Translational Medical Research Commons^™

Perioperative Antibiotic Use In Neonatal General Surgery: A Survey Of Apsa Membership, Samuel K. Osei, Ashley Williams, Diane Studzinski, Patrick Karabon, Begum Akay, Pavan Brahmamdam

Posters

• Guidelines for antibiotic prophylaxis for surgical site infection (SSI) are widely used for adult patients.
• There is limited data on prophylaxis in pediatrics, and there are no standardized guidelines for neonates.
• Perioperative antibiotic use in neonates based on the surgeon’s preference.

Characterizing The Effectiveness Of Prehospital Pediatric Pain Management In Children With Long Bone Fractures, Revelle Gappy, Ashima Goyal, John Frawley, Sariely Sandoval, Nai-Wei Chen, Remle Crowe, Robert Swor

Posters

Prehospital pediatric pain management has been poorly understood and sub-optimally treated.1-3 Pain scales for children differ from adult pain scales and it is unclear if pain assessments are well documented, particularly in infants and toddlers.4-6 Surveys of emergency medical services (EMS) personnel identify barriers to pain management including discomfort with emergency care of injured children, concern for allergic reactions, additional pain from intravenous catheter insertion, parental influence, as well as lack of knowledge and experience secondary to the relatively infrequent treatment of acutely injured children.7-9

The effectiveness of prehospital pain medication administration for children is unknown, as is the efficacy …

Investigating The Role Of The Gut Microbiota On Immune Checkpoint Inhibitor-Mediated Colitis, Taylor Halsey, Robert Jenq

Dissertations and Theses (Open Access)

Immune checkpoint inhibitors (ICIs) have been revolutionary in the fight against cancer by recruiting the host immune system as an agent for attack on malignant cells. Unfortunately, immune-related adverse events (irAEs), including ICI-mediated colitis (IMC), are common side effects that result from immune cell mediated damage on healthy tissues. Recent studies have highlighted a role for the gut microbiota in modulating ICI-mediated anti-tumor responses, but less is known regarding how the gut microbiota may impact on irAEs. Considering that the gastrointestinal tract harbors thousands of unique microbial species, many of which are known to modulate the immune system, microbes and …

Cord Blood-Derived Invariant Natural Killer T Cells As A Platform For Allogeneic Chimeric Antigen Receptor Cell Therapy, Maison Grefe

Dissertations and Theses (Open Access)

Chimeric antigen receptor (CAR) T cells have revolutionized the treatment of hematopoietic malignancies achieving >50% complete response rates in numerous refractory/relapsed B cell malignancies. However, there are challenges that hinder CAR-T efficacy and bar the broader use of this therapy in patients. One approach to address these challenges is to create a safe allogeneic CAR cell product by using cells that do not cause graft versus host disease (GvHD). Invariant natural killer T (iNKT) cells are an ideal candidate as they are restricted to the monomorphic CD1d protein in contrast to HLA restricted αβ-T cells and therefore are safe in …

Interrogating Therapeutic Resistance To Oncogenic Krasg12c-Based Therapies In Colorectal Cancer, Oluwadara Coker

Dissertations and Theses (Open Access)

Colorectal cancer is the second leading cause of cancer-related deaths and the third most common cancer in the United States. Although KRAS is mutated in 50% of patients with metastatic CRC (mCRC), it has historically been a challenging therapeutic target. The recent approval of novel covalent inhibitors selective for KRASG12C mutation have entered the clinic, which has not only marked a major milestone in cancer drug discovery but has also intensified efforts to directly target other KRAS mutations that have also successfully entered the clinic. However, treatment-associated resistance mechanisms have long threatened to attenuate clinical benefit through either adaptive or …

Association Between Primary Care And Emergency Department Utilization, Donna Kayal, Jacob Keeley, Ramin Homayouni

Posters

Emergency departments have been designed to provide rapid and accessible care for emergent and acute needs for a broad scope of illnesses and injuries.1-2 However, the emergency department (ED) has been facing an overwhelming increase in demand, leading to an increase in wait time and significant overcrowding, which decreases the effectiveness of the ED.1-4 A common explanation that has been noted over the years is utilization of ED services for non-emergent care, which professionals have often labeled as “inappropriate use.”2,5 Such encounters take away time from ED physicians and health care workers, compromising the care for true emergencies and leading …

