Medicine and Health Sciences Commons^™

Supporting Families Impacted By Adverse Childhood Experiences (Aces), Jennifer Paumen, Laura Plencner, Jacqueline Kitchen

Research Days

Background: Adverse childhood experiences (ACEs) impact a majority of individuals, with approximately two-thirds of adults having experienced 1 or more ACE.1 The health consequences of ACEs are significant, including cardiovascular disease, cancer, autoimmune diseases, and mental illnesses.1 These health impacts can even start as early as childhood, leading to an increased risk of learning and behavioral concerns.2,3 Recent evidence has also identified the impact that parental ACEs may have on parenting and child development,4,5,6 which in turn may lead to an intergenerational transmission of ACEs.4,7 As a nurturing caregiver relationship is key for buffering adversity,2,8 it is imperative to address …

Pediatric Serum-Like Sickness: A Multicenter Analysis, Maya Gibson, Sarah Suppes, Jared Lovins, Emma Monique, Keith Feldman, Jennifer Goldman

Research Days

Background: Serum sickness-like reaction (SSLR) is a type III immune hypersensitivity reaction that presents 5-21 days following exposure to a medication. SSLR has nonspecific symptoms including fever, rash, and joint involvement. There are no standardized diagnostic criteria or treatment for SSLR, making this a challenging diagnosis.

Objectives/Goal: Our objective was to describe pediatric SSLR clinical manifestations, medical encounter types, and treatment strategies.

Methods/Design: A retrospective chart review across 2 freestanding children’s hospitals was used to identify patients 0-21 years of age diagnosed with SSLR by ICD-9/10 codes [T80.69XA, 999.59], SNOMED codes [1782626019, 3293325014], or pharmacovigilance review in the emergency department …

Increasing Incentive Spirometry Use In Patients With Sickle Cell Disease: Longer Follow-Up Of Pdsa Cycle 1, Alexandra Prosser, Thomas Cochran

Research Days

Problem Statement/Question: Acute chest syndrome (ACS) is one of the leading causes of morbidity and mortality in patients with sickle cell disease. Patients are at higher risk for this complication during hospital admission due to limited mobility leading to decreased lung inflation. The National Heart, Lung, and Blood Institute (NHLBI) recommends providing ten breaths of incentive spirometry (IS) every two hours while awake for patients admitted to the hospital with sickle cell disease to help prevent development of acute chest syndrome. Without this intervention, patients are more likely to develop ACS requiring increased level of care, prolonged hospital stays, and …

Influencing Influenza Immunization: Qi Project In A Pediatric Resident Continuity Clinic, Brittany Moore

Research Days

Problem Statement/Question: There have been a multitude of approaches to vaccine hesitancy in regard to childhood vaccinations. In light of the COVID-19 pandemic there was a noticeable decline in influenza vaccination among children aged 6 months to 18 years. The influenza vaccination rate in the pediatric resident continuity clinic at Children’s Mercy Hospital was below the national average for pediatric patients.

Background/Project Intent (Aim Statement): The aim of this study is to increase the percentage of patients aged 6 month and older currently enrolled in ROYAL clinic receiving at least one influenza vaccine from 38.6% to 55% by January 1, …

Increasing Utilization Of Gestational Age Based Table For Initial Intubation In A Level Iv Neonatal Intensive Care Unit, Maribel Martinez, Dianne Lee, Christopher R. Nitkin

Research Days

Problem Statement/Question: Most providers in our unit are not using the NRP recommended method to determine the initial ETT insertion depth in neonates.

Background/Project Intent (Aim Statement): Endotracheal tube (ETT) depth in neonates is of critical importance due to significant adverse events when malpositioned. While randomized trials comparing different methods have not shown superiority of any particular method, the weight-based method (weight (kg) +6) has been found to be highly inaccurate in extremely low birth weight neonates. Furthermore, the Neonatal Resuscitation Program (NRP) recommends using gestational age (GA)-based table (Kempley ST, et al, Resuscitation 2008) or nasal-tragal length for initial …

Converting Paper Faxes To Electronic Faxes To Improve Patient Care, Decrease Paper Burden, And Improve Staff And Provider Satisfaction: A Quality Improvement Project, Stephanie Green, Amanda Lindenberg

