Judged 3-Minute Oral Presentation Session IV

Background/Significance:

Rohingya refugee women in the United States face barriers to obstetric care, including language isolation, gender norms, prior trauma, and unfamiliarity with Western healthcare systems. Milwaukee hosts the largest Rohingya community nationwide (~3,000 residents), yet little is known about their perinatal care experiences.

Purpose:

Our quality improvement project aimed to characterize obstetric needs and care experiences among Rohingya women in Milwaukee and inform community-centered interventions.

Methods:

We conducted a quality improvement study of Rohingya women who delivered at Aurora Sinai Medical Center from 2019 to 2023. Eligible participants were foreign-born Milwaukee County residents with at least one prenatal visit. Semi-structured phone interviews were conducted with a certified female Rohingya healthcare interpreter. Each question was read out loud and interpreted for the patient, with the interpreter relaying their response in English to be recorded by the study team in REDCap. Quantitative data were summarized descriptively, and open-ended responses were systematically reviewed and manually coded in R using an inductive thematic framework, with recurring patterns iteratively refined and organized into higher order themes.

Results:

Of 25 eligible individuals who delivered in the study timeframe, 24 (96%) completed interviews. Participants (median age 31 years) all received prenatal and postpartum care, with 88% rating prenatal care as “excellent.” However, 71% reported that their birth experience did not meet expectations. The majority (88%) said their cultural background influenced comfort with delivering provider gender. Reported barriers to care included transportation (38%), language access (25%), and healthcare navigation (13%). Most preferred verbal communication and relied primarily on healthcare providers for information (96%), more than family (38%) or community (17%). Themes reflected appreciation for provider kindness alongside fear, uncertainty, and limited agency during labor.

Conclusions:

Although provider relationships were strong, cultural and structural barriers persisted. Findings 109 support expanded interpreter access, culturally tailored patient education, and communication strategies that enhance patient understanding and agency.

Background/Significance:

Cholesterol management is a well-studied secondary prevention measure to mitigate the risk of procedural failure and future cardiovascular events after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Purpose:

This study sought to characterize the level of adherence to cholesterol-lowering regimens in post-PCI and post-CABG patients across Advocate Aurora Health (AAH) medical institutions in hopes of improving knowledge about adherence to secondary prevention cholesterol guidelines for those at risk after coronary artery revascularization at AAH medical centers.

Methods:

This is a retrospective study with 22,060 patients who were eligible for review. The patients used lipid-lowering therapy as secondary risk reduction after PCI or CABG from September 2011 to September 2023 across all 25 AAH medical centers located in Wisconsin and Illinois. The primary goal was to evaluate various post-revascularization low-density lipoprotein (LDL) levels: those with LDL≥100 versus LDL< 100, LDL≥70 versus LDL< 70, and LDL≥55 versus LDL < 55 after revascularization. Secondary analyses included patient demographics, medical conditions associated with increased cardiovascular risk, and prevalence of non-statin therapy usage. The Chi-square test or Fisher’s exact test was used to compare the groups for categorical variables, and the Wilcoxon Rank Sum test was used to compare the groups for numerical variables. Confidence intervals (95%) were also used with the descriptive statistics to describe the characteristics of the cohorts.

Results:

Those in the LDL ≥100 and ≥70 groups had greater prevalence of females, a history of myocardial infarction, and no tobacco use history. Those in the LDL <100, <70, <55 groups had more congestive heart failure, diabetes, hypertension, peripheral arterial disease, chronic kidney disease, atrial fibrillation, and cancer. Interestingly, only the prevalence of stroke was statistically higher in the LDL <55 group vs LDL >55 group, 11.7% vs 10.8% respectively. American Indian or Alaskan ethnicity was more prevalent in LDL <100, <70, <55 groups whereas Hispanic ethnicity was more prevalent in LDL <70 and <55 groups. Groups with LDL ≥ 100, ≥70, and ≥55 had greater use of ezetimibe and evolocumab.

