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Item Exploring Relationships Between Fear of Cancer Recurrence, Psychological Distress, & Mental Health Service Use in Breast Cancer Survivors(2023-07-28) Danner, Ana; Hays, Matthew; Li, Yang; Johns, ShelleyBackground: Breast cancer survivors (BCS) have an increased risk of psychological distress compared with healthy controls. Fear of cancer recurrence (FCR) is one of the most reported forms of distress, with approximately 50% of BCS reporting clinically significant FCR. Designed to give alternatives to avoidant coping, acceptance and commitment therapy (ACT) has shown promise in reducing distress and FCR in BCS. The primary objective of this study was to explore relationships between psychological distress and mental health service use in BCS with FCR. Methods: Baseline data from 384 early-stage, post-treatment BCS with clinically significant FCR at screening enrolled in an RCT comparing 3 FCR interventions were analyzed. Prevalence of clinically significant FCR and symptoms of anxiety, depression, and post-traumatic stress was measured. Associations between each distress measure and mental health service use were assessed, in addition to the association between FCR and avoidant coping. Results: Clinically significant levels of at least one form of psychological distress besides FCR were reported in 226 (58.85%) BCS. Of 298 (77.60%) BCS with at least one significant distress score including FCR at baseline, only 61 (20.47%) reported using any mental health service within the 3 months before baseline. Clinically significant anxiety (p = 0.0027), depression (p = 0.0015), and post-traumatic stress symptoms (p = 0.0227) were significantly associated with mental health service use. FCR was significantly associated with fewer visits to certain mental health services. FCR was strongly correlated with increased avoidant coping (ρ = .631, p < .0001). Conclusion: Anxiety, depression, and post-traumatic stress symptoms may be better predictors of mental health service use than FCR given the tendency for patients with fear to cope with avoidance. ACT interventions emphasizing alternatives to avoidant coping may benefit BCS with FCR. Further research is needed to identify barriers to mental health service use in BCS.Item A Review on Methods & Importance of Increasing FIT Testing Completion for FQHC Patients(2023-07-28) Fairbanks, Ethan; Messmore, NikiAccording to the American Cancer Society in their triannual paper on the subject, over 150,000 Americans will be diagnosed with colorectal cancer (CRC) this year with over 50,000 dying from the cancer as well. As a whole, it is the third leading cause of cancer related diagnoses and deaths. In the past several decades there have been great strides in increasing testing and catching the disease in earlier, localized stages. However, this push has been uneven and there has been an observed increase in the diagnosing of later stage CRC in patients younger than 50. Additionally, these new diagnoses have had a preference of the left colon rather than right. Suggesting environmental factors playing a stronger role than common CRC causing genes such as those involved in lynch syndrome. This reaffirms the need for widespread testing of younger patients to screen for CRC, and leaves fecal immunochemical test (FIT) kits as part of a potential solution.Item Day 3 readings can be omitted from patch testing: Medium-sized healthcare system experience(The Journal of Allergy and Clinical Immunology, 2024-02) Bell, K; Happe, M; Veeraraghavan, S; Goffinet, T; Koleilat, MItem Analysis of Lung Cancer Disparities in Northwest Indiana(2023-07-28) Colston, Kyra; Ndama, Mia; Han, AmyItem Electronic Health Record-based Surveillance of Hypertension Prevalence(2023-07-27) Stiles, Justin; Dixon, BrianItem Radiological Findings in Patients Presenting with Brief Resolved Unexplained Events (BRUEs)(2023-07-27) Mallin, Stasianne; Kambalyal, Amogh; Holloran, Tara; Newman, Christopher; Marine, MeganBackground/Hypothesis: Brief resolved unexplained events (BRUEs) are events in infants characterized by cyanosis, abnormal breathing, abnormal tone, and altered responsiveness. Practice guidelines define high-risk and low-risk BRUEs and do not recommend imaging in low-risk patients. We evaluated imaging in these patients and hypothesized that high-risk patients would have more imaging studies and abnormalities. Methods: Using the radiology information system, a retrospective review was performed between 2016-2022 for patients <1 year presenting with BRUE. Defined search terms were used to identify imaging within one week of presentation. Patients were evaluated for clinical presentation, medical history, physical examination, imaging studies ordered, and final diagnoses. Results: 126 patients were identified. 113 patients (46 female; 93 high-risk), between 3 and 355 days old (average age 97 days), met inclusion criteria. Imaging included chest radiographs (99), head CTs (24), brain MRIs (19), skeletal surveys (16), and others (22). There was no difference in the number of imaging studies obtained between these groups (p=0.423, Mann-Whitney U test). However, a greater proportion of high-risk patients had imaging abnormalities (p=0.023, Fisher’s exact test). Only 1/20 (5%) low-risk patients had abnormal imaging (PCR proven viral bronchiolitis). 26/93 (28%) high-risk patients had abnormal findings, most commonly on chest radiographs (15), brain MRIs (9), head CTs (4), and skeletal surveys (3). 18/26 high-risk patients had imaging abnormalities leading to a diagnosis other than BRUE (viral bronchiolitis, bronchopulmonary dysplasia, nonaccidental trauma, perinatal HSV infection, ventricular septal defect, double aortic arch, intestinal malrotation, and neurofibromatosis). Overall, 7/93 (7.5%) high-risk BRUE patients had significant pathology. Conclusion: High-risk patients were more likely to have an imaging abnormality compared to low-risk patients, which is consistent with current imaging recommendations given only one low-risk imaging abnormality. Interestingly, 7.5% of the high-risk patients had significant pathology diagnosed by imaging.Item Abortion in The United States: The Impact of Changing Legislation on Prescription Patterns in Pediatric and Maternal Patients(2023-07-28) Zuch, Camryn; Kirkpatrick, Lindsey; Zhang, Pengyue; Quinney, SaraItem 31+ Metals are Not Needed for Patch Testing in Joint Replacement Patients: Medium-Sized Health System Experience.(Orthopedic Research Society, 2024-02-23) Bell , K; Happe, M; Veeraraghavan, S; Goffinet, T; Koleilat, MD, MIntroduction: The non-standardized workup methods among allergist providers over allergic contact dermatitis (ACD) due to metals leads to variable communication back to referring surgeons. The testing protocol, history taking, and size of patch testing panel vary considerably across the country, with vague directions provided by practice parameters. To optimize current practices and decrease cost, it would be useful to reduce the metals tested on the panel to reflect the most commonly identified allergens in implant patients, establish an efficient assessment-day strategy, and to refine history taking methods to best predict positive results. Methods: We conducted a blinded retrospective chart review of 157 patients in a single outpatient allergy clinic from 7/20-7/23 referred for the evaluation of ACD due to metals. Questions used to evaluate the patient dataset revealed individual symptomatology, characteristics of historical reactions, purpose for visit, patch testing results, and the days tests turned positive. A chi-square analysis determined if a significant difference existed between population sub-group prevalences. Defined Terms: Preoperative screening joint replacement (JR) patients: patients referred to an allergist after answering yes to past metal sensitivity. Problematic JR patients: postoperative patients expressing issues with the recovery process to the allergist. Non-JR patients: patients with ACD due to metals attending the clinic for non-JR related purposes. Grid: lines drawn around patch testing wells on the skin after removing the testing kit. Results: 84.1% of patients referred for metal allergy concerns were joint related. 45.5% of non-JR patients, 39.0% of JR patients, and 39.5% of the total patient population were positive for any metal allergy. Population subgroups such as preoperative screening and problematic JR patients were allergic 42.2% and 23.3% of the time. Preoperative screening JR patients were more likely to test allergic to nickel, palladium, cobalt, chromium, gold, silver, and indium in order of prevalence. Problematic JR patients were more likely to test allergic to benzoyl peroxide, nickel, palladium, platinum, aluminum, and methyl methacrylate. The most prevalent allergens were nickel, cobalt, chromium, benzoyl peroxide, and methyl methacrylate. Preoperative screening JR patients were 18.9% more likely to be allergic to nickel than problematic JR patients. Of the 30 problematic JR patients, 76.7% reported pain and/or swelling, 13% tested positive to any of the 31 metals, and only 8% tested positive to a metal used in surgery. Patients were more likely to be positive if presenting with redness (p=0.0307) or lesions/blistering (p= 0.0018), but not with swelling, itch, oozing, and rash (p>0.05). All positive JR patients tested positive on day 7. Discussion: The majority of patient referrals for metal allergy concerns involved a metal implant, indicating the importance of optimizing patch testing protocol. Problematic JR patients(N=30) were less likely to test positive for a metal allergy than pre-JR patients and non-JR patients(N=22), a clinically significant observation. Statistical significance was not established (p=0.0588 and p=0.1359 respectively) due to small sample size. Preoperative screening JR patients were more likely to test allergic for nickel, palladium, cobalt, chromium, gold, and silver potentially from jewelry exposure. Problematic JR patients were just as likely to be allergic to benzoyl peroxide as nickel, which is most likely due to surgical exposure through an open wound. Problematic JR patients were also more likely to test allergic to aluminum and platinum metals potentially from surgical use. Only 12/31 metals tested positive in the total JR-related population. An abbreviated metal patch test may be sufficient in certain situations, like for patients with poor geographic access to an allergist office. All positive JR patients tested positive on day 7, reflecting the clinical insignificance of day 3 readings for JR patients. Omitting day 3 readings requires a patient’s family/friend to redraw the grid on the patient's back as needed. Many problematic JR patients report pain and/or swelling, however only a small fraction