United States

Abstract Title: Making Sense of Insensible Losses: A Case Study on Post-Operative Fluid Management 

Background: Fluid management in post-operative patients remains a critical yet complex aspect of care. Balancing volume overload with adequate resuscitation is a delicate practice, with shifts contributing to electrolyte abnormalities, delayed wound healing, and organ dysfunction. This case study examines a sentinel event involving fluid overload, performed to investigate systemic shortcomings and potential solutions for optimizing fluid monitoring in the ICU. 

Methods: We conducted a retrospective case analysis of a 53-year-old female who presented on postoperative day eight following a laparoscopic appendectomy, complicated by necrotizing fasciitis. Her clinical course was reviewed in detail including surgical and medical interventions, imaging findings, and sequence of ICU care. A root cause analysis was performed to identify factors contributing to the harm event. A process map was created to review current hospital fluid monitoring practices. A literature review was completed, and a revised process map was created to highlight targeted strategies for improvement. 

Results: Despite current fluid monitoring protocols, the patient developed progressive respiratory failure in the setting of net positive fluid balance to 91-liters and worsening pulmonary edema on imaging. A root cause analysis revealed notable contributing factors as unquantified insensible losses, non-protocolized measurement of wound losses, and communication gaps between teams. A literature review supported interventions for future implementation including insensible loss calculators, protocols for weighing wound dressings, automated output monitoring systems, daily POCUS rounds, and structured communication tools such as rounding checklists and EMR-integrated fluid alerts. 

Conclusion: This case exemplifies the complexities of fluid management in the ICU and the need for continuous assessment and revision of current protocols. Fluid overload is a preventable, iatrogenic cause of patient harm events. Through exploration of the various systems involved, preventable harm events can be reduced using strategies focusing on accurate fluid monitoring/documentation, knowledge of assessment methods, and open communication between treatment teams. 



AMA Research Challenge 2025 

Making Sense of Insensible Losses

[EPJ Web of Conferences, Volume 249 (2021)](https://www.epj-conferences.org/articles/epjconf/abs/2021/03/contents/contents.html)

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Powders & Grains 2021

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Join the AMA Research Challenge poster symposium and semifinals to explore top research posters and score posters in the semifinals (an AMA member exclusive opportunity).

Background At large academic centers, healthcare providers manage patients with multiple chief complaints and diagnoses. Clinical pathways are evidence-based tools that integrate scientific knowledge into practice, improving care quality, reducing costs, and enhancing workflow efficiency. These pathways help minimize clinical variation and promote cost-effective care. Ensuring providers use them effectively and seamlessly integrate them into their workflow is crucial. Our goal was to analyze provider usage rates and gather feedback to improve pathway usability. We aimed to determine which providers are using the pathways, collect feedback, and generate suggestions for improvement. This led us to implement an educational session for clinical-year medical students to enhance the practice of high-value care at MUSC.

Methods: We designed surveys to collect feedback for quality improvement and distributed them to 100 healthcare providers across various MUSC campuses. To increase participation, we introduced a small incentive program (gift card raffle). We collected responses over four weeks, analyzed the data, and proposed improvements based on the feedback.

Results: We received 41 survey responses, including 10 attending physicians, 24 residents, and 7 other healthcare providers (PA, NP, nurse). Among respondents, 90% of attending physicians, 100% of residents, and 26% of others reported using pathways regularly. 74.3% found pathways "easy" or "very easy" to use, 62.9% reported workflow improvement, and 68.6% agreed that pathways helped implement high-value care. Feedback for improvement included issues with specific pathways, tracking progress, prolonged usage times, ease of access, linked resources, and a need for better medical education on pathway use and benefits.
Conclusion: Clinical pathways in EPIC are effective tools for streamlining the management of common diagnoses and are widely used among those surveyed. Improvements will focus on enhancing access and usability. Future efforts include incorporating pathway education into the third-year medical student curriculum to foster early adoption and further refine the tool.

