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Letter by Peled et al Regarding Article, Intravascular Imaging as a Performance Measure for Percutaneous Coronary Intervention .
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Optimal Medical Therapy Is Associated With Improved Limb Outcomes in PAD Patients: A BEST-CLI Substudy.
No full textDeterminants of Implementing an Adapted Version of STEADI for Fall Prevention of Older Adults Attending Outpatient Rehabilitation in a Large Health Care System.
No full textBACKGROUND AND PURPOSE: An adapted version of the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention initiative was implemented for older adults ≥ 65 years of age attending 34 outpatient physical therapy clinics in a large state-wide health system.
METHODS: We explored physical therapists\u27 (PTs) use and perceived determinants of implementation of an adapted version of STEADI using an explanatory mixed-methods approach (n = 50 surveys, 13 interviews). We analyzed survey data using descriptive statistics and mapped interview data to Consolidated Framework for Implementation Research 2.0 constructs using rapid template analysis.
RESULTS AND DISCUSSION: Participants believed that falls were preventable, used STEADI \u3e 50% of the time, and agreed that STEADI was suitable and implementable. The STEADI components with low reported complexity aligned with high use and are included in the original STEADI (\u3e50%; assessing and intervening in foot problems/footwear, home safety, balance, strength, endurance, gait, activity modifications, and caregiver training). Components with high reported complexity aligned with lower use, and the majority are not included in the original STEADI (\u3c 50%; assessing medication, vestibular function, cognition, and pelvic health interventions). Implementation facilitators included compatibility, embedding components of STEADI (eg, questionnaire and functional assessment) in the workflow and electronic health record (EHR), and relational connections. Implementation barriers included perceived lack of capability to conduct specific STEADI components (eg, medication assessment and specific interventions), lack of the EHR workflow of assessment and intervention components, and desire for more clinical decision support in the EHR, implementation support, and ongoing training.
CONCLUSION: Physical therapists reported higher adoption rates and lower complexity to implement components original to STEADI or common in physical therapy practice compared to the adapted/additional components added by the health system. The study results can be used to develop and adapt strategies to support the implementation and dissemination of STEADI or adapted versions in other outpatient clinics and health systems
Intrathecal Dexamethasone as a FIRES Extinguisher: A 12-Patient Clinical Experience with Usage of Intrathecal Dexamethasone for Febrile Infection-Related Epilepsy Syndrome.
No full textBACKGROUND: New-onset refractory status epilepticus (NORSE) is a devastating condition with high mortality and poor long-term outcomes. Febrile infection-related epilepsy syndrome (FIRES) is a subset of NORSE, preceded by fever. Intrathecal dexamethasone (IT-DEX) has emerged as a potential treatment, but few cases have been reported. This study aims to describe the use of IT-DEX in NORSE/FIRES, focusing on treatment logistics, dosing strategies, and patient outcomes.
METHODS: We conducted a retrospective analysis of 12 patients (10 children and 2 adults) with NORSE (including FIRES) enrolled in an international multicenter clinical biorepository who received IT-DEX as part of their treatment. Demographic and clinical data were extracted. IT-DEX pharmacological details and administration logistics were collected by contacting the primary investigators. A descriptive analysis was performed to evaluate treatment timing, dosage, and concurrent management, as well as clinical outcomes and cytokine profiles.
RESULTS: All patients qualified as FIRES. Patients were treated with a median of five doses of IT-DEX, starting a median of 20 days after refractory status epilepticus onset, with a median dose per infusion of 5 mg (0.21 mg/kg/dose). Clinicians reported a perceived favorable effect on seizure control in 83% of cases, with a median delay of 5 days to wean off continuous infusions after the last IT-DEX administration. Cytokine analysis (based on data from four patients with serial cerebrospinal fluid measurements and two patients with serial blood measurements) revealed persistently elevated levels of proinflammatory markers in most patients, with no significant changes following IT-DEX administration. No adverse effects were reported.
CONCLUSIONS: Most clinicians perceived a favorable effect of IT-DEX in refractory status epilepticus termination, and its use appears to be safe in patients with FIRES. This study provides a detailed description of administration logistics and dosing strategies from an international multicenter cohort. Additional studies are needed to confirm the safety and efficacy of IT-DEX and determine its impact on long-term outcomes including epilepsy prevention and functional recovery
Building a Home for Family Medicine: Reflections on the Development of a Consultant Clinic at Mangochi District Hospital in Rural Malawi.
