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 Table of Contents  
Year : 2021  |  Volume : 7  |  Issue : 3  |  Page : 185-201

The 2021 St. Luke's University Health Network Annual Research Symposium: Event highlights and scientific abstracts

1 Department of Anesthesiology, St. Luke's University Health Network, Bethlehem, Pennsylvania 18015, USA
2 Department of Research & Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania 18015, USA

Date of Submission08-Sep-2021
Date of Acceptance15-Sep-2021
Date of Web Publication28-Sep-2021

Correspondence Address:
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2455-5568.326811

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How to cite this article:
Pellegrino AN, Birk R, Kumar KN. The 2021 St. Luke's University Health Network Annual Research Symposium: Event highlights and scientific abstracts. Int J Acad Med 2021;7:185-201

How to cite this URL:
Pellegrino AN, Birk R, Kumar KN. The 2021 St. Luke's University Health Network Annual Research Symposium: Event highlights and scientific abstracts. Int J Acad Med [serial online] 2021 [cited 2021 Dec 2];7:185-201. Available from: https://www.ijam-web.org/text.asp?2021/7/3/185/326811

  Background Information and Event Highlights Top

The Annual St. Luke's University Health Network (SLUHN) Research Symposium was created in 1992 to showcase research and quality improvement projects by residents, fellows, and other trainees. The event is organized by a multi-departmental Research Symposium Planning Committee, with collaboration and consultation provided by graduate medical education (GME) leadership, medical school leadership, as well as residency and fellowship faculty. Residents, fellows, and medical students submit an application for podium (8-min) and/or quick shot (5-min) presentation along with an accompanying abstract describing their project or case report.

This year's event featured the largest number of podium and quick shot presentations in St. Luke's 29-year research day history. Prior to the event, each project is assessed by at least two independent judges for the overall scientific quality (60% of the score). This is followed by a live audience vote for the best presentation (40% of the score). Based on the above methodology, prizes are awarded to the top three podium presenters and to the best quick shot presenter. In addition, medical students from Temple/St. Luke's Medical School, the only 4-year regional medical school in the Greater Lehigh Valley region, participated in the event, with Best Medical Student Presentation awarded accordingly.

The 2021 research symposium winners are as follows:

  1. Podium presentations

    1. First place – Brittney Shupp, Internal MMedicine Rresidency, University Campus, Bethlehem: Proton-pump inhibitor therapy usage and associated hospitalization rates and ccritical care ooutcomes of COVID-19 patients.
    2. Second place – Chris McCarthy, Psychiatry Residency, Richard A. Anderson Campus, Easton: Improving prior authorization efficiency in a multi-provider ppsychiatry cclinic.
    3. Third place – Matthew Meyers, Emergency Medicine Residency, University Hospital Campus, Bethlehem: Predicting 30 – day outcomes in Emergency Department patients discharged with COVID-19.

  2. Quick shot presentation

    1. First place – Emily Gombosi, Podiatry Residency, St. Luke's Sacred Heart Campus, Allentown: Rare clear cell hidradenoma of the dorsal foot.

  3. Medical student presentation

    1. First place – Sally Wen, Temple//St. Luke's Medical School, University Hospital Campus, Bethlehem: Retrospective review of the efficacy of tocilizumab for COVID19.

As in the previous 5 years, the 2021 Research Symposium included a nationally known Keynote Speaker. This year's Guest of Honor was Dr. David P. Bahner from The Ohio State University College of Medicine, Columbus, Ohio. Dr. Bahner is Professor and Ultrasound Division Director at Ohio State's Department of Emergency Medicine. The Keynote presentation focused on clinical innovation at the bedside, discussing a range of related topics, from the coronavirus disease 2019 (COVID-19) pandemic response to the opportunities and promises of a post-pandemic future. Dr. Bahner provided historical stories of clinical innovation and how the same lessons can be applicable today at the bedside. He emphasized the critical importance of the provider-patient relationship at the bedside. The Keynote Address concluded the morning session of the Research Symposium.

The afternoon session of the event included presentations from various departments that directly and indirectly support research and scholarly activity at SLUHN. This highly informative session featured content from the following areas: Clinical Trials, the Institutional Review Board, the PostDoctoral Fellows Research Program, GME Data Management and Outcomes Assessment, an update on REDcap software, Temple/St. Luke's Medical School, information technology (IT)/St. Luke's Technology Ventures, physical therapy, quality department, as well as narrative medicine.

Due to the ongoing COVID-19 pandemic and associated restrictions on large gatherings, the 2021 research day was conducted entirely online. With the help of the St. Luke's IT media team, we were able to conduct the largest and most complex virtual event in the Network's history.

The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, Patient care and procedural skills, Professionalism, and Systems-based practice.

  Abstract Number 1 Top

Influenza and Social Determinants of Health

R. Carneiro1, K. Joseph1, L. Keil1

1Residency/Fellowship Program: Family Medicine Residency, St. Luke's Sacred Heart Hospital Campus, Allentown.

Keywords: Education, influenza, public health, social determinants of health, vaccination rate

Introduction: It is estimated that 3%–11% of the U.S. population becomes ill from the influenza virus each season. The Centers for Disease Control and Prevention (CDC) monitors the rate and effectiveness of the influenza vaccination each year to determine whether the vaccine retains value as a public health intervention. Our urban clinic, with a high-minority population, has been a CDC influenza-like illness sentinel surveillance center for 15 years. In addition, for the past year, we have participated in a research project with the Pennsylvania Department of Health tracking vaccination effectiveness. This study describes our experiences with the above initiatives and associated outcomes. Our hypothesis was that participation in CDC surveillance and aggressive offering education for providers and patients will improve vaccination rates.

Methods: To increase awareness of the influenza vaccine, during the years of 2018–2020 influenza season, our practice engaged in the following interventions: Conducted ongoing provider education; (2) emphasized vaccination during resident precepting; (3) provided signage in patient; (4) nursing and provider areas; (5) held vaccination clinics; and (6) developed a nurse-driven vaccine protocol. After the flu season, we reviewed our office data to determine vaccination rate in our patient population and compare it to the national vaccine rate data available through the CDC. In addition, we compared our clinic vaccination rate to similar settings to determine whether participation in CDC surveillance had an effect on vaccination rate. With the assistance of the information technology Department, practice reports were generated for the seasons 2018–2019 and 2019–2020, and the data were analyzed accordingly.

