Background and Hypothesis:This project assessed brain activation during a scene encoding task in 4 groups: older adults who were cognitively normal (CN), subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia due to Alzheimer’s disease (AD). Associations between scene encoding related brain activation and tau, amyloid, and other biomarkers were analyzed. Our hypothesis was that higher levels of cerebral tau and amyloid would be associated with reduced scene encoding activation. In addition, we hypothesized that scene encoding activation would be significantly different between cognitively normal and cognitively impaired groups. Methods:234 individuals from the Indiana Memory and Aging Study (79 CN, 67 SCD, 70 MCI, and 18 AD) completed structural and functional MRI, clinical/cognitive assessment and biomarkers; 155 underwent amyloid ([18F]florbetapir/[18F]florbetaben) PET, while 111 also underwent [18F]flortaucipir PET. For the fMRI scene encoding task, participants were asked to view and remember a set of images. A one-way ANOVA test was used to analyze scene encoding related activation differences among the 4 groups. Regression was used to identify associations between scene encoding activation and tau and amyloid deposition. Results:Significant differences in activation were observed between the MCI and CN groups, including less activation in widespread regions during the task and reduced deactivation in the default mode network (DMN) in MCI participants relative to CN. Significant associations between higher amyloid and tau deposition and altered scene encoding activation were also observed. Conclusion and Potential Impact:Cognitive decline is associated with activation changes during scene encoding, as well as reduced deactivation in the DMN, especially in the posterior cingulate region. Higher cerebral amyloid and tau deposition predicted decreased scene encoding related activation. These findings are consistent with models linking cognitive status, functional brain activation during episodic encoding, and pathophysiological processes in the AD continuum.
{"title":"Brain activation during scene encoding fMRI in the Alzheimer’s disease continuum: Association with amyloid and tau burden in PE","authors":"Mia S. Trueblood, A. Saykin, S. Risacher","doi":"10.18060/27806","DOIUrl":"https://doi.org/10.18060/27806","url":null,"abstract":"Background and Hypothesis:This project assessed brain activation during a scene encoding task in 4 groups: older adults who were cognitively normal (CN), subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia due to Alzheimer’s disease (AD). Associations between scene encoding related brain activation and tau, amyloid, and other biomarkers were analyzed. Our hypothesis was that higher levels of cerebral tau and amyloid would be associated with reduced scene encoding activation. In addition, we hypothesized that scene encoding activation would be significantly different between cognitively normal and cognitively impaired groups. \u0000Methods:234 individuals from the Indiana Memory and Aging Study (79 CN, 67 SCD, 70 MCI, and 18 AD) completed structural and functional MRI, clinical/cognitive assessment and biomarkers; 155 underwent amyloid ([18F]florbetapir/[18F]florbetaben) PET, while 111 also underwent [18F]flortaucipir PET. For the fMRI scene encoding task, participants were asked to view and remember a set of images. A one-way ANOVA test was used to analyze scene encoding related activation differences among the 4 groups. Regression was used to identify associations between scene encoding activation and tau and amyloid deposition. \u0000Results:Significant differences in activation were observed between the MCI and CN groups, including less activation in widespread regions during the task and reduced deactivation in the default mode network (DMN) in MCI participants relative to CN. Significant associations between higher amyloid and tau deposition and altered scene encoding activation were also observed. \u0000Conclusion and Potential Impact:Cognitive decline is associated with activation changes during scene encoding, as well as reduced deactivation in the DMN, especially in the posterior cingulate region. Higher cerebral amyloid and tau deposition predicted decreased scene encoding related activation. These findings are consistent with models linking cognitive status, functional brain activation during episodic encoding, and pathophysiological processes in the AD continuum.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"44 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Objective: In monitoring inpatient care quality and efficiency, one metric of interest is Length of Stay (LOS) by diagnosis-related group (DRG) system and how this compares to peer institutions. Vizient Inc. provides a source of such benchmarking - collecting and analyzing individual case-level data from community and academic medical center hospitals nationwide. Using this data, Vizient calculates an expected LOS by DRGs and adjusts for severity of illness and other factors for inter-hospital comparison. Because LOS reduction is an important mechanism for improving outcomes and efficiency of care, The Department of Dermatology would like to understand which dermatologic consults are exceeding the Vizient expected LOS (LOS index > 1). Project Methods: Consecutive charts of 663 patients with dermatology-related diagnoses in the inpatient setting at IU University and Methodist Hospitals between January 2021 and January 2023 were reviewed. Parameters identified included: category of dermatologic disorder, LOS index, time to consult, and quarter of encounter. Data was organized and analyzed using paired t-tests, linear regression, and descriptive statistics in JMP software. Results: The mean LOS index for Dermatology inpatient consults was 1.89 (n=469). Patients whose dermatologic diagnosis fell under chronic wound, mechanical, infectious, drug adverse event, autoimmune, neoplasm, inflammatory, vascular, and blistering had a significant increase in observed length of stay compared to expected length of stay (p < 0.05). Time to dermatology consult was not found to correlate to shortening or prolonging LOS index. Potential Impact: The data from this review will help direct the Department of Dermatology to the dermatologic consults with the highest need for potential interventions.