Research Days

Problem Statement/Question: Reliance on provider and administrative staff to be physically present at Adele Hall creates delays in delivery of completed documentation. Delays of up to 7-14 days are possible. Delays in completion result in outside offices resending (wasted duplication of work) requests and delay downstream delivery of equipment/services, ultimately negatively impacting patient care. Over a 2-week period in November 2022, it took at average of 6.08 days for time to completion of requests. Over a 4-week period in August 2022, divisional outgoing faxes in response to requests averaged 79.5 per week. In addition, reliance on hardcopies of requests increases …

Improving Frequency Of Peer Review Of Abnormal Genital Exam Findings In Patients Undergoing Sexual Abuse Evaluation, Lyndsey Hultman, Julia G. Harris, Terra N. Frazier, Jennifer B. Hansen

Research Days

Problem Statement/Question: Child Advocacy Centers (CACs) coordinate child abuse MDTs, and 2023 CAC accreditation standards require that “all medical professionals providing services to CAC clients must demonstrate that 100% of all findings deemed abnormal or “diagnostic” of trauma from sexual abuse have undergone expert review by an advanced medical consultant.” Scheduled Case Review occurs among Children’s Mercy child abuse pediatricians (CAPs), but current practice is to review cases only upon CAP request.

Background/Project Intent (Aim Statement): Appropriate interpretation of sexual abuse exam findings is crucial for accurate diagnosis and provision of medical information to multidisciplinary child protection teams (MDTs). Medical …

Unique Endoscopic Retrieval Of A Large Rectal Foreign Body, Laurie Mccann, Jose Cocjin

Research Days

Introduction: Large rectal foreign bodies are usually difficult to extract, usually requiring operative management.

Case: A 14-year-old male presented to the ER for a rectal foreign body. Earlier in the day, he had rectal itching and inflammation. He used a cylindrical reusable ice stick (for water bottles) for topical relief, which did not work, so he placed the tube in his rectum, then he was unable to retrieve it and sought medical help. Physical exam was significant for lower abdominal pain and palpable mass just below his umbilicus, which was painful to palpate. CT abdomen/pelvis showed a large foreign body …

Improving Imaging Practices Following Arterial Switch Operation, Mollie Walton, Nir Atlas, Sanket Shah

Research Days

Problem Statement/Question: Long-term risk in post-operative cardiac patients exists, and morbidity may be avoided with advanced imaging surveillance.

Background/Project Intent (Aim Statement): The Appropriate Use Criteria (AUC) for Multimodality Imaging During Follow-Up Care of Patients with Congenital Heart Disease (CHD) was published in 2020 by the American College of Cardiology Foundation. This includes a subsection for D-Looped Transposition of the Great Arteries (D-Loop TGA). The arterial switch operation (ASO) is the preferred method for surgical repair of D-Loop TGA. Appropriate and timely use of advanced imaging is essential in optimizing long-term postsurgical outcomes. The objective of this quality improvement (QI) …

Improving Fluid Management Of Extreme Premature Infants By Providing A Restrictive Fluid Management Algorithm In The Nicu, Jacob S. Ward, Dena Hubbard, Nicholas Clark

Research Days

Problem Statement/Question: At our institution we found wide variability in and a lack of an evidence-based standard for fluid management in premature infants.

Background/Project Intent (Aim Statement): Excessive fluid intake in premature infants during the first week of life increases the risk of adverse events and overall mortality. Fluid restriction is recommended to help decrease morbidity and mortality in this patient population. We aimed to improve the fluid management of premature infants born < 29 weeks gestation admitted to our intensive care nursery (ICN) by implementing a fluid restriction protocol with the goal of >70% compliance over a 16-month period.

Methods (include PDSA cycles): Institution of daily weights started at beginning of baseline period. In April of 2021, we implemented a …

Hypereosinophilia With An Anterior Mediastinal Mass, Sonya Parashar, Aarti Pandya

Research Days

Background: Hypereosinophilia is defined as 1500 eosinophils/mL or above with evidence of end-organ damage due to the eosinophils at least 4 weeks apart.

Objectives/Goal: We describe a case of steroid resistant hypereosinophilia.