Results: Our hypothesis proved correct in that participation in CDC surveillance and aggressive educational offering for both providers and patients did improve vaccination rates. Overall, our clinic vaccination rates increased by an average of 6.2% over the 2 years studied. This is compared to a Pennsylvania overall increase of 2% for the same period. However, vaccination rates in our population were significantly lower than Pennsylvania rates, both for minority and nonminority patients. In contrast to Pennsylvania and national trends, there were no differences in vaccination rates between minority and nonminority populations in our clinic.

Conclusion: We postulate our findings to be due to biopsychosocial stressors in our urban population, including under-education, poverty, mental health diagnoses, and multiple life traumas and adverse events. We plan to conduct a focus group with our patients who did not receive the vaccine to help elucidate possible social determinants of health and develop a plan for the next flu season.

  Abstract Number 2 Top

The Impact of COVID-19 on Medical Students and Their Perceived Barriers

J. Paster1, S. I. Rutherford1, R. K. Jeanmonod1, H. A. Stankewicz1

1Residency/Fellowship Program: Emergency Medicine Residency, St. Luke's Richard A. Anderson Campus, Easton.

Keywords: Barriers, COVID-19, pandemic, residency, students

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has had significant repercussions on U.S. medical students preparing to enter the residency match, both personally and professionally. The objective of this study was to explore these repercussions and assess perceived barriers imposed by the pandemic on medical students applying to residency in 2020.

Methods: This is a cross-sectional study of all applicants invited and choosing to interview at a single emergency medicine residency. Applicants answered a standardized question (“what were the biggest barriers to you this year as a result of COVID-19, whether personally or professionally?”) which was asked by one of two faculty members who, between them, interviewed 100% of applicants at the residency program. Faculty members entered applicant responses into a standardized Excel spreadsheet and de-identified the data. Data were then reviewed and categorized by trained, blinded investigators using grounded theory methodology. Data reviewers were not involved in the interview process, nor were they involved in candidate selection. Basic demographic information was obtained, including geographic region of medical school and sex. Data were analyzed using descriptive statistics and Fisher Exact. The study was reviewed by the Institutional Review Board and found to be exempt.

Results: Over 900 applications were received, and 199 applicants interviewed for positions in the residency program. Applicants were chosen through routine methods, and this study had no impact on candidate selection. 32.2% of interviewees were female, 67.3% were male, and 1 was not recorded. In terms of impact on their professional lives, over a third of students felt that their education had lagged as a result of the pandemic (36.7%), and 22.1% expressed concern for inability to perform at their audition rotations. In their personal lives, the biggest impacts of COVID-19 were feelings of isolation (36.3%), feelings of frustration and helplessness (9%), concerns about personal safety (4.5%), and general fear and worry (4%). Male and female applicants responded similarly in all categories except in feelings of frustration and helplessness, in which female applicants were much more likely to express those feelings than male applicants (18.8% vs. 4.5%, P = 0.002).

Conclusion: Medical students applying to residency perceive significant personal and professional disruption as a result of the COVID-19 pandemic. The most common personal barrier reported was isolation, while impact on education was the biggest professional concern. Women expressed feelings of frustration and helplessness more frequently than men.

  Abstract Number 3 Top

Typing Speed and Accuracy as Neurocognitive Measures of Emergency Medicine Physician Fatigue

P. Salen1, P. Gould1, F. Ghattas1, J. Stoltzfus1, H. A. Stankewicz1

1Residency/Fellowship Program: Emergency Medicine Residency, University Hospital Campus, Bethlehem.

Keywords: Accuracy, neurocognitive, provider fatigue, typing speed

Introduction: Fatigue impairs performance and productivity and escalates the risk of accidents and injuries. Fatigue impairs the ability to think clearly and impacts the capacity of personnel to gauge their own level of debility. An objective tool to screen for physician fatigue would promote a culture of safety. Typing is an important task in the electronic medical record era. Typing speed and accuracy have been used as a neurocognitive screening tool for fatigue. This study assessed the impact of shift and time of day on emergency resident physician typing speed and accuracy.

Methods: This prospective, observational, Institutional Review Board approved, single institution study assessed a cohort of emergency medicine resident physicians' typing speed (word number) and accuracy (error number) at three different times of the day: 0900-day shift, 1600-evening shift, and 0400-night shift. Physicians were given 2 min to type one of 3 different cases representative of typical emergency medicine electronic medical records depending on the time slot. Each resident participated twice in each time slot and were assessed based on investigator availability. Typing samples were then screened for word count and number of errors. Data analysis utilized repeated measures of analysis of variance (ANOVA) to assess word count and error rates for each time slot; both analyses met the assumption of sphericity. Because of error rate skew, they were log-transformed before ANOVA and reported as medians with ranges to facilitate interpretation. Data analysis utilized SPSS version 27 (Armonk, NY, USA: IBM Corp) with P < 0.05 denoting statistical significance and no adjustment for the multiple comparisons.

Results: Investigators screened 35 subjects twice during day, evening, and night shifts. Subjects typed significantly higher mean word counts of 126.0 ± 23.5 during the day shift and 140.1 ± 24.1 during the evening shift compared to 114.2 ± 23.3 in the night shift [P < 0.001, [Table 1]]. Error rates did not significantly differ based on shift worked: Day 6 (0–28), evening 5 (0–24), and night 5 (0–21), P 0.9. Subjects were also compared based on program year [Figure 1] and [Figure 2]. Word count was higher for day and evening shifts than night shifts regardless of PGY status (day, evening, night means ± standard deviation): PGY 1 (121.4 ± 21.5, 133.1 ± 109 ± 26.8), PGY2 (131.5 ± 25.9, 140.6 ± 26.2, 119.9 ± 25.9), PGY3 (125.5 ± 24.1, 146.7 ± 20.5, 114.3 ± 17.0). Error rate was lower for PGY1 and PGY2 than PGY 3 regardless of time of day (day, evening, night) (median, range): PGY1 (3.5 [0–19], 4.0 [1–10], 5.0 [0–15]), PGY 2 (6.0 [1–26], 4.0 [0–12], 4.0 [0–9], PGY 3 (7.0 [0–28] 7.0 [0–24] 7.0 [0–2]). See [Table 1] and [Table 2] for further analytical details.

Conclusion: Physicians typed significantly faster (had the highest word count) during morning and evening shifts compared to the night shift. Shift and time of day did not significantly impact typing error rates. Subjects in their 1st year of training typed the slowest in all 3 time periods while subjects in their 3rd year of training were the least accurate. Assessing typing speed and accuracy can provide meaningful information regarding physician neurocognitive status based on time of day.

