Medical Specialties Commons^™

Effect Of Comorbidities And Choice Of Treatment On Overall Survival In Elderly Patients With Acute Myeloid Leukemia: A Beaumont Experience, Bilal M. Ali, Emma Herrman, James Huang Huang, Mohammad Muhsin Chisti

Posters

First line therapy for Acute Myeloid Leukemia (AML) is 7+3 regimen. It often cannot be used in elderly patients due to intensity. Venetoclax + hypomethylating agent (HMA) is approved for AML treatment in these patients. We investigate the efficacy of this treatment in a community setting where patients do not have the same resources available to them as a large academic center. Primary outcome was survival of patients greater than 60 years of age with a diagnosis of AML who received 7+3 therapy versus those who received venetoclax + HMA. Secondary outcomes included characteristics of those who received the two …

The Effects Of Bmi On The Development Of Radiation Cystitis Onset: A Pilot Study, Kelsa G. Kazyak, Bernadette Mm Zwaans

Posters

Radiation cystitis (RC) is a debilitating adverse side effect of pelvic radiation therapy. Despite advancements within the field of radiation oncology, the location of the bladder makes it difficult to avoid during radiation and approximately 5-10% of cancer survivors with a history of pelvic radiation are at risk. While RC is not common, the long-term effects can be crippling and we hope to provide more information on the risk factors to help survivors and inform clinicians.

A Prospective Sonographic Evaluation Of Peripheral Intravenous Catheter Associated Thrombophlebitis, Nicholas Mielke, Steven Johnson, Patrick Karabon, Amit Bahl

Posters

Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment.

Evaluation Of Online Patient Information Regarding Emergency Center Utilization, Rachel Truland, Steven Joseph

Posters

The decision a patient makes when seeking emergency medical care comes with risks and ambiguity if the right decision is not made. The internet is increasingly accessible to patients, and they often consult an internet search prior to seeking healthcare. The aim of this study is to assess the readability and reliability of online information regarding a patient’s decision to seek emergency care.

Rapid Response Team Codes Following Transition-Of-Care From The Emergency Department To An Inpatient Medicine Unit, Kerrin Bersani, Brett Todd

Posters

Transitions-of-care from the emergency department (ED) to an inpatient unit have been identified as a high-risk period for medical error due to multiple causes, such as communication mishaps, excessive workload, variability in patient flow, and unclear assignment of responsibility. Patients who experience a diagnostic error are also at increased risk for poor outcomes, including increased length-of-stay and mortality. Rapid Response Teams (RRTs) are frequently utilized by hospitals to address a sudden deterioration in clinical status, often after a transition-of-care. We investigated the occurrence of RRT in patients shortly after a transition-of-care from the ED to a medicine unit. Further, we …

Impact Of Earlier Ophthalmology Clerkships On Medical Student Match Rates In Ophthalmology, Andrew Lee, Steven Joseph

Posters

The purpose of this study is to analyze the association between earlier clerkship exposure and match success, specifically in ophthalmology. Medical schools are constantly changing their clinical curriculums to provide a stronger foundational education to their students. The structure of each medical school’s clerkship curriculum varies in timing, length and availability of certain core and elective rotations. Gaining a better understanding of the factors that affect student match rates in certain specialties can influence changes in clinical curricula to maximize future match success.

Trends & Outcomes In Shoulder Arthroplasty: Comparing Anatomic, Reverse, & Hemiarthroplasty, James Gannon, Anthony Arveschoug, Leonardo M. Cavinatto

Posters

The field of shoulder replacement has evolved greatly since the inception of the reverse shoulder arthroplasty (RTSA) in 2004. With yearly gains of 32%, the RTSA now encompasses the largest portion of shoulder arthroplasty procedures. In contrast, the anatomic total shoulder arthroplasty (ATSA) and hemiarthroplasty (HA) have steadied or decreased. Surgical outcomes between these three procedures are mixed however. The purpose of this study was to characterize trends and outcomes between the RTSA, ATSA, and HA at a large-volume, single-institution center

Decompression And Dynamic Sagittal Tether For Patients With Stenosis And Degenerative Spondylolisthesis: 4 Year Comparative Results To Tlif From The Us Ide Trial, Todd Alamin, Eugene Carragee, Sigurd Berven, Serena Hu, Zack Ray, Elizabeth Yu, Richard Guyer, Calvin Kuo, Matthew Mermer, Mick Perez-Cruet

Conference Presentation Abstracts

Background/Introduction

Introduction. Durable surgical outcome for patients with degenerative spondylolisthesis (DS) usually requires decompression and fusion. An FDA IDE study (NCT03115983) compares direct surgical decompression and stabilization with a novel dynamic sagittal tether (Limiflex, Empirical Spine) (DST) to decompression and instrumented TLIF for symptomatic DS. Aim. Compare clinical outcomes of DST and TLIF to 4 years for symptomatic degenerative spondylolisthesis.

