Medicine and Health Sciences Commons^™

S6k1 Controls Dna Damage Signaling Modulated By The Mrn Complex To Induce Radioresistance In Lung Cancer, Ali Calderon-Aparicio, Jun He, Nicole L. Simone

Department of Radiation Oncology Faculty Papers

Radiation is a mainstay of lung cancer treatment; however, resistance frequently develops. Identifying novel therapeutic targets to increase radiation sensitivity is crucial. S6K1 is a serine/threonine kinase known to regulate protein translation which is associated with radioresistance, but the mechanisms involved are unknown. We proposed to determine whether S6K1 promotes radioresistance by regulating DNA repair in lung cancer. Colony formation, protein expression and proliferation were assessed. S6K1 was modulated pharmacologically by either PF-4708671 or genetically by Crispr-Cas9. Higher radioresistance levels in lung cancer cells were associated with lower phosphoactivation of MRN complex members, a key activator of radiation-induced DNA repair …

A Framework For Human Evaluation Of Large Language Models In Healthcare Derived From Literature Review, Thomas Yu Chow Tam, Sonish Sivarajkumar, Sumit Kapoor, Alisa V Stolyar, Katelyn Polanska, Karleigh R Mccarthy, Hunter Osterhoudt, Xizhi Wu, Shyam Visweswaran, Sunyang Fu, Piyush Mathur, Giovanni E Cacciamani, Cong Sun, Yifan Peng, Yanshan Wang

Faculty, Staff and Student Publications

With generative artificial intelligence (GenAI), particularly large language models (LLMs), continuing to make inroads in healthcare, assessing LLMs with human evaluations is essential to assuring safety and effectiveness. This study reviews existing literature on human evaluation methodologies for LLMs in healthcare across various medical specialties and addresses factors such as evaluation dimensions, sample types and sizes, selection, and recruitment of evaluators, frameworks and metrics, evaluation process, and statistical analysis type. Our literature review of 142 studies shows gaps in reliability, generalizability, and applicability of current human evaluation practices. To overcome such significant obstacles to healthcare LLM developments and deployments, we …

How To Utilize Current Guidelines To Manage Patients With Cancer At High Risk For Heart Failure, Michelle Bloom, Jose A Alvarez-Cardona, Sarju Ganatra, Ana Barac, Iskra Pusic, Daniel Lenihan, Susan Dent

2020-Current year OA Pubs

Heart failure (HF) in patients with cancer is associated with high morbidity and mortality. The success of cancer therapy has resulted in an exponential rise in the population of cancer survivors, however cardiovascular disease (CVD) is now a major life limiting condition more than 5 years after cancer diagnosis [Sturgeon, Deng, Bluethmann, et al 40(48):3889-3897, 2019]. Prevention and early detection of CVD, including cardiomyopathy (CM) and HF is of paramount importance. The European Society of Cardiology (ESC) published guidelines on Cardio-Oncology (CO) [Lyon, López-Fernández, Couch, et al 43(41):4229-4361, 2022] detailing cardiovascular (CV) risk stratification, prevention, monitoring, diagnosis, and treatment throughout …

Broad Applicability Of The Goldspire™ Platform For The Treatment Of Solid Tumors, Jenny Zilberberg, Christopher Uhl, Charles B Scott, David W. Andrews, Mark A Exley

Department of Neurosurgery Faculty Papers

Goldspire™ is a personalized immunotherapy platform that combines whole tumor-derived cells with antisense oligonucleotide (IMV-001) against Insulin-Like Growth Factor-1 Receptor (IGF-1R) in biodiffusion chambers (BDCs; 0.1 μm pore). BDCs are exposed to 5-6 Gy and implanted at abdominal sites for ∼48 h to deliver an antigenic payload and immunostimulatory factors to train the immune system. Lead product IGV-001 was evaluated in newly diagnosed glioblastoma (ndGBM) patients in Phase 1a and 1b trials (NCT02507583). A Phase 2b study (NCT04485949) recently completed enrollment. Preventative treatment with tumor-specific products manufactured with Goldspire limited tumor progression and extended overall survival in mice challenged with …

Immunomodulation Of Macrophages In Diabetic Wound Individuals By Structurally Diverse Bioactive Phytochemicals, Krishnendu Adhikary, Riya Sarkar, Sriparna Maity, Ishani Sadhukhan, Riya Sarkar, Krishnendu Ganguly, Saurav Barman, Rajkumar Maiti, Sanjoy Chakraborty, Tandra R. Chakraborty, Debasis Bagchi, Pradipta Banerjee

