Digital Commons Network^™

Thrombosis Rate And Risk Factors In Pediatric Patients With Peripherally Inserted Central Catheters, Ahmed A. Alabdulkarim, Abdullah I. Almojali, Tharaa S. Alhowaish, Dena S. Alsuhaibani, Norah I. Alshafi, Amin I. Alzahrani, Mohammed O. Alotaibi, Yousef A. Alghamdi, Hamad A. Alkhalaf

Saudi Medical Journal

Objective: To determine symptomatic thrombosis incidence in pediatric patients with peripherally inserted central catheters (PICCs) and identify associated patient and procedure-related risk factors in a tertiary pediatric center in Saudi Arabia.
Methods: We conducted a retrospective cohort study at King Abdullah Specialized Children's Hospital, Riyadh, Kingdom of Saudi Arabia, including patients aged 0–14 years who underwent PICC insertion in the Interventional Radiology department between January 2019 and June 2023. Data on demographics, comorbidities, procedural details, and outcomes were extracted from the electronic medical record system (BestCare). Symptomatic thrombosis was defined as Doppler-confirmed thrombosis with clinical signs. Associations were tested using …

Estimating Radiation Dose And Proposing Institutional Diagnostic Reference Levels For Paediatric Fluoroscopy Of Micturating Cystourethrogram: Age- And Weight - Specific Comparisons, Khalid M. Aloufi

Saudi Medical Journal

Objective: To compare age- and weight-specific methods used to estimate radiation doses and to propose institutional diagnostic reference levels (DRLs) for paediatric fluoroscopy of micturating cystourethrogram (MCUG).
Methods: In this retrospective study, MCUG fluoroscopy parameters were gathered for 100 paediatric patients from July 2025 to January 2026. The data included the MCUG paediatric procedures for patients aged 0–15 years. The data were categorized into paediatric weight- and age-specific groups. Paediatric weight-specific groups were ≤ 5, 5 < – 10, 10 < – 20, and >20 kg, and paediatric age-specific groups were ≤ 1, 1 < – 5, 5 < – 10, and < 10 – 15 years old.
Results: Differences were observed in dose area product (DAP) and DRL results for age- …

Potential Drug–Drug Interactions In Patients Undergoing Hemodialysis: A Retrospective Observational Study, Buthainah B. Al-Ammash, Fawaz A. Alharbi, Omar D. Al-Hejaili, Mansour A. Mahmoud, Mazin A. A. Abdelaziz, Alaa I. Alrais, Shahad A. Albakri, Ibrahim F. Alharbi, Sara A. Felemban, Abdullah H. Almatrafi, Salman A. Alabdali, Yaser M. Alahmadi

Saudi Medical Journal

Objectives: To evaluate the prevalence, characteristics, and determinants of potential drug–drug interactions (pDDIs) among patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) at a tertiary care hospital in Al-Madinah Al-Monawara, Kingdom of Saudi Arabia.
Methods: Data for this retrospective observational study were extracted from the electronic medical records of adult patients (≥ 18 years) diagnosed with ESRD and receiving hemodialysis (HD) between October 2022 and March 2023. The pDDIs were identified and classified using Lexicomp® (Wolters Kluwer, Alphen aan den Rijn, Netherlands). Descriptive statistics summarized patient characteristics and pDDIs, and univariate logistic regression was implemented to investigate the determinants …

Drooling In Children With Cerebral Palsy: A Narrative Review Of The Current Management Landscape, Kamel A. Alenazi

Saudi Medical Journal

Children with developmental or neurological disorders, such as cerebral palsy, present with impaired motor function, resulting in impaired swallowing, feeding, and drooling. The prevalence of chronic drooling radically changes from 0.5% in children >4 years to 60% in children with neurological ailments. Drooling can have a serious impact on the quality of life of affected children, which can create a sense of isolation and refusal by peers. In addition, drooling results in not only financial but also considerable emotional turmoil for caregivers of affected children, who are frequently confronted with difficulty managing the underlying neurological impairment of their child. In …

