51
|
Eaton JL, Truong T, Polotsky AJ. MORE MAY NOT ALWAYS BE BETTER: THE EFFECT OF HIGH-DOSE GONADOTROPINS ON CUMULATIVE LIVE BIRTH IN OVER 300,000 FRESH AND FREEZE-ALL CYCLES. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
52
|
Tsai S, Sun M, Asbury ML, Weber JM, Truong T, Deans E. Correction to: Novel Spaced Repetition Flashcard System for the In-training Examination for Obstetrics and Gynecology. MEDICAL SCIENCE EDUCATOR 2021; 31:1559. [PMID: 34459835 PMCID: PMC8368837 DOI: 10.1007/s40670-021-01344-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
[This corrects the article DOI: 10.1007/s40670-021-01320-z.].
Collapse
|
53
|
Tsai S, Sun M, Asbury ML, Weber JM, Truong T, Deans E. Novel Spaced Repetition Flashcard System for the In-training Examination for Obstetrics and Gynecology. MEDICAL SCIENCE EDUCATOR 2021; 31:1393-1399. [PMID: 34457982 PMCID: PMC8368326 DOI: 10.1007/s40670-021-01320-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Electronic flashcards allow repeated information exposure over time along with active recall. It is increasingly used for self-study by medical students but remains poorly implemented for graduate medical education. The primary goal of this study was to determine whether a flashcard system enhances preparation for the in-training examination in obstetrics and gynecology (ob-gyn) conducted by the Council on Resident Education in Obstetrics and Gynecology (CREOG). METHODS Ob-gyn residents at Duke University were included in this study. A total of 883 electronic flashcards were created and distributed. CREOG scores and flashcard usage statistics, generated internally by interacting with the electronic flashcard system, were collected after the 2019 exam. The primary outcome was study aid usage and satisfaction. The secondary outcome was the impact of flashcard usage on CREOG exam scores. RESULTS Of the 32 residents, 31 (97%) participated in this study. Eighteen (58%) residents used the study's flashcards with a median of 276 flashcards studied over a median of 3.7 h. All of the flashcard users found the study aid helpful, and all would recommend them to another ob-gyn resident. Using the flashcards to study for the 2019 CREOG exam appeared to correlate with improvement in scores from 2018 to 2019, but did not achieve statistical significance after adjusting for post-graduate year (beta coefficient = 10.5; 95% confidence interval = - 0.60,21.7; p = 0.06). DISCUSSION This flashcard resource was well received by ob-gyn residents for in-training examination preparation, though it was not significantly correlated with improvement in CREOG scores after adjusting for post-graduate year.
Collapse
|
54
|
Kazaure HS, Truong T, Kuchibhatla M, Lagoo-Deenadayalan S, Wren SM, Johnson KS. Identifying high-risk surgical patients: A study of older adults whose code status changed to Do-Not-Resuscitate. J Am Geriatr Soc 2021; 69:3445-3456. [PMID: 34331702 DOI: 10.1111/jgs.17391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/02/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a paucity of data on older adults (age ≥65 years) undergoing surgery who had an inpatient do-not-resuscitate (DNR) order, and the association between timing of DNR order and outcomes. METHODS This was a retrospective analysis of 1976 older adults in the American College of Surgeons National Surgical Quality Improvement Program geriatric-specific database (2014-2018). Patients were stratified by institution of a DNR order during their surgical admission ("new-DNR" vs. "no-DNR"), and matched by age (±3 years), frailty score (range: 0-1), and procedure. The main outcome of interest was occurrence of death or hospice transition (DoH) ≤30 postoperative days; this was analyzed using bivariate and multivariable methods. RESULTS One in 36 older adults had a new-DNR order. After matching, there were 988 new-DNR and 988 no-DNR patients. Median age and frailty score were 82 years and 0.2, respectively. Most underwent orthopedic (47.6%), general (37.6%), and vascular procedures (8.4%). Overall DoH rate ≤30 days was 44.4% for new-DNR versus 4.0% for no-DNR patients (p < 0.001). DoH rate for patients who had DNR orders placed in the preoperative, day of surgery, and postoperative setting was 16.7%, 23.3%, and 64.6%, respectively (p < 0.001). In multivariable analysis, compared to no-DNR patients, those with a new-DNR order had a 28-fold higher adjusted odds of DoH (odds ratio [OR] 28.1, 95% confidence interval: 13.0-60.1, p < 0.001); however, odds were 10-fold lower if the DNR order was placed preoperatively (OR: 5.8, p = 0.003) versus postoperatively (OR: 52.9, p < 0.001). Traditional markers of poor postoperative outcomes such as American Society of Anesthesiologists class and emergency surgery were not independently associated with DoH. CONCLUSIONS An inpatient DNR order was associated with risk of DoH independent of traditional markers of poor surgical outcomes. Further research is needed to understand factors leading to a DNR order that may aid early recognition of high-risk older adults undergoing surgery.
