Medical Specialties Commons^™

The Impact Of Patch Placement Using Fluoroscopy Guidance On Outcome Of Electrical Cardioversion Of Atrial Fibrillation, Joshua France, Luai Madanat, Nolan Shoukri, Daniel Walsh, Ilana Kutinsky, Sujana Gundlapalli, Abhay Bilolikar, Anil Kumar Anil, Brian Williamson, Elvis Cami, Michael Gallagher, Richard Bloomingdale, David E. Haines, Nishaki Mehta

Posters

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and is Conclusions increasing in prevalence, especially as the population ages.1 Proper management of AF is imperative to prevent long-term complications including hemodynamic impairment and thromboembolic events which result in significant morbidity, mortality, and health care cost.2 Electrical cardioversion (EC) is frequently used to restore sinus rhythm in patients with AF.3, 4 However, it can be unsuccessful in up to 10-12% of patients.5 Despite the increased utilization of EC for the treatment of AF, guidelines provide little procedural guidance on methods to maximize EC success rates. Current European and American …

Hypofractionated Regional Nodal Irradiation In Breast Cancer, Joseph Salib, Allison Hazy, Joshua T. Dilworth

Posters

• In women with breast cancer requiring whole breast irradiation therapy (WBI), current guidelines endorse moderately hypofractionated whole breast irradiation (HWBI), which includes a shorter, 3-4-week regimen of radiation with a higher dose per daily fraction in comparison to conventional whole breast irradiation (CWBI), which includes a 5-6.5-week regimen.
• Patients with certain risk factors may benefit from treatment to the regional lymph nodes (RNI), which include the ipsilateral axillary, internal mammary and supraclavicular chains.
• Some centers have been slower to adopt short-course treatment when regional lymph nodes also require treatment (H-RNI), despite a reduction in the number of treatments for the …

Clinical Outcomes Of Hypofractionated Whole Breast Irradiation In Early Stage, Biologically High-Risk Breast Cancer, Eva Leung, Benjamin D. Willen, Thomas J. Quinn, Muayad F. Almahari, Peter Y. Chen, Maha Saada Jawad, Gregory S. Gustafson, Michelle Ka Yan Wu, Joshua T. Dilworth

Posters

• Whole breast irradiation (WBI) has been used in the treatment of breast cancer patients after partial mastectomy.
• There has been increasing utilization of hypofractionated whole breast irradiation (HWBI), defined as a larger daily dose and fewer fractions compared to conventionally fractionated whole breast irradiation (CWBI). However, HWBI for patients with early-stage, biologically high-risk breast cancer remains relatively low.
• We define biologically high-risk breast cancer as either triple negative (estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 (Her-2) negative), Her-2 amplified, and/or patients with a high-risk multigene assay.
• The 2018 ASTRO guidelines form the basis for treating breast cancer patients with …

The Effects Of Untreated Reflux On The Incidence Of Feeding Difficulties In Neonates, Anne Grossbauer, Anya Costeloe, Prasad J. Thottam

Posters

• Gastroesophageal reflux (GERD) is the involuntary regurgitation of gastric contents into the esophagus and commonly occurs in infants.
• It is associated with various consequences related to feeding difficulty, such as feeding resistance, oral aversion, dysphagia, laryngomalacia, and failure to thrive.2
• There is a paucity in the literature regarding the incidence rate of feeding difficulties in latepreterm and full-term neonates in the neonatal intensive care unit (NICU).
• Many NICUs employ the use of anti-reflux medications, such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2As), to treat GERD.3
• The use of these medications is debated and variable due to perceived …

Clinical Differences In Isolated Post-Capillary Pulmonary Hypertension And Combined Pre- And Postcapillary Pulmonary Hypertension, Emily Schneider, Bhavinkumar D. Dalal

Posters

PULMONARY HYPERTENSION (PH) = RESTING MEAN PULMONARY ARTERY PRESSURE (MPAP) > 20 MMHG.

The World Health Organization recognizes five groups of pulmonary hypertensions:

• • Estimated that > 50% of patients with left heart disease are also affected by pulmonary hypertension.1
• 1 in 4 Americans will develop heart failure in their lifetime.
• Gold standard for diagnosis of PH is a right heart catheterization (RHC).3
• Global burden of PH remains unknown as this illness is poorly surveilled and cases remain underestimated.4,5

Barriers To Mental Health Treatment Among Medical Students: Preclinical Vs. Clinical Years, Urvashi Singh, Agnes Wrobel

Posters

Our study aims to:

• Investigate medical students’ attitudes towards seeking assistance from mental health professionals.
• Compare the importance of various barriers that deter help-seeking in preclinical vs. clinical years of medical education.

