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Stripping versus ligation of vas deferens in microscopic denervation of spermatic cord in men with chronic orchialgia: A multicenter study
No full textBackground: Microdenervation of the spermatic cord (MSCD) is an effective treatment modality for men with intractable scrotal content pain. For patients not interested in preserving fertility, some centers advocate ligation of the vas during denervation, while others prefer stripping of the vas deferens to preserve the vasal artery, hence preserving vasculature to the testis and possibly decreasing post-operative congestion pain.
Objective: To compare outcomes of patients with chronic orchialgia, who underwent MSCD by either stripping or ligating the vas deferens.
Materials and methods: A retrospective chart review of 85 patients who underwent MSCD from 2017-2023 was performed. Patients' demographics including history of prior surgical procedures were recorded. Response to surgery was evaluated as either complete resolution of pain, partial resolution of pain, or no improvement in pain.
Results: Eighty-five patients underwent MSCD with a median (interquartile range, IQR) age of 36 (25.5-46.5) years and median duration of pain of 16 (6-31) months. Thirty-seven patients underwent stripping of vas, while 48 underwent ligation of vas during MSCD. Median follow up was 12 months. Twenty-one (43.5%) patients had prior inguinal scrotal surgery in the ligation group compared to 5 (13.5%) in the stripping group, p = 0.003. The etiology of pain was similar between the groups. The response to MSCD between the two groups was similar, 67.6% of patients who underwent stripping had complete resolution of pain versus 66.7% of those who had ligation (p = 0.968), with similar rates of post-operative complications (p-value = 0.132).
Conclusions: In men with intractable chronic scrotal content pain with no interest in preserving fertility, ligation, or stripping of the vas deferens yields similar outcomes with regard to pain resolution. Both techniques are safe with no reports of any testicular atrophy
Advancing the Metabolic Dysfunction-Associated Steatotic Liver Disease Proteome: A Post-Translational Outlook
No full textMetabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent liver disorder with limited treatment options. This review explores the role of post-translational modifications (PTMs) in MASLD pathogenesis, highlighting their potential as therapeutic targets. We discuss the impact of PTMs, including their phosphorylation, ubiquitylation, acetylation, and glycosylation, on key proteins involved in MASLD, drawing on studies that use both human subjects and animal models. These modifications influence various cellular processes, such as lipid metabolism, inflammation, and fibrosis, contributing to disease progression. Understanding the intricate PTM network in MASLD offers the potential for developing novel therapeutic strategies that target specific PTMs to modulate protein function and alleviate disease pathology. Further research is needed to fully elucidate the complexity of PTMs in MASLD and translate these findings into effective clinical applications
Use of Ultrasound in the Prehospital Setting: A Scoping Review
No full textObjectives: With the advent of portable devices, prehospital ultrasound is increasingly available and has the potential to provide clinical and procedural decision support. This scoping review seeks to examine current literature on prehospital ultrasound, including study indications, the level of the health care professionals performing prehospital ultrasound, and reported research outcomes.
Methods: We searched PubMed, Embase, Web of Science, CINAHL, and Cochrane databases for research articles and conference abstracts focused on prehospital ultrasound with scans performed in the field. After title/abstract screening by 2 independent reviewers, a full-text review was performed. We excluded reviews, case reports, letters to the editor, and research published in nonEnglish language. Descriptive statistics were reported.
Results: We identified 9718 unique articles, and 109 were included after title/abstract review (Kappa 0.68) and full-text analysis. Annual publications increased yearly (P < .01). Nineteen countries were represented, with the United States having the highest number of publications (n = 34, 31.2%). Most studies were prospective (n = 74, 67.9%) with few randomized control trials (n = 6, 5.5%). Feasibility studies comprised 45.9% (n = 50) of the included publications, while clinical outcomes were the primary interest in 18 studies (16.5%). Physicians (n = 58, 53.2%) and paramedics (n = 38, 34.9%) were the most studied prehospital clinicians. The most common indication was trauma (n = 49, 45%) followed by dyspnea (n = 13, 11.9%) and cardiac emergencies (n = 10, 9.2%).