  Abstract Number 4 Top

The Use of Physician Education to Increase Compliance for Routine Care of Diabetes Mellitus during the COVID-19 Pandemic

N. Farooqui1, H. G. Levine1

1Residency/Fellowship Program: Family Medicine Residency, St. Luke's Warren Hospital Campus, Phillipsburg, New Jersey.

Keywords: Compliance, COVID-19, diabetes mellitus, physician education

Introduction: The COVID-19 pandemic created a major disruption in care delivery, especially in the family medicine setting where close, highly personalized follow-up is required to provide optimal management of chronic health conditions and health maintenance activities. In addition, pandemic-related social distancing mandates resulted in significant underutilization of available primary care and preventive resources. In this study, we sought to determine the effect of physician-driven patient education on diabetes care compliance in the setting of an active pandemic.

Methods: Patients who are hesitant to come for routine care of type 2 diabetes mellitus care due to COVID-19 will be reassured of office safety precautions and be motivated to schedule and complete appointments when contacted by their primary care physician. These patients could be “recaptured” through physician-led engagement and education. The goal was to successful recapture 50% of patients who were contacted and educated by the primary care physician. The study was performed at St Luke's Coventry Family Practice, a residency-based community clinic in Phillipsburg, NJ. A cohort of patients was identified with an electronic medical record query for diabetes performed in November 2020 for the period of January to October 2020. Patients met inclusion criteria by having a Resident Physician primary care provider, at least one office visit in the past year with no office visit in the previous 3 months. Patients were excluded if they were deceased or being managed by Endocrinology. Resident physicians were asked to call patients with a Hemoglobin A1C >9.0%. A minimum of three telephone call attempts were made. Patients were given explanations regarding the need to resume regular care for diabetes as well as information regarding COVID-19 precautions being taken in the office to protect patients and staff. Names of patients who requested a visit were given to office clerical staff for scheduling.

Results: Of the 405 patients who met inclusion criteria, 78 patients were found to have a most recent Hemoglobin A1C >9.0%. Of the 78 patients, 46 patients were successfully contacted by their physician. Of these, 34 were seen for an office visit, with a recapture rate of 74% [Table 1] As success was defined by a recapture rate of >50%, the study concluded that physician intervention was successful in educating diabetic patients regarding the importance of routine diabetic care resulting in better follow-up.

Conclusion: Limitations of this study included the inability to reach all patients via telephone with the possibility that patients may have moved or changed their telephone number. While the initial educational call was initiated by the resident physician, the scheduling call was made by clerical staff. Some patients, while educated by the resident physician, were not able to be reached for a scheduling call. With the increasing prevalence of Diabetes, the importance of routine and preventative care cannot be overemphasized. The rapport between a Family Medicine Physician and patients with diabetes can be key to improving patient compliance, outcomes, and quality of life.

  Abstract Number 5 Top

Tophaceous. Back Pain?

D. M. Reeves1, M. Salim1, O. S. Kurucz1

1Residency/Fellowship Program: Internal Medicine Residency, University Hospital Campus, Bethlehem.

Keywords: Back pain, gout, Krystexxa, pegloticase, tophaceous

Introduction: The goal of writing this case report is to contribute to the existing medical literature by adding a truly unique case. Chronic back pain is commonly encountered in the outpatient setting, as well as in the hospital. This issue can prove challenging to both patients and physicians. The underlying etiology is often at times difficult to treat and patients are often slow to embrace prescribed medical interventions. Most causes of chronic back pain are appropriately treated with interventions such as physical therapy, mild symptomatic management, and management of patient expectations. However, it is essential to keep a broad differential when approaching a patient with chronic pain in this area. We present a case of chronic back pain which had been resistant to conventional treatment approaches. The patient was found to have a unique etiology of back pain, which is now being worked up and treated more appropriately.

Case Report: A 63-year-old male with several chronic comorbidities presented to the hospital for a second opinion after declining physical therapy and occupational therapy (PT/OT) for his back pain during the previous hospitalization. Magnetic resonance imaging (MRI) of the lumbar (L) spine during initial stay showed mild canal stenosis L4-5, moderate right foraminal stenosis L5-S1 with right L5 nerve root impingement. An incidental posterior 1.5 cm synovial cyst at the right facet joint L4-5 was noted at that time, without evidence of infectious pathology. Neurosurgery performed further diagnostic work-up, and declined to intervene during the inpatient stay. The patient was advised to undergo PT/OT treatment, which he declined. The patient presented again for a second opinion after suffering from increasing ambulatory dysfunction at home. MRI was repeated during the most recent hospitalization demonstrating chronic findings, as well as edema and enhancement present within and adjacent to the right L4-5 facet join concerning for septic arthritis [Figure 1]. Given elevated c-reactive protein and erythrocyte sedimentation rate, and recent spinal epidural, aspiration of the dorsal extraspinal synovial facet cyst was recommended. Patient did undergo needle biopsy performed by his neurosurgeon on day three of hospitalization. Three mL of white caseous material were aspirated from the patient's right L4-5 facet joint. Crystal analysis demonstrated positive monosodium urate crystals. The uric acid level was checked, with its final result as 12.6. The patient was given colchicine, and rheumatology was consulted. The patient was worked up by rheumatology while inpatient, with plans to start allopurinol as well as for outpatient administration of Pegloticase. Patient's allopurinol was discontinued outpatient due to intolerable side effects.

Discussion and Conclusion: Thorough workup for recurrent chronic back pain is essential. Keeping a broad differential helps ensure a patient receives the correct diagnosis and therefore, the correct treatment. Our patient would not have realized significant benefits from PT/OT management of his gout-induced back pain. Thanks to further workup, the correct diagnosis was reached. The patient will need to follow-up with rheumatology to receive appropriate long-term treatment of his pathology. With aggressive rheumatologic management, he should continue to improve and regain function. This case highlights the atypical ways in which gout can present. Typically involved joints include 1st metatarsophalangeal (MTP), other MTP joints, ankles, knees, occasionally the fingers. Common areas for tophi to form include the pinna, olecranon bursa, Achilles tendon. Presentation with isolated back pain secondary to tophaceous gout is certainly uncommon but illustrates the need to keep a broad differential diagnosis when working up and managing patients.

  Abstract Number 6 Top

Case Report: A Rare Cause of Painless Lateral Knee Swelling

K. R. Diller1, S. J. Bogdan1, M. P. Vikram1, W. R. McCafferty1

1Residency/Fellowship Program: Orthopaedic Sports Medicine, University Hospital Campus, Bethlehem.

Keywords: Cyst, gastrocnemius, knee, swelling, ultrasound

Rationale: This case represents an exceedingly rare cause of atraumatic, painless lateral knee swelling. Intramuscular ganglion cysts of the lateral head of the gastrocnemius muscle are inherently rare. A literature search reveals that the medial head of the gastrocnemius ganglion cysts are more commonly involved. This case also highlights the utility of office-based diagnostic ultrasound in guiding decision making and diagnostic efficacy.

Case Report: An otherwise healthy 39-year-old male college track and field coach presented to sports medicine clinic with a 2-year history of left lateral knee swelling. He denied a history of trauma, internal knee derangement or surgery. The swelling had increased in size over the previous several weeks leading to his initial evaluation. There was no pain, overlying skin changes or obstructive symptoms. An office based limited lateral knee ultrasound [Figure 1] revealed a multilobulated lesion measuring 3.25 cm × 2.6 cm × 1.32 cm, with areas of hypoechogenicity and compressible cystic change. An magnetic resonance imaging confirmed the diagnosis of a complex ganglion cyst of the lateral gastrocnemius [Figure 2]. This case represents an exceedingly rare cause of asymptomatic extraarticular knee swelling secondary to a ganglion cyst involving the lateral head of the gastrocnemius muscle.

Conclusion: Due to the painless and loculated nature of the ganglion cyst, a shared informed decision was made to forego aspiration or surgical treatment. He was instructed to follow-up in 6 months or sooner if needed. The plan was to consider aspiration vs. referral for excision if the lesion became painful. The patient was instructed to return to running and coaching as tolerated. At a 6-month follow-up, he did not experience an increase in size, pain, or limitation of functional capacity. The decision was made to continue with conservative care.

  Abstract Number 7 Top

Case Report: Rhombencephalitis

S. Y. Kim1

1Residency/Fellowship Program: Neurology Residency, St. Luke's Richard A. Anderson Campus, Easton.

Keywords: Anti-GRAF1 antibody, autoimmune, cerebellum, idiopathic, rhombencephalitis

Rationale: Rhombencephalitis is an uncommon condition. It can present in the inpatient setting with diverse etiologies, the majority of which fall into autoimmune, infectious, and paraneoplastic types. Among autoimmune causes, the most common is Behcet's Disease. For infectious causes, the most common cause is Listeria. However, it is not always clear what the exact etiology for rhombencephalitis may be, as outlined in this case report.

Case Report: A 50-year-old female who does not follow up with healthcare providers and has no documented past medical history, presents with stroke-like symptoms including severe ataxia, photophobia, slow speech, dizziness. No apparent cancer history, autoimmune history, infectious history. PE was significant for nystagmus, truncal and appendicular ataxia, loss of coordination, slow/slurred speech. Computed tomographic angiography did not show findings of significance, but magnetic resonance imaging (MRI) is positive for diffuse edema of bilateral cerebellum significant for rhombencephalitis [Figure 1]. Lumbar puncture was proceeded with a wide variety of cerebrospinal fluid labs drawn. White blood cell count, red blood cell count, glucose, protein labs were unremarkable. Autoimmune labs showed normal antinuclear antibody but elevated SSA. Paraneoplastic labs did not support malignancy as a contributory factor. At this point, rhombencephalitis differential diagnosis continued to be broad due to unclear clinical history and laboratory work. Based on our work-up, differential still included idiopathic or autoimmune etiology for rhombencephalitis. Management of rhombencephalitis initially started with anti-inflammatory management consisting of 5 days of corticosteroid administration, which did not alleviate the clinical condition. Intravenous immunoglobulins for a total of 5 days and plasmapheresis for 5 days were also subsequently initiated. Of note, clinical course did improve with plasmapheresis and repeat MRI showed resolution. Postdischarge, the patient continues to stabilize while on a prednisone taper. However, the patient also required additional hospitalizations for continued ataxia. Most recently, anti-GRAF Ab positivity was also detected, with further work-up ongoing.

Conclusion: Clinical progression, course, and understanding of rhombencephalitis presents both a diagnostic and a therapeutic challenge. It is not an immediate and straightforward diagnosis. Many common labs for the disease came back negative except for SSA, which was not convincing for autoimmune causes. Paraneoplastic causes and infectious causes seemed unlikely. With possible positive findings of Anti-GRAF there may be a better understanding of the etiology of the patient's inflammatory condition. With a better understanding of patient's etiology of rhombencephalitis, more effective management in terms of rhombencephalitis can hopefully be identified and implemented. The patient's treatment is currently still ongoing and hopefully more information will become available on the etiology of her condition, thus enabling more accurate and personalized clinical management. [Figure 1]. MRI scan of patient with rhombencephalitis

  Abstract Number 8 Top

Increasing Compliance with Medicare Annual Wellness Visits

A. Polsky1, C. Humphrey1

1Residency/Fellowship Program: Family Medicine Residency, University Hospital Campus, Bethlehem.

Keywords: Compliance, health maintenance, Medicare, wellness visit

Introduction: The Medicare annual wellness visit (AWV) is an excellent tool for creating personalized prevention plans for aging adults. However, ccompliance rates are poor, and previous successful methods to improve upon them have focused on patient outreach. We sought to increase compliance with AWVs at our federally qualified health center look-alikes (FQHC-LA) by 20% over a 12-month period by providing targeted patient education regarding the benefits of FQHC-LA while also increasing the awareness of the above benefits amongst our staff. After interventions including mail outreach, scripting for clerical staff, and increased provider awareness yielded a minimal increase in compliance rates, “on the fly” visits were initiated, which resulted in a much greater impact. We learned that simple interventions to improve accessibility may be effective at increasing preventive care services.

Methods: Our quality improvement project focused on outreach and education interventions with the goal to increase compliance with Medicare AWVs at our FQHC-LA. The Medicare AWV serves as a tool to create personalized prevention plans for aging adults to help reduce the incidence of morbidity and disability based on current health and risk factors. Our interventions included mailed letters to eligible beneficiaries with call to action, provision of FQHC-LA office staff with a script of verbiage to use when calling to schedule the AWV, weekly email reminders for residents and faculty to schedule eligible patients, as well as the initiation of “on the fly” AWVs for eligible patients who could be captured in the office and utilizing clinical support and other licensed providers to complete the visits. Compliance rates were monitored via the Epic Electronic Medical Record (Verona, Wisconsin) dashboard, and clinic volume was monitored considering decreased patient volumes during the coronavirus disease 2019 (COVID-19) pandemic [Figure 1].

Results: Initially, in July 2020 our baseline compliance rate was 22%. The compliance rate increased steadily with increases in clinic volumes and was 27% in January 2021. The overall program performance continued to improve, with compliance rates of eligible beneficiaries who have completed their AWV reaching 42% as of May 2021, thus surpassing the Network compliance rate of 34% [Figure 2] and [Figure 3].

Conclusion: Our results indicate that study interventions produced significant improvement in AWV compliance despite challenges due to COVID-19 precautions which resulted in diminished clinic volumes for a period during the intervention. Moving forward, we are planning for continued outreach based on patient eligibility and continuing to utilize other licensed providers within our clinic to help facilitate AWVs and continuing “on the fly” visits, where patients are scheduled for routine visit (if/when eligible) despite not having scheduled ahead of time. As a result, patients will be able to complete their AWV on the same day.

  Abstract Number 9 Top

Rare Clear Cell Hidradenoma of the Dorsal Foot: A Case Presentation

E. W. Gombosi1

1Residency/Fellowship Program: Podiatry Residency, University Hospital Campus, Bethlehem.

Keywords: Clear cell hidradenoma, hidradenoma of the foot, magnetic resonance imaging hidradenoma, pathology hidradenoma

Rationale: Clear cell hidradenoma (CCH) is a relatively uncommon tumor, being exceedingly rare in the anatomic region of the foot. CCHs are most commonly found on the scalp, face, anterior trunk, and proximal limbs. The tumor is most likely benign and is typically treated with complete excision. We report a case of CCH in a 34-year-old female who presented with a solitary raised lesion on the dorsal foot. Few reports are available in recent literature, with notable paucity of sources describing this type of tumor in the pedal region. The following is a single case report including a brief review of presentation, imaging, pathology, and treatment regarding the presentation of clear cell hidradenoma of the foot.

Case Report: A 34-year-old female presented to the clinic with a chief complaint of pain and lesion to the top of her right foot. The patient stated that about 1 year ago, a small bump developed on the dorsum of the right foot and has been slowly growing since then. Lesion was initially nonpainful; however, at presentation, pain is rated at 8/10 and worsened with shoe gear and ambulation. The patient noted drainage, tingling, and swelling to the area. The patient denied trauma to the area. No radiographs were taken, and no specialist seen prior to this initial visit. The patient is a current every day smoker. Medical history was remarkable for class 2 obesity (BMI 36–36.9). Family history, past surgical history, medications, allergies were otherwise negative. Review of systems was otherwise negative.

On physical examination, the patient was noted to be healthy appearing with normal body habitus and mild obesity. Pedal examination was within normal limits except for a mass to the dorsum of the right foot, measuring approximately 4.8 cm in diameter. Surrounding skin was intact to the foot, without any clinical signs of infection. The patient had pain on palpation of the soft-tissue mass. There was also noted to be mild hypermobility of raised lesion, irregular borders, red [Figure 1]. A magnetic resonance imaging was ordered at the initial visit, showing 42 mm x 15 mm x 34 mm superficial skin lesion with only mild rim enhancement on postcontrast images, highly suggestive of skin cyst [Figure 2].

Following the MRI results, it was decided that the best treatment course would be surgical excision with biopsy of the right dorsal foot. Intraoperative findings included a large growth superficial to deep fascia with multiple blood vessels noted during dissection. The mass was noted to be well vascularized without muscle, major artery or nerve involvement. The lesion was excised in a 3:1 manner with primary closure and sent to pathology in formalin. Pathology report revealed focal cytologic atypia (reactive atypia secondary to irritation is favored), examined margins uninvolved, negative for malignancy. Final diagnosis was determined to be hidradenoma with clear cell features.

Postoperative course was complicated by mild cellulitis, which was treated with oral antibiotics. The patient also had mild surgical site dehiscence secondary to trauma, which was treated with local wound care. The surgical wound was fully healed with no residual pain or edema at postoperative day #48. Scar reducing cream was prescribed for the associated scarring. The patient had the final postoperative visit one month later at which time the wound was fully healed [Figure 3].

Conclusion: Clear cell hidradenoma is a relatively rare, mainly benign (but occasionally malignant) tumor originating from the epithelial matrix of the ductal/poral segment of eccrine or apocrine sweat glands, the majority being immature eccrine sweat gland tumors. Our current case report describes a relatively rare location for a clear cell hidradenoma of the dorsal foot, including initial presentation, advanced imaging, and pathology assessment with surgical excision for condition management. In conclusion, although clear cell hidradenoma is a rare disorder in the foot, our patient was able to fully heal with surgical resection. This allowed the patient to go back to a normal, active, and pain-free lifestyle.

  Abstract Number 10 Top

Fibular Cortical Break in Collegiate Athlete: Ultrasound for the Assist

S. J. Bogdan1, M. P. Vikram1, W. R. McCafferty1, K. R. Diller1

1Residency/Fellowship Program: Orthopaedic Sports Medicine (University Campus, Bethlehem).

Keywords: Athlete, diagnosis, fracture, knee, ultrasound

Rationale: The importance of in-office ultrasound diagnostic scanning has just recently begun to be elucidated in case reports and research. In our case the ultrasound assessment was diagnostic of less common pathology, which was able to be treated appropriately, while waiting for formal magnetic resonance imaging (MRI) to be completed. This allowed the patient additional days of nonweight bearing status, which expedited his treatment plan. Having physicians trained in diagnostic ultrasound assessments can provide immediate care with informed treatment beyond just history, physical exam, and initial.

Case Report: A 19-year-old male collegiate soccer athlete presented to our sports medicine office for evaluation of his acute left knee pain. Five days prior while playing he was struck from behind landing forcefully on to his left knee. His pain was over his medial knee. He denied swelling but noted a small abrasion on his lateral knee. He denied popping, clicking, or catching sensations. He has no previous history of left knee injuries or surgeries. Lastly, with the help of his ATs he was provided with crutches and a hinged knee brace, which helped him to ambulate after injury. Formal diagnostic imaging is shown in [Figure 1]. Point-of-care ultrasound demonstrated evidence of a fibular cortical break or “stress fracture” [Figure 2].

