Internal Medicine Commons^™

Assessment And Intervention For Health Behavior Change In Primary Care Across The Lifespan: A Guide For Residents In Primary Care Specialties, Stacy A. Ogbeide, Alexis Ramos, Bridget Murphy, Angel Ogbeide

HCA Healthcare Journal of Medicine

More than 45% of Americans have at least 1 chronic disease, with chronic disease also being a leading cause of death in the United States. In primary care settings, about 75% of visits are for management of multiple chronic diseases. Due to the increasing medical complexity of patients who present to primary care, these numbers make it more challenging for Primary Care Clinicians (PCCs) to manage these conditions alone and point to the need for innovative solutions to chronic disease care. One evidence-based innovation is team-based care to improve the treatment of these conditions. Clinicians such as clinical pharmacists, registered …

Health Practices And Use Of Traditional Medicine Among Asian Indian Immigrants In The United States: A Pilot Study, Parita Patel, Anil N.F. Aranha

Medical Student Research Symposium

Title: Health Practices and Use of Traditional Medicine Among Asian Indian Immigrants in the United States: A Pilot Study

Authors

Parita Patel, MPH¹; Anil N.F. Aranha, PhD^1,2

Medical Education¹, Internal Medicine², Wayne State University School of Medicine, Detroit, Michigan

Abstract

Background and Purpose: Traditional and alternative medicine (TAM), including Ayurveda, Homeopathy, Naturopathy, and home remedies, remains widely used among Asian Indian (AI) immigrants in the United States alongside Western medicine. Cultural familiarity, family influence, and perceived safety shape these practices. This pilot study examined TAM prevalence, patterns, and perceptions among AI immigrants and …

Getting To The Heart Of The Problem: Blood Pressure Management Through Medication Adherence, Mallory G. Livengood

Evidence-Based Practice Project Reports

Clinical hypertension affects one in four adults globally, making it the most common chronic condition. Despite its widespread impact, hypertension can be prevented, as it represents the most modifiable risk factor in preventing cardiovascular disease. The primary purpose of this evidence-based project was to determine whether a one-month follow-up with a healthcare provider improved medication adherence through enhanced hypertension management. Twelve eligible participants were selected from a primary clinic located in Northwest Indiana, based on their newly initiated anti-hypertensive medications or who required a medication adjustment due to poor hypertension management. Each participant’s preferred method of communication was noted, and …

Stronger Together: A Resident-Led Initiative Advancing School Nurse Readiness In Pediatric Seizures And Pediatric Cardiology, Shana-Kay Lambert-Johnson, Amy Nguyen-Pham, Tony Do, Devika Adusumilli, Jorim Parmar, Dimitar Semerdzhiev, Elizabeth White, Joanna John, Myrna Garcia, Nicholas Gerden, Tasaduq Mir, Michele Mccarroll

North Texas GME Research Forum 2026

BACKGROUND: School nurses play a vital role in safeguarding the health and safety of children by serving as frontline providers within the school setting. Timely recognition and appropriate management of acute medical conditions can reduce morbidity, prevent unnecessary emergency department utilization, and improve long-term outcomes. Needs assessment surveys identified knowledge and confidence gaps among school nurses related to pediatric seizure management and pediatric cardiology.

METHODS: This prospective educational quality improvement initiative was conducted across the Dallas–Fort Worth (DFW) region during the 2025-2026 academic year. Over 25 residents served as curriculum developers and educators, creating and delivering evidence- and case-based education …

Giant Cell Arteritis After Mrna Covid Vaccines: Concerning Or A False Alarm?-A Retrospective Cohort Study, Syed M. F. Zabiullah, Rutwik Pradeep Sharma, Roshan Subedi, Viqarunnisa Faaiza Zahid, Yasir Loai, Sarathlal Mannumbethlal, Aatifa Aatifa

Advances in Clinical Medical Research and Healthcare Delivery

Background: The coronavirus disease (COVID-19) pandemic led to the first large-scale rapid deployment of novel messenger RNA (mRNA) vaccines. Although the effectiveness and safety of these vaccines were rigorously studied, post-vaccination adverse events such as giant cell arteritis (GCA) continue to be reported. More than two hundred and sixty three cases of new-onset GCA occurring after mRNA vaccine administration are listed in the Vaccine Adverse Events Reporting System as of October 2024. We aimed to explore the incidence of GCA after mRNA vaccines among patients in our health system and study their characteristics and outcomes.

Methods: We conducted a …

Hepatocellular Carcinoma Surveillance In Patients With Cirrhosis, Identifying Gaps In Clinical Practice, Abdullah Orakzai, Muhammad Hammad Sharif, Basil George Verghese, Shiamak Cooper, Venkat Arutla, Purva Shah, Himal Kharel, Aditya Sanjeevi, Aniket-Vijay Rao

Advances in Clinical Medical Research and Healthcare Delivery

Background:Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide, with rising mortality rates in the United States. Early detection of HCC through routine screening significantly improves survival rates in patients with cirrhosis. Current guidelines recommend bi-annual screening using abdominal ultrasound with or without serum AFP levels; however, adherence to these guidelines is suboptimal in clinical practice.

Methods:We conducted a retrospective study of 320 adult patients diagnosed with HCC at our institution between January 1, 2023, and July 31, 2023. Patients aged >22 years were included, and their medical records were reviewed to evaluate routine surveillance …

Iron Deficiency—More Than Just Anemia: A Literature Review, Arianna S Moss, Zahra Pakbaz

Journal of Community Hospital Internal Medicine Perspectives

Iron deficiency (ID) is a global public health concern, as it can be a prodrome of gastrointestinal (GI) malignancies, exacerbate chronic conditions, and lead to an overall decreased quality of life. Despite being the most prevalent nutritional deficiency, it remains underdiagnosed by many healthcare professionals. Misconceptions regarding the clinical and laboratory manifestations of ID lead to delayed or missed diagnoses, contributing to poor patient outcomes. Though anemia is a commonly known consequence of ID, there are additional consequences that remain underrecognized by the medical community, including vague signs and symptoms, such as fatigue, depression, and abnormalities in white blood cell …

Preserving What Matters: A Multimodal Approach To Maintaining Fat-Free Mass During Anti-Obesity Medication Based Weight Loss, Sarah Gore

Evidence-Based Practice Project Reports

Weight loss is often associated with reductions in fat-free mass (FFM), which can negatively impact metabolic rate, thermoregulation, bone density, functional capacity, and overall quality of life (Roth et al., 2022; Sedlmeier et al., 2021). This Evidence-Based Practice project aimed to reduce FFM loss in adults prescribed anti-obesity medications (AOMs) for weight management through a targeted, multimodal intervention. Twenty-two patients beginning AOM treatment at a family practice in northwest Indiana were invited to participate, with 19 consenting to enroll. Each participant received personalized guidance, including tailored calorie and protein intake goals to support a hypocaloric, high-protein diet, alongside evidence-based aerobic …

Indeterminate Benefit Of Long-Term Beta-Blocker Use After Acute Myocardial Infarction For Some Patients, Logan S. Thayer, Khush Hussain, Nicholas Apostolakis, Gretchen Swift, Arifbillah Sarowar, Mohammad Al-Hadidi, Scott Yaekle

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Yndigegn T, Lindahl B, Mars K, et. al., Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. April 7 2024;390:1372-1381. https://doi.org/10.1056/NEJMoa2401479

for a patient showing 55% left ventricular ejection fraction after myocardial infarction.

Stop The Bleed! Acute Epistaxis Management, Christopher R. Cannell

Lynchburg Journal of Medical Science

Epistaxis, the most common Otolaryngology-related emergency, is responsible for one in 200 emergency department (ED) visits in the United States (US) and one-third of otolaryngology visits.^1,11 Up to 60% of the population will experience epistaxis during their lifetime, and 6% -10 % will require medical intervention.^2,3 Epistaxis occurs in children and adults and has a seasonal variation. Although 85% of nosebleeds are idiopathic, they are more frequent in those on supplemental oxygen, anticoagulation, antiplatelet therapy, and in those with other conditions that may predispose them to bleeding. Most clinicians will encounter patients with acute epistaxis; therefore, it is …

Testosterone Replacement Therapy In The Middle-Aged Male, Gina N. Demilt

Lynchburg Journal of Medical Science

The purpose of this review was to investigate the use of testosterone supplementation in the middle-aged male with a focus on the pathophysiology of testosterone throughout the lifespan, current supplementation options and their adverse effects, and the overall benefit of supplementing to enhance quality of life. A comprehensive search of electronic databases was conducted identifying studies that assessed clinical outcomes, pathophysiology, supplementation options, adverse effects and benefits of treatments. The findings suggested that testosterone levels naturally decline with age with most men developing symptoms of hypogonadism around age 60. Testosterone supplementation outside of current guidelines is not recommended, however men …

A Literary Review Of Physician Approach To Patient Care: Implications In Cancer Care, Daniel Ramirez, Kinsley Batson

Annual Research Symposium

No abstract provided.

