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Acellular Adipose Matrices Seem to Be an Effective and Safe Strategy for Soft Tissue Regeneration and Volume Restoration: A Systematic Review of Clinically Relevant Literature
No full textSignificance: Autologous adipose tissue grafting (AAG) can provide soft tissue reconstruction in congenital defects, traumatic injuries, cancer care, or cosmetic procedures; over 94,000 AAG procedures are performed in the United States every year. Despite its effectiveness, the efficiency of AAG is limited by unpredictable adipocyte survival, impacting graft volume retention (26-83%). Recent Advances: Acellular adipose matrices (AAMs) have emerged as a potential alternative to AAG. AAMs include adipose tissue-derived extracellular matrix (ECM) and growth factors (GFs), but not cells. When grafted, AAMs serve as scaffolds with biochemical and biophysical cues for local cell (especially adipocytes) proliferation, regenerating soft tissue, and restoring volume. Being acellular, the AAM is not limited by adipocyte necrosis/apoptosis. Critical Issues: Research on AAM has mostly been conducted on small animal models and with small grafts. Clinically relevant AAM research (large animal models and/or clinical trials) is sparse and limited. To address this gap, we conducted a systematic review of clinically relevant AAM literature to assess AAM\u27s clinical efficacy and safety. Across 11 human and 1 porcine study involving reconstructive or cosmetic procedures, we found that AAMs resulted in significant volume retention, adipogenesis, and angiogenesis, without notable adverse effects. Future Directions: Available quantitative and qualitative data suggest that AAM is an effective and safe alternative to AAG. Yet, the current literature is still limited; more robustly designed studies with standardized methods to assess outcomes will help validate these positive preliminary findings, and possibly pave the way for a broader clinical adoption of AAM.
Keywords: acellular adipose matrix; adipogenesis; adipose tissue graft; allograft; biological matrices; fat graft; scaffold; tissue engineering
Nursing News & Views - January 2025
Full text linkNursing News & Views - January 2025https://scholarlycommons.libraryinfo.bhs.org/nursing_newsletters/1041/thumbnail.jp
A pilot intervention to reduce burnout and enhance resilience through transcendental meditation among Georgetown University medical students
No full textBackground: Rates of burnout, depression, and anxiety among healthcare workers are at historically high levels and have remained high in the aftermath of the COVID-19 pandemic. As aspiring physicians, medical students are the future of the healthcare profession. The practice of Transcendental Meditation (TM) has been shown to reduce burnout and stress in diverse populations, including healthcare professionals. To date, no data have been published on the benefits of TM for medical students. Our objective was to assess the efficacy of TM practice in reducing burnout and increasing resilience among medical students at Georgetown University School of Medicine (GUSoM) over three months between October 2022 and May 2023.
Methods: Forty-two GUSoM medical students qualified for and enrolled in the study. Thirty-nine students completed three months of TM training and practice, with the recommended regimen of meditating for 20 min twice a day. The students were assessed at baseline, one month, and three months using measures of burnout, depression, anxiety, insomnia, well-being, and resilience, of which burnout (emotional exhaustion) and resilience were the primary outcomes. Two-tailed paired-sample t-tests were used to determine the significance of changes in outcome measures over time.
Results: In the three-month post-test, significant changes were found for both primary outcomes, emotional exhaustion (p = 0.001, Cohen\u27s d effect size = -0.61) and resilience (p = 0.002, d = 0.53), as well as for anxiety (p \u3c 0.001, d = -0.71), insomnia (p = 0.002, d = -0.53), depersonalization (p = 0.017, d = -0.40), depression (p = 0.006, d = -0.47), and mental wellbeing (p = 0.031, d = 0.36). TM practice compliance was high at 85%. Additionally, there were significant relationships between frequency of TM home practice and improvements in emotional exhaustion (p = 0.005), anxiety (p = 0.008), and insomnia (p \u3c 0.001), and a marginally significant relationship with depression (p = 0.088).
