bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-treatment Efficacy and Safety Follow-up in Women with Uterine Fibroids Treated for 52 Weeks With Linzagolix [A108]
Authors: Taylor Hugh S. , Donnez Jacques , Bestel Elke , Humberstone Andrew , Garner Elizabeth
Published: June 2022

INTRODUCTION:

We previously reported safety and efficacy results from the PRIMROSE 1 and 2 trials of linzagolix in the treatment of women with heavy menstrual bleeding associated with uterine fibroids (UFs), which showed maintenance of treatment effect for up to 52 weeks of dosing. Here we report post-treatment follow-up of key efficacy and safety results from weeks 64 and 76.

METHODS:

PRIMROSE1 and PRIMROSE2 were two randomized, double-blind, placebo-controlled phase 3 trials investigating the efficacy and safety of linzagolix 100 mg and 200 mg once daily, with or without hormonal add-back therapy (ABT) in the treatment of UFs for 52 weeks. Participants were followed for up to 6 months (week 76) after completion of treatment.

RESULTS:

At week 64, improvements in pain, hemoglobin, health-related quality of life, and uterine and fibroid volumes, observed at 24 and 52 weeks, were diminished but a beneficial difference from baseline was maintained. In patients with amenorrhea at week 52, the median (95% CI) time to first uterine bleeding was 30 (SD 27; SD 32) and 31 (SD 29; SD 32) days in PRIMROSE 1 and 2, respectively. At week 76, participants had full or partial recovery of lumbar spine bone mineral density (BMD): with 53%, 52% and 64% for 100 mg, 100 mg+ABT and 200 mg+ABT, respectively in PRIMROSE1 and 59%, 80% and 67% in PRIMROSE2.

CONCLUSION:

Linzagolix effects persisted following treatment discontinuation, although there was partial return to baseline for all measured efficacy endpoints. BMD also improved. The return to menstruation was rapid.
Disparities in HPV Vaccination Among Young Women From the 2017-2019 National Survey of Family Growth [A110]
Authors: Cahoon Sigita , Sriprasert Intira , Nguyen Brian
Published: June 2022

INTRODUCTION:

While human papillomavirus (HPV) vaccination is recommended for all individuals through age 26, uptake remains limited. As minorities are disproportionately affected by cervical cancer, characterizing HPV vaccination disparities among young women is necessary to guide prevention of HPV.

METHODS:

We analyzed weighted survey data from young female respondents (aged 15-25 years) from the 2017-2019 US National Survey of Family Growth (NSFG), comparing sociodemographic characteristics of HPV vaccine recipients versus unvaccinated women. We summarize self-reported probabilities of HPV vaccination in the next 12 months, examining factors linked to vaccination likelihood via bivariate analyses.

RESULTS:

Approximately half (49.9%; n=864/1786) of women reported receiving the vaccine. Among unvaccinated women, 52.1% reported being “not at all likely” to become vaccinated in the next 12 months; only 5% reported being “very likely.” Hispanic (41.4%) and non-Hispanic Black (43.0%) women were less likely to be vaccinated than non-Hispanic White (54.7%) women (P<.01), as were respondents who did not speak English at home (37.3% vs 51.1%, P=.02). Unvaccinated women who had never had sex were less likely to get vaccinated than women reporting prior intercourse (56.4% vs 42.9%, P=.03). HPV vaccination was more common among those with higher education, higher income, health insurance, and those previously tested for sexually transmitted infections (STIs) or a Pap smear (P<.05) in the last 12 months.

CONCLUSION:

The HPV vaccine remains underutilized among young women, particularly among non-English speaking, Hispanic and non-Hispanic Black women and uninsured women. Providers of STI testing and cervical cancer screening should continue offering HPV vaccination, regardless of intercourse history.
Management of Nonrelaxing Pelvic Floor Dysfunction and Pain: Identifying the Gaps [A111]
Authors: Young Riley , Cope Adela , Green Isabel
Published: June 2022

INTRODUCTION:

Nonrelaxing pelvic floor dysfunction (PFD) is a condition characterized by tension of the pelvic floor musculature, often resulting in pelvic pain. The objective of this study was to review patient-reported pain outcomes following treatment of nonrelaxing pelvic floor dysfunction to identify gaps in current evidence.

METHODS:

A systematic review of the following databases from inception to July 2020 was performed: Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. Two authors reviewed titles and abstracts for relevance, and full articles were obtained and evaluated for inclusion. Studies were included if they assess interventions for nonrelaxing PFD characterized by pelvic pain. The third author was consulted in instances of disagreement.

RESULTS:

Of the 1,184 abstracts identified and reviewed, 36 full text articles were reviewed. Treatments for nonrelaxing PFD included biofeedback, botulinum toxin injections, electrical stimulation, intravaginal diazepam, massage, osteopathy, psychiatric interview, physical therapy, sacral nerve stimulation, trigger point injection, and combined therapies. Nineteen studies assessed the effectiveness of treatment based on patient reported pain outcomes. All studies demonstrated an improvement in pelvic pain. Several limitations were identified including varied pre-treatment diagnostic evaluation, small sample size, retrospective and single arm design, heterogeneity in treatment administration within and between studies, lack of standardized pain assessments, and limited long term outcome data.

