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Unveiling the influence of hyponatremia on morbidity, mortality, and resource utilization in colorectal carcinoma: Insights from a 5-year nationwide study.
Get PDFMeeting Abstract: 2024 ASCO Annual Meeting
Background: Historically, Hyponatremia has been associated with higher mortality rates and longer hospital stays in patients with solid tumors. The existing literature contains limited information on the connection between hyponatremia and Colorectal cancer (CRC). Thus, our study aimed to assess the impact of hyponatremia on mortality, morbidity, and resource usage in patients with CRC.
Methods: A retrospective analysis using the National Inpatient Sample database and International Classification of Diseases, Tenth Revision codes was conducted to examine the impact of hyponatremia on mortality, morbidity, and resource utilization in patients with CRC. Categorical variables were compared using chi-square tests, while continuous variables were compared using t-tests. Multivariable regression analyses were performed, adjusting for demographics, hospital-level characteristics, and relevant comorbidities. Confounding variables were adjusted using multivariate logistic and linear regression analyses. These included gender, race, Charlson Comorbidity Index, chronic kidney disease, congestive heart failure, cirrhosis, nephrotic syndrome, hypothyroidism, adrenal insufficiency, alcohol use disorder, and admission for hypovolemia or psychogenic polydipsia and various patient and hospital characteristics.
Results: A total of 337,190 patients with a primary diagnosis of colon cancer were included in the study, of which 12.6% (3,369) presented with hyponatremia (Table 1). The in-hospital mortality rate was 7.8% for patients with hyponatremia, compared to 4.1% for patients without hyponatremia. After adjusting for confounding factors, hyponatremia was found to significantly increase the odds of mortality (adjusted odds ratio [aOR] for mortality 1.85, 95% confidence interval [CI]: 1.68–2.03, P \u3c 0.01). Patients with colon cancer and hyponatremia also had higher odds of developing sepsis (OR = 2.60), acute kidney injury (OR = 2.63), peritonitis (OR = 2.25), and ICU admission (OR = 2.12) (Table 1). Additionally, hyponatremia was associated with increased resource utilization, as evidenced by a longer mean length of stay and higher mean total hospital charges.
Conclusions: This retrospective analysis demonstrated that hyponatremia significantly increases mortality, morbidity, and resource utilization in individuals with CRC. Patients with colorectal cancer and hyponatremia have substantially higher mortality rates, underscoring the importance of monitoring sodium levels and implementing appropriate interventions to prevent and manage this electrolyte imbalance. The high incidence rates of sepsis, acute kidney injury, and peritonitis, along with frequent ICU admissions, provide further evidence of the negative impact of hyponatremia on patient outcomes
Intravascular Ultrasound in Percutaneous Coronary Interventions: A Nationwide Overview of its Use and Outcomes
Get PDFBackground Intravascular ultrasound (IVUS) is a valuable adjunct to angiography, aiding interventionists in evaluating lesion severity, plaque morphology, stent apposition, stent expansion, and edge dissection. IVUS-guided PCI may increase procedure time but can lead to increased stent patency rates. This study aims to provide insights into the comparative outcomes of IVUS and non-IVUS-guided PCI in real-world clinical settings. Methods We compared outcome measures with the 2020 United States National Inpatient Sample in patients who received IVUS-guided PCI and those who did not. The primary outcome was the mortality rate between the two groups. Results IVUS was used in 10,757 of the 86,844 patients (12.4%) with a PCI. The mean age was similar in those with IVUS-guided PCI and those without (65.5 years vs. 65.6 years, p = 0.58). The mean length of stay was slightly higher in the IVUS group than in the non-IVUS group (4.3 vs. 3.9 days, p\u3c0.001). IVUS was more likely to be used in urban teaching hospitals at 12.9% than in rural hospitals at 10%, p\u3c0.001. IVUS was most used in the West and Northeast regions of the United States at 17.8% and 17.2%, respectively, and less in the Midwest at 13.1% and South at 9.5%, p\u3c0.001. IVUS was more likely to be used in large-sized hospitals at 14.1% compared to medium-sized hospitals at 10.6% and small-sized hospitals at 10.1%, p\u3c0.001. IVUS was used less in patients who had an ST elevated myocardial infarction (STEMI) than those who did not, 10.7% vs. 13%, p\u3c0.001. In the multivariate analysis, IVUS use was associated with decreased inpatient mortality (OR 0.86, 95% CI 0.76-0.97, p = 0.015), even after adjusting for baseline characteristics. Conclusions IVUS was used less during a STEMI and was associated with a decreased inpatient mortality. IVUS guided-PCI is highest in large and urban-sized hospitals and hospitals in the West and Northeast regions of the United States
Association Between Psychosocial Acuity and Glycemic Control in a Pediatric Type 1 Diabetes Clinic.
