Citations

Background: Patients with severe and life-limiting illnesses transitioning out of the hospital often rely on family caregivers (FCGs) to manage communication with health care teams during hospitalizations and outpatient care. However, FCGs infrequently receive adequate training or support to prepare for these responsibilities. Effective communication between FCGs and health care teams is critical for preparing FCGs and reducing risks for poor outcomes. This study tested an eight-week intervention to improve FCG preparedness and communication practices during transitions out of the hospital. Methods: Conducted from 2018 to 2022, this randomized controlled trial included adult FCGs in rural areas in the United States (Minnesota, Wisconsin, and Iowa). FCGs caring for adults who received inpatient palliative care and were transitioning out of the hospital were eligible. The intervention group received teaching, guidance, and counseling from a palliative care nurse interventionist via video visits before and for eight weeks after discharge. The control group received monthly phone calls but no intervention. Outcomes included changes in FCG-reported preparedness for caregiving and communication with health care teams. Results: Of the 429 consented, 367 (183 intervention and 184 control participants) initiated the intervention; 164 had complete preparedness data, and 161 had complete communication data at baseline and eight weeks. In unadjusted analyses, the intervention group showed statistically significant improvements in preparedness but not communication practices. After adjusting for factors associated with care transitions, the findings persisted. Conclusion: Partnering rural FCGs with palliative care nurses via video can improve caregiver preparedness during care transitions. Improving communication practices may need more targeted strategies.

Abstract RATIONALE: Community engagement is critical in the conduct of research seeking to address healthcare disparities. Indigenous peoples (American Indians and Alaskan Natives) have the highest prevalence of cigarette smoking and commercial tobacco use among all racial and ethnic groups in the United States. Including Indigenous people as partners in the research process is critical for moving interventions to improve health forward. Engagement in the research process should be considerate of the time, travel, and ease of use for research participants and advisors. Based on feedback from community members, we launched social media pages with deidentified study updates for past participants and any interested community members to receive updates on a prospective mixed methods study designed to inform a pilot smoking cessation intervention. METHODS: Facebook and Instagram were the social media platforms identified for this study. Prior themes identified from the principal investigator's previous work and results of current study informed the development of posts. Institutional Review Board approval was granted for this community engagement method. There were no recruitment activities conducted on these pages, and all information was presented in a deidentified, thematic fashion to protect research participants. There were two social media moderators monitoring interaction with social media pages. An Indigenous artist created accompanying images to enhance engagement with posts. The content covered discussions on smoking cessation identified from the primary study along with profiles highlighting team members and allies. Posts were made at non-fixed, variable intervals from May to September 2024, and were checked bi-weekly to ensure respectful conduct. RESULTS: Between May and September 2024, ten posts were shared, including three highlighting Indigenous team members and allies and seven focused on smoking cessation discussions. Instagram had more engagement when compared to Facebook. Posts that featured Indigenous team members and allies received higher interaction when compared to those on smoking cessation alone, contributing to Instagram's overall success. CONCLUSION: Instagram was the more effective platform demonstrating higher engagement and follower growth when compared to Facebook. Of note, on both platforms, posts that highlighted team members and allies resonated well, and generated the most interaction. This not only emphasizes social media as an effective tool to engage underserved populations in the research process, but also suggests that emphasizing representation and ally-ship among research teams is impactful when engaging Indigenous audiences. This outcome exemplifies the importance of integrating cultural relevance in public health messaging when discussing thoughts and attitudes surrounding smoking cessation.

