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Unseen burden: Emotional, financial and occupational impacts on caregivers of patients with short bowel syndrome
No full textRationale: Short bowel syndrome (SBS) is a complex condition often requiring parenteral support (PS), leading to significant caregiver burden. This study assessed the multidimensional impacts of caregiving. Methods: A noninterventional, cross-sectional, online survey was conducted in the US and Europe among caregivers (≥18 years) of patients with SBS. The SF-12 Health Survey version 2 (SF-12v2) assessed health-related quality of life, and the Kingston Caregiver Stress Scale (KCSS) measured caregiver burden. SF-12v2 norm-based scores were compared with a US population-based mean score of 50.0. Results: 66 caregivers participated (US, n=45; Europe, n=21); most were White (62.3%), female (57.6%), and ≥45 years-old (56.1%). They were commonly a spouse partner (39.4%), child (33.3%), or parent (15.1%); 51.5% provided care ≥25 hours week, including errands (86.4%), appointments (84.8%), home healthcare (81.8%), and PS (78.8%). Caregivers reported moderate stress (mean KCSS, 20.2). Over 25% experienced moderate to extreme financial stress, with most (70.6%) caregiving ≥25 hours week. 40 caregivers were unemployed. In the past 7 days, 53.8% of employed caregivers reported caregiver-related absenteeism and 92.0% reported impaired work productivity; impairment was highest for those who spent ≥25 hours caregiving. SF-12v2 physical (54.0) and social (49.2) domain scores were comparable to the general population; role–emotional (47.2) domain scores were lower. Conclusion: Caregivers of patients with SBS dependent on PS experience a substantial emotional, financial, and professional burden. Caregivers in this study, especially those who provided care ≥25 hours week, reported substantial unemployment and financial stress. Most employed caregivers reported impaired work productivity and absenteeism. These findings emphasize the urgent need for support to alleviate caregiver burden and improve their well-being. Disclosure of Interest: M. Winkler Consultant for: Ironwood and Takeda Pharmaceutical, J. Harrison Other: Volunteer for Girls With Guts, R. Vemulapalli Other: CME Faculty for Novus Medical Education, V. Kumpf Consultant for: Ironwood, Baxter Healthcare, and Fresenius Kabi, G. Mitchell Other: Employee of Ironwood and may hold shares and or stock options in the company., D. Wolin Other: Full-time employee of RTI Health Solutions, an independent nonprofit research organization, which was retained by Ironwood to conduct the research that is the subject of this abstract. Their compensation is unconnected to the studies on which they work., L. Zografos Other: Full-time employee of RTI Health Solutions, an independent nonprofit research organization, which was retained by Ironwood to conduct the research that is the subject of this abstract. Their compensation is unconnected to the studies on which they work., M. Yang Other: Employee of Ironwood and may hold shares and or stock options in the company., L. Jackson Other: Full-time employee of RTI Health Solutions, an independent nonprofit research organization, which was retained by Ironwood to conduct the research that is the subject of this abstract. Their compensation is unconnected to the studies on which they work., J. Wang Other: Full-time employee of RTI Health Solutions, an independent nonprofit research organization, which was retained by Ironwood to conduct the research that is the subject of this abstract. Their compensation is unconnected to the studies on which they work., J. Henderson Other: Employee of Ironwood and may hold shares and or stock options in the company., M. Boules Other: Employee of Ironwood and may hold shares and or stock options in the company., S.-M. Jafri Consultant for: Intercept, Ironwood, AbbVie, Gilead, Takeda, and Ipse
Beyond Fitzpatrick Skin Types: A Delphi Consensus on Key Considerations for a Universal Skin Typing Classification
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Trends in hospice and palliative care consults initiated in the emergency department: An eight-year utilization analysis
No full textBACKGROUND: Emergency departments (EDs) play a central role in end-of-life care, yet the early integration of hospice and palliative care (HPC) is often underutilized. Early access to HPC improves outcomes, aligns care with patient goals, and reduces costs. However, incorporating primary and specialized palliative care resources in the ED remains inconsistent, and utilization trends are not well understood. Our study evaluates the incidence and trends of ED-initiated HPC consults over 8 years within a large metropolitan health system.
METHODS: We conducted a retrospective cohort study of electronic health records from 5 EDs between 2016 and 2023. Our cohort included all ED visits where HPC consults were ordered. We examined the annual number of HPC consults, patient demographics, and health outcomes. A subgroup analysis evaluated HPC consults per 1000 ED patients aged 60 or older admitted for inpatient care.
RESULTS: A total of 8055 HPC consults were ordered for 6370 unique patients. The average age was 78.1 years, with 56.4 % female and 75.0 % White. Of the cohort, 91.7 % were admitted, 5.3 % discharged home, and 53.2 % died in-hospital. HPC consults increased from 369 in 2016 to 1355 in 2023 (367 % increase, p \u3c 0.001). The ratio of hospice to palliative care consults reversed from 1.5:1 in 2016 to 1:1.9 in 2023. Post-COVID-19, daily HPC consults rose by 173.6 % compared to pre-pandemic levels.
