Digital Commons Network^™

Rethinking Gout Through An Inflammatory Lens, James Espinosa, Alan A. Lucerna

Rowan-Virtua Research Day

This review reframes gout not as a static disease of urate deposition, but as a dynamic inflammatory phenomenon. The emphasis is on immune activation, threshold behavior, and systemic inflammatory context rather than isolated joint pathology.

From Clinical Observation To Scholarly Question Academic Curiosity As A Professional Virtue In Emergency Medicine Introducing The Mindful Observation → Curious Inquiry → Clinical Structuring → Scholarly Sharing (Moccs) Model, James Espinosa, Alan A. Lucerna

Rowan-Virtua Research Day

Emergency Medicine generates continuous clinical observations, yet many potentially meaningful insights never progress beyond informal reflection. This poster reframes every day shift observations as the ecological foundation of scholarly inquiry. Conceptual Framework: We propose a simple, repeatable process to lower the activation energy for academic engagement The Mindful Observation → Curious Inquiry → Clinical Structuring → Scholarly Sharing (MOCCS) Model. This model centers disciplined noticing as a professional virtue. By naming and normalizing the “hmmm” and “huh?” moments, this approach validates frontline clinical wisdom, democratizes scholarly participation, and restores intellectual joy within high-stress clinical environments. Conclusion: Curiosity is not hierarchical. …

Brief Review : Listening Closely--Stethoscopes, Hygiene Gaps, And The Unfinished Work Of Healthcare-Associated Infection Prevention, James Espinosa, Swet Patel, Robin Lahr, Sergey Medlenov, Russell Mordecai, James Lee, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Healthcare-associated infections (HAIs) remain a persistent patient safety challenge. While hand hygiene has received sustained institutional focus, stethoscope hygiene remains inconsistently addressed despite longstanding evidence of contamination. Stethoscopes function as portable, patient-to-patient devices that may serve as under-recognized fomites in emergency and inpatient settings. Prior pilot work demonstrated that clinicians were unable to reliably distinguish between disposable and standard stethoscopes, and that perceived acoustic degradation from a diaphragm barrier was minimal. These findings suggest that acoustic concerns may not represent a primary barrier to hygiene-enhancing strategies. This brief review examines the literature surrounding stethoscope contamination and cleaning behavior, frames the …

Brief Review: Does Red Hair Phenotype Affect Propofol Pharmacokinetics Or Pharmacodynamics?, James Espinosa, Frank Wheeler, Robin Lahr, Sergey Medlenov, Alan Lucerna

Rowan-Virtua Research Day

Background: A persistent belief within Emergency Medicine and perioperative culture suggests that individuals with red hair require altered anesthetic dosing. While early studies demonstrated increased requirements for certain volatile anesthetics in red-haired individuals, this association is frequently generalized to propofol without clear supporting evidence.

Objective: To review current literature regarding the relationship between red hair phenotype (and MC1R variants) and propofol pharmacokinetics (PK) and pharmacodynamics (PD).

Methods: A focused narrative review of controlled human studies and relevant clinical outcome data evaluating propofol PK and PD in red-haired individuals.

Results: Evidence supporting altered anesthetic requirement in red-haired individuals primarily derives from …

Air Quality, Atmospheric Pressure, And Migraine Presentations In The Emergency Department, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Migraine is a leading cause of Emergency Department (ED) visits and global disability. Weather has long been reported by patients as a trigger, yet the literature remains inconsistent. Prior ED-based data demonstrated an association between higher mean barometric pressure and increased migraine presentations, without a relationship to short-term pressure change. Because high-pressure systems are frequently associated with atmospheric stagnation and pollutant accumulation, air quality may represent a biologically plausible mediator.

Objective: To examine the relationship between air quality and ED migraine presentations within the existing body of literature and to explore whether air quality may help explain previously observed …

Medical Clearance For Behavioral Health Patients In The Emergency Department: A Conceptual Overview Of Practice Variability, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Patients presenting to the emergency department (ED) with behavioral health complaints frequently undergo medical clearance prior to behavioral health evaluation or admission. Substantial variability appears to be found in laboratory utilization, documentation language, and interdepartmental workflow.

Objective: To provide a conceptual overview of variability in medical clearance practices and to synthesize existing guideline recommendations and literature regarding routine laboratory testing in low-risk psychiatric patients.

Methods: Narrative review of professional policy statements, selected peer-reviewed studies, and operational considerations influencing emergency physician practice patterns.

Results: Evidence suggests that routine laboratory testing in psychiatric patients has low diagnostic yield and rarely changes …

Reset To Learn For Ite And Boards: The Neurobiology Supporting The Advantage Of Micro-Breaks During Content-Dense Lectures--And Why Continuous (No Micro-Breaks) Test-Bank Studying And Test-Taking ("Plowing Through") Is Suboptimal, James Espinosa, Robin Lahr, Swet Patel, James Lee, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Background: Working memory is a limited-capacity system vulnerable to saturation during sustained cognitive effort. In medical education, board review lectures, intensive test-bank studying, and prolonged examination sessions require extended executive control engagement. Emerging evidence from cognitive neuroscience suggests that brief, intentional cognitive disengagement ('micro-resets')  of even 90 seconds may restore working memory efficiency and improve encoding, integration, and retrieval. This applies to brief breaks during content-dense lectures (needs support of lecturer), during test bank use for preparation as well as for test-taking. Objective: To propose a neurocognitive framework explaining why structured micro-breaks of even 90 seconds can enhance learning during …

The Neurobiology Of Interruptions In Emergency Medicine: The Case For Informed Interruption Management In Support Of Cognitive Stability In High-Reliability Clinical Environments, James Espinosa, Henry Schuitema, Alan Lucerna

Rowan-Virtua Research Day

Background: Interruptions are ubiquitous in Emergency Departments (EDs) and have been associated with task delay, multitasking, and increased error risk. While operational and human-factors impacts are well described, the underlying neurocognitive mechanisms remain underexplored. Not all interruptions are avoidable.  However,  interruptions in emergency medicine represent neurocognitive destabilization events that can degrade task representation and increase vulnerability to error during task resumption. Recognizing the neural mechanisms underlying interruptions reframes their management as a systems-level patient safety priority. The aim is not elimination of clinically necessary communication, but thoughtful reduction, prioritization, and design that protects cognitive stability.

Objective: To synthesize cognitive neuroscience …

Protecting The Protectors: Supporting Emergency Department Security Officer Wellness: A Brief Conceptual Review And Research Agenda, James A. Espinosa Md, Paul Sarnese, Alan Lucerna

Rowan-Virtua Research Day

Background: Workplace violence in emergency departments (EDs) has been widely studied, yet the occupational wellness of ED security officers has received comparatively limited focused attention in emergency medicine literature.

Objective: To conceptually examine the role of ED security personnel within the emergency care environment and outline a research agenda addressing their wellness.

Discussion: Security officers frequently respond to behavioral crises, assist with restraint events, and help maintain safety for patients, visitors, and staff. These duties include vigilance between events, sudden physical exertion, and exposure to aggression. ED security work often follows a recognizable rhythm: baseline vigilance, rapid escalation response, physical …

Wildfires And Emergency Department Respiratory Surge: Brief Review, Systems Forecasting Implications And Recommendations For Research, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Wildfire smoke produces abrupt increases in PM2.5 and Air Quality Index (AQI) levels. Event-based and multi-season studies demonstrate short-term increases in asthma-related Emergency Department (ED) visits, with additional evidence supporting increased utilization for broader respiratory disease and chronic lower respiratory disease (including COPD) (Reid et al., 2016; Liu et al., 2015; Stowell et al., 2025; CDC, 2023).

Objective: To synthesize current evidence linking wildfire smoke to ED respiratory surge and to propose a systems forecasting model that translates environmental signals into structured operational stabilization within a complex adaptive system (CAS).

Methods (Review & Model Development): Narrative synthesis of event-based …

Procedural Narration As An Important Cognitive Adjunct To Analgesia: Naming And Neurobiologically Grounding An Established Emergency Medicine Practice, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Experienced emergency physicians routinely provide real-time verbal guidance during procedures. Although widespread and intuitive, this practice has not been commonly conceptualized within pain neuroscience.

Objective: To name and mechanistically ground procedural narration as a form of cognitive analgesia, and to promote its intentional use and teaching in Emergency Medicine.

Methods: Narrative review integrating predictive coding theory, placebo/nocebo research, affective neuroscience, descending inhibitory pathway literature, and attentional modulation studies.

