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Democratizing the Advancement of Ultrasound Technology to Expedite Care, Improve Outcomes, and Overcome Health Disparities
No full textCME available for 1 year after presentation
CME Text Code: 97012
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1070/thumbnail.jp
The feasibility and utility of intraoperative ultrasound in spinal cord injury patients: an international survey of AO spine members
No full textSTUDY DESIGN: Survey. OBJECTIVES: Intraoperative ultrasound (IOUS) is an emerging tool for assessing the injured spinal cord during surgical intervention and particularly after traumatic spinal cord injury (SCI). The extent of utilization of this technique is unknown. To assess whether a knowledge gap exists regarding IOUS in managing SCI patients, an international survey of spine surgeons was performed. SETTING: International Survey. METHODS: Members of the AO Spine international community were surveyed using a web-based questionnaire developed by an SCI expert commission. The categorical data were analyzed descriptively. RESULTS: Of the 276 completed surveys, 22% (n = 61/276) indicated IOUS was utilized during spine surgery, with most responses coming from Europe (38% n = 24/61) and North America (30% n = 18/61). Only 41% (n = 25/61) had received formal IOUS training. There were 59% (n = 36/61) of respondents who indicated they use IOUS on patients with acute SCI, mainly to assess adequate decompression. Of those not using IOUS, 50% (n = 107/215) did not have access to an ultrasound machine available. Overall, 92% (n = 254/276) indicated that an IOUS training course would be beneficial to improve understanding and patient care. CONCLUSIONS: This international survey of spine surgeons demonstrated that currently, there is limited use of IOUS in the surgical management of acute SCI. Understanding the needs of spine surgeons and tailoring educational opportunities may increase the role of IOUS. Given the importance of surgical decompression in enhancing outcomes after acute SCI coupled with the ability of IOUS to assess decompression, greater adoption of IOUS could further enhance the efficacy of decompressive surgery
Worsening Renal Function Is Common and Associated With Higher Mortality in Cardiogenic Shock: A Cardiogenic Shock Working Group Report
No full textBACKGROUND: Outcomes associated with worsening renal function (WRF) in cardiogenic shock (CS) remain poorly understood. OBJECTIVES: To study the incidence of WRF in heart failure-CS (HF-CS) and acute myocardial infarction CS (AMI-CS), examine its association with in-hospital mortality (IHM), define the trajectory of renal function in CS, and identify independent predictors of WRF in HF-CS versus AMI-CS. METHODS: Patients in the Cardiogenic Shock Working Group registry (CSWG) from 2021-2024 were analyzed; those with baseline end-stage renal disease were excluded. WRF was defined as an increase in creatinine ≥0.3 mg/dl, a decrease in eGFR \u3e25%, or initiation of renal replacement therapy (RRT) within 72 hours of CS diagnosis. RESULTS: Of 6269 CS patients, 35% developed WRF, including 32% of HF-CS and 41% of AMI-CS patients. Patients who developed WRF were more likely to be transferred from other hospitals (63% vs 50%, p\u3c0.001). Baseline right atrial pressure (RAP) was higher in both HF-CS (15 mmHg vs 12 mmHg, p\u3c0.001) and AMI-CS (13 mmHg vs 11 mmHg, p=0.02) patients with WRF compared to patients without WRF. Incidence of WRF was higher among patients exposed to both tMCS and vasoactive agents as compared to vasoactive drugs alone (46% vs. 29%, p\u3c0.001). Overall rate of RRT initiation was 20% throughout admission with higher rates in patients with acute on chronic versus de novo HF-CS and in patients with STEMI-CS versus NSTEMI-CS in the first 24 hours. IHM was higher in patients with WRF (41% vs 21%, p\u3c0.001). In patients with WRF, median eGFR declined steadily throughout the first 72 hours after CS diagnosis. Key independent predictors of WRF included RAP, lactate, transfer status, in patients with HF-CS and CKD, lactate and transfer status in patients with AMI-CS. CONCLUSION: WRF is common and deleterious in both HF- and AMI-CS. Given the early association with worse outcomes, WRF may not only be prognostic but also represent a potential therapeutic target in future CS studies
Severe Left Ventricular Outflow Obstruction by Native Anterior Mitral Leaflet After Bileaflet Preserving Mechanical Mitral Valve Replacement
No full textLeft ventricular outflow tract obstruction (LVOTO) after mitral valve replacement (MVR) is a challenging complication. This case report describes a 70-year-old female who developed systolic anterior motion (SAM) secondary to an unresected anterior mitral leaflet several years following leaflet-preserving mitral valve replacement, with associated heart failure and tricuspid regurgitation. Surgical intervention included trans-aortic resection of the obstructing anterior mitral leaflet and chordae without re-replacing the mitral valve, followed by tricuspid valve bicuspidization. The transaortic resection approach was chosen in this case due to its ability to effectively address SAM by directly accessing and resecting the anterior mitral leaflet and preferred over others to minimize surgical complexity while adequately managing the LVOT obstruction. The postoperative course and management are discussed. Surgical strategies to prevent LVOTO and SAM are reviewed, highlighting the importance of proper leaflet management and valve orientation to ensure optimal patient outcomes
Early-life and concurrent predictors of the healthy adolescent microbiome in a cohort study
