Browsing by Author "Bosslet, Gabriel"
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Item Application Trends in Pulmonary and Critical Care Medicine Fellowships(American Thoracic Society, 2022-09-30) Allen, Duane; Bosslet, Gabriel; Medicine, School of MedicineItem Indwelling Pleural Catheters in Hepatic Hydrothorax: A Single-Center Series of Outcomes and Complications(Elsevier, 2018) Kniese, Christopher; Diab, Khalil; Ghabril, Marwan; Bosslet, Gabriel; Medicine, School of MedicineBackground Treatment of hepatic hydrothorax (HH) generally involves sodium restriction, diuretics, and serial thoracentesis. In more advanced cases, transjugular intrahepatic portosystemic shunt and liver transplantation may be required. Previously, indwelling tube drainage has been avoided due to concerns regarding high complication rates and overall poor outcomes. Recently, indwelling pleural catheters (IPCs) have been proposed as a novel treatment option for HH. Methods This study was a retrospective review of patients who had undergone IPC placement for HH over a 10-year period at a large liver transplant referral center. We tracked outcomes, including complication rates and liver transplantation, as well as biomarkers of nutritional status. Results Sixty-two patients underwent IPC placement between 2007 and 2017, with 33 IPCs (53%) placed as a bridge to liver transplantation. Complications were recorded in 22 patients (36%); empyema was the most common, diagnosed in 10 patients (16.1%). Ten patients evaluated for liver transplantation underwent successful transplantation following IPC placement. There were statistically significant decreases in both BMI and serum albumin levels following IPC placement. Conclusions IPCs represent a potential treatment for refractory HH and should be used with caution in patients eligible for liver transplantation. Ideally, IPC use for these patients would be evaluated by a multidisciplinary team. IPC use may lead to small decreases in BMI and serum albumin levels in patients over time.Item Mortality Rates in a Diverse Cohort of Mechanically Ventilated Patients With Novel Coronavirus in the Urban Midwest(Wolters Kluwer, 2020-08) Twigg, Homer L. III; Khan, Sikandar H.; Perkins, Anthony J.; Roberts, Scott; Sears, Catherine R.; Rahman, Omar; Smith, Joseph P.; Kapoor, Rajat; Farber, Mark O.; Ellender, Timothy; Carlos, Graham; Gilroy, Grant; Buckley, John; Bosslet, Gabriel; Machado, Roberto; Gao, Sujuan; Khan, Babar A.; Medicine, School of MedicineObjectives: Differences in mortality rates previously reported in critically ill patients with coronavirus disease 2019 have increased the need for additional data on mortality and risk factors for death. We conducted this study to describe length of stay, mortality, and risk factors associated with in-hospital mortality in mechanically ventilated patients with coronavirus disease 2019. Design: Observational study. Setting: Two urban, academic referral hospitals in Indianapolis, Indiana. Patients or Subjects: Participants were critically ill patients 18 years old and older, admitted with coronavirus disease 2019 between March 1, 2020, and April 27, 2020. Interventions: None. Measurements and Main Results: Outcomes included in-hospital mortality, duration of mechanical ventilation, and length of stay. A total of 242 patients were included with mean age of 59.6 years (sd, 15.5 yr), 41.7% female and 45% African American. Mortality in the overall cohort was 19.8% and 20.5% in the mechanically ventilated subset. Patients who died were older compared with those that survived (deceased: mean age, 72.8 yr [sd, 10.6 yr] vs patients discharged alive: 54.3 yr [sd, 14.8 yr]; p < 0.001 vs still hospitalized: 59.5 yr [sd, 14.4 yr]; p < 0.001) and had more comorbidities compared with those that survived (deceased: 2 [0.5–3] vs survived: 1 [interquartile range, 0–1]; p = 0.001 vs still hospitalized: 1 [interquartile range, 0–2]; p = 0.015). Older age and end-stage renal disease were associated with increased hazard of in-hospital mortality: age 65–74 years (hazard ratio, 3.1 yr; 95% CI, 1.2–7.9 yr), age 75+ (hazard ratio, 4.1 yr; 95% CI, 1.6–10.5 yr), and end-stage renal disease (hazard ratio, 5.9 yr; 95% CI, 1.3–26.9 yr). The overall median duration of mechanical ventilation was 9.3 days (interquartile range, 5.7–13.7 d), and median ICU length of stay in those that died was 8.7 days (interquartile range, 4.0–14.9 d), compared with 9.2 days (interquartile range, 4.0–14.0 d) in those discharged alive, and 12.7 days (interquartile range, 7.2–20.3 d) in those still remaining hospitalized. Conclusions: We found mortality rates in mechanically ventilated patients with coronavirus disease 2019 to be lower than some previously reported with longer lengths of stay.Item Op/Ed: Indiana abortion law won't improve health for Hoosiers, but will increase obstacles(The Indianapolis Star, 2022-08-05) Levine Daniel, Jamie; Bosslet, Gabriel; Zee-Cheng, JanineThe