Medicine and Health Sciences Commons^™

Vesicant Infusates Are Not Associated With Ultrasound-Guided Peripheral Intravenous Catheter Failure: A Secondary Analysis Of Existing Data, Mahmoud Hijazi, Amit Bahl, Nai-Wei Chen

Posters

With over 300 million used annually in the United States, peripheral intravenous catheters (PIVC) are the most commonly used invasive device in the acute care setting1,2. Unfortunately, PIVCs have high failure rates with up to 63% failing prematurely3,4.

Certain intravenous medications categorized as vesicants and irritants are known to cause vein and local tissue injury. The Infusion Nursing Society (INS) created this list based on infusate osmolarity thresholds that increase the likelihood of these complications5.

It is perceived the impact of these medications on larger proximal veins with higher flow rates and improved hemodilution diminishes the likelihood of these complications. …

Hypofractionated Regional Nodal Irradiation In Breast Cancer, Joseph Salib, Allison Hazy, Joshua T. Dilworth

Posters

• In women with breast cancer requiring whole breast irradiation therapy (WBI), current guidelines endorse moderately hypofractionated whole breast irradiation (HWBI), which includes a shorter, 3-4-week regimen of radiation with a higher dose per daily fraction in comparison to conventional whole breast irradiation (CWBI), which includes a 5-6.5-week regimen.
• Patients with certain risk factors may benefit from treatment to the regional lymph nodes (RNI), which include the ipsilateral axillary, internal mammary and supraclavicular chains.
• Some centers have been slower to adopt short-course treatment when regional lymph nodes also require treatment (H-RNI), despite a reduction in the number of treatments for the …

Breast Irradiation Is Well Tolerated In Carriers Of A Pathogenic Atm Variant, Leah R. Rotenbakh, Andrew H. Zureick, Dana Zakalik, Thomas J. Quinn, Vincent P. Grzywacz, Peter Y. Chen, Joshua T. Dilworth

Posters

• The ataxia telangiectasia mutant (ATM) gene is implicated in DNA damage repair.
• A pathogenic germline variant of the ATM gene is present in approximately 1% of the population.
• ATM gene variant increases radiation sensitivity and elevates the life-time risk of developing breast cancer by two- to four-fold.
• Potential for increased radiosensitivity poses concern for the utilization of radiation therapy (RT) for oncologic treatment in patients with the ATM gene variant.
• Current data regarding RT tolerance are limited and conflicting in this patient population.
• Current guidelines for hereditary breast cancer management issued jointly by the American Society for Radiation Oncology, American …

Clinical Outcomes Of Hypofractionated Whole Breast Irradiation In Early Stage, Biologically High-Risk Breast Cancer, Eva Leung, Benjamin D. Willen, Thomas J. Quinn, Muayad F. Almahari, Peter Y. Chen, Maha Saada Jawad, Gregory S. Gustafson, Michelle Ka Yan Wu, Joshua T. Dilworth

Posters

• Whole breast irradiation (WBI) has been used in the treatment of breast cancer patients after partial mastectomy.
• There has been increasing utilization of hypofractionated whole breast irradiation (HWBI), defined as a larger daily dose and fewer fractions compared to conventionally fractionated whole breast irradiation (CWBI). However, HWBI for patients with early-stage, biologically high-risk breast cancer remains relatively low.
• We define biologically high-risk breast cancer as either triple negative (estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 (Her-2) negative), Her-2 amplified, and/or patients with a high-risk multigene assay.
• The 2018 ASTRO guidelines form the basis for treating breast cancer patients with …

Comparison Of Associated Autoimmune Disease Diagnoses In Myasthenia Gravis And Multiple Sclerosis Patients, Alecca Como, Jacob Keeley, Daniel Menkes

Posters

Autoimmune diseases often co-exist given the non-specific nature of the immune response. For example, myasthenia gravis [MG], a well-established autoimmune disease, has a 2.36-fold increased risk of developing thyroid diseases as compared to normal controls. 1,2 In contrast, multiple sclerosis [MS] is a disorder in which the immune system subserves an important pathogenic role, although there is insufficient evidence to definitively classify it as an autoimmune disease. 3,4 Since the etiology of MS has yet to be identified, and the specific autoimmune mechanism requires further elucidation, the comparison of its coassociated autoimmune diseases with that of a well-studied neuroautoimmune disease, …

