Divisions Kettering Health Main Campus, formerly known as Kettering Medical Center (KMC), is a faith-based, nonprofit hospital located in Kettering, Ohio, United States. Founded in 1964, it is the flagship hospital of the Kettering Health, and is directly affiliated with the Seventh-day Adventist Church. It is also affiliated with the Boonshoft School of Medicine. In 2020, Forbes and Great Places to Work named Kettering Health a "Best Place to Work", regardless of industry.
BACKGROUND:Standardized implant protocols have shown promise in improving outcomes in transcatheter aortic valve replacement (TAVR). However, the impact of implantation depth on clinical outcomes remains unclear. OBJECTIVES:The aim of this study was to evaluate clinical and hemodynamic outcomes across varying TAVR implantation depths using data from the Optimize PRO study. METHODS:This prospective, multicenter Optimize PRO study included patients with symptomatic severe aortic stenosis undergoing TAVR with Evolut PRO and Evolut PRO+ systems. Patients were stratified by core laboratory-adjudicated noncoronary cusp implantation depth. The echocardiographic outcome composite included no or trace paravalvular regurgitation, aortic mean gradient ≤ 10 mm Hg, and no prosthesis-patient mismatch at discharge. RESULTS:Patients (N = 603) were stratified by implantation depth: <1 mm (n = 88), 1 to ≤3 mm (n = 196), >3 to ≤5 mm (n = 170), and >5 mm (n = 149). Baseline characteristics were similar across implantation depth groups, except for a higher proportion of women for higher implantation depths. Higher implantation depths were associated with less resheathing and recapture (27.3% [24 of 88], 33.7% [66 of 196], 48.8% [83 of 170], and 51.7% [77 of 149]; P < 0.001) and shorter median hospital stay (1 day [Q1-Q3: 1-1 day], 1 day [Q1-Q3: 1-2 days], 2 days [Q1-Q3: 1-3 days], and 2 days [Q1-Q3: 1-4 days]; P < 0.001). Rates of valve migration (0%, 0.5% [95% CI: 0.1%-3.6%], 0.6% [95% CI: 0.1%-4.1%], and 1.3% [95% CI: 0.3%-5.3%]; P = 0.63) were low across implantation depth groups. The 1-year all-cause mortality or all-stroke rate was comparable across implantation depth groups (8.1% [95% CI: 3.9%-16.2%], 7.2% [95% CI: 4.3%-11.8%], 10.7% [95% CI: 6.9%-16.5%], and 12.5% [95% CI: 8.1%-19.2%]; P = 0.40). After 1 year, higher implantation depths were associated with lower rates of permanent pacemaker implantation (2.3% [95% CI: 0.6%-8.8%], 9.2% [95% CI: 5.9%-14.3%], 15.9% [95% CI: 11.2%-22.4%], and 20.3% [95% CI: 14.6%-%27.7]; P < 0.001). Rates of NYHA functional class I were numerically different across implantation depth groups but did not reach statistical significance (77.8% [56 of 72], 71.8% [130 of 181], 65.2% [101 of 155], and 67.7% [84 of 124]; P = 0.09 across all classes). In men, echocardiographic outcome composite rates were not statistically different across depth groups (58.6% [17 of 29], 50.6% [39 of 77], 43.8% [35 of 80], and 36.1% [26 of 72]; P = 0.14), although the exploratory trend test reached statistical significance (P = 0.02). CONCLUSIONS:Higher TAVR device implantation was associated with improved clinical outcomes with similar safety events, including valve migration, across depths. The long-term effect of this approach, including the ability to perform redo TAVR safely, will be further studied in the future. (Optimize PRO; NCT04091048).
Background: Residential lifestyle medicine programs have documented immediate and long-term improvements in cardiometabolic risk factors. Despite this, adherence among participants varies in such programs, limiting the positive outcomes that can be achieved. This study aimed to assess how adherence to positive lifestyle behaviors correlates with cardiometabolic risk factors at the end of a residential lifestyle medicine program and at three or more months of follow-up. Methods: Patients enrolled in a NEWSTART® lifestyle medicine program were invited to participate in this prospective chart review. Outcomes included changes in BMI, blood pressure, medication and supplement use, cardiometabolic disease biomarkers, Mediterranean eating pattern, meat intake, and other lifestyle behaviors. Results: Among 109 adults (78% female; 62% overweight or obese) enrolled in a 6- to 39-day (mean 14.5-day) residential intervention, meat intake reduced by 3.2 servings/week, MEPA III scores increased by 2.3, water intake increased by 2.1 glasses/day, and exercise increased by 193 min/week (all p < 0.01). From baseline to end of program, reductions were noted in blood glucose (-5.3 mg/dL, p = 0.01), total cholesterol (-16.0 mg/dL, p < 0.01), LDL cholesterol (-11.0 mg/dL, p < 0.01), HDL cholesterol (-2.0 mg/dL, p < 0.01), triglycerides (-13 mg/dL, p < 0.01), serum creatinine (-0.03 mg/dL, p = 0.049), systolic blood pressure (-6.0 mmHg, p < 0.01), diastolic blood pressure (-3.0 mmHg, p = 0.01), and weight (-3.2 kg, p < 0.01). At a mean of 8.6 months follow-up, reductions in triglycerides (14.9 mg/dL, p = 0.03) and weight (2.8 kg, p < 0.01) from baseline were sustained, and water intake increased 20% from baseline (1.1 glasses/day, p = 0.01). Improved adherence to a Mediterranean eating pattern score, increase in water intake and reductions in meat intake and BMI predicted favorable health outcomes. Conclusions: Participation in the lifestyle medicine program was associated with improvements in cardiometabolic risk factors during intervention and at follow-up. These outcomes correlated with adherence to positive lifestyle behaviors. Sustained weight reduction as well as dietary and cardiometabolic improvements in our participants suggest the NEWSTART® intervention may hold promise for maintaining cardiometabolic health.
Successful orthopedic training includes mastering the orthopedic principles while developing a high level of surgical skills. Gaining experience and repetitions with these techniques can be particularly challenging for junior orthopedic residents, who typically have limited time in the operating room. There is a need to improve the education approach for junior orthopedic residents, and some residency programs have begun exploring the possibility of using virtual reality to augment orthopedic surgical training. Immersive Virtual Reality (iVR) technology is revolutionizing medical education and can potentially mitigate some of the challenges associated with traditional surgical training. This paper aims to describe how iVR training enhanced the skills of a first-year orthopedic surgery resident through a narrative review of their experiences. The resident participated in a comprehensive iVR training program (PrecisionOS™ iVR system) where the resident completed a learning curriculum of all-encompassing modules focusing on basic anatomy, surgical approaches, individual procedure techniques, and more. Utilizing iVR training allowed the resident to get real-time feedback, learn the anatomy, and also master the steps of different procedures before stepping into the operating room. The repetitive nature of iVR with the constant feedback allowed the resident to refine their technical skills, and with time, the steps became muscle memory. The resident observed a noticeable improvement in the overall efficiency and mastery in performing orthopedic procedures. From the attending’s standpoint, the guided preoperative preparation increased the trust and confidence in the resident, as the attending was able to give real-time feedback during the iVR module, making active changes and modifications. If there was a mistake made in the iVR space, it was very easy to reset the step and repeat it, and there was never any risk to the patient. In the experience of this resident, Immersive Virtual Reality (iVR) can be a helpful tool for a junior orthopedic surgery resident. It provides the resident with an opportunity to learn the surgical workflow and increase surgical efficiency in a safe and cost-effective environment.