Methods/Design: A 3-year-old male was admitted for newly found anterior mediastinal mass and left pleural effusion. About 6 weeks prior to admission, he was seen in his primary care office for difficulty breathing. Despite the appropriate treatment for his symptoms, the patient continued to have significant respiratory symptoms and a chest x-ray showed a large left pleural effusion. He was immediately transferred to a tertiary care center and …

Bone Marrow Transplant For Macrophage Activation Syndrome In Systemic Juvenile Idiopathic Arthritis, Shailly Gaur, Michael J. Holland, J Allyson Hays, Ibrahim A. Ahmed

Research Days

Background

The recognition of macrophage-activation-syndrome (MAS) in the setting of systemic-juvenileidiopathic-arthritis (sJIA) is complex, but a necessary distinction given emerging treatment options. With overlapping clinical manifestations including fever, end-organ involvement and lymphadenopathy, there is a focus on laboratory values to differentiate MAS from a sJIA flare. Once parameters are met, multiple treatment modalities can be considered, as monotherapy or in combination, including steroids, immunosuppression, chemotherapy, intravenous immunoglobulin, and cytokine-directed biologics. Given the long-term morbidity and mortality associated with progressive inflammation and immune dysregulation due to MAS with sJIA, it is imperative to regain control over this complication. However, these treatments …

Improving In Pacu Sign-Out Times, Manan Karki, Todd A. Glenski, Christian M. Taylor

Research Days

The post anesthesia care unit (PACU) provides specialized care to post-surgical patients recovering from anesthesia. Patients are discharged from the PACU to other clinical units or home after they are deemed stable depending on the type of surgery. A delayed discharge from the PACU can occur due to varied reasons which can affect the dynamic patient flow, have implications on pediatric population (e.g., anxiety due to parental separation), and increase the overall cost of service.

This quality improvement project looks at possible causes to PACU sign-out delays and helps develop countermeasures to improve the efficiency of signouts once patients are …

Determining The Inflammatory And Microbial Profiles Of Peritoneal Fluid From Trauma Patients Following Damage Control Laparotomy, Paige Deville, Jenna Dennis, C. Fontenot, O. Warren, Jeff Carter, Herb Phelan, Johnathan Schoen, Jeffery Hobden, Alison A. Smith

Surgery Research Symposium

Objectives: The dynamic environment of the peritoneal cavity has not been well-studied in the trauma patient population, which is high risk for inflammatory dysregulation given the systemic changes induced by traumatic injury. The objective of this study is to better characterize the milieu of the peritoneal cavity to understand the mechanisms that lead to infectious complications which impair the healing of damage tissue.

Methods: Peritoneal fluid was collected from adult trauma patients who underwent damage control laparotomy during one of their subsequent return trips to the operating room for re- exploration (N=4). Cytokine profiles were analyzed and determined using a …

Elucidating The Racial Disparity In The Age And Stage At Diagnosis Of Colorectal Cancer, Mckenzie Hargis, Sabine Saeed, Elijah Thompson, Cassandra Villa, Valentine Nfonsam

Surgery Research Symposium

Introduction:

The overall incidence of colorectal cancer (CRC) has been decreasing in the United States, however disparities remain with certain age and race groups. Data has indicated that African American patients under 50 years of age have an increasing incidence of CRC. Additionally, their overall rate of CRC is declining more slowly when compared to White and Asian races. It is important to explore these trends in order to determine if reducing screening age guidelines for African Americans is beneficial.

Methods:

The Cancer Query System of the Surveillance, Epidemiology, and End Results Program (SEER) database was used to obtain incidence …

Enzymatic Disaggregation Is Superior To Mechanical De - Epithelialization In Preparation Of Cutis Grafts For Hernia Repair: Results Of The Cutis Ex - Vivo Graft I Study (Cute Graft I), Mchael Cook, Jeanette A. Zavala, Ian Hodgdon, John Paige, Jeff Carter, Herb Phelan

Surgery Research Symposium

Introduction

Biologic or synthetic mesh reinforcement is the current standard of care for abdominal hernia repairs but remains prohibitively expensive and can increase healthcare costs by over 100,000 USD per complication. The use of autologous cutis grafts (full thickness skin grafts with the epidermis removed) are a cost-effective solution. However, the process of mechanical de-epithelialization can be physically demanding, time consuming, and result in discrepancies between patients due to differences in skin pigment, with darker pigments being easier to de-epithelialize. To facilitate this process, we proposed the use of enzymatic disaggregation. In this study, we compare the effectiveness of mechanical …

Treatment Of Infected Total Hip Arthroplasty With Pelvic Discontinuity: A Case Report, Leland Van Deventer, Peter Krause, Anna Cohen-Rosenblum

Surgery Research Symposium

INTRODUCTION

Although two-stage exchange for prosthetic joint infection (PJI) following total hip arthroplasty (THA) is considered the standard of care in the United States, this treatment poses technical challenges when pelvic discontinuity is present. We present the case of a deep infection associated with pelvic discontinuity successfully treated with a two-stage exchange using an articulating antibiotic spacer.

