A novel, multimodal, interprofessional program to improve communication skills in the CICU

Peter W. Bates Award for Excellence in Health Professions Education Research: Faculty/Staff Award - Scientific Talk. 2020 Costas T. Lambrew Research Retreat. Rebecca Hutchinson, MD, Hospice & Palliative Medicine, Maine Medical Center: A novel, multimodal, interprofessional program to improve communication skills in the CIC

How Well Does the Surprise Question Predict 1-year Mortality for Patients Admitted with COPD?

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) often receive burdensome care at end-of-life (EOL) and infrequently complete advance care planning (ACP). The surprise question (SQ) is a prognostic tool that may facilitate ACP. OBJECTIVE: To assess how well the SQ predicts mortality and prompts ACP for COPD patients. DESIGN: Retrospective cohort study. SUBJECTS: Patients admitted to the hospital for an acute exacerbation of COPD between July 2015 and September 2018. MAIN MEASURES: Emergency department (ED) and inpatient clinicians answered, Would you be surprised if this patient died in the next 30 days (ED)/one year (inpatient)? The primary outcome measure was the accuracy of the SQ in predicting 30-day and 1-year mortality. The secondary outcome was the correlation between SQ and ACP (palliative care consultation, documented goals-of-care conversation, change in code status, or completion of ACP document). KEY RESULTS: The 30-day SQ had a high specificity but low sensitivity for predicting 30-day mortality: sensitivity 12%, specificity 95%, PPV 11%, and NPV 96%. The 1-year SQ demonstrated better accuracy for predicting 1-year mortality: sensitivity 47%, specificity 75%, PPV 35%, and NPV 83%. After multivariable adjustment for age, sex, and prior 6-month admissions, 1-year SQ+ responses were associated with greater odds of 1-year mortality (OR 2.38, 95% CI 1.39-4.08) versus SQ-. One-year SQ+ patients were more likely to have a goals-of-care conversation (25% vs. 11%, p \u3c 0.01) and complete an advance directive or POLST (46% vs. 23%, p \u3c 0.01). After multivariable adjustment, SQ+ responses to the 1-year SQ were associated with greater odds of ACP receipt (OR 2.67, 95% CI 1.64-4.36). CONCLUSIONS: The 1-year surprise question may be an effective component of prognostication and advance care planning for COPD patients in the inpatient setting

Influence of Copper(II) and Nickel(II) Ions in the Topology of Systems Based on a Flexible Bis-Oxamate and Bipyridine Building Blocks

Single crystals of the mononuclear bis-oxamate nickel­(II) complex [Ni­(bipy)­(H₂edpba)]·dmso (<b>1</b>) are obtained by reacting [Ni­(bipy)­Cl₂]·H₂O and the flexible K₂(H₂edpba) ligand [bipy = 2,2′<b>-</b>bipyridine; H₄edpba = <i>N</i>,<i>N</i>′-2,2′-ethylenediphenylenebis­(oxamic acid)]. The reaction of <b>1</b> with copper­(II) ions resulted in two products in which the replacement of the nickel­(II) ion by copper­(II) took place: the chain compound [Cu­(bipy)­(H₂edpba)]_<i>n</i>·3<i>n</i>H₂O·<i>n</i>dmso [dmso = dimethyl sulfoxide] (<b>2</b>) and the analogous chain compound without dmso crystallization molecules [Cu­(bipy)­(H₂edpba)]_<i>n</i>·1.5<i>n</i>H₂O (<b>3a</b>) in its polycrystalline form. The reaction of [Cu­(bipy)­Cl₂] and K₂(H₂edpba) yielded single crystals of [Cu­(bipy)­(H₂edpba)]_<i>n</i>·1.5<i>n</i>H₂O (<b>3b</b>). The H₂edpba^2– ligand exhibits the <i>anti</i> conformation in <b>1</b>, <b>2</b>, and <b>3b</b>, but it adopts different coordination modes: terminal bis-bidentate (<b>1</b>) and bridging bis-bidentate (<b>2</b> and <b>3b</b>) through the two pairs of carbonyl-oxygen atoms of the two oxamate arms. Magnetic susceptibility measurements carried out on a polycrystalline sample of <b>3b</b> in the temperature range 1.9–295 K showed the occurrence of very weak intrachain antiferromagnetic interactions [<i>J</i> = −0.40 cm^–1, the Hamiltonian being defined as <i><b>H</b></i> = −<i>J</i> ∑_<i>i</i><i><b>S</b></i>_<i>i</i>·<i><b>S</b></i>_<i>i</i>+1], in agreement with the large values of the copper–copper separation [8.308(3) Å]

Tracking cyanobacteria blooms: Do different monitoring approaches tell the same story?

© 2016 Elsevier B.V. Cyanobacteria blooms are a major environmental issue worldwide. Our understanding of the biophysical processes driving cyanobacterial proliferation and the ability to develop predictive models that inform resource managers and policy makers rely upon the accurate characterization of bloom dynamics. Models quantifying relationships between bloom severity and environmental drivers are often calibrated to an individual set of bloom observations, and few studies have assessed whether differences among observing platforms could lead to contrasting results in terms of relevant bloom predictors and their estimated influence on bloom severity. The aim of this study was to assess the degree of coherence of different monitoring methods in (1) capturing short- and long-term cyanobacteria bloom dynamics and (2) identifying environmental drivers associated with bloom variability. Using western Lake Erie as a case study, we applied boosted regression tree (BRT) models to long-term time series of cyanobacteria bloom estimates from multiple in-situ and remote sensing approaches to quantify the relative influence of physico-chemical and meteorological drivers on bloom variability. Results of BRT models showed remarkable consistency with known ecological requirements of cyanobacteria (e.g., nutrient loading, water temperature, and tributary discharge). However, discrepancies in inter-annual and intra-seasonal bloom dynamics across monitoring approaches led to some inconsistencies in the relative importance, shape, and sign of the modeled relationships between select environmental drivers and bloom severity. This was especially true for variables characterized by high short-term variability, such as wind forcing. These discrepancies might have implications for our understanding of the role of different environmental drivers in regulating bloom dynamics, and subsequently for the development of models capable of informing management and decision making. Our results highlight the need to develop methods to integrate multiple data sources to better characterize bloom spatio-temporal variability and improve our ability to understand and predict cyanobacteria blooms

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline