High Value Cost Conscious Care
1st Place – Dr. Allison Schue, “Advance Care Planning at Medicare Annual Wellness Visits – Empowering Patients to Have Meaningful Goals of Care Discussions in Primary Care”
Clinical Vignette
3rd Place – Dr. Divya Nimmatoori, “When Doctors Disagree, You Get Stuck Between the Devil and the Deep Blue Sea”
Quality Improvement
3rd Place – Dr. Bethany Koschel, “Standardizing Sepsis Patient Education – A QI Process”
Oral Presentation
2nd Place – Dr. Omar Pandhair, “Swelling, Skin, and Sick”
High Value Care
1st Place – Dr. Banu Ramachandran, “No Need to Schedule that Colonoscopy!”
Quality Improvement
2nd Place – Dr. Jakob Feeney, “Under Pressure: A QI Initiative Reduces Inappropriate Use of IV Antihypertensives for Asymptomatic Blood Pressure Elevations”
Clinical Research - Oral Presentation
3rdPlace – Dr. Banu Ramachandran
Clinical Vignette
2nd Place – Dr. Alexis Amatisto, “Anchors Away to Seize the Day
Clinical Research - Oral Presentation
3rd Place – Dr. Nathan Zvejnieks, “Improving Outcomes Related to COPD Admissions: Pulmonary Rehabilitation”
Clinical Vignette
2nd Place – Dr. Banu Ramachandran, My Doctor Just Doubled My Canaglifozin: A Case of Euglycemic DKA?
Quality Improvement
1st Place – Dr. Joanna Bove, Clinical Research, “Are elevated inflammatory markers and acute phase reactants associated with more severe disease in COVID 19 patients?”
2nd Place – Place – Dr. Jillian Catral, Quality Improvement, “When Two Isn’t Better Thank One: A Case of Severe Hyponatremia from Combination Thiazide Diuretic and ARB Therapy”
Quality Improvement
1st Place – Dr’s Michael Silvas & Joe Miller, “Delirium: Delirious ELders, Implementing Reduction Interventions Using Mobility”
2nd Place – Dr. Larissa Sharma, “Addressing The Social Determinants of Health in the Clinic Setting”
Clinical Vignettes
1st Place – Dr. Alireza Abadi, “Nitrous Oxide Induced Subacute Combined Degeneration”
Quality Improvement
1st Place – Dr. Cody Talbot, “Just” a phone call away: Reducing 30 day Readmission Rates through Increased Outpatient Follow Up”
3rd Place – Dr. Brandon Tullis, “Improving Plain Language Usage in Hospitalist Discharge Instructions”
Oral Presentation
2nd Place – Dr. Maeve MacMurdo, “Bullae It Or Not”
Oral Presentation
3rd Place – Dr. Justin Moyers, “Don’t Stop Bleeding: An Atypical Cause of Hemolytic Uremic Syndrome”
Clinical Vignette
1st Place – Dr. Joe Simonett, A Legion in Disguise
2nd Place – Dr. Stephanie Griffith, “Pulmonary Cryptococcal Infection Mimicking Primary Lung Cancer”
Research Poster
1st Place – Katie Atkins, MD, The impact of anatomic tumor location
on inter-fraction tumor motion during lung stereotactic body radiation
therapy (SBRT)
Alireza Abadi, MD
Faculty Mentor: Claudia Leonard, MD
The neurological manifestations of vitamin B12 deficiency are well known.
This case highlights the need to consider N2O recreational use, especially
in younger patients presenting with symptoms concerning for deficiency
yet with normal B12 levels.
Leah Grant, MD
Faculty Mentor: Imran Mohamedy, MD
One hundred eighty-eight million cases of Shigella diarrhea or dysentery
occur annually worldwide, with 164,000 associated deaths. Successful diagnosis
and treatment of Shigella enteritis requires an understanding of the epidemiology
of the disease and the limitations of our laboratory test.
Richard Cam, DO
Faculty Mentor: Emily Hitchcock, MD; Steven Freer, MD; Angela Gibbs, MD
Cardiac complications from infective endocarditis are fairly common. A
cardiothoracic surgery evaluation was indicated as infectious endocarditis
may rapidly progress. Generally, indications for valve replacement include
valve dysfunction, paravalvular extension of the infection, and persistent
or resistant infection. As up to 50% of patients with infectious endocarditis
develop heart failure, primarily due to valvular dysfunction, and up to
40% develop a perivalvular abscess, a significant portion of patients
with infectious endocarditis do indeed undergo valve replacement.
