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Project #094: Pharmacy Roles in HCAHPS Score Improvement
Get PDFhttps://scholarlycommons.henryford.com/qualityexpo2025/1014/thumbnail.jp
Project #084: ZAP VAP: A Quality Improvement Initiative to decrease Ventilator Associated Pneumonia (VAP) in the Henry Ford Hospital NICU
Get PDFhttps://scholarlycommons.henryford.com/qualityexpo2025/1012/thumbnail.jp
Racial Disparities Among Patients Undergoing Balloon-Expandable Transcatheter Aortic Valve Replacement
No full textBACKGROUND: Aortic stenosis is the most frequently acquired native valve disease. Transcatheter aortic valve replacement (TAVR) has emerged as a transformative intervention for patients with severe aortic stenosis. Despite its success, studies have shed light on racial and ethnic disparities in utilization and outcomes of TAVR.
METHODS: Using the Transcatheter Valve Therapy Registry between November 2011 through June 2023, we evaluated volume trends of SAPIEN balloon-expandable TAVR performed by race/ethnicity, and its association with in-hospital and 1-year outcomes after the procedure.
RESULTS: In the 12-year period, 395,618 patients were identified; 357,729 (90.42%) were White, 18,810 (4.75%) Hispanic, 15,100 (3.82%) Black, and 3979 (1.01%) Asian. There was an overall rising trend in proportional usage of TAVR among Hispanics (from 3.3% in 2011/2012 to 5.2% in 2023, P \u3c .01) and Asian patients (from 1.1% in 2011/2012 to 1.3% in 2023, P \u3c .01). Adjusted 1-year major adverse cardiac events (all-cause mortality, stroke, or rehospitalization) were comparable among Black patients (hazard ratio [HR], 1.00; 95% CI, 0.97-1.03; P = .82) and lower among Asian (HR, 0.91; 95% CI, 0.86-0.97; P \u3c .01) and Hispanic patients (HR, 0.89; 95% CI, 0.86-0.91; P \u3c .01) compared with White patients.
CONCLUSIONS: Evidence supports favorable outcomes across different ethnic groups, despite the presence of higher levels of comorbidities and lower TAVR utilization. Modest improvements in TAVR utilization disparities among Asian and Hispanic patients have occurred since its introduction; however, utilization in Black patients remains low despite favorable outcomes. Further efforts are needed to understand the reasons and mitigate disparities in minority patients
Alcohol use after metabolic and bariatric surgery: a qualitative investigation of the relation with mood and food
No full textBACKGROUND: Individuals who undergo metabolic and bariatric surgery are at increased risk for an alcohol use disorder. Clarity on the relationships between mood, food, and alcohol use could inform interventions to reduce alcohol use and mitigate risk of alcohol use disorders after metabolic and bariatric surgery (MBS).
METHODS: Twenty patients who underwent MBS at a single health care system and reported engaging in post-operative alcohol use were recruited. Participants were between 6 months and 3 years post-operative and reported consuming alcohol at least 2-3 times per month. Participants engaged in a 1-hour semi-structured interview about factors influencing post-operative mood, eating behaviors, and alcohol use. All interviews were recorded, transcribed, and coded by two independent raters.
RESULTS: Statements by participants were deductively coded within different themes: (1) changes in mood, (2) changes in eating patterns, and (3) unintended alcohol use and eating. Participants reported positive changes in mood and eating behaviors following MBS, but also indicated potential for negative mood states and new eating patterns. They also suggested that mood was a driver of both eating and alcohol use, including unintended (i.e. unplanned) eating and unintended alcohol use. However, most did not consume food and alcohol at the same time.