Efficacy Of An Integrated Computer Assisted Learning (Cal) Module In Student Understanding Of Cardiovascular Embryology, Nicolaas Schimmel, Forrest Bohler, Varna Taranikanti

Posters

• Embryology is one of the most difficult topics for students to master1

Students’ perceptions of embryology are generally more negative:

• Not clinically important1

• More negative attitude than towards gross anatomy1

• Unhappy with current teaching methods and not confident learning it2

An integrated CAL module will allow a more linear model for learning congenital heart diseases, which may help improve students’ understanding of cardiovascular embryology.

• Compared to traditional, more segmental model where students learn embryology separately from clinical presentation, ECG interpretation, etc.
• CAL modules have proven effective for other organ systems3.

• We hypothesized that students would demonstrate …

Smoking And Covid-19: An Analysis Of Demographics, Risk Factors, And Outcomes, Andrew Vrtar, Luca Cucullo, Richard H. Kennedy

Posters

• Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a respiratory pathogen that first emerged in late 20191 and was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020.
• Cigarette use is a significant public health concern throughout the world. Despite reductions in prevalence in recent years, tobacco smoking remains one of the main preventable causes of ill-health and premature death.
• Both tobacco smoking and vaping are phenomena that may increase the vulnerability of these individuals to COVID19 infection.4 Therefore, it is crucial to explore the medical consequences of and …

Using Age-Adjusted D-Dimer Vs Traditional D-Dimer To Rule Out Acute Aortic Syndrome, Jacob Nelson, Divyani Patel, Sylvia Kashat, Gorune Geloian, Karen Childers, David A. Berger, Brett Todd

Conference Presentation Abstracts

Background and Objectives: Acute aortic syndromes (AS), including aortic dissection, are rare and life-threatening diagnoses. Early diagnosis is critical as mortality increases by 1%–2% per hour after symptom onset. D-dimer (DD) Methods: In this retrospective chart review, we identified all patients who presented to any Emergency Department (ED) at a multicenter health system between 2012 and 2021, received a D-dimer test, and underwent CTA Dissection, CTA Coronary Study, or CTA Triple Rule-Out. Patients under the age of 18, pregnant, had prior dissection or thoracic aorta repair, or who presented altered/unresponsive were excluded. For patients with multiple presentations, the first visit …

Diuretic Dose Ratio Is Associated With Reduced Hospital Length Of Stay In Acute Heart Failure, Sarah Galla, Yuying Xing, Lihua Qu, David A. Berger

Conference Presentation Abstracts

No abstract provided.

Diuretic Dose Ratio Is Associated With Reduced Hospital Length Of Stay In Acute Heart Failure, Sarah Galla, Yuying Xing, Lihua Qu, David A. Berger

Conference Presentation Abstracts

Background and Objectives: Congestive heart failure (CHF) is anticipated to affect eight million Americans by 2030. Treatment for CHF exacerbation is centered around IV diuretics. There are no current studies indicating an optimal initial diuretic dose in the Emergency Department (ED), and our objective is to test our hypothesis that higher diuretic dose ratio may shorten hospital length of stay (LOS). Methods: We conducted a retrospective cohort study of a large health system from 2016 to 2022. We included patients admitted from the ED with a primary diagnosis of “CHF exacerbation” with a history of CHF and prescribed diuretics. Exclusions …

A Comparison Of Post-Operative Pain Management Following Lumbar Laminectomy Fusions Utilizing Tlip Or Intra-Operative Local Anesthesia Block, Lauren Eberhardt, Philip Zakko, Karen Childers, Daniel Park

Conference Presentation Abstracts

Background/Introduction: Spinal fusion patients suffer significant acute post-operative pain, potentially leading to chronic pain. Opioids are commonly used for peri-operative pain management despite significant side effects. The thoracolumbar interfascial plane (TLIP) and erector spinae plane (ESP) block, alternative analgesic options with rare side effects, have proven to reduce pain and opioid consumption compared to standard non-block care. This study aimed to determine if a significant difference exists between block groups with multi- and single level laminectomy fusions in post-operative and discharge opioid consumption and length of stay. Materials/Methods: A retrospective review was performed via data query for lumbar laminectomy fusion …

