Internal Medicine Commons^™

Medical Student Attitudes Toward Cell Phone Use On Rounds, Jacob Garcia, Sarah E. Rosenberg, Md

Phase 1

Purpose: Mobile devices are ubiquitous and serve as an important resource for on-the-spot research about patient questions and conditions. However, even when a device is used to address patient needs, patients and members of the medical team may assume the student is using their phone for non-clinical activities and perceive the student as uninterested and disengaged. Medical students are aware of this potential for misperception, and as such, we designed a study to investigate the attitudes of third and fourth year medical students towards cell phone use on internal medicine rounds.

Methods: Our target learner population was third and fourth …

A Policy Analysis Of The 2017 Fasting Guidelines Among Gi Surgical Patients, Toney Banks

Doctor of Nursing Practice Projects

The objective of the fasting guidelines is to improve the quality and efficacy of anesthesia care. It is based on two main researched principles: The ingested material must be clear without particulates, and it must not be within two hours of the procedure. The purpose of this project is to equip the medical community with the latest guidelines on NPO (fasting), ensuring that patients are seen on time without delays or cancellations of surgery and with improved patient comfort. A retrospective chart review of 500 randomly chosen charts from patients seen at an Endoscopy Center. Pearson’s Chi-square value and the …

Time-To-Completed-Imaging, Survival And Function In Patients With Spinal Epidural Abscess: Description Of A Series Of 34 Patients, 2015–2018, Caroline King, Cameron Fisher, Patrick C.M. Brown, Kelsey C. Priest, Mary Tanski, Peter Sullivan

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: Spinal epidural abscess (SEA) is a rare and life-threatening infection with increasing incidence over the past two decades. Delays in diagnosis can cause significant morbidity and mortality among patients.

Objective: The objective of this study was to describe trends in time-to-imaging and intervention, risk factors, and outcomes among patients presenting to the emergency department with SEA at a single academic medical center in Portland, Oregon.

Methods: This retrospective cohort study analyzed data from patients with new SEA diagnosis at a single hospital from October 1, 2015 to April 1, 2018. We describe averages to time-to-imaging and …

Point-Of-Care Ultrasound (Pocus) Workshop For Internal Medicine Residents: A Pre/Post-Training Assessment Of Confidence And Knowledge, Abraham Lee, Cesar Gutierrez, Michelle Lopez

MEDI 9331 Scholarly Activities Clinical Years

Across the country, internal medicine residency training programs are having difficulty figuring out how to optimally implement an effective point-of-care ultrasound training into their respective curricula. This study aimed to assess whether a week-long training course of didactics, followed by hands-on practice, improved both the confidence and knowledge skills of internal medicine residents using point-of-care ultrasound (POCUS). The trainees were asked to complete pre/post-training surveys, which tested their ability to interpret POCUS images and also asked them to score their confidence in using POCUS. Results showed a statistically significant improvement in not only their confidence in using POCUS, but also …

The Impact Of Scaling Up Cervical Cancer Screening And Treatment Services Among Women Living With Hiv In Kenya: A Modelling Study, Pablo Noel Perez-Guzman, Michael Chung, Hugo De Vuyst, Shona Dalal, Kennedy K. Mutai, Karanja Muthoni, Bartilol Kigen, Timothy B. Hallett, Mikaela Smit

Internal Medicine, East Africa

Introduction: We aimed to quantify health outcomes and programmatic implications of scaling up cervical cancer (CC) screening and treatment options for women living with HIV in care aged 18–65 in Kenya.

Methods: Mathematical model comparing from 2020 to 2040: (1) visual inspection with acetic acid (VIA) and cryotherapy (Cryo); (2) VIA and Cryo or loop excision electrical procedure (LEEP), as indicated; (3) human papillomavirus (HPV)-DNA testing and Cryo or LEEP; and (4) enhanced screening technologies (either same-day HPV-DNA testing or digitally enhanced VIA) and Cryo or LEEP. Outcomes measured were annual number of CC cases, deaths, screening and treatment interventions, …

Case Report Of Kikuchi-Fujimoto Disease From Sub-Saharan Africa: An Important Mimic Of Tuberculous Lymphadenitis, Karishma Sharma, Fredrick Otieno, Reena Shah

