Saint Luke's Research Day 2026

Background

Superior mesenteric artery aneurysms (SMAAs) are rare but carry a significant risk of rupture, with reported mortality rates after rupture approaching 25% to 70%. Clinical presentation is often nonspecific, including abdominal pain, weight loss, and decreased appetite, leading to delays in diagnosis. While endovascular repair is preferred when anatomically feasible, aneurysms involving multiple branch vessels often require open surgical reconstruction.

Case Description

We present the case of a 37-year-old male who presented with worsening diffuse abdominal pain for three days. His past medical history includes hypertension, methamphetamine use, tobacco use, mitral valve prolapse, and prior ascending hemi-arch repair for type A aortic dissection, consistent with underlying aneurysmal degeneration. CT angiography revealed a descending thoracic aortic dissection with an associated distal hemiarch aneurysm and a 2.5 cm proximal SMA aneurysm with a distal dissection flap. Multiple jejunal branches originated from the aneurysmal segment of the SMA.

Given the concern for visceral malperfusion and potential rupture, he was taken to the operating room for open SMA aneurysm repair. A midline laparotomy was performed, and the SMA aneurysm was identified at the base of the transverse mesocolon, densely adherent to the posterior peritoneum.

After obtaining proximal and distal SMA control and controlling multiple jejunal branches, the aneurysm was opened longitudinally, revealing a dissection flap with two perfusing lumens. An interposition reconstruction was performed using a rifampin-soaked Dacron conduit with an end-to-end distal anastomosis to the ileocolic artery beyond the dissected segment. The jejunal branches were reimplanted using Carrel patches anastomosed to the graft.

Results

Intraoperative assessment demonstrated strong Doppler signals in all reconstructed branch vessels with excellent flow through the reconstructed SMA. There was preserved perfusion throughout the small bowel mesentery with no evidence of visceral malperfusion.

Conclusion

SMAAs are not well studied in the literature, and there remains a lack of consensus in their management. This case highlights the complexity of treating SMAAs with associated dissection, particularly when multiple branch vessels are involved. In anatomically challenging cases, open reconstruction with branch reimplantation offers a safe and effective approach to restore mesenteric perfusion.

Lay Summary

Superior mesenteric artery aneurysms occur when a blood vessel supplying the intestines becomes enlarged and weakened. Although rare, they are dangerous because they can rupture, causing life-threatening complications. Symptoms such as abdominal pain and weight loss are often vague, which can delay diagnosis.

This case describes a young man with a complex aneurysm and a tear in this artery. Because several smaller vessels branched from the damaged area, minimally invasive repair was not possible. Surgeons performed an open operation to remove the damaged segment and rebuild it using a synthetic graft. The smaller vessels were preserved by removing them with small patches of surrounding tissue, similar to cutting out a button with fabric attached, and sewing them onto the graft to maintain blood flow.

Open surgical repair with vessel reimplantation is safe and effective for complex intestinal artery aneurysms. Documenting such cases helps guide treatment, standardize care, and improve outcomes.

Girish, Devan, BA

University of Missouri - Kansas City School of Medicine; St. Luke's Hospital

Background

Chronic pain is strongly associated with increased alcohol use due to self-medication and negative reinforcement mechanisms 1. While direct interventional studies are limited, mechanistic and clinical evidence suggests that improved pain control may reduce the motivation for alcohol consumption in this population 1. Alcohol use has been shown to provide short-term analgesia but worsen long-term outcomes due to its impact on the safety, efficacy, and overall outcomes of spinal cord stimulation (SCS) therapy.

Objective

This case evaluates the use of SCS therapy in providing patients with failed back syndrome more effective pain relief, leading to improvement in quality of life, functional outcomes, and patient satisfaction.

Results

After agreeing to a significant reduction in alcohol for nearly 16 months and repeat psychiatry evaluation, the patient was approved for, and proceeded with, SCS trial and implantation. At one week trial follow-up, patient reported “excellent improvement” to his pain and activity, with greater than 90% improvement. Six weeks after surgical implantation of the generator, the patient reported continued 90% reduction of pain symptoms and alcohol consumption.

Conclusion

This case demonstrates the utility of SCS therapy in providing patients with failed back syndrome more effective pain relief, leading to improvement in quality of life, functional outcomes, and patient satisfaction 3 The adequate treatment of this patient’s pain symptoms may likely have contributed to reducing his overall alcohol dependence.