CONCLUSION:

Nonrelaxing PFD is a debilitating condition. There is a paucity of high-quality clinical trials evaluating the effectiveness of pelvic floor muscle dysfunction treatments. Although preliminary studies support multi-modal treatment options, robust trials assessing patient-centered outcomes are necessary.
Endowed Chairs and Professorships: A New Frontier in Gender Equity
Authors: Thorndyke Luanne E. , Milner Robert J. , Jaffe Laurinda A.
Published: June 2022

Purpose

Endowed chairs and professorships are prestigious and financially important awards that symbolize individual faculty recognition. However, data about the gender distribution of these positions are lacking. The purpose of this study was to examine the gender distribution of endowed positions at U.S. medical schools and identify strategies that have been used to promote investiture of women into these positions.

Method

The authors interrogated the websites for all U.S. medical schools for publicly available data. Of 38 schools that listed schoolwide information, they analyzed data from the 30 with at least 10 endowed positions. Then, they conducted interviews with deans of the 10 schools with the highest percentages of women holding endowed positions (“top 10”) to understand the strategies they used to increase gender equity in this area.

Results

The percentage of endowed positions held by women at the 30 schools analyzed ranged from 10.8% to 34.6%, with a mean of 21.6%. Themes that emerged from interviews with deans included (1) intentionality to identify women candidates in the selection process, (2) monitoring the numbers of women holding endowed positions, (3) inclusion of endowed positions as part of larger institutional goals on gender equity and diversity, (4) use of endowed positions to recruit, retain, and recognize women faculty, (5) purposeful fundraising to increase the number of endowed positions, and (6) institutional investment of resources to develop women faculty.

Conclusions

Analysis of the gender distribution of endowed positions across 30 representative U.S. medical schools revealed a significant gender disparity. Interviews with deans at the top 10 schools revealed strategies that they have used to promote equity in this important area. Implementation of a systematic national reporting process could provide schools with comparative data to gauge their progress.
Teetering on the Edge
Authors: Beck Cheryl Tatano
Published: June 2022

Reported prevalence rates of elevated postpartum depressive symptoms in immigrant and refugee women range from 24% to 82%. A third modification of Teetering on the Edge, a grounded theory of postpartum depression, was conducted to extend this midrange theory to address immigrant and refugee women. Data from 13 qualitative studies that specifically focused on this vulnerable population were included in this modification. Two categories were added to the third stage of Teetering on the Edge: Barriers to Sources of Support and Battling Self and Culture. These new categories shed light on the struggles of immigrant and refugee mothers.
Treatment Failure in Femoral Neck Fractures in Adults Less Than 50 Years of Age: Analysis of 492 Patients Repaired at 26 North American Trauma Centers
Authors: Collinge Cory A. , Finlay Andrea , Rodriguez-Buitrago Andres , Beltran Michael J. , Mitchell Phillip M. , Mir Hassan R. , Gardner Michael J. , Archdeacon Michael T. , Tornetta Paul ,   on behalf of the Young Femoral Neck Working Group
Published: June 2022

Objectives:

To assess the operative results of femoral neck fractures (FNFs) in young adults in a large multicenter series, specifically focusing on risk factors for treatment failure.

Design:

Large multicenter retrospective cohort series.

Setting:

Twenty-six North American Level 1 trauma centers.

Patients:

Skeletally mature patients younger than 50 years with displaced and nondisplaced FNFs treated between 2005 and 2017.

Intervention:

Operative repair of FNF.

Main outcome measurements:

The main outcome measure is treatment failure: nonunion and/or failed fixation, osteonecrosis, malunion, and need for subsequent major reconstructive surgery (arthroplasty or proximal femoral osteotomy). Logistic regression models were conducted to examine factors associated with treatment failure.

Results:

Of 492 patients with FNFs studied, a major complication and/or subsequent major reconstructive surgery occurred in 45% (52% of 377 displaced fractures and 21% of 115 nondisplaced fractures). Overall, 23% of patients had nonunion/failure of fixation, 12% osteonecrosis type 2b or worse, 15% malunion (>10 mm), and 32% required major reconstructive surgery. Odds of failure were increased with fair-to-poor reduction [odds ratio (OR) = 5.29, 95% confidence interval (CI) = 2.41–13.31], chronic alcohol misuse (OR = 3.08, 95% CI = 1.59–6.38), comminution (OR = 2.63, 95% CI = 1.69–4.13), multiple screw constructs (vs. fixed-angle devices, OR = 1.95, 95% CI = 1.30–2.95), metabolic bone disease (OR = 1.77, 95% CI = 1.17–2.67), and increasing age (OR = 1.03, 95% CI = 1.01–1.06). Women (OR = 0.57, 95% CI = 0.37–0.88), Pauwels angle ≤50 degrees (type 1 or 2; OR = 0.64, 95% CI = 0.41–0.98), or associated femoral shaft fracture (OR = 0.19, 95% CI = 0.10–0.33) had lower odds of failure.

Conclusions:

FNFs in adults <50 years old remain a difficult clinical and surgical problem, with 45% of patients experiencing major complications and 32% undergoing subsequent major reconstructive surgery. Risk factors for complications after treatment of displaced FNFs were numerous.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Incidence and risk factors for persistent acetabular dysplasia in patients with developmental dislocation of the hip treated by Pavlik Harness
Authors: Li YiQiang , Canavese Federico , Liu YanHan , Wu JianPing , Li JingChun , Yuan Zhe , Xu HongWen
Published: June 2022

