Virtual Poster Session for ENRICH Week 2021

ENRICH Week 2021

UAB ENRICH Week

Educational Research & Innovations in Clinical & Health Sciences (ENRICH) Week is an annual conference for healthcare educators that promotes teaching skills, fosters curriculum innovation, and showcases research in health education for the 21st century. Formerly RIME Week, the event was renamed in 2020 to be inclusive of interprofessional collaboration and scholarship among all health-related fields. 


Poster Session Tips & Tricks: 

  • You may navigate the poster session tracks (Research & Scholarship, Innovations, and Clinical Vignettes) by clicking the headers for each track at the top of this page. 

  • Presenters have pre-recorded their poster presentation and you may view these by clicking the green "Watch Presentation" button on each poster block. 
  • Additionally, most presenters have made themselves available via Zoom in time frames between 1-3 PM on Tuesday, September 21 to answer questions and discuss their work with attendees. Presenters have listed the times they are available and you may click on the purple "Chat with Presenter" button to access this.
  • If you are looking for a specific poster or presentation, you may search for it in the search bar at the top right of this page. 
  • To enlarge posters, you may click on the poster and view the file as a PDF. 

More info: https://https://www.uab.edu/medicine/home/faculty-staff/healthcare-educators-academy/enrich-week

Show posters

Show or hide this track Back to top ↑

Poster: Resident Self-Assessment of Common Endocrine Procedures

Resident Self-Assessment of Common Endocrine Procedures

Peter J. Abraham, MD; Jessica Fazendin, MD; Rongbing Xie, DrPH, MPH; Herbert Chen, MD; Brenessa Lindeman, MD, MEHP

Abstract
Background: General surgery residency graduates are expected to be proficient in straightforward endocrine operations upon completion of their training program. However, in a prior study, attending endocrine surgeons disagreed that general surgery residents achieved sufficient competence to perform thyroid and parathyroid procedures in practice.

Hypotheses/Aims: This study aimed to elucidate residents’ self-assessment of their ability to perform common endocrine operations.

Methods: A fourteen-question, anonymous survey was emailed to general surgery residents from seven U.S. residency programs between August-October, 2020 regarding their self-assessed ability to perform each step of a straightforward thyroidectomy and parathyroidectomy. Demographics and perceived ability to perform the various procedural steps were collected. Bi- and multi-variate analyses were conducted utilizing Chi-squared tests and logistic regression, as appropriate.

Results: Responses were received from 78 residents (31%). A majority were female (54%) and senior residents (PGY 3-5, 55.1%). The vast majority (92.1%, n=70) planned to pursue fellowship training, with 4.3% (n=3) selecting endocrine surgery. Most respondents (75.6%, n=59) did not anticipate performing thyroidectomies or parathyroidectomies once in practice. Dissection of the recurrent laryngeal nerve was cited to be the most difficult step of both procedures, with only 10.3% (n=8) and 6.3% (n=10) of residents stating they could perform this step without attending assistance, respectively. A minority of respondents (n=17, 27.9%) agreed they could complete a straightforward thyroidectomy for benign disease, with only 11.7% (n=7) agreeing they could complete a straightforward thyroidectomy for malignant disease. 26.2% (n=16) of respondents agreed they could complete a straightforward parathyroidectomy. Completed number of cases was significantly associated with greater self-assessed ability to perform the endocrine operations (p=0.02).

Conclusion: Most general surgery residents surveyed did not feel capable of performing common, straightforward endocrine procedures. Although confidence in operative ability increased with PGY-level and number of cases completed, the majority of PGY-5 residents still did not feel able to perform a thyroidectomy for malignant disease unassisted.
Presented by
Peter J. Abraham
Institution
University of Alabama at Birmingham, Department of Surgery
Chat with PresenterAvailable September 21st, 1-3pm Watch Presentation
Poster: Health Coaching via Motivational Interviewing in a worksite health program during COVID-19: Participant and Coach Perspectives and Health Outcomes

Health Coaching via Motivational Interviewing in a worksite health program during COVID-19: Participant and Coach Perspectives and Health Outcomes

Jordin Lane MA, CHES

Abstract
Background: Motivational Interviewing (MI) was first established in the early 1980’s as a tool used in addiction counselling. MI has since spread into other fields including education, and criminal justice. Corporate Health Partners is a third-party wellness program that works to provide corporate wellness programs. Employees of the participating companies are offered the option to enroll in a worksite health program and in return, employees are offered an incentive of reduced monthly insurance premium. Participants must attend 15-minute health coaching sessions using motivational interviewing and frequency is determined by blood work and biometrics taken annually. High risk participants receive 8 (held monthly) sessions, Moderate risk participants receive 4 (bi-monthly) sessions and low risk participants receive 1 session. At the initial session, the coach reviews blood work. The participant will then set a long term goal behavior change goal, rate their motivation, confidence, and importance and establish an action plan with their health coach. Aims: Aim 1: To assess participant perspectives of utility, impact, and delivery mode of motivational interviewing health coaching conducted via in-person versus telehealth. Aim 2: To elucidate the relationship between patient perceptions of motivational interviewing health coaching and their health outcomes and whether there are variations between in-person versus telehealth experiences. Aim 3: To explore coach perspectives of barriers, facilitators, and impact of motivational interviewing health coaching conducted via in-person versus telephonic. Methods: Conducting in-depth semi-structured interviews with 12-15 participants who have participated in the worksite health program for at least 12 months between August 2019 –July 2021 will be used to determine the participant perspectives of MI health coaching. Collecting health data from the annual biometrics screening and comparing to the perceptions of utility, impact, and delivery mode of motivational interviewing health coaching can help determine the health outcomes of those participants. Comparisons will also explore in-person versus telehealth experiences. Lastly, we will conduct focus group with 4 coaches who conducted health coaching sessions in the worksite health program for at least 12 months between August 2019 –July 2021 to explore the coach perspectives of MI health coaching. The study is set to begin Spring 2022.
Presented by
Jordin Lane
Institution
School of Public Health, Health Behavior
Other Affiliations
Corporate Health Partners
Chat with PresenterAvailable September 21 1:00-2:00 Watch Presentation
Poster: ID Fellows Cup: Leveraging Gamification and Social Media to Enhance Infectious Diseases Education

ID Fellows Cup: Leveraging Gamification and Social Media to Enhance Infectious Diseases Education

Herrera LN, Nolan N, Chavez M, Kahn M, Cleveland J, McCarty T, Escota G, Kulkarni P, Patel M, Rodriguez JM, Hunsinger H, Dempsey D, Willig J, Walker J.

Abstract
Kaizen-Education is a software developed at University of Alabama at Birmingham (UAB). This app has been used for educational purposes in the School of Nursing, School of Medicine, and Internal Medicine Residency Program at UAB. To this point, it has not been used outside of UAB. Novel, low burden education techniques was important to identify given evolving educational needs during the COVID pandemic. Hypothesis: We hypothesized that we could leverage social media to recruit learners to a gamification-infused ID knowledge competition, and entice them to explore additional online educational resources.

Methods: We created the ID Fellows Cup, a knowledge-based trivia competition, to engage Infectious Diseases fellows. The game was crafted via Kaizen-Education, a software platform developed at UAB that uses gamification to engage learners. Multiple choice questions including figures and/or text are presented to learners, followed by detailed teaching explanations. 60 questions emphasizing high-yield concepts were delivered over4 weeks. Questions were written by fellows and reviewed by faculty at three programs. Elements of gamification (virtual rewards, leaderboards, etc.) were included to enhance engagement. Recruitment strategies included Twitter, program director emails, and peer-to-peer. We measured game statistics and participation. Learners were invited to complete a post-game survey about their experience.

Results: We had broad geographic reach including 42 fellowship programs. Most fellows matriculated in 2019 or 2020;the number of US ID fellows equaled 17% of those completing ID in training exam. Recruitment sources included 44% co-fellow, 42% Twitter, and 15% Program Director. Through 20 days with questions, we had 155 daily average users. Overall, fellows answered 11,419 total questions, representing 89% of all released questions. Of 103 responses to post-game survey (table 1) 97% would participate again and all felt the game was a good use of their time. Over 80% of participants reported some engagement with linked resources included in the answer explanations. In general, 78% felt engagement with online resources increased subsequent to participating in the game, including learning about at least one new online.
Presented by
Lauren Nicholas Herrera <nherrera@uabmc.edu>
Institution
University of Alabama At Birmingham, Division of Infectious Diseases
Watch Presentation
Poster: Mid-Training Resident Boot Camp Improves Confidence Prior to Senior Role Transition

Mid-Training Resident Boot Camp Improves Confidence Prior to Senior Role Transition

Michelle D. Tubinis, MD, Robyn M. Davis, MPH; Albert T. Pierce, MD; Richard C. Clayton; Shivani Patel, Emma C. O’Hagan, MLIS, Lee Ann Riesenberg, PhD, MS, RN, CMQ

Abstract
Background Boot camp style courses are often utilized at the beginning of training programs to increase trainee knowledge, skills, and confidence. These activities are limited by faculty and trainee time and cost of materials for simulation. Our anesthesiology residency program developed a boot camp course for PGY-3 residents to provide training prior to their transition to senior trauma call role, facilitated by faculty and senior trainees. Objective: The objective of our boot camp was to increase knowledge, skills, and self-confidence prior to assuming this role mid-training. Methods The two-session senior trauma boot camp was developed for residents and delivered in December 2019, just prior to their assuming the role of senior trauma call resident. Sessions focused on induction and airway management in unstable patients, indications for fiberoptic intubations, management of the operating room schedule, and provided hands-on practice with equipment utilized on call. Results Sixteen of 19 (84%) and 16 of 17 (94%) participants completed the survey on day one and two, respectively. Statistically significant increases in self-reported confidence were found on all 12 retrospective pre/post-test questions. All participants strongly agreed/agreed that sessions were useful in developing their knowledge and would improve their clinical performance. Conclusions Although traditionally offered at the beginning of training programs, our results show that boot camps can be effective at any point during training to increase confidence and perceived knowledge and clinical skills. Future studies should include follow-up assessment of knowledge after transition into the role to document effect on knowledge and skill acquisition.
Presented by
Michelle D. Tubinis
Institution
University of Alabama at Birmingham
Other Affiliations
School of Medicine, Department of Anesthesiology and Perioperative Medicine
Watch Presentation
Poster: Hesitant or Resistant? The Impact of a COVID-19 Interventional Study Among Undergraduate Students’ Perceptions of the Pandemic and the COVID-19 Vaccines

Hesitant or Resistant? The Impact of a COVID-19 Interventional Study Among Undergraduate Students’ Perceptions of the Pandemic and the COVID-19 Vaccines

Christina N. Morra, Ph.D. 1, 2, Derek Dang2, Sarah J. Adkins-Jablonky2, Sloan E. Almehmi2, Tristan W. Boling2, Bianca J. Convers2, Michael L. Howell2, and Samiksha A. Raut, Ph.D. 2 

Abstract
The COVID-19 pandemic has made the last year in higher education unrecognizable. As evidence mounted that existing prevention and treatment methods would be insufficient to end the pandemic, it became clear that vaccines would be critical to achieve and maintain reduced COVID case numbers. Unfortunately, anti-vaccine and vaccine-hesitant sentiments have become widespread especially via social media platforms. As active consumers of the various social media platforms, college students thus represent a critical population for the success of the COVID vaccine campaign. Therefore, this study aimed at specifically exploring the perceptions of the COVID-19 pandemic and the COVID-19 vaccines by undergraduate students enrolled in non-major’s biology courses during the Spring 2021 semester. We targeted non-major’s biology courses (>100) as it enrolled students who rely on completing 1-2 core science courses to fulfill their core curriculum and thus, are dependent on these courses for developing their general understanding of science as it relates to day-to-day life.

In this study, we included two interventions that were deployed with the goal of addressing and alleviating COVID and vaccine-related misinformation and concerns. First, expert, guest lecturers spoke to the students addressing (1) COVID microbiology; (2) unique COVID epidemiological factors; and (3) the personal experiences of an infectious disease physician. For the second in-class intervention, students were assigned a service-learning group project in which they created a podcast to counter a COVID vaccine misconception. Furthermore, students were asked to share this product over their social media platforms and course Instagram page. We assessed the impact of these interventions through surveys, reflection writings and one-on-one interviews. Analysis of our findings demonstrate a significant impact of these interventions on student perceptions of the COVID-19 pandemic and the COVID vaccines. Moreover, our findings suggest that incorporating current events in a community-centered manner may be particularly impactful for non-major’s biology students to combat misinformation that gets propagated via social media platforms.
Presented by
Christina Morra and Derek Dang
Institution
1 IRACDA-MERIT Program, University of Alabama at Birmingham, Birmingham, AL; 2 Biology Department, University of Alabama at Birmingham, Birmingham, AL
Chat with PresenterAvailable September 21st 1-3PM CT Watch Presentation
Poster: Comparing Traditional, Immersive Simulation with Rapid Cycle Deliberate Practice in Postgraduate Year 2 Anesthesiology Residents

Comparing Traditional, Immersive Simulation with Rapid Cycle Deliberate Practice in Postgraduate Year 2 Anesthesiology Residents

Erin Blanchard, PhD, MSN, RN, CHSE, Lee Ann Riesenberg, PhD, MS, RN, CMQ, Lisa Bergman, MSN, RN, CEN, CHSE, Michelle R. Brown PhD, MS(ASCP)SBB, CHSE, Emma O’Hagan, MLIS, Tekuila Carter, MD

Abstract
Background: Rapid Cycle Deliberate Practice (RCDP) is an increasingly popular simulation technique that allows learners to achieve mastery of skills through repetition, feedback, and increasing difficulty. This manuscript describes the implementation and assessment of RCDP in an anesthesia residency curriculum.

