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Health advocacy through translational science: an experimental model to quantify the impact of human social stressors on health outcomes
No full textHealth status and outcomes are known to be impacted by social stressors, yet social-political change to improve health outcomes through social determinants of health is stagnant. The well understood associations between social stressors and health are often chronic in nature and are without causal evidence. A new model that demonstrates a clear cause and effect between food insecurity and accelerated tumor growth has the potential to change the way public health scientists and advocates frame their arguments for change. This model provides a novel framework for ethically sound, controllable, and translatable social determinants of health research based in objective science. Implementation of this model across other human stressors and pathologies will lay the groundwork for irrefutable evidence to support social-political change for improved health outcomes
Popliteal-distal bypass versus infra-popliteal endovascular therapy for infra-popliteal occlusive disease
No full textOBJECTIVE: Isolated infrapopliteal occlusive disease poses significant clinical challenges due to limited durable treatment options and poor limb salvage and survival rates. Although endovascular therapy (ET) has gained prominence for its minimally invasive approach, popliteal-distal bypass (PDB) provides an effective open approach that minimizes dissection and length of bypass required. This study aims to compare real-world outcomes of PDB vs infrapopliteal ET for chronic limb-threatening ischemia (CLTI) secondary to isolated infrapopliteal occlusive disease.
METHODS: Patients who underwent a PDB or isolated infrapopliteal ET for CLTI between 2010 and 2024 were identified in the Vascular Quality Initiative. PDB was defined as a bypass using single-segment great saphenous vein originating from an above-knee or below-knee popliteal artery inflow; patients with a concomitant more proximal peripheral vascular intervention or bypass were excluded. Infrapopliteal ET was defined as transluminal balloon angioplasty, atherectomy, and/or stenting of a tibial artery; patients with a concomitant bypass or femoropopliteal intervention were excluded. Three-to-one nearest-neighbor propensity score matching without replacement was performed to ensure balance of covariates between the two comparison groups. Kaplan-Meier and Cox regression analysis were used to estimate long-term event rates and evaluate the association of type of intervention with the long-term outcomes of survival, amputation-free survival, primary patency, and major adverse limb events defined as the composite outcome of amputation and/or reintervention.
RESULTS: A total of 3619 patients who underwent PDB were matched to 10,857 patients who underwent isolated infrapopliteal ET. All baseline characteristics and demographics were balanced after propensity score matching. The utilization of PDB for isolated infrapopliteal occlusive disease decreased from 25% to 5% between 2010 and 2023, whereas that of infrapopliteal ET increased from 75% to 95%. PDB was associated with a significantly longer hospital stay (6 days vs 1 day; P \u3c .001) and higher rates of in-hospital mortality (1.4% vs 0.9%; P = .021), myocardial infarction (2.5% vs 0.4%; P \u3c .001), acute kidney injury (7.2% vs 1.4%; P \u3c .001), pneumonia (2.2% vs 0.7%; P \u3c .001), and surgical site infection (2.9% vs 0.0%; P \u3c .001) compared with infrapopliteal ET. At 1-year follow-up, PDB was associated with significantly higher survival (86.7% vs 83.9%; P \u3c .001), amputation-free survival (72.6% vs 65.9%; P \u3c .001), and primary patency (73.6% vs 69.0%; P = .002) and lower major adverse limb events (25.9% vs 30.1%; P = .007) compared with infrapopliteal ET. PDB was associated with significantly higher amputation-free survival compared with infrapopliteal ET for both above-knee PDB (73.6% vs 65.9%; P \u3c .001) and below-knee PDB (71.9% vs 65.9%; P \u3c .001), with no difference observed between above-knee and below-knee PDB (P = .407). Similarly, PDB was associated with significantly higher amputation-free survival compared with infrapopliteal ET for both PDB to a tibial artery (72.3% vs 65.9%; P \u3c .001) and PDB to a pedal artery (72.6% vs 65.9%; P \u3c .001), with no difference observed between PDB to a tibial artery and PDB to a pedal artery (P = .860).