Current Trends In School Nursing For Diabetes & Dermatology, Ali Al-Nahi, Jeffrey Dickerson, Enith Espinosa Palmett, Shterna Frand, Garrett Furth, Matthew Gutzmer, Marshall Hall, Sana Khan, Shana-Kay Lambert-Johnson, Henry Lim, Kelly Mofor, Lakshmi Morla, Ali Nazim, Rui Zhang, Christian Scheufele, Zara Soomro, Michele Mccarroll, Taylor Pickering, Jasmine Silva, Brina Gonzalez, Devika Adusumilli, Sherri Morgan, Nischal Pokhrel

North Texas Research Forum 2025

Background: School nurses are on the front lines of assessing, identifying and treating school-age children with a number of health complications. Implementing nursing services in schools has previously demonstrated improved medical care costs for students, less productivity loss for parents, and less productivity loss for teachers. As a result, nursing services in schools provide a cost-beneficial investment of public money, and warrant both financial support from policy makers as well as educational support from local healthcare services. Aim Statement: This quality improvement project addressed the targeted continuing education gap topics of Dermatology and Diabetes management in school age children. Methods: …

Occlusive Thrombosis Of Superior Mesenteric And Portal Veins, Radhika Mohan, Genevieve Mccloskey, Curtis Wong, Hedaya Othman, Valerie Sinkler

South Atlantic Division GME Research Day 2025

No abstract provided.

Bundled Approach To Improve Colorectal Cancer In Primary Care, Elizabeth Reddiar

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States, despite being preventable through timely screening. National guidelines recommend regular screening for adults aged 45 to 75; (American cancer Society (ACS), 2025) however, screening rates remain suboptimal, particularly in primary care settings serving diverse and high-volume populations. Local Problem: At the project site, a community-oriented primary care clinic in North Texas, baseline data revealed CRC screening completion rates were below benchmarks set by the organization. Barriers included limited patient awareness, inconsistent provider reminders, and workflow challenges in distributing and tracking fecal immunochemical test …

Second Generation Antipsychotics And Cardiovascular Adverse Effects: Developing Evidence-Based Recommendations For Primary Care Medicine, Sana Borda, Ahn-Dao Lee, Paul F. Bell

HCA Healthcare Journal of Medicine

Background

Second-generation antipsychotic medications (SGAs) are often used by primary care physicians (PCPs) to treat multiple psychiatric diagnoses. SGAs have been connected to a number of adverse effects, including cardiovascular disease. Currently, there are no published evidence-based recommendations addressing SGAs and cardiotoxicity that are directed toward PCPs. This project aims to fill this gap.

Methods

Relevant search terms related to SGAs and cardiovascular disease were identified and then used to search databases (PubMed, PubMed Central, and AccessMedicine). Research studies obtained from the searches were narrowed to include systematic reviews and meta-analyses. The Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool was …

Pengaruh Durasi Pengobatan Dan Preferensi Pasien Kanker Stadium Akhir Terhadap Layanan Homecare Di Rumah Sakit Medistra Pada Tahun 2021-2023, Peter Brian Sutanto Putra Dr, Erfen Gustiawan Suwangto Dr, Tena Djuartina Dr, Iskandar Rahardjo Budianto Dr, C. Rinaldi A. Lesmana

Jurnal Penyakit Dalam Indonesia

Introduction. Cancer is still an enormous health problem in the world and rank second as the most common cause of mortality. End-stage cancer requires end-of-life or palliative care to improve the patient’s quality of life before death. Homecare services have become an option for providing palliative care to avoid long-term hospital stays. The study aimed to provide an overview of the treatment duration and other factors in end-stage cancer patients regarding the selection of homecare services at Medistra Hospital during the period of 2021-2023.

Methods. This study with a cross-sectional design analyzed medical records of end-stage cancer patients …

Musical Hallucinations In An Elderly Female With Hearing Loss, Jacqueline Cavendish, Lynne J. Goebel

Internal Medicine

Musical hallucinations (MH) are rare auditory phenomena in which patients perceive music without a known source. Risk factors for MH include hearing loss, older age, female gender, epilepsy, and certain medications. This case report details the presentation, diagnosis, and treatment of an 82-year-old woman who developed MH following the onset of hearing loss. Despite treatment attempts with gabapentin, quetiapine, and donepezil, the symptoms persisted, demonstrating the difficulty in treating this condition.