Collapse
|
55
|
Swartz JJ, Rowe C, Truong T, Bryant AG, Morse JE, Stuart GS. Comparing Website Identification for Crisis Pregnancy Centers and Abortion Clinics. Womens Health Issues 2021; 31:432-439. [PMID: 34266709 DOI: 10.1016/j.whi.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Crisis pregnancy centers (CPCs) seeking to dissuade women from abortion often appear in Internet searches for abortion clinics. We aimed to assess whether women can use screenshots from real websites to differentiate between CPCs and abortion clinics. METHODS We conducted a cross-sectional, nationally representative online study of English- and Spanish-speaking women aged 18-49 years in the United States. We presented participants with screenshots from five CPCs and five abortion clinic websites and asked if they thought an abortion could be obtained at that center. We scored correct answers based on clinic type. Outcomes included ability to correctly identify CPCs and abortion clinics as well as risk factors for misidentification. The survey also included five questions about common abortion myths and a validated health literacy assessment. RESULTS We contacted 2,223 women, of whom 1,057 (48%) completed the survey and 1,044 (47%) were included in the analysis. The median score for correctly identifying CPCs as facilities not performing abortion was 2 out of 5 (Q:1 0, Q:3 4). The median score for correctly identifying abortion clinics as facilities performing abortion was 5 out of 5 (Q:1 3, Q:3 5). Those less likely to endorse abortion myths had higher odds of correctly identifying CPCs (adjusted odds ratio, 2.43; 95% confidence interval, 1.78-3.32). A low health literacy score was associated with decreased odds of correct identification of CPCs (adjusted odds ratio, 0.39; 95% confidence interval, 0.25-0.59). CONCLUSIONS Websites of CPCs were more difficult for women to correctly identify than those of abortion clinics. Women with limited knowledge about abortion and low health literacy may be particularly susceptible to misidentification of CPC websites.
Collapse
|
56
|
Peipert BJ, Spinosa D, Howell EP, Weber JM, Truong T, Harris BS. Innovations in infertility: a comprehensive analysis of the ClinicalTrials.gov database. Fertil Steril 2021; 116:1381-1390. [PMID: 34256949 DOI: 10.1016/j.fertnstert.2021.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize the interventional clinical trials in infertility and to assess whether trial location or industry sponsorship was associated with trial noncompletion. DESIGN Retrospective review of trials registered with ClinicalTrials.gov. SETTING None. PATIENT(S) None. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Descriptive statistics characterizing the attributes of the clinical trials including intervention type, topic, population, completion status, size, location, sponsor, and results. The effects of the sponsor and trial location on trial noncompletion were assessed via logistic regression. RESULT(S) In total, 505 trials initiated between 2010 and 2020 were included in our analysis. Drug interventions were the most commonly studied (45%); ovarian stimulation trials accounted for 27% of the studies. Live birth was tracked as an outcome by 20% of the studies; 3% of the trials included mental health outcomes. Few trials (15%) enrolled male participants. Only 11% of the trials reported results, and 4% of the trials reported the race or ethnicity of the participants. Most trials (82%) were conducted outside the United States. Overall, 18% of the trials were not completed, most often because of lack of accrual (47%). United States trials had over twice the odds of noncompletion in univariate analysis (odds ratio = 2.48, 95% confidence interval = [1.47, 4.17]); however, this relationship lost significance after adjusting for potential confounders (odds ratio = 0.95, 95% confidence interval = [0.42, 2.14]). Trial sponsorship was not associated with trial noncompletion. CONCLUSION(S) Infertility trials predominantly investigated drug interventions, particularly ovarian stimulation. Live birth was an infrequent outcome despite its relevance to patients. Clinical trials should aim to address the unmet needs in fertility care and be inclusive of underserved populations affected by infertility.
