HISTORY AND PHYSICAL WRITE-UP

HISTORY

Identifying Information:

Name: JB

Sex: Male

DOB: 1949

Religion: Roman Catholic

Date of Visit: 10/23/23

Source of Information: Self

Reliability: Reliable

Chief Complaint: 

rash x several years

HPI:

74-year-old Caucasian male who is dependent on some ADLs/IADLs (previously independent with all activities), with PMHx of psoriasis, BCC (2013), previous syncopal episode (2017), DJD (neck, right hand, left elbow, lower back), lumbar stenosis, HTN, HLD, lung nodules, glaucoma, BPH, and PTSD (100% service connected) was recently admitted on 10/13/23 as a Sub-Acute Rehab patient to St. Albans VA from Brooklyn VA (admitted from 10/04-10/13).

Patient presented to the Brooklyn VA Emergency Room on 10/04 stating that he had fallen and was unable to get up or call 911 for three days. Patient stated he was walking when his legs suddenly gave out and he fell on his bedroom floor, but denied syncope, hitting his head, or losing consciousness. In the ER he reported severe weakness but denied any pain. CPK was mildly elevated, patient was started on IVF for rhabdomyolysis with subsequent decrease in CPK. During hospital stay patient was noted with sustained tachycardia and hypertension, concern was raised for poor volume status versus PE. POCUS showed a non-collapsible IVC, CTA did not show evidence of PE, and EKG showed sinus tachycardia. Cardiology was consulted and determined there was no indication for beta blockers. CT head and chest X-ray were performed which showed no acute findings. CT lumbar spine showed severe lumbar stenosis and DJD, and a pelvic X-ray showed findings consistent with osteoarthritis in the bilateral hips.

Patient was evaluated today for a rash along the bilateral inguinal folds. Patient reports that he has had the rash for “many years” but it has been bothering him again for the past week. He admits to mild pruritis (4/10) and reports that he had a cream at home that he would use when the rash flared. Patient reports that he used to go to a dermatology clinic regularly but stopped going around 2018. He also used to take acitretin which he says controlled his psoriasis well, but it was discontinued in 2018. Denies fever, chills, recent changes in weight, fatigue, pain, discharge, or bleeding.

Geriatric Assessment:

ADLs: Needs assistance for dressing, bathing, ambulation.

IADLs: Needs assistance for shopping, prepping meals, house cleaning. Reports increasing difficulty with some IADLs prior to fall. Was increasingly using home delivery services for groceries due to pain with walking long distances.

Home Health Aide: Did not have a HHA prior to admission.

Visual impairment: No. History of glaucoma. Recent b/l cataract surgery (2019).

Hearing impairment: No.

Falls: Previous syncopal fall in 2017, no injuries. Subsequent echocardiogram showed impaired LV relaxation. Patient refused Holter monitor.

Assistive Devices: Did not use any assistive devices prior to admission, currently using rolling walker in VA.

Gait Impairment: Yes. Able to ambulate 400 feet with rolling walker (compared to 50 feet on admission date). Able to navigate 4 steps compared to none at admission.

Urinary incontinence: Yes, uses adult diaper.

Fecal incontinence: No.

Osteoporosis: No.

Cognitive Impairment: Mini-Cog: 5/5

Depression: PHQ-2: 0/6

Home safety issues: Lives alone in single family home. Home requires six steps to enter. No second floor. No handrails in tub or shower seat.

Health Care Proxy: His niece who resides in South Carolina.

Advance Directives: Full code.

Past Medical History:

HTN, 10/2023

lumbar stenosis, 10/2023

bilateral hip osteoarthritis, 2016

lung nodules (last LDCT in 2019), 2016

PTSD, 2015

DJD of cervical spine, 2010

BPH, 2007

chronic open angle glaucoma, 2004

HLD, 2002

psoriasis, 2002

BCC of right abdomen, 2013 (resolved)

Medications:

fluticasone 50mcg nasal spray 2 puffs bilaterally QHS for allergic rhinitis

atorvastatin 40mg PO QHS for HLD

acetaminophen 1000mg PO Q8H for pain

meloxicam 7.5mg PO daily for pain

gabapentin 200mg PO TID for nerve pain

amlodipine 12.5mg daily for high blood pressure

tamsulosin 0.4mg PO daily for BPH

latanoprost 125mcg/2.5mL one drop bilaterally QHS for glaucoma

Surgical History:

right eye cataract extraction w/ IOL implantation, 04/2019, no complications

left eye cataract extraction w/ IOL implantation, 01/2019, no complications

excision of left upper lobe lesion, 2016, no complications

electrodesiccation and curettage of right abdomen BCC, 2013, no complications

Allergies:

No known drug, food, or environmental allergies.

