Lown Institute Vignette Competition


2018 Lown Vignette Competition Winners!

The Lown Institute is proud to announce the winners of the 2018 Lown Vignette Competition:

What should the target blood pressure be?

Deepa Ramadurai, MD David Tanaka, MD

University of Colorado Internal Medicine Residency Training Program, Aurora, CO

Deepa Ramadurai was born and raised in the southwest suburbs of Chicago. She attended Northwestern University in Evanston, Illinois for undergraduate studies and graduated with a major in Biological Sciences and minor in Spanish Language in 2012. She was part of the second medical class at the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York and graduated in 2016. She is currently in her second year of internal medicine residency training at the University of Colorado, where she couples matched with her husband Kevin, a pediatrics resident at Children’s Hospital Colorado. She plans to apply for subspecialty training and ultimately hopes to pursue a career in academic pulmonary and critical care medicine with a focus on medical education.

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The Devil is in the Details: Combination Medications, Oversedation, and Unnecessary Testing in the Geriatric Population

Ricardo Nieves, MD
Tariq Salim, MD
Casey McQuade, MD

University of Pittsburgh Medical Center, Pittsburgh, PA

Ricardo Nieves was born in Nashville, Tennessee and raised in several places including Florida, Puerto Rico, and Delaware. Being born into a Hispanic family he is fluent in both English and Spanish and regularly travels back to Puerto Rico to visit his family. Ricardo completed his undergraduate studies at the University of Delaware, graduating Magna Cum Laude with majors in both Neuroscience and Spanish Literature. During his undergraduate career, Ricardo competed on the national level as an oarsman for the University of Delaware men’s lightweight crew team. Ricardo attended medical school at the University of Pittsburgh and graduated in 2016. He is currently in his second year of residency for Internal Medicine at the University of Pittsburgh Medical Center. His research interests lie in the application and utilization of advanced Nuclear Cardiology imaging techniques in clinical practice, and he currently serves as a coordinator for the Spanish speaking free clinic at the University of Pittsburgh. Following his residency, Dr. Nieves plans to pursue a career in academic cardiology and medical education.

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Preoperative Evaluation in Low-Risk Surgery

Valeria Chew, MD Candidate, Drexel University College of Medicine
Jian Liang Tan, MD, Crozer-Chester Medical Center
Kshitij Thakur, MD, Crozer-Chester Medical Center

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Blood Transfusions in Sickle Cell Disease

Neil Keshvani, MD
Srikanth Nagalla, MD
Arjun Gupta, MD

University of Texas Southwestern Medical Center

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Reducing Inappropriate Use of Peripherally Inserted Central Catheters

Jian Liang Tan, MD
Kshitij Thakur, MD

Crozer-Chester Medical Center, PA

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Partner Therapy in Sexually Transmitted Infections

Neil Keshvani, MD
Ank Nijhawan, MD, MPH
Arjun Gupta, MD

University of Texas Southwestern Medical Center

Honorable Mentions

Shared Decision Making, Appropriate for Inappropriate Coronary Stenting

Vivek Podder, MBBS, Tairunnessa Memorial Medical College
Madhava Sai Sivapuram, MBBS Candidate, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation
Amy Price, PhD, Department of Continuing Education, The University of Oxford

The unintended consequence of listening for a carotid bruit

Mehrnaz Ghasemiesfe, MD, UCSF School of Medicine, San Francisco Veterans Affairs Medical Center
Deborah Korenstein, MD, Memorial Sloan Kettering Cancer Center
Salomeh Keyhani, MD, MPH, UCSF Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center

Telemetry — The Physical and Emotional Restraint

Rachna Rawal, MD
Jennifer M. Schmidt, MD

St. Louis University Hospital

Tobacco, insomnia and benzodiazepines: A rural story

Ana Júlia Araújo de Carvalho, MS-IV, Universidade Federal de Uberlândia
Mayara Floss, MD, Secretaria Municipal de Saúde Cunha Porã
Andreia Costa, RN, Secretaria Municipal de Saúde Cunha Porã

Arterial Thrombosis Following Diagnostic Cardiac Catheterization

Angelo Canedo, DO
Alan Roth, DO

Jamaica Hospital Medical Center

Medical Imaging Course Correction

Lynn McVey, MHA
Van Ly, MHA
Raydelin Hernandez, PTN

New Jersey Innovation Institute, New Jersey Institute of Technology

Too Much or Too Little?

Jessica Barnhill, MD, University of North Carolina at Chapel Hill

About the Lown Vignette Competition

Medical overuse – the provision of unnecessary or unwanted medical tests and procedures to patients – is common in our health system, but often goes unnoticed. One third of health care interventions are considered unnecessary, but such instances can be hard to recognize in real time. Underuse – not providing high-value, necessary care – is also prevalent in our health system and leads to patient harm. Overuse and underuse can occur simultaneously in the same country, the same hospital, even in the same patient.

The purpose of the Lown Institute Vignette Competition is to shine a light on everyday overuse and underuse – common practices that either give patients unnecessary tests and procedures, or that fail to give patients necessary care. Sharing stories of the downstream consequences of overuse can be a powerful counterbalance to the ‘more is better’ culture and can help clinicians recognize and avoid overuse. Spending our resources on low-value care means we often miss chances to give patients the high-value care they need, as shown by stories of underuse.

The goal of this competition is to improve clinicians’ awareness of the harms patients may face as a result of overuse and underuse and to share ideas about how the delivery of care may be improved in the future. In an era of increasingly depersonalized health care, we hope to promote the importance of thoughtful, individualized care tailored to the patient.


2017 Vignette Competition Winners

Learn more about last year’s Vignette Competition winners and finalists.