Medicine and Health Sciences Commons^™

The Impact Of Race-Corrected Spirometry Results On Eligibility Into An Asthma Clinical Trial, Carina H. Perdew, Bridgette L. Jones, Wumi V. Akinjole

Research Days

BACKGROUND: Spirometry is a widely used pulmonary function test that assesses lung function by examining airflow and capacity. Spirometry measurements assist in the diagnosis, severity classification, and management of asthma, and can affect one’s eligibility into various events (e.g., clinical trials, high-risk jobs, sports). Reference equations are used to establish predicted values to account for biological variables such as age, sex, and height; however past clinical guidelines recommended utilizing race-correction. The incorporation of race may negatively impact people of color due to misrepresentation of one's lung function, consequently impacting future medical management. OBJECTIVES: To characterize differences in spirometry values across …

Delaying Infant Inguinal Hernia Repair Does Not Increase Incarceration Rate, Seth Saylors, Cory Nonnemacher, Charles Snyder, Pablo Aguayo, Richard Hendrickson, Bhargava Mullapudi, Irene Lim-Beutel, Rebecca Rentea, Shawn St. Peter, David Juang, Tolulope Oyetunji

Research Days

Introduction: Inguinal hernia repair is one of the most common pediatric surgical procedures performed with an estimated incidence of 1-5% in children. Patients can present with or without symptoms, with symptomatic hernias (incarcerated or strangulated) that may require emergent or urgent operative intervention. During the Covid-19 pandemic, restrictions, and shutdowns of elective surgeries at our institution resulted in delaying elective inguinal hernia repair unless presenting with more emergent symptoms, with no apparent increase in complication. In our institution, this practice was continued even after COVID restrictions were lifted, with elective repairs delayed until patients were older before completing elective inguinal …

Single-Incision Laparoscopic Ileocecectomy In Pediatric Crohn’S Disease: A 15-Year Experience, Seth Saylors, Cory Nonnemacher, Meredith Elman, Shawn St. Peter

Research Days

Purpose: In refractory Crohn’s disease, the terminal ileum is a common site requiring excision. Laparoscopic ileocecectomy is the procedure of choice and we use a single-incision laparoscopic technique (SILS). We have previously reported our experience with SILS ileocecectomy with a sizeable cohort compared to other series. This project aims to expand on our single institutional experience with SILS ileocecectomy and evaluate the impact of experience.

Methods: We completed a retrospective review of patients who underwent single-incision laparoscopic (SILS) ileocecectomy for Crohn’s disease from 1/1/2009-3/31/2024 at a single institution by a single surgeon. Operative and inpatient characteristics were collected to determine …

Asking About Gender Identity In Pediatric And Adolescent Gynecology Clinic: Patient, Family And Provider Perspectives (The Reflective Study), Madeline Ross, Hariye Sema Baghaki, Hannah Suffian, Lauren Roth, Jeanette Higgins, Tazim Dowlut-Mcelroy

Research Days

Background

The provision of medical and psychosocial support requires the identification of gender diverse individuals in health care settings. However, in primary care settings, some adolescents and parents expressed that gender identity screening (GIS) was offensive and clinicians expressed that GIS negatively affected their workflow. We sought to assess the acceptability and feasibility of GIS in Pediatric and Adolescent Gynecology (PAG) clinics of a large tertiary care children’s hospital in the United States (US) Midwest.

Methods

A GIS survey developed in the US West Coast was modified with permission. After IRB approval, the anonymous single-site cross-sectional survey was administered to …

Emergency Department Utilization For Educational Prioritization For Children By Levels Of Community Advantage, Katherine Randolph, Chris Kennedy, Jennifer Watts, Matt Hall

Research Days

Background: Children with higher social deprivation have higher emergency department (ED) utilization. The Childhood Opportunity Index (COI) is a validated multidimensional measure of community advantage which includes access to resources and healthy neighborhood factors. Educational priorities are frequently not tied to risk data.

Objective: This study aimed to identify zip codes with higher-than-expected ED utilization by diagnoses to prioritize the development of educational initiatives for hospitals, emergency medical services, pediatrician offices, and the community.

