Tallahassee Memorial HealthCare

Background: Congenital circulatory anomalies remain a significant cause of mortality in the United States, especially among infants and young children. Understanding long-term mortality trends and disparities across demographics and geography is crucial for targeted public health interventions. Methods: Mortality data for congenital circulatory anomalies were extracted from CDC WONDER for the years 1999 to 2020. Annualized Percentage Change (APC) in absolute death counts was calculated using log-linear regression models, stratified by state, census region, urbanization, sex, age group, race, and Hispanic origin. Results: Nationally, deaths declined from 4,436 in 1999 to 3,011 in 2020, reflecting an APC of –2.14%. Among census regions, the Northeast experienced the steepest decline (APC: –2.37%), followed by the Midwest (–2.25%), South (–2.05%), and West (–2.02%). Urbanization-wise, the greatest reduction was noted in NonCore (–2.53%) and Large Fringe Metro areas (–2.01%), while Small Metro areas had a milder decline (–1.44%). State-level analysis showed that Alaska had an increasing trend (APC: +4.66%), while several states showed moderate-to-high declines, with California (–3.12%) and Texas (–2.84%) among the top. Age-specific trends revealed significant reductions in the 1–4 year age group (APC: –1.70%) and 75–84 year group (–1.56%), with relatively stable trends among those aged 55–64 (–0.04%). Sex-stratified analysis showed a sharper decline in females (–2.33%) compared to males (–1.97%). Racial disparities were evident: White individuals experienced the highest decline (–2.36%), followed by Black or African American (–1.82%), American Indian or Alaska Native (–0.60%), while Asian or Pacific Islanders showed a slight increase (APC: +1.02%). By Hispanic origin, deaths among Hispanic or Latino populations declined with an APC of –1.20%, while those not of Hispanic origin declined more steeply (–2.29%). The "Not Stated" category also declined (–2.13%). Conclusion: Despite overall declining mortality from congenital circulatory anomalies in the U.S. from 1999 to 2020, marked disparities persist across race, state, age, and urbanization level. Targeted efforts are needed to reduce the widening gaps and address the concerning upward trends observed in specific states and ethnic groups.

The first case describes a patient who underwent genetic testing for autoimmune polyendocrine syndrome (APS), revealing a change in the autoimmune regulator (AIRE) gene, c.1066C>T. To diagnose classical APS-1, two of the following endocrinopathies are required: hypoparathyroidism, adrenal insufficiency, and mucocutaneous candidiasis. Due to the patient’s genetic mutation and high susceptibility to developing other endocrinopathies later in life, he is presumed to have a nonclassical APS-1 presentation given his genetic testing.The second case discusses APS-2. This patient has a history of autoimmune diabetes, primary hypogonadism, and hypothyroidism. APS-2 is diagnosed when a patient has two of the following endocrinopathies: adrenal insufficiency, autoimmune thyroid disease, and type 1 diabetes. This patient has a strong family history of autoimmune endocrinopathies. With more knowledge and recognition of APS, complications and detrimental outcomes can be more easily predicted and prevented.

This research was supported in whole or in part by HCA Healthcare and/or an HCA Healthcare-affiliated entity. The views expressed in this publication represent those of the authors and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities. The authors declare no conflicts of interest.

