Digital Commons Network^™

Postoperative Opioid Usage And Disposal Strategies After Arthroscopic Procedures In A Young Cohort: A Prospective Observational Study, William Johns, Emma Johnson, Joseph Brutico, Matthew Sherman, Kevin Freedman, William Emper, John Salvo, Sommer Hammoud

Rothman Institute Papers

BACKGROUND: Although several studies have noted that patients are routinely overprescribed opioids, few have reported usage after arthroscopic surgery.

PURPOSE: To determine opioid consumption and allocation for unused opioids after common arthroscopic surgeries.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Patients between the ages of 15 and 40 years who were scheduled to undergo anterior cruciate ligament reconstruction (ACLR), labral repair of the hip or shoulder, meniscectomy, or meniscal repair were prospectively enrolled. Patients were prescribed either 5 mg hydrocodone-325 mg acetaminophen or 5 mg oxycodone-325 mg acetaminophen based on surgeon preference. Patients completed a daily opioid usage …

Life-Space Mobility And Cognitive Function: The Reasons For Geographic And Racial Differences In Stroke (Regards) Study, Emiri Matsuda, Michael Crowe, Virginia J. Howard, Cynthia J. Brown, Madeline R. Sterling, Emily B. Levitan

School of Medicine Faculty Publications

No abstract provided.

To Bpd Or Not To Bpd: A Comparison Of The 2022 Versus 2011 Nichd Web-Based Risk Estimator For Bronchopulmonary Dysplasia, Mitch Kinkor, Jake Schneider, Farhath Sulthana, Janelle R. Noel-Macdonnell Phd, Alain Cuna

Research Days

This study compares the performance of the 2022 National Institute of Child Health and Human Development (NICHD) Bronchopulmonary Dysplasia (BPD) Outcome Estimator and its original 2011 version in identifying high-risk infants.

Outcomes Of Toddler’S Fractures After Implementation Of Comprehensive Care Management Protocol With Controlled Ankle (Cam) Boots, Sheena J. Amin Md, Janet K. O'Rear Bsn, Julia Leamon Msn, Olivia R. Pruss Bs, Mckenna C. Noe Bs, Micah K. Sinclair Md, Caleb W. Grote Md, Phd

Research Days

A study comparing skin breakdown complications in patients being treated for toddler's fractures at a single academic medical center before and after implementation of a new management and immobilization protocol involving the use of CAM boots.

Pediatric Readiness In The Ambulatory Care Setting, Mary Haywood, Chris Kennedy, Robert D. Schremmer Md, Emily Cramer, Kevin Meilak Md

Research Days

Background: Emergent presentations are a relatively uncommon occurrence in the ambulatory care setting. However, when they do occur, they can be life threatening. Given their uncommon occurrence, many clinicians believe that emergencies do not present or do not occur in these settings. However, there can be up to 42 emergent presentations per office site per year, depending on location. Most commonly pediatric patients present with respiratory distress, but seizures, anaphylaxis, dehydration, and psychological/behavioral complaints can also present emergently to these clinics. Despite this, most offices are not prepared to handle these presentations. According to various studies, this is typically due …

Automate Isolation Infection-Prevention Precautions (Aid-Ip): Improving The Efficiency Of Hospital Isolation With Viral Respiratory Infections, Timothy Burchard, Michael Platt, La'sonya Buford

Research Days

The AID-IP project is a QI study working to improve the process of isolation and de-isolation regarding respiratory viruses at Children's Mercy Hospital. Specifically, we aim to improve adherence to proper isolation precautions, minimize cognitive workload regarding the maintenance of isolation for staff, and improve family satisfaction with isolation practice.

Nrp, Pals, And Their Utilization During Code Events In A Pediatric Quaternary Hospital: A 'Compressed' Analysis, Mitch Kinkor, Deepa Kumar, Allison Taber, Stephen Pfeiffer, Jessica Brunkhorst, Danielle Reed

Research Days

Both the Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Program (NRP) algorithms are utilized for resuscitation during pediatric codes. The optimal time period to transition from NRP to PALS is not well studied. This study describes the utilization of chest compressions, prescribed medications, and patient outcomes during and after code events organized by the algorithm used to direct resuscitation (PALS or NRP) in a similarly aged patient population.

Emergency Care Of An Older Adult With Complex Care Needs, Muhammad Adnan Khan, Himika Dalia, Michelle Dietz

Journal of Geriatric Emergency Medicine

In this case report, we demonstrate the application of a stepwise guiding approach for older adults with complex care needs who present to the emergency department. It also highlights the challenges encountered during the implementation of these principles, and sheds light on the factors affecting the management of complex older populations. This case report emphasizes the pressing need for the development of a standardized protocol tailored to emergency physicians, addressing the unique needs of complex-multimorbid older adults, and overcoming the system barriers in emergency care.

Bridging Services To Evidenced-Based Care: Implementing A Psychology Consult Check-Up Clinic, Jacqueline Pabis Phd, Sabrina Ung Ma, Angela Combs Ma, Mallory Netz Phd, Carisa Parrish Phd, Casey Lawless Phd

Research Days

This quality improvement project examines the feasibility, satisfaction, and preliminary outcomes of a hospital follow-up program for the CMH Inpatient Psychology Consultation & Liaison team.

Improving Awareness And Utilization Of Safety Net Resources After Extremity Firearm Injury, Colleen M. Moreland, Caleb W. Grote, Richard M. Schwend, Julia G. Harris

Research Days

The orthopaedic surgery department can improve follow-on care for pediatric survivors of extremity firearm injuries by creating and implementing a checklist of defined safety net resources.

A Quality Improvement Project To Improve Antibiotic Choice For Children Admitted With Urinary Tract Infections (Utis), Philip Jurasinski Do, Pgy-3, Adrienne Deporre Md, Kathleen Berg Md, Allison Hadley Md, Viktoriya Stoycheva Mha, Rn, Cpn, Rana El Feghaly Md

Research Days

This is an antibiotic stewardship quality improvement project focused on improving antibiotic choices for children with urinary tract infections who are in the Children's Mercy Kansas City system. This project aims to improve the rates of cefazolin or cephalexin for treatment from 27% to 60%. 96% of urinary tract infections in our system are caused by E. Coli that are susceptible to these first generation cephalosporins.

More Of Less: Optimizing Opioid Prescriptions For Acute Fractures In The Emergency Department At A Children’S Hospital, Colton Schwarz, Spencer Wittmeyer, Mitch Kinkor, Michelle Dephillips, Elizabeth Edmundson, Ryan Mcdonough, Warren Teachout, Nicholas Clark

Research Days

Quality improvement project that aims to improve opioid stewardship in acute fracture management.

Characterization Of Nationally Reported Pediatric Deaths Involving Fentanyl Ingestions In Missouri, Margaret Campbell, Mary Moffatt, Emily Killough, Terra Frazier

Research Days

There has been a dramatic rise in pediatric deaths associated with synthetic opioid use, with the most prominent being Fentanyl. This is a retrospective cohort study using data from the National Center for Fatality Review and Prevention with the goal of identifying risk factors that increase the vulnerability of children to Fentanyl ingestion. Ultimately this research may help lead to improved identification of at risk children with the goal of implementation of targeted prevention programming.

How Neonates Die: Mortality Trends And Associations In A Level Iv Neonatal Intensive Care Unit, Erin Bolen, Ashley K. Sherman, Julie Weiner, Jotishna Sharma

Research Days

Background

Modes of neonatal mortality include withdrawal of life-sustaining interventions, non-escalation of interventions, and secondary to a code event. Mortality trends have been examined broadly, but the impact of clinical and demographic factors on the mode of neonatal mortality has yet to be evaluated. A greater understanding of this information would help guide medical decision-making and identify potential inequities. The aim is to evaluate the impact of clinical and demographic factors on the mode of neonatal death in a level IV neonatal intensive care unit (NICU).

Study Design/Methods

Data were collected via retrospective chart review of patients who died at …

Socioeconomic Differences In Penicillin Allergy Label Rates Of Children Evaluated In Pediatric Emergency Departments And Urgent Cares, Zoya Siddiqui, Brian R. Lee, Amanda Nedved, Jennifer Mckinsey, Frances Turcotte Benedict, Brandi Missel, Aarti Pandya, Rana El Feghaly

Research Days

In this retrospective study of 183,692 patients ≤19 years evaluated in urgent cares and emergency departments of a large pediatric academic center July 2022- June 2023, we found that in addition to race, socioeconomic status reflected by insurance and area deprivation index had a large association with penicillin allergy labels.

