�Ǹ����

Author:  Ahmed Abdelwahab, University of Toledo;

Presenting Author: Milan Patel, University of Toledo

Abstract:  

Objective: Previous studies evaluating bicarbonate therapy in pediatric diabetic ketoacidosis (DKA) populations have been limited by confounding factors such as differences in illness severity, ICU admission bias, and fluid resuscitation. Our study aims to address these limitations by using propensity score (PS) matching to balance baseline characteristics on key clinical outcomes. Our study aims to provide a clearer understanding of bicarbonate’s effects on factors such as cerebral edema, coma risk, acute respiratory failure, and mortality, specifically in pediatric DKA population 

Methods: Our study used TriNetX, a global health research network that aggregates deidentified electronic medical records from over 140 healthcare organizations, to analyze children (<12 years) with DKA. Patients were divided into Cohort A (no bicarbonate) and Cohort B (bicarbonate-treated). Propensity score matching was performed to balance key baseline characteristics and minimize confounding. Risk analysis was conducted to assess outcome differences, with risk differences (RD) and 95% confidence intervals reported. 

Results: Before matching, Cohort A included 226 patients, while Cohort B had 8,950 patients. After matching, both cohorts consisted of 211 patients. Risk analysis showed that cerebral edema risk equalized after matching (RD 0.002, 95% CI: -0.039-0.044, p=0.911). However, coma risk remained significantly higher in bicarbonate-treated patients (RD 0.047, 95% CI: 0.019-0.076, p=0.001), as did acute respiratory failure (RD 0.071, 95% CI: 0.019-0.123, p=0.008). Furthermore, the mortality difference observed before matching disappeared (RD 0.000, 95% CI: -0.040-0.041, p=0.991). 

Discussion: After matching, bicarbonate was not associated with increased cerebral edema risk but remained linked to higher coma and acute respiratory failure rates. Furthermore, the mortality difference disappeared, suggesting bias in earlier studies. These findings indicate that routine bicarbonate use may worsen outcomes, highlighting the need to reconsider its role in pediatric DKA management. 

Author:  Ifeoluwa Babatunde, �Ǹ����

Abstract: 

Objectives: The objective of this study is to conduct a network meta-analysis (NMA) and systematic review of available pharmacological interventions used to prevent postoperative pain in adult patients after craniotomy.

Methods: A comprehensive search was conducted in PubMed, EMBASE and Cochrane library for randomized control trials (RCTs) evaluating the effect of various types of analgesic interventions administered to prevent pain in adults undergoing brain surgery. We performed a random effects frequentist network meta-analysis to evaluate outcomes such as postoperative pain score, analgesic consumption, and nausea & vomiting. Lastly, the certainty of evidence (CoE) for each network comparison will be assessed using the GRADE approach. We will classify each intervention from least to most effective.

Anticipated Results: The search identified 84 studies for the analysis. Preliminary findings show varying analgesic efficacy as indicated by the postoperative pain score at 0, 6, 12 and 24 hours for NSAIDs, opioids, and anesthetics. The results showed similar efficacy between the different types of anesthetics regardless of the route of administration. Some studies indicate a benefit in adding epinephrine to the anesthetic block. However, this benefit was inconsistent at the different time points. We anticipate finding a range of certainty of evidence for the different comparisons within the network.

Discussion: This network meta-analysis will provide clinicians with evidence to facilitate pain management decisions for patients who are undergoing brain surgery. These results will also guide the development of standardized pain management protocols for health systems. The network estimates calculated here are limited by the lack of direct comparative studies between combinations of interventions in the literature. However, these limitations should be used to inform future research priorities. Overall, this synthesis of evidence highlights important insights into the effectiveness of options available to patients.

Author: Samantha Bentley, �Ǹ����

Abstract: 

Nourishing Beginnings (NB) is an integrated referral and service delivery program that provides low-income pregnant individuals with increased nutritional food access throughout pregnancy up to three months postpartum, through community health workers (CHW), who simultaneously address and provide support for social service needs of the client.

Population and Inclusion: Pregnant individuals who are 18 yrs +, Medicaid-eligible, <22 week pregnant, and English speaking. Study Design: 160 participants, randomized to two intervention arms (n=80 each), with additional propensity matched control group (n=160) for primary outcomes only. Data collected at baseline, 8 weeks, near/at delivery and 3 months post-delivery.

Primary Outcomes: Food security, birthweight (gms; <2500), gestational age (weeks,<37 weeks), neonatal or special nursery care stay. The goal of Nourishing Beginnings is to improve long-term health outcomes (i.e., maternal and infant) both directly and mediated through a set of proximal outcomes, including prenatal care, food security, diet and nutrition, reported race discrimination and psychosocial factors including depression, stress, healthy eating self-efficacy, and social support.

Author: Brian Biroscak, �Ǹ����

Abstract: 

Goals: In addition to the dual challenge facing the D&I field of how to increase the volume as well as optimize the pace of delivered, evidence-based innovations, implementation scientists and practitioners face the triple challenge of how to optimize the effectiveness, efficiency, and equity of their innovations. The NIH-funded Systems Marketing Analysis for Research Translation (SMART) innovation program addresses this gap by combining methods for selecting, tailoring, and optimizing implementation, scale-up and sustainability for effectiveness, efficiency, and equity of clinical and community practices of interest. 

