Medicine and Health Sciences Commons^™

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).

“Restless And Uneasy…Thin And Stretched”: The Ring, The Ringbearers, And Bodies In Psychological Crisis In Tolkien’S The Lord Of The Rings., Sara Brown

Journal of Tolkien Research

The attachment that Tolkien’s Ring-bearers have for the Ring, a twisted and perverted form of love, is sterile and barren; it leaves those affected unable to settle and form fruitful, loving relationships with others, an effect that Tolkien referred to as a “Ring-restlessness.” Gollum, Bilbo, and Frodo all suffer, to their own degree, from the psychological crisis caused by the Ring that renders them uneasy and agitated. This paper examines this crisis through a psychological lens, exploring how the Ringbearers are living in discord with their true selves, and struggling with the meaninglessness of life that the Ring leaves behind.

The Only Thriller J.R.R. Tolkien (Never) Wrote: Jungian Shapes Of Evil In “The New Shadow”, Martin Hauberg-Lund Laugesen, Bo Kampmann Walther

Journal of Tolkien Research

J.R.R. Tolkien's The New Shadow, a fragment set in the Fourth Age of Middle-earth, offers a rich but often overlooked exploration of the psychological and cultural implications of peace following the defeat of Sauron. Although Tolkien abandoned the project, dismissing it as a mere “thriller”, the text presents significant insights into the dynamics of generational conflict, the origins of Evil, and the moral challenges of a post-heroic world. This paper examines The New Shadow through a dual lens: first, by contextualizing Tolkien’s depiction of good and evil within Christian ethical frameworks, and second, by applying Carl Gustav Jung’s psychological …

Tolkien And Attachment Theory : A Theory To Bind Them All?, Lelie Bremont

Journal of Tolkien Research

Tolkien and Attachment theory: One Theory to Bind Them All?

Ever since the first publication of The Hobbit in 1937, Tolkien’s works have been dominating the fantasy genre, often imitated but rarely equalled. Dozens of scholars over decades have looked for the reason behind this success, the secret ingredient that made Middle-earth so compelling.

Nicole Guédeney is a French psychiatrist specializing in Attachment Theory. Attachment Theory emerged in the early 20^th century and combines psychology with anthropology and ethnology to explore the early attachments created between a baby and the adults surrounding them and how these attachments determine the …

Perceiving The Perceiver: “Viewing” Sauron Through The Gestalt Theory Of Perception, Cameron Bourquein

Journal of Tolkien Research

This paper uses Gestalt theory, the Gestalt laws of perception, and the reception theory of Wolfgang Iser to elucidate the character “Sauron” as he appears in The Lord of the Rings, The Rings of Power, and Tolkien’s wider legendarium. It argues firstly that Sauron’s high degree of indeterminacy and ambiguity suggests he can be read as a gestalt entity, one the reader creates by mentally constructing a whole from (seemingly) disparate parts. Building on the semiotics work of Nagy (2013), it argues that Sauron in The Lord of the Rings can be read as gestalt across the spatial, …

Fears And Pains And Rages: The Psychology Of Gandalf's Anger, Nicholas Birns

Journal of Tolkien Research

We are used to seeing emotions in Tolkien as coded morally. Lust or possessiveness is evil whereas care and forbearance are good. There are some emotions, though, that cross these moral boundaries and one of these is anger Moreover, anger in Tolkien is very coded in terms of gender, as it is nearly always male rage. After examining the cases of Saruman and Wormtongue (angry because the world will not cooperate with their plans) and Thingol (angry because he realizes he has just postponed his doom rather than staved it off), we will examine the case of Gandalf. Gandalf is …

Mental Health And Law: How Can Attorneys Improve Their Wellbeing?, Matthew P. Ruble

Honors Program Theses and Research Projects

Mental health is a concern for attorneys that affects elements such as well-being and performance. Poor mental health results in various risky behaviors such as substance abuse, depression, stress, vicarious trauma symptoms, and other issues. The legal profession requires tremendous commitment to the discipline’s work, and poor mental health prevents attorneys from achieving this outcome. Much research about the nature of mental health and law focuses on data prior to or during COVID-19. Literature is analyzed to provide a framework about the current knowledge of mental health in the legal profession. The literature discusses research studies about depression, secondary trauma, …

