Virginia Tech Carilion (VTC)
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Browsing Virginia Tech Carilion (VTC) by Content Type "Poster"
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- Acute onset apathy in the context of malignancy: a case reportSamarbafzadeh, Ehsan; Adikey, Archana; Alee Koloukani, Sahar (2021-05-03)
- Alice in Wonderland Syndrome: The Case of the Elongating StrawsStavig, Alissa; O'Brien, Virginia C. (2019-10-18)Accurately interpreting visual stimuli requires a complicated interplay between the eye, visual pathways and cortical pathways. The temporal lobe is responsible for object recognition and the parietal lobe is responsible for motion. Vision requires the integration of information from all cortical areas (temporal, parietal, occipital). Alice in Wonderland Syndrome (AIWS) describes a set of visual and somatosensory symptoms characterized by a distortion in perception of the environment, time or self in contrast to hallucinations or illusions.
- A Bridge too far: Myocardial Bridging as a cause of NSTEMIStokka, Jordan; Penmetsa, Megha; Hama Amin, Ali (2023-05-12)
- Challenges in Psychiatric Oncology: Cancer-Related Cognitive Impairment and Use of PsychostimulantsO'Brien, Virginia C. (2019-09-24)Cancer-related cognitive impairment (CRCI) is a common side effect of cancer and its treatment that can significantly impact patients' quality of life. CRCI may arise before, during or after cancer treatment, but for up to 30% of patients, CRCI persists1. The etiology of CRCI is hypothesized to be due to direct cytotoxic effects, oxidative stress, and/or the body's immune response to cancer and its treatment. This lack of certainty surrounding the cause of CRCI makes identification of appropriate interventions challenging. Persistent CRCI can significantly impact patients' role functioning, thus treating the symptoms of CRCI is paramount to comprehensive cancer care.
- Co-localized Substance Use and Hepatitis C TreatmentLee, Andrew; Tarasidis, Charles; Venuto-Ashton, Angela D.; Rubio, Marrieth G. (2022-10-24)In the US, there has been a dramatic rise in hepatitis C infection and a shifting demographic with the highest rates in persons aged 20-39 years. Injection drug use is the most common mode of transmission. While many novel strategies to expanding hepatitis C treatment have been proposed, there has been little reported progress toward establishing a standardized, wide scale approach. In response, we developed a pilot quality improvement program combining screening and initiation of hepatitis C treatment utilizing a simplified algorithm adapted for the office based opioid treatment (OBOT) to provide co-localization of substance use and hepatitis C treatment. Initial results revealed a high rate of seroprevalence among screened OBOT patients highlighting several challenges faced by this population including lack of awareness of infection and barriers to accessing care. Within this same group, 48.2% had either initiated or completed their course of DAA treatment within the first 6 months of the intervention phase of the program. Targeting patients in outpatient substance use treatment could identify a subset of at risk individuals with a high propensity for engaging and facilitate following through with hepatitis C treatment. On site treatment is an efficient alternative for treatment.
- Creating and Supporting Health Systems Science Content Integration within the Clerkship Environment Through Intentionally Designed Clinical Faculty Professional DevelopmentHarendt, Sarah M.; Rudd, Mariah J.; Whicker, Shari A.; Karp, Natalie (2022-04-28)
- Enhancing Inpatient Team Communication Among Pediatric Nurses and ResidentsHayes, Andrew; Washofsky, Anne; Boggs, Lia; Ward, Chad (2022-04-28)Background: Nurse and physician collaboration is important in patient care satisfaction. Improving communication among the inpatient nurses and residents was identified as a top priority within our Pediatric Quality Improvement Committee at Carilion Children's Hospital for 2021. Methods: Communication committee formed (inpatient pediatric residents and nurses). Communication survey administered. Interventions were identified through survey results and committee planning: - Nurse-Intern Mentor Program - Human Factor Engineers audit of rounding which led to addition of a clinical lead nurse on rounds - Communication Guidelines for nurses and residents PDSA cycles carried out following interventions. Post-intervention survey administered 1 year from start of project. Summary and Conclusion: Communication deficiencies among nurses and residents decreased following the initiation of Nurse-Intern Mentor program, addition of Clinical Lead Nurse on rounds, and implementing communication guidelines for nurses and residents. There was NO improvement in the communication deficiency responses involving the “delays of care”. Face-to-face communication also did not significantly improve post-intervention. More intervention planning is required to promote improvement in face-to-face communication among nurses and residents.
- Establishing A Multidisciplinary Clinic To Improve The Quality Of Care For Patients With Interstitial Lung DiseaseBankole, Adegbenga; Kazmi, Taskeen; Strazanac, Alyssa; Scheuing, William; Fleming, Jessica (2022-06-03)
- Implementing Human Factors Principles to Utilize Healthcare Workers as an Essential Source of Safety and Resilience to Impact Wellbeing & BurnoutFarley, Heather; Harry, Elizabeth; Privitera, Michael R.; Sinsky, Christine; Price, Justin; Wolf, Laurie (2023-03-22)
- Improving Care Transitions Through Risk Reduction with Machine Learning SupportCarver, M. Colette; Jones, Nate; Djuric, Dan; Butt, Caroline; Markham, Carla; Brookman, Jeremy; Reece, Chanda; Smith, Jamie (2020-04-15)Problem: The ambulatory care management team at Carilion Clinic lacked the necessary tools to demonstrate readmission risk reduction for patients undergoing care transitions. Purpose: This quality improvement project aimed to determine if implementing a real-time workflow management system which supported the prioritization, intervention tracking, and coordination of transitions of care, would result in readmission avoidance through risk reduction. Background: The Accountable Care Strategies team implemented an electronic Transition Tracking Tool (T3), as one aspect of Carilion’s readmission reduction program. Evidence from the literature: Approximately 20% of Medicare beneficiaries are readmitted within 30 days following hospital or facility-based care (Fischer et al., 2014). Many health systems across the country have developed strategies to reduce hospital readmissions after the passage of the Patient Protection and Affordable Care Act and its requirement for the implementation of a Hospital Readmissions Reduction Program (ACA, 2010). While there are a variety of readmission risk stratification tools used to identify patients, the predictive performance of these tools, according to Kansagara et al., (2011), has been marginal due in part to the complex factors contributing to a readmission. These researchers recommend incorporating a larger data set to include social determinants of health (Kansagara et al., 2011). Patient’s social determinants have a significant impact on their readmission risk, thus ambulatory programs which address these factors are essential (Calvillo-King et al., 2013). EBP Question: (1) Is there an impact on readmission for a patient who undergoes risk reduction strategies by a nurse using an automated patient prioritization tool with predictive interventions? Methods: The ambulatory care management team uses a relationship-based model, partnering with patients in self-care which is grounded in Dorothea Orem’s Theory of Self-Care (Petiprin, 2016). The aim is to support personal agency in the achievement of effective self-management. A tool was needed to replace a manual system, which could identify and prioritize at risk patients and track interventions and readmissions. A real-time data system was implemented called T3, it aggregates patients from both in and out of network hospitals. T3 also ingests information from Jvion, a machine learning platform that provides a readmission risk scoring and associated interventions. A dashboard displays patients and their risk scores, along with recommended interventions. Ambulatory nurses working remotely select a patient for outreach, review machine-recommended interventions and use nursing judgement for a patient-centric approach. Readmissions prevented are recorded using specific criteria. Outcomes: On average 2200 patient were managed each month and received risk reduction interventions. Over 11 months 212 patients had a readmission prevented. With the average cost of a hospital stay at $11,200.00, these 212 prevented readmission would have cost well over 2 million dollars. Most importantly the team saved patients from sustaining additional health complications due to a readmission. Implications for practice: Health systems focusing on readmission reduction need to consider using a predictive tool which incorporates social determinants of health and recommends targeted interventions. Prioritizing discharged patients, managing and tracking interventions, and recording readmissions prevented by ambulatory nurses will demonstrate improved quality of care transitions. References: (avail)
- Jumping MetastasesFeldman, Scott; Ofondu, Chuck; Karanjeet, Raina; Loschner, Anthony (2019-04-09)
- Lidocaine Infusion as An Adjuvant for Acute Pain Using a Multimodal Approach to Pain: A Case SeriesEnnasr, Areej; Jain, Sunil K. (2023-11-16)Case Diagnosis: Acute hip pain related to abdominal trauma and skin grafting; Acute lower back pain related to paraspinal abscesses Case Description OR Program Description (A tertiary care hospital): A 17-year-old female was admitted into the Pediatric Intensive Care Unit after a motor vehicle crash. She had multiple procedures, including exploratory laparotomy and skin grafting over the hip which caused a constant ache and throbbing pain. She was NPO and was treated with hydromorphone PCA. A 54-year-old female with a history of intravenous drug use and osteomyelitis was admitted with abscesses in the lumbar paraspinal region through to the gluteal region. She required surgical debridement, and her lower back pain was initially treated with Tylenol, baclofen, and oxycodone. Discussion (relevance): Acute pain management involves a complex, multimodal treatment plan. This approach is further complicated with patients with a history of substance use disorder or NPO. The adverse risk of addiction to opioids cannot be minimized with these patients, limiting the options of medications that can be used in this setting. This case series sheds light on lidocaine infusion as an adjuvant treatment possible for those who are ineligible for or may not respond to current approaches. Setting: Pediatric Intensive Care; Transitional Care Assessment/Results The addition of Lidocaine infusion in the morning to the pain treatment plan of the 17-year-old female decreased the pain from 7/10 on the Modified Clinically Aligned Pain Assessment (MCAPA) scale to 4/10. Her 24-hour Dilaudid requirement decrease from 28 mg to 20 mg. For the 54-year-old female, the pain was unrelenting, even with increases in the dosage of medications and the addition of ibuprofen, gabapentin, and hydrocodone/acetaminophen. After lidocaine infusion, pain decreased from 5/10 to 4/10 on MCAPA with the patient noting that the pain is now tolerated. Once lidocaine infusion was discontinued, she complained of increased burning pain again which responded to oral Trileptal, another sodium channel blocker that can be given orally. Conclusions: Physiatrists should be aware of the possible benefits of lidocaine infusion in acute pain relief with complex pain patients, including those with a history of substance use disorder or those who are NPO.
- Mouth on Fire: A Case of Burning Mouth Syndrome and its Relevance in PsychiatryBubel, Kristen; O'Brien, Virginia C. (Academy of Consultation Liaison Psychiatry, 2021-11-01)Burning Mouth Syndrome (BMS) is a complex pain condition of the oral cavity characterized by a burning sensation without clinical or laboratory abnormalities. It affects an estimated 0.1-3.9% of the general population. BMS can originate in the central nervous system or the peripheral nervous system and is frequently accompanied by depression, anxiety, and/or somatic symptom disorder. The overlap of pain, neurologic pathophysiology, mental health and impaired quality of life highlight the need for collaboration among specialists in its identification and treatment.
- Pain Management of Uterine Fibroid Embolization (UFE) with Lidocaine and Hydromorphone Combination TherapyAnzivino, Anthony P.; Simpson, Lisa Y.; Jain, Sunil K. (2022-05-01)
- A Rare Case of Mycobacterium chelonae Septic JointTorres, Jordan L.; Zhao, Yang; Griffin, Daniel; Baffoe-Bonnie, Anthony W.; Grider, Douglas J.; Gomez, Mariana (2022-10-21)Background: Nontuberculous mycobacteria (NTM) are abundant in soil and water. They can cause infection by direct inoculation via even minimal trauma. Chronic soft tissue infection may extend to involve joints and underlying bone by direct extension. Septic joint infections due to NTM are rare and much of what is known about their management is either taken from case reports or extrapolated from the tuberculosis literature. Methods: Here we describe a case of septic ankle due to M. chelonae, a rapidly growing NTM. We also review the literature of mycobacterial infection, prognosis, and the treatment pharmacology of these difficult to treat infections. Results: An 86-year-old man presented to our hospital with complaints of a painful, swollen, left ankle. Three months earlier he had seen a pimple on his left foot after tripping over a lawn mower. The lesion evolved into erythema and swelling of the left ankle which was so painful that he could not bear weight on his left lower extremity (LLE). MRI of the LLE revealed a comminuted nondisplaced fracture of the distal tibial metaphysis. Turbid joint fluid was aspirated, and cell studies showed 211,450 k/uL white blood cells with 97% neutrophils. Patient underwent partial removal of the left tibia with insertion of a drug implant device. Tissue culture grew acid fast bacilli. Histopathology also showed acid-fast bacilli, confirming an atypical mycobacterial infection. Meropenem, linezolid, and azithromycin were initiated until the organism was identified as Mycobacterium chelonae. Based on susceptibility report, meropenem was discontinued, and ciprofloxacin was initiated. After discharge, a repeat MRI showed possible osteomyelitis and small abscesses about the left ankle. This prompted a repeat debridement. Tobramycin was started and ciprofloxacin was discontinued. The patient was re-admitted shortly after discharge with acute renal failure and lactic acidosis; he ultimately passed away on comfort care per patient and family wishes. Conclusion: NTM are more resistant to antimycobacterial therapy compared with mycobacteria tuberculosis (MTb) and repeat surgical debridement is often necessary for cure. Because these cases are rare, it is important to approach treatment as a team including ID physicians, ID pharmacists, and surgeons to improve outcomes.
- Successful Management of a Rare Case of Recurrent Multi-Vessel Spontaneous Coronary Artery Dissection (SCAD)Marof, Biwar; Berzingi, Chalak O.; Mirza, Mohd; Hama Amin, Ali (Elsevier, 2022-04-02)
- The Unintended Consequences of Pelvic CellulitisKaranjeet, Raina; Timmerman, Clinton; Peterson, Jennifer; Mooney, Shayna (2022-04-05)