Methods: We used participatory group model building (GMB) with a multidisciplinary team to develop and refine the SMART program theory for selecting and tailoring implementation strategies. Using system dynamics (SD) computer modeling, we then simulated the SMART model across a range of dynamic environments and optimized the pace of implementation outcomes including appropriateness, feasibility, reach, and equity. A sensitivity analysis was then run for optimized pacing to evaluate and identify regions of program path dependence and improve the robustness of implementation outcomes to model uncertainty. 

Results: Computer simulation as an implementation strategy helped identify potential path dependencies in program theory and sensitivity to initial conditions, parameters, and model assumptions. Combining social marketing analysis with scaling up supply to meet demand for practices of interests improved program design with respect to the effectiveness, efficiency, and equity of clinical and community practices of interests. Future work will include empirically testing the program theory with 12 or more translational research projects. 

Discussion: Integrating systems- and marketing sciences for optimizing innovation effectiveness, efficiency, and equity is a promising approach that can help address challenges of equitably implementing clinical and community practices of interest in increasingly dynamic, fast changing environments.

Author: Gabriel Bonassi, University of Toledo

Abstract: 

Objectives/Goals: Evaluate potential trends and disparities in the use of physical restraint (PR) during emergency room (ER) visits in the United States from 2018 to 2024.

Methods/Study Population: This observational retrospective cohort analysis used deidentified electronic health records from the TriNetX US Collaborative Network to identify adult patients (≥18 years) who experienced PR (ICD10CM: Z78.1) during an ER visit (HL7V3.0: Visit Type: EMER) on the same day between January 1, 2018 and December 31, 2024. We used a standardized 12‑month lookback period to capture only incident restraint events.

Results: In this study, a total of 59,793 patients were identified (mean age: 61 ± 18 years; range: 18–90). Sex of the cohort was 61.63% male, 37.12% female, and 1.25% undetermined. Regarding patient ethnicity, 12.03% identified as Hispanic or Latino, 76.46% as not Hispanic or Latino, and 11.51% had undetermined ethnicity. With respect to race, 60.62% were classified as White, 25.51% as Black or African American, 5.75% as unknown race, 3.86% as Asian, and 3.64% as other races. In our incidence analysis, we found that the proportion of patients with an incident of PR increased from 23.183% (n = 9,610) in the pre‑pandemic phase (January 1, 2018–March 10, 2020) to 69.971% (n = 33,577) during the C-19 intrapandemic phase (March 11, 2020–May 11, 2023), before declining to 64.712% (n = 16,849) in the post‑pandemic phase (May 12, 2023–December 31, 2024).

Discussion/Significance of Impact: This study emphasizes that while Black or African American patients constitute roughly 13% of the US population, they accounted for approximately 26% of all patients who experienced PR in an ER visit from 2018 to 2024. This two-fold overrepresentation suggests disparities in the application of PR and that patient demographics, such as race, can influence the odds of PR application in the ER. In addition, the higher incidence of PR in the ER during the pandemic suggests that operational stress, resource constraints, and altered care protocols can potentially amplify such disparities.

Author: Neel Dayal, University of Toledo

Abstract:

Objective: Describe the development of treatment-resistant pediatric POTS in previously well-controlled patients, and demonstrate the effectiveness of sotalol as an alternative therapy.

Cases: 3 patients were evaluated that had a previous diagnosis of POTS.

Patient 1 is an 18-year-old female with POTS treated with atenolol and fludrocortisone until she contracted C-19. She had increased dysautonomia-related symptoms post-infection requiring escalation of her medications and addition of midodrine to help with associated hypotension. These changes were ineffective in providing symptom control.

Patient 2 is an 18-year-old female with Ehlers-Danlos syndrome and POTS controlled with metoprolol, until she developed recurrent episodes of syncope and severe tachycardia. Even after addition of ivabradine and dose escalation of metoprolol, she had increased frequency and worsening of her POTS symptoms.

Patient 3 is a 17-year-old female treated with metoprolol, midodrine, and ivabradine. After an Epstein-Barr viral infection, her POTS symptoms considerably worsened, and her medications no longer provided benefit.

Results: All 3 patients were started on sotalol twice per day, which provided heart rate control after they became treatment-resistant to other therapies following a viral infection or some unknown etiology. Sotalol caused an average decrease in heart rate of 98.7 bpm, and a standing heart rate of 100 bpm or less for all 3 patients, with remission of their tachycardia symptoms. None of these patients developed any symptoms of dizziness, lightheadedness, or syncope following initiation of sotalol. ECG
evaluation of these patients after starting sotalol treatment showed no proarrhythmias and no QTc prolongation.

Conclusion: 3 previously stable pediatric POTS patients were evaluated after becoming resistant to their previous medications. Sotalol was effective in all 3 patients with remission of their tachycardia symptoms without QTc prolongation or proarrhythmia. These findings show the effectiveness of sotalol in medically resistant pediatric POTS.

Author: Juliann Di Fiore, �Ǹ����

Abstract: 

Background: The NICU can vary drastically between noisy open bays to extremely quiet single patient rooms.  Both environments are dissimilar to that of the womb. NICU sounds that emulate the womb environment may play a critical role in neuronal maturation of the respiratory control regions of the brain in preterm infants. Apnea, often resulting in bradycardia and intermittent hypoxemia (IH), are common in preterm infants. IH can induce a range of sequelae including anatomical changes in the cardio-respiratory brainstem nuclei further perpetuating respiratory instability. Music exposure in the NICU has been shown to have beneficial effects on sucking behavior, caloric intake, heart rate, pain scores and sleep patterns.  However, the effect of early postnatal womb sound exposure on neuronal maturation of the respiratory control regions of the brain in preterm infants is unclear. 

