Medicine and Health Sciences Commons^™

Diaphragmatic Function In Cardiovascular Disease: Jacc Review Topic Of The Week., Husam M Salah, Lee R Goldberg, Jeroen Molinger, G Michael Felker, Willard Applefeld, Tienush Rassaf, Ryan J Tedford, Michael Mirro Md, Facc, Fhrs, Faha, John G F Cleland, Marat Fudim

Parkview Heart Institute

In addition to the diaphragm's role as the primary respiratory muscle, it also plays an under-recognized role in cardiac function. It serves as a pump facilitating venous and lymph return, modulating left ventricular afterload hemodynamics and pericardial pressures, as well as regulating autonomic tone. Heart failure (HF) is associated with diaphragmatic changes (ie, muscle fiber atrophy and weakness, increased ratio of type I to type II muscle fibers, and altered muscle metaboreflex) that lead to diaphragmatic dysfunction with subsequent symptomatic manifestations of HF. Herein, it is proposed that targeting the diaphragm in patients with HF via inspiratory muscle training or …

Self-Regulation As A Protective Factor For Diabetes Distress And Adherence In Youth With Type 1 Diabetes During The Covid-19 Pandemic., Alison L Miller, Dana K. Albright Phd, Katherine W Bauer, Hurley O Riley, Marisa E Hilliard, Julie Sturza, Niko Kaciroti, Sharon L Lo, Katy M Clark, Joyce M Lee, Emily M Fredericks

Health Services and Informatics Research

OBJECTIVE: The COVID-19 pandemic increased economic, social, and health stressors for families, yet its impacts on families of youth with chronic conditions, such as type 1 diabetes (T1D), are not well understood. Self-regulation (SR)-or the capacities to control emotions, cognition, and behavior in response to challenge-is known to support T1D management and coping in the face of stress. Strong SR may have protected youth with T1D from the impacts of pandemic-related stressors. This study compared youth and parent emotional functioning and T1D management before and after the pandemic's onset in relation to family pandemic-related stress and youth SR.

METHODS: Parents …

Synchronized Diaphragmatic Stimulation For Heart Failure Using The Visone System: A First-In-Patient Study., Ana Jorbendaze, Robin Young, Tamaz Shaburishvili, Vitaly Demyanchuk, Roman Buriak, Borys Todurov, Kostyantyn Rudenko, Michel Zuber, Simon F Stämpfli, Felix C Tanner, Paul Erne, Michael Mirro Md, Facc, Fhrs, Faha, Marat Fudim, Lee R Goldberg, John G F Cleland

Parkview Heart Institute

AIMS: Synchronized diaphragmatic stimulation (SDS) modulates intrathoracic and intra-abdominal pressures with favourable effects on cardiac function for patients with a reduced left ventricular ejection fraction (LVEF) and heart failure (HFrEF). VisONE-HF is a first-in-patient, observational study assessing the feasibility and 1 year effects of a novel, minimally invasive SDS device.

METHODS AND RESULTS: The SDS system comprises a pulse generator and two laparoscopically delivered, bipolar, active-fixation leads on the inferior diaphragmatic surface. Fifteen symptomatic men with HFrEF and ischaemic heart disease receiving guideline-recommended therapy were enrolled (age 60 [56, 67] years, New York Heart Association class II [53%] /III [47%], …

Synchronized Diaphragmatic Stimulation: A Case Report Of A Novel Extra-Cardiac Intervention For Chronic Heart Failure., Lee R Goldberg, Ana Jorbenadze, Tamaz Shaburishvilli, Michael Mirro Md, Marat Fudim, Michel Zuber, Simon F Stämpfli, Felix C Tanner, Paul Erne, John G Cleland

Parkview Heart Institute

Synchronized diaphragmatic stimulation (SDS) is a novel extra-cardiac device-based therapy for symptomatic heart failure with reduced ejection fraction. SDS provides imperceptible chronic stimulation of the diaphragm through a laparoscopically implanted system consisting of an implantable pulse generator and two sensing/stimulating leads affixed to the inferior surface of the diaphragm delivering imperceptible R-wave gaited pulses that alter intrathoracic pressure improving ventricular filling and cardiac output. We describe, in a man with a history of myocardial infarctions resulting in heart failure and persistent New York Heart Association Class III symptoms despite standard therapies, the successful implantation of SDS resulting in improved quality …

"It's A Mess Sometimes": Patient Perspectives On Provider Responses To Healthcare Costs, And How Informatics Interventions Can Help Support Cost-Sensitive Care Decisions., Olivia K Richards, Bradley E Iott, Tammy Toscos, Jessica Pater, Shauna Wagner, Tiffany C Veinot

Health Services and Informatics Research

OBJECTIVE: We investigated patient experiences with medication- and test-related cost conversations with healthcare providers to identify their preferences for future informatics tools to facilitate cost-sensitive care decisions.