Materials/Methods

Patients and Methods. All patients had DS and spinal canal stenosis with ODI≥35 and VAS-leg/hip≥50 (full eligibility criteria at clinicaltrials.gov, NCT03115983). Patients received a decompression and DST or TLIF at the level of DS, with or without an adjacent …

Biportal Endoscopic Spine Surgery For Lumbar Laminectomy And Discectomy: Post-Operative Outcomes And Surgical Learning Curve, Matthew Lipphardt, Philip Zakko, Ali Jawad, Daniel Park, Maximillian Lee

Conference Presentation Abstracts

Background/Introduction

Biportal endoscopic spine surgery (BESS) is a minimally invasive spinal surgery which has gained increased traction for lumbar laminectomy and discectomy. To justify the transition from tubular or open surgery to BESS, BESS outcomes and surgical learning curve should be known. The primary goal of this study is to evaluate rates of complications with BESS as well as how these rates change with increased surgeon experience, especially in the US environment.

Materials/Methods

A United States Fellowship trained orthopaedic surgeon's clinical practice database was interrogated for consecutive patients who underwent BESS at a single institution. Patients aged greater than 18 …

Osteoporosis Is Underdiagnosed And Undertreated In Patients With Fragility Femoral Neck And Vertebral Compression Fractures, Philip Zakko, Lauren Eberhardt, Madeline Declercq, Ahyoung Park, Megan Audet, Daniel Park

Conference Presentation Abstracts

Background/Introduction

Femoral neck (FNF) and vertebral compression fractures (VCF) are common fragility fractures (FF) in the elderly population. Defined as fractures from low-energy trauma, FF are diagnostic of osteoporosis and require treatment. The purpose of this study was to assess whether patients were appropriately diagnosed and treated for osteoporosis following fragility FNF and VCF.

Materials/Methods

A retrospective chart review was performed at a single-institution from 1/1/2017 to 12/31/2020 on consecutive patients who sustained fragility FNF treated with closed reduction percutaneous pinning, hemiarthroplasty, or total hip arthroplasty or VCF treated with kyphoplasty. Patients <50 years of age, who sustained a high-energy or a non-osteoporotic pathologic fracture, were treated non-operatively, or deceased within one-year post-op were excluded. Preoperative demographics, ASA, CCI, smoking, alcohol, and glucocorticoid use were obtained. Diagnosis and treatment of osteoporosis, including dual-energy X-ray absorptiometry (DEXA) scans, calcium, vitamin D, bisphosphonates, denosumab, and alternative treatments (teriparatide, calcitonin, raloxifene, estrogen) were assessed pre-op and within one-year post-op. Subsequent FF were recorded.

Results

Of 593 patients, 276 FNF and 94 …

A Retrospective Evaluation Of External Rotation At 0 Degree And 90 Degrees Of Abduction After Atrhoscopic Latarjet Procedure, Michael E. Bodine, Shariff K. Bishai, Guy Ball, Cameron King, Lydia Wait, Grace Brannan

Conference Presentation Abstracts

BACKGROUND: Several papers have shown that shoulder stabilizing procedures, including the Latarjet procedure, lead to postoperative external rotation (ER) deficits. However, no study on arthroscopic Latarjet procedures has investigated the effect on ER when the arm is abducted at 0° and 90°. This study examined the relationship between the arthroscopic Latarjet procedure and the subsequent effect on external rotation at both 0° and 90° of abduction compared to the contralateral extremity. METHODS: Records of patients who underwent an arthroscopic Latarjet Procedure from December 2015 to April 2021 were retrospectively evaluated for this study. Requirements included both a three- and six-month …

Public Perception Of Robotic-Assisted Total Hip Replacement Surgery, James E. Feng, Marvee Espiritu, Phillip Vartanyan, Drew Moore, Robert Runner, Mark Karadsheh

