1
|
Ulderich Williams SC, Qaddoumi AI, Meghreblian JT, McBride ME, King SA, Elahi MA, Tuggle D, Heidel RE, Smith LM. Incidence and Risk Factors for ICU-Associated Delirium in the Alert Geriatric Trauma Population. Am Surg 2024:31348241241707. [PMID: 38520278 DOI: 10.1177/00031348241241707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
BACKGROUND This study analyzed the overall incidence of delirium, comorbid conditions, injury patterns, and pharmacological risk factors for the development of delirium in an alert, geriatric trauma population. METHODS IRB-approved, prospective, consecutive cohort series at two Southeastern Level 1 trauma centers from June 11 to August 15, 2023. Delirium was assessed using the Confusion Assessment Method (CAM) score. Comorbidities and medications were detailed from electronic medical records. Inclusion criteria: age ≥55, GCS ≥14, and ICU admission for trauma. Patients on a ventilator were excluded. Data was analyzed using SPSS version 28 (Armonk, NY: IBM Corp). RESULTS In total, 196 patients met inclusion criteria. Incidences of delirium for Hospital 1 (n = 103) and Hospital 2 (n = 93) were 15.5% and 12.9%, respectively, with an overall incidence of 14.3% and with no statistical differences between hospitals (P = .599). CAD, CKD, dementia, stroke history, and depression were statistically significant risk factors for developing delirium during ICU admission. Inpatient SSRI/SNRIs, epinephrine/norepinephrine, and lorazepam were significant risk factors. Injury patterns, operative intervention, and use of lidocaine infusions and gabapentin were not statistically significant in delirium development. Using binary linear regression (BLR) analysis, independent risk factors for delirium were dementia, any stage CKD, home SSRI/SRNI prescription, any spine injury and cerebrovascular disease, or injury. DISCUSSION Comorbidities of CAD, CHF, CKD, and depression, and these medications: home lorazepam and ICU epinephrine/norepinephrine statistically are more common in patients developing delirium. Dementia, CKD, home SSRI/SRNI and stroke/cerebrovascular disease/injury, and spine injuries are independent predictors by BLR.
Collapse
Affiliation(s)
| | - Ansam I Qaddoumi
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - John T Meghreblian
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Mary E McBride
- Department of Surgery, East Tennessee State University, Johnson City, TN, USA
| | - Sarah A King
- Department of Surgery, University of Tennessee Medical Center Knoxville, Knoxville, TN, USA
| | - Muhammad A Elahi
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Debbie Tuggle
- Department of Surgery, University of Tennessee Medical Center Knoxville, Knoxville, TN, USA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Medical Center Knoxville, Knoxville, TN, USA
| | - Lou M Smith
- Department of Surgery, East Tennessee State University, Johnson City, TN, USA
- Department of Surgery, University of Tennessee Medical Center Knoxville, Knoxville, TN, USA
| |
Collapse
|
2
|
Clegg DJ, Whiteaker EN, Salomon BJ, Gee KN, Porter CG, Mazonas TW, Heidel RE, Brooks AJ, Bell JL, Boukovalas S, Lloyd JM. Contralateral prophylactic mastectomy in a rural population: A single-institution experience. Surg Open Sci 2024; 18:70-77. [PMID: 38435489 PMCID: PMC10905041 DOI: 10.1016/j.sopen.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Background The incidence of contralateral prophylactic mastectomy (CPM) for unilateral breast cancer (UBC) has continued to increase, despite an absent survival benefit except in populations at highest risk for developing contralateral breast cancer (CBC). CPM rates may be higher in rural populations but causes remain unclear. A study performed at our institution previously found that 21.8 % of patients with UBC underwent CPM from 2000 to 2009. This study aimed to evaluate the CPM trend at a single institution serving a rural population and identify the CPM rate in average-risk patients. Methods Retrospective review of patients who underwent mastectomies for UBC at our institution from 2017 to 2021 was performed. Analysis utilized frequencies and percentages, descriptive statistics, chi-square, and independent sample t-tests. Results A total of 438 patients were included, of whom 64.4 % underwent bilateral mastectomy for UBC (CPM). Patients who underwent CPM were significantly younger, underwent genetic testing, had germline pathogenic variants, had a family history of breast cancer, had smaller tumors, underwent reconstruction, and had more wound infections. Of CPM patients, 50.4 % had no identifiable factors for increased risk of developing CBC. Conclusions The rate of CPM in a rural population at a single institution increased from 21.8 % to 64.4 % over two decades, with an average-risk CPM rate of 50.4 %. Those that undergo CPM are more likely to undergo reconstruction and have more wound infections. Identifying characteristics of patients undergoing CPM in a rural population and the increased associated risks allows for a better understanding of this trend to guide conversations with patients. Key message This study demonstrates that the rate of contralateral prophylactic mastectomy for unilateral breast cancers performed at a single institution serving a largely rural population has nearly tripled over the last two decades, with half of these patients having no factors that increase the risk for developing contralateral breast cancers. Contralateral prophylactic mastectomy was significantly associated with smaller tumors, younger age, genetic testing, germline pathogenic variants, family history of breast cancer, breast reconstruction, and increased wound infections.
Collapse
Affiliation(s)
- Devin J. Clegg
- University of Tennessee Graduate School of Medicine, Department of Surgery, Knoxville, TN, United States of America
| | - Erica N. Whiteaker
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN, United States of America
| | - Brett J. Salomon
- University of Tennessee Graduate School of Medicine, Department of Surgery, Knoxville, TN, United States of America
| | - Kaylan N. Gee
- University of Tennessee Graduate School of Medicine, Department of Surgery, Knoxville, TN, United States of America
| | - Christopher G. Porter
- University of Tennessee Graduate School of Medicine, Department of Surgery, Knoxville, TN, United States of America
| | - Thomas W. Mazonas
- University of Tennessee Graduate School of Medicine, Department of Surgery, Knoxville, TN, United States of America
| | - R. Eric Heidel
- University of Tennessee Graduate School of Medicine, Department of Surgery, Division of Biostatistics, Knoxville, TN, United States of America
| | - Ashton J. Brooks
- University of Tennessee Graduate School of Medicine, Department of Surgery, Division of Surgical Oncology, Knoxville, TN, United States of America
| | - John L. Bell
- University of Tennessee Graduate School of Medicine, Department of Surgery, Division of Surgical Oncology, Knoxville, TN, United States of America
| | - Stefanos Boukovalas
- University of Tennessee Graduate School of Medicine, Department of Surgery, Division of Plastic & Reconstructive Surgery, Knoxville, TN, United States of America
| | - Jillian M. Lloyd
- University of Tennessee Graduate School of Medicine, Department of Surgery, Division of Surgical Oncology, Knoxville, TN, United States of America
| |
Collapse
|
3
|
Grabeel KL, Burton SE, Heidel RE, Chamberlin SM, Wilson AQ. Utilizing the Newest Vital Sign (NVS) to Assess Health Literacy at a Regional Academic Medical Center's Family Medicine Clinic. J Patient Exp 2023; 10:23743735231219361. [PMID: 38106340 PMCID: PMC10722918 DOI: 10.1177/23743735231219361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Researchers examined the correlation between the physician's subjective assessment of health literacy rates and actual health literacy rates among patients as determined by the Newest Vital Sign (NVS). A sample of n = 150 patients, 18 years of age or older, were verbally interviewed using NVS tool before seeing their physician. After the physician met with the patient, the physician was asked to measure that patient's level of health literacy on a Likert-type scale and a "yes/no" scale. Frequency and percentage statistics were performed in SPSS to describe the distributions of patient and physician responses. Between-subjects statistics were used. Analysis of the patient surveys revealed one in 4 patients has a high likelihood of low health literacy. Analysis revealed there were significant positive correlations between physician response to perception of a patient's low health literacy risk and NVS survey responses. Despite the risk of limited literacy, 97.3% of physicians perceived the patient to understand what the physician was saying. Physicians should use teach-back and other health literacy principles with each patient, regardless of perceived risk.
Collapse
Affiliation(s)
- Kelsey L. Grabeel
- Preston Medical Library/Health Information Center, University of Tennessee Graduate School of Medicine/University of Tennessee Medical Center, Knoxville, TN, USA
| | - Sarah E. Burton
- Preston Medical Library/Health Information Center, University of Tennessee Graduate School of Medicine/University of Tennessee Medical Center, Knoxville, TN, USA
- Department of Library and Information Science, University of North Carolina at Greensboro (UNCG), Greensboro, NC, USA
| | - R. Eric Heidel
- Department of Surgery/University of Tennessee Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Shauntá M. Chamberlin
- Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Alexandria Q. Wilson
- Preston Medical Library/Health Information Center, University of Tennessee Graduate School of Medicine/University of Tennessee Medical Center, Knoxville, TN, USA
| |
Collapse
|
4
|
Isart FA, Isart-Infante FJ, Heidel RE. Association of Blood Calcidiol Levels and Metabolic Syndrome in Children and Adolescents With Vitamin D Deficiency. Clin Pediatr (Phila) 2023:99228231204444. [PMID: 37978861 DOI: 10.1177/00099228231204444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
This retrospective cohort study aimed to determine whether severe calcidiol deficiency [25-hydroxyvitamin (OH)D <30 nmol/L] improvement has a beneficial effect on cardiometabolic parameters in children and adolescents (5-17 years) with or without metabolic syndrome (MetS). Logistic regression analysis was performed to test for multivariate associations between potential confounders and changes in vitamin D (VD) status from baseline to follow-up care when predicting binary categorical outcomes. Of 562 participants, 146 (26%) had MetS. Individuals with severe VD deficiency (VDD) were more likely to have MetS with elevated blood pressure than those with sufficient (≥75 nmol) VD levels (adjusted odds ratio [AOR], 4.46; 1.08-18.43; p < .05) at follow-up. In the logistic regression model, every unit increase in VD across time decreased the odds of MetS (AOR, 0.98; 95% confidence interval: [0.96, 0.99]; p < .05). Improvement in VD status demonstrated a beneficial metabolic effect in children and adolescents with severe VDD.
