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Donor App Increases Awareness and Overall Living Kidney Organ Donation
No full textThirty-seven million adult Americans have chronic kidney disease with African Americans are significantly more likely to develop end-stage renal disease (ESRD) compared to other racial groups. Donor App was designed to help kidney transplant candidates (KTCs) identify potential living donors (LDs) by creating social media postings about their need for transplant. The purpose of this study is to evaluate the feasibility of using Donor App in improving awareness about living organ donation and rates of living donor kidney transplantation (LDKT). LD inquiries and transplant outcomes were compared between KTCs who used the Donor App with 1:3 matched historic controls from our center\u27s waitlist. Forty-nine KTCs posted their stories using Donor App. The total views on all platforms and patients were 11 881. Ninety-three potential LD inquiries came on behalf of 26/49 KTCs (53%). KTCs with at least one potential LD inquiry were likely to have at least one donor champion (p = 0.01), used multiple social media outlets (p = 0.003), and had significantly higher median views versus candidates without inquiries (263 [interquartile range (IQR): 117-624] vs. 42 [IQR: 15-96], respectively; p \u3c 0.001). To date, three underwent transplants (two LDKTs and one deceased direct donation). None of the matched controls had any potential LD inquiries (p = 0.01). The Donor App can significantly increase awareness and rate of living organ donation
Percutaneous mechanical circulatory support for acute right heart failure: A practical approach
No full textAcute right heart failure (RHF) represents a critical entity with significant morbidity and mortality. This review examines the role of percutaneous right ventricular assist devices (pRVADs) as a cornerstone of therapy in cases refractory to conventional management. Devices such as the Impella RP and dual-lumen cannulas provide targeted haemodynamic support, with indications in various clinical scenarios, including acute myocardial infarction, post-cardiac surgery, myocarditis, and after left ventricular assist device (LVAD) implantation. Successful implementation requires meticulous haemodynamic assessment, including parameters derived from pulmonary artery catheterization and echocardiography, to guide patient selection, optimize device placement, and monitor therapeutic response. The manuscript highlights contemporary weaning strategies, emphasizing recovery of right ventricular function, stabilization of systemic haemodynamics, and restoration of end-organ perfusion. While no universal protocols exist, this review presents a pragmatic framework informed by available evidence and expert consensus. Furthermore, the potential complications of pRVAD use-ranging from thromboembolism and haemolysis to device-specific issues such as migration and tricuspid valve damage-are discussed alongside preventive and management strategies. Key challenges in RHF management, including the interplay between right and left ventricular function, the impact of pulmonary vascular resistance, and the use of adjunctive pulmonary vasodilators, are addressed. The review underscores the absence of durable right ventricular assist devices and the need for innovation to close this therapeutic gap. Multidisciplinary collaboration among intensivists, cardiologists, and cardiac surgeons is critical to optimizing outcomes. This review provides actionable insights to assist clinicians in navigating the complexities of acute RHF, fostering a tailored and evidence-based approach to this high-risk population
From error to insight: Removing non-systematic responding data in the delay discounting task may introduce systematic bias
No full textDelay discounting (DD), which reflects a tendency to devalue rewards as the time to their receipt increases, is associated with health behaviors such as sleep disturbances, obesity, and externalizing behavior among adolescents. Response patterns characterized by inconsistent or unexpected reward valuation, called non-systematic responding (NSR), may also predict health outcomes. Many researchers flag and exclude NSR trials prior to analysis, which could lead to systematic bias if NSR (a) varies by demographic characteristics or (b) predicts health outcomes. Thus, in this study we characterized NSR and examined its potential beyond error by comparing it against DD with a secondary data analysis of the Adolescent Brain Cognitive Development (ABCD) Study-a population-based study that tracked youths (N = 11,948) annually from 8 to 11 years of age over 4 years. We assessed DD and NSR using the Adjusting Delay Discounting Task when youths were approximately 9.48 years old (SD = 0.51). We also examined three maladaptive health outcomes annually: sleep disturbances, obesity, and externalizing psychopathology. Our analysis revealed variations in NSR across races, ethnicities, and body mass index categories, with no significant differences observed by sex or gender. Notably, NSR was a stronger predictor of obesity and externalizing psychopathology than DD and inversely predicted the growth trajectory of obesity. These findings suggest that removing NSR patterns could systematically bias analyses given that NSR may capture unexplored response variability. This study demonstrates the significance of NSR and underscores the necessity for further research on how to manage NSR in future DD studies
A comparison of magnetocardiography with noninvasive cardiac testing in the evaluation of patients with chest pain
No full textOBJECTIVES: Chest pain is a common complaint of outpatients and emergency department patients. These patients are often referred for noninvasive cardiac imaging (NCI). Problems with NCI include limited availability, lengthy test delays, test duration, radiation exposure, adverse events, NPO (holding medications, caffeine/food/liquids/tobacco), exercise requirement, limitations for certain populations, inability to assess for ischemia with no obstructive coronary artery disease (INOCA), contrast/medication/needlestick-intravenous (IV) line needed.Magnetocardiography (MCG) advantages include faster, easier test administration, radiation avoidance, less resource utilization, safer, no needlestick/IV requirement, no NPO for caffeine/food/liquids/tobacco, and no holding medications. By avoiding medications and/or exercise, MCG avoids risk of provoking myocardial injury and dangerous events (arrhythmias). No contrast or pharmacologic agents are needed with MCG, eliminating side effects/complications: tissue necrosis from extravasation, contrast-induced nephropathy, allergic reactions including life threatening anaphylaxis.
