Medicine and Health Sciences Commons^™

Understanding Inpatient Diagnostic Imaging Use In Children’S Hospitals To Prioritize Stewardship Efforts, Megan Collins, Matt Hall, John R. Stephens, Jessica Markham

Posters

Background: Healthcare waste, including overuse of treatments or testing such as unnecessary diagnostic imaging, has estimated annual costs of over $760 billion in the United States. The most prevalent and costly imaging studies among hospitalized children are not known. Objective: To describe diagnostic imaging studies among hospitalized children with the highest prevalence, cost, rates of repetition, and hospital variation to help inform de-implementation efforts. Design/Methods: We performed a retrospective cohort study of children <18 years of age hospitalized from 1/1/2021 to 12/31/2022 across 45 hospitals in the Pediatric Health Information System. We identified all radiologic imaging for inpatient and observation encounters using billing codes. We grouped images by modality and body location, and excluded images classified as other/unspecified body location. The intraclass correlation coefficient was used to measure variation across hospitals in imaging use after adjusting for age and severity. Higher numbers indicate a higher degree of variation. Results: We identified 1,523,343 encounters; 59.1% had diagnostic imaging (Table 1). The most prevalent diagnostic imaging studies were chest x-ray (XR), abdominal XR, and echocardiogram. The images most frequently repeated were chest XR, echocardiogram, and abdominal XR. The costliest individual diagnostic imaging studies were echocardiogram, chest XR, and head/brain MRI (Table 2). Although chest XR was among the least expensive imaging modalities per unit cost, given the high prevalence of use and repeat use it was one of the costliest tests overall. Head US, interventional XR, and abdominal US had the highest variability of use between hospitals (Table 2, Figure). Conclusion(s): Chest XR and echocardiograms were among the most prevalent, costly, and frequently repeated imaging studies. Abdominal XR, abdominal ultrasound, bone/joint XR, head/brain CT, and head/brain MRI were high in both prevalence and cost among hospitalized children. Five of the 10 most commonly used imaging techniques and four of the 10 most commonly repeated imaging techniques expose children to ionizing radiation. These results could help identify areas that should be targeted to reduce radiation exposure, improve care, and decrease costs for hospitalized children.

The Association Of Season Of Surgery And Patient Reported Outcomes Following Total Hip Arthroplasty, Catherine M. Call, Andrew Lachance, Zachary Radford, Henry Stoddard, Callahan Sturgeon, George Babikian, Adam Rana, Brian J. Mcgrory

Costas T. Lambrew Research Retreat 2024

Introduction

• Understanding the impact of situational variables on surgical recovery can improve outcomes in total hip arthroplasty (THA).

• Literature examining hospital outcomes by season remains inconclusive, with limited focus on patient experience.

• The aim of this study was to investigate if there were differences in hospital and patient-reported outcomes measures (PROMS) after THA depending on the season in an area with 4 distinct seasons.

Machine Learning Approaches For Neurological Risk Stratification Within 6 Hours Of Cardiac Arrest, Richard R. Riker, Qingchu Jin, Hunter Williams, Teresa May, David Seder, Raimond L. Winslow

Costas T. Lambrew Research Retreat 2024

Background:

• Prognostication of neurological outcome should be delayed at least 72 hours after cardiac arrest. Early stratification of risk severity provides important information enabling improved medical decision making, research enrollment, and precision medicine approaches.

• We propose that electroencephalography (EEG)-derived indices are valid biomarkers of severity of neurological injury very early after cardiac arrest.

• This study was designed to assess the relative impact of early clinical data and processed EEG indices in the first 6 hours after recovery of spontaneous circulation (ROSC) after cardiac arrest.

