Citations

ABSTRACT Background High‐power short‐duration (HPSD) ablation has emerged as a promising alternative to conventional power delivery (CPD) for pulmonary vein isolation (PVI) among patients with atrial fibrillation (AF), though its efficacy, procedural efficiency, and safety profile remain uncertain. Aims To evaluate and compare the efficacy, procedural efficiency, and safety of HPSD versus CPD ablation strategies for PVI in patients with AF through a systematic review and meta‐analysis of randomized controlled trials (RCTs). Materials and Methods PubMed, Embase, Cochrane Library, and ClinicalTrials.Gov databases were systematically searched for RCTs comparing HPSD with CPD ablation for PVI in patients with AF. Random‐effects models were used to pool hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI). R version 4.4.2 was used for statistical analysis. Results Eight RCTs with 1094 patients (558 undergoing HPSD and 536 undergoing CPD ablation) were included. No significant differences were found in freedom from arrhythmia during the follow‐up period (HR: 0.77; 95% CI: 0.41–1.45; p = 0.424). AF recurrence did not differ (RR: 0.83; 95% CI: 0.59–1.16; p = 0.268) between groups. HPSD had a significantly shorter procedural (mean difference [MD]: −21.93 min; 95% CI: −31.34, −12.53; p < 0.001) and RF ablation times (MD: −13.87 min; 95% CI: −19.46, −8.27; p < 0.001). No differences were observed in fluoroscopy time and first‐pass isolation for right and left pulmonary veins. There was no difference in esophageal lesion rates, pericardial, or neurological complications, but there was a higher incidence of steam pops in HPSD (RR: 3.42; 95% CI: 1.45–8.09; p = 0.005). Discussion Although HPSD ablation did not significantly improve freedom from arrhythmia or reduce AF recurrence compared to CPD, it demonstrated enhanced procedural efficiency, with shorter procedure and RF ablation times. Despite the higher rate of steam pops, the overall safety profile was similar between both groups. Conclusion High‐power short‐duration ablation for pulmonary vein isolation in atrial fibrillation demonstrated comparable efficacy and safety to conventional power delivery, with the added benefit of shorter procedure and RF ablation times. However, HPSD ablation was associated with increased occurrence of steam pops.

Objective Preparation for a career in plastic and reconstructive surgery (PRS) begins long before the residency application process. Given the challenging nature of matching into integrated PRS, the expectations for competitive applicants, including research productivity and networking at conferences, incur significant expenses. Our study is the first to detail the comprehensive costs of pursuing PRS, highlighting many hidden expenses that precede the application process. Design and Setting A branched logic survey was created to inquire about respondents' demographics, personal finances, expenses related to education and research, and opinions on the comprehensive costs of pursuing PRS. Qualitative and quantitative data were collected and analyzed using descriptive statistics. Participants The survey was distributed to PRS residency applicants in the 2023–2024 cycle and to senior members of a virtual PRS research group. The survey achieved a 28.9% response rate. Results Most respondents were fourth-year medical students (57.3%) and attended a school without a home integrated residency program (42.7%). Of students who pursued a research year (37.1%), 40.7% were unpaid, and 53.3% reported living expenses exceeding their income. Most attended more than 5 PRS conferences (29.9%), corresponding to a median total cost of $2000 to $3000. Fourth-year students typically participated in 3 away rotations (40.0%) at a cost of $6000 to $9000. The financial burden of pursuing a career in PRS, including PRS-related extracurricular activities and application-associated costs, is estimated to be $33,400–$45,479. Nearly all respondents (96.6%) believed this cost was too high or excessively high; however, 93.3% determined that it was probably or definitely worth a career in PRS. Conclusions The lofty costs associated with pursuing PRS are unsustainable for many. Additional efforts should be made to reduce financial barriers for PRS applicants. Ensuring funding to all students pursuing a research year, diversifying scholarships for conference attendance and away rotations, increasing loan forgiveness opportunities, and expanding use of lower-cost application options such as the Plastic Surgery Common Application are potential solutions to offset the cost of pursuing PRS.

