The Effect of Anesthetic Drugs During Craniotomy on Patient Outcomes

Glioblastoma remains an aggressive, highly malignant brain cancer with poor prognosis despite treatment options including surgery, radiotherapy, and chemotherapy. The objective of this retrospective chart review study was to evaluate if there is a correlation between the type and dose of anesthetic drugs administered during craniotomy surgery for glioblastoma and the time to first postoperative tumor progression and mortality. Based on preliminary data in mice, it was hypothesized that the use of propofol during surgery is associated with slower tumor progression and lower mortality, when compared with other anesthetic drugs. In the observed time frame, 133 patients were diagnosed with glioblastoma and underwent a total of 161 craniotomy surgeries (23 awake, 138 asleep) at Henry Ford Hospital. Propofol was utilized in 97.5% of these surgeries. Other anesthetics such as isoflurane (53.4%), dexmedetomidine (37.7%), sevoflurane (31.0%), desflurane (14.3%), and nitrous oxide (4.9%) were used less frequently. Data analysis regarding time to progression and mortality after use of each anesthetic remains in progress. This study will guide the administration of anesthetic drugs during surgery to treat glioblastoma, with potential to improve the poor prognosis for these patients

Emergent Surgical Airway Skills: Time to Re-evaluate the Competencies

Introduction: One of the most challenging scenarios an anesthesia provider can face is treating a can\u27t intubate can\u27t ventilate (CICV) patient. The incidence of CICV is estimated to be around one in 10,000 cases. According to the American Society of Anesthesiology Closed Claims Study, adverse respiratory events are the most common type of injury, with difficult intubation and ventilation contributing to the majority of these cases. The objective of this non-interventional quality improvement project was to evaluate the prior training, exposure, and self-reported confidence in handling the CICV scenario among anesthesia providers at Henry Ford Hospital in Detroit, MI. Methods: An online questionnaire was distributed via email to all residents, certified registered nurse anesthetists (CRNAs), and attending anesthesiologists in March 2021. The email contained a link to an online questionnaire via Microsoft Forms (Microsoft Corporation, Redmond, WA). Univariate group comparisons were carried out between the respondents\u27 role (attending, CRNA, or resident), as well as between the number of years that the respondents were in practice (\u3c 5 years, 5-10 years, \u3e 10 years). Results: Out of the total 170 anesthesia providers, 119 participated in the study where 54 (45%) were attendings, 44 (37%) were residents, and 21 (18%) were CRNAs. The majority (75%) did not know the surgical airway kit location, and 87% had not performed the surgical airway procedure before. The vast majority (96.7%) recommended simulation training compared to online training or lecture series, and just over 50% recommended annual training frequency. When looking at the differences in responses based on years of experience as an anesthesia provider, the majority of those with \u3e 10 years in practice knew how to perform the surgical airway technique while respondents with \u3c 5 years did not know how to perform the technique, and 50% of those with five to 10 years experience knew how to perform the surgical airway procedure for a CICV scenario. Conclusion: Although there were many significant differences observed between the various provider roles and years in practice, surprisingly, the responses revealed both a lack of experience and confidence in performing the surgical airway procedure in all provider roles. These findings highlight a need for better emergency airway teaching and training. These findings will be used to guide the design and implementation of improved surgical airway training for residents, CRNAs, and attending anesthesiologists with the goal of better preparedness for handling a CICV scenario

Sequential Organ Failure Assessment (SOFA) Score and Mortality Prediction in Patients With Severe Respiratory Distress Secondary to COVID-19

