Research Spotlight

Lajos, P., R. Bangiyev, S. Safir, A. Weinberg, A. Vouyouka, P. Faries and R. Reddy (2021). “Placement of Simultaneous Inferior Vena Cava Filter During Emergent Open Pulmonary Thromboembolectomy.” Surg Technol Int Oct 13;39:sti39/1486. [Epub ahead of print].

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BACKGROUND: This study retrospectively reviewed results of simultaneous (SIM) inferior vena cava (IVC) filter and separate (SEP) IVC filter placement with open pulmonary thromboembolectomy (PTE) in pulmonary embolism and its clinical outcomes. MATERIALS AND METHODS: From November 2006 to May 2014, 23 patients (14 females and 9 males; median age 58 years; range, 21-88 years) underwent emergent PTE for submassive (12) or massive (11) pulmonary embolism (PE). All had a preoperative computed tomography (CT) scan and echocardiography consistent with right ventricular (RV) strain. Mean cardiopulmonary bypass times and temperatures; chest tube outputs; length of stay; perioperative complications; and survival were compared between groups. RESULTS: There were 13 patients in the SIM group and 10 in the SEP group. PE consisted of 14 acute (60.9%) and nine acute on chronic (39.1%). There were seven deaths (30.4%). Median follow up was 44 days (range, 2-2204 days). Follow up was 81% complete in surviving patients. Actuarial survival at one and three years was 83% for the SIM group and 43% for the SEP group, respectively. There were no differences in cardiopulmonary bypass (CPB) times and temperatures, chest tube outputs, or length of stay between groups. Using multivariable logistic regression, we found SIM was associated with increased survival (p=0.09). Further analysis showed patients >55 years in the SEP group were at significantly higher risk of death (hazard ratio [HR]=7.1:1; 95% confidence interval [CI]: 1.55, 32.5, p=0.011). CONCLUSION: IVC filter placement can be performed simultaneously and safely at PTE. Age >55 years and PTE with IVC filter placed separately were at significantly higher risk of death. A larger cohort is needed to evaluate efficacy of simultaneous IVC filter placement and PTE.

Pannala, R., K. Krishnan, R. R. Watson, M. F. Vela, B. K. Abu Dayyeh, A. Bhatt, M. S. Bhutani, J. C. Bucobo, V. Chandrasekhara, A. P. Copland, P. Jirapinyo, N. A. Kumta, R. J. Law, J. T. Maple, J. Melson, M. A. Parsi, E. F. Rahimi, M. Saumoy, A. Sethi, G. Trikudanathan, A. J. Trindade, J. Yang and D. R. Lichtenstein (2021). “Devices for esophageal function testing.” Gastrointest Endosc Oct 8;S0016-5107(21)01608-4. [Epub ahead of print].

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Esophageal symptoms are commonly encountered in clinical practice from a variety of conditions including GERD, motility abnormalities, functional disorders, structural anomalies, and behavioral conditions. Esophageal function testing has become an integral component for evaluation of selected individuals with these disorders. This technology document provides an overview of the current esophageal function technologies including functional luminal imaging probe (FLIP), high-resolution esophageal manometry (HRM), and multichannel intraluminal impedance (MII) and pH monitoring.[No abstract; excerpt from article].

Cullaro, G., E. C. Verna, A. Duarte-Rojo, M. R. Kappus, D. R. Ganger, R. S. Rahimi, B. Boyarsky, D. L. Segev, M. McAdams-DeMarco, D. P. Ladner, M. L. Volk, C. Y. Hsu and J. C. Lai (2021). “Frailty and the Risk of Acute Kidney Injury Among Patients With Cirrhosis.” Hepatol Commun Oct 22. [Epub ahead of print].

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Acute kidney injury (AKI) and frailty are major drivers of outcomes among patients with cirrhosis. What is unknown is the impact of physical frailty on the development of AKI. We included adults with cirrhosis without hepatocellular carcinoma listed for liver transplantation at nine US centers (n = 1,033). Frailty was assessed using the Liver Frailty Index (LFI); “frail” was defined by LFI ≥ 4.2. Chronic kidney disease as a baseline estimated glomerular filtration rate <60 mL/min/1.73 m(2) . Our primary outcome, AKI, was defined as an increase in serum creatinine ≥0.3 mg/dL or a serum creatinine ≥1.5-fold increase. Wait-list mortality was defined as either a death on the wait list or removal for being too sick. We performed Cox regression analyses to estimate the hazard ratios (HRs) for AKI and wait-list mortality. Of 1,033 participants, 41% were frail and 23% had CKD. Twenty-one percent had an episode of AKI during follow-up. Frail versus nonfrail patients were more likely to develop AKI (25% vs. 19%) and wait-list mortality (21% vs. 13%) (P < 0.01 for each). In multivariable Cox regression, each of the following groups was associated with a higher risk of AKI as compared with not frail/no CKD: frail/no CKD (adjusted HR [aHR] = 1.87, 95% confidence interval [CI] = 1.29-2.72); not frail/CKD (aHR = 4.30, CI = 2.88-6.42); and frail/CKD (aHR = 4.85, CI = 3.33-7.07). We use a readily available metric, LFI, to identify those patients with cirrhosis most at risk for AKI. We highlight that serum creatinine and creatinine-based estimations of glomerular filtration rate may not fully capture a patient's vulnerability to AKI among the frail phenotype. Conclusion: Our work lays the foundation for implementing physical frailty in clinical practice to identify AKI earlier, implement reno-protective strategies, and expedite liver transplantation.

