Medicine and Health Sciences Commons^™

Use Of Early Enteral Nutrition In Mechanically Ventilated Covid-19 Patients, Vivian Chang, Ramin Homayouni, Virginia Uhley

Posters

Malnutrition in critically ill patients has been associated with a greater length of hospital stay, incidence of complications, and risk of death. Up to 37% of critically ill patients in the intensive care unit (ICU) are either moderately or severely malnourished1. Optimizing enteral nutrition delivery is key to maximizing the benefits of nutrition support for critically ill patients. At the onset of the COVID-19 pandemic in March 2020, the role of nutrition support for COVID-19 patients was poorly understood. In May 2020, the American Society of Parenteral and Enteral Nutrition (ASPEN) approved nutrition guidelines for COVID-19 patients that state that …

Incidence Of Symptomatic Upper Extremity Deep Vein Thrombosis In Respect To Subcutaneous Port Venous Access Site In Adults: A Retrospective Review, Catherine Bark, Alexsandra Biel, Corinne G. Bowditch, Paul Bove, Jimmi Mangla

Posters

Subcutaneous ports are an essential component of care in patients who require long-term central venous access and are commonly indicated for patients that require chemotherapy, infusions, intravenous (IV) antibiotics or frequent blood draws.1,2 The catheter of the subcutaneous port is commonly inserted through the subclavian vein and internal jugular vein via percutaneous insertion, or the external jugular vein and cephalic vein via surgical cutdown of the vein.

One of the most common port-related complications is venous thromboembolic (VTE) events with rates of symptomatic VTE as high as 13.6%.4,6–11 Patients with symptomatic upper extremity deep vein thrombosis (DVT) can present with …

A Novel Targeted-Sequencing Panel To Detect Lrp5 Gene Variants In Orphan Pediatric Retinal Diseases, Daeun Jeong, Kenneth P. Mitton, Kimberly A. Drenser

Posters

Orphan pediatric retinal diseases which encompass Familial exudative vitreoretinopathy (FEVR), Norrie Disease, and Retinoschisis are associated with mutations in genes involved in the Wnt signaling network, including FZD4, LRP5, TSPAN12, and NDP. See figure-1. FEVR is a retinal disease that lacks normal vascularization and angiogenesis to the peripheral retina. LRP5 variants account for 10-25% of cases of autosomal dominant FEVR. However, not all cases have been linked to these existing variants. Next generation sequencing was used to sequence 76 subjects for novel variants to expand the spectrum of LRP5 variants and better understand the mechanism of pathogenicity.

Demographics And Pain: An Observational Study Of Men Attending An Urban Health Event, Steven A. Kessler, Michael D. Lutz

Posters

• Chronic pain has been estimated to be present in 11.4 to 24 percent of the population.
• Of the 369 measured diseases, the World Health Organization’s Global Burden of Disease Study has 3 conditions associated with chronic pain in the top.
• The economic burden associated with chronic pain is high, with one study suggesting higher annual costs than heart disease, cancer, and diabetes.
• Studies have shown that race and socioeconomic status are factors associated with higher prevalence of chronic pain.

• Higher in minority populations, and those of lower socioeconomic status.
• One study showed that after correcting for income, employment and adverse …

Nocturia In Men And Associated Comorbidities; A Southeast Michigan Study, Daniel Fortney, Alexander Geisenhoff, Bernadette Zwaans, Michael Lutz

Posters

• Nocturia, defined as waking up during the night to void, is a prevalent condition affecting a considerable proportion of the population.
• Many studies have demonstrated that nocturia is associated with poor quality of life and numerous adverse health outcomes 1,2,3,4.
• Patients with nocturia are estimated to have 60% greater hospitalization rates and 19% higher rates of outpatient visits, equating to an annual economic cost of $3,491 per patient 5.
• Although pre-existing studies have not consistently aligned on the association between nocturia and specific comorbidities, the overall agreement on the negative health outcomes and economic strain caused by untreated nocturia remains …

Dental Manifestations And Management Of A Pediatric Patient With Hypophosphatasia: Case Report And Literature Review, Dev Patel, Robin Onikul, Amy Burleson, Brenda S Bohaty, Jenna Sparks, Neena Patel

Posters

Hypophosphatasia is a rare autosomal recessive disorder affecting the ALPL gene, which is involved in mineralization of bones and teeth. Given the importance of mineralization on proper tooth development, patients with hypophosphatasia present with numerous dental manifestations and require careful, coordinated care to maintain function and esthetics. This case report details a 9-year-old patient presenting to Children’s Mercy Kansas City Dental Clinic with complex medical history including hypophosphatasia, hypophosphatemic rickets, and developmental delay. The case report will include the patient’s clinical and radiographic presentation and will detail the patient’s treatment history. The presentation will also review the relevant scientific literature …