Lay Summary

A 74-year-old with chronic low back pain and failed back syndrome experienced worsening symptoms after chiropractic adjustment. His history included multiple surgeries and unsuccessful treatments such as epidural steroid injections, radiofrequency ablations, and lumbar decompression and fusion. Imaging revealed severe foraminal stenosis and chronic radiculopathy. Despite interest in spinal cord stimulator (SCS) therapy, initial psychiatric evaluation advised against it due to long-standing alcohol use for pain self-management. Chronic pain is associated with increased alcohol consumption, which may worsen long-term outcomes and complicate SCS effectiveness. After significantly reducing alcohol intake for 16 months and receiving psychiatric clearance, the patient underwent SCS trial and implantation. He reported over 90% improvement in pain and function during the trial and sustained relief six weeks post-implantation, alongside reduced alcohol use. This case highlights the importance of addressing substance use in patient selection and suggests that effective pain control with SCS may improve both functional outcomes and alcohol dependence.

Penman, Jourdan, DO

University of Missouri Kansas City, Department of Anesthesiology

Background

Traumatic tricuspid regurgitation (TR) is an uncommon complication of blunt chest trauma and may be under recognized, particularly when presenting with transient arrhythmias. Early identification is critical to guide management and prevent long-term right heart dysfunction.

Case Presentation

A 44-year-old male presented as a level 1 trauma activation following a high-speed motor vehicle collision with multiple injuries, including femur and rib fractures, pulmonary contusions, and pleural effusion. During early hospitalization, he developed atrial fibrillation with rapid ventricular response, which resolved within 24 hours with rate control. Laboratory findings revealed elevated troponin consistent with myocardial contusion. Infectious evaluation, including blood cultures and serologies, was negative. Transthoracic echocardiography demonstrated right ventricular dilation with reduced systolic function, a flail tricuspid leaflet, and severe TR. Transesophageal echocardiography confirmed severe TR with suspected torn chordae and right atrial dilation. Follow-up imaging one month later showed preserved left ventricular function, normalization of right ventricular size, and persistent moderate-to-severe TR.

Methods

The patient was managed in the intensive care unit with telemetry monitoring and short-term intravenous amiodarone with resolution of atrial fibrillation. No emergent surgical intervention was pursued due to hemodynamic stability and absence of right heart failure. He underwent orthopedic repair of his femur fracture and supportive care for thoracic injuries. The patient was discharged with outpatient cardiac monitoring and multidisciplinary follow-up. At follow-up, he remained stable with mild exertional dyspnea and persistent TR and is undergoing evaluation for elective tricuspid valve repair or replacement. Conclusions

This case highlights traumatic TR as a rare but significant sequela of blunt chest trauma, often associated with myocardial contusion and transient arrhythmias. Echocardiography, particularly transesophageal imaging is essential for diagnosis. In hemodynamically stable patients without right heart failure, conservative management with close follow-up and planned surgical evaluation is appropriate. Early recognition and timely referral are key to optimizing outcomes and preventing progression to right ventricular dysfunction.

Lay Summary

Blunt chest injuries from car accidents can sometimes damage the heart in ways that are not immediately obvious. One rare complication is injury to the tricuspid valve, which helps control blood flow through the right side of the heart. If this valve is damaged, it can leak (called regurgitation), potentially leading to long-term heart problems if not recognized early. This case describes a 44-year-old man who developed a temporary abnormal heart rhythm and was later found to have severe tricuspid valve damage after a car crash. Our goal is to highlight how careful heart imaging can detect this condition, even when symptoms are mild. The patient was safely managed without emergency surgery and is being monitored for planned repair. This case emphasizes the importance of early diagnosis and follow-up, which can help prevent future heart failure and improve outcomes for trauma patients.

Bhardwaj, Anjali, MD

University of Missouri- Kansas City

Background

Sacroiliac joint dysfunction is a commonly underrecognized source of chronic low back pain that burdens the healthcare system1. Patients refractory to common conservative therapies may benefit from SI joint fusion as a minimally invasive, safe, and more accessible way to treat chronic low back and SI joint pain.

Objective

Evaluate the effectiveness of PainTEQ system as a minimally invasive SI joint fusion technique that allows for stabilization of the joint while minimizing dangers of more invasive techniques, doing so without drilling, and minimizing tissue disruption2.

Case Study

A 54-year-old female with a history of chronic low back and buttock pain presented with symptoms consistent with SI joint dysfunction. Pain was localized to the right side of her lower back and pain was described as sharp, was exacerbated by walking, standing, and lifting, and was mildly improved by rest and over-the-counter medications. Patient had a 6-week trial of physical therapy without improvement. Patient underwent a diagnostic/therapeutic SI joint injection with a strong response and 100% improvement of pain for eight hours before her pain returned to baseline. On physical exam, patient had tenderness over right SI joint space, positive right FABER maneuver, positive right thigh thrust, and positive right Gaenslen’s maneuver. After discussion with patient, plan was made to undergo a sacroiliac joint fusion using the PainTEQ system.

