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Item Using Botulinum Toxin for the Treatment of Gastroparesis (GP) Post Gastric Peroral Endoscopic Myotomy (GPOEM)(2025-04-25) Kais, Amr; Al-Haddad, MohammadIntroduction/Background: Gastroparesis (GP) is a motility disorder that causes delayed gastric emptying, leading to significant morbidity and deterioration of quality of life. Gastric peroral endoscopic myotomy (G-POEM) is a minimally invasive procedure targeting the pyloric sphincter, which has shown efficacy in managing refractory GP. However, not all patients respond equally to G-POEM. Botulinum toxin (Botox) injection into the pylorus may help predict clinical success by identifying responders who would benefit most from G-POEM. Study objective/Hypothesis: The objective of this study was to evaluate the impact of pre-G-POEM botulinum toxin (Botox) injections on improving quality of life (QoL) and symptom severity in patients with gastroparesis (GP). By identifying patients who respond to Botox therapy, we aim to optimize patient selection for G-POEM and maximize the procedure's impact on overall well-being and social functioning. Methods: This retrospective cohort study included 124 GP patients (median age: 50) treated with G-POEM at a single tertiary care center between February 2018 and November 2022. Patients received Botox injections pre-G-POEM and were assessed for symptom severity (Gastroparesis Cardinal Symptom Index [GCSI]), QoL, and social functioning at baseline and follow-up intervals (1, 3, 6, 12, 24, 36, and 48 months). Clinical success was defined as a ≥1-point reduction in GCSI score. Comparative analyses between Botox responders and non-responders were performed, along with quality-of-life assessments using validated scales (e.g., SF-36). Results: Significant short- and intermediate-term improvements were observed in GCSI scores, QoL, and social functioning for Botox responders. GCSI improvement was higher among responders at 3 months post-G-POEM (0.38 vs. 0.03; p < 0.05). Clinical success rates were greater for patients who demonstrated initial improvement with Botox therapy. Overall QoL metrics, including physical and social functioning, were consistently higher among responders across all follow-up intervals. At the 48-month follow-up, 64% of patients demonstrated sustained clinical success, with Botox responders showing the most substantial improvements. Limitations included loss to follow-up and limited data beyond 48 months; however, clinical success at the 1-year mark and beyond was not statistically insignificant, underscoring the potential durability of QoL and symptom improvements over time. Conclusions: Pre-G-POEM Botox injection is a valuable predictive tool for identifying GP patients likely to benefit from G-POEM, resulting in better symptom management, QoL, and clinical success. These findings suggest that incorporating Botox injection prior to G-POEM may optimize patient selection and procedural outcomes. However, clinical success at 1 year and beyond was not statistically proven, highlighting the need for further research to solidify these findings and confirm long-term efficacy. Further studies with larger sample sizes and longer follow-up periods are needed to validate these results.Item Characterizing Demographics, Perceptions, and Food Insecurity based on Client Transportation when Accessing Food Aid in the Greater St. Joseph County Area(2024-04-02) Bales, John; Harris, Johnathan; Harper, Claire; Joshua, Scott; Stone, Jackson; Lassen, DavidIntroduction: Food insecurity is a pervasive injustice within St. Joseph County, with many turning to local pantries and kitchens for aid. To assess barriers to pantry operation and client accessibility, we conducted a survey of 10 organizations between June and July 2023. A trend appeared as some pantries were disproportionately accessed by cars, indicative of inequitable access for those limited to walking, biking, and taking the bus (WBB). As part of an ongoing project, we first look to characterize the demographics and perceptions of the disadvantaged population as it relates to transportation type. Methods: Participants (n=474) completed questions pertaining to demographics, living situation, food insecurity, and perceptions on transportation and food selection. Results were stratified by transportation method. Results: Those who WBB to the pantry were more likely to be younger (50.3 vs. 54.8 years, p=0.0097), self-identify as non-white (60% vs. 38%, p=0.0014), have smaller household sizes (2.34 vs. 3.33 persons, p=0.0002), and have greater food insecurity scores (6.03 vs. 4.88, p=0.0016). Those who WBB were more likely to agree with “transportation is frequently difficult for me” (66% vs. 43%, p=0.0007) and report ease of transportation having at least a moderate effect in pantry food selection (52% vs. 32%, p=0.0056). Discussion: Our analysis suggests that those who WBB face unique challenges in obtaining food aid. This may be a result of complex socioeconomic factors or inequitable urban planning efforts. Future work will focus on how pantries and community characteristics most effectively promote equitable access.Item Food insecurity as a social determinant of 30-day congestive heart failure readmissions(2025-04-25) Blodgett, Alison; Guerrero, Jonathan; Muvuka, BarakaBackground: Approximately 6.7 million Americans have congestive heart failure (CHF), costing the healthcare system over $30 billion annually. Readmissions contribute significantly to these costs, as 20-25% of hospitalized CHF patients are readmitted within 30 days of discharge. The Hospital Readmissions Reduction Program monitors 30-day readmission rates and penalizes hospitals that do not meet targets. Previous research on factors impacting CHF readmissions has largely focused on downstream factors, such as clinical practices, patient health characteristics, income level, insurance type, etc., rather than upstream factors that can potentially inform high-impact interventions. This study explored downstream, midstream, and upstream factors—including demographics, social determinants of health (SDOH), and health behaviors—and their relationship with 30-day CHF readmissions in an urban healthcare system in Northwest Indiana. This was part of an academic-health system participatory research partnership. Methods: This retrospective study analyzed a limited dataset from EPIC™ with SDOH, demographic, health behavior, and health outcomes of adult inpatients between January 2021 and April 2024. Data analysis consisted of descriptive, bivariate (Chi-Square; 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 consisted of 5,489 patients with CHF, predominantly White (63.8%), 65+ years old (76.2%), and publicly insured (91.8%). 30-day readmissions represented 22.4% of CHF admissions. The bivariate analysis revealed significant associations between 30-day CHF readmissions and ethnicity (p=.003), sex (p=.046), language (p=.017), hospital (p=.009), insurance type (p=.003), food insecurity (p=.048), and depression risk (p=.003). Food insecurity remained significantly associated with 30-day CHF readmission (OR=2.128; p=.033) after adjusting for these factors in the multivariate analysis. Conclusion: This study identified food insecurity as an upstream SDOH predicting 30-day CHF readmission. Future research should further explore other upstream factors contributing to 30-day CHF readmissions and evaluate evidence-based food insecurity interventions.Item Psychosocial Barriers to Equitable Food Access: A Qualitative Analysis of Food Pantries in Northern Indiana(2025-04-25) Abrinko, Christopher; Lain, Morgan; Andrews, Madeline; Dennis, Caymah; Al-Fadhl, Mahmoud; Lassen, DavidThe prevalence of food insecurity in the United States is significant and the consequences transcend hunger to include chronic health conditions such as anemia, asthma, COPD, hypertension, diabetes, and arthritis. To address the rising prevalence of food insecurity, food pantries have provided a vital source of sustenance to those who suffer from it. While physical barriers such as lack of transportation and limited pantry resources exist, more subtle psychosocial barriers such as expectations of gratitude and self-fulfilling prophecy may undermine the goals of pantries in diminishing food insecurity. Thus, we report on the results of surveys performed at 35 food pantries in Northern Indiana exploring the disconnect between client and pantry staff perceptions and possible contributors to that disconnect while also discussing implications for the aforementioned, preventable psychosocial barriers. Pantry staff and clientele were asked multiple choice, Likert scale, and short-answer questions regarding their experiences with the clients and pantries respectively, as well as food insecurity in general which revealed disconnects between perceived client-satisfaction and actual client-satisfaction, client perceived self-ability and staff perceived client-ability, and client-desire and staff-perceived client-desire for healthier food options. These findings exposed areas of misunderstanding and miscommunication between a large portion of pantries and their patrons, possibly exacerbated by self-fulfilling prophecies and expectations of gratitude. The psychosocial barriers discussed are subtle and often go unnoticed, as most of them can be implicit in nature. Therefore, when discussing food pantries and their contributions to people who grapple with food insecurity, it is imperative to keep these subtleties in mind. Foregoing the uncomfortable confrontation of these harmful modalities may mean perpetuating food insecurity in the very population food pantries hope to serve. Our findings elucidate the importance of self-awareness, strong means of communication, and intentional compassion being the forefront of the pantry-client relationship.Item Perspectives on Healthy Food Access: Insights from Food Pantry Leadership in Northern Indiana(2025-04-25) Johnson, Mackenzie; Bales, John; Scott, Joshua; Harper, Claire; Lassen, DavidFood pantries serve as an important resource for many experiencing food insecurity. Many pantries seek to support these individuals by providing nutritious food. However, the quality of food provided is often limited by factors affecting the pantry as well as those experienced by the clients. Through partnerships with Cultivate Food Rescue and Indiana University School of Medicine, our team sought to better understand how food pantries in the greater St. Joseph County community define healthy food, recognize barriers for themselves and their clients, and support healthy food choices from the level of pantry leadership. Our team completed interviews with directors from food pantries between June 2023 and November 2024. These 45-minute semi-structured interviews covered topics including pantry overview, food characteristics, client perceptions, and community partnerships. Qualitative code-based analysis was performed to identify common themes across interviews. From the Cultivate Food Rescue partners contacted, 10 directors participated in interviews. When asked to define healthy food, 90% of directors stated fruits and vegetables often with a preference for fresh produce, 60% identified a form of protein, 20% categorized it as foods that are more filling. They frequently noted challenges obtaining these types of products. Many directors noted their “biggest challenges” to complete the pantry’s mission include funding (50%), storage spaces (30%), vehicle transportation (20%), volunteer power (20%), shelf-life (30%), and appropriately supporting clients (20%). Several directors spoke to barriers related to client’s preference for and ability to utilize healthier food options. From these interviews, nearly all directors noted a desire to provide nutritious food for their clients. However, the most common barriers were related to donations, costs, and storage of the perishable items. Our hope is that these results may support decision making related to acquiring and distributing healthy yet desirable food to those experiencing food insecurity.Item Gastric Ultrasound Education: Participant Survey Data from a Statewide Gastric POCUS Workshop(2025-04-25) Libiran, Nicole Bianca; Mohammed, Azam; Tanner, Brandon; Boyer, Tanna; Packiasabapathy, SenthilBackground Prior studies implementing POCUS into medical education through standardized workshops have been shown to improve knowledge and POCUS comfort. In one study, hands-on training and asynchronous online modules increased PGY-1 residents’ confidence in obtaining POCUS images, recognizing anatomical structures, and incorporating POCUS into clinical practice. Our study aims to reinforce these findings in the population of practicing anesthesiologists, with an emphasis on the use of gastric ultrasound. Gastric ultrasound can be a vital tool for anesthesiologists in determining an appropriate anesthesia induction and maintenance technique with uncertain patient fasting status. Objectives This study aimed to assess practicing anesthesiologists' confidence, knowledge, and skill in performing gastric POCUS before and after a focused workshop that used deliberate practice. Methods Participants of the 2024 Indiana Society of Anesthesia annual meeting participated in a hands-on gastric point of care ultrasound workshop as part of the statewide conference. Participants completed a survey to assess their knowledge and comfort with performing gastric ultrasound prior to the workshop. They also completed a post-workshop survey and a knowledge test to assess their ability to identify structures on a gastric ultrasound. This study is a prospective analysis comparing survey data before and after the workshop. Pre- and post-workshop responses were analyzed using two-tailed Fisher’s exact tests and statistical significance was defined as p < 0.05. Results 37 participants completed the pre-workshop survey, and 25 completed the post-workshop survey. Statistically significant differences were found in physicians' confidence in obtaining gastric images (p<0.0001), interpreting gastric ultrasound (p<0.0001), and