Results: Procedural narration reduces uncertainty, aligns expectation with sensation, modulates limbic threat processing, engages prefrontal cortical regulation, and supports descending inhibitory control of nociception.

Conclusion: Procedural narration is not a novel …

Stroke Mimics And Stroke Chameleons: Leveraging The False Positive/False Negative Diagnostic Schema In Resident Teaching, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Stroke mimics and stroke chameleons contribute significantly to diagnostic uncertainty in Emergency Medicine. Traditional teaching often relies on enumerating examples, yet residents struggle to internalize these distinctions.

Objective

To present a conceptual teaching framework that maps stroke mimics to false positives and stroke chameleons to false negatives, leveraging pre-existing diagnostic schemas.

Methods

Using representative cases—including hypoglycemic hemiparesis and spinal epidural lipomatosis presenting as stroke mimic—we developed an explanation for residents involving framing mimics as false positives and chameleons as false negatives.

Results

Framing mimics as false positives and chameleons as false negatives activates existing learner schemas related to sensitivity …

Light Therapy Vs. Pharmacotherapy In Improving Quality Of Life In Seasonal Affective Disorder, Hitanshi Patel

Rowan-Virtua Research Day

Seasonal Affective Disorder (SAD) is a pattern of depressive episodes triggered by seasonal changes. Light therapy involves exposure to artificial bright light by stimulating the production of serotonin. Pharmacotherapy primarily requires careful consideration of side effects and patient response times. Findings indicate that light therapy not only leads to significant improvements in depressive symptoms but also long-term enhancement in quality of life. Pharmacotherapy, while effective for some, often involves delays in response and potential adverse effects that can diminish overall satisfaction.

Soundscapes (Ambient Sound, Noise, Music And Other Background Sound) In The Emergency Department: An Under-Theorized Environmental Modifier In A Complex Adaptive System, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background:

Music and ambient sound (including noise and other sounds) are frequently present in emergency departments (EDs), yet their role as environmental modifiers remains under-theorized. Existing literature largely examines background music, for example,  in procedural or perioperative contexts, with limited attention to open, high-density, multi-agent acute care systems.

Objective:

To conceptualize auditory input as a dynamic environmental variable within the ED viewed as a Complex Adaptive System (CAS), integrating neurobiological mechanisms with systems-level implications.

Methods/Conceptual Approach: Narrative conceptual synthesis integrating neurobiology of auditory processing, affective neuroscience, cognitive load theory, and complexity science.

Results:

Conceptual Insights: Auditory stimuli engage distributed neural …

A Conceptual Framework That Supports The Transition From Supervised Training To Independent Clinical Practice, Aligned With Acgme Milestones, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: The transition from residency to independent attending practice represents a critical developmental inflection point. Although residents achieve competency-based milestones, many graduates report challenges related to decision ownership, uncertainty tolerance, and the assumption of final clinical authority. Traditional training emphasizes competence under supervision, while independent practice requires performance without supervision. Objective: To propose a conceptual framework that supports the transition from supervised training to independent clinical practice, aligned with ACGME Milestones. Methods: Conceptual synthesis of literature on preparedness for practice, entrustment, and professional identity formation, integrated with practical observations from graduate medical education. Results (Conceptual): Six domains central to transition …

Identifying And Generalizing Best Attending Teaching Practices: A Proposal For The Use Of Appreciative Inquiry To Enhance Emergency Medicine Residency Teaching Practices, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Teaching in the Emergency Department (ED) occurs within a complex adaptive system characterized by time pressure, interruptions, and high cognitive load. Studying what works well in clinical teaching , even in such a challenging  environment for  teaching, may reveal reproducible patterns that strengthen educational culture, enhance resident learning, and accelerate the development of teaching expertise. In complex clinical environments, excellence is often present but under-recognized; An approach called Appreciative Inquiry provides a structured method for making it visible.

Conceptual Framework

Appreciative Inquiry (AI) offers an alternative approach by systematically studying successful practices rather than failures. AI explores how and …

Medical Journals As Complex Adaptive System (Cas) Reports: Reframing Journals As Structured Detection, Interpretation, And Feedback Systems In Healthcare, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background Healthcare operates as a complex adaptive system (CAS) characterized by distributed agents, nonlinear interactions, and emergent behavior. Effective adaptation depends on mechanisms capable of detecting and redistributing signals from across the system.

