Scholarly Commons @ Baystate Health
Not a member yet
8474 research outputs found
Sort by
Treatment of cannabinoid hyperemesis syndrome: A systematic review and treatment algorithm for consultation-liaison psychiatrists
No full textHeart Failure with Reduced Ejection Fraction
No full textHeart failure (HF) is no longer centered on the failing ventricle. Various salutary treatment discoveries now support substantially improved survival with lesser likelihood for urgent care or hospitalization. Careful assessment of comorbidities and early recognition of symptoms further support the care for patients with HF. Advanced care strategies are effective, but not only includes mechanical circulatory assist and heart transplantation, but also clinical trial participation, palliative care, and hospice. With this contemporary view of HF, failure is supplanted with opportunity. At the patient level, longer healthier lives, in concert with expert management of ventricular dysfunction, becomes the contemporary expectation.
Keywords: Guideline-directed medical therapy; Heart failure with reduced ejection fraction; Heart transplantation; Left ventricular systolic dysfunction
Enhanced recovery after surgery: overarching themes of the ERAS® Society Guidelines & Consensus Statements for Adult Specialty Surgery
No full textBackground: The Enhanced Recovery After Surgery (ERAS®) Society has overseen the development and publication of more than two dozen specialty-specific guidelines and consensus statements. We conducted an appraisal of existing guidelines to compare and contrast recommendations to identify overarching themes regarding the current role and future direction of those guidelines for clinicians and researchers.
Methods: After deriving a list of potential perioperative interventions associated with an ERAS program, specialty-specific guidelines were evaluated on the basis of their inclusion and the strength of the grade of those elements.
Results: Following appraisal of the existing ERAS guidelines, a list of common interventions emerges, which includes pre-, intra-, and postoperative care elements that are endorsed by the overwhelming majority of surgical specialties. However, this perioperative rubric should be modifiable to include a broader range of potential perioperative elements, where appropriate, based on literature specific to those subspecialty surgeries.
Conclusions: More uniform consensus regarding common care elements is likely to contribute to greater harmony in guidelines development as well as the development of process measures and outcome definitions. Guidelines can thus foster the creation of data repositories, establish program benchmarks, and contribute to future research and knowledge transfer.
Keywords: Enhanced recovery programs; Guidelines; Perioperative care
Expansion of Variant Panels in Newborn Screening Algorithms to Identify Cystic Fibrosis: A Retrospective Analysis of 25 Years of Genotypes and Implications on Diagnosis
No full textPurpose: We seek to understand the incremental value of applying expanded variant panels or sequencing in population-based screening algorithms for a well-understood condition like cystic fibrosis (CF). We compared newborn screening methods to determine at what point do attempts to increase sensitivity of second-tier testing meet diminishing returns.
Methods: Using the genotypes of all Massachusetts CF-affected patients who were born between February 1,1999 and January 31,2024, we retrospectively applied screening algorithms that used: (a) 39 CF gene (CFTR) variants, 139 CFTR variants, or CFTR sequencing, and (b) different algorithms for referral to CF Center. Sensitivity, specificity, and timing of diagnosis were evaluated.
Results: Our current 39 CFTR variant panel and referral algorithm yields a clinical sensitivity of 98.7%. In Massachusetts, expanding the variant panel might result in limited sensitivity improvement but if the referral algorithm requires detection of two CFTR variants, might decrease the sensitivity.
Conclusion: Expanding the CFTR variants genotyped does not necessarily guarantee an increase in screening sensitivity. Using a conservative cutoff for DNA testing might accomplish as much. Screening turn-around time, costs, and geographic location of CF Centers should be factored into decisions about the benefit of NGS technology within newborn screening.
Keywords: CFTR variant panels; Cystic Fibrosis; Newborn screening; Next Generation Sequencing
Nationwide Trends in Hospitalizations for Sudden Cardiac Arrest Before and During the COVID Outbreak
No full textBackground/Objectives: Sudden cardiac arrest (SCA) accounts for ~50% of cardiovascular mortality in the U.S. Cardiovascular complications are common in acute and post-acute COVID-19 infection. We aimed to examine nationwide trends in SCA-related hospitalizations in the United States before and during the COVID-19 outbreak. Methods: Using data from the National Inpatient Sample, we conducted a retrospective analysis of hospitalizations for SCA in the U.S. between 2016 and 2020. Sociodemographic and clinical characteristics and in-hospital mortality were compared between the pre-COVID (2016-2019) and COVID (2020) eras. Multivariable analysis was performed to identify factors associated with mortality. Results: Among a weighted total of 153,100 SCA hospitalizations between 2016 and 2020, the median age was 65 years, 62.7% were male, and 66.6% were white. There was a trend towards fewer hospitalizations in 2020 compared to prior years (n = 28,585 vs. naverage = 32,129, p = 0.07). In-hospital mortality remained unchanged between the pre-COVID and COVID eras (47.7% vs. 47.3%, p = 0.66). Increased mortality was associated with female sex (OR: 1.21; 95% CI: 1.15-1.28; p \u3c 0.001), non-white race (OR: 1.24; 95% CI: 1.15-1.28; p \u3c 0.001), history of renal failure (OR: 1.08; 95% CI: 1.02-1.15; p = 0.007), and diabetes (OR: 1.32; 95% CI: 1.25-1.39; p \u3c 0.001). In 2020, 1.5% of the study population was diagnosed with COVID-19 infection, which was found to be independently associated with increased in-hospital mortality (OR: 1.57; 95% CI: 1.27-1.95; p \u3c 0.001). Conclusions: In 2020, there was a trend towards a decrease in hospitalizations for SCA, while COVID-19 infection was independently associated with higher in-hospital mortality among patients admitted with SCA.
