1
|
Frangakis SG, MacEachern M, Akbar TA, Bolton C, Lin V, Smith AV, Brummett CM, Bicket MC. Association of Genetic Variants with Postsurgical Pain: A Systematic Review and Meta-analyses. Anesthesiology 2023; 139:827-839. [PMID: 37774411 PMCID: PMC10859728 DOI: 10.1097/aln.0000000000004677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Postsurgical pain is a key component of surgical recovery. However, the genetic drivers of postsurgical pain remain unclear. A broad review and meta-analyses of variants of interest will help investigators understand the potential effects of genetic variation. METHODS This article is a systematic review of genetic variants associated with postsurgical pain in humans, assessing association with postsurgical pain scores and opioid use in both acute (0 to 48 h postoperatively) and chronic (at least 3 months postoperatively) settings. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from 2000 to 2022 for studies using search terms related to genetic variants and postsurgical pain in humans. English-language studies in adult patients examining associations of one or more genetic variants with postsurgical pain were included. The primary outcome was association of genetic variants with either acute or chronic postsurgical pain. Pain was measured by patient-reported pain score or analgesic or opioid consumption. RESULTS A total of 163 studies were included, evaluating 129 unique genes and 594 unique genetic variants. Many of the reported significant associations fail to be replicated in other studies. Meta-analyses were performed for seven variants for which there was sufficient data (OPRM1 rs1799971; COMT rs4680, rs4818, rs4633, and rs6269; and ABCB1 rs1045642 and rs2032582). Only two variants were associated with small differences in postsurgical pain: OPRM1 rs1799971 (for acute postsurgical opioid use standard mean difference = 0.25; 95% CI, 0.16 to 0.35; cohort size, 8,227; acute postsurgical pain score standard mean difference = 0.20; 95% CI, 0.09 to 0.31; cohort size, 4,619) and COMT rs4680 (chronic postsurgical pain score standard mean difference = 0.26; 95% CI, 0.08 to 0.44; cohort size, 1,726). CONCLUSIONS Despite much published data, only two alleles have a small association with postsurgical pain. Small sample sizes, potential confounding variables, and inconsistent findings underscore the need to examine larger cohorts with consistent outcome measures. EDITOR’S PERSPECTIVE
Collapse
Affiliation(s)
- Stephan G Frangakis
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - T Adam Akbar
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan. Current Position: Department of Anesthesiology, Northwestern Medicine, Chicago, Illinois
| | - Christian Bolton
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Victor Lin
- Victor Lin, D.O., Ph.D.; Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Albert V Smith
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan; Opioid Prescribing and Engagement Network, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan
| | - Mark C Bicket
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan; Opioid Prescribing and Engagement Network, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
2
|
Prabhu M, Wilkie G, MacEachern M, LaBuda D, Purtell J, Rao K, Riley LE, Fuller M, Rosser M, Habib AS, Bauer ME. Procalcitonin levels in pregnancy: A systematic review and meta-analysis of observational studies. Int J Gynaecol Obstet 2023; 163:484-494. [PMID: 37118923 DOI: 10.1002/ijgo.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The utility of procalcitonin to identify obstetric sepsis is unknown. OBJECTIVE To calculate the mean (range) procalcitonin in pregnancy among healthy women not in labor (group 1), healthy women in labor (group 2), and women with preterm prelabor rupture of membranes (PPROM) without clinical chorioamnionitis (group 3). SEARCH STRATEGY NLM PubMed, Elsevier Embase, and Wiley Cochrane Central Register of Controlled Trials from inception to February 21, 2022. SELECTION CRITERIA Ten or more pregnant women with procalcitonin reported at more than 20 weeks of pregnancy, with information on labor, PPROM, and infection. Exclusions were major medical comorbidities. DATA COLLECTION AND ANALYSIS Each abstract and full-text review was independently reviewed by the same two authors. Quality was reviewed using the Newcastle-Ottawa Scale. A meta-analysis was performed using a random effects model. MAIN RESULTS The systematic review included 25 studies: 10 (40%) of good quality and 15 (60%) of poor quality. The meta-analysis included 21 studies. Mean procalcitonin in group 1 was 0.092 ng/mL (range 0.036-0.049 ng/mL), in group 2 it was 0.130 ng/mL (range 0.049-0.259 ng/mL), and in group 3 it was 0.345 ng/mL (range 0.005-1.292 ng/mL). CONCLUSIONS Among healthy pregnant women not in labor, procalcitonin levels are comparable to those in non-pregnant adults and may be useful in identifying infection. Procalcitonin levels in other groups overlap abnormal values of procalcitonin in non-pregnant adults, and may not discriminate infection among women in labor or with obstetric comorbidities. PROSPERO CRD42020157376, registered 4/28/2020.
Collapse
Affiliation(s)
- Malavika Prabhu
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Gianna Wilkie
- Department of Obstetrics & Gynecology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | | | - Dana LaBuda
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Krishna Rao
- Division of Infectious Diseases, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura E Riley
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Matthew Fuller
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Morgan Rosser
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Ashraf S Habib
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Melissa E Bauer
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
Winder GS, Clifton EG, Fernandez AC, MacEachern M, Andrews S, Perumalswami P, DiMartini AF, Mellinger JL. Definition and measurement of alcohol-associated insight in early liver transplantation for acute alcohol-associated hepatitis: A systematic review. Liver Transpl 2023; 29:757-767. [PMID: 37016758 DOI: 10.1097/lvt.0000000000000144] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/27/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Alcohol accounts for a large disease burden in hepatology and liver transplantation (LT) and across the globe. Clinical evaluations and decisions about LT candidacy are challenging because they rely on detailed psychosocial assessments and interpretations of psychiatric and substance use disorder data, which often must occur rapidly according to the acuity of end-stage liver disease. Such difficulties commonly occur during the process of candidate selection and liver allocation, particularly during early LT (eLT) in patients with acute alcohol-associated hepatitis (AAH). Patients with AAH commonly have very recent or active substance use, high short-term mortality, psychiatric comorbidities, and compressed evaluation and treatment timetables. LT clinicians report that patients' alcohol-associated insight (AAI) is among the most relevant psychosocial data in this population, yet no studies exist examining how LT teams define and use AAI in eLT or its effect on clinical outcomes. In April 2022, we searched Ovid MEDLINE, Elsevier Embase, EBSCOhost PsycInfo and CINAHL, and Wiley Cochrane Central Register of Controlled Trials for reports describing AAH populations who underwent eLT, which also described psychosocial evaluation parameters. The searches retrieved 1603 unique reports. After eligibility screening, 8 were included in the qualitative analysis. This systematic review reveals that AAI is a poorly defined construct that is not measured in a standardized way. Yet it is a commonly cited parameter in articles that describe the psychosocial evaluation and decision-making of patients undergoing eLT for AAH. This article also discusses the general challenges of assessing AAI during eLT for AAH, existing AAI definitions and rating scales, how AAI has been used to date in the broader hepatology and LT literature, and future areas for clinical and research progress.
