Open Accessibility Menu
Hide

ACP Oregon Chapter

Winners

November 2019

Quality Improvement

1st Place – Dr’s Michael Silvas & Joe Miller, “Delirium: Delirious ELders, Implementing Reduction Interventions Using Mobility”


November 2018

Clinical Vignettes

1st Place – Dr. Alireza Abadi, “Nitrous Oxide Induced Subacute Combined Degeneration


2nd Place – Dr. Lucy Zhou, “Improving Hepatitis B Vaccination

November 2017

Oral Presentation
2nd Place – Dr. Maeve MacMurdo, “Bullae It Or Not”

November 2016

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

November 2014

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)

2018 Oregon ACP Resident Presentations

Clinical Vignette Posters

Nitrous Oxide Induced Subacute Combined Degeneration – 1st Place

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.

Suspecting Shigella

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.

Aortic Valve Endocarditis Complicated by Perivalvular Abscess causing NSTEMI

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.

Steroid-Induced Intracranial Hypertension

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.

Thyrotoxic Hypokalemic Periodic Paralysis

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.

A Shockingly Sweet Diagnosis

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.

Being Basic – Alkali Ingestion Suicide Attempt

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.

The Trees Have No Tongues

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).

Quality Improvement Research Posters

“Just” a phone call away – Reducing 30 day Readmission Rates through Increased Outpatient Follow Up – 1st Place

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.

Improving Hepatitis B Vaccination Rates in Patients with Type I and II Diabetes Mellitus – 2nd Place

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.

Improving Plain Language Usage in Hospitalist Discharge Instructions – 3rd place

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.

Increasing the Rate of Recognition of Inflammatory Back Pain

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.