Collapse
Affiliation(s)
- Fernando A Isart
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Kids'n Teens Clinics P.A., Houston, TX, USA
| | | | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| |
Collapse
|
5
|
Wall JS, Martin EB, Lands R, Ramchandren R, Stuckey A, Heidel RE, Whittle B, Powell D, Richey T, Williams AD, Foster JS, Guthrie S, Kennel SJ. Cardiac Amyloid Detection by PET/CT Imaging of Iodine ( 124I) Evuzamitide ( 124I-p5+14): A Phase 1/2 Study. JACC Cardiovasc Imaging 2023; 16:1433-1448. [PMID: 37940323 DOI: 10.1016/j.jcmg.2023.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The noninvasive detection of cardiac amyloid, as well as deposits in other vital organs, is critical for early diagnosis and quantitative disease monitoring. Positron emission tomography is an intrinsically quantitative imaging modality suitable for high-resolution amyloid detection. OBJECTIVES This study sought to evaluate the safety and efficacy of a novel amyloid-reactive peptide, designated p5+14, labeled with iodine-124 (124I), in patients with diverse types of systemic amyloidosis. METHODS In a single-site, open label phase 1/2 study (NCT03678259), the safety, biodistribution, and sensitivity of a single intravenous infusion of 124I-evuzamitide was assessed in patients with systemic amyloidosis (n = 50), asymptomatic transthyretin sequence variant carriers (n = 2), and healthy volunteers (n = 5). Subjects were administered 1.4 ± 0.2 mg of 124I-evuzamitide (71.5 ± 12.4 MBq) and positron emission tomography/x-ray computed tomography images acquired at 5.2 hours (Q25-Q75: 4.9-5.4 hours) postinfusion. Images were assessed visually and semi-quantitatively for positive uptake of radiotracer in the heart and other major organs. RESULTS Uptake of 124I-evuzamitide in the heart and other abdominothoracic organs was consistent with the patient's clinical presentation and the type of amyloidosis. The patient- and cardiac-associated sensitivity for imaging and clinical observations was 93.6% (95% CI: 82.8%-97.8%) and 96.2% (95% CI: 81.8%-99.8%), respectively. Semi-quantitative uptake of the radiotracer correlated significantly with serum N-terminal pro-B-type natriuretic peptide measurements in patients with light chain-associated amyloidosis. Cardiac uptake was not observed in any healthy volunteers. The agent was well tolerated, with 1 drug-related adverse event and no deaths. CONCLUSIONS 124I-evuzamitide is an amyloid-binding radiotracer capable of detecting cardiac amyloid in patients with high sensitivity.
Collapse
Affiliation(s)
- Jonathan S Wall
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA.
| | - Emily B Martin
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Ronald Lands
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | | | - Alan Stuckey
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Bryan Whittle
- Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Dustin Powell
- Hendersonville Radiologic Consultants, Hendersonville, North Carolina, USA
| | - Tina Richey
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Angela D Williams
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - James S Foster
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | | | - Stephen J Kennel
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| |
Collapse
|
6
|
Abstract
ABSTRACT Mahoney, K, Heidel, RE, and Olewinski, L. Prevalence and normalization of stress urinary incontinence in female strength athletes. J Strength Cond Res 37(9): 1877-1881, 2023-Strength training is increasing in popularity in women but is also a potential risk factor for stress urinary incontinence (SUI). There is potential for normalization of SUI in sports with high rates of SUI. Pelvic floor physical therapy is an effective treatment for SUI in both athletes and nonathletes, but female strength athletes may not be aware of this option. Our study sought to assess prevalence, normalization, rates of treatment, and preferred sources of information about SUI in female strength athletes. A novel cross-sectional survey was distributed online through social media groups dedicated to female strength athletes with 425 women responding within 4 days. Statistical significance of results was assumed at a 2-sided alpha value of 0.05. 43.5% of athletes experienced incontinence with daily tasks, 59.1% experienced incontinence with normal strength training, and 50.2% experienced incontinence during competition. Of the athletes who experienced incontinence, 61.4% did not have incontinence before starting their sport and only 9.4% had ever sought treatment. 67.9% of all athletes surveyed believed that urinary incontinence was a normal part of their sport. Our findings indicate that SUI is common in female strength athletes and may be a consequence of the sport itself. Normalization of SUI is common, and few athletes seek treatment.
Collapse
Affiliation(s)
| | | | - Luci Olewinski
- Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| |
Collapse
|
7
|
Jackson JW, Foster JS, Martin EB, Macy S, Wooliver C, Balachandran M, Richey T, Heidel RE, Williams AD, Kennel SJ, Wall JS. Collagen inhibits phagocytosis of amyloid in vitro and in vivo and may act as a 'don't eat me' signal. Amyloid 2023; 30:249-260. [PMID: 36541892 DOI: 10.1080/13506129.2022.2155133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/04/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Systemic amyloidosis refers to a group of protein misfolding disorders characterized by the extracellular deposition of amyloid fibrils in organs and tissues. For reasons heretofore unknown, amyloid deposits are not recognized by the immune system, and progressive deposition leads to organ dysfunction. METHODS In vitro and in vivo phagocytosis assays were performed to elucidate the impact of collagen and other amyloid associated proteins (eg serum amyloid p component and apolipoprotein E) had on amyloid phagocytosis. Immunohistochemical and histopathological staining regimens were employed to analyze collagen-amyloid interactions and immune responses. RESULTS Histological analysis of amyloid-laden tissue indicated that collagen is intimately associated with amyloid deposits. We report that collagen inhibits phagocytosis of amyloid fibrils by macrophages. Treatment of 15 patient-derived amyloid extracts with collagenase significantly enhanced amyloid phagocytosis. Preclinical mouse studies indicated that collagenase treatment of amyloid extracts significantly enhanced clearance as compared to controls, coincident with increased immune cell infiltration of the subcutaneous amyloid lesion. CONCLUSIONS These data suggest that amyloid-associated collagen serves as a 'don't eat me' signal, thereby hindering clearance of amyloid. Targeted degradation of amyloid-associated collagen could result in innate immune cell recognition and clearance of pathologic amyloid deposits.
Collapse
Affiliation(s)
- Joseph W Jackson
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - James S Foster
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Emily B Martin
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Sallie Macy
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Craig Wooliver
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Manasi Balachandran
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Tina Richey
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Angela D Williams
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Stephen J Kennel
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Jonathan S Wall
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| |
Collapse
|
8
|
Barenie RE, Cernasev A, Hohmeier KC, Heidel RE, Knight P, Forrest-Bank S. Student Perceptions of Substance Use Disorder Stigma as a Factor for Health Disparities: A Mixed-Methods Study. Pharmacy (Basel) 2023; 11:112. [PMID: 37489343 PMCID: PMC10366849 DOI: 10.3390/pharmacy11040112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The prevalence of substance use disorders (SUDs) is an alarming problem in the United States; however, only a fraction of patients receive treatment. Stigma from both healthcare professionals and society at large negatively impacts SUD treatment. There are limited data regarding the perceptions of healthcare students on SUD stigma as a health disparity. METHODS We conducted a concurrent mixed-methods study among students enrolled in six health-related colleges at one mid-south health science center in the US over 3 months. Both an electronic survey consisting of 17 close-ended questions and researcher-led focus groups were conducted to understand their perceptions of stigma and SUDs. The research team followed the six steps recommended by Braun and Clarke regarding the data that aimed to capture associations between categories and extract and conceptualize the themes, and thematic analysis was done using Dedoose® (Manhattan Beach, CA, USA) qualitative software, which facilitated all the codes being kept organized and compared the frequency of codes across categories. RESULTS A total of n = 428 students participated in the survey (response rate = 13%), and n = 31 students took part in five focus groups. Most student respondents, on average, either agreed or strongly agreed that: stigma currently exists in the healthcare field; stigma can lead to patients' not receiving the appropriate care for an SUD; and stigma can lead to lower quality care provided to patients with SUDs. Two themes were identified based on the thematic analysis: (1) additional training is necessary to better equip students for addressing SUDs in practice and (2) suggestions were formed to develop synergy between didactic and clinical rotations to improve SUD training. CONCLUSIONS It is evident that students perceive the stigma surrounding SUDs as a detriment to patient care. Opportunities may exist in professional training programs to more seamlessly and intentionally weave SUD treatment and management concepts throughout the curriculum, as well as to empower students to operate in the complex regulatory scheme that exists for SUDs in the US.
Collapse
Affiliation(s)
- Rachel E Barenie
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Alina Cernasev
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Kenneth C Hohmeier
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - R Eric Heidel
- Department of Surgery, Office of Medical Education, Research, and Development, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA
| | - Phillip Knight
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | | |
Collapse
|
9
|
Terry PD, Heidel RE, Dhand R. The association of preexisting severe asthma with COVID-19 outcomes. Curr Opin Pulm Med 2023; 29:215-222. [PMID: 36928032 PMCID: PMC10090339 DOI: 10.1097/mcp.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE OF REVIEW Three years after the emergence of coronavirus disease 2019 (COVID-19), many studies have examined the association between asthma and COVID-related morbidity and mortality, with most showing that asthma does not increase risk. However, the U.S. Centers for Disease Control (CDC) currently suggests that patients with severe asthma may, nonetheless, be particularly vulnerable to COVID-19-related morbidity. RECENT FINDINGS With respect to poor COVID-19 outcomes, our search yielded nine studies that quantified associations with severe asthma, seven that considered use of monoclonal antibodies (mAB), and 14 that considered inhaled corticosteroids (ICS) use. mAb and ICS use have been used as measures of severe asthma in several studies. Severe asthma was significantly associated with poor COVID-19 outcomes. The results for mAb and ICS were mixed. SUMMARY An increased risk of poor COVID-19 outcomes in patients with severe asthma is possible. However, these studies remain sparse and suffer from several methodological limitations that hinder their interpretation. Additional evidence is needed to provide clear, cogent guidance for health agencies seeking to inform patients with asthma about potential risks due to COVID-19.
Collapse
Affiliation(s)
| | - R. Eric Heidel
- Department of Surgery, Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | | |
Collapse
|
10
|
Barenie RE, Frederick KD, Heidel RE, Wheeler JS. A Survey of Hiring and Non-hiring Pharmacists' Perceptions of a Primary Care Certificate Training Program. Am J Pharm Educ 2023; 87:ajpe9072. [PMID: 36319073 PMCID: PMC10159027 DOI: 10.5688/ajpe9072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/27/2022] [Indexed: 05/03/2023]
Abstract
Objective. To survey pharmacists, including those who make or contribute to hiring decisions, regarding certificate training programs and specifically about a primary care certificate for pharmacists.Methods. We conducted a cross-sectional survey of pharmacist registrants of the Office of Continuing Professional Development at the University of Tennessee Health Science Center College of Pharmacy's listserve, including both hiring and non-hiring pharmacists. The 40-question survey probed perceptions of various types of postgraduate training and the design of a primary care certificate training program for pharmacists. Data were collected between November and December 2020.Results. A total of 230 pharmacists participated in this study (14% response rate), and most reported practicing in the community (n=126, 57%). Nearly half of the respondents reported making or contributing to hiring decisions of other pharmacists (n=94, 41%), and, of those, most reported that completion of a primary care certificate program by a candidate would increase their likelihood of hiring that candidate (n=50, 78%). Both groups (hiring and non-hiring pharmacists) most commonly reported that a primary care certificate training program should be 30 hours total and 12 weeks in length, ranked communication as the most important topic to be included, and indicated the didactic and simulation/experiential components should be similarly weighted.Conclusions. Pharmacists, including those who make or contribute to hiring decisions, reported valuing certificate training programs. Developing a certificate training program that is at least 30 hours in length over 12 weeks may serve as an opportunity to address gaps in primary care in the United States.
