Carolinas Medical Center

Artificial intelligence (AI)-based electrocardiogram (ECG) analysis has emerged as a promising adjunct to human ECG interpretation in suspected ST-segment elevation myocardial infarction (STEMI). To expand knowledge in this evolving field, the authors retrospectively analyzed the performance of a novel AI-ECG model in patients with cardiac catheterization laboratory activation for suspected STEMI. Consecutive patients were gathered from a multicenter U.S. STEMI registry (2018-2022) and categorized into 3 clinical cohorts based on the presence or absence of angiographic culprit and troponin elevation: acute myocardial infarction (AMI) with culprit, AMI without culprit, and no-AMI. Cardiac catheterization laboratory-activating ECGs were analyzed using an AI-ECG model trained to identify acute coronary occlusion and classified as occlusion myocardial infarction, OMI(+) or not, OMI(-). The study included 2,523 patients, 68.3% male, with a median age of 63 years. AMI with culprit was present in 2076 (82.3%), AMI without culprit in 314 (12.4%), and no-AMI in 133 (5.3%). Among AMI with culprit patients, the model correctly identified 93.8% as OMI(+). Sensitivity for TIMI flow 0/1, 2, and 3 was 96.3%, 93.1%, and 86.9% respectively; P < 0.001. The model correctly identified 79.7% of no-AMI patients as OMI(-). The AUCROC was 0.952 (95% CI: 0.924-0.966). The AMI without culprit cohort included takotsubo syndrome OMI(+) = 78%, MI with nonobstructive coronary arteries OMI(+) = 61%, and myopericarditis OMI(+) = 67%. In suspected STEMI, this AI-ECG model correctly identified nearly all patients with acute coronary obstruction and most of those without AMI. If prospectively validated, this approach could improve management of patients with suspected AMI.

Introduction: Research is vital for improving care among critically ill and injured patients, yet despite this awareness, enrollment in critical care trials remains challenging. The high acuity of a patient’s condition often impacts emotional and physical health, in turn affecting disposition on research participation. Furthermore, key demographic groups remain underrepresented. We hypothesized that factors such as race, sex, age, education, and clinical acuity influence willingness to participate in critical care research, and motivators/deterrents vary across these demographic groups. Methods: We conducted a single-center cross-sectional survey at a tertiary hospital over 10 months, enrolling adult ICU patients or their legally authorized representatives (LARs). A validated survey containing 20 closed-ended questions measured willingness to participate in research and identified motivators/deterrents. Demographic and clinical data were obtained from the electronic health record. Statistical analysis included univariate testing and multivariable logistic regression. Results: Out of 700 participants, 70.1% indicated that they would be willing to participate in research. Multivariable analysis revealed that participants of older age (p=.041) and better well-being (p=.071) were predictors of willingness. Key motivators included the belief that research would benefit future patients (81.3%) and personal/family members’ outcomes (74.9%). However, Black participants were significantly less likely than White participants to select benefiting future patients as a motivator (70.9% vs. 23.1%, p=.010). Major deterrents across respondents included fear of being experimented on (46.6%) and potential side effects (43.5%). Participants with lower education were more likely to cite distrust in research and fear of personal data misuse as deterrents. Conclusions: Our study found that the majority of patients/LARs were open to participating in critical care research. Age and current well-being affected willingness to participate, while motivators and deterrents varied widely by demographics. By understanding the motivators and deterrents across demographic groups, we can enable thoughtful engagement with patients/LARs that address their specific concerns, thus increasing research participation among the critically ill.

