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CONFERENCE ABSTRACTS AND REPORTS
Year : 2022 | Volume
: 8
| Issue : 3 | Page : 151-188
The 2022 St. Luke's University health network annual research symposium: Event highlights and scientific abstracts
Allincia Michaud1, Anna Ng-Pellegrino2, Rachel Birk1, Stanislaw P Stawicki1
1 Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
2 Department of Anesthesiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
Correspondence Address:
Dr. Anna Ng-Pellegrino
Department of Research and Innovation, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015
USA
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijam.ijam_87_22
The annual St. Luke's University Health Network (SLUHN) Research Symposium was established in 1992 to highlight the various research and quality improvement projects completed by residents, fellows, and other trainees within the network. It allows trainees to discuss and reflect on current healthcare issues, hone their research skills and receive valuable feedback. The event is organized by a multi-departmental planning committee, with collaboration and consultation provided by Graduate Medical Education (GME) leadership, medical school leadership, as well as residency and fellowship faculty. Residents, fellows, and students submit their application either for the podium (8-min) or quick shot (5-min) presentation along with an accompanying abstract describing their project or case report.
This year's event featured one of the largest numbers of podium and quick-shot presentations in SLUHN's 30-year Research Symposium history. Several of the research projects presented during this year's symposium were published in journals of their respective fields. Before the event, each submitted project was assessed by at least two independent academics who judged its' overall scientific quality (60% of the score). This was followed by a live audience vote for the best presentation (40% of the score). Based on the above methodology, prizes were presented to the top three podium presenters and the best quick-shot presenter. Since 2018, students from the Temple/St. Luke's Medical School were invited to participate in the Research Symposium, where they competed for the scientific competition prize of “Best Presentation by a Medical Student.” Several of the research projects presented during the symposium were published in journals of their respective fields.
The 2022 Research Symposium winners were as follows:
Podium presentationsFirst place – Dr. John Hayes – Family Medicine Residency, St. Luke' Richard A. Anderson Campus, Easton “”Farmacy”: Food as Medicine for Chronic Diseases”Second place – Dr. Daniel Franey – General Surgery Residency, University Hospital Campus, Bethlehem: Innovation or Tried and True? Retrospective Cost Analysis of Robotic and Laparoscopic Paraesophageal Hernia Repair Third place – Dr. Timothy Daly – Internal Medicine Residency, University Hospital Campus, Bethlehem: Premorbid Echocardiography and Risk of Severe COVID-19Quick shot presentationFirst place - Steven Tessier – Lewis Katz School of Medicine (LKSOM): A Novel Mutation Causing Prolidase Deficiency: Genetic Testing as the Candle in the DarkMedical student presentationFirst place – Katherine Peake- Lewis Katz School of Medicine (LKSOM): Effects of the COVID-19 Pandemic on Depressive Symptoms in AdolescentsAs in the previous 6 years, the 2022 Research Symposium included a Keynote Speaker. This year's invitee is Dr. Lisa Moreno-Walton, MD, MS, MSCR, FAAEM, FACEP. Dr. Moreno-Walton is the Associate Dean of Diversity and Inclusion and a Tenured Professor of Emergency Medicine at the Brody School of Medicine of East Carolina University, Greenville, NC. The Keynote presentation discussed disparities in research and the associated relationships to healthcare outcomes. During her presentation, Dr. Moreno-Walton discussed key historical aspects of medical research, both in the United States and around the world. She then highlighted the need for greater diversification, equity, and inclusion, based on statistical data on who conducts research, on whom the research is conducted, and how this affects response to therapy — examining whether equitable treatment (and thus access to research opportunities) is available to all patients and how these factors may affect outcomes at both individual and societal levels. Keynote Address concluded the morning session of the Research Symposium.
The afternoon session of the event included presentations from various departments that directly and indirectly support research and scholarly activity at SLUHN. This highly informative session featured content from the following areas: Clinical Trials, the Institutional Review Board, Graduate Medical Education Data Management and Outcomes Assessment, Temple/St. Luke's Medical School, Information Technology (IT)/St. Luke's Technology Ventures, Knowledge Management, Nursing/Evidence-Based Practice, Physical Therapy, Quality and Safety, Narrative Medicine, as well as several other specialties, departments, and topics. The 2022 Research Symposium took place on a virtual platform, in accordance with established Network / hospital guidelines applicable to the ongoing COVID-19 pandemic. The event was among the most highly attended virtual meetings at SLUHN this year.
This document contains a total of 13 original research / podium presentation abstracts as well as 15 case or case series presentations. Abstracts published and/or presented at other fora were not included herein. In addition, primary authors' consent was required prior to inclusion of Research Symposium abstracts in this published collection.
The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, Patient care and procedural skills, Professionalism, and Systems-based practice.
