Pulmonology Commons^™

Ecmo As A Bridge To Lung Transplant For Refractory Rapidly Progressive Interstitial Lung Disease, Matthew Moritz, Omar Pandhair

Books, Presentations, Posters, Etc.

Anti-melanoma differentiation-associated gene 5 (MDA-5) antibody is most frequently associated with dermatomyositis with various degrees of clinical manifestations including rapidly progressive interstitial lung disease (RP-ILD), inflammatory arthritis, vasculopathy, and other cutaneous findings. Clinically amyopathic dermatomyositis (CADM) is frequently associated with RP-ILD and has high mortality rates. Here we present a case of anti-MDA5 associated RPILD but without other features of dermatomyositis that did not respond to standard immunosuppressive therapy. A 41-year-old woman with recently diagnosed interstitial lung disease and polyarthritis previously on methotrexate presented with progressive dyspnea and worsening hypoxemic respiratory failure. She was previously admitted for respiratory failure two …

Pulmonary Pseudomyxoma Peritonei, Hannah Kirk, Do, Omar Pandhair

Books, Presentations, Posters, Etc.

Introduction: Pseudomyxoma peritonei (PMP) is an intra -abdominal cancer occurring in one to four out of one million patients. It begins as a mucinous adenocarcinoma of the appendix that implants on other peritoneal surfaces, spreading into gelatinous ascites. Treatment consists of hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS). Extra -abdominal metastases are rare. We present the case of a patient who underwent treatment for PMP and was found to have lung nodules over a decade later. Case Presentation: A 73 -year -old woman with pseudomyxoma peritonei presented to the emergency department with progressive dyspnea and unintentional weight loss. Twenty …

Leappt: Leveraging Generative Artificial Intelligence-Pediatric Pulmonology Training. Curriculum And Content Development., Alvin Singh, Erin Khan, Mary Moffatt

Manuscripts, Articles, Book Chapters and Other Papers

After redesigning the curriculum of the pediatric pulmonology fellowship program at Children's Mercy-Kansas City, leadership continued to make changes based on feedback from a faculty survey concerned about the quality and structure of didactics. These changes included leveraging generative artificial intelligence to create a detailed course content outline containing specific objectives and study points for each subject related to pediatric pulmonology. Using the content outline as a foundational reference for learners, fellowship leadership continues to enhance the curriculum by creating testing questions, flipped classroom sessions and evaluations, and hope that these specific changes will help address decreased passing rates on …

Increasing Documentation Of Endotracheal Tube Cuff Pressures: A Quality Improvement Initiative For Flight Crew Providers, Matthew D. Noss

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Background: There was a lack of documentation of endotracheal tube (ETT) cuff pressures (CPs) by flight crew providers at Base 1 of HealthNet Aeromedical Services. A three-month pre-intervention data collection showed 1.8% of patients had initial CPs documented. Inadequate documentation and monitoring of ETT CPs can lead to patient complications such as tracheal injury and aspiration making this an important area for quality improvement.

Purpose: To increase documentation of ETT CPs through education and evidence-based interventions.

Intervention: This project implemented an educational in-service on ETT cuff syringe manometry for flight crew providers. The educational intervention consisted of …

Development Of A Longitudinal, Small-Group Pocus Curriculum For Internal Medicine Residents, Shah N. Mahmud Do, Ammar W. Bhatti Do, Ariq Rahman Md, Omar Al Qassab Md, Fraser Mackay Md

The Lahey Journal

Development of a Longitudinal, Small-Group POCUS Curriculum for Internal Medicine Residents

Introduction

Point-of-Care Ultrasound (POCUS) is integral for clinicians to enhance their diagnostic and procedural skills. Unlike Emergency Medicine or Anesthesia training programs, Internal Medicine programs often lack a structured and standardized curriculum. We thus developed a longitudinal and multi-pronged POCUS curriculum aimed at building trainee competency when utilizing ultrasound for diagnostic and procedural work-up.