Objective To conceptualize the medical journal as a structured CAS report and to examine its role in supporting system awareness among clinicians.

Conceptual Model Recurring journal sections—including original research, reviews, editorials, clinical cases, perspectives, humanities, and letters—function as distinct sensing and signaling channels. Together, they provide a multi-dimensional representation of system activity.

Implications Journals serve not only as repositories of knowledge but as adaptive communication nodes that …

Impaired Mitochondrial Magnesium Transport Induces Genome-Wide Transcriptional Changes In Hepatic Steatosis, Inflammatory Signaling, And Detoxification Pathways During High-Fat Diet Feeding, Abhishek Shastry, Thiruvelselvan Ponnusamy, Asha Parveen Sakkarai Mohamed, Marianne Assogba, Natarajaseenivasan Kalimuthusamy, Shanmughapriya Santhanam

Rowan-Virtua Research Day

Calcium overload during fatty diet consumption induces oxidative stress and mitochondrial apoptosis. Intramitochondrial magnesium inhibits calcium uptake into mitochondria; therefore, modulating the activity of the mitochondrial magnesium transporter Mrs2 may regulate calcium-induced hepatocellular stress. As previous work demonstrates that liver-specific Mrs2 inhibition increases hepatic lipid deposition, RNA-sequencing was performed to identify potential transcriptional mechanisms for hepatocellular stress.

Mrs2 knockout (Mrs2^KO) mice were generated by crossing male Mrs2^fl/fl mice with liver-specific-Cre transgenic mice. Eight-week-old wild-type (Mrs2^WT) and Mrs2^KO mice were placed on chow or high-fat diet (HFD) for 12 months (n=3/group). Whole liver was collected …

Atomoxetine Enhances Specific Dimensions Of Cognitive Performance In A Rodent Strategy Shifting Assay, Jessica Ivanov

Rowan-Virtua Research Day

Title: Atomoxetine enhances specific dimensions of cognitive performance in a rodent strategy shifting assay

Authors: Jessica Ivanov, Christopher P. Knapp, Barry D. Waterhouse, Rachel L. Navarra

Objective: Cognitive flexibility, a domain of executive function, supports adaptive shifts in behavior in response to changing environmental demands and task contingencies. Deficits in this capacity are common to neuropsychiatric disorders such as Attention Deficit Hyperactivity Disorder (ADHD), where improper regulation of the catecholamine transmitters dopamine (DA) and norepinephrine (NE) within the prefrontal cortex (PFC) has been implicated. Atomoxetine (ATX), a selective NE transporter (NET) inhibitor, elevates levels of NE and DA in the …

Improving Pediatric Vaccination Rates In The United States, Maanasi Dudi

Rowan-Virtua Research Day

Pediatric vaccination has been one of the most effective public health strategies for preventing infectious diseases and reducing childhood morbidity and mortality. However, vaccination rates have dropped in recent years, due to increasing vaccine hesitancy, as well as interruptions in regular healthcare during the COVID-19 pandemic. This has been reflected in primary care settings, where pediatricians are seeing more parents refuse vaccinations.

This literature review examines current trends in pediatric vaccination rates, factors contributing to vaccine hesitancy, and interventions that have been used to improve vaccination uptake. A systematic search of peer-reviewed literature was conducted on PubMed to identify studies …

Impact Of Spanish-Speaking Medical Interpreters On Healthcare Access, Outcomes, And Equity In Patients With Limited English Proficiency, Emily Fried, Catherine Awad, Rebecca Moore

Rowan-Virtua Research Day

Impact of Spanish-Speaking Medical Interpreters on Healthcare Access, Outcomes, and Equity in Patients with Limited English Proficiency

Background

Limited English proficiency (LEP) is a significant barrier to equitable healthcare in the United States and is associated with reduced access to care, poorer clinical outcomes, and increased healthcare disparities. The Spanish-speaking population represents the largest proportion of LEP patients, making language access a crucial component of high-quality care. Language discordance between patients and providers contributes to impaired communication, increased medical errors, and decreased utilization of preventative services1-4.

