The Sixth Annual Regional Osteopathic Poster Exhibition and Competition

The Sixth Annual Regional Osteopathic Poster Exhibition and Competition 2016 1 April 23, 2016 B1 Title: The Routine Use of Tranexamic Acid (TXA) Decreases Transfusion Rates and Financial Costs in Total Knee and Hip Arthroplasty Authors: J. Freeland Ackley, DO (PGY 4); Robert Hampton, DO; Gordon Preston, DO Affiliations: Cleveland Clinic Foundation/South Pointe Hospital, Cleveland, Ohio; Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio Introduction: TXA is an option to decrease major blood loss and postoperative anemia following TJA. The primary objective of this retrospective study was to evaluate/confirm that intraoperative TXA decreases transfusion rates in patients undergoing TJA. Secondly, to determine if it’s more economical to prevent postoperative anemia following TJA with the use of TXA rather than treatment with an allogenic blood transfusions postoperatively. Methodology: 275 total joint replacements were conducted during the study. Results: The primary joint transfusion rate significantly decreased from 54 in 234 patients(23.1%) to 2 in 41 patients(4.88%) after the initiation of TXA administration(P=0.014). The transfusion rate in primary THA decreased significantly as well from 18 in 78 patients(23.08%) to 0 in 20 patients(0%, P=0.02). The primary unilateral TKA transfusion rates also decreased from 21 in 125 patients (16.8%) to 1 in 17 patients (5.88%). When comparing the average cost between patients, a difference of over $400 per case was observed with TXA. Conclusion: Allogenic blood transfusions are associated with a variety of complications that can increase patient's morbidity, hospital costs and cost to the patient. With current changes in healthcare including bundled payments and decreased reimbursements, with rising healthcare costs, it’s important for physicians to strive to stay financially prudent; therefore, every effort should be made to do the best surgery possible for the patient in the safest, most cost effective manner. TXA decreases costs directly by being inexpensive and indirectly by decreasing blood transfusion rates, which decreases the amount of post-transfusion complications and significantly for our study group hospital length of stays. B2 Title: The Outcome of Visceral Artery Aneurysms Treated with Endovascular Coiling at a Community Hospital Setting Authors: Adem Aktas (OMS III); Christine Ou, DO; Gregory Kasper, MD Affiliations: Kansas City University of Medicine and Biosciences, Kansas City, KS; Mercy St. Vincent Medical Center, Toledo, Ohio Introduction: Visceral artery aneurysms (VAA) present as a unique set of vascular arterial disease that are uncommon but can present with high morbidity and mortality due to their risk of rupture. With the advance in technology, surgical procedures such as laparoscopic, percutaneous, and endoluminal hepatobiliary interventions has resulted in an increase in VAA. Autopsies have revealed aneurysms in 0.01-2% of individuals. Pseudoaneurysms, on the other hand, can occur after trauma or inflammations which include pancreatitis, autoimmune disorders, vascular interventions. Most patients are asymptomatic but symptoms can arise, developing as abdominal pain, hypotension, vomiting, diarrhea, and hemorrhage. Surgical options have included open repair, ligation of aneurysm with or without end organ resection, and resection of aneurysm with revascularization. Several large center reports have shown a success rate of upwards of 98%. This review is to investigate the outcomes of endovascular coiling techniques in a community hospital setting. Objectives: To investigate how many endovascular coiling repairs are done each year by a private vascular practice group on patients with visceral artery aneurysms and to describe the immediate and long term outcomes of patients who have undergone interventional coiling of VAA’s in a community setting. Methodology: Retrospective, observational case series design. Time frame is January 1, 2005 until February 28, 2015. Results: Results pending. Summary: Endovascular coiling techniques have shown to have a successful outcome in a community setting comparable to large multicenter facilities. B3 Title: Concussion Reporting Practices of Adolescent Student Athletes in Central Ohio Authors: Brandon Arehart (OMS II); Jacob Boucher, MD; Trevor Kitchin, MD Affiliations: Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio; OhioHealth/Grant Medical Center, Family Medicine Residency, Columbus, Ohio Introduction: Increasing nationwide concern for concussions in athletes has driven the requirement of medical professionals to focus their attention on diagnosing and caring for these traumatic brain injuries. However, studies have shown that up to 50% of concussions go undetected or unreported. Objectives: To obtain information on the number of concussions, concussion