DESIGN: MCG comparison with NCI: exercise stress test, stress echo, dobutamine stress echocardiogram, myocardial perfusion imaging: single photon emission computed tomography (SPECT) or positron emission tomography (PET), cardiac magnetic resonance imaging (cMRI), coronary computed tomography angiography (CCTA).
OUTCOME MEASURES: Literature review: NCI versus MCG.
CONCLUSION: MCG is a rapid, safe, effective, painless and radiation-free test, does not require contrast/medication administration. MCG by avoiding provocative medications and/or exercise eliminates the risk of provoking myocardial injury and causing dangerous events such as arrhythmias. MCG avoids testing delays, has higher patient satisfaction, no NPO requirement, no holding medications or caffeine/food/liquids/tobacco, with similar sensitivity and specificity. Additional clinical research is needed to validate its utility. MCG may be a complementary modality alongside current NCI
Using the Modified Minnesota Detoxification Scale to Evaluate Alcohol Withdrawal Syndrome: An Integrative Review
No full textBACKGROUND: Alcohol use disorder in the United States is increasing. Alcohol is the second most commonly abused drug worldwide, resulting in acute hospitalizations related to alcohol use and alcohol withdrawal syndrome. Management of alcohol withdrawal syndrome relies on screening tools to determine the need for treatment. The most commonly used tool is the Clinical Institute Withdrawal Assessment for Alcohol Scale-Revised (CIWA-Ar), which has not been validated for use in critical care units.
OBJECTIVE: To evaluate whether the modified Minnesota Detoxification Scale (mMINDS) is more effective than the CIWA-Ar for evaluating acute withdrawal symptoms in patients in intensive care units.
METHODS: This integrative review used the framework of Whittemore and Knafl. The literature was searched for studies related to mMINDS, neurocritical care, and critical care.
RESULTS: Nine articles were included in the review. The review revealed 3 outcomes: nurses preferred the mMINDS over the CIWA-Ar, assessments with the mMINDS tool was more accurate for patients with CIWA-Ar scores greater than 10, and patient outcomes were improved with use of the mMINDS. The mMINDS is preferred over the CIWA-Ar for managing alcohol withdrawal syndrome in patients in intensive care units because it is associated with shorter stays, less benzodiazepine use, and a decrease in delirium tremens.
CONCLUSION: The findings regarding mMINDS can apply to both critical care and non-critical care settings. The mMINDS is preferred by nurses and results in more positive patient outcomes. The mMINDS is effective and should be used in critical care areas
Time to Diagnosis and Treatment of Postpartum Hypertensive Disorders in the Emergency Department—A Single Retrospective Cohort Study
No full textBackground/Objectives: In the postpartum period, approximately 12% of patients seek care in the emergency department (ED), with a higher representation of Black patients. Hypertension is a common reason for ED visits during this period, often leading to dangerously delayed diagnosis and treatment.
Objective: This study aims to assess the time to diagnosis and treatment of hypertensive disorders in the postpartum period in the ED, focusing on potential disparities in care, to identify areas for quality improvement.
Design: Retrospective cohort study.
Setting: A multi-centered large medical institution in the metro Detroit area.
Methods: Postpartum patients (day 2 through day 28) presenting to the ED from November 2015 to December 2022.
Exposures: none.
Main Outcome Measures: Primary analysis assessed the time elapsed between severe-range blood pressure readings (greater than/equal to 160 systolic and/or 110 diastolic) and the administration of antihypertensives. Secondary analyses assessed the presence of essential laboratory workups such as complete blood counts, complete metabolic panels, and urine protein and creatinine.