Internal Medicine, East Africa

Kikuchi-Fujimoto disease (KFD) is a rare form of painful lymphadenopathy, usually cervical, which is more common in Southeast Asia and rarely reported from Africa. Symptoms are usually nonspecific (fever, night sweats, etc.), and can mimic more common diseases such as tuberculosis (TB) in endemic areas. We report a case of a 29-year-old black African woman who was admitted with headache, neck pain, fever, and lymphadenopathy. She was found to have aseptic meningitis, eventually attributed to TB based on cervical node biopsy, although further histology suggested KFD. Blood tests for systemic lupus erythematosus (SLE) were negative; she had already been commenced …

Proprotein Convertase Subtilisin/Kexin Type-9 (Pcsk-9) Inhibitors Induced Liver Injury - A Retrospective Analysis., Yousuf Zafar, Yasar Sattar, Waqas Ullah, Sohaib Roomi, Mamoon-Ur- Rashid, Muhammad Shayan Khan, Laura Schmidt

Abington Jefferson Health Papers

Background: Proprotein convertase subtilisin/Kexin type 9 (PCSK-9) inhibitors induced liver dysfunction in patients with or without previous liver injury, and this is not well discussed in the previous literature.

Methods: A total sample of 202 patients were retrospectively reviewed at the University of Missouri, Kansas City, from the year 2015 to 2018 based on predefined selection criteria. Inclusion criteria involved patients with dyslipidemia, with or without PCSK-9 inhibitors, liver function tests and lipid profile at baseline and at a mean of 6-month follow-up. The variables, including age, gender, and confounding factors like other medications (statin, oral antidiabetic, and antihypertensive) induced, …

Individual And Community Social Determinants Of Health Associated With Diabetes Management In A Mexican American Population, Cici Bauer

Faculty, Staff and Student Publications

Background: Diabetes is a major health burden in Mexican American populations, especially among those in the Lower Rio Grande Valley (LRGV) in the border region of Texas. Understanding the roles that social determinants of health (SDOH) play in diabetes management programs, both at the individual and community level, may inform future intervention strategies.

Methods: This study performed a secondary data analysis on 1,568 individuals who participated in Salud y Vida (SyV), a local diabetes and chronic disease management program, between October 2013 and September 2018 recruited from a local clinic. The primary outcome was the reduction of hemoglobin A1C (HbA1C) …

Unusual Infectious Metastases Secondary To Acupuncture Induced Mssa Septicemia

Faculty, Staff and Student Publications

We describe a rare case of methicillin-sensitive

Stakeholder Alliances Are Essential To Reduce The Scourge Of Plastic Pollution, Xing Yin, Mohammad H Rahbar, Deborah Vela, Curtis Genstler, Kevin J Haworth, Christy K Holland, David D Mcpherson

Faculty, Staff and Student Publications

Late in-stent restenosis remains a significant problem. Bare-metal stents were implanted into peripheral arteries in miniature swine, followed by direct intra-arterial infusion of nitric oxide-loaded echogenic liposomes (ELIPs) and anti-intercellular adhesion molecule-1 conjugated ELIPs loaded with pioglitazone exposed to an endovascular catheter with an ultrasonic core. Ultrasound-facilitated delivery of ELIP formulations into stented peripheral arteries attenuated neointimal growth. Local atheroma-targeted, ultrasound-triggered delivery of nitric oxide and pioglitazone, an anti-inflammatory peroxisome proliferator-activated receptor-γ agonist, into stented arteries has the potential to stabilize stent-induced neointimal growth and obviate the need for long-term antiplatelet therapy.

The Fms21 (Pila)-Fms20 Locus Encoding One Of Four Distinct Pili Of Enterococcus Faecium Is Harboured On A Large Transferable Plasmid Associated With Gut Colonization And Virulence, Michelle Mcdonald, M Tarek Elghetany, Daniel Ocazionez Trujillo, Gabriel M Aisenberg, Mohammad Madjid, Biswajit Kar

Faculty, Staff and Student Publications

This paper collates the pathological findings from initial published autopsy reports on 23 patients with coronavirus disease 2019 (COVID-19) from 5 centers in the United States of America, including 3 cases from Houston, Texas. Findings confirm that COVID-19 is a systemic disease with major involvement of the lungs and heart. Acute COVID-19 pneumonia has features of a distinctive acute interstitial pneumonia with a diffuse alveolar damage component, coupled with microvascular involvement with intra- and extravascular fibrin deposition and intravascular trapping of neutrophils, and, frequently, with formation of microthombi in arterioles. Major pulmonary thromboemboli with pulmonary infarcts and/or hemorrhage occurred in …

