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Clinical question: Does emergency department management of patients with febrile neutropenia (FN) follow current guidelines?

Background: Chemotherapy-related FN is an oncologic emergency frequently leading to hospitalization and intravenous antibiotics. Familiarity with FN guidelines allows risk stratification for inpatient versus outpatient therapy.

Study design: Single-center, retrospective, cohort study.

Setting: Large, urban, tertiary-care academic hospital.

Synopsis: Of 173 patient visits, 25% were risk stratified as eligible for outpatient treatment and 75% as inpatient care. All patient care was assessed for guideline concordance at the time of ED disposition and therapy.

Primary outcome analysis demonstrated management was guideline discordant in 98% of low-risk patients versus 7% of high-risk patients. Secondary 30-day clinical outcomes showed high-risk patients were more likely to have positive blood cultures (54%), sepsis-induced hypotension (9.3%), and death (5.4%). Seventeen percent of all patients who received IV antibiotics were prescribed vancomycin without guideline support.

Bottom line: Low-risk FN patients in the ED received more aggressive treatment than recommended. Further research is needed to strategize means of better aligning FN management with standards of care.

Citation: Baugh CW, Wang TJ, Caterino JM, et al. ED management of patients with febrile neutropenia: guideline concordant or overly aggressive [published online ahead of print Sept. 9, 2016]? Acad Emerg Med. doi: 10.1111/acem.13079.

Dr. Zuleta is an assistant professor and associate program director of the Jackson Memorial/University of Miami Internal Medicine residency training program and the site director of the program at University of Miami Hospital.

Clinical question: Does emergency department management of patients with febrile neutropenia (FN) follow current guidelines?

Background: Chemotherapy-related FN is an oncologic emergency frequently leading to hospitalization and intravenous antibiotics. Familiarity with FN guidelines allows risk stratification for inpatient versus outpatient therapy.

Study design: Single-center, retrospective, cohort study.

Setting: Large, urban, tertiary-care academic hospital.

Synopsis: Of 173 patient visits, 25% were risk stratified as eligible for outpatient treatment and 75% as inpatient care. All patient care was assessed for guideline concordance at the time of ED disposition and therapy.

Primary outcome analysis demonstrated management was guideline discordant in 98% of low-risk patients versus 7% of high-risk patients. Secondary 30-day clinical outcomes showed high-risk patients were more likely to have positive blood cultures (54%), sepsis-induced hypotension (9.3%), and death (5.4%). Seventeen percent of all patients who received IV antibiotics were prescribed vancomycin without guideline support.

Bottom line: Low-risk FN patients in the ED received more aggressive treatment than recommended. Further research is needed to strategize means of better aligning FN management with standards of care.

Citation: Baugh CW, Wang TJ, Caterino JM, et al. ED management of patients with febrile neutropenia: guideline concordant or overly aggressive [published online ahead of print Sept. 9, 2016]? Acad Emerg Med. doi: 10.1111/acem.13079.

Dr. Zuleta is an assistant professor and associate program director of the Jackson Memorial/University of Miami Internal Medicine residency training program and the site director of the program at University of Miami Hospital.

Clinical question: Does emergency department management of patients with febrile neutropenia (FN) follow current guidelines?

Background: Chemotherapy-related FN is an oncologic emergency frequently leading to hospitalization and intravenous antibiotics. Familiarity with FN guidelines allows risk stratification for inpatient versus outpatient therapy.

Study design: Single-center, retrospective, cohort study.

Setting: Large, urban, tertiary-care academic hospital.

Synopsis: Of 173 patient visits, 25% were risk stratified as eligible for outpatient treatment and 75% as inpatient care. All patient care was assessed for guideline concordance at the time of ED disposition and therapy.

Primary outcome analysis demonstrated management was guideline discordant in 98% of low-risk patients versus 7% of high-risk patients. Secondary 30-day clinical outcomes showed high-risk patients were more likely to have positive blood cultures (54%), sepsis-induced hypotension (9.3%), and death (5.4%). Seventeen percent of all patients who received IV antibiotics were prescribed vancomycin without guideline support.

Bottom line: Low-risk FN patients in the ED received more aggressive treatment than recommended. Further research is needed to strategize means of better aligning FN management with standards of care.

Citation: Baugh CW, Wang TJ, Caterino JM, et al. ED management of patients with febrile neutropenia: guideline concordant or overly aggressive [published online ahead of print Sept. 9, 2016]? Acad Emerg Med. doi: 10.1111/acem.13079.

Dr. Zuleta is an assistant professor and associate program director of the Jackson Memorial/University of Miami Internal Medicine residency training program and the site director of the program at University of Miami Hospital.

Clinical question: Does therapeutic anticoagulation of isolated calf deep vein thrombosis (DVT) decrease risk for proximal DVT or PE?

Background: Optimal management of isolated calf DVT lacks consensus.

Study design: Single-center, retrospective, cohort study.

Setting: Large academic hospital.

Nevertheless, 9.2% of control patients and 3.3% of exposure patients developed a proximal DVT or PE. The anticoagulation group was associated with lower likelihood of proximal DVT or PE (risk ratio 0.36; 95% CI, 0.15-0.84) but an increased risk of bleeding (8.6%), compared with the nonexposure group (2.2%). Sensitivity analysis did not alter the observed association.

Bottom line: Therapeutic anticoagulation for isolated calf DVT may be warranted to decrease the risk for proximal DVT or PE but with an increased risk of bleeding. Randomized trials are needed to clarify the risk versus benefit.

Citation: Utter GH, Dhillon TS, Salcedo ES, et al. Therapeutic anticoagulation for isolated calf deep vein thrombosis. JAMA Surg. 2016;151(9):e161770. doi: 10.1001/jamasurg.2016.1770.


Dr. Zuleta is an assistant professor and associate program director of the Jackson Memorial/University of Miami Internal Medicine residency training program and the site director of the program at University of Miami Hospital.

Clinical question: Does therapeutic anticoagulation of isolated calf deep vein thrombosis (DVT) decrease risk for proximal DVT or PE?

Background: Optimal management of isolated calf DVT lacks consensus.

Study design: Single-center, retrospective, cohort study.

Setting: Large academic hospital.

Nevertheless, 9.2% of control patients and 3.3% of exposure patients developed a proximal DVT or PE. The anticoagulation group was associated with lower likelihood of proximal DVT or PE (risk ratio 0.36; 95% CI, 0.15-0.84) but an increased risk of bleeding (8.6%), compared with the nonexposure group (2.2%). Sensitivity analysis did not alter the observed association.

Bottom line: Therapeutic anticoagulation for isolated calf DVT may be warranted to decrease the risk for proximal DVT or PE but with an increased risk of bleeding. Randomized trials are needed to clarify the risk versus benefit.

Citation: Utter GH, Dhillon TS, Salcedo ES, et al. Therapeutic anticoagulation for isolated calf deep vein thrombosis. JAMA Surg. 2016;151(9):e161770. doi: 10.1001/jamasurg.2016.1770.


Dr. Zuleta is an assistant professor and associate program director of the Jackson Memorial/University of Miami Internal Medicine residency training program and the site director of the program at University of Miami Hospital.

Clinical question: Does therapeutic anticoagulation of isolated calf deep vein thrombosis (DVT) decrease risk for proximal DVT or PE?

Background: Optimal management of isolated calf DVT lacks consensus.

Study design: Single-center, retrospective, cohort study.

Setting: Large academic hospital.

Nevertheless, 9.2% of control patients and 3.3% of exposure patients developed a proximal DVT or PE. The anticoagulation group was associated with lower likelihood of proximal DVT or PE (risk ratio 0.36; 95% CI, 0.15-0.84) but an increased risk of bleeding (8.6%), compared with the nonexposure group (2.2%). Sensitivity analysis did not alter the observed association.

Bottom line: Therapeutic anticoagulation for isolated calf DVT may be warranted to decrease the risk for proximal DVT or PE but with an increased risk of bleeding. Randomized trials are needed to clarify the risk versus benefit.

Citation: Utter GH, Dhillon TS, Salcedo ES, et al. Therapeutic anticoagulation for isolated calf deep vein thrombosis. JAMA Surg. 2016;151(9):e161770. doi: 10.1001/jamasurg.2016.1770.


Dr. Zuleta is an assistant professor and associate program director of the Jackson Memorial/University of Miami Internal Medicine residency training program and the site director of the program at University of Miami Hospital.

Editor’s note: Each month, SHM puts the spotlight on our most active members and explores how they are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise and help SHM improve the care of hospitalized patients.

This month, The Hospitalist spotlights Alessandra G. Cornelio, MPH, the acquisition manager at Hartford Healthcare Medical Group in Connecticut. Ms. Cornelio is an active member of SHM’s Practice Administrators Committee. She developed and now directs the Practice Administrators’ Mentor Program.

To complement my career goals, SHM helped my professional growth by exposing me to the variety of topics and issues that practice administrators deal with regularly in their practices. I was also able to review and learn from the many resources available on the SHM website, such as white papers and articles, which were extremely useful for a new administrator.
 

Q: What prompted you to join the Practice Administrators Committee? What are some of the most impactful projects the committee is currently working on?

A: Within my first year of being a practice administrator, I attended a practice administrators’ forum at the SHM annual meeting in Washington. I found that the information was relevant to my daily functions as an administrator, and I was also able to meet and share ideas with other practice administrators from throughout the country. Down the line, I learned that SHM needed new members for the Practice Administrators Committee. I wanted to become more involved in a meaningful way, so I decided to apply.

