The Annual Quality and Safety Summit is a cornerstone event dedicated to advancing excellence in health care delivery, bringing together a diverse community of health care professionals, educators, researchers, and learners. Each year, the summit serves as a dynamic platform to showcase innovative initiatives, evidence-based practices, and transformative ideas that aim to enhance patient care, improve safety, and drive better system-wide outcomes across the health care continuum. Jointly sponsored by the Joan C. Edwards School of Medicine and Marshall Health Network, the Summit features abstracts spanning a wide range of topics, including innovative care delivery models, quality improvement strategies, patient safety efforts, change management, and clinical impact. Through a strong emphasis on collaboration, knowledge sharing, and innovation, the Summit remains instrumental in advancing clinical practices, strengthening the health care system, and ensuring safer, more effective, patient-centered care. These abstracts highlight practical, evidence-based approaches applicable across diverse care settings and serve as a valuable resource and catalyst for change, particularly within West Virginia.
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare subtype of primary cutaneous T-cell lymphoma that has clinical overlap with common benign conditions, thus making diagnosis challenging. SPTCL primarily affects younger adults with a female predominance. Pediatric cases are exceedingly rare and often misdiagnosed as bacterial infections, delaying proper clinical diagnosis and treatment. In this case study, we report on a 9-year-old female who initially presented to an urgent care clinic with two weeks of an itchy, painful nodule on her right buttock and thigh. The nodule was initially misidentified as a skin abscess, and the patient was prescribed sulfamethoxazole/trimethoprim. The diagnosis was later changed to infectious panniculitis by the primary care physician. Due to unresolved symptoms and abnormal lab findings and imaging studies, the patient was referred to pediatric dermatology, where histological, immunophenotypic, and molecular diagnostic findings established a diagnosis of SPTCL. The patient was treated with topical triamcinolone and mechlorethamine resulting in substantial clinical improvement. This case highlights the diagnostic challenge of SPTCL in pediatric patients, where the disease often mimics benign processes such as bacterial infections. It is important to conduct a thorough workup of children who present with vague systemic symptoms along with subcutaneous nodules, as this may prevent delay in the diagnosis of SPTCL.
Abstract Introduction Professional identity formation is known to be responsive to outside forces. Previous longitudinal research has shown changes occurred pre-and post-COVID-19 pandemic among medical students. The purpose of this longitudinal study was to assess changes among pre-medical students. Methods With a 100% response rate, 85 Career Eulogies (CE) from 2015 through 2025 recorded a free text response to the prompt: "Imagine that you are ready to retire from medicine in the distant future. In about 50 words, write a short speech outlining what you would like to be said about you at the retirement ceremony." The responses were coded into previously validated clusters and generalized estimating equations were used to assess changes in the CE clusters of patient relationships, quality, compassion, and passion. Results The CE patient relationship cluster decreased during the pandemic, stabilized, and then steadily recovered from 2023 to 2025. The CE compassion cluster showed a significant decline from 2015 compared with 2022, followed by a rising trend from 2022 to 2025. There were no changes for the CE passion cluster. In the entire population, there was no change in the quality cluster. Among men, there was a significant decrease in the quality cluster during the pandemic, and this remained low until it recovered in 2022. No change was seen among women. Discussion The authors postulate that the decreases during the pandemic in mentions of patient relationships and compassion were related to lack of shadowing opportunities during the pandemic as well as widespread misinformation and suspicion of medical providers that undermined the doctor patient relationship. The gender difference in the quality cluster could be explained by men generally placing more emphasis on quality of care outcomes, while women were focused more on quality defined as the process of individual patient interactions. As this is one population studied, these results will need to be confirmed in other more diverse groups with repetitive longitudinal measures. Conclusion This longitudinal study found that, during the COVID-19 pandemic, premedical students in this program made fewer references to patient relationships and compassion in their Career Eulogies. Among male participants, references to quality decreased significantly during the pandemic but subsequently returned to pre-pandemic levels.