CONCLUSIONS: Although its use has declined over the past decade, PDB continues to provide superior long-term outcomes in amputation-free survival, patency, and limb salvage compared with infrapopliteal ET in patients with infrapopliteal occlusive disease, albeit with a higher rate of perioperative mortality and morbidity. Careful preoperative risk assessment and thoughtful patient selection are essential to optimize the outcomes of isolated infrapopliteal interventions, ensuring that immediate procedural risks are appropriately weighed against the potential for improved longer-term outcomes in this patient population
Perspectives of healthcare providers on telemedicine implementation during the COVID-19 pandemic in Colombia: a mixed-method study
No full textBACKGROUND: The COVID-19 pandemic accelerated the adoption of telemedicine (TM) in Colombia as a tool for delivering healthcare for both chronic and non-chronic conditions. This study aimed to explore the perspectives of healthcare providers, directors, and managers on TM implementation within a major health plan provider covering 15% of the Colombia population.
METHODS: Mixed-methods study was conducted, combining surveys and in-depth interviews with medical professionals and decision-makers. Thematic analysis of qualitative data and statistical analysis of survey responses provided insights into the challenges and opportunities of TM during the pandemic.
RESULTS: Healthcare providers recognized TM as a valuable tool but identified key challenges to its optimization. Three main strategies were proposed: (1) enhancing medical training to improve remote diagnosis, (2) integrating wearables and digital technologies to support clinical decision-making, and (3) fostering a culture of TM use among patients and providers to ensure acceptance and sustainability.
CONCLUSION: Telemedicine facilitated equitable healthcare delivery and contributed to reducing the digital gap in Colombia. However, to ensure long-term viability, national policies must improve internet connectivity and strengthen primary care infrastructure, particularly in underserved regions
Association Between Specific Cognitive Domains and Diabetes Self-Management Behaviors in People with Diabetes and Mild Cognitive Impairment
No full textIn Our Simulation Era: Transitioning from Passive to Immersive Training
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1017/thumbnail.jp
Stepping Towards Healing: The Impact of Early Mobility in the ICU
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1030/thumbnail.jp
Keynote: Every Nurse is an Informaticist
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1046/thumbnail.jp
Impact of Methicillin-Resistant Staphylococcus aureus Nasal PCR Versus Culture on Vancomycin Utilization in Pneumonia Management
No full textIntroduction: Methicillin-resistant Staphylococcus aureus pneumonia (PNA) can be ruled out via methicillin-resistant Staphylococcus aureus (MRSA) culture and polymerase chain reaction (PCR) nasal screening, facilitating the de-escalation of empiric anti-MRSA agents like intravenous vancomycin. This study evaluated the impact of transitioning from culture to PCR-based MRSA nasal screening in patients with PNA.
Methods: This Institutional Review Board (IRB)-approved retrospective quasi-experimental study was conducted at a 5-hospital system and included adult, nonpregnant hospitalized patients from September to December 2021 ( culture group ) and September to December 2022 ( PCR group ) and diagnosed with PNA. Exclusion criteria were ventilator-acquired PNA or positive MRSA respiratory culture. The primary endpoint was the number of vancomycin levels obtained. Secondary endpoints were vancomycin duration as well as acute kidney injury (AKI) and all-cause 30-day readmission rates.
Results: Two-hundred patients were included: 100 in each group. Baseline characteristics were similar. There were 117 vancomycin levels obtained: 67 (67) and 50 (50) in the culture and PCR group, respectively (P = .021). Median vancomycin duration was 50% shorter in the PCR group: 2 days (1-3) versus 3 days (2-4), P \u3c .001. After adjusting for confounders, the culture group was more likely to have vancomycin levels obtained compared to the PCR group: adjusted odd ratio (aOR) (95% confidence interval [CI])] = 1.833 (1.016-3.309). Long-term obstructive pulmonary disease was associated with reduced risk of ordering vancomycin levels: aOR [95% CI] = 0.426 (0.218-0.831). Readmission and AKI rates were comparable.