背景与目标：在监控住院病人护理质量和效率方面，一个值得关注的指标是按诊断相关组 (DRG) 系统划分的住院时间 (LOS)，以及与同行机构的比较情况。Vizient Inc. 提供了此类基准的来源--收集和分析来自全国社区和学术医疗中心医院的个案级数据。利用这些数据，Vizient 按 DRGs 计算出预期 LOS，并根据病情严重程度和其他因素进行调整，以便进行医院间比较。由于缩短病程是提高疗效和护理效率的重要机制，皮肤科希望了解哪些皮肤科会诊超过了 Vizient 的预期病程（病程指数 > 1）。 项目方法：对 2021 年 1 月至 2023 年 1 月期间在 IU 大学医院和卫理公会医院住院的 663 名皮肤科相关诊断患者的连续病历进行审查。确定的参数包括：皮肤病类别、LOS 指数、就诊时间和就诊季度。使用配对 t 检验、线性回归和 JMP 软件中的描述性统计对数据进行了整理和分析。 结果皮肤科住院病人会诊的平均 LOS 指数为 1.89（n=469）。皮肤科诊断为慢性伤口、机械性、感染性、药物不良事件、自身免疫、肿瘤、炎症、血管和水疱的患者，其观察到的住院时间比预期住院时间显著增加（P < 0.05）。没有发现皮肤科会诊时间与缩短或延长住院时间指数相关。 潜在影响：本研究的数据将帮助皮肤科找到最需要采取潜在干预措施的皮肤科会诊对象。
{"title":"Length of Stay Index – A Retrospective Chart Review on In-patient Dermatology Consults","authors":"Cynthia Cahya, Edita Newton","doi":"10.18060/27951","DOIUrl":"https://doi.org/10.18060/27951","url":null,"abstract":"Background and Objective: In monitoring inpatient care quality and efficiency, one metric of interest is Length of Stay (LOS) by diagnosis-related group (DRG) system and how this compares to peer institutions. Vizient Inc. provides a source of such benchmarking - collecting and analyzing individual case-level data from community and academic medical center hospitals nationwide. Using this data, Vizient calculates an expected LOS by DRGs and adjusts for severity of illness and other factors for inter-hospital comparison. Because LOS reduction is an important mechanism for improving outcomes and efficiency of care, The Department of Dermatology would like to understand which dermatologic consults are exceeding the Vizient expected LOS (LOS index > 1). \u0000Project Methods: Consecutive charts of 663 patients with dermatology-related diagnoses in the inpatient setting at IU University and Methodist Hospitals between January 2021 and January 2023 were reviewed. Parameters identified included: category of dermatologic disorder, LOS index, time to consult, and quarter of encounter. Data was organized and analyzed using paired t-tests, linear regression, and descriptive statistics in JMP software. \u0000Results: The mean LOS index for Dermatology inpatient consults was 1.89 (n=469). Patients whose dermatologic diagnosis fell under chronic wound, mechanical, infectious, drug adverse event, autoimmune, neoplasm, inflammatory, vascular, and blistering had a significant increase in observed length of stay compared to expected length of stay (p < 0.05). Time to dermatology consult was not found to correlate to shortening or prolonging LOS index. \u0000Potential Impact: The data from this review will help direct the Department of Dermatology to the dermatologic consults with the highest need for potential interventions. ","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"46 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139534110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cristina Delgado, Peyton Robinson, Khalid Khan, Vijay Ramakrishnan
Background and Hypothesis: Chronic rhinosinusitis (CRS) is defined as persistent inflammation of the mucosa of the nose and paranasal sinuses, either with or without nasal polyps. The pathophysiology of CRS is thought to occur due to a dysfunction of the immune response leading to prolonged NF-kB signaling. Many chronic diseases like CRS have been shown to have chronic NF-kB dysregulation. One hypothesis for the persistent inflammation seen in CRS patients is that they have a less robust pro-resolution response that aids in termination of the NF-kB pathway. In this study, we sought to validate our previous results from nasal polyp tissue using qPCR for key inflammatory mediators, CXCL1, CSF3, and myd88. Methods: Human CRS nasal polyp tissue was collected during functional endoscopic sinus surgery to be grown in cell culture. The nasal polyp tissue was grown in 10 ug/ml of LPS to mimic gram-negative conditions commonly seen in CRS. Tissue cDNA was extracted and frozen at – 80° C. Tissue cDNA for control, RvD2, LPS, and LPS+RvD2 was thawed and used to run qPCR for myd88, CXCL1, and CSF3. Results: qPCR data was normalized using GAPDH and B-actin. When normalized with GAPDH and B-actin, CSF3 was found to be downregulated with RvD2 exposure, while both myd88 and CXCL1 showed inconsistent results. Downregulation of CSF3 with RvD2 exposure, is consistentwith our hypothesis that RvD2 plays a role in NF-kB resolution. Conclusion: Downregulation of the NF-kB pathway can play an important role in reducing the chronic inflammation seen in CRS. CSF3 was one gene target of the NF-kB pathway that was continuously found to be downregulated when nasal polyp tissue was treated with RvD2. Ourfindings demonstrate that when nasal polyp tissue is treated with pro-resolving mediators such as RvD2, at least one or more of the NF-kB-associated genes are downregulated.