Collapse
Affiliation(s)
- Rachel E Barenie
- The University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| | - Kelsey D Frederick
- The University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| | - R Eric Heidel
- The University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - James S Wheeler
- The University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| |
Collapse
|
11
|
Murphy BE, Card PD, Ramirez-Kelly L, Xaysuda AM, Heidel RE. Effects of the Strong Hearts program after a major cardiovascular event in patients with cardiovascular disease. J Osteopath Med 2023; 123:279-285. [PMID: 36958944 DOI: 10.1515/jom-2022-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
CONTEXT Cardiac rehabilitation (CR) and intensive cardiac rehabilitation (ICR) are secondary prevention interventions for cardiovascular disease (CVD) with a class 1a indication yet suboptimal utilization. To date, there are only three approved ICR programs. Alternative programing should be explored to increase enrollment and adherence in these interventions. OBJECTIVES This study aims to evaluate the effectiveness of the Strong Hearts program in cardiovascular patients following a major cardiovascular event. METHODS One hundred ninety-seven (n = 197) participants were enrolled in this prospective, nonrandomized study. Patients were eligible for participation if they were referred by a physician after a major cardiovascular event, defined as any of the following: (1) acute myocardial infarction (MI) within the preceding 12 months; (2) current stable or unstable angina pectoris; (3) heart valve procedure; (4) percutaneous intervention of any kind; (5) heart transplant; (6) coronary artery bypass grafting (CABG); or (7) congestive heart failure (CHF) with reduced or preserved ejection fraction. Participants were asked to attend program visits four times per week for 9 weeks. Visits consisted of individualized exercise and intensive healthy lifestyle education. Paired t tests were utilized to compare pre- and postprogram outcome measures. RESULTS One hundred twenty-eight (n = 128) participants completed the program within the 9-week time frame and their outcome measures were included in the data analysis. Among this, 35.2% participants were female and 64.8% were male. The mean age was 65 (range, 19-88). Qualifying diagnoses were percutaneous coronary intervention (PCI; 60, 46.9%), CABG (33, 25.8%), angina (24, 18.8%), valve procedures (8, 6.2%), and CHF (3, 2.3%). After implementation of the intervention, statistically significant decreases in weight (P < .001), body mass index (BMI, P < .001), waist circumference (P < .001), triglycerides (P = .01), systolic blood pressure (SBP, P <.001), diastolic blood pressure (DBP, P = .002), total fat mass (P < .001), Dartmouth Quality of Life Index P < .001), and cardiac depression scores (P = .044) were detected. In other instances, there were statistically significant increases across time for the clinical parameters of high-density lipoprotein (HDL, P = .02), Vitamin D (P = .001), metabolic equivalents (METS, P < .001), Duke activity scores (P < .001), and Rate Your Plate nutrition scores (P < .001). There were no significant changes across time for total cholesterol (P = .17), low-density lipoprotein (LDL, P = .21), A1c (P = .27), or dual-energy X-ray absorptiometry (DXA) total lean mass (P = .86). CONCLUSIONS The 9-week structured program resulted in significant cardiovascular benefit to patients with CVD by reducing cardiac risk factors, increasing exercise capacity, and improving quality of life.
Collapse
Affiliation(s)
| | | | | | | | - R Eric Heidel
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| |
Collapse
|
12
|
Crumpton MW, Mileusnic-Polchan D, Lewis J, Heidel RE, Marks MK. Fetal Age Assessment From Primary Teeth and Long Bones. Am J Forensic Med Pathol 2023; 44:42-51. [PMID: 36730562 DOI: 10.1097/paf.0000000000000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT This study evaluated traditional and expedited methods for assessing the age of fetal remains. Because of their rare occurrence, the discovery of fresh, decomposing, disfigured, or skeletal fetuses engenders heightened awareness by forensic pathologists primarily tasked with age estimation in relation to viability. With decomposed complete or isolated fetal remains, dentists focus on primary molar mineralization, whereas anthropologists perform long bone measurements along with discernment of other indicators of skeletal maturity to obtain an age estimation.The results of this study are 4-fold: (1) The "best" technique for harvesting fetal tooth buds and long bones is the dissection of the developing tooth buds with maceration for the long bones. (2) Metric analysis was applied to the tooth buds and long bones for age estimation, and the findings were correlated. (3) There is a statistically significant difference between known age and dental age and between dental age and long bone age. The difference between known age and long bone age is not statistically significant, but a type II error exists because of the small sample size. (4) A central incisor staging technique for fetuses younger than 26 weeks was developed as a supplement to the molar staging system of Kraus and Jordan (1965).
Collapse
Affiliation(s)
| | | | - James Lewis
- College of Dental Medicine, Lincoln Memorial University;and
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | | |
Collapse
|
13
|
Collier SL, Lewis JM, Kasper KA, Marks MK, Heidel RE. Dental Age Assessment of United States Black and White Children: Performance Reliability of Harris and McKee (1990). Am J Forensic Med Pathol 2023; 44:33-41. [PMID: 36165591 DOI: 10.1097/paf.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT Medicolegal authorities use forensic dental age assessment of children to establish a biologic profile to assist in human identification, answer questions related to immigration, and answer questions used to substantiate eligibility for social benefits. The goal of this study was to assess the performance reliability of the child dental age assessment data previously published for White and Black children in the United States. A total of 432 dental panoramic radiographs were obtained from 3 geographic locations in the United States: Memphis, Tennessee, Knoxville, Tennessee, and Saint Louis, Missouri. Radiographs were staged, and the estimated age was calculated using the previously published data. Multiple age assessments were conducted to determine the effect of excluding certain teeth on estimated age. The results indicated estimated ages using the previously published reference data set were accurate and concordant with known chronologic age across the ancestral, sex, and geographic categories. The results also indicated that the known chronologic age fell within one standard deviation of the estimated age more than the statistical expectation for most categories. Excluding canines provided the most accurate estimation of known chronologic age.
Collapse
Affiliation(s)
- Shanetha L Collier
- From the Division of Forensic Dentistry, Department of Dental Sciences, Department of General Dentistry, University of Tennessee Health Science Center College of Graduate Health Sciences/Graduate School of Medicine, Knoxville, TN
| | - James M Lewis
- From the Division of Forensic Dentistry, Department of Dental Sciences, Department of General Dentistry, University of Tennessee Health Science Center College of Graduate Health Sciences/Graduate School of Medicine, Knoxville, TN
| | | | - Murray K Marks
- From the Division of Forensic Dentistry, Department of Dental Sciences, Department of General Dentistry, University of Tennessee Health Science Center College of Graduate Health Sciences/Graduate School of Medicine, Knoxville, TN
| | - R Eric Heidel
- Office of Biostatistics and Research Consultation, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| |
Collapse
|
14
|
Lohmeier SJ, Heidel RE, Hechler BL. Does three-dimensional intraglandular location predict malignancy in parotid tumors? Int J Oral Maxillofac Surg 2023; 52:296-303. [PMID: 35791993 DOI: 10.1016/j.ijom.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
Tumors arising within the parotid encompass a heterogeneous mix of benign and malignant neoplasms and other tissue growths. The purpose of this study was to determine the association between the location of intraparotid masses and the risk of malignancy. A retrospective cohort study was performed of patients diagnosed with parotid tumors following open tumor excision. The primary predictor variable was the location of the epicenter of the tumor in three-dimensional space, as determined from preoperative imaging. Other variables were patient demographics and clinical parameters. The primary outcome variable was the final histopathologic diagnosis of a benign or malignant process. A χ2 analysis was performed to test for any significant associations between demographic, clinical, and radiographic factors in relation to the outcome, and backwards stepwise logistic regression analysis was used to control for variables. Both increasing age (P = 0.002) and the presence of local pain (P = 0.020) were associated with malignancy. Tumors located anterior to the posterior border of the retromandibular vein had 2.18 times higher odds of malignancy (95% confidence interval 1.13-4.21; P = 0.020). Multivariate regression analysis suggested that patient age, the presence of pain, and tumor location anterosuperiorly and superoinferiorly could all assist in determining the odds of malignancy.
Collapse
Affiliation(s)
- S J Lohmeier
- Department of Oral and Maxillofacial Surgery, San Antonio Military Health System, San Antonio, TX, USA
| | - R E Heidel
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - B L Hechler
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA.
| |
Collapse
|
15
|
Schmocker RK, Gray KD, Eric Heidel R, Vanterpool SG, McLoughlin JM. A Novel Preoperative Patient Survey Predicts Adverse Patient Outcomes-Implementation and Preliminary Results of the Tennessee Preoperative Assessment Tool. Am Surg 2023:31348231157848. [PMID: 36852709 DOI: 10.1177/00031348231157848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Accurate preoperative risk stratification remains elusive. Existing tools are often missing important patient-reported and functional factors. We sought to implement a novel tool, with dynamic functional data and comorbidity variables, to define factors which predict postoperative outcomes. MATERIALS AND METHODS We expanded a previously validated functional questionnaire to create the Tennessee Preoperative Assessment Tool (TPAT). Unique elements included change in functional status, usual and best activity tolerance, and development of new conditions. The survey was administered to all new patients seen in several surgery clinics from July 2021 to June 2022. RESULTS A total of 1950 patients completed the survey. Of the completed surveys, 197 patients underwent an elective, inpatient, abdominal surgery and were included in the study. Several patient-reported factors were associated with poor postoperative outcomes. For example, decrease in functional activity in the previous 60 days (n = 50; 25.4%) was a strong predictor of poor postoperative outcomes including readmission (30-day: 8.8% vs .0%; P = .034), wound dehiscence (12.0% vs 3.4%; P = .022), blood transfusion (6.0% vs .0%; P = .003), sepsis (4.0% vs .0%; P = .015), and wound infection (18.0% vs 6.8%; P = .076). DISCUSSION In this preliminary implementation study, patients undergoing elective, inpatient, abdominal surgery, utilization of a novel, patient-reported survey tool proactively identifies patients at risk of clinically relevant postoperative outcomes. Patient-reported decreased activity in the 60 days prior to surgeon evaluation was associated with several adverse postoperative outcomes. Additionally, this study demonstrates that the TPAT can be seamlessly integrated into the usual clinical workflow and is hypothesis generating for future interventional studies.
Collapse
Affiliation(s)
- Ryan K Schmocker
- Department of Surgery, 37355University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Keith D Gray
- Department of Surgery, 37355University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - R Eric Heidel
- Department of Surgery, 37355University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Stephanie G Vanterpool
- Department of Anesthesiology, 37355University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - James M McLoughlin
- Department of Surgery, 37355University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| |
Collapse
|
16
|
Barenie RE, Cernasev A, Heidel RE, Stewart S, Hohmeier K. Faculty, staff, and student perceptions of substance use disorder stigma in health profession training programs: a quantitative study. Subst Abuse Treat Prev Policy 2023; 18:2. [PMID: 36609268 PMCID: PMC9821344 DOI: 10.1186/s13011-022-00509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Research indicates that stigma impacts the care provided to individuals with Substance Use Disorders (SUDs), but perceptions of SUDs in various healthcare training programs are not well known. We aimed to characterize perceptions of faculty, staff, and students about SUD stigma in professional healthcare training programs. METHODS We conducted a cross-sectional survey of faculty, staff, and students employed at or enrolled in one of six health-related colleges at one Mid-South health science center in the United States, including medicine, pharmacy, dentistry, nursing, health professions, and graduate health sciences. Data collection occurred between February and March 2021. We used descriptive and frequency statistics to assess the constructs within the survey instrument. RESULTS A total of 572 respondents participated in this study (response rate = 9%; students, n = 428, 75%; faculty, n = 107, 19%; staff, n = 32, 6%). Most respondents reported interacting with persons with a SUD, cited challenges with the interaction, and perceived SUDs to be mental health condition (n = 463) or biological disease (n = 326). Most respondents believed that their college: emphasizes learning about SUDs; promotes an accurate perception of SUDs; and fosters respect for persons with. Few respondents reported they hear faculty, staff, or students express negative comments about persons with SUDs, but they were sometimes expressed by students. CONCLUSIONS Most faculty, staff, and students reported experiencing challenges when interacting with a person with a SUD, mainly communication, but few recalled hearing negative comments from their peers. Whether interventions tailored towards improving communication in academic healthcare training settings could minimize challenges experience by faculty, staff, and students when serving individuals with SUDs should be further evaluated.
