A longitudinal analysis of the impact of fatigue on return to activities of daily living during the first year after liver transplantation

poster abstractLiver transplantation is often thought of as organ recovery and lifesaving surgery. The reality is a prolonged and stressful time for the patient and their family (Scott & Brown, 2011). The persistence of fatigue after liver transplantation is well documented in the research literature (Aadahl, Hansen, Kirkegaard, & Groenvold, 2002; van den Berg-Emons et al., 2006; Van Ginneken et al., 2010). However, there is no evidence as to the timing of how this fatigue dissipates during the early transplanted period and its impact on quality of life. Furthermore, studies on changes in fatigue do not start until 6 months after transplant, leaving a gap in knowledge of the patient’s experience post-surgery up to this point. This ongoing longitudinal study is aimed at better understanding the recovery process. Patients from a Midwest medical center (N=21) were followed post-discharge, at weeks 1-8 and at months 3, 6, 9, and 12. The FACIT-Fatigue Scale (Cella, 1997) indicates a decrease in fatigue scores (less fatigue) in those subjects without adverse events. Adverse events including re-hospitalization, surgical complications and organ rejection were associated with higher FACIT scores (higher level of fatigue) and less resolution over this first year. Through this research Dr. Scott and her team hope to translate their findings into educational resources for patients and their families to understand what to anticipate during the post-transplant recovery period

Impact of medical, health related, social and occupational factors on post-liver transplant recovery: a longitudinal study

poster abstractPurpose: Organ transplantation is a serious surgery with nearly 10% of patients failing to survive the first three months. Studies of quality of life reflect an increase post-transplant, as compared to pre-transplant, then reports vary including a trend towards decreasing QOL scores by the end of the first transplanted year. In this first year, patients have an increased risk of re-hospitalization due to infection, failure of the body to accept the graft, problems with anti-rejection medications or post- surgical complications. Methods: A longitudinal study of liver transplant recipients (n=23) followed medical, social, and occupational factors, along with SF-36 measures. Results: Variability in QOL scores at 1, 2, 3, 6, 9, and 12 months were directly related to identifiable factors. In those subjects where health returned in an uncomplicated manner, QOL scores consistently improved with the greatest change occurring over the first six months and then tapering off through the end of the first year. Conclusions: These subjects almost uniformly expressed frustration at the length of time it took to return to a healthy state. In circumstances where recovery was delayed due to medical reasons, QOL scores declined significantly until the problems were resolved. In several cases, QOL scores stayed low as these individuals were unprepared for the potential complications associated with this difficult surgery

The Efficacy of Zuranolone Versus Placebo in Postpartum Depression and Major Depressive Disorder: A Systematic Review and Meta-Analysis

Background Zuranolone, an oral version of allopregnanolone and neurosteroid, is a novel drug for the treatment of major depressive disorder (MDD) and postpartum depression (PPD). Aim The purpose of this systematic review and meta-analysis was to assess the efficacy of zuranolone in the treatment of MDD and PPD. Method A systematic search was conducted using EBSCOhost to simultaneously search Academic Search Premier, APA PsycArticles, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL Ultimate, and MEDLINE with Full Text. Two independent reviewers screened the articles and completed a full-text review using Covidence. The quality of each study was assessed using the Cochrane Risk of Bias tool for randomized trials (RoB 2). A meta-analysis was then conducted using Review Manager (RevMan v5.4) software. Results The initial search yielded 127 results, with 6 articles fitting our inclusion and exclusion criteria. All 6 studies, comprising 1707 participants, had an overall low risk of bias. There was a significant decrease in HAM-D scores for MDD at 15 days versus placebo (MD − 2.40, 95% CI − 3.07 to − 1.63; p \u3c .001). When pooling data for PDD, there was an overall significant decrease in HAM-D scores at 15 days versus placebo (MD − 4.06, 95% CI − 4.25 to − 3.87; p \u3c .001). Conclusion The results suggest that zuranolone can improve symptoms of PPD at 15 days; however, results were not clinically significant for MDD. Future research is needed to evaluate the long-term efficacy of zuranolone in PPD and the treatment efficacy in MDD

The number of inpatient consultations is negatively correlated with patient satisfaction in patients with prolonged hospital stays