Some patients with developmental dysplasia of the hip (DDH) before 6 months of age successfully treated by Pavlik Harness (PH) still had persistent acetabular dysplasia (PAD). This study aimed to investigate the incidence and risk factors for PAD in patients with DDH treated by PH. We retrospectively reviewed the data of 89 patients (109 hips; mean age, 3.2 ± 1.5 months) with DDH treated by PH. Prior to treatment, all patients underwent ultrasound examination and classified according to Graf’s method. PH was terminated once the hip achieved imaging recovery criteria. At final follow-up, the acetabular index (AI), center-edge angle (CEA) of Wiberg were measured on radiograph. Overall, 67/109 hips (61.5%) had successful PH treatment. Among these 67 hips, 58 hips (86.6%) achieved satisfactory outcome, nine (13.4%) had PAD. Age of the patients with PAD (4.3 ± 1 months) was significantly higher than those without PAD (2.8 ± 1.5 months) (P = 0.001). Hips with PAD had higher mean Graf grade than those with satisfactory outcome (P = 0.014). Logistic regression-confirmed age and Graf classification were risk factors for PAD. Overall, 55/67 (82.1%) met imaging recovery criteria to stop PH treatment, whereas 12/67 hips (17.9%) did not. The rate of PAD at final follow-up in patients achieving recovery criteria (4/55; 7.3%) was significantly lower than those not achieving it (41.7%) (P = 0.007). In conclusion, age and Graf classification are risk factors for PAD. If hips are not normal at the end of PH treatment, the risk of PAD increases further.
Functional and radiological outcome of C-shaped intercondylar fractures in children
Authors: Canavese Federico , Montanari Lucrezia , Alberghina Flavia , Louise McCracken Kathryn , Monget Faustine , Sapienza Marco , Pavone Vito , Andreacchio Antonio
Published: June 2022

The aim of this study was to retrospectively evaluate the clinical, functional, and radiographic outcomes of displaced C-shaped intercondylar fractures of the humerus in children and adolescents, and evaluate upper-extremity function with the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). We retrospectively reviewed the data of nine children with displaced C-intercondylar fractures that were treated surgically. Age, sex, laterality, mechanism of injury, amount of displacement, type of treatment, fixation method, and outcome were recorded. The outcome of C-shaped fractures was compared with that of T-intercondylar fractures published by the same surgeons in a previous study. A total of nine consecutive patients (median age, 12 years; range, 9–14 years) with displaced C-intercondylar fractures of the humerus (3 females) were included; in six cases (67%), the left side was affected. Median follow-up was 2 years (range, 2–6). All patients underwent open reduction and internal fixation by screws (n = 5), Kirschner-wires (n = 3), or both (n = 1). Overall, four out of nine patients developed a total of five complications (55.5%): one case of secondary displacement, one case of fishtail deformity, two cases extension deficit, and one case of limited flexion/extension requiring release. The median Quick DASH score at last follow-up visit was 0 (range, 0–4.5). C-intercondylar fractures should be added as a class to complete the Tnoniolo and Wilkin’s classification. The prognosis is similar to that of T-intercondylar fractures because, in both cases, fractures are intra-articular and require open reduction and internal fixation.
Identifying the Knowledge Structure and Trends of Nursing Informatics
Authors: Park Jinah , Park Jinkyung
Published: June 2022

With the advent of the information age and technological development, the importance of digital health technologies has increased. Subsequently, nursing informatics has been developed to enhance the effectiveness of healthcare information management and communication. This study aimed to identify the nursing informatics knowledge structure and research trends through quantitative analysis using text network analysis. Here, we analyzed 14 225 studies published by 2020. The knowledge structure of nursing informatics and changes therein were clarified by identifying and analyzing the core keywords, topics, and changes in the topics of related studies over time. We identified “patient,” “health,” “system,” and “information” as core keywords connecting other keywords. Over time, the networks between “information,” “communication,” and “technology” strengthened, and “patient safety” and “quality” have recently emerged as research keywords. This change indicates an increase in the importance of nursing education on technology. Similar changes appeared in the topic analysis, showing an increased proportion of research related to system and technology and nursing education. These results can broaden a systematic understanding of nursing informatics research. Furthermore, given these findings, the importance of nursing informatics on patient safety and nursing education—based on the development of systems and technology—can be expected to continue growing.
Effects of Blue Light on the Skin and Its Therapeutic Uses: Photodynamic Therapy and Beyond
Authors: Pieper Collin , Lee Erica B. , Swali Ritu , Harp Kimberly , Wysong Ashley
Published: June 2022

BACKGROUND

Blue light is the most energetic portion of the visible light spectrum. Recent awareness of its ubiquity and potential has led to greater developments in therapeutic uses.

OBJECTIVE

Provide up-to-date information on the effects of blue light on the skin, with a focus on the benefits and its place in therapeutic modalities within dermatology.

MATERIALS AND METHODS

A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for articles related to blue light's effect on the skin and therapeutic modalities using blue light. This search resulted in 223 unique results with 60 articles selected for review.

RESULTS

Therapeutic modalities using blue light have been proven to be effective as a monotherapy or component of a comprehensive treatment plan for common dermatologic diseases such as actinic keratosis, acne, cutaneous infections, and psoriasis, and early reports support its use in disseminated superficial actinic porokeratosis and actinic cheilitis.

CONCLUSION

The benefits and treatment applications of blue light have proven effective in multiple forms and uses. In the correct setting, blue light can be a useful tool to the practicing dermatologist for many common and sometimes refractory skin diseases while remaining low-risk and convenient. Further standardization and monitoring should be pursued to determine the most appropriate use.
Exercise Training Programs Improve Cardiorespiratory and Functional Fitness in Adults With Asthma
Authors: Valkenborghs Sarah R. , Anderson Sophie L. , Scott Hayley A. , Callister Robin
Published: June 2022

Purpose:

This systematic review aimed to identify the characteristics and determine the effects of exercise interventions on improving health-related physical fitness in adults with asthma.