Results: Among the 430 women who presented to the ED during the postpartum period with hypertension, 372 (86.5%) exhibited severe-range blood pressure (greater than/equal to 160 systolic and/or 110 diastolic). Patients presented on average on postpartum day 6. Of the patients with severe hypertension, only 72% received a complete blood count, 66% underwent evaluation of creatinine and liver profile, and 4% had a urine protein and creatinine test ordered. The average time from severe-range blood pressure reading to antihypertensive administration was 189 min for Black patients and 370 min for White patients. There were no statistically significant differences in the time of the first blood pressure reading, laboratory evaluation, or treatment of severe-range blood pressure between racial groups.
Conclusions: This study identifies the most significant area for improvement in the timely administration of antihypertensive medication following severe-range blood pressure readings. Additional areas for improvement were observed in ordering essential laboratory tests to assess the severity of preeclampsia. The institution demonstrated delayed yet equitable care for White and Black patients, contrary to the existing literature indicating potential racial disparities. A targeted quality improvement plan has been implemented to improve the identified areas of concern to adhere to the ACOG’s treatment recommendations for hypertensive disorders of pregnancy. The impact on patient care will be reassessed at the 1-year mark
Intraoperative Irrigation and Topical Antibiotic Use Fail to Reduce Early Periprosthetic Joint Infection Rates: A Michigan Arthroplasty Registry Collaborative Quality Initiative Study
No full textBACKGROUND: Periprosthetic joint infections remain a major complication in total joint arthroplasty. Tremendous efforts made intraoperatively to prevent periprosthetic joint infection during primary procedures include antiseptics or antibiotics in irrigation solutions. This study analyzed the incidence of postoperative infection in relation to use of irrigation solutions and antibiotic powder.
METHODS: We reviewed primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) cases from the Michigan Arthroplasty Registry Collaborative Quality Initiative between January 2019 and December 2022. Data on irrigation solutions were categorized by those containing antibiotics, chlorhexidine-gluconate, povidone-iodine, or other substances, compared to normal saline. Logistic regression analyses were conducted, adjusting for various factors such as age, body mass index, sex, American Society of Anesthesiologists score, smoking, and more. There were 67,871 THA and 105,963 TKA cases analyzed, with an overall infection rate of 0.6% (confidence interval: 0.6 to 0.7, n = 420) for THA and 0.4% (0.36 to 0.43, n = 419) for TKA within 90 days postsurgery.
RESULTS: There were statistical differences between the use of normal saline alone versus other irrigation solutions in THA, including povidone and others. For TKA, there was a statistically significant difference with lower infection rates using normal saline alone than multiple types, chlorhexidine-gluconate, and povidone. Notably, the use of nonsaline irrigation increased over the study period.
CONCLUSIONS: There was no reduction in 90-day infection rates for primary THA or TKA with irrigation additives. Higher infection rates were noted with povidone than saline for THA and TKA, potentially due to selection bias or local adverse tissue effects. Topical powders did not improve infection control. While irrigation is strongly recommended in all patients having TKA or THA, multiple irrigation solutions were not correlated with lower infection rates, suggesting importance of patient selection and optimization over irrigation type
Factors Influencing Growth in Gender Diversity Within Orthopaedic Surgery
No full textINTRODUCTION: Despite increasing numbers of female medical students, there is low female representation in orthopaedic residencies across the globe. It is unknown whether female representation in orthopaedics is lower than other specialties and whether regional presence relates to patient population or residency positions.
METHODS: The provider directory from the United States Centers for Medicare and Medicaid Services was reviewed from 2018 to 2023. Data for eight specialty subgroups (anesthesia, family medicine, gastroenterology, general surgery, internal medicine, obstetrics/gynecology, orthopaedics, and urology) were examined and grouped according to regions depicted by the Electronic Residency Application Service.
RESULTS: The mean percentage of female orthopaedic Centers for Medicare and Medicaid Services providers increased 1.49% over the 6-year period, at a markedly lower rate compared with general surgery (3.7%, P = 0.018) and obstetrics and gynecology (4.7%, P = 0.012). It was also lower compared with gastroenterology (3.73%), family medicine (3.52%), urology (3.10%), internal medicine (1.82%), and anesthesia (1.66%). Pacific-West and South-Atlantic regions demonstrated the greatest increase in representation. The number of female orthopaedic surgeons and growth in all orthopaedic surgeons in a state correlated with increased representation, whereas residency positions and patient population did not. Graduation year was 6 years later for female versus male students.