Methods

The curriculum encompasses the following: basics of ultrasound, ultrasound-guided procedures, thoracic ultrasound/Bed Lung Ultrasound in Emergency (BLUE), and cardiac ultrasound/Focus-Assessed Transthoracic Echocardiography (FATE). These modules were integrated into the residents’ clinic blocks. We utilized …

Pulmonopoly: A Game-Based Approach To Teach And Reinforce Basic Concepts Of Pulmonary Medicine To Medical Students, Michael Dong, James Uricheck, Urvashi Vaid

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

INTRODUCTION: Pulmonopoly is an innovative active-learning medical board game addressses core pulmonary concepts in an engaging, competitive style. The strength of Pulmonopoly lies in its ability to combine ease of setup and play with comprehensive content coverage that comprises a significant proportion of national board examinations, offering a gamification experience that can be readily applied in different settings and modified for learner levels.

METHODS: We created an instructional game, Pulmonopoly, based on pulmonary content delivered to preclinical medical students and required for national board examinations. We invited first-year medical students to participate in 60-minute small-group sessions. Content addressed pulmonary subject …

Mycotic Aneurysm And Rare Complication From Infection Masquerading As Lung Cancer, Rithvik Nallapareddy, Mary Anne Nidiry

Books, Presentations, Posters, Etc.

Introduction: Mycotic Aneurysm: Dilation of an arterial wall due to infection • Majority are bacterial, Staphylococcus and Salmonella • Called mycotic because it resembled the appearance of fleshy fungus1 • Most commonly in femoral artery, aorta, and visceral Causes • Form from adjacent bacteria infections • Lung, esophagus, endocarditis • Direct invasion of vessel walls or atherosclerotic plaque in bacteremia General Presentation • Fever, back pain, immunocompromised, IV drug user • Positive blood cultures 50-85%2 • Elevated WBC, ESR, CRP • Lack of standard criteria for diagnosis and management Risk Factors • Tobacco • Atherosclerosis • Diabetes Mellitus Case Presentation: …

Characterization Of Sarcoidosis At A Combined Rheumatology-Pulmonary Clinic, Megan Schermerhorn, Md, Julianna Desmarais, Md

Books, Presentations, Posters, Etc.

Introduction: Sarcoidosis is a disease of unknown etiology characterized by formation of small clusters of inflammatory cells that form granulomas. Heterogenous and typically involves multiple organ systems with varying degrees of morbidity and mortality. Poorly defined treatment landscape. The purpose of this study was to characterize a cohort of sarcoidosis patients in a combined rheumatology-pulmonary clinic according to organ involvement and treatment over 5 years. Discussion: •Single center academic study of a that is the first of its kind. •Data highlights complexity and heterogeneity of patients with sarcoidosis and utility of combined rheumatology – pulmonary clinic. •65.3% of patients exhibited …

Cloudy Consequences: Exploring Vaping-Induced Alveolar Proteinosis, Jennifer Wong, Do, Omar Pandhair, Abby Lindseth, Md, Cameron Long

Abstracts, Posters, Presentations

No abstract provided.

A Case Of “Double Positive” Goodpasture Syndrome, Nidhi Patel, Md, Qian Leng, Md

Books, Presentations, Posters, Etc.

Background: • Goodpasture Syndrome is a rare autoimmune vasculitis disorder that affects the glomerular capillaries, pulmonary capillaries, or both, with glomerular basement membrane (GBM)deposition of anti-GBM autoantibodies. • Initial presentationis generally characterized byrapidly progressive glomerulonephritisand diffuse alveolar hemorrhage • Early recognition and subsequent treatment are vital fof management of Goodpasture Case Presentation: • 59 F presenting to the ED with a month-long history of hemoptysis and shortness of breath • Had been living in her car and is a vague historian. Mentions previously traveling but would not specify where • Has had frequent nosebleeds and two new pruritic wounds on …

Inhalational Drug Devices: Revisiting The Linchpin Of Asthma Management, Damini Saxena, Neveda Murugesan, Uyioghosa D Evbayiro, Marina K Ngassa, Muhammad Adrish

Faculty, Staff and Students Publications

Asthma remains a prevalent condition among all age groups globally. First-line treatment requires the delivery of medications into the distal respiratory tract via inhalers. Using appropriate inhaler techniques is a significant challenge in achieving disease control. A variety of inhalers are available for treating asthma, and selecting the appropriate inhaler type for any given patient is crucial to achieving and maintaining symptomatic control. This review will discuss the anatomy and physiology behind drug delivery via inhalers, the types of inhalers currently available for use, nebulizers, and future directions in the delivery of inhaled medications for asthma.

Evaluating The Association Of Influenza Vaccination On Long-Term Covid-19 Symptoms In U.S. Adults, Ratnakar Pingili

Capstone Experience: Master of Public Health

Objective. To evaluate the association of influenza vaccination in the past 12 months with Long COVID effects and clinical and sociodemographic factors.

Methods. Cross-sectional study with data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), covering 415,132 non-institutionalized U.S. adults with a confirmed COVID-19 diagnosis and influenza vaccination reported within the last 12 months. Logistic regression was conducted between influenza vaccination (exposure) and Long COVID (outcome), controlling for demographic variables, pre-existing health conditions, and socioeconomic status.

Results. Of 120,603 participants, 21.89% reported Long COVID symptoms and 42.04% had received an influenza vaccine. Findings indicate a statistically significant 13% reduction …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Simplifying Treatment From Double-Inhaler To Single-Inhaler Triple Therapy In Patients With Chronic Obstructive Pulmonary Disease, Kelly Yang, Leah Warren

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using

Ferguson GT, Brown N, Compton C, et al. Once-daily single-inhaler versus twice-daily multiple-inhaler triple therapy in patients with COPD: lung function and health status results from two replicate randomized controlled trials. Respir Res. 2020;21(1):131. https://doi.org/10.1186/s12931-020-01360-w

for a patient requesting a simplified therapeutic regimen with equal efficacy for chronic obstructive pulmonary disease (COPD) management.

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Advancing Virtual At-Home Care For Community Health Center Patients Using Patient Self-Care Tools, Technology, And Education [Letter], Cheryl Modica, Joy H. Lewis, Curtis Bay

SOMA Faculty Publications

Abstract

Introduction

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.

Objective

This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven …

Characterization Of Sarcoidosis At A Combined Rheumatology- Pulmonary Clinic, Megan Schermerhorn, Md, Julianna Desmarais, Md

Poster Presentations

No abstract provided.

Case Study: A Severe Presentation Of Chronic Eosinophilic Pneumonia, Revati Kalluri, Md, Mari Kai, Md

Poster Presentations

No abstract provided.

Outpatient Medications Deimplemented By The Aap Bronchiolitis Guidelines: An Umbrella Review Of Meta-Analyses, Larry Mellick, Paul Walsh, Clista Clanton, Sarathi Kalra, Shane Mckinney

University Research Data and Datasets

OBJECTIVE: To systematically perform an umbrella review all meta-analyses that included outpatient sub-analyses or network meta-analyses with medication treatment comparisons to study the clinical benefits of these deimplemented medications in the outpatient setting.

Titratable, Weight-Based Cisatracurium Infusions For Ventilation Synchrony In Ards, Nanako Miimi, Pharmd, Celine Munoz

Books, Presentations, Posters, Etc.

Abstract: Cisatracurium is a non-depolarizing neuromuscular blocking agent used for paralysis in paitents with acute respiratory distress syndrome on mechanical ventilation. Paralysis prevents ventilator dyssynchrony and reduces patient’s work of breathing, which decreases the risk of pneumothorax. On November 1, 2023, PSVMC critical care units transitioned from fixed dosing of cisatracurium for ARDS to a weight-based, titratable dosing protocol. A single-center retrospective cohort study demonstrated cisatracurium titrated using train-of-four was associated with similar ventilatory and clinical outcomes with three folds reduction in cisatracrurium dose in comparison to fixed dose strategy. The purpose of this project is to evaluate the drug …

Prevalence And Patterns Of Cardiovascular Risk Factors In Young Hypertensive Patients, *Raghu V S R Tanuku Dr., Major Venkata Shree Krishna Dr., Sreedhar Tanuku Dr