knowledge, and concussion reporting practices in central Ohio adolescent athletes. Methodology: Via a cross sectional, de-identified survey, the authors sampled a total of 357 student-athletes at OhioHealth pre-participation physicals representing all 6 Ohio high school athletic divisions in various contact and noncontact sports. Results: Of the athletes surveyed, nearly 20% (n=67) had sustained a concussion previously. Of these 67 athletes, approximately 25% reported having multiple concussions prior, only 46.8% (n=29) reported their injury to an athletic trainer or physician, 16.1% (n=10) reported only to a parent or coach, and 7.4% (n=5) did not report their injury at all. Concussions were also reported in both contact and noncontact sports. There proved no significant difference in reporting non-concussive versus concussive injuries (p=0.129). Lastly, 52.1% of the surveyed athletes were unaware of the Return-to-Play law, even though the vast majority understood that athletes cannot return to play the same day (89.6%), and that one must be cleared by a medical professional to return (97.5%). Conclusion: These results suggest the need for continued education in all central Ohio student-athletes concerning concussions, their symptoms, and how to properly report these injuries. B4 Title: Evaluation of Pediatric Vision Screening and Referrals at an Academic Family Medicine Practice Authors: Nicole Ascanio, MD (PGY2); Brandon Baartman, MD (PGY3); Carl Tyler, MD, MSc Affiliation: Cleveland Clinic Foundation/Fairview Center for Family Medicine, Cleveland, Ohio Introduction: The prevalence of undetected vision problems in school age children is estimated to be between 5 and 10 percent. Primary care physicians are responsible for appropriate screening and referral of children at risk for long-term visual morbidity. While many studies have investigated the sensitivity of various visual screening guidelines, few have evaluated referral outcomes in real-life clinical practice. Objectives: To evaluate patterns of pediatric vision screening at an academic family medicine center and outcomes of pediatric vision specialist referrals. Methodology: Retrospective chart review of all patients under the age of 15 referred to pediatric vision specialists in a 5-year period. Results: This is a work in progress. We will characterize our present pediatric vision screening practices and describe the indications for and outcomes of pediatric vision specialty referrals. Summary: Based on our study findings, we plan to modify our family medicine residency clinic pediatric vision screening protocol, develop family medicine postgraduate educational resources and tailor practice supports to improve pediatric vision care. The Sixth Annual Regional Osteopathic Poster Exhibition and Competition 2016 2 April 23, 2016 B5 Title: Examining the Effect of Anacardic Acid Alone or in Combination with Chemotherapeutics on Pancreatic Cancer Cells Authors: Melodie Blackmon (OMS II); Scott Craver; Valerie Eversol; Danielle Upton Affiliation: University of Pikeville, Kentucky College of Osteopathic Medicine, Pikeville, Kentucky Introduction: Pancreatic cancer is the 4 leading cause of cancer related death and its incidence has risen steadily. Although anti-cancer drugs have been developed based on the new molecular findings, the chemotherapy has produced unsatisfactory results due to chemotoxicity and chemoresistance. Thus, a new therapeutic regimen is in urgent need for pancreatic cancer patients. Objectives: The specific objectives of the present study are to investigate the anti-tumor effects of Anacardic Acid (AA) on pancreatic cancer cell growth, examine the synergistic effect of AA on Gemcitabine or 5-Fluorouracil, and explore the underlying molecular mechanisms of Anacardic Acid. Methodology: After treatment with AA, Gemcitabine or 5-Fluorouracil individually or in combination, we determined cell viability with cell number count and MTT assays. In addition, we performed 3D spheroid formation assays to examine the effect of AA alone or in combination with the chemotherapeutics in a tumor environment. Western blot analysis and immunostaining were performed to investigate the underlying mechanisms of AA. Results: Our preliminary data indicates that AA induced growth inhibition in pancreatic cancer cells in cell viability and 3D spheroid formation assays. In addition, AA potentiated the anti-cancer activity of Gemcitabine or 5-Fluorouracil in cell viability and spheroid formation assays. Mechanistically, AA appears to exert its anti-tumor activity via the activation of tumor suppressors, Chromatin Modifying Protein 1A, Ataxia Telangiectasia Mutated, and p53. Conclusion: Our data suggests that cashew nuts and mangos, which contain a number of Anacardic Acids, are promising complementary supplements to slow the initiation or progression of pancreatic cancer.