The Year in Perioperative Echocardiography: Selected Highlights From 2022.

THIS SPECIAL article is part of an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the Editorial Board for the opportunity to continue this series, which focuses on the past year's research highlights that pertain to perioperative echocardiography in relation to cardiothoracic and vascular anesthesia. The major selected themes for 2022 include (1) updates on mitral valve assessments and interventions, (2) training and simulation updates, (3) outcomes and complications of transesophageal echocardiography, and (4) point-of-care cardiac ultrasound. The themes selected for this special article are just a sample of the advances in perioperative echocardiography during 2022. An appreciation and understanding of these highlights will help to ensure and improve the perioperative outcomes for patients with cardiovascular disease undergoing cardiac surgery.

Implementation of a heart failure educational intervention for patients with recent admissions for acute decompensated heart failure.

Purpose: This study examined whether implementation of a heart failure (HF) education class targeted at patients and their caregivers decreased worsening HF, emergency department (ED) visits and hospital admissions, and improved patient quality of life and confidence in disease state management. Methods: Patients with HF and a recent hospital admission for acute decompensated heart failure (ADHF) were offered an educational course covering HF pathophysiology, medications, diet, and lifestyle modifications. Patients completed surveys before and 30 days after completion of the educational course. Outcomes of participants at 30 and 90 days after class completion were compared against outcomes for the same patients at 30 and 90 days prior to course attendance. Data was collected using electronic medical records, in-person during the class, and during a phone follow-up. Results: The primary outcome was a composite of hospital admission, ED visit, and/or outpatient visit for HF at 90 days. A total of twenty-six patients attended classes between September 2018 and February 2019 and were included in the analysis. Median age was 70 years, and most patients were white. All patients were American College of Cardiology/American Heart Association (ACC/AHA) Stage C and a majority had New York Heart Association (NYHA) Class II or III symptoms. Median left ventricular ejection fraction (LVEF) was 40%. The primary composite outcome occurred significantly more frequently in the 90 days prior to class attendance than in the 90 days following attendance (96% vs. 35%, p < 0.01). Likewise, the secondary composite outcome occurred significantly more frequently in the 30 days before class attendance than in the 30 days following (54% vs. 19%, p = 0.02). These results were driven by a decrease in admissions and ED visits for HF symptoms. Survey scores related to patient HF self-management practices and patient confidence in ability to self-manage HF increased numerically from baseline to 30 days after class attendance. Conclusion: Implementation of an educational class for HF patients improved patient outcomes, confidence, and ability to self-manage HF. Hospital admissions and ED visits also decreased. Adoption of such a course might help to decrease overall health care costs and improve patient quality of life.

In Situ Hybridization (ISH) Combined with Immunocytochemistry (ICC) Co-detection of Phosphorylated EGFR in A431 Cultured Cells.

Antibodies have been commonly used to study protein phosphorylation since the first phospho-specific antibody was described in 1981. Antibodies can be developed so that they specifically recognize phosphorylated areas of particular proteins. In situ hybridization (ISH) is the technique where specific RNA or DNA molecules can be detected in a single cell without the need for antibodies. Using ACD's integrated Co-Detection Workflow (ICW), we have developed a protocol to use phospho-specific antibodies in combination with ISH to show co-localization of EGFR mRNA and EGFR proteins phosphorylated at different sites in tumor cells. Our protocol has been used for multiplexing Y1086 phosphorylated EGFR, Y1068 phosphorylated EGFR, and EGFR RNA in A431 human epidermoid carcinoma cells.

In Situ Hybridization (ISH) Combined with Immunohistochemistry (IHC) for Co-detection of EGFR RNA and Phosphorylated EGFR Protein in Lung Cancer Tissue.

