Comparing Anatomical Imaging With Functional Imaging For Coronary Artery Disease: The Limitations Of Vessel Stenosis And The Benefits Of Non-Invasive Measurement Of Fractional Flow Reserve, Zachary Zajac, Laura Aravena, Madeline Simone, David R. Allen Lll, Pranally Desai, Chanel Harvey, Nolan Tews, Nickolas Vinokurov

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising

Neglia D, Rovai D, Caselli C, Pietila M, Teresinska A, Aguadé-Bruix S, et al. Detection of Significant Coronary Artery Disease by Noninvasive Anatomical and Functional Imaging. Circ: Cardiovascular Imaging. 2015;8(3):e002179. https://doi.org/10.1161/CIRCIMAGING.114.002179

for a stable hospitalized patient admitted for acute coronary syndrome (ACS) rule out.

When Systems Fail: The Impact Of Protocol On Physician Moral Distress, Aya Dudar

Clinical Research in Practice: The Journal of Team Hippocrates

Physicians often face the decision between following rigid hospital protocol and doing the right thing for the patient, creating moral distress and contributing to burnout. This letter describes a case in which an elderly patient with COVID-19 pneumonia and a DNI order developed worsening hypercapnia and required noninvasive ventilation. Despite clinical appropriateness, hospital policy prohibited BiPAP use in obtunded patients due to aspiration risk - even when the resident offered continuous bedside monitoring. This case highlights the ethical tension that arises when rigid hospital policies prevent physicians from making real-time exceptions in appropriate situations. Empowering physicians to make context-driven decisions …

Tadalafil Monotherapy Is A Reasonable Alternative For The Treatment Of Lower Urinary Tract Symptoms In Patients With Comorbid Benign Prostatic Hyperplasia And Erectile Dysfunction, Daniel M. Ibrahim, Anam Ahmed, Swetha Reddy, Meet S. Patel, Nabeel Sumbal, Adam Chaban, Aminah I. Fayyaz

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising

Oelke M, Giuliano F, Mirone V, Xu L, Cox D, Viktrup L. Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomized, parallel, placebo-controlled clinical trial. Eur Urol. 2012;61(5):917-925. https://doi.org/10.1016/j.eururo.2012.01.0131

for a vigorous 75-year-old man with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) who discontinued dutasteride due to intolerable sexual side effects.

Pcornet’S Patient Advisory Councils Relevance To Research, Toni Hill

Mountain Plains Business Conference

This presentation will provide an overview of the UNMC award and UNK sub-award with the Patient-Centered Outcomes Research Network (PCORnet) specific to the research of patient and family-focused research using the Patient Advisory Council (PAC) framework. The UNMC PCORnet project is now in Phase 4 (2025 – 2029). This four-year, $13,500,000 project includes 14 partner organizations as part of the Great Plains Collaborative (GPC) with data from 8.9 million unique individuals across 14 states. This presentation will begin a discussion related to the uniqueness of patient engagement, community engagement, and Patient Advisory Council engagement.

Pilot Survey Of Attitudes Toward Xenotransplantation Among Nursing Students In London, Uk., Daniel Rodger, Luz A. Padilla, Daniel J. Hurst, David K C Cooper, Gilberto Buzzi, Antonio Ríos

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Solid organ xenotransplantation has been approved for clinical trials in the United States. Because of the role of nurses in patient decision-making, it is important to understand the attitudes of the future nursing workforce toward xenotransplantation. This pilot study aimed to investigate the attitudes of adult nursing students toward xenotransplantation.

METHODS: A cross-sectional survey design was used. The online pilot survey was completed by 33 undergraduate adult nursing students at one university in London, England. A minority of the hospitals that students may have had a clinical placement in had a transplant unit. The protocol for this study was …

Jeremy Bentham Will See You Now, Kevin Suiter

Clinical Research in Practice: The Journal of Team Hippocrates

A discussion of remote patient monitoring through the lens of Jeremy Bentham's Panopticon

Clinical Decision-Making And Artificial Intelligence: The Role Of Large Language Models In Medicine, Richa Bhasin, Wassim El-Sayed, Kassim Salami, Mura Abdul-Nabi, Ahmed Elashmawy, M. Ellis Jaruzel Ii

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Goh E, Gallo R, Hom J, et al. Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(10):e2440969. https://doi.org/10.1001/jamanetworkopen.2024.40969

to explore the role of artificial intelligence in clinical settings.

