Medicine and Health Sciences Commons^™

Oncology Infusion Center Hyperglycemia Protocol, Gunjan Umarji, Md, Eric J. Shiffrin, Md, Rose Dimarco, Pharmd, Bcps, Bcop, Emily Brand, Pharmd, Daniel Lin, Md, Ashley Miles, Msn, Rn, Helen Evers-Hunt, Msn, Anp-Bc, Ocn, Claudia Thomas-Nembhard, Msn, Rn

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem: Patients receiving chemotherapy may find it challenging to get care in a timely fashion if they develop diabetes or dysglycemia while receiving chemotherapy. Preliminary research indicates that dysglycemia may reduce the effectiveness of chemotherapy.

Aim: To initiate a protocol to ensure adequate euglycemia in patients at the Oncology Infusion Center (OIC) to eliminate insulin treatment guesswork and create a pathway that is least disruptive to the timing of patients' chemotherapy regimens.

Improving The Quality Of Internal Medicine Discharge Summaries Via Accurate Admission Medication Reconciliation, Natasa Kostic, Md, Tammy Tran, Md, Kenneth Meserole, Md, Jon Zaid, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Transitions of care are a time of vulnerability for patients.
• Nearly 20% of patients experience an adverse event within 3 weeks of hospital discharge, with adverse drug events being the most common.
• Discharge (DC) summaries serve to provide safe transition of care by describing hospital course and medication changes for review by outpatient providers.
• At TJUH, DC summaries are completed by internal medicine (IM) senior residents, but there is variability in quality of hospital course and thoroughness of medication reconciliation.
• Inaccurate admission medication reconciliation may lead to inaccurate reporting of discharge medication lists, causing confusion for both patients and …

Project Proposal: The Impact Of The Septa Zero Fare Program On Healthcare Access Among Philadelphia's Refugee And Migrant Population, Emily Hashem, Bs, Paranshu Shah, Mitchell Kaminski, Md, Mba

Health Equity and Quality Improvement (HEQI) Summit

Background

Since the 1960s, private, state sponsored, and charitable programs have attempted to increase transportation programs to improve healthcare access. Among these are the Centers for Medicare and Medicaid Services' Non-Emergency Medical Transportation (NEMT) program, Pennsylvania’s Medical Assistance Transportation Program (MATP) benefiting Medicaid recipients, Southeastern Pennsylvania Transit Association’s (SEPTA) SEPTA Access (formerly known as CCT connect) for disabled and elderly people, and ModivCare, a social services corporation that offers non-emergency medical transportation for qualifying people with low incomes. The importance of these programs is emphasized by the body of evidence surrounding healthcare metrics and transportation access. A Robert Wood Johnson …

Readmission For Picc Line Placement In Spine Surgery, Joseph Schaefer, Md, Joshua Heller, Md, James Harrop, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Pseudoarthrosis is failure of adequate bony fusion after a spinal fusion
• Prior literature has implicated occult C. acnes infection in cases of pseudoarthrosis
• Intraoperative cultures are often sent in cases of pseudoarthrosis at Jefferson
• C. acnes cultures often result after discharge requiring readmission

Medical Assistance In Dying In A Profit-Driven Health System: Ethical And Equity Challenges In The U.S. Vs. Canada, Joseph A. Zwillenberg, Eric M. Teichner, Jacob Schwell, Cameron Haghshenas, Joseph F. Majdan, Md, Facp, Fcpp

Health Equity and Quality Improvement (HEQI) Summit

Introduction

Medical Assistance in Dying (MAID), legalized in Canada in 2016, now accounts for 4.1% of all deaths nationwide and 6.6% in Quebec as of 2022(1). In Canada’s single-payer system, MAID is integrated as a publicly funded medical service. In contrast, the U.S.’s fragmented, market-driven system is defined by profit maximization, inequitable access, and insurer- driven decision-making. While MAID aims to promote autonomy and compassion, introducing it into the American context raises profound ethical concerns, particularly regarding nonmaleficence and systemic coercion. This poster evaluates the unique risks MAID poses within the U.S. healthcare system, particularly for vulnerable populations.