Quality Improvement Project Promotion Of Policy Adherence Through Education On Shared Governance, Chelsea Baker

Doctor of Nursing Practice Projects

The quality improvement project aimed to enhance compliance with the project site’s policy on participation in shared governance by providing an educational session on the importance of shared governance to faculty roles. Literature reviews revealed that shared governance increases faculty voice and satisfaction with their roles. By educating faculty about the role of shared governance and how to engage in institutional shared governance policies, both the institution and the faculty can benefit from more effective participation, leading to the continuous improvement of the program and incorporation of evidence-based practices into the curriculum. Using a quasi-experimental pre-post design, the principal investigator …

Morphological And Immunohistochemical Support For The Origin Of The Carcinoid Component In Strumal Carcinoids: A Case Report And Literature Review, Yu Liu, Asra Feroze, Liz Yang, Ridin Balakrishnan

School of Medicine Faculty Publications

Strumal carcinoid tumors of the ovary are rare neoplasms composed of an intimate mixture of thyroid and carcinoid tissues. Although various theories regarding their histogenesis have been proposed, evidence confirming the origin of the carcinoid component has been lacking. We report a case of a 40-year-old female with an ovarian strumal carcinoid arising in the background of a mature cystic teratoma. Morphological and immunohistochemical findings support the hypothesis that the carcinoid component originates from the thyroid follicular epithelium, undergoing neuroendocrine differentiation. A single-cell growth pattern was also identified, expanding the known histological spectrum of strumal carcinoids. Our case provides additional …

The Use Of Systemic Inflammatory Response Syndrome (Sirs) Criteria By Nurses In The Nursing Home Setting To Identify Sepsis, Edwin Tobbee Y. Arceo Jr

Doctor of Nursing Practice Final Manuscripts

Background: Sepsis is a life-threatening organ dysfunction caused by an infection. In the United States, treating sepsis costs approximately $23 billion annually, making it the most expensive condition treated in hospitals. Severe infections in nursing homes are estimated to occur in one to three million cases annually. Infections in nursing homes are on the rise, and the cost of hospitalization due to sepsis is increasing dramatically. Diagnosing sepsis is often delayed in nursing homes.

Purpose of the Project: This project aims to train nursing home nurses to use the SIRS screening tool to identify potential sepsis cases early and administer …

Decreasing Dermal Filler Adverse Events Using Qsen And Benner Theoretical Frameworks To Assess Competency, Stacey D. Stephens Ross

Doctor of Nursing Practice Final Manuscripts

Background: Aesthetic nursing is a new branch of nursing practice. Formal nursing education and standards are lacking, making it challenging to assess competency of an aesthetic nurse. Adverse events (AEs) range from minor (bruising) to severe (vascular compromise and blindness) and can be associated with poor technique or lack of knowledge. Standardized practice using evidence-based (EB) protocols is necessary to provide safe, high-quality care. The Institute of Medicine (IOM) and the Joint Commission support the use of the Quality and Safety in Nursing (QSEN) programs to improve outcomes and promote safety. Due to varied training, “experienced” aesthetic nurses may or …

Strategic Policy Development To Reduce Same-Day Cancellations: A Nurse-Led Preoperative Approach, Amanda Kuelz

Doctor of Nursing Practice Final Manuscripts

Background: Same-day surgical cancellations are a persistent and costly issue within outpatient surgery centers, accounting for approximately 5% of elective cases. These disruptions result in inefficient utilization of operating room (OR) time, increased staffing burdens, lost reimbursement, and diminished patient satisfaction. Unanticipated cancellations undermine scheduling reliability and workflow efficiency, contributing to care fragmentation and increased financial strain on health systems. A growing body of evidence suggests that nurse-led, structured preoperative screening has the potential to mitigate these challenges by identifying risk factors in advance and facilitating timely interventions. Nurses' clinical acumen and communication expertise uniquely position them to lead such …

