bluuebunny/crossref_metadata_2025 huggingface dataset:
Adenomatoid tumor of the adrenal gland: unexpected guest
Authors: Al-Maghrabi Haneen , Al-Maghrabi Jaudah
Published: March 2024

Adenomatoid tumor (AT) is a benign growth that originates from mesothelial cells. Typically, it encompasses the uterus, fallopian tubes, and paratesticular area. One-third of all AT is in paratesticular area, and it accounts for 60% of all benign paratesticular tumors. ATs have been seldom reported as a case report in adrenal gland, liver, pleura, and mediastinal cavity. To date, English literature has only documented 46 instances of adrenal AT. We present the occurrence of a new clinically unexpected case of adrenal AT in a 37-year-old male patient. Computed tomography (CT scan) incidentally revealed the presence of a tumor. To the best of our knowledge, this is the first reported instance of primary adrenal gland AT reported in Saudi Arabia and the 47th instance worldwide in the English-based published literature. It is crucial to thoroughly investigate these tumors, utilizing techniques such as histopathological analysis and immunohistochemical staining to correctly diagnose AT.
Apolipoprotein A-IV and its derived peptide, T55−121, improve glycemic control and increase energy expenditure
Authors: Cao Zhen , Lei Lei , Zhou Ziyun , Xu Shimeng , Wang Linlin , Gong Weikang , Zhang Qi , Pan Bin , Zhang Gaoxin , Yuan Quan , Cui Liujuan , Zheng Min , Xu Tao , Wang You , Zhang Shuyan , Liu Pingsheng
Published: March 2024

It is crucial to understand the glucose control within our bodies. Bariatric/metabolic surgeries, including laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB), provide an avenue for exploring the potential key factors involved in maintaining glucose homeostasis since these surgeries have shown promising results in improving glycemic control among patients with severe type 2 diabetes (T2D). For the first time, a markedly altered population of serum proteins in patients after LSG was discovered and analyzed through proteomics. Apolipoprotein A-IV (apoA-IV) was revealed to be increased dramatically in diabetic obese patients following LSG, and a similar effect was observed in patients after RYGB surgery. Moreover, recombinant apoA-IV protein treatment was proven to enhance insulin secretion in isolated human islets. These results showed that apoA-IV may play a crucial role in glycemic control in humans, potentially through enhancing insulin secretion in human islets. ApoA-IV was further shown to enhance energy expenditure and improve glucose tolerance in diabetic rodents, through stimulating glucose-dependent insulin secretion in pancreatic β cells, partially via Gαs-coupled GPCR/cAMP (G protein-coupled receptor/cyclic adenosine monophosphate) signaling. Furthermore, T55−121, truncated peptide 55−121 of apoA-IV, was discovered to mediate the function of apoA-IV. These collective findings contribute to our understanding of the relationship between apoA-IV and glycemic control, highlighting its potential as a biomarker or therapeutic target in managing and improving glucose regulation.
“Electronic Phenotyping” Antimicrobials to Facilitate Outpatient Stewardship for Asymptomatic Bacteriuria and Urinary Tract Infection in Renal Transplant
Authors: Zimmet Alex N , Ha David , Mui Emily , Smith Mary , Hawkins Marten , Alegria William , Holubar Marisa
Published: March 2024

Asymptomatic bacteriuria and urinary tract infection in renal transplant are important antimicrobial stewardship targets but are difficult to identify within electronic medical records. We validated an “electronic phenotype” of antibacterials prescribed for these indications. This may be more useful than billing data in assessing antibiotic indication in this outpatient setting.
Emerging Tick-borne Infections in the Upper Midwest and Northeast United States Among Patients With Suspected Anaplasmosis
Authors: Reller Megan E , Clemens Emily G , Bakken Johan S , Dumler J Stephen
Published: March 2024

Background

Emerging tick-transmitted illnesses are increasingly recognized in the United States (US). To identify multiple potential tick-borne pathogens in patients from the Upper Midwest and Northeast US with suspected anaplasmosis, we used state-of-the-art methods (polymerase chain reaction [PCR] and paired serology) to test samples from patients in whom anaplasmosis had been excluded.

Methods

Five hundred sixty-eight patients without anaplasmosis had optimal samples available for confirmation of alternative tick-borne pathogens, including PCR and/or paired serology (acute-convalescent interval ≤42 days).

Results

Among 266 paired serology evaluations, for which the median acute-convalescent sampling interval was 28 (interquartile range, 21–33) days, we identified 35 acute/recent infections (24 [9%] Borrelia burgdorferi; 6 [2%] Ehrlichia chaffeensis/Ehrlichia muris subsp eauclairensis [EC/EME]; 3 [1%] spotted fever group rickettsioses [SFGR], and 2 [<1%] Babesia microti) in 33 (12%) patients. Two had concurrent or closely sequential infections (1 B burgdorferi and EC/EME, and 1 B burgdorferi and SFGR). Using multiplex PCR and reverse-transcription PCR, we identified 7 acute infections (5/334 [1%] Borrelia miyamotoi and 2/334 [1%] B microti) in 5 (1%) patients, including 2 with B microti–B miyamotoi coinfection, but no Borrelia mayonii, SFGR, Candidatus Anaplasma capra, Heartland virus, or Powassan virus infections. Thus, among 568 patients with ruled-out anaplasmosis, 38 (6.7%) had ≥1 agent of tick-borne illness identified, with 33 patients (35 infections) diagnosed by paired serology and 5 additional patients (7 infections) by PCR.