Instituting A New Traumatic Ich Algorithm At Jefferson, Michael Baldassari, Md, Matthews Lan, Md, Caitlin Ritz, Md, Tyler Alexander, Bs, Richard Schmidt, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Traumatic brain injury (TBI) is a high-incidence condition causing substantial economic burden on trauma centers worldwide. Many institutions have begun using validated algorithms for safe management, such as the Modified Brain Injury Guidelines (BIG) Criteria. At Jefferson, tICH have not historically been treated algorithmically, and therefore, tICH patients are often subject to excessive imaging surveillance and admission lengths.

Aim Statement: To institute a new algorithm modeled off mBIG criteria for the management of tICH patient at Jefferson to streamline treatment and safely reduce the number of surveillance HCTs obtained, as well as length of stay in this …

Incorporation Of The 4ms, With A Focus On Mentation, Into The H&P For Older Adults Hospitalized With A Hip Fracture And Its Effect On Delirium Documentation, Emily Custer, Do, Kristine Swartz, Md, Lily Ackermann, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Delirium affects 15% to over 50% of patients with hip fractures during their hospital stay (1) and is associated with increased mortality, increased length of hospital stay, poorer functional outcomes, and higher risk of nursing home placement (1,2). However, at Thomas Jefferson University Hospital, the prevalence of documented delirium post-hip fracture is only 5.22%, suggesting potential under recognition. Additionally, at the end of 2025, a new CMS inpatient quality metric will require public reporting on a hospital's capability to provide age-appropriate care for older adults, which can be done by utilizing the 4M framework of age-friendly health care. The …

Deprescribing Type 2 Diabetes Mellitus Medications In Older Adults In An Urban Primary Care Setting, Katelyn Koons, Md, Eugenie Hughes, Md, Eunice Choe, Md, Julio Garcia, Md, Munifa King, Md, Emily Lavell, Md, Michael Danielewicz, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Adults 65+ take on average five medications daily
• Polypharmacy increases risks of drug interactions and adverse events
• About 29% adults 65+ in developed countries have type 2 diabetes mellitus (T2DM) and the number of older adults living with these conditions is expected to increase rapidly in the coming decades
• Over-treatment of DM in older adults is common and increases risks of serios adverse outcomes including hypoglycemia
• Older adults with T2DM should have higher A1c goal consistent with ADA guidelines: [See Table on Poster]

Evaluation Of Immediate Postpartum Long-Acting Reversible Contraception For Reducing Short Interval Pregnancies, Andrew Grover, Md, Molly Haas, Bs, Amanda Ricard, Do, Heather Cunningham, Md, Joanne N. Quiñones, Amanda Flicker, Md

Health Equity and Quality Improvement (HEQI) Summit

Objective

• Short interval pregnancy (SIP): any pregnancy that occurs within 18 months of a previous delivery or pregnancy loss.
• SIP is associated with increased risk of gestational diabetes, placenta accreta spectrum,1preterm birth, low birth weight, and small size for gestational age.²
• Long-acting reversible contraceptive (LARC) methods such as intrauterine devices (IUDs) and subdermal implants offer solutions to the limitations of daily oral contraception. Despite these options, 45% of U.S. pregnancies in 2011 were unintentional.³

While immediate postpartum LARC has been shown to be effective for mitigating unintended pregnancy, implementation of programs providing access to this contraceptive option have …

The N-Alternative Optional Choice Experiment, Benjamin T. Backus, James J. Blaha, Thaddeus B. Czuba

MODVIS Workshop

When testing visual function in clinical settings, one encounters test-takers who have difficulty following a forced-choice instruction when stimulus intensity is low. “I didn’t see anything, why do I have to guess?” An optional-choice paradigm makes it easier for these test-takers to provide data. Here we describe a theory of signal detection for N-alternative optional-choice (N-AOC) psychophysical tasks. The theory generalizes two well-known paradigms into a single framework: the theory for yes-no tasks is a degenerate case in which N=1, and the theory for N-alternative forced choice tasks (N-AFC) is a degenerate case in which the decision criterion is liberal. …

Agenda (Pdf), Department Of Surgery

Surgery Research Symposium

Agenda for the 3rd Annual Surgery Research Symposium held May 15, 2025.