Results

Upon completion of surgery, patient reported improvement in pain, function, and tolerated activity better from one week post-operatively.

Conclusion

This case demonstrates that posterior SI joint fusion using the PainTEQ system may provide effective pain relief and functional improvement in patients with refractory SI joint dysfunction. Studies have proven that this is a safe and effective procedure to decrease, and potentially resolve, pain that originates from SI joint dysfunction3,4. This not only improves the patient quality of life, but also lessens the cost burden on healthcare in the short-term setting1. Further studies are warranted to evaluate long-term outcomes, cost impact, and comparative efficacy versus alternative fusion techniques.

Lay Summary

Sacroiliac joint dysfunction is a commonly underrecognized and undertreated source of chronic low back pain that further burdens the healthcare system. Patients refractory to common conservative therapies may benefit from SI joint fusion as a minimally invasive, safe, and more accessible way to treat chronic low back and SI joint pain. The PainTEQ system is a minimally invasive SI joint fusion technique that allows for stabilization of the SI joint while minimizing dangers of more invasive techniques, doing so without drilling, and minimizing tissue disruption. Studies have proven that this is a safe, effective, and dependable procedure to decrease, and in some cases completely resolve, pain that originates from SI joint dysfunction. This not only improves the patient quality of life, but also lessens the cost burden on healthcare in the short-term setting. Further studies are warranted to evaluate long-term outcomes, cost impact, and comparative efficacy versus alternative fusion techniques.

Eaton, Vincent, MD

UMKC

Background

Occupational exposure to ionizing scatter radiation remains a significant hazard for operators performing cardiac catheterization procedures. A sterile, disposable lead-free radiation attenuation pad has been shown to reduce operator exposure when placed on the patient; however, the optimal orientation of this pad remains unclear.

Objective

This study evaluates whether vertical versus horizontal pad orientation affects operator radiation exposure.

Methods

We conducted a prospective, single-center study over 12 weeks, including patients undergoing diagnostic coronary angiography with or without percutaneous coronary intervention. Two catheterization laboratories were randomly assigned weekly to either vertical or horizontal pad orientation. A mobile radiation shield was used in all procedures. Outcomes included fluoroscopy time, total radiation dose (mGy), dose area product (DAP), and operator exposure measured by personal dosimeter (μrem). Relative exposure indices were calculated as μrem/DAP and μrem/mGy. Comparisons between groups were performed using Welch’s t-test and chi-square testing.

Results

A total of 199 cases were analyzed (vertical: n=106; horizontal: n=93). Baseline characteristics were similar between groups. Fluoroscopy time (19.4±15.6 vs 18.9±17.3 minutes, p=0.86), total radiation dose (444.4±401.9 vs 436.5±370.8 mGy, p=0.89), and DAP (61.1±58.2 vs 64.7±58.2, p=0.66) were comparable. Absolute operator exposure did not differ significantly (189.7±200.3 vs 184.2±229.9 μrem, p=0.86). Relative exposure per DAP (3.5±3.2 vs 3.4±3.5, p=0.93) and per radiation dose (0.3±0.4 vs 0.4±0.7 μrem/mGy, p=0.10) were also similar between groups.

Conclusions

Pad orientation (vertical vs horizontal) did not significantly impact operator radiation exposure across all measured metrics. These findings suggest that, when standard shielding strategies are employed, pad orientation may have limited influence on radiation reduction. Optimization efforts may be better directed toward comprehensive shielding techniques and procedural factors rather than pad orientation alone.

Lay Summary

Radiation exposure is a daily concern for doctors performing heart catheterization procedures, as repeated exposure over time can affect long-term health. A lightweight, disposable pad placed on the patient has been designed to reduce this exposure, but it is unclear whether the way the pad is positioned makes a difference.

In this study, we compared two ways of placing the pad—vertically and horizontally—during real-world procedures and measured how much radiation the doctor received.

We found that radiation exposure was similar regardless of how the pad was positioned. This suggests that the exact orientation of the pad may not be as important as previously thought when other protective measures are used. These results highlight that focusing on overall radiation safety strategies may be more impactful than adjusting pad position alone.

Gonzalez Sanchez, David, MD

Saint Luke's Mid America Heart Institute

Background

Cardiovascular disease (CVD) remains the leading cause of hospitalization and mortality in the United States. While national data highlight disparities across sex, race, and socioeconomic status, local-level analyses are essential to identify high-risk populations and inform targeted interventions.

Objective

This study evaluates differences in CVD-related hospitalizations across demographic and geographic subgroups in Kansas City, Missouri, from 2016 to 2022.