Methods: We performed a population-based study of children aged 0-17 years who presented to an ED in Kansas or Missouri in 2023 using census data via …

Variables Affecting Neurodevelopmental Outcome In Infants With Critical Congenital Heart Disease, Elizabeth Loughman, Julie Weiner Do, Marcie Files Md

Research Days

Background: The mortality of cardiac conditions in infancy is improving with advances in surgical planning and medical management. Neurologic morbidity remains significant. Clinically correlating an infant with their neurologic exam, MRI/EEG, and subsequent developmental testing remains a challenge. Counseling regarding neurologic outcomes after cardiac intervention is difficult due to the wide range of findings that can sometimes be clinically irrelevant.

Purpose: The goal of this study is to identify factors associated with poor neurodevelopmental outcomes in infants with critical congenital heart defects (CCHD) as assessed by the Bayley Scales of Infant and Toddler Development Edition IV (Bayley).

Methods: This is …

Implementation Of A Weaning Protocol For Inhaled Nitric Oxide In A Level Iv Neonatal Intensive Care Unit, Elizabeth Loughman, Julie Weiner Do, Maryam El Tawil, Chris Nitkin Md

Research Days

Background: Decrease time to begin iNO weaning from 13 hours to 9.75 hours by 31 December 2024 in patients with persistent pulmonary hypertension of the newborn (PPHN).

Methods: Countermeasures include (1) provider education at each disciplinary level, (2) badge reminder cards and laminated copies of the protocol available at the bedside, (3) order set modifications, (4) abnormality tracking at huddles. Data collection will be automated through weekly Business Objects report. The main outcome measure will be time to first wean of iNO after meeting protocol criteria. Feedback regarding the ease of weaning will be generated via Gemba Rounds.

Results: These …

Preferred And Actual Place Of Death To Assess Goal Concordant End Of Life Care For Children With Cancer, Amy Johnson Md, Mba, Lisa Tarbell Msn, Rn, Fnp-C, Brooke Fridley Phd, Terrie Flatt Do

Research Days

This study examines disparities in pediatric end-of-life (EOL) cancer care, highlighting socioeconomic and racial inequities in concordance between preferred and actual death locations, ICU deaths, and intensive interventions, with findings emphasizing the need for earlier palliative care integration, proactive preference documentation, and tailored approaches to improve equity and family-centered care.

Effect Of Social Determinants Of Health On Clinic Visit Attendance In Patients With Hemophilia, Shailly Gaur Md, Brian Lee Phd, Mph, James Anderst Md, Msci, Katie Foote Lscsw, Lcsw, Osw-C, Andrea Bradley-Ewing Mpa, Ma, Shannon Carpenter Md

Research Days

Background

Social determinants of health (SDOH) create barriers to seeking care regularly, especially for patients with chronic disease. Patients with moderate-severe hemophilia A and B (factor 8 and 9 deficiencies respectively) have a life-long higher risk of bleeding and require chronic therapies. Specialized care is offered through hemophilia treatment centers (HTCs); however, these can be difficult to access for some individuals. Previous SDOH research in this patient population has been limited; therefore, it can be difficult to identify the barriers to care that exist. There is a need to examine SDOH more thoroughly to create patient-directed interventions to improve access …

Intraspinal Anomalies In Presumed Ais Does Not Increase The Risk Of Intraoperative Neuromonitoring Changes During Posterior Spinal Fusion, Connor Mathes, Bill Woodhams, Aaron Shaw, John Anderson, Michael Benvenuti, Richard Schwend

Research Days

This study aims to identify the association between intraoperative neuromonitoring changes during posterior spinal fusion surgery among patients with adolescent idiopathic scoliosis and those found to have intraspinal anomalies on standard preoperative imaging.