BackgroundFlow-diverting stents (FDS) have revolutionized the treatment of large, giant, and wide-neck intracranial aneurysms. FDS promote thrombosis and aneurysm occlusion by redirecting blood flow within the parent artery. This method of endovascular therapy has proven efficacious, although leaving room for improvement. This study evaluated computational flow dynamics (CFD) and technical feasibility of the novel Surpass Elite FDS (Elite) in comparison with the Pipeline Embolization Device with Shield Technology (PED-Shield) across seven in vitro aneurysm models.MethodsSurpass Elite FDS and PED-Shield were assessed primarily with three CFD metrics to quantify flow diversion: inflow rate reduction, impact zone reduction, and turnover time. Seven patient-specific aneurysm models were utilized. These included one basilar tip, one vertebral artery, two middle cerebral artery, and three internal carotid artery aneurysms. Further evaluation of pore densities and velocity profiles was performed to create a robust comparison summary.ResultsSurpass Elite FDS demonstrated greater reduction in inflow rate and impact zone with improved turnover time in all models. Elite additionally displayed higher pore densities at nearly all proximal (inlet), aneurysm, and distal (outlet) points across the aneurysm models.ConclusionsThe next-generation Surpass Elite established better CFD metrics in comparison with PED-Shield in all in vitro aneurysm models evaluated here. Further, Elite demonstrated a higher pore density at nearly all aneurysm points assessed in this study, promoting enhanced flow diversion and thrombosis in the aneurysm sac. Considering these findings, Elite has strong potential to improve on the occlusion rates of PED-Shield.

Background: Transesophageal echocardiography (TEE) is mandatory before transvenous lead extraction (TLE), but its usefulness remains underestimated. This study aims to describe the broad range of TEE findings in TLE candidates, as well as their influence on procedure complexity, major complications (MCs) and long-term survival. Methods: Preoperative TEE was performed in 1191 patients undergoing TLE. Results: Lead thickening (OR = 1.536; p = 0.007), lead adhesion to heart structures (OR = 2.531; p < 0.001) and abnormally long lead loops (OR = 1.632; p = 0.006) increased the complexity of TLE. Vegetation-like masses on the lead (OR = 4.080; p = 0.44), lead thickening (OR = 2.389; p = 0.049) and lead adhesion to heart structures (OR = 6.341; p < 0.001) increased the rate of MCs. The presence of vegetations (HR = 7.254; p < 0.001) was the strongest predictor of death during a 1-year follow-up period. Conclusions: TEE before TLE provides a lot of important information for the operator. Apart from the visualization of possible vegetations, it can also detect various forms of lead-related scar tissue. Build-up of scar tissue and the presence of long lead loops are associated with increased complexity of the procedure and risk of MCs. Preoperative TEE performed outside the operating room may have an impact on the clinical decision-making process, such as transferring potentially more difficult patients to a more experienced center or having the procedure performed by the most experienced operator. Moreover, the presence of masses or vegetations on the leads significantly increases 1-year and all-cause mortality.

Introduction Effective communication between doctors and patients is one of the 19 core questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Positive patient experiences, as reflected in HCAHPS scores, are associated with higher quality of care, reduced mortality, and fewer readmissions. These scores also influence a hospital's financial bonuses or penalties from the Centers for Medicare & Medicaid Services. Methods This quality improvement (QI) initiative evaluated how early surveys of patients' feedback on doctors' communication skills during admission impacted discharge communication scores. The approach involved promptly sharing patients' feedback with physicians and focusing on improving communication skills for those with less-than-perfect scores. Results This QI initiative involved 41 patients. By surveying patients early during admission and addressing communication issues for those with less-than-perfect scores, the percentage of patients achieving a perfect score on all survey questions increased from 18 (43.9%) at admission to 34 (82.9%) at discharge. The largest improvement was seen in perfect scores for doctors' explanations of patients' conditions, which rose from 59% at admission to 90% at discharge. Conversely, the increase in perfect scores for doctors' respectful treatment was smaller, rising from 88% at admission to 98% at discharge. Conclusion Surveying patients about their doctors' communication skills early in admission to identify those with less-than-perfect scores and improving communication for this group resulted in a 39% increase in satisfaction with doctors' communication.

