Clinical Research
This section includes Class of 2024 Embark Projects within the Clinical and Translational research areas. Many of these projects were initiated from our OUWB Clinical Faculty within many areas of clinical practice.
Quantifying the Importance of Orthopaedic Surgeon Attributes by the Public
Rasheed Abdullah1, James E. Feng M.D., M.S.2, Phillip Vartanyan, M.D.2, Hassan Alosh, M.D.2, Drew Moore, M.D.2, Leonardo M. Cavinatto, M.D., Ph.D.2, Betina Hinckel M.D., Ph.D2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Orthopaedics, Beaumont Health, Royal Oak, MI
INTRODUCTION
With an evolving patient population, new modalities and strategies for finding orthopaedic surgeons are available. This study aimed to identify what attributes patients perceive as most important when choosing an orthopaedic surgeon and what modalities may be most effective.
METHODS
An online survey was developed and distributed in January 2022. In total, 510 responses were collected. Participants responded to questions regarding their demographics and rated the relative importance of various physician characteristics on a unipolar Likert scale. Descriptive statistics were performed.
RESULTS
Respondents demographics: on average age 40.4 years old, Caucasians (83.14%), and with a bachelor’s degree (45.49%) or higher and salary between $25,000-74,000 USD (56.07%). Most applicants lived in a suburban location (47.05%) and the southern region of the US (40.78%). The majority were privately insured (60.59%) and averaged 2.91±4.99 PCP visits per year. Nearly one-third had seen an orthopedist in the past (32.55%).
Surgical skill was the most important attribute with 81.96% ranking it as “most important.” This was followed by years in practice (Most important: 50.39%), and medical school (Most important: 35.69%). Conversely, the three least important factors were surgeon gender (Least important 60.2%), race (Least important: 65.1%), and religion (Least important: 68.63%).
When asked about the most effective marketing method, referral from a physician or therapist was ranked #1 with 72.16%, while family and friend recommendations were #2 with 23.33%. Social media and traditional advertisement were #3 and #4 and collectively comprised less than 5% of respondents.
CONCLUSIONS
Surgical skill and physician experience were reported as the most important attributes when choosing an orthopaedic surgeon by this survey cohort, above academic performance, race, gender, or religion. Despite the rise of social media platforms, physician referrals, and reputation remain the most important marketing tool to orthopaedic surgeons.
Methenamine Prophylaxis for Recurrent Urinary Tract Infections
Salwan Al Hani, B.S.1, Matthew Sims, M.D./Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell William Beaumont University Hospital, Section of Infectious Diseases & International Medicine, Royal Oak, Michigan
INTRODUCTION
Urinary tract infections (UTIs) are the most common outpatient infection in the US. Between 50%-60% of women will experience at least one UTI during their life. Recurrent UTIs are often managed with antimicrobials in clinical practice, which decreases effectiveness and increases resistance rates. Methenamine is an antiseptic compound approved by the FDA to prevent rUTIs but is seldom used in clinical practice. This study seeks to determine the success of methenamine for prevention of recurrent UTIs by retrospectively analyzing UTI data in patients prescribed methenamine for rUTI prophylaxis.
METHODS
283 patients with recurrent UTIs prescribed methenamine at Corewell William Beaumont University Hospital for rUTI prophylaxis were screened, and 93 were included in this study. Patient demographics, UTI history, kidney function, and medications were assessed before and after 12 months of methenamine prophylaxis following a rUTI. Patients with insufficient UTI data, unknown methenamine prescription dates, allergies to methenamine or less than 12 months of methenamine prophylaxis were excluded.
RESULTS
70 female and 23 male patients with a median age of 81 experienced 263 UTI episodes in the 12 months before and 132 episodes after methenamine prophylaxis. Male patients had 3.4 UTIs before and 1.9 UTIs after prophylaxis (SD 1.3, p<0.0001), female patients had 2.7 UTIs before and 1.3 UTIs after prophylaxis (SD 1.6, p<0.0001). In patients with varying severity of chronic kidney disease ME prophylaxis resulted in similar reductions in UTI recurrence. Methenamine decreased UTI recurrence in patients with chronic urinary catheters from 3.4 UTIs before to 2.3 UTIs after prophylaxis. Patients without chronic urinary catheters had 2.7 and 1.2 UTIs before and after methenamine prophylaxis respectively.
CONCLUSIONS
Methenamine can serve as a useful prophylactic agent in patients aged 50 and over with recurrent UTIs. Methenamine reduced UTI recurrence across all age groups, in patients with mild or severe CKD, and chronic urinary catheters.
Effect of Emsella Chair Therapy on Stress Urinary Incontinence
Ayman Alam, M.S.1, Bernadette Zwaans, Ph.D.2, Erica Zagaja, M.D.2, Kenneth Peters, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell Health System, Department of Urology, Royal Oak, MI
INTRODUCTION
Stress urinary incontinence (SUI) results from weakened pelvic floor muscles or urethral sphincter. Up to 33% of women experience this condition once in their lifetime. This study aims to evaluate the efficacy of BTL Emsella ("Emsella Chair") in reducing SUI frequency and increase the quality of life for both men and women. The Emsella Chair is a non-invasive method that strengthens the pelvic floor muscles through electromagnetic stimulation.
METHODS
Adults aged 18 to 80 with a history of SUI were randomized into a sham or active Emsella therapy group. Over the course of four weeks, participants received eight treatments, with two treatments per week. The active therapy group received treatment at 100% threshold intensity, while the sham group received less than 10% intensity. Each session lasted 28 minutes. Participants recorded their symptoms before starting therapy (baseline), four weeks after post-treatment (V9), and eight weeks post-treatment (V10). SUI improvement was assessed using self-recorded 3-day voiding diaries, and symptom improvement was measured using validated questionnaires (e.g., I-QOL, UDI-6).
RESULTS
22 participants were enrolled and randomized to sham (n=10) or active (n=12) therapy treatments. While the active group demonstrated a statistically significant reduction in the number of SUI events compared to baseline, no significant difference was observed between active and sham groups. Symptom improvement, though not statistically significant, was noted in both groups via I-QOL and UDI-6 surveys.
CONCLUSIONS
BTL Emsella therapy shows promise in reducing number of SUI events and enhancing quality of life. Our study indicates that both active and sham groups benefited from treatment, suggesting the possibility that the stimulation intensity required is less than previously thought, a placebo effect is present, or that a larger sample size is needed. Further research should be done to explore the effects of Emsella therapy on SUI events.
An Analysis of ED visitors for Dermatological Disorders Prior to and During the COVID Pandemic
Faris Alkhouri, B.S.1, Jacob Keeley, M.S.1, Ramin Homayouni, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Dermatology-related ED visits make up more than 3% of total ED visits; however, only around 2% of these visits can be considered true emergencies. To our knowledge, there are no studies that looked at demographic influence on ED visits in regards to skin disorders in the adult population. In addition, the Covid pandemic has greatly influenced the ED utilization, it has also been seen to cause many cutaneous manifestations. This project aims to provide a review of the dermatologic conditions that were seen in the ED and compare the rates and population characteristics prior to and during the Covid pandemic.
METHODS
A retrospective chart review was conducted. Patients that visited the Beaumont ED in a three-month period prior to the pandemic (2019) and soon after its onset (2020) and had been diagnosed with a dermatological disorder were screen using ICD 10 codes. Variables of interest, which were the patient population demographics, were first analyzed overall and then stratified based on hospital year. To compare the two hospital years, t-tests, chi square analysis, and Fisher's Exact Test were performed on the variables.
RESULTS
Our data showed similar dermatologic rates for the two compared periods. There were about half as many visits in 2020 as there were in 2019, however the composite of the disease categories presented in a very similar order with the top three in both years being cellulitis, rashes, and abscesses. There was, however, a higher number of repeat visitors in 2020, as well as an increase in Medicaid/Medicare users’ percentage.
CONCLUSIONS
Dermatologic conditions still comprise a significant number of ED visits. Despite the onset of a pandemic, ED usage for dermatologic conditions was not significantly changed. This study highlights important points for future discussions on ED utilization.
Documentation of Social Determinants of Health and Outcomes
Adel Andemeskel, B.S.1, Jacob Keely, M.S.1, Tracy Wunderlich-Barillas, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Social determinants of health (SDH) - including a person’s physical environment, education, employment, social support, and access to health care - have a significant impact on a person’s health2. Population characteristics influencing SDH include age, sex, race and ethnicity, and socioeconomic status3. Taking a detailed history of the SDH that affect a patient may lead to improved health outcomes4. This study aims to find associations between documenting SDH while medical history taking and utilization of healthcare in follow-up by determining the prevalence of ICD 10 codes related to SDH in medical records (Aim I) and determining whether or not SDH are being addressed during patient history taking (Aim II).
METHODS
The study was done at a large health system in southeastern Michigan. Patients whose age was greater than 18 years and had a new patient visit with a physical exam between 2018 and 2021 were included in the study. We queried 21,901 subjects, and 38 had at least one ICD-10 code specific to SDH identified via electronic medical records. Demographic variables such as age, sex, race, ethnicity, payor status, employee status, and marital status were analyzed. Qualitative analysis was performed through chart review in order to determine if follow-up was initiated by the physician.
RESULTS
The mean age of the 38 subjects was 37.9 years (19.1-63.7). The majority identified as White/Caucasian (60.5%), non-Hispanic/Latino (81.6%), insured (100%), employed full-time (54.8%), and single (42.1%). Qualitative analysis revealed that social determinants of health were indeed addressed during health visits with SDH ICD-10 codes. Actions to address SDH included referrals to specialists, such as clinical psychologists and psychiatrists as well as in-house consultations with social workers.
CONCLUSIONS
The results support the hypothesis that SDH are addressed during health visits when they are documented through social history taking and appropriate billing of ICD-10 codes.
Gender and ethnic representation of incoming Mohs micrographic surgery fellows in the United States: A look into fellowship diversity
Mustafa Azam, B.S.1, Rafey Rehman, M.D.1, Suzan Kamel-ElSayed, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
The US population is becoming increasingly diverse, and it has been estimated that no single ethnic group will become majority of the population by 2043.1 Although dermatology has been one of the least-diverse specialties in medicine, there is paucity of research on diversity trends in different dermatology subspecialties, including Mohs micrographic surgery.2 The purpose of this study was to characterize gender and ethnic trends of incoming Mohs micrographic surgery fellowship classes in the United States over a 10-year period from 2011 to 2020.
METHODS
Demographic information of incoming Mohs micrographic surgery fellows was retrieved from the Graduate Medical Education census published in the Journal of the American Medical Association.3 Information regarding gender and ethnic representation was collected from 2011 to 2020, and these data were then subsequently analyzed.
RESULTS
Overall, men and women represented an average of 52.2% and 47.8%, respectively, of the incoming fellows during this 10-year interval. The distribution of different ethnicities during this time was as follows: 76.7% Whites, 16.2% Asians, 3.7% Hispanics, 2.0% Blacks, 0.3% Native Hawaiian or Pacific Islanders, 0.8% multiracial groups, and 3.9% other or unknown identities. The average yearly rate of change for the various gender and ethnic backgrounds were as follows: −0.76% for men, +0.76% for women, +1.01% for Whites, −0.46% for Asians, −0.5% for Hispanics, −0.77% for Blacks, −0.05% for Native Hawaiian or Pacific Islander, +0.59% for multiracial groups, and −0.02% for other or unknown identities.
CONCLUSIONS
Over the last decade, the proportion of women matriculating into US Mohs micrographic surgery fellowships has been proportional to the female US population, and slowly increasing.4 The proportion of incoming Black and Hispanic fellows has steadily decreased over the last decade. Although Blacks and Hispanics represent 13.4% and 18.5% of the US population, respectively, this proportion is not reflected in the incoming fellowship classes.
Operative Versus Non-Operative Treatment of Z-Type Clavicle Shaft Fracture in Adolescents: A Retrospective Study
Sami Azeroual, B.S.1, Colin Van Wagoner, B.S.1, Joseph M. Leider, M.D.2, Ehab Saleh, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell Health System - Department of Orthopaedic Surgery
INTRODUCTION
Clavicle fractures are common in both adult and pediatric populations1. Yet, the literature describes differences regarding treatment in such fractures between these populations, favoring operative treatment for adults and nonoperative treatment for pediatric patients1-5. An exception to this is a subgroup of adolescent clavicle fractures known as the Z-type comminuted fracture. The literature regarding treatment in these cases is conflicting6. Thus, this study aims to determine outcome differences between surgical or non-surgical treatment for adolescent Z-type fractures and to ascertain if differences exist in patient-reported outcomes between the two interventions.
