Tenet Healthcare

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.

Aims: Calhoun et al. assessed the effectiveness of in-situ simulation education and showed that adding in-situ simulation to current educational practices may improve patient mortality and morbidity.Collaborative Working is when individuals with various professional backgrounds work together and combine their expertise with other individuals to provide the best care possible. The essence of collaborative working is “working as a team with respect and value for each team member’s unique role and contribution”.The practice of interdisciplinary learning is already in place when Immediate Life Support simulation training is delivered. The concept of broadening this practice out to other areas of clinical practice is therefore not far-fetched and is evidence based.Aims: Embed lessons learnt from serious untoward incidents within an simulated inter-professional educational environment; OSE implementation will improve staff ability to respond to clinical scenarios.Methods: A total of 27 participants attended these sessions conducted across 2 days. The staff rotated through a four-station circuit (10 minutes each with 5 minutes verbal feedback): completing a NEWS2 chart (National Early Warning Score); recording glucose levels on a blood glucose monitoring chart; documenting neurological observations following Rapid Tranquillization administration and effective communication.At each station, participants were asked to complete a Likert questionnaire to self-report their status in 4 key areas: Knowledge, Confidence, Management, Resource Awareness, and preference between Face-to-Face (F2F) or E-learning teaching. Following the station, participants received constructive feedback on their performance and repeated the questionnaire.Results: Qualitative and quantitative data analysis was completed to assess the questionnaire responses, with all stations showing a significant increase in average scores (AS) across all Key Areas, ranging between 16.4% (NEWS2) and 54% (Neurological Observation).Confidence in handling clinical scenarios showed the smallest AS increase across all stations ranging from 12.3% (NEWS2) to 46.1% (Neurological observation).Awareness of trusted resources available had consistent minimal score change, with lowest score change of 6.1% observed in NEWS2. Post-session learning preferences strongly favoured F2F teaching, with all 27 participants preferring it for Communication and Blood Glucose monitoring stations. Neurological observation station showed the biggest improvements in knowledge (58.3%) and confidence in management (65.2%).Conclusion: These findings highlight the importance of interactive teaching to improve clinical competency and knowledge retention. The data also suggests the need for improved resource awareness and accessibility and as a result resource folders have been disseminated. Cygnet Healthcare is also implementing OSEs across other hospital sites.

Sedentary lifestyles, such as consuming foods high in energy, protein, carbohydrates, and fat, sleeping less than 8 hours, smoking and drink an alcohol can approximately double the risk of obesity and hypertension. These factors can affect nutritional status and impact physical fitness and achievement in junior athletes. This study aims to identify the lifestyle and nutritional status of junior athletes aged 11-24 years during the match preparation period. The sample consisted of 110 junior athletes in Sumedang, West Java. This research using a cross-sectional approach. Results showed that the average athlete in Sumedang Regency consumed 2,035 Kcal daily, with male athletes consuming 2,218.8 Kcal and female athletes consuming 1,797.7 Kcal. More than half of the male athletes (64.5%) are smoked but did not consume an alcohol (95.2%). On other hand, most of female athletes neither smoke (85.4%) nor consume an alcohol. The data also shows there is a significant (p-value < 0.05) consumption among male and female athletes on cigarette consumption. Findings indicate that athletes did not meet the nutritional intake adequate even for normal individuals, while athletes require a higher nutritional adequacy due to their intensive training regimens. Athletes in Sumedang Regency are not meeting their nutritional needs and engage in unhealthy behaviors such as smoking and alcohol consumption, which may affect their physical fitness and performance. These lifestyle factors need to be addressed to improve their nutritional status and overall athletic performance.