G. Herbst1, P. Kaur2, H. Levin2,3, S. Makary2,3, D. Nunez2,3
1Temple Lewis Katz School of Medicine, Philadelphia, PA, USA; Departments of 2Graduate Medical Education, St. Luke's Richard A. Anderson Campus, Easton, 3Psychiatry Department University Hospital Campus, Bethlehem, PA, USA
Introduction: Mental illness is a pervasive issue in America, afflicting nearly 20% of U.S. adults. In serious mental illness (SMI) cases, the functional impairments of the disease warrant intensive treatment programs. One such program is the partial hospitalization program (PHP), in which patients attend outpatient group therapy for approximately 30 hours per week for an average of 10 treatment days. Depression, on its own and co-morbidly, is one of the most common reasons patients present to a PHP. Depression is a mood disorder characterized by feelings of persistent sadness, loss of interest in one's normal activities, fatigue, and changes in appetite.[3] Depression is often treated with psychotherapy and/or medication; however, the efficacy of these treatments is often variable, substantiating the need for alternative/additional therapies.[4] Due to the COVID-19 pandemic, mental health programs such as St. Luke's PHP had to adapt to the safety needs of our patient population and initiated a virtual option for patients. Research comparing the efficacy of virtual vs in-person therapy has been mixed. Some data point to online therapy as a means of providing easier access to treatment than in-person therapy, thus increasing patient adherence and satisfaction,[1],[5] while other data show online therapy to be less efficacious than in-person therapy due to issues with emotional connectivity between therapist and patient.[2],[5] The primary aim of our study was to compare the depression and quality of life scores of patients who attended therapy at the online St. Luke's PHP campus to those who attended therapy at the in-person St. Luke's PHP campus. Journaling is an intervention that has shown some promise as an adjunct to therapy for a variety of mental health disorders.[7] Our secondary aim was to compare the depression and quality of life scores between those who engaged in journaling over the course of their PHP treatment and those who did not.
Methods: Patients undergoing PHP at St. Luke's from June 2021- August 2021 were included in the study. St. Luke's has 2 PHP campuses, the Bowmanstown campus (group 1) and the Sacred Heart Campus (group 2). Both sites conduct similar treatment protocols; however, patients enrolled at Bowmanstown meet virtually for their treatment, while those at Sacred Heart meet in person. Inclusion criteria were being at least 18 yrs. and fluent and literate in English. Exclusion criteria were having a primary psychotic disorder- schizophrenia/schizoaffective disorder/psychotic disorder NOS. All participants in the study were asked to engage in pre, post, and 1-month follow-up survey evaluations. The outcomes measured were severity of depressive symptoms using the PHQ-9*, quality of life (QoL) measure using a single-item visual analogue scale (0–100), journaling frequency, as well as engagement in health behaviors as measured by the survey. * A PHQ-9 score of 0-4 points equals “normal” or minimal depression. Scoring between 5-9 points indicates mild depression, 10-14 points moderate depression, 15-19 points moderately severe depression, and 20 or more points severe depression.
Results: We used SPSS version 28 to analyze the data (Armonk, NY: IBM Corp.). Since continuous variables like PHQ-9 and QOL had a skewed distribution, we ran a non-parametric test. Due to multiple comparisons, Bonferroni corrections were used in interpreting the p-values. A p-value of <0.006 was considered statistically significant. 49 patients underwent PHP. Virtual group (N=24) had median age of 39.5 years (min=20, max=85) with 75% females while in-person group (n=25) was 34 years (min=19, max= 70) with 72% females. 17 patients journaled in virtual groups, while 13 patients journaled in the in-person group. When analyzing both PHP campuses together, PHQ-9 scores decreased by 5 points (p=.006), and QoL increased by 8 points (p=.003). However, when analyzing the outcomes for the 2 campuses separately, in-person therapy outperformed virtual therapy. The median PHQ-9 for the in-person group decreased from 16 (2-23) before therapy to 5.50 (0-14), while in the virtual group, the median PHQ-9 was 18 (3-27) before therapy and decreased to 14 (2-27) [Figure 1]. QOL scores improved for the in-person group from 40 (2-87) to 73.50 (50-100) (p=0.004), but no improvement in QOL was seen in the virtual group [Figure 2]. Changes in exercise and sleep for either group were not statistically significant [Table 1]. There were 13 patients who did journaling at the start of the study and did at least half of the days during the program. No statistical improvement was seen for QoL or PHQ-9 in journalers [Table 2].
Conclusion: Previous research suggests that online therapy can be less efficacious than in-person therapy for a variety of reasons,[2],[5],[6] which we found to be the case at St. Luke's PHP. However, online therapy has been successful for many populations.[7],[8] and is often more accessible than in-person therapy.[1] Future studies could investigate ways to enhance online therapy, including education about online therapy for patients [2] and reserving online therapy for older and more experienced therapists, who tend to be less affected by the drawbacks of online therapy.[6] Though journaling was not correlated with enhanced outcomes in PHP, many reported that they found it helpful, a trend also found in the literature.[9] Future studies could investigate what aspects of journaling the participants found helpful and use that information to design a directed journaling intervention. Additional studies could look for ways to enhance survey delivery, as we had a low response rate after one month.