Collapse
Affiliation(s)
- Rachel E Barenie
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alina Cernasev
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - R Eric Heidel
- Department of Surgery, Office of Medical Education, Research, and Development, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | | | - Kenneth Hohmeier
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
17
|
Eudaley ST, Farland MZ, Melton T, Brooks SP, Heidel RE, Franks AS. Student Performance on Graded Versus Ungraded Readiness Assurance Tests in a Team-Based Learning Elective. Am J Pharm Educ 2022; 86:ajpe8851. [PMID: 35012943 PMCID: PMC10159393 DOI: 10.5688/ajpe8851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/04/2022] [Indexed: 05/06/2023]
Abstract
Objective. Team-based learning is widely used in pharmacy education. In this context, students need to be incentivized to do preclass preparation, thus ensuring they are ready for team-based learning, via graded readiness assurance tests (RATs). The purpose of this study was to determine the effect of graded versus ungraded RATs on examination performance in an ambulatory care elective course for third-year student pharmacists.Methods. For the course offered in spring 2020 and 2021, a standard team-based learning framework was employed. In 2020 the RATs were graded and contributed to the overall course grade (graded RAT cohort), but in 2021 RAT grades did not contribute to the course grade (ungraded RAT cohort). For the ungraded RAT cohort, at the end of the course students completed an online anonymous survey regarding class preparation and perceived team accountability.Results. No significant difference was found between the graded RAT (n=47) and ungraded RAT cohorts (n=36) in the overall mean percentage score on individual RATs (76% vs 74%) and individual examinations (82% vs 80%). Most students (69%-91%) in the ungraded RAT cohort reported completing preclass preparation assignments. In the postcourse survey, 94% of students agreed or strongly agreed that RATs contributed to team members' learning, and 86% agreed or strongly agreed that they were proud of their ability to assist in the team's learning.Conclusion. Ungraded RATs did not significantly impact students' examination performance in an elective course. Removing the grading of this test, whereby grading promotes the performance approach to learning, may have shifted the students' motivation to the mastery approach in the context of preclass preparation. This challenges a widely held belief that grades are necessary incentives for preclass preparation within team-based learning.
Collapse
Affiliation(s)
- Sarah T Eudaley
- University of Tennessee Health Science Center, College of Pharmacy, Knoxville, Tennessee
| | | | - Tyler Melton
- University of Tennessee Health Science Center, College of Pharmacy, Knoxville, Tennessee
| | - Shelby P Brooks
- University of Louisiana at Monroe, College of Pharmacy - Shreveport Campus, Shreveport, Louisiana
| | - R Eric Heidel
- University of Tennessee, Graduate School of Medicine, Knoxville, Tennessee
| | - Andrea S Franks
- University of Tennessee Health Science Center, College of Pharmacy, Knoxville, Tennessee
| |
Collapse
|
18
|
Lewis RE, Muluk SL, Reitz KM, Guyette FX, Brown JB, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Yazer MH, Heidel RE, Rowe AS, Sperry JL, Daley BJ. Prehospital plasma is associated with survival principally in patients transferred from the scene of injury: A secondary analysis of the PAMPer trial. Surgery 2022; 172:1278-1284. [PMID: 35864051 PMCID: PMC9999176 DOI: 10.1016/j.surg.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/06/2022] [Accepted: 04/29/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND We sought to characterize if prehospital transfer origin from the scene of injury (SCENE) or from a referral emergency department (REF) alters the survival benefit attributable to prehospital plasma resuscitation in patients at risk of hemorrhagic shock. METHODS We performed a secondary analysis of data from a recently completed prehospital plasma clinical trial. All of the enrolled patients from either the SCENE or REF groups were included. The demographics, injury characteristics, shock severity and resuscitation needs were compared. The primary outcome was a 30-day mortality. Kaplan-Meier analysis and Cox-hazard regression were used to characterize the independent survival benefits of prehospital plasma for transport origin groups. RESULTS Of the 501 enrolled patients, the REF group patients (n = 111) accounted for 22% with the remaining (n = 390) originating from the scene. The SCENE group patients had higher injury severity and were more likely intubated prehospital. The REF group patients had longer prehospital times and received greater prehospital crystalloid and blood products. Kaplan-Meier analysis revealed a significant 30-day survival benefit associated with prehospital plasma in the SCENE group (P < .01) with no difference found in the REF group patients (P = .36). The Cox-regression verified after controlling for relevant confounders that prehospital plasma was independently associated with a 30-day survival in the SCENE group patients (hazard ratio 0.59; 95% confidence interval 0.39-0.89; P = .01) with no significant relationship found in the REF group patients (hazard ratio 1.03, 95% confidence interval 0.4-3.0). CONCLUSION Important differences across the SCENE and REF cohorts exist that are essential to understand when planning prehospital studies. Prehospital plasma is associated with a survival benefit primarily in SCENE group patients. The results are exploratory but suggest transfer origin may be an important determinant of prehospital plasma benefit.
Collapse
Affiliation(s)
- Rachel E Lewis
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Sruthi L Muluk
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Joshua B Brown
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Richard S Miller
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Jeffrey A Claridge
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Herb A Phelan
- Department of Surgery, University of Texas Southwestern, Dallas, TX
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - A Shawn Rowe
- Department of Surgery, University of Tennessee Medical Center at Knoxville, Knoxville, TN
| | - Jason L Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
| | - Brian J Daley
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | | |
Collapse
|
19
|
Olewinski L, Brooks MA, Wilson J, Heidel RE, Watson A. Collegiate athletes opinions regarding helmet use while riding scooters or mopeds. J Am Coll Health 2022; 70:1999-2007. [PMID: 33151832 DOI: 10.1080/07448481.2020.1841773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/03/2020] [Accepted: 10/18/2020] [Indexed: 06/11/2023]
Abstract
Many collegiate athletes use scooters and mopeds for transportation, and they are at greater risk for head injury without helmets. Objective: Investigate college athletes' reasons for wearing/not wearing helmets while riding a scooter or moped. Participants, Methods: 125 Division I athletes across five teams (two with helmet mandates) completed a cross sectional survey on rates and attitudes about helmet use on scooters or mopeds. Results: Helmet use on mandated vs non-mandated teams was 100% vs 3.6% (OR 1141; 95% CI 56.97, 22,850). For the question, "if you do not wear a helmet, what might make you change your mind and wear one?", players most commonly wrote in a law or coaches' rule (57%). Conclusions: A coach's rule is associated with a higher rate of helmet use in collegiate athletes, and athletes primarily report a rule or law as the reason they would wear a helmet on a scooter or moped.
Collapse
Affiliation(s)
- Luci Olewinski
- Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - M Alison Brooks
- Department of Orthopedics & Rehabilitation, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - John Wilson
- Department of Orthopedics & Rehabilitation, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Andrew Watson
- Department of Orthopedics & Rehabilitation, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
20
|
Johnson BR, Franks AS, Bullock LN, Dennis DL, Heidel RE, Self TH. Pharmacist‐Led
Inhaler Training for Nurses on an Acute Care Pulmonary Unit. J Am Coll Clin Pharm 2022. [DOI: 10.1002/jac5.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Blake R. Johnson
- University of Tennessee Medical Center Knoxville Tennessee
- University of Georgia College of Pharmacy, Athens, Georgia (Dr. Johnson was a resident at UT Medical Center at the time of this study.)
| | - Andrea S. Franks
- University of Tennessee Medical Center Knoxville Tennessee
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
- University of Tennessee Graduate School of Medicine Knoxville Tennessee
| | - Laura N. Bullock
- University of Tennessee Medical Center Knoxville Tennessee
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
| | - Danielle L. Dennis
- University of Tennessee Medical Center Knoxville Tennessee
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
| | - R. Eric Heidel
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
| | | |
Collapse
|
21
|
Barenie RE, Winbigler BL, Heidel RE, Wheeler JS. Accuracy of publicly-listed locator information for buprenorphine waivered practitioners and opioid treatment programs in the US, 2020. Subst Abus 2022; 43:999-1003. [DOI: 10.1080/08897077.2022.2060430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rachel E. Barenie
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brian L. Winbigler
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - R. Eric Heidel
- Department of Surgery, Office of Medical Education, Research, and Development, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - James S. Wheeler
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
22
|
Wilson AQ, Wombles C, Heidel RE, Grabeel KL. The status of scholarly efforts of librarians on health literacy: a bibliometric analysis. J Med Libr Assoc 2022; 110:166-173. [PMID: 35440903 PMCID: PMC9014954 DOI: 10.5195/jmla.2022.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: In order to determine the status of scholarly efforts on health literacy by librarians, researchers examined the characteristics of health literacy publications authored by librarians from 2000 to 2020. Methods: Bibliometric analysis was used to assess the indicators of productivity, affiliation, collaboration, and citation metrics of librarians in health literacy–related research. Data were collected using the Scopus database; articles were screened for inclusion before importation into Microsoft Excel for analysis. SPSS software was used to run basic descriptive statistics. Results: Of 797 search results, 460 references met the inclusion criteria of librarian authorship. There was a significant linear trend upward in publications since 2001 with an average increase of 1.52 papers per year. The number of publications per year peaked in 2019 (n=59). Journal of Consumer Health on the Internet was the most prolific journal. The majority of references were authored by at least two authors and by multidisciplinary teams. Nineteen percent (n=107) of the librarian authors were responsible for more than one publication, and 84.1% of publications were cited at least once. Conclusions: In the last two decades, librarian involvement in health literacy publications has exponentially increased, most markedly in the years following 2014. The productivity, multidisciplinary collaboration efforts, and consistent growth in literature indicate that librarians are engaged in health literacy scholarship. Further research is needed to explore the work of librarians whose impacts on health literacy may not be reflected within well-indexed, peer-reviewed publications.
Collapse
Affiliation(s)
- Alexandria Quesenberry Wilson
- , Assistant Professor, Research and Learning Services Librarian, Preston Medical Library/Health Information Center, University of Tennessee Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, TN
| | - Courtney Wombles
- , Medical Librarian, Reed Health Sciences Library, Lincoln Memorial University, Knoxville, TN
| | - R Eric Heidel
- , Associate Professor of Biostatistics, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Kelsey Leonard Grabeel
- , Associate Professor, Assistant Director, Preston Medical Library, Health Information Center, University of Tennessee Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, TN
| |
Collapse
|
23
|
Wall J, Heidel RE, Martin EB, Stuckey A, Powell D, Guthrie S, Lands R, Kennel SJ. DETECTION OF CARDIAC AMYLOIDOSIS IN PATIENTS WITH SYSTEMIC AL AND ATTR AMYLOIDOSIS USING IODINE EVUZAMITIDE PET/CT IMAGING AND THE CORRELATION WITH SERUM NT-PROBNP. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02175-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
Morris MH, Barton M, Zane M, Hutson SP, Raman R, Heidel RE. A Nurse-Navigated, Postpartum Support Text Messaging Intervention: Satisfaction Among Primiparous Women. J Perinat Neonatal Nurs 2021; 35:330-339. [PMID: 34726650 PMCID: PMC8567297 DOI: 10.1097/jpn.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
More than 50% of maternal deaths in the United States occur during the first year following childbirth. Nearly 40% of these deaths occur between days 1 and 41 of the postpartum period. Historically, women receive less attention from healthcare providers during the postpartum period when compared with the care provided during pregnancy and childbirth. Women may not return for scheduled follow-up care until 4 to 6 weeks after birth, if they return at all. The role of postpartum nurse navigator (PPNN) was developed to deliver a novel, text messaging intervention as part of a randomized controlled trial to 43 primiparous women who experienced an unplanned cesarean birth. Through daily, interactive text messaging, the PPNN assessed study participants' general well-being, assisted with symptom navigation, offered anticipatory guidance, and provided informational support until 4 weeks postpartum. Satisfaction with the intervention was evaluated using a survey that incorporated quantitative and qualitative responses. Overwhelmingly, 93% of participants rated their overall experience with the text messaging intervention as outstanding or good. At least 95% of the participants indicated that they would likely choose to receive daily text messaging from a PPNN following a subsequent birth. Convenient access to professional nurse support for women postbirth warrants further evaluation.
Collapse
Affiliation(s)
- Melanie Hall Morris
- Vanderbilt University School of Nursing, Vanderbilt University, Nashville, Tennessee (Dr Morris and Ms Barton); TriStar Summit Medical Center, Hermitage, Tennessee (Ms Zane); College of Nursing, The University of Tennessee, Knoxville (Dr Hutson); Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Raman); and Office of Biostatistics & Research Consultation, University of Tennessee Graduate School of Medicine, Knoxville (Dr Heidel)
| | | | | | | | | | | |
Collapse
|
25
|
Fahmy MD, Clegg D, Belcastro A, Smith BD, Eric Heidel R, Carlson ER, Hechler B. Are Throat Pain and Otalgia Predictive of Perineural Invasion in Squamous Cell Carcinoma of the Oropharynx? J Oral Maxillofac Surg 2021; 80:363-371. [PMID: 34606767 DOI: 10.1016/j.joms.2021.08.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Head and neck cancer is often associated with pain and perineural invasion (PNI). The purpose of this study was to determine the association of pain complaints and the microscopic identification of PNI in patients with oropharyngeal squamous cell carcinoma (OPSCC). PATIENTS AND METHODS A retrospective cohort study was performed including patients diagnosed with OPSCC from 2010 to 2019. Patients diagnosed and operated on with curative intent at 2 institutions were included. The primary predictor variable was pain (measured as no pain, ear pain, throat pain, or simultaneous pain). Other variables were patient demographics, p16 status, and TNM staging. The primary outcome variable was the histologic presence of PNI. Chi-square analysis was performed to test for any significant associations between pain, T stage, overall stage, and p16 status in relation to PNI outcome. Multivariate logistic regression analysis was used to control for cancer staging variables when testing the association between pain and PNI. RESULTS The final sample was composed of 157 subjects of whom 126 were men. The mean age was 59.7 years. Seventy-seven (49.0%) presented with no pain, while 35 (22.3%), 39 (24.8%), and 6 (3.8%) presented with both throat/ear pain, throat pain only, and ear pain only, respectively. Patients with simultaneous pain had 3.41 times higher odds of PNI compared to the no pain group (P = .02), although only pathologic T stage 4 and a diagnosis on the base of the tongue were independent postoperative predictors of PNI (P < .05). CONCLUSIONS Our study demonstrates that otalgia is a preoperative predictor of PNI in OPSCC and also demonstrates a trend of increasing pain complaints with PNI.
Collapse
Affiliation(s)
- Mina D Fahmy
- Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Devin Clegg
- Resident, Department of Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Alexandra Belcastro
- Resident, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC
| | - Blaine D Smith
- Resident, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC
| | - R Eric Heidel
- Associate Professor of Biostatistics, Department of Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Eric R Carlson
- Professor and Kelly L. Krahwinkel Chairman, Director of Oral/Head and Neck Oncologic Surgery Fellowship Program, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, University of Tennessee Cancer Institute, Knoxville, TN
| | - Benjamin Hechler
- Assistant Professor, Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
| |
Collapse
|
26
|
Wheeler JS, Wu L, Heidel RE, Earl M. Assessing pharmacy students drug information skills and perceptions using the critically appraised topic approach. Curr Pharm Teach Learn 2021; 13:1210-1214. [PMID: 34330400 DOI: 10.1016/j.cptl.2021.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 02/19/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE Competence in drug information (DI) skills fosters the application of evidence-based medicine (EBM) principles. However, concern exists about whether there is adequate DI preparation in curricula. This report describes the development, implementation, and evaluation of a team project utilizing the critically appraised topic (CAT) approach in a DI course. EDUCATIONAL ACTIVITY AND SETTING To assess abilities and skills in DI and EBM principles, student teams (N = 26) were assigned DI requests. A grading rubric based on the validated EBM Critical Presentation Evaluation Tool was used to evaluate each team's project. As a secondary measure, students completed pre-and post-class self-efficacy assessments describing their confidence in DI processes. FINDINGS Twenty-six team posters were submitted with a mean project rubric score of 43 out of 50 points (86%). One hundred one of 172 students (59% response rate) completed the pre- and post-self-efficacy surveys, and results revealed gains in confidence for MEDLINE searching skills, properly citing sources, and knowing where to go next if the answer could not be found in a tertiary resource (all P < .001). The majority of respondents noted their teams collaborated to achieve project goals, actively participated, were open and accepting of others' ideas, and were satisfied with group interactions. SUMMARY Student team creation of DI responses via CATs are an innovative way to introduce, measure, and enhance DI skills in a didactic classroom setting. Fostering DI skills prepares pharmacy students for evidenced-based pharmacy practice.
Collapse
Affiliation(s)
- James S Wheeler
- Clinical Pharmacy and Translational Science, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 1924 Alcoa Highway, Box 117, Knoxville, TN 37920, United States.
| | - Lin Wu
- Research and Learning Services, University of Tennessee Health Science Center Library, 218 Lamar Alexander Building, 877 Madison Avenue, Memphis, TN 38163, United States.
| | - R Eric Heidel
- Biostatistics, Department of Surgery, Office of Medical Education, Research, and Development, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Box U11, Knoxville, TN 37920, United States.
| | - Martha Earl
- Preston Medical Library, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN 37920, United States.
| |
Collapse
|
27
|
Carlson ER, Heidel RE, Houston K, Vahdani S, Winstead M. Tracheotomies in COVID-19 Patients: Protocols and Outcomes. J Oral Maxillofac Surg 2021; 79:1629-1642. [PMID: 33901449 PMCID: PMC7952266 DOI: 10.1016/j.joms.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/05/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Approximately 3-15% of COVID-19 patients will require prolonged mechanical ventilation thereby requiring consideration for tracheotomy. Guidelines for tracheotomy in this cohort of patients are therefore required with assessed outcomes of tracheotomies. PATIENTS AND METHODS A retrospective chart review was performed of COVID-19 patients undergoing tracheotomy. Inclusion criteria were the performance of a tracheotomy in COVID-19 positive patients between March 11 and December 31, 2020. Exclusion criteria were lack of consent, extubation prior to the performance of a tracheotomy, death prior to the performance of the tracheotomy, and COVID-19 patients undergoing tracheotomy who tested negative twice after medical treatment. The primary predictor variable was the performance of a tracheotomy in COVID-19 positive patients and the primary outcome variable was the time to cessation of mechanical ventilation with the institution of supplemental oxygen via trach mask. RESULTS Seventeen tracheotomies were performed between 4-25 days following intubation (mean = 17 days). Seven patients died between 4 and 16 days (mean = 8.7 days) following tracheotomy and 10 living patients realized cessation of mechanical ventilation from 4 hours to 61 days following tracheotomy (mean = 19.3 days). These patients underwent tracheotomy between 4 and 22 days following intubation (mean = 14 days). The 7 patients who died following tracheotomy underwent the procedure between 7 and 25 days following intubation (mean = 18.2 days). Seven patients underwent tracheotomy on or after 20 days of intubation and 3 survived (43%). Ten patients underwent tracheotomy before 20 days of intubation and 7 patients survived (70%). Significant differences between the mortality groups were detected for age (P = .006), and for P/F ratio at time of consult (P = .047) and the time of tracheotomy (P = .03). CONCLUSIONS Tracheotomies are safely performed in COVID-19 patients with a standardized protocol. The timing of tracheotomy in COVID-19 patients is based on ventilator parameters, P/F ratio, patient prognosis, patient advanced directives, and family wishes.
Collapse
Affiliation(s)
- Eric R Carlson
- Professor and Kelly L. Krahwinkel Chairman, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN.
| | - R Eric Heidel
- Associate Professor of Biostatistics, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Kyle Houston
- Chief Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Soheil Vahdani
- Fellow, Oral/Head and Neck Oncologic Surgery, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Michael Winstead
- Chief Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| |
Collapse
|
28
|
Grabeel KL, Heidel RE, Oelschlegel S, Rudd R. Collaborative updating of an organizational health literacy tool confirms medical librarians' leadership roles. Health Info Libr J 2021; 39:142-154. [PMID: 34272926 DOI: 10.1111/hir.12390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/25/2021] [Accepted: 06/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A librarian led task force at the University of Tennessee Medical Center sought to evaluate their medical centre's health literacy attributes utilizing a widely used tool. This research ultimately led to the update of the tool. OBJECTIVES To discuss the evaluation of health literacy attributes of health care organizations and detail the process of updating the Health Literacy Environment of Hospitals and Health Centers (HLEHHC) tool. METHODS Subsequent to utilizing the HLEHHC, the task force was invited to assist in updating the tool. A collaborative was formed between the original author and task force. The collaborative performed an extensive literature review focused on emerging health literacy issues, reviewed each section and formulated changes. RESULTS The collaborative update process yielded an improved instrument for assessing the extent to which a health care organization accommodates low health literacy patients. DISCUSSION Through editing, creating new questions and rearranging the format, the HLEHHC was improved and updated. CONCLUSION The assessment conducted by the health literacy task force is helping shape changes in the organization. Medical librarians acted in leadership roles in the collaborative process of developing the new institutional assessment tool for health literacy (HLE2).
Collapse
Affiliation(s)
- Kelsey Leonard Grabeel
- Health Information Center, Preston Medical Library, University of Tennessee Medical Center, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Sandy Oelschlegel
- Health Information Center, Preston Medical Library, University of Tennessee Medical Center, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Rima Rudd
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
29
|
Winings NA, Daley BJ, Bollig RW, Roberts RF, Radtke J, Heidel RE, Taylor JE, McMillen JC. Dexmedetomidine versus propofol for prolonged sedation in critically ill trauma and surgical patients. Surgeon 2021; 19:129-134. [DOI: 10.1016/j.surge.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
|
30
|
Winstead ML, Clegg DJ, Heidel RE, Ledderhof NJ, Gotcher JE. Fall-Related Facial Trauma: A Retrospective Review of Fracture Patterns and Medical Comorbidity. J Oral Maxillofac Surg 2021; 79:864-870. [DOI: 10.1016/j.joms.2020.09.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022]
|
31
|
Terry PD, Heidel RE, Dhand R. Asthma in Adult Patients with COVID-19. Prevalence and Risk of Severe Disease. Am J Respir Crit Care Med 2021; 203:893-905. [PMID: 33493416 PMCID: PMC8017581 DOI: 10.1164/rccm.202008-3266oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Rationale: Health outcomes of people with coronavirus disease (COVID-19) range from no symptoms to severe illness and death. Asthma, a common chronic lung disease, has been considered likely to increase the severity of COVID-19, although data addressing this hypothesis have been scarce until very recently.Objectives: To review the epidemiologic literature related to asthma's potential role in COVID-19 severity.Methods: Studies were identified through the PubMed (MEDLINE) and medRxiv (preprint) databases using the search terms "asthma," "SARS-CoV-2" (severe acute respiratory syndrome coronavirus 2), and "COVID-19," and by cross-referencing citations in identified studies that were available in print or online before December 22, 2020.Measurements and Main Results: Asthma prevalence data were obtained from studies of people with COVID-19 and regional health statistics. We identified 150 studies worldwide that allowed us to compare the prevalence of asthma in patients with COVID-19 by region, disease severity, and mortality. The results of our analyses do not provide clear evidence of increased risk of COVID-19 diagnosis, hospitalization, severity, or mortality due to asthma.Conclusions: These findings could provide some reassurance to people with asthma regarding its potential to increase their risk of severe morbidity from COVID-19.
Collapse
Affiliation(s)
| | | | - Rajiv Dhand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| |
Collapse
|
32
|
Belcastro A, Smith BD, Heidel RE, Hechler BL. Incidence of pain complaints in oropharyngeal squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:626-632. [PMID: 33958314 DOI: 10.1016/j.oooo.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/27/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of throat pain and otalgia as presenting symptoms in patients with oropharyngeal squamous cell carcinoma (OPSCC) stratified by the cancer being their first or recurrent/second primary head and neck cancer (fHNC or rsHNC). STUDY DESIGN A retrospective analysis of patients operated on for OPSCC was performed. The primary predictor variable was HNC instance (fHNC/rsHNC) with outcome variables of throat pain and/or otalgia. Chi-square analysis was performed to test for significant associations between HNC instance and pain variables. Unadjusted odds ratios were calculated. RESULTS Eighty-nine patients met the inclusion criteria. Patients with OPSCC as an rsHNC had 4.67 times higher odds of throat pain (95% confidence interval [CI], 1.45-15.06) than those with OPSCC as an fHNC and had 20.22 times higher odds of simultaneous throat pain and otalgia (95% CI, 4.76-85.97) than those presenting with an fHNC. Current smoking status and human papillomavirus (HPV)-negative disease were also significantly predictive of rsHNC. HPV-negative disease was also predictive of pain. CONCLUSIONS In addition to the known associations of smoking and HPV status on recurrence and pain, there is a statistically significant association between cancer instance and pain in patients presenting with newly diagnosed, operable OPSCC.
Collapse
Affiliation(s)
- Alexandra Belcastro
- Resident, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Blaine D Smith
- Resident, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - R Eric Heidel
- Associate Professor of Biostatistics, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Benjamin L Hechler
- Assistant Professor, Department of Surgery - Division of Plastic, Maxillofacial, and Oral Surgery, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA.
| |
Collapse
|
33
|
McCarley CB, Mirsky EL, Wolfe LM, Nelson CH, Epps JL, Heidel RE, Fortner KB. 1043 Standardized patient-care protocol for drug-use associated illness in pregnancy and postpartum decreases inpatient adverse events. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
34
|
Fahmy MD, Hechler BL, Carlson ER, Gross AJ, Heidel RE. Preoperative Serum Albumin Predicts Wound Dehiscence but Not Infection After Surgery for Oral Squamous Cell Carcinoma. J Oral Maxillofac Surg 2021; 79:1355-1363. [PMID: 33460561 DOI: 10.1016/j.joms.2020.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Inadequate nutrition is common in individuals diagnosed with cancer. The present study evaluated the association between preoperative albumin and postoperative complications in otherwise healthy patients presenting with newly diagnosed squamous cell carcinoma of the oral cavity primarily managed with ablative surgery. PATIENTS AND METHODS A retrospective cohort study of patients with newly diagnosed oral squamous cell carcinoma from 2005 to 2019 was performed. Patients referred to and managed by a single surgeon (ERC) and who had not received any nutritional support in the preoperative period were included in the study. The primary predictor variable was preoperative albumin level. Other studied variables were patient demographic data and TNM stage. Complications related to primary ablative surgery represented the primary outcome variable. χ2 analysis was completed to assess for significant associations between independent albumin groups (4+, 3.5 to 3.9, and 3.0 to 3.4 g/dL) in relation to postoperative complications. Multivariate logistic regression analysis was completed to control for clinical variables and medical comorbidities when testing the association between albumin and dehiscence. RESULTS The patient cohort included 268 individuals; of whom, 154 were men. The average age of the patients at surgery was 63 years. When controlling for all other variables, albumin was the only statistically significant predictor of postoperative dehiscence, P = .005. Patients with albumin of 3.5 to 3.9 g/dL had 3.24 times higher odds of dehiscence (95% confidence interval 1.42 to 7.38) in comparison with participants in the 4+ g/dL group. There was no difference of odds between the 3.0 to 3.4 group and the 4+ reference group. CONCLUSIONS Our study demonstrated that among those individuals meeting the inclusion criteria, there is a statistically significant association between lower albumin levels and postoperative complication rates, specifically dehiscence.
Collapse
Affiliation(s)
- Mina D Fahmy
- Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Benjamin L Hechler
- Assistant Professor, Department of Surgery- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC
| | - Eric R Carlson
- Professor and Kelly L. Krahwinkel Chairman, Director of Oral/Head and Neck Oncologic Surgery Fellowship Program, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, University of Tennessee Cancer Institute, Knoxville, TN.
| | - Andrew J Gross
- Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - R Eric Heidel
- Associate Professor of Biostatistics, Department of Surgery, University of Tennessee Medical Center, Knoxville, TN
| |
Collapse
|
35
|
Bittman B, Poornima I, Smith MA, Heidel RE. Gospel Music: A Catalyst for Retention, Engagement, and Positive Health Outcomes for African Americans in a Cardiovascular Prevention and Treatment Program. Adv Mind Body Med 2020; 34:8-16. [PMID: 32277749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CONTEXT Mortality associated with cardiovascular disease is significantly higher in African Americans compared with people of other ethnicities, with hypertension being the single most significant risk factor in this population. Underdiagnosis and undertreatment of hypertension is common. Although cardiovascular lifestyle education and self-management programs are available for the general public, many African Americans prefer to learn about health-promoting activities through interactive programs led by church ministries. OBJECTIVE This study examined the influence of adding a faith-based protocol using creative musical expression as a catalyst for improving retention, engagement, and positive health outcomes for African Americans participating in a 1-y, lifestyle skills program for reducing cardiovascular risk factors. DESIGN The study was a randomized, controlled trial. SETTING The study occurred at Rodman Street Missionary Baptist Church (Pittsburgh, PA, USA). PARTICIPANTS Participants were African Americans with at least 2 of the following medical conditions: high blood pressure, elevated cholesterol and/or triglycerides, heart attack, angina, stroke, irregular heartbeats, palpitations, shortness of breath, dizziness or fainting, diabetes, and tobacco use. INTERVENTION Intervention and control groups both participated every other week in one 45-min structured cardiovascular risk reduction educational session over the course of 1 year. During alternative weeks, sessions comprised blood pressure checks, coupled with individualized support discussions focused on challenges and identified obstacles to adherence. In addition to the aforementioned sessions, the intervention group participated in a novel gospel music program with weekly, 45-minute vocal and instrumental sessions. OUTCOME MEASURES Outcome measures include retention, attendance, systolic and diastolic blood pressures, weight, body mass index, hip measurement, and waist measurement as well as the Short Form-12 (SH-12) Health Survey. RESULTS Subjects in the intervention group demonstrated a statistically significant 83.3% retention rate in the course of 1 year compared with only 54.3% for the control group (cardiovascular lifestyle education sessions alone). Six dropouts were noted in the intervention group in sharp contrast to 16 dropouts in the control group. Participants in the intervention group were 4.21 times more likely to complete the program than the control group. A significant difference was also noted for attendance, which was higher for the intervention group (21.33 sessions for the intervention group vs 17.95 sessions for the control group). Statistically significant systolic blood pressure reductions noted in both groups were sustained 6 mo postprogram conclusion. In addition, a statistically significant pre-between post-between group improvement in SF-12 Physical Component Scores was noted for intervention subjects in sharp contrast with controls who actually demonstrated worsening scores. CONCLUSIONS The addition of a gospel music program as a catalyst for increase engagement in a sustainable, healthy lifestyle program warrants further consideration and additional study in African American churches.
Collapse
|
36
|
Goff ZD, Heidel RE, Grabeel K, Hauptman PJ. Roadblocks For Patients with Heart Failure Navigating Clinicaltrials.gov. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
37
|
Goff ZD, Eric Heidel R, Hauptman PJ. Is ClinicalTrials.gov Searchable for Patients With Heart Failure? J Card Fail 2020; 27:120-122. [PMID: 32991983 DOI: 10.1016/j.cardfail.2020.09.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Zackary D Goff
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Paul J Hauptman
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
| |
Collapse
|
38
|
Landry M, Lewis R, Antill A, Eric Heidel R, Taylor J, Casillas MA, Russ AJ, Daley B, McLoughlin J. Effect of Enhanced Recovery After Surgery Protocol Implementation on Cost and Outcomes by Type of Colectomy Performed. Am Surg 2020; 86:1078-1082. [PMID: 32845734 DOI: 10.1177/0003134820943545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols are widely utilized for elective colorectal surgery to improve outcomes and decrease costs, but few studies have evaluated the impact of ERAS protocols on cost with respect to anatomic site of resection. This study evaluated the impact of ERAS protocol on elective colon resections by site and longitudinal impact over time. METHODS A single-center retrospective cohort study of 598 consecutive patients undergoing elective colorectal resection before and after implementation of ERAS protocol from 2013 to 2017 was performed. The primary outcomes were length of stay (LOS) and cost. Comparative and multivariate inferential statistics were used to assess additional outcomes. RESULTS A total of 598 patients (100 pre-ERAS vs 498 post-ERAS) were evaluated with an overall median LOS of 4 days for right and left colectomies and 3 days for transverse colectomies. When comparing type of resection before and after ERAS protocol introduction, an increased LOS for left hemicolectomies from 3.09 to 4.03 days (P = .047) was noted, with all other comparisons failing to reach statistical significance. Over time, an initial decrease in LOS for MIS approach after protocol introduction was observed; however, this effect diminished in the ensuing years and had no significant effect overall. Total cost of care was significantly increased post-ERAS for all cohorts except transverse colectomies. No further statistically significant differences were found. CONCLUSION After an initial improvement in outcomes, continued utilization of ERAS protocols demonstrated no improvement in LOS compared to pre-ERAS data and increased cost overall for patients regardless of site of resection.