Variation In Blood Culture Testing And Outcomes In Children Hospitalized With Three Common Infections., Smit Shah, Jessica L. Markham, Jennifer Goldman, Matt Hall, Jillian Cotter, Samantha A. House, Matthew J. Molloy, Michelle Polich, Michael J. Steiner, John R. Stephens, Michael J. Tchou, Ronald J. Teufel Ii, Irma Ugalde, Andrew Yu

Research Days

Background: Prior studies of blood culture (BC) testing in uncomplicated community acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) have demonstrated low utility of routine testing given similar rates of pathogen versus contaminant detection and little effect on clinical management. Understanding patterns and outcomes of BC testing can identify opportunities to curb unnecessary testing.

Objectives: The objectives of this study were to: 1) Evaluate BC testing trends over time for children hospitalized for CAP, SSTI, and UTI; and 2) describe differences in clinical outcomes between hospital groups with low, moderate, or high testing rates. …

Association Between Neighborhood Opportunity And Youth Mental Health Emergency Department Visits, Shelby Chesbro Md, Henry T. Puls, Adrienne G. Deporre, Molly Krager, Laura Plencner, Shayla Sullivant, Matthew Hall Phd

Research Days

Background: Youth mental health emergency department visits are increasing and are a burden on the health care system. Prevalence of mental health disorders may be influenced by the neighborhood youths live in.

Objectives/Goal: Determine differences in rates of youth mental health ED visits across zip code levels of neighborhood opportunity.

Methods/Design: We performed a cross-sectional study using the Hospital Industry Data Institute dataset identifying ED visits with a primary mental health diagnosis in Kansas and Missouri for youths aged 5-19 years in 2022-2023. Mental health ED visits were then categorized at the zip code level by neighborhood opportunity using the …

Early Hematopoietic Differentiation Of An Inducible Pluripotent Stem Cell Model Of Infant Lymphoblastic Leukemia, Meagan Vacek, Jacqelyn Nemechek, Irina Pushel, Bradley Thornton, Priyanka Kumar, Jay L. Vivian, John M. Perry

Research Days

This abstract describes our work regarding the differentiation of human inducible pluripotent stem cells into hematopoietic stem and progenitor cells as the groundwork for the development of a genomics driven inducible pluripotent stem cell model of KMT2A rearranged infant acute lymphoblastic leukemia.

Mental Health Diagnoses Amongst Children With Complex Chronic Medical Conditions, Maria Newmaster M.D., Matt Hall, Adrienne Deporre, Molly Krager, Cy Nadler, Laura Plencner, Henry T. Puls

Research Days

Background: Mental health (MH) diagnoses are known to complicate outcomes of underlying medical conditions in pediatrics, but the prevalence of MH diagnoses across the array of medically complex and/or chronic conditions are not well known.

Objectives/Goal: To compare prevalence of MH diagnoses across levels of medical complexity and chronicity, and identify factors associated with MH diagnoses among children with complex chronic conditions (CCC).

Methods/Design: This retrospective cross-sectional study included children ages 5-17 years with at least 11 months of continuous Medicaid enrollment in 2022 from the Merative Marketscan Medicaid Database which collects data from all children with Medicaid in the …

Reducing Vancomycin Use In The Cicu, Karoline Krzywda, Ali Taber, Lauren Johnson

Research Days

Background/Aim Statement: In the CICU empiric vancomycin is frequently prescribed. This practice occurs without broad knowledge of the actual rates of methicillin resistant staph aureus (MRSA) and methicillin resistant staph epidermidis (MRSE) infections. Given the potential for harmful side effects of vancomycin as well as concern for growing antibiotic resistance, we sought to better characterize local unit prescribing practices and MRSA/MRSE infection rates to guide our QI project with an aim of reducing vancomycin use in the CICU.

