Research Spotlight

Gulliver, S.B., Zimering, R.T., Knight, J., Morissette, S.B., Kamholz, B.W., Pennington, M.L., Dobani, F., Carpenter, T.P., Kimbrel, N.A., Keane, T.M. and Meyer, E.C. (2021). “A prospective study of firefighters’ PTSD and depression symptoms: The first 3 years of service.” Psychol Trauma 13(1): 44-55.

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Objective: Firefighters are an important sample of convenience to study traumatic exposure and symptom development. This study assessed trauma exposure inside and outside of fire service, diagnosed posttraumatic stress disorder (PTSD) and associated disorders using clinical interviews and self-report measures, then tested the hypothesis that trauma exposure would predict distress in firefighters over the first 3 years in service. Method: In total, 322 professional firefighter recruits were assessed during academy training and through their first 3 years of service. Diagnostic assessments were conducted by psychologists annually, and symptom checklists were completed by telephone every 4 months. Results: Firefighter recruits were exposed to approximately nine potentially traumatic events (PTEs) in the first 3 years of fire service, with 66% of these events occurring in the line of duty. Very few (3%) developed diagnoses of PTSD, major depression, or generalized anxiety disorder. Models of distress supported a trait model of distress. Distress was stable within individuals over time, and although those reporting more distress also reported more trauma exposure, variation in distress over time was not predicted by trauma exposure. Conclusions: Professional firefighters experience frequent exposure to potentially traumatic events during their early careers. This exposure, although large, does not result in a large proportion of mental health diagnoses. Distress was consistent and low, which provides evidence of the resilient nature of those selecting a career in emergency service. Future work is needed to understand the disconnection between the current rigorously collected prospective data and the existing literature regarding the increased risk of PTSD and associated disorders in fire service.

Fleshman, J. (2020). “The Birth of the Board of Colon and Rectal Surgery: Curtice Rosser JD, MD, FACS, FAPS (January 3, 1891 to October 23, 1969) remembered at Baylor University Medical Center, Dallas, Texas.” Dis Colon Rectum Dec 7. [Epub ahead of print].

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Great leaders carry a vision with them that shapes and defines their life and their career. They believe in what can be and, in so doing, bring the vision into reality. They motivate others and, by their effort and enthusiasm, drive the betterment of the institution or group with which they find themselves associated. Curtice Rosser JD, MD, was such a man. The world of Colon and Rectal Surgery owes Dr Rosser a great deal of gratitude for his vision and his leadership. Baylor University Medical Center, Baylor College of Medicine and Southwestern Medical College (now University of Texas Southwestern Medical School) also benefitted greatly from his presence during the early part of their existence. The American Board of Colon and Rectal Surgery exists directly because Dr Rosser and his colleagues envisioned colorectal surgery as a self-governing and credentialing subspecialty, equivalent to other strong surgical subspecialties, and invested time, energy and political capital to realize their dream. [No abstract; excerpt from article].

Filardo, G., Pollock, B.D., da Graca, B., Sass, D.M., Phan, T.K., Montenegro, D.E., Ailawadi, G., Thourani, V.H. and Damiano, R.J., Jr. (2020). “Lower Survival After Coronary Artery Bypass in Patients Who Had Atrial Fibrillation Missed by Widely Used Definitions.” Mayo Clin Proc Innov Qual Outcomes 4(6): 630-637.

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OBJECTIVE: To investigate the impact of limiting the definition of post-coronary artery bypass graft (CABG) atrial fibrillation (AF) to AF/flutter requiring treatment-as in the Society of Thoracic Surgeons’ (STS) database- on the association with survival. PATIENTS AND METHODS: We assessed in-hospital incidence of post-CABG AF in 7110 consecutive isolated patients with CABG without preoperative AF at 4 hospitals (January 1, 2004 to December 31, 2010). Patients with ≥1 episode of post-CABG AF detected via continuous in-hospital electrocardiogram (ECG)/telemetry monitoring documented by physicians were assigned to the following: Group 1, identified as having post-CABG AF in STS data and Group 2, not identified as having post-CABG AF in STS data. Patients without documented post-CABG AF constituted Group 3. Survival was compared via a Cox model, adjusted for STS risk of mortality and accounting for site differences. RESULTS: Over 7 years’ follow-up, 16.0% (295 of 1841) of Group 1, 18.7% (79 of 422) of Group 2, and 7.9% (382 of 4847) of Group 3 died. Group 2 had a significantly greater adjusted risk of death than both Group 1 (hazard ratio [HR]: 1.16; 95% confidence interval [CI], 1.02 to 1.33) and Group 3 (HR: 1.94; 95% CI, 1.69 to 2.22). CONCLUSIONS: The statistically significant 16% higher risk of death for patients with AF post-CABG missed vs captured in STS data suggests treatment and postdischarge management should be investigated for differences. The historical misclassification of “missed” patients as experiencing no AF in the STS data weakens the ability to observe differences in risk between patients with and without post-CABG AF. Therefore, STS data should not be used for research examining post-CABG AF.