The Impact Of Birth Volume On Neonatal Resuscitation Practices In Neonates Treated With Therapeutic Hypothermia, Allison Zanno, Matthew Ryzewski, Leah M. Seften, Anya K. Cutler, Whittney Barkhuff, Deirdre O Reilly, Jay Kerecman, Alexa Craig, Misty Melendi

Costas T. Lambrew Research Retreat 2024

Background

• Neonatal resuscitation is a high acuity, low-occurrence (HALO) event

• Clinicians in hospitals with low birth volumes lack regular opportunities to maintain Neonatal Resuscitation Program (NRP®) skills due to low birth volumes

• Data used for this analysis was provided through the Northeast Regional Hypothermia Consortium of neonates who received therapeutic hypothermia at four northern New England tertiary care centers

• We investigated differences in resuscitative practices in hospitals with varied birth volumes.

A Retrospective Review Of Cosmetic Surgery Medical Tourism Complications During Covid-19 Pandemic, Rachel Blaisdell, Claire Mcnary, Catherine Barkach, Emanuela Peshel, Elizabeth Boudiab, Lauren Oliver, Samuel Mucci

Posters

• Cosmetic surgery medical tourism refers to traveling outside one’s geographic region for the purpose of a cosmetic procedure
• Benefits include reduced cost, shorter wait times, and newer “trendy” procedures
• Potential problems include a lack of continuity of care for patients, travel after surgery, and exposure to foreign pathogens

Heart Rate Metrics In Surgical Residents Performing An Educational Task Under Stress, Harkirat Jawanda, Kathryn K. Howard, Rose E. Callahan

Posters

Although a moderate amount of stress can be beneficial for performance, excess stress can lead to a decrease in fine motor skills, focus, decision-making skills, and communication.1-3.

• These effects can be especially detrimental in the operating room, where a stress-induced lapse in performance can lead to catastrophic outcomes for patients.
• One unique stressor experienced by surgical residents is observation by an attending surgeon during procedures, which has been shown to lead to an increase in stress related behaviors.4
• Mimicking the stress of the operating room in simulation environments presents the opportunity for residents to improve their ability to recognize and …

Comparing Plastic Surgeon Operative Time For Deep Inferior Epigastric Perforator (Diep) Flap Breast Reconstruction, Christopher J. Issa, Elizabeth M. Boudiab, Jeffrey Desano, Neil S. Sachanandani, Jeremy Powers, Kongkrit Chaiyasate

Posters

The deep inferior epigastric perforator (DIEP) flap has remained the gold standard for perforator flap reconstruction due to its consistent anatomy and low morbidity. Despite higher longterm patient satisfaction in autologous breast reconstruction compared to breast implants,1–3 implant-based reconstruction remains more common due to shorter operative time.

Several studies have examined the issue of optimizing efficiency of autologous breast reconstruction but were typically performed in the context of immediate reconstruction. In our institution and others, however, two-stage delayed reconstruction is the norm — a tissue expander is placed at the first stage for preservation of the skin envelope; after expansion …

Perioperative Antibiotic Use In Neonatal General Surgery: A Survey Of Apsa Membership, Samuel K. Osei, Ashley Williams, Diane Studzinski, Patrick Karabon, Begum Akay, Pavan Brahmamdam

Posters

• Guidelines for antibiotic prophylaxis for surgical site infection (SSI) are widely used for adult patients.
• There is limited data on prophylaxis in pediatrics, and there are no standardized guidelines for neonates.
• Perioperative antibiotic use in neonates based on the surgeon’s preference.

Emergency Department Treatment Of Elevated Blood Pressure In The Headache Patient, Lauren Eberhardt, Michelle Jankowski, Brett Todd

Posters

• Headache is an extremely common emergency department (ED) chief complaint, accounting for 1-3% of emergency department (ED) visits per year globally.
• Headache is often associated with elevated blood pressure and the most frequent clinical manifestation of hypertensive urgency, occurring in 35.9% of patients.5
• First line treatments used for acute headache management in the ED include intravenous fluid (IVF), anti-dopaminergic agents, aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), and ketorolac.6
• Rescue analgesia is needed for pain management in 16% to 18.1% of patients.8,9.
• Rescue analgesia includes: additional doses of first line analgesia or initiation of a second line medication1,6,10,11 such as magnesium sulfate, …