Pulmonary Embolism In Pregnancy And Early Postpartum – Identifying Significant Variables To Improve Risk Stratification, Nida Haider, Bhavinkumar Dalal

Posters

• Pulmonary embolism (PE) resulting from deep vein thrombosis (DVT) is one of the leading causes of maternal deaths in developed countries1
• The causative Virchow triad (venous stasis, endothelial injury, and hypercoagulable state) is enhanced in pregnancy making pregnancy an independent risk factor1
• Due to significant overlap between normal physiological changes in pregnancy and clinical symptoms of PE, the threshold for CTPA, confirmatory imaging for PE with potentially harmful effects due to ionizing radiation, is low with increasing incidence of false positives2

Understanding Infectious Disease Consultation Role For Septic Patients In The Medical Intensive Care Unit, Marisa Stratelak, Cloe Nazeer, Bhavinkumar Dalal

Posters

• Sepsis is a medical emergency requiring immediate recognition and prompt treatment.
• 1 in every 3 hospitalized patients who die have sepsis1.
• The mortality rate for patients with severe sepsis in the intensive care unit (ICU) is 32.2%2.
• Early intervention with fluid resuscitation and intravenous antibiotics can reduce mortality rates by 7-9%3.
• Infectious disease (ID) consultation on antimicrobial therapy in the ICU is associated with reduced ICU mortality and ICU length of stay (LOS)4.
• Gaps in literature exist regarding frequency of ID consultation for septic patients in the ICU, including comparing outcomes of patients with and without ID consultation.
• It is …

Water-Soluble Contrast Challenge In The Management Of Pediatric Adhesive Small Bowel Obstruction: A Systematic Review, Max Fliegner, Daniel Finn, Spencer Wilhelm, Nathan Novotny, Anthony Stallion

Posters

Background: Adhesive small bowel obstruction (ASBO) is a serious complication of intra-abdominal surgery1 Water-soluble contrast (WSC) challenges have been used for medical management in the adult population2,3

Knowledge Gap: The therapeutic value of water-soluble contrast challenge in the pediatric population with ASBO is under-studied3,4

Research Question: Does administration of water-soluble contrast challenge reduce the need for surgery in pediatric patients with adhesive small bowel obstruction?

Patient Population Representation In Medical Education Textbooks: Gender Imbalance Of Diagnostic Images, Yasin Sahin, Abdul-Majid Khan, Nicolas Baker, Joshua Daniel, Jacob Keeley

Posters

Gender inequality: a longstanding issue that has been gaining overdue attention. Even within esteemed institutions such as medical schools, gender biases persist. Society trusts that those who attend medical school are given the knowledge needed to provide care and support during their most vulnerable moments as patients. While the education may be there, the “patients” may not be represented accurately. Future healthcare professionals must provide care for all patients, a diverse group encompassing all genders, ages, ethnicities, and backgrounds.

In 2019, the United States Census Bureau reported that the population was about 49% male and 51% female.¹ Therefore, medical students …

Quantitative And Comparative Analysis Of Dream Content In Parkinson’S Disease Patients Pre- And Postdeep Brain Stimulation, Sarvar Oreizi-Esfahani, Michael Staud

Posters

Parkinson’s Disease (PD) is a neurodegenerative disorder stemming from the loss of dopaminergic neurons in the substantia nigra, resulting in impaired neuronal activation which primarily affects the body’s motor function1. Common symptoms include tremor, rigidity, akinesia and loss of balance.

PD also exerts significant effects on sleep patterns. The Default Mode Network (DMN), a series of hubs in the brain with increased metabolic rate during rest, are implicated in the process of dreaming2. Differential activation of these regions may alter the content and quality of one’s dreams2. PD has been shown to impact the function of the DMN and as …

You’Re Testing My Patients: Clinicians’ Preferences For Structured Reporting And Measurement Data, Davit Melik, Adela Pouzar, Allan Brazier, Sayf Al-Katib