Conclusions

By identifying other tick-borne agents in patients in whom anaplasmosis had been excluded, we demonstrate that emerging tick-borne infections will be identified if specifically sought.
Equity Return Predictability with the ICAPM
Authors: Hasler Michael , Martineau Charles
Published: March 2024

This paper highlights a positive and significant beta-return relationship in high expected market return states, as suggested by the ICAPM. The ICAPM has strong out-of-sample predictive power for equity returns. As a result, timing strategies exploiting this predictive power have Sharpe ratios about double those of the buy-and-hold strategies, alphas of about 5% per annum, and average returns increasing sharply with unconditional betas. Our findings relate to the positive beta-return relation uncovered overnight, on macroeconomic announcement days, and in low inflation times because these periods share an important common feature: high market returns. (JEL D53, G11, G12)
Machine learning–driven immunophenotypic stratification of mixed connective tissue disease, corroborating the clinical heterogeneity
Authors: Izuka Shinji , Komai Toshihiko , Itamiya Takahiro , Ota Mineto , Nagafuchi Yasuo , Shoda Hirofumi , Matsuki Kosuke , Yamamoto Kazuhiko , Okamura Tomohisa , Fujio Keishi
Published: March 2024

Objective

The objective of this study was to stratify patients with MCTD, based on their immunophenotype.

Methods

We analysed the immunophenotype and transcriptome of 24 immune cell subsets [from patients with MCTD, SLE, idiopathic inflammatory myopathy (IIM) and SSc] from our functional genome database, ImmuNexUT (https://www.immunexut.org/). MCTD patients were stratified by employing machine-learning models, including Random Forest, trained by immunophenotyping data from SLE, IIM and SSc patients. The transcriptomes were analysed with gene set variation analysis (GSVA), and the clinical features of the MCTD subgroups were compared.

Results

This study included 215 patients, including 22 patients with MCTD. Machine-learning models, constructed to classify SLE, IIM and SSc patients, based on immunophenotyping, were applied to MCTD patients, resulting in 16 patients being classified as having an SLEimmunophenotype and 6 as having a non-SLE immunophenotype. Among the MCTD patients, patients with the SLE immunophenotype had higher proportions of Th1 cells {2.85% [interquartile range (IQR) 1.54–3.91] vs 1.33% (IQR 0.99–1.74) P = 0.027} and plasmablasts [6.35% (IQR 4.17–17.49) vs 2.00% (IQR 1.20–2.80) P = 0.010]. Notably, the number of SLE-related symptoms was higher in patients with the SLE immunophenotype [2.0 (IQR 1.0–2.0) vs 1.0 (IQR 1.0–1.0) P = 0.038]. Moreover, the GSVA scores of interferon-α and -γ responses were significantly higher in patients with the SLE immunophenotype in central memory CD8+ T cells, while hedgehog signalling was higher in patients with the non-SLE immunophenotype, in five-cell subsets.

Conclusion

This study describes the stratification of MCTD patients, based on immunophenotyping, suggesting the presence of distinct immunological processes behind the clinical subtypes of MCTD.
Assessing the sensitivity and specificity of myositis-specific and associated autoantibodies: a sub-study from the MyoCite cohort
Authors: Loganathan Aravinthan , Gupta Latika , Rudge Alex , Lu Hui , Bowler Elizabeth , McMorrow Fionnuala , Naveen R , Anuja Anamika K , Agarwal Vikas , McHugh Neil , Tansley Sarah
Published: March 2024

Objectives

Myositis-specific and associated autoantibodies are important biomarkers in routine clinical use. We assessed local testing performance for myositis autoantibodies by comparing line immunoassay (LIA) to protein radio-immunoprecipitation and identifying clinical characteristics associated with each myositis autoantibody in the MyoCite cohort.

Methods

Serum samples from patients within the MyoCite cohort, a well-characterized retro-prospective dataset of adult and juvenile idiopathic inflammatory myopathy (IIM) patients in Lucknow, India (2017–2020), underwent LIA at Sanjay Gandhi Postgraduate Institute of Medical Science (SGPGIMS), Lucknow. Immunoprecipitation of 147 IIM patients’ serum samples (125 adult-onset, 22 juvenile-onset) was conducted at the University of Bath, with researchers blind to LIA results. LIA performance was assessed against immunoprecipitation as the reference standard, measuring sensitivity, specificity and inter-rater agreement. Univariate and multivariate logistic regression determined clinical associations for specific myositis-specific autoantibodies.

Results

Immunoprecipitation identified myositis autoantibodies in 56.5% (n = 83) of patient samples, with anti-Jo1 (n = 16; 10.9%) as the most common, followed by anti-MDA5 (n = 14, 9.5%). While LIA showed good agreement for anti-Jo1, anti-PL7 and anti-PL12 (Cohen's κ 0.79, 0.83 and 1, respectively), poor agreement was observed in other subgroups, notably anti-TIF1γ (Cohen's κ 0.21). Strongly positive samples, especially in myositis-specific autoantibodies, correlated more with immunoprecipitation results. Overall, 59 (40.1%) samples exhibited non-congruence on LIA and immunoprecipitation, and κ values for LIAs for anti-TIF1γ, anti-Ku, anti-PmScl, anti-Mi2 and anti-SAE ranged between 0.21 and 0.60.

