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Analysis of Amyloid Beta Plasma Biomarkers in Intensive Care Unit Delirium Survivors
Get PDFBackground & Objective: Intensive care unit (ICU) delirium occurs in up to 70% of patients with 20-40% later developing dementia post-discharge. Plasma amyloid-beta (Aβ) levels have been associated with Alzheimer’s Disease. Whether ICU delirium compared to subsyndromal delirium (SSD) is associated with higher plasma Aβ levels at hospital discharge is not well described.
Methods: This is a secondary analysis of the IMPROVE randomized controlled trial. Subjects were ICU delirium survivors aged 50 years or older who provided venous blood samples at discharge. Delirium was assessed twice daily until discharge using Confusion Assessment Measurement in the ICU (CAM-ICU). SSD is a less severe form of delirium with one abnormal CAM-ICU feature. Samples were analyzed using a Multiplex Luminex Assay (Thermofisher), values were reported in pg/mL, and compared using the Wilcoxon Rank Sum Test using SAS. The detection range is 451 – 1846900pg/mL for Aβ1-40 vs. 0.68 – 2800pg/mL for Aβ1-42.
Results: In total, 68 subjects were included, 45% experienced SSD, and 54% had delirium. The mean age in the SSD group was 63.7 years [SD 7.3] vs. 64.4 years [SD 7.1] in the delirium group (p=0.667). The SSD group had a mean education of 13.6 years [SD 2.6] vs. 13.1 years [SD 2.3] (p=0.441) in the delirium group. Median plasma Aβ1-40 levels were 200.55 pg/mL (IQR 137.76, 286.57) in the SSD group, and 189.35 (IQR 150.38, 283.00) in the delirium group. The median plasma values of Aβ1-42 were 0.02 (IQR 0.02, 0.72) for the SSD group and 0.67 (IQR 0.02, 1.85) for the delirium group. There were no significant differences in plasma levels between the two groups (Aβ1-40: p=0.936; Aβ1-42: p=0.178).
Conclusion & Impact: There were no significant differences in plasma Aβ levels between ICU delirium and SSD. Further studies are needed to explore the relationship between delirium and plasma Aβ levels
Parent-Reported Outcomes Following Type B Ulnar Polydactyly Excision in the Clinic Versus the Operating Room
Get PDFBackground: Ulnar polydactyly is the presence of an extra finger on the post-axial aspect of the hand. It is one of the most common congenital abnormalities and causes aesthetic and functional impairments that can be treated with surgical excision in the office or the operating room (OR). Our goal was to compare outcomes between type B ulnar polydactyly surgery performed in OR vs. office.
Methods: We reviewed treatment outcomes and administered a satisfaction survey via telephone or email link via REDCaps to parents of children with type B ulnar polydactyly treated at Riley Children’s Hospital between 2020 and 2024. We assessed satisfaction with treatment decisions, outcomes, and motivational factors. Outcomes were assessed via visual analog scale from 1 to 10; 1 equating to minimum satisfaction, 10 equating to maximum satisfaction.
Results: In total, 34 of the 165 (20%) parents agreed to participate in the study. Of those 34, 17 parents elected for excision in the OR and 17 chose the office. There were no significant differences in race, education, or marital status between groups. In total, 15 families had a history of polydactyly and chose the operating room 64.3% of the time compared to 38.9% of the time from the families without a history of polydactyly. There was no significant difference in average comfort, satisfaction of outcome, function, and appearance VAS scores when stratified by family history of ulnar polydactyly. There were no significant differences in satisfaction between excision in the office or OR.
Conclusions: Office-based excision faces challenging logistics—sufficient lighting, staffing, and cooperation from parents and children. Parents who choose surgical excision in the office are satisfied with the treatment outcomes, would not change any of their treatment decisions, and would recommend their treatment process to others. While challenges exist, excision in the office may result in lower healthcare costs while providing similar outcomes
Planning for Dementia Diagnoses: The Physician’s Role in Developing Firearm Retirement Plans in Aging Populations
Get PDFIntroduction: Firearm ownership poses a critical risk to people living with dementia (PLWD) and their caregivers. Out of 241 veteran suicides that took place from 2001-2005, 73% were carried out using firearms with most suicides occurring in patients newly diagnosed with dementia. However, little is understood regarding how clinicians can effectively approach the subject of gun safety and cognitive decline.
Methods: A prospective survey was given to patients over 60 to assess attitudes and preferences regarding physician intervention in firearm safety planning in the case of cognitive decline. A second survey was distributed by the Marion County Youth Violence Prevention Coalition to determine the rate at which physicians discussed firearm safety with the caregivers of aging patients.
Results: Before participating in this study, 67% (n=12) of participants stated that they had never had a conversation about firearm safety and cognitive decline. 50% (n=9) reported that they were open to discussing firearm safety with their physician, with 11% (n=2) selecting that they were “undecided.” After the survey, 72% (n=13) of participants planned on having a conversation related to firearm safety planning in the case of cognitive decline. The survey directed toward caregivers reported that 21% (n=5) of participants discussed firearm safety with a healthcare provider.