Collapse
Affiliation(s)
- Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin G Clifton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah Andrews
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ponni Perumalswami
- Gastroenterology Section, Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Andrea F DiMartini
- Departments of Psychiatry, Surgery, and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessica L Mellinger
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
4
|
Millis MA, Vitous CA, Ferguson C, Van Wieren I, Kalata S, Shen MR, MacEachern M, Suwanabol PA. To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons. Ann Palliat Med 2023; 12:376-389. [PMID: 37019642 DOI: 10.21037/apm-22-916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/20/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND There is increasing concern about the prevalence and impact of moral distress among healthcare workers. While this body of literature is growing, research specifically examining sources of moral distress among surgeons remains sparse. The unique attributes of the surgeon-patient relationship and the context of surgery may expose surgeons to sources of distress that are distinct from other healthcare providers. To date, a summative assessment of moral distress among surgeons does not exist. METHODS We conducted a scoping review of studies focused on moral distress among surgeons. Using guidelines established by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), relevant articles were identified in EBSCOhost PsycINFO, Elsevier EMBASE, Ovid MEDLINE, and Wiley Cochrane Central Register of Controlled Trials Library from January 1, 2009 to September 29, 2022. Detailed data abstraction was performed on a predetermined instrument and compared across studies. A mixed-methods meta-synthesis was employed for data analysis, and both deductive and inductive methodology was used in our thematic analysis. RESULTS A total of 1,003 abstracts were screened, and 26 articles (19 quantitative and 7 qualitative) were included for full-text review. Of these, 10 focused only on surgeons. Our analysis revealed numerous definitions of moral distress and 25 instruments used to understand the sources of distress. Moral distress among surgeons is complex and influenced by factors at multiple levels, The most frequent sources originate at the individual and interpersonal levels. However, the environmental, community and policy levels also noted sources of distress. CONCLUSIONS The reviewed articles identified several common themes and sources of moral distress among surgeons. We also found that research investigating sources of moral distress among surgeons is relatively sparse and confounded by various definitions of moral distress, multiple measurement tools, and frequently conflated terms of moral distress, moral injury, and burnout. This summative assessment presents a model of moral distress delineating these distinct terms, which may be applied to other professions at risk for moral distress.
Collapse
Affiliation(s)
- M Andrew Millis
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - C Ann Vitous
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Cara Ferguson
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Stanley Kalata
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Mary R Shen
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Mark MacEachern
- Taubman Health Science Library, University of Michigan, Ann Arbor, MI, USA
| | - Pasithorn A Suwanabol
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
5
|
Puli AV, Lussiez A, MacEachern M, Hayward L, Dualeh S, Richburg CE, Capellari E, Kwakye G. Barriers to Colorectal Cancer Screening in US Immigrants: A Scoping Review. J Surg Res 2023; 282:53-64. [PMID: 36257164 PMCID: PMC10369365 DOI: 10.1016/j.jss.2022.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/26/2022] [Accepted: 08/19/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Timely colorectal cancer (CRC) screening has been shown to improve CRC-related morbidity and mortality rates. However, even with this preventative care tool, CRC screening rates remain below 70% among eligible United States (US) adults, with even lower rates among US immigrants. The aim of this scoping review is to describe the barriers to CRC screening faced by this unique and growing immigrant population and discuss possible interventions to improve screening. METHODS Four electronic databases were systematically searched for all original research articles related to CRC screening in US immigrants published after 2010. Following a full-text review of articles for inclusion in the final analysis, data extraction was conducted while coding descriptive themes. Thematic analysis led to the organization of this data into five themes. RESULTS Of the 4637 articles initially identified, 55 met inclusion criteria. Thematic analysis of the barriers to CRC screening identified five unique themes: access, knowledge, culture, trust, health perception, and beliefs. The most cited barriers were in access (financial burden and limited primary care access) and knowledge (CRC/screening knowledge). CONCLUSIONS US immigrants face several barriers to the receipt of CRC screening. When designing interventions to increase screening uptake among immigrants, gaps in physician and screening education, access to care, and trust need to be addressed through culturally sensitive supports. These interventions should be tailored to the specific immigrant group, since a one-size-fits approach fails to consider the heterogeneity within this population.
Collapse
Affiliation(s)
| | - Alisha Lussiez
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Laura Hayward
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Shukri Dualeh
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Emily Capellari
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Gifty Kwakye
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
6
|
Khouri AN, Haley C, MacEachern M, Morrison SD. Current Concepts in Gender-Affirming Surgery Postgraduate Training. Indian J Plast Surg 2022; 55:129-138. [PMID: 36017402 PMCID: PMC9398522 DOI: 10.1055/s-0042-1751021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background
Recent advocacy efforts and expanded insurance coverage has increased health care utilization among transgender patients. Therefore, it is pivotal that surgical residents are properly trained to care for transgender patients in both clinical and surgical settings. Yet, no formal curriculum or training requirements exist for surgical residents. The aim of this systematic review is to understand the surgical trainee's postgraduate education and training with respect to transgender health and gender-affirming surgeries (GAS).
Methods
A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant literature search was performed on December 04, 2020 in PubMed, Elsevier Embase, and Wiley Cochrane Central Register of Controlled Trials. The retrieved hits were screened and reviewed by two independent reviewers.
Results
Our literature search identified 186 unique publications, of which 14 surveys and one interventional study from various surgical specialties including plastic surgery, urology, otolaryngology, oral and maxillofacial surgery (OMS), dermatology, and obstetrics and gynecology (OBGYN) were included in this study. The majority of residents and program directors in surgical specialties believe education related to transgender health is important, and the current exposure in surgical training does not sufficiently prepare surgical residents to care for this marginalized population.
