Medical Specialties Commons^™

Symptom Clusters., Andrea M. Barsevick

Department of Medical Oncology Faculty Papers

No abstract provided.

The Targetable Epigenetic Tumor Protein Ezh2 Is Enriched In Intraocular Medulloepithelioma., Sarah E. Avedschmidt, Anna M. Stagner, Ralph C Eagle, George J. Harocopos, Yali Dou, Rajesh C. Rao

Wills Eye Hospital Papers

Purpose: Intraocular medulloepithelioma (IM), the second most common primary neuroepithelial tumor of the eye, can lead to blindness in the affected eye and in rare cases, is deadly. Intraocular medulloepithelioma lacks targetable biomarkers for potential pharmacologic therapy. The purpose of this study was to identify actionable, tumor-specific proteins for potential diagnostic or therapeutic strategies. We hypothesize that the tumor-specific epigenetic enzyme EZH2 is selectively expressed in IM.

Methods: We conducted a retrospective case series study of five IM from five eyes of four children and one adult. Hematoxylin and eosin (H&E) stains of sections from formalin-fixed, paraffin-embedded blocks of IM …

Differential Item Functioning In The Patient Reported Outcomes Measurement Information System Pediatric Short Forms In A Sample Of Children And Adolescents With Cerebral Palsy., Wendy J. Coster, Pengsheng Ni, Mary D. Slavin, Pamela A. Kisala, Ratna Nandakumar, Mary Jane Mulcahey, David S. Tulsky, Alan M. Jette

Department of Occupational Therapy Faculty Papers

AIM: The present study examined the Patient Reported Outcomes Measurement Information System (PROMIS) Mobility, Fatigue, and Pain Interference Short Forms (SFs) in children and adolescents with cerebral palsy (CP) for the presence of differential item functioning (DIF) relative to the original calibration sample.

METHOD: Using the Graded Response Model we compared item parameter estimates generated from a sample of 303 children and adolescents with CP (175 males, 128 females; mean age 15y 5mo) to parameter estimates from the PROMIS calibration sample, which served as the reference group. DIF was assessed in a two-step process using the item response theory-likelihood ratio-differential …

Should Family Presence Be Allowed During Cardiopulmonary Resuscitation?, Karen J. Brasel, John W. Entwistle Iii, Md, Phd, Robert M. Sade

Department of Surgery Faculty Papers

No abstract provided.

Bleeding With Direct Oral Anticoagulants Vs Warfarin: Clinical Experience., John Eikelboom, Geno J. Merli

Department of Surgery Faculty Papers

The risk of bleeding in the setting of anticoagulant therapy continues to be re-evaluated following the introduction of a new generation of direct oral anticoagulants (DOACs). Interruption of DOAC therapy and supportive care may be sufficient for the management of patients who present with mild or moderate bleeding, but in those with life-threatening bleeding, a specific reversal agent is desirable. We review the phase 3 clinical studies of dabigatran, rivaroxaban, apixaban, and edoxaban in patients with nonvalvular atrial fibrillation, in the context of bleeding risk and management.

Semiological Classification Of Psychogenic Nonepileptic Seizures., Ali Akbar Asadi-Pooya, Jennifer Tinker, Elizabeth W. Fletman

Department of Neurology Faculty Papers

PURPOSE: We classified patients with psychogenic nonepileptic seizures (PNESs) according to a newly proposed classification system. Then, we investigated the demographic and clinical differences between various classes of the patients.

METHODS: We retrospectively investigated all patients with PNESs admitted to the Jefferson Comprehensive Epilepsy Center from 2012 through 2016. We classified the patients into four distinct classes: patients with generalized motor seizures, patients with akinetic seizures, patients with focal motor seizures, and patients with seizures with subjective symptoms. All patients were interviewed by a neuropsychologist and were administered psychological assessment measures, including questions about PNES risk factors. For the statistical …

Haploinsufficiency Of The Myc Regulator Mtbp Extends Survival And Delays Tumor Development In Aging Mice., Brian C. Grieb, Kelli Boyd, Ramkrishna Mitra, Christine M. Eischen

