittenden, Tiffany Blair

Technology Transfer - Patents

No abstract provided.

Axillary Transvalvular Microaxial Pump As Bridge To Transcatheter Aortic Valve Replacement In Cardiogenic Shock, Jacob Abraham, Lian Wang, V Kumar, Eric B Kirker, Kateri Spinelli

Articles, Abstracts, and Reports

No abstract provided.

Successful Pivot Of A Community Exercise Program To Virtual During The Covid-19 Pandemic, Letracia Rose, James G Beckerman

Articles, Abstracts, and Reports

No abstract provided.

Pediatric Surgery Nurses Lead And Coordinate Covid-19 Recovery Efforts, Shelly Johnson, Alice E. Dupler

2021 Providence Nurse Research Conference

Background: In early 2020, the appearance of the novel COVID-19 virus became a global concern, infecting hundreds of thousands of people. To reduce the spread of the virus, the United States government instituted social distancing and required hospitals to take steps to create extra beds for patient with COVID. One method to increase hospital capacity was the cancellation of scheduled, elective surgeries. In one large pediatric hospital in the Pacific Northwest, there was no formal process in place for cancelling elective procedures or for prioritizing when or how to reschedule the case. Because nurses were being called on to provide …

Evaluation Of A Coronary Artery Bypass Graft Care Steps Program, Sheri Havel, Karen Colorafi, Mirjeta Beqiri

2021 Providence Nurse Research Conference

Background: Across the U.S., 20% of cardiothoracic surgery patients who are discharged to home experience unplanned readmission within 30 days of discharge. Readmissions and postsurgical complications are associated with poor patient outcomes, increased mortality rates, and increased cost of healthcare. Evidence-based recommendations for reducing preventable readmission are limited, although there is some indication that high quality pre-operative and discharge education can reduce this burden. Providing appropriate patient education at time of discharge from acute care to home regarding medication adherence, prescheduled follow-up appointments, wound management and monitoring, and symptom management education is theorized to have a significant positive impact on …

Improving Outcomes For Pregnant Women With Severe Hypertension, Danette Schloeder

2021 Providence Nurse Research Conference

Background: In 2019, a large hospital in Alaska joined the Alaska Perinatal Quality Collaborative (PQC). The first project was the AIM Hypertension Project. The goals of the project were to reduce severe maternal morbidity among preeclampsia cases by 20% and Increase the timely treatment of hypertension to 80%. Other process and structure measures included education, simulation, clinical debriefs, and follow-up visits.

Methods/Approach: The PQC used monthly educational sessions, data collection and review of every case with severe hypertension, and Plan-Do-Study-Act cycles. Data collection occurred over an 18-month period. Cases were identified by the Washington State Hospital Association database and reviewed …

Improving Primary Care Screening For Familial Hypercholesterolemia, Mary Nametka, Brenda Senger

2021 Providence Nurse Research Conference

Background: Familial Hypercholesterolemia (FH) is the most common genetic condition resulting in cardiovascular disease, a leading cause of death in the United States. FH is estimated to affect 1 in 250 individuals with elevated lipid levels present from birth. An estimated 90% of individuals with FH remain undiagnosed. '

Purpose: The purpose of this quality improvement project was to increase provider awareness and promote screening for FH among adults ages 20 years and older. '

Methods: This quality improvement project consisted of an online educational intervention for providers working at an outpatient clinic regarding FH. Outcomes included: 1) pre-intervention …

Pain Management Trends Among Adults Hospitalized With Cellulitis: An Evidence-Based Practice Project, Syndey Pham, Teresa Bigand, Brenda Senger, Kenn Daratha, Kris Daratha

2021 Providence Nurse Research Conference

Background: Cellulitis is an infection of the skin causing swelling and acute pain. Two and a half to three and a half million adults seek care in the emergency department annually for this condition. Opioid medications are commonly administered and prescribed for pain, especially following the Joint Commission’s campaign in 2001 characterizing “pain as the 5th vital sign”. An estimated 22% of older adults hospitalized with a painful medical condition receive a new prescription for an opioid medication. Evidence suggests that there is no difference in pain outcomes among adults prescribed opioid versus non-opioid medications for acute pain conditions in …