Conclusion
Current postgraduate surgical training in gender-affirming surgery is nonuniform across surgical specialty, geographical region, and individual program. Incorporating training modules and hands-on experiences into surgical trainee education will better prepare residents for the numerous clinical and surgical interactions with transgender patients. Further research is required to better understand how to best incorporate these experiences into existing surgical curriculums.
Collapse
Affiliation(s)
- Alexander N. Khouri
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Caleb Haley
- Medical School, University of Michigan, Ann Arbor, MI, United States
| | - Mark MacEachern
- University of Michigan Taubman Health Sciences Library, Ann Arbor, MI, United States
| | - Shane D. Morrison
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
7
|
Khouri AN, Adidharma W, MacEachern M, Haase SC, Waljee JF, Cederna PS, Strong AL. The Current State of Fat Grafting in the Hand: A Systematic Review for Hand Diseases. Hand (N Y) 2022; 18:543-552. [PMID: 35130761 DOI: 10.1177/15589447211066347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Autologous fat grafting (AFG) has traditionally been used for facial rejuvenation and soft tissue augmentation, but in recent years, its use has expanded to treat diseases of the hand. Autologous fat grafting is ideal for use in the hand because it is minimally invasive, can restore volume, and has regenerative capabilities. This review summarizes the emerging evidence regarding the safety and efficacy of AFG to the hand in several conditions, including systemic sclerosis, Dupuytren disease, osteoarthritis, burns, and traumatic fingertip injuries. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant literature search on the use of AFG in hand pathologies was performed on October 8, 2020, in Ovid MEDLINE, Elsevier Embase, Clarivate Web of Science, and Wiley Cochrane Central Register of Controlled Trials. The retrieved hits were screened and reviewed by 2 independent reviewers and a third reviewer adjudicated when required. Reviewers identified 919 unique hits. Screening of the abstracts identified 22 manuscripts which described the use of AFG to treat an identified hand condition. Studies suggest AFG in the hands is a safe, noninvasive option for the management of systemic sclerosis, Dupuytren contracture, osteoarthritis, burns, and traumatic fingertip injuries. While AFG is a promising therapeutic option for autoimmune, inflammatory, and fibrotic disease manifestations in the hand, further studies are warranted to understand its efficacy and to establish more robust clinical guidelines. Studies to date show the regenerative, immunomodulatory, and volume-filling properties of AFG that facilitate wound healing and restoration of hand function with limited complications.
Collapse
|
8
|
Prabhu M, Wilkie G, MacEachern M, LaBuda D, Purtell J, Riley L, Habib A, Bauer M. Procalcitonin Levels in Pregnancy: A Systematic Review and Meta-Analysis of Observational Studies. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
9
|
Bauer ME, Arendt K, Beilin Y, Gernsheimer T, Perez Botero J, James AH, Yaghmour E, Toledano RD, Turrentine M, Houle T, MacEachern M, Madden H, Rajasekhar A, Segal S, Wu C, Cooper JP, Landau R, Leffert L. The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia. Anesth Analg 2021; 132:1531-1544. [PMID: 33861047 DOI: 10.1213/ane.0000000000005355] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Because up to 12% of obstetric patients meet criteria for the diagnosis of thrombocytopenia in pregnancy, it is not infrequent that the anesthesiologist must decide whether to proceed with a neuraxial procedure in an affected patient. Given the potential morbidity associated with general anesthesia for cesarean delivery, thoughtful consideration of which patients with thrombocytopenia are likely to have an increased risk of spinal epidural hematoma with neuraxial procedures, and when these risks outweigh the relative benefits is important to consider and to inform shared decision making with patients. Because there are substantial risks associated with withholding a neuraxial analgesic/anesthetic procedure in obstetric patients, every effort should be made to perform a bleeding history assessment and determine the thrombocytopenia etiology before admission for delivery. Whereas multiple other professional societies (obstetric, interventional pain, and hematologic) have published guidelines addressing platelet thresholds for safe neuraxial procedures, the US anesthesia professional societies have been silent on this topic. Despite a paucity of high-quality data, there are now meta-analyses that provide better estimations of risks. An interdisciplinary taskforce was convened to unite the relevant professional societies, synthesize the data, and provide a practical decision algorithm to help inform risk-benefit discussions and shared decision making with patients. Through a systematic review and modified Delphi process, the taskforce concluded that the best available evidence indicates the risk of spinal epidural hematoma associated with a platelet count ≥70,000 × 106/L is likely to be very low in obstetric patients with thrombocytopenia secondary to gestational thrombocytopenia, immune thrombocytopenia (ITP), and hypertensive disorders of pregnancy in the absence of other risk factors. Ultimately, the decision of whether to proceed with a neuraxial procedure in an obstetric patient with thrombocytopenia occurs within a clinical context. Potentially relevant factors include, but are not limited to, patient comorbidities, obstetric risk factors, airway examination, available airway equipment, risk of general anesthesia, and patient preference.
Collapse
Affiliation(s)
- Melissa E Bauer
- From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Katherine Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yaakov Beilin
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Terry Gernsheimer
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Juliana Perez Botero
- Department of Medicine, Medical College of Wisconsin and Versiti, Milwaukee, Wisconsin
| | - Andra H James
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Edward Yaghmour
- Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee
| | - Roulhac D Toledano
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, New York, New York
| | - Mark Turrentine
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, Liaison for the American College of Obstetricians and Gynecologists
| | - Timothy Houle
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan Medical School, Ann Arbor, Michigan
| | - Hannah Madden
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anita Rajasekhar
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Scott Segal
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Christopher Wu
- Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Jason P Cooper
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Ruth Landau
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Lisa Leffert
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
10
|
Vitous CA, Dinh DQ, Jafri SM, Bennett OM, MacEachern M, Suwanabol PA. Optimizing Surgeon Well-Being: A Review and Synthesis of Best Practices. Ann Surg Open 2021; 2:e029. [PMID: 36714393 PMCID: PMC9872854 DOI: 10.1097/as9.0000000000000029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/19/2020] [Indexed: 02/01/2023] Open
Abstract
Through a systematic review and mixed-methods meta-synthesis of the existing literature on surgeon well-being, we sought to identify the specific elements of surgeon well-being, examine factors associated with suboptimal well-being, and highlight opportunities to promote well-being. Background Suboptimal surgeon well-being has lasting and substantial impacts to the individual surgeon, patients, and to society as a whole. However, most of the existing literature focuses on only 1 aspect of well-being-burnout. While undoubtedly a crucial component of overall well-being, the mere absence of burnout does not fully consider the complexities of being a surgeon. Methods We performed a literature search within Ovid Medline, Elsevier Excerpta Medica dataBASE, EBSCOhost Cumulative Index to Nursing and Allied Health Literature, and Clarivate Web of Science from inception to May 7, 2020, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies with primary data examining surgeon well-being were included. Using a predetermined instrument, data were abstracted from each study and compared using thematic analysis. Results A total of 5369 abstracts were identified and screened, with 184 full articles (172 quantitative, 3 qualitative, 9 mixed methods) selected for analysis. Among these, 91 articles measured burnout, 82 examined career satisfaction, 95 examined work-related stressors, 44 explored relationships and families, and 85 assessed emotional and physical health. Thematic analysis revealed 4 themes: professional components, personal components, work-life balance, and impacts to well-being. Conclusions Surgeon well-being is complex and multifaceted. This nuanced examination of surgeon well-being highlights the critical need to develop and provide more long-term support to surgeons-with interventions being tailored based on individual, institutional, and systemic factors.