Methods: Researchers describe the comparison of RCDP with traditional instructional methods for anesthesiology residents' application of Emergency Cardiovascular Care (ECC) and communication principles in a simulated environment. Residents (n = 21) were randomly assigned to either Traditional or RCDP education groups, with each resident attending 2 days of bootcamp. On their first day, the Traditional group received a lecture, then participated in a group, immersive simulation with reflective debriefing. The RCDP group received education through an RCDP simulation session. On their second bootcamp day, all participants individually engaged in an immersive simulation, then completed the "Satisfaction and Self-Confidence in Learning" survey. Application of ECC and communication principles during the simulation was scored by a blinded reviewer through video review. Participants ended the bootcamp by ranking the experiences they found most valuable.

Results: No significant differences were found in the different group members' individual performances during the immersive simulation, nor in the experiences they deemed most valuable. However, the Traditional education group reported higher levels of satisfaction and self-confidence in learning in 5 areas (p = 0.004-0.04).

Conclusions: Regardless of RCDP or Traditional education grouping, anesthesia residents demonstrated no difference in ECC skill level or perceived value of interventions. However, members of the Traditional education group reported higher levels of satisfaction and self-confidence in numerous areas. Additional RCDP opportunities in the anesthesia residency program should be considered prior to excluding it as an educational method in our program.

Keywords: Anesthesiology residents; Medical education; Rapid cycle deliberate practice; Simulation.
Presented by
Erin Blanchard
Institution
University of Alabama Birmingham
Other Affiliations
Department of Anesthesiology and Perioperative Medicine; UAB Clinical Simulation/Office of Interprofessional Simulation for Innovative Clinical Practice
Watch Presentation
Poster: A Fast Pivot to Expand Interprofessional Education Through Online Team Training

A Fast Pivot to Expand Interprofessional Education Through Online Team Training

Allison Shorten, PhD, RN, FACM, FAAN., Penni Watts, PhD, RN, CHSE-A., Peter Bosworth, MBA, Shelly Camp, BS

Abstract
Background: Interprofessional team-based training (IPTT) provides a clinically relevant opportunity for students from multiple professions to experience learning across the four interprofessional (IP) competency sub-domains. Implemented over 10 years, prior to the COVID pandemic, IPTT served approximately 900 students in two cohorts, in-person each year. COVID-19 forced IPTT faculty to pivot swiftly to online delivery via Zoom, providing an opportunity for health professions students to obtain clinically focused IP learning experiences.

Aim: The aim was to take a face-to-face IPTT activity and successfully convert it to an online offering and expand its availability to remote learners.

Methods: Students from nursing, medicine, dentistry, optometry, pharmacy, physical therapy, occupational therapy, laboratory sciences, social work, and public health are placed in groups of approximately 10-15 students. Students prepare an elevator pitch to introduce their profession to their team. Groups are divided into smaller teams to focus on a patient case designed to address social determinants of health. Trained facilitators use a video and training guide for the 1.5-hour experience. While developing their plan together, student teams are guided by facilitators to explore professional roles, values, priorities, and most importantly, communicate with students from other professions.

Results: After successfully piloting ‘IPTT on-line’ during summer 2020 (18 sessions), ‘IPTT on-line’ served 324 learners from 10 professions in Fall 2020, and 447 learners from 12 professions in Spring 2021. Student and facilitator feedback revealed significant advantages to on-line delivery including greater scheduling flexibility, increased access to “distance” students, smaller group size and expanded reach to new professions. Students shared that they enjoyed the learning experience, valued the opportunity to engage in IP teamwork, and acknowledged the value of other professions in planning patient care. ICCAS survey 20-item mean scores also showed improvements in perceptions of IP knowledge and competence, increasing from 3.45 to 4.11 (Cohen’s D = 1.31) before and after the IPTT experience.

Conclusion: The ability to run IPTT ‘on-demand’ balances initial logistical challenges such as re-training facilitators and adapting to online engagement strategies. Future evaluation will examine outcomes for on-line cohorts across different professions with pre-COVID delivery and strategies for sustaining hybrid delivery.
Presented by
Allison Shorten
Institution
University of Alabama at Birmingham, Office of Interprofessional Curriculum
Chat with PresenterAvailable September 21st 1-3 pm Watch Presentation
Poster: Match Distance: How School and Specialty Characteristics Affect Residency Match Geography

Match Distance: How School and Specialty Characteristics Affect Residency Match Geography

Ammar Hasnie, Usman Hasnie, Ana Preda-Naumescu, Ben Nelson, Carlos Estrada, Winter Williams

Abstract
Purpose: To explore how school and specialty characteristics impact the match location of US senior medical students.

Method: The authors collected student match data between 2018-2020 from US allopathic medical schools and calculated match distance between medical school and residency training. Ordinal logistic regression correlated school and specialty characteristics with match distance.

Results: 26,102 medical students, representing 66 medical schools from 28 states, matched in 23 specialties. 59% of students were from public institutions, and 27% of schools ranked in the top 40 of research funding. The match space was higher for students graduating from private institutions (OR 1.14; 95% CI, 1.06 to 1.22), matching into more competitive specialties (OR 1.07; 95% CI, 1 to 1.14). The match space was lower for students graduating from top NIH-funded institutions (OR 0.89; 95% CI, 0.85 to 0.94), and from schools with higher percentage of in-state matriculants (OR 0.75; 95% CI, 0.72 to 0.77).

Conclusions: School characteristics such as region, public/private designation, NIH funding, and percentage of in-state students were associated with an impact on residency match geography. Matching into more competitive specialties also showed a marginal increase in match distance. These findings suggest that a student’s choice of specialty and medical school may impact subsequent geographic placement for residency training. The impact of geography should be considered by students and residency programs alike.
Presented by
Ammar Hasnie
Institution
University of Alabama in Birmingham
Watch Presentation
Poster: Medical Students Ask: How is a ‘competitive’ specialty defined?

Medical Students Ask: How is a ‘competitive’ specialty defined?

Ammar Hasnie, Usman Hasnie, Ana Preda-Naumescu, Ben Nelson, Carlos Estrada, Winter Williams

Abstract
Background: Medical students decide on which specialty to pursue based on interests, prior experiences, geographic preferences, and other factors including specialty competitiveness, yet how competitiveness is operationalized is not well defined.

Aim: To examine how residency matching specialty characteristics correlate with each other and explore which specialties are more competitive.

Methods: Design: Cross-sectional. Participants/setting: US residency specialties. Inclusion: US allopathic medical schools with publicly available match data of individual students, 2018-2020. Exclusions: Combined residencies, interventional radiology, oral and maxillofacial surgery, child psychiatry, non-residency fellowships, or Canadian residencies. Specialty data: US senior applicants per position, US senior fill rate, number of post-graduate year (PGY) positions available, salary, number of programs, applicants (total, US), applicants/position, mean Steps 1 and 2, % AOA, % from top 40 NIH funding school, scholarship (mean abstracts, presentations, publications), and US Sr Fill Rate from 2020 National Resident Matching Program(NRMP) data of all matched applicants by specialty. Analysis: Spearman rho correlation, factor analysis.

Results: Of the 155 US medical schools, 66 displayed match data of 26,102 students matching into 23 specialties. Among the 23 included specialties, 10/14 variables had correlation coefficients of 0.8-0.9 (all p<0.001).

Factor 1 explained 58% of the variance (Eigenvalue 8.2) and comprised of US senior fill rate, salary, Step 1, Step 2, % AOA, % from top 40 NIH funding school, and scholarship. Factor 2 explained 17% of the variance (Eigenvalue 2.3) and comprised of number of PGY-1 positions available, number of programs, applicants (total), and applicants (US). Factor 3 explained 10% of the variance (Eigenvalue 1.5) and comprised of US senior applicants per position and applicants/position. The internal consistencies were excellent (Factor 1, Cronbach’s alpha =0.94; Factor 2, Cronbach’s alpha = 0.97) – Table.

Based on the ranking of the predictive value for Factor 1, the top 5 most competitive specialties were Plastic Surgery, Neurosurgery, Dermatology, Orthopedic Surgery, and ENT.

Conclusions: Residency matching specialty characteristics are highly correlated to each other and fall within one main construct representing academic achievement, salary potential, and program preference. Supply-demand mismatch appears less influential in the residency match process.
Presented by
Ammar Hasnie
Institution
University of Alabama in Birmingham
Watch Presentation
Poster: Leadership development among junior surgery residents: communication and perception at different levels of training

Leadership development among junior surgery residents: communication and perception at different levels of training

Connie Shao MD, Grace Kennedy MD, Courtney Rentas MD, Herbert Chen MD, Jessica Fazendin MD

Abstract
Cover Page Primary Presenter: Name: Connie Shao School: Medicine Department: Surgery Academic Rank: General Surgery Resident Email: shaocc@uab.edu

Other authors: Name: Grace Kennedy School: Medicine Academic Rank: Medical Student Email: gracek@uab.edu

Name: Courtney Rentas School: Medicine Academic Rank: Medical Student Email: cmrentas@uab.edu

Name: Herbert Chen School: Medicine Department: Surgery Division: Breast and Endocrine Academic Rank: Professor Email: hchen@uabmc.edu

Name: Jessica Fazendin School: Medicine Department: Surgery Division: Breast and Endocrine Academic Rank: Assistant Professor Email: jmfazendin@uabmc.edu

  Leadership development among junior surgery residents: communication and perception at different levels of training Shao C, Kennedy G, Rentas C, Chen H, Fazendin J BACKGROUND: Leadership is necessary for effective healthcare teams, particularly for surgeons. However, surgical leadership is rarely formally assessed, particularly for junior trainees. HYPOTHESES/AIM: We aimed to establish themes of communication, self-perception, and external perception under stress among junior surgical residents at a single institution. METHODS: The Data Dome Inc.(datadome.com) DiSC personality assessment was administered 2018-2020 to residents at an academic General Surgery training program in Alabama. Resident demographics were recorded and themes from de-identified reports were analyzed by year (PGY-1, PGY-2) using JMP 14 Pro. RESULTS: Of the residents surveyed(n=54), half(48.2%) responded: 17 PGY-1(65.4%), 7 PGY-2(26.9%). Respondent demographics reflected the training program(57.7% White, 73% female). Mean age at assessment was not significantly different between PGY-1(27.7) and PGY-2(29.9, p=0.27). PGY-1 communication was most frequently described as ‘accomplished best by well-defined avenues’(n=9) with ‘duties and responsibilities of others who will be involved explained’(n=9) in ‘friendly terms’(n=9). PGY-2 communication involved ‘deal with people’(n=6), ‘strong feelings about a particular problem’(n=5), and ‘good at giving verbal and nonverbal feedback’(n=4). Self-perception of PGY-1’s was ‘charming’(n=6), ‘considerate’(n=6), and ‘dependable’(n=6); PGY-2’s were ‘charming’(n=6), ‘enthusiastic’(n=6), and ‘inspiring’(n=6). Under stress, PGY-1 external perception was ‘detached’(n=6), ‘insensitive’(n=6), and ‘poor listener’(n=6); PGY-2’s were ‘overly confident’(n=4), ‘poor listener’(n=4), and ‘self-promoter’(n=4). CONCLUSION: Communication style, self-perception, and external perception under stress vary by training level. Clear expectations and approachable communication are important for PGY-1’s, interpersonal feedback for PGY-2’s. Under ideal conditions, junior residents self-perceive as naturally engaging. Under stress, PGY-1’s seem distracted/uninvolved, PGY-2’s arrogant. Understanding stress responses can help trainees adapt to become more effective leaders.
Presented by
Connie Shao
Institution
University of Alabama at Birmingham
Watch Presentation
Poster: An Enhanced Recovery Protocol Decreases Length of Stay for Patients Undergoing Complex Abdominal Wall Reconstruction

An Enhanced Recovery Protocol Decreases Length of Stay for Patients Undergoing Complex Abdominal Wall Reconstruction

: Dasiel Bellido de Luna (primary presenter) Jameson Wiener, Todd Smolinsky, Sellers Boudreau, Lauren Wood, Britney Corey, Daniel I. Chu, Abhishek D. Parmar