Collapse
Affiliation(s)
- Miles Landry
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Rachel Lewis
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Andrew Antill
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - R Eric Heidel
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Jessica Taylor
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Mark A Casillas
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Andrew J Russ
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Brian Daley
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - James McLoughlin
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| |
Collapse
|
39
|
Brusseau C, Burnette T, Heidel RE. Clonidine versus phenobarbital as adjunctive therapy for neonatal abstinence syndrome. J Perinatol 2020; 40:1050-1055. [PMID: 32424335 DOI: 10.1038/s41372-020-0685-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/06/2020] [Accepted: 04/30/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare clonidine versus phenobarbital as adjunctive therapy in infants who failed monotherapy with morphine for neonatal abstinence syndrome (NAS). STUDY DESIGN Prospective, randomized, open-label study of infants ≥ 35 weeks' gestation. Infants received clonidine or phenobarbital per protocol. Primary outcome was morphine treatment days. Secondary outcomes were inpatient adjunctive days, length of stay (LOS), triple therapy, safety, and readmission rates. RESULTS A total of 25 infants were treated with clonidine (n = 14) or phenobarbital (n = 11). Mean morphine treatment duration was significantly longer with clonidine (34.4 days, SD = 10.6) compared with phenobarbital (25.5 days, SD = 7.3, p = 0.026). The clonidine group also had higher inpatient adjunctive days (mean: 33.8 days [SD = 14.3] vs. 22 days [SD = 12.6], p = 0.042) and LOS (mean: 41.8 days [SD = 10.9] vs. 31 days [SD = 10]; p = 0.018) compared with phenobarbital. CONCLUSIONS Phenobarbital, as adjunctive therapy, led to significantly shorter duration of morphine therapy, inpatient adjunctive days, and length of stay compared with clonidine.
Collapse
Affiliation(s)
- Carrie Brusseau
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA.
| | - Tara Burnette
- Department of Neonatology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| |
Collapse
|
40
|
Hamilton LA, Suda KJ, Heidel RE, McDonough SLK, Hunt ME, Franks AS. The role of online learning in pharmacy education: A nationwide survey of student pharmacists. Curr Pharm Teach Learn 2020; 12:614-625. [PMID: 32482262 DOI: 10.1016/j.cptl.2020.01.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/05/2019] [Accepted: 01/30/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Student pharmacists have significant exposure to online learning methods in their pre-pharmacy educational experiences. With decreasing resources and faculty shortages in pharmacy education, online delivery of course content is an efficient way to deliver pharmacy curricula while optimizing classroom time for active learning strategies. The purpose of this study was to assess student preferences associated with the utility of online learning methods such as online platforms, social media, and handheld devices. METHODS An anonymous, voluntary 43-question online survey was delivered to students at colleges and schools of pharmacy in the United States (US). Frequency statistics were used to establish prevalence of student preferences. RESULTS Overall, 1873 students from 29 schools of pharmacy completed the survey. Of these students, 30% preferred a blended course structure (with online and classroom components) throughout the curriculum, as compared to 47% of students who preferred live lectures exclusively. Approximately 57% of students found smart phones very or extremely valuable for their academic success. Approximately 61% of students reported using their smart phones and 37% reported using their tablets "always" or "often" during the past year for academic activities; however, only 31% of students found paper textbooks very or extremely valuable for their academic success, with approximately 26% using them "always" or "often." CONCLUSIONS US pharmacy students prefer a blend of traditional classroom and online learning methods. When updating and revising pharmacy curricula, colleges and schools of pharmacy should consider the inclusion of technology and online learning methodologies.
Collapse
Affiliation(s)
- Leslie A Hamilton
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 1924 Alcoa Highway, Box 117, Knoxville, TN 37920, United States.
| | - Katie J Suda
- Department of Veterans Affairs, Center for Health Equity Research and Promotion, Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, United States.
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, United States.
| | - Sharon L K McDonough
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, United States
| | - Molly E Hunt
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 1924 Alcoa Highway, Box 117, Knoxville, TN 37920, United States.
| | - Andrea S Franks
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 1924 Alcoa Highway, Box 117, Knoxville, TN 37920, United States.
| |
Collapse
|
41
|
Ledderhof NJ, Carlson ER, Heidel RE, Winstead ML, Fahmy MD, Johnston DT. Are Tracheotomies Required for Patients Undergoing Composite Mandibular Resections for Oral Cancer? J Oral Maxillofac Surg 2020; 78:1427-1435. [PMID: 32353259 DOI: 10.1016/j.joms.2020.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/16/2020] [Accepted: 03/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Prophylactic tracheotomy has traditionally been performed during composite mandibular resection of oral cavity cancer to avoid postoperative airway compromise. The purpose of the present study was to measure the frequency and identify the factors associated with an increased or a decreased risk of an adverse airway event (AAE) within 30 days postoperatively. PATIENTS AND METHODS A retrospective cohort study of patients who had undergone composite mandibular resection for oral cancer from 2006 to 2018 was conducted at the University of Tennessee Medical Center. The primary predictor variable was composite resection with or without immediate flap reconstruction. The primary outcome variable was realization of a 30-day AAE, defined as the requirement for tracheotomy for any reason, emergent endotracheal reintubation at any time during the postoperative admission, or prolonged (>48 hours) postoperative endotracheal intubation. The secondary outcome variable was the inpatient length of stay. Descriptive and bivariate statistics were used to compare the patients with and without an AAE for demographic, confounding, and clinical characteristics. RESULTS A total of 114 patients were identified through retrospective medical record review. The prevalence of AAEs in the sample was 8.8% (10 of 114). None of the 49 patients without immediate flap reconstruction developed an AAE. Of the 65 patients who had undergone flap reconstruction, 10 (15.4%) developed an AAE. The χ2 analysis revealed a significantly greater rate of AAEs when flap reconstruction was implemented (P < .05). Also, a significantly greater rate of AAEs was found in the group requiring resection of the floor of the mouth with bilateral neck dissections and immediate flap reconstruction compared with all other flap reconstruction groups (P < .05). CONCLUSIONS A composite resection involving the floor of the mouth with bilateral neck dissection and flap reconstruction should receive strong consideration for prophylactic tracheotomy to avoid an AAE.
Collapse
Affiliation(s)
- Nicholas J Ledderhof
- Former Fellow, Oral/Head and Neck Oncologic Surgery, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Eric R Carlson
- Professor and Kelly L. Krahwinkel Chairman, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN.
| | - R Eric Heidel
- Associate Professor of Biostatistics, Department of Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Michael L Winstead
- Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Mina D Fahmy
- Resident, Department of Oral and Maxillofacial Surgery
| | | |
Collapse
|
42
|
Hechler B, Carlson ER, Heidel RE, Fahmy MD, McCoy JM. Are Oral Pain and Otalgia Predictive of Perineural Invasion in Squamous Cell Carcinoma of the Oral Tongue? J Oral Maxillofac Surg 2020; 78:1418-1426. [PMID: 32360237 DOI: 10.1016/j.joms.2020.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/08/2020] [Accepted: 03/20/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Tongue cancer is often associated with pain and perineural invasion. The purpose of the present study was to determine the association between tongue pain and otalgia and the microscopic identification of perineural invasion (PNI) in patients with squamous cell carcinoma of the tongue (SCCOT). PATIENTS AND METHODS A retrospective cohort study was performed of patients with a diagnosis of SCCOT from January 2013 through June 2019. Patients without a history of head and neck cancer, who had SCCOT diagnosed and treated surgically by a single surgeon, were included in the present study. The primary predictor variables were tongue pain and otalgia (presence vs absence of both). Other variables included patient demographic data and TNM stage. The primary outcome variable was the histologic presence of PNI. A χ2 analysis was performed to test for any significant associations between pain, T stage, and overall stage in relation to PNI outcome. Multivariate logistic regression analysis was used to control for cancer staging variables when testing the association between pain and PNI. RESULTS The sample included 128 subjects, of whom 76 were men. Their mean age was 60 years. Most patients (n = 97; 75.8%) complained of tongue pain and a few (n = 50; 39.1%) complained of otalgia. The patients with otalgia had a 3.15 times greater odds of PNI when controlling for T stage (P = .016) and 3.68 times greater odds of PNI when controlling for overall stage (P = .007). Increasing T stage and overall stage-with the exception of stage II-were also significantly associated with PNI (P ≤ .05). CONCLUSIONS Our study has demonstrated a statistically significant association between preoperative otalgia and PNI in a consecutive group of patients presenting with newly diagnosed SCCOT.
Collapse
Affiliation(s)
- Benjamin Hechler
- Fellow, Oral/Head and Neck Oncologic Surgery Fellowship Program, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, University of Tennessee Cancer Institute, Knoxville, TN
| | - Eric R Carlson
- Professor and Kelly L. Krahwinkel Chairman, Department of Oral and Maxillofacial Surgery, and Director, Oral/Head and Neck Oncologic Surgery Fellowship Program, University of Tennessee Medical Center, University of Tennessee Cancer Institute, Knoxville, TN.
| | - R Eric Heidel
- Associate Professor of Biostatistics, Department of Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Mina D Fahmy
- Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - J Michael McCoy
- Professor, Departments of Oral and Maxillofacial Surgery, Pathology, and Radiology, University of Tennessee Medical Center, Knoxville, TN
| |
Collapse
|
43
|
Hochman-Elam LN, Heidel RE, Shmalberg JW. Effects of laser power, wavelength, coat length, and coat color on tissue penetration using photobiomodulation in healthy dogs. Can J Vet Res 2020; 84:131-137. [PMID: 32255908 PMCID: PMC7088515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/03/2019] [Indexed: 06/11/2023]
Abstract
Photobiomodulation is an accepted regenerative medicine treatment modality used to stimulate tissue repair, mediate inflammation, and improve mobility in humans and animals. The objective of this study was to assess the influence of laser power and wavelength, coat length and color, and shaving on in-vivo photon delivery by therapeutic laser in dogs. Forty-seven dogs of various breeds and coat colors (17 black, 15 brown, and 15 white) and with varying coat lengths were assessed with 2 commercially available veterinary lasers. Photons were delivered to the lateral aspect of the inguinal fold and calcaneal tendon, with direct penetration through the dermis, as well as dermis and tendon, as measured with a thermopile laser sensor. Significant impacts on laser transmission were noted for laser power (P = 0.001), wavelength (P < 0.002), coat color (P < 0.001), and shaved coat (P < 0.001). Percent transmission was higher for a class IV 810/980 nm wavelength laser at 0.5 W than for a class IIIb 904 nm laser (P < 0.001). There was a significant difference between transmission of photons among white, brown, and black coats, with less transmission noted with increasing coat pigment (P < 0.001). Transmission was greater at higher power levels (3 W, 5 W) Results showed significant differences in laser transmission for all variables assessed, with the exception of coat length, which was not a significant predictor of laser transmission. As transmission was significantly reduced in darker and unshaved areas, higher power lasers may be necessary for darker pigmented dogs and shaving of hair is recommended before laser therapy.