Collapse
|
57
|
Baghfalaki T, Sugier P, Truong T, Pettitt A, Mengersen K, Liquet B. Analyse de la pléiotropie dans les GWAS à l’aide de méthodes bayésiennes prenant en compte la structure de groupe de variables. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
58
|
Issa K, Abi Hachem R, Gordee A, Truong T, Pfohl R, Doublestein B, Lee W. Analysis of Self- and 360-Evaluation Scores of the Professionalism Intelligence Model Within an Academic Otolaryngology-Head and Neck Surgery Department. J Healthc Leadersh 2021; 13:129-136. [PMID: 34007234 PMCID: PMC8123941 DOI: 10.2147/jhl.s296501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze self and 360-evaluation scores of the professionalism intelligence model domains within an academic Otolaryngology-Head and Neck Surgery Department. Methods A leadership course was introduced within the Department of Head and Neck Surgery & Communication Sciences at Duke University Medical Center. A 360 evaluation assessing domains of the professional intelligence model was recorded for all participants. Participant demographics included gender (male vs female), generation group (generation Y vs older generations) and physician status of participants (physician vs non-physician). Differences in mean self-scores were modeled using linear regression. When analyzing the evaluator scores, gaps were defined as self-score minus evaluator-score for each member of a participant’s evaluator groupings (supervisor, peer, and direct report). Two types of linear mixed models were fit with a random intercept to account for the correlated gaps in the same participant. Results Scores of 50 participants and 394 evaluators were analyzed. The average age was 40.6 (standard deviation 9.3) years, and 50% (N=25) of participants were females. Physicians accounted for 36% (N=18) of the cohort, and 61% (N=11) of physicians were residents. Physicians scored themselves lower than non-physicians when assessing leadership intelligence, interpersonal relations, empathy, and focused thinking. On average, participants under-rated themselves compared to their evaluators with direct reports giving higher scores than managers and peers. When compared with generation Y, older generations tended to rate themselves lower than their peers and managers in cognitive intelligence. No significant association was observed between gender and any scores. Conclusion Participants rate themselves lower on average than their evaluators. This work is important in understanding how perceived leadership qualities are assessed and developed within an academic surgical department. Finally, the results presented could serve as a model to address the gap between self- and other-perceptions of defined leadership virtues in future leadership development activities.
Collapse
|
59
|
Roeca C, Johnson RL, Truong T, Carlson NE, Polotsky AJ. Birth outcomes are superior after transfer of fresh versus frozen embryos for donor oocyte recipients. Hum Reprod 2021; 35:2850-2859. [PMID: 33190157 DOI: 10.1093/humrep/deaa245] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/04/2020] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION For donor oocyte recipients, are birth outcomes superior for fresh versus frozen embryos? SUMMARY ANSWER Among fresh donor oocyte recipients, fresh embryos are associated with better birth outcomes when compared with frozen embryos. WHAT IS KNOWN ALREADY Frozen embryo transfer (ET) with vitrification has been associated with improved pregnancy rates, but also increased rates of large for gestational age infants. Donor oocyte recipients represent an attractive biological model to attempt to isolate the impact of embryo cryopreservation on IVF outcomes, yet there is a paucity of studies in this population. STUDY DESIGN, SIZE, DURATION A retrospective cohort of the US national registry, the Society for Assisted Reproductive Technology Clinic Outcome Reporting System, of IVF cycles of women using fresh donor oocytes resulting in ET between 2013 and 2015. Thawed oocytes were excluded. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Good obstetric outcome (GBO), defined as a singleton, term, live birth with appropriate for gestational age birth weight, was the primary outcome measure. Secondary outcomes included live birth, clinical pregnancy, spontaneous abortion, preterm birth, multiple births and gestational age-adjusted weight. Outcomes were modeled using the generalized estimating equation approach. MAIN RESULTS AND THE ROLE OF CHANCE Data are from 25 387 donor oocyte cycles, in which 14 289 were fresh and 11 098 were frozen ETs. A GBO was 27% more likely in fresh ETs (26.3%) compared to frozen (20.9%) (adjusted risk ratio 1.27; 95% confidence interval (CI) 1.21-1.35; P < 0.001). Overall, fresh transfer was more likely to result in a live birth (55.7% versus 39.5%; adjusted risk ratio 1.21; 95% CI 1.18-1.26; P < 0.001). Among singleton births, there was no difference in gestational age-adjusted birth weight between groups. LIMITATION, REASONS FOR CAUTION Our cohort findings contrast with data from autologous oocytes. Prospective studies with this population are warranted. WIDER IMPLICATIONS OF THE FINDINGS Among donor oocyte recipients, fresh ETs may be associated with better birth outcomes. Reassuringly, given its prevalent use, modern embryo cryopreservation does not appear to result in phenotypically larger infants. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
Collapse
|
60
|
Chung EH, Truong T, Jooste KR, Fischer JE, Davidson BA. The Implementation of Communication Didactics for OB/GYN Residents on the Disclosure of Adverse Perioperative Events. JOURNAL OF SURGICAL EDUCATION 2021; 78:942-949. [PMID: 32988796 DOI: 10.1016/j.jsurg.2020.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/03/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Communication skills are key components of the patient-physician relationship, yet are not routinely taught during residency. Institutional data demonstrates 75% of residents regularly encounter difficult communication scenarios. This study's objective is to develop and pilot a communications didactic/skills training program for Obstetrics & Gynecology (OB/GYN) residents focused on the disclosure of adverse perioperative events. DESIGN This was an observational, prospective cohort pilot study. OB/GYN residents completed a 4-hour interactive curriculum using VitalTalk methodology, certified facilitators, and simulated patients in 2019. Participants completed self-assessments of their skill levels at 3 time points: prior to training, immediately post-training, 3-month post-training. Wilcoxon signed rank tests were used to evaluate change in skill levels. SETTING University-based program in North Carolina. PARTICIPANTS Participants included all OB/GYN residents from postgraduate years 1-4. Out of 31 residents, 27 participated in the training, 24 completed the immediately post-training survey, and 23 completed the 3-month post-training survey. RESULTS At baseline, most residents rated their global skill level in communication as novice (37.0%) or advanced beginner (33.3%). Immediately following the intervention, 41.7% of residents ranked their global skill as "competent" and 20.8% as "proficient." These changes were statistically significant (p < 0.001). Notable improvements were seen across multiple variables, including the handling of emotional reactions (p = 0.046). No significant changes were noted between the immediately post-training and 3-month time points, suggesting skill retention. Majority of trainees (78.3%) felt that refresher courses would be useful for skill maintenance. CONCLUSION A simulation-based formalized communication curriculum is effective for improving OB/GYN resident competence and skill levels in the disclosure of adverse perioperative events. Specific to adverse surgical complications, this curriculum appears feasible for implementation by other training programs. Further work is needed to identify the most beneficial timing and modality of these workshops.