Methods

We performed a retrospective analysis of hospitalization data from Kansas City, Missouri (2016–2022). Encounters containing ICD-10-CM codes for acute ischemic heart disease (I21, I22, I24) and cardiac arrest (I46) were identified. Hospitalization proportions were calculated as the percentage of total hospitalizations and stratified by sex, race, ethnicity, year, and census tract of residence. Geographic variation was assessed using census tract–level data as a proxy for neighborhood-level differences.

Results

Significant disparities in CVD-related hospitalizations were observed across demographic groups. Males had a higher proportion of hospitalizations compared with females (2.20% vs 1.27%). By race, Native Hawaiian/Pacific Islander (1.95%), Black or African American (1.88%), and American Indian/Alaska Native (1.70%) populations demonstrated higher hospitalization proportions compared with White (1.64%) and Asian (1.11%) populations, while multiracial individuals had the lowest proportion (0.99%). Hispanic/Latino patients had lower hospitalization proportions compared with non-Hispanic patients (0.95% vs 1.71%). Geographic variation was evident, with census tract–level hospitalization proportions ranging from 1.29% to 1.67%, suggesting clustering of disease burden in specific neighborhoods. Temporal trends showed relatively stable rates from 2016–2020 (1.35%–1.64%), a marked increase in 2021 (4.67%), and a return to baseline in 2022 (1.41%).

Conclusions

CVD-related hospitalizations in Kansas City demonstrate important disparities by sex, race, ethnicity, and geography. Higher hospitalization proportions among males and certain racial groups, along with geographic clustering, highlight inequities in cardiovascular health. These findings underscore the need for targeted, community-based prevention strategies and equitable access to care. Future studies should integrate socioeconomic and environmental factors to better understand and address drivers of these disparities.

Lay Summary

Gonzalez Sanchez, David, MD

Department of Internal Medicine, University of Missouri Kansas City, KC, MO

Background

Cardiac amyloidosis is an increasingly recognized cause of heart failure where early diagnosis is critical for management and prognosis. Cardiac Magnetic Resonance (CMR) detects indirect structural and tissue changes such as extracellular volume expansion and late gadolinium enhancement, whereas Positron Emission Tomography (PET) enables direct molecular imaging of amyloid deposition. Differences in cost, radiation exposure, and availability make comparison clinically relevant, and no prior meta-analysis has directly compared their diagnostic accuracy.

Objective

Two advanced imaging tests are commonly used: Cardiac MRI, which shows structural changes in the heart, and PET scans, which can directly detect protein buildup. In this study, we combined results from multiple studies to compare how well these tests diagnose cardiac amyloidosis.

Methods

A systematic review following PRISMA guidelines searched PubMed, Embase, Scopus, and Cochrane through February 2026. Studies evaluating diagnostic performance of both modalities were included, including transthyretin and light-chain cardiac amyloidosis. Pooled sensitivity and specificity were calculated using meta-analytic models, and relative sensitivity and specificity were compared using risk ratios.

Results

Of 72 screened records, 15 studies were fully reviewed and 10 met inclusion criteria. Pooled sensitivity was similar between modalities (CMR 90%, PET 90%), with no significant difference on relative analysis (RR 0.98, 95% CI 0.91-1.05; p = 0.59). Pooled specificity was numerically higher for PET (99%) compared with CMR (89%); however, relative specificity analysis showed no statistically significant difference (RR 0.98, 95% CI 0.87-1.10; p = 0.72).

Conclusion

CMR and PET demonstrate comparable sensitivity and specificity for detection of cardiac amyloidosis. Although PET showed numerically higher pooled specificity, relative analysis found no significant difference between modalities. PET and CMR provide complementary strengths through direct molecular imaging and tissue characterization, supporting a multimodality approach to improve diagnostic confidence in suspected cardiac amyloidosis.

Lay Summary

Cardiac amyloidosis is a condition where abnormal proteins build up in the heart, leading to heart failure if not detected early. Early and accurate diagnosis is important because treatment can improve outcomes.

Two advanced imaging tests are commonly used: Cardiac MRI, which shows structural changes in the heart, and PET scans, which can directly detect protein buildup. In this study, we combined results from multiple studies to compare how well these tests diagnose cardiac amyloidosis.

We found that both tests perform similarly in detecting the disease, with PET showing slightly higher ability to rule it out, though the difference was not significant. These findings suggest both tests are valuable and can complement each other, helping doctors choose the most appropriate test based on patient needs.

Prajapati, Poojan, MBBS

University of Missouri - Kansas City

Background

Upper gastrointestinal (GI) bleeding is a common and serious complication. Proton pump inhibitors (PPIs) are standard for prevention, but potassium-competitive acid blockers (PCABs) offer more rapid and potent acid suppression, faster onset of action, and the advantage of reliable oral administration compared with intravenous PPIs. Most evidence for PCABs comes from Asian studies, including post–endoscopic submucosal dissection (ESD) patients, while US data remain limited. Comparative effectiveness across broader populations is not well established.

