Abstract Rationale Prolonged oxygen therapy (O2) can delay discharge, increase healthcare costs, and raise hyperoxia risk. To promote timely oxygen discontinuation, an oxygen weaning protocol was implemented on general medicine wards in a 222-bed community hospital in mid-2025. Methods In this retrospective cohort study, patient charts from one general medicine ward were reviewed for a historical cohort (June-October 2024) to compare to a protocol cohort (June-October 2025). Inclusion Adult patients hospitalized >24 hours for hypoxia/hypoxemia, acute or acute-on-chronic respiratory failure (ARF/ACRF), or chronic obstructive pulmonary disease (COPD), who underwent oxygen weaning on nasal cannula or Venturi mask. Exclusion use of other oxygen modalities during the weaning period, transfers, hospice discharge, death, or incomplete data. Primary outcomes Time to Wean (TTW, days from weaning initiation to baseline oxygen) and Length of Stay (LOS). Secondary outcome Discharge on oxygen higher than baseline. Baseline, initial, and peak oxygen flows and comorbidities were extracted. Cohorts were compared using Welch’s t-tests, Mann-Whitney U-tests, and multivariable regression. Protocol compliance was defined as de-escalation of oxygen when SpO2>95%. Results Among 631 charts reviewed (protocol n = 318, non-compliant n = 36; historical n = 313), 255 were eligible (protocol n = 113, historical n = 142). Unadjusted TTW was shorter under the protocol (2.17 ± 2.54 days) versus historical (2.81 ± 2.94 days) (p = 0.098) while LOS was longer (protocol 5.60 ± 4.73 days versus historical 5.08 ± 4.61 days; p = 0.06). Multivariable regression showed the protocol significantly reduced TTW by ∼0.70 days (95 %CI -1.27 to -0.14, p = 0.015) but had no effect on LOS (p = 0.58). Protocol patients had lower discharge oxygen flows (0.79 versus 1.09 L/min), smaller increases from baseline, and lower odds of discharge on new/higher oxygen (OR≈0.53, 95 %CI 0.26-1.08, p = 0.08). TTW and LOS were moderately correlated across all groups (Pearson r = 0.46, Spearman ρ = 0.43, both p < 10⁻), but strongest in ARF (r = 0.55) and COPD (r = 0.59). Observed statistical power was low (10%). Protocol compliance was 76%. Conclusion A standardized oxygenweaning protocol modestly shortened duration of oxygen therapy but did not reduce hospital LOS. The moderate TTW-LOS correlations suggest timely weaning influences discharge timing, but patient severity and nonrespiratory factors are major drivers of LOS. Protocol patients were less likely to be discharged on increased home oxygen, which can decrease costs (from 2018-2021, Medicare fee-for-service durable medical equipment (DME) spent ∼9.8% of >$8 billion in total expenditures on oxygen products). However, larger adequately powered studies with higher protocol adherence are needed to clarify the clinical impact of protocoldriven oxygen weaning. This abstract is funded by: None
Background: The incidence of Takotsubo cardiomyopathy (TTC) has risen due to increased clinical awareness, improved diagnostics, and the broader use of coronary angiography in patients presenting with acute coronary syndrome (ACS)-like symptoms. Despite the risk of life-threatening cardiogenic shock, ventricular arrhythmias, and ventricular thrombus formation, the pathophysiology of TTC remains poorly understood. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. We identified adults (≥18 years) with an incident diagnosis of TTC and compared them with a group consisting of adults with an incident diagnosis of ACS. Propensity score matching (1:1) was performed using a greedy nearest-neighbor algorithm with a caliper of 0.1 pooled standard deviations. The primary outcomes were inflammatory and immune laboratory values measured within ±7 days of the index cardiac event, including leukocyte and differential counts (neutrophils, lymphocytes, monocytes, eosinophils, basophils), platelets, C-reactive protein, erythrocyte sedimentation rate, ferritin, lactate dehydrogenase, and D-dimer. Secondary biomarkers included troponin, brain natriuretic peptide, and cortisol. Results: After propensity score matching, 47,246 Takotsubo patients were matched 1:1 with 47,246 ACS controls, yielding a final analytic cohort of 94,492 individuals. Across inflammatory cell counts, monocytes emerged as the only marker demonstrating a difference between groups. Monocyte values were modest but significantly lower in TTC than in ACS (TTC mean 7.82 ± 4.45 vs ACS 8.10 ± 4.10) (Image 1). Conclusion: In this large, propensity-matched TriNetX analysis, TTC and ACS demonstrated broadly similar routine inflammatory profiles, with only modest differences in monocyte values. These findings support a hypothesis-generating framework suggesting that TTC does not exhibit a globally distinct inflammatory signature compared with ACS in real-world clinical practice. Even though our results support the pathophysiology of TTC and ACS as being more similar than previously assumed, monocyte attenuation could serve as a supportive diagnostic signal.
