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Item Social Determinants of Health and Their Effects on Readmission and 30-Day Readmission in Patients with a History of Cardiovascular Interventions(2025-04-25) Delos Reyes, Mark; Muvuka , Baraka; Guerrero , JonathanSocial Determinants of Health and Their Effects on Readmission and 30-Day Readmission in Patients with a History of Cardiovascular Interventions Mark Delos Reyes, Baraka Muvuka, Jonathan Guerrero Indiana University School of Medicine- Northwest (IUSM-NW) Background: 30-day readmission is a quality indicator impacting patients and healthcare systems. Medicare patients accounted for 2.3 million 30-day readmissions, costing $35.7 billion 4 years following the 2012 Hospital Readmission Reduction Program (HRRP) launch . Three of six HRRP measures are cardiovascular: myocardial infarction, Heart Failure, and Coronary Artery Bypass Graft Surgery. This study examined relationships between social determinants of health (SDOH), demographics, and behavioral factors on readmission and 30-day readmission among patients with a cardiovascular intervention history in partnership with an urban Northwest Indiana (NWI)-based health system. Methods: This retrospective study analyzed de-identified data from inpatient SDOH screenings in Epic using the Protocol for Responding to and Assessing Patients Assets, Risks and Experiences (PRAPARE) at 3 urban hospitals between January 2021 and April 2024. Data analysis included descriptive, bivariate (Chi-Square, Mann-Whitney U, Kruskal Wallis; p<0.05), and multivariate (binary logistic regression; p<0.05) analyses in SPSS 29.0. This study was exempted by the Indiana University Human Research Protection Program (IRB #14040). Results: The sample comprised 3717 patients, majority White (70.2%), publicly insured (87.4%), and older adults (73+17). Readmissions represented 43.5% of admissions, 19.8% being 30-day readmissions. Bivariate analysis revealed significant associations between readmission and age (p<0.001), ethnicity (p=0.001), race (p<0.001), sex (p<0.001), sexual orientation (p=0.007), insurance type (p<0.001), financial resource risk (<0.001), housing risk (p=0.05), smoking status (p=0.041), BMI (p<0.001), hospital (p<0.001), and comorbidities (p=0.027). Sex, insurance type, sexual orientation, BMI, and hospital were also associated with 30-day readmission. Multivariate analysis revealed significantly higher odds of readmission with prolonged hospital stay (OR=1.051; p<0.001), former smoking (OR=1.759; p=0.039), and patients at a small, lower SES-serving hospital (OR=1.473; p<0.001). Conclusions: Social-behavioral factors were associated with readmissions and 30-day readmissions among patients with a history of cardiovascular interventions. Integrating SDOH and behavioral screenings and interventions into hospital readmission reduction initiatives could strengthen these programs.Item Leveraging Advanced Cardiac POCUS in the Diagnosis of Infective Endocarditis with Negative Conventional Imaging: A Case Report(2025-04) Sanjuan, Adriano; Andrade, Heather; Bundy, Alyson; Clapham, Philip; Markus, Nathan; Brenner, Daniel; Hariri, Irina; Jackson, EdwinIntroduction. Infective endocarditis (IE) is a life-threatening condition that includes bacteremia and echocardiographic findings. However, many cases yield inconclusive results with transthoracic (TTE) or transesophageal echocardiography (TEE), creating diagnostic challenges. This report highlights the role of advanced cardiac point-of-care ultrasound (POCUS) in addressing these limitations, using daily POCUS exams to address these limitations. Case report. A 68-year-old male with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and recurrent fevers underwent multiple conventional TTEs and a TEE, that failed to detect valvular vegetations. Advanced cardiac POCUS, including parasternal long-axis (PLAX), parasternal short-axis (PSAX), right ventricular (RV) inflow/outflow, and apical four-chamber views, was performed daily at the bedside. The PLAX view enabled visualization of new onset of aortic regurgitation, and Color Doppler imaging was applied to assess the severity of the valve disfunction. A vegetation in the aortic valve was identified, later confirmed by a consultative TTE and TEE, leading to a change in management. Discussion. This case highlights the utility of advanced cardiac POCUS in diagnosing IE when conventional imaging is inconclusive. Advanced cardiac POCUS offers immediate, bedside diagnostic insights, making it a valuable tool for critically ill patients. Compared to basic cardiac POCUS, the advanced cardiac POCUS includes the RV inflow/outflow (that can be achieved through tilting or fanning of the probe), and use of color Doppler. A study by Hellmann et al. demonstrated that medical residents could achieve significant proficiency with color Doppler, with minimal formal training, aligning with our experience. Despite limitations such as operator dependency and patient characteristics, the integration of advanced cardiac POCUS into diagnostic workflows has the potential to improve diagnostic accuracy and outcomes. Additionally, the case emphasizes the need for advanced cardiac POCUS education among trainees, expanding