Conclusions: These findings suggest that TM practice is an accessible, achievable, and effective intervention to decrease burnout and increase resilience for medical students. This study paves the way for future initiatives to evaluate a broad range of benefits of TM for medical students.
Keywords: Academic stress; Anxiety and depression; Burnout and emotional exhaustion; Medical students; Resilience and wellbeing; Transcendental Meditation (TM)
Effect of Red Blood Cell Transfusion Strategy on Clinical Outcomes Among Patients with Acute Myocardial Infarction Undergoing Revascularization: A Prespecified Analysis of the MINT Trial
No full textBackground: The Myocardial Ischemia and Transfusion (MINT) Trial (N=3504) randomized patients with acute MI and a hemoglobin ≤ 10 g/dL to liberal (maintain Hgb ≥ 10 g/dL) or restrictive (maintain Hgb ≥ 8 g/dL) red blood cell transfusion. The results suggested a benefit on 30-day death or MI with a liberal transfusion strategy. The effect of transfusion in acute MI patients undergoing revascularization is unclear. Methods: In this pre-specified analysis of the MINT trial, patients who underwent revascularization (N=1002) before randomization but during index hospitalization were compared with those who did not (N=2442). The primary outcome was 30-day death or MI; secondary outcomes included 30-day death, recurrent MI, the composite of death, recurrent MI, ischemia driven unscheduled revascularization, or readmission for ischemic cardiac diagnosis, heart failure, and cardiac death. Multivariable log binomial regression was used to determine the relative risks of the primary and secondary outcomes by transfusion strategy for revascularized and non-revascularized patients with interaction terms. Results: Patients undergoing revascularization were younger, more often female, and had fewer comorbidities than those who did not. There was no significant interaction between revascularization and assigned transfusion strategy for any outcome except cardiac death. Compared with liberal transfusion, restrictive transfusion increased the risk of 30-day cardiac death among non-revascularized patients [RR 2.45 (1.58, 3.81)] but not among revascularized patients [(RR 0.97 (0.59, 1.60), interaction p 0.006]. Conclusions: In this analysis of the MINT trial, revascularization did not alter the effect of randomized transfusion strategy on 30-day death or MI. The hypothesis-generating finding that a restrictive transfusion strategy was associated with an increased risk of cardiac death among anemic patients with acute MI who do not undergo revascularization requires confirmation
Patient- and Community-Level Characteristics Associated With Respiratory Syncytial Virus Vaccination
No full textImportance: In 2023, the first respiratory syncytial virus (RSV) vaccines were recommended for US adults 60 years or older, but few data are available about which patients were most likely to receive vaccine to inform future RSV vaccine outreach efforts.
Objective: To assess patient- and community-level characteristics associated with RSV vaccine receipt and patient knowledge and attitudes related to RSV disease and RSV vaccines.
Design, setting, and participants: During the first season of RSV vaccine use from October 1, 2023, to April 30, 2024, adults 60 years or older hospitalized with RSV-negative acute respiratory illness were enrolled in this cross-sectional study from 26 hospitals in 20 US states. Sociodemographic and clinical data were abstracted from health records, and structured interviews were conducted for knowledge and attitudes about RSV disease and RSV vaccines.
Exposures: Age, sex, race and ethnicity, pulmonary disease, immunocompromised status, long-term care facility residence, medical insurance, social vulnerability index (SVI), and educational level.
Main outcomes and measures: The exposures were identified a priori as possible factors associated with RSV vaccine receipt and were entered into a modified Poisson regression model accounting for state clustering, to assess for association with RSV vaccine receipt. Knowledge and attitudes were summarized with frequencies and proportions.