Methods (include PDSA cycles): Patient data from January 2021 to January 2023 was analyzed. The number of monthly days spent on vancomycin …

Postoperative Caregiver Decision Regret Following Velopharyngeal Dysfunction Surgery, Rohit Nallani, Nathan Farrokhian, Meghan Tracy, Kevin Sykes, Jill M. Arganbright

Research Days

Background

Decision regret (DR) is a powerful factor in medical decision-making, particularly for surgical decisions which carry multiple risks, impact quality of life (QOL), and have uncertain outcomes. While prior studies have investigated caregiver DR after tonsillectomy and otologic surgery, there is a paucity of data assessing DR following pediatric otolaryngology procedures. The aim of this study is to measure DR following velopharyngeal dysfunction (VPD) surgery.

Methods

A cross-sectional survey study with chart review was performed of caregivers of children who had VPD surgery performed by a single surgeon at a tertiary children’s hospital. Demographic, medical, and surgical history were …

Discrepancy Between Hyaluronic Acid Levels And Mri-Based Measurements Of Hepatic Fat And Fibrosis, Daniel Aaron Borman, Rachel L. Chevalier, Jonathan Body Ingestion Clinical Wagner, Michele T. Pritchard, Sherwin S. Chan, Nathan S. Artz, Johnston K. Fite, Yoon Y. Cho, Valentina Shakhnovich, Veronica Williams, Voytek Slowik

Research Days

Introduction

Metabolic-dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease in children in the United States and, when left untreated, can progress to liver fibrosis. Clinicians currently utilize imaging and biopsy to assess fibrosis in this patient population as there is no validated serum biomarker available for detecting fibrosis. Previous research suggests that serum hyaluronic acid levels are predictive of hepatic fibrosis in children with MASLD.

Methods

Retrospective data were obtained from the Children’s Mercy Hospital Liver Lab study. Pediatric subjects with both hyaluronic acid (HA) samples and MRI evaluation within a month were identified and included for …

Q Fever Pericardial And Pleural Effusions In A Pediatric Patient, Jonathan Ermer, Ben Kazdan, Cooper Bassham, Jacqueline Walker

Research Days

Background: Q fever is a bacterial infection caused by Coxiella burnetii. Q fever commonly presents with flu-like symptoms (fever, chills, fatigue, myalgias) in patients about 2-3 weeks after exposure to farm animals. Less commonly, Q fever can cause severe illness such as myocarditis, pericarditis, or meningitis. We present a rare case of a pediatric patient with pericardial and pleural effusions secondary to Q fever.

Case presentation: History of present illness: The patient is a 9-year-old female who presented as a referral from an outside hospital due to chest pain, shortness of breath, and 2 weeks of fever. The patient started …

A Risk Score To Predict Recurrent High Intensity Inpatient Resource Utilization For Children With Medical Complexity., Charles Maloy, Matthew Hall, Jessica L. Bettenhausen, Yui-Yee Chan, Leah Jones, Kathryn Kyler, Laura Plencner Md, Jessica Markham, Jacqueline M. Walker, Smit Shah, Sîan Best, Jonathan Ermer, Shelby Chesbro, Maria Newmaster, Henry T. Puls

Research Days

Background: Children with medical complexity (CMC) use a greater amount of inpatient resources and stand to benefit from unique care models and coordination. However, hospital resources can be limited, and a better understanding of which CMC are high resource users could improve hospital and staff planning.

Objectives/Goal: To develop a risk score predictive of recurrent high intensity inpatient utilization among CMC.

Methods/Design: We conducted a retrospective cohort study of children <18 years old with ≥3 complex chronic conditions (CCC) discharged from one of 48 children’s hospitals in the Pediatric Health Information System during 2021 and 2022. To reflect CMC typically cared for by a general medical service, children with cardiac procedures, dialysis, oncology, or transplant CCCs, and index hospitalization mortality were excluded. We used multivariable logistic regression to determine factors present on the index hospitalization associated with ≥5 hospitalizations or ≥3 hospitalizations with one lasting ≥25 days within any 365-day period (high inpatient utilization) in 2021-2023. We developed risk scoring system using model coefficients and defined the optimal risk score cutoff to maximize sensitivity and specificity. We then applied the risk score cutoff to children discharged to determine (a) ratio of predicted:actual CMC with recurrent high resource use and (b) the total predicted daily volume on 50th, 75th, and 90th percentile days for each hospital.