Scoping Review Of Mental Health Outcomes Of Cosmetic Procedures Among The Saudi Population, Hessah Alzahrani

Saudi Medical Journal

Objective: To comprehensively examine the mental health outcomes associated with cosmetic procedures among the Saudi population, with a particular focus on psychological well-being, self-esteem, anxiety, body image, and quality of life.
Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. A structured search was performed across international databases, including PubMed, PsycINFO, Scopus, Web of Science, and Google Scholar, in addition to national Arabic databases. Studies investigating the psychological outcomes of both surgical (rhinoplasty and body contouring) and …

Implementing Diagnosis-Related Groups For Value-Based Healthcare In Saudi Arabia: A Systematic Review Of Evidence On Barriers And Facilitators, Racha M. Naim, Michelle A. Badore, Justin J. Needle

Saudi Medical Journal

Objective: To examine the barriers and facilitators to implementing Diagnosis-related groups (DRGs) in Kingdom of Saudi Arabia, aiming to identify actionable insights for policymakers and stakeholders to advance value-based healthcare (VBHC) adoption effectively.
Methods: A systematic search of bibliographic databases and relevant grey literature was conducted. Data were synthesized using the Consolidated Framework for Implementation Research (CFIR) to categorize barriers and facilitators across 5 domains.
Results: A total of 10 studies met the eligibility criteria. Key facilitators included the adoption of patient classification systems, standardized data sets, government policy support, and the availability of advanced health information systems. Barriers included …

From Bench To Bedside: Evolving Definitions Of Translational Research, Hana A. Alhumud, Fars K. Alanazi, Edward B. Devol

Saudi Medical Journal

Objective: To synthesize current evidence on the evolution, frameworks, and methodological approaches used to define and operationalize translational research, which serves as a bridge between scientific discovery and its application in clinical medicine, public health, and policy.
Methods: We systematically searched PubMed, Scopus, and Web of Science for peer-reviewed studies published up to 2023. Search terms combined translational research–related keywords (such as ``bench-to-bedside,'' ``implementation science,'' ``precision medicine'') and relevant MeSH terms. Eligible studies focused on conceptual models, frameworks, or methodological approaches related to translational research and were published in English. After duplicate removal and PRISMA-guided screening, 33 publications were included. …

Strengthening Health System-Community Partnerships To Address Pediatric Social Needs: A Qualitative Study, Joy Friedman, Melissa A. Alderfer, Kelsey Higgins, Aaron Carpenter, Jennifer Sciolla, Sarah E. Wawrzynski

Department of Pediatrics Faculty Papers

IntroductionStructural and social conditions influence pediatric health outcomes. Successful implementation of social needs screening and referral programs depends on community-based organizations (CBOs) to provide resources that address health-related social needs (HRSN). We explored current practices and perspectives of health care workers and CBO representatives on improving health system-CBO partnerships.MethodsParticipants were purposively recruited from a variety of health care settings involved in HRSN screening and CBOs delivering resources in the community. Participants completed semi-structured interviews. Qualitative thematic analysis was used to summarize data.ResultsTen key informants participated (six health care workers and four CBO representatives). Four themes were identified: 1) mismatches in …

Arriving At A Diagnosis: Effective Strategies Used By The Undiagnosed Diseases Network, Somin Hwang, Rachel M Brown, Dustin Baldridge, Erin E Baldwin, Alan H Beggs, Jonathan A Bernstein, Elizabeth Blue, Nicholas A Borja, Lorenzo D Botto, Lauren C Briere, Thomas Cassini, Cecilia Esteves, Elizabeth L Fieg, Gail P Jarvik, Shilpa Nadimpalli Kobren, Mia P Levanto, Julian A Martínez-Agosto, Shruti Marwaha, Stanley F Nelson, Jill A Rosenfeld, Tim Schedl, Tina K Truong, Jennifer A Wambach, Matthew T Wheeler, Shinya Yamamoto, Undiagnosed Diseases Network, Vandana Shashi, Alexa T Mccray, David R Adams, Kimberly Leblanc

Duncan NRI Faculty and Staff Publications

Purpose: Despite the increasing use of exome sequencing (ES) and genome sequencing (GS) in clinical settings, many individuals remain undiagnosed. This study examined the Undiagnosed Diseases Network (UDN)'s approach to establishing diagnoses for participants.