their ability to address complex clinical scenarios.Item Know Before You Go: Evaluating the Utility of Pre-Departure Training for Internal Medicine Residents Prior to an International Elective(2025-04-25) Arias, Grace; Goble, Gretchen; Thornton, Corinne; Baenziger, JenniferA needs assessment at Indiana University revealed that a large majority of internal medicine residents desired formal pre-departure training for their international elective in Kenya. In response, a two-hour orientation covering cultural context and site-specific clinical cases was developed and led by residents with prior experience in Eldoret. Pre- and post-curriculum surveys showed that participants, 75% of whom had minimal to moderate prior LMIC experience, reported increased familiarity with clinical challenges, improved preparedness, and reduced anxiety.Item Point-of-Care Ultrasound and the Pediatric Patient-Family Experience: A Randomized Control Study(2025-04-25) Gutierrez, Samuel; Pamela, Soriano; Matthew , Hays; Benjamin , NtiBackground: Existing literature indicates that patients respond positively to point-of-care ultrasound (POCUS) across various clinical settings. However, limited research explores how patient families perceive its use in pediatric emergency department (ED) care. Our study aims to evaluate POCUS’s impact on patient experience, stress, and anxiety in the pediatric ED. Methods: We conducted a randomized study (1:1) of pediatric patients (<17 years) presenting with a clinical indication for POCUS (lung, FAST, cardiac, or soft tissue applications). Patients were assigned to either a POCUS or non-POCUS group, excluding those who were unstable or had prior POCUS evaluations. Patient families completed pre- and post-surveys (5-point Likert scale) at triage and ED disposition. Demographic data were obtained from the electronic medical record. Statistical analyses included Chi-Square, Fisher’s Exact, Wilcoxon, and sign tests (α=0.05) to compare group responses and assess for changes in responses over time. Results: A total of 200 patient-families were enrolled. The cohort was primarily English-speaking, non-Hispanic white males, with an average age of 5.16 years (SEM ±0.37). Common chief complaints included cough (34%), fever (15%), abdominal pain (14%), and shortness of breath (13%). No significant differences were observed in patient experience or ED length of stay. However, sign tests indicated significant reductions in stress and anxiety within both groups from pre- to post-survey assessments [Anxiety: p<0.0001 (POCUS), p=0.0003 (non-POCUS); Stress: p<0.0001 (POCUS), p<0.0001 (non-POCUS)]. POCUS patient-families reported a significantly greater perceived importance of imaging and stated that POCUS directly alleviated their stress and anxiety. Conclusion: POCUS was associated with a positive patient-family experience in the pediatric ED, reducing perceived stress and anxiety. While overall experience and length of stay remained unchanged, most families in the POCUS group strongly supported its use, highlighting its potential to enhance patient-centered care and need for further research into its broader clinical integration.Item Building a Culture of Growth and Safety: A Workshop on Positive Reinforcement, Mistreatment, and Psychological Safety(2025-04-25) Sanjuan, Adriano; Akolkar Kishor, Jay; Duncan, FrancescaIntroduction/Background. Medical training environments play a critical role in shaping the professional development and well-being of trainees. However, challenges such as ineffective feedback, mistreatment, and the absence of psychological safety can hinder learning and contribute to burnout and disengagement. This workshop integrates evidence-based strategies to foster positive reinforcement, address mistreatment, and promote psychological safety within educational and clinical settings. Study Objective/Hypothesis. We hypothesize that participants will report improved knowledge, skills, and confidence in: Recognizing, addressing, and reporting mistreatment effectively; providing feedback that promotes growth and motivation; creating environments that foster psychological safety. Objective: We aim to improve participants’ knowledge, skills, and confidence in: 1. Recognizing, addressing, and reporting mistreatment effectively. 2. Learn motivation techniques such as Self-Determination Theory, Growth-mindset and how to praise trainees, Effective Feedback, that fosters growth and motivation. 3. Creating psychologically safe environments conducive to learning and collaboration. Methods. This workshop was first delivered in March 2025 and will be repeated for a new group of participants. It consists of two parts: • Part I: Motivation Science and Learning Culture – This segment covers growth mindset, self-determination theory, psychological safety, and feedback strategies such as the Feedback Sandwich and Pendleton Model. It is followed by an interactive small-group scenario in which participants apply these concepts in a practical discussion. • Part II: Mistreatment Awareness and Response – This portion uses storytelling, video reflection, and case-based dialogue to explore mistreatment in clinical training. Participants are then introduced to the STAND-UP mnemonic, a