Publications and Research

Diabetes-related ulcers and slow-healing wounds pose a significant health risk to individuals due to their uncertain causes. Mortality rates for diabetes foot ulcers (DFUs) range from 10% after 16 months to 24% after five years. The use of bioactive phytochemicals can play a key role in healing wounds in a predictable time. Recent literature has demonstrated that various natural substances, including flavonoids, saponins, phenolic compounds, and polysaccharides, play key roles at different stages of the wound-healing process through diverse mechanisms. These studies have categorized the compounds according to their characteristics, bioactivities, and modes of action. In this study, we evaluated …

Urinary Tract Infection Caused By Gardnerella Vaginalis In A 6 Week Old Infant, Rhythm Sharma, Malika Goel, Ruba Barbar

Conference Presentation Abstracts

Introduction: Gardnerella vaginalis is a frequent cause of bacterial vaginosis (BV) in adults. However, G. vaginalis infection is infrequent in infants. Only a few cases of G. vaginalis UTI have been reported so far in infants and none in the United States.

Case Description: A 6-week-old female, ex full-term at 39 3/7 weeks via vaginal delivery with no significant postnatal medical history, presented with a 2-day history of fever, mild cough, and congestion.

In the emergency department, the patient was febrile to 38.1°C, pulse 139 beats/minute, respiratory rate 34 breaths/minute, and SpO2 98% on room air. She was active and …

A Multicenter, Randomized, Non-Comparative, Phase Ii Study Of Nivolumab ± Ipilimumab For Patients With Metastatic Sarcoma (Alliance A091401): Expansion Cohorts And Correlative Analyses, Nathan D Seligson, James L Chen, Austin C Goodrich, Brian A Van Tine, Jordan D Campbell, Allison L Richards, Cristina R Antonescu, David A Liebner, Mohammed M Milhem, Howard Streicher, William D Tap, Gary K Schwartz, Suzanne George, Sandra P D'Angelo

2020-Current year OA Pubs

BACKGROUND: In this open-label, randomized, non-comparative, multicenter phase II study (Alliance A091401) we report on three expansion cohorts treated with nivolumab (N) with and without ipilimumab (N+I) and provide a multi-omic correlative analysis of actionable biomarkers.

METHODS: Patients were randomized (non-comparative) to receive either N or N+I. The primary endpoint was a 6-month confirmed response rate (CRR) defined by Response Evaluation Criteria in Solid Tumors version 1.1. Secondary endpoints included treatment-related adverse events (TRAEs), progression-free survival, and overall survival. Multi-omic correlative analyses were conducted using samples from both the primary and expansion cohorts.

RESULTS: A total of 66 patients were …

Inorganic Polyphosphate Promotes Colorectal Cancer Growth Via Trpm8 Receptor Signaling Pathway, Valentina Arrè, Chen Shen, Et Al.

2020-Current year OA Pubs

BACKGROUND: Colorectal cancer (CRC) is characterized by a pro-inflammatory microenvironment and features high-energy-supply molecules that assure tumor growth. A still less studied macromolecule is inorganic polyphosphate (iPolyP), a high-energy linear polymer that is ubiquitous in all forms of life. Made up of hundreds of repeated orthophosphate units, iPolyP is essential for a wide variety of functions in mammalian cells, including the regulation of proliferative signaling pathways. Some evidence has suggested its involvement in carcinogenesis, although more studies need to be pursued. Moreover, iPolyP regulates several homeostatic processes in animals, spanning from energy metabolism to blood coagulation and tissue regeneration.

RESULTS: …

Safety Of Dostarlimab In Combination With Chemotherapy In Patients With Primary Advanced Or Recurrent Endometrial Cancer In A Phase Iii, Randomized, Placebo-Controlled Trial (Engot-En6-Nsgo/Gog-3031/Ruby), Annika Auranen, Matthew A Powell, Et Al.

2020-Current year OA Pubs

BACKGROUND: In Part 1 of the phase III RUBY trial (NCT03981796) in patients with primary advanced or recurrent endometrial cancer (EC), dostarlimab plus carboplatin-paclitaxel (CP) significantly improved progression-free survival and overall survival compared with CP alone. Limited safety data have been reported for the combination of immunotherapies plus chemotherapy in this setting.

