11210 research outputs found
Sort by
Lateral decubitus strategy (LADS) is superior to ventilatory strategy (VESPA) in preventing atelectasis from obscuring targets during robotic bronchoscopy, leading to improved procedural outcomes (LADS vs VESPA trial)
No full textBackground: Atelectasis during peripheral bronchoscopy can cause CT-to body divergence, false positive radial-probe endobronchial ultrasound images, and can obscure a target. As shown in prior studies, ventilatory strategies to prevent atelectasis, though useful, cannot completely avoid this phenomenon.
Research question: Is a lateral decubitus superior to a ventilatory strategy in preventing atelectasis from obscuring targets in patients with lung nodules in dependent zones?
Study design and methods: Randomized controlled study (1:1) in which patients undergoing robotic bronchoscopy for nodules ≤ 3 cm in dependent lung zones were randomized to lateral decubitus strategy (LADS) vs. a ventilatory strategy to prevent atelectasis (VESPA). Patients who developed atelectasis obscuring the target crossed over to the opposite arm. Primary outcome was the development of atelectasis obscuring the target detected with m-CBCT. Secondary endpoints included tool in lesion (TIL), diagnostic yield (DY), and safety.
Results: 62 patients were analyzed, 29 in LADS and 33 in VESPA. No patients developed atelectasis obscuring target in LADS, and 9 patients did in VESPA (27.3%, 95% CI, 13.3%-45.5%) (p=0.002). TIL was achieved in 29 patients (100%, 95%CI 88.1%-100%) in LADS and in 24 patients (72.7%, 95% CI 54.5%-86.7%) in VESPA (p=0.005). DY on index biopsy was made in 25 patients (86.2%, 95% CI 68.3%-96.1%) in LADS and 19 patients (57.6%, 95% CI 39.2%-74.5%) in VESPA (p=0.026). In all 9 patients who crossed over from VESPA to LADS, atelectasis was eliminated leading to TIL, and diagnosis was obtained in 7 (78%). There were no major complications and no differences in the rate of minor complications
Would You Trust this Person Professionally? Seeking Agreement on Unprofessional Behaviors
No full textBackground
“That’s just your perception” is a frequent response when told “That’s unprofessional.” Yet unprofessional behavior adversely affects individual learning and team functioning, while increasing avoidable patient complications and malpractice claims. But what if professionalism is reframed as trust? Is there agreement on which behaviors would adversely affect trust; thus, providing a different way to approach this quagmire? Is the person competent with humility? Is reliable? Do they care about others (beneficence)? Using an established four component model of trust as a framework, we wondered if key GME stakeholders would agree on what were untrustworthy behaviors.
Objectives
1. To identify an established evidence-based trust framework that intuitively resonated with those in GME.
2. To develop and conduct a needs assessment framed within the trust framework of key GME stakeholders (eg, residents, faculty, GME leaders, staff) to rate the degree to which selected professionalism-related behaviors are considered untrustworthy.
3. To examine if there are differences by role and/or by selected geographic locations (eg, Illinois, N Carolina, Wisconsin) to inform future interventions.
Methods
Residents, faculty, GME leaders/staff were asked to submit brief, de-identified unprofessional behaviors that they had experienced/witnessed. The behavior could be exhibited by anyone in GME (eg, resident, faculty member, coordinator). Behaviors were then categorized into 1 of 4 trust categories: reliability, competence (with humility), sincerity, or caring. 5 items were selected for each category (to represent an array of behaviors, settings, actors) yielding a 20-item assessment tool with two demographic items (role, state). Respondents rated items on the degree to which they would trust this person as a professional (4-point Likert scale). Protected time was provided in existing forums (eg, GMEC, faculty/resident meetings), to present a brief introduction to the tool and then complete it using SurveyMonkey to minimize anonymity concerns.
Results/Outcomes/Improvements
206 responses were received between July and September 2025 from Residents/Fellows (47%), Faculty (19%); DIOs, PDs, APDs (16%); and coordinators (18%), with average completion time \u3c 4.5 minutes. Greater than 70% of respondents expressed a lack of trust (rating “No, Probably Not or No, Definitely Not trust) on 75% of the items. For example, respondents expressed lack of trust on items about unapproved days off (85%), being unresponsive to feedback (96%), and heavy cell phone use in front of patients (84%) . Items with less consensus focused on timeliness of certification completions (47%), personal hygiene (46%), and asking for feedback (46%). When items were examined by the 4 elements of trust “sincerity” related items had the highest not trustworthy agreement ranging from 78%-86% while “competence with humility” related items had the lowest range of agreement 46%-75% of respondents expressing lack of trust. There were no observed differences by role or location.
Significance/Implications/Relevance
Unprofessional behavior poses a significant challenge in GME, as one’s perception is often reality—adversely impacting patients, teams, and learning environments. However, differing perceptions on what constitutes unprofessional conduct can complicate efforts to address these behaviors effectively. To navigate this complexity, we conducted a needs assessment using the 4 elements of trust framework to establish common ground as we seek to foster candid conversations about professionalism and appropriate conduct. Using trust as a framework is consistent with EPA decisions and reframes what can be thorny discussions about professionalism into one about trust among team members performing stressful jobs that require individuals to act with integrity, reliability, competence with humility, and caring. Our next steps are to hold scenario-based professionalism / trust discussions in our existing GME forums facilitated by trained residents and faculty
PTSD symptoms and substance use problems in traumatic injury patients: A 24-month follow-up
No full textBACKGROUND: People who experience traumatic injuries may be at risk for a variety of post-injury emotional and behavioral sequalae. In particular, the level of trauma experienced in relation to those injuries may place individuals at increased risk for substance use-related problems. Given the lack of research directly investigating the impact of injury-related PTSD on substance use problems post-injury, we conducted a secondary analysis of a study of injured patients to explore this issue.
METHODS: To address the hypothesis that those experiencing more trauma at baseline were at increased risk for substance use problems at follow-up, this study utilized a prospective longitudinal design to investigate the relationship between traumatic injury, PTSD symptoms, and drug use problems over a 24-month follow-up period in 215 patients with traumatic injuries admitted for treatment to an urban Level 1 trauma center. The main study aim was to investigate whether the baseline major of trauma was associated with higher levels of substance use problems at follow-up, controlling for key background variables. Accordingly, we conducted mixed model longitudinal regression analysis where the 10-item DAST was regressed on time, demographic variables (age, sex, race, and income), and initial post-injury PTSD symptoms (as measured by the PCL-5 assessed two weeks post-injury). Separate analyses were conducted using continuous and binary measures of the DAST-10.
RESULTS: Forty-two percent of the sample exceeded the clinical threshold for PTSD. Elevated PTSD symptoms increased the risk for the emergence of substance use problems over the follow-up period. The impact of PTSD symptoms remained when we looked at continuous and binary indicators of substance use problems, and when we controlled for retrospectively reported substance use problems. Male sex, older age, and lower income were also associated with the emergence of substance use problems.
CONCLUSION: PTSD symptoms occurring immediately post-injury, when elevated, lead to an increased risk for the emergence of substance use problems at follow-up. Substance use problems at follow-up are not merely a continuation of problems experienced before the injury. These findings underscore the importance of screening and of psychologically focused interventions soon after the traumatic injury experience
Middle meningeal artery embolization for subdural hematoma: CT/MRI end points of the EMBOLISE trial
No full textBackground: Chronic subdural hematomas (cSDHs) are associated with high recurrence risks following surgical evacuation. The EMBOLISE trial demonstrated that, compared with surgery alone, adjunctive middle meningeal artery embolization (MMAE) significantly reduced reoperation rates. However, given the limitations of the clinical end points of the trial, which may be subject to interrater variability and certain biases, the quantitative imaging metrics need to be evaluated.
Purpose: To evaluate the prespecified imaging end points of the EMBOLISE trial and assess the long-term resolution of cSDH through quantitative imaging analyses.
Materials and Methods: EMBOLISE was a multicenter, randomized, interventional trial conducted across 39 U.S. sites between December 2020 and August 2023. Prespecified secondary imaging end points included changes in hematoma volume and thickness and midline shifts from 24 hours to 90 days after the procedure at CT and MRI. The post hoc analyses performed herein extended the assessment to 180 days and included absolute hematoma metrics. Mixed-effects modeling was employed to adjust for confounders.
Results: Four hundred patients were enrolled in the EMBOLISE study, among whom 352 were included (mean age, 72 years ± 10.4 [SD]; 256 men). The mean cSDH volume was 126 mL at screening, with no intergroup differences. At 90 and 180 days, the MMAE plus surgery group had lower cSDH volumes (20.6 mL vs 28.9 mL [P = .03] and 19.4 mL vs 31.5 mL [P = .04], respectively). Mixed-effects models revealed a 6.9 mL (95% CI: -13.5, -0.40; approximately 25%) greater volume reduction and an 8.4 mL (95% CI: -15.2, -1.6; approximately 30%) lower absolute volume at 90 days in the MMAE group There was no evidence of a difference in the prespecified secondary imaging end points between the groups.
Conclusion: While the prespecified secondary imaging end points did not significantly differ, the absolute 90- and 180-day hematoma volumes were significantly lower in patients who received MMAE and surgery. Confounder-adjusted mixed-effects analysis indicated a greater reduction in hematoma volume with adjunctive MMAE
Inside Aurora Sinai Medical Center, 2002 August
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2244/thumbnail.jp
Inside Aurora Sinai Medical Center, 2003 August
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2254/thumbnail.jp
Inside Aurora Sinai Medical Center, 2004 September
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2265/thumbnail.jp
Inside Aurora Sinai Medical Center, 2002 October
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2245/thumbnail.jp
Inside Aurora Sinai Medical Center, 2004 July
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2263/thumbnail.jp