11210 research outputs found
Sort by
The unseen hands: Elevating neurointerventional education through operator hand visualization
No full textIn neurointervention, fluoroscopic images dominate the educational narrative, highlighting device navigation and deployment but neglecting the manual expertise that enables them. The physician\u27s hands, which execute precise torques, tensions, and micro-movements, remain unseen and underappreciated, leaving a critical gap in procedural education. This editorial argues for systematic recording of operator hand movements during neurointerventional procedures and for aligning these recordings with fluoroscopic feeds to create a dual-visual educational resource. Such integration could enhance procedural understanding, improve trainee skill acquisition through direct visual mimicry, and foster more effective case debriefings. We discuss technological feasibility, cost, privacy concerns, and the potential of this approach to standardize and elevate neurointerventional education worldwide. By widening the lens beyond the screen, we can preserve and transmit the tacit manual knowledge that defines procedural mastery
Implementation of an outpatient cervical ripening initiative: Outcomes and patient & provider perspectives
No full textObjective: To examine implementation and patient/provider acceptance of an outpatient mechanical cervical ripening program for labor induction with the goal of reducing length of stay on Labor & Delivery (L&D).
Study design: Initially, outpatient cervical ripening was available , and later (due to low utilization) mandatory for eligible patients induced Monday-Friday, with weekend induction available for those declining outpatient ripening. Single-balloon catheters were used, with supplemental vaginal misoprostol for inpatients. Utilization was compared for two 3-month periods (pre- and post-mandatory phases). Patient and provider surveys queried perceived benefits, risks, barriers, pain, likelihood to recommend, and satisfaction. Outcomes (length of stay in L&D, delivery mode, chorioamnionitis, hemorrhage, and NICU admission) were compared between the inpatient and outpatient groups.
Results: Outpatient ripening among eligible patients increased from 13.5% to 55.1% after becoming mandatory (p\u3c0.01), with 71.4% of patients undergoing either outpatient ripening or induction over the weekend. Staff satisfaction was high, with 91.7% somewhat to very likely to recommend outpatient ripening. Perceived benefits included decreased time in L&D. Barriers included office workflow and provider comfort with placement. Patient satisfaction and pain scores did not differ by balloon placement location. Among patients eligible for outpatient ripening (n=224), there was no difference in L&D length of stay (22.1 hours outpatient versus 24.2 inpatient, p=0.19). However, among all patients undergoing mechanical ripening (n=397, a measure of the initiative\u27s impact on L&D congestion), outpatient ripening length of stay was shorter by 4h (22.1 versus 26.1 hours, p=0.01). Delivery outcomes were similar between groups.
Conclusion: Outpatient cervical ripening utilization was minimal until it became mandatory. Providers were overall satisfied. Balloon placement location did not affect patient satisfaction. Among patients undergoing mechanical ripening, those receiving an outpatient balloon had a 4-hour decreased L&D length of stay. There were no differences in delivery outcomes
Chronic stress and autoimmunity: The role of HPA axis and cortisol dysregulation
No full textAutoimmune diseases are chronic inflammatory conditions characterized by the breakdown of immune tolerance to self-antigens. While genetic and environmental factors play key roles, growing evidence highlights chronic stress as a significant contributor to immune dysregulation through its impact on the hypothalamic–pituitary–adrenal (HPA) axis. The HPA axis, primarily via cortisol secretion, serves as the major neuroendocrine mediator of stress responses, influencing both immune regulation and systemic homeostasis. This review synthesizes current literature on HPA axis physiology, the mechanisms of cortisol signaling, and the maladaptive effects of chronic stress. Emphasis is placed on clinical and experimental findings linking HPA dysfunction to immune imbalance and autoimmunity, as well as organ-specific consequences across neuroimmune, endocrine, cardiovascular, gastrointestinal, integumentary, and musculoskeletal systems. Chronic stress leads to impaired HPA axis feedback, glucocorticoid receptor resistance, and paradoxical cortisol dysregulation, fostering a pro-inflammatory state. This dysregulation promotes cytokine imbalance, weakens protective immune mechanisms, and shifts the immune response toward autoimmunity. Evidence from both human and animal studies associates persistent HPA dysfunction with diseases such as systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis. HPA axis dysregulation under chronic stress constitutes a critical mechanistic link between psychological stress and autoimmune disease. Understanding these pathways provides opportunities for therapeutic interventions, including stress management, lifestyle modification, and neuroendocrine-targeted treatments. Future research should focus on multi-omics and longitudinal approaches to clarify the reversibility of HPA alterations and identify resilience factors
TCT-251 Fifteen years of ST-elevation myocardial infarction and cardiogenic shock in the United States: Have we closed the sex gap in mortality?
