Faculty Bibliography

BACKGROUND/UNASSIGNED:Many patients first learn of a pregnancy in the emergency department (ED). However, limited ED physician knowledge in pregnancy disclosure and options counseling may contribute to challenges in patient care and potential missed opportunities for timely access to reproductive care. No standardized instruments exist to teach or assess this important communication skill for the ED physicians. This study aimed to develop and collect validity evidence for a checklist for effective pregnancy disclosure and options counseling by ED physicians in an environment with unrestricted access to comprehensive reproductive care. METHODS/UNASSIGNED:A prospective checklist creation and validity evidence collection study was conducted, involving literature review, expert input through a modified Delphi process, and pilot testing with ED faculty and residents at an urban academic medical center. We structured the validity evidence collection process using Messick's criteria for construct validity, addressing content, response process, internal structure, and relations to other variables. Data analysis focused on collecting validity evidence, including inter-rater reliability and participant performance assessment based on faculty or resident status. RESULTS/UNASSIGNED:The study resulted in a final 17-item checklist for pregnancy disclosure and options counseling in the ED. Pilot testing with 20 participants (eight faculty members and 12 residents) revealed high overall inter-rater reliability with almost perfect agreement (kappa = 0.81) and acceptable internal consistency (Cronbach's alpha = 0.88). Checklist scores showed no significant difference across standardized patients, indicating consistency. Faculty members outperformed residents, suggesting concurrent validity based on levels of clinical experience. CONCLUSIONS/UNASSIGNED:Preliminary validity evidence supports the use of this novel checklist to assess physician competency in pregnancy disclosure and options counseling in the ED. Given the frequency of new pregnancy encounters in the ED and the dynamic changes to pregnant patients' reproductive rights, enhancing physician education in these areas is critical for optimizing patient care and autonomy.

Secondary mitral regurgitation is one of the most common valve diseases. The disease is a result of left atrial or left ventricular dysfunction. It is generally classified into stages based on its severity. While surgical intervention does not confer improved survival in this subset of mitral disease, recent advances in transcatheter interventions have resulted in improved survival and symptomatology in carefully selected patients. In this review, the multimodality imaging evaluation of the mitral valve and secondary mitral regurgitation is discussed. Commercially available and investigational transcatheter interventions for secondary mitral regurgitation management are also reviewed.

Prospective memory (PM) impairment is a common consequence of moderate-severe traumatic brain injury (TBI). Compensatory strategy training and rehabilitation (COMP) is the usual treatment of PM deficits through environmental modification and the use of assistive methods such as diaries and routines. The study intends to examine the changes in white matter integrity, as measured by advanced diffusion magnetic resonance imaging (dMRI) following COMP intervention in moderate-severe TBI patients. Nine COMP intervention and twelve routine care comparison cohort moderate-severe TBI patients were recruited from level 1 trauma centres in the Brisbane metropolitan area. Both groups were imaged at least one-month post-TBI for a baseline scan. COMP group was imaged again after a 6-week COMP intervention program and the comparison group was imaged again at least 6 weeks after the baseline scan. MRI scan included structural imaging and dMRI, which the latter fitted for the Neurite Orientation Dispersion and Density Imaging (NODDI) model. Only the comparison group had decreased Neurite Density Index in the major white matter tracts and increased isotropic diffusion in the fluid space between the cortical folds. Our results indicated that COMP intervention slowed down the neural degeneration in moderate-severe TBI patients as compared to routine medical care/rehabilitation.