Conclusion

While LIA reliably detected anti-Jo1, anti-PL7, anti-PL12, anti-MDA5 and anti-NXP-2, it also displayed false positives and negatives. Its effectiveness in detecting other autoantibodies, such as anti-TIF1γ, was poor.
An ERP investigation of electrocortical responses in pain empathy from childhood through adolescence into adulthood
Authors: Wu Xiangci , Jia Huibin , Zhao Kaibin , Wang Enguo , Li Yongxin
Published: March 2024

Only a few studies investigated the neurodevelopment of pain empathy. Here, the temporal dynamics of electrocortical processes in pain empathy during individual neurodevelopment from childhood through adolescence into adulthood, along with the moderation effect of top-down attention, were investigated using the event-related potential (ERP) technique. To investigate the role of top-down attention in empathy development, both A-P task and A-N task were conducted. In the A-P and A-N task, participants are instructed to judge whether the models in pictures were painful or non-painful and count the number of limbs in pictures, respectively. We found that compared to the adolescent and adult groups, the children group responded significantly worse, along with stronger neural responses in both tasks. Compared to the adolescent and adult groups, the differential amplitudes between painful and non-painful conditions of P2, N2 and P3 were significantly larger in the children group. Moreover, this P3 differential amplitude could only be modulated by age in the A-P task. These results suggest that the capacity to empathize has not yet attained complete development in these children. Significantly more attention resources were involuntarily attracted by the nociceptive cues in these children, which could also reflect the immaturity of empathy ability in these children.
Examining present beneficiaries’ requests for trust information and ascertaining what is “reasonable” through consideration of the common law and industry practice
Authors: Kelleher William M , Quinn Abigail
Published: March 2024

It is often a challenge for trustees to determine to what information a requesting present beneficiary is entitled. While the weight of the sources indicates that the trust instrument and statements of trust assets should be provided, what those statements must include and what types of other information must be provided remains a grey area. Still, trustees can find some guidance in case law and commonsense practices.
Global Health Competencies of Undergraduate Nursing Students in Jordan
Authors: Abunab Hamzeh Yousef , Mrayyan Majd T. , Alfayoumi Imad , Algunmeeyn Abdullah , Alzaatreh Mohammad Y.
Published: March 2024

This study aimed to assess and compare the global health competencies (GHCs) of nursing students in Jordan. GHCs are crucial to ensure the delivery of culturally sensitive care to diverse populations. A cross-sectional survey using the GHC questionnaire was administered to 256 nursing students. Students ranked their ability in health implications of migration, travel, and displacement as the highest domain and health care as a human right and development resources as the lowest. Assessing nursing students’ GHCs is important as they pursue their responsibilities toward global health in the future.
Pemafibrate and other triglyceride-lowering therapies to reduce risk of cardiovascular and metabolic disease
Authors: Miller Michael
Published: March 2024

Purpose of review

Although high triglycerides are consistently associated with elevated risk of cardiovascular disease (CVD), therapies that reduce triglyceride levels have inconsistently translated into reduced CVD risk.

Recent findings

To date, three clinical trials have tested triglyceride-lowering therapies in patients with hypertriglyceridemia (HTG) and elevated risk of incident/recurrent CVD. In REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), assignment to IPE, a highly purified eicosapentanoic acid (EPA), resulted in a 25% reduction in nonfatal myocardial infarction), nonfatal stroke, cardiovascular death, coronary revascularization and hospitalization for unstable angina. By contrast, the combination of EPA and docosahexanoic acid (DHA) carboxylic fatty acids used in the STRENGTH trial (Statin Residual Risk With Epanova in High Cardiovascular Risk Patients With Hypertriglyceridemia) failed to reduce CVD risk. Most recently, PROMINENT (Pemafibrate to Reduce Cardiovascular Outcomes by Reducing Triglycerides in Patients with Diabetes) also failed to demonstrate reduction in CVD events despite use of a potent triglyceride-lowering, fibric-acid derivative. However, improvement in HTG-associated metabolic complications (e.g. nonalcoholic fatty liver disease) was observed with pemafibrate as well as with another potent triglyceride-lowering therapy (i.e. pegozafermin). Moreover, trials are underway evaluating whether the most fatal metabolic complication of HTG, pancreatitis, may be reduced with highly potent triglyceride-lowering therapies (e.g. apolipoprotein C3 inhibitors).

Taken together, HTG is associated with increased risk of CVD and attendant adverse metabolic sequalae. To this end, a potentially promising and evidence-based landscape is emerging for treating a clinical phenotype that in the past has been insufficiently addressed.
The Effects of Repetitive Head Impact Exposure on Mental Health Symptoms Following Traumatic Brain Injury
Authors: de Souza Nicola L. , Bogner Jennifer , Corrigan John D. , Rabinowitz Amanda R. , Walker William C. , Kumar Raj G. , Dams-O’Connor Kristen
Published: March 2024

Objective:

This study aimed to characterize the types and timing of repetitive head impact (RHI) exposures in individuals with moderate to severe traumatic brain injury (TBI) and to examine the effects of RHI exposures on mental health outcomes.

Setting:

TBI Model Systems National Database.

Participants:

447 patients with moderate to severe TBI who reported RHI exposure between 2015 and 2022.

Design:

Secondary data analysis.

Main Measures:

RHI exposures reported on the Ohio State University TBI Identification Method (OSU TBI-ID) were characterized by exposure category, duration, and timing relative to the index TBI. Mental health outcomes were evaluated at the 5-year follow-up assessment using the Patient Health Questionnaire-9 (PHQ-9) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms.