Review Methods:

A systematic search was completed in MEDLINE, CINAHL, Embase, and SPORTDiscus for peer-reviewed publications of experimental studies that investigated the effects of an exercise training intervention on performance-based health-related physical fitness outcomes in adults with asthma. Two reviewers independently screened studies for inclusion according to predetermined criteria and performed data extraction and quality assessment of included studies.

Forty-five articles were included, in which results for 39 unique studies were reported. Subjects (n = 2135) were aged 22 ± 4 to 71 ± 11 yr with mild-severe asthma. Most exercise programs used aerobic exercise, either alone or in combination with resistance or breathing/stretching exercises. The most common exercise program characteristics were supervised moderate-to-vigorous intensity aerobic exercise performed for 30-45 min 3 d/wk. Meta-analyses revealed significant improvements in cardiorespiratory fitness (V˙o2peak: unstandardized mean difference [MD] 3.1 mL/kg/min, 95% CI, 1.9-4.3), functional fitness (walking distance: MD 41 m, 95% CI, 27-54), and overall health-related physical fitness (standardized mean difference [SMD] 0.67, 95% CI, 0.46-0.89) in favor of groups who underwent experimental exercise training interventions. Aerobic exercise elicited superior improvements in health-related physical fitness compared with breathing/stretching exercise (SMD 0.47, 95% CI, 0.14-0.81).

Supervised exercise training programs, particularly those aerobic in nature, are effective in eliciting clinically meaningful improvements in cardiorespiratory and functional fitness in adults with asthma.

PROSPERO registration ID number = CRD42018092828.
Predictive ability of arterial stiffness parameters for renal function decline: a retrospective cohort study comparing cardio-ankle vascular index, pulse wave velocity and cardio-ankle vascular index0
Authors: Nagayama Daiji , Fujishiro Kentaro , Miyoshi Toru , Horinaka Shigeo , Suzuki Kenji , Shimizu Kazuhiro , Saiki Atsuhito , Shirai Kohji
Published: June 2022

Objective:

The relative usefulness of arterial stiffness parameters on renal function remains controversial. This study aimed to compare the predictive ability of three arterial stiffness parameters at baseline; cardio-ankle vascular index (CAVI), heart–ankle pulse wave velocity (haPWV) and CAVI0, a variant of CAVI that theoretically excludes dependence on blood pressure, for renal function decline in Japanese general population.

Methods:

A total of 27 864 Japanese urban residents without renal impairment at baseline who participated in two to eight consecutive (mean 3.5 ± 1.7 times) annual health examinations were studied.

Results:

During the study period, 6.6% of participants developed renal function decline (estimated glomerular filtration rate <60 ml/min per 1.73 m2), all of whom had relatively high values in all arterial stiffness parameters. In receiver-operating characteristic curve analysis, the discriminatory power for renal function decline showed a decreasing trend of CAVI to haPWV to CAVI0 (C-statistic: 0.740 vs. 0.734 vs. 0.726). The cut-offs were CAVI 8.0, haPWV 7.23 and CAVI0 11.6. In Cox-proportional hazards analysis for increase of each parameter above cut-off or by 1 standard deviation (SD) adjusted for two models of confounders, only CAVI always contributed significantly to renal function decline. Restricted cubic spline regression analysis suggested that CAVI most accurately reflected the risk of renal function decline.

Conclusion:

Increase in arterial stiffness parameters, especially CAVI, may represent a major modifiable risk factor for renal function decline in the general population. Further research is needed to examine whether CAVI-lowering interventions contribute to the prevention of chronic kidney disease.
CLINICAL CHARACTERISTICS OF EALES DISEASE AND THE EFFICACY OF DIFFERENT INTERVENTIONS FOR NEOVASCULAR COMPLICATIONS
Authors: Zhao Xin-yu , Cheng Shi-yu , Zhang Wen-fei , Meng Li-hui , Chen You-xin
Published: June 2022

Purpose:

To evaluate clinical features and manifestations of Eales disease and the efficacy of different interventions.

Methods:

The databases PubMed, EMBASE, and Ovid from inception until February 2021 were searched. Pooled analyses included 1) presenting features, 2) symptoms and signs, and 3) postoperative vision outcomes and complications. Statistical analyses were conducted with R software version 3.6.3.

Results:

Forty-seven studies involving 3,557 patients and 4,959 eyes were included. The pooling results showed that Eales disease was male dominated (94%), bilateral involvement (64%), and mainly occurred in adolescents. Approximately 83% of patients were positive in Mantoux test, and 31% of patients have vitreous tap polymerase chain reaction positive for tuberculosis genome. More than half of the patients had decreased vision at the first clinic visit. The common signs of Eales disease included sclerotic vessels (83%), neovascularization of retina elsewhere (64%) and periphlebitis (51%). Macular changes could be detected in 24% of patients. The most common complication was vitreous hemorrhage, followed by cataracts and retinal detachment. Photocoagulation was directed at nonperfusion or neovascularization areas, with a decrease in the incidence of later pars plana vitrectomy (19%). Anti–vascular endothelial growth factor treatment was suggested for vitreous hemorrhage, which could achieve high visual acuity improvement rate (82%) while increasing the possibility of retinal detachment (18%). Pars plana vitrectomy was indicated in cases with persistent vitreous hemorrhage or retinal detachment, with 56% of patients obtaining visual improvement. Still, 17% of patients needed a second pars plana vitrectomy, mainly because of recurrent vitreous hemorrhage or retinal detachment.

