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Educational impact of a podcast curriculum for hematology/oncology fellows: Final results of the multicenter cluster randomized PODCAST-HOF trial
No full textPurpose: Medical podcast integration into hematology/oncology fellowship curricula remains largely unstudied. We conducted a multicenter cluster randomized trial to evaluate the educational impact of a podcast-based curriculum (PC) when delivered alongside standard didactics compared with standard didactics alone.
Methods: Twenty-seven US Accreditation Council for Graduate Medical Education-accredited hematology/oncology fellowship programs were randomized to receive either PC plus standard didactics (podcast arm, n = 14) or standard didactics alone (control arm, n = 13). The PC included curated podcast episodes and detailed show notes on breast cancer (BC), multiple myeloma (MM), bleeding disorders (BDs), and heparin-induced thrombocytopenia (HIT), developed by The Fellow on Call and Two Onc Docs . Fellows completed preintervention and postintervention comfort surveys (Likert scale 1-7) and a 16-item knowledge assessment. Coprimary end points were improvement in mean comfort (≥0.5 points) and knowledge (≥10%). Mixed-effects ANCOVA was used to adjust for baseline scores and program clustering.
Results: Of 420 eligible fellows, 221 (52%) completed baseline surveys and 186 (44%) completed the knowledge assessment. Ninety-nine fellows (53 podcast, 46 control) completed both postintervention assessments. Baseline comfort was similar across groups. The podcast arm demonstrated significantly greater adjusted mean improvements in comfort: BC (0.48; P \u3c .01), MM (0.65; P \u3c .01), BD (0.70; P \u3c .01), and HIT (0.40; P \u3c .01). Knowledge scores improved from 39.7% to 62.0% in the podcast arm versus 43.5% to 50.3% in the control arm (adjusted mean difference, 15.5%; P \u3c .01). Most fellows in the podcast arm (83%) rated show notes as highly useful, and 89% planned continued podcast use.
Conclusion: The PODCAST-HOF trial showed that adding curated podcasts and show notes significantly improved fellow comfort and knowledge. These findings support incorporating The Fellow on Call and Two Onc Docs as a recommended supplement to traditional fellowship didactics
E-26 | Clinical outcomes in discordant aortic stenosis patients with preserved ejection fraction following a transcatheter aortic valve replacement
No full textPrevalence of sepsis as defined by Phoenix Sepsis definition among children with COVID-19
No full textIntroduction:A retrospective cohort study on patients aged \u3c 18 years included in the Society of Critical Care Medicine: Viral Infection and Respiratory Illness Universal Study registry from March 2020 to April 2024 with an objective of calculating the prevalence of sepsis as defined by the Phoenix Sepsis Score (PSS) and to validate the PSS with respect to outcomes in children with COVID-19.
Methods:Linear mixed-effects regression was used to examine the relationship between the PSS and hospital length of stay after controlling for confounding factors. The performance of the PSS was assessed using the receiver operating characteristic (ROC) and the precision-recall curve (PRC). Cross-validation was performed using leave-one-out cross-validation.
Results:Out of 1731 patients (58 hospitals), 326 (18.8%) met criteria for sepsis and 167 (9.7%) for septic shock. The overall mortality was 1.4% (25/1731), with significant differences between nonseptic (10/1405, 0.7%) and both sepsis (15/326, 4.6%) and septic shock (9/167, 5.4%) groups. After adjusting for confounders, the septic group was associated with a longer hospital length of stay than the nonseptic group. One unit increase in the numeric PSS led to a 70% increase in risk of mortality (odds ratio 1.70; P \u3c .001). The area under the ROC curve was 0.80 and the area under the PRC curve was 0.13. The threshold of ≥ 2 for detection of mortality had a sensitivity of 0.63, specificity of 0.82, and positive predictive value of 0.05.
Conclusion:Phoenix Sepsis Criteria retain its validity in identifying sepsis in children with COVID-19 and can be used in further epidemiological studies in this population
Indocyanine green (ICG) imaging: Case report of innovative isthmocele diagnosis and repair in a post-ablation patient and literature review
No full textObjective:To present a case of a 43-year-old woman with a uterine isthmocele causing severe abnormal uterine bleeding (AUB) and chronic pelvic pain and to demonstrate the effectiveness of indocyanine green (ICG) fluorescence in minimally invasive surgical management.
Case presentation:A 43-year-old woman, gravida 7, para 2052, was referred for surgical management of a uterine isthmocele after experiencing persistent AUB and chronic pelvic pain despite multiple conservative treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal therapy. The patient expressed a desire to avoid hysterectomy.