Background and objectives Arteriovenous malformations (AVMs) with perinidal aneurysms and single draining vein are associated with an elevated risk of rupture and increased procedural complexity. The role of preoperative embolization in this high-risk anatomical subset remains unclear. This study aimed to evaluate the safety and efficacy of microsurgery with preoperative embolization, compared with microsurgery alone in patients with such AVMs. Methods We conducted a multicenter retrospective analysis of an AVM registry from the MISTA (Multicenter International Study for Treatment of Brain AVMs) consortium and included AVMs with perinidal aneurysms and a single draining vein. Baseline characteristics, angiographic outcomes, functional outcomes, and complication rates were compared. Propensity score weighting (PSW) using the covariate balancing method was applied to adjust for baseline differences. Results Out of a total of 1919 patients, 65 met the inclusion criteria; 45 patients underwent preoperative embolization followed by microsurgery, and 20 underwent microsurgery alone. After adjustment, complete obliteration rates were similar between groups (OR 0.87, 95% CI 0.04 to 16.33, P=0.92), as were rates of functional independence at discharge and follow-up. Overall complication, symptomatic complication, and mortality rates did not differ significantly between groups. However, permanent complications were significantly lower in patients with preoperative embolization (OR 0.06, 95% CI 0.004 to 0.84, P=0.03). Discussion In patients with AVMs featuring perinidal aneurysms and single draining vein, preoperative embolization followed by microsurgery was associated with fewer permanent complications and no increase in adverse outcomes compared with microsurgery alone. However, given the small number of events, this finding should be interpreted cautiously.

ABSTRACT Introduction Although liver transplantation (LT) rates have increased globally, the demand for organs still exceeds the supply. This review highlights cultures with significant influences on organ donation and LT. Methods We performed a literature search for articles related to cultures, ethnologies, philosophies, policies, religions, socio‐economic factors, and other influences affecting organ donation in LT around the world. Results There are astonishing similarities between different cultures. In Africa, Asia, and Europe, people often view the postmortem bodies as sacred and believe that their bodies are gifts from “God” or ancestors. To respect the gift of life, to have a chance in reincarnation, or to enjoy life after death, many believe that their bodily sanctity must be preserved. In Asia, Europe, and Latin America, there is a general reluctance to speak about death. Religions also play an important role in people's views on organ donation. Different regions around the world have similar challenges to organ donation, such as misconceptions about organ trafficking, political and economic instability, and a lack of governmental or religious support. Conclusion Addressing the complexities of organ donation and LT requires a multifaceted approach. Culturally sensitive education tailored to diverse communities can dispel myths and misconceptions surrounding organ donation. Fostering partnerships between healthcare providers, religious leaders, community organizations, and policymakers can further facilitate open dialogues and promote organ donation as a noble act to save lives. Social Media Similar cultures around the world post challenges for organ donation. Organizations should foster partnerships between healthcare providers, politicians, and religious leaders to promote donation.

AbstractDocumentation burden contributes to health professional burnout and negatively impacts health professional well-being and patient care quality. Yet, there is a gap in the literature regarding an effective measure to assess the perceived documentation burden of health professionals in a wide range of care settings over time.We developed and administered a pulse survey to trend, with subsequent administrations, the perceived documentation burden of health professionals in all care settings in the United States over time.A multimethods approach was used which included conducting a scoping review of the literature to identify and then curate a set of potential survey items based on scoping review results. Next, a modified Delphi approach was used with clinical informatics experts for consensus-driven item selection and pulse survey development. Finally, we administered the pulse survey nationally using snowball sampling through professional listservs and networks of organizations.The scoping review helped to identify constructs and items to include on the pulse survey. After four iterations of the modified Delphi approach, consensus was reached on five final items for the pulse survey, labeled “TrendBurden.” The first administration of “TrendBurden” was completed by 1,253 healthcare professionals in April 2024. Most respondents (73.26%) disagreed that the time and effort spent documenting patient care is appropriate, with 77.42% reporting finishing work later or needing to work from home due to excessive documentation tasks. Seventy-four point three-eight percent agreed that the effort or time required to complete documentation tasks impedes patient care, and less than one-third (31.76%) agreed that the EHR is easy to use.The “TrendBurden” Pulse Survey was developed through a scoping review of the literature and expert consensus. The resulting five-question pulse survey was administered nationally and provided insight into current perceptions of documentation burden among healthcare professionals.

