Medical Specialties Commons^™

Stimwave For Pudendal Neuralgia, Ly Hoang Roberts, Joshua Volin, Teresa Mccartney, Annah Vollstedt, Kenneth M. Peters

Conference Presentation Abstracts

Introduction: In patients with pudendal neuralgia refractory to traditional therapies, prior studies have shown efficacy in chronic stimulation with Interstim® (Medtronic, Inc., Minneapolis, MN). This study reports on a wireless system to power an implanted lead at the pudendal nerve, StimWave®, to treat pudendal neuralgia. Methods: Retrospective chart review identified patients with a lead placed at the pudendal nerve for neuralgia and powered wirelessly. Clinical outcomes were assessed at postoperative visits and phone calls. Administered non-validated follow-up questionnaire evaluated the GRA, percentage of pain improvement, satisfaction with device, and initial and current settings of the device (hours/day of stimulation). Results: …

Multi-Institutional Outcomes Of A One-Sided Dorsal Onlay Buccal Mucosal Urethroplasty For Penile Urethral Strictures Accessed Via A Penoscrotal Incision, David Abramowitz, Felicia Balzano, Jay Simhan, Frank Burks, Dmitriy Nikolavsky, Stephen Blakely

Conference Presentation Abstracts

Introduction: Optimal surgical management of penile urethral strictures remains unclear. Herein, we report our multi-institutional series of patients undergoing a one-sided dorsal onlay buccal mucosal urethropalsty for penile urethral strictures accessed via a penoscrotal invagination technique. Methods: We retrospectively reviewed consecutively treated penile urethral stricture patients who underwent a one-sided dorsal onlay buccal mucosal urethroplasty accessed via a penoscrotal incision and penile invagination across 7 institutions. This technique is a modification of the Kulkarni invagination technique to include penoscrotal rather than perineal incision for penile strictures. Thus, allowing for supine positioning, and less dissection to reach the stricture location. Minimum …

Medical Outcomes, Quality Of Life, And Family Perceptions For Outpatient Vs Inpatient Neutropenia Management After Chemotherapy For Pediatric Acute Myeloid Leukemia, Kelly D Getz, Julia E Szymczak, Yimei Li, Rachel Madding, Yuan-Shung V Huang, Catherine Aftandilian, Staci D Arnold, Kira O Bona, Emi Caywood, Anderson B Collier, M Monica Gramatges, Meret Henry, Craig Lotterman, Kelly Maloney, Amir Mian, Rajen Mody, Elaine Morgan, Elizabeth A Raetz, Jeffrey Rubnitz, Anupam Verma, Naomi Winick, Jennifer J Wilkes, Jennifer C Yu, Brian T Fisher, Richard Aplenc

Department of Medicine Faculty Papers

Importance: Pediatric acute myeloid leukemia (AML) requires multiple courses of intensive chemotherapy that result in neutropenia, with significant risk for infectious complications. Supportive care guidelines recommend hospitalization until neutrophil recovery. However, there are little data to support inpatient over outpatient management.

Objective: To evaluate outpatient vs inpatient neutropenia management for pediatric AML.

Design, setting, and participants: This cohort study used qualitative and quantitative methods to compare medical outcomes, patient health-related quality of life (HRQOL), and patient and family perceptions between outpatient and inpatient neutropenia management. The study included patients from 17 US pediatric hospitals with frontline chemotherapy start dates ranging …

The Write Stuff - Autumn 2021 (Vol. 18, No. 4), Research Medical Library

Write Stuff 2021

• The growing acceptance of preprints in biomedical publishing
• NIH biosketch changes
• Opening up the functionality of Microsoft Word with the Read Aloud tool
• NCI’s Author Arranger tool for manuscript title pages
• NIH tips for writing a research plan
• Unusual terms used in scientific writing and publishing: Creative Commons