Teen And Young Adult Experiences With Intrauterine Device Placement Under Procedural Sedation: A Pilot Study, Ellen Bryant, Stephani L. Stancil, Anne-Marie Priebe, Andrea Nos, Ashli A. Lawson

Research Days

Intrauterine devices (IUDs) are a reliable method of contraception and menstrual management, but uptake of them, especially in the adolescent population, can be limited by concerns for pain and anxiety during the placement procedure. Pain management plans for IUD insertion are recommended prior to placement, but data regarding multiple modes of analgesia and anxiolysis have shown mixed results. This study is designed as a pilot study to analyze adolescent experiences with IUD placement with sedation, as well as to identify patient characteristics that may be associated with a favorable or unfavorable experience.

Implementation Of An Enhanced Recovery After Surgery Pathway In Adolescent Patients Undergoing Laparoscopic Evaluation Of Endometriosis, Lauren Roth Md, Madeline Ross Md, Todd Glenski Md, Emily Weisberg Md, Ashli Lawson

Research Days

This study evaluates the implementation of an Enhanced Recovery After Surgery (ERAS) pathway for adolescent patients undergoing diagnostic laparoscopy for endometriosis at a tertiary children's hospital. The retrospective reviewed included 53 patients (20 pre-ERAS, 33 post-ERAS) aged 12-20 years old, comparing preoperative compliance, intraoperative adherence, and postoperative outcomes. Findings showed 81% compliance with preoperative medication, 76% received appropriate preoperative medications, and 39% had recommended carbohydrate loading. Intraoperative compliance was 87%, with 61% adherence to postoperative medications. Post-anesthesia care unit (PACU) stay time increased (44 vs 53 minutes, p=0.21), but pain scores, postoperative prescriptions, and hospital readmissions remained unchanged. This study …

Impact Of A Multidisciplinary Clinic On Hormone Replacement Therapy In Adolescents With Turner Syndrome, Madeline Ross, Trisha Patel, Ashli A. Lawson, Joseph Cernich, Tazim Dowlut-Mcelroy

Research Days

Background

Turner Syndrome (TS) is associated with primary ovarian insufficiency (POI). Most adolescents with TS require hormone replacement therapy (HRT).1 International guidelines recommend transdermal estradiol (TDE) as first-line estrogen replacement therapy.1 Care within a multidisciplinary clinic (MDC) has been associated with higher adherence to screening guidelines for metabolic and auditory disorders in TS.2 It is unknown if adherence to guidelines for postpubertal HRT differ for adolescents with TS managed in a MDC compared to those managed outside of a MDC. Our study aimed to compare 1) postpubertal HRT regimen prescribed, and 2) compliance to HRT and menstrual bleeding patterns for …

Analytical Verification Of The Fda Cleared Xpert® Xpress Cov-2 Plus Test For Sars-Cov-2 Detection In Respiratory Specimens, Gabriela M. Henriquez, Neena Kanwar, Rangaraj Selvarangan

Research Days

Introduction

The COVID-19 pandemic, caused by SARS-CoV-2, highlighted severe gaps in broad testing and prompt diagnosis. Rapid real-time RT-PCR assay Xpert® Xpress CoV-2 Plus was developed to enhance SARSCoV-2 detection in respiratory specimens. Using ZeptoMetrix's inactivated organisms, this study seeks to assess its analytical performance and compare its accuracy with current standard of care diagnostic assay.

Methods

The accuracy of the Xpert® Xpress CoV-2 Plus test was evaluated using ZeptoMetrix NATtrol inactivated SARS-CoV-2 organisms diluted with pooled negative nasopharyngeal (NP) swabs. Ten positive and ten negative NP swabs were tested over five days at two sites, with >90% agreement required. …

A Novel Approach To The Management Of Extreme Hypernatremia Using Continuous Kidney Replacement Therapy And Hypertonic Saline, Bahar Barani, Xuexin Lu, Darcy Weidemann, Jenna Miller, Nathan Beins, Judith Vansickle, Vimal Chadha

Research Days

Case series about two patients with severe hypernatremia and kidney failure who were treated with a novel mechanism using continuous dialysis and customized fluids with good outcomes.