Get PDFPURPOSE: The purpose of this study was to describe the frequency of psychosocial risk and its associations with glycemic levels in youth with type 1 diabetes (T1D) seen by social work staff during regular clinical care.
METHODS: A retrospective longitudinal analysis of observational clinical data was conducted. Individuals (1-26 years) with known T1D who were seen at a pediatric diabetes clinic in a US academic medical center between 2014 and 2021 were included. Variables included psychosocial acuity, A1C, and demographic characteristics. Chi-square tests, Wilcoxon rank sum tests, and mixed linear regressions were used to examine associations between demographic variables, psychosocial acuity, and A1C.
RESULTS: Of 966 patients, 513 (53.1%) were male, 76 (7.9%) were non-Hispanic Black, and 804 (83.2%) were non-Hispanic White. There was a mean of 6.9 annual social work encounters per patient, with 3 psychosocial domains measured at each visit. Results showed that as psychosocial acuity level increased, glycemic control decreased. There were significant differences in A1C according to race/ethnicity, insurance, age, and psychosocial acuity.
CONCLUSIONS: In a real-world clinical population, psychosocial acuity was associated with glycemic control. Presenting for psychosocial issues in their diabetes clinic was associated with reduced glycemic control among youth with T1D. There is an opportunity to connect pediatric patients with appropriate mental health services and psychosocial supports
Daily smartphone use predicts parent depressive symptoms, but parents\u27 perceptions of responsiveness to their child moderate this effect.
Get PDFINTRODUCTION: Smartphone use during caregiving has become increasingly common, especially around infants and very young children, and this use around young children has been linked with lower quality and quantity of parent-child interaction, with potential implications for child behavior, and parent-child attachment. To understand drivers and consequences of parent phone use, we were interested in the daily associations between parent phone use and depressed mood, as well as the potential for parent perceptions of their responsiveness toward their infant to alter the association between parent phone use and mood.
METHODS: In the present study, we explored associations between day-to-day changes in parent smartphone use (objectively-measured via passive sensing) around their infant, depressed mood, and parent perceptions of their responsiveness to their infants among a sample of 264 parents across eight days. We utilized multilevel modeling to examine these within-person daily associations.
RESULTS: Objectively-measured parent smartphone use during time around their infant was significantly associated with depressed mood on a daily basis. Interestingly, this was not true on days when parents perceived themselves to be more responsive to their infant.
DISCUSSION: These results suggest that parent judgements and perceptions of their parenting behavior may impact the potential link between parent phone use and parent mood. This is the first study utilizing intensive daily data to examine how parent perceptions may alter the felt effects of phone use on their parenting. Future work examining potential impacts of smartphone use on parenting should consider the effects of both actual use and perceptions about that use
Evaluation of cardiometabolic monitoring in patients taking antipsychotic agents within a community health system.
Get PDFPresented at the ASHP Midyear Clinical Meeting. New Orleans, LA
This evaluation found that the majority of patients on antipsychotic agents do not have all baseline monitoring completed, and that there are significant gaps especially in lipid panel and hemoglobin A1c. Other parameters (e.g., blood pressure, weight) were more likely to be gathered, likely as part of routine visit procedure
Curriculum Vitae of Thein Zhu
Get PDFCurriculum Vitae of Thein Zhu
1999- To Date in Fort Wayne, Indiana, USA (Past career for 1963-1998 period in Myanmar (Burma) is also attached)
Thein Hlaing Zhu (as Thein Hlaing before 2009)
Occupation :Trauma Epidemiologis
Shock and Awe: An Angiotensin II Clinical Outcomes Assessment.
Get PDFPresented at the Great Lakes Pharmacy Residents Conference. West Lafayette, IN: April 2024.