novel tool created for this workshop, which consists of: Spot the situation. Think about intent. Acknowledge emotions. Name the situation. Document: Report events. Uplift yourself/others. Prevent future events). Results. Survey data will be collected for this workshop. Conclusions. This workshop aims to enhance learners’ ability to foster motivation, deliver effective feedback, and respond constructively to mistreatment. It offers a replicable model for improving educational climates and aligns with institutional goals of promoting inclusion and well-being in residency training.Item Social Determinants of Inequities in Neurodegenerative Disease Readmissions in Northwest Indiana: An Advocacy Opportunity(2025-04-25) Calumpang, Neon; Zhou Armstrong, Grace; Guerrero, Jonathan; Muvuka, Baraka; Gospodarek , KyleBackground: Neurodegenerative diseases, such as Alzheimer's and Parkinson's disease, pose significant challenges given their progressive nature and multifaceted care needs. This research examined the intricate interplay between social determinants of health (SDOH) and hospital readmissions among individuals with neurodegenerative diseases. It is part of a Participatory Research partnership between Indiana University School of Medicine-Northwest and an urban health system in Northwest Indiana (NWI). Methods: This retrospective study analyzed a dataset generated from routine SDOH screenings and referrals in Epic using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) for inpatient admissions from 3 NWI urban hospitals between January 2021 to April 2024. Data analysis was conducted in SPSS 29.0 with descriptive statistics, bivariate analysis (Chi-square), and multivariate analysis (binary logistic regression). This study received exemption from Indiana University Human Research Protection Program (IRB #14040). Results: The sample consisted of 1,338 patients admitted for neurodegenerative diseases. Patients were predominantly older adults (73 ± 14), publicly insured (91.5%), and 31% racial/ethnic minorities. The bivariate analysis found that readmission was significantly associated with age (p<0.001), insurance type (p=0.003), hospital (p<0.001), physical activity level (0.034), and length of stay (p<0.001). After adjusting for these factors, the multivariate analysis found higher odds of hospital readmission among patients with public insurance (OR=76.1%; p=0.028), prolonged hospital stay (OR=8.5%; p<0.001), and within a small hospital in a medically underserved area (MUA) (OR=69.6%; p<0.001). Conclusion: Understanding the impact of SDOH on hospital readmissions is crucial for developing multi-level interventions to reduce readmissions, inequities, and healthcare costs. Findings from this research underscore the critical need for policy advocacy and integrated approaches addressing SDOH as part of comprehensive readmission reduction programs. Examples of evidence-based approaches include improving access to quality neurodegenerative care in MUAs, increasing education on at-home neurodegenerative care, and comprehensive SDOH screenings and referrals.Item Objective Assessment and Scoring of Parkinsonian Tremors using Wrist Sensor Technology(2025-04-25) Sullivan, Megan E.; Shanghavi, Aditya A.; Rentley, Oliwia; Zauber, Sarah Elizabeth; Sereno, Anne B.Background: Parkinson’s Disease (PD) is the second leading cause of neurodegenerative disease in humans. The gold standard for assessing disease progression is the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Neurologists score motor symptoms from 0-4 and determine medication adjustments based on score variation between the OFF and ON medication states. Numerous studies have noted inter-rater variability due to the subjectivity of the visual-based MDS-UPDRS rating scale complicating treatment plans. Objective: This clinical study evaluated the use of wrist-worn inertial sensors as a more objective and reliable method for measuring the severity of Parkinsonian rest and postural tremors, in comparison to the current gold standard, the MDS-UPDRS. Methods: 30 PD patients and 30 age-matched healthy controls performed the rest and postural tasks. Shimmer3 IMU sensors, sampling at 100Hz, were attached to both wrists to record angular velocity and linear acceleration. Tremor Severity Score (TSS), a novel objective tremor scoring algorithm based on sensor signals, was developed to measure tremor severity. Results: In a subset of controls and PD patients tested only ON medication, the mean scores for rest and postural tremor showed significant differences using both MDS-UPDRS (0.53 vs 0.46) and TSS (0.53 vs 0.39) rating scales, with TSS showing a marginally greater effect size (0.07 vs 0.06). When comparing OFF/ON states in a subset of 7 PD patients, the MDS-UPDRS showed no significant difference between scores, while the TSS showed significantly lower scores in the ON vs OFF state for both postural (0.44 vs 1.1) and rest tremor (0.91 vs 1.97). Conclusion: Results suggest TSS is more sensitive to changes in tasks (rest, postural) and medication effects (OFF vs ON). The ability to more objectively assess tremor severity and progression has implications for early diagnosis, medication dose adjustments, and more accurate assessment