Understanding Inpatient Diagnostic Imaging Use In Children’S Hospitals To Prioritize Stewardship Efforts, Megan Collins, Matt Hall, John R. Stephens, Jessica Markham

Posters

Background: Healthcare waste, including overuse of treatments or testing such as unnecessary diagnostic imaging, has estimated annual costs of over $760 billion in the United States. The most prevalent and costly imaging studies among hospitalized children are not known. Objective: To describe diagnostic imaging studies among hospitalized children with the highest prevalence, cost, rates of repetition, and hospital variation to help inform de-implementation efforts. Design/Methods: We performed a retrospective cohort study of children <18 years of age hospitalized from 1/1/2021 to 12/31/2022 across 45 hospitals in the Pediatric Health Information System. We identified all radiologic imaging for inpatient and observation encounters using billing codes. We grouped images by modality and body location, and excluded images classified as other/unspecified body location. The intraclass correlation coefficient was used to measure variation across hospitals in imaging use after adjusting for age and severity. Higher numbers indicate a higher degree of variation. Results: We identified 1,523,343 encounters; 59.1% had diagnostic imaging (Table 1). The most prevalent diagnostic imaging studies were chest x-ray (XR), abdominal XR, and echocardiogram. The images most frequently repeated were chest XR, echocardiogram, and abdominal XR. The costliest individual diagnostic imaging studies were echocardiogram, chest XR, and head/brain MRI (Table 2). Although chest XR was among the least expensive imaging modalities per unit cost, given the high prevalence of use and repeat use it was one of the costliest tests overall. Head US, interventional XR, and abdominal US had the highest variability of use between hospitals (Table 2, Figure). Conclusion(s): Chest XR and echocardiograms were among the most prevalent, costly, and frequently repeated imaging studies. Abdominal XR, abdominal ultrasound, bone/joint XR, head/brain CT, and head/brain MRI were high in both prevalence and cost among hospitalized children. Five of the 10 most commonly used imaging techniques and four of the 10 most commonly repeated imaging techniques expose children to ionizing radiation. These results could help identify areas that should be targeted to reduce radiation exposure, improve care, and decrease costs for hospitalized children.

A Retrospective Review Of Cosmetic Surgery Medical Tourism Complications During Covid-19 Pandemic, Rachel Blaisdell, Claire Mcnary, Catherine Barkach, Emanuela Peshel, Elizabeth Boudiab, Lauren Oliver, Samuel Mucci

Posters

• Cosmetic surgery medical tourism refers to traveling outside one’s geographic region for the purpose of a cosmetic procedure
• Benefits include reduced cost, shorter wait times, and newer “trendy” procedures
• Potential problems include a lack of continuity of care for patients, travel after surgery, and exposure to foreign pathogens

Heart Rate Metrics In Surgical Residents Performing An Educational Task Under Stress, Harkirat Jawanda, Kathryn K. Howard, Rose E. Callahan

Posters

Although a moderate amount of stress can be beneficial for performance, excess stress can lead to a decrease in fine motor skills, focus, decision-making skills, and communication.1-3.

• These effects can be especially detrimental in the operating room, where a stress-induced lapse in performance can lead to catastrophic outcomes for patients.
• One unique stressor experienced by surgical residents is observation by an attending surgeon during procedures, which has been shown to lead to an increase in stress related behaviors.4
• Mimicking the stress of the operating room in simulation environments presents the opportunity for residents to improve their ability to recognize and …

Comparing Plastic Surgeon Operative Time For Deep Inferior Epigastric Perforator (Diep) Flap Breast Reconstruction, Christopher J. Issa, Elizabeth M. Boudiab, Jeffrey Desano, Neil S. Sachanandani, Jeremy Powers, Kongkrit Chaiyasate

Posters

The deep inferior epigastric perforator (DIEP) flap has remained the gold standard for perforator flap reconstruction due to its consistent anatomy and low morbidity. Despite higher longterm patient satisfaction in autologous breast reconstruction compared to breast implants,1–3 implant-based reconstruction remains more common due to shorter operative time.