Conclusion:

Eales disease most commonly affects young men. It has diverse clinical features, and management should be based on the progression of the disease.
DETECTION AND CHARACTERISTICS OF UNRUPTURED RETINAL ARTERIAL MACROANEURYSMS
Authors: Sakaguchi Saori , Muraoka Yuki , Nishigori Naomi , Ishikura Masaharu , Kadomoto Shin , Miyata Manabu , Murakami Tomoaki , Ooto Sotaro , Tsujikawa Akitaka
Published: June 2022

Purpose:

To determine the presence of unruptured retinal arterial macroaneurysms (RAMs) and to examine the characteristics of the detected lesions.

Methods:

This retrospective observational study included the affected and contralateral eyes of 50 patients (100 eyes) with symptomatic, unilateral, ruptured RAMs who visited the Department of Ophthalmology at the Kyoto University Hospital (April 2014–April 2020) and were followed up for at least 6 months after the onset. The presence and characteristics of unruptured RAMs were examined by reviewing the findings of color fundus photography and infrared scanning laser ophthalmoscopy performed before the onset or during the follow-up period.

Results:

Unruptured RAMs were detected in six of the 50 patients. Some patients had bilateral or multiple unruptured RAMs, and a total of 12 unruptured RAMs were detected in eight eyes of the six patients. Among the detected lesions, eight exhibited a longitudinal increase in their diameter during the follow-up period, whereas six exhibited ruptures.

Conclusion:

Unruptured RAM is not an uncommon retinal vascular abnormality and can enlarge and progress to ruptured RAM.
Performance of Xpert MTB/RIF and Mycobacterial Culture on Multiple Specimen Types for Diagnosis of Tuberculosis Disease in Young Children and Clinical Characterization According to Standardized Research Case Definitions
Authors: Click Eleanor S. , Song Rinn , Smith Jonathan P. , Mchembere Walter , Fajans Mark , Hariri Parisa , Okeyo Elisha , McCarthy Kimberly D. , Gethi Dickson , Odeny Lazarus , Musau Susan , Okumu Albert , Orwa James , Perez-Velez Carlos M. , Wright Colleen A. , Andres Mariaem , Marais Ben J. , Schaaf H. Simon , Graham Stephen M. , Cruz Andrea T. , Cain Kevin P.
Published: June 2022

Background:

Tuberculosis (TB) is a leading cause of illness and death in children globally. Improved bacteriologic and clinical diagnostic approaches in children are urgently needed.

Methods:

In a prospective cohort study, a consecutive series of young (<5 years) children presenting with symptoms suggestive of TB and parenchymal abnormality on chest radiograph in inpatient and outpatient settings in Kisumu County, Kenya from October 2013 to August 2015 were evaluated at baseline and over 6 months. Up to 14 specimens per child were tested for the Mycobacterium tuberculosis complex by fluorescence microscopy, Xpert MTB/RIF and mycobacterial culture. Using detailed clinical characterization, cases were retrospectively classified according to standardized research case definitions and the sensitivity and specificity of microbiological tests on different specimen types were determined.

Results:

Among 300 young children enrolled, 266 had sufficient information to be classified according to the research clinical case definition. Of these, 36% (96/266) had TB disease; 32% (31/96) with bacteriologically confirmed intrathoracic TB. Compared to culture, the sensitivity of a single Xpert test ranged from 60 to 67% and specificity from 97.5 to 100% for different specimen types.

Conclusions:

Despite extensive specimen collection and laboratory testing, TB could not be bacteriologically confirmed in almost two-thirds of children with intrathoracic TB classified by research clinical case definitions. Improved diagnostic tests are needed to identify children with TB and to exclude other potential causes of illness.
Early Transition to Oral Antimicrobial Therapy Among Children With Staphylococcus aureus Bacteremia and Acute Hematogenous Osteomyelitis
Authors: Sanchez Maria J. , Patel Karisma , Lindsay Eduardo A. , Tareen Naureen G. , Jo Chanhee , Copley Lawson A. , Sue Paul K.
Published: June 2022

Background:

Staphylococcus aureus bacteremia (SAB) is a frequent complication of acute hematogenous osteomyelitis (AHO) in children, but data on the optimal duration of parenteral antibiotics prior to transition to oral antibiotics remains sparse. We examined clinical outcomes associated with early transition to oral antimicrobial therapy among children admitted to our institution with AHO and SAB, and evaluated the utility of a severity of illness score (SIS) to guide treatment decisions in this setting.

Methods:

Children with AHO and SAB admitted to our institution between January 1, 2009, and December 31, 2018, were retrospectively reviewed and stratified according to a previously validated SIS into mild (0–3), moderate (4–7) and severe (8–10) cohorts. Groups were assessed for differences in treatment (eg, parenteral and oral antibiotic durations, surgeries) and clinical response (eg, bacteremia duration, acute kidney injury, length of stay and treatment failure).

Results:

Among 246 children identified with AHO and SAB, median parenteral antibiotic duration differed significantly between mild (n = 80), moderate (n = 98) and severe (n = 68) cohorts (3.6 vs. 6.5 vs. 14.3 days; P ≤ 0.001). SIS cohorts also differed with regard to number of surgeries (0.4 vs. 1.0 vs. 2.1; P ≤ 0.001), duration of bacteremia (1.0 vs. 2.0 vs. 4.0 days; P ≤ 0.001), acute kidney injury (0.0% vs. 3.0% vs. 20.5%; P ≤ 0.001), hospital length of stay (4.8 vs. 7.4 vs. 16.4 days; P ≤ 0.001) and total duration of antibiotics (34.5 vs. 44.7 vs. 60.7 days; P ≤ 0.001). Early transition to oral antimicrobial therapy among mild or moderate SIS cohorts was not associated with treatment failure despite SAB.

