Medical Specialties Commons^™

Early Non-Invasive Monitoring Of Fatty Liver Disease Using Emr Software, Franklin L. Thelmo, Do Jr., Eric J. Shiffrin, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Problem: Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH) are liver diseases that have rapidly increased in the population over the last few years and are becoming an evercommon cause of liver failure and the need for liver transplant. Disease presence long predates concerning symptoms and many individuals will not be made aware until after the diseased has progressed in severity. Earlier intervention is often inhibited due to the need of invasive biopsy or specific lab testing not easily available leading to significant underdiagnosis of patients with early disease
• Project AIM: We sought to add a …

Streamlined Pre-Authorization Expedites Patient Discharges From Stroke Units To Rehabilitation Centers, Michael Vo, William Nguyen, Matthew Trotter, Jeffrey Zhou, Glenn A. Gonzalez, Eric Mong, Rene Daniel, Ross-Jordan Elliott, James Harrop

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem statement: Patient discharge from neurosurgical stroke units to rehabilitation centers is a complex administrative and clinical endeavor involving a population often with cognitive and motor morbidity that can be intensified with extensive hospital length of stay (LOS).

Project aim: This project aims to analyze the change in LOS due to the introduction of liaisons, who advocate for and expedite pre-authorization, rounds, and plan of care establishment for patients with strokes.

Providing A Latch Key: Increasing Lactation Education For Medical Students, Elizabeth Wagman, Bs, Santosh Coorg, Md, Cheryl Godcharles, Md, Nabblem-C

Health Equity and Quality Improvement (HEQI) Summit

Background

• Problem Statement: Current Healthy People 2030 data suggests that only up to 25% of infants are exclusively breastfed at six months of life, but target rates are upwards of 40%. Though this trend is multifactorial, an actionable solution is to increase lactation education for residents and medical students to better equip them to counsel patients.
• Project AIM: We aim to increase provider comfort in lactation counseling by implementing lactation education, resources, hands-on training, and postpartum follow-up strategies for Thomas Jefferson University pre-clerkship/ rotating medical students and OB/GYN residents.

Racial Disparities In Transcatheter And Surgical Aortic Valve Replacement, Maggie Doyle, Svenja Schneider, Md, Kashka Mallari, Md, Nicholas Ruggiero, Md, Rebecca Marcantuono, Crnp, Alec Vishnevsky, Md, Yevgeniy Brailovsky, Do

Health Equity and Quality Improvement (HEQI) Summit

Background

• Transcatheter and surgical aortic valve replacement (TAVR, SAVR) is disproportionately distributed across racial and ethnicity groups.^{1, 2}
• Nationally, 87-91% of individuals undergoing AVR are White, despite making up approximately 60% of the US population.^1-4
• Jefferson’s AVR demographic data is consistent with national trends.
• Further studies have found that zip codes associated with lower socioeconomic status (SES) have lower rates of TAVR.⁵
• Although this disparity is widely recognized, there lacks understanding of contributing factors and potential interventions.

Project Aim:

• Investigate additional demographic data of Thomas Jefferson University Hospital (TJUH) patients undergoing TAVR to isolate targets for future …

Importance Of The Assessment Of Left Ventricular Function Following A Diagnosis Of Left Bundle Branch Block, Samuel Dyer, Bs, Benjamin Mass, Bs, Alyson Owen, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Left bundle branch block (LBBB) is a diagnosis often encountered in clinical practice.
• It can be seen as a harbinger of decreased left ventricular function in the future. LBBB has been associated with new onset congestive heart failure (CHF) and death from cardiovascular diseases.¹

Problem Statement

• LBBB in and of itself is given inadequate follow-up and attention by clinicians. Project AIM: bring to light the delay in follow-up after diagnosis of LBBB.

Ventilation Method During Intensive Care Unit Transport After Cardiac Surgeries; When Should We Use A Ventilator?, Francis Anderson, Do, Kent Berg, Md, Marc Torjman, Phd, Yoshihisa Morita, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Manual ventilation with AMBU bag is utilized mostly for transporting post cardiac surgery patients to the intensive care unit, but some patients need mechanical ventilation due to concern for oxygenation, ventilation, and cardiac function.

Also, transport can be a critical moment because of limited hemodynamic information and suboptimal environment for therapeutic intervention.

