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SHEA position statement on pandemic preparedness for policymakers: the role of healthcare epidemiologists in communicating during infectious diseases outbreaks
No full textOutcomes of transcatheter aortic valve replacement in patients with amyloidosis: a comparative meta-analysis
No full textGeriatric trauma triage: optimizing systems for older adults-a publication of the American Association for the Surgery of Trauma Geriatric Trauma Committee
No full textBackground: Geriatric trauma patients are an increasing population of the United States (US), sustaining a high incidence of falls, and suffer greater morbidity and mortality to their younger counterparts. Significant variation and challenges exist to optimize outcomes for this cohort, while being mindful of available resources. This manuscript provides concise summary of locoregional and national practices, including relevant updates in the triage of geriatric trauma in an effort to synthesize the results and provide guidance for further investigation.
Methods: We conducted a review of geriatric triage in the United States (US) at multiple stages in the care of the older patient, evaluating existing literature and guidelines. Opportunities for improvement or standardization were identified.
Results: Opportunities for improved geriatric trauma triage exist in the pre-hospital setting, in the trauma bay, and continue after admission. They may include physiologic criteria, biochemical markers, radiologic criteria and even age. Recent Trauma Quality Improvement Program (TQIP) Best Practices Guidelines for Geriatric Trauma Management published in 2024 support these findings.
Conclusion: Trauma systems must adjust to provide optimal care for older adults. Further investigation is required to provide pertinent guidance.
Keywords: Outcome Assessment, Health Care; geriatrics; resource allocation; triage
SHEA position statement on pandemic preparedness for policymakers: emerging infectious threats
No full textRacial, ethnic, and sex disparities in the utilization and outcomes of tricuspid valve surgery
No full textBackground: Data on racial/ethnic and sex disparities in the utilization and outcomes of tricuspid valve surgery (TVS) in the United States are scarce. The authors aimed to evaluate the impact of race/ethnicity and sex on the utilization and outcomes of TVS.
Methods: The authors analyzed the National Inpatient Sample database from 2016 to 2020 to identify hospitalizations for TVS. Racial/ethnic and sex disparities in TVS outcomes were determined using logistic regression models.
Results: Between 2016 and 2020, 19 395 hospitalizations for TVS were identified. The utilization rate (number of surgeries/100,000 hospitalizations) was lower in Black and Hispanic patients compared with White patients for surgical tricuspid valve repair (STVr) (331 versus 493 versus 634, P\u3c0.01) and surgical tricuspid valve replacement (STVR) (312 versus 601 versus 728, P\u3c0.01). Similarly, the utilization rate was lower for women compared with men for STVr (1021 versus 1364, P\u3c0.01) and STVR (930 versus 1,316, P\u3c0.01). Compared to White men undergoing TVS, all women had lower odds of acute kidney injury [adjusted odds ratio (aOR) 0.65, 95% CI 0.55-0.78] and higher odds of blood transfusion (aOR 1.30, 95% CI 1.07-1.59), and Black men had higher odds of blood transfusion (aOR 1.59, 95% CI 1.08-2.35). In-hospital mortality and other surgical complications were similar between all groups (all P\u3e0.05).
Conclusions: Significant racial/ethnic and sex disparities exist in the utilization of TVS in the United States. Further studies are needed to understand the reasons for these disparities and to identify effective strategies for their mitigation.
Keywords: racial disparities; sex disparities; tricuspid valve disease; tricuspid valve repair; tricuspid valve replacement
Management of Esophageal Inflammatory Myofibroblastic Tumor With Endoscopic Submucosal Dissection
No full textInflammatory myofibroblastic tumors are rare tumors that have been described in virtually all organs. Even though they are extremely rare in the esophagus, several cases have been described in the literature. Surgical resection has been the therapeutic modality used in most of those cases. In this report, we describe a case of inflammatory myofibroblastic tumor that was successfully managed endoscopically for the first time with the endoscopic submucosal dissection technique.