Conference Presentation Abstracts

PURPOSE: Computer-assisted and robotic (CA/R) total hip arthroplasty (THA) has gained considerable attention due to its superior accuracy and precision. However, few studies have evaluated the public’s understanding and appraisal of this technology. Here, we evaluate the public’s initial perception of technology-assisted compared to traditional THA, and if interactive education may alter an individual’s preferences. MATERIALS & METHODS: A prospective cohort study was developed utilizing a 48-question, paid survey distributed via a clinically validated, public, online marketplace in April 2022. After collecting baseline demographics and knowledge regarding THA, participants were queried whether they would prefer a CA/R THA or traditional …

Preoperative Mri Delays Surgery In Pediatric Patients With Infectious Atraumatic Extremity Pain, Ethan Englert, Collin Braithwaite, Aaron Lam, Mohamed Sarraj, Maria Aguirre-Flores, Abigail Kumagai, Amr Abdelgawad, Ahmed Thabet Hagag, Waleed Kishta, Ehab Saleh

Conference Presentation Abstracts

INTRODUCTION: Management of atraumatic extremity pain in a pediatric patient often poses a dilemma to the treating orthopedic surgeon. The benefits of timely intervention must often be weighed against the utility of preoperative MRI to better characterize the responsible infection or other pathology. To determine if outcomes were superior for patients who underwent preoperative vs. postoperative MRI, this multicenter study reviewed the hospital courses of pediatric patients who presented with atraumatic extremity pain, underwent irrigation and debridement, and received at least one preoperative or postoperative MRI during their admission. METHODS: This study is a multi-institution retrospective review from four pediatric …

Patellofemoral Disorders, Betina Hinckel

Conference Presentation Abstracts

No abstract provided.

Eliminating Barriers To Prosthetic Use Following Lower Extremity Amputation, Matthew Laskovy, Graham Long, Samuel Osei, Jonathon Murdock, Diane Studzinski, Rose E. Callahan, Otto W. Brown

Conference Presentation Abstracts

OBJECTIVES: Approximately 60,000 lower extremity amputations (LEA) are performed annually in the United States and 38%-55% of those individuals are fitted for a prosthesis. The average price of a lower extremity prosthetic device alone is $10,000, not including the associated costs of physical therapy and prosthetic fitting and maintenance. The most important factor influencing quality of life for individuals who have undergone LEA is the ability to ambulate with a prosthesis. The goal of our study was to investigate characteristics of individuals who abandon use of their prosthesis following LEA and identify any modifiable factors that may increase long-term successful …

Atomic Habits In Meded: Tiny Changes, Remarkable Results, Eric Shappell, Sreeja Natesan, Brett Todd

Website/Multimedia Contributions

No abstract provided.

Pedicle Screw-Associated Violation Of The Adjacent Unfused Facet Joint: Clinical Outcomes And Fusion Rates, Nathan J. Sinz, David Hanwuk Kim, Raymond W. Hwang, Gyu-Ho Lee, Kevin Charles Baker, Rick C. Sasso, Daniel K. Park, Jeffrey S. Fischgrund, Ruijia Niu

Conference Presentation Abstracts

INTRODUCTION: Lumbar spine pedicle screws are the most commonly utilized implants for providing immediate spinal stability during fusion surgery. Ideal pedicle screw positioning includes avoiding violation of any adjacent unfused facet joints. Nevertheless, inadvertent screw malposition and screw-associated violation of adjacent facet joints (FJV) remains a potential complication of the procedure regardless of whether surgery is performed in open fashion or with minimally invasive techniques and despite the use of intraoperative imaging or surgical navigation. Given the proximity of the lumbar vertebral pedicle to the proximal facet joint, FJV occurs almost exclusively at the level of the proximal as opposed …

Analysis Of The Effects Of Intraoperative Neurophysiological Monitoring On Anterior Cervical Surgery: A Michigan Spine Surgery Improvement Collaborative (Mssic) Study, Conner D. Ahlgren, Philip Zakko, Andrew Zachary Blankenship, Daniel K. Park

Conference Presentation Abstracts

INTRODUCTION: The utility of intraoperative neurophysiological monitoring (IOM) for anterior cervical surgery remains controversial. Despite insufficient evidence demonstrating a clear benefit, IOM continues to be utilized and in some areas is considered standard of care. The aim of this study was to evaluate the effects of IOM on anterior cervical surgery outcomes by utilizing data from the Michigan Spine Surgery Improvement collaborative. METHODS: Anterior cervical surgeries from February 2014 to November 2019 were included for analysis. IOM (EMG, MMG, SSEPs, or MEP) was the primary variable examined. Primary outcome measures were: new weakness after surgery, new radicular symptoms, return to …

Assessing General Vs. Spinal Anesthesia As A Risk Factor For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