Detection of phosphorylated proteins in tissue sections using immunohistochemistry (IHC) is a challenging task. The absence of tissue staining may be caused by either a lack of protein expression or a lack of protein activation via its phosphorylation. To address this problem, we employed Integrated Co-detection Workflow (ICW) protocol to analyze lung cancer tissue sections by combining in situ hybridization (ISH) with IHC. The target protein of interest was epidermal growth factor receptor (EGFR, also known as ErbB1 and HER1) which is the founding member of the ErbB family of receptor tyrosine kinases. Using phospho-specific antibodies specific for a phosphorylated site Y1173 of EGFR molecule allowed us to analyze IHC and ISH staining at a single cell level in lung cancer tissue. We have observed both a co-localization of IHC with ISH signals and ISH-positive cells lacking IHC labeling for phosphorylated EGFR. ICW appears to be a very powerful spatial biology technique for accurate localization of cancer cells with phosphorylated/activated and non-phosphorylated/nonactivated proteins.

Developing a Unit Profile Dashboard to Inform Nursing Care Delivery Based on Unique Needs of Patients.

Nurse leaders need real-time, accurate data to design care delivery models and make decisions that reflect the patient populations they serve. To support nurse leader practice and optimize patient care, we developed a unit profile dashboard to describe the unique characteristics of patient populations cared for on each clinical unit at our hospital. In this article, we describe dashboard development, challenges, use cases, and plans for data analytics to further advance nursing practice.

Pharmacists perceptions and preparedness regarding gender-affirming hormone therapy.

BACKGROUND: As the transgender and gender non-conforming (TGNC) population in the United States continues to grow, there is a need for health care providers who are competent in managing gender-affirming therapy (GAT) for these individuals. OBJECTIVES: The purpose of this study was to assess practicing pharmacists' readiness to care for transgender and gender nonconforming (TGNC) patients and to compare the perceptions between pharmacists who have received formal education about gender-affirming therapy (GAT) and those who have not received such training. METHODS: This was a cross-sectional study that was conducted online over 4 weeks (January 2019-February 2019). A survey was distributed to pharmacists in the United States. Distribution of the survey was conducted through professional pharmacy social media groups. Respondents were asked to anonymously rate their perceived preparedness to care for a TGNC patient and to disclose any formal GAT training they had received during pharmacy school or through continuing pharmacy education. Responses were further stratified on the basis of self-reported completion of GAT education taken after pharmacy school. The responses of those who had received GAT training were compared with the responses of those who had not received GAT training. RESULTS: The results of this survey indicated that few pharmacists felt prepared to care for TGNC patients. Furthermore, few pharmacists report receiving formal education over GAT during pharmacy school or postgraduation. Approximately 41% and 40% of respondents, respectively, reported that they did not feel prepared to make recommendations to other health care providers on GAT and counsel TGNC patients about GAT regimens. However, the self-reported GAT-trained pharmacists showed a significantly increased level of perceived preparedness in caring for TGNC patients when compared with pharmacists who did not receive such education. CONCLUSION: Increased accessibility to GAT education for pharmacists may be associated with a significant growth in pharmacists' perceived ability to provide care for and interact with transgender patients.

Role of Rifaximin in Spontaneous Bacterial Peritonitis Prevention.

Cirrhosis affects millions of people around the world and is associated with increased morbidity and mortality. Spontaneous bacterial peritonitis (SBP) is a common complication of liver disease with cirrhosis and accounts for up to 30% of infections in patients with cirrhosis. Patients with a history of SBP and those deemed to be at high risk often are prescribed antibiotics to reduce the incidence of SBP. Fluoroquinolones and sulfamethoxazole-trimethoprim are commonly used antibiotics for long-term prevention for these specified populations; however, these antibiotics are associated with several adverse effects and interactions that may be harmful to patients. In addition, resistance development may decrease the efficacy of SBP treatment and prophylaxis. Given these limitations, rifaximin, a nonabsorbable, broad-spectrum antibiotic that is used for hepatic encephalopathy, may serve as a prophylactic alternative to conventional therapy. This review discusses guideline-recommended therapy and the evidence for using rifaximin for SBP prophylaxis.

The Impact of Prescriptions on Sex Partner Treatment Using Expedited Partner Therapy for Chlamydia trachomatis Infection, New York City, 2014-2015.