Thus, risk stratification for appropriate ventilation is necessary for safe transport. •

Project AIM: We assessed biventricular function (with a hand-held echocardiography), arterial blood gas, and hemodynamics pre and post transport in manual and mechanical ventilation groups.

Patient Perceptions Of Screening For Social Determinants Of Health In A Primary Care Setting, Blaise O'Malley, Zarin Mohsenin, Olivia George, Geoffrey Mills

Health Equity and Quality Improvement (HEQI) Summit

Background

• Social determinants of health (SDOH) screenings have become increasingly common in healthcare settings over the past decade (Berkowitz et al., 2021; Rogers et al., 2020)
• These screenings can help healthcare providers direct care and provide resources to patients with social needs (Bleacher et al., 2019)
• The sensitive nature of the screening questions may cause patients to feel uncomfortable (Broaddus- Shea et al., 2022)
• Many related studies focus on the perspective of adult caregivers of pediatric patients, less on the perspective of adult patients (Emengo et al., 2020)

Project Aims

1. To further our understanding of adult patient perceptions of the …

Do Large Language Models Adhere To Clinical Guidelines For Cervical Fusion? A Comparison Of Chatbotgenerated Responses With Nass Coverage Recommendations, Advith Sarikonda, Ba, Bs, Emily Self, Md, Dwight Mitchell Self, Md, Abhijeet Sambangi, Bs, Angeleah Carreras, Md, Jack Jallo, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Introduction:

• Cervical fusion is a widely performed procedure with rapidly increasing usage.
• Despite this surge in utilization, there has been limited exploration into whether cervical fusion procedures align with evidence-based guidelines.
• To address these issues, the North American Spine Society (NASS) has developed EBM coverage recommendations for various diagnostic procedures and therapeutic treatments in the field of spine surgery

Project AIM:

• To assess the efficacy of chatbots in adhering to official guidelines for indications for cervical spine surgery

Utilizing Inpatient Opportunities To Increase Comprehensive Advanced Care Planning In Oncology Patients, Alexandros Grivas, Md, Brian Schonewald, Md, Sawan Dutta, Md, Matt Bierowski, Md, Chioma Nwonu, Do, Evan Nardone, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

- Advanced Care Planning (ACP) is a high-value intervention that significantly improves end-of-life (EOL) care.

- ACP includes discussion between the patient and a qualified healthcare provider in an appropriate healthcare setting aiming: o To recognize patient’s wishes at end-of-life situations.

• To identify surrogates to act in the patient’s best wishes if they become unable to make such decisions.
• ACPs provide comfort on patients and their families during stressful end-of-life situations and facilitates appropriate use of resources.
• Absence of ACP leads to non-beneficial care, higher financial burden, and family distress.
• Ideal locations to form and document ACP are outpatient …

Oncology Infusion Center Hyperglycemia Protocol, Franklin L. Thelmo, Do Jr., Eric J. Shiffrin, Md, Rose Dimarco, Pharmd, Bcps, Bcop, Emily Brand, Pharmd, Daniel Lin, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Problem: Patients receiving chemotherapy for their cancer are often overwhelmed with the stresses of their new diagnoses and other coexistent medical issues may be forgotten or ignored. In the event dysglycemia or diabetes appears during the course of chemotherapy it may difficult for these patients to obtain care in a timely fashion and early literature suggests that dysglycemia may decrease the efficacy of chemotherapy
• Aim: Our goal was a protocol designed to ensure adequate euglycemia in patients at the Oncology Infusion Center (OIC) to eliminate insulin treatment guesswork for hyperglycemia, allow timely care with endocrinology specialists, and create a …

Implementation Of Pediatric Behavioral And Developmental Health Screening Tools At Student-Run Free Clinics In Philadelphia Shelters, Renee Li, Jasmine Miller, Martin Henry, Do, Bob Motley, Md, David Beckmann, Md, Mph

Health Equity and Quality Improvement (HEQI) Summit

Background & Project Aims

• Children experiencing homelessness (CEH) are at increased risk for behavioral health problems: 78% show behavioral problems, academic delays, or depression.¹

• Recent research suggests an increased prevalence of Autism Spectrum Disorder (ASD) among people experiencing homelessness.^2,3