INTRODUCTION: As bundle payment care initiatives become ever prevalent in total knee arthroplasty (TKA), institutions have increasingly focused on cost-saving measures which maintain or improve upon the standard of care. One area of interest is identifying potential modifiable and non-modifiable risk factors. Here we evaluate the correlations of general versus spinal anesthesia in TKAs in perioperative outcomes. METHODS: All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. Prospective data includes baseline demographics, select medical comorbidities, intraoperative variables and postoperative course/complications. Patients were separated into two …

Shorter Length Of Stay And Increased Return To Work With Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy And Fusion, Philip Zakko, Alex Miller, Daniel K. Park, Jad Khalil

Conference Presentation Abstracts

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are established surgical options for the treatment of cervical radiculopathy, myelopathy, and cervical degenerative disc disease. However, current literature does not demonstrate a clear benefit between ACDF or CDA. The primary objective of this study is to compare the outcomes of ACDF and CDA for patients enrolled in the Michigan Spine Surgery Improvement Collaborative (MSSIC) database. Secondary objectives include assessment of early complications, procedural/perioperative outcomes, and patient-reported outcome measures after both ACDF and CDA. METHODS: Patients undergoing 1 or 2 level ACDF or CDA surgery were included. A …

Assessing Public Reported Perceptions Of Hand Surgery Provided In The Office Vs. An Ambulatory Surgery Center, Trevor Tooley, James Feng, Jannat Khan, Paul Scott Shapiro

Conference Presentation Abstracts

INTRODUCTION: There is a growing body of literature supporting the efficacy, safety, and benefits of wide awake office-based low risk hand surgery. Procedures such as a carpal tunnel release are now, under the right clinical circumstances, being performed in the office-setting as opposed to a traditional operating room. While there is growing evidence supporting technique, procedure room setup, and cost analyses of office-based surgery, there is little investigation into the public perceptions of having surgery done in the office. Here we sought to evaluate public perceptions of undergoing low risk hand surgery in the office setting. METHODS: A prospective survey …

Assessing Risk Factors For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, Phil Vartanyan, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

INTRODUCTION: With the increasing adoption of value-based healthcare initiatives in total knee arthroplasty (TKA), a greater emphasis has been placed on implementing cost-saving measures while maintaining or improving quality of care. One area of interest has been postoperative ED visits. Here we evaluate potential risk factors for 90-day ED visits. METHODS: This is a case control study from a large, tertiary, private, academic institution. All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. All patient charts were subsequently verified and reviewed for all-cause 90-day ED …

Pilot Study Of The Association Between Microbiome And The Development Of Adverse Posttraumatic Neuropsychiatric Sequelae After Traumatic Stress Exposure, Abigail L. Zeamer, Marie-Claire Salive, Xinming An, Stacey L. House, Francesca L. Beaudoin, Jennifer S. Stevens, Donglin Zeng, Thomas C. Neylan, Gari D. Clifford, Robert A. Swor

Articles

Background Patients exposed to trauma often experience high rates of adverse post-traumatic neuropsychiatric sequelae (APNS). The biologic mechanisms promoting APNS are currently unknown, but the microbiota-gut-brain axis offers an avenue to understanding mechanisms as well as possibilities for intervention. Microbiome composition at the time of trauma exposure has been poorly examined regarding neuropsychiatric outcomes. We aimed to determine whether baseline the gut microbiomes of trauma-exposed emergency department patients who later develop APNS have dysfunctional gut microbiome profiles and discover potential associated mechanisms.

Methods We performed metagenomic analysis on stool samples (n=51) from a subset of adults enrolled in the Advancing …

Ultrastructural Findings Of Budding Ballooning Clusters Are Best Correlated With Punctate Autoimmune Antibodies Seen By Immunofluorescence In Minimal Change Disease, Vasudevan Mahalingam, Seyedalireza Fatemi, Wei Li, Hassan Kanaan, Ping Zhang

Conference Presentation Abstracts

Background: The etiology of minimal change disease (MCD) remains a mystery as the only hallmark findings are the diffuse effacement of foot processes by electron microscopy (EM). Punctate IgG staining floating outside of glomerular capillary loops have recently been identified as autoimmune antibodies against nephrin in podocytes from a set of MCD cases (Watts AJB et al., JASN 2022;33:238-252). The corresponding ultrastructural findings by EM, however, of the autoimmune antibodies are not yet described. We hypothesized that budding ballooning clusters (BBC) seen in EM may be correlated with the punctate IgG staining granules. Design: We identified 7 patients with MCD …

