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Second-trimester ultrasound receipt mediates the relationship between public insurance and prenatal diagnosis of a congenital heart defect
No full textObjective:To delineate the mechanism behind insurance-related disparities in the prenatal diagnosis of a congenital heart defect (CHD).
Methods:This was a retrospective analysis of electronic health records of pregnant individuals whose infants received CHD surgery between 2019 and 2020 in the third-largest United States metropolitan area. The outcome was whether a prenatal diagnosis was received. The exposure was the pregnant individual\u27s insurance status. The mediator was second-trimester ultrasound receipt. Control variables included sociodemographic and clinical characteristics of the pregnant individual and infant. The relationships between exposure, mediator, and outcome were quantified using mediation analysis with multivariable fixed-effects regression.
Results:In total, 496 pregnant individuals met inclusion criteria; 215 (43.3%) were publicly insured and 305 (61.5%) had prenatal diagnosis. In bivariate regressions, public insurance was associated with a 12.6% lower probability (CI 3%-21%) of prenatal diagnosis. In multivariable models, public insurance was associated with 13.2% lower probability (CI 2%-25%) of second-trimester ultrasound receipt but was no longer associated with prenatal diagnosis after adjusting for second-trimester ultrasound receipt, suggesting a possible mediation effect. Mediation analysis confirmed that second-trimester ultrasound receipt mediated 39% of the relationship between public insurance and prenatal diagnosis.
Conclusion:An appreciable portion of insurance-related differences in prenatal CHD diagnosis is due to the lower frequency of second-trimester ultrasound receipt among those with public insurance
Brain computer interfaces: An introduction for clinical neurodiagnostic technologists
No full textBrain-computer interface (BCI) is a term used to describe systems that translate biological information into commands that can control external devices such as computers, prosthetics, and other machinery. While BCI is used in military applications, home control systems, and a wide array of entertainment, much of its modern interest and funding can be attributed to its utility in the medical community, where it has rapidly propelled advancements in the restoration or replacement of critical functions robbed from victims of disease, stroke, and traumatic injury. BCI devices can allow patients to move prosthetic limbs, operate devices such as wheelchairs or computers, and communicate through writing and speech-generating devices. In this article, we aim to provide an introductory summary of the historical context and modern growing utility of BCI, with specific interest in igniting the conversation of where and how the neurodiagnostics community and its associated parties can embrace and contribute to the world of BCI
Daptomycin dilemma: Navigating dosing in a critically ill post-LVAD, post-xenothymokidney transplant patient: A1200
No full textMechanisms and Intermediate Outcomes of a Community Translation to Adapt a Whole Family-Inclusive Lifestyle Intervention: A Pilot Evaluation
No full textPurpose: Involving community members in the process of translating scientific evidence into health messaging and interventions can lead to improved health outcomes and more patient-centered healthcare. Community Translation (CT) is one methodology for fostering collaboration between researchers and community members, and it has been shown to result in locally relevant, acceptable solutions to health challenges. There has been very little research on the direct effects that participation may have on community members who become involved in CT. Understanding the mechanisms of CT and its outcomes on participating community members is essential to maximizing the potential of CT. To address this gap, the present study explores processes theorized to be important to the effectiveness of CT.
Methods: Utilizing self-report survey and brief open response data from community partners (N = 8) involved in a CT to adapt a family-inclusive lifestyle intervention in the rural Mountain West, we sought to describe change in theorized mechanisms – knowledge, attitudes, and partnership dynamics – and intermediate effectiveness outcomes.
Results: The results indicate that perceived knowledge, attitudes, partnership dynamics, and intermediate effectiveness outcomes all tended to increase across the CT, with intermediate effectiveness outcomes such as group impact, perceived benefits, belonging, and cultural relevance showing the largest changes.
Conclusions: The findings provide preliminary support for the logic model and theoretical basis outlined by the developers of CT, as well as insights for ways to optimize this powerful community-based participatory research methodology
Impact of probiotic/synbiotic supplementation on post-bariatric surgery anthropometric and cardiometabolic outcomes: An updated systematic review and meta-analysis of randomized controlled trials
No full textBackground/objectives: Bariatric surgery improves weight and metabolic health in individuals with severe obesity; however, challenges like gut dysbiosis and nutrient deficiencies persist postoperatively. Probiotic supplementation may enhance recovery by modulating gut microbiota. This updated meta-analysis aimed to assess the effects of probiotics/synbiotics on metabolic, anthropometric, and nutritional outcomes after bariatric surgery.
Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using PubMed, SCOPUS, Web of Science, and CENTRAL through December 2024. Studies comparing probiotics/synbiotics (which contain both probiotics and prebiotics) versus a placebo in adults post-bariatric surgery were included. Meta-analyses were conducted, with subgroup analyses by surgery type, the timing of the intervention, and probiotic formulation (PROSPERO ID: CRD420251019199).
Results: Thirteen RCTs involving 809 patients were included in the analysis. Probiotic use significantly reduced BMI (MD = 0.67, 95% CI: 0.33 to 1.00), HbA1c (MD = -0.19%, 95% CI: -0.36 to -0.01), triglycerides (MD = -16.56 mg/dL), and AST levels (MD = -3.68 U/L), while increasing ALP (MD = 8.12 U/L) and vitamin D (MD = 13.68 pg/mL). Ferritin levels were significantly lower (MD = -18.89 µg/L) in the probiotic group. A subgroup analysis showed enhanced benefits in patients undergoing mini-gastric bypass, with perioperative or synbiotic interventions specifically improving triglycerides, total cholesterol, and HbA1c.
Conclusions: Probiotics may offer modest but significant improvements in BMI, glycemic control, lipid profile, liver enzymes, and vitamin D levels after bariatric surgery. These findings support the potential role of probiotics/synbiotics as an adjunct therapy, though further large-scale trials are warranted to confirm long-term benefits
Spinal analgesia in cancer pain management-MASCC general practice recommendations
No full textPatients with cancer pain refractory to conventional medical management may benefit from spinal analgesia, although there are some critical points regarding some aspects which cannot be examined by an evidence-based approach. A group of experts was selected by MASSC to provide clinical practice advice on the use of spinal drug delivery in patients with cancer-related pain. Refractory cancer pain should be considered a condition in which a patient has failed to receive adequate analgesia or has developed uncontrolled side effects after comprehensive pain management. The intrathecal route (IT) with an implantable drug delivery system allows the administration of minimal doses of analgesics with significant clinical effects while avoiding major adverse effects and lower risks with prolonged use. Morphine and hydromorphone are the opioids of choice for IT treatment. Local anesthetics are an added value because of their additive-synergic effect on segmental areas. The efficacy of adding small amounts of local anesthetics to an ITDD relies on the positioning of the tip of the catheter close to the dermatome where the origin of the pain comes from. Their use, however, depends on the delivery system, because larger volumes are necessary. Ziconotide requires a slow dose titration, but it can be used in small volumes. In addition, once doses are stabilized, no tolerance occurs. A conversion ratio of 100:1 between oral and IT morphine is suggested for patients who receive high doses of systemic opioids. A higher ratio (300:1) should be used in patients prevalently switched to the IT route for uncontrollable adverse effects, receiving lower doses of systemic opioids. The use of boluses of hydrophilic opioids, like morphine, for treating breakthrough pain may be inadequate, as intrathecal opioids alone may be unable to adequately treat an episode of rapid pain onset and duration. The decision-making process for employing interventional therapies, like spinal analgesia, should be shared, taking into account the actual indications and needs, previous treatments, prognosis, timing, advantages and disadvantages, and complications, in any individual situation, managing all the aspects of care
Development of a risk score predicting survival after adult heart transplantation in the United States
No full textBackground: In the US, donor hearts for transplant are currently allocated to the candidates with the highest risk of death on the waiting list, based on a categorical status-based system. The upcoming continuous distribution provides an opportunity to implement a post-transplant risk score that may help avoid futile transplants.
Methods: In this observational study of the Scientific Registry of Transplant Recipients, a novel US transplant risk score (US-TRS) was developed and validated using a mixed-effects Cox proportional hazards model. Study participants included adult heart transplant recipients between October 18, 2018, and February 28, 2022, split temporally into training (first 70% of recipients) and test (last 30% of recipients) datasets. We included 8 of 9 French Transplant Risk Score (French-TRS) components plus additional US variables that improved the Akaike Information Criterion (AIC) in the training data. In the test dataset, we assessed US-TRS 1-year post-transplant survival predictions with Uno\u27s concordance index (c-index) and restricted mean survival time and compared these results to other post-transplant risk scores including the French-TRS, the Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score, and recipients\u27 waitlist status at transplantation.
Results: The study cohort consisted of 9,071 heart transplant recipients (mean age 54 [SD 13] years, 72% male), of which 828 (9.1%) died and 29 (0.3%) underwent retransplant within 1 year of transplant. The final US-TRS model included recipient age, bilirubin, estimated glomerular filtration rate, albumin, durable left ventricular assist device (LVAD), diabetes, mechanical ventilation, congenital heart disease, donor age, donor sex, and donor-recipient size mismatch. The c-index in the test dataset was of 0.671 (95% CI, 0.665-0.687) for the US-TRS model, 0.620 (95% CI, 0.611-0.632) for the French-TRS model, 0.598 for the calculated IMPACT score, and 0.551 (95% CI, 0.540 - 0.576) for waitlist Status at transplant. US-TRS estimated excellent survival for most recipients, but a minority (17%) of recipients were high risk with an estimated 1-year survival probability of 78% and an average estimated restricted mean survival time of 311.9 days in the first year.
Conclusions: In this registry-based study of US adult heart transplant recipients, a multivariable risk score outperformed existing models in predicting 1-year post-transplant survival and may be useful for integrating post-transplant survival into the upcoming continuous distribution framework.
Key points: Question: Which prediction model most accurately rank orders US adult heart transplant recipients by 1-year post-transplant survival?
Findings: In this registry-based study of 9,071 heart transplant recipients, the novel US Transplant Risk Score (US-TRS) outperformed existing survival prediction models in rank ordering recipients by 1-year post-transplant survival. Meaning: The US Transplant Risk Score may be useful for incorporating expected post-transplant survival into allocation of deceased donor hearts in the US
EXPRESS: Two decades of inflammatory bowel disease-related cardiovascular mortality in the United States: Temporal trends and demographic disparities from a National Death Registry
No full textAlthough the association between inflammatory bowel disease (IBD) and cardiovascular disease (CVD) is well established, long-term, population-level trends in cardiovascular mortality among individuals with IBD remain poorly characterized. This study provides a comprehensive, nationwide analysis of IBD-associated cardiovascular mortality in the United States over a two-decade period, emphasizing temporal patterns and sociodemographic disparities. We performed a retrospective analysis using the CDC WONDER database from 1999 to 2020, identifying decedents with CVD (ICD-10 I00-I99) as the underlying cause and IBD (ICD-10 K50/K51) as a contributing condition. Mortality rates were age-adjusted using the direct standardization method and stratified by demographic and geographic variables. Total of 11,891 cardiovascular deaths were linked to IBD during the study period. From 1999 to 2015, age-adjusted mortality rates (AAMRs) declined significantly, with an annual percent change of -2.74% (p = 0.0064). However, between 2015 and 2020, this trend plateaued. Subgroup analyses revealed significant post-2015 increases among Black individuals (+23.03%, 2017-2020; p = 0.0416) and men (+27.19%, 2018-2020; p = 0.0100). AAMRs were highest among White and non-Hispanic populations and varied by state and urbanization level. In addition, we implemented ARIMA-based forecasting models, which project continued increases in mortality among males and White individuals through 2040, suggesting that recent adverse trends may persist. Over the past two decades, IBD-related cardiovascular mortality in the U.S. declined until 2015, followed by stabilization and modest resurgence, particularly among men and Black individuals. These findings underscore persistent disparities and call for targeted, multidisciplinary strategies to mitigate cardiovascular risk among individuals with IBD
