Background: Since the implementation of social distancing practices during the global coronavirus disease 2019 (COVID-19) pandemic there have been a myriad of definitions for ‘social distancing.’ The ...objective of this study was to determine students’ awareness of the various definitions of social distancing, how strictly they adhered to social distancing guidelines, and how they perceived the importance of various social distancing practices.
Methods: This cross-sectional survey was distributed via email to students at Emory-affiliated graduate schools, including the Medical, Nursing, and Public Health Schools.
Results: Of the 2,453 recipients of the survey, 415 students responded (16.9% response rate). The majority of respondents were medical students (n=225, 55.6%). Of the respondents, 357 noted that they “frequently” or “always” abided by social distancing. The most common definition of social distancing with which respondents were familiar was the Centers for Disease Control and Prevention (CDC)’s (n=276 of 369 responses, 74.8%). There were significant differences across groups when grouping students by the definition of social distancing that they were aware of, the social distancing guideline they most closely followed, and their school of attendance regarding the importance of specific social distancing examples (p<0.05 for each).
Conclusions: A survey of healthcare students identified differences in the importance of social distancing practices based on the definition of social distancing that they were aware of. The results of this study underscore the importance of having unified definitions of public health messaging, which ultimately may impact disease spread.
This report describes the case of a previously healthy 30-year-old woman who presented with uncontrolled hypertension and renal failure. This case emphasizes the importance of considering renal ...artery disease. The differential diagnosis for renal artery stenosis is discussed, and the diagnosis and management of Takayasu's arteritis in this patient are highlighted. (Level of Difficulty: Beginner.)
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This report describes the case of a previously healthy 30-year-old woman who presented with uncontrolled hypertension and renal failure. This case emphasizes…
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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Background:
Late gadolinium enhancement (LGE) on cardiac MRI (CMR) correlates with fibrosis and arrhythmic risk, but cannot be used in several clinical settings compared the ...availability of echocardiography (TTE).
Aim:
To develop and evaluate a machine learning (ML) model that uses standard clinical and echocardiography (TTE) variables to identify LGE on paired CMR.
Methods:
Amongst 725 patients (mean age 56.9 ± 16.5 years, 40.3% female) with TTE and CMR within 3 months at our institution, 2018-2023, we derived and tested several ML models (recursive partitioning, random forest, boosted tree, neural networks, LASSO/Elastic Net) to identify LGE on CMR using age and 24 TTE features. Ten-fold cross validation was used for internal validation.
Results:
A total of 165 (23%) had the presence of LGE (40% ischemic, 60% nonischemic pattern). Of tested models, a boosted neural network performed best (validation area under the curve AUC = 0.98;
Figure
). In the validation cohort, the algorithm had a sensitivity and specificity of 93.8% and 94.6% for identifying presence of LGE. Accuracy remained high regardless of gender (M vs. F, AUC, 0.987 vs. 0.988) or race (blacks vs. whites, AUC, 0.987 vs. 0.984) and was not related to time between studies (r = -0.06, p = 0.09). Accuracy was better for ischemic LGE (AUC = 0.94) than nonischemic LGE (AUC = 0.90). Left ventricular size, age, fractional shortening, and wall thickness, were amongst the top predictors of LGE presence in the model.
Conclusions:
In this single center study, a boosted neural network using TTE features identified LGE on paired CMR with high sensitivity and specificity. If confirmed in external data, this suggests possible utility of ML for improving the diagnostic value of TTE for LGE assessment.
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Background:
In observational studies, older adults with insufficient or deficient serum vitamin D levels are at higher risk of cardiovascular disease (CVD), but randomized trials have ...failed to demonstrate reduction in CVD risk from vitamin D supplementation. This is possibly because the doses of vitamin D supplements tested were too low.
Objective:
To determine if higher doses of vitamin D supplementation lower high sensitivity cardiac troponin level (hs-cTnI) and N-terminal pro b-type natriuretic peptide (NT-proBNP), markers of subclinical CVD.
Methods:
The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a double-blind, randomized, response-adaptive trial that tested the effects of 4 doses of vitamin D3 supplementation (200, 1000, 2000, and 4000 IU/day) on fall risk in adults aged ≥70 years old with low serum 25-hydroxyvitamin D levels (10-29 ng/ml). Hs-cTnI and NT-proBNP levels were measured at baseline and at 3-, 12- and 24-month follow-up visits. For analysis, participants were divided into low (200 IU/day) and high dose (1000+ IU/day) vitamin D treatment groups. The effects of vitamin D dose on hs-cTnI and NT-proBNP were assessed via mixed effects tobit models.
Results:
Among 688 participants (mean age of 77 ± 5 years, 44% were women, and 18% were Black), 50.7% were in the high-dose treatment group (1000+ IU/day). Hs-cTnI increased in both the low and high dose groups by 5.1% and 5.8%, respectively; likewise, NT-proBNP increased in both groups by 11.3% and 9.3%, respectively (
Figure).
Compared to the low-dose group, high-dose vitamin D treatment did not affect hs-cTnI (1.7 % difference; 95% CI: -5.3, 9.3) or NT-proBNP (-1.8 % difference; 95% CI: -9.3, 6.3).
Conclusions:
Compared to low dose vitamin D supplementation, a higher dose did not affect markers of subclinical CVD in older adults with low serum vitamin D levels. These findings do not support higher doses of vitamin D as an intervention to reduce the risk of CVD in this population.