Objective

Compare proton pump inhibitors (PPIs) and the newer drugs known as potassium-competitive acid blockers (PCABs) to see which better prevents bleeding.

Methods

Following PRISMA guidelines, we searched PubMed, Cochrane, Embase, and Scopus through October 2025 using the following terms (vonoprazan OR “TAK 438” OR “potassium competitive acid blocker”) AND (“proton pump inhibitor” OR PPI OR omeprazole OR lansoprazole OR pantoprazole) AND (“gastrointestinal bleeding” OR “peptic ulcer bleeding” OR “re bleeding” OR “post ESD bleeding”). Studies comparing PCABs with PPIs for GI bleeding prevention were included. The primary outcome was incidence of GI bleeding. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random- or fixed-effects models. Subgroup analyses included randomized controlled trials (RCTs) only and analyses excluding post-ESD patients.

Results

Of 22 screened records, 10 studies (97,377 patients: 37,944 PCAB, 50,003 PPI) met inclusion criteria. Across all patients, PCABs showed a non-significant reduction in GI bleeding (RR 0.79, 95% CI 0.59–1.07; p = 0.13). In RCTs only, bleeding trended lower with PCABs (RR 0.57, 95% CI 0.29–1.13; p = 0.108). Excluding post-ESD patients, the effect was attenuated (RR 0.87, 95% CI 0.67–1.13; p = 0.3).

Conclusion

PCABs demonstrate a trend toward lower GI bleeding compared with PPIs, particularly in randomized controlled trials, though differences were not statistically significant. The benefit appears less pronounced when post-ESD patients are excluded. Given their rapid onset, potent acid suppression, and ease of oral administration, further large, high-quality studies are needed to clarify the role of PCABs in preventing GI bleeding across diverse patient populations.

Lay Summary

Upper gastrointestinal (GI) bleeding can be a serious and sometimes life-threatening condition. Medications called proton pump inhibitors (PPIs) are commonly used to prevent it, but newer drugs known as potassium-competitive acid blockers (PCABs) may work faster and more effectively. We reviewed available studies comparing these two treatments to see which better prevents bleeding. Our findings suggest that PCABs may reduce the risk of bleeding compared to PPIs, but the difference was not statistically significant. More research, especially in diverse populations, is needed. If confirmed, PCABs could offer a faster, more convenient option for preventing GI bleeding in everyday clinical practice.

Prajapati, Poojan, MBBS

University of Missouri - Kansas City

Background

Pancreatic cancer is associated with high symptom burden and frequent acute care utilization. Although early palliative care improves quality of life in advanced malignancies, real-world data describing its timing and downstream impact in pancreatic cancer remain limited.

Objective

Evaluate if early implementation of palliative care may improve coordination of symptom-focused care and represent an actionable quality-of-care target in pancreatic cancer.

Methods

We conducted a retrospective cohort study using Epic Cosmos (2015–2025). Adults (≥18 years) with pancreatic cancer were identified using ICD-10 code C25. Early palliative care was defined as a documented palliative care encounter (ICD-10 Z51.5) within 0–2 months of cancer diagnosis. Patients were categorized as early palliative care versus not-early palliative care (late or no palliative care). A landmark approach was applied, with outcomes assessed beginning 2 months after diagnosis to mitigate immortal time bias. Outcomes included opioid use, antiemetic use, occupational/physical therapy (OT/PT) utilization, emergency department (ED) encounters resulting in inpatient admission, and inpatient length of stay.

Results

Among 4,641 patients with pancreatic cancer, 464 (10.0%) received early palliative care, 365 (7.9%) received palliative care later, and 3,812 (82.1%) had no documented palliative care encounter. Compared with patients without early palliative care, early palliative care recipients demonstrated higher utilization of symptom-directed interventions, including opioids (40.6% vs 22.5%), antiemetics (37.2% vs 20.3%), and occupational/physical therapy services (6.2% vs 3.2%). Early palliative care was associated with a higher proportion of emergency department encounters resulting in inpatient admission (52.5% vs 23.6%), consistent with earlier consolidation of symptom-driven care. Mean inpatient length of stay was similar between groups (6.0 vs 6.2 days). Overall survival appeared comparable between groups; however, survival estimates in EHR-based analyses are limited by residual confounding and timing constraints.

Conclusions

In a large national EHR cohort, early palliative care within two months of pancreatic cancer diagnosis was infrequently used but was associated with greater engagement in symptom-directed medications and supportive services, as well as a distinct downstream pattern of acute care utilization. These findings suggest that earlier integration of palliative care may improve coordination of symptom-focused care and represent an actionable quality-of-care target in pancreatic cancer.

