Medical Specialties Commons^™

Epic Best Practice Alerts Increases Sep1 Orderset Usage, Mark Munir, Zachary Awad, Paul Bozyk, Ramin Homayouni

Posters

Sepsis is a massive, system-wide inflammatory response to an infection that can lead to multisystem organ failure.1 Sepsis has a very high mortality rate of 20-50% in patients with severe sepsis and is the 10th leading cause of death in the United States.2 One of the most significant ways of reducing mortality from sepsis is timely detection and initiation of treatment in septic patients.3

Electronic medical records such as Epic have implemented sepsis warning algorithms and alerts to facilitate quicker detection of sepsis and thus earlier initiation of treatment. The goal of this study is to determine if an Epic …

Aquablation Compared With Simple Prostatectomy For Prostate Volumes >80 Grams, Joshua Kuperus, Minhaj Jabeer, Aidan Kennedy, Paul Horning, Greg Palmateer, Bernadette M.M. Zwaans, Jason Hafron, Kenneth M. Peters

Posters

• Benign prostatic hyperplasia (BPH) is the most common benign urological disease in men. 1

• Moderate-to-severe lower urinary tract symptoms (LUTS) from BPH affect 30% of men over 502 and medical treatment often fails for men with moderate-to-severe symptoms, leading them to seek surgical options. 3

• Transurethral resection of the prostate (TURP) remains the gold standard for prostates less than 80 mL; simple prostatectomy (SP) remains the standard for larger prostates.

• Aquablation (Aqua) is a novel BPH procedure that may be used for both small and large prostates from 50 to 150 mL. 4

• Although TURP …

Bisphosphonate Treatment In Pediatric Patients With Rare Ovarian Malignancy And Hypercalcemia: A Case Series, Seth Lamb, Samhita Bhattarai, Jennifer Boyd

Posters

Objective: To describe the presentation, management, and outcomes of severe hypercalcemia in two adolescent females secondary to ovarian malignancy. Methods: The case series includes two adolescent female patients, aged 11 and 16, diagnosed with rare ovarian malignancies and associated hypercalcemia. The 11-year-old female was diagnosed with small cell carcinoma of ovary while the 16-year-old was diagnosed with dysgerminoma. Both patients presented with abdominal pain, nausea and constipation. The 11-year-old received zoledronic acid while the 16-year-old received pamidronate. Serum calcium level, symptoms and adverse effects were monitored before and after both medications. Results: Both patients presented with severe hypercalcemia. The 11-year …

Physician Use Of Progesterone In Transgender Adolescents: A Survey, Samhita Bhattarai, Michelle Knoll

Posters

Objectives To evaluate the current perspective and clinical practices of physicians regarding the use of synthetic progestins as an adjunct to estrogen therapy in transfeminine adolescents. The survey focuses on perceived benefits, risks and overall efficacy in gender affirming hormone therapy. Methods A cross sectional survey was conducted among physicians who care for transfeminine patients. The survey included questions regarding their specialty, practice setting, age range of patients. Data was also collected regarding their indication for use, perceived benefits (e.g. breast development) and rationale if not using progestins for this purpose. Results Of 110 physicians who participated in the survey, …

Preliminary Assessment For Quality Improvement Of Hypertension Management In Kenya, Shubhangi Singh

Honors Theses

Hypertension is a leading contributor to cardiovascular disease (CVD) morbidity and mortality worldwide, with a disproportionate burden in low- and middle-income countries (LMICs). Despite relatively low rates of common behavioral risk factors, the Kasigau region of Kenya experiences high prevalence of hypertension and hypertension-related complications. This study explores self-efficacy, health beliefs, and management behaviors among adults in Kasigau to provide pilot quality improvement data for providers and future intervention planning. A cross-sectional, randomized survey of 45 adults was conducted at the Bughuta Clinic in southeastern Kenya. Participants completed a five-question hypertension-specific, self-efficacy assessment and a health belief model-based survey, with …

Global Multi-Specialty Clinician Perspectives On The Implementation Of Alzheimer's Disease Blood Biomarkers, Joanne Rodda, Lindsey A. Kuchenbecker, Wyllians V. Borelli, Mari L. Demarco, Raphael M. Castilhos, Erin E. Cawston, Tinatin Chabrashvili, Melissa M. Budelier, Claudia Duran Aniotz, Chinedu Momoh

Brain and Mind Institute

Introduction: Clinicians' views on the clinical readiness of Alzheimer's disease (AD) blood biomarkers (BBMs) are not well understood.