Several studies have examined the issue of optimizing efficiency of autologous breast reconstruction but were typically performed in the context of immediate reconstruction. In our institution and others, however, two-stage delayed reconstruction is the norm — a tissue expander is placed at the first stage for preservation of the skin envelope; after expansion …

Perioperative Antibiotic Use In Neonatal General Surgery: A Survey Of Apsa Membership, Samuel K. Osei, Ashley Williams, Diane Studzinski, Patrick Karabon, Begum Akay, Pavan Brahmamdam

Posters

• Guidelines for antibiotic prophylaxis for surgical site infection (SSI) are widely used for adult patients.
• There is limited data on prophylaxis in pediatrics, and there are no standardized guidelines for neonates.
• Perioperative antibiotic use in neonates based on the surgeon’s preference.

Emergency Department Treatment Of Elevated Blood Pressure In The Headache Patient, Lauren Eberhardt, Michelle Jankowski, Brett Todd

Posters

• Headache is an extremely common emergency department (ED) chief complaint, accounting for 1-3% of emergency department (ED) visits per year globally.
• Headache is often associated with elevated blood pressure and the most frequent clinical manifestation of hypertensive urgency, occurring in 35.9% of patients.5
• First line treatments used for acute headache management in the ED include intravenous fluid (IVF), anti-dopaminergic agents, aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), and ketorolac.6
• Rescue analgesia is needed for pain management in 16% to 18.1% of patients.8,9.
• Rescue analgesia includes: additional doses of first line analgesia or initiation of a second line medication1,6,10,11 such as magnesium sulfate, …

Characterizing The Effectiveness Of Prehospital Pediatric Pain Management In Children With Long Bone Fractures, Revelle Gappy, Ashima Goyal, John Frawley, Sariely Sandoval, Nai-Wei Chen, Remle Crowe, Robert Swor

Posters

Prehospital pediatric pain management has been poorly understood and sub-optimally treated.1-3 Pain scales for children differ from adult pain scales and it is unclear if pain assessments are well documented, particularly in infants and toddlers.4-6 Surveys of emergency medical services (EMS) personnel identify barriers to pain management including discomfort with emergency care of injured children, concern for allergic reactions, additional pain from intravenous catheter insertion, parental influence, as well as lack of knowledge and experience secondary to the relatively infrequent treatment of acutely injured children.7-9

The effectiveness of prehospital pain medication administration for children is unknown, as is the efficacy …

Quantifying The Importance Of Orthopaedic Surgeon Attributes By The Public, Rasheed Abdullah, James E. Feng, Phillip Vartanyan, Hassan Alosh, Drew Moore, Leonardo M. Cavinatto, Betina Hinckel

Posters

Evaluate what surgeon attributes are currently important to our patients, and what modalities may be most effective in finding orthopaedic surgeons, using online crowdsourcing.

Operative Versus Non-Operative Treatment Of Z-Type Clavicle Shaft Fracture In Adolescents: A Retrospective Study, Sami Azeroual, Colin Van Wagoner, Jeffrey Leider, Ehab Saleh

Posters

• The clavicle is one of the most fractured bones in the human body.
• Traditional treatment involves conservative management with a sling or immobilization but recently the effectiveness of the approach has been questioned.
• Studies done on the adult population have found higher rates of mal or non-union than previously noted, especially in those with displaced or comminuted fractures.
• The noted malunion or non-union was noted to have effects on shoulder mechanics, pain with overhead activity, and loss of strength and endurance.
• Due to differences in physiology the findings in the adult studies do not necessarily translate to the pediatric population. …

The Impact Of Health-Related Social Needs On Health Outcomes Among Youth Presenting To A Midwest Pediatric Diabetes Clinic Network, Jasmine Roghair, Emily Dewit, Katelyn Evans, Mitchell Barnes, Heather Feingold, Samantha Jacob, Courtney M. Winterer, Jeffrey D. Colvin, Mark A. Clements, Shilpi Relan, Kelsee Halpin

Posters

Objective: Screening for health-related social needs (HRSNs) is recommended as part of routine diabetes care given the strong impact of social factors on health outcomes. Our objective was to compare diabetes-related health outcomes among youth presenting to a tertiary diabetes center based on whether they screened positive or negative for HRSNs at a routine clinic visit. Methods: Baseline data were collected from patients whose parent/guardian completed a HRSN screen as part of their child’s diabetes clinic intake from 9/1/21 to 8/30/22. The screen is a 6-item questionnaire adapted from the Accountable Health Communities HRSNs Screening Tool. Longitudinal data were analyzed …

Dental Manifestations Of A 4-Year Old Male Patient With Congenital Vitamin D Rickets: Review Of The Literature And Report Of A Case, Richard Nguyen, Robin Onikul, Brenda S. Bohaty, Neena Patel, Jenna Sparks, Amy Burleson

Posters

Patients that present with Vitamin D-resistant rickets may have abnormal tooth morphology, such as enlarged pulp horns that may extend into the dentino-enamel junction. As a result of this communication, there may be an increased chance of pulpal infection, resulting in spontaneous dental abscesses occurring without evident caries or history of trauma. The purpose of this poster is to report the case of a four-year-old patient who presented to Children’s Mercy Kansas City Dental clinic with chief concern for swelling of the face with unknown causes. The patient’s medical history was significant for congenital Vitamin D-resistant rickets. The poster presents …

February In Santiago Atitlan, Guatemala, Grace Milburn

Posters

Describes her experience working in Santiago Atitlan, Guatemala.