BACKGROUND: Chlamydia trachomatis reinfections, often resulting from resuming sex with untreated partners, can increase the risk of pelvic inflammatory disease, infertility, and ectopic pregnancy. Expedited partner therapy (EPT) has been shown to prevent reinfection when provided as medication (Medication-EPT) that patients give to sex partners; however, EPT is often provided as a prescription (Prescription-EPT). We compared partner treatment outcomes for Medication-EPT versus Prescription-EPT. METHODS: We conducted telephone interviews from October 2014 to October 2015 with a population-based random sample of women aged 15 to 25 years diagnosed with Chlamydia trachomatis. Interview questions included: demographics, patient-treatment, EPT type, and patient report of partner treatment. The main outcomes explored were: proportion of women receiving EPT, proportion of Prescription-EPT and Medication-EPT, and proportion of partners reported as treated. We used χ and Fisher exact tests for analysis. RESULTS: A total of 421 women completed the interview; 357 (84.8%) of 421 women reported having been treated, and 109/357 (30.5%) received EPT for any partner. Women given a prescription (vs medication) for their own treatment were more likely to receive EPT (odds ratio, 1.57; P = 0.05) and to receive Prescription-EPT specifically (odds ratio, 6.85; P < 0.0001). Forty-eight (52.2%) of 92 patients who received EPT for their most recent partner received Prescription-EPT. There was no difference by EPT type in proportion of index patients reporting partner treatment: 77.1% (37/48) for Prescription-EPT versus 79.5% (35/44) for Medication-EPT (P > 0.05). CONCLUSIONS: Prescription-EPT and Medication-EPT appear to result in comparable rates of partner treatment. Further research is needed to assess the effects of Prescription-EPT on partner treatment among adolescents and in other contexts.

Dapagliflozin: A Sodium Glucose Cotransporter 2 Inhibitor for the Treatment of Diabetes Mellitus.

OBJECTIVE: To review clinical evidence for the efficacy, safety, and tolerability of dapagliflozin (Farxiga-AstraZeneca), a sodium glucose cotransporter 2 inhibitor, as monotherapy or in combination with other hypoglycemic agents for the treatment of type 2 diabetes. DATA SOURCES: Literature was identified through a systematic MEDLINE search of clinical trial results for dapagliflozin. DATA SYNTHESIS: Multiple controlled clinical trials have established the efficacy, safety, and tolerability of dapagliflozin as monotherapy or in combination with other therapies for type 2 diabetes. Dapagliflozin is approved by Food and Drug Administration as monotherapy or as an add-on to other glucose lowering agents including insulin for the treatment of type 2 diabetes. CONCLUSION: Dapagliflozin is effective for the treatment of type 2 diabetes.

Albiglutide: A once-weekly glucagon-like peptide-1 receptor agonist for type 2 diabetes mellitus.

PURPOSE: The pharmacology, pharmacokinetics, efficacy, safety, dosage and administration, and place in therapy of the glucagon-like peptide-1 (GLP-1) receptor agonist albiglutide are reviewed. SUMMARY: Albiglutide (Tanzeum, GlaxoSmithKline) is an injectable GLP-1 agonist approved in 2014 for use as an adjunct to diet modification and exercise to improve glycemic control in adults with type 2 diabetes. Albiglutide augments glucose-dependent insulin secretion and slows gastric emptying; it has an elimination half-life of approximately five days, allowing for once-weekly administration. Clinical trials demonstrated mean absolute reductions in glycosylated hemoglobin (HbA1c) values of 0.78-1.55% after 16 weeks of adjunctive therapy with albiglutide. Specific recommendations on albiglutide use have been issued by the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA). Studies show that the potential for hypoglycemic episodes with albiglutide use is low. In clinical trials, the most frequently reported adverse events were nausea and diarrhea. The use of albiglutide is contraindicated in patients with a history of pancreatitis and patients with a personal or family history of thyroid cancer. CONCLUSION: Albiglutide has been shown to be effective for the management of type 2 diabetes in adults and is recommended (by ADA) as second-line therapy when used in combination with metformin and (by AACE) as first-line monotherapy in patients with an HbA1c concentration of ≤7.5% at treatment initiation. In clinical trials, albiglutide was generally well tolerated by patients, with adverse effects comparable to those seen with other GLP-1 agonists.