Discussion and Conclusion: A study of 320 athletes with stress fractures revealed the most common bone injured was the tibia (49.1%), followed by the tarsals (25.3%), metatarsals (8.8%), femur (7.2%), fibula (6.6%), pelvis (1.6%), sesamoids (0.9%), and spine (0.6%) 1. Suspected stress injuries are assessed initially with a plain radiograph; however, symptoms and signs precede the appearance of radiographic findings by week 2. MRI becomes the most sensitive and gold standard for diagnosis. Our athlete was initially treated with limited and partial weight-bearing with the assistance of a total range of motion brace and axillary crutches. With the help of his on campus athletic trainers, he was able to work on ROM and quadriceps strengthening efforts. He followed up after 6 weeks and had significant improvement. He progressed well with significant improvement in pain. He was fully weight-bearing without discomfort, no longer requiring the use of the knee brace at 6 weeks from injury.

  Abstract Number 11 Top

Exercise as Medicine

S. J. Bogdan1, M. P. Vikram1, W. R. McCafferty1, K. R. Diller1

Residency/Fellowship Program: Orthopaedic Sports Medicine, University Hospital Campus, Bethlehem.

Keywords: Body mass index, exercise, physical, prescription, vital sign

Introduction: Health benefits of exercise are indisputably far-reaching and extensive. Physical activity can lower the risk of cardiovascular disease, type 2 diabetes, metabolic syndrome, and several cancers. In addition, exercise can improve quality of life metrics, reduce the risk of osteoporosis, and improve pain associated with arthritis and other rheumatologic conditions.

The hypothesis of the current study was that exercise counseling from a physician could serve as a catalyst to motivate patients to increase physical activity. Weight loss metrics were evaluated as secondary endpoints. It was our intention to evaluate the practicality of incorporating the “exercise as vital sign” within our healthcare system.

Methods: The benign and common practice nature of our intervention qualified for IRB exception, which was obtained prior to proceeding. The study design started with identifying individuals 18 years of age and older who had a body mass index of 25 or greater. We then proceeded to counsel them regarding weekly exercise goals and provide an exercise prescription (see ACSM exercise prescription). Preintervention data collection involved office visit height, weight, and body mass index (BMI) measures as well as utilizing the ACSM's “Exercise is Medicine” summary sheet. This asked patients two questions: “On average, how many days/weeks do you engage in moderate to vigorous PA (like brisk walking)?” and “On average, how many minutes do you engage in PA at this level.” This allowed our authors to calculate the patient's total amount of activity per week in minutes. Postintervention data collection involved our researchers calling the patients after at least 1 month had lapsed and asking their new amount of exercise per week in minutes and their updated weight. The entire process spanned about 5 months.

Results: Forty-five patients were surveyed. A total of 21 patients responded to follow-up calls. This included 2 male and 19 female responders. Of the respondents, preintervention BMIs included 4 overweight individuals, 4 obese class I individuals, and 12 obese class II or above. Postintervention BMIs included 4 overweight individuals, 3 obese class I individuals, and 13 obese class II or above. Before intervention, of those who responded 13 participated in 0–49.9 min of exercise per week, 4 participated in 50–99.9 min of exercise per week, 1 participated in 100–149.9 min of exercise per week, 1 participated in 150–199.9 min of exercise per week, 1 participated in 250–299.9 min of exercise per week, and 1 participated in 400–449.9 min of exercise per week. Postintervention exercise in minutes per week included individuals in the following categories: 9 in the 0–49.9 min per week group, 3 in the 50–99.9 min per week group, 4 in the 100–149.9 min per week group, 1 in the 200–249.9 min per week group, 1 in the 300–349.9 min per week group, and 3 in the >500 min per week group. Of those who responded, a total of 5 individuals (23.8%) who previously did not exercise at the ACSM's weekly recommended minimum increased their activity to this level or above. A total of 12 respondents (57.1%) increased activity by 25% or started exercising when previously sedentary, and 47.6% experienced weight loss.

Conclusion: These findings suggest that the combination of both formal exercise counseling and exercise prescription may encourage patients to increase activity level. The implication is that we, as clinicians, may serve as the catalyst to potentially improve the health and quality of life of our patients. Incorporating the “exercise vital sign” into both our medical record and patient notes could serve as an efficient means to aid clinicians in broaching the topic to create positive outcomes.

  Abstract Number 12 Top

Efficacy of Continuous Use Disposable n95 Masks in Clinical Practice in the Emergency Department

L. Rivard1, J. M. Pester1, K. McMahon1, V. Balakrishnan1, R. Check1, D. Jeanmonod1, R. K. Jeanmonod1

1Residency/Fellowship Program: Emergency Medicine Residency, University Hospital Campus, Bethlehem.

Keywords: Continuous use, emergency department, fit testing, N95 masks

Introduction: During the 2020 COVID-19 pandemic, many emergency departments in the United States initiated continuous use of N95 disposable respirators rather than disposing of respirators after each patient encounter in order to conserve personal protective equipment (PPE). This study investigates the efficacy of wearing disposable n95 respirators continuously throughout an ED shift using qualitative fit testing as a measure of appropriate mask seal and function.

Methods: This is a prospective cohort study at a single level I trauma center of ED staff required to wear respirators continuously throughout their shifts during the COVID-19 pandemic. Subjects were doctors, nurses, and technicians and enrolled in the study on a voluntary basis over the course of the 6-week duration. Subjects were previously fitted for their assigned respirator by employee health per hospital policy, and personnel that failed this initial testing were excluded from the study. Investigators enrolling subjects were trained to perform qualitative fit testing using OSHA guidelines. Subjects were fit tested periodically throughout their shifts by investigators. At any time a mask failed, it was replaced. Investigators filled out a questionnaire for each subject enrolled, noting the type of respirator and hours of continuous wear that shift, as well as subjective sense of seal security. As subjects were working clinically, no attempt was made to modify their on-shift behavior regarding taking breaks or donning/doffing for nourishment or hydration. Data were analyzed using descriptive statistics. The study was approved by the Institutional Review Board.

Results: Seventy disposable N95 respirators were evaluated using qualitative fit testing while on shift in the ED, with 15 failures at first testing. These masks were not retested, and the subjects received new masks. Sixteen masks passed at the start of a shift (time zero) and did not have repeat testing during the course of the shift. These were excluded from further analysis. Eight masks passed testing after several hours of continuous wear but only had a single fit test done partway or at the end of a shift. These were assumed to have passed if tested at shift start and were assigned as “passes” for continuous use. Thirty-three disposable N95 masks had an initial pass and were evaluated for continuous use, of which five subsequently failed fit testing later in the shift, giving a fail rate with continuous use of 12%. Of the 20 failed fit tests, the subjects documented that they believed their seal was adequate in 14 cases (70%).