Methods: The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment Biofluid-Based Biomarkers Professional Interest Area conducted a survey to elicit clinician opinions on AD BBM implementation, including contexts of use, assay selection, reporting, and result interpretation.

Results: Clinician respondents (n = 212) practiced in Europe (56%), North America (24%), the Caribbean and Central/South America (11%), and other continents (9%). Most respondents were medical doctors (80%) practicing in secondary or tertiary care (88%). For 56%, cerebrospinal fluid AD …

Double-Edged Sword: Troubleshooting "Wide-Complex Tachycardia" And "Palpitations" Caused By Gastric Neurostimulator., Tori Hensley, Ankur Shah, Jennifer J Miller, Jason R Foreman, Allen C Brown, Asim S Ahmed

Heart and Vascular Articles

No abstract provided.

Optimum Volume Of Serious Fluid For The Detection Of Malignancy: A Systematic Review, Sarah Atieno Okech

Master of Medicine in Anatomic Pathology

No abstract provided.

Influence Of Medicaid And Medicare On Total Joint Arthroplasty Outcomes: 10-Year Report Of Michigan Hospitals, Madeleine Declercq, Jacob Keeley, Robert Runner, Kevin Weisz, Leonardo Cavinatto, Drew Moore

Posters

Access to healthcare significantly varies by medical insurance type, particularly for individuals for low socioeconomic status.

• Medicaid often covers these individuals (a government-funded program for low-income adults and children).

• Only 45% of primary care providers accept new Medicaid patients, versus 94% for private insurance.1

• Large non-profit medical centers accept Medicaid but still present considerable access challenges for patients.

• Lower reimbursement rates, complex medical needs, and extensive administrative requirements are key barriers for providers accepting Medicaid.

• Studies, such as those by Deans et al., highlight greater travel burdens for Medicaid patients needing revision hip or knee …

Does The Possibility Of No Surgery In Watch And Wait For Rectal Cancer Affect Patient Decision-Making?, Joanna F. Wasvary, Ga-Ram Han, Jacob A. Applegarth, Matthew A. Ziegler

Posters

INTRODUCTION & OBJECTIVE

Prior studies have established that the watch and wait protocol for rectal cancer is a reasonable approach in patients with excellent response to total neoadjuvant therapy (TNT). Current guidelines stipulate that patients eligible for this protocol have no residual tumor on re-staging imaging and endoscopy. Patients who have evidence of residual disease are referred for surgery. This study assessed all patients in our institution who underwent TNT for rectal cancer and the subsequent recommendations for treatment. Primary aim: assess patient compliance with surgeon recommendations for residual disease after TNT.

Secondary aim: assessment of oncologic outcomes and the …

Implementation Of An Opioid Free Pediatric Hernia Repair Protocol, Corey Shafer, Antonela Muca, Randy Hilleary, Kristin Lemarbe, Diane Studzinsk, Kaveh Aslani, Nathan Novotny, Pavan Brahmamdam, Begum Akay

Posters

Surgery most often provides children with their first exposure to opioids which may lead to misuse and overuse. Protocolizing pain management perioperatively can reduce opioid exposure in children while still providing adequate pain management.

Surgical Site Infection Bundle For Babies: Preliminary Data, Cullen Woodley, John Nida, Alexis Lonjin, Katelyn Ward, Diane Studzinski, Begum Akay

Posters

Surgical Site Infections (SSIs) are infections that occur in or around the area where a surgery was recently performed. They are estimated to account for 20% of all healthcare associated infection, and lead to an increase in morbidity and mortality. Perioperative care bundles show promise in reducing SSIs in adults but are not often used in neonatal surgery. Infections in babies after surgery are less common than adults but carry significant morbidity in a fragile patient.

Enhancing Reproductive Anatomy Education: A Comprehensive Approach Integrating Near-Peer And Reciprocal Peer Tutoring, Hope Hefferan, Emelie-Jo Scheffler, Erin Mueller, Varna Taranikanti

Posters

• Near-peer tutoring (NPT): Tutors are more advanced than tutees, typically offering support in understanding complex concepts.1

• Reciprocal peer tutoring (RPT): Students with similar levels of training alternate between tutor and tutee roles, facilitating collaborative learning.1

• Peer tutoring fosters professional development and improves long-term retention of complex medical concepts.3,4,5

• Reproductive anatomy is a challenging area for many medical students; Innovative peer tutoring methods may help improve understanding and retention of anatomical structures.

• We hypothesize that integrating NPT and RPT within the laboratory setting in the reproductive organ system course will enhance student motivation, self-efficacy, and long-term …

Stroke Risk After Lowering Elevated Blood Pressure In Transient Ischemic Attack, Alexsandra Biel, Jacob Keeley, Brett Todd

Posters

• There is a relationship between the diagnosis of TIA and the subsequent development of a stroke1–4.
• The risk of developing a stroke within 90 days of a TIA is approximately 10.5% with about half of these occurring in the first 1-2 days of the TIA3.

Risk factors that may increase the likelihood of developing a stroke following a TIA include:

• Having age over 60
• A blood pressure of 140/90 or greater
• Diabetes
• Increased TIA duration
• Increased symptomatology at the time of presentation5–8.

Manual Versus Mechanical Cardiopulmonary Resuscitation Complications After Successful Resuscitation For Out-Of-Hospital Cardiac Arrest, Connie Chen, Jacob Keeley, Julian Sit, Robert Swor

Posters

Over 300,000 people in the United States annually suffer from an out of hospital cardiac arrest (OHCA); 90% of cases are fatal.1

EMS-treated OHCA approximately has a 30% rate of Return of Spontaneous Circulation (ROSC), but not all survive to hospital admission or discharge.2

Quality cardiopulmonary resuscitation (CPR) provides vital organ reperfusion until cardiac activity can be restored.

Mechanical CPR is increasingly being used for field OHCA care. It is most often performed by the Lund University Cardiopulmonary Assist System (LUCAS) device, a piston chest compressor which incorporates a mechanism for active chest recoil.

Benefits of mechanical CPR:

• Uninterrupted …

Examining Health Disparities: An Observational Study On Peripheral Vascular Access Outcomes Among Hospitalized Patients, Charlotte O’Sullivan, Nicholas Mielke, Yuying Xing, Amit Bahl

Posters

Peripheral intravenous catheter (PIVC) placement is the most common invasive procedure performed in healthcare, with an estimated 90% of hospitalized patients requiring PIVC access during their stay. This equates to around two billion PIVCs used annually.1–3 Studies report 36% to 63% of catheters fail due to a variety of complications, including infiltration, occlusion, phlebitis, dislodgment, and infection. 2–6 These failures not only cause immediate patient discomfort and increased clinical workload but also have wider implications such as prolonged hospital stays and delays in critical treatments.2 The factors contributing to PIVC failure are multifaceted, involving clinical presentation, patient anatomy, provider skill …

Pr Novel Hematoma Prevention Device, Nolan Shoukri, Steven Pearl, Nishaki Mehta

Posters

• Hematomas are a common complication in cardiac internal electronic device (CIED) placement procedures, they occur in up to 20-25% of CIED implants.

• Previous RCT tested a novel hematoma compression device (PR) and showed good tolerability, decreased hematoma formation from 15% to 6%, and wound improvement.

• Based on feedback collected from the nurses, physicians, allied health professionals during the randomized control trial, iteration of the PR was done (Gen 2 PR).

• This study evaluated 1) bench testing of the Gen 2 PR device and 2) healthy volunteer testing of Gen 2 PR device.

Beyond The Epi-Pen: Prehospital Use Of Epinephrine In Anaphylaxis, Randy Hilleary, Corey Shafer, Margaret Menoch

Posters

• Prehospital epinephrine administration has been historically low by the individuals having the reaction, their caregivers, or emergency medical service (EMS) personnel
• With rising anaphylaxis cases, it becomes more imperative that there is appropriate administration of epinephrine to improve outcomes in both pediatric and adult populations

Assessing The Impact Of Street Medicine Oakland On Medical Student Perceptions Of Clinical Preparedness, Michael Marchiori, Laura Ortiz

Posters

• Medical students spend the first two years of medical school focusing on didactic learning supplemented with clinical skills training as they prepare for their hospital rotations

• Opportunities for in-field practice of clinical skills are typically sparse for medical students during their M1 and M2 didactic years

• Research suggests clinical supervisors rank professionalism and willingness as the two most important characteristics in students that promote clinical preparedness, but there is limited research on interventions that promote students’ self-perceptions of clinical preparedness1

• Medical students at Oakland University William Beaumont (OUWB) have the opportunity to volunteer with Street Medicine …

Fc Gamma Receptors Facilitate Antigenic Modulation Of Lilrb4 And Function As Predictive Biomarkers In Acute Monocytic Leukemia, Joshua Morse

Dissertations and Theses (Open Access)

Acute monocytic leukemia (monocytic AML) is a subtype of AML marked by a proliferation of abnormal monoblasts. This subtype represents approximately 10% of AML cases. The prognosis of monocytic AML is poor, with a 5-year survival of ~30%. Most patients are diagnosed at an age when they are unlikely to survive first-line non-targeted cytotoxic chemotherapy as a bridge to hematopoietic stem cell transplant (HSCT). Even patients who achieve remission commonly relapse. This population of patients would greatly benefit from precision-targeted therapies but currently there are none approved for monocytic AML.

Leukocyte immunoglobulin-like receptor B4 (LILRB4) is an immune checkpoint expressed …

Novel Application Of Orthopedic Suture Tape For Sternal Closure After Upper Hemisternotomy, Vishal N. Shah, Joshua R. Chen, Konstadinos A. Plestis

Department of Surgery Faculty Papers

The FiberTape (FT) System (Arthrex, Naples, FL, USA), initially developed for orthopedic surgery, is a new, nonmetallic, suture-based alternative to standard stainless-steel wires for sternal reapproximation. Publications on FT use after cardiothoracic surgery are limited. The FT System has not been used in upper hemisternotomy (UHS) closure. Consequently, we report the use of the FT System for sternal closure in a 70-year-old man after UHS aortic valve replacement and discuss several advantages of its application.

Targeting Bard1 Suppresses A Myc-Dependent Transcriptional Program And Tumor Growth In Pancreatic Ductal Adenocarcinoma, Sohum Patel, Eleanor Jenkins, Rutuj P. Kusurkar, Sherry Lee, Wei Jiang, Avinoam Nevler, Matthew Mccoy, Michael J. Pishvaian, Rosalie C. Sears, Jonathan R. Brody, Charles J. Yeo, Aditi Jain

Department of Surgery Faculty Papers

Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest cancers demanding better and more effective therapies. BARD1 or BRCA1-Associated -Ring Domain-1 plays a pivotal role in homologous recombination repair (HRR). However, its function and the underlying molecular mechanisms in PDAC are still not fully elucidated. Here, we demonstrate that BARD1 is overexpressed in PDAC and its genetic inhibition suppresses c-Myc and disrupts c-Myc dependent transcriptional program. Mechanistically, BARD1 stabilizes c-Myc through ubiquitin-proteasome system by regulating FBXW7. Importantly, targeting BARD1 using either siRNAs or CRISPR/Cas9 deletion blocks PDAC growth in vitro and in vivo, without any signs of toxicity to mice. …

Intratumoral Fibrin As A Novel Immunomodulatory Factor In Pancreatic Ductal Adenocarcinoma, Mazharul Karim

Open Access Theses & Dissertations

In-situ coagulation is a common clinical feature of pancreatic ductal adenocarcinoma (PDAC) that presents a highly thrombotic and crosslinked insoluble fibrin (x-fibrin)-laden tumor stroma (FibTS). However, the specific impact of FibTS on immune cells behavior remains largely unexplored in this poorly infiltrated tumor. We aimed to elucidate how FibTS in PDAC regulates immune cell infiltration, polarization, and crosstalk that favors immunosuppressive microenvironment and tumor growth. We characterized human PDAC tissues by multiplex immunostaining and checked the spatial distribution of immune cells based on the presence of x-fibrin. We investigated how FibTS influences the infiltration of tumor-associated macrophage (TAM) and T-cell …

Jak1 V658f Drives Oncogenic Transformation Via Transcriptional Reprogramming Independent Of Y598 Phosphorylation And Canonical Jak-Stat Signaling, Omar Javier Rodriguez Moncivais

Open Access Theses & Dissertations

T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive and complex malignancy that accounts for 15% of pediatric acute lymphoblastic leukemia (ALL) cases in the United States. Tyrosine kinases control critical cellular processes, including the development, survival, and activation of T cells, and are established drivers of leukemia.Tyrosine kinases involved in hematological disorders include receptor tyrosine kinases and non-receptor tyrosine kinases family members such as SRC, ABL, FAK, and Janus kinases (JAKs). This study primarily focused on JAK1 gain-of-function (GoF) mutations. These mutations are recognized as hyperactivating mutations, maintaining kinase activity of JAKs on and essentially keeping downstream signaling effectors, like …

Natural Killer T Cell-Mediated Control Of Francisella Tularensis-Induced Cytokine Storm Syndrome, Cameron M. Torres

Open Access Theses & Dissertations

Inflammation is critical for the effective clearance of viral and bacterial challenges, while simultaneously a mechanism utilized by many highly infectious pathogens to cause disease. The bacterium Francisella tularensis, the causative agent of human tularemia, elicits a cytokine storm, wherein the immune system over-responds to the presence of the bacterium causing a dysregulated release of proinflammatory and regulatory cytokines. Without treatment, tularemia mortality can be as high as 30%, with inhalation of as few as 10 CFUs inducing respiratory tularemia. Natural Killer T (NKT) cells are innate-like T lymphocytes with a diverse array of regulatory functions. Unlike conventional T cells, …

Current Standards And Future Directions Of Duchenne Muscular Dystrophy Respiratory Care: The Ppmd Italy Meeting Report, Jane Black, David J. Birnkrant

Faculty Scholarship

Objective: This report summarizes key discussions from the meeting “Current Standards and Future Directions of Respiratory Assessment and Management of Duchenne Muscular Dystrophy (DMD),” organized by Parent Project Muscular Dystrophy (PPMD) Italy and the United States to address current challenges and opportunities in DMD respiratory care. Methods: The meeting brought together researchers, clinicians, and patient advocates who shared experiences, discussed advancements in DMD respiratory management, and identified areas of debate that require further research. Results: The speakers emphasized routine assessment of pulmonary function and of breathing during sleep to achieve timely diagnosis of respiratory complications. Therapeutic discussions focused on airway …

Alphamissense Predictions And Clinvar Annotations: A Deep Learning Approach To Uveal Melanoma, David J. Taylor Gonzalez, Mak B. Djulbegovic, Meghan Sharma, Michael Antonietti, Colin K. Kim, Vladimir N. Uversky, Carol L. Karp, Carol L. Shields, Matthew W. Wilson

Wills Eye Hospital Papers

OBJECTIVE: Uveal melanoma (UM) poses significant diagnostic and prognostic challenges due to its variable genetic landscape. We explore the use of a novel deep learning tool to assess the functional impact of genetic mutations in UM.

DESIGN: A cross-sectional bioinformatics exploratory data analysis of genetic mutations from UM cases.

SUBJECTS: Genetic data from patients diagnosed with UM were analyzed, explicitly focusing on missense mutations sourced from the Catalogue of Somatic Mutations in Cancer (COSMIC) database.

METHODS: We identified missense mutations frequently observed in UM using the COSMIC database, assessed their potential pathogenicity using AlphaMissense, and visualized mutations using AlphaFold. Clinical …

Ai Model For Predicting Asthma Prognosis In Children, Elham Sagheb, Chung-Il Wi, Katherine S King, Bhavani Singh Agnikula Kshatriya, Euijung Ryu, Hongfang Liu, Miguel A Park, Hee Yun Seol, Shauna M Overgaard, Deepak K Sharma, Young J Juhn, Sunghwan Sohn

Faculty, Staff and Student Publications

BACKGROUND: Childhood asthma often continues into adulthood, but some children experience remission. Utilizing electronic health records (EHRs) to predict asthma prognosis can aid health care providers and patients in developing effective prioritized care plans.

OBJECTIVE: We aimed to develop artificial intelligence (AI) models using various clinical variables extracted from EHRs to predict childhood asthma prognosis (remission vs no remission) in different age groups.

METHODS: We developed AI models utilizing patients' EHRs during the first 6, 9, or 12 years of their lives to predict their asthma prognosis status at ages 6 to 9, 9 to 12, or 12 to 15 …

Association Of Delayed Asthma Diagnosis With Asthma Exacerbations In Children, Chung-Il Wi, Euijung Ryu, Katherine S King, Jung Hyun Kwon, Joshua T Bublitz, Miguel Park, Sergio E Chiarella, Jason D Greenwood, Thanai Pongdee, Lynnea Myers, Björn Nordlund, Sunghwan Sohn, Elham Sagheb, Bhavani Singh Agnikula Kshatriya, Dave Watson, Hongfang Liu, Beverley J Sheares, Carla M Davis, Wade Schulz, Young J Juhn

Faculty, Staff and Student Publications

Background: There is a significant delay between symptom onset and diagnosis of childhood asthma, but the impact of this delay on asthma outcomes has not been well understood.

Objectives: We sought to study the association of delayed diagnosis of asthma with asthma exacerbations (AEs) in children.

Methods: Using the Mayo Clinic birth cohort, we identified children with a diagnosis of asthma from electronic health records. We defined onset date as the date when subjects first met predetermined asthma criteria ascertained by an electronic health records-based natural language processing algorithm. Delay in diagnosis (DD) was defined as first diagnosis >30 days …

Clinical Implications Of Mismatch Repair Deficiency In Pancreatic Ductal Adenocarcinoma, Zachary Kaplan, Elizabeth Prezioso, Aditi Jain, Harish Lavu, Charles Yeo, Wilbur Bowne, Avinoam Nevler

Kimmel Cancer Center Faculty Papers

BACKGROUND: Pancreatic cancer is a highly aggressive and lethal disease, characterized by a limited response to chemotherapy and overall poor prognosis. Pancreatic cancers with a distinct mismatch repair deficiency, although relatively rare, have been shown to be associated with markedly better outcomes in comparison. Furthermore, whereas pancreatic cancers are generally unresponsive to current immunotherapy, this specific group of tumors has been shown to have a notable susceptibility to immune checkpoint inhibitors.

AIMS: In this review, we aim to summarize the relevant literature regarding mismatch-repair associated pancreatic cancers, the impacted biological mechanisms, and the resulting vulnerabilities for potential opportunistic immunotherapeutic treatment …