Times of uncertainty and rapid change can negatively impact academic health centers (AHC) in complex ways, creating challenges for leaders. These include policy uncertainty, financial instability, workforce stress, reputational risk, operational disruptions, and advocacy pressure. There are also potential opportunities for AHCs during this time of immense change and disruption. This perspective piece reviews the diverse negative and positive impacts of political turmoil on academic health centers. Five considerations are offered for leaders navigating times of uncertainty.
Ulnar stress fractures are relatively rare, particularly in the context of collegiate cheerleading. This case report explores the presentation, diagnosis, and surgical management of an unexpected stress fracture in the ulna of a collegiate cheerleader. An 18-year-old female presented with persistent, localized pain in her non-dominant arm. Imaging revealed an isolated ulnar stress fracture, an unusual finding despite participating in this physically demanding sport. Surgical intervention was deemed necessary, and a nail fixation technique was employed to stabilize the fracture. Ulnar stress fractures, though rare in cheerleading, can present unique challenges. This case report documents the effectiveness of an operative approach in facilitating a successful return to sport.
A Warthin tumor is a salivary gland neoplasm that arises in the parotid gland which is frequently benign. This case study presents a rare instance of a Warthin tumor occurring in an extraparotid location; specifically, within the left-sided cervical lymph nodes of a 64-year-old male patient. The patient initially presented with fluctuating cervical adenopathy. Although an initial ultrasound-guided biopsy was inconclusive, a computed tomography (CT) scan revealed a well-demarcated, heterogeneous lesion in an atypical location between the parotid gland and the sternocleidomastoid muscle. Surgical excision of the mass was performed and the specimen was sent to pathology for further analysis. Histopathological analysis, along with flow cytometry, confirmed the diagnosis of a Warthin tumor.. Flow cytometry was used to exclude lymphoproliferative disease, aiding in narrowing down a broad range of potential diagnoses. This case highlights the importance of including Warthin tumor in the differential diagnosis of cervical masses, particularly when they arise outside the typical parotid location. Recognizing such atypical presentations is essential for accurate diagnosis and appropriate management.
Background: The timing of coronary artery bypass grafting (CABG) in patients with non-ST-elevation myocardial infarction (NSTEMI) may critically impact clinical outcomes, yet the ideal surgical window remains unclear. We aimed to evaluate the association between time-to-CABG and in-hospital outcomes among NSTEMI admissions undergoing CABG. Methods: This retrospective cohort study utilized the US National Inpatient Sample database from 2017 to 2021 to evaluate the association between time-to-CABG and key in-hospital outcomes, including mortality, cardiac arrest, cardiogenic shock, ischemic stroke, acute kidney injury, and blood transfusion rates, while assessing length of stay (LOS) and hospital charges exclusively among survivors. Adult admissions with principal diagnosis of NSTEMI who underwent CABG without prior interhospital transfer were grouped by the calendar day of CABG from admission (0, 1, 2, 3, 4, 5, 6, and ≥7). Multivariate regression models were used to assess the outcomes across these eight groups. Results: Of 142,200 included admissions, same-day CABG (hospital day 0) was associated with the highest rates of in-hospital mortality, cardiac arrest, cardiogenic shock, and ischemic stroke. The adjusted odds of mortality, cardiac arrest, and cardiogenic shock were lower among admissions undergoing CABG between days 2 and 5. Likewise, the adjusted odds of ischemic stroke were lowest when CABG occurred on days 2 to 4. The odds of AKI increased when CABG was delayed beyond day 6, whereas blood transfusion rates showed no statistically significant association with time-to-CABG. Among survivors, LOS and hospital charges progressively increased with delayed CABGs. Conclusions: Among NSTEMI admissions undergoing CABG, CABG performed on hospital days 2 to 4 was associated with lower adjusted odds of several adverse in-hospital outcomes compared with same-day CABG. Further prospective studies are needed to validate these results and guide clinical decision-making.
