Franciscan Health Indianapolis

Background/Objectives: Surgical ablation for atrial fibrillation (AF) during cardiac surgery decreases perioperative morbidity and mortality and improves long-term patient outcomes. Because of these benefits, it has been designated a Class I surgical society recommendation. As surgical ablation techniques have evolved, so too have ablation tools such as radiofrequency and cryothermal devices. In this study, we evaluated real-world evidence (RWE) of concomitant surgical ablation featuring an epicardial left atrial encircling lesion created by a novel bipolar radiofrequency clamp. Methods: Thirteen centers in the observational Tracking Results of Ablation to Combat AF (TRAC-AF) Registry (NCT05111015) contributed data used in this analysis. Included patients had AF and received the epicardial encircling lesion during cardiac surgery. Additional ablation and follow-up were per institutional standard of care. Freedom from AF/atrial tachycardia (AT)/atrial flutter (AFL) and survival were evaluated using the Kaplan-Meier method. Safety was evaluated within 30 days of the procedure. Results: Among 327 patients, 70% were male with a median age of 69 years. Sixty-nine percent had paroxysmal AF. Median left atrial diameter was 4.1 cm, and CHA2DS2-VASc score was 3. Isolated coronary artery bypass graft and aortic valve surgery were performed in 51% and 11% of patients, respectively. One- and two-year survival rates were 95.3% (95% CI, 91.7-97.3%) and 88.1% (95% CI, 81.5-92.5%). Through 12- and 24-months freedom from AF/AT/AFL was 87.4% (95% CI, 81.3-91.6%) and 79.9% (95% CI 72.0-85.8%). Mortality within 30 days of the index procedure was 1.5%. No serious adverse events were related to the epicardial cardiac ablation procedure or device. Conclusions: RWE from the TRAC-AF Registry demonstrates surgical ablation including an epicardial left atrial encircling lesion made by a novel bipolar RF clamp was safe and resulted in favorable long-term rhythm outcomes.

ABSTRACTBackgroundHereditary hematological malignancy syndromes (HHMS) are more common than previously thought, and identification of an HHMS syndrome can inform the choice of treatments, transplant, and testing of other family members. Genetic testing guidelines for hematological malignancy have broadened; however, there remain a multitude of barriers and complexities with germline genetic testing for these patients. Here, we describe a process for the evaluation and testing of patients for HHMS as well as our respective findings.MethodsAdult patients with a new diagnosis or history of myeloid malignancy and referred for genetic counseling from 2020 to 2023 within a single institution were reviewed. Descriptive statistics were performed, and frequency data was gathered for relevant patients.ResultsA total of forty‐nine patients were evaluated by a genetic counselor based on their myeloid malignancy; forty‐three patients underwent genetic testing. Genetic testing revealed an HHMS for six patients, with two additional patients found to have abnormalities on ancillary testing that could not be genetically characterized. Thirty‐five patients met NCCN age‐based criteria for genetic testing; however, this was not mutually exclusive with those diagnosed with HHMS. Inpatient genetic counseling had a median timeline of 53 days from referral to result (range: 32–56.75 days). Outpatient genetic counseling had a median timeline of 96 days from referral to result (range: 64–144 days).ConclusionOur proposed process demonstrates an efficient structure for patients with hematological malignancy while supporting the importance of the genetic counselor within the malignant hematology and stem cell transplant teams.

Abstract IntroductionOral targeted anticancer drugs (OTADs) have become a key component of therapy for multiple malignancies, and their use continues to expand. While several studies have identified numerous drug interactions (DIs) associated with these oral therapies, very few have described the role of an oncology pharmacist in DI management.ObjectivesThe purpose of this study was to quantify moderate/severe DIs with OTADs at initiation and describe the role of the pharmacist in interaction detection and management.MethodsThis retrospective analysis was completed utilizing an electronic health record review of adult patients initiated on an OTAD with pharmacist documentation of medication review between July 2020 and July 2022. The outcomes of this study included the incidence of moderate/severe DIs, the distribution of pharmacokinetic/pharmacodynamic DIs, the incidence of pharmacist documentation of moderate/severe DIs, prescriber acceptance of documented pharmacist‐recommended interventions, the evaluation of severe DIs, and presence of DI related adverse effects within 60 days of OTAD initiation.ResultsTwo hundred sixty‐six patients were included. Forty‐six percent (122/266) of patients had at least one moderate/severe DI identified by investigators with a total of 220 moderate/severe DIs detected. Fifty‐eight percent (127/220) of the identified DIs were pharmacokinetic and 42% (93/220) were pharmacodynamic in nature. Pharmacist documentation was present for 36% (75/207) of the moderate DIs and 92% (12/13) of the severe DIs identified at OTAD initiation, and prescribers accepted 94% (82/87) of the pharmacists' recommended interventions. Lastly, 12.5% (26/208) of the incidence of adverse effects was potentially related to moderate/severe DIs within 60 days of OTAD initiation.ConclusionClinically significant (moderate/severe) DIs are common in patients receiving OTADs and may impact patient outcomes. Pharmacists can help to identify, prevent, and create a plan of action for the management of DIs and we advocate for their involvement in the management of OTAD therapies.

