Medicine and Health Sciences Commons^™

Longitudinal Outcomes Assessment: 8 Years Of A Facial Nerve Disorders Multidisciplinary Clinic, Carley Boyce Md, Aimee Galatas Bs, Sara Macdowell Pt, Dpt, Laura T. Hetzler Md, Mba, Facs

Quality Improvement & Patient Safety Forum

No abstract provided.

Standardizing Naloxone Co-Prescription To Promote Harm Reduction In Pediatric Sickle Cell Pain Management, Nali Gillepsie Md, Morgan Viviano Md, Alexis Brantley Md, Leah Smith Do, Ushma Bhandary Md, Dana Leblanc Md, Molly Sonenklar Md

Quality Improvement & Patient Safety Forum

No abstract provided.

Standardizing And Improving Neurodevelopmental Follow Up Of Infants With Hypoxic Ischemic Encephalopathy In The Nicu, Michael L. Evers Md, Michelle Knecht Md, Christy Mumphrey Md, Raegan Gupta Md, Julie Gallois Md

Quality Improvement & Patient Safety Forum

No abstract provided.

2025 Qi Forum Agenda, Equip Program Office Ogme

Quality Improvement & Patient Safety Forum

No abstract provided.

Developmental Bases Of Open Neural Tube Defects In Rat Embryos, Padmanabhan Rengasamy

Research Colloquium

Background: Anencephaly, a severe form of congenital malformation of the brain and calvarium is reported to result from arrest of rostral neuropore closure. However, no clear mechanism has been discovered for anencephaly. Experimental models developed to study the mechanism have established a similar but less severe form of this anomaly called exencephaly. This phenotype is possibly due to the shorter gestational periods characteristic of experimental models of exencephaly. We had serendipitously discovered exencephaly when studying limb defects in rat embryos that were treated with cyclophosphamide on gestation day 12 after neural tube closure. We wished to determine whether exencephaly induced …

How Far Does It Go? An Analysis On The Extent Of Spinal Cord Injury In Post-Traumatic Patients, Sravani Mannuru, Sarvani Uppati, Kelsey Baker

Research Colloquium

Background: Spinal cord injury causes debilitating functional loss in post-trauma patients. Previous studies have showed that an area of edema (tissue damage and swelling) occurs at the level of spinal damage and may be related to the amount of functional loss in the patient and their associated recovery potential. We hypothesized that the extent of the injury is greater than previously studied and may better explain functional loss and recovery potential.

Methods: We retrospectively analyzed five T2-weighted MRI spinal cord images from post-trauma patients ages 32-67. Patients had a clinically diagnosed spinal cord injury that affected the cervical …

Prognostic Risk Factors For Postoperative Complications In Patients With Pancreatic Adenocarcinoma: A Single Center Retrospective Cohort Study, Stacy M. Sebastian, Adedayo O. Okanlawon, Giuiseppe Fonseca Badillo, Daniel Nwoschua, Christian Abraham, Chelsea Chang

Research Colloquium

The postoperative complications of surgical interventions to treat pancreatic cancer are a major cause of cancer-related morbidity and death. Identification of prognostic factors that may exist at the time of presentation can allow for early stratification of patients who face the greatest risk of developing these complications following surgical resection. Early consideration of high-risk patients can improve the prediction of disease-free survival for patients with pancreatic adenocarcinoma (PDAC) who undergo surgical resection. The goal of this retrospective study is to identify postoperative complications and risk factors that may affect disease-free survival after classic pancreaticoduodenectomy (CP) and pylorus-preserving pancreaticoduodenectomy (PPP), two …

Vitamin B12 Deficiency And Subacute Combined Degeneration, Bhargavi Akkineni

Research Colloquium

A 23 year old male with no pertinent past medical history presented to ED with acute worsening ataxia and paresthesia of upper and lower extremities with an onset of 5 days. Patient denied recent vaccinations, respiratory or GI illness, prior episodes of ataxia or paresthesia, bowel or urinary incontinence, and camping or tick bites. On physical exam, patient exhibited hyporeflexia in upper and lower extremities, along with impaired proprioception and detection of light touch and vibration, but patient’s motor strength was preserved. MRI of brain revealed no abnormalities. MRI of C-spine demonstrated an abnormal T2 signal within the cervical spinal …