The Practice Administrators Committee is a hardworking committee that takes on many meaningful projects. Most recently, the team has been working on developing a more user-friendly website for practice administrators, and a subgroup of the committee has cross-referenced “The Key Principles and Characteristics of an Effective Hospital Medicine Group” with existing resources, which will prove valuable to all administrators in the final product.
 

Q: Can you discuss how you began leading the work group for the Practice Administrators’ Mentor Program and how it has evolved since its inception?

A: As part of the committee’s initiative to help fellow practice administrators, we formed a subcommittee to begin developing a mentor program. (Former SHM staffer) Joseph Miller and I worked together to create an appropriate program model through research and brainstorming. We also utilized the HMX Practice Administrators Community to ask fellow practice administrators what they would expect from a mentor program and if they would participate. There was a strong favorable response rate, and we were able to implement a pilot program.

We implemented two different tracks for the program – the buddy system track and the career development track. The buddy system track is for those of any level of expertise or experience who are more interested in short-term assistance or in need of a sounding board. The career development track is a more traditional approach, matching a seasoned practice administrator with a less experienced practice administrator.

The program was designed to have annual cohorts, with the Practice Administrators Committee members as mentors. There is a detailed application process to ensure that each mentee is matched with an appropriate mentor, based on their interests and needs. We provide an orientation webinar to both parties before kicking off the relationship to present program expectations. The pilot program used this model, and comments from 6-month and annual evaluations showed tremendous satisfaction with the structure and value of this program.

There were approximately 16 pairs during the pilot year, and the following year, we grew to almost 20 pairs. Our goal as a committee is to maintain this program year after year, and in order to expand, we’ll need more than just the committee members to volunteer as mentors. There are so many talented practice administrators, and it would be wonderful to fold them into this gratifying program to pay it forward.

Many mentors, including myself, found value in acting as a mentor. I learned from my mentees as well as made connections and friendships with other professionals in the field.
 

Q: Given your intimate involvement, how have you seen the Practice Administrators’ Mentor Program benefit both the mentors and the mentees? Can you provide any specific examples?

A: Mentees are able to connect with seasoned mentors and can ask specific questions about career development and any issues they may be experiencing. Mentors are able to share their experiences and pass along important and valuable lessons learned to mentees. I served as a mentor, even though I did not yet consider myself a qualified candidate. However, I found that I was more equipped than I had realized, and I was able to assist my mentee with many aspects of career development (i.e., resume building, discussions with the C-suite, etc.).

My mentee was a practice coordinator who had only been in hospital medicine for 1 year. She had little experience hiring hospitalists, so this was a major area that we worked on together during our yearlong connection. I introduced her to collaborating with her HR department when posting positions, as well as working with permanent placement agencies. Her service was also undergoing a change in leadership, which can be difficult for any service line to experience. We discussed ways in which she could present important information to the new medical director that would produce a meaningful conversation.

In turn, my mentee introduced me to new online resources and was able to connect me with the manager of her practice, who assisted me with streamlining the payroll structure in my practice. I truly enjoyed my experience developing and participating in the program.

Felicia Steele is SHM’s communications coordinator.

Learn more about how you can benefit from the Practice Administrators’ Mentor program via the SHM website.

Editor’s note: Each month, SHM puts the spotlight on our most active members and explores how they are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise and help SHM improve the care of hospitalized patients.

This month, The Hospitalist spotlights Alessandra G. Cornelio, MPH, the acquisition manager at Hartford Healthcare Medical Group in Connecticut. Ms. Cornelio is an active member of SHM’s Practice Administrators Committee. She developed and now directs the Practice Administrators’ Mentor Program.

To complement my career goals, SHM helped my professional growth by exposing me to the variety of topics and issues that practice administrators deal with regularly in their practices. I was also able to review and learn from the many resources available on the SHM website, such as white papers and articles, which were extremely useful for a new administrator.
 

Q: What prompted you to join the Practice Administrators Committee? What are some of the most impactful projects the committee is currently working on?

A: Within my first year of being a practice administrator, I attended a practice administrators’ forum at the SHM annual meeting in Washington. I found that the information was relevant to my daily functions as an administrator, and I was also able to meet and share ideas with other practice administrators from throughout the country. Down the line, I learned that SHM needed new members for the Practice Administrators Committee. I wanted to become more involved in a meaningful way, so I decided to apply.

The Practice Administrators Committee is a hardworking committee that takes on many meaningful projects. Most recently, the team has been working on developing a more user-friendly website for practice administrators, and a subgroup of the committee has cross-referenced “The Key Principles and Characteristics of an Effective Hospital Medicine Group” with existing resources, which will prove valuable to all administrators in the final product.
 

Q: Can you discuss how you began leading the work group for the Practice Administrators’ Mentor Program and how it has evolved since its inception?

A: As part of the committee’s initiative to help fellow practice administrators, we formed a subcommittee to begin developing a mentor program. (Former SHM staffer) Joseph Miller and I worked together to create an appropriate program model through research and brainstorming. We also utilized the HMX Practice Administrators Community to ask fellow practice administrators what they would expect from a mentor program and if they would participate. There was a strong favorable response rate, and we were able to implement a pilot program.

We implemented two different tracks for the program – the buddy system track and the career development track. The buddy system track is for those of any level of expertise or experience who are more interested in short-term assistance or in need of a sounding board. The career development track is a more traditional approach, matching a seasoned practice administrator with a less experienced practice administrator.

The program was designed to have annual cohorts, with the Practice Administrators Committee members as mentors. There is a detailed application process to ensure that each mentee is matched with an appropriate mentor, based on their interests and needs. We provide an orientation webinar to both parties before kicking off the relationship to present program expectations. The pilot program used this model, and comments from 6-month and annual evaluations showed tremendous satisfaction with the structure and value of this program.

There were approximately 16 pairs during the pilot year, and the following year, we grew to almost 20 pairs. Our goal as a committee is to maintain this program year after year, and in order to expand, we’ll need more than just the committee members to volunteer as mentors. There are so many talented practice administrators, and it would be wonderful to fold them into this gratifying program to pay it forward.

Many mentors, including myself, found value in acting as a mentor. I learned from my mentees as well as made connections and friendships with other professionals in the field.
 

Q: Given your intimate involvement, how have you seen the Practice Administrators’ Mentor Program benefit both the mentors and the mentees? Can you provide any specific examples?

A: Mentees are able to connect with seasoned mentors and can ask specific questions about career development and any issues they may be experiencing. Mentors are able to share their experiences and pass along important and valuable lessons learned to mentees. I served as a mentor, even though I did not yet consider myself a qualified candidate. However, I found that I was more equipped than I had realized, and I was able to assist my mentee with many aspects of career development (i.e., resume building, discussions with the C-suite, etc.).

My mentee was a practice coordinator who had only been in hospital medicine for 1 year. She had little experience hiring hospitalists, so this was a major area that we worked on together during our yearlong connection. I introduced her to collaborating with her HR department when posting positions, as well as working with permanent placement agencies. Her service was also undergoing a change in leadership, which can be difficult for any service line to experience. We discussed ways in which she could present important information to the new medical director that would produce a meaningful conversation.

In turn, my mentee introduced me to new online resources and was able to connect me with the manager of her practice, who assisted me with streamlining the payroll structure in my practice. I truly enjoyed my experience developing and participating in the program.

Felicia Steele is SHM’s communications coordinator.

Learn more about how you can benefit from the Practice Administrators’ Mentor program via the SHM website.

Editor’s note: Each month, SHM puts the spotlight on our most active members and explores how they are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise and help SHM improve the care of hospitalized patients.

This month, The Hospitalist spotlights Alessandra G. Cornelio, MPH, the acquisition manager at Hartford Healthcare Medical Group in Connecticut. Ms. Cornelio is an active member of SHM’s Practice Administrators Committee. She developed and now directs the Practice Administrators’ Mentor Program.

To complement my career goals, SHM helped my professional growth by exposing me to the variety of topics and issues that practice administrators deal with regularly in their practices. I was also able to review and learn from the many resources available on the SHM website, such as white papers and articles, which were extremely useful for a new administrator.
 

Q: What prompted you to join the Practice Administrators Committee? What are some of the most impactful projects the committee is currently working on?

A: Within my first year of being a practice administrator, I attended a practice administrators’ forum at the SHM annual meeting in Washington. I found that the information was relevant to my daily functions as an administrator, and I was also able to meet and share ideas with other practice administrators from throughout the country. Down the line, I learned that SHM needed new members for the Practice Administrators Committee. I wanted to become more involved in a meaningful way, so I decided to apply.

The Practice Administrators Committee is a hardworking committee that takes on many meaningful projects. Most recently, the team has been working on developing a more user-friendly website for practice administrators, and a subgroup of the committee has cross-referenced “The Key Principles and Characteristics of an Effective Hospital Medicine Group” with existing resources, which will prove valuable to all administrators in the final product.
 

Q: Can you discuss how you began leading the work group for the Practice Administrators’ Mentor Program and how it has evolved since its inception?

A: As part of the committee’s initiative to help fellow practice administrators, we formed a subcommittee to begin developing a mentor program. (Former SHM staffer) Joseph Miller and I worked together to create an appropriate program model through research and brainstorming. We also utilized the HMX Practice Administrators Community to ask fellow practice administrators what they would expect from a mentor program and if they would participate. There was a strong favorable response rate, and we were able to implement a pilot program.