Digital Journal of Clinical Medicine

Hypertension ranks among the top ten causes of mortality, with around 4% attributed to hypertensive complications. High salt intake, Type 2 diabetes, smoking, elevated serum lipids, a sedentary lifestyle, a diet heavy in saturated fat, genetic predisposition, as well as stress are among the factors that contribute to hypertension. Hypertension affects about 1 billion people worldwide, with considerable differences between populations and ethnic groups [2]. The Framingham Heart Study indicates that a person's lifetime risk of developing hypertension is 90% if they are normotensive at age 55. According to the NHANES IV (4th National Health and Nutrition Examination Survey), the …

E-Cigarette Or Vaping Use-Associated Lung Injury (Evali) In A Hispanic Male During The Covid-19 Pandemic, Juan C. Naranjo, Muhammad Jamal, Aramide Tijani, Fatimah Bello

Research Colloquium

Background: Electronic cigarette or vaping product use–associated lung injury established the relationship between vaping products and lung injury. Overlapping clinical manifestations may mimic those of other respiratory conditions including COVID-19. Multiple radiographic findings including diffuse, bilateral, ground-glass infiltrates with lower-lobe predominance, eosinophilic pneumonia, and diffuse alveolar damage have been described. It is important to consider this as an alternative diagnosis, particularly in patients with respiratory symptoms and a history of vaping in the last 90 days due to increased risk of COVID-19 infection and worse outcomes.

Case presentation: A 25-year-old male with a history of polysubstance abuse and frequent E-cigarette …

Access To Pediatric Type 1 Diabetes Care In Montana, James C. Bohnhoff, Michael Kohut Phd, Chelsea Bodnar, Elizabeth A. Jacobs

Costas T. Lambrew Research Retreat 2023

Introduction: Management of Type 1 Diabetes (T1D) requires significant family effort and specialty support. We aimed to understand how living in a rural state impacts families’ experiences during and after diagnosis.

Preventable Tacrolimus Toxicity, Brooke Parker, Jessica Sterner, John Mele, Laura Dewald, Cassidy Johnston

Articles, Abstracts, and Reports

No abstract provided.

Change In Basic Pulmonary Function With Change In Altitude, Jaden Arnold, Mindy Cook, Bivash Neupane, Erika Noonan Md, Rex Ripplinger Md

Annual Research Symposium

No abstract provided.

Recurrent Cyanotic Spells In An Octogenarian, Chin Tong Kwok, Chun Kit Wong

Journal of the Hong Kong College of Cardiology

We report rare case of an octogenarian who, after years of diagnostic delay, was found to have a patent foramen ovale, and due to an ascending aortic aneurysm that anatomically facilitated right-to-left shunt, presenting with life-threatening cyanotic attacks. The characteristic orthodeoxia-platypnea syndrome and high alveolar arterial gradient hint to the diagnosis. She was eventually treated successfully with urgent percutaneous PFO closure. Routine ordering of a transthoracic echocardiogram, without agitated saline injection under provocation maneuvers, may not be sufficient to rule out shunts.

Tuberculosis Myositis In Leg Musculature, Tho Nguyen, Md, Justin Jin, Md

Poster Presentations

No abstract provided.

Indwelling Pleural Catheterization Maximizes Functionality And Quality Of Life In Management Of Recurrent Malignant Pleural Effusions, Avinash Ramkissoon

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Davies HE, Mishra EK, Kahan BC, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: The TIME2 randomized controlled trial. J Am Med Assoc. 2012;307(22):2383-2389. https://doi.org/10.1001/jama.2012.5535

for the management of recurrent malignant pleural effusions in a patient with metastatic renal cell carcinoma.

Evaluation Of Pharmacist-Led Transitions Of Care (Toc) Discharge Pilot Program For Reducing 30-Day Readmission Rates In Patients With Chronic Obstructive Pulmonary Disease (Copd, Ann Tong, Hyesoo Chae, Addison Pang, Tony Lucchi

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2022

No abstract provided.