Results:

The majority of RHI exposures were sports-related (61.1%), followed by other causes (20.8%; including falls), repetitive violence/assault (18.8%), and military exposures (6.7%). Males predominantly reported sports and military exposures, while a larger proportion of females reported violence and falls. Sports exposures were most common before the index TBI, while exposures from falls and violence/abuse were most common after TBI. RHI exposures occurring after the index TBI were associated with higher levels of depression (β = 5.05; 95% CI, 1.59-8.50) and anxiety (β = 4.53; 95% CI, 1.02-8.05) symptoms than exposures before the index TBI.

Conclusion:

The findings emphasize the need to consider RHI exposures and their interaction with TBI when assessing mental health outcomes. Understanding the prevalence and challenges associated with RHI post-TBI can inform targeted interventions and improve the well-being of individuals with TBI. Preventive measures and ongoing care should be implemented to address the risks posed by RHI, particularly in individuals with prior TBI, especially surrounding fall and violence/abuse prevention.
SAFETY AND EFFICACY OF PHOTODYNAMIC THERAPY WITH CHLORIN E6 IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY
Authors: Maltsev Dmitrii S. , Kulikov Alexei N. , Vasiliev Alexander S. , Chhablani Jay
Published: March 2024

Purpose:

To evaluate the efficacy and safety of photodynamic therapy (PDT) with chlorin E6 in chronic central serous chorioretinopathy.

Methods:

In this single-center retrospective cohort study, all patients received standard PDT with 6 mg of chlorin E6 (Fotoran E6) for each m2 of body surface area with 50 J/cm2 fluence and a treatment time of 83 seconds. The changes in central retinal thickness, subfoveal choroidal thickness, and best-corrected visual acuity were evaluated at the end of the follow-up. The main outcome measure was the presence of subretinal fluid at 3 months after PDT.

Results:

Thirty-nine eyes (32 men and 7 women, 43.7 ± 10.0 years) were included. In total, 50 PDT sessions were performed. At 3 months of follow-up, 31 of 39 (79.5%) study eyes showed complete resolution of subretinal fluid. The mean follow-up period after PDT was 15.3 ± 7.8 months. At the end of the follow-up, a complete resolution of subretinal fluid was observed in 32 of 39 (82.7%) eyes. The mean change in central retinal thickness, subfoveal choroidal thickness, and best-corrected visual acuity at the end of the follow-up was −139.7 ± 136.4 µm, −66.8 ± 36.2 µm, and −0.05 ± 0.08 logMAR, respectively (P < 0.001). Neither systemic nor ocular adverse events were observed, nor were local reactions seen.

Conclusion:

Standard PDT with chlorin E6 is an effective and safe option in the management of chronic central serous chorioretinopathy and may be considered as an alternative to the standard PDT with Visudyne.
Repeatability of pyramidal aberrometer measurements in keratoconus and normal eyes
Authors: Ibrahim Perla , Assaf Jad F. , Bejjani Romy , Torbey Julien , Yehia Madeleine , Bahir Al-Ulloom Saleh , Awwad Shady T.
Published: March 2024

Purpose:

To evaluate the intrasubject repeatability of pyramidal aberrometer measurements in a sample of keratoconus and normal eyes.

Setting:

American University of Beirut Medical Center, Beirut, Lebanon.

Design:

Prospective comparative repeatability analysis.

Methods:

Study population: Keratoconus and normal eyes from adult patients. Observation procedures: Each eye was evaluated with 3 consecutive acquisitions using a pyramidal aberrometer. Main outcome measures: The repeatability of different ocular higher-order aberrations and lower-order aberrations (HOAs and LOAs, respectively), and Zernike coefficients down to the fifth order, was evaluated. Repeatability was assessed by within-subject SDs (Sw), repeatability limits (r), and intraclass correlation coefficients (ICCs), among other parameters.

Results:

72 keratoconus patients (72 eyes) and 76 normal patients (76 eyes) were included. In normal and keratoconus eyes, the ICC of total LOAs and HOAs, as well as each of the Zernike coefficients, was >0.9. The Sw for keratoconus eyes with mean maximal keratometry (Kmax) <50 diopters (D) was 0.1345 for total LOAs, 0.0619 for total HOAs, 0.0292 for horizontal coma, 0.0561 for vertical coma, and 0.0221 for spherical aberration as compared with 0.2696, 0.1486, 0.0972, 0.1497, and 0.0757 for keratoconus eyes with Kmax ≥50 D. Similar trend of better repeatability for grade 1 keratoconus and HOAs <2 D as compared with grades 2 and 3 keratoconus and eyes with HOAs >2 D were also noted.

Conclusions:

Ocular aberrometer measurements generated by high definition pyramidal aberrometers have high repeatability in both normal and mild keratoconus eyes and moderate repeatability, yet still clinically acceptable, in advanced keratoconus. This is of particular importance in ocular wavefront-guided treatments.
Surgical quality assessment for the prospective study of oncologic outcomes after laparoscopic modified complete mesocolic excision for nonmetastatic right colon cancer (PIONEER study)
Authors: Yang Seung Yoon , Kim Min Jung , Kye Bong-Hyeon , Han Yoon Dae , Cho Min Soo , Park Ji Won , Jeong Seung-Yong , Song Seung Ho , Park Jun Seok , Park Soo Yeun , Kim Jin , Min Byung Soh
Published: March 2024

Background:

The modified complete mesocolic excision (mCME) procedure for right-sided colon cancer is a tailored approach based on the original complete mesocolic excision (CME) methodology. Limited studies evaluated the safety and feasibility of laparoscopic mCME using objective surgical quality assessments in patients with right colon cancer. The objectives of the PIONEER study were to evaluate oncologic outcomes after laparoscopic mCME and to identify optimal clinically relevant endpoints and values for standardizing laparoscopic right colon cancer surgery based on short-term outcomes of procedures performed by expert laparoscopic surgeons.