Development Of An International Standard Set Of Outcomes And Measurement Methods For Routine Practice For Adults With Epilepsy: The International Consortium For Health Outcomes Measurement Consensus Recommendations, Martha Sajatovic

Faculty Scholarship

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. Therefore, the International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy and their representatives to develop minimum sets of standardized outcomes and outcomes measurement methods for clinical practice that support patient–clinician decision-making and quality improvement. Consensus methods identified 20 core outcomes. Measurement tools were recommended based on their evidence of strong clinical measurement properties, feasibility, and cross-cultural applicability. The essential outcomes included many non-seizure outcomes: anxiety, depression, suicidality, memory and attention, sleep …

Parental Factors Associated With Covid-19 Vaccine Uptake For Children Over 5 Years Of Age In Texas, Paula M Cuccaro, Jihye Choi, Yordanos M Tiruneh, Journey Martinez, Jing Xie, Michelle Crum, Mark Owens, Jose-Miguel Yamal

Faculty, Staff and Student Publications

The COVID-19 vaccine is safe and effective for children, yet parental hesitancy towards vaccinating children against the virus persists. We conducted a telephone-administered weighted survey in Texas to examine parents' sociodemographic factors and medical conditions associated with COVID-19 vaccination intention for parents with unvaccinated children ages 5-17 years. We collected responses from 19,502 participants, of which 4879 were parents of children ages 5-17 years. We conducted multiple logistic regression with Lasso-selected variables to identify factors associated with children's vaccination status and parents' intention to vaccinate their children. From the unweighted sample, less than half of the parents (46.8%) had at …

The Effect Of Task Demands On Decision Making In Dynamic, Sport-Like Virtual Environments, Jeromy Alt, Paula L. Silva, Tehran Davis, Adam W. Kiefer, Ryan Macpherson

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

OBJECTIVE

To determine if level of temporal pressure to arrive at a desired location explains decisions about passability of closing gaps between opponents encountered and how decisions change with task experience.

Peripheral Nerve Stimulation Of The Shoulder: A Technical Primer, Sailesh Arulkumar, Elisa E. Neuchat, Eric Ly, Austin Ingwei Ly, Kiana Fahimipour, Mehul J. Desai

School of Medicine Faculty Publications

Scapulalgia or shoulder pain accounts for 16% of all musculoskeletal complaints in the healthy adult population and becomes more common as we age. When this pain exceeds 3 months in duration, it is deemed to be chronic, and typically treated in an escalating manner. Spanning a continuum of conservative and non-conservative measures, chronic shoulder pain treatments range from rest and physical therapy to surgery. Since each patient presents with a unique spectrum of symptoms a customized treatment plan is often required. Over the lifetime of many of these patients, a variety of treatment options are required. One of these treatment …

Disparities In Accessing Specialty Behavioral Health Services During The Covid-19 Pandemic And Why We Need Pediatric Integrated Primary Care., Ayanda Chakawa, Trista Perez Crawford, Leslee Belzer, Hung-Wen Yeh

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Youth unmet behavioral health needs are at public health crisis status and have worsened since the onset of the coronavirus disease 2019 pandemic (Covid-19). Integrating behavioral health services into pediatric primary care has shown efficacy in addressing youth behavioral health needs. However, there is limited guidance on facilitating equitable access to care in this setting, including in triaging access to co-located services (i.e., onsite outpatient behavioral health services with only the behavioral health provider) or to specialty behavioral health services in other clinics within larger health systems.

METHODS: A retrospective, comparative study was conducted to examine variability in access …

Effects Of Mechanism Of Injury And Socioeconomic Status On Behavioral And Clinical Sequelae In Pediatric Trauma Patients, Rebekah Fayard, Hannah Leblanc, Logan Gold, Rebecca Moreci, Lindsay Elliot, Jessica Zagory

Surgery Research Symposium

No abstract provided.

Best Practices In The Care Of Older Adults During An Unplanned Acute Observation Stay, Jonny Macias Tejada, Michael Malone

Journal of Geriatric Emergency Medicine

No abstract provided.

Beyond The Task: Developing A Tool To Measure Workplace Characteristics That Affect Cognitive Load And Learning, Sarah Blissett, Sebastian Rodriguez, Atif Qasim, Patricia O'Sullivan

Department of Medicine Faculty Papers

PURPOSE: Educators lack tools to measure the workplace characteristics that learners perceive to affect learning. Without a tool that encompasses the social, organizational, and physical components of workplace learning environments (WLEs), it is challenging to identify and improve problematic workplace characteristics. Using echocardiography WLE, this study developed a tool to measure workplace characteristics that cardiology fellows perceive to affect learning.