• Psychosocial challenges are exacerbated by limited access to behavioral health and developmental disability screening, which is essential for early intervention.^4-6

• Recent studies have found that behavioral health screening in shelters is feasible, can generate a large number of referrals, and can be carried out by a student-run clinic without significantly disrupting workflow.^7,8

Correlation Of Neck Circumference With Bmi And Waist Circumference In A High-Risk Urban Cohort, Jay Satasiya, Bs, Meera Patel, Bs, Antoinette Portnoy, Bs, Noel Tharakan, Bs, Brian D. Fedgchin, Md, Glenn S. Cooper, Md, Cindy Cheng, Md, Phd

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• Obesity is a global epidemic requiring accurate ongoing clinical assessment, as it increases risk of multiple health conditions, such as CVD.
• Body mass index (BMI) is the most widely used anthropometric measure.
• Waist circumference (WC) is an accurate measure of visceral fat.
• Neck circumference (NC) is a newer, simple assessment tool positively correlated with percent body fat, BMI and WC.
• NC is easier to measure than WC, and unaffected by external factors like lean muscle mass for BMI, and abdominal distension, respiration, and patient discomfort for WC.

Hypothesis:

• NC, less studied in black patients, who are at …

The Tensegrity Curriculum: A Comprehensive Curricular Structure Supporting Cultural Humility In Undergraduate Medical Education., Anne C Jones, Kristin N Bertsch, Deborah Williams, Millicent King Channell

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Due to growing health disparities in underserved communities, a comprehensive approach is needed to train physicians to work effectively with patients who have cultures and belief systems different from their own. To address these complex healthcare inequities, Rowan-Virtua SOM implemented a new curriculum, The Tensegrity Curriculum, designed to expand beyond just teaching skills of cultural competence to include trainees' exploration of cultural humility. The hypothesis is that this component of the curriculum will mitigate health inequity by training physicians to recognize and interrupt the bias within themselves and within systems. Early outcomes of this curricular renewal process reveal increased student …

Promoting Physiologic Birth By Improving Access To Doulas, Karen Schwartz

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Birth in the United States (U.S.) leans towards a medicalized approach, overlooking the advantages of physiologic birth. Physiologic birth is a natural approach to childbirth, without medical interventions. Intrapartum nurses play an integral role in caring for women during labor by providing continuous labor support. Competing nursing tasks, exacerbated nursing shortages and increased nurse to patient ratios have made it increasingly challenging for intrapartum (IP) nurses to provide continuous labor support to their patients. The aim of this DNP project is to gain insight into the beliefs of IP nurses regarding childbirth and how these beliefs impact their approach to …

Nsaids Role In Triggering Ibd Exacerbations; Reality Or Misunderstanding? A Systematic Review, Alec Swartz, Malitha Hettiarachchi

Conference Presentation Abstracts

Introduction: Initial studies seemed to show that NSAID use was associated with increased risk of IBD exacerbation. Supported by known role of COX-1/2 isoenzymes (specifically their prostaglandin [PG] products) in maintaining GI mucosal barrier and mediating inflammation Combination of early research findings and COX prostaglandin knowledge resulted in NSAID avoidance in IBD patients. Recent data seemingly contradicts prior research, and NSAID use is predicted to not play a role in IBD exacerbation Methods: We conducted a systematic review of the literature using PubMed and American Journal of Gastroenterology. Of the thousands of results, we narrowed our results to 4 recent …

Minimally Invasive Tissue Extraction: Continued Growth Through Simulation For Obgyn Residents, Angela Frankel, Md, Mph, Melanie Hotz, Md, Patrick Teefey, Md

Department of Obstetrics and Gynecology Posters

Background

• Minimally invasive surgery often requires tissue morcellation for extraction of large surgical specimens.¹
• Surgeon comfort with tissue morcellation in gynecologic surgery is vital in providing a minimally invasive (MIS) approach.
• However, OBGYN residents often feel underprepared to perform this skill independently.²
• While practicing tissue morcellation in the OR is ideal, simulation has been shown to improve resident technical skill without risking increased operative time or associated morbidity.³
• This intervention seeks to build upon a prior simulation exercise, with the ultimate goal of improving OB-GYN resident self-reported comfort with minimally invasive tissue extraction.