DISCUSSION: Food and alcohol may be used as a coping strategy for mood, though they are not often consumed together. There is currently a lack of post-operative interventions to reduce alcohol use and findings suggest that interventions could simultaneously target mood, unintended eating, and alcohol use
Trends in ischemic heart disease-related mortality in obese population in the United States
No full textObesity affects approximately 72 million Americans and is a significant contributor to ischemic heart disease (IHD). Given the scarcity of data, this observational study examines trends and disparities in IHD-related mortality among obese individuals in the United States from 2003 to 2019 using Centers for Disease Control and Prevention\u27s Wide-Ranging Online Data for Epidemiologic Research data. Age-adjusted mortality rates (AAMRs) were calculated for IHD as the underlying cause of death and obesity as a contributing cause of death, revealing an increase in IHD-related mortality among obese adults. AAMR rose from 2.1 in 2003 to 3.9 in 2019, with higher rates in men, non-Hispanic Black individuals, the elderly, and those in nonmetropolitan and Midwest regions. These findings underscore significant sex, racial, and regional disparities in mortality, suggesting a need for targeted health policies and resource allocation, improving overall cardiovascular health outcomes
Pridopidine in Amyotrophic Lateral Sclerosis: The HEALEY ALS Platform Trial
No full textIMPORTANCE: Amyotrophic lateral sclerosis (ALS) is a fatal disease. The sigma-1 (σ1) receptor emerged as a target for intervention.
OBJECTIVE: To determine the effects of pridopidine, a σ1-receptor agonist, in ALS.
DESIGN, SETTINGS, AND PARTICIPANTS: Pridopidine was tested as a regimen of the HEALEY ALS Platform Trial, a phase 2/3, multicenter, randomized, double-blind, platform trial. The study was conducted at 54 sites in the US from January 2021 to July 2022 (final follow-up, July 14, 2022). A total of 163 participants with ALS were randomized to receive pridopidine or placebo. An additional 122 concurrently randomized participants were assigned to receive placebo in other regimens and included in the analyses.
INTERVENTIONS: Eligible participants were randomized 3:1 to receive oral pridopidine 45 mg twice daily (n = 121) or matching oral placebo (n = 42) for a planned duration of 24 weeks.
MAIN OUTCOMES AND MEASURES: The primary efficacy outcome was change from baseline through week 24 in ALS disease severity, analyzed using a bayesian shared parameter model, which has components for function (Revised Amyotrophic Lateral Sclerosis Functional Rating Scale [ALSFRS-R]) and survival that were linked through an integrated estimate of treatment-dependent disease slowing across these 2 components. This was denoted as the disease rate ratio (DRR), with DRR less than 1 indicating a slowing in disease progression on pridopidine relative to placebo. There were 5 key secondary end points: time to 2-point or greater reduction in ALSFRS-R total score among participants with bulbar dysfunction at baseline, rate of decline in slow vital capacity among participants with bulbar dysfunction at baseline, percentage of participants with no worsening in the ALSFRS-R bulbar domain score, time to 1-point or greater change in the ALSFRS-R bulbar domain score, and time to death or permanent assisted ventilation.
RESULTS: Among 162 patients (mean age, 57.5 years; 35% female) who were randomized to receive the pridopidine regimen and included in the primary efficacy analysis, 136 (84%) completed the trial. In the primary analysis comparing pridopidine vs the combined placebo groups, there was no significant difference between pridopidine and placebo in the primary end point (DRR, 0.99 [95% credible interval, 0.80-1.21]; probability of DRR \u3c 1, 0.55) and no differences were seen in the components of ALSFRS-R or survival. There was no benefit of pridopidine on the secondary end points. In the safety dataset (pridopidine, n = 121; placebo, n = 163), the most common adverse events were falls (28.1% vs 29.3%, respectively) and muscular weakness (24.0% vs 31.7%, respectively).
CONCLUSIONS AND RELEVANCE: In this 24-week study, pridopidine did not impact the progression of ALS.
TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT04297683, NCT04615923
Grapheme-color synesthesia in patients with epilepsy: A pilot study
No full textBACKGROUND: Synesthesia is a condition in which the stimulation of one sensory modality triggers unusual experiences in a second sensory modality such as colors or shapes. Synesthesia has been linked to specific conditions such as autism spectrum disorder, although the mechanisms underlying synesthesia remain largely unclear.
OBJECTIVE: This pilot study aimed to investigate the prevalence of grapheme-color synesthesia (GCS) in patients with epilepsy and to characterize the epilepsy features associated with GCS experiences.
METHODS: Participants were asked whether they reported experiences suggesting GCS. Those reporting GCS underwent a standard online consistency and congruency battery test (http://www.synesthete.org). Epilepsy features, electroencephalogram (EEG) findings, and magnetic resonance imaging (MRI) findings were collected and analyzed.