Family History:

Mother: deceased, age 87, cause unknown

Father: deceased, age 78, stroke

Sister: alive, age 69, hx of DM, HTN, HLD, breast cancer

Social History:

Admits to smoking up to one pack of cigarettes per day, has been smoking for the past 25 years. Denies current or past alcohol or illicit drug use. Prior to admission, typical daily diet would include cereal and fruits (banana, oranges, apples, etc.), chicken or turkey sandwich for lunch, and rice or soup for dinner. Reports not exercising due to lower back and hip pain, used to spend most of his day watching TV. Sleeps for about 6 hours every night. Lived alone in a single-family home. Never married and does not have any children. Patient served during the Vietnam War era. He was deployed from 1968-1969 as a member of the Army. Denies recent travel.

ROS:

General: See HPI.

Skin: See HPI

HEENT: Denies recent head trauma, headache, dizziness, changes in vision, eye pain/pruritis, changes in hearing, tinnitus, ear pain/pruritis, nasal obstruction or discharge, sore throat.

Pulmonary: Denies chest pain dyspnea, DOE, orthopnea, cough, wheezing.

Cardiovascular: Reports syncopal episode several years ago. Denies chest pain, palpitations, peripheral edema.

Gastrointestinal: Denies abdominal pain, N/V/D, constipation, change in appearance of stool, fecal incontinence, dysphagia.

Genitourinary: Reports urinary incontinence. Denies dysuria, flank pain, frequency, urgency, change in appearance of urine, nocturia, hesitancy, dribbling.

Nervous System: Reports lingering symmetrical weakness in upper and lower extremities but admits significant improvement compared to when he fell. Denies numbness, altered sensation, history of seizures, changes in gait, changes in alertness or memory impairment.

Musculoskeletal: Reports 3/10 sharp pain to bilateral hips that worsens with weight bearing, walking, or climbing stairs, reports 5/10 sharp lower back pain that radiates down to right posterior calf and worsens with leaning backwards, walking, or standing for long periods.

Vascular: Denies intermittent claudication, darkness or pallor of extremities, hair loss to extremities, peripheral edema, or varicose veins.

Psychiatric: Reports intermittent anxiety, especially around his health. Denies feelings of depression.

PHYSICAL EXAM

Vitals:

BP 108/74

pulse 102

respiratory rate 18

temperature 98.1 °F

SpO2 96%

height 68 inches

weight 199 pounds

BMI 30.32

General: 

alert and oriented x 3, well-groomed, well-nourished, no acute distress

Skin: 

warm and dry, well demarcated scaly erythematous plaques noted to bilateral inguinal creases, approximately 1cm x 1cm well demarcated scaly pink plaque noted around umbilicus

onycholysis and oil spots noted on fingernails, no nail pitting appreciated

HEENT:

head normocephalic/atraumatic, EAC clear bilaterally without erythema, edema, or foreign bodies, TMs visible without erythema, effusion, or bulging, cone of light visible bilaterally, visual fields intact, PERRL, EOMs intact, red light reflex present, nares patent bilaterally, minimal clear discharge noted, septum midline, oral mucosa pink and moist without lesions, full dentition, no tonsillar swelling or exudates

Heart:

regular rate and rhythm, S1 and S2 heard with no murmurs, rubs, gallops

Lungs:

clear to auscultation bilaterally, no labored breathing, no wheezes, rales, rhonchi

Musculoskeletal: 

no edema, erythema, or gross deformities noted to any joints, no muscular atrophy to palpation of bilateral upper or lower extremities

full passive and active ROM to neck, wrists, elbows, shoulders, hips, knees, ankles; crepitus appreciated with passive ROM to bilateral hips and knees

Neurologic:

Cranial Nerves:

-CN II, III, IV, VI: visual fields intact bilaterally, PERRL, EOMs intact, no ptosis noted

-CN V: senses touch to entire face

-CN VII: full range of expressions (raises eyebrows, frowns, smiles, shows teeth, puffs out cheeks), can squeeze eyes shut and resist opening, no difficulty with m/p/b sounds

-CN VIII: normal whisper tests

-CN IX, X: symmetrical elevation of soft palate, uvula midline, swallows smoothly and symmetrically

-CN XI: 5/5 strength to neck rotation, shoulder shrugs

-CN XII: sticks tongue out without deviations, no difficulties with l/t/n/d sounds

Strength:

-5/5 strength to hand grip b/l, 4/5 strength to wrist flexion and extension b/l, 4/5 strength to elbow flexion and extension b/l, 4/5 strength to shoulder abduction and adduction b/l

-3/5 strength to hip flexion and extension b/l, 4/5 strength to knee flexion and extension b/l, 4/5 strength to plantar flexion and dorsiflexion b/l

Sensation/Cerebellar Tests/Reflexes:

-sensation intact to touch on bilateral upper and lower extremities, able to localize touch

-able to perform rapid alternating movements with hands bilaterally, point-to-point ability intact bilaterally, heel to shin test normal bilaterally

-2+ reflexes to brachioradialis, biceps, triceps, patellar, and Achilles tendons bilaterally

LABS

CBC (10/06):

RBC                4.21 L

HGB               12.9 L

HCT                40.1

MCV               93.8

MCH               30.4

MCHC            32.4

RDW               12.8

PLT                 295

MPV               9.7

BMP (10/06):

GLUCOSE                 112

BUN                           21

CREATININE                       0.8

SODIUM                    136

POTASSIUM             4.5

CHLORIDE               103

CO2                            24

CALCIUM                 9.0

ANION GAP              9

EGFR                          93

Lipids (10/16):

CHOLESTEROL       171

TRIGLYCERIDES    368 H

HDL                            51

LDL                            46

ASSESSMENT/PLAN

74-year-old Caucasian male with PMHx of psoriasis and BCC (2013) recently admitted on 10/13/23 as a Sub-Acute Rehab patient to St. Albans VA for deconditioning from Brooklyn VA Hospital (admitted from 10/04-10/13 s/p non-syncopal fall) presenting with well demarcated scaly erythematous plaques to bilateral inguinal creases and umbilicus and complaints of itching and exacerbation for the past week. Patient was previously followed by dermatology (2002 to 2018) and was previously on acitretin 25mg which was discontinued in 2018. Denies fever, chills, recent changes in weight, fatigue, pain, discharge, or bleeding.

Symptoms are most likely due to exacerbation of psoriasis due to history and classic appearance on physical exam. Rule out superimposed fungal infection, also consider diaper dermatitis and erythema intertrigo. Superimposed cellulitis or erysipelas less likely due to absence of pain, edema, warmth, or purulence. No concern for BCC recurrence or other cancers at this time due to history and appearance of lesion.

#Psoriasis Exacerbation

-KOH preparation with skin scrapings to r/o superimposed fungal infection

-apply hydrocortisone 1% ointment in AM

-apply calcipotriol ointment in PM

-apply petroleum jelly after showers and PRN

-use super absorbent diaper

-dermatology consult to consider systemic treatment

#Deconditioning

-strength and endurance improving (walks further, climbs stairs compared to admission)

-continue physical therapy 5x per week

-arrange for HHA prior to discharge

#DJD/osteoarthritis/lumbar stenosis

-patient still reporting hip pain and lower back pain radiating down leg

-continue acetaminophen, meloxicam, gabapentin

-add lidocaine patch to lower back, 12 hours on, 12 hours off

-continue PT

#HTN

-BP consistently under 120/80 since admission

-consider trial off amlodipine

#HLD

-LDL well controlled

-triglycerides elevated to 368

-reinforce importance of exercise even after discharge from PT

-set a weight loss goal of 5% (~10 pounds)

-start fish oil capsules 2g PO BID

#PTSD

-not reporting any symptoms

-ensure outpatient psychiatry follow-up is in place

#Glaucoma

-not complaining of acute vision changes

-no eye exam in the past year

-schedule ophthalmology appointment

-continue latanoprost

#lung nodules

-no current respiratory complaints

-last LDCT in 2019

-schedule pulmonology follow-up

#BPH

-stable, no obstructive symptoms

-continue tamsulosin

JOURNAL ARTICLE

Systemic pharmacological treatments for chronic plaque psoriasis: a network meta‐analysis