Imprecise Clinical Assessments And Inaccurate Grades: Family Medicine Clerkship Director Perspectives, Arindam Sarkar, Joel J Heidelbaugh, Gage Hallbauer, Nital Appelbaum

Faculty, Staff and Students Publications

BACKGROUND AND OBJECTIVES: As application to residency programs becomes increasingly competitive, educational leaders face growing student concern about imprecise clinical assessments and clerkship grades.

METHODS: As part of a large annual survey of family medicine clerkship directors (FMCDs), 10 questions were disseminated in May 2023 about perceived levels of imprecise assessments by faculty. We aimed to determine to what extent respondents felt their institution's evaluation system propagated inaccurate grading.

RESULTS: A total of 52% of 169 FMCDs responded to the survey. Of these, 7% of respondents were completely confident that their preceptors would give two students of identical competence the …

The Effects Of The Covid-19 Pandemic On Resident Education And Burnout, Timbre Backen, Oliwier Dziadkowiec, Jeffery S. Durbin, Gregory Guldner, Glenda Quan

HCA Healthcare Journal of Medicine

Background

The COVID-19 pandemic has impacted the residency experience for physicians across all specialties. There have been studies examining resident perspectives on changes in curriculum and clinical experiences due to the pandemic; however, little research has been conducted on how residents in different specialties interpreted their educational experience and rates of burnout during the pandemic.

Methods

We extended surveys to 281 residents across 15 separate residency programs between November 17, 2020, and December 20, 2020. The questions pertained to burnout and the effects of the pandemic on their careers. Differences between general and specialty medicine resident responses were analyzed using …

Small Intestinal Bacterial Overgrowth, Sandesh R. Parajuli, Anish C. Paudel, Anthony Donato

Transformative Medicine

No abstract provided.

Challenges And Implications For Substance Use And Mental Healthcare Among Under-Resourced Women In The Covid-19 Era, Maria C Mejia, Alicia Kowalchuk, Sandra J Gonzalez, Muktha Nair, Lisa Webb, Nadine Scamp

Faculty, Staff and Students Publications

BACKGROUND: The COVID-19 pandemic exacerbated disparities in mental healthcare and substance use disorder (SUD) treatment access, especially in under-resourced communities. This study aimed to comprehend the experiences of under-resourced women with SUD during the pandemic, their knowledge and attitudes toward it, and its impact on substance use and treatment access.

METHODS: A cross-sectional study included 66 under-resourced women receiving medically managed withdrawal treatment at a community residential SUD center. Data collection occurred between November 2021 and August 2022, utilizing a 75-item instrument covering COVID-19 exposure and its impact on health, substance use, treatment access, vaccination status, beliefs, and knowledge. Descriptive …

Sodium-Glucose Transport Protein 2 (Sglt2) Inhibitors And The Risk Of Pancreatitis: A Case Report, Zamanali Khakhar, Soraiya Manji, Ronakkumar Patel, Sayed Karar

Internal Medicine, East Africa

Acute pancreatitis is a condition seldom encountered with the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors. They are beneficial in the treatment of various conditions and offer great promise. Despite this, they are associated with several adverse effects, necessitating vigilance and further research. This case study reports a 69-year-old male with multiple comorbidities who presented with epigastric pain radiating to the back. Laboratory tests revealed elevated AST, ALT, GGT and lipase. The patient was diagnosed with acute pancreatitis secondary to the SGLT2 inhibitor therapy regimen. Cessation of dapagliflozin resulted in a complete resolution of symptoms. There is credible evidence to …

Factors Associated With Intention To Implement Sbi And Sud Treatment: A Survey Of Primary Care Clinicians In Texas Enrolled In An Online Course, Alicia Kowalchuk, Tiffany G Ostovar-Kermani, Kylie Schaper, Larissa Grigoryan, Jacqueline M Hirth, Maria Carmenza Mejia, Kiara K Spooner, Roger J Zoorob

Faculty, Staff and Students Publications

BACKGROUND: Substance use disorder (SUD) presents a range of public health challenges and consequences. Despite the prevention potential of screening and brief intervention (SBI) in the primary care setting, implementation is low. The purpose of this study was to assess associations of primary care clinicians' knowledge of SBI and SUD treatment, subjective norms, and perceived behavioral control with intention to incorporate SBI and SUD treatment into regular clinical practice.