Abstract Rationale: Prior studies report association between pulmonary artery (PA) dilation on computed tomography (CT) imaging and pulmonary hypertension (PH). These studies predate expansion of PH hemodynamic diagnostic criteria and do not report patient mortality. As such, little is known about the presence of vascular changes in mild PH or their association with survival. We sought to investigate these relationships in individuals without significant parenchymal lung disease. Methods: We obtained CT images for subjects with group 1 or 2 PH, disease comparators, and healthy controls enrolled in the Pulmonary Vascular Disease Phenomics (PVDOMICS) study. We used Osirix imaging software to measure the main, left, and right PA (MPA, LPA, and RPA) and MPA:aorta (PA:Ao) ratio by diameter and cross-sectional area at locations consistent with prior studies. We evaluated associations with mortality and mean PA pressure (mPAP) using multivariable Cox and linear regression models adjusting for age, sex, and BMI. Descriptive statistics are presented as mean ± SD. Results: We identified 558 subjects (59 controls, 138 comparators, and 361 PH [267 group 1, 94 group 2]). 79 subjects had mPAP < 21 mmHg, 39 had mPAP 21-24 mmHg, and 371 had mPAP ≥ 25 mmHg. Increased MPA, LPA, and RPA diameter and area, PA:Aodia, and PA:Aoarea were associated with decreased survival (all p < 0.001) after multivariable adjustment. First versus third quantiles of all measurements were associated with mortality, with adjusted hazard ratio of 2.99 [95% CI 1.77, 5.05] for MPA diameter (2.84 vs 3.82 cm), 3.74 [2.07, 6.74] for MPA area (7.26 vs 12.74 cm2) and 5.24 [2.58, 10.66] for LPA area (4.55 vs 7.03 cm2). All measures significantly increased alongside PH severity from mPAP < 20 to 21-24 to ≥ 25 mmHg (see figure 1 for MPA diameter). All measures positively correlated with mPAP, including MPA diameter (ρspearman = 0.55) and PA:Aodia (ρ = 0.56). After multivariable adjustment, Q1 to Q3 increments in MPA diameter and PA:Aodia were associated with mPAP increase of 12.5 [10.7, 14.4] and 13.9 [11.9, 15.8] mmHg, respectively. BMI showed no correlation with PA size (ρ = 0.076 for MPA area, -0.051 for PA:Aodia). Conclusions: PA size increases alongside PH severity using updated hemodynamic criteria and is associated with incremental increases in PA pressure and mortality. LPA dilation demonstrates particularly strong association with mortality. PA size does not correlate with BMI. These novel findings enhance our understanding of vascular changes across the PH disease spectrum.

Abstract Rationale: ICU nurses can experience high levels of burnout and job dissatisfaction due to stressors associated with high-stakes patient care, uncertain outcomes, and constant exposure to death. Witnessing patient recovery and/or disability status in the weeks or months after hospital discharge through reconnection with survivors of critical illness and their families may offer emotional and professional benefits to ICU nurses. However, the impact of connecting with patients’ post-ICU outcomes on nursing clinical practice and job satisfaction has not been well explored. This study aimed to investigate pragmatic perspectives from ICU nurses related to their insights on long-term patient outcomes after critical illness with a goal of identifying key mechanisms that may be associated with impacts on clinical practice and job satisfaction. Methods: A web-based investigator-designed survey was distributed to ICU nurses with endorsement from the American Association of Critical-Care Nurses for completion via their website and annual conference. Survey items included quantitative and open-ended prompts to examine the impact of reconnecting with ICU survivors on clinical practice and job satisfaction. Thematic analysis was performed on free-text responses. Results: Fifty-four ICU nurses (76% female) participated in the survey (June 2023-May 2024), with a median age of 41 years and a median of 7 years of critical care experience. Among them, 89% reported that reconnecting with survivors positively impacted their job satisfaction, and 78% felt that reconnecting influenced their clinical practice. Thematic analysis revealed three themes: Empathy and Human Connection – Nurses felt validated and fulfilled knowing their care positively impacted patients’ lives, reinforcing the meaning of their work. These interactions fostered greater empathy, reminding nurses of the real-life impact of their care.Validation of Effort and Accomplishment – Nurses reported a stronger sense of accomplishment seeing the positive outcomes of their work. Reconnecting with survivors reaffirmed the importance of their roles, strengthening nurses’ sense of purpose and commitment.Positive Emotional Impact and Job Satisfaction – Interactions with survivors provided emotional uplift, enhancing job satisfaction and reminding nurses of the rewarding aspects of their roles. Gratitude and progress from survivors motivated nurses, helping them manage the emotional challenges of ICU work. Conclusion: Reconnecting with ICU survivors and their families may have positive impacts on job satisfaction and clinical practice by providing emotional rewards, reinforcing nurses’ professional purpose, and validating their contributions to patient recovery. Embedding structured, low-cost re-engagement activities with critical illness survivors could offer valuable benefits to the ICU nurse workforce.