Paradigm Shifts: Efficacy Of Cabg For Diabetic Patients With Coronary Artery Disease And Prior Pci, And The Utility Of Artificial Intelligence In Clinical Decision-Making, Jacob Mallad, Kevin Suiter, Mahdi Mahmoud, Sidney Caudell, Richard Lewandowski, Hazem Alata, Bethany Lyche, Zarin Kothari

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Thielmann M, Neuhäuser M, Knipp S, et al. Prognostic impact of previous percutaneous coronary intervention in patients with diabetes mellitus and triple-vessel disease undergoing coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2007;134(2):470-476. https://doi.org/10.1016/j.jtcvs.2007.04.019

for a patient with prior coronary artery catheterization being referred for surgical intervention, and a clinician encountering a nonexistent clinical reference hallucinated by a large language model.

Paradigm Shifts In Medicine, David Meza, James Peter Meza

Clinical Research in Practice: The Journal of Team Hippocrates

Implications for history of science, scientific revolutions and paradigm shifts in the context of rapidly developing artificial intelligence.

Life Course Analysis: How Social Needs And Family Dynamics Impact Clinical Decision-Making, Vito Agrusa, Laila N. Abdallah, Bryen Turco

Clinical Research in Practice: The Journal of Team Hippocrates

The authors explore Life Course Analysis and how social needs (including pet care), changing demographics, and loneliness affect inpatient hospitalization and clinical decision making.

Off-Label Long-Term Use Of Phentermine For Weight Management, Monique Morin, Yamini Pandey, Sarah Bdeir, Rumyah Rafique, Taim-Allah Al-Jarrah, Ali Farhat

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Hendricks EJ, Greenway FL, Westman EC, Gupta AK. Blood pressure and heart rate effects, weight loss and maintenance during long-term phentermine pharmacotherapy for obesity. Obesity. 2011;19(12):2351-2360 https://doi.org/10.1038/oby.2011.94

for a patient struggling at the intersection of weight loss and financial instability.

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.

Exploring Alternative Treatments For Acute Exacerbations Of Cannabis Hyperemesis Syndrome In Patients Who Plan To Continue Using Cannabis, Tabitha E H Moses

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Dean DJ, Sabagha N, Rose K, et al. A Pilot Trial of Topical Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome. Acad Emerg Med. 2020;27(11):1166-1172. https://doi.org/10.1111/acem.14062

for a patient with cannabis hyperemesis syndrome.

Clinical Utility Of Abbreviated Eeg Monitoring In Patients Unable To Tolerate A Long-Term, Ambulatory Eeg, Jack T. Mcconnell

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Lee C, Lim S-N, Lien F, et al. Duration of electroencephalographic recordings in patients with epilepsy. Seizure. 2013;22(6):438-442. https://10.1016/j.seizure.2013.02.016

for a patient with an inability to tolerate a long-term, ambulatory EEG.

Breast Cancer Screening In Transgender Women With High-Risk Family History, John F. Lloyd

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

de Blok CJM, Wiepjes CM, Nota NM, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019;365:l1652. https://doi.org/10.1136/bmj.l1652

for a transgender woman with family history of breast cancer.

The Use Of Chewing Gum To Alleviate Thirst In Chf Patients Requiring Fluid Restrictions And Oral Diuretics, Madeline B. Simone

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Allida SM, Shehab S, Inglis SC, Davidson PM, Hayward CS, Newton PJ. A RandomisEd ControLled TrIal of ChEwing Gum to RelieVE Thirst in Chronic Heart Failure (RELIEVE-CHF). Heart Lung Circ. 2021;30(4):516-524. https://doi.org/10.1016/j.hlc.2020.09.004

for a woman with heart failure and under fluid restriction.