METHODS: This online survey was administered to primary care clinicians who practice in Texas between March 1, 2021, and February 5, 2023. Survey questions were mapped to factors in the Theory …

A Multi-Modal Intervention To Decrease Hpv Vaccine Hesitancy And Increase Uptake In Young Adult Women, Rylee Cartales

Evidence-Based Practice Project Reports

Human Papillomavirus (HPV) is the leading cause of cervical cancer worldwide and the most common sexually transmitted disease, yet hesitancy towards the HPV vaccine remains high and uptake of the HPV vaccine remains remarkably low (CDC, 2021b). The purpose of this evidence-based practice (EBP) project was to determine if the implementation of a multimodal intervention including a motivational interview, strong provider recommendation, and educational materials will decrease HPV vaccine hesitancy and consequentially increase uptake of the vaccine. Eleven young adult women ages 18-26 from a rural outpatient Obstetrics and Gynecology (OBGYN) clinic in Indiana participated in this project. After agreeing …

A Multimodal Approach To Decreasing Hesitancy Of The Influenza Vaccine In The Family Care Setting, Carley J. Ellenberger

Evidence-Based Practice Project Reports

The uptake of the influenza vaccine is the most effective and proactive action an individual can take to defend themselves against the influenza outbreak each season; therefore, it is recommended that everyone at least six months of age and older should receive the annual flu vaccine (CDC, 2022; WHO, 2023). Unfortunately, influenza vaccine hesitancy is demonstrated on a global level affecting the uptake compliance annually each influenza season despite the millions of people that experience influenza symptoms annually (CDC, 2022, WHO, n.d.; Healthy People 2030, n.d.). The PICOT question for this project was in adults, over the age of 18, …

Conscientious Objection: Understanding When And Why Primary Care Physicians Object To Providing Health Care To Transgender And Gender-Diverse Patients In An Appalachian Medical Center, Mili S. Patel, Kelley A. Jones, Laura Davisson, Elizabeth Miller, Nicole Kahn, Pamela J. Murray, Kacie M. Kidd

Journal of Appalachian Health

Introduction: Transgender and gender-diverse (TGD) individuals face barriers to accessing primary and gender-affirming care, especially in rural regions where a national shortage of medical providers with skills in caring for TGD people is further magnified. This care may also be impacted by individual providers’ strongly held personal or faith beliefs and associated conscientious objection to care.

Purpose: This study assesses the prevalence of conscientious objection to providing care and gender-affirming hormone (GAH) therapy to TGD individuals among physicians in an Appalachian academic medical center.

Methods: An anonymous, online, cross-sectional survey of physicians was distributed to resident and faculty physicians in …

A Multimodal Intervention To Aid In Smoking Cessation, Lauren Druzbicki

Evidence-Based Practice Project Reports

The Centers for Disease Control and Prevention (CDC; 2023a) notes there are 28.3 million smokers in the United States. In Indiana alone, nearly 29% of adults currently use tobacco, with 19% of the total being cigarette smokers (Indiana Department of Health, 2022). The purpose of this evidence-based practice (EBP) project was to implement a multi-modal intervention to aid in smoking cessation in adults aged 18 and older who are cigarette smokers. The intervention included physician/nurse advise using the ask, advise, refer (AAR) model, the SmokefreeTXT program, and FDA approved smoking cessation medications. The project took place at a primary care …

Strategies For Combating Vaccine Hesitancy In Primary Care, Elizabeth Perkins Hayes

Student Scholar Showcase

This article will summarize methods for providers to effectively combat vaccine hesitancy in their patient populations. Vaccine hesitancy is a growing concern in the medical field, as new cases of vaccine preventable diseases arise. However, vaccine hesitancy is more common than vaccine resistance and can be converted into vaccine acceptance with effective communication strategies.

There is no easy solution to the complex problem of vaccine hesitancy. Most studies demonstrate that effective conversion to vaccine acceptance requires tailoring vaccine information to the patient and listening to their concerns. Other methods include exposing patients to survivors of vaccine preventable diseases, or using …

Storylines Of Family Medicine Xii: Family Medicine And The Healthcare System, William B Ventres, Leslie A Stone, Jeannette E South-Paul, Kendall M Campbell, Aerial R Petty, Hima Ekanadham, Kurt C Stange, Rebecca S Etz, William L Miller, Robert L Ferrer, Marianna Kong, Thomas Bodenheimer, Roger Strasser, Sharon C M Reece, Joshua Freeman, John M Westfall

Faculty, Staff and Students Publications

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘XII: Family medicine and the future of the healthcare system’, authors address the following themes: ‘Leadership in family medicine’, ‘Becoming an academic family physician’, ‘Advocare—our call to act’, ‘The paradox of primary care and three simple rules’, ‘The quadruple aim—melding the patient and the health system’, ‘Fit-for-purpose medical workforce’, ‘Universal healthcare—coverage for all’, ‘The futures of family …