Conclusion:

Those with more cardiovascular risk factors identified were able to achieve lower LDL levels. Patients with higher post-revascularization LDL levels had a greater prevalence of additional therapies beyond statins.

Background/Significance:

With the rapid growth of Pediatric Hospital Medicine (PHM) and the growing number of PHM fellows requiring scholarship oversight, there is a critical need for PHM faculty who can supervise fellows in the execution of scholarly requirements. However, variation exists in faculty skill sets and available training for PHM fellows.

Purpose:

We developed and implemented a 1-year research program for fellows and junior faculty grounded in the four pillars of Boyer’s Model of Scholarship. Scholarly productivity and self-reflective, behavior-based assessments were evaluated before and after the program.

Methods:

A needs assessment of PHM faculty at four children’s hospitals within Advocate Health identified a desire to participate in scholarship but low self-perceived mastery, mirroring national data. We developed a longitudinal program with emphasis on adult learning theory which mirrored a step wise approach to research: scholarship of discovery. We recruited pediatric research experts for monthly didactics: scholarship of integration. These talks were coupled with pre-work and small group peer and near-peer mentoring sessions to apply knowledge learned to real-world problems: scholarship of application. Finally, we administered a validated behavioral instrument (the CARE inventory) prior to and 1 year following completion to assess course quality, relevance to learners, and academic productivity: scholarship of teaching and learning. We summarized data using descriptive statistics and tested for normality. Outcomes were compared using paired t-test or Mann-Whitney U for continuous variables and chi square for categorical variables. We used content analysis to review qualitative comments.

Results:

Five junior faculty members and five fellows were selected for a pilot cohort in 2024. Before and after the course, respondents identified the following barriers to scholarship success: lack of mentorship (38% vs 10%, p=0.12) and lack of skills (69% vs 40%, p=0.16). Positive ratings of scholarship satisfaction increased from 54% to 100%. There was an increase in scholarly productivity across all categories, with a statistically significant increase in number of oral presentations (p=0.04).

Conclusion:

A longitudinal research program for PHM fellows and junior faculty grounded in adult learning theory can increase scholarly productivity and satisfaction while reducing barriers to success. Future work will focus on expansion of participants and outcomes at the 2- and 5-year post-course timepoints.

Background/Significance:

Cesarean delivery rates in the United States remain high at ~32% of deliveries. Primary cesarean deliveries or Nulliparous, Term, Singleton, Vertex (NTSV) cesareans are ~26%. National benchmarks focus on reducing NTSV cesareans as a key strategy to addressing the overall cesarean delivery rate. While the NTSV benchmark (NTSV rate 23.6% or lower) is an important benchmark for quality improvement, it does not account for clinical factors that may influence delivery decisions. Non-reassuring fetal status (Category II or III) is a frequent indication for NTSV cesareans, yet it is inconsistently defined and fetal heart rate (FHR) monitoring guidelines (Clark guidelines) are variably applied in clinical practice.

Purpose:

To determine the rate of NTSV cesareans and adherence to FHR guidelines.

Methods:

We conducted a quality improvement project within one urban, teaching hospital among patients ≥ 37 weeks’ gestation who presented with a singleton, vertex pregnancy for their first term live birth between 6/1/2021-6/1/2022. NTSV cesarean maternal/neonatal characteristics and outcomes were further reviewed and collected. For cases citing non-reassuring fetal status, FHR tracings and labor progression data were separately reviewed by two OB/GYN physicians to assess adherence to Clark guidelines. Discrepancies between interpretations were reviewed by a third OB/GYN physician for a final decision on adherence. Basic descriptive statistics were computed.