Results: Of 44,432 included children, 9,596 (21.6%) had high inpatient utilization (Table). Children under 1 year of age had the highest odds of high inpatient utilization (OR 2.26 [95% CI: …

Failure To Launch: Pediatric Colorectal Surgery Center Utilization By Patients Over 18 Years Of Age, Vatche Melkonian, Andres Gonzalez Salazar, Cory Nonnemacher, Seth Saylors, Margaret Martin-Mclain, Iris Lim-Beutel, Rebecca Rentea

Research Days

Background: As patients with childhood colorectal diseases transition into adulthood, many continue to seek care at pediatric colorectal centers rather than transitioning to adult hospital systems. This preference often stems from a sense of comfort and familiarity with their pediatric care teams. Additionally, patients often perceive inadequacies in adult healthcare systems in managing their specific conditions. As these numbers of patients continue to grow, pediatric colorectal centers may face increasing demands on their resources, potentially diverting attention away from pediatric patients.

Objectives/Goal: The objective of this study was to assess the utilization of our pediatric colorectal center by patients aged …

Protective Factors Against Child Maltreatment Among Postpartum Mothers, Maggie Mann, Hank Puls, Matt Hall, Cristy Toburen, Ann Mattison, Jennifer Anderson, Francesca Donohue, Heather Willaims, J Sprague-Jones, James Anderst Md, Msci

Research Days

Background: Child maltreatment risk arises from a balance of risk and protective factors (PF). Prevention efforts — most notably evidence-based home visiting — focus on strengthening PF. Yet the prevalence of PF across maternal characteristics remains unknown.

Objectives: Compare frequency of PF against child maltreatment between mothers with and without risk factors for maltreatment and across race and ethnicity.

Methods: This was a cross-sectional study of 480 English- and Spanish-speaking mothers prospectively enrolled during their birth hospitalizations at UH. Participants completed the validated Protective Factors Survey, 2nd Edition, which assessed domains of PF against child maltreatment on a 0–4 scale, …

Family-Based Health Promotion To The Early Phases Of Pediatric Acute Lymphoblastic Leukemia Treatment: A Qualitative Review, Anna Van Asselt, Renee Gilbert, Hide Okuno, Ann M. Davis, Keith J. August, Carolyn R. Bates, Robert C. Gibler

Research Days

Introduction: Excessive weight gain during early phases of Acute Lymphoblastic Leukemia (ALL) treatment elevates risk for long-term morbidities, late effects, and secondary cancers. Behavioral factors including physical inactivity and poor diet quality play a significant role in weight outcomes. Existing health behavior and obesity interventions do not address challenges that children and families face during cancer treatment. The current study qualitatively investigated caregiver, child, and multi-disciplinary expert perspectives on health behavior engagement and intervention content for the future adaptation of NOURISH-ALL.

Method: Caregivers (N=11) and youth with ALL (N=6) in the first year of treatment completed semi-structured interviews …

Impact Of The Covid-19 Pandemic On Pediatric Complicated Sinusitis: A Single Institutional Experience, Rohit Nallani, Mackenzie O'Donnell, Nathan Farrokhian, Meghan Tracy, David Garcia, Jill M. Arganbright

Research Days

Background: Institutions around the world have noted increasing trends in complicated sinogenic infections in children following the start of the COVID-19 pandemic. Treatment of these infections often requires combined medical and surgical management. Further study is needed to understand changing epidemiology, microbiology, and contributing demographic factors for these infections. We noted increasing trend of surgically managed complicated sinusitis during the COVID-19 pandemic at our institution and hypothesized there were higher rates of intracranial complications.

Methods: We performed a retrospective cohort study with chart review of all children under the age of 18 treated surgically for complicated sinusitis between January 1, …

Patterns And Growth Of A Dedicated Pediatric Coagulation Consult Service In A Freestanding Children's Hospital, Nicole Demarco, Shannon Carpenter, Brian Lee

Research Days

Background: Hospital-acquired thrombosis remains a significant concern in pediatric care, contributing to morbidity and extended hospital stays. At Children’s Mercy, a dedicated inpatient coagulation consultation service has existed for many years. Efforts have been made to implement prophylactic measures aimed at reducing the incidence of hospital-acquired thrombosis. With the recent COVID pandemic we saw an influx in prophylactic anticoagulation due to recommended guidelines.