Conclusion: Before taking this survey, only 33% of participants had discussed firearm safety in the case of cognitive decline. After participating, 72% planned to have that conversation. We will continue this project by determining the preferences of caregivers regarding physician intervention in firearm safety planning and discover the resources physicians need to assist in these conversations. When the most efficacious intervention strategy is understood, physicians can use their influential roles to equip aging populations with the ability to protect themselves and their families from firearm related injuries and deaths in the case of cognitive decline
Predicting hypocalcemia in multiple myeloma patients undergoing autologous stem cell collection
Get PDFBackground/Objective: Multiple myeloma is a plasma cell dyscrasia that can be treated with an autologous stem cell transplant, which involves the harvest of autologous hematopoietic cells by apheresis following induction therapy. Citrate anticoagulation-induced hypocalcemia is more common with large volume apheresis, which is defined as processing 3 or more total blood volumes. Although calcium is given parenterally to mitigate this complication, about a third of this patient population still experiences symptoms of hypocalcemia. Total calcium to ionized calcium ratio (T:iCa) has been employed widely to predict iatrogenic hypocalcemia induced by citrate anticoagulation during renal dialysis. Our aim is to assess the utility of total to ionized calcium ratio to predict hypocalcemia in multiple myeloma patients during autologous stem cell collection by leukapheresis.
Methods: A retrospective chart review study of a cohort of patients with multiple myeloma, who underwent autologous stem cell collection over a period of 6 months from October 2023 to March 2024 was conducted after an institutional review board approval. Demographic, clinical and laboratory data were obtained from the electronic medical record. The cohort was categorized into two groups: T:iCa ≥ 2.00, and T:iCa < 2.00. The binary outcome variable measured was the presence or absence of symptoms of hypocalcemia. A 2x2 table was constructed to examine the relationship between the two categorical variables.
Results: A total of 22 multiple myeloma patients that underwent apheresis for the harvest of autologous stem cells were identified. About 55% of the patients were female; the median age of the patients was 56 years (IQR, 48-62) and the median weight of the patients was 79 kg (IQR, 72-100). The pre-procedure median peripheral CD34+ cell count was 46 cells/μL (IQR, 33-72), the median pre-procedure ionized calcium was 1.14 mmol/L (IQR, 1.1-1.2), and the median preprocedure total calcium was 9.2 mg/dL (IQR, 8.8-9.4). The median duration of the apheresis procedure was 329 mins (IQR, 286-365). During apheresis, the median number of total blood volumes processed was 4.25 (IQR, 3.43-4.88), and the median volume of ACD-A infused was 1504 mLs (IQR, 1241-1914). The overall prevalence of symptoms of hypocalcemia was 27% during the apheresis procedure. The median T:iCa was calculated to be 1.96 (IQR, 1.89-2.06). Results of the analysis of the 2x2 table are as follows: sensitivity 50%, specificity 62.5%, positive predictive value 0.33, and negative predictive value 0.77 using a T:iCa cut-off of 2.00.
Conclusion/Potential Impact: Hypocalcemia is highly prevalent among multiple myeloma patients undergoing apheresis for hematopoietic stem cell collection. A third of the patient cohort have an increased probability of developing symptoms of hypocalcemia with a T:iCa of ≥ 2. Additional calcium supplementation in this subset of patients may be helpful in mitigating hypocalcemia during the procedure. A majority of the patient population who have T:iCa of ≥ 2 are likely to undergo autologous stem cell collection without experiencing symptoms of hypocalcemia
Derivation of a Multivariable Model to Assist Emergency Department Triage of Heart Failure Patients by Their Diuretic Treatment Needs
Get PDFBackground: Emergency medicine physicians (EMP) treat 1 million patients with acute decompensated heart failure (ADHF) annually. After emergency department (ED) treatment, EMPs must determine the need for further intravenous loop diuretic (IVLD) therapy in dispositioning patients to home (no further IVLD treatment), short stay observation (≤24hrs treatment), or inpatient hospitalization (>48 hours treatment). We hypothesized that EMPs overestimate IVLD needs, resulting in unnecessary admission, and derived a multivariable prediction model to aid EMP decision making.
Methods: We prospectively enrolled 63 patients with ADHF. The primary predicted outcome was the number of guideline-based doses of IVLD (1 dose = 1x home furosemide dose) received during the total acute care encounter. Variables available prior to ED disposition (labs, imaging, risk-scores, structured physical exam {edema, JVP, orthopnea grade, hepatojuglar reflux}, patient symptom scores) were used to derive a multivariable prediction model with linear regression. Control predictor models included A) ED physical exam + symptom score + natriuretic peptide (NP) and B) EMP disposition decision adjusted for risk of 30-day serious adverse events. Models were compared by adjusted R2.