Department of Cancer Biology Faculty Papers

Alterations of specific genes can modulate aging. Myc, a transcription factor that regulates the expression of many genes involved in critical cellular functions was shown to have a role in controlling longevity. Decreased expression of Myc inhibited many of the deleterious effects of aging and increased lifespan in mice. Without altering Myc expression, reduced levels of Mtbp, a recently identified regulator of Myc, limit Myc transcriptional activity and proliferation, while increased levels promote Myc-mediated effects. To determine the contribution of Mtbp to the effects of Myc on aging, we studied a large cohort of Mtbp heterozygous mice and littermate matched …

An Interprofessional Clinical Integrations Pilot Program: Integrating Third-Year Pharmd Students Into Family Medicine Clinics, Eric Gilliam, Pharmd, Arian Hilsendager, Fnp, Erin Hagerman, Pa, Benjamin Kirkley, Md, Benjamin Chavez, Pharmd, Kari Franson, Pharmd

JCIPE Conference

Purpose: Pilot an interprofessional student placement model by entrusting Doctor of Pharmacy students to deliver value-added patient engagement within interprofessional clinical environments.

Background: Beginning in January 2016, pharmacy education standards mandate students actively engage in early patient care experiences with interprofessional teams, thus necessitating new models by which students collaborate with providers in the provision of patient care.

Intervention: Between May and August 2016, two family medicine clinics are incorporating 65 third-year pharmacy students into shared medical patient care visits during an interprofessional-provider introductory pharmacy practice experience (IP Provider IPPE) pilot program. Students engage with patients and …

Evaluation Of Patient Perceptions Of Team Based Care In A Geriatric Oncology Clinic, Kristine Swartz, Md, Andrew Chapman, Do, Lauren Collins, Md, Shoshana Sicks, Med, Abigail Sherburne, Bsn

JCIPE Conference

Purpose: To measure patient perceptions of collaborative practice in an interprofessional team providing geriatric oncology assessments to older patients with cancer.

Background: The Senior Adult Oncology Clinic (SAOC) at Thomas Jefferson University’s Kimmel Cancer Center utilizes an interprofessional team approach to provide comprehensive geriatric oncology assessments and treatment plans for older patients with cancer. The importance of team-based healthcare delivery is well documented, however, experts agree that there is a need for more tools to assess the skills required to become a high-functioning team and a need to study the impact of collaborative practice on patient reported outcomes …

Pulse Shaping For Improved Diagnosis Of Portal Hypertension Using Subharmonic Aided Pressure Estimation, Ipshita Gupta, John R. Eisenbrey, Maria Stanczak, Anush Sridharan, Jaydev K. Dave, Ji-Bin Liu, Christopher Hazard, Colette Shaw, Susan Shamini-Noori, Jonathan M. Fenkel, Michael Soluen, Chandra Sehgal, Kirk Wallace, Flemming Forsberg

Department of Radiology Posters

Subharmonic aided pressure estimation (SHAPE) is based on the inverse relationship between the subharmonic amplitude of contrast microbubbles (obtained by transmitting at the fundamental frequency fo and receiving at fo/2) and the ambient pressure (see fig.1).

A noninvasive ultrasound based pressure estimation procedure would be a major development in the diagnosis of portal hypertension and less invasive than the current catheter-based hepatic venous pressure gradient (HVPG) measurement.

The hypothesis of this study was that portal vein pressures can be monitored and quantified noninvasively in humans using SHAPE.

First selected waveforms were optimized in vitro and in canines, then SHAPE was …

Ictal Kissing: Occurrence And Etiology., Ali Akbar Asadi-Pooya, Elizabeth W. Fletman

Department of Neurology Faculty Papers

Ictal kissing is a rare semiological manifestation in patients with epilepsy. We tried to estimate its occurrence and characterize the underlying etiology. We retrospectively reviewed all video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term "kiss". We then searched the electronic database PubMed on September 21, 2016 using the following search terms in the English language: "ictal" OR "seizure" OR "epilepsy" AND "kiss" OR "kissing". Relevant original studies were included. During the study period, 5133 patients were investigated in our epilepsy monitoring unit. One patient (0.02%) had one episode of documented …