Methods: As a continuation of the first UDN cohort (9/16/2015-5/23/2017), this study reviewed diagnostic strategies and outcomes in the second UDN cohort (5/24/2017-6/30/2023).

Results: Over the study period, the proportion of UDN participants with prior ES/GS increased from 40.2% to 75.0%. The diagnostic rate for the UDN was 22.1% (379/1,713). Reanalysis/reinterpretation of sequencing data (prior ES: 21.4%, prior GS: 2.6%, UDN ES: 4.8%, UDN GS: 17.3%) …

Intravascular Immune Cell Labeling As A Critical Methodological Tool For Characterizing Cd4+ T Cells In The Lung In Eae, Gholamreza Azizi, Mohamad Rostami

Department of Neurology Faculty Papers

INTRODUCTION: Growing evidence highlights the lung -brain axis as a key contributor to CNS autoimmunity. However, accurate characterization of lung immune cells remains technically challenging because standard transcardial perfusion does not eliminate the lung's extensive marginated intravascular leukocyte pool, allowing circulating cells to contaminate analyses of the lung parenchyma.

METHODS: Experimental autoimmune encephalomyelitis (EAE) was induced in mice by immunization with MOG35-55 peptide in complete Freund's adjuvant, followed by pertussis toxin administration. Lung mononuclear cells were isolated after intravascular (IV) CD45 labeling, transcardial perfusion, and enzymatic digestion. Immune cell populations and intracellular cytokine production were analyzed by multicolor flow cytometry …

Medetomidine As A Fentanyl Adulterant: Pharmacology, Detection, Clinical Presentation, And Management, Kory S. London, Phil Durney, Brendan Hart, Ashish Thakrar, Dennis Goodstein, Alex J. Krotulski, Daniel Teixeira Da Silva, Joseph D’Orazio, Lara Weinstein, Jeanmarie Perrone, Michael J. Lynch

Division of Internal Medicine Faculty Papers & Presentations

Purpose of Review Medetomidine is a veterinary α2-adrenergic agonist that has been an adulterant of illicitly manufactured opioids since 2022. We review its pharmacology, detection, intoxication, withdrawal, and management, and assess why severe withdrawal has emerged in some regions but not others. Recent Findings Medetomidine has spread through North American drug markets yet evades most toxicology testing. Roughly two hundred times more potent than xylazine, with greater α2 selectivity and imidazoline-1 activity, it causes intoxication resembling other α2 agonists: sedation and bradycardia. The dominant clinical problem is withdrawal: autonomic dysregulation, intractable vomiting, and encephalopathy frequently requiring intensive care. Treatment requires …

Blinatumomab Care Delivery For Pediatric B-Cell Acute Lymphoblastic Leukemia, Daniel Zheng, Katelyn Oranges, Subhash Ramakrishnan, Lingyun Ji, Melissa Beauchemin, Sarah Alexander, Allison Leahy, Kira Bona, Emi Caywood, Sharon Castellino, Sumit Gupta, Douglas Hawkins, Olga Militano, Kathleen Montgomery, Haley Newman, Rachel Rau, Susan Rheingold, Joanna Robles, Michael Roth, David Teachey, Sarah Vargas, Sue Zupanec, Susan Parsons

Department of Pediatrics Faculty Papers

IMPORTANCE: Blinatumomab, a novel immunotherapy administered as a 28-day continuous infusion, has fundamentally shifted the treatment paradigm for pediatric B-cell acute lymphoblastic leukemia (B-ALL) and is now considered a component of standard therapy for the most common childhood cancer. However, the care delivery challenges in transitioning from an experimental agent on a clinical trial to widespread clinical implementation are unknown.