Targeted-Sequencing Evaluation For Fzd4 Variants In Familial Exudative Vitreo-Retinopathy, Mary Drekh, Wendy Dailey, Vincent Le, Savyo Krikor, Kimberly A. Drenser, Kenneth P. Mitton

Posters

• The Familial hereditary vision loss disease may present with symptoms including retinal detachment, folding, neovascularization, or vitreous hemorrhage due to peripheral retina avascularity.
• The manifestation of FEVR genetically has been associated with a loss of function mutation of the Wnt/bcantenin-signaling pathway involving 7 genes (FZD4, NDP, CTNNB1, KIF11, LRP5, TSPAN12, and ZNF408). In our patient population of 72 individuals the distribution of FZD4 gene variants leading to FEVR has been recorded.
• The Frizzled4 gene (FZD4) codes for the G-coupled protein receptor and effects Wnt/b-cantenin-signaling pathway In endothelial cells.
• What frequency of FEVR from our patient pool will have FZD4 variants …

Reducing Reportable Hospital Acquired Pressure Injuries In The Medical Intensive Care Unit, Vallerie Push Msn, Rn, Cnl, Ccrn, Ryan Crabb Rn, Pamela D'Ambrosio Bsn, Rn, Sheryl Phino Msn, Rn, Ccrn,, Marianne Scofield Msn, Rn, Anne M. Aquila

Posters

The purpose of this quality improvement (QI) project was to reduce the rate of reportable HAPIs/1000 patient days in the MICU by 25% from a baseline rate of 2.92/1000 patient days to a target rate of 2.19 by September 30, 2023

Pods: A Team-Based Approached To Reduce The Left Without Being Seen Rate In An Urban, High-Volume Emergency Department, Charis Keane Md, Daryn Brauner Msn, Amy Bobbit Rn, Nikki Campbell Bsn, April Alfano Ms

Posters

The purpose of this QI project is to evaluate the impact of the Patient-Oriented Discharge System (PODS) model, a registered nurse-provider team-based approach, on reducing the rate of LWBS in a high-volume, urban ED

Improving Pain Air Cycles With Implementation Of Evidence-Based Reassessment Strategies, Carissa Corraro Dnp (C), Bsn, Rn.

Posters

The purpose of this quality improvement project was to implement evidence-based strategies (i.e., compliance audits, educational in-services, badge reels, and Posters with QR codes) to increase compliance of oncology nurses’ documentation of pain assessments and reassessments.

Health Equity Innovation To End Clinicians’ Unconscious Bias When Caring For Emergency Department Patients, Kenneth Forte, Adam Chess, April Alfano, Keri Bill, Cheryl Green, Mary Christoffersen, Joubin Bavarian

Posters

Bridgeport Hospital has successfully improved patient care by implementing Individualized Clinical Bias Scores (ICBS) for triage nurses in our emergency department (ED). Through the use of data analysis, we identified that patients of color were being assigned less urgent acuities when presenting with the same complaints as white patients. By addressing this implicit bias and implementing a new system of ICBS for our ED Triage Nurses, we have seen a significant improvement in the equitable treatment of all patients regardless of race or ethnicity.

All Clear For Virtual Simulation In Transition To Practice, Stephanie Barrett Msn, Rn, Onc

Posters

A knowledge gap in emergency management was identified through transition to practice program (TTPP) data and discussions with new nurses and nurse leaders. In response an Emergency Management Virtual Simulation (EMVS) was implemented. This evidence based educational method is engaging and is shown to increase confidence and learning outcomes. Virtual simulation gives new graduate nurses an opportunity to collaborate, critically think in stressful situations, and “experience the real-life chaos” in a safe learning environment.