A Case Of Infective Endocarditis In Aortic Stenosis Status Post Tvar, Bhargavi Akkineni, Gabriel Lopez

Research Colloquium

A 80 year old woman, with a past medical history of aortic stenosis status post TVAR, sick sinus syndrome with permanent pacemaker placement, and hypertension, presented to ED with generalized body weakness and persistent fevers with an onset of three days. On physical exam, patient was tachypneic, tachycardic, febrile, and she exhibited a motor strength of 1/5 in her left upper extremity with intact motor strength in all other extremities. CT of head revealed chronic small vessel ischemic changes, and an MRI of the head, obtained consequently, depicted multifocal bilateral supratentorial acute infarcts. Patient’s physical findings also prompted for blood …

Gastrointestinal Tumor Presenting As A Upper Gi Bleeding, Jorge R. Duarte

Research Colloquium

Gastrointestinal stromal tumors (GISTs) are the most common nonepithelial solid neoplasms involving the alimentary tract. We report a case of a 61-year-old man presented with epigastric abdominal pain for one month. Further evaluation revealed slowly decrease in hemoglobin with a sudden drop while hospitalized for alter mental status in a setting of urinary tract infection. Rectal exam showed melena. CT scan of the abdomen shows a large complex cystic mass attached to the abdominal wall. An upper endoscopy was done finding a 3cm tumor in greater curvature that resemble Gastrointestinal stromal tumors (GISTs). Patient underwent to exploratory laparotomy with wedge …

The Impact Of Covid 19 Infection On Graves' Disease, Shadi Jafari-Esfahani, Semenawit B. Burka, Edwardo D. Luna

Research Colloquium

Background: Although there are not many studies regarding the effects of Covid-19 infection on Graves’ disease, few case reports demonstrate the association between the two. The SARS-CoV-2 uses the angiotensin II converting enzyme to gain entry into cells. This results in hyperactive immune response involving Th1 and Th17 lymphocytes which activates proinflammatory cytokines; IL-6 and TNF-alpha. Research shows elevation of IL-6 in patients with Graves’ disease.

Case report: A 22 years old man with no past medical history presented to the Emergency Room for the complaint of generalized weakness and dyspnea of one day. He had associated dry cough, palpitations, …

2025 Prep Symposium Agenda, School Of Medicine

Postbaccalaureate Research Education Program in Biomedical Sciences (PREP)

No abstract provided.

Effects Of Nicotine On Dopamine Signaling In Sprague Dawley Rats, Dominik Sretenovic, Kyle A. Marsh, Sabin Mulch, Gahnan Schaff, Anthony Jones, Sukhman Bains, David Daberkow

2025 Symposium

Nicotine influences dopamine (DA) release in the nucleus accumbens, a brain region associated with reward processing and addiction. This study examined nicotine’s effects on DA signaling using fast-scan cyclic voltammetry (FSCV) in anesthetized rats. Electrodes were implanted to stimulate DA release in the medial forebrain bundle and record signals in the ventral striatum. After administering saline or nicotine, DA levels were monitored in real-time, and electrode placement was later verified through histological analysis. Saline-treated rats showed minor DA fluctuations, with a peak signal detected at 50 minutes, while technical difficulties prevented complete nicotine data collection. However, previous experiments indicated significantly …

Investigating Empathy In Rats: Behavioral Responses To Distress, Isabella Sophia Avery, Kolette Stuhmer, Jeffrey Schell

2025 Symposium

INTRODUCTION: Empathy can be defined as the ability to recognize, understand, and match one’s emotional state to that of another. Previous research has suggested that emotional contagion produces empathetic responses among familiar rats when their cage mate is exposed to a stressor. This study seeks to further explore this relationship and compare responses among familiar vs. unfamiliar rats. METHODS: Male and female Sprague-Dawley rats were divided into cohorts including an observer, demonstrator, and stranger rat. The demonstrator was exposed to shock paired with a tone and the demonstrator, its cage mate, was only exposed a tone but no shock. The …