Initial Laparotomy Versus Peritoneal Drainage In Extremely Low Birthweight Infants With Surgical Necrotizing Enterocolitis Or Isolated Intestinal Perforation: A Multicenter Randomized Clinical Trial, Martin L Blakely, Jon E Tyson, Kevin P Lally, Susan R Hintz, Barry Eggleston, David K Stevenson, Gail E Besner, Abhik Das, Robin K Ohls, William E Truog, Leif D Nelin, Brenda B Poindexter, Claudia Pedroza, Michele C Walsh, Barbara J Stoll, Rachel Geller, Kathleen A Kennedy, Reed A Dimmitt, Waldemar A Carlo, C Michael Cotten, Abbot R Laptook, Krisa P Van Meurs, Kara L Calkins, Gregory M Sokol, Pablo J Sanchez, Myra H Wyckoff, Ravi M Patel, Ivan D Frantz, Seetha Shankaran, Carl T D'Angio, Bradley A Yoder, Edward F Bell, Kristi L Watterberg, Colin A Martin, Carroll M Harmon, Henry Rice, Arlet G Kurkchubasche, Karl Sylvester, James C Y Dunn, Troy A Markel, Diana L Diesen, Amina M Bhatia, Alan Flake, Walter J Chwals, Rebeccah Brown, Kathryn D Bass, Shawn D St Peter, Christina M Shanti, Walter Pegoli, David Skarda, Joel Shilyansky, David G Lemon, Ricardo A Mosquera, Myriam Peralta-Carcelen, Ricki F Goldstein, Betty R Vohr, Isabell B Purdy, Abbey C Hines, Nathalie L Maitre, Roy J Heyne, Sara B Demauro, Elisabeth C Mcgowan, Kimberly Yolton, Howard W Kilbride, Girija Natarajan, Kelley Yost, Sarah Winter, Tarah T Colaizy, Matthew M Laughon, Satyanarayana Lakshminrusimha, Rosemary D Higgins, Eunice Kennedy Shriver National Institute Of Child Health And Human Development Neonatal Research Network

Faculty, Staff and Student Publications

OBJECTIVE: The aim of this study was to determine which initial surgical treatment results in the lowest rate of death or neurodevelopmental impairment (NDI) in premature infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP).

SUMMARY BACKGROUND DATA: The impact of initial laparotomy versus peritoneal drainage for NEC or IP on the rate of death or NDI in extremely low birth weight infants is unknown.

METHODS: We conducted the largest feasible randomized trial in 20 US centers, comparing initial laparotomy versus peritoneal drainage. The primary outcome was a composite of death or NDI at 18 to 22 months corrected …

Initial Laparotomy Versus Peritoneal Drainage In Extremely Low Birthweight Infants With Surgical Necrotizing Enterocolitis Or Isolated Intestinal Perforation: A Multicenter Randomized Clinical Trial, Martin L Blakely, Jon E Tyson, Kevin P Lally, Susan R Hintz, Barry Eggleston, David K Stevenson, Gail E Besner, Abhik Das, Robin K Ohls, William E Truog, Leif D Nelin, Brenda B Poindexter, Claudia Pedroza, Michele C Walsh, Barbara J Stoll, Rachel Geller, Kathleen A Kennedy, Reed A Dimmitt, Waldemar A Carlo, C Michael Cotten, Abbot R Laptook, Krisa P Van Meurs, Kara L Calkins, Gregory M Sokol, Pablo J Sanchez, Myra H Wyckoff, Ravi M Patel, Ivan D Frantz, Seetha Shankaran, Carl T D'Angio, Bradley A Yoder, Edward F Bell, Kristi L Watterberg, Colin A Martin, Carroll M Harmon, Henry Rice, Arlet G Kurkchubasche, Karl Sylvester, James C Y Dunn, Troy A Markel, Diana L Diesen, Amina M Bhatia, Alan Flake, Walter J Chwals, Rebeccah Brown, Kathryn D Bass, Shawn D St Peter, Christina M Shanti, Walter Pegoli, David Skarda, Joel Shilyansky, David G Lemon, Ricardo A Mosquera, Myriam Peralta-Carcelen, Ricki F Goldstein, Betty R Vohr, Isabell B Purdy, Abbey C Hines, Nathalie L Maitre, Roy J Heyne, Sara B Demauro, Elisabeth C Mcgowan, Kimberly Yolton, Howard W Kilbride, Girija Natarajan, Kelley Yost, Sarah Winter, Tarah T Colaizy, Matthew M Laughon, Satyanarayana Lakshminrusimha, Rosemary D Higgins, Eunice Kennedy Shriver National Institute Of Child Health And Human Development Neonatal Research Network

Faculty, Staff and Student Publications

OBJECTIVE: The aim of this study was to determine which initial surgical treatment results in the lowest rate of death or neurodevelopmental impairment (NDI) in premature infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP).