Exploring Alternative Treatment Options For A Patient With Acute Disseminated Encephalomyelitis (Adem) Suffering From Iatrogenic Cushing’S Symptoms, Alejandro Ponce Sepulveda

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Ravaglia, S,MD, P., Piccolo G, MD, Ceroni M, MD, et al. Severe steroid-resistant post-infectious encephalomyelitis: General features and effects of IVIg. J Neurol. 2007;254(11):1518-23. https://doi.org/10.1007/s00415-007-0561-4

for a patient with ADEM and iatrogenic Cushing’s secondary to long-term high dose corticosteroid therapy.

Etanercept, Methotrexate, Or Combined Therapy For Improving Rheumatoid Arthritis Symptoms, Ajith Dupati

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

van der Heijde D, Klareskog L, Rodriguez-Valverde V, et al. Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: two-year clinical and radiographic results from the TEMPO study, a double-blind, randomized trial. Arthritis Rheum. 2006;54(4):1063-1074. https://doi.org/10.1002/art.21655

for a patient with rheumatoid arthritis.

Use Of Empagliflozin As An Adjuvant Treatment For Obstructive Sleep Apnea For A Patient Who Has Not Seen A Physician In Over 40 Years, Andrew Demko

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Neeland IJ, Eliasson B, Kasai T, et al. The Impact of Empagliflozin on Obstructive Sleep Apnea and Cardiovascular and Renal Outcomes: An Exploratory Analysis of the EMPA-REG OUTCOME Trial. Diabetes Care. 2020;43(12):3007-3015. https://doi.org/10.2337/dc20-1096

for a patient with obstructive sleep apnea who has not seen a physician in over 40 years.

Mirabegron Does Not Adversely Impact Cognitive Function In Older Adults With Overactive Bladder Compared To Placebo, Sanjna Ghanshani, Abbie R. Bauer

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Griebling TL, Campbell NL, Mangel J, et al. Effect of mirabegron on cognitive function in elderly patients with overactive bladder: MoCA results from a phase 4, randomized, placebo-controlled study (PILLAR). BMC Geriatr. 2020;20(1):109. https://doi.org/10.1186/s12877-020-1474-7

for a patient with a history of lacunar infarctions who is experiencing urge incontinence.

Predictors And Diagnosis Of Adjustment Disorder In A Middle-Aged Patient With Cholangiocarcinoma, Zoya Gurm, Abbie R. Bauer

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Hund B, Reuter K, Härter M, et al. Stressors, Symptom Profile, and Predictors of Adjustment Disorder in Cancer Patients. Results from an Epidemiological Study with the Composite International Diagnostic Interview, Adaptation for Oncology (CIDI-O). Depression and Anxiety. 2016;33(2):153. https://doi.org/10.1002/da.22441

for a patient with recently diagnosed solid tumor malignancy.

Safety Of Ipsilateral Intravenous Access In Breast Cancer Surgery Patients, Austin J. Piontkowski, Abbie R. Bauer

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising

Naranjo J, Portner ER, Jakub JW, Cheville AL, Nuttall GA. Ipsilateral Intravenous Catheter Placement in Breast Cancer Surgery Patients. Anesth Analg. 2021 Sep 1;133(3):707-712. https://doi.org/10.1213/ANE.0000000000005597

for a post-lumpectomy patient requiring ipsilateral peripherally inserted central catheter.