Cochrane Database Systematic Review

Emilie Sbidian, Anna Chaimani, Robin Guelimi, Ignacio Garcia-Doval, Camille Hua, Carolyn Hughes, Luigi Naldi, Maria Kinberger, Sivem Afach, Laurence Le Cleach

This was a systematic review of 179 randomized controlled trials, and a meta-analysis was performed for 140 of those trials. The total number of participants was 62,339, and the mean sample size per trial was 348. The authors aimed to compare the efficacy between different systemic therapies in the treatment of chronic plaque psoriasis, including non-biologicals (acitretin, cyclosporine, methotrexate), small molecules (apremilast, deucravacitinib), and biologics (anti-TNF alpha, anti-IL12/23, anti-IL17, anti-IL23). Participants included those 18 years and older with moderate-severe plaque psoriasis; the mean Psoriasis Area and Severity Index (PASI) score at baseline was 20.4. The primary outcomes were the proportion of patients who achieved clear skin (PASI 90 or higher) and the proportion of participants with serious adverse events.

The biological treatments were the most effective, with a higher proportion of patients reaching PASI 90 compared to all other interventions. Infliximab (anti-TNF alpha), bimekizumab (anti-IL17), ixekizumab (anti-IL17), and risankizumab (anti-IL23) were the most effective, with no significant difference in effectiveness between the four. There were also no significant differences between apremilast, cyclosporine, and methotrexate. All drugs were more effective than placebo. There was no significant difference between any of the interventions versus placebo for the risk of significant adverse events.

SITE EVALUATION PRESENTATION SUMMARY

For my first site visit, I presented five drug cards and two history and physicals, and for the second I presented another five drug cards, a history and physical, and a related journal article. Professor Davidson was very helpful in pointing out what aspects of the history need to be included or emphasized for Long Term Care. For example, we talked about including the patient’s initial event that caused them to be admitted to LTC and how much progress has been made towards rehabilitation, even if their admitting condition was not related to the present complaint. She also encouraged me to tell the story in chronological order versus mentioning something in the beginning and then expanding on it later, which should be more easily understood by any readers. One last thing we discussed was giving a little background to justify my plan. For example, mentioning the LDL before changing HLD medication, or summarizing the current pain picture before changing analgesics.

TYPHON POSTINGS

ROTATION SELF-REFLECTION

I really enjoyed this rotation. One thing I got a lot of practice doing here was creating a sound plan and documenting it in my note. Whilst in previous rotations I would mostly see the patient and then discuss it with the provider, my preceptor at the VA would have me create a student note and have me come up with a plan of treatment for each patient independently. For example, instead of just recommending iron for a patient with anemia, I would have to document the formulation, dose, and length of treatment, when I wanted follow-up labs, what alarm signs would cause us to send to send the patient to the ER, and so on.

Another thing I got exposure to was how different the treatment approach was for hospice patients. The highest priority for these patients was maximizing comfort. For example, they didn’t get vitals or fingerstick BGs checked nearly as often as other patients. Weight was also not monitored regularly, as it was expected that all the patients would eventually be losing weight. For diabetic patients, the main priority was preventing hypoglycemic episodes or severe prolonged hyperglycemia (due to potential for HHS). Most patients also had a ‘Do Not Transfer’ order in place, meaning they would not be sent to ER for emergencies unless the ER could provide better comfort than the VA.

One new procedure I got exposure to was replacing suprapubic catheters, which are typically exchanged every four to six weeks. It is very similar to standard Foley catheters, but there is even greater emphasis on proper aseptic technique. The insertion of the tube itself was simplified compared to Foleys as the cystostomy opening is very apparent and the catheter tends to enter without much difficulty. A challenge that can pop up with this catheter type is insertion when the bladder is empty, as there is no spontaneous outflow of urine to let you know you have passed the bladder wall. To get around this, you can mark the old catheter prior to removal and insert the new one the same amount or a little further before inflating the balloon.

I also spent some time with the wound care team, where I learned a lot about different types of dressings, how to facilitate ulcer healing, and when to use appropriate interventions. For example, one of the patients had a gangrenous lower extremity but their family had refused amputation. In this patient, it would be a very bad idea to use a product like collagenase, a product typically used for enzymatic debridement, because it would accelerate tissue destruction in the foot.