Conclusions:

SAB is associated with a wide range of illness among children with AHO, and classification of severity may be useful for guiding treatment decisions. Early transition to oral antimicrobial therapy appears safe in children with mild or moderate AHO despite the presence of SAB.
Activity of Tedizolid and Comparator Agents Against Gram-positive Isolates Causing Skin and Skin Structure Infections in Pediatric Patients in United States Hospitals (2015–2019)
Authors: Carvalhaes Cecilia Godoy , Sader Helio Silva , Rhomberg Paul Richard , Castanheira Mariana , DeVries Sean , Mendes Rodrigo Elisandro
Published: June 2022

Background:

Tedizolid was approved by the United States Food and Drug Administration to treat acute bacterial skin and skin structure infections in adults in 2014, and in 2020, United States Food and Drug Administration expanded the approval of tedizolid to treat pediatric patients 12 years of age and older. This study assessed the activity of tedizolid and comparator agents against clinical surveillance isolates collected from pediatric patients with skin and skin structure infection in the United States.

Methods:

A total of 2747 gram-positive organisms (1 per patient) were collected in 2015 to 2019 from pediatric (≤17 years old) patients with skin and skin structure infections. The isolates were collected from 33 US medical centers and susceptibility tested against tedizolid and comparators by reference broth microdilution methods. Susceptibility results for main pathogens were stratified by patient age: ≤1 years old (851 isolates), 2 to 5 years old (623), 6 to 12 years old (754) and 13 to 17 years old (519).

Results:

Staphylococcus aureus (n = 2163) was the main pathogen recovered from all age groups, followed by β-hemolytic streptococci (n = 460). Tedizolid inhibited all S. aureus, including methicillin-resistant S. aureus (MRSA) isolates (41.0%), regardless of the age group. MRSA rates varied by age group; MRSA was highest among ≤1 years old (45.0%) and lowest in the 13 to 17 years old (32.7%) groups. Linezolid, daptomycin and vancomycin also displayed susceptibility rates of 100% against S. aureus isolates. Clindamycin (81.3%–98.5%), tetracycline (91.6%–97.1%) and trimethoprim-sulfamethoxazole (97.0%–100%) susceptibility rates varied among age groups and methicillin resistance profiles. Overall, tedizolid, linezolid, daptomycin and vancomycin inhibited all gram-positive pathogens in this collection.

Conclusions:

Tedizolid was very active against a large collection of gram-positive pathogens causing skin and skin structure infection in pediatric patients, including MRSA isolates.
Changing Incidence of Invasive Pneumococcal Disease in Infants Less Than 90 Days of Age Before and After Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Blantyre, Malawi: A 14-Year Hospital Based Surveillance Study
Authors: Koenraads Marianne , Swarthout Todd D. , Bar-Zeev Naor , Brown Comfort , Msefula Jacquline , Denis Brigitte , Dube Queen , Gordon Stephen B. , Heyderman Robert S. , Gladstone Melissa J. , French Neil
Published: June 2022

Background:

Invasive pneumococcal disease (IPD) in young infants is uncommon but associated with high morbidity and mortality. Accurate data on the burden of IPD in young infants in low-income countries are lacking. We examined the burden of IPD in infants <90 days old in Blantyre, Malawi over a 14-year period and evaluated the indirect impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on vaccine-serotype IPD (VT-IPD) in this population.

Methods:

We conducted laboratory-based prospective IPD surveillance in infants <90 days of age admitted to Queen Elizabeth Central Hospital in Blantyre between 2005 and 2018, including 7 years pre-PCV13 and 7 years post-PCV13 introduction. IPD was defined as Streptococcus pneumoniae identified by culture from blood or cerebrospinal fluid. Serotypes were determined by multiplex polymerase chain reaction and latex agglutination testing.

Results:

We identified 130 cases of culture-confirmed IPD in infants <90 days old between 2005 and 2018. Total IPD incidence was declining before PCV13 introduction. The mean incidence of IPD was significantly lower in the post-PCV13 era. Serotypes 5 (27.8%) and 1 (15.6%) were most prevalent. Even after PCV13 introduction, VTs remained the primary cause of IPD, with serotype 5 accounting for 17.4% and serotype 1 for 13.0% of cases in young infants.

Conclusion:

Vaccine serotypes 1 and 5 were the main cause of IPD in neonates and young infants, both before and after PCV13 introduction. This suggests incomplete indirect protection with persisting VT carriage across the population despite vaccination in this setting. Alternative vaccine schedules and other vaccine introduction approaches need to be considered to protect this vulnerable population.
Streptococcus intermedius Acute Meningitis in an Immunocompetent Child
Authors: Tkacz Kamil , Piwowarczyk Anna , Podsiadły Edyta , Kuchar Ernest
Published: June 2022

Streptococcus intermedius is a commensal bacterium increasingly associated with brain abscesses. It can infect the brain through a direct extension of an inflammatory process or a hematogenous route. Meningitis due to this pathogen is sporadic and has not been described in children before. We report a case of an immunocompetent 6-year-old boy who developed bacterial meningitis due to S. intermedius.
Reassessing the Performance of the “Step-By-Step” Approach to Febrile Infants 90 Days of Age and Younger in the Context of the COVID-19 Pandemic: A Multicentric Retrospective Study
Authors: Rybak Alexis , Aupiais Camille , Cotillon Marie , Basmaci Romain , de Pontual Loïc , Bonacorsi Stéphane , Mariani Patricia , Landraud Luce , Brichler Ségolène , Poilane Isabelle , Ouldali Naïm , Titomanlio Luigi
Published: June 2022

Background:

Infants with COVID-19 can often present with fever without source, which is a challenging situation in infants <90 days old. The “step-by-step” algorithm has been proposed to identify children at high risk of bacterial infection. In the context of the COVID-19 pandemic, we aimed to reassess the diagnostic performance of this algorithm.