Abstract Background Instruments to assess patient-reported outcomes (PRO) should generate high-quality evidence. Reliable PRO evidence is essential to policymakers, in conjunction with outcomes such as survival and radiological response, to understand the net clinical benefit of antitumor treatments. This study aimed to establish the content validity of 215 identified PRO measures used in patients with brain tumors. Methods A survey (n = 148 items) was developed reflecting aspects of the WHO International Classification of Functioning, Disability, and Health (ICF) framework. Patients with brain tumors, their proxies, and healthcare professionals (HCPs) were asked to rate each survey item on relevance. An item was considered a relevant issue if ≥25% of the patients or proxies or ≥50% of the HCPs considered that item to be an issue. Next, all items in the identified PRO measures were linked to ICF and relevant items in the survey, and the percentage of content coverage was calculated. Results In total, 114 patients, 71 proxies, and 65 HCPs from different countries completed the survey. Fifty-six of 148 (37.8%) items in the survey were considered relevant. The most important aspects mentioned by both patients and proxies were difficulty concentrating, difficulty remembering, multitasking, and handling stress. Depending on the definition, between 35% and 49% of PRO measures were considered to have sufficient content validity (≥80% coverage). Conclusion The content validity was insufficient in more than half of the identified PRO measures, particularly multidimensional measures. Future research should investigate whether different approaches to PRO assessment better meet the needs of all stakeholders.

Abstract A hallmark of GBM is its highly-immunosuppressive tumor microenvironment (TME). GBM stem-like cells (GSCs) can evade immune surveillance to allow for continued tumor growth and propagation. GSCs regulate the immune TME through recruitment and production of immunosuppressive cells and factors via tumor cell-intrinsic mechanisms. Blocking these cell-intrinsic immunosuppressive mechanisms is widely viewed as a way to enhance the effects of current immune therapies. We recently showed that TGFβ type II receptor (TGFBR2) promotes a mesenchymal transition in GBM cells characterized by high expression levels of immunosuppressive genes NT5E (CD73), ENTPD1 (CD73), LGALS1 (galectin-1), CD274 (PD-L1), PDCD1LG2 (PD-L2), and TGFB1. miRNA network analysis identified miR-16-5p and miR-124-3p as high-confidence candidates to block the expression of these immunosuppressive signaling axis in GBM cells. Transgenic miR-16-5p and miR-124-3p simultaneously reduced expression of CD274, ENTPD1, NT5E, TGFB1, and LGALS1 and increased tumor cell killing of PBMC-derived CD4+ and CD8+ T cells. We also measured an increase in drivers of the CD8+ effector state and a decrease in expression of exhaustion marker PD1 in PBMC-derived CD8+ T cells. In addition to the effects on CD4+ and CD8+ T cell activation and function, miRNA-mediated knock-down of this immunosuppressive gene signature in tumor cells also resulted in a decrease in CD206 expression and reduced release of anti-inflammatory chemokines in THP1 cells. These findings demonstrate that miRNA-based gene inhibition can block cell-intrinsic immunosuppressive pathways to enhance anti-tumor immune cell function in vitro and predicts that delivering these miRNAs using advanced nanocarriers will cooperate with current immunotherapies in vivo. Citation Format: TC Taylor, Amanda Johnson, Harmon Khela, Jack Korleski, Sophie Sall, Bachchu Lal, Karen Smith-Connor, Hernando Lopez-Bertoni. miR-16-5p and miR-124-3p block the immunosuppressive phenotype of GBM cells in vitro. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 1357.