Keywords: Depression, in-person therapy, partial hospitalization program, virtual therapy
J. Hafycz, K. Morley1, S. Melanson, H. Stankewicz
Emergency Medicine Department, St. Luke's University Hospital Campus, 1Department of Graduate Medical Education, St. Luke's University Hospital Campus, Bethlehem, PA, USA
Introduction: Wellness of physicians continues to be a major focus for administrators and residency programs. Even with the advances of the ACGME (Accreditation Council for Graduate Medical Education) in terms of duty hours and other improvements, the demands of residency programs are well known. Residency affects the emotional and physical well-being of junior physicians. Shift work, in particular, results in many negative health effects, poorer sleep quality, and quantity. The goal of this study was to gather data by shift on how much emergency medicine residents sleep and compare it to how much they believe they are sleeping.
Methods: This was an IRB-approved, prospective, observational study in which Emergency Medicine (EM) residents had sleep characteristics (sleep time, light, deep, and REM sleep) recorded by a Fitbit™ Charge 3 device (FBD Fitbit/Google LLC, San Francisco, California, USA). Thirty-three EM residents consented and had their sleep data sent to a secure database, Fitabase ©. While wearing the FBDs, residents were instructed to fill out a sleep diary recording their sleep and other information. Data was recorded from December 2019 to May 2020 for six months total, although some residents opted out of the study early due to the Covid-19 pandemic. Emergency Department shifts were 8-10 hours long and coded as either day (starting between 6a-10a), evening (starting between 11a-4p), night shift (starting between 9p-12a), post-night (day after night shift), or off. T tests were used to compare the sleep recorded by Fitbit and by residents in sleep journals.
Results: There were statistically significant differences between sleep times in every shift between resident recorded sleep and FBD recorded sleep. There was less sleep recorded on FBDs (M=465), than sleep journals (M=408) for shifts off t (1669) =11.42 p=1.98*10^-29. Likewise, this was similar for post-nights (t (149) =2.06, p=0.02), day (t (570) =3.63, p=0.00016), evening (t (1178) =11.32, p=1.44*10^-28), and night shifts (385) =7.46, p=2.84*10^-13 [Figure 1]. Night shifts also resulted in statistically significant lowest amount of sleep recorded for both the sleep journals and FBDs.
Conclusion: Fitbit devices show that residents sleep significantly less than they believe they are sleeping for all shifts. This difference is roughly an hour less sleep. Thus, residents and residency programs need to be aware of this sleep deficit, specifically in evening and night shifts. As sleep quality and quantity are linked to the development of both emotional and physical diseases, it is important for residency programs to support its residents in improving their sleep patterns. Emergency medicine physicians need to do a better job of protecting their night shift workers. Advancements in wellness could lower burnout rates and ultimately lengthen the careers of emergency physicians.
Keywords: Emergency medicine, Fitbit device, residents, shift, sleep
A. Yamada2, N. Zambas1, H. Nwazuruokeh2, K. Kumar1, A. Remde1
1Family Medicine Department, St. Luke's Hospital, Warren Campus, 2Family Medicine Department St. Luke's University Hospital, Bethlehem, PA, USA
Introduction: Physician burnout is a significant problem within the community of family physicians, with burnout rates as high as 46%. One of the most common sources of stressors in an outpatient clinic setting is finishing/catching up with work from job at home, documenting patients into the electronic health record (EHR), completing nonclinical activities, and completing external regulatory requirements while staying current on medical knowledge. Studies have shown that family physicians spend on average 86 minutes doing administrative work after hours or at home. Clerical and administrative tasks such as documentation, order entry, billing and coding, and system security accounted for 44% of the total EHR usage time. Physician wellness will not only benefit the individual physician, but it will also be vital to the delivery of high-quality health care. Among things to consider when considering emotional exhaustion and sense of fulfillment include work stress related to administrative tasks, the mean number of healthy habits, and resiliency. Organizational interventions, as well as individual changes, are needed to address the well-being of family physicians. The COVID-19 pandemic has brought upon additional new challenges that have strained primary care practices, with the need to rapidly adapt telehealth visits to account for reduced in-patient visits, as well as physicians and other health care personnel possibly leaving the practice threatening the sustainability of one's practice. The emotional, financial, and physical health burdens by volatile COVID-19 surges have led to worsening physician burnout. This study's goal is to answer the question: are residents feeling fulfilled at St Luke's Warren amongst COVID-19 pandemic? We will calculate the means of results per PGY class for every question and compare results per class.
Methods: This study uses a validated fulfillment survey with 3 sections and 16 questions that uses a Likert scale, asking participating residents to grade their response to questions concerning fulfillment, burnout, and the impact of COVID-19 on their emotional well-being [Table 1]. The research was performed 2 separate times, three (3) months apart, to compare the changes or stability in the responses over time. The Kruskal Wallis test was used to determine any statistical significance between any differences in response among the 3 different PGY classes.