We implemented two different tracks for the program – the buddy system track and the career development track. The buddy system track is for those of any level of expertise or experience who are more interested in short-term assistance or in need of a sounding board. The career development track is a more traditional approach, matching a seasoned practice administrator with a less experienced practice administrator.

The program was designed to have annual cohorts, with the Practice Administrators Committee members as mentors. There is a detailed application process to ensure that each mentee is matched with an appropriate mentor, based on their interests and needs. We provide an orientation webinar to both parties before kicking off the relationship to present program expectations. The pilot program used this model, and comments from 6-month and annual evaluations showed tremendous satisfaction with the structure and value of this program.

There were approximately 16 pairs during the pilot year, and the following year, we grew to almost 20 pairs. Our goal as a committee is to maintain this program year after year, and in order to expand, we’ll need more than just the committee members to volunteer as mentors. There are so many talented practice administrators, and it would be wonderful to fold them into this gratifying program to pay it forward.

Many mentors, including myself, found value in acting as a mentor. I learned from my mentees as well as made connections and friendships with other professionals in the field.
 

Q: Given your intimate involvement, how have you seen the Practice Administrators’ Mentor Program benefit both the mentors and the mentees? Can you provide any specific examples?

A: Mentees are able to connect with seasoned mentors and can ask specific questions about career development and any issues they may be experiencing. Mentors are able to share their experiences and pass along important and valuable lessons learned to mentees. I served as a mentor, even though I did not yet consider myself a qualified candidate. However, I found that I was more equipped than I had realized, and I was able to assist my mentee with many aspects of career development (i.e., resume building, discussions with the C-suite, etc.).

My mentee was a practice coordinator who had only been in hospital medicine for 1 year. She had little experience hiring hospitalists, so this was a major area that we worked on together during our yearlong connection. I introduced her to collaborating with her HR department when posting positions, as well as working with permanent placement agencies. Her service was also undergoing a change in leadership, which can be difficult for any service line to experience. We discussed ways in which she could present important information to the new medical director that would produce a meaningful conversation.

In turn, my mentee introduced me to new online resources and was able to connect me with the manager of her practice, who assisted me with streamlining the payroll structure in my practice. I truly enjoyed my experience developing and participating in the program.

Felicia Steele is SHM’s communications coordinator.

Learn more about how you can benefit from the Practice Administrators’ Mentor program via the SHM website.

Clinical question: Are the components of the ventilator bundles (VBs) associated with better outcomes for patients?

Background: VBs have been shown to prevent ventilator-associated pneumonia (VAP). However, most of the studies have analyzed outcomes based on the whole bundle without considering each individual component.

Study design: Retrospective cohort study.

Setting: Brigham and Women’s Hospital in Boston.

Spontaneous breathing trials were associated with lower hazards for VAEs (HR, 0.55; 95% CI, 0.40-0.76; P less than .001) and infection-related ventilator-associated complications (IVACs) (HR, 0.60; 95% CI, 0.37-1.00; P = .05). Head-of-bed elevation (HR, 1.38; 95% CI, 1.14-1.68; P = 0.001) and thromboembolism prophylaxis (HR, 2.57; 95% CI, 1.80-3.66; P less than .001) were associated with less time to extubation.

Oral care with chlorhexidine was associated with lower hazards for IVACs (HR, 0.60; 95% CI 0.36-1.00; P = .05) and for VAPs (HR, 0.55; 95% CI, 0.27-1.14; P = .11) but an increased risk for ventilator mortality (HR, 1.63; 95% CI, 1.15-2.31; P = .006). Stress ulcer prophylaxis was associated with higher risk for VAP (HR, 7.69; 95% CI, 1.44-41.10; P = .02).

Bottom line: Standard VB components merit revision to increase emphasis on beneficial components and eliminate potentially harmful ones.

Citation: Klompas M, Li L, Kleinman K, Szumita PM, Massaro AF. Association between ventilator bundle components and outcomes. JAMA Intern Med. 2016;176(9):1277-1283.


Dr. Mosetti is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Are the components of the ventilator bundles (VBs) associated with better outcomes for patients?

Background: VBs have been shown to prevent ventilator-associated pneumonia (VAP). However, most of the studies have analyzed outcomes based on the whole bundle without considering each individual component.

Study design: Retrospective cohort study.

Setting: Brigham and Women’s Hospital in Boston.

Spontaneous breathing trials were associated with lower hazards for VAEs (HR, 0.55; 95% CI, 0.40-0.76; P less than .001) and infection-related ventilator-associated complications (IVACs) (HR, 0.60; 95% CI, 0.37-1.00; P = .05). Head-of-bed elevation (HR, 1.38; 95% CI, 1.14-1.68; P = 0.001) and thromboembolism prophylaxis (HR, 2.57; 95% CI, 1.80-3.66; P less than .001) were associated with less time to extubation.

Oral care with chlorhexidine was associated with lower hazards for IVACs (HR, 0.60; 95% CI 0.36-1.00; P = .05) and for VAPs (HR, 0.55; 95% CI, 0.27-1.14; P = .11) but an increased risk for ventilator mortality (HR, 1.63; 95% CI, 1.15-2.31; P = .006). Stress ulcer prophylaxis was associated with higher risk for VAP (HR, 7.69; 95% CI, 1.44-41.10; P = .02).

Bottom line: Standard VB components merit revision to increase emphasis on beneficial components and eliminate potentially harmful ones.

Citation: Klompas M, Li L, Kleinman K, Szumita PM, Massaro AF. Association between ventilator bundle components and outcomes. JAMA Intern Med. 2016;176(9):1277-1283.


Dr. Mosetti is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Are the components of the ventilator bundles (VBs) associated with better outcomes for patients?

Background: VBs have been shown to prevent ventilator-associated pneumonia (VAP). However, most of the studies have analyzed outcomes based on the whole bundle without considering each individual component.

Study design: Retrospective cohort study.

Setting: Brigham and Women’s Hospital in Boston.

Spontaneous breathing trials were associated with lower hazards for VAEs (HR, 0.55; 95% CI, 0.40-0.76; P less than .001) and infection-related ventilator-associated complications (IVACs) (HR, 0.60; 95% CI, 0.37-1.00; P = .05). Head-of-bed elevation (HR, 1.38; 95% CI, 1.14-1.68; P = 0.001) and thromboembolism prophylaxis (HR, 2.57; 95% CI, 1.80-3.66; P less than .001) were associated with less time to extubation.

Oral care with chlorhexidine was associated with lower hazards for IVACs (HR, 0.60; 95% CI 0.36-1.00; P = .05) and for VAPs (HR, 0.55; 95% CI, 0.27-1.14; P = .11) but an increased risk for ventilator mortality (HR, 1.63; 95% CI, 1.15-2.31; P = .006). Stress ulcer prophylaxis was associated with higher risk for VAP (HR, 7.69; 95% CI, 1.44-41.10; P = .02).

Bottom line: Standard VB components merit revision to increase emphasis on beneficial components and eliminate potentially harmful ones.

Citation: Klompas M, Li L, Kleinman K, Szumita PM, Massaro AF. Association between ventilator bundle components and outcomes. JAMA Intern Med. 2016;176(9):1277-1283.


Dr. Mosetti is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Are overnight extubations in intensive care units associated with higher mortality rate?

Background: Little is known about the frequency, safety, and effectiveness of overnight extubations in the ICU.

Study design: Retrospective cohort study.

Setting: One-hundred sixty-five ICUs in the United States.

Synopsis: Using the Project IMPACT database, 97,844 adults undergoing mechanical ventilation (MV) admitted to ICUs were studied. Overnight extubation was defined as occurring between 7 p.m. and 6:59 a.m. Primary outcome was reintubation; secondary outcomes were ICU and hospital mortality and ICU and hospital length of stay.

Only one-fifth of patients with MV underwent overnight extubations. For MV duration of at least 12 hours, rates of reintubation were higher for patients undergoing overnight extubation (14.6% vs. 12.4%; P less than .001). Mortality was significantly higher for patients undergoing overnight versus daytime extubation in the ICU (11.2% vs. 6.1%; P less than.001) and in the hospital (16.0% vs. 11.1%; P less than .001). Length of ICU and hospital stays did not differ.

Bottom line: Overnight extubations occur in one of five patients in U.S. ICUs and are associated with worse outcomes, compared with daytime extubations.

Citation: Gershengorn HB, Scales DC, Kramer A, Wunsch H. Association between overnight extubations and outcomes in the intensive care unit. JAMA Intern Med. 2016;176(11):1651-1660.

Dr. Mosetti is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Are overnight extubations in intensive care units associated with higher mortality rate?

Background: Little is known about the frequency, safety, and effectiveness of overnight extubations in the ICU.

Study design: Retrospective cohort study.

Setting: One-hundred sixty-five ICUs in the United States.

Synopsis: Using the Project IMPACT database, 97,844 adults undergoing mechanical ventilation (MV) admitted to ICUs were studied. Overnight extubation was defined as occurring between 7 p.m. and 6:59 a.m. Primary outcome was reintubation; secondary outcomes were ICU and hospital mortality and ICU and hospital length of stay.