Bivalirudin Versus Heparin In Patients With Congenital Diaphragmatic Hernias Requiring Extracorporeal Life Support, Cory Nonnemacher, Seth Saylors, Vatche Melkonian, Richard Hendrickson, Inna Lobeck

Research Days

Introduction

Congenital Diaphragmatic Hernia (CDH) is a rare congenital anomaly. The pulmonary hypoplasia, pulmonary hypertension and altered cardiac function associated with CDH may result in early cardiorespiratory failure requiring life-saving extracorporeal life support (ECLS). Early repair of CDH on ECLS has shown to improve survival, but poses an increased bleeding risk due to anticoagulation. Heparin has traditionally been the anticoagulant of choice for ECLS. Recent data has suggested that the use of bivalirudin may result in lower bleeding rates and transfusion requirements. This study aims to stratify complications for patients with CDH repaired on heparin versus bivalirudin, hypothesizing that complications …

Spinal Deformity Characteristics Associated With Intraspinal Anomalies In A Population Of Presumed Ais, Connor Mathes, Aaron Shaw, Bill Woodhams, John Anderson, Michael Benvenuti, Richard Schwend

Research Days

This study aims to identify an association between pre-operative radiographic criterion and the presence of an underlying intraspinal anomaly in patients presenting with presumed adolescent idiopathic scoliosis undergoing posterior spinal fusion.

Adherence To Oral Iron In Adolescent Females With Iron Deficiency Secondary To Heavy Menstrual Bleeding, Kennedy Sheedy, Lauren Amos Md, Ms

Research Days

Iron deficiency is an important, but often minimized issue among adolescent females. While treat with oral iron is generally first-line treatment, IV iron has been shown to be safe and effective. Our study looks at adherence and barriers to oral iron treatment and assesses current use of IV iron for iron deficiency at Children's Mercy, in hopes of helping move towards utilizing the most beneficial treatment for each individual patient.

Teaming Up For Better Health: An Interprofessional Collaborative Approach To Older Adult Oral Care, Deborah Dowd, Jodie Lopez, Jennifer Goodman

Utah Conference on Community Engagement

Oral health is a critical component of overall health, significantly influencing systemic diseases and the quality of life in older adults. Conditions such as xerostomia, swallowing difficulties, and poor oral self-care are associated with aspiration pneumonia. Integrating oral health into healthcare in long-term care facilities (LTCFs) is essential for preventing various conditions and improving quality of life. Effective oral hygiene is crucial in avoiding non-ventilator hospital-associated pneumonia by reducing oral biofilm and lowering the risk of pneumonia. Nurses' knowledge and care in oral health across healthcare settings are vital for positive health outcomes. Revising nursing curricula to incorporate oral health …

Sevier County Adventures - Poster Presentation, Jori Kloosterman, Anna Gilliam

Utah Conference on Community Engagement

"The Sevier County Adventures is a community engagement series of events that are fun for all and center on 4 community-identified needs; mental health, substance abuse, suicide, and parenting/family relationships. Once a quarter in 2025, the USU Sevier County Extension Office and the Central Utah Health Department, in conjunction with other entities, will hold community events to provide resources and information that highlight a specific need from the 4 community-identified needs. 1-Mental Health Game Night – Participants will be given a resource packet with information on local providers and teams will play an escape room game box. 2-Home Run for …

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenburg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Research Days

Background: Our aim is to increase the percentage of children discharged home from the ED with a diagnosis of CAP or ABRS treated with an optimal antibiotic duration (3-5 days for CAP, 5-7 days for ABRS) from 13% to 70% by July 25.

Methods: Outcome metric is the percentage of patients receiving recommended antibiotic duration for CAP and ABRS. Process metrics include use of order set, "Quick Discharge” order set, and clinical pathway QR codes. Balancing metric is the number of return visits with the same diagnosis < 14 days. Plan-Do-Study-Act methodology was used. In Aug 23, our ASP disseminated a handbook that emphasized shorter durations. A new multidisciplinary team (infectious diseases, ED, and urgent care physicians, advanced practice providers, nurses, and pharmacy) formed in Dec 23. We utilized cause-and-effect analysis, driver diagram, and prioritization matrix, which helped identify other impactful interventions, including implementation of new internal CAP clinical pathway order set (April 24) and “Quick Discharge” order sets (May 24). Next, we surveyed prescriber comfort (June 24) with shorter duration identifying barriers and providing education, leading to posted evidence for lower duration treatment in practitioner workrooms and developing a new ABRS clinical pathway (Sept 24). Top prescribers providing optimal duration received email acknowledgement (Oct 24) and resident rotators received antibiotic handbook and CAP clinical pathway QR codes (Nov 24). New best treatment practices for ABRS were elucidated and disseminated through clinical pathway and internal article publishing to our hospital and associated clinics (Dec 24).