Conclusion: Continuous use of disposable N95 masks throughout an ED shift is reasonable during a PPE shortage if wearers are assured of fit at the start of their shift. However, passing on initial fit testing is not a guarantee that wearers will pass again later in their shift. Mask wearers have little insight into the adequacy of fit.

  Abstract Number 13 Top

Sleep Time and Characteristics Measured using Fitbit Devices in Emergency Medicine Residents

L. Rivard1, S. W. Melanson1, H. A. Stankewicz1, K. A. Morley1

1Residency/Fellowship Program: Emergency Medicine Residency, University Hospital Campus, Bethlehem.

Keywords: Emergency medicine, Fitbit device, residents, sleep time

Introduction: Sleep is an integral part of both physical and mental well-being. We sought to quantify and characterize the sleep of emergency medicine (EM) residents training at a level one trauma center. This study sought to determine sleep-related characteristics using specialized portable electronic (Fitbit) devices.

Methods: This study was an IRB approved, prospective, observational study that assessed EM residents' objective sleep data obtained from a Fitbit. EM residents gave consent to participate in the study. A Fitbit Charge 3 device was given to each resident and they were asked to wear the Fitbit at all times, except for a brief period required for weekly charging of the device. The Fitbit automatically tracks time in bed, total sleep time, and time spent in light, deep, and REM sleep. The study was conducted over a 3-month period. The data from each Fitbit was automatically synced to a database, Fitabase. Each resident was identified by a subject number and their identity was hidden from investigators. Data were interpreted using descriptive statistics, first taking the median time for each subject and then the mean for the group. Median times overall for female and male subjects were compared using a two-tailed t-test.

Results: Fitbit sleep data were collected for 33 EM residents over a 3-month period, 10 female and 23 males. The average median sleep time per night was 423.1 min (7.1 h), 450.1 for females and 411.4 for males (P = 0.0063). In total, 18 participants had a median nightly sleep time of <7 h (54.5%), only two subjects had a median sleep time of <6 h (6.1%), and there were no subjects with a median sleep time of <5 h. The average median REM time nightly was 85.7 minutes, 93.3 for females and 82.3 for males (P = 0.087). The average median time spent in bed while awake was 56.5 min, 62.9 for females and 53.7 for males (P = 0.0064). This value represents the total latency, defined as the time it takes the subject to fall asleep as well time spent awake between sleep phases. In that regard, it may be used as a marker for poor sleep quality or difficulty initiating sleep.

Conclusion: Although the average median sleep time in our EM residents is 7.1 h, more than half of our residents had a median sleep time of <7 h nightly. Comparatively, only 35.2% of adults in the United States sleep <7 h nightly per 2014 CDC data. Females had statistically significant higher average median sleep times and total sleep latency. EM residents, in particular, are at risk for poor sleep hygiene given the predominance of shift work, which may be one reason many of our residents had a median sleep time of <7 h nightly. For residents, especially, paying attention to sleep amount and adequacy may be an important wellness tool to promote both physical and mental health.

  Abstract Number 14 Top

Pain Reduction in Symptomatic Arthritic Ankle Joints after Bone Marrow Aspirate Concentration and Amniotic Injections

K. Patel1, Z. T. Ritter1

1Residency/Fellowship Program: Podiatry Residency, University Hospital Campus, Bethlehem.

Keywords: Amniotic membrane injections, arthroscopy, biologics, bone marrow aspirate concentrate, osteoarthritis

Introduction: Ankle osteoarthritis (OA) is a degenerative disease characterized by progressive deterioration and loss of articular cartilage with concomitant structural and functional changes in the joint. Conservative treatments include rest, PT, nonsteroidal anti-inflammatory drugs and corticosteroid injections. The use of biologics injection is gaining increased popularity to address OA-related symptoms. Bone marrow aspirate concentration (BMAC) and human amniotic membrane graft are increasingly used as an injective treatment in OA, with the rationale of its chondro-regenerative property. The primary aim of this study was to evaluate the efficacy of pain reduction in symptomatic arthritic ankle joints after intra-articular BMAC and amniotic membrane injections postankle arthroscopy.

Methods: A total of 32 patients diagnosed with degenerative ankle arthritis were retrospectively evaluated and treated with isolated arthroscopy (Control Group), arthroscopy with BMAC or human amniotic membrane intra-articular injections at a single study center. Kellegren-Lawrence grade was used for assessing the radiologic degree of OA, whereas Outerbridge classification was used to assess direct visualization of the cartilage of ankle joints. BMAC from the calcaneus was aspirated/concentrated and injected into the ankles with standardized technique postankle joint debridement. Cryopreserved human amniotic membrane was injected into the respective ankles using standardized technique postankle joint debridement. Patients were evaluated preoperatively, immediate postoperatively, 3 months, and 1 year postoperatively using the visual analogue scale (VAS) score. Due to the small and imbalanced samples, as well as the ordinal nature of our outcomes, we conducted separate Kruskal Wallis tests to evaluate median pain scores preoperatively, immediate postoperatively, and 3 months postoperatively using SPSS version 25 (Armonk, NY: IBM Corp.). One-year pain scores were presented descriptively due to the very small subgroup samples from lost to follow-up.

Results: From preoperatively to 1 year follow up the median VAS score decreased 5 to 1 in the control group, 5.5 to 2 in BMAC group and 6 to 3 in the human amniotic membrane group. The statistical analysis revealed a significant reduction in the pain at 1-year postoperative follow-up in each group. However, the differences in median pain scores were not significantly different between each group immediately following surgery, 3 months postoperatively or at 1-year follow-up.

Conclusion: This study calls into a question that the use of biologics in providing pain relief in arthritic ankles may not be as effective as other larger joints. The limitation of this study is the low sample size and loss of follow-up with more than half of the patients at 1 year postoperatively. Therefore, further clinical research is needed to further demonstrate the efficacy of BMAC and human amniotic membrane injections in the treatment of symptomatic ankle OA.

  Abstract Number 15 Top

Implementation of an e-Learning Platform to Supplement Family Medicine Residency Didactics for Board Exam Preparation

S. B. Matza1, K. Sheth1, C. McGinley1

1Residency/Fellowship Program: Family Medicine Residency/Rural Training Track, St. Luke's Miners Campus, Coaldale.