{"title":"Validation of Blunting of Inflammatory Markers in LPS Induced Tissue with SPM Treatment","authors":"Cristina Delgado, Peyton Robinson, Khalid Khan, Vijay Ramakrishnan","doi":"10.18060/27799","DOIUrl":"https://doi.org/10.18060/27799","url":null,"abstract":"Background and Hypothesis: Chronic rhinosinusitis (CRS) is defined as persistent inflammation of the mucosa of the nose and paranasal sinuses, either with or without nasal polyps. The pathophysiology of CRS is thought to occur due to a dysfunction of the immune response leading to prolonged NF-kB signaling. Many chronic diseases like CRS have been shown to have chronic NF-kB dysregulation. One hypothesis for the persistent inflammation seen in CRS patients is that they have a less robust pro-resolution response that aids in termination of the NF-kB pathway. In this study, we sought to validate our previous results from nasal polyp tissue using qPCR for key inflammatory mediators, CXCL1, CSF3, and myd88. \u0000Methods: Human CRS nasal polyp tissue was collected during functional endoscopic sinus surgery to be grown in cell culture. The nasal polyp tissue was grown in 10 ug/ml of LPS to mimic gram-negative conditions commonly seen in CRS. Tissue cDNA was extracted and frozen at – 80° C. Tissue cDNA for control, RvD2, LPS, and LPS+RvD2 was thawed and used to run qPCR for myd88, CXCL1, and CSF3. \u0000Results: qPCR data was normalized using GAPDH and B-actin. When normalized with GAPDH and B-actin, CSF3 was found to be downregulated with RvD2 exposure, while both myd88 and CXCL1 showed inconsistent results. Downregulation of CSF3 with RvD2 exposure, is consistentwith our hypothesis that RvD2 plays a role in NF-kB resolution. \u0000Conclusion: Downregulation of the NF-kB pathway can play an important role in reducing the chronic inflammation seen in CRS. CSF3 was one gene target of the NF-kB pathway that was continuously found to be downregulated when nasal polyp tissue was treated with RvD2. Ourfindings demonstrate that when nasal polyp tissue is treated with pro-resolving mediators such as RvD2, at least one or more of the NF-kB-associated genes are downregulated.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brendan Jones, Brianna Chandler, Kelly DeMichael, Baraka Muvuka, Jonathan E. Guerrero, Kyle Gosporadek
Background: Brain health equity remains an underexplored research area despite high prevalence of neurovascular conditions and related health impacts. This study examined the associations between socio-demographic, behavioral factors, and hospital admissions for neurovascular-related morbidity in an urban underserved community. It is part of a multi-phased Community-Based Participatory Research (CBPR) partnership between Indiana University School of Medicine-Northwest and St. Mary Medical Center (SMMC) to examine the prevalence, distribution, and relationships between social determinants of health (SDOH), demographics, health behaviors, and health outcomes in Northwest Indiana. Methods: This retrospective study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, behavioral and health outcomes data for adult inpatient visits from January 2021 to March 2023. Neurovascular admission was determined by ICD-10 Codes I67-69. Data analysis was conducted in SPSS 29.0 using descriptive statistics (i.e., frequencies and central tendency), bivariate analysis (Chi-square; p<0.05), and multivariate analysis (binary logistic regression; p<0.05). This study received exemption from Indiana University Human Research Protection Program (IRB #14040). Results: There were 1,489 participants included in this study. The majority were white (77.7%), older adults (67 ± 21.5) and publicly insured (77.8%). The bivariate analysis demonstrated significant relationships between admission for neurovascular conditions and age group (p<0.001), veteran status (p<0.001), insurance type (p<0.037), and physical activity (p<0.001). After adjusting for these factors in multivariate analysis, age group (p< 0.003) and physical inactivity (p<0.008) were significantly associated with admission for neurovascular conditions. Conclusion: Understanding how SDOH and behavioral factors influence neurovascular admissions and inequities in urban settings will enhance collaborative efforts to develop, implement, and evaluate evidence-based interventions. The subsequent CBPR phases will utilize these findings to explore how socioeconomic status affects these patients’ ability to seek emergent and/or surgical care. This will enable implementation of strategies that better account for SDOH in patient care.