Collapse
Affiliation(s)
- C. Ann Vitous
- From the Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Sara M. Jafri
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | | | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI
| | | |
Collapse
|
11
|
Haydar B, Baetzel A, Elliott A, MacEachern M, Kamal A, Christensen R. Adverse Events During Intrahospital Transport of Critically Ill Children: A Systematic Review. Anesth Analg 2020; 131:1135-1145. [PMID: 32925334 DOI: 10.1213/ane.0000000000004585] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intrahospital transport of a critically ill patient is often required to achieve a diagnostic and/or therapeutic objective. However, clinicians who recommend a procedure that requires transport are often not fully aware of the risks of transport. Clinicians involved in the care of critically ill children may therefore benefit from a clear enumeration of adverse events that have occurred during transport, risk factors for those events, and guidance for event prevention. The objective of this review was to collect all published harm and adverse events that occurred in critically ill children in the context of transport within a medical center, as well as the incidence of each type of event. A secondary objective was to identify what interventions have been previously studied that reduce events and to collect recommendations for harm prevention from study authors. Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and CINAHL were searched in January 2018 and again in December 2018. Terms indicating pediatric patients, intrahospital transport, critical illness, and adverse events were used. Titles and abstracts were screened and full text was reviewed for any article meeting inclusion criteria. If articles included both children and adults, incidence data were collected only if the number of pediatric patients could be ascertained. Of 471 full-text articles reviewed, 40 met inclusion criteria, of which 24 included only children, totaling 4104 patient transports. Heterogeneity was high, owing to a wide range of populations, settings, data collection methods, and outcomes. The incidence of adverse events varied widely between studies. Examples of harm included emergent tracheostomy, pneumothorax, and cardiac arrest requiring chest compressions. Respiratory and airway events were the most common type of adverse event. Hypothermia was common in infants. One transport-associated death was reported. When causation was assessed, most events were judged to have been preventable or potentially mitigated by improved double-checks and usage of checklists. Prospective studies demonstrated the superiority of mechanical ventilation over manual ventilation for intubated patients. Risk of adverse events during critical care transport appears to relate to the patient's underlying illness and degree of respiratory support. Recommendations for reducing these adverse events have frequently included the use of checklists. Other recommendations include optimization of the patient's physiological status before transport, training with transport equipment, double-checking of equipment before transport, and having experienced clinicians accompany the patient. All available recommendations for reducing transport-associated adverse events in included articles were collated and included.
Collapse
Affiliation(s)
- Bishr Haydar
- From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anne Baetzel
- From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anila Elliott
- From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Afra Kamal
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Robert Christensen
- From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| |
Collapse
|
12
|
Abstract
Background The use of extracorporeal life support (ECLS) has expanded to include unique populations such as peripartum women. This systematic review aims to (1) quantify the number of cases and indications for ECLS in women during the peripartum period reported in the literature and (2) report maternal and fetal complications and outcomes associated with peripartum ECLS. Methods and Results This review was registered in PROSPERO (CRD42018108142). MEDLINE, Embase, and CINAHL were searched for case reports, case series, and studies reporting cases of ECLS during the peripartum period that reported one or more of the following outcomes: maternal survival, maternal complications, fetal survival, and/or fetal complications. Qualitative assessment of 221 publications evaluated the number of cases, clinical details, and maternal and fetal outcomes of ECLS during the peripartum period. There were 358 women included and 68 reported fetal outcomes in cases where the mother was pregnant at the time of cannulation. The aggregate maternal survival at 30 days was 270 (75.4%) and at 1 year was 266 (74.3%); fetal survival was 44 (64.7%). The most common indications for ECLS overall in pregnancy included acute respiratory distress syndrome 177 (49.4%), cardiac failure 67 (18.7%), and cardiac arrest 57 (15.9%). The most common maternal complications included mild to moderate bleeding 66 (18.4%), severe bleeding requiring surgical intervention 48 (13.4%), and intracranial neurologic morbidity 19 (5.3%). The most commonly reported fetal complications included preterm delivery 33 (48.5%) and neonatal intensive care unit admission 19 (27.9%). Conclusions Reported rates of survival in ECLS in pregnant and postpartum women are high and major complications relatively low.
