University Medical Center of Princeton

The behavioural tendency to expand sleep opportunity to compensate for prior sleep loss is referred to as 'sleep extension.' It is believed that sleep extension (here referred to as 'sleep opportunity extension' [SOE]) is the primary perpetuating factor explaining the transition from acute to chronic insomnia. Recently, this proposition was prospectively evaluated by assessing how sleep opportunity varied, week-by-week, relative to the incidence of acute and chronic insomnia. Significant differences in sleep opportunity before and after onset of acute insomnia were not detected. In the present analysis, a more granular evaluation was undertaken to assess whether SOE occurs on the nights and/or weekends following poor sleep. The data set (n = 1243) was modelled by group (good sleepers and participants with acute insomnia) for SOE occurring on the nights and weekends following poor nights of sleep (i.e., ≥ 30 min of sleep latency and/or nocturnal wakefulness and/or early morning awakenings) for the post-acute insomnia interval. A linear mixed effects model was used to account for up to one year of night-to-night sleep per participant. During the weekdays, sleep opportunity following a poor night of sleep was not found to increase (overall or by group) (< 5 min). During the weekends, all groups tended to decrease their sleep opportunity. This counterintuitive finding casts further doubt on the proposition that SOE is responsible for the transition between acute insomnia and chronic insomnia. This finding does not, however, change the relevance of addressing the mismatch between sleep opportunity and ability as part of behavioural treatment.

Background:Bifurcation lesions pose unique challenges during percutaneous coronary intervention (PCI) and are associated with suboptimal outcomes. The standard approach involves provisional stenting of the main branch (MB) with plain balloon angioplasty (BA) for compromised side branches (SBs). It remains unclear whether drug-coated balloon (DCB) or plain balloon angioplasty pose a better strategy to treat SB in bifurcation lesions. This systematic review and meta-analysis compared the efficacy of DCB versus BA in managing SBs of bifurcation lesions.Methods:MEDLINE, Cochrane, and EMBASE databases were searched for randomized controlled trials (RCTs) comparing DCB and BA for treating bifurcation lesions. Outcomes included SB late lumen loss (LLL), major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), and target lesion revascularization (TLR).Results:Five RCTs were included, encompassing 1,255 patients, of whom 628 (50.4%) underwent DCB angioplasty; 946 (75.4%) were male, and the mean age was 63.5 years. Drug-coated balloons significantly reduced MI risk (risk ratio [RR] = 0.56, 95% CI: 0.35-0.88, P = .010). DCB use resulted in similar LLL in the SB compared with BA (mean difference (MD) = −0.12 mm, 95% CI: −0.24-0.01, P = .070). No significant differences were observed in TLR (RR = 1.19, 95% CI: 0.45-3.14, P = .720), MACE (RR = 0.70, 95% CI: 0.48-1.02, P = .070), and all-cause mortality (RR = 2.35, 95% CI: 0.61-9.00, P = .210).Conclusion:In this meta-analysis of RCTs, DCB significantly reduced MI without affecting LLL, TLR, MACE, and all-cause mortality compared with BA in the SB of bifurcation lesions.

ABSTRACTCurrently, healthcare professionals face challenges such as excessive stress, mental distress, psychiatric issues, and burnout. Contributors include various personal, professional, and environmental stressors such as prolonged work hours, high workload, patient care responsibility, information overload, and financial concerns. Stress and burnout can cause employee turnover, staffing shortages, medical errors, reduced job satisfaction, and reduced interest in pursuing or continuing healthcare as a career. This paper explores meditation as a possible solution for tackling stress- and burnout-related issues among healthcare professionals. We present findings from various studies that have revealed the physiological effects of meditation and demonstrated its impact on stress reduction, cardiovascular health, immune function, brain structure, pain management, and genetic expression. We provide insights into commonly used meditation tools such as mindfulness-based stress reduction (MSBR) programs, challenges, and solutions for implementing meditation-related programs in mainstream healthcare delivery.