OBJECTIVE: To characterize the clinical landscape of pediatric blinatumomab care-delivery practice and challenges in the US from the perspective of treating centers.

DESIGN, SETTING, AND PARTICIPANTS: This survey study was conducted from February to March 2025 among US member institutions …

Diversity Among Academic Orthopaedic Surgery Sports Medicine Faculty Across Us Residency Programs, Terence L. Thomas, Alexander Zavitsanos, Claude Regis, John Czarnicki, Harrison S. Fellheimer, Gabriel I. Onor, William Justice, Jalen Broome, Damon V. Briggs, Edward S. Chang, Meghan Bishop, Christopher C. Dodson

Rothman Institute Papers

BACKGROUND: Despite growing attention to workforce diversity in orthopaedic surgery, limited data exist describing the demographic composition of academic sports medicine faculty. This study examines the diversity of sports medicine fellowship-trained orthopaedic surgery faculty across US orthopaedic surgery residency training programs.

METHODS: A cross-sectional analysis of all ACGME-accredited orthopaedic surgery sports medicine faculty was conducted. Faculty data included sex, race, level of professorship, residency attended, year of residency graduation, and h-index. Underrepresented in Orthopaedics (URiO) was defined as non-White and non-Asian by race and all women. Descriptive statistics were performed.

RESULTS: A total of 812 sports medicine-fellowship trained faculty were …

Skin Carotenoid Scores Reflect Immune Status Among Children Living With Hiv In Tanzania, Wilbert Mbuya, Thobias Boniphace, Michael Mwagala, Peter Agrea, Nazareth M Mbilinyi, Nancy E Moran, Andrew R Dinardo, Mkunde Chachage

Children’s Nutrition Research Center Staff Publications

Many individuals living with HIV experience persistent inflammation despite antiretroviral treatment, increasing their risk for cardiovascular diseases, cognitive decline, and other noncommunicable diseases. Carotenoids can inhibit this inflammation by reducing lipid peroxidation. Carotenoid intake and plasma concentrations can be approximated using a noninvasive cutaneous spectrophotometer. This study quantified skin carotenoid levels in Tanzanian children ages 5 to 15 years old (N = 185) both with and without HIV. Over 95% had low to moderate skin carotenoid scores (< 400 units). In children living with HIV, higher viral loads were linked to lower skin carotenoid scores (rho = -0.57, P < 0.001), whereas higher CD4 counts correlated with increased skin carotenoid scores (rho = 0.52, P < 0.001). Overall, carotenoid levels were low and associated with immune status, suggesting that elevated carotenoid scores correlate with lower inflammation in children living with HIV. Future studies investigating dietary carotenoid interventions to support immune function are warranted.

Distinct Cell States Define Larval And Adult Body Plans In A Hemichordate, Paul Bump, Carolyn Brewster, Laurent Formery, Lauren Lubeck, Catherine Campbell, Maurizio Morri, Rene Sit, Daniel S Rokhsar, Blair Benham-Pyle, Alejandro Sánchez Alvarado, Christopher J Lowe

Faculty, Staff and Students Publications

A major gap in our understanding of animal development is how adult body plans arise in animals with indirect development, where adults emerge from the transformation of a distinct larval form during metamorphosis. We address this question by examining cellular changes in the enteropneust hemichordate Schizocardium californicum, a species with a complex lifecycle and dramatic metamorphosis. Employing whole-body single-cell RNA sequencing, we chart the cellular composition and transcriptional dynamics of larval, metamorphic, and adult stages. Our tissue-level atlas reveals that ectodermal and endodermal cell types in larvae and adults occupy distinct transcriptional spaces, showing greater similarity to other cell types …