OBJECTIVES: The objective of this analysis was to identify the occurrence of treatment-related adverse events (TRAEs) and immune-related adverse events (irAEs) and to describe irAE management in Part 1 of the RUBY trial.

DESIGN: RUBY is a phase III, randomized, double-blind, multicenter study of dostarlimab plus CP compared …

Accelerated 3ymd Programs: The Last Decade Of Growth Of The Consortium Of Accelerated Medical Pathway Programs (Campp)., Catherine L Coe, Sally A Santen, Annette Reboli, Jeffrey R Boscamp, Amanda M Stoltz, Erin Latif, Lisa Grill Dodson, Matthew Hunsaker, Anuradha Paavuluri, Judith Brenner, Seethalakshmi Ramanathan, Allison Macerollo, Shou Ling Leong, Lisa Strano-Paul, Christin Traba, Betsy Goebel Jones, Kristen Rundell, Alicia Gonzalez-Flores, William J Crump, Mark Vining, April O Buchanan, Debaroti Tina Mullick Borschel, Christina M Vitto, Joan Cangiarella

Cooper Medical School of Rowan University Departmental Research

INTRODUCTION: Over the past decade, the growth of accelerated three-year MD (3YMD) programs has flourished. In 2015, with support from the Josiah Macy Jr. Foundation, the Consortium of Medical Pathway Programs (CAMPP) started with eight North American medical schools. The objective of this paper is to evaluate the current state of the 3YMD programs.

MATERIAL AND METHODS: Since 2015, the CAMPP has tracked new and prospective 3YMD programs. An electronic survey collecting curricular and programmatic information about the programs was disseminated to all members of the CAMPP in August 2023. The survey included elements related to year of initiation, number …

Little Lungs, Big Care: Prevent Unplanned Extubation, Leslie Huntington, Emily Jordan Ressman, Carmen Yearego

2024

QUALITY

Background: The pediatric critical care unit in a large medical center benchmarks a variety of quality metrics to ensure we are providing our patients with the best care. At the end of 2023, the unit rate of 0.58 was higher than the national benchmark rate of 0.33 for unplanned extubation (UE). Additionally, the unit was lower for failed extubation rate than the national benchmark which led to questioning if the unit was too conservative with when patients are deemed ready to extubate.

Objectives: The primary goal is to lower the rate of UE while maintaining a failed extubation rate …

Exploring Parent/Child Peri-Anesthesia Anxiety And Anesthesia Effects On Children, Ann Johnson, Alejandra Lozano, Pauline Chen

2024

RESEARCH

Approximately four million children undergo procedures with anesthesia yearly. For children and parents, this can be anxiety-provoking. In extant literature, level and timing of pre-anesthesia anxiety in children are not adequately studied; associated factors are largely unknown in humans. Preparing for anesthesia and its effects may cause parental worry, and little is known about these effects on school-age children in the weeks following a procedure. The purpose of this study was to explore longitudinal peri-anesthesia factors of anxiety and behavior in children ages 7 through 12. Spanish and English-speaking dyads consented to four data collection points beginning at the …

Nurse Manager Hiring Practices And The Experience Of New Graduate Nurses, Tiffany Montgomery, Zara Sajwani-Merchant

2024

RESEARCH

Purpose
/="/">Hiring decisions have implications for the hiring unit and the healthcare organization, including nursing retention, orientation costs, and organizational culture. Despite available literature, hiring practices, and diversity, equity, and inclusion practices are unknown within nurse residency programs. This study explores the experiences of nursing hiring managers and newly hired nurse candidates with the interview and hiring process into residency programs within the DFW metroplex.
/="/">Methods
/="/">A qualitative phenomenological study was conducted to describe the nursing manager experiences and thoughts through the hiring process and how they compare to nurse candidate’s perspective hired into an established …

Reducing The Burden Of Tracking Age Of Majority (Aom) Research Participant Consents, Beena Pappen, Lindsay Therrian, Bobby Lawrence

2024

QUALITY

Background
/="/">Reconsenting research participants when they reach Age of Majority (AOM) – age 18 in the state of Texas – is a vital responsibility of the pediatric research world. It requires tracking and planning for an activity that may not happen until months, years, or over a decade later. Not obtaining AOM consent may violate the rights of the research participant, as well as impede the ongoing collection and usage of their research data. At the Center for Cancer and Blood Disorders (CCBD) Clinical Research Office (CRO), a very manual process was being used to identify and notify …

Preventing Patient Deterioration By Creating A Reassessment And Escalation Process For The Ed Waiting Room, Virginia Elizondo, Amanda Caipo, Cory Carlos

2024

EBP

Practice Problem:

Long wait times in the emergency department (ED) waiting room significantly impact patient outcomes. Waiting times increase the risk of deterioration, the number of patients leaving without being seen (LWBS), and lead to dissatisfaction with care. 1,2,3 The urgency and significance of early recognition of abnormal vital signs and the appropriate responses cannot be overstated.3 Current ED practices lack a structured process for regular reassessment and escalation in the waiting room.