Elizabeth Peijnenburg, MD
Faculty Mentor: Irene Hendrickson, MD
Steroids are widely used for a large variety of conditions and are a mainstay
in the treatment of chronic inflammatory diseases. With great benefit
comes great risk of adverse effects and numerous adverse effects have
been documented for glucocorticoids. There have been reports of intracranial
hypertension both with chronic steroid use as well as with rapid tapering
of steroids. The mechanism of action is unknown making it a diagnosis
of exclusion. It is speculated to involve transient hypophysealadrenal
suppression causing intracranial pressure.
Joshua Genstler, MD
Faculty Mentor: Steve Freer, MD
The thyrotoxic hypokalemic periodic paralysis variant is most common in
Asian populations where at least some symptoms of weakness had been reported
in as many as 2% of individuals who develop thyrotoxicosis. This case
illustrates that THPP is a rare form of sudden paralysis that is important
not to miss, as early treatment with potassium repletion and achievement
of a euthyroid state is important for the avoiding cardiopulmonary complications
and resolution of paralysis symptoms.
Boris Rozenberg, DO
Faculty Mentor: Man Tran, MD
Although not commonly described in the literature, this patient’s
hypotension may be attributed to Sweet’s syndrome. He presented
with circulatory shock and persistently elevated procalcitonin mimicking
sepsis in the setting of a completely negative infectious and shock workup.
The pathogenesis of Sweet’s syndrome is poorly understood but one
theory includes dysregulation of cytokines with increased interleukins
leading to a systemic inflammatory response which may explain how Sweets
Syndrome can present similarly to septic shock. This case highlights a
potential unique aspect of Sweet’s Syndrome that has not been described
in the literature; as a cause of shock.
Heidi Reich, MD
Faculty Mentor: Jeff Youker, MD
Patients with caustic ingestions are at highest risk for airway compromise
and viscus perforation. No definitive guidelines exist, but initial management
should focus on two areas: 1) Assessment of the oropharynx for erosions
or edema. This may prompt intubation for airway security. 2) Physical
exam findings indicating perforation – rebound tenderness, subcutaneous
emphysema, or hemodynamic instability should prompt surgical evaluation.
Chad Brizendine, MD
Faculty Mentor: Jeffrey Bluhm, MD
Hypersensitivity pneumonitis remains an elusive and yet highly treatable
lung disease. It presents as a wide spectrum of clinical and histopathologic
findings that require an elevated clinical index of suspicion. A meticulous
exposure history and timeline is necessary in order to recognize the offending
antigen and instruct on avoidance. If the condition or antigen is not
identified then chronic hypersensitivity pneumonitis can lead to irreversible
emphysema, interstitial fibrosis, and airway reactivity. Capturing the
disease while still in the acute to sub-acute phenotype, as seen in this
case, can lead to complete resolution of the findings on imaging (and,
in this case, they did resolve six months later as shown in image D).
Cody Talbot, DO
Faculty Mentor: Shelley Sanders, MD
At the end of relaunch a total of 329 patients were discharged and 66 were
readmitted within 30 days. Unfortunately, the intervention did not appear
to increase outpatient follow-up within 14 days (Figure 2).
Despite two cycles of change, increasing 14-day follow-up proved difficult.
We were however able to identify several root causes using failure mode
and effects analysis.
Lucy Zhou, MD
Faculty Mentor: Shelley Sanders, MD
Education, provider reminders, and patient engagement through letter outreach
effectively improved hepatitis B vaccination significantly over 11 months.
Hepatitis B vaccination involves a series of 3 shots, therefore harder
to complete compared to other vaccinations such as flu shot, Tdap, etc.
One limitation was the patient accessibility by mail or phone. It is unclear
if multiple reminders or more education will further improve the vaccination
rate, and further investigation might clarify these questions.
Brandon Tullis, MD
Faculty Mentor: Claudia Leonard, MD; Emily Hitchcock, MD; Shelley Sanders, MD
This project demonstrates that hospitalist education and individualized
feedback can improve plain language usage in the discharge instructions
they write for patients. Further research investigating the optimal extent
of education and frequency of feedback would be helpful. While smart texts
for discharge instructions can be quite informative for patients, many
of these are written at an 8th-9th grade reading level, which is not ideal.
Future quality improvement projects could involve rewriting smart texts
to employ simpler language; this could have a repeated and lasting impact
on the complexity of language used in patient discharge instructions.
Any adjustments to electronic medical record programs enabling real-time
RGL calculation of written patient communications could potentially result
in increased plain language usage as well.
Barbara Jacobs, MD
Faculty Mentor: Tom Chau, MD; Shelley Sanders, MD
Physician education and implementation of a smartphrase are useful interventions
to facilitate primary care physicians to appropriately evaluate for inflammatory
back pain. More so, they are promising tools to increase screening rate
for axial spondyloarthritis. Further observations are underway to increase
the number of participants to better assess the efficacy of these interventions.