METHODS
A retrospective chart review was conducted of 78 patients at Beaumont Royal Oak Hospital from 01/01/2019 and 12/31/2022. Inclusion criteria included patients between ages 12 and 16, diagnosis of a Z-type comminuted fracture, in-patient admission with surgical treatment, and out-patient cases treated surgically. Data collected included demographics, treatment modality, union achievement, follow-up period, return to activity, range of motion, and patient reported pain. A chi-squared test was performed to compare the outcomes between the treatment groups.
RESULTS
21 patients underwent surgery while the remaining 57 did not. A total of 54 patients either did not follow up or their follow up was not present in any charts. 3 patients experienced non-union. (2 non-surgical, 1 surgical.) (p = .798514.) Every patient who continued to follow-up was able to return to normal activity and regained normal ROM and had minimal to no lingering pain with an average follow-up time of 7.5 months.
CONCLUSIONS
The study found no significant difference in adverse outcomes between surgical and non-surgical treatments for adolescent Z-type comminuted fractures. Non-union rates did not significantly vary between groups, suggesting no superior treatment option. Limited follow-up data poses a study limitation, potentially due to symptom improvement prompting fewer follow-ups. Further research tracking patients longitudinally is needed for comprehensive understanding.
Incidence of Symptomatic Upper Extremity Deep Vein Thrombosis in Respect to Subcutaneous Port Venous Access Site in Adults: A Retrospective Review
Catherine Barkach, M.S.1, Alexsandra Biel, B.A.1, Corinne G Bowditch, B.S.1,
Paul Bove, M.D.2, Jimmi Mangla, M.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Vascular Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI
3Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI
INTRODUCTION
This study aims to evaluate the incidence of symptomatic upper extremity deep vein thrombosis (UEDVT) based on the subcutaneous port venous access site.
METHODS
We performed a retrospective review of adult patients who underwent subcutaneous port implantation in two hospitals. Patients were included if the subcutaneous port venous access site was the subclavian vein (SCV), internal jugular vein (IJV), external jugular vein (EJV), or cephalic vein. Patients diagnosed with subsequent symptomatic UEDVT were identified. Data regarding patient characteristics, port characteristics, and diagnosis of symptomatic UEDVT were collected, and summary statistics were performed.
RESULTS
We identified 3,681 patients who underwent 3,765 port implantations for inclusion and analysis. The catheter insertion site was the cephalic vein in 785 cases (21%), SCV in 824 cases (22%), IJV in 2,052 cases (54%), and EJV in 104 cases (3%). Subsequently, 64 cases were diagnosed with symptomatic UEDVT. The incidence of symptomatic UEDVT was 3.8% (cephalic vein), 1.9% (EJV), 1.3% (IJV) and 0.7% (SCV). A chi square analysis was performed and showed that the cephalic vein had significantly more symptomatic UEDVT’s when compared to all other catheter insertion sites (p<0.0001). Additionally, the cephalic vein had significantly more symptomatic DVTs when compared individually to the subclavian vein (p<0.0001) and the internal jugular vein (p<0.0001).
CONCLUSIONS
At our institution, the overall incidence of symptomatic UEDVT following subcutaneous port implantation was 1.7%. Our study reports that the cephalic vein as the subcutaneous port venous access site had a significantly higher rate of symptomatic UEDVT.
How Does The Body Respond to Passive Physical Activity?
Sarah Battle, B.A.1, Lisa L.M. Welling, Ph.D.2, Kathryn M. Rogueau
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Oakland University, College of Arts & Sciences. Rochester Michigan
3Oakland University School of Health Sciences, Rochester, Michigan
INTRODUCTION
Physical activity (PA) has been shown to be beneficial in the regulation of stress hormones and modifying the stress pathway. However, many individuals face barriers to participating in PA, such as musculoskeletal injuries, neuromuscular disorders, spinal cord injuries, or brain trauma. One potential intervention for those individuals is passive PA, defined as the movement of the body without muscle engagement or voluntary effort. There is a poor understanding of the physiological response to passive PA and how it compares to the response to active PA. In particular cortisol and salivary alpha-amylase (sAA), hormones implicated in the stress response, are known to be altered by active PA.
METHODS
This study aimed to investigate if these hormones are similarly influenced by passive cycling. Thirty-five healthy, young adults (13 males, Mage= 21.20 ± 2.93) participated in an active cycling condition, in which they provided the force to cycle, and a passive cycling condition, in which their feet and ankles were affixed to the cycle and a motor moved their limbs for 35 minutes. Saliva samples were collected before PA, immediately after, and 30 minutes after, and were used to quantify cortisol and sAA levels at those time points.
RESULTS
Paired t-tests revealed no significant difference in cortisol and sAA levels between the active and passive conditions (p>.08). Enjoyment of active (94.13 ± 15.87) and passive (88.81 ± 21.94) cycling did not differ significantly (p=0.109).
CONCLUSIONS
The changes in hormones in response to active PA were not significantly different from the changes in hormones in passive PA, therefore, making passive PA a potential therapeutic intervention that yields similar physiological effects on the stress pathway and similar levels of enjoyment as active PA.
A Retrospective Review of Cosmetic Surgery Medical Tourism Complications During COVID-19 Pandemic
Rachel Blaisdell, B.S.1, Claire McNary, M.D.1, Catherine Barkach, M.S.1, Emanuela Peshel, M.D.2, Elizabeth Boudiab, D.O.2, Lauren Oliver, M.D.3, Samuel Mucci, M.D.3
1Oakland University William Beaumont School of Medicine, Rochester, MI
2Department of Surgery, Beaumont Health Systems, Royal Oak, MI
3Department of Plastic and Reconstructive Surgery, Beaumont Health Systems, Royal Oak, MI
INTRODUCTION
Cosmetic surgery tourism involves traveling outside the geographic region for a procedure. Although it promises lower costs, shorter wait times, and trendy, new procedures, patients lack the continuity of care needed to manage potential complications. Here, we evaluate the change in trends of cosmetic tourism complications during the COVID-19 pandemic.
METHODS
A retrospective review and keyword query was done to identify patients pre-COVID (January 2018-Febuary 2020) and during COVID (March 2020-October 2021). Patients presenting to Beaumont Hospital System with a complication were included if they travelled outside the state for the sole purpose of undergoing a cosmetic procedure. Descriptive statistics were used to compare patient characteristics and outcomes.
RESULTS
33 patients were identified, 10 (30.3%) pre-COVID and 23 (69.6%) during COVID. All patients were female with a mean age of 34.8 (±7.2) years. There was no significant difference in tourism location (Florida [57.6%], the Dominican Republic [27.3%], and Mexico [9.1%]) or type of procedure (liposuction [64.6%], abdominoplasty [57.6%], and gluteal enlargement [51.5%]); the majority of patients (87.9%) underwent multiple procedures. All patients presented with wound complications; 18 (78.3%) patients during COVID required intervention compared to 6 (60.0%) pre-COVID. The mean length of stay was similar between groups (6.3±9.3 vs 6.0±5.3 days) with two patients during COVID requiring ICU-level care.
CONCLUSIONS
There was increase in patients presenting with complications caused by cosmetic tourism despite the COVID-19 pandemic. Patients are unable to follow-up with their original surgeon, placing the burden of care on their local healthcare system.
Comparing the outcomes of titanium and stainless steel flexible nails in repairing pediatric long bone fractures
Novelpreet Boparai, B.S.1, Ehab Saleh, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Orthopedic Surgery, Corewell Health
INTRODUCTION
Traditionally, pediatric femoral fracture treatment favored conservative methods, relying on casting and the inherent bone remodeling ability in immature bones. Surgical intervention was deferred until age 6, as non-operative approaches often resulted in complications. Titanium elastic nailing (TENS) emerged as an effective treatment for diaphyseal femoral fractures in ages 6 to 16. However, the choice between TENS and stainless steel elastic nailing (SSENS) remains debated due to inconsistent findings. This study aimed to evaluate the effectiveness of both nailing systems in pediatric long bone fractures.
METHODS
A retrospective chart review at William Beaumont Hospital Royal Oak included 83 patients aged 6 to 16 treated with TENS or SSENS between January 2011 and January 2021. Data collected encompassed nail-related issues, time to fracture union, full weight bearing, and nail removal.
RESULTS
In the TENS group (n=29), the average age was 8.8±2.4 years, and the average BMI was 17.2±3.4. The SSENS group (n=54) had an average age of 9.3±2.7 and an average BMI of 19.7±8.4. No statistically significant differences were observed in nail-related complications. Rod breakage and superficial infection were rare. Time to fracture union for TENS was 93.8±60.5 days, while SSENS was 82.2±40.0 days. Time to full weight bearing for TENS was 66.9±38.0 days and for SSENS was 80.0±46.7 days.
CONCLUSIONS
This study found no statistically significant differences in nail-related complications, time to fracture union, full weight bearing, or nail removal between TENS and SSENS in pediatric long bone fractures. The choice between these systems should be based on individual circumstances. While TENS has been popular, SSENS appears cost-effective. Limitations include a small sample size and the study's retrospective nature. Future research should involve larger samples and focus on specific long bones to enhance understanding.
Outcomes of Primary ACL Repair for Proximal Tears: A Systematic Review and Meta Analysis
Collin Braithwaite, B.A.1, Tanner Hafen, B.S.1, Robert Dean, M.D.2, Joseph Guettler, M.D.2, James Bicos, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell Health University William Beaumont Hospital Orthopedic Department
INTRODUCTION
Primary ACL (anterior cruciate ligament) repair has recently become increasingly popular within the last few years. A variety of primary ACL repair techniques have been developed and have shown favorable outcomes in small case control studies.
METHODS
PRISMA guidelines were followed. All studies from Embase, Cochrane, and PubMed published between June 2011 and June 2022 reporting outcomes of primary ACL repair on proximal tears with a minimum two-year follow-up were included. Primary ACL repair was divided into Dynamic, static, and non-augmented repair. The primary outcome was failure rates, secondary outcomes included patient reported outcomes and tibial stability.
RESULTS
17 studies on primary ACL repair were included with a total of 558 patients (ages ranges from 6-65, 60% male). Only 2 studies were level one randomized controlled clinical trials. Static repair had a failure rate of 31 out of 324 (13.2%), non-augmented was 13 out of 150 (8.9%), dynamic repair was 31 out of 174 (17.8%), no statistically significant difference was found comparing the failure rates (p=0.090). Patient reported outcomes using IKDC and lysholm scores had weighted averages of 91.7 (95% CI: 89.6-93.8) and 94.7 (95% CI: 92.7-96.7). Anterior tibial translation (ATT) had a weighted average of 1.668 mm (95% CI: 1.002-2.334)
CONCLUSIONS
A combined failure rate of 13.4% was found for primary repair in proximal ACL tears with no significant difference in failure rates when accounting for the methodology of repair. Acceptable patient reported outcomes were reported amongst the different types of primary repair. There is a lack of high-quality studies with high risk of bias but it appears primary repair may be a useful treatment option for indicated candidates with proximal ACL ruptures.
Use of Early Enteral Nutrition in Mechanically Ventilated COVID-19 Patients
Vivian Chang, B.A.1, Ramin Homayouni, Ph.D.2, Virginia Uhley2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Malnutrition in critically ill patients is associated with a greater length of hospital stay (LOS), incidence of complications, and increased risk of death. Up to 37% of critically ill patients in the intensive care unit (ICU) are either moderately or severely malnourished. Optimizing enteral nutrition delivery is the key to maximizing the benefits of nutrition support for critically ill patients. The role of nutrition support for mechanically ventilated COVID-19 patients was poorly understood at the onset of the COVID-19 pandemic in March 2020. The primary goal of this study was to examine the association between time from mechanical ventilation to enteral nutrition initiation and clinical outcomes in patients hospitalized with severe COVID-19 infection. The secondary goal was to investigate its association with mortality and LOS after adjusting for gender, race, and comorbidities.
METHODS
Electronic medical record data were extracted from EPIC between March 2020 and March 2021. We identified 1546 adult patients admitted to the Beaumont Health system who tested positive for SARS-CoV-2 and were placed on mechanical ventilation. After accounting for duplicate patients with no tube feeding and outliers, a total of 1098 patients formed Cohort A, of which 688 patients died and 408 patients were presumed alive. Cohort B included 408 presumed alive patients Among these, 196 patients had a LOS than or equal to 23 days.
RESULTS
Using a multivariable linear regression model (Cohort A) adjusted for gender, race, and comorbidities, we found no associations between mechanical ventilation to tube feeding time and mortality and LOS. Increased age and BMI in mechanically ventilated patients with severe COVID-19 did show significant associations with mortality. Regression analysis of Cohort B revealed that patients with a history of atrial fibrillation were significantly more likely (OR 2.5, p<0.0016) more likely to have a LOS greater than 23 days.