PICO/CAT TABLE

Student	PICO #1	PICO #2	Pub Health PICO	OSCE Case	CAT Draft	Final CAT
Axelrod, Emily	In adult patients with acute pharyngitis, is a short course of adjuvant corticosteroids effective in reducing pain and symptom duration, as compared to placebo?	In adult patients with acute wounds, is topical honey effective in accelerating healing and preventing infection, as compared to traditional wound dressings?	In urban neighborhoods, do community gardens promote health by increasing access to healthy food and encourging physical activity?	Orthodox Jewish female fasting with syncope	In adult patients with acute wounds, is topical honey effective in accelerating healing and preventing infection, as compared to traditional wound dressings?
Bak, Jessica	In adult patients undergoing bariatric surgeries such as gastric sleeve or RYGB is robotic surgery more effective compared to laparoscopic in terms of OR operative time, length of hospital stay and mortality?	Is normal saline more effective than lactated ringers when treating patients with acute pancreatitis in terms of SIRs, mortality and length of hospital stay.	How effective is exercising during pregnancy to prevent occurrence of gestational diabetes?	African American with diagnosed HTN	Is normal saline more effective than lactated ringers when treating patients with acute pancreatitis in terms of SIRs, mortality and length of hospital stay.	Is normal saline more effective than lactated ringers when treating patients with acute pancreatitis in terms of SIRs, mortality and length of hospital stay.
Bowers, Abbie	In patients with a history of CKD who need CT imaging, what is the risk of developing an AKI secondary to IV contrast administration?	When performing intubations in the emergency room, does video laryngoscopy result in better first time success rates vs direct laryngoscopy?	What are the best screening guidelines for breast cancer amongst transgender individuals?	African migrant with skin lesions	What are the best screening guidelines for breast cancer amongst transgender individuals?	What are the best screening guidelines for breast cancer amongst transgender individuals?
Chong, Vin Kie	In patients with knee osteoarthritis (KOA), what is the overall efficacy of duloxetine as compared to no intervention or placebo?	What is the overall efficacy of aspirin for the primary prevention of cardiovascular disease (CVD) in patients with diabetes mellitus (DM) as compared to no intervention or placebo?	In people who inject drugs (PWID), does the implementation of needle and syringe programs (NSP) result in a significant reduction in the transmission of infectious diseases as compared to no intervention or placebo?	Mental Health Stigma Within the Chinese-American Community	What is the overall efficacy of aspirin for the primary prevention of cardiovascular disease (CVD) in patients with diabetes mellitus (DM) as compared to no intervention or placebo?	What is the overall efficacy of aspirin for the primary prevention of cardiovascular disease (CVD) in patients with diabetes mellitus (DM) as compared to no intervention or placebo?
Exime, Azline	In patients who use condoms occasionally and have an IUD in place, does having an IUD increase the risk of sexually transmitted diseases?	In adults, does Ashwagandha (WS) help prevent and alleviate anxiety and stress?	In type 2 diabetic patients, is intermittent fasting more effective than daily caloric restrictions in improving glycemic control and decreasing hemoglobin A1C?		In adults, does Ashwagandha (WS) help prevent and alleviate anxiety and stress?	In adults, does Ashwagandha (WS) help prevent and alleviate anxiety and stress?
Fakir, Heba	In cases of threatened abortions, what are the results of administering progesterone?	In cases of preterm birth, what are the results of administering progesterone?	Do school-based mental health programs in underserved urban communities effectively serve as preventive measures for mental disorders?	Initial Annual Checkup for Newly Arrived Male Immigrant	In cases of threatened abortions, what are the results of administering progesterone?	In cases of threatened abortions, what are the results of administering progesterone?
Godoy, Mackenzie	In patients with complicated appendicitis who undergo a laparoscopic appendectomy, is abdominal drainage more effective in preventing pelvic abscesses compared to standard post-operative management?	In patients undergoing elective surgery, does immunonutrition decrease the risk of post-operative surgical complication compared to standard nutrition?	In obese adults, is self-monitoring via digital tracking an effective behavioral weight management intervention for promoting weight loss?
Grant, Nia	In individuals with treatment resistant major depressive disorder, does psilocybin treatment help to reduce depression symptoms?	In individuals with diabetes, does cinnamon use improve glycemic control?	In teenagers, does the use of comprehensive sexual education compared to no intervention or abstinence only education lead to a reduced number of teen pregnancies?	A 40 year old hispanic male with PMHx DM2, HTN who recently immigrated to the US seeking treatment for worsening depressive symptoms.	In individuals with treatment resistant major depressive disorder, does psilocybin treatment help to reduce depression symptoms compared to no intervention or alternative options?	In individuals with treatment resistant major depressive disorder, does psilocybin treatment help to reduce depression symptoms compared to no intervention or alternative options?