Abstract
ABSTRACT Background: Even if Enhanced recovery protocols (ERP) were introduced more than 20 years ago, and their benefits are widely accepted and published, studies have demonstrated a lack of adherence to guidelines and protocols. As a result, patients experience a delay in recovery after surgery. Aim: ERP have the potential to streamline care and improve short-term outcomes for surgical patients. However, for patients undergoing modern iterations of complex abdominal wall reconstruction (AWR), little literature exists on the effectiveness of these protocols. Methods: In this retrospective study we reviewed our institutional experience with complex AWR over a 2-year period both before and after implementation of our ERP in May 2019 (January 2018-February 2020). Patients undergoing primarily minimally invasive complex AWR who were compliant with 11 elements of our ERP (N=46) were compared to patients who did not meet these criteria (N=86). Baseline patient characteristics and patient outcomes including hospital length of stay, narcotic usage, and readmissions were compared across groups. Finally, our modern cohort of patients was compared to a historical cohort of primarily open AWR patients. Multivariable regression modelling was also performed. Results: Most patients were female (60.6%), white (77.3%) with ASA class 3 (71.2%) and BMI average BMI 31.7. Median hernia width was 6cm (IQR 5-9) and length was 10 (IQR 7-15). Fifty-three percent of all cases were performed robotically, and 47.0% of cases required transversus abdominus release. Median length of stay for the overall cohort was 3 days (IQR 1-4). Morbidity and mortality rates were 22.6% and 0.7%. ERP patients were less likely to have a complication (8.7% vs. 30.2%, p=0.005), had a significantly lower median length of stay (1 days vs. 3 days, p<0.001), and receive fewer morphine equivalents (31 vs. 45, p=0.005). ERP patients had a trend towards lower rates of readmissions (6.5% vs. 11.8%, p=0.3). In a multivariate analysis, ERP was independently associated with decreased length of stay and decreased narcotic usage, but not complications or readmissions. Conclusion: A modern cohort of patients undergoing complex abdominal wall reconstruction within an ERP experience a decreased post-operative length of stay and require fewer morphine equivalents during their hospitalization compared to their non-ERP counterparts. ERPs are effective in patients undergoing complex abdominal wall reconstruction and can provide benefits for both patients and hospitals.
Presented by
Dasiel Bellidode Luna
Institution
UAB School of Medicine/ Department of Surgery
Watch Presentation
Poster: Management of Sexual Assault Victims in the Emergency Department

Management of Sexual Assault Victims in the Emergency Department

Erin Ward, Nicholas Carlisle, JD, Ebony Williams, MBA, MA, CHES, Sonya Heath, MD Lauren Walter, MD

Abstract
Prevalence of HCV in Sexual Assault Survivors Presenting to a SANE Clinic: A Descriptive Analysis Erin Ward, Nicholas Carlisle, JD, Ebony Williams, MBA, MA, CHES, Sonya Heath, MD Lauren Walter, MD Introduction: Over two million Americans are living with chronic Hepatitis C (HCV); however, as many as 75% may not be aware that they are infected, resulting in subsequent disease progression and transmission. While previous epidemiologic research has demonstrated that Survivors of Sexual Assault (SAS) may be at disproportionate risk for exposure to HCV, HCV screening in SAS is not addressed in current CDC post-sexual assault testing recommendations. We sought to identify the prevalence of HCV among a SAS cohort along with associated basic demographics. Methods: Universal, opt-out HCV antibody screening and RNA confirmatory testing was provided for all SAS at a Sexual Assault Nurse Examiner (SANE) clinic in Birmingham, Alabama, beginning in April, 2020. In February 2021, a retrospective chart review was conducted inclusive of SAS seen from April, 2020, through December, 2020, to assess number of HCV screens performed, proportion of HCV positive screens, and associated available demographics. Descriptive statistical and Chi-square analyses were performed. Results: Of 226 SAS who presented to the SANE clinic in an 8-month period, 189 (83.6%) were screened for HCV; 16 (8.5%) of those tested were HCV positive. This is significantly higher than state (<1.0%) and national (1.0%) HCV incidence rates (p <.0001). No significant testing rate differences were noted with regards to race, gender, or age. Male SAS were more likely to screen positive for HCV (22.7%, p = .01). SAS aged 25-44 were also more likely to screen positive (14.6%, p = .01). Overall SAS demographics also demonstrate the presence of significant social vulnerabilities among this cohort, specifically high rates of homelessness (4.4%) and incarceration (4.9%). Conclusion: Routine HCV screening at a SANE clinic suggests a relatively high prevalence of HCV among SAS as compared to the general population, particularly in younger, male, and incarcerated patients. These results highlight the importance of universal HCV screening and risk counseling in this setting and suggest opportunities for future focused interventions aimed at harm reduction and social disparities.
Presented by
Erin Ward
Institution
University of Alabama at Birmingham
Watch Presentation
Poster: Interactive Educational Videos at UAB: Objective and Student-Reported Engagement

Interactive Educational Videos at UAB: Objective and Student-Reported Engagement

Gregory Pavela, PhD; Tara Harman MS, RDN; Jessica Chambliss, PhD, MPH

Abstract
COVID-19 sparked a rapid and dramatic shift to online learning across all educational levels. This shift highlighted the importance of identifying strategies to increase student engagement in the learning process. One potential strategy to improve student engagement is to embed questions within educational videos, requiring learners to select an answer before continuing the video. Accordingly, the purpose of this project is to assess the influence of embedded multiple-choice questions in educational videos on student engagement in an online graduate course at the University of Alabama at Birmingham (UAB)

Hypotheses/Aims This research tests the hypothesis that embedding questions within educational videos will increase student engagement as measured by a) the percentage of students watching a video; b) the average number of minutes a video is viewed; and c) student reported engagement.

Methods Data on the number of views and minutes watched come from Kaltura Analytics. Data on student preferences come from an online survey of students enrolled in the course. In Weeks 1-3 of the course, videos without embedded questions were used to deliver course content. In Week 4 of the course, videos with embedded questions were used to deliver course content. Students were invited to complete the survey in Week 5 of the course, assessing their preferences and self-reported engagement with the educational videos.

Results 68% of students enrolled in the course completed the survey (n=19). Educational videos without embedded questions were viewed by 92% of students and viewed for 39.8 minutes (standardized to video length). Educational videos with embedded questions, on average, were viewed by 100% of students and viewed for 44.1 minutes. 58% of student respondents indicated that compared to video lectures without embedded questions, those with embedded lecture questions were much more or somewhat more engaging, 10% reported that they were somewhat less or much less engaging.

Conclusions Results from this study suggest that educational videos with embedded questions increase the number of students viewing the lecture content, the number of minutes spent viewing the lecture content, and that a majority of students found embedded questions to enhance engagement with the content.
Presented by
Gregory Pavela
Institution
UAB School of Public Health
Chat with PresenterAvailable September 21st, 1:00 PM to 1:30 PM Central Watch Presentation
Poster: Leveraging Gamification to Engage Medical Students in a Locally Developed Question Bank Supplementing Pre-Clinical Modules

Leveraging Gamification to Engage Medical Students in a Locally Developed Question Bank Supplementing Pre-Clinical Modules

JP Heudebert MPH, R. Chad Wade MD, Mukesh Patel MD, Monica Agarwal MD, Rachael Lee MD. MSPH, Maria Acosta Lara MD, John D. Cleveland MS, Don Dempsey MS, James Willig MD, Jeremey Walker MD

Abstract
Technology allows new opportunities to engage with students in undergraduate medical education. We introduced a clinically focused, question-bank application that leverages gamification (self-efficacy, points, leaderboards, badges) within pre-clinical modules. We hypothesized higher engagement would improve knowledge retention as evidenced by end of module exam scores.

We found that our gamified question-bank was associated with higher student engagement and higher mean final exam scores for the first-year modules. There was a drop off in engagement and effect for the second-year module which occurs later in the year during a time when many students turn focus toward preparation for national licensing exams with outside question-banks; however, all courses had over 50% of the class complete this optional activity with strongly positive reviews by those who engaged with the resource.
Presented by
JP Heudebert <jpheudebert@uab.edu>
Institution
University of Alabama at Birmingham Department of Medicine
Chat with Presenter Watch Presentation
Poster: Artificial Intelligence Literacy: Preparing residents for the future of Radiology

Artificial Intelligence Literacy: Preparing residents for the future of Radiology

Jordan Perchik, Andrew Smith, Asser Abou Elkassem, Houman Sotoudeh

Abstract
ABSTRACT

Needs and Objectives: As artificial intelligence tools and algorithms evolve and mature, AI is poised to play a significant role in the future of radiology practice. Although radiology residents feel that AI literacy is important, few programs have a dedicated AI related curriculum. We detail the rollout of our AI curriculum and its effect on resident competency with basic terms and methods of AI and interest in AI related scholarship.

Setting and Participants: We hosted a one week series of hour long AI focused lectures for UAB radiology residents from November 2-6, 2020. Due to COVID protocols, we held lectures in a hybrid in person and remote setting. A small, in person contingent attended lectures in the resident education space, and the lectures were simultaneously broadcast on zoom, which were open to all UAB Radiology residents. Description: Sessions covered basic terms, methods, and statistics of AI, practical applications of AI, economics and ethics of AI in medicine, and a "hands on" session with an FDA approved AI algorithm. A voluntary evaluation and survey were given to the participants before and after the week of lectures to assess residents' knowledge of AI terms and applications and gauge their subjective comfort with AI.

Evaluation: An average total of 15 residents participated in the daily lectures in person and remotely. Participant scores on the AI knowledge evaluation increased significantly after the week of lectures (35% before to 55% after, p<0.01). AI scholarship increased among within the residency with nine new residents joining the local AI in Radiology interest group, an increase from two in the previous year. Resident comfort with AI terms also increased and 100% of surveyed residents reported that they felt the curriculum was valuable and would be interested in continuing the AI curriculum in the future.

Lessons Learned: Instituting an AI literacy curriculum for radiology residents is valuable and feasible for radiology programs across the country. Effective rollout in AI curricula improves residents familiarity and comfort with AI and can also lead to future AI scholarship.
Presented by
Jordan Perchik
Institution
University of Alabama at Birmingham
Other Affiliations
Department of Diagnostic Radiology
Chat with Presenter Watch Presentation
Poster: “What’s in a Shame?” Improving Timely Completion of Clerkship Evaluations with QI

“What’s in a Shame?” Improving Timely Completion of Clerkship Evaluations with QI

Michelle D. Veters, MD, Brian May, MD, MEd, Erinn O. Schmit, MD, MEd, Chang L. Wu, MD, MSCR, Stephanie Berger, MD

Abstract
Background- Medical student written evaluations completed by attendings during their pediatric clerkship provide feedback for growth, are essential in determining the clerkship grade, and contribute to the residency application Medical Student Performance Evaluation (MSPE) letter. Additionally, it has been shown that the best feedback is timely, specific, and actionable. Despite this knowledge, completion of evaluations by attendings has been shown to be a challenge. To our knowledge, no study has looked to improve timely completion of written student evaluations through education-focused QI methodology.

Aim- We aim to increase the percentage of student evaluations completed by pediatric hospital medicine (PHM) attendings within 14 days of assignment to 75 percent through interactive interventions based on QI methodology with PDSA cycles over a one-year period (January - December 2021.)

Methods- PHM division focus groups, a pareto diagram, an impact to effort matrix, baseline completion data, and PDSA cycles influenced the interventions. Interventions have included education of the PHM division, providing individual and divisional baseline data, moving the day of assignment from Friday to Wednesday to ensure availability, providing quarterly updates of individual and divisional data with recognition awards/gamification, and public announcements at weekly meeting of attendings with incomplete evaluations. Our primary outcome is percentage of evaluations completed within 14 days. Balancing measures will include a comparison of word count of written evaluations and total number of evaluations completed pre- and post-project initiation. Routine statistical analysis will be performed, and proportions will be analyzed using a chi-squared test.

Results- Baseline data from May 2019 to December 2020 shows 45 percent of evaluations are completed by PHM attendings within 14 days of assignment. Low priority and availability of evaluations were the greatest barriers to timely completion. The most recent data shows improvement in timely completion from 45 percent to an average of 85 percent over the past three months.

Conclusions- Data is promising that QI interventions are an effective and practical way to improve timely clerkship evaluation completion by attendings, a problem with limited promise thus far. Finding solutions to improve timely completion of student evaluations is especially pertinent now that Step 1 will have a pass/fail measure, and residency programs will likely rely more heavily on clerkship grades in considering applicants. We postulate that publicly announcing attendings who have incomplete evaluations at weekly meetings is the most effective intervention, though controversial as this could be considered "public shaming." Future efforts may explore generalizability to other specialties and institutions and evaluate positive vs negative reinforcement as academic motivators.