In the United States and around the world, physical inactivity is a leading cause of morbidity, disability, and premature mortality. While the importance of physical activity is known, there is a disconnect in how we are translating it to our patients. This may be due to poor physical activity education during undergraduate and graduate medical education. Despite the paucity of physical activity prescription education and competence, there are ample resources within the community. It is time for physicians to take an active role in optimizing patient lifestyle and helping prevent or mitigate chronic diseases.
From 2019–2023, the United States Food and Drug Administration has cleared 9 novel obstructive sleep apnea-detecting wearables for home sleep apnea testing, with many now commercially available for sleep clinicians to integrate into their clinical practices. To help clinicians comprehend these devices and their functionalities, we meticulously reviewed their operating mechanisms, sensors, algorithms, data output, and related performance evaluation literature. We collected information from PubMed, United States Food and Drug Administration clearance documents, ClinicalTrials.gov, and web sources, with direct industry input whenever feasible. In this “device-centered” review, we broadly categorized these wearables into 2 main groups: those that primarily harness photoplethysmography data and those that do not. The former include the peripheral arterial tonometry-based devices. The latter was further broken down into 2 key subgroups: acoustic-based and respiratory effort-based devices. We provided a performance evaluation literature review and objectively compared device-derived metrics and specifications pertinent to sleep clinicians. Detailed demographics of study populations, exclusion criteria, and pivotal statistical analyses of the key validation studies are summarized. In the foreseeable future, these novel obstructive sleep apnea-detecting wearables may emerge as primary diagnostic tools for patients at risk for moderate-to-severe obstructive sleep apnea without significant comorbidities. While more devices are anticipated to join this category, there remains a critical need for cross-device comparison studies as well as independent performance evaluation and outcome research in diverse populations. Now is the moment for sleep clinicians to immerse themselves in understanding these emerging tools to ensure our patient-centered care is improved through the appropriate implementation and utilization of these novel sleep technologies. Chiang AA, Jerkins E, Holfinger S, et al. OSA diagnosis goes wearable: are the latest devices ready to shine? J Clin Sleep Med. 2024;20(11):1823–1838.
Coronavirus-19 exacerbated daily stressors for nurses due to long hours, understaffing, and potential burnout in health care personnel. There is evidence that nurses who participate in mindfulness activities may experience significant changes related to stress, anxiety, and mood; however, more quantitative research studies are needed to investigate and substantiate the impact of mindfulness-based interventions. This intervention investigated the impact of a 4-week mindfulness meditation on perceived stress and self-compassion. Thirty-two participants were enrolled at the beginning of the study and 26 completed the intervention (intervention group, n = 17; control group, n = 9). A 2-tailed Mann-Whitney U sample rank-sum test was used to explore differences between groups on the 2 outcome variables-Perceived Stress Scale (PSS) and the Self-Compassion Scale (SC). Postintervention assessments were conducted, and statistically significant differences were found between the intervention and control groups for 2 constructs. The intervention group was more likely to "feel confident handling problems" (PSS#4) versus the control group (median = 11.76, 16.78, respectively; P = .020; α = .05); and the intervention group tended to "take a more balanced view of life situations" (SC#3) than the control group (median = 12.50, 15.39, respectively; P =.047; α = .05). Other constructs from the PSS and the SC were not statistically different. In conclusion, this study found observable improvements in the raw data and statistically significant differences for the intervention group; however, more research is warranted.
