Brian N. Fink

Safety of outpatient surgery for obstructive sleep apnea.

Objective Determine the safety experience of adult obstructive sleep apnea patients undergoing airway surgery. Study Design A retrospective cohort study. Setting The experience of members of a large Medicaid managed care organization between January 10, 2009, and June 30, 2011. Subjects and Methods Four hundred fifty-two adult Medicaid obstructive sleep apnea (OSA) patients (404 ambulatory, 48 inpatient) receiving head and neck airway surgery form the basis of this report. Four safety indicators were reported from administrative data for 30 days: emergency room visit, inpatient admission, observation day, and 3 or more primary care physician visits. The occurrence of myocardial infarction, deep venous thrombosis, stroke, pulmonary embolism, tracheostomy, or transfusion was noted. Results Ninety-four percent of the nasal, 86% of the palatal, and 79% of the nasal/palatal surgeries (89% overall) were ambulatory. The observed catastrophic complication rate among ambulatory patients was zero (95% confidence interval, 0.0%-1.1%). Emergency room visits for pain-related diagnoses were the most common adverse outcome (51%). Administrative data sets can be used to provide insight into practice safety questions. Conclusion Contrary to guidelines, most OSA patients underwent ambulatory head and neck airway surgery. The observed catastrophic complication rate was zero. Administrative data sets can be used to provide insight into practice safety questions. Further study is warranted of ambulatory surgery management of adult sleep apnea patients.

Adherence to antiretroviral therapy: a survey of factors associated with medication usage

Abstract The use of highly active antiretroviral therapy (HAART) has decreased morbidity and mortality for people living with HIV/AIDS, but adherence to HAART is a critical factor in successful treatment. Adherence to medication is a complex and poorly understood behavior. A survey was undertaken to evaluate subjective correlates of adherence and non-adherence based on previously distilled themes from a qualitative study of adherence. A 60-question survey was completed by patients in the outpatient clinic setting regarding demographics, CD4 cell count, viral load, adherence, and screening questions about medication usage and attitudes toward HIV. Ninety-eight adherent and 34 non-adherent patients completed the survey. After logistic regression analysis, several questions appeared to be the main predictors of non-adherence: Have you ever thought of having HIV as a “punishment?” Do you feel that your medicines are hard to take? Do you believe the medicines for HIV that you take are working for you? These questions may be helpful in the development of a clinically useful screening tool to assess patients at risk for non-adherence.

Analysis of the Relationship Between Diet and Exercise Beliefs and Actual Behaviors Among Breast Cancer Survivors in Northwest Ohio

Introduction Studies have shown that a diet high in fruit and vegetable intake, as well as a routine including daily exercise or physical activity, can independently affect relapse rates and survivorship in breast cancer patients. Fruits and vegetables contain powerful anti-oxidant molecules, capable of preventing tumor formation and proliferation. Exercise can lower circulating levels of estrogen, the female hormone responsible for tumor proliferation in the estrogen-sensitive form of the disease. The most beneficial results have been shown in women who exercise and consume a diet rich in fruits and vegetables. We studied the attitudes towards and behaviors related to fruit and vegetable intake and exercise in a cohort of breast cancer survivors in northwest Ohio. Materials and Methods Data were gathered from a survey sent out by the Northwest Ohio Branch of the Susan G. Komen For the Cure Foundation. We assessed and evaluated survivors’ self-reported beliefs, attitudes, and behaviors regarding exercise and fruit and vegetable intake. Results Nearly half of the survivors (46.5%) reported being unsure or in disagreement with the statement “Eating at least 5 servings of fruits and/or vegetables per day will reduce the risk of breast cancer recurrence.” Only 46.8% of those in agreement with the previous statement actually report eating at least 5 fruits and/or vegetables per day. With respect to exercise, 32.9% reported being unsure or in disagreement with the statement “Engaging in regular physical activity will reduce the risk of breast cancer recurrence.” Only 68.5% of those in agreement with the previous statement report any physical activity in the past 30 days. Conclusions Many breast cancer survivors do not appear to be aware of the benefits of diet and exercise. Further, a large proportion of those who are aware of the benefits do not adapt a healthy diet and exercise as part of their lifestyle. A majority of these survivors see a primary care physician, which we believe is the best venue to bridge this education gap. It is apparent by the pattern our data shows that more needs to be done to educate breast cancer survivors about the benefits of exercise and fruit and vegetable intake. Steps need to be taken to ensure that those who are educated also remain motivated to engage in a healthy lifestyle with the hopes of avoiding breast cancer recurrence.

Retroviral gene insertion in breast milk mediated lymphomagenesis.