Lay Summary

Pancreatic cancer often causes serious symptoms such as pain, nausea, and fatigue, which can greatly affect daily life and lead to frequent hospital visits. Palliative care focuses on relieving these symptoms and improving quality of life, but it is not always offered early in the course of illness.

This study found that only about 1 in 10 patients received early palliative care. Those who did were more likely to receive treatments for pain and nausea and to use supportive services like physical or occupational therapy. They also had more hospital admissions through the emergency department, likely reflecting more proactive symptom management.

Future efforts could focus on encouraging earlier use of palliative care, improving patient and family awareness, and developing systems to connect patients with supportive care soon after diagnosis. Overall, this study highlights an opportunity to improve care by integrating supportive services earlier in treatment.

Overall, this study highlights a clear opportunity to improve care for people with pancreatic cancer by integrating supportive services earlier in their treatment journey

Srinivasan, Varshini, MBBS, PGY1 Internal Medicine

Saint Luke's & UMKC

Background

For patients admitted to Intensive Care Units (ICUs) with acute stroke, ICU delirium can compound an already complex hospitalization. The incidence of ICU delirium in patients with acute stroke ranges from 12% to 75%. Development of delirium has been associated with increased length of ICU stay, increased healthcare costs, impaired cognition, and decreased functional independence. Prediction models would facilitate recognition of those at greatest risk for delirium, improve understanding of acute delirium events, and enhance early implementation of interventions. Current models for predicting delirium in acute stroke patients have limited generalizability and clinical applicability.

Objective

The purpose of this secondary data analysis was to determine the incidence of ICU delirium in acute stroke patients and to examine relationships between underexplored factors that may be associated with the development of delirium in this population.

Method

Supported by prevention theory, a retrospective, descriptive, correlational study was conducted. Using data extracted from the electronic medical record, descriptive statistics were used to analyze demographic data and the incidence of delirium. A binary logistic regression statistical analysis was employed to determine the extent to which factors can predict ICU delirium in adult patients admitted to the ICU with acute stroke.

Results

Results indicated a total of 501 of the 2,388 (20.98%) stroke patients in this sample developed delirium at least once during their hospitalization, Of the 501 patients that developed delirium, 42.12% did so within 24 hours of ICU admission, and 60.68% did so within 48 hours of ICU admission.

Conclusion

The final regression model suggested factors significantly associated with development of delirium included type of stroke; history of vision impairment, schizophrenia, or dementia; first RASS score; first MORSE Fall Risk Scale score consistent with “High Fall Risk;” first blood glucose above normal limits; placement of nasogastric tube, peripheral line, or peripherally inserted central catheter within 24 hours of ICU admission; transferring to IR or Neuro OR within 24 hours of ICU admission; and occurrence of fever > 100F. Though these factors are mostly non-modifiable in nature, these data do support a better understanding of the critically ill acute stroke patients most at risk for developing delirium.

Lay Summary

Delirium is a common and serious complication in stroke patients admitted to the ICU, contributing to extended ICU stays, cognitive and functional impairment, and increased mortality. Determining factors capable of predicting delirium could improve our ability to prevent and treat delirium. We sought to determine the incidence of delirium and evaluated factors that commonly occur in ICUs to determine predictive ability. Approximately 20% of patients admitted to the ICU with acute stroke developed delirium, and 60% of those that developed delirium did so within 48 hours of ICU admission. We found that past medical history, high fall risk score, altered level of consciousness, elevated blood glucose, placement of nasogastric tubes or peripheral lines, and transferring to procedures outside the ICU within 24 hours of admission could increase stroke patients’ risk of developing delirium. These findings support a better understanding of critically ill stroke patients most at risk for developing delirium.

Callahan, Katie, BSN, RN

University of Missouri-Kansas City School of Nursing and Health Studies

Background

Stroke care continues to advance, yet major disparities persist across race, socioeconomic status, geography, and access to timely treatment. Populations most affected by stroke also carry higher lifetime exposure to trauma, including adverse childhood experiences, structural inequities, and chronic stressors shaped by the social drivers of health. These trauma histories influence how individuals interpret threat, loss of control, and vulnerability during acute neurological events. Despite this overlap, trauma‑informed approaches are not routinely integrated into stroke workflows. A central barrier is that trauma in stroke remains poorly defined, limiting the ability to operationalize Trauma‑Informed Care (TIC) across the stroke continuum. Empirical studies consistently show that survivors experience stroke as a traumatic event marked by sudden threat to multiple domains of life.

