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Intraoperative Cognitive Load Differences between Trainees and Attending Surgeons
Get PDFBackground/Objective: Cognitive load (CL) is the amount of mental effort and resources required to complete a task and process information in the working memory. In a surgical setting, high CL decreases attention to critical details, and slows down decision-making, increasing errors which can compromise patient safety. Our aim was to determine if CL differences exist between trainees and experienced attending surgeons. Such differences could inform readiness for trainee autonomy and training paradigms.
Methods: Eye trackers were used by attending general surgeons and trainees during robotic gastrointestinal procedures to determine their CL. Average fixation rate (AFR), fixation to saccade (F:S) ratio, and change in pupil size, were recorded and compared between attending surgeons and trainees to determine differences in intraoperative cognitive load.
Results: Three attendings and three trainees participated. While operating, trainees had a lower AFR (M=0.775, SD= 0.093) and a lower F:S (M=0.497, SD=0.102) compared to attendings (M=0.842, SD=0.152 and M=0.592, SD=0.243, respectively). Both trainees and attendings had a larger pupil size (M=4.29, SD=0.773 and M=3.63, SD=0.077, respectively) while operating compared to their pupil size while not operating (M=4.057, SD=0.821 and M=3.496, SD=0.059, respectively.
Conclusion and Potential Impact:In this pilot study, we determined eye tracking metrics can be used to detect differences in intraoperative CL between trainees and attending surgeons and while they were operating or observing. Further research should determine methods that decrease CL of trainees
“There’s Healing in Music”: Veteran Perceptions of Music Interventions for Their Chronic Musculoskeletal Pain
Get PDFBackground/Objective: For veterans suffering from chronic musculoskeletal pain, finding alternative treatments to analgesics is critical for safer, more effective pain management. While music interventions have shown promise for acute pain, their acceptability for chronic pain and telehealth delivery needs more rigorous examination.
Methods: The Feasibility and Acceptability of Music Imagery and Listening Interventions for Analgesia (FAMILIA) study randomized 60 veterans with chronic musculoskeletal pain to receive usual care, telehealth music listening (ML), or telehealth music imagery (MI). ML involved independent listening to songs of each participant’s choosing, while MI consisted of one-on-one music therapist-led sessions combining ML, imagery, and verbal processing. To complement quantitative analysis of patient-reported outcomes, qualitative interviews of participants were conducted to understand perceived benefits, acceptability, barriers, and facilitators of study interventions. We analyzed 15 interviews using thematic analysis to assess acceptability of the music interventions.
Results: All interviewees perceived mental-emotional benefits and almost all experienced physical pain relief during their music listening or therapy sessions. However, many noted that the pain relief was short term, and for some veterans randomized to ML, certain songs evoked negative associations. Participants also benefited from study participation and its formal structure, in contrast to their prior informal music listening experiences. Planned study activities like participant check-ins with staff and interactions with therapists fostered a deeper understanding of how music can be therapeutic and increased veterans’ confidence in their own ability to use music therapeutically. Study acceptability was further evidenced by interviewees’ intention to continue using music listening and imagery techniques after study completion and their strong support for expanding access to music interventions to other veterans.
Conclusion/Implications: The FAMILIA study not only supports telehealth music interventions as acceptable treatments for chronic musculoskeletal pain, but the reported physical pain and mental-emotional benefits necessitate a larger, fully powered study
MR1/MAIT Cell Axis Impacts Innate Immunity and Synaptic Proteins in 5XFAD Mice
Get PDFBackground:
Amyloid beta (Aβ)-induced synaptic dysfunction and inflammation are features of Alzheimer’s disease (AD). One contributor to inflammation is mucosal-associated invariant T (MAIT) cells, an innate T cell that recognizes antigens presented by the MR1 molecule. Previously, we found increased MR1 expression in microglia near plaques and the loss of MR1/MAIT cell axis slowed the progression of Aβ pathology. This study aimed to determine contributions of the MR1/MAIT cell axis to immunity and synaptic proteins in the 5XFAD AD model mouse.
Methods:
We crossed 5XFAD mice with MR1-deficient mice (which lack MR1 and MAIT cells). At 2-, 4-, 6-, and 8-months of age, hippocampal and cortical brain tissue from wild-type, MR1KO, 5XFAD, and 5XFAD/MR1KO mice were analyzed by Western blot. Protein levels were analyzed with antibodies against GFAP (astrocytes), complement C3, and postsynaptic density protein (PSD)95. Additionally, Novel Object Recognition, Open Field, and Barnes Maze behavioral tests were performed in the 5XFAD mice to measure memory deficits.