SUMMARY BACKGROUND DATA: The impact of initial laparotomy versus peritoneal drainage for NEC or IP on the rate of death or NDI in extremely low birth weight infants is unknown.

METHODS: We conducted the largest feasible randomized trial in 20 US centers, comparing initial laparotomy versus peritoneal drainage. The primary outcome was a composite of death or NDI at 18 to 22 months corrected …

Terrorism In Your Brain: The Battles Of Multiple Sclerosis (Ms), Paul W. Asper

Student Publications

This paper is a review of Multiple Sclerosis (MS) looking at the phenotypes, epidemiology, etiology, pathology, and immunology. Additionally, this paper examines the clinical presentations and criteria for diagnosis along with the treatment and management of symptoms.

Short-Term Impact Of Bracing In Multi-Level Posterior Lumbar Spinal Fusion, Ryan Dimentberg, Saurabh Sinha, Gregory Glauser, Ian F. Caplan, James M. Schuster, Scott Mcclintock, Jang W. Yoon, Paul J. Marcotte, Zarina S. Ali, Neil R. Malhotra

Mathematics Faculty Publications

Background: Clinical practice in postoperative bracing after posterior lumbar spine fusion (PLF) is inconsistent between providers. This paper attempts to assess the effect of bracing on short-term outcomes related to safety, quality of care, and direct costs.

Methods: Retrospective cohort analysis of consecutive patients undergoing multilevel PLF with or without bracing (2013-2017) was undertaken (n = 980). Patient demographics and comorbidities were analyzed. Outcomes assessed included length of stay (LOS), discharge disposition, quality-adjusted life years (QALY), surgical-site infection (SSI), total cost, readmission within 30 days, and emergency department (ED) evaluation within 30 days.

Results: Amongst the study population, 936 were …

Bassini Inguinal Hernia Repair: Obsolete Or Still A Viable Surgical Option? A Single Center Cohort Study, Wayne Tse, William Johns, James Maher, Jeannie Rivers, Thomas Miller

Department of Orthopaedic Surgery Faculty Papers

Background: Most inguinal hernias are presently repaired using some type of mesh technique. This mesh can be placed through an inguinal incision or positioned through a laparoscopic approach. Either way, results have been impressive including a low recurrence rate, minimal pain and a rapid return to work and normal activity compared to tissue based approaches. Notwithstanding these results, there is still a subset of patients who, for various reasons, are strongly opposed to having a mesh repair. This study summarizes our 13 year experience with such patients and why the Bassini hernia repair is a viable surgical option in these …

Descriptive Study Of The Safety Behaviors And Attitudes Of Portable Pool Owners, Kristyn Jeffries, Kathy W. Monroe, Alicia Webb, Kristin L. Chancellor, Justina C. Goldman, David C. Schwebel

Posters

Background Drowning is the leading cause of injury death for children 1-4 years old and the second leading cause for children 5-9 years old. Most prior epidemiology work has focused on submersions in below-ground swimming pools and natural bodies of water. Portable pools pose a new and emerging risk for drowning due to their affordability, convenience, and easy assembly. Successful drowning prevention consumer products, such as 4-sided fencing, may prove more difficult to implement with portable pools, and currently are not marketed for such use. Furthermore, parental perceptions and knowledge of drowning risks associated with portable pools has not yet …

Diabetic Preventative Care In A Resident Clinic: A Quality Improvement Study, Karishma Chopra, Charity Owusu-Asare, Aimee Espinosa, Alexandra Halalau

Conference Presentation Abstracts

Introduction: Studies have shown significant gaps in diabetic preventative care in resident clinics compared to private clinics of practicing physicians. In our medicine-pediatrics resident clinic at Beaumont Hospital, diabetic point of care resources are largely underutilized. We aim to improve the care of patients with diabetes by increasing resident awareness of point of care A1c and retina scan resources. Methods: A team of residents, attendings, and nurses was created. Baseline data looking at use of point of care resources, specifically the number of orders placed in electronic medical record for A1c and retina scan tests, was obtained. A root cause …

Type 1 Cryoglobulinemia Secondary To Primary Plasma Cell Leukemia, Antonio Faieta, Khatoon Tawhida