Newborn Screening Reduces Survival Disparities In Scid After Stem Cell Transplant: A Pidtc Report, Lena E Winestone, Brent R Logan, Xuerong Liu, Olatundun Williams, Elizabeth A Dunn, Monica S Thakar, Sharon A Kidd, Talal Mousallem, Morna J Dorsey, Richard J O'Reilly, Neena Kapoor, Lisa Forbes Satter, Malika Kapadia, Soma C Jyonouchi, Sharat Chandra, Christen L Ebens, Deepakbabu Chellapandian, Sonali Chaudhury, Karin Chen, Blachy J Dávila Saldaña, Ahmad Rayes, Troy C Quigg, Shanmuganathan Chandrakasan, Jeffrey J Bednarski, Kenneth B Desantes, Pierre Teira, Alfred P Gillio, Hesham Eissa, Alan P Knutsen, Victor M Aquino, Evan B Shereck, Theodore B Moore, Emi H Caywood, Mark T Vander Lugt, Jacob Rozmus, Larisa Broglie, Lolie C Yu, Ami J Shah, Avni Y Joshi, Rebecca H Buckley, Jasmeen Dara, Joseph H Oved, Hisham Abdel Azim, Caridad A Martinez, Susan Prockop, Kathleen E Sullivan, Jack J Bleesing, Michael D Keller, Lisa M Madden, Suhag Parikh, Shalini Shenoy, Christine M Seroogy, Tamar Rubin, Jennifer Licata, Jeffrey R Andolina, Donald B Kohn, Lauri Burroughs, Jennifer W Leiding, Rebecca A Marsh, Luigi D Notarangelo, Sung-Yun Pai, Troy R Torgerson, Michael A Pulsipher, Jennifer Heimall, Geoffrey D E Cuvelier, Linda M Griffith, Jennifer M Puck, Christopher C Dvorak, Morton J Cowan, Elie Haddad

Faculty, Staff and Students Publications

Black race and Hispanic ethnicity are associated with higher mortality in severe combined immunodeficiency (SCID) following hematopoietic cell transplantation (HCT), though mechanisms remain unclear. We evaluated 796 children with SCID who received nonsibling HCT between 1982 and 2020 using data from the Primary Immune Deficiency Treatment Consortium. Overall survival for Black (aHR 2.47, 95%CI 1.64, 3.71) and Asian/Pacific Islander patients (aHR 1.82, 95%CI 1.00, 3.30) was significantly lower compared with non-Hispanic White patients, while Hispanic patients had lower event-free survival (aHR 1.83, 95%CI 1.27, 2.63) compared with non-Hispanic White patients. Even after adjusting for age and infection, Black patients with …

The High Cost Of Incomplete Physical Exams: Missed Diagnosis Of Cushing Syndrome In A Patient With Recurrent Hospital Admissions, Tarah M Burton, Miranda K Hunter, Mihail Zilbermint

Journal of Community Hospital Internal Medicine Perspectives

Cushing syndrome is a rare but life-threatening endocrine disorder associated with a classic constellation of physical exam findings (e.g. “moon facies”, abdominal striae, etc.). However, thorough biochemical testing is needed to confirm this diagnosis. We present the case of a 35-year-old male with multiple hospitalizations across a variety of healthcare institutions for heart failure, cellulitis, uncontrolled hypertension, and diabetes.  While an adrenal mass was eventually identified on imaging, classic signs of Cushing syndrome – including violaceous striae, truncal obesity, and facial plethora – were missed during prior admissions.  This case illustrates the diagnostic delay that can result from incomplete physical …

Universal Screening For Measles Immunity During Pregnancy: A Cost-Effectiveness Analysis, Anuradha Devabhaktuni, Sarah Boudova, Elias Kassir, Sohum Shah, Neil S. Silverman, Christina S. Han

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Measles is a highly contagious illness capable of causing significant morbidity and mortality, including adverse pregnancy outcomes. Routine screening for measles immunity is not currently recommended during pregnancy. Given the increasing frequency of measles outbreaks nationally and globally, awareness of measles immunity status can influence management of pregnant individuals who incur measles exposures and offer an opportunity for postpartum or preconception vaccination.