Collapse
Affiliation(s)
- Emily E. Naoum
- Department of AnesthesiologyUniversity of MichiganAnn ArborMI
| | - Andrew Chalupka
- Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General HospitalBostonMA
| | - Jonathan Haft
- Department of Cardiac SurgeryUniversity of MichiganAnn ArborMI
| | - Mark MacEachern
- Taubman Health Sciences LibraryUniversity of MichiganAnn ArborMI
| | - Cosmas J. M. Vandeven
- Department of Obstetrics and GynecologyMaternal‐Fetal MedicineUniversity of MichiganAnn ArborMI
| | - Sarah Rae Easter
- Division of Maternal‐Fetal MedicineDepartment of Obstetrics and GynecologyBrigham and Women’s HospitalBostonMA
| | - Michael Maile
- Department of AnesthesiologyUniversity of MichiganAnn ArborMI
| | - Brian T. Bateman
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineDepartment of Anesthesiology, Perioperative and Pain MedicineBrigham and Women’s HospitalBostonMA
| | | |
Collapse
|
13
|
Bauer ME, Toledano RD, Houle T, Beilin Y, MacEachern M, McCabe M, Rector D, Cooper JP, Gernsheimer T, Landau R, Leffert L. Lumbar neuraxial procedures in thrombocytopenic patients across populations: A systematic review and meta-analysis. J Clin Anesth 2020; 61:109666. [DOI: 10.1016/j.jclinane.2019.109666] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/04/2019] [Accepted: 11/16/2019] [Indexed: 01/19/2023]
|
14
|
Muzyk A, Smothers ZPW, Andolsek KM, Bradner M, Bratberg JP, Clark SA, Collins K, Greskovic GA, Gruppen L, MacEachern M, Ramsey SE, Ruiz Veve J, Tetrault JM. Interprofessional Substance Use Disorder Education in Health Professions Education Programs: A Scoping Review. Acad Med 2020; 95:470-480. [PMID: 31651435 DOI: 10.1097/acm.0000000000003053] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE The authors conducted this scoping review to (1) provide a comprehensive evaluation and summation of published literature reporting on interprofessional substance use disorder (SUD) education for students in health professions education programs and (2) appraise the research quality and outcomes of interprofessional SUD education studies. Their goals were to inform health professions educators of interventions that may be useful to consider as they create their own interprofessional SUD courses and to identify areas of improvement for education and research. METHOD The authors searched 3 Ovid MEDLINE databases (MEDLINE, In-Process & Other Non-Indexed Citations, and Epub Ahead of Print), Embase.com, ERIC via FirstSearch, and Clarivate Analytics Web of Science from inception through December 7, 2018. The authors used the Medical Education Research Study Quality Instrument (MERSQI) to assess included studies' quality. RESULTS The authors screened 1,402 unique articles, and 14 met inclusion criteria. Publications dated from 2014 to 2018. Ten (71%) included students from at least 3 health professions education programs. The mean MERSQI score was 10.64 (SD = 1.73) (range, 7.5-15). Interventions varied by study, and topics included general substance use (n = 4, 29%), tobacco (n = 4, 29%), alcohol (n = 3, 21%), and opioids (n = 3, 21%). Two studies (14%) used a nonrandomized 2-group design. Four (29%) included patients in a clinical setting or panel discussion. Ten (72%) used an assessment tool with validity evidence. Studies reported interventions improved students' educational outcomes related to SUDs and/or interprofessionalism. CONCLUSIONS Interprofessional SUD educational interventions improved health professions students' knowledge, skills, and attitudes toward SUDs and interprofessional collaboration. Future SUD curriculum design should emphasize assessment and measure changes in students' behaviors and patient or health care outcomes. Interprofessional SUD education can be instrumental in preparing the future workforce to manage this pressing and complex public health threat.
Collapse
Affiliation(s)
- Andrew Muzyk
- A. Muzyk is associate professor, Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina, and associate professor of the practice of medical education, Duke University School of Medicine, Durham, North Carolina; ORCID: http://orcid.org/0000-0002-6904-2466. Z.P.W. Smothers is a third-year medical student, Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina. K.M. Andolsek is professor, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina. M. Bradner is associate professor, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond Virginia. J.P. Bratberg is clinical professor, Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island. S.A. Clark is a Brown University Addiction Medicine Fellow, Department of Internal Medicine, Rhode Island Hospital, Providence, Rhode Island. K. Collins is a third-year pharmacy student, Doctor of Pharmacy Program, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina. G.A. Greskovic is system director, Ambulatory Disease Management Programs, Geisinger Health System, Danville, Pennsylvania. L. Gruppen is professor, Department of Learning Sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0002-2107-0126. M. MacEachern is an informationist, Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0002-8872-1181. S.E. Ramsey is associate professor (research), Departments of Psychiatry and Human Behavior and Medicine, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island; ORCID: https://orcid.org/0000-0001-7169-727X. J. Ruiz Veve is a fourth-year pharmacy student, Doctor of Pharmacy Program, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina. J.M. Tetrault is associate professor, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Muzyk A, Smothers ZPW, Akrobetu D, Ruiz Veve J, MacEachern M, Tetrault JM, Gruppen L. Substance Use Disorder Education in Medical Schools: A Scoping Review. Acad Med 2019; 94:1825-1834. [PMID: 31663960 DOI: 10.1097/acm.0000000000002883] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE As medical schools adapt their curricula to prepare future physicians for the opioid crisis and for treating patients with substance use disorders (SUDs), educators should refer to courses described in the literature. This scoping review aimed to (1) provide a comprehensive evaluation and summation of peer-reviewed literature reporting on SUD education in medical schools globally and (2) appraise the research quality and educational outcomes reported in SUD education studies in medical schools. METHOD The authors searched 6 databases (3 Ovid MEDLINE databases, Embase, ERIC, and Web of Science) from inception through May 25, 2018. Original English-language research studies focusing on medical students and describing SUD education in medical schools were included. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess included studies. RESULTS Of 3,178 articles identified, 43 met inclusion criteria. Studies were conducted in 9 countries. Most reported on educational interventions for tobacco (n = 20; 47%); others reported on interventions for SUDs broadly (n = 15; 35%), alcohol (n = 8; 19%), and opioids (n = 1; 2%). The mean MERSQI score was 12.27 (standard deviation 2.30). Four studies (9%) reported on educational outcomes at the level of behaviors or patient or health care outcomes. The majority (n = 39; 91%) reported significant benefits. CONCLUSIONS Educational interventions relating to SUDs were effective in improving medical students' knowledge, skills, and attitudes. Educators should develop courses that achieve higher-level educational outcomes, increase education on opioid use disorders, and focus on the greatest public health concerns.