Results: EMPs admitted 57 patients for full hospitalization, 5 for observation, and did not discharge any patients directly after ED IVLD treatment. Total-encounter IVLD requirements were median 2.5 guideline-standardized doses (IQR:0.8-4.5). ED disposition was poorly correlated with post-ED treatment needs, explaining only 2.1% of variance in IVLD requirements (i.e. R2=0.021). Physical exam, symptom score, and NP explained 24.7% of IVLD requirements. The new model (predictors: NP, BUN, sodium, troponin, heart rate, blood pressure, chest x-ray, medication adherence, edema severity) explained 54.7% of IVLD requirements.
Conclusion: EMPs may increase unnecessary hospitalizations by overestimating post-ED IVLD treatment needs. Our novel model, pending external validation in a new >5000 patient sample, was 26 times more accurate than risk-adjusted ED disposition and twice as accurate as physical exam/symptom score/NPs
The Impact of Social, Legal and Medical Transition on Psychological Distress for Transgender Persons
Get PDFPsychological distress is a major health concern for transgender persons going through the transition process. The purpose of this secondary data analysis of the United States Transgender Survey (USTS) compiled by the National Center for Transgender Equality was to explore the relationship between the three stages of transition (social, legal, medical) and levels of psychological distress. While much of the current social work research focuses on risk factors related to psychological distress, particularly around discrimination, this study explores how each stage of transition can serve as a protective factor to increase overall well-being. Independent sample t-tests, ANOVA, and regressions were completed to determine if social, legal, and/or medical transition had a significant effect on psychological distress. Findings indicated that improving access to services supporting transition can reduce psychological distress. Implications for social work education and practice are provided. 
Differences Between Students of Color and White Students in Prevalence and Trauma Effects of Sexual Assault
Get PDFSexual assault is a public health issue, particularly among college students. College students have a risk of perpetrating sexual assault and being victimized. Students of color are at an increased risk of experiencing sexual assault and are more likely to have worse outcomes due to the trauma compared to White students. However, very little research has sought to understand the differences in prevalence and negative trauma outcomes. The following secondary data analysis sought to find out if there are differences in rates of sexual violence, where those differences are, and whether students of color have different outcomes. Results showed significant differences in the prevalence of sexual assaults and the effects of trauma for students of color, with students of color consistently demonstrating higher risk
Rethinking Academic Conferences: Carbon Footprints and Sustainable Alternatives in the Climate Crisis Era
Get PDFIn the era of the climate crisis, academic conferences, while crucial for knowledge exchange, present a dilemma due to their significant carbon emissions from air travel. This commentary examines the environmental impact of attending academic conferences, focusing on the carbon footprint of traveling to the annual Society for Social Work and Research (SSWR) conference to begin to shed light on our field’s contribution to climate change. We estimate that the average air travel carbon footprint for an individual who presented at SSWR 2023 was 0.82 tonnes of carbon emissions. Furthermore, we explore alternative conference models, such as virtual and hub and node models, highlighting their potential to reduce carbon emissions while enhancing accessibility. As climate change requires collective global efforts and systemic change, we argue that the field of social work, with its commitment to social justice and activism, has a crucial role to play in driving these changes within academia and beyond. Reflecting on our part in climate change, initiating dialogue, and creating a strategic roadmap for alternative conference formats is an essential step for our field to contribute to a more sustainable and equitable future
An Anti-Racist Practice in Social Work Research Teams: One Story of Germination and Pollination
Get PDFSocial work researchers must intentionally and explicitly be anti-racist in commitments and actions if we are to disrupt, rather than simply acknowledge, racist systems and practices. This article, written by members of several research teams (including research staff, graduate research assistants, and principal investigators), describes an anti-racist team practice, which germinated in one research team and pollinated to others within a school of social work. We share our learnings and barriers, collected via an online, synchronous, anonymous platform, based on engagement in and implementation of the anti-racist research team practice. Learnings regarding the anti-racist research team practice clustered around three areas: professional individual experiences, takeaways, and ways the practice shaped our thinking about research teams. Identified takeaways included the importance of developing an anti-racist lens; a critical understanding of the role of academia in oppressive systems; transferring anti-racist content to other (non-research) areas; and augmenting our sense of responsibility to take action to combat racism. Anti-racist research team practices are one mechanism to disrupt “white logic, white methods” of normative research that is embedded in and perpetuates oppressive systems. Furthermore, sprouting anti-racist practices at the research team level can create a stronger culture of anti-racism within the social work discipline
Addressing Identity Disruption and Displacement Through a Culturally Responsive Ecological Model of Trauma Assessment
Get PDFIdentity is complex and embodies cultural, social, and place identity. These three parts of identity connect to an individual’s sense of belonging in the world. Identity disruption or identity displacement can occur when trauma happens related to one’s culture. Current methods of assessment fail to recognize the role of disruption or displacement among marginalized populations. Furthermore, current validated trauma assessments are often not generalizable to racial and ethnic minorities. The primary aim of this conceptual paper is to provide guidelines for the inclusion of identity-based factors in culturally responsive trauma assessment. The secondary aim is to discuss culturally responsive trauma assessment approaches, which include an exploration of identity disruption and displacement as a dimension of adverse experiences. A culturally responsive, ecological approach to trauma assessment is then introduced with implications for social work education, practice, policy, and research