METHODS

A 37-year-old female with rheumatoid arthritis presented with a periprosthetic right, transverse acetabular fracture and pelvic discontinuity. An acetabular revision using a jumbo cup and posterior column plate was performed without complication. Seven months later, she returned with a large open draining …

Bug Juice And Chest Tubes: Are Prophylactic Antibiotics Needed For Tube Thoracostomy Placement?, Morgan Brown, Katherine Pavleszek, Ryan Schroeder, Johnathan Schoen, Alan Marr, Partick P. Greiffenstein, John Hunt, Lance Stuke, Alison Smith

Surgery Research Symposium

Introduction: Chest tube placement for pneumothorax or hemothorax is common in trauma patients. These are often associated with associated risk of empyema and pneumonia. The use of prophylactic antibiotics prior to tube thoracostomy for traumatic thoracic injuries is controversial. Previous authors have shown decreased incidence of empyema and pneumonia with presumptive use of antibiotics in patients undergoing tube thoracostomy for trauma. Other authors, however, have shown no benefit and even increased risk of antibiotic resistance and complications related to antibiotic use. The purpose of this study is to determine if prophylactic use of antibiotics for tube thoracostomy following trauma was …

An Analysis Of Age At Cleft Surgery Based On Gender, Race, Distance From Treatment Center, And Payor Status, Sarah Rimmer, Jonathan Richard, Zhide Fang, Mohamad Masoumy, Delora Mount, Gregory Fulton

Surgery Research Symposium

Background/Purpose: This project retrospectively assessed the cleft population at a regional cleft center using a standardized set of outcomes developed by the cleft team. Surgical data regarding age at primary cleft lip repair (PCLR), primary cleft palate repair (PCPR), and alveolar bone graft (ABG) was analyzed based on gender, race, payor status, and distance to treatment center.

Methods/Description: ICD-10 and CPT codes that correlated with cleft anomalies and surgical procedures of the lip and palate were used to generate a sample of 167 surgical procedures at a regional cleft center from April 2018 to May 2022. Linear regression analyses, Wilcoxon …

Retrospective Study Of Regional Anesthesia Or General Anesthesia For Percutaneous Transluminal Angioplasty, Austin Primeaux, C. Norlin, Brannon Broussard, Meredith Shaw, Gregory Tortorich, Jose Gallardo, Julie Gayle, Matthew R. Eng

Surgery Research Symposium

INTRODUCTION

Revascularization is vital in treating peripheral arterial disease (PAD). When medical management fails, patients with severe claudication and critical ischemia can undergo Percutaneous Transluminal Angioplasty (PTA). The patient population requiring PTA often has numerous comorbidities, and we propose these patients may experience fewer adverse events when regional anesthesia is utilized in lieu of general anesthesia.

The primary objective of this study is to determine whether patients who received regional anesthesia with femoral and sciatic nerve block had a lower rate of morbidity post-procedure versus patients who received general anesthesia for PTA for lower extremity revascularization.

METHODS

A retrospective chart …

Risk Factors For Readmission After Elective Colectomy For Uncomplicated Diverticulitis, Katherine Pavleszek, Claudia Leonardi, Danielle Dooley, David Otohinoyi, Brian Carr, Valentine Nfonsam

Surgery Research Symposium

Introduction:

Readmission is used as a quality measure for surgical outcomes. Mitigating post-operative readmission is paramount to decrease morbidity, mortality, and healthcare cost. In this study, we assess the predictive factors of 30 day readmissions for patients who underwent a colectomy for uncomplicated diverticulitis.