Keywords: Board exam, e-learning, residency

Introduction: To keep up with the constantly changing state of medicine, residency programs should seek out ways to improve access to the most current and relevant information and accommodate different learning styles. The traditional model of residency didactics consists of lectures given by faculty, specialists, and other residents. This model does have some drawbacks. Residents may be off-site or working shifts that prevent them from attending lectures. Lectures are notoriously a passive form of learning. In addition, small residency programs may have fewer choices of lecturers available for presentation. The addition of a web-based e-learning platform to supplement existing didactics could help address these issues by improving access to educational material, broadening the information presented, or by accommodating learning styles better suited for independent reading and answering questions.

Methods: With input from our program director, faculty, and residents, we selected an e-learning platform to implement for the 2019–2020 academic year. The chosen product consisted of weekly assigned readings and quizzes. Resident completion reports were tracked, however performance on quizzes was not monitored. Scores on the in-training examination (ITE) were analyzed, comparing the class average score to the national average for each PGY level, for the year before the curriculum was introduced and the year after. Z scores were calculated to quantify the difference between class performance and national average. Individual resident scores were not examined in the interest of maintaining resident privacy. A survey was conducted using REDCap to collect additional information on the residents' experience using the platform and see what other resources were being used to study.

Results: We hypothesized that integration of an e-learning platform would improve resident performance on the annual ITE when comparing PGY class average scores to the national mean. Class average scores were utilized to protect individual resident privacy. For the class of 2021, the initial ITE average score (461) was very near the national average (463) in 2019, and in 2020, the ITE average score (497) was above the national average (485). For the class of 2022, initial ITE average scores in 2019 revealed a result (381) which was below the national average (414), and in 2020 revealed an average ITE score (401) which was below the national average (447). Calculated Z scores for the class of 2021 were −0.03 before e-learning integration and 0.15 after. The class of 2022 scored -0.48 before e-learning integration and −0.61 after. Compared to the national average for each PGY class, the class of 2021 performed better after integration of the e-learning platform and the class of 2022 performed worse. These results were not statistically significant.

Conclusion: There were many confounding factors to consider in our study, including the COVID-19 pandemic forcing a didactics transition to a virtual platform halfway through the year. Based on survey results, residents utilized several other resources including question banks, review books, and board review courses. Performance on weekly quizzes were also not monitored and could have been done for the sake of completion. Finally, due to small class sizes and in the interest of protecting resident privacy, individual score changes between years could not be analyzed. Only 3 of 20 residents who participated would subscribe to the e-learning platform again. Resident feedback indicated that while the structure of this e-learning platform was helpful to direct studying, most preferred more self-directed learning with resources of their choosing. Given the lack of significant improvement across classes and less than favorable reviews from residents, the e-learning platform subscription was not renewed

  Abstract Number 16 Top

Too Little Time to Catch Your Breath: A Case Report

M. Salim1, D. Reeves 1, F. Jaffari 1

Residency/Fellowship Program: Internal Medicine, University Hospital Campus, Bethlehem

Keywords: Myositis, Dermatomyositis, Interstitial Lung Disease, Melanoma Differentiating Associated gene 5 Antibody (MDA-5 AB), Rapid Progressive Respiratory Failure

Introduction: A 68 year-old male with a hx of hyperthyroidism on methimazole and recent new onset arthralgias, fevers, unintentional weight loss about 30lbs, weakness, non-productive cough for the last 6 weeks who presented to the ED 1/16/21 w progressive SOB x1 week, high grade fever, hypoxia spO2 in 50s requiring nearly immediate intubation and pressor support. As an outpatient, initial concerns for COVID-19 infection prompted testing which ultimately was negative on 11/21/20. Outpatient labs 12/19 revealed PLTs 145, BUN 19, Cr 1.23, eGFR 60, AST 180 IU/L, ALT 105 IU/L, glucose 58, ProBNP 94, ESR 55, Positive ANA (1:80 homogenous, 1:80 speckled), positive RA latex turbid 15.4 units, negative CCP Ab, serum uric acid 4.2, EBV IgG, negative IgM [Table 1]. These results prompted further autoimmune workup laboratory testing [Table 2]. Repeat COVID-19 PCR was negative on 12/21. Patient presented to ED 12/29 complaining of progressive severe bilateral LE weakness and stiffness. CTA chest notable for moderate patchy consolidation and GGO in the dependent juxtapleural upper and lower lobes [Figure 1]. Repeat COVID-19 PCR, Influenza A/B, RSV testing was negative. Instructed to f/u with rheumatology and PCP.

Pt evidently re-presented to the ED on 1/16. VS: T 103F, BP 115/79, HR 141 sinus rhythm, RR 33, SpO2 50% on RA and 77% on NRB. On physical exam, acutely distressed, using accessory muscles, dyspneic with speech, diaphoretic, tachypneic, diminished breaths B/L. otherwise unremarkable exam. Pt was admitted to the ICU and aggressive support and treatment was started.

On autopsy, the lungs results demonstrated acute and organizing diffuse alveolar damage with numerous hyalin membranes, edema, and polyps of organizing pneumonia. This is compatible with acute bronchopneumonia superimposed. A significant inflammatory cell infiltrate is not appreciated. No active vasculitis is identified. There are no granulomas or necrosis. There is no vasculitis. Findings are suggestive of chronic underlying fibrotic interstitial lung disease.

Conclusion: The myositis panel resulted with a high positive titer antibody for the melanoma differentiation-associated gene 5 (MDA-5 AB), consistent with the patient's diagnosis of MDA-5 associated interstitial lung disease with rapid progressive respiratory failure. This subtype of myositis usually portends aggressive features and can be difficult to treat if not initiated promptly. Despite our patient being treated with IVIG, high dose steroids, and broad-spectrum antibiotics, the patient unfortunately passed away. Lung autopsy results were consistent with interstitial lung disease given chronic underlying fibrosis. Special attention should be drawn to cases such as this to better diagnose and treat patients with rare autoimmune diseases, especially ones with a rapid progressive course.


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Conflicts of interest

There are no conflicts of interest.

Content inclusion

Please note that due to subsequent knowledge dissemination plans, including content submission to other journal(s) and scientific meeting(s), not all abstracts presented during the 2021 St. Luke's University Health Network Research Symposium are included herein.

Ethical conduct of research

All research projects presented during the St. Luke's University Health Network Annual Research Symposium were verified to have either appropriate Institutional Review Board approvals or exemptions. For case reports, proof of appropriate patient consent documentation was required. In all instances, appropriate EQUATOR guidelines (see https://www.equator network.org/reporting guidelines/) for scientific reporting were followed.


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