confidence in incorporating gastric POCUS into practice (p=0.0003) [Fig. 1]. No significant difference was found in general POCUS confidence (p=0.5336). Conclusion Anesthesia faculty who attended the workshop reported increased confidence with gastric POCUS, demonstrated improved skills in identifying structures, and reported greater confidence in integrating it into clinical practice, suggesting the addition of deliberate practice was positive.Item Preclinical Medical Student Perceptions of Two Exam Feedback Approaches(2025-04-25) Gasaway, Elsie; O'Loughlin, Valerie DeanIntroduction: Medical school requires students to learn abundant information in a short period of time. Feedback is a critical component of this learning process, allowing students to learn from their mistakes. At Indiana University School of Medicine (IUSM), preclinical course feedback includes post-exam reviews. The first two basic science courses, Human Structure (HS) and Molecules to Cells and Tissues (MCT), differ in post-exam review format. HS provides a delayed post-exam review and MCT provides an immediate post-exam review, leading to subjective student accounts regarding utility and preference. Objective: This study examines IUSM-Bloomington medical students’ perceptions of HS versus MCT post-exam review utility. The present research builds upon an initial study, which examined class of 2026 HS versus MCT post-exam feedback, to identify if themes persist across academic years. Methods: Five class of 2026 and six class of 2027 IUSM-Bloomington students participated in one or two focus groups, respectively, to discuss their HS and MCT post-exam feedback experiences. Thematic analysis was used to interpret the data. Results: Thematic analysis identified 16 themes and eight subthemes, each of which were categorized as ‘helpful’ or ‘unhelpful’ aspects of post-exam reviews. Helpful MCT feedback components included immediate score access, written explanations, and opportunities for metacognitive practice. HS offered benefits such as the ability to collaborate, and review with renewed focus. Students mentioned feedback could elicit positive or negative emotions, which impacted engagement. Students also described useful aspects of feedback that were lacking in the current post-exam reviews. Perceptions were largely consistent; however, differences emerged across cohorts regarding HS post-exam review convenience. Conclusions: Our study suggests that certain components of post-exam feedback are necessary for it to be valuable to students. Implementing minor changes in preclinical post-exam reviews at IUSM could provide substantial benefit to students, leading to greater feedback utilization and learning gains.Item Association of Socio-Demographic Factors and Social Determinants of Health with Physical Activity Level in Patients with Disabilities(2025-04-25) Clark, Austin; Mangum, Joshua; Muvuka, Baraka; Guerrero, JonathanBackground: Regular exercise has been shown to improve health outcomes and an important component of preventative medicine. The CDC has shown that patients with disabilities get less regular exercise than patients without disabilities. Identifying groups with low physical activity levels, such as patients with disabilities, and the barriers to physical activity can guide policy and decision making to improve health outcomes. This study examined associations between social determinants of health (SDOH) and physical activity levels. Methods: This retrospective study focused on patients with disabilities admitted at 3 urban hospitals in Northwest Indiana between January 2021 and April 2024. SDOH were screened and participants were selected based on CDC’s disability categories (Cognitive, Mobility, Vision, Hearing, Independent Living, and Self Care). Physical activity level was based on exercise minutes per week: Inactive (IA)=0 minutes, Insufficiently Active (ISA)=<150 minutes, and Sufficiently Active (SA)=150+ minutes. Results: 705 patients with disabilities with recorded physical activity levels were identified. No significant differences were found in physical activity levels between disability categories. The IA group differed significantly from both SA and ISA groups in Age Group, Social Connections Risk, and Length of Stay (p=<0.01). The SA and ISA groups showed significant difference in Financial Resource Risk (p=.045). Regression Analysis showed an increased risk for physical inactivity as Age increased (p=<.001), as well as patients with public insurance compared to private (p=0.02). Conclusion: Age is a common risk factor for reduced physical and the association of lower physical activity with Financial Resource Risk and Social Connections Risk is not novel, but