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Nurses\u27 psychological impact of caring for patients with LVADs: Patients, providers, & caregivers triangle of relationships .
No full textUNLABELLED: Nurses risk developing psychological distress due to the nature of their work environments and patient populations. Nurses caring for Left Ventricular Assist Device (LVAD) patients are at risk of distress related to stressful care requirements, patient relationships, and ethical dilemmas.
OBJECTIVES: To explore the impact of caring for patients with LVADs on nurses\u27 psychological health and examine strategies for stress management.
METHODS: A descriptive, qualitative study was completed using a semi-structured interview process. Interviews with registered nurses working in various roles and settings included predetermined questions to provide structure while allowing for open-ended elaboration of the topic from the participant\u27s perspective through natural conversation.
FINDINGS: Five themes were developed from interviews with nurses and include Caring for the LVAD Instead of the Patient; Right Implant, Wrong Patient; Complex and Connected Care; Mental Exhaustion and Life Balance; Effective Coping and Semi-effective Resources.
CONCLUSIONS: The results of the study provide implications for nursing practice and education surrounding the use of LVADs while highlighting the importance of emotional and mental health support in the workplace to decrease the burden experienced by nurses caring for these patients.
IMPLICATIONS FOR CLINICAL PRACTICE: The complexity of relationships with patients with LVADs and their multidisciplinary teams creates a workplace culture that fails to prioritize mental health support for nurses caring for these patients. Current support for nurses caring for patients with LVADs is not effective. Clinical practice settings would benefit in supporting nurses\u27 mental health to allow them to remain mentally present, resilient, and effective clinically
Subsequent primary malignancies in patients with initial diagnosis of pituitary adenoma: a surveillance, epidemiology, and end results (SEER) data analysis.
No full textBACKGROUND: Pituitary adenoma is a frequently encountered intracranial mass that is typically characterized by slow growth and benign behavior. There remains limited knowledge regarding the risk of developing a subsequent primary malignancy (SPM) in a patient with a pituitary adenoma. This study assessed the risk of developing a SPM after a pituitary adenoma diagnosis.
METHODS: The Surveillance, Epidemiology, and End Results (SEER-17) data registry, which consisted of 9,208,295 patients, was utilized to generate a cohort of 60,677 patients diagnosed with pituitary adenoma to identify patients at risk for a SPM. The SEER patient data was collected from the years 2000 to 2020. Statistical analysis was performed through SEER\u27s stat package and Standardized Incidence Ratios (SIRs) for various malignancies after the diagnosis of primary pituitary adenoma were obtained. We also collected basic demographic, surgical, and postoperative data.
RESULTS: Of the 60,677 patients, 4067 (6.7%) received a diagnosis of a SPM, which correlates to a higher risk than the general population (SIR, 1.1, 99% CI, 1.06-1.15). Patients with a pituitary adenoma had an increased risk of the following cancers: lymphatic and hematopoietic (SIR, 1.25; 99% CI, 1.09-1.41), kidney and renal pelvis (SIR, 1.45; 99% CI, 1.2-1.74), cutaneous melanoma (SIR, 1.36; 99% CI, 1.15-1.16), and thyroid cancer (SIR, 2.76; 99% CI, 2.32-3.26). Additionally, females were more predisposed to the following cancers: Digestive system (SIR, 1.19; 99% CI, 1.11-1.25), and non-Hodgkin\u27s Lymphoma (SIR, 1.41; 99% CI, 1.04-1.88).
CONCLUSION: Utilizing the SEER database, we have discovered an increased risk of SPM in patients with pituitary adenoma. Supplementary research may be done to determine any shared genetic abnormalities between the development of pituitary adenoma and these SPMs. Additionally, further research of the endocrinological effects of pituitary adenoma and potential associations to SPMs should be studied
Onset of Ocular Abnormalities in Children with Hearing Loss.
No full textPURPOSE: Children with hearing loss are commonly referred for eye examinations, but the optimal timing of asymptomatic ophthalmological screening exams is unclear. We sought to determine the prevalence and onset of abnormal ocular findings in children with hearing loss.
DESIGN: Retrospective cohort study.
SUBJECTS: Children with hearing loss seen for any indication by the pediatric ophthalmology practice at Children\u27s Hospital of Philadelphia over a 15-year period.
METHODS: Ophthalmology and other medical records, including slit-lamp and fundus exam findings and genetic testing results, were reviewed.
MAIN OUTCOME MEASURES: Prevalence and onset of ocular abnormalities, sensitivity and yield of continuing screening eye exams by age.
RESULTS: Of 11,437 children with hearing loss, 3,399 had sensorineural, 2,729 conductive, 1,601 mixed, and 3,708 unspecified types. Ocular abnormalities were identified in 2,199 children (19.2%), including 1,339 (12.7%) with possible syndromic association (e.g., retinal degeneration or signs of a genetic syndrome). Among the latter, the cumulative sensitivity of continued screening was 48-72% by age 5, 71-87% by age 10, and 90-96% by age 15. The estimated yield of continued screening beyond age 5 was 3.7%; beyond age 10, 1.9%; and beyond age 15, 0.6%.
CONCLUSION: Ocular abnormalities in children with hearing loss may present throughout childhood and adolescence. We recommend asymptomatic children have an ophthalmologist exam upon diagnosis of hearing loss, 2 years later, and again at ages 5, 10, and 15; or sooner if visual symptoms develop or pediatrician vision screening identifies a concern. When genetic testing is possible, an identified genetic cause may help tailor the timing of ophthalmologist exams
A Prospective Natural History Study Protocol for Clinical Trial Readiness in Synaptic Disorders.
No full textOBJECTIVE:
METHODS: Here, we describe a protocol, regulatory structure, and supportive preliminary data for multi-center, prospective natural history studies of
RESULTS: Our data support that existing developmental measures are feasible, informative, and show minimal floor or ceiling effects. Furthermore, we demonstrate that medical record-based seizure history reconstruction reveals unique epilepsy trajectories while minimizing burden to families. We observe disease-specific patterns of developmental performance and distinct longitudinal seizure dynamics, highlighting the need for data generation in a gene/disorder-specific manner for clinical trial readiness.
SIGNIFICANCE: In summary, we present a feasible natural history protocol with prospective data for two complex neurodevelopmental disorders with natural histories that have previously been incompletely characterized, within a regulatory framework that will support the use of these data to expedite clinical trial development.
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Hemodynamics-driven magnetoelastic vascular grafts for stenosis diagnosis.
No full textConventional approaches for vascular graft stenosis diagnostics, including X-ray angiography, magnetic resonance imaging and Doppler ultrasound, although highly accurate, are cumbersome, used intermittently and often do not detect stenosis early enough, leading to diagnosis only after substantial narrowing. Here we report a magnetoelastic vascular graft (MVG) for post-implantation stenosis diagnosis that is hemodynamics-driven, biocompatible and waterproof. It enables wireless, real-time and continuous diagnosis of stenosis by converting arterial hemodynamics into high-fidelity electrical signals. The MVGs were scalably manufactured with customizable diameters and tested in vivo in the femoral arteries of rats and swine through microsurgical anastomosis. The anastomosed MVGs restored blood flow and identified the location and severity of induced stenosis through artificial intelligence-assisted analysis. Furthermore, a 4-month in vivo study in rats verified the stability and biocompatibility of the MVGs in the host, with no evident signs of an adverse immune response. The MVG is expected to advance existing vascular graft solutions and improve vascular disease management