Transcriptional Insights Into Pathogenesis Of Cutaneous Systemic Sclerosis Using Pathway Driven Meta-Analysis Assisted By Machine Learning Methods, Zheng Liu

Faculty, Staff and Student Publications

Pathophysiology of systemic sclerosis (SSc, Scleroderma), an autoimmune rheumatic disease, comprises of mechanisms that drive vasculopathy, inflammation and fibrosis. Understanding of the disease and associated clinical heterogeneity has advanced considerably in the past decade, highlighting the necessity of more specific targeted therapy. While many of the recent trials in SSc failed to meet the primary end points that predominantly relied on changes in modified Rodnan skin scores (MRSS), sub-group analysis, especially those focused on the basal skin transcriptomic data have provided insights into patient subsets that respond to therapies. These findings suggest that deeper understanding of the molecular changes in …

Developing And Evaluating A Remote Quality Assurance System For Point-Of-Care Ultrasound For An Internal Medicine Residency Global Health Track, Ayako Wendy Fujita, Thuy Bui

Faculty, Staff and Student Publications

Background: A quality assurance system is vital when using point-of-care ultrasound (POCUS) to ensure safe and effective ultrasound use. There are many barriers to implementing a quality assurance system including need for costly software, faculty time, and extra work to log images. Methods: With minimal funding or protected faculty time, we successfully developed an effective remote quality assurance system between residents rotating internationally and faculty in the US. Results: 270 total exams were logged using this system (41 per resident over a 7 week period). Over the course of the implementation period, a significant increase was seen in average image …

Recent Advances In The Treatment Of Clostridioides Difficile Infection: The Ever-Changing Guidelines

Faculty, Staff and Student Publications

No abstract provided.

Anesthesiology Resident Performance On The Us Medical Licensing Examination Predicts Success On The American Board Of Anesthesiology Basic Staged Examination: An Observational Study, Semhar J Ghebremichael

Faculty, Staff and Student Publications

BACKGROUND: Correlation has been found between the US Medical Licensing Examination (USMLE) Step 1 examination results and anesthesiology resident success on American Board of Anesthesiology (ABA) examinations. In 2014, the ABA instituted the BASIC examination at the end of the postgraduate year-2 year. We hypothesized a similar predictive value of USMLE scores on BASIC examination success.

METHODS: After the Committee for the Protection of Human Subjects at UTHealth Institutional Review Board approved and waived written consent, we retrospectively evaluated USMLE Step examination performance on first-time BASIC examination success in a single academic department from 2014-2018.

RESULTS: Over 5 years, 120 …

Adenosine At The Interphase Of Hypoxia And Inflammation In Lung Injury, Holger K Eltzschig

Faculty, Staff and Student Publications

Hypoxia and inflammation often coincide in pathogenic conditions such as acute respiratory distress syndrome (ARDS) and chronic lung diseases, which are significant contributors to morbidity and mortality for the general population. For example, the recent global outbreak of Coronavirus disease 2019 (COVID-19) has placed viral infection-induced ARDS under the spotlight. Moreover, chronic lung disease ranks the third leading cause of death in the United States. Hypoxia signaling plays a diverse role in both acute and chronic lung inflammation, which could partially be explained by the divergent function of downstream target pathways such as adenosine signaling. Particularly, hypoxia signaling activates adenosine …

Characteristics Of The Indonesian Pilgrims Mortality Due To Cardiovascular Disease, Ali Sakti, Idrus Alwi, Muhadi Muhadi, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Cardiovascular disease is one of the health problems in Indonesian pilgrims and has become the main cause of death for pilgrims in the past 3 years. Most of them are considered high risk for cardiovascular disease. Some of those risk factors are predicted to have strong association with the pilgrims mortality rate. This study is meant to seek for risk factor associated with the pilgrims mortality rate. Methods. Observational study method of the Indonesian pilgrims in 2017 was conducted to assess the characteristics of Indonesian pilgrims who follow the hajj in 2017 as well as the characteristics of pilgrims …