Abstract BackgroundWell-annotated, high-quality biorepositories provide a valuable platform to support translational research and discovery. However, most biorepositories have poor representation of minority groups, limiting the ability to address cancer health disparities and improve disease outcomes. This report describes the establishment of the Florida Pancreas Collaborative (FPC), the first state-wide prospective longitudinal cohort study and biorepository specifically designed to address the higher burden of pancreatic cancer (PaCa) in African Americans (AA) compared to Non-Hispanic Whites (NHW) and Hispanic/Latinx (H/L).MethodsWe describe rationale for establishing the FPC and provide an overview of key stakeholders; study eligibility and design; ascertainment and recruitment strategies; and standard operating procedures (SOPs) developed to collect, process, store, and transfer biospecimens, medical images, and data. We also describe the customized cloud-based, secure data management platform built to facilitate recruitment, track study-related workflow, house data, and perform queries. We also present progress to date regarding recruitment and biobanking.ResultsThe FPC consists of multidisciplinary teams from fifteen Florida medical institutions. From March 2019 through August 2020, 350 patients were assessed for study eligibility, 323 met inclusion/exclusion criteria, and 305 (94%) enrolled, including 228 NHW, 30 AA, and 47 H/L, with 94%, 100%, and 94% participation rates, respectively. A high percentage of participants have donated blood (87%), pancreatic tumor tissue (41%), computed tomography scans (76%), and baseline questionnaire data (62%).ConclusionsThis biorepository addresses a critical gap in PaCa research with the potential to advance basic, clinical, population-based, and translational studies intended to minimize disparities, increase quality of life, and reduce PaCa-related morbidity and mortality.ImpactThis multi-institutional infrastructure can serve as a prototype for development of similar resources across the country and disease sites.

e18553 Background: Neutropenic fever (NF) can result in significant mortality if not managed properly and in swift fashion. There has been a recent shift from small oncology private practices commonly affiliated with non-teaching hospitals (NTH) to large teaching hospitals (TH) with an abundance of specialized faculty and financial resources. We sought to analyze admissions for NF comparing TH versus NHT institutions’ mortality in breast (BC), lung (LC), renal (RC), prostate (PC) and multiple myeloma (MM) from 2006-2014. Methods: We analyzed data from the Healthcare Cost and Utilization Project’s National Inpatient Sample between 2006-2014 using ICD 9 codes for a primary diagnosis of BC, LC, MM, RC and PC. NF was used as a secondary diagnosis. TH and NTH mortality was compared using hazard ratios (HR) which were controlled for confounding factors of age, race, sex, income, insurance status, & comorbidities. Results: There were 77,215 admissions (weighted [w] 383,225) to TH vs 42,860 to NTH (w: 208,430). NTH accounted for 35.21% admissions, 0.031% related to NF. TH accounted for 64.72% with 0.076% related to NF (p = 0.0033). HR of death related to NF during during hospitalization within 30 days were compared for TH vs NTH. Results are listed below. Conclusions: Most admissions for NF occurred at TH. This could be related to resource requirements, higher acuity patients or more intensive regimens used in TH. Hospital mortality of NF at NTH was increased for RC and MM. This may be due to delays in implementing appropriate antimicrobial therapy. However, there was no significant difference in outcomes for BC, LC and PC, possibly due to the routine use of growth factor support or shorter duration of neutropenia in the chemotherapy regimens used in these cancers. With the continual shift in health care delivery to consolidate, it remains important for small NTH to be able to manage oncologic emergencies such as a NF resulting in the same hospital mortality outcomes. TH vs NTH Hazard Ratio 95% Cl P value BC 1.033 0.83 - 1.285 0.7743 LC 1.031 0.955 - 1.113 0.4355 MM 3.662 3.253 - 4.121 < .0001 PC 1.52 0.61-2.16 0.65 RC 2.85 1.71-4.75 < .0001

The use of mechanical circulatory support (MCS) devices is a viable therapeutic treatment option for patients with congestive heart failure. Ventricular assist devices, cavopulmonary assist devices, and total artificial heart pumps continue to gain acceptance as viable treatment strategies for both adults and pediatric patients as bridge-to-transplant, bridge-to-recovery, and longer-term circulatory support alternatives. We present a review of the current and future MCS devices for patients having congenital heart disease (CHD) with biventricular or univentricular circulations. Several devices that are specifically designed for patients with complex CHD are in the development pipeline undergoing rigorous animal testing as readiness experiments in preparation for future clinical trials. These advances in the development of new blood pumps for patients with CHD will address a significant unmet clinical need, as well as generally improve innovation of the current state of the art in MCS technology.