Telehealth Implementation Of A Young Adult Ibd Clinic: Uptake, Benefits To Patient Care, And Challenges, Angela Combs Ma, Alaina Linafelter, Jordan Sevart, Michele H. Maddux

Posters

Introduction: Since the COVID-19 pandemic, pediatric psychologists have been at the forefront of telemedicine expansion to ensure access for patients and families to needed mental health services. This has required adaptations across the care continuum – from scheduling to service delivery to documentation. This poster aims to summarize the telehealth (TH) application of a Young Adult IBD Clinic (YAC-IBD) that provides transition preparation to youth with Inflammatory Bowel Disease (IBD). Methods: In April 2020, the YAC-IBD was converted from in-person visits to a virtual visit format. Since then, 119 youth ages 17-21 (inclusive) have been seen in this clinic. This …

Increasing Palliative Care Team Involvement In Pediatric Hematopoietic Stem Cell Transplant Patients, Meagan Vacek, Lisa Tarbell, Melissa List, Erin Hall, Jennifer Linebarger, Kelstan Ellis, Gina Jones, Joel Thompson

Posters

Background: Palliative care facilitates communication, helps with physical and psychological symptom management, and assists in goals of care and advance care planning discussions.1 Multiple organizations, including the American Academy of Pediatrics and American Society of Clinical Oncology encourage palliative care engagement and their involvement with hematopoietic stem cell transplant (HSCT) patients has been shown to be beneficial as HSCT is associated with a high degree of morbidity and possible mortality.2-3 Objective: To increase the number of PaCT consults for patients receiving HSCT for our targeted diagnoses from 48% to 75% by December 2023. Methods: Chart review was conducted for patients …

Speeding Up Time: An Old Back In A Young Athlete, Carey Wagoner, Greg Canty

Posters

Case of a 16 year old female competitive dancer with chronic back pain. Previous diagnosis of mechanical low back pain being treated by PT without improvement. Further workup demonstrated bilateral spinal synovial cysts at L4/L5 facet joints. Patient underwent IR guided aspiration and steroid injection with resolution of her symptoms and ultimately returned to dance.

Something's Gnawing At Me, Catharine Kral, Brian Harvey

Posters

17-year-old female presented to Sports Medicine clinic with a chief complaint of bilateral hip pain and difficulty walking who was found to have bilateral ovarian teratoma.

Hearing Loss In Children With 22q11.2 Deletion Syndrome, Lori Yaktine, Amanda Moore, Jamie Hamm, Blaine Crowley, Meghan Tracy, Janelle R. Noel-Macdonnell Phd, Kim Graiser, Bernice Marrow, Hansoo Song, Srivats Narayanan, Nikita Raje, Donna Mcdonald-Mcginn, Jill M. Arganbright

Posters

22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion syndrome, with most recent published prevalence of 1:2,140 live births. Hearing loss is common in children with 22q11.2DS and has been reported to occur in 32-60% of people. Hearing loss is typically conductive in nature secondary to chronic eustachian tube dysfunction and chronic otitis media with effusion (COME). Close monitoring of hearing and the middle ears is recommended to detect COME and the need for ear tubes. Additionally, there is a high prevalence of speech delay in children with 22q11.2DS, stressing the importance of close audiometric evaluation and medical intervention as …

Anterior Hip Pain In Adolescent Female Wrestler, Melanie Kennedy

Posters

No abstract provided.

An Increased Failure Rate Of Asparaginase Desensitization With Calaspargase Pegol, Jillian Fry, Erin M. Guest, Keith J. August

Posters

Background: In late 2022, pegaspargase (SS-PEG) became unavailable to patients younger than 22 years in the United States, leaving calaspargase pegol (SC-PEG) as the only available long-acting asparaginase formulation. SC-PEG has been compared to SS-PEG in two randomized, pediatric clinical trials and found to have similar rates of adverse events with comparable rates of event-free survival. Our institution uses a desensitization protocol for patients who experience a hypersensitivity reaction to asparaginase. Here we review our experience with desensitization since the transition to SC-PEG from SS-PEG. Objectives: To compare the rate of hypersensitivity reactions, success of desensitization protocols, and need for …

Diagnosis Of Mosaic Rasopathy In A Child With Rhabdomyosarcoma, Meagan Vacek, Paige Johnson, Midhat S. Farooqi, Kristi M. Canty, Dihong Zhou, Brendan Lanpher, Wendy Allen-Rhoades, Erin M. Guest