Methods:Preoperative evaluation included a 2-dimensional transvaginal ultrasound (2D-TVUS) with saline infusion sonohysterogram (SIS), which revealed a 10-mm echolucent space at the anterior uterine isthmus, confirming the diagnosis of isthmocele. The patient underwent hysteroscopic and robotic-assisted laparoscopic resection of the isthmocele. ICG fluorescence was utilized to enhance visualization during the procedure. ICG was prepared by mixing a 25 mg vial with 10 cc of sterile water to achieve a 2.5 mg/cc concentration, with 2 cc (5 mg) injected into the uterine cavity via syringe through the inflow port of the uterine manipulator 10 minutes before the surgical incision.
Results:The surgical procedure was successful, with improved residual myometrial thickness observed in follow-up imaging. The patient reported resolution of AUB and pelvic pain two months post-surgery.
Conclusion:This case demonstrates that ICG imaging enhances defect localization and surgical precision, reducing operative time and complications. By optimizing the procedure and minimizing intraoperative challenges, ICG represents a significant advancement in isthmocele repair surgery, offering improved outcomes for complex uterine pathologies
Adopting self-measured blood pressure monitoring among underserved communities (ASPIRE): A pilot randomized controlled trial
No full textBackground:Addressing barriers to self-measured blood pressure (SMBP) engagement through tailored implementation strategies is critical for improving hypertension-related outcomes.
Objective:To evaluate the feasibility of implementing the ASPIRE Clinical Integration Package, a multifaceted intervention designed to support SMBP adoption and engagement in under-resourced primary care settings.
Design:This randomized trial was conducted in 2024 at one large primary care clinic serving racially and ethnically diverse populations.
Participants:Patients were eligible if they had hypertension, were prescribed ≥1 blood pressure-lowering medication, and presented to the clinic with an elevated blood pressure reading.
Approach:Patients were randomized to receive a free SMBP device (control; n=25) or a free SMBP device and the ASPIRE Clinical Integration Package (intervention; n=25) which included 6 components; 1. Cuff sizing, 2. Training on accurate readings, 3. ASPIRE log, 4. Reminders/support for sharing readings, 5. Social needs screening, 6. Clinic workflow for SMBP documentation. The primary outcomes included feasibility metrics (referral, recruitment, and retention) and fidelity described in terms of the proportion of patients who received each of the 6 ASPIRE components. Secondary outcomes included SMBP engagement (1+ reading documented in the electronic health record) and change in systolic blood pressure.
Key results:In total, 50 patients were randomized and included in analyses. Referral (60.0%), recruitment (60.2%), and retention (90.0%) targets were met. Fidelity evaluation revealed that 100% of patients received components 1 - 4, 96% and 93% received components 5 and 6, respectively. At 6-months the difference in SMBP engagement was 52.0% (95% confidence interval [CI] 29.3%-74.7%) favoring the intervention arm, and the difference in change in systolic blood pressure was -11.9mmHg (95% CI -21.7, -2.1) favoring the intervention arm.
Conclusions:The ASPIRE Clinical Integration Package demonstrates feasibility and acceptability in promoting SMBP adoption in under-resourced primary care settings. These findings lay the groundwork for a larger trial to assess effectiveness in improving hypertension control and reducing disparities.
Trial registration:ClinicalTrials.gov Identifier NCT06175793
Nationwide trends and disparities in end-of-life care for acute myeloid leukemia: A 2019-2021 NIS analysis of palliative care utilization and hospitalization costs
No full textPurpose: Acute myeloid leukemia (AML) is a high-mortality hematologic malignancy, particularly in older adults. Early palliative care (PC) improves symptom control, quality of life, and outcomes, yet disparities in utilization persist. This study evaluated trends in inpatient PC use among AML patients and associations with mortality, costs, and complications.
Patients and Methods: A retrospective cohort analysis was conducted using the 2019-2021 National Inpatient Sample. AML cases were identified via ICD-10 codes and stratified by PC use. The primary outcome was inpatient mortality; secondary outcomes included length of stay (LOS), costs, and complications. Analyses included t-tests, chi-square tests, and logistic regression adjusted for demographic, socioeconomic, and hospital-level factors.
Results: Among 2 20 790 AML hospitalizations, 27 540 (12.4%) involved PC. PC recipients were older (67.4 vs 58.7 years, P \u3c .01) and more often White (75.3% vs 70.7%, P \u3c .01). PC use was lower among Black (OR 0.90, P = .05), Hispanic (OR 0.70, P \u3c .01), and Asian (OR 0.77, P \u3c .01) patients. Utilization was highest in urban teaching hospitals (89.2%, P \u3c .01) and Medicare beneficiaries (OR 1.87, P \u3c .01). PC use was associated with higher mortality (37.4% vs 4.4%, OR 11.74, P \u3c .01), longer LOS (12.9 vs 12.3 days, P \u3c .01), increased costs (174,193, P \u3c .01), and more complications (all P \u3c .01).
Conclusion: PC utilization in AML is associated with poorer clinical metrics, likely reflecting late-stage intervention. Earlier PC integration and addressing disparities are urgently needed to improve equity, outcomes, and resource use in AML care