Lactate Expression, Mortality, And Length Of Stay In Emergency Department Patients With Sepsis And Intubation, Heaveen Ahdi, Nadine Talia, Ray Lee, Lili Zhao, Ronny Otero, David A. Berger

Conference Presentation Abstracts

Background and Objectives: Studies demonstrate that patients in septic shock with a lactate < 2 have a mortality between 20% to 46%. Our prior work reported that in emergency department (ED) patients with a second lactate ≥2 (lac), there is a two-fold increase in 30-day mortality when compared to patients with a second lactate < 2 (alac). On secondary analysis, we found that intubated patients with a second lactate ≤2 had a longer hospital length of stay (LOS). Our objective is to further scrutinize this 30-day mortality and LOS. Methods: This is a retrospective cohort study of an eight-hospital health system using data from the electronic medical record. Inclusion criteria consisted of patients ≥18 years of age who presented to the ED from 1/1/2017 to 11/30/2022 with ≥2 lactate levels measured in the ED, were diagnosed with sepsis, and admitted to the intensive care unit (ICU) within 24 h. We excluded lactate auto-expressors, pregnant patients, transfers, and those taken for a surgical procedure within 72 h of presentation. Patients were classified based on initial and second lactate as < 2 (alac) or ≥2 (lac). Multivariable regression analysis was performed for 30-day mortality and LOS, adjusting for vitals, BMI, DNR status, and intubation timing. Results: Of the 3100 patients who met inclusion criteria, 1285 patients were intubated and categorized based on their lactate expression: alac -> alac (reference; 111/1285, 8.9%), alac -> lac (28/1285, 2.2%), lac -> alac (259/1285, 20.2%), and lac -> lac (887/1285, 69.0%). Lac -> lac had a significantly higher 30-day mortality (OR = 2.058, 95% CI = [1.353–3.154]) compared to alac -> alac. Lac -> alac had a significantly increased LOS (OR = 1.133 (95% CI = [1.003–1.280]) compared to alac -> alac. Other group comparisons for 30-day mortality and LOS were not significant. Conclusion: Intubated sepsis and septic shock patients in the lac -> lac group had a …

Telehealth Utilization In Clinical Trials: Facilitators, Barriers, And Future Directions, Michael Carpenter

MUSC Theses and Dissertations

Purpose: Telehealth implementation in clinical trials is not as well developed as compared to telehealth utilization in other areas of medical care. The focus of this project will explore the factors that foster and hinder the effective use of telehealth in clinical trials and how these insights can inform future strategies and policies.

Method: The project synthesizes empirical research and theoretical literature on the integration of telehealth into clinical trial. The research utilizes an online survey via REDCap to gauge the level of acceptance, perceived effectiveness, and potential barriers to the implementation of telehealth in clinical research.

Results: The responses …

The Use Of Patient Stories As A Knowledge Translation Strategy To Facilitate The Sustainability Of Evidence-Based Interventions (Ebis) In Healthcare, Rachel Flynn, Lauren Dobson, Ella Milne, Alyson Campbell, Kelly Mrklas, Tracy Wasylak, Shannon D. Scott

Patient Experience Journal

Background: Patient stories are real-life experiences told from a patient’s or their family’s perspective. In the past, patient stories have served many purposes in healthcare, such as spreading knowledge, educating providers, or conveying the patient experience. Patient stories are increasingly used as a knowledge translation (KT) strategy to improve the uptake of evidence-based interventions (EBIs) into clinical healthcare practices by embodying the patient experience. However, little is known about the use of patient stories to support the sustainability of EBIs in healthcare practices. There is a need to understand how patient stories can be used for the long-term use and …

Exploring Strategies To Increase Genomic Literacy And Integrate Genomic Medicine Education Into Graduate Medical Education Programs: A Multi-Case Qualitative Study, Vinaya S. Murthy

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Some predict that genomic sequencing will become fully integrated into standard medical care within the next ten years, making genomic testing as routine as complete blood counts (Green et al., 2020; McCauley et al., 2017). Non-geneticist physicians, whose practices are being increasingly influenced by genomic medicine (GM), need to be knowledgeable and confident in GM to bridge the gap in patient access and quality of care due to genomic workforce shortages.