Results:
Region-specific results were obtained for the hippocampus and cortex. The expression levels of PSD95 and C3 were significantly upregulated in the hippocampus of 5XFAD/MR1KO compared to 5XFAD mice at 6-8 months of age; in the cortex, GFAP levels were also significantly increased in 5XFAD/MR1KO mice. Finally, compared to wildtype C57BL/6 mice, 5XFAD mice showed memory deficits.
Conclusions and Potential Impact:
Approximately 6.7 million Americans are living with AD. This number is expected to double by 2050. Without any currently demonstrated therapy against AD, there is a need for therapeutic target(s) as part of novel treatment paradigms. Our results demonstrate an impact of the MR1/MAIT cell axis on postsynaptic proteins and consequent AD pathology. Thus, understanding the contribution of this axis could help reveal the role of innate immunity in AD and potentially serve as a future therapeutic target in AD patients
Assessment of IL-9/IL-9R Expression and Therapeutic Effect of IL-9 Blockade in a Mouse Breast Cancer Model
Get PDFBackground and Hypothesis:IL-9 is a cytokine produced by TH9, mast cells, and innate lymphoid cells. IL-9 acts on the IL-9 receptor (IL-9R) and is primarily involved in parasitic immunity and allergic inflammation. IL-9 has anti-tumor effects in solid tumors such as melanoma. IL-9 also has pro-tumor effects in various cancer types, including lung cancer. Previous studies have shown that increased serum IL-9 in breast cancer patients correlates with tumor metastasis. Therefore, we hypothesize that IL9 signaling contributes to breast tumor metastasis and blocking IL-9 may have a therapeutic benefit in reducing metastasis.
Methods:Mice were orthotopically implanted with 4T1 breast tumor cells. Organs were harvested after 28 days. Total RNA was extracted and expression of IL-9/IL-9R and leukocyte markers were assessed. To test therapeutic effect of IL-9 blockade, tumor-bearing mice were treated with anti-IL-9 monoclonal antibody (αIL-9). Tumor sizes were monitored every 4 days. On day 28, tumor tissue was harvested and weighed. Lung was also harvested and stained with H&E for metastasis analysis.
Results:Primary tumor growth was not altered by αIL-9. The effect of αIL-9 treatment on lung metastasis is pending pathological analysis. We further examined IL-9R to define how tumor burden alters expression of IL-9 and IL-9R across tissues. Lymphoid organs, such as the thymus, spleen, and inguinal lymph node (inguinal LN), exhibit high levels of IL-9R. Additionally, the small intestine is notably enriched with IL-9R. The thymus exhibited the highest IL-9 expression.
Conclusion and Future Directions:Although blockade of IL-9 did not impact tumor growth in this model, this will be examined in other models to confirm the findings. Further research is needed to investigate the potential therapeutic benefits of αIL-9 with other established therapies. We observed that there is altered IL-9 and IL-9R expression in tumor bearing mice and the physiological significance of that finding remains to be determined
Factors Affecting Patient Reported Outcomes Following Tibial Plateau Fracture
Get PDFBackground/Objective:
Tibial Plateau Fractures (TPFs) account for ~1% of all fractures and ~8% of all fractures in the elderly. Despite the frequency and severity of TPFs there is a paucity of data evaluating factors that affect patient recovery after injury and surgical fixation. We hypothesized that patient reported outcomes are modulated by several variables including patient demographics, comorbidities, injury characteristics, and Social Determinants of Health (SDH).
Methods:
In this retrospective cohort study, we collected the interval patient reported outcome scores (PROs) of patients with TPFs treated with open reduction internal fixation occurring between February 2013 and November 2020. PROs included 1) Visual Analog Scale (VAS) pain scores, 2) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) scores, and 3) Physical Function (PF) survey scores. Patient demographics, comorbidities, fracture characteristics, insurance status, and area deprivation index (ADI) of the patient’s residence were collected via electronic medical record review. Bivariate analyses of PRO scores to the aforementioned factors were performed using generalized estimating equations to account for participant repeated measures, with p<0.05 being considered significant.