Utilization and Benefits of Clinical Pathways in the Electronic Medical Record

Title: New diagnosis HIV linkage to care evaluation in Southeastern United States: A retrospective cohort study 

Background: The HIV epidemic has disproportionally impacted the southern US states, specifically, South Carolina with its estimated 20,000 residents living with HIV/AIDs. To combat this epidemic, the Ending the HIV Epidemic in the US initiative was published with 4 main pillars: diagnose HIV as early as possible, treat HIV rapidly to reach viral load suppression (<200 copies/L) (VS), prevent new HIV transmissions, and respond quickly to HIV outbreaks. New guidelines recommend initiating rapid antiretroviral therapy (ART) within 7 days of HIV diagnosis compared to the traditional goal of 30 days. This study investigated time to patient notification of positive HIV result, linkage to care, ART initiation, and achievement of VS in the SC Midlands. 

Methods: We retrospectively analyzed new HIV diagnoses from Prisma Health Midlands locations from 2022-2023. Descriptive statistics were used to analyze time to notifying patient of result, to first evaluation by HIV provider, to ART initiation, and to VS in both the inpatient and outpatient setting. 

Results: Among 91 patients newly diagnosed with HIV, 82.4% (75/91) were notified of results within 7 days and 69.2% (63/91) within 72 hours. For the remaining 16 patients, 15 were unreachable by phone after an average 3.2 attempts per patient. Eventually, 96.7% (88/91) were made aware of their diagnosis. Of 71 patients that established care with Prisma Health Immunology Center (PHIC), 33 were first evaluated by an HIV provider while inpatient and 38 in the outpatient clinic. Only 63.6% (21/33) of the patients evaluated inpatient initiated ART within 7 days of diagnosis, predominantly due to provider’s choice to wait until outpatient follow-up. For those with initial evaluation at PHIC, 47.4% (18/38) were seen within 7 days of diagnosis and 94.7% (36/38) were seen within 30 days. All patients initially seen outpatient were started on ART during their first appointment. Overall, for patients that established with PHIC, 67.6% (48/71) saw an HIV provider and 53.5% (38/71) initiated ART within 7 days of diagnosis. Nearly all patients (94.3%, 67/71) saw an HIV provider and (91.5%, 65/71) initiated ART within 30 days. For patients established with PHIC, 85.9% (61/71) achieved VS, averaging 97.15 days from diagnosis to VS. Patient non-adherence was the most common reason for not achieving VS. 

Conclusion: While almost all patients with new HIV diagnosis were linked to care and started ART within 30 days of diagnosis, only about half were started within 7 days. This study highlights opportunities to reduce this timeline by prioritizing patient contact information collection during medical encounters, considering point-of-care testing when applicable, standardizing inpatient HIV medication initiation protocols, and evaluating barriers to timely clinic referrals. Future studies with larger sample sizes could assess for demographic risk factors and system-based barriers leading to these delays.

New diagnosis HIV linkage to care evaluation in Southeastern US: A retrospective cohort study

Background: The chronic autoimmune condition, pediatric vitiligo, causes depigmentation, which leads to severe psychological distress during important developmental periods. The emerging therapies JAK inhibitors and oral compound glycyrrhizin address the immune-mediated melanocyte destruction in pediatric vitiligo patients, but they do not address the substantial psychosocial challenges these children face. This review examines the clinical effectiveness and psychosocial results of combined treatments for pediatric vitiligo while focusing on cultural elements and new gene-directed therapeutic approaches.

Methods: A systematic literature search was conducted across PubMed, Embase, PsycINFO, Web of Science, and Cochrane Library in May 2025 using terms related to pediatric vitiligo, clinical and psychosocial interventions, suicide risk, and molecular therapies. Eligible peer-reviewed studies (2010–2025) included children aged 0–18 with vitiligo and evaluated repigmentation outcomes, mental health impacts, or integrated treatment approaches. Studies were screened and reviewed by five independent reviewers. Risk of bias was assessed using Cochrane and ROBINS-I tools, and evidence strength was evaluated with GRADE.