Collapse
Affiliation(s)
- Lindsay N Hochman-Elam
- Department of Comparative, Diagnostic, and Population Medicine, University of Florida College of Veterinary Medicine, 2015 SW 16th Avenue, PO Box 100123, Gainesville, Florida 32608, USA (Hochman-Elam, Shmalberg); Department of Surgery, Division of Biostatistics, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, Tennessee 37920, USA (Heidel RE)
| | - R Eric Heidel
- Department of Comparative, Diagnostic, and Population Medicine, University of Florida College of Veterinary Medicine, 2015 SW 16th Avenue, PO Box 100123, Gainesville, Florida 32608, USA (Hochman-Elam, Shmalberg); Department of Surgery, Division of Biostatistics, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, Tennessee 37920, USA (Heidel RE)
| | - Justin W Shmalberg
- Department of Comparative, Diagnostic, and Population Medicine, University of Florida College of Veterinary Medicine, 2015 SW 16th Avenue, PO Box 100123, Gainesville, Florida 32608, USA (Hochman-Elam, Shmalberg); Department of Surgery, Division of Biostatistics, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, Tennessee 37920, USA (Heidel RE)
| |
Collapse
|
44
|
Towers CV, Chattin K, Liske E, Rangnekar N, Katz K, Heidel RE. 374: Universal hepatitis C virus testing as part of prenatal care. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Koszalinski RS, Heidel RE, McCarthy J. Difficulty envisioning a positive future: Secondary analyses in patients in intensive care who are communication vulnerable. Nurs Health Sci 2019; 22:374-380. [PMID: 31736225 DOI: 10.1111/nhs.12664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to report a secondary analysis of data collected through a primary study. The primary study was a, randomized, control trial that used a team-designed (nursing, speech language hearing, engineering, communication sciences, and biostatistics), nurse-led, electronic communication intervention (Speak for Myself Voice) and measured patient outcomes of symptoms of anxiety and depression in five intensive care units at a regional, magnet-status, academic medical center. A secondary analysis of data using the Hospital Anxiety and Depression scale is reported here. The extant literature supports patient expressions of frustration, anger, anxiety, and depression when unable to communicate. This secondary analysis study report adds information about Hospital Anxiety and Depression subscales in the communication-vulnerable population. Implications include emerging awareness of potential feelings of depression and anxiety in patients who are receiving mechanical ventilation or who are unable to verbally communicate for any reason (e.g. obstruction, trauma, head and neck cancer) in the intensive care unit.
Collapse
Affiliation(s)
| | - R Eric Heidel
- Department of Surgery, The University of Tennessee School of Graduate Medicine, Knoxville, Tennessee, USA
| | - Jillian McCarthy
- Department of Audiology and Speech Pathology, The University of Tennessee Health Science Center, Knoxville, Tennessee, USA
| |
Collapse
|
46
|
Livesay J, Lorson W, Eric Heidel R, Shorman M. 154. Do I Really Need a Transesophageal Echo? Comparing Echocardiographic Modalities in Native Valve Infective Endocarditis due to Methicillin-Resistant Staphylococcus aureus. Open Forum Infect Dis 2019. [PMCID: PMC6809529 DOI: 10.1093/ofid/ofz360.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis (IE) is associated with high morbidity and mortality. Management commonly includes six-weeks of antibiotics and surgical intervention, if the patient has complications. Current guidelines recommend obtaining an echocardiogram. Transesophageal echocardiogram (TEE) is preferred over transthoracic echocardiogram (TTE). We wanted to evaluate the role of a TEE in changing management of MRSA IE. Methods A retrospective cohort of patients with MRSA IE was analyzed between January 2013 and July 2017 at a tertiary care facility in East Tennessee. Patients with prosthetic valves or cardiac devices were excluded. Demographic, echocardiographic, antibiotic, blood culture, mortality, and intravenous drug use data were collected (Figure 1). Results Seventy-eight patients met the inclusion criteria. TTE was performed on 73 patients while five patients proceeded directly to TEE. Of the 73 patients that had a TTE, 33 (45.2%) detected the presence of vegetation and 40 (54.8%) did not. Of the 33 patients with a positive TTE, 15 subsequently underwent TEE, confirming IE. Out of the 40 patients with a negative TTE, 34 underwent TEE, of which 22 (64.7%) showed a vegetation. (Figure 2). A total of ten patients (12.8%) from the study underwent surgery. Of these ten, three (30%) had a positive TTE only, with no subsequent TEE. Five (50%) had both a positive TTE and TEE, and two (20%) had a negative TTE but positive TEE. Conclusion Transthoracic echocardiogram was adequate to visualize vegetations in 45.2% of patients. Completing a TEE increased the sensitivity of visualizing a vegetation, but management was most often not altered. Only two patients (5%) with a negative TTE, but positive TEE proceeded to surgery because of the findings. This causes us to question whether a subsequent TEE needs to be pursued when a TTE is negative in the setting of definite or possible IE by the modified Duke criteria. Even if a vegetation is seen on TEE the patient would most likely receive the same treatment, 6 weeks of intravenous antibiotics, as if no vegetation was seen. Forgoing a TEE reduces risk to the patient of undergoing a procedure, and reduces costs to the healthcare system. ![]()
![]()
Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- James Livesay
- Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee
| | - William Lorson
- Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee
| | - R Eric Heidel
- Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee
| | | |
Collapse
|
47
|
Frisbee J, Heidel RE, Rasnake MS. Adverse Outcomes Associated With Potentially Inappropriate Antibiotic Use in Heart Failure Admissions. Open Forum Infect Dis 2019; 6:ofz220. [PMID: 31211161 PMCID: PMC6559271 DOI: 10.1093/ofid/ofz220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/07/2019] [Indexed: 11/15/2022] Open
Abstract
Background Acute decompensated heart failure (ADHF) can be confused with other conditions that cause dyspnea. Patients with ADHF are often simultaneously treated for community-acquired pneumonia (CAP), even when evidence for infection is lacking. We hypothesized that the fluid and sodium content of potentially unnecessary intravenous antibiotic (IVAB) therapy could worsen outcomes of ADHF patients. Methods We reviewed 144 ADHF patients at low risk of pneumonia based on diagnostic findings and clinical documentation. The primary end point was length of stay. Secondary outcomes were mortality, readmission rates, amount of diuretic received, and fluid volume and quantity of sodium administered as part of IVAB therapy. Results Of the 144 admissions reviewed, 88 did not and 56 did receive IVAB. IVAB-treated patients received an average of 1.7 L of additional fluid (230 mL/d) and 9311 mg of additional sodium (1381 mg/d) as a result of IVAB therapy. Length of stay was longer in the IVAB arm (6.6 days) compared with the no-IVAB arm (3.0 days; P < .001). Patients required more furosemide in the IVAB arm (930 mg) compared with the no-IVAB arm (320 mg; P < .001). Patients who received IVAB were also 2.51 times more likely to be readmitted compared with patients who did not receive IVAB (P = .04). Conclusions ADHF patients who received IVAB without evidence of infection had longer lengths of stay, required more diuretics, and were more likely to be readmitted compared with ADHF patients not exposed to IVAB. ADHF patients are a promising target of antibiotic stewardship interventions.
Collapse
Affiliation(s)
- Jason Frisbee
- Department of Medicine, Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee
| | - R Eric Heidel
- Department of Surgery, Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee
| | - Mark S Rasnake
- Department of Medicine, Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee
| |
Collapse
|
48
|
Tester E, Grabeel KL, Oelschlegel S, Heidel RE, Russomanno J. Call to Action: Librarians Promoting Health Literacy Assessments in Oral Communication. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/15323269.2019.1586287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Emily Tester
- Health Information Center at the Preston Medical Library and University of Tennessee Medical Center, The University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Kelsey Leonard Grabeel
- Health Information Center at the Preston Medical Library and University of Tennessee Medical Center, The University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Sandy Oelschlegel
- Health Information Center at the Preston Medical Library and University of Tennessee Medical Center, The University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - R. Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Jennifer Russomanno
- The Office of Continuing Education and Professional Development, The University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| |
Collapse
|
49
|
Roberson PN, Southerland A, Mitchel H, Lloyd J, Heidel RE, Bell JL. Factors predicting medication prescription adherence in Appalachian breast cancer patients. Breast J 2019; 25:338-339. [DOI: 10.1111/tbj.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 10/27/2022]
Affiliation(s)
- Patricia N.E. Roberson
- Department of Human Ecology; Human Development; University of California, Davis; Davis California
| | - Aubrey Southerland
- Graduate School of Medicine; University of Tennessee; Knoxville Tennessee
| | - Hannah Mitchel
- Graduate School of Medicine; University of Tennessee; Knoxville Tennessee
| | - Jillian Lloyd
- Graduate School of Medicine; University of Tennessee; Knoxville Tennessee
| | - R. Eric Heidel
- Graduate School of Medicine; University of Tennessee; Knoxville Tennessee
| | - John L. Bell
- Graduate School of Medicine; University of Tennessee; Knoxville Tennessee
| |
Collapse
|
50
|
Richey T, Foster JS, Williams AD, Williams AB, Stroh A, Macy S, Wooliver C, Heidel RE, Varanasi SK, Ergen EN, Trent DJ, Kania SA, Kennel SJ, Martin EB, Wall JS. Macrophage-Mediated Phagocytosis and Dissolution of Amyloid-Like Fibrils in Mice, Monitored by Optical Imaging. Am J Pathol 2019; 189:989-998. [PMID: 30735627 DOI: 10.1016/j.ajpath.2019.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 01/27/2023]
Abstract
Light chain-associated amyloidosis is characterized by the extracellular deposition of amyloid fibrils in abdominothoracic organs, skin, soft tissue, and peripheral nerves. Phagocytic cells of the innate immune system appear to be ineffective at clearing the material; however, human light chain amyloid extract, injected subcutaneously into mice, is rapidly cleared in a process that requires neutrophil activity. To better elucidate the phagocytosis of light chain fibrils, a potential method of cell-mediated dissolution, amyloid-like fibrils were labeled with the pH-sensitive dye pHrodo red and a near infrared fluorophore. After injecting this material subcutaneously in mice, optical imaging was used to quantitatively monitor phagocytosis and dissolution of fibrils concurrently. Histologic evaluation of the residual fibril masses revealed the presence of CD68+, F4/80+, ionized calcium binding adaptor molecule 1- macrophages containing Congo red-stained fibrils as well as neutrophil-associated proteins with no evidence of intact neutrophils. These data suggest an early infiltration of neutrophils, followed by extensive phagocytosis of the light chain fibrils by macrophages, leading to dissolution of the mass. Optical imaging of this novel murine model, coupled with histologic evaluation, can be used to study the cellular mechanisms underlying dissolution of synthetic amyloid-like fibrils and human amyloid extracts. In addition, it may serve as a test bed to evaluate investigational opsonizing agents that might serve as therapeutic agents for light chain-associated amyloidosis.
Collapse
Affiliation(s)
- Tina Richey
- Department of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - James S Foster
- Department of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Angela D Williams
- Department of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | | | - Alexa Stroh
- Department of Biochemistry, Cellular and Molecular Biology, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Sallie Macy
- Department of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Craig Wooliver
- Department of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Siva K Varanasi
- Department of Biochemistry, Cellular and Molecular Biology, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Elizabeth N Ergen
- Department of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Dianne J Trent
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Stephen A Kania
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Stephen J Kennel
- Department of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Emily B Martin
- Department of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Jonathan S Wall
- Department of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee.
| |
Collapse
|