Only one-fifth of patients with MV underwent overnight extubations. For MV duration of at least 12 hours, rates of reintubation were higher for patients undergoing overnight extubation (14.6% vs. 12.4%; P less than .001). Mortality was significantly higher for patients undergoing overnight versus daytime extubation in the ICU (11.2% vs. 6.1%; P less than.001) and in the hospital (16.0% vs. 11.1%; P less than .001). Length of ICU and hospital stays did not differ.

Bottom line: Overnight extubations occur in one of five patients in U.S. ICUs and are associated with worse outcomes, compared with daytime extubations.

Citation: Gershengorn HB, Scales DC, Kramer A, Wunsch H. Association between overnight extubations and outcomes in the intensive care unit. JAMA Intern Med. 2016;176(11):1651-1660.

Dr. Mosetti is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Are overnight extubations in intensive care units associated with higher mortality rate?

Background: Little is known about the frequency, safety, and effectiveness of overnight extubations in the ICU.

Study design: Retrospective cohort study.

Setting: One-hundred sixty-five ICUs in the United States.

Synopsis: Using the Project IMPACT database, 97,844 adults undergoing mechanical ventilation (MV) admitted to ICUs were studied. Overnight extubation was defined as occurring between 7 p.m. and 6:59 a.m. Primary outcome was reintubation; secondary outcomes were ICU and hospital mortality and ICU and hospital length of stay.

Only one-fifth of patients with MV underwent overnight extubations. For MV duration of at least 12 hours, rates of reintubation were higher for patients undergoing overnight extubation (14.6% vs. 12.4%; P less than .001). Mortality was significantly higher for patients undergoing overnight versus daytime extubation in the ICU (11.2% vs. 6.1%; P less than.001) and in the hospital (16.0% vs. 11.1%; P less than .001). Length of ICU and hospital stays did not differ.

Bottom line: Overnight extubations occur in one of five patients in U.S. ICUs and are associated with worse outcomes, compared with daytime extubations.

Citation: Gershengorn HB, Scales DC, Kramer A, Wunsch H. Association between overnight extubations and outcomes in the intensive care unit. JAMA Intern Med. 2016;176(11):1651-1660.

Dr. Mosetti is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Is fecal microbiota transplantation (FMT) an efficacious and safe treatment approach for patients with recurrent Clostridium difficile infection (CDI)?

Background: FMT restores the normal composition of gut microbiota and is recommended when antibiotics fail to clear CDI. To date, only case series and open-labeled clinical trials support the use of FMT.

Study design: Randomized, controlled, double-blinded clinical trial.


Setting: Academic medical centers.

The primary endpoint was resolution of diarrhea without anti-CDI therapy after 8 weeks of follow-up. In the donor FMT group, 90.9% achieved clinical cure, compared with 62.5% in the autologous group. Patients who developed recurrent CDI were free of further disease after subsequent donor FMT.

The study included only patients who experienced three or more recurrences but excluded immunocompromised and older patients (older than 75 years of age).

Bottom line: Donor stool administered via colonoscopy was more effective than autologous FMT in preventing further CDI episodes.

Citation: Kelly CR, Khoruts A, Staley C, et al. Effect of fecal microbiota transplantation on recurrence in multiply recurrent Clostridium difficile infection: a randomized trial. Ann Intern Med. 2016;165(9):609-616.

Dr. Fernandez de la Vara is an instructor at the University of Miami Miller School of Medicine and chief medical resident at the University of Miami Hospital.

Clinical question: Is fecal microbiota transplantation (FMT) an efficacious and safe treatment approach for patients with recurrent Clostridium difficile infection (CDI)?

Background: FMT restores the normal composition of gut microbiota and is recommended when antibiotics fail to clear CDI. To date, only case series and open-labeled clinical trials support the use of FMT.

Study design: Randomized, controlled, double-blinded clinical trial.


Setting: Academic medical centers.

The primary endpoint was resolution of diarrhea without anti-CDI therapy after 8 weeks of follow-up. In the donor FMT group, 90.9% achieved clinical cure, compared with 62.5% in the autologous group. Patients who developed recurrent CDI were free of further disease after subsequent donor FMT.

The study included only patients who experienced three or more recurrences but excluded immunocompromised and older patients (older than 75 years of age).

Bottom line: Donor stool administered via colonoscopy was more effective than autologous FMT in preventing further CDI episodes.

Citation: Kelly CR, Khoruts A, Staley C, et al. Effect of fecal microbiota transplantation on recurrence in multiply recurrent Clostridium difficile infection: a randomized trial. Ann Intern Med. 2016;165(9):609-616.

Dr. Fernandez de la Vara is an instructor at the University of Miami Miller School of Medicine and chief medical resident at the University of Miami Hospital.

Clinical question: Is fecal microbiota transplantation (FMT) an efficacious and safe treatment approach for patients with recurrent Clostridium difficile infection (CDI)?

Background: FMT restores the normal composition of gut microbiota and is recommended when antibiotics fail to clear CDI. To date, only case series and open-labeled clinical trials support the use of FMT.

Study design: Randomized, controlled, double-blinded clinical trial.


Setting: Academic medical centers.

The primary endpoint was resolution of diarrhea without anti-CDI therapy after 8 weeks of follow-up. In the donor FMT group, 90.9% achieved clinical cure, compared with 62.5% in the autologous group. Patients who developed recurrent CDI were free of further disease after subsequent donor FMT.

The study included only patients who experienced three or more recurrences but excluded immunocompromised and older patients (older than 75 years of age).

Bottom line: Donor stool administered via colonoscopy was more effective than autologous FMT in preventing further CDI episodes.

Citation: Kelly CR, Khoruts A, Staley C, et al. Effect of fecal microbiota transplantation on recurrence in multiply recurrent Clostridium difficile infection: a randomized trial. Ann Intern Med. 2016;165(9):609-616.

Dr. Fernandez de la Vara is an instructor at the University of Miami Miller School of Medicine and chief medical resident at the University of Miami Hospital.

Clinical question: How does edoxaban compare with enoxaparin-warfarin in patients with nonvalvular atrial fibrillation undergoing cardioversion?

Background: Studies on non–vitamin K antagonist oral anticoagulants (NOACs) for patients with nonvalvular atrial fibrillation undergoing cardioversion are limited.

Study design: Multicenter, prospective, randomized trial.

Setting: Nineteen countries at 239 study sites.

Synopsis: This trial compared edoxaban with enoxaparin-warfarin. The study was stratified by cardioversion approach, anticoagulant experience, selected edoxaban dose, and region. There were 2,199 patients, mean age was 64, mean CHA2DS2-VASc score was 2.6, and mean therapeutic time on warfarin was 70.8%.

The primary efficacy endpoint was a composite of stroke, systemic emboli, myocardial infarction, and cardiovascular mortality, which occurred in 5 (1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin-warfarin group (odds ratio, 0.46; 95% CI, 0.12-1.43).

The primary safety endpoint was major and clinically relevant nonmajor bleeding for patients receiving at least one dose of the study drug, occurring in 16 (1%) of 1,067 patients given edoxaban versus 11 (1%) of 1,082 patients given enoxaparin-warfarin (OR, 1.48; 95% CI, 0.64-3.55).

Bottom line: In patients with nonvalvular atrial fibrillation undergoing cardioversion, edoxaban had low rates of major bleeding and thromboembolism similar to enoxaparin-warfarin therapy.

Citation: Goette A, Merino JL, Ezekowitz MD, et al. Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. Lancet. 2016;388(10055):1995-2003.

Dr. Fernandez de la Vara is an instructor at the University of Miami Miller School of Medicine and chief medical resident at the University of Miami Hospital.

Clinical question: How does edoxaban compare with enoxaparin-warfarin in patients with nonvalvular atrial fibrillation undergoing cardioversion?

Background: Studies on non–vitamin K antagonist oral anticoagulants (NOACs) for patients with nonvalvular atrial fibrillation undergoing cardioversion are limited.

Study design: Multicenter, prospective, randomized trial.

Setting: Nineteen countries at 239 study sites.

Synopsis: This trial compared edoxaban with enoxaparin-warfarin. The study was stratified by cardioversion approach, anticoagulant experience, selected edoxaban dose, and region. There were 2,199 patients, mean age was 64, mean CHA2DS2-VASc score was 2.6, and mean therapeutic time on warfarin was 70.8%.

The primary efficacy endpoint was a composite of stroke, systemic emboli, myocardial infarction, and cardiovascular mortality, which occurred in 5 (1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin-warfarin group (odds ratio, 0.46; 95% CI, 0.12-1.43).

The primary safety endpoint was major and clinically relevant nonmajor bleeding for patients receiving at least one dose of the study drug, occurring in 16 (1%) of 1,067 patients given edoxaban versus 11 (1%) of 1,082 patients given enoxaparin-warfarin (OR, 1.48; 95% CI, 0.64-3.55).

Bottom line: In patients with nonvalvular atrial fibrillation undergoing cardioversion, edoxaban had low rates of major bleeding and thromboembolism similar to enoxaparin-warfarin therapy.

Citation: Goette A, Merino JL, Ezekowitz MD, et al. Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. Lancet. 2016;388(10055):1995-2003.

Dr. Fernandez de la Vara is an instructor at the University of Miami Miller School of Medicine and chief medical resident at the University of Miami Hospital.

Clinical question: How does edoxaban compare with enoxaparin-warfarin in patients with nonvalvular atrial fibrillation undergoing cardioversion?

Background: Studies on non–vitamin K antagonist oral anticoagulants (NOACs) for patients with nonvalvular atrial fibrillation undergoing cardioversion are limited.

Study design: Multicenter, prospective, randomized trial.

Setting: Nineteen countries at 239 study sites.

Synopsis: This trial compared edoxaban with enoxaparin-warfarin. The study was stratified by cardioversion approach, anticoagulant experience, selected edoxaban dose, and region. There were 2,199 patients, mean age was 64, mean CHA2DS2-VASc score was 2.6, and mean therapeutic time on warfarin was 70.8%.

The primary efficacy endpoint was a composite of stroke, systemic emboli, myocardial infarction, and cardiovascular mortality, which occurred in 5 (1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin-warfarin group (odds ratio, 0.46; 95% CI, 0.12-1.43).

The primary safety endpoint was major and clinically relevant nonmajor bleeding for patients receiving at least one dose of the study drug, occurring in 16 (1%) of 1,067 patients given edoxaban versus 11 (1%) of 1,082 patients given enoxaparin-warfarin (OR, 1.48; 95% CI, 0.64-3.55).

Bottom line: In patients with nonvalvular atrial fibrillation undergoing cardioversion, edoxaban had low rates of major bleeding and thromboembolism similar to enoxaparin-warfarin therapy.

Citation: Goette A, Merino JL, Ezekowitz MD, et al. Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. Lancet. 2016;388(10055):1995-2003.

Dr. Fernandez de la Vara is an instructor at the University of Miami Miller School of Medicine and chief medical resident at the University of Miami Hospital.

Clinical question: What is the prevalence of outpatient treatment of acute pulmonary embolism (PE)?

Background: PE traditionally is perceived as a serious condition requiring hospitalization. Many studies, however, have shown that outpatient treatment of PE in low-risk, compliant patients is safe. Several scoring systems have been derived to identify patients with PE who are at low risk of adverse events and may be candidates for home treatment.

Clinical question: What is the prevalence of outpatient treatment of acute pulmonary embolism (PE)?

Background: PE traditionally is perceived as a serious condition requiring hospitalization. Many studies, however, have shown that outpatient treatment of PE in low-risk, compliant patients is safe. Several scoring systems have been derived to identify patients with PE who are at low risk of adverse events and may be candidates for home treatment.

Clinical question: What is the prevalence of outpatient treatment of acute pulmonary embolism (PE)?

Background: PE traditionally is perceived as a serious condition requiring hospitalization. Many studies, however, have shown that outpatient treatment of PE in low-risk, compliant patients is safe. Several scoring systems have been derived to identify patients with PE who are at low risk of adverse events and may be candidates for home treatment.

Clinical question: What are the new treatment options for gout?

Background: The 2006 European League Against Rheumatism (EULAR) guidelines recommend that acute flares of gout be treated as early as possible with either oral colchicine, oral corticosteroids, or intra-articular corticosteroids. Experts recommend starting urate-lowering therapy (ULT) only when certain severe clinical features occur, such as recurrent acute attacks and tophi.

Study design: Systematic review.

Setting: EULAR task force members from 12 European countries.

Synopsis: Since the last guidelines, interleukin-1 blockers (IL-1) were found to play a crucial role in crystal-induced inflammation. IL-1, NSAIDs, and corticosteroids should be considered in patients with frequent flares and contraindications to colchicine.

Unlike in the previous guidelines, ULT should be considered from first presentation of gout; for severe disease, serum uric acid (SUA) levels should be maintained at less than 6 mg/dL and less than 5 mg/dL.

Allopurinol is recommended for first-line ULT, and if the SUA target cannot be reached, it should be switched to another xanthine oxidase inhibitor (febuxostat) or a uricosuric or combined with a uricosuric.

Pegloticase is recommended for refractory gout.

Bottom line: The updated 2016 EULAR guidelines recommend new treatment options for gout and updated indications for ULT.

Citation: Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout [published online ahead of print July 25, 2016]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2016-209707.


Dr. Gummalla is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: What are the new treatment options for gout?

Background: The 2006 European League Against Rheumatism (EULAR) guidelines recommend that acute flares of gout be treated as early as possible with either oral colchicine, oral corticosteroids, or intra-articular corticosteroids. Experts recommend starting urate-lowering therapy (ULT) only when certain severe clinical features occur, such as recurrent acute attacks and tophi.

Study design: Systematic review.

Setting: EULAR task force members from 12 European countries.

Synopsis: Since the last guidelines, interleukin-1 blockers (IL-1) were found to play a crucial role in crystal-induced inflammation. IL-1, NSAIDs, and corticosteroids should be considered in patients with frequent flares and contraindications to colchicine.

Unlike in the previous guidelines, ULT should be considered from first presentation of gout; for severe disease, serum uric acid (SUA) levels should be maintained at less than 6 mg/dL and less than 5 mg/dL.

Allopurinol is recommended for first-line ULT, and if the SUA target cannot be reached, it should be switched to another xanthine oxidase inhibitor (febuxostat) or a uricosuric or combined with a uricosuric.

Pegloticase is recommended for refractory gout.

Bottom line: The updated 2016 EULAR guidelines recommend new treatment options for gout and updated indications for ULT.

Citation: Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout [published online ahead of print July 25, 2016]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2016-209707.


Dr. Gummalla is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: What are the new treatment options for gout?

Background: The 2006 European League Against Rheumatism (EULAR) guidelines recommend that acute flares of gout be treated as early as possible with either oral colchicine, oral corticosteroids, or intra-articular corticosteroids. Experts recommend starting urate-lowering therapy (ULT) only when certain severe clinical features occur, such as recurrent acute attacks and tophi.

Study design: Systematic review.

Setting: EULAR task force members from 12 European countries.

Synopsis: Since the last guidelines, interleukin-1 blockers (IL-1) were found to play a crucial role in crystal-induced inflammation. IL-1, NSAIDs, and corticosteroids should be considered in patients with frequent flares and contraindications to colchicine.

Unlike in the previous guidelines, ULT should be considered from first presentation of gout; for severe disease, serum uric acid (SUA) levels should be maintained at less than 6 mg/dL and less than 5 mg/dL.

Allopurinol is recommended for first-line ULT, and if the SUA target cannot be reached, it should be switched to another xanthine oxidase inhibitor (febuxostat) or a uricosuric or combined with a uricosuric.

Pegloticase is recommended for refractory gout.

Bottom line: The updated 2016 EULAR guidelines recommend new treatment options for gout and updated indications for ULT.

Citation: Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout [published online ahead of print July 25, 2016]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2016-209707.


Dr. Gummalla is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Justin Kimsey, Alabama