Purpose: This study examined if vertical bladder excursion during pelvic floor muscle (PFM) contraction, measured with transabdominal ultrasound (TAUS), improved following a single training session 0-5 days postpartum. It also assessed patient satisfaction with the training. Methods: 75 healthy, female volunteers within 0-5 days post-vaginal delivery were recruited during their inpatient postpartum stay. Participants completed one in-person session involving a standardized bladder filling protocol, TAUS imaging during PFM contractions, a PFM training session using TAUS as visual biofeedback, and a two-question post intervention survey. Vertical bladder base excursions were compared pre- and post- training between two groups: those whose bladder bases descended and those whose ascended during baseline contractions. A mixed model ANOVA with one between-group factor (baseline descenders vs. ascenders) and one within-group factor (pre- vs. post-training) analyzed the change in bladder lift. Patient satisfaction was assessed with Likert scales. Results: Mean vertical excursion increased from 0.12 cm (SD = 0.48) to 0.32 cm (SD = 0.33) post-training, which was statistically significant (p <.001, Cohens d = 0.767). Greater improvements were noted in those with a bladder base descent at baseline. All participants reported the experience to be helpful or very helpful and were satisfied or very satisfied. Discussion: Participants increased vertical bladder excursion during PFM contraction with TAUS biofeedback within a single session, especially those with baseline paradoxical bladder excursion and perineal trauma during delivery. Participants found the experience helpful and satisfying, suggesting TAUS biofeedback may be a useful tool in early postpartum PFM rehabilitation.

Background: Cardiac rehabilitation (CR) is essential to secondary cardiovascular disease prevention and management of cardiac patients. Despite its proven benefits, CR remains underutilized with enrollment and completion rates ranging from 10-30% in the US. Yet, there is a scarcity of nationally representative data among diverse populations on socioeconomic differences in barriers and beliefs of CR participation and delivery mode preferences. Hypothesis: The perceptions (barriers, beliefs), CR delivery mode preferences, and CR utilization (prior enrollment) varies by socioeconomic status (SES) among CR-eligible individuals. Methods: We conducted an anonymous national electronic survey from March 2023 to January 2024 of individuals self-reporting a prior CR-eligible diagnosis. The 22-item CR Barriers Scale assessed perceived barriers to CR enrollment and participation using a 5-point Likert scale (strongly disagree to strongly agree). A 13-item, validated questionnaire assessed 4 subscales pertaining to patients’ beliefs about CR, each rated on a 5-point Likert scale (strongly disagree to strongly agree): perceived necessity, concerns about exercise, practical barriers and perceived suitability. CR delivery mode preferences were ascertained (eg, virtual, at-home, etc.). Mean barriers and belief scores as well as delivery mode preferences were stratified by SES. Low SES was defined as ≤ high school education, Medicaid insurance, or uninsured. High SES was defined as > high school education and non-Medicaid health insurance. Responses were analyzed using descriptive statistics with R software. Results: A total of 466 participants completed the survey (38.1% women, 30.6% minoritized racial/ethnic group, 29.6% low SES, 95% response rate) ( Table 1 ). The majority indicated prior enrollment in CR (81.5%) with no difference by SES. CR barrier scores did not differ significantly by SES (p=0.331) ( Table 2 ). Beliefs about CR perceived necessity and perceived suitability differed by SES (p<0.001 and p=0.025), but beliefs regarding concerns about exercise and practical barriers did not. The low SES group reported a higher preference for completely at-home CR compared to the high SES group (33.6% vs 7.4%, p<0.001). Conclusion: Our findings suggest that CR beliefs varied by SES while utilization did not. For CR-eligible patients experiencing socioeconomic disadvantage, at-home CR may be a preferred alternative to center-based CR to increase CR participation and adherence.