Results: We saw shifts in the outcome metric’s center line in Sept 23 …

Decreasing Time To Narcotic Pain Medication In Patients With Sickle Cell Disease Presenting With Acute Pain Crises In A Pediatric Emergency Department: A Quality Improvement Initiative., Allison Adam, Leslie Hueschen, Lina Patel, Christopher Kaberline, Ibad Siddiqi

Research Days

Background: Guidelines published by the National Heart, Lung and Blood Institute recommend that patients with sickle cell disease who present in acute pain crisis receive narcotic medication < 60 minutes from arrival. Multi-center studies indicate approximately 50% of institutions are adherent to this level 1a recommendation. From October 2022-October 2023, our institutional median time to narcotic was 61 minutes.

Objective: Our aim was to decrease the time to narcotic administration by 10% (61 min to 55 min) in patients with Sickle Cell Disease presenting to the emergency department for acute pain crisis while simultaneously decreasing disparities in our patient population by Oct 2024. Additionally, we sought to increase the percentage of patients within this population to receive their first narcotic in 60 min from 49% to 70%, by Oct 2024.

Methods: We …

Same Day Discharge Following Minimally Invasive Repair Of Pectus Excavatum Following An Eras Protocol, Cory Nonnemacher, Seth Saylors, Meredith Elman, Pablo Aguayo, Charles Snyder, David Juang, Beth A. Orrick, Amy L. Pierce, Shawn St. Peter, Tolulope Oyetunji

Research Days

Background/Purpose

Corrective surgery for Pectus Excavatum comes primarily via the Nuss procedure. Pain control contributes significantly to the postoperative length of stay (LOS). Optimization of pain control can be achieved in multiple ways in the form of an Enhanced Recovery After Surgery (ERAS) protocol. The purpose of our study is to assess the success of same-day discharge with a ERAS protocol for same-day discharge (SDD) of patients undergoing Pectus Excavatum repair.

Methods

A retrospective review of patients from August 2022 to August 2024 at a stand-alone tertiary care children’s hospital who underwent minimally invasive repair of Pectus Excavatum was performed. …

A Single Center Qualitative Study To Improve Coordination Of Follow-Up Care For Patients Diagnosed With Abusive Head Trauma, Ruairi Smith-Dewey, Elise Wright, Daniella Donofrio, Hannah Goebel, Sara Kilbride

Research Days

Background/Project Intent: Review of cases identified 16 possible follow-up needs. A single patient had a maximum of 12 potential needs. Needs not being addressed included written documentation for need of follow-up without subsequent referral placed/appointment scheduled or need not addressed at all. The goal of this project was to have all follow-up needs addressed for at least 50% of children diagnosed with AHT by January 2025.

Methods: All children admitted to CMH from January 2024-December 2024 and diagnosed with AHT by the Safety, Care & Nurturing (SCAN) team were included. Interventions were designed and implemented by a multidisciplinary team to …

Implementing Balanced Fluid Resuscitation For Sepsis Patients In A Tertiary Care Pediatric Emergency Department, Grace E. Arends Md, Christopher Kaberline, Ibad Siddiqi, Sarah Nienhaus, Viktoriya Stoycheva Mha, Rn, Cpn, Leslie Hueschen

Research Days

Background

National data supports balanced fluid during volume resuscitation in the setting of sepsis as it improves morbidity and mortality, particularly preventing acidosis and kidney injury. Despite this recommendation, the CMH ED still has not implemented balanced fluid resuscitation.