Results:

There were a total of 528 NTSVs with a cesarean rate of 24.1% (N=127). Patients were of median age 25.0 years, and were predominately Black, non-Hispanic (48.8%) with median gestational age of 39w3d. Overall, 61.3% had >10 prenatal visits at that facility. Pre-pregnancy/pregnancy characteristics include diabetes (4.7%), gestational diabetes (3.9%), chronic hypertension (7.1%), and gestational hypertension (29.9%). Of NTSV cesareans citing non-reassuring fetal heart tones (66.1%, N=84), 61.9% did not meet Clark guidelines; those not meeting criteria had 11.5% and 88.5% decreased and increased time, respectively. Neonates born within this subpopulation had a median 5-min APGAR of 9.0; 14.3% were admitted to the NICU.

Conclusion:

While non-reassuring fetal status was the most common indication for NTSV cesarean delivery, over 50% did not meet Clark guidelines, suggesting inconsistent FHR interpretation. Improving adherence to standardized guidelines may help reduce preventable primary cesareans while maintaining maternal and neonatal safety.

Background/Significance:

Preterm pre-labor rupture of membranes (PPROM, membrane rupture <37 weeks>gestation) is associated with increased morbidity/mortality. Guidelines recommend inpatient management until the risks of pregnancy outweigh the risks of neonatal prematurity under 34 weeks’ gestation. Latency, time from PPROM to delivery, varies from days to weeks secondary to potential maternal/fetal complications. ACOG cites that most people deliver within 7.0 days with latency inversely correlating with gestational age at the time of PPROM. However, this is based on an older study out of Israel that may not be generalizable in the US. Updated studies can improve counseling for estimated gestational age at birth, which correlates with neonatal outcomes, and inform patients on anticipated length of inpatient stay.

Purpose:

To determine latency with inpatient PPROM management, and secondarily the relationship between latency and gestational age or other maternal/fetal factors.

Methods:

We retrospectively reviewed encounters with a singleton pregnancy diagnosed with PPROM between 23w0d–34w0d gestation at an urban, teaching hospital from 10/2012 – 10/2024. PPROM was identified using ICD-9 and ICD-10 codes. Encounters were excluded if patient did not receive standard management (7-day course of antibiotics, corticosteroids, and magnesium sulfate if <32w0d). For the latency period, we estimated the median (interquartile ranges [IQR]) and generalized linear models (GLM) with Tweedie distribution and a log link. Two-sided p < 0.05 were considered statistically significant.

Results:

Overall, 343 pregnancy encounters were identified. Following exclusions, 242 unique encounters were included. Primary reasons for delivery were spontaneous delivery (59.1%), induction at 34w0d (19.8%), and placental abruption (9.1%). Latency from inpatient management to delivery was 7.0 (IQR 3.0, 13.0) days. Patients diagnosed before 24w0d had the longest latency (14.5 days; IQR 7.0, 34.5), and patients diagnosed after 32w0d had the shortest latency (4.0 days; IQR 2.0, 8.0). Gestational age at time of PPROM diagnosis (adjusted Mean Ratio (aMR) 0.98, 95% Confidence Interval [CI] 0.97-0.99; p < 0.01) and spontaneous delivery (aMR 0.65, 95%CI 0.44-0.96; p < 0.03) were associated with latency time in multivariable GLM models.

Conclusion:

Our study reinforces previously available evidence with median latency time of 7.0 days and shorter latency periods with later PPROM diagnosis.

Background/Significance:

Catheter ablation is a class 1 indication for treatment of symptomatic atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) is an alternative option to anticoagulation in patients with AF and a contraindication to long-term anticoagulation. Combining catheter ablation and LAAO in a single procedure, referred to as the concomitant procedure, has emerged as a strategy for management of AF.

Purpose:

To assess the efficacy and safety of the concomitant procedure at a single center.