Fear And Oxytocin: Effects Of Intraperitoneal Pretreatment In Rats, Daniel Yeromenko, Kelsie German, Eros Fuentes, Jenna Meade, Ben Bustos

2025 Symposium

INTRODUCTION: Oxytocin is a neuropeptide widely known for its role in social bonding and emotional regulation. Recent studies have suggested its involvement in modulating fear, stress, and anxiety responses, potentially offering therapeutic applications for trauma-related disorders such as PTSD. This study investigated whether pretreatment with oxytocin reduces behavioral and physiological fear responses in male and female Sprague-Dawley rats using a classical fear conditioning model. METHODS : Twenty-four Sprague-Dawley rats (12 males, 12 females) were assigned to one of four groups: control (no shock, no oxytocin), shock only, shock + low-dose oxytocin (0.5 mg/kg), and shock + high-dose oxytocin (1.0 mg/kg). …

Evaluating The Reliability And Accuracy Of Three Sensor Prototypes For Enhancing Stair Mobility, Chloe R. Schmidt

2025 Symposium

Peripheral neuropathy causes sensory deficits, impaired motor control, and instability. One challenge for individuals with neuropathy is stair navigation due to reduced sensory feedback and altered mechanics, increasing fall risk. Few commercial products mitigate sensory issues, creating a need for an affordable and easy to use product for individuals with neuropathy safely navigate stairs. PURPOSE: To evaluate the reliability and accuracy of three sensor prototypes designed to provide assistive feedback through tactile and visual cues during stair navigation. METHODS: 15 healthy adults (22.33 ± 2.87 y) completed the study, consisting of stair ascent and descent with the prototypes placed in …

Detection Of Chromosomal Mosaicism- The Importance Of Karyotyping And Fish, Allison Kalinousky, Jennifer L. Roberts, Madeeha Alikhan, John Herriges, Lei Zhang, Elena Repnikova

Research Days

This project evaluates the prevalence of chromosomal mosaicism in constitutional samples using conventional cytogenetic techniques evaluated at Children's Mercy Hospital during a 20-year period.

Effects Of Genetic Polymorphisms On The Oct1 And Oct2-Mediated Uptake Of Atenolol, Mollie Margaret Walton Md, Jonathan Wagner Do, Ceclia E. Villanueva Phd, Bruno Hagenbuch Phd

Research Days

This project characterizes the role of OCT1 and OCT2 on cellular uptake of atenolol and tests the hypothesis that OCT1 and OCT2 proteins with genetic polymorphisms, when expressed in vitro, will result in altered cellular uptake of atenolol relative to the reference genotype. This approach utilizes transiently transfected OCT1 and OCT2 cell assays to perform time-dependent atenolol uptake experiments to generate kinetics information. The goal is to provide a better understanding of polymorphisms associated with OCT1 and OCT2 expression and function as a means to individualize pharmacologic therapy for atenolol.

Exploring Anticoagulation Trends As Early Infection Markers In Pediatric Ecmo And Crrt Patients, Samantha Davidson, Jay Rilinger, Jenna Miller, Caroline Holton, Joshua Herigon, Brian Lee

Research Days

This retrospective cohort study at a tertiary pediatric hospital included ICU patients who developed infections after 72 hours on extracorporeal support from 2017-2023. We assessed whether the number of anticoagulation dose changes are linked to acquired infections.

Diagnostic And Clinical Utility Of Oncoscan Microarray And Ngs-Based Sequencing In Pediatric Solid Tumors: Children’S Mercy Hospital’S Experience, Aravindh Nagarajan, Lisa Lansdon, Midhat Farooqi, Lei Zhang, Elena Repnikova

Research Days

This papers attempts to evaluate the diagnostic and clinical utility of microarray-based OS+ in detecting clinically relevant genetic alterations in FFPE solid tumor samples and to compare the yield of somatic mutation detection by WGS/WES in pediatric solid tumors at Children’s Mercy Hospital - Kansas City.