Aim

The aim of the project is to increase the percentage of patients with positive sepsis screen treated in the CMH Adele Hall Emergency Department receiving lactated ringer’s fluid resuscitation from 4.6% to 15% by June 2024.

Methods

Primary outcome measures were percentage of patients with suspected sepsis who received at least one LR fluid bolus, as well as percentage of …

Ecmo Without Compressions Versus Ecpr For Lcos Following Cardiac Surgery, Amjad Halloum, Apurva Panchal, Sarah Tabbutt, Martina Steurer, Mousumi Banerjee, John Charpie, Javi Lasa, Amy Mccammond, Katie Moynihan, Nancy Ghanayem, Tia Raymond

Research Days

A retrospective study looking into ECMO vs eCPR outcomes in the CICU. By refining the approach to postoperative ECMO initiation, this study aims to contribute valuable insights that could improve survival and reduce complications in pediatric cardiac surgery patients.

Respiratory Failure In Pediatric Hematology And Oncology Patients On Extracorporeal Membrane Oxygenation: A Comparative Analysis, Michelle Brown Do, Jenna Miller, Asdis Finnsdottir Wagner, Erin Hall, Maya Dewan Md, Christopher Dandoy Md, Kalee Grassia Md, Bin Zhang Phd

Research Days

This project was a retrospective comparative analysis between two tertiary care pediatric institutions. The primary objective entailed examining survival outcomes in the oncologic and hematopoetic stem cell transplant patient populations with respiratory failure in the presence and absence of ECMO support.

A Case Of Heterotaxy And Common Atrioventricular Canal With Bradycardia, Mohamed Aashiq Abdul Ghayum, Jenna Schermerhorn, Hayley S. Hancock, Kelsey Brattrud, Melanie Kathol, Maria Kiaffas

Research Days

Background

Heterotaxy-polysplenia syndrome (otherwise known as left atrial isomerism) should be suspected in the presence of complete atrioventricular canal defect (CAVC) with interruption of the inferior vena cava (IVC), atrioventricular block (AVB), and viscero-cardiac heterotaxy. The prognosis remains dismal for the fetus with such entity, especially in the presence of major structural heart disease and high-grade atrioventricular block. Early diagnosis, close follow up, and appropriate delivery planning, allows for effective stabilization of the baby after birth and might improve survival.

Methods

A 26-year-old mother at 26 weeks gestational age was referred for cardiac evaluation of cardiomegaly, suspected CAVC and bradycardia. …

Utilization Of Physical Activity As A Vital Sign (Pavs) To Improve Personalized Exercise Assessment And Counseling In Pediatric Cardiology Patients, Lavina Desai, Josh Holbert, Jessica S. Watson, Amanda Mcintosh, David A. White, Megan Jensen

Research Days

Background: Physical activity is a known preventative effort that has a clear role in improving cardiorespiratory fitness and health outcomes. Low levels of habitual physical activity (PA) in children and adolescents with congenital heart disease (CHD) leads to various negative health outcomes, yet review of the literature indicates that physicians, caregivers, and patients restrict physical activity owing to safety concerns [1]. Root cause analysis (Fig 1.1) identified a lack of readily available data to provide assessment of baseline PA in patients presenting to the cardiology clinic. Therefore, this project aims to implement physical activity as vital sign (PAVS) via a …

Bisphosphonate Treatment In Pediatric Patients With Rare Ovarian Malignancy And Hypercalcemia: A Case Series, Samhita Bhattarai, Seth Lamb, Jennifer W. Boyd

Research Days

Objectives

To describe the presentation, management, and outcomes of severe hypercalcemia in two adolescent females secondary to ovarian malignancy.

Methods

The case series includes two adolescent female patients, aged 11 and 16, diagnosed with rare ovarian malignancies and associated hypercalcemia. Both patients presented with abdominal pain, nausea and constipation. The 11-year-old received zoledronic acid while the 16-year-old received pamidronate. Serum calcium levels, symptoms and medication side effects were monitored before and after bisphosphonate therapy.

Results

Both girls presented with severe hypercalcemia. Patient 1 was an 11-year old girl who presented with serum calcium of 15.0 mg/dL. She began hyperhydration with …