Posters

Background: Phacomatosis pigmentokeratotica (PPK) is a subtype of epidermal nevus syndrome characterized by the co-existence of a sebaceous nevus and a speckled lentiginous nevus and described in approximately 30 cases in literature. PPK is now recognized as a mosaic RASopathy due a postzygotic mutation in the Ras-Raf-MEK-ERK pathway. RAS variants are also known to contribute to tumorigenesis, in some pediatric cancers, including rhabdomyosarcoma. Objective: Describe the presentation and evaluation of a child with pelvic rhabdomyosarcoma and evolving skin lesions found to have a rare mosaic-RASopathy. Design/Method: Case Report Results: The patient is a former 32-week premature female who presented to …

Anesthetic And Multidisciplinary Management Of A 2-Staged Liver Transplant​, Kasey Brooks, Lisa Conley, Brandon Layton

Posters

We present a case of a 2 staged liver transplant on a 12-month-old 8kg male with newly diagnosed mitochondrial depletion syndrome causing acute liver failure, refractory lactic acidosis, and cardiopulmonary collapse requiring ECMO. The patient’s past medical history at the time of presentation included history of prematurity at 32 weeks, developmental delay, and a brother with an undiagnosed pancreatic disorder. The patient was brought in by parents to the emergency department with a cough, minimal PO intake for 5 days, and increased fatigue who was found to be URI positive. Initial labs were concerning for anemia, elevated bilirubin, elevated AST/ALT, …

Early Cholestasis And Vitamin K Deficiency Secondary To Biliary Atresia Presenting As Coagulopathy And Thymic Hemorrhage, Abbey Elsbernd, Lauren Amos Md

Posters

Background Bleeding and progressive coagulopathy are established symptoms of early cholestasis, including extrahepatic biliary atresia. We present a patient with bleeding secondary to vitamin K deficiency and cholestasis-induced fat malabsorption with unusual presentation of mediastinal mass. Objective Describe a case of late-onset vitamin K deficiency and cholestasis ¬¬presenting as jaundice and coagulopathy with associated bleeding into thymic structures Design/Method Case report Results A 4-week-old term male infant was brought to the ED with fussiness and bruising. Prior to presentation, he was afebrile and followed regularly with his primary care provider for jaundice below phototherapy thresholds. Infant received vitamin K at …

Single Center Retrospective Comparison Of Bivalirudin And Heparin For Therapeutic Anticoagulation In Pediatric Patients, Clayton Habiger, Shannon L. Carpenter

Posters

Background: The pharmacological choice for continuous anticoagulation therapy in pediatric patients has classically been unfractionated heparin. However, with heparin there are risks of treatment resistance in pediatrics given differences in developmental hemostasis, and contemporary medications such as bivalirudin offer a valuable alternative. Bivalirudin binds to thrombin and has shown encouraging results compared to heparin in pediatric patients receiving ECMO, but no comparison has been made in patients receiving therapeutic anticoagulation. Three years ago, Children’s Mercy Pediatric Hematology department encouraged bivalirudin use over heparin use for therapeutic anticoagulation requiring a continuous infusion. Objectives: Compare clinical and laboratory outcomes in patients receiving …

Transition Skills Lab: A Telehealth Intervention For Improving Healthcare Transition In Youth With Special Health Care Needs, Angela Combs Ma, Alaina Linafelter, Jordan Sevart, Michele H. Maddux

Posters

Introduction: Few interventions exist to provide hands-on practice of key health management tasks to youth with special health care needs (YSHCN). The Transition Skills Lab was adapted from Jerlym Porter’s work and piloted as a virtual intervention in YSHCN. Methods: Sixteen young adults participated in the virtual Transition Skills Lab, during which they practiced three key patient competencies pertaining to health care tasks: reading an insurance card, reading a pill bottle label, and scheduling an initial visit with an adult doctor. Participants were then asked to rate their confidence on skills taught within the intervention on a four-point scale from …

Congenital Heart Defects And Autism: Understanding The Breakdown Of Associated Risk Factors In A Clinically Referred Sample, Elizabeth Raines, Amanda Strasser, Amanda Manderfeld, Paul Glasier, Elizabeth J. Willen

Posters

Background: Children with Congenital Heart Disease (CHD) have higher odds of developing social difficulties and/or an Autism Spectrum Disorder (AuSD) than the general population (i.e., ~10% vs. ~1%). However, there is a paucity of nuanced understanding of specific drivers of the increased rates of AuSD in extant literature. The purpose of this study is to identify the rates of co-occurring cardiac, neurological, and genetic conditions to better understand associated risk factors in a patient sample from a medium-size children’s hospital. Methods: Our population includes a clinically referred sample of children (i.e., medical history of CHD and neurodevelopmental risk) under 18 …