Objective

To define trauma in stroke by integrating survivor and caregiver narratives and applying SAMHSA’s Trauma‑Informed Care (TIC) principles as analytic categories.

Methods

Guided by the research question, “How does incorporating survivor and caregiver narratives reshape the conceptual understanding of trauma in stroke care, and what implications does this have for designing trauma‑informed systems?” a hybrid theory‑building approach was used. Walker and Avant’s eight‑step method structured the concept analysis; SAMHSA’s trauma framework informed coding categories; and Braun and Clarke’s reflexive thematic analysis guided data interpretation. A targeted literature review identified qualitative, mixed‑methods, and observational studies containing narrative accounts of stroke onset, acute care, hospitalization, rehabilitation, and early recovery. Data were extracted, coded, and synthesized to identify antecedents, defining attributes, consequences, and TIC gaps. Model, borderline, related, and contrary cases were developed to refine conceptual boundaries and support construction of an integrated conceptual model.

Results

Twelve articles were reviewed. Trauma in stroke emerged as a multifaceted, ongoing experience beginning at acute onset and shaped by prior trauma, neurobiological vulnerability, and coping styles. Antecedents, defining attributes, consequences, and TIC gaps were identified and incorporated into a preliminary conceptual model and working definition of trauma in stroke.

Conclusions

This analysis offers a working definition and conceptual model of trauma in stroke. A systematic review will further refine the construct and strengthen theoretical clarity and clinical applicability.

Implications:

Findings position trauma as a core component of the stroke experience and provide a framework for integrating TIC across acute care, rehabilitation, and follow‑up to improve communication, reduce emotional harm, and enhance recovery, equity, and patient experience.

Lay Summary

Stroke is a time sensitive frightening medical emergency. Survivors often describe the sudden loss of control, changes in their body, confusion, and fear of dying as overwhelming. These reactions can be even stronger for people who have experienced trauma earlier in life which is common in stroke survivors or who face ongoing stress, discrimination, or limited access to care.

This project reviewed survivor and caregiver stories to better understand what trauma looks like during and after a stroke. We found that trauma can come from the stroke itself, from how the brain and body react, and from how the healthcare system responds. These experiences can affect recovery, relationships, and long‑term health.

By defining trauma in stroke more clearly helps guide the development of trauma‑informed approach, care that supports safety, trust, communication, and healing for every patient. The use of this type of care can prevent additional harm during healthcare interactions.

Doan, Erin, PhD

Saint Luke's Neurology, Saint Luke's Health System, BJC

BACKGROUND

New graduate APPs often face role ambiguity, limited structural support, and high turnover, nearly twice that of physicians. A national neurologist shortage further strains access to care. In response, Saint Luke’s Health System launched a structured fellowship aligned with the American Academy of Neurology’s (AAN) call for collaborative care models to support clinical readiness, identity formation, and retention.

OBJECTIVE

To describe the development, evolution, and institutional impact of a neurology Advanced Practice Provider (APP) fellowship program, as experienced and shaped by the lead APP, the first fellow, and the most recent graduate.

METHODS

Initiated in 2019, the 9-month fellowship hired APPs into budgeted roles with asynchronous enrollment based on departmental needs. It expanded to include experienced APPs and hybrid fellows. Core components included APP co-director leadership, milestone-based salary adjustments, protected education,, weekly mentorship, and optional stress assessments. Fellows accessed resident didactics, AAN’s Continuum journal review, peer-led teaching, and multidisciplinary sessions. Additional foundational activities included shadowing APP/physician experts, monthly meetings on ethics, legal training, professionalism, career development, and a flexible peer support comprehensive program tailored to clinical focus.

Results

Twenty-one fellows across seven subspecialties (Movement, Cognitive, Neuroimmunology, Epilepsy, Headache, Vascular, Neuromuscular) graduated with 100% two-year retention and 90% retention at seven years. APPs evolved into educators, co-developing curricula, mentoring, and leading peer teaching. Physician engagement increased, strengthening a collaborative teaching culture. APP Journal club participation fostered leadership and department engagement. Fellows reported increased confidence in safe, effective practice. Unanticipated outcomes included APP-led research, system-wide committee work, statewide service and expanded leadership roles.

Conclusion

This fellowship model offers a scalable, emotionally attuned framework for integrating APPs into neurology. Its evolution reflects institutional responsiveness, interdisciplinary leadership, and a commitment to sustainable workforce development. Future iterations may include dedicated time for clinic logistics review and mentorship from APPs with efficient workflows based on survey data by neuroscience multidisciplinary feedback.

