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Authors: |
Kaur P; Liaqat A; Tariq F; Emmanuel Tangco; Elferjani B; Chang Park; Johnson K. |
| Background: |
Obstructive sleep apnea (OSA) is one of the serious risk factors implicated in worsening clinical outcomes for patients with congestive heart failure (CHF). The aim of this study is to evaluate the effects of OSA on the hospitalization outcomes of patients admitted with Acute CHF exacerbation. |
| Design: |
In this retrospective cohort study, we included patients with a primary diagnosis of CHF exacerbation, who were admitted at our institution from January 2021 to March 2022. We divided the patients into two groups, Group 1 included patients who had underlying OSA (CHF-OSA), and Group 2 included patients without underlying diagnosis of OSA (CHF-only group). The primary outcome for this study was 28-day in-hospital mortality. Secondary outcome was overall length of hospital stay. |
| Results: |
A total of 146 patients were identified, out of which 64 patients were found to have underlying OSA (CHF-OSA) group and 82 patients were included in CHF-only group. The mean age of patients in CHF-OSA group was 71 vs. 72 years in CHF-only group. Predominant sex involved in both groups were males, 55% in CHF-OSA group, versus 57% in CHF-only group. Among races, white race was noted to have highest presence (64% in CHF-OSA group, and 61% in CHF-only group). Patients in CHF-OSA group had a 28-day mortality of 16% versus 15% in CHF-only group, P > 0.05. Lastly, the mean length of stay (LOS) was longer in CHF-OSA patients, 7 days versus 6 days in CHF-only group. |
| Conclusion: | Presence of underlying OSA was associated with increased 28-day in- hospital mortality and prolonged length of stay among patients with CHF. However, our results were not statistically significant. We believe further research is required to risk stratify hospitalized patients and mitigate adverse outcomes in such patient population. |
| Authors: |
Nathan Jacobsen, OMS-II, Lindsey Chapman, OMS-II, Abeer Fatima, OMS-II, John Michael McAllister, OMS-II, Connie Morizio, M.S., OMS-II, Parth Patel, OMS-II, Sanjana RasamseL, OMS-II, Samiha Sayed, OMS-II, Pamela Miles, M.S., Starla Meighan, PhD |
| Abstract: |
The NeurOptimal Neurofeedback System (NOS) is a nonlinear neurofeedback device designed to optimize user brain function based on self-identified behavioral goals. During sessions, the NOS uses scalp electrode data to generate auditory cues that prompt the user to recenter behavioral focus which increases functional cohesiveness of the brain. Evidence suggests training sessions can provide benefits in many areas of the user’s life including but not limited to stress management, sleep habits, productivity, and self-esteem. The purpose of this study was to conduct a preliminary evaluation of users’ perceptions of the effectiveness of NOS. Forty subjects with no previous exposure to neurofeedback were given background information on NOS and were invited to participate in the study. Prior to each session, the user was asked to rate on a scale of 0 to 5 their perceived stress, productivity, and sleep quality since their previous session. A total of 11 subjects completed 2 or more sessions and were included in the statistical analysis to assess improvement over multiple sessions. Looking specifically at stress, productivity, and improved sleep, the results indicated an improvement in sleep and stress from baseline, with varying effects on productivity. These data were preliminary and show the potential that NOS has for improving users’ quality of life. A larger sample size, with subjects undergoing a greater number of training sessions, would be needed to increase the power of the statistical analysis for some parameters. |
| Authors: |
Mary Olivia Smith OMS-II, Shelby Barron MSHS OMS-II, Amy Chiou JD OMS-II, Matthew D. Schriefer OMS-II, W. Reid Norman OMS-II, R. Wayne Parker PharmD, Rahul Garg PhD |
| Background: |
Opioids are often prescribed to patients with COPD for musculoskeletal pain, insomnia, and refractory dyspnea despite national standards cautioning against high doses of opioids to this patient population. This project documents the prevalence of patients who unintentionally overdosed on opioids with concomitant COPD in Southeast Health (SEH) ED in FY2012-2022. |
| Design: | This was a retrospective study utilizing EMRs from SEH in FY2012-2022. Patients who received Naloxone in the ED and were diagnosed with having an unintentional opioid overdose were identified and comorbidities were examined using ICD-9 and ICD-10 codes. Patients identified as overdosing with the intent of self-harm were excluded from the data search. |
| Results: |
A chi-square analysis comparing COPD and unintentional overdose yielded a value of 10.89, p-value of .00096. An odds ratio analysis comparing the odds that a patient with COPD would overdose yielded a value of 1.605, indicating that patients with COPD are 60% more likely to have an unintentional overdose when compared to patients who are not diagnosed with COPD. Patients with COPD consistently presented with an unintentional opioid overdose more often than patients without. |
| Conclusion: | The results show that patients with COPD are more likely to present with unintentional opioid overdose than patients without COPD, giving keen insight into the distinct challenges of providers managing patients with COPD who require opioids. It is vital to emphasize diligent supervision and enhanced medication management for COPD patients to mitigate risks associated with opioids and to recognize the unique vulnerabilities facing this population. |
| Authors: |
Mary L. Fabbrini, OMS-II, Rebecca N. Suk, M.S., OMS-II, Susana Giraldo, M.S. OMS-II, Andrew D. Vogel, M.S., OMS-III |
| Background: |
Partial Heart Transplantation (PHT) is a promising procedure in the field of congenital cardiac surgery. Our study aimed to determine medical students' awareness of PHT, assess their attitudes, and evaluate their willingness to support patients receiving this procedure. |
| Design: |
Active medical students at a US osteopathic institution were invited to complete an original online survey. Baseline demographics, years of medical experience, awareness and attitudes towards PHT were captured. Awareness and attitudes were measured using a Likert scale. Statistical comparisons in ranked responses between survey questions and student demographics were calculated using Two-Way ANOVA. Differences in statistical means for survey questions were assessed by a Kruskal-Wallis test. |
| Results: |
Our survey included 95 responses from medical students (12.1%). Prior to survey distribution, 20% of respondents were aware of PHT. Students are more interested in learning about PHT in comparison to them recommending the procedure to a future patient (4.24 vs. 3.73, p = 0.001) and in comparison to their confidence in knowledge regarding organ transplantation (4.24 vs. 2.42, p = <0.001). Furthermore, students that have prior knowledge of PHT are more willing to recommend/perform PHT in the future as well as believe PHT should be utilized more in practice (p = 0.05). |
| Conclusion: |
Students are interested in learning more about PHT, but there is a knowledge gap in their understanding of organ transplantation. By introducing PHT to physicians early in their career, they may be more likely to recommend/perform the procedure in the future as they increase their knowledge base. |
| Authors: | Rebecca N. Suk, M.S., OMS-II, Mary L. Fabbrini, OMS-II, Rahul Garg, PhD, M. Pharm, Andrew D. Vogel, M.S., OMS-III |
| Background: |
Partial Heart Transplantation (PHT) is a new investigative procedure under clinical trials for neonatal patients. Our study assessed the awareness, attitudes, and perceptions of congenital heart surgeons. |
| Design: |
A novel online survey was conducted among members of the Congenital Heart Surgical Society and chief pediatric cardiologists. The survey measured their knowledge, perceptions, and attitudes regarding the use of PHT in various age groups. Perceptions and attitudes were measured using a Likert scale. Differences in mean responses for the perception and attitudes of PHT as well as utilization in various patient age groups were calculated using a Kruskal-Wallis test. |
| Results: |
Our survey included 22 responses from congenital cardiac surgeons with 54.55% respondentspracticing for 20 years or more. Almost all participants have heard about (95.45%) PHT. While these surgeons understand the concepts of PHT, they are less likely to recommend or inform their patients about the procedure if they meet the criteria (4.68 vs. 3.14, p=0.01). Perceptions regarding the use of PHT for different patient age groups developed significant differences (p<0.001). More surgeons believed that PHT is appropriate for neonates (3.08), infants (2.75) and children (2.41) compared to adults (1.84). |
| Conclusions: |
As PHT is an investigative procedure, it is essential to determine its acceptance in the field of congenital cardiology. Surgeons are becoming more knowledgeable of the procedure and its concepts; however, there is a gap between knowledge and their willingness to recommend, utilize, or perform PHT. Further research must be dedicated to investigating this new procedure. |
| Authors: | Susana Giraldo, OMS-II, Andrew D. Vogel, OMS-III, Zachary T. Silvano, OMS-III, Tyler J. Wallen, D.O. |
| Background: |
Cerebral oximetry, employing near-infrared spectroscopy (NIRS), tracks brain oxygen levels. Intraoperative NIRS can identify reduced blood flow, a precursor to postoperative cognitive decline (POCD) and stroke. Recent research has created algorithms for intervention guidance to prevent POCD and stroke. Our systematic review evaluates the effectiveness of algorithm-based interventions in the perioperative phase to prevent POCD and stroke. |
| Design: |
Inclusion criteria required an article to (a) be original research (b) relate to cardiothoracic surgical procedures; (c) include algorithm-based approaches in near-infrared spectroscopy monitoring; (d) focus on coronary artery bypass grafting or valve repair procedures; (e) employ neurocognitive monitoring intraoperatively; (f) be in English; and (f) be published between January 2013 and July 2023. Embase® was searched using key words and filters. Rayyan®, a systematic review research tool, was utilized to assess articles in a blinded two-person review process. A blinded third researcher resolved conflicts. |
| Results: |
A total of 249 articles were compiled; 229 articles did not meet inclusion criteria, and 20 articles were retrieved after an abstract review. Ultimately, six articles were included after a full-text review. These articles defined an algorithm-based approach to patients experiencing desaturations during cardiac surgery. Most institutions developed an algorithm that intervened during a desaturation of 10%-20%. Interventions significantly reduced further decrease in rSO2, and the time patients spent desaturated. |
| Conclusions: | These interventions may protect neurocognitive function in patients. A further systematic review through MEDLINE is warranted. Further research including a meta-analysis is needed to determine the effect of NIRS monitoring during cardiac surgery. |
| Authors: | Lea V. Oliveros OMS-I, Jerry M. Brown, Abigail L. Fabbrini, Andrew A. Farrar, Luke Lamos, Jared Florio, Jesse Beacker, Jessica V. Baran, Michael J. Wilsey MD |
| Background: | Cow's milk protein allergy (CMPA) affects 2-3% of infants and is treated with hypoallergenic formulas. The 2022 recall of infant formulas due to issues like bacterial contamination led to shortages, challenging clinicians managing CMPA. Understanding healthcare providers' (HCPs) decision-making in transitioning to alternative formulas is crucial. This study aimed to investigate factors influencing formula changes during shortages, with a focus on safety and availability. |
| Design: | This cross-sectional analysis used de-identified survey data from experienced HCPs specializing in pediatrics, gastroenterology, or allergy/immunology. They treated infants aged 0-24 months with CMPA who switched to Formula 1 during the 2022 shortage. Statistical methods, including chi-square tests and logistic regression, were employed, and the study was IRB-exempt. |
| Results: | The analysis included 104 HCPs (86 general pediatrics, 17 pediatric allergy/immunology, and 1 pediatric gastroenterologist). Safety, tolerability, and efficacy in relieving CMPA symptoms were the top factors for 84%, 70%, and 73% of HCPs when choosing an alternative extensively hydrolyzed formula. Formula 1 was well-tolerated and accepted by all infants and deemed safe by all HCPs. Additionally, 80% believed in Formula 1's exceptional safety, and 99% thought it effectively relieved CMPA symptoms and was readily available. |
| Conclusion: | This study revealed critical factors guiding HCPs when managing CMPA during the 2022 formula shortage, with a focus on safety and availability. The findings can assist HCPs in making appropriate formula choices during shortages and enhance overall CMPA management. |
| Authors: | Rebecca Suk, OMS-II, Jesse York, MS-III, James O’Toole, MS-IV, Andrea Makowski, MS-III, Alyssa Woodward, MS-IV, Roman Petrov, MD, PhD, MBA, Charles Bakhos, MD, MS, MBA, Doraid Jarrar, MD, MHCI, Sai Yendamuri, MD, MBA |
| Background: | To investigate the relationship between psychiatric illness and long-term survival following lobectomy for early-stage non-small cell lung cancer (NSCLC). An understanding of this relationship will help identify opportunities to optimize post-surgical care for NSCLC patients with comorbid mental illness. |
| Design: | This is a retrospective, cohort, population-based study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database of patients with pre-existing diagnosis of psychiatric comorbidity (PC) as identified by ICD-9/10 codes. Patients who underwent lobectomy for stage I NSCLC diagnosed in 2007–2013 were included. Those older than 80 years, with multiple cancers, or histology other than adenocarcinoma or squamous cell carcinoma were excluded. Survival of patients with PC was compared to controls using univariable and multivariable analysis adjusting for age, sex, race, stage (IA/IB), histology, and Charlson Comorbidity Index. |
| Results: | Of 5,516 patients, 1,369 (24.8%) had PC. Patients with PC were more likely to be younger (P < 0.001), female (P < 0.001), Caucasian (P < 0.001), and have stage-IA cancer (P < 0.001). PC was associated with shorter survival (median 2,478 vs. 2,820 days; P = 0.002). Multivariable analysis retained PC in the final model, with hazard ratio 1.1 (P < 0.001). Sub-group analysis revealed that this was driven by differences in survival of patients with schizophrenia (P < 0.001) and alcohol use disorder (P = 0.006). |
| Conclusions: | PC are associated with reduced survival after lobectomy for early-stage NSCLC. Further investigations are warranted to better clarify the relationship and to optimize the care of this patient population. |
| Authors: | Ji Won Li MS-2, Ruchi Patel MS-3, Joshua B. Palma MS-2, Arash Nikjoo MS-2, Christine N Song MS-2, Fatima Vandi MSc, Charles B. Cairns MD, Edward S. Schulman MD |
| Background: | Peripheral blood eosinophil count (PBEC) variability as a biomarker for asthma hospitalization risk has recently been demonstrated (Toledo-Pons et al., 2022). The reasons for such variability are poorly understood. We investigated whether select comorbidities might serve as markers for and underscore PBEC variability in asthma patients. |
| Design: | We conducted a retrospective review of inner-city patients (n=154; 11% Caucasian, 81.1% African-American, 7.1% Latinx, 0.6% other; 87.6% female) seen at the Drexel Severe Asthma Clinic (IRB ID: 1803006182). Information collected included demographics, annual PBECs over 10 years, immunoglobulin E (IgE) levels, and comorbid conditions: COPD, OSA, GERD under active treatment (GERD-UAT), allergic rhinitis, atopic dermatitis, and HIV. PBECs were excluded when drawn within four weeks of an exacerbation that required systemic steroids. We modeled within-patient variation of PBECs with IgE levels and comorbidities as covariates using a Generalized Additive Model for Location, Scale, and Shape (GAMLSS). |
| Results: | Increasing IgE levels tracked significantly with increasing PBEC variability (p=0.04). We further identified that female sex was associated with higher PBEC variability than male sex (p=0.03), and GERD-UAT reduced PBEC variability (p<0.0001). COPD, OSA, allergic rhinitis, atopic dermatitis, and HIV diagnosis had no significant impact on PBEC variability. |
| Conclusions: | We show PBEC variability, an asthma hospitalization risk, is significantly associated with high IgE levels and female sex, and negatively associated with GERD-UAT. Other examined comorbid conditions had no significant effect on PBEC variability. To our knowledge, this 10-year study of PBEC variability is the most comprehensive study over a timespan conducted to date. |