Conclusion: There is a growing, heterogeneous body of literature describing the use of prehospital ultrasound. Published literature was primarily prospective and described feasibility trials. Identified gaps include a lack of studies in pediatric patients and research identifying clinical outcomes
Continuing Education in Healthcare Professions (CEHP) Program-Based Analysis of Accreditation Evaluation Criteria
No full textIntroduction/Background: As a Jointly Accredited Provider of Interprofessional Continuing Education, IUSM Office of Continuing Education in Healthcare Professions (CEHP) follows accreditation Criteria to evaluate both activities and our program overall. Our CEHP Mission is: As the preeminent provider and accrediting body of comprehensive and innovative lifelong learning opportunities through educational activities for healthcare teams, it is our mission to enhance healthcare outcomes through educational activities that foster innovation and excellence in knowledge, practice, and change in strategy and/or performance of the healthcare team in the state of Indiana and beyond.
Study Objective: The purpose of this study is to conduct a program-based analysis on the degree to which our CE mission has been met through conducting CME/CE activities as expected in Joint Accreditation Criteria (JAC) 2. This is specifically as it relates to changes in skills/strategy, or performance of the healthcare team, and/or patient outcomes. The sampling of CME/CE activities used for this study are the activity type of Regularly Scheduled Series (RSS) occurring in academic year 2024.
Methods: We conduct this study by gathering data as expected in JAC 11 at the CME/CE activity level regarding changes in the healthcare team (skills/strategy, performance) and/or patient outcomes. We then aggregate the individual activity level evaluation results from Qualtrics into one overall program level analysis being tabulated in Microsoft Excel.
Results: Preliminary analysis of this data set reveals that 80.27% of CME/CE learners anticipate enhancing their skills and strategies as healthcare team members after participating in our accredited activities. Additionally, 77.94% of these learners expect to improve patient-level outcomes based on their participation in these activities.
Conclusions: Based on the preliminary analysis, our organization is significantly meeting its mission. Overall, these metrics suggest that our accredited activities are successfully contributing to the mission of fostering innovation and excellence in healthcare teams, both within Indiana and beyond
Genetic influences for distinct impulsivity domains are differentially associated with early substance use initiation: Results from the ABCD Study
No full textBackground: Impulsivity is among the strongest correlates of substance involvement and its distinct domains (e.g., sensation seeking, urgency) are differentially correlated, phenotypically and genetically, with unique substance involvement stages. Understanding whether polygenic influences for distinct impulsivity domains are differentially predictive of early substance use initiation, a major risk factor for later problematic use, will improve our understanding of the role of impulsivity in addiction etiology.
Methods: Data collected from participants (n=4,808) of genetically-inferred European ancestry enrolled in the Adolescent Brain Cognitive Development StudySM were used to estimate associations between polygenic scores (PGS) for UPPS-P impulsivity domains (i.e., sensation seeking, lack of premeditation/perseverance, and negative/positive urgency) and substance (i.e., any, alcohol, nicotine, cannabis) use initiation before age 15. Mediation models examined whether child impulsivity (ages 9-11) mediated links between PGSs and substance use initiation.
Results: Sensation seeking PGS was significantly associated with any substance and alcohol use initiation (ORs>1.10, psFDR1.06, ps0.05). No significant associations were observed for lack of premeditation PGS or cannabis use initiation. Measured impulsivity domains accounted for 5-9% of associations between UPPS-P PGSs and substance use initiation.
Conclusions: Genetic influences for distinct impulsivity domains have differential associations with early substance use initiation with sensation seeking showing the most robust associations. Evaluating genetic influences for distinct impulsivity domains can yield valuable etiologic insight into the earliest stages of substance involvement that may be missed when adopting broad impulsivity definitions
Social Determinants of Inequities in Neurodegenerative Disease Readmissions in Northwest Indiana: An Advocacy Opportunity
No full textBackground: Neurodegenerative diseases, such as Alzheimer's and Parkinson's disease, pose significant challenges given their progressive nature and multifaceted care needs. This research examined the intricate interplay between social determinants of health (SDOH) and hospital readmissions among individuals with neurodegenerative diseases. It is part of a Participatory Research partnership between Indiana University School of Medicine-Northwest and an urban health system in Northwest Indiana (NWI).