Background: This study looks at the validity of the sequential organ failure assessment score (SOFA) in detecting mortality in patients with Coronavirus disease of 2019 (COVID-19) pneumonia. Also, it is looking to determine the optimal SOFA score that will discriminate between mortality and survival. Methods: It is a retrospective chart review of the patients admitted to Henry Ford Hospital from March 2020 to December 2020 with COVID-19 pneumonia who developed severe respiratory distress. We collected the following information; patient demographics (age, sex, body mass index), co-morbidities (history of diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, coronary artery disease, or cancer), SOFA scores (the ratio of arterial oxygen tension (PaO(2)) to the fraction of inspired oxygen, Glasgow Coma Scale (GCS) score, mean arterial pressure, serum creatinine level, bilirubin level, and platelet count) as well as inpatient mortality. Results: There were 320 patients; out of these, 111 were intubated. The receiver operating characteristic (ROC) curve for SOFA at the moment of inclusion in the study had an area under the curve of 0.883. The optimal point for discrimination between mortality and survival is SOFA of 5. A SOFA score of less than two is associated with 100% survival, while a score of more than 11 is associated with 100% mortality. Conclusions: SOFA score in COVID-19 patients with severe respiratory distress strongly correlates with the initial SOFA score. It is a valuable tool for predicting mortality in COVID-19 patients

O Pensamento Crítico pode ser fomentado por museus através do uso de redes sociais? E isso pode ser mensurado?

As museums more frequently employ cyberlearning tools to engage target audiences, questions are left as to the effect they have on critical thinking and participant interaction. While research exists regarding the extent to which critical thinking is stimulated in formal cyber-learning environments, studies related to informal cyber-learning environments, such as virtual conferences, are lacking. The scope of this project was to evaluate whether critical thinking could be assessed in virtual conferences and the extent to which it could be stimulated. A mixed- method approach, evaluating participation logistics and conversation analysis, revealed that, while critical thinking was stimulated during the virtual conferences, mostly the less complex stages, ””such as problem identification and definition””were observed. More complex stages ””such as problem exploration, application, and integration””were not as commonly observed. The study also confirmed the crucial role of the moderator in facilitating participation. Com o crescimento do uso de ferramentas de cyber-aprendizagem (cyber-learning) por parte dos museus para envolver seus públicos-alvo, permanecem questões sobre o efeito dessas ferramentas sobre o pensamento crítico e a interação dos participantes. Apesar da existência de pesquisas sobre a que extensão o pensamento crítico é fomentado em ambientes formais de cyber-aprendizagem, há uma falta de pesquisas em ambientes informais de cyber-aprendizagem, como conferências virtuais. O objetivo do projeto era avaliar se o pensamento crítico poderia ser mensurado em conferências virtuais e em eu medida ele poderia ser estimulado. Uma abordagem de métodos mistos avaliando a logística de participação e a análise de conversas revelou que, embora o pensamento crítico tenha sido estimulado durante as conferências virtuais, apenas as primeiras fases, como a identificação e definição de problemas, foram utilizadas pelos participantes. As fases superiores do pensamento crítico, a exploração de problemas, a aplicação e a integração não foram muito utilizadas durante as conferências virtuais. O estudo também confirmou o papel crucial do moderador na facilitação da participação

O Pensamento Crítico pode ser fomentado por museus através do uso de redes sociais? E isso pode ser mensurado?

As museums more frequently employ cyberlearning tools to engage target audiences, questions are left as to the effect they have on critical thinking and participant interaction. While research exists regarding the extent to which critical thinking is stimulated in formal cyber-learning environments, studies related to informal cyber-learning environments, such as virtual conferences, are lacking. The scope of this project was to evaluate whether critical thinking could be assessed in virtual conferences and the extent to which it could be stimulated. A mixed- method approach, evaluating participation logistics and conversation analysis, revealed that, while critical thinking was stimulated during the virtual conferences, mostly the less complex stages, ””such as problem identification and definition””were observed. More complex stages ””such as problem exploration, application, and integration””were not as commonly observed. The study also confirmed the crucial role of the moderator in facilitating participation. Com o crescimento do uso de ferramentas de cyber-aprendizagem (cyber-learning) por parte dos museus para envolver seus públicos-alvo, permanecem questões sobre o efeito dessas ferramentas sobre o pensamento crítico e a interação dos participantes. Apesar da existência de pesquisas sobre a que extensão o pensamento crítico é fomentado em ambientes formais de cyber-aprendizagem, há uma falta de pesquisas em ambientes informais de cyber-aprendizagem, como conferências virtuais. O objetivo do projeto era avaliar se o pensamento crítico poderia ser mensurado em conferências virtuais e em eu medida ele poderia ser estimulado. Uma abordagem de métodos mistos avaliando a logística de participação e a análise de conversas revelou que, embora o pensamento crítico tenha sido estimulado durante as conferências virtuais, apenas as primeiras fases, como a identificação e definição de problemas, foram utilizadas pelos participantes. As fases superiores do pensamento crítico, a exploração de problemas, a aplicação e a integração não foram muito utilizadas durante as conferências virtuais. O estudo também confirmou o papel crucial do moderador na facilitação da participação