{"title":"Neurovascular Conditions and Associated Socio-Demographic and Behavioral Factors in an Urban Hospital in Northwest Indiana","authors":"Brendan Jones, Brianna Chandler, Kelly DeMichael, Baraka Muvuka, Jonathan E. Guerrero, Kyle Gosporadek","doi":"10.18060/27849","DOIUrl":"https://doi.org/10.18060/27849","url":null,"abstract":"Background: Brain health equity remains an underexplored research area despite high prevalence of neurovascular conditions and related health impacts. This study examined the associations between socio-demographic, behavioral factors, and hospital admissions for neurovascular-related morbidity in an urban underserved community. It is part of a multi-phased Community-Based Participatory Research (CBPR) partnership between Indiana University School of Medicine-Northwest and St. Mary Medical Center (SMMC) to examine the prevalence, distribution, and relationships between social determinants of health (SDOH), demographics, health behaviors, and health outcomes in Northwest Indiana. \u0000Methods: This retrospective study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, behavioral and health outcomes data for adult inpatient visits from January 2021 to March 2023. Neurovascular admission was determined by ICD-10 Codes I67-69. Data analysis was conducted in SPSS 29.0 using descriptive statistics (i.e., frequencies and central tendency), bivariate analysis (Chi-square; p<0.05), and multivariate analysis (binary logistic regression; p<0.05). This study received exemption from Indiana University Human Research Protection Program (IRB #14040). \u0000Results: There were 1,489 participants included in this study. The majority were white (77.7%), older adults (67 ± 21.5) and publicly insured (77.8%). The bivariate analysis demonstrated significant relationships between admission for neurovascular conditions and age group (p<0.001), veteran status (p<0.001), insurance type (p<0.037), and physical activity (p<0.001). After adjusting for these factors in multivariate analysis, age group (p< 0.003) and physical inactivity (p<0.008) were significantly associated with admission for neurovascular conditions. \u0000Conclusion: Understanding how SDOH and behavioral factors influence neurovascular admissions and inequities in urban settings will enhance collaborative efforts to develop, implement, and evaluate evidence-based interventions. The subsequent CBPR phases will utilize these findings to explore how socioeconomic status affects these patients’ ability to seek emergent and/or surgical care. This will enable implementation of strategies that better account for SDOH in patient care.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139626431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/Objective: Patients undergoing inflatable penile prosthetic (IPP) surgery are at an increased risk for cardiovascular complications such as venous thromboembolism (VTE) following surgery due to pre-existing comorbidities associated with erectile dysfunction. The use of perioperative subcutaneous heparin (SqH) along with a surgical drain has been shown to be effective in preventing VTE in IPP patients, without increasing hematoma formation. Not all prosthetic surgeons utilize surgical drains postoperatively. In this study we aim to assess the safety and efficacy of perioperative SqH in preventing VTE in IPP patients without the use of a surgical drain. Methods: This was a retrospective review from January 2021-July 2023 of patients who underwent IPP placement or explant and replacement at a single institution. Patient demographics, comorbidities, Caprini risk factor scores, VTE risk factors, and 90-day postoperative complications, including hematoma formation, were reviewed. Statistical analyses were performed comparing these variables in men who received SqH and those who did not. Results: We reviewed data for 240 patients; 53% (n=127) received perioperative SqH. The incidence of VTE was 0.9% (1/113) in the non-SqH group, and no VTE was recorded in the group receiving SqH. There was no statistical significance in hematoma formation betweengroups (SqH 5.5% vs. non-SqH 6.2% p=.898). Beyond hypertension prevalence (SqH 74.8% vs. non-SqH 62.8% p=.045), there was no difference between comorbidities or Caprini risk factor scores (SqH 6.79 vs. non-SqH 6.82 p=.474) between groups (Table 1). 94% of thepatients in this study were considered high risk for VTE. Conclusions: Perioperative SqH use without placement of a surgical drain was found to be safe and effective in preventing VTE in patients undergoing IPP surgery. There was no increased risk of hematoma formation or post-operative complications between the groups. Perioperative SqH should be considered in all patients undergoing IPP surgery.