Objectives

The objective of this study was to evaluate the impact of Spanish-speaking professional …

Unusual Etiology Of Cauda Equina Syndrome In An Aids Patient: A Case Report, Wesley Augustus Kim, Brandon Velazquez

Rowan-Virtua Research Day

Patients with advanced HIV/AIDS are at high risk for primary central nervous system (CNS) lymphoma due to impaired immune surveillance and HIV-driven B-cell proliferation. While intracranial lesions are well recognized, spinal involvement remains underrecognized due to the scarcity of well documented report cases in current literature. In this patient,we describe the case of a 35-year-old male with a new HIV diagnosis who experienced acute bilateral lower extremity weakness and urinary retention during hospitalization for fever, perianal abscess, and urinary tract infection. Initial CD4 count revealed profound immunosuppression with a CD4 count less than 20 cells/μL and a viral load of …

The Obstacles Of Performing A Retrospective Chart Review, Emily Reilly, Robert Hudrick D.O.

Rowan-Virtua Research Day

Introduction: This research project "Comparing timing of care for skin cancer patients with limited English proficiency who require interpretation during medical visits to patients with English proficiency" was accepted under the CREATE Grant. The hypothesis was that patients who require medical interpretation during their visits would show a longer period of time between noticing a skin lesion to definitive diagnosis. Previous research has shown improved health care outcomes, but has mixed results on patient satisfaction and health care experience. This poster aims to detail the limitations faced during the execution of a retrospective chart review from the perspective of a …

Schizophrenia And Multiple Dka Episodes Leading To Neurocognitive Deficits In A 37yo Patient, Andrew Harmon D.O.

Rowan-Virtua Research Day

Patient is a 37 year old female with a PPHx of schizoaffective disorder and PMH of type 1 Diabetes who has had numerous admissions to the ICU due to uncontrolled blood sugars in the setting of continued delusions and medication noncompliance. With continued episodes of DKA, patient continued to psychiatrically decline over the course of multiple years. Studies have shown that anti-psychotic treatment in schizophrenia can help improve cognitive functioning.

X-Ray Versus Ct For Femoral Landmark Identification: A Systematic Review And Meta-Analysis, Akash B. Patel, Marzieh Saeedi-Hosseiny, Mohammad Abedin-Nasab

Rowan-Virtua Research Day

Background Accurate femoral bone landmark identification is essential for orthopedic surgical planning, deformity correction, and fracture risk assessment. Radiography offers accessibility and low cost, while CT provides superior spatial resolution and three-dimensional visualization. Despite technological advances, no quantitative synthesis has compared these modalities specifically for femoral landmark identification.

Hypothesis CT provides superior measurement accuracy and interobserver reliability compared to radiography for femoral bone landmark identification.

Methods Following PRISMA 2020 guidelines, Embase, Scopus, and PubMed were searched from 2015-2025. Studies comparing radiography and CT for femoral landmark identification with quantitative outcomes were included. Dual-reviewer screening of 604 records yielded 27 studies …

Efficacy Of Repetitive Transcranial Magnetic Stimulation In Reducing Pain Intensity In Chronic Neuropathic Pain: A Sham-Controlled Analysis, Aprupa Alahari, Nathan Nhan, Cindy Nguyen, Samnit Gill, Simran Parmar, Annelisse Zara

Rowan-Virtua Research Day

Background 

Chronic neuropathic pain (CNP) can be refractory to traditional pharmacologic therapies, giving rise to the investigation of non-invasive alternatives such as repetitive transcranial magnetic stimulation (rTMS). rTMS utilizes magnetic fields to modulate neuronal activity within specific brain regions, offering a targeted approach to analgesia without the side effects of systemic medication1,2,3,4.

Hypothesis 

rTMS produces a greater reduction in reported pain intensity compared to sham stimulation in adults diagnosed with CNP.

Methods 

A systematic review and analysis  were conducted, utilizing PubMed and Embase (2004–2025) for sham-controlled randomized controlled trials (RCTs) and relevant meta-analyses. The review focused on outcomes such as …

Mental Health Comorbidities And Ibd Outcomes In Patients Treated With Anti–Il-23 Therapy, Jashanveer S. Johal, Archana Salek, Mahmoud Al-Bataineh, Bianca Patel, Om Patel, Yecheskel Schneider, Jason Hyman, Abdallah Hussein

Rowan-Virtua Research Day

Background: Depression and anxiety are prevalent in inflammatory bowel disease (IBD) and may adversely influence outcomes. We evaluated the impact of comorbid mood disorders on clinical outcomes among IBD patients treated with anti–IL-23 agents.