Characterizing The Effectiveness Of Prehospital Pediatric Pain Management In Children With Long Bone Fractures, Revelle Gappy, Ashima Goyal, John Frawley, Sariely Sandoval, Nai-Wei Chen, Remle Crowe, Robert Swor

Posters

Prehospital pediatric pain management has been poorly understood and sub-optimally treated.1-3 Pain scales for children differ from adult pain scales and it is unclear if pain assessments are well documented, particularly in infants and toddlers.4-6 Surveys of emergency medical services (EMS) personnel identify barriers to pain management including discomfort with emergency care of injured children, concern for allergic reactions, additional pain from intravenous catheter insertion, parental influence, as well as lack of knowledge and experience secondary to the relatively infrequent treatment of acutely injured children.7-9

The effectiveness of prehospital pain medication administration for children is unknown, as is the efficacy …

Vesicant Infusates Are Not Associated With Ultrasound-Guided Peripheral Intravenous Catheter Failure: A Secondary Analysis Of Existing Data, Mahmoud Hijazi, Amit Bahl, Nai-Wei Chen

Posters

With over 300 million used annually in the United States, peripheral intravenous catheters (PIVC) are the most commonly used invasive device in the acute care setting1,2. Unfortunately, PIVCs have high failure rates with up to 63% failing prematurely3,4.

Certain intravenous medications categorized as vesicants and irritants are known to cause vein and local tissue injury. The Infusion Nursing Society (INS) created this list based on infusate osmolarity thresholds that increase the likelihood of these complications5.

It is perceived the impact of these medications on larger proximal veins with higher flow rates and improved hemodilution diminishes the likelihood of these complications. …

Quantifying The Importance Of Orthopaedic Surgeon Attributes By The Public, Rasheed Abdullah, James E. Feng, Phillip Vartanyan, Hassan Alosh, Drew Moore, Leonardo M. Cavinatto, Betina Hinckel

Posters

Evaluate what surgeon attributes are currently important to our patients, and what modalities may be most effective in finding orthopaedic surgeons, using online crowdsourcing.

Operative Versus Non-Operative Treatment Of Z-Type Clavicle Shaft Fracture In Adolescents: A Retrospective Study, Sami Azeroual, Colin Van Wagoner, Jeffrey Leider, Ehab Saleh

Posters

• The clavicle is one of the most fractured bones in the human body.
• Traditional treatment involves conservative management with a sling or immobilization but recently the effectiveness of the approach has been questioned.
• Studies done on the adult population have found higher rates of mal or non-union than previously noted, especially in those with displaced or comminuted fractures.
• The noted malunion or non-union was noted to have effects on shoulder mechanics, pain with overhead activity, and loss of strength and endurance.
• Due to differences in physiology the findings in the adult studies do not necessarily translate to the pediatric population. …

Implementing A Two-Nurse Indwelling Urinary Catheter Insertion Process With A Checklist To Decrease Catheter-Associated Urinary Tract Infections In The Intensive Care Unit, Alexa Austin

Doctor of Nursing Practice Final Project Abstract

Implementing a Two-Nurse Indwelling Urinary Catheter Insertion Process with a Checklist to Decrease Catheter-Associated Urinary Tract Infections in the Intensive Care Unit

PURPOSE The purpose of this quality improvement project was to decrease CAUTI rates within the Intensive Care Unit (ICU) by implementing a two-nurse indwelling urinary catheter (IUC) insertion process utilizing the Agency for Healthcare Research and Quality (AHRQ) IUC evidence-based checklist.