RESULTS: Of the 40 study participants, 21 reported GCS experiences and 3 (7.5 %) resulted synesthetes from the battery test. Analysis of the test results showed that participants with focal seizures had lower median consistency scores (indicating they were less consistent in their color assignments) and higher congruency scores (indicating they were more accurate in quickly identifying matching color and letter/number combinations) compared to patients with generalized-onset seizures (2.9 and 51.4 respectively; p = 0.006, p = 0.001). Participants with non-motor seizures had lower median consistency scores (1.1) and higher congruency scores (79.2) compared to patients with motor seizures (2.8 and 52.8, respectively; p = 0.011, p = 0.036).
CONCLUSION: GCS may be more prevalent in patients with epilepsy than the general population. Focal and non-motor seizures may be associated with predisposition to GCS. Further larger scale studies are needed to confirm and expand these observations
Multicenter study of association between socioeconomic status and treatment of ruptured cerebral aneurysms compared to unruptured cerebral aneurysms: insights from 4,517 patients using the area deprivation index
No full textBACKGROUND: Socioeconomic status influences health outcomes, including cerebrovascular diseases. Patients from socioeconomically deprived areas may present with more severe conditions due to delayed access to care. This study evaluates the association between neighborhood-level deprivation, measured by the Area Deprivation Index (ADI), and the treatment of ruptured intracranial aneurysms (RIAs) compared with unruptured intracranial aneurysms (UIAs) across multiple centers.
METHODS: This retrospective cohort study analyzed data from 4517 patients treated for cerebral aneurysms at 10 US comprehensive stroke centers between 2018 and 2024. Patients were stratified by national ADI decile based on their residential addresses. Multivariable logistic regression was used to examine the relationship between ADI and aneurysm rupture (reference being unruptured aneurysms) and controlled for age, sex, smoking history, family history, and race.
RESULTS: Of 4517 total patients, 1260 (27.9%) underwent treatment of RIAs. Multivariable analysis confirmed ADI as an independent predictor of presentation for treatment of RIA (odds ratio (OR)=1.100, 95% confidence interval (CI)=1.068-1.133, P\u3c 0.0001) after adjusting for age, sex, smoking history, and race. This corresponds to a 10% increase in likelihood of presenting for treatment of a ruptured vs unruptured intracranial aneurysm with each ADI decile.
CONCLUSION: Socioeconomic deprivation independently predicts treatment of RIAs compared with the treatment of UIAs. These findings highlight disparities in aneurysm detection and management, emphasizing the need for targeted preventive care and accessible screening programs to mitigate the impact of socioeconomic disadvantage on cerebral aneurysm outcomes
Evaluating if ChatGPT Can Answer Common Patient Questions Compared With OrthoInfo Regarding Rotator Cuff Tears
No full textPURPOSE: To evaluate ChatGPT\u27s (OpenAI) ability to provide accurate, appropriate, and readable responses to common patient questions about rotator cuff tears.
METHODS: Eight questions from the OrthoInfo rotator cuff tear web page were input into ChatGPT at two levels: standard and at a sixth-grade reading level. Five orthopaedic surgeons assessed the accuracy and appropriateness of responses using a Likert scale, and the Flesch-Kincaid Grade Level measured readability. Results were analyzed with a paired Student t-test.
RESULTS: Standard ChatGPT responses scored higher in accuracy (4.7 ± 0.47 vs. 3.6 ± 0.76; P \u3c 0.001) and appropriateness (4.5 ± 0.57 vs. 3.7 ± 0.98; P \u3c 0.001) compared with sixth-grade responses. However, standard ChatGPT responses were less accurate (4.7 ± 0.47 vs. 5.0 ± 0.0; P = 0.004) and appropriate (4.5 ± 0.57 vs. 5.0 ± 0.0; P = 0.016) when compared with OrthoInfo responses. OrthoInfo responses were also notably better than sixth-grade responses in both accuracy and appropriateness (P \u3c 0.001). Standard responses had a higher Flesch-Kincaid grade level compared with both OrthoInfo and sixth-grade responses (P \u3c 0.001).
CONCLUSION: Standard ChatGPT responses were less accurate and appropriate, with worse readability compared with OrthoInfo responses. Despite being easier to read, sixth-grade level ChatGPT responses compromised on accuracy and appropriateness. At this time, ChatGPT is not recommended as a standalone source for patient information on rotator cuff tears but may supplement information provided by orthopaedic surgeons