A Novel Surgical Technique For The Management Of Recurrent Thyroglossal Duct Cysts Using Dakins Solution Packing, Jay Szekely, Meghan Tracy, Janelle R. Noel-Macdonnell, Elie Khalifee

Research Days

Background: Thyroglossal duct cyst (TGDC) is the most common congenital midline neck anomaly occurring in 7% of the population more commonly in infants or adolescents with no predilection to sex. [1] This anomaly consists of epithelial remnants due to failure of obliteration of the thyroglossal duct, a structure that forms as the thyroid gland originates at the foramen cecum of the tongue and is displaced caudally, anterior to or through the hyoid bone, towards its final position in the lower neck. Successful surgical management of TGDCs requires complete removal of the cyst and the duct. Initial surgery for these lesions …

Decreasing Time To Antibiotics In Febrile Oncology Patients With Central Line In The Pediatric Emergency Department; A Quality Improvement Initiative, Abbigayle Carlson, Leslie Hueschen, Stephanie Clark, Christopher Kaberline, Joel Thompson

Research Days

Background: Oncology patients are at a high risk for sepsis, due to chemotherapy-induced immunosuppression and neutropenia as well as presence of a central venous catheter. Due to the high risk of sepsis, these patients require antibiotics within 60 minutes of Emergency Department (ED) arrival. During our baseline period, Sept 2022-May 2023, we only achieved this 38% of the time at Children’s Mercy ED.

Aim: By April 30th, 2024, we will increase the percentage of ED febrile oncology patients receiving antibiotics < 60 min of arrival from 36.6% to 80%, stratifying by race and ethnicity, to monitor for inequities.

Methods: Our outcome measures were the percentage of ED febrile oncology patients with antibiotics given < 60 min of arrival and the median time to antibiotic administration. Our process measures were the percentage of standard order-set usage and percentage of patients with critical information notes. Our balance measure was time from arrival to ED triage. We created a process map and fishbone diagram and identified several delays in antibiotics administration. We performed interventions with Plan-Do-Study-Act methodology. First, we implemented standing nursing orders to decrease the time spent waiting for a provider to order antibiotics (June 2024). Next, the outpatient oncology providers created a Critical Information Note, which directed prompt antibiotic administration prior to labs or consultation (August 2024). To engage physicians, we made this a Maintenance of Certification (MOC) project, with monthly review of run charts (Oct 2024). Next, we prioritized timely access of the patients’ central line, with a nursing script to communicate with families the importance of accessing their child’s central line as soon as possible (Oct 2024). We created a Central Line Note, identifying the type of central line and needle size required to access the line (March 2024).

Results: With the implementation of …

Examining Learner Preferences Of Teaching Techniques By Phm Attendings And Fellows On Multilevel Teaching Rounds, Sian Best, Jacqueline M. Walker

Research Days

This study describes the teaching techniques used on morning rounds by pediatric hospital medicine faculty and fellows at an academic institution, and describes reported effectiveness by learners of the various teaching strategies.

Switching Lanes: Leaving Behind Discharge Antibiotics And Laboratory Testing In Perforated Appendicitis, Seth Saylors, Cory Nonnemacher, Meredith Elman, Pablo Aguayo, Richard Hendrickson, David Juang, Irene Isabel P. Lim, Rebecca Rentea, Charles Snyder, Shawn St. Peter, Tolulope Oyetunji

Research Days

Purpose: Appendicitis is the most common surgical emergency in children with approximately 30% of patients presenting with perforation, defined as a hole in the appendix or a fecalith found in the abdomen, at time of surgery. Our previous protocol at time of discharge, with an 11% intraabdominal abscess (IAA) rate, included checking a white blood cell count (WBC) on day of discharge, with a value ≥10 serving as a trigger for additional outpatient oral antibiotics course. Beginning in May, 2023 we changed our protocol to no longer obtain WBC or prescribe outpatient antibiotics at time of discharge. The purpose of …

Time From Triage To Imaging In Stroke Activations At Children’S Mercy Hospital, Annie Altschul, Marcie Files, Jennifer Flint, Brooke Fridley Phd

Research Days

Background: Stroke affects 2-3 per 100,000 children annually. Timely diagnosis is vital to provide the highest quality care to pediatric stroke patients. Features that contribute to delays in diagnosis of pediatric stroke include complex or subtle signs and symptoms, limited exams in young children, broad differential and frequent stroke mimics, low awareness in the community, and sedating or paralytic medication use in critically ill children. The establishment of stroke activation protocols for children has led to improvements in care for pediatric stroke across numerous centers, expediting time to imaging and treatment.