OBJECTIVE/UNASSIGNED:To evaluate for equivalence in postoperative changes of speech recognition scores in a veteran patient population undergoing cochlear implantation (CI) compared to matched nonveteran patients. STUDY DESIGN/UNASSIGNED:Retrospective chart review. SETTING/UNASSIGNED:Tertiary referral center. PATIENTS/UNASSIGNED:A total of 83 veteran patients who underwent CI at a single Veterans Affairs Medical Center (VA cohort) were matched to 83 nonveteran patients from the Health Insurance Portability and Accountability Act-secure, Encrypted, Research, Management and Evaluation Solution database (HERMES cohort) based on age, sex, and baseline Consonant-Nucleus-Consonant (CNC) scores. INTERVENTION/UNASSIGNED:Patients underwent CI. MAIN OUTCOME MEASURES/UNASSIGNED:Comparison of postoperative CNC and Arizona Biomedical Institute recognition scores. RESULTS/UNASSIGNED:The mean difference and lower confidence interval of CNC scores between matched Veterans Affairs and HERMES cohorts were within a -ΔNI boundary of -15% at the 3-month (mean = 6.15, lower confidence interval = -2.38), 6-month (mean = 7.36, lower confidence interval = -2.21), and 12-month (mean = 4.03, lower confidence interval = -4.88) postoperative time points. The mean difference and lower confidence interval of Arizona Biomedical Institute scores between cohorts were within the -ΔNI boundary of -30% at 3 months (mean = 1, lower confidence interval = -8.71), 6 months (mean = 0.31, lower confidence interval = -12.30), and 12 months (mean = 0.72, lower confidence interval = -10.48). CONCLUSION/UNASSIGNED:Our veteran population demonstrated improvements in speech recognition scores after CI comparable to a matched nonveteran population. Although veterans face unique factors that affect their hearing, access to medical care, and baseline general health, these findings affirm appropriate veteran candidates should be offered CI.

Although the representation of women and ethnic minority students in the US medical schools has recently increased, discrepancies in representation among plastic surgery residents and faculty continue. The state of sex and ethnic diversity in academic microsurgery remains minimally investigated. We aimed to evaluate the sex, race, and ethnicity demographics among academic microsurgeons and identify underrepresentation along the leadership pathway. The US-based microsurgery fellowship programs provided contact information of fellowship graduates from 2006 to 2020. An anonymous electronic survey was distributed, and demographic, training background, mentorship, and career path data were collected. Program websites were reviewed to collect data on academic microsurgery faculty nationwide. We found that women and non-White surgeons reported similar rates of effective mentorship in training. Compared with White surgeons, non-White surgeons had lower probability of holding an academic position directly after fellowship (odds ratio = 0.28, P = 0.023) and reported fewer perceived opportunities for professional advancement (61% versus 91%, P = 0.007). The majority of academic leadership positions were held by White surgeons (72%). Overall, women faculty were earlier in their careers than men (mean time out of fellowship 7.2 years for women versus 14.8 years for men, P < 0.001), signifying a lack of senior female faculty. Male faculty had higher rates of leadership than female faculty (24.7% versus 8.0%, P = 0.01). Our results demonstrate that women and non-White surgeons are not adequately represented in academic microsurgery faculty and leadership positions. Future interventions seeking to increase diversity can help improve the delivery of equitable reconstructive care.

Patients who receive solid organ transplants often require lifelong immunosuppression, which increases their risk for hematologic disorders. Allogeneic hematopoietic stem cell transplantation (HSCT) offers a potential curative treatment option for these patients. However, there is still a lack of understanding and guidance on graft-vs-host disease (GVHD) immunosuppression regimens, potential complications, and outcomes in patients with solid organ transplants who undergo HSCT. The rate of solid organ transplantation continues to increase annually, making this a common clinical scenario that hematologists encounter. In this case series, we present three patients who underwent liver, kidney and cardiac transplants and each developed hematological malignancies requiring allogeneic stem cell transplant. This is the first case report of two patients who received post-transplant cyclophosphamide with mycophenolate mofetil and tacrolimus GVHD prophylaxis. We also review recent advances in GVHD prophylaxis in allogeneic HSCT and solid organ transplantation including immune tolerance and immunosuppression-free protocols. Our case series support the use of post-transplant cyclophosphamide with mycophenolate mofetil and tacrolimus as post-transplant GVHD prophylaxis, which does not appear to compromise solid organ graft function. Our case series also provides evidence that allogeneic HSCT is a feasible and potentially life-saving treatment option in patients who develop hematologic malignancies after solid organ transplantation.