Materials and methods:

This is an ongoing prospective, multi-institutional, single-arm study conducted at five tertiary colorectal cancer centers in South Korea. Study registrants included 250 patients scheduled for laparoscopic mCME with right-sided colon adenocarcinoma (from the appendix to the proximal half of the transverse colon). The primary endpoint was 3-year disease-free survival. Secondary outcomes included 3-year overall survival, incidence of morbidity in the first 4 weeks postoperatively, completeness of mCME, central radicality, and distribution of metastatic lymph nodes. Survival data will be available after the final follow-up date (June 2024).

Results:

The postoperative complication rate was 12.9%, with a major complication rate of 2.7%. In 87% of patients, central radicality was achieved with dissection at or beyond the level of complete exposure of the superior mesenteric vein. Mesocolic plane resection with an intact mesocolon was achieved in 75.9% of patients, as assessed through photographs. Metastatic lymph node distribution varied by tumor location and extent. Seven optimal clinically relevant endpoints and values were identified based on the analysis of complications in low-risk patients.

Conclusions:

Laparoscopic mCME for right-sided colon cancer produced favorable short-term postoperative outcomes. The identified optimal clinically relevant endpoints and values can serve as a reference for evaluating surgical performance of this procedure.
So You Want to Do Trauma Research? A Practical Guide to Creating a Research Program at Your Home Institution
Authors: Larson Nicholas J. , Altamirano Heidi M. , Dries David J. , Blondeau Benoit , Rogers Frederick B.
Published: March 2024

BACKGROUND:

There are 3 pillars upon which the foundation of a teaching program in health care is founded: research, education, and clinical care. However, in a busy academic trauma practice, the unfortunate reality is that research is often a low priority in the frenzy of mandates for clinical productivity.

OBJECTIVE:

The purpose of this report is to advise hospitals on how to create a modest trauma research program that supports research interests without significantly impacting the overall clinical productivity of the department.

METHODS:

Relevant literature related to the development of an academic trauma research department was reviewed. Relevant articles were then compared to this manuscript to assess the novelty of the topic.

RESULTS:

There are 4 essential components of a trauma research program: (1) a zealot, (2) institutional commitment and support, (3) a statistician, and (4) registry data access.

CONCLUSION:

The creation of a trauma research program may seem like a herculean effort, but this work is necessary for institutions hoping to achieve status as a Level I/II trauma center. Following the steps outlined in this report, trauma providers can create a robust research program at their institution without sacrificing clinical productivity.
Trauma Registry Professionals’ Perspectives on the Secondary Traumatic Stress Component of Compassion Fatigue: A Qualitative Study
Authors: Truelove Amanda L. , Arcipowski Erin , Herndon Michele , McCormack Jane , Steurer Lisa M. , Broeder Jennifer Lee , Newcomb Anna B.
Published: March 2024

BACKGROUND:

Secondary traumatic stress and compassion fatigue have been studied among trauma clinicians yet have not been explored in trauma registry professionals (TRPs).

OBJECTIVE:

The purpose of this study is to describe the secondary traumatic stress component of compassion fatigue among TRPs.

METHODS:

A qualitative, phenomenological study was conducted to examine TRPs’ experiences with the secondary traumatic stress component of compassion fatigue. The primary investigator assembled a multidisciplinary team of researchers, including nursing leadership, registry educators, mental health experts, and qualitative researchers. Two focus groups were held virtually in January 2021, using an interview guide designed by the research team. Participants were recruited via an email sent to a list of colleagues known to the research team from training classes held nationally and selected for their diverse clinical experiences, years in the role, demographic background, and trauma center representation. The recorded sessions were independently transcribed and analyzed by a five-member subgroup of the research team; the analysis concluded in December 2022.

RESULTS:

Nine TRPs participated in the focus groups. Participants came from Level I, II, and III adult and pediatric trauma centers and military centers. Four themes emerged from the data: disquieting and rewarding work, reactions and emotional responses, the influence of personal histories and background, and coping strategies.

CONCLUSION:

A qualitative analysis of focus group discussions revealed the secondary traumatic stress component of compassion fatigue is present in the TRP.
Traumatic Brain Injury, Psychological Trauma Exposure, and Anxious and Depressive Symptoms in a Clinical Population
Authors: Clausen Ashley N. , Meyers Katherine R. , Stamey Heather M. , Spilman Sarah K.
Published: March 2024

BACKGROUND:

Approximately 90% of adults endorse psychological trauma exposure. However, barriers to assessment of psychological trauma and sequelae include limited access to care, lack of standardized assessments in nonpsychiatric settings, and comorbid diagnoses, such as traumatic brain injury (TBI), that may mimic psychiatric syndromes.

OBJECTIVES:

This study aims to assess the prevalence rates of psychological trauma exposure and TBI to understand the relationship of these experiences with current psychiatric symptoms.