Burnout is an occupation-related condition resulting from chronic workplace stress and is associated with significant psychological and physical morbidity. This commentary recognizes burnout as a public health concern across both healthcare and non-healthcare professions, illuminates key occupational risk and protective factors, reviews the biopsychosocial impacts of burnout, and argues for the integration of occupational health screening into clinical practice. A synthesis of the literature highlighted that existing research has focused primarily on healthcare occupations; however, emerging evidence demonstrates an elevated burnout risk in numerous non-healthcare occupations. Characterized by high job demands, limited autonomy, inadequate social support, and physically demanding labor, non-healthcare professions have a unique set of stressors. Moreover, prolonged occupational exposure to these stressors further increases susceptibility to burnout-related psychological distress and risk of depression, anxiety, suicidal ideation, cardiovascular disease, metabolic dysregulation, sleep disturbances, and other somatic symptoms. Overall, burnout represents a widespread occupational health issue with substantial biopsychosocial consequences. Incorporating occupational health screening into routine clinical assessments may improve early identification of burnout-related symptoms, reduce misdiagnosis, and support timely intervention at both individual and system levels.
Background: Addressing rural healthcare provider shortages requires approaches to inspire and prepare future generations for rural health careers. The purpose of this evaluation was to assess the impact of an undergraduate rural shadowing pipeline program in advancement to graduate health professional school and future rural practice. Methods: Baccalaureate-level students from multiple cohorts (2016-2021) who participated in the [University] Rural Undergraduate Shadowing in Healthcare Program completed surveys to assess their experience immediately following program completion. Descriptive statistics of end of program and follow-up surveys conducted 2023 were examined to evaluate the undergraduate pipeline program’s effectiveness. Results: From 2016-2021, 26 students participated in the rural undergraduate shadowing program. End-of-program evaluation was completed by 25 participants who reported that the quality of the shadowing experience was excellent or very good, and the experience increased their understanding of what it is like to be a health practitioner in a rural area. Twenty-one program completers responded to a follow-up survey in July 2023. Most participants had begun a graduate health professional program and still intend to practice as a health professional in a medically underserved and/or rural area. Two participants have graduated from their health professional program. One is continuing training as a medical resident with plans to work in a rural area and the other is currently practicing in a rural setting in West Virginia. Conclusions: High quality shadowing opportunities provided through a structured program increase understanding of and interest in rural health and support the rural healthcare pipeline during undergraduate education.
Propriospinal myoclonus (PSM) is a rare disorder characterized by axial muscle jerks originating in the thoracoabdominal region; medical management of this disease is extremely challenging given the paucity of trials and few reported cases only. Chronic cough has not been described in the literature in association with PSM. We describe a 51 year old female presenting with chronic unexplained cough along with myoclonic jerking, ultimately diagnosed with severe PSM. Fortunately our case after different medication trials showed great response to lacasomide which has been rarely reported in PSM management.
Background: Lyme disease is a well-recognized illness commonly associated with skin manifestations such as erythema migrans. However, atypical presentations can complicate diagnosis, particularly when they deviate from classic clinical and histological findings. Methods: We report a potential case of Lyme disease presenting as a dermal hypersensitivity reaction (DHR), with clinical findings resembling urticaria rather than urticarial vasculitis. Skin biopsy findings were reviewed, and Lyme serology testing was performed. Results: The biopsy did not demonstrate the characteristic superficial perivascular lymphocytic infiltrate typically seen with erythema migrans. The patient's history included prior tick exposures, but while Lyme IgM was positive, the Lyme IgG testing was negative, suggesting no prior Lyme exposure. With PCR and repeat IgG scheduled the patient was diagnosed with Lyme disease. Conclusions: This case highlights an atypical presentation of potential Lyme disease and underscores the importance of considering Lyme disease in the differential diagnosis of DHR, especially in patients with a history of tick exposure. In cases of DHR, a thorough clinical history regarding arthropod bites and tick exposure should guide targeted testing for Lyme and other tick-borne illnesses. Keywords: Lyme disease, dermal hypersensitivity reaction, erythema migrans, atypical presentation, tick-borne disease