Impact Of Diagnosis To Treatment Interval On Outcomes In Patients With Newly Diagnosed Marginal Zone Lymphoma - A Us Multisite Study, Narendranath Epperla, Geoffrey Shouse, Natalie Grover, Pallawi Torka, Kaitlin Annunzio, Marcus Watkins, Andrea Anampa-Guzmán, Beth Christian, Colin Thomas, Md, Stefan Barta, Praveen Geethakumari, Reem Karmali, Nancy Bartlett, Adam Olszewski

Department of Medicine Faculty Papers

Diagnosis-to-treatment interval (DTI) is an important prognostic factor in patients with newly diagnosed aggressive lymphomas, however the impact of DTI on outcomes in marginal zone lymphoma (MZL) is unknown. In this multicenter retrospective cohort study, we included adult patients with MZL who received first-line immunochemotherapy within 120 days of diagnosis at 10 US medical centers. Patients who received treatment within 60 days from their diagnosis were classified into the short DTI group and those who received treatment beyond 60 days into long DTI group. The primary objective was progression-free survival (PFS), while secondary objectives included overall survival (OS) and cumulative …

Developing The Mycancergene Digital Health Portal To Improve Patients' Understanding Of Germline Cancer Genetic Test Results: Development, User, And Usability Testing Study, Phillip Trieu, Dominique Fetzer, Briana Mcleod, Kathryn Schweickert, Lauren Gutstein, Brian Egleston, Susan Domchek, Linda Fleisher, Lynne Wagner, Kuang-Yi Wen, Cara Cacioppo, Jessica E. Ebrahimzadeh, Dana Falcone, Claire Langer, Elisabeth Wood, Kelsey Karpink, Shelby Posen, Enida Selmani, Angela R. Bradbury

Department of Medical Oncology Faculty Papers

BACKGROUND: The use of multigene panels has significantly increased the likelihood that genetic testing will leave patients with uncertainties regarding test interpretation, implications, and recommendations, which will change over time. Effective longitudinal care models are needed to provide patients with updated information and to obtain patient and family history updates.

OBJECTIVE: To bridge this gap, we aimed to develop a patient- and genetic provider-informed digital genetic health portal (GHP), MyCancerGene, to improve longitudinal patient understanding of and responses to genetic testing.

METHODS: We used a 5-step process to develop MyCancerGene. To better understand their interest in and willingness to use …

Comparative Analysis Of Drug-Induced Sleep Endoscopy With Positive Airway Pressure And Therapeutic Continuous Positive Airway Pressure In The Treatment Of Obstructive Sleep Apnea, Elliott M. Sina, Nicole Molin, Praneet C. Kaki, Henry Ideker, Stephen White, Maurits Boon, Colin Huntley

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

No abstract provided.

Causes Of Death Among Us Medical Residents, Nicholas A. Yaghmour, William E. Bynum, Frederic W. Hafferty, Karen D. Könings, Thomas Richter, Timothy P. Brigham, Thomas J. Nasca

Division of Nephrology Faculty Papers

IMPORTANCE: From 2000 to 2014, the leading causes of medical resident death in the United States were neoplastic diseases and suicide.

OBJECTIVE: To examine whether US medical resident rates of death have changed since 2014 and whether causes of resident death differ by specialty.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, residents and fellows who were enrolled in Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs and who died from January 2015 to December 2021 were submitted to the National Death Index to obtain causes of death. These decedents were compared with residents and fellows who died between …

Physician Assistant 20-Minute Introduction, Daniel Fidel Ferrer

Other Scholarly Works

No abstract provided.