METHODS:

This is a cross-sectional study of a convenience sample of adult patients (age 18 years and older) referred for outpatient evaluation at a neuropsychology clinic in the Western United States between September 2021 and October 2022. Patients completed a clinical interview to assess their history of psychological trauma, TBI, and current psychiatric symptoms.

RESULTS:

A total of 118 patients met inclusion criteria. Patients in the TBI group (n = 83) endorsed significantly higher rates of childhood trauma and prior physical, emotional, and sexual abuse compared with the No TBI group (n = 35). Psychological trauma exposure and TBI significantly predicted current anxiety and depressive symptoms, but there was no interaction between these experiences in predicting current psychiatric symptoms.

CONCLUSIONS:

Individuals with prior TBI experienced psychological trauma, particularly childhood trauma, at a significantly higher rate than those without TBI. Psychological trauma exposure and TBI independently predicted anxious and depressive symptoms, suggesting both may be viable treatment targets. Evaluation of prior psychological trauma exposure during evaluation of TBI may provide opportunities for trauma-informed care and may allow for improved outpatient treatment planning.
Integration of Substance Use Screening Into the Electronic Health Record for Adolescent Trauma Patients: A Quality Improvement Project
Authors: Troncoso-Munoz Samantha , Davis Khalil D.
Published: March 2024

BACKGROUND:

Adolescent substance abuse is a well-acknowledged and increasing concern. Screening brief intervention and referral to treatment for alcohol and drug use in adolescent trauma is a requirement, but program implementation remains a challenge for many trauma centers.

OBJECTIVE:

This study aims to examine the effect of an integrated electronic health record screening tool and staff training on screening, brief intervention, and referral to treatment compliance in adolescent trauma.

METHODS:

This is a single-center, pre- and postintervention study of substance use screening compliance in adolescent trauma patients (age 12–21) conducted at a Level I pediatric trauma center in the Southeastern United States following the integration of the CRAFFT substance abuse screening tool into the electronic health record. The study compared 12 months of preintervention data (January 2021 through January 2022) to 15 months of postintervention data (February 2022 through May 2023).

RESULTS:

A total of N = 241 patients met inclusion criteria, of which most were male, n = 168 (69.7%), White n = 185 (76.8%), and Hispanic n = 179 (74.3%). Screening compliance increased from preintervention 81% to postintervention 92%.

CONCLUSION:

Our study demonstrates that integrating a digital screening tool into the electronic health record resulted in an average increased screening compliance of 11%.
Normothermic machine perfusion for liver transplantation: current state and future directions
Authors: Lindemann Jessica , Yu Jennifer , Doyle MB Majella
Published: March 2024

Purpose of review

The number of patients on the liver transplant waitlist continues to grow and far exceeds the number of livers available for transplantation. Normothermic machine perfusion (NMP) allows for ex-vivo perfusion under physiologic conditions with the potential to significantly increase organ yield and expand the donor pool.

Recent findings

Several studies have found increased utilization of donation after cardiac death and extended criteria brain-dead donor livers with implementation of NMP, largely due to the ability to perform viability testing during machine perfusion. Recently, proposed viability criteria include lactate clearance, maintenance of perfusate pH more than 7.2, ALT less than 6000 u/l, evidence of glucose metabolism and bile production. Optimization of liver grafts during NMP is an active area of research and includes interventions for defatting steatotic livers, preventing ischemic cholangiopathy and rejection, and minimizing ischemia reperfusion injury.

NMP has resulted in increased organ utilization from marginal donors with acceptable outcomes. The added flexibility of prolonged organ storage times has the potential to improve time constraints and transplant logistics. Further research to determine ideal viability criteria and investigate ways to optimize marginal and otherwise nontransplantable liver grafts during NMP is warranted.
Expanding MELD exceptions for colorectal liver metastasis: data and policy
Authors: Whitrock Jenna N. , Pratt Catherine G. , Shah Shimul A.
Published: March 2024

Purpose of review

While liver transplant for unresectable colorectal cancer liver metastases (CRLM) has been demonstrated to be a promising treatment in selected patients, the typically low MELD score of these patients and lack of exception points may lead to challenges in receiving a deceased donor liver for transplant.

Recent findings

Several studies have shown improved outcomes in select patients with CRLM who undergo liver transplant, and several trials are ongoing and will conclude in the next several years. MELD exception points have recently been proposed in qualifying patients with CRLM to help this group obtain more timely quality allografts. Under the current proposal, patients with CRLM would receive a score of the median MELD at transplant (MMaT) for their center minus 20 with a minimum score of 15 in cases where MMaT minus 20 would be less than 15. This would allow them to receive transplants faster without competing unnecessarily with those with greater medical need.

Giving MELD exception points to patients with colorectal cancer liver metastases in need of transplant may decrease time on the waitlist and improve outcomes for these patients.
Interfacility Referral Communication for PICU Transfer*
Authors: Thirnbeck Caitlin K. , Espinoza Elizabeth T. , Beaman Elizabeth A. , Rozen Alexis L. , Dukes Kimberly C. , Singh Hardeep , Herwaldt Loreen A. , Landrigan Christopher P. , Reisinger Heather Schacht , Cifra Christina L.
Published: March 2024

OBJECTIVES:

For patients requiring transfer to a higher level of care, excellent interfacility communication is essential. Our objective was to characterize verbal handoffs for urgent interfacility transfers of children to the PICU and compare these characteristics with known elements of high-quality intrahospital shift-to-shift handoffs.