Objective Mechanical thrombectomy (MT) is well-established for the treatment of acute ischemic stroke (AIS) from large vessel occlusion (LVO), with growing data supporting the expansion to distal and medium vessel occlusions (DMVO). Despite successful recanalization in DMVO, certain patients still experience poor long-term clinical outcomes, prompting our study to comprehensively explore pre-MT factors influencing outcome despite excellent recanalization (final modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2c). Methods We retrospectively examined data from patients who consecutively underwent MT for a primary middle cerebral artery (MCA) DMVO across 37 centers in North America, Asia, and Europe. We identified baseline clinical and imaging factors associated with poor clinical outcome (defined as a modified Rankin Scale [mRS] score of 3–6) at 3 months, despite excellent recanalization using a multivariable model. Results Between September 2017 and July 2021, 623 patients achieved mTICI > 2b and they were included in our study. Among them, 198 (32%) experienced a poor clinical outcome (mRS 3–6). Predictors of poor clinical outcome included higher age (OR 1.05 [1.03–1.07], p < 0.001), higher NIHSS at admission (OR 1.12 [1.08–1.15], p < 0.001), higher baseline mRS (OR 1.77 [0.96–3.26], p = 0.067), and diabetes (OR 1.59 [1.01–2.48], p = 0.044). Higher ASPECTS was associated with a decreased risk of poor clinical outcome (OR 0.82 [0.71–0.94], p = 0.006). Conclusion Older age, diabetes, higher baseline mRS, and NIHSS were associated with poor clinical outcome in MCA DMVO despite excellent recanalization. Conversely, a higher ASPECTS decreased the probability of such an outcome.

Background and Objectives: Heart failure (HF) represents a major public health challenge worldwide, with rising prevalence, high morbidity and mortality rates, and substantial healthcare costs. Non-invasive telemonitoring has emerged as a promising adjunct in HF management, yet its clinical effectiveness remains unclear. Materials and Methods: In this systematic review, we summarize randomized controlled trials (RCTs) between 2004 and 2024 examining the efficacy of non-invasive telemonitoring on mortality, readmission, and quality of life (QoL) in HF. In addition, we characterize the heterogeneity of features of different telemonitoring interventions. Results: In total, 32 RCTs were included, comprising 13,294 participants. While some individual studies reported benefits, non-invasive telemonitoring demonstrated mixed effects on mortality, readmission rates, and QoL. The most common modality for interfacing with patients was by mobile application (53%), followed by web portals (22%), and stand-alone devices (19%). Periodic feedback (63%) was more common than continuous feedback (31%) or on-demand feedback (6%). Clinician reviews of patient telemonitoring data was event-triggered (44%) more commonly than based on a prespecified timeline (38%). In most designs (90%), patients played a passive role in telemonitoring. Conclusions: Non-invasive telemonitoring interventions for HF exhibited considerable variation in duration and system design and had a low rate of patient engagement. Future work should focus on identifying telemonitoring-responsive subgroups and refining telemonitoring strategies to complement traditional HF care.

Background and importance Rapid sequence intubation in emergency settings may involve opioid pretreatment to blunt hemodynamic responses during laryngoscopy and intubation; however, opioids may lead to postintubation hypotension, increasing morbidity and mortality. Global clinical practice varies significantly, reflecting uncertainty about opioids’ benefits and risks. Objective Our goal was to evaluate the association between opioid pretreatment and hemodynamic instability, focusing on postintubation hypotension in adult patients undergoing emergency intubation. Design, settings, and participants We performed a systematic review of randomized controlled trials and observational studies comparing opioid administration vs. no opioids before adult emergency intubations. Searches included Cochrane, Embase, Medline, Scopus, and Web of Science databases until November 2024. Elective intubations were excluded. Eight (6708 patients) studies met criteria. Outcomes measure and analysis The primary outcome was postintubation hypotension, variably defined across studies. Secondary outcomes included hypoxemia, first-attempt success, cardiac arrest, and vasopressor use. Independent reviewers conducted data extraction, risk-of-bias assessments, and certainty evaluation. Results were qualitatively synthesized. Main results Among 6708 (2757 opioids and 3951 controls) patients, postintubation hypotension incidence varied widely (risk differences: −12.5% favoring opioids to +13.2% favoring controls). The single low-risk randomized study reported opioids increased hypotension (risk difference: 13%, odds ratio: 2.15, 95% confidence interval: 1.22–3.78). Observational studies yielded inconsistent results. Secondary outcomes showed no consistent differences. Evidence certainty was very low because of risk of bias, inconsistency, and imprecision. Conclusions Current evidence regarding opioid pretreatment effect on postintubation hypotension risk during emergency intubation is limited and conflicting.