Effect of Intubation Timing on the Outcome of Patients With Severe Respiratory Distress Secondary to COVID-19 Pneumonia.

Background: The optimal timing of intubation for critically ill patients with severe respiratory illness remains controversial among healthcare providers. The coronavirus disease 2019 (COVID-19) pandemic has raised even more questions about when to implement this life-saving therapy. While one group of providers prefers early intubation for patients with respiratory distress because these patients may deteriorate rapidly without it, other providers believe that intubation should be delayed or avoided because of its associated risks including worse outcomes. Research question: Our objective was to assess whether the timing of intubation in patients with severe COVID-19 pneumonia was associated with differences in mortality or other outcomes. Study design and methods: This was a single-center retrospective observational cohort study. We analyzed outcomes of patients who were intubated secondary to COVID-19 pneumonia between March 13, 2020, and December 12, 2020, at Henry Ford Hospital in Detroit, Michigan. Patients were categorized into two groups: early intubated (intubated within 24 hours of the onset of severe respiratory distress) and late intubated (intubated after 24 hours of the onset of severe respiratory distress). Demographics, comorbidities, respiratory rate oxygenation (ROX) index, sequential organ failure assessment (SOFA) score, and treatment received were compared between groups. The primary outcome was mortality. Secondary outcomes were ventilation time, intensive care unit stay, hospital length of stay, and discharge disposition. Post hoc and Kaplan-Meier survival analyses were performed. Results: A total of 110 patients were included: 55 early intubated and 55 late intubated. We did not observe a significant difference in overall mortality between the early intubated (43%) and the late intubated groups (53%) (p = 0.34). There was no statistically significant difference in patients\u27 baseline characteristics including SOFA scores (the early intubation group had a mean score of 7.5 compared to 6.7 in the late intubation group). Based on the ROX index, the early intubation group had significantly more patients with a reduced risk of intubation (45%) than the late group (27%) (p = 0.029). The early intubation group was treated with a high-flow nasal cannula at a significantly lower rate (47%) than the late intubation group (83%) (p \u3c 0.001). Significant differences in patient baseline characteristics, treatment received, and other outcomes were not observed. Post hoc analysis adjusting for SOFA score between 0 and 9 revealed significantly higher mortality in the late intubation group (49%) than in the early intubation group (26%) (p = 0.03). Patients in the 0 to 9 SOFA group who were intubated later had 2.7 times the odds of dying during hospital admission compared to patients who were intubated early (CI, 1.09-6.67). Interpretation: The timing of intubation for patients with severe COVID-19 pneumonia was not significantly associated with overall mortality or other patient outcomes. However, within the subgroup of patients with SOFA scores of 9 or lower at the time of intubation, patients intubated after 24 hours of the onset of respiratory distress had a higher risk of death than those who were intubated within 24 hours of respiratory distress. Thus, patients with COVID-19 pneumonia who are not at a high level of organ dysfunction may benefit from early mechanical ventilation

The Burnout Epidemic Within A Viral Pandemic: Impact of a Wellness Initiative

Background: Anesthesiologists are at high risk of developing burnout, a condition which can lead to many deleterious effects for the physician, and far-reaching effects on their patients and hospital systems. The COVID-19 pandemic has presented new challenges that have further exacerbated the risk of burnout in anesthesiologists. It is critical to develop effective strategies to promote well-being and decrease burnout for physicians in this specialty. The purpose of this observational study was to evaluate the impact of a Physician Well-Being Initiative on distress and well-being in anesthesiologists. It was hypothesized that the wellness intervention would promote an improvement in well-being scores. Methods: The Physician Well-Being Initiative was launched in August 2019 in the Department of Anesthesiology, Pain Management and Perioperative Medicine at Henry Ford Hospital in Detroit, Michigan. The Physician Well-Being Initiative was designed to address several of the key factors that improve physician wellness, including 1) a sense of autonomy; 2) positive view of leadership; and 3) flexible schedule opportunities. To assess the impact of the Physician Well-Being Initiative on the well-being and distress scores of participating anesthesiologists, the physicians were emailed the validated Well-Being Index survey at baseline and 3, 6 and 12 months. The Well-Being Index evaluates multiple items of distress in the healthcare setting. The sample size was limited to the 54 anesthesiologists at Henry Ford Hospital. Results: Forty-four of the 54 anesthesiologists completed the baseline questionnaire. A total of 44 physicians answered the questionnaire at baseline, with more male than female physicians (35 males and 7 females) and the majority (17/44) in practice for 5-10 years. Thirty-two physicians completed the survey at 3 and 6 months, and 31 physicians at 12 months after the launch of the Physician Well-Being Initiative. Twenty-one physicians completed the questionnaire at all 4 time points. Although the COVID-19 pandemic started shortly after the 6-month surveys were submitted, results indicated that there was a 0.05 decrease in the Well-Being Index sum score for every 1-month of time (coefficient -0.05, 95% CI -0.01, -0.08, P = 0.013). This study shows that, with the wellness initiative in place, the department was able to maintain and potentially even reduce physician distress despite the concurrent onset of the pandemic. Conclusions: Following the launch of a sustained wellness initiative, this study demonstrates that physician wellness improved with time. This suggests that it takes time for a wellness initiative to have an effect on well-being and distress in anesthesiologists

Bordetella pertussis Whole Cell Immunization, Unlike Acellular Immunization, Mimics Naïve Infection by Driving Hematopoietic Stem and Progenitor Cell Expansion in Mice

Hematopoietic stem and progenitor cell (HSPC) compartments are altered to direct immune responses to infection. Their roles during immunization are not well-described. To elucidate mechanisms for waning immunity following immunization with acellular vaccines (ACVs) against Bordetella pertussis (Bp), we tested the hypothesis that immunization with Bp ACVs and whole cell vaccines (WCVs) differ in directing the HSPC characteristics and immune cell development patterns that ultimately contribute to the types and quantities of cells produced to fight infection. Our data demonstrate that compared to control and ACV-immunized CD-1 mice, immunization with an efficacious WCV drives expansion of hematopoietic multipotent progenitor cells (MPPs), increases circulating white blood cells (WBCs), and alters the size and composition of lymphoid organs. In addition to MPPs, common lymphoid progenitor (CLP) proportions increase in the bone marrow of WCV-immunized mice, while B220+ cell proportions decrease. Upon subsequent infection, increases in maturing B cell populations are striking in WCV-immunized mice. RNAseq analyses of HSPCs revealed that WCV and ACV-immunized mice vastly differ in developing VDJ gene segment diversity. Moreover, gene set enrichment analyses demonstrate WCV-immunized mice exhibit unique gene signatures that suggest roles for interferon (IFN) induced gene expression. Also observed in naïve infection, these IFN stimulated gene (ISG) signatures point toward roles in cell survival, cell cycle, autophagy, and antigen processing and presentation. Taken together, these findings underscore the impact of vaccine antigen and adjuvant content on skewing and/or priming HSPC populations for immune response

Bostonia: The Boston University Alumni Magazine. Volume 10

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs