Scholarly Commons @ Baystate Health
Not a member yet
8474 research outputs found
Sort by
Perspective: Are Grapes Worthy of the Moniker Superfood?
No full textSuperfood, an au courant word in the American vernacular, refers to mainstream foods that are basically individual components of the Mediterranean diet, i.e., berries, fish, olive oil, cruciferous vegetables, legumes, etc., and perceived as healthy. There is no regulation; the main source of information is the Internet. Blueberries and strawberries are generally featured as superior. However, when tested as a whole food in human beings, grapes modulate the gut microbiome, the metabolome and gene expression, and there are associated health benefits. Thus, based on actual scientific data, grapes have earned what should be a prominent position in the superfood family.
Keywords: Mediterranean diet; grapes; gut microbiome; health benefits; superfood
Venoarterial extracorporeal membrane oxygenation with and without left ventricular unloading in patients with cardiac arrest: A nationwide analysis from the United States
No full textBackground: Extracorporeal cardiopulmonary resuscitation (ECPR) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a promising strategy for refractory cardiac arrest. However, the role of left ventricular (LV) unloading during ECPR remains uncertain.
Methods: We queried the United States National Inpatient Sample (2016-2021) to identify adult patients with out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA) who received ECPR. Patients were stratified based on the use of either VA-ECMO only or VA-ECMO with intra-aortic balloon pump (IABP) or VA-ECMO with Impella (ECPELLA) for ventricular unloading. Multivariable logistic regression was used to compare in-hospital outcomes between the groups.
Results: Among 6915 patients receiving ECPR, VA-ECMO alone was used in 5147 (74.4 %), VA-ECMO-IABP in 811 (11.7 %), and ECPELLA in 957 (13.9 %). In IHCA patients, ECPELLA was associated with 50 % lower odds of in-hospital mortality compared to VA-ECMO alone (adjusted odds ratio [aOR] 0.50, 95 % CI 0.31-0.81, p \u3c 0.01). No significant difference was found in OHCA patients. VA-ECMO-IABP was not associated with a mortality benefit vs. VA-ECMO alone in either OHCA or IHCA.
Conclusion: LV mechanical unloading with ECPELLA was associated with improved survival in IHCA patients but not in OHCA patients compared to VA-ECMO alone. The addition of an IABP to VA-ECMO was not associated with a mortality benefit.
Keywords: Cardiac arrest; ECPELLA; ECPR; Impella; Outcomes; VA-ECMO
A good day is just being able to breathe : Aligning COPD research with patient needs, a qualitative study
No full textBackground: Chronic obstructive pulmonary disease (COPD) is a common and impactful disease that is the target of a large portfolio of clinical research. However, there is limited understanding of how individuals with COPD perceive trial designs, outcomes, and intervention acceptability. The objective of this project was to explore the perspectives and priorities of patients and their caregivers toward COPD-focused clinical research.
Methods: Semi-structured interviews were conducted with participants living with COPD and their caregivers using the Theoretical Framework of Acceptability (TFA) to guide data collection and analysis. Interviews were transcribed and coded using qualitative analysis software and analyzed using an inductive thematic approach.
Results: Fifteen interviews were performed. Key themes included participant preference for outcome measures that directly impact daily living, such as mental wellness and physical function. Participants highlighted the need for research data to be actionable, advocating for health insights to be shared with participants and their healthcare providers. Study engagement was influenced by the perceived burden and complexity of interventions as well as their direct relevance to patients. Patients favored research designs that minimize physical and logistical challenges. Lastly, participants desired greater involvement in the research design process.
Conclusions: Aligning COPD research with patient priorities requires incorporating meaningful outcome measures, reducing participation burdens, and fostering ongoing engagement. Integrating patient-centered approaches in study design can enhance recruitment, adherence, and the real-world impact of COPD interventions
Simulation Resources in Emergency Medicine Residencies: A National Survey
No full textObjectives: The American Board of Emergency Medicine\u27s new Certifying Exam features simulation-based assessment. The current resources available to prepare residents to pass this high-stakes exam are unknown. We sought to assess the current state of simulation resources and utilization in EM residency programs.
Methods: This was a cross-sectional survey study of residency or simulation leadership at ACGME-accredited EM programs. We developed an online survey consisting of multiple-choice items, which was piloted before use. We collected data from August to December 2024. We calculated descriptive statistics, used chi-squared testing for categorical data comparisons, and Kruskal-Wallis for ordinal variables. Univariate logistic regression was used to examine associations between EM residency and simulation resource factors with annual simulation training hours.
Results: We identified contact information for 287 programs, and 194 completed the survey (67.6%). Most EM Residency programs had a simulation center (94.8%, 184/194). Fewer programs had simulation fellowship-trained physician faculty (44.3%, 86/194) or a division of simulation (40.7%, 79/194). Approximately 83% (161/194) of respondents felt that accessing simulation resources was easy or very easy. The median number of hours residents were engaged in simulation training per year was 40 (IQR 25-59). Univariate logistic regression found no association between EM program demographics and the annual number of hours of simulation training. The presence of simulation-trained faculty was associated with increased hours of simulation (OR 1.82, 95% CI 1.1-3.0, p = 0.05).
Conclusions: While most participating EM residency programs have access to simulation resources, variability exists in resources and implementation across programs, which may lead to inequities in preparing trainees for the new ABEM Certifying Exam
Development of Zafirlukast Analogues for Improved Antithrombotic Activity Through Thiol Isomerase Inhibition
No full textBackground: Thiol isomerases play essential and nonredundant roles in platelet activation, aggregation, and thrombus formation. Thiol isomerase inhibitors have the potential to overcome the 2 major drawbacks of current antithrombotic therapies, as they target both arterial and venous thrombosis without enhancing bleeding risks. Recently, a Food and Drug Administration-approved drug, zafirlukast (ZAF), was shown to be a promising pan-thiol isomerase inhibitor. The objective of this study is to develop analogues of ZAF with optimized thiol isomerase inhibition and antithrombotic activity.
Methods: Thirty-five ZAF analogues were tested in an insulin turbidometric assay for thiol isomerase inhibition. Analogues were tested for platelet activation, aggregation, P-selectin expression, and laser-induced thrombosis in mice and compared with the parent compound.
Results: Of the 35 analogues, 12 retained activity, with 1, compound 21, that demonstrated a greater potency than that of ZAF, 5 had a similar potency to that of ZAF, and 6 had a weaker potency. Analogues demonstrated inhibition of platelet aggregation and P-selectin expression as compared with ZAF, consistent with their potencies. ZAF and compound 21 were shown to be reversible inhibitors of thiol isomerases, and not cytotoxic to cultured, lung, liver, and kidney cells. Finally, in an in vivo assessment of thrombus formation, compound 21 was able to significantly inhibit thrombus formation without affecting bleeding times.
Conclusions: A ZAF analogue, compound 21, with properties superior to those of ZAF was synthesized, demonstrating improved inhibition of platelet activation, aggregation, and thrombus formation as compared with the parent ZAF. This approach could yield a promising clinical candidate for treatment and prophylaxis of arterial and venous thrombosis.
Keywords: drug repositioning; isomerases; liver; structure-activity relationship; thrombosis
Nursing News & Views - March 2025
Get PDFNursing News & Views Newsletter - March 2025https://scholarlycommons.libraryinfo.bhs.org/nursing_newsletters/1043/thumbnail.jp
Impact of a Lifestyle Intervention Among Latina Women on Infant Birth and Anthropometric Measures: Pooled Analyses of 2 Randomized Controlled Trials
No full textBackground: To assess the impact of a pregnancy and postpartum culturally modified, motivationally targeted, individually tailored intervention on infant outcomes among Latinas.