Methods: Using a global de-identified electronic health record network, adults with Crohn's disease or ulcerative colitis initiating an anti–IL-23 agent were identified. Cohort 1 included patients with a documented mood disorder (depression and/or anxiety) at or prior to treatment initiation; Cohort 2 included those without mood disorders. Propensity score matching (1:1) on demographics and comorbidities yielded 3,546 patients per cohort. Primary outcomes included inpatient/ED encounters, abscess/fistula, …

Risk Of Colorectal And Gastrointestinal Neoplasia In Inflammatory Bowel Disease Treated With Infliximab Versus Vedolizumab And Ustekinumab: A 5-Year Multicenter Retrospective Cohort Study, Jashanveer S. Johal, Archana Salek, Mahmoud Al-Bataineh, Bianca Patel, Abdallah Hussein, Om Patel, Jason Hyman, Yecheskel Schneider

Rowan-Virtua Research Day

Background: Inflammatory bowel disease (IBD) confers elevated colorectal cancer (CRC) risk, but comparative long-term neoplastic risks between anti-TNF and gut-selective or IL-12/23–targeted biologics remain incompletely defined. We evaluated 5-year risks of CRC and GI neoplasia in IBD patients treated with infliximab versus vedolizumab and ustekinumab.

Methods: Using the TriNetX federated research network, two parallel 5-year propensity score–matched cohort analyses were conducted among adults with Crohn's disease or ulcerative colitis initiating infliximab, vedolizumab, or ustekinumab between 2018–2024. Patients with prior CRC, colectomy, or baseline comparator biologic exposure were excluded. The infliximab–vedolizumab analysis matched 13,111 patients per cohort; the infliximab–ustekinumab analysis matched …

Sodium-Glucose Cotransporter-2 Inhibitor Use In Patients With Cirrhosis And Type 2 Diabetes: Impact On Hepatic Decompensation And Hospitalization, Jashanveer S. Johal, Archana Salek, Mahmoud Al-Bataineh, Bianca Patel, Abdallah Hussein, Om Patel, Jason Hyman, Yecheskel Schneider

Rowan-Virtua Research Day

Background: SGLT2 inhibitors improve cardiovascular and renal outcomes in type 2 diabetes mellitus (T2DM), but their safety in cirrhosis remains uncertain given risks of volume depletion, infection, and decompensation. We evaluated the association between SGLT2 inhibitor use and hepatic decompensation and healthcare utilization in cirrhotic patients with T2DM.

Methods: A retrospective cohort study was performed using the TriNetX multicenter electronic health record network. Adults with cirrhosis and T2DM between 2018–2024 were classified as SGLT2 inhibitor-treated versus untreated. Propensity score matching (1:1) yielded 23,234 patients per group. Primary outcomes included new ascites, hepatic encephalopathy (HE), ED visits/inpatient admissions, and all-cause mortality. …

Bone Health And Healthcare Utilization Outcomes In Crohn’S Disease Patients Without Baseline Fracture Or Vitamin D Deficiency Treated With Infliximab Versus Adalimumab: A Propensity-Matched Cohort Study, Jashanveer S. Johal, Bianca Patel, Archana Salek, Mahmoud Al-Bataineh, Abdallah Hussein, Om Patel, Jason Hyman, Yecheskel Schneider

Rowan-Virtua Research Day

Background: Biologic therapies are central to Crohn's disease (CD) management, yet the comparative effects of infliximab and adalimumab on bone health and healthcare utilization remain poorly characterized in patients without baseline vitamin D deficiency or prior fractures.

Methods: A retrospective cohort study was conducted using the TriNetX U.S. Collaborative Network. Adult CD patients (≥18 years) initiating infliximab or adalimumab between 2018–2024 were included. Patients with ulcerative colitis, indeterminate colitis, or positive pregnancy tests were excluded. All patients had normal baseline vitamin D (≥20 ng/mL) and no history of pathological fracture. Propensity score matching (1:1) yielded 7,340 patients per cohort. Outcomes …