We describe a rare but interesting complication of totally endoscopic robotic mitral valve repair in a patient with severe mitral regurgitation. The mitral valve was repaired robotically by standard techniques, and the intraoperative transesophageal echocardiogram demonstrated no residual mitral regurgitation. However, there was unexpected hypokinesia of the posterior and lateral walls of the left ventricle, with subsequent electrocardiography showing acute ST elevations of the lateral segment. Immediate cardiac catheterization revealed occlusion of the left circumflex artery. Aspiration thrombectomy was performed and a drug-eluting stent placed to restore the contour, thus preventing potential morbidity of the patient.

BACKGROUND/UNASSIGNED:Pain medicine care has expanded to encompass a wider range of conditions, necessitating updated education and training for pain specialists to utilize emerging technologies effectively. A national survey was conducted through several verified Pain organizations regarding pain physician employers' perspectives on pain medicine fellowship training and education. The survey aimed to gather insights from a diverse range of geographic locations, practice types (academic and private practice), and practice settings. The findings emphasize the need for educational programs to adapt to the evolving landscape of pain medicine. METHODS/UNASSIGNED:A survey was disseminated through several national professional pain societies, including the AAPM, ASIPP, NANS, and ASPN, and Pain DocMatters forum, an online verified pain physician forum to ensure a wide reach among potential respondents. The survey received responses from 196 participants, 39 from the Pain DocMatters forum and 157 through pain societies' channels. RESULTS/UNASSIGNED:Most survey respondents reported a need for additional training and experience beyond what is offered during the one-year ACGME-approved fellowship. Professionalism and basic interventional skills were identified as the highest valued attributes of pain physician candidates by potential employers. Employers rated spinal cord stimulator (SCS) trials as the most important advanced procedure for trainees to learn. Other advanced procedures such as SCS implants, PNS implants, interspinous spacers, and percutaneous procedures involving the vertebral body were also rated as either very important or somewhat important by most respondents. A significant gap in training has been identified, with only 7% of respondents feeling that fellows were adequately prepared to independently practice in the current educational model. A vast majority of respondents stated that fellows need additional training following graduation from fellowship to practice independently. CONCLUSION/UNASSIGNED:Training programs should provide more robust education to prepare their graduates for independent practice.

INTRODUCTION/BACKGROUND:To assess whether a diagnosis of preexisting anemia impacts outcomes of geriatric hip fractures. METHODS:This is a retrospective comparative study conducted at a single, urban hospital system consisting of an orthopaedic specialty hospital, two level 1 trauma centers, and one university-based tertiary care hospital. Data of patients aged 55 years or older with a femoral neck, intertrochanteric, or subtrochanteric hip fracture (AO/OA 31A, 31B, and 32A-C) at a single hospital center treated from October 2014 to October 2023 were retrieved from an institutional review board-approved database. Patients were included if they had a hemoglobin measurement recorded between 6 and 12 months before hospitalization for their hip fracture. Patients were cohorted based on whether their hemoglobin values recorded anemic or not. Comparative analysis was conducted to analyze 1-year mortality, 30-day mortality, 30-day readmission, 90-day readmission, and inpatient major complications. RESULTS:Four hundred ninety-eight patients had hemoglobin values recorded at 6 to 12 months before their surgery in the electronic medical record. Two hundred seventy-three patients (54.8%) were considered anemic at that time, whereas 225 patients (45.2%) were not. Cohorts were markedly different regarding sex, Charlson Comorbidity Index, preinjury ambulatory status, and Score for Trauma Triage in Geriatric and Middle-Aged Patients (STTGMA) score (P < 0.05 for all). Multivariable analysis revealed that chronic preinjury anemia patients had a higher likelihood of 1-year mortality and a higher risk of major inpatient complication and 30- and 90-day readmission (P < 0.05 for all). CONCLUSION/CONCLUSIONS:Chronic preinjury anemia within 6 to 12 months before a hip fracture is associated with an increased risk of 1-year mortality, inpatient major complications, and 30- and 90-day readmission after hip fracture fixation. LEVEL OF EVIDENCE/METHODS:Level III.