Methods:

We performed a six-year retrospective review and analysis (2013-2018) of the ACS-NSQIP database of patients who underwent elective colectomy for acute and chronic uncomplicated diverticulitis. We included patients who were 18 years old and above who were readmitted within 30 days post colectomy. Baseline patient characteristics included patient demographics, operation type, bowel prep, comorbidities, and …

Stratification Of Neuroendocrine Cancer Patients For Ecto - 5’ - Nucleotidase Inhibition, Michael Maurer, Nicholas Skill, Yvette Bren-Mattison, Mary A. Maluccio

Surgery Research Symposium

Introduction: Neuroendocrine Tumors (NET) are a group of rare cancers originating from neuroendocrine cells within multiple organs. The evidence that supports medical decision making must consider the heterogeneity of these tumors, differences in biologic behavior between primary sites, and the moderate to high risk of developing metastatic disease over a patient’s lifetime. Based on preliminary omic studies and current clinical trials in other cancers, the enzyme 5′-nucleotidase (CD73) has been identified as a potential biomarker for patient stratification as well as likely treatment target for NET patients. CD73 is a cell membrane bound enzyme and has been linked to cancer …

Solid Organ Pseudoaneurysms In Patients With High Grade Traumatic Injuries: A Case Series, Shivani Jain, Alexis Scheuermann, Meredyth Berard, Harrison Travis, Alison A. Smith

Surgery Research Symposium

Introduction: Blunt abdominal trauma affects 25% of all patients admitted with traumatic injuries. Although relatively rare, the development of solid organ pseudoaneurysms (PSA) can pose a significant threat to patients. If untreated, these PSAs may rupture and lead to life- threatening hemorrhage. Despite this risk, the use of follow-up imaging after initial CT for abdominal trauma has not been widely embraced.

Methods: A database was created to include all adult patients admitted at a level 1 and a level 2 trauma center between 2012 and 2020 for abdominal injuries with an AAST grade of ≥3. A retrospective review of this …

Women Pursuing Metabolic/Bariatric Surgery Are At Increased Risk For Endometrial Cancer, Robert Ross

Surgery Research Symposium

No abstract provided.

Quality Of Life Improvement After Surgical Management Of Severe Hidradenitis Supprativa In Adolescents, Anne Faulk, Julia Power, India Hill, Jessica A. Zagory

Surgery Research Symposium

BACKGROUND: Hidradenitis supprativa (HS) can have significant psychological, social, and financial burden in addition to its medical issues. Patients with HS can suffer from shame, embarrassment, and stress. It can significantly impact interpersonal and intimate relationships, leading to poor quality of life. We hypothesized that surgical excision can help improve these issues among adolescent patients with HS.

MATERIALS AND METHODS: We performed a single-center, retrospective review of patients ≤20 years of age seen by surgery for Hurley stage 3 HS at a Children's Hospital. Demographic and medical information was collected for analysis.

RESLUTS: 8 patients met inclusion criteria. All were …

Hepatic Vagotomy In Patients With Obesity Leads To Improvement Of The Cholesterol To High - Density Lipoprotein Ratio, Ashlin J. Hinojosa

Surgery Research Symposium

No abstract provided.

Ileal Interposition Preserves Lean Muscle Mass And Alters Intestinal Mitochondrial Function, Robert C. Ross

Surgery Research Symposium

No abstract provided.

Outcomes In Pediatric Vascular Trauma, Amanda Tullos

Surgery Research Symposium

Purpose: Although pediatric vascular trauma is rare, it can result in severe functional deficits or death. The purpose of this study is to evaluate the demographics, injuries, and outcomes of the pediatric vascular trauma population and identify any risk factors associated with complications or death.

Methods: The authors conducted a retrospective cohort study that included all patients with penetrating and blunt trauma age 18 and under that presented to a large urban level 1 trauma center from January 2016 to August 2021. Demographic, injury, treatment, and outcome variables were recorded. The primary outcome variable was the presence of a vascular …

T4n0 Colon Cancer Has Worse Oncologic Outcomes Than Stage 3 Colon Cancer: Using Genomic Information To Decip Her The Molecular Basis Of This Phenomenon, David Otohinoyi

Surgery Research Symposium

No abstract provided.

Identifying Risk Factors Predictive Of Urgent And Emergent Surgical Intervention For Initial Presentation Of Colorectal Adenocarcinoma, Jaclyn Isabella

Surgery Research Symposium

No abstract provided.