Keywords: SARS-CoV-2; epidemiology; in-hospital mortality; out-of-hospital cardiac arrest; sudden cardiac arrest; ventricular fibrillation; ventricular tachycardia
Maternal Psychological Trauma Assessed Prenatally and Offspring Outcomes
No full textPsychologically traumatic experiences can have long-lasting physical and mental health effects on pregnant people, increasing the risk of adverse pregnancy, childbirth, and neonatal outcomes. The effect of maternal psychological trauma, assessed prenatally, on offspring outcomes throughout development is understudied. This secondary analysis of a systematic review investigated the scope of research examining links between prenatally assessed maternal trauma and offspring outcomes to identify areas of focus and those needing further investigation. Of 576 studies identified in the systematic review, 80 included offspring measures. Of these, 70 investigated associations between maternal trauma and offspring outcomes. We examined these studies for the type of maternal psychological trauma (including post-traumatic stress disorder [PTSD]), type and timing of assessment of offspring outcomes, and regional variations reported. Most studies used a cross-sectional assessment of offspring outcomes (80%). The most common type of offspring outcome was birth or neonatal outcome (n = 40), which aligned with the most frequently examined time period. Interpersonal trauma (n = 41) and general trauma (n = 41) were the most common maternal trauma types examined prenatally, followed by childhood abuse (n = 37). Only 31.4% of studies measuring offspring outcomes included data on maternal PTSD status. Future research should longitudinally measure the impact of maternal psychological trauma on offspring outcomes through childhood and adolescence, providing insights for clinicians and policymakers. Pregnancy represents a critical period for the assessment and treatment of psychological trauma/PTSD, and further research will improve two-generation interventions across development to improve family health and well-being.
Keywords: intergenerational transmission of trauma; parenting; pregnancy/childbirth/postpartum; research methodology/measurement; trauma
3D-Printed Battery Caps: A Cost-Saving Innovation for Scanner Repair at Baystate Wing Hospital
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1012/thumbnail.jp
Physician Perspectives on Diagnostic Uncertainty in Radiographic Imaging Reports for Pulmonary Embolism: A Qualitative Study
No full textStudy objectives: To explore physicians\u27 interpretation and decisionmaking when encountering computed tomographic pulmonary angiogram (CTPA) reports communicating diagnostic uncertainty about the presence of pulmonary embolism (PE).
Methods: We conducted semistructured interviews from February 1 to June 3, 2024 among purposively sampled emergency medicine and hospital medicine physicians in the United States. Interviews were recorded, transcribed, and analyzed in an iterative process using reflexive thematic analysis.
Results: We analyzed interviews from 25 emergency physicians and 17 hospitalists. The median age was 41 years and 33% identified as women. Participants were diverse in practice setting and years of practice. Central themes included a lack of organized approach to diagnostic uncertainty, a perception that empiric anticoagulation would represent erring on the side of caution, a tendency to defer additional testing and ascertainment of diagnostic certainty to downstream decision makers, and a disinclination to engage in repeat testing due to time pressures and local culture. Although many participants expressed support for the general idea of standardized communication of diagnostic uncertainty, most resisted its quantification in the context of CTPA reports. Many voiced concern that quantification of uncertainty left them without a clear course of action.
Conclusion: Although diagnostic uncertainty regarding the presence of PE is commonly encountered in CTPA reports, most physicians report a lack of an organized approach to this scenario, often defaulting to empiric anticoagulation and deferring additional diagnostic testing. Future efforts are needed to develop data-driven guidance for encountering diagnostic uncertainty in radiographic imaging reports for PE.
Keywords: Diagnostic uncertainty; Emergency medicine; Pulmonary embolism; Qualitative methods
Influenza Vaccination Among Children with Asthma: Challenges and Future Directions
No full textKeywords: Asthma; Influenza Vaccines; Medicaid; Pediatrics; Vaccination Hesitancy