CONCLUSIONS
Our findings are consistent with those of prior studies such that initiating early enteral nutrition did not improve the clinical outcomes of mechanically ventilated COVID-19 patients.
Comparison of Associated Autoimmune Disease Diagnoses in Myasthenia Gravis and Multiple Sclerosis Patients
Alecca Como, B.S.1, Jacob Keeley, M.S.1, Daniel Menkes, M.D.1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Neurology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
INTRODUCTION
Autoimmune diseases often co-exist given the non-specific nature of the immune response. For example, myasthenia gravis [MG], a well-established autoimmune disease, has a 2.36-fold increased risk of developing thyroid diseases as compared to normal controls. Contrarily, multiple sclerosis [MS] has known immune pathogenesis, although there is insufficient evidence to classify it as an autoimmune disease. To further explore the coexistence of autoimmune disorders, this study compared the association of concordant autoimmune diseases between MG and MS patients, using migraine, a non-autoimmune neurological disorder, as a control group.
METHODS
A retrospective chart review was conducted utilizing data from the electronic medical record at William Beaumont University Hospital. Adult patients with a preexisting diagnosis of MG, MS, or migraine were matched by age, sex, and race, resulting in three groups of 297 patients each. These subsets were queried for additional autoimmune diagnoses including pernicious anemia, thyroid disease, type 1 diabetes mellitus, asthma, inflammatory bowel disease, psoriasis, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus [SLE], Sjogren’s syndrome, temporal arteritis, dermatomyositis, polymyalgia rheumatica, and systemic sclerosis. The percentage of patients in each group with autoimmune comorbidities was compared using Chi-Square tests with correction for multiple comparisons.
RESULTS
MG patients had more total autoimmune diagnoses than MS (P<.0001) and migraine (P<.05). Migraine patients had more total diagnoses than MS (P<.05). MG patients also had significantly more thyroid disease, SLE, and asthma diagnoses than both MS and migraine. There was no difference between MS and migraine for any of the individual autoimmune diagnoses.
CONCLUSIONS
The overall lack of a significant association between other autoimmune diseases and MS lends further credence to the concept that MS in not primarily an autoimmune disease. The significant association between MG and asthma indicates that MG patients should be evaluated for concordant asthma with a low threshold for ordering pulmonary function studies.
The Impact of COVID-19 on Adolescent Eating Disorders
Caroline Desler, B.S.1, Mary B. Eberly Lewis, Ph.D.2, Jaime L. Taylor, 3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Psychology, Oakland University, Rochester, Michigan
3Corewell Health Beaumont Children's Hospital, Royal Oak, Michigan
INTRODUCTION
Higher rates of eating disorders (EDs) were reported during COVID among adolescents. Lockdown measures created changes to daily routines that limited in-person social interactions, putting adolescents at greater risk of isolation and loneliness. This project aims to explore the impact of the pandemic on adolescents with newly diagnosed EDs, specifically through a psychosocial lens.
METHODS
A list of 1145 patients was generated using inclusion criteria. Patients were split into pre-COVID and COVID groups. A coding scheme was created to guide data entry, and four independent data loggers were recruited and trained. Data analysis was performed using t-test and Chi-square analyses.
RESULTS
When compared to patients diagnosed with an ED during the pre-COVID period, patients diagnosed with an ED during COVID were less likely to live with parents in an intact marriage or partnership (p = 0.0691), and less likely to spend time with friends (p = 0.0073). The COVID group was 8.9% more likely to have an overlapping diagnosis of depression (p = 0.0095), 46.6% more likely to have anxiety (p < 0.0001), and 8% more likely to report prior suicidal ideation (p = 0.0564).
Patients with depression and/or anxiety who were diagnosed with an ED during COVID were less likely to spend time with friends when compared to the pre-COVID group (p = 0.0650, p = 0.0255). For patients with comorbid ED + depression, min and mean pre-albumin levels (indicator of ED severity/nutritional deficiency) were on average lower (more severe) when diagnosed with an ED during COVID as compared to pre-COVID (p = 0.0125).
CONCLUSIONS
The results suggest that elements of the adolescent psychosocial milieu, specifically family living situation, social dynamics, and psychiatric comorbidities, contributed to the higher ED rates observed during the pandemic. COVID also led to worsening measures of ED severity for patients with a comorbid eating disorder and depression.
Emergency Department Treatment of Elevated Blood Pressure in the Headache Patient
Lauren Eberhardt, B.S.1, Michelle Jankowski, M.S.1, Brett Todd, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Emergency Medicine, Corewell Health Hospital, Royal Oak, MI
INTRODUCTION
Headache accounts for 2 – 3% of emergency department (ED) visits in the United States and often requires rescue analgesia to alleviate symptoms. Despite the common co-presentation with hypertension, it is unclear if this population benefits from antihypertensive treatment in the ED. We aimed to assess the effects of antihypertensive therapy in ED headache patients on the rate of rescue analgesia administration, hospital admission, and ED length of stay (LOS).
METHODS
We performed a retrospective study of ED headache patients with hypertension treated from 1/1/2016 to 12/31/2019. We included patients > 18 years old with a chief complaint of headache, rescue analgesia during ED visit, and stage 2 hypertension, defined as systolic > 160 and/or diastolic > 100. Patients were excluded for leaving against medical advice, pregnancy or postpartum period < 6 weeks, stroke, trauma, intracranial hemorrhage, and mass effect.
Data extracted from the medical record included demographics, history of hypertension, triage blood pressure, administration of rescue analgesia and anti-hypertensive therapy, ED disposition, and ED LOS. Clinical characteristics of patients stratified by presence or absence of antihypertensive therapy were summarized using descriptive statistics for continuous and categorical variables. Tests of bivariate analyses as well as multivariable logistic and linear regression analysis assessed effects on rescue analgesia, ED LOS, and hospital admission.
RESULTS
We identified 5,378 patients who presented to the ED with headache and hypertension within the time frame. After applying criteria, 1,385 patients remained. 366 received anti-hypertensive therapy. The anti-hypertensive therapy cohort was older (p < 0.001) with increased odds of admission (p < 0.001) and 2.385 hrs longer ED LOS (p < 0.001). No difference in rescue analgesia was found (p < 0.429).
CONCLUSIONS
Anti-hypertensive therapy in hypertensive ED headache patients is associated with increased hospital admission and ED LOS, but no difference in rescue analgesia utilization.
Public Perception of Robotic Assisted Total Hip Replacement Surgery
Marvee Espiritu, M.S.1, James E. Feng, M.D.2, Phillip Vartanyan, M.D.2, Drew Moore, M.D.2, Robert Runner, M.D.2, Mark Karadsheh, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Orthopaedics, Corewell Health
INTRODUCTION
Computer-assisted and robotic (CA/R) total hip arthroplasty (THA) has gained considerable attention among patients. Here we evaluate the public’s perception of technology-assisted compared to traditional THA.
METHODS
A prospective cohort study was developed utilizing a survey distributed via a public, online marketplace. Participants were queried whether they would prefer a CA/R or traditional THA without additional information. Respondents were subsequently separated into “Tech” and “Traditional” cohorts. Respondents then completed an educational questionnaire which gathered respondent preferences while presenting evidence-based information regarding the surgical modalities. Respondents were asked again which modality they would prefer at the current time.
RESULTS
507 surveys were completed with 311 (61.34%) Tech and 196 (38.66%) Traditional THA respondents initially. After completing the educational questionnaire, 48.47% of Traditional and 85.85% of Tech THA respondents (aggregate: 71.40%) would choose CA/R THA today. Among this subset, 73.20% would switch surgeons for CA/R THA. Among all respondents, 88.27% Traditional and 94.53% Tech respondents believed health insurance should cover the costs of CA/R THA (p<.05). Individuals willing to supplement insurance costs for CA/R THA was lower (40.51% Tech vs 27.04% Traditional, p<.01).
Both groups indicated that surgeons should be trained for CA/R THA in its current state (aggregate 69.63%). Semi-active robotic (65.29%) was preferable to fully autonomous robotic (16.57%) and computer-assisted (18.15%) THA.
CONCLUSIONS
Technology-assisted THA is valued by the public. It is recommended that newer generation of surgeons be familiar with this technology to accommodate the growing demand.
Novel Patient Decision Aid for Wide-Awake-Local-Anesthesia-No-Tourniquet (WALANT) Use in Carpal Tunnel Release
Majd Faraj, B.S.1,2, Nikhil R Yedulla, M.D.2,3, Cade C Cantu2,4, Brooke G Garnica, M.D.2,3, Austin M Meadows, B.S.2,3, Charles S Day, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Henry Ford Health Hospital, Detroit, Michigan
3Wayne State University School of Medicine, Detroit, Michigan
4University of Michigan, Ann Arbor, Michigan
INTRODUCTION
This study sought to develop a decision aid to guide patients’ decision-making process when deciding on an anesthetic technique for carpal tunnel release (CTR).
METHODS
Using the International Patient Decision Aid Standards, a decision aid packet (DAP) was drafted. The DAP included an Orientation, Memory, and Concentration Test (OMCT), a knowledge pre-test, a decision aid table, a knowledge post-test, and a decisional conflict score assessment. Following review by a committee of hand surgeons and a patient advisory council, the DAP was further refined based on feedback. Next, patients at associated orthopedic hand clinics who were eligible for CTR were administered the WALANT DAP. Responses were then analyzed to determine decision aid effectiveness and patient preferences.
RESULTS
Of the 113 patients queried, 100 were enrolled after passing an orientation memory concentration test (OMCT) and completing all survey questions. Regarding knowledge test scores, patients scored significantly better after reading the decision aid. The decisional conflict score was 6.82, which reflects high decisional confidence. Furthermore, 50% of patients surveyed reported preferring WALANT surgery while 34% preferred non-WALANT procedures. Additionally, male and non-white patients are significantly more likely to report higher control of their anxiety levels compared to female and white patients respectively. Similarly, employed and retired patients were significantly more likely to report better control of their anxiety compared to their unemployed counterparts.
CONCLUSIONS
The significant increase in post-test scores following the WALANT DAP administration and the low decisional conflict scale attest to the decision aid’s effectiveness in guiding patients towards an informed decision-making process. Our study indicates that while half of the surveyed patient population prefer the WALANT technique, about a third of patients still prefer non-WALANT techniques highlighting the need to offer a decision aid if considering CTR.
Hip Osteoarthritis Patient-Centered Literature: A Scoping Review
Luke Fickenworth, B.S.1, Mani Veerappan, M.S.2, Skyler Porcaro, M.D.3, Joshua Haworth, Ph.D.4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Physical Therapy, Western Michigan University, Kalamazoo, MI
3Baylor Scott & White All Saints Medical Center, Fort Worth, TX
4Department of Human Movement Science, School of Health Sciences, Oakland University, Rochester, MI
INTRODUCTION
The CDC has estimated that by 2040 there will be 78 million U.S. adults (26%) with osteoarthritis (OA). In addition to the mental and physical toll OA takes on patients, there is also considerable financial cost. The gold standard guidelines for treating hip osteoarthritis emphasize a patient-centered approach. In order to provide patient-centered care, it is important to understand the patient’s illness experience. The objective of this review is to characterize the literature done regarding the illness experience of patients with hip osteoarthritis.
METHODS
Following the established scoping review protocol, five reviewers performed searches on two electronic databases and identified papers that met the criteria. The key study characteristics (aims, methods, participants) were extracted by four reviewers. Descriptive statistical analysis was completed.
RESULTS
Of the 161 studies screened, 26 were included. The number of publications has risen sharply the last two decades. Among the 26 studies; 96% reported pain, 62% reported mobility, 62% reported quality of life, and 19% reported range of motion.
CONCLUSIONS
Considering there were over 9500 studies found via searching hip osteoarthritis on the two electronic databases, the literature shows markedly little research into the lived experience. The vast majority of research investigates treatment and diagnosis. The number of articles investigating the illness experience of patients with hip osteoarthritis is growing but remains a tiny fraction of the overall hip osteoarthritis research field. Understanding the patient experience of hip osteoarthritis will help physicians better diagnose and treat the condition, which is only expected to increase in prevalence in the coming years. Future studies should be conducted to better understand the intersection of pain and mobility as they relate to the activities of daily living for those living with hip osteoarthritis in order to better understand what drives care-seeking.
Morbidity of Tendon Harvest Site for Anterior Cruciate Ligament Autograft; A Systematic Review
Jessi Fore, B.A.1, Betina Hinckel, M.D.2, Elijah Auch, M.D2
1Oakland University William Beaumont School of Medicine, Rochester, MI
2Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI
INTRODUCTION
Primary anterior cruciate ligament (ACL) ruptures are highly common and lead to a significant number of primary ACL reconstruction surgeries in the U.S.When choosing a graft, surgeons can pick between auto- and allografts. An autograft can include a bone-patellar tendon-bone graft (BPTB), hamstrings tendon (HT) graft, or quadriceps tendon (QT) graft2. Currently, there is a wide range of research on graft types, but no paper compares all three graft types directly. This review aims to evaluate current literature to compare these three grafts and determine the morbidity and complications associated with each graft.