Results: Our review demonstrated that topical JAK inhibitors together with glycyrrhizin-phototherapy combinations and prostaglandin analogues and Wnt/β-catenin signaling agonists proved effective for repigmentation with good safety results in children. There is an urgent need for randomized trials to evaluate the combination of medical and psychosocial interventions. The combination of psychological stress and stigma particularly affected children of color because it led to decreased quality of life and elevated their chances of developing depression, anxiety, and suicidal tendencies. The combination of family-based therapy with cognitive behavioral therapy (CBT) and culturally adapted interventions demonstrated effectiveness in strengthening emotional resilience and improving treatment adherence. The experimental phase of pediatric research includes gene-editing technologies (e.g., CRISPR), mRNA-based therapies, and melanocyte transplantation.

Conclusion: Pediatric vitiligo management must evolve toward an integrated model that addresses both biological and psychosocial dimensions of care. Existing therapies offer promising repigmentation outcomes, but their full potential is limited without concurrent psychological support. Longitudinal, multicenter trials measuring both clinical and psychosocial endpoints, particularly in diverse pediatric populations, are urgently needed. Additionally, culturally sensitive interventions and gene-based strategies may shape the future of personalized vitiligo care.


A Comprehensive Review of Integrated Psychosocial and Medical Approaches to Pediatric Vitiligo: Current Therapies, Suicide Risk, and Future Gene-Targeted Innovations

Background
Opioid use disorder (OUD) continues to drive significant morbidity and mortality across the U.S., yet emergency departments (EDs) remain underutilized as initiation points for evidence-based medication-assisted treatment (MAT). Despite legislation such as the 2023 MAT Act removing prior prescribing restrictions for buprenorphine, most ED physicians remain unfamiliar and reluctant to treat patients experiencing opioid withdrawal with partial opioid agonists such as buprenorphine. Academic centers such as Yale and UCSF have successfully piloted and implemented ED-based buprenorphine programs, but many hospital systems lack comprehensive systems to treat OUD in patients effectively in the fast-paced ED setting. Recognizing this gap, we developed and initiated a streamlined, evidence-informed algorithm for buprenorphine initiation in ED patients presenting with opioid withdrawal at Houston Methodist Hospital in Texas.

Methods
Our team synthesized peer-reviewed protocols and national guidelines from AAEM, ACEP, and published institutional frameworks to construct a simplified algorithm tailored for frontline ED use. The algorithm incorporated patient assessment via the Clinical Opiate Withdrawal Scale (COWS) and guided physicians through staged buprenorphine-naloxone induction steps based on symptom severity. Adjuvant therapy choices were included as algorithm side branches for patients experiencing buprenorphine-induced withdrawal. Recognizing physician hesitancy and knowledge gaps, the algorithm was designed for ease-of-use. Supplemental material for successful adoption by ED physicians incorporated research-driven treatment statistics, education on partial opioid agonists pharmacologic principles, and contraindications for treatment. In collaboration with institution staff, the tool was integrated into ED workflows, paired with a standardized discharge bundle including a curated list of outpatient MAT resources.

Results 
A simplified algorithm was implemented into the emergency department and electronic medical record. Data collection from outcomes of the implementation is ongoing across the Houston Methodist system. Formal tracking of MAT initiation rates and longitudinal patient outcomes are planned. Study design includes evaluation of implementation fidelity, patient engagement at follow-up, and trends in ED recidivism. Patient-facing resources are being distributed at the point of discharge for OUD patients started on buprenorphine, improving continuity of care and outpatient follow-up.

Conclusion
This project demonstrates the feasibility of deploying a simplified ED-based buprenorphine algorithm within a large healthcare system, the first of its kind in Texas. By addressing key barriers to MAT initiation, this approach has the potential to shift emergency departments from treating transient opioid withdrawal toward long-term treatment engagement for patients suffering from OUD. Future evaluation will assess clinical impact and generalizability, with the goal of encouraging replication at other hospitals and institutions nationwide.