CONCLUSIONS: ED-initiated HPC consults increased significantly over time, suggesting an evolving role for EDs in delivering primary palliative care. Further research is needed to determine national trends and identify barriers to broader implementation
Downstream Outcomes of Elevated Prostate-Specific Antigen (PSA) Detected Through Routine Screening in Men Aged 55-70: A 10-Year Retrospective Study
No full textIntroduction: Prostate-specific antigen (PSA) screening remains a contentious issue due to its high sensitivity but low specificity. While elevated PSA can indicate prostate cancer, it may also result from benign conditions such as benign prostatic hyperplasia (BPH), prostatitis, or infection. The variability in downstream management following elevated PSA in nonspecialist outpatient settings is not well-characterized. Downstream management refers to clinical follow-up measures after elevated PSA results, including referral, biopsy, repeat testing, benign diagnoses, refusal, or no further evaluation.
Objective: This study aimed to assess the clinical outcomes following elevated PSA levels (≥ 4 ng/mL) identified through routine screening in men aged 55-70 years in a primary care clinic over a 10-year period.
Methods: We conducted a retrospective observational study at an independent outpatient clinic in Michigan, analyzing electronic health records (EHRs) from 2015 to 2024. A total of 1,258 men aged 55-70 who underwent routine PSA testing were included. Patients with known urologic conditions or prostate cancer were excluded. Among those with elevated PSA levels, downstream outcomes such as urology referrals, biopsy status, cancer detection, benign diagnoses, repeat testing, and loss to follow-up were evaluated using descriptive statistics.
Results: Of 1,258 screened patients, 127 (10.1%) had PSA levels ≥4 ng/mL. Among them, 44 (34.6%) underwent biopsy, with prostate cancer confirmed in 18 patients (40.9% of biopsied; 1.4% of total screened). The remaining 83 patients (65.4%) did not undergo biopsy: 13 normalized their PSA on repeat testing, 37 were diagnosed clinically with BPH, eight had other benign causes (e.g., urinary tract infection (UTI), prostatitis), 12 declined biopsy, and 13 were lost to follow-up. These findings reveal considerable heterogeneity in follow-up care and clinical decision-making.
Conclusion: In this real-world primary care setting, most men with elevated PSA were managed noninvasively, with a substantial proportion avoiding biopsy. Despite this, the cancer detection rate among biopsied individuals was significant. These results underscore the need for standardized follow-up protocols and decision-support frameworks to guide post-PSA screening management in outpatient environments
Gastric electrical stimulation versus standard medical therapies for long-term symptom control and improved quality of life in drug-refractory gastroparesis patients
No full textOBJECTIVES: This systematic review and meta-analysis evaluated the effectiveness of gastric electrical stimulation (GES) in alleviating symptoms of gastroparesis (GP) compared to alternative medical therapies.
METHODS: We conducted a comprehensive search of PubMed, Cochrane Library, and Embase from January 2004 to October 2024 using MeSH terms and keywords related to GP and GES. The search included randomized controlled trials (RCTs) and observational studies published in English. Data extraction followed PRISMA and AMSTAR guidelines. The primary outcome was symptom control, measured using the weighted mean difference and a 95% confidence interval (CI). Statistical analysis was performed using RevMan software, and the certainty of evidence was assessed using the GRADE tool.
RESULTS: A total of 1918 articles were screened, with 4 studies included in the final analysis. The mean difference in symptom control was -0.16 (95% CI: -0.57, 0.26). Heterogeneity was assessed using the chi-square Test, and inconsistency was quantified using the I(2) index.
CONCLUSIONS: GES provides some symptomatic relief in GP, particularly for nausea and vomiting, though the improvements were not statistically significant. Future research should focus on non-crossover RCTs to minimize bias and further explore GES efficacy in idiopathic and postsurgical gastroparesis cases
Virtual Registered Nurse: Journey to Improved Outcomes and Increased Patient Satisfaction
Get PDFPurpose: The purpose of this quality improvement project was to improve patient outcomes and increase Background: Many hospitals are being tasked with becoming creative with staffing as the national nursing shortage continues to increase. One creative way many hospitals have combat staffing concerns is with the implementation of a vRN (Hughes et al., 2021). The main goal of the vRN is to decrease workload of the nurses caring directly for the patient at the bedside through visual monitoring, chart reviews, or assistance with specific tasks (Lisk et al., 2020). Methods: The unit leadership team held meetings with staff to identify areas where staff felt the vRN would be helpful. A unit Task Force was also created to outline specific workflows to ensure efficiency, standardization of tasks and achieve key stakeholder buy-in. Each room had a two-way audio and visual feedback device installed, so the patient and RN could both see and clearly hear each other. To monitor improved patient outcomes, the following nurse-sensitive indicators were analyzed: falls, hospital-acquired pressure injuries, number of call lights, patient experience (Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]) data, and time to discharge. Regarding staff satisfaction, voluntary RN turnover and RN satisfaction surveys (Press Ganey National Database of Nursing Quality Indicators RN Survey and hospital-specific satisfaction survey) are monitored. Results: The vRN role was started in May of 2024 and was fully up and running by June of 2024. In July of 2024, the unit had a record high HCAHPS score for their likelihood to recommend. Conclusion: The use of technology in healthcare, especially as a creative solution to our nursing shortage, is vital to the success of hospitals. Based on the impressive outcomes of this quality improvement project, the vRN role will be implemented throughout the hospital.https://scholarlycommons.henryford.com/hfjhrs2025/1006/thumbnail.jp
Mild asthma-What matters to patients and parents
No full textBACKGROUND: Mild asthma has received less attention despite accounting for most of patient with asthma. However, asthma complications including hospitalizations and progressive loss of lung function frequently occur in such patients. The priorities of patients with mild asthma are unknown, hindering the ability to advance care.