Objective: To determine the acute effects of womb sound recordings on cardiorespiratory and oxygen stability in moderately preterm infants during hospitalization.

Methods: 19 preterm infants (gestational age 31.6±0.8 wks, birthweight 1822±372gm) were exposed to alternating 6h periods of commercially available womb sound recordings (55-60dB) and ambient noise over a 24 hr period at 34 weeks +/- 2 days corrected age. Respiration, oxygen saturation and heart rate were monitored. Apnea (>5sec), IH (SpO2<85%), and bradycardia (<80bpm) were compared between ambient and womb sound exposures to assess the acute effect of auditory stimulation on cardiorespiratory stability. 

Results: A significant correlation was found between increased oxygen/respiratory instability during ambient conditions and reduced frequency of IH (r2=.24, p=.031), time with hypoxemia (r2=.23, p=.036) and shorter duration of periodic breathing (r2=.38, p=.005) during womb sounds. The reduction in apnea frequency during womb recordings did not reach statistical significance (r2=.17, p=.083). There was no difference in bradycardia frequency or movement duration between exposures suggesting no effect on irritability.
Conclusion

Author: Chloe Edmonds, NEOMED

Abstract: 

Objectives: Dysphagia (difficulty swallowing) is a significant health burden in infants, but these infants are fragile and require a translational model to explore the neurological substrates underlying swallowing pathophysiology. Dysphagia is often associated with airway compromise, which can be predicted by the size of the bolus prior to swallowing. This study used an infant pig model to determine the mechanism underlying the relationship between bolus sizes and entry of ingested material into the airway.

Methods: We recorded infant pigs using videofluoroscopy as they fed on bottles, and measured total pharyngeal transit time (TPT time), which notably occurs after bolus formation. We collected data across three experimental conditions: control infant pigs, pigs with an induced sensory deficit (bilateral anesthetization of the inferior alveolar nerve [IAN], which is known to disrupt feeding), and in pigs with IAN anesthetization along with oropharyngeal stimulation (using capsaicin, which is known to improve swallowing).  

Results: All three experimental groups had a positive relationship between bolus size and TPT time. This relationship did not differ when comparing the three treatments. 

Discussion: These results suggest that a mechanism by which larger boluses produce aspiration is increasing the time it takes the bolus to travel through the pharynx. Further, because this relationship did not differ with IAN lesion nor capsaicin, this study provides further support for the theory that the swallow is reflexive. This reflex is triggered by the growing bolus, but once initiated it is generally unaffected by sensory deficits or stimulation. These results also highlight the role of behavior timing in predicting airway compromise, such that the timing of behaviors may be more critical to performance than the behaviors themselves. This implies that in some cases, treatments for dysphagia may be more successful when they induce changes in coordination of structures involved in swallowing, rather than focusing on strength or the extent of movement of these structures.

Author: Megan Foradori, VA Northeast Ohio Healthcare System

Abstract: 

Objective: This study includes the pre-implementation and implementation phases of incorporating Age-Friendly Health Systems (AFHS) care for older hospitalized Veterans. Specifically, this work tests the efficacy of the AFHS uptake across four clinical units before, during, and after use of The Implementation Playbook (TIP) as an e-facilitation implementation strategy. The study will provide understanding of the usability, feasibility, fidelity, and acceptability of TIP. 

Study Population: The implementation project seeks to enrich the care of older adult Veterans through enhancing healthcare providers' practices in the Community Living Center (CLC) at the Louis Stokes Cleveland VA Medical Center.

Results: Now completed, the pre-implementation phase included the formation of a multidisciplinary leadership team, including members with experiences at all levels, ensuring many perspectives will inform and enrich the resulting implementation. The naming of a project champion well known to the VA division set the stage for buy-in and ownership. A comprehensive review of the pre-implementation of AFHS activities preceding the effort was completed, including details on the initial staff education and early efforts to integrate AFHS’s mobility assessment and act-ons. Working with informaticists, new electronic health record documentation tools and a dashboard to track progress were developed. After the pre-implementation, the team and the CLC staff will be poised to carry out their efficacy study of e-facilitation using an electronic guide to provide Age-Friendly Healthcare to Veterans in the CLC. 

Discussion: Acknowledging ever-present barriers to implementation, the pre-implementation phase enables the team to complete essential pre-work to increase the likelihood of change adoption. Gathering key perspectives, naming an engaging champion, understanding historical and immediate antecedents orbiting the clinical change, and preparing for data collection and dissemination in the effort ensure that these essential components are established to reduce confounders.
 

Author: Sarah Frischmann, University Hospitals

Abstract: 

Objective: To describe factors associated with chronic school absenteeism (missing >=10% eligible school days) in a cohort of Medicaid-insured children residing in Northeast Ohio.

Methods: Analysis of Medicaid claims, social services and school records July 2018 - June 2022 of Cuyahoga County children aged 6-12 years with 1+ encounters with University Hospitals and enrollment in 1+ participating school districts. Children with asthma had diagnosis code ICD-10 J45 and prescription for a beta-agonist +/- inhaled corticosteroid during the study period. The Andersen and Aday Framework was used to identify variables included in multivariable logistic regression models exploring modifiable factors associated with chronic absenteeism in 2 or more academic years ("persistent chronic absenteeism").