DISCUSSION: This study demonstrated a statistically significantly lower rate of change in female representation within orthopaedics compared with other specialties. Presence of practicing female orthopaedic surgeons was associated with growth in certain geographic regions. Future work should investigate factors associated with regional growth if specialties seek to move toward sex representation that reflects the United States population
Supraspinatus muscle length in the torn rotator cuff: associations with shoulder strength and tear size
No full textBACKGROUND: Rotator cuff tears are a prevalent condition, affecting more than 40% of individuals aged more than 60 years and leading to approximately 250,000 surgical repairs annually in the United States. The supraspinatus tendon is most commonly involved, resulting in retraction of the supraspinatus muscle-tendon unit. Clinically, retraction is often assessed through medial-lateral (ML) tear size or muscle-tendon junction (MTJ) position relative to the glenoid. However, muscle length is rarely measured despite its importance for force-generating capacity and patient outcomes postsurgery. This study aimed to compare supraspinatus muscle length in patients with and without rotator cuff tears and to determine the extent to which muscle length was associated with anterior-posterior (AP) tear size, ML tear size, and shoulder strength.
METHODS: A convenience sample of 32 patients with rotator cuff tears and a control group of 32 individuals with intact rotator cuffs were analyzed. All participants underwent magnetic resonance imaging scans with supraspinatus muscle length calculated using a previously validated approach that assessed the muscle-tendon junction position and supraspinatus fossa length. Normalized muscle length was determined by dividing muscle length by fossa length. Shoulder strength was measured with an isokinetic dynamometer during shoulder abduction (ABD), flexion, and internal and external rotation, with the strength data expressed relative to age-predicted maximum values and as strength ratios. Statistical analyses included t-tests for group comparisons and linear regression for association assessments, with significance set at P \u3c .05.
RESULTS: No significant difference in patient age was detected between the 2 groups (torn: 59.3 ± 7.0; intact: 58.1 ± 4.9, P = .42). The average rotator cuff tear size was 16.8 ± 5.7 mm (AP) and 18.2 ± 8.7 mm (ML). Supraspinatus muscle length was significantly shorter in the rotator cuff tear group (96.6 ± 5.8% of fossa length) compared to the intact group (102.7 ± 6.3% of fossa length, P = .0002). In patients with tears, muscle length did not correlate with tear sizes (ML: r = 0.01, P = .95; AP: r = 0.27, P = .15). However, muscle length was significantly associated with normalized ABD strength (r = 0.41, P = .02) and the ABD/internal rotation strength ratio (r = 0.46, P = .008).
DISCUSSION: The findings indicate that supraspinatus muscle length is significantly reduced in rotator cuff tears and is associated with shoulder ABD strength, but not with tear size. This suggests that muscle shortening negatively impacts shoulder function and highlights potential implications for surgical repair strategies and postoperative recovery. Future studies should explore the effects of surgical interventions on muscle length and strength recovery in rotator cuff repair patients
Early-life wheeze trajectories are associated with distinct asthma transcriptomes later in life
No full textBACKGROUND: Early childhood wheeze is characterized by heterogeneous trajectories having differential associations with later-life asthma development.
OBJECTIVE: We sought to determine how early-life wheeze trajectories impact later life asthma gene expression.
METHODS: The Children\u27s Respiratory Environmental Workgroup is a collective of 12 birth cohorts, 7 of which conducted an additional visit with a nasal lavage collected and subjected to bulk RNA-sequencing. Early-life wheeze trajectories were defined using latent class analysis of longitudinal early-life wheezing data. Weighted gene correlation network analysis was used to associate gene expression patterns and current asthma with early-life wheeze trajectories.
RESULTS: We investigated 743 children (mean age, 17 ± 5.1 years; 360 [48.5%] male). Four patterns of early-life wheeze were identified: infrequent, transient, late-onset, and persistent. Early-life transient wheeze was associated with gene expression patterns related to increased antiviral response, and late-onset wheeze was associated with decreased insulin signaling and glucose metabolism. Early-life persistent wheeze was associated with gene expression modules of type 2 inflammation and epithelial development, but these modules did not distinguish those with current asthma. Children who had persistent wheeze in early life and current asthma displayed a unique increase in expression of genes enriched for neuronal processes and ciliated epithelial function compared with those without asthma.
CONCLUSIONS: Early-life longitudinal wheeze trajectories are associated with specific asthma transcriptomes later in life. These data suggest that early-life asthma prevention strategies may be most beneficial when tailored to the specific wheeze pattern