OBJECTIVE: To identify patient and parent perspectives on the definition of mild asthma, treatment preferences, concerns and goals of care.
METHODS: Participants with self-defined mild/intermittent asthma were recruited using emails distributed through the Allergy & Asthma Network and Allergy Foundation of America. A demographic survey and measures of asthma control/quality of life were completed. Focus groups consisting of approximately 5 participants and a focus group leader were conducted.
RESULTS: A total of 20 patients and 20 parents of children with mild asthma participated. Focus groups revealed significant variability in the definition and treatment preferences. Frequency of symptoms appears to be a key driver in treatment decisions for mild asthma, and those with infrequent symptoms were opposed to the addition of an inhaled corticosteroid to albuterol. Use of recommended asthma monitoring strategies such as asthma action plans or peak flow meters was low among adults. Participants desired more education from their providers regarding asthma remission and long-term complications associated with mild asthma.
CONCLUSION: There is significant heterogeneity in the definition and treatment preferences among patients and parents of those with mild asthma. Shared decision making between patients and providers is necessary to personalize medical decisions in those with mild asthma
Weight and shape overvaluation and its relation to anxiety, depression, and maladaptive eating symptoms for patients up to 4 years after bariatric surgery
No full textBACKGROUND: Weight and shape overvaluation (WSO; undue influence of weight and shape on self-evaluation) is common among individuals undergoing bariatric surgery. Little is known about how WSO relates to poorer outcomes for patients remote from surgery.
OBJECTIVES: To examine associations between WSO with anxiety and depression symptoms and various maladaptive eating behaviors in patients up to 4 years post-bariatric surgery.
SETTING: Henry Ford Health, United States.
METHODS: Patients who underwent surgery between 2018 and 2021 were invited to complete the study between 2021 and 2022. Participants (N = 765) completed anxiety and depression symptom and eating behavior measures.
RESULTS: Participants endorsed moderate WSO (M = 3.62, standard deviation = 1.87), which was positively related to anxiety (r = .37) and depression (r = .20) symptoms; eating in response to anger/frustration (r = .26), anxiety (r = .28), and depression (r = .31); and addictive eating behaviors (r = .26); and was significantly associated with the presence of loss-of-control (odds ratio [OR] = 1.39), binge (OR = 1.39), and graze (OR = 1.24) eating. WSO also was related to more frequent grazing (r = .23) but not loss-of-control or binge eating frequency for participants who endorsed behavior presence.
CONCLUSIONS: Findings underscore that links between WSO, psychiatric distress, and maladaptive eating behaviors persist up to 4 years after bariatric surgery. These domains should be assessed at bariatric follow-ups, and assessment of WSO may help providers identify patients at risk for poorer outcomes. Findings should be used to inform temporal modeling of how WSO may predispose patients to poorer bariatric outcomes
The Role of Fluoroscopic Guidance in Spinal Drain Placement for Thoracoabdominal Aneurysm Repair Patients: A Retrospective Study
No full textOBJECTIVES: To evaluate outcomes after implementation of a preoperative protocol requiring fluoroscopic guidance in patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair identified as being at risk for spinal drain placement complications.
DESIGN: This retrospective analysis included patients who underwent spinal drain placement for TAAA repair between November 2013 and November 2018. Patient outcomes were assessed before (control) and after (study) protocol implementation.
SETTING: Single tertiary care hospital.
PARTICIPANTS: A total of 58 patient records were analyzed.
INTERVENTION: The protocol was implemented in November 2015 to identify at-risk patients for difficult spinal drain placement undergoing TAAA repair who would benefit from placement under fluoroscopic guidance.
MEASUREMENT AND MAIN RESULTS: The mean operating room arrival time to drain placement was lower in the study group than in the control group (44.9 ± 12.7 minutes v 80.5 ± 55.8 minutes; p = 0.03). The mean time to incision was lower in the study group than in the control group (114.9 ± 38.1 minutes v 172.4 ± 32.0 minutes; p \u3c 0.001), and fewer drain placement attempts were done in the study group than in the control group (mean, 1.3 ± 0.7 attempts v 2.7 ± 2.5 attempts; p = 0.006). The mean length of stay was lower in the study group (9.5 ± 6.7 days v 18.7 ± 22.7 days; p = 0.04).
CONCLUSIONS: Preoperative identification of at-risk patients before TAAA repair may reduce operating room arrival to the incision time, operating room to spinal drain placement time, number of spinal drain placement attempts, length of hospital stay, and complications associated with spinal drain placement