Results: Overall, the graded responses to the questions showed no significant changes amongst the classes except for this question in the initial survey: I feel happy at work (The mean value for each class for this response were as follows: 2.38 (somewhat true) for PGY1;3.5 (very true) for PGY2; & 2.5 (somewhat-moderately true) for PGY3). The average response to the fulfillment questions were leaning towards fulfilling with a score >2.5. However, the average response to the first 4 out of 9 questions leans toward burnout with a score >2.5. The 3rd section related to COVID-19 questions remained relatively stable between the 2 surveys except for the response to how the COVID-19 pandemic has affected their survey responses, which has gone from a mean score of 2.25 (Somewhat true) to 2.13 (not at all true-somewhat true). Mean score to the question, “less connected with my colleagues,” residents scored a mean value of 1.94 (somewhat true) initially and then 2.44 (median response is still “under somewhat true”) on the subsequent survey.
Conclusion: Burnout is a pervasive problem in the medical profession, and its effect has been felt as early in one's professional life as in residency training. According to the response to the survey by St Luke's Warren Family residency program, residents, on average, have endorsed symptoms of burnout but have sustained a level of empathy towards fellow patients and co-workers as well as a sense of fulfillment. The average resident reports being less affected by COVID-19 in the 2nd survey, which may reflect the specific pandemic situation at the time. Future considerations include incorporating an intervention to help lessen burnout and assess how residents' response to the survey changes before and after the intervention. Such interventions may include a protected half-day admin time to acknowledge the additional administrative tasks demanded by residents outside of clinic visits involving patient care. A cohort study following the responses of upcoming interns from orientation may be informative.
Keywords: Burnout, COVID-19, family, residency
Abstract Number 4: Exploration of Relationship between Adverse Childhood Experiences and Hospital AdmissionsS. Ha1, K. Kumar2, A. Remde1, K. Viotto1, B. Susskind1
1Family Medicine Department, St. Luke's Hospital, Warren Campus, St. Luke's University Hospital, Bethlehem, PA, USA; 2Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
Introduction: Adverse childhood experiences have been known to contribute to both short and long-term chronic health problems, including mental illness and substance abuse in adulthood. In 1998, a groundbreaking study by Dr. Felitti et al. exposed the relationship between how childhood abuse and household dysfunction are related leading causes of death in adults.[1] From this study, the Adverse Childhood Experiences (ACE) questionnaire was created to collect information on child abuse and neglect, household challenges, and other socio-behavioral factors. It is estimated that approximately 61 % of adults (surveyed across 25 states) reported that they experienced at least one type of adverse childhood experience, with one out of six of those individuals reporting that they had experienced more than four types.[2] A high ACE Score has also been associated with increased social and economic costs for the individual, which can further complicate their health and may lead to increased clinical care costs. Hospital readmission continues to be a daunting problem at St. Luke's Warren Hospital. In this study, we aim to explore the relationship between a patient's ACE Score, a patient's chronic illnesses (calculated by their frequency of hospital admissions), and a patient's HOSPITAL Readmissions Score. It is our hypothesis that we will see a direct correlation between a patient's ACE Score, HOSPITAL Readmission Score, and the number of times they are admitted to St. Luke's Warren Hospital. It is our hope that we can identify the patients in need of targeted medical care and provide them with the right resources to help reduce their hospital readmission rates as well as clinical costs.
Methods: Adults who consent to be part of the study will be asked to fill out the ACE questionnaire, from which their ACE Score will be calculated. Then, at their discharge, their HOSPITAL Readmission Score will be calculated, and the number of times they have visited the ER in the past year will also be recorded. We will determine if there is a correlation between the subject's ACE Score and their HOSPITAL Readmission Score.
Results: There was no correlation between ACE score and HOSPITAL Score in this study [Figure 1].
Conclusion: This study did not find a correlation between patients' ACE scores and admission rates. There were many areas of this study that can be changed and improved. First, the sample size was too small for a complete data analysis. Many barriers inhibited admitted patients from filling out the ACE survey during their admission. The most significant barrier was patients' unwillingness to take the survey because of the acuity of their illnesses or discharges. It would be our suggestion to a new research group to have the survey filled out during a patient's follow-up Transition of Care Management visit at the Coventry Family Practice outpatient clinic. We believe patients may be more willing to participate when they are out of the hospital.
Keywords: Adverse, chronic, Hospital, Illness, readmission
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) study. Am J Prev Med 1998;14:245-58.Center for Disease Control and Prevention (CDC). Adverse Childhood Experience 2022. Available from: https://www.cdc.gov/violenceprevention/aces.Accessed 1 May. 2022
J. Pisan1, J. Ritchie1, I. Zighelboim1, N. Taylor1, A. Graul1
1Obstetrics and Gynecology Department St. Luke's University Hospital Campus, Gynecology Oncology Physicians Group, University Hospital Campus, Bethlehem, PA, USA
Introduction: Insurance status can reflect social determinants of health, such as income, education level, occupation, or access to care. Patients without insurance or who are underinsured have been shown to be less likely to have regular care, use prescriptions, and have all medical needs met. In gynecological malignancies, insurance status has previously been suggested to have a correlation with morbidity, mortality, treatment, and clinical outcomes. Gynecologic oncologists operate on patients with known gynecological malignancy but also on patients with concern for malignancy or a surgicallycomplex or difficult case. In 2016, 4.3% of Pennsylvania patients were uninsured, and 34% had public insurance (Medicare or Medicaid). Insurance status can be a proxy for social determinants of health and has been shown to correlate with poorer postoperative and oncologic outcomes. We sought to evaluate the relationship between insurance status and clinical outcomes among patients undergoing minimally invasive hysterectomy (MIS-H) by gynecologic oncologists at a single institution.