Methods: This retrospective study analyzed a dataset generated from routine SDOH screenings and referrals in Epic using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) for inpatient admissions from 3 NWI urban hospitals between January 2021 to April 2024. Data analysis was conducted in SPSS 29.0 with descriptive statistics, bivariate analysis (Chi-square), and multivariate analysis (binary logistic regression). This study received exemption from Indiana University Human Research Protection Program (IRB #14040).
Results: The sample consisted of 1,338 patients admitted for neurodegenerative diseases. Patients were predominantly older adults (73 ± 14), publicly insured (91.5%), and 31% racial/ethnic minorities. The bivariate analysis found that readmission was significantly associated with age (p<0.001), insurance type (p=0.003), hospital (p<0.001), physical activity level (0.034), and length of stay (p<0.001). After adjusting for these factors, the multivariate analysis found higher odds of hospital readmission among patients with public insurance (OR=76.1%; p=0.028), prolonged hospital stay (OR=8.5%; p<0.001), and within a small hospital in a medically underserved area (MUA) (OR=69.6%; p<0.001).
Conclusion: Understanding the impact of SDOH on hospital readmissions is crucial for developing multi-level interventions to reduce readmissions, inequities, and healthcare costs. Findings from this research underscore the critical need for policy advocacy and integrated approaches addressing SDOH as part of comprehensive readmission reduction programs. Examples of evidence-based approaches include improving access to quality neurodegenerative care in MUAs, increasing education on at-home neurodegenerative care, and comprehensive SDOH screenings and referrals
Impact of Race and Industry on Stroke Incidence in Northwest Indiana – A Report to Advocate for Targeted Community-Based Interventions
No full textImpact of Race and Industry on Stroke Incidence on Patients in Northwest Indiana – A Report to Advocate for Targeted Community-Based Interventions
Miranda M. Cash¹*, Sahar A. Abdullah¹*, Amy Han, PhD2
Indiana University School of Medicine-Northwest1, Indiana University School of Medicine Department of Psychiatry2
Background & Hypothesis: Stroke is a leading cause of death and disability in the US and studies have shown racial/ethnic disparities in stroke, including in Hispanics/Latinos: the fastest growing segment of the US population. St. Catherine Hospital is located in East Chicago, Indiana and the majority population is Hispanic/Latino (54.8%) and is disproportionately at risk of stroke with a death rate of 79 per 100,000 people. With such disparities in stroke mortality across Northwest Indiana, especially among minority patients, we aim to report which zip codes show particular associations in stroke incidence and report possible social determinants of health (SDoH) between White, Black/African American, and Hispanic/Latino patients that receive treatment at St. Catherine Hospital.
Project Methods: Powers Health System provided data from St. Catherine Hospital in East Chicago, Indiana from January 2022 - March 2024 collecting socio-demographic data from 304 patients residing in the greater Northwest Indiana area. We calculated odds ratios to investigate associations in stroke outcome, race, and zip codes.
Results: In Whiting, IN, stroke is less likely to occur in Hispanics/Latinos compared to Whites. In South Chicago, stroke is more likely to occur in Hispanics/Latinos compared to Blacks/African Americans. Based on U.S Census Bureau metrics, residents of South Chicago face more negative SDoH than residents of Whiting.