test positive to any of the 31 metals included in patch testing or surgery. This observation may be linked to prosthesis-induced desensitization. The most prevalent allergens in our data set were nickel, cobalt, chromium, benzoyl peroxide, and methyl methacrylate. Titanium and aluminum may be necessary to test for despite only being in the data set once (limitation of study) because they are used in implants and during surgery. It is important to note that the nonmetal allergens methyl methacrylate (MMA) and benzoyl peroxide (BP) may test positive on day 3 but not day 7. The limitations of our findings lie in our small sample size (N=157) and the inherent selection bias seen in physician indications for testing and research analysis. Significance/Clinical Relevance: Our findings clarify the most commonly reacted metals, optimal days to assess readings, and historical indicators for the joint replacement population. This information can be applied in clinical practice for both allergy and orthopedic offices to optimize workflow and minimize cost. A cheaper, abbreviated, and readily-available testing kit for joint replacement patients located geographically far from an allergist office could mitigate negative patient outcomes.Item A QI Initiative: Assessing Predictive Value of Jewelry Sensitivity for Patch Testing Outcomes in a Medium Sized Hospital System(IMPRS, 2023-07-28) Bell, K; Happe, M; Veeraraghavan, S; Goffinet, T; Koleilat, MD, MRATIONALE: True prevalence and patient morbidity of allergic contact dermatitis (ACD) due to metals remains obscure in part due to vague practice parameters creating variability in history collection.1-5 The practice parameters only acknowledge the importance of a patient history for diagnosis with “moderate” strength, and give no definite guidelines for which historical indicators best signify positive patch test results.1 The Deaconess Clinical Research Institute aims to assess the prevalence of jewelry sensitivity and if such sensitivity impacts the days when tests turn positive. We hypothesize that by identifying if jewelry sensitivity correlates with test results, physicians can prioritize specific questions to optimize visit efficiency. OBJECTIVE: Identify the difference in prevalence of metal allergies between patients with and without history of jewelry sensitivity, if history of jewelry sensitivity changed what days patients turned positive, which metals were most common with this history and reveal if the “jewelry sensitivity” historical cue predicts positive results. METHODS: A blinded retrospective chart review of 157 patients in a single outpatient allergy clinic from July 2020 to July 2023 referred for the evaluation of ACD. RESULTS: There was no significant difference in days tests turned positive between patients with or without history of jewelry sensitivity (p=0.3383). 75.8% of allergic patients were jewelry sensitive, and 42.0% of patients with a jewelry sensitivity were positive. Patients with jewelry sensitivity were 25.5% more likely to test positive than those without jewelry sensitivity but were not significantly associated with a positive test result for all or specific metals (p>0.05). 85.1% of positive results came from nickel, palladium, and cobalt. CONCLUSION: History of jewelry sensitivity cannot reliably predict the days when tests turn positive or likelihood of positive results, although low sample size likely caused the latter observation.Item Detection of Bowel and Mesenteric Injuries Using Deep Learning Computer Vision Models(2023-07-08) Mahajan, Neal; Steenburg, Scott; Gunderman, Peter; Burns , John; Iranmanesh, AryaBackground/Objective: While only seen in 1-5% of patients who undergo a CT (computed tomography) scan, blunt bowel and mesenteric injuries (BMI) are associated with significantly increased morbidity and mortality. A significant cause of the increased morbidity of BMI is due to the difficulty of diagnosis from clinical and imaging information which leads to delay in diagnosis. Accurate and timely diagnosis is vital to reduce the morbidity of BMI. Methods: For this project, our primary objective is to create a binary prediction model that determines if a patient has BMI based on their abdominal CT scans. Due to the importance of the early and definitive diagnosis of BMI in trauma patients, an extension of this project will seek to introduce explainability into the model to highlight which features on the CT scan caused the model to make its prediction. The patients with BMI were sourced from a trauma registry that recorded trauma cases from IU Health with relevant diagnosis codes. The images from our search will be reduced to the relevant slices for diagnosis of BMI and then used to train an ML model to make a yes/no prediction from the image. Once the model is trained, testing data will be evaluated on the model and the gradient vectors from the model during inference will be used to create a heatmap with GRAD-CAM that illustrates what portions of the image were relevant for the decision made by the algorithm. Future Directions: Using the collected abdominal CTs, we can train our machine learning pipeline to detect BMI. Based on the performance of the model, we will determine if we need to collect more data. Then, we can evaluate the explainability of the model using GRAD-CAM and compare performance of the ML model to the performance of expert and trainee radiologists.