METHODS
A comprehensive literature search was performed on PubMed. We included prospective research that compared two or more of the BPTB, HT, or QT grafts on primary ACL reconstruction and evaluated the grafts for post-operative morbidity, return-to-sport, function, and other terms dealing with graft outcomes. These articles were screened by at least two researchers independently for inclusion in the study. Qualitative and quantitative data was compared through a variety of statistical functions. T-value <0.05 was considered statistically significant.
RESULTS
22 studies matched the inclusion criteria and were thereby included. Of these studies, 12 showed no significant difference between graft choices at 1-year post-operative. Two studies did show improved outcomes with BPTB graft when comparing overall strength of surgical limb, function, and laxity of knee; however, BPTB graft was noted to be associated with a higher incidence of knee osteoarthritis and anterior knee pain. HT graft showed a decreased risk of thigh atrophy and fewer early post-operative complications in two studies.
CONCLUSIONS
The results demonstrate that there is no clear best option for autograft choice in a primary ACL reconstruction, and surgeons should choose a graft based on other factors such as risk for arthritis, pre-operative muscle strength, and comfort with technique graft harvest.
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The Impact of Patch Placement Using Fluoroscopy Guidance on Outcome of Electrical Cardioversion of Atrial Fibrillation
Joshua G. France, B.S.1, Nishaki Mehta, M.D.2,3, Luai Madanat, M.D.2, Nolan Shoukri, B.S.1, David Haines, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Cardiovascular Medicine, William Beaumont University Hospital, Corewell Health East, Royal Oak, MI
3University of Virginia, Charlottesville, VA
INTRODUCTION
Anterior-posterior (AP) patch placement is the preferred configuration in electrical cardioversion (EC) of atrial fibrillation (AF). However, literature on the optimal procedural approach is conflicting.
METHODS
We performed a prospective observational study on adult patients presenting for EC of AF at Beaumont Hospital. Patches were placed in the AP position and EC was delivered with a biphasic AED in step up approach (100J 200J360J) using manual pressure augmentation. Cine fluoroscopic images were obtained, and distances measured from: A) mid-anterior patch, B) mid-posterior patch and C) midpoint between both patches, to the midpoint of cardiac silhouette. Patients requiring one 100J shock for EC success (Group A) were compared to those requiring >1 shock/100J (Group B). Multivariate logistic regression was used to determine predictors of low energy (100J) EC success.
RESULTS
Of the 87 patients included, 54 (62%) had success with a single 100J shock (Group A) and 33 (38%) required additional shocks (Group B). Mean age of participants was 71 years (±11) with 52 (59.8%) being males. Group A had a significantly lower distances from mid-cardiac silhouette to points A (5.0 ± 2.4cm vs 7.4 ± 3.3cm, p<0.001), B (7.3 ± 3.0cm vs 10.0 ± 3.8cm, P=0.002) and C (5.2 ± 2.6cm vs 8.3 ± 3.1cm, p<0.001) compared to Group B. On multivariate analysis, higher distances from mid-cardiac silhouette to points A (OR: 1.33, 95% CI:1.07-1.70, p=0.01), B (OR:1.24, 95% CI:1.05-1.50, p=0.01) and C (OR:1.50, 95% CI:1.20-1.90, p=0.001) were independent predictors of low energy (100J) EC failure.
CONCLUSIONS
In routine AP patch placement, closer proximity to the cardiac silhouette predicts successful 100J cardioversion irrespective of body habitus and clinical factors. In a sub-set of patients, image-guided patch placement may improve outcomes.
Characterizing the Effectiveness of Prehospital Pediatric Pain Management in Children with Long Bone Fractures
Revelle Gappy, B.S.1, Ashima Goyal, D.O.2, John Frawley, M.D.3, Sariely Sandoval, M.D.3, Nai-Wei Chen, Ph.D.4, Robert Swor, D.O.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Division of Pediatric Emergency Medicine, Beaumont Hospital
3Department of Emergency Medicine, Beaumont Hospital
4Division of Informatics and Biostatistics, Beaumont Research Institute
INTRODUCTION
Limited studies exist evaluating the effectiveness of prehospital analgesics and non-pharmacologic interventions for children. The objective of this study was to assess the effectiveness of prehospital pain management for pediatric patients with long bone fractures.
METHODS
We performed a retrospective data analysis of a linked EMS record hospital dataset of patients ≤ 18 years old who were transported after a 911 response and had a hospital ICD-10 code of long bone fractures during the calendar years 2019-2020. Our primary outcome was the proportion of patients whose final ordinal (0-10) pain score was severe (≥7). Our secondary outcome was the effectiveness of prehospital analgesia strategies, using a decrease in an ordinal 10-point pain score by ≥ 2 as a threshold.
RESULTS
Among 1,591 included patients, few patients (18.8%) received only non-pharmacological interventions, and approximately half received non-pharmacological interventions with analgesics (94.1% opioids). Final severe pain (pain score ≥ 7) was recorded in 30.1% of patients and 41.2% had a ≥ 2-point decrease in final pain score. Patients with severe pain are those ages > 12, urban location, and shorter EMS duration of care. Patients with the lowest proportion of analgesia were younger, Black race, lesser weight, and of shorter EMS duration of care.
CONCLUSIONS
Approximately half of this population received prehospital analgesics for pain. Almost a third of children with long bone fractures transported by EMS had severe pain on hospital arrival. When analgesics were used, the vast majority received opioids. Continued work is needed to address gaps in pain management for pediatric patients with long bone fractures.
The Effects of Untreated Reflux on the Incidence of Feeding Difficulties in Neonates
Anne Grossbauer, B.S.1, Ani Mnatsakanian, D.O.2, Anya Costeloe, D.O.2, Prasad John Thottam, D.O.3,4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Otolaryngology, Ascension Providence Hospital, Detroit, Michigan
3Department of Pediatric Otolaryngology, Beaumont Health, Royal Oak, Michigan
4Michigan Pediatric Ear Nose and Throat Associates, West Bloomfield Township, Michigan
INTRODUCTION
Gastroesophageal reflux (GERD), the involuntary regurgitation of gastric contents into the esophagus, commonly occurs in infants but is associated with various detrimental consequences. One consequence involves feeding difficulties, and there is a paucity in the literature regarding its incidence in late-preterm and full-term infants in the neonatal intensive care unit (NICU). Treatment for GERD in this population has also been debated and is highly variable. The objectives of this study are to determine whether late-preterm and full-term neonates in the NICU with GERD have an increased incidence of feeding difficulties, dysphagia, and oral aversion when compared to the same population without GERD, and to determine the incidence of anti-reflux medication use as treatment in this population.
METHODS
This retrospective chart review included neonates greater than 34 weeks gestational age (GA) who were admitted to the NICU for at least five days. Neonates with anatomical anomalies that interfere with feeding were excluded. The experimental group included neonates greater than 34 weeks GA diagnosed with reflux, and the control group included the same population without reflux. Outcome measures included subjective ease of feeding, oral aversion, and placement on nasogastric, orogastric, or requirement of total parenteral nutrition. Statistical analysis was performed using chi-squared and t-test. A p-value < 0.05 was considered significant.
RESULTS
In neonates with diagnosed reflux, 42.02% had feeding difficulties (66 patients). In neonates without diagnosed reflux, 30.49% had feeding difficulties (218 patients). Feeding difficulties in the experimental group was 11.55% higher than in the control group (p = 0.001). Only 0.86% of neonates diagnosed with reflux were treated with anti-reflux medications.
CONCLUSIONS
Late-preterm and full-term neonates diagnosed with reflux have a higher incidence of feeding difficulties than those without reflux. This study heightens our understanding of consequences associated with GERD and the use of anti-reflux medication as treatment.
Assessing Patient Preferences for Technology-Assisted versus Traditional Total Knee Arthroplasty Using a Validated Online Survey Marketplace: Before and After Patient Education
Tanner J. Hafen, B.S.1, James E. Feng, M.D.2, Phillip Vartanyan, M.D.2, Drew Moore, M.D.2, Robert Runner, M.D.2, Mark Karadsheh, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Orthopaedics Corewell Health, Royal Oak, Michigan
INTRODUCTION
Although technology-assisted total knee arthroplasty (TKA) is becoming increasingly prevalent, insight into its reception by the public is limited. Here we evaluate the public’s perception of technology-assisted TKA compared to traditional TKA.
METHODS
A prospective cohort study was performed utilizing a paid survey distributed via a validated online marketplace. Following baseline demographics, participants were queried whether they would prefer a computer-/robotic-assisted (technology) TKA or traditional TKA without additional information. Participants were separated into “Tech TKA” and “Traditional TKA” cohorts based on their responses. All respondents sequentially completed a pre-test, an evidence-based education table, and a post-test survey focused on the differences between technology versus traditional TKA. Upon completion, cohorts were again asked which TKA modality they would prefer. Statistical tests performed included Student’s t-tests and χ2 tests.
RESULTS
500 surveys were completed with 402 (80.4%) respondents in the tech TKA and 98 (19.6%) in the traditional TKA cohort. Tech TKA respondents were more educated (Bachelor’s degree: 46.88% vs 31.63%, p<.01), had higher incomes (>$75,000: 35.6% vs 18.4%), and were more familiar with TKA (know of, very familiar, or underwent TKA: 93.2% vs 82.65%; p<.01. Age, gender, race, ethnicity, and annual doctor visits were similar.
After reviewing the educational table, 33 (33.67%) of the traditional TKA respondents switched their preferences to technology TKA. Conversely, 95 (23.63%) Tech TKA switched to traditional TKA. Among post-test respondents interested in technology-assisted TKA, 75.00% were willing to switch their surgeons and 35.29% would pay an additional sum of moneys if not covered by insurance (35.29%). The most important information from the table for technology-assisted TKA respondents was length of stay, while traditional TKA was “who does the surgery.”
CONCLUSIONS
Technology-assisted TKA appears to be well-regarded and valued amongst the public. Educational material does not appear to dramatically change preferences.
Pulmonary Embolism in Pregnancy and Early Postpartum – Identifying Significant Variables to Improve Risk Stratification
Nida Haider, B.S.1, Bhavinkumar Dalal, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
INTRODUCTION
Pulmonary embolism (PE) is one of the leading causes of maternal deaths in developed countries. Due to significant overlap between normal physiological changes in pregnancy and symptoms of PE, the threshold for CTPA, confirmatory imaging for PE, is low with increasing incidence of false positives. We aim to assess various variables for association with PE in pregnant and early portpartum women in order to improve risk stratification.
METHODS
We conducted a retrospective study involving pregnant or up to 8 weeks postpartum women who were 18 years and older, admitted at the Royal Oak hospital between 2018-2020. We divided them into two groups based on CTPA results. Using a univariate method, the following variables were assessed between groups: Age, BMI, vital signs, presenting symptoms, DVT on venous doppler, chest x-ray, signs of right ventricular strain on echocardiography, D-dimer, troponin, chronic conditions, pregnancy complications, pregnancy/postpartum duration, and # of babies in womb. The Fisher's Exact tests was performed for the categorical variables and a 2-sample t-tests for the continuous variables. P value of <0.05 is considered significant.
RESULTS
A total of 96 women were screened and 36 were excluded due to suboptimal CTPA study. Of the remaining 57 women, 7 had positive CTPA results and 50 were negative. Of the target variables, the following were missing: 34 venous doppler, 15 chest x-ray, 27 echocardiography, 47 D-dimer, and 19 troponin studies. The available variables were analyzed and no significant association was found except for gastroesophageal reflux disease (GERD) which is significantly more prevalent in women with PE.
CONCLUSIONS
No significant association was found between PE and the target variables, except for GERD, suggesting that presence of GERD should be taken into account for risk-stratification. However, the small sample size, only 7 positive CTPA outcomes, and several missing variables severely limit the accuracy of these findings.
Accuracy of diagnosis codes for patients with concurrent geographic atrophy and exudative age-related macular degeneration
Megan Clontz, B.S.1, Jong Park, M.D.1,2, Xing Chen, M.D. 1,2, Tedi Begaj, M.D.1,2, Margaret Runner, M.D.1,2, Jeremy Wolfe, M.D.1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Associated Retinal Consultants, Royal Oak, Michigan
INTRODUCTION
Age-related macular degeneration (AMD) is a leading cause of blindness. This disease progresses from the non-exudative/non-neovascular form to geographic atrophy (GA) or exudative AMD, which are regarded as distinct late AMD subtypes. However, histopathologic data confirms their coexistence. Despite this evidence, the International Classification of Diseases (ICD) diagnostic coding system offers no option for GA within the context of exudative AMD. Thus, the likelihood of underreporting GA coexisting with exudative AMD in the electronic medical record (EMR) is highly probable.
