Thomas, Colleen S.

Background: Home telemetry has been shown to reduce 30-day readmissions in patients at high risk for readmission. It remains unclear whether this finding is due to the telemetry itself or the nurse contact that follows detection of an abnormal parameter. Purpose: This study was a subgroup analysis from a prior trial comparing patients on home telemetry for 30 days to usual care after discharge to determine if nurse contact affected readmission rates. Methods: Patients randomized to telemetry who had at least 1 nurse contact were compared to those who had none to see if the contact reduced the rate of readmissions. Results: Of 449 home telemetry patients, 292 (65.0%) received 1 or more nurse contacts. Single and multivariable logistic regression models exploring the association of contact with 30-day readmission did not find any statistically significant associations of nurse contact with readmission (all unadjusted P ≥ .13, all adjusted P ≥ .18). Conclusion: Our subset analysis did not show that the nurse contact was the factor that reduced readmission in patients on home telemetry.

Introduction: To analyze the association of patient characteristics on operating room (OR) times for robotic-assisted partial nephrectomies (RAPNs). Methods: In total, 248 consecutive RAPNs were performed by a single surgeon from October 2018 to August 2022. Data were collected on the following patient factors: sex, age, race, weight, body mass index (BMI), diabetes, hypertension (HTN), tumor side, tumor mass, and American Society of Anesthesiologists (ASA) score. Total fixed OR times were evaluated as the sum of in-room time to anesthesia-release time (IRAT), anesthesia-release time to cut time (ARCT), close time to wheels out time (CTWO), and in-room time to cut time (IRAT + ARCT). Total variable OR times were defined as cut time to close time (CTCT). Total operative time was defined as wheels into wheel out (WIWO). Results: Median OR time was 265 minutes (interquartile range [IQR]: 247–298 minutes) for WIWO, 191 minutes (IQR: 170–225 minutes) for CTCT, and 75 minutes (IQR: 68–83 minutes) for total fixed time. There was a significant increase in WIWO with the following patient variables: male sex (18.0 minutes, 95% confidence interval [CI]: 6.3–29.7 minutes), weight (5.6 minutes, 95% CI: 2.8–8.4 minutes), BMI (14.3 minutes, 95% CI: 4.2–24.4 minutes), HTN (15.1 minutes, 95% CI: 3.7–26.5 minutes), pathology tumor size (cm) (6.4 minutes, 95% CI: 2.2–10.6 minutes), and ASA score (13.8 minutes, 95% CI: 3.1–24.4 minutes). Sex, age, BMI, weight, HTN, and pathology tumor size significantly impacted CTCT ( P < 0.05). Total fixed OR time was only affected by ASA score ( P = 0.02). Conclusions: Patient variables significantly affect total OR time and variable OR time. These variables do not impact total fixed OR times, confirming fixed OR time as a viable OR efficiency point.

Abstract Hydroxychloroquine (HCQ) induced cardiotoxicity is a rare diagnosis and is often associated with chronic use of the medication. It has been shown that chronic HCQ use is associated with a drug-induced cardiomyopathy mainly driven by acquired lysosomal storage defects leading to hypertrophy and conduction abnormalities. As the only proven treatment is the discontinuation of the offending agent, prompt recognition is required to avoid further exposure to the drug and potential progression of disease. History, physical examination and advanced imaging modalities are useful diagnostic tools, but more invasive testing with an endomyocardial biopsy is required for definitive diagnosis. We present a descriptive case series of ten patients that were diagnosed with biopsy proven HCQ cardiotoxicity.

AbstractBackgroundThe American Academy of Neurology Practice Guidelines recommends physical exercise to help maintain cognition in people with Mild Cognitive Impairment (pwMCI). We previously demonstrated yoga’s benefit in maintenance of memory related activities of daily living at one year follow‐up in pwMCI (Chandler et al., 2019), and yoga may be beneficial in offsetting a sense of burden in care partners at 12 months (Amofa et al., submitted). In this analysis, we sought to examine the impact of yoga training on physical performance in pwMCI and their care partners.MethodIn this multisite, randomized clinical trial, we enrolled 272 patients meeting National Institute on Aging–Alzheimer’s Association criteria for MCI and a care partner. The intervention program was modeled on the 10 day Mayo Clinic HABIT Healthy Action to Benefit Independence and Thinking® program. Of 5 possible interventions (memory compensation training, computerized cognitive training, yoga, patient and partner support groups, and wellness education), 1 of 5 interventions was randomly selected to be withheld for each intervention group, thus allowing us to examine comparative effectiveness. Participants and their partners had 1‐day booster sessions at 6 and 12 months after intervention. The Short Physical Performance Battery (SPPB), a measure of balance, gait speed, and repeated chair stands was used to assess physical function outcomes.ResultThere was a general pattern of physical decline on the SPPB over the year in pwMCI, regardless of yoga training (d=‐0.04, p=0.78) (Figure 1, Panel A). Among care partners, those randomized to the no yoga group had a worse decline in physical function compared to those receiving yoga (d=‐0.31, p=0.034) (Figure 1, Panel B). While not reaching statistical significance in subgroup comparisons, yoga training tended to have a greater effect on SPPB than computerized cognitive training (d = 0.35, p = .06) or wellness education (d = 0.32, p =.09) (Table 1).ConclusionParticipation in yoga had a positive impact on physical performance outcomes at one year for care partners, but did not counteract general physical decline in pwMCI.