BACKGROUND The project was implemented in a 52-bed Medical-Surgical ICU of a large academic specialty hospital in the Southwestern United States of America (USA). At the project site, there was an increase in CAUTI rates above the …

Athletic Identity Association And Prospective Basic Psychological Needs Satisfaction Predict Attitudes Of Collegiate Athletes Toward Seeking Help From The Athletic Department, Allie Zerr

Master's Theses

There is an epidemic of mental health issues that has begun to be more openly talked about in college athletics. In 2022, the National Collegiate Athletic Association has found that college student-athletes are now 1.5-2 times more likely to report struggling with mental health than ever before. Previous research has shown a significant association with basic psychological needs satisfaction and overall psychological well-being. Furthermore, the purpose of this study was to investigate the possible ways that reported of autonomy, competence, and relatedness need satisfaction predicted whether athletes would seek mental health services and identify how athletic identity plays into this …

Improving Patient Safety By Reducing The Use Of Restraint And Seclusion Through De-Escalation In An Inpatient Psychiatric Unit, Ndidiamaka Okafor

Doctor of Nursing Practice Final Project Abstract

Improving Patient Safety by Reducing the Use of Restraint and Seclusion through De-escalation in an Inpatient Psychiatric Unit

PURPOSE:

The purpose of this quality improvement project is to improve safety among adolescent patients ages 13 – 17 on an inpatient psychiatric unit through improved staff de-escalation techniques as evidenced by a decrease in the use of restraint and seclusion combined by 23% from 65% to 50% within 3 months. A secondary aim is that staff will provide self-reported improvement in confidence.

BACKGROUND:

Aggression from adolescents admitted to the inpatient psychiatric unit is one challenge nursing staff face when providing care. …

Insights Into The Radioprotective Efficacy Of Pterocarpus Santalinus L. Aqueous Extract, Eswara N. Hanuma Kumar Ghali, Sravan Kumar Sandopu, Dharmendra Kumar Maurya, Balaji Meriga

School of Medicine Publications

In the present study, we have attempted a comprehensive assessment of the possible radioprotective efficacy of Pterocarpus santalinus aqueous extract (PSAE). All the studied models were gamma-irradiated with prior treatment with PSAE. First, the content of total phenols (4.061 μg/mg gallic acid equivalents), flavonoids (6.616 μg/mg quercetin equivalents), and tannins (0.008 mg/L of PSAE) were determined spectrophotometrically. Second, UHPLC-HRMS analysis was performed to identify the possible radioprotectors. Of those, santalins A & B are known for their usage as natural color in foods and alcoholic beverages identified in PSAE. Treatment was well tolerated with no side effects from PSAE. Later, …

Current Trends And Challenges Of Microbiome Research In Prostate Cancer, Shaun Trecarten, Bernard Fongang, Michael Liss

School of Medicine Publications

Purpose of review: The role of the gut microbiome in prostate cancer is an emerging area of research interest. However, no single causative organism has yet been identified. The goal of this paper is to examine the role of the microbiome in prostate cancer and summarize the challenges relating to methodology in specimen collection, sequencing technology, and interpretation of results.

Recent findings: Significant heterogeneity still exists in methodology for stool sampling/storage, preservative options, DNA extraction, and sequencing database selection/in silico processing. Debate persists over primer choice in amplicon sequencing as well as optimal methods for data normalization. Statistical methods for …

Rising Trends In Metabolically Healthy Obesity In Cancer Patients And Its Impact On Cardiovascular Events: Insights From A Contemporary Nationwide Analysis In The Usa (2016-2020), Vamsikalayan Borra, Akhil Jain, Nithya Borra, Lakshmi Prasanna Vaishnavi Kattamuri, Sidhartha Gautam Senapati, Naga Vamsi Krishna Machineni, Sindhuja Kukkala, Karthikeya Ramasahayam, Kesar Prajapati, Ankit Vyas, Rupak Desai

School of Medicine Publications

Background: Obesity or overweight raises the risk of developing 13 types of cancer, representing 40% of all cancers diagnosed in the United States annually. Given the ongoing debate surrounding the impact of metabolically healthy obesity (MHO) on cardiovascular outcomes, it is crucial to comprehend the incidence of Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs) and the influence of MHO on these outcomes in cancer patients. Methods: Data of hospitalized cancer patients with and without obesity were analyzed from the National Inpatient Sample 2016-2020. Metabolically healthy patients were identified by excluding diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity software, v.2022.1. After …

The Internist's Post V.1 N.3, The University Of Texas Rio Grande Valley. School Of Medicine, Eunbee Cho, Jian Garcia Cruz, Diana Othon Martinez, Edgar Dorsey Trevino, Ramon Elizondo Romo, Roque Mifuji, Martha Solis

School of Medicine Publications

No abstract provided.