Addressing Intimate Partner Violence (Ipv) Amongst Pregnant And Postpartum Individuals, Charlette E. Williams, Md, Elizabeth S. Hood, Bs, Julia F. Switzer, Md

Department of Obstetrics and Gynecology Posters

Goals of Project

1. Better recognition of Intimate Partner Violence (IPV) as it relates to our poor maternal morbidity and mortality statistics/outcomes
2. Better trauma-informed education surrounding recognition of red flag signs/symptoms for House Staff/Ob-Gyn rotation students
3. Better paring of patients with resources both in the clinic setting & postpartum

Moonlighting: A Pilot Project To Assess Impact Of Extracurricular Activities On Career Satisfaction And Quality-Of-Life In Graduate Medical Education, Charlotte O'Sullivan, David Lee, Karen Childers, Justine Nasr

Conference Presentation Abstracts

Background: Moonlighting is the delivery of healthcare outside of training programs in exchange for compensation. The Accreditation Council on Graduate Medical Education allows individual training programs to permit or restrict moonlighting, which leads to variation in prevalence and practice. Guidelines and regulations for moonlighting vary greatly across graduate medical education programs. Yet, limited research has been done to determine resident and fellow physician attitudes towards moonlighting and its impact on quality-of-life. Objective: This pilot study investigates how participating in moonlighting and extracurricular activities may impact resident and fellow physicians’ self-perceptions of quality-of-life and career satisfaction. Methods: 442 residents and fellow …

Amniotic Bladder Therapy For Treating Interstitial Cystitis/Bladder Pain Syndrome: A 6 Month Follow Up, Jack Considine, Codrut Radoiu, Sophie Wittenberg, Nivedita Dhar, Raghav Madan, Jack Vercnocke, Aron Liaw, Alaa Hamada

Conference Presentation Abstracts

Introduction: Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a debilitating condition marked by chronic pelvic pain and concurrent lower urinary tract symptoms. Our prior research established the efficacy of Amniotic Bladder Therapy (ABT) in offering symptomatic relief to refractory IC/BPS patients for a duration of up to 3 months. This study aims to delve into the durability of ABT, examining its effects over a more extended period, specifically up to 6 months. Materials and Methods: Consecutive IC/BPS patients participated in the study, receiving intra-detrusor injections of 100mg micronized amniotic membrane. Comprehensive clinical evaluations were complemented by patient reported outcome measures, encompassing …

Oncology Treatment Plan Updates In Epic-Beacon, Rose Dimarco, Pharmd, Bcps, Bcop, Gloria Espinosa, Mat, Pharmd, Bcop, Kelly Miskovsky, Pharmd, Bcop, Gina Hemmert, Pharmd

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Background

In Medical Oncology, the utilization of EPIC-Beacon Treatment Plans is integral for prescribing and administering cancer treatments. These treatment plans typically consist of anticancer infusion medications (chemotherapy, immunotherapy, etc.), supportive care medications, required laboratory orders, and other monitoring recommendations to ensure that patients receive safe and effective care. In 2017, TJUH transitioned from Varian’s Aria to EPIC’s electronic medical record system. Since then, there has not been a formal review of existing plans, and there are many inconsistencies between plans in different cancer types.

Problem Statement:

• Currently, there is not a formal process for review of existing treatment plans, …

Navigating Clinical Uncertainty: A Convergence Of Hiv, Positive Ana, And Genetic Cardiomyopathy, Ioannis Karageorgiou, Nicolaas Schimmel, Phillip Marchese, Tawhida Khatoon

Conference Presentation Abstracts

We present a case involving a 36-year-old male with a complex medical history, including hypertension, hyperlipidemia, cerebrovascular accident (CVA), and Hypertrophic Obstructive Cardiomyopathy (HOCM). The patient presented with a week-long history of chest, lower extremity, and back pain, tingling, and a history of recurrent falls. The initial presentation, combined with his history of ICD placement in 2019, led to investigations for Acute Coronary Syndrome (ACS) and ICD malfunction. The patient's initial laboratory workup, which included a comprehensive drug screen, was unremarkable except for mild normocytic anemia and elevated protein levels. CT scans of the head and spine and X-rays of …

Has Colon Cancer Screening Guidelines Reduced Mortality Associated With Colon Cancer?, Sumit Gami, Rakesh Shah, Malitha Hettiarachchi