Keywords: endoscopic submucosal dissection; esophageal tumor; esophagus; inflammatory myofibroblastic tumor; plasma cell granulomas
Familial Hypocalciuric hypercalcemia in an infant: diagnosis and management quandaries
No full textFamilial hypocalciuric hypercalcemia (FHH) is typically a benign condition characterized by elevated serum calcium, low urinary calcium excretion, and non-suppressed circulating levels of parathyroid hormone (PTH), usually requiring no intervention. FHH is inherited in an autosomal-dominant manner. Three subtypes are described, representing variants in genes with critical roles in extracellular calcium-sensing. FHH1, due to heterozygous inactivating variants in the calcium-sensing receptor gene (CASR) accounts for the majority of cases. FHH2, due to variants in GNA11, encoding the α-subunit of the downstream signaling protein, G11, is the rarest form of FHH. FHH3, resulting from variants in AP2S1, may present with a more pronounced phenotype than FHH1 or FHH2. We describe herein a newborn girl presenting with in utero femoral fractures, hypercalcemia, hypophosphatemia, and elevated circulating PTH. She was diagnosed with mild hyperparathyroidism and provided supplemental phosphate upon hospital discharge. However, serum calcium and PTH remained elevated at 5 months of age. The combination of low-calcium formula and cinacalcet improved the biochemical profile. No pathogenic variants in the coding region of CASR were identified; subsequent whole exome sequencing revealed a G-\u3eT transition at c.44 (p.R15L) in AP2S1. Family studies identified this variant in the father and an affected brother. The mother was unexpectedly found to be hypocalcemic and was diagnosed with idiopathic hypoparathyroidism. This case demonstrates successful treatment of FHH3 using a low-calcium formula to limit dietary calcium availability and cinacalcet to modify PTH levels. Plain language summary
An infant girl with a history of an in utero femoral fracture and a maternal history of hypoparathyroidism presented with persistent hypercalcemia, hypophosphatemia, and elevated parathyroid hormone levels. Despite receiving supplemental phosphorus upon hospital discharge, her serum calcium and PTH levels remained elevated at 4 months of age, and she was diagnosed with FHH type 3. Family studies also identified the presence of this variant in her father and an affected brother. After a trial with bisphosphonate failed to decrease calcium levels, she was treated with a combination of low-calcium formula and cinacalcet, which improved her biochemical profile. The patient remained on a stable clinical course on this regimen until she was weaned off cinacalcet at the age of 4 years
Nursing News & Views - August 2024
Get PDFNursing News & Views - August 2024https://scholarlycommons.libraryinfo.bhs.org/nursing_newsletters/1036/thumbnail.jp
Impact of Gift Giving During General Surgery Resident Match Interviewing Since Initiation of Virtual Interviews
No full textObjective: Following the transition to virtual interviews in 2021, interviewees began receiving gifts as a recruitment strategy in lieu of the preinterview dinner. This study characterizes quantity, type, and frequency of gift receipt in relation to program perception and ranking.
Design: An anonymous survey study was conducted. Variables included demographics, interview modality, gift type, frequency of gift receipt, monetary value, and changes in program perception and ranking. Descriptive analyses and Pearson\u27s chi-square testing were performed.
Setting: Single institution with a medium to large general surgery program size.
Participants: All general surgery residents at the single institution without exclusion.
Results: About 25 residents responded (60% response). Two respondents (8%) participated in both in-person (IPIs) and virtual interviews (VIs). About 72% (n = 18) participated in VIs, 36% (n = 9) IPIs. About 68% matched in 2021 or later. Overall, 76% received a gift during interviews. 100% of IPIs received a gift, while 67% of VIs received a gift. 88.9% of IPIs received a meal. VIs received: meal shared (28.6%), meal not shared (14.3%), food-specific gift card (28.6%), other food items (21.4%), or other (7.1%). About 66.7% of IPIs (n = 6) reported 76% to100% of programs offered a meal, whereas no VIs reported 76% to 100% of programs offering (p = 0.0002). VIs were less likely to have a shared meal experience (p = 0.017). About 55.5% of IPIs and VIs received nonfood gifts. Residents\u27 perception of a program\u27s interest, resources, and ranking of the program were not significantly different based on gifting.
Conclusion: Virtual interviews introduced heterogeneity in the receipt of gifts. The impact of a variable gifting experience is uncertain but raises concern for a potential new source of bias in the recruitment process.
Keywords: Interview; Match; bias; gift; resident
Transformation of a System-Wide Nursing Team Orientation: Bridging the Past with the Future
Get PDFhttps://scholarlycommons.libraryinfo.bhs.org/nurs_presentations2024/1008/thumbnail.jp