Methods: We conducted a pooled analysis of 2 randomized controlled trials in Western Massachusetts: Estudio Parto (collected 2013-2017, analyzed 2018-2020, n = 203) and Proyecto Mamá (data collected 2014-2020, analyzed 2021-2022, n = 141) focused on pregnant Latinas (predominantly Puerto Rican) with abnormal glucose tolerance and prepregnancy body mass index in the overweight/obese range, respectively. Women were randomized in pregnancy to a Lifestyle Intervention (n = 167) focusing on healthy exercise and diet or to a comparison Health and Wellness Intervention (n = 177) with no mention of exercise or diet. The primary outcomes in both studies were birth weight, gestational age, birth weight-for-gestational-age z score, low birth weight, preterm birth, small-for-gestational-age, large for gestational age, macrosomia). Proyecto Mamá also assessed infant anthropometrics (ie, weight, length, sum and ratio of skin fold thickness, ponderal index) at 6 weeks of age. We used linear regression for continuous outcomes and logistic regression for dichotomous outcomes.
Results: In modified intent-to-treat analyses, we observed no statistically significant impact of the Lifestyle Intervention on infant outcomes or anthropometric measures. For example, there was no difference in odds of small-for-gestational-age between intervention arms (odds ratio = 1.29; 95% confidence interval, 0.60-2.76).
Conclusions: In these randomized trials among pregnant Latina women, we found that a culturally modified, individually tailored Lifestyle Intervention did not lead to a significant difference in infant birth weight outcomes or anthropometric measures when compared to the Health and Wellness control arm.
Keywords: Hispanic; exercise; obesity; overweight; pregnancy
Best Practices for the Gastroenterologist: Trauma-Informed Care in the Endoscopy Suite
No full textTrauma is a risk factor for several gastrointestinal illnesses, especially disorders related to the gut-brain axis. Gastroenterology (GI) care environments, particularly endoscopy units, put patients at risk of unintentional re-traumatization due to the sensitive nature of the questions, examinations, and procedures. Trauma-informed care has six pillars outlined by the Substance Abuse and Mental Health Services Administration: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment voice and choice, and cultural historical and gender issues. Adopting these pillars for trauma-informed GI care can transform the patient and staff experience. Traumatic or potentially traumatic experiences are common, and therefore a universal trauma precautions approach is useful in a busy GI environment. There are considerations for each of the pre-, peri-, and post-procedural settings that are simple to implement, which can increase the sense of safety, trust, and autonomy for each patient in the endoscopy suite.
Keywords: Endoscopy; Patient-centered care; Trauma-informed care
Protocol for a pragmatic trial to enhance quality safety, and patient experience in chronic obstructive pulmonary disease (EQuiP-COPD)
No full textChronic obstructive pulmonary disease (COPD) affects nearly 26 million Americans, causes functional impairment and reduced quality of life, and is the fifth leading cause of death. Evidence-based therapies can reduce morbidity and improve symptoms, but too few patients receive them. Moreover, many patients receive unnecessary treatments that increase risks of harm. Systematic and population-based approaches are needed to address the widespread gaps in care. Among these, high-quality evidence shows that proactive electronic consultations to primary care providers can improve COPD care quality and clinical outcomes. While effective, these strategies rely on pulmonary specialists who are a scarce and costly resource nationwide. Given their relevant expertise, there is increasing interest around clinical pharmacist-led population management of COPD, but the effectiveness of this approach is unclear. We designed the cluster-randomized EQuiP-COPD trial to test the non-inferiority of clinical pharmacist relative to pulmonary specialist-led population health management of COPD. The primary outcome is the composite endpoint of COPD exacerbation, pneumonia, all-cause hospitalization, or death. Secondary outcomes will compare disease-related quality of life, quality of care, costs incurred by patients and caregivers, and heterogeneity of treatment effect. We will also conduct qualitative interviews among patients and staff to elicit experiences with the intervention.
Keywords: Chronic disease; Chronic obstructive; Disease attributes; Lung diseases; Obstructive; Population health management; Pulmonary disease; Respiratory tract diseases