A Prospective Evaluation Of Opioid Utilization After Upper-Extremity Surgical Procedures: Identifying Consumption Patterns And Determining Prescribing Guidelines., Nayoung Kim, Jonas L. Matzon, Jack Abboudi, Christopher M. Jones, William Kirkpatrick, Charles Leinberry, Frederic Liss, Kevin F F. Lutsky, Mark L. Wang, Mitchell Maltenfort, Asif M Ilyas

Rothman Institute Papers

BACKGROUND: Although adequate management of postoperative pain with oral analgesics is an important aspect of surgical procedures, inadvertent overprescribing can lead to excess availability of opioids in the community for potential diversion. The purpose of our study was to prospectively evaluate opioid consumption following outpatient upper-extremity surgical procedures to determine opioid utilization patterns and to develop prescribing guidelines.

METHODS: All patients undergoing outpatient upper-extremity surgical procedures over a consecutive 6-month period had the following prospective data collected: patient demographic characteristics, surgical details, anesthesia type, and opioid prescription and consumption patterns. Analysis of variance and post hoc comparisons were performed using …

A Case Of Arterioportal Fistula Leading To Non-Cirrhotic Portal Hypertension, Sheela S. Reddy, Raja K. Dhanekula, Md, Warren R. Maley, Md, Colette Shaw, Md, Jesse M. Civan, Md, David A. Sass, Md, Jonathan M. Fenkel, Md, Susan Shamini Noori, Md, Dina Halegoua-De Marzio, Md

Division of Gastroenterology and Hepatology Posters

Background

• Arterioportal fistula (APF) is a rare cause of non-cirrhotic portal hypertension.

• This is a case of a hepatic artery-portal vein fistula presenting with recurrent variceal hemorrhage and ascites in a patient with no known liver disease.

Remote Preoperative Tonic-Clonic Seizures Do Not Influence Outcome After Surgery For Temporal Lobe Epilepsy., Ali Akbar Asadi-Pooya, Amin H. Rabiei, Edward J. Gracely, Michael R. Sperling

Department of Neurology Faculty Papers

OBJECTIVES: Tonic-clonic seizures are associated with greater chance of seizure relapse after anterior temporal lobectomy. We investigated whether the interval between the last preoperative tonic-clonic seizure and surgery relates to seizure outcome in patients with drug-resistant mesial temporal lobe epilepsy (MTLE).

METHODS: In this retrospective study, patients were prospectively registered in a database from 1986 through 2014. Postsurgical outcome was categorized as seizure freedom or relapse. The relationship between surgical outcome and the interval between the last preoperative tonic-clonic seizure and surgery was investigated.

RESULTS: One-hundred seventy-one patients were studied. Seventy nine (46.2%) patients experienced tonic-clonic seizures before surgery. Receiver …

Neuromodulation, Stephen Silberstein

Department of Neurology Faculty Papers

Neuromodulation is a new promising treatment for headache disorders. It consists of peripheral nerve neurostimulation and central neurostimulation. © 2016, Touch Briefings. All rights reserved.

Distinct Cell Stress Responses Induced By Atp Restriction In Quiescent Human Fibroblasts., Nirupama Yalamanchili, Andres Kriete, David Alfego, Kelli M Danowski, Csaba Kari, Ulrich Rodeck

Department of Dermatology and Cutaneous Biology Faculty Papers

Quiescence is the prevailing state of many cell types under homeostatic conditions. Yet, surprisingly little is known about how quiescent cells respond to energetic and metabolic challenges. To better understand compensatory responses of quiescent cells to metabolic stress, we established, in human primary dermal fibroblasts, an experimental 'energy restriction' model. Quiescence was achieved by short-term culture in serum-deprived media and ATP supply restricted using a combination of glucose transport inhibitors and mitochondrial uncouplers. In aggregate, these measures led to markedly reduced intracellular ATP levels while not compromising cell viability over the observation period of 48 h. Analysis of the transcription …

A Survey Of Physician Receptivity To Molecular Diagnostic Testing And Readiness To Act On Results For Early-Stage Colon Cancer Patients., Ronald E. Myers, Thomas Wolf, Phillip Shwae, Sarah E. Hegarty, Stephen C. Peiper, Scott A. Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: We sought to assess physician interest in molecular prognosic testing for patients with early stage colon cancer, and identify factors associated with the likelihood of test adoption.