Ferdinands, J.M., Gaglani, M., Ghamande, S., Martin, E.T., Middleton, D., Monto, A.S., Silveira, F., Talbot, H.K., Zimmerman, R., Smith, E.R. and Patel, M. (2020). “Vaccine effectiveness against influenza-associated hospitalizations among adults, 2018-2019, US Hospitalized Adult Influenza Vaccine Effectiveness Network.” J Infect Dis Dec 18;jiaa772. [Epub ahead of print].

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We estimated vaccine effectiveness for prevention of influenza-associated hospitalizations among adults during the 2018-2019 influenza season. Adults admitted with acute respiratory illness to 14 hospitals of the US Hospitalized Adult Influenza Vaccine Effectiveness Network and testing positive for influenza were cases; patients testing negative were controls. Vaccine effectiveness was estimated using logistic regression and inverse probability of treatment weighting. We analyzed data from 2863 patients with mean age of 63 years. Adjusted VE against influenza A(H1N1)pdm09-associated hospitalization was 51% (95%CI 25, 68). Adjusted VE against influenza A(H3N2) virus-associated hospitalization was -2% (95%CI -65, 37) and differed significantly by age, with VE of -130% (95% CI -374, -27) among adults 18 to ≤56 years of age. Although vaccination halved the risk of influenza-A(H1N1)pdm09-associated hospitalizations, it conferred no protection against influenza A(H3N2)-associated hospitalizations. We observed negative VE for young-and middle-aged adults but cannot exclude residual confounding as a potential explanation.

Elbadawi, A., Ugwu, J., Elgendy, I.Y., Megaly, M., Ogunbayo, G.O., Omer, M.A., Elzeneini, M., Chatila, K., Al-Azizi, K., Goel, S.S. and Gafoor, S. (2021). “Outcomes of transcatheter versus surgical aortic valve replacement among solid organ transplant recipients.” Catheter Cardiovasc Interv Jan 5. [Epub ahead of print].

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BACKGROUND: There is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) among solid-organ transplant recipients. METHODS: Temporal trends in hospitalizations for aortic valve replacement among solid-organ transplant recipients were determined using the National Inpatient Sample database years 2012-2017. Propensity matching was conducted to compare admissions who underwent TAVR versus SAVR. The primary outcome was in-hospital mortality. RESULTS: The analysis included 1,730 hospitalizations for isolated AVR; 920 (53.2%) underwent TAVR and 810 (46.7%) underwent SAVR. TAVR was increasingly utilized for solid-organ transplant recipients (P(trend) = 0.01), while there was no change in the number of SAVR procedures (P(trend) = 0.20). The predictors of undergoing TAVR for solid-organ transplant recipients included older age, diabetes, and prior coronary artery bypass surgery, while TAVR was less likely utilized in small-sized hospitals. TAVR was associated with lower in-hospital mortality after matching (0.9 vs. 4.7%, odds ratio [OR] 0.19; 95% confidence interval [CI] 0.11-0.35, p < .001) and after multivariable adjustment (OR 0.07; 95% CI 0.03-0.21, p < .001). TAVR was associated with lower rate of acute kidney injury, acute stroke, postoperative bleeding, blood transfusion, vascular complications, discharge to nursing facilities, and shorter median length of hospital stay. There was no difference between both groups in the use of mechanical circulatory support, hemodialysis, arrhythmias, or pacemaker insertion. CONCLUSION: This contemporary observational nationwide analysis showed that TAVR is increasingly performed among solid-organ transplant recipients. Compared with SAVR, TAVR was associated with lower in-hospital mortality, complications, and shorter length of stay.