Posters

Radiological reports are a crucial part of patient care and management. Radiologists play a major role in patient care by interpreting imaging studies and making recommendations to referring physicians. 1,2,3 Although some physicians may prefer to initially interpret the imaging studies by themselves, radiologists’ reports have been shown to be significantly more accurate and detailed, which ultimately results in better patient care. 1,4,5,3 Thus it is important for radiology reports to be timely and as accurate as possible to improve overall patient care. The clarity of communication between radiologists and referring physicians in these reports remains an important factor in …

Incidence Of Symptomatic Upper Extremity Deep Vein Thrombosis In Respect To Subcutaneous Port Venous Access Site In Adults: A Retrospective Review, Catherine Bark, Alexsandra Biel, Corinne G. Bowditch, Paul Bove, Jimmi Mangla

Posters

Subcutaneous ports are an essential component of care in patients who require long-term central venous access and are commonly indicated for patients that require chemotherapy, infusions, intravenous (IV) antibiotics or frequent blood draws.1,2 The catheter of the subcutaneous port is commonly inserted through the subclavian vein and internal jugular vein via percutaneous insertion, or the external jugular vein and cephalic vein via surgical cutdown of the vein.

One of the most common port-related complications is venous thromboembolic (VTE) events with rates of symptomatic VTE as high as 13.6%.4,6–11 Patients with symptomatic upper extremity deep vein thrombosis (DVT) can present with …

Breast Irradiation Is Well Tolerated In Carriers Of A Pathogenic Atm Variant, Leah R. Rotenbakh, Andrew H. Zureick, Dana Zakalik, Thomas J. Quinn, Vincent P. Grzywacz, Peter Y. Chen, Joshua T. Dilworth

Posters

• The ataxia telangiectasia mutant (ATM) gene is implicated in DNA damage repair.
• A pathogenic germline variant of the ATM gene is present in approximately 1% of the population.
• ATM gene variant increases radiation sensitivity and elevates the life-time risk of developing breast cancer by two- to four-fold.
• Potential for increased radiosensitivity poses concern for the utilization of radiation therapy (RT) for oncologic treatment in patients with the ATM gene variant.
• Current data regarding RT tolerance are limited and conflicting in this patient population.
• Current guidelines for hereditary breast cancer management issued jointly by the American Society for Radiation Oncology, American …

A Novel Targeted-Sequencing Panel To Detect Lrp5 Gene Variants In Orphan Pediatric Retinal Diseases, Daeun Jeong, Kenneth P. Mitton, Kimberly A. Drenser

Posters

Orphan pediatric retinal diseases which encompass Familial exudative vitreoretinopathy (FEVR), Norrie Disease, and Retinoschisis are associated with mutations in genes involved in the Wnt signaling network, including FZD4, LRP5, TSPAN12, and NDP. See figure-1. FEVR is a retinal disease that lacks normal vascularization and angiogenesis to the peripheral retina. LRP5 variants account for 10-25% of cases of autosomal dominant FEVR. However, not all cases have been linked to these existing variants. Next generation sequencing was used to sequence 76 subjects for novel variants to expand the spectrum of LRP5 variants and better understand the mechanism of pathogenicity.

Demographics And Pain: An Observational Study Of Men Attending An Urban Health Event, Steven A. Kessler, Michael D. Lutz

Posters

• Chronic pain has been estimated to be present in 11.4 to 24 percent of the population.
• Of the 369 measured diseases, the World Health Organization’s Global Burden of Disease Study has 3 conditions associated with chronic pain in the top.
• The economic burden associated with chronic pain is high, with one study suggesting higher annual costs than heart disease, cancer, and diabetes.
• Studies have shown that race and socioeconomic status are factors associated with higher prevalence of chronic pain.

• Higher in minority populations, and those of lower socioeconomic status.
• One study showed that after correcting for income, employment and adverse …

Nocturia In Men And Associated Comorbidities; A Southeast Michigan Study, Daniel Fortney, Alexander Geisenhoff, Bernadette Zwaans, Michael Lutz

Posters

• Nocturia, defined as waking up during the night to void, is a prevalent condition affecting a considerable proportion of the population.
• Many studies have demonstrated that nocturia is associated with poor quality of life and numerous adverse health outcomes 1,2,3,4.
• Patients with nocturia are estimated to have 60% greater hospitalization rates and 19% higher rates of outpatient visits, equating to an annual economic cost of $3,491 per patient 5.
• Although pre-existing studies have not consistently aligned on the association between nocturia and specific comorbidities, the overall agreement on the negative health outcomes and economic strain caused by untreated nocturia remains …