Exercise Is A Vital Sign, Megan Dannemiller, Anthony Shadiack, Marvin Sineath Jr, Andrew Baird, Marc Poirier, Kevin Thomas, Michael G. Flynn

HCA Healthcare Journal of Medicine

In this review, we argue that exercise (physical activity) be monitored as a vital sign since no other basic sign or symptom provides as much information about a patient's health status. The influence of regular exercise on patient health is indisputable, with strong evidence to show the power of exercise to mitigate chronic disease and improve overall health. Several simple tools, such as Physical Activity as a Vital Sign and Exercise as a Vital Sign are available to assess patient physical activity. When properly applied, there is evidence to support the efficacy of these tools, but there are barriers that …

Global Implications Of Covid-19 On Education And Research In Healthcare And Stem: Analysis Of Case Studies, Yumna Indorewala, Santanu De

FDLA Journal

The zoonotic novel coronavirus, SARS-CoV-2 posed major threats to the world’s economy, social development, and public health. Education and research in STEM and healthcare were no exceptions to the global implications of the Coronavirus Infectious Disease 2019 (COVID-19) pandemic. Social distancing guidelines were initially recommended to refrain from in-person operations for preventing the transmission of the virus. As academic organizations implemented multifarious methods to effectively transition to remote/online or hybrid educational formats, COVID-19 necessitated designing, adopting, as well as evaluating the efficacy of new instructional approaches, especially for disciplines that require active, experiential learning such as healthcare and STEM. These …

Honoring Veterans’ Wishes: Efficacy Of An Evidence-Based Shared Decision-Making Tool In Va Icu Goals-Of-Care Discussions, Stephanie Alexander, Anna Astashchanka Md, Venktesh Ramnath Md

Doctor of Nursing Practice Final Manuscripts

Abstract

Introduction: This Doctor of Nursing Practice project aimed to enhance the knowledge and confidence of the San Diego Veterans Health Administration’s (VASD) Intensive Care Unit (ICU) medical providers in goals-of-care discussions (GOCD). Additionally, this project aimed to improve the documentation of these discussions.

Background: Delays in GOCD can lead to futile medical and surgical interventions, inappropriate antibiotic use, and higher rates of mental health conditions in patients and their loved ones. Earlier GOCD are associated with lower ventilation and resuscitation rates, earlier hospice enrollment, reduced ICU admissions, lower financial costs, and better patient and caregiver quality of life. However, …

Operative Versus Nonoperative Management For Diverticulitis Complicated By Abscess, Alix Bernholtz, Abbie R. Bauer

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

You K, Bendl R, Taut C, et al. Randomized clinical trial of elective resection versus observation in diverticulitis with extraluminal air or abscess initially managed conservatively. Br J Surg. 2018;105(8):971-979. https://doi.org/10.1002/bjs.10868

for a patient with a recurrent diverticulitis complicated by abscess formation.

Buprenorphine For Pain Management Vs. Chronic Hydrocodone-Acetaminophen Therapy When Comorbidities Increase The Risk Of Opioid-Related Side Effects, Jessica Zhao, Doo Hee Kim

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Gordon A, Callaghan D, Spink D, et al. Buprenorphine transdermal system in adults with chronic low back pain: a randomized, double-blind, placebo-controlled crossover study, followed by an open-label extension phase. Clin Ther. 2010;32(5):844-860. https://doi.org/10.1016/j.clinthera.2010.04.018

for a patient on long-term opioid therapy with high risk factors for adverse effects.

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.

Effects Of Chaplain Care On Coping With Cancer, Sarah Battiston, Scott L. Baughan

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical case decision report using:

Piderman KM, Radecki CR, Jenkins SM, et al. Hearing and heeding the voices of those with advanced illnesses. Journal of Palliative Care. 2020;35(4):248-255. https://doi.org/10.1177/0825859720928623

for a patient having difficulty coping with cancer

Radiofreqency Device As An Alternative Therapy For Refractory Nasal Valve Collapse, Sara Farooqui, Doo Hee Kim

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using

Silvers SL, Rosenthal JN, McDuffie CM, Yen DM, Han JK. Temperature-controlled radiofrequency device treatment of the nasal valve for nasal airway obstruction: A randomized controlled trial. Int Forum Allergy Rhinol. 2021 Dec;11(12):1676-1684. http://doi.org/10.1002/alr.22861

for a patient with nasal valve collapse.