Immunohistochemistry Profile Of Breast Cancer Patients That Get Anthracyclin–Based Chemotherapy In Rsud Kota Bogor, Marthino Robinson, Tubagus Djumhana Atmakusumah, Cosphiadi Irawan, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Breast cancer is the most prominent cancer and causing death in women. Treatment of breast cancer requires immunohistochemistry (IHC) to determine prognostic and predictive and imaging tests to determine staging. However, currently in Indonesia only 17 hospital can conduct IHC test. RSUD Kota Bogor like other Type B Hospital have no IHC test facilities. To fullfil that test, its important to refer patient to referal hospital. Because of limitation there are patients who did not do IHC test and continued get anthracycline chemotherapy. The objective of this research is to find out immunohistochemistry profile of breast cancer patients who …

Prediksi Respons Terapi Leukemia Granulositik Kronis: Skor Mana Yang Lebih Baik?, Nadia Ayu Mulansari

Jurnal Penyakit Dalam Indonesia

Leukemia granulositik kronik (LGK) merupakan suatu keganasan myeloproliferatif dengan karakteristik ditemukannya kromosom Philadelphia (Ph). Kromosom Ph ini disebabkan oleh translokasi resiprokal antara kromosom 9 dan 22 [t(9;22)] dan terbentuknya fusi gen BCR-ABL1. Fusi gen tersebut akan menghasilkan suatu protein yang menderegulasi aktivitas dari tirosin kinase (p210) yang berperan pada patogenesis LGK.

Role Of Cytokines In Stressful Condition As A Trigger For A Depression, Febyan Febyan, Sri Handawati Wijaya, Ayudhea Tannika, Johannes Hudyono

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Comparison Of Socal Score And Hasford Score Against The Response Of Imatinib Mesylate Therapy In Patients With Chronic Granulocytic Leukemia In Dr. Saiful Anwar Hospital Malang, Somarnam Somarnam, Budi Darmawan Machsoos, Djoko Heri Hermanto

Jurnal Penyakit Dalam Indonesia

Introduction. The Socal and Hasford scores developed before the era of tirosine kinase inhibitor (TKI) therapy to provide predictions and prognosis for the results of therapy for chronic myeloid leukemia patients (CML). Until now the superiority of Socal and Hasford scores is still debated in predicting the results of therapy in the era of TKI. Imatinib mesylat is a first line TKI in the treatment of CML. This study aims to determine the superior predictive score in predicting hematological and molecular response of patients treated with imatinib mesylate. Methods. A survey study was conducted with data taken retrospectively from medical …

Young Kidney-Transplant Recipient Woman With Recurrent Urinary Tract Infection And Graft Rejection: A Case Report, Nursamsu Nursamsu, M. Reza Febriliant

Jurnal Penyakit Dalam Indonesia

Urinary tract infection (UTI), especially recurrent UTI, is a common problem, occurring in >75% of kidney transplant recipients. Urinary tract infection (UTI) can reduce the quality of life, graft potential, and patient survival. Urosepsis with impairment of graft function is potential long-term sequelae of recurrent UTI in kidney transplantation recipients. We present a case of UTI that developed within a month after renal transplant. The patient got a urinary tract infection repeatedly. We suspect lack of hygiene as the cause of urinary tract infection, the patient was rarely cleaning-up, took a bath, changing clothes, and did not wash after urinating. …

The Role Of Paternal History Of Type 2 Diabetes Mellitus On Prediabetes Status Among The Offspring Of Type 2 Diabetes Mellitus Patients, Maulidia Ekaputri, Henrico Citrawijaya, Adrian Reynaldo Sudirman, Kevin Jonathan, Radityo Alu Murti, Ayu Putri Balqis, Dyah Purnamasari

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Association Of Comprehensive Geriatric Assessments Component And Sarcopenia In Elderly, Diar Meitha Wardhana, Novira Widajanti, Jusri Ichwani

Jurnal Penyakit Dalam Indonesia

Introduction. Sarcopenia is defined as a declined in skeletal muscle mass and strength along with its function may causes an increase in hospitalization, mortality, and health burden. Multi-factorial conditions of the aging process may cause sarcopenia. To assess those multi-factorial conditions in the elderly, a comprehensive geriatric assessment (CGA) method should be used, in which comprises of socio-demographic, medical, psychological, and functional domains. This research aims to analyze the components of CGA, including age, gender, nutritional status, mental status, and functional status as factors associated to sarcopenia in the elderly community in Surabaya. Methods. This community research was a cross …