Patient satisfaction is often measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. Our aim was to examine the structural and clinical determinants of satisfaction among inpatients with prolonged lengths of stays (LOS)

The metabolic regimes of 356 rivers in the United States

A national-scale quantification of metabolic energy flow in streams and rivers can improve understanding of the temporal dynamics of in-stream activity, links between energy cycling and ecosystem services, and the effects of human activities on aquatic metabolism. The two dominant terms in aquatic metabolism, gross primary production (GPP) and aerobic respiration (ER), have recently become practical to estimate for many sites due to improved modeling approaches and the availability of requisite model inputs in public datasets. We assembled inputs from the U.S. Geological Survey and National Aeronautics and Space Administration for October 2007 to January 2017. We then ran models to estimate daily GPP, ER, and the gas exchange rate coefficient for 356 streams and rivers across the continental United States. We also gathered potential explanatory variables and spatial information for cross-referencing this dataset with other datasets of watershed characteristics. This dataset offers a first national assessment of many-day time series of metabolic rates for up to 9 years per site, with a total of 490,907 site-days of estimates.We thank Jill Baron and the USGS Powell Center for financial support for this collaborative effort (Powell Center Working Group title: "Continental-scale overview of stream primary productivity, its links to water quality, and consequences for aquatic carbon biogeochemistry"). Additional financial support came from the USGS NAWQA program and Office of Water Information. NSF grants DEB-1146283 and EF1442501 partially supported ROH. A post-doctoral grant from the Basque Government partially supported MA. NAG was supported by the U.S. Department of Energy's Office of Science, Biological and Environmental Research. Oak Ridge National Laboratory is managed by UT-Battelle, LLC, for the U.S. Department of Energy under contract DE-AC05-00OR22725. Leah Colasuonno provided expert logistical support of our working group meetings. The developers of USGS ScienceBase were very helpful both in hosting this dataset and in responding to our requests. Randy Hunt and Mike Fienen of the USGS Wisconsin Modeling Center graciously provided access to their HTCondor cluster. Mike Vlah provided detailed and insightful reviews of the data and metadata

Does lake size matter? Combining morphology and process modeling to examine the contribution of lake classes to population-scale processes

With lake abundances in the thousands to millions, creating an intuitive understanding of the global distribution of morphology and processes in lakes is challenging. To improve researchers’ understanding of large-scale lake processes, we developed a parsimonious mathematical model based on the Pareto distribution to describe the distribution of lake morphology (area, perimeter, and volume). While debate continues over which mathematical representation best fits any one distribution of lake morphometric characteristics, we recognize the need for a simple, flexible model to advance understanding of how the interaction between morphometry and function dictates scaling across large populations of lakes. These models make clear the relative contribution of individual lakes to the total amount of lake surface area, volume, and perimeter. They also highlight the critical thresholds at which total perimeter, area, and volume would be evenly distributed across lake-size classes having Pareto slopes of 0.63, 1.00, and 1.12, respectively. These morphological models can be used in combination with process models to create overarching “lake population” level models of process. To illustrate this potential, we combined the model of surface area distribution with a model of carbon mass accumulation rate. We found that even if smaller lakes contribute relatively less to total surface area than larger lakes, the increasing carbon accumulation rate with decreasing lake size is strong enough to bias the distribution of carbon mass accumulation toward smaller lakes. This analytical framework provides a relatively simple approach to upscaling morphology and process that can be easily generalized to other ecosystem processes

Lymphovascular and perineural invasion as selection criteria for adjuvant therapy in intrahepatic cholangiocarcinoma: a multi-institution analysis

AbstractObjectivesCriteria for the selection of patients for adjuvant chemotherapy in intrahepatic cholangiocarcinoma (IHCC) are lacking. Some authors advocate treating patients with lymph node (LN) involvement; however, nodal assessment is often inadequate or not performed. This study aimed to identify surrogate criteria based on characteristics of the primary tumour.MethodsA total of 58 patients who underwent resection for IHCC between January 2000 and January 2010 at any of three institutions were identified. Primary outcome was overall survival (OS).ResultsMedian OS was 23.0months. Median tumour size was 6.5cm and the median number of lesions was one. Overall, 16% of patients had positive margins, 38% had perineural invasion (PNI), 40% had lymphovascular invasion (LVI) and 22% had LN involvement. A median of two LNs were removed and a median of zero were positive. Lymph nodes were not sampled in 34% of patients. Lymphovascular and perineural invasion were associated with reduced OS [9.6months vs. 32.7months (P= 0.020) and 10.7months vs. 32.7months (P= 0.008), respectively]. Lymph node involvement indicated a trend towards reduced OS (10.7months vs. 30.0months; P= 0.063). The presence of either LVI or PNI in node-negative patients was associated with a reduction in OS similar to that in node-positive patients (12.1months vs. 10.7months; P= 0.541). After accounting for adverse tumour factors, only LVI and PNI remained associated with decreased OS on multivariate analysis (hazard ratio4.07, 95% confidence interval 1.60–10.40; P= 0.003).ConclusionsLymphovascular and perineural invasion are separately associated with a reduction in OS similar to that in patients with LN-positive disease. As nodal dissection is often not performed and the number of nodes retrieved is frequently inadequate, these tumour-specific factors should be considered as criteria for selection for adjuvant chemotherapy

The impact of failure to achieve symptom control after resection of functional neuroendocrine tumors: An 8â institution study from the US Neuroendocrine Tumor Study Group

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147162/1/jso25306_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147162/2/jso25306.pd

CommunityRx, a social care assistance intervention for family and friend caregivers delivered at the point of care: Two concurrent blinded randomized controlled trials

Background: CommunityRx is an evidence-based social care intervention delivered to family and friend caregivers (“caregivers”) at the point of healthcare to address health-related social risks (HRSRs). Two CommunityRx randomized controlled trials (RCTs) are being fielded concurrently on Chicago’s South Side, a predominantly African American/Black community. CommunityRx-Hunger is a double-blind RCT enrolling caregivers of hospitalized children. CommunityRx-Dementia is a single-blind RCT enrolling caregivers of community-residing people with dementia. RCTs with caregivers face recruitment barriers, including caregiver burden and lack of systematic strategies to identify caregivers in clinical settings. COVID-19 pandemic-related visitor restrictions exacerbated these barriers and prompted the need for iteration of the protocols from in-person to remote operations. This study describes these protocols and methods used for successful iteration to overcome barriers. Methods and findings: CommunityRx uses individual-level data to generate personalized, local community resource referrals for basic, health and caregiving needs. In early 2020, two in-person RCT protocols were pre-tested. In March 2020, when pandemic conditions prohibited face-to-face clinical enrollment, both protocols were iterated to efficient, caregiver-centered remote operations. Iterations were enabled in part by the Automated Randomized Controlled Trial Information-Communication System (ARCTICS), a trial management system innovation engineered to integrate the data collection database (REDCap) with community resource referral (NowPow) and SMS texting (Mosio) platforms. Enabled by engaged Community Advisory Boards and ARCTICS, both RCTs quickly adapted to remote operations. To accommodate these adaptations, launch was delayed until November (CommunityRx-Hunger) and December (CommunityRx-Dementia) 2020. Despite the delay, 65% of all planned participants (CommunityRx-Hunger n = 417/640; CommunityRx-Dementia n = 222/344) were enrolled by December 2021, halfway through our projected enrollment timeline. Both trials enrolled 13% more participants in the first 12 months than originally projected for in-person enrollment. Discussion: Our asset-based, community-engaged approach combined with widely accessible institutional and commercial information technologies facilitated rapid migration of in-person trials to remote operations. Remote or hybrid RCT designs for social care interventions may be a viable, scalable alternative to in-person recruitment and intervention delivery protocols, particularly for caregivers and other groups that are under-represented in traditional health services research. Trial registration: ClinicalTrials.gov: CommunityRx-Hunger (NCT04171999, 11/21/2019); CommunityRx for Caregivers (NCT04146545, 10/31/2019).</p

Perception Is Reality: quality metrics in pancreas surgery – a Central Pancreas Consortium (CPC) analysis of 1399 patients

Several groups have defined pancreatic surgery quality metrics that identify centers delivering quality care. Although these metrics are perceived to be associated with good outcomes, their relationship with actual outcomes has not been established