A Case Of Hereditary Hemorrhagic Telangiectasia With Juvenile Polyposis Syndrome Associated With Smad4 Mutation, Mai Elzieny, Ashbita Pokharel, Zhenhong Qu

Conference Presentation Abstracts

Background: Hereditary hemorrhagic telangiectasia (HHT), also called Osler–Weber–Rendu syndrome, is an autosomal dominant disease characterized by aberrant blood vessel development throughout the body that results in telangiectasias, arteriovenous malformations (AVMs), and arteriovenous fistulas. Pathogenic variants in multiple genes can cause HHT, with three major disease associated genes, one of which is SMAD4. HHT caused by mutations in SMAD4 is also associated with juvenile polyposis syndrome (JPS), a condition termed JPS-HHT. Histologic features of HHT polyps have not been well characterized other than their non-adenomatous nature. Here we attempt to characterize the histologic features of such polyps in this typical case …

Injured Proximal Tubules Stain Positivity For Arginase-1 To Indicate Acute Tubular Injury (Ati), Jessica Anderson, Neal Blatt, Olabisi Afolayan-Oloye, Hassan Kanaan, Wei Li, Larysa Wickman, Ping Zhang

Conference Presentation Abstracts

Background: A recent study indicates that arginase-1 participates in M2 macrophage-mediated renal tubular regeneration in a rodent model (Shin et al. JASN 2022). As injured proximal tubule cells have a phagocytotic capacity (stain positively for CD68 and kidney injury moleucule-1 in previous studies), we hypothesized that the injured proximal tubules may stain positively for arginase1. Design: We analyzed PAS-stained renal biopsy sections for evidence of ATI using a semiquantitative scale: 0 (no injury) to 1-2+ (mild to moderate ATI) to 3+ (severe ATI). First group (N=7) consisted of renal biopsies that had no evidence of ATI or were obtained from …

Updated Documentation Requirements, Michael Gratson

Website/Multimedia Contributions

No abstract provided.

Leadership Matters: How Leadership Interacts With Physician Burnout In Private And Employed Practice Physicians, Peggy Nowak, Amy Williams

Conference Presentation Abstracts

Project objective/background Physician burnout is an occupational hazard that is multifactorial. Prior research has found that health care leadership qualities impact physician well-being and role satisfaction. However, this research was conducted in a fully employed physician model health system. The current study seeks to further understand the associations of physician satisfaction with their direct leaders and physician burnout and wellbeing in a mixed employed and private practice physician sample. Methods/approach Cross-sectional sample of 1300 physicians in both employed and private practice models received email invitations to take an anonymous survey in mid-2019. The physicians represented specialties providing care at inpatient …

Detection Of Progression Or Regression Of Breast Cancer By Circulating Tumor Dna (Ctdna), Ujjwal Karki, Bipin Ghimire, Emma Herrman, Siddhartha Yadav, Mohammad Muhsin Chisti

Conference Presentation Abstracts

Circulating tumor DNA (ctDNA) are short DNA sequences shed by tumor cells into the systemic circulation. Studies have shown potential utility of the test to predict relapse or recurrence following treatment in solid tumors, but sensitivity and specificity have varied widely, ranging from 19-100% and 80-100% respectively, in breast cancer specifically. Moreover, literature describing the utility of monitoring dynamic changes in ctDNA trends is limited. We aim to evaluate the correlation between ctDNA test, both single test as well as dynamic trends in value over time, with imaging findings.

Responsive Neurostimulation (Rns) Of The Centromedian Nucleus Of The Thalamus For The Treatment Of Drug Resistant Idiopathic Generalized Epilepsy, Angelique Manasseh, Hannah Guider, Brooklynn Bondy, Ayman Haykal, Nour Baki, Ashleigh Terrell, Michael Staudt, Christopher Parres, Andrew Zillgitt

Conference Presentation Abstracts

Rationale: Idiopathic generalized epilepsy (IGE) accounts for approximately one-third of all epilepsies. The majority of people with IGE achieve seizure-freedom from treatment with anti-seizure medications (ASM). However, up to 25% of people with IGE continue to experience seizures despite adequate ASM trials. In patients with drug resistant IGE, neuromodulation with responsive neurostimulation (RNS) in the bilateral centromedian nucleus (CMN) of the thalamus may be an effective treatment option. Methods: Five patients with drug resistant IGE were evaluated through the Beaumont Adult Comprehensive Epilepsy Center and underwent an epilepsy presurgical evaluation including video-EEG monitoring in the epilepsy monitoring unit, brain MRI, …