Conference Presentation Abstracts

Primary plasma cell leukemia (pPCL) is a rare and aggressive form of plasma cell dyscrasia that comprises 1% of the plasma cell dyscrasias. Even more rare is its association with type 1 cryoglobulinemia which management can be challenging. A 63-year-old African American male with no past medical history presented with severe burning pain in his legs, necrotizing rash, constitutional symptoms and severe acute kidney injury (AKI). HIV, hepatitis B and C were negative. Serum electrophoresis revealed an M-spike of 5.67, IgG of 7000, free lambda of 152.10 with a K/L of 0 and cryoglobulin of 81%. CT revealed extensive lytic …

Massive Pulmonary Embolism After Pfizer Vaccine, Samiksha Pandey, Bipin Ghimire, Emma Herrmann, Dilip Khanal

Conference Presentation Abstracts

Introduction Vaccines against COVID -19 have been reported to cause venous thromboembolism (VTE). To our knowledge, this is the first case to report the massive, near-fatal Pulmonary Embolism (PE) associated with BNT162b2 Covid-19 (Pfizer/BioNTech) vaccine and discuss the associated risk factors for PE. Case 41-year-old, non-smoker, female on OCP, presented for syncope and seizure-like activity. Upon presentation, she was obtunded and tachypneic. Initial labs showed leukocytosis, mild anemia, and thrombocytopenia, respiratory and metabolic acidosis. She deteriorated quickly to cardiac arrest requiring Cardiopulmonary Resuscitation and intubation. Tissue Plasminogen Activator administered for possible PE. Computed Tomography Angiography (CTA) pulmonary confirmed sagittal pulmonary …

Improving Telemetry Utilization In An Inpatient Hospital Setting, Kamil Sardarli, Lauren Reinhold, Ankit Arora, Sumesh Khanal, Pradeep Kaminoulu, Alexandra Halalau

Conference Presentation Abstracts

Background: Telemetry is a cardiac monitor that continuously records heart activity and monitors abnormal rhythms. Most current clinical indications are limited to 48 hours maximum, but telemetry monitoring service (TMS) is commonly used for a greater duration. This leads to resource exploitation that may create limitations of the resource and also comes with economic burden. Limiting usage to appropriate indications and durations can reduce overall costs and improve profit margin for the hospital and also cut down on unnecessary burden for patients. Through our study, we aim to decrease TMS overuse. Methods: The study was done at Beaumont Hospital Royal …

Concordance Between Antibiotic Resistance Genes By Multiplex Polymerase Chain Reaction And Antibiotic Susceptibility By Pooled Antibiotic Sensitivity Testing In Symptomatic Patients With Urinary Tract Infection, Annah Vollstedt, Dakun Wang, Natalie Luke, David Baunoch, Kirk J. Wojno, Howard Korman, Natalie Gaines, Shuguang Huang, S Mohammad Jafri, David Wenzler, Patrick Cacdac, Frank Burks, Larry Sirls

Conference Presentation Abstracts

Introduction: Studies have shown many genes influence antibiotic resistance, and the relationship between genotypic and phenotypic antibiotic resistance is unclear. We sought to analyze the concordance between the presence of antibiotic resistance (ABR) genes and antibiotic susceptibility results. Methods: Urine samples were collected from patients presenting with possible UTI to 37 Urology clinics from July 2018 to February 2019. Multiplex polymerase chain reaction (M-PCR) was used to test for 33 ABR genes. Pooled Antibiotic Susceptibility Testing (P-AST) was performed against 14 different antibiotics. The concordance rate between the ABR genes and P-AST results was generated. The concordance rates for each …

Metastatic Crohn's Disease: A Case Of Genital Cutaneous Crohn's Disease Involving The Penis And Scrotum, Zubin Shetty, Megen Schober

Conference Presentation Abstracts

Introduction: Crohn’s disease is an autoimmune inflammatory disorder affecting the gastrointestinal tract. Rarely, Crohn’s disease can cause cutaneous manifestations that are non-contiguous with the GI tract or “metastatic.” Genital Cutaneous Crohn’s Disease (CCD) is the most frequent presentation of CCD in the pediatric population and has shown to be difficult to manage. Case: A 13-year-old boy with a history of fistulizing Crohn’s disease presented with severe penile and scrotal edema for the previous 4 years. While his gastrointestinal symptoms were responsive to Adalimumab, his genital swelling only minimally and temporarily improved between treatments. He was referred to pediatric urology for …

Prevalence Of Os Acromiale In An Indigenous East African Population: A Computerized Tomography Scan-Based Study, Mordicai Atinga, Njalalle Baraza, Sarah Wambui, Wachira Joseph Thiong’O, Angela Atinga

General Surgery, East Africa

Background: Failure of fusion to any of the acromion physes at maturity may lead to an os acromiale. A radiological review into the prevalence of os acromiale in an indigenous East African population was performed using computer tomography (CT) imaging. The study aimed to demonstrate a lower prevalence of os acromiale in an urban population compared with cadaveric studies.