Methods:

In this retrospective observational study, data were collected on 28 patients who underwent LAAO with either the WATCHMAN FLX-PRO (n=26) or the Amplatzer Amulet device (n=2) concomitant with pulsed field ablation (PFA) from October 2024 to March 2025. Fluoroscopy was used in addition to transesophageal echocardiography (TEE) and/or intracardiac echocardiography for transseptal puncture and LAAO implantation. Left atrial appendage measurements were made prior to AF ablation to avoid measurement bias caused by edema from AF ablation. Efficacy was defined as complete pulmonary vein isolation (PVI), successful implantation of LAAO device, and < 3 mm residual LAAO leak at 45-day post-procedural imaging.

Results:

The study cohort average age was (72.6 ± 5.2 years), 28.6% were females and 96.4% were White; the average CHA2DS2VASc (1.57 ± 0.74) and HAS-BLED (1.96 ± 1.04) scores were calculated; the average body mass index was (31.1 ± 6.13 kg/m2). AF was classified as paroxysmal in 67.9%, persistent in 28.6% and long standing persistent in 3.5%. All patients had successful PVI. Device implantation was successful with the initial attempt in 27 (96.4%) patients;1 patient required resizing. Median procedure time was 151.9 (118, 164) min, median fluoroscopy time 34.0 (28.8, 47.0) min, and median left atrial dwell time 104 (82.5, 119) min. Of 19 patients with post-procedural TEE, 11 (57.9%) patients had < 1 mm peri-device leak, 4 (21.1%) patients had a residual leak of 1- 3 mm leak, and 4 (21.1%) patients had a residual leak of ≥ 3 mm. Post-procedure, 2 (7.1%) patients had minor bleeding, and 1 (3.6%) patient had a pericardial effusion which did not require intervention.

Conclusion:

Concomitant catheter ablation of AF and LAAO was feasible in our study cohort, demonstrating 100% acute PVI and minimal complications. Larger cohort studies with longer follow-up periods are needed to report patient safety and optimize outcomes.

Background/Significance:

Kidney biopsy remains the gold standard for diagnosis and management of patients with medical kidney diseases. Recent data suggest an increasing incidence of inadequate kidney biopsy samples in the United States. The Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend that an adequate kidney biopsy specimen should contain at least 8 glomeruli (KDIGO Glomerular Diseases Work Group, 2021).

Purpose:

Improving kidney biopsy adequacy is essential to ensure accurate diagnosis, reduce repeat procedures, and optimize outcomes. Optimizing procedural techniques targeting the outer renal cortex and selecting larger-gauge needles—has been shown to improve tissue adequacy. Standardizing biopsy protocols, enhancing operator training, and incorporating routine quality improvement reviews can further reduce variability. Patient-specific factors such as advanced age or cortical thinning warrant tailored biopsy planning and enhanced intra-procedure adequacy review.

Methods:

We retrospectively analyzed the adequacy of kidney biopsies performed at our institution between January 2021 and June 2023. Adequacy was defined according to KDIGO criteria.

Results:

A total of 381 kidney biopsies were included in the analysis. The cohort consisted of 218 females (57.2%) and 163 males (42.8%), with a mean age of 55 years (range 5–93 years). African American patients represented 182 cases (47.8%). Using the predefined adequacy threshold, 91 biopsies (23.9%) were deemed inadequate. Despite this, a definitive pathological diagnosis was achieved in 48 of these inadequate samples (52.7%). A diagnosis was not possible in 43 cases (11.2%), so a second biopsy was advised. Notably, 48 patients (52.7% of those with inadequate biopsies) were over 60 years of age.

Conclusion:

The high proportion of non-diagnostic kidney biopsies (11.2%) has several important clinical implications. Inadequate tissue sampling may delay diagnosis and initiation of appropriate therapy. Although over half of inadequate specimens still yielded a diagnosis, patients without sufficient tissue may require repeat biopsy, adding risk, cost, and anxiety. Older adults, particularly those over 60, were disproportionately affected, highlighting a need for modified biopsy strategies such as optimized imaging guidance, or real-time adequacy evaluation. Quality improvement measures in biopsy technique, operator training, and real-time assessment are essential for ensuring high-quality diagnostic tissue.