Results: Among 6746 hospitalized adults 60 years or older, median age was 73 (IQR, 66-80) years and 3451 (51.2%) were female. Among the 6599 patients with self-reported race and ethnicity, 699 (10.6%) were Hispanic, 1288 (19.5%) were non-Hispanic Black, 4299 (65.1%) were non-Hispanic White, and 313 (4.7%) were other race or ethnicity. There were 700 RSV-vaccinated (10.4%) and 6046 unvaccinated (89.6%) adults. Among 3219 unvaccinated adults who responded to RSV knowledge questions, 1519 (47.2%) had not heard of RSV or were unsure; 2525 of 3218 (78.5%) were unsure if they were eligible for RSV vaccine or thought they were not. In adjusted analyses, characteristics associated with RSV vaccination were being 75 years or older (adjusted risk ratio [ARR], 1.23; 95% CI, 1.10-1.38, P \u3c .001), being male (ARR, 1.15; 95% CI, 1.01-1.30; P = .04), and having pulmonary disease (ARR, 1.39; 95% CI, 1.16-1.67; P \u3c .001), immunocompromised status (ARR, 1.30; 95% CI, 1.14-1.48; P \u3c .001), low (ARR, 1.47; 95% CI, 1.18-1.83, P \u3c .001) or moderate (ARR, 1.47; 95% CI, 1.21-1.79; P \u3c .001) SVI, and educational level consisting of 4 or more years of college (ARR, 2.91; 95% CI, 2.14-3.96; P \u3c .001), at least some college or technical training (ARR, 1.85; 95% CI, 1.35-2.53; P \u3c .001), or grade 12 education or General Educational Development (ARR, 1.44; 95% CI, 1.03-2.00; P = .03). RSV vaccination was less likely among residents of long-term care facilities, patients with Medicaid coverage, and uninsured patients.
Conclusions and relevance: In this cross-sectional study of hospitalized adults, knowledge of RSV disease and RSV vaccine eligibility was low. Older adults and those with certain medical conditions were more likely to have received vaccine, suggesting appropriate prioritization, but sociodemographic differences in vaccine uptake occurred
Semaglutide reverses the chronic myopathy of hyperkalemic periodic paralysis: a case report
No full textBackground: Hyperkalemic Periodic Paralysis (hyperPP) is an autosomal dominant genetic disorder where high extracellular potassium is associated with skeletal muscle depolarization and both flaccid muscle weakness as well as delayed muscle relaxation that can lead to myotonia and myopathy. Interventions have typically relied on avoidance of triggers, low potassium diets, and diuretics like acetazolamide and diclofenamide with limited success.
Case presentation: The patient is a 48 year old man with hyperPP from a familial autosomal dominant sodium channel point mutation in the SCN4A gene at position 704 with a Threonine to Methionine substitution that lead to symptoms starting in early childhood. By age 30 he developed permanent muscle weakness and neither acetazolamide nor diclofenamide as interventions had improved his myopathy. In the spring of 2023, semaglutide was initiated for weight loss. Before the semaglutide he could not rise out of a chair without help and his gait was very slow. Over the next year his strength and quality of life returned to levels he had not had in decades.
Conclusion: This is a promising alternative treatment for hyperPP. By directly acting on skeletal muscle both dependent and independent of insulin, Semaglutide and likely other Glucagon-like peptide agonists show promise as a novel once weekly option that may treat not just the hyperkalemic periodic paralysis but also the skeletal muscle atrophy in a multimodal way.
Keywords: GLP-1; Hyperkalemia; Paralysis; Reversal; Semaglutide
Artificial Intelligence-Assisted Narratives: Analysis of Surgical Residency Personal Statements
No full textObjective: Personal statements (PSs) express applicants\u27 personal characteristics and motivations informing pursuit of a surgical career. Generative artificial intelligence (AI) is a revolutionary technology. There are currently no data to suggest how and to what extent AI is used in surgical residency applications. We examined the prevalence of AI use and applicant pool characteristics in PSs submitted to a surgical residency.
Design: PSs from US MD and DO applicants to an academic general surgery program were collected for both the 2022-23 and 2023-24 NRMP Match cycles. PSs were analyzed using 2 AI-detection tools: GPTZero and Copyleaks. Data were analyzed using T-test and Fisher\u27s Exact Test.