Abstract Background: Pancreatic cancer portends a very poor prognosis. It is the third leading cause of cancer deaths in the United States. African Americans have a 50- 90% increased incidence of pancreatic cancer in comparison to other racial groups. 20% of patients present with operable disease and will have a median overall survival of 2.5 years if able to undergo surgical resection. There is a desperate need to discover novel ways of treating pancreatic cancer. Understanding of the microbiome may be informative to overcoming chemotherapy resistance, toxicity and improving outcomes and disparities. The aim of this study is to (1) identify changes in the microbiota during neoadjuvant treatment of pancreatic ductal adenocarcinoma that correlate with treatment response and (2) identify changes in the microbiota during neoadjuvant treatment of pancreatic ductal adenocarcinoma that correlate with treatment toxicity in a diverse patient population. Methods: Patients with resectable or borderline resectable pancreatic cancer who are enrolled in a multi-site clinical trial (NCT03483038) receiving neoadjuvant NEO-Nali-IRI (oxaliplatin, liposomal irinotecan and 5- FU) followed by surgical resection were asked to provide serial microbiome collections of saliva, urine (collected in clinic), and stool with a dietary log during the following four (or five) time points: at baseline, mid-therapy (after C4), at completion of chemotherapy (after C8), after radiation if applicable, and at 4-6 weeks post-operative. Participants were given stool collection kits during clinic visits for home sample acquisition. All stool samples were mailed to the University of Florida Health Cancer Center Microbiome Biorepository. Demographics, stage, medical history and concurrent medications including antimicrobics and probiotics, chemotherapy dose-reductions, delays, discontinuations, adverse events, safety adverse events, attribution of causality, and hospitalizations were obtained. Outcomes include imaging response using RECIST criteria, CA 19-9 trend, development of metastatic disease, and the ability to proceed to definitive surgical resection. DNA will be extracted from stool and analyzed using 16S rRNA sequencing methods to determine signatures and alpha/beta biodiversity. Descriptive statistics and correlative analysis will be reported. Continuous and categorical variables will be compared with Student’s t-test and Chi-squared test. Multiple groups will be compared by ANOVA. Kaplan-Meier logistic regression will be performed to compare outcomes between the different microbiota groupings. Conclusion: Serial microbiome collection from a multi-site clinical trial is feasible during neoadjuvant chemotherapy for pancreatic cancer and can increase the diversity of the sample population. Citation Format: Sherise Rogers, Ryan Thomas, Ibrahim Nassour, Ilyas Sahin, Brian Ramnaraign, Karen Russell, Steven Hughes, Kathryn Hitchcock, Omar Kayaleh, Anita Turk, Maisey Ratcliff, Thomas George. Feasibility of serial microbiome collection in a multi-site neoadjuvant pancreatic cancer clinical trial allowing for a diverse patient population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1010.

COVID-19 can have a particularly detrimental effect on patients with cancer, but no studies to date have examined if the presence, or site, of metastatic cancer is related to COVID-19 outcomes. Using the COVID-19 and Cancer Consortium (CCC19) registry, the authors identified 10,065 patients with COVID-19 and cancer (2325 with and 7740 without metastasis at the time of COVID-19 diagnosis). The primary ordinal outcome was COVID-19 severity: not hospitalized, hospitalized but did not receive supplemental O2, hospitalized and received supplemental O2, admitted to an intensive care unit, received mechanical ventilation, or died from any cause. The authors used ordinal logistic regression models to compare COVID-19 severity by presence and specific site of metastatic cancer. They used logistic regression models to assess 30-day all-cause mortality. Compared to patients without metastasis, patients with metastases have increased hospitalization rates (59% vs. 49%) and higher 30day mortality (18% vs. 9%). Patients with metastasis to bone, lung, liver, lymph nodes, and brain have significantly higher COVID-19 severity (adjusted odds ratios [ORs], 1.38, 1.59, 1.38, 1.00, and 2.21) compared to patients without metastases at those sites. Patients with metastasis to the lung have significantly higher odds of 30-day mortality (adjusted OR, 1.53; 95% confidence interval, 1.17-2.00) when adjusting for COVID-19 severity. Patients with metastatic cancer, especially with metastasis to the brain, are more likely to have severe outcomes after COVID-19 whereas patients with metastasis to the lung, compared to patients with cancer metastasis to other sites, have the highest 30-day mortality after COVID-19.