Analyzing The Relationship Between Cannabis Use And Hearing Loss, Ashley Howe

Doctoral Scholarly Projects & Capstones

The purpose of this study was to assess the cross-sectional relationship between cannabis use and hearing thresholds to determine if cannabis use is associated with poorer hearing sensitivity while controlling for covariates and other risk factors in a large population-based data set. To answer this question, we analyzed audiometric hearing threshold data, drug use data, and covariate data from the U.S. National Health and Nutrition Examination Survey (NHANES) cycles. A total of 5,140 participants from 2009–2012 and 2015–2016 aged 20–59 years were included in the analyses. Univariable and multivariable main effects logistic regression models were used to compare cannabis use …

Pediatric Ototoxic Monitoring, Destiny Victoria Padilla

Doctoral Scholarly Projects & Capstones

The prevalence of children living with cancer is estimated to be 129,221 in the United States (National Cancer Institute, 2022). The chemotherapy treatment that these children receive can cause ototoxicity, especially when platinum-based chemotherapy agents are used. Ototoxic monitoring is beneficial for patients undergoing chemotherapy treatment as it allows for treatment modification, dosage modification, early intervention, or auditory rehabilitation to take place based on the patient’s hearing status. This is especially important due to the effect hearing loss may have on children’s development and quality of life. There are several objective and behavioral auditory tests that can be used to …

Macrophage Polarization And Colorectal Cancer Immune Checkpoint Protein Expression., Anne Macleod

Electronic Theses and Dissertations

The majority of patients with colorectal cancer do not respond to treatment with immunotherapy. Immunotherapy requires the expression of cell surface immune checkpoint proteins (e.g. PDL1) to exert its effect. Most (>85%) of colorectal cancers do not express these proteins and this contributes in part to the poor prognosis and survival in patients with advanced disease. The patients in which immunotherapy is a potential treatment option, are a genetic subtype known as mismatch repair deficient, and have demonstrated an excellent response to anti-PD-1/PDL1 immunotherapy. A key feature of mismatch repair deficient (MMRd) cancers is their immune cell rich tumor …

The 2022 Symposium On Dementia And Brain Aging In Low- And Middle-Income Countries: Highlights On Research, Diagnosis, Care, And Impact, Raj Kalaria, Gladys Maestre, Simin Mahinrad, Daisy Acosta, Rufus Akinyemi, Suvarna Alladi, Ricardo Allegri, Faheem Arshad, Wambui Karanja, Chinedu Momoh

Brain and Mind Institute

Two of every three persons living with dementia reside in low- and middle-incomecountries (LMICs). The projected increase in global dementia rates is expected toaffect LMICs disproportionately. However, the majority of global dementia care costsoccur in high-income countries (HICs), with dementia research predominantly focus-ing on HICs. This imbalance necessitates LMIC-focused research to ensure thatcharacterization of dementia accurately reflects the involvement and specificities ofdiverse populations. Development of effective preventive, diagnostic, and therapeu-tic approaches for dementia in LMICs requires targeted, personalized, and harmonizedefforts. Our article represents timely discussions at the 2022 Symposium on Demen-tia and Brain Aging in LMICs that identified the foremost …

A Systematic Review Of Mental Health Of Women In Fragile And Humanitarian Settings Of The Eastern Mediterranean Region, Fauziah Rabbani, Aysha Zahidie, Amna Siddiqui, Sanam Shah, Zul Merali, Khalid Saeed, Mohamed Afifi

Brain and Mind Institute

Background: The increasing emergencies and humanitarian challenges have worsened the mental health condition of women in the Eastern Mediterranean Region.

Aim: To assess the prevalence, determinants and interventions to address mental health among women in fragile and humanitarian settings in the Eastern Mediterranean Region.

