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The Feasibility and Impact of Implementing Brief Educator Development Sessions in Underresourced Residency Training Sites.
No full textBackground Busy physician educators teaching in rural and underserved communities face challenges finding time and resources to support their professional development. Objective We developed and assessed the feasibility and utility of delivering 25-minute virtual educator development sessions for educators in residency training programs located in rural and underserved communities. Methods This study evaluated a monthly 25-minute web-based education program designed to develop residency program directors\u27 and other educators\u27 teaching and assessment skills in training programs located in rural and underresourced communities. Participants included educators from Oregon and California between September 2021 and October 2023. Feasibility was evaluated by educator attendance and technology use. Utility was measured by continuing medical education credit requests regarding educational value and participant-reported application of skills. Results Ninety-one educators participated, 59 from Oregon and 32 from California. Most were female (64.8%, 59 of 91), between the ages of 30 and 49 (68.1%, 62 of 91), White (85.7%, 78 of 91), and non-Hispanic/Latinx (90.1%, 82 of 91). Physicians made up 75.8% (69 of 91), while 18.7% (17 of 91) were other program educators. Feasibility in terms of technology use was found to be 50% or greater by desktop computer connection, with the remaining by mobile devices. Regarding utility, continuing medical education credit was requested for 48 (29.8%) of the 161 viewed sessions. Conclusions Brief, web-based educator development sessions are feasible to implement in residency training sites located in remote and underresourced communities. Participants self-reported their intention to apply what they learned in their work with trainees
Long-Range Air Transportation for High-Consequence Infectious Diseases: Findings from a Global Tabletop Exercise on Patients with Viral Hemorrhagic Fever.
No full textOBJECTIVES: Air medical services evacuation of patients with viral hemorrhagic fevers (VHFs) is a complex process. The United States National Emerging Special Pathogens Training and Education Center held an in-person tabletop exercise (TTX) in June 2023 to review and evaluate global processes and plans for long-range VHF air transportation capabilities. The TTX sought to test the coordination, prioritization, capacities, and plans for using VHF transportation capabilities when multiple countries simultaneously request support in air medical services evacuation of their sick or exposed citizens to a high-level isolation unit in their country for care.
METHODS: Organizations invited to participate in the exercise (
RESULTS: Representatives from 15 organizations in six countries participated in the TTX; the only organization unable to attend was the World Health Organization. Findings indicated many countries rely on the same organization for VHF air transportation resources that would be quickly exceeded in this scenario. There is a need to further define processes for determining global prioritization of transportation assets when requests exceed capacity.
CONCLUSIONS: Reliance on the same limited global transportation assets has implications for health security and limits the global response to multiple patients or individuals needing repatriation simultaneously. This indicates the importance of prioritizing resources, enhancing multinational coordination, and highlights the need to elevate these findings and discussions to national and international policy levels to increase air transportation resources and expand global capacity for managing patients with VHFs
An Indicator Cell Assay-based Multivariate Blood Test for Early Detection of Alzheimer\u27s Disease.
No full textThe indicator cell assay platform (iCAP) is a novel next-generation approach for blood-based diagnostics that uses standardized cells as biosensors to amplify weak disease signals in blood. We developed an Alzheimer\u27s disease iCAP (AD-iCAP) for early detection at the mild cognitive impairment/mild dementia stages. To develop the assay, patient plasma is incubated with standardized neurons, which transduce complex circulating signals into gene-expression readouts used to train multivariate disease classifiers via machine learning. We applied systems biology analyses (e.g., GSEA, PCA, correlation/network analyses) to optimize analytical and computational parameters, and then evaluated a locked model in a study with retrospectively collected samples. Performance was AUC 0.64 (95% CI 0.51-0.78, n=82) on an independent external-validation set and AUC 0.77 (95% CI 0.57-0.96, n=23) on a blind set, supporting prospective confirmation in a larger cohort. To overcome pre-analytical noise and reduce bias in feature-selection, modeling was done using a fixed panel of 84 candidate genes chosen a priori from an external AD-iCAP dataset generated with 5XFAD mouse plasma. Despite using no AD-specific prior knowledge in this approach, the assay readout was enriched for Alzheimer\u27s-relevant pathways, including cholesterol biosynthesis, synaptic structure/neurotransmission and PIK3/AKT activation. Because the assay senses a multivalent cellular response, which is orthogonal to circulating amyloid or tau measurements, AD-iCAP may complement existing blood tests, and its multivariate readout offers a path to precision-medicine applications such as patient stratification for treatment response
Medicare\u27s Benchmarking Spinal DRGs have Limited Capacity in Capturing the Nuances of Surgical Invasiveness, Hospital Length of Stay, Discharge Disposition, Key Quality Metrics, and Reimbursement Costs for Adult Spinal Deformity.
No full textSTUDY DESIGN: Retrospective cohort analysis.