Methods: This was a cross-sectional study with consecutive sampling. CT scans of both shoulders obtained for non-shoulder pathology were used for the analysis. CT scanning was performed at a tertiary referral hospital from January 2019 to July 2020.

Results …

Endovascular Thrombectomy In Patients With Large Core Ischemic Stroke: A Cost-Effectiveness Analysis From The Select Study, Amrou Sarraj, Elena Pizzo, Kyriakos Lobotesis, James C. Grotta, Ameer E. Hassan, Michael G. Abraham, Spiros Blackburn, Arthur L. Day, Mark J. Dannenbaum, William Hicks

School of Medicine Publications

Background It is unknown whether endovascular thrombectomy (EVT) is cost effective in large ischemic core infarcts.

Methods In the prospective, multicenter, cohort study of imaging selection study (SELECT), large core was defined as computed tomography (CT) ASPECTS(CTP) ischemic core volume (rCBF

Results From 361 patients enrolled in SELECT, 105 had large core on CT or CTP (EVT 62, MM 43). 19 (31%) EVT vs 6 (14%) MM patients achieved modified Rankin Scale (mRS) score 0–2 (OR 3.27, 95% CI 1.11 to 9.62, P=0.03) with a shift towards better mRS (cOR 2.12, 95% CI 1.05 to 4.31, P=0.04). Over the projected …

Data-Driven Clustering Identifies Features Distinguishing Multisystem Inflammatory Syndrome From Acute Covid-19 In Children And Adolescents., Alon Geva, Manish M. Patel, Margaret M. Newhams, Cameron C. Young, Mary Beth F. Son, Michele Kong, Aline B. Maddux, Mark W. Hall, Becky J. Riggs, Aalok R. Singh, John S. Giuliano, Charlotte V. Hobbs, Laura L. Loftis, Gwenn E. Mclaughlin, Stephanie P. Schwartz, Jennifer E. Schuster, Christopher J. Babbitt, Natasha B. Halasa, Shira J. Gertz, Sule Doymaz, Janet R. Hume, Tamara T. Bradford, Katherine Irby, Christopher L. Carroll, John K. Mcguire, Keiko M. Tarquinio, Courtney M. Rowan, Elizabeth H. Mack, Natalie Z. Cvijanovich, Julie C. Fitzgerald, Philip C. Spinella, Mary A. Staat, Katharine N. Clouser, Vijaya L. Soma, Heda Dapul, Mia Maamari, Cindy Bowens, Kevin M. Havlin, Peter M. Mourani, Sabrina M. Heidemann, Steven M. Horwitz, Leora R. Feldstein, Mark W. Tenforde, Jane W. Newburger, Kenneth D. Mandl, Adrienne G. Randolph, Overcoming Covid-19 Investigators

Manuscripts, Articles, Book Chapters and Other Papers

Background: Multisystem inflammatory syndrome in children (MIS-C) consensus criteria were designed for maximal sensitivity and therefore capture patients with acute COVID-19 pneumonia.

Methods: We performed unsupervised clustering on data from 1,526 patients (684 labeled MIS-C by clinicians)clusters, followed by recursive feature elimination to identify characteristics of potentially misclassified MIS-C-labeled patients.

Findings: Of 94 clinical features tested, 46 were retained for clustering. Cluster 1 patients (N = 498; 92% labeled MIS-C) were mostly previously healthy (71%), with mean age 7·2 ± 0·4 years, predominant cardiovascular (77%) and/or mucocutaneous (82%) involvement, high inflammatory biomarkers, and mostly SARS-CoV-2 PCR negative (60%). Cluster …

The Contribution Of Patient Reported Outcome Measures To Shared Decision-Making In Radiation Oncology At A Midwestern Comprehensive Cancer Center, Kellie Bodeker