Hussaini, Immadullah	In adult patients who smoke marijuana, what is the effect of marijuana smoking on the development of lung cancer?	In female patients with menorrhagia, what is the efficacy of tranexamic acid compared to NSAIDs for the resolution of bleeding?	What is the effectiveness of pharmacist-led medication reconciliation in prevention of hospital readmissions?	A 28 year old single niqabi female, who recently immigrated from Pakistan, presents to the ED complaining of fever and stomach pain x 4 days.	In adult patients who present with hyperkalemia, does the administration of 5 units of insulin lead to comparable reductions in hyperkalemia while reducing rates of hypoglycemia, as compared to 10 units of insulin?	In adult patients who present with hyperkalemia, does the administration of 5 units of insulin lead to comparable reductions in hyperkalemia while reducing rates of hypoglycemia, as compared to 10 units of insulin?
Ishmael, Akram	Are pediatric ADHD patients being treated with methylphenidate (MPH) at increased risk for growth restriction?	Is honey a viable treatment option for pediatric patients with cough compared to cough medicines?	What were the mental health effects of mandated remote learning and lockdown policies on students?	68-year-old Pakistani Muslim woman presenting presents for CABG procedure.	In patients with acute cholecystitis, does early laparoscopic cholecystectomy result in better patient outcomes versus delayed laparoscopic cholecystectomy?	In patients with acute cholecystitis, does early laparoscopic cholecystectomy result in better patient outcomes versus delayed laparoscopic cholecystectomy?
Jacobs, Lily	In pregnant women with a breech presentation (P), does the use of anesthesia (I) during external cephalic version compared to no anesthesia (C) result in higher success rate of cephalic presentation and lower maternal and fetal complications (O)?	Among women of reproductive age who have been diagnosed with PCOS seeking fertility treatment (P), is letrozole (I) superior to clomiphene (C) as a treatment option for inducing ovulation and ultimately achieve pregnancy (O)?	In women under the age of 26, does the use of a digital interventions such as mobile apps or text message reminders increase HPV vaccination rates and series completion, compared to standard methods or no digital interventions?	Buddhism and pain management	In pregnant women with a breech presentation (P), does the use of anesthesia (I) during external cephalic version compared to no anesthesia (C) result in higher success rate of cephalic presentation and lower maternal and fetal complications (O)?	In pregnant women with a breech presentation (P), does the use of anesthesia (I) during external cephalic version compared to no anesthesia (C) result in higher success rate of cephalic presentation and lower maternal and fetal complications (O)?
Kaur, Navneet	In adults with COVID-19 infection, is zinc supplementation effective in lowering mortality compared to no intervention/placebo?	In adults with PTSD, is Prazosin effective in improving nightmare symptoms and improving quality of sleep compared to no intervention/placebo?	In adolescents, does the implementation of school-based pregnancy prevention programs significantly reduce the rate of pregnancies compared to no intervention or program?	Sikh male with severe hypothyroidism	In adults with COVID-19 infection, is zinc supplementation effective in lowering mortality compared to no intervention/placebo?	In adults with COVID-19 infection, is zinc supplementation effective in lowering mortality compared to no intervention/placebo?
Kwong, Jennifer	In patients with end-stage renal disease, is kidney transplantation a more cost-effective and better treatment option compared to long-term dialysis treatment?	In patients with varicose veins and chronic venous insufficiency, does endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) compared to traditional vein stripping result in better clinical outcomes, lower recurrence rates, and reduced recovery time?	How does the implementation of enhanced recovery after surgery (ERAS) protocols impact the length of hospital stay and complication rates in major surgeries compared to standard post operative care?	Cultural Competency in Transgender Healthcare	In patients with varicose veins and chronic venous insufficiency, does endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) compared to traditional vein stripping result in better clinical outcomes, lower recurrence rates, and reduced recovery time?	In patients with varicose veins and chronic venous insufficiency, does endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) compared to traditional vein stripping result in better clinical outcomes, lower recurrence rates, and reduced recovery time?