of patients in the telehealth setting.Item Impact of Indiana University School of Medicine’s Service Learning Experience in the Dominican Republic on Medical Students(2025-04-25) Goins, Ethan; Messmore, Niki; Munguia-Vasquez, Ray; Baker, ElizabethService learning experiences are used at the high school, undergraduate, and graduate levels of educational spaces as opportunities for academic and professional development in the context of community service. Over the past few years, Indiana University School of Medicine has led a weeklong service learning trip in December to the Dominican Republic in partnership with the 7 Elements organization. The trip includes medical brigades to rural communities, educational activities, and reflection. This project seeks to examine the impact that this service experience has on medical students including their personal and professional development. Participants of the 2023 cohort were surveyed anonymously roughly a year after their experience. Participants of the 2024 trip were surveyed before and after their trip. For the 2024 cohort, our study found that participants felt better prepared to work with migrant patients, Spanish-speaking patients, and underserved communities after the trip. The majority of participants also reported having a greater desire to work with underserved communities and engage with other service learning opportunities in the future. Overall, the trip has been of some benefit to medical students when it comes to their professional development and increasing their desire to work with underserved and global populations.Item Reanalysis and Reclassification of UBA2 Variants in Patient with Syndactyly, Polydactyly, Aplasia Cutis Congenita and Other Anomalies Reveals Diagnosis(2025-04-25) Liaqat, Khurram; Felipe, Kimberly; Treat, Kayla; McPheron, Molly; Conboy, Erin; Vetrini, FrancescoAplasia cutis congenita and ectrodactyly skeletal syndrome (ACCES) is known to cause by heterozygous mutation in the UBA2 gene. In this report we present the case of 7-year-old male with cutis aplasia, syndactyly, pre-axial polydactyly, and severe complex hypospadias. The exome sequencing identified a heterozygous frameshift variant [c.52_58dupGGCCGGG p.(Val20Gfs*31)] in UBA2 gene. This variant is absent in gnomAD and has been predicted to be pathogenic by various as insilico tools. Following enrollment of the patient at Undiagnosed Rare Disease Clinic (URDC) this frameshift variant [c.52_58dupGGCCGGG p.(Val20Gfs*31)] was reclassified as a pathogenic from Variant of unknown significance (VUS) according to ACMG guidelines. The variant classification affects the patient diagnosis, precision therapy and family screening. In this study, we highlighted the importance of reanalysis of genetic data for reclassification of variant from VUS to pathogenic in unsolved cases.Item Patient Care Ownership in Radiology Residency: Insights from Structured Interviews of Residents and Faculty(2025-04-25) Fromke, Molli; Ahmadi, Tina; Gunderman, PeterIntroduction/Background: In radiology residency and education globally, fostering a sense of ownership can be an undervalued metric of program success. Ownership drives individual achievement, enhances organizational outcomes, and contributes to improved patient care in medicine. Objective: To explore radiology residents' perceptions of ownership at the start of their postgraduate training, alongside faculty members’ perspectives, identify barriers and facilitators, and use these insights to develop targeted professional development activities. Methods: First-year radiology residents and faculty from the same department participated in 45-minute, semi-structured interviews focusing on participants' views of roles, ownership, and conflict responses. Five residents and five faculty were interviewed. Interviews were transcribed and coded using software. Analysis included three phases: open coding for initial perspectives, axial coding to condense codes into themes, and selective coding to identify theme frequency. Results: Residents' main conception of ownership was taking responsibility. Key factors promoting ownership included: 1) intrinsic motivation, 2) responsibility for patient outcomes, 3) integrity, and 4) patient relationships. Barriers included: 1) others assuming responsibility, 2) report criticism, 3) lack of program support, and 4) lack of confidence. Faculty viewed residents as primarily trainees, with a secondary role in supporting the service, while their own primary responsibility was managing the list and patient care. Faculty noted that residents develop ownership most significantly when challenged and uncomfortable, with a supportive environment enhancing this process. Faculty emphasized the importance of culture and attitudes in fostering the willingness to grow through discomfort. Conclusions: Residents shared similar definitions of ownership but varied in its role during training. External environment was their most significant barrier to ownership. Faculty agreed that the best way to develop ownership is to form a culture that normalizes discomfort and emphasizes its importance. These perspectives offer opportunities for programs to improve professional development and foster ownership.