DESIGN:

Mixed methods retrospective study of audio-recorded referral calls between referring clinicians and receiving PICU physicians for urgent interfacility PICU transfers.

SETTING:

Academic tertiary referral PICU.

PATIENTS:

Children 0–18 years old admitted to a single PICU following interfacility transfer over a 4-month period (October 2019 to January 2020).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We reviewed interfacility referral phone calls for 49 patients. Referral calls between clinicians lasted a median of 9.7 minutes (interquartile range, 6.8–14.5 min). Most referring clinicians provided information on history (96%), physical examination (94%), test results (94%), and interventions (98%). Fewer clinicians provided assessments of illness severity (87%) or code status (19%). Seventy-seven percent of referring clinicians and 6% of receiving PICU physicians stated the working diagnosis. Only 9% of PICU physicians summarized information received. Interfacility handoffs usually involved: 1) indirect references to illness severity and diagnosis rather than explicit discussions, 2) justifications for PICU admission, 3) statements communicating and addressing uncertainty, and 4) statements indicating the referring hospital’s reliance on PICU resources. Interfacility referral communication was similar to intrahospital shift-to-shift handoffs with some key differences: 1) use of contextual information for appropriate PICU triage, 2) difference in expertise between communicating clinicians, and 3) reliance of referring clinicians and PICU physicians on each other for accurate information and medical/transport guidance.

CONCLUSIONS:

Interfacility PICU referral communication shared characteristics with intrahospital shift-to-shift handoffs; however, communication did not adhere to known elements of high-quality handovers. Structured tools specific to PICU interfacility referral communication must be developed and investigated for effectiveness in improving communication and patient outcomes.
Evaluation of ChatGPT for Pelvic Floor Surgery Counseling
Authors: Johnson Colin M. , Bradley Catherine S. , Kenne Kimberly A. , Rabice Sarah , Takacs Elizabeth , Vollstedt Annah , Kowalski Joseph T.
Published: March 2024

Importance

Large language models are artificial intelligence applications that can comprehend and produce human-like text and language. ChatGPT is one such model. Recent advances have increased interest in the utility of large language models in medicine. Urogynecology counseling is complex and time-consuming. Therefore, we evaluated ChatGPT as a potential adjunct for patient counseling.

Objective

Our primary objective was to compare the accuracy and completeness of ChatGPT responses to information in standard patient counseling leaflets regarding common urogynecological procedures.

Study Design

Seven urogynecologists compared the accuracy and completeness of ChatGPT responses to standard patient leaflets using 5-point Likert scales with a score of 3 being “equally accurate” and “equally complete,” and a score of 5 being “much more accurate” and much more complete, respectively. This was repeated 3 months later to evaluate the consistency of ChatGPT. Additional analysis of the understandability and actionability was completed by 2 authors using the Patient Education Materials Assessment Tool. Analysis was primarily descriptive. First and second ChatGPT queries were compared with the Wilcoxon signed rank test.

Results

The median (interquartile range) accuracy was 3 (2–3) and completeness 3 (2–4) for the first ChatGPT query and 3 (3–3) and 4 (3–4), respectively, for the second query. Accuracy and completeness were significantly higher in the second query (P < 0.01). Understandability and actionability of ChatGPT responses were lower than the standard leaflets.

Conclusions

ChatGPT is similarly accurate and complete when compared with standard patient information leaflets for common urogynecological procedures. Large language models may be a helpful adjunct to direct patient-provider counseling. Further research to determine the efficacy and patient satisfaction of ChatGPT for patient counseling is needed.
Antibiotic Switches in Urinary Tract Infection Are Associated With Atypical Symptoms and Emergent Care
Authors: Khalfay Nuha , Murray Kristen , Shimabukuro Julianna , Chiang Jeffrey N. , Ackerman A. Lenore
Published: March 2024

Importance

Given worsening global antibiotic resistance, antimicrobial stewardship aims to use the shortest effective duration of the most narrow-spectrum, effective antibiotic for patients with specific urinary symptoms and laboratory testing consistent with urinary tract infection (UTI). Inappropriate treatment and unnecessary antibiotic switching for UTIs harms patients in a multitude of ways.

Objective

This study sought to analyze antibiotic treatment failures as measured by antibiotic switching for treatment of UTI in emergent and ambulatory care.

Study Design

For this retrospective cohort study, 908 encounters during July 2019 bearing a diagnostic code for UTI/cystitis in a single health care system were reviewed. Urinary and microbiological testing, symptoms endorsed at presentation, and treatments prescribed were extracted from the medical record.

Results

Of 908 patients diagnosed with UTI, 64% of patients (579/908) received antibiotics, 86% of which were empiric. All patients evaluated in emergent care settings were prescribed antibiotics empirically in contrast to 71% of patients in ambulatory settings (P < 0.001). Of patients given antibiotics, 89 of 579 patients (15%, 10% of all 908 patients) were switched to alternative antibiotics within 28 days. Emergent care settings and positive urine cultures were significantly associated with increased antibiotic switching. Patients subjected to switching tended to have higher rates of presenting symptoms inconsistent with UTI.

Conclusions

Empiric treatment, particularly in an emergent care setting, was frequently inappropriate and associated with increasing rates of antibiotic switching. Given the profound potential contribution to antibiotic resistance, these findings highlight the need for improved diagnostic and prescribing accuracy for UTI.
Obesity and Reconstructive Pelvic Surgery: An ACS NSQIP Study
Authors: Ashmore Sarah , Kenton Kimberly , Das Deepanjana , Bretschneider C. Emi
Published: March 2024

Importance

Obesity is steadily increasing in the United States and is a risk factor for many medical and surgical complications. Literature is limited regarding obesity as an independent risk factor for perioperative complications after reconstructive pelvic surgery (RPS).