ED-Initiated Buprenorphine: Designing a Simplified Algorithm for Opioid Use Disorder Treatment

Recurrent Hypoglycemia and Dementia Risk in Older Adults with Type 2 Diabetes: A Systematic Review

Background
Type 2 diabetes mellitus (T2DM) affects over 25% of adults aged 65 and older. While tight glycemic control is often indicated to reduce the risk of complications, it also elevates the risk of hypoglycemic episodes, particularly in older adults with reduced regulatory responses. Increasing evidence suggests that the recurrence of hypoglycemia may be linked to long-term cognitive decline and dementia. However, the strength of this association continues to be unclear. This systematic review analyzes current literature to assess how repeated hypoglycemic episodes can negatively impact cognitive function in older adults with T2DM.

Methods
A literature search was conducted in Ovid MEDLINE on May 11, 2025. The search terms included combinations of “type 2 diabetes,” “recurrent hypoglycemia,” “cognitive impairment,” “dementia,” and “older adults.” MeSH keywords were used for sensitivity. The inclusion criteria were: (1) studies involving human subjects older than 60 years of age, (2) a documented association between recurrent hypoglycemia episodes and cognitive outcomes, and (3) English-language publications. Study screening, reviewing, and data extraction were done by two reviewers using the Catchii platform. The final inclusion was determined with consensus, and PRISMA guidelines were followed.

Results
Eighteen studies met the inclusion criteria, including large-scale cohort studies, case-control studies, and meta-analyses. Across these studies, recurrent hypoglycemia was consistently associated with increased risk of dementia, Alzheimer’s disease, and vascular dementia. Several studies demonstrated a dose-response relationship, emphasizing the frequency of these events on the cognitive outcome in patients. Several biological mechanisms have been proposed throughout the studies, including neuronal glucose deprivation, cerebral microvascular damage, and accumulation of amyloid-beta and tau proteins. However, inconsistencies were noted in the definitions of hypoglycemia, cognitive assessment tools, and population characteristics. Most of the studies focused on severe hypoglycemia that required hospitalization, which limits generalizability to outpatient-managed patients.

Conclusion
Recurrent hypoglycemia is a significant risk factor for cognitive decline in older adults with T2DM. Increasing frequencies of hypoglycemic episodes, whether secondary to tight glycemic control or age-related diminished regulatory responses, predict even higher dementia risks. Data suggests a strong association, but limitations remain in the generalizability of the results due to differences in study = design and outcome measures. Future research should aim to standardize the definitions of hypoglycemia and measure specific cognitive functions. Additionally, we should investigate whether preventing hypoglycemia in elderly patients can decrease the risk of cognitive deterioration. These findings highlight the importance of individualized glycemic regimen in elderly diabetic patients to preserve long-term cognitive function.

Recurrent Hypoglycemia and Dementia Risk in Older Adults with Type 2 Diabetes: A Systematic Review

Abstract:
Short-term memory (STM) is a fundamental cognitive ability allowing individuals to store and recall small amounts of information for brief periods. Although STM plays a critical role in everyday cognitive tasks, gender differences in its performance remain underexplored. This study investigates the influence of gender on short-term memory performance in healthy individuals aged 15-20 years. A total of 130 participants (65 males, 65 females) were tested. The results revealed that females outperformed males, with an average recall score of 97% for females compared to 85% for males. These findings suggest that gender may influence short-term memory performance, offering new insights into cognitive gender differences.
Keywords: Short-term memory, gender differences, cognitive function, memory retention


Effect of short term memory on gender difference

Background 
Turnover time (TOT)—the interval between one patient exiting and the next entering the same operating room (OR)—is a key determinant of surgical efficiency. While industry benchmarks suggest a baseline of 30-40 min TOT for most surgical subspecialties, neurosurgery presents unique challenges due to procedural complexity and specialized equipment requirements. Extended turnover times can disrupt perioperative workflows, delay case start times, and decrease potential revenue as OR operational costs range from US$30-100 per minute. This study aims to identify modifiable drivers of prolonged neurosurgical TOT and propose data-driven interventions. 

Methods 
We conducted a mixed-methods study analyzing 1,232 neurosurgical turnovers at a high-volume academic hospital. A linear mixed-effects model was used to assess the influence of factors including inpatient versus outpatient status, procedure type, and temporal variables (day and month). Semi-structured interviews with perioperative staff and administrators (n=18) and direct OR observations were conducted to triangulate findings. 

Results 
Mean TOT was 58.9 minutes (SD = 13.1 minutes), with inpatient status adding 8.6 minutes (p<0.001). Complex procedures (e.g., spine tumor) averaged over 65 minutes, yet the 25th percentile within those categories achieved TOTs 9.6 minutes shorter than average—demonstrating that there is room for TOT improvement even for high-complexity cases. Stakeholders cited delayed patient transport, equipment readiness, and poor team coordination as recurrent issues. Electronic health record alert failures and inconsistent staffing compounded delays. Stakeholders also stressed the critical importance of aligning incentives and transparent accountability across services to ensure all personnel are motivated to achieve more efficient turnovers while maintaining regulatory compliance. Interviewees viewed the 30-minute target as unrealistic for neurosurgery. 

Conclusion 
TOT drivers are multifactorial, stemming from poorly coordinated patient flow, equipment setup inefficiencies, and fragmented intra-team communication. Next steps include piloting OR dashboards with real-time alerts, implementing role-specific turnover checklists, and setting tailored benchmarks by procedure type. Modeling interventions on the most efficient turnovers could reclaim OR time, reduce overtime costs, and improve team workflow without compromising safety.

Multimodal Analysis to Assess Drivers of High Neurosurgical Operating Room Turnover Time

Abstract Title
Enhancing Medical Education and Patient Care Through a Method of Loci-Based Medical Spanish Learning Platform

Background
Language barriers in healthcare, affecting over 41 million Spanish speakers in the U.S., impair patient-provider communication and trust, a problem underscored by studies on healthcare disparities. Traditional language learning methods are time-intensive, limiting adoption by busy medical professionals. Research on the method of loci (MoL) and visual mnemonics demonstrates enhanced vocabulary retention, with a 2022 study showing 20% better retention in language contexts (p < 0.05) and a 2018 study reporting 18% improved recall in paired-associate tasks. This gap in efficient, targeted language tools for providers informs the objective: to determine if a platform using MoL and visual mnemonics accelerates medical Spanish acquisition.

Methods
A language learning platform is being developed, integrating interactive imagery and MoL to teach medical Spanish. The platform anchors terminology using spatial memory techniques. A pilot study is designed with 50 novice Spanish-speaking medical providers, split into two groups: one using the MoL platform, the other a conventional app. Participants will train for 10 hours over 4 weeks, with pre- and post-tests measuring vocabulary retention and conversational fluency for 200 medical terms.

Results
A 2022 study on MoL in English as a foreign language contexts showed 20% better vocabulary retention in immediate post-tests compared to rehearsal methods (p < 0.05). A 2018 study on paired-associate learning found MoL users recalled 18% more words than controls, indicating potential for medical Spanish acquisition. These findings provide evidence of the platform’s potential to enhance retention and engagement, enabling faster mastery of medical terminology in a foreign language.

Conclusion
The platform, utilizing visual mnemonics and MoL, has the potential to accelerate medical Spanish acquisition, offering a more efficient alternative to traditional methods. By enabling providers to communicate in patients’ native languages, it can enhance trust, reduce miscommunication, and improve health outcomes. Future expansion to other languages could address broader language barriers, promoting equitable care across diverse populations.