Parents’ Perception Of An Intensive Interdisciplinary Pain Treatment For Amplified Pain Syndrome, Jacqueline Pabis Phd, Sabrina Ung, Jenny Scheurich, Dustin Wallace Phd

Posters

Introduction: Intensive interdisciplinary pain treatment (IIPT) is an effective treatment for youth impaired by chronic pain (Claus et al., 2022). IIPT programs incorporate parents in treatment, as parental distress has been found to impact health and functioning in youth with chronic pain. Research has suggested parent satisfaction may be related to increased child adherence, and in turn, reduced pain (Gorodzinsky et al., 2012). There is limited research on parental satisfaction with IIPT and the role of parent-provider communication. Method: Parents (n=99) of children in an IIPT program completed questionnaires related to treatment satisfaction, parent-provider communication (e.g., provider listened carefully, provider …

Pediatric Site Response To Rapid Implementation Of Decentralized Clinical Trials, Abby Kietzman, An-Lin Cheng

Posters

In 2020, the COVID-19 pandemic drastically altered the way clinical research is conducted through a widespread adoption of telemedicine practices. Using telehealth/telemedicine services allowed researchers to conduct “decentralized clinical trials”, or DCTs, for all or portions of study protocol procedures while maintaining safety measures implemented for pandemic control. However, current review of available literature details the explosion in use of decentralized clinical trials, resulting in gaps in evidence-based outcomes and lack of standardization across research entities. While sponsors and contract research organizations (CROs) tend to lead the charge around adoption of DCTs, research sites are hesitant to make the transition …

Double Aortic Arch With Atresia Of The Left Aortic Arch Proximal To The Left Common Carotid Artery In A Patient With Phace Syndrome – A Management Conundrum, Mohamed Aashiq Abdul Ghayum, Anmol Goyal, Aliessa P. Barnes, Sanket Shah

Posters

Background Cardiac anomalies in PHACE syndrome (P: posterior fossa anomalies, H: hemangiomas, A: arterial lesions, C: cardiac abnormalities, E: abnormalities of the eye) often consists of complex aortic arch anomalies with double aortic arch (DAA) being an uncommon association. Atresia of the proximal segment of the left arch in DAA is extremely rare and can pose a diagnostic and management conundrum due to formation of a loose vascular ring and asymptomatic nature as seen in our case. Case Description A 5-year-old male, diagnosed with PHACE syndrome, at a different center was noted to have an incidental finding on head imaging …

Transposition Of The Great Arteries With Intramural Left Main Coronary Artery: Salient Imaging Findings And Description Of Two Operative Techniques, Joshua Holbert, Manasa Gadiraju, Sanket Shah, Edo Bedzra

Posters

Background: Transposition of the great arteries (TGA) is a common cyanotic critical congenital heart disease, with a feasible prenatal diagnosis. Arterial switch operation (ASO) with/without VSD closure is the preferred surgical approach with added challenge when an intramural coronary artery (IMC) is present. ASO is technically quite demanding with IMC, and incidence of post-operative complications and mortality are potentially higher. We present our recent TGA-IMC experience focusing on salient features identified on echocardiography, CT and invasive angiograms, as well as variations in ASO surgical techniques for repair. Methods: Our echo imaging acquisition required high frequency transducers and shallow image depth …

A Rare Case Of A Giant Cell Tumor Of The Peroneal Tendon Sheath, Francois M. Lokenye Dpm, Breana Marine Dpm, Orlexia Thomas Dpm, Mariam Kamil Bs

Posters

This case report discusses a 31-year-old male with TGCT in the peroneal tendon sheath, detailing clinical and radiological features.

his study explores the surgical interventions, diagnostic challenges, treatment options, and outcomes of TGCT, emphasizing its consideration in the differential diagnoses of painful foot and ankle masses.

Impact Of A Designated Intravenous Team On Central Line Associated Blood Stream Infections, Andrew Drozd, Mason Everlith, John Brennan, Kenneth Forte, Stacy Peach, Anne M. Aquila

Posters

No abstract provided.