METHODS
The study design was a cross-sectional retrospective chart review. EMRs of patients with exudative AMD who were seen at Associated Retinal Consultants in April 2021 were reviewed. These patients’ optical coherence tomography (OCT) scans were reviewed by two trained graders to evaluate for the presence of GA. Visual acuity, documentation of GA in the diagnosis codes, physical examination findings, and OCT interpretation were recorded.
RESULTS
A total of 656 patients were identified with exudative AMD, of which 377 (57%) had concurrent GA by OCT. This cohort had 102 males (27%) and 275 females (73%), with a mean age of 83.5 ± 9.0 (SD) years. An accurate ICD-10 code of GA was documented in 31 of the 377 patients (8%), while 346 of the 377 patients (92%) had evidence of GA on OCT but no diagnosis code for GA documented in the EMR. Although GA was not coded, 257 patients (68%) had GA documented accurately in the examination findings and 202 patients (54%) had GA documented accurately in the OCT interpretation.
CONCLUSIONS
A majority of patients with exudative AMD have evidence of concurrent GA on OCT. However, most do not have a GA diagnosis code listed in the EMR. Improving coding accuracy for GA will be important for identifying patients in large data registry studies and aid in selecting patients for new therapies.
Comparing Plastic Surgeon Operative Time for Deep Inferior Epigastric Perforator Flap Breast Reconstruction
Christopher J. Issa, B.S.1, Stephen M. Lu, M.D.2, Elizabeth M. Boudiab, M.D.3, Jeffrey DeSano, D.O.4, Neil S. Sachanandani, M.D.4, Kongkrit Chaiyasate, M.D.4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Division of Plastic and Reconstructive Surgery, UPMC Pinnacle, Mechanicsburg, PA
3Department of General Surgery, Beaumont Health System, Royal Oak, MI
4Division of Plastic and Reconstructive Surgery, Beaumont Health System, Royal Oak, MI
INTRODUCTION
The deep inferior epigastric perforator (DIEP) flap for breast reconstruction is associated with lengthy operative times that remain an issue for plastic surgeons today. The main objective of this study was to determine if a two-stage DIEP flap reconstruction resulted in a shorter total plastic surgeon operative time compared to an immediate reconstruction. The secondary objective was to compare total patient time under anesthesia and overall complications through a retrospective chart review.
METHODS
A retrospective chart review was conducted on all patients who underwent DIEP flap breast reconstruction from February 2013 to July 2020 by the senior author. Patient demographics, medical comorbidities, mastectomy characteristics, expander placement, reconstructive procedures, operative time, and complications were tabulated.
RESULTS
The study included a total of 128 patients. For immediate/one-stage flap reconstruction, average operative times for the plastic surgeon were 427.0 minutes for unilateral procedures and 506.3 minutes for bilateral procedures. For delayed/two-stage reconstruction, average combined plastic surgeon operative times were 351.1 minutes for unilateral expander followed by flap reconstruction (75.9 minutes shorter than immediate unilateral, p=0.007) and 464.8 minutes for bilateral reconstruction (41.5 minutes shorter than immediate bilateral, p=0.04). Total patient time under anesthesia was longer for two-staged bilateral reconstruction (p=0.0001) but did not differ significantly for unilateral reconstruction. Complications between immediate and delayed groups were not significantly different.
CONCLUSIONS
We found that staged reconstruction over two procedures resulted in a significant reduction in operative time for the plastic surgeon for both unilateral and bilateral reconstruction, without significantly prolonging total patient time under anesthesia for unilateral reconstruction and without significantly increasing flap complications. With amenable breast surgeons and patients, the advantages of controlling scheduling and the operating room may encourage plastic surgeons to consider performing free flap reconstruction in a delayed fashion.
Impact of COVID-19 Pandemic on Changes in Healthcare and Medication and Substance Use Among Individuals with Fibromyalgia
Alexandra Jankulov, M.S.1, Lynee Matallana2, Guohao Zhu, M.D.3, Jill Schneiderhan, M.D.4, Jenna McAfee, Ph.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2National Fibromyalgia Association, Newport Beach, CA
3Department of Anesthesiology, University of Michigan, Ann Arbor, MI
4Department of Family Medicine, University of Michigan, Ann Arbor, MI
INTRODUCTION
Data on the impact of the COVID-19 pandemic on patients with fibromyalgia (FM) are limited. This study investigated changes in healthcare, medication use, and substance use in patients with FM during the first year of the COVID-19 pandemic. We aimed to: 1) explore healthcare changes and associated impact; 2) assess changes in medication and substance use; and 3) identify reasons for changes in medication and substance use.
METHODS
We developed an online Qualtrics survey for the National Fibromyalgia Association (NFA). Participants with FM completed a baseline survey and follow-up survey approximately three months later. Participants’ demographics, physical, and mental health data was collected at baseline. Data regarding healthcare utilization and changes in medication use and substance use was collected at follow up.
RESULTS
The study included n= 1,193 NFA members. Perceptions of helpfulness of telemedicine for pain, medication, and mental health management were favorable. Additionally, when participants changed medication use, the most common reasons for increased use were worsening of mental health symptoms (47.20%), followed by worsening of physical symptoms (35.40%). Alcohol, cannabis, and tobacco use all increased by 31.06%, 33.51%, and 29.63%, respectively. Reasons for increases in substance use included worsening of mental health symptoms (36.09%), followed by worsening of physical symptoms (26.52%).
CONCLUSIONS
Overall, participants found managing pain, prescriptions, and mental health through telemedicine helpful. Medication and substance use both increased as a direct result of the COVID-19 pandemic in participants with FM. The results from this study will help inform effective and supportive care for patients with FM moving forward.
Demographics and Pain: An Observational Study of Men Attending an Urban Health Event
Steven Kessler, B.S.1, Michael D. Lutz, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
INTRODUCTION
Chronic pain has been estimated to be present in 11.4 to 24 percent of the population. Of the 369 measured diseases, the World Health Organization’s Global Burden of Disease Study has three conditions associated with chronic pain in the top 25. The economic burden associated with chronic pain is high, and studies have shown race and socioeconomic status are factors associated with higher prevalence of chronic pain, specifically higher in minority populations, and those with lower socioeconomic status. The goal of this study is to observe the correlation of demographics to chronic pain in men attending a free health event in an urban setting by use of a survey.
METHODS
Men attending a free urban health event and were asked to fill out surveys regarding demographics and other health related questions. They answered a question about whether or not they experience pain on a daily basis. Using the answers to this question and the demographics including age, race, education, marital status, employment/retired status, income level, disability status, and insurance status, chi square analyses were completed to observe if a correlation was significant.
RESULTS
524 men answered the question about pain. Of that group, anywhere from 373 to 523 men answered questions about demographics. Chi square analyses revealed p<0.05 when comparing pain to employment status, income level, and disability status; the other demographics were not significant. When removing the disabled individuals from the analyses of income level and employment status, these factors remained significant.
CONCLUSIONS
Our study confirmed previous studies – correlating chronic pain to lower socioeconomic status. Although other studies have also stated a relationship between minority race and pain, our study showed no relationship in our population. Further studies should be focused on defining the link between pain and these factors, since a relationship seems to be present.
Accuracy of ORA and newer generation formulas for IOL power calculation after prior refractive surgery
Raheel Khan, B.S.1, Mark Rolain, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Ophthalmology, Beaumont Health, Royal Oak, Michigan
INTRODUCTION
Patients with cataracts have cloudiness of the lens that impairs vision. It must be replaced with a prosthetic lens however the lens’ refractive power has to be calculated using formulas to predict the kind of lens that will be implanted for best visual outcomes. The concern is that there is not a gold-standard formula that can be used for patients that have had prior refractive surgery to predict the refractive power of the lens that should be implanted. This study aims to provide objective data as to whether optiwave refractive analysis (ORA) or other newer generation formulas are more accurate at predicting refractive outcomes in this patient population.
METHODS
80 eyes with a history of refractive surgery that had gotten cataract surgery done were analyzed for their refraction post cataract surgery and what ORA, Shammas formula, Barret formula, and Holladay II formulas had predicted that their refraction would be. The refractive and absolute difference between the prediction and the actual refraction in diopters was calculated for ORA and each formula to determine which had the smallest difference. Refractive error predicts whether the formula over or underpredicts while absolute error is a more accurate reflection of the actual difference between predicted and actual refraction.
RESULTS
The mean refractive prediction error of ORA, Shammas, Barret, and Holladay II were 0.0 (SD .73), .4 (SD .72), .2 (SD .72), -.2 (SD .73) diopters respectively with the mean absolute prediction error being .5 (SD .51), .7 (SD .48), .6 (SD .47), .5 (SD .53) diopters.
CONCLUSIONS
ORA, Holladay II, Barret, then Shammas is the order of most to least accurate formula based on absolute prediction error however the differences were not statistically significant. Holladay II tends to under-predict while Shammas and Barret tend to over-predict based on refractive prediction error.
Fractionated Radiosurgery Associated with High Rates of Local Control for Large Volume Intact Brain Metastases
Ryan Ko, B.S.1, Vincent P. Grzywacz, M.D.2, Hong Ye, Ph.D.2, Peter Y. Chen, M.D./Ph.D.2, Zachary Seymour, M.D.2, Kuei Lee, M.D./Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Beaumont Health
INTRODUCTION
Radiosurgery is a well-established treatment modality for patients with intact brain metastases, and there is a known impact of tumor size and volume on tumor control. Utilizing our single-institution database, we investigated outcomes for patients with intact brain metastases treated with FSR using LINAC or GK modalities.
METHODS
Institutional records of patients with intact brain metastases treated with FSR were retrospectively reviewed. Patients treated with either GK or LINAC-based FSR were included. Descriptive analyses were performed of primary histology, lesion location, dose/fractionation, modality, tumor volume, and maximum tumor dimension. T-test and chi-square statistics were performed to compare characteristics and outcomes between patients treated with GK versus LINAC FSRT. Kaplan-Meier was used for survival estimates. Univariate analyses and Cox regression models were generated.
RESULTS
56 patients with 137 brain metastases were reviewed. 67.2% of lesions were treated via GK and 32.8% were treated via LINAC. The 1-y OS for all patients was 54.1% with a median OS of 15 mos. With a median follow-up of 6 months, the 1-year local control rate was 94.5%. For lesions ≤2 cc, 1-y LC was 97.4% compared to 91% for lesions > 2 cc, though this difference was not statistically significant. On Cox regression, neither maximum tumor dimension nor volume were predictive of local control. Univariate analysis demonstrated increased local recurrence in patients with prior history of neurosurgical intervention. No differences in LC or OS were observed between GK and LINAC.
CONCLUSIONS
FSR using 3 to 5 fractions for large volume intact metastases was associated with a high rate of LC compared to rates historically achieved with single fraction radiosurgery for tumors of similar volume. No statistically significant differences in LC or OS were detected according to maximum tumor dimension, volume, fractionation schedule, or treatment modality. FSR should be considered for larger brain metastases to improve LC.
Clinical Outcomes of Hypofractionated Whole Breast Irradiation in Early Stage, Biologically High-Risk Breast Cancer
Eva Leung, B.S.1, Benjamin D. Willen, M.D.2, Thomas J. Quinn, M.D.2, Muayad F. Almahariq, M.D./Ph.D.2, Peter Y. Chen, M.D.2, Joshua T. Dilworth, M.D./Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Radiation Oncology, Corewell Health, Royal Oak, Michigan
INTRODUCTION
Adoption of hypofractionated whole breast irradiation (HWBI) for patients with early-stage, biologically high-risk breast cancer remains relatively low. The primary goal of this study is to compare the clinical outcomes of conventionally fractionated whole breast irradiation (CWBI) versus moderate HWBI in this patient population.
METHODS
We queried a prospectively maintained database for patients with early-stage (T1-2, N0, M0) breast cancer who received whole breast irradiation with either CWBI or moderate HWBI at a single institution. We included only patients with biologically high-risk tumors (defined as either estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 negative, human epidermal growth factor receptor 2 amplified, and/or patients with a high-risk multigene assay) who received systemic chemotherapy. Inverse probability of treatment weighting was used to compare treatment cohorts and to estimate 5-year time to event endpoints. Hazard ratios (HR) and 95% confidence interval (CI) were determined based on Cox proportional hazards model.