MATERIALS AND METHODS: We conducted 18 semistructured interviews with diverse patients (ages 24-81) in a Midwestern health system in the United States. We identified themes through 2 rounds of qualitative coding.

RESULTS: Patients believed their providers could help reduce medication-related costs but did not see how providers could influence test-related costs. Patients viewed cost conversations about medications as beneficial when providers could adjust medical recommendations or provide resources. However, cost conversations did not …

Neuropsychological Outcomes In Individuals With Type 1 And Type 2 Diabetes., Nathaniel M Putnam, Evan L Reynolds, Mousumi Banerjee, Kara Mizokami-Stout, Dana K. Albright Phd, Joyce Lee, Rodica Pop-Busui, Eva L Feldman, Brian C Callaghan

Health Services and Informatics Research

OBJECTIVE: To determine the prevalence of neuropsychological outcomes in individuals with type 1 diabetes compared to individuals with type 2 diabetes or without diabetes, and to evaluate the association of diabetes status and microvascular/macrovascular complications with neuropsychological outcomes.

PATIENTS AND METHODS: We used a nationally representative healthcare claims database of privately insured individuals (1/1/2001-12/31/2018) to identify individuals with type 1 diabetes. Propensity score matching was used as a quasi-randomization technique to match type 1 diabetes individuals to type 2 diabetes individuals and controls. Diabetes status, microvascular/macrovascular complications (retinopathy, neuropathy, nephropathy, stroke, myocardial infarction, peripheral vascular disease, amputations), and neuropsychological outcomes …

Perhaps It Was Too Soon: College Students' Reflections On The Timing Of Their Sexual Debut., Susan Sprecher, Lucia F O'Sullivan, Michelle Drouin, Julie Verette-Lindenbaum, Marion C Willetts

Health Services and Informatics Research

Early sexual debut has been a focus of social scientific research due to its association with adverse circumstances and negative outcomes. However, there has been a recent shift to considering not only chronological age, but also the degree to which the event is viewed to be optimally timed (i.e., the perception that it occurred at the "right time" versus too soon). The purpose of this study was to assess how individual/family background variables and contextual aspects of the experience (including partner and relationship aspects) are associated with both the actual age at sexual debut and the perceived acceptability of the …

Cross-Mentorship: A Unique Lens Into The Realities And Challenges Of Diversity In Surgery., Marina Affi Koprowski, Karen J Dickinson, Crystal N Johnson-Mann, Martha Godfrey, Emilia J Diego, Marie Crandall, Kevin Y. Pei Md, Mhsed

Other Specialties

Mentorship in surgery is a perennial topic of interest, as successful mentoring relationships are associated with improved career satisfaction, academic promotion, research productivity, and overall well-being. While it is true that certain minority groups in surgery find great personal and professional benefit in receiving and providing mentorship among “their own” (ie, a female academic surgeon mentoring a female resident), it is important to recognize that many mentoring relationships, whether intentionally or otherwise, extend across gender, sexuality, generations, race, ethnicity, and other differences. Lived examples of these include an Asian man hailing from the Northeast with no children mentoring a White …

The Roles And Contributions Of Certified Transport Registered Nurses In Critical Care Ground Transport Today., Jennifer Esslinger Bsn, Rn, Cfrn, Ctrn, Sue L Parrigin, Amy Grand, Kimberly D Bronow, Jacqueline C Stocking

Nursing Publications

Registered nurses are core members of critical care ground transport teams because of their education, experience, and scope of practice. Advances in medicine, technology, and equipment, combined with regionalization of specialized care and, most recently, the coronavirus disease 2019 pandemic, necessitate that transport nurses possess specialized knowledge, skills, and abilities. National specialty certification in ground transport nursing via the Certified Transport Registered Nurse (CTRN) offers registered nurses a process to validate their expertise. The most recent transport nursing role delineation study, which was conducted by the Board of Certification for Emergency Nursingin 2019, provided the foundation for the revised CTRN …