Presented by
Michelle D. Veters, MD
Institution
University of Alabama School of Medicine, Department of Pediatrics
Chat with PresenterAvailable Tuesday, Sept. 21, 2021 1-3 pm Watch Presentation
Poster: The Role of Race and Ethnicity in Team Dynamics

The Role of Race and Ethnicity in Team Dynamics

Steve Otero, Christine Loyd PhD, Samantha Giordano-Mooga PhD, N. Robert Estes II PhD

Abstract
Title: The Role of Race and Ethnicity in Team Dynamics

Background: Current emphasis is focused on increasing diversity within healthcare teams to better serve a more diverse patient population. Teamwork has been integrated into the undergraduate biomedical science curriculum to help students learn to work effectively in teams, which aligns with their goals of working effectively on inter-professional healthcare teams. Studies have suggested that racial and ethnic factors affect team dynamics and can play a significant role in the learning process, specifically for underrepresented minority students (URM). We sought to determine if racial or ethnic factors affected peer evaluation scores within diverse teams and to determine if a correlation exists between the racial/ethnic composition of a team, peer evaluation scores, and overall grades. Hypotheses/Aim: We hypothesize that the racial and ethnic composition of teams influences peer evaluations and course grades, specifically for URM undergraduates. Methods: To assess teamwork within two undergraduate courses, microbiology and pathophysiology, the Comprehensive Assessment of Team Member Effectiveness (CATME) tool was used for peer evaluation of teammates. Data were collected from courses in 2018-2021. Demographic information, CATME peer evaluation scores, and course grades for individual students, demographics, and teams were analyzed for trends. Results: There were 348 students enrolled in the courses, 64.5% female and 32.5% male. On average CATME scores were highest among Asian and White students compared to URMs and students with higher final grades had higher average CATME scores. The racial and ethnic composition of teams differentially affects peer evaluation scores for African American (AA) and Latino students and has no effect on peer evaluation scores of Asian or White students. Conclusion: Racial and ethnic composition of teams is an important criterion when forming teams, specifically for AA students, who tend to perform better on teams with a higher percentage of AA students. Grades are a major factor driving overall peer evaluation scores which can further affect overall class grades which already favor White and Asian team members. A better understanding of the influence of the racial and ethnic composition of teams, including healthcare teams, can potentially increase team cohesiveness and team function, leading to better care and treatment of patients.
Presented by
N. Robert Estes II and Steve Otero
Institution
University of Alabama at Birmingham, Department of Chemistry and Department of Clinical and Diagnostic Sciences, Biomedical Sciences Program
Watch Presentation
Poster: Surgeon Perspectives on the STITCH Trial

Surgeon Perspectives on the STITCH Trial

Steven L. Cochrun, MS, Ivan Herbey, MD, MPH, Nataliya Ivankova, PhD, MPH Jan L. Jansen, MBBS, PhD, FRCS, FFICM, and Abhishek Parmar, MD FACS

Abstract
Introduction: The STITCH technique for laparotomy closure has been shown to be associated with decreased incisional hernia rates but has not been widely accepted. The reasons behind the lack of integration and application of the trial’s findings have not been elucidated in the greater surgical community. Identifying surgeon perspectives on the trial is a critical first step to developing interventions to enhance widespread adoption of STITCH trial technical tenets. Methods: In this initial phase of our mixed methods study, quantitative surveys with embedded qualitative responses were distributed to practicing surgeons and surgical residents around the country. Survey questions were based on the previously validated Theoretical Domains Framework (TDF) for skill acquisition. The TDF uses a large body of previous research of behavioral theory, to identify a unified series of 12 domains to account for behavioral change in clinical practice. The Patient Safety Behaviors Questionnaire is a quantitative survey that operationalizes the TDF and has been previously validated for understanding healthcare provider adoption of new interventions; this was adapted for use in the context of the STITCH trial. The survey was first pilot-tested amongst practicing surgeons and individual interviews performed to assess usability. The second phase of the study will include individual semi-structured qualitative interviews with surgeons across the country. Results: One hundred thirty participants responded to the survey. Respondents were relatively evenly split by training and experience, with 23.62% trainees, 24.41% in early (1-5 years) practice, 18.11% in mid (6-10 years) practice, and 33.86% with 11+ years of experience. While 93.08% were aware of experts’ recommendations to use the technique, only 57.26% of participants agreed with the technique. We noted that a similar percentage (66.7%) did not note deficits in the knowledge domain of the TDF. Most (74.19%) felt they had access to the resources needed (environmental limitations domain), but ultimately only 33.33% of respondents felt that there would be negative consequences for patients if STITCH techniques were not used. Finally, few felt that there was a limitation in the Action Planning domain, and only 12.9% felt that they could not implement the techniques if they had wanted to do so. In the embedded qualitative portion, many cited the lack of long-term outcomes data, the need for additional studies, and/or the lack of investigation of a more diverse, heterogenous population as limitations to STITCH implementation. Some surgeons noted equipment discrepancies (needle size versus suture size), difficulty in the ability to execute 5mm bites correctly, and the appropriateness for their respective fields as additional barriers. Trainees felt there was little option to utilize techniques that differed from supervising attendings’ beliefs. Conclusion: We identified that most surgeons were aware of the study findings but only a slight majority agreed with the recommendations, citing multiple barriers to implementation. Faculty surgeons may impact resident selection of suture. Additional insight is expected to be derived from future qualitative interviews in the second portion of our study.
Presented by
Steven Lee Cochrun
Institution
University of Alabama at Birmingham, Department of Surgery
Other Affiliations
America's Hernia Society
Watch Presentation
Poster: Glecaprevir/Pibrentasvir is an Effective Treatment for Patients Receiving HCV Positive Liver Transplants

Glecaprevir/Pibrentasvir is an Effective Treatment for Patients Receiving HCV Positive Liver Transplants

Yassmin Hegazy, MD, Moustafa Massoud, MD, DeAnn Jones, PharmD, Mohamed Shoreibah, MD

Abstract
Background: Liver transplantation (LT) from HCV positive donors has become an option to expand a limited donor pool with the advent of Direct-Acting Antiviral therapy (DAA). Current guidelines for post-LT Hepatitis C treatment includes Glecaprevir/Pibrentasvir (Mavyret) with the goal to achieve a Sustained Virological Response (SVR) post-transplantation.

Hypothesis/Aim: Our study focuses on Glecaprevir/Pibrentasvir’s efficacy in achieving SVR and an undetectable Viral Load (VL) in HCV Donor (D+)/Recipient (R-) transplanted patients.

Methods: We performed a retrospective cohort review of 13 HCV D+/R- patients who underwent LT at the University of Alabama-Birmingham Medical Center from January 2019 to November 2020. Patient demographics, co-morbidities, liver cirrhosis etiology, HCV VL and genotype was recorded. Patients received a standard 12 weeks of Glecaprevir/Pibrentasvir initiated at the time of VL detection on post-op day 3. Other data included post-LT complications, mortality, graft rejection, and time to achieve undetectable VL post-LT.

Results: Our cohort consisted of 13 patients; 92% male, 62% white, 12 orthotopic liver transplants, and 1 simultaneous liver kidney transplant with an average age 58 +/- 11, BMI of 30 +/- 6 and MELD-Na 27 +/- 8. Liver cirrhosis etiology included NASH (50%), Alcohol (33%), NASH/Alcohol (8%) and other (9%). HCV genotypes at the time of VL detection included 1a (54%), 2 (8%), and 3 (31%). Among the HCV D+/R- recipients (n=13), all patients completed treatment and 92% (n=12) achieved SVR at 12 weeks. Mean VL detected within the first week post-LT was 10.7 million +/- 9.7 million and mean undetectable VL was achieved within 34 +/- 21 days. Following treatment completion, one patient had graft rejection and one patient mortality was noted due to events following post-operative complications.

Conclusion: Patients treated with Glecaprevir/Pibrentasvir following LT from HCV positive donors had overall excellent graft survival with most patients achieve SVR at 12 weeks and maintaining undetectable VL post-transplantation. Glecaprevir/Pibrentasvir is an effective treatment for patients receiving LT from HCV positive donors.
Presented by
Yassmin Hegazy
Institution
University of Alabama Birmingham, Department of Medicine
Other Affiliations
Department of Hepatology
Watch Presentation

Show or hide this track Back to top ↑

Poster: The Educational Exchange Program: Filling the Gap in Subspecialty Education

The Educational Exchange Program: Filling the Gap in Subspecialty Education

Mohamed Shoreibah, MD

Abstract
The didactic education experience is a fundamental element in internal medicine residency training. This type of educational activity is an important complement to the experiential learning experiences of medical residents, helping to prepare them for the next step in their education and practice, whether that is the licensing examination, fellowship training, or clinical practice coupled with continuing medical education. This education therefore plays a pivotal role in residents’ transitions along the medical education continuum beyond medical residency. The limited access to specialty speakers in community-based programs creates inequity in the achievement of educational goals for residents in training. A national platform matching residency programs with needed subspecialty speakers via a web-based live format can provide a breakthrough solution for this issue. A pilot program was launched, whereby speakers from three university programs provided subspecialty lectures to two community-based residency programs. The pilot program was met with enthusiasm from both the giving and receiving ends, as evidenced both by informal feedback and a preliminary survey. The goal of the current proposal is to build on this success by expanding the program to internal medicine residency programs nation-wide. This expansion will be supported by a speaker-to-program matching software. The program can ultimately expand to residencies in specialties beyond internal medicine as well.
Presented by
Mohamed Shoreibah
Institution
University of Alabama at Birmingham
Watch Presentation
Poster: Revolutionary skill building: Development of a screen-based interprofessional change management simulation to engage and enrich healthcare teams

Revolutionary skill building: Development of a screen-based interprofessional change management simulation to engage and enrich healthcare teams

Mrs. Ashleigh Allgood, Dr. Nancy Borkowski, Dr. Melanie Hallman, & Dr. Wei Li

Abstract
Objectives 1. Learn how to develop a screen-based change management simulation with a collaborative, interprofessional team using available software applicable in both live and distance-accessible formats. 2. Learn how to deploy a screen-based change management simulation for interprofessional student groups and practicing professionals.

Setting and Participants The purpose of this presentation is to share an innovative modifiable educational method developed for interprofessional learning applicable to healthcare students and healthcare professionals alike. This method of education incorporates simulation and technology that can be applied in live classroom settings and in synchronous and asynchronous distance accessible education.

Description Our team developed a screen-based change management simulation to engage learners in a collaborative interdisciplinary environment using an available interactive software platform. The simulation introduces skills and processes necessary to implement successful change in a complex interprofessional healthcare environment. The topic and delivery method are applicable to both healthcare students and functioning healthcare professionals. The simulation design includes a behavioral health case study within an emergency department setting and incorporates a modified version of Kotter's model of change to inform learner’s decision-making processes. Computer programming strategies were guided by key learning objectives and desired simulation outcomes. During the simulation learners work together as a team to interview and select a strategic healthcare-affiliated interprofessional change team. Students then determine best use of a projected budget with allotted expenditures and develop a timeline to accomplish the project. The end goal is to improve the quality and safety of care for a vulnerable patient population in a simulated overburdened hospital emergency department.

Evaluation This presentation describes development of a screen-based change management simulation designed to create a "real-world" experience to teach interprofessional students how to successfully lead change initiatives. This experience enables learners to internalize skills necessary to successfully lead change, optimizing interprofessional stakeholder buy-in to minimize resistance to change initiatives.

Lessons Learned The use of this simulation reduces passive learning, cultivates problem-solving skills, establishes a novel method of active learning, and has an impact on educational efforts for student learners as well as practicing providers positively influencing future healthcare. 
Presented by
Melanie Gibbons Hallman
Institution
University of Alabama at Birmingham School of Health Professions and School of Nursing
Chat with PresenterAvailable Sep 21 1-3 PM Watch Presentation
Poster: Service-Learning Module Improves Non-STEM major’s Understanding of Opioid Epidemic

Service-Learning Module Improves Non-STEM major’s Understanding of Opioid Epidemic

Ryleigh Fleming, Sarah Adkins-Jablonsky, Cinnamon Cross , Marco Esteban, J. Jefferey Morris, and Samiksha Raut

Abstract
Over 50,000 people die from opioid overdose per year in the United States leading to what is now known as the opioid epidemic. This is a special cause for concern in states like Alabama that have higher rates of overall drug use. Thus, it is increasingly important for undergraduate students to be informed about the opioid crisis especially the non-majors biology students. This sub-set of college students, rely on completing one or two science courses as a part of their core requirements and yet constitutes an informed scientific citizenry of tomorrow’s voters, workers, consumers, and policymakers. Previous studies have shown that it is important to engage these students in innovative pedagogies like service-learning, to enhance their understanding and awareness about contemporary issues. Despite its pedagogical potential, the impact of opioid related service-learning endeavors continues to remain unexplored. We, therefore, introduced an opioid service-learning module in a non-major’s biology course. This module included the science behind opioids, Naloxone training, and active student discussions with physicians and former illicit substance user in a non-major’s biology course. Our assessment of the thematic analysis of pre and post reflection data from 87 consenting students revealed 10 categories that students reported in the post but not pre-reflections (gain), pre and post reflections (neutral), and pre but not post reflections (loss). We found gains in students humanizing addiction and awareness of the cultural context of opioid addiction and losses from students reporting they had a low level of awareness of these issues. Eight one-on-one semi-structured interviews revealed that students were personally impacted by the epidemic and greatly valued its curricular inclusion. Our data supports that service-learning has the potential to increase student awareness and contextual understanding about the opioid epidemic. Above all, service-learning modules represent a potential to not only provide direct training for narcotic overdose related to opioids but most importantly enables the students to envision the opioid epidemic as an inexplicably intertwined phenomenon with human lives. This ultimately, helps to reduce the stigma related to the opioid epidemic and enables to champion the much-needed advocacy to further enhance its awareness among the public.
Presented by
Ryleigh Fleming and Sarah Adkins-Jablonsky
Institution
University of Alabama at Birmingham
Other Affiliations
Alabama College of Osteopathic Medicine
Chat with PresenterAvailable September 21 from 1-3pm Watch Presentation
Poster: Introducing Adverse Childhood Experiences (ACEs) to Third Year Medical Students

Introducing Adverse Childhood Experiences (ACEs) to Third Year Medical Students

Adriana Green; Christopher Johnston, MD; Alexandra Fischer; Giana Angotti; Louanne Friend, PhD, MN, RN; Nancy Rubin, PsyD

Abstract
Adverse childhood experiences (ACEs) are various forms of physical and emotional abuse, neglect, and household dysfunction experienced in childhood. ACEs have been linked to negative mental and physical health outcomes. Over the last few decades, the knowledge and practice of ACEs has been slowly introduced into mainstream medical practice to prevent, recognize, and address adverse experiences that affect patients’ health. Introducing this ideal into medical student education, however, has not yet had much emphasis. We believe educating medical students on the ACEs will likely provide a strong foundation to better understand their patients and the impact of trauma on their health and wellbeing, as well as ensuring that the acknowledgment of ACEs becomes a regular part of future medical practice and culture. A one-hour educational session was held to 3rd year Tuscaloosa UASOM students to provide knowledge on integrating this practice into patient encounters. A PowerPoint presentation to introduce ACEs was followed by case-based learning centered on a clinic encounter with a patient for whom the impact of their ACEs serves as a barrier to their optimum health outcomes. The medical students had time to discuss the impacts and how they would provide intervention. Participants completed pre- and post-intervention surveys to self-assess their knowledge and attitudes of ACEs on a 5-point Likert scale. Overall, we found that introducing ACEs into medical education is feasible. We hope that this lecture can be readily incorporated into medical student curricula.
Presented by
Adriana Green
Institution
University of Alabama School of Medicine
Other Affiliations
University of Alabama, College of Community Health Sciences
Chat with PresenterAvailable September 21st, 1-2PM CST Watch Presentation
Poster: Med-Peds Near-Peer Mentorship Program under COVID Restrictions

Med-Peds Near-Peer Mentorship Program under COVID Restrictions

Ansley Smoak MS3, Lauren Oliver MS3, Carlie Stein Somerville MD

Abstract
Needs and Objectives: • Design near-peer mentoring program for medical students interested in Med-Peds with Med-Peds residents during COVID-related restricted access to hospitals • Create opportunity for exposure and understanding of Med-Peds • Develop skills to be an effective mentor/ mentee.

Setting and Participants: Eleven first- and second-year medical students and six Internal Medicine-Pediatric residents participated in the mentorship program hosted by UAB Med-Peds combined residency program and UAB School of Medicine via Zoom over July 2020-May 2021.

Description: UAB Med-Peds residency program offers a unique near-peer mentorship program. In previous years this program focused on in person meeting with shadowing component. Following COVID-19 precautions, pre-clinical students were not allowed in the clinical setting. We designed a program to engage participants in mentorship centered around clinical discussions and professional advising. COVID compliant program expectations were distributed to student members and residents in Fall 2020. Interested students were paired with residents. Expectations included four virtual meetings: one introductory, two topic discussions, and one focused on academic success and professional goals. At the end of the year both students and residents filled out surveys assessing the benefits of the program and areas for improvement.

Evaluation: Participants were surveyed about the frequency of meetings, discussion topics, takeaways, and overall satisfaction with the program. Participation in the program was limited due to COVID19. Eight students and two residents responded to the exit survey. Most common discussion topics included academic success, personal wellbeing, and underserved patient populations. Residents reported Zoom was an adequate platform for mentoring students; students commented they would prefer shadowing opportunities with their mentor. All students reported a positive experience and an increased exposure to the field. s

Lessons Learned: Hybrid curriculum and limited hospital access call for increased effort towards building connection between clinical staff and students. In previous years, participants listed “providing support, encouragement, and advice,” as primary focuses of their mentorship experiences. Though the importance of mentorship increased with COVID, the increased responsibilities of residents and high burden of Zoom meetings for students likely inhibited program participation. We look forward to transitioning back to an in-person model with possibility for hybrid zoom meetings.
Presented by
Ansley Smoak
Institution
University of Alabama-Birmingham, School of Medicine
Chat with PresenterAvailable September 21 1:30-2:00 pm Watch Presentation
Poster: The Great Sepsis Escape Tabletop: An Experience for Everyone

The Great Sepsis Escape Tabletop: An Experience for Everyone

April Belle, DNP, RN, CCNS; Andres Viles, MSN, RN, CNS, CHSE; Shelby May, MSHS: Teldra B. Thomas, MSME; Ivory J. Daniels II, BS

Abstract
Decreasing sepsis mortality is an institutional priority. To meet this need, an escape tabletop simulation was developed with a focus on sepsis for our learners, facilitators, and budget. By merging the escape room concept and serious games, a new opportunity for simulation emerged. This simulation happens with a moderating facilitator and 5-7 participants around a table. Supplies are portable and require 20 minutes to setup. All elements are either on or connected to the table. It takes 1 hour or less to prebrief, simulate, and debrief. Prebriefing includes elements of best practice and rules of simulation engagement. Participants have 30 minutes to complete the challenge. Debriefing is designed as a self-guided experience to support novice facilitators. Designed with elements of best practice, numbered cards are randomly chosen by the participants. In numerical order, each participant reads their card to facilitate the self-guided debriefing. This simulation is designed for any member of the interprofessional, clinical or non-clinical, team including students and practicing professionals. Surveys with a 5-point Likert scale were used to evaluate participant experience. Qualitative data was collected to evaluate what they felt was beneficial versus what could be improved. Evaluations demonstrated the overwhelming majority of responders felt the experience was valuable and would recommend to others. A tabletop escape simulation is a low-resource, cost-effective activity. For $200.00, anyone can replicate this experience to introduce and reinforce a variety of skills. In addition, the objectives of the experience can be adjusted to meet the needs of any learner group.
Presented by
April Belle, DNP, RN, CCNS <abelle@uabmc.edu>
Institution
University of Alabama at Birmingham, UAB Clinical Simulation
Other Affiliations
UAB Health System
Watch Presentation
Poster: Many as to One: Using Technology to Teach Sterile Technique to Large Groups

Many as to One: Using Technology to Teach Sterile Technique to Large Groups

Caroline Littleton, MSN, RN, CNEcl & Victoria Bolus, MSN, RN, CNEcl

Abstract
Teaching the fundamentals of sterile technique and sterile gloving to a large group of students presented a challenge. Demonstrating these skills at the front of a classroom or lecture hall did not allow students to observe the technical intricacies required to maintain sterility. The goal of this activity was to allow the students to experience the equivalent of a 1:1 instructional session while in a large group setting. This activity occurred in a large classroom with 35 pre-licensure nursing students. Each student stood at a table and with a pair of sterile gloves, sterile bowl, non-fenestrated sterile drape, and sterile 2” x 2” gauze. Two overbed tables with supplies matching the students’ were placed at the front of the classroom, one beside the projection screen and one beside the podium. A document camera was adjusted to display an over-head view of the overbed table beside the podium. This activity has since been completed using a webcam attached to equipment, such as a surgical instrument stand, to allow for optimal positioning to replicate the use of a hovercam. During the activity, one instructor stood beside the projection screen, teaching the principles of sterile technique, and demonstrating while guiding the students through the steps of setting up a sterile field and donning and doffing sterile gloves. Simultaneously, the other instructor demonstrated the skills under the camera while the image was projected on the screen, mirroring the students’ workstation. This allowed the students to view the minute details associated with proper sterile technique as they prepared their sterile fields and donned and doffed sterile gloves along with their instructors. While instructional videos provide similar perspective and detail, this activity allowed student engagement. Students were able to ask questions, request repeat demonstrations, and return demonstrate during periodic checkpoints in the activity. Feedback from students was consistently positive and students demonstrated increased confidence in demonstration of sterile technique. Educators recognized the enhanced quality of instruction when using this method of teaching precision skills to large groups. This method has since been successfully implemented when teaching other skills, including venipuncture, IV start, and tracheostomy care.
Presented by
Caroline Littleton & Victoria Bolus <cblittleton@uab.edu>
Institution
UAB School of Nursing
Watch Presentation
Poster: Medical Students as Future Gatekeepers to the Physician Workforce: An Innovative Approach to Training in Diversity, Bias and Selection

Medical Students as Future Gatekeepers to the Physician Workforce: An Innovative Approach to Training in Diversity, Bias and Selection

Christina J. Grabowski, PhD, Tara G. Edmonds, PhD, F. Shawn Galin, PhD

Abstract
Needs and Objectives While the medical education community appreciates the need to diversify the healthcare workforce, barriers persist in selection processes. Medical students represent the future gatekeepers to medical school and residency programs as admissions committee members and deans, residency program directors, department chairs, and medical school leaders. Few leaders, however, receive formal training in selection. To address this need, a new elective course, Holistic Review: Creating a Mission-Driven Physician Workforce, was created to train medical students to understand diversity, bias, and holistic selection.

Setting and Participants Forty medical students took this co-enrolled elective course in Fall 2019 and twenty students took the course in Fall 2020.

Description The course included both theoretical and practical frameworks for selecting a physician workforce poised to meet the needs of a diverse patient population. Topics included the history of medical school admissions, the role of diversity in health care, unconscious bias, race-conscious admissions legal issues, and evidence-based tools used in selection. Students applied their learning by screening medical school applications and rating applicants in multiple mini interviews (MMIs).

Evaluation At the conclusion of the course, students wrote reflection papers on their experiences and learning. Students selected two prompts from a list of three or four possible prompts. Two independent raters coded qualitative responses for themes.

Lessons Learned Several themes emerged in evaluating student reflections of the course and their learning. Students indicated that while they understood that holistic review involves looking beyond academic metrics, the course helped them to understand the complex, data-informed, and mission-driven aspects of both diversity and the holistic process. Their favorite parts of the course involved hands-on experiences reading and evaluating applications, and interviewing and evaluating candidates using mission-aligned evaluation tools. They also felt the lessons could be applied as clinicians as well as in roles involving selection of medical students or residents. Student reflections demonstrated that the course provided learning in holistic review, diversity, and selection, better preparing students for careers as gatekeepers to medical education.
Presented by
Christina J. Grabowski
Institution
University of Alabama at Birmingham School of Medicine
Chat with PresenterAvailable September 22, 2021, 1:00 - 2:00 PM Watch Presentation
Poster: Community Outreach to Expand Access to COVID-19 Vaccine in the Alabama Black Belt Region by Equal Access Alabama

Community Outreach to Expand Access to COVID-19 Vaccine in the Alabama Black Belt Region by Equal Access Alabama

Gargya Malla, Raymond A Lopez, Sandra Ford, Mike Anderson, Magdalene P Blevins, John W Harmon

Abstract
Objectives: The role of community service as part of medical education is well established. The SARS-CoV-2 pandemic highlighted the role of social determinants of health and the disproportionate impact of COVID-19 in Alabama’s Black Belt region. Their low vaccination rates pose a challenge to public health and risks worse outcomes in these counties. Our organization, Equal Access Alabama, a UAB medical student initiative, aims to encourage pre-health students, medical students and house staff to develop a deeper understanding of the challenges faced by socioeconomically disadvantaged Alabamians and leverage this knowledge to increase access to vaccines.

Settings and Participants: This effort targeted 12 Alabama counties. Students from several schools within UAB, Samford University, and Auburn VCOM partnered with Spirit of Luke/A Promise to Help (a mobile healthcare clinic) and Community of Hope Health Clinic (a primary care clinic and AHEC affiliate) to identify communities needing vaccinations. Alabama state & regional (West Central and Southeast) Area Health Education Centers (AHECs) supplied the vaccine. Ministers, mayors, and council members were involved in outreach efforts to create a community-academic partnership.

Description: This campaign aimed to augment the state’s response to the public health crisis. Our collaboration with local leaders established connections with individuals/communities open to receiving vaccinations. We also expanded our reach by contacting public officials, public health organizations and community leaders. All volunteers were required to complete a training session to enable them to screen individuals for vaccine eligibility, dilute and administer the vaccine and conduct post-vaccination monitoring. Volunteers were prepared to address concerns stemming from vaccine hesitancy. We also tailored our approach to each community, by setting up a stationary clinic and/or a mobile team traveling door-to-door.

Lessons Learned: Since June 2021, we have administered over 500 vaccine doses with the help 50 on-the-ground volunteers. We served people living in isolated rural areas, with targeted outreach to those from underrepresented racial/ethnic groups and incarcerated individuals. A consistent challenge was the low turnout at the stationary clinics. Reasons included unforeseen social events (funerals, community parties), lack of transport for patients, and insufficient community outreach. However, we observed that turnout was stable or increased when we returned to the same locations repeatedly. Word-of-mouth between community members appears to be an effective means of increasing community buy-in to the vaccination effort if our volunteers returned consistently. Most importantly, we remain committed to returning to clinical sites as often as is necessary to ensure everyone who desires the vaccine, may get one.
Presented by
Dr. Gargya Malla & Raymond A Lopez <gmalla@uab.edu>
Institution
University of Alabama at Birmingham, Department of Epidemiology; University of Alabama at Birmingham, School of Medicine
Other Affiliations
Spirit of Luke/A Promise to Help, Community of Hope Health Clinic (CHHC)
Watch Presentation
Poster: Resident Reflection Rounds

Resident Reflection Rounds

Gabriel Daniels, MD; Madhura Hallman, MD; Lauren Nassetta, MD

Abstract
Burnout is a psychosomatic, psychological, and social consequence of work that exceeds an individual’s capacity. It is characterized by fatigue, emotional exhaustion, reduced personal sense of accomplishment, and distancing from others. Methods to mitigate this phenomenon include individual (e.g. mindfulness and personal limits), organizational (e.g. acknowledging culture and group discussions), and systems-based (e.g. schedule flexibility and support staff) approaches. Resident Reflection Rounds seeks to bring together residents and faculty mentors, facilitate meaningful discussion of important matters affecting daily medical practice, and provide residents with a wellness outlet and resources for self-reflection.

To accomplish this, the program invites members of the UAB Pediatrics Residency Program and 1-2 topic-informed Faculty SEALs (Safe, Empathetic Advisors and Leaders) to a monthly informal roundtable discussion that occurs during the residents' protected lunch hour. Sessions involve confidential, open-ended, evidence-based, group discussions addressing ethical and wellness topics affecting residents’ daily practice such as “making mistakes in medicine”. The program is objectively evaluated via an anonymous electronic survey of residents. Responses to date indicate appreciation of open discussion about challenges in medicine, a desire for systems that ensure uninterrupted time for future reflections, validation of residents’ emotional distress, and development of skills in reflection.
Presented by
Gabriel Daniels <gmdaniels@uabmc.edu>
Institution
University of Alabama at Birmingham, Department of Pediatrics
Other Affiliations
Pediatrics Residency Program and Divisions of Pediatric Critical Care Medicine and Pediatric Hospital Medicine
Chat with PresenterAvailable September 21, 2021 @ 1-3pm CST Watch Presentation
Poster: Development of a Statewide, Multi-disciplinary Addictive Substances and Pain Management Curriculum for Health Professional Student (ALAHOPE)

Development of a Statewide, Multi-disciplinary Addictive Substances and Pain Management Curriculum for Health Professional Student (ALAHOPE)

Heather D. Martin, Sue S. Feldman, F. Darlene Traffanstedt

Abstract
Needs and Objectives: The National Academy of Medicine (NAM) recently identified health professional gaps to treating those with substance use disorder (SUD) and/or pain and determined the education system must collaborate across health care professions to address these gaps. Alabama’s (AL) health professional schools, including medical, nursing, physician assistant, pharmacy, dental, optometry, and veterinary schools, have common goals for teaching around SUD and pain. However, no such multi-disciplinary, core curriculum exists. These topics are often taught in siloed cultures lacking multi-disciplinary perspectives which hinders patient outcomes. Moreover, AL dispenses the most opioids in the U.S. AL’s future prescribers should be educated about diagnosing and appropriately treating people with SUD and/or pain. Settings and Participants: Requirements gathering included a stakeholder round table discussion, stakeholder surveys, documentation of curricula content in 6 programs outside AL, documentation of prescribing controlled substances regulatory codes, and 17 subject matter expert interviews, all from multiple health professions. Description: Using an adapted form of the Kern Model for Curriculum Development, a modular, multi-media core addictive substances and pain management curriculum was developed. Evaluation: A thematic analysis was performed on each information source, followed by a cross-thematic analysis of all assessments to develop broad curriculum goals and specific learning objectives which were then mapped to curriculum content and delivery methods. Lessons Learned: An adapted form of the Kern Model of Curriculum Development was used to create a statewide, multi-disciplinary, online curriculum around addictive substances and pain management for future AL health professionals. Two major curriculum units, Pain and Substance Use, were identified, with 6 and 11 modules, respectively. Each module contains one or more lectures. Lectures include interactive, online information delivery as well as short subject matter expert videos and learner knowledge check points. The analysis indicated that the content should be high level, comprehensive, longitudinal, and streamlined to be easily integrated into existing curricula programs and applied in different settings with various SUD and/or pain resources. Many subject matter experts reported that stigma, language, and referrals to specialists should be priority topics, and a multi-disciplinary approach is needed for best patient outcomes around SUD and pain.
Presented by
Heather D. Martin
Institution
University of Alabama at Birmingham1, Jefferson County Department of Health2
Chat with PresenterAvailable September 21st, 1-3pm CST Watch Presentation
Poster: Trainee and Faculty Perceptions of Remote PACS Workstations and Next Steps in the UAB Radiology Department

Trainee and Faculty Perceptions of Remote PACS Workstations and Next Steps in the UAB Radiology Department

Rachel Bass MD, Srini Tridandapani PhD MD MBA

Abstract
Remote workstations were rapidly deployed in our academic radiology practice in late March 2020 in response to the COVID-19 pandemic. While faculty appeared unaffected, we hypothesized residents’ perceived their education had suffered. Surveys of the radiology trainees and faculty were conducted seven-months following workstation deployment to assess the impact on radiology education, faculty wellness, and assess the future interest in remote work in an academic setting. Teleconferencing techniques were optimized and the same participants were resurveyed six months later. The majority of trainees reported remote work had a negative impact on education in both surveys, greatest among lower level residents (p<.001), despite reportedly improved teleconferencing techniques. The majority of radiologists with a remote workstation reported improved wellness. The majority of all respondents voted to continue or expand remote work following the COVID-19 pandemic in both surveys. An inclusive hybrid model for remote work focused on list decompression rather than education may improve radiologist’s longevity and future recruiting of the next generation into academics.
Presented by
Rachel Bass
Institution
University of Alabama at Birmingham/School of Medicine/Department of Radiology
Chat with PresenterAvailable Sept 21 1:15-2:00 Watch Presentation

Show or hide this track Back to top ↑

Poster: Improving Firearm Safety Counseling in Primary Care Clinic

Improving Firearm Safety Counseling in Primary Care Clinic

Andrew Donahue, MD, Austin Wheeler, MD, Joshua Bell, MD, Christina Hunley, MD, Abby Martin, MD, Morrisa Ladinsky, MD

Abstract
Background: Pediatricians can play a major role in the prevention of pediatric firearm injuries. How frequently and effectively we provide firearm safety counseling to Primary Care Clinic (PCC) patients is poor. The objectives of this QI project are to improve the consistency and quality of firearm safety counseling in PCC and distribute gun locks to patients. Aim: To improve firearm safety counseling and gunlock distribution in PCC. Methods: This project has undergone multiple PDSA cycles including PCC “spotlights”, a didactic lecture, and resident surveys. The current focus is on retrospective chart review of 9-month-old and 24-month-old well checks in PCC and determining if the resident documented that a gunlock was provided and if firearm safety counseling was provided. Charts from June 2017 to present were reviewed. Results: To date, 1,269 well visits have been reviewed. Of these, residents documented that 7 gunlocks were distributed (0.6%) and firearm safety education was provided to 237/1269 (18.7%). Manual monthly gunlock counts demonstrate that, in reality, 86 gunlocks have been distributed from Jan 2020-April 2021. Conclusion: The discrepancy in resident documentation and manual gunlock counts is likely secondary to a busy clinic and a difficult to navigate Electronic Medical Record (EMR) system. A future PDSA cycle will include creating templates within the EMR to improve documentation. We hope to continue to expand the project to maximize firearm safety counseling and gun lock distribution in PCC.
Presented by
Andrew Donahue, MD
Institution
University of Alabama at Birmingham
Watch Presentation
Poster: A Rare Cause of Lactic Acidosis

A Rare Cause of Lactic Acidosis

Adam Bonner, Leela Kantemneni MD, Farrah Ibrahim MD

Abstract
Lactic acidosis can occur in two different scenarios: Type A which occurs in the setting of organ hypoperfusion leading to reduced clearance of lactate most commonly associated with DKA, Type B which occurs due to impaired cellular metabolism leading to increased production of lactate most commonly associated with drugs, toxins, and rarely malignancy.

We present a rare case of sarcoma induced type B lactic acidosis. A 60 year old female presented initially with syncope and 20 pound unintentional weight loss.ALP 162 U/L, lactic acid 10 mg/dL, CRP 6.4 mg/L with an anion gap of 24 were prominent on labs. Lactate trended up to 17.9 on day 4 of admission. CT showed widely metastatic disease and liver biopsy showed high grade sarcoma likely originating from the uterus.

Studies have shown that malignant cells undergo a poorly understood biosynthetic reprogramming of energy production that enables them to divert from the normal oxidative process towards a glycolytic pathway with the generation of lactate, thus causing type B lactic acidosis. This reprogramming could be partly explained by an enhanced glycolytic pathway secondary to the production of -inducible factor-1a by oncogenic lesions.
Presented by
Adam Bonner
Institution
University of Alabama at Birmingham- Huntsville Campus
Other Affiliations
Department of Internal Medicine
Watch Presentation
Poster: Not all Parinaud Syndromes are Secondary to Pinealomas

Not all Parinaud Syndromes are Secondary to Pinealomas

Anthony L. Wilson MS3, Clark C. Ingram MS3, Tejanand G Mulpur MD

Abstract
Title: Not all Parinaud Syndromes are Secondary to Pinealomas

Authors: Anthony L. Wilson MS3, Clark C. Ingram MS3, Tejanand G Mulpur MD

Departmental Affiliation: UABSOM Huntsville Campus, Department of Neurology

Learning Objectives · Consider hemorrhagic and ischemic strokes in adult patients presenting with eyelid retraction · Early correction of blood pressure and hydrocephalus can allow for a complete return to baseline in patients with hemorrhagic causes of Parinaud syndrome

Introduction

Parinaud syndrome is described by the triad of impaired vertical gaze, convergence retraction nystagmus, and pupillary hyporeflexia.1 The pathophysiology involves compression of vertical gaze centers located within the rostral midbrain, pretectal area, and superior colliculus.2 Here, we describe a patient suffering a hemorrhagic stroke of the right thalamus, which extends in the rostrocaudal direction into the third ventricle and causes compression of the anterior surface of the tectum. Pressure transmitted through the tectum causes impingement of the superior colliculus via mass effect. Clinically, this patient presented with the Parinaud Syndrome triad, which later reversed with management of blood and intracranial pressure (ICP).

Case Presentation

A 60-year-old male with a history of alcohol abuse, congestive heart failure, hypertension, hyperlipidemia, and peripheral vascular disease presents to the emergency department after hitting multiple cars while acutely intoxicated. His blood pressure is 217/116 mm Hg. The patient is obtunded and briefly arousable by sternal rub. Imaging obtained shows acute right thalamic hemorrhage with extension posteriorly, causing indirect pressure on the superior colliculus.(Figure 1,2) Early signs of hydrocephalus are noted. Aggressive blood pressure control (<140 mm Hg) was achieved with hydralazine, metoprolol, labetalol, and nicardipine. Neurosurgery recommended a right frontal external ventricular drain to control intracranial pressure. Shortly after, he had vertical gaze impairment, lid retraction, and posturing of his head to look upward. The patient remained under strict monitoring of ICP and blood pressure. Gaze palsy improvement was noted clinically and correlated with hemorrhage resolution on repeat scans. (Figure 3) The patient returned to baseline neurological status within 4 weeks.

Discussion

Parinaud syndrome, also known as dorsal midbrain syndrome, was first reported by French ophthalmologist Henri Parinaud in 1883.3 Etiologies of Parinaud syndrome include pineal gland tumors, arteriovenous malformation, dilation of the third ventricle, lesions to the posterior commissure, multiple sclerosis, and midbrain infarction. Early recognition and intervention in patients with Parinaud syndrome secondary to hemorrhagic stroke and pressure on the tectum can lead to the reversal of ophthalmologic symptoms. Clinicians should monitor hemorrhage regression and ICP correction, which may correlate with symptom resolution.4

References

1. Shields M, Sinkar S, Chan W, Crompton J. Parinaud syndrome: a 25-year (1991-2016) review of 40 consecutive adult cases. Acta Ophthalmol. 2017 Dec;95(8):e792-e793. doi: 10.1111/aos.13283. Epub 2016 Oct 24. PMID: 27778456.

2. Feroze KB, Patel BC. Parinaud Syndrome. [Updated 2021 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441892/

3. Keane J. R. (1990). The pretectal syndrome: 206 patients. Neurology, 40(4), 684–690. https://doi.org/10.1212/wnl.40.4.684

4. A Case of Parinaud Syndrome After Intracranial Hemorrhage. J Korean Ophthalmol Soc. 2009;50(1):172-175. Published online January 15, 2009 DOI: https://doi.org/10.3341/jkos.2009.50.1.172
Presented by
Anthony L. Wilson
Institution
University of Alabama at Birmingham School of Medicine, Huntsville Campus
Other Affiliations
Department of Neurology
Watch Presentation
Poster: A Rare Case of Chronic Myeloid Leukemia with Extramedullary Manifestations

A Rare Case of Chronic Myeloid Leukemia with Extramedullary Manifestations

Christopher Terrell, DO; Leela Kantamneni, MD; Farrah Ibrahim, MD; Ali Hachem, MD

Abstract
Extramedullary CML is a rare disease manifestation where CML is noted outside of the bone marrow. It typically accompanies a blast crisis; however, we present a case of extramedullary CML not in blast crisis.

Presented by
Christopher Terrell
Institution
Huntsville Regional Medical Campus, Internal Medicine, University of Alabama at Birmingham
Chat with Presenter Watch Presentation
Poster: A Rare Case of Hypercalcemia in Chronic Lymphocytic Leukemia

A Rare Case of Hypercalcemia in Chronic Lymphocytic Leukemia

David Heaner, Mouna Gunda, Amitkumar Mehta, Mayur Narkhede, Monica Agarwal

Abstract
Introduction: Hypercalcemia is a common clinical problem and a known red flag for malignancy. Commonly, this elevation in calcium is humorally induced (PTHrP), with solid tumors being common culprits. However, hypercalcemia is rare in most hematologic cancers with multiple myeloma and T cell lymphoma/leukemia being notable exceptions. In chronic lymphocytic leukemia (CLL), the elevated calcium can be due to PTHrP, bone lesions, elevated calcitriol, and rarely due to leukemic/lymphoma transformation (Richter’s syndrome). We describe a rare case of a patient with significant CLL tumor burden and hypercalcemia, elevated PTHrP, and calcitriol. Case Description: A 63-year-old male with a history of CLL (11q deletion) with 4 recurrences over 15 years, currently enrolled in a clinical trial with CD20 bi-specific antibody, presented with hypercalcemia of 13.9 mg/dL (8.4-10.4). The imaging showed interval increase in splenic size and adenopathy without evidence of bone lesions. There was no evidence to suggest Richter’s transformation or plasma cell dyscrasias. Laboratory results were significant for a suppressed PTH 1.5 pg/mL (12-88), vitamin D 24 ng/mL (20-100), alkaline phosphatase 174 Units/L (37-117), calcitriol 109 pg/mL (18-72), PTHrP 21 pMol/L (<4.2), and LDH 477 Units/L (120-240). Patient was treated with zolendronic acid and calcitonin and was discharged as hypercalcemia improved. He was hospitalized a few days later with calcium 16.6 mg/dL. Hypercalcemia is managed with calcitonin, IV fluids and denosumab. In addition, he also received prednisone and denosumab. Educational tool: Concerning hypercalcemia in hematologic malignancies like CLL, we propose the following pneumonic/phrase: if it’s not endocrine (parathyroid, vitamin D), it’s something “OTHER” [Osteolytic bone lesions, Tumor burden, Humoral hypercalcemia, Extra cancers (MM), Richter’s transformation]. Discussion: Hypercalcemia in CLL is very rare and is a negative prognostic marker. In our patient, PTHrP is elevated which is consistent with humoral hypercalcemia. Calcitriol is not elevated in cases of PTHrP elevation in CLL reported in the literature. We hypothesis that at a certain threshold of PTHrP elevation, it could cause elevation in calcitriol level, or the tumor is producing both. Other possible causes include granulomatous disease but is less likely in this case.
Presented by
David Heaner
Institution
University of Alabama at Birmingham
Watch Presentation
Poster: Transesophageal Echocardiogram in Enterococcal Bacteremia: Does Every Patient Need One?

Transesophageal Echocardiogram in Enterococcal Bacteremia: Does Every Patient Need One?

Graham Husband MD, John Murphy MD, Erin Contratto MD

Abstract
Title: Transesophageal Echocardiogram in Enterococcal Bacteremia: Does Every Patient Need One? Introduction: Endocarditis can create a potentially life-threatening situation, not only from heart failure and conduction abnormalities, but also systemically with embolic phenomenon. Patients with suspected gram-positive endocarditis should undergo transesophageal echocardiogram (TEE) to rule this out, but many patients with bacteremia can either be too acutely or chronically ill to safely perform. Here, we present a case of prolonged Enterococcal bacteremia in a man with many chronic medical conditions that was able to avoid what would have been a risky TEE with implementation of the DENOVA score. Case Description: A 75 year-old male with End-stage Renal Disease (ESRD) on intermittent hemodialysis, COPD, late-stage Alzheimer’s, and recently treated Vancomycin-sensitive Enterococcal bacteremia presented to the ED acutely altered. Blood cultures were collected which re-demonstrated Vancomycin-sensitive Enterococcal bacteremia. Because of the longstanding bacteremia, concern for endocarditis was high, but TEE could not be performed using standard sedation due to the patient’s dementia. As such, general anesthesia would be necessary to complete the test. Due to the patient’s medical comorbidities, it was felt the patient would have a prolonged intubation. A DENOVA score was calculated and was found to be 1, indicating a low likelihood for endocarditis, so the patient was discharged 8 weeks of Vancomycin with dialysis. Educational Tool: The DENOVA score determines the likelihood of endocarditis in patients with Enterococcal bacteremia. The score has a 0-to-6 scale with a score less than 3 indicating a low probability of Enterococcal endocarditis. In a study of 397 patients, the score was found to be 100% sensitive and 85% specific. Discussion: In patients with low- to intermediate-risk Enterococcal bacteremia, the DENOVA score offers a clinical tool to avoid potential risks of TEE, particularly in medically complex patients. It should be noted, this tool requires further validation and cannot rule out endocarditis.
Presented by
Graham Husband
Institution
University of Alabama at Birmingham, Department of Medicine
Chat with PresenterAvailable 9/21/2021, 1-2pm, Meeting ID: 868 3273 2178 Passcode: F5LmXA Watch Presentation
Poster: Central Pontine Myelinolysis as a Result of Poorly Controlled Diabetes Mellitus

Central Pontine Myelinolysis as a Result of Poorly Controlled Diabetes Mellitus

Jennifer Lamar MD, Peshitha Nimmagadda MD, Mariam Riad MD, Farrah Ibrahim MD, FACP

Abstract
Introduction: Rapid correction of hyponatremia is universally known to cause Central Pontine Myelinolysis (CPM). It can rarely develop in patients with diabetes mellitus (DM) due to abrupt fluctuations in serum osmolality. We present a patient with CPM due to poorly controlled DM to highlight the importance of adequate control of blood glucose level.

CASE DESCRIPTION A 65-year-old nonalcoholic, nonsmoker, right hand dominant man known to have type 2 diabetes, hypertension, hyperlipidemia, chronic kidney disease, coronary artery disease and ischemic cardiomyopathy, who presented to the emergency department with progressive generalized weakness and slurred speech for two weeks. Vital signs were within normal range (Temperature was 36.7°C, blood pressure 108/51 mmHg, pulse 85 bpm, respiratory rate 19 breath per minute, oxygen saturation 97% on room air). Neurological examination was remarkable for dysarthric speech, decreased motor strength symmetrically bilaterally 4/5 in lower extremities and sensation was intact to fine touch, sharp sensation and vibration. Laboratory test results was significant for serum glucose 547 mg/dl, serum sodium, 127 meq/L with corrected sodium level of 134 meq/L, blood urea nitrogen 54 mg/dl, creatinine 2.0 mg/dl and HbA1c of 18.4%. Patient underwent further evaluation with brain imaging. CT head without contrast did not reveal any acute intracranial abnormality. MRI brain with and without contrast demonstrated non-enhancing diffusion abnormalities bilaterally within the pons suggestive of osmotic demyelination. Patient’s blood glucose was strictly controlled with improvement in his symptoms, and he was discharged home at hospital day 4.

Discussion: Central Pontine Myelinolysis can present in the setting of severe hyperglycemia or days to weeks following correction of hyperglycemia. The most common neurological symptoms include gait ataxia, dysarthria, dysphagia, and pseudobulbar affect. High clinical suspicion is essential as symptoms may be mild and lesions are only detectable by MRI brain. Patient education and strict blood glucose control is crucial in preventing CPM in the setting of severe hyperglycemia.
Presented by
Jennifer Lamar
Institution
University Of Alabama at Birmingham School of Medicine, Huntsville Campus
Watch Presentation
Poster: A Rare Case of Hemophagocytic Lymphohistiocytosis (HLH)

A Rare Case of Hemophagocytic Lymphohistiocytosis (HLH)

Lauren Beggs MD1, Dyan Alvarez Dupaya MD2, Farrah Ibrahim MD2, Katie Glosemeyer MD3


Abstract
Introduction: Hemophagocytic Lymphohistiocytosis (HLH) is a rare exaggerated immune response causing deposition of lymphocytes and histiocytes throughout multiple organ systems causing organomegaly and ultimately organ failure. This case study serves to illustrate the clinical features and diagnosis of HLH. Early identification and treatment will decrease the risk for life-threatening complications. Case description: A 39-year-old Hispanic male with no past medical history presented with left scrotal pain and swelling. On admission physical exam was significant for fever, left scrotal swelling and tenderness. Patient had severe pancytopenia with hemoglobin of 7.9 g/dL, platelet count of 13 x10^3/mcL, and severe neutropenia of 0.36 x10^3/mcL. Additionally, ferritin was elevated at 82,191 ng/mL, and hypofibrinogenemia was present. Scrotal ultrasound was suggestive of increased vascularity and possible epididymitis. He was started empirically on Ceftriaxone and Doxycycline. Due to persistent fevers and neutropenia, antibiotics were broadened to Cefepime and Vancomycin along with Doxycycline. He was transferred to the intensive care unit for probable bone marrow failure and atypical bacterial infection in the setting of HLH syndrome. Bone marrow biopsy revealed hypercellular marrow, increased lymphocytes, histiocytes and hemophagocytosis. Patient was started on Dexamethasone 10 mg IV daily and etoposide 75 mg/m2, dose adjusted due to abnormal liver function tests. Antibiotics were subsequently discontinued. Urology was consulted for a left unilateral orchiectomy for definitive pathology. Procedure was deferred due to persistent thrombocytopenia. Patient remains hospitalized, receiving supportive care and HLH treatment.

Discussion: HLH is an aggressive and life-threatening condition that requires early diagnosis and treatment to prevent multi-organ injury and mortality. Per HLH 2009 modified criteria, a molecular diagnosis of HLH is definitive. Additional criteria include three of the following: fever, splenomegaly, cytopenias of at least 2 cell lines, hepatitis and at least one of the following: hemophagocytosis, hyperferritinemia, increased sIL2Rα, and absent or decreased NK function. A patient fulfilling these HLH criteria warrants urgent initiation of HLH treatment protocol.
Presented by
Lauren Beggs
Institution
University of Alabama Huntsville Regional Campus Departments of Family and Internal Medicine
Watch Presentation
Poster: Brown Recluse Bites: Identification, Differentiation, and Treatment

Brown Recluse Bites: Identification, Differentiation, and Treatment

Mack Bozman, Kym Middleton MD, Christopher Johnson MD

Abstract
Mack Bozman University of Alabama at Birmingham School of Medicine Department of Pediatrics - MS3 Bozman@uab.edu Resident: Christopher Johnson PGY2, christopherajohnson@uabmc.edu Attending: Kym Middleton, MD

Brown Recluse Spider Bites 4-year-old female who presented to the ED for an infected wound on right anterior mid-shin. Her parents noticed small pimple-like lesions one day prior to admit but no witnessed bug bites, significant exposures, or recent injuries. She awoke the morning of admit with pain, swelling, and redness of her leg. Her appetite was decreased, and she began to limp and was febrile so she was brought to Peds ER. The largest lesion was ulcerated with black necrotic center and exudation. US revealed a small abscess and she underwent I&D with culture. CMP/CBC was ordered with pertinent findings of WBC elevation 15.93 and CRP of 18.2. Due to necrotic character of her leg lesion, there was a significant concern for brown recluse spider bite. Further research was performed to differentiate from other possible diagnoses. Though the brown recluse spider is common here, the following mnemonic of interest (NOT RECLUSE) was used to differentiate the recluse bite from other skin lesions: N – Numerous (recluse bites are typically a single focal lesion) O – Occurrence (recluse bites typically occur in secluded locations in the home such as attic space, garage, or closet) T – Timing (lesions from bites are less common from November to March) R – Red center (recluse bites typically have a pale center) E – Elevated (recluse bites are flat or sunken) C – Chronic (lesions presenting longer than several weeks are unlikely to be recluse spider bites) L – Large (lesions >10 cm are uncommon after a recluse spider bite) U – Ulcerates too early (<7 days) suggests infection or pyoderma gangrenosum rather than a recluse spider bite S – Swollen (except for bites to the face or feet, significant swelling is not typical for recluse spider bites) E – Exudative (other than bites on eyelids or toes, recluse spider bites are not moist or exudative; frank pus suggests infection) Our patient had 3 lesions on her right anterior shin that were elevated and swollen which had ulcerated within <48 hours. Additionally, the largest lesion was exudative and weeping upon examination. She was not found to have ventured to any secluded areas of the house. 7/10 of the above were positive, which lowered the likelihood of a recluse bite.