Literature/Evidence:

A comprehensive literature search was conducted, utilizing EBSCOhost, PubMed, and Ovid. The literature supports continuous reassessment to enhance safety and satisfaction in the waiting room. …

A Transformative Leadership Approach To Reducing Nursing Turnover In A Pediatric Cardiac Intensive Care Unit, Deniro Brown, Lindsey Daigle, Brandi Brown, Julia Gerstmann, Emily Hernandez, Delaney O’Brien, Casey Conrad, Christina Whittington, Lindsey Wren, Gustavo Barbero

2024

INNOVATION

Introduction/Objective:
Retention of nurses in the pediatric cardiac intensive care unit (CICU) is essential for optimal patient outcomes, as nurse experience significantly impacts patient mortality and hospital-acquired conditions. In April 2022, our CICU faced high voluntary turnover among direct bedside nurses. Our immediate goal was to reduce this turnover, with a longer-term objective of improving overall nurse retention.

Methods:|
We established global and SMART aims by comparing organizational benchmarks for nurse turnover with unit-specific data from human resources. Co-managers and eight nurse team leaders conducted stay interviews with direct bedside nurses during the first half of 2022. These …

Improving Sepsis Response, Awareness, And Engagement In The Emergency Department, Virginia Elizondo, Nicole Bizzack, Amber Dayton, Angie Rodick, Ashley Collins, Georgina Hernandez, Amber Albiar

2024

QUALITY

Sepsis background:
Sepsis is the leading cause of death in children² and a global health problem³. The primary source of infection is often not apparent¹, making early patient identification, initiation of sepsis protocols, and continued awareness crucial to improve outcomes and prevent mortality in patients at risk for sepsis.

Purpose:
An emergency department (ED) Sepsis Response Team (SRT) and other initiatives were designed to enhance workflow efficiency, improve time to antibiotic administration (TTA) tominutes, improve sepsis recognition, and uphold standards by maintaining staff engagement.

Implementations:
Once a patient screens positive for sepsis risk, an …

Bridging The Gap: Leveraging Cnap To Enhance Professional Development, Align With Organization Goals And Create A Culture Of Safety, Marissa Crosley, Brooke Harris, Gwenetta Hicks, Cornelius Metili

2024

INNOVATION

Abstract: As our organization strives for its fifth Magnet designation, enhancing nurse professional development has become a clear priority. Currently, only half of our nursing staff participate in the Clinical Nurse Achievement Program (CNAP), highlighting a need for increased engagement. Additionally, feedback from the latest Experience, Inclusion, and Engagement (EIE) Survey identified an opportunity to improve nurse recognition within our department. These insights prompted an exploration of how the Team Lead role, uniquely positioned between frontline nurses and leadership, could be more effectively utilized.

A key challenge identified is the time-consuming process of documenting CNAP achievements. Nurses often defer …

Closing The Gap For Psychiatric Resource Nurse Orientation, Kelly Bonilla, Madison Mcqueen, Cornelius Metili, Annietra Udoh

2024

EBP

A nursing orientation program can positively impact new nurses that are joining the organization (Nobles, 2022). The implementation of a new psychiatric nurse role within the hospital system developed the necessity for an orientation program that would provide quality, safe, and positive outcomes. Psychiatric Resource Nurse roles were created within the organization to provide support and education to staff regarding patients with behavioral or mental health needs. An orientation program was created to support the specific role of the Psychiatric Resource Nurse role to fulfill the need for patient centered care.

A need for an orientation program for Psychiatric …

Fall Prevention Strategies In A Pediatric Epilepsy Monitoring Unit, Bailey Cochrum

2024

EBP

Practice Problem: In 2023, our Epilepsy Monitoring Unit (EMU) had 8 falls, 5 with injuries, up from zero falls with injury in 2022. Enhancing patient and family education on fall risks and prevention is crucial for improving safety and reducing falls.