Methods:

We performed a multicentric retrospective study in 3 French pediatric emergency departments between 2018 and 2020. We applied the “step-by-step” algorithm to 4 clinical entities: COVID-19, febrile urinary tract infections (FUTI), invasive bacterial infection (IBI), and enterovirus infections. The main outcome was the proportion of infants classified at high risk (ill-appearing, ≤21 days old, with leukocyturia or procalcitonin level ≥0.5 ng/mL).

Results:

Among the 199 infants included, 40 had isolated COVID-19, 25 had IBI, 60 had FUTI, and 74 had enterovirus infection. All but 1 infant with bacterial infection were classified at high risk (96% for IBI and 100% for FUTI) as well as 95% with enterovirus and 82% with COVID-19. Infants with COVID-19 were classified at high risk because an ill-appearance (72%), an age ≤21 days (27%), or leukocyturia (19%). All these infants had procalcitonin values <0.5 ng/mL and only 1 had C-reactive protein level >20 mg/L.

Conclusions:

The “step-by-step” algorithm remains effective to identify infants with bacterial infection but misclassifies most infants with COVID-19 as at high risk of bacterial infection leading to unnecessary cares. An updated algorithm based adding viral testing may be needed to discriminate fever related to isolated COVID-19 in infants <90 days old.
Child Sexual Abuse and Suicide
Authors: Hornor Gail , Tucker Sarah
Published: June 2022

Sexual abuse can result in significant negative sequelae for victims. One particularly harmful consequence is suicidal ideation, which can lead to suicide attempts and even death. It is essential to screen children and adolescents for suicidal ideation when providing medical forensic care after disclosure of acute or nonacute sexual abuse/assault. Forensic nurses must feel confident in their abilities to assess suicide risk and provide appropriate intervention and referrals. A thorough understanding of the relationship between sexual abuse and suicidal ideation and behaviors can assist the forensic nurse in the development of practice behaviors to better identify, intervene, and prevent suicidal ideation and behaviors among youth experiencing sexual abuse.
Thromboprophylaxis with argatroban in critically ill patients with sepsis: a review
Authors: Bachler Mirjam , Asmis Lars M. , Koscielny Jürgen , Lang Thomas , Nowak Hartmuth , Paulus Patrick , Schewe Jens-Christian , von Heymann Christian , Fries Dietmar
Published: June 2022

During sepsis, an initial prothrombotic shift takes place, in which coagulatory acute-phase proteins are increased, while anticoagulatory factors and platelet count decrease. Further on, the fibrinolytic system becomes impaired, which contributes to disease severity. At a later stage in sepsis, coagulation factors may become depleted, and sepsis patients may shift into a hypo-coagulable state with an increased bleeding risk. During the pro-coagulatory shift, critically ill patients have an increased thrombosis risk that ranges from developing micro-thromboses that impair organ function to life-threatening thromboembolic events. Here, thrombin plays a key role in coagulation as well as in inflammation. For thromboprophylaxis, low molecular weight heparins (LMWH) and unfractionated heparins (UFHs) are recommended. Nevertheless, there are conditions such as heparin resistance or heparin-induced thrombocytopenia (HIT), wherein heparin becomes ineffective or even puts the patient at an increased prothrombotic risk. In these cases, argatroban, a direct thrombin inhibitor (DTI), might be a potential alternative anticoagulatory strategy. Yet, caution is advised with regard to dosing of argatroban especially in sepsis. Therefore, the starting dose of argatroban is recommended to be low and should be titrated to the targeted anticoagulation level and be closely monitored in the further course of treatment. The authors of this review recommend using DTIs such as argatroban as an alternative anticoagulant in critically ill patients suffering from sepsis or COVID-19 with suspected or confirmed HIT, HIT-like conditions, impaired fibrinolysis, in patients on extracorporeal circuits and patients with heparin resistance, when closely monitored.
Bloom’s Taxonomy
Authors: Ortiz Myralyn , Kent Denise , Carlucci Melissa , Ricca Paige , Zeiher Wendy , Vanderzwan Kathryn , Betka Alisha A. , Kilroy Susan
Published: June 2022

The COVID-19 pandemic required a significant pivot in nursing education, whereby in-person simulations moved to an online format. Kaplan’s i-Human Patients was a virtual simulation platform utilized at a large Midwestern university for student nurses. This online virtual simulation platform helped evaluate students’ clinical knowledge and understanding using the Bloom’s taxonomy framework to scaffold cases. In addition, the five phases of professional development was incorporated to aid faculty instruction.
Returning to Work After an Orthopaedic Injury
Authors: Hammond Stephanie , Hallman Melanie Gibbons , Bowen Pamela , Combs Bryan , Heaton Karen
Published: June 2022

Workers' compensation and orthopaedic nursing are often intertwined for the treatment of an injured worker and returning them to work. The workers' compensation system can be complex, and knowing the regulations can be beneficial in the treatment of an injured worker and returning them to work safely. Orthopaedic nurses often play an integral role in the evaluation, treatment, and discharge of an injured worker, so understanding workers' compensation, workers' job, and expectations is important for the safe return of a worker back to duty. Orthopaedic nurses are in key positions to assist with the planning, treatment, and return of a worker back to their job.
Life After Total Hip Replacement
Authors: Öztürk Ramazan İlter , Küçük Öztürk Gülhan
Published: June 2022