Objective: The aim of this study was to identify ways to accelerate adoption of GM in clinical practice by studying graduate medical education (GME) training programs. …

Acetaminophen Influences Musculoskeletal Signaling But Not Adaptations To Endurance Exercise Training, Brandon Roberts, Alyssa Geddis, Alexandra Ciuciu, Marinaliz Reynoso, Nikhil Mehta, Alyssa Varanoske, Alyssa Kelley, Raymond Walker, Rigoberto Munoz, Alexander Kolb, Jeffery Staab, Marshall Naimo, Ryan Tomlinson

Department of Orthopaedic Surgery Faculty Papers

Acetaminophen (ACE) is a widely used analgesic and antipyretic drug with various applications, from pain relief to fever reduction. Recent studies have reported equivocal effects of habitual ACE intake on exercise performance, muscle growth, and risks to bone health. Thus, this study aimed to assess the impact of a 6-week, low-dose ACE regimen on muscle and bone adaptations in exercising and non-exercising rats. Nine-week-old Wistar rats (n = 40) were randomized to an exercise or control (no exercise) condition with ACE or without (placebo). For the exercise condition, rats ran 5 days per week for 6 weeks at a 5% …

An Explanatory Sequential Mixed Methods Study To Understand Stakeholder Collaboration In Precision Medicine, Worlanyo Sosu-Sedzorme

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Precision medicine is a promising approach to healthcare that can improve the diagnosis, treatment, and prevention of various health conditions. However, its implementation into clinical practice is complex and requires effective collaboration among multiple stakeholders. Unfortunately, the current state of stakeholder collaboration in precision medicine is poorly understood.

Objective: This study explored stakeholder collaboration in precision medicine to identify barriers and facilitators and propose recommendations for effective collaboration.

Study participants: The study recruited thirty-eight individuals involved in precision medicine, including providers, patients or guardians, administrative personnel, and researchers from multiple healthcare organizations, mainly in the mid-Atlantic …

Intraprocedural Versus Initial Follow-Up Minimal Ablative Margin Assessment After Colorectal Liver Metastasis Thermal Ablation: Which One Better Predicts Local Outcomes?, Yuan-Mao Lin, Iwan Paolucci, Jessica Albuquerque Marques Silva, Caleb S O'Connor, Bryan M Fellman, Aaron K Jones, Joshua D Kuban, Steven Y Huang, Zeyad A Metwalli, Kristy K Brock, Bruno C Odisio

Faculty, Staff and Student Publications

Objectives: The aim of this study was to investigate the prognostic value of 3-dimensional minimal ablative margin (MAM) quantified by intraprocedural versus initial follow-up computed tomography (CT) in predicting local tumor progression (LTP) after colorectal liver metastasis (CLM) thermal ablation.

Materials and methods: This single-institution, patient-clustered, tumor-based retrospective study included patients undergoing microwave and radiofrequency ablation between 2016 and 2021. Patients without intraprocedural and initial follow-up contrast-enhanced CT, residual tumors, or with follow-up less than 1 year without LTP were excluded. Minimal ablative margin was quantified by a biomechanical deformable image registration method with segmentations of CLMs on intraprocedural preablation …

Toward A Patient-Partnered Model Of Clinical Trial Design: A Qualitative Descriptive Case Study Of The Duchenne Muscular Dystrophy Clinical Research Partnership, Jennifer Catena Davis

Doctor of Philosophy in Translational Health Sciences Dissertations

To provide actionable information about the safety and efficacy of new medications, clinical trials should be designed to test outcomes that patients find meaningful. This imperative is increasingly acknowledged by the scientific community and regulatory authorities and in recent years has been enshrined in regulatory guidance documents for industry; however, clinical trials often fail to adequately address patient priorities. Evidence suggests that partnerships between researchers and patient communities may result in clinical trials that better reflect the patient experience, but there are few successful models of such partnerships. Within the clinical research landscape, the Duchenne Muscular Dystrophy (DMD) community has …