OBJECTIVE: Assess the distribution of Medicare\u27s spinal-deformity-specific diagnosis-related group (DRGs) relative to surgical invasiveness, hospital length of stay (LOS), discharge disposition, 90-day post-operative quality metrics, and reimbursement costs for adult spinal deformity (ASD) operations.
SUMMARY OF BACKGROUND DATA: Heterogeneity of ASD call into question Medicare\u27s DRGs to accurately capture nuances of ASD surgical episodes of care.
METHODS: Adults who underwent thoracic to pelvis instrumentation with associated DRGs were identified from a multi-center database. Demographics, operative details, inpatient course, discharge disposition, 90-day adverse events, and reimbursement costs were compared between spinal deformity-specific DRG codes. Distribution of DRGs for a subset of these patients who fit into one of 6 commonly performed surgical strategies to address ASD were also assessed.
RESULTS: Of the 314 patients included for analysis, the majority fell into +CC DRGs, while the minority had +MCC DRGs or no MCC/CC DRG. Within each DRG there was considerable heterogeneity in regard to patients\u27 ages, ASA, CCI, frailty, surgical invasiveness, post-operative ICU/hospital LOS, discharge disposition, and complication profiles.+MCC DRGs had significantly greater ASA and Edmonton Frailty Scores. While +MCC and +CC had relatively similar surgical invasiveness, +MCC had greater ICU admissions, in-hospital adverse events, and non-home discharges as well as longer ICU, hospital, and rehab LOS. While reimbursements were significantly higher for +MCC DRG compared to +CC DRGs and DRGs without MCC/CC, there were large ranges in reimbursement within all DRG subgroups.The 7 DRGs varied significantly within and between the subset of 6 commonly performed surgical strategies, although there were no differences in regard to ICU admissions and LOS, hospital LOS, discharge disposition, and number of adverse events (in-hospital, 90-day).
CONCLUSIONS: While Medicare\u27s spinal-deformity DRG codes capture average trends in surgical/post-operative episodes of care for ASD patients, each encompasses highly heterogeneous patients and associated surgical operations rendering them unreliable gauges of patient/surgical complexity, early post-operative trajectories, and reimbursement costs. A more granular system is needed to more accurately capture the nuances of ASD operations and their associated quality metrics and reimbursement costs
Incidence and Outcomes of Atrial Fibrillation and Systolic Dysfunction in Patients Receiving Mavacamten for Obstructive Hypertrophic Cardiomyopathy: A Multicenter Study.
No full textIMPORTANCE: Mavacamten is highly effective in treating symptomatic obstructive hypertrophic cardiomyopathy (oHCM) and was approved for commercial use with a risk mitigation program (REMS) to monitor the impact on left ventricular systolic function (LVSD). The impact of mavacamten on atrial fibrillation (AF) occurrence is not well characterized.
OBJECTIVE: Determine the real-world incidence of new-onset and recurrent AF among patients with HCM treated with commercial mavacamten. Secondary objectives included assessing the incidences of LVSD, heart failure (HF), and cardiogenic shock.
DESIGN: A multicenter cohort study. Center-level data were aggregated for patients who received mavacamten from May 2022 through December 2024.
SETTING: Twenty-one outpatient HCM centers in the United States.
PARTICIPANTS: Consecutive patients ≥18 years of age with oHCM were included; those with permanent AF were excluded.
EXPOSURES: At least one dose of commercial mavacamten.
MAIN OUTCOMES AND MEASURES: Incidence of new-onset and recurrent AF, LVSD, HF, and cardiogenic shock.
RESULTS: Among 1,538 patients (median age, 66 years [95% CI, 65.9-66.1]; 57% female [95% CI, 54-59%]), 25% [95% CI, 22-27%] had prior AF. Median mavacamten exposure was 13.4 months [95% CI, 11.8-15.0]. Overall AF incidence was 13% [95% CI, 10-17%], including 5% [95% CI, 4-7%] new-onset and 39% [95% CI, 27-51%] recurrent AF in those with history of AF prior to mavacamten initiation. LVEF \u3c 50% occurred in 8% [95% CI, 6-9%], of whom 70% had AF. Symptomatic HF occurred in 1.5% [95% CI, 0.8-2.2%], cardiogenic shock in 0.6% [95% CI, 0.1-1.0%], and an overall permanent discontinuation of mavacamten in 7% [95% CI, 4-10%].
CONCLUSIONS AND RELEVANCE: In this multicenter cohort receiving commercial mavacamten, we identified an annual incidence of 5% new-onset AF and 39% recurrent AF, while 70% of patients who developed LVEF\u3c 50% had concurrent AF. Given this association and the morbidity that can be associated with AF, protocols for LVEF assessment and aggressive rhythm management following AF detection may be warranted to improve patient care. Further studies are needed to improve understanding of the impact of mavacamten on AF and patient outcomes
Placental network differences among obstetric syndromes identified with an integrated multiomics approach.