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. …

Cardiac Magnetic Resonance Imaging Reduces Radiation Exposure In Emergency Department Patients With Chest Pain, Cedric W. Lefebvre, Anna C. Snavely, Nicklaus P. Ashburn, Nathanael Franks, Robin Rainey Kiehl, Simon A. Mahler, Jason P. Stopyra, Lauren E. Koehler, Brian C. Hiestand, Sujethra Vasu, Michael A. Hall, Alan E. Jones, Carol L. Clark, Jeffrey M. Caterino, Subha V. Raman, Chadwick D. Miller

Conference Presentation Abstracts

Background and Objectives: Patients presenting to the Emergency Department (ED) with chest pain who have an indeterminate (detectable to mildly elevated) troponin are often further evaluated with tests that use ionizing radiation. We hypothesized that patients initially evaluated with stress cardiac magnetic resonance (CMR) imaging receive less ionizing radiation through 1-year of follow-up than those initially evaluated with invasive angiography. Methods: We conducted a secondary analysis of the CMR-IMPACT trial, which randomized adult patients at 4 U.S. sites (9/2013– 7/2018) with a contemporary troponin of 0.006–1.0 ng/mL to either CMR imaging or invasive angiography. Cumulative radiation exposure from coronary computed …

Diuretic Dose Ratio Is Associated With Reduced Hospital Length Of Stay In Acute Heart Failure, Sarah Galla, Yuying Xing, Lihua Qu, David A. Berger

Conference Presentation Abstracts

No abstract provided.

Lactate Expression, Mortality, And Length Of Stay In Emergency Department Patients With Sepsis And Intubation, Heaveen Ahdi, Nadine Talia, Ray Lee, Lili Zhao, Ronny Otero, David A. Berger

Conference Presentation Abstracts

Background and Objectives: Studies demonstrate that patients in septic shock with a lactate < 2 have a mortality between 20% to 46%. Our prior work reported that in emergency department (ED) patients with a second lactate ≥2 (lac), there is a two-fold increase in 30-day mortality when compared to patients with a second lactate < 2 (alac). On secondary analysis, we found that intubated patients with a second lactate ≤2 had a longer hospital length of stay (LOS). Our objective is to further scrutinize this 30-day mortality and LOS. Methods: This is a retrospective cohort study of an eight-hospital health system using data from the electronic medical record. Inclusion criteria consisted of patients ≥18 years of age who presented to the ED from 1/1/2017 to 11/30/2022 with ≥2 lactate levels measured in the ED, were diagnosed with sepsis, and admitted to the intensive care unit (ICU) within 24 h. We excluded lactate auto-expressors, pregnant patients, transfers, and those taken for a surgical procedure within 72 h of presentation. Patients were classified based on initial and second lactate as < 2 (alac) or ≥2 (lac). Multivariable regression analysis was performed for 30-day mortality and LOS, adjusting for vitals, BMI, DNR status, and intubation timing. Results: Of the 3100 patients who met inclusion criteria, 1285 patients were intubated and categorized based on their lactate expression: alac -> alac (reference; 111/1285, 8.9%), alac -> lac (28/1285, 2.2%), lac -> alac (259/1285, 20.2%), and lac -> lac (887/1285, 69.0%). Lac -> lac had a significantly higher 30-day mortality (OR = 2.058, 95% CI = [1.353–3.154]) compared to alac -> alac. Lac -> alac had a significantly increased LOS (OR = 1.133 (95% CI = [1.003–1.280]) compared to alac -> alac. Other group comparisons for 30-day mortality and LOS were not significant. Conclusion: Intubated sepsis and septic shock patients in the lac -> lac group had a …

Diuretic Dose Ratio Is Associated With Reduced Hospital Length Of Stay In Acute Heart Failure, Sarah Galla, Yuying Xing, Lihua Qu, David A. Berger

Conference Presentation Abstracts

Background and Objectives: Congestive heart failure (CHF) is anticipated to affect eight million Americans by 2030. Treatment for CHF exacerbation is centered around IV diuretics. There are no current studies indicating an optimal initial diuretic dose in the Emergency Department (ED), and our objective is to test our hypothesis that higher diuretic dose ratio may shorten hospital length of stay (LOS). Methods: We conducted a retrospective cohort study of a large health system from 2016 to 2022. We included patients admitted from the ED with a primary diagnosis of “CHF exacerbation” with a history of CHF and prescribed diuretics. Exclusions …