Literature: Falls in an EMU are common adverse events. Patients with epilepsy are at increased risk of falls due to seizures. In the EMU, seizures are provoked by changing medications, sleep patterns, and stimulation, increasing fall risk and possible injury.

Practice Change(s): For planned EMU admissions, we developed additional seizure-specific education for patients and families, sent prior …

Improving The Lactation Journey: Empowering Moms’ Utilization Of Breast Milk From Admission To Discharge In A Level Iv Neonatal Intensive Care Unit, Rebecca Palmer, Jerithea Tidwell, Traci Hankins, Sharetha Hollier, Nicole Jenkins, Dawn Schindler, Jeanne Gaines

2024

INNOVATION

Background
The benefits of MBM is well-known in literature, especially for infants admitted to the NICU. There is difficulty in engaging and empowering NICU mothers due to multiple barriers including holding limitations, inability to feed orally, and separation of mother and infant for extended periods. Opportunities for improving MBM utilization throughout admission include oral immune therapy (OIT) and/or oral care with MBM, skin to skin (STS), and non-nutritive attempts at breast. Access to lactation education, support, and resources throughout admission is imperative.

Methodology
Utilization of the plan-do-study-act (PDSA) cycle of quality improvement (QI) has improved our overall lactation processes …

Emergent Medication Labels In The Pediatric Intensive Care Unit, Christine Hajovsky

2024

EBP

PICOT: In emergent situations in a pediatric ICU requiring nurses to draw up emergent doses of medication, is it safer to use color coded, pre-printed fill-in-the-dose medication labels vs. our current practice of white handwritten labels? In our pediatric ICUs, nurses use handwritten labels for emergent drug administration, which can lead to illegibility and increased risks of adverse events. This project assessed whether pre-printed, color-coded, fill-in-the-blank labels enhance nurse confidence and nurses’ perceptions of patient safety during emergent drug procedures.

Literature/Evidence: Search strategy in the CINAHL (EBSCOhost) database used MeSH headings and keywords, including English articles published within the …

Ironing Out The Details: Early Detection And Treatment Of Iron Deficiency In A Level 4 Nicu, Rachel Mills

2024

EBP

Practice Problem: In a level 4 neonatal intensive care unit (NICU), no standardized method existed for identifying and treating iron deficiency (ID) in preterm or low birth weight (LBW) infants. Common practice was to adjust iron supplementation based on hematocrit levels, though this was not based on any formal protocol or guideline. ID of the brain in neonates may be associated with neurologic and developmental deficits. Thus, it is prudent to identify and treat early. In a recent survey, providers reported a lack of familiarity with biomarkers for early identification of ID.

Literature/Evidence: A comprehensive review of the literature …

Ready, Set, Code! Investigating The Use Of Two Standardized Resuscitation Algorithms To Improve Outcomes In Patients In A Level 4 Nicu, Lauren Ayala, Grace Farina, Shelby Hudson, Anna Nguyen, Mireya Ortiz, Luke Wuesthoff

2024

EBP

Background:
Resuscitation efforts can be challenging in a Level IV NICU. Most Heath Care Providers in pediatric hospitals are Pediatric Advanced Life Support (PALS) certified. Some NICU providers are certified in both Neonatal Resuscitation Program (NRP) & PALS. There is concern regarding use of NRP vs PALS for Level IV NICU patients who are up to one year of age. Strategies need to be identified to assist nurses in determining which resuscitation algorithm (PALS or NRP) to utilize during a code/peri-arrest event involving patients in a Level IV NICU.

PICO:
Will designing a resuscitation tool improve outcomes and effectiveness …

Partnering Up To Prevent Pediatric Peripheral Intravenous Infiltration, Melissa Ruffini, Ashlyn Coenraad, Rachael Burris-Alcala, Victoria Washington, Emily Jordan Ressman, Alexandra Birely

2024

QUALITY

Background: Peripheral Intravenous Infiltrations and Extravasations (PIVIE) occur in up to 78% of peripheral IVs (PIVs) in some pediatric studies. Proper site assessment is essential in preventing patient harm from PIVIEs, with hourly nursing assessments considered best practice for patients receiving continuous infusions. Many nurses work 12-hour shifts, and evidence suggests that inattentional blindness and cognitive bias can contribute to failure to notice physiologic differences in patient assessments over time. To address this challenge and ensure early identification of symptoms, the local project team proposed an innovative ‘buddy check’ approach to minimize patient harm.