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Introduction:
Leading hospital code teams is stressful for resident physicians, and variability in training and experience may result in inconsistent care and outcomes. Nearly all ...bedside aids like AHA advanced cardiovascular life support (ACLS) pocket cards and third-party ACLS mobile apps lack step-by-step guidance or reminders. Our team designed a guided ACLS mobile app to help trainees lead more effective hospital resuscitations and conducted a randomized controlled trial to assess user experience and performance according to 2020 AHA ACLS guidelines.
Hypothesis:
A guided ACLS app will improve subjective user experience and adherence to AHA ACLS guidelines.
Methods:
The ACLS mobile app was developed using Swift UIKit. Internal Medicine, Emergency Medicine, Surgery, and Anesthesia residents (N = 46) were randomized to lead a simulated code for cardiac arrest due to massive pulmonary embolism using either AHA pockets cards (N = 22) or the ACLS app (N = 24). User experience was assessed via surveys. Code outcomes, guideline adherence, and errors were analyzed from video recordings. A focus group of 22 residents provided feedback. Statistical analysis was conducted using R software and included two-sided t-tests and Fisher exact tests.
Results:
App users showed significantly increased confidence (1.0 vs 0.3; p = 0.005), backboard use (96% vs 27%; p <0.001), end-tidal CO2 monitoring (58% vs 27%; p = 0.042), correct thrombolytic administration (54% vs 23%; p = 0.035), and achieving return of spontaneous circulation (50% vs 18%; p = 0.032) compared to controls. Focus group results showed that 100% of the participants would use the app and that 82% preferred the guided app to AHA pocket cards.
Conclusions:
The guided app improves user confidence and adherence to AHA ACLS guidelines and addresses the need for greater standardization in hospital code management. Validation studies are necessary to confirm its effectiveness in clinical practice.
We aim to compare in-hospital and 30-day outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) for native aortic insufficiency (AI).
TAVR is ...increasingly used off-label in patients with AI deemed high risk for SAVR. There is a paucity of data comparing TAVR and SAVR with current commercially available TAVR devices.
A single-center, retrospective cohort study of patients undergoing TAVR or SAVR for native AI between 2014 and 2020 was performed. Data were obtained from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database, Transcatheter Valve Therapy (TVT) registry, and chart review. In-hospital and 30-day outcomes are reported.
Of 125 total patients, 91 underwent SAVR and 34 underwent TAVR. The TAVR group had a higher STS predictive risk of mortality (PROM) (TAVR = 3.96 %, SAVR = 1.25 %, p < 0.0001). In the postoperative period, the SAVR group had higher rates of new-onset atrial fibrillation (20.9 % vs. 0 %, p < 0.001), while the TAVR group had higher rates of complete heart block requiring permanent pacemaker implantation (20.6 % vs. 2.2 %, p < 0.001). There was no difference in in-hospital or 30-day mortality, stroke, myocardial infarction, residual AI, or repeat valve intervention.
Despite higher STS PROM and more comorbidities, patients who underwent TAVR for AI had similar in-hospital and 30-day outcomes as patients who underwent SAVR for AI. These results support TAVR in selected high-risk patients with AI, with the knowledge that pacemaker needs may be higher than patients undergoing SAVR.
Pertinent findings when comparing patients with native aortic valve insufficiency who underwent either surgical aortic valve replacement or transcatheter aortic valve replacement. Abbreviations: AVR, Aortic Valve Replacement; MI, Myocardial Infarction; SAVR, Surgical Aortic Valve Replacement; STS, Society of Thoracic Surgeons Predicted Risk of Mortality; TAVR, Transcatheter Aortic Valve Replacement. Display omitted
•TAVR for AI has similar peri-procedural survival and valve performance compared to SAVR.•Post-operative atrial fibrillation is higher in SAVR cohorts balanced by higher pacemaker implantation rates in TAVR cohorts.•TAVR should be considered for native AI in high risk surgical patients who do not qualify for dedicated AI device trials.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Radiation exposure during invasive cardiovascular procedures remains an important health care issue. Lead aprons and shields (LAS) are used to decrease radiation exposure but leave large portions of ...the body unshielded. The Rampart IC M1128 is a portable radiation shielding system that may significantly attenuate radiation exposure.
Catheterization laboratory teams were randomized in a 1:1 fashion to perform elective invasive cardiovascular procedures utilizing either traditional LAS or the Rampart IC M1128. Radiation exposure was measured using real-time dosimetry monitoring in prespecified anatomic locations on 3 operators (position 1: first operator/fellow; position 2: second operator/attending; and position 3: catheterization laboratory nurse/technologist). Radiation exposure was measured on a per-case basis.
In total, 100 consecutive cases were randomized in this study (47 Rampart; 53 LAS). There was no difference in fluoroscopy time (12.3 minutes for Rampart vs 15.4 minutes for LAS; P = .52), dose area product (288 Gy⋅cm2 for Rampart vs 376.5 Gy⋅cm2 for LAS; P = .52), or scatter radiation (38.8 mRem for Rampart vs 46.8 mRem for LAS; P = .61) between the groups. There was significantly lower total body radiation (in milliroentgen equivalent man) exposure using the Rampart than that using LAS for each team member: position 1—0.1 mRem for Rampart vs 2.2 mRem for LAS; P < .001; position 2—0.1 mRem Rampart vs 3.2 mRem LAS; P < .001; and position 3—0.0 mRem for Rampart vs 0.8 mRem for LAS; P < .001.
During routine clinical procedures, the Rampart system significantly decreases total body radiation exposure compared with traditional LAS.
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•Rampart reduces total body radiation compared to traditional lead aprons and shields.•Rampart significantly reduces radiation to the head and neck.•Rampart enables lead-free invasive cardiac procedures.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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