Objective: We aimed to quantify the time …

But, It's Just A Uti, Gillian Long

Research Days

A case report of a 12 year old female presenting to the emergency room with rash, hematuria and shortness of breath, ultimately found to have a life changing diagnosis.

Variability In Methotrexate Metabolites In A Cohort Of Jia Patients, Nuria Lara Castillo, Mara Becker, Marc Sudman, Susan Thompson, Laura Ramsey

Research Days

Background: Methotrexate (MTX) is the cornerstone disease-modifying anti-rheumatic drug for the treatment of Juvenile Idiopathic Arthritis (JIA). While most patients receiving MTX have a favorable outcome, approximately 30% do not respond, and several experience toxic events, suggesting interindividual difference. Furthermore, evaluation of MTX response takes several months, with the risk of missing the early “window of opportunity” for treatment. Predicting MTX response prior to administration would greatly benefit these patients and their treating physicians by saving valuable time during the early stages of the disease onset. MTX is a folate antagonist and, similar to folate, it undergoes polyglutamation inside the …

What Happens After They Leave The Ed? Following Up Acute Asthma Exacerbations After Changes In Clinical Practice Guidelines For Treatment, Phillip S. Wozniak, Jade B. Tam-Williams

Research Days

In 2022, Children’s Mercy Hospital (CMH) implemented a new clinical practice guideline (CPG) recommending single-dose dexamethasone as the first line oral steroid for treatment of mild to moderate acute asthma exacerbations. We assessed the impact of this CPG change on readmission rates after discharge from emergency department/urgent care (ED/UC). We hypothesized that single-dose dexamethasone would be non-inferior to a 5-day course of prednisone/prednisolone with respect to 7-day and 30-day acute care readmission rates and need for additional outpatient steroid courses.

Bilateral Buccal Myomucosal Flap Palatoplasty For The Management Of Velopharyngeal Dysfunction In Children, Jay Szekely, Meghan Tracy, Janelle R. Noel-Macdonnell, Jill M. Arganbright

Research Days

Background: The use of bilateral myomucosal buccal flap palatoplasty (BMBFP) for velopharyngeal insufficiency (VPI) has increased in popularity. Despite the increasing popularity, there is a paucity in research examining their outcomes, especially in reference to the pediatric population.

Objectives/Goal: The objective of this paper was to investigate the utility of BMBFP for the correction of VPI in children.

Methods/Design: Retrospective chart review was performed using CPT codes to locate patients with BMBFP performed at our pediatric institution between July 2020 to July 2024. Data collected included demographics, associated syndromes, complications, pre-operative and post-operative resonance outcomes, and the need for revision …

Posterior Pharyngeal Flap For The Management Of Velopharyngeal Dysfunction: Comparing Outcomes For Children With 22q11.2 Deletion Syndrome To Those Without, Jay Szekely, Meghan Tracy, Janelle R. Noel-Macdonnell, Jill M. Arganbright

Research Days

Introduction (including objectives): Velopharyngeal dysfunction (VPD) is one of the most common clinical features of 22q11.2 deletion syndrome (22q11.2DS) and often requires surgical intervention; due to the multifactorial nature of VPD, these patients present unique and often complex surgical challenges. Prior studies have generally demonstrated poorer speech outcomes postoperatively in children with 22q11.2DS. The posterior pharyngeal flap (PPF) is often considered first-line surgical choice for correction of VPD in children with 22q11.2DS. The aim of this study is to compare PPF outcomes for children with 22q11.2DS to those without.

Methods: Retrospective review for pediatric patients diagnosed with VPI who underwent …