We have demonstrated breast milk transmitted MoMuLV-ts1 retrovirus infection and subsequent lymphoma development in offspring of uninfected mothers suckled by infected surrogate mothers. Additionally, we have shown that the lymphoma development occurs as a result of viral gene integration into host genome. A total of 146 pups from Balb/C mice were divided into 5 groups; one control and 4 experimental. All offspring suckled from surrogate infected or control mothers, except one group of infected pups left with their biological mothers. Thirteen of 91 infected pups developed lymphoma. Inverse-PCR, DNA cloning, and quantitative real-time PCR (qRT-PCR) were used to study the virus integration sites (VIS) and alterations in gene expression. VIS were randomly distributed throughout the genome. The majority of insertion sites were found in chromosomes 10, 12 and 13. A total of 209 proviral genomic insertion sites were located with 52 intragenic and 157 intergenic sites. We have identified 29 target genes. Four genes including Tacc3, Aurka, Gfi1 and Ahi1 showed the maximum upregulation of mRNA expression. These four genes can be considered as candidate genes based on their association with cancer. Upregulation of these genes may be involved in this type of lymphoma development. This model provides an important opportunity to gain insight into the relationship of viral gene insertion into host genome and development of lymphoma via natural transmission route such as breast milk.

Nutrient Pathways and Breast Cancer Risk: The Long Island Breast Cancer Study Project

The relative importance of biochemical pathways has not been previously examined when considering the influence of diet on breast cancer risk. To address this issue, we used interview data from a population-based sample of 1463 breast cancer cases and 1500 controls. Dietary intake was assessed shortly after diagnosis using a 101-item food frequency questionnaire. Age- and energy-adjusted odds ratios (ORs) for individual micro- and macronutrients were estimated with logistic regression. Hierarchical modeling was used to account for biologically plausible nutrient pathways (1-carbon metabolism, oxidative stress, glycemic control, and phytoestrogens). Effect estimates from hierarchical modeling were more precise and plausible compared to those from multivariable models. The strongest relationship observed was for the glycemic control pathway, but confidence intervals (CI) were wide [OR (95% CI): 0.86 (0.62, 1.21)]. Little or no effect was observed for the 1-carbon metabolism, oxidative stress, and phytoestrogen pathways. Associations were similar when stratified by supplement use. Our approach that emphasizes biochemical pathways, rather than individual nutrients, revealed that breast cancer risk may be more strongly associated with glycemic control factors than those from other pathways considered. Our study emphasizes the importance of accounting for multiple nutrient pathways when examining associations between dietary intake and breast cancer.

Immersive Simulation Education: A Novel Approach to Pandemic Preparedness and Response

Pandemic management involves strategic and tactical concepts rarely experienced with other disasters. To comprehend the enormity of these tasks and experience the critical decision-making required, local public health and other stakeholders participate in tabletop and functional exercises. Students in Master of Public Health (MPH) programs not only rarely experience this educational format, but also are seldom afforded substantive time to appreciate the critical decision making that is unique to pandemics. An immersive semester-long simulation exercise was created to educate graduate public health students about pandemics. Students in a MPH course were divided into groups representing county health departments. During the semester, students collaborated and completed incident command training, received audio lectures, and materials concerning an imminent pandemic. The students then participated in the 2.5-hr facilitated tabletop exercises in the classroom. A survey was developed to assess their perceptions of the experience. Most students felt more knowledgeable afterward and thought that this training style was innovative, entertaining, educational, and recommended it to fellow students and colleagues. The students believed that delivering a tabletop exercise in this fashion was educational and entertaining. It gave the students a better appreciation of the role of public health in managing the complexities associated with pandemics.

Early Stage Breast Cancer and its Association with Diet and Exercise-Related Perceptions and Behaviors to Prevent Recurrence

Background The favorable prognosis for early stage breast cancer survivors may be a reason for the minimal research regarding their quality of life. Prior research has observed more long-term weight gain among early stage survivors compared to cancer-free women of a similar age. It would be useful to study survivors’ perceptions and reported behaviors regarding diet and exercise to see if there is a correlation with previous studies. Methods A sample of 700 breast cancer survivors from Ohio and Michigan was randomly selected from the Northwest Ohio affiliate of the Susan G. Komen For the Cure mailing list and sent a survey for completion. Results 389 survivors completed the survey and among Stage 1 (50/197 = 25.4%) and Stage 2 survivors (24/105 = 22.9%), a small proportion had a positive correlation between self-reported dietary behaviors and their perceived benefits of eating fruits and vegetables. Similar correlations were observed between their self-reported exercise behaviors and their perceived benefits of exercise (Stage 1: 36/197 = 18.3%, Stage 2: 18/105 = 17.1%). Conclusions Regardless of stage, a small proportion of survivors’ self-reported dietary and exercise behaviors match their perceived benefits of diet and exercise. Factors such as access, motivation, and lack of co-morbidities among early stage survivors may prevent them from living healthier post-diagnosis. More thorough dietary and clinical measurements will provide greater certainty. Thus, innovative, sustainable programs must be accessible and provide motivation and social support from family, friends, and other survivors to truly improve quality of life.