Ma, L., S. Mor, P. L. Anderson, R. M. Baños, C. Botella, S. Bouchard, G. Cárdenas-López, T. Donker, J. Fernández-Álvarez, P. Lindner, A. Mühlberger, M. B. Powers, S. Quero, B. Rothbaum, B. K. Wiederhold and P. Carlbring (2021). “Integrating virtual realities and psychotherapy: SWOT analysis on VR and MR based treatments of anxiety and stress-related disorders.” Cogn Behav Ther 50(6): 509-526.

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The use of virtual reality (VR) and mixed reality (MR) technology in clinical psychology is growing. Efficacious VR-based treatments for a variety of disorders have been developed. However, the field of technology-assisted psychotherapy is constantly changing with the advancement in technology. Factors such as interdisciplinary collaboration, consumer familiarity and adoption of VR products, and progress in clinical science all need to be taken into consideration when integrating virtual technologies into psychotherapies. We aim to present an overview of current expert opinions on the use of virtual technologies in the treatment of anxiety and stress-related disorders. An anonymous survey was distributed to a select group of researchers and clinicians, using an analytic framework known as Strengths, Weaknesses, Opportunities, and Threats (SWOT). Overall, the respondents had an optimistic outlook regarding the current use as well as future development and implementation of technology-assisted interventions. VR and MR psychotherapies offer distinct advantages that can overcome shortcomings associated with traditional therapy. The respondents acknowledged and discussed current limitations of VR and MR psychotherapies. They recommended consolidation of existing knowledge and encouraged standardisation in both theory and practice. Continued research is needed to leverage the strengths of VR and MR to develop better treatments.Abbreviations: AR: Augmented Reality; MR: Mixed Reality; RCT: Randomised Controlled Trial; SWOT: Strengths, Weaknesses, Opportunities, and Threats; VR: Virtual Reality; VR-EBT: Virtual Reality Exposure-Based Therapy.

Elliott, T. R., P. B. Perrin, A. S. Bell, M. B. Powers and A. M. Warren (2021). “Resilience, coping, and distress among healthcare service personnel during the COVID-19 pandemic.” BMC Psychiatry 21(1): 489.

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BACKGROUND: The COVID-19 pandemic has a detrimental effect on the health and well-being of health care workers (HCWs). The extent to which HCWs may differ in their experience of depression and anxiety is unclear, and longitudinal studies are lacking. The present study examined theorized differences in distress between resilient and non-resilient HCWs over time, as reported in a national online survey. We also examined possible differences in distress as a function of sex and doctoral-level status. METHODS: A national sample responded to an online survey data that included the study measures. Of the HCWs who responded, 666 had useable data at the two time points. A longitudinal structural equation model tested an a priori model that specified the relationship of a resilient personality prototype to self-reported resilience, coping, depression and anxiety at both measurement occasions. Additional invariance models examined possible differences by sex and doctoral-level status. RESULTS: The final model explained 46.4% of the variance in psychological distress at Time 1 and 69.1% at Time 2. A non-resilient personality prototype predicted greater depression and anxiety. A resilient personality prototype was predictive of and operated through self-reported resilience and less disengaged coping to effect lower distress. No effects were found for active coping, however. The final model was generally invariant by sex and HCWs status. Additional analyses revealed that non-doctoral level HCWs had significantly higher depression and anxiety than doctoral-level HCWs on both occasions. CONCLUSIONS: HCWs differ in their susceptibility to distress imposed by COVID-19. Those who are particularly vulnerable may have characteristics that contribute to a lower sense of confidence and efficacy in stressful situations, and more likely to rely on ineffective, disengaged coping behaviors that can exacerbate stress levels. Individual interventions and institutional policies may be implemented to support HCWs at risk.