Presented by
Mack Bozman
Institution
University of Alabama at Birmingham
Other Affiliations
Huntsville Campus, Pediatrics
Chat with PresenterAvailable September 17th 3-4 PM Watch Presentation
Poster: A Case of Unilateral Optic Neuritis Secondary to Acquired Toxoplasmosis

A Case of Unilateral Optic Neuritis Secondary to Acquired Toxoplasmosis

Maha Al-Baghdadi MD, Khalid Ameen MD, Jesse Faulk MD

Abstract
Toxoplasmosis caused by parasite Toxoplasma gondii is widely distributed infection with estimated prevalence of 25-30%. Immunocompetent patients are typically asymptomatic. However, T. gondii infection may present as ocular disease.
Presented by
Maha Al Baghdadi
Institution
UAB Huntsville Regional Medical Campus
Watch Presentation
Poster: Are you Sure It's not HIT? This is Why a Low 4T Score Rules Out HIT

Are you Sure It's not HIT? This is Why a Low 4T Score Rules Out HIT

Marquis Griffin, Danielle Bayer, Radhika Gangaraju

Abstract
Introduction Acute thrombocytopenia requires prompt intervention to prevent adverse clinical outcomes. Thrombocytopenia has a broad differential, and careful analysis of the clinical scenario will provide clues that help to narrow the differential. The 4T score is a useful pre-test calculator, with good evidence, when HIT is a possible diagnosis.

Case Description We present a case of hyperacute drug-induced immune thrombocytopenia after tirofiban infusion for a spontaneous coronary artery dissection with a large thrombus burden. A 30 year old female was transferred to UAB after she was diagnosed with spontaneous coronary artery dissection complicated by a large thrombus burden not amenable to percutaneous intervention. She was anticoagulated with heparin and tirofiban, a glycoprotein IIb/IIIa inhibitor. Within 24 hours, she developed acute severe thrombocytopenia, large hematomas, and palpable purpura. Upon transfer, platelet transfusions, and IVIG were administered. Given the rapid onset of thrombocytopenia after exposure and a low 4T score, HIT was unlikely. With treatment, her platelets normalized, and the diagnosis was confirmed with the detection of tirofiban IgG antibodies.

Important Educational Tool Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings Lo et al, published in 2006, tasked physicians with scoring patients during retrospective review and prospective assessments of patients in which HIT was on the differential. The 4T scores were compared to the HIT antibody tests obtained during the initial hematology consultation. Discussion The 4T score has good sensitivity and poor specificity as depicted in Table 1. The utility of the 4T score, as outlined in the study, is best described after stratification of high, intermediate, and low-risk categories. The positive predictive value for scores >3 is highly variable. Intermediate and high scores have a high false-positive rate that may vary from institution to institution. The 4T score has excellent negative predictive value for scores < 3, and the false negative rate was <2% across both institutions. Therefore, negative scores should confer a high level of confidence in ruling out HIT.
Presented by
Marquis Griffin <mjgriffin@uabmc.edu>
Institution
University of Alabama at Birmingham
Watch Presentation
Poster: A Deep Dive into Epidermolysis Bullosa Acquisita of the Esophagus

A Deep Dive into Epidermolysis Bullosa Acquisita of the Esophagus

Natalie Garcia, Dr. Nida Choudry MD, Shadi Awad, Dr. Ryan Kraemer MD

Abstract
Introduction: Epidermolysis Bullosa Acquisita (EBA) is a rare autoimmune condition involving the skin and mucosal membranes. Clinically, EBA is characterized by sloughing of skin on areas that experience friction, such as the palms, soles, and mouth, and milial scarring surrounding healed bullae. EBA less commonly involves mucosal surfaces; however, dysphagia and esophageal strictures raise concern for esophageal involvement in patients with previously diagnosed EBA.

Case Description: A 62-year-old white male with a history of NASH cirrhosis s/p liver transplant, HFrEF with EF 30-35%, CKD due to IgA nephropathy, and a recent diagnosis of EBA presented to the ED with asymptomatic anemia. Patient has had recurrent hospitalizations due to anemia, with concern for occult GI bleeding. He has had extensive workup involving multiple EGDs, many of which have shown Grade D esophagitis. In recent years, patient has had esophageal dilations, given complaints of dysphagia and strictures found on EGD.

On this admission, patient had concern for upper GI bleed given hematemesis. EGD was done which demonstrated sloughing of proximal and mid esophagus, concerning for mucosal manifestation of epidermolysis bullosa acquisita (EBA). Dermatology consulted and agreed the patient’s esophageal sloughing was likely due to esophageal involvement of bullous disease. They recommended IVIG infusions as an outpatient.

Important Educational Tool: Immunosuppressive agents, such as CellCept and Dapsone, are first line medications for EBA treatment, while IVIG is second line and is beneficial for patients who cannot withstand further immunosuppression, such as ours.

Discussion: EBA is a rare autoimmune condition, with even rarer esophageal manifestations. These often present as concern for upper GI bleed or dysphagia. It is often missed given it is labeled as severe esophagitis when seen on EGD or a stricture, which is dilated. It is important to recognize that these are manifestations of this disease, given treatment should be focused on the underlying disease.
Presented by
Natalie Garcia <nhvoss@uab.edu>
Institution
University of Alabama at Birmingham
Chat with PresenterAvailable September 21, 2021 1-3 pm Watch Presentation
Poster: A Case of concealed Primary CNS Lymphoma masquerading as encephalopathy in elderly

A Case of concealed Primary CNS Lymphoma masquerading as encephalopathy in elderly

Peshitha Nimmagadda ,Dhivya Velu, Nessy Abraham

Abstract
Title:

A case of concealed Primary CNS Lymphoma masquerading as encephalopathy in elderly

Introduction:

Primary CNS Lymphoma (PCNSL) are a rare group of extra-nodal Non-Hodgkin Lymphoma (NHL) confined to Brain with incidence of 0.5 per 100,000 population. Even though better therapeutic options were introduced in the last decade, the survival rates are still inferior compared to other extracranial NHL.

Case Description

A 74-year-old healthy independent Caucasian woman presented with sudden cognitive decline in a span of 48 hours. Physical examination revealed a pleasantly confused elderly woman who was alert, partially oriented with short term memory loss. No other focal neurological deficits noted. Initial vitals and lab works were unremarkable. Incidentally, the brain imaging unveiled mass like lesions with enhancing components located along both sides of the lateral ventricle with extensive vasogenic edema. Further imaging with CT Chest, Abdomen and Pelvis was inconclusive confirming it to be primary CNS tumor. Biopsy of the lesion uncovered the final diagnosis of diffuse large B-cell lymphoma (DLBCL), non-germinal center B-cell–like (non-GCB) subtype. With her stable physical health except for confusion, treatment was considered despite moderate prognosis revealed by IELSG score of 2. High dose Methotrexate (MTX) in combination with Temozolomide along with Rituximab was planned to begin with whole brain irradiation later on.

Important educational tool

1. Eastern Cooperative Oncology Group (ECOG) Score to assess functional status. 2. International Extra-nodal Lymphoma Study Group (IELSG) Score to predict survival rate.

Discussion

PCNSL is a highly aggressive NHL with grim prognosis. Immunochemistry helps to differentiate between GCB and Non-GCB type based on positive MUM1 markers which decides prognosis. However, the treatment of PCNSL despite the type remains the same with upfront regimen with Methotrexate at high doses >1.5g/m2 as rapid infusion along with Alkylating agents with or without Rituximab. The treatment is challenging in elderly especially with multiple co-morbidities. Whole Brain Irradiation is usually offered along for better outcome. Unlike other brain tumors, PCNSL often has a favorable response to both chemotherapy and radiation therapy, but compared with lymphomas outside the CNS, survival is usually inferior.

Presented by
Peshitha Nimmagadda <pnimmagadda@uabmc.edu>
Institution
UAB Huntsville, Department of Internal Medicine
Watch Presentation
Poster: Using Self-Measured Blood Pressure Monitoring to Increase Hypertension Control among Priority Populations using MAP (Measure Accurately, Act Rapidly, Partner with patients)

Using Self-Measured Blood Pressure Monitoring to Increase Hypertension Control among Priority Populations using MAP (Measure Accurately, Act Rapidly, Partner with patients)

Tyler Newell, Louanne Friend, Alex Fischer, Neil Tindell

Abstract
Introduction Treatment of hypertension is the most common cause of healthcare provider visits and long-term use of medications among nonpregnant adults. Approximately 50% of hypertensive adults do not have adequate blood pressure (BP) control which can contribute to serious health conditions including atherosclerosis, coronary artery disease and stroke. When patients measure their BP at home, it provides more accurate data for providers. Furthermore, self-monitoring of BP may lead to increased hypertension control, especially when paired with supportive interventions (e.g., telemonitoring). Medical students provided patient education and telemonitoring of BP control through a quality improvement initiative to control hypertension among priority populations. Engaging directly with patients provided valuable experience and insight.

Case Description A 51-year-old male with uncontrolled hypertension (>140/90 on two separate occasions) agreed to participate in this study and was provided a BP cuff and educational materials. He is a married nonsmoker with employment-based health insurance who has hypertension, hypercholesterolemia, and sleep apnea. His physical activity is limited by his job, but he denies problems with obtaining or taking his medications.

Educational Tool This project provides medical students with experience in managing hypertension. I called him on a biweekly basis for three months to collect his data and discuss his goals.I had two interactions with him in the clinic and four more via telephone. With each subsequent encounter, he appeared more engaged in gaining control of his BP, reporting increased exercise, etc.

Discussion This project has helped me realize the importance of supportive interventions in hypertension control. Initial data analysis shows an average BP of 150/90 mmHg with an average mean arterial pressure of 110 mmHg. This data will serve as the baseline for this patient’s BP. Data will be collected and trended as part of the final data analysis. Challenges with data collection include participant availability and reporting of accurate data. This patient appears more proactive in managing his hypertension, and supportive intervention is a potential tool for future practice.
Presented by
Tyler Newell
Institution
University of Alabama, Department of Community Medicine and Population Health
Other Affiliations
American College of Preventive Medicine, Centers for Disease Control and Prevention
Watch Presentation
Poster: Hepatic Injury Caused by Hydroxycut Weight Loss Supplements

Hepatic Injury Caused by Hydroxycut Weight Loss Supplements

Yassmin Hegazy, MD, Michael Fister, MD, Cameron Mason, MD, and David Fettig, MD

Abstract
Introduction: Hydroxycut weight loss supplements have been known to cause hepatotoxicity with some patients requiring liver transplantation. This is a patient presenting to the hepatology service with acute liver injury in the setting of recent Hydroxycut weight loss supplement use.

Case Description: A 51 year-old Caucasian male with a past medical history of hypertension and depression presented with several months of abdominal pain with associated nausea, vomiting, darkening urine, and intermittent episodes of encephalopathy. He reported taking two pills of “Hydroxycut Black” weight loss supplements per day for the past several months. On presentation, his vitals were significant for hypertension (BP 163/121) and physical exam notable for hepatomegaly and diffuse abdominal tenderness. Labs were notable for MELD-Na 22 (Na 135, Tbili 2.1, INR 2.55, Cr 1.0), AST 12628, ALT 6303, Alkaline phosphatase 63, LDH 12892, and negative UDS, alcohol and Acetaminophen levels. Abdominal ultrasound was significant for moderate steatosis without cirrhosis. He was started on empiric IV Acetylcysteine and lactulose with symptomatic improvement and discharged four days post-presentation with improving liver function tests (AST 101, ALT 1297, INR 1.02).

Important Educational Tool: This case highlights the importance of taking a patient’s history of over the counter medication use that otherwise wouldn’t be apparent on a patient’s medication list or urine drug screen as well as obtaining a MELD-Na score to evaluate the severity of liver disease and need for transplantation.

Discussion: Hydroxcut products have been known to cause hepatocellular toxicity with elevations in aminotransferase levels and in some patients causing acute liver failure requiring transplantation. Ingredients in Hydroxycut Black including Garcinia cambogia and Green tea leaf extract have been associated with liver toxicity with significant peak in ALT (~2500), AST (~1600) and INR elevations (~1.2-6.45) and common symptoms including nausea, vomiting, and abdominal pain. Duration of use and recovery varies in patients with most patients improving with supportive care. This case demonstrates the importance of including dietary and herbal supplementation use in the differential diagnosis in patients presenting with elevated liver enzymes with a negative infectious and autoimmune workup.
Presented by
Yassmin Hegazy
Institution
University of Alabama Birmingham, Department of Medicine
Other Affiliations
Department of Hepatology
Watch Presentation