RESULTS
We identified 300 patients, of whom 171 received CWBI and 129 received HWBI. There was a statistically significant difference in median age at diagnosis, 59 years for CWBI versus 63 years for HWBI (P = .004), and in median follow-up time, 97 months for CWBI versus 55 months for HWBI (P < .001). After accounting for differences in patient and tumor characteristics with inverse probability of treatment weighting, we found similar 5-year freedom from local recurrence (HR, 0.76; 95% CI, 0.14-4.1), freedom from regional recurrence (HR, 3.395% CI 0.15-69), freedom from distant metastasis (HR 3.9, 95% CI 0.86-17), and disease-free survival (HR 0.84; 95% CI, 0.3-2.4), between those treated with CWBI and those treated with HWBI. Results were similar among each of the 3 high-risk subtypes.
CONCLUSIONS
Our data support the use of moderate HWBI in patients with early-stage, biologically high-risk breast cancer.
Cognitive Reappraisal Mediates the Relationship between Neuroticism and Loneliness
Nathan Lwo1, Changiz Mohiyeddini, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Previous studies indicate that neuroticism as a personality trait is associated with and predictive of loneliness. Currently, however, the mechanism through which neuroticism predisposes one to develop loneliness is unknown. Therefore, we aim to investigate emotion regulation – how one responds to emotional situations and manages consequent feelings – as a potential mediating factor of the link between neuroticism and loneliness among medical students, a risk group for developing loneliness and associated psychopathologies.
METHODS
This project’s cross-sectional survey-based design consists of well-validated and reliable surveys such as the Big Five Inventory, UCLA Loneliness Questionnaire, and the Emotion Regulation Questionnaire. These surveys respectively collected personality trait, loneliness, and emotion regulation data from medical school students recruited over six months.
RESULTS
At an N = 113, a mediation analysis using hierarchical regression showed that cognitive reappraisal – a healthy emotion regulation strategy – had a significant negative association with both neuroticism (ß = -0.51, p < 0.001) and loneliness (ß = -0.29, p < 0.001); in addition, the positive correlation between neuroticism and loneliness was decreased when considering cognitive reappraisal in the mediation analysis versus without (ß = 0.38 versus ß = 0.49).
CONCLUSIONS
This study’s results firmly establish how changing one’s emotion regulation while considering one’s unique personality traits can modify feelings of loneliness. These findings contrast most current loneliness therapies that only center around providing external social support. Thus, we offer an optimistic and realistic approach to resolving societal loneliness that encourages the use and development of personal positive cognitive abilities.
Radiotherapy-Induced Vitiligo: A Systematic Review of Patient Demographics and Clinical Characteristics of Vitiligo Following Radiation Therapy
Meghan Mansour, B.S.1, Yasmine Abushukur, M.D.1, Rafey Rehman, M.D.2, Chirag Shah, M.D.3, Darius Mehregan, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Dermatology, Wayne State University, Detroit, MI
3Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH
INTRODUCTION
Vitiligo is depigmentation of the skin and hair due to autoimmune destruction of melanocytes. The etiology is multifactorial and may include some forms of radiation therapy, such as external beam radiation therapy (EBRT). Our purpose was to conduct a systematic review of the patient demographics and clinical characteristics of radiotherapy-induced vitiligo.
METHODS
The EMBASE and PubMed and databases were searched for articles pertaining to vitiligo following radiotherapy. Of the 1,626 total articles screened, 15 met the inclusion criteria. The 2009 Oxford Levels of Evidence criteria was used to determine the quality of evidence presented in the included articles.
RESULTS
We identified 18 unique patients reporting new depigmentation following radiotherapy. Vitiligo was diagnosed clinically in 89% (n=16) of cases, while 11% (n=2) of cases were biopsy-confirmed. Only 50% (n=9) of patients reported a personal history of vitiligo, and 0% (n=0) of these patients reported a positive family history of vitiligo. Patients presented with vitiligo an average of 5.1 months following completion of radiotherapy. Depigmentation began locally and then generalized in 32% (n=6) of patients. EBRT was the only reported radiotherapy modality used, at a mean radiation dose of 52.3 Gy (Range: 40-70) in 26.2 (Range: 15-35) fractions.
CONCLUSIONS
Patients may be predisposed to vitiligo. For instance, one patient who initially reported radiation-induced vitiligo in one breast, later presented with a similar sequence of radiation-induced vitiligo after being treated for a second cancer in the opposite breast. There also may be a dose-dependent relationship between vitiligo and radiation, as one study described increasing surface area of depigmentation in areas of the body which received higher radiation doses. Limitations include a small sample size and heterogeneity of reported data. Future investigations may determine a true causation between EBRT and vitiligo, to encourage further communication and collaboration between dermatologists and radiation oncologists.
Does The Use of Intraoperative Neuromonitoring During Thyroid And Parathyroid Surgery Reduce The Incidence Of Recurrent Laryngeal Nerve Injuries: A Systematic Review and Meta-analysis
Mohamed Idris, B.S.1, Andrew Saxe, M.D.2, Jickssa Gemechu, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Sciences, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Injury to the recurrent laryngeal nerve can be a devastating complication of thyroid and parathyroid surgery. Intraoperative neuromonitoring has been proposed as a method to reduce the number of recurrent laryngeal nerve injuries, although the data are conflicting. We performed a meta-analysis to critically assess the data.
METHODS
A literature search was performed in the following electronic databases: PubMed, Embase, the Cochrane Library, Web Of Science, and ISRCTN registry databases for all relevant studies regardless of the date of publication. Covidence [Systematic Review Software, Veritas Health Innovation, Melbourne, Australia] was used to download and organize retrieved studies. Data were extracted to an Excel [Google, Mountain View, California] spreadsheet. RevMan 5 [Computer Program Version 5.0, Copenhagen, Denmark] was employed for statistical analyses and estimation of risk of bias.
RESULTS
After applying inclusion and exclusion criteria, 60 studies, including five randomized trials and eight non-randomized prospective trials, were included. Meta-analysis of all studies demonstrated an odds ratio 0.66 (95% CI [0.56, 0.79], p<0.00001) favoring intraoperative neuromonitoring compared to visual identification of the recurrent laryngeal nerve in limiting permanent nerve injuries. Meta-analysis of studies employing contemporaneous controls and routine postoperative laryngoscopy to diagnose nerve injuries demonstrated an odds ratio of 0.69 (95% CI [0.56, 0.84], p=0.0003) favoring intraoperative neuromonitoring.
CONCLUSIONS
A meta-analysis of all 60 studies as well as meta-analyses of subsets of studies considered the most reliable demonstrated statistically significant effects favoring the use of intraoperative neuromonitoring to reduce the incidence of permanent recurrent laryngeal nerve injury. Strong consideration should be given to employing intraoperative neuromonitoring when performing thyroid and parathyroid surgery.
The Altis Mid-Urethral Sling: One Surgeon’s Experience With Immediate Post-Operative Adjustment
Jennifer L. Nguyen, B.S.1, Brett Friedman, M.D.1, Annah Vollstedt, M.D.2, Mireya Diaz, Ph.D.3, Ly Hoang Roberts, M.D.4, Larry Sirls, M.D.4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Urology, University of Iowa, Iowa City, Iowa
3Independent Consultant, Portage, MI
4Department of Urology, Beaumont Health System, Royal Oak, MI
INTRODUCTION
The Altis transobturator sling uses a dynamic anchor on a pulley suture for intraoperative tension adjustment. Given the potential for incorrect tensioning with sling placement, we adopted a technique that allows post-operative adjustment using the pulley suture for sling tightening should stress urinary incontinence (SUI) or sling loosening if there is bladder outlet obstruction. Our objective is to describe our technique and rate of post-operative adjustment.
METHODS
In this single-surgeon experience, retrospective chart review, demographic and clinical data were collected on patients who had received the Altis sling between 2014 and 2019. Descriptive statistics were used.
RESULTS
197 patients underwent the Altis sling placement. Eighty-four percent (165/197) of the patients did not receive postoperative adjustment. Of the 32 patients who received post-operative adjustment, eight (4.1%) had loosening performed and 24 (12.2%) had tightening performed at an average of 10 days post-op. All 24 tightening procedures were done in the clinic. Of the 8 patients with postoperative loosening performed, six were performed in the clinic and two in the operating room under general anesthesia. Of these two patients, one was still inpatient and one required an additional concomitant procedure.
CONCLUSIONS
This novel Altis sling technique allows the surgeon to tighten or loosen postoperatively depending on immediate postoperative results. Overall, in the hands of one surgeon, 16% of patients were adjusted in the postoperative period. All tightening procedures and all but two loosening procedures were performed in the clinic.
Quantitative and Comparative Analysis of Dream Content in Parkinson’s Disease patients Pre- and Post-Deep Brain Stimulation
Sarvar Oreizi-Esfahani, B.S.1, Michael Staudt, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2William Beaumont Hospital, Royal Oak, Michigan
INTRODUCTION
Parkinson's Disease (PD) is a neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra, resulting in motor symptoms such as tremor, rigidity, akinesia, and impaired balance. The Default Mode Network (DMN), a network of brain regions involved in various cognitive processes including dreaming, is also affected in PD patients, contributing to diminished sleep quality and altered dream content.
Deep Brain Stimulation (DBS) has emerged as an effective therapeutic option for managing motor symptoms in PD patients. By delivering electrical pulses to specific brain regions such as the subthalamic nucleus (STN), globus pallidus interna (Gpi), or ventral intermediate nucleus of the thalamus (VITn), DBS can modulate neuronal activity and alleviate motor symptoms. However, the effects of DBS on the neurocircuitry underlying sleep quality and dream content in PD patients remain poorly understood. It is hypothesized that PD patients undergoing DBS may experience changes to their sleep quality and dream content.
METHODS
15 PD patients undergoing DBS at Beaumont Hospital, MI were recruited to participate in a prospective observational study aimed at assessing changes in sleep quality and dream characteristics. Participants completed questionnaires evaluating PD parameters and dream quality/content both preoperatively and 6-month post-DBS recovery.
RESULTS
Our findings reveal that while participants maintained relatively stable sleep quality post-DBS surgery (REM Sleep Behavior Disorder Screening Questionnaire, p= 0.0531), there was a significant increase in dream content featuring themes of Physical Aggression, Befriender, and Bodily Misfortune.
CONCLUSIONS
These findings suggest that DBS may influence dream content in PD patients, potentially through modulation of brain networks involved in dream generation. This study provides novel insights into the effects of DBS on sleep quality and dream content in PD patients. Further research is warranted to elucidate the underlying mechanisms and implications of these findings for patient care and management.
Breast Irradiation is Well Tolerated in Carriers a Pathogenic ATM Variant
Leah R. Rotenbakh, B.S.1, Andrew H. Zureick, M.D.2, Joshua T. Dilworth, M.D./Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Radiation Oncology, Corewell Health, Royal Oak, Michigan
INTRODUCTION
There are mixed and limited data regarding radiation therapy (RT) tolerance in carriers of a germline pathogenic or likely pathogenic (P/LP) ATM variant. We investigated RT-related toxic effects in carriers of an ATM variant who received treatment for breast cancer.
METHODS
We identified 71 patients treated with adjuvant RT for breast cancer who were carriers of a variant in ATM: 15 were classified as P/LP and 56 classified as variants of unknown significance (VUS). We additionally identified 205 consecutively treated patients during a similar timeframe who were either confirmed ATM wild type or had no prior genetic testing. RT plans were reviewed. Acute and chronic toxic effects were evaluated using Common Terminology Criteria for Adverse Events version 4.0 criteria. Fisher's exact tests for count data were performed to compare toxic effects between the cohorts (P/LP vs VUS vs control). Wilcoxon rank-sum testing was performed to assess for differences in patient characteristics.
RESULTS
The median toxicity follow-up was 19.4 months; median follow-up for the subcohorts was 13.3 months (P/LP), 12.6 months (VUS), and 23.3 months (control). There were no significant differences in radiation plan heterogeneity, receipt of a boost, or size of breast/chest wall planning target volume. After accounting for patient- and treatment-related factors that may affect toxic effects, we found no significant differences with respect to acute dermatitis, hyperpigmentation, moist desquamation, breast/chest wall pain, or breast edema. Additionally, we found no significant differences with respect to chronic breast/chest wall pain, induration, telangiectasia, or cosmetic outcome.
CONCLUSIONS
RT as part of the management of breast cancer was well tolerated in carriers of a P/LP ATM variant, with toxic effect profiles that were similar to those seen in patients without known ATM mutations. High rates of excellent or good cosmesis were observed in carriers of a P/LP ATM variant who underwent breast conservation.
