Broward Health

Background Dexmedetomidine is a highly selective α2-adrenergic agonist that provides sedative, anxiolytic, sympatholytic and analgesic-sparing effects while generally preserving patient arousability and respiratory drive, making it attractive in palliative inpatient units where maintaining meaningful interactions is a priority. Its pharmacologic profile allows lighter, more “wakeful” sedation compared with benzodiazepines or propofol and it has demonstrated opioid-sparing effects in perioperative and critical-care literature.We have safely used dexmedetomidine in the IPU for sedation protocols in patients with various end of life conditions. We would like to extrapolate this use to patients with severe pain at the end-of-life patients especially patients with advanced cancer. These patients often require escalating opioids for intractable pain, which can cause sedation and delirium, limiting their ability to communicate with family and negatively impacting quality of life and interactions with their loved ones at the end of life. Dexmedetomidine is an α2-agonist that provides analgesia and anxiolysis while preserving rousable alertness and may reduce opioid requirements. Objective To reduce opioid-related neurologic side effects while maintaining effective pain control by using low-dose dexmedetomidine as an adjunct in the IPU allowing for a more meaningful death experience. Conclusions A simple bedside dexmedetomidine protocol as an adjunct to opioids may reduce opioid-related sedation and delirium while maintaining effective analgesia, allowing patients to remain alert and interact meaningfully with family at the end of life.

PROBLEM:Cardiovascular disease in Haiti is a major public health issue, yet fewer than 17 cardiologists are present nationwide. Consequently, general practitioners assume a substantial portion of demand for complex disease management. Following their experience of the 2019 International Cardiology Curriculum Accessible by Remote Distance Learning (ICARDs), the authors identified a desire for practical instruction in echocardiography and a low-cost, effective imaging tool to screen for pertinent heart conditions. Current geopolitical challenges in Haiti render in-person echocardiography training unfeasible. A novel remote echocardiology curriculum for internal medicine residents could meet this challenge in a manner that is effective, sustainable, and sensitive to the Haitian context. APPROACH:University Hospital of La Paix served as the pilot intervention site for the Focused Echocardiography Training Intervention Package (FETIP). Portable ultrasound devices and a telemedicine-enabled robot were selected to mediate remote training, which was delivered in September of 2023 to 16 internal medicine residents over the course of 12 weeks. The first phase of training included live didactic sessions created and delivered by board-certified cardiologists. In the second phase, residents received hands-on training in image acquisition under direct supervision. The third phase centered on image interpretation skills. A diverse Training Advisory Board oversaw the implementation of FETIP and offered guidance for ongoing refinements. OUTCOMES:Results demonstrate improvement in three primary endpoints: fundamentals of knowledge, image acquisition, and image interpretation. Residents not only improved their technical performance but also applied echocardiography in appropriate clinical contexts, identifying previously unrecognized cases of heart failure. NEXT STEPS:The challenges in cardiovascular care in Haiti are ongoing, yet technology-driven training models like FETIP provide meaningful support to Haitian physicians, leading to future self-sufficiency in echocardiography. Further, the authors' experience offers the global medical community a scalable framework for echocardiography training for use in other resource-limited settings.

Study designRetrospective cohort study.ObjectiveTo evaluate radiographic durability and clinical outcomes following placement of a novel expandable interlaminar stabilization device for single-level lumbar spinal stenosis. Specifically, we aimed to: 1) quantify immediate postoperative posterior column distraction; 2) determine whether foraminal expansion is improved postoperatively without radiographic subsidence; and (3) assess potential improvements in patient-reported pain/clinical outcomes.MethodsA retrospective review was performed of adult patients undergoing single-level decompression supplemented by an interlaminar device for symptomatic lumbar spinal stenosis by a single surgeon from 2024 to 2025. Radiographic parameters included anterior, middle, and posterior disc height, foraminal height, and segmental lordosis that were measured preoperatively and longitudinally through 12 months. Postoperative changes were assessed relative to preoperative using paired t-tests, with longitudinal trends analyzed by linear mixed-effects modeling. Clinical outcomes were assessed using Visual Analog Scale (VAS) pain scores. Complications and reoperations were recorded, with statistical significance defined as P < 0.05.ResultsA total of 33 patients (mean age 72.6 ± 10.0 years) were included. Posterior disc height increased from 0.46 cm to 0.58 cm (mean +0.12 cm, P < 0.001), and foraminal height increased from 1.88 cm to 2.13 cm (mean +0.26 cm, P < 0.001). There were no significant changes in anterior disc height, middle disc height, or segmental lordosis. Mixed-effects modeling demonstrated no progressive loss of posterior disc height/foraminal expansion through 12 months postoperatively. Mean VAS improved from 6.8 preoperatively to 4.5 at latest follow-up (mean −2.36, P < 0.001). 31/33 patients (93.9%) had no perioperative complications; two (6.1%) required hardware removal following unrelated postoperative trauma or spinous process fracture.ConclusionsExpandable interlaminar stabilization produced immediate posterior column distraction and foraminal expansion improved at 12 months postoperatively. Clinically meaningful pain reduction was observed in this lumbar stenosis cohort. Our findings support the biomechanical durability and clinical efficacy of interlaminar posterior column stabilization as an adjunct to decompression.

Large-scale clinical studies investigating the safety and efficacy of novel therapeutics in ovarian cancer rarely include Black women or women of African ancestry. The sampled population in the PRIMA study was only 1.6% Black. Our objective is to evaluate the safety and tolerability of maintenance niraparib treatment in women of African ancestry. We hypothesize that the Poly (ADP-ribose) polymerase inhibitor (PARP) niraparib administered at standard doses in a population of African ancestry may demonstrate different safety and efficacy profiles to those in the PRIMA trial who were of primarily European ancestry. We will conduct a prospective, single-arm, multicenter, international study of 70 women of African ancestry designed to evaluate the safety and efficacy of niraparib maintenance therapy following completion of primary treatment for epithelial ovarian cancer. Study sites will include the United States, Bahamas, and Nigeria. Eligible patients must have histologically confirmed high-grade serous or endometrioid ovarian carcinoma, completed primary treatment for newly diagnosed stage III or IV ovarian, fallopian tube, or primary peritoneal carcinoma (surgery and chemotherapy) with partial or complete response, and self-identify as Black or African or Afro-Caribbean. The primary endpoint is the proportion of women with any grade 3 or higher adverse event. Secondary endpoints and translational endpoints will include progression free survival, pharmacokinetics, quality of life assessments, and biomarkers of PARP inhibitor resistance and metabolism.Clinical Trial Registrationhttps://clinicaltrials.gov/study/NCT06412120, identifier NCT06412120.