No full textBACKGROUND: The microbiome of adolescents is poorly understood, as are factors influencing its composition. We aimed to describe the healthy adolescent microbiome and identify early-life and concurrent predictors of its composition. METHODS: We performed metagenomic sequencing of 247 fecal specimens from 167 adolescents aged 11-14 years participating in the Health Outcomes and Measures of the Environment (HOME) Study, a longitudinal pregnancy and birth cohort (Cincinnati, OH). We described common features of the adolescent gut microbiome and applied self-organizing maps (SOMs)-a machine-learning approach-to identify distinct microbial profiles (n = 4). Using prospectively collected data on sociodemographic characteristics, lifestyle, diet, and sexual maturation, we identified early-life and concurrent factors associated with microbial diversity and phylum relative abundance with linear regression models and composition with Kruskal-Wallis and Fisher\u27s exact tests. RESULTS: We found that household income and other sociodemographic factors were consistent predictors of the microbiome, with higher income associated with lower diversity and differential relative abundances of Firmicutes (increased) and Actinobacteria (decreased). Sexual maturation, distinct from chronological age, was related to higher diversity in females and differences in phylum relative abundances and compositional profiles in both males and females. CONCLUSIONS: Our study suggests that adolescence is a unique window for gut microbial composition and that it may be shaped by both early-life and concurrent exposures, highlighting its potential in future epidemiologic research
Iterative Simulation and Healthcare Failure Modes and Effects Analysis Improves Child Abduction Response Systems Over Four Years of Testing in a Children\u27s Hospital
Get PDFIterative Simulations Improve Child Abduction Unit Readiness.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1029/thumbnail.jp
Does Cohort Selection Affect Machine Learning from Clinical Data?
No full textThis study investigates cohort selection and its effects on the quality of machine learning (ML) models trained on clinical data, focusing on measurements taken within the first 48 hours of hospital admission. It discusses the potential repercussions of making arbitrary decisions during data processing prior to applying ML methods. Experiments are performed within the framework of the National COVID Cohort Collaborative (N3C) dataset. The research aims to unravel biases and assess the fairness of machine learning models used to predict outcomes for hospitalized patients. Detailed discussions cover the data, decision-making processes, and the resulting impact on model predictions regarding patient outcomes. An experiment is conducted in which four arbitrary decisions are made, resulting in 16 distinct datasets characterized by varying sizes and properties. The findings demonstrate significant differences in the obtained datasets and indicate a high potential for bias based on inclusion or exclusion decisions. The results also confirm significant differences in the performance of models constructed on different cohorts, especially when cross-compared between ones based on different inclusion criteria. The study specifically chose to analyze gender, race, and ethnicity as these social determinants of health played a significant role in COVID-19 outcomes
Evaluating community engagement efforts in a clinical and translational research initiative.
No full textA priority of the Northern New England Clinical and Translational Research (NNE-CTR) Network is conducting, promoting, and advancing community-engaged research through its Community Engagement and Outreach (CEO) Core. We sought to measure the CEO Core\u27s success in strengthening community-level research partnerships using a validated survey platform based on network science to map and track collaborations over time. The survey was completed by 59/76 organizations (77.6% response rate). Key findings included a high level of trust and a modest level of perceived value relative to published benchmarks. Additional specific findings will inform opportunities to improve the network as the NNE-CTR matures.
Summary found @ Summary of: Evaluating community engagement efforts in a clinical and by Kelly Finck Waters, Brenda Joly et al
Mitochondrial Responses to Conventional and Ultra-high Dose Rate (FLASH) Radiation
No full textPURPOSE: Ultra-high dose rate (\u3e40 Gy/s, FLASH) radiation therapy (RT) provides equivalent tumor control while reducing normal tissue toxicity relative to conventional dose rate (CONV) RT. However, the mechanisms underlying the observed FLASH effect are unknown. We hypothesized that the preservation of mitochondrial integrity in nontumorigenic cells by FLASH RT could be a key factor in reducing normal tissue toxicity and improving overall treatment outcomes. METHODS: We examined mitochondrial health and function after CONV and FLASH in vitro, ex vivo, and in vivo through assays of metabolic flux, mitochondrial membrane potential, mitochondrial reactive oxygen species (ROS), mitochondrial DNA damage and copy number, mitochondrial morphology, and tumor growth and survival. RESULTS: In in vitro assays, murine pancreatic cancer (PDAC) cells showed evidence of equal mitochondrial damage in response to CONV and FLASH, but nontumorigenic pancreatic cells were spared by FLASH. These results were recapitulated ex vivo, and mice treated with FLASH showed higher response rates and longer survival time than mice treated with CONV in an in vivo tumor model. CONCLUSIONS: Collectively, these results suggest that FLASH spares mitochondrial function in nontumorigenic cells, but not in PDAC cells, relative to CONV. The preservation of mitochondrial integrity in nontumorigenic cells may be a key mechanism underlying the reduced normal tissue toxicity observed with FLASH RT
Importance of Mobility During Hospital Stays
Get PDFPICOT Question: In hospitalized patients, how does lack of mobility compared to regular ambulation affect mental health during their hospital stays?https://knowledgeconnection.mainehealth.org/nurseresidency/1126/thumbnail.jp