{"title":"Incidence of Venous Thromboembolism and Hematoma Following Placement of Inflatable Penile Prosthetic: Safety of Perioperative Subcutaneous Heparin","authors":"Jacob Good, Helen Bernie","doi":"10.18060/27899","DOIUrl":"https://doi.org/10.18060/27899","url":null,"abstract":"Background/Objective: Patients undergoing inflatable penile prosthetic (IPP) surgery are at an increased risk for cardiovascular complications such as venous thromboembolism (VTE) following surgery due to pre-existing comorbidities associated with erectile dysfunction. The use of perioperative subcutaneous heparin (SqH) along with a surgical drain has been shown to be effective in preventing VTE in IPP patients, without increasing hematoma formation. Not all prosthetic surgeons utilize surgical drains postoperatively. In this study we aim to assess the safety and efficacy of perioperative SqH in preventing VTE in IPP patients without the use of a surgical drain. \u0000Methods: This was a retrospective review from January 2021-July 2023 of patients who underwent IPP placement or explant and replacement at a single institution. Patient demographics, comorbidities, Caprini risk factor scores, VTE risk factors, and 90-day postoperative complications, including hematoma formation, were reviewed. Statistical analyses were performed comparing these variables in men who received SqH and those who did not. \u0000Results: We reviewed data for 240 patients; 53% (n=127) received perioperative SqH. The incidence of VTE was 0.9% (1/113) in the non-SqH group, and no VTE was recorded in the group receiving SqH. There was no statistical significance in hematoma formation betweengroups (SqH 5.5% vs. non-SqH 6.2% p=.898). Beyond hypertension prevalence (SqH 74.8% vs. non-SqH 62.8% p=.045), there was no difference between comorbidities or Caprini risk factor scores (SqH 6.79 vs. non-SqH 6.82 p=.474) between groups (Table 1). 94% of thepatients in this study were considered high risk for VTE. \u0000Conclusions: Perioperative SqH use without placement of a surgical drain was found to be safe and effective in preventing VTE in patients undergoing IPP surgery. There was no increased risk of hematoma formation or post-operative complications between the groups. Perioperative SqH should be considered in all patients undergoing IPP surgery.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"32 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139534481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/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.
背景/目的：对于患有慢性肌肉骨骼疼痛的退伍军人来说，找到镇痛剂的替代疗法对于更安全、更有效的疼痛管理至关重要。虽然音乐干预已显示出治疗急性疼痛的前景，但其对慢性疼痛和远程医疗服务的可接受性还需要更严格的审查。方法：音乐想象和聆听镇痛干预的可行性和可接受性（FAMILIA）研究将 60 名患有慢性肌肉骨骼疼痛的退伍军人随机分组，分别接受常规护理、远程保健音乐聆听（ML）或远程保健音乐想象（MI）。ML 包括独立聆听每位参与者自选的歌曲，而 MI 则包括由音乐治疗师指导的一对一疗程，其中结合了 ML、想象和语言处理。为了补充对患者报告结果的定量分析，我们还对参与者进行了定性访谈，以了解他们对研究干预措施的益处、可接受性、障碍和促进因素的看法。我们使用主题分析法对 15 个访谈进行了分析，以评估音乐干预的可接受性。 结果所有受访者都认为在聆听音乐或接受治疗的过程中，精神和情感都得到了愉悦，几乎所有受访者的身体疼痛都得到了缓解。然而，许多人指出，疼痛缓解是短期的，而且对于一些被随机分配到 ML 的退伍军人来说，某些歌曲会唤起他们的负面联想。与之前的非正式音乐聆听经历相比，参与者还从参与研究及其正式结构中获益匪浅。有计划的研究活动，如参与者与工作人员的签到以及与治疗师的互动，加深了他们对音乐如何起到治疗作用的理解，并增强了退伍军人对自己使用音乐进行治疗的能力的信心。受访者有意在研究结束后继续使用音乐聆听和想象技巧，并强烈支持将音乐干预措施推广到其他退伍军人，这进一步证明了研究的可接受性。结论/意义： FAMILIA 研究不仅支持将远程医疗音乐干预作为可接受的慢性肌肉骨骼疼痛治疗方法，而且报告的身体疼痛和精神情感方面的益处表明有必要进行更大规模的、全面的研究。
{"title":"“There’s Healing in Music”: Veteran Perceptions of Music Interventions for Their Chronic Musculoskeletal Pain","authors":"Claire Whalen, K. M. Story, Matthew J. Bair","doi":"10.18060/27821","DOIUrl":"https://doi.org/10.18060/27821","url":null,"abstract":"Background/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. \u0000Methods: 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. \u0000 \u0000Results: 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. \u0000Conclusion/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.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Deckbar, Kelly DeMichael, Wael Gad, Baraka Muvuka, Jonathan E. Guerrero
Introduction: The CDC and American Lung Association estimate that congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disorder (COPD), and asthma (COPD/asthma) cost Americans $30.7 billion, $327 billion, and $50 billion respectively each year. They account for most inpatient readmissions at St. Mary Medical Center (SMMC), an urban hospital in Northwest Indiana. There is need for further research on the social, behavioral, and demographic determinants associated with these conditions. This study examined the social, behavioral, and demographic determinants associated with inpatient admission for CHF, diabetes, COPD/asthma in SMMC’s service area. Methods: This retrospective study was part of a multi-phased Community-Based Participatory Research partnership between SMMC and Indiana University School of Medicine Northwest. SMMC implemented a pilot screening and referral program to assess social determinants of health in their service area as part of their Hospital Readmission Reduction Program. This study included data from 10,953 inpatient admissions between January 2021 to March 2023, majority of whom were transferred from the emergency department. Data analysis consisted ofunivariate, bivariate (Chi-square), and multivariate (binary logistic regression) analysis in SPSS 29.0. Results: Bivariate analysis revealed a statistically significant association between CHF and smoking, age, insurance type, and income. Diabetes was significantly associated with smoking, smokeless tobacco use, age group, race, income, and sex. COPD/asthma was significantly associated with smoking, age group, transportation needs, stress, insurance, ethnicity, and sex. Multivariate analysis found the following significant associations: age group with both CHF (p<0.001) and diabetes (p<0.001), former smoking with both CHF (p = 0.007) and COPD/asthma (p = 0.049), current smoking with COPD/asthma (p = 0.016), and sex with diabetes (p <0.001). Conclusions: These findings indicate significant associations between multiple sociobehavioral factors and admission for CHF, diabetes, COPD/asthma. Multi-risk-factor interventions may address these interactions and contribute to reducing readmission.