Lam, Tiffany	In pregnant women, does myo-inositol dietary supplementation prevent gestational diabetes mellitus?	Does vaginal antiseptic preparation before cesarean section prevent postoperative infections?	How effective is iron fortified foods in preventing and treating iron deficiency anemia in pregnant women?	Chinese speaking female immigrant diagnosed with breast cancer	In pregnant women, does myo-inositol dietary supplementation prevent gestational diabetes mellitus?	In pregnant women, does myo-inositol dietary supplementation prevent gestational diabetes mellitus?
Lerebours, Nicole	In geriatric patients diagnosed with mild cognitive impairment (MCI), does regular engagement in computerized/virtual reality cognitive training exercises compared to no cognitive trainingresult inimprovement in cognitive function and slowing of cognitive decline?	In older adults, does participating in a Tai Chi exercise program reduce the incidence of falls?	In the youth and young adult population, does Media Literacy intervention reduce body image dissatisfaction or related disorders?	29 y.o Hispanic female, Jehovah’s Witness, presents for initial OB visit.	In the youth and young adult population, does Media Literacy intervention reduce body image dissatisfaction or related disorders?	In the youth and young adult population, does Media Literacy intervention reduce body image dissatisfaction or related disorders?
Levine, Robert	Are lifestyle interventions more effective than placebo in managing obesity in elderly patients? Remake – Is Alendronate more effective than Denosumab in preventing adult osteoporotic fractures?	Is Donepezil more effective than Memantine at reducing cognitive decline in patients diagnosed with Alzheimer dementia?	Is the Montreal Cognitive Assessment (MoCA) more effective than the Mini-mental Status Exam (MMSE) in identifying dementia in the adult population?		Is Alendronate more effective than Denosumab in preventing adult osteoporotic fractures?	Is Alendronate more effective than Denosumab in preventing adult osteoporotic fractures?
Martinez, Rafael	In a patient that is experiencing symptoms secondary to Meniere’s disease, does intratympanic gentamicin therapy lead to greater symptomatic relief, in comparison to diuretics.	In a patient with acute cluster headache does the use of sumatriptan produce greater symptom relief in comparison to oxygen therapy.	In young adults, has the increase use of electronic cigarettes related to the rate of acute pulmonary infections/illness, in comparison to non-smokers.
McNussen, Amanda	In adults with treatment-resistant depressive disorders (P), does the administration of ketamine (I) compared to a placebo or standard antidepressant therapy (C) result in improved depressive symptom relief and long-term remission (O)?	In adult patients with antisocial personality disorder (P), does pharmacotherapy (I) versus cognitive behavioral therapy (C) decrease negative behaviors and increase social functioning (O)?	Effects of screen time in early childhood and achieving childhood milestones	Recent Immigrant from South America Presents to the ED	In children aged 0-18 years, does reducing or limiting screen time compared to regular or unrestricted screen time have an impact on physical and mental health, academic performance, and social development?	In children aged 0-18 years, does reducing or limiting screen time compared to regular or unrestricted screen time have an impact on physical and mental health, academic performance, and social development?
Newmark, Stevie	In patients diagnosed with schizophrenia, how does the use of long-acting injectable (LAI) antipsychotics with or without education, compared to oral medications alone, impact medication adherence and rate of relapse?	In adult patients with acute agitation in a psychiatric emergency setting, does the administration of ketamine compared to administration of antipsychotics result in a more rapid, effective, and sustained decrease in agitation while maintaining safety and tolerability?	In adolescents, does the implementation of school-based mental health education programs compared to no programs result in a significant reduction in suicide rates?	Immigrant with medication misuse	In adult patients with submassive pulmonary embolism, does catheter-directed thrombolysis compared to systemic anticoagulation therapy alone result in lower mortality rates?	In adult patients with submassive pulmonary embolism, does catheter-directed thrombolysis compared to systemic anticoagulation therapy alone result in lower mortality rates?
Pinsky, Shaindel	In patients presenting with a sore throat, is a rapid strep test as accurate as a throat culture in diagnosing group A strep pharyngitis?	In patients presenting with allergic dermatitis, are oral antihistamines more effective for symptom control when compared with placebo?	In adults, does nutritional labeling of calorie counts promote healthier food choices and consumption?	Cultural competency in end of life care	In patients presenting with allergic dermatitis, are oral antihistamines more effective for symptom control when compared with placebo?	In patients presenting with allergic dermatitis, are oral antihistamines more effective for symptom control when compared with placebo?