Methods: This quality improvement project …

Standardization Of Adult Transition Across Ambulatory, Virginia Vecchio, Monica Fuller

2024

QUALITY

Background:

Historically, at Children’s Health initiatives involving patient transition to adult care have been focused on the clinics which are ranked in U.S. News & World Report’s Best Children’s Hospitals. Other clinics had no process for transition and were unaware of available resources.

Purpose:

A subgroup from the Ambulatory Clinical Practice Council identified the need for a standardized framework and EPIC documentation that every clinic could utilize.

Methodology:

The Office of Patient Transition (OPT) was onboard with revamping the current program and allowing nurses to drive the changes. A knowledge assessment was performed with nurses in 2022. The results …

Collaboration Is Key: Engaging A Multidisciplinary And Multi-Departmental Team To Create Clinical Practice Guidelines (Cpg) Within A Level Iv Nicu, Rebecca Palmer, Sushmita Yallapragada, Jeanne Gaines, Jerithea Tidwell, Kymeyone Lanehart, Charmaine Shaw

2024

INNOVATION

Background
Within a Level IV collaboration between different disciplines and departments is needed to provide care delivery that is effective and efficient. Emergent situations arise that require care to be provided quickly, including patients with necrotizing enterocolitis (NEC) and/or require bedside surgery. Upon review, multiple inconsistencies and inefficiencies were identified in these processes.

Implementation
Utilizing Lean and Quality Improvement methodology, CPGs were created for both necrotizing enterocolitis and bedside surgery. The steps taken in creation of these CPG include:
 • Identification of key stakeholders of all departments, including neonatology, surgery, and anesthesia
 • Evaluation of the Sepsis CPG to …

Residency Resources To The Rescue!, Jill Hesler, Martha Shaw

2024

INNOVATION

Collaboration and communication between residency facilitators and residency coordinators is imperative to overall nurse residency program and individual resident success. Increased cohort sizes and the lasting impact of a global pandemic to academia continued to contribute to a noticeable trend in nurse residents’ failure to progress. Failure to progress is defined as an inability to move forward during unit level orientation. Signs of failure to progress may include inability to perform new tasks or tasks previously completed, lack of interest in new opportunities, and anxiety disproportionate to the situation. This upward trend was made evident by an increase in …

Caring For Manes: Creating Diverse Hair Care Guidelines For A Large Pediatric Hospital, Jeri Tidwell, Tiffany Montgomery, Phyllis Carter-Riles, Victoria Washington, Kym Lanehart, Jesse Leos

2024

QUALITY

Background
Hair care products should be available to all patients regardless of hair type and texture. Recent movements like the Crown Project sparked pediatric hospitals across the country to focus efforts on ensuring hair care equity for their patients. Children’s health joined the movement by sanctioning a multidisciplinary, multidepartment task force to address BIPOC hair concerns. A smaller group was tasked with aligning practices and policies to address the gaps in education and resources available to assist nurses in caring for ethnic hair.

Methodology
Review of literature was conducted. Limited published work was found. The workgroup benchmarked and consulted …

A Methodical And Multidisciplinary Approach To Reducing Unplanned Extubationin A Level Iv Nicu, Rebecca Palmer, Ashley Reed, Reed Graham, Nimrod Otieno, Veronica Contreras, Jeanne Gaines, Jerithea Tidwell, Alice Figueroa, Travis Reynolds, Syed Ahmed, Sushmita Yallapragada

2024

QUALITY

Background: Unplanned extubations (UE) in neonates can result in severe consequences such as airway obstruction, hypoxia, respiratory distress, and even death. It is crucial to prevent UEs to maintain stable breathing, minimize the need for reintubation, and improve outcomes for neonates in the neonatal intensive care unit (NICU). The multidisciplinary NICU UE team has been working to prevent UEs since 2017. After an increase in 2022, the team conducted an evaluation to identify potential gaps and discovered over 50% of patients were not being reintubated post-event. Identified factors that contributed to UE events were: infants with weight < 4 kilograms; unadjusted high endotracheal tubes (ETT) per x-ray; inadequate sedation; lack of extubation readiness trial; and inadequate taping of the ETT. In 2022, our UE rate spiked to 0.50 UEs/100 vent days which prompted our multidisciplinary team to reinvigorate our work.

Methodology: A …