METHODS: We identified physicians who care for patients with early-stage (pN0) colon cancer patients, mailed them a survey, and analyzed survey responses to assess clinician receptivity to the use of a new molecular test (GUCY2C) that identifies patients at risk for recurrence, and clinician readiness to act on abnormal test results.

RESULTS: Of 104 eligible potential respondents, 41 completed and returned the survey. Among responding physicians, 56 % were receptive to using …

An Approach Using Psa Levels Of 1.5 Ng/Ml As The Cutoff For Prostate Cancer Screening In Primary Care., E. David Crawford, Matt T. Rosenberg, Alan W. Partin, Matthew R. Cooperberg, Michael Maccini, Stacy Loeb, Curtis A. Pettaway, Neal D. Shore, Paul Arangua, John Hoenemeyer, Mike Leveridge, Michael Leapman, Peter Pinto, Ian M. Thompson, Peter Carroll, James Eastham, Leonard G. Gomella, Eric A. Klein

Department of Urology Faculty Papers

No abstract provided.

Post-Transplant Outcomes In High-Risk Compared With Non-High-Risk Multiple Myeloma: A Cibmtr Analysis., Emma C. Scott, Parameswaran Hari, Manish Sharma, Jennifer Le-Rademacher, Jiaxing Huang, Dan Vogl, Muneer Abidi, Amer Beitinjaneh, Henry Fung, Siddhartha Ganguly, Gerhard Hildebrandt, Leona Holmberg, Matt Kalaycio, Shaji Kumar, Robert Kyle, Hillard Lazarus, Cindy Lee, Richard T. Maziarz, Kenneth Meehan, Joseph Mikhael, Taiga Nishihori, Muthalagu Ramanathan, Saad Usmani, Jason Tay, David Vesole, Baldeep Wirk, Jean Yared, Bipin N. Savani, Cristina Gasparetto, Amrita Krishnan, Tomer Mark, Yago Nieto, Anita D'Souza

Department of Medical Oncology Faculty Papers

Conventional cytogenetics and interphase fluorescence in situ hybridization (FISH) identify high-risk multiple myeloma (HRM) populations characterized by poor outcomes. We analyzed these differences among HRM versus non-HRM populations after upfront autologous hematopoietic cell transplantation (autoHCT). Between 2008 and 2012, 715 patients with multiple myeloma identified by FISH and/or cytogenetic data with upfront autoHCT were identified in the Center for International Blood and Marrow Transplant Research database. HRM was defined as del17p, t(4;14), t(14;16), hypodiploidy (-Y) or chromosome 1 p and 1q abnormalities; all others were non-HRM. Among 125 HRM patients (17.5%), induction with bortezomib and immunomodulatory agents (imids) was higher …

Practice Characteristics Of Emergency Department Extracorporeal Cardiopulmonary Resuscitation (Ecpr) Programs In The United States: The Current State Of The Art Of Emergency Department Extracorporeal Membrane Oxygenation (Ed Ecmo)., Joseph E. Tonna, Nicholas J. Johnson, John Greenwood, David F. Gaieski, Zachary Shinar, Joseph M. Bellezo, Lance Becker, Atman P. Shah, Scott T. Youngquist, Michael P. Mallin, James Franklin Fair, Kyle J. Gunnerson, Cindy Weng, Stephen Mckellar

Department of Emergency Medicine Faculty Papers

PURPOSE: To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department.

METHODS: We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel.

RESULTS: Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. …

Exploring Patient And Family Satisfaction In Pediatric Neurological Surgery, Randa R. Barsoom, Todd A. Maugans, James F. Burrows, Paul Rosen

Student Papers, Posters & Projects

Introduction Patient and family satisfaction during outpatient visits is correlated with a continuance of care and likelihood to recommend the practice to others. Additionally, patient-family satisfaction can determine the success of the practice and influence medical outcomes. Utilizing a well-validated surveys instrument, patient and family satisfaction can be explored in the office setting. Methods During a consecutive 36 month period, a standardized and validated patient satisfaction survey instrument was provided to the family members of patients who presented to two pediatric neurosurgery clinics associated with Nemours Children's Health System. The completed surveys were analyzed statistically to identify correlations between overall …

Evaluation And Management Of Sleep Disorders In The Hand Surgery Patient., Michael P. Gaspar, Patrick M. Kane, Sidney M. Jacoby, Patrick S. Gaspar, A. Lee Osterman

Department of Orthopaedic Surgery Faculty Papers

Despite posing a significant public health threat, sleep disorders remain poorly understood and often underdiagnosed and mismanaged. Although sleep disorders are seemingly unrelated, hand surgeons should be mindful of these because numerous conditions of the upper extremity have known associations with sleep disturbances that can adversely affect patient function and satisfaction. In addition, patients with sleep disorders are at significantly higher risk for severe, even life-threatening medical comorbidities, further amplifying the role of hand surgeons in the recognition of this condition.

Detection And Characterization Of Circulating Tumor Associated Cells In Metastatic Breast Cancer., Zhaomei Mu, Naoual Benali-Furet, Georges Uzan, Anaëlle Znaty, Zhong Ye, Carmela Paolillo, Chun Wang, Laura Austin, Giovanna Rossi, Paolo Fortina, Hushan Yang, Massimo Cristofanilli

Department of Medical Oncology Faculty Papers

The availability of blood-based diagnostic testing using a non-invasive technique holds promise for real-time monitoring of disease progression and treatment selection. Circulating tumor cells (CTCs) have been used as a prognostic biomarker for the metastatic breast cancer (MBC). The molecular characterization of CTCs is fundamental to the phenotypic identification of malignant cells and description of the relevant genetic alterations that may change according to disease progression and therapy resistance. However, the molecular characterization of CTCs remains a challenge because of the rarity and heterogeneity of CTCs and technological difficulties in the enrichment, isolation and molecular characterization of CTCs. In this …

Community Health Worker Knowledge And Management Of Pre-Eclampsia In Rural Karnataka State, India., Umesh Ramadurg, Marianne Vidler, Umesh Charanthimath, Geetanjali Katageri, Mrutyunjaya Bellad, Ashalata Mallapur, Shivaprasad Goudar, Shashidhar Bannale, Chandrashekhar Karadiguddi, Diane Sawchuck, Rahat Qureshi, Peter Von Dadelszen, Richard Derman

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: In India, the hypertensive disorders of pregnancy and postpartum haemorrhage are responsible for nearly 40 % of all maternal deaths. Most of these deaths occur in primary health settings which frequently lack essential equipment and medication, are understaffed, and have limited or no access to specialist care. Community health care workers are regarded as essential providers of basic maternity care; and the quality of care they provide is dependent on the level of knowledge and skills they possess. However, there is limited research regarding their ability to manage pregnancy complications. This study aims to describe the current state of …

The Clock Is Ticking: Countdown To Metastases., Linda D. Siracusa, Karen M. Bussard

Department of Microbiology and Immunology Faculty Papers

No abstract provided.

Impact Of Hur Inhibition By The Small Molecule Ms-444 On Colorectal Cancer Cell Tumorigenesis., Fernando F. Blanco, Ranjan Preet, Andrea Aguado, Vikalp Vishwakarma, Laura E. Stevens, Alok Vyas, Subhash Padhye, Liang Xu, Scott J. Weir, Shrikant Anant, Nicole Meisner-Kober, Jonathan R. Brody, Dan A. Dixon

Department of Surgery Faculty Papers

Colorectal cancer (CRC) is the third most common cancer and a leading cause of cancer-related mortality. Observed during CRC tumorigenesis is loss of post-transcriptional regulation of tumor-promoting genes such as COX-2, TNFα and VEGF. Overexpression of the RNA-binding protein HuR (ELAVL1) occurs during colon tumorigenesis and is abnormally present within the cytoplasm, where it post-transcriptionally regulates genes through its interaction with 3'UTR AU-rich elements (AREs). Here, we examine the therapeutic potential of targeting HuR using MS-444, a small molecule HuR inhibitor. Treatment of CRC cells with MS-444 resulted in growth inhibition and increased apoptotic gene expression, while similar treatment doses …

Conversion Of Intermediate Lirads Categories To Hepatocellular Carcinoma In Patients With Chronic Hepatitis B: Korean Immigrant Experience, Kofi-Buaku Atsina, Md, Zhenteng Li, Md, Sandeep Deshmukh, Md

Department of Radiology Posters

Introduction and Objective

The Liver Imaging Reporting and Data System (LIRADS) was created to standardize the reporting and data collection of MR imaging for hepatocellular carcinoma (HCC) in high risk patients. The major categories for LIRADS have the following descriptors:

LI-RADS 1 = Definitely benign

LI-RADS 2 = Probably benign

LI-RADS 3 = Intermediate probability for HCC

LI-RADS 4 = Probably HCC

LI-RADS 5 = Definitely HCC

LI-RADS 5V = Definitely HCC with tumor in vein

LI-RADS M = Probable malignancy, not specific for HCC

LI-RADS T = Treated Observation

However, there is a paucity of quantitative evidence for the …

Four-Dimensional (4d) Subharmonic Aided Pressure Estimation For Monitoring Neoadjuvant Chemotherapy Response Of Breast Cancer, Kibo Nam, Maria Stanczak, Anush Sridharan, Adam C. Berger, Tiffany Avery, John R. Eisenbrey, Flemming Forsberg

Department of Radiology Posters

Introduction

Neoadjuvant chemotherapy is a well-established treatment option for patients with non-metastatic breast cancer. The patient response is correlated with survival. However, the optimal method for monitoring neoadjuvant therapy response has not been established. One factor that may affect the response of neoadjuvant therapy is the interstitial fluid pressure (IFP). Increased IFP prevents an effective delivery of therapeutic agents and reduces the efficacy of the therapy. Recently, subharmonic-aided pressure estimation (SHAPE) using contrast-enhanced ultrasound (CEUS) has been developed and its potential was demonstrated in animals as a non-invasive technique for IFP measurements. The SHAPE method estimates IFP based on the …

Aging-Associated Changes In Microrna Expression Profile Of Internal Anal Sphincter Smooth Muscle: Role Of Microrna-133a., Jagmohan Singh, Boopathi Ettickan, Sankar Addya, Benjamin Philllips, Isidore Rigoutsos, Raymond B. Penn, Phd, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

A comprehensive -omic, computational, and physiological approach was employed to examine the (previously unexplored) role of microRNAs (miRNAs) as regulators of IAS smooth muscle contractile phenotype and basal tone. MicroRNA profiling, genome wide expression, validation and network analyses were employed to assess changes in mRNA and miRNA expression in IAS smooth muscles from young vs. aging rats. Multiple miRNAs, including rno-miR-1, rno-miR-340-5p, rno-miR-185, rno-miR-199a-3p, rno-miR-200c, rno-miR-200b, rno-miR-31, rno-miR-133a and rno-miR-206 were found to be up-regulated in aging IAS. qRT-PCR confirmed the up-regulated expression of these miRNAs and down regulation of multiple, predicted targets (Eln, Col3a1, Col1a1, Zeb2, Myocd, SRF, Smad1, …

Higher Body Mass Index (Bmi) And Low-Volume Surgeons Confer Increased Operative Complications In Anterior Spinal Exposures, Aisha Shaheen, Md, Mha, Naveed A. Rahman, Abhay Mathur, Bs, Deepika Koganti, Md, Pgy-4, Alec C. Beekley, Md, Facs, John R. Eisenbrey, Phd, Joshua A. Marks, Md, Michael S. Weinstein, Md, Facs, Fccm, Murray J. Cohen, Md, Facs

Department of Surgery Posters

Background

Anterior spinal exposures performed by spine or vascular surgeons have a known complication rate of 2-11%. We present the largest single institution experience of anterior spinal exposures performed by Acute Care Surgeons.

The purpose of this study was to characterize the incidence of vascular and visceral injuries during spinal exposures and to identify risk factors contributing to operative complications during the exposure. We hypothesized that patients with a BMI >30 as well as low-volume surgeons (<20 >operations) would have an increased complication rate.

Poster presented at: American Association for Surgery of Trauma (AAST) in Hawaii