Conclusion: Transitioning from culture to PCR-based MRSA nasal screening significantly reduced vancomycin levels obtained from patients and shortened vancomycin duration without negatively impacting patient outcome
Two paths to paralysis: A multicenter comparison of cisatracurium to atracurium in the management of acute respiratory distress syndrome
No full textPURPOSE: Neuromuscular blocking agents (NMBAs) such as cisatracurium and atracurium are used to facilitate lung-protective ventilation in moderate-to-severe acute respiratory distress syndrome (ARDS). Although cisatracurium has been more extensively studied, data comparing these agents directly are limited. This study compares clinical outcomes between atracurium and cisatracurium in patients with moderate-to-severe ARDS.
MATERIALS AND METHODS: This multicenter, retrospective cohort study was conducted between January 2017 and December 2023 across 11 Ascension Health hospitals. Mechanically ventilated adults with a PaO(2)/FiO(2) ratio \u3c 150 who received a continuous infusion of atracurium or cisatracurium for at least 12 h within 48 h of ARDS diagnosis were included. The primary endpoint was ventilator-free days at day 28.
RESULTS: A total of 384 patients were included, with 192 in each group. Median 28-day ventilator-free days did not differ between groups in the unmatched (0 [IQR 0-16.7] vs. 0 [IQR 0-16.4], p = 0.72) or matched (0 [IQR 0-18.3] vs. 0 [IQR 0-14.4], p = 0.09) cohorts. These findings were further confirmed by multivariable analysis. After matching, there were no significant differences in 90-day inpatient mortality, length of stay, or duration of mechanical ventilation. While patients receiving cisatracurium showed greater improvements in PaO(2)/FiO(2) ratio at 72 h (p \u3c 0.01), resolution of ARDS was similar between groups. Safety outcomes were comparable between agents.
CONCLUSIONS: Atracurium and cisatracurium demonstrated similar safety and effectiveness in patients with moderate-to-severe ARDS. These results suggest that atracurium is a viable alternative to cisatracurium for the treatment of ARDS
From Pancreas to Pleura: Insights Into Pancreatic Fistula as a Result of Recurrent Pancreatic Inflammation
No full textIntroduction:Pleuro-pancreatic fistula (PPF) is a rare complication of chronic pancreatitis, involving anabnormal connection between the pancreatic duct and pleural space due to pancreaticinflammation. It typically presents with recurrent pleural effusions and pulmonary symptoms,often without overt pancreatic signs. Key indicators include a history of pancreatitis, significantweight loss, and pleural effusions or ascites unresponsive to diuretics.Case presentation:A 33-year-old male with a history of alcohol use disorder, chronic pancreatitis, pseudocystformation, and a pleuropancreatic fistula presented with worsening shortness of breath and chestpain. He had a recent large pleural effusion, with thoracentesis revealing pleural fluid pancreaticamylase at 300 U/L. Imaging showed a large left pleural effusion and new pancreatic cysticlesions. After thoracentesis and chest tube placement, a trapped lung was revealed. An attemptedERCP was complicated by pancreatic duct obstruction, but a stent was eventually placed. Hiscondition worsened due to ongoing fistula leakage, and a pancreaticoduodenal arterypseudoaneurysm was identified, requiring IR-guided embolization. He was transferred to atertiary hospital, where a mini atrium collecting system was placed for fluid drainage. He wasdischarged with a left chest tube and scheduled for outpatient follow-up.Discussion:Pleuro-pancreatic fistula (PPF) is a rare complication, occurring in less than 1% of acutepancreatitis cases and 4.5% of pancreatic pseudocyst cases, primarily linked to alcohol-relatedchronic pancreatitis. Diagnosis involves chest X-ray, CT scans, and thoracentesis, with pleuralfluid analysis showing high pancreatic amylase levels, often above 10,000 U/L. MRCP is thepreferred imaging modality for confirming the fistula. Treatment options include medicalmanagement with octreotide and TPN (31%-65% success), ERCP stenting, or surgery. Surgery ismost effective (94% success), particularly in cases where medical and ERCP treatments fail. The choice of treatment depends on imaging findings, with surgery indicated for complete duct-obstruction or disruption in the pancreatic tail.Conclusion:In conclusion, PF diagnosis relies on clinical suspicion, high pleural fluid amylase, and the imaging.,with treatment—medical, endoscopic, or surgical— determined by case specifics and a multidisciplinary approach