further studies using larger samples may offer insight for future interventions. Future research would benefit from more specific physical activity data from patients with disabilities that may also give insight into adaptive interventions to improve exercise levels in this population.Item Utilization of Lecture-Based and Simulation-Based Teaching of Trauma-Informed Care in First-Year Medical Curriculum(2025-04-25) Kerns, Elizabeth; Gasaway, Elsie; Baumberger, Geneva; Husmann, PollyIntroduction: Trauma-informed care (TIC) has become increasingly recognized in clinical practice and medical education. It is essential that medical students understand how to provide care using a trauma-informed approach before entering the clinical environment. With various modalities for teaching TIC, best practices for medical student education should be established. Therefore, instructional methods for teaching TIC principles must be evaluated with similar appraisal to other clinical skills. Objective: This study evaluates the effectiveness of an introductory trauma lecture and intimate partner violence (IPV) simulation in teaching TIC to medical students. Methods: First-year IUSM-Bloomington medical students attended a 1-hour lecture about trauma followed by an optional peer-led IPV simulation. De-identified data was collected at this time for quality improvement, including a pre/post-lecture survey (n=29), and a post-simulation survey (n=5) and focus group transcription (n=6). The present study used retrospective analysis to further explore this data. Lecture survey data was analyzed using a Wilcoxon signed-rank test. De-identified data for dissemination was deemed not human-subjects research. Results: Lecture survey data indicated that participants felt significantly more confident in identifying red flags of domestic violence, mandatory reporting, safety planning, and considering TIC in patient encounters. Simulation survey data revealed decreased confidence with TIC, which participants attributed to an awareness of their limited knowledge. During the focus group, participants recognized the simulation as an effective learning tool and emphasized the importance of widespread TIC education and more practice-based learning opportunities. Conclusions: The data suggest that lecture based-learning can increase medical student confidence in their ability to conduct TIC. Additionally, simulation-based learning provides a potential avenue to advance TIC education. Students express favorable views towards experiential learning through simulation and report positive learning outcomes. Integrating TIC curriculum into medical school could enhance students’ confidence in applying a trauma focused approach to patient care.Item Celiac Disease in Medical Curriculum(2025-04-25) Kerns, Elizabeth; Husmann, PollyIntroduction/Background: Students attending US medical schools are often turning to commercial resources as a primary learning tool during their preclinical years. However, the quality and content of the material presented within these sources has not been widely studied. This study sought to compare sources of preclinical medical education using celiac disease, a common autoimmune illness. Celiac disease has an exceedingly variable range of presentations across many body systems, including subclinical symptoms. Despite accessible testing and treatment, most individuals with celiac have not been diagnosed, imposing significant disease burden. Study objective/Hypothesis: This study sought to evaluate and compare the IUSM preclinical curriculum and popular commercial resources regarding their presentation of celiac disease. Methods: After conducting a literature review, an evidence-based rubric was created to evaluate information about celiac disease. The rubric was applied to the IUSM preclinical curriculum and USMLE World, First Aid for the USMLE Step 1, and Boards and Beyond, commercial resources widely used by preclinical medical students. Results: The IUSM curriculum scored higher overall and higher in all but one category than all the commercial resources. USMLE World had the highest score of the commercial resources. All sources showed deficits in two or more categories. Conclusions: All sources assessed exhibit opportunities for improvement. However, the IUSM curriculum presented more thorough information regarding celiac disease. Although the commercial resources included within this study are used by students to prepare for standardized exams, they may be more concerned with improving test scores than providing students with the information needed to become effective physicians. Students may gain more complete information regarding celiac disease from the IUSM curriculum.