In this retrospective cohort study, angiotensin II was not found to have a benefit on morbidity and mortality compared to placebo. However, further prospective, randomized controlled trials are needed to identify patient subgroups who might benefit
Enhancing Nurse Confidence and Efficiency in Chest Tube Management: Implementation of a Structured Troubleshooting Checklist
Get PDFPresented at the 2024 Nursing Research Symposium
Background: Chest tube management is critical in pulmonary care, yet challenges arise with unexpected events such as air leaks, dislodgement, failed clamping trials, and tubing disconnections. Concerns raised by the Pulmonology team highlighted nurses\u27 uncertainties and the frequent need for guidance during these events. This prompted the development of a troubleshooting checklist aimed at providing clear, step-by-step instructions for managing these scenarios. By following structured checklists, nurses can reduce the risk of errors, ensure adherence to best practices, and enhance patient safety. Objectives/Purpose: The primary aim of this quality improvement project was to enhance nurses\u27 confidence in managing chest tube complications through the implementation of a structured troubleshooting checklist. Specifically, the project aimed to assess baseline confidence levels, implement targeted training and checklist utilization, and evaluate post-intervention improvements in confidence and reduction in reliance on immediate clinical support. Methods: Nurse leads from units 6 Medical, 6 South, and 7 Medical participated in initial training sessions focused on the troubleshooting checklist. Following this, training was integrated into the curriculum of acute care professional development days, ensuring broad implementation across relevant nursing staff for all acute care nurses. Pre- and post-training surveys were distributed initially to the nurse leads on 6 Medical, 6 South and 7 Medical and a post survey following professional development days for all acute care nurses at PRMC. Results: Analysis of survey data revealed a significant increase in nurses\u27 confidence levels post-training and checklist implementation. Prior to training, only 61% of nurse leads felt confident in managing chest tube complications, compared to 100% post-training. Following the implementation of the checklist training at acute care professional development days, 99% of nurses reported an increase in confidence in caring for a chest tube patient. There was a notable decrease in the frequency of calls to Pulmonology or managing providers regarding chest tube issues, indicating improved autonomy and proficiency among nursing staff. Conclusion: The implementation of a structured chest tube troubleshooting checklist effectively enhanced nurses\u27 confidence in managing unexpected events. This project demonstrates the importance of targeted training and standardized tools in improving clinical outcomes and reducing reliance on immediate clinical support
Maternal depression and phone use around their children: A phone tracking and daily survey study
Get PDFPrevious research has connected phone use with mood and depressive symptoms but has typically relied on self-report measures of phone use. The current study examined the potential connection between objectively tracked phone use and self-reported depressive symptoms among 42 U.S. mothers with a young child (M age = 2.34 years). Their phone use was measured continuously for 5 days via an app installed on their smartphones, and mothers also completed a nightly survey each day. Mothers spent an average of 4.73 hours on their phone each day (SD = 2.87; Range = 0.70 - 13.59), and maternal phone use occurred on average during 26% of their time around their child (Range = 0% - 82%). Multilevel modeling revealed that greater daily phone use around their child was linked with greater daily depressive symptoms (b = 0.61, p = .02). Our results suggest that how much mothers use their phone around their child, not just perceptions of use, is tied to daily depressive symptoms. Intervention efforts with mothers would likely benefit from understanding and remembering how intricately tied mood and phone use may be. Mothers may also need assistance in recognizing this link in their daily lives
Development and Assessment of a Rubric for Evaluating Teaching Portfolios Developed by Teaching and Learning Curriculum (TLC) Program Participants.
No full textOBJECTIVE: To describe the validation and reliability assessment of a rubric designed to assess the participants\u27 teaching portfolios and identify teaching excellence among teaching and learning curriculum (TLC) program participants.
METHODS: Following focus groups with program leadership at a single TLC program, an initial rubric was developed, consisting of criteria mapped to 5 domains, to be rated on a 4-point scale. The rubric was then redistributed to the TLC program leadership and external stakeholders for evaluation of face and content validity. The rubric was piloted using teaching portfolios from 3 cycles of the program. Cronbach αwas used to measure internal consistency and a 2-way random-effects model was used to assess the inter-rater reliability.
RESULTS: A total of 18 portfolios were independently evaluated by 4 raters. The overall mean Cronbach α for internal consistency was 0.90 and ranged from 0.65 to 0.84 by domain. The overall mean intraclass correlation coefficient for inter-rater reliability was 0.95 and ranged from 0.57 to 0.91 by domain.
CONCLUSION: The rubric evaluates characteristics of teaching portfolios important to internal and external stakeholders and had good to excellent internal consistency and inter-rater reliability. It can be adapted and applied by TLC programs to identify teaching excellence