Collapse
Affiliation(s)
- Andrew Muzyk
- A. Muzyk is associate professor, Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina, and associate professor of the practice of medical education, Duke University School of Medicine, Durham, North Carolina; ORCID: http://orcid.org/0000-0002-6904-2466. Z.P.W. Smothers is a second-year student, Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina. D. Akrobetu is a second-year student, Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina. J. Ruiz Veve is a third-year student, Doctor of Pharmacy Program, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina. M. MacEachern is informationist, Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0002-8872-1181. J.M. Tetrault is associate professor, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. L. Gruppen is professor, Department of Learning Sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0002-2107-0126
| | | | | | | | | | | | | |
Collapse
|
16
|
Marti KC, Mylonas AI, MacEachern M, Gruppen L. Humanities in Predoctoral Dental Education: A Scoping Review. J Dent Educ 2019; 83:1174-1198. [DOI: 10.21815/jde.019.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/17/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Kyriaki C. Marti
- Departments of Oral and Maxillofacial Surgery, Periodontics and Oral Medicine; Cariology, Restorative Sciences, and Endodontics; University of Michigan School of Dentistry
| | - Anastassios I. Mylonas
- Departments of History and Philosophy of Medicine and Oral and Maxillofacial Surgery; Schools of Medicine and Dentistry; National and Kapodistrian University of Athens; Metropolitan Hospital
| | | | - Larry Gruppen
- Department of Learning Health Sciences; University of Michigan Medical School
| |
Collapse
|
17
|
Muzyk A, Smothers ZPW, Collins K, MacEachern M, Wu LT. Pharmacists' attitudes toward dispensing naloxone and medications for opioid use disorder: A scoping review of the literature. Subst Abus 2019; 40:476-483. [PMID: 31418645 PMCID: PMC6920531 DOI: 10.1080/08897077.2019.1616349] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Pharmacists are on the frontline caring for patients at risk of an opioid overdose and for patients with an opioid use disorder (OUD). Dispensing naloxone and medications for OUD and counseling patients about these medications are ways pharmacists can provide care. Key to pharmacists' involvement is their willingness to take on these practice responsibilities. Methods: The purpose of this scoping review is to identify, evaluate, and summarize published literature describing pharmacists' attitudes toward naloxone and medications for OUD, i.e., methadone, buprenorphine, and naltrexone. All searches were performed on December 7, 2018, in 5 databases: Embase.com, PubMed.gov, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost, Cochrane Central Register of Controlled Trials via Wiley, and Clarivate Web of Science. Articles included original research conducted in the United States, described attitude-related language toward naloxone and medications for OUD, and pharmacists. Results: A total of 1323 articles were retrieved, 7 were included. Five studies reported on pharmacists' attitudes toward naloxone dispensing, 1 study reported on attitudes toward naloxone, buprenorphine, and buprenorphine/naloxone, and 1 reported on attitudes toward buprenorphine/naloxone. Respondents were diverse, including pharmacists from different practice specialties. Studies found that pharmacists agreed with a naloxone standing order, believed that naloxone should be dispensed to individuals at risk of an opioid overdose, and were supportive of dispensing buprenorphine. A minority of pharmacists expressed negative attitudes. Barriers cited to implementation included education and training, workflow, and management support. Conclusions: Pharmacists were positive in their attitudes toward increased practice responsibilities for patients at risk of an opioid overdose or with an OUD. Pharmacists must receive education and training to be current in their understanding of OUD medications, and they must be supported in order to provide effective care to this patient population.
Collapse
Affiliation(s)
- Andrew Muzyk
- Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina, USA
| | - Zachary P W Smothers
- Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kathryn Collins
- Doctor of Pharmacy Program, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina, USA
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
18
|
Bauer ME, Balistreri M, MacEachern M, Cassidy R, Schoenfeld R, Sankar K, Clauw DJ, Langen E. Normal Range for Maternal Lactic Acid during Pregnancy and Labor: A Systematic Review and Meta-Analysis of Observational Studies. Am J Perinatol 2019; 36:898-906. [PMID: 30396223 DOI: 10.1055/s-0038-1675243] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This article systematically reviews the literature to establish the normal range of lactic acid in healthy pregnant women. STUDY DESIGN Ovid MEDLINE, Embase.com, and Clinicaltrials.gov were searched to identify studies that reported maternal lactic acid in healthy pregnant women. Pooled aggregate means and two standard deviations for each time period were computed using the inverse variance weighting technique. Analyses were performed separately for 1st, 2nd, and 3rd trimesters, scheduled cesarean delivery, early labor, active labor, 2nd stage of labor, and delivery. RESULTS Overall, 22 studies met the inclusion criteria. There were 1,193 patients, and 2,008 observations identified. All time periods had maternal venous lactic acid aggregate means and two-standard-deviation ranges less than 4 mmol/L. Outside of labor, all ranges were less than 2 mmol/L. All labor periods had a range higher than 2 mmol/L. While the pooled ranges were less than 4 mmol/L, many individual studies reported ranges > 4 mmol/L during labor. CONCLUSION This meta-analysis suggests that venous lactic acid levels can be used as a screening tool in pregnant women just as the test would be used in nonpregnant women, except that elevations may be seen during labor, especially later in labor when there is maximal skeletal muscle contraction.
Collapse
Affiliation(s)
- Melissa E Bauer
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Michael Balistreri
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, St. Mary's Hospital - Madison, Madison, Wisconsin
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Ruth Cassidy
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | | | - Keerthana Sankar
- Wayne State University School of Medicine, Wayne State University, Detroit, Michigan
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Elizabeth Langen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
19
|
Gunn AH, Smothers ZPW, Schramm-Sapyta N, Freiermuth CE, MacEachern M, Muzyk AJ. The Emergency Department as an Opportunity for Naloxone Distribution. West J Emerg Med 2018; 19:1036-1042. [PMID: 30429939 PMCID: PMC6225944 DOI: 10.5811/westjem.2018.8.38829] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/26/2018] [Accepted: 08/16/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Substance use disorders, including opioid use disorders, are a major public health concern in the United States. Between 2005 and 2014, the rate of opioid-related emergency department (ED) visits nearly doubled, from 89.1 per 100,000 persons in 2005 to 177.7 per 100,000 persons in 2014. Thus, the ED presents a distinctive opportunity for harm-reduction strategies such as distribution of naloxone to patients who are at risk for an opioid overdose. Methods We conducted a systematic review of all existing literature related to naloxone distribution from the ED. We included only those articles published in peer-reviewed journals that described results relating to naloxone distribution from the ED. Results Of the 2,286 articles we identified from the search, five met the inclusion criteria and had direct relevance to naloxone distribution from the ED setting. Across the studies, we found variation in the methods of implementation and evaluation of take-home naloxone programs in the ED. In the three studies that attempted patient follow-up, success was low, limiting the evidence for the programs’ effectiveness. Overall, in the included studies there is evidence that distributing take-home naloxone from the ED has the potential for harm reduction; however, the uptake of the practice remained low. Barriers to implementation included time allocated for training hospital staff and the burden on workflow. Conclusion This systematic review of the best evidence available supports the ED as a potential setting for naloxone distribution for overdose reversal in the community. The variability of the implementation methods across the studies highlights the need for future research to determine the most effective practices.