Introduction Globally, dental caries affects 2 billion people worldwide, and good oral health is important to maintain proper functioning teeth, ensure good breath, and improve nutrition. The study aimed to assess the factors contributing to dental caries among patients attending a dental clinic at Soroti Regional Referral Hospital. The specific objectives is to assess the level of knowledge and dental carries prevention practices of patients attending dental clinic at SRRH Methodology A descriptive cross-sectional study design using a quantitative method of data collection was used to carry out the study. A sample of 130 respondents who were attending dental clinics was enrolled using a convenient sampling method. Data was collected using self-administered questionnaires and presented as descriptive data using frequency tables, pie charts, bar charts, and line graphs. Results The majority of respondents 71% were females. Respondents had moderate knowledge of dental caries as 102 (78.5%) respondents had ever heard about dental caries. 55.4% of respondents knew about dental flossing and the majority 64.6% knew that dental caries needed treatment. The practices were generally poor as the majority 88% of respondents had never flossed their teeth and the majority 74% didn't regularly brush their teeth after every meal. Conclusion There is a high prevalence of dental caries and the majority supported that there is a need for treatment however most of the participants reported that there is no need for dental checkups. Recommendation There is a need to create more awareness about oral health. There is also a need to encourage regular brushing of teeth after every meal and also encourage dental checkups. In conclusion, there was a moderate level of knowledge towards dental caries among respondents but the practices towards oral care were poor.

Selection of an antiretroviral regimen for people living with HIV (PLWH) involves various clinical considerations, such as comorbidities, archived drug resistance mutations, concomitant medications, and potential drug interactions and side effects. Alterations in the surface area and pH of the gastrointestinal tract following bariatric surgery may alter absorption, antiretroviral pharmacokinetics and viral suppression. Data on the efficacy of antiretroviral (ARV) therapy in PLWH who have undergone bariatric surgery are limited or lacking for new antiretrovirals, such as dolutegravir and bictegravir. This case series reports virologic outcomes and side effects in eight cases of PLWH receiving ARV therapy who underwent bariatric surgery. A systematic literature review was performed to review the available literature on the efficacy and safety of antiretroviral regimens in PLWH who have undergone bariatric surgery. Virologic suppression was not impacted for obese PLWH who underwent bariatric surgery following failure of life-style modifications and pharmacological therapy. There were no deleterious effects on HIV progression for PLWH that underwent bariatric surgery. More prospective research is required to validate the effects of bariatric surgery on immunologic and virologic function outcomes. Close involvement of HIV and surgical specialists is recommended to manage ARV therapy in patients undergoing bariatric surgery.

Despite the benefits established for multiple surgical specialties, enhanced recovery after surgery has been underused in cardiac surgery. A cardiac enhanced recovery after surgery summit was convened at the 102nd American Association for Thoracic Surgery annual meeting in May 2022 for experts to convey key enhanced recovery after surgery concepts, best practices, and applicable results for cardiac surgery. Topics included implementation of enhanced recovery after surgery, prehabilitation and nutrition, rigid sternal fixation, goal-directed therapy, and multimodal pain management.

Background and Significance:Much discussion has surrounded how the COVID-19 pandemic impacted youth mental health, but less has been done to determine its impact on teachers. Youth First, Inc. of Evansville, IN places masters-level social workers in K-12 schools, providing critical support for Indiana youth. A common report among Youth First social workers has been the increase in personal consultations the teachers request. The objective of this study is to analyze the quantity and nature of teacher consultations across the COVID-19 pandemic.Methods:Youth First collects data on services and compiles it on an internal server. For this study, access was given to data regarding teacher consultations. The data was then analyzed to determine trends. To better understand the nationwide teacher shortage, a literature review was conducted.Results:The data shows that in AY 2019-2020, there were 957 personal mental health consultations between teachers and social workers, accounting for 4.7% of total teacher consultations. Data from AY 2020-2021 shows an increase to 1,816 personal consultations, accounting for 5.6% of total consultations. While this jump does correspond to an increase in number of schools served, it also corresponds to the peak of the COVID-19 pandemic in the United States. AY 2021-2022 had 1,567 personal teacher consultations, accounting for 4.5% of the total number of consultations.Conclusion and Future Implications:According to the U.S. National Center for Education Statistics, 44% of U.S. public schools currently report teaching vacancies. Of these schools, 61% “identified the pandemic as a cause of increased teaching vacancies”. According to a 2022 study by Indiana State University, nearly 97% of Indiana schools are reporting a teacher shortage. It is my hope that this data can be shared with Indiana school systems to address mental health needs of teachers, which may potentially improve the state-wide teacher shortage over time.

It is a fact that the field of Cardio-Oncology is growing rapidly throughout the USA and abroad. Cancer and heart disease continue to be the leading causes of death in the USA, and oncologic therapies are evolving to the point that cancer survivors are increasing yearly, some living long enough to develop cardiovascular disease, and others living with sequelae from their cancer therapy. The financial burdens to the healthcare system continue to present barriers for the delivery of healthcare, especially for patients with heart disease and cancer as chronic diseases. Collaboration between cardiologists and oncologists is paramount to ensure timely cancer care while minimizing cardiotoxicity. The field of Cardio-Oncology is the perfect model for the current management of these patients, positioned to break down silos, avoid delays in cancer care, and treating potential short- and long-term sequela of cancer therapy in a cost-efficient manner. While cardio-oncology programs initially sprang from the academic and defined cancer centers, it is rapidly growing in the nonacademic settings. This paper explores reasons that occurred and explores some of the unique aspects to cancer care and cardio-oncology delivery in the nonacademic setting. The ultimate goal is to achieve the best cancer care with the least degree of disruption to therapy that also minimizes cardiotoxicity, lowering costs, and improving outcomes for patients.