Enhancing Medical Education and Patient Care Through a Method of Loci-Based Medical Spanish Learning Platform

Abstract Title 

Early Integration of Harm Reduction in Medical Education: A Pilot Curriculum for First-Year Medical Students 



Background 

Harm reduction is an evidence-based public health framework that mitigates the adverse outcomes associated with substance use, mental health crises, and other high-risk behaviors without requiring abstinence. Harm reduction training implemented in graduate medical education has enhanced physician preparedness and effectiveness in caring for people struggling with substance abuse and the formation of trusting patient-physician relationships. These principles are rarely emphasized in formal undergraduate medical training. Consequently, medical students often begin clinical practice without adequate preparation to provide effective, compassionate care for people who use illicit substances, and frequently lack the tools to reduce stigma, establish trust, and apply evidence-based interventions. Despite the proven effectiveness of harm reduction principles in reducing overdose deaths, transmission of infectious diseases, and facilitating the development of a trusting patient-physician relationship to improve patient treatment outcomes, a structured curriculum for harm reduction strategies is lacking in formal undergraduate medical education. This study aims to evaluate the impact of a newly developed pilot curriculum for first-year medical students, assessing their comprehension and application of harm reduction principles throughout their undergraduate medical education. 



Methods 

A novel harm reduction curriculum introduced in the preclinical phase of medical education, with a focus on practical strategies and person-first language to enhance the patient-centered care of those who use illicit substances. An anonymous, online pre- and post- questionnaire will assess first year medical student’s perspectives, bias, beliefs, preparedness, knowledge, and confidence utilizing harm reduction strategies. The curriculum and questionnaires will be administered to first year undergraduate medical students before and after the education session and longitudinally throughout their undergraduate medical education. Participants will serve as their own cross-sectional controls through the pre- and post-curriculum surveys, and longitudinal comparisons will be made using a control group of students from preceding academic years who have not received the novel harm reduction curriculum. 



Results 

Pending IRB approval, the curriculum is set to take place in November 2025. 



Conclusion 

We anticipate the harm reduction curriculum will lead to sustained improvements in the medical student's knowledge, confidence, and clinical application of harm reduction principles. By embedding these practices early in medical training, the curriculum has the potential to shift institutional culture and reduce stigma toward people who use illicit substances, and better prepare future physicians to deliver equitable, person-centered care. This model may serve as a scalable framework for nationwide integration into undergraduate medical health education.

Early Integration of Harm Reduction in Medical Education: A Pilot Curriculum for First-Year Medical Students

Background
Pathway programs have been successful in diversifying the physician workforce, which leads to improved quality of care for all patients. These programs are a key component in advancing equity in medical education to students from various backgrounds. While pathway programs develop a student’s professional skills, they also foster a sense of community that supports learning and growth. Despite the value of community in pathway programs, little qualitative research has explored its impact on pre-medical students. This study examines how the sense of community cultivated within a premedical pathway program influences students’ trajectories toward a career in medicine.

Methods
An in-depth focus group was conducted with 23 students who participated in a structured premedical pathway program. Using Social Cognitive Theory as a conceptual framework, we employed a deductive qualitative approach to thematic analysis and investigated how the social factors within the program affected a student’s sense of self-efficacy. Two independent researchers coded the transcript and identified core themes related to the students’ experiences of community within the program.

Results
Thematic analysis revealed five major themes: “Confidence/Empowerment,” “Professional development,” “Embodied mentorship,” “Shared experience,” and “Structured support.” The average inter-rater agreement was 87.36%. The most common theme that emerged was “Support,” with 21 references, followed by “Shared experience,” with 13 references. Students described the community fostered by the program as a meaningful source of comfort, encouragement, and guidance–particularly in navigating the challenges of the medical school application process. Overall, students were motivated and more confident in their ability to successfully pursue a career in medicine. 

Conclusion
Pathway programs offer more than professional development; they also build communities where students with shared goals and lived experiences can develop a lasting support system. Our analysis of the pre-medical pathway program highlights how this sense of belonging fosters peer mentorship, resource-sharing, and confidence in navigating the medical school application process. As admissions become increasingly competitive, these social resources are essential to increasing the representation of a diverse student body in medicine. Our results further illustrate the value of pathway programs and their place in advancing equity in the future physician workforce. 



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