Intermittent catheterization (IC) remains the standard of care for patients who are unable to empty their bladder. However, incomplete bladder emptying and urinary tract infections (UTIs) can persist, leading to complications such as recurrent infections, episodes of hospitalizations, and decreased quality of life. The Micro-hole Zone Technology (MHZT) catheter (Luja™) represents an innovative catheter design that aims to address known mechanical risk factors for UTI by minimizing flow-stops, mucosal microtrauma, and residual urine, all key contributors to infection risk. A scoping literature search was performed in PubMed and Google Scholar to identify all preclinical, clinical, and patient-reported outcome (PRO) studies evaluating the MHZT catheter (Luja). To contextualize its performance, findings were systematically compared with conventional two-eyelet catheters (CEC) across the same endpoints. The co-primary endpoints were (1) frequency of flow-stops and (2) residual urine volume at first flow-stop (RV1). Secondary endpoints included intracatheter pressure peaks, haematuria, and PRO measures related to comfort, ease of use, and perceived completeness of bladder emptying. Preclinical studies demonstrated significantly fewer flow stop with the MHZT (0% vs. up to 80% with CEC), markedly reduced residual volume at first flow-stop (mean 3.6 ± 3.9 mL vs. 38.1 ± 26.7 mL; p < 0.001) and lower intraluminal pressure peaks (− 42 ± 11 vs. − 132 ± 7 mbar; p < 0.001). From summarized data across randomized controlled trials (n > 250), catheterizations with Luja resulted in zero flow-stops and complete emptying at first flow-stop (RV1 < 10 mL) > 87% of the times compared to approximately 50% for CEC. PRO data from > 3,400 users indicated improved confidence in complete emptying, easier use and less worry for UTIs. By triangulating evidence across preclinical, clinical, and PRO studies, this review demonstrates that the MHZT/Luja catheter significantly improves bladder drainage compared with conventional designs, reducing flow-stops, residual urine, and urothelial trauma. Given that infection remains one of the most frequent IC complications, Luja offers a promising approach to lowering UTI risk factors. Enhanced user experience and confidence in complete emptying further support its potential clinical benefit.

Prehabilitation, including smoking cessation, weight loss, and glycemic control, has been shown to improve outcomes in abdominal wall reconstruction (AWR). While many AWR programs have adopted these strategies, it remains unclear how consistently general surgeons (GS) implement prehabilitation in elective AWR. An 18-question anonymous survey was distributed via REDCap to GS at two tertiary care institutions with active AWR programs. Surgeons who performed hernia repair but were not members of the AWR programs were questioned. Descriptive statistics compared attitudes, practices, and institutional support across hospitals by surgical volume were performed. Surveys were sent to 57 GS at Hospital System 1 (HS1) and 27 GS at Hospital System 2 (HS2). Of 84 surveys, 28 GS responded, yielding response rates of 30% for HS1, 48% for HS2, and 33% overall. All respondents agreed that active smoking, obesity, and uncontrolled diabetes negatively impact AWR outcomes. However, less than one-third postpone surgery for smoking cessation (32%), weight loss (29%), HbA1C improvement (32%). Barriers included concern about surgical volume/income (25%), limited perceived support from colleagues (43%) or their institution (53%). Although 57% reported access to prehabilitation resources, only 13% consistently referred patients. Despite strong evidence, unanimous agreement of its benefits, and active, institutional AWR programs that perform prehabilitation, this practice remains underutilized among general surgeons. Concerns about reduced operative volume, income, and colleague and institutional support are key barriers. Addressing these may increase prehabilitation utilization among GS and ultimately improve outcomes.

ABSTRACTBiliary complications after orthotopic liver transplantation (OLTx) have a high incidence with inherent risks. Given the rise of obesity and subsequent bariatric surgery, there are new challenges for management, particularly in the setting of bypass anatomy, which is not well described. Trans‐gastric remnant endoscopic retrograde cholangiopancreatography (TG‐ERCP) is a novel technique that could evolve into a primary tool for the diagnosis and treatment of biliary complications after OLTx. A 35‐year‐old female with a history of Roux‐en‐Y gastric bypass (RYGB), decompensated alcoholic cirrhosis, and a MELD of 40 underwent standard OLTx. The postoperative course was complicated by rising liver function tests and common bile duct (CBD) dilatation without graft biliary tree dilation. Due to her bypass anatomy, TG‐ERCP was used to diagnose a biliary stricture which was treated with CBD stenting. A gastric remnant gastrostomy tube (G‐tube) was placed as easy access for all interval ERCP interventions until stricture resolution. As metabolic dysfunction‐associated steatotic liver disease becomes a larger transplant indication, centers will undoubtedly encounter more recipients with RYGB anatomy. When compared to alternative options, TG‐ERCP should be the primary tool for the diagnosis and treatment of postoperative biliary complications, given its high success rate with fewer complications and graft vascular injuries. Future cohort‐based studies are necessary to validate this approach and the proposed treatment algorithm.