Setting: UMass Chan Medical School-Baystate general surgery residency program in Springfield, Massachusetts.
Participants: There were 1332 applications during 2022-23 NRMP Match cycle and 1221 for 2023-24. After excluding international medical graduates and incomplete applications, 1490 PSs were analyzed.
Results: 1490 PS were included (758 [50.9%] for 2022-23; 732 [49.1%] for 2023-24). Demographic characteristics did not differ between the 2 cycles. GPTZero identified AI use in 77 (10.2%) PSs in 2022-23 and 268 (36.6%) in 2023-24 (p \u3c 0.001). Copyleaks identified AI use in 20 (2.6%) PSs in 2022-23 and 165 (22.5%) in 2023-24 (p \u3c 0.001). Concordance in AI detection with both tools was observed in 13 (1.7% of total PSs) for 2022-23 and 155 (21.2%) for 2023-24 (p \u3c 0.001). Subgroup analysis of concordance in 2023-24 showed increased non-English native language characteristics (38.7% vs 19.6%; p \u3c 0.001), a lower average personal statement word count (597.3 vs 645.9; p \u3c 0.001) and shorter average sentence (10.0 vs 10.4 words; p \u3c 0.001) in the AI group.
Conclusions: Although AI-detection tools are imperfect, demonstration of increased AI use in personal statement preparation is compelling. Implications of AI use in residency applications are unknown, and programs must develop policies anticipating ongoing and potentially increased use of AI in the upcoming application cycles.
Keywords: NRMP match; artificial intelligence; general surgery residency; graduate medical education; interpersonal and communication skills; personal statements
Home-based family recovery supports: Feasibility, acceptability, and adoption of training home visitors in Mothering from the Inside Out
No full textSupport for families affected by substance use disorders (SUDs) remains challenging, particularly during the postpartum period. The objective of this study was to assess the introduction of an evidence-based parenting intervention, Mothering from the Inside Out (MIO), into the early intervention (EI) home visiting setting. We conducted a mixed methods pilot study in the United States to assess the training and delivery of MIO within EI. MIO training involves didactic learning followed by MIO delivery with weekly consultation. Our primary implementation outcomes were feasibility, acceptability, and factors influencing adoption. We assessed feasibility and fidelity via quantitative measures, and acceptability and adoption via qualitative interviews with providers and parents. Two cohorts of EI providers completed the didactic training: 2019 (in-person) and 2020 (virtually). Ten providers participated in the MIO didactic training and began delivering MIO to 11 mothers; 4 of 10 providers (2 from each cohort) completed the full training. All providers that completed achieved adequate fidelity. Acceptability of MIO and perceived fit within EI was high, though challenges related to complexity limited adoption. Despite encouraging preliminary findings that EI providers achieved adequate adoption and fidelity, further adaptations are needed to address implementation challenges and improve retention of providers and parents.
Keywords: Elternschaft; Hausbesuche; Substanzkonsumstörungen; Visite à domicile; crianza; home visiting; parentage; parenting; substance use disorder; trastorno de uso de sustancias; troubles liés à l\u27usage de substances; visitas a casa; الكلمات المفتاحية: الزيارة المنزلية، الأبوة والأمومة، اضطراب تعاطي المخدرات; 家庭訪問、子育て、物質使用障害; 家访; 育儿; 药物使用障碍
CuddleCard: Protocol for a randomized controlled trial evaluating the effect of providing financial support to low-income mothers of preterm infants on parental caregiving in the neonatal intensive care unit (NICU)
No full textBackground: Preterm birth is a leading cause of childhood mortality and developmental disabilities, with persistent socioeconomic disparities in incidence and outcomes. Maternal presence during prolonged neonatal intensive care unit (NICU) hospitalization is critical for preterm infant health, enabling mothers to provide breast milk, directly breastfeed, and engage in skin-to-skin care-all of which promote infant physiological stability and neurodevelopment. Low-income mothers face significant barriers to visiting the NICU and participating in caregiving due to financial burdens and the psychological impact of financial stress. This randomized controlled trial aims to evaluate the effectiveness of financial transfers in promoting maternal caregiving behaviors that directly impact preterm infant health outcomes during NICU hospitalization.