Conference Presentation Abstracts

Introduction Colorectal cancer (CRC) is a major public health concern worldwide, with high incidence and mortality rates. Globally, CRC is the third most commonly diagnosed cancer in males and the second in females, according to the World Health Organization GLOBOCAN database. The primary goal of CRC screening is to prevent mortality and morbidity from the disease. USPSTF screening recommendations for colorectal cancer, May 18, 2021: Screen all adults 45 to 75 years of age. Recommended screening strategies include: High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year or Stool DNA-FIT every 1 to 3 years …

Not-So-Typical Neurologic Effects: Unraveling Lithium Toxicity, Alexsandra Biel, Vickie Xin, Mujtaba Moazzam, Ramona Berghea

Conference Presentation Abstracts

Introduction: Lithium is one of the mainstay treatments for bipolar disorder. Given its narrow therapeutic window, acute and chronic toxicity can develop. Acute toxicity includes gastrointestinal and cardiac manifestations whereas chronic toxicity manifests as neurologic, thyroid, and renal dysfunction. The therapeutic range of lithium is 0.6 to 1.2 mmol/L. With chronic use, lithium may be toxic at 1.2 mmol/L or greater (1). Neurological toxicity includes tremors, hyperreflexia, nystagmus, ataxia, confusion, and even seizures, however, rare reports have shown peripheral neuropathy as a manifestation. Case: A 40-year-old male with a history of bipolar disorder complicated by lithium induced chronic kidney disease …

Aids Associated Cryptosporidial And Cmv Cholangiopathy, Nada Alsharif, Luxhman Gunaseelan, Mamoun Souleiman, Cecilia Big

Conference Presentation Abstracts

Introduction AIDS-associated cholangiopathy is a biliary tract condition seen in AIDS patients who are severely immunosuppressed, contributing to significant mortality in this population even in developed countries with access to HAART therapy. Case Description We discuss a thirty-six-year-old HIV positive male, non-compliant with HAART therapy, who presented with a one year history of weight loss, persistent fatigue and chronic diarrhea, which had worsened significantly in the past few weeks. Routine laboratory studies on presentation indicated elevated liver enzymes and alkaline phosphatase, a CD4 count of two, and a high HIV RNA count of 8.8 million. Imaging via CT abdomen and …

Streptococcus Pneumoniae Neck Abscess In A Patient With Waldenstrom's Macroglobulnemia, Tanya Amal, Paul Johnson, Ayesha Sharif

Conference Presentation Abstracts

Patients with Waldenstrom's macroglobulinemia/lymphoplasmacytic lymphoma are at increased risk of sinopulmonary infections, pyelonephritis, and septicemia. The underlying etiology is assumed to be immune dysregulation. Patient's with Waldenstrom's macroglobulinemia have been shown to have somatic mutations in the "V". "D" and "J/H' segments of immunoglobulin gene. These mutations can affect affinity maturation and formation of memory B cells. Subsequently patient's with Waldenstrom's macroglobulinemia also have a suboptimal response to vaccination against Staphylococcus aureus, Streptococcus pneumoniae and Varicella, similar to those with multiple myeloma. Severe infections with gram positive organisms causing multifocal osteomyelitis, pleural effusion and sepsis have also been reported with …

Double Trouble Unmasked: Femoral Pseudoaneurysm And Deep Venous Thromboses Following Coronary Angiography, Mariam Jamil, Antoine Egbe, Khurram Arshad, Yazan Alamro, Essa Kadiri

Conference Presentation Abstracts

Iatrogenic pseudoaneurysms, while infrequent, represent a formidable complication of interventional cardiac catheterization, particularly in cases involving femoral artery access. This report details a unique case involving a 73-year-old male, receiving warfarin for a mechanical aortic valve, who developed a substantial right groin hematoma attributed to an iatrogenic pseudoaneurysm post-cardiac catheterization, subsequently resulting in concomitant deep venous thromboses (DVTs) in the right leg. The pathophysiology of DVTs following left heart catheterization typically involves the formation of a sizable pseudoaneurysm, exerting pressure on adjacent veins, leading to blood pooling and subsequent clot formation. Alternatively, the development of large hematomas in the thigh …

Effect Of Iv Iron-Carbohydrate Supplement On Morbidity And Mortality In Patients With Heart Failure, Yousef Alsmairat, Malitha Hettiarachchi

Conference Presentation Abstracts

Objectives: To study the effect of intravenous iron on morbidity and mortality in hospitalized patients with heart failure with reduced ejection fraction. The current European Society of Cardiology's 2021 heart failure guidelines recommend the consideration of Ferric Carboxymaltose in symptomatic patients with a left ventricular ejection fraction < 45%. Methods and results: We conducted a systematic review using articles published in PubMed and EMBASE databases. The number of records first identified was 263. The study only reviewed Randomized Clinical Trails (RCTs) published in the years 2013-2023 and removed all the duplicates and irrelevant articles using Rayyan.ai tool. The final number of qualified articles that met the study's inclusion criteria was 3, with a total of 2,279 participants. The inclusion criteria for the study included: Age > 18, and heart failure (HF) with left ventricular ejection fraction (LVEF) < 50%. The study showed that intravenous iron supplementation in patients with heart failure and iron deficiency has been proven to reduce the symptoms of heart failure, improve quality of life, increase exercise capacity and skeletal muscle strength. IV iron-carbohydrate therapy significantly reduced hospitalization for worsening heart failure, but did not significantly impact all-cause mortality, compared to control. Conclusion: IV iron-carbohydrate therapy significantly reduced hospitalization for worsening heart failure, but did not significantly impact all-cause mortality, compared to control. Based on the study review, we recommend IV iron therapy for patients with systolic dysfunction heart failure associated with iron deficiency anemia.

Sages Guidelines For The Use Of Laparoscopy During Pregnancy, Sunjay S. Kumar, Amelia T. Collings, Claire Wunker, Dimitrios I. Athanasiadis, Colin G. Delong, Julie S. Hong, Mohammed T. Ansari, Ahmed Abou-Setta, Emily Oliver, Vincenzo Berghella, Vamsi Alli, Imran Hassan, Celeste Hollands, Patricia Sylla, Bethany J. Slater, Francesco Palazzo

Department of Surgery Faculty Papers

BACKGROUND: When pregnant patients present with nonobstetric pathology, the physicians caring for them may be uncertain about the optimal management strategy. The aim of this guideline is to develop evidence-based recommendations for pregnant patients presenting with common surgical pathologies including appendicitis, biliary disease, and inflammatory bowel disease (IBD).

METHODS: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee convened a working group to address these issues. The group generated five key questions and completed a systematic review and meta-analysis of the literature. An expert panel then met to form evidence-based recommendations according to the Grading of Recommendations Assessment, …

Comparison Of Hospital Volume And Risk-Standardized Mortality Rate As A Proxy For Hospital Quality In Complex Oncologic Hepatopancreatobiliary Surgery, William T. Julian, John B. Ammori, Jeffrey M. Hardacre, Lee M. Ocuin

Faculty Scholarship

Background: Centralization of hepatopancreatobiliary procedures to more experienced centers has been recommended but remains controversial. Hospital volume and risk-stratified mortality rates (RSMR) are metrics for interhospital comparison. We compared facility operative volume with facility RSMR as a proxy for hospital quality. Patients and Methods: Patients who underwent surgery for liver (LC), biliary tract (BTC), and pancreatic (PDAC) cancer were identified in the National Cancer Database (2004–2018). Hierarchical logistic regression was used to create facility-specific models for RSMR. Volume (high versus low) was determined by quintile. Performance (high versus low) was determined by RSMR tercile. Primary outcomes included median facility RSMR …

How Dry Is Too Dry? Dehydration Management Of Pediatric Patients In The Ed, Shruthi Rethi

Conference Presentation Abstracts

Background: Gastroenteritis and dehydration are some of the leading causes of morbidity within pediatric EDs in the US, with over 1.7 million visits and more than 70,000 hospitalizations. There are many different guidelines/standards on the definition of dehydration. Clinical exam guidance using dehydration scales have been explored (eyes, mucous membranes, and tears). However, use of them in practice is varied.
Electrolyte lab values have not been included in dehydration scales, as a cut off is difficult to determine to guide IV vs oral rehydration, or admission. There can be little overlap between clinical exam and laboratory results. Studies have shown …