No full textThis article reflects on the establishment of a family medicine consultant clinic at Mangochi District Hospital in rural Malawi, highlighting its significance in enhancing primary health care access and education. Founded under the Department of Family Medicine at Kamuzu University of Health Sciences, which was established in 2008, the clinic aims to address the high disease burden faced by the district\u27s 1.3 million residents, where specialist care is often inaccessible. Since its inception in early 2020, the clinic has provided critical care for patients with complex medical needs, emphasizing a holistic, patient-centered approach to their care. The clinic facilitates continuity of care and coordinates referrals to higher-level facilities, while also functioning as a training platform for medical students and residents. Challenges such as patient overflow, inappropriate referrals, and resource limitations are discussed, alongside strategies for ongoing evaluation and improvement. Early anecdotal evidence indicates a positive impact on patient satisfaction and care quality. The article underscores the importance of integrating family medicine specialists into rural health care settings to strengthen clinical education and improve patient outcomes. This initiative exemplifies a successful model for expanding family medicine influence in other rural districts and will potentially contribute to improved health systems throughout Malawi
Do Hourly Neuro Exams Lead to Sleep Deprivation and ICU Delirium: A Research Review
No full texthttps://digitalcommons.providence.org/covenant_nurses_week_2025/1005/thumbnail.jp
Implementation of a Traceback Testing Program for Ovarian Cancer: Findings from the FACTS Study.
No full textBackground: Traceback testing-identifying and offering testing to people with previous cancer diagnoses who have not received current standard genetic testing-could benefit patients and their at-risk relatives.
Methods: We conducted a multisite, nonrandomized pilot implementation study of a Traceback program at three integrated United States health systems. We assessed the reach, fidelity, effectiveness, and acceptability of the program using quantitative and qualitative methods.
Results: We identified 597 eligible individuals using administrative data and manual chart review. We attempted to reach everyone identified (100% fidelity). We successfully contacted 354 people, for a reach of 59% of confirmed eligible individuals. In total, 133 people completed Traceback genetic testing. Ten of these (8%) received pathogenic or likely pathogenic results;. Nine of these ten people received positive results for which cascade testing of at-risk relatives would be indicated. None of their relatives underwent cascade testing during the study period. Thirty-six received variants of uncertain significance (VUS). Traceback programs were acceptable to participants and implementers and thought to be applicable to other genetic screening conditions. The time and resources required to accurately identify Traceback-eligible individuals are likely determinants of future sustainability.
Conclusions: Education about free cascade testing, reminder calls to probands, and offers to directly contact at-risk relatives did not result in cascade testing in this pilot study. However, participant and implementer discussions suggest that the potential benefits of Traceback programs and high participant acceptability are worthy of further study
PloverDB: A high-performance platform for serving biomedical knowledge graphs as standards-compliant web APIs.
No full textUNLABELLED: Knowledge graphs are increasingly being used to integrate heterogeneous biomedical knowledge and data. General-purpose graph database management systems such as Neo4j are often used to host and search knowledge graphs, but such tools come with overhead and leave biomedical-specific standards compliance and reasoning to the user. Interoperability across biomedical knowledge bases and reasoning systems necessitates the use of standards such as those adopted by the Biomedical Data Translator consortium. We present PloverDB, a comprehensive software platform for hosting and efficiently serving biomedical knowledge graphs as standards-compliant web application programming interfaces. In addition to fundamental back-end knowledge reasoning tasks, PloverDB automatically handles entity resolution, exposure of standardized metadata and test data, and multiplexing of knowledge graphs, all in a single platform designed specifically for efficient query answering and ease of deployment. PloverDB increases data accessibility and utility by allowing data providers to quickly serve their biomedical knowledge graphs as standards-compliant web services.
AVAILABILITY AND IMPLEMENTATION: PloverDB\u27s source code and technical documentation are publicly available under an MIT License at github:RTXteam/PloverDB, archived on Zenodo at doi:10.5281/zenodo.15454600
Updates on radiotherapy-immunotherapy combinations: Proceedings of 8th Annual ImmunoRad Conference.
No full textThe annual ImmunoRad Conference has established itself as a recurrent occasion to explore the possibility of combining radiation therapy (RT) and immunotherapy (IT) for clinical cancer management. Bringing together a number of preclinical and clinical leaders in the fields of radiation oncology, immuno-oncology and IT, this annual event fosters indeed essential conversations and fruitful exchanges on how to address existing challenges to expand the therapeutic value of RT-IT combinations. The 8th edition of the ImmunoRad Conference, which has been held in October 2024 at the Weill Cornell Medical College of New York City, highlighted exciting preclinical and clinical advances at the interface between RT and IT, setting the stage for extra progress toward extended benefits for patients with an increasing variety of tumor types. Here, we critically summarize the lines of investigation that have been discussed at the occasion of the 8th Annual ImmunoRad Conference