Barriers To Mental Health Treatment Among Medical Students: Preclinical Vs. Clinical Years, Urvashi Singh, Agnes Wrobel

Posters

Our study aims to:

• Investigate medical students’ attitudes towards seeking assistance from mental health professionals.
• Compare the importance of various barriers that deter help-seeking in preclinical vs. clinical years of medical education.

Predictors Of Icu Admission Following Endoscopic Endonasal Skull Base Surgery, Brandon Prentice, Max Dehaan, Adam Folbe

Posters

• Endoscopic Endonasal Skull Base Surgery (EESBS) encompasses a wide range of surgeries; pituitary adenoma resection is the most common of these.
• Patients routinely are admitted to the ICU post-operatively for monitoring of serious complications such as intracerebral hemorrhage and meningitis.
• Some complications such as diabetes insipidus, however, do not require a stay within the ICU and can be managed as an out-patient.
• Besides adding stress and discomfort to the patient, stays in the ICU are costly with one study reporting a cost of $2,902 per day.
• Previous studies identified preoperative hypertension and large tumor volume (>4500 mm3) as risk …

Clinical Differences In Isolated Post-Capillary Pulmonary Hypertension And Combined Pre- And Postcapillary Pulmonary Hypertension, Emily Schneider, Bhavinkumar D. Dalal

Posters

PULMONARY HYPERTENSION (PH) = RESTING MEAN PULMONARY ARTERY PRESSURE (MPAP) > 20 MMHG.

The World Health Organization recognizes five groups of pulmonary hypertensions:

• • Estimated that > 50% of patients with left heart disease are also affected by pulmonary hypertension.1
• 1 in 4 Americans will develop heart failure in their lifetime.
• Gold standard for diagnosis of PH is a right heart catheterization (RHC).3
• Global burden of PH remains unknown as this illness is poorly surveilled and cases remain underestimated.4,5

Understanding Infectious Disease Consultation Role For Septic Patients In The Medical Intensive Care Unit, Marisa Stratelak, Cloe Nazeer, Bhavinkumar Dalal

Posters

• Sepsis is a medical emergency requiring immediate recognition and prompt treatment.
• 1 in every 3 hospitalized patients who die have sepsis1.
• The mortality rate for patients with severe sepsis in the intensive care unit (ICU) is 32.2%2.
• Early intervention with fluid resuscitation and intravenous antibiotics can reduce mortality rates by 7-9%3.
• Infectious disease (ID) consultation on antimicrobial therapy in the ICU is associated with reduced ICU mortality and ICU length of stay (LOS)4.
• Gaps in literature exist regarding frequency of ID consultation for septic patients in the ICU, including comparing outcomes of patients with and without ID consultation.
• It is …

Association Between Primary Care And Emergency Department Utilization, Donna Kayal, Jacob Keeley, Ramin Homayouni

Posters

Emergency departments have been designed to provide rapid and accessible care for emergent and acute needs for a broad scope of illnesses and injuries.1-2 However, the emergency department (ED) has been facing an overwhelming increase in demand, leading to an increase in wait time and significant overcrowding, which decreases the effectiveness of the ED.1-4 A common explanation that has been noted over the years is utilization of ED services for non-emergent care, which professionals have often labeled as “inappropriate use.”2,5 Such encounters take away time from ED physicians and health care workers, compromising the care for true emergencies and leading …

Efficacy Of An Integrated Computer Assisted Learning (Cal) Module In Student Understanding Of Cardiovascular Embryology, Nicolaas Schimmel, Forrest Bohler, Varna Taranikanti

Posters

• Embryology is one of the most difficult topics for students to master1

Students’ perceptions of embryology are generally more negative:

• Not clinically important1

• More negative attitude than towards gross anatomy1

• Unhappy with current teaching methods and not confident learning it2

An integrated CAL module will allow a more linear model for learning congenital heart diseases, which may help improve students’ understanding of cardiovascular embryology.