Methods: Using the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, we reviewed 59 peer-reviewed published studies (PubMed, IMEMR) and grey literature (WHO/IRIS) from January 2001 to February 2023, focusing on women's mental health in the Eastern Mediterranean Region. We then conducted a descriptive analysis of the sociodemographic characteristics.

Results: Among …

Amphipathic Hybrid Cyclic-Linear Peptides As A Drug Delivery System, Jonathan Moreno

Pharmaceutical Sciences (PhD) Dissertations

Amphipathic Hybrid Cyclic-Linear Peptides as a Drug Delivery System by Jonathan A. Moreno Peptides

[RW]₄ and [R₅W₄] have been previously identified as molecular transporter Cell Penetrating Peptide (CPP) and antimicrobial agents, respectively. These peptides consisted of alternating and non-alternating arginine (R) as positively charged residues and tryptophan (W) as hydrophobic residues. Herein we report the synthesis of two hybrid amphipathic cyclic-linear cell-penetrating peptides [RW]₄K-AH135 (1) and [R₅W₄]K-AH135 (2) composed of [RW]₄ and [R₅W₄] and a linear peptide AH-135 (Ac)NH-RWLRRWLRWWRR-COOH. The …

Approvals, Utilization, And Cost Of Biologics For The Treatment Of Rheumatoid Arthritis, Roya Hosseini

Pharmaceutical Sciences (PhD) Dissertations

Introduction: RA treatment has been revolutionized by the development and approval of biologic disease-modifying antirheumatic drugs (bDMARDs). However, the approval status, utilization, and high cost of bDMARDs pose challenges in RA management.

Objectives: This dissertation evaluated the association between the utilization of bDMARDs and the sociodemographic characteristics of the RA patient population. It also identified the FDA approval status of bDMARDs and assessed the annual cost of bDMARDs used in RA treatment, evaluated the factors explaining annual cost at market entry.

Methods: In the retrospective analysis of Medical Expenditure Panel Survey (MEPS) data from 2010-2021, the population includes RA patients …

Mechanistic Study Of Antimicrobial Cyclic Peptide [R4w4] Antibacterial Effectiveness Against Methicillin-Resistant Staphylococcus Aureus (Mrsa), Ajayi Akinwale

Pharmaceutical Sciences (PhD) Dissertations

Antimicrobial peptides (AMPs) are being explored as a potential solution to combat antibiotic resistance, as they have shown promise in reducing susceptibility to antibiotics. This study explores if [R₄W₄] peptide is bacteriostatic or bactericidal using modified two-fold serial dilution and evaluates synergism of gentamicin and [R₄W₄] against Escherichia coli (E. coli) and Methicillin-resistant Staphylococcus aureus (MRSA) by checkered board assay. The MRSA resistant to [R₄W₄] and possibility with other antibiotics was evaluated with serial passage. Moreover, we investigated the mechanism of action of [R₄W_{4 …}

Perceptions Of Metabolic Syndrome Management Utilization In Relation With Patient Characteristics And Health-Related Quality Of Life, Olajide Adekunle

Pharmaceutical Sciences (PhD) Dissertations

Challenges in managing MetS include untreated risk factors and ineffective management, resulting in poor health-related quality of life (HRQoL). A significant factor contributing to these challenges is the underutilization of management services, possibly due to patients' perceptions of disease management resource utilization (PMU). Therefore, understanding patients' PMU is crucial for improving health outcomes. The study investigated PMU, explored PMU predictors, and investigated the impact of PMU and patients’ demographics on HRQoL. Using a cross-sectional design, data on perceptions of healthcare, medication, and pharmacy service utilization, prior experience with pharmacy services, demographics, and HRQoL were collected from adult individuals with obesity …

The Power Of Empowerment: What Happens When We Include Patients In Nutritional Decision-Making, Katarina Konstantino Bsn, Julia Vaughan Bsn, Jennifer Hillyard Bsn

Nurse Residency

In hospitalized patients, how do personalized meal selections impact patient satisfaction and overall quality of life during hospital stays?