Results: 25,058 children met inclusion criteria, of whom 4970 (19.8%) had asthma.  Chronic absenteeism in the study cohort exceeded State-level estimates in all academic years (from 33 vs 17% in AY2018-19 to 64% vs 30% in AY2021-22).  Among those with asthma, 67.5% were ever chronically absent and 25.3% were persistently chronically absent.  Accounting for demographics (age, sex & race), risks for persistent chronic absenteeism included: poorer indoor air quality (as measured by prenatal tobacco exposure, aOR 1.48, 95%CI 1.07-2.04, p=0.017) & mental health concerns (aOR 1.34, 95%CI 1.01-1.81, p=0.048).  Protective factors included: residence in a census tract with greater opportunity for Health & Environment (aOR 0.66, 95%CI 0.49-0.89, p=0.006) and achieving an Asthma Medication Ratio >50% (aOR 0.77, 95%CI 0.59-1.00, p=0.052).

Discussion: Chronic absenteeism is common among Medicaid-insured children obtaining care in our health system, and influences on attendance are not limited to asthma alone.  Opportunities for clinicians to optimize outcomes for this population include: inquiring about school attendance, absenteeism and reasons for absenteeism, increasing Asthma Medication Ratios, and screening for and treating comorbid mental and behavioral health conditions.
 

Author: Gunnur Karakurt, �Ǹ����

Abstract: 

Objectives/Goals: Intimate partner violence (IPV) is a significant public health issue that adversely affects victims' well-being. IPV is often under-reported, and non-physical forms may not be recognized as IPV. With the rise of social media, people increasingly share relationship problems online, providing valuable data for identifying and understanding IPV. This study aims to develop DetectIPV, a tool using machine learning to predict IPV from free text and to characterize the predictability of different violence types (physical, emotional, sexual) from these texts.

Methods/Study Population: We utilized data from established IPV questionnaires to train machine learning models, including random forest, SVM, logistic regression, and Naïve Bayes, combined with the Universal Sentence Encoder (USE). These models were trained to detect IPV in free text. The study population includes social media posts and other free-text sources where individuals describe their relationship experiences.

Results/Anticipated Results: DetectIPV can identify IPV from free text with an area under the ROC curve (AUROC) of 89%. Type-specific models show that physical abuse is identified with the highest accuracy (AUROC 98%), while sexual abuse is detected with high precision but with lower recall. Emotional abuse prediction is more challenging but still achieves an AUROC above 80%. These results demonstrate the tool's effectiveness in detecting various forms of IPV.

Discussion/Significance of Impact: DetectIPV represents a significant advancement in using technology to address IPV. By analyzing social media and other text corpuses, it can help identify and understand the prevalence, causes, and consequences of IPV. This tool can be used for flagging social media posts, aiding research, and ultimately supporting interventions for victims. DetectIPV is available as a web service, providing a valuable resource for researchers and practitioners in the field.

Author: Bailey Klein, �Ǹ����

Abstract: 

Hematopoietic stem cells (HSCs) play a crucial role in generating all blood cell types, vital for a functional immune system and oxygen transport. Maintaining this balance throughout life involves a tight regulation of self-renewal, differentiation, and quiescence, influenced by both intrinsic and extrinsic signals. While the influence of many HSC progeny on HSC decisions is known, the role of mast cells (MCs) has remained unexplored. MCs, known for their immunomodulatory functions through secretion of various factors including histamine, present a novel avenue for understanding HSC regulation. In this study, we uncover a novel role for MC-derived histamine in modulating HSC behavior. Our hypothesis posits that MCs act as negative regulators of HSCs. We observed that genetically MC-deficient “SASH” mice exhibit increased hematopoietic output and bone marrow (BM) HSCs, characterized by an enhanced quiescent signature that increases chemoresistance. The SASH microenvironment also shows elevated frequencies of HSC-supportive cell types and increased expression of genes conducive to HSC maintenance, providing a functional advantage when wild-type BM is transplanted into this microenvironment. Moreover, we found that the genetic loss of MCs correlates with lower serum histamine levels in SASH mice, and the augmented hematopoietic phenotype can be reversed by administering exogenous histamine. Subsequent experiments with FDA-approved antihistamines in wild-type mice revealed that cetirizine, an H1R inverse agonist, notably increased HSC frequency in the BM. Overall, our findings highlight MCs as negative regulators of HSCs, laying the groundwork for future studies to unravel the underlying mechanisms and explore the therapeutic potential of cetirizine.

Author: Trisha Lal, University Hospitals

Abstract: 

Objective: To identify community-level factors driving geographic discrepancies between colorectal cancer (CRC) screening uptake and early-stage diagnosis. While individual predictors of CRC outcomes are well-documented, the role of broader community characteristics in shaping geographic variability in screening effectiveness remains unclear. We hypothesized broader community characteristics, beyond screening rates, drive these discrepancies.

Methods: CRC patients diagnosed between 2010 and 2019 were identified in the Ohio Cancer Incidence Surveillance System (OCISS). Screening rates were obtained from CDC PLACES (2018). Max-P regionalization aggregated census tracts into statistically reliable communities based on sociodemographic characteristics. Geographic weighted regression (GWR) explored associations between screening rates and early-stage diagnosis proportions. Predictors of discordance, including socioeconomic status, education, healthcare context, and physical infrastructure, were identified using the Variable Selection Using Random Forest (VSURF) algorithm.

Results: 869 communities were delineated from 2,952 census tracts. High screening rates did not consistently predict early detection, with significant regional variability. GWR revealed a positive association in Southern Ohio (avg. coefficient: 0.21, p = 0.002), but no correlation in Northeast Ohio (avg. coefficient: -0.03, p = 0.720). VSURF ranked transportation and vehicle accessibility as the most critical variable influencing early-stage diagnosis. Screening alone was not significant. 

Discussion: Screening rates alone cannot predict early-stage CRC diagnosis, suggesting structural or environmental barriers to timely follow-up colonoscopy after non-invasive screening. By highlighting outlier communities, this approach provides a framework for targeted interventions and future studies. These findings emphasize the need to investigate nuanced, population-level predictors to improve CRC outcomes equitably.

Author: Kyungmi Lee, �Ǹ����

Abstract: 

Objectives: Multiple sclerosis (MS) is a chronic neurological disease with symptoms that fluctuate and often worsen with age, impacting quality of life. Understanding how age influences daily variability in these symptoms, including fatigue, stress, and happiness, is essential for developing effective management strategies tailored to individuals with MS. The goal of this study was to examine the impact of age on the daily variability and individual differences

Methods: Data were collected from 107 participants with MS over 10 days using the LifeData app, which captured ecological momentary assessment (EMA) responses five times daily. A mixed-effects model was employed to analyze the effects of time, age, and their interactions on fatigue, stress, and happiness, based on a dataset of 5,250 observations.

Results: The within-individual analysis showed a significant increase in fatigue over time (β = 0.221, p  0.05), but older participants reported significantly lower stress levels (β = -0.022, p  0.05) and with age (β = 0.010, p > 0.05). The between-individual analysis revealed significant baseline differences in fatigue (β = -1.435, p  0.05). Age-related differences in fatigue and stress persisted over time.

Discussion: These findings underscore the importance of understanding how age-related factors influence daily fluctuations in fatigue and stress among individuals with MS. By using EMA to capture detailed, real-world data in everyday settings, this study highlights the potential for developing targeted, age-specific interventions. Such personalized care strategies can optimize symptom management and improve quality of life for individuals with MS. Furthermore, real-time symptom tracking through EMA provides insights to guide effective treatments and interventions seamlessly integrated into clinical practice. 

Author: Gloria Liu, �Ǹ����

Abstract: 

Objectives/Goals: To determine the acute effects of womb sound recordings on cardiorespiratory and oxygen stability in moderately preterm infants during hospitalization.

Methods/Study Population: 19 preterm infants (gestational age 31.6±0.8 wks, birthweight 1822±372gm) were exposed to alternating 6h periods of commercially available womb sound recordings (55-60dB) and ambient noise over a 24 hr period at 34 weeks +/- 2 days corrected age. Respiration, oxygen saturation and heart rate were monitored. Apnea (>5sec), IH (SpO2<85%), and bradycardia (<80bpm) were compared between ambient and womb sound exposures to assess the acute effect of auditory stimulation on cardiorespiratory stability. 

Results: A significant correlation was found between increased oxygen/respiratory instability during ambient conditions and reduced frequency of IH (r2=.24, p=.031, Fig 1), time with hypoxemia (r2=.23, p=.036, Fig 2) and shorter duration of periodic breathing (r2=.38, p=.005, Fig 3) during womb sounds. The reduction in apnea frequency during womb recordings did not reach statistical significance (r2=.17, p=.083). There was no difference in bradycardia frequency or duration of movement between exposures suggesting no effect on irritability.

Discussion/Significance of Impact: Womb sound recordings reduce IH, time in hypoxemia and duration of periodic breathing in infants with increased respiratory instability. These results suggest that womb sounds may play an acute role in peripheral chemoreceptor excitation during early postnatal life in moderately preterm infants with delayed maturation of respiratory control.

Author: Liping Liu, MetroHealth

Abstract: 

Introduction: Fear, anxiety, and depression significantly and conversely affect the recovery post-surgery and satisfaction with care of patients with spine surgery. Pre-operative education classes (POEC) may reduce anxiety and improve patient satisfaction. But there is no formal online POEC framework commonly used in spine surgery. We studied the impact of a POEC on patient satisfaction with spine surgery. We aimed to (1) identify POEC attendance rates and (2) evaluate the patient’s satisfaction with POEC.

Materials and Methods: Patients scheduled for elective spine surgeries from July 2021 to Dec 2023 were voluntarily planned for the POEC; the online course was performed by an experienced neurosurgery registered nurse for an hour, followed by 20 minutes of questions and answers (Q &A). After Oct 2022, we switched the online platform from Webex to Zoom with a designed online survey attached to the meeting. The survey was collected and analyzed electronically.

Results: About 53% of patients who underwent spine surgeries were scheduled for the class in 2023, which increased compared to 48% in 2021. The attendance of those patients scheduled for the course increased from 77 (87%) to 236 (89%) in 2022 and 226 (84%) in 2023. The patients showed high satisfaction with our classes; about 96% of patients agreed or strongly agreed that the class was beneficial, were easy to understand answered their questions, and will recommend them to their friends or family. Patients stated in the comments that the preoperative education decreases their anxiety and fear and helps them to prepare for the surgery. The survey return rate dramatically increased from 40% in 2021 to 84% in 2023 after switching to online Zoom classes.

Conclusions: POEC is associated with a high rate of patient-reported satisfaction. Well-designed online education platforms with online surveys can be very effective, efficient, and easy to implement. Future work will analyze the post-surgical assessment of the spine education classes.