Potential Impact: Northwest Indiana has the largest steel making facility in North America; this study aims to provide St. Catherine Hospital with a better understanding of which patients may be at particular risk of stroke based on SDoH (type of employment, pollution levels, and population density) that contribute to increased stroke incidence. Targeted community outreach efforts, such as policy change, patient education/training, and a stroke support group at St. Catherine Hospital, are future steps to increase positive SDoH
A Man Living in the Wilderness Presents With a Unique Case of Erysipelothrix rhusiopathiae Causing Primary CNS Infection
No full textWe report the first published case of Erysipelothrix rhusiopathiae causing subdural empyema. This 66-year-old male patient had relevant exposure history including living in a tent in the woods and having direct contact with wildlife. His main symptom which triggered his presentation was diplopia with exam findings consistent with a left partial oculomotor nerve palsy. Initial attempts at less invasive source control via burr holes alone failed. He was treated successfully with craniectomy and aqueous penicillin G with a duration of 6 weeks following surgery. CNS infection as the primary manifestation of Erysipelothrix rhusiopathiae has been reported in only one other case based on our review of the literature. This pathogen demonstrates an ability to manifest infection in many ways and remains susceptible to narrow spectrum beta-lactams
Area-Level Indices and Health Care Use in a Pediatric Brain and Central Nervous System Tumor Cohort: Observational Study
No full textBackground: While survival among pediatric patients with cancer has advanced, disparities persist. Public health tools such as the Area Deprivation Index, the Child Opportunity Index (COI), and the Social Vulnerability Index (SVI) are potential proxies for social determinants of health and could help researchers, public health practitioners, and clinicians identify neighborhoods or populations most likely to experience adverse outcomes. However, evidence regarding their relationship with health care use, especially in the pediatric population with cancer, remains mixed.
Objective: We sought to evaluate the relationship between emergency department (ED) visits and hospitalizations with these area-level indices in our study population.
Methods: We conducted a cross-sectional study of pediatric patients with brain and central nervous system tumors in a single Midwestern state who were diagnosed between 2010 and 2020. We fitted zero-inflated Poisson models for counts of ED and inpatient visits to determine if any of these use measures were associated with our 3 area-level indices. Finally, we mapped index quintiles onto neighborhoods to visualize and compare how each index differentially ranks neighborhoods.
Results: Our study cohort consisted of 524 patients; 78.6% (n=412) of them had no recorded ED visit, and 39.7% (n=208) had no record of hospitalization. Moderate (coefficient=0.306; P=.01) and high (coefficient=0.315; P=.01) deprivation were associated with more ED visits. Both low child opportunity (coefficient=0.497; P<.001) and very high child opportunity (coefficient=0.328; P=.01) were associated with more ED visits. All quintiles of SVI were associated with ED visits, but the relationship was not dose-dependent. Low and very high deprivation were associated with hospitalizations, but COI and SVI were not. Additionally, by overlaying index quintiles onto census tracts and census block groups, we showed that most patients who had an ED visit lived in disadvantaged neighborhoods based on Area Deprivation Index rankings, but not necessarily COI or SVI rankings.
Conclusions: Although indices provide useful context about the environment in which our patient population resides in, we found little evidence that neighborhood conditions as measured by these indices consistently or reliably relate to health care use
Chaotic fun! Promoting active recall of anatomical structures and relationships using the Catch‐Phrase game
No full textActive recall, the act of recalling knowledge from memory, and games-based learning, the use of games and game elements for learning, are well-established as effective strategies for learning gross anatomy. An activity that applies both principles is Catch-Phrase, a fast-paced word guessing game. In Anatomy Catch-Phrase, players must get their teammates to identify an anatomical term by describing its features, functions, or relationships without saying the term itself. Once a teammate guesses the term, players switch roles and continue play with the next term(s) until time runs out. Meanwhile, the instructor notes common errors and reviews knowledge gaps with the team at the end of the round. Prior to the first exam, a seven-question evaluation was distributed to the health professional students. A total of 18 dissection lab groups (86%) played one round of Anatomy Catch-Phrase, with many groups playing multiple times. After the first exam, 73 students (61%) completed the evaluation. On a five-point scale, most students indicated they enjoyed Anatomy Catch-Phrase (4.3 ± 0.9), highly recommended it (4.2 ± 0.9), and wanted to play it in the future (4.3 ± 1.0). Most students also found the game relevant to the course material (4.5 ± 0.8), useful for reviewing (3.9 ± 0.9), and helped reinforce their knowledge (3.9 ± 0.9). Anatomy Catch-Phrase was highly rated, with a score of 4.3 ± 0.9. Multiple students also provided enthusiastic unsolicited comments, such as 'LOVED IT! A fun way to study anatomy!:)'. Overall, Anatomy Catch-Phrase was well-received as a fun activity for reviewing the anatomy relevant to the course