{"title":"Social Determinants of Health Associated with Inpatient Admissions for Congestive Heart Failure, Diabetes, Chronic Obstructive Pulmonary Disease, and Asthma","authors":"John Deckbar, Kelly DeMichael, Wael Gad, Baraka Muvuka, Jonathan E. Guerrero","doi":"10.18060/27798","DOIUrl":"https://doi.org/10.18060/27798","url":null,"abstract":"Introduction: The CDC and American Lung Association estimate that congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disorder (COPD), and asthma (COPD/asthma) cost Americans $30.7 billion, $327 billion, and $50 billion respectively each year. They account for most inpatient readmissions at St. Mary Medical Center (SMMC), an urban hospital in Northwest Indiana. There is need for further research on the social, behavioral, and demographic determinants associated with these conditions. This study examined the social, behavioral, and demographic determinants associated with inpatient admission for CHF, diabetes, COPD/asthma in SMMC’s service area. \u0000Methods: This retrospective study was part of a multi-phased Community-Based Participatory Research partnership between SMMC and Indiana University School of Medicine Northwest. SMMC implemented a pilot screening and referral program to assess social determinants of health in their service area as part of their Hospital Readmission Reduction Program. This study included data from 10,953 inpatient admissions between January 2021 to March 2023, majority of whom were transferred from the emergency department. Data analysis consisted ofunivariate, bivariate (Chi-square), and multivariate (binary logistic regression) analysis in SPSS 29.0. \u0000Results: Bivariate analysis revealed a statistically significant association between CHF and smoking, age, insurance type, and income. Diabetes was significantly associated with smoking, smokeless tobacco use, age group, race, income, and sex. COPD/asthma was significantly associated with smoking, age group, transportation needs, stress, insurance, ethnicity, and sex. Multivariate analysis found the following significant associations: age group with both CHF (p<0.001) and diabetes (p<0.001), former smoking with both CHF (p = 0.007) and COPD/asthma (p = 0.049), current smoking with COPD/asthma (p = 0.016), and sex with diabetes (p <0.001). \u0000Conclusions: These findings indicate significant associations between multiple sociobehavioral factors and admission for CHF, diabetes, COPD/asthma. Multi-risk-factor interventions may address these interactions and contribute to reducing readmission.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139626941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aneesha Anand, Nikhitha Lavu, Kenneth A. Kesler, Patrick J. Loehrer
Thymic epithelial tumors (TETs) are rare malignancies originating from the thymus in the anterior mediastinum. TETs include thymic carcinoma and thymoma. Approximately 30-40% of thymomas have associated autoimmune paraneoplastic disorders, the most common being myasthenia gravis. A broad range of other paraneoplastic syndromes have also been reported. Currently, little is known about demographic or histological trends in thymoma patients with comorbid autoimmune disease. In this single institution retrospective chart review, we assessed the distribution of thymoma-associated paraneoplastic syndromes at the IU Simon Cancer Center (IUSCC) to identify trends within demographic and histological features. We created a database of IUSCC patients seen from 2000-2023 and identified 170 subjects with biopsy-proven malignant TET and associated autoimmune disease. Data was exported to excel and R for analysis. Factors analyzed included: age at diagnosis, sex assigned at birth, BMI, WHO (World Health Organization) classification, and Masaoka staging. Overall survival was also compared to matched controls without paraneoplastic syndrome. A total of 37 different paraneoplastic syndromes were identified in association with thymoma in IUSCC patients. The most prevalent was Myasthenia Gravis (110 patients), followed by Hypothyroidism (21 patients, 5 confirmed as Hashimoto’s thyroiditis), Good Syndrome (19 patients), and Pure Red Cell Aplasia (15 patients). Significant findings included: 36.4% of patients with paraneoplastic comorbidity had >1 paraneoplastic syndrome, 51.8% presented with Stage IV disease, and 40.4% had WHO Type B2 tumor pathology, with Type B3 being second most common (25%). No significant demographic associations were identified. 10-year survival of TET patients with paraneoplastic syndromes was not significantly different from those without (p= 0.721). These results indicate potential associations between thymoma staging and grading and development of paraneoplastic disease. Further analysis with a larger data set is warranted. Serum and blood test analysis may also elucidate reasons behind the development of paraneoplastic disease in thymoma patients.