Mohammed N.Y. Shah, MD, Alaska

Katharina Beeler, MD, Arizona

Khoi Nguyen, MD, Arizona

Vinay Saini, MD, Arizona

Maria Aceves, PA-C, California

Sarvenaz Alibeigi, California

Peter Cadman, MD, California

Katrina Chapman, DO, MPH, California

Cheryll Gallardo-Villena, MD, California

Sripriya Ganesan, California

Alice Gong, MD, California

Henry Kwang, MD, California

Kevin Li, California

Anthony Murphy, MD, California

Dan Nguyen, California

Daniel Oh, California

Joon Parle, California

Katie Raffel, California

Darshana Sarathchandra, MD, California

Lifang Zhang, California

Jaime Baker, MD, Colorado

Eric Johnson, PA-C, Colorado

Juan Lessing, MD, Colorado

Benjamin Ruckman, DO, Colorado

Rehaan Shaffie, MD, Colorado

Deborah Casey, MD, Connecticut

Daniel Heacock, PA-C, Connecticut

Shabana Ansari, DO, Delaware

Madhu Prattipati, MD, Delaware

Pallavi Aneja, MD, Florida

Satcha Borgella, MD, Florida

Thendrex H. Estrella, MD, Florida

Abid Hussain, MD, Florida

Daphnee Hutchinson, DO, Florida

Muhammad Jaffer, Florida

Sue Lee, ANP, Florida

Melissa Odermann, DO, Florida

Jose Guillermo Revelo Paiz, MD, Florida

Rafael J. Rolon Rivera, MD, Florida

Eleonor Rongo, Florida

Esther Roth, Florida

Shitaye Argaw, MD, Georgia

Taryn DeGrazia, Georgia

Becca Feistritzer, Georgia

Jamal Fitts, Georgia

Kristen Flint, Georgia

Zachary Hermes, Georgia

Mukesh Kumar, Georgia

Kajal Patel, Georgia

Madeline Smith, Georgia

Wade Flowers, PharmD, Idaho

Ajay Bhandare, Illinois

Kimberly Brighton, Illinois

Hristo D. Hristov, MD, Illinois

Sidney Iriana, Illinois

Aurelian Ivan, Illinois

Ming Lee, MD, Illinois

Michelle Lundholm, Illinois

Idrees Mohiuddin, MD, Illinois

Murr Murray, Illinois

Tad Nair, MD, Illinois

Shalini Reddy, MD, Illinois

Richard Rethorst, MD, Illinois

Kelly Robertshaw, Illinois

Gracelene Wegrzyn, Illinois

Evan Yates, Illinois

Lora J. Jones McClure, MD, Indiana

Carleigh Wilson, DO, Indiana

Erin Brown, ARNP, Iowa

Adam Gray, Iowa

Paul Greco, MD, Iowa

Shelly McGurk, ACNP, ARNP, Iowa

Julie Stanik-Hutt, ACNP, CNS, PhD, Iowa

Elizabeth Cozad, DO, Kansas

Roshan Pais, Kentucky

Mark Youssef, MD, Kentucky

Heather Kahn, MD, Louisiana

Danielle Parrott, PA-C, Maine

Erica Lafferty, ACNP, Maryland

Andrea Limpuangthip, Maryland

Steven Schwartz, CCM, MD, Maryland

Eisha Azhar, MBBS, Massachusetts

Badal Kalamkar, MD, MPH, Massachusetts

Bhavya Rajanna, MD, Massachusetts

Sahib Baljinder Singh, MD, Massachusetts

Kathryn Adams, Michigan

Haseeb Aslam, MD, MBBS, Michigan

Hilda Crispin, MD, Michigan

Sharmistha Dev, MD, Michigan

Tristan Feierabend, MD, Michigan

Sonal Kamalia, MD, MBBS, Michigan

Matthew Luzum, MD, Michigan

Daniel Mitzel, MD, Michigan

Richard Raad, Michigan

Mythri Ramegowda, MD, Michigan

Katie Scally, MD, Michigan

Linden Spital, MSN, NP, Michigan

Porama Koy Thanaporn, MD, Michigan

Chanteil Ulatowski, Michigan

Tingting Xiong, MD, Michigan

Adam Zahr, Michigan

Mike Beste, MD, Minnesota

Elise Haupt, PA-C, Minnesota

Lobsang Trasar, MD, Minnesota

Kari Goan, DO, Mississippi

David C. Pierre, Mississippi

Sudheer Tangella, MD, Mississippi

Tahani Atieh, Missouri

Nicholas Arnold, Missouri

Amanda Calhoun, Missouri

Jyotirmoy Das, Missouri

Umber Dube, Missouri

Daniel Gaughan, Missouri

Woojin Joo, Missouri

Khaled Jumean, MBBS, Missouri

Salma Kazmi, MBBS, MD, Missouri

Yoon Kook (Danny) Kim, Missouri

Ryan Kronen, Missouri

Alyssa Kroner, Missouri

Randy Laine, Missouri

Edward Lee, Missouri

Cerena Leung, Missouri

Patricia Lithrow, Missouri

Brandt Lydon, Missouri

Mary Morgan Scott, Missouri

Jay Patel, Missouri

Justin Porter, Missouri

Danelle Reagin, FNP-C, Missouri

Amanda Reis, Missouri

Awik Som, Missouri

Abby Sung, Missouri

Mary Sutherland, Missouri

Maggie Wang, Missouri

Noah Wasserman, Missouri

Alexis Webber, Missouri

Ryan White, Missouri

Amy Xu, Missouri

Ran Xu, Missouri

Michael Yang, Missouri

Christopher Dietrich, MD, Montana

Jason Kunz, DO, Montana

Jodi Cantrell, MD, Nebraska

Steven Hart, MD, Nebraska

Kurt Kapels, MD, Nebraska

Brian Keegan, MD, Nebraska

Shaun Jang, MD, Nevada

Gurpinder Singh, MD, New Hampshire

Pragati Banda, MD, New Jersey

Sahai Donaldson, MBBS, New Jersey

Ashesha Mechineni, MD, New Jersey

Alisa Clark, New Mexico

Prajit Arora, MBBS, New Mexico

Crystal Cardwell, New Mexico

Landon Casaus, New Mexico

Tapuwa Mupfumira, MD, New Mexico

Eric Rightley, New Mexico

David S. Anderson, New York

Joan Bosco, MD, New York

Jessica Caro, New York

Anna Dewan, New York

Amrita Dhillon, MBBS, New York

Julia Frydman, New York

Radhika Gali, MBBS, MDS, New York

Allison Guttmann, MD, New York

Aryles Hedjar, MD, New York

Peter Janes, New York

Nadine Kalavazoff, New York

Jeffrey Lach, DO, New York

Keron Lezama, MD, New York

Yingheng Liu, New York

Taimur Mirza, New York

Cyrus Nensey, MD, New York

Nekee Pandya, MD, New York

Thushara Paul, MD, New York

Yu Sung, New York

Joel Boggan, MD, North Carolina

Angela Fletcher, North Carolina

Rebecca Gimpert, PA-C, North Carolina

Samantha Levering, PA-C, North Carolina

Nancy Martin, North Carolina

Richard Sherwood, North Carolina

Kranthi K. Sitammagari, MD, North Carolina

Aaron Swedberg, MPAS, PA-C, North Carolina

Yih-Cherng Tsai, North Carolina

Richard Bakker, MD, PhD, Ohio

Matthew Broderick, MD, Ohio

Subbaraju Budharaju, MD, MS, Ohio

Steven Bumb, MD, Ohio

Ahmed Eltelbany, MD, Ohio

Tracey Hardin, MS, Ohio

Patricia Hardman, APRN, Ohio

Michael Lewis, MD, Ohio

Volodymyr Manko, Ohio

Rebecca Stone, Ohio

Chaitanya Valluri, Ohio

Holly Wierzbicki, CNP, Ohio

Jamie Yockey, APRN, CNP, Ohio

Mahdi Mussa, MD, Oklahoma

Monica Saemz, DO, Oklahoma

Peter Ganter, MD, Oregon

Bethany Roy, MD, Oregon

Mary Clare Bohnett, Oregon

Molly Rabinowitz, Oregon

Abdullateef Abdulkareem, MD, MPH, Pennsylvania

David Ahamba, MD, MPH, Pennsylvania

David Chin, MD, Pennsylvania

Thomas Conlon, Pennsylvania

Dan Giesler, MD, Pennsylvania

Umair Randhawa, MD, Pennsylvania

Syed Yusuf, MBBS, Pennsylvania

Michael Rigatti, Pennsylvania

Thaylon Barreto, Rhode Island

Jessica Cook, MD, South Carolina

Robin Malik, MD, South Carolina

John Busigin, Tennessee

Shefali Paranjape, MD, Tennessee

Thai Dang, MD, Texas

Matthew Glover, MD, Texas

Snigdha Jain, MD, Texas

David Kellenberger, Texas

Sumeet Kumar, Texas

Kyle McClendon, PA-C, Texas

Sowjanya Mohan, Texas

Akhil D. Vats, MD, Texas

Samatha Vellanki, Texas

Lee-Anna Burgess, MD, Vermont

Rick Hildebrant, MD, Vermont

Matthew Backens, MD, Virginia

Megan Coe, Virginia

Kevin Dehaan, Virginia

Stephen Fox, Virginia

Amber Inofuentes, MD, Virginia

Jessica Keiser, MD, Virginia

Joseph Perez, MD, FAAFP, MBA, Virginia

Kanwapreet S. Saini, MD, Virginia

Erin Vipler, MD, Virginia

Naveen Voore, MBBS, Virginia

Abhishek Agarwal, MD, MBBS, Washington

Robert Cooney, MD, Washington

Cynthia Horton, MD, Washington

Rich A. Kukreja, MD, Washington

Ji Young Nam, MD, Washington

Kai Wilhelm, MD, Washington

In Kyu Yoo, Washington

Temu Brown, Wisconsin

Pablo Colon Nieves, Wisconsin

Christina Evans, PAC, Wisconsin

Swetha Karturi, MBBS, Wisconsin

Mark Babcock, DO, Wyoming

Ahmad Von Schlegell, Canada

Anand Kartha, Japan

Mohamed Sadek, Qatar

Amine Rakab, MD, Qatar

Abazar Saeed, Qatar

Joao Guerra, MD

Justin Kimsey, Alabama