• Compared to traditional, more segmental model where students learn embryology separately from clinical presentation, ECG interpretation, etc.
• CAL modules have proven effective for other organ systems3.

• We hypothesized that students would demonstrate …

Smoking And Covid-19: An Analysis Of Demographics, Risk Factors, And Outcomes, Andrew Vrtar, Luca Cucullo, Richard H. Kennedy

Posters

• Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a respiratory pathogen that first emerged in late 20191 and was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020.
• Cigarette use is a significant public health concern throughout the world. Despite reductions in prevalence in recent years, tobacco smoking remains one of the main preventable causes of ill-health and premature death.
• Both tobacco smoking and vaping are phenomena that may increase the vulnerability of these individuals to COVID19 infection.4 Therefore, it is crucial to explore the medical consequences of and …

Patient Population Representation In Medical Education Textbooks: Gender Imbalance Of Diagnostic Images, Yasin Sahin, Abdul-Majid Khan, Nicolas Baker, Joshua Daniel, Jacob Keeley

Posters

Gender inequality: a longstanding issue that has been gaining overdue attention. Even within esteemed institutions such as medical schools, gender biases persist. Society trusts that those who attend medical school are given the knowledge needed to provide care and support during their most vulnerable moments as patients. While the education may be there, the “patients” may not be represented accurately. Future healthcare professionals must provide care for all patients, a diverse group encompassing all genders, ages, ethnicities, and backgrounds.

In 2019, the United States Census Bureau reported that the population was about 49% male and 51% female.¹ Therefore, medical students …

You’Re Testing My Patients: Clinicians’ Preferences For Structured Reporting And Measurement Data, Davit Melik, Adela Pouzar, Allan Brazier, Sayf Al-Katib

Posters

Radiological reports are a crucial part of patient care and management. Radiologists play a major role in patient care by interpreting imaging studies and making recommendations to referring physicians. 1,2,3 Although some physicians may prefer to initially interpret the imaging studies by themselves, radiologists’ reports have been shown to be significantly more accurate and detailed, which ultimately results in better patient care. 1,4,5,3 Thus it is important for radiology reports to be timely and as accurate as possible to improve overall patient care. The clarity of communication between radiologists and referring physicians in these reports remains an important factor in …

Water-Soluble Contrast Challenge In The Management Of Pediatric Adhesive Small Bowel Obstruction: A Systematic Review, Max Fliegner, Daniel Finn, Spencer Wilhelm, Nathan Novotny, Anthony Stallion

Posters

Background: Adhesive small bowel obstruction (ASBO) is a serious complication of intra-abdominal surgery1 Water-soluble contrast (WSC) challenges have been used for medical management in the adult population2,3

Knowledge Gap: The therapeutic value of water-soluble contrast challenge in the pediatric population with ASBO is under-studied3,4

Research Question: Does administration of water-soluble contrast challenge reduce the need for surgery in pediatric patients with adhesive small bowel obstruction?

Molecular Characterization Of Kif11 Variants In Familial Exudative Vitreoretinopathy, Konstantinos Koustas, Kenneth P. Mitton, Wendy Dailey, Kimberly A. Drenser

Posters

Pediatric retinal diseases including Familial exudative vitreoretinopathy (FEVR) and Norrie Disease are linked to mutations in Wnt signaling network genes like FZD4, LRP5, TSPAN12, and NDP (see Figure-1). Active Norrin signaling is crucial for the normal growth and proliferation of developing retinal vasculature. Similarly, the absence of KIF11's kinesin activity can hinder the growth and proliferation of retinal vasculature, leading to peripheral avascular neural retina. According to the UniProt database there are about 41 disease causing variants for KIF11, and 17 specifically associated with FEVR. Nextgeneration sequencing was employed to sequence 76 subjects, aiming to identify novel variants to broaden …

Physician-Patient Face Masking’S Influence On Post-Intravitreal Injection Endophthalmitis Rates, Conner Liddle, Antonio Capone Jr, Matthew Trese

Posters

Intravitreal injections (IVI) of anti-vascular endothelial growth factor (VEGF) medications and intravitreal steroids are standard treatment options for variety of retinal diseases. Serial IVIs are often required to achieve disease control, but IVIs are not without risk. Recognized serious complications of IVIs include but are not limited to retinal detachment, vitreous hemorrhage, and acute endophthalmitis.1 Although post-IVI endophthalmitis is uncommon, it is a feared complication because of the potential for irreversible vision loss. Given that IVIs are one of the most commonly performed medical procedures in the United States, it is essential to ensure that steps are taken to mitigate …