{"title":"Trends in Thymic Epithelial Tumor Patients with Comorbid Autoimmune Disease","authors":"Aneesha Anand, Nikhitha Lavu, Kenneth A. Kesler, Patrick J. Loehrer","doi":"10.18060/27958","DOIUrl":"https://doi.org/10.18060/27958","url":null,"abstract":"Thymic epithelial tumors (TETs) are rare malignancies originating from the thymus in the anterior mediastinum. TETs include thymic carcinoma and thymoma. Approximately 30-40% of thymomas have associated autoimmune paraneoplastic disorders, the most common being myasthenia gravis. A broad range of other paraneoplastic syndromes have also been reported. Currently, little is known about demographic or histological trends in thymoma patients with comorbid autoimmune disease. In this single institution retrospective chart review, we assessed the distribution of thymoma-associated paraneoplastic syndromes at the IU Simon Cancer Center (IUSCC) to identify trends within demographic and histological features. We created a database of IUSCC patients seen from 2000-2023 and identified 170 subjects with biopsy-proven malignant TET and associated autoimmune disease. Data was exported to excel and R for analysis. Factors analyzed included: age at diagnosis, sex assigned at birth, BMI, WHO (World Health Organization) classification, and Masaoka staging. Overall survival was also compared to matched controls without paraneoplastic syndrome. A total of 37 different paraneoplastic syndromes were identified in association with thymoma in IUSCC patients. The most prevalent was Myasthenia Gravis (110 patients), followed by Hypothyroidism (21 patients, 5 confirmed as Hashimoto’s thyroiditis), Good Syndrome (19 patients), and Pure Red Cell Aplasia (15 patients). Significant findings included: 36.4% of patients with paraneoplastic comorbidity had >1 paraneoplastic syndrome, 51.8% presented with Stage IV disease, and 40.4% had WHO Type B2 tumor pathology, with Type B3 being second most common (25%). No significant demographic associations were identified. 10-year survival of TET patients with paraneoplastic syndromes was not significantly different from those without (p= 0.721). These results indicate potential associations between thymoma staging and grading and development of paraneoplastic disease. Further analysis with a larger data set is warranted. Serum and blood test analysis may also elucidate reasons behind the development of paraneoplastic disease in thymoma patients. ","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"42 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background & Hypothesis: Lyme disease, caused by the bacterium Borrelia burgdorferi, is the most common vector-borne infectious disease in the United States. Although easily treated with antibiotics, undiagnosed cases may develop into persistent infections with complications including Lyme carditis, neuroborreliosis, & arthritis. VlsE antigen variation is one of the major mechanisms employed by B. burgdorferi to establish persistent infection. We hypothesize that YebC modulates VlsE expression and antigen variation, enabling the shift from acute to persistent infection. Materials & Methods: C3H/HeN or C3H/SCID mice were infected with the B. burgdorferi strain 5A4NP1, yebC mutant, and yebC complement at a dose of 105 or 106 spirochetes. Mice were sacrificed at days 7, 30, 60, and 90 post-infection and tissue samples were subjected to RNA and DNA extraction. Results: YebC levels were closely associated with the upregulation of vlsE and the downregulation of ospC in vitro and in vivo. The yebC mutant displayed loss of infectivity in C3H/HeN mice, and reduced VlsE antigen variation. Conclusion & Impact: This data demonstrates that YebC of B burgdorferi can regulate the frequency of vlsE recombination and modulates the inverse regulation of OspC and VlsE. This new factor may serve as an avenue for developing drugs which can target vlsE recombination to combat complications of persistent Lyme disease.
