Category Archives: Educational Resources

Seldin Symposium 2017

On May 4th, we held our 2nd annual Donald W. Seldin, MD Research Symposium showcasing the scholarly work of our housestaff.

Over 85 Interns, senior residents and fellows from the various Internal Medicine departments presented their work. The breadth and depth of the work was outstanding! Poster were presented on May 4th with judging taking place that afternoon. We thank all our judges, including our guest Grand Rounds speaker Dr. Rabinovitch (Stanford University) for joining us in the judging process. After intense probing into each poster and researcher’s work, the adjucation committee selected six finalists: our six Foster Fellows.

After Dr. Rabinovitch’s grand rounds lecture on May 5th, the six Foster Fellows were announced and scheduled to present their work on that following Friday, May 12th.

  • Elizabeth McGehee (R2) Treatment and Outcomes of PrimaryPericardial Mesothelioma: A Systematic Review
  • Jeanney Lew (R3) Understanding the Venus and Mars Effect: Sex-Based Differences in Cardiovascular Biomarkers
  • Arjun Gupta (R3) Gastric Acid Suppression and Recurrent Clostridium difficile Infection: A Systematic Review and Meta-Analysis
  • Justin Chen (Allergy Fellow) Reflexive Penicillin Allergy Testing with In-Hospital Aztreonam Use
  • Glynnis Garry (R1)  A Twist-Dependent Progenitor Cell Contributes to Adult Skeletal Muscle
  • Jasmine Singh (R1) Homemade Silver Nanoparticle Pharmacology and Dramatic Activity in Highly Refractory Metastatic Head and Neck Squamous Cell Cancer

On May 12th, these six housestaff presented their work in a 5 minute short-oral form to the UTSW community, including Parkland, Clements and Texas Health. The D1.500 room was a packed house with great attendance from residents, faculty and researchers. Thank you also Dr. Podolsky for joining us! After 2 minutes of fast and furious questioning, including some tough questions by Dr. Helen Hobbes for Dr. Garry  and Dr. James De Lemos for Dr. Gupta – it was time for all the audience to VOTE. The audience voted using their phones and paper ballots on the winning presentation and the chosen Seldin Scholar.

While votes were actively tallied, Dr. J ohnson took a moment to present a separate award that specifically recognized research in quality of care and education at Parkland Hospital (enabled  by the Ron Anderson MD Professorship held by Dr. Carlos Girod, supported by  a donation from the Hoblitzelle Foundation​  to UT Southwestern).  Great way to our committment as a department and institution to research and care of those most in need in Dallas County.

This year’s Award for Research in Quality of Care  at Parkland Memorial Hospital went to Deepika Satish, for her project, “Prescription Practices of Pancreatic Enzyme Replacement Therapy in a Public Health System.” Her mentor, Dr. Deepak Agrawal had a number of submissions.

And then, came the Finale! Votes were in! And in a close race with votes tallied from across all UTSW sites – the 2017 Seldin Scholar was:
Dr. Glynnis Gary and her mentor Dr. Rhonda Bassel-Duby

Congratulations to all our winners – and to all the housestaff and their fabulous mentors for their submissions.

We also would like thank all those that made this event possible, including Dr. Johnson and Dr. Towler along with the extraordinary team of Chris Huang, Shannon Carver, Beni Stewart, Mikki Ames and many others!

See you all in 2018 at next year’s symposium! 

Resident Recognition!

Shout out to R1 Dr. Pokala!  You know you’re doing a great job when your attending tries to change your career path!! 🙂

“Dr. Pokala was placed on emergency residency on call for the CF/PH service. I thought he had a good attitude regarding losing a weekend day off,  he prepared as if he would continue to follow the patients for several days, asked questions, followed up on  lab test,  and I felt he gave his best for my patients.

I feel this is a sign of an exemplary resident, and I want him to know it was greatly appreciated.

I know he is interested in heme/onc, but I hope he would consider pulmonary critical care instead one day. ”

Way to go Nagendra!!

#fridayimagechallenge

54yo man with known a-fib presents to the ED with abdominal pain. You are on CCU overnight and get a call from J pod asking for help interpreting this ECG.