OBJECTIVE: We sought to evaluate the cost-effectiveness of universal screening for measles immunity during pregnancy in the United States.

STUDY DESIGN: A decision-analytic model was constructed to evaluate the cost-effectiveness of universal screening for measles immunity during …

Prepregnancy Obesity Versus Excessive Gestational Weight Gain: A Comparative Evaluation Of Adverse Outcomes, Samuel Schultz, David Krantz, Matthew Blitz, Ashley Battarbee, Moti Gulersen

Department of Obstetrics and Gynecology Faculty Papers

Background/Objectives: Obesity and excessive gestational weight gain (EGWG) are known risk factors for adverse outcomes in pregnancy, but the comparative risk is less well defined and increasingly relevant in an era of increasing use of weight loss medications. We aimed to determine whether EGWG was associated with adverse maternal and neonatal outcomes, compared with prepregnancy obesity. Methods: Multicenter retrospective cohort study of pregnant patients who delivered a singleton within a single university health system from 2019–2024. Patients with missing prepregnancy body mass index (BMI) data, BMI < 18.5 kg/m2, or pregestational diabetes were excluded. Logistic regression with propensity score weights and g-computation were used to evaluate if the incidence of several adverse maternal and neonatal outcomes were impacted by prepregnancy obesity and gestational weight gain (GWG). p values were adjusted for multiple comparisons. Results: Among the 129,615 pregnancies included, 28,516 (22.0%) had prepregnancy obesity, 36,943 (28.5%) were overweight prior to pregnancy, and 64,156 (49.5%) had a normal BMI prior to pregnancy. When compared to patients with obesity, patients with normal prepregnancy BMI and EGWG had a lower risk of adverse maternal and neonatal outcomes, including gestational diabetes, gestational hypertension, preeclampsia, eclampsia, cesarean delivery, and postpartum hemorrhage, as well as large and small for gestational age birthweight, stillbirth, neonatal intensive care unit admission, neonatal mechanical ventilation, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and sepsis. Beneficial effects were attenuated for patients with overweight prepregnancy BMI or for larger EGWG. Conclusions: Lower prepregnancy BMI, even with the potential unintended consequence of EGWG, may be more favorable than untreated prepregnancy obesity with regard to perinatal outcomes.

Intrawound Vancomycin For Prevention Of Surgical Site Infection: Meta-Analysis Of Randomized Clinical Trials, Shaan Patel, Shiva Nischal, Kush Kale, Angelette Mendonca, Nelson Sofoluke, Srinivas Prasad, James Harrop, Daniel Refai

Department of Neurosurgery Faculty Papers

BACKGROUND: Surgical site infection remains a major cause of postoperative morbidity. Intrawound vancomycin has been proposed as an adjunct to standard prophylaxis, but its effectiveness across surgical settings remains uncertain. This systematic review and meta-analysis of randomized clinical trials aimed to evaluate the association between intraoperative intrawound vancomycin and surgical site infection in adults undergoing surgery.

METHODS: MEDLINE, Embase, and CENTRAL were searched from database inception to March 2026 for randomized clinical trials comparing intrawound vancomycin with standard care in adults undergoing operative procedures. Two reviewers independently performed screening, data extraction, and risk-of-bias assessment using the Cochrane Risk of Bias …

Artificial Intelligence Models For Automated And Semiautomated Analysis And Interpretation Of Clinical Electroencephalography, Sándor Beniczky, Birgit Frauscher, Fábio Nascimento, Shobi Sivathamboo, Catalina Rojas, Michael Sperling, Samden Lhatoo, Philippe Ryvlin, Levin Kuhlmann