{"title":"YebC Modulates OspC and VlsE Inverse Regulation and VlsE Expression in Persistent Lyme Disease","authors":"Andrew Zoss, S. Raghunandanan, X. F. Yang","doi":"10.18060/27717","DOIUrl":"https://doi.org/10.18060/27717","url":null,"abstract":"Background & Hypothesis: Lyme disease, caused by the bacterium Borrelia burgdorferi, is the most common vector-borne infectious disease in the United States. Although easily treated with antibiotics, undiagnosed cases may develop into persistent infections with complications including Lyme carditis, neuroborreliosis, & arthritis. VlsE antigen variation is one of the major mechanisms employed by B. burgdorferi to establish persistent infection. We hypothesize that YebC modulates VlsE expression and antigen variation, enabling the shift from acute to persistent infection. \u0000Materials & Methods: C3H/HeN or C3H/SCID mice were infected with the B. burgdorferi strain 5A4NP1, yebC mutant, and yebC complement at a dose of 105 or 106 spirochetes. Mice were sacrificed at days 7, 30, 60, and 90 post-infection and tissue samples were subjected to RNA and DNA extraction. \u0000Results: YebC levels were closely associated with the upregulation of vlsE and the downregulation of ospC in vitro and in vivo. The yebC mutant displayed loss of infectivity in C3H/HeN mice, and reduced VlsE antigen variation. \u0000Conclusion & Impact: This data demonstrates that YebC of B burgdorferi can regulate the frequency of vlsE recombination and modulates the inverse regulation of OspC and VlsE. This new factor may serve as an avenue for developing drugs which can target vlsE recombination to combat complications of persistent Lyme disease.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"34 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/Objective: Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are the two procedures used to treat severe symptomatic aortic stenosis. One of the most feared outcomes of both procedures is stroke. Conduction abnormalities and arrhythmias after TAVR are relatively common, but few studies have been done comparing the rate of these events between TAVR and SAVR. The objective of our study is to find if there are any differences between the rates of stroke, conduction abnormalities, and arrhythmias between patients that have undergone TAVR and patients that have undergone SAVR. Methods: The CRC/Sidus Real World Evidence Cardiology Dataset was used to obtain samples for this project. Patients who underwent TAVR and SAVR were identified using CPT codes. These two cohorts of patients were tracked for complications between 0 to 30 days after the procedure and between 0 days to 1 year after the procedure using ICD-10 codes. Results: Patients who underwent TAVR (n=3621) were much more likely to have conduction disorders and arrhythmias both in the 0-30 day range and 0 days-1 year range after the procedure compared to patients who underwent SAVR (n=2137). Cerebral infarction and transient cerebral ischemic attack rates were also higher in the TAVR group. Mortality rates for TAVR were lower than mortality rates for SAVR, both 30 days and 1 year after the procedure. Conclusion/Impact: TAVR has revolutionized aortic valve replacement and allowed many patients with aortic stenosis (many of whom are at high surgical risk) a minimally invasive option to improve their quality of life. Finding ways to reduce the rates of stroke, arrhythmias, and conduction abnormalities; for example, through improved devices and techniques, and improvedanti-thrombotic therapy, is extremely important as TAVR becomes more and more widely utilized.
{"title":"Comparing Complication Rates of Transcatheter Aortic Valve Replacement to Surgical Aortic Valve Replacement","authors":"Jacob Hedberg, James Butler","doi":"10.18060/27857","DOIUrl":"https://doi.org/10.18060/27857","url":null,"abstract":"Background/Objective: Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are the two procedures used to treat severe symptomatic aortic stenosis. One of the most feared outcomes of both procedures is stroke. Conduction abnormalities and arrhythmias after TAVR are relatively common, but few studies have been done comparing the rate of these events between TAVR and SAVR. The objective of our study is to find if there are any differences between the rates of stroke, conduction abnormalities, and arrhythmias between patients that have undergone TAVR and patients that have undergone SAVR.\u0000Methods: The CRC/Sidus Real World Evidence Cardiology Dataset was used to obtain samples for this project. Patients who underwent TAVR and SAVR were identified using CPT codes. These two cohorts of patients were tracked for complications between 0 to 30 days after the procedure and between 0 days to 1 year after the procedure using ICD-10 codes.\u0000Results: Patients who underwent TAVR (n=3621) were much more likely to have conduction disorders and arrhythmias both in the 0-30 day range and 0 days-1 year range after the procedure compared to patients who underwent SAVR (n=2137). Cerebral infarction and transient cerebral ischemic attack rates were also higher in the TAVR group. Mortality rates for TAVR were lower than mortality rates for SAVR, both 30 days and 1 year after the procedure.\u0000Conclusion/Impact: TAVR has revolutionized aortic valve replacement and allowed many patients with aortic stenosis (many of whom are at high surgical risk) a minimally invasive option to improve their quality of life. Finding ways to reduce the rates of stroke, arrhythmias, and conduction abnormalities; for example, through improved devices and techniques, and improvedanti-thrombotic therapy, is extremely important as TAVR becomes more and more widely utilized.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"46 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139534070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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