Lay Summary

Saint Luke’s Health System created a neurology fellowship to help new Nurse Practitioners and Physician Associates (NPs and PAs) transition confidently into their jobs. Many new NPs and PAs enter the workforce with limited support, unclear expectations, and high stress, especially in fields like neurology where provider shortages and community demands are increasing. The fellowship, launched in 2019, offers a structured six‑month learning period with protected education time, weekly mentorship, and opportunities to learn alongside physicians, residents, and experienced NPs and PAs. Fellows participate in classes, case discussions, journal reviews, and hands‑on shadowing across neurology subspecialties.

Over eight years, 21 fellows have completed the program, representing seven areas of neurology. Retention has been strong, and graduates have become educators, mentors, and leaders. The program has strengthened teamwork, expanded NP and PA involvement in research and committees, and improved confidence among new clinicians. Future survey data will guide program improvements.

Doan, Erin, PhD <etompkins@saintlukeskc.org>

Saint Luke's Neurology, Health System, BJC

Background

Emerging experimental and human data suggest that autoreactive T cells may undergo pathogenic “licensing” within the gut before trafficking to the central nervous system (CNS) and contributing to multiple sclerosis (MS). Disruption of gut-associated immune activation may therefore have implications for CNS autoimmunity. Vedolizumab, a gut-selective monoclonal antibody targeting α4β7 integrin and approved for inflammatory bowel disease (IBD), provides a unique clinical context to explore the gut–CNS immune axis.

Objective

To evaluate whether exposure to vedolizumab is associated with differences in MS prevalence among patients with Crohn’s disease (CD) or ulcerative colitis (UC).

Methods: We conducted a retrospective observational study using Epic Cosmos, a large de-identified electronic health record platform comprising data from hundreds of healthcare systems, primarily in the United States with additional international representation, encompassing approximately 300 million patients. Individuals with CD (ICD-10: K50) or UC (ICD-10: K51) and a concomitant MS diagnosis (ICD-10: G35) between August 21, 2010, and August 20, 2025 were identified. We then examined a subset of vedolizumab-treated IBD patients, excluding those with a diagnosis of MS prior to vedolizumab initiation, and calculated the proportion diagnosed with MS within five years of exposure. Prevalence estimates with 95% confidence intervals (CIs) were calculated and compared using chi-square testing. Results

Among 1,027,704 patients with CD, 8,098 (0.79%; 95% CI 0.77–0.81%) had MS. In contrast, among vedolizumab-treated CD patients, 125 (0.22%; 95% CI 0.18–0.26%) were diagnosed with MS within five years of exposure (p<0.001). Similarly, among 1,294,362 patients with UC, 9,564 (0.74%; 95% CI 0.73–0.76%) had MS, whereas only 109 vedolizumab-treated UC patients (0.17%; 95% CI 0.14–0.20%) developed MS within five years (p<0.001).

Conclusions

In this large real-world analysis, MS prevalence was substantially lower among vedolizumab-treated IBD patients compared with the overall IBD population. While causality cannot be inferred and confounding by indication and diagnostic limitations remain important considerations, these findings are biologically plausible and hypothesis-generating. They support further investigation into the role of gut-associated immune mechanisms in MS pathogenesis and the potential relevance of gut-selective immune modulation in CNS autoimmunity.

Lay Summary

Multiple sclerosis (MS) is a disease in which the body’s own immune system attacks the brain and spinal cord. Scientists are still learning what triggers this immune attack, but there is growing evidence that the gut—often called the “second brain”—may play an important role. Immune cells known as T cells can become activated, or “licensed,” in the gut before traveling through the bloodstream to other parts of the body, including the brain. In this study, we asked whether blocking immune cell movement from the gut might reduce the risk of developing MS. We focused on a drug called vedolizumab, which is approved for treating inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis. Vedolizumab works by preventing certain immune cells from leaving the gut and entering circulation. Using a large, nationwide U.S. database of electronic health records (Epic Cosmos), we analyzed data from more than 2.3 million people with IBD between 2010 and 2025. We found that approximately 0.7–0.8% of patients with Crohn’s disease or ulcerative colitis also had a diagnosis of MS. However, a smaller proportion of patients treated with vedolizumab—about 0.17–0.22%—had an MS diagnosis recorded within five years after starting the drug. Because this was an observational study using health records, it cannot determine whether vedolizumab causes a lower risk of MS. The observed differences may be influenced by other factors, such as treatment selection or differences in healthcare use. However, these findings suggest a potential association between gut-targeted immune therapy and MS that warrants further study. They also support growing interest in the connection between the gut and the brain through the immune system, often referred to as the gut–brain axis. Future research, including prospective and mechanistic studies, will be needed to better understand these relationships and their implications.

Shirani, Afsaneh, MD, MSCI

Saint Luke’s Marion Bloch Neuroscience Institute, Kansas City, MO; University of Missouri-Kansas City, MO