Department of Neurology Faculty Papers

Electroencephalography is the most commonly used diagnostic tool for epilepsy. However, interpreting electroencephalograms (EEGs) requires expertise that is not widely available. Advances in digital technology and wearables have enabled large-scale EEG recording, generating vast amounts of data that cannot be managed through traditional visual interpretation by experts. Artificial intelligence (AI) has the potential to augment human expertise and reduce workloads. The application of artificial neural networks in analysing clinical EEG recordings has led to major breakthroughs, bringing AI-based EEG interpretation closer to clinical implementation. In this Review, we summarise the most important research and development results in this field from …

Systematic Review Of Sports Safety Best Practice Implementation In Non-Scholastic Youth Sport Organizations, Katie Sniffen, Hayley J. Root, Richelle M. Williams

Internet Journal of Allied Health Sciences and Practice

Purpose: Non-scholastic youth sports organizations offer competitive and recreational activities to millions of children each year but lack centralized oversight for health and safety policy. Despite the benefits of sport participation, there are inherent risks, including cardiac-, concussion-, heat-, and musculoskeletal-related conditions. Therefore, it is important to understand how youth sports safety policies are implemented in non-scholastic youth sport organizations. This systematic review aimed to synthesize the current literature on the implementation of youth sports safety policies in non-scholastic youth sport organizations in the United States. Methods: A computerized search of Cochrane, CINHAL, Ovid Medline, Web of Science, and Scopus …

Measuring Quality Of Life In Advanced Chronic Liver Disease With Fact-Hep: Findings From The Pal Liver Trial, Manisha Verma, Binu John, Don Rockey, Sid Barritt, Victor Navarro, Linda Shaw, Andrzej Kosinski, Elliot Tapper, Archita Desai

Einstein Health Papers

BACKGROUND: Patient-reported outcome measures (PROMs) are increasingly incorporated into hepatology research, yet few have been rigorously evaluated, particularly among patients with decompensated cirrhosis. The Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) captures multidimensional liver disease-specific burden, while the disease-agnostic PROMIS-29 assesses physical and mental health broadly. We evaluated the performance of FACT-Hep and its relationship to PROMIS-29 among participants with cirrhosis or hepatocellular carcinoma (HCC) enrolled in a prospective multicenter clinical trial.

METHODS: Baseline data were analyzed from 935 participants enrolled in the PAL LIVER trial. This study enrolled patients with Child-Turcotte-Pugh (CTP) B/C cirrhosis and/or with HCC. Health-related quality of …

Postoperative Complications In Patients With Sickle Cell Disease After Total Shoulder Arthroplasty, Katie Zehner, Gwyneth C. Maloy, John Slevin, Wesley Day, Mitchell K. Ng, Xuan Luo, Jonathan N. Grauer, Arya G. Varthi

Rothman Institute Papers

BACKGROUND: Sickle cell disease (SCD) encompasses a spectrum of genetic hematologic disorders characterized by erythrocyte sickling. Patients may experience musculoskeletal manifestations, such as osteonecrosis, which may warrant consideration for total shoulder arthroplasty (TSA). While prior literature suggests patients with SCD more frequently suffer complications after orthopaedic procedures, this is not well characterized for TSA.

METHODS: Adult TSA patients (older than 18 years) were identified in the 2010 to 2023 PearlDiver M170 database. Patients with SCD were matched 1:4 to patients without SCD based on age, sex, and Elixhauser Comorbidity Index (ECI). Ninety-day postoperative complications, emergency department (ED) visits, and readmissions …

Timing Of Isotretinoin Exposure And Early Postoperative Complications After Anterior Cruciate Ligament Reconstruction, Areeb Ahmad, Ronald J. Shamus, Kassem Ghayyad, Daryl C. Osbahr, Adam J. Money, Michael G. Ciccotti, George J. Richard

Rothman Institute Papers

INTRODUCTION: Isotretinoin (ITN) is widely prescribed for severe acne in adolescents and young adults, a population where anterior cruciate ligament reconstruction (ACLR) is commonly performed. Long-standing concerns about impaired wound healing have prompted many surgeons to delay procedures, despite limited orthopaedic-specific evidence. This retrospective case series evaluates early postoperative clinical complications in patients with documented ITN exposure undergoing ACLR.

METHODS: We retrospectively reviewed primary ACLR cases from 2015 to 2025 at a multisite orthopaedic practice with documented ITN exposure within 12 months of surgery and at least 3 months of follow-up. ITN exposure was categorized as perioperative (≤10 days), recent …

Emergency Contraception, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Skin Carotenoid Scores Are A Valid Approximation Of Fruit And Vegetable Intake Among Adults With Obesity, Stephanie B Jilcott Pitts, Qiang Wu, Elizabeth Gates, Melissa N Laska, Andrew R Dinardo, Nancy E Moran

Children’s Nutrition Research Center Staff Publications

Skin carotenoid score (SCS) as measured using pressure-mediated reflection spectroscopy has been validated among adults with normal and overweight body mass index, with little validation research among adults with obesity. Therefore, the purpose of this exploratory study was to examine the validity of SCS as an approximation of fruit and vegetable intake among adults with obesity. We used samples from adults with obesity from three prior studies: The first study examined the validity of SCS among 213 adults, 34 with obesity; the second, examined sensitivity of SCS to a β-carotene-rich juice intervention among 162 adults, 14 with obesity; the third …

Closing Gaps In Urban Trauma Systems: Outcomes Of An Inner-City Community Emergency Department Multidisciplinary Trauma Protocol, Kory S. London, Alan Cherney, Sulabh Neupane, H. Alex Tomlinson, Joseph Cervone, Elaine Qian, Casey Fishman, Jennifer Davis, Sean Mcgann, Varsha Goswami, George Koenig, Frederick Randolph

Department of Emergency Medicine Faculty Papers

BACKGROUND: Non-trauma center (NTC) emergency departments (EDs) play regular but underappreciated roles in the management of severely injured patients, yet many lack formal protocols to guide care. We describe the implementation and outcomes of a structured trauma evaluation and transfer protocol at an urban NTC emergency department.

METHODS: A multidisciplinary trauma protocol was implemented on April 1, 2023, at an urban NTC, supported by a Level I trauma center, 2.5 miles apart. The study period ran from January 1, 2019, to June 30, 2025. Using pre-post study design, 62 patients treated prior to implementation were compared with 49 post-intervention patients. …

A National Study Of Tetanus Vaccine Knowledge, Receipt And Acceptance Among Emergency Department Patients, Francesco Sergi, Elisa Vaezazizi, Shaokui Ge, Christopher Alvarez, Jesus Torres, Brian Chinnock, Michael Gottlieb, Vijaya Arun Kumar, Kristin L. Rising, Efrat Kean, Stephanie Eucker, Robert M. Rodriguez

Department of Emergency Medicine Faculty Papers

OBJECTIVE: The Tetanus, Diphtheria, Pertussis (Tdap, "tetanus") vaccine is recommended for adults every 10 years. In a national sample of adult emergency department (ED) patients, we sought to determine (1) knowledge and up-to-date status of the tetanus vaccine; (2) reasons for nonreceipt of the vaccine; (3) vaccine acceptability if offered in the ED; and (4) reasons for nonacceptance in the ED if offered.

METHODS: This was a cross-sectional survey study among non-critically ill adults at 10 US EDs, asking questions about knowledge, receipt, and acceptability of the tetanus vaccine. Vaccine receipt was determined by self-report. Aggregate responses are reported as …

Reply, Jacqueline L. Chen, Amanda J. Lu, Rohan Verma, Li Wang, Douglas D. Koch, Allison J. Chen

Department of Medicine Faculty Papers

No abstract provided.