Mohammed N.Y. Shah, MD, Alaska

Katharina Beeler, MD, Arizona

Khoi Nguyen, MD, Arizona

Vinay Saini, MD, Arizona

Maria Aceves, PA-C, California

Sarvenaz Alibeigi, California

Peter Cadman, MD, California

Katrina Chapman, DO, MPH, California

Cheryll Gallardo-Villena, MD, California

Sripriya Ganesan, California

Alice Gong, MD, California

Henry Kwang, MD, California

Kevin Li, California

Anthony Murphy, MD, California

Dan Nguyen, California

Daniel Oh, California

Joon Parle, California

Katie Raffel, California

Darshana Sarathchandra, MD, California

Lifang Zhang, California

Jaime Baker, MD, Colorado

Eric Johnson, PA-C, Colorado

Juan Lessing, MD, Colorado

Benjamin Ruckman, DO, Colorado

Rehaan Shaffie, MD, Colorado

Deborah Casey, MD, Connecticut

Daniel Heacock, PA-C, Connecticut

Shabana Ansari, DO, Delaware

Madhu Prattipati, MD, Delaware

Pallavi Aneja, MD, Florida

Satcha Borgella, MD, Florida

Thendrex H. Estrella, MD, Florida

Abid Hussain, MD, Florida

Daphnee Hutchinson, DO, Florida

Muhammad Jaffer, Florida

Sue Lee, ANP, Florida

Melissa Odermann, DO, Florida

Jose Guillermo Revelo Paiz, MD, Florida

Rafael J. Rolon Rivera, MD, Florida

Eleonor Rongo, Florida

Esther Roth, Florida

Shitaye Argaw, MD, Georgia

Taryn DeGrazia, Georgia

Becca Feistritzer, Georgia

Jamal Fitts, Georgia

Kristen Flint, Georgia

Zachary Hermes, Georgia

Mukesh Kumar, Georgia

Kajal Patel, Georgia

Madeline Smith, Georgia

Wade Flowers, PharmD, Idaho

Ajay Bhandare, Illinois

Kimberly Brighton, Illinois

Hristo D. Hristov, MD, Illinois

Sidney Iriana, Illinois

Aurelian Ivan, Illinois

Ming Lee, MD, Illinois

Michelle Lundholm, Illinois

Idrees Mohiuddin, MD, Illinois

Murr Murray, Illinois

Tad Nair, MD, Illinois

Shalini Reddy, MD, Illinois

Richard Rethorst, MD, Illinois

Kelly Robertshaw, Illinois

Gracelene Wegrzyn, Illinois

Evan Yates, Illinois

Lora J. Jones McClure, MD, Indiana

Carleigh Wilson, DO, Indiana

Erin Brown, ARNP, Iowa

Adam Gray, Iowa

Paul Greco, MD, Iowa

Shelly McGurk, ACNP, ARNP, Iowa

Julie Stanik-Hutt, ACNP, CNS, PhD, Iowa

Elizabeth Cozad, DO, Kansas

Roshan Pais, Kentucky

Mark Youssef, MD, Kentucky

Heather Kahn, MD, Louisiana

Danielle Parrott, PA-C, Maine

Erica Lafferty, ACNP, Maryland

Andrea Limpuangthip, Maryland

Steven Schwartz, CCM, MD, Maryland

Eisha Azhar, MBBS, Massachusetts

Badal Kalamkar, MD, MPH, Massachusetts

Bhavya Rajanna, MD, Massachusetts

Sahib Baljinder Singh, MD, Massachusetts

Kathryn Adams, Michigan

Haseeb Aslam, MD, MBBS, Michigan

Hilda Crispin, MD, Michigan

Sharmistha Dev, MD, Michigan

Tristan Feierabend, MD, Michigan

Sonal Kamalia, MD, MBBS, Michigan

Matthew Luzum, MD, Michigan

Daniel Mitzel, MD, Michigan

Richard Raad, Michigan

Mythri Ramegowda, MD, Michigan

Katie Scally, MD, Michigan

Linden Spital, MSN, NP, Michigan

Porama Koy Thanaporn, MD, Michigan

Chanteil Ulatowski, Michigan

Tingting Xiong, MD, Michigan

Adam Zahr, Michigan

Mike Beste, MD, Minnesota

Elise Haupt, PA-C, Minnesota

Lobsang Trasar, MD, Minnesota

Kari Goan, DO, Mississippi

David C. Pierre, Mississippi

Sudheer Tangella, MD, Mississippi

Tahani Atieh, Missouri

Nicholas Arnold, Missouri

Amanda Calhoun, Missouri

Jyotirmoy Das, Missouri

Umber Dube, Missouri

Daniel Gaughan, Missouri

Woojin Joo, Missouri

Khaled Jumean, MBBS, Missouri

Salma Kazmi, MBBS, MD, Missouri

Yoon Kook (Danny) Kim, Missouri

Ryan Kronen, Missouri

Alyssa Kroner, Missouri

Randy Laine, Missouri

Edward Lee, Missouri

Cerena Leung, Missouri

Patricia Lithrow, Missouri

Brandt Lydon, Missouri

Mary Morgan Scott, Missouri

Jay Patel, Missouri

Justin Porter, Missouri

Danelle Reagin, FNP-C, Missouri

Amanda Reis, Missouri

Awik Som, Missouri

Abby Sung, Missouri

Mary Sutherland, Missouri

Maggie Wang, Missouri

Noah Wasserman, Missouri

Alexis Webber, Missouri

Ryan White, Missouri

Amy Xu, Missouri

Ran Xu, Missouri

Michael Yang, Missouri

Christopher Dietrich, MD, Montana

Jason Kunz, DO, Montana

Jodi Cantrell, MD, Nebraska

Steven Hart, MD, Nebraska

Kurt Kapels, MD, Nebraska

Brian Keegan, MD, Nebraska

Shaun Jang, MD, Nevada

Gurpinder Singh, MD, New Hampshire

Pragati Banda, MD, New Jersey

Sahai Donaldson, MBBS, New Jersey

Ashesha Mechineni, MD, New Jersey

Alisa Clark, New Mexico

Prajit Arora, MBBS, New Mexico

Crystal Cardwell, New Mexico

Landon Casaus, New Mexico

Tapuwa Mupfumira, MD, New Mexico

Eric Rightley, New Mexico

David S. Anderson, New York

Joan Bosco, MD, New York

Jessica Caro, New York

Anna Dewan, New York

Amrita Dhillon, MBBS, New York

Julia Frydman, New York

Radhika Gali, MBBS, MDS, New York

Allison Guttmann, MD, New York

Aryles Hedjar, MD, New York

Peter Janes, New York

Nadine Kalavazoff, New York

Jeffrey Lach, DO, New York

Keron Lezama, MD, New York

Yingheng Liu, New York

Taimur Mirza, New York

Cyrus Nensey, MD, New York

Nekee Pandya, MD, New York

Thushara Paul, MD, New York

Yu Sung, New York

Joel Boggan, MD, North Carolina

Angela Fletcher, North Carolina

Rebecca Gimpert, PA-C, North Carolina

Samantha Levering, PA-C, North Carolina

Nancy Martin, North Carolina

Richard Sherwood, North Carolina

Kranthi K. Sitammagari, MD, North Carolina

Aaron Swedberg, MPAS, PA-C, North Carolina

Yih-Cherng Tsai, North Carolina

Richard Bakker, MD, PhD, Ohio

Matthew Broderick, MD, Ohio

Subbaraju Budharaju, MD, MS, Ohio

Steven Bumb, MD, Ohio

Ahmed Eltelbany, MD, Ohio

Tracey Hardin, MS, Ohio

Patricia Hardman, APRN, Ohio

Michael Lewis, MD, Ohio

Volodymyr Manko, Ohio

Rebecca Stone, Ohio

Chaitanya Valluri, Ohio

Holly Wierzbicki, CNP, Ohio

Jamie Yockey, APRN, CNP, Ohio

Mahdi Mussa, MD, Oklahoma

Monica Saemz, DO, Oklahoma

Peter Ganter, MD, Oregon

Bethany Roy, MD, Oregon

Mary Clare Bohnett, Oregon

Molly Rabinowitz, Oregon

Abdullateef Abdulkareem, MD, MPH, Pennsylvania

David Ahamba, MD, MPH, Pennsylvania

David Chin, MD, Pennsylvania

Thomas Conlon, Pennsylvania

Dan Giesler, MD, Pennsylvania

Umair Randhawa, MD, Pennsylvania

Syed Yusuf, MBBS, Pennsylvania

Michael Rigatti, Pennsylvania

Thaylon Barreto, Rhode Island

Jessica Cook, MD, South Carolina

Robin Malik, MD, South Carolina

John Busigin, Tennessee

Shefali Paranjape, MD, Tennessee

Thai Dang, MD, Texas

Matthew Glover, MD, Texas

Snigdha Jain, MD, Texas

David Kellenberger, Texas

Sumeet Kumar, Texas

Kyle McClendon, PA-C, Texas

Sowjanya Mohan, Texas

Akhil D. Vats, MD, Texas

Samatha Vellanki, Texas

Lee-Anna Burgess, MD, Vermont

Rick Hildebrant, MD, Vermont

Matthew Backens, MD, Virginia

Megan Coe, Virginia

Kevin Dehaan, Virginia

Stephen Fox, Virginia

Amber Inofuentes, MD, Virginia

Jessica Keiser, MD, Virginia

Joseph Perez, MD, FAAFP, MBA, Virginia

Kanwapreet S. Saini, MD, Virginia

Erin Vipler, MD, Virginia

Naveen Voore, MBBS, Virginia

Abhishek Agarwal, MD, MBBS, Washington

Robert Cooney, MD, Washington

Cynthia Horton, MD, Washington

Rich A. Kukreja, MD, Washington

Ji Young Nam, MD, Washington

Kai Wilhelm, MD, Washington

In Kyu Yoo, Washington

Temu Brown, Wisconsin

Pablo Colon Nieves, Wisconsin

Christina Evans, PAC, Wisconsin

Swetha Karturi, MBBS, Wisconsin

Mark Babcock, DO, Wyoming

Ahmad Von Schlegell, Canada

Anand Kartha, Japan

Mohamed Sadek, Qatar

Amine Rakab, MD, Qatar

Abazar Saeed, Qatar

Joao Guerra, MD