Methods: We conducted an IRB-approved retrospective chart review of patients who underwent MIS-H by a gynecologic oncologist for benign or malignant pathology from January 2015 to December 2017. Insurance status (private or public), demographics, co-morbidity information, surgical outcomes and 3-year overall survival (OS) were collected and analyzed. Non-parametric tests and multivariate logistic regression were used to evaluate associations.
Results: MIS-H was performed in 202 women, with 125 (61.9%) having private insurance and 77 (38.1%) having only public insurance (Medicare, Medicaid, or self-pay). Demographic characteristics are summarized in [Table 1]. Publicly insured patients were older (median 67 vs. 52, p=<0.001), predominantly menopausal (79.2% vs. 45.6%, p=<0.001), multiparous (3.9% nulliparous vs 17.7%, p=0.004), less likely to be White (85.7% vs 93.6%, p=0.009), and less likely to be married (46.8% vs 71.0%, p<0.001). Publicly insured patients also had significantly more comorbidities. They were more likely to have diabetes (32.5% vs. 14.4%, p=0.004), COPD or asthma (19.5% vs. 8.8%, p=0.032), hypertension (72.7% vs. 38.2%, p=<0.001), hyperlipidemia (64.9% vs. 25.0%, p=<0.001), and coronary artery disease (11.7% vs. 2.4%, p=0.011). Surgical pathology was more likely to be benign in privately insured patients (57.3% vs. 36.4%, p=0.006). Peri-operative outcomes were evaluated with no significant difference in intraoperative complications (p=0.19), readmissions (p=0.81), or subsequent surgeries related to the initial operation (including hernia surgeries or other elective procedures) (private 14.4%, public 5.2%, p=0.061). On univariate analysis of oncologic patients only (n=104), privately insured patients had significantly more future operations (22% private vs. 6% public, p=0.027). Further, among those with an oncologic diagnosis, there was no difference in OS (p=0.30).
Conclusion: Publicly insured patients, as expected, were older and had increased comorbidities. Despite this, readmission rates, operative times, and complications were not significantly different between populations. After controlling for confounders, insurance status was noted to be independently associated with subsequent surgical intervention, more frequent among the publicly insured. Further research may explore the possible differences that lead to increased reoperations among these patients.
Keywords: Gynecological malignancies, insurance, outcome
Abstract Number 6: The Montreal Cognitive Assessment and the NeuroTrax Test in Cognitive ImpairmentK. Nguyen1, R. Anmolsingh1, P. Pham1, E. Coyne1, A. Mandalapu1, P. Kaur2
Departments of 1Internal Medicine and 2Graduate Medical Education, St. Luke's Richard A. Anderson Campus, Easton, PA, USA
Introduction: Cognitive impairment is a common concern for older patients and their families. Furthermore, the population of older adults continues to rise. In 2019 there were an estimated 54.1 million US adults above the age of 65, which represents 16% of the total population. This number is expected to rise to 94.7 million in 2060, making up 25% of the US population.[1] Clinicians will be increasingly tasked to identify and assess cognitive symptoms. The initial evaluation for cognitive symptoms is aided by history, examination and several screening tools. The Montreal Cognitive Assessment (MoCA) is a widely validated screening tool used for mild cognitive impairment (MCI).[2] The MoCA test has a total of 30 points and assesses multiple cognitive domains, including short-term memory, visuospatial ability, executive function, attention/concentration, language and orientation to time and place. A score of 26 or above is considered normal while scores below 26 indicate varying levels of cognitive dysfunction.[3] The NeuroTrax (NT) system is a computerized series of tests used for the detection of cognitive impairment. A Global Score (GS) is computed as a weighted average of every cognitive domain index and summary scores with a score of 100 or greater (out of 130) being considered the norm. The purpose of this project was to analyze the relationship between the MoCA and the NT score equivalency.
Methods: Patients referred to St. Luke's Senior Care Associates for memory concerns were recruited to undergo a comprehensive geriatric assessment. Testing included both the Montreal Cognitive Assessment (MoCA) and the NT computerized cognitive assessment system. IBM SPSS version 26 was used to analyze data. Continuous variables were presented as mean +// standard deviation (SD) and median, P25 and P75 were also calculated.
Results: There was a total of 176 patients, with a median age of 78 (SD 7.7) years and 63.1% females. MoCA scores were significantly correlated with age (r = -0.14, p = 0.05) and educational years (r = 0.29, p <0.001) in the whole sample. NT Global Cognitive Score (GCS) did not show any correlation with age (p = 0.6), however it did show significant correlation with educational years (r = 0.23, p = 0.002). There was also a significant difference between gender in the scores (91.6 SD 10.5 versus 88.2 SD 9.9 p-value 0.04). The NT GCS had an area under the curve (AUC) of 0.816, p=0.05 when using MoCA as a gold standard [Figure 1].