Indiana Senate passed Senate Bill 1 on Saturday (July 30, 2022), which will ban abortion in Indiana. The House is set to vote on it this week. A close examination of the bill and the fate of amendments proposed in the Senate’s legislative process demonstrate that this process does not appear to be motivated by improving health outcomes for Hoosiers, limiting the number of abortions in the state or representing the will of the majority of Hoosiers.Item Op/Ed: Marion County health agency's SCOTUS case could end protections for most vulnerable(The Indianapolis Star, 2022-11-06) Hartsock, Jane; Bosslet, Gabriel; Levine Daniel, JamieThe Health & Hospital Corp. (HHC) v. Talevski case arises out of allegations that Gorgi Talevski, a disabled person with dementia who resided at a long-term care facility owned by HHC, was kept in physical restraints in violation of a federal law ― the Federal Nursing Home Reform Act (FNHRA). HHC has responded not only that its use of restraints did not violate the FNHRA, but Talevski’s wife Ivanka (who is bringing the lawsuit on behalf of the estate of her now deceased husband) should not be able to sue at all. HHC goes so far as to argue the Supreme Court should overturn two existing rulings, which would mean that Talevski and other disabled patients would not be able to sue at all under the act. This request, if granted, would result in extraordinary damage to the rights, health and welfare of Hoosiers — and of all vulnerable Americans.Item Twelve Tips for Just in Time Teaching of Communication Skills for Difficult Conversations in the Clinical Setting(Taylor & Francis, 2017) Hinkle, Laura; Fettig, Lyle; Carlos, W. Graham; Bosslet, Gabriel; Medicine, School of MedicineThe ability to communicate well with patients and other members of the healthcare team is a vital skill for physicians to have, but one that is often not emphasized in medical education. Learners of all levels can obtain and develop good communication skills regardless of their natural ability in this area, and the clinical setting represents an underutilized resource to accomplish this task. With this in mind, we have reviewed the growing body of literature on the subject and organized our findings into twelve tips to help educators capitalize on these missed opportunities. While our emphasis is helping learners with difficult discussions, these tips can be easily adapted to any other clinical encounter requiring clear communication. Teaching effective communication skills in the clinical setting requires some extra time, but the steps outlined should not take more than a few minutes to complete. Taking the time to develop these skills in our learners will make a significant difference not only their lives but also their patients and their families.Item What Do Program Directors Value in Personal Statements? A Qualitative Analysis(American Thoracic Society, 2020-02-21) Hinkle, Laura; Carlos, W. Graham; Burkart, Kristin M.; McCallister, Jennifer; Bosslet, Gabriel; Medicine, School of MedicineBackground: All applicants to accredited training programs must write a personal statement as part of the application process. This may provoke anxiety on the part of the applicant and can result in an impersonal product that does not enhance his or her application. Little has been written about what program directors are seeking in personal statements. Objective: To gain a better understanding of how pulmonary and critical care fellowship program directors view and interpret these essays and to help applicants create more effective personal statements and make the writing process less stressful. Methods: We surveyed the membership of the Association of Pulmonary and Critical Care Medicine Program Directors in 2018. Quantitative data were collected regarding the importance of the personal statement in the candidate selection process. Qualitative data exploring the characteristics of personal statements, what the personal statement reveals about applicants, and advice for writing them were also collected. Comparative analysis was used for coding and analysis of qualitative data. Results: Surveys were completed by 114 out of 344 possible respondents (33%). More than half of the respondents believed that the personal statement is at least moderately important when deciding to offer an interview, and 40% believed it is at least moderately important when deciding rank order. A qualitative analysis revealed consistent themes: communication skills, provision of information not found elsewhere, applicant characteristics, and things to avoid. Conclusion: The respondents view the personal statement as moderately important in the application process. They value succinct, quality writing that reveals personal details not noted elsewhere. The information presented may help reduce anxiety associated with writing the personal statement and result in making the personal statement a more meaningful part of the application.