BackgroundWhile some findings indicate high levels of patient satisfaction with remote eating disorder treatment, others reflect feelings of disconnection due to unique telehealth treatment challenges. The COVID-19 pandemic presented circumstances that likely impacted the findings established thus far. As such, the present study sought to understand patient experiences of connection in an intentionally remote eating disorder treatment program, specifically in a context outside of pandemic transition.MethodsA secondary analysis of de-identified qualitative data previously obtained for quality improvement purposes via a client satisfaction survey was conducted. Adult patient responses (N = 38) were analyzed via reflexive thematic analysis within a critical realist framework.ResultsFour themes were generated from the data: (1) Embracing one’s humanity paves the way for connection, (2) Discovering a “sense of community” in remote care, (3) “They made me feel I was worth recovering”: connection as a vehicle for healing, and (4) Aligning expectations and reality: reconceptualizing the journey to connection in remote eating disorder care.ConclusionsOverall, findings suggest that it is possible for patients to form strong, impactful connections in remote treatment. Importantly, patient perspectives indicated that there were shifts in how these connections were experienced as a result of the remote care environment (e.g., how support could be provided and by whom). Considerations unique to remote care (e.g., offering training to improve clients’ comfort with technology) may be important to fostering connection, thereby contributing to improved patient experiences and treatment outcomes.

Clinical documentation of patient visits has changed over the last 20 years, with the increasing use of electronic records causing a seismic shift in how notes are taken. Electronic note-taking aims at reducing the time taken to document a visit, and the introduction of dot phrases, or DotPhrases, in electronic medical records is a step toward reducing the time required to update patients’ charts, which might allow doctors to spend more time with their patients. DotPhrases, abbreviated phrases used in the electronic medical record, help in the simplification of note-taking and the standardization of notes. They also allow for a more comprehensive note from physicians and ensure that no information is undocumented. On the contrary, however, excessive usage of DotPhrases can lead to an excessively long and cumbersome note. This can overwhelm physicians and lead to them missing crucial information that is buried somewhere in the notes. Although there is ample research studying the benefits of DotPhrases, adequate research must also be carried out to understand their shortcomings and disadvantages. This article aims to shed some light on use of DotPhrases and to outline their advantages and disadvantages affecting patient management and care.

Introduction: The United States healthcare system is responsible for a quarter of global health care greenhouse gas emissions- more than any other nation. Delivering standard-of care in the United States involves using vast amounts of energy, requires a multitude of testing, and invariably generates a large amount of solid waste. Endoscopy, due to its high procedural volume and regular use of disposable equipment, contributes substantially to this total as it is the third largest generator of waste in healthcare. Case Description/Methods: A 74-year-old man with a past medical history of gastroesophageal reflux disease on chronic omeprazole, presented with 2 days of coffee-ground emesis and melena. Endoscopy 2 years prior revealed erosive, granular gastropathy in the gastric body, angularis and antrum. Biopsies per the Sydney protocol confirmed diffuse gastric intestinal metaplasia, without dysplasia. On this admission, his hemoglobin was 6.0 g/dl (14.2 g/dl one month prior), with normal coagulation studies. Repeat endoscopy revealed a 5 cm submucosal mass with a 15mm centralized ulcer and a raised visible vessel (Forest Class IIa). Given the elevated risk of re-bleeding, the vessel was treated with cautery. Assuming that the lesion was a malignancy, biopsies of the mass were also obtained which confirmed poorly-differentiated gastric adenocarcinoma. In this case, the patient needed both treatment of the bleeding and biopsies of the ulcer. Gastroenterologists generally treat bleeding and subsequently obtain samples using multiple different instruments. In an effort to accomplish both goals while minimizing the amount of equipment, a hot forceps was used to successfully cauterize the visible vessel and biopsies were then taken from a separate location of the mass with the same forceps (Figure 1). Both cautery and biopsy were safely and successfully performed with one instrument. Discussion: We are all responsible to do our part in reducing the solid waste we generate, whether it be through improved waste segregation, increased recycling or avoidance of single-use items where possible. Efforts are ongoing to optimize the balance between treating our patients and implementing sustainable practice, but finding the answers will take time. What we can do now, however, is adopt a mindset of considering the environmental impact of each procedure and choosing a greener option, if one is available.Figure 1.: Cautery of visible vessel using hot forceps.