Collapse
|
61
|
Watson CH, Puechl AM, Lim S, Monuszko K, Truong T, Havrilesky LJ, Davidson BA. Chemotherapy discontinuation processes in a gynecologic oncology population. Gynecol Oncol 2021; 161:508-511. [PMID: 33771398 DOI: 10.1016/j.ygyno.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We sought to categorize the processes by which gynecologic oncology patients stop chemotherapy and to evaluate associations between these processes and end-of-life outcome metrics. METHODS A cohort of patients with metastatic or recurrent gynecologic cancer in an outpatient setting from January 2016 to May 2018 was identified. All deceased patients in this cohort were included for analysis. Processes of discontinuing chemotherapy were categorized as: 1) definitive decision inpatient; 2) definitive decision outpatient; 3) delayed decision (eg: treatment break and never resumed chemotherapy); 4) no decision. Associations between patient characteristics and clinical outcomes of those who made a definitive outpatient decision versus those who made any other type of decision were assessed. RESULTS 220 patients were identified; 205 patients were deceased at time of analysis. Of these, 36.6% made a definitive decision to stop chemotherapy as an outpatient, while 41.5% never made a decision to discontinue chemotherapy. Making a definitive decision as an outpatient, when compared to all other decision types, was associated with significantly lower incidence of death in the hospital (5.6% vs 21.1%, p < 0.004) and hospitalization within 30 days of death (20.8% vs 56.6%, p < 0.001), and significantly increased median time from last chemotherapy to death (135.5 vs 62 days, p < 0.001). CONCLUSION Only one in three women in this cohort of patients deceased from gynecologic cancer made a definitive decision to discontinue chemotherapy in an outpatient setting, and this process was associated with improved end-of-life outcomes. Future efforts should examine the impact of interventions designed to increase the proportion of patients who transition away from chemotherapy via shared decision making in the outpatient setting.
Collapse
|
62
|
Cobert J, Lerebours R, Peskoe SB, Gordee A, Truong T, Krishnamoorthy V, Raghunathan K, Mureebe L. Exploring Factors Associated With Morbidity and Mortality in Patients With Do-Not-Resuscitate Orders: A National Surgical Quality Improvement Program Database Analysis Within Surgical Groups. Anesth Analg 2021; 132:512-523. [PMID: 33369926 DOI: 10.1213/ane.0000000000005311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anesthesiologists caring for patients with do-not-resuscitate (DNR) orders may have ethical concerns because of their resuscitative wishes and may have clinical concerns because of their known increased risk of morbidity/mortality. Patient heterogeneity and/or emphasis on mortality outcomes make previous studies among patients with DNR orders difficult to interpret. We sought to explore factors associated with morbidity and mortality among patients with DNR orders, which were stratified by surgical subgroups. METHODS Exploratory retrospective cohort study in adult patients undergoing prespecified colorectal, vascular, and orthopedic surgeries was performed using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File data from 2010 to 2013. Among patients with preoperative DNR orders (ie, active DNR order written in the patient's chart before surgery), factors associated with 30-day mortality, increased length of stay, and inpatient death were determined via penalized regression. Unadjusted and adjusted estimates for selected variables are presented. RESULTS After selection as above, 211,420 patients underwent prespecified procedures, and of those, 2755 (1.3%) had pre-existing DNR orders and met above selection to address morbidity/mortality aims. By specialty, of these patients with a preoperative DNR, 1149 underwent colorectal, 870 vascular, and 736 orthopedic surgery. Across groups, 36.2% were male and had a mean age 79.9 years (range 21-90). The 30-day mortality was 15.4%-27.2% and median length of stay was 6-12 days. Death at discharge was 7.0%, 13.1%, and 23.0% in orthopedics, vascular, and colorectal patients with a DNR, respectively. The strongest factors associated with increased odds of 30-day mortality were preoperative septic shock in colorectal patients, preoperative ascites in vascular patients, and any requirement of mechanical ventilation at admission in orthopedic patients. CONCLUSIONS In patients with DNR orders undergoing common surgical procedures, the association of characteristics with morbidity and mortality varies in both direction and magnitude. The DNR order itself should not be the defining measure of risk.
Collapse
|
63
|
Truong T, Koh Y, Yosufi R, Marangou J, Slack-Smith L, Katzenellenbogen JM. Understanding valvular heart disease in the dental setting. Aust Dent J 2021; 66:254-261. [PMID: 33448018 DOI: 10.1111/adj.12821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited evidence is available regarding dentists' knowledge and interpretation of infective endocarditis (IE) prophylaxis guidelines. The aim of this study was to determine understanding and management of rheumatic and non-rheumatic valvular heart disease (VHD) in the dental setting in Western Australia (WA). METHODS A cross-sectional survey of dentists within Perth utilized an online Qualtrics questionnaire developed after consultation with stakeholders. A sampling frame was compiled from the Australian Health Practitioner Regulation Agency with contact details obtained from the White Pages (online), using five quintiles of Socio-Economic Indexes for Areas according to dentist's place of practice. RESULTS Of 41 (13.7% of 300 approached) dentists completing the survey (95.1% general dentists, mean years of practice = 15.6), 90.2% reported following the Australian Therapeutic Guidelines (ATG) regarding IE antibiotic prophylaxis in VHD. Most (92.7%) were unaware of the rheumatic heart disease (RHD) control program. Nearly all participants indicated prophylaxis for clearly invasive procedures such as tooth extraction (100.0%) and periodontal surgery (95.1%). Many dentists made the decision to prescribe antibiotics themselves (36.6%). CONCLUSIONS The majority of dentists followed the ATG's IE prophylaxis recommendations for cardiac lesions and dental procedures. There was limited knowledge of the national RHD guidelines and the WA RHD control program.
Collapse
|
64
|
Mundy LR, Truong T, Shammas RL, Cunningham D, Hollenbeck ST, Pomann GM, Gage MJ. Amputation Rates in More Than 175,000 Open Tibia Fractures in the United States. Orthopedics 2021; 44:48-53. [PMID: 33284985 DOI: 10.3928/01477447-20201202-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/06/2019] [Indexed: 02/03/2023]
Abstract
Open tibia fractures are often associated with considerable soft tissue injuries. Management of open tibia fractures can be challenging, and some patients require amputation. The patient and treatment factors have not been described on a population level in the United States. A retrospective analysis was completed using the 2000 to 2011 Nationwide Inpatient Sample. Amputation rates during the index hospitalization after open tibia fracture were computed based on injury, patient, and hospital characteristics in patients 18 years or older. The overall amputation rate in open tibia fractures during the index hospitalization was 2.2% (n=3769). Patients with midshaft tibia fractures comprised the largest portion of patients undergoing amputation (46.8% of total amputations) compared with distal tibia (34.0%) and proximal tibia (19.3%) fractures. Patients with no neurovascular injury comprised the largest portion of patients undergoing amputation (85.9%), followed by isolated arterial injury (11.1%), combined neurovascular injury (1.9%), and isolated nerve injury (1.1%). Amputation rates were significantly increased for midshaft tibia fractures with neurovascular injury (odds ratio, 12.39; 95% CI, 5.52-27.83) and distal tibia fractures with neurovascular injury (odds ratio, 5.45; 95% CI, 1.73-17.19) compared with tibia fractures with no neurovascular injury while controlling for confounders. On the basis of a review of the Nationwide In-patient Sample during the past decade, the authors have shown that the early amputation rate in open tibia fractures for all-comers is 2.2%. Rates of amputation varied based on fracture site, associated neurovascular injury, medical comorbidities, and hospital location. [Orthopedics. 2021;44(1):48-53.].
Collapse
|
65
|
Siegel AM, Clinton CM, Post AL, Truong T, Pieper CF, Hughes BL. Assessing patient perceptions of cytomegalovirus infection in pregnancy. J Med Virol 2020; 92:3658-3664. [PMID: 32073162 DOI: 10.1002/jmv.25714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/11/2020] [Indexed: 11/07/2022]
Abstract
Pregnant women impacted by cytomegalovirus (CMV) make clinical decisions despite uncertain outcomes. Intolerance of uncertainty score (IUS) is a validated measure of tendency for individuals to find unacceptable that a negative event might occur. We investigated patient perceptions of CMV infection during pregnancy and correlated IUS and knowledge with decision-making. Electronic questionnaire was sent to women from July to August 2017. The questionnaire evaluated knowledge of CMV, IUS, and responses regarding management to three clinical scenarios with escalating risk of CMV including choices for no further testing, ultrasound, amniocentesis, or abortion. For each scenario, logistic regression was used to model IUS on responses. A total of 815 women were included. The majority of participants was white (63.1%) and 42% had a postgraduate degree. Over 70% reported that they had not previously heard of CMV. In the scenario with only CMV exposure, participants with increasing IUS were more likely to choose abortion (odds ratio [OR] = 1.04; 95% confidence interval [CI]: 1.01, 1.06) and no further testing (OR = 0.97; 95% CI: 0.95, 0.99). In the scenario with mild ultrasound findings in setting of CMV exposure, increasing IUS was associated with higher odds of choosing no further testing (OR = 0.97; 95% CI, 0.94, 0.99). No significant association was observed between IUS and responses in the scenario with severe ultrasound abnormalities in setting of CMV exposure. The majority of patients had no knowledge of CMV. Higher IUS was associated more intervention in low severity scenarios, but in severe scenarios, IUS was not associated with participants' choices.
Collapse
|
66
|
Sullivan AE, Holder T, Truong T, Green CL, Sofela O, Dahhan T, Granger CB, Jones WS, Patel MR. Use of hospital resources in the care of patients with intermediate risk pulmonary embolism. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 10:2048872620921601. [PMID: 33242980 DOI: 10.1177/2048872620921601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Risk stratification and management of hemodynamically stable pulmonary embolism remains challenging. Professional societies have published stratification schemes, but little is known about the management of patients with intermediate risk pulmonary embolism. We describe the care of these patients at an academic health system. METHODS Patient encounters from 1 January 2016 to 30 June 2017 were retrospectively identified utilizing a multihospital, electronic health record-based data warehouse. Using the 2019 European Society of Cardiology criteria, differences in hospital resource utilization, defined as intensive care unit admission, use of invasive therapies, and length of stay, were examined in patients with intermediate risk characteristics. RESULTS A cohort of 322 intermediate risk patients, including 165 intermediate-low and 157 intermediate-high risk patients, was identified. Intermediate-high risk patients more often underwent catheter-directed therapy (14.0% vs. 1.8%; P<0.001) compared to intermediate-low risk patients and had a 50% higher rate of intensive care unit admission (relative risk 1.50; 95% confidence interval 1.06, 2.12; P=0.023). There was no difference in median intensive care unit length of stay (2.7 vs. 2.0 days; P=0.761) or hospital length of stay (5.0 vs. 5.0 days; P=0.775) between intermediate-high risk and intermediate-low risk patients. Patients that underwent invasive therapies had a 3.8-day shorter hospital length of stay (beta -3.75; 95% confidence interval -6.17, -1.32; P=0.002). CONCLUSION This study presents insights into the hospital resource utilization of patients with intermediate risk pulmonary embolism. The 2019 European Society of Cardiology risk stratification criteria are a clinically relevant scheme that identifies patients more often treated with intensive care unit admission and advanced therapies.
Collapse
|
67
|
Greene SJ, Mentz RJ, Limkakeng AT, Irons T, Truong T, Green CL, Nowak C, Blumer V, Pang PS. Comparison of Dyspnea Measurement Instruments in Acute Heart Failure: The DYSPNEA-AHF Pilot Study. J Card Fail 2020; 27:607-609. [PMID: 33091609 DOI: 10.1016/j.cardfail.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022]
|
68
|
Shihao Lao W, Truong T, Kasotakis G, Agarwal S, Haines K. Factors Influencing Transfer to Higher-Level Trauma Center for Severely Injured Patients: A 10-Year Analysis. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
69
|
Puechl A, Lim S, Gatta L, Lorenzo A, Galanos A, Truong T, Berchuck A, Secord A, Previs R, Lee P, Havrilesky L, Davidson B. A systematic outpatient quality improvement intervention results in earlier goals of care conversations between high-risk gynecologic cancer patients and their providers. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
70
|
Tsai S, Chung EH, Truong T, Weber JM, Farrell AS, Wu J, Ohamadike O, Eaton JL. RACIAL AND ETHNIC DISPARITIES AMONG DONOR OOCYTE BANKS IN THE UNITED STATES. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
71
|
Shaia KL, Truong T, Pieper CF, Steiner AZ. IMPACT OF IN VITRO FERTILIZATION AND PREIMPLANTATION GENETIC TESTING ON THE SEX RATIO IN THE UNITED STATES. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
72
|
Lucotte E, Sugier P, Lefranc A, Boland A, Deleuze J, Ostroumovae E, Boutron M, de Vathaire F, Guénel P, Liquet B, Truong T. Analysis of the pleiotropy between breast cancer and thyroid cancer. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
73
|
Luu TH, Nel-Themaat L, Truong T, Polotsky AJ. PUBLIC REPORTING OF CLINICAL OUTCOMES IN ASSISTED REPRODUCTIVE TECHNOLOGY IN THE US FOR 2014-2017: REPORTING TO CDC ONLY IS ASSOCIATED WITH FEWER CANCELLATIONS AND LOWER SUCCESS RATES. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