Results:
196 patients were evaluated with >1 year follow-up. It was determined that patients’ insurance status affected their VAS (p0<.001), PI (p<0.001), and PF (p<0.001) scores. Patient ADI affected VAS (p<0.001) and PI (p=0.0026), with increased ADI scores resulting in worse PROs. Diabetes and depression were found to negatively impact VAS (p=0.010 & 0.008 respectively) and PI (p=0.0044 & 0.0048, respectively). Additionally, age and sex both influence VAS (p=0.0006 & 0.0033, respectively), and compartment syndrome was associated with decreased PF (p=0.0206).
Conclusion and Potential Impact:
To our knowledge, this is the first investigation to evaluate the effect of SDH on patient recovery following surgical fixation of TPFs—suggesting that insurance status and residence ADI scores are associated with worsened PROs. Further investigation is necessary to identify if these factors are independent of other covariates. 
The Effects of Integrative Palliative Oncology on Health System Burden
Get PDFBackground: Early integration of palliative care in oncology has been shown to benefit patients on an individual level, especially regarding mood and quality of life. These patients both have a difficult disease course – where palliative care can help with interpersonal, spiritual, physical, and care planning concerns – and represent a substantial burden on inpatient facilities like intensive care units and emergency departments. This study explores relationships between early palliative oncology, patient healthcare experience, and broader burden on the health system.
Methods: A retrospective chart review was performed comparing oncology patients at Parkview Regional Medical Center in Fort Wayne, IN. Cohort A (200 patients) received palliative care along with standard oncology care while cohort B (200 patients) received standard oncology care alone. Post-diagnosis emergency department visits, inpatient stays, and intensive care unit stays were compared. So were in-hospital deaths, referrals to hospice, and record of advance care planning documents.
Results: Two endpoints evaluated by Chi2 analysis were statistically significant (p values <0.01): Cohort A was more likely than cohort B to be referred to hospice (79.5% vs 31.5%) and more likely to have advance care planning documents on file (38.5% vs 21%). Additionally, a T-test showed statistically significant difference (p=.001) for inpatient stays post-palliative care encounter versus patients who had no palliative care (1.75 vs 2.41).
Conclusion: This study shows correlation between integrated oncology care with patients filing ACP documents and being referred to hospice. Additionally, it finds that cancer patients who visit the palliative care office have fewer inpatient stays after their visit than those who don’t visit at all.
Future Implications: Future studies in this area should explore the latter finding from new perspectives, perhaps focusing on the differences between palliative care visit promptly after diagnosis/staging and palliative care implemented long after diagnosis/staging or not administered at all.  
Learning From Their Stakeholders: Social Work Students’ Perspectives on a University’s Response to the COVID-19 Pandemic
Get PDFEmerging initially in Wuhan, China in December 2019, COVID-19 steadily spread throughout and overtook the world by March 2020. College and university administrators were tasked with responding to COVID-19’s unpredictability and persistence. The purpose of this study was to learn social work students’ attitudes toward a large, public Midwestern U.S. university’s response to COVID-19 at the outset and in January 2022 during the surge of COVID-19’s Omicron strain. Using mixed methods, 43 social work students were surveyed (28 MSW and 15 BSW) in January 2022. The survey’s data suggested four important lessons for universities navigating public health responses. First, students are not oblivious to the politics and budgeting concerns that drive many university decisions. Second, pertaining to the emergence of the Omicron variant, students are extremely divided over their level of concern with contracting the virus themselves and/or infecting others. Third, colleges and universities need to have a plan of action prepared for addressing future public health emergencies and digital equity. Finally, faculty and staff from social work departments need to be “at the table” when university decisions are made because social workers will ensure that student concerns and well-being are at the core of policy decisions
MSW Student Wellness, Training Satisfaction, and Readiness to Address Substance Misuse
No full textSocial work educators aim to increase the goodness of fit between student preparation and the needs of the community. Because working with individuals with substance use disorders (SUD) can be emotionally challenging, training MSW students to do this well does require not only development of skills and knowledge but also a capacity to maintain personal wellness. The purpose of this study is to better understand how wellness strategies affect MSW students’ preparation. This study examined two strategies to maintain wellness used by MSW students, pro-active stress management and classmate support network, and their relationship to training satisfaction and student readiness to assist clients struggling with substance use. Thirty-three MSW students in the final month of their degrees completed program evaluation surveys in Spring and Summer 2020. We conducted linear regressions to assess how proactive stress management and classmate support network contributed to student satisfaction and practice readiness. While both proactive stress management and supportive classmate networks were significantly predictive of training satisfaction, only pro-active stress management also predicted several measures of student readiness to address substance misuse. Findings highlight the importance of student wellness in preparing students for practice, particularly the value of fostering student capacity for proactive stress management