No full textThe placenta is essential for pregnancy, and its dysfunction can harm both mother and fetus. To better understand placental physiology and its disruption in disease, we employ a multiomics approach (transcriptomics, metabolomics, and proteomics) combined with clinical data and histopathology from 321 placentas across conditions: severe fetal growth restriction (FGR), FGR with hypertension (FGR + HDP), severe preeclampsia (PE), and spontaneous preterm delivery (PTD). Cellular deconvolution reveals FGR + HDP placentas have more extravillous trophoblasts than controls (p \u3c 0.0001). After adjusting for fetal sex and gestational age, we build condition-specific interomics networks and detect communities (a.k.a. subnetworks). In a control community, miR-365a-3p is the most connected node, whereas in FGR + HDP placentas, it is hypoxia-induced miR-210-3p. From this community, we identify a signature containing mRNAs implicated in placental dysfunction (e.g. FLT1, FSTL3, HTRA4, LEP, and PHYHIP), which distinguishes FGR + HDP placentas from those with other conditions, illustrating the power of interomics in understanding obstetric syndromes
Deploying ambient clinical intelligence to improve care: A research article assessing the impact of nuance DAX on documentation burden and burnout.
No full textINTRODUCTION: Occupational burnout among clinical care providers, due in part to documentation burden, has reached crisis level. This study measured the effect of using new clinical documentation software, an \u27ambient clinical intelligence\u27 (ACI) program, to reduce the documentation workload and improve provider wellbeing.
METHODS: This was a randomised, control study with a step-wedge design. Providers were randomly assigned to use ACI early or late in the study. Medical records metadata captured time spent on documentation. Measures of burden and burnout were collected monthly.
RESULTS: ACI significantly reduced documentation burden, provider frustration and burnout. Providers spent less documentation time each day, and 2.5 h less per week of off-hours documentation.
DISCUSSION: This study demonstrates that the use of ACI does indeed relieve the documentation burden and had both subjective and objective benefits. The widespread use of ACI has the potential to alleviate the crisis of physician burnout
Global Insights Into Spondylodiscitis: A Bibliometric Analysis of Four Decades of Research.
No full textThe diagnosis and management of spondylodiscitis (SD) remain challenging for clinicians due to its insidious onset and nonspecific clinical presentation. Patients often have multiple comorbidities, requiring a multidisciplinary approach that may involve both nonsurgical and surgical interventions. This bibliometric study aims to analyze global research output on SD, exploring publication trends, citation patterns, contributing countries and journals, and commonly associated keywords. Data were collected from the Clarivate Analytics Web of Science (WoS) database on July 22, 2024, using the search terms Spondylodiscitis OR Spondylodiskitis OR vertebral osteomyelitis OR spine osteomyelitis OR spinal osteomyelitis OR osteodiscitis OR osteodiskitis OR discitis OR diskitis . A total of 4,363 relevant publications were identified, spanning the years 1982 to 2023. Descriptive and quantitative analyses were conducted, including keyword network visualizations. There was an almost 15-fold increase in publication volume, from 18 publications in 1982 to 269 in 2023. Citation frequency followed a similar trajectory, rising from a single citation in 1982 to 7,148 in 2023. The United States, Germany, and France accounted for over 50% of the total research output, with Spine identified as the most prolific journal. Commonly co-occurring keywords included endocarditis and staphylococcus aureus, as revealed by network visualization analysis. In conclusion, SD is a complex condition requiring multidisciplinary care. This bibliometric review demonstrates significant growth in both research volume and citation impact, particularly from high-income countries. Notably, keyword mapping revealed an underrepresentation of comorbidity-related terms in recent literature, indicating a potential gap in current academic discourse
The Impact of a Chief Nursing Officer Development Program on New and Emerging Executive Nurse Leaders: A Mixed-Methods Study.
No full textOBJECTIVE: This cross-sectional, mixed-methods study explored new and aspiring chief nursing officers\u27 (CNOs) perceived leadership effectiveness after attending an executive leadership development program.
BACKGROUND: CNOs deal with complex challenges that require new leadership acumen. Higher CNO turnover and shortened tenure (2-7 years) indicate the need for specific, early programmatic leadership development to meet emerging challenges.
METHODS: An exploratory cross-sectional, mixed-methods approach was used to gain a deeper understanding of the impact, attitudes, challenges, issues, and leadership support of new/aspiring CNOs.
RESULTS: Respondents indicated the program positively influenced their leadership development, encouraged them to attain higher leadership roles, and supported them to expand their professional network.
CONCLUSIONS: Findings demonstrated the effect leadership development programs can have on new/aspiring CNOs and identified an ongoing need for development. Additional research exploring multilevel effects is needed to convey the return on investment for executive nursing leadership development programs