Comparison Of Mortality Between Intravenous Albumin And No Intravenous Albumin In Sepsis Patients With Hypoalbuminemia Conditions And Factors That Influence The Mortality Of Sepsis Patients, Mochammad Jalalul Marzuki, Supriono Supriono, Bogi Pratomo, Syifa Mustika

Jurnal Penyakit Dalam Indonesia

Introduction. Hypoalbuminemia is a strong predictor of mortality in nonoperative and operative patients. Albumin plays a role in maintaining oncotic pressure in critical conditions such as sepsis. The administration of exogenous Human Serum Albumin (HSA) in sepsis with hypoalbuminemia conditions is still controversial with varying outcomes.This study aimed to know the mortality ratio between intravenous albumin administration and no intravenous albumin administration in sepsis patients with hypoalbuminemia conditions and also to know the factors that influence the mortality of sepsis patients. Methods. An observational study with a prospective approach involving 75 research subjects aged >18 years with sepsis accompanied by …

Sex Differences In 10-Year Ischemic Cardiovascular Disease Risk Prediction In Chinese Patients With Prediabetes And Type 2 Diabetes., Lihong Yang, Anne Fish, Yuanyuan Zhu, Xiaodan Yuan, Jianing Li, Xiaoyun Wang, Li Yuan, Zhumin Jia, Chao Liu, Yunchen Xu, Qingqing Lou

Nursing Faculty Works

No abstract provided.

Methods To Impair Hematologic Cancer Progenitor Cells And Compounds Related Thereto, Craig Jordan

Internal Medicine Faculty Patents

Primitive or progenitor hematologic cancer cells have been implicated in the early stages and development of leukemia and malignant lymphoproliferative disorders, including acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML) and chronic lymphoid leukemia (CLL). Interleukin-3 receptor alpha chain (IL-3Ra or CD123) is strongly expressed on progenitor hematologic cancer cells, but is virtually undetectable on normal bone marrow cells. The present invention provides methods of impairing progenitor hematologic cancer (e.g., leukemia and lymphomic) cells by selectively targeting cells expressing CD123. These methods are useful in the detection and treatment of leukemias and malignant lymphoproliferative disorders. Also provided are compounds useful …

Role Of Echocardiography In Diagnostic Evaluation Of Patients Admitted To Observation Unit., Muhammad Arslan Cheema, Hafez Mohammad Ammar Abdullah, Waqas Ullah, Yasar Sattar, Shujaul Haq, Khadija Cheema, Asrar Ahmad, Zain Ali, Asoka Balaratna

Abington Jefferson Health Papers

BACKGROUND: Syncope is a transient loss of consciousness due to transient decrease in cerebral perfusion. Syncope accounts for a 3-6% of all emergency department visits. Etiology of syncope can be neural, cardiogenic, or vascular. Previous studies have evaluated the types and management of syncope. Echocardiography is a commonly used test in the evaluation of causes of syncope. Whether the benefit compared to financial burden of this diagnostic study is in all subsets of syncope cases remains unclear.

AIM: To evaluate the impact of echocardiography in the diagnostic evaluation of syncope and to evaluate the subset of patients that would benefit …

The Use Of Probiotics To Prevent Ventilator-Associated Pneumonia In Adults, Michael Roper, Paige Douthett

Physician Assistant Capstones, 2016 to 2019

Objective: To assess the efficacy and safety of preventing the acquisition of ventilator- associated pneumonia with the use of probiotic supplementation, as compared to a placebo, among hospitalized adult men and women receiving more than 24 hours of mechanical ventilation. Design: Systematic Literature Review. Methods: Systematic searches were conducted through PubMed and Scopus using the search terms “ventilator”, “probiotics”, and “prevention”. Records were excluded from the analysis if they were published before 2015, full text was not available, studies other than randomized control trial or cohort studies, and if the study population was less than 18 years old. Results: Of …

Preparing Healthcare Staff For Cardiac Arrest Codes In The Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes, Rowan Edwards, Rn

Master's Projects and Capstones

Preparing Healthcare Staff for Cardiac Arrest Codes in the Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes

The acuity of care provided in outpatient clinical settings across the United States continues to rise. It is estimated that more than 350,000 cardiac arrests occur outside of a hospital each year (AHA, 2019). For the purpose of this clinical nurse leader (CNL)-lead quality improvement project, the relevant focus is directed towards improving the knowledge, physical skills and perceptions of healthcare staff within an urgent care center (UCC) regarding the application of advanced rescue skills. It is important to note that the …