No full textNutrition effects on brain outcomes and recovery in stroke after hospitalization (NOURISH): Randomized controlled trial protocol and rationale
No full textBackground: Risk of dementia doubles after stroke. There is limited information on reduction of risk, but diet is a significant modifiable risk factor for both vascular health and cognition.
Objective: Nutrition effects on brain Outcomes and Recovery In Stroke after Hospitalization (NOURISH; registration no. NCT04337255) is a phase III randomized controlled trial designed to test the effects of the MIND diet on changes in cognition following an acute ischemic stroke.
Study methods: Eligible participants aged 55 and older were randomized to either the MIND diet intervention facilitated by credentialled nutritionists plus post-stroke care (Coach) or a post-stroke care intervention led by health educators (Self) for 24-36 months. Repeated assessments included anthropometric measurements, cognitive testing, blood and urinary biomarkers, and a variety of validated post-stroke outcome measures and follow-up visits for up to 3 years, with MRI scans conducted on a subset of participants at baseline and the study\u27s end. Unique features of this study include: CONCLUSIONS: This study will evaluate the MIND diet intervention in preventing cognitive impairment in older adults after acute stroke. Findings will provide insights for the development of dietary guidelines for post-stroke care
Abstract 4359837: Clinical and echocardiographic predictors of aortopathy in patients with bicuspid aortic valve: Insights from a large community cohort
No full textGLP-1 receptor agonists decrease the colorectal cancer rates in inflammatory bowel disease
No full textPotassium-competitive acid blockers vs protonpump inhibitors: A real-world comparative effectiveness study
No full textLong-acting dexamethasone viscous gel (SP-102) transforaminal injection for lumbosacral radicular pain
No full textLumbosacral radicular pain (LRP) is a condition characterized by debilitating pain and functional impairment. Epidural steroid injections (ESIs) are frequently used to relieve symptoms of LRP; there are currently no FDA-approved corticosteroid products specifically indicated for this condition. Moreover, existing products carry safety warnings against epidural administration, which have been linked to the off-label use of formulations. SP-102 (10 mg dexamethasone in a 2 ml viscous gel) is a proposed product that is formulated to provide rapid onset of action while prolonging the duration of effect, potentially resulting in extended pain relief and an improved safety profile for dexamethasone. Phase I and phase II studies have demonstrated SP-102 to be safe and well-tolerated. In phase III, SP-102 demonstrated greater pain relief compared to placebo; SP-102 reduced leg pain scores by an average of 1.1 points more than placebo over four weeks (p \u3c 0.001) and extended the median time before repeat injection to 84 days compared with 58 days for placebo. SP-102 also produced an average 8.9-point reduction in the Oswestry Disability Index (ODI) from baseline versus 5.5 points with placebo (p = 0.015). Importantly, no serious adverse events related to the injection of SP-102 were reported
Category II Tracing Simulation
No full textBackground: A common reason for primary cesarean sections is abnormal fetal tracings, specifically category 2 tracings. The expectation of Labor and Delivery (L&D) nurses is to be able to recognize these category 2 tracings and implement interventions to promote the best possible outcomes for the mom and baby and reduce the likelihood of progressing to a cesarean delivery.
Local Problem: All Labor & Delivery nurses at Advocate Christ Medical Center (CMC) take a fetal monitoring course when hired. However, there is no platform to allow them to practice applying this knowledge into their practice. Therefore, the nurses are not always confident in identifying a category 2 tracing. This could lead to a delay in implementing interventions and/or notifying the physician in a timely manner.
Method: To increase the L&D nurses comfort level with identifying abnormal fetal tracings and their management, the OB department and the Simulation Lab team developed a simulation focusing on recognition and management of category 2 fetal tracings. Between November and December of 2024, L&D nurses attended a simulation. The nurses completed an anonymous survey about their comfort level with category 2 tracings before and after the simulation.
Results: Compared to the pre-survey, the post-survey showed a 47% increase in the nurse’s comfort level with recognizing and managing abnormal tracings.
Implications for Practice: Simulation allows leaners to apply their knowledge in a safe, non-threatening environment without fear of mistakes that could potentially harm patients. Increased comfort level can lead to feeling more secure in decision making and contribute to psychological safety