74
|
Pomann GM, Boulware LE, Cayetano SM, Desai M, Enders FT, Gallis JA, Gelfond J, Grambow SC, Hanlon AL, Hendrix A, Kulkarni P, Lapidus J, Lee HJ, Mahnken JD, McKeel JP, Moen R, Oster RA, Peskoe S, Samsa G, Stewart TG, Truong T, Wruck L, Thomas SM. Methods for training collaborative biostatisticians. J Clin Transl Sci 2020; 5:e26. [PMID: 33948249 PMCID: PMC8057395 DOI: 10.1017/cts.2020.518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/01/2020] [Accepted: 07/25/2020] [Indexed: 11/06/2022] Open
Abstract
The emphasis on team science in clinical and translational research increases the importance of collaborative biostatisticians (CBs) in healthcare. Adequate training and development of CBs ensure appropriate conduct of robust and meaningful research and, therefore, should be considered as a high-priority focus for biostatistics groups. Comprehensive training enhances clinical and translational research by facilitating more productive and efficient collaborations. While many graduate programs in Biostatistics and Epidemiology include training in research collaboration, it is often limited in scope and duration. Therefore, additional training is often required once a CB is hired into a full-time position. This article presents a comprehensive CB training strategy that can be adapted to any collaborative biostatistics group. This strategy follows a roadmap of the biostatistics collaboration process, which is also presented. A TIE approach (Teach the necessary skills, monitor the Implementation of these skills, and Evaluate the proficiency of these skills) was developed to support the adoption of key principles. The training strategy also incorporates a "train the trainer" approach to enable CBs who have successfully completed training to train new staff or faculty.
Collapse
|
75
|
Wang A, Truong T, Black-Maier E, Green C, Campbell KB, Barnett AS, Febre J, Loring Z, Al-Khatib SM, Atwater BD, Daubert JP, Frazier-Mills C, Hegland DD, Jackson KP, Jackson LR, Koontz JI, Lewis RK, Pokorney SD, Sun AY, Thomas KL, Bahnson TD, Piccini JP. Catheter ablation of atrial fibrillation in patients with diabetes mellitus. Heart Rhythm O2 2020; 1:180-188. [PMID: 34113872 PMCID: PMC8183889 DOI: 10.1016/j.hroo.2020.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Few studies have compared clinical outcomes after catheter ablation between patients with and those without DM. OBJECTIVE The purpose of this study was to compare AF ablation outcomes in patients with and those without DM. METHODS We performed a retrospective analysis of 351 consecutive patients who underwent first-time AF ablation. Clinical outcomes included freedom from recurrent atrial arrhythmia, symptom burden (Mayo AF Symptom Inventory score), cardiovascular and all-cause hospitalizations, and periprocedural complications. RESULTS Patients with DM (n = 65) were older, had a higher body mass index, more persistent AF, more hypertension, and larger left atrial diameter (P <.05 for all). Median (Q1, Q3) total radiofrequency duration [64.0 (43.6, 81.4) minutes vs 54.3 (39.2, 76.4) minutes; P = .132] and periprocedural complications (P = .868) did not differ between patients with and those without DM. After a median follow-up of 29.5 months, arrhythmia recurrence was significantly higher in the DM group compared to the no-DM group after adjustment for baseline differences (adjusted hazard ratio [HR] 2.24; 95% confidence [CI] 1.42-3.55; P = .001). There was a nonsignificant trend toward higher AF recurrence with worse glycemic levels (HR 1.29; 95% CI 0.99-1.69; P = .064). CONCLUSION Although safety outcomes associated with AF ablation were similar between patients with and those without DM, arrhythmia-free survival was significantly lower among patients with DM. Poor glycemic control seems to an important risk factor for AF recurrence.
Collapse
|