Doctor of Philosophy in Translational Health Sciences Dissertations

Background. Chronic diseases, such as lung cancer, require a provider-patient relationship developed over time. This relationship fosters shared decision-making (SDM), a collaborative, dynamic information exchange and analysis between provider and patient regarding treatment and desired outcomes. Established benefits to SDM include an improved quality of life and decreased anxiety and depression. Despite established benefits, recent research suggests radiation oncologists are not engaging in SDM. A decision-aid tool utilizing patient reported outcome measures may increase SDM between radiation oncologists and patients with lung cancer. Patient-reported outcome measures, wherein the patient provides direct assessment of their health and quality of life, …

Engaging Patients With Late-Stage Non-Small Cell Lung Cancer In Shared Decision Making About Treatment., Ronald E. Myers, Phd, Dsw, Shailesh M Advani, Pamela Myers, Preethi Selvan Mph Student, Gregory Garber, Msw, Lcsw, Brooke Worster, Md, Neal Flomenberg, Md, Andrew Chapman, Do, Ralph Zinner

Department of Medical Oncology Faculty Papers

Few treatment decision support interventions (DSIs) are available to engage patients diagnosed with late-stage non-small cell lung cancer (NSCLC) in treatment shared decision making (SDM). We designed a novel DSI that includes care plan cards and a companion patient preference clarification tool to assist in shared decision making. The cards answer common patient questions about treatment options (chemotherapy, chemotherapy plus immunotherapy, targeted therapy, immunotherapy, clinical trial participation, and supportive care). The form elicits patient treatment preference. We then conducted interviews with clinicians and patients to obtain feedback on the DSI. We also trained oncology nurse educators to implement the prototype. …

Granular Cell Tumor Of The Breast: A Breast Malignancy Mimicker, Emma Herrmann, Markie Zimmer, Bana Antonios, Bipin Ghimire, Mohammad Muhsin Chisti

Conference Presentation Abstracts

Granular cell tumors are soft tissue neoplasms that can arise from virtually any body site. They are thought to arise from Schwann cells of the peripheral nervous system. The overwhelming majority are benign, with only 1-2% of cases being malignant. Granular cell tumors of the breast can often mimic breast malignancy. A 62-year-old female with past medical history of hypertension and prior tobacco use had abnormal screening mammography. Family history was positive for breast malignancy in 2 sisters and a maternal first cousin. Prior mammography was unremarkable, aside from one year prior which revealed a concerning 6 mm nodule in …

Refractory Non-Tumor Lambert Eaton Syndrome Treated With Rituximab, Bipin Ghimire, Samiksha Pandey, Ashbina Pokharel, Emma Herrmann, Mohammad Muhsin Chisti

Conference Presentation Abstracts

With a worldwide prevalence of 3-4 per million, Lambert-Eaton syndrome is a rare entity. It often occurs as a paraneoplastic syndrome, most commonly associated with small cell lung cancer. Less frequently, it occurs as an autoimmune disease in the absence of cancer. Both entities demonstrate circulating immunoglobulins against presynaptic voltage-gated calcium channels and Electromyogram (EMG) with an increase in compound muscle action potential on repetitive stimulation. A 35-year-old female with past medical history of hypothyroidism presented with bilateral lower extremity weakness, generalized fatigue, blurry vision, and slurred speech in 2010. Upon further workup, Lambert-Eaton syndrome was diagnosed after she tested …

Metronidazole Neurotoxicity--Not Your Usual Suspect, Markie Zimmer, Bana Antonios, Emma Herrmann, Ramona Berghea

Conference Presentation Abstracts

An 85-year-old female with past medical history notable for chronic lymphocytic leukemia and Stage III Merckel cell carcinoma presented to our hospital for evaluation of generalized weakness of a few weeks duration. Notably, she had a recent hospital admission for E. coli bacteremia in the setting of hepatic abscesses that underwent ultrasound guided drainage. She was discharged to inpatient rehabilitation, and ultimately home, with a planned six-week course of ceftriaxone and metronidazole, in addition to oral vancomycin for C. difficile infection. Upon readmission, she was fatigued and had progressive lower extremity weakness. She denied any bowel or bladder incontinence or …

Impact Of Covid-19 On The Pre And Post Analytical Clinical Laboratory Testing Processes- A Performance Evaluation Study Using Six Sigma, Sibtain Ahmed, Farhat Jahan, Muhammad Umer Naeem Effendi, Farooq Ghani