Assessing The Relationship Between Planter Fascia And Planter Calcaneonavicular Ligament Thickness In Individuals Suffering From Planter Fasciitis Using Musculoskeletal Ultrasonography, Wessam Eissa Hamed Attia

Journal of Medicine in Scientific Research

Abstract Objective: There is uncertainty regarding how thick spring ligament is in persons with plantar fasciitis complaints, despite the fact that they exhibit laxity of this ligament. The purpose of this study was to use an ultrasonic imaging system (US) to clarify the anatomical features of spring ligament in individuals who suffer from plantar fasciitis. Methods: The study was conducted on 30 feet of thirty patients suffering from plantar fasciitis representing the painful group and 30 feet of thirty healthy individuals that have no planter pain representing the healthy group that were chosen from Mataria Teaching Hospital's rheumatology and rehabilitation …

Characteristics Of Pediatric Patients With Sports-Related Concussions: A Single Site Retrospective Review, Jose A. Cruz Ayala, Shahrukh Khan, Holly Monk, Emma Cole, Alison Smith, Scott Schultz, Lindsay Elliott, Jessica Zagory

School of Medicine Faculty Publications

PURPOSE: Sports-related concussion (SRC) cases have increased among children in the last decade. Differences in concussion symptoms, presentation, and follow-up care exist when comparing demographics. The aim of this study was to explore SRC within the pediatric population. METHODS: A retrospective chart review of patients ≤ 18 years old diagnosed with SRC at a New Orleans stand-alone children's hospital from January 2007 to December 2021 was performed. T-test and Fisher's exact test were used for relationship between outcomes and sports, demographics, setting, insurance, and follow-up care. RESULTS: Children who sustained SRC at practice were more likely to be male (p …

Early Results With Hypofractionated Gamma Knife Radiotherapy For Treatment Of Vestibular Schwannoma, Omar Azmeh, Samuel R. Barber, Maurice King, Moisés A. Arriaga

School of Medicine Faculty Publications

OBJECTIVE: Vestibular schwannoma (VS) management with stereotactic radiation previously only included stereotactic radiosurgery with Gamma Knife (GKRS) or LINAC-based radiotherapy (LBR). Hypofractionated Gamma Knife radiotherapy (hfGKRS) is a novel protocol potentially producing less toxicity than the alternatives. This study examines early results in tumor control, complications and hearing preservation outcomes in a consecutive series of VS patients treated with hfGKRS. STUDY DESIGN: A retrospective review was conducted for all patients with unilateral VS treated with primary hfGKRS at an academic center between 2017 and 2023. SETTING: Tertiary referral center. INTERVENTIONS: Therapeutic. MAIN OUTCOME MEASURES: Pre- and post-treatment imaging, notes and …

Chronic Inflammatory Pain And Chronic Thc Vapor Inhalation Alter Midbrain Neuronal Activity, Leslie K. Kelley, Nicholas W. Gilpin, Jason W. Middleton

School of Medicine Faculty Publications

In an effort to reduce reliance on opioids for the treatment of pain in the clinic, ongoing work is testing the utility of cannabinoid drugs as a potential alternative for treatment of chronic pain. We tested chronic delta-9 tetrahydrocannabinol (THC) vapor inhalation effects on intrinsic and synaptic properties of ventrolateral periaqueductal gray (vlPAG) neurons in male and female rats treated with complete Freund's adjuvant (CFA). We report that chronic THC vapor inhalation modulates intrinsic and synaptic properties of vlPAG neurons, including reductions in action potential firing rate and spontaneous inhibitory synaptic transmission in males, and that these effects occur specifically …

Implementing Sacred Pause After Patient Death To Reduce Burnout In Icu Nurses, Kimberly Lee

Doctor of Nursing Practice Final Project Abstract

This quality improvement project aimed to implement the Sacred Pause in a hospital Intensive Care Unit (ICU) and evaluate its impact on nurse burnout using the Maslach Burnout Inventory (MBI). Background ICU nurses are at high risk for burnout due to frequent exposure to trauma, highacuity care, and patient death. Burnout can negatively affect nurse well-being, staff retention, and quality of care delivery. The Sacred Pause is a brief, intentional moment of silence observed by staff following a patient’s death. This practice honors the life lost and acknowledges the contributions of the healthcare Methodology team, offering a potential source of …