Active Shooter Exercise Training for Nurses in Emergency Medicine

The recent horrific events surrounding San Bernardino and Paris underscore the conceit that active shooter incidents must be included into the new reality of day-to-day existence in virtually every part of the world. In the United States, the incidence of active shooter events has more than doubled, comparing the period 2000-2006 with 2007-2013 [1-5]. The literature indicates that many countries share this concern [6-20]. With a recent report indicating global terror groups are planning more attacks upon the western industrialized countries, there should be no expectation that this increase in active shooter events is an aberration. Among the soft targets that remain a cause of concern for federal and state agencies is the healthcare system [21]. In fact, active shooter incidents have increased in hospitals from nine per year in 2000-2005 to 16.7 per year in 2006-2011 [1]. Granted, most of the incidents target specific individuals, but it does underscore the vulnerability of healthcare facilities, their staff and clients.

AED Education: A Dilemma for Public Health and a Challenge for Critical Care Specialists

Objective: The proper management of out-of-hospital cardiac arrests (OHCA) includes proper CPR and early defibrillation with a public access AED (automated external defibrillator). However, the general public is largely ignorant of their role in OHCA. This behavior has resulted in only a minority of OHCA patients being successfully resuscitated and leaving the hospital neurologically intact. One particularly revealing study demonstrated that American college students not only were hesitant to employ an AED, they did not even know its location within their own campus. The purpose of this study was to ascertain whether this was true even among healthcare students in a healthcare academic environment. Method: A local university population of students and faculty in nursing, medicine, public health, physician assistant, pharmacy, and biological sciences completed a survey which included not only the AED training and knowledge aspects, but also whether or not they knew the location of the nearest AED. A total of 553 participants (532 students and 21 faculty) agreed to participate and completed the anonymous IRB-approved survey. Results: Of those that completed the survey, 89.5% received AED training, 55.3% within the prior twelve months. However, only 110 of those who received AED/ CPR education (19.9%) knew the location of the AED in the building where they received the majority of their education. This lack of knowledge crossed all the disciplines. It ranged from as low as 17.5% for medical students up to 22.5% for PA students. These data reached statistical significance. Conclusion: Health professionals and the general public need to know not only how to use an AED but where the nearest one is located to actually save lives in the pre-hospital environment. Critical care specialists and intensivists are advised to work with the local public health infrastructure to ensure that AED/CPR training includes empowering the trainees to actively seek out AED locations at the more popular public venues in a community. Knowledge of CPR and defibrillator training alone are useless if the individual cannot find the device in a timely manner.

Abstract 4440: From gray to pink: Helping older adults with breast cancer understand and utilize the health care system in the real world

Proceedings: AACR 103rd Annual Meeting 2012‐‐ Mar 31‐Apr 4, 2012; Chicago, IL Background: Breast cancer education programs while abundant tend to focus on young and middle age women. However, the median age of breast cancer diagnosis is 61 years of age. With increasing debate on when to begin mammography, the risk of being diagnosed at a later age also increases. As the senior breast cancer survivor and at-risk population continues to grow, their need to be educated regarding breast cancer and other health and legal-related issues of aging is key to reducing risk, finding breast cancer early, and improving the quality of life for survivors. This pilot program was designed to educate seniors about breast cancer in relation to healthy aging and nutrition, elder law, patient advocacy, and occupational and physical therapy. The intent is to improve senior confidence and knowledge pertaining to these issues in order to create a sustainable population of seniors that can help themselves and each other. Methods and Materials: Two senior centers located in Northwest Ohio agreed to host the four individual workshops of From Gray to Pink during September and October 2011, respectively. Senior breast cancer survivors (age ≤ 60), their family and friends, and women at risk were welcome to attend. The workshops covered breast cancer and issues related to diet, aging, elder law, patient advocacy and navigation, and physical therapy and occupational therapy. Participant knowledge and confidence were assessed using pre- and post-surveys and the Students paired t-test was used to compare mean pre- and post-test knowledge and confidence scores. Results: Among the 25 total participants, there were statistically significant differences between pre- and post-test knowledge for the aging and nutrition (p = 0.01), elder law (p < 0.01), physical and occupational therapy (p = 0.03) workshops. Conclusion: Senior breast cancer survivors and those at risk scored higher in both topic knowledge and confidence on post-surveys compared to pre-surveys. This pilot study has provided sufficient data to apply for funding to bring this program to additional rural Ohio counties. While improvements in confidence were not statistically significant, most participants did have the same level of or greater confidence following each workshop. Given the aging of our population and increasing health care costs and needs, breast cancer education for seniors at risk and senior survivors is crucial. The knowledge and confidence gained by seniors can be shared among all to provide an ever-growing network of people who can educate and help each other improve their quality of life. Further implementation will help in determining if this educational methodology may be useful in other parts of the country for seniors who have or are at risk for breast cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4440. doi:1538-7445.AM2012-4440