Rogers, Amanda	In patients diagnosed with pityriasis rosea, is treatment with antiviral agents effective in shortening recovery time compared to only symptomatic treatment or no treatment at all?	In pregnant patients with hyperemesis gravidrum, is Ondansetron more effective than Metoclopramide at eliminating nausea and vomiting symptoms?	In adult smokers, are electronic cigarettes more effective than nicotine replacement therapy in producing long term smoking cessation rates and abstinence?	Hispanic Spanish speaking woman with cholecystitis	In patients diagnosed with pityriasis rosea, is treatment with antiviral agent more effective in shortening recovery time and managing symptoms compared to only symptomatic treatment or no treatment at all?	In patients diagnosed with pityriasis rosea, is treatment with antiviral agent more effective in shortening recovery time and managing symptoms compared to only symptomatic treatment or no treatment at all?
Shah, Siddharth	For patients who are obese and prediabetic, does early pharmacological treatment such as Metformin help prevent the progression to diabetes when compared to no pharmacological intervention?	In patients with chronic kidney disease who are not on dialysis, can a low-protein diet prevent the transition to dialysis therapy?	Do school-based programs that offer condoms decrease the prevalence of STDs?		For patients who are obese and prediabetic, does early pharmacological treatment such as Metformin help prevent the progression to diabetes when compared to no pharmacological intervention?	For patients who are obese and prediabetic, does early pharmacological treatment such as Metformin help prevent the progression to diabetes when compared to no pharmacological intervention?
Simon, Andrew	In patients undergoing lower extremity orthopedic procedures, are factor Xa inhibitors more effective than low molecular weight heparin in preventing venous thrombus Embolism?	In patients undergoing pancreaticoduodenectomy, is piperacillin/tazobactam more effective in reducing surgical site incision infections than cephalosporins?	Did the COVID-19 pandemic lead to an increase in alcohol consumption?
Tekalign, Isaiah	Among patients with diabetes mellitus does using continuous subcutaneous insulin infusion compared to multiple daily insulin injections lead to better glycemic control and improved quality of life?	Among elderly patients with dementia does a structured reminiscence therapy program compared to standard social activity lead to an increase in cognition and decrease depression?	In the pediatric population are school based programs aimed at obesity reduction and increasing physical activity effective at weight management and BMI reduction?	Buddhist female and end of life care	Among patients with diabetes mellitus does using continuous subcutaneous insulin infusion compared to multiple daily insulin injections lead to better glycemic control and improved quality of life?	Among patients with diabetes mellitus does using continuous subcutaneous insulin infusion compared to multiple daily insulin injections lead to better glycemic control and improved quality of life?
Winter, Hannah	In patients with community acquired pneumonia, does the use of ultrasound compared to traditional imaging (ie CXR) result in better diagnostic rates?	In adult patients following cardiac arrest, is maintaining a normothermic temperature effective in improving morbidity and mortality compared to traditional targeted temperature management (ie hypothermic range of 32-24C)?	For adults with a history of  hypertension, does the use of mobile apps / digital intervention improve medication adherence and patient outcomes compared to no intervention?	Cultural competency in regards to LGBTQ+ community	In adult patients following cardiac arrest, is maintaining a normothermic temperature effective in improving morbidity and mortality compared to traditional targeted temperature management (ie hypothermic range of 32-24C)?	In adult patients following cardiac arrest, is maintaining a normothermic temperature effective in improving morbidity and mortality compared to traditional targeted temperature management (ie hypothermic range of 32-24C)?
Yeasmin, Tamanna	In adult patients with osteoarthritis, how does exercise therapy compared to NSAIDs or other analgesics help to improve pain and function?	In adult patients with COVID-19 infection, does the use of remdesivir help to decrease morbidity and mortality compared to no treatment or placebo?	In the adult post-stroke population, is the use of selective serotonin reuptake inhibitors (SSRIs) effective in the prevention of post-stroke depression (PSD) compared to no treatment or placebo?	Bangladeshi female recently diagnosed with T2DM	In adult patients with COVID-19 infection, does the use of remdesivir help to decrease morbidity and mortality compared to no treatment or placebo?	In adult patients with COVID-19 infection, does the use of remdesivir help to decrease morbidity and mortality compared to no treatment or placebo?