Objective

This study aimed to analyze the association of obesity on 30-day perioperative complications after RPS.

Study Design

This was a database study comparing perioperative complications after RPS of obese versus nonobese patients using the American College of Surgeons National Surgical Quality Improvement Program. Patients who underwent surgery for uterovaginal or vaginal vault prolapse were selected, and perioperative outcomes were compared between obese and nonobese patients. Obesity was defined as a body mass index ≥30 (calculated as weight in kilograms divided by height in meters squared).

Results

A total of 13,302 patients met the inclusion criteria and were included in this study; 4,815 patients were obese, whereas 8,487 were nonobese. The overall rate of any 30-day postoperative complication was 6.8%, and the rate of complications did not differ between groups. Superficial and organ space surgical site infections were significantly higher in the obese cohort, whereas nonobese patients were more likely to receive a blood transfusion. A multivariable logistic regression model was performed with variables that were statistically significant on bivariate analysis and deemed clinically significant. Variables included obesity, age, American Society of Anesthesiologists class, current smoker, diabetes, hypertension, operative time, colpopexy, and obliterative procedure. After controlling for potential confounding factors, obesity was not associated with any 30-day postoperative complications after pelvic organ prolapse surgery.

Conclusion

Obesity was not associated with 30-day postoperative complications after RPS after controlling for possible confounding variables.
No-Show Rates in a Urogynecology Clinic
Authors: Melnyk Alexandra I. , Pollard Aja , Matten Nathan , Napoe Gnankang Sarah
Published: March 2024

Importance

No-show appointments, or scheduled appointments that patients do not attend without giving notice of cancellation, are a prevalent problem in the outpatient setting.

Objective

The objective of this study was to compare the proportion of patients by decades of life who “no-show” to their urogynecology appointments.

Study Design

This retrospective cohort included women 20 years and older who did not show to their urogynecologic clinical encounters at an academic practice between January 1, 2022, and December 31, 2022. Demographics and visit history were recorded. The primary outcome was the proportion of patients by decade of age who were a “no-show” to their appointments. All decades were compared with women in their 70s, the decade with the most patients seen. Secondary outcomes included descriptive data of patients. Descriptive statistics and χ2 analyses were used.

Results

The cohort of 450 no-show encounters (composed of 391 patients), out of 6729 encounters, demonstrated an overall no-show rate of 6.7%. Baseline demographics of “no-show” patients were 67.3% White and 27.4% Black. The odds of women in their 20s–50s who no-show was 2–3 times higher than women in their 70s (P < 0.01). The highest no-show rates occurred in 20s (12.6%) and 40s (11.8%). Forty-six patients missed multiple appointments. The odds of a Black patient having multiple no-shows was 3.15 times higher than the odds of a White patient.

Conclusions

No-show rates are low in this urogynecology practice. Younger women are more likely to no-show. This knowledge can facilitate potential double bookings necessary for urgent appointments and to maximize resource utilization.
Impact of the Duration of the Second Stage of Labor on Postpartum Pelvic Floor Symptoms
Authors: McKenzie Collin M. , Woolfolk Candice L. , Rieger Mary M. , White Amanda B. , Tuuli Methodius G. , Srinivas Sindhu K. , Caughey Aaron B. , Tita Alan , Gregory W. Thomas , Richter Holly E. , Cahill Alison G.
Published: March 2024

Importance

The associated effect of duration of the second stage of labor (SSL) on pelvic floor symptoms development is not well studied.

Objective

This study aimed to examine the association between duration of SSL and pelvic floor symptoms at 6 months postpartum among primiparous women.

Study Design

A planned secondary analysis of a multicenter randomized trial evaluating the impact of immediate versus delayed pushing on vaginal delivery rates, maternal morbidity, and neonatal outcomes was conducted between 2014 and 2018. For pelvic floor arm participants, demographic, pelvic examination, and validated questionnaire data were collected postpartum. Primary outcome was change in Pelvic Floor Distress Inventory 20 (PFDI-20) score from immediate to 6 months postpartum. Secondary outcomes included changes in the Pelvic Floor Impact Questionnaire, Fecal Incontinence Severity Index, Modified Manchester Health Questionnaire scores, and Pelvic Organ Prolapse Quantification measurements at 6 months postpartum. Participants were analyzed by SSL duration ≤60 minutes or >60 minutes.

Results

Of the 2,414 trial participants, 767 (32%) completed pelvic floor assessments at 6 months. Pelvic Floor Distress Inventory 20 scores significantly improved at 6 months in the ≤60 minutes SSL group compared with >60 minutes SSL (−14.3 ± 48.0 and −3.2 ± 45.3, respectively; P = 0.04). Changes from immediate postpartum in total and subscale scores for other questionnaires at 6 months did not differ between groups. Prolapse stage did not differ between groups. Perineal body was significantly shorter in the >60 minutes SSL group (3.7 ± 0.7, 3.5 ± 0.8; P = 0.03).

Conclusions

Women with SSL >60 minutes experience less improvement in PFDI-20 scores at 6 months. Greater tissue and innervation trauma in those with SSL >60 minutes may explain persistently less improvement in PFDI-20 scores.