Author: Liping Liu, MetroHealth

Abstract: 

Introduction: Preoperative Education Class (EC) has been used by many institutions to deal with patient anxiety, pain control, and overall satisfaction. Although the literature suggests EC's effectiveness in joint reconstruction, a few data suggest a positive impact on patient satisfaction, and pain management in spinal surgery. There is no systemic study regarding the effects of EC on elective spine surgery patients' outcomes.

Materials and Methods: Patients with elective spine surgeries from July 2021 to July 2024 were voluntarily scheduled for EC; the EC was performed by an experienced neurosurgery registered nurse for an hour, followed by 20 minutes of questions and answers. We extracted the outcomes data from EMR and further analyzed these patients' outcomes.

Results: Of 1524 patients who had elective spine surgery, 597 (39%) attended the class, whereas 927 (61%) did not. Patient characteristics analysis showed that there were no differences in age; race, ethnic, HA1C, but have significantly slightly differences in BMI, smoking and alcohol use between these two groups. The evaluation of outcomes showed that there was significantly decreased hospital length of stay (LOS) (3 vs 4; P<0.01), surgical site infection (SSI) (1.0% vs 3.3%); P<0.01) and a dramatically increased discharge home (82 % vs 74%; P<0.01) for patients with EC compared to the patients without EC. Patients with EC encounter more with doctors through telephone (44% vs. 31%), messages (38% vs 18%), and refills (49% vs 32%) (P<0.01) four wks. after the surgery compared to the patients without EC. We observed a trend toward decreased 30-day readmission to IP (3.2% vs 3.9%) and ED (7.5% vs 8.5%).

Conclusions: Implementing EC is associated with reduced hospital LOS, lower SSI, and increased the number of patients discharged home. We observed a trend toward decreased 30-day readmission to IP and ED. Further study is needed to evaluate other outcomes such as post-surgery complications, mortality morbidity, and underlying mechanisms for the 30-day readmission. 

Author: Nicolas Mas D Alessandro, MetroHealth

Abstract: 

Objectives/Goals: Intraoperative teaching in anesthesiology residency programs often lacks structure, negatively impacting educational consistency. This study aimed to develop and evaluate the Intraoperative Learning Modules program to enhance the quality and structure of intraoperative education.

Methods/Study Population: Our institution's residency program implemented the Intraoperative Learning Modules program, focusing on critical clinical issues, including anaphylaxis, bronchospasm, delayed emergence, difficult airway management, hemorrhage, hypotension, local anesthetic toxicity, malignant hyperthermia, myocardial ischemia, and pneumothorax. Faculty and residents participated in structured discussions about these topics using badge-sized cards to track compliance.

Results/Anticipated Results: The program achieved 100% compliance among faculty and residents. Post-implementation surveys indicated a 29% increase in residents feeling faculty were interested in education and a 16% increase in those who believed faculty fostered inquiry. However, there was a 2% decrease in perceived teaching quality.

Discussion/Significance of Impact: The Intraoperative Learning Modules program established a structured teaching framework, enhancing faculty engagement and perceived educational quality. Despite a slight decline in teaching quality ratings, the initiative highlights the importance of structured approaches in residency education. Future research should focus on balancing structured teaching with quality to ensure sustained improvements in educational outcomes.

Author: Mary Nantongo, �Ǹ����

Abstract: 

Objectives: Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), is a serious global public health burden. Peptidoglycan synthesis is an underexplored drug target in Mtb. Carbapenems are effective against TB as they are poor substrates for the Mtb β-lactamase BlaC and inhibit L, D-transpeptidases (LDTs), key β-lactam resistance mechanisms in Mtb. We hypothesize that substituting the C5 position and modifying the R2-side chain enhances carbapenem activity against Mtb. We explored the activity of two novel carbapenems; JDB/NA-1-157 (A) and JDB/NA-1-208 (B) with these modifications both alone and in combinations with β-lactamase inhibitors (Durlobactam and clavulanate) and β-lactam antibiotics (amoxicillin and Ceftriaxone) and evaluated their structure-activity relationships with Mtb peptidoglycan synthesis enzymes.

Methods: Antibiotic susceptibility testing was conducted using broth microdilution for 9 Mtb isolates from TB patients. Timed electrospray ionization mass spectrometry captured acyl-enzyme complexes. Kinetic parameters were measured using a spectrophotometer, Circular dichroism (CD) spectroscopy evaluated BlaC's thermal stability and structural conformational changes.

Results: MICs for A and B, against Mtb isolates, were 1–2 and 2–4 μg/ml, respectively, comparable to meropenem (1–8 μg/ml). Combinations with durlobactam, clavulanate, ceftriaxone, and amoxicillin lowered MICs. Acyl-enzyme complexes were captured with BlaC, LDTs (LdtMt1-3),  PonA1, and DacB1 (only A) but not with LdtMt5 or PBPLipo. Compound A showed superior inhibitory kinetics with BlaC, with a Kiapp of 14 ± 1.4 μM and a Kon of 800 M-1S-1 similar to meropenem (11.4 ± 1.1 μM and 800 M-1S-1 respectively, as well as koff of 1x10-4  ± 0.1 x 10-4 S-1, while B had a Kiapp of 97 ± 19.7 μM. CD revealed secondary structural changes in BlaC without altering its melting temperature. 

Discussion: The novel compounds, particularly A, exhibit significant activity against Mtb peptidoglycan synthesis. Drug A offers slightly increased potential than B. Both could improve TB treatment.

Author: Oscar Ose, �Ǹ����

Abstract: 

Dysplastic nevi exemplify the challenge of communicating abstract concepts about ambiguous disease prognoses–an ambiguity that often leads to great concern among patients who think they have or are about to have cancer. The prognostic value of dysplastic nevi and their relationship to melanoma is evolving and debated, creating difficulty in accurately presenting risks despite low objective risk associations. To assess if increased understanding of dysplastic nevi could lead to decreased associated concern, a concise ~1 minute educational video, developed with expert feedback, was analyzed using questions testing knowledge of objective risk as well as cognitive and affective ratings of subjective risk.

100 patients diagnosed with dysplastic nevi were recruited from 11 dermatologists’ clinics at two UH Dermatology locations. Before and after watching the video, patients completed a survey with visual analog and Likert scales describing their perceptions of dysplastic nevi. Paired t-tests were used to analyze how perceptions changed.

After the video, patients reported significantly decreased concern (mean difference -7.01; VAS 0-100; p-value: 0.001) and significantly increased understanding (mean difference 30.76; VAS 0-100; p-value: 2.2 x 10-16) regarding dysplastic nevi. Patients reported ~3 fold decreased perceived associated melanoma risk and significantly increased planned sunscreen (mean difference 0.5; Likert 1-5, p-value: 6.0 x 10-9) and sun protective strategy (mean difference 0.34; Likert 1-5, p-value: 4.3 x 10-5) use.

Our results show that a brief intervention can effectively increase understanding and decrease concern regarding dysplastic nevi in a way that is easy to disseminate in a variety of clinical settings. Next steps include greater distribution of this intervention and expanding the work to focus on how this information modulates intention to get dysplastic nevi surgically removed.

Author: Anny Reyes, Cleveland Clinic

Abstract: 

Goals: Individual-level social determinants of health (SDOH), including education, income, occupation, health behaviors, social support, and healthcare access, play a critical role in shaping health outcomes. This study examines the impact of SDOH on cognitive outcomes in PWE.

Methods: Data from 607 patients with pharmacoresistant epilepsy (average age=38.72, education= 13.4, 54.7% male, 7.7% non-White) evaluated at the Cleveland Clinic, including neuropsychological assessments and SDOH measures, were analyzed. SDOH variables included financial strength, economic hardship, median household income, educational attainment, and household characteristics (e.g., complex occupation, unemployment, lack of vehicle ownership, single-parent status). Stepwise regression analyses examined the contributions of these SDOH factors to cognitive performance, controlling for demographic (age, sex, race) and clinical variables (epilepsy duration, antiseizure medications, and mesial temporal sclerosis).

Results: Reduced financial strength was linked to poorer Verbal Comprehension (p = .030), Processing Speed (p < .001), Naming (p < .001), and Phonemic Fluency (p = .007), and higher depressive symptoms (p < .001). Lower household income was associated with poorer Auditory Delayed Recall (p = .004) and higher anxiety symptoms (p = .014). Single-parent status, unemployment, and low educational attainment were linked to lower cognitive performance in Naming (p < .001), Visual Attention/Motor Speed (p = .017), and increased Perseverative Errors on a problem-solving task (p = .009), respectively. Conversely, complex occupational roles predicted higher scores across multiple cognitive domains, including Full-Scale IQ (p < .001), Verbal Comprehension (p = .012), and Working Memory (p < .001).

Conclusion: SDOH was associated with cognitive and emotional outcomes in PWE, highlighting the need to address socioeconomic disparities in epilepsy care. Integrating SDOH considerations into clinical strategies could improve outcomes for this vulnerable population.

Author: Samuel Rodgers-Melnick, University Hospitals

Abstract: 

Objective: To investigate which characteristics are associated with clinically significant reductions in pain intensity (i.e., numeric rating scale [NRS] reduction ≥2 units) within a single music therapy (MT) session among hospitalized patients.

Methods: We conducted a retrospective electronic health record review of 2039 MT sessions conducted across a large health system among 1203 adult patients reporting a pre-session pain NRS score ≥4 and a complete post-session pain score. We employed a logistic mixed effects model to predict the binary pain reduction response (≥2 units vs. < 2 units) where patients were considered nested within therapists. The model included the following fixed covariates: (1) MT intervention type (i.e., receptive only, recreative [i.e., active instrument play], compositional/creative [e.g., songwriting], or receptive + relaxation/imagery), (2) Other MT characteristics including session length and goal; (3) sociodemographic variables (e.g., age, sex, race/ethnicity, census tract-level social vulnerability index); and (4) clinical characteristics (e.g., total Elixhauser comorbidities, sickle cell disease, receipt of opioids in 12 hours prior to session).

Results: Covariates associated with higher adjusted odds ratios (aOR [95% CI]) included (1) recreative (1.367 [1.004, 1.861]) and relaxation/imagery MT interventions (1.482 [1.014, 2.167]) as compared to receptive; (2) 15-minute increases in session length (1.402 [1.223, 1.607]); (3) 1-unit increases in pre-session pain (1.190 [1.106, 1.281]), (4) 5-unit increase in Elixhauser comorbidities (1.295 [1.047, 1.602); and (5) a documented MT session goal of pain management (3.581, [2.640, 4.856]). Male sex, Medicaid insurance status, and sickle cell disease diagnoses were associated with lower odds of pain reduction ≥2 units.

Discussion: MT interventions involving singing or active instrument play and relaxation/imagery interventions involving guided relaxation, imagery, or breathing exercises may be more effective for reducing pain than interventions only involving live or recorded music.

Author: Asha Sethuraman, MetroHealth

Abstract: 

Area deprivation index (ADI) is associate with disparities in outcomes across various medical conditions. The impact of ADI on outcomes in neuro-oncology is largely understudied. This study analyzed the association of ADI with outcomes for patients with glioma. 

The oncology registry was queried for patients diagnosed with cancer at MetroHealth for between 2016-2022 and patients with gliomas and astrocytoma were identified. The medical record was accessed for each patient to obtain additional demographic, medical, procedural, and outcome data. The patient population was stratified by ADI quartile and tests for statistical significance were done to assess for similarities and differences between quartile 1 (low deprivation) and quartile 4 (high deprivation). 
The high deprivation and low deprivation ADI quartiles had no statistically significant difference in baseline demographics. The high deprivation quartile had more African American patients (25% vs 0%; p-value: .02) and more patients on public insurance plans (81% vs 50%; p-value: .05). The laterality, tumor location, IDH status, MGMT status, and surgical procedure types were similar. 

Patients in the higher deprivation group were discharged to a non-home setting at significantly higher rate (50% vs 29%; p-value: .03). We observed a trend towards increased length of stay in the higher deprivation group although this did not achieve statistical significance (9.88 vs. 6.18 days; p-value: .13). More patients in the low deprivation quartile survived to or past the one-year mark (73% vs 88%; p-value: .28). At one year we observed no difference in readmissions, ED visits, tumor progression, or the need for revision surgery. 

Our study showed several differences in baseline demographics and clinical outcomes between the top and bottom ADI quartiles. Most significantly, patients with high deprivation experienced non-home discharge and trends towards longer hospital lengths of stay. Further studies will elaborate on the association of ADI on outcomes in neuro-oncology patients.  

Author: Asha Sethuraman, MetroHealth

Abstract: 

In 2018, andexanet alfa (Andexxa) became FDA approved as an anti-factor Xa inhibitor reversal agent intended for patients who require the reversal of anticoagulation due to rivaroxaban (Xarelto) or apixaban (Eliquis). A key consideration when utilizing Andexxa is its notably high cost. This study’s objective is to assess the clinical benefit of Andexxa on patients with spontaneous intracerebral hemorrhages (ICH). 

For this retrospective study, the American Heart Association stroke registry was queried for patients admitted to MetroHealth for ICH between 2020-2023. The medical record was accessed for each patient to obtain demographic, medical, procedural, outcome, and financial data.  A univariate analysis was done to assess for predictors of poor outcomes in patients with ICH.

48 patients on a DOAC with spontaneous ICH between 2020 and 2023 were identified. There were no significant differences in basic demographic information such as age, sex, race, and insurance status. Additionally, there were no significant differences in the baseline ICH score or the NIHSS. While not statistically significant, the Andexxa group trended towards a higher initial ICH volume (19 cc vs 7 cc; p= 0.21). Furthermore, there were no statistically significant differences in dosage of each respective DOAC prescribed between the two groups. The length of stay was higher in the Andexxa group (11 days vs 8 days, p = 0.04). We observed no significant differences in ICH expansion volume between the initial scan and first repeat scan between the two groups (2.4 cc vs 0.21 cc; p =.29). We observed no significant difference between the two groups when looking at hospital and 6-month mortality rates. Total pharmacy charges for Andexxa during the study period was $551,760.00. 

In our study, patients who received Andexxa therapy after spontaneous ICH showed no difference in ICH expansion within 24 hours but had increased cost of care. Further studies should examine whether Andexxa is of clinical value for patients with spontaneous ICH.

Author: Yanqiu Shen, �Ǹ����

Abstract: 

Objectives: Heart failure remains a significant health burden, affecting over 6 million people in the United States. While current FDA-approved drugs provide only short-term benefits by enhancing cardiac contractility, they ultimately worsen heart failure symptoms over time. This underscores the urgent need for safer and more effective small-molecule therapies to enhance myocardial performance. Given that cardiac-type myosin binding protein C (cMyBP-C) is a critical modulator of heart muscle function, it represents a promising novel target for treating myocardial diseases.
Methods: Previous studies utilizing a cMyBP-C null mouse model revealed cardiac hypertrophy, reduced systolic function, impaired contractility, and accelerated cross-bridge kinetics, accompanied by increased myosin ATPase activity. These findings indicate that cMyBP-C serves as a key regulatory protein controlling cardiac muscle function by acting as a brake on myosin ATPase activity. To develop new therapeutics, we aim to refine and miniaturize an ex vivo biochemical assay into a high-throughput format for identifying small molecules that target cMyBP-C and regulate myocardial ATPase activity in isolated cardiac myofibrils.
Results: The study will outline the general workflow of the novel high-throughput screening assay, present representative ATPase activity data, and provide dose-response curves for well-characterized sarcomeric contractile modulators. The anticipated results include establishing a robust, sensitive, and reproducible screening assay capable of detecting changes in ATPase activity in response to small molecules targeting cMyBP-C.
Discussion: The ATPase rate measurements will validate the assay’s performance, demonstrating a reliable platform with well-defined control signals for identifying sarcomere-targeted proteins, including cMyBP-C. By enabling the discovery of novel small-molecule modulators, this approach has the potential to advance heart failure treatment by improving myocardial contractility in a safer and more effective manner.