Department of Pathology and Laboratory Medicine

Background: The aim of this study was to determine the impact of COVID-19 pandemic on the total testing process using six sigma metrics based on a comparison of pre and during pandemic periods.
Material & methods: The study duration was over 12 months, 6 months before and 6 months after the COVID-19 onset in Pakistan in March 2020 after the recognition of the first case, using quality indicators (QIs). QIs were chosen from a model of QIs recommended by the CAP. Analysis was performed using Six Sigma calculators and QIs were expressed in percentage (%) and Sigma value were computed. …

Hemobilia Secondary To Choledochal Cyst, Stanley Mugambi, S. R. Hussain, Ahmed Laving, Patricia Okiro, Bernadette Muthee

General Surgery, East Africa

Non variceal upper gastrointestinal hemorrhage in children is rare. A 5-year-old presented with hematemesis and melena. Pre-referral imaging and exploratory laparotomy did not reveal the source of bleeding. Hemobilia was detected on endoscopy MRI showed a choledochal cyst. The patient underwent successful resection of the cyst and hepaticojejunostomy.

Relative Risk Of Anxiety And Depression Among Covid-19 Survivor Healthcare Workers From A Tertiary Care Hospital In Pakistan: A Pilot Cohort Study, Farnaz Zahoor, Zahid Nazar, Sarwat Masud, Rehana Rahim

Department of Emergency Medicine

Longitudinal studies for determining the risk of anxiety and depression among COVID-19 survivor healthcare workers are lacking. This study aimed to determine the risk of anxiety and depression among healthcare workers that survived COVID-19 infection through a six-month post-recovery follow-up. This was a cohort study conducted at the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar, from 1st March to 30th August 2020. A total of 64 subjects participated. Hospital Anxiety and Depression Scale (HADS) was used for assessing the anxiety and depression symptoms. HADS has three score cutoff as normal, borderline abnormal and, abnormal anxiety/depression. For the purpose …

Engaging Patients With Late-Stage Non-Small Cell Lung Cancer In Shared Decision Making About Treatment, Ronald E. Myers, Shailesh M. Advani, Pamela Myers, Preethi Selvan, Gregory Garber, Brooke Worster, Neal Flomenberg, Andrew Chapman, Ralph Zinner

Internal Medicine Faculty Publications

Few treatment decision support interventions (DSIs) are available to engage patients diagnosed with late-stage non-small cell lung cancer (NSCLC) in treatment shared decision making (SDM). We designed a novel DSI that includes care plan cards and a companion patient preference clarification tool to assist in shared decision making. The cards answer common patient questions about treatment options (chemotherapy, chemotherapy plus immunotherapy, targeted therapy, immunotherapy, clinical trial participation, and supportive care). The form elicits patient treatment preference. We then conducted interviews with clinicians and patients to obtain feedback on the DSI. We also trained oncology nurse educators to implement the prototype. …

Utilization Of 2d Barcode Technology To Create Surgical Pathology Reports, Zhenhong Qu, Elaine Qu, James Huang, Mark A. Micale, E Li

Conference Presentation Abstracts

Introduction/Objective: After professional transcription service is eliminated, pathologists inevitably undertake the task of diagnostic data entry into pathology repot by adapting a variety of methods such as speech recognition, manual typing, and pre-texted command. Errors and inefficiency in reporting remain common problems, especially for information with unusual syntax such as genotype or nucleotide sequences. To overcome these shortcomings, we introduce here a novel application of a well-established technology as a complementary method, namely 2- dimensional (2D) barcode symbology. Methods/Case Report: Commonly used diagnostic wordings of pathology reports including specimen type, surgical procedure, diagnosis, and test results are collated and organized …

Cost-Effectiveness Analysis Of Recombinant Zoster Vaccine For The Prevention Of Herpes Zoster In Immunocompromised Adults Diagnosed With Select Cancers In The United States, Desmond Curran, Brandon Patterson, Justin Carrico, Ahmed Salem, Elizabeth La, Stephane Lorenc, Katherine Hicks, Sara Poston, Christopher Carpenter

Conference Presentation Abstracts

Introduction / Background / Significance: Immunocompromised (IC) populations diagnosed with cancer are at increased risk for herpes zoster (HZ) due to their underlying disease and/or therapy. This risk is highest among individuals receiving hematopoietic stem cell transplant (HSCT) to treat multiple myeloma, lymphomas, or other diseases. HZ is characterized by a painful vesicular rash. IC populations with HZ are also at increased risk of developing HZ-related complications such as postherpetic neuralgia, a persistent pain that can last for months or years. This study evaluates the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in …