Justin Kimsey, Alabama

Mohammed N.Y. Shah, MD, Alaska

Katharina Beeler, MD, Arizona

Khoi Nguyen, MD, Arizona

Vinay Saini, MD, Arizona

Maria Aceves, PA-C, California

Sarvenaz Alibeigi, California

Peter Cadman, MD, California

Katrina Chapman, DO, MPH, California

Cheryll Gallardo-Villena, MD, California

Sripriya Ganesan, California

Alice Gong, MD, California

Henry Kwang, MD, California

Kevin Li, California

Anthony Murphy, MD, California

Dan Nguyen, California

Daniel Oh, California

Joon Parle, California

Katie Raffel, California

Darshana Sarathchandra, MD, California

Lifang Zhang, California

Jaime Baker, MD, Colorado

Eric Johnson, PA-C, Colorado

Juan Lessing, MD, Colorado

Benjamin Ruckman, DO, Colorado

Rehaan Shaffie, MD, Colorado

Deborah Casey, MD, Connecticut

Daniel Heacock, PA-C, Connecticut

Shabana Ansari, DO, Delaware

Madhu Prattipati, MD, Delaware

Pallavi Aneja, MD, Florida

Satcha Borgella, MD, Florida

Thendrex H. Estrella, MD, Florida

Abid Hussain, MD, Florida

Daphnee Hutchinson, DO, Florida

Muhammad Jaffer, Florida

Sue Lee, ANP, Florida

Melissa Odermann, DO, Florida

Jose Guillermo Revelo Paiz, MD, Florida

Rafael J. Rolon Rivera, MD, Florida

Eleonor Rongo, Florida

Esther Roth, Florida

Shitaye Argaw, MD, Georgia

Taryn DeGrazia, Georgia

Becca Feistritzer, Georgia

Jamal Fitts, Georgia

Kristen Flint, Georgia

Zachary Hermes, Georgia

Mukesh Kumar, Georgia

Kajal Patel, Georgia

Madeline Smith, Georgia

Wade Flowers, PharmD, Idaho

Ajay Bhandare, Illinois

Kimberly Brighton, Illinois

Hristo D. Hristov, MD, Illinois

Sidney Iriana, Illinois

Aurelian Ivan, Illinois

Ming Lee, MD, Illinois

Michelle Lundholm, Illinois

Idrees Mohiuddin, MD, Illinois

Murr Murray, Illinois

Tad Nair, MD, Illinois

Shalini Reddy, MD, Illinois

Richard Rethorst, MD, Illinois

Kelly Robertshaw, Illinois

Gracelene Wegrzyn, Illinois

Evan Yates, Illinois

Lora J. Jones McClure, MD, Indiana

Carleigh Wilson, DO, Indiana

Erin Brown, ARNP, Iowa

Adam Gray, Iowa

Paul Greco, MD, Iowa

Shelly McGurk, ACNP, ARNP, Iowa

Julie Stanik-Hutt, ACNP, CNS, PhD, Iowa

Elizabeth Cozad, DO, Kansas

Roshan Pais, Kentucky

Mark Youssef, MD, Kentucky

Heather Kahn, MD, Louisiana

Danielle Parrott, PA-C, Maine

Erica Lafferty, ACNP, Maryland

Andrea Limpuangthip, Maryland

Steven Schwartz, CCM, MD, Maryland

Eisha Azhar, MBBS, Massachusetts

Badal Kalamkar, MD, MPH, Massachusetts

Bhavya Rajanna, MD, Massachusetts

Sahib Baljinder Singh, MD, Massachusetts

Kathryn Adams, Michigan

Haseeb Aslam, MD, MBBS, Michigan

Hilda Crispin, MD, Michigan

Sharmistha Dev, MD, Michigan

Tristan Feierabend, MD, Michigan

Sonal Kamalia, MD, MBBS, Michigan

Matthew Luzum, MD, Michigan

Daniel Mitzel, MD, Michigan

Richard Raad, Michigan

Mythri Ramegowda, MD, Michigan

Katie Scally, MD, Michigan

Linden Spital, MSN, NP, Michigan

Porama Koy Thanaporn, MD, Michigan

Chanteil Ulatowski, Michigan

Tingting Xiong, MD, Michigan

Adam Zahr, Michigan

Mike Beste, MD, Minnesota

Elise Haupt, PA-C, Minnesota

Lobsang Trasar, MD, Minnesota

Kari Goan, DO, Mississippi

David C. Pierre, Mississippi

Sudheer Tangella, MD, Mississippi

Tahani Atieh, Missouri

Nicholas Arnold, Missouri

Amanda Calhoun, Missouri

Jyotirmoy Das, Missouri

Umber Dube, Missouri

Daniel Gaughan, Missouri

Woojin Joo, Missouri

Khaled Jumean, MBBS, Missouri

Salma Kazmi, MBBS, MD, Missouri

Yoon Kook (Danny) Kim, Missouri

Ryan Kronen, Missouri

Alyssa Kroner, Missouri

Randy Laine, Missouri

Edward Lee, Missouri

Cerena Leung, Missouri

Patricia Lithrow, Missouri

Brandt Lydon, Missouri

Mary Morgan Scott, Missouri

Jay Patel, Missouri

Justin Porter, Missouri

Danelle Reagin, FNP-C, Missouri

Amanda Reis, Missouri

Awik Som, Missouri

Abby Sung, Missouri

Mary Sutherland, Missouri

Maggie Wang, Missouri

Noah Wasserman, Missouri

Alexis Webber, Missouri

Ryan White, Missouri

Amy Xu, Missouri

Ran Xu, Missouri

Michael Yang, Missouri

Christopher Dietrich, MD, Montana

Jason Kunz, DO, Montana

Jodi Cantrell, MD, Nebraska

Steven Hart, MD, Nebraska

Kurt Kapels, MD, Nebraska

Brian Keegan, MD, Nebraska

Shaun Jang, MD, Nevada

Gurpinder Singh, MD, New Hampshire

Pragati Banda, MD, New Jersey

Sahai Donaldson, MBBS, New Jersey

Ashesha Mechineni, MD, New Jersey

Alisa Clark, New Mexico

Prajit Arora, MBBS, New Mexico

Crystal Cardwell, New Mexico

Landon Casaus, New Mexico

Tapuwa Mupfumira, MD, New Mexico

Eric Rightley, New Mexico

David S. Anderson, New York

Joan Bosco, MD, New York

Jessica Caro, New York

Anna Dewan, New York

Amrita Dhillon, MBBS, New York

Julia Frydman, New York

Radhika Gali, MBBS, MDS, New York

Allison Guttmann, MD, New York

Aryles Hedjar, MD, New York

Peter Janes, New York

Nadine Kalavazoff, New York

Jeffrey Lach, DO, New York

Keron Lezama, MD, New York

Yingheng Liu, New York

Taimur Mirza, New York

Cyrus Nensey, MD, New York

Nekee Pandya, MD, New York

Thushara Paul, MD, New York

Yu Sung, New York

Joel Boggan, MD, North Carolina

Angela Fletcher, North Carolina

Rebecca Gimpert, PA-C, North Carolina

Samantha Levering, PA-C, North Carolina

Nancy Martin, North Carolina

Richard Sherwood, North Carolina

Kranthi K. Sitammagari, MD, North Carolina

Aaron Swedberg, MPAS, PA-C, North Carolina

Yih-Cherng Tsai, North Carolina

Richard Bakker, MD, PhD, Ohio

Matthew Broderick, MD, Ohio

Subbaraju Budharaju, MD, MS, Ohio

Steven Bumb, MD, Ohio

Ahmed Eltelbany, MD, Ohio

Tracey Hardin, MS, Ohio

Patricia Hardman, APRN, Ohio

Michael Lewis, MD, Ohio

Volodymyr Manko, Ohio

Rebecca Stone, Ohio

Chaitanya Valluri, Ohio

Holly Wierzbicki, CNP, Ohio

Jamie Yockey, APRN, CNP, Ohio

Mahdi Mussa, MD, Oklahoma

Monica Saemz, DO, Oklahoma

Peter Ganter, MD, Oregon

Bethany Roy, MD, Oregon

Mary Clare Bohnett, Oregon

Molly Rabinowitz, Oregon

Abdullateef Abdulkareem, MD, MPH, Pennsylvania

David Ahamba, MD, MPH, Pennsylvania

David Chin, MD, Pennsylvania

Thomas Conlon, Pennsylvania

Dan Giesler, MD, Pennsylvania

Umair Randhawa, MD, Pennsylvania

Syed Yusuf, MBBS, Pennsylvania

Michael Rigatti, Pennsylvania

Thaylon Barreto, Rhode Island

Jessica Cook, MD, South Carolina

Robin Malik, MD, South Carolina

John Busigin, Tennessee

Shefali Paranjape, MD, Tennessee

Thai Dang, MD, Texas

Matthew Glover, MD, Texas

Snigdha Jain, MD, Texas

David Kellenberger, Texas

Sumeet Kumar, Texas

Kyle McClendon, PA-C, Texas

Sowjanya Mohan, Texas

Akhil D. Vats, MD, Texas

Samatha Vellanki, Texas

Lee-Anna Burgess, MD, Vermont

Rick Hildebrant, MD, Vermont

Matthew Backens, MD, Virginia

Megan Coe, Virginia

Kevin Dehaan, Virginia

Stephen Fox, Virginia

Amber Inofuentes, MD, Virginia

Jessica Keiser, MD, Virginia

Joseph Perez, MD, FAAFP, MBA, Virginia

Kanwapreet S. Saini, MD, Virginia

Erin Vipler, MD, Virginia

Naveen Voore, MBBS, Virginia

Abhishek Agarwal, MD, MBBS, Washington

Robert Cooney, MD, Washington

Cynthia Horton, MD, Washington

Rich A. Kukreja, MD, Washington

Ji Young Nam, MD, Washington

Kai Wilhelm, MD, Washington

In Kyu Yoo, Washington

Temu Brown, Wisconsin

Pablo Colon Nieves, Wisconsin

Christina Evans, PAC, Wisconsin

Swetha Karturi, MBBS, Wisconsin

Mark Babcock, DO, Wyoming

Ahmad Von Schlegell, Canada

Anand Kartha, Japan

Mohamed Sadek, Qatar

Amine Rakab, MD, Qatar

Abazar Saeed, Qatar

Joao Guerra, MD