Coats’ and Coats’-like Retinopathy in Female Patients
Zara Saleem, B.S.1,2, Drew Scoles, M.D./Ph.D.2,3, Antonio Capone Jr., M.D.4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
3Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
4Associated Retinal Consultants, Royal Oak, Michigan, USA
INTRODUCTION
To report the presentation, and clinical course of female patients with Coats’ and Coats’-like retinopathy.
METHODS
A retrospective, IRB-approved review was conducted of female patients referred to our center and diagnosed Coats’ disease between 2001-2022. Diagnosis was based on clinical and angiographic evidence. Patients lost to follow-up were excluded.
RESULTS
A total of thirteen eyes of eight patients were identified. Ten of 13 eyes demonstrated active disease. The median age at presentation was 19 years (range 15 months to 79 years). Three patients presented unilaterally (OD n=1, OS n=2), whereas five patients displayed asymmetric bilateral disease. Initial corrected visual acuity varied from 20/20-2 to CF. Retinal features were classified based on the system proposed by Shields et al. The most common stage at presentation was 3A (40%), followed by 2A (30%) and 1 (30%). All patients had characteristic findings of vascular telangiectasia with both resolved (n=2) and active lesions noted in parafoveal (n=2), peripheral (n=1), temporal (n=2), superior (n=2), and inferior (n=1) regions. Lipid exudation developed in all active eyes, three of which progressed to exudative detachment as a single (n=2) and recurrent (n=1) occurrence. Light bulb aneurysms were noted in three eyes, with multiple occurrences in two eyes, separated by time and place. Localized hemorrhage was noted in seven eyes (70%) near telangiectasic and aneurysmal vessels. Treatment consisted of ablative therapy (34.5%), ablation and intravitreal bevacizumab (16.1%), ablation and intravitreal steroid injection (12.9%), intravitreal bevacizumab (6.5%), retinopexy (6.5%), vitreoretinal surgery (19.4%) and observation. Persistent subretinal fluid was present in six eyes (60%), with recurrence after resolution occurring in two eyes (average of 5 months).
CONCLUSIONS
Coats’ disease is uncommon and may present with atypical clinical features in female patients, leading to misdiagnosis. Recognizing the varying spectrum of disease is imperative for early intervention and prevention of vision loss.
Hypofractionated Regional Nodal Irradiation in Breast Cancer
Joseph Salib, B.S.1, Allison Hazy, M.D.2, Joshua T. Dilworth, M.D/Ph.D1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Radiation Oncology, Corewell Health System, Royal Oak, MI
INTRODUCTION
Randomized clinical trials have validated the efficacy and safety of moderately hypofractionated whole breast irradiation. We report the acute and chronic toxic effects of patients who received moderately hypofractionated regional nodal irradiation (H-RNI).
METHODS
We identified 43 patients who received H-RNI in this IRB-approved retrospective cohort study. All patients received 42.56 Gy delivered in 16 fractions to the breast/chest wall and regional lymphatics, including the ipsilateral axillary, supraclavicular, and internal mammary chains, followed by a sequential boost of 10-12.5 Gy in 4-5 fractions to the lumpectomy cavity/mastectomy scar. Acute (occurring between end-of-treatment and 3 months) and chronic (greater than 3 months following radiation therapy) toxicity assessments were completed using the Common Terminology Criteria for Adverse Events (CTCAE) version 5. Cosmetic outcomes were assessed per the Harvard Scale.
RESULTS
The median follow up was 12 months. Seven patients received axillary lymph node dissection. The most prevalent acute grade 1 and grade 2 toxicities were fatigue (60%) and radiation dermatitis (29%), respectively. The only acute grade 3 toxicity was hyperpigmentation (9%). There were no acute grade 4 toxicities. The most prevalent chronic grade 1 and grade 2 toxicities were hyperpigmentation (48%) and breast edema (14%), respectively. There were no chronic grade 3 or grade 4 toxicities. The majority (85%) of patients had an “excellent” or “good” cosmetic outcome. Two patients (6%) experienced grade 1 or 2 upper extremity lymphedema on the treated side in the acute time period, while 3 patients (12%) experienced this in the chronic time period. Grade 2 radiation pneumonitis occurred in 3% of patients in the acute time period; all cases resolved by three months.
CONCLUSIONS
H-RNI was well tolerated in this cohort. Additional follow-up is required to evaluate long-term cancer control. Further direct comparison between conventionally fractionated and H-RNI is warranted.
Clinical Differences in Isolated Post-Capillary Pulmonary Hypertension and Combined Pre- and Post-Capillary Pulmonary Hypertension
Emily Schneider, B.A.1, Bhavinkumar Dalal, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Internal Medicine, Corewell Health, Royal Oak, Michigan
INTRODUCTION
Pulmonary hypertension (PH) is a common condition associated with left heart disease.1 Known as the World Health Organization (WHO) group 2, pulmonary hypertension due to left heart disease (PH-LHD) can be further classified into isolated post-capillary (IpcPH) and combined pre- and post-capillary (CpcPH). The primary goal of this study is to examine isolated post-capillary and combined pre- and post-capillary pulmonary hypertension in PH population at Beaumont Health to identify clinical differences in patient presentations, demographics and outcomes between the two subtypes.
METHODS
150 patients from the accredited Beaumont Pulmonary Hypertension clinic with a right heart catheterization between 2020 and 2023 were categorized by PH subtype by the guidelines set forth at the 6th World Symposium on Pulmonary Hypertension. Of those patients, 75 were categorized as having IpcPH (n = 27) or CpcPH (n = 48). A preliminary analysis of the of the difference in average mean pulmonary artery pressures (mPAP) between the two groups was performed.
RESULTS
An F-test was performed and supported the assumption of equal variances among the two samples F(26, 47) = 0.66, p(F<=f) = 0.13. A two-sample t-test assuming equal variances was then performed and revealed that compared to the IpcPH group, the CpcPH group had a higher average mPAP t(73) = -6.21, p = 2.98 x 10-8.
CONCLUSIONS
A preliminary analysis of the relationship between mean pulmonary artery pressure and subtype of pulmonary hypertension demonstrated significantly higher mean pulmonary artery pressures amongst the CpcPH subtype as compared to the IpcPH subtype. Although this finding provides support that the CpcPH subtype is in fact a more severe subtype of pulmonary hypertension, this finding should be interpreted with caution until further data analysis suggests whether or not this finding is clinically significant.
Virtual Pee Pee Party in the Time of a Pandemic: A Cost and Time Analysis of Participant Recruitment and Urine Sample Collection through Social Media Optimization
Prasun Sharma, B.S.1, Sarah N Bartolone, M.S.2, Eli P Ward, B.S.2, Bernadette M.M. Zwaans, Ph.D.2, Joseph Janicki, Ph.D.2, Michael B Chancellor, M.D./Ph.D.1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Beaumont Research Institute, Royal Oak, MI, USA
INTRODUCTION
Clinical research can be expensive and time-consuming due to the high associated costs and/or duration of the study. We hypothesized that urine sample collection using online recruitment and engagement of research participants via social media could reach a large population in a small timeframe at a reasonable cost.
METHODS
We performed a retrospective cost analysis of a cohort study comparing cost per sample and time per sample for both online and clinically recruited participants for urine sample collection. During this time, cost data were collected based on study-associated costs from invoices and budget spreadsheets. The data were subsequently analyzed using descriptive statistics.
RESULTS
Each sample collection kit contained three urine cups, 1 for the disease sample and 2 for the control samples. Out of the 3,576 (1,192 diseases _ 2,384 control) total sample cups mailed, 1,254 (695 control) samples were returned. Comparatively, the two clinical sites collected 305 samples. Although the initial startup cost of online recruitment was higher, the cost per sample for online recruitment was found to be $81.45 compared to $398.14 for the clinic sample.
CONCLUSIONS
We conducted a nationwide, contactless urine sample collection through online recruitment in the midst of the COVID-19 pandemic. Results were compared with the samples collected in the clinical setting. Online recruitment can be utilized to collect urine samples rapidly, efficiently, and at a cost per sample that was 20% of an in-person clinic and without risk of COVID-19 exposure.
Association of Primary Care Shortage Areas with Adverse Outcomes after Pediatric Liver Transplant
Holly P. Shifman, M.S.1, Erika Rasnick, M.S.2, Chiung-Yu Huang, Ph.D.3, Andrew F. Beck, M.D.2,4, John Bucuvalas, M.D.5,6, Jennifer C. Lai, M.D.3, Sharad Wadhwani, MD, MPH3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
3University of California, San Francisco, San Francisco, CA
4University of Cincinnati School of Medicine, Cincinnati, OH
5Icahn School of Medicine at Mount Sinai, New York, NY
6Kravis Children’s Hospital, NY, NY
6University of California, San Francisco, San Francisco, CA
INTRODUCTION
Objective: To characterize associations between living in primary care shortage areas and graft failure/death for children after liver transplantation.
METHODS
This was an observational study of all pediatric patients (aged <19 years) who received a liver transplant between January 1, 2005, and December 31, 2015 in the US, with follow-up through January 2019 (N = 5964). One hundred ninety-five patients whose home ZIP code could not be matched to primary care shortage area status were excluded. The primary outcome was a composite endpoint of graft failure or death. We used Cox proportional hazards to model the associations between health professional shortage area (HPSA) and graft failure/death.
RESULTS
Children living in HPSAs had lower estimated graft survival rates at 10 years compared with those not in HPSAs (76% vs 80%; P < .001). In univariable analysis, residence in an HPSA was associated with a 22% higher hazard of graft failure/death than non-residence in an HPSA (hazard ratio [HR], 1.22; 95% CI, 1.09-1.36; P < .001). Black children from HPSAs had a 67% higher hazard of graft failure/death compared with those not in HPSAs (HR, 1.67; 95% CI, 1.29 to 2.16; P = .006); the effect of HPSA status was less pronounced for White children (HR, 1.11; 95% CI, 0.98-1.27; P = .10).
CONCLUSIONS
Children living in primary care shortage areas are at increased risk of graft failure and death after liver transplant, and this risk is particularly salient for Black children. Future work to understand how living in these regions contributes to adverse outcomes may enable teams to mitigate this risk for all children with chronic illness.
Mood Impacts of Hypersexuality and the Potential of Naltrexone: A Comprehensive Review of Clinical Trials and Two Case Studies
Jonathan Stone, B.S.1, Moham Gautam, M.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Hypersexuality and compulsive sexual behavior, two facets of a complex spectrum of sexual disorders, have profound implications that transcend mere behavioral manifestations.1 These disorders cast a pervasive shadow, affecting personal relationships, professional engagements, and overall mental well-being. The emotional toll, marked by feelings of guilt, shame, and distress, can escalate to mood disorders and even suicidal tendencies.1 The acute intensity of hypersexuality symptoms presents a therapeutic challenge, especially given the delayed efficacy of treatments like SSRIs. Within this intricate therapeutic milieu, this review explores naltrexone, an opioid receptor antagonist, as a beacon of hope.
METHODS
A systematic review, adhering to PRIMA-P guidelines, was undertaken to evaluate naltrexone's role in addressing hypersexuality. Comprehensive database searches in PubMed and EMBASE yielded four relevant clinical trials. This was enriched by insights from two case studies at a Midwest inpatient psychiatric facility, focusing on individuals hospitalized due to suicidal ideation stemming from intense hypersexual obsessions.
RESULTS
The therapeutic promise of naltrexone resonated consistently across studies.2-5 Two RCTs highlighted its significant impact on symptom severity, as measured by the Hypersexual Behavior Inventory.2-3 While naltrexone dosages varied from 25-100mg, a 50mg dose was predominant. One study noted naltrexone's transient negative effect on sexual arousal.4 Interestingly, elevated prolactin levels, potentially driving sexual satiation, shed light on naltrexone's therapeutic mechanism. Both paroxetine and naltrexone showcased safety and superior efficacy compared to placebos.2 An intriguing RCT highlighted naltrexone's role in curbing impulsive sexual behaviors in Parkinson’s disease patients.5 In the case studies, the combination of an SSRI and naltrexone led to a marked reduction in hypersexual obsessions within a day of initiation.
CONCLUSIONS
Synthesizing insights from clinical trials and real-world case studies, naltrexone stands out as a potent therapeutic ally in the battle against hypersexuality and its associated emotional challenges.
Understanding Infectious Disease Consultation Role for Septic Patients in the Medical Intensive Care Unit
Marisa Stratelak1, Cloe Nazeer1, Bhavinkumar Dalal, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell Health William Beaumont University Hospital , Royal Oak, Michigan
INTRODUCTION
Sepsis is a medical emergency which requires immediate recognition and prompt treatment to maximize a patient’s chance of survival. The objective of this project is to determine the role infectious disease (ID) consultation serves for septic patients in a medical intensive care unit (MICU). While previous studies document the value of antimicrobial management with ID consultation, few investigations have explored the correlation between ID consultation and outcomes for septic patients in the MICU. Examining the role of ID in treating septic MICU patients will provide valuable information for managing this population in the future.