Collapse
Affiliation(s)
- Alexander H Gunn
- Duke University, Duke-Margolis Center for Health Policy, Durham, North Carolina
| | | | - Nicole Schramm-Sapyta
- Duke Institute for Brain Sciences, Department of Psychiatry, Duke University, Durham, North Carolina
| | - Caroline E Freiermuth
- Duke University School of Medicine, Division of Emergency Medicine, Durham, North Carolina
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Andrew J Muzyk
- Duke University Hospital, Department of Pharmacy, Durham, North Carolina.,Campbell University College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Buies Creek, North Carolina
| |
Collapse
|
20
|
Zisblatt L, Naughton NN, Byrne M, Dobija N, Fowler LC, MacEachern M, McLean S, Munzer BW, Rochlen LR, Santen SA, Peoples E. An Analysis of the Top-cited Articles in Anesthesiology Education Literature. J Educ Perioper Med 2018; 20:E627. [PMID: 30510975 PMCID: PMC6256997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND In the same way that impact factor is calculated for journals, the number of citations an article receives can indicate its influence or value to a particular field. This study was designed to identify the most frequently cited articles in anesthesiology education to yield insight into which articles have been most useful for researchers in ongoing research and publication. METHODS The Web of Science database was searched to capture the top-cited articles in anesthesiology education both in anesthesiology and nonanesthesiology journals. Results were sorted by the most frequently cited. The top 40 cited articles were identified. Articles were included if they (1) related to anesthesiology or included anesthesiologists as subjects and (2) were related to the education of current or future anesthesiologists. The full text was analyzed, and themes were identified. RESULTS There was a total of 2923 citations of articles in anesthesiology journals and 924 citations of articles in nonanesthesiology journals. Thirty-two of 40 articles (80%) were research studies. Twenty-four of 40 (60%) were about teaching methods. Twenty-five of 40 (63%) focused on simulation, and 31 of 40 (78%) had residents as the subjects. Twenty-eight of 40 (70%) articles were about either case management (15) or learning procedures (13). CONCLUSIONS This study identifies the most widely cited articles in anesthesiology education. Common themes included procedural learning, interventional research study designs, simulation, and studies involving residents as subjects. This article may be a resource to anesthesiology education researchers to identify what articles are widely cited by other researchers.
Collapse
|
21
|
Bhaskar V, Chan HL, MacEachern M, Kripfgans OD. Updates on ultrasound research in implant dentistry: a systematic review of potential clinical indications. Dentomaxillofac Radiol 2018; 47:20180076. [PMID: 29791198 DOI: 10.1259/dmfr.20180076] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Ultrasonography has shown promising diagnostic value in dental implant imaging research; however, exactly how ultrasound was used and at what stage of implant therapy it can be applied has not been systematically evaluated. Therefore, the aim of this review is to investigate potential indications of ultrasound use in the three implant treatment phases, namely planning, intraoperative and post-operative phase. METHODS Eligible manuscripts were searched in major databases with a combination of keywords related to the use of ultrasound imaging in implant therapy. An initial search yielded 414 articles, after further review, 28 articles were finally included for this systematic review. RESULTS Ultrasound was found valuable, though at various development stages, for evaluating (1) soft tissues, (2) hard tissues (3) vital structures and (4) implant stability. B-mode, the main function to image anatomical structures of interest, has been evaluated in pre-clinical and clinical studies. Quantitative ultrasound parameters, e.g. sound speed and amplitude, are being developed to evaluate implant-bone stability, mainly in simulation and pre-clinical studies. Ultrasound could be potentially useful in all three treatment phases. In the planning phase, ultrasound could evaluate vital structures, tissue biotype, ridge width/density, and cortical bone thickness. During surgery, it can provide feedback by identifying vital structures and bone boundary. At follow-up visits, it could evaluate marginal bone level and implant stability. CONCLUSIONS Understanding the current status of ultrasound imaging research for implant therapy would be extremely beneficial for accelerating translational research and its use in dental clinics.
Collapse
Affiliation(s)
| | - Hsun-Liang Chan
- 2 Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry , Ann Arbor, MI , USA
| | - Mark MacEachern
- 3 Taubman Health Sciences Library, University of Michigan , Ann Arbor, MI , USA
| | - Oliver D Kripfgans
- 4 Department of Biomedical Engineering, College of Engineering , Ann Arbor, MI , USA.,5 Department of Radiology, University of Michigan Medical School , Ann Arbor, MI , USA
| |
Collapse
|
22
|
Abdul-Aziz AA, Altawil M, Lyon A, MacEachern M, Richardson CR, Rubenfire M, Pelosi F, Jackson EA. Lifestyle Therapy for the Management of Atrial Fibrillation. Am J Cardiol 2018; 121:1112-1117. [PMID: 29650239 DOI: 10.1016/j.amjcard.2018.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/10/2018] [Accepted: 01/17/2018] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) is a common arrhythmia associated with increased risk of morbidity and mortality. There is evidence that lifestyle interventions may serve as complementary treatments to reduce AF burden. The objective of this review was to summarize the efficacy of lifestyle interventions for the management of AF. Studies which included patients with systolic heart failure (ejection fraction ≤40%), and those limited to an examination of vigorous physical activity were excluded from our search. Studies were identified through a search of the following databases: MEDLINE, EMBASE, CINAHIL, and PubMed, run from inception through August 2016. All studies were graded for quality using the Oxford Centre for Evidence-based Medicine recommendations. Meta-analyses of the studies were not performed due to the heterogeneity of the studies. From a total of 1,811 publications, 10 articles were identified and included. Selected publications included 1 study on yoga, 2 studies on acupuncture, 3 studies that examined weight loss programs, and 4 studies that evaluated the impact of moderate physical activity. Yoga was associated with less symptomatic AF episodes and improved quality of life. Acupuncture was associated with reduced AF occurrence in patients with persistent and paroxysmal AF. Weight loss was associated with a significant reduction AF burden and symptoms. Moderate exercise resulted in greater arrhythmia free survival and a mean reduction in AF burden. In conclusion, evidence exists to suggest that yoga, weight loss, and moderate exercise are associated with reductions in AF burden and symptoms. Evidence is greatest for weight loss and moderate exercise.
Collapse
Affiliation(s)
- Ahmad A Abdul-Aziz
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mahmoud Altawil
- Department of Internal Medicine, Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan
| | - Amanda Lyon
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | | | - Melvyn Rubenfire
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Frank Pelosi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Elizabeth A Jackson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
23
|
Abstract
Metformin is the recommended first-line oral glucose-lowering drug initiated to control hyperglycemia in type 2 diabetes mellitus. It acts in the liver, small intestines, and skeletal muscles with its major effect on decreasing hepatic gluconeogenesis. It is safe, inexpensive, and weight neutral and can be associated with weight loss. It can reduce microvascular complication risk and its use is associated with a lower cardiovascular mortality compared with sulfonylurea therapy. It is also used to delay the onset of type 2 diabetes mellitus, in treating gestational diabetes, and in women with polycystic ovary syndrome.
Collapse
Affiliation(s)
- Meng H Tan
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Hussain Alquraini
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kara Mizokami-Stout
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
24
|
Giusto LL, Santiago-Lastra Y, Hughes MV, MacEachern M, Cameron AP. MP26-01 INCONSISTENCY IN THE DEFINITION OF URINARY TRACT INFECTION IN THE SPINAL CORD INJURY POPULATION: A SYSTEMATIC REVIEW. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
25
|
Mailoa J, Lin GH, Khoshkam V, MacEachern M, Chan HL, Wang HL. Long-Term Effect of Four Surgical Periodontal Therapies and One Non-Surgical Therapy: A Systematic Review and Meta-Analysis. J Periodontol 2015; 86:1150-8. [DOI: 10.1902/jop.2015.150159] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
26
|
Abstract
Gingival recession represents a clinical condition in adults frequently encountered in the general dental practice. Clinicians often face dilemmas of whether or not to treat such a condition surgically. An initial condensed literature search was performed using a combination of gingival recession and surgery controlled terms and keywords. An analysis of the search results highlights the limited understanding of the factors that guide the treatment of gingival recession. Understanding the cause, prognosis, and treatment of gingival recession continues to offer many unanswered questions and challenges in periodontics as we strive to provide the best care possible for our patients.
Collapse
Affiliation(s)
- Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, R3323B 1011 North University Avenue, Ann Arbor, MI 48105, USA
| | - Yong-Hee Patricia Chun
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, 1135 East Catherine Street, Ann Arbor, MI 48109, USA
| | - Thomas W Oates
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| |
Collapse
|
27
|
Chan HL, Lin GH, Suarez F, MacEachern M, Wang HL. Surgical Management of Peri-Implantitis: A Systematic Review and Meta-Analysis of Treatment Outcomes. J Periodontol 2014; 85:1027-41. [DOI: 10.1902/jop.2013.130563] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
28
|
Mailoa J, Lin GH, Chan HL, MacEachern M, Wang HL. Clinical outcomes of using lasers for peri-implantitis surface detoxification: a systematic review and meta-analysis. J Periodontol 2014; 85:1194-202. [PMID: 24476547 DOI: 10.1902/jop.2014.130620] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
UNLABELLED The aim of this systematic review is to compare the clinical outcomes of lasers with other commonly applied detoxification methods for treating peri-implantitis. An electronic search of four databases and a hand search of peer-reviewed journals for relevant articles were conducted. Comparative human clinical trials and case series with ≥ 6 months of follow-up in ≥ 10 patients with peri-implantitis treated with lasers were included. Additionally, animal studies applying lasers for treating peri-implantitis were also included. The included studies had to report probing depth (PD) reduction after the therapy. RESULTS Seven human prospective clinical trials and two animal studies were included. In four and three human studies, lasers were accompanied with surgical and non-surgical treatments, respectively. The meta-analyses showed an overall weighted mean difference of 0.00 mm (95% confidence interval = -0.18 to 0.19 mm) PD reduction between the laser and conventional treatment groups (P = 0.98) for non-surgical intervention. In animal studies, laser-treated rough-surface implants had a higher percentage of bone-to-implant contact than smooth-surface implants. In a short-term follow-up, lasers resulted in similar PD reduction when compared with conventional implant surface decontamination methods.
Collapse
Affiliation(s)
- James Mailoa
- Graduate Periodontics, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | | | | | | | | |
Collapse
|
29
|
Abstract
The Taubman Health Sciences Library (THL) is integrated in all four years of the University of Michigan Medical School (UMMS) curriculum. Information resources are introduced at strategic points throughout the curriculum so that students receive training at times when they are most likely to need the resource. Most of the core instruction sessions are taught in teams that consist of librarians and UMMS faculty, which provides unique learning opportunities for students. This article describes each THL instruction activity in the four-year undergraduate UMMS curriculum and provides commentary on the overall effectiveness of this integrated approach to instruction.
Collapse
Affiliation(s)
- Mark MacEachern
- A. Alfred Taubman Health Sciences Library, University of Michigan, 1135 East Catherine Street, Ann Arbor, MI 48109, USA.
| | | | | | | |
Collapse
|
30
|
Oviatt S, Levow GA, Moreton E, MacEachern M. Modeling global and focal hyperarticulation during human-computer error resolution. J Acoust Soc Am 1998; 104:3080-3098. [PMID: 9821350 DOI: 10.1121/1.423888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
When resolving errors with interactive systems, people sometimes hyperarticulate--or adopt a clarified style of speech that has been associated with increased recognition errors. The primary goals of the present study were: (1) to provide a comprehensive analysis of acoustic, prosodic, and phonological adaptations to speech during human-computer error resolution after different types of recognition error; and (2) to examine changes in speech during both global and focal utterance repairs. A semi-automatic simulation method with a novel error-generation capability was used to compare speech immediately before and after system recognition errors. Matched original-repeat utterance pairs then were analyzed for type and magnitude of linguistic adaption during global and focal repairs. Results indicated that the primary hyperarticulate changes in speech following all error types were durational, with increases in number and length of pauses most noteworthy. Speech also was adapted toward a more deliberate and hyperclear articulatory style. During focal error repairs, large durational effects functioned together with pitch and amplitude to provide selective prominence marking of the repair region. These results corroborate and generalize the computer-elicited hyperarticulate adaptation model (CHAM). Implications are discussed for improved error handling in next-generation spoken language and multimodal systems.
Collapse
Affiliation(s)
- S Oviatt
- Department of Computer Science, Oregon Graduate Institute of Science and Technology, Portland 97291, USA.
| | | | | | | |
Collapse
|
31
|
MacEachern M, Brown J, Murphy D. Evaluation of DCL creatine kinase-MB reagent on the cobas mira. Clin Biochem 1995. [DOI: 10.1016/0009-9120(95)91350-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|