Conclusion: When using the well-established MoCA as a gold standard screening test, NT was good for discrimination between normal cognition and MCI with an AUC of 0.816. NeuroTrax is a reliable diagnostic measure for neurocognitive assessments. However, no single test has high discriminatory ability and the pattern of performance in various domains must be interpreted in conjunction with the history, neuroimaging studies, and other testing to make a diagnosis. Participants attending a single center have caused a spectrum bias which may reduce the external validity.
Keywords: Cognitive screening, Montreal cognitive assessment, NeuroTrax
Promoting Health for Older Adults. Centers for Disease Control and Prevention. 6 June 2022. Available from: www.cdc.gov/chronicdisease/resources/publications/factsheets/promoting-health-for-older-adults.htm. Accessed 6 June 2022Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695-9.McLennan SN, Mathias JL, Brennan LC, Stewart S. Validity of the montreal cognitive assessment (MoCA) as a screening test for Mild Cognitive Impairment (MCI) in a cardiovascular population. J Geriatr Psychiatry Neurol 2011;24:33-8. Abstract Number 7: Effects of the COVID-19 Pandemic on Depressive Symptoms in Adolescents K. Peake1, D. Jacobetz2, J. Lee-Park2, P. Kaur3, H. Levin1, D. Wong1, R. Bates1
1Temple Lewis Katz School of Medicine, Philadelphia, 2Department of Pediatrics, St. Luke's University Health Network, Bethlehem, Departments of 3Graduate Medical Education, St. Luke's Richard A. Anderson Campus, Easton, PA, USA
Introduction: At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the Center for Disease Control and Prevention (CDC) mandated that the American population develop measures to control the effects of the virus. This included social distancing, quarantine, lockdown restrictions, and wearing face masks to avoid human-to-human transmission. Thus, adolescents solely interact with their peers, teachers, and others through a virtual world. According to the American Academy of Pediatrics and the Children's Hospital Association, in the United States (U.S.) children currently represent approximately 16% of all COVID-19 cases. Although COVID-19 has had physical impacts on the adolescent population, the precautions and guidelines used to control the recent pandemic have also fostered a psychological impact as well. Over the first academic year of the pandemic, essentially all schools closed. Learning was either interrupted, or the predominant modality of learning became virtual. From March 2020-June 2020, significant emphasis was placed on social distancing, quarantining, and minimizing social relationships with people outside the home. During the second academic year of the pandemic, September 2020-June 2021, most schools utilized a hybrid learning format. This format included a mix of in-person and virtual learning but continued to have strict social isolation protocols and limited extracurricular activities. During the third academic year of the pandemic, September 2021-present day, schools have returned to fully in-person learning, with many students falling behind academically due to difficulties learning in virtual format. Within the third academic year, restrictions on extracurricular activities were lifted, but this was dependent on the community, as well as reported COVID-19 case levels. Additionally, most schools continued to require masks for most of the current academic year and had significant social distancing guidelines.
Although adolescents who have tested positive for COVID-19 are more often asymptomatic, their age predisposes them to be a more impressionable and vulnerable population. This, in turn, may allow the fear of contracting COVID-19 to have a larger negative impact on the mental health of adolescents than that of older populations. Major depressive disorder (depression) was reported among the mental health outcomes in adolescents throughout the pandemic. Thus, it is pertinent to continue examining adolescents' mental health over the course of COVID-19 in hopes of providing prompt, robust relief and better preparedness for future pandemics that may lead to similar social isolation in the future. The primary aim of the current study is to investigate the psychological impact over different periods during the pandemic of depressive symptoms in adolescents.
Methods: The authors implemented a retrospective chart review to determine the effect of different time periods over the course of the pandemic on depressive symptoms in adolescents. The Patient Health Questionnaire adapted for Adolescents (PHQ-A) scores were the primary method of measuring depressive symptoms in adolescents. A score of greater than 10 was indicative of a positive depression screening. The time periods were defined as the following: 1st Surge (March 2020-August 2020), 2nd Surge (September 2020-August 2021), and 3rd Surge (September 2021-March 2022). The sample adolescent population, 11-17 years, was taken from St. Luke's University Health Network (SLUHN) pediatric population in primary care and specialty care settings. The authors utilized the SlicerDicer application within the Epic Electronic Medical Record system to examine the adolescent population within the SLUHN system that met the criteria of having a PHQ-A completed over the period of the study. The authors examined the COVID-19 infection status of the patient population as well as associated demographic factors to look for trends in the data. PHQ-A scores were the primary way of measuring depression in adolescence. The authors described results for four cohorts of adolescent patients: PHQ+/COVID+, PHQ+/COVID-, PHQ-/COVID+, and PHQ-/COVID-.The retrospective chart review obtained age, gender, and PHQ-A scores over the course of the pandemic. All data were collected in a HIPAA-protected data collection software app.