Development Of A Smartphrase In The Electronic Health Record To Promote Chemotherapy And Immunotherapy Safety, Mary Jo Sarver, Monica Mcmanus, Amy Allen, Bethany Johnson, Dennielle Padgett, Elizabeth Ser

2021 Providence Nurse Research Conference

Background: Chemotherapy-immunotherapies are high risk medications that can include multi-drug and multi-day regimens with narrow therapeutic indexes and high risk for toxicities. Susceptibility for errors exists if adherence to protocol is inconsistent or if pertinent patient specific information is omitted. Prior to the creation of the "SmartPhrase" in the Electronic HealthRecord (EHR) pre-administration safety checks were on paper, not included in the EHR, not standardized among clinicians, and not completed every time. Chart audits revealed a need for consistent, centralized documentation to enhance patient safety while minimizing professional liability. A trans-disciplinary team created a "SmartPhrase" template for streamlining relevant …

Blind Taste Testing: A Case Study Of An Emergency Room Rn With Covid-19 Anosmia & Hypogeusia (Loss Of Taste & Smell), Marietta Sperry, Kimberly Kohlieber

2021 Providence Nurse Research Conference

Background: Anosmia, or the loss of taste and smell, is an important symptom for nurses to screen for among patients, as this can result in a poor appetite which impairs healing. In the early stages of the COVID19 pandemic, anosmia was not a known symptom indicative of infection with the virus. Yet, one Registered Nurse who was working in an Emergency Room received a positive COVID test following a workplace exposure to the virus while wearing personal protective equipment, and began to complain of anosmia shortly thereafter. Because the anosmia persisted, his spouse conducted blind taste test on him …

An Evaluation Of The Use Of Tranexamic Acid In The Treatment Of Bradykinin-Mediated Angioedema In The Emergency Department, Sarah Yb Kim, Carol Keller

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2021

Background

Bradykinin mediated angioedema is an overarching term that includes idiopathic angioedema, angiotensin converting enzyme inhibitor (ACEi) induced angioedema and hereditary angioedema (HAE). •This is an emergent condition that must be treated with the utmost urgency due to the fatal outcomes associated with the rapid constriction of the throat. •Bradykinin mediated angioedema is treated differently from histamine associated angioedema due to its resistance to corticosteroids and antihistamines. •HAE and ACEi induced angioedema are treated similarly but there is a lack of unanimity in the first line pharmacologic treatment. •Current treatment options include fresh frozen plasma, bradykinin-2 receptor antagonists, plasma-kallikrein inhibitors …

Medication And Pharmacy-Related Outcomes As Part Of The Seniors At Risk For Falls After Emergency Room Visit (Safer) Project, Hyesoo Chae, Sharon Leigh, Colleen M Casey

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

Background

The United States is comprised of an aging population; adults over the age of 85 are the fastest-growing age group in the United States and will reach approximately 9 million in 2030.1 25% of patients ≥ 65 years old in the United States report falling each year.1 There are over 3 million emergency department visits related to falls in the United States, totaling approximately 50 billion dollars in total medical expenditures.2 Falls are a major threat for older adults as they can lead to increased risk of further injury, loss of independence, decreased mobility, and premature death.1,2 Despite numerous …

Temporal Trends And Predictors Of Surgical Ablation For Atrial Fibrillation In A Large Western Us Healthcare System, Scott Brancato, Mansen Wang, Kateri Spinelli, Alison Leiataua, James Brevig, Zachary M Deboard, Torin P. Fitton, Maheer Gandhavadi, Jonathan P. Piccini, Neil Worrall, Tyler J Gluckman

Articles, Abstracts, and Reports

No abstract provided.