The present study aimed to determine the life experiences of patients undergoing total hip replacement. This study was a qualitative study conducted using the content analysis method. Using purposive sampling, 10 patients with total hip replacement were selected and interviewed. Data were collected using semistructured interviews and were analyzed using the content analysis method. The mean age of the 10 patients was 59.33 ± 9.9 years. Six patients were female and four were male. Of these 10 participants, eight were married and had nuclear families; all participants were literate, and seven belonged to the middle-income group. Four main themes and 10 subthemes were identified. The themes included a painful process (severe pain and feeling of pain due to emotional exhaustion), fear (fear of feeling pain, fear of moving, and fear of recurrence), difficulty (self-care, sleep, and participation in social life), and positive thinking about life (feeling good and hope). The participants expressed mostly negative life experiences while also pointing out the positive life experiences. This study provides an in-depth understanding of the views of patients with total hip replacement on life experiences. These results can be used in planning and implementing health services for patients with total hip replacement.
Postmortem Diagnosis of Invasive Disseminated Aspergillosis After Tongue Piercing
Authors: Tambuzzi Stefano , Gentile Guendalina , Andreola Salvatore , Zoja Riccardo
Published: June 2022

Severe fungal infections caused by highly invasive fungi such as Aspergillus are not easy to diagnose and often have a poor prognosis. In these cases, the nonspecific symptoms may make clinical diagnosis challenging, and consequently, the autopsy and postmortem histological investigations acquire a crucial role. We report the case of a young man in good health who died of septic shock 3 weeks after having had a tongue piercing. Intravitam investigations did not identify the etiology of the rapidly fatal infectious condition. The autopsy revealed flaccid organs of uniformly diminished consistency with abscesses and granulomatous foci with central necrosis. Histological examination showed the presence of septate mycotic hyphae, with a dichotomous 45-degree bifurcation, typical for Aspergillus, in all the examined organs, including the tongue. The molecular identification confirmed the presence of Aspergillus fumigatus. The observed macroscopic framework and the laboratory findings made it possible to diagnose pseudomembranous invasive tracheobronchial aspergillosis and to attribute the death to fatal invasive disseminated aspergillosis. The consistency and concordance of all the findings in our possession led us to suspect the practice of piercing as the triggering cause of the man's pathology.
Gastroesophageal Glomus Tumors
Authors: Papke David J. , Sholl Lynette M. , Doyle Leona A. , Fletcher Christopher D.M. , Hornick Jason L.
Published: June 2022

Although criteria for malignancy have been established for glomus tumors of soft tissue, there are no accepted criteria for gastroesophageal glomus tumors, the behavior of which is considered to be unpredictable. Recently, both benign and aggressive gastroesophageal glomus tumors have been shown to harbor CARMN::NOTCH2 fusions, but, as yet, there are no described genetic features that predict clinical behavior. Here, we evaluated 26 gastroesophageal glomus tumors to investigate histologic and genetic features that might predict malignant behavior. Seventeen patients (65%) were male. The median age at presentation was 54.5 years (range: 16 to 81 y). Primary sites were stomach (25 tumors) and distal esophagus (1). The median tumor size was 4.05 cm (range: 0.8 to 19.5 cm). Tumors were composed of lobules of rounded cells with sharp borders, palely eosinophilic to clear cytoplasm, and round nuclei. All tumors involved the muscularis propria, and 12 also involved the serosal surface. Mitoses ranged from <1 to 53/10 HPF (median: 5/10 HPF). Sixteen tumors, including all 15 with mitoses ≥2/10 HPF, showed atypia (3 mild, 10 moderate, 3 severe), defined as spindle cell morphology, nuclear irregularity, nuclear size variability, enlarged nuclei, or coarse chromatin. Considering these histologic features and clinical behavior, tumors were classified as malignant (15 tumors) if they measured ≥5 cm or showed both atypia and mitoses ≥2/10 HPF, or benign (11 tumors) if these criteria were not met. Follow-up was available for 19 patients (73%; range: 1 to 15 y; median: 5.8 y), including 7 with benign tumors and 12 with malignant tumors. Two patients with malignant tumors had metastases at presentation, and 7 developed metastases subsequently. Follow-up was available for 8 of 9 patients with metastatic disease. Two were alive with disease at most recent follow-up. One underwent resection of a liver metastasis, with no subsequent metastases in 3 years of follow-up. Five patients died of metastatic disease. By immunohistochemistry, smooth muscle actin was diffusely positive in all evaluated tumors, and caldesmon and synaptophysin were positive in 94% and 73%, respectively. Sequencing identified NOTCH2 alterations in 4 benign tumors (80%) and 8 malignant tumors (80%), including CARMN::NOTCH2 fusions in 2 benign and 5 malignant tumors. All 5 sequenced benign tumors lacked complex copy number alterations (CNAs), whereas all 10 sequenced malignant tumors showed complex CNAs, including recurrent loss of 9p21.3 (4/10, variably including CDKN2A/B and MTAP) and ATRX inactivation (4/10). Complex CNAs were identified in all sequenced tumors that were ≥5 cm, exhibited both cytologic atypia and ≥2 mitoses/10 HPF, involved the serosa or metastasized. We propose that gastroesophageal glomus tumors ≥5 cm or with both atypia and mitoses ≥2/10 HPF should be considered malignant. Copy number analysis might be helpful in borderline cases.