Objectives: To characterize the impact increased efforts in thromboprophylaxis during and after the COVID-19 pandemic on care delivery and the development of thrombosis among pediatric hospitalized patients.

Methods: This retrospective review included all pediatric inpatients with a …

Multi-Omic Analysis Of Kmt2a-Rearranged Pediatric Acute Myeloid Leukemia Reveals Novel Pathways Of Interest, Trenton Edwards, Irina Pushel, Thomas Gremminger, Lisa Lansdon, Byunggil Yoo, Michaella Rekowski, Michael Washburn, Midhat Farooqi

Research Days

Objectives/Goals

Acute Myeloid Leukemia (AML) is the second most common leukemia among pediatric populations. Approximately 15% of pediatric AML cases have KMT2A gene rearrangements (KMT2A-r), which carry a worse prognosis. Our goal is to better characterize the biologic landscape of KMT2A-r pediatric AML. We hypothesize that a multi-omic approach will reveal mechanisms underlying the aggressive nature of KMT2A-r AML.

Methods/Study Population

This study makes use of deidentified peripheral blood and/or bone marrow samples banked in the Children’s Mercy Tumor Bank Biorepository. For this study, we used samples at diagnosis and remission from four KMT2A-r pediatric AML …

No Suspicion For Nocarh: A Cautionary Tale Of Anchoring Bias, Nicole Demarco, Shannon Haines, Julia Allyson Hays, Bonnie Sullivan, Michael Price, Kimberly A. Horii

Research Days

Neonatal onset of cytopenia autoinflammation rash and hemophagocytic lymphohistiocytosis syndrome (NOCARH), a subset of hemophagocytic lymphohistiocytosis (HLH), is a rare and life-threatening condition characterized by uncontrolled immune response. It presents a diagnostic challenge in neonates due to the overlap of clinical features with other conditions, particularly congenital infections.

Nrp And Pals In Icu Code Events At A Quaternary Care Pediatric Hospital: A ‘Compressed’ Analysis, Deepa Kumar, Mitch Kinkor, Stephen Pfeiffer, Allison Taber, Janelle R. Noel-Macdonnell Phd, Jessica Brunkhorst, Danielle Reed

Research Days

This is a retrospective observational study comparing code events in children less than 18 months of age who were resuscitated in the NICU, PICU, and CICU using neonatal resuscitation program (NRP) and pediatric advance life support (PALS).

"Bridging Research, Outreach, And Care: Advancing Community-Driven Cancer Solutions", Rachel M. Ceballos Phd​, Angie Fausett Agnp-C, Dnp​, Allison Foust Mha, Mches​

Utah Conference on Community Engagement

"This panel will provide an overview of Huntsman Cancer Institute’s (HCI) collaborative efforts to enhance cancer care through innovative community outreach and local treatment programs, with a specific focus on rural outreach and care. Panelists will discuss HCI’s approach to fostering partnerships with community champions, integrating regional outreach through initiatives like the Mountain West Cancer Collaborative (MWCC), and expanding local treatment options to increase accessibility and equity in care, especially in rural areas. By highlighting how these initiatives align with HCI’s mission to reduce cancer disparities, the panel will emphasize strategies for improving cancer prevention, treatment, and survivorship in underserved …

Strengthening Community Health Through Dementia Listening Sessions, Raven Albertson

Utah Conference on Community Engagement

"This session explores innovative strategies for strengthening community health through dementia listening sessions and engagement, equipping community partners with the knowledge to make informed decisions regarding dementia care and support. Participants will gain insights into effective partnership-building, impactful dementia education delivery, and strategies for fostering meaningful community involvement through community listening sessions and collaboration. Through a live listening session workshop, attendees will participate in interactive discussions, inform efforts in Utah communities, and acquire practical tools to drive sustainable, community-led improvements in dementia care and support."