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 …

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 …

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, …

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 Surgical Antibiotic Prophylaxis Compliance At A Large, Tertiary Medical Center, Meagan Greckel, Brent Footer

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

Background

• Surgical site infections (SSIs) are a significant cause of morbidity, prolonged hospitalization, and mortality. •Studies estimate SSIs contribute to nearly one million additional inpatient days per year and SSI mortality rate has been estimated to be 3%. •Additionally, SSIs in the US alone have an annual cost of approximately $3.5 billion. •A prior quality improvement project performed at a large, tertiary medical center in 2018-2019 identified that consistent adherence to the system surgical antibiotic prophylaxis (SAP) guideline and institutional antibiogram for antibiotic selection was an area for improvement. •This was particularly evident in hysterectomy and colorectal surgeries; therefore, …

A Case Of Vaccine-Preventable Back Pain, Gerald Hutfles, Tricia James

Providence Portland Medical Center Internal Medicine 2021

The Case 55-year-old male with minimal medical history who presented multiple times over 9 months with progressive and severe gluteal & back pain, ultimately found to be from anal cancer.

HPV - The Bad, Insidious Bug

What is it? •Human Papillomavirus (HPV) is a double-stranded DNA virus of the Papillomaviridaefamily. Its lifecycle is tied to epithelial tissue. Why do we care? •HPV is associated with warts (including condyloma acuminatum) and cancer •Approximately 45,000 HPV-associated cancers occur in the US each year •7,083 -anal cancer •12,143 -cervical cancer •19,975 -oropharyngeal cancer What About Anal Cancer? •Affects ~1.6/100,000 women, and 1.0/100,000 men …

Navigating Uncertainty In A Critically Ill Patient, Brandon Tempte, Amy Dechet

Providence Portland Medical Center Internal Medicine 2021

Introduction Aspergillus spores are routinely inhaled.Innate immune defenses prevent fungal growth and disease in immunocompetent individuals.However, immunocompromised patients are at risk of developing invasive aspergillosis. Diagnosis of invasive aspergillus is often difficult as biopsy is not always feasible and relies on the interpretation of non-invasive testing. Early recognition and initiation of therapy is paramount as the mortality rate is high.

Case Presentation Patient is a 59 year oldfemale with a history of alcohol abuse admitted with acute encephalopathy and new onset seizure. History: -Initially presented 3 weeks earlier for jaundice, found to have acute alcoholic hepatitis, started and discharged on …

The Peculiar Case Of Purulent Pericarditis, Laura Bennetts, Meera Jain

Providence Portland Medical Center Internal Medicine 2021

Introduction

Purulent pericarditis is a localized purulent infection in the pericardial space •Before the era of antibiotics, purulent pericarditis was related to complications of pneumococcal pneumonia. Now more frequently associated with thoracic surgeries, immunocompromised hosts and nosocomial blood infections.1 •This case is an unusual presentation of acute methicillin-resistant staphylococcus aureus (MRSA) purulent pericarditis with a course complicated by cardiac tamponade, opiate withdrawal, and a right ventricle (RV) laceration.

Case Presentation

History of Present Illness •Patient is a 30-year-old M active intravenous drug use (IDU) with a recent history of MRSA bacteremia, endocarditis, parasternal abscess s/p I&D, and sternal osteomyelitis with …

Increasing Hpv Vaccination Rates At Pmg Milwaukie Family Medicine, Sean Brachvogel, Justin Ferley, Jessica Hu, Lauren Moore, Sebastian Reeve, Tyler Reimann, John Yates, Daniel Ruegg

Milwaukie Family Medicine 2021

Background

Introduction • Between 2013 and 2017 about 45 000 HPV related cancers were diagnosed in the US per year • Of these, cervical cancer is the most common and is almost exclusively caused by HPV • About two thirds of vulvar/vaginal and penile cancers are the result of HPV infection • Vaccination has potential to dramatically reduce incidence of these cancers, and nearly eliminate cervical cancer Nationally, only 51 of teens are fully vaccinated against HPV and Oregon averages 58 59 Background Research and Literature Review Many interventions to improve HPV vaccination rates have been undertaken and studied Interventions …