After implementing a comprehensive fall program, a critical process for investigating patient fall events, the post-fall huddle form (PFHF), was identified as an opportunity to collect extensive data to promote fall prevention. However, the PFHF was a manual process in paper format only and consisted of approximately 50 questions. The process was deemed laborious and wasn't consistently completed. The aim was to promote completion rates and evaluate the impact on direct care nurses in a neurosciences unit. The quality improvement project included designing an electronic PFHF, education for entering and validating the data, routine feedback, and pre- and postimplementation surveys. Supportive features included force functions, deidentification, electronic health record interoperability, and automated leader notification. Completion rates improved from 11.1% to an overall average of 99.6%. There was statistical significance related to decreased time to complete the form electronically for the initiator (P = .035) and the validator (P = .003). Frustrations and concerns expressed during the preimplementation survey decreased upon using the electronic PFHF. Utilizing technology, the electronic PFHF increased completion rates, enhanced data collection, and improved staff satisfaction. In addition, health care leaders increased the valuable data needed to promote patient safety and cost-savings.

Purpose: This study describes the design and implementation of a multimodal prehabilitation program for patients undergoing radical cystectomy, utilizing the comprehensive geriatric assessment (CGA) to identify and address preoperative impairments. It also characterizes baseline patient findings obtained through the CGA.Materials and Methods: We describe a multimodal prehabilitation program within the Department of Supportive Oncology at Atrium Health Levine Cancer, a large academic hybrid cancer center in United States. Patients with bladder cancer scheduled for radical cystectomy were referred by the genitourinary oncology team at least 2 weeks before surgery and underwent baseline evaluation using the CGA. Tailored interventions were subsequently implemented to address vulnerabilities identified during the assessment.Results: Between February 2022 and January 2024, 142 patients undergoing cystectomy were offered prehabilitation; 54 (38%) enrolled, and an additional 4 completed the program before its formal launch. Assessments were performed either in person or virtually. At baseline, 64% of participants were classified as intermediate frail or frail; 40% screened positive for cognitive impairment, and 57% were either malnourished or at risk of malnutrition. All patients received individualized exercise prescriptions based on their frailty phenotype (fit, intermediate frail, or frail). Referrals were made to an exercise specialist, registered dietitian, or counselor, depending on identified needs.Conclusion: The use of the CGA facilitated the implementation of a multimodal prehabilitation program for patients undergoing radical cystectomy. High rates of preoperative frailty, cognitive impairment, and nutritional risk were observed, allowing targeted interventions before surgery. While the program demonstrated successful integration and participation, future efforts should focus on standardizing intervention delivery and adherence monitoring to assess the objective impact of prehabilitation on postoperative outcomes.

Kiran Gajurel has served as a consultant to Karius. The other authors declare no conflicts of interest.

Fascia iliaca compartment nerve blocks (FICNB) have been shown to be an effective management strategy for pediatric femur fractures in the emergency department, but they can be performed using different techniques. Our main objective was to evaluate the association between needle tip distance to the femoral nerve and pain score reduction following ultrasound-guided FICNB in pediatric patients with acute femur fractures. We conducted a secondary analysis of a prospective, multicenter observational study conducted in the United States and Australia. Participants were children aged 4 to 17 years with isolated femur fractures who received a FICNB, divided into 2 groups based on ultrasound visualization of needle tip distance from the femoral nerve: ≥5mm or <5mm. The main outcome was a comparison of the mean pain score reduction between groups using the Faces Pain Scale-Revised (FPS-R). The FPS-R is a validated 0 to 10 continuous scale in which participants self-report their pain intensity. Pain scores were taken immediately before the nerve block (t 0 ) and 60 minutes postprocedure (t 60 ). In addition, adverse events were recorded. Differences in mean pain scores were analyzed using t tests, and categorical variables were compared with Fisher exact test. Of the 54 participants who received a FICNB (31 with needle tip ≥5mm from the femoral nerve, 23 with needle tip <5mm), 49 had a t 60 pain score available for analysis (30 in the ≥5mm group, 19 in the <5mm group). Pain scores at t 0 were similar between both groups. Both groups experienced a reduction in mean pain score at t 60 [≥5mm group 3.5 vs <5mm group 4.6, difference between groups: 1.1 (95% CI, -0.6 to 2.7)]. No serious adverse events were reported. In pediatric patients with acute femur fractures, needle tip distance from the femoral nerve does not seem to be associated with a difference in pain score reduction or the occurrence of serious adverse events.

Abstract Background Hyperacute T waves (HATWs) are widely recognized as an important electrocardiographic (ECG) marker of acute coronary occlusion myocardial infarction (OMI). The American College of Cardiology (ACC) and European Society of Cardiology (ESC) recommend identifying HATWs as a STEMI equivalent. However, to date there have been no objective criteria for HATW proposed. Purpose We sought to derive and validate a quantitative definition of HATWs as a diagnostic indicator for OMI in a cohort of possible acute coronary syndrome (ACS) patients in the Emergency Department (ED), specifically in patients whose ECGs do not meet STEMI criteria. Methods We derived the HATW score by logistic regression based on expert-labelled HATWs in patients with angiographically proven acute OMI, then validated the HATW score as a diagnostic indicator of OMI on a separate population of ED patients with suspected ACS. The primary analysis was sensitivity (at 98% specificity) of the HATW score for OMI in the validation group patients without STEMI criteria. From 5 PCI centers in USA and Europe, we collected 3,474 ECGs from 2,656 adult patients undergoing ED evaluation for possible ACS. We excluded patients with no ECG available, QRS duration &amp;gt;110 msec, and those with elevated troponin but no angiogram due to inability to determine the primary outcome definition. 1,291 and 1,395 were allocated to the derivation and validation groups. The first available ECG was measured by proprietary software (PMCardio) for all ECG measurements including STEMI criteria (Fourth Universal Definition of Myocardial Infarction). OMI was defined as a culprit lesion with TIMI 0 or 1 flow. We hypothesized HATWs would be best defined not by amplitude, but by "magnitude" (area under the curve of the T wave relative to the QRS amplitude) and T wave symmetry (Time from T wave peak to end, relative to Time from T wave start to peak). We analyzed limb leads, and right and left precordial leads separately. Results The derivation group included 2,079 ECGs from 1,261 patients (21% with OMI), with expert annotations yielding 1,401 leads with HATWs and 18,062 without. Logistic regression of T wave magnitude and symmetry yielded the optimal HATW score presented in Figure 1, example case shown in Figure 2. The validation group included 1,395 patients (10.6% OMI). Among the 1,300 patients without STEMI criteria, the HATW score (using 2 contiguous leads with mean score &amp;gt; 0.7) had 98.4% specificity, 20.7% sensitivity, 47.4% PPV, and 94.5% NPV for OMI. Conclusion HATWs can be defined by increased T wave magnitude and symmetry. Our resulting HATW score shows clinical utility as an ECG finding of OMI, even in patients without STEMI criteria. While further validation studies are needed, our findings add further support to the ACC and ESC recommendations that HATWs be identified and treated as STEMI equivalents, or ECG features of acute coronary occlusion myocardial infarction.