METHODS
A retrospective chart review was performed on 223 MICU patients diagnosed with severe sepsis between January 2019 to December 2019. Independent variables included ID consultation; outcomes measured included total length of stay (LOS) in the MICU, inpatient (IP) death, and mean age. An unequal variance two sample t-test and chi-square P-value were performed to assess for correlation between variables.
RESULTS
There was a statistical significance (p <.0001) between age and ID consults, where the mean age for patients with and without ID consult was 65.2 and 73.8 years, respectively. In addition, there was a statistical significance (p .0008) between ID consult and LOS in the MICU, with a mean LOS with and without ID consultation of 10834.3 and 6802.7 minutes respectively. No statistical significance (p 0.0939) existed between IP death and ID consultation.
CONCLUSIONS
The results reveal increased ID consultation is associated with younger patients and a longer LOS in the MICU; there is no correlation between ID consultation and mortality. More research is needed to determine why ID consultation is not associated with better outcomes, such as patient hemodynamic stability at the time of consult.
Near-Surface Dose Correlates With Moist Desquamation and Unplanned Reconstructive Surgery in Patients With Implant-Based Reconstruction Receiving Postmastectomy Radiation Therapy
Patrick Thrasher, B.S.1, Ronald Levitin, M.D.2, Kamran Salari, M.D.2, Bryan S. Squires, M.D.3, Allison J. Hazy, M.D.3, Joshua T. Dilworth, M.D./Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
3Radiation Oncology, Huron River Radiation Oncology Specialists, Ypsilanti, Michigan
INTRODUCTION
Postmastectomy radiation therapy (PMRT) reduces disease recurrence in appropriately selected patients but may compromise implant-based reconstruction. We investigated whether near-surface dose correlates with radiation-related toxic effects in these patients.
METHODS
Patients receiving PMRT at a single institution from 2016 to 2019 were retrospectively reviewed. Patient demographics and treatment information were collected. Three near-surface structures were retrospectively generated, bound by the chest wall tangent beam as well as the skin surface to skin-3 mm contour (SR3), skin surface to 5 mm contour (SR5), or skin-5 and skin-10 mm contours. Dosimetric analysis of these contours was performed in 2 Gy intervals. Univariate and multivariate analyses were used to identify predictors of moist desquamation, grade 2+ chest wall pain, use of opiate pain medication, unplanned reconstructive surgery, and implant failure. Logistic regression for each outcome and near-surface contour was performed for receiver-operator area under the curve (AUC) analysis and the Youden J Statistic was used to determine the optimal threshold for each dosimetric parameter.
RESULTS
Of 126 patients reviewed, 109 met the study's eligibility criteria. Median follow-up was 2.3 years. Twenty-five patients (23%) underwent unplanned reconstructive surgery, and 10 (9.2%) experienced implant failure. Among clinical variables, low body mass index and history of smoking predicted unplanned surgery on univariate and multivariate analyses, and moist desquamation predicted grade 2+ chest wall pain. The top dosimetric parameters by AUC for moist desquamation, grade 2+ chest wall pain, use of opiates, unplanned reconstructive surgery, and implant failure were SR5 D10 cc, SR3 D10 cc, SR5 D10 cc, SR3 V44 Gy, and SR3 V44 Gy, respectively.
CONCLUSIONS
Near-surface dose correlates with moist desquamation and unplanned reconstructive surgery after PMRT. Further evaluation of prospective optimization of dosimetric parameters related to SR3 and SR5 should be considered.
Relationships between the Number of Chaplain Visits and Patient Characteristics at a Large, Midwestern Suburban Teaching Hospital
Sarah Toates, B.S.1, Ven. Kevin D. Hickey1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2 Corewell Health William Beaumont University Hospital - Royal Oak, Michigan
INTRODUCTION
It is imperative to identify which patients are most interested in and likely to benefit from chaplain visits in order to allocate limited chaplaincy resources effectively. The purpose of this study is to investigate the associations between the demographic background of patients and chaplain visits as well as the primary reasons for patients to be admitted to the hospital and the number of chaplain visits. This study aims to provide empirical evidence that would help healthcare professionals to improve spiritual care outreach and further understand which patients received inpatient spiritual care, why those visits occurred, and the characteristics of those visits.
METHODS
This study evaluated 2,373 records from chaplain visits provided to 1,315 patients over a three-month period and characterizes inpatient spiritual care encounters at a large suburban teaching hospital.
RESULTS
Most patients were visited by a chaplain once, with the visit frequency increasing significantly if the admission was emergent or patients were seen for reasons related to self-harm or suicidality.
CONCLUSIONS
This study found a need for the robust provision of spiritual care services to patients with mental health conditions and reports empirical data supporting the need for specialized spiritual care support to specific patient populations most likely to benefit from targeted chaplaincy care.
Exploring Illness Beyond Disease: Development of a sense of identity in patients with inflammatory bowel disease (IBD)
Nicholas Totah, B.S.1, Jason Wasserman, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Inflammatory bowel disease (IBD) poses significant challenges to an individual’s physical and emotional well-being, often reshaping their sense of self and life trajectories. The meaningful influence that patient narratives can carry speaks towards the growing usage of support groups for patients who suffer from disease. Particularly, many patients who suffer from inflammatory bowel diseases not only struggle through the physical symptoms of the illness, but often experience bouts of isolation, hopelessness, and anxiety surrounding their quality of life, and what their futures hold. This research offers to illuminate the often-concealed burdens of the disease manifestations to physicians, in hopes for better patient outcomes and satisfaction as clinicians would possess a stronger understanding and willingness to address the challenges of the lived patient experience.
METHODS
This research qualitatively analyzes patient narratives accessible through the Crohn’s and Colitis Foundation website; thirty-nine narratives were analyzed for language and emotional themes displayed as the patients battle to find new ways of defining purpose in their lives. Narratives were analyzed using a line-by-line coding approach, linking similar codes together into categories and then identifying patterns among those categories to form themes. These patterns are visualized using mind-mapping software.
RESULTS
Emergent themes include 1) invisibility and feeling misunderstood, 2) incompletely address of challenges they face, 3) and newfound perspectives following diagnosis, including optimism, resilience amidst adversity, and connection through shared experience.
CONCLUSIONS
The nuanced findings highlighted above can reveal opportunities for increased IBD awareness and education, which physicians and healthcare professionals can help to facilitate. Through probing for social and emotional illness experiences and providing patients with community support resources, clinicians can address the many challenges that IBD patients continue to face which often remain invisible in the clinical encounter.
Smoking and COVID-19: An Analysis of Demographics, Risk Factors, and Outcomes
Andrew Vrtar, B.S.1, Luca Cucullo, Ph.D.1, Richard Kennedy, Ph.D.1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Beaumont Research Institute, Royal Oak, Michigan
INTRODUCTION
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in a global health crisis, affecting millions of people worldwide. Active and passive tobacco smoking has been associated with respiratory and inflammatory dysfunction in a causative and dose-dependent manner, which can significantly impact the progression and severity of Covid-19. This study aims to identify significant risk factors and characteristics correlated with clinical outcomes between smoking and non-smoking patients with COVID-19 infection.
METHODS
This was a retrospective cohort study of 2230 adult COVID-19 patients treated in the inpatient setting at Beaumont Royal Oak. The patients were grouped by smoking status and sex to compare demographic data, comorbidities, and clinical outcomes. The difference between these groups was analyzed using t-tests and chi-square tests.
RESULTS
The final cohort comprised of 859 male non-smokers, 129 male smokers, 1155 female non-smokers, and 87 female smokers. There were significant differences between smoking and non-smoking populations in alcohol use (39.9% vs. 26.4%; p=0.0004), chronic lung disease (27.3% vs. 14.6%; p<0.0001), venous thromboembolism (10.6% vs 5.7%; p=0.0042), stroke (15.3% vs 8.1%; p=0.0004), and heart disease (18.1% vs 10.3%; p=0.0006). Length of hospitalization in female smokers was greater than nonsmokers (9.2 days vs 7.8 days; p=0.0045). Males in general were ventilated more frequently than females (26.8% vs 16.9%; p=0.0007), however the number of days ventilated did not differ by sex or smoking status. There was also no significant difference in death due to COVID-19 while inpatient between smokers and non-smokers (11.6% vs 12.1%; p=0.8165).
CONCLUSIONS
Smoking correlated with increased incidence of risk factors among COVID-19 patients, including not only chronic lung disease but also VTE and stroke. However, clinical outcomes such as length of hospitalization, ventilation requirement and duration, and morbidity did not differ between smoking and non-smoking populations.
Eye Contact Avoidance and Acquisition of Verbal Commands in Children with Autism Spectrum Disorder
Victoria Whiting, B.S.1, Lesly Hendershot1, Lori J. Warner, Ph.D.1, James Grogan, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
This study investigates the predictive value of baseline eye contact skills on the acquisition of verbal requesting skills in pediatric autism patients. Children aged 2 to 7 undergoing intensive applied behavior analysis therapy at the Ted Lindsay Foundation HOPE Center at Beaumont Children’s provided retrospective Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) data.
METHODS
Baseline eye contact and manding (requesting) skills were assessed using VB-MAPP, a tool for language and social skills assessment. Retrospective data from 79 patients were analyzed using T-tests and linear mixed models to compare data within and among patients. Patients were grouped by age (younger = 0-48 months; older = 48+ months).
RESULTS
The interaction between time and eye contact at baseline on verbal requesting milestones was non-significant in both groups, (younger: F(1, 75) = 1.50, p = 0.1373), (older: F(1, 42) = 1.71, p = 0.0954). Younger children without eye contact at baseline achieved on average 2.3 requesting milestones per year, whereas those with eye contact at baseline achieved on average 3.4 milestones per year. Older children without eye contact at baseline achieved on average 4 milestones per year, while those with eye contact at baseline achieved on average 2.3 milestones per year.
Time remained a significant predictor of overall milestones achieved (t(120) = 8.56, p < 0.0001), with an average increase of 2.5 milestones per year, irrespective of age.
CONCLUSIONS
Children who evidenced eye contact at baseline gained more verbal requesting skills over time in both age groups, but this finding was not statistically significant. Teaching or enforcing eye contact may inadvertently contribute to discomfort in some individuals with autism. In the absence of a predictive relationship between baseline eye contact and manding acquisition, a more nuanced approach to therapy may be warranted.
Perioperative Antibiotic Use in Neonatal General Surgery: A Survey of APSA Membership
Ashley Williams, B.S.1, Samuel K. Osei, M.D.2, Diane Studzinski, B.S.2, Patrick Karabon, M.S.2, Begum Akay, M.D.2, Pavan Brahmamdam, M.D.6
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell Health William Beaumont University Hospital
INTRODUCTION
Limited data exists on antibiotic prophylaxis in neonates. We aimed to fill this knowledge gap by investigating pediatric surgeons' practice patterns in antibiotic prophylaxis for SSI in neonatal surgery.
METHODS
A survey was distributed to the American Pediatric Surgical Association (APSA). Members were asked to respond to 6 hypothetical case scenarios: Tracheoesophageal fistula/Esophageal atresia, Hirschsprung’s disease, Gastroschisis, Congenital diaphragmatic hernia repair, Neonatal intestinal obstruction (malrotation with volvulus), and Intestinal atresia type 1. Our questions focused on antibiotic initiation timing, the type of antibiotics used, and the duration of the antibiotic therapy. Responses were analyzed using chi-square with pair-wise comparison.
RESULTS
The survey was distributed to 1271 members, and results were analyzed based on 156 responses. The majority of the respondents practiced in academic centers and were a median of 12 years out in practice. Overall, we identified areas of consensus, and variation (Figure 1). For example, in gastroschisis, most would initiate antibiotics at the time of silo placement (73%) and continue until definitive closure (87.8%), but there was no consensus on the type of antibiotics administered. In other scenarios, such as tracheoesophageal fistula, 54% would initiate antibiotics less than one hour before surgery, but 40% would start them at the time of diagnosis. Post-operatively, 59% would continue antibiotics, but there was no consensus on the duration; only 42% would continue those antibiotics for less than 24 hours. These differences were also significant when stratified by hospital type and region. Across all scenarios, most respondents would start antibiotics within one hour of skin incision. Cephalosporin was the most common pre-operative antibiotic type chosen. Depending on the case scenario, respondents also favored either a two-drug combination or a single, broad-spectrum antibiotic (Figure 2).
CONCLUSIONS
Comprehensive data on SSIs and antibiotic use in neonates is crucial for developing standardized guidelines on perioperative antibiotic use.