ECG credit Life in the fast lane

Continue reading #fridayimagechallenge

Costs and Ethics: Dr. Kaldjian

Today Dr. Kaldjian, Director of the Program in Bioethics and Humanities at the University of Iowa Carver College of Medicine and professor in the Department of Internal Medicine visited UTSW today.

After joining us at Morning Report today with resident Dr. Bryan Wilner presenting a very difficult and interesting ethical case.

Dr. Kaldjian then went on to give the Ethics Lecture during UTSW’s Update in Internal Medicine (lead by Dr. Weissler) entited “Ethics, Goals, and Role when Discussing Healthcare Costs with Patients.”

He spoke about the tension between patient-centered concerns and society-centered concerns. We were encouraged to think about which concern promotes the good of person vs. promotes justice.

Promoting the Good of Persons:

  • beneficence (one patient at a time)
  • utility (maximizing beneficience)

Promoting Justice

  • commutative: giving to each what they are due as a person (in healthcare: to each according to their need)
  • distributive: justice as fairness (similar treatment for similar cases)

Dr. Kaldjian also reminded the audience that as patient advocates, he encourages us to think about “intention.”

Some additional notes and references used in his talk. Enjoy!

Choosing your words wisely: stewardship vs. rationing

 

“Hospital-acquired bankrupcy” and a recent survey by the Kaiser Family Foundation: in order to pay the bills, what do patients?

 

 

Chest xray and Chest CT: discrepancy?

Today at #MorningReport we had a case of a common diagnosis with an uncommon presentation.

A patient with recent cancer, s/p kidney transplant on immunosuppression but now with CKDIII came into the hospital for worsening shortness of breath and a dry cough. PA+lateral chest xray showed patchy RLL consolidation with very small bilateral effusions. He was started on antibiotics for community-acquired pneumonia and no JVD, rales and trace bilateral edema.

See the initial PA/lateral CXR:

Over the next 6 hours after lying in his bed, he came significantly more tachynpenic with an ABG of pH 7.42 and pCO2 24 and pO2 56. What do you think?

Repeat portable CXR at that time. Yikes!

Looks like worsening interstitial pattern! Differentials included: 

  • Bacterial: CAP, atypical, legionella, nocardia, actino, aspiration, MRSA
  • Fungal: PCP (“fluffed out”), crypto, histo, NTMB
  • Non-infectious: metastic cancer, pneumotoxicity – COP/BOOP/eos pneumonia 2/2 Tacro or Statin or pneumonitis, PF and DAD 2/2 chemo, DAD, DAH or sarcoid
  • Hypervolemia from CKD
  • Pulmonary embolism
  • ACS, heart failure

CT scan confirmed the diagnosis!

Cause of his SOB and acute worsening? Volume!

Patient recieved some diuretics and tachypnea improved dramatically.

Dr. Meredith Greer sent these notes over from our very own, Dr. Abbara, in the Radiology Department: look at the CT chest because there you can see the bilateral pleural effusions looking much bigger as the patient is laying supine and they are sort of layered out. When the pt is getting the PA/L CXR a lot of the effusion can hide in the gutters. It is possible that while the pt was laying down he developed atelectasis on top of his effusions and when he stood upright for the plain film that his effusions went down but the atelectasis didn’t have time to open back up yet.

https://radiopaedia.org/articles/pulmonary-pseudotumour

 

 

#TodayAtMorningReport

We had a fascinating case of anemia, thrombocytopenia and hemolysis – initially we had a broad differential but eventually focusing on MAHA vs transfusion reaction.

Take a look at the graphic below as well as some slides from Dr. Nagalla discussing a Clinical-Pathology-Case recently and his diagnostic reasoning around this topic.

From Wintrobe’s Clinical Hematology 13th edition:

 

 

 

 

#fridayimagechallenge(with answers)

45yo Buddhist monk with no past medical history presents to the parkland ED with 1 week mild chest pain on exertion and palpitations. Initial ECG is shown below.

 

Continue reading #fridayimagechallenge(with answers)