Methods: We will conduct a two-arm, single-blinded randomized controlled trial with 420 Medicaid-eligible mothers of infants born between 24 weeks 0 days to 34 weeks 1 day gestation across four Level 3 NICUs in Georgia and Massachusetts. Mothers in the intervention arm will receive standard of care enhanced with weekly financial transfers and will be informed that these funds are intended to help them spend more time with their infants in the NICU. All participants will be provided with a hospital-grade breast pump and educational materials on the benefits of breast milk and skin-to-skin care. Participants will complete surveys during their infant\u27s hospitalization and following discharge, capturing outcomes related to maternal mental and physical health, caregiving behaviors, cognitive function, financial and socioeconomic factors, infant health and growth, and perceptions of NICU care quality. Primary outcomes are the provision of breast milk and engagement in skin-to-skin care. Secondary outcomes include infant growth and health outcomes, NICU visitation, financial and socioeconomic hardship, maternal physical and mental health measures, cognitive function, and perception of NICU care quality.
Discussion: This study will provide evidence of the impact of financial transfers on maternal caregiving behaviors in the NICU, addressing critical gaps in our understanding of how financial stress affects low-income mothers. Findings may inform health policy, particularly regarding Medicaid coverage of non-medical services, and contribute to understanding how to address disparities in preterm infant care.
Trial registration: The trial was prospectively registered with the American Economic Association Trial Registry, the primary registry for academic economists conducting policy trials, on 16 April 2024 (AEARCTR-0013256). It was also registered on ClinicalTrials.gov (NCT06362798) on 10 April 2024.
Keywords: Breastfeeding; Financial transfers; Preterm birth; Randomized controlled trial; Skin-to-skin
Overdose education and naloxone distribution in jails: Examining the impact of the Communities That HEAL intervention in 4 states
No full textBackground: Opioid-related overdose is the leading cause of mortality among individuals recently released from incarceration in the U.S. Naloxone is an FDA-approved opioid antagonist medication designed to rapidly reverse opioid overdose. Despite evidence of its acceptability and effectiveness at reducing the risk of opioid overdose death after release from incarceration, only an estimated 25% of US jails provide naloxone upon release. This study examines the effectiveness of the HEALing Communities Study (HCS) Communities That HEAL (CTH) intervention on enhancing access to overdose education and naloxone distribution (OEND) in participating jails in Kentucky, New York, Massachusetts, and Ohio.
Methods: Communities were randomized to intervention (n = 34) or wait-list control (n = 33) arms stratified by state. Jail-based surveys (n = 59) were implemented at three time points during 2019 to 2022. Generalized linear mixed models (GLMM) with imputation captured intervention effects during the evaluation period (July 1, 2021-June 30, 2022). Interpretation of results was informed by the Practical, Robust Implementation and Sustainability Model framework.
Results: The CTH intervention was significantly associated with the hypothesized outcome, resulting in a greater number of jails providing overdose education (H1, relative riskAdj = 1.51 [95% CI: 1.09, 2.08], p = 0.013) and the number of jails providing naloxone upon release (H2, relative riskAdj = 1.49 [95% CI: 1.05, 2.13)], p = 0.027). External factors related to OEND implementation, such as correctional health care models, available resources, and state COVID restrictions, varied across communities.
Conclusions: The CTH intervention engaging community coalitions to deploy evidence-based practices was effective in increasing OEND implementation in jails, helping address elevated overdose risks for individuals during and post-release from incarceration. Partnerships between state, community, and jail-based stakeholders are needed to assure expanded access to this lifesaving, evidence-based approach.
Supplementary Information: The online version contains supplementary material available at 10.1186/s40352-025-00353-5.
Keywords: Carceral settings; Jail; Naloxone distribution; Opioid epidemic; Overdose education