Results: A total of 3043 adolescents were screened for depression using PHQ-A from July 2019 to March 2022. 58% of these were females. There was an overall increase in PHQ-A screening in all patient groups; PHQ+/COVID+, PHQ+/COVID-, PHQ-/COVID+, PHQ-/COVID- during this time [Figure 1]. The authors compared monthly pre-pandemic PHQ+ prevalence of depression with post-pandemic and saw an upward trend during post-pandemic surges. There was a significant upward trend in PHQ-positive scores in the second and third surges of the pandemic [Figure 2]. The authors used SPSS version 28 to see the distribution of depression among Covid positive and negative adolescents during COVID-19 surges starting from March 2020 to March 2022. Due to multiple comparisons, Bonferroni corrections were used in interpreting the p-values. A p-value of <0.01 was considered statistically significant after Bonferroni correction. The authors did not see any statistical difference in the distribution of depression among COVID-19 positive and negative adolescents when all surges were collectively analyzed. The authors also compared gender differences in the distribution of depression during this time and saw a significant difference between males and females as well as a significant difference between surges [Table 1].
Conclusion: This study provides empirical data on depressive symptoms in adolescents between the ages of 11 and 17 throughout the different stages of the COVID-19 pandemic. The current study demonstrates that there was an increase in PHQ-A assessments over the course of the COVID-19 pandemic and an increase in positive PHQ-A assessments. Females were more likely to experience depressive symptoms. The increase in depressive symptoms, regardless of SARS-CoV-2 infection status, is hypothesized to be due to the social toll of the COVID-19 pandemic. This included social distancing, mask wearing, quarantine, and lockdown that may have increased the burden of the pandemic on adolescents by causing fear of infection, an uncertain timetable, family conflict, isolation, and disruption of daily routines. It is vital that primary care providers recognize the increased burden of depressive disorders that arise from the COVID-19 pandemic in this vulnerable population.
Keywords: Adolescent, COVID-19, depression, PHQ-9
B. Ciccarelli, V. Balakrishnan, H. Stankewicz, A. Reiss
Emergency Medicine Department, St. Luke's Hospital, Miners Campus, Coaldale, PA, USA
Introduction: Ultrasound-guided intravenous line placement is often used in the emergency department for venous access in patients whose veins are difficult to cannulate by traditional methods. This study aims to evaluate the performance of various interventions in augmenting venous cross-sectional areas using ultrasound imaging.
Methods: This is a prospective, single-emergency department study involving 41 volunteers. Each had their basilic vein identified on ultrasound with no intervention, and measurements of the area proximal to its branching point at the antecubital fossa were taken with the arm positioned parallel to the floor and approximately 30-60 degrees below the level of the bed. These two positions were repeated with the following interventions: one rubber tourniquet applied approximately 5 cm proximal to vein measurement, an additional rubber tourniquet applied 5 cm proximal to first tourniquet, blood pressure cuff inflated to between 160 to 200 mmHg, CAT tourniquet application, and soaked warm towel applied to brachium for up to one minute.
Results: All interventions were statistically significant in increasing venous cross-sectional area as compared to no intervention, with the most significant being CAT tourniquet (p < 0.001, mean change +7.32 mm2, 95% CI +5.73 to + 8.91 mm2). The addition of change in position of the arm was not statistically significant for any intervention except for the CAT tourniquet (p = 0.0056, mean change -1.74 mm2, 95% CI –0.54 to – mm2). Notably, there was no significant difference between the application of two tourniquets and the blood pressure cuff (p = 0.496, mean change +0.58 mm2, 95% CI –1.13 to +2.29 mm2), but there was a significant increase in cross-sectional area with CAT tourniquet use compared to blood pressure cuff (p = 0.018, mean change +1.62 mm2, 95% CI +0.29 to +2.95 mm2). Lastly, two tourniquets significantly increased cross-sectional area compared to one tourniquet (p < 0.001, mean change +2.20 mm2, 95% CI +1.14 to +3.26 mm2). The primary outcome of this study was an increase in venous cross-sectional area from baseline measurement.
Conclusion: This study identified several potential interventions for maximizing venous cross-sectional area on ultrasound. All the tested interventions resulted in a statistically significant increase in cross-sectional area. The addition of arm positioning did not show significant changes in most interventions except the CAT tourniquet. The devices used in this study are readily accessible in most emergency departments, allowing the results to be broadly applicable to practicing emergency physicians. Further study should be conducted to assess how these interventions affect overall success when used in ultrasound-guided intravenous line placement.
Keywords: Emergency department, tourniquet, venous
Abstract Number 9: The Effect of COVID-19 on Pregnant Patients at SLUHNA. Ohnona1, K. Glassburn1, M. Martinez-Baladejo2, A. Pellegrino3
1Obstetrics and Gynecology Department, St. Luke's University Hospital, Departments of 2Research and Innovation and 3Anesthesiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
Introduction: Since the pandemic started over two years ago, COVID-19 has been shown to impact individuals who are already at high risk for respiratory, cardiac, and thromboembolic conditions. The parturient population is no exception. Recent studies published around the world at the end of 2020 have consistently identified an association between COVID-19 and preterm labor. In the US, the preterm labor incidence is around 10-15% with a COVID-19 diagnosis. In addition, the pregnant state may have a higher risk of needing mechanical ventilation, ICU admission, extracorporeal membrane oxygenation (ECMO) use, and death than the non-parturient state.[1],[2],[3] As vaccines were created and rolled out near the end of 2020, parturients were also left to decide whether inoculation was appropriate.[4] Additionally, the effects of COVID-19 on the babies of mothers who were infected during pregnancy are still unknown and warrant further analysis.