METHOD: The Workplace-Cognitive Load Tool (W-CLT) was developed, which encompasses 17 items to measure workplace characteristics that could affect perceived cognitive load and learning. Exploratory factor analysis was used to identify the most parsimonious structure. A total of 646 cardiology …

Sexual Function After Gender Affirming Surgery, Alicia R. Castellanos, Rachel Pope

Faculty Scholarship

Purpose of Review: Sexual function and satisfaction in the transgender community is a nascent field with a paucity of data due to the fast paced nature of improving upon surgical technique and variety of patient experiences. The authors aim to review the current literature for areas of success as well as areas of improvement in order to better the sexual health of the transgender community. Recent Findings: Gender dysphoria is a feeling of distress experienced by those whose gender assigned at birth is not in line with their gender identity. While social transition to the desired gender can suffice for …

A Case Study On The Effects Of Pregnancy On Expiratory Flow Limitation (Efl) And Operating Lung Volumes During Exercise, Hannah Young

Masters Theses, 2020-current

The purpose of this study was to examine the effects of pregnancy on expiratory flow limitation (EFL) and operating lung volumes (end expiratory lung volume and end inspiratory lung volume; EELV and EILV) during exercise, with an exploratory aim to assess differences in the above measures between exercise modalities. EFL has been shown to occur in several other subgroups but has never been studied in pregnant individuals. We followed one 35-year-old pregnant subject throughout her pregnancy, completing exercise and pulmonary testing every other week from 8 weeks gestation to 38 weeks gestation, and once again ~8 weeks postpartum. Testing was …

Improving Quality Of Life In Menopausal Women Through A Best Practice Protocol: The Use Of Hormone Therapy, Mindfulness-Based Module And Exercise, Claire Czerwonka

Evidence-Based Practice Project Reports

Menopause is a normal process of aging, but many of the symptoms negatively impact women’s day-to-day quality of life (QOL), as well as activities of daily living, physical and mental health (ACOG, 2014). Generally, systemic estrogen hormone therapy is indicated for menopause-related vasomotor symptoms, but there is no research further addressing QOL issues or lifestyle management in addition to hormone therapy. The purpose of this evidence-base practice (EBP) project was to implement a menopause protocol to address QOL issues in menopausal women with the use of hormone replacement therapy, education through an online mindfulness module, and the use of exercise. …

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …

Risks Of Depression, Anxiety, And Suicide In Partners Of Men With Prostate Cancer: A National Cohort Study, Casey Crump, Pär Stattin, James D Brooks, Jan Sundquist, Alexis C Edwards, Kristina Sundquist, Weiva Sieh

Faculty, Staff and Student Publications

BACKGROUND: A diagnosis of prostate cancer (PC) may cause psychosocial distress not only in a man but also in his intimate partner. However, long-term risks of depression, anxiety, or suicide in partners of men with PC are largely unknown.

METHODS: A national cohort study was conducted of 121 530 partners of men diagnosed with PC during 1998-2017 and 1 093 304 population-based controls in Sweden. Major depression, anxiety disorder, and suicide death were ascertained through 2018. Cox regression was used to compute hazard ratios (HRs) while adjusting for sociodemographic factors.

RESULTS: Partners of men with high-risk PC had increased risks …

Correction: Horne Et Al White Matter Correlates Of Domain-Specific Working Memory, Autumn Horne, Junhua Ding, Tatiana T Schnur, Randi C Martin

Faculty, Staff and Student Publications

In the original publication [...].

Towards A Remote Patient Monitoring Platform For Comprehensive Risk Evaluations For People With Diabetic Foot Ulcers, Gozde Cay, M G Finco, Jason Garcia, Jill L Mcnitt-Gray, David G Armstrong, Bijan Najafi

Center on Aging Staff Publications

Diabetic foot ulcers (DFUs) significantly affect the lives of patients and increase the risk of hospital stays and amputation. We suggest a remote monitoring platform for better DFU care. This system uses digital health metrics (scaled from 0 to 10, where higher scores indicate a greater risk of slow healing) to provide a comprehensive overview through a visual interface. The platform features smart offloading devices that capture behavioral metrics such as offloading adherence, daily steps, and cadence. Coupled with remotely measurable frailty and phenotypic metrics, it offers an in-depth patient profile. Additional demographic data, characteristics of the wound, and clinical …