Methods: After IRB approval, we conducted a retrospective chart review from Jan 2020-Dec 2020 on parturients and their newborns from Allentown and Anderson Campuses. We reviewed 100 patients diagnosed with COVID 19 during their pregnancy and 100 patients who did not have COVID-19 while pregnant. In addition, we reviewed growth data on the newborns of both study groups. The groups were matched based on demographics, peripartum diagnoses, and comorbidities. Our primary outcome determined 1) Cesarean section rate and pre-eclampsia. Secondary outcomes include 1) newborn growth measures and 2) placental outcomes.
Results: The cesarean section rate was found to be 38% for COVID-19 patients, compared with 22% for non-COVID-19 patients. Cesarean section rates are known to vary widely due to the array of reasons to perform one; however, we found that 11% of COVID-19 patients required a cesarean section due to category II tracing, compared to 8% for non-COVID-19 patients. A major difference between both groups is the prevalence of pre-eclampsia, with COVID-19 patients being affected at a rate of 17% compared to 7% with non-COVID19 patients [Table 1]. The average birth length and weight for newborns exposed to COVID-19 during pregnancy were 19.56 and 3274, respectively. For the non-COVID19 group, the average birth length and weight were 19.55 and 3367, respectively. The placental complications in the non-COVID1-9 group were 39% compared to the COVID-19 group at 28%. Finally, only 3% of the COVID-19 babies needed positive pressure ventilation (PPV) compared to 5% in the non-COVID-19 group. The average age, BMI, and social status were unequivocal between the two groups. However, the mothers exposed to COVID-19 while pregnant were more likely to be Hispanics and with Spanish as their primary language [Table 2]. The COVID-19 mothers were more likely to acquire COVID-19 in the second trimester and be vaccinated against the disease [Table 3]. The COVID-19 mothers were also more likely to show mild symptoms of COVID-19 [Table 3].
Conclusion: COVID has been known to affect coagulation amongst patients, which can have a drastic impact on placental function. This could be an explanation as to why COVID patients had a more than two-time rate for preeclampsia. Similarly, this thought process helps explain why there could be fetal growth restriction in pregnancy as the placenta cannot function to its full ability. However, we did not find any evidence of fetal growth restriction as the standard growth metrics between the two groups were unequivocal. Furthermore, there were more placental complications in the non-COVI19 group compared to the COVID19 group. The array of placental complications in both groups is a subject of interest for future study. Lastly, the number of Hispanics and Spanish speakers in the COVID19 group was remarkably higher than in the non-COVID19 group. This correlated to the national metrics where we have seen that minority groups, and especially Hispanics, are at increased risk of exposure and infection.
Keywords: COVID-19, labor, pregnancy
ReferencesZambrano LD, Ellington S, Strid P, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(44):1641-1647.CDC. Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19-COVID-NET, 13 States, March 1-August 22, 2020. Morbidity and Mortality Weekly Report: Centers for Disease Control and Prevention; 2020.Karimi L, Makvandi S, Vahedian-Azimi A, Sathyapalan T, Sahebkar A. Effect of COVID-19 on Mortality of Pregnant and Postpartum Women: A Systematic Review and Meta-Analysis. J Pregnancy. 2021;2021:8870129Lokken EM, Huebner EM, Taylor GG, et al. Disease severity, pregnancy outcomes, and maternal deaths among pregnant patients with severe acute respiratory syndrome coronavirus 2 infection in Washington State. Am J Obstet Gynecol. 2021;225(1):77 e71-77 e14. Abstract Number 10: The Efficacy of Liposomal Bupivacaine in Regional Nerve Blocks for Below Knee Amputations: A Retrospective Case-Controlled Study A. Allsbrook, A. Pellegrino1, C. Tran2, A. Gotsch
General Surgery Department, St. Luke's University Hospital Campus, 1Department of Anesthesiology, St. Luke's University Health Network, 2Department of Analytics, Senior Clinical Analytics Analyst, St. Luke's University Hospital Campus, Bethlehem, PA, USA
Introduction: Postamputation pain is highly prevalent, with an incidence of up to 95%. The pathophysiology of amputation pain is multifactorial therefore, the emphasis on a multimodal pain regimen is essential. Opioids are utilized in the postoperative course; however, their side effect profile can prolong a patient's hospital stay. The field of regional anesthesia has grown in the past two decades to provide new techniques for amputations, such as adductor canal and popliteal nerve blocks, for pain control after surgery. In addition, liposomal bupivacaine (LB) was introduced to extend a nerve block from hours into days. Regional nerve blocks